[Unsafe practices fostering cutaneous abscesses in people who inject substances : Results from the ANRS-OUTSIDER study]. / Des pratiques à risque favorisant la survenue d'abcès cutanés chez les personnes qui injectent des substances : résultats de l'étude ANRS-OUTSIDER.

INTRODUCTION: Cutaneous abscesses are a common complication of intravenous substance use. Although these skin and soft tissue infections represent one of the main causes of emergency room visits and hospitalizations in people who inject drugs (PWID), data on their prevalence and causes are scarce. The present study was part of the larger ANRS-OUTSIDER project and aimed to study the factors associated with skin abscesses in PWID, focusing in particular on the different stages of injection. METHOD: Analyses were based on data of the 164 persons who regularly injected psychoactive substances participating in the French ANRS-OUTSIDER project. A face-to-face questionnaire collected data on sociodemographics, substance use, injection practices, and experience of skin abscesses in the previous six months. Factors associated with skin abscesses were studied using a logistic regression model. RESULTS: Of the 140 participants for whom abscess data were recorded at inclusion, 35% reported having a skin abscess in the previous six months. Factors associated with skin abscesses were: benefiting from universal health coverage (PUMA/CMU/AME) (Odd ratio (OR) = 0.28, confidence interval (CI) à 95%=0.08-0.99), finding the vein to inject by touch (OR=3.44, 95% CI=1.41-8.43) and licking the needle before injection (OR=5.16, 95% CI=1.10-24.30). CONCLUSION: Our results highlight that skin abscesses were very frequent among the complications observed in our sample of French PWID, and that certain injection practices fostered their occurrence. These data will provide stakeholders with useful information to improve prevention and harm reduction messages for PWID.

Representations of English- and French-speaking Internet users on urinary incontinence: a webometric study.

Urinary incontinence is a major public health problem that affects nearly 9% of the world's population. Numerous studies have defined it, as well as its frequency, contributing factors, means of prevention and therapeutic approaches, but there are very few publications on its social representations. However, the literature raises that a better understanding of the social representations associated with this phenomenon could improve its management. This study focuses on its representations, and more specifically those of Internet users. Its ambition is to bring out some of the representations related to this phenomenon and thus provide initial factual and useful elements for the following research program. We conducted a webometric study and drew on Moliner's social representations theory. Using textual and iconographic data posted on the search engines and social networks most used by Internet users between January 1st, 2015 and October 15th, 2020, this research examined how urinary incontinence is perceived by English- and French-speaking Internet users. For quantitative data analysis, two textometric analysis software packages were used: Lexico® and Iramuteq®. For qualitative data, the analysis was carried out with ATLAS Ti® 9 software. Formerly hidden, urinary incontinence seems to be nowadays less and less a taboo subject and has been arousing growing interest for several years. However, this study also highlights the many preconceived ideas, false beliefs and the obvious lack of knowledge about this phenomenon. It also shows that urinary incontinence should not be trivialized nor the difficulty for the patients concerned to live with it. This study made it possible to understand the representations that a part of the population has on the phenomenon of urinary incontinence. It was the first of a larger research program which aims at improving the care of institutionalized elderly people suffering from urinary incontinence.

Maternal mortality study in the Eastern Democratic Republic of the Congo.

