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Dejonckheere M, Antonelli M, Arvaniti K, Blot K, CreaghBrown B, de Lange DW, De Waele J, Deschepper M, Dikmen Y, Dimopoulos G, Eckmann C, Francois G, Girardis M, Koulenti D, Labeau S, Lipman J, Lipovestky F, Maseda E, Montravers P, Mikstacki A, Paiva J, Pereyra C, Rello J, Timsit J, Vogelaers D, Blot S. Epidemiology and risk factors for mortality in critically ill patients with pancreatic infection. J Intensive Med 2024; 4:81-93. [PMID: 38263964 PMCID: PMC10800767 DOI: 10.1016/j.jointm.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 01/25/2024]
Abstract
Background The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the (1) setting of infection onset (community-acquired, early onset, or late-onset hospital-acquired), (2) presence or absence of either localized or diffuse peritonitis, and (3) severity of disease expression (infection, sepsis, or septic shock). This classification system demonstrated reliable risk stratification in intensive care unit (ICU) patients with intra-abdominal infection. This study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and mortality. Methods This was a secondary analysis of an international observational study ("AbSeS") investigating ICU patients with intra-abdominal infection. Only patients with pancreatic infection were included in this analysis (n=165). Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the ICU. Relationships with mortality were assessed using logistic regression analysis and reported as odds ratio (OR) and 95% confidence interval (CI). Results The overall mortality was 35.2% (n=58). The independent risk factors for mortality included older age (OR=1.03, 95% CI: 1.0 to 1.1 P=0.023), localized peritonitis (OR=4.4, 95% CI: 1.4 to 13.9 P=0.011), and persistent signs of inflammation at day 7 (OR=9.5, 95% CI: 3.8 to 23.9, P<0.001) or after the implementation of additional source control interventions within the first week (OR=4.0, 95% CI: 1.3 to 12.2, P=0.013). Gram-negative bacteria were most frequently isolated (n=58, 49.2%) without clinically relevant differences in microbial etiology between survivors and non-survivors. Conclusions In pancreatic infection, a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term outcome. In this limited series, essentials of the AbSeS-classification, such as the setting of infection onset, diffuse peritonitis, and severity of disease expression, were not associated with an increased mortality risk.ClinicalTrials.gov number: NCT03270345.
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Affiliation(s)
- Marie Dejonckheere
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Massimo Antonelli
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - Koen Blot
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Epidemiology and Public Health, Sciensano, Ixelles, Belgium
| | - Ben CreaghBrown
- Surrey Perioperative Anaesthetic Critical Care Collaborative Research Group (SPACeR), Royal Surrey County Hospital, Guildford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Dylan W. de Lange
- Department of Intensive Care Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Jan De Waele
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Mieke Deschepper
- Data Science Institute, Ghent University Hospital, Ghent, Belgium
| | - Yalim Dikmen
- Department of Anesthesiology and Reanimation, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - George Dimopoulos
- 3rd Department of Critical Care, “EVGENIDIO” Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christian Eckmann
- Department of General, Visceral and Thoracic Surgery, Klinikum Hannoversch-Muenden, Goettingen University, Göttingen, Germany
| | - Guy Francois
- Division of Scientific Affairs-Research, European Society of Intensive Care Medicine, Brussels, Belgium
| | - Massimo Girardis
- Anesthesia and Intensive Care Department, University Hospital of Modena, Modena, Italy
| | - Despoina Koulenti
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece
| | - Sonia Labeau
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Nursing, Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Jeffrey Lipman
- Jamieson Trauma Institute, The University of Queensland, Brisbane, QLD, Australia
- Nimes University Hospital, University of Montpellier, Nimes, France
| | - Fernando Lipovestky
- Critical Care Department, Hospital of the Interamerican Open University (UAI), Buenos Aires, Argentina
| | - Emilio Maseda
