Influenza vaccine coverage for healthcare workers in geriatric settings in France

Background and aims: Because of a relative lack of efficiency of influenza vaccine in the elderly population, influenza outbreaks in geriatric healthcare settings are probable, despite high influenza vaccination rates in patients. Nosocomial influenza outbreaks, more probably related to healthcare workers, have also been reported. Therefore, vaccination of healthcare workers is considered to be an important preventive policy, to decrease the in- hospital influenza burden during the viral circulation period. Methods: This multicenter study measured influenza vaccine coverage of Health Care Worker in 102 geriatric healthcare settings (acute care, rehabilitation care, long- term care) by a first questionnaire. A second questionnaire assessed main factors associated with vaccine acceptance. Results: 102 geriatric healthcare settings (20%) answered the first questionnaire. Vaccine coverage for physicians (n=187), nurses (n=631) and nurse assistants (n=1487) were 48.4%, 30.5% and 27.9%, respectively. Vaccination rates were correlated between occupational categories according to healthcare settings. Vaccination rates were significantly lower in acute care settings compared with rehabilitation and long- term care settings. Local recommendations was reported for 29.9%, but was not correlated with vaccine coverage. The second questionnaire showed that lack of motivation and knowledge, and organizational problems were the three main reasons for reluctance to be vaccinated. Conclusions: In French geriatric settings, influenza vaccine coverage of healthcare workers is low and highly variable, according to the type of healthcare setting. A group effect was found between occupational categories. However, the reasons for non- acceptance need further evaluation to improve HCW influenza vaccine coverag

Effective components of self-management programs for chronic obstructive pulmonary disease patients: scoping review

Introduction: To date, little guidance is available to support the development of effective programs for improving self-management in chronic obstructive pulmonary disease (COPD) patients. Yet, given the global burden of this disease, it seems important to identify the components of a self-management program that are effective in terms of health outcomes for COPD patients. Objectives: This review aims to identify effective elements of a self-management program for COPD patients, the ones that may impact quality of life, emergency visits, and rehospitalization rates.Material and methods: A systematic literature search of three databases (Medline, Cochrane, and CINHAL) was conducted to identify studies on self-management of COPD, with three limiting parameters: published in twelve years prior to November 2019, in English or French, and including patients over 40 years old. Prisma was used to guide the work process. Results: The search yielded 361 studies from the three electronic databases by applying limiting criteria, and after removing duplicates. Sixty-five articles were identified as relevant based on their titles and abstracts. However, 16 documents were retained after full reading. The analysis of the included articles identified 4 components in self-management programs for COPD patients: initiation stage of the intervention, educational sessions, support and monitoring methods. Conclusions: Although the combination of self-management program initiation, educational sessions, support and monitoring methods were effective, further research is needed to identify the components that have better impact on COPD patients’ skills and quality of life

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

Impact de la COVID-19 sur les services de prévention du VIH et de prise en charge des personnes vivant avec le VIH dans la ville de Bukavu : une étude mixte séquentielle explicative

