The aim of the study was to assess feeding practices and the use of lysine and methionine in pig rationing on intensified and semi-intensive pig breeding in the Koudougou and Bobo-Dioulasso areas. To this end, a cross...The aim of the study was to assess feeding practices and the use of lysine and methionine in pig rationing on intensified and semi-intensive pig breeding in the Koudougou and Bobo-Dioulasso areas. To this end, a cross-sectional survey was carried out on 87 breeding in these towns. A Discriminant Factorial Analysis (DFA) confirming a k-means classification of the data collected was used to retain 71 breeding divided into three breeding classes: Class A (32.4% of breeding), Class B (14.08%) and Class C (53.52%). The results show that the majority of pig breeders were men between the ages of 36 and 59. Average herd sizes were 35 ± 28;79 ± 42 and 89 ± 21 pigs for Classes A, B and C respectively. The main breeds of pig found on the breeding were crossbred, Large white, local, Landrace and Duroc. Class A (26.1%), B (30%) and C (15.8%) breeders were familiar with both lysine and methionine. Class A breeders distributed feed staggered (65.2%) and in rations (34.8%). Lysine (13%) and methionine (8.7%) were purchased at 5250 FCFA/kg. Those in class B distributed feed staggered (50%) and in the form of rations (50%), in which they incorporated lysine (30%) and methionine (30%) purchased at a cost of 2500 FCFA/kg and 3000 FCFA/kg respectively. Rationing and staggered feeding were practiced by 23.7% and 76.3% of Class C breeders respectively. Only lysine purchased at 3400 FCFA/kg was incorporated into rations by 10.5% of breeders. The high cost of lysine and methionine was incriminated by Class A (100%), B (33.3%) and C (50%) breeders. In conclusion, intensive pig breeding, the practice of rationing and the incorporation of the amino acids lysine and methionine are of ascending importance from classes C, A to B. The high cost of feedstuffs, particularly lysine and methionine, compromises their use in rations, which could have a negative impact on expected breeding performance. The screening and use of feeds rich in and/or enriched with these amino acids, through the development or adaptation of technologies, could improve the efficiency of rations and the productivity of intensive pig breeding in Burkina Faso.展开更多
The coronavirus disease pandemic caught many pediatric hospitals unpreparedand has forced pediatric healthcare systems to scramble as they examine and planfor the optimal allocation of medical resources for the highes...The coronavirus disease pandemic caught many pediatric hospitals unpreparedand has forced pediatric healthcare systems to scramble as they examine and planfor the optimal allocation of medical resources for the highest priority patients.There is limited data describing pediatric intensive care unit (PICU) preparednessand their health worker protections.AIMTo describe the current coronavirus disease 2019 (COVID-19) preparedness effortsamong a set of PICUs within a simulation-based network nationwide.METHODS A cross-sectional multi-center national survey of PICU medical director(s) fromchildren’s hospitals across the United States. The questionnaire was developedand reviewed by physicians with expertise in pediatric critical care, disasterreadiness, human factors, and survey development. Thirty-five children’shospitals were identified for recruitment through a long-established nationalresearch network. The questions focused on six themes: (1) PICU and medicaldirector demographics;(2) Pediatric patient flow during the pandemic;(3)Changes to the staffing models related to the pandemic;(4) Use of personalprotective equipment (PPE);(5) Changes in clinical practice and innovations;and(6) Current modalities of training including simulation.RESULTSWe report on survey responses from 22 of 35 PICUs (63%). The majority of PICUswere located within children’s hospitals (87%). All PICUs cared for pediatricpatients with COVID-19 at the time of the survey. The majority of PICUs (83.4%)witnessed decreases in non-COVID-19 patients, 43% had COVID-19 dedicatedunits, and 74.6% pivoted to accept adult COVID-19 patients. All PICUsimplemented changes to their staffing models with the most common changesbeing changes in COVID-19 patient room assignment in 50% of surveyed PICUsand introducing remote patient monitoring in 36% of the PICU units. Ninety-fivepercent of PICUs conducted training for donning and doffing of enhanced PPE.Even 6 months into the pandemic, one-third of PICUs across the United Statesreported shortages in PPE. The most common training formats for PPE werehands-on training (73%) and video-based content (82%). The most commonconcerns related to COVID-19 practice were changes