The goals of global vaccination are to control,eliminate,or eradicate infectious diseases in a sustainable way that strengthens public health systems.Although the use of vaccines is essential for the control of epidem...The goals of global vaccination are to control,eliminate,or eradicate infectious diseases in a sustainable way that strengthens public health systems.Although the use of vaccines is essential for the control of epidemics,the vaccines against coronavirus disease 2019(COVID-19)proved to be inadequate to end the pandemic and thus are considered incomplete.These vaccines failed to prevent infection,so their primary purpose has been shifted to prevent severe disease and reduce hospitalizations and deaths.Therefore,we believe that all the strategies available to reduce transmission,hospitalizations and deaths due to COVID-19 will be put in place.It is reported that uncontrolled inflammation and thrombosis are the principal mechanisms for aggravation and death in patients with COVID-19.Unlike corticosteroids that should not be administered at the beginning of the symptoms for their immunosuppressive action,which could worsen the evolution of the disease,the usefulness of non-steroidal anti-inflammatory drugs in the early at-home treatment of the disease is becoming evident.展开更多
Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new proph...Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new prophylactic and treatment options have been evaluated to reduce the incidence of CRIs and infection related catheter removals. In children, two retrospective studies have shown the efficacy of ethanol lock treatment (ELT) in reducing the incidence of CRIs in pediatric oncology patients. However, prospective data are missing. Our aim of the present study was to evaluate prospectively the effect of ELT on the cure and recurrence rate of CRIs, duration of hospitalization and antibiotic use in HPN pediatric patients. Methods: HPN children older than three months with a clinical suspicion of a CRI were included and randomised to ELT or standard flushing treatment (heparin or taurolidine). The primary outcomes were persistence and recurrence of the bacteraemia and Central Venous Access Device (CVAD) removal. Secondary outcomes included duration of antibiotic use, duration of hospitalization and side effects. Results: Data from eight HPN children experiencing 14 suspected CRI were analysed. Seven patients had proven CRIs by positive blood cultures. Four were treated with ELT and three with their standard flushing treatment. One CRI persisted in the control group. In one single patient, bacteraemia recurred three times within 24 weeks. This patient had been enrolled in both study arms. A CVAD removal was needed in one patient because of occlusion. Conclusions: This small study showed no additional efficacy of the use of ELT on cure rate or recurrences of CRIs compared to standard therapy in HPN treated children. There were also no differences in duration of hospitalization, the use of antibiotics or CVAD removal between both groups.展开更多
Background and Objectives: Permanent reduction of unwanted hair on skin types V and VI is the most challenging procedure among all hair removal technologies based on selective absorption of light or laser. The objecti...Background and Objectives: Permanent reduction of unwanted hair on skin types V and VI is the most challenging procedure among all hair removal technologies based on selective absorption of light or laser. The objective of this study is to evaluate the safety and efficacy of a low energy pulsed-light device combined with galvanic energy, intended for home-use hair removal on dark skin. Materials and Methods: Fifteen women with skin types V and VI and dark terminal hair in axillaarea self-administrated 6 treatments at 2 week intervals, using a hand-held IPL combined with galvanicenergy device, using HPL (Home Pulsed Light) technology. Hair count and photographs were performed pre-treatment and 1 and 3 months after the last sixth treatment. Adverse events and subject satisfaction scores were recorded. Results: All patients showed a positive clinical response to treatment, with reduction of unwanted hair. Hair counts were significantly reduced by 57.3% 1 month following last treatment and by 44.5% 3 months following last treatment. No adverse events were recorded. Subject satisfaction scores of the device usability and the treatment outcome were high. Conclusions: Low energy pulsed light combined with galvanic energy may be applied safely and effectively for at-home hair removal for people with dark skin types V and VI.展开更多
Background It is debatable whether treating multimorbid nursing home patients with antihypertensive drugs produces beneficial effects. Most cardiovascular guidelines promote treatment; few have advice on how to depres...Background It is debatable whether treating multimorbid nursing home patients with antihypertensive drugs produces beneficial effects. Most cardiovascular guidelines promote treatment; few have advice on how to deprescribe when treatment may no longer be necessary. We investigated the effect of medication review on antihypertensive drug use and the association between cognition, blood pressure, and prescribing. Methods From August 2014 to December 2015, 765 patients from 72 units （clusters） in 32 Norwegian nursing homes were included in a 4-month, multicentre, cluster-randomized, controlled trial, with 9-month follow-up. Patients ≥ 65 years old with antihypertensive treatment （n = 295, 39%） were randomized to systematic medication review where the physician received support from peers （collegial mentoring） or were given care as usual （control condition）. Outcome measures were the number of antihypertensive drugs, systolic blood pressure, and pulse. We used hospitalizations and deaths as criteria to assess harm. Results At baseline, each patient used 9.2 ± 3.5 regular drugs, and 1.6 ± 0.7 antihypertensives. Mean blood pressure was 128/71 mmHg and 9% had a systolic pressure ≥ 160 mmHg. Between baseline and month four, antihypertensives were deprescribed to a significantly higher extent in the intervention group （n = 43, 32%） compared to control （n = 11, 10%）; Incidence Rate Ratio = 0.8, 95% CI = 0.7？