Introduction: Since its appearance in China at the end of 2019, the sanitary response to COVID-19 infection has disrupted the delivery of primary healthcare services, including those related to the human immunodeficiency virus (HIV). In the Democratic Republic of Congo, anti-COVID-19 measures (containment) effect on the use of HIV preventive and care services for people living with HIV (PLHIV) remains poorly described to date. Objective: Compare and understand the effect of anti-COVID measures on the use of HIV prevention and care services for PLHIV in Outpatient treatment centers from Bukavu before (October 2019 to February 2020) and during (March to July 2020) anti-COVID measures. Methods: Multisite mixed study with an explanatory sequential design carried out in Bukavu between July and September 2021. Quantitative phase is observational, descriptive, retrospective and based on programmatic data from Outpatient treatment centers (OTC). Qualitative phase, guided by quantitative results, is based on 31 semi-structured interviews with caregivers and PLHIV. Results: Compared to the pre-COVID-19 period, anti-COVID-19 measures resulted in an 11-20% decrease in HIV preventive and PLHIV’s care services. They also led to stock outs of antiretrovirals and HIV tests, HIV services reorganization, some caregiver’s contamination with COVID-19 and death of others, and a drop in HIV services use. Discussion and conclusion: In Bukavu, anti-COVID-19 measures have had a negative impact on the care of at-risk, HIV-infected people. They have hampered progress towards the objectives of 95% of people tested for HIV, 95% of PLHIV on treatment and 95% of PLHIV with a suppressed viral load.Introduction : Depuis son apparition fin 2019 en Chine, les mesures de riposte contre l’infection à COVID-19 ont perturbé la prestation des services de santé primaires dont ceux liés au virus de l’immunodéficience humaine (VIH). En République démocratique du Congo, l’effet des mesures anti-COVID-19 (confinement) sur l’utilisation des services de prévention du VIH et de prise en charge des personnes vivant avec le VIH (PVVIH) reste peu décrit à ce jour. Objectif : Comparer et comprendre l’effet des mesures anti-COVID-19 sur l’utilisation des services préventifs du VIH et de prise en charge des PVVIH dans les Centres de traitement ambulatoire (CTA) de Bukavu avant (octobre 2019 à février 2020) et pendant (mars à juillet 2020) la période des mesures anti-COVID-19. Méthodes : Étude mixte multisite avec un devis séquentiel explicatif réalisée à Bukavu entre juillet et septembre 2021. La phase quantitative est observationnelle, descriptive, rétrospective et basée sur des données programmatiques issues des CTA. La phase qualitative, guidée par les résultats quantitatifs, est basée sur 31 entretiens semi-structurés avec les soignants et les PVVIH. Résultats : Par comparaison avec la période pré-COVID-19, les mesures anti-COVID-19 ont entrainé une baisse de 11 à 20% des services de prévention du VIH et de prise en charge des PVVIH. Elles ont également induit les ruptures de stock d’antirétroviraux et de tests VIH, la réorganisation des services VIH, la contamination de certains soignants à la COVID-19 et le décès d’autres, ainsi qu’une baisse de l’utilisation des services VIH. Discussion et conclusion : À Bukavu, les mesures anti-COVID-19 ont eu un impact négatif sur le parcours de soins des personnes à risque et infectées par le VIH. Elles ont entravé les progrès vers les objectifs : 95% des personnes dépistées au VIH, 95% des PVVIH sous traitement et 95% des PVVIH avec une charge virale supprimée.&nbsp

A Rapid Evidence Appraisal of influenza vaccination in health workers: an important policy in an area of imperfect evidence

IntroductionThe World Health Organization recommends vaccination of health workers (HWs) against influenza, but low uptake is intransigent.We conducted a Rapid Evidence Appraisal on: the risk of influenza in HWs, transmission risk from HWs to patients, the benefit of HW vaccination, and strategies for improving uptake. We aimed to capture a ‘whole-of-system’ perspective to consider possible benefits for HWs, employers and patients.MethodsWe executed a comprehensive search of the available literature published from 2006 to 2018 in the English language. We developed search terms for seven separate questions following the PICO framework (population, intervention, comparators, outcomes) and queried nine databases.ResultsOf 3784 publications identified, 52 met inclusion criteria. Seven addressed HW influenza risk, of which four found increased risk; 15 addressed influenza vaccine benefit to HWs or their employers, of which 10 found benefit; 11 addressed influenza transmission from HWs to patients, of which 6 found evidence for transmission; 12 unique studies addressed whether vaccinating HWs produced patient benefit, of which 9 concluded benefits accrued. Regarding the number of HWs needed to vaccinate (NNV) to deliver patient benefit, NNV estimates ranged from 3 to 36,000 but were in significant disagreement. Fourteen studies provided insights on strategies to improve uptake; the strongest evidence was for mandatory vaccination.ConclusionsThe evidence on most questions related to influenza vaccination in HWs is mixed and often of low-quality. Substantial heterogeneity exists in terms of study designs and settings, making comparison between studies difficult. Notwithstanding these limitations, a majority of studies suggests that influenza vaccination benefit HWs and their employers; and HWs are implicated in transmission events. The effects of vaccinating HWs on patient morbidity and mortality may include reductions in all-cause mortality and influenza-like illness (ILI). Taken together, the evidence suggests that HW vaccination is an important policy for HWs themselves, their employers, and their patients

Dental and microbiological risk factors for hospital-acquired pneumonia in non-ventilated older patients

