Vancomycin-resistant Enterococci in Intensive Care Hospital Settings

Vancomycin-resistant enterococci (VRE) have recently emerged as a nosocomial pathogen and present an increasing threat to the treatment of severely ill patients in intensive-care hospital settings. We outline results of a study of the epidemiology of VRE transmission in ICUs and define a reproductive number R0; the number of secondary colonization cases induced by a single VRE-colonized patient in a VRE-free ICU, for VRE transmission. For VRE to become endemic requires R0 >1. We estimate that in the absence of infection control measures R0 lies in the range 3-4 in defined ICU settings. Once infection control measures are included R0=0.6, suggesting that admission of VRE-colonized patients can stabilize endemic VRE.

Mothers' and Fathers' Early Relationship With Their Infant: Similar Yet Temporally Discordant Themes [La relation initiale des parents avec leur nourrisson: Thèmes similaires quoique temporellement discordants]

Objective: To examine first-time mothers' and fathers' themes in their relationship with their infant, how these themes change during the first four months postpartum, and similarities and differences in mothers' and fathers' themes. Participants: Eighteen first-time mother-father couples were separately interviewed at one; six and 16 weeks postpartum. Data Analysis: Audio-taped, transcribed interviews were analysed using a Grounded Theory approach. Results: Our findings reveal a common set of themes for mothers and fathers in relation to the infant : 1: Discovery, 2: Physical Proximity, 3: Emotional Closeness, 4: Initiation of Complementary Interactions and 5: Commitment to Love and Care. However, there was a striking lack of concordance between mothers and fathers for these themes at each point in time. Conclusions: Mothers' and fathers' experience of the early relationship with their infant is unique. Focussing on maternal as well as paternal ways of experiencing the early relationship with their infant sets the way to understanding early developing relationships in the family context.

Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care : A statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine.

Neurocritical care depends, in part, on careful patient monitoring but as yet there are little data on what processes are the most important to monitor, how these should be monitored, and whether monitoring these processes is cost-effective and impacts outcome. At the same time, bioinformatics is a rapidly emerging field in critical care but as yet there is little agreement or standardization on what information is important and how it should be displayed and analyzed. The Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine, and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to begin to address these needs. International experts from neurosurgery, neurocritical care, neurology, critical care, neuroanesthesiology, nursing, pharmacy, and informatics were recruited on the basis of their research, publication record, and expertise. They undertook a systematic literature review to develop recommendations about specific topics on physiologic processes important to the care of patients with disorders that require neurocritical care. This review does not make recommendations about treatment, imaging, and intraoperative monitoring. A multidisciplinary jury, selected for their expertise in clinical investigation and development of practice guidelines, guided this process. The GRADE system was used to develop recommendations based on literature review, discussion, integrating the literature with the participants' collective experience, and critical review by an impartial jury. Emphasis was placed on the principle that recommendations should be based on both data quality and on trade-offs and translation into clinical practice. Strong consideration was given to providing pragmatic guidance and recommendations for bedside neuromonitoring, even in the absence of high quality data.

Cybercafés de Bamako : les usages de l'Internet au prisme de la parenté et des classes d'âge

Au Mali, les technologies de l'information et de la communication ont suscité un vif engouement. Portés par l'ancien Président Alpha Oumar Konaré, de nombreux projets gouvernementaux ont vu le jour. Parallèlement, les cybercafés se sont multipliés : moins de dix en 1997, ils étaient presque plus de 120 en 2006. Si les possibilités de se connecter à domicile et sur son lieu de travail se sont développées, les cybercafés restent des espaces idéaux pour découvrir les pratiques numériques. Une façon d'étudier les usages de l'Internet est de s'intéresser aux liens qui se nouent autour de l'ordinateur. La situation est complexe à Bamako, car les personnes qui accompagnent les clients des cybercafés sont nombreuses. L'analyse de cette nébuleuse relationnelle est l'occasion de procéder à un double détour. Géographique tout d'abord, dans la mesure où l'anthropologue est conduit à quitter le cybercafé pour se rendre dans l'espace social plus vaste appelé Cyber. Disciplinaire ensuite puisque son regard se déplace progressivement du média vers l'étude des règles qui régissent la parenté et les classes d'âge.

Alcool et comorbidités psychiatriques pour le praticien [Alcohol and psychiatric comorbidities in primary care].

Patients presenting with alcohol-related problems frequently suffer from comorbid mental health problems. From a broader perspective, patients having a comorbid situation between an addiction and a psychiatric trouble are at risk of being underdiagnosed for one of the two diseases. This litterature review tries to outline the issues linked to rigorous psychiatric diagnoses in the alcoologic situation, to describe the epidemiology of alcohol dual diagnosis, and to sum up scientific knowledge about the most adapted medication options and treatment settings.