in clinical protocols andguidelines (50%). The majority of PICUs implemented significant changes in theirairway management (82%) and cardiac arrest management protocols in COVID-19patients (68%). Simulation-based training was the most commonly utilizedtraining modality (82%), whereas team training (73%) and team dynamics (77%)were the most common training objectives.CONCLUSIONSA substantial proportion of surveyed PICUs reported on large changes in theirpreparedness and training efforts before and during the pandemic. PICUsimplemented broad strategies including modifications to staffing, PPE usage,workflow, and clinical practice, while using simulation as the preferred trainingmodality. Further research is needed to advance the level of preparedness,support staff assuredness, and support deep learning about which preparednessactions were effective and what lessons are needed to improve PICU care andstaff protection for the next COVID-19 patient waves.展开更多
Background:This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).Methods:From July 1 to October 5 2021, 67 French ICUs pr...Background:This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).Methods:From July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the circuit.Results:A total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, respectively.Conclusions:Practices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.展开更多
目的调查重症监护病房(intensive care unit,ICU)护士预防再喂养综合征知识、态度和行为现况,并分析其影响因素,为临床开展相关教学、培训提供依据。方法采用便利抽样法,自行编制一般资料调查表、ICU护士对预防RFS再喂养综合征(refeedin...目的调查重症监护病房(intensive care unit,ICU)护士预防再喂养综合征知识、态度和行为现况,并分析其影响因素,为临床开展相关教学、培训提供依据。方法采用便利抽样法,自行编制一般资料调查表、ICU护士对预防RFS再喂养综合征(refeeding syndrome,RFS)知识、态度和行为问卷以及护理阻碍因素及知识需求问卷,对上海市5所三级甲等综合医院和2所二级甲等综合医院的366名ICU护士进行调查,并采用多重线性回归分析RFS的知识、态度和行为的影响因素。结果366名ICU护士预防RFS知识、态度和行为问卷总分、知识维度、态度维度、主观规范、感知行为控制及行为意向维度得分分别为(133.73±20.55)分、(35.79±9.04)分、(37.44±6.20)分、(12.07±2.27)分、(17.82±4.00)分、(30.61±6.09)分,总分处于中等水平。多重线性回归分析显示,医院级别、ICU类型以及是否为营养学组成员、接受过相关培训、从学术期刊获取知识的频率是ICU护士对预防RFS知识、态度和行为的影响因素(均P<0.05),共同解释其20.90%的变异。结论从学术期刊获取知识、三级医院、综合ICU及接受过RFS相关知识培训、营养学组成员的护士有较高的预防RFS知识、态度和行为水平。护理管理者应重视ICU护士的培训,加强其对预防RFS护理的知识和行为,从而提高ICU护理管理质量。展开更多
目的将重症监护病房(intensive care unit,ICU)机械通气患者撤机后呼吸肌训练的最佳证据应用于临床实践并评价其效果。方法运用循证护理的方法,将获取的最佳证据应用于临床,比较循证实践前后上海市某三级甲等医院ICU机械通气患者撤机后...目的将重症监护病房(intensive care unit,ICU)机械通气患者撤机后呼吸肌训练的最佳证据应用于临床实践并评价其效果。方法运用循证护理的方法,将获取的最佳证据应用于临床,比较循证实践前后上海市某三级甲等医院ICU机械通气患者撤机后肺功能、再插管率以及ICU住院时间,以及护士对ICU机械通气患者撤机后呼吸肌训练知识问卷得分和各个审查指标的执行情况。结果证据应用后,ICU机械通气撤机患者呼气峰流速及第1 s用力呼吸容积均有所改善,撤机后ICU住院时间缩短,护士的知识问卷得分以及对审查指标的执行率有所提高(均P<0.05)。结论开展基于最佳证据的循证实践,能够有效改善ICU机械通气撤机患者的肺功能,提高ICU护士对相关知识的掌握程度,缩短证据与临床实践的差距,从而提高护理质量。展开更多
文摘The aim of the study was to assess feeding practices and the use of lysine and methionine in pig rationing on intensified and semi-intensive pig breeding in the Koudougou and Bobo-Dioulasso areas. To this end, a cross-sectional survey was carried out on 87 breeding in these towns. A Discriminant Factorial Analysis (DFA) confirming a k-means classification of the data collected was used to retain 71 breeding divided into three breeding classes: Class A (32.4% of breeding), Class B (14.08%) and Class C (53.52%). The results show that the majority of pig breeders were men between the ages of 36 and 59. Average herd sizes were 35 ± 28;79 ± 42 and 89 ± 21 pigs for Classes A, B and C respectively. The main breeds of pig found on the breeding were crossbred, Large white, local, Landrace and Duroc. Class A (26.1%), B (30%) and C (15.8%) breeders were familiar with both lysine and methionine. Class A breeders distributed feed staggered (65.2%) and in rations (34.8%). Lysine (13%) and methionine (8.7%) were purchased at 5250 FCFA/kg. Those in class B distributed feed staggered (50%) and in the form of rations (50%), in which they incorporated lysine (30%) and methionine (30%) purchased at a cost of 2500 FCFA/kg and 3000 FCFA/kg respectively. Rationing and staggered feeding were practiced by 23.7% and 76.3% of Class C breeders respectively. Only lysine purchased at 3400 FCFA/kg was incorporated into rations by 10.5% of breeders. The high cost of lysine and methionine was incriminated by Class A (100%), B (33.3%) and C (50%) breeders. In conclusion, intensive pig breeding, the practice of rationing and the incorporation of the amino acids lysine and methionine are of ascending importance from classes C, A to B. The high cost of feedstuffs, particularly lysine and methionine, compromises their use in rations, which could have a negative impact on expected breeding performance. The screening and use of feeds rich in and/or enriched with these amino acids, through the development or adaptation of technologies, could improve the efficiency of rations and the productivity of intensive pig breeding in Burkina Faso.
