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Search Results: 1 - 10 of 785 matches for " Carole Schwebel "
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New materials and devices for preventing catheter-related infections
Jean-Fran?ois Timsit, Yohann Dubois, Clémence Minet, Agnès Bonadona, Maxime Lugosi, Claire Ara-Somohano, Rebecca Hamidfar-Roy, Carole Schwebel
Annals of Intensive Care , 2011, DOI: 10.1186/2110-5820-1-34
Abstract: Central venous catheters (CVCs) are inserted in approximately half of all patients in the intensive care unit (ICU). In Europe, the incidence density of catheter-related bloodstream infections (CR-BSI) ranges from 1 to 3.1 per 1,000 patient-days [1]. CR-BSIs were associated with an attributable mortality of 0% to 11.5% [2] and an additional stay length of 9-12 days [3,4].In contrast to other nosocomial infections, CR-BSI has many device-related risk factors. Consequently, prevention should be possible, provided that rigorous policies are implemented. Specific education and training of healthcare workers in CR-BSI prevention and continuous implementation of unit-based quality-improvement programs are essential. We discuss the potential usefulness of new technical developments and put these into perspective according to available recommendations.Colonization of the catheter occurs via two main pathways: the extraluminal route and the intraluminal route. Colonization of short-term CVCs (< 15-20 days) occurs predominantly from the skin puncture site, whereas colonization of long-term CVCs is usually related to intraluminal bacterial spread from a contaminated hub [5]. In both cases, the source of the micro-organisms is the patient's own commensal skin flora. Accordingly, S. epidermidis is responsible for 40-50% of episodes, followed by S. aureus (10-20%). Gram-negative bloodstream infection, especially Pseudomonas aeruginosa, Stenotrophomonas sp., and Acinetobacter baumannii, are recovered in one-third of cases. Candida sp. are recovered in 3-10% of cases.Biofilm formation on the inner and outer surfaces of the catheter contributes to the development of CR-BSI. A biofilm is a complex structure formed by bacteria that have attached to an artificial surface or dead tissue. Bacterial attachment to the catheter surface begins within 24 hours after catheter insertion. The bacteria proliferate and secrete a polysaccharide matrix, which provides a medium for the attachment of
Efficacy of renal replacement therapy in critically ill patients: a propensity analysis
Christophe Clec'h, Micha?l Darmon, Alexandre Lautrette, Frank Chemouni, Elie Azoulay, Carole Schwebel, Anne-Sylvie Dumenil, Ma?té Garrouste-Orgeas, Dany Goldgran-Toledano, Yves Cohen, Jean-Fran?ois Timsit
Critical Care , 2012, DOI: 10.1186/cc11905
Abstract: We performed a propensity analysis using data of the French longitudinal prospective multicenter Outcomerea database. Two propensity scores for RRT were built to match patients who received RRT to controls who did not despite having a close probability of receiving the procedure. AKI was defined according to RIFLE criteria. The association between RRT and hospital mortality was examined through multivariate conditional logistic regression analyses to control for residual confounding. Sensitivity analyses were conducted to examine the impact of RRT timing.Among the 2846 study patients, 545 (19%) received RRT. Crude mortality rates were higher in patients with than in those without RRT (38% vs 17.5%, P < 0.001). After matching and adjustment, RRT was not associated with a reduced hospital mortality. The two propensity models yielded concordant results.In our study population, RRT failed to reduce hospital mortality. This result emphasizes the need for randomized studies comparing RRT to conservative management in selected ICU patients, with special focus on RRT timing.Acute kidney injury (AKI) significantly contributes to the morbidity and the mortality of critically ill patients through metabolic derangements, fluid overload and harmful effects of these disturbances on other failing organs. Renal replacement therapy (RRT), although not achieving the same level of homeostasis as a normally functioning kidney, helps limit the consequences of AKI and allows adequate administration of fluids and nutritional support. However, its benefits (aside from life-threatening complications, such as severe hyperkalemia, pulmonary edema, and intractable acidosis) in critically ill patients with AKI remain unclear.Available data are derived from uncontrolled studies, which all showed higher mortality rates among populations treated with RRT [1-5]. Due to their design, however, confounders and biases may have limited their accuracy. Particularly, treatment selection bias [6] may have
Outcome of ICU patients with Clostridium difficile infection
Jean-Ralph Zahar, Carole Schwebel, Christophe Adrie, Maité Garrouste-Orgeas, Adrien Fran?ais, Aurélien Vesin, Molière Nguile-Makao, Alexis Tabah, Kevin Laupland, Alban Le-Monnier, Jean-Fran?ois Timsit, the OUTCOMEREA study group
Critical Care , 2012, DOI: 10.1186/cc11852
