International comparison of pressure ulcer measures in long-term care facilities: Assessing the methodological robustness of 4 approaches to point prevalence measurement

INTRODUCTION: Pressure ulcer indicators are among the most frequently used performance measures in long-term care settings. However, measurement systems vary and there is limited knowledge about the international comparability of different measurement systems. The aim of this analysis was to identify possible avenues for international comparisons of data on pressure ulcer prevalence among residents of long-term care facilities. MATERIAL AND METHODS: A descriptive analysis of the four point prevalence measurement systems programs used in 28 countries on three continents was performed. The criteria for the description and analysis were based on the scientific literature on criteria for indicator selection, on issues in international comparisons of data and on specific challenges of pressure ulcer measurements. RESULTS: The four measurement systems use a prevalence measure based on very similar numerator and denominator definitions. All four measurement systems also collect data on patient mobility. They differ in the pressure ulcer classifications used and the requirements for a head-to-toe resident examination. The regional or country representativeness of long-term care facilities also varies among the four measurement systems. CONCLUSIONS: Methodological differences among the point prevalence measurement systems are an important barrier to reliable comparisons of pressure ulcer prevalence data. The alignment of the methodologies may be improved by implementing changes to the study protocols, such as aligning the classification of pressure ulcers and requirements for a head-to-toe resident skin assessment. The effort required for each change varies. All these elements need to be considered by any initiative to facilitate international comparison and learning

La résistance aux antibiotiques chez les enfants dans les pays à faible revenu - Enquête sur la consommation d'antibiotiques

Antimicrobial resistance is a growing threat across the world and is likely to disproportionately affect children in low-income countries (LICs).To estimate the burden of antibiotic resistance in the community among children under two in LICs we undertook a review of published literature. Common isolates in neonatal sepsis cases included Staphylococcus aureus, Escherichia coli, and Klebsiella. Among children 1 mo. to 2 yrs., Streptococcus pneumonia and Salmonella were most often reported. Information on antibiotic resistance was sparse and often relied on few isolates.We reviewed methods to measure antibiotic consumption in LICs from published literature and showed that current techniques used in isolation are insufficient to respond to all the data needs in LICs. Integrating study techniques and starting with community surveys may respond more adequately to this issue in LICs and lead to more actionable results.To investigate patterns of antibiotic consumption and related factors among children under two in Madagascar and Senegal we undertook community surveys in two sites in Madagasgar (Antananarvo and Moramanga) and one site in Senegal. Results showed relatively high levels of antibiotic use among children. The majority of antibiotics were purchased in pharmacies with a prescription in both countries. Data suggest a high proportion of use for likely viral infections. Local contexts including the availability of health care facilities, availability of pharmacies, national payment schemes, and provider training seemed to play a role in country usage rates.Results from this work add essential data to the literature where relatively little data exists and reveal important lessons about studying and combating antibiotic resistance in LICs.La résistance bactérienne aux antibiotiques est un problème de santé publique majeur, touchant plus particulièrement les enfants dans les pays en développement (PED).Nous avons effectué une revue systématique de la littérature pour quantifier le niveau de résistance aux antibiotiques chez les enfants âgés de moins de 2 ans dans les PED. De manière générale, les données sur la résistance aux antibiotiques dans la population étudiées sont rares. Selon les publications identifiées, Staphylococcus aureus, Escherichia coli, et Klebsiella spp. apparaissent comme les causes les plus fréquentes d’infections néonatales sévères. Chez les enfants âgés de 1 à 24 mois, Streptococcus pneumoniae et Salmonella spp. apparaissent comme les causes les plus fréquentes d’infections bactériennes invasives.Dans une seconde revue systématique, nous avons examiné les méthodologies actuelles utilisées pour mesurer la consommation d’antibiotiques dans les PED.Nos résultats montrent qu’aucunes des méthodologiesne permet, à elle seule, de répondre aux besoins de ces pays en terme de données.Nous avons conduit une enquête en population à Madagascar et au Sénégal afin d’examiner les modalités de consommation d’antibiotiques chez des enfants de moins de 2 ans. Dans les 2 pays, la plupart des antibiotiques étaient achetés en pharmacie sur présentation d’une ordonnance. Une proportion élevée des antibiotiques était utilisée pour le traitement d’infections probablement d’origine virale. Des facteurs tels que la disponibilité de centres de santé, de pharmacies, l’existence de programmes de remboursement ou encore la formation du personnel pourraient influencer la fréquence de consommations d’antibiotiques au niveau national.Les résultats issus de ces travaux de recherche ajoutent des données essentielles à la littérature existante et mettent en évidence des leçons importantes pour la lutte contre la résistance aux antibiotiques dans les PEDs