BACKGROUND: The reduction of maternal mortality in developing countries such as the Democratic Republic of Congo (DRC) still raises many questions. Indeed, this large country in the heart of Africa ranks 4th among the eight countries that alone account for more than 50% of maternal deaths in the world, behind India, Nigeria and Pakistan. However, there is no up-to-date data on maternal mortality in eastern DRC. This study measures the mortality rate rate in health facilities in eastern DRC and identifies the associated risk factors. METHODS: This analytical epidemiological study was based on retrospective data materna deaths recorded in 59 health facilities, in three health zones in the southern part of Maniema province in east DRC. The study was conducted from July 1, 2015 to June 30, 2020. Descriptive, bi and multivariate analyses were used. RESULTS: The maternal mortality rate was estimated at 620 deaths per 100,000 live births, of which 46% of maternal deaths were related to a parturients' delayed decision in seeking healthcare in time (first delay). Maternal deaths were significantly associated with extreme ages (≤ 19 years and ≥ 40 years: p = < 0.001), patient parity (in primigravidas and in large multiparas: p = 0.001), complications such as hemorrhagic, (p = < 0.001), uterine ruptures:(p = < 0.001), infections, (p = < 0.001), and dystocia (p = < 0.001). CONCLUSION: Despite the efforts made by the DRC and its partners in the fight against maternal mortality, women continue to lose their lives when they decide to give birth. The results imply that it is imperative to strengthen both women and health professionals' knowledge about pregnancy and maternal health and their power to reduce instances of first delay by supporting women in formulating their birth plans.

Decisional issues in antibiotic prescribing in French nursing homes: An ethnographic study.

Background:Medication prescription is generally the responsibility of doctors. In nursing homes, the nursing staff is often the first to suspect an infection. Today, physicians are more confident with nursing assessment, relying primarily on nursing staff information. Very few studies have investigated the nurses' influence on decision of medical prescription. This study investigates the role of nurses in antibiotic prescribing for the treatment of suspected infections in nursing home residents. Design and methods:An ethnographic study based on semi-structured interviews and participant observations was conducted. Sixteen nurses and five doctors working in five nursing homes in Paris, France participated between October 2015 and January 2016. Results:Given their proximity to elderly residents, registered nurses at the nursing homes occasionally assisted doctors in their medical diagnostic. However, nurses who are theoretically incompetent have met difficulties in their ability to participate in their decisions to prescribe antibiotics when managing residents' infections. Conclusion: if proximity and nursing skills reinforce the relevance of the clinical judgment of nurses, the effective and collaborative communication between the nurse and the doctor may help the nurse to enhance their role in the antibiotic prescribing in nursing homes, which would enhance antimicrobial stewardship efficiency.

Enfermeros prescribiendo medicamentos en centros geriátricos: mapeo Internacional / Nurses prescribing medications in geriatric centers: international mapping

OBJETIVO: La meta de este estudio fue identificar la percepción de los enfermeros y médicos con respecto a los centros de atención de largo plazo, al mismo tiempo, explicar la intervención de los enfermeros en la prescripción médica. METODOLOGÍA: estudio multinacional transversal en el que participaron enfermeros y médicos en centros de cuidado geriátrico durante las fechas de abril y octubre de 2017. Se utilizaron tres cuestionarios en línea en idiomas francés e inglés. RESULTADOS: un 78.7% de médicos discutieron la relevancia que existe entre las prescripciones y enfermeros competentes. El mapeo demuestra la relación entre el nivel de evidencia que existe en el rol de enfermería y las prescripciones médicas, y enfermeros autorizados en los 51 países participantes. CONCLUSIONES: La relacion interpersonal entre médicos y enfermeros es esencial para facilitar el rol de enfermería en el manejo de tratamientos eficientes

OBJECTIVE: the aim of this study was to identify the perceptions of nurses and physicians and describe the involvement of nurses in medical prescription in general and that of antibiotics in particular, in geriatric institutions. METHODS: a cross-sectional multinational study was conducted among nurses and physicians in geriatric institutions between April and October 2017. Data was collected using three online questionnaires in both French and English. RESULTS: in total, 78.7% of doctors discussed the relevance of the prescription with competent nurses. A map shows the relationship between the evidence level of nursing role in medical prescription, and prescriptive authorization nurses in the 51 participating countries. CONCLUSIONS: interpersonal physician-nurse relationships are essential in facilitating the nursing role of effective treatment management

End-Users and Caregivers' Involvement in Health Interventional Research Carried Out in Geriatric Facilities: A Systematic Review.

