Point prevalence study of antibiotic appropriateness and possibility of early discharge from hospital among patients treated with antibiotics in a Swiss University Hospital.

BACKGROUND The growing threat of multidrug resistant organisms have led to increasingly promote prudent and rational use of antimicrobials as well as early hospital discharge plan. Antibiotic stewardship programs (ASP) have been developed as multifaceted approaches to improve use of current antibiotics and are now widely applied through different strategies. Proactive interventions are still limited in Switzerland and data on antimicrobial appropriateness and early discharge strategies are lacking. We aimed to describe the opportunities of antibiotics prescriptions optimization at Lausanne University Hospital, Switzerland and evaluate the suitability for early discharge among patients receiving antibiotics. The need for outpatient medical structures was also assessed. METHODS We conducted a point prevalence survey of antibiotic prescriptions in adult medical and surgical units with exclusion of intermediate and intensive care units. All hospitalized patients receiving a systemic antibiotic on the day of evaluation were included. An infectious diseases specialist evaluated antimicrobial appropriateness and assessed suitability for discharge according to medical and nursing observations. The need of flexible additional outpatient facility for a close medical follow-up was evaluated concomitantly. RESULTS A total of 564 patients' files were reviewed. 182 (32%) patients received one or more systemic antibiotic: 62 (34%) as a prophylaxis and 120 (66%) as a treatment with or without concomitant prophylaxis. 37/62 (60%) patients receiving prophylaxis had no indication to continue the antibacterial. Regarding the patients treated with antibiotics, 69/120 (58%) presented at least one opportunity for treatment optimization, mainly interruption of treatment. A previous ID consultation was recorded for 55/120 (46%) patients, of whom 21 (38%) could have benefited from antimicrobial therapy optimization on the day of the point assessment. 9.2% patients were eligible for discharge of whom 64% could leave the hospital with a close outpatient follow-up for infectious issues. CONCLUSIONS This point prevalence study offers precious indicators for tailoring future antibiotic stewardship interventions that can be combined with early discharge. Any centre considering implementing ASP should conduct this type of analysis with a pragmatic approach to gain insight into local practices and needed resources

Structure and evolution of the Gulf of Lions: The Sardinia seismic experiment and the GOLD (Gulf of Lions Drilling) project

International audienceThe study of the deep structure and evolution of passive continental margins is important for the understanding of rifting processes and the formation of associated sedimentary basins. Since the classical models of McKenzie (1978) and Wernicke (1985), understanding how passive continental margins form, that is to say mainly the way that continental lithosphere is thinned leading to subsidence, remains one of the main challenges in the Earth sciences. Many recent observations and discoveries have modified our basic views of margin formation. The conservational models paradigm (i.e., simple shear, pure shear, or polyphase models), which exclude exchanges between lower continental crust and upper mantle and which are usually proposed to explain lithospheric stretching and consequent crustal thinning of passive continental margins, fail to completely explain all these observations. Furthermore, these models imply a large amount of horizontal movement, movements not observed in the field. In consequence, new concepts need to be built and tested

The MAORY laser guide star wavefront sensor: design status

MAORY will be the multi-adaptive optics module feeding the high resolution camera and spectrograph MICADO at the Extremely Large Telescope (ELT) first light. In order to ensure high and homogeneous image quality over the MICADO field of view and high sky coverage, the baseline is to operate wavefront sensing using six Sodium Laser Guide Stars. The Laser Guide Star Wavefront Sensor (LGS WFS) is the MAORY sub-system devoted to real-time measurement of the high order wavefront distortions. In this paper we describe the MAORY LGS WFS current design, including opto-mechanics, trade-offs and possible future improvements

MAORY for ELT: preliminary design overview

MAORY is one of the approved instruments for the European Extremely Large Telescope. It is an adaptive optics module, enabling high-angular resolution observations in the near infrared by real-time compensation of the wavefront distortions due to atmospheric turbulence and other disturbances such as wind action on the telescope. An overview of the instrument design is given in this paper

Point prevalence study of antibiotic appropriateness and possibly of early discharge from hospital among patients treated with antibiotics in a Swiss University Hospital

