0000000000095848

AUTHOR

Catherine Quantin

French Doctors Working in Great Britain: A Study of their Characteristics and Motivations for Migration

International audience

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Hospitalizations for Stroke in France During the COVID-19 Pandemic Before, During, and After the National Lockdown.

Background and Purpose: In France, the entire population was put under a total lockdown from March 17 to May 11, 2020 during the peak of the coronavirus disease 2019 (COVID-19) pandemic. Whether the lockdown had consequences on the management of medical emergencies such as stroke and transient ischemic attack (TIA) has yet to be fully evaluated. This article describes hospitalization rates for acute stroke in 2 French regions that experienced contrasting rates of COVID-19 infection, before, during, and after the nationwide lockdown (January to June 2020). Methods: All patients admitted for acute stroke/TIA into all public and private hospitals of the 2 study regions were included. Data wer…

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Risque augmenté de ré-hospitalisation chez les personnes atteintes de diabète de type 1 et de schizophrénie

Introduction La morbidite et mortalite associees au diabete comme a la schizophrenie suggerent que leur combinaison puisse generer de graves problemes. L’objectif de l’etude etait d’estimer le risque de re-hospitalisation pour complications aigues du diabete et tentative de suicide a trois ans chez des personnes atteintes de diabete et de schizophrenie. Methodes A partir des donnees nationales d’hospitalisation, l’etude en population s’est interessee aux personnes âgees de 15 a 35 ans pour lesquelles une hospitalisation mentionnait un diabete de type 1, entre 2009 et 2012. Pour identifier les personnes atteintes de schizophrenie, un code correspondant a ete recherche pendant ou dans les deu…

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Age–Period–Cohort Analysis of Stroke Incidence in Dijon From 1985 to 2005

Background and Purpose— Variations in stroke incidence could be explained by changes in vascular and environmental factors that affect the risk of stroke and changes in risk factors that are present in early life. The aim of this study was to identify and measure the effects of 3 interrelated factors, age, calendar period of stroke onset, and birth year cohort, on the incidence rates of stroke from 1985 through 2005. Methods— Age–period–cohort models were used to analyze stroke incidence in Dijon from 1985 to 2005 from a population-based registry that collects data on all stroke patients whatever the type of management, in the public hospital, private hospitals, or at home, in the populati…

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A Hospital-Based and a Population-Based Stroke Registry Yield Different Results: The Experience in Dijon, France

The aim of this study was to demonstrate the different results obtained from a population-based and a hospital-based stroke study in the same city.Between January 1 and December 31, 1993, we collected information on all of the first strokes in the population of the city of Dijon, in conjunction with the Dijon Stroke Registry, collecting the first-ever strokes from patients living in Dijon as well as on all the first strokes in residents and nonresidents of Dijon who were treated at Dijon University Hospital. Demographic details, medical history, vascular risk factors, stroke subtype, as diagnosed by CT scan, and mortality rates were compared between the strokes observed in the population of…

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État des lieux et évaluation de la surveillance des Staphylococcus aureus résistants à la méticilline (SARM) : PMSI versus surveillance Raisin

Abstract Background The surveillance of methicillin-resistant Staphylococcus aureus (MRSA) is a national priority. The rate of MRSA infections is one of six indicators tracked by the Department of Health. Since 2002, the French institute for public health surveillance (InVS) has monitored MRSA infections to estimate incidence density. Today, the use of the French administrative database (PMSI) could facilitate this surveillance. The aim of this study was to compare MRSA incidence density computed at a national level using PMSI databases with the results from the InVS taken as the reference. Methods PMSI databases for the years 2006 to 2009 were used. The reference results were those publish…

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How accurate is the reporting of stroke in hospital discharge data? A pilot validation study using a population-based stroke registry as control.

Population-based stroke registries can provide valid stroke incidence because they ensure exhaustiveness of case ascertainment. However, their results are difficult to extrapolate because they cover a small population. The French Hospital Discharge Database (FHDDB), which routinely collects administrative data, could be a useful tool for providing data on the nationwide burden of stroke. The aim of our pilot study was to assess the validity of stroke diagnosis reported in the FHDDB. All records of patients with a diagnosis of stroke between 2004 and 2008 were retrieved from the FHDDB of Dijon Teaching Hospital. The Dijon Stroke Registry was considered as the gold standard. The sensitivity, …

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Les réadmissions après résection pulmonaire en France : la base de données du PMSI

BACKGROUND Readmission within 30 days is an indicator of the quality of care, because it often reflects post-discharge care that is not optimal. The objective of this work is to measure over time on the one hand the readmission rate and on the other hand the number of hospitals with a standardized readmission rate beyond the national average. METHOD All patients with major pulmonary resection for lung cancer in France were extracted from the PMSI national database. Readmission within 30 days was defined as any new hospitalization either in the same hospital or in another establishment. RESULTS From January 1, 2005 to December 31, 2018, 110,603 patients were included. The 30-day all-cause re…

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Chirurgie combinée de la cataracte et endophtalmie postopératoire aiguë en France de 2005 à 2014

Introduction : L’objectif de cette étude était d’analyser l’association entre chirurgie de la cataracte combinée avec des interventions chirurgicales de traitement du glaucome, vitréorétiniennes ou cornéennes et la survenue d’une (EPOA), de 2005 à 2014 en France. Méthodes : Les procédures de chirurgie de la cataracte par phacoémulsification et/ou de traitement du glaucome, vitréorétiniennes ou cornéennes ont été repérées par les codes correspondant de la classification commune des actes médicaux (CCAM) dans le programme de médicalisation des systèmes d’information (PMSI) du 1er janvier 2005 au 31 décembre 2014. L’EPOA était définie par la présence d’un diagnostic d’endophtalmie lors d’une h…

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The use of national administrative data to describe the spatial distribution of in-hospital mortality following stroke in France, 2008-2011.

International audience; Background: In the context of implementing the National Stroke Plan in France, a spatial approach was used to measure inequalities in this disease. Using the national PMSI-MCO databases, we analyzed the in-hospital prevalence of stroke and established a map of in-hospital mortality rates with regard to the socio-demographic structure of the country.Methods: The principal characteristics of patients identified according to ICD10 codes relative to stroke (in accordance with earlier validation work) were studied. A map of standardized mortality rates at the level of PMSI geographic codes was established. An exploratory analysis (principal component analysis followed by …

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Mesure de la qualité des soins à partir de la base de données nationale du PMSI. Étude de la mortalité hospitalière après résections pulmonaires pour cancer

Introduction En 2009, les centres prenant en charge des cancers ont ete soumis a autorisation suite au premier plan cancer. Cinq annees plus tard, il nous paraissait interessant de connaitre l’impact de cette nouvelle organisation. L’objectif est d’estimer l’effet periode et d’evaluer l’influence du volume d’activite sur la mortalite. Methodes De la base de donnees PMSI ont ete extraits pour tous les patients ayant eu une resection pulmonaire pour cancer bronchique. Les caracteristiques des centres comprennent le volume d’activite annuel et le type d’etablissement : publiques non universitaires, prives et CHU. L’indicateur de qualite utilise est la mortalite hospitaliere definie comme tout …

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Healthcare trajectory mining by combining multidimensional component and itemsets

Sequential pattern mining is aimed at extracting correlations among temporal data. Many different methods were proposed to either enumerate sequences of set valued data (i.e., itemsets) or sequences containing multidimensional items. However, in real-world scenarios, data sequences are described as events of both multidimensional items and set valued information. These rich heterogeneous descriptions cannot be exploited by traditional approaches. For example, in healthcare domain, hospitalizations are defined as sequences of multi-dimensional attributes (e.g. Hospital or Diagnosis) associated with two sets, set of medical procedures (e.g. $ \lbrace $ Radiography, Appendectomy $\rbrace$) and…

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L’échantillon généraliste des bénéficiaires : un outil pour l’évaluation du risque vaccinal ?

Introduction Les bases de donnees medico-administratives sont de plus en plus utilisees pour evaluer le risque vaccinal. L’echantillon generaliste des beneficiaires (EGB) a ete cree a partir de celle de l’Assurance-maladie par echantillonnage au 1/97 e de la population francaise. L’objectif de l’etude est de calculer pour differentes associations effet indesirable/vaccin un nombre de cas necessaires et de comparer ces effectifs avec ceux disponibles dans l’EGB. Methodes L’analyse en serie de cas est une approche frequemment utilisee pour ce type d’etude. Les effectifs ont ete calcules dans ce cadre, avec et sans prise en compte de l’effet âge. Pour l’association convulsion febrile (CF)/vacc…

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Soins ambulatoires et facteurs associés à la réhospitalisation précoce des sujets âgés (65+) après un infarctus du myocarde : étude observationnelle à partir des données nationales de l’Échantillon généraliste de bénéficiaires (EGB)

Etat de la question Les rehospitalisations precoces (RHP), dans les 30 jours suivant la sortie d’hospitalisation, sont frequentes chez les sujets âges, notamment apres un infarctus du myocarde (IDM). Elles augmentent la morbi-mortalite et les depenses de sante. Il a ete demontre qu’une meilleure organisation de la sortie d’hospitalisation reduit significativement le risque de RHP. Neanmoins, il n’existe aucune recommandation sur le suivi ambulatoire en sortie d’hospitalisation. L’objectif de l’etude etait d’analyser les soins ambulatoires post-hospitaliers et les facteurs associes a la RHP des sujets âges apres un IDM. Materiel et methodes Etude observationnelle retrospective a partir des d…

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A decision tree to help determine the best timing and antiretroviral strategy in HIV-infected patients.

