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

Which method is best for the induction of labour?: A systematic review, network meta-analysis and cost-effectiveness analysis

Background: More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective: To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods: We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results: We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 μg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 μg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations: There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention

Formation au management : les vertus du théâtre en formation continue et en formation initiale

National audienceL'objectif de cette communication est de montrer comment le théâtre peut être utilisé dans des programmes de formation continue et dans des cursus de formation initiale. Pour cela, nous nous appuyons sur une deux études effectuées dans deux contextes différents : des managers en activité professionnelle, et une expérimentation auprès d'étudiants d'IUT. Les résultats obtenus montrent une forte convergence des perceptions de ces deux populations sur les vertus du théâtre, et sur sa pertinente comme outil de formation au management

La performance des entreprises et des établissements publics

International audienceThis article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/authorsright

Enseignement et recherche en sciences de gestion : des complémentarités naturelles ?

National audienceCe travail porte sur l'analyse de l'articulation entre l'activité d'enseignement et de recherche. Nous nous appuyons tout d'abord sur la revue de la littérature existante pour préciser les relations ago-antagonistes, qui existent entre la formation et la recherche en sciences de gestion à l'université. Trois exemples d'actions mises en place dans un IUT, permettent ensuite d'illustrer les synergies entre ces deux activités, pour produire et transmettre, ou transmettre et produire de la connaissance d'intention scientifique

Analyse des fondamentaux de la performance et de sa valorisation : le projet RVAL

L'objet de cette communication est de proposer un travail de clarification sur le concept de performance organisationnelle à partir d'une revue de la littérature existante en sciences de gestion sur ce sujet, et de la présentation de deux axes d'un projet de recherche qui vise à évaluer la performance des stratégies de rapprochements interentreprises, des entreprises publiques et de celles qui relèvent du secteur solidaire et social. Tout d'abord, il ressort de ce travail que la performance est un mot " valise ", un concept flou et multidimensionnel. De plus, ce travail met en relief, l'aspect contingent de la performance liée au contexte de son évaluation : performance de quoi ? Performance pourquoi ? Performance pour qui

Vers la construction d'une grille d'analyse des coopérations interentreprises

International audienc

Art et Management : une expérience via le théâtre, communication sur «L’Art peut-il renouveler la formation au management ? Premier bilan et perspectives»

International audienc

Gérer les interactions entre production et transmission des connaissances : une responsabilité de l'enseignant-chercheur en sciences de gestion ?

International audienceLa question liée au déficit d'utilité des connaissances issues de la recherche scientifique fait l'objet d'une forte actualité en Europe et en Amérique du Nord (Mesny et Mailhot, 2010). En sciences de gestion cette même question fait aussi l'objet de controverses dans la communauté académique. En effet, les sciences de gestion sont une des plus jeunes sciences sociales, et leur statut épistémologique suscite encore aujourd'hui de nombreux débats sur leur scientificité. David et al. (2008) signalent que la gestion souffre d'un déficit d'identité, et le contexte lié à la crise économique actuelle interroge sur l'intérêt pratique des recherches effectuées dans ce domaine