Hand hygiene improvement of individual healthcare workers: results of the multicentre PROHIBIT study

Hand hygiene; Intensive care; InterventionHigiene de manos; Cuidados intensivos; IntervenciónHigiene de mans; Cures intensives; IntervencióBackground Traditionally, hand hygiene (HH) interventions do not identify the observed healthcare workers (HWCs) and therefore, reflect HH compliance only at population level. Intensive care units (ICUs) in seven European hospitals participating in the “Prevention of Hospital Infections by Intervention and Training” (PROHIBIT) study provided individual HH compliance levels. We analysed these to understand the determinants and dynamics of individual change in relation to the overall intervention effect. Methods We included HCWs who contributed at least two observation sessions before and after intervention. Improving, non-changing, and worsening HCWs were defined with a threshold of 20% compliance change. We used multivariable linear regression and spearman’s rank correlation to estimate determinants for the individual response to the intervention and correlation to overall change. Swarm graphs visualized ICU-specific patterns. Results In total 280 HCWs contributed 17,748 HH opportunities during 2677 observation sessions. Overall, pooled HH compliance increased from 43.1 to 58.7%. The proportion of improving HCWs ranged from 33 to 95% among ICUs. The median HH increase per improving HCW ranged from 16 to 34 percentage points. ICU wide improvement correlated significantly with both the proportion of improving HCWs (ρ = 0.82 [95% CI 0.18–0.97], and their median HH increase (ρ = 0.79 [0.08–0.97]). Multilevel regression demonstrated that individual improvement was significantly associated with nurse profession, lower activity index, higher nurse-to-patient ratio, and lower baseline compliance. Conclusions Both the proportion of improving HCWs and their median individual improvement differed substantially among ICUs but correlated with the ICUs’ overall HH improvement. With comparable overall means the range in individual HH varied considerably between some hospitals, implying different transmission risks. Greater insight into improvement dynamics might help to design more effective HH interventions in the future.The study was funded by the European Commission 7th Framework Programme

De novo mutations in SMCHD1 cause Bosma arhinia microphthalmia syndrome and abrogate nasal development

Bosma arhinia microphthalmia syndrome (BAMS) is an extremely rare and striking condition characterized by complete absence of the nose with or without ocular defects. We report here that missense mutations in the epigenetic regulator SMCHD1 mapping to the extended ATPase domain of the encoded protein cause BAMS in all 14 cases studied. All mutations were de novo where parental DNA was available. Biochemical tests and in vivo assays in Xenopus laevis embryos suggest that these mutations may behave as gain-of-function alleles. This finding is in contrast to the loss-of-function mutations in SMCHD1 that have been associated with facioscapulohumeral muscular dystrophy (FSHD) type 2. Our results establish SMCHD1 as a key player in nasal development and provide biochemical insight into its enzymatic function that may be exploited for development of therapeutics for FSHD

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary.

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withdrawn 2017 hrs ehra ecas aphrs solaece expert consensus statement on catheter and surgical ablation of atrial fibrillation

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2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary.

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Le droit public existe-t-il ?

Site collaboratif et interdisciplinaire sur les mutations contemporaines du droit public. Ouverture :01/05/2007 - Clôture :01/05/2011. Le contenu (50 contributions, la plupart originales, des notes de lecture et de jurisprudence) reste accessible gratuitement en ligne.info:eu-repo/semantics/nonPublishe

Managing forensic DNA records in a divided world : the Belgian case

Purpose – This paper aims to describe the activity of managing records related to forensic DNA identification. First, it illustrates the fundamentals behind the technique of forensic DNA identification. Second, it explains the legal and institutional contexts in which it is used as well as the notion of DNA-based judicial records. Third, it provides details of records management issues that are met in practice. Design/methodology/approach – An interdisciplinary team reflects upon the practices surrounding the management of DNA-based records in the Belgian National DNA database during more than 10 years. Findings – The main problems with managing DNA-based judicial records stem from the existence of natural boundaries between the various stakeholders operating with or within the Belgian judicial system. Six types of issues have been found: non-automaticity and omission, error-prone and inefficient manual operations, electronic issues, results quality, useful reporting and incoherence and duplication. These problems are discussed in terms of four records characteristics: completeness, correctness, traceability and usability

Managing forensic DNA records in a divided world: the Belgian case Managing forensic DNA records 269

Abstract Purpose -This paper aims to describe the activity of managing records related to forensic DNA identification. First, it illustrates the fundamentals behind the technique of forensic DNA identification. Second, it explains the legal and institutional contexts in which it is used as well as the notion of DNA-based judicial records. Third, it provides details of records management issues that are met in practice. Design/methodology/approach -An interdisciplinary team reflects upon the practices surrounding the management of DNA-based records in the Belgian National DNA database during more than 10 years. Findings -The main problems with managing DNA-based judicial records stem from the existence of natural boundaries between the various stakeholders operating with or within the Belgian judicial system. Six types of issues have been found: non-automaticity and omission, error-prone and inefficient manual operations, electronic issues, results quality, useful reporting and incoherence and duplication. These problems are discussed in terms of four records characteristics: completeness, correctness, traceability and usability. Research limitations/implications -The research is limited to the Belgian case with no comparison with other countries. Practical implications -This paper attempts to formulate general principles that aim to stimulate good practices in managing records in the field of criminal justice. Social implications -The ethical issues surrounding the domain of criminal policy (e.g. the proper use of financial resources, the fair and balance use of records to carry out justice) are of general interest to the public. Originality/value -The paper benefits from a large temporal angle (more than 10 years) and applies a multidisciplinary viewpoint on its subject