SUMMARYOptimal antiretroviral strategies for HIV-infected patients still need to be established. To this end a decision tree including different antiretroviral strategies that could be adopted for HIV-infected patients was built. A 10-year follow-up was simulated by using transitional probabilities estimated from a large cohort using a time-homogeneous Markov model. The desired outcome was for patients to maintain a CD4 cell count of >500 cells/mm3without experiencing AIDS or death. For patients with a baseline HIV viral load ⩾5 log10copies/ml, boosted protease inhibitor-based immediate highly active antiretroviral therapy (HAART) allowed them to spend 12% more time with CD4 ⩾500/mm3than…

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Proposition d’une méthode d’exploitation d’une base de données nationales : le PMSI, pour estimer la fréquence, repérer les situations à risques et les conséquences, des maltraitances physiques à enfants en France

Introduction L’objectif de ce travail est de reperer les situations de maltraitances physiques a enfants et d’evaluer leurs consequences, en termes de mortalite, a partir des donnees du PMSI. Methodes Ont ete incluse, tous les enfants âges de 0 a 2 ans, hospitalises en France entre 2007 et 2014. A partir des codes CIM-10, generes pour le PMSI a chaque sejour hospitalier, trois groupes d’enfants ont ete definis : 1) ceux ayant un code dedie aux maltraitances physiques ; 2) ceux ayant un code de lesions suspectes de mauvais traitement, 3) les autres enfants hospitalises. Une estimation de la frequence nationale de ces maltraitances physiques a ete calculee, selon deux methodes, l’une conduisa…

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Does age over 80 years have to be a contraindication for lung cancer surgery—a nationwide database study

IF 1.804 (2017); International audience; Background: Nowadays surgery remains the best treatment for localized lung cancer (LC). However, patients over 80 years old are often denied surgery because of the postoperative risk of death. This study aimed to estimate in-hospital mortality (IHM) and determine whether age over 80 is the most important predictor of IHM after LC surgery.Methods: From January 2005 to December 2015, 97,440 patients, including 4,438 patients over 80 years old, were operated on for LC and recorded in the French Administrative Database. Characteristics of patients, hospitals and surgery were analysed.Results: Crude IHM was 3.73% (n=3,639) and 7.77% (n=345) for the over 8…

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Étude de prévalence de l’endométriose à la Réunion et en métropole à partir du PMSI

Introduction Objectif principal : determiner la prevalence des hospitalisations pour endometriose a la Reunion et en metropole. Objectif secondaire : apprecier l’evolution des soins chirurgicaux pour cette pathologie dans l’ile comparee a la metropole. L’endometriose est une maladie de la femme reglee. Les principaux modes de decouverte sont la douleur et l’infertilite. Le diagnostic de certitude repose sur la cœlioscopie et donc sur une hospitalisation. Methodes Du 1/01/2008 au 31/12/2012, a partir du PMSI national, nous avons releve les codes de diagnostic principal concernant l’endometriose (N800 a N809). Dans cette population, nous avons consulte les actes realises et ceux qui concernai…

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Survie des receveurs après transfusion de concentrés de globules rouges, étude pronostique en chirurgie cardiovasculaire en fonction de l’âge des CGR et du sexe donneur/receveur

L’influence de la duree de conservation des CGR sur la mortalite apres transfusion reste controversee. La survie des receveurs masculins pourrait etre alteree apres transfusion de CGR de donneuses. L’etude visait a estimer la survie des receveurs d’une premiere transfusion et a analyser l’effet pronostique de la conservation et du sexe du donneur sur la survie, en particulier apres chirurgie cardiovasculaire (CCV). Les donnees EFS et hospitalieres des patients adultes receveurs d’une premiere transfusion de CGR entre 2007 et 2011 aux CHU de Besancon et Dijon ont ete compilees. Le statut vital provenait du registre des personnes physiques. La survie apres transfusion a ete estimee pour l’ens…

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Combined effects of increasing maternal age and nulliparity on hypertensive disorders of pregnancy and small for gestational age

The mean age of women delivering for the first time is increasing, and this combination could lead to an increased risk of perinatal complications.The objective was to evaluate the potential combined effects of nulliparity and increasing maternal age on small for gestational age (SGA  10th percentile) and hypertensive disorders of pregnancy (HDP).A population-based cohort study was conducted using data routinely collected on all births in 11 hospitals in the Burgundy perinatal network between 2007 and 2016. Pregnant women with singleton deliveries aged 20 years or older were included at delivery and divided into groups according to maternal age (20 to 24-year-old group as a reference). Mult…

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Comparison of British and French expatriate doctors’ characteristics and motivations

Objective The aim of this study was to analyse the migration of doctors between the UK and France, in an attempt to identify the reasons for these migrations. Design This was a cross-sectional study conducted using a self-completed questionnaire. Setting The questionnaire was sent to all British doctors practising in France and to all French doctors practising in the UK. Participants The doctors were identified, thanks to official data of the National Medical Councils. There were 244 French doctors practising in the UK and 86 British doctors practising in France. Outcome measures A questionnaire was specifically developed for the study to determine the reasons why doctors moved to the other…

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Combining hashing and enciphering algorithms for epidemiological analysis of gathered data.

Summary Objectives: Compiling individual records coming from different sources is necessary for multi-center studies. Legal aspects can be satisfied by implementing anonymization procedures. When using these procedures with a different key for each study it becomes almost impossible to link records from separate data collections. Methods: The originality of the method relies on the way the combination of hashing and enciphering techniques is performed: like in asymmetric encryption, two keys are used but the private key depends on the patient’s identity. Results: The combination of hashing and enciphering techniques provides a great improvement in the overall security of the proposed scheme…

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Séroconversion toxoplasmique chez la femme enceinte

Resume Introduction La France possede depuis 1992 un programme de prevention de la toxoplasmose reposant sur la detection serologique des infections en cours de grossesse. En l’absence de consensus, les seroconversions depistees sont prises en charge de facon variable selon les centres. Objectif Decrire les pratiques des centres experts francais et faire des propositions pour reduire leur heterogeneite. Methode Enquete postale par questionnaire aupres des centres de parasitologie francais de reference pour la prise en charge des seroconversions toxoplasmiques en cours de grossesse. Resultats La totalite des 30 centres interroges ont repondu. Cinq d’entre eux ne font pas de recommandations t…

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Accuracy of blood transfusion in postpartum hemorrhage to assess maternal morbidity.

International audience; OBJECTIVE: To measure the accuracy of blood transfusion (timing and number of blood units) in postpartum hemorrhage (PPH) in a perinatal network. STUDY DESIGN: (1) The ANONYMAT software system was used for anonymization and linkage of two large stand-alone databases, the Burgundy Perinatal Network (BPN) and the National Blood Centre (EFS) databases, which contain, respectively, clinical data from hospital discharges and information concerning any blood transfusion in France (considered as the gold standard database for identifying any transfusion). (2) Identification of prescriptions of at least one red blood cell (RBC) unit at the day of delivery (≥22 weeks) and up …

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Multiple pregnancies and environmental exposure: An impact of air pollution on fetal growth?

Introduction Multiple pregnancies display all the complications of singletons, but in highest frequencies, especially for fetal growth abnormalities. In singletons, air pollution seems to be negatively associated with fetal growth. A similar relationship in multiple pregnancies can be expected. However, multiple pregnancies are systematically excluded from the studies of the impact of air pollution on pregnancy outcomes. This study aims to analyze in a population of multiple pregnancies the relationship between fetal growth restriction (FGR), small for gestational age (SGA) and environmental chronic exposure to air pollution in moderately polluted cities. Methods All the multiple pregnancie…

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Évaluation de la qualité métrologique des données du Programme de médicalisation du système d’information (PMSI) en périnatalité. Étude pilote réalisée dans les CHU de Dijon, Port-Royal et Nancy

Introduction Le plan de perinatalite et les recommandations europeennes expriment la necessite de fournir des informations fiables indispensables a la realisation de travaux de recherche et a la production d’indicateurs nationaux. Parmi les multiples sources de donnees perinatales, les donnees du PMSI offrent la potentialite de fournir des informations systematiques et standardisees pour l’ensemble des naissances. L’objectif de l’etude etait de mesurer la faisabilite de valider la qualite metrologique des donnees du PMSI pour des indicateurs de base de sante perinatale dans trois centres hospitaliers universitaires pilotes, avant de mener une etude a l’echelon national. Methodes Dans trois …

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Flexible modelling of the risks associated with donor sex and age of blood on survival after red blood cell transfusion

Etat de la question Les etudes realisees jusqu’a present en epidemiologie transfusionnelle affichent des resultats contradictoires sur l’association entre caracteristiques du CGR et la mortalite du patient receveur. La prise en compte des transfusions repetees de concentres de globules rouges (CGR) dans la survie est un domaine methodologiquement complexe, pouvant expliquer le manque de consensus scientifique. L’objectif de notre etude etait d’analyser l’impact du sexe du donneur et de la duree de conservation sur la survie par modele flexibles de type « Weighted Cumulative Exposure » (WCE) et de comparer les resultats au modele de Cox. Materiel et methodes Cette etude de survie a ete reali…

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Caractéristiques et motivations des médecins français ayant choisi d’émigrer en Grande Bretagne

International audience

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Empirical study of the dependence of the results of multivariable flexible survival analyses on model selection strategy

Flexible survival models, which avoid assumptions about hazards proportionality (PH) or linearity of continuous covariates effects, bring the issues of model selection to a new level of complexity. Each ‘candidate covariate’ requires inter-dependent decisions regarding (i) its inclusion in the model, and representation of its effects on the log hazard as (ii) either constant over time or time-dependent (TD) and, for continuous covariates, (iii) either loglinear or non-loglinear (NL). Moreover, ‘optimal’ decisions for one covariate depend on the decisions regarding others. Thus, some efficient model-building strategy is necessary. We carried out an empirical study of the impact of the model …

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Classification of hospital pathways in the management of cancer: application to lung cancer in the region of burgundy.

Abstract Context : The evaluation of national cancer plans is an important aspect of their implementation. For this evaluation, the principal actors in the field (doctors, nurses, etc.) as well as decision-makers must have access to information that is reliable, synthetic and easy to interpret, and which reflects the implementation process in the field. We propose here a methodology to make this type of information available in the context of reducing inequalities with regard to access to healthcare for patients with lung cancer in the region of Burgundy. Methods : We used the national medico-administrative DRG-type database, which gathers together all hospital stays. By using this database…

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Prise en charge des pathologies cardiovasculaires, pulmonaires et traumatiques : lieux d’hospitalisation et flux des patients domiciliés en Autunois et Morvan

Introduction Meme si l’egal acces aux soins est prone par la loi HPST, depuis cinq ans, deux millions de Francais supplementaires ont ete touches par la desertification medicale et les inegalites entre les territoires ne cessent d’augmenter. Pour faire face a cet enjeu, un pacte « territoire sante » a ete presente par le ministre charge de la sante qui necessite d’identifier les bassins de desserte des hopitaux et les flux des patients. L’objectif de cette etude est de localiser les lieux d’hospitalisation et de decrire les flux des patients en prenant pour exemple des zones mal desservies telles que celles de l’Autunois et du Morvan. Materiels et methodes Cette etude concernait l’ensemble …

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Qualité des données périnatales issues du PMSI : comparaison avec l’état civil et l’enquête nationale périnatale 2010

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 43 - N° 9 - p. 680-690

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Depression and obesity, data from a national administrative database study: Geographic evidence for an epidemiological overlap

BackgroundDepression and obesity are two major conditions with both psychological and somatic burdens. Some data suggest strong connections between depression and obesity and more particularly associated prevalence of both disorders. However, little is known about the geographical distribution of these two diseases. This study aimed to determine if there is spatial overlap between obesity and depression using data from the entire French territory.MethodsData for 5,627 geographic codes for metropolitan France were collected from the two national hospital databases (PMSI-MCO and RIM-P) for the year 2016. We identified people who were depressed, obese or both registered in the two public medic…

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Évaluation de la pratique chirurgicale dans le traitement du cancer bronchique en France à partir de la base nationale du PMSI

Background - In recent years, improving the quality of care has been a concern for health professionals in France, through the certification of institutions, accreditation and continuous professional development. Evaluation of these different measures has rarely been carried out. The objective of the study was to evaluate the quality of surgical management of lung cancer in different regions using hospital mortality as an indicator. Method - From the national database of the Program of Medical Information Systems (PMSI), data on all patients who had undergone surgery for lung cancer were extracted as well as the characteristics of the centers. The main outcome criterion was hospital mortali…

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Multiple pregnancies and air pollution in moderately polluted cities: Is there an association between air pollution and fetal growth?

