Influence of socioeconomic factors on delays, management and outcome amongst patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.

The outcome after primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) is strongly affected by time delays. In this study, we sought to identify the impact of specific socioeconomic factors on time delays, subsequent STEMI management and outcomes in STEMI patients undergoing pPCI, who came from a well-defined region of the French part of Switzerland. A total of 402 consecutive patients undergoing pPCI for STEMI in a large tertiary hospital were retrospectively studied. Symptom-to-first-medical-contact time was analysed for the following socioeconomic factors: level of education, origin and marital status. Main exclusion criteria were: time delay beyond 12 hours, previous treatment with fibrinolytic agents or patients immediately referred for coronary artery bypass graft surgery. Therefore, 222 patients were finally included. At 1 year, there was no difference in mortality between the different socioeconomic groups. Furthermore, there was no difference in management characteristics between them. Symptom-to-first-medical-contact time was significantly longer for patients with a low level of education, Swiss citizens and unmarried patients, with median differences of 23 minutes, 18 minutes and 13 minutes, respectively (p <0.05). Nevertheless, no difference was found regarding in-hospital management and clinical outcome. This study demonstrates that symptom-to-first-medical-contact time is longer amongst people with a lower educational level, Swiss citizens and unmarried people. Because of the low mortality rate in general, these differences in delays did not affect clinical outcomes. Still, tertiary prevention measures should particularly focus on these vulnerable populations.

Unlicensed and off-label drug use in a Swiss paediatric university hospital.

BACKGROUND: Many medicines used in newborns, infants, children and adolescents are not licensed ("unlicensed") or are prescribed outside the terms of the marketing authorization ("off-label"). Several studies have shown that this is a common practice in various healthcare settings in the USA, Europe and Australia, but data are scarce in Switzerland. OBJECTIVES: The aim of our prospective study was to determine the proportion of unlicensed or off-label prescriptions in paediatric patients. METHODS: This pilot study was conducted prospectively over a six month period in the department of paediatrics of a university hospital. RESULTS: Sixty patients aged from three days to 14 years were included in the study. A total of 483 prescriptions were written for the patients. More than half of all prescriptions (247; 51%) followed the terms of the marketing authorization. 114 (24%) were unlicensed and 122 (25%) off-label. All patients received at least one unlicensed or offlabel medicine. CONCLUSION: The use of unlicensed or off-label medicines to treat children was found to be common. Co-operation between the pharmaceutical industry, national regulatory authorities, clinical researchers, healthcare professionals and parents is required in order to ensure that children do not remain "therapeutic orphans".

Reduction in the use of diagnostic tests in infants with risk factors for early-onset neonatal sepsis does not delay antibiotic treatment.

Despite a low positive predictive value, diagnostic tests such as complete blood count (CBC) and C-reactive protein (CRP) are commonly used to evaluate whether infants with risk factors for early-onset neonatal sepsis (EOS) should be treated with antibiotics. We investigated the impact of implementing a protocol aiming at reducing the number of diagnostic tests in infants with risk factors for EOS in order to compare the diagnostic performance of repeated clinical examination with CBC and CRP measurement. The primary outcome was the time between birth and the first dose of antibiotics in infants treated for suspected EOS. Among the 11,503 infants born at ≥35 weeks during the study period, 222 were treated with antibiotics for suspected EOS. The proportion of infants receiving antibiotics for suspected EOS was 2.1% and 1.7% before and after the change of protocol (p = 0.09). Reduction of diagnostic tests was associated with earlier antibiotic treatment in infants treated for suspected EOS (hazard ratio 1.58; 95% confidence interval [CI] 1.20-2.07; p <0.001), and in infants with neonatal infection (hazard ratio 2.20; 95% CI 1.19-4.06; p = 0.01). There was no difference in the duration of hospital stay nor in the proportion of infants requiring respiratory or cardiovascular support before and after the change of protocol. Reduction of diagnostic tests such as CBC and CRP does not delay initiation of antibiotic treatment in infants with suspected EOS. The importance of clinical examination in infants with risk factors for EOS should be emphasised.

Iowa Department of Transportation Major Items - Preliminary Quantity Report, June 21, 2016; With Addendums

Weekly letting report

L'Écho de Paris

1884/10/19 (Numéro 222).

Guiron le Courtois, translaté de latin en françois par Luce du Châtel du Gat. « Cy commence li seconds livres de Guiron le Courtois »

Commencement : « Or dist li contes que li rois Melyadus demoura ou chastel... » — Fin : « ...et encore est communement son nom par toute Engleterre. — Cy fine le tiers et derrenier livre de Guiron le Courtois. »

Biblia sacra, pars.

Avec prologues. Evang. Matthaei (2), Marci (45v), Lucae (72v), Johannis (116) ; Actus Apost. (148v) ; Apocalypsis (186v) ; VII Epist. canon. (205) ; XIV Epist. Pauli (222). F. 1v Addition : Ezechiel, XXXV, 1-5 et Jeremias, IV, 7. F. 305 Calendrier de Florence, avec des additions (dans le sens dominicain).