We obtained a time series of tongue/throat swabs from 90 patients with lower limb fracture, aged 65-101 in a general hospital in the North East of England between April 2009-July 2010. We used novel real-time multiplex PCR assays to detect S. aureus, MRSA, E. coli, P. aeruginosa, S. pneumoniae, H. influenza and Acinetobacter spp. We collected data on dental/denture plaque (modified Quigley-Hein index) and outcomes of clinician-diagnosed HAP.The crude incidence of HAP was 10% (n = 90), with mortality of 80% at 90 days post discharge. 50% of cases occurred within the first 25 days. HAP was not associated with being dentate, tooth number, or heavy dental/denture plaque. HAP was associated with prior oral carriage with E. coli/S. aureus/P.aeruginosa/MRSA (p = 0.002, OR 9.48 95% CI 2.28-38.78). The incidence of HAP in those with carriage was 35% (4% without), with relative risk 6.44 (95% CI 2.04-20.34, p = 0.002). HAP was associated with increased length of stay (Fishers exact test, p=0.01), with mean 30 excess days (range -11.5-115). Target organisms were first detected within 72 hours of admission in 90% participants, but HAP was significantly associated with S. aureus/MRSA/P. aeruginosa/E. coli being detected at days 5 (OR 4.39, 95%CI1.73-11.16) or 14 (OR 6.69, 95%CI 2.40-18.60).Patients with lower limb fracture who were colonised orally with E. coli/ S. aureus/MRSA/P. aeruginosa after 5 days in hospital were at significantly greater risk of HAP (p = 0.002)

: guide de rédaction d'un protocole de recherche

International audienceCet ouvrage est destiné aux infirmières et à tous les paramédicaux qui souhaitent entamer une recherche. On assiste aujourd’hui à l’émergence et à l’affirmation d’une culture scientifique au sein du groupe professionnel des paramédicaux. Le monde de la santé a compris ce changement et soutient la recherche infirmière et paramédicale, en particulier au travers des programmes de PHRI.Mais conduire une recherche ne s’invente pas. Il faut en respecter les règles, il faut être rigoureux, intègre, mais aussi passionné, curieux et organisé. Une recherche se prépare avec soin.Une bonne préparation du travail de recherche est le garant de sa réussite. De même, une étude bien préparée permet aussi d’obtenir des financements.L’objectif de cet ouvrage n’a qu’une ambition : se familiariser avec la méthodologie de recherche. Il se veut simple, il comporte de précieux conseils pour aider les infirmières et autres professionnels de la santé à préparer un travail de recherche. Ces conseils sont basés à la fois sur des éléments théoriques, sur la littérature et sur l’expérience des auteurs. Des exemples complètent ces conseils. Les différents chapitres abordent les points suivants :– Définir et conceptualiser le thème de recherche– Préparer le travail de recherche– Rédiger le contexte et présenter la question de recherche – Elaborer et rédiger la méthode de recherche– Préparer et rédiger les aspects organisationnels de la recherche Un outil indispensable

Infections en gériatrie (création d'un Observatoire du Risque Infectieux en Gériatrie)

PARIS7-Bibliothèque centrale (751132105) / SudocSudocFranceF

End-Users and Caregivers’ Involvement in Health Interventional Research Carried Out in Geriatric Facilities: A Systematic Review

Public involvement (PI) is of great interest. However, little is known about this topic in the design, development, and/or implementation of health interventions in geriatric facilities. This study aimed to provide a critical overview of the involvement of caregivers and end-users in interventions in these facilities, based on Rifkin’s analytical framework. This systematic review, supplemented by a questionnaire to the corresponding authors, covered non-drug intervention reports targeting nurses, doctors, residents, and their relatives. Articles were published in Pubmed, Medline, Scopus, and Cinahl, from January 2016 to April 2018. Ninety-seven articles were included. The review shows a low level or partial PI in geriatric facilities where it exists. These results are further supported by the authors’ responses to the questionnaire. PI remains uncommon in geriatric institutions and consists of a consumerist model, suggesting the need for improved practices. More efforts are needed to experiment with recommendations to meet the challenges of PI and enhance the public ownership of interventions. The protocol was registered on Prospero under the number CRD42018098504