Background: Multiple pregnancies (where more than one fetus develops simultaneously in the womb) are systematically excluded from studies of the impact of air pollution on pregnancy outcomes. This study aims to analyze, in a population of multiple pregnancies, the relationship between fetal growth restriction (FGR), small for gestational age (SGA) and exposure to air pollution in moderately polluted cities. Methods: All women with multiple pregnancies living in the city of Besançon or in the urban area of Dijon and who delivered at a university hospital between 2005 and 2009 were included. FGR and SGA were obtained from medical records. Outdoor residential nitrogen dioxide (NO2) exposure wa…

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Advantages and limitations of using national administrative data on obstetric blood transfusions to estimate the frequency of obstetric hemorrhages

International audience; BACKGROUND: Obstetric hemorrhages are a frequent cause of maternal death all over the world, but are not routinely monitored. Health systems administrative databases could be used for this purpose, but data quality needs to be assessed. OBJECTIVES: Using blood transfusion data recorded in administrative databases to estimate the frequency of obstetric hemorrhages. Research design A population-based study. Subjects Validation sub-sample: all mothers who gave birth in a French region in 2006-07 (35 123 pregnancies). Main study: all mothers who gave birth in France in 2006-07 (1 629 537 pregnancies). METHOD: Linkage and comparison of administrative data on blood transfu…

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Modeling of medical activity heterogenity to improve the hospital management by diagnosis-related groups

Since the early 1980s healthcare systems in the industrialized nations have been undergoing radical reform aimed at curbing overspending of hospital expenditure. After a discussion of the limits of a prospective payment due to heterogeneity of costs within DRGs, we demonstrate the ability of anovel statistical model to identify high cost patients. We derive from this statistical model an economic heuristic in order to account for high cost patients in budget allocation and a Structural and Contingent method is proposed as a budgeting tool. Economic analysis based on this modeling of DRG heterogeneity further reveals the potential for improving the equity and the efficiency of the prospectiv…

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Évaluation de la qualité des données du programme de médicalisation des systèmes d’information pour la mesure de l’incidence hospitalière de l’accident vasculaire cérébral

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sj-pdf-1-pmj-10.1177_02692163211019299 – Supplemental material for Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data

Supplemental material, sj-pdf-1-pmj-10.1177_02692163211019299 for Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data by Michael K. Gusmano, Victor G. Rodwin, Daniel Weisz, Jonathan Cottenet and Catherine Quantin in Palliative Medicine

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Validation of the French national health insurance information system as a tool in vaccine safety assessment: Application to febrile convulsions after pediatric measles/mumps/rubella immunization

In the French national health insurance information system (SNIIR-AM), routine records of health claimed reimbursements are linked to hospital admissions for the whole French population. The main focus of this work is the usability of this system for vaccine safety assessment programme. Self-controlled case series analyses were performed using an exhaustive SNIIR-AM extraction of French children aged less than 3 years, to investigate the relationship between MMR immunization and children hospitalizations for febrile convulsions, a well-documented rare adverse event, over 2009-2010. The results suggest a significant increase of febrile convulsions during the 6-11 days period following any MM…

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Chaînage de bases de données anonymisées pour les études épidémiologiques multicentriques nationales et internationales : proposition d'un algorithme cryptographique

Background: Compiling individual records coming from different sources is very important for multicenter epidemiological studies; however, European directives and other national legislation concerning nominal data processing must be respected. These legal aspects can be satisfied by implementing mechanisms that allow anonymization of patient data (such as hashing techniques). Moreover, for security reasons, official recommendations suggest using different cryptographic keys in combination with a cryptographic hash function for each study. Unfortunately, this type of anonymization procedure is in contradiction with common requirements in public health and biomedical research because it becom…

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Évaluation de la qualité métrologique des données du programme de médicalisation du système d’information (PMSI) en périnatalité : étude pilote réalisée dans 3 CHU

Resume Position du probleme La France est l’un des derniers pays europeens a ne pas pouvoir fournir d’informations perinatales fiables, indispensables a la realisation de travaux de recherche et a la production d’indicateurs nationaux. Le systeme d’information perinatale en France est fragmente et les donnees, difficiles a regrouper, ne repondent pas aux exigences d’Europeristat. Les donnees du PMSI offrent la potentialite de fournir des informations systematiques et standardisees pour l’ensemble des naissances. L’objectif etait d’etudier la qualite metrologique des donnees du PMSI pour construire des indicateurs de base en sante perinatale dans trois centres hospitaliers universitaires, av…

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Accessibilité de la maternité la plus proche en Bourgogne, comparaison de deux méthodes de calcul d’itinéraires

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Construction of quality of life change patterns: example in oncology in a phase III therapeutic trial (FFCD 0307)

Objective Quality of life data in cancerology are often difficult to summarize due to missing data and difficulty to analyze the pattern of evolution in different groups of patients. The aim of this work was to apply a new methodology to construct Quality of Life (QoL) change patterns within patients included in a clinical trial comparing to regimen of treatment in locally advanced eosogastric cancer. Materials and methods In this trial, QoL was assessed every 2 months by self-reported EORTC QLQ-C30 questionnaire. Physical dimension scores were analyzed. After multiple imputation of missing data, 27 statistical measures aiming to describe the variation of QoL measures among follow-up were c…

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Dépistage du cancer du sein dans treize départements français

Resume Objectif L’objectif de ce travail etait de decrire la participation au depistage organise (DO) et la demarche de detection par mammographie individuelle (MI) en 2010–2011 dans 13 departements francais. Methodes L’analyse a porte sur les donnees de 622 382 femmes âgees de 51 a 74 ans invitees au DO du cancer du sein en 2010–2011. Le type de mammographie realisee a ete etudie selon l’âge, le regime d’Assurance maladie, la ruralite et le niveau socio-economique du lieu de residence. L’analyse a egalement permis de cartographier et d’analyser les zones etudiees en fonction de la defavorisation socio-economique et de la participation au depistage. Resultats Une mammographie de DO ou indiv…

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L’utilisation des antiTNFα pendant la grossesse augmente le risque de complications chez les femmes atteintes de maladies inflammatoires chroniques de l’intestin. Cohorte rétrospective sur le Système national d’information inter-régimes de l’assurance maladie (EVASION)

Introduction Les maladies inflammatoires chroniques intestinales (MICI) necessitent un traitement chronique, pouvant interferer avec le desir de grossesse chez les jeunes femmes. Une MICI non controlee en debut de grossesse est un facteur de mauvais pronostic maternel et fœtal. L’utilisation, hors autorisation, des antagonistes du « Tumor Necrosis Factor α » (anti-TNFα) durant la grossesse, augmente actuellement, et peuvent exposer la femme et le fœtus a des complications iatrogenes. Les recommandations actuelles sur les anti-TNFα dans cette population sont discordantes. Cette etude visait a evaluer, les modalites d’utilisation et le rapport benefice-risque des anti-TNFα pendant la grossess…

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De la standardisation à la normalisation de la gestion médicalisée à l'hôpital : L’apport de la méthode de compensation structurelle et conjoncturelle

Utilization of GHM in budget allocation leads to a reduction of strategic behaviors and restores equity between hospitals. However, heterogeneousness of GHM, with subgroups, is also generating perverse effects. The contractual economical analysis, applied to the statistical modelization of Quantin et al. (1995), underlines how the opportunist behaviors can be reduced. As the PMSI is almost unanimously adopted and considered as an irreversible investment, this approach generates questions on ways to improve the tool. The ultimate goal is to move from standardized costs tonormalized (optimized) costs for maximum efficiency of the tool. Finally, this statistical analysis generates a financial …

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More than one in two venous thromboembolism treated in French hospitals occurs during the hospital stays

Objective The objective was to describe the prevalence of venous thromboembolism, pulmonary embolism, and deep vein thrombosis among hospitalized patients and the percentages of those occurring during the hospital stays. Methods French DRG gave now the opportunity to investigate the frequency of venous thromboembolism occurring during the hospital stay. Statistics are issued from the national PMSI MCO databases encoded using the CIM10. Since 2010–2011 it is possible to differentiate the reason for hospital admission from the pathologies which secondly occurred. Any stay with the ICD-10 codes selected was considered as a hospital-occurred thrombosis unless it was the principal diagnosis of t…

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Comparaison France-Suisse des taux hospitaliers standardisés d’événements thromboemboliques et hémorragiques après arthroplastie totale primaire programmée de hanche ou de genou

Introduction La Suisse et la France ne contribuent pas aux comparaisons internationales de l’OCDE sur la securite des arthroplasties de hanche (PTH) et de genou (PTG) utilisant les taux standardises de thromboses veineuses profondes (TVP) ou d’embolies pulmonaires (EP) a 30 jours. L’objectif principal de cette etude etait d’estimer et de comparer les taux hospitaliers standardises d’evenements indesirables (TSEI) thromboemboliques et hemorragiques survenant apres une PTH/PTG primaire programmee chez les patients âges hospitalises en Suisse et en France. Methodes Nous avons mene deux etudes transversales basees sur des donnees medico-administratives nationales chainees (periode 2011–2014) de…

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Hospitalization for self-harm during the early months of the Covid-19 pandemic in France: a nationwide study

ABSTRACTIntroductionLittle is known to date about the impact of Covid-19 pandemic on self-harm incidence.MethodsThe number of hospitalizations for self-harm in France (mainland and overseas) from January to August 2020 (which includes the first confinement from March 17th to May 11th) was compared to the same period in 2019-2017. Hospital data with the ICD-10 codes X60-84 were extracted from the national administrative database (PMSI).ResultsThere were 53,583 hospitalizations for self-harm in France between January and August 2020. Compared to the same period in 2019, this represents an overall 8.5% decrease. This decrease started the first week of the confinement and the number of hospital…

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Emergence des pathologies pulmonaires non infectieuses chez les patients vivant avec le virus de l’immunodéficience humaine (VIH) : étude sur la base nationale des données du PMSI de 2007 à 2013

Introduction Une modification de l’epidemiologie des pathologies respiratoires a ete constatee chez les patients infectes par le VIH depuis la mise en place des therapies antiretrovirales. Les objectifs de notre travail sont de determiner la prevalence francaise des pathologies respiratoires chez les personnes infectees par le VIH et d’evaluer le risque que represente l’infection par le VIH dans la survenue de pathologies respiratoires non infectieuses. Methodes A partir de la base nationale de donnees du Programme de medicalisation des systemes d’information (PMSI), nous avons calcule la prevalence hospitaliere d’un panel de pathologies respiratoires chez les patients infectes par le VIH h…

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Qualité de la surveillance de l’hémoglobine glyquée après un infarctus cérébral ou un accident ischémique transitoire : une étude nationale

