@article{fitoussi_management_2023,
	title = {Management of medial femorotibial osteoarthritis:{Epidemiology}, and survival of unicompartmental knee arthroplasty versus valgus high tibial osteotomy in {France}. {Study} of 108,007 cases from the {French} {National} {Hospitals} {Database}},
	issn = {1877-0568},
	shorttitle = {Management of medial femorotibial osteoarthritis},
	doi = {10.1016/j.otsr.2023.103692},
	abstract = {INTRODUCTION: Unicompartmental knee arthroplasty (UKA) and valgus high tibial osteotomy (HTO) are two options for isolated medial femorotibial osteoarthritis in genu varum. In the absence of registries for osteotomies and for arthroplasty in the knee, epidemiological data are hard to obtain in France. We therefore performed a retrospective study, with the aims of 1) estimating UKA and HTO survival without revision by total knee arthroplasty (TKA), and 2) assessing risk factors for revision according to treatment group.
HYPOTHESIS: Medium-term survival is better with HTO than UKA in under-70 year-olds.
MATERIALS AND METHOD: All elderly patients undergoing HTO or UKA in the French National Hospitals Database for the period 2011-2020 were included: i.e., 108,007 patients; 43,537 HTO (29,330 male, 14,207 female; mean age 49.7 years, 95\% CI 49.6-49.8) and 64,470 UKA (31,181 male, 33,289 female; mean age 60.5 years, 95\% CI 60.5-60.6).
RESULTS: Survival free of revision by TKA was 75.8\% (95\% CI =75.2-76.4) for UKA and 80.6\% (95\% CI =80.0-81.3) for HTO (p{\textless} 0.00001). In UKA, revision risk factors comprised: low annual center volume ({\textless}17 UKAs per year) (HR=1.50; 95\% CI=1.41-1.59), obesity (HR=1.25; 95\% CI=1.18-1.32), and age {\textless}60 years, with maximum risk for 50-59 years (HR=2.41; 95\% CI=1.83-3.16 in 50-59 year-olds). In HTO, revision risk factors comprised: obesity (HR=1.42; 95\% CI=1.31-1.53), rheumatoid arthritis (HR=2.75; 95\% CI=1.37-5.51), joint chondrocalcinosis (HR=2.01; 95\% CI=1.18-3.39), and age {\textgreater}60 years (HR=8.81; 95\% CI=7.23-19.73 in 60-69 year-olds). Maler gender was a protective factor against revision in both groups: UKA, HR= 0.75 (95\% CI=0.72-0.79); HTO, HR=0.73 (95\% CI=0.69-0.77). The number of UKAs increased over the years, matching the increase in arthroplasty in France, with a decrease in HTOs until 2019.
CONCLUSION: HTO showed better medium-term survival than UKA in under-70 year-olds in France. Even so, indications decreased in favor of UKA, although the respective risk factors differ. These findings suggest that conservative surgery still has a role, depending on osteoarthritis stage.
LEVEL OF EVIDENCE: III; retrospective comparative study.},
	language = {eng},
	journal = {Orthopaedics \& traumatology, surgery \& research: OTSR},
	author = {Fitoussi, Allison and Dartus, Julien and Erivan, Roger and Pasquier, Gilles and Migaud, Henri and Putman, Sophie and Chazard, Emmanuel},
	month = sep,
	year = {2023},
	pmid = {37776952},
	keywords = {Big data, Surgical revision, Survival, Unicompartmental knee arthroplasty, Valgus high tibial osteotomy, big data, surgical revision, survival, unicompartmental knee arthroplasty, valgus high tibial osteotomy},
	pages = {103692},
}

INTRODUCTION: Unicompartmental knee arthroplasty (UKA) and valgus high tibial osteotomy (HTO) are two options for isolated medial femorotibial osteoarthritis in genu varum. In the absence of registries for osteotomies and for arthroplasty in the knee, epidemiological data are hard to obtain in France. We therefore performed a retrospective study, with the aims of 1) estimating UKA and HTO survival without revision by total knee arthroplasty (TKA), and 2) assessing risk factors for revision according to treatment group. HYPOTHESIS: Medium-term survival is better with HTO than UKA in under-70 year-olds. MATERIALS AND METHOD: All elderly patients undergoing HTO or UKA in the French National Hospitals Database for the period 2011-2020 were included: i.e., 108,007 patients; 43,537 HTO (29,330 male, 14,207 female; mean age 49.7 years, 95% CI 49.6-49.8) and 64,470 UKA (31,181 male, 33,289 female; mean age 60.5 years, 95% CI 60.5-60.6). RESULTS: Survival free of revision by TKA was 75.8% (95% CI =75.2-76.4) for UKA and 80.6% (95% CI =80.0-81.3) for HTO (p\textless 0.00001). In UKA, revision risk factors comprised: low annual center volume (\textless17 UKAs per year) (HR=1.50; 95% CI=1.41-1.59), obesity (HR=1.25; 95% CI=1.18-1.32), and age \textless60 years, with maximum risk for 50-59 years (HR=2.41; 95% CI=1.83-3.16 in 50-59 year-olds). In HTO, revision risk factors comprised: obesity (HR=1.42; 95% CI=1.31-1.53), rheumatoid arthritis (HR=2.75; 95% CI=1.37-5.51), joint chondrocalcinosis (HR=2.01; 95% CI=1.18-3.39), and age \textgreater60 years (HR=8.81; 95% CI=7.23-19.73 in 60-69 year-olds). Maler gender was a protective factor against revision in both groups: UKA, HR= 0.75 (95% CI=0.72-0.79); HTO, HR=0.73 (95% CI=0.69-0.77). The number of UKAs increased over the years, matching the increase in arthroplasty in France, with a decrease in HTOs until 2019. CONCLUSION: HTO showed better medium-term survival than UKA in under-70 year-olds in France. Even so, indications decreased in favor of UKA, although the respective risk factors differ. These findings suggest that conservative surgery still has a role, depending on osteoarthritis stage. LEVEL OF EVIDENCE: III; retrospective comparative study.

@article{demesmaeker_suicide_2023,
	title = {Suicide and {All}-{Cause} {Mortality} {Within} 1 {Year} {After} a {Suicide} {Attempt} in the {VigilanS} {Cohort}},
	volume = {84},
	issn = {1555-2101},
	doi = {10.4088/JCP.22m14520},
	abstract = {Objective: Obtaining better knowledge on the outcomes of patients who attempt suicide is crucial for suicide prevention. The aim of our study was to determine the causes of death 1 year after a suicide attempt (SA) in the VigilanS program, mortality rates, and risk factors associated with any cause of death and suicide. Methods: A prospective cohort of 7,406 people who had attempted suicide between January 1, 2017, and December 31, 2018, was included in the study. The vital status of each participant was sought, and the cause of death was established through a phone call to their general practitioner or psychiatrist. Second, the relationship between sociodemographic and clinical factors and death by suicide within 1 year of an SA was assessed using a multivariable Cox model. Results: At 1 year, 125 (1.7\%) participants had died, 77 of whom died by suicide. Half of the deaths occurred within the first 4 months after an SA. Hanging (20.3\%; 24/125) and self-poisoning (19.5\%; 23/125) were the methods the most often used for suicide. We demonstrated that male sex (HR = 1.79 [1.13-2.82], P = .01) and being 45 years of age or older (between 45 and 64 years old, HR = 2.08 [1.21-3.56], P {\textless} .01; 65 years or older, HR = 5.36 [2.72-10.54], P {\textless} .01) were associated with a higher risk of death by suicide 1 year after an SA and that being younger than 25 years was associated with a lower risk (HR = 0.22 [0.07-0.76], P = .02). Conclusions: One out of 100 people who attempted suicide died by suicide within 1 year after an SA. Greater vigilance is required in the first months following an SA, especially for males older than 45 years. Trial Registration: ClinicalTrials.gov identifier: NCT03134885.},
	language = {eng},
	number = {6},
	journal = {The Journal of Clinical Psychiatry},
	author = {Demesmaeker, Alice and Amad, Ali and Chazard, Emmanuel and Demarty, Anne-Laure and Schlienger, Honorine and Lehmann, Emma and Debien, Christophe and Jardon, Vincent and Bounebache, Karim and Rey, Gregoire and Vaiva, Guillaume},
	month = sep,
	year = {2023},
	pmid = {37707316},
	keywords = {Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Suicide Prevention, Suicide, Attempted, Wakefulness},
	pages = {22m14520},
}

Objective: Obtaining better knowledge on the outcomes of patients who attempt suicide is crucial for suicide prevention. The aim of our study was to determine the causes of death 1 year after a suicide attempt (SA) in the VigilanS program, mortality rates, and risk factors associated with any cause of death and suicide. Methods: A prospective cohort of 7,406 people who had attempted suicide between January 1, 2017, and December 31, 2018, was included in the study. The vital status of each participant was sought, and the cause of death was established through a phone call to their general practitioner or psychiatrist. Second, the relationship between sociodemographic and clinical factors and death by suicide within 1 year of an SA was assessed using a multivariable Cox model. Results: At 1 year, 125 (1.7%) participants had died, 77 of whom died by suicide. Half of the deaths occurred within the first 4 months after an SA. Hanging (20.3%; 24/125) and self-poisoning (19.5%; 23/125) were the methods the most often used for suicide. We demonstrated that male sex (HR = 1.79 [1.13-2.82], P = .01) and being 45 years of age or older (between 45 and 64 years old, HR = 2.08 [1.21-3.56], P \textless .01; 65 years or older, HR = 5.36 [2.72-10.54], P \textless .01) were associated with a higher risk of death by suicide 1 year after an SA and that being younger than 25 years was associated with a lower risk (HR = 0.22 [0.07-0.76], P = .02). Conclusions: One out of 100 people who attempted suicide died by suicide within 1 year after an SA. Greater vigilance is required in the first months following an SA, especially for males older than 45 years. Trial Registration: ClinicalTrials.gov identifier: NCT03134885.

@article{jauffret_association_2023,
	title = {Association {Between} {Sarcopenia} and {Fracture} {Risk} in a {Population} {From} the {UK} {Biobank} {Database}},
	issn = {1523-4681},
	doi = {10.1002/jbmr.4884},
	abstract = {Studies on the fracture risk in presarcopenic and sarcopenic patients report contradictory results. The objective was to assess whether presarcopenia and sarcopenia are associated with an increase in fracture risk. We conducted a retrospective study using the UK Biobank cohort and the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle strength was evaluated using hand-grip strength (HGS) and muscle mass using the skeletal muscle index (SMI; from bioimpedance analysis). Presarcopenia was defined through the two definitions available in the literature, as low HGS with normal SMI and as normal HGS with low SMI, and sarcopenia as low HGS and low SMI. Fracture events were recorded as "fracture" (location compatible with an osteoporotic origin) and "major osteoporotic fracture" (MOF), as listed in the FRAX tool. Associations were assessed using Cox proportional hazards models, adjusted for sarcopenia and osteoporosis risk factors. Adjusted hazard ratios (HRa ) and their 95\% confidence intervals (CI) were reported. A total of 387,025 participants (women 54.4\%; median age 58.0 years; interquartile range [IQR] 51.0-63.0 years) were included. At baseline, there were 18,257 (4.7\%) presarcopenic participants-subgroup 1 (low HGS only), 7940 (2.1\%) presarcopenic participants-subgroup 2 (low SMI only), and 1124 (0.3\%) sarcopenic participants. Over a median follow-up of 12.0 years (IQR 11.4-12.6 years), 18,300 (4.7\%) participants were diagnosed with at least one incident fracture. Presarcopenic (subgroups 1 and 2) and sarcopenic status were significantly associated with a higher risk of fracture (respectively adjusted HRs: HR = 1.26 [1.19-1.33], HR = 1.20 [1.11-1.30], HR = 1.30 [1.08-1.56]) and with a higher risk of MOF (respectively adjusted HRs: HR = 1.30 [1.21-1.40], HR = 1.19 [1.08-1.72], HR = 1.18 [0.93-1.49]). In a middle-aged population, the fracture and MOF risks were higher in both presarcopenic and sarcopenic participants compared with nonsarcopenic participants. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).},
	language = {eng},
	journal = {Journal of Bone and Mineral Research: The Official Journal of the American Society for Bone and Mineral Research},
	author = {Jauffret, Charlotte and Périchon, Renaud and Lamer, Antoine and Cortet, Bernard and Chazard, Emmanuel and Paccou, Julien},
	month = jul,
	year = {2023},
	pmid = {37458535},
	keywords = {FRACTURES, MUSCLE MASS, MUSCLE STRENGTH, SARCOPENIA, UK BIOBANK},
}

Studies on the fracture risk in presarcopenic and sarcopenic patients report contradictory results. The objective was to assess whether presarcopenia and sarcopenia are associated with an increase in fracture risk. We conducted a retrospective study using the UK Biobank cohort and the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle strength was evaluated using hand-grip strength (HGS) and muscle mass using the skeletal muscle index (SMI; from bioimpedance analysis). Presarcopenia was defined through the two definitions available in the literature, as low HGS with normal SMI and as normal HGS with low SMI, and sarcopenia as low HGS and low SMI. Fracture events were recorded as "fracture" (location compatible with an osteoporotic origin) and "major osteoporotic fracture" (MOF), as listed in the FRAX tool. Associations were assessed using Cox proportional hazards models, adjusted for sarcopenia and osteoporosis risk factors. Adjusted hazard ratios (HRa ) and their 95% confidence intervals (CI) were reported. A total of 387,025 participants (women 54.4%; median age 58.0 years; interquartile range [IQR] 51.0-63.0 years) were included. At baseline, there were 18,257 (4.7%) presarcopenic participants-subgroup 1 (low HGS only), 7940 (2.1%) presarcopenic participants-subgroup 2 (low SMI only), and 1124 (0.3%) sarcopenic participants. Over a median follow-up of 12.0 years (IQR 11.4-12.6 years), 18,300 (4.7%) participants were diagnosed with at least one incident fracture. Presarcopenic (subgroups 1 and 2) and sarcopenic status were significantly associated with a higher risk of fracture (respectively adjusted HRs: HR = 1.26 [1.19-1.33], HR = 1.20 [1.11-1.30], HR = 1.30 [1.08-1.56]) and with a higher risk of MOF (respectively adjusted HRs: HR = 1.30 [1.21-1.40], HR = 1.19 [1.08-1.72], HR = 1.18 [0.93-1.49]). In a middle-aged population, the fracture and MOF risks were higher in both presarcopenic and sarcopenic participants compared with nonsarcopenic participants. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

@article{thelliez_migration_2023,
	title = {Migration of di(2-ethylhexyl) phthalate, diisononylcyclohexane-1,2-dicarboxylate and di(2-ethylhexyl) terephthalate from transfusion medical devices in labile blood products: {A} comparative study},
	issn = {1423-0410},
	shorttitle = {Migration of di(2-ethylhexyl) phthalate, diisononylcyclohexane-1,2-dicarboxylate and di(2-ethylhexyl) terephthalate from transfusion medical devices in labile blood products},
	doi = {10.1111/vox.13446},
	abstract = {BACKGROUND AND OBJECTIVES: Polyvinyl chloride (PVC) plasticized with di(2-ethylhexyl) phthalate (DEHP) is a widely used material for medical transfusion devices. Not covalently bound to PVC, DEHP can migrate into blood products during storage. Recognized as an endocrine disruptor and raising concerns about its potential carcinogenicity and reprotoxicity, DEHP is gradually being withdrawn from the medical device market. Therefore, the use of alternative plasticizers, such as diisononylcyclohexane-1,2-dicarboxylate (DINCH) and di(2-ethylhexyl) terephthalate (DEHT), as potential candidates for the replacement of DEHP in medical transfusion devices has been investigated. The purpose of this study was to evaluate the quantity of PVC-plasticizers in the blood components according to their preparation, storage conditions and in function of the plasticizer.
MATERIALS AND METHODS: Whole blood was collected, and labile blood products (LBPs) were prepared by the buffy-coat method with a PVC blood bag plasticized either with DEHP, DINCH or DEHT. DINCH and DEHT equivalent concentrations were quantified in LBPs by liquid chromatography-tandem mass spectrometry or coupled with UV and compared to DEHP equivalent concentrations.
RESULTS: The plasticizer equivalent concentration to which a patient is exposed during a transfusion depends on the preparation of LBPs as well as their storage conditions, that is, temperature and storage time. At day 1, for all LBPs, the migration of DEHP is 5.0 and 8.5 times greater than DINCH and DEHT, respectively. At the end of the 49 days storage period, the DEHP equivalent concentration in red blood cells concentrate is statistically higher when compared to DINCH and DEHT, with maximal values of 1.85, 1.13 and 0.86 μg/dm2 /mL, respectively.
CONCLUSION: In addition to lower toxicity, transfused patients using PVC-DEHT or PVC-DINCH blood bags are less exposed to plasticizers than using PVC-DEHP bags with a ranging exposure reduction from 38.9\% to 87.3\%, due to lower leachability into blood components.},
	language = {eng},
	journal = {Vox Sanguinis},
	author = {Thelliez, Aurélie and Sumian, Chryslain and Chazard, Emmanuel and Reichenberg, Stefan and Lecoeur, Marie and Decaudin, Bertrand},
	month = may,
	year = {2023},
	pmid = {37246454},
	keywords = {2-dicarboxylate, di(2-ethylhexyl) phthalate, di(2-ethylhexyl) terephthalate, diisononylcyclohexane-1, diisononylcyclohexane-1,2-dicarboxylate, labile blood product, metabolites, plasticizer migration},
}

BACKGROUND AND OBJECTIVES: Polyvinyl chloride (PVC) plasticized with di(2-ethylhexyl) phthalate (DEHP) is a widely used material for medical transfusion devices. Not covalently bound to PVC, DEHP can migrate into blood products during storage. Recognized as an endocrine disruptor and raising concerns about its potential carcinogenicity and reprotoxicity, DEHP is gradually being withdrawn from the medical device market. Therefore, the use of alternative plasticizers, such as diisononylcyclohexane-1,2-dicarboxylate (DINCH) and di(2-ethylhexyl) terephthalate (DEHT), as potential candidates for the replacement of DEHP in medical transfusion devices has been investigated. The purpose of this study was to evaluate the quantity of PVC-plasticizers in the blood components according to their preparation, storage conditions and in function of the plasticizer. MATERIALS AND METHODS: Whole blood was collected, and labile blood products (LBPs) were prepared by the buffy-coat method with a PVC blood bag plasticized either with DEHP, DINCH or DEHT. DINCH and DEHT equivalent concentrations were quantified in LBPs by liquid chromatography-tandem mass spectrometry or coupled with UV and compared to DEHP equivalent concentrations. RESULTS: The plasticizer equivalent concentration to which a patient is exposed during a transfusion depends on the preparation of LBPs as well as their storage conditions, that is, temperature and storage time. At day 1, for all LBPs, the migration of DEHP is 5.0 and 8.5 times greater than DINCH and DEHT, respectively. At the end of the 49 days storage period, the DEHP equivalent concentration in red blood cells concentrate is statistically higher when compared to DINCH and DEHT, with maximal values of 1.85, 1.13 and 0.86 μg/dm2 /mL, respectively. CONCLUSION: In addition to lower toxicity, transfused patients using PVC-DEHT or PVC-DINCH blood bags are less exposed to plasticizers than using PVC-DEHP bags with a ranging exposure reduction from 38.9% to 87.3%, due to lower leachability into blood components.

@article{lamer_description_2023,
	series = {Congrès national {Emois} 2023},
	title = {Description standardisée du processus d'extraction de caractéristiques afin d'améliorer la réutilisation des données},
	volume = {71},
	issn = {0398-7620},
	url = {https://www.sciencedirect.com/science/article/pii/S0398762023000433},
	doi = {10.1016/j.respe.2023.101465},
	abstract = {Introduction
Malgré les nombreuses possibilités qu'offre la réutilisation des données, sa mise en œuvre présente de nombreuses difficultés, et les données brutes ne peuvent pas être réutilisées directement. Les informations ne sont pas toujours directement disponibles dans la base de données source et doivent être calculées a posteriori. L'objectif principal de cette étude est de présenter une description standardisée des étapes et des transformations nécessaires lors du processus d'extraction de caractéristiques.
Méthodes
Cette étude a comporté les deux étapes suivantes: (1) la collecte de cas d'étude pertinents liés à l'extraction de caractéristiques; (2) la description normalisée des données brutes, des étapes et des transformations, qui étaient communes aux cas d'étude.
Résultats
Nous avons interrogé 10 chercheurs de trois hôpitaux universitaires français et de la Haute Autorité de santé, qui ont participé à huit études rétrospectives et observationnelles. Sur la base de ces études, deux états (piste et caractéristique) et deux transformations (la définition de pistes et l'agrégation de pistes) ont émergé. La "piste" est un signal ou une période d'intérêt dépendant du temps, défini par une unité statistique, une valeur et deux jalons (un événement de début et un événement de fin). La "caractéristique" est une information de haut niveau indépendante du temps, de dimension identique à l'unité statistique de l'étude, définie par un label et une valeur. La dimension temporelle est devenue implicite dans la valeur ou le nom de la variable.
Discussion/Conclusion
Nous proposons une description standardisée du processus d'extraction de caractéristiques. Ce processus combine les deux étapes de définition et d'agrégation des pistes. En divisant l'extraction de caractéristiques en ces deux étapes, la difficulté a été gérée lors de la définition des pistes. La standardisation des pistes nécessite une grande expertise au niveau des données, mais permet l'application d'un nombre infini de transformations complexes. Au contraire, l'agrégation des pistes est une opération très simple avec un nombre fini de possibilités. Une description complète de ces étapes pourrait améliorer la reproductibilité des études rétrospectives.
Mots-clés
Réutilisation de données ; Base de données ; Entrepôt de données ; OMOP ; Caractéristique
Déclaration de liens d'intérêts
Les auteurs déclarent ne pas avoir de liens d'intérêts.},
	urldate = {2023-11-02},
	journal = {Revue d'Épidémiologie et de Santé Publique},
	author = {Lamer, A. and Fruchart, M. and Paris, N. and Popoff, B. and Payen, A. and Balcaen, T. and Gacquer, W. and Cuggia, M. and Doutreligne, M. and Chazard, E.},
	month = mar,
	year = {2023},
	pages = {101465},
}

Introduction Malgré les nombreuses possibilités qu'offre la réutilisation des données, sa mise en œuvre présente de nombreuses difficultés, et les données brutes ne peuvent pas être réutilisées directement. Les informations ne sont pas toujours directement disponibles dans la base de données source et doivent être calculées a posteriori. L'objectif principal de cette étude est de présenter une description standardisée des étapes et des transformations nécessaires lors du processus d'extraction de caractéristiques. Méthodes Cette étude a comporté les deux étapes suivantes: (1) la collecte de cas d'étude pertinents liés à l'extraction de caractéristiques; (2) la description normalisée des données brutes, des étapes et des transformations, qui étaient communes aux cas d'étude. Résultats Nous avons interrogé 10 chercheurs de trois hôpitaux universitaires français et de la Haute Autorité de santé, qui ont participé à huit études rétrospectives et observationnelles. Sur la base de ces études, deux états (piste et caractéristique) et deux transformations (la définition de pistes et l'agrégation de pistes) ont émergé. La "piste" est un signal ou une période d'intérêt dépendant du temps, défini par une unité statistique, une valeur et deux jalons (un événement de début et un événement de fin). La "caractéristique" est une information de haut niveau indépendante du temps, de dimension identique à l'unité statistique de l'étude, définie par un label et une valeur. La dimension temporelle est devenue implicite dans la valeur ou le nom de la variable. Discussion/Conclusion Nous proposons une description standardisée du processus d'extraction de caractéristiques. Ce processus combine les deux étapes de définition et d'agrégation des pistes. En divisant l'extraction de caractéristiques en ces deux étapes, la difficulté a été gérée lors de la définition des pistes. La standardisation des pistes nécessite une grande expertise au niveau des données, mais permet l'application d'un nombre infini de transformations complexes. Au contraire, l'agrégation des pistes est une opération très simple avec un nombre fini de possibilités. Une description complète de ces étapes pourrait améliorer la reproductibilité des études rétrospectives. Mots-clés Réutilisation de données ; Base de données ; Entrepôt de données ; OMOP ; Caractéristique Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.

@article{cren_association_2023,
	series = {Congrès national {Emois} 2023},
	title = {Association entre les séjours hospitaliers avec infection et la survie globale des patients traités par ipilimumab : analyse de 1585 patients du {PMSI}},
	volume = {71},
	issn = {0398-7620},
	shorttitle = {Association entre les séjours hospitaliers avec infection et la survie globale des patients traités par ipilimumab},
	url = {https://www.sciencedirect.com/science/article/pii/S0398762023000470},
	doi = {10.1016/j.respe.2023.101469},
	abstract = {Introduction
Le microbiote intestinal joue un rôle clé dans la régulation du système immunitaire. La perturbation de la composition du microbiote intestinal par des antibiotiques pourrait affecter l'efficacité des inhibiteurs de point de contrôle immunitaire. Dans une étude portant sur des patients traités par ipilimumab, nous avons cherché à évaluer la relation entre l'administration d'antibiotiques à l'hôpital et la survie globale.
Méthodes
Les patients ayant été traités par ipilimumab entre janvier 2012 et novembre 2014 ont été sélectionnés à partir de la base de données nationale française du Programme de médicalisation des systèmes d'information. L'exposition aux antibiotiques était définie comme la présence d'un séjour hospitalier avec une infection bactérienne systémique documentée dans les deux mois précédant ou le mois suivant l'initiation de la toute première cure d'ipilimumab du patient. Le critère de jugement principal était la survie globale.
Résultats
Nous avons étudié 43 124 séjours hospitaliers impliquant 1585 patients pris en charge dans 97 centres en France. Tous les patients avaient reçu une monothérapie par ipilimumab pour un mélanome avancé ; 117 des 1585 patients (7,4 \%) ont été exposés à une antibiothérapie systémique à l'hôpital pendant la période d'exposition définie. La survie globale médiane était plus courte chez les patients présentant une infection (6,3 mois, contre 15,4 mois chez les patients sans infection; hazard ratio (HR)=1,88, intervalle de confiance à 95\% [1,46; 2,43], p=10−6). Dans l'analyse multivariée, l'infection était toujours associée de manière significative à une diminution de la survie globale (HR=1,68, [1,30; 2,18], p=10−5).
Discussion/Conclusion
Chez les patients traités par ipilimumab pour un mélanome avancé, l'infection et l'administration d'antibiotiques à l'hôpital autour de la toute première cure d'ipilimumab semblent être associées à une diminution significative de l'efficacité de cet inhibiteur de point de contrôle immunitaire.
Mots-clés
Mélanome ; Ipilimumab ; Microbiote intestinal ; PMSI ; Réutilisation de données ; Données massives
Déclaration de liens d'intérêts
Les auteurs déclarent ne pas avoir de liens d'intérêts.},
	urldate = {2023-11-02},
	journal = {Revue d'Épidémiologie et de Santé Publique},
	author = {Cren, P-Y. and Bertrand, N. and Deley, M-C. Le and Génin, M. and Mortier, L. and Odou, P. and Penel, N. and Chazard, E.},
	month = mar,
	year = {2023},
	pages = {101469},
}

Introduction Le microbiote intestinal joue un rôle clé dans la régulation du système immunitaire. La perturbation de la composition du microbiote intestinal par des antibiotiques pourrait affecter l'efficacité des inhibiteurs de point de contrôle immunitaire. Dans une étude portant sur des patients traités par ipilimumab, nous avons cherché à évaluer la relation entre l'administration d'antibiotiques à l'hôpital et la survie globale. Méthodes Les patients ayant été traités par ipilimumab entre janvier 2012 et novembre 2014 ont été sélectionnés à partir de la base de données nationale française du Programme de médicalisation des systèmes d'information. L'exposition aux antibiotiques était définie comme la présence d'un séjour hospitalier avec une infection bactérienne systémique documentée dans les deux mois précédant ou le mois suivant l'initiation de la toute première cure d'ipilimumab du patient. Le critère de jugement principal était la survie globale. Résultats Nous avons étudié 43 124 séjours hospitaliers impliquant 1585 patients pris en charge dans 97 centres en France. Tous les patients avaient reçu une monothérapie par ipilimumab pour un mélanome avancé ; 117 des 1585 patients (7,4 %) ont été exposés à une antibiothérapie systémique à l'hôpital pendant la période d'exposition définie. La survie globale médiane était plus courte chez les patients présentant une infection (6,3 mois, contre 15,4 mois chez les patients sans infection; hazard ratio (HR)=1,88, intervalle de confiance à 95% [1,46; 2,43], p=10−6). Dans l'analyse multivariée, l'infection était toujours associée de manière significative à une diminution de la survie globale (HR=1,68, [1,30; 2,18], p=10−5). Discussion/Conclusion Chez les patients traités par ipilimumab pour un mélanome avancé, l'infection et l'administration d'antibiotiques à l'hôpital autour de la toute première cure d'ipilimumab semblent être associées à une diminution significative de l'efficacité de cet inhibiteur de point de contrôle immunitaire. Mots-clés Mélanome ; Ipilimumab ; Microbiote intestinal ; PMSI ; Réutilisation de données ; Données massives Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.

