Intégration de critères de développement durable dans les appels d’offres en milieu hospitalier

De par leurs activités, les hôpitaux génèrent des impacts non négligeables sur l’environnement, ces derniers se répercutent indirectement sur la santé des citoyens. En réévaluant leurs besoins lors de l’achat de produits, ces organisations auraient l’occasion de réduire leurs effets environnementaux et sociaux néfastes. À cet effet, la présente étude visait à faciliter l’intégration de critères de développement durable dans les appels d’offres pour les produits consommés en milieu hospitalier. Il est constaté que les centres hospitaliers sont peu avancés en matière d’approvisionnement responsable et qu’ils font usage, à l’occasion, de clauses de développement durable pour certains appels d’offres, mais sans planification préalable. Afin de pallier à cette problématique, la méthodologie proposée, qui permet de clarifier les principales étapes d’une démarche d’approvisionnement responsable, devrait être appliquée. Cette méthode tient compte des modes de fonctionnement des hôpitaux et de leur contexte organisationnel. À cette fin, trois niveaux sont privilégiés, soit les niveaux stratégique, tactique et opérationnel, chacun d’entre eux ayant une série d’étapes gérées par des ressources humaines spécifiques. L’une des étapes clés est la priorisation des produits qui permet de donner les grandes orientations à la démarche d’approvisionnement responsable de l’organisation, en plus de mieux justifier l’usage de critères de développement durable au sein des équipes du Service d’approvisionnement. Une analyse du marché préalable et l’élaboration d’une stratégie d’achat facilitent également l’intégration de critères aux appels d’offres et permet d’assurer qu’un nombre suffisant de soumissionnaires pourront appliquer. Afin d’éviter des hausses de coûts, les critères de conformité devraient être utilisés préférablement à la marge préférentielle. Pour répondre aux besoins des acheteurs et des agents d’approvisionnement, des fiches synthèses sur la durée de vie et l’élimination, l’emballage et le transport des produits devraient être utilisées en plus de fiches spécifiques aux contrats venant à échéance et de fiches pour l’achat d’équipements. Un questionnaire devrait aussi être envoyé aux fournisseurs afin que l’organisation puisse prendre connaissance de leurs pratiques en développement durable. Aussi, les requérants devraient être sensibilisés directement étant donné qu’ils établissent le besoin pour l’achat et qu’il est plus facile de modifier la demande en amont qu’une fois rendue au Service d’approvisionnement. Enfin, un établissement de santé devrait définir ses besoins en développement durable et les acheminer à son regroupement d’achats pour s’assurer que les produits achetés répondent à ses besoins et à ses valeurs. Bien que plusieurs outils aient été élaborés dans cette étude, un effort accru devrait être fourni par le ministère de la Santé et des Services sociaux et par les hôpitaux pour développer d’autres outils adaptés à la réalité des établissements du réseau de la santé

Firearm-Related Pediatric Head Trauma: A Scoping Review.

BACKGROUND: Firearm-related injury is a significant cause of morbidity and mortality in pediatric populations. Despite a disproportionate role in the most morbid outcomes in both traumatic brain injury and firearm-related injury populations, firearm-related traumatic brain injury (frTBI) is an understudied epidemiological entity. There is need to increase understanding and promote interventions that reduce this burden of disease. OBJECTIVE: To assess the evidence characterizing pediatric frTBI to highlight trends and gaps regarding burden of disease and interventions to reduce frTBI. METHODS: We conducted a scoping review under Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review (PRISMA-ScR) guidelines on peer-reviewed studies across 5 databases (Medline OVID, EMBASE, Web of Science Legal Collection, PsychINFO, and Academic Search Complete). English studies examining pediatric frTBI epidemiology, prevention, and/or social or legal policy advocacy were included. Articles were excluded if they more generally discussed pediatric firearm-related injury without specific analysis of frTBI. RESULTS: Six studies satisfied inclusion criteria after screening and full-text assessment. Limited studies specifically addressed the burden of disease caused by frTBI. There was an increased risk for both injury and death from frTBI in men, preteenage and teenage youths, minorities, and individuals in firearm-owning households. Further study is required to ascertain if suggested methods of targeted patient screening, firearm-injury prevention counseling, and advocacy of safety-oriented policy tangibly affect rates or outcomes of pediatric frTBI. CONCLUSION: By understanding published epidemiological data and areas of intervention shown to reduce frTBIs, neurosurgeons can become further engaged in public health and prevention rather than strictly treatment after injury

Firearm-Related Traumatic Brain Injuries in Adults: A Scoping Review.

