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- 저자 : Melissa Thompson (검색결과 3 건)
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Barlow Brooke,Thompson Bastin Melissa L.,Shadler Aric,Cook Aaron M. 대한신경집중치료학회 2022 대한신경집중치료학회지 Vol.15 No.2
Background: Chloride-rich fluid administration is frequently employed in the management of aneurysmal subarachnoid hemorrhage (aSAH). However, the incidence and consequences of hyperchloremia in aSAH remain poorly defined. This study aimed to describe the incidence of hyperchloremia in aSAH, the contribution of fluid sources to chloride exposure, and the potential associations of hyperchloremia with patient outcomes.Methods: This was a single-center retrospective cohort study of patients admitted to a neurointensive care unit with aSAH. The primary outcome was incidence of hyperchloremia (chloride >109 mEq/L). Secondary outcomes included incidence of severe hyperchloremia (chloride >115 mEq/L), incidence of acute kidney injury (AKI), need for renal replacement therapy (RRT), intensive care unit (ICU) length of stay (LOS), hospital LOS, and in-hospital mortality.Results: Of the 234 patients included in the analysis, hyperchloremia occurred in 75% (n=175), and 58% (n=101) developed severe hyperchloremia. Median time to onset was 3 days (interquartile range, 1–5) after admission. Hyperchloremia was associated with prolonged ICU LOS (12 vs. 8 days, P<0.001), duration of mechanical ventilation (16 vs. 10 days, P<0.001), hospital LOS (15 vs. 9 days, P<0.001), and in-hospital mortality (14.3% vs. 0%, P=0.002) compared to no hyperchloremia. No significant difference was observed in the incidence of AKI or the need for RRT. Maintenance intravenous fluids accounted for the highest proportion of the cumulative chloride burden.Conclusion: Hyperchloremia occurs at a high frequency in aSAH and is associated with poor patient outcomes. Maintenance intravenous fluids accounted for the highest proportion of cumulative chloride burden.
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Prevalence and prediction of augmented renal clearance in the neurocritical care population
Cook Aaron M.,Li David,Nestor Melissa A.,Bastin Melissa L. Thompson 대한신경집중치료학회 2022 대한신경집중치료학회지 Vol.15 No.2
Background: Augmented renal clearance (ARC; creatinine clearance [CrCl] >130 mL/min/1.73 m2) is prevalent in patients with neurological injuries and may influence their exposure to important pharmacological therapies. Little is known about the relationship between estimated and measured CrCl in this population.Methods: This single-center, prospective, observational cohort study aimed to describe the association between ARC and estimated CrCl and neurological outcomes in a broad neurocritical care population. Prospective patient screening criteria included adults aged 18–85 years, with critical illness due to neurologic causes (such as ischemic stroke or subarachnoid hemorrhage) and lack of renal dysfunction on admission. Patients who had at least one urine CrCl measurement performed within the first 7 days of hospitalization were included. Two cohorts were evaluated: those with ARC and those without ARC. Results: Fifty-seven patients were included, of whom 49 (86%) exhibited ARC. Subjects with ARC were more likely to be male and had a significantly higher median measured CrCl (201.7 mL/min/1.73 m2) than those without ARC (109.8 mL/min/1.73 m2). The Augmented Renal Clearance in Trauma Intensive Care (ARCTIC) score displayed the strongest association (vs. CrCl equations) with ARC development (area under the receiver operating characteristic curve, 0.648). Conclusion: The prevalence of ARC in the present study of a broad neurocritical care population appeared to be high (86%). The ARCTIC score had higher sensitivity and specificity for diagnosing ARC than the common serum creatinine-based estimation.
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Clayton R. Kuklick,Brian T. Gearity,Melissa Thompson 한국코칭능력개발원 2015 International Journal of Coaching Science Vol.9 No.2
Given the need for coach education to develop the essential skill of reflection in coaches (Cushion & Nelson, 2013; Gilbert & Trudel, 2001), the purpose of the current study was to understand how and why 21 coaching students enrolled in a practicum course at a southeastern United States institution engage in reflective practice. This research draws upon Schon’s (1983, 1987) work on reflective practice, which underpinned a set of online structured reflective journaling prompts (ORJ) used as an intervention. Each week, for 12 weeks of the practicum course, students were asked to respond to a theoretically informed prompt. We collected data from the Self-Reflection and Insight Scale (SRIS; Grant et al., 2002), Powell’s (1989) levels of reflection rubric, and the students’ weekly journal responses. The quantitative results revealed that time had significant influence on levels of reflection (p < .01), but not SRIS. The qualitative findings resulted in 15 themes which were categorized as: students’ role frames, students’ self-identified weaknesses, students’ dilemma identification, and students’ responses to dilemmas that describe what students reflected upon in their practicum. These findings are discussed in relation to existing research on reflective practice, student learning in higher education, intrapersonal knowledge development, and the use of technology. Implications for future research and coach educators are offered by considering the prompts influence on the students and the use of technology to facilitate learning in coach education.
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