Decisional issues in antibiotic prescribing in French nursing homes: An ethnographic study

Background: Medication prescription is generally the responsibility of doctors. In nursing homes, the nursing staff is often the first to suspect an infection. Today, physicians are more confident with nursing assessment, relying primarily on nursing staff information. Very few studies have investigated the nurses’ influence on decision of medical prescription. This study investigates the role of nurses in antibiotic prescribing for the treatment of suspected infections in nursing home residents. Design and methods: An ethnographic study based on semi-structured interviews and participant observations was conducted. Sixteen nurses and five doctors working in five nursing homes in Paris, France participated between October 2015 and January 2016. Results: Given their proximity to elderly residents, registered nurses at the nursing homes occasionally assisted doctors in their medical diagnostic. However, nurses who are theoretically incompetent have met difficulties in their ability to participate in their decisions to prescribe antibiotics when managing residents’ infections.Conclusion: if proximity and nursing skills reinforce the relevance of the clinical judgment of nurses, the effective and collaborative communication between the nurse and the doctor may help the nurse to enhance their role in the antibiotic prescribing in nursing homes, which would enhance antimicrobial stewardship efficiency

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Nurses prescribing medications in geriatric centers: international mapping

International audienceObjective:the aim of this study was to identify the perceptions of nurses and physicians and describe the involvement of nurses in medical prescription in general and that of antibiotics in particular, in geriatric institutions.Methods:a cross-sectional multinational study was conducted among nurses and physicians in geriatric institutions between April and October 2017. Data was collected using three online questionnaires in both French and English.Results:in total, 78.7% of doctors discussed the relevance of the prescription with competent nurses. A map shows the relationship between the evidence level of nursing role in medical prescription, and prescriptive authorization nurses in the 51 participating countries.Conclusions:interpersonal physician-nurse relationships are essential in facilitating the nursing role of effective treatment management

Potential roles of erythropoietin in the management of anaemia and other complications diabetes

Erythropoietin (EPO) is a haematopoietic cytokine, mainly generated in the renal cortex, and its secretion and action is impaired in chronic kidney disease (CKD). Early renal damage in diabetes mellitus (DM) is usually not detected because diabetes-induced nephron hypertrophy maintains glomerular filtration rate (GFR) and an elevated plasma creatinine concentration is a relatively late manifestation of diabetic nephropathy. However, anaemia occurs more frequently in subjects with DM when compared with those with non-DM renal disease. While reduced production and a blunted response to EPO occurs in DM with early renal damage, other factors including chronic inflammation, autonomic neuropathy and iron deficiency are also important. Although recombinant human erythropoietin (rhEPO) has been an effective therapeutic agent in CKD anaemia, it appears to be more effective in patients with DM, even in earlier stages. Nevertheless, patients with DM are also more likely to be iron deficient, a barrier to effective rhEPO therapy. The effect of treatment on the reliability of haemoglobin A1c as an index of glycaemic control must be remembered. It is proposed that anaemia and its causes must be important components of care in subjects with early diabetic renal damage

Morphologic, immunphenotypic and clinical discriminators between T-cell/histiocyterich large B-cell lymphoma and lymphocyte-predominant Hodgkin lymphoma

BACKGROUND: Features of T-cell/histiocyte rich large B-cell lymphoma (THRLBCL) overlap with those of lymphocyte predominant Hodgkin lymphoma (LPHL). The two lymphomas may represent a spectrum of the same disease, and differentiation between the two can sometimes be difficult. We looked at histomorphologic, immunophenotypic and clinical information that may help differentiate the two entities. METHODS: Cases of THRLBCL and LPHL were blindly reviewed and studied for histological pattern (nodular vs. diffuse), nuclear features and pattern of expression of CD20, CD30, CD57, epithelial membrane antigen (EMA) and Epstein-Barr virus (EBV). A score encompassing diffuse histology, high nuclear grade, CD20 single-cell pattern, CD30+, CD57-, EMA-, and EBV+was estimated for the diagnosis of TCHRLBCL. RESULTS: There were 58 cases, including 30 cases of TCHRLBL and 28 cases of LPHL. The median age was 36 years for TCHRLBCL and 21 years for LPHL (P=0.0001). Three types of nuclei were identified (lymphocytic/histocytic, Reed-Sternberg and centroblast-like). The latter two high-grade nuclei were suggestive of TCHRLBCL. TCHRLBCL and LPHL, respectively, showed diffuse histology, 90% vs. 4% (P=0.001), single CD20+ cells, 93% vs. 3.5% (P=0.00004), CD30+ cells, 30% vs. 0% (P=0.01), CD57+ cells, 41% vs. 93% (P=0.008), EMA+cells, 27% vs. 60% (P=0.113), EBV+cells, 24% vs. 0% (P=0.117), high nuclear grade, 70% vs. 0% (P=0.001), total score 2-7 (mean 4.68) vs. 0-2 (mean 0.72) (P=0.001), high stage, 86% vs. 7% (P=0.0001). CONCLUSION: Our findings indicate that a combination of multiple parameters can help differentiate between the two diseases. Two cases originally diagnosed as LPHL were re-assigned the diagnosis of THRLBCL

High Performance Green Homes (sequence unknown), IPRO 317 - Deliverables: IPRO 317 IPRO Day Presentation F09

The purpose of this project is to show how a team committed to helping people help save the world can leapfrog today's best designs. As opposed to the tradition of minimum design standards that just meeting the building code, highest practical design standards are the focus. True sustainability is the goal of this project, including; Zero Carbon Emissions, Net Zero Energy, 100% Solar Power, 10 times the traditional design life, 1/10th the maintenance, rot proof, termite proof, fire proof, hurricane and earthquake resistant. The project team, using cutting edge technology, will develop all aspects of a start-up design and build company to promote High Performance Green Homes. This project will provide a great opportunity for IIT students to experience a challenging and interesting project and to significantly contribute to a better world.Sponsorship: Jimmy En

High Performance Green Homes (sequence unknown), IPRO 317 - Deliverables

The purpose of this project is to show how a team committed to helping people help save the world can leapfrog today's best designs. As opposed to the tradition of minimum design standards that just meeting the building code, highest practical design standards are the focus. True sustainability is the goal of this project, including; Zero Carbon Emissions, Net Zero Energy, 100% Solar Power, 10 times the traditional design life, 1/10th the maintenance, rot proof, termite proof, fire proof, hurricane and earthquake resistant. The project team, using cutting edge technology, will develop all aspects of a start-up design and build company to promote High Performance Green Homes. This project will provide a great opportunity for IIT students to experience a challenging and interesting project and to significantly contribute to a better world.Sponsorship: Jimmy En