BACKGROUND AND OBJECTIVES: Firearm-related traumatic brain injury (TBI) has emerged as a significant public health issue in the United States, coinciding with a rapid increase in gun-related deaths. This scoping review aims to update our understanding of firearm-related TBI in adult populations. METHODS: A comprehensive search of 6 online databases yielded 22 studies that met the inclusion criteria. The reviewed studies predominantly focused on young adult men who were victims of assault, although other vulnerable populations were also affected. RESULTS: Key factors in evaluating patients with firearm-related TBI included low Glasgow Coma Scale scores, central nervous system involvement, hypotension, and coagulopathies at presentation. Poor outcomes in firearm-related TBIs were influenced by various factors, including the location and trajectory of the gunshot wound, hypercoagulability, hemodynamic instability, insurance status, and specific clinical findings at hospital admission. CONCLUSION: Proposed interventions aimed to reduce the incidence and mortality of penetrating TBIs, including medical interventions such as coagulopathy reversal and changes to prehospital stabilization procedures. However, further research is needed to demonstrate the effectiveness of these interventions. The findings of this scoping review hope to inform future policy research, advocacy efforts, and the training of neurosurgeons and other treating clinicians in the management of firearm-related TBI

Viral Coinfections in Kawasaki Disease: A Meta-analysis.

CONTEXT: Viral infections are suspected triggers in Kawasaki disease (KD); however, a specific viral trigger has not been identified. OBJECTIVES: In children with KD, to identify (1) overall prevalence of viral infections; (2) prevalence of specific viruses; and (3) whether viral positivity was associated with coronary artery aneurysms (CAAs) or refractoriness to intravenous immunoglobin (IVIG). DATA SOURCES: We searched Embase, Medline, and Cochrane databases and gray literature. STUDY SELECTION: Eligible studies were conducted between 1999 and 2019, and included children diagnosed with KD who underwent viral testing. DATA EXTRACTION: Two investigators independently reviewed full-text articles to confirm eligibility, extract data, appraise for bias, and assess evidence quality for outcomes using the Grading of Recommendations Assessment Development and Evaluation criteria. We defined viral positivity as number of children with a positive viral test divided by total tested. Secondary outcomes were CAA (z score ≥2.5) and IVIG refractoriness (fever ≥36 hours after IVIG). RESULTS: Of 3189 unique articles identified, 54 full-text articles were reviewed, and 18 observational studies were included. Viral positivity weighted mean prevalence was 30% (95% confidence interval [CI], 14-51) and varied from 5% to 66%, with significant between-study heterogeneity. Individual virus positivity was highest for rhinovirus (19%), adenovirus (10%), and coronavirus (7%). Odds of CAA (odds ratio, 1.08; 95% CI, 0.75-1.56) or IVIG refractoriness (odds ratio, 0.88; 95% CI, 0.58-1.35) did not differ on the basis of viral status. LIMITATIONS: Low or very low evidence quality. CONCLUSIONS: Viral infection was common with KD but without a predominant virus. Viral positivity was not associated with CAAs or IVIG refractoriness

Academic performance of children with sickle cell disease in the United States: A meta-analysis