文摘The coronavirus disease pandemic caught many pediatric hospitals unpreparedand has forced pediatric healthcare systems to scramble as they examine and planfor the optimal allocation of medical resources for the highest priority patients.There is limited data describing pediatric intensive care unit (PICU) preparednessand their health worker protections.AIMTo describe the current coronavirus disease 2019 (COVID-19) preparedness effortsamong a set of PICUs within a simulation-based network nationwide.METHODS A cross-sectional multi-center national survey of PICU medical director(s) fromchildren’s hospitals across the United States. The questionnaire was developedand reviewed by physicians with expertise in pediatric critical care, disasterreadiness, human factors, and survey development. Thirty-five children’shospitals were identified for recruitment through a long-established nationalresearch network. The questions focused on six themes: (1) PICU and medicaldirector demographics;(2) Pediatric patient flow during the pandemic;(3)Changes to the staffing models related to the pandemic;(4) Use of personalprotective equipment (PPE);(5) Changes in clinical practice and innovations;and(6) Current modalities of training including simulation.RESULTSWe report on survey responses from 22 of 35 PICUs (63%). The majority of PICUswere located within children’s hospitals (87%). All PICUs cared for pediatricpatients with COVID-19 at the time of the survey. The majority of PICUs (83.4%)witnessed decreases in non-COVID-19 patients, 43% had COVID-19 dedicatedunits, and 74.6% pivoted to accept adult COVID-19 patients. All PICUsimplemented changes to their staffing models with the most common changesbeing changes in COVID-19 patient room assignment in 50% of surveyed PICUsand introducing remote patient monitoring in 36% of the PICU units. Ninety-fivepercent of PICUs conducted training for donning and doffing of enhanced PPE.Even 6 months into the pandemic, one-third of PICUs across the United Statesreported shortages in PPE. The most common training formats for PPE werehands-on training (73%) and video-based content (82%). The most commonconcerns related to COVID-19 practice were changes in clinical protocols andguidelines (50%). The majority of PICUs implemented significant changes in theirairway management (82%) and cardiac arrest management protocols in COVID-19patients (68%). Simulation-based training was the most commonly utilizedtraining modality (82%), whereas team training (73%) and team dynamics (77%)were the most common training objectives.CONCLUSIONSA substantial proportion of surveyed PICUs reported on large changes in theirpreparedness and training efforts before and during the pandemic. PICUsimplemented broad strategies including modifications to staffing, PPE usage,workflow, and clinical practice, while using simulation as the preferred trainingmodality. Further research is needed to advance the level of preparedness,support staff assuredness, and support deep learning about which preparednessactions were effective and what lessons are needed to improve PICU care andstaff protection for the next COVID-19 patient waves.
文摘Background:This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).Methods:From July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the circuit.Results:A total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, respectively.Conclusions:Practices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.
文摘目的调查重症监护病房(intensive care unit,ICU)护士预防再喂养综合征知识、态度和行为现况,并分析其影响因素,为临床开展相关教学、培训提供依据。方法采用便利抽样法,自行编制一般资料调查表、ICU护士对预防RFS再喂养综合征(refeeding syndrome,RFS)知识、态度和行为问卷以及护理阻碍因素及知识需求问卷,对上海市5所三级甲等综合医院和2所二级甲等综合医院的366名ICU护士进行调查,并采用多重线性回归分析RFS的知识、态度和行为的影响因素。结果366名ICU护士预防RFS知识、态度和行为问卷总分、知识维度、态度维度、主观规范、感知行为控制及行为意向维度得分分别为(133.73±20.55)分、(35.79±9.04)分、(37.44±6.20)分、(12.07±2.27)分、(17.82±4.00)分、(30.61±6.09)分,总分处于中等水平。多重线性回归分析显示,医院级别、ICU类型以及是否为营养学组成员、接受过相关培训、从学术期刊获取知识的频率是ICU护士对预防RFS知识、态度和行为的影响因素(均P<0.05),共同解释其20.90%的变异。结论从学术期刊获取知识、三级医院、综合ICU及接受过RFS相关知识培训、营养学组成员的护士有较高的预防RFS知识、态度和行为水平。护理管理者应重视ICU护士的培训,加强其对预防RFS护理的知识和行为,从而提高ICU护理管理质量。
文摘目的将重症监护病房(intensive care unit,ICU)机械通气患者撤机后呼吸肌训练的最佳证据应用于临床实践并评价其效果。方法运用循证护理的方法,将获取的最佳证据应用于临床,比较循证实践前后上海市某三级甲等医院ICU机械通气患者撤机后肺功能、再插管率以及ICU住院时间,以及护士对ICU机械通气患者撤机后呼吸肌训练知识问卷得分和各个审查指标的执行情况。结果证据应用后,ICU机械通气撤机患者呼气峰流速及第1 s用力呼吸容积均有所改善,撤机后ICU住院时间缩短,护士的知识问卷得分以及对审查指标的执行率有所提高(均P<0.05)。结论开展基于最佳证据的循证实践,能够有效改善ICU机械通气撤机患者的肺功能,提高ICU护士对相关知识的掌握程度,缩短证据与临床实践的差距,从而提高护理质量。