- Surgical Critical Care, Department of Anesthesia, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | - Philippe Montravers
- Université de Paris, INSERM, UMR-S 1152-PHERE, Paris, France
- Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP, Paris, France
| | - Adam Mikstacki
- Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital in Poznan, Poznan, Poland
| | - JoseArtur Paiva
- Intensive Care Department, Centro Hospitalar Universitario S. Joao, Faculty of Medicine, University of Porto, Grupo Infecao e Sepsis, Porto, Portugal
| | - Cecilia Pereyra
- Intensive Care Unit from Hospital Interzonal General de Agudos “Prof Dr Luis Guemes”, Buenos Aires, Argentina
| | - Jordi Rello
- Ciberes and Vall d'Hebron Institute of Research, Barcelona, Spain
| | - JeanFrancois Timsit
- Université Paris-Cité, IAME, INSERM 1137, Paris, France
- AP-HP, Hôpital Bichat, Medical and Infection Diseases ICU (MI2), Paris, France
| | - Dirk Vogelaers
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of General Internal Medicine and Infectious Diseases, AZ Delta, Roeselare, Belgium
| | - Stijn Blot
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Rubatto Birri PN, Giannoni R, Furche M, Nahra M, Arce Gallardo M, Segui G, Ilutovich S, Olmos M, Birri P, Romano M, Ayala P, Petrochelli V, Huespe L, Banegas D, Gomez A, Zakalik G, Lipovestky F, Montefiore JP, Galletti C, Pendino C, Vera M, Mare S, Bergallo L, Fernandez G, Campassi ML, Ríos F, Saul P, Bonsignore P, Gallardo B, Gimenez M, Estenssoro E. Epidemiology, patterns of care and prognosis of acute kidney injury in critically ill patients: A multicenter study in Argentina (The EPIRA study). J Crit Care 2023; 78:154382. [PMID: 37516091 DOI: 10.1016/j.jcrc.2023.154382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with high morbidity and mortality rates in the intensive care unit (ICU). In low- and middle-income countries (LMICs), epidemiological information about this condition is still scarce. Our main objective was to characterize its epidemiology, prognosis, and its treatment. METHODS This multicenter prospective cohort study included 1466 patients from 35 ICUs during 6 months in Argentina in 2018. Risk factors and outcomes in patients with and without AKI, and between AKI on admission (AKIadm) and that developed during hospitalization (AKIhosp) were analyzed. RESULTS AKI occurred in 61.3% of patients (900/1466); 72.6% were AKIadm and 27.3% AKIhosp. Risk factors were age, BMI, arterial hypertension, cardiovascular diseases, diabetes, SOFA, APACHE II, dehydration, sepsis, vasopressor use, radiocontrast, diuresis/h and mechanical ventilation. Independent predictors for AKI were sepsis, diabetes, dehydration, vasopressors on admission, APACHE II and radiocontrast use. Renal replacement therapies (RRT) requirement in AKI patients was 14.8%. Hospital mortality in AKI vs. non-AKI was 38.7% and 23.3% (p < 0.001); and in AKIadm vs. AKIhosp, 41.2% and 37.8% (p = 0.53). CONCLUSIONS ICU-acquired AKI has high incidence, complications and mortality. Risk factors for AKI and RRT utilization were similar to those described in other epidemiological studies. AKIadm was more frequent than AKIhosp, but had equal prognosis.
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Affiliation(s)
| | - Roberto Giannoni
- Hospital Regional Ramon Carrillo, Santiago del Estero, Santiago del Estero, Argentina; Centro Integral de Salud, La Banda, Santiago del Estero, Argentina.
| | - Mariano Furche
- Sanatorio De los Arcos, Ciudad Autónoma de Buenos Aires, Argentina.
| | - M Nahra
- Hospital Español, Ciudad Autónoma de Buenos Aires, Argentina
| | - M Arce Gallardo
- Hospital Regional Ramon Carrillo, Santiago del Estero, Santiago del Estero, Argentina
| | - Gabriela Segui
- Hospital Dr. Luis Güemes, Haedo, Buenos Aires, Argentina
| | | | - Matias Olmos
- Hospital Universitario Fundación Favaloro, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | | | | | - Luis Huespe
- Hospital Escuela General San Martin, Corrientes, Argentina
| | - David Banegas
- Sanatorio Otamendi, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alejandro Gomez
- Sanatorio De los Arcos, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | - Pablo Saul
- Policlínico UOM, Ciudad Autónoma Buenos Aires, Argentina
| | | | | | - Mirta Gimenez
- Hospital Centenario, Gualeguaychú, Entre Ríos, Argentina
| | - Elisa Estenssoro
- Escuela de Gobierno en Salud, Ministerio de Salud de la Provincia de Buenos Aires, Buenos Aires, Argentina.
