Point-of-care multiplex PCR promises short turnaround times for microbial testing in hospital-acquired pneumonia--an observational pilot study in critical ill patients.

BACKGROUND: The early beginning of an adequate antibiotic therapy is crucial in hospital-acquired pneumonia (HAP), but depends on the results of conventional microbiological diagnostics (cMD). It was the aim of this study to evaluate the performance and turnaround times of a new point-of-care multiplex polymerase chain reaction (mPCR) system for rapid identification of pathogens and antibiotic resistance markers. We assessed the applicability of the system under real-life conditions in critical ill patients with HAP. METHODS: We enrolled forty critical ill patients with clinical signs for HAP into an observational study. Two samples of respiratory secretions were collected during one course of aspiration and cMD and mPCR testing (Unyvero, Curetis AG, Holzgerlingen, Germany) were performed immediately. The mPCR device was operated as a point-of-care system at the intensive care unit. We compared turnaround times, results of pathogen identification and results of antibiotic resistance testing of both methods. RESULTS: Mean turnaround times (min-max) were 6.5 h (4.7-18.3 h) for multiplex PCR and 71 h (37.2-217.8 h) for conventional microbiology (final cMD results, incomplete results neglected). 60% (n = 24) of the mPCR tests were completely valid. Complete test failure occurred in 10% (n = 4) and partial test failure occurred in 30% (n = 12). We found concordant results in 45% (n = 18) and non-concordant results in 45% (n = 18) of all patients. 55% (n = 16) of the results were concordant in patients with a clinical pulmonary infection score (CPIS) > 5 (n = 29). Concordant results included three cases of multidrug resistant bacteria. MPCR frequently detected antibiotic resistance markers that were not found by cMD. CONCLUSIONS: Unyvero allowed point-of-care microbial testing with short turnaround times. The performance of the system was poor. However, an improved system with a more reliable performance and an extended microbial panel could be a useful addition to cMD in intensive care medicine. TRIAL REGISTRATION: ClinicalTrials.gov NCT01858974 (registered 16 May 2013).

Access to health care for undocumented migrant children and pregnant women: the paradox between values and attitudes of health care professionals.

Access to health care for undocumented migrant children and pregnant women confronts human rights and professional values with political and institutional regulations that limit services. In order to understand how health care professionals deal with these diverging mandates, we assessed their attitudes toward providing care to this population. Clinicians, administrators, and support staff (n = 1,048) in hospitals and primary care centers of a large multiethnic city responded to an online survey about attitudes toward access to health care services. Analysis examined the role of personal and institutional correlates of these attitudes. Foreign-born respondents and those in primary care centers were more likely to assess the present access to care as a serious problem, and to endorse broad or full access to services, primarily based on human rights reasons. Clinicians were more likely than support staff to endorse full or broad access to health care services. Respondents who approved of restricted or no access also endorsed health as a basic human right (61.1%) and child development as a priority (68.6%). A wide gap separates attitudes toward entitlement to health care and the endorsement of principles stemming from human rights and the best interest of the child. Case-based discussions with professionals facing value dilemmas and training on children's rights are needed to promote equitable practices and advocacy against regulations limiting services.

Uninsured immigrant and refugee children presenting to Canadian paediatric emergency departments: Disparities in help-seeking and service delivery.

INTRODUCTION: Access to health care for medically uninsured immigrant and refugee children is a public health concern due to the consequences of delayed or substandard care for child development and health. OBJECTIVE: To explore possible differences in help-seeking and service delivery across migratory statuses, institutions and provinces. METHODS: A review was undertaken of 2035 emergency files of immigrant, refugee and undocumented children without provincial health care coverage who sought care at three major paediatric hospitals in Montreal (Quebec) and Toronto (Ontario) during 2008 and 2009. RESULTS: Refugee claimant children with Interim Federal Health Program benefits consulted for less urgent problems than the overall hospital population, except in one hospital that had a multicultural paediatric ambulatory clinic. Undocumented children and new permanent resident immigrant children within the three-month waiting period for provincial health care coverage were over-represented in the very urgent triage category and presented more often for injuries, trauma and mental health problems than did refugee claimant children. DISCUSSION/CONCLUSIONS: Wide interhospital differences suggest that the predicament of limited access to health care of these groups of vulnerable medically uninsured children needs to be addressed through further research to inform policies and develop training.

INTRODUCTION: L'accès aux soins de santé pour les enfants immigrants et réfugiés qui n'ont pas d'assurance est un problème de santé publique, en raison des conséquences du retard des soins ou des soins de second ordre sur leur développement et leur santé. OBJECTIF: Explorer les différences possibles de recherche d'aide et de prestation des soins selon les statuts migratoires, les établissements et les provinces. MÉTHODOLOGIE: Les chercheurs ont entrepris une analyse de 2 035 dossiers urgents d'enfants immigrants, réfugiés et sans papiers, sans assurance-maladie provinciale, qui ont consulté dans trois grands hôpitaux pédiatriques de Montréal, au Québec, et de Toronto, en Ontario, en 2008 et en 2009. RÉSULTATS: Les enfants demandeurs du statut de réfugié profitant des prestations du Programme fédéral de santé intérimaire consultaient pour des problèmes moins urgents que l'ensemble de la population hospitalière, sauf dans un hôpital doté d'une clinique ambulatoire pédiatrique multiculturelle. Les enfants sans papiers et les enfants immigrants qui étaient de nouveaux résidents permanents assujettis à la période d'attente de trois mois avant d'avoir droit à l'assurance-maladie provinciale étaient surreprésentés dans la catégorie de triage très urgent et présentaient plus souvent des blessures, des traumatismes et des problèmes de santé mentale que les enfants demandeurs du statut de réfugié. EXPOSÉ ET CONCLUSIONS: D'après les vastes différences interhos-pitalières, il faudrait poursuivre les recherches sur la situation difficile causée par l'accès limité aux soins de santé de ces groupes d'enfants non assurés vulnérables pour étayer les politiques et élaborer les formations.

Efficacy of forced-air warming systems with full body blankets.

PURPOSE: Postoperative hypothermia after cardiac surgery is still a common problem often treated with forced-air warming. This study was conducted to determine the heat transfer efficacy of 11 forced-air warming systems with full body blankets on a validated copper manikin. METHODS: The following systems were tested: 1) Bair Hugger 505; 2) Bair Hugger 750; 3) Life-Air 1000 S; 4) Snuggle Warm; 5) Thermacare; 6) Thermacare with reusable Optisan blanket; 7) WarmAir; 8) Warm-Gard; 9) Warm-Gard and reusable blanket; 10) WarmTouch; and 11) WarmTouch and reusable blanket. Heat transfer of forced-air warmers can be described as follows: Q = h x DeltaT x A. Where Q = heat flux (W), h = heat exchange coefficient (W x m-2 x degrees C-1), DeltaT = temperature gradient between blanket and manikin surface (degrees C), A = covered area (m2). Heat flux per unit area and surface temperature were measured with 16 heat flux transducers. Blanket temperature was measured using 16 thermocouples. The temperature gradient between blanket and surface (DeltaT) was varied and h was determined by linear regression analysis. Mean DeltaT was determined for surface temperatures between 32 degrees C and 38 degrees C. The covered area was estimated to be 1.21 m2. RESULTS: For the 11 devices, heat transfers of 30.7 W to 77.3 W were observed for surface temperatures of 32 degrees C, and between -8.8 W to 29.6 W for surface temperatures of 38 degrees C. CONCLUSION: There are clinically relevant differences between the tested forced-air warming systems with full body blankets. Several systems were unable to transfer heat to the manikin at a surface temperature of 38 degrees C.