Etat de la question Chez les patients diabetiques, la prevention de la recidive d’un infarctus cerebral (IC) et d’un accident ischemique transitoire (AIT) necessite l’equilibre glycemique. Notre etude s’interesse a l’association entre la survenue d’un IC ou d’un AIT et la realisation d’un suivi de l’HbA1c acceptable ou optimal selon les recommandations actuelles. Materiel et methodes Les patients diabetiques victimes d’un IC ou d’un AIT durant l’annee 2011 (exposes) ont ete identifies a partir des donnees du Programme de medicalisation des systemes d’information, et compares a un groupe de patients diabetiques indemnes d’IC ou d’AIT (non exposes) issus de l’echantillon general des beneficia…

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Réflexions sur l’identification du patient dans les systèmes d’information de santé

Resume Objectif Le but de notre etude est de faire le point sur les concepts de base et les methodologies mises en œuvre dans les systemes d’informations de sante pour identifier le patient. Methodologie La methode utilisee est une analyse des contraintes intrinseques et extrinseques des systemes deja utilisees liees respectivement a leurs objectifs et aux exigences ethiques ; et une recherche d’assise methodologique ouverte, evolutive basee sur le constat illusoire d’identifiant unique et universel. Resultat Malgre de nombreuses contraintes notre analyse des differents travaux montre que certaines solutions sont envisageables. Celles-ci sont centrees sur un modele simple d’identification r…

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Hospital Readmission after Major Pulmonary Resection for Lung Cancer in France: A Nationwide Medico-Administrative Database

Objectives: After major pulmonary resection for lung cancer, hospital readmission is considered an indicator of the quality of care. Our main objective was to define the readmission rate at 30 days after pulmonary resection. Secondary objectives were to determine the causes and predictive factors. Methods: Data for all patients operated for lung cancer were extracted from the national medico-administrative database of the Programme de Medicalisation des Systemes d'Information (PMSI). Thirty-days hospital readmission was defined as any new hospitalization within 30 days after discharge from the surgical department following major lung resection, regardless of the reason for readmission. Resu…

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Efficiency of telemedicine for acute stroke: a cost-effectiveness analysis from a French pilot study

AbstractObjectivesTelestroke is an effective way to improve care and health outcomes for stroke patients. This study evaluates the cost-effectiveness of a French telestroke network.MethodsA decision analysis model was built using population-based data. We compared short-term clinical outcomes and costs for the management of acute ischemic stroke patients before and after the implementation of a telestroke network from the point of view of the national health insurance system. Three effectiveness endpoints were used: hospital death, death at 3 months, and severe disability 3 months after stroke (assessed with the modified Rankin scale). Most clinical and economic parameters were estimated fr…

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Impact of the COVID‐19 Epidemic on hospitalization for diabetic foot ulcers during lockdown: A French nationwide population‐based study

AIMS/HYPOTHESIS: The aim of this study was to examine the impact of the COVID-19 epidemic on the hospitalization rates for diabetic foot ulcer (DFU), osteomyelitis and lower limb revascularization procedure in people with DFU. METHODS: This nationwide retrospective cohort study included hospital data on all people hospitalized in France for diabetes in weeks 2-43 in 2020, including the COVID-19 lockdown period, compared to same period in 2019. RESULTS: The number of hospitalizations for DFU decreased significantly in weeks 12-19 (during the lockdown) (p < 10-4 ). Hospitalization for foot osteomyelitis also decreased significantly in weeks 12-19 (p < 10-4 ). The trend was the same for lower …

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Hospitalization Within the First Year After Stroke

Background and Purpose— This population-based study aimed to identify unplanned hospitalization within the first year after stroke to determine factors associated with it and consequences on survival. Methods— All first-ever acute strokes occurring in Dijon, France, from 2009 to 2011, were prospectively collected from a population-based registry. Demographics and clinical data, including stroke severity measured by the National Institutes of Health Stroke Scale and disability after stroke, were recorded. For each patient, the first unplanned hospitalization that occurred within 1 year after stroke was retrieved by linking data with the national French Hospital Discharge Database. Predictor…

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Stratification dépendante du temps dans la modélisation de Cox en tant que méthode de prise en compte d’interventions répétées dans la prise en charge des patients : l’exemple de la transfusion de sang

International audience; IntroductionLa transfusion de concentrés de globules rouges (CGR) est le traitement symptomatique de l’anémie et contribue à l’oxygénation des tissus au cours de pathologies sévères. Nous menons une recherche sur l’effet des caractéristiques des CGRs sur la survie des patients dans les CHU de Besançon et Dijon : l’étude STeF-BFC. Nous étudions l’effet de la durée de conservation (DC) et du sexe du donneur (SD) des CGR sur la survie à un an de patients de chirurgie cardiovasculaire. Dans ce type d’étude, le nombre de CGR reçus est un facteur de confusion majeur. Il s’agit d’un biais d’indication mais aussi un biais de survivant (il faut avoir survécu jusqu’à la transf…

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Additional file 1: of Construction of quality of life change patterns: example in oncology in a phase III therapeutic trial (FFCD 0307)

Annex 1: The Full EORTC QLQ-C30 version 3 questionnaire with 30 items and their answer options. The physical functioning scale is concerned by items 1 to 5. Annex 2: Construction steps of quality of life change pattern from longitudinal data score, taking into account the presence of missing scores. Annex 3: Listing of the 27 statistical measures of change with in bold case (N°), the measures selected for the classification. Annex 4: The CritCF formula. (DOCX 568 kb)

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Haemoptysis: a frequent diagnostic challenge

We appreciate and agree with the comments of M. Mondoni and colleagues, that the results of the ongoing prospective Italian multicentre trial ([www.ClinicalTrial.gov][1] identifier [NCT02045394][2]) will be of considerable interest for the management of haemoptysis, a frequent and severe symptom, especially since there is no clear consensus concerning aetiology and treatment. Interestingly, beyond determining the prevalence of diseases that may present with haemoptysis, their epidemiological results will be analysed according to the severity of the symptom. More importantly, their trial will hopefully make it possible to analyse the sensitivity and specificity of complementary tests, such a…

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Total plasma protein in very preterm babies: prognostic value and comparison with illness severity scores

International audience; OBJECTIVE: We aimed to investigate the predictive value for severe adverse outcome of plasma protein measurements on day one of life in very preterm infants and to compare total plasma protein levels with the validated illness severity scores CRIB, CRIB-II, SNAP-II and SNAPPE-II, regarding their predictive ability for severe adverse outcome. METHODS: We analyzed a cohort of infants born at 24-31 weeks gestation, admitted to the tertiary intensive care unit of a university hospital over 10.5 years. The outcome measure was "severe adverse outcome" defined as death before discharge or severe neurological injury on cranial ultrasound. The adjusted odd ratio (aOR) and 95%…

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Early cardiovascular events in women with a history of gestational diabetes mellitus

International audience; Background: The effect of gestational diabetes mellitus (GDM) on cardiovascular diseases (CVD) is not assessed within the first 10 years postpartum, regardless of subsequent diabetes. The aim of this study was to determine the risk of CVD events related to GDM within 7 years of postpartum.Methods: This nationwide population-based study of deliveries in 2007 and 2008 with a follow-up of 7 years was based on data from the French medico-administrative database. Two groups were formed: women with a history of GDM and women without GDM or previous diabetes. CVD included angina pectoris, myocardial infarction, stroke, heart bypass surgery, coronary angioplasty, carotid end…

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A Pharmacoepidemiological study of intravitreal drug consumption in the first 12 months of treatment. The EPIdemiology and SAFEty collaboration

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Précocité des pathologies cardiovasculaires chez les femmes ayant un antécédent de diabète gestationnel

Introduction La precocite de dysfonctions cardiaques et du syndrome metabolique apres une grossesse marquee par un diabete gestationnel (DG) est un sujet d’actualite. L’objectif de l’etude etait de determiner, a partir des donnees hospitalieres, l’association entre antecedent de DG et maladies cardiovasculaires (MCV) dans les six annees du post-partum. Methodes Cette etude concerne l’ensemble des accouchements reperes dans la base nationale du PMSI en 2007 et 2008. Parmi ces femmes, ont ete distinguees celles ayant presente un DG au cours de leur grossesse (en 2007 ou 2008), et celles sans DG. Ces femmes ont ete suivies via le chainage des resumes PMSI, jusqu’en 2013. Une analyse par regres…

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Does low to moderate environmental exposure to noise and air pollution influence preterm delivery in medium-sized cities?

International audience; Background: Preterm birth (PB) is an important predictor of childhood morbidity and educational performance. Beyond the known risk factors, environmental factors, such as air pollution and noise, have been implicated in PB. In urban areas, these pollutants coexist. Very few studies have examined the effects of multi-exposure on the pregnancy duration. The objective of this study was to analyse the relationship between PB and environmental chronic multi-exposure to noise and air pollution in medium-sized cities.Methods: A case-control study was conducted among women living in the city of Besançon (121 671 inhabitants) or in the urban unit of Dijon (243 936 inhabitants…

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Les facteurs pronostiques de décès des candidémies chez les patients hospitalisés : une étude rétrospective dans un hôpital universitaire en France

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Caractéristiques et motivations des médecins français ayant choisi d’émigrer en Grande-Bretagne

Abstract Background As member states in the European Union now recognize the national qualifications of other member states, doctors will be able to move more freely within Europe according to the opportunities on offer and the constraints imposed by the different health-care systems. The aim of this study is to understand the reasons why French doctors choose to work in Great Britain. Method A self-completed questionnaire was used to conduct a survey among French doctors registered with the British Medical Council in 2005 who had done their studies in France and for whom the address was correct. Results The response rate, which was difficult to assess (impossible to distinguish between inc…

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Association entre hospitalisation pour acidocétose et risque d’hospitalisation pour tentatives de suicide parmi les personnes atteintes de diabète de type 1

Introduction L’objectif de notre etude etait d’estimer l’association entre un antecedent d’hospitalisation pour acidocetose ou coma hyperglycemique et une hospitalisation pour tentative de suicide chez des personnes atteintes d’un diabete de type 1. Methodes Le principe de cette cohorte retrospective en population etait d’explorer les donnees hospitalieres des personnes ayant presente une hospitalisation mentionnant un diabete de type 1, en France, en 2008. Elles ont ete identifiees a partir d’un code diagnostique de diabete enregistre en diagnostic principal, associe ou relie. Pour eviter d’inclure des personnes atteintes de diabete de type 2, seules les personnes âgees de 18 a 35 ans ont …

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European transnational ecological deprivation index and participation in population-based breast cancer screening programmes in France.