@article{choteau_extraction_2023,
	series = {Congrès national {Emois} 2023},
	title = {Extraction de caractéristiques pour la réutilisation de données: comment les variables seront-elles transformées et analysées ?},
	volume = {71},
	issn = {0398-7620},
	shorttitle = {Extraction de caractéristiques pour la réutilisation de données},
	url = {https://www.sciencedirect.com/science/article/pii/S0398762023000445},
	doi = {10.1016/j.respe.2023.101466},
	abstract = {Introduction
La réutilisation de données (recherche sur des données) permet généralement de constituer des cohortes historiques. Elle s'appuie sur une étape d'extraction de caractéristiques, qui simplifie les données avant l'analyse statistique. Quelles variables sont généralement utilisées ? Comment sont-elles transformées ? Nous analyserons des cohortes historiques traditionnelles (recherche sur des personnes).
Méthodes
Revue de la littérature: analyse de toutes les cohortes historiques publiées dans les quatre plus grands journaux généralistes en 2019 (pré-COVID), analyse des variables utilisées et de leurs transformations.
Résultats
Les journaux sont: JAMA, BMJ, Lancet et NEJM. Ils ont publié 22 cohortes historiques sur des personnes en 2019, impliquant 660 variables, dont 570 explicatives (86,4 \%) et 90 à expliquer (13,6 \%). Onze articles (50,0 \%) utilisent un modèle de Cox. Les variables rencontrées décrivent le sexe (86,4 \% des articles), l'âge (81,8 \%), d'autres informations démographiques (100 \%), des maladies chroniques (86,4 \%) ou aiguës (50,1 \%), des caractéristiques de l'hôpital (18,2 \%), d'autres informations liées au soin (72,7 \%), des résultats de biologie (36,4 \%), des médicaments (50 \%), le décès (63,6 \%). Nativement, elles sont binaires (62,6 \%), quantitatives (21,3 \%), qualitatives (12,6 \%), ou purement temporelles (2,6 \%). Les variables sont transformées pendant l'analyse. Les variables explicatives sont majoritairement temps-dépendantes (465 soit 70,5 \%), mais presque toutes considérées comme constantes lors de l'analyse (438 soit 94,1 \% d'entre elles). En outre, 65 des 660 variables (9,8 \%) changent de nature, principalement des variables quantitatives qui sont discrétisées (43 des 147 variables quantitatives, soit 29,3 \%).
Discussion/Conclusion
Ces résultats nous orientent pour concevoir un cadre méthodologique de réutilisation de données. Leçon 1: conserver le caractère quantitatif des variables explicatives n'est pas une priorité, ce qui s'explique par les hypothèses non-vérifiées (linéarité, log-linéarité) et le besoin de seuils de décision. Leçon 2: les chercheurs gèrent bien les variables à expliquer temps-dépendantes (survie), mais pas les variables explicatives temps-dépendantes. Il faut donc développer des méthodes simples d'extraction de caractéristiques permettant de préserver le temps. Rappelons que, au fond, presque toutes les variables sont temps-dépendantes.
Mots-clés
Extraction de caractéristiques ; Revue de la littérature ; Réutilisation de données ; Cohorte historique
Déclaration de liens d'intérêts
Les auteurs déclarent ne pas avoir de liens d'intérêts.},
	urldate = {2023-11-02},
	journal = {Revue d'Épidémiologie et de Santé Publique},
	author = {Choteau, T. and Lamer, A. and Balayé, P. and Chazard, E.},
	month = mar,
	year = {2023},
	pages = {101466},
}

Introduction La réutilisation de données (recherche sur des données) permet généralement de constituer des cohortes historiques. Elle s'appuie sur une étape d'extraction de caractéristiques, qui simplifie les données avant l'analyse statistique. Quelles variables sont généralement utilisées ? Comment sont-elles transformées ? Nous analyserons des cohortes historiques traditionnelles (recherche sur des personnes). Méthodes Revue de la littérature: analyse de toutes les cohortes historiques publiées dans les quatre plus grands journaux généralistes en 2019 (pré-COVID), analyse des variables utilisées et de leurs transformations. Résultats Les journaux sont: JAMA, BMJ, Lancet et NEJM. Ils ont publié 22 cohortes historiques sur des personnes en 2019, impliquant 660 variables, dont 570 explicatives (86,4 %) et 90 à expliquer (13,6 %). Onze articles (50,0 %) utilisent un modèle de Cox. Les variables rencontrées décrivent le sexe (86,4 % des articles), l'âge (81,8 %), d'autres informations démographiques (100 %), des maladies chroniques (86,4 %) ou aiguës (50,1 %), des caractéristiques de l'hôpital (18,2 %), d'autres informations liées au soin (72,7 %), des résultats de biologie (36,4 %), des médicaments (50 %), le décès (63,6 %). Nativement, elles sont binaires (62,6 %), quantitatives (21,3 %), qualitatives (12,6 %), ou purement temporelles (2,6 %). Les variables sont transformées pendant l'analyse. Les variables explicatives sont majoritairement temps-dépendantes (465 soit 70,5 %), mais presque toutes considérées comme constantes lors de l'analyse (438 soit 94,1 % d'entre elles). En outre, 65 des 660 variables (9,8 %) changent de nature, principalement des variables quantitatives qui sont discrétisées (43 des 147 variables quantitatives, soit 29,3 %). Discussion/Conclusion Ces résultats nous orientent pour concevoir un cadre méthodologique de réutilisation de données. Leçon 1: conserver le caractère quantitatif des variables explicatives n'est pas une priorité, ce qui s'explique par les hypothèses non-vérifiées (linéarité, log-linéarité) et le besoin de seuils de décision. Leçon 2: les chercheurs gèrent bien les variables à expliquer temps-dépendantes (survie), mais pas les variables explicatives temps-dépendantes. Il faut donc développer des méthodes simples d'extraction de caractéristiques permettant de préserver le temps. Rappelons que, au fond, presque toutes les variables sont temps-dépendantes. Mots-clés Extraction de caractéristiques ; Revue de la littérature ; Réutilisation de données ; Cohorte historique Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.

@article{balaye_dans_2023,
	series = {Congrès national {Emois} 2023},
	title = {Dans votre étude de survie dans le {PMSI}, combien vous manque-t-il de décès hors {PMSI} ?},
	volume = {71},
	issn = {0398-7620},
	url = {https://www.sciencedirect.com/science/article/pii/S0398762023000391},
	doi = {10.1016/j.respe.2023.101461},
	abstract = {Introduction
La base nationale du PMSI permet de bâtir de véritables cohortes historiques. Le suivi des réhospitalisations dans tous les établissements de France et tous les champs (MCO, HAD, SSR, Psychiatrie) permet d'étudier la survie des patients. Les chercheurs qui accèdent au SNDS peuvent, à l'aide des données de l'Assurance maladie et du CepiDC, identifier des décès supplémentaires hors PMSI. Les autres chercheurs, qui n'accèdent qu'au PMSI, se contentent généralement d'écrire que, à leur connaissance, la plupart des patients décèdent en établissement. Est-ce vrai ? Quelle est la proportion de décès hors du PMSI, en fonction des âges et des pathologies étudiées ? Notre objectif est de fournir aux chercheurs un outil simple pour estimer le nombre de décès qu'il leur manque.
Méthodes
Nous utilisons les données du CepiDC de 2017 (avant la pandémie), disponibles sur la plateforme du Système national des données de santé (SNDS). Nous préparons un calculateur permettant, en renseignant l'âge et la cause de décès (chapitre de la CIM10) de patients ou groupes de patients dont le décès a été observé dans le PMSI, d'estimer le nombre de décès hors du PMSI.
Résultats
L'outil est disponible gratuitement, sans inscription et sans traçage sur la page http://deceshorspmsi.chazard.org .La proportion de décès hors PMSI est globalement de 3,13\%. Elle varie notablement en fonction du motif de décès, allant de 0,0 \% pour "Grossesse, accouchement et puerpéralité" à 86,7 \% pour "Certaines affections dont l'origine se situe dans la période périnatale (...)". Elle varie également en fonction de l'âge, allant de 2,11 \% pour les décès entre 70 et 74 ans, à 57,8 \% pour les décès entre 0 et 4 ans.
Discussion/Conclusion
Cet outil, simple d'utilisation, permettra aux chercheurs accédant uniquement à la Base Nationale du PMSI de facilement estimer le nombre de décès qu'il leur manque, en fonction des âges et catégories diagnostiques des décès observés dans le PMSI dans leur cohorte. L'exactitude de ces données n'est pas garantie, mais l'ordre de grandeur sera utile.
Mots-clés
Décès ; PMSI ; CepiDC
Déclaration de liens d'intérêts
Les auteurs déclarent ne pas avoir de liens d'intérêts.},
	urldate = {2023-11-02},
	journal = {Revue d'Épidémiologie et de Santé Publique},
	author = {Balayé, P. and Lamer, A. and Chazard, E.},
	month = mar,
	year = {2023},
	pages = {101461},
}

Introduction La base nationale du PMSI permet de bâtir de véritables cohortes historiques. Le suivi des réhospitalisations dans tous les établissements de France et tous les champs (MCO, HAD, SSR, Psychiatrie) permet d'étudier la survie des patients. Les chercheurs qui accèdent au SNDS peuvent, à l'aide des données de l'Assurance maladie et du CepiDC, identifier des décès supplémentaires hors PMSI. Les autres chercheurs, qui n'accèdent qu'au PMSI, se contentent généralement d'écrire que, à leur connaissance, la plupart des patients décèdent en établissement. Est-ce vrai ? Quelle est la proportion de décès hors du PMSI, en fonction des âges et des pathologies étudiées ? Notre objectif est de fournir aux chercheurs un outil simple pour estimer le nombre de décès qu'il leur manque. Méthodes Nous utilisons les données du CepiDC de 2017 (avant la pandémie), disponibles sur la plateforme du Système national des données de santé (SNDS). Nous préparons un calculateur permettant, en renseignant l'âge et la cause de décès (chapitre de la CIM10) de patients ou groupes de patients dont le décès a été observé dans le PMSI, d'estimer le nombre de décès hors du PMSI. Résultats L'outil est disponible gratuitement, sans inscription et sans traçage sur la page http://deceshorspmsi.chazard.org .La proportion de décès hors PMSI est globalement de 3,13%. Elle varie notablement en fonction du motif de décès, allant de 0,0 % pour "Grossesse, accouchement et puerpéralité" à 86,7 % pour "Certaines affections dont l'origine se situe dans la période périnatale (...)". Elle varie également en fonction de l'âge, allant de 2,11 % pour les décès entre 70 et 74 ans, à 57,8 % pour les décès entre 0 et 4 ans. Discussion/Conclusion Cet outil, simple d'utilisation, permettra aux chercheurs accédant uniquement à la Base Nationale du PMSI de facilement estimer le nombre de décès qu'il leur manque, en fonction des âges et catégories diagnostiques des décès observés dans le PMSI dans leur cohorte. L'exactitude de ces données n'est pas garantie, mais l'ordre de grandeur sera utile. Mots-clés Décès ; PMSI ; CepiDC Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.

@article{lacroix_toute_2023,
	series = {Congrès national {Emois} 2023},
	title = {De toute évidence les femmes meurent moins de cardiopathie ischémique que les hommes},
	volume = {71},
	issn = {0398-7620},
	url = {https://www.sciencedirect.com/science/article/pii/S0398762023000524},
	doi = {10.1016/j.respe.2023.101474},
	abstract = {Introduction
Il devient courant d'affirmer que les femmes meurent plus que les hommes de maladie cardiovasculaire, y compris en introduction d'articles scientifiques. Objectif: utiliser des données ouvertes de mortalité pour illustrer comment un calcul simpliste peut induire en erreur.
Méthodes
Nous utilisons les données 2016 du CepiDC en France métropolitaine, en séparant les cardiopathies ischémiques (CI) de toutes les autres causes. Pour tous les morts de l'année 2016, ces données fournissent le sexe, l'âge au décès, et la cause. Méthode 1 (morts réels): à la manière d'une étude rétrospective, nous calculons le sex ratio des morts par CI (en ignorant les autres causes), par classe d'âge. Méthode 2 (cohorte virtuelle): nous simulons des naissances une année donnée. Supposant que ces personnes mourraient au même âge que les morts de 2016, nous simulons leurs décès par CI ou pour d'autres causes, année après année. Pour chaque classe d'âge, nous calculons le risque relatif entre le sexe masculin et le décès par CI.
Résultats
Méthode 1: le sex ratio vaut successivement 2,36 (25-34 ans), 5,60 (35-44 ans), 4,85 (45-54 ans), 5,03 (55-64 ans), 3,76 (65-74 ans), 1,87 (75-84 ans), 0,90 (85-94 ans), 0,41 (95-104 ans), et 0,40 (après 105 ans). Méthode 2: le risque relatif vaut successivement 2,39 (25-34 ans), 5,69 (35-44 ans), 4,98 (45-54 ans), 5,32 (55-64 ans), 4,33 (65-74 ans), 2,52 (75-84 ans), 1,59 (85-94 ans), 1,31 (95-104 ans), et 1,29 (après 105 ans).
Discussion/Conclusion
La méthode 1 peut faire croire que les femmes meurent plus de CI que les hommes au-delà de 85 ans. Elle ne prend pas en compte les risques concurrents (ex: cancers), ni le fait que les hommes vivent moins longtemps (notamment à cause de la mortalité par CI). Elle reste une approximation acceptable de la méthode 2 en-dessous de 45 ans. La méthode 2 est plus fidèle à la réalité: à tout âge, les hommes meurent plus que les femmes de CI.
Mots-clés
CepiDC ; Mortalité ; Cardiopathie ischémique ; Sex ratio ; Risque relatif
Déclaration de liens d'intérêts
Les auteurs déclarent ne pas avoir de liens d'intérêts.},
	urldate = {2023-11-02},
	journal = {Revue d'Épidémiologie et de Santé Publique},
	author = {Lacroix, D-F. and Beuscart, J-B. and Hubert, H. and Chazard, E.},
	month = mar,
	year = {2023},
	pages = {101474},
}

Introduction Il devient courant d'affirmer que les femmes meurent plus que les hommes de maladie cardiovasculaire, y compris en introduction d'articles scientifiques. Objectif: utiliser des données ouvertes de mortalité pour illustrer comment un calcul simpliste peut induire en erreur. Méthodes Nous utilisons les données 2016 du CepiDC en France métropolitaine, en séparant les cardiopathies ischémiques (CI) de toutes les autres causes. Pour tous les morts de l'année 2016, ces données fournissent le sexe, l'âge au décès, et la cause. Méthode 1 (morts réels): à la manière d'une étude rétrospective, nous calculons le sex ratio des morts par CI (en ignorant les autres causes), par classe d'âge. Méthode 2 (cohorte virtuelle): nous simulons des naissances une année donnée. Supposant que ces personnes mourraient au même âge que les morts de 2016, nous simulons leurs décès par CI ou pour d'autres causes, année après année. Pour chaque classe d'âge, nous calculons le risque relatif entre le sexe masculin et le décès par CI. Résultats Méthode 1: le sex ratio vaut successivement 2,36 (25-34 ans), 5,60 (35-44 ans), 4,85 (45-54 ans), 5,03 (55-64 ans), 3,76 (65-74 ans), 1,87 (75-84 ans), 0,90 (85-94 ans), 0,41 (95-104 ans), et 0,40 (après 105 ans). Méthode 2: le risque relatif vaut successivement 2,39 (25-34 ans), 5,69 (35-44 ans), 4,98 (45-54 ans), 5,32 (55-64 ans), 4,33 (65-74 ans), 2,52 (75-84 ans), 1,59 (85-94 ans), 1,31 (95-104 ans), et 1,29 (après 105 ans). Discussion/Conclusion La méthode 1 peut faire croire que les femmes meurent plus de CI que les hommes au-delà de 85 ans. Elle ne prend pas en compte les risques concurrents (ex: cancers), ni le fait que les hommes vivent moins longtemps (notamment à cause de la mortalité par CI). Elle reste une approximation acceptable de la méthode 2 en-dessous de 45 ans. La méthode 2 est plus fidèle à la réalité: à tout âge, les hommes meurent plus que les femmes de CI. Mots-clés CepiDC ; Mortalité ; Cardiopathie ischémique ; Sex ratio ; Risque relatif Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.

@article{pierard_rendez-vous_2023,
	series = {Congrès national {Emois} 2023},
	title = {Rendez-vous non-honorés par les patients, ou "lapins": quel est leur impact en ville et à l'hôpital ?},
	volume = {71},
	issn = {0398-7620},
	shorttitle = {Rendez-vous non-honorés par les patients, ou "lapins"},
	url = {https://www.sciencedirect.com/science/article/pii/S0398762023000639},
	doi = {10.1016/j.respe.2023.101485},
	abstract = {Introduction
Alors que les décideurs et commentateurs redoublent de propositions pour réformer l'offre de soins ambulatoires (en cabinet ou établissement), les médecins libéraux et hospitaliers se plaignent de voir leur travail affecté par de trop nombreux rendez-vous (RDV) non-honorés par les patients, ou "lapins". L'objectif principal est d'évaluer leur impact.
Méthodes
Sous l'égide et avec le financement du Conseil de l'Ordre des Médecins du Nord (CDOM59), nous avons tiré au sort 200 médecins payant une cotisation complète au CDOM59, et leur avons envoyé un questionnaire papier anonyme avec enveloppe retour. Des relances téléphoniques systématiques ont été faites.
Résultats
Le taux de réponse est de 84,0 \%. L'âge moyen est 48,4, il y a 50,6 \% d'hommes ; 86 (57,7 \%) travaillent en cabinet. 44 (29,9 \%) réalisent du soin premier en médecine générale ; 150 font des consultations (89,3 \%). Ces médecins réalisent en médiane 60 consultations par semaine (Q1-Q3 [28,5;100]). Ils subissent en moyenne 4 [2;7] lapins par semaine, soit 7,60 \% des consultations, correspondant à 2h01 par semaine, alors que leur délai médian d'obtention d'un rendez-vous est de 20 jours ([5;60]). Le temps libéré est réparti ainsi: 14,9 \% de nouveaux soins, 35,8 \% de soins rallongés, 37,6 \%de temps professionnel hors soin, 11,7 \% de temps personnel ou perdu. Pour les médecins interrogés, le profil type du "lapin" est un patient jeune, inconnu du cabinet, prenant RDV sur internet, non-adressé par un confrère, pour un motif non-grave et aigu, et présentant un problème psychologique ou social ou organisationnel. Les médecins interrogés préconisent en priorité de sensibiliser les patients, de ne plus accueillir les récidivistes (hors urgences), et de les sanctionner financièrement (cotation non-remboursable, déduite des remboursements ultérieurs).
Discussion / conclusion
Résoudre le problème des "lapins" serait aussi efficace que repousser de l'âge de la retraite de 2,4 ans ou supprimer 16,3 jours de congés chaque année, ou rajouter 1h43 de travail chaque semaine pour TOUS les médecins de France. Ce serait un levier très important sur l'offre de soins ambulatoire.
Mots-clés
Rendez-vous non-honoré ; « Lapin » ; Offre de soins
Déclaration de liens d'intérêts
Les auteurs déclarent ne pas avoir de liens d'intérêts.},
	urldate = {2023-11-02},
	journal = {Revue d'Épidémiologie et de Santé Publique},
	author = {Piérard, C. and Vogel, M. and Platel, J-P. and Chazard, E.},
	month = mar,
	year = {2023},
	pages = {101485},
}

Introduction Alors que les décideurs et commentateurs redoublent de propositions pour réformer l'offre de soins ambulatoires (en cabinet ou établissement), les médecins libéraux et hospitaliers se plaignent de voir leur travail affecté par de trop nombreux rendez-vous (RDV) non-honorés par les patients, ou "lapins". L'objectif principal est d'évaluer leur impact. Méthodes Sous l'égide et avec le financement du Conseil de l'Ordre des Médecins du Nord (CDOM59), nous avons tiré au sort 200 médecins payant une cotisation complète au CDOM59, et leur avons envoyé un questionnaire papier anonyme avec enveloppe retour. Des relances téléphoniques systématiques ont été faites. Résultats Le taux de réponse est de 84,0 %. L'âge moyen est 48,4, il y a 50,6 % d'hommes ; 86 (57,7 %) travaillent en cabinet. 44 (29,9 %) réalisent du soin premier en médecine générale ; 150 font des consultations (89,3 %). Ces médecins réalisent en médiane 60 consultations par semaine (Q1-Q3 [28,5;100]). Ils subissent en moyenne 4 [2;7] lapins par semaine, soit 7,60 % des consultations, correspondant à 2h01 par semaine, alors que leur délai médian d'obtention d'un rendez-vous est de 20 jours ([5;60]). Le temps libéré est réparti ainsi: 14,9 % de nouveaux soins, 35,8 % de soins rallongés, 37,6 %de temps professionnel hors soin, 11,7 % de temps personnel ou perdu. Pour les médecins interrogés, le profil type du "lapin" est un patient jeune, inconnu du cabinet, prenant RDV sur internet, non-adressé par un confrère, pour un motif non-grave et aigu, et présentant un problème psychologique ou social ou organisationnel. Les médecins interrogés préconisent en priorité de sensibiliser les patients, de ne plus accueillir les récidivistes (hors urgences), et de les sanctionner financièrement (cotation non-remboursable, déduite des remboursements ultérieurs). Discussion / conclusion Résoudre le problème des "lapins" serait aussi efficace que repousser de l'âge de la retraite de 2,4 ans ou supprimer 16,3 jours de congés chaque année, ou rajouter 1h43 de travail chaque semaine pour TOUS les médecins de France. Ce serait un levier très important sur l'offre de soins ambulatoire. Mots-clés Rendez-vous non-honoré ; « Lapin » ; Offre de soins Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.

@article{chazard_congres_2023,
	title = {Congrès {Emois} – {Nancy}, 16 et 17 mars 2023},
	volume = {71 Suppl 1},
	issn = {0398-7620},
	doi = {10.1016/j.respe.2023.101425},
	language = {fre},
	journal = {Revue D'epidemiologie Et De Sante Publique},
	author = {Chazard, Emmanuel and Bannay, Aurélie and Jay, Nicolas and Chevalier, Stéphanie},
	month = feb,
	year = {2023},
	pmid = {36736041},
	pages = {101425},
}

@article{deneuville_sauve-kapandji_2023,
	title = {The {Sauvé}-{Kapandji} procedure for post-traumatic distal radioulnar arthrosis: long-term results and analysis of risks factors for revision surgery},
	issn = {1877-0568},
	shorttitle = {The {Sauvé}-{Kapandji} procedure for post-traumatic distal radioulnar arthrosis},
	doi = {10.1016/j.otsr.2023.103562},
	abstract = {INTRODUCTION: The Sauvé Kapandji (SKp) procedure is a frequently used surgery for the management of post-traumatic sequelae of the distal radioulnar joint (DRU). Series evaluating long-term outcomes and the risk of complications are rare. The main objective was to describe the long-term clinical and radiographic results after SKp performed in a post-traumatic context. The secondary objectives were to identify postoperative complications, surgical revisions, and their risk factors for occurrence. Our hypothesis was that although SKp confers good clinical results, identifiable risk factors for complications exist.
PATIENTS AND METHODS: This monocentric retrospective study included all patients for whom an SKp was performed in a post-traumatic context from 2008 to 2018. Pain, satisfaction, range of motion and pre- and postoperative radiographic measurements were recorded. All complications were sought and described, as well as surgical revisions. Several variables were analyzed to identify risk factors for revision surgery after SKp: age, sex, initial traumatic mechanism, initial non-surgical or surgical treatment and type of surgery, time until revision surgery with SKp after the initial trauma.
RESULTS: Thirty-seven patients were included. At a median follow-up of 9.5 years (min 7.3 - max 11.5), 22 patients (60\%) had a VAS of 0. Range of motion was significantly improved for all the patients (p{\textless}0.001). Seventeen (46\%) patients had a complication, including 5 (13.4\%) cases of ossification, 4 (10.8\%) cases of discomfort related to the hardware and 4 (10.8\%) painful instability at the proximal ulnar stump. Thirteen (35\%) patients required revision surgery. Two risk factors for revision surgery after SKp were found: time period between initial treatment and SKp of less than 7.2 months and an age of less than 53.5 years; the combination of the two factors having a sensitivity of 97.5 and a specificity of 56.7.
CONCLUSION: SKp in a post-traumatic context significantly improved range of motion and allowed pain control at long follow-up. Revision surgery seemed more frequent in patients under 53.5 years of age and when SKp was performed less than 7.2 months after the initial trauma.
LEVEL OF EVIDENCE: IV, retrospective study.},
	language = {eng},
	journal = {Orthopaedics \& traumatology, surgery \& research: OTSR},
	author = {Deneuville, Marine and Germon, Charlotte and Nachef, Nadine Sturbois and Chazard, Emmanuel and Chantelot, Christophe and Saab, Marc},
	month = jan,
	year = {2023},
	pmid = {36702297},
	keywords = {Distal radioulnar osteoarthritis, Radioulnar joint, Sauve Kapandji procedure, Wrist},
	pages = {103562},
}

INTRODUCTION: The Sauvé Kapandji (SKp) procedure is a frequently used surgery for the management of post-traumatic sequelae of the distal radioulnar joint (DRU). Series evaluating long-term outcomes and the risk of complications are rare. The main objective was to describe the long-term clinical and radiographic results after SKp performed in a post-traumatic context. The secondary objectives were to identify postoperative complications, surgical revisions, and their risk factors for occurrence. Our hypothesis was that although SKp confers good clinical results, identifiable risk factors for complications exist. PATIENTS AND METHODS: This monocentric retrospective study included all patients for whom an SKp was performed in a post-traumatic context from 2008 to 2018. Pain, satisfaction, range of motion and pre- and postoperative radiographic measurements were recorded. All complications were sought and described, as well as surgical revisions. Several variables were analyzed to identify risk factors for revision surgery after SKp: age, sex, initial traumatic mechanism, initial non-surgical or surgical treatment and type of surgery, time until revision surgery with SKp after the initial trauma. RESULTS: Thirty-seven patients were included. At a median follow-up of 9.5 years (min 7.3 - max 11.5), 22 patients (60%) had a VAS of 0. Range of motion was significantly improved for all the patients (p\textless0.001). Seventeen (46%) patients had a complication, including 5 (13.4%) cases of ossification, 4 (10.8%) cases of discomfort related to the hardware and 4 (10.8%) painful instability at the proximal ulnar stump. Thirteen (35%) patients required revision surgery. Two risk factors for revision surgery after SKp were found: time period between initial treatment and SKp of less than 7.2 months and an age of less than 53.5 years; the combination of the two factors having a sensitivity of 97.5 and a specificity of 56.7. CONCLUSION: SKp in a post-traumatic context significantly improved range of motion and allowed pain control at long follow-up. Revision surgery seemed more frequent in patients under 53.5 years of age and when SKp was performed less than 7.2 months after the initial trauma. LEVEL OF EVIDENCE: IV, retrospective study.