IPH response to NI Health and Social Care Board 'Tranforming Your Care' consultation

The 'Transforming Your Care (TYC)' consultation relates to proposals for changes in the delivery of Health and Social Care in Northern Ireland in the context of the TYC report published in December 2011. TYC is about making changes to ensure safe, high quality and sustainable services for patients, service users and staff. TYC sets out proposals in respect of how health and social services will need to adapt and be organised to best meet the needs associated with population ageing, increasing long-term conditions and other challenges. Key points from IPH response include: IPH welcomes the HSC commitment to transform health and social care services to meet Northern Ireland’s changing population health needs Inequalities are a dominant feature of health service utilisation patterns in Northern Ireland – for example hospital admission rates for self-harm and alcohol-related admissions in the most deprived areas are double the regional figure. IPH recommends that

Zerebrale Probleme in der pädiatrischen Intensivmedizin [Cerebral problems in pediatric intensive care]

This paper presents a review of different methods enabling the monitoring of cerebral function in neonatal and paediatric intensive care. EEG, evoked potentials, conventional radiological studies, computerized tomography, ultrasound, intracranial pressure measurements, nuclear magnetic resonance, Doppler ultrasound, radioisotope studies, angiography, infra-red spectral analysis and last, but not least, clinical examination produce information regarding the neurological state of the patient which must be critically analysed in order to ensure optimal management of the case. Unfortunately, and in spite of impressive progress in non-invasive monitoring of the cerebral function, we are still forced to make important medical and ethical decisions without precise information about the neurological state of our patients.

IPH response to Health and Social Care Board and Public Health Agency Community Development Strategy

The Health and Social Care Board (HSCB) and the Public Health Agency (PHA) launched a new Community Development Strategy for public consultation.  The HSCB and PHA want to see strong, resilient communities where everyone has good health and wellbeing, places where people look out for each other and have community pride in where they live. The HSCB and PHA seek a number of benefits from implementing this strategy including; a reduction in health and wellbeing inequalities, which also means addressing the social factors that affect health; strengthening partnership working with service users, the community and voluntary sectors and other organisations; strengthening families and communities; supporting volunteering and making best use of our resources. Key points from the IPH summary include IPH welcome the Community Development Strategy as an approach to enhance health and wellbeing and tackle health inequalities in Northern Ireland.   IPH recommend the current three strategy documents (Full and summary versions and the Performance Management Framework) are merged into one document for greater clarity. Reference to the Performance Management Framework is required in the main body of the text is to ensure good practice is implemented. IPH welcome the focus on tackling health inequalities using community development approaches however the contribution of community development approaches needs to be highlighted. HIA is a tool to support community engagement and provides a mechanism for HSCB and PHA to support the implementation of this strategy.

IPH response to Palliative and End of Life Care Strategy Consultation

Palliative care and end of life care is the active, holistic care of patients with advanced and progressive illness.  It is an integral part of the care delivered by all health and social care professionals, and indeed by families and carers, to those living with, and dying from any advanced, progressive and incurable conditions.  The Department of Health, Social Services and Public Safety (NI) issued a consultation document on a 5 year Strategy in December 2009.

IPH response to the HIQA consultation on the National Demographic Dataset and Guidance for use in health and social care settings in Ireland

The remit of the Institute of Public Health in Ireland (IPH) is to promote cooperation for public health between Northern Ireland and the Republic of Ireland in the areas of research and information, capacity building and policy advice. Our approach is to support Departments of Health and their agencies in both jurisdictions, and maximise the benefits of all-island cooperation to achieve practical benefits for people in Northern Ireland and the Republic of Ireland. IPH have previously responded to consultations to the Department of Health’s Discussion Paper on the Proposed Health Information Bill (June 2008), the Health Information and Quality Authority on their Corporate Plan (Oct 2007), and the Road Safety Authority of Ireland Road Safety Strategy (Jul 2012). IPH supports the development of a national standard demographic dataset for use within the health and social care services. Provided necessary safeguards are put in place (such as ethics and data protection) and the purpose of collecting the information is fully explained to subjects, mandatory provision of a minimum demographic dataset is usually the best way to achieve the necessary coverage and data quality. Demographic information is needed in several forms to support the public health function: Detailed aggregated information for comparison to population counts in order to assess equity of access to healthcare as well as examining population patterns and trends in morbidity and mortality Accurate demographic information for the surveillance of infectious disease outbreaks, monitoring vaccination programmes, setting priorities for public health interventions Linked to other data outside of health and social care such as population data, survey data, and longitudinal studies for research and analysis purposes.   Identify and address public health issues to tackle health inequalities, and to monitor the success of such efforts to tackle them.

Minimum Kinship Care Standards (PDF 400KB)

May 2012 (amended March 2014)