Public involvement (PI) is of great interest. However, little is known about this topic in the design, development, and/or implementation of health interventions in geriatric facilities. This study aimed to provide a critical overview of the involvement of caregivers and end-users in interventions in these facilities, based on Rifkin's analytical framework. This systematic review, supplemented by a questionnaire to the corresponding authors, covered non-drug intervention reports targeting nurses, doctors, residents, and their relatives. Articles were published in Pubmed, Medline, Scopus, and Cinahl, from January 2016 to April 2018. Ninety-seven articles were included. The review shows a low level or partial PI in geriatric facilities where it exists. These results are further supported by the authors' responses to the questionnaire. PI remains uncommon in geriatric institutions and consists of a consumerist model, suggesting the need for improved practices. More efforts are needed to experiment with recommendations to meet the challenges of PI and enhance the public ownership of interventions. The protocol was registered on Prospero under the number CRD42018098504.

Perceptions of Antibiotic Therapy Among Nursing Home Residents: Perspectives of Caregivers and Residents in a Mixed Exploratory Study.

Antimicrobial resistance is a major public health threat worldwide. Some authors have suggested that end-users of nursing homes have an influence on antibiotic prescribing. The objective of this study is to describe the views of end-users and professionals on residents' behavior towards antibiotic therapy in terms of knowledge, beliefs, and attitudes towards this drug class and its prescribing process. This is a concurrent mixed methodology study using questionnaires and semi-directive individual interviews with nursing homes residents, nurses, and doctors practicing in these facilities. The questionnaires analyzed were collected from 35 residents (24.3%) and 109 nurses (75.7%). The qualitative interview involved 26 of total participants that agreed to be interviewed. We noticed misconceptions being held by the residents regarding the antibiotic resistance phenomenon. Additionally, nurses were not considered as a source of information about antibiotics. Nurses and residents had conflicting opinions about residents requesting antibiotics, and the findings depict a stereotypical view of the nurse profession as a reflection of a cognitive representation. The authors conclude that, despite many campaigns, further efforts are needed to tackle antimicrobial resistance. Initiatives could include raising awareness about antimicrobial resistance, clarifying the role of nurses, and communicating well with residents about their needs in nursing homes.

Nursing Role for Medication Stewardship Within Long-Term Care Facilities.

Elderly residents in long-term care facilities (LTCFs) constitute a population noted to have a large number of medications prescribed and administered. The aim of this article is to explore the nursing role for medication management, with an emphasis on antimicrobial stewardship, guided by disciplinary knowledge of King's theory of goal attainment and skill-based medication knowledge. The outcome is a nursing workforce truly engaged in working with interdisciplinary colleagues and focusing on care planning that includes medication management to improve the health status of residents in long-term care facilities.

ATOUM 6: does a multimodal intervention involving nurses reduce the use of antibiotics in French nursing homes?: A protocol for a cluster randomized study.

INTRODUCTION: Urinary tract infection (UTI) is common in elderly living in nursing homes, and antibiotics prescription for this infection is particularly challenging. In these facilities, due to the absence of on-site physicians, nurses play an essential role when an infection is suspected, as they are the ones who collect and communicate by phone all the information needed by the physician for the decision-making process. In that context, our study aims to reduce antibiotic consumption in nursing homes, using a multimodal intervention, by strengthening nurses' involvement during the process of prescription for UTI. METHODS/DESIGN: This is a planned 2-arm cluster randomized study of 40 nursing homes randomly assigned either to the control group or to the intervention group, using a 1:1 ratio. The intervention consists of reinforcing the nurses' knowledge concerning antibiotics and UTI; assist their clinical judgment using a decision aid diagram; improving their communication skills with the residents, their relatives, and the prescribers; and also increasing their involvement in the intervention' process by organizing a competition opposing the nursing homes of the interventional group to select additional intervention tools. ANALYSIS: The main outcome is the reduction of the relative frequency of antibiotics prescription for UTIs in the interventional group. ETHICS AND DISSEMINATION: Ethics approval was obtained from the French Committee for the Protection of Persons (N. 19.01.04/SI CNRIPH 18.12.07.48123). An article including the main outcome will be submitted to a peer review journal.

Observance to antiretroviral treatment in the rural region of the Democratic Republic of Congo: a cognitive dissonance.

