Investigating Pneumonia Etiology Among Refugees and the Lebanese population (PEARL): A study protocol

Background: Community-acquired pneumonia (CAP), a leading cause of mortality, mainly affects children in developing countries. The harsh circumstances experienced by refugees include various factors associated with respiratory pathogen transmission, and clinical progression of CAP. Consequently, the etiology of CAP in humanitarian crisis situations may differ to that of settled populations, which would impact appropriate case management. Therefore, the Pneumonia Etiology Among Refugees and the Lebanese population (PEARL) study was initiated with the objective of identifying the causal pathogenic microorganisms in the respiratory tract of children and adults from both the refugee and host country population presenting with signs of CAP during a humanitarian crisis. Methods: PEARL, a prospective, multicentric, case-control study, will be conducted at four primary healthcare facilities in Tripoli and the Bekaa valley over 15 months (including two high-transmission seasons/winters). Sociodemographic and medical data, and biological samples will be collected from at least 600 CAP cases and 600 controls. Nasopharyngeal swabs, sputum, urine and blood samples will be analyzed at five clinical pathology laboratories in Lebanon to identify the bacterial and viral etiological agents of CAP. Transcriptomic profiling of host le

Les infections nosocomiales (indicateurs de qualité en réanimation et en chirurgie ?)

Nosocomial infections (NI) are infections that occur during or after a patient care. With the development of evaluation and accreditation initiatives, these infections started to be used as indicators of quality of care. However, the validity of these rates is the subject of scientific debate. This work is carried out in the framework of clinical research project Noso.Qual aiming at studying the link between structure and process indicators and NI as performance indicators in intensive care and in surgery. The design of the scores required a literature review, expert consultations and field surveys. The scores were organized into seven dimensions: Human Resources, Architecture, Safety and Environment, Management of documentation, Patient care management, Risk management of infections, Evaluation and Surveillance. Scores were compared to surveillance data using a Poisson regression. Only two dimensions Architecture and Management of documentation were significantly associated with the NI with a protective effect. As for the overall scores, they were significantly associated with NI in intensive care units for all the sites of infections considered but not in surgery. The results obtained in intensive care show that NI would be a valid indicator which could support the construction of indicators already initiated in France and other countries. As for the results in surgery, they should not call into question either the principle of surveillance of NI or the necessity of evaluating actions of prevention and improving professional practices activitiesLes infections nosocomiales (IN) sont des infections qui surviennent au cours ou à la suite de la prise en charge d un patient. Avec le développement des démarches d évaluation et d accréditation, ces infections ont commencé à être utilisées comme indicateurs de la qualité des soins. Cependant, la validité de ces taux fait l objet d un débat scientifique. Ce travail s inscrit dans le cadre du Projet Hospitalier de Recherche Clinique Noso.Qual qui visait à étudier le lien entre d une part les indicateurs de structure et processus, et d autre part les IN comme indicateurs de résultats en réanimation et en chirurgie. L élaboration des scores a nécessité une revue de la littérature, des consultations d experts, et des enquêtes de terrain. Les scores étaient organisés en sept dimensions : Ressources humaines, Architecture, Sécurité et environnement, Gestion de la documentation, Prise en charge du patient, Gestion du risque infectieux, Evaluation et surveillance. Les scores obtenus ont été confrontés aux données de surveillances en utilisant une régression de Poisson. Deux dimensions seulement Architecture et Gestion de la documentation étaient significativement associées aux IN avec un effet protecteur. Quant aux scores globaux, ils étaient significativement associés aux IN en réanimation pour tous les sites étudiés mais pas en chirurgie. Le constat obtenu en réanimation pourrait ainsi soutenir la construction d'indicateurs initiés en France et dans d'autres pays. Quant aux résultats en chirurgie, ils ne doivent pas remettre en cause ni le principe de surveillance des IN ni la nécessité de l évaluation des actions de prévention et d améliorations des pratiques professionnellesLYON1-BU.Sciences (692662101) / SudocSudocFranceF