Triage nurse-initiated X-ray radiography in minor trauma.

BACKGROUND: Overcrowding of paediatric emergency departments (EDs) is a worldwide issue, where improving the quality of care is a priority. The main objective of this study was to determine the effect of triage nurse-initiated X-ray radiography on length of stay in paediatric emergency admissions. METHODS: This retrospective, monocentric, descriptive study was performed in two successive 3-month periods: a pre-protocol ('before') period from 3 February to 3 May 2020 and a protocol ('after') period from 4 May to 2 August 2020, when patients underwent nurse-initiated X-ray radiography. The study involved all patients who were aged ≥3 years, valid, non-hyperalgic, accompanied by their parents and consulting at the paediatric ED for a simple closed distal trauma, involving a single limb segment or joint. RESULTS: A total of 695 patients were included, 298 in the first period and 397 in the second period. The median length of stay in the paediatric ED was significantly shorter during the second period (119 min [80, 165] vs. 80 min [60, 105], P < 0.001), i.e. a median reduction time of 39 min or 33% (effect size = - 0.68, 95% confidence interval [-0.84 to -0.53]). Triage nurse requests were judged 'adequate and sufficient' in 95.2% of cases, with only 2.0% of instances deemed 'unnecessary' by the medical team. In 2.8% of cases, 'another X-ray' was required to support diagnosis. CONCLUSIONS: The application of a triage nurse X-ray protocol significantly reduced the length of stay in a paediatric ED. The quality of patient management remained unchanged, and nurse requests were relevant.

Understanding the cryotolerance of lactic acid bacteria using combined synchrotron infrared and fluorescence microscopies.

Freezing is widely used for preserving different types of cells. Frozen concentrates of lactic acid bacteria (LAB) are extensively used for manufacturing food, probiotic products and for green chemistry and medical applications. However, the freezing and thawing processes cause cell injuries that result in significant cell death. Producing homogeneous bacterial populations with high cryotolerance remains a real challenge. Our objective was to investigate the biochemical and physiological changes in a LAB model at the cell scale following fermentation and freezing in order to identify cellular biomarkers of cryotolerance. Infrared spectra of individual bacteria produced by applying different fermentation and freezing conditions were acquired using synchrotron radiation-based Fourier-transform infrared (SR-FTIR) microspectroscopy to achieve sub-cellular spatial resolution. Fluorescent microscopy was concomitantly assessed, thus making possible to simultaneously analyse the biochemistry and physiological state of a single cell for the first time. Principal component analysis was used to evaluate changes in cell composition, with particular focus on lipids, proteins and polysaccharides. SR-FTIR results indicated that before freezing, freeze-resistant cells grown in a rich medium presented a high content of CH3 groups from lipid chains, of cell proteins in an α-helix secondary structure and of charged polymers such as teichoic and lipoteichoic acids that constitute the Gram-positive bacterial wall. Moreover, SR-FTIR microspectroscopy made it possible to reveal cell heterogeneity within the cluster of resistant cells, which was ascribed to the diversity of potential substrates in the growth medium. Freezing and thawing processes induced losses of membrane integrity and cell viability in more than 90% of the freeze-sensitive bacterial population. These damages leading to cell death were ascribed to biochemical modification of cell membrane phospholipids, in particular a rigidification of the cytoplasmic membrane following freezing. Furthermore the freeze-resistant cells remained viable after freezing and thawing but a modification of protein secondary structure was detected by SR-FTIR analysis. These results highlighted the potential application of bimodal analysis by SR-FTIR and fluorescence microscopy to increase our knowledge about mechanisms related to cell damage.