Does size matter? The impact of caseload and expertise concentration on AMI 30-day mortality—A comparison across 10 OECD countries

International audienceObjectiveTo examine the variability of hospital performance within and across countries, using 30-day acute myocardial infarction (AMI) mortality, and to study the impact of hospital characteristics on performance.Study settingHospital-level adjusted risk standardized mortality rates (RSMR) and hospital characteristics were collected from 10 OECD and two collaborating countries including 1,163 hospitals.Study designAssociations between RSMR and hospital characteristics were studied using univariate and multivariate linear regressions. Clusters of hospitals were created using hierarchical clustering and mortality compared using linear regression.FindingsWide variation between countries was found for RSMR and hospital characteristics. Regression models showed large country effects. A high volume of AMI admission was associated with lower RSMR in a model using a restricted number of hospital characteristics (−0.83, p < 0.001) but not in a model using all characteristics (−1.03, p = 0.06). Analysis within countries supported this association. Hospital clusters showed clear differences in characteristic distributions but no difference in RSMR.ConclusionsThe effect of volume may support policies toward a concentration of services within the hospital sector. The effect of other hospital characteristics was inconclusive and suggests the importance of system-wide characteristics or pathways of care (i.e. timeliness and nature of initial response and during transportation to a hospital, transfers between hospitals, post-discharge organization) in explaining variation

An investigation into the formation of N- [2-(dimethylamino)ethyl]acridine-4-carboxamide (DACA) and 6-[2-(dimethylamino)ethylamino]- 3-hydroxy-7H-indeno[2, 1-C]quinolin-7-one dihydrochloride (TAS-103) stabilised DNA topoisomerase I and II cleavable complexes in human leukaemia cells

The antitumour agents DACA (XR5000; N-[2-(dimethylamino)ethyl]acridine-4-carboxamide) and TAS-103 (6-[2-(dimethylamino)ethylamino]-3-hydroxy-7H-indeno[2, 1-c]quinolin-7-one dihydrochloride) have been shown to inhibit two essential nuclear enzymes in vitro, DNA topoisomerase I and DNA topoisomerase (topo) II. To examine whether DACA or TAS-103 stabilise topo I, topo IIalpha, and topo IIbeta cleavable complexes in human leukaemia CCRF-CEM cells, the TARDIS assay (trapped in agarose DNA immunostaining) was used. This assay can reveal drug-stabilised topo-DNA complexes formed in situ in individual cells. The results showed that both DACA and TAS-103 can stabilise topo IIalpha cleavable complexes in these cells. Topo IIbeta cleavable complexes were also formed, but only at high concentrations of DACA and TAS-103. The effect on topo I was less clear, with TAS-103 showing only low levels of cleavable complex formation and DACA having no detectable effect under these assay conditions. This is in contrast to the purified enzyme cleavable complex assay, where both DACA and TAS-103 poisoned topo I. Although both DACA and TAS-103 show a preference for topo IIalpha in whole cells using the TARDIS assay, the formation of low levels of topo I or topo IIbeta cleavable complexes may still play a role in cell death

Us, them, and the others: Testing for discrimination amongst outgroups in a single‐piece nesting termite, Zootermopsis angusticollis

Natural Environment Research Council https://doi.org/10.13039/50110000027

Camptothecin-stabilised topoisomerase I-DNA complexes in leukaemia cells visualised and quantified in situ by the TARDIS assay (trapped in agarose DNA immunostaining)

We have shown that the TARDIS assay (trapped in agarose DNA immunostaining) can be used to detect DNA-topoisomerase I (topo I) cleavable complexes in situ in individual cells following treatment with topo I-targeting drugs. This assay is a modification of the assay for DNA-topoisomerase II (topo II) cleavable complexes (Willmore et al., Mol Pharmacol 53: 78-85, 1998). Drug-stabilised topo I-DNA complexes were detected in situ by topo I-specific primary antibodies and then visualised using fluorescein isothiocyanate conjugated second antibodies. Immunofluorescence was then quantified using a cooled slow-scan coupled device camera and image analysis procedures. Camptothecin (CPT) was shown to stabilise topo I-DNA cleavable complexes in whole cells in a dose-dependent manner in both CCRF-CEM and K562 cells and in lymphoblasts from an adult with newly diagnosed acute myeloid leukaemia treated ex vivo with CPT. In K562 cells, cleavable complexes were found to be maximal between 30 and 90 minutes continuous exposure of CPT, and approximately 78% of cleavable complexes formed in these cells were found to be reversed within 5 minutes of drug removal. It has also been shown that the immunofluorescence detected by the TARDIS assay was specific for topo I-targeting agents. Hence, the TARDIS assay provides a powerful tool to determine the levels of drug-stabilised cleavable complexes in whole cells and thereby aid in the understanding of the mechanism of interaction between topo I-targeting drugs and their target