@article{demesmaeker_author_2022,
	title = {Author reply to {Letter} to the {Editor} regarding '{Suicide} mortality after a nonfatal suicide attempt. {A} systematic review and meta-analysis'},
	volume = {56},
	issn = {1440-1614},
	doi = {10.1177/00048674221136458},
	language = {eng},
	number = {12},
	journal = {The Australian and New Zealand Journal of Psychiatry},
	author = {Demesmaeker, Alice and Chazard, Emmanuel and Hoang, Aline and Vaiva, Guillaume and Amad, Ali},
	month = dec,
	year = {2022},
	pmid = {36366799},
	keywords = {Humans, Suicide, Attempted},
	pages = {1676--1677},
}

@article{lamer_standardized_2022,
	title = {Standardized {Description} of the {Feature} {Extraction} {Process} to {Transform} {Raw} {Data} {Into} {Meaningful} {Information} for {Enhancing} {Data} {Reuse}: {Consensus} {Study}},
	volume = {10},
	issn = {2291-9694},
	shorttitle = {Standardized {Description} of the {Feature} {Extraction} {Process} to {Transform} {Raw} {Data} {Into} {Meaningful} {Information} for {Enhancing} {Data} {Reuse}},
	doi = {10.2196/38936},
	abstract = {BACKGROUND: Despite the many opportunities data reuse offers, its implementation presents many difficulties, and raw data cannot be reused directly. Information is not always directly available in the source database and needs to be computed afterwards with raw data for defining an algorithm.
OBJECTIVE: The main purpose of this article is to present a standardized description of the steps and transformations required during the feature extraction process when conducting retrospective observational studies. A secondary objective is to identify how the features could be stored in the schema of a data warehouse.
METHODS: This study involved the following 3 main steps: (1) the collection of relevant study cases related to feature extraction and based on the automatic and secondary use of data; (2) the standardized description of raw data, steps, and transformations, which were common to the study cases; and (3) the identification of an appropriate table to store the features in the Observation Medical Outcomes Partnership (OMOP) common data model (CDM).
RESULTS: We interviewed 10 researchers from 3 French university hospitals and a national institution, who were involved in 8 retrospective and observational studies. Based on these studies, 2 states (track and feature) and 2 transformations (track definition and track aggregation) emerged. "Track" is a time-dependent signal or period of interest, defined by a statistical unit, a value, and 2 milestones (a start event and an end event). "Feature" is time-independent high-level information with dimensionality identical to the statistical unit of the study, defined by a label and a value. The time dimension has become implicit in the value or name of the variable. We propose the 2 tables "TRACK" and "FEATURE" to store variables obtained in feature extraction and extend the OMOP CDM.
CONCLUSIONS: We propose a standardized description of the feature extraction process. The process combined the 2 steps of track definition and track aggregation. By dividing the feature extraction into these 2 steps, difficulty was managed during track definition. The standardization of tracks requires great expertise with regard to the data, but allows the application of an infinite number of complex transformations. On the contrary, track aggregation is a very simple operation with a finite number of possibilities. A complete description of these steps could enhance the reproducibility of retrospective studies.},
	language = {eng},
	number = {10},
	journal = {JMIR medical informatics},
	author = {Lamer, Antoine and Fruchart, Mathilde and Paris, Nicolas and Popoff, Benjamin and Payen, Anaïs and Balcaen, Thibaut and Gacquer, William and Bouzillé, Guillaume and Cuggia, Marc and Doutreligne, Matthieu and Chazard, Emmanuel},
	month = oct,
	year = {2022},
	pmid = {36251369},
	pmcid = {PMC9623460},
	keywords = {Observation Medical Outcomes Partnership, algorithm, data reuse, data warehouse, database, feature extraction},
	pages = {e38936},
}

BACKGROUND: Despite the many opportunities data reuse offers, its implementation presents many difficulties, and raw data cannot be reused directly. Information is not always directly available in the source database and needs to be computed afterwards with raw data for defining an algorithm. OBJECTIVE: The main purpose of this article is to present a standardized description of the steps and transformations required during the feature extraction process when conducting retrospective observational studies. A secondary objective is to identify how the features could be stored in the schema of a data warehouse. METHODS: This study involved the following 3 main steps: (1) the collection of relevant study cases related to feature extraction and based on the automatic and secondary use of data; (2) the standardized description of raw data, steps, and transformations, which were common to the study cases; and (3) the identification of an appropriate table to store the features in the Observation Medical Outcomes Partnership (OMOP) common data model (CDM). RESULTS: We interviewed 10 researchers from 3 French university hospitals and a national institution, who were involved in 8 retrospective and observational studies. Based on these studies, 2 states (track and feature) and 2 transformations (track definition and track aggregation) emerged. "Track" is a time-dependent signal or period of interest, defined by a statistical unit, a value, and 2 milestones (a start event and an end event). "Feature" is time-independent high-level information with dimensionality identical to the statistical unit of the study, defined by a label and a value. The time dimension has become implicit in the value or name of the variable. We propose the 2 tables "TRACK" and "FEATURE" to store variables obtained in feature extraction and extend the OMOP CDM. CONCLUSIONS: We propose a standardized description of the feature extraction process. The process combined the 2 steps of track definition and track aggregation. By dividing the feature extraction into these 2 steps, difficulty was managed during track definition. The standardization of tracks requires great expertise with regard to the data, but allows the application of an infinite number of complex transformations. On the contrary, track aggregation is a very simple operation with a finite number of possibilities. A complete description of these steps could enhance the reproducibility of retrospective studies.

@article{lamer_data_2022,
	title = {Data {Management} for {Health} {Data} {Reuse}: {Proposal} of a {Standard} {Workflow} and a {R} {Tutorial} with {Jupyter} {Notebook}},
	volume = {298},
	issn = {1879-8365},
	shorttitle = {Data {Management} for {Health} {Data} {Reuse}},
	doi = {10.3233/SHTI220912},
	abstract = {The data collected in the clinical registries or by data reuse require some modifications in order to suit the research needs. Several common operations are frequently applied to select relevant patients across the cohort, combine data from multiple sources, add new variables if needed and create unique tables depending on the research purpose. We carried out a qualitative survey by conducting semi-structured interviews with 7 experts in data reuse and proposed a standard workflow for health data management. We implemented a R tutorial based on a synthetic data set using Jupyter Notebook for a better understanding of the data management workflow.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Lamer, Antoine and Al Massati, Sanae and Saint-Dizier, Chloé and Fares, Emile and Chazard, Emmanuel and Fruchart, Mathilde},
	month = aug,
	year = {2022},
	pmid = {36073461},
	keywords = {Data Management, Data Science, Data management, Data reuse, Education, Humans, Programming, Workflow},
	pages = {82--86},
}

The data collected in the clinical registries or by data reuse require some modifications in order to suit the research needs. Several common operations are frequently applied to select relevant patients across the cohort, combine data from multiple sources, add new variables if needed and create unique tables depending on the research purpose. We carried out a qualitative survey by conducting semi-structured interviews with 7 experts in data reuse and proposed a standard workflow for health data management. We implemented a R tutorial based on a synthetic data set using Jupyter Notebook for a better understanding of the data management workflow.

@article{herbaux_formative_2022,
	title = {Formative {Assessment} of {Diagnostic} {Testing} in {Family} {Medicine} with {Comprehensive} {MCQ} {Followed} by {Certainty}-{Based} {Mark}},
	volume = {10},
	issn = {2227-9032},
	doi = {10.3390/healthcare10081558},
	abstract = {INTRODUCTION: The choice of diagnostic tests in front of a given clinical case is a major part of medical reasoning. Failure to prescribe the right test can lead to serious diagnostic errors. Furthermore, unnecessary medical tests are a waste of money and could possibly generate injuries to patients, especially in family medicine.
METHODS: In an effort to improve the training of our students to the choice of laboratory and imaging studies, we implemented a specific multiple-choice questions (MCQ), called comprehensive MCQ (cMCQ), with a fixed and high number of options matching various basic medical tests, followed by a certainty-based mark (CBM). This tool was used in the assessment of diagnostic test choice in various clinical cases of general practice in 456 sixth-year medical students.
RESULTS: The scores were significantly correlated with the traditional exams (standard MCQ), with matched themes. The proportion of "cMCQ/CBM score" variance explained by "standard MCQ score" was 21.3\%. The cMCQ placed students in a situation closer to practice reality than standard MCQ. In addition to its usefulness as an assessment tool, those tests had a formative value and allowed students to work on their ability to measure their doubt/certainty in order to develop a reflexive approach, required for their future professional practice.
CONCLUSION: cMCQ followed by CBM is a feasible and reliable evaluation method for the assessment of diagnostic testing.},
	language = {eng},
	number = {8},
	journal = {Healthcare (Basel, Switzerland)},
	author = {Herbaux, Charles and Dupré, Aurélie and Rénier, Wendy and Gabellier, Ludovic and Chazard, Emmanuel and Lambert, Philippe and Sobanski, Vincent and Gosset, Didier and Lacroix, Dominique and Truffert, Patrick},
	month = aug,
	year = {2022},
	pmid = {36011215},
	keywords = {diagnostics, education},
	pages = {1558},
}

INTRODUCTION: The choice of diagnostic tests in front of a given clinical case is a major part of medical reasoning. Failure to prescribe the right test can lead to serious diagnostic errors. Furthermore, unnecessary medical tests are a waste of money and could possibly generate injuries to patients, especially in family medicine. METHODS: In an effort to improve the training of our students to the choice of laboratory and imaging studies, we implemented a specific multiple-choice questions (MCQ), called comprehensive MCQ (cMCQ), with a fixed and high number of options matching various basic medical tests, followed by a certainty-based mark (CBM). This tool was used in the assessment of diagnostic test choice in various clinical cases of general practice in 456 sixth-year medical students. RESULTS: The scores were significantly correlated with the traditional exams (standard MCQ), with matched themes. The proportion of "cMCQ/CBM score" variance explained by "standard MCQ score" was 21.3%. The cMCQ placed students in a situation closer to practice reality than standard MCQ. In addition to its usefulness as an assessment tool, those tests had a formative value and allowed students to work on their ability to measure their doubt/certainty in order to develop a reflexive approach, required for their future professional practice. CONCLUSION: cMCQ followed by CBM is a feasible and reliable evaluation method for the assessment of diagnostic testing.

@article{boullenger_type_2022,
	title = {Type 2 diabetics followed up by family physicians: {Treatment} sequences and changes over time in weight and glycated hemoglobin},
	issn = {1878-0210},
	shorttitle = {Type 2 diabetics followed up by family physicians},
	doi = {10.1016/j.pcd.2022.07.002},
	abstract = {INTRODUCTION: The treatment of type 2 diabetes mellitus (T2DM) is based on preventive hygiene and dietary measures (HDM), oral antidiabetic drugs (OADs), and insulin. The objective of the present study was to reuse general practice data from electronic health records and describe changes over time among patients with T2DM in primary care.
METHODS: We analyzed data on patients with T2DM collected by three family physicians in Tourcoing (France) from 2006 to 2018.
RESULTS: 403 patients, 1030 treatment sequences, 39,042 appointments, 2440 glycated hemoglobin (HbA1c) measurements, and 9722 wt measurements were included. On inclusion, the mean age was 57.0, the mean weight was 84.4 kg, the mean body mass index was 30.3 kg/m2, and the median HbA1c level was 6.8 \% (51 mmol/mol). The patients were following appropriate HDM (40.7 \%) and/or were being treated with OADs (54.1 \%) or insulin (5.2 \%). The median length of follow-up was 3.51 years. Overall, bodyweight was stable for two years during HDM and then increased. The HbA1c level decreased and then increased during HDM, was stable on OADs, and then decreased on insulin.
DISCUSSION/CONCLUSION: The present descriptive results may be of value in helping to predict changes over time in bodyweight and HbA1c in T2DM.},
	language = {eng},
	journal = {Primary Care Diabetes},
	author = {Boullenger, Léna and Quindroit, Paul and Legrand, Bertrand and Balcaen, Thibaut and Calafiore, Matthieu and Rochoy, Michaël and Beuscart, Jean-Baptiste and Chazard, Emmanuel},
	month = jul,
	year = {2022},
	pmid = {35864077},
	keywords = {Data reuse, Electronic health records, General practice, Glycated hemoglobin, Type 2 diabetes mellitus},
	pages = {S1751--9918(22)00126--7},
}

INTRODUCTION: The treatment of type 2 diabetes mellitus (T2DM) is based on preventive hygiene and dietary measures (HDM), oral antidiabetic drugs (OADs), and insulin. The objective of the present study was to reuse general practice data from electronic health records and describe changes over time among patients with T2DM in primary care. METHODS: We analyzed data on patients with T2DM collected by three family physicians in Tourcoing (France) from 2006 to 2018. RESULTS: 403 patients, 1030 treatment sequences, 39,042 appointments, 2440 glycated hemoglobin (HbA1c) measurements, and 9722 wt measurements were included. On inclusion, the mean age was 57.0, the mean weight was 84.4 kg, the mean body mass index was 30.3 kg/m2, and the median HbA1c level was 6.8 % (51 mmol/mol). The patients were following appropriate HDM (40.7 %) and/or were being treated with OADs (54.1 %) or insulin (5.2 %). The median length of follow-up was 3.51 years. Overall, bodyweight was stable for two years during HDM and then increased. The HbA1c level decreased and then increased during HDM, was stable on OADs, and then decreased on insulin. DISCUSSION/CONCLUSION: The present descriptive results may be of value in helping to predict changes over time in bodyweight and HbA1c in T2DM.

@article{calafiore_gps_2022,
	title = {{GPs}' interest in integrated care for frail older adults and corresponding consulting and prescribing data: qualitative and quantitative analyses of the {PAERPA} integrated care project},
	issn = {1478-5242},
	shorttitle = {{GPs}' interest in integrated care for frail older adults and corresponding consulting and prescribing data},
	doi = {10.3399/BJGP.2021.0626},
	abstract = {BACKGROUND: Integrated care pathways can help to avoid unnecessary admissions to hospital and improve the overall quality of care for frail older patients. Although these integrated care pathways should be coordinated by GPs their level of commitment may vary.
AIM: To profile GPs who had participated or had declined to participate in the Personnes Agées En Risque de Perte d'Autonomie (PAERPA) integrated care project (ICP) in the Valenciennois-Quercitain area of France between 2014 and 2019.
DESIGN AND SETTING: A combined qualitative and quantitative analysis of GPs who were participating in or had declined to participate in the PAERPA ICP.
METHOD: Both GPs participating in the ICP and GPs who chose not to participate in the ICP were interviewed, and then consultation and prescription profiles for these two groups were compared.
RESULTS: Some GPs were interested in the PAERPA ICP, whereas others were opposed. The 48 qualitative interviews revealed four issues that influenced participation in the PAERPA ICP: 1) awareness of issues in care of older adults and the value of collaborative work; 2) time saving; 3) task delegation; and 4) advantages of coordination. The level of interest in the ICP for frail older adults was indirectly reflected by the data on consulting and prescribing. In GPs who participated in the PAERPA ICP there was a greater proportion of older (aged ≥70 years) patients (P{\textless}0.05), a larger number of consultations per year (P{\textless}0.05), and a larger number of home visits (P{\textless}0.01), relative to GPs who declined to participate.
CONCLUSION: The level of interest in the PAERPA ICP for frail older adults varied widely among GPs. These findings suggest that commitment to an integrated care pathway could be increased by customising the recruitment strategy as a function of the GP's profile.},
	language = {eng},
	journal = {The British Journal of General Practice: The Journal of the Royal College of General Practitioners},
	author = {Calafiore, Matthieu and Chazard, Emmanuel and Averlant, Lorette and Ramez, Claire and Sarrazin, Fanny and Leveque, Nathalie and Dambre, Delphine and Verloop, David and Defebvre, Marguerite-Marie and Di Martino, Carla and Beuscart, Jean-Baptiste},
	month = jul,
	year = {2022},
	pmid = {36192356},
	keywords = {frail older adults, general practice, preventive medicine, primary health care},
	pages = {BJGP.2021.0626},
}

BACKGROUND: Integrated care pathways can help to avoid unnecessary admissions to hospital and improve the overall quality of care for frail older patients. Although these integrated care pathways should be coordinated by GPs their level of commitment may vary. AIM: To profile GPs who had participated or had declined to participate in the Personnes Agées En Risque de Perte d'Autonomie (PAERPA) integrated care project (ICP) in the Valenciennois-Quercitain area of France between 2014 and 2019. DESIGN AND SETTING: A combined qualitative and quantitative analysis of GPs who were participating in or had declined to participate in the PAERPA ICP. METHOD: Both GPs participating in the ICP and GPs who chose not to participate in the ICP were interviewed, and then consultation and prescription profiles for these two groups were compared. RESULTS: Some GPs were interested in the PAERPA ICP, whereas others were opposed. The 48 qualitative interviews revealed four issues that influenced participation in the PAERPA ICP: 1) awareness of issues in care of older adults and the value of collaborative work; 2) time saving; 3) task delegation; and 4) advantages of coordination. The level of interest in the ICP for frail older adults was indirectly reflected by the data on consulting and prescribing. In GPs who participated in the PAERPA ICP there was a greater proportion of older (aged ≥70 years) patients (P\textless0.05), a larger number of consultations per year (P\textless0.05), and a larger number of home visits (P\textless0.01), relative to GPs who declined to participate. CONCLUSION: The level of interest in the PAERPA ICP for frail older adults varied widely among GPs. These findings suggest that commitment to an integrated care pathway could be increased by customising the recruitment strategy as a function of the GP's profile.

@article{dang_impact_2022,
	title = {Impact of artificial intelligence in breast cancer screening with mammography},
	issn = {1880-4233},
	doi = {10.1007/s12282-022-01375-9},
	abstract = {OBJECTIVES: To demonstrate that radiologists, with the help of artificial intelligence (AI), are able to better classify screening mammograms into the correct breast imaging reporting and data system (BI-RADS) category, and as a secondary objective, to explore the impact of AI on cancer detection and mammogram interpretation time.
METHODS: A multi-reader, multi-case study with cross-over design, was performed, including 314 mammograms. Twelve radiologists interpreted the examinations in two sessions delayed by a 4 weeks wash-out period with and without AI support. For each breast of each mammogram, they had to mark the most suspicious lesion (if any) and assign it with a forced BI-RADS category and a level of suspicion or "continuous BI-RADS 100". Cohen's kappa correlation coefficient evaluating the inter-observer agreement for BI-RADS category per breast, and the area under the receiver operating characteristic curve (AUC), were used as metrics and analyzed.
RESULTS: On average, the quadratic kappa coefficient increased significantly when using AI for all readers [κ = 0.549, 95\% CI (0.528-0.571) without AI and κ = 0.626, 95\% CI (0.607-0.6455) with AI]. AUC was significantly improved when using AI (0.74 vs 0.77, p = 0.004). Reading time was not significantly affected for all readers (106 s without AI and vs 102 s with AI; p = 0.754).
CONCLUSIONS: When using AI, radiologists were able to better assign mammograms with the correct BI-RADS category without slowing down the interpretation time.},
	language = {eng},
	journal = {Breast Cancer (Tokyo, Japan)},
	author = {Dang, Lan-Anh and Chazard, Emmanuel and Poncelet, Edouard and Serb, Teodora and Rusu, Aniela and Pauwels, Xavier and Parsy, Clémence and Poclet, Thibault and Cauliez, Hugo and Engelaere, Constance and Ramette, Guillaume and Brienne, Charlotte and Dujardin, Sofiane and Laurent, Nicolas},
	month = jun,
	year = {2022},
	pmid = {35763243},
	keywords = {Artificial intelligence, BI-RADS classification, Breast cancer, Mammography},
}

OBJECTIVES: To demonstrate that radiologists, with the help of artificial intelligence (AI), are able to better classify screening mammograms into the correct breast imaging reporting and data system (BI-RADS) category, and as a secondary objective, to explore the impact of AI on cancer detection and mammogram interpretation time. METHODS: A multi-reader, multi-case study with cross-over design, was performed, including 314 mammograms. Twelve radiologists interpreted the examinations in two sessions delayed by a 4 weeks wash-out period with and without AI support. For each breast of each mammogram, they had to mark the most suspicious lesion (if any) and assign it with a forced BI-RADS category and a level of suspicion or "continuous BI-RADS 100". Cohen's kappa correlation coefficient evaluating the inter-observer agreement for BI-RADS category per breast, and the area under the receiver operating characteristic curve (AUC), were used as metrics and analyzed. RESULTS: On average, the quadratic kappa coefficient increased significantly when using AI for all readers [κ = 0.549, 95% CI (0.528-0.571) without AI and κ = 0.626, 95% CI (0.607-0.6455) with AI]. AUC was significantly improved when using AI (0.74 vs 0.77, p = 0.004). Reading time was not significantly affected for all readers (106 s without AI and vs 102 s with AI; p = 0.754). CONCLUSIONS: When using AI, radiologists were able to better assign mammograms with the correct BI-RADS category without slowing down the interpretation time.

@article{lauriot_dit_prevost_re-materialized_2022,
	title = {"{Re}-{Materialized}" {Medical} {Data}: {Paper}-{Based} {Transmission} of {Structured} {Medical} {Data} {Using} {QR}-{Code}, for {Medical} {Imaging} {Reports}},
	volume = {290},
	issn = {1879-8365},
	shorttitle = {"{Re}-{Materialized}" {Medical} {Data}},
	doi = {10.3233/SHTI220063},
	abstract = {Although paper-based transmission of medical information might seem outdated, it has proven efficient, and remains structurally safe from massive data leaks. As part of the ICIPEMIR project for improving medical imaging report, we explored the idea of structured data storage within a medical report, by embedding the data themselves in a QR-Code (and no URL-to-the-data). Three different datasets from ICIPEMIR were serialized, then encoded in a QR-Code. We compared 4 compression algorithms to reduce file size before QR-Encoding. YAML was the most concise format (character sparing), and allowed for embedding of a 2633-character serialized file within a QR-Code. The best compression rate was obtained with gzip, with a compression ratio of 2.32 in 15.7ms. Data were easily extracted and decompressed from a digital QR-Code using a simple command line. YAML file was also successfully recovered from the printed QR-Code with both Android and iOS smartphone. Minimal detected size was 3*3cm.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Lauriot Dit Prevost, Arthur and Bentegeac, Raphaël and Dequesnes, Audrey and Billiau, Adrien and Baudelet, Emmanuel and Legleye, Rémi and Hubaut, Marc-Antoine and Cassagnou, Michel and Puech, Philippe and Besson, Rémi and Chazard, Emmanuel},
	month = jun,
	year = {2022},
	pmid = {35673002},
	keywords = {Data Collection, Data Compression, Health Information Exchange},
	pages = {210--214},
}

Although paper-based transmission of medical information might seem outdated, it has proven efficient, and remains structurally safe from massive data leaks. As part of the ICIPEMIR project for improving medical imaging report, we explored the idea of structured data storage within a medical report, by embedding the data themselves in a QR-Code (and no URL-to-the-data). Three different datasets from ICIPEMIR were serialized, then encoded in a QR-Code. We compared 4 compression algorithms to reduce file size before QR-Encoding. YAML was the most concise format (character sparing), and allowed for embedding of a 2633-character serialized file within a QR-Code. The best compression rate was obtained with gzip, with a compression ratio of 2.32 in 15.7ms. Data were easily extracted and decompressed from a digital QR-Code using a simple command line. YAML file was also successfully recovered from the printed QR-Code with both Android and iOS smartphone. Minimal detected size was 3*3cm.

@article{kerisit_awareness_2022,
	title = {Awareness and {Perception} of {Google}® {Reviews} {Among} {French} {GPs}},
	volume = {290},
	issn = {1879-8365},
	doi = {10.3233/SHTI220296},
	abstract = {The objective of this study was to assess the perception of French general practitioners (GPs) and the impact of the Google® online physician rating system. We questioned the French GPs with a self-administered questionnaire. A total of 412 GPs had answered the complete questionnaire. 83.25\% of respondents did not validate the relevance of the physician rating websites. The most decried limitations were the lack of validity of these opinions and the negative impact on physicians.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Kerisit, Erwan and Legrand, Bertrand and Calafiore, Matthieu and Rochoy, Michaël and Chazard, Emmanuel and Marcilly, Romaric and Lamer, Antoine},
	month = jun,
	year = {2022},
	pmid = {35673234},
	keywords = {General Practitioners, Internet, Physician rating websites},
	pages = {1118--1119},
}

The objective of this study was to assess the perception of French general practitioners (GPs) and the impact of the Google® online physician rating system. We questioned the French GPs with a self-administered questionnaire. A total of 412 GPs had answered the complete questionnaire. 83.25% of respondents did not validate the relevance of the physician rating websites. The most decried limitations were the lack of validity of these opinions and the negative impact on physicians.

@article{tabla_artificial_2022,
	title = {Artificial {Intelligence} and {Clinical} {Decision} {Support} {Systems} or {Automated} {Interpreters}: {What} {Characteristics} {Are} {Expected} by {French} {General} {Practitioners}?},
	volume = {290},
	issn = {1879-8365},
	shorttitle = {Artificial {Intelligence} and {Clinical} {Decision} {Support} {Systems} or {Automated} {Interpreters}},
	doi = {10.3233/SHTI220207},
	abstract = {Development of artificial intelligence (AI) modules should rely on technical progress, but also on users' needs. Our objective is to identify criteria that make a hypothetical AI module desirable for general practitioners (GPs). Method: random selection of 200 French GPs, and paper-based questionnaire. Results: the population was representative. GPs expect AI modules to diagnose or eliminate an urgent pathology for which they are not competent and for which specialists are not available. They also demand interoperability, automated electronic health record integration and facilitated information sharing. GPs would like AI modules to make them save time, simplify some procedures and delegate tasks to the secretary. They expect AI modules to allow them to associate the patient with the care, to reassure him or her, and to personalize the care. Interestingly, GPs would also rely on a machine to cut off abusive requests, such as work stoppages or certificates of convenience.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Tabla, Smaïn and Calafiore, Matthieu and Legrand, Bertrand and Descamps, Axel and Andre, Charlotte and Rochoy, Michaël and Chazard, Emmanuel},
	month = jun,
	year = {2022},
	pmid = {35673146},
	keywords = {Artificial intelligence, automated diagnosis, computerized interpreter, usability},
	pages = {887--891},
}

Development of artificial intelligence (AI) modules should rely on technical progress, but also on users' needs. Our objective is to identify criteria that make a hypothetical AI module desirable for general practitioners (GPs). Method: random selection of 200 French GPs, and paper-based questionnaire. Results: the population was representative. GPs expect AI modules to diagnose or eliminate an urgent pathology for which they are not competent and for which specialists are not available. They also demand interoperability, automated electronic health record integration and facilitated information sharing. GPs would like AI modules to make them save time, simplify some procedures and delegate tasks to the secretary. They expect AI modules to allow them to associate the patient with the care, to reassure him or her, and to personalize the care. Interestingly, GPs would also rely on a machine to cut off abusive requests, such as work stoppages or certificates of convenience.

@article{chazard_book_2022,
	title = {"{Book} {Music}" {Representation} for {Temporal} {Data}, as a {Part} of the {Feature} {Extraction} {Process}: {A} {Novel} {Approach} to {Improve} the {Handling} of {Time}-{Dependent} {Data} in {Secondary} {Use} of {Healthcare} {Structured} {Data}},
	volume = {290},
	issn = {1879-8365},
	shorttitle = {"{Book} {Music}" {Representation} for {Temporal} {Data}, as a {Part} of the {Feature} {Extraction} {Process}},
	doi = {10.3233/SHTI220141},
	abstract = {Book music is extensively used in street organs. It consists of thick cardboard, containing perforated holes specifying the musical notes. We propose to represent clinical time-dependent data in a tabular form inspired from this principle. The sheet represents a statistical individual, each row represents a binary time-dependent variable, and each hole denotes the "true" value. Data from electronic health records or nationwide medical-administrative databases can then be represented: demographics, patient flow, drugs, laboratory results, diagnoses, and procedures. This data representation is suitable for survival analysis (e.g., Cox model with repeated outcomes and changing covariates) and different types of temporal association rules. Quantitative continuous variables can be discretized, as in clinical studies. The "book music" approach could become an intermediary step in feature extraction from structured data. It would enable to better account for time in analyses, notably for historical cohort analyses based on healthcare data reuse.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Chazard, Emmanuel and Balaye, Pierre and Balcaen, Thibaut and Genin, Michaël and Cuggia, Marc and Bouzille, Guillaume and Lamer, Antoine},
	month = jun,
	year = {2022},
	pmid = {35673080},
	keywords = {Data reuse, feature extraction, survival analyses},
	pages = {567--571},
}

Book music is extensively used in street organs. It consists of thick cardboard, containing perforated holes specifying the musical notes. We propose to represent clinical time-dependent data in a tabular form inspired from this principle. The sheet represents a statistical individual, each row represents a binary time-dependent variable, and each hole denotes the "true" value. Data from electronic health records or nationwide medical-administrative databases can then be represented: demographics, patient flow, drugs, laboratory results, diagnoses, and procedures. This data representation is suitable for survival analysis (e.g., Cox model with repeated outcomes and changing covariates) and different types of temporal association rules. Quantitative continuous variables can be discretized, as in clinical studies. The "book music" approach could become an intermediary step in feature extraction from structured data. It would enable to better account for time in analyses, notably for historical cohort analyses based on healthcare data reuse.