INTRODUCTION: This study aimed to understand the influence of local media, religion and cultural beliefs on the therapeutic compliance of patients living with HIV. METHODS: This study was conducted in two rural hospitals in the Central Kongo province of the Democratic Republic of Congo. Semi-directional interviews were conducted with patients on antiretroviral therapy using a phenomenological qualitative method. RESULTS: Our results indicated that patients living with HIV in the rural region of the Democratic Republic of Congo are in a constant state of tension between the messages for compliance to antiretroviral treatment advocated by caregivers, and those broadcasted by audiovisual media, religious leaders and local beliefs. This dissonance constitutes a real barrier to therapeutic compliance. CONCLUSION: Collaborative strategies between healthcare providers, patients, as well as religious, media and traditional organizations are urgently needed.

Aortic stiffness improves the prediction of both diagnosis and severity of coronary artery disease.

Elective coronography has low diagnostic yield for obstructive coronary artery disease (CAD). We aim to determine whether non-invasive aortic stiffness assessment improves diagnostic accuracy of CAD screening by reducing the number of false-positive results from the cardiac stress test. A cross-sectional study was conducted from January 2013 to September 2014 in our medical center. Electrocardiogram (ECG) stress test coupled with nuclear imaging was performed in 367 consecutive patients routinely followed for myocardial ischemia screening. Aortic pulse wave velocity (PWV) was assessed by applanation tonometry in the overall population. Forty-two patients underwent elective coronography because of ischemia. Theoretical PWV was calculated according to age, blood pressure and gender. The results were expressed as an index ((measured PWV-theoretical PWV)/theoretical PWV) for each patient. Ten patients presented with obstructive CAD, 16 patients had non-obstructive CAD and 16 patients had normal coronary angiography. PWV index and severity of CAD were positively correlated (P=0.001). All patients with obstructive CAD had a positive PWV index. When considering the PWV index retrospectively, the false positive results of cardiac stress test were significantly reduced (P<0.001). Twenty-three procedures may have been avoided in the present study cohort. The salient finding of this study was that in patients with known or suspected CAD, routinely followed aortic PWV index may be considered clinically useful for reducing the rate of unnecessary invasive angiographies. The clinical relevance of this individualized decision approach should be confirmed in a large-scale study. Prospective studies have the potential to evaluate the PWV index as a marker of CAD.

Hemodynamic parameters in hypertensive diabetic patients.

OBJECTIVE: Despite adequate glycemic and blood pressure control, diabetic hypertensives remain at increased cardiovascular risk. Aortic stiffness and pulse pressure (PP) amplification may provide complementary information to correct cardiovascular risk. We aim to determine whether these hemodynamic parameters are interrelated or not and to explore the factors related to pressure pulsatility. METHODS: A cross-sectional study was conducted in 351 patients, involving controls, hypertensives without diabetes and diabetic patients with or without hypertension. Hemodynamic parameters were determined by applanation tonometry. Multivariate regression analyses evaluated the interest of therapeutic strategies. RESULTS: Aortic stiffness and PP amplification were not interrelated (P = 0.32) in multivariate-adjusted analysis and were both independently associated with previous cardiovascular events. Although disproportionately increased aortic stiffness in diabetic hypertensives (P < 0.001), no difference was found for PP amplification. The present dissociation between these two hemodynamic parameters may be related to the effect of increased heart rate (P < 0.001) in the presence of diabetes, in men and women. In diabetic hypertensives, aortic stiffness was correlated with glycated hemoglobin level (P = 0.04), but not with blood pressure or heart rate. Antihypertensive and statin treatments were correlated with PP amplification but not with aortic stiffness. CONCLUSION: Aortic stiffness and PP amplification were not interrelated, suggesting that these markers may provide complementary information for cardiovascular risk. New therapeutic strategies targeting pressure pulsatility should take into account the impact of hyperglycemia and increased heart rate in diabetic hypertensives. Gender influence on the role of autonomic nervous system in attenuating pressure wave reflections remains to be further established.