Management of carbapenemase-producing Enterobacteriaceae in a low incidence area: A six-year experience in a university hospital

2019 ◽  
Vol 40 (8) ◽  
pp. 936-938 ◽  
Author(s):  
Audrey Emery ◽  
Audrey Jeanvoine ◽  
Pascale Bailly ◽  
Houssein Gbaguidi-Haore ◽  
Didier Hocquet ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
University Hospital ◽  
Large Hospital ◽  
Low Incidence

AbstractWe conducted a 6-year retrospective analysis of monitoring of carbapenemase-producing Enterobacteriaceae (CPE) in a large hospital in a low CPE incidence area, and we evaluated the “search and isolate” strategy implemented. In total, 40 CPE isolates were collected from 32 patients, and only 1.4% of contact patients screened were CPE carriers.

scholarly journals Occupational Voice Disorders in Slovakia Today and in the Past

2019 ◽  
Vol 19 (1) ◽  
pp. 38-44
Author(s):  
M Mikolajcikova ◽  
V Ferencikova ◽  
K Fiolkova ◽  
V Sokolikova ◽  
Z Matuskova ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Medical Information ◽  
Slovak Republic ◽  
Voice Disorders ◽  
University Hospital ◽  
Voice Disorder ◽  
Occupational Health Services ◽  
Teaching Staff ◽  
Low Incidence

Abstract Introduction: Voice disorders primarily affect workers in professions with increased voice demands, such as teaching personnel in educational system, singers, lecturers, actors or managers. Severe voice disorders often require a permanent change of work position. Methods: Retrospective analysis of a set of patients with occupational voice disorders who were hospitalized at the Clinic of Occupational Medicine and Toxicology, Martin University Hospital (COMaT, MUH) in the years of 2000–2017. Comparison of the data obtained with the National Centre of Medical Information (NCMI) data on the occurrence of occupational voice disorders throughout the Slovak Republic (SR). Comparison with the retrospective analysis of reported occupational voice disorders in the years of 1967-1996. Case report of a patient with an occupational voice disorder. Results: We point to a long-term low incidence of occupational voice disorders. In the years of 2000-2017, 24 cases of occupational voice disorders were reported in Slovakia, of which 20 cases were reported under item 42-1 and 4 cases under item 42-2 in the List of Occupational Diseases. Through the COMaT, MUH 11 cases of occupational voice disorders were reported during these years, of which 9 cases were listed under item 42-1 and 2 cases under item 42-2. From 1967 to 1996 there were 52 occupational voice disorders reported in Slovakia, of which 45 were under item 42-1 and 7 under item 42-2. Conclusions: As there is a tendency to underestimate the voice difficulties among teaching staff, it is necessary to provide better information about the possible consequences, prevention, and treatment of these diseases. All of this should be in the competency of occupational health services.

scholarly journals Different treatment modalities and outcomes in cesarean scar pregnancy: a retrospective analysis of 31 cases in a unıversity hospital

2019 ◽  
Vol 90 (6) ◽  
pp. 291-307 ◽  
Author(s):  
Adnan Orhan ◽  
Işıl Kasapoğlu ◽  
Bilge Çetinkaya Demir ◽  
Kemal Özerkan ◽  
Nergis Duzok ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
University Hospital ◽  
Treatment Modalities ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar

scholarly journals Effect of national HIV testing recommendations and local interventions on HIV testing practices in a Swiss university hospital: a retrospective analysis between 2012 and 2015

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e021203
Author(s):  
Tosca Lazzarino ◽  
Sebastien Martenet ◽  
Rachel Mamin ◽  
Renaud A Du Pasquier ◽  
Solange Peters ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Hiv Testing ◽  
Retrospective Analysis ◽  
University Hospital ◽  
Secondary Outcome ◽  
Clinical Services ◽  
Demographic Profiles ◽  
Testing Rate ◽  
Number Of Patients ◽  
Living With Hiv

ObjectivesDespite HIV testing recommendations published by the Federal Office of Public Health (FOPH) since 2007, many individuals living with HIV are diagnosed late in Switzerland. The aim of this study is to examine the effect of the 2013 FOPH HIV testing recommendations on HIV testing rates.SettingTen clinical services at Lausanne University Hospital, Lausanne, Switzerland.ParticipantsPatients attending between 1 January 2012 and 31 December 2015.DesignRetrospective analysis using two existing hospital databases. HIV testing rates calculated as the percentage of tests performed (from the Immunology Service database) per number of patients seen (from the central hospital database).Primary and secondary outcome measuresThe primary outcome was testing rate change following the 2013 FOPH testing recommendations, comparing testing rates 2 years before and 2 years after their publication. Secondary outcomes were demographic factors of patients tested or not tested for HIV.Results147 884 patients were seen during the study period of whom 9653 (6.5%) were tested for HIV, with 34 new HIV diagnoses. Mean testing rate increased from 5.6% to 7.8% after the recommendations (p=0.001). Testing rate increases were most marked in services involved in clinical trials on HIV testing, whose staff had attended training seminars on testing indications and practice. Testing rates were lower among older (aged >50 years), female and Swiss patients compared with younger, male and non-Swiss patients, both globally (p=0.001) and in specific clinical services.ConclusionsThis simple two-database tool demonstrates clinical services in which HIV testing practice can be optimised. Improved testing rates in services involved in clinical trials on testing suggest that local engagement complements the effect of national recommendations. While, overall, HIV testing rates increased significantly over time, testing rates were lower among patients with similar demographic profiles to individuals diagnosed late in Switzerland.