@article{rochoy_doping_2022,
	title = {Doping with aromatase inhibitors and oestrogen receptor modulators in steroid users: {Analysis} of a forum to identify dosages, durations and adverse drug reactions},
	issn = {1958-5578},
	shorttitle = {Doping with aromatase inhibitors and oestrogen receptor modulators in steroid users},
	doi = {10.1016/j.therap.2022.03.004},
	abstract = {INTRODUCTION: Some users of anabolic androgenic steroids (AAS) secretly consume aromatase inhibitors (AI) and selective oestrogen receptor modulators (SERM). Cyber-forums can be potential sources of information. Our aim was to determine the cycles used, and to identify the adverse drug reactions (ADRs) experienced, reported in a bodybuilding forum.
METHOD: We collected discussions on a French forum for AAS users (MESO-Rx®), from January 2013 to 2019 on concerning clomiphene, tamoxifen, anastrozole, exemestane and letrozole were collected. Characteristics of the users, duration of cures, treatments, dosages, point of purchase and occurrence of ADRs were analysed.
RESULTS: Among the 1792 posts published on the forum, 845 concerned SERM and 571 concerned AI, i.e. 2180 drugs used (several cycles included concomitant consumption). Our population was exclusively male, with an average age of 28.2±6.3years, and had been practising weight training for 6.7±5.6years. The SERMs were mainly used to "revive the hypothalamohypophyseal axis" and the AIs to "fight against androgen aromatisation". The median treatment duration was 22 days for SERM, 70days for anastrozole, 84days for exemestane and 30days for letrozole, with a mean dose of 69mg/d for clomiphene, 22mg/d for tamoxifen, 0.4mg/d for anastrozole, 10mg/d for exemestane, 2mg/d for letrozole. The main way of obtaining these drugs was through the internet. 157 ADRs were identified: 95 for SERMs and 62 for AI. The most represented were acne, musculoskeletal, mood and reproductive disorders. Impaired quality of life (according to the patient) was described in 54\% of the SERM posts and 26\% of the AI posts.
CONCLUSIONS: Patient narratives posted on forums can be a useful tool in the context of doping, to better understand practices, motivations and possibly to bring up pharmacovigilance signals.},
	language = {eng},
	journal = {Therapie},
	author = {Rochoy, Michaël and Danel, Antoine and Chazard, Emmanuel and Gautier, Sophie and Berkhout, Christophe},
	month = apr,
	year = {2022},
	pmid = {35660259},
	keywords = {Aromatase inhibitors, Doping, Forums, Oestrogen receptor modulators, Pharmacovigilance},
	pages = {S0040--5957(22)00064--6},
}

INTRODUCTION: Some users of anabolic androgenic steroids (AAS) secretly consume aromatase inhibitors (AI) and selective oestrogen receptor modulators (SERM). Cyber-forums can be potential sources of information. Our aim was to determine the cycles used, and to identify the adverse drug reactions (ADRs) experienced, reported in a bodybuilding forum. METHOD: We collected discussions on a French forum for AAS users (MESO-Rx®), from January 2013 to 2019 on concerning clomiphene, tamoxifen, anastrozole, exemestane and letrozole were collected. Characteristics of the users, duration of cures, treatments, dosages, point of purchase and occurrence of ADRs were analysed. RESULTS: Among the 1792 posts published on the forum, 845 concerned SERM and 571 concerned AI, i.e. 2180 drugs used (several cycles included concomitant consumption). Our population was exclusively male, with an average age of 28.2±6.3years, and had been practising weight training for 6.7±5.6years. The SERMs were mainly used to "revive the hypothalamohypophyseal axis" and the AIs to "fight against androgen aromatisation". The median treatment duration was 22 days for SERM, 70days for anastrozole, 84days for exemestane and 30days for letrozole, with a mean dose of 69mg/d for clomiphene, 22mg/d for tamoxifen, 0.4mg/d for anastrozole, 10mg/d for exemestane, 2mg/d for letrozole. The main way of obtaining these drugs was through the internet. 157 ADRs were identified: 95 for SERMs and 62 for AI. The most represented were acne, musculoskeletal, mood and reproductive disorders. Impaired quality of life (according to the patient) was described in 54% of the SERM posts and 26% of the AI posts. CONCLUSIONS: Patient narratives posted on forums can be a useful tool in the context of doping, to better understand practices, motivations and possibly to bring up pharmacovigilance signals.

@article{chazard_orgue_2022,
	series = {{VIIIe} {Colloque} national {Adelf}-{Emois}},
	title = {L'orgue de barbarie : proposition d'une représentation des données de santé temps-dépendantes, visant à faciliter leur réutilisation},
	volume = {70},
	issn = {0398-7620},
	shorttitle = {L'orgue de barbarie},
	url = {https://www.sciencedirect.com/science/article/pii/S0398762022000694},
	doi = {10.1016/j.respe.2022.01.068},
	abstract = {Introduction
Les données structurées d'entrepôts de santé sont complexes (centaines de tables, variables qualitatives multivaluées, déséquilibrées, manquantes). L'extraction de caractéristique génère des données ressemblant aux données de questionnaires, aisément analysables. Trop souvent, elle écrase la temporalité des données.
Objectif
Proposer une méthodologie d'extraction de caractéristiques sécurisant la gestion du temps.
Méthodes
Analogie entre les partitions d'orgue de barbarie et les données de santé temps-dépendantes. Etude de compatibilité avec les données structurées fréquemment rencontrées (PMSI, médicaments, biologie médicale). Etude de compatibilité avec les méthodes statistiques d'analyse de données temps-dépendantes.
Résultats
Les partitions d'orgue de barbarie sont constituées de pistes représentant des notes, qui peuvent être actives (perforées) ou non. Ces pistes synchronisées défilent et jouent une musique. Pareillement, un patient peut être représentée par des variables temps dépendantes (même le sexe), volontiers binaires. Il s'agit d'événements ponctuel (notes "staccato") ou d'états prolongées (notes tenues). Ce modèle de données est compatible avec les données usuelles de santé : - les mouvements, événements (admission, mutation) ou états (séjour, passage en soins intensifs) - les données démographiques (âge en classes, sexe) - les mesures de biologie médicale, événements (mesure) ou états (hypo/hyper/normo-kaliémie, période sans mesure) - les médicaments, avec ou sans dose (kayexalate, kayexalate {\textgreater} 15) - les codes PMSI, événements (actes CCAM) ou états (diagnostics CIM10). Cette représentation intermédiaire de données serait compatible avec toutes les caractéristiques du modèle de Cox à covariables temps dépendantes, des arbres de survie, et des règles d'association temporelles, hormis l'utilisation directe de variables quantitatives.
Discussion/Conclusion
L'extraction de caractéristiques serait ainsi séparée en : 1 - génération d'une partition d'orgue de barbarie (simplifie la structure des données, abolit l'hétérogénéité, préserve le temps) ; 2 - constitution de données de type questionnaire (simplifie le temps ou le décrit comme une variable). La forme des données étant standardisée par cette approche, la deuxième étape s'appuiera sur des fonctions standardisées (ex : état à un instant, pire état durant une période, temps passé dans un état, délai jusqu'à un événement).},
	language = {fr},
	urldate = {2022-05-02},
	journal = {Revue d'Épidémiologie et de Santé Publique},
	author = {Chazard, E. and Balaye, P. and Balcaen, T. and Genin, M. and Cuggia, M. and Bouzille, G. and Lamer, A.},
	month = mar,
	year = {2022},
	keywords = {Analyses de survie, Extraction de caractéristiques, Réutilisation de données},
	pages = {S8},
}

Introduction Les données structurées d'entrepôts de santé sont complexes (centaines de tables, variables qualitatives multivaluées, déséquilibrées, manquantes). L'extraction de caractéristique génère des données ressemblant aux données de questionnaires, aisément analysables. Trop souvent, elle écrase la temporalité des données. Objectif Proposer une méthodologie d'extraction de caractéristiques sécurisant la gestion du temps. Méthodes Analogie entre les partitions d'orgue de barbarie et les données de santé temps-dépendantes. Etude de compatibilité avec les données structurées fréquemment rencontrées (PMSI, médicaments, biologie médicale). Etude de compatibilité avec les méthodes statistiques d'analyse de données temps-dépendantes. Résultats Les partitions d'orgue de barbarie sont constituées de pistes représentant des notes, qui peuvent être actives (perforées) ou non. Ces pistes synchronisées défilent et jouent une musique. Pareillement, un patient peut être représentée par des variables temps dépendantes (même le sexe), volontiers binaires. Il s'agit d'événements ponctuel (notes "staccato") ou d'états prolongées (notes tenues). Ce modèle de données est compatible avec les données usuelles de santé : - les mouvements, événements (admission, mutation) ou états (séjour, passage en soins intensifs) - les données démographiques (âge en classes, sexe) - les mesures de biologie médicale, événements (mesure) ou états (hypo/hyper/normo-kaliémie, période sans mesure) - les médicaments, avec ou sans dose (kayexalate, kayexalate \textgreater 15) - les codes PMSI, événements (actes CCAM) ou états (diagnostics CIM10). Cette représentation intermédiaire de données serait compatible avec toutes les caractéristiques du modèle de Cox à covariables temps dépendantes, des arbres de survie, et des règles d'association temporelles, hormis l'utilisation directe de variables quantitatives. Discussion/Conclusion L'extraction de caractéristiques serait ainsi séparée en : 1 - génération d'une partition d'orgue de barbarie (simplifie la structure des données, abolit l'hétérogénéité, préserve le temps) ; 2 - constitution de données de type questionnaire (simplifie le temps ou le décrit comme une variable). La forme des données étant standardisée par cette approche, la deuxième étape s'appuiera sur des fonctions standardisées (ex : état à un instant, pire état durant une période, temps passé dans un état, délai jusqu'à un événement).

@article{tabla_intelligence_2022,
	series = {{VIIIe} {Colloque} national {Adelf}-{Emois}},
	title = {Intelligence artificielle et systèmes d'aide à la décision ou d'interprétation automatisée : quelles sont les attentes des médecins généralistes libéraux français ?},
	volume = {70},
	issn = {0398-7620},
	shorttitle = {Intelligence artificielle et systèmes d'aide à la décision ou d'interprétation automatisée},
	url = {https://www.sciencedirect.com/science/article/pii/S0398762022000475},
	doi = {10.1016/j.respe.2022.01.046},
	abstract = {Introduction
L'intelligence artificielle (IA) a déjà de nombreuses applications en médecine générale (MG): interpréteurs automatisés d'ECG, stéthoscopes intelligents, etc. En 2018 déjà, un quart des MG français étaient équipés de modules d'IA. Le développement de nouveaux modules est cependant guidé par la technologie, et non par les besoins, ce qui amène à des produits parfois incohérents. Notre objectif est d'identifier ces besoins.
Méthodes
Nous avons envoyé un questionnaire papier à 200 MG tirés au sort sur le territoire, avec enveloppe retour prétimbrée. Les sondés ont tous été relancés par téléphone à deux semaines.
Résultats
Parmi les sondés, 139 MG (69,5 \%) ont répondu. Treize étant de pauvre qualité, 126 réponses ont été analysées. Caractéristiques des répondants: 66 femmes (52,4 \%), âge moyen 47,8 ans (SD=11,2), 88 en cabinet de groupe (71,0 \%), 90 en ville (71,4 \%). Les MG déclarent désirer des modules qui permettent de (par intérêt décroissant): - poser ou éliminer un diagnostic urgent - poser un diagnostic pour lequel le MG n'est pas compétent, ou aucun spécialiste n'est disponible - enregistrer automatiquement l'information dans le dossier patient, la partager avec un autre professionnel - simplifier un acte, passer plus de temps avec le patient, déléguer des tâches au secrétariat - exercer une médecine personnalisée, prédire un niveau de risque - impliquer et rassurer le patient - couper court à des demandes abusives (certificats de complaisance, arrêts de travail) - former le MG. Les MG rejettent les modules qui déclencheraient automatiquement un appel au 15, décideraient automatiquement, interviendraient dans leur champ de compétence, ou pourraient être utilisés par le patient lui-même en salle d'attente. Les MG sont indifférents aux autres items proposés. De nombreuses caractéristiques dépendent du profil (sexe, âge, lieu d'exercice).
Discussion/Conclusion
Les fabricants développent à ce jour essentiellement des modules permettant de remplacer des spécialistes, pour des maladies chroniques. Ils devraient envisager en priorité de s'intéresser aux urgences, en assistance et non en remplacement des médecins.},
	language = {fr},
	urldate = {2022-05-02},
	journal = {Revue d'Épidémiologie et de Santé Publique},
	author = {Tabla, S. and Calafiore, M. and Legrand, B. and Descamps, A. and André, C. and Rochoy, M. and Chazard, E.},
	month = mar,
	year = {2022},
	keywords = {Intelligence artificielle, Interpréteur automatisé, Utilisabilité},
	pages = {S51},
}

Introduction L'intelligence artificielle (IA) a déjà de nombreuses applications en médecine générale (MG): interpréteurs automatisés d'ECG, stéthoscopes intelligents, etc. En 2018 déjà, un quart des MG français étaient équipés de modules d'IA. Le développement de nouveaux modules est cependant guidé par la technologie, et non par les besoins, ce qui amène à des produits parfois incohérents. Notre objectif est d'identifier ces besoins. Méthodes Nous avons envoyé un questionnaire papier à 200 MG tirés au sort sur le territoire, avec enveloppe retour prétimbrée. Les sondés ont tous été relancés par téléphone à deux semaines. Résultats Parmi les sondés, 139 MG (69,5 %) ont répondu. Treize étant de pauvre qualité, 126 réponses ont été analysées. Caractéristiques des répondants: 66 femmes (52,4 %), âge moyen 47,8 ans (SD=11,2), 88 en cabinet de groupe (71,0 %), 90 en ville (71,4 %). Les MG déclarent désirer des modules qui permettent de (par intérêt décroissant): - poser ou éliminer un diagnostic urgent - poser un diagnostic pour lequel le MG n'est pas compétent, ou aucun spécialiste n'est disponible - enregistrer automatiquement l'information dans le dossier patient, la partager avec un autre professionnel - simplifier un acte, passer plus de temps avec le patient, déléguer des tâches au secrétariat - exercer une médecine personnalisée, prédire un niveau de risque - impliquer et rassurer le patient - couper court à des demandes abusives (certificats de complaisance, arrêts de travail) - former le MG. Les MG rejettent les modules qui déclencheraient automatiquement un appel au 15, décideraient automatiquement, interviendraient dans leur champ de compétence, ou pourraient être utilisés par le patient lui-même en salle d'attente. Les MG sont indifférents aux autres items proposés. De nombreuses caractéristiques dépendent du profil (sexe, âge, lieu d'exercice). Discussion/Conclusion Les fabricants développent à ce jour essentiellement des modules permettant de remplacer des spécialistes, pour des maladies chroniques. Ils devraient envisager en priorité de s'intéresser aux urgences, en assistance et non en remplacement des médecins.

@article{prevost_amelioration_2022,
	series = {{VIIIe} {Colloque} national {Adelf}-{Emois}},
	title = {Amélioration des compte rendus d'imagerie médicale: exhaustivité, interopérabilité, et support d'information patient},
	volume = {70},
	issn = {0398-7620},
	shorttitle = {Amélioration des compte rendus d'imagerie médicale},
	url = {https://www.sciencedirect.com/science/article/pii/S0398762022000268},
	doi = {10.1016/j.respe.2022.01.025},
	abstract = {Introduction
La production de compte rendus médicaux est une tache chronophage, mais c'est une étape clef de l'information médicale. Des voies d'optimisation pourraient être: qualité du contenu (exhaustivité, structuration), compréhension par les patients (schéma explicatif), rédaction (production semi-automatisée), transmission et stockage (interopérabilité). Nous avons imaginé le projet "ICIPEMIR" (« Improving the completeness, interoperability and patients explanation of medical imaging reports »), afin d'améliorer la production des compte rendus d'imagerie médicale. Nous décrivons ici la partie médicale et académique de ce projet, visant à de déterminer les informations nécessaires à chaque type de compte rendu d'imagerie.
Méthodes
Nous proposons une méthodologie reproductible pour identifier -pour un type d'examen- les champs nécessaires au compte rendu. Ils doivent répondre aux exigences légales, aux recommandations de sociétés savantes du domaine, et à une revue de littérature du domaine. Puis un modèle de donnée est successivement établi à partir de ces champs (UML, JSON Schema, YAML). Basé sur ce modèle de données, un formulaire est généré en utilisant l'outil open source d'e-CRF Goupile. De plus, une représentation graphique est modélisée, en lien avec le modèle de données, de même qu'un modèle de document textuel. Enfin, l'instance YAML est encodée dans un QR-Code pour permettre une transmission (re-)matérialisée des données structurées.
Résultats
Nous avons testé cette méthode pour le compte rendu de scanner dans la lithiase urinaire. Nous avons défini 73 champs, transformés en modèle de données, avec une représentation graphique, et un modèle de document textuel. Le QR-Code a permis la transmission d'un fichier YAML de 2615 caractères, décodé à l'aide d'un smartphone.
Discussion/Conclusion
Bien que la production automatisée de compte rendus médicaux nécessite des modèles de données spécifiques à chaque domaine, ils pourraient être définis itérativement en utilisant une méthodologie reproductible, à travers des travaux académiques dédiés. La suite de nos travaux aura pour but de définir un méta-modèle, et d'homogénéiser ces modèles de données en lien avec les référentiels de terminologies.},
	language = {fr},
	urldate = {2022-05-02},
	journal = {Revue d'Épidémiologie et de Santé Publique},
	author = {Prevost, A. Lauriot Dit and Gaillard, V. and Bouzille, G. and Besson, R. and Sharma, D. and Puech, P. and Chazard, E.},
	month = mar,
	year = {2022},
	keywords = {Imagerie médicale, Interopérabilité Compte rendu médical, Transmission d'information},
	pages = {S42},
}

Introduction La production de compte rendus médicaux est une tache chronophage, mais c'est une étape clef de l'information médicale. Des voies d'optimisation pourraient être: qualité du contenu (exhaustivité, structuration), compréhension par les patients (schéma explicatif), rédaction (production semi-automatisée), transmission et stockage (interopérabilité). Nous avons imaginé le projet "ICIPEMIR" (« Improving the completeness, interoperability and patients explanation of medical imaging reports »), afin d'améliorer la production des compte rendus d'imagerie médicale. Nous décrivons ici la partie médicale et académique de ce projet, visant à de déterminer les informations nécessaires à chaque type de compte rendu d'imagerie. Méthodes Nous proposons une méthodologie reproductible pour identifier -pour un type d'examen- les champs nécessaires au compte rendu. Ils doivent répondre aux exigences légales, aux recommandations de sociétés savantes du domaine, et à une revue de littérature du domaine. Puis un modèle de donnée est successivement établi à partir de ces champs (UML, JSON Schema, YAML). Basé sur ce modèle de données, un formulaire est généré en utilisant l'outil open source d'e-CRF Goupile. De plus, une représentation graphique est modélisée, en lien avec le modèle de données, de même qu'un modèle de document textuel. Enfin, l'instance YAML est encodée dans un QR-Code pour permettre une transmission (re-)matérialisée des données structurées. Résultats Nous avons testé cette méthode pour le compte rendu de scanner dans la lithiase urinaire. Nous avons défini 73 champs, transformés en modèle de données, avec une représentation graphique, et un modèle de document textuel. Le QR-Code a permis la transmission d'un fichier YAML de 2615 caractères, décodé à l'aide d'un smartphone. Discussion/Conclusion Bien que la production automatisée de compte rendus médicaux nécessite des modèles de données spécifiques à chaque domaine, ils pourraient être définis itérativement en utilisant une méthodologie reproductible, à travers des travaux académiques dédiés. La suite de nos travaux aura pour but de définir un méta-modèle, et d'homogénéiser ces modèles de données en lien avec les référentiels de terminologies.

@article{bannay_apport_2022,
	series = {{VIIIe} {Colloque} national {Adelf}-{Emois}},
	title = {Apport du {PMSI} pour l'appariement de données cliniques hospitalières avec le {SNDS} : cas d'usage en pharmacovigilance sur les patients consommateurs de statines},
	volume = {70},
	issn = {0398-7620},
	shorttitle = {Apport du {PMSI} pour l'appariement de données cliniques hospitalières avec le {SNDS}},
	url = {https://www.sciencedirect.com/science/article/pii/S0398762022000748},
	doi = {10.1016/j.respe.2022.01.073},
	abstract = {Introduction
L'appariement de différentes sources de données de santé est une approche prometteuse dans l'analyse des parcours de soins. Le projet INSHARE voulait proposer un cadre à une plateforme technologique pour faciliter l'intégration, le partage et la réutilisation de données issues de deux sources : i) un entrepôt de données cliniques hospitalières et d'une extraction du Système national des données de santé (SNDS). L'objectif de cette étude était de montrer l'intérêt de la plateforme INSHARE pour l'analyse de données massives en santé à partir d'un cas d'usage en pharmacovigilance chez des sujets consommateurs de statines.
Méthodes
Une méthode d'appariement semi-déterministe entre les données de l'entrepôt de données hospitalières du CHU de Rennes et celles du SNDS a été développée à partir des variables du PMSI entre 2015 et 2017. Un cas d'usage en pharmacovigilance a recruté une cohorte de patients traités par statines. La base de connaissance Thériaque a permis d'identifier les médicaments potentiellement en interaction avec les statines allant des contre-indications aux précautions d'emploi.
Résultats
A partir des 161 532 patients issus du SNDS et des 164 316 patients issus de l'entrepôt eHOP, 159 495 ont pu être appariés (98,74 \% pour le SNDS et 97,07 \% pour eHOP). Parmi les 16 806 patients sous statines, 8293 patients initialement traités en ville poursuivaient ce traitement à l'hôpital, 6382 patients arrêtaient les statines lors de leur hospitalisation et 2132 patients initiaient leur traitement au cours de leur séjour hospitalier. La prévalence des interactions variait entre 22,17 \% en ville et 36,47 \% à l'hôpital (p{\textless}0,001). La lourdeur des prises en charge hospitalières était plus importante chez les patients présentant une interaction durant leur séjour hospitalier.
Discussion/Conclusion
Montrant l'intérêt de la réutilisation et de la complémentarité de données cliniques et médico-administratives, ce travail s'inscrit dans le cadre de la transition entre les systèmes d'information en santé et les systèmes apprenant en santé fondés sur la connaissance issue des données en vie réelle.},
	language = {fr},
	urldate = {2022-05-02},
	journal = {Revue d'Épidémiologie et de Santé Publique},
	author = {Bannay, A. and Bories, M. and Corre, P. Le and Riou, C. and Lemordant, P. and Van Hille, P. and Chazard, E. and Dode, X. and Cuggia, M. and Bouzille, G.},
	month = mar,
	year = {2022},
	keywords = {Appariement, Pharmacovigilance, Réutilisation de données, SNDS},
	pages = {S10},
}

Introduction L'appariement de différentes sources de données de santé est une approche prometteuse dans l'analyse des parcours de soins. Le projet INSHARE voulait proposer un cadre à une plateforme technologique pour faciliter l'intégration, le partage et la réutilisation de données issues de deux sources : i) un entrepôt de données cliniques hospitalières et d'une extraction du Système national des données de santé (SNDS). L'objectif de cette étude était de montrer l'intérêt de la plateforme INSHARE pour l'analyse de données massives en santé à partir d'un cas d'usage en pharmacovigilance chez des sujets consommateurs de statines. Méthodes Une méthode d'appariement semi-déterministe entre les données de l'entrepôt de données hospitalières du CHU de Rennes et celles du SNDS a été développée à partir des variables du PMSI entre 2015 et 2017. Un cas d'usage en pharmacovigilance a recruté une cohorte de patients traités par statines. La base de connaissance Thériaque a permis d'identifier les médicaments potentiellement en interaction avec les statines allant des contre-indications aux précautions d'emploi. Résultats A partir des 161 532 patients issus du SNDS et des 164 316 patients issus de l'entrepôt eHOP, 159 495 ont pu être appariés (98,74 % pour le SNDS et 97,07 % pour eHOP). Parmi les 16 806 patients sous statines, 8293 patients initialement traités en ville poursuivaient ce traitement à l'hôpital, 6382 patients arrêtaient les statines lors de leur hospitalisation et 2132 patients initiaient leur traitement au cours de leur séjour hospitalier. La prévalence des interactions variait entre 22,17 % en ville et 36,47 % à l'hôpital (p\textless0,001). La lourdeur des prises en charge hospitalières était plus importante chez les patients présentant une interaction durant leur séjour hospitalier. Discussion/Conclusion Montrant l'intérêt de la réutilisation et de la complémentarité de données cliniques et médico-administratives, ce travail s'inscrit dans le cadre de la transition entre les systèmes d'information en santé et les systèmes apprenant en santé fondés sur la connaissance issue des données en vie réelle.

@article{prevost_transmission_2022,
	series = {{VIIIe} {Colloque} national {Adelf}-{Emois}},
	title = {Transmission “{Re}-matérialisée” : intégration de données structurées au sein d'un compte rendu d'imagerie médicale, par l'utilisation de {QR}-{Code}},
	volume = {70},
	issn = {0398-7620},
	shorttitle = {Transmission “{Re}-matérialisée”},
	url = {https://www.sciencedirect.com/science/article/pii/S0398762022000736},
	doi = {10.1016/j.respe.2022.01.072},
	abstract = {Introduction
Bien qu'elle puisse sembler obsolète, la transmission d'information médicale via le compte-rendu "papier" a prouvé son efficacité. Ce canal de communication reste à l'abri de fuites de données massives ou de piratage. Dans le cadre de notre projet "ICIPEMIR", visant à améliorer les compte rendus d'imagerie médicale, nous avons cherché à explorer l'idée d'une intégration de données structurées au sein même du compte rendu "papier", en encodant les données dans un QR-Code (et non une URL menant à des données centralisées), en considérant la limite de caractères imposée par le format QR-Code
Méthodes
Trois jeux de données issus du projet ICIPEMIR ont été sérialisés aux formats XML, JSON et YAML. Les fichiers ont été comparés sur le nombre de caractères, puis les données ont été intégrées dans un QR-Code. Afin de réduire la taille des fichiers avant intégration dans le QR-Code, nous avons comparé quatre algorithmes de compression. Les algorithmes de compression décompression étaient comparés sur la vitesse d'exécution et le ratio de compression. La faisabilité de l'utilisation du QR-Code était testée avec un décodage « digital » (analyse du fichier image), et physique (Scan par smartphone du QR-Code imprimé de taille progressivement décroissante).
Résultats
Le format YAML était le plus concis. L'algorithme gzip était le plus performant (ratio de compression 2.32 en 15.7ms). La capacité maximale d'un QR-Code pour un fichier binaire est de 2953 caractères (eg. ISO 8859-1). Le décodage « digital », avec extraction et décompression des données était obtenu sans difficultés par une simple ligne de commande. Le fichier YAML était également aisément récupéré par un smartphone (Android et iOS). La taille de QR-Code minimale permettant la détection était de 3*3 cm.
Discussion/Conclusion
L'utilisation de QR-Code pourrait permettre la transmission de données structurées via le canal de transmission traditionnel des documents "papier". Cette solution pourrait permettre de contourner certaines difficultés techniques de l'interopérabilité physique entre les différents établissements de soin},
	language = {fr},
	urldate = {2022-05-02},
	journal = {Revue d'Épidémiologie et de Santé Publique},
	author = {Prevost, A. Lauriot Dit and Bentegeac, R. and Desquesnes, A. and Billiau, A. and Baudelet, E. and Legleye, R. and Puech, P. and Chazard, E.},
	month = mar,
	year = {2022},
	keywords = {Interopérabilité, QR-Code, Transmission d'information médicale},
	pages = {S9--S10},
}

Introduction Bien qu'elle puisse sembler obsolète, la transmission d'information médicale via le compte-rendu "papier" a prouvé son efficacité. Ce canal de communication reste à l'abri de fuites de données massives ou de piratage. Dans le cadre de notre projet "ICIPEMIR", visant à améliorer les compte rendus d'imagerie médicale, nous avons cherché à explorer l'idée d'une intégration de données structurées au sein même du compte rendu "papier", en encodant les données dans un QR-Code (et non une URL menant à des données centralisées), en considérant la limite de caractères imposée par le format QR-Code Méthodes Trois jeux de données issus du projet ICIPEMIR ont été sérialisés aux formats XML, JSON et YAML. Les fichiers ont été comparés sur le nombre de caractères, puis les données ont été intégrées dans un QR-Code. Afin de réduire la taille des fichiers avant intégration dans le QR-Code, nous avons comparé quatre algorithmes de compression. Les algorithmes de compression décompression étaient comparés sur la vitesse d'exécution et le ratio de compression. La faisabilité de l'utilisation du QR-Code était testée avec un décodage « digital » (analyse du fichier image), et physique (Scan par smartphone du QR-Code imprimé de taille progressivement décroissante). Résultats Le format YAML était le plus concis. L'algorithme gzip était le plus performant (ratio de compression 2.32 en 15.7ms). La capacité maximale d'un QR-Code pour un fichier binaire est de 2953 caractères (eg. ISO 8859-1). Le décodage « digital », avec extraction et décompression des données était obtenu sans difficultés par une simple ligne de commande. Le fichier YAML était également aisément récupéré par un smartphone (Android et iOS). La taille de QR-Code minimale permettant la détection était de 3*3 cm. Discussion/Conclusion L'utilisation de QR-Code pourrait permettre la transmission de données structurées via le canal de transmission traditionnel des documents "papier". Cette solution pourrait permettre de contourner certaines difficultés techniques de l'interopérabilité physique entre les différents établissements de soin

