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This study aims to describe the increase in students' creative thinking by combining cooperative script learning models with reciprocal teaching. This research is a Class Action Research (CAR). This research was conducted in class XI SMA. Learning tools, essay questions combined with creative thinking, observation sheets of learning implementation, and creative thinking instruments were used to collect data. Data analysis on the increase in creative thinking was calculated using the score gain (N-Gain) formula. The results show an increase in students' creative thinking, namely from cycle I with a score of 0.28 which is included in the low category, rising to a score of 0.5 in cycle II which is included in the medium category. The results of this study indicate an increase in students' learning activities and creative thinking in each learning cycle. Combining cooperative and reciprocal learning models can encourage students to dare to express opinions, thoughts, and ideas to empower students' creative thinking skills. This shows that applying the cooperative learning model, a combination of collaborative learning models with a reciprocal teaching model used continuously, can increase students' learning activities and creative thinking to train them to become self-regulation learners.

Background Antibiotic stewardship programmes have a pivotal role in ICUs, but the level of implementation of these programmes at the regional or national level is not well known. Objectives The aim of our study was to assess the level of implementation of antibiotic stewardship programmes in French ICUs. Methods We conducted a nationwide cross-sectional survey from January to March 2018 using an online questionnaire sent as an E-mail link to ICU specialists (one questionnaire per ICU). Results Overall, 113 out of 206 (55%) ICUs participated. Access to local epidemiology regarding bacterial resistance and antibiotic consumption data was reported in 84% and 65% of ICUs, respectively. Local guidelines for antibiotic use were available in 54% of ICUs. The duration of empirical antibiotic therapy was limited in 46% of cases, following the recommendation of an external expert in 33%. An antibiotic stewardship programme leader was reported at the hospital level by 94% of respondents, being an infectious disease physician in 80%. His/her role in the ICU was mostly to discuss specific cases (50%) and to provide advice on antibiotic prescriptions (26%). Regarding microbiological diagnosis, blood cultures were not processed at night or during weekends in 57%. Molecular biology and MS techniques were available in 62% and 59% of cases, respectively. Therapeutic drug monitoring of β-lactams was available in 46% of cases. Forty-three percent of respondents knew the expression 'antimicrobial/antibiotic stewardship'. Conclusions Antibiotic stewardship programmes are not optimally implemented in French ICUs. Improvement efforts and regular monitoring of the level of implementation are needed. [ABSTRACT FROM AUTHOR]

Résumé: Les lésions traumatiques de l’aorte thoracique descendante en dehors de l’isthme sont rares et moins connues des anesthésistes réanimateurs. Nous présentons deux cas de patients polytraumatisés. Le diagnostic précoce et un traitement endovasculaire adapté ont permis une évolution favorable chez les deux patients. Le mécanisme physiopathologique et l’attitude pratique devant ce type de lésion sont discutés au vu des données de la littérature. [ABSTRACT FROM AUTHOR]

Résumé: Nous rapportons deux cas de cisaillements accidentels de cathéters nerveux périphériques survenus lors de leur mise en place en fémoral, sous contrôle échographique. Les mécanismes possibles de ces cisaillements sont exposés ainsi que les différences de composition et de propriétés mécaniques des kits de cathéters nerveux périphériques à l’origine de ce type d’accident. La gestion de cette complication est également présentée. [ABSTRACT FROM AUTHOR]