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Arvaniti K, Dimopoulos G, Antonelli M, Blot K, Creagh-Brown B, Deschepper M, de Lange D, De Waele J, Dikmen Y, Eckmann C, Einav S, Francois G, Fjeldsoee-Nielsen H, Girardis M, Jovanovic B, Lindner M, Koulenti D, Labeau S, Lipman J, Lipovestky F, Makikado LDU, Maseda E, Mikstacki A, Montravers P, Paiva JA, Pereyra C, Rello J, Timsit JF, Tomescu D, Vogelaers D, Blot S. Epidemiology and Age-Related Mortality in Critically Ill Patients With Intra-Abdominal Infection or Sepsis: An International Cohort Study. Int J Antimicrob Agents 2022; 60:106591. [PMID: 35460850 DOI: 10.1016/j.ijantimicag.2022.106591] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/24/2022] [Accepted: 04/11/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The objective of this study is to describe the epidemiology and age-related mortality in older critically ill adults with intra-abdominal infections. METHODS This is a secondary analysis of a prospective, multinational, observational study (AbSeS, ClinicalTrials.gov #NCT03270345) including patients with intra-abdominal infection from 309 ICUs in 42 countries (January-December, 2016). Mortality was considered as ICU mortality with a minimum of 28 days of observation when patients were discharged earlier. Relationships with mortality were assessed by logistic regression analysis. RESULTS The cohort included 2337 patients. Four age groups were defined: middle-aged patients as reference category (40-59 years; n=659 [28.2%]), young-old (60-69 years; n=622 [26.6%]), middle-old (70-79 years; n=667 [28.5%]) and very-old patients (≥80 years; n=389 [16.6%]). Secondary peritonitis was the predominant infection (68.7%) and equally prevalent across age groups. Mortality increased with age: 20.9% in middle-aged patients, 30.5% in young-old, 31.2% in middle-old, and 44.7% in very-old patients (p<0.001). Compared to middle-aged patients, young-old age (OR 1.62, 95% CI 1.21-2.17), middle-old age (OR 1.80, 95% CI 1.35-2.41), and very-old age (OR 3.69, 95% CI 2.66-5.12) were independently associated with mortality. Other independent risk factors for mortality included late-onset hospital-acquired intra-abdominal infection, diffuse peritonitis, sepsis/septic shock, source control failure, liver disease, congestive heart failure, diabetes, and malnutrition. CONCLUSIONS For ICU patients with intra-abdominal infections, age above 60 years was associated with mortality while patients above 80 years had the worst prognosis. Comorbidities and overall disease severity further compromised survival. As all these factors are non-modifiable it remains unclear how to improve outcomes.
