Investigation of antibiotics in health care wastewater in Ho Chi Minh City, Vietnam.

Hospital wastewater contains huge amounts of hazardous pollutants which are being discharged daily to environment with or without treatment. Antibiotics were among the important group of pharmaceuticals considered as a potential source of health risk for human and other living creatures. Although the investigations about the existence of antibiotics in hospital wastewater have gained concern for researchers in many countries, there is only one research conducted in Hanoi-Vietnam. Hence, in this study, investigations have been done to fulfill the requirement of real situation in Vietnam by accomplishing survey for 39 health care facilities in Ho Chi Minh City. As results, seven popular antibiotics were detected to exist in all samples such as sulfamethoxazole (2.5 ± 1.9 µg/L), norfloxacin (9.6 ± 9.8 µg/L), ciprofloxacin (5.3 ± 4.8 µg/L), ofloxacin (10.9 ± 8.1 µg/L), erythromycin (1.2 ± 1.2 µg/L), tetracycline (0.1 ± 0.0 µg/L), and trimethoprim (1.0 ± 0.9 µg/L). On the other hand, survey also showed that only 64% of health care facilities using conventional activate sludge (AS) processes in wastewater treatment plants (WWTPs). As a consequence, basic environmental factors (BOD5, COD, TSS, NH4+-N, or total coliforms) were not effectively removed from the hospital wastewater due to problems relating to initial design or operational conditions. Therefore, 18% effluent samples of the surveyed WWTPs have exceeded the national standard limits (QCVN 28:2010, level B).

Evaluation of the PRADO home discharge support programme for orthopaedic surgery in 2018.

BACKGROUND: Between 2015 and 2017, nearly 80,000 hospital stays in orthopaedic surgery were entered into a home discharge support programme (PRADO) offered by the statutory health insurance system. The objective of this study was to assess the impact of the PRADO programme on enrolled stays in orthopaedic surgery over the last three years. HYPOTHESIS: The home discharge support programme used in orthopaedic surgery shortens hospital stays and decreases the rate of readmission within 30days. MATERIAL AND METHODS: The home discharge support programme PRADO was evaluated both quantitatively and qualitatively. The quantitative study used a multicentre retrospective cohort design with matching to controls identified in the national healthcare database. All hospital stays entered into the home discharge support programme between January 2015 and December 2017 were enrolled in the study. Follow-up was 6months after discharge. The main outcome measure was the rate of readmission within 30days after discharge. The secondary outcome measures were emergency department visits, admission to rehabilitation, mean stay duration, visits to recommended healthcare professionals, medication consumption, and total healthcare expenditure at 6months. The statistical analysis used the per protocol approach. The qualitative study involved semi-structured individual and group interviews designed to investigate adhesion of the professionals and their perceptions of programme implementation, funding, and costs. RESULTS: Of 82,202 stays in the programme, 71,761 (87%) were matched and included in the analysis. Characteristics were comparable between the programme stays and the control stays. The programme stays had a significant reduction in the number of all-cause ambulatory and non-ambulatory readmissions (4.5% vs. 4.9%, p<0.0001 and 3.9% vs. 4.2%, p=0.0009, respectively). Emergency department visits and rehabilitation admissions within 30days were significantly less common in the programme group than in the control group (mean values, 2.1% vs. 2.3%, p=0.01 and 3.4% vs. 8.4%, p≤0.0001, respectively). Mean stay length was not significantly different between the two groups. Visits to recommended healthcare professionals occurred significantly more often and earlier in the programme group. The delivery of analgesics and heparin was significantly higher in the programme group, whereas no difference occurred in the delivery of antibiotics. Mean total health expenditures at 6months were lower in the programme group (2248 € vs. 2485 €). The success of the PRADO programme was dependent on leadership from the medical staff within the institution and on assistance provided by the hospital throughout its implementation. The criteria for patient eligibility to the programme were not routinely shared by or clear to the healthcare staff. DISCUSSION: The PRADO programme effectively improves the care of orthopaedic surgery patients and raises the issue of whether some admissions to rehabilitation may be unnecessary. LEVEL OF EVIDENCE: III; comparative retrospective study.

Personalized Reimbursement Model (PRM) program: A real-world data platform of cancer drugs use to improve and personalize drug pricing and reimbursement in France.