Background: Students with sickle cell disease are at risk for poor academic performance due to the combined and/or interactive effects of environmental, psychosocial, and disease-specific factors. Poor academic performance has significant social and health consequences. Objective: To study academic achievement and attainment in children with sickle cell disease in the United States. Design: Medline, Embase, SCOPUS, CINAHL, ERIC, and PsycINFO were searched for peer-reviewed articles. Studies of children (ages 5–18) diagnosed with sickle cell disease of any genotype reporting academic achievement (standardized tests of reading, math, and spelling) or attainment (grade retention or special education) outcomes were included. Outcomes were analyzed using a random effects model. Achievement scores were compared to within study controls or normative expectations. Prevalence of grade retention and special education services were compared to national (United States) estimates for Black students. Age at assessment and overall IQ were evaluated separately for association with reading and mathematics scores. Subgroup analyses of reading and math scores were analyzed by cerebral infarct status (no cerebrovascular accident, silent infarct, stroke). Results: There were 44 eligible studies. Students with sickle cell disease scored 0.70, 0.87, and 0.80 (p < 0.001) SD below normative expectations on measures of reading, mathematics, and spelling, respectively. Compared to unaffected sibling and/or healthy controls (k = 8, n = 508), reading and math scores were 0.40 (p = 0.017) and 0.36 (p = 0.033) SD below expectations. Grade retention was approximately 10 times higher in students with sickle cell disease than Black students nationally. Intellectual functioning explained 97.3 and 85.8% of the variance in reading and mathematics performance, respectively (p < 0.001). Subgroup analyses revealed significant differences in reading (p = 0.034) and mathematics (p < 0.001) based on infarct status, with lower performance associated with presence of a silent infarct or stroke. Conclusion: Students with sickle cell disease demonstrate notable academic difficulties and are at high risk for grade retainment. Development of academic interventions and increased access to school support services are needed for this vulnerable population. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020179062

Coronavirus Disease 2019 (COVID-19) Vaccination and Assisted Reproduction Outcomes: A Systematic Review and Meta-analysis.

OBJECTIVE: To assess the association between coronavirus disease 2019 (COVID-19) vaccination and female assisted reproduction outcomes through a systematic review and meta-analysis. DATA SOURCES: We searched Medline (OVID), EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov on January 11, 2023, for original articles on assisted reproduction outcomes after COVID-19 vaccination. The primary outcome was rates of clinical pregnancy; secondary outcomes included number of oocytes retrieved, number of mature oocytes retrieved, fertilization rate, implantation rate, ongoing pregnancy rate, and live-birth rate. METHODS OF STUDY SELECTION: Two reviewers independently screened citations for relevance, extracted pertinent data, and rated study quality. Only peer-reviewed published studies were included. TABULATION, INTEGRATION, AND RESULTS: Our query retrieved 216 citations, of which 25 were studies with original, relevant data. Nineteen studies reported embryo transfer outcomes, with a total of 4,899 vaccinated and 13,491 unvaccinated patients. Eighteen studies reported data on ovarian stimulation outcomes, with a total of 1,878 vaccinated and 3,174 unvaccinated patients. There were no statistically significant results among our pooled data for any of the primary or secondary outcomes: clinical pregnancy rate (odds ratio [OR] 0.94, 95% CI 0.88-1.01, P=.10), number of oocytes retrieved (mean difference -0.26, 95% CI -0.68 to 0.15, P=.21), number of mature oocytes retrieved (mean difference 0.31, 95% CI -0.14 to 0.75, P=.18), fertilization rate (OR 0.99, 95% CI 0.87-1.11, P=.83), implantation rate (OR 0.92, 95% CI 0.84-1.00, P=.06), ongoing pregnancy rate (OR 0.95, 95% CI 0.86-1.06, P=.40), or live-birth rate (OR 0.95, 95% CI 0.78-1.17, P=.63). A subanalysis based on country of origin and vaccine type was also performed for the primary and secondary outcomes and did not change the study results. CONCLUSION: Vaccination against COVID-19 is not associated with different fertility outcomes in patients undergoing assisted reproductive technologies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42023400023

Screening tests for active pulmonary tuberculosis in children

Objectives This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To determine the sensitivity, specificity, and positive and negative predictive value of 1) the presence of one or more tuberculosis symptoms, or symptom combinations; 2) chest radiography; 3) Xpert MTB/RIF; 4) Xpert Ultra; and 5) combinations of the aforementioned tests as screening tests for detecting active pulmonary tuberculosis in children in the following groups. Household contacts of a person with active tuberculosis; School contacts of a person with active tuberculosis; Other close contacts of a person with active tuberculosis; Children living with HIV; Children with pneumonia; Other risk groups (e.g. children with a history of previous tuberculosis, malnourished children); Children in the general population in high burden settings Secondary objectives To compare the accuracy of the different index tests, including different applications of tests (e.g. CXR with any abnormality versus, more specifically, CXR with abnormality suggestive of tuberculosis); we are interested in the accuracy of the index tests in any setting (i.e. community, outpatient, and inpatient). To investigate potential sources of heterogeneity in accuracy estimates in relation to age group, HIV status, whether the study was conducted in a high tuberculosis burden country, and whether the child received a single screening or more than one screening

Quality assessment of optic nerve sheath diameter ultrasonography: Scoping literature review and Delphi protocol.