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Affiliation(s)
- Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - George Dimopoulos
- Critical Care Department, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens, Greece
| | - Massimo Antonelli
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Koen Blot
- Department of Internal Medicine and Pediatrics, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Ben Creagh-Brown
- Surrey Perioperative Anaesthetic Critical Care Collaborative Research Group (SPACeR), Royal Surrey County Hospital Guildford, UK; Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Mieke Deschepper
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium
| | - Dylan de Lange
- Department of Intensive Care Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Jan De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Yalim Dikmen
- Department of Anesthesiology and Reanimation, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Christian Eckmann
- Department of General, Visceral and Thoracic Surgery, Klinikum Hannoversch-Muenden, Goettingen University, Germany
| | - Sharon Einav
- General Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Guy Francois
- Division of Scientific Affairs-Research, European Society of Intensive Care Medicine, Brussels, Belgium
| | - Hans Fjeldsoee-Nielsen
- Department of Anesthesiology and Intensive Care, Nykoebing Falster Hospital, Nykoebing Falster, Denmark
| | - Massimo Girardis
- Anesthesia and Intensive Care Department, University Hospital of Modena, Modena, Italy
| | - Bojan Jovanovic
- Center for Anesthesia and Resuscitation, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Matthias Lindner
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Despoina Koulenti
- Burns, Trauma and Critical Care Research Centre, Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; 2nd Critical Care Department, Attikon University Hospital, Athens, Greece
| | - Sonia Labeau
- Department of Internal Medicine and Pediatrics, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Nursing, Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Jeffrey Lipman
- Jamieson Trauma Institute and The University of Queensland, Brisbane, Australia; Nimes University Hospital, University of Montpellier, Nimes, France
| | - Fernando Lipovestky
- Critical Care Department, Hospital of the Interamerican Open University (UAI), Buenos Aires, Argentina
| | | | - Emilio Maseda
- Surgical Critical Care, Department of Anesthesia, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | - Adam Mikstacki
- Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland; Department of Anaesthesiology and Intensive Therapy, Regional Hospital in Poznan, Poznan, Poland
| | - Philippe Montravers
- Université de Paris, NSERM UMR 1152 - ANR10-LABX-17, Paris, 75018, France.; AP-HP, Hôpital Bichat, Department of Anesthesiology and Critical Care Medicine, Paris, 75018, France
| | - José Artur Paiva
- Intensive Care Department, Faculty of Medicine, Centro Hospitalar Universitario S. Joao, Faculty of Medicine, University of Porto, Grupo Infecçao e Sepsis, Porto, Portugal
| | - Cecilia Pereyra
- Intensive Care Unit from Hospital Interzonal General de Agudos "Prof Dr Luis Guemes", Buenos Aires, Argentina
| | - Jordi Rello
- Ciberes and Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Jean-Francois Timsit
- Université de Paris, IAME, INSERM, Paris 75018, France; P-HP and Hôpital Bichat, Medical and Infection Diseases ICU (MI2), Paris 75018, France
| | - Dana Tomescu
- Department of Anaesthesia and Critical Care, Fundeni Clinical Institute, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Dirk Vogelaers
- Department of General Internal Medicine and Infectious Diseases, AZ Delta, Roeselare, Belgium; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Stijn Blot
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
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Cardenas D, Díaz G, Fuchs-Tarlovsky V, Cristina Gonzalez M, Carrasco F, Cano AMP, Bermúdez C, Maza C, Ferraresi E, Lipovestky F, Villafana H, Arenas-Márquez H, Calvo I, Cordova LRA, Canicoba M, Sánchez P, Santana S, Tihista S, Adrianza de Baptista GM, Garcia Y, Correia MITD. Nutrition competencies for undergraduate medical education: Results of an international interdisciplinary consensus. JPEN J Parenter Enteral Nutr 2021; 46:635-645. [PMID: 34117790 DOI: 10.1002/jpen.2203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The gap between the nutrition education provided to medical students and the nutrition competencies and attitudes needed for physicians to provide adequate nutrition care is a global concern. There is no universally accepted benchmark on nutrition competencies for doctors. The objective of this study was to establish, by expert consensus, the objectives of undergraduate nutrition medial education, the nutrition core competencies, and strategies for curriculum development in medical nutrition education. METHODS We administered a Delphi survey to systematically