Judith Leblanc

Background In many settings, studies have shown that establishing patient-to-nurse ratios has benefits for both patients and staff. Whether this is transposable to emergency department (ED) is unclear. Objective The primary objective was to assess the association between patient-to-nurse ratios in EDs and mortality. Design In this systematic review, a search strategy identified studies published in 2004–2025 in MEDLINE, Cochrane, and CINAHL. Two independent reviewers performed selection and data extraction, followed by a narrative synthesis. Outcomes The primary outcome was in-hospital mortality. Secondary outcomes were other patient outcomes, staff, and organizational outcomes. Results Of 2214 identified references, 17 studies were included and all of which were observational. The primary outcome was assessed in only one cohort study ( n = 73 EDs), where an increase in the number of nurses per patient was associated with a reduction in ED mortality (adjusted odds ratio = 0.68; 95% confidence interval: 0.49; 0.94). An increase in the number of nurses per patient was also associated with a reduction in cardiac arrests (one study: relative risk = 1.33, 95% confidence interval: 1.05, 1.67 for ≥8.5 patients/nurse vs. <8.5) and medication errors (one of two studies), and an improvement in patient experience (two studies) and nurse satisfaction (one study). Mixed results were observed with regard to reducing length of stay (one of two studies), administration time (three of four studies) and the number of patients who left without being seen (three of four studies), while waiting time before diagnosis or treatment improved (three studies). Conclusion Although evidence is limited, several observational studies suggest that a higher nurse-to-patient ratio is associated with better patient, nurse, and ED organizational outcomes.

Parce qu’il favorise l’initiation précoce du traitement qui limite la morbi-mortalité et les transmissions secondaires, le dépistage du VIH est essentiel au contrôle de l’épidémie. En France, plusieurs milliers de personnes ignorent encore leur séropositivité et un quart des diagnostics du VIH est tardif. La participation infirmière au dépistage du VIH suscite un vif intérêt car elle permet d’élargir les acteurs impliqués. Nous avons suggéré à partir d’une revue de littérature systématique que, dans les pays à épidémie concentrée du VIH comme la France, les Etats Unis ou le Royaume Uni, les infirmiers pouvaient renforcer l’offre et la réalisation du dépistage du VIH. Dans ces pays, les autorités de santé ont préconisé un dépistage généralisé (non ciblé) du VIH dans les structures de santé non spécialisées. En raison de son efficacité modeste et de la charge de travail associée, cette recommandation a progressivement été remise en cause. L’étude DICI-VIH a été conçue pour explorer un nouveau mode, ciblé, de dépistage du VIH par les infirmiers dans les services d’urgences d’Ile-de-France, une région à forte prévalence. Nous avons montré, à l’aide d’un essai à large échelle randomisé en cluster et crossover en deux périodes, que ce mode de dépistage constitue une approche intéressante. En optimisant l’utilisation des ressources consacrées au dépistage dans les services d’urgences, cette stratégie ciblant un nombre limité de patients est réalisable et efficace pour identifier les personnes qui ne connaitraient pas leur séropositivité et, de plus, son coût est limité. Ces résultats fournissent de nouvelles données permettant l’adaptation des stratégies de dépistage du VIH proposées dans les régions où l’épidémie est concentrée. Ils participent également à l’évaluation de l’implication infirmière dans les programmes de dépistage.

Aim: To describe the characteristics, methods and publications of studies funded by a French research programme for nursing and allied health professions.Background: In some countries, the emerging field of nursing and allied health research is supported by funding programmes that are poorly documented.Design: Observational descriptive study.Methods: Data from funded studies in 2012–2020 were identified in publications, registries or an institutional repository by two authors in April–May 2022. Methods (quantitative, qualitative, mixed‐method), study designs using the mixed‐methods appraisal tool and thematic categories were extracted.Results: In total, 212 studies were funded. The yearly number of studies has risen from 19 in 2012 to 33 in 2020. Eight nursing and allied health professions were represented among grant recipients, including 42% (89/212) of nurses. Half of the studies with identified methods were multicentric (91/185, 16% in 2012 and 71% in 2018). The median funding per study has risen from €63,471 in 2012 to €251,665 in 2020. The predominant methods were quantitative and interventional (144/185, 78%), with randomised controlled trials being the most frequent study design (125/144, 87%). Among the 38 quantitative observational studies, 14 (37%) were diagnostic studies. Three qualitative or mixed‐methods studies were reported. The thematic categories included rehabilitation, nursing care, complementary medicine, patient education and metrology. Of the 50 completed studies, 18 publications were identified.Conclusions: The number of studies, multicentric studies and funding appeared to increase over the nine‐year study period. The predominance of high‐level evidence studies is encouraging, although a limited number of studies have been published.Implications for nursing and health policy: This study highlights the gradual involvement in a nursing and allied health research programme and the support needed to disseminate research.

Background: Asymptomatic and paucisymptomatic infections account for a substantial portion of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmissions. The value of intensified screening strategies, especially in emergency departments (EDs), in reaching asymptomatic and paucisymptomatic patients and helping to improve detection and reduce transmission has not been documented. The objective of this study was to evaluate in EDs whether an intensified SARS-CoV-2 screening strategy combining nurse-driven screening for asymptomatic/paucisymptomatic patients with routine practice (intervention) could contribute to higher detection of SARS-CoV-2 infections compared to routine practice alone, including screening for symptomatic or hospitalized patients (control). Methods and findings: We conducted a cluster-randomized, two-period, crossover trial from February 2021 to May 2021 in 18 EDs in the Paris metropolitan area, France. All adults visiting the EDs were eligible. At the start of the first period, 18 EDs were randomized to the intervention or control strategy by balanced block randomization with stratification, with the alternative condition being applied in the second period. During the control period, routine screening for SARS-CoV-2 included screening for symptomatic or hospitalized patients. During the intervention period, in addition to routine screening practice, a questionnaire about risk exposure and symptoms and a SARS-CoV-2 screening test were offered by nurses to all remaining asymptomatic/paucisymptomatic patients. The primary outcome was the proportion of newly diagnosed SARS-CoV-2–positive patients among all adults visiting the 18 EDs. Primary analysis was by intention-to-treat. The primary outcome was analyzed using a generalized linear mixed model (Poisson distribution) with the center and center by period as random effects and the strategy (intervention versus control) and period (modeled as a weekly categorical variable) as fixed effects with additional adjustment for community incidence. During the intervention and control periods, 69,248 patients and 69,104 patients, respectively, were included for a total of 138,352 patients. Patients had a median age of 45.0 years [31.0, 63.0], and women represented 45.7% of the patients. During the intervention period, 6,332 asymptomatic/paucisymptomatic patients completed the questionnaire; 4,283 were screened for SARS-CoV-2 by nurses, leading to 224 new SARS-CoV-2 diagnoses. A total of 1,859 patients versus 2,084 patients were newly diagnosed during the intervention and control periods, respectively (adjusted analysis: 26.7/1,000 versus 26.2/1,000, adjusted relative risk: 1.02 (95% confidence interval (CI) [0.94, 1.11]; p = 0.634)). The main limitation of this study is that it was conducted in a rapidly evolving epidemiological context. Conclusions: The results of this study showed that intensified screening for SARS-CoV-2 in EDs was unlikely to identify a higher proportion of newly diagnosed patients. Trial registration: Trial registration number: ClinicalTrials.gov NCT04756609.