Abstract: We compared patients with ICU-acquired CDI (watery or unformed stools occurring ≥ 72 hours after ICU admission with a stool sample positive for C. difficile toxin A or B) with two groups of controls hospitalized at the same time in the same unit. The first control group comprised patients with ICU-acquired diarrhea occurring ≥ 72 hours after ICU admission with a stool sample negative for C. difficile and for toxin A or B. The second group comprised patients without any diarrhea.Among 5,260 patients, 512 patients developed one episode of diarrhea. Among them, 69 (13.5%) had a CDI; 10 (14.5%) of them were community-acquired, contrasting with 12 (17.4%) that were hospital-acquired and 47 (68%) that were ICU-acquired. A pseudomembranous colitis was associated in 24/47 (51%) ICU patients. The median delay between diagnosis and metronidazole administration was one day (25th Quartile; 75th Quartile (0; 2) days). The case-fatality rate for patients with ICU-acquired CDI was 10/47 (21.5%), as compared to 112/443 (25.3%) for patients with negative tests. Neither the crude mortality (cause specific hazard ratio; CSHR = 0.70, 95% confidence interval; CI 0.36 to 1.35, P = 0.3) nor the adjusted mortality to confounding variables (CSHR = 0.81, 95% CI 0.4 to 1.64, P = 0.6) were significantly different between CDI patients and diarrheic patients without CDI. Compared to the general ICU population, neither the crude mortality (SHR = 0.64, 95% CI 0.34 to 1.21, P = 0.17), nor the mortality adjusted to confounding variables (CSHR = 0.71, 95% confidence interval (CI) 0.38 to 1.35, P = 0.3), were significantly different between the two groups. The estimated increase in the duration of stay due to CDI was 8.0 days ± 9.3 days, (P = 0.4) in comparison to the diarrheic population, and 6.3 days ± 4.3 (P = 0.14) in comparison to the general ICU population.If treated early, ICU-acquired CDI is not independently associated with an increased mortality and impacts marginally the ICU length of stay.
Mortality associated with timing of admission to and discharge from ICU: a retrospective cohort study
Kevin B Laupland, Benoit Misset, Bertrand Souweine, Alexis Tabah, Elie Azoulay, Dany Goldgran-Toledano, Anne-Sylvie Dumenil, Aurélien Vésin, Samir Jamali, Hatem Kallel, Christophe Clec'h, Michael Darmon, Carole Schwebel, Jean-Francois Timsit
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-321
Abstract: Adults (≥18 years) admitted to French ICUs participating in Outcomerea between January 2006 and November 2010 were included.Among the 7,380 patients included, 61% (4,481) were male, the median age was 62 (IQR, 49-75) years, and the median SAPS II score was 40 (IQR, 28-56). Admissions to ICU occurred during weekends (Saturday and Sunday) in 1,708 (23%) cases, during the night (18:00-07:59) in 3,855 (52%), and on nights and/or weekends in 4,659 (63%) cases. Among 5,992 survivors to ICU discharge, 903 (15%) were discharged on weekends, 659 (11%) at night, and 1,434 (24%) on nights and/or weekends. After controlling for a number of co-variates using logistic regression analysis, admission during the after hours was not associated with an increased risk for death. However, patients discharged from ICU on nights were at higher adjusted risk (odds ratio, 1.54; 95% confidence interval, 1.12-2.11) for death.In this study, ICU discharge at night but not admission was associated with a significant increased risk for death. Further studies are needed to examine whether minimizing night time discharges from ICU may improve outcome.Patients who suffer acute illness and are admitted during the "after hours" (weekends or nights) may be at higher risk for adverse outcome as compared to patients admitted during weekdays [1]. Cavallazzi et al recently conducted a meta-analysis of ten studies conducted in adult ICUs and found that while night time admission was not associated with an increased risk, a small but significant increased risk for death was associated with weekend admission [2]. Since, Kuijsten et al reported a relative risk for death associated with admission in the afterhours of 1.059 (95% confidence interval 1.031-1.088) among 149,894 admissions to Dutch ICUs [3]. More recently Kevat et al reported on 245,057 admissions to Australian ICUs and found an increased risk for hospital mortality associated with admission during evenings/nights (17% vs. 14%; p < 0.001) and during
Preventing Paraffin-Related Injury
David C. Schwebel,Dehran Swart
Journal of Injury and Violence Research , 2009,
Abstract: Paraffin (called kerosene in North America and other parts of the world) is the most commonly used fuel in non-electrified dwellings worldwide. It is especially popular in Africa and South Asia. Although paraffin offers many advantages – especially its comparatively low cost to produce – it poses two major risks of injury. First, paraffin poisoning is common, either through ingestion or through inhalation of smoke and fumes. Second, paraffin is highly flammable, and poses fire risk through multiple causes. This commentary discusses strategies to prevent paraffin-related injury. Prevention of paraffin-related injury must be through multiple strategies, and should include policy-oriented change, changes to the safety of home environments, and behavioral changes targeting how individuals store and use paraffin and paraffin appliances. We review successful prevention strategies in each of these domains and discuss appropriate research and community initiatives that should be implemented to improve paraffin safety among at-risk populations.
