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See detailBreaking Bad News: the TAKE five program
VAN CAUWENBERGE, Isabelle ULg; GILLET, Aline ULg; Bragard, Isabelle ULg et al

Conference (2017, January 14)

Introduction For years, bad news delivery’s impact on patients or their relatives, as well as physicians’ stress has been a major concern. Based on studies claiming the efficacy of training courses to ... [more ▼]

Introduction For years, bad news delivery’s impact on patients or their relatives, as well as physicians’ stress has been a major concern. Based on studies claiming the efficacy of training courses to help physicians delivering such news, many protocols, like SPIKES, BREAKS or SHARE, have emerged worldwide. However, training to such protocol might be time-consuming and not suitable with junior doctors or trainees’ turnover. We hypothesised that a standardized 5-hours training program could improve bad news delivery practice. Participants and methods This preliminary study was conducted in the ED of a tertiary care academic hospital accounting for 90000 ED census per year, 16 attending physicians, 10 junior residents, and 5 trainees per month. Data were collected between November 2015 and April 2016. The study included 3 phases over 4 weeks. Video recorded single role-playing sessions happened the 1st (T1) and the 4th (T3) weeks. A 3-hour theory lesson happened the second week (T2), introducing the basics of therapeutic communication and delivering bad news. Each role-playing session lasted almost 1 hour (10 minutes briefing and medical case reading, 10 minutes role-plays and 40 minutes group debriefing). Bad news delivery performance was evaluated by a 14-points retrospective assessment tool (1). We collected data about the status and impact of a stressful event at 3-days using the French version of the IES-R scale (2). We applied Student t-tests for statistical analysis. Results 14 volunteers (10 trainees and 4 junior emergency physicians) were included in the study. On average, bad-news delivery process took 9’45’’ at T1 and 10’20’’ at T3. From T1 to T3, bad-news delivery performance increased significantly for both junior emergency physicians and trainees (p=0.0003 and p=0.0006, respectively). Further analysis revealed that most relevant increases involved the “situation” (p<0.001), “presentation” (p=0.009), “knowledge” (p=0.037), “emotions” (p=0.01) and “summary” (p=0.001) steps. We also found a significant decrease of the impact of bad-news delivery on trainee physicians’ stress (p=0.006). Discussion and conclusion These preliminary results indicate some potential for this new standardized course of bad news delivery. Apart from allowing physicians increase their communications skills, we believe that this simple 5-hour simulation-training program could alleviate physicians’ stress when they happen to break bad news. References 1. Brunet, A. et al. (2003). Validation of a French version of the Impact of Event Scale-Revised. Can J Psychiatry, 48(1), 56-61. 2. Park, I. et al. (2010). Breaking bad news education for emergency medicine residents: A novel training module using simulation with the SPIKES protocol. J Emerg Trauma Shock, 3(4), 385-388. [less ▲]

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See detailBreaking Bad News: the TAKE five program.
GILLET, Aline ULg; VAN CAUWENBERGE, Isabelle ULg; TUBES, Rebecca ULg et al

Poster (2016, October)

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See detailINCIDENCE AND RISK FACTORS FOR EARLY RENAL DYSFUNCTION AFTER LIVER TRANSPLANTATION
WIESEN, Patricia ULg; GOERGANTA, Elmina; VAN CAUWENBERGE, Isabelle ULg et al

in Intensive Care Medicine (2014, October), 40(S1), 1740628

INTRODUCTION. Renal dysfunction often occurred after liver transplantation. OBJECTIVES. The aim of the study was to determine its incidence and its risk factors in a clinical series at the University ... [more ▼]

