Clinical impact and cost-consequence analysis of ePlex® blood culture identification panels for the rapid diagnosis of bloodstream infections: a single-center randomized controlled trial.

To assess clinical impact and perform cost-consequence analysis of the broadest multiplex PCR panels available for the rapid diagnosis of bloodstream infections (BSI). Single-center, randomized controlled trial conducted from June 2019 to February 2021 at a French University hospital with an institutional antimicrobial stewardship program. Primary endpoint was the percentage of patients with optimized antimicrobial treatment 12 h after transmission of positivity and Gram stain results from the first positive BC. This percentage was significantly higher in the multiplex PCR (mPCR) group (90/105 = 85.7% %, CI95% [77.5 ; 91.8] vs. 68/107 = 63.6%, CI95% [53.7 ; 72.6]; p < 10- 3) at interim analysis, resulting in the early termination of the study after the inclusion of 309 patients. For patients not optimized at baseline, the median time to obtain an optimized therapy was much shorter in the mPCR group than in the control group (6.9 h, IQR [2.9; 17.8] vs. 26.4 h, IQR [3.4; 47.5]; p = 0.001). Early optimization of antibiotic therapy resulted in a non-statistically significant decrease in mortality from 12.4 to 8.8% (p = 0.306), with a trend towards a shorter median length of stay (18 vs. 20 days; p = 0.064) and a non-significant reduction in the average cost per patient of €3,065 (p = 0.15). mPCR identified all the bacteria present in 88% of the samples. Despite its higher laboratory cost, the use of multiplex PCR for BSI diagnosis leads to early-optimised therapy, seems cost-effective and could reduce mortality and length of stay. Their impact could probably be improved if implemented 24/7.

Effect of Milliamperage Reduction on Pre-surgical Implant Planning Using Cone Beam Computed Tomography by Surgeons of Varying Experience.

BACKGROUND: Differences in CBCT units and the lack of standardization result in exposure to radiation doses beyond what is required for diagnostic purposes, especially when planning the surgical placement of dental implants. AIM: To assess the influence of low- and high-dose milliamperage settings on CBCT images for objective and subjective implant planning among senior specialists (5 years of experience) and juniors (fresh graduates). MATERIALS AND METHODS: Two dry skulls (4 hemi-maxillary segments of the maxilla and 4 hemi-maxillary segments of the mandible) were scanned under low (2 mA) and high (6.3 mA) dosage settings using the Carestream CS 9300 machine. Cross-sectional slices of both image qualities were evaluated by the 5 seniors and the 5 juniors for subjective image utility for implant planning and for objective linear bone measurements. RESULTS: There were no significant differences in bone measurements taken on high- or low-dose images by all seniors and by the majority of juniors (p > 0.05). In qualitative image assessments, there was independence between assessment and image quality for almost all observers. For planning posterior mandibular implant placement, increased dosage improved concordance and kappa values between low- and high-dose images for senior observers (from K = 0.287 at low dose to K = 0.718 at high does) but not for juniors (K = 0.661 and K = 0.509 for low and high dose, respectively). CONCLUSION: Reduction in milliamperage did not affect diagnostic image quality for objective bone measurements and produced sufficient concordance for qualitative assessment. Judicious optimization of milliamperage settings based on individual diagnostic requirements can result in significant dose reduction without compromising diagnostic decision-making.

Sinus floor elevation with a crestal approach using a press-fit bone block: a case series.

This prospective study aimed to provide detailed clinical information on a sinus augmentation procedure, i.e., transcrestal sinus floor elevation with a bone block using the press-fit technique. A bone block is harvested with a trephine burr to obtain a cylinder. This block is inserted into the antrum via a crestal approach after creation of a circular crestal window. Thirty-three patients were treated with a fixed prosthesis supported by implants placed on 70 cylindrical bone blocks. The mean bone augmentation was 6.08±2.87 mm, ranging from 0 to 12.7 mm. Only one graft failed before implant placement. During surgery and the subsequent observation period, no complications were recorded, one implant was lost, and no infection or inflammation was observed. This proof-of-concept study suggests that the use of a bone block inserted into the sinus cavity via a crestal approach can be an alternative to the sinus lift procedure with the creation of a lateral window. It reduces the duration of surgery, cost of treatment, and overall discomfort.

[Influence of hospital location on short-term fate of premature infants born at 34 weeks of gestation]. / Influence du lieu d'hospitalisation sur le devenir à court terme des prématurés nés à 34 semaines d'aménorrhée.