Abstract Background We investigated factors explaining low breast cancer screening programme (BCSP) attendance taking into account a European transnational ecological Deprivation Index. Patients and methods Data of 13,565 women aged 51–74 years old invited to attend an organised mammography screening session between 2010 and 2011 in thirteen French departments were randomly selected. Information on the women's participation in BCSP, their individual characteristics and the characteristics of their area of residence were recorded and analysed in a multilevel model. Results Between 2010 and 2012, 7121 (52.5%) women of the studied population had their mammography examination after they receive…

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Use of drug treatments for Alzheimer's disease in France: a study on a national level based on the National Alzheimer's Data Bank (Banque Nationale Alzheimer)

Purpose To examine the way in which specific drug treatments for Alzheimer's disease are used and whether their use complies with clinical practice guidelines issued by the French National Authority for Health in patients with Alzheimer's disease. Methods We analysed a cross-section of the French National Alzheimer's databank (BNA). Participants were individuals who consulted centres contributing to the BNA in 2010 and diagnosed with Alzheimer's disease and with at least one Mini Mental State Examination (MMSE) score recorded during the course of the year. Results Of 191 919 consultations recorded in the database, 29.9% involved a diagnosis of Alzheimer's disease, and 26 809 patients had co…

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Sécurité, aspects juridiques et éthiques des données de santé informatisées

Apres avoir lu ce chapitre, vous devriez : pouvoir expliquer quels sont les objectifs d’un systeme d’information hospitalier et lister les principales fonctions pouvant faire l’objet d’une informatisation ; savoir analyser la circulation, dans un hopital, des informations relatives aux examens biologiques ou radiologiques et connaitre les principales etapes qui peuvent beneficier au mieux d’une informatisation, d’une automatisation ; savoir analyser la circulation, dans un hopital, des informations relatives aux prescriptions therapeutiques ; quelles etapes peuvent beneficier au mieux d’une informatisation, d’une automatisation ? pouvoir citer les principaux sous systemes et ensembles de fo…

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Epidemiology of acute endophthalmitis after ophthalmological procedures, a national database description

International audience; Purpose : Although rare, endophthalmitis is a severe complication of ophthalmological procedures. The incidence of endophthalmitis following cataract, glaucoma, vitreoretinal surgeries, and intravitreal injections has previously been described in large-scale studies, but no data is available on the proportion of causative procedures. We aimed to describe longitudinally the causes of endophthalmitis at a national scale using the French medico-administrative database.Methods : The SNIIRAM (French national inter-scheme insurance database) collects all data of medical expenditures and procedures performed in France. We extracted acute endophthalmitis occurring 42 days af…

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The cost-effectiveness of neonatal versus prenatal screening for congenital toxoplasmosis

BackgroundCongenital Toxoplasmosis (CT) can have severe consequences. France, Austria, and Slovenia have prenatal screening programs whereas some other countries are considering universal screening to reduce congenital transmission and severity of infection in children. The efficiency of such programs is debated increasingly as seroprevalence among pregnant women and incidence of congenital toxoplasmosis show a steady decrease. In addition, uncertainty remains regarding the effectiveness of pre- and postnatal treatments.MethodTo identify cost-effective strategies, prenatal and neonatal screenings were compared using a decision-analytic model based on French guidelines and current knowledge …

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Effect of storage time and donor sex of transfused red blood cells on 1-year survival in patients undergoing cardiac surgery: an observational study

BACKGROUND Red blood cell (RBC) storage lesions and RBCs from females transfused into male recipients may have adverse effects on transfusion recipients' survival. We hypothesized that the effect of donor sex and the effect of age of blood on mortality would be most apparent in cardiac surgery patients. STUDY DESIGN AND METHODS Using data from French Blood Services and two university hospitals, we conducted a retrospective cohort study on cardiac surgery patients whose first transfusion occurred between 2007 and 2011. The age of blood and donor sex effects on 1-year survival were studied using Cox regression modeling, with time-dependent stratification on the number of RBCs and adjustments …

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Multi-state relative survival modelling of colorectal cancer progression and mortality.

Abstract Accurate identification of factors associated with progression of colorectal cancer remains a challenge. In particular, it is unclear which statistical methods are most suitable to separate the effects of putative prognostic factors on cancer progression vs cancer-specific and other cause mortality. To address these challenges, we analyzed 10 year follow-up data for patients who underwent curative surgery for colorectal cancer in 1985–2000. Separate analyses were performed in two French cancer registries. Results of three multivariable models were compared: Cox model with recurrence as a time-dependent variable, and two multi-state models, which separated prognostic factor effects …

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Hypoproteinemia on the first day of life and adverse outcome in very preterm infants admitted to the neonatal intensive care unit

International audience; OBJECTIVE: We aimed to investigate the relationship between day-1 hypoproteinemia and severe adverse outcome (SAO) in very preterm infants admitted to the neonatal intensive care unit (NICU). STUDY DESIGN: Retrospective study of all patients born from 24 to 31 weeks gestation and cared for in our NICU over an 8-year period. Infants were excluded if the serum protein value on the first day of life was not available. RESULT: A total of 913 patients were included. In all, 14.6% presented with SAO (death or severe neurological injury on cranial ultrasound). Hypoproteinemia (total protein level \textless40 g l(-1)) on day 1 of life occurred in 19.5 % of all patients. The …

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Watermarking - A new way to bring evidence in case of telemedicine litigation

International audience; When dealing with medical data sharing, in particular within telemedicine applications, there is a need to ensure information security. Being able to verify that the information belongs to the right patient and is from the right source or that it has been rerouted or modified is a major concern. Watermarking, which is the embedding of security elements, such as a digital signature, within a document, can help to ensure that a digital document is reliable. However, at the same time, questions arise about the validity of watermarking-based proof. In this paper, beyond the technical aspects, we discuss the legal acceptability of watermarking in the context of telemedici…

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Comparative Analysis of Patients with Acute Coronary and Cerebrovascular Syndromes from the National French Hospitalization Health Care System Database

&lt;i&gt;Background:&lt;/i&gt; Nationwide evaluations of the epidemiology of acute coronary syndrome (ACS) or cerebrovascular syndrome (CVS) are scarce. We aimed to analyze nationwide French data on patients referred to hospital for either ACS or CVS. &lt;i&gt;Methods:&lt;/i&gt; Using the French national hospital discharge diagnosis records, all patients hospitalized between 2005 and 2008 with a diagnosis of ACS and CVS based on the ICD-10 were identified. We analyzed vascular risk factors and early outcomes in patients with a single hospitalization for ACS or CVS or for both ACV and CVS in a 2-month time window. &lt;i&gt;Results:&lt;/i&gt; 1,187,643 patients were recorded. Among these, 638…

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Dose-response relationship in the context of a maintenance randomized control trial: reanalysis of the PRODIGE 9 trial

Introduction The dose-response relationship is considered as one of the major criteria when the causality of a relationship between an exposure and an outcome is discussed. This criterion is mainly studied in observational studies but may be also of interest in Randomized Controlled Trial (RCT), particularly if the administered dose of treatment varies over time and between patients. Maintenance trials with a long follow-up meet these characteristics. We reanalyzed a maintenance trial in digestive oncology (PRODIGE 9 trial) in order to explore the dose-response relationship between the maintenance treatment and overall survival (OS). Methods The PRODIGE 9 study was a maintenance trial asses…

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Est-il possible de construire un indicateur de morbidité maternelle sévère (hémorragie maternelle) à partir des données du programme de médicalisation des systèmes d’information complétées par celles de l’Établissement français du sang ?

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Antibiotic prophylaxis and intravitreal injections: impact on the incidence of acute endophthalmitis

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Hémorragie sévère du post-partum et distance domicile-hôpital : étude en population à partir des données hospitalières

Introduction Afin de diminuer la mortalite et morbidite severe maternelle, une attention particuliere merite d’etre portee a l’hemorragie severe du post-partum (HPP), notamment a la recherche de nouveaux facteurs de risque. L’objectif de l’etude etait d’estimer le risque d’HPP severe lie a la distance entre le domicile et le service d’obstetrique et de decrire les facteurs de risque de l’HPP severe identifies par le Programme de medicalisation des systemes d’information (PMSI). Methodes Une cohorte retrospective en population a ete realisee a partir de la base nationale du PMSI de 2011, via le code Z37. La variable d’interet etait l’HPP severe par atonie uterine identifiee par le code corre…

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Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data.

Background: Many studies explore the clinical and ethical dimensions of care at the end-of-life, but fewer use administrative data to examine individual and geographic differences, including the use of palliative care. Aim: Provide a population-based perspective on end-of-life and hospital palliative care among local authorities and hospitals in France. Design: Retrospective cohort study of care received by 17,928 decedents 65 and over (last 6 months of life), using the French national health insurance database Results: 55.7% of decedents died in acute-care hospitals; 79% were hospitalized in them at least once; 11.7% were admitted at least once for hospital palliative care. Among 31 academ…

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Outcomes after acute myocardial infarction in HIV-infected patients: analysis of data from a French nationwide hospital medical information database.

Background— We aimed to assess in-hospital case fatality and 1-year prognosis in HIV-infected patients with acute myocardial infarction. Methods and Results— From the PMSI (Program de Medicalisation des Systèmes d’informatique) database, data from 277 303 consecutive acute myocardial infarction patients hospitalized from January 1, 2005, to December 31, 2009, were analyzed. Surviving patients were followed up for 1 year after discharge. HIV-infected patients were compared with uninfected patients. Among the cohort, HIV-infected patients (n=608) accounted for 0.22%. All-cause hospital and 1-year mortality rates were lower in the HIV-infected group than in uninfected patients (3.1% versus 8.…

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Mortalité à un an post-hospitalisation pour lésion auto-infligée: une étude nationale française

Introduction Les personnes qui se presentent a l’hopital pour un acte auto-inflige non mortel courent un risque accru de deces premature. Dans la presente etude, nous avons cherche a consolider et a etendre les resultats anterieurs sur la base d’un tres grand echantillon d’individus extraits des registres nationaux. Methodes Les donnees ont ete extraites du projet AMPHI, consistant en la collecte des bases de donnees PMSI et CepiDC. Nous avons extrait des donnees sur les personnes hospitalisees pour lesions auto-infligees (codes X60 a X84 de la CIM-10) du 1er janvier 2008 au 31 decembre 2009. Nous avons considere la premiere hospitalisation durant la periode etudiee comme l’acte index. La m…

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Is an activity volume threshold really realistic for lung cancer resection?

