Objectives
Autism spectrum disorder (ASD) has a major impact on caregivers. We aimed to describe caregivers’ perceptions concerning their level of knowledge about ASD and their needs to better adapt ...education and training programs.
Methods
This was a descriptive cross-sectional study conducted through a declarative and self-administered survey in France.
Results
1,013 individuals answered the questionnaire in 2020. If most caregivers felt they had sufficient knowledge about ASD, they still expressed a high level of needs regarding acquiring knowledge, identifying available resources, and finding social/emotional support.
Conclusions
This study highlights the high level of needs of caregivers and their expectations of improving their knowledge and skills to help the person with ASD.
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Background: Despite being recommended early in the course of advanced cancer, palliative care (PC) referral remains often late. Taking into account limited PC resources, ...disease-specific referral criteria and models of care need to be explored. In a previous work, we showed that a weekly onco-palliative meeting (OPM) allowed earlier introduction of the PC team (PCT) and decreased aggressiveness of end-of-life (EOL) care1. We describe patient’s profile when first referred to this Integrated Onco-Palliative Care program (IOPC), the timing of the referral relatively to the course of his/her disease and the impact on the trajectory of EOL care. Methods: The IOPC of our University Hospital combined a weekly OPM, dedicated to patients with incurable diseases for whom goals and organization of care need to be discussed, and/or clinical evaluation with possible follow-up by the PCT. We retrospectively analysed all patients reported for the first time at OPM between 2011 and 2013. We calculated an index of precocity, defined as the ratio of time from the first referral to death and the time from the diagnosis of incurability to death, with values ranging from 0 (late referral) to 1 (early referral). Results: Of the 416 patients included, 57% presented with lung cancer, urinary carcinoma and sarcoma. At first referral to IOPC program, 76% were receiving chemotherapy, 63% were outpatients, 56% had a PS ≤ 2 and 46% had a serum albumin level > 35g/l. The median (1
st
-3
rd
quartile) index of precocity was 0.39 (0.16-0.72), ranging between 0.53 (0.20-0.79) (earliest, for lung cancer) to 0.16 (0.07-0.56) (latest, for prostate cancer). Among 367 decedents, 42 (13%) received chemotherapy within 14 days before death, 157 (43%) died in hospice care setting. Conclusions: Most patients first referred to IOPC were still under antitumoral treatment and had intermediate prognostic markers. However the time of referral between diagnosis of incurability and death is highly variable according to cancer type, and should probably be adapted while therapies progress.
1
Colombet I, et al. Effect of integrated palliative care on the quality of end-of-life care: retrospective analysis of 521 cancer patients. BMJ Support Palliat Care. 2012;2(3):239–47
Pelagic cyanobacteria are key players in the functioning of aquatic ecosystems, and their viruses (cyanophages) potentially affect the abundance and composition of cyanobacterial communities. Yet, ...there are few well-described freshwater cyanophages relative to their marine counterparts, and in general, few cyanosiphoviruses (family
) have been characterized, limiting our understanding of the biology and the ecology of this prominent group of viruses. Here, we characterize S-LBS1, a freshwater siphovirus lytic to a phycoerythrin-rich
isolate (Strain TCC793). S-LBS1 has a narrow host range, a burst size of ∼400 and a relatively long infecting step before cell lysis occurs. It has a dsDNA 34,641 bp genome with putative genes for structure, DNA packing, lysis, replication, host interactions, DNA repair and metabolism. S-LBS1 is similar in genome size, genome architecture, and gene content, to previously described marine siphoviruses also infecting PE-rich
, e.g., S-CBS1 and S-CBS3. However, unlike other
phages, S-LBS1 encodes an integrase, suggesting its ability to establish lysogenic relationships with its host. Sequence recruitment from viral metagenomic data showed that S-LBS1-like viruses are diversely present in a wide range of aquatic environments, emphasizing their potential importance in controlling and structuring
populations. A comparative analysis with 16 available sequenced cyanosiphoviruses reveals the absence of core genes within the genomes, suggesting high degree of genetic variability in siphoviruses infecting cyanobacteria. It is likely that cyanosiphoviruses have evolved as distinct evolutionary lineages and that adaptive co-evolution occurred between these viruses and their hosts (i.e.,
,
, and
), constituting an important driving force for such phage diversification.
