Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: population based retrospective study

Objectives To examine variations in the registration of extremely low birthweight and early gestation births and to assess their effect on perinatal and infant mortality rankings of industrialised countries

La substitution de la gentamicine par la tobramycine en contexte de pénurie : évaluation de l’impact sur la résistance bactérienne

Objectif : Décrire les effets de la substitution de la gentamicine par la tobramycine sur le développement de résistance bactérienne pour lutter contre différentes entérobactéries et le Pseudomonas aeruginosa.Mise en contexte : La pénurie de gentamicine de septembre 2014 à juin 2016 a entraîné sa substitution par la tobramycine pour tous les patients à partir de l’âge d’un an, excepté lors d’une utilisation synergique pour le traitement des endocardites, de la tularémie et de la brucellose au Centre intégré universitaire de santé et de services sociaux de l’Estrie – Centre hospitalier universitaire de Sherbrooke, installations Hôpital Fleurimont et Hôtel-Dieu.Résultats : Le nombre d’isolats bactériens à Gram négatif pour la période précédant la pénurie (P1) est de 169 comparativement à 287 pour celle suivant la pénurie (P2). Lors de l’analyse par microorganisme, on ne note aucun changement statistiquement significatif de la sensibilité à la gentamicine et à la tobramycine entre les deux périodes.Conclusion : Tant les entérobactéries que le Pseudomonas aeruginosa ne semblent pas augmenter leur résistance aux deux antibiotiques mentionnés ci-après lors du remplacement de la gentamicine par la tobramycine pendant 24 mois.AbstractObjective: To describe the impact of substituting gentamicin with tobramycin on the development of bacterial resistance to fight different enterobacteria and Pseudomonas aeruginosa.Background: Shortage of gentamicin from September 2014 to June 2016 resulted in it being substituted for tobramycin for all patients from the age of one year, except when used synergistically for the treatment of endocarditis, tularemia and brucellosis at the Hôpital Fleurimont and the Hôpital Hôtel-Dieu of the Centre intégré universitaire de santé et de services sociaux de l’Estrie - Centre hospitalier universitaire de Sherbrooke.Results: The number of Gram-negative bacterial isolates for the period before the shortage (P1) was 169 compared to 287 for the period after the shortage (P2). The analysis by microorganism did not show a statistically significant change in susceptibility to gentamicin or tobramycin between the two periods.Conclusion: When gentamicin was substituted with tobramycin for 24 months, there did not appear to be any increased resistance to these two antibiotics by either enterobacteria or Pseudomonas aeruginosa

Differences in perinatal and infant mortality in high-income countries: Artifacts of birth registration or evidence of true differences?

Background: Variation in birth registration criteria may compromise international comparisons of fetal and infant mortality. We examined the effect of birth registration practices on fetal and infant mortality rates to determine whether observed differences in perinatal and infant mortality rates were artifacts of birth registration or reflected true differences in health status. Methods: A retrospective population-based cohort study was done using data from Canada, United States, Denmark, Finland, Iceland, Norway, and Sweden from 1995–2005. Main outcome measures included live births by gestational age and birth weight; gestational age—and birth weight-specific stillbirth rates; neonatal, post-neonatal, and cause-specific infant mortality. Results: Proportion of live births <22 weeks varied substantially: Sweden (not reported), Iceland (0.00 %), Finland (0.001 %), Denmark (0.01 %), Norway (0.02 %), Canada (0.07 %) and United States (0.08 %). At 22–23 weeks, neonatal mortality rates were highest in Canada (892.2 per 1000 live births), Denmark (879.3) and Iceland (1000.0), moderately high in the United States (724.1), Finland (794.3) and Norway (739.0) and low in Sweden (561.2). Stillbirth:live birth ratios at 22–23 weeks were significantly lower in the United States (79.2 stillbirths per 100 live births) and Finland (90.8) than in Canada (112.1), Iceland (176.2) and Norway (173.9). Crude neonatal mortality rates were 83 % higher in Canada and 96 % higher in the United States than Finland. Neonatal mortality rates among live births ≥28 weeks were lower in Canada and United States compared with Finland. Post-neonatal mortality rates were higher in Canada and United States than in Nordic countries. Conclusions: Live birth frequencies and stillbirth and neonatal mortality patterns at the borderline of viability are likely due to differences in birth registration practices, although true differences in maternal, fetal and infant health cannot be ruled out. This study emphasises the need for further standardisations, in order to enhance the relevance of international comparisons of infant mortality