0.9. In the intervention group, there was an immediate increase in systolic blood pressure when antihypertensives were reduced, from baseline 128 ± 19.5 mmHg to 143 ± 25.5 mmHg at month four. However, at month nine, the blood pressure had reverted to baseline values （mean 134 mmHg）. Deprescription did not affect pulse and systolic pressure. The number of hospitalizations was higher in control patients at month four （P = 0.031） and nine （P = 0.041）. Conclusion A systematic medication review supported by collegial mentoring significantly decreased the use of antihypertensive drugs in nursing home patients without an effect on the systolic blood pressure over time.展开更多
Lack of engagement in activities is a common feature of nursing homes residents. As apathy is the most frequent behavioural disturbance, understanding residents’ interests is a milestone for tailored challenging inte...Lack of engagement in activities is a common feature of nursing homes residents. As apathy is the most frequent behavioural disturbance, understanding residents’ interests is a milestone for tailored challenging interventions targeting engagement enhancement. Objective: To depict the activities interests of nursing homes residents. Method: An electronic version of the Test of Interest “TILT” which regroups 40 images of activities has been developed and adapted for the Ipad. Residents were asked to answer by yes or no to the question “are you interested by this activity”, for each activity found interesting, the patient had then to categorize it in either Work/ occupation-Personal-Leisure-Family. Population: A total of 601 residents from 19 nursing homes have completed the survey from March to May 2011. The surveyed nursing homes from the South East of France were comparable of nursing homes figures in France. Results: We interviewed 601 individuals (female, n = 484) aged 85.9 years, out of those, 56% had stayed more than one year in an institution. Nearly half of the population (45.3%) was from 80 - 89 year of age, followed by 36.1% from 90 - 99. The educational background was principally from primary school (36%) and high school (30.8%). Most of the residents were classified has having dementia (35.3%). From the 40 activities presented to each participant, “enjoying a good meal” has been found to be the most interesting activity by 83% of the population followed by “dressing up”, 75.9% and “watching TV”, 75.5%. Female participants reported more interest in place of worship, family pictures and being with grand children then males (p < 0.01). We found that the presence of “dementia” diagnosis” triggered the lack of interest compared to none demented or none cognitively impaired residents (p < 0.01). It was found that participants aged 55 - 69 were more the most interested to do video games (p < 0.05), though this may be interpreted as a positive step toward functional and cognitive rehabilitation program using virtual reality as a mean for intervention.展开更多
文摘The goals of global vaccination are to control,eliminate,or eradicate infectious diseases in a sustainable way that strengthens public health systems.Although the use of vaccines is essential for the control of epidemics,the vaccines against coronavirus disease 2019(COVID-19)proved to be inadequate to end the pandemic and thus are considered incomplete.These vaccines failed to prevent infection,so their primary purpose has been shifted to prevent severe disease and reduce hospitalizations and deaths.Therefore,we believe that all the strategies available to reduce transmission,hospitalizations and deaths due to COVID-19 will be put in place.It is reported that uncontrolled inflammation and thrombosis are the principal mechanisms for aggravation and death in patients with COVID-19.Unlike corticosteroids that should not be administered at the beginning of the symptoms for their immunosuppressive action,which could worsen the evolution of the disease,the usefulness of non-steroidal anti-inflammatory drugs in the early at-home treatment of the disease is becoming evident.
文摘Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new prophylactic and treatment options have been evaluated to reduce the incidence of CRIs and infection related catheter removals. In children, two retrospective studies have shown the efficacy of ethanol lock treatment (ELT) in reducing the incidence of CRIs in pediatric oncology patients. However, prospective data are missing. Our aim of the present study was to evaluate prospectively the effect of ELT on the cure and recurrence rate of CRIs, duration of hospitalization and antibiotic use in HPN pediatric patients. Methods: HPN children older than three months with a clinical suspicion of a CRI were included and randomised to ELT or standard flushing treatment (heparin or taurolidine). The primary outcomes were persistence and recurrence of the bacteraemia and Central Venous Access Device (CVAD) removal. Secondary outcomes included duration of antibiotic use, duration of hospitalization and side effects. Results: Data from eight HPN children experiencing 14 suspected CRI were analysed. Seven patients had proven CRIs by positive blood cultures. Four were treated with ELT and three with their standard flushing treatment. One CRI persisted in the control group. In one single patient, bacteraemia recurred three times within 24 weeks. This patient had been enrolled in both study arms. A CVAD removal was needed in one patient because of occlusion. Conclusions: This small study showed no additional efficacy of the use of ELT on cure rate or recurrences of CRIs compared to standard therapy in HPN treated children. There were also no differences in duration of hospitalization, the use of antibiotics or CVAD removal between both groups.
