Transmitter Architecture for the Evaluation of Beamforming Schemes in the IEEE 802.11n Standard

International audienc

Hospital-wide multidisciplinary, multimodal intervention programme to reduce central venous catheter-associated bloodstream infection.

Central line-associated bloodstream infection (CLABSI) is the major complication of central venous catheters (CVC). The aim of the study was to test the effectiveness of a hospital-wide strategy on CLABSI reduction. Between 2008 and 2011, all CVCs were observed individually and hospital-wide at a large university-affiliated, tertiary care hospital. CVC insertion training started from the 3rd quarter and a total of 146 physicians employed or newly entering the hospital were trained in simulator workshops. CVC care started from quarter 7 and a total of 1274 nurses were trained by their supervisors using a web-based, modular, e-learning programme. The study included 3952 patients with 6353 CVCs accumulating 61,366 catheter-days. Hospital-wide, 106 patients had 114 CLABSIs with a cumulative incidence of 1.79 infections per 100 catheters. We observed a significant quarterly reduction of the incidence density (incidence rate ratios [95% confidence interval]: 0.92 [0.88-0.96]; P<0.001) after adjusting for multiple confounders. The incidence densities (n/1000 catheter-days) in the first and last study year were 2.3/1000 and 0.7/1000 hospital-wide, 1.7/1000 and 0.4/1000 in the intensive care units, and 2.7/1000 and 0.9/1000 in non-intensive care settings, respectively. Median time-to-infection was 15 days (Interquartile range, 8-22). Our findings suggest that clinically relevant reduction of hospital-wide CLABSI was reached with a comprehensive, multidisciplinary and multimodal quality improvement programme including aspects of behavioural change and key principles of good implementation practice. This is one of the first multimodal, multidisciplinary, hospital-wide training strategies successfully reducing CLABSI

Factors Associated with Central Line-Associated Bloodstream Infections: Hospital-wide Prevention Programme for Central Venous Catheter-Associated Bloodstream Infections, University of Geneva Hospitals, 2008–2011.

<p>ICU: intensive care unit</p><p>IRR: incidence rate ratio.</p><p>95% CI: 95% confidence interval.</p>1<p>Quarter: modelled as per additional quarter.</p>2<p>Age: modelled as per additional year of age.</p>3<p>Gender: modelled as male vs. female.</p>4<p>Charlson score: modelled as per score-point increase.</p>5<p>ICU stay: hospitalization in the intensive care unit; modelled as yes vs. no.</p>6<p>Multilumen catheters: any catheter with more than 1 lumen; modelled as yes/no.</p>7<p>Femoral position: any catheter inserted at the femoral site; modelled as yes/no.</p>8<p>Dwell-time (quartiles): 2^nd (4–6 days), 3^rd (7–12 days), and 4^th (>12 days) quartile as compared with the first quartile (1–3 days).</p

28-Day All-Cause Mortality: Hospital-wide Prevention Programme for Central Line-Associated Bloodstream Infection, University of Geneva Hospitals, 2008–2011.

<p>CI: confidence interval.</p><p>CLABSI: central line-associated bloodstream infection.</p><p>CVC: central venous catheter.</p><p>ICU: intensive care unit.</p><p>OR: odds ratio.</p><p>95% CI: 95% confidence interval.</p>1<p>Quarter: modelled as per additional quarter.</p>2<p>Age: modelled as per additional year of age.</p>3<p>Gender: modelled as male vs. female.</p>4<p>Charlson index: modelled as per score-point increase.</p>5<p>Emergency admission: modelled as yes/no.</p>6<p>ICU stay: hospitalization in the intensive care unit at any time; modelled as yes/no.</p>7<p>Central line-associated bloodstream infection at any time during hospitalization; modelled as yes/no.</p>8<p>Number of CVCs during hospitalization; modelled as per additional catheter.</p

Distribution of Pathogens: Hospital-wide Prevention Programme for Central Line-Associated Bloodstream Infection, University of Geneva Hospitals, 2008–2011.

