Clostridioides difficile infection (CDI): A pan-European multi-center cost and resource utilization study, results from the Combatting Bacterial Resistance in Europe CDI (COMBACTE-CDI).

OBJECTIVES: Clostridioides difficile infection (CDI) is one of the leading nosocomial infections worldwide, resulting in a significantly increasing burden on the healthcare systems. However, Pan-European data about cost and resource utilization of CDI treatment do not exist. METHODS: A retrospective analysis within the Combatting Bacterial Resistance in Europe CDI project was conducted based on resource costs for inpatient treatment and productivity costs. Country-specific cost values were converted to EURO referred to 1 January, 2019 values. Differences in price levels for healthcare services among the participating countries were adjusted by using an international approach of the Organisation for Economic Co-operation and Development. As the study focused on patients with recurrent CDI, the observed study population was categorized into (a) patients with CDI but without CDI recurrence (case group), (b) patients with CDI recurrence (recurrence group), and (c) patients without CDI (control group). RESULTS: Overall, 430 hospitalized patients from 12 European countries were included into the analysis between July 2018 and November 2018. Distribution of mean hospital length of stay and mean overall costs per patient between the case group, recurrence group, and control group were as follows: 22 days (95% CI 17-27 days) vs. 55 days (95% CI 17-94 days) vs. 26 days (95% CI 22-31 days; p 0.008) and € 15 242 (95% CI 10 593-19 891) vs. € 52 024 (95% CI 715-103 334) vs. € 21 759 (95% CI 16 484-27 035; p 0.010), respectively. The CDI recurrence rate during the observational period was 18%. Change escalation in CDI medication (OR 3.735) and treatment in an intensive care unit (OR 5.454) were found to be the most important variables associated with increased overall costs of patients with CDI. CONCLUSIONS: Treatment of patients with recurrent CDI results in a significant burden. Prevention of CDI recurrences should be in focus of daily patient care to identify the most cost-effective treatment strategy.

A purakau analysis of institutional barriers facing Maori occupational therapy students.

INTRODUCTION: Across Aotearoa (New Zealand), there are chronic shortages of qualified Maori (Indigenous peoples of Aotearoa) health practitioners and systemic ethnic health inequities. This study, focussing on the discipline of occupational therapy, explores Maori graduates' recollections of the institutional barriers that impacted on their study in this field over a 25-year period. METHODS: This qualitative study interviewed seven Maori occupational therapy graduates using purakau-an innovative Maori narrative inquiry method. Purakau (stories) were collected in 2018 via kanohi ki te kanohi (face to face) semi-structured interviews. They were analysed using the kaupapa Maori (Maori philosophical) framework of Pu-Ra-Ka-U which draws on traditional Maori matauranga (knowledge). FINDINGS: The institutional barriers identified were (1) cultural dissonance, (2) cultural (in)competency and (3) the limitations of (Western) pastoral care. CONCLUSION: This study highlighted how racism is embedded within the Western tertiary education system. To create a safe learning environment for Maori students, tertiary education institutions require a planned approach to address racism within policy, procedures, the curriculum, teaching and professional staff.

Opportunities and constraints for developing a sustainable E-waste management system at local government level in Australia.

E-waste refers to both electronic and electrical waste materials; namely any items which rely on an electric current or electromagnetic fields in order to operate, and contain a hard-drive or significant electronic components and/or a printed circuit board. E-waste is outstripping the general growth of the municipal waste stream. Increasingly, smaller and cheaper electronic items are being disposed of in municipal waste systems and this, coupled with an increase in the number of, and turnover of manufacturers and suppliers, may see local councils assuming a key role in future e-waste management. A survey of local councils across Australia was undertaken to determine the current level of understanding and action on e-waste, and to solicit key responses regarding the identification of areas where improvements could be made. The survey achieved an overall response rate of 35%. Survey results identified key barriers experienced by councils regarding the collection and treatment of e-wastes, such as access to reprocessing facilities and the limited or complete unawareness by the public of the issues. With regards to who should pay for e-waste disposal at end-of-life, consumers and producers were most commonly cited, depending on the state with the preferred funding mechanisms being 'advanced recycling fee' and Expanded Producer Responsibility. Overwhelmingly, 88% of respondents believed that federal legislation was required to manage e-waste. Overall, the results did not indicate differences in views between states for most questions.