The intensive care unit (ICU) environment is prone to the risk of adverse events (AEs) and medication errors (MEs). The objective of this work was to describe a multidisciplinary safety program ...focused on AE and ME reporting and review in an ICU over a 7-year period.
The program was implemented in an 18-bed medical ICU of a 2,200-bed university hospital. A multidisciplinary steering committee (intensivist, clinical pharmacist, nurses, and research assistants) met monthly. The first part of the meeting was dedicated to the review of events targeted through an internal voluntary reporting system, and the second part concerned the analysis of the previous month's events, according to a standardized method called Orion, inspired by the aeronautic industry.
A total of 808 AEs were reported, mostly related to medication processes (30.3% and 33.4% for prescription and administration, respectively). Among these, 526 AEs were related to medications (65.1%), of which 464 were MEs (88.2%). These MEs concerned mostly anti-infective drugs (23.5%) and related to wrong doses (35.8%). Among all AEs reported, 58 (43 MEs 74.1%) were analyzed further and found to be associated with anti-infective (16.1%) and vasoactive drugs (16.1%). According to National Coordinating Council for Medication Error Reporting and Prevention classification, most AEs caused no harm to patients (category A-D: 38 events, 65.5%). Nurses were most often involved in the analysis (50.7%), along with pharmacists (37.5%). Training was identified as the most frequent corrective action (45.1%).
This program dedicated to AE and ME reporting, review, and analysis in ICU showed long-term engagement of the health care team in AE surveillance and helped in targeting measures for education, organization, and promoting teamwork and safety.
Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient's profile when first ...referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life.
The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011-2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral).
Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level > 35 g/l. The median 1st-3rd quartile IP was 0.39 0.16-0.72, ranging between 0.53 0.20-0.79 (earliest referral, i.e. close to diagnosis of incurability, for lung cancer) to 0.16 0.07-0.56 (latest referral, i.e. close to death relatively to length of metastatic disease, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units.
The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the timing of referral to IOPC, while taking into account each cancer types and therapeutic advances.
Objective To determine the association between surgeons’ experience and postoperative complications in thyroid surgery.Design Prospective cross sectional multicentre study.Setting High volume ...referral centres in five academic hospitals in France.Participants All patients who underwent a thyroidectomy undertaken by every surgeon in these hospitals from 1 April 2008 to 31 December 2009.Main outcome measures Presence of two permanent major complications (recurrent laryngeal nerve palsy or hypoparathyroidism), six months after thyroid surgery. We used mixed effects logistic regression to determine the association between length of experience and postoperative complications. Results 28 surgeons completed 3574 thyroid procedures during a one year period. Overall rates of recurrent laryngeal nerve palsy and hypoparathyroidism were 2.08% (95% confidence interval 1.53% to 2.67%) and 2.69% (2.10% to 3.31%), respectively. In a multivariate analysis, 20 years or more of practice was associated with increased probability of both recurrent laryngeal nerve palsy (odds ratio 3.06 (1.07 to 8.80), P=0.04) and hypoparathyroidism (7.56 (1.79 to 31.99), P=0.01). Surgeons’ performance had a concave association with their length of experience (P=0.036) and age (P=0.035); surgeons aged 35 to 50 years had better outcomes than their younger and older colleagues.Conclusions Optimum individual performance in thyroid surgery cannot be passively achieved or maintained by accumulating experience. Factors contributing to poor performance in very experienced surgeons should be explored further.
Background Permanent recurrent laryngeal nerve palsy and hypoparathyroidism are 2 major complications after thyroid operation. Assuming that the rate of immediate complications can predict the ...permanent complication rate, some authors consider these complications as a valid metric for assessing the performance of individual surgeons. This study aimed to determine the correlation between rates of immediate and permanent complications after thyroidectomy at the surgeon level. Methods We conducted a prospective, cross-sectional study in 5 academic hospitals between April 2008 and December 2009. The correlation between the rates of immediate and permanent complications for each of the 22 participating surgeons was calculated using the Pearson correlation test (r). Results The study period included 3,605 patients. There was a fairly good correlation between rates of immediate and permanent recurrent laryngeal nerve palsy (r = 0.70, P = .004), but no correlation was found for immediate and permanent hypoparathyroidism (r = 0.18, P = .427). Conclusion The immediate hypoparathyroidism rate does not reflect the permanent hypoparathyroidism rate. Consequently, immediate hypoparathyroidism should not be used to assess the quality of thyroidectomy or to monitor the performance of surgeons.