scholarly journals A Retrospective Analysis of Interruptive versus Non-interruptive Clinical Decision Support for Identification of Patients Needing Contact Isolation

2013 ◽  
Vol 04 (04) ◽  
pp. 569-582 ◽  
Author(s):  
X. Li ◽  
J. Grein ◽  
D.S. Bell ◽  
P. Silka ◽  
J.M. Pevnick
Keyword(s):  
Decision Support ◽  
Retrospective Analysis ◽  
Clinical Decision Support ◽  
Primary Outcome ◽  
Objective Assessment ◽  
Clinical Decision ◽  
Second Primary ◽  
Large Hospital ◽  
Contact Isolation ◽  
The Difference

SummaryBackground: In determining whether clinical decision support (CDS) should be interruptive or non-interruptive, CDS designers need more guidance to balance the potential for interruptive CDS to overburden clinicians and the potential for non-interruptive CDS to be overlooked by clinicians.Objectives: (1)To compare performance achieved by clinicians using interruptive CDS versus using similar, non-interruptive CDS. (2)To compare performance achieved using non-interruptive CDS among clinicians exposed to interruptive CDS versus clinicians not exposed to interruptive CDS.Methods: We studied 42 emergency medicine physicians working in a large hospital where an interruptive CDS to help identify patients requiring contact isolation was replaced by a similar, but non-interruptive CDS. The first primary outcome was the change in sensitivity in identifying these patients associated with the conversion from an interruptive to a non-interruptive CDS. The second primary outcome was the difference in sensitivities yielded by the non-interruptive CDS when used by providers who had and who had not been exposed to the interruptive CDS. The reference standard was an epidemiologist-designed, structured, objective assessment.Results: In identifying patients needing contact isolation, the interruptive CDS-physician dyad had sensitivity of 24% (95% CI: 17%-32%), versus sensitivity of 14% (95% CI: 9%-21%) for the non-interruptive CDS-physician dyad (p = 0.04). Users of the non-interruptive CDS with prior exposure to the interruptive CDS were more sensitive than those without exposure (14% [95% CI: 9%-21%] versus 7% [95% CI: 3%-13%], p = 0.05).Limitations: As with all observational studies, we cannot confirm that our analysis controlled for every important difference between time periods and physician groups.Conclusions: Interruptive CDS affected clinicians more than non-interruptive CDS. Designers of CDS might explicitly weigh the benefits of interruptive CDS versus its associated increased clinician burden. Further research should study longer term effects of clinician exposure to interruptive CDS, including whether it may improve clinician performance when using a similar, subsequent non-interruptive CDS.Citation: Pevnick JM, Li X, Grein J, Bell DS, Silka P. A retrospective analysis of interruptive versus non-interruptive clinical decision support for identification of patients needing contact isolation. Appl Clin Inf 2013; 4: 569–582http://dx.doi.org/10.4338/ACI-2013-04-RA-0021

scholarly journals Strategies to reduce external ventricular drain–related infections: a multicenter retrospective study

2019 ◽  
Vol 130 (6) ◽  
pp. 2034-2039 ◽  
Author(s):  
Julia Champey ◽  
Clément Mourey ◽  
Gilles Francony ◽  
Patricia Pavese ◽  
Emmanuel Gay ◽  
...  
Keyword(s):  
External Ventricular Drain ◽  
Neurological Status ◽  
External Ventricular Drainage ◽  
University Hospital ◽  
Care Bundle ◽  
Intraventricular Administration ◽  
Csf Pleocytosis ◽  
Low Incidence ◽  
The Impact ◽  
Biochemical Abnormalities

OBJECTIVEVarious strategies have been proposed to reduce the incidence of external ventricular drain (EVD)–related infections. The authors retrospectively studied the impact of EVD care management on EVD-related infections at 3 French university hospital intensive care units.METHODSBetween 2010 and 2014, 462 consecutive adult patients with no evidence of a preexisting CSF infection received EVDs as part of their care at one of the following sites: Grenoble (221 patients), Saint-Etienne (130 patients), and Marseille (111 patients). Written protocols describing the EVD placement procedure, management, and removal were implemented at the 3 sites. Daily CSF sampling and intraventricular administration of antibiotics prior to EVD removal were performed at the Grenoble site only. EVD-related infection was considered for any confirmed ventriculostomy-related infection (VRI) and ventriculitis. VRI was defined as one or more positive CSF cultures or Gram stain with CSF pleocytosis and biochemical abnormalities. Ventriculitis was defined as CSF pleocytosis and biochemical abnormalities with degradation of neurological status and fever.RESULTSA total of 6945 EVD days were observed in the entire population. In the Grenoble cohort, the mean cumulative incidence of EVD-related infections was significantly lower than that in the 2 other cohorts: 1.4% (95% CI 0.0%–2.9%) versus 9.2% (95% CI 4.2%–14.2%) and 7.2% (95% CI 2.4%–12.0%) at Saint-Etienne and Marseille, respectively (p < 0.01). Accounting for the duration of external ventricular drainage at each site, the risk for EVD-related CSF infections was significantly higher at Saint-Etienne and Marseille than at Grenoble, with ORs of 15.9 (95% CI 3.6–71.4, p < 0.001) and 10.0 (95% CI 2.2–45.5, p = 0.003), respectively.CONCLUSIONSThese findings indicate that it is possible to attain a low incidence of EVD-related infections, provided that an EVD care bundle, which can include routine daily CSF sampling, is implemented and strongly adhered to.

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