Designing and implementing a COPD discharge care bundle

National surveys have revealed significant differences in patient outcomes following admission to hospital with acute exacerbation of COPD which are likely to be due to variations in care. We developed a care bundle, comprising a short list of evidence-based practices to be implemented prior to discharge for all patients admitted with this condition, based on a review of national guidelines and other relevant literature, expert opinion and patient consultation. Implementation was then piloted using action research methodologies with patient input. Actively involving staff was vital to ensure that the changes introduced were understood and the process followed. Implementation of a care bundle has the potential to produce a dramatic improvement in compliance with optimum health care practice

ShORRT (Short, all-Oral Regimens for Rifampicin-resistant Tuberculosis) Research Package

TDR in close collaboration with the Global TB Programme at WHO and technical partners the WHO Global TB Programme is leading the development of ShORRT (Short, all-Oral Regimens For Rifampicin-resistant Tuberculosis), an operational research package to assess the effectiveness, safety, feasibility, acceptability, cost and impact (including on health-related quality of life) of the use of all-oral shorter drug regimens for adults and children with MDR/RR-TB

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Health, education, and social care provision after diagnosis of childhood visual disability

Aim: To investigate the health, education, and social care provision for children newly diagnosed with visual disability.Method: This was a national prospective study, the British Childhood Visual Impairment and Blindness Study 2 (BCVIS2), ascertaining new diagnoses of visual impairment or severe visual impairment and blindness (SVIBL), or equivalent vi-sion. Data collection was performed by managing clinicians up to 1-year follow-up, and included health and developmental needs, and health, education, and social care provision.Results: BCVIS2 identified 784 children newly diagnosed with visual impairment/SVIBL (313 with visual impairment, 471 with SVIBL). Most children had associated systemic disorders (559 [71%], 167 [54%] with visual impairment, and 392 [84%] with SVIBL). Care from multidisciplinary teams was provided for 549 children (70%). Two-thirds (515) had not received an Education, Health, and Care Plan (EHCP). Fewer children with visual impairment had seen a specialist teacher (SVIBL 35%, visual impairment 28%, χ2p < 0.001), or had an EHCP (11% vs 7%, χ2p < 0 . 01).Interpretation: Families need additional support from managing clinicians to access recommended complex interventions such as the use of multidisciplinary teams and educational support. This need is pressing, as the population of children with visual impairment/SVIBL is expected to grow in size and complexity.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

La conception participative en simulation : un moyen de développement du « soin de manutention raisonné »

International audiencePour répondre aux insuffisances des formations à la manutention de personnes, un programme au « soin de manutention raisonné » a été développé. Son objectif n’est pas de former au « bon geste », mais d’accompagner les soignants vers la construction d’un geste adapté préservant la santé, le bien-être, l’autonomie du patient et du soignant. Ce dispositif de formation expérimental utilise la simulation comme outil d’apprentissage. Il permet à l’apprenant de se confronter à la construction et la résolution de problème pour en débattre avec ses pairs. Dans la phase présentée dans cette contribution, les apprenants conçoivent eux-mêmes les scénarios. L’hypothèse est que la conception du scenario par les apprenants leur offre la possibilité d’explorer l’espace problème de façon plus fine, de tester davantage de solutions et d’élargir le champ des possibles. La conception par les apprenants fait donc partie du dispositif pédagogique. Cette hypothèse est testée empiriquement

La formation au « soin de manutention raisonné » : (re)trouver le sens du métier

International audienc

Des apprenants concepteurs de leur espace d’apprentissage

International audienceSimulation has been used as a training method for more than fifty years in the health sector. Research results have shown that the development of the problem has in itself a pedagogical value. How does this apply to vocational training? Could learners define themselves the simulation scenarios? Would these scenarios allow them to acquire the targeted competences? These issues have been investigated in the context of a patient handling training program, the “reasoned patient handling care ”. The program is intended for paramedical personnel and uses role play simulation. The program is an alternative to programs focusing on the acquisition of the “good gestures”. It promotes the construction of a tailored and situated solution, resulting in the empowerment of the healthcare professional and in the well-being and autonomy of the patient. This text presents the experimentation, its context and its effects, the general conclusions that can be drawn and the possible paths for further research.La simulation est un moyen de formation utilisé depuis plus de cinquante ans dans le domaine de la santé. Les travaux menés sur la problématisation montrent que l’élaboration même du problème est pédagogiquement intéressante. Qu’en est-il pour la formation professionnelle utilisant la simulation ? Les apprenants pourraient-ils eux-mêmes concevoir les scénarios de simulation ? Ces scénarios seraient-ils propres à leur faire acquérir les compétences visées ? Ces questions ont été appréhendées dans le cadre d’un dispositif de formation à la manutention des patients destiné aux soignants. Il utilise la simulation par jeu de rôle pour l’apprentissage du « soin de manutention raisonné » (SMR). L’approche pédagogique proposée s’érige en alternative aux formations prônant l’apprentissage des « bons gestes » puisqu’elle vise l’accompagnement à la construction d’un geste adapté et situé, source d’émancipation pour le professionnel, de bien-être et d’autonomie pour le patient Ce texte présente le contexte de cette expérimentation, l’expérimentation elle-même et ses effets, les leçons générales qu’on peut en tirer et les possibles pistes à explorer

Developing Patient Handling Competences Through Participatory Design of Simulation Scenarios

International audienceThe paper focuses on recent advances in the development of a simulation-based training program for patient handling. The program [1] intends to support caregivers in the construction of a relevant and efficient gesture, integrating situational variations, preserving health and encouraging the autonomy of patients: the “reasoned handling care”. Videos of scenario-based simulations are made during the training session and discussed with the trainees. Scenarios used to be designed by the trainer. In this experiment, trainees were asked to design themselves the simulation scenarios. It was hypothesized that designing scenarios would increase the trainees’ capacities for situational awareness. The methodology that was used and the benefits and limits of the participatory design of scenarios are presented and discussed

Ergonomie, formation et développement

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