IF 1.804 (2017); International audience; Background:We analyzed volume as a continuous variable to estimate threshold, which is a methodology rarely seen in the literature. The objective of this work was to assess hospital volume for lung cancer (LC) surgery and to establish the associated threshold for acceptable in-hospital mortality (IHM). Data was obtained from the French national medico-administrative database.Methods:From January 2005 to December 2016, data from 108,571 patients operated for LC in France were collected from the national administrative database. To estimate the volume threshold, hierarchical logistic regression models were developed.Results:The crude IHM rate was 5.2% …

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Analyse géographique de la prévalence de l’obésité et de la dépression à partir des bases du Programme de médicalisation des systèmes d’information et du RIM-P

Introduction La prise en charge de l’obesite et de la depression represente un poids consequent et en augmentation pour le systeme de soins. Plusieurs etudes ont montre que ces deux pathologies partagent des mecanismes physiopathologiques communs. Par ailleurs, aux Etats-Unis, la repartition spatiale des zones de forte prevalence des deux pathologies presente des similitudes. Cette repartition etant meconnue en France, nous avons cherche si les deux pathologies touchaient les memes territoires. Methodes Nous avons identifie dans le PMSI-MCO les patients presentant un diagnostic d’obesite ou un diagnostic principal de depression. A partir du RIM-P, nous avons identifie les patients presentan…

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Hospitalization for self-harm during the early months of the COVID-19 pandemic in France: A nationwide retrospective observational cohort study

ABSTRACT Background Little is known to date about the impact of COVID-19 pandemic on self-harm. Methods The number of hospitalizations for self-harm (ICD-10 codes X60-X84) in France from 1st January to 31st August 2020 (including a two-month confinement) was compared to the same periods in 2017–2019. Statistical methods comprised Poisson regression, Cox regression and Student's t-test, plus Spearman's correlation test relating to spatial analysis of hospitalizations. Outcomes There were 53,583 self-harm hospitalizations in France during January to August 2020. Compared to the same period in 2019, this represents an overall 8·5% decrease (Relative Risk [95% Confidence Interval] = 0·91 [0·90–…

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Flexible statistical models provided new insights into the role of quantitative prognostic factors for mortality in gastric cancer.

Abstract Objectives To reassess the effects of prognostic factors on mortality in gastric cancers, and to illustrate the advantages of flexible modeling. Study Design and Setting A prospective population-based cohort of persons diagnosed with gastric cancers in 1976 to 1995 in Burgundy, France, was followed for 5 years since diagnosis. Multivariable survival analyses, stratified by cancer stage, involved both conventional Cox's model and its flexible generalization, which permitted testing the underlying assumptions and accounting for changes over time in the effects of prognostic factors. Results Conventional assumptions of proportional hazards (PH) (P = 0.003) and linear increase in risk …

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Risque de maladie thromboembolique veineuse dans l’année qui suit le diagnostic de cancer du poumon en France

Etat de la question La maladie thromboembolique veineuse (MTEV) comprend la thrombose veineuse profonde (TVP) et sa principale complication l’embolie pulmonaire (EP). La MTEV est une pathologie frequente chez les patients atteints de cancer et est responsable d’une morbi-mortalite importante. L’objectif de notre etude etait d’estimer la frequence de la MTEV chez les patients atteints d’un cancer du poumon en France et d’en identifier des facteurs de risque. Materiel et methodes Les donnees ont ete extraites de la base de donnees de l’echantillon generaliste des beneficiaires (EGB), qui est un echantillon permanent des donnees de l’Assurance maladie francaise (incluant des donnees d’hospital…

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Apport de l’utilisation des données médico-administratives pour une politique de santé territorialisée : l’exemple de la mortalité hospitalière des accidents vasculaires cérébraux, 2008–2011

Introduction La mise en œuvre du Plan national AVC prevoit l’utilisation des grandes bases de donnees medico-administratives pour etablir et suivre certains indicateurs de prise en charge des personnes victimes d’AVC. A partir des bases nationales du PMSI-MCO 2008–2011, nous avons etabli une analyse de la prevalence hospitaliere des AVC ischemiques et hemorragiques ainsi qu’une cartographie des taux de mortalite hospitaliere. Methodes Les principales caracteristiques des patients identifies selon une liste de codes CIM10 relatifs a un AVC (retenus suite a des travaux de validation anterieurs) ont ete etudiees. Une cartographie des taux de mortalite standardises a ete effectuee a l’echelle d…

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Gestational age and 1-year hospital admission or mortality: a nation-wide population-based study

International audience; Background: Describe the 1-year hospitalization and in-hospital mortality rates, in infants born after 31 weeks ofgestational age (GA).Methods: This nation-wide population-based study used the French medico-administrative database to assess thefollowing outcomes in singleton live-born infants (32–43 weeks) without congenital anomalies (year 2011): neonatalhospitalization (day of life 1 – 28), post-neonatal hospitalization (day of life 29 – 365), and 1-year in-hospital mortalityrates. Marginal models and negative binomial regressions were used.Results: The study included 696,698 live-born babies. The neonatal hospitalization rate was 9.8%. Up to 40 weeks,the lower the…

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Quantification et qualification des erreurs hospitalières d’identification des patients dans un local d’archives vivantes

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Cancer du sein chez l’homme en France

Introduction En France, il n’existe pas de donnees decrivant les caracteristiques cliniques ainsi que les traitements des hommes atteints de cancer du sein. L’objectif de cette etude etait de decrire les caracteristiques cliniques et les traitements des hommes atteints de cancer du sein en France entre 2007 et 2013 et identifies grâce aux donnees du PMSI national. Methodes Les cas de cancer du sein infiltrant chez l’homme entre 2007 et 2013 ont ete identifies grâce aux donnees du PMSI national. La prevalence par annee a ete calculee en faisant le rapport entre le nombre de cas prevalents par annee et la population francaise pour l’annee correspondante. Les donnees cliniques : âge, la presen…

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Validation des hémorragies maternelles codées dans le programme de médicalisation des systèmes d’information (PMSI) par couplage aux données de l’Établissement français du sang (EFS)

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L'administration conjointe du dossier patient: une responsabilité partagée entre le patient et le praticien

National audience; The main problem faced by patients, health practitioners and the authorities, is namely the gathering and updating of administrative and medical data in order to accurately reconstitute a patient's medical history. Although solutions to accelerate and to ease this gathering are being implemented at the national level in several European countries, as unique health identifier in France, information still have to be validated before use. Through this article, we propose a mixed management of patients' data, split between the patient regarding administrative information and the Medical Practitioner (MP) regarding medical information. This method is based on two processes. Th…

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Detection of Temporal Clusters of Healthcare-Associated Infections or Colonizations with Pseudomonas aeruginosa in Two Hospitals: Comparison of SaTScan and WHONET Software Packages.

International audience; The identification of temporal clusters of healthcare-associated colonizations or infections is a challenge in infection control. WHONET software is available to achieve these objectives using laboratory databases of hospitals but it has never been compared with SaTScan regarding its detection performance. This study provided the opportunity to evaluate the performance of WHONET software in comparison with SaTScan software as a reference to detect clusters of Pseudomonas aeruginosa. A retrospective study was conducted in two French university hospitals. Cases of P. aeruginosa colonizations or infections occurring between 1st January 2005 and 30th April 2014 in the fi…

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Gestion décentralisée des documents médicaux des patients

National audience

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A Comparative Analysis of Hospital Readmissions in France and the US

International audience; Policymakers in the US and France are struggling to improve coordination among hospitals and other health care providers. A comparison of hospital readmission rates, and the factors that may explain them, can provide important insights about the French and US health care systems. In addition, it illustrates a methodological approach to comparative research: how an empirical inquiry along a single indicator can reveal broader issues about system-wide differences across health care systems and policy. Using data from three French regions, the article extends a previous national-level comparison indicating that rates of hospital readmission for the population aged 65+ a…

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Incidence de l’endophtalmie aiguë postopératoire après chirurgie de la cataracte par phacoémulsification et injection intracamérulaire d’antibiotiques, en France de 2005 à 2014

National audience; Introduction La chirurgie de la cataracte est l’intervention la plus fréquente dans le monde. Parmi ses complications, l’endophtalmie aiguë postopératoire (EAPO) est une infection intraoculaire sévère, qui peut conduire à la cécité. Les objectifs étaient de déterminer l’incidence de l’EAPO après chirurgie de la cataracte par phacoémulsification en France de 2005 à 2014 et d’analyser l’association entre injection intracamérulaire d’antibiotique (IICA) et EAPO. Méthodes Tous les patients hospitalisés pour une chirurgie de la cataracte en France entre le 1er janvier 2005 et le 31 décembre 2014 ont été identifiés dans le programme de médicalisation des systèmes d’information …

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Estimation of National Colorectal-Cancer Incidence Using Claims Databases

Background.The aim of the study was to assess the accuracy of the colorectal-cancer incidence estimated from administrative data.Methods.We selected potential incident colorectal-cancer cases in 2004-2005 French administrative data, using two alternative algorithms. The first was based only on diagnostic and procedure codes, whereas the second considered the past history of the patient. Results of both methods were assessed against two corresponding local cancer registries, acting as “gold standards.” We then constructed a multivariable regression model to estimate the corrected total number of incident colorectal-cancer cases from the whole national administrative database.Results.The firs…

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Territoires de vie, santé périnatale et adéquation des services de santé : influence des temps d’accès à la maternité la plus proche sur les résultats de santé périnatale en Bourgogne

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Increased Risk of Rehospitalization for Acute Diabetes Complications and Suicide Attempts in Patients With Type 1 Diabetes and Comorbid Schizophrenia

OBJECTIVE The aim of this large retrospective cohort study was to estimate the supplementary morbidity and mortality risks conferred by the co-occurrence of schizophrenia among young people with type 1 diabetes. RESEARCH DESIGN AND METHODS This nationwide population-based study included individuals aged 15–35 years hospitalized in France for type 1 diabetes from 2009 to 2012 with or without schizophrenia. For assessment of the occurrence of rehospitalization for acute diabetes complications, suicide attempts, and hospital mortality, multivariate logistic regressions and survival analysis adjusted for age, sex, and Charlson comorbidity index scores were performed. The association between ho…

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Haemoptysis in adults: a 5-year study using the French nationwide hospital administrative database.

Haemoptysis is a serious symptom with various aetiologies. Our aim was to define the aetiologies, outcomes and associations with lung cancer in the entire population of a high-income country.This retrospective multicentre study was based on the French nationwide hospital medical information database collected over 5 years (2008–2012). We analysed haemoptysis incidence, aetiologies, geographical and seasonal distribution and mortality. We studied recurrence, association with lung cancer and mortality in a 3-year follow-up analysis.Each year, ∼15 000 adult patients (mean age 62 years, male/female ratio 2/1) were admitted for haemoptysis or had haemoptysis as a complication of their hospital s…

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Auswirkungen eines neuen Wassersystems auf nosokomiale Kolonisierung oder Infektion mit Pseudomonas aeruginosa

Aim: We aimed to study the impact of new water systems, which were less contaminated with P. aeruginosa, on the incidence of healthcare-associated P. aeruginosa cases (colonizations or infections) in care units that moved to a different building between 2005 and 2014. Methods: Generalized Estimated Equations were used to compare the incidence of P. aeruginosa healthcare-associated cases according to the building. Results: Twenty-nine units moved during the study period and 2,759 cases occurred in these units. No difference was observed when the new building was compared with older buildings overall. Conclusion: Our results did not support our hypothesis of a positive association between wat…

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Impact of video-assisted thoracic surgery approach on postoperative mortality after lobectomy in octogenarians.

