Epidemiology of invasive early-onset neonatal infection in a French administrative district: A 10-year population-based study.

BACKGROUND: In light of the pending update of the French guidelines for the management of neonatal infections, knowing the current epidemiology of early-onset neonatal infection (EONI) is essential. OBJECTIVES: The aim of this study was to assess the current epidemiology of a French administrative district population of proven EONI, including umbilical cord blood procalcitonin levels. METHODS: We conducted a retrospective population-based study in the Nantes metropolitan area. We included all infants treated for proven EONI in the maternity, neonatology, and intensive care wards between 1 January 2006 and 31 December 2015 in the Nantes University Hospital. RESULTS: Among the 140,502 children born during the study period, 61 cases of EONI were documented. The overall incidence of confirmed EONI was 0.43/1000 live births, with 0.23/1000 GBS (group B streptococcus) infections and 0.08/1000 Escherichia coli infections. The majority of infected newborns were full-term or late-preterm infants (67% were≥34 weeks of gestation), 88% had symptoms of EONI in the first 24h of life, most of which were respiratory. The mortality rate was 8% (in premature infants). Available in 51% of the population, the cord blood PCT value could contribute to an earlier diagnostic screening in 10% of cases but with a very low sensitivity. CONCLUSIONS: The incidence of confirmed EONI is low in this French district. The diagnostic value of PCT umbilical blood cord should be assessed based on further studies before confirming its value. We suggest that a national registry of these rare but serious cases of EONI could contribute to monitoring the epidemiological progression as well as to optimizing our diagnostic and therapeutic strategies.

Supplemental datasets for the examination of the revival of large consulting practices at the big 4 and audit quality.

These data analyses have been co-submitted to Accounting, Organizations, and Society with the research article "The Revival of Large Consulting Practices at the Big 4 and Audit Quality " [2]. The purpose of these data analyses is to assist readers of the research article in obtaining further detailed analyses performed therein regarding the channels through which audit quality is affected by consulting firm acquisitions. These analyses include 1) the timing of the effects of consulting firm acquisitions on audit quality; 2) the size of the consulting firm acquisition's effect on audit quality; 3) whether acquisitions differentially affect restatement breadth; 4) whether results are due to the PCAOB targeting offices that acquire consulting practices; and 5) whether consulting firm acquisitions affect national audit firm audit quality. These analyses can inform future research on audit quality by providing insights that may be useful in developing research ideas and performing extensions of these analyses. Some data used in these analyses are available via a subscription to the Wharton Research Data Service while other data are publicly available via search of Google, and, with subscription, via search of Factiva, and the Capital IQ database.

How valuable is feedback of information on hospital referral patterns?

OBJECTIVES: To determine general practitioners' responses to and explanations for variation in rates of referral to hospital and how feedback of data on rates of referral could be used to facilitate practices in auditing their own referral behaviour. DESIGN: Visits by audit facilitators to general practices after feedback of details of rates of referral to hospital derived from annual reports in general practice. SETTING: 92 general practices in East Anglia. RESULTS: General practitioners judged that access to specialist care, the individual skill of general practitioners, patient demand, and fear of litigation were major determinants of referral behaviour. Because there was widespread scepticism about the accuracy of the data on which the feedback was based and because there is no clear relation between rates of referral and quality of care, it was extremely difficult to encourage doctors to use the feedback as a basis for auditing their own hospital referrals. CONCLUSION: If general practitioners are to contribute meaningfully to monitoring future changes in referral patterns it will be essential to develop reliable information systems in which doctors have confidence. Furthermore, audits need to be based on analysis of clinical cases rather than on rates of referral.