Le niveau de compréhension de l’anglais des étudiants en médecine peut être amélioré. Résultats d’une stratégie d’évaluation systématique

Objectives To describe the level of English of a population of medical students and the improvement after the implementation of systematic assessment that all students achieve a minimal level. Population and methods For the past 5 years, all medical students in our medical school have been taking the Test of English for International Communication (TOEIC). The baseline population (students entering second year in 2004) had no specific obligation. After 2004, a score above 600 was mandatory for graduation. Teaching was oriented towards training for the TOEIC and the number of hours was more important for low-level students. Results The mean score has increased from 618 ± 146 in 2004, to 687 ± 94, 717 ± 97, 733 ± 96 and 731 ± 104 for the next four years. The proportion of students who do not achieve a score of 550 (B1 level of the European framework) has decreased from 30 to 0%. Discussion Improving the level of English of French medical students is possible, if this is made a priority. The objective, as set in engineering studies, that all medical students reach a B2 level would require national guidelines

Evolution entre 2007 et 2009 de la résistance de Pseudomonas aeruginosa à la ciprofloxacine en fonction de la consommation des fluoroquinolones au CHU d'Angers

National audienc

Factors affecting compliance with glove removal after contact with a patient or environment in four intensive care units

International audienc

Measurement and interpretation of hand hygiene compliance rates: importance of monitoring entire care episodes

SummaryOur objective was to assess the importance of monitoring hand hygiene compliance (HHC) during series of successive contacts with patients or surroundings for measurement and interpretation of the compliance rates. A direct observational study of HHC was performed in four intensive care units (ICUs) and four healthcare settings with non-intensive care wards (NICWs). Hand hygiene (HH) opportunities were differentiated into two categories: extra-series opportunities (ESOs) (before or after a single contact, and before the first contact or after the last contact of a series of successive contacts) or as intra-series opportunities (ISOs) (from the opportunity following the first contact to the opportunity preceding the last in the same series). In all, 903 opportunities of HH were performed in ICUs and 760 in NICWs. The proportion of ISOs was 46.0% in ICUs and 22.9% in NICWs. The overall HHC was significantly higher in NICWs than in ICUs (61.2% vs 47.5%, P < 0.00001). The HHC was significantly higher for ESOs than for ISOs (67.7% vs 28.5%, P < 0.00001). The HHC for ISOs was significantly higher in ICUs (32.2% vs 19.0%, P < 0.005). If the distribution of categories of HH opportunities observed in NICWs had been the same as in ICUs, the overall HHC would have been similar in NICWs (46.4%) and in ICUs (47.5%). Monitoring HHC during entire care episodes in series of successive contacts is necessary to avoid a strong overestimation of the overall compliance rates. Concurrently, comparison of compliance data should take into account the proportion of ISOs included in the evaluation study

Extra-human epidemiology of Acinetobacter baumannii in Lebanon

Presence of Acinetobacter baumannii outside hospitals is still a controversial issue. The objective of our study was to explore the extra hospital epidemiology of A. baumannii in Lebanon. From February 2012 to October 2013, a total of 73 water samples, 51 soil samples, 37 raw cow milk samples, 50 cow meat samples, 7 raw cheese samples and 379 animal samples were analysed by cultural methods for the presence of A. baumannii. Species identification was performed by rpoB gene sequencing. Antibiotic susceptibility was investigated and A. baumannii population was studied by two genotyping approaches: Multilocus Sequence Typing (MLST) and blaOXA-51 Sequence-Based Typing (blaOXA-51 SBT). A. baumannii was detected in 6.9% of water samples, 2.7% of milk samples, 8.0% of meat samples, 14.3% of cheese samples and 7.7% of animal samples. All isolates showed a susceptible phenotype against most of the antibiotics tested and lacked carbapenemase encoding genes except one that harboured a blaOXA-143 gene. MLST analysis revealed the presence of 36 sequence types (ST), among them 24 were novel ST(s), reported for the first time in this study. blaOXA-51 SBT showed the presence of 34 variants, among them 21 were novel and all isolated from animal origin. Finally, 30 isolates had new partial rpoB sequences and were considered as putative new Acinetobacter species. In conclusion, animals can be a potential reservoir for A. baumannii and the dissemination of new emerging carbapenemases. The role of novel identified animal clones in community-acquired infections should be investigated

Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program

BACKGROUND: The Assistance Publique-Hôpitaux de Paris (AP-HP) institution administers 38 teaching hospitals (23 acute care and 15 rehabilitation and long-term care hospitals; total, 23 000 beds) scattered across Paris and surrounding suburbs in France. In the late 1980s, the proportion of methicillin resistance among clinical strains of Staphylococcus aureus (MRSA) reached approximately 40% at AP-HP.METHODS: A program aimed at curbing the MRSA burden was launched in 1993, based on passive and active surveillance, barrier precautions, training, and feedback. This program, supported by the strong commitment of the institution, was reinforced in 2001 by a campaign promoting the use of alcohol-based hand-rub solutions. An observational study on MRSA rate was prospectively carried out from 1993 onwards. RESULTS: There was a significant progressive decrease in MRSA burden (-35%) from 1993 to 2007, whether recorded as the proportion (expressed as percentage) of MRSA among S aureus strains (41.0% down to 26.6% overall; 45.3% to 24.2% in blood cultures) or incidence of MRSA cases (0.86 down to 0.56 per 1000 hospital days). The MRSA burden decreased more markedly in intensive care units (-59%) than in surgical (-44%) and medical (-32%) wards. The use of ABHR solutions (in liters per 1000 hospital days) increased steadily from 2 L to 21 L (to 26 L in acute care hospitals and to 10 L in rehabilitation and long-term care hospitals) following the campaign. CONCLUSION: A sustained reduction of MRSA burden can be obtained at the scale of a large hospital institution with high endemic MRSA rates, providing that an intensive program is maintained for a long period