Background
Evidence is lacking regarding the potential association between daily variation in individual surgeon’s operative time, procedure after procedure, and risk of patient complication. We ...assumed that surgeon deviation from the expected procedure duration may be harmful for patient.
Method
All patients who underwent a thyroidectomy undertaken in five hospitals during a 1-year period were included prospectively. For each thyroidectomy, we estimated the expected operative time from a multilevel linear regression considering the attending surgeon who performed the operation, the patient preoperative risk, and the procedure complexity. Three groups of thyroidectomies were identified according to whether the observed duration is: slower than expected, as expected, or faster than expected. Rates of permanent recurrent laryngeal nerve palsy and hypoparathyroidism at 6 months were then compared between these groups.
Results
A total of 3102 patients who underwent a thyroidectomy undertaken by 22 surgeons were considered. Risk of laryngeal nerve palsy was higher in the “slow” group than in the “normal” group (OR = 4.63, 95% confidence interval 2.21–9.70), as was that of hypoparathyroidism (OR = 2.43, 95% confidence interval 1.21–4.88). There was no significant difference between “fast” and “normal” groups for either complication. Deviation from expected procedure duration was more frequent at the end than at the beginning of the daily operation schedule (29.4% vs. 18.3%, respectively,
P
< .001).
Conclusion
Patients had a greater risk of complication when the surgeon performed thyroidectomy slower than expected. Surgeons avoiding excessive deviations from their expected procedures durations reflect safer practice.
Efforts to provide a valid picture of surgeons' individual performance evolution should frame their outcomes in relation to what is expected depending on their experience. We derived the learning ...curve of young thyroidectomy surgeons as a baseline to enable the accurate assessment of their individual outcomes and avoid erroneous conclusions that may derive from more traditional approaches.
Operative time and postoperative recurrent laryngeal nerve palsy of 2006 patients who underwent a thyroidectomy performed by 19 young surgeons in five academic hospitals were monitored from April 2008 to December 2009. The database was randomly divided into training and testing datasets. The training data served to determine the expected performance curve of surgeons during their career and factors influencing outcome variation using generalized estimating equations (GEEs). To simulate prospective monitoring of individual surgeon outcomes, the testing data were plotted on funnel plots and cumulative sum charts (CUSUM). Performance charting methods were utilized to present outcomes adjusted both for patient case-mix and surgeon experience.
Generation of performance curves demonstrated a gradual reduction in operative time from 139 (95% CI, 137 to 141) to 75 (71 to 80) minutes, and from 15.7% (15.1% to 16.3%) to 3.3% (3.0% to 3.6%) regarding the nerve palsy rate. Charts interpretation revealed that a very young surgeon had better outcomes than expected, whereas a more experienced surgeon appeared to be a poor performer given the number of years that he had already spent in practice.
Not considering the initial learning curve of surgeons exposes them to biased measurement and to misinterpretation in assessing their individual performance for thyroidectomy. The performance chart represents a valuable tool to monitor the outcome of surgeons with the expectation to provide safe and efficient care to patients.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The aim of the CAPABLE project was to identify management practices of Cirsium arvense, Rumex crispus and Rumex obtusifolius. To meet this objective, various tasks were carried out, combining ...designing of solutions with practitioners, trials and the development of management decision-making tool (only for Cirsum arvense). Thanks to the results obtained, several practices have been identified, including innovative solutions that will need to be evaluated in further work. The project also provided an opportunity to highlight the methodological difficulties inherent in work dedicated to perennial weeds.
Le projet CAPABLE avait pour objectif d’identifier les leviers de gestion du chardon vivace et des rumex (parelle crépue et à feuilles obtuses). Pour répondre à cet objectif, divers travaux ont été menés, alliant la recherche de solutions auprès des praticiens, des essais sur chardon et rumex et le calage d’un outil d’aide à la décision sur la gestion du chardon. Grace aux résultats obtenus, plusieurs leviers de gestion ont été identifiés notamment des solutions innovantes (ex binage des céréales, outils adaptés…) qu’il sera nécessaire d’évaluer dans des travaux ultérieurs. Le projet a été aussi l’occasion de relever les difficultés méthodologiques inhérentes aux travaux dédiés aux adventices vivaces.
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