Bloodstream infections related to totally implantable venous access port: What is the situation in our hospital?

Port-a-Cath© (PAC) are totally implantable devices that offer an easy and long term access to venous circulation. They have been extensively used for intravenous therapy administration and are particularly well suited for chemotherapy in oncologic patients. Previous comparative studies have shown that these devices have the lowest catheter-related bloodstream infection rates among all intravascular access systems. However, bloodstream infection (BSI) still remains a major issue of port use and epidemiology data for PAC-associated BSI (PABSI) rates differ strongly depending on studies. Also, current literature about PABSI risk factors is scarce and sometimes controversial. Such heterogeneity may depend on type of studied population and local factors. Therefore, the aim of this study was to describe local epidemiology and risk factors for PABSI in adult patients in our tertiary- care university hospital. We conducted a retrospective cohort study in order to describe local epidemiology. We also performed a nested case-control study to identify local risk factors of PABSI. We analyzed medical files of adult patients who had a PAC implanted between January 1st, 2008 and December 31st, 2009 and looked for PABSI occurrence before May 1st, 2011 to define cases. Thirty nine PABSI occurred in this population with an attack rate of 5.8%. We estimated an incidence rate of 0.08/1000 PAC-days using the case-control study. PABSI causative agents were mainly Gram positive cocci (62%). We identified three predictive factors of PABSI by multivariate statistical analysis: neutropenia on outcome date (Odds Ratio [OR]: 4.05; 95% confidence interval [CI]:1.05- 15.66; p=0.042), diabetes (OR: 11.53; 95% CI: 1.07-124.70; p=0.044) and having another infection than PABSI on outcome date (OR: 6.35; 95% CI: 1.50-26.86; p=0.012). Patients suffering from acute or renal failure (OR: 4.26; 95% CI: 0.94-19.21; p=0.059) or wearing another invasive device (OR: 2.99; 95%CI:0.96-9.31; p=0.059) did not have a statistically increased risk for developing a PABSI according to classical threshold (p<0.05) but nevertheless remained close to significance. Our study demonstrated that local epidemiology and microbiology of PABSI in our institution was similar to previous reports. A larger prospective study is required to confirm our results or to test preventive measures.

Eradication d'une population d'écrevisses de Louisiane, Procambarus clarkii, à l'étang de Vidy et situation des populations d'écrevisses à Lausanne, Suisse.

En juillet 2007, des écrevisses de Louisiane, Procambarus clarkii, ont été observées, pour la première fois en Suisse romande, dans l'étang artificiel de Vidy à Lausanne. Au printemps 2008, l'étang a été asséché pendant 2 mois pour tenter d'éradiquer les écrevisses. En juillet 2008, et au printemps 2009, des écrevisses de Louisiane furent à nouveau observées dans l'étang: des individus avaient survécu au traitement et/ou des écrevisses avaient à nouveau été introduites. En 2010, une nouvelle campagne d'éradication a été mise en place: l'étang fut asséché, son lit chaulé et les interstices entre les enrochements bétonnés. Lors du suivi 2011, plus aucune écrevisse ne fut capturée. L'opération semble donc finalement avoir été un succès. Les observations effectuées sur 20 plans d'eau dans un rayon de 4.5 km autour de l'étang de Vidy n'ont pas mis en évidence d'autres populations d'écrevisses de Louisiane. Plusieurs populations d'écrevisses américaines, orconectes limosus, et signal ̧ Pacifastacus lenuisculus, ont été localisées, ainsi qu'une population d'écrevisses à pattes rouges, Astacus astacus.

Prévention du VIH/sida, Suisse 2007: situation satisfaisante chez les jeunes, situation problématique chez les personnes plus âgées.

Depuis 1987, la Suisse dispose d'études répétées sur les comportements sexuels dans plusieurs populations, ce qui permet de suivre l'évolution de paramètres importants concernant la santé sexuelle et l'exposition au risque de transmission du VIH/sida et d'autres IST. Cet article, tiré du dernier rapport de suivi de la stratégie du VIH/sida en Suisse, présente la situation relative à l'activité sexuelle et aux comportements préventifs chez les jeunes de 17 à 20 ans et compare ces paramètres à divers âges de la vie.

Lack of Discipline in Cape Verdean Secondary Schools: The Need to Better Define the Problem and Develop Strategies to Prevent or Manage the Situation

This research paper has been written with the intention to discuss the problem of discipline in Cape Verdean secondary schools. While many of us discuss the effects that student misbehavior has on the student misbehavior has on the student, school and society as a whole, very few of us seek solutions which would impact on the prevention and management of this problem that each day becomes more complicated and harder to handle. This paper will discuss the need to better define discipline at the school level; identify the causes and factors that aggravate the problem, in addition, to provide what I hope to be useful strategies to better manage the problem as we make the effort to reclaim our schools and better educate our students. My research included surveys completed by teachers and student alike as they baffled over the question: what is discipline and how can we better manage discipline problems at our schools?

REMAP - A Probabilistic Survery of Iowa's Perennial Rivers and Streams, 2007

This monthly report from the Iowa Department of Transportation is about the water quality management of Iowa's rivers, streams and lakes.