INTRODUCTION. Renal dysfunction often occurred after liver transplantation. OBJECTIVES. The aim of the study was to determine its incidence and its risk factors in a clinical series at the University Hospital of Liege, Belgium. METHODS. Orthotopic liver transplantations performed from January 2006 until Sep- tember 2012 were retrospectively reviewed (n = 187). Patients, with no renal replacement therapy (RRT) before transplantation were classified in four groups according to their highest creatinine plasma level during the first postoperative week. First group had a cre- atinine level below 12 mg/l, the second group between 12 and 20 mg/l, the third group between 20 and 35 mg/l, and the fourth above 35 mg/l. In addition, patients who needed RRT during the first week after transplantation were also classified in the fourth group. Preoperative and perioperative parameters were tested as risk factors: age, sex, body mass index (BMI), length of hospital preoperative stay, prior bacterial infection within one month, preoperative ascites, preoperative treatment with ß-blocker, converting enzyme inhibitor, or non steroidal antiinflammatory drugs, preoperative creatinine and bilirubine level, postop- erative lactate level, need for postoperative vasopressive drugs, surgical revision, mechanical ventilation for more than 24 h, postoperative peaks in bilirubine and transam- inase levels, postoperative hemoglobin level, amount of perioperative blood transfusions, type of immunosuppression. Univariate and multivariate analysis were performed using logistic ordinal regression method. RESULTS. There were 78 patients in group 1 (41.7 %), 46 in group 2 (24.6 %), 38 in group 3 (20.3 %) and 25 in group 4 (13.4 %). Eighteen patients required RRT: 13 (7 %) during the first week after transplantation (group 4), the 5 others after the first week after transplan- tation (2 in group 1 and 2, and 1 in group 3). There were 7 (3.7 %) early deaths within 28 days after transplantation. Using univariate analysis, the severity of renal dysfunction was correlated with presence of ascites and prior bacterial infection, preoperative bilirubin and creatinine level, need for surgical revision, use of vasopressor, postoperative mechanical ventilation, postoperative bilirubine, transaminase, and hemoglobin levels. The need for transfusion of each type of products also affected renal dysfunction. The ordinal logistic analysis pointed out the BMI (OR = 1.1, p = 0.004), preoperative creatinine level (OR = 11.1, p \ 0.0001), use of vasopressor (OR = 3.31, p = 0.0002), maximal postop- erative bilirubine level (OR = 1.44, p = 0.044) and minimal postoperative hemoglobin level (OR 0.059 p = 0.0005). CONCLUSIONS. More than half of liver transplanted patients experienced some degree of early renal dysfunction after transplantation. Risk factors are preoperative renal dysfunction, and mainly perioperative circulatory instability requiring the use of vasopressor and post- operative anemia. [less ▲]

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See detailReduction in VAP incidence by subglottic secretion drainage and antibiotic consumption in ICU patients
VAN CAUWENBERGE, Isabelle ULg; ANCION, Arnaud ULg; LAMBERMONT, Bernard ULg et al

in Intensive Care Medicine (2013), 39(Suppl 2), 465-4660898

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See detailRisque anesthesique lie a une neuropathie autonome cardiaque chez le patient diabetique.
Van Cauwenberge, Isabelle ULg; Philips, Jean-Christophe ULg; Scheen, André ULg

in Revue Médicale de Liège (2008), 63(7-8), 488-93

Cardiac autonomic neuropathy is an underestimated complication among diabetic patients. It affects both the sympathetic and parasympathetic systems and is often associated with other, autonomic or not ... [more ▼]

Cardiac autonomic neuropathy is an underestimated complication among diabetic patients. It affects both the sympathetic and parasympathetic systems and is often associated with other, autonomic or not, complications, which make the patient even more frail. Some autonomic clinical manifestations have a direct impact on perioperative morbidity and mortality. The most important ones consist in haemodynamic instability, rhythmic disorders, mainly related to increased QT interval, and finally a higher risk of cardiorespiratory arrest. Recommendations are proposed before, during and after surgery to reduce the incidence of these complications in high risk patients. A screening for autonomic neuropathy may be helpful to improve the management of patients with diabetes who undergo surgery requiring general anaesthesia. [less ▲]

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