In France, new care units have emerged in maternity wards for the treatment of moderate prematurity, called mother-child units (MCU). We compared the length of hospitalization between the MCUs and the neonatal units (NNUs) for premature infants born at 34 weeks of amenorrhea at Grenoble university hospital. This was a retrospective, single-center study, including 99 premature infants born from 34 of amenorrhea to 34 weeks+6 days between 2004 and 2009. Were included all premature 34-week infants hospitalized in the NNU or the MCU excluding those with respiratory distress, birth defects, and including infants whose birth weight was less than 1500g admitted to the neonatal intensive care unit or transferred secondarily to the MCU. The characteristics of both groups were similar apart from a lower birth weight in the NNU group (1892 vs. 2182g) and gestational age less than in the NNU group (34.1 vs. 34.3 SA). Our primary outcome, length of hospital stay, was significantly shorter in the MCU (15.4 vs. 20.7 days in the NNU, P<0.01) as well as the duration of nasogastric tube feeding (2.8 vs. 9.1 days, P<0.01). This difference remained after adjustment for birth weight and gestational age. Our retrospective study shows that the length of hospitalization of premature infants born at 34 weeks gestation and hospitalized in our center is significantly shorter when they are admitted to the MCU rather than neonatology. For this reason, this mode of hospitalization in maternity MCUs can be recommended.

[Preterm births circumstances in babies born before 35 weeks in French Alpes: PREMALP study]. / Etude des circonstances de naissance prématurée avant 35SA dans le sillon alpin : étude PREMALP.

OBJECTIVES: In a regional study of preterm infants born before 35weeks of gestation, the aim was to propose a new classification of preterm births into three groups, and to describe the pregnancy complications and fetal disorders in each group. PATIENTS AND METHODS: In two areas covered by a perinatal network, all preterm births, live births and stillbirths, which occurred between 22 and 34 completed weeks were recorded over a 21-month period. Each case was classified either in the medically-indicated preterm birth (I) group, or in the accepted spontaneous preterm birth (ASp) group or in the non-accepted spontaneous preterm birth (NASp) group. RESULTS: One thousand and sixty cases of preterm births were included; among them, 981 were live births or ended with per partum infant death. Forty-nine percent of these births were medically indicated, 32 % were ASp and 19 % were NASp. The distribution of pregnancy complications and fetal disorders differed between preterm birth groups: ischemic placental diseases were present in 38,2 % of medically-indicated births; preterm premature rupture of membranes occurred twice more often in I and ASp preterm births than in NASp preterm births. CONCLUSION: This classification is based on the medical decision; it allows to compare medical practices in given obstetrical situations. It appears to be reproducible and easy to use.

[Tobacco consumption among young adults in the two French departments of Savoie in 2008]. / Modes de consommation du tabac des jeunes adultes des deux Savoies en 2008.

BACKGROUND: As a result of tobacco control measures in France, smoking among adolescents is decreasing. However, this decrease is associated with changes in the way youth are consuming tobacco and turning towards new tobacco products: cheaper forms of tobacco such as rolling or chewing tobacco, or fashionable forms such as narghile. The aim of this study is to describe in young adults: (1) prevalence of tobacco use and main risk factors of daily smoking, (2) the entry mode for tobacco use and (3) prevalence and main risk factors related to "chewing tobacco" used as snuff. METHODS: A descriptive transversal study was undertaken in five private and public high schools in the French Alps region in 2008. Anonymous questionnaires were given out to the students of 12th grade (last year of general secondary education) and BTS (professional training). Smoking prevalence and other forms of tobacco consumption were described, as well as the entry mode in tobacco use. Finally, we used logistic models to identify the main determinants of smoking cigarettes and using chewing tobacco. RESULTS: This study included 920 students: 22.3% (95% IC: 19.6-25.0) were daily smokers and 65.9% (95% IC: 62.8-69.0) had tried tobacco. Approximately 40% had experimented with rolling tobacco, cannabis or narghile. We found the usual determinants of daily smoking: an environment conducive to smoking, and not belonging to a sports club. Around 11% (95% IC: 9.2-13.2) had tried chewing tobacco. Risk factors associated with chewing tobacco were: having a smoking friend (adjusted OR: 3.07; 95% IC: 1.95-4.83), studying in a private school (adjusted OR: 2.57; 95% IC: 1.52-4.31), or being male (adjusted OR: 1.79; 95% IC: 1.15-2.79). CONCLUSION: As found in national studies, cigarette smoking is declining among young adults, but the use of other tobacco products (narghile, chewing tobacco) is emerging. The relatively high consumption rate and the risk factors of chewing tobacco need to be examined in depth in order to organize prevention programs for young adults.