<p>Distribution of Pathogens: Hospital-wide Prevention Programme for Central Line-Associated Bloodstream Infection, University of Geneva Hospitals, 2008–2011.</p

Characteristics of Patients With and Without Central Line-Associated Bloodstream Infection, University of Geneva Hospitals, 2008–2011.

<p>CLABSI: central line-associated bloodstream infection.</p><p>NA: not applicable.</p><p>IQR: interquartile range.</p><p>ICU: intensive care unit.</p>#<p>A total of 189,643 patients were admitted during the study period.</p><p>*As per hospitalization (n = 4,452).</p

Feasibility of a knowledge translation CME program: courriels Cochrane.

INTRODUCTION: Systematic literature reviews provide best evidence, but are underused by clinicians. Thus, integrating Cochrane reviews into continuing medical education (CME) is challenging. We designed a pilot CME program where summaries of Cochrane reviews (Courriels Cochrane) were disseminated by e-mail. Program participants automatically received CME credit for each Courriel Cochrane they rated. The feasibility of this program is reported (delivery, participation, and participant evaluation). METHOD: We recruited French-speaking physicians through the Canadian Medical Association. Program delivery and participation were documented. Participants rated the informational value of Courriels Cochrane using the Information Assessment Method (IAM), which documented their reflective learning (relevance, cognitive impact, use for a patient, expected health benefits). IAM responses were aggregated and analyzed. RESULTS: The program was delivered as planned. Thirty Courriels Cochrane were delivered to 985 physicians, and 127 (12.9%) completed at least one IAM questionnaire. Out of 1109 Courriels Cochrane ratings, 973 (87.7%) conta-ined 1 or more types of positive cognitive impact, while 835 (75.3%) were clinically relevant. Participants reported the use of information for a patient and expected health benefits in 595 (53.7%) and 569 (51.3%) ratings, respectively. DISCUSSION: Program delivery required partnering with 5 organizations. Participants valued Courriels Cochrane. IAM ratings documented their reflective learning. The aggregation of IAM ratings documented 3 levels of CME outcomes: participation, learning, and performance. This evaluation study demonstrates the feasibility of the Courriels Cochrane as an approach to further disseminate Cochrane systematic literature reviews to clinicians and document self-reported knowledge translation associated with Cochrane reviews

Feasibility of a knowledge translation CME program: courriels Cochrane.

INTRODUCTION: Systematic literature reviews provide best evidence, but are underused by clinicians. Thus, integrating Cochrane reviews into continuing medical education (CME) is challenging. We designed a pilot CME program where summaries of Cochrane reviews (Courriels Cochrane) were disseminated by e-mail. Program participants automatically received CME credit for each Courriel Cochrane they rated. The feasibility of this program is reported (delivery, participation, and participant evaluation). METHOD: We recruited French-speaking physicians through the Canadian Medical Association. Program delivery and participation were documented. Participants rated the informational value of Courriels Cochrane using the Information Assessment Method (IAM), which documented their reflective learning (relevance, cognitive impact, use for a patient, expected health benefits). IAM responses were aggregated and analyzed. RESULTS: The program was delivered as planned. Thirty Courriels Cochrane were delivered to 985 physicians, and 127 (12.9%) completed at least one IAM questionnaire. Out of 1109 Courriels Cochrane ratings, 973 (87.7%) conta-ined 1 or more types of positive cognitive impact, while 835 (75.3%) were clinically relevant. Participants reported the use of information for a patient and expected health benefits in 595 (53.7%) and 569 (51.3%) ratings, respectively. DISCUSSION: Program delivery required partnering with 5 organizations. Participants valued Courriels Cochrane. IAM ratings documented their reflective learning. The aggregation of IAM ratings documented 3 levels of CME outcomes: participation, learning, and performance. This evaluation study demonstrates the feasibility of the Courriels Cochrane as an approach to further disseminate Cochrane systematic literature reviews to clinicians and document self-reported knowledge translation associated with Cochrane reviews

Central Line-Associated Bloodstream Infections and Number of Trained Healthcare Workers, Hospital-wide Prevention Programme, University of Geneva Hospitals, 2008–2011.

<p>CLABSI: central line-associated bloodstream infection IRR: incidence rate ratio 95% CI: 95% confidence interval.</p