BACKGROUND AND PURPOSE: The optic nerve is surrounded by the extension of meningeal coverings of the brain. When the pressure in the cerebrospinal fluid increases, it causes a distention of the optic nerve sheath diameter (ONSD), which allows the use of this measurement by ultrasonography (US) as a noninvasive surrogate of elevated intracranial pressure. However, ONSD measurements in the literature have exhibited significant heterogeneity, suggesting a need for consensus on ONSD image acquisition and measurement. We aim to establish a consensus for an ONSD US Quality Criteria Checklist (ONSD US QCC). METHODS: A scoping systematic review of published ultrasound ONSD imaging and measurement criteria was performed to guide the development of a preliminary ONSD US QCC that will undergo a modified Delphi study to reach expert consensus on ONSD quality criteria. The protocol of this modified Delphi study is presented in this manuscript. RESULTS: A total of 357 ultrasound studies were included in the review. Quality criteria were evaluated under five categories: probe selection, safety, positioning, image acquisition, and measurement. CONCLUSIONS: This review and Delphi protocol aim to establish ONSD US QCC. A broad consensus from this process may reduce the variability of ONSD measurements in future studies, which would ultimately translate into improved ONSD clinical applications. This protocol was reviewed and endorsed by the German Society of Ultrasound in Medicine

Understanding the Impact of Adverse Childhood Experiences on Non-suicidal Self-Injury in Youth: A Systematic Review

Objective: Non-suicidal self-injury (NSSI), defined as a deliberate destruction of one’s own body without a suicidal intent, is a global public health issue. Adverse childhood events (ACEs) have been shown to be associated with various mental illnesses; however, to date the impact of such events on NSSI in youth has not been reviewed. Methods: We conducted a systematic review, searched 5 databases for published articles evaluating ACE and NSSI in youth less than or equal to 21 years of age. After screening 247 articles, we included 21 unique articles in this systematic review. Results: Increasing ACE score, physical, sexual or emotional abuse, parental neglect and substance use, parental separation or dysfunctional family, and death of a close family member had statistically significant correlation with NSSI. Conclusion: Non-suicidal self-injury is an impairing diagnosis with far reaching psychiatric manifestations and repercussions. Practitioners having high clinical suspicion for ACEs in youth with NSSI must intervene early by administering the ACEs questionnaire. Effective treatment of NSSI in those with ACEs with psychotherapy significantly improves outcomes and prevents suicide in youth

Screening tests for active pulmonary tuberculosis in children

Objectives This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To determine the sensitivity, specificity, and positive and negative predictive value of 1) the presence of one or more tuberculosis symptoms, or symptom combinations; 2) chest radiography; 3) Xpert MTB/RIF; 4) Xpert Ultra; and 5) combinations of the aforementioned tests as screening tests for detecting active pulmonary tuberculosis in children in the following groups. Household contacts of a person with active tuberculosis; School contacts of a person with active tuberculosis; Other close contacts of a person with active tuberculosis; Children living with HIV; Children with pneumonia; Other risk groups (e.g. children with a history of previous tuberculosis, malnourished children); Children in the general population in high burden settings Secondary objectives To compare the accuracy of the different index tests, including different applications of tests (e.g. CXR with any abnormality versus, more specifically, CXR with abnormality suggestive of tuberculosis); we are interested in the accuracy of the index tests in any setting (i.e. community, outpatient, and inpatient). To investigate potential sources of heterogeneity in accuracy estimates in relation to age group, HIV status, whether the study was conducted in a high tuberculosis burden country, and whether the child received a single screening or more than one screening