@article{nicot_three-dimensional_2022,
	title = {Three-{Dimensional} {Printing} {Model} {Enhances} {Craniofacial} {Trauma} {Teaching} by {Improving} {Morphologic} and {Biomechanical} {Understanding}: {A} {Randomized} {Controlled} {Study}},
	volume = {149},
	issn = {1529-4242},
	shorttitle = {Three-{Dimensional} {Printing} {Model} {Enhances} {Craniofacial} {Trauma} {Teaching} by {Improving} {Morphologic} and {Biomechanical} {Understanding}},
	doi = {10.1097/PRS.0000000000008869},
	abstract = {BACKGROUND: Teaching about craniofacial traumas is challenging given the complexity of the craniofacial anatomy and the necessity for good spatial representation skills. To solve these problems, three-dimensional printing seems to be an appropriate educative material. In this study, the authors conducted a randomized controlled trial. The authors' main objective was to compare the performance of the undergraduate medical students in an examination based on the teaching support: three-dimensionally printed models versus two-dimensional pictures.
METHODS: All participants were randomly assigned to one of two groups using a random number table: the three-dimensionally-printed support group (three-dimensional group) or the two-dimensionally-displayed support group (two-dimensional group). All participants completed a multiple-choice question evaluation questionnaire on facial traumatology (first, a zygomatic bone fracture; then, a double mandible fracture). Sex and potential confounding factors were evaluated.
RESULTS: Four hundred thirty-two fifth-year undergraduate medical students were enrolled in this study. Two hundred six students were allocated to the three-dimensional group, and 226 were allocated to the two-dimensional group. The three-dimensionally printed model was considered to be a better teaching material compared with two-dimensional support. The global mean score was 2.36 in the three-dimensional group versus 1.99 in the two-dimensional group (p = 0.008). Regarding teaching of biomechanical aspects, three-dimensionally-printed models provide better understanding (p = 0.015). Participants in both groups exhibited similar previous student educational achievements and visuospatial skills.
CONCLUSIONS: This prospective, randomized, controlled educational trial demonstrated that incorporation of three-dimensionally-printed models improves medical students' understanding. This trial reinforces previous studies highlighting academic benefits in using three-dimensionally-printed models mostly in the field of understanding complex structures.},
	language = {eng},
	number = {3},
	journal = {Plastic and Reconstructive Surgery},
	author = {Nicot, Romain and Druelle, Charles and Chazard, Emmanuel and Roland-Billecart, Thomas and Nuytten, Alexandra and Richard, Florence and Dupré, Aurélie and Raoul, Gwénaël and Ferri, Joël and Lacroix, Dominique and Gosset, Didier and Schlund, Matthias and Truffert, Patrick},
	month = mar,
	year = {2022},
	pmid = {35196687},
	pages = {475e--484e},
}

BACKGROUND: Teaching about craniofacial traumas is challenging given the complexity of the craniofacial anatomy and the necessity for good spatial representation skills. To solve these problems, three-dimensional printing seems to be an appropriate educative material. In this study, the authors conducted a randomized controlled trial. The authors' main objective was to compare the performance of the undergraduate medical students in an examination based on the teaching support: three-dimensionally printed models versus two-dimensional pictures. METHODS: All participants were randomly assigned to one of two groups using a random number table: the three-dimensionally-printed support group (three-dimensional group) or the two-dimensionally-displayed support group (two-dimensional group). All participants completed a multiple-choice question evaluation questionnaire on facial traumatology (first, a zygomatic bone fracture; then, a double mandible fracture). Sex and potential confounding factors were evaluated. RESULTS: Four hundred thirty-two fifth-year undergraduate medical students were enrolled in this study. Two hundred six students were allocated to the three-dimensional group, and 226 were allocated to the two-dimensional group. The three-dimensionally printed model was considered to be a better teaching material compared with two-dimensional support. The global mean score was 2.36 in the three-dimensional group versus 1.99 in the two-dimensional group (p = 0.008). Regarding teaching of biomechanical aspects, three-dimensionally-printed models provide better understanding (p = 0.015). Participants in both groups exhibited similar previous student educational achievements and visuospatial skills. CONCLUSIONS: This prospective, randomized, controlled educational trial demonstrated that incorporation of three-dimensionally-printed models improves medical students' understanding. This trial reinforces previous studies highlighting academic benefits in using three-dimensionally-printed models mostly in the field of understanding complex structures.

@article{lukas_knee_2022,
	title = {Knee {Ligament} {Sprains}: {Diagnosing} {Anterior} {Cruciate} {Ligament} {Injuries} by {Patient} {Interview}. {Development} and {Evaluation} of the {Anterior} {Cruciate} {Ligament} {Injury} {Score} ({ACLIS})},
	issn = {1877-0568},
	shorttitle = {Knee {Ligament} {Sprains}},
	doi = {10.1016/j.otsr.2022.103257},
	abstract = {BACKGROUND: Knee ligament sprains are a common reason for emergency-room visits. Initially, the often difficult physical examination provides limited information, creating a risk of missing cruciate-ligament injuries, which can result in substantial functional impairments. No simple tool is available to emergency and primary-care physicians for decisions regarding specialist referral of patients with knee ligament sprains. An easy to use clinical score for the emergency setting would help identify patients at high risk of anterior cruciate ligament (ACL) tears after knee ligament sprains. The primary objective of this study, in two separate cohorts with acute knee injuries, was to develop, then validate a score for assessing the probability of ACL tear and, therefore, the need for specialist referral.
HYPOTHESIS: A score based on patient-interview information with a cut-off associated to good sensitivity and positive predictive value (PPV) for ACL tears can be developed.
MATERIAL AND METHODS: A literature review identified seven items to be used in the score: pivoting and contact activity at the time of injury, perceived cracking sound, sensation of dislocation, joint effusion, suggestive mechanism, inability to resume the activity, and immediate sensation of instability upon walking. To select the most relevant items, we recruited a development cohort of 228 patients (127 males and 101 females) with a mean age of 32±9 years who were seen for knee injuries between November 2017 and November 2018 at three healthcare institutions; 183 (80\%) had ACL tears. The score was then tested in a validation cohort of 121 patients (79 males and 42 females) with a mean age of 28±2.5 years seen at two healthcare institutions between November 2019 and November 2020; 81 (67\%) had ACL tears. In all patients, the diagnosis of ACL tear was confirmed by a specialist examination and magnetic resonance imaging.
RESULTS: Four items proved both sensitive and specific for ACL injury and were combined into the score: an immediate sensation of knee instability, an inability to resume the sports activity, a sensation of dislocation, and injury during a pivoting-contact activity. Patient report of two or more of these four criteria had 96\% sensitivity and 66\% specificity for ACL tear, with a PPV of 91\% and an NPV of 83\%. Results were similar in the validation cohort, confirming that a cut-off of at least two of the four items strongly suggested an ACL tear, with 94\% sensitivity, 56\% specificity, a PPV of 82\% and an NPV of 82\%.
CONCLUSION: The ACLIS score performs well for the emergency-room diagnosis of ACL tear, with 95\% sensitivity, 62\% specificity, an 88\% PPV, and an 82\% NPV. Patients with ACLIS scores of 2 or more probably require specialist referral with or without magnetic resonance imaging. The ACLIS score could be used routinely in emergency departments to decrease the proportion of patients with undiagnosed ACL tears.
LEVEL OF EVIDENCE: III, prospective case-control study of a diagnostic score.},
	language = {eng},
	journal = {Orthopaedics \& traumatology, surgery \& research: OTSR},
	author = {Lukas, Simon and Putman, Sophie and Delay, Cyril and Blairon, Alexandre and Chazard, Emmanuel and Letartre, Romain},
	month = feb,
	year = {2022},
	pmid = {35219887},
	keywords = {Anterior cruciate ligament, Knee, Score, Sprain},
	pages = {103257},
}

BACKGROUND: Knee ligament sprains are a common reason for emergency-room visits. Initially, the often difficult physical examination provides limited information, creating a risk of missing cruciate-ligament injuries, which can result in substantial functional impairments. No simple tool is available to emergency and primary-care physicians for decisions regarding specialist referral of patients with knee ligament sprains. An easy to use clinical score for the emergency setting would help identify patients at high risk of anterior cruciate ligament (ACL) tears after knee ligament sprains. The primary objective of this study, in two separate cohorts with acute knee injuries, was to develop, then validate a score for assessing the probability of ACL tear and, therefore, the need for specialist referral. HYPOTHESIS: A score based on patient-interview information with a cut-off associated to good sensitivity and positive predictive value (PPV) for ACL tears can be developed. MATERIAL AND METHODS: A literature review identified seven items to be used in the score: pivoting and contact activity at the time of injury, perceived cracking sound, sensation of dislocation, joint effusion, suggestive mechanism, inability to resume the activity, and immediate sensation of instability upon walking. To select the most relevant items, we recruited a development cohort of 228 patients (127 males and 101 females) with a mean age of 32±9 years who were seen for knee injuries between November 2017 and November 2018 at three healthcare institutions; 183 (80%) had ACL tears. The score was then tested in a validation cohort of 121 patients (79 males and 42 females) with a mean age of 28±2.5 years seen at two healthcare institutions between November 2019 and November 2020; 81 (67%) had ACL tears. In all patients, the diagnosis of ACL tear was confirmed by a specialist examination and magnetic resonance imaging. RESULTS: Four items proved both sensitive and specific for ACL injury and were combined into the score: an immediate sensation of knee instability, an inability to resume the sports activity, a sensation of dislocation, and injury during a pivoting-contact activity. Patient report of two or more of these four criteria had 96% sensitivity and 66% specificity for ACL tear, with a PPV of 91% and an NPV of 83%. Results were similar in the validation cohort, confirming that a cut-off of at least two of the four items strongly suggested an ACL tear, with 94% sensitivity, 56% specificity, a PPV of 82% and an NPV of 82%. CONCLUSION: The ACLIS score performs well for the emergency-room diagnosis of ACL tear, with 95% sensitivity, 62% specificity, an 88% PPV, and an 82% NPV. Patients with ACLIS scores of 2 or more probably require specialist referral with or without magnetic resonance imaging. The ACLIS score could be used routinely in emergency departments to decrease the proportion of patients with undiagnosed ACL tears. LEVEL OF EVIDENCE: III, prospective case-control study of a diagnostic score.

@book{rouet_algorithmes_2022,
	address = {Paris},
	title = {Algorithmes et décisions publiques},
	isbn = {978-2-271-14166-8},
	url = {https://books.openedition.org/editionscnrs/46122},
	abstract = {Les algorithmes, nourris par des masses de données de plus en plus importantes, sont désormais au cœur de nombreux dispositifs susceptibles d'orienter, voire de prendre des décisions publiques. Le recours aux algorithmes permet d'envisager de réels progrès dans la qualité et l'adaptation des services publics aux besoins des citoyens/usagers, par ailleurs eux-mêmes producteurs de données nécessaires à leur fonctionnement. Tous les secteurs, ou presque, sont déjà concernés : santé, justice, police, sécurité, éducation, etc. Mais à quel prix et avec quels risques ?  Ce volume propose un panorama critique du recours aux algorithmes dans le secteur public, avec des focalisations sur des applications concrètes et une réflexion sur l'évolution de l'État, des administrations et de la communication entre les citoyens et les décideurs publics.  La loi pour une République numérique a instauré en 2016 un droit d'information spécifique pour les citoyens concernés par une décision individuelle fondée sur un algorithme. Il convient aujourd'hui non seulement d'envisager les modalités de mise en application de ce droit, mais aussi d'en considérer les aspects collectifs. Comment, dans ce contexte, maintenir et développer les conditions de liberté de choix et d'action des citoyens ?},
	language = {français},
	urldate = {2022-03-10},
	publisher = {CNRS Éditions},
	author = {Rouet, Gilles and Barraud, Boris and Benbouzid, Bilel and Carmès, Maryse and Carnis, Laurent and Chazard, Emmanuel and Côme, Thierry and Deydier, Jean and Mabi, Clément and Magne, Stéphane and Rouet, Gilles},
	year = {2022},
}

Les algorithmes, nourris par des masses de données de plus en plus importantes, sont désormais au cœur de nombreux dispositifs susceptibles d'orienter, voire de prendre des décisions publiques. Le recours aux algorithmes permet d'envisager de réels progrès dans la qualité et l'adaptation des services publics aux besoins des citoyens/usagers, par ailleurs eux-mêmes producteurs de données nécessaires à leur fonctionnement. Tous les secteurs, ou presque, sont déjà concernés : santé, justice, police, sécurité, éducation, etc. Mais à quel prix et avec quels risques ? Ce volume propose un panorama critique du recours aux algorithmes dans le secteur public, avec des focalisations sur des applications concrètes et une réflexion sur l'évolution de l'État, des administrations et de la communication entre les citoyens et les décideurs publics. La loi pour une République numérique a instauré en 2016 un droit d'information spécifique pour les citoyens concernés par une décision individuelle fondée sur un algorithme. Il convient aujourd'hui non seulement d'envisager les modalités de mise en application de ce droit, mais aussi d'en considérer les aspects collectifs. Comment, dans ce contexte, maintenir et développer les conditions de liberté de choix et d'action des citoyens ?

@article{bannay_leveraging_2021,
	title = {Leveraging {National} {Claims} and {Hospital} {Big} {Data}: {Cohort} {Study} on a {Statin}-{Drug} {Interaction} {Use} {Case}},
	volume = {9},
	issn = {2291-9694},
	shorttitle = {Leveraging {National} {Claims} and {Hospital} {Big} {Data}},
	doi = {10.2196/29286},
	abstract = {BACKGROUND: Linking different sources of medical data is a promising approach to analyze care trajectories. The aim of the INSHARE (Integrating and Sharing Health Big Data for Research) project was to provide the blueprint for a technological platform that facilitates integration, sharing, and reuse of data from 2 sources: the clinical data warehouse (CDW) of the Rennes academic hospital, called eHOP (entrepôt Hôpital), and a data set extracted from the French national claim data warehouse (Système National des Données de Santé [SNDS]).
OBJECTIVE: This study aims to demonstrate how the INSHARE platform can support big data analytic tasks in the health field using a pharmacovigilance use case based on statin consumption and statin-drug interactions.
METHODS: A Spark distributed cluster-computing framework was used for the record linkage procedure and all analyses. A semideterministic record linkage method based on the common variables between the chosen data sources was developed to identify all patients discharged after at least one hospital stay at the Rennes academic hospital between 2015 and 2017. The use-case study focused on a cohort of patients treated with statins prescribed by their general practitioner or during their hospital stay.
RESULTS: The whole process (record linkage procedure and use-case analyses) required 88 minutes. Of the 161,532 and 164,316 patients from the SNDS and eHOP CDW data sets, respectively, 159,495 patients were successfully linked (98.74\% and 97.07\% of patients from SNDS and eHOP CDW, respectively). Of the 16,806 patients with at least one statin delivery, 8293 patients started the consumption before and continued during the hospital stay, 6382 patients stopped statin consumption at hospital admission, and 2131 patients initiated statins in hospital. Statin-drug interactions occurred more frequently during hospitalization than in the community (3800/10,424, 36.45\% and 3253/14,675, 22.17\%, respectively; P{\textless}.001). Only 121 patients had the most severe level of statin-drug interaction. Hospital stay burden (length of stay and in-hospital mortality) was more severe in patients with statin-drug interactions during hospitalization.
CONCLUSIONS: This study demonstrates the added value of combining and reusing clinical and claim data to provide large-scale measures of drug-drug interaction prevalence and care pathways outside hospitals. It builds a path to move the current health care system toward a Learning Health System using knowledge generated from research on real-world health data.},
	language = {eng},
	number = {12},
	journal = {JMIR medical informatics},
	author = {Bannay, Aurélie and Bories, Mathilde and Le Corre, Pascal and Riou, Christine and Lemordant, Pierre and Van Hille, Pascal and Chazard, Emmanuel and Dode, Xavier and Cuggia, Marc and Bouzillé, Guillaume},
	month = dec,
	year = {2021},
	pmid = {34898457},
	keywords = {administrative claims, big data, data linking, data warehousing, drug interactions, health care, statins},
	pages = {e29286},
}

BACKGROUND: Linking different sources of medical data is a promising approach to analyze care trajectories. The aim of the INSHARE (Integrating and Sharing Health Big Data for Research) project was to provide the blueprint for a technological platform that facilitates integration, sharing, and reuse of data from 2 sources: the clinical data warehouse (CDW) of the Rennes academic hospital, called eHOP (entrepôt Hôpital), and a data set extracted from the French national claim data warehouse (Système National des Données de Santé [SNDS]). OBJECTIVE: This study aims to demonstrate how the INSHARE platform can support big data analytic tasks in the health field using a pharmacovigilance use case based on statin consumption and statin-drug interactions. METHODS: A Spark distributed cluster-computing framework was used for the record linkage procedure and all analyses. A semideterministic record linkage method based on the common variables between the chosen data sources was developed to identify all patients discharged after at least one hospital stay at the Rennes academic hospital between 2015 and 2017. The use-case study focused on a cohort of patients treated with statins prescribed by their general practitioner or during their hospital stay. RESULTS: The whole process (record linkage procedure and use-case analyses) required 88 minutes. Of the 161,532 and 164,316 patients from the SNDS and eHOP CDW data sets, respectively, 159,495 patients were successfully linked (98.74% and 97.07% of patients from SNDS and eHOP CDW, respectively). Of the 16,806 patients with at least one statin delivery, 8293 patients started the consumption before and continued during the hospital stay, 6382 patients stopped statin consumption at hospital admission, and 2131 patients initiated statins in hospital. Statin-drug interactions occurred more frequently during hospitalization than in the community (3800/10,424, 36.45% and 3253/14,675, 22.17%, respectively; P\textless.001). Only 121 patients had the most severe level of statin-drug interaction. Hospital stay burden (length of stay and in-hospital mortality) was more severe in patients with statin-drug interactions during hospitalization. CONCLUSIONS: This study demonstrates the added value of combining and reusing clinical and claim data to provide large-scale measures of drug-drug interaction prevalence and care pathways outside hospitals. It builds a path to move the current health care system toward a Learning Health System using knowledge generated from research on real-world health data.

@article{tillard_burden_2021,
	title = {Burden of influenza disease in children under 2 years of age hospitalized between 2011 and 2020 in {France}},
	volume = {0},
	issn = {0163-4453, 1532-2742},
	url = {https://www.journalofinfection.com/article/S0163-4453(21)00549-1/fulltext},
	doi = {10.1016/j.jinf.2021.11.006},
	language = {English},
	number = {0},
	urldate = {2021-11-15},
	journal = {Journal of Infection},
	author = {Tillard, Célia and Chazard, Emmanuel and Faure, Karine and Bartolo, Stéphanie and Martinot, Alain and Dubos, François},
	month = nov,
	year = {2021},
	note = {Publisher: Elsevier},
	keywords = {Burden of disease, children, influenza, morbidity, mortality},
}

@article{baert_coronavirus_2021,
	title = {Coronavirus {Disease} 2019 and {Out}-of-{Hospital} {Cardiac} {Arrest}: {No} {Survivors}},
	issn = {1530-0293},
	shorttitle = {Coronavirus {Disease} 2019 and {Out}-of-{Hospital} {Cardiac} {Arrest}},
	doi = {10.1097/CCM.0000000000005374},
	abstract = {OBJECTIVES: To describe and compare survival among patients with out-of-hospital cardiac arrest as a function of their status for coronavirus disease 2019.
DESIGN: We performed an observational study of out-of-hospital cardiac arrest patients between March 2020 and December 2020. Coronavirus disease 2019 status (confirmed, suspected, or negative) was defined according to the World Health Organization's criteria.
SETTING: Information on the patients and their care was extracted from the French national out-of-hospital cardiac arrest registry. The French prehospital emergency medical system has two tiers: the fire department intervenes rapidly to provide basic life support, and mobile ICUs provide advanced life support. The study data (including each patient's coronavirus disease 2019 status) were collected by 95 mobile ICUs throughout France.
PATIENTS: We included 6,624 out-of-hospital cardiac arrest patients: 127 cases with confirmed coronavirus disease 2019, 473 with suspected coronavirus disease 2019, and 6,024 negative for coronavirus disease 2019.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: The "confirmed" and "suspected" groups of coronavirus disease 2019 patients had similar characteristics and were more likely to have suffered an out-of-hospital cardiac arrest with a respiratory cause (confirmed: 53.7\%, suspected coronavirus disease 2019: 56.5\%; p = 0.472) than noncoronavirus disease 2019 patients (14.0\%; p {\textless} 0.001 vs confirmed coronavirus disease 2019 patients). Advanced life support was initiated for 57.5\% of the confirmed coronavirus disease 2019 patients, compared with 64.5\% of the suspected coronavirus disease 2019 patients (p = 0.149) and 70.6\% of the noncoronavirus disease 2019 ones (p = 0.002). The survival rate at 30-day postout-of-hospital cardiac arrest was 0\% in the confirmed coronavirus disease 2019 group, 0.9\% in the suspected coronavirus disease 2019 group (p = 0.583 vs confirmed), and 3.5\% (p = 0.023) in the noncoronavirus disease 2019 group.
CONCLUSIONS: Our results highlighted a zero survival rate in out-of-hospital cardiac arrest patients with confirmed coronavirus disease 2019. This finding raises important questions with regard to the futility of resuscitation for coronavirus disease 2019 patients and the management of the associated risks.},
	language = {eng},
	journal = {Critical Care Medicine},
	author = {Baert, Valentine and Beuscart, Jean-Baptiste and Recher, Morgan and Javaudin, François and Hugenschmitt, Delphine and Bony, Thomas and Revaux, François and Mansouri, Nadia and Larcher, Fanny and Chazard, Emmanuel and Hubert, Hervé and {French National OHCA Registry (RéAC) Study Group}},
	month = oct,
	year = {2021},
	pmid = {34605777},
}

OBJECTIVES: To describe and compare survival among patients with out-of-hospital cardiac arrest as a function of their status for coronavirus disease 2019. DESIGN: We performed an observational study of out-of-hospital cardiac arrest patients between March 2020 and December 2020. Coronavirus disease 2019 status (confirmed, suspected, or negative) was defined according to the World Health Organization's criteria. SETTING: Information on the patients and their care was extracted from the French national out-of-hospital cardiac arrest registry. The French prehospital emergency medical system has two tiers: the fire department intervenes rapidly to provide basic life support, and mobile ICUs provide advanced life support. The study data (including each patient's coronavirus disease 2019 status) were collected by 95 mobile ICUs throughout France. PATIENTS: We included 6,624 out-of-hospital cardiac arrest patients: 127 cases with confirmed coronavirus disease 2019, 473 with suspected coronavirus disease 2019, and 6,024 negative for coronavirus disease 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The "confirmed" and "suspected" groups of coronavirus disease 2019 patients had similar characteristics and were more likely to have suffered an out-of-hospital cardiac arrest with a respiratory cause (confirmed: 53.7%, suspected coronavirus disease 2019: 56.5%; p = 0.472) than noncoronavirus disease 2019 patients (14.0%; p \textless 0.001 vs confirmed coronavirus disease 2019 patients). Advanced life support was initiated for 57.5% of the confirmed coronavirus disease 2019 patients, compared with 64.5% of the suspected coronavirus disease 2019 patients (p = 0.149) and 70.6% of the noncoronavirus disease 2019 ones (p = 0.002). The survival rate at 30-day postout-of-hospital cardiac arrest was 0% in the confirmed coronavirus disease 2019 group, 0.9% in the suspected coronavirus disease 2019 group (p = 0.583 vs confirmed), and 3.5% (p = 0.023) in the noncoronavirus disease 2019 group. CONCLUSIONS: Our results highlighted a zero survival rate in out-of-hospital cardiac arrest patients with confirmed coronavirus disease 2019. This finding raises important questions with regard to the futility of resuscitation for coronavirus disease 2019 patients and the management of the associated risks.

@article{bertrand_1829p_2021,
	series = {Abstract {Book} of the {ESMO} {Congress} 2021, 16 – 21 {September} 2021},
	title = {{1829P} {In}-hospital survival of metastatic patients admitted into medical intensive care units: {A} {French} nationwide study about 57,717 cases},
	volume = {32},
	issn = {0923-7534},
	shorttitle = {{1829P} {In}-hospital survival of metastatic patients admitted into medical intensive care units},
	url = {https://www.sciencedirect.com/science/article/pii/S092375342102946X},
	doi = {10.1016/j.annonc.2021.08.717},
	language = {en},
	urldate = {2022-05-02},
	journal = {Annals of Oncology},
	author = {Bertrand, N. and Benoit, D. and Escande, A. and Ficheur, G. and Nseir, S. and Moreau, A. S. and Chazard, E.},
	month = sep,
	year = {2021},
	pages = {S1238},
}

@article{demesmaeker_suicide_2021,
	title = {Suicide mortality after a nonfatal suicide attempt: {A} systematic review and meta-analysis},
	issn = {1440-1614},
	shorttitle = {Suicide mortality after a nonfatal suicide attempt},
	doi = {10.1177/00048674211043455},
	abstract = {INTRODUCTION: Deliberate self-harm and suicide attempts share common risk factors but are associated with different epidemiological features. While the rate of suicide after deliberate self-harm has been evaluated in meta-analyses, the specific rate of death by suicide after a previous suicide attempt has never been assessed. The aim of our study was to estimate the incidence of death by suicide after a nonfatal suicide attempt.
METHOD: We developed and followed a standard meta-analysis protocol (systematic review registration-PROSPERO 2021: CRD42021221111). Randomized controlled trials and cohort studies published between 1970 and 2020 focusing on the rate of suicide after suicide attempt were identified in PubMed, PsycInfo and Scopus and qualitatively described. The rates of deaths by suicide at 1, 5 and 10 years after a nonfatal suicide attempt were pooled in a meta-analysis using a random-effects model. Subgroup analysis and meta-regressions were also performed.
RESULTS: Our meta-analysis is based on 41 studies. The suicide rate after a nonfatal suicide attempt was 2.8\% (2.2-3.5) at 1 year, 5.6\% (3.9-7.9) at 5 years and 7.4\% (5.2-10.4) at 10 years. Estimates of the suicide rate vary widely depending on the psychiatric diagnosis, the method used for the suicide attempt, the type of study and the age group considered.
CONCLUSION: The evidence of a high rate of suicide deaths in the year following nonfatal suicide attempts should prompt prevention systems to be particularly vigilant during this period.},
	language = {eng},
	journal = {The Australian and New Zealand Journal of Psychiatry},
	author = {Demesmaeker, Alice and Chazard, Emmanuel and Hoang, Aline and Vaiva, Guillaume and Amad, Ali},
	month = sep,
	year = {2021},
	pmid = {34465221},
	keywords = {Suicide attempt, epidemiology, mortality, suicide},
	pages = {48674211043455},
}

INTRODUCTION: Deliberate self-harm and suicide attempts share common risk factors but are associated with different epidemiological features. While the rate of suicide after deliberate self-harm has been evaluated in meta-analyses, the specific rate of death by suicide after a previous suicide attempt has never been assessed. The aim of our study was to estimate the incidence of death by suicide after a nonfatal suicide attempt. METHOD: We developed and followed a standard meta-analysis protocol (systematic review registration-PROSPERO 2021: CRD42021221111). Randomized controlled trials and cohort studies published between 1970 and 2020 focusing on the rate of suicide after suicide attempt were identified in PubMed, PsycInfo and Scopus and qualitatively described. The rates of deaths by suicide at 1, 5 and 10 years after a nonfatal suicide attempt were pooled in a meta-analysis using a random-effects model. Subgroup analysis and meta-regressions were also performed. RESULTS: Our meta-analysis is based on 41 studies. The suicide rate after a nonfatal suicide attempt was 2.8% (2.2-3.5) at 1 year, 5.6% (3.9-7.9) at 5 years and 7.4% (5.2-10.4) at 10 years. Estimates of the suicide rate vary widely depending on the psychiatric diagnosis, the method used for the suicide attempt, the type of study and the age group considered. CONCLUSION: The evidence of a high rate of suicide deaths in the year following nonfatal suicide attempts should prompt prevention systems to be particularly vigilant during this period.