Homeliarum (partie d'hiver)

F. I. Fragments d'un temporal d'hiver. Extraits d'Isaïe, LV, LVI, LX-LXII : « Omnes sitientes... », « Surge illuminare... », « Gaudens gaudebo... » F. 1-7. Le premier cahier contenant des homélies liées à la fête de l'Ascension, provient certainement d'un homéliaire d'été : sermons sur Matth., XIX, 21 et VIII, 5 (f. 1-2) ; sermons de s. Augustin et de s. Léon sur l'Ascension (f. 3-7). F. 8-224. Partie primitive du manuscrit : temporal d'hiver suivi de la fête de s. André. — Vers sibyllins (Carmen de die Judicii) (40) ; — Oratio Jeremiae (214v)F. 218v, début du sanctoral (9 leçons).

Jacobus de Voragine. Ogerius Locediensis. Guillelmus de Malliaco.

F. 13-142v [Jacobus de Voragine, Sermones excerpti e collectione sermonum festivalium per anni circulum]; cf. Schneyer, Repert. lat. Serm., III, 246-268. [In Nativitate]; cf. ibid., n° 319, incomplet du début, et n° 324 (13-18v); — « In circumcissione [sic] Domini »; cf. ibid., n° 346 et 347 (18v-24); — « In Epiphania Domini »; cf. ibid., n° 351 et 354 (24-28v); — « In Purificatione sancte Marie »; cf. ibid., n° 374 et 376 (28v-34); — « In Adnunciatione beate Marie.; cf. ibid., n° 396 (34-36v) et n° 397, incomplet du début par lacune matérielle (38-39); — « De s. Johanne Baptista »; cf. ibid., n° 465 et 467 (39-44); — « De apostolis Petro et Paulo »; cf. ibid., n° 471 et 473 (44-49v); — « De b. Paulo apostolo »; cf. ibid., n° 474 (49v-53); — « De s. Maria Magdalena »; cf. ibid., n° 479 et 480 (53-59v); — « De b. Laurentio martyre »; cf. ibid., n° 497 et 499 (59v-65); — « In Assumpcione b. Marie »; cf. ibid., n° 504 et 509 (65-72v); — « De s. Augustino »; cf. ibid., n° 521 et 523 (72v-79v); — « In Nativitate b. Marie »; cf. ibid., n° 528 et 530, incomplet de la fin, en réclame « virginis » (79v-84v); — [De s. Michaele]; cf. ibid., n° 544, incomplet du début par lacune matérielle, et n° 550 (86-90v); — « In festo omnium sanctorum »; cf. ibid., n° 568 et 570 (90v-96v); — « De mortuis »; cf. ibid., n° 574-577 (96v-107v); — « De s. Martino »; cf. ibid., n° 582, incomplet de la fin (107v-109v) et n° 583 incomplet du début par lacune matérielle (111-113v); — « De b. Katerina »; cf. ibid., n° 591 et 592 (113v-119v); — « De dedicacione ecclesie »; cf. ibid., n° 594 et 595 (119v-127); — « De consecracione altaris »; cf. ibid., n° 597 (127-130); — « De vestibus sacris sacerdotis quid significant »; cf. ibid., n° 598 (130-134); — « De exposicione misse »; cf. ibid., n° 599 et 600 (134-142v). F. 142v-146 « Sermo ad religiosos. Quia existis indesertum... (Mt. XI, 7). Istam questionem quam fecit Dominus... ». F. 146-150v [Guillelmus de Malliaco, Sermo excerptus e collectione sermonum de Tempore dicta « Abjiciamus »]; cf. Schneyer, op. cit., II, 483-489. « De visitacione et officio visitacionis »; cf. ibid., n° 72. F. 150v-158 Sermones. « In concilio magnatum. Quoniam ecce reges terre... (Ps. XLVII, 5). Hic duo tanguntur scilicet magnorum conveniencia temporalis... » (150v-151v); — « In synodo clericorum. Pro patribus tui nati sunt tibi filii... (Ps. XLIV, 17). Adtendant ecclesiarum prelati tria... » (151v-155); — « Sermo ad religiosos. Deus qui habit are facit unanimes in domo secundum hebraicam veritatem et secundum Johannem. Deus qui habitare racit monachos... » (155-158). F. 158-160v [Jacobus de Voragine, Sermo de s. Mathia] « Sermo in electione », incomplet par lacune matérielle, en réclame « vir perfectus »; cr. Schneyer, loc. cit., n° 382, moins développé. F. 161-169v [Ogerius Locediensis] « Planctus b. Bernardi de dolore Marie virginis propter filium » (en titre-courant). « Quis dabit capiti meo aquam et oculis meis imbrem sicut presens dies demostrat [sic] cunctis aperte. Inclita regina celica rosa flos sine spina// ...memento mei »; extrait du De Laudibus b. Virginis, rédaction B; cf. H. Barré, dans Revue d'ascétique et de mystique, XXVIII (1952), 