mercredi 5 février 2020 

14h10 - 15h10


 
E04

Evaluation

MODÉRATEUR(S) :  Bertrand GUIDET (Paris), Jean-Paul MIRA (Paris)  
  

Score for the risk of acquisition of pressure ulcer in the ICU: Data from the Pressure Study

Orateur(s) :   Gaël PITON (Paris) 

Auteur(s) :  Philippe MICHEL (Paris)   Gwenaëlle JACQ (Paris)   Gregoire MULLER (Paris)   Guillaume DECORMEILLE (Paris)   Atika YOUSSOUFA (Paris)   Laurent POIROUX (Paris)   Brigitte BARROIS (Paris)   Nadia AISSAOUI (PAris)   Saber Davide BARBAR (Paris)   Florence BOISSIER (Paris)   David GRIMALDI (Paris, BELGIQUE)   Sami HRAIECH (Paris)   Nicholas HEMING (Paris)   Bertrand HERMANN (Paris)   Jean-François LLITJOS (Paris)   Lamia BESBES (Paris, TUNISIE)   Jean-Baptiste LASCARROU (Paris)  

14h10 - 14h25
Durée de la présentation : 10 min
Durée de la discussion : 5 min


Abstract : 
Score for the risk of acquisition of pressure ulcer in the ICU: Data from the Pressure Study

Introduction / Rationale :
Critically ill patients are at risk of developing pressure ulcers (PUs) during their ICU stay. Existing scores of PU have not been validated in the context of ICU. We aimed to create a score evaluating the risk of acquisition of PU being specific of the ICU.

Méthodes / Patients and Methods :
Data from a one-day point prevalence study performed in June 2017 in 1228 patients in 86 ICUs in France (The Pressure Study). On the same day, the presence or absence of PUs in all hospitalized patients of participating ICUs, data on the ICUs, and the characteristics of patients and of PUs had been evaluated. Factors having been significantly associated with acquisition of PU in the ICU by univariate analysis were selected. Quantitative variables were dichotomized at a threshold identified by the ROC curve analysis. The variables were included in a multiple logistic regression analysis for the acquisition of PU in the ICU. The independent variables being the most clinically relevant were included in a score, with a weighting of 1 point for each variable.

Résultats / Results :
After exclusion of the IGS2 score, 6 variables were independently associated with acquisition of PU in the ICU: having been confined to bed before ICU admission, presence of motor neurological disorder, body weight ≥ 90 kg, use of high-dose steroids, length of ICU stay > 10 days and need for artificial nutrition (AUC = 0.78). The AUC of a model limited to the four first described variables was correct (AUC = 0.73). A “BCD Weight” score (Bed, Corticosteroids, motor Deficit, body WEIGHT) ranging from 0 to 4 was created. The prevalence of acquired PU was 4.6%, 12.9%, 26.0%, 48.8%, and 100%, among patients presenting with a score 0, 1, 2, 3, and 4, respectively (Figure 1). Comparatively, the prevalence of acquired PU was 0%, 3.7%, 9.3% and 26.9% among patients classified as no risk, low risk, moderate risk, and high risk with the usual scale evaluating the risk of PU.

Discussion / Discussion :


Conclusion / Conclusion :
We identified an easy to remember score addressing the risk of PU in the context of ICU. This “BCD Weight” score, calculable from ICU admission and throughout the stay, might help clinicians to evaluate the risk of acquisition of PU in their patients.
 

Effect of short incitement to follow social media to improve knowledge of scientific literature by intensive care trainees.

Orateur(s) :   Jean-Baptiste LASCARROU (Nantes) 

Auteur(s) :  Stephan EHRMANN (Tours)   Maelle MARTIN (Nantes)   Pierre POTIER (Nantes)   Jean-marie CASTILLO (Nantes)   Jean REIGNIER (Nantes)   Emmanuel CANET (Nantes)  

14h25 - 14h40
Durée de la présentation : 10 min
Durée de la discussion : 5 min


Abstract : 
Effect of short incitement to follow social media to improve knowledge of scientific literature by intensive care trainees.

Introduction / Rationale :
Improving knowledge of recent medical literature by intensive care trainees is a major target for medical education and the first step to improve patient’s care. We test hypothesis than following major Twitter feeds dedicated to intensive care will improve knowledge of recent studies published in medical journals by intensive care trainees.

Méthodes / Patients and Methods :
We included French intensive care trainees (ICT) between March 2019 and October 2019 in an educational randomized trial. All ICT were informed and they consent to the trial. After initial online interrogation, ICT were separated between those already on Twitter© or not (Group 1: ICT already on Twitter©). All ICT not already on Twitter were randomized on 2 groups: Group 2 (short information and incitation to open a Twitter account and to follow critical care journal feeds) or group 3 (control group). ICT were interrogated on their recent medical literature knowledge at 3 and 6 month on 5 trials published in pre-selected journals.

Résultats / Results :
During the study period, on the 969 French ICT contacted, 77 agree to participate: 16 were already on Twitter, 31 were randomized to Twitter incitation and 30 to control group. At 3 month, there were 62 who answered electronic questionnaire. Self-declaration of article knowledge was not different between 3 groups (P=0.85). Knowledge of primary outcome of each trial was not significantly better in 3 groups (P=0.09). In per-protocol analysis of ICT on Twitter or not, knowledge of article and primary outcome were also not significantly different (respectively P=0.57 and P=0.17).