@article{dubernard_retrograde_2021,
	title = {Retrograde {Extraperitoneal} {Laparoscopic} {Prostatectomy} ({RELP}). {A} {Prospective} {Study} about 1,000 {Consecutive} {Patients}, with {Oncological} and {Functional} {Results}},
	issn = {1735-546X},
	doi = {10.22037/uj.v18i.6233},
	abstract = {PURPOSE: Usual laparoscopic surgery of localized prostate cancer uses antegrade dissection. We describe and evaluate the original RELP (Retrograde Extraperitoneal Laparoscopic Prostatectomy).
MATERIALS AND METHODS: A prospective cohort of 1005 patients with clinical localized cancer prostate were operated from December 1999 to September 2013, in Lyon (France), and followed up to 172 months (median: 60 months). Patients encountered a RELP procedure, a totally extra-peritoneal approach with a retrograde dissection from the apex to the bladder neck, and ascending dissection of the erectile neurovascular bundles, facilitated by the 30° optic telescope. Adjunctive treatments were: immediate radiotherapy (9.2\%), salvage radiotherapy (13.4\%), androgen deprivation therapy (10.8\%), chemotherapy (1.4\%), no treatment (75.8\%). Results The mean age was 63.4, the Gleason score was 4+3 or worse in 24.9\%, there were 2.3\% unifocal tumors. The pathology stages were pT2A (8.71\%), pT2B (2.80\%), pT2C (69.0\%), pT3A (13.1\%), and pT3B (6.41\%). There were 60.8\% negative margins (R0) in total (90.1\% for basal locations, and 75.8\% for apical locations). The mean operating time was 115 minutes for the last 100 patients. The BPFSR (biological progression free survival rate, PSA≤0.10 ng/ml) was 71.9\% at 5 years, and 61.4\% at 10 years. The cancer specific survival rate was 99.4\% at 5 years, and 98.3\% at 10 years. After 12 months, 88.6\% of patients did not require an incontinence pad, and 67.0\% retained the pre-operative quality of their erection.
CONCLUSION: RELP yields good oncologic results and quality of life, as good as robot-assisted surgery.},
	language = {eng},
	journal = {Urology Journal},
	author = {Dubernard, Pierre and Chaffange, Pierre and Pacheco, Philippe and Pricaz, Elie and Vaziri, Nader and Vinet, Maxime and Chalabreysse, Philippe and Rochat, Charles-Henry and Ficheur, Grégoire and Chazard, Emmanuel},
	month = jul,
	year = {2021},
	pmid = {34308534},
	keywords = {Functional Results, Laparoscopy, Oncological Results, Prostatectomy, Prostatic Neoplasms, Retrograde Extraperitoneal Laparoscopic Prostatectomy},
}

PURPOSE: Usual laparoscopic surgery of localized prostate cancer uses antegrade dissection. We describe and evaluate the original RELP (Retrograde Extraperitoneal Laparoscopic Prostatectomy). MATERIALS AND METHODS: A prospective cohort of 1005 patients with clinical localized cancer prostate were operated from December 1999 to September 2013, in Lyon (France), and followed up to 172 months (median: 60 months). Patients encountered a RELP procedure, a totally extra-peritoneal approach with a retrograde dissection from the apex to the bladder neck, and ascending dissection of the erectile neurovascular bundles, facilitated by the 30° optic telescope. Adjunctive treatments were: immediate radiotherapy (9.2%), salvage radiotherapy (13.4%), androgen deprivation therapy (10.8%), chemotherapy (1.4%), no treatment (75.8%). Results The mean age was 63.4, the Gleason score was 4+3 or worse in 24.9%, there were 2.3% unifocal tumors. The pathology stages were pT2A (8.71%), pT2B (2.80%), pT2C (69.0%), pT3A (13.1%), and pT3B (6.41%). There were 60.8% negative margins (R0) in total (90.1% for basal locations, and 75.8% for apical locations). The mean operating time was 115 minutes for the last 100 patients. The BPFSR (biological progression free survival rate, PSA≤0.10 ng/ml) was 71.9% at 5 years, and 61.4% at 10 years. The cancer specific survival rate was 99.4% at 5 years, and 98.3% at 10 years. After 12 months, 88.6% of patients did not require an incontinence pad, and 67.0% retained the pre-operative quality of their erection. CONCLUSION: RELP yields good oncologic results and quality of life, as good as robot-assisted surgery.

@article{duthe_how_2021,
	title = {How to {Identify} {Potential} {Candidates} for {HIV} {Pre}-{Exposure} {Prophylaxis}: {An} {AI} {Algorithm} {Reusing} {Real}-{World} {Hospital} {Data}},
	volume = {281},
	issn = {1879-8365},
	shorttitle = {How to {Identify} {Potential} {Candidates} for {HIV} {Pre}-{Exposure} {Prophylaxis}},
	doi = {10.3233/SHTI210265},
	abstract = {HIV Pre-Exposure Prophylaxis (PrEP) is effective in Men who have Sex with Men (MSM), and is reimbursed by the social security in France. Yet, PrEP is underused due to the difficulty to identify people at risk of HIV infection outside the "sexual health" care path. We developed and validated an automated algorithm that re-uses Electronic Health Record (EHR) data available in eHOP, the Clinical Data Warehouse of Rennes University Hospital (France). Using machine learning methods, we developed five models to predict incident HIV infections with 162 variables that might be exploited to predict HIV risk using EHR data. We divided patients aged 18 or more having at least one hospital admission between 2013 and 2019 in two groups: cases (patients with known HIV infection in the study period) and controls (patients without known HIV infection and no PrEP in the study period, but with at least one HIV risk factor). Among the 624,708 admissions, we selected 156 cases (incident HIV infection) and 761 controls. The best performing model for identifying incident HIV infections was the combined model (LASSO, Random Forest, and Generalized Linear Model): AUC = 0.88 (95\% CI: 0.8143-0.9619), specificity = 0.887, and sensitivity = 0.733 using the test dataset. The algorithm seems to efficiently identify patients at risk of HIV infection.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Duthe, Jean-Charles and Bouzille, Guillaume and Sylvestre, Emmanuelle and Chazard, Emmanuel and Arvieux, Cedric and Cuggia, Marc},
	month = may,
	year = {2021},
	pmid = {34042669},
	keywords = {Algorithms, Anti-HIV Agents, France, HIV Infections, HIV prevention, Homosexuality, Male, Hospitals, Humans, Male, Pre-Exposure Prophylaxis, Pre-exposure prophylaxis (PrEP), Sexual and Gender Minorities, clinical informatics, machine learning, predictive analytics, risk reduction practices, sexual health},
	pages = {714--718},
}

HIV Pre-Exposure Prophylaxis (PrEP) is effective in Men who have Sex with Men (MSM), and is reimbursed by the social security in France. Yet, PrEP is underused due to the difficulty to identify people at risk of HIV infection outside the "sexual health" care path. We developed and validated an automated algorithm that re-uses Electronic Health Record (EHR) data available in eHOP, the Clinical Data Warehouse of Rennes University Hospital (France). Using machine learning methods, we developed five models to predict incident HIV infections with 162 variables that might be exploited to predict HIV risk using EHR data. We divided patients aged 18 or more having at least one hospital admission between 2013 and 2019 in two groups: cases (patients with known HIV infection in the study period) and controls (patients without known HIV infection and no PrEP in the study period, but with at least one HIV risk factor). Among the 624,708 admissions, we selected 156 cases (incident HIV infection) and 761 controls. The best performing model for identifying incident HIV infections was the combined model (LASSO, Random Forest, and Generalized Linear Model): AUC = 0.88 (95% CI: 0.8143-0.9619), specificity = 0.887, and sensitivity = 0.733 using the test dataset. The algorithm seems to efficiently identify patients at risk of HIV infection.

@article{lauriot_dit_prevost_icipemir_2021,
	title = {{ICIPEMIR}: {Improving} the {Completeness}, {Interoperability} and {Patient} {Explanations} of {Medical} {Imaging} {Reports}},
	volume = {281},
	issn = {1879-8365},
	shorttitle = {{ICIPEMIR}},
	doi = {10.3233/SHTI210193},
	abstract = {INTRODUCTION: Although electronic health records have been facilitating the management of medical information, there is still room for improvement in daily production of medical report. Possible areas for improvement would be: to improve reports quality (by increasing exhaustivity), to improve patients' understanding (by mean of a graphical display), to save physicians' time (by helping reports writing), and to improve sharing and storage (by enhancing interoperability). We set up the ICIPEMIR project (Improving the completeness, interoperability and patients explanation of medical imaging reports) as an academic solution to optimize medical imaging reports production. Such a project requires two layers: one engineering layer to build the automation process, and a second medical layer to determine domain-specific data models for each type of report. We describe here the medical layer of this project.
METHODS: We designed a reproducible methodology to identify -for a given medical imaging exam- mandatory fields, and describe a corresponding simple data model using validated formats. The mandatory fields had to meet legal requirements, domain-specific guidelines, and results of a bibliographic review on clinical studies. An UML representation, a JSON Schema, and a YAML instance dataset were defined. Based on this data model a form was created using Goupile, an open source eCRF script-based editor. In addition, a graphical display was designed and mapped with the data model, as well as a text template to automatically produce a free-text report. Finally, the YAML instance was encoded in a QR-Code to allow offline paper-based transmission of structured data.
RESULTS: We tested this methodology in a specific domain: computed tomography for urolithiasis. We successfully extracted 73 fields, and transformed them into a simple data model, with mapping to a simple graphical display, and textual report template. The offline QR-code transmission of a 2,615 characters YAML file was successful with simple smartphone QR-Code scanner.
CONCLUSION: Although automated production of medical report requires domain-specific data model and mapping, these can be defined using a reproducible methodology. Hopefully this proof of concept will lead to a computer solution to optimize medical imaging reports, driven by academic research.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Lauriot Dit Prevost, Arthur and Trencart, Marie and Gaillard, Vianney and Bouzille, Guillaume and Besson, Rémi and Sharma, Dyuti and Puech, Philippe and Chazard, Emmanuel},
	month = may,
	year = {2021},
	pmid = {34042778},
	keywords = {Data model, Diagnostic Imaging, Electronic Health Records, Humans, QR-Code, medical imaging report, patient participation},
	pages = {422--426},
}

INTRODUCTION: Although electronic health records have been facilitating the management of medical information, there is still room for improvement in daily production of medical report. Possible areas for improvement would be: to improve reports quality (by increasing exhaustivity), to improve patients' understanding (by mean of a graphical display), to save physicians' time (by helping reports writing), and to improve sharing and storage (by enhancing interoperability). We set up the ICIPEMIR project (Improving the completeness, interoperability and patients explanation of medical imaging reports) as an academic solution to optimize medical imaging reports production. Such a project requires two layers: one engineering layer to build the automation process, and a second medical layer to determine domain-specific data models for each type of report. We describe here the medical layer of this project. METHODS: We designed a reproducible methodology to identify -for a given medical imaging exam- mandatory fields, and describe a corresponding simple data model using validated formats. The mandatory fields had to meet legal requirements, domain-specific guidelines, and results of a bibliographic review on clinical studies. An UML representation, a JSON Schema, and a YAML instance dataset were defined. Based on this data model a form was created using Goupile, an open source eCRF script-based editor. In addition, a graphical display was designed and mapped with the data model, as well as a text template to automatically produce a free-text report. Finally, the YAML instance was encoded in a QR-Code to allow offline paper-based transmission of structured data. RESULTS: We tested this methodology in a specific domain: computed tomography for urolithiasis. We successfully extracted 73 fields, and transformed them into a simple data model, with mapping to a simple graphical display, and textual report template. The offline QR-code transmission of a 2,615 characters YAML file was successful with simple smartphone QR-Code scanner. CONCLUSION: Although automated production of medical report requires domain-specific data model and mapping, these can be defined using a reproducible methodology. Hopefully this proof of concept will lead to a computer solution to optimize medical imaging reports, driven by academic research.

@article{robert_integration_2021,
	title = {Integration of {Explicit} {Criteria} in a {Clinical} {Decision} {Support} {System} {Through} {Evaluation} of {Acute} {Kidney} {Injury} {Events}},
	volume = {281},
	issn = {1879-8365},
	doi = {10.3233/SHTI210249},
	abstract = {In Clinical Decision Support System (CDSS), relevance of alerts is essential to limit alert fatigue and risk of overriding relevant alerts by health professionals. Detection of acute kidney injury (AKI) situations is of great importance in clinical practice and could improve quality of care. Nevertheless, to our knowledge, no explicit rule has been created to detect AKI situations in CDSS. The objective of the study was to implement an AKI detection rule based on KDIGO criteria in a CDSS and to optimize this rule to increase its relevance in clinical pharmacy use. Two explicit rules were implemented in a CDSS (basic AKI rule and improved AKI rule), based on KDIGO criteria. Only the improved rule was optimized by a group of experts during the two-month study period. The CDSS provided 1,125 alerts on AKI situations (i.e. 643 were triggered for the basic AKI rule and 482 for the improved AKI rule). As the study proceeds, the pharmaceutically and medically relevance of alerts from the improved AKI rule increased. A ten-fold increase was shown for the improved AKI rule compared to the basic AKI rule. The study highlights the usefulness of a multidisciplinary review to enhance explicit rules integrated in CDSS. The improved AKI is able to detect AKI situations and can improve workflow of health professionals.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Robert, Laurine and Rousseliere, Chloé and Beuscart, Jean-Baptiste and Gautier, Sophie and Chazard, Emmanuel and Decaudin, Bertrand and Odou, Pascal},
	month = may,
	year = {2021},
	pmid = {34042654},
	keywords = {AKI, Acute Kidney Injury, CDSS, Decision Support Systems, Clinical, Detection, Explicit criteria, Humans, Pharmacy Service, Hospital},
	pages = {640--644},
}

In Clinical Decision Support System (CDSS), relevance of alerts is essential to limit alert fatigue and risk of overriding relevant alerts by health professionals. Detection of acute kidney injury (AKI) situations is of great importance in clinical practice and could improve quality of care. Nevertheless, to our knowledge, no explicit rule has been created to detect AKI situations in CDSS. The objective of the study was to implement an AKI detection rule based on KDIGO criteria in a CDSS and to optimize this rule to increase its relevance in clinical pharmacy use. Two explicit rules were implemented in a CDSS (basic AKI rule and improved AKI rule), based on KDIGO criteria. Only the improved rule was optimized by a group of experts during the two-month study period. The CDSS provided 1,125 alerts on AKI situations (i.e. 643 were triggered for the basic AKI rule and 482 for the improved AKI rule). As the study proceeds, the pharmaceutically and medically relevance of alerts from the improved AKI rule increased. A ten-fold increase was shown for the improved AKI rule compared to the basic AKI rule. The study highlights the usefulness of a multidisciplinary review to enhance explicit rules integrated in CDSS. The improved AKI is able to detect AKI situations and can improve workflow of health professionals.

@article{demesmaeker_pharmacoepidemiological_2021,
	title = {A pharmacoepidemiological study of the association of suicide reattempt risk with psychotropic drug exposure},
	volume = {138},
	issn = {1879-1379},
	doi = {10.1016/j.jpsychires.2021.04.006},
	abstract = {INTRODUCTION: Recent pharmacoepidemiological studies have suggested that consumption of certain classes of psychotropic drugs could be considered protective or risk factors for suicidal behaviour. The aim of the study was to evaluate the association between the risk of suicide reattempt within 6 and 14 months after a suicide attempt (SA) with the use of different classes of psychotropic drugs, combination pairs and treatment adequacy from inclusion through 6 and 14 months post-SA.
METHOD: A prospective observational cohort of 972 subjects from the ALGOS study from January 2010 to February 2013 was used to evaluate the association of risk of suicide reattempt within 6 and 14 months with the use of different classes of psychotropic drugs (antidepressants, anxiolytics, antipsychotics, lithium, anticonvulsants, analgesics, opioid maintenance therapy and maintenance treatment for alcohol dependence). A multivariable Cox model was performed after imputation of missing data using the multiple imputation method.
RESULTS: Our main results did not show an association between psychotropic drug use and suicide reattempt after 6 months of follow-up. We demonstrated that the use of benzodiazepines (HR = 1.87 [1.25; 2.81], p {\textless} 0.01) and hypnotics (HR = 1.49 [1.03; 2.17], p = 0.04) or a combination of both (HR = 1.80 [1.17; 2.72], p = 0.01) were associated with suicide reattempt within 14 months after a previous SA.
CONCLUSION: The early identification of a positive association between psychotropic drugs and the risk of suicidal behaviour is extremely important for prevention of suicide reattempts. Special precautions should be considered when prescribing psychotropic drugs for these subjects, particularly those at risk of suicide reattempt.},
	language = {eng},
	journal = {Journal of Psychiatric Research},
	author = {Demesmaeker, Alice and Chazard, Emmanuel and Vaiva, Guillaume and Amad, Ali},
	month = apr,
	year = {2021},
	pmid = {33872962},
	keywords = {Pharmacoepidemiology, Psychotropic drug, Suicide, Suicide attempt, pharmacoepidemiology, psychotropic drug, suicide attempt},
	pages = {256--263},
}

INTRODUCTION: Recent pharmacoepidemiological studies have suggested that consumption of certain classes of psychotropic drugs could be considered protective or risk factors for suicidal behaviour. The aim of the study was to evaluate the association between the risk of suicide reattempt within 6 and 14 months after a suicide attempt (SA) with the use of different classes of psychotropic drugs, combination pairs and treatment adequacy from inclusion through 6 and 14 months post-SA. METHOD: A prospective observational cohort of 972 subjects from the ALGOS study from January 2010 to February 2013 was used to evaluate the association of risk of suicide reattempt within 6 and 14 months with the use of different classes of psychotropic drugs (antidepressants, anxiolytics, antipsychotics, lithium, anticonvulsants, analgesics, opioid maintenance therapy and maintenance treatment for alcohol dependence). A multivariable Cox model was performed after imputation of missing data using the multiple imputation method. RESULTS: Our main results did not show an association between psychotropic drug use and suicide reattempt after 6 months of follow-up. We demonstrated that the use of benzodiazepines (HR = 1.87 [1.25; 2.81], p \textless 0.01) and hypnotics (HR = 1.49 [1.03; 2.17], p = 0.04) or a combination of both (HR = 1.80 [1.17; 2.72], p = 0.01) were associated with suicide reattempt within 14 months after a previous SA. CONCLUSION: The early identification of a positive association between psychotropic drugs and the risk of suicidal behaviour is extremely important for prevention of suicide reattempts. Special precautions should be considered when prescribing psychotropic drugs for these subjects, particularly those at risk of suicide reattempt.

@article{hendriks_change_2021,
	title = {Change over time in the surgical management of pelvic organ prolapse between 2008 and 2014 in {France}: patient profiles, surgical approaches, and outcomes},
	volume = {32},
	issn = {1433-3023},
	shorttitle = {Change over time in the surgical management of pelvic organ prolapse between 2008 and 2014 in {France}},
	doi = {10.1007/s00192-020-04491-2},
	abstract = {INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) is a common pathological condition that may require surgical management. Several surgical treatment options are possible, and practice varies from one center to another. The objective of the present study was to describe the surgical management and outcomes of POP in France from 2008 to 2014.
METHODS: We performed a retrospective cohort study of all patients operated on for POP from 2008 to 2014, according to the French national hospital discharge summary database. Patient characteristics, surgical approaches, concomitant hysterectomy and/or incontinence surgery, the length of stay, the proportion of day-case operations, and patient outcomes were analyzed.
RESULTS: We analyzed 310,938 hospital stays with POP surgery between 2008 and 2014; 130,908 (42\%) of the operations took place in hospitals performing more than 100 prolapse surgical procedures per year. The proportion of day-case operations was low, but rose significantly from 1.2\% to 4.6\% during the study period. More than half of the operations featured a vaginal approach. The proportions of operations with concomitant hysterectomy or urinary incontinence surgery fell from 41.0\% to 36.1\% and from 33.0\% to 25.8\% respectively. The proportions of laparoscopic procedures increased. The mortality rate was stable (0.07\% for all years).
CONCLUSIONS: The number of patients undergoing POP surgery remained stable from 2008 to 2014. The proportion of laparoscopic procedures increased (in parallel with the rising proportion of day-case operations) and the proportion of procedures with concomitant hysterectomy or incontinence treatment decreased.},
	language = {eng},
	number = {4},
	journal = {International Urogynecology Journal},
	author = {Hendriks, Mathilde and Bartolo, Stéphanie and Giraudet, Géraldine and Cosson, Michel and Chazard, Emmanuel},
	month = apr,
	year = {2021},
	pmid = {32894328},
	keywords = {Female, France, Gynecologic Surgical Procedures, Humans, Hysterectomy, Pelvic Organ Prolapse, Pelvic organ prolapse, Retrospective Studies, Treatment Outcome, Urinary Incontinence, Urinary incontinence},
	pages = {961--966},
}

INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) is a common pathological condition that may require surgical management. Several surgical treatment options are possible, and practice varies from one center to another. The objective of the present study was to describe the surgical management and outcomes of POP in France from 2008 to 2014. METHODS: We performed a retrospective cohort study of all patients operated on for POP from 2008 to 2014, according to the French national hospital discharge summary database. Patient characteristics, surgical approaches, concomitant hysterectomy and/or incontinence surgery, the length of stay, the proportion of day-case operations, and patient outcomes were analyzed. RESULTS: We analyzed 310,938 hospital stays with POP surgery between 2008 and 2014; 130,908 (42%) of the operations took place in hospitals performing more than 100 prolapse surgical procedures per year. The proportion of day-case operations was low, but rose significantly from 1.2% to 4.6% during the study period. More than half of the operations featured a vaginal approach. The proportions of operations with concomitant hysterectomy or urinary incontinence surgery fell from 41.0% to 36.1% and from 33.0% to 25.8% respectively. The proportions of laparoscopic procedures increased. The mortality rate was stable (0.07% for all years). CONCLUSIONS: The number of patients undergoing POP surgery remained stable from 2008 to 2014. The proportion of laparoscopic procedures increased (in parallel with the rising proportion of day-case operations) and the proportion of procedures with concomitant hysterectomy or incontinence treatment decreased.

@article{demesmaeker_risk_2021,
	title = {Risk {Factors} for {Reattempt} and {Suicide} {Within} 6 {Months} {After} an {Attempt} in the {French} {ALGOS} {Cohort}: {A} {Survival} {Tree} {Analysis}},
	volume = {82},
	issn = {1555-2101},
	shorttitle = {Risk {Factors} for {Reattempt} and {Suicide} {Within} 6 {Months} {After} an {Attempt} in the {French} {ALGOS} {Cohort}},
	doi = {10.4088/JCP.20m13589},
	abstract = {OBJECTIVE: Understanding the cumulative effect of several risk factors involved in suicidal behavior is crucial for the development of effective prevention plans. The objective of this study is to provide clinicians with a simple predictive model of the risk of suicide attempts and suicide within 6 months after suicide attempt.
METHODS: A prospective observational cohort of 972 subjects, included from January 26, 2010, to February 28, 2013, was used to perform a survival tree analysis with all sociodemographic and clinical variables available at inclusion. The results of the decision tree were then used to define a simple predictive algorithm for clinicians.
RESULTS: The results of survival tree analysis highlighted 3 subgroups of patients with an increased risk of suicide attempt or death by suicide within 6 months after suicide attempt: patients with alcohol use disorder and a previous suicide attempt with acute alcohol use (risk ratio [RR] = 2.92; 95\% CI, 2.08 to 4.10), patients with anxiety disorders (RR = 0.98; 95\% CI, 0.69 to 1.39), and patients with a history of more than 2 suicide attempts in the past 3 years (RR = 2.11; 95\% CI, 1.25 to 3.54). The good prognosis group comprised all other patients.
CONCLUSIONS: By using a data-driven method, this study identified 4 clinical factors interacting together to reduce or increase the risk of recidivism. These combinations of risk factors allow for a better evaluation of a subject's suicide risk in clinical practice.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01123174.},
	language = {eng},
	number = {1},
	journal = {The Journal of Clinical Psychiatry},
	author = {Demesmaeker, Alice and Chazard, Emmanuel and Vaiva, Guillaume and Amad, Ali},
	month = feb,
	year = {2021},
	pmid = {33999539},
}

OBJECTIVE: Understanding the cumulative effect of several risk factors involved in suicidal behavior is crucial for the development of effective prevention plans. The objective of this study is to provide clinicians with a simple predictive model of the risk of suicide attempts and suicide within 6 months after suicide attempt. METHODS: A prospective observational cohort of 972 subjects, included from January 26, 2010, to February 28, 2013, was used to perform a survival tree analysis with all sociodemographic and clinical variables available at inclusion. The results of the decision tree were then used to define a simple predictive algorithm for clinicians. RESULTS: The results of survival tree analysis highlighted 3 subgroups of patients with an increased risk of suicide attempt or death by suicide within 6 months after suicide attempt: patients with alcohol use disorder and a previous suicide attempt with acute alcohol use (risk ratio [RR] = 2.92; 95% CI, 2.08 to 4.10), patients with anxiety disorders (RR = 0.98; 95% CI, 0.69 to 1.39), and patients with a history of more than 2 suicide attempts in the past 3 years (RR = 2.11; 95% CI, 1.25 to 3.54). The good prognosis group comprised all other patients. CONCLUSIONS: By using a data-driven method, this study identified 4 clinical factors interacting together to reduce or increase the risk of recidivism. These combinations of risk factors allow for a better evaluation of a subject's suicide risk in clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01123174.

@article{disegni_hip_2021,
	title = {Hip arthroscopy in {France}: {An} epidemiological study of postoperative care and outcomes involving 3699 patients},
	volume = {107},
	issn = {1877-0568},
	shorttitle = {Hip arthroscopy in {France}},
	doi = {10.1016/j.otsr.2020.102767},
	abstract = {BACKGROUND: Hip arthroscopy is a surgical procedure that is becoming more and more prevalent in France. Even though indications are now well-established little is still known about patient outcomes. Therefore, the purpose of our retrospective study was to: (1) describe the circumstances in which hip arthroscopies are being performed; (2) study arthroscopy and arthroplasty reoperation rates; (3) assess the incidence of readmissions for complications.
HYPOTHESIS: Hip arthroscopy in France produced similar results to those observed in other countries.
MATERIALS AND METHODS: We conducted a cohort study from January 2008 to December 2014 in the French population using the national hospital discharge database called "Programme de médicalisation des systèmes d'information (PMSI)." We included all admissions that had a hip arthroscopy code and analyzed readmissions for conversion to hip arthroplasty, revision hip arthroscopy and complications (without being able to provide detailed descriptions). Risk factors associated with conversion, revision and readmission for complications were studied after performing a population analysis.
RESULTS: A total of 3,699 patients were included over a period of seven years. The mean age was 40 years, with women being significantly older (mean age of 43 years) than men (38 years) (p{\textless}0.05). The number of procedures increased from 240 in 2008 to 702 in 2014. Synovectomies (67.9\%; 2514/3699) and surgical bone procedures (acetabuloplasty or femoroplasty) (47.3\%; 1751/3699) were the main procedures performed during the primary arthroscopy. In total, 410 patients underwent a conversion to arthroplasty, 231 patients had a revision arthroscopy, and 126 patients suffered a complication. Five years after the index procedure, the conversion rate was 16.3\%, revision rate was 8.2\%, and readmission rate for a postoperative complication was 5\%. The main risk factor associated with conversions was [Hazard ratio (HR) and 95\% Confidence Index (CI)] an age between 40 and 79 years during the first arthroscopy [3.04 (2.40; 3.87) compared with the reference class of 25-39 years]. Patients between ages 16 to 24 years during the first arthroscopy (0.35 [0.20; 0.61] compared with the reference class of 25-39 years) had a decreased risk of conversion (HR and 95\% CI). The main risk factors associated with revisions were: synovectomies [1.90 (1.34; 2.70)] and surgical bone procedures on the femoral neck and/or the acetabulum [1.82 (1.36; 2.4)]. The risk factor associated with complication-related readmissions was an age greater than 40 years [2.23 (1.43; 3.49)].
CONCLUSION: Unlike the international literature, our study population was largely male. The rates of revision (8.2\% after five years) and conversion to arthroplasty (16.3\% after five years) were relatively low and comparable to the different international studies. This procedure, which is not widely performed, is growing in popularity, has low morbidity and remains an interesting approach given the revision and conversion rates after five years. The implementation of specific coding for arthroscopic hip procedures and the pathologies to be treated seems warranted.
LEVEL OF EVIDENCE: IV; descriptive epidemiological study.},
	language = {eng},
	number = {1},
	journal = {Orthopaedics \& traumatology, surgery \& research: OTSR},
	author = {Disegni, Elio and Martinot, Pierre and Dartus, Julien and Migaud, Henri and Putman, Sophie and May, Olivier and Girard, Julien and Chazard, Emmanuel},
	month = feb,
	year = {2021},
	pmid = {33333273},
	keywords = {Complication, Femoroacetabular impingement syndrome, Hip arthroplasty, Hip arthroscopy, Readmission},
	pages = {102767},
}

BACKGROUND: Hip arthroscopy is a surgical procedure that is becoming more and more prevalent in France. Even though indications are now well-established little is still known about patient outcomes. Therefore, the purpose of our retrospective study was to: (1) describe the circumstances in which hip arthroscopies are being performed; (2) study arthroscopy and arthroplasty reoperation rates; (3) assess the incidence of readmissions for complications. HYPOTHESIS: Hip arthroscopy in France produced similar results to those observed in other countries. MATERIALS AND METHODS: We conducted a cohort study from January 2008 to December 2014 in the French population using the national hospital discharge database called "Programme de médicalisation des systèmes d'information (PMSI)." We included all admissions that had a hip arthroscopy code and analyzed readmissions for conversion to hip arthroplasty, revision hip arthroscopy and complications (without being able to provide detailed descriptions). Risk factors associated with conversion, revision and readmission for complications were studied after performing a population analysis. RESULTS: A total of 3,699 patients were included over a period of seven years. The mean age was 40 years, with women being significantly older (mean age of 43 years) than men (38 years) (p\textless0.05). The number of procedures increased from 240 in 2008 to 702 in 2014. Synovectomies (67.9%; 2514/3699) and surgical bone procedures (acetabuloplasty or femoroplasty) (47.3%; 1751/3699) were the main procedures performed during the primary arthroscopy. In total, 410 patients underwent a conversion to arthroplasty, 231 patients had a revision arthroscopy, and 126 patients suffered a complication. Five years after the index procedure, the conversion rate was 16.3%, revision rate was 8.2%, and readmission rate for a postoperative complication was 5%. The main risk factor associated with conversions was [Hazard ratio (HR) and 95% Confidence Index (CI)] an age between 40 and 79 years during the first arthroscopy [3.04 (2.40; 3.87) compared with the reference class of 25-39 years]. Patients between ages 16 to 24 years during the first arthroscopy (0.35 [0.20; 0.61] compared with the reference class of 25-39 years) had a decreased risk of conversion (HR and 95% CI). The main risk factors associated with revisions were: synovectomies [1.90 (1.34; 2.70)] and surgical bone procedures on the femoral neck and/or the acetabulum [1.82 (1.36; 2.4)]. The risk factor associated with complication-related readmissions was an age greater than 40 years [2.23 (1.43; 3.49)]. CONCLUSION: Unlike the international literature, our study population was largely male. The rates of revision (8.2% after five years) and conversion to arthroplasty (16.3% after five years) were relatively low and comparable to the different international studies. This procedure, which is not widely performed, is growing in popularity, has low morbidity and remains an interesting approach given the revision and conversion rates after five years. The implementation of specific coding for arthroscopic hip procedures and the pathologies to be treated seems warranted. LEVEL OF EVIDENCE: IV; descriptive epidemiological study.

