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N Delorme

Publications and source records attributed to N Delorme.

44 records · Page 3Linked to original sources
PubMedDate not supplied

Assessment of deep vein thrombosis prophylaxis in surgical patients: a study conducted at Nancy University Hospital, France.

OBJECTIVE: This retrospective evaluation aimed to assess the adequacy of prophylaxis against thromboembolism prescribed to surgical patients at the authors' institution, and to compare it with generally accepted published guidelines. Aspects considered were indications for prophylaxis, regimens used and monitoring. METHODS: Eleven units (nine surgical and two surgical intensive care) took part in the survey on a voluntary basis. The clinical audit system used involved developing a set of criteria based on existing guidelines, comparing observed practice with those recommendations, analysing the factors underlying any deviation and developing corrective measures. RESULTS: When the medical records of 117 patients hospitalized in October 1995 were examined, prophylaxis against deep vein thrombosis was documented in 86 (low molecular weight heparin in 85, dextran in one). No associated physical preventative measures were recorded. Indications and dosage were appropriately handled in 90.7% and 75.2% of patients, respectively. Ninety-five cases were outside the reference criteria: 74 for excluded surgical indications, 13 which involved laparoscopy, and eight in which spinal or epidural anaesthesia was administered. Platelet count was performed in 73.8% of cases before prophylactic treatment, and in 23.10% during its course. Anti-Xa activity was measured in 0.4% of cases. Analysis of causes showed that guidelines were not complied with either because of lack of organization, or because of disagreement with them. DISCUSSION: In this study, indications for prophylaxis were well established and heparin dosages used were not fundamentally flawed. The weak point in practice was a failure to carry out platelet counts, particularly during the course of treatment. Appropriate corrective action consists of disseminating guidelines and relevant information, and using a preoperative checklist to assess thromboembolic risk. CONCLUSION: Physicians agree that opportunities to improve preventative practices exist, and that the quality improvement programme should be pursued.

Adult↗
PubMedDate not supplied

[Severe complications related to metabisulfites].

Metabisulfite intolerance is encountered in 8 p. 100 of cases of extrinsic asthma and in 20 p. 100 of cases of the "aspirin triad" with nasosinusal polyposis, asthma and aspirin sensitivity. The possibility that anaphylactoid shock or acute severe asthma leading to status asthmaticus, might be related to sulfite sensitivity must be well known. Two case reports are set out. The first observation is that of a 35-year-old woman suffering from intrinsic asthma with alcohol intolerance, who developed status asthmaticus a few minutes after intravenous administration of Doxycycline associated with a metabisulfite preservative. The other 33-year-old patient presented with an acute bronchospasm in the course of a fiberoscopy using Lidocaine associated by mishap with epinephrine, as local anesthetic. The authors point to the miscellaneous drugs containing sulfites, that are employed in asthmatics by different routes, i.e. parenteral, oral, inhalational and other local treatments. Heavy metabisulfite intake may also arise from daily alcohol consumption. Sulfite intolerance could contribute to the persistence of chronic inflammatory processes in bronchial asthma and therefore should be systematically investigated.

Adult↗
PubMedDate not supplied

[Effect of artificial ventilation with an end-expiratory plateau on gas exchange amd hemodynamics in chronic respiratory failure].

Previous studies of pulmonary models and with animals have shown that in obstructive disease of the airways, ventilation with an end-expiratory plateau improves ventilation distribution. Paradoxically, there has been no data published on patients with obstructive disease. For this reason, we examined the effects of mechanical ventilation with an end-expiratory plateau on gas exchange and haemodynamics in 12 patients presenting acute exacerbations of chronic respiratory failure. Following a period of conventional controlled ventilation, two plateaux of 0.3 and 0.5 s respectively are successively introduced while the I/E ratio (1/2.5) and then inspiratory flow (respiratory frequency and end-tidal volume remaining the same) are kept constant. PaCO2 decreases by approximately 10% with the addition of each plateau. In spite of a moderate increase in mean airway pressure (+8%), greatest improvement in gas exchange is observed with the longer plateau (0.5 s), maintaining expiration time (I/E constant) : a decrease in PaCO2 and in VD/VT (approximately - 14%), an increase in PaO2 (+7%) and a decrease of venous admixture (shunt + shunt effect : - 18.5%). The plateau tends to reduce ventilation/perfusion mismatch, whereas maintaining prolonged expiration assures "emptying" of slow alveoli. However, no matter which plateau is used, cardiac output decreases by more than 10% in six patients, probably due to a drop in systemic venous return. PaCO2 increase is too slight to hinder a decrease in arterial oxygen transport. The variability of these results accounts for patient diversity and restricts the indication of end-expiratory plateau to patients with severe ventilatory distribution disturbances who can benefit from close cardiorespiratory monitoring.

Aged↗
PubMedDate not supplied

[A survey on the practice of drug prescription in hospitals. Concepts and methodology].

A clinical practice survey, if patient focused, identifies and analyses complexity of drug use. It is not a clinical audit whose aim is to compare observed practice with predetermined criteria. A clinical practice survey is useful when a problem exists in a low evidence based clinical area or to elaborate clinical guidelines. Implementation is based on epidemiological methodology and project management and needs a framework determined by a facilitator (trained in quality improvement methods and expert in the clinical area concerned), planning (the more higher the number of wards, the higher the complexity) and the project guidelines must be respected. Since lack of physician involvement is a drawback, support provided by the quality centre (if it exists) must be limited to technical aspects. It is important to appreciate the level of quality culture of the organization and the project must be approved by the hospital manager.

Data Interpretation, Statistical↗