Discussion / Discussion :


Conclusion / Conclusion :
Short incitation to open a Twitter account and follow major medical journals with specific focus on cardiac arrest did not improve knowledge of medical literature by intensive care trainees at 3 month. Further trials are needed to better imply intensive care trainees in scientific medical literature.
 

Construction of a stress scale specific to intensive care units: the PS-ICU scale

Orateur(s) :   Alicia FOURNIER (Dijon) 

Auteur(s) :  Florent LHEUREUX (Besançon)   Maria cruz MARTIN DELGADO (Madrid, ESPAGNE)   Maria grazia BOCCI (Roma, ITALIE)   Alessia PRESTIFILIPPO (Roma)   Amélie ANOTA (Besançon)   Pierre ASLANIAN (Montréal)   Guillaume BESCH (Besançon)   Jean-Michel CONSTANTIN (Paris)   Jean-Pierre QUENOT (Dijon)   Belaid BOUHEMAD (Dijon)   Gilles CAPELLIER (Besançon)   Alexandra LAURENT (Dijon)  

14h40 - 14h55
Durée de la présentation : 10 min
Durée de la discussion : 5 min


Abstract : 
Construction of a stress scale specific to intensive care units: the PS-ICU scale

Introduction / Rationale :
The intensive care units (ICU) are fertile ground for the emergence of professional stressors. Assessed by individuals as situations that weaken or are beyond their resources, work-related stressors impact the mental and physical health of workers and the quality and safety of care. Currently, many tools are used to assess caregiver stress in ICU, but do not consider the specificity of this work. The objective of this international and multicentric study was to develop a perceived stress scale specific to ICU.

Méthodes / Patients and Methods :
Interviews were conducted with 166 caregivers (84 nurses and 81 physicians) in four countries (France, Italy, Spain, Canada). These interviews were recorded, transcribed and then a thematic analysis was carried out to identify stress factors. A first version of the scale was pre-tested with 70 caregivers (30 physicians and 40 nurses) in the same countries. Finally, we carried out qualitative and quantitative analyses select the most relevant items.

Résultats / Results :
We identified 99 stressors specific to the ICU that were grouped into eight main themes: stress in relation to 1) the patient, 2) the task to be performed, 3) the institutional context, 4) the team, 5) the organization of the service, 6) the personal dimensions, 7) the patient's family, 8) the working conditions. Following the pre-test, 50 items were selected to constitute the PS-ICU scale.

Discussion / Discussion :


Conclusion / Conclusion :
Our results highlight specific items related to vital risk/emergency management and ethically and morally problematic situations. These dimensions will be discussed and compared against existing scales (e.g., JCQ). The PS-ICU scale will allow to better identify and measure stressors in ICU. This scale will contribute to the development of targeted actions in terms of prevention, training and support for professionals. The creation of an internationally validated tool will make it possible to develop comparative studies on cultural and organizational factors.
 

Are Intensive Care Residents more exposed to Anxiety/Depression?

Orateur(s) :   Mehdi MARZOUK (Beuvry) 

Auteur(s) :  Manel LAHMAR (Monastir)   Zeineb HAMMOUDA (Monastir)   Islem OUANES (Monastir)   Fahmi DACHRAOUI (Monastir)   Lamia BESBES (Monastir, TUNISIE)   Fekri ABROUG (Monastir, TUNISIE)  

14h55 - 15h10
Durée de la présentation : 10 min
Durée de la discussion : 5 min


Abstract : 
Are Intensive Care Residents more exposed to Anxiety/Depression?

Introduction / Rationale :
When compared to general population, moods disorders are more prevalent among health care workers and especially young doctors. Whether certain specialties are more exposed than others given the burden of workload and specific aspects is not known.
The aim of this study is to assess the prevalence of anxiety and depressive symptoms among Tunisian young residents and verify whether they are more frequent in specialties with high workload such as Intensive Care Medicine.

Méthodes / Patients and Methods :
we conducted a cross-sectional survey in all Tunisian medical residents brought together between 14 and 22 December 2015 to choose their next 6-month rotation. The items of the Hospital Anxiety and Depression (HAD) questionnaire were employed to capture the prevalence of anxiety and/or depression among the residents. The statistical relationships between anxiety and depression (HAD score) and work-related data were explored by Poisson regression. In particular we compared a group of specialties including Intensive care, Anesthesiology, and Emergency medicine (Acute care group), to the rest of specialties.

Résultats / Results :
1700 out of 2200 (77%) medical residents answered the questionnaire. Among these, residents who started the first semester of a new curriculum (n=320) were not included. 243 (17.6%) were in the acute care group.
Overall, 73.5% of the participating residents had either definite (44.2%) or probable (29.3%) anxiety, while 65% had definite (33.5%) or probable (31.5%) depression symptoms. In the acute care group, these proportions were not substantially higher: 48.6% and 27.6% for definite and probable anxiety, respectively; and 37% and 31.7% for definite and probable depression, respectively. Total HAD score was significantly associated with the resident’s age (OR=1.01, 95% CI 1.004 to 1.02, p=0.001); female gender; and the heavy burden of work imposed on a weekly or monthly basis, as reflected by the number of hours worked per week (0.3% increase per worked hour per week), and the number of night shifts per month (1.5% increase per night shift).

Discussion / Discussion :


Conclusion / Conclusion :
Anxiety/Depression symptoms are not more frequent in Intensive Care, Anesthesiology, or Emergency medicine residents. Rather, these symptoms are related to the socio-demographic situation of residents, and the workload characteristics in general.