@article{chazard_towards_2021,
	title = {Towards {The} {Automated}, {Empirical} {Filtering} of {Drug}-{Drug} {Interaction} {Alerts} in {Clinical} {Decision} {Support} {Systems}: {Historical} {Cohort} {Study} of {Vitamin} {K} {Antagonists}},
	volume = {9},
	issn = {2291-9694},
	shorttitle = {Towards {The} {Automated}, {Empirical} {Filtering} of {Drug}-{Drug} {Interaction} {Alerts} in {Clinical} {Decision} {Support} {Systems}},
	doi = {10.2196/20862},
	abstract = {BACKGROUND: Drug-drug interactions (DDIs) involving vitamin K antagonists (VKAs) constitute an important cause of in-hospital morbidity and mortality. However, the list of potential DDIs is long; the implementation of all these interactions in a clinical decision support system (CDSS) results in over-alerting and alert fatigue, limiting the benefits provided by the CDSS.
OBJECTIVE: To estimate the probability of occurrence of international normalized ratio (INR) changes for each DDI rule, via the reuse of electronic health records.
METHODS: An 8-year, exhaustive, population-based, historical cohort study including a French community hospital, a group of Danish community hospitals, and a Bulgarian hospital. The study database included 156,893 stays. After filtering against two criteria (at least one VKA administration and at least one INR laboratory result), the final analysis covered 4047 stays. Exposure to any of the 145 drugs known to interact with VKA was tracked and analyzed if at least 3 patients were concerned. The main outcomes are VKA potentiation (defined as an INR≥5) and VKA inhibition (defined as an INR≤1.5). Groups were compared using the Fisher exact test and logistic regression, and the results were expressed as an odds ratio (95\% confidence limits).
RESULTS: The drugs known to interact with VKAs either did not have a statistically significant association regarding the outcome (47 drug administrations and 14 discontinuations) or were associated with significant reduction in risk of its occurrence (odds ratio{\textless}1 for 18 administrations and 21 discontinuations).
CONCLUSIONS: The probabilities of outcomes obtained were not those expected on the basis of our current body of pharmacological knowledge. The results do not cast doubt on our current pharmacological knowledge per se but do challenge the commonly accepted idea whereby this knowledge alone should be used to define when a DDI alert should be displayed. Real-life probabilities should also be considered during the filtration of DDI alerts by CDSSs, as proposed in SPC-CDSS (statistically prioritized and contextualized CDSS). However, these probabilities may differ from one hospital to another and so should probably be calculated locally.},
	language = {eng},
	number = {1},
	journal = {JMIR medical informatics},
	author = {Chazard, Emmanuel and Boudry, Augustin and Beeler, Patrick Emanuel and Dalleur, Olivia and Hubert, Hervé and Tréhou, Eric and Beuscart, Jean-Baptiste and Bates, David Westfall},
	month = jan,
	year = {2021},
	pmid = {33470938},
	keywords = {alert fatigue, anticoagulants, clinical decision support system, computerized physician order entry, decision support systems, clinical, drug-drug interaction, drug-related side effects and adverse reactions, medical order entry system, over-alerting, vitamin K antagonist},
	pages = {e20862},
}

BACKGROUND: Drug-drug interactions (DDIs) involving vitamin K antagonists (VKAs) constitute an important cause of in-hospital morbidity and mortality. However, the list of potential DDIs is long; the implementation of all these interactions in a clinical decision support system (CDSS) results in over-alerting and alert fatigue, limiting the benefits provided by the CDSS. OBJECTIVE: To estimate the probability of occurrence of international normalized ratio (INR) changes for each DDI rule, via the reuse of electronic health records. METHODS: An 8-year, exhaustive, population-based, historical cohort study including a French community hospital, a group of Danish community hospitals, and a Bulgarian hospital. The study database included 156,893 stays. After filtering against two criteria (at least one VKA administration and at least one INR laboratory result), the final analysis covered 4047 stays. Exposure to any of the 145 drugs known to interact with VKA was tracked and analyzed if at least 3 patients were concerned. The main outcomes are VKA potentiation (defined as an INR≥5) and VKA inhibition (defined as an INR≤1.5). Groups were compared using the Fisher exact test and logistic regression, and the results were expressed as an odds ratio (95% confidence limits). RESULTS: The drugs known to interact with VKAs either did not have a statistically significant association regarding the outcome (47 drug administrations and 14 discontinuations) or were associated with significant reduction in risk of its occurrence (odds ratio\textless1 for 18 administrations and 21 discontinuations). CONCLUSIONS: The probabilities of outcomes obtained were not those expected on the basis of our current body of pharmacological knowledge. The results do not cast doubt on our current pharmacological knowledge per se but do challenge the commonly accepted idea whereby this knowledge alone should be used to define when a DDI alert should be displayed. Real-life probabilities should also be considered during the filtration of DDI alerts by CDSSs, as proposed in SPC-CDSS (statistically prioritized and contextualized CDSS). However, these probabilities may differ from one hospital to another and so should probably be calculated locally.

@article{hubert_use_2020,
	title = {Use of out-of-hospital cardiac arrest registries to assess {COVID}-19 home mortality},
	volume = {20},
	issn = {1471-2288},
	doi = {10.1186/s12874-020-01189-3},
	abstract = {BACKGROUND: In most countries, the official statistics for the coronavirus disease 2019 (COVID-19) take account of in-hospital deaths but not those that occur at home. The study's objective was to introduce a methodology to assess COVID-19 home deaths by analysing the French national out-of-hospital cardiac arrest (OHCA) registry (RéAC).
METHODS: We performed a retrospective multicentre cohort study based on data recorded in the RéAC by 20 mobile medical teams (MMTs) between March 1st and April 15th, 2020. The participating MMTs covered 10.1\% of the French population. OHCA patients were classified as probable or confirmed COVID-19 cases or as non-COVID-19 cases. To achieve our primary objective, we computed the incidence and survival at hospital admission of cases of COVID-19 OHCA occurring at home. Cardiac arrests that occurred in retirement homes or public places were excluded. Hence, we estimated the number of at-home COVID-19-related deaths that were not accounted for in the French national statistics.
RESULTS: We included 670 patients with OHCA. The extrapolated annual incidence of OHCA per 100,000 inhabitants was 91.9 overall and 17.6 for COVID-19 OHCA occurring at home. In the latter group, the survival rate after being taken to the hospital after an OHCA was 10.9\%. We estimated that 1322 deaths were not accounted in the French national statistics on April 15, 2020.
CONCLUSIONS: The ratio of COVID-19 out-of-hospital deaths to in-hospital deaths was 12.4\%, and so the national statistics underestimated the death rate.},
	language = {eng},
	number = {1},
	journal = {BMC medical research methodology},
	author = {Hubert, Hervé and Baert, Valentine and Beuscart, Jean-Baptiste and Chazard, Emmanuel},
	month = dec,
	year = {2020},
	pmid = {33317467},
	pmcid = {PMC7734460},
	keywords = {COVID-19, COVID-19 home mortality, Epidemiology, Out-of-hospital cardiac arrest},
	pages = {305},
}

BACKGROUND: In most countries, the official statistics for the coronavirus disease 2019 (COVID-19) take account of in-hospital deaths but not those that occur at home. The study's objective was to introduce a methodology to assess COVID-19 home deaths by analysing the French national out-of-hospital cardiac arrest (OHCA) registry (RéAC). METHODS: We performed a retrospective multicentre cohort study based on data recorded in the RéAC by 20 mobile medical teams (MMTs) between March 1st and April 15th, 2020. The participating MMTs covered 10.1% of the French population. OHCA patients were classified as probable or confirmed COVID-19 cases or as non-COVID-19 cases. To achieve our primary objective, we computed the incidence and survival at hospital admission of cases of COVID-19 OHCA occurring at home. Cardiac arrests that occurred in retirement homes or public places were excluded. Hence, we estimated the number of at-home COVID-19-related deaths that were not accounted for in the French national statistics. RESULTS: We included 670 patients with OHCA. The extrapolated annual incidence of OHCA per 100,000 inhabitants was 91.9 overall and 17.6 for COVID-19 OHCA occurring at home. In the latter group, the survival rate after being taken to the hospital after an OHCA was 10.9%. We estimated that 1322 deaths were not accounted in the French national statistics on April 15, 2020. CONCLUSIONS: The ratio of COVID-19 out-of-hospital deaths to in-hospital deaths was 12.4%, and so the national statistics underestimated the death rate.

@article{cren_is_2020,
	title = {Is the survival of patients treated with ipilimumab affected by antibiotics? {An} analysis of 1585 patients from the {French} {National} hospital discharge summary database ({PMSI})},
	volume = {9},
	issn = {2162-402X},
	shorttitle = {Is the survival of patients treated with ipilimumab affected by antibiotics?},
	doi = {10.1080/2162402X.2020.1846914},
	abstract = {Background: The gut microbiota has a key role in the regulation of the immune system. Disruption of the gut microbiota's composition by antibiotics might significantly affect the efficacy of immune checkpoint inhibitors. In a study of patients treated with ipilimumab, we sought to assess the relationship between overall survival and in-hospital antibiotic administration. Methods: Patients having been treated with ipilimumab between January 2012 and November 2014 were selected from the French National Hospital Discharge Summary Database. Exposure to antibiotics was defined as the presence of a hospital stay with a documented systemic bacterial infection in the 2 months before or the month after initiation of the patient's first ever course of ipilimumab. The primary outcome was overall survival. Results: We studied 43,124 hospital stays involving 1585 patients from 97 centers. All patients had received ipilimumab monotherapy for advanced melanoma. Overall, 117 of the 1585 patients (7.4\%) were documented as having received systemic antibiotic therapy in hospital during the defined exposure period. The median overall survival time was shorter in patients with infection (6.3 months, vs. 15.4 months in patients without an infection; hazard ratio (HR) = 1.88, 95\% confidence interval [1.46; 2.43], p = 10-6). In a multivariate analysis adjusted for covariates, infection was still significantly associated with overall survival (HR = 1.68, [1.30; 2.18], p = 10-5). Conclusions: In patients treated with ipilimumab for advanced melanoma, infection, and antibiotic administration in hospital at around the time of the patient's first ever course of ipilimumab appears to be associated with significantly lower clinical benefit.},
	language = {eng},
	number = {1},
	journal = {Oncoimmunology},
	author = {Cren, Pierre-Yves and Bertrand, Nicolas and Le Deley, Marie-Cécile and Génin, Michaël and Mortier, Laurent and Odou, Pascal and Penel, Nicolas and Chazard, Emmanuel},
	month = nov,
	year = {2020},
	pmid = {33299658},
	pmcid = {PMC7714497},
	keywords = {Melanoma, antibiotics, data reuse, gut microbiota, immune checkpoint inhibitor, immunotherapy, infection, ipilimumab},
	pages = {1846914},
}

Background: The gut microbiota has a key role in the regulation of the immune system. Disruption of the gut microbiota's composition by antibiotics might significantly affect the efficacy of immune checkpoint inhibitors. In a study of patients treated with ipilimumab, we sought to assess the relationship between overall survival and in-hospital antibiotic administration. Methods: Patients having been treated with ipilimumab between January 2012 and November 2014 were selected from the French National Hospital Discharge Summary Database. Exposure to antibiotics was defined as the presence of a hospital stay with a documented systemic bacterial infection in the 2 months before or the month after initiation of the patient's first ever course of ipilimumab. The primary outcome was overall survival. Results: We studied 43,124 hospital stays involving 1585 patients from 97 centers. All patients had received ipilimumab monotherapy for advanced melanoma. Overall, 117 of the 1585 patients (7.4%) were documented as having received systemic antibiotic therapy in hospital during the defined exposure period. The median overall survival time was shorter in patients with infection (6.3 months, vs. 15.4 months in patients without an infection; hazard ratio (HR) = 1.88, 95% confidence interval [1.46; 2.43], p = 10-6). In a multivariate analysis adjusted for covariates, infection was still significantly associated with overall survival (HR = 1.68, [1.30; 2.18], p = 10-5). Conclusions: In patients treated with ipilimumab for advanced melanoma, infection, and antibiotic administration in hospital at around the time of the patient's first ever course of ipilimumab appears to be associated with significantly lower clinical benefit.

@article{chazard_big_2020,
	title = {Big data, data reuse en santé : un chemin semé d’embûches nécessitant une approche pluridisciplinaire},
	issn = {1243-275X},
	url = {https://www.hcsp.fr/Explore.cgi/adsp?clef=1173},
	language = {Fr},
	number = {112},
	urldate = {2021-01-05},
	journal = {Actualité et dossier en santé publique},
	author = {Chazard, Emmanuel},
	month = sep,
	year = {2020},
	pages = {51--53},
}

@article{chazard_statistically_2020,
	title = {Statistically {Prioritized} and {Contextualized} {Clinical} {Decision} {Support} {Systems}, the {Future} of {Adverse} {Drug} {Events} {Prevention}?},
	volume = {270},
	issn = {1879-8365},
	doi = {10.3233/SHTI200247},
	abstract = {Clinical decision support systems (CDSS) fail to prevent adverse drug events (ADE), notably due to over-alerting and alert-fatigue. Many methods have been proposed in the literature to reduce over-alerting of CDSS: enhancing post-alert medical management, taking into account user-related context, patient-related context and temporal aspects, improving medical relevance of alerts, filtering or tiering alerts on the basis of their strength of evidence, their severity, their override rate, or the probability of outcome. This paper analyzes the different options, and proposes the setup of SPC-CDSS (statistically prioritized and contextualized CDSS). The principle is that, when a SPC-CDSS is implemented in a medical unit, it first reuses actual clinical data, and searches for traceable outcomes. Then, for each rule trying to prevent this outcome, the SPC-CDSS automatically estimates the conditional probability of outcome knowing that the conditions of the rule are met, by retrospective secondary use of data. The alert can be turned off below a chosen probability threshold. This probability computation can be performed in each medical unit, in order to take into account its sensitivity to context.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Chazard, Emmanuel and Beuscart, Jean-Baptiste and Rochoy, Michaël and Dalleur, Olivia and Decaudin, Bertrand and Odou, Pascal and Ficheur, Grégoire},
	month = jun,
	year = {2020},
	pmid = {32570470},
	keywords = {Adverse drug events, Clinical decision support systems, data reuse},
	pages = {683--687},
}

Clinical decision support systems (CDSS) fail to prevent adverse drug events (ADE), notably due to over-alerting and alert-fatigue. Many methods have been proposed in the literature to reduce over-alerting of CDSS: enhancing post-alert medical management, taking into account user-related context, patient-related context and temporal aspects, improving medical relevance of alerts, filtering or tiering alerts on the basis of their strength of evidence, their severity, their override rate, or the probability of outcome. This paper analyzes the different options, and proposes the setup of SPC-CDSS (statistically prioritized and contextualized CDSS). The principle is that, when a SPC-CDSS is implemented in a medical unit, it first reuses actual clinical data, and searches for traceable outcomes. Then, for each rule trying to prevent this outcome, the SPC-CDSS automatically estimates the conditional probability of outcome knowing that the conditions of the rule are met, by retrospective secondary use of data. The alert can be turned off below a chosen probability threshold. This probability computation can be performed in each medical unit, in order to take into account its sensitivity to context.

@article{dhalluin_comparison_2020,
	title = {Comparison of {Unplanned} 30-{Day} {Readmission} {Prediction} {Models}, {Based} on {Hospital} {Warehouse} and {Demographic} {Data}},
	volume = {270},
	issn = {1879-8365},
	doi = {10.3233/SHTI200220},
	abstract = {Anticipating unplanned hospital readmission episodes is a safety and medico-economic issue. We compared statistics (Logistic Regression) and machine learning algorithms (Gradient Boosting, Random Forest, and Neural Network) for predicting the risk of all-cause, 30-day hospital readmission using data from the clinical data warehouse of Rennes and from other sources. The dataset included hospital stays based on the criteria of the French national methodology for the 30-day readmission rate (i.e., patients older than 18 years, geolocation, no iterative stays, and no hospitalization for palliative care), with a similar pre-processing for all algorithms. We calculated the area under the ROC curve (AUC) for 30-day readmission prediction by each model. In total, we included 259114 hospital stays, with a readmission rate of 8.8\%. The AUC was 0.61 for the Logistic Regression, 0.69 for the Gradient Boosting, 0.69 for the Random Forest, and 0.62 for the Neural Network model. We obtained the best performance and reproducibility to predict readmissions with Random Forest, and found that the algorithms performed better when data came from different sources.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Dhalluin, Thibault and Bannay, Aurélie and Lemordant, Pierre and Sylvestre, Emmanuelle and Chazard, Emmanuel and Cuggia, Marc and Bouzille, Guillaume},
	month = jun,
	year = {2020},
	pmid = {32570443},
	keywords = {Data Warehousing, Medical Informatics, Patient Readmission/statistics and numerical data, Supervised Machine Learning},
	pages = {547--551},
}

Anticipating unplanned hospital readmission episodes is a safety and medico-economic issue. We compared statistics (Logistic Regression) and machine learning algorithms (Gradient Boosting, Random Forest, and Neural Network) for predicting the risk of all-cause, 30-day hospital readmission using data from the clinical data warehouse of Rennes and from other sources. The dataset included hospital stays based on the criteria of the French national methodology for the 30-day readmission rate (i.e., patients older than 18 years, geolocation, no iterative stays, and no hospitalization for palliative care), with a similar pre-processing for all algorithms. We calculated the area under the ROC curve (AUC) for 30-day readmission prediction by each model. In total, we included 259114 hospital stays, with a readmission rate of 8.8%. The AUC was 0.61 for the Logistic Regression, 0.69 for the Gradient Boosting, 0.69 for the Random Forest, and 0.62 for the Neural Network model. We obtained the best performance and reproducibility to predict readmissions with Random Forest, and found that the algorithms performed better when data came from different sources.

@article{lamer_exploring_2020,
	title = {Exploring {Patient} {Path} {Through} {Sankey} {Diagram}: {A} {Proof} of {Concept}},
	volume = {270},
	issn = {1879-8365},
	shorttitle = {Exploring {Patient} {Path} {Through} {Sankey} {Diagram}},
	doi = {10.3233/SHTI200154},
	abstract = {Managers, physicians and researchers need to study patient's path for purposes of management, quality of care and research. We present the proof of concept of the use of a flow diagram, the Sankey diagram, to visualize the trajectory of a population that experienced an event. This representation was tested with two case studies in populations from the anesthesia data warehouse of Lille University Hospital. For the 551 patients undergoing a pancreaticoduodenectomy, Sankey diagram helped us identify atypical care paths of patient being transferred too late in an intensive care unit. For 473953 patients who have had anesthesia procedure, Sankey diagram highlighted that mortality and re-operation rates increase with the number of operations. This preliminary work has been well received by end-users and allowed managers, physicians and researchers to visualize the paths of patients and to provide visualization support for research questions. This work will be followed by generalization.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Lamer, Antoine and Laurent, Gery and Pelayo, Sylvia and El Amrani, Mehdi and Chazard, Emmanuel and Marcilly, Romaric},
	month = jun,
	year = {2020},
	pmid = {32570378},
	keywords = {Data Reuse, Data Visualization, Patient Path, Sankey Diagram},
	pages = {218--222},
}

Managers, physicians and researchers need to study patient's path for purposes of management, quality of care and research. We present the proof of concept of the use of a flow diagram, the Sankey diagram, to visualize the trajectory of a population that experienced an event. This representation was tested with two case studies in populations from the anesthesia data warehouse of Lille University Hospital. For the 551 patients undergoing a pancreaticoduodenectomy, Sankey diagram helped us identify atypical care paths of patient being transferred too late in an intensive care unit. For 473953 patients who have had anesthesia procedure, Sankey diagram highlighted that mortality and re-operation rates increase with the number of operations. This preliminary work has been well received by end-users and allowed managers, physicians and researchers to visualize the paths of patients and to provide visualization support for research questions. This work will be followed by generalization.

@article{martignene_heimdall_2020,
	title = {Heimdall, a {Computer} {Program} for {Electronic} {Health} {Records} {Data} {Visualization}},
	volume = {270},
	issn = {1879-8365},
	doi = {10.3233/SHTI200160},
	abstract = {INTRODUCTION: Electronic health records (EHR) comprehend structured and unstructured data, that are usually time dependent, enabling the use of timelines. However, it is often difficult to display all data without inducing information overload. In both clinical usual care and medical research, users should be able to quickly find relevant information, with minimal cognitive overhead. Our goal was to devise simple visualization techniques for handling medical data in both contexts.
METHODS: An abstraction layer for structured EHR data was devised after an informal literature review and discussions between authors. The "Heimdall" prototype was developed. Two experts evaluated the tool by answering 5 questions on 24 clinical cases.
RESULTS: Temporal data was abstracted in three simple types: events, states and measures, with appropriate visual representations for each type. Heimdall can load and display complex heterogeneous structured temporal data in a straightforward way. The main view can display events, states and measures along a shared timeline. Users can summarize data using temporal, hierarchical compression and filters. Default and custom views can be used to work in problem- oriented ways. The evaluation found conclusive results.
CONCLUSION: The "Heimdall" prototype provides a comprehensive and efficient graphical interface for EHR data visualization. It is open source, can be used with an R package, and is available at https://koromix.dev/files/R.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Martignene, Niels and Balcaen, Thibaut and Bouzille, Guillaume and Calafiore, Matthieu and Beuscart, Jean-Baptiste and Lamer, Antoine and Legrand, Bertrand and Ficheur, Grégoire and Chazard, Emmanuel},
	month = jun,
	year = {2020},
	pmid = {32570384},
	keywords = {Electronic health records, Feature extraction, Timeline, Visualization},
	pages = {247--251},
}

INTRODUCTION: Electronic health records (EHR) comprehend structured and unstructured data, that are usually time dependent, enabling the use of timelines. However, it is often difficult to display all data without inducing information overload. In both clinical usual care and medical research, users should be able to quickly find relevant information, with minimal cognitive overhead. Our goal was to devise simple visualization techniques for handling medical data in both contexts. METHODS: An abstraction layer for structured EHR data was devised after an informal literature review and discussions between authors. The "Heimdall" prototype was developed. Two experts evaluated the tool by answering 5 questions on 24 clinical cases. RESULTS: Temporal data was abstracted in three simple types: events, states and measures, with appropriate visual representations for each type. Heimdall can load and display complex heterogeneous structured temporal data in a straightforward way. The main view can display events, states and measures along a shared timeline. Users can summarize data using temporal, hierarchical compression and filters. Default and custom views can be used to work in problem- oriented ways. The evaluation found conclusive results. CONCLUSION: The "Heimdall" prototype provides a comprehensive and efficient graphical interface for EHR data visualization. It is open source, can be used with an R package, and is available at https://koromix.dev/files/R.

@article{sylvestre_semi-automated_2020,
	title = {A {Semi}-{Automated} {Approach} for {Multilingual} {Terminology} {Matching}: {Mapping} the {French} {Version} of the {ICD}-10 to the {ICD}-10 {CM}},
	volume = {270},
	issn = {1879-8365},
	shorttitle = {A {Semi}-{Automated} {Approach} for {Multilingual} {Terminology} {Matching}},
	doi = {10.3233/SHTI200114},
	abstract = {The aim of this study was to develop a simple method to map the French International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) with the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10 CM). We sought to map these terminologies forward (ICD-10 to ICD-10 CM) and backward (ICD-10 CM to ICD-10) and to assess the accuracy of these two mappings. We used several terminology resources such as the Unified Medical Language System (UMLS) Metathesaurus, Bioportal, the latest version available of the French ICD-10 and several official mapping files between different versions of the ICD-10. We first retrieved existing partial mapping between the ICD-10 and the ICD-10 CM. Then, we automatically matched the ICD-10 with the ICD-10-CM, using our different reference mapping files. Finally, we used manual review and natural language processing (NLP) to match labels between the two terminologies. We assessed the accuracy of both methods with a manual review of a random dataset from the results files. The overall matching was between 94.2 and 100\%. The backward mapping was better than the forward one, especially regarding exact matches. In both cases, the NLP step was highly accurate. When there are no available experts from the ontology or NLP fields for multi-lingual ontology matching, this simple approach enables secondary reuse of Electronic Health Records (EHR) and billing data for research purposes in an international context.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Sylvestre, Emmanuelle and Bouzillé, Guillaume and McDuffie, Michael and Chazard, Emmanuel and Avillach, Paul and Cuggia, Marc},
	month = jun,
	year = {2020},
	pmid = {32570338},
	keywords = {Clinical terminologies, ICD-10, Interoperability, Multilingual matching},
	pages = {18--22},
}

The aim of this study was to develop a simple method to map the French International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) with the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10 CM). We sought to map these terminologies forward (ICD-10 to ICD-10 CM) and backward (ICD-10 CM to ICD-10) and to assess the accuracy of these two mappings. We used several terminology resources such as the Unified Medical Language System (UMLS) Metathesaurus, Bioportal, the latest version available of the French ICD-10 and several official mapping files between different versions of the ICD-10. We first retrieved existing partial mapping between the ICD-10 and the ICD-10 CM. Then, we automatically matched the ICD-10 with the ICD-10-CM, using our different reference mapping files. Finally, we used manual review and natural language processing (NLP) to match labels between the two terminologies. We assessed the accuracy of both methods with a manual review of a random dataset from the results files. The overall matching was between 94.2 and 100%. The backward mapping was better than the forward one, especially regarding exact matches. In both cases, the NLP step was highly accurate. When there are no available experts from the ontology or NLP fields for multi-lingual ontology matching, this simple approach enables secondary reuse of Electronic Health Records (EHR) and billing data for research purposes in an international context.

