Impact of Morbidity and Mortality Conferences on Analysis of Mortality and Critical Events in Intensive Care Practice

Background Morbidity and mortality conferences are a tool for evaluating care management, but they lack a precise format for practice in intensive care units.Objectives To evaluate the feasibility and usefulness of regular morbidity and mortality conferences specific to intensive care units for improving quality of care and patient safety. Methods For 1 year, a prospective study was conducted in an 18-bed intensive care unit. Events analyzed included deaths in the unit and 4 adverse events (unexpected cardiac arrest, unplanned extubation, reintubation within 24–48 hours after planned extubation, and readmission to the unit within 48 hours after discharge) considered potentially preventable in optimal intensive care practice. During conferences, events were collectively analyzed with the help of an external auditor to determine their severity, causality, and preventability. Results During the study period, 260 deaths and 100 adverse events involving 300 patients were analyzed. The adverse events rate was 16.6 per 1000 patient-days. Adverse events occurred more often between noon and 4 pm (P = .001).The conference consensus was that 6.1% of deaths and 36% of adverse events were preventable. Preventable deaths were associated with iatrogenesis (P = .008), human errors (P < .001), and failure of unit management factors or communication (P = .003). Three major recommendations were made concerning standardization of care or prescription and organizational management, and no similar incidents have recurred. Conclusion In addition to their educational value, regular morbidity and mortality conferences formatted for intensive care units are useful for assessing quality of care and patient safety

First case of yellow fever in French Guiana since 1902.

The first case of yellow fever in French Guiana since 1902 was reported in March 1998. The yellow fever virus genome was detected in postmortem liver biopsies by seminested polymerase chain reaction. Sequence analysis showed that this strain was most closely related to strains from Brazil and Ecuador

L'utilisation par la viticulture française d'un exercice de prospective pour l'élaboration d'une stratégie d'adaptation au changement climatique

Foresight studies are regularly conducted at sectoral or geographical scales, in order to help policy makers and economic actors to define their strategy of adaptation to climate change (CC)

Le secteur vitivinicole français avant les défis du marché

Coleccion de estudios ambientales y socioeconomicos ; 7International audienceLe chapitre étudie le secteur vitivinicole français. Les auteurs analysent, tout d'abord, l'évolution et le développement de cette activité en s'arrêtant aux périodes de crises les plus significatives et en essayant de mettre en évidence quelles stratégies le secteur employa pour répondre aux principaux facteurs déclenchants de la crise. Ils présentent ensuite un panorama des composants essentiels de la chaîne vitivinicole actuelle. Pour ce faire, ils mettent l'accent sur deux éléments de base de la crise vinicole : la baisse de la consommation interne et la situation du secteur exportation. Enfin, ils signalent quelques uns des changements qui se sont produits ces dernières années ainsi que certains grands thèmes dont on débat actuellement

[Les réponses de la distribution aux changements de préférences du consommateur : le cas de la grande distribution européenne]

Agriculture information bulletin ; 794 Diffusion du document : INRA Unité Mixte de Recherche MOISA Marchés Organisations Institutions et Stratégies d'acteurs 2 place Viala 34060 Montpellier Cedex 1 (FRA)International audienceDans le cadre d'un colloque organisé par l'ERS/USDA à Washington en février 2002 sur le thème "New directions in global food markets", les auteurs montrent qu'à côté des marques bien connues de substitution aux marques nationales, les distributeurs mettent en place, depuis la fin des années 90, un autre type de marque visant à apporter à un consommateur de plus en plus exigeant des garanties de qualité sanitaire et commerciale supérieures à celles fournies par le standard public. Le développement de ces marques est plus marqué en Europe qu'aux Etats-Unis. Il conduit le distributeur à s'impliquer dans la définition et le contrôle de normes en production et à resserrer ses liens avec les fournisseurs. Ces démarches dites de filière, qui diffèrent selon les caractéristiques des produits, sont illustrées pour les approvisionnements de la grande distribution française en viande bovine et en fruits et légumes

Identification of novel paramyxoviruses in insectivorous bats of the Southwest Indian Ocean

Bats are reservoirs for many emerging zoonotic viruses. In this study, we screened 197 animals from 15 different bat species of the Southwest Indian Ocean for paramyxovirus infection and identified paramyxoviruses in five insectivorous bat-species from the Union of the Comoros (3/66), Mauritius (1/55) and Madagascar (4/76). Viral isolation was possible via cell culture and phylogenetic analysis revealed these viruses clustered in a Morbillivirus-related lineage, with relatively high nucleotide sequence similarity to other recently discovered insectivorous-bat paramyxoviruses but distinct from those known to circulate in frugivorous bats

Epidemiological and virological characteristics of influenza B: results of the Global Influenza B Study

Contains fulltext : 155189.pdf (publisher's version ) (Open Access)INTRODUCTION: Literature on influenza focuses on influenza A, despite influenza B having a large public health impact. The Global Influenza B Study aims to collect information on global epidemiology and burden of disease of influenza B since 2000. METHODS: Twenty-six countries in the Southern (n = 5) and Northern (n = 7) hemispheres and intertropical belt (n = 14) provided virological and epidemiological data. We calculated the proportion of influenza cases due to type B and Victoria and Yamagata lineages in each country and season; tested the correlation between proportion of influenza B and maximum weekly influenza-like illness (ILI) rate during the same season; determined the frequency of vaccine mismatches; and described the age distribution of cases by virus type. RESULTS: The database included 935 673 influenza cases (2000-2013). Overall median proportion of influenza B was 22.6%, with no statistically significant differences across seasons. During seasons where influenza B was dominant or co-circulated (>20% of total detections), Victoria and Yamagata lineages predominated during 64% and 36% of seasons, respectively, and a vaccine mismatch was observed in approximately 25% of seasons. Proportion of influenza B was inversely correlated with maximum ILI rate in the same season in the Northern and (with borderline significance) Southern hemispheres. Patients infected with influenza B were usually younger (5-17 years) than patients infected with influenza A. CONCLUSION: Influenza B is a common disease with some epidemiological differences from influenza A. This should be considered when optimizing control/prevention strategies in different regions and reducing the global burden of disease due to influenza

Severe Acute Respiratory Illness Deaths in Sub-Saharan Africa and the Role of Influenza: A Case Series From 8 Countries

Item does not contain fulltextBACKGROUND: Data on causes of death due to respiratory illness in Africa are limited. METHODS: From January to April 2013, 28 African countries were invited to participate in a review of severe acute respiratory illness (SARI)-associated deaths identified from influenza surveillance during 2009-2012. RESULTS: Twenty-three countries (82%) responded, 11 (48%) collect mortality data, and 8 provided data. Data were collected from 37 714 SARI cases, and 3091 (8.2%; range by country, 5.1%-25.9%) tested positive for influenza virus. There were 1073 deaths (2.8%; range by country, 0.1%-5.3%) reported, among which influenza virus was detected in 57 (5.3%). Case-fatality proportion (CFP) was higher among countries with systematic death reporting than among those with sporadic reporting. The influenza-associated CFP was 1.8% (57 of 3091), compared with 2.9% (1016 of 34 623) for influenza virus-negative cases (P /=50 years. CONCLUSIONS: Few African countries systematically collect data on outcomes of people hospitalized with respiratory illness. Stronger surveillance for deaths due to respiratory illness may identify risk groups for targeted vaccine use and other prevention strategies