The number of octogenarians who present with localized lung cancer eligible for surgical resection is increasing. Video-assisted thoracic surgery lobectomy has been widely accepted, but the potential benefit in octogenarians is not well established, especially for postoperative mortality. This study aimed to assess the impact of a video-assisted thoracic surgery approach on postoperative mortality after lobectomy for lung cancer in octogenarians.From January 2005 to December 2016, all patients aged more than 80 years who received lobectomy treatment for lung cancer were retrieved from the French Administrative Database. The end point was 30-day postoperative death. A propensity score was ge…

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Giving patients secure " google-like " access to their medical record

International audience; The main problem for the patient who wants to have access to all of the information about his health is that this information is very often spread over many medical records. Therefore, it would be convenient for the patient, after being identified and authenticated, to use a kind of specific medical search engine as one part of the solution to this main problem. The principal objective is for the patient to have access to his or her medical information at anytime and wherever it has been stored. This proposal for secure "Google Like" access requires the addition of different conditions: very strict identity checks using cryptographic techniques such as those planned …

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Le dossier médical personnel du patient : réflexions sur le portail d’accès unique et le masquage du dossier

Resume Objectifs La loi de financement de la securite sociale du 19 decembre 2007 a precise deux principes fondamentaux du dossier medical personnel qui soulevent de nombreuses questions : le portail unique et le masquage des informations. Materiel et methodes Selon la loi, l’existence d’un portail permet « aux beneficiaires de l’Assurance maladie de gerer leur dossier medical personnel et les droits d’acces des professionnels de sante » et « assure le controle et la tracabilite des acces aux dossiers medicaux personnels ». Il s’agit d’un enjeu majeur tant pour la protection de la vie privee des patients que des promoteurs et des responsables du portail qui pourraient voir leur responsabili…

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Le réseau REDSIAM (Réseau données Sniiram) – Spécial REDSIAM

The French national health database (SNIIRAM) proved to be very useful for epidemiology, health economics, evaluation, surveillance or public health. However, it is a complex database requiring important resources and expertise for being used. The REDSIAM network has been set up for promoting the collaboration of teams working on the Sniiram. The main aim of REDSIAM is to develop and validate methods for analyzing the Sniiram database for research, surveillance, evaluation and public health purposes by sharing the knowledge and experience of specialized teams in the fields of diseases identification from the Sniiram data. The work conducted within the network is devoted to the development a…

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Positive Predictive Value of French Hospitalization Discharge Codes for Stroke and Transient Ischemic Attack.

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; We aimed at measuring the positive predictive value (PPV) of data in the French Hospital Medical Information Database (FHD). &lt;b&gt;&lt;i&gt;Summary:&lt;/i&gt;&lt;/b&gt; This retrospective multicenter study included 31 hospitals from where 56 hospital stays were randomly selected among all hospitalizations for the years 2009 and 2010 with at least 1 principal diagnosis of stroke or transient ischemic attack (TIA). Three algorithms were evaluated. Algorithm 1 selected discharge abstracts with at least 1 principal diagnosis identified by one of the relevant International Classification of Diseases, 10th revision codes. Algorithm 2 selected s…

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Comparison of Epithor clinical national database and medico-administrative database to identify the influence of case-mix on the estimation of hospital outliers

BackgroundThe national Epithor database was initiated in 2003 in France. Fifteen years on, a quality assessment of the recorded data seemed necessary. This study examines the completeness of the data recorded in Epithor through a comparison with the French PMSI database, which is the national medico-administrative reference database. The aim of this study was to demonstrate the influence of data quality with respect to identifying 30-day mortality hospital outliers.MethodsWe used each hospital's individual FINESS code to compare the number of pulmonary resections and deaths recorded in Epithor to the figures found in the PMSI. Centers were classified into either the good-quality data (GQD) …

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Economic analysis of the costs associated with prematurity from a literature review

International audience; Abstract : Objectives : To analyse published cost-of-illness studies that had assessed the cost of prematurity according to gestational age at birth. Methods : A review of the literature was carried out in March 2011 using the following databases: Medline, ScienceDirect, The Cochrane Library, Econlit and Business Source Premier, and a French Public-Health database. Key-word sequences related to ‘prematurity’ and ‘costs’ were considered. Studies that assessed costs according to the gestational age (GA) at the premature birth (&lt;37 weeks of gestation) in industrialized countries and during the last two decades were included. Variations in the reported costs were anal…

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Prevalence and incidence of kidney diseases leading to hospital admission in people living with HIV in France: an observational nationwide study.

ObjectivesTo describe hospitalisations for kidney disease (KD) among people living with HIV (PLHIV) in France and to identify the factors associated with such hospitalisations since data on the epidemiology of KD leading to hospitalisation are globally scarce.DesignObservational nationwide study using the French Programme de Médicalisation des Systèmes d’Information database.SettingFrance 2008–2013.ParticipantsAround 10 862 PLHIV out of a mean of 5 210 856 patients hospitalised each year. All hospital admissions with a main diagnosis code indicating KD (International Classification of Diseases, 10th revision codes, N00 to –N39) were collected.Main outcome measuresThe prevalence and incidenc…

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270 Increased hospital mortality in HIV-infected patients with acute coronary or cerebrovascular syndromes. Analysis from a French nationwide hospital medical information database

Background After more than two decades of the AIDS epidemic, the spectrum of HIV-associated vascular diseases has considerably evolved from infectious disease with improved survival, to premature atherosclerosis. As a consequence, acute atherosclerosis complications, such as acute coronary and cerebrovascular syndromes (ACS and CVS) are currently growing. However, only few data are available on HIV-infected patients in the setting of ACS/CVS. The aim of the present study was to determine the prevalence of HIV, as well as the characteristics and hospital case fatality of HIV-infected patients with CVS and ACS. Methods From the French nationwide hospital medical information database, data fro…

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Ophthalmic Outcomes of Congenital Toxoplasmosis Followed Until Adolescence

BACKGROUND: Congenital toxoplasmosis (CT) can elicit severe damage to several organs, especially the eye, and may be manifested at birth or later. We assessed the long-term ocular prognosis in a cohort of congenitally infected children treated according to a standardized protocol and monitored for up to 22 years. METHODS: This prospective study included confirmed cases of CT, which were identified by obligatory antenatal screening at the Lyon (France) reference center between 1987 and 2008. Data obtained through ocular examinations were recorded on a standardized form and confirmed by an independent external committee. Risk factors for retinochoroiditis were identified by using a multivari…

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Dépistage précoce du diabète après une grossesse marquée par un diabète gestationnel

Introduction Les femmes ayant presente un diabete gestationnel (DG) ont ulterieurement un risque eleve de diabete de type 2 (DT2). Le taux de depistage du DT2 apres un antecedent de DG est estime entre 3,4 et 92,6 % selon les etudes. L’objectif de notre etude etait de decrire le depistage precoce du DT2 apres une grossesse marquee par un DG entre 2007 et 2013. Methodes L’etude s’est interessee aux femmes ayant presente un DG a partir de l’echantillon generaliste des beneficiaires des donnees de l’assurance maladie obligatoire. Dans les donnees hospitalieres, les accouchements ont ete reperes a partir des codes Z37 de la CIM-10 et le diabete gestationnel a partir du code O24.4. Les examens d…

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Incidence de l’endophtalmie postopératoire aiguë après chirurgie maculaire en France entre 2006 et 2016

Etat de la question L’objectif de cette etude nationale etait de rapporter l’incidence de l’endophtalmie postoperatoire aigue (EPOA) apres chirurgie maculaire en France entre 2006 et 2016 et d’identifier si le passage a la vitrectomie transconjonctivale en 2010–2011 etait associe a une modification du risque d’EPOA en France. Materiel et methodes Toutes les interventions chirurgicales pour membrane epiretinienne ou trou maculaire realisees en France entre janvier 2006 et octobre 2016 ont ete incluses a partir du PMSI. L’EPOA etait identifiee dans les 42 jours apres la chirurgie maculaire. Les effets du changement de technique (periode), des facteurs demographiques et cliniques sur la surven…

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274 Comparative analysis of patients with acute coronary and cerebrovascular syndromes from the national French hospitalisation heath care system database

Objective To compare vascular risk factor profiles and early outcomes in all French patients hospitalized for either acute coronary (ACS), or cerebrovascular syndromes (CVS), or both, between 2005 and 2008. Setting All French hospitals. Design Retrospective analysis. Data sources National database called “Hospital Discharge Diagnosis Records”. Main outcomes measured Number and annual rates, vascular risk factors, and early outcome of hospitalized patients for a unique stay for ACS or CVS or for both ACV and CVS in a 2-month time window. Results Over the 4-year study-period, 1,189,043 patients were hospitalized for CVS and/or ACS. Among these, 638,061 (53.7%) had CVS alone, 525,419 (44.3%) h…

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Exposition environnementale au bruit et à la pollution de l'air au cours de la grossesse avec comorbidités associées

L’objectif était d’analyser le lien entre l’exposition environnementale au bruit et à la pollution de l’air en milieu urbain et la prématurité chez les femmes dont le risque d’accouchement prématuré était augmenté par la présence d’une ou plusieurs comorbidités. Méthode. Une étude cas-témoins a été conduite sur les grossesses uniques accompagnées d’au moins une comorbidité. Les accouchements ont eu au CHU de Besançon ou de Dijon entre 2005 et 2009. Le niveau sonore de nuit (Lnight en façade du bâtiment d’habitation) et la concentration en dioxyde d’azote (NO2) dans les 50 m autour de l’habitation ont été modélisés à l’adresse déclarée au moment de l’accouchement. Une régression logistique c…

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Prevalence of patients hospitalised for male breast cancer in France using the French nationwide hospital administrative database

BACKGROUND Breast cancer (BC) in men is a rare and neglected disease representing <1% of all cancers in men and only 1% of all incident BC in western countries. OBJECTIVE This study aimed to describe trends in the prevalence of patients hospitalised for male BC in France from 2009 to 2013, using the national administrative database (PMSI). METHODS We included all men aged ≥18 admitted to hospital for BC during this period and estimated the prevalence of male breast cancer hospitalised in France over 5 years. We also describe clinical characteristics and treatments in men with surgery for BC over the 5-year period of the study. RESULTS The prevalence of patients hospitalised for BC significa…

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Using Discharge Abstracts to Evaluate a Regional Perinatal Network: Assessment of the Linkage Procedure of Anonymous Data

To assess the Burgundy perinatal network (18 obstetrical units; 18 500 births per year), discharge abstracts and additional data were collected for all mothers and newborns. In accordance with French law, data were rendered anonymous before statistical analysis, and were linked to patients using a specific procedure. This procedure allowed data concerning each mother to be linked to those for her newborn(s). This study showed that all mothers and newborns were included in the regional database; the data for all mothers were linked to those for their infant(s) in all cases. Additional data (gestational age) were obtained for 99.9% of newborns.