Etoposide targets topoisomerase IIalpha and IIbeta in leukemic cells: isoform-specific cleavable complexes visualized and quantified in situ by a novel immunofluorescence technique

We have shown that both DNA topoisomerase (topo) IIalpha and beta are in vivo targets for etoposide using a new assay which directly measures topo IIalpha and beta cleavable complexes in individual cells after treatment with topo II targeting drugs. CCRF-CEM human leukemic cells were exposed to etoposide for 2 hr, then embedded in agarose on microscope slides before cell lysis. DNA from each cell remained trapped in the agarose and covalently bound topo II molecules from drug-stabilized cleavable complexes remained associated with the DNA. The covalently bound topo II was detected in situ by immunofluorescence. Isoform-specific covalent complexes were detected with antisera specific for either the alpha or beta isoform of topo II followed by a fluorescein isothiocyanate-conjugated second antibody. DNA was detected using the fluorescent stain Hoechst 33258. A cooled slow scan charged coupled device camera was used to capture images. A dose-dependent increase in green immunofluorescence was observed when using antisera to either the alpha or beta isoforms of topo II, indicating that both isoforms are targets for etoposide. We have called this the TARDIS method, for trapped in agarose DNA immunostaining. Two key advantages of the TARDIS method are that it is isoform-specific and that it requires small numbers of cells, making it suitable for analysis of samples from patients being treated with topo II-targeting drugs. The isoform specificity will enable us to extend our understanding of the mechanism of interaction between topo II-targeting agents and their target, the two human isoforms

Évaluer l’impact environnemental des soins : l’exemple de la dépression

National audienceSaviez-vous que le système de santé contribue de manière significative au changement climatique, puisqu'il est responsable d'environ 5 % du total des émissions de carbone dans le monde ? Ce fait attire de plus en plus l'attention

Comment choisir un soin durable ? Faisabilité d'un modèle de décision « médico-éco-climatique » pour la prise en charge de la dépression

L'impact du système de santé sur le changement climatique est estimé à environ 5% des émissions totales de carbone au niveau mondial et à 8% en France. Les systèmes de santé se préparent ainsi à inclure l'empreinte carbone des modes de prise en charge dans leurs processus décisionnels. Les arbitrages en santé sont souvent effectués avec des outils d’aide à la décision standardisés de type évaluation médico-économique. Notre objectif était le développement d’un outil de prise de décision qui prend en compte les émissions de carbone dans la même mesure que les critères d'évaluation actuellement établis : le bénéfice clinique et le coût économique.Nous avons comparé les trois modalités de prise en charge principales de la dépression : 1) la pharmacothérapie ; 2) la psychothérapie ; 3) la combinaison des deux en effectuant une analyse coût-utilité pour le système de santé avec un horizon temporel à cinq ans, à l’aide d’un modèle de décision de type état transition semi-markovien. L’empreinte carbone a été estimée par Analyse de Cycle de Vie et elle a été convertie en valeur monétaire via le coût social du CO2. Reporté sur une année et à t0, l’empreinte carbone de la pharmacothérapie est la plus faible et celle de la thérapie combinée la plus élevée. La modélisation sur 5 ans en termes de coût efficacité suggère que la psychothérapie est aussi efficace que la pharmacothérapie, avec un coût moins élevé. La thérapie combinée est plus coûteuse, mais aussi plus efficace que chacune des autres stratégies. La prise en compte du coût social du carbone ne change ces résultats qu’à la marge.Nos résultats préliminaires illustrent la faisabilité d’un outil concret capable d’intégrer, dans un même modèle de décision, des priorités (santé, économie, environnement) potentiellement en compétition l’une avec l’autre. Le type d’évaluation multidimensionnelle présenté ici sortdu cadre (restreint) de l’évaluation des technologies de santé, et a vocation à stimuler la discussion sur les politiques de santé plus largement, dans un système de santé qui intègre l’environnement dans son concept de qualité même

Bacterial neonatal sepsis and antibiotic resistance in low-income countries

International audienc