243-266, mss. et éditions. Le texte est incomplet par lacune matérielle, un f. ayant été coupé entre les fr. 163 et 164. F. 169v-184 Sermones. « Sermo in Assumptione b. Marie. Surrexit rex in occursum... (III Reg. II, 19). Quam multiplici figura Salomon ille... », incomplet de la fin (169v-171v); — sermon incomplet du début par lacune matérielle (174); — « Sermo in capite jejunii. Convertimini ad Dominum Deum vestrum... (Joel II, 13). Agreditur hodie Spiritus sanctus multitudinem peccatorum... » (174-175v); — « Sermo in Paraceve. Cum egressus fuero de urbe... (Ex. lX, 29). Verba ista sunt Moysi qui gerit typum Salvatoris... » (175v-180v); — « Alius sermo in Paraceve. O vos omnes qui transitis per viam... (Thren. I, 12). Consideranti michi piam et superpiam materiam... » (180v-183v); — « Domine, bonum est nos hic esse... (Lc. lX, 33). Ubi? Petro. Isti enim tria tanguntur in mentis sublimitate... » (183v-184). F. 184v Table des ff. 1 à 193. — Addition fin XIVe s. F. 185-193 Sermones. « Sermo in Nativitate. Sicut lux aurore oriente sole... (II Reg. XXIII, 4, 2). Verba sunt David cui Dominus... » (185-186); — « Sermo in Paraceve. Deducant oculi nostri lacrimas... (Jer. lX, 18). ...ut gloriosa Virgo septies flevisse.. » (186-191); — « Quod Corpus Christi vere sit in altari. Cenantibus autem eis, accepit Jesus panem... Item Joh. (VI, 51): Ego sum panis vivus... Credebant enim quod manducaretur sicut alie carnes. ..) (191-193). F. 193v Table des ff. 194 à 285. — Addition fin XIVe s. La suite de la table a été coupée. F. 194-335v Sermones de Tempore, excerpti praesertim e collectione « Abjiciamus » Guillelmi de Malliaco et e collectionibus De Tempore et De Sanctis et festis Jacobi de Voragine; cf. Schneyer, op. cit., II, 483-489 et III, 221-233 et 246-268. F. 194-208. [Guillelmus de Malliaco] « Dom. 1a in Adventu Domini »; cf. Schneyer, II, loc. cit., n° 1 et 2 (194-203); Dom. 2a »; cf. ibid., n° 3 (203-208). F. 208-213 [Jacobus de Voragine] « Dom. 2a in Adventu Domini »; cf. Schneyer, III, loc. cit., n° 5. F. 213-218 [Guillelmus de Malliaco] « Dom. 3a »; cf. Schneyer, II, n° 6. F. 218-222 [Jacobus de Voragine] « Dom. 3a »; cf. Schneyer, III, n° 8. F. 222v-228 [Guillelmus de Malliaco] « Dom. 4a »; cf. Schneyer, II, n° 7. F. 228-232 [Jacobus de Voragine] « Dom. eadem »; cf. Schneyer, III, n° 11. F. 232-236. « Feria 4a in capite jejunii. Cum jejunatis nolite fieri... (Mt. VI, 16). Hodie incipit tempus penitentie... ». F. 236-240 « De eadem feria. Convertimini ad me in toto corde... (Joel II, 12). Homo per peccatum tria mala incurrit... ». F. 240-246 [Guillelmus de Malliaco] « Dom. 1a in quadragesima »; cf. Schneyer, II, n° 25. F. 246-319 [Jacobus de Voragine] « Dom. eadem »; cf. Schneyer, 111, n° 41 (246-251v); — « Dom. 2a in quadragesima »; cf. ibid. n° 44 et 45 (251v-259v); — « Dom. 3a in quadragesima »; cf. ibid., n° 47 et 48 (259v-270); — « Dom. 4a in quadragesima »; cf. ibid., n° 50 et 51 (270-279v); — « Dom. de passione »; cf. ibid., n° 53 et 54 (279v-290); — « Dom. de Ramis »; cf. ibid., n° 56 et 57 (290-302); — « In Cena Domini »; cf. ibid., n° 401 et 402 (302-307v); — « In Parasceve »; cf. ibid., n° 405 et 411 (307v-312); — « In die Pasce »; cf. ibid., n° 414 et 415 (312-316v); — « Feria 2a post Pasca »; cf. ibid., n° 419 (316v-319). F. 319-325v « De eadem feria. Duo ex discipulis Jhesu ibant... (Lc. XXIV, 13). Introduxit nos Dominus in terram fluentem lac... » F. 326-334 [Jacobus de Voragine] « In adscensione Domini »; cf. ibid., n° 446 et 445 (326-329v); — [In Pentecoste]; cf. ibid., n° 452 et 457 (329v-334). F. 334-335v « De eodem. Ad Deum [sic pro: eum] veniemus et mansionem... (Job. XIV, 23). Super illo verbo dicit b. Eusebius... ». F. 335v-337v Extraits patristiques. « Incipiunt quedam problemata. Lingua mea calamus ego sum. » Sont cités s. Grégoire, s. Paul, s. Augustin, s. Isidore, Boèce, Bède, Josèphe, s. Hilaire, etc.