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Magnetic resonance image segmentation and heart motion tracking with an active mesh based system

International audience; Abstract: The work presented here relates to a method fir motion tracking in sequences of medical images. The purpose is to. quantify the general motions and the local deformations of a beating heart during a cardiac cycle. In order to achieve this goal, we first tessellate the,first image of the sequence into triangular patches. A Delaunay triangulation is applied to find the optimal set of triangles describing this image, giving a mesh covering the organs. One imposes the contours of the organs to correspond to edges of triangles so that each part of the heart (left ventricle, right ventricle, myocardium) can he described as a different set of triai izles, each set…

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A data mining approach for grouping and analyzing trajectories of care using claim data: the example of breast cancer

International audience; BACKGROUND: With the increasing burden of chronic diseases, analyzing and understanding trajectories of care is essential for efficient planning and fair allocation of resources. We propose an approach based on mining claim data to support the exploration of trajectories of care. METHODS: A clustering of trajectories of care for breast cancer was performed with Formal Concept Analysis. We exported Data from the French national casemix system, covering all inpatient admissions in the country. Patients admitted for breast cancer surgery in 2009 were selected and their trajectory of care was recomposed with all hospitalizations occuring within one year after surgery. Th…

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In-hospital mortality following lung cancer resection: nationwide administrative database.

Our aim was to determine the effect of a national strategy for quality improvement in cancer management (the “Plan Cancer”) according to time period and to assess the influence of type and volume of hospital activity on in-hospital mortality (IHM) within a large national cohort of patients operated on for lung cancer.From January 2005 to December 2013, 76 235 patients were included in the French Administrative Database. Patient characteristics, hospital volume of activity and hospital type were analysed over three periods: 2005–2007, 2008–2010 and 2011–2013.Global crude IHM was 3.9%: 4.3% during 2005–2007, 4% during 2008–2010 and 3.5% during 2011–2013 (p&lt;0.01). 296, 259 and 209 centres p…

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225 Comparative analysis of patients with acute coronary and cerebrovascular syndromes from the national French hospitalisation heath care system database

ObjectiveTo compare vascular risk factor profiles and early outcomes in all French patients hospitalized for either acute coronary (ACS), or cerebrovascular syndromes (CVS), or both, between 2005 and 2008.SettingAll French hospitals.DesignRetrospective analysis.Data sourcesNational database called “Hospital Discharge Diagnosis Records”.Main outcomes measuredNumber and annual rates, vascular risk factors, and early outcome of hospitalized patients for a unique stay for ACS or CVS or for both ACV and CVS in a 2-month time window.ResultsOver the 4-year study-period, 1,189,043 patients were hospitalized for CVS and/or ACS. Among these, 638,061 (53.7%) had CVS alone, 525,419 (44.3%) had ACS alon…

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Comparative Metrics and Policy Learning: End-of-Life Care in France and the US

AbstractComparative policy analysis sometimes relies on the use of metrics to foster policy learning. We compare health care for patients at the end of life (EOL) in the US and France. The analysis...

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Les écarts entre la durée moyenne de séjour (DMS) observée au CHU de Dijon pour les hospitalisations des enfants de moins de 1000g sont-ils le fait d’une prise en charge trop longue ou d’une hétérogénéité des Groupes homogènes de malades (GHM) ?

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The Impact of World and European Football Cups on Stroke in the Population of Dijon, France: A Longitudinal Study from 1986 to 2006

Background: Acute stress may trigger vascular events. We aimed to investigate whether important football competitions involving the French football team increased the occurrence of stroke. Methods: We retrospectively retrieved data of fatal and nonfatal stroke during 4 World Football Cups (1986, 1998, 2002, and 2006) and 4 European Championships (1992, 1996, 2000, and 2004), based on data from the population-based Stroke Registry of Dijon, France. One period of exposure was analyzed: the period of competition extended to 15 days before and after the competitions. The number of strokes was compared between exposed and unexposed corresponding periods of preceding and following years using Poi…

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Comparaison des caractéristiques et des motivations des médecins expatriés français et britanniques

Resume Position du probleme Les phenomenes migratoires dans les populations de medecins etant encore peu etudies, malgre l’importante de connaitre la demographie medicale, cette etude vise a determiner les caracteristiques et les motivations des medecins francais installes au Royaume-Uni et des medecins britanniques installes en France. Methodes Il s’agit d’une etude transversale par auto-questionnaire adresse en 2005 a tous les medecins francais exercant en Grande-Bretagne et en 2009 a tous les medecins britanniques exercant en France, en utilisant les donnees officielles des conseils nationaux de medecins. Ce questionnaire, developpe pour l’etude et envoye par courrier, explorait les moti…

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530: Intrauterine balloon tamponade (IUBT) for management of severe postpartum hemorrhage (PPH) within a perinatal network: efficacy and factors predicting failure

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Comparison of rehospitalization rates in France and the United States

Objective To compare rates of 30-day all-cause rehospitalization in France and the US among patients aged 65 years and older and explain any difference between the countries. Methods To calculate rehospitalization rates in France, we use an individual identifying variable in the national hospital administrative dataset to track unique individuals aged 65 years or more hospitalized in France in 2010. To calculate the proportion of rehospitalized patients (65+) who received outpatient visits between the time of initial discharge and rehospitalization, we linked the hospital database with a database that includes all medical and surgical admissions. We used step by step regression models to pr…

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Validation of the French national health insurance information system as a tool in vaccine safety assessment: Application to febrile convulsions after pediatric MMR immunization

International audience

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Detection of temporal clusters of health care-associated infections or colonizations with Pseudomonas aeruginosa.

International audience; We investigated temporal clusters of Pseudomonas aeruginosa cases between 2005 and 2014 in 1 French university hospital, overall and by ward, using the Kulldorff method. Clusters of positive water samples were also investigated at the whole hospital level. Our results suggest that water outlets are not closely involved in the occurrence of clusters of P aeruginosa cases.

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ANR Inforare : proposition d’un modèle d’identifiant patient individuel pour les patients drépanocytaires

Resume Ce projet a comme objectifs d’organiser le partage d’information et d’evaluer son acceptation par les patients et par les professionnels. La methode repose sur : evaluation de l’acceptabilite du recueil des donnees familiales par les patients ; gestion centralisee de dossiers medicaux rendus anonymes ; proposition d’un modele d’identification du patient et evaluation de la faisabilite du recueil de l’identification et de la qualite du chainage des donnees. Resultats L’entretien semidirectif realise par le LEM a permis d’interroger 43 patients, six membres d’association et six professionnels de sante sur l’acceptabilite du recueil. La plateforme informatique permettant la gestion cent…

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Étude de l’association entre les troubles des conduites alimentaires et le risque suicidaire chez les adolescents et jeunes adultes

Introduction Alors que le suicide represente la seconde cause de mortalite chez les 15–24 ans, l’adolescence apparait comme la periode charniere de decollage du nombre de cas de suicide. Il est clairement etabli que les pathologies mentales peuvent augmenter le risque de suicide. Toutefois, en raison de la relative rarete du suicide, la connaissance des facteurs de risque de mortalite par suicide durant l’adolescence ou le debut de l’âge adulte reste limitee. Les donnees du Systeme national des donnees de sante (SNDS) en population nous offrent l’opportunite d’etudier des evenements rares, difficilement accessibles par des etudes cliniques impliquant les personnes. L’objectif de notre etude…

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Comparison of the ability of alternative birthweight and fetal weight standards to identify preterm newborns at increased risk of perinatal death

Objective To compare prediction of perinatal deaths among preterm infants based on fetal weight standards versus a new subpopulation-based birthweight standard. Design Population-based cohort study. Setting France. Population A total of 9100 preterm singletons, born between 24 and 36 weeks of gestation in 2000–09, in Burgundy (France). Methods We first classified all newborns as either small for gestational age (SGA) or not, based on alternative fetal weight or birthweight standards, including a new birthweight standard that excludes infants born to mothers with disease related to the weight of a fetus. Based on discrepancies between the different classifications, we then divided the newbor…

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Prescription drug use during pregnancy in France: a study from the national health insurance permanent sample.

International audience; PurposeTo provide an up-to-date account of drug prescription during pregnancy in France from 2011 to 2014 using the permanent sample of the French national computerized healthcare database and with a focus on recommended supplementations, fetotoxic drugs and teratogenic drugs.MethodsAll pregnancies identified by the International Classification of Diseases, 10th Revision codes list in the hospitalization database, lasting more than 9 weeks of amenorrhea and whose delivery occurred between 01/01/2011 and 12/31/2014, were included. Drugs delivered between the trimester before and until the end of the pregnancy were included. Drug exposure prevalence was calculated for …

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Sensibilité et valeur prédictive positive du Programme de médicalisation des systèmes d’information (PMSI) pour le recueil des données d’accidents vasculaires cérébraux : étude de validation préliminaire avec le Registre dijonnais des accidents vasculaires cérébraux comme gold standard

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Linkage of De-Identified Records in Accordance to the European Legislation

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La Télémédecine deviendra coût / efficace grâce aux applications sur smartphone

National audience

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Qualité de la surveillance de l’hémoglobine glyquée après un infarctus cérébral, un accident ischémique transitoire ou une hémorragie intra-cérébrale chez des patients diabétiques : une étude nationale

Introduction Chez les patients diabetiques, l’equilibre glycemique est un element cle de la prevention des accidents neuro-vasculaires, notamment de la recidive d’un infarctus cerebral (IC) et d’un accident ischemique transitoire (AIT). Notre etude s’interesse a l’association entre la survenue d’un IC, d’un AIT ou d’une hemorragie intra-cerebrale (HIC) et la realisation d’un suivi de l’HbA1c acceptable ou optimal selon les recommandations actuelles. Methodes Les patients diabetiques victimes d’un IC, d’un AIT ou d’une HIC en 2011 (exposes) ont ete identifies a partir des donnees du systeme national d’information interregimes de l’assurance maladie (Sniiram), et compares a un groupe de patie…

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Les enjeux de la sécurité des objets connectés et applications de santé

International audience; The challenges of security of connected objects and health applicationsThe market for connected objects and health applications is booming and is expected to be several billion euros in revenue in the coming years. Their development will have a similar impact to what we experienced with the development of internet earlier this century but even more it should disrupt the organization of our health system, profoundly change the management of care and revolutionize prevention, but it could also call into question medical confidentiality and protection of personal data. This article analyses the societal implications of OCS, the need for a dual medical and ethical evalua…

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Identification of Infant Victims of Abusive Head Trauma Hospitalised in France from 2015 to 2017

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sj-pdf-1-pmj-10.1177_02692163211019299 – Supplemental material for Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data

Supplemental material, sj-pdf-1-pmj-10.1177_02692163211019299 for Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data by Michael K. Gusmano, Victor G. Rodwin, Daniel Weisz, Jonathan Cottenet and Catherine Quantin in Palliative Medicine

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Changes in blood pressure in a large cohort of elderly individuals: Study 3C

Summary Objective Analysis of changes in blood pressure with a two-year interval, and of factors associated with this change, in a large cohort of elderly individuals. Methods Follow-up of a cohort of 9294 individuals aged 65 years and over recruited from the general population for Study 3C. Changes in blood pressure are defined as the difference in its averages between the inclusion visit and the follow-up visit at 2 years. The factors associated with changes in systolic blood pressure were identified by univariate and multivariate analyses. Results Systolic and diastolic blood pressure decreased on average by 7.60 mmHg and 4.45 mmHg respectively in 7659 individuals included in the study b…

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