ABSTRACT
BACKGROUND: Long-term residential care facilities and nursing homes are known to be particularly vulnerable to viral respiratory diseases and have expressed the need for multidisciplinary collaboration to help manage outbreaks when they occur. METHOD: In April 2020, Tours University Medical Center created a multidisciplinary mobile team to help local nursing homes deal with outbreaks of coronavirus disease 2019 (COVID-19). The team included a geriatrician, infectious disease experts, and palliative care specialists. RESULTS: On April 8th, 2020, the first intervention took place in a 100 residents nursing home with a total of 18 confirmed cases among 26 symptomatic residents and five deaths. The nursing home staffs' main requests were a multidisciplinary approach, consensus decision-making, and the dissemination of information on disease management. CONCLUSION: Three lessons emerged from this collaboration: (i) intensify collaborations between hospitals and nursing homes, (ii) limit disease transmission through the use of appropriate hygiene measures, broad screening, and the isolation of sick residents and sick employees, and (iii) provide sufficient human resources.
Subject(s)
COVID-19 , Academic Medical Centers , Humans , Nursing Homes , SARS-CoV-2ABSTRACT
Candida nivariensis is a cryptic fungal species classified within the Candida glabrata complex. It was described for the first time in 2005 by the means of DNA sequencing. We report a rare case of C. nivariensis deep-seated infection occurring in a 77-year-old man hospitalized for cysto-prostatectomy. Phenotypic testing based on the direct examination and the macroscopic features of the in vitro culture initially suggested C. glabrata species, while MALDI-TOF mass spectrometry enables correct identification. The isolate was found resistant to fluconazole, like in almost 20% of the reported cases. Herein, we present our practical strategy to reliably characterize this rare cryptic species. To date, MALDI-TOF mass spectrometry-based analysis showed very good results for such a purpose.
Subject(s)
Candidemia/microbiology , Saccharomycetales/classification , Saccharomycetales/isolation & purification , Adenocarcinoma of Lung/complications , Adenocarcinoma of Lung/immunology , Adenocarcinoma of Lung/microbiology , Aged , Candidemia/etiology , Carcinoma, Transitional Cell/microbiology , Carcinoma, Transitional Cell/pathology , France , Humans , Lung Neoplasms/complications , Lung Neoplasms/immunology , Lung Neoplasms/microbiology , Male , Microbial Sensitivity Tests , Mycological Typing Techniques/methods , Recurrence , Urinary Bladder Neoplasms/microbiology , Urinary Bladder Neoplasms/pathology , Urothelium/pathologyABSTRACT
BACKGROUND: CMV infections are the most frequent congenital infections worldwide. AIM: Assess the cost-effectiveness of vaccination strategies of adolescent girls vs. current practice (hygiene counseling) to prevent CMV seroconversions during pregnancy in France. METHOD: A Markov decision-tree model simulated overtime the trajectory of a single fictive cohort of 390,000 adolescent women aged 14â¯years old, living in France. Impact of vaccination was explored until the end of their reproductive live 40â¯years later. STRATEGIES COMPARED: "S1: No vaccination" (current practice); "S2: Routine vaccination"; "S3: Screening and vaccination of the seronegative". MODEL PARAMETERS: Seroconversion rate without vaccination (0.035%/pregnant woman-week); fetal transmission risk (41%). Vaccine vs. no vaccination: a 50% decrease in maternal seroconversions. OUTCOMES: Quality-Adjusted Life-Years (QALYs) of the cohort-born babies; discounted costs; Incremental Cost-Effectiveness Ratio (ICER). RESULTS: S2 was the most effective strategy (with 35,000 QALYs gained) and the most expensive (211,533,000); S1 was the least effective and least costly (75,423,000). ICERs of strategy S3 vs. S1, and S2 vs. S3 were 6,000/QALY gained (95% uncertainty range [2700-13,300]) and 16,000/QALY [negative ICER (S3 dominated by S2) - 94,000] gained, respectively; highly cost-effective because ICERâ¯<â¯1∗France's GPD/capitaâ¯=â¯30,000. SENSITIVITY ANALYSIS: If the seroprevalence was >62% (vs. 20% in the base case), S3 would become the most efficient strategy. CONCLUSION: In France, systematic vaccination of adolescent girls was the most efficient strategy to prevent maternal seroconversions. If the population was less than 62% immune, systematic screening and vaccination of susceptibles would become the most cost-effective approach.