Intelligence, academic achievement, and pediatric injury among a large sample of kindergartners
David C. Schwebel,Carl M. Brezausek
Italian Journal of Public Health , 2010, DOI: 10.2427/5722
Abstract: Objectives: Previous work reports mixed results on the roles of intelligence and academic achievement on child injury risk. Some early research offered evidence of links between lower levels of intelligence and higher rates of pediatric injury, but other work has suggested there is no relation between the variables. This study investigated the matter further, in the context of a large sample and with strong statistical power. Methods: Data from a national sample of 8002 kindergartners in the United States, all from low-income families, were analyzed. Intelligence was estimated using the Peabody Picture Vocabulary Test-Revised and academic achievement with the Reading and Mathematics scales of the Woodcock Johnson Psycho- Educational Battery-Revised. Mothers reported whether children had experienced an injury in the previous year that required professional medical attention. Results: Results of both bivariate and multivariate ordinal logistic regression models suggest higher levels of reading achievement and of mathematics achievement were associated with slightly reduced risk of pediatric injury. Intelligence was not related to injury history. Conclusions: Academic achievement, but not intelligence, appears to relate in a small but statistically significant inverse manner with risk for pediatric injury among kindergartners from a low-income background. Possible mediators include children’s ability to learn and remember safety-related rules or the fact that parents who encourage learning in the household might also safeguard children more effectively.
Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change
Michael Darmon, Eric Diconne, Bertrand Souweine, Stéphane Ruckly, Christophe Adrie, Elie Azoulay, Christophe Clec'h, Ma?té Garrouste-Orgeas, Carole Schwebel, Dany Goldgran-Toledano, Hatem Khallel, Anne-Sylvie Dumenil, Samir Jamali, Christine Cheval, Bernard Allaouchiche, Fabrice Zeni, Jean-Fran?ois Timsit
Critical Care , 2013, DOI: 10.1186/cc11937
Abstract: Observational study on a prospective database fed by 13 intensive care units (ICUs). Unselected patients with ICU stay longer than 48 h were enrolled over a 14-year period were included in this study. Mild to severe hyponatremia were defined as serum sodium concentration < 135, < 130, and < 125 mmol/L respectively. Mild to severe hypernatremia were defined as serum sodium concentration > 145, > 150, and > 155 mmol/L respectively. Borderline hyponatremia and hypernatremia were defined as serum sodium concentration between 135 and 137 mmol/L or 143 and 145 respectively.A total of 11,125 patients were included in this study. Among these patients, 3,047 (27.4%) had mild to severe hyponatremia at ICU admission, 2,258 (20.3%) had borderline hyponatremia at ICU admission, 1,078 (9.7%) had borderline hypernatremia and 877 (7.9%) had mild to severe hypernatremia. After adjustment for confounder, both moderate and severe hyponatremia (subdistribution hazard ratio (sHR) 1.82, 95% CI 1.002 to 1.395 and 1.27, 95% CI 1.01 to 1.60 respectively) were associated with day-30 mortality. Similarly, mild, moderate and severe hypernatremia (sHR 1.34, 95% CI 1.14 to 1.57; 1.51, 95% CI 1.15 to 1.99; and 2.64, 95% CI 2.00 to 3.81 respectively) were independently associated with day-30 mortality.One-third of critically ill patients had a mild to moderate dysnatremia at ICU admission. Dysnatremia, including mild changes in serum sodium concentration, is an independent risk factor for hospital mortality and should not be neglected.Dysnatremia is a common finding at ICU admission [1-3]. Abnormal serum sodium concentrations are known to adversely affect physiologic function and an increasing body of evidence suggests that dysnatremia may be associated with adverse outcome [1-4]. Critically ill patients are particularly exposed to dysnatremia due to the nature of the disease leading to ICU admission and to lack of free access to water [2,4,5]. Up to one-third of critically ill patients have a dys