文摘Background and Objectives: Permanent reduction of unwanted hair on skin types V and VI is the most challenging procedure among all hair removal technologies based on selective absorption of light or laser. The objective of this study is to evaluate the safety and efficacy of a low energy pulsed-light device combined with galvanic energy, intended for home-use hair removal on dark skin. Materials and Methods: Fifteen women with skin types V and VI and dark terminal hair in axillaarea self-administrated 6 treatments at 2 week intervals, using a hand-held IPL combined with galvanicenergy device, using HPL (Home Pulsed Light) technology. Hair count and photographs were performed pre-treatment and 1 and 3 months after the last sixth treatment. Adverse events and subject satisfaction scores were recorded. Results: All patients showed a positive clinical response to treatment, with reduction of unwanted hair. Hair counts were significantly reduced by 57.3% 1 month following last treatment and by 44.5% 3 months following last treatment. No adverse events were recorded. Subject satisfaction scores of the device usability and the treatment outcome were high. Conclusions: Low energy pulsed light combined with galvanic energy may be applied safely and effectively for at-home hair removal for people with dark skin types V and VI.
文摘Background It is debatable whether treating multimorbid nursing home patients with antihypertensive drugs produces beneficial effects. Most cardiovascular guidelines promote treatment; few have advice on how to deprescribe when treatment may no longer be necessary. We investigated the effect of medication review on antihypertensive drug use and the association between cognition, blood pressure, and prescribing. Methods From August 2014 to December 2015, 765 patients from 72 units （clusters） in 32 Norwegian nursing homes were included in a 4-month, multicentre, cluster-randomized, controlled trial, with 9-month follow-up. Patients ≥ 65 years old with antihypertensive treatment （n = 295, 39%） were randomized to systematic medication review where the physician received support from peers （collegial mentoring） or were given care as usual （control condition）. Outcome measures were the number of antihypertensive drugs, systolic blood pressure, and pulse. We used hospitalizations and deaths as criteria to assess harm. Results At baseline, each patient used 9.2 ± 3.5 regular drugs, and 1.6 ± 0.7 antihypertensives. Mean blood pressure was 128/71 mmHg and 9% had a systolic pressure ≥ 160 mmHg. Between baseline and month four, antihypertensives were deprescribed to a significantly higher extent in the intervention group （n = 43, 32%） compared to control （n = 11, 10%）; Incidence Rate Ratio = 0.8, 95% CI = 0.7？0.9. In the intervention group, there was an immediate increase in systolic blood pressure when antihypertensives were reduced, from baseline 128 ± 19.5 mmHg to 143 ± 25.5 mmHg at month four. However, at month nine, the blood pressure had reverted to baseline values （mean 134 mmHg）. Deprescription did not affect pulse and systolic pressure. The number of hospitalizations was higher in control patients at month four （P = 0.031） and nine （P = 0.041）. Conclusion A systematic medication review supported by collegial mentoring significantly decreased the use of antihypertensive drugs in nursing home patients without an effect on the systolic blood pressure over time.
文摘Lack of engagement in activities is a common feature of nursing homes residents. As apathy is the most frequent behavioural disturbance, understanding residents’ interests is a milestone for tailored challenging interventions targeting engagement enhancement. Objective: To depict the activities interests of nursing homes residents. Method: An electronic version of the Test of Interest “TILT” which regroups 40 images of activities has been developed and adapted for the Ipad. Residents were asked to answer by yes or no to the question “are you interested by this activity”, for each activity found interesting, the patient had then to categorize it in either Work/ occupation-Personal-Leisure-Family. Population: A total of 601 residents from 19 nursing homes have completed the survey from March to May 2011. The surveyed nursing homes from the South East of France were comparable of nursing homes figures in France. Results: We interviewed 601 individuals (female, n = 484) aged 85.9 years, out of those, 56% had stayed more than one year in an institution. Nearly half of the population (45.3%) was from 80 - 89 year of age, followed by 36.1% from 90 - 99. The educational background was principally from primary school (36%) and high school (30.8%). Most of the residents were classified has having dementia (35.3%). From the 40 activities presented to each participant, “enjoying a good meal” has been found to be the most interesting activity by 83% of the population followed by “dressing up”, 75.9% and “watching TV”, 75.5%. Female participants reported more interest in place of worship, family pictures and being with grand children then males (p < 0.01). We found that the presence of “dementia” diagnosis” triggered the lack of interest compared to none demented or none cognitively impaired residents (p < 0.01). It was found that participants aged 55 - 69 were more the most interested to do video games (p < 0.05), though this may be interpreted as a positive step toward functional and cognitive rehabilitation program using virtual reality as a mean for intervention.