La résistance aux antibiotiques, directement corrélée à la consommation des antimicrobiens, fait l’objet de préoccupations croissantes notamment dans le secteur hospitalier. Cette problématique est responsable d’une augmentation de morbidité, mortalité, des durées de séjour et des coûts. Parallèlement, dans bien des cas, les patients restent hospitalisés pour la durée complète de leur traitement antibiotique les exposant à un risque majoré d’infections nosocomiales. Promouvoir un usage prudent et rationnel des antibiotiques constitue un enjeu majeur de santé publique. Si grâce à des organes de surveillance nationaux tels que le programme anresis.ch nous disposons en Suisse de données quant à la quantité d’antibiotiques prescrits à l’échelle d’un hôpital ou d’un service, nous n’avons en revanche que très peu d’informations sur la qualité de nos prescriptions antibiotiques à l’échelle du patient et sur la possibilité de prises en charge ambulatoires plus précoces. Nous avons ainsi cherché à décrire les possibilités d'optimisation des prescriptions antibiotiques à l'hôpital universitaire de Lausanne et à évaluer la pertinence d'un retour à domicile précoce parmi les patients recevant des antibactériens. Durant cette enquête, le besoin en structures ambulatoires intermédiaires, permettant d’assurer une suite de prise en charge infectiologique prompte après le retour à domicile, a également été évalué. Nous avons mené une enquête de prévalence ponctuelle des prescriptions antibiotiques et de l’éligibilité à un retour à domicile précoce dans les services somatiques aigus adultes, à l'exclusion des unités de soins intermédiaires et intensifs. Tous les patients hospitalisés recevant un antibiotique systémique le jour de l'évaluation ont été inclus. Au total, 564 dossiers de patients ont été examinés. 182 (32%) patients recevaient un ou plusieurs antibiotiques par voie systémique : 62 (34%) sous forme de prophylaxie seule et 120 (66%) sous forme de traitement avec ou sans prophylaxie concomitante. 37/62 (60%) des patients recevant une prophylaxie n'avaient pas d'indication pour continuer l'antibactérien. Concernant les patients traités par antibiotiques, 69/120 (58%) présentaient au moins une opportunité d'optimisation de leur antibiothérapie, principalement des interruptions. Une consultation antérieure du service des maladies infectieuses était enregistrée pour 55/120 (46%) patients, dont 21 (38%) auraient pu bénéficier d'une optimisation de l'antibiothérapie le jour de l'évaluation ponctuelle. 9,2% des patients étaient éligibles pour un retour à domicile le jour de l’audit, dont 64% sous condition d’un suivi infectiologique ambulatoire étroit. Cette étude de prévalence ponctuelle offre de précieux indicateurs pour orienter des interventions futures d’encadrement des prescriptions pouvant être associées à un plan de sortie précoce. Tout centre envisageant de mettre en œuvre des programmes d’antibiotic stewardship devrait, à notre sens, mener ce type d'analyse selon une approche pragmatique, afin d’évaluer les pratiques locales et identifier les ressources nécessaires

Three-dimensional complex shapes analysis from 3D local curvature measurements: application to intermetallic particles in aluminium alloy 5xxx

International audienceThe studied material is a 5xxx aluminium alloys containing 2 types of intermetallic particles : Alx(Fe;Mn) and Mg2Si. It is usually used in car industry as reinforcement pieces or in packaging industry, such as bottle liquid box lid. Scanning electronic microscope coupled with EDX analysis shows complex shapes of intermetallic particles. The particle shape is obtained during the solidification of alloys. Particles fill vacant spaces between aluminium grains. Therefore final sheet properties depend on intermetallic particles shapes and notably on the matrix-particle interface properties. The goal of the present study is to classify intermetallic particles versus their shapes using local curvature information. The aluminium alloys sample is observed by X ray micro tomography performed at the ESRF. Three dimensional images are segmented, and intermetallic particles are identified in a data base. Each particle is stored as a set of voxels. The surface of each particle is meshed by a marching cubes triangular meshing with the software Amira©. A simplification of the surface is performed by an algorithm contracting the edges. Finally, principal curvatures: kmin and kmax are estimated by Amira© on each facet centre of the mesh. From the full intermetallic population, the bivariate distribution of kmin and kmax is estimated. The obtained graph kmin ¡kmax shows geometrical properties of interface portions of the surface of particles. A factorial correspondence analysis is performed to summarize the information on all intermetallic particles. In the obtained subspace, particles are classified into five shape families, in relation with their interface geometrical properties