OBJECTIVE: This article describes the Personalized Reimbursement Model (PRM) program methodology, limitations, achievement and perspectives in using real-world data of cancer drugs use to improve and personalize drug pricing and reimbursement in France. MATERIALS AND METHODS: PRM platform aggregates Electronic Pharmacy Records (EPR) data from French medical centers (PRM centers) to build retrospective cohorts of patients treated with injectable cancer drugs in a hospital setting. Data extracted on January 1st, 2020, from breast cancer (BC) patients who received trastuzumab, trastuzumab emtansin or pertuzumab since January 1st, 2011, and from lung cancer (LC) patients who received bevacizumab or atezolizumab since January 1st, 2015, enabled recovering their injectable cancer drugs history from diagnosis date until December 30th, 2019, and served as dataset for assessment. RESULTS: 123 PRM centers provided data from 30,730 patients (25,660 BC and 5,070 LC patients respectively). Overall, 20,942 (82%) of BC and 4,716 (93%) of LC patients were analyzed. Completion rate was above 98% for patients characteristics, diagnostic and treatment related data. PRM centers cover 48% and 33% of BC and LC patients in-hospital therapeutic management in France, respectively. Distribution of BC and LC patients therapeutic management, by medical center category and geographic location, was similar in PRM centers to all French medical centers, ensuring the representativeness of the PRM platform. CONCLUSION: PRM Platform enabled building a national database generating on demand Real-World Evidence based on EPR. This enabled the first performance-based risk-sharing arrangements based on PRM data, between the CEPS and Roche, for atezolizumab cancer immunotherapy in metastatic non-small cell lung cancer indication.

Removal of antibiotics in sponge membrane bioreactors treating hospital wastewater: Comparison between hollow fiber and flat sheet membrane systems.

Hollow fiber (HF) and flat sheet (FS) Sponge MBRs were operated at 10-20 LMH flux treating hospital wastewater. Simultaneous nitrification denitrification (SND) occurred considerably with TN removal rate of 0.011-0.020mg TN mgVSS-1d-1. Furthermore, there was a remarkable removal of antibiotics in both Sponge MBRs, namely Norfloxacin (93-99% (FS); 62-86% (HF)), Ofloxacin (73-93% (FS); 68-93% (HF)), Ciprofloxacin (76-93% (FS); 54-70% (HF)), Tetracycline (approximately 100% for both FS and HF) and Trimethoprim (60-97% (FS); 47-93% (HF). Whereas there was a quite high removal efficiency of Erythromycin in Sponge MBRs, with 67-78% (FS) and 22-48% (HF). Moreover, a slightly higher removal of antibiotics in FS than in HF achieved, with the removal rate being of 0.67-32.40 and 0.44-30.42µgmgVSS-1d-1, respectively. In addition, a significant reduction of membrane fouling of 2-50 times was achieved in HF-Sponge MBR for the flux range.

Does low to moderate environmental exposure to noise and air pollution influence preterm delivery in medium-sized cities?

Background: Preterm birth (PB) is an important predictor of childhood morbidity and educational performance. Beyond the known risk factors, environmental factors, such as air pollution and noise, have been implicated in PB. In urban areas, these pollutants coexist. Very few studies have examined the effects of multi-exposure on the pregnancy duration. The objective of this study was to analyse the relationship between PB and environmental chronic multi-exposure to noise and air pollution in medium-sized cities. Methods: A case-control study was conducted among women living in the city of Besançon (121 671 inhabitants) or in the urban unit of Dijon (243 936 inhabitants) and who delivered in a university hospital between 2005 and 2009. Only singleton pregnancies without associated pathologies were considered. Four controls were matched to each case in terms of the mother's age and delivery location. Residential noise and nitrogen dioxide (NO2) exposures were calculated at the mother's address. Conditional logistic regression models were applied, and sensitivity analyses were performed. Results: This study included 302 cases and 1204 controls. The correlation between noise and NO2 indices ranged from 0.41 to 0.59. No significant differences were found in pollutant exposure levels between cases and controls. The adjusted odds ratios ranged between 0.96 and 1.08. Sensitivity analysis conducted using different temporal and spatial exposure windows demonstrated the same results. Conclusions: The results are in favour of a lack of connection between preterm delivery and multi-exposure to noise and air pollution in medium-sized cities for pregnant women without underlying disease.