An International Comparison of Death Classification at 22 to 25 Weeks' Gestational Age

OBJECTIVES: To explore international differences in the classification of births at extremely low gestation and the subsequent impact on the calculation of survival rates. METHODS: We used national data on births at 22 to 25 weeks' gestation from the United States (2014; n = 11 144), Canada (2009-2014; n = 5668), the United Kingdom (2014-2015; n = 2992), Norway (2010-2014; n = 409), Finland (2010-2015; n = 348), Sweden (2011-2014; n = 489), and Japan (2014-2015; n = 2288) to compare neonatal survival rates using different denominators: all births, births alive at the onset of labor, live births, live births surviving to 1 hour, and live births surviving to 24 hours. RESULTS: For births at 22 weeks' gestation, neonatal survival rates for which we used live births as the denominator varied from 3.7% to 56.7% among the 7 countries. This variation decreased when the denominator was changed to include stillbirths (ie, all births [1.8%-22.3%] and fetuses alive at the onset of labor [3.7%-38.2%]) or exclude early deaths and limited to births surviving at least 12 hours (50.0%-77.8%). Similar trends were seen for infants born at 23 weeks' gestation. Variation diminished considerably at 24 and 25 weeks' gestation. CONCLUSIONS: International variation in neonatal survival rates at 22 to 23 weeks' gestation diminished considerably when including stillbirths in the denominator, revealing the variation arises in part from differences in the proportion of births reported as live births, which itself is closely connected to the provision of active care

A web-based tailored nursing intervention to support illness management in patients hospitalized for an acute coronary syndrome : a pilot study

Background: Illness management after an acute coronary syndrome (ACS) is crucial to prevent cardiac complications, to foster participation in a cardiac rehabilitation (CR) program, and to optimize recovery. Web-based tailored interventions have the potential to provide individualized information and counseling to optimize patient’s illness management after hospital discharge. Objective: We aimed to assess the feasibility and acceptability of a Web-based tailored intervention (TAVIE@COEUR) designed to improve illness management in patients hospitalized for an ACS. Illness management outcomes were operationalized by self-care, medication adherence, anxiety management, cardiac risk factors reduction, and enrollment in a CR program. Methods: This posttest pilot study was conducted with one group (N=30) of patients hospitalized for an ACS on the coronary care unit of a tertiary cardiology center. TAVIE@COEUR comprises three Web-based sessions, with a duration ranging from 10 to 45 min and is structured around an algorithm to allow the tailoring of the intervention to different pathways according to patients’ responses to questions. TAVIE@COEUR includes 90 pages, 85 videos, and 47 PDF documents divided across session 1 (S1), session 2 (S2), and session 3 (S3). These sessions concern self-care and self-observation skills related to medication-taking (S1), emotional control and problem-solving skills (S2), and social skills and interacting with health professionals (S3). Throughout the videos, a virtual nurse (providing the intervention virtually) guides the participants in the acquisition of self-care skills. Patients completed S1 of TAVIE@COEUR before hospital discharge and were asked to complete S2 and S3 within 2 weeks after discharge. Feasibility indicators were extracted from the TAVIE@COEUR system. Data regarding acceptability (satisfaction and appreciation of the platform) and preliminary effect (self-care, medication adherence, anxiety management, risk factor reduction, and CR enrollment) were assessed through questionnaires at 1 month following discharge. Preliminary effect was assessed by comparing baseline and 1-month illness management variables. Results: Of the 30 participants, 20 completed S1, 10 completed S2, and 5 completed S3. Good acceptability scores were observed for ease of navigation (mean=3.58, standard deviation [SD]=0.70; scale=0-4), ease of understanding (mean=3.46, SD=0.63; scale=0-4), and applicability (mean=3.55, SD=0.74; scale=0-4). The lowest acceptability scores were observed for information tailoring (mean=2.93, SD=0.68; scale=0-4) and individual relevance (mean=2.56, SD=0.96; scale=0-4). With regard to preliminary effect, we observed an overall self-care at 1 month following discharge score higher than at baseline (mean at 1 month=54.07, SD=3.99 vs mean at baseline=49.09, SD=6.92; scale-0-60). Conclusions: Although participants reported general satisfaction and appreciation of TAVIE@COEUR, acceptability and feasibility results show the need for further development of the Web-based intervention to enhance its tailoring before undertaking a full-fledged randomized controlled trial. This may be accomplished by optimizing the adaptability of TAVIE@COEUR to patients’ knowledge, needs, interests, individual capabilities, and emotional and cognitive responses during session completion