gather the opinion of a panel of Latin American experts in nutrition. The survey questionnaire was constructed considering scientific literature by using a 5-point Likert scale. Consensus was defined as >70% agreement on the importance of an item (Likert scale 4 and 5). RESULTS A four-round Delphi survey was conducted for this research. In the second, third, and fourth rounds, we validated a total of 130 competencies by consensus, which were distributed into four different thematic areas: (1) basic nutrition concepts, (2) public nutrition and nutrition prevention throughout the life cycle, (3) nutrition status and disease, and (4) nutrition care process. CONCLUSION The curricula for general physician education in medical school must include health promotion, prevention, and treatment of diseases related to nutrition. This goal can be reached by integrating ≤130 competencies into four different fundamental areas.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogotá, Colombia
| | - Gustavo Díaz
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogotá, Colombia
| | | | | | | | | | - Charles Bermúdez
- Surgery department, Clinica la Colina, Clinica del Country, Bogotá, Colombia
| | - Claudia Maza
- Clinical Nutrition Section, Centro Médico Militar, Universidad del Valle de Guatemala, Guatemala
| | - Eduardo Ferraresi
- Hospital Interzonal General de Agudos Profesor Dr Rodolfo Rossi, La Plata, Buenos Aires, Argentina
| | | | - Haydee Villafana
- Faculty of Pharmacy and Biochemistry, Universidad Nacional de Trujillo, Perú
| | | | - Isabel Calvo
- Nutrition service, Hospital General de Tijuana, México
| | | | - Marisa Canicoba
- Hospital National Alejandro Posadas, Universidad de Buenos Aires, Argentina
| | - Paola Sánchez
- Faculty of Medicine, Universidad Hispanoamericana, San José, Costa Rica.,Faculty of Medicina Universidad de Ciencias Médicas, San José, Costa Rica.,Faculty of Medicine Universidad Latina, San José, Costa Rica
| | - Sergio Santana
- Hospital Pediátrico Juan Manuel Márquez, Marianao, Ciudad de la Habana, Cuba
| | | | | | - Yawelida Garcia
- Faculty of Nutrition, Universidad O&M, Santo Domingo, Dominican Republic
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Cardenas D, Díaz G, Cadavid J, Lipovestky F, Canicoba M, Sánchez P, Álvarez L, Duarte Y, Reyes JGG, de Noyola GM, Maza C, Porbén SS, Bermúdez CE, García Y, Calvo I, Arenas H. Nutrition in medical education in Latin America: Results of a cross-sectional survey. JPEN J Parenter Enteral Nutr 2021; 46:229-237. [PMID: 33735516 DOI: 10.1002/jpen.2107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 12/21/2022]
Abstract
RATIONALE The gap between the nutrition education provided to medical students and the nutrition competences and attitudes needed for doctors to provide effective nutrition care is a global concern. The goal of this study was to investigate the curricular content on nutrition education in Latin American medical schools and to evaluate the self-perceived knowledge, attitudes, and barriers to nutrition practice of final-year medical students. METHODS Eighty-five public and private medical schools from 17 Latin American countries were invited to participate in the study. Two close-ended online questionnaires consisting of 25 and 43 questions were sent to medical school directors. Quantitative variables were expressed as frequencies, percentages, mean ± standard deviation, medians, and ranges. RESULTS A total of 22 (26%) medical school directors responded, of which 11 schools (50%) offered stand-alone mandatory nutrition courses in preclinical and 8 (36%) in clinical years. The mean hours dedicated to nutrition education was 47 (range: 0-150). A total of 1530 of 1630 (94%) students from 12 countries responded. Students' average age was 25 ± 3 years, and 59% were female. Most students agreed that improving patients' health through nutrition (91%) is important and that nutrition counseling and assessment should be part of routine care provided by all physicians (89%), but they lack the level of education and training required to address nutrition-related issues. CONCLUSIONS Positive attitude and interest in nutrition among final-year medical students is high, but nutrition education is not perceived as sufficient to adequately prepare doctors in the field of nutrition.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogotá, Colombia
| | - Gustavo Díaz
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogotá, Colombia
| | - Jessika Cadavid
- Faculty of Medical Sciences, Federal University of Mato Grosso, Cuiaba, Brazil
| | - Fernando Lipovestky
- Faculty of Medicine, Universidad Abierta Interamericana, Buenos Aires, Argentina
| | - Marisa Canicoba
- Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Paola Sánchez
- Faculty of Medicine, Universidad Latina de Costa Rica, San José, Costa Rica
| | - Ludwig Álvarez
- Nutrition department, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Yan Duarte
- Faculty of Medicine, Universidad Estatal de Guayaquil, Guayaquil, Ecuador