Life Satisfaction between Chinese-Immigrant Adolescents and Their Counterparts in the United States and China  [PDF]
Jessica J. Lee, Carole Kimberlin
Open Journal of Social Sciences (JSS) , 2015, DOI: 10.4236/jss.2015.34014
Abstract: The objective of this study was to compare the life satisfaction (LS) of Chinese-immigrant children in the United States (US) with their counterparts in America and China by using the Students’ Life Satisfaction Scale (SLSS). The mean scores of SLSS were examined and compared among three groups. Multivariate linear regression analysis was conducted to identify the differences of LS among comparison groups after adjusting for other potential risk factors. Out of 161 children who completed the surveys, 47 (29%) were Chinese-immigrant children, 81 (50%) were native Chinese children, and 33 (20%) were non-immigrant US children. The results showed that Chinese- immigrant children had higher overall LS than native Chinese children (4.39 ± 0.83 vs 3.79 ± 0.81; p = 0.0001), but lower overall LS than non-immigrant children in the US (4.39 ± 0.83 vs 4.81 ± 0.69; p = 0.0207). Systematic investigation on larger populations will be necessary to identify the potential contributing factors.
Evaluation of Dream Content Among Patients with Schizophrenia, their Siblings, Patients with Psychiatric Diagnoses Other than Schizophrenia, and Healthy Control
Habibolah Khazaie,Masoud Tahmasian,Golrokh Younesi,David C Schwebel
Iranian Journal of Psychiatry , 2012,
Abstract: Objective: Schizophrenia is a chronic psychotic disorder with unknown etiology that causes cognitive impairment, affecting thinking, behavior, social function, sleep and dream content. This study considered the dream content of patients with schizophrenia, siblings of patients with schizophrenia, patients with psychiatric diagnoses other than schizophrenia, and a group of healthy controls. The aim of this study was to compare the dream content of patients with schizophrenia with dream content of individuals with other mental disorders, first degree relatives of patients with schizophrenia, and community controls . Method: Seventy-two patients were selected and placed in 4 groups. The first group consisted of 18 inpatients with schizophrenia whose medications were stable for at least four weeks; the second group consisted of 16 nonpsychotic mentally ill inpatients; the third group consisted of 18 individuals who were siblings of patients with schizophrenia; and the fourth group consisted of 20 healthy individuals in the community with no family history of mental or somatic disorders. The four groups were matched by age and gender. A 14-item dream content questionnaire was administered for all the participants, and the Positive and Negative Symptoms Scale (PANSS) was also administered for the two groups of hospitalized patients . Results: Results showed that there were significant differences in dream content among groups included friends acquaintances, females and colorful components. No significant differences were found between the positive and negative subscales of PANSS and any of the dream questionnaire subscales. Conclusion: Our results suggest that there were a few changes in the dream content of the patients with schizophrenia compare to other groups.
Lifeguards: A Forgotten Aspect of Drowning Prevention
David C. Schwebel,Heather N. Jones,Erika Holder,Francesca Marciani
Journal of Injury and Violence Research , 2010,
Abstract: An alarming number of drownings occur in lifeguarded swimming areas, where one might presume swimmers are protected from injury. One reason drownings occur in lifeguarded swimming areas is because lifeguard surveillance is a highly difficult task. Observational research suggests lifeguards are usually alert, but researchers also report egregious examples of inattention. We offer three strategies that have initial empirical support to reduce risk of drowning at lifeguarded swimming areas: (a) regular training to help lifeguards recognize they are vulnerable to drowning events and to raise their confidence; (b) regular practice via simulated emergency responses, and (c) addressing staff schedules so lifeguards can devote full attention to protecting swimmer safety while on duty.
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