A prospective randomized study of two reminding strategies: telephone versus mail in the screening of cervical cancer in women who did not initially respond.

OBJECTIVE: To compare the efficacy and cost-effectiveness of two reminding strategies addressed to women who did not respond to a first invitation to undergo cervical cancer screening. STUDY DESIGN: A randomized study was carried out by a programme created in Alsace to organize cervical cancer screening. In total, 10,662 women who did not have a smear test 1 year after a first notice was sent, were randomly allocated to receive either a new letter with a reply coupon or a telephone call. The uptake of screening was measured using routine data. Efficacy and direct costs of the two methods were compared. RESULTS: Uptake at 8 months was 6.3% [95% confidence interval (CI) 5.6-7.0%] for telephone calls and 5.8% (95% CI 5.2-6.4%) for letters. The difference was not significant. More information was collected through telephone calls than by letters, but with less reliability. Furthermore, telephone calls were more costly. CONCLUSIONS: We found that in our region, a mail reminder was as effective as, and less expensive than, a telephone call; moreover, it was applicable to the whole population, including patients without a telephone.

[Management of a scabies epidemic in the Strasbourg teaching hospital, France]. / Gestion d'une épidémie de gale aux Hôpitaux universitaires de Strasbourg.

CONTEXT: An outbreak of scabies occurred in the geriatric department of the Strasbourg University Hospital in September 2005. The index case presented with hyperkeratosic scabies, an extremely contagious form. The epidemic spread to several wards and pavilions and also contaminated healthcare staff and patient's families. OBJECTIVE: Our objective was to describe the outbreak, its progression, and the measures taken to eradicate it. METHODOLOGY: All healthcare workers, patients, and families affected in the outbreak were retrospectively studied, using medical prescriptions recorded by the hospital pharmacy, listings established by the occupational health department, and patient files. RESULTS: Two epidemic waves were recorded, between August 31 and December 16, 2005, affecting 51 patients and staff members in the geriatric department, with a total of 58 episodes of scabies, seven of which were recurrences. Three main measures were taken to eradicate the epidemic: setting up of "contact" isolation precautions, information for the affected individuals, and treatment of the infected patients associated to mass treatment of contact cases. The mass treatment was widely applied, involving 490 patients and 592 caregivers. All of these measures successfully curtailed the outbreak in 3 months. CONCLUSION: Rapid and radical action is essential to prevent extension of scabies within a community.

[Incidence of hospital-acquired and community-acquired bloodstream infections in the University of Strasbourg Hospitals, France, between 2005 and 2007]. / Incidence des bactériémies et fongémies aux hôpitaux universitaires de Strasbourg de 2005 à 2007.

OBJECTIVE: To follow the evolution of incidence of the main feature of bloodstream infections identified in a french hospital between 2005 and 2007. METHODS: We included all the patients hospitalised during three times three-month periods, according to the protocol given by the coordination center against nosocomial infections. For every positive blood culture, we collected clinical and microbiological datas. RESULTS: Hospital-acquired bacteremias are the most frequent with an incidence rate between 0.996 to 1.31 per thousand days of hospitalisation. The population is mainly over 50 years old. The main sources of infection are central catheter, digestive and urinary tracts. Organisms causing the majority of nosocomial bloodstream infections are coagulase-negative staphylococci, Staphylococcus aureus and Escherichia coli. The mortality rate during the first week varies from 16% in 2005 to 8% in 2007. Community-acquired bloodstream infections represent 28% of all episodes, and affect people who are over 70 years old. The main sources of infection are urinary, digestive and pulmonary. Escherichia coli, Staphylococcus aureus and Streptococcus pneumoniae are most frequently isolated. The mortality rate during the first week varies from 3.7 to 9.8% according to the year of study. CONCLUSION: This annual investigation enables us to measure the infection risk level in our hospital, to identify the main sources implied and to create targeted actions to prevent nosocomial bloodstream infections.