| | | | | | - Claudia Maza
- Faculty of Nutrition, Centro Médico Militar, Ciudad de Guatemala, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Sergio Santana Porbén
- Nutrition department, Hospital Pediatrico Docente "Juan Manuel Marquez,", La Habana, Cuba
| | - Charles Elleri Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica del Country, Bogotá, Colombia
| | - Yawelida García
- Faculty of Nutrition, Universidad O&M, Santo Domingo, Dominican Republic
| | - Isabel Calvo
- Nutrition service, Hospital General de Tijuana, Tijuana, Mexico
| | - Humberto Arenas
- Integrated Practice Unit on Intestinal Failure, Hospital San Javier, Guadalajara, Mexico
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Cardenas D, Díaz G, Cadavid Sierra J, Lipovestky F, Canicoba M, Duarte Vera Y, Gutierrez Reyes J, Sanchez P, Maza C, Calvo I, Garcia Y, Jimenez M, Arenas H, Bermúdez C. Nutrition education in Latin-American medical schools: Results of an international survey. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Blot S, Antonelli M, Arvaniti K, Blot K, Creagh-Brown B, de Lange D, De Waele J, Deschepper M, Dikmen Y, Dimopoulos G, Eckmann C, Francois G, Girardis M, Koulenti D, Labeau S, Lipman J, Lipovestky F, Maseda E, Montravers P, Mikstacki A, Paiva JA, Pereyra C, Rello J, Timsit JF, Vogelaers D. Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project. Intensive Care Med 2019; 45:1703-1717. [PMID: 31664501 PMCID: PMC6863788 DOI: 10.1007/s00134-019-05819-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/09/2019] [Indexed: 12/29/2022]
Abstract
Purpose To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection. Electronic supplementary material The online version of this article (10.1007/s00134-019-05819-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stijn Blot
- Department of Internal Medicine and Pediatrics, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Massimo Antonelli
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - Koen Blot
- Department of Internal Medicine and Pediatrics, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Ben Creagh-Brown
- Surrey Perioperative Anaesthetic Critical Care Collaborative Research Group (SPACeR), Royal Surrey County Hospital, Guildford, UK.,Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Dylan de Lange
- Department of Intensive Care Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Jan De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Mieke Deschepper
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium
| | - Yalim Dikmen
- Department of Anesthesiology and Reanimation, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - George Dimopoulos
- Critical Care Department, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens, Greece
| | - Christian Eckmann
- Department of General, Visceral and Thoracic Surgery, Klinikum Peine, Medical University Hannover, Hannover, Germany
| | - Guy Francois
- Division of Scientific Affairs-Research, European Society of Intensive Care Medicine, Brussels, Belgium
| | - Massimo Girardis
- Anesthesia and Intensive Care Department, University Hospital of Modena, Modena, Italy
| | - Despoina Koulenti
- Burns, Trauma and Critical Care Research Centre, Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,2nd Critical Care Department, Attikon University Hospital, Athens, Greece
| | - Sonia Labeau
- Department of Internal Medicine and Pediatrics, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of Nursing, Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Jeffrey Lipman
- Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, Australia.,Nimes University Hospital, University of Montpellier, Nimes, France
| | - Fernando Lipovestky
- Critical Care Department, Hospital of the Interamerican Open University (UAI), Buenos Aires, Argentina
| | - Emilio Maseda
- Surgical Critical Care, Department of Anesthesia, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | - Philippe Montravers
- Université de Paris, INSERM, UMR 1152, Paris, France.,Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP, Paris, France
| | - Adam Mikstacki
- Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland.,Department of Anaesthesiology and Intensive Therapy, Regional Hospital in Poznan, Poznan, Poland
| | - José-Artur Paiva
- Intensive Care Department, Faculty of Medicine, Centro Hospitalar Universitario S. Joao, University of Porto, Grupo Infecçao e Sepsis, Porto, Portugal
| | - Cecilia Pereyra
- Intensive Care Unit from Hospital Interzonal General de Agudos "Prof Dr Luis Guemes", Buenos Aires, Argentina
| | - Jordi Rello
- Ciberes and Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Jean-Francois Timsit
- Université de Paris, IAME, INSERM, Paris, 75018, France.,AP-HP, Hôpital Bichat, Medical and Infection Diseases ICU (MI2), Paris, 75018, France
| | - Dirk Vogelaers
- General Internal Medicine, Infectious Diseases, and Psychometric Medicine, Ghent University Hospital, Ghent, Belgium
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