@article{hequette-ruz_hip_2020,
	title = {Hip fractures and characteristics of living area: a fine-scale spatial analysis in {France}},
	issn = {1433-2965},
	shorttitle = {Hip fractures and characteristics of living area},
	doi = {10.1007/s00198-020-05363-7},
	abstract = {We investigated the association between hip fracture incidence and living area characteristics in France. The spatial distribution of hip fracture incidence was heterogeneous and there was a significant relationship between social deprivation, urbanization, health access, and hip fracture risk.
INTRODUCTION: Several studies have shown great disparities in spatial repartition of hip fractures (HF). The aim of the study was to analyze the association between HF incidence and characteristics of the living area.
METHODS: All patients aged 50 or older, living in France, who were hospitalized for HF between 2012 and 2014 were included, using the French national hospital discharge database. Standardized incidence ratio (SIR) was calculated for each spatial unit and adjusted on age and sex. An ecological regression was performed to analyze the association between HF standardized incidence and ecological variables. We adjusted the model for neighborhood spatial structure. We used three variables to characterize the living areas: a deprivation index (French-EDI); healthcare access (French standardized index); land use (percentage of artificialized surfaces).
RESULTS: A total of 236,328 HF were recorded in the French hospital national database, leading to an annual HF incidence of 333/100,000. The spatial analysis revealed geographical variations of HF incidence with SIR varying from 0.67 (0.52; 0.85) to 1.45 (1.23; 1.70). There was a significant association between HF incidence rates and (1) French-EDI (trend p = 0.0023); (2) general practitioner and nurse accessibility (trend p = 0.0232 and p = 0.0129, respectively); (3) percentage of artificialized surfaces (p {\textless} 0.0001).
CONCLUSION: The characteristics of the living area are associated with significant differences in the risk of hip fracture of older people.},
	language = {eng},
	journal = {Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA},
	author = {Héquette-Ruz, R. and Beuscart, J.-B. and Ficheur, G. and Chazard, E. and Guillaume, E. and Paccou, J. and Puisieux, F. and Genin, M.},
	month = mar,
	year = {2020},
	pmid = {32140738},
	keywords = {Aged, Aged, 80 and over, Ecological factors, Elderly, France, Hip Fractures, Hip fracture, Humans, Incidence, Middle Aged, Residence Characteristics, Spatial Analysis, Spatial regression},
}

We investigated the association between hip fracture incidence and living area characteristics in France. The spatial distribution of hip fracture incidence was heterogeneous and there was a significant relationship between social deprivation, urbanization, health access, and hip fracture risk. INTRODUCTION: Several studies have shown great disparities in spatial repartition of hip fractures (HF). The aim of the study was to analyze the association between HF incidence and characteristics of the living area. METHODS: All patients aged 50 or older, living in France, who were hospitalized for HF between 2012 and 2014 were included, using the French national hospital discharge database. Standardized incidence ratio (SIR) was calculated for each spatial unit and adjusted on age and sex. An ecological regression was performed to analyze the association between HF standardized incidence and ecological variables. We adjusted the model for neighborhood spatial structure. We used three variables to characterize the living areas: a deprivation index (French-EDI); healthcare access (French standardized index); land use (percentage of artificialized surfaces). RESULTS: A total of 236,328 HF were recorded in the French hospital national database, leading to an annual HF incidence of 333/100,000. The spatial analysis revealed geographical variations of HF incidence with SIR varying from 0.67 (0.52; 0.85) to 1.45 (1.23; 1.70). There was a significant association between HF incidence rates and (1) French-EDI (trend p = 0.0023); (2) general practitioner and nurse accessibility (trend p = 0.0232 and p = 0.0129, respectively); (3) percentage of artificialized surfaces (p \textless 0.0001). CONCLUSION: The characteristics of the living area are associated with significant differences in the risk of hip fracture of older people.

@article{martignene_heimdall_2020-1,
	series = {{VIIe} {Colloque} national organisé conjointement par l’{Association} des {Epidémiologistes} de langue française ({Adelf}) et par l’{Association} {Evaluation}, management, organisations, santé ({Emois}) {Livre} des résumés présentés au {Congrès} {Paris}, 12 et 13 mars 2020},
	title = {Heimdall, logiciel de visualisation des données temporelles des dossiers patients électroniques},
	volume = {68},
	issn = {0398-7620},
	url = {http://www.sciencedirect.com/science/article/pii/S0398762020300651},
	doi = {10.1016/j.respe.2020.01.057},
	abstract = {Introduction
Le dossier patient électronique contient des données temporelles structurées (PMSI, biologie médicale, médicaments, etc.) ou non (documents, images, etc.). Leur utilisation est double : transactionnelle (un seul patient, pour le soin) ou décisionnelle (plusieurs patients, réutilisation de données). Des outils de visualisation existent mais ne couvrent pas ces deux champs, rendent mal l’aspect hiérarchique des terminologies, et décloisonnent mal les données de sources différentes. L’objectif est de concevoir un tel outil.
Méthodes
Conception : nous abstrayons les types de données, puis spécifions les composants graphiques et leur mode de compactage. Développement : le prototype est développé en C++, disponible en librairie R. Évaluation : deux médecins répondent à cinq questions portant sur 24 cas cliniques réels d’insuffisance rénale aiguë, en utilisant trois interfaces dont Heimdall.
Résultats
Prototype : le temps suit l’axe horizontal, les concepts suivent l’axe vertical. Les « événements » sont représentés sous forme de triangles, les « états » de rectangles, les « mesures » de courbes (avec interpolation LOCF, linéaire ou spline). Ces composants sont embarqués dans une arborescence exploitant notamment celle des terminologies (CIM10, CCAM, etc.). Cette arborescence permet un repliement vertical, avec fusion des composants. Une condensation temporelle est possible. En mode décisionnel, les patients peuvent être alignés sur un événement (ex : appendicectomie). Les vues par problème (ex : fonction rénale, hématologie, etc.) déploient automatiquement des composants et en compactent d’autres. Évaluation : pour charger 3500 patients (360 000 valeurs), il faut une seconde et 50 Mo de mémoire. L’interface Heimdall est aussi rapide à utiliser par des médecins qu’une interface filtrée, et plus qu’une interface brute. Le taux d’erreur est identique.
Discussion/Conclusion
Heimdall est intuitif, entièrement automatisé et interfacé avec R. Les vues par problème font gagner du temps. Actuellement, les données non temporelles n’y trouvent pas de place, et Heimdall n’embarque pas d’outil de requête. Heimdall est open source et peut être téléchargé sur https://koromix.dev/files/R.},
	language = {fr},
	urldate = {2020-03-23},
	journal = {Revue d'Épidémiologie et de Santé Publique},
	author = {Martignene, N. and Balcaen, T. and Bouzillé, G. and Calafiore, M. and Legrand, B. and Chazard, E.},
	month = mar,
	year = {2020},
	keywords = {Dossier patient électronique, Extraction de caractéristiques, Visualisation de données},
	pages = {S26},
}

Introduction Le dossier patient électronique contient des données temporelles structurées (PMSI, biologie médicale, médicaments, etc.) ou non (documents, images, etc.). Leur utilisation est double : transactionnelle (un seul patient, pour le soin) ou décisionnelle (plusieurs patients, réutilisation de données). Des outils de visualisation existent mais ne couvrent pas ces deux champs, rendent mal l’aspect hiérarchique des terminologies, et décloisonnent mal les données de sources différentes. L’objectif est de concevoir un tel outil. Méthodes Conception : nous abstrayons les types de données, puis spécifions les composants graphiques et leur mode de compactage. Développement : le prototype est développé en C++, disponible en librairie R. Évaluation : deux médecins répondent à cinq questions portant sur 24 cas cliniques réels d’insuffisance rénale aiguë, en utilisant trois interfaces dont Heimdall. Résultats Prototype : le temps suit l’axe horizontal, les concepts suivent l’axe vertical. Les « événements » sont représentés sous forme de triangles, les « états » de rectangles, les « mesures » de courbes (avec interpolation LOCF, linéaire ou spline). Ces composants sont embarqués dans une arborescence exploitant notamment celle des terminologies (CIM10, CCAM, etc.). Cette arborescence permet un repliement vertical, avec fusion des composants. Une condensation temporelle est possible. En mode décisionnel, les patients peuvent être alignés sur un événement (ex : appendicectomie). Les vues par problème (ex : fonction rénale, hématologie, etc.) déploient automatiquement des composants et en compactent d’autres. Évaluation : pour charger 3500 patients (360 000 valeurs), il faut une seconde et 50 Mo de mémoire. L’interface Heimdall est aussi rapide à utiliser par des médecins qu’une interface filtrée, et plus qu’une interface brute. Le taux d’erreur est identique. Discussion/Conclusion Heimdall est intuitif, entièrement automatisé et interfacé avec R. Les vues par problème font gagner du temps. Actuellement, les données non temporelles n’y trouvent pas de place, et Heimdall n’embarque pas d’outil de requête. Heimdall est open source et peut être téléchargé sur https://koromix.dev/files/R.

@article{boullenger_diabetiques_2020,
	series = {{VIIe} {Colloque} national organisé conjointement par l’{Association} des {Epidémiologistes} de langue française ({Adelf}) et par l’{Association} {Evaluation}, management, organisations, santé ({Emois}) {Livre} des résumés présentés au {Congrès} {Paris}, 12 et 13 mars 2020},
	title = {Diabétiques de type 2 suivis en médecine générale : séquences de traitements et évolution},
	volume = {68},
	issn = {0398-7620},
	shorttitle = {Diabétiques de type 2 suivis en médecine générale},
	url = {http://www.sciencedirect.com/science/article/pii/S0398762020300584},
	doi = {10.1016/j.respe.2020.01.050},
	abstract = {Introduction
Le traitement des diabétiques de type 2 repose sur le régime, les antidiabétiques oraux (ADO) et l’insuline. L’enchaînement des séquences et l’évolution du poids et de l’hémoglobine glyquée (HbA1c) ont été décrites aux USA et en Australie notamment, pas en France. La plupart des cabinets de médecine générale sont informatisés, mais à ce jour très peu de données ambulatoires sont exploitées en France, en dehors des données de remboursement. L’objectif est de réutiliser des données de médecine générale pour décrire l’évolution des patients diabétiques de type 2 traités en ville.
Méthodes
Les données d’un cabinet de groupe de médecine générale de Tourcoing de 2006 à 2018 sont analysées. Pour les patients diabétiques de type 2, sont analysés : traitements, diagnostics, résultats d’analyse de biologie médicale, taille et poids. Les femmes enceintes sont exclues.
Résultats
Sont inclus : 403 patients, 1030 séquences de traitement, 39 042 consultations, 2440 mesures d’HbA1c et 9722 poids. À l’inclusion, on trouve 50,1 \% de femmes, un âge moyen de 57,0 ans, un poids moyen de 84,4kg, un IMC moyen de 30,3kg/m2. L’HbA1c médiane est de 6,8 \%. Les patients sont sous régime (40,7 \%), ADO (54,1 \%) ou insuline (5,2 \%). Le suivi dure en médiane 3,51 ans. On observe en moyenne 5,18 poids par an et par patient, et 1,30 HbA1c. Pour les 375 patients compatibles avec une séquence « régime puis ADO puis insuline » (durées et âges médians), le régime commence à 54,7 ans et se termine après 3,71 ans, le traitement oral commence à 56,6 ans et dure 3,61 ans, enfin le traitement par insuline commence à 62,5 ans. Le poids est stable deux ans sous régime puis augmente, puis est stable sous ADO, puis finit par diminuer sous insuline. L’HbA1c baisse puis remonte sous régime, est stable sous ADO, puis diminue sous insuline.
Discussion/Conclusion
Ces résultats descriptifs sont utiles pour anticiper et expliquer aux patients leur évolution. Ils illustrent la richesse des données de médecine générale, et leur potentiel de réutilisation.},
	language = {fr},
	urldate = {2020-03-23},
	journal = {Revue d'Épidémiologie et de Santé Publique},
	author = {Boullenger, L. and Balcaen, T. and Calafiore, M. and Legrand, B. and Rochoy, M. and Chazard, E.},
	month = mar,
	year = {2020},
	keywords = {Diabète type 2, HbA, Logiciels des cabinets médicaux, Médecine générale, Réutilisation de données},
	pages = {S23},
}

Introduction Le traitement des diabétiques de type 2 repose sur le régime, les antidiabétiques oraux (ADO) et l’insuline. L’enchaînement des séquences et l’évolution du poids et de l’hémoglobine glyquée (HbA1c) ont été décrites aux USA et en Australie notamment, pas en France. La plupart des cabinets de médecine générale sont informatisés, mais à ce jour très peu de données ambulatoires sont exploitées en France, en dehors des données de remboursement. L’objectif est de réutiliser des données de médecine générale pour décrire l’évolution des patients diabétiques de type 2 traités en ville. Méthodes Les données d’un cabinet de groupe de médecine générale de Tourcoing de 2006 à 2018 sont analysées. Pour les patients diabétiques de type 2, sont analysés : traitements, diagnostics, résultats d’analyse de biologie médicale, taille et poids. Les femmes enceintes sont exclues. Résultats Sont inclus : 403 patients, 1030 séquences de traitement, 39 042 consultations, 2440 mesures d’HbA1c et 9722 poids. À l’inclusion, on trouve 50,1 % de femmes, un âge moyen de 57,0 ans, un poids moyen de 84,4kg, un IMC moyen de 30,3kg/m2. L’HbA1c médiane est de 6,8 %. Les patients sont sous régime (40,7 %), ADO (54,1 %) ou insuline (5,2 %). Le suivi dure en médiane 3,51 ans. On observe en moyenne 5,18 poids par an et par patient, et 1,30 HbA1c. Pour les 375 patients compatibles avec une séquence « régime puis ADO puis insuline » (durées et âges médians), le régime commence à 54,7 ans et se termine après 3,71 ans, le traitement oral commence à 56,6 ans et dure 3,61 ans, enfin le traitement par insuline commence à 62,5 ans. Le poids est stable deux ans sous régime puis augmente, puis est stable sous ADO, puis finit par diminuer sous insuline. L’HbA1c baisse puis remonte sous régime, est stable sous ADO, puis diminue sous insuline. Discussion/Conclusion Ces résultats descriptifs sont utiles pour anticiper et expliquer aux patients leur évolution. Ils illustrent la richesse des données de médecine générale, et leur potentiel de réutilisation.

@article{degoul_lntraoperative_2020,
	title = {lntraoperative administration of 6\% hydroxyethyl starch 130/0.4 is not associated with acute kidney injury in elective non-cardiac surgery: a sequential and propensity-matched analysis},
	issn = {2352-5568},
	shorttitle = {lntraoperative administration of 6\% hydroxyethyl starch 130/0.4 is not associated with acute kidney injury in elective non-cardiac surgery},
	doi = {10.1016/j.accpm.2019.08.002},
	abstract = {BACKGROUND: Intraoperative use of hydroxyethyl starch (HES) may increase the risk of postoperative acute kidney injury (AKI). Data from large populations are lacking. We aimed to assess whether intraoperative administration of 6\% HES 130/0.4 is associated with AKI in non-cardiac surgery.
METHODS: This retrospective study used the electronic records concerning elective abdominal, urologic, thoracic and peripheral vascular surgeries from 2010 to 2015. HES and non-HES patients were compared using a propensity score matching. Postoperative AKI, defined by stage 3 of the Kidney Disease Improving Global Outcomes (KDIGO) score, was the primary outcome. Because the use of HES markedly decreased in 2013, additional analyses, restricted to the 2010-2012 period, were also performed.
RESULTS: 23 045, and 11 691 patients were included in the whole, and restricted periods, respectively. The reduction in HES use was not accompanied by any change in the incidence of AKI. Unadjusted association between HES and KDIGO 3 AKI was significant (OR [95\% CI] of 2.13 [1.67, 2.71]). For the whole period, 6460 patients were matched. Odd ratios for KDIGO 3 and all-stage AKI when using HES (10.3 ± 4.7 ml.kg-1 ) were 1.20 (95\% CI [0.74, 1.95]), and 1.21 (95\% CI [0.95, 1.54]), respectively. There was no association with the initiation of renal replacement therapy or in-hospital mortality either. Similar results were found for the restricted period.
CONCLUSION: The intraoperative use of moderate doses of 6\% HES 130/0.4 was not associated with increased risk of AKI. No conclusion can be drawn for higher doses of HES.},
	language = {eng},
	journal = {Anaesthesia, Critical Care \& Pain Medicine},
	author = {Degoul, Samuel and Chazard, Emmanuel and Lamer, Antoine and Lebuffe, Gilles and Duhamel, Alain and Tavernier, Benoît},
	month = feb,
	year = {2020},
	pmid = {32068135},
	keywords = {Acute Kidney Injury, Acute kidney injury, Elective Surgical Procedures, Elective surgical procedures, Hydroxyethyl Starch Derivatives, Hydroxyethyl starch derivatives, Patient Outcome Assessment, Patient outcome assessment},
}

BACKGROUND: Intraoperative use of hydroxyethyl starch (HES) may increase the risk of postoperative acute kidney injury (AKI). Data from large populations are lacking. We aimed to assess whether intraoperative administration of 6% HES 130/0.4 is associated with AKI in non-cardiac surgery. METHODS: This retrospective study used the electronic records concerning elective abdominal, urologic, thoracic and peripheral vascular surgeries from 2010 to 2015. HES and non-HES patients were compared using a propensity score matching. Postoperative AKI, defined by stage 3 of the Kidney Disease Improving Global Outcomes (KDIGO) score, was the primary outcome. Because the use of HES markedly decreased in 2013, additional analyses, restricted to the 2010-2012 period, were also performed. RESULTS: 23 045, and 11 691 patients were included in the whole, and restricted periods, respectively. The reduction in HES use was not accompanied by any change in the incidence of AKI. Unadjusted association between HES and KDIGO 3 AKI was significant (OR [95% CI] of 2.13 [1.67, 2.71]). For the whole period, 6460 patients were matched. Odd ratios for KDIGO 3 and all-stage AKI when using HES (10.3 ± 4.7 ml.kg-1 ) were 1.20 (95% CI [0.74, 1.95]), and 1.21 (95% CI [0.95, 1.54]), respectively. There was no association with the initiation of renal replacement therapy or in-hospital mortality either. Similar results were found for the restricted period. CONCLUSION: The intraoperative use of moderate doses of 6% HES 130/0.4 was not associated with increased risk of AKI. No conclusion can be drawn for higher doses of HES.

@article{mairesse_complications_2020,
	title = {Complications and reoperation after pelvic organ prolapse, impact of hysterectomy, surgical approach and surgeon experience},
	issn = {1433-3023},
	doi = {10.1007/s00192-019-04210-6},
	abstract = {INTRODUCTION AND HYPOTHESIS: The surgical treatment of pelvic organ prolapse (POP) is associated with specific complications. Our primary objective was to assess the recurrence requiring reoperation after prolapse surgery, and our secondary objectives were to assess the early complications and secondary surgery for urinary incontinence.
METHODS: Retrospective study of a population-based cohort of all hospital or outpatient stays including POP surgery from 2008 to 2014, using the French nationwide discharge summary database. We calculated the rates of hospital readmission following surgery as well as the rates of reoperation for recurrent prolapse and subsequent procedures performed for urinary incontinence.
RESULTS: A total of 310,938 patients had undergone surgery for POP. Two hundred fourteen (0.07\%) patients died, and 0.45\% were admitted to an intensive care unit; 4.4\% of the patients underwent surgery for the recurrence of prolapse. Concomitant hysterectomy in the first surgery was associated with a significantly lower risk of POP surgery recurrence: (hazard ratio (HR) [95\% confidence interval (CI)] = 0.51 [0.49; 0.53]). A total of 1386 (2.5\%) patients were readmitted to the hospital for early (30-day) complications of prolapse surgery. The most frequent reasons for early readmission were local infection (32.8\%), hemorrhage (21.4\%) and pain (17.2\%). Risk factors for complications were obesity, hospitals with low levels of activity and associated incontinence surgery; 4.6\% of the patients required secondary surgery for urinary incontinence; obesity was a risk factor (HR [95\% CI] = 1.12 [1.01; 1.24]), and the vaginal route was a protective factor (odds ratio = 1.86 for laparoscopy, 1.44 for laparotomy and 1.25 for multiple approaches).
CONCLUSIONS: POP surgery is associated with low rates of complication and recurrence. Complications occurred most commonly following combined surgeries for both prolapse and incontinence and in hospitals with low surgical volumes. Concomitant hysterectomy appears to be protective for the need for additional prolapse surgery, and the vaginal route leads to a lower frequency of secondary surgery for urinary incontinence.},
	language = {eng},
	journal = {International Urogynecology Journal},
	author = {Mairesse, Sybil and Chazard, Emmanuel and Giraudet, Géraldine and Cosson, Michel and Bartolo, Stéphanie},
	month = jan,
	year = {2020},
	pmid = {31912174},
	keywords = {Complication, Hysterectomy, Prolapse surgery, Urinary incontinence},
}

INTRODUCTION AND HYPOTHESIS: The surgical treatment of pelvic organ prolapse (POP) is associated with specific complications. Our primary objective was to assess the recurrence requiring reoperation after prolapse surgery, and our secondary objectives were to assess the early complications and secondary surgery for urinary incontinence. METHODS: Retrospective study of a population-based cohort of all hospital or outpatient stays including POP surgery from 2008 to 2014, using the French nationwide discharge summary database. We calculated the rates of hospital readmission following surgery as well as the rates of reoperation for recurrent prolapse and subsequent procedures performed for urinary incontinence. RESULTS: A total of 310,938 patients had undergone surgery for POP. Two hundred fourteen (0.07%) patients died, and 0.45% were admitted to an intensive care unit; 4.4% of the patients underwent surgery for the recurrence of prolapse. Concomitant hysterectomy in the first surgery was associated with a significantly lower risk of POP surgery recurrence: (hazard ratio (HR) [95% confidence interval (CI)] = 0.51 [0.49; 0.53]). A total of 1386 (2.5%) patients were readmitted to the hospital for early (30-day) complications of prolapse surgery. The most frequent reasons for early readmission were local infection (32.8%), hemorrhage (21.4%) and pain (17.2%). Risk factors for complications were obesity, hospitals with low levels of activity and associated incontinence surgery; 4.6% of the patients required secondary surgery for urinary incontinence; obesity was a risk factor (HR [95% CI] = 1.12 [1.01; 1.24]), and the vaginal route was a protective factor (odds ratio = 1.86 for laparoscopy, 1.44 for laparotomy and 1.25 for multiple approaches). CONCLUSIONS: POP surgery is associated with low rates of complication and recurrence. Complications occurred most commonly following combined surgeries for both prolapse and incontinence and in hospitals with low surgical volumes. Concomitant hysterectomy appears to be protective for the need for additional prolapse surgery, and the vaginal route leads to a lower frequency of secondary surgery for urinary incontinence.

@article{lamer_transforming_2020,
	title = {Transforming {French} {Electronic} {Health} {Records} into the {Observational} {Medical} {Outcome} {Partnership}'s {Common} {Data} {Model}: {A} {Feasibility} {Study}},
	volume = {11},
	issn = {1869-0327},
	shorttitle = {Transforming {French} {Electronic} {Health} {Records} into the {Observational} {Medical} {Outcome} {Partnership}'s {Common} {Data} {Model}},
	doi = {10.1055/s-0039-3402754},
	abstract = {BACKGROUND: Common data models (CDMs) enable data to be standardized, and facilitate data exchange, sharing, and storage, particularly when the data have been collected via distinct, heterogeneous systems. Moreover, CDMs provide tools for data quality assessment, integration into models, visualization, and analysis. The observational medical outcome partnership (OMOP) provides a CDM for organizing and standardizing databases. Common data models not only facilitate data integration but also (and especially for the OMOP model) extends the range of available statistical analyses.
OBJECTIVE: This study aimed to evaluate the feasibility of implementing French national electronic health records in the OMOP CDM.
METHODS: The OMOP's specifications were used to audit the source data, specify the transformation into the OMOP CDM, implement an extract-transform-load process to feed data from the French health care system into the OMOP CDM, and evaluate the final database.
RESULTS: Seventeen vocabularies corresponding to the French context were added to the OMOP CDM's concepts. Three French terminologies were automatically mapped to standardized vocabularies. We loaded nine tables from the OMOP CDM's "standardized clinical data" section, and three tables from the "standardized health system data" section. Outpatient and inpatient data from 38,730 individuals were integrated. The median (interquartile range) number of outpatient and inpatient stays per patient was 160 (19-364).
CONCLUSION: Our results demonstrated that data from the French national health care system can be integrated into the OMOP CDM. One of the main challenges was the use of international OMOP concepts to annotate data recorded in a French context. The use of local terminologies was an obstacle to conceptual mapping; with the exception of an adaptation of the International Classification of Diseases 10th Revision, the French health care system does not use international terminologies. It would be interesting to extend our present findings to the 65 million people registered in the French health care system.},
	language = {eng},
	number = {1},
	journal = {Applied Clinical Informatics},
	author = {Lamer, Antoine and Depas, Nicolas and Doutreligne, Matthieu and Parrot, Adrien and Verloop, David and Defebvre, Marguerite-Marie and Ficheur, Grégoire and Chazard, Emmanuel and Beuscart, Jean-Baptiste},
	month = jan,
	year = {2020},
	pmid = {31914471},
	pmcid = {PMC6949163},
	keywords = {Observational Health Data Sciences and Informatics, data integration, observational medical outcome partnership, secondary use},
	pages = {13--22},
}

BACKGROUND: Common data models (CDMs) enable data to be standardized, and facilitate data exchange, sharing, and storage, particularly when the data have been collected via distinct, heterogeneous systems. Moreover, CDMs provide tools for data quality assessment, integration into models, visualization, and analysis. The observational medical outcome partnership (OMOP) provides a CDM for organizing and standardizing databases. Common data models not only facilitate data integration but also (and especially for the OMOP model) extends the range of available statistical analyses. OBJECTIVE: This study aimed to evaluate the feasibility of implementing French national electronic health records in the OMOP CDM. METHODS: The OMOP's specifications were used to audit the source data, specify the transformation into the OMOP CDM, implement an extract-transform-load process to feed data from the French health care system into the OMOP CDM, and evaluate the final database. RESULTS: Seventeen vocabularies corresponding to the French context were added to the OMOP CDM's concepts. Three French terminologies were automatically mapped to standardized vocabularies. We loaded nine tables from the OMOP CDM's "standardized clinical data" section, and three tables from the "standardized health system data" section. Outpatient and inpatient data from 38,730 individuals were integrated. The median (interquartile range) number of outpatient and inpatient stays per patient was 160 (19-364). CONCLUSION: Our results demonstrated that data from the French national health care system can be integrated into the OMOP CDM. One of the main challenges was the use of international OMOP concepts to annotate data recorded in a French context. The use of local terminologies was an obstacle to conceptual mapping; with the exception of an adaptation of the International Classification of Diseases 10th Revision, the French health care system does not use international terminologies. It would be interesting to extend our present findings to the 65 million people registered in the French health care system.

@article{thillard_psychiatric_2020,
	title = {Psychiatric {Adverse} {Events} {Associated} {With} {Infliximab}: {A} {Cohort} {Study} {From} the {French} {Nationwide} {Discharge} {Abstract} {Database}},
	volume = {11},
	issn = {1663-9812},
	shorttitle = {Psychiatric {Adverse} {Events} {Associated} {With} {Infliximab}},
	doi = {10.3389/fphar.2020.00513},
	abstract = {Introduction: Infliximab (IFX) was the first anti-tumor necrosis factor (TNFα) antibody to be used in the treatment of severe chronic inflammatory diseases, such as Crohn's disease and rheumatoid arthritis. A number of serious adverse drug reactions are known to be associated with IFX use; they include infections, malignancies, and injection site reactions. Although a few case reports have described potential psychiatric adverse events (including suicide attempts and manic episodes), the latter are barely mentioned in IFX's summary of product characteristics. The objective of the present retrospective study was to detect potential psychiatric adverse events associated with IFX treatment by analyzing a national discharge abstract database.
Materials and Methods: We performed an historical cohort study by analyzing data from the French national hospital discharge abstract database (PMSI) between 2008 and 2014. All patients admitted with one of the five diseases treated with IFX were included.
Results: Of the 325,319 patients included in the study, 7,600 had been treated with IFX. The proportion of hospital admissions for one or more psychiatric events was higher among IFX-exposed patients (750 out of 7,600; 9.87\%) than among non-exposed patients (17,456 out of 317,719; 5.49\%). After taking account of potential confounders in the cohort as a whole, a semi-parametric Cox regression analysis gave an overall hazard ratio (HR) [95\% confidence interval] (CI) of 4.5 [3.95; 5.13] for a hospital admission with a psychiatric adverse event during treatment with IFX. The HR (95\%CI) for a depressive disorder was 4.97 (7.35; 6.68). Even higher risks were observed for certain pairs of adverse events and underlying pathologies: psychotic disorders in patients treated for ulcerative colitis (HR = 5.43 [2.01; 14.6]), manic episodes in patients treated for severe psoriasis (HR = 12.6 [4.65; 34.2]), and suicide attempts in patients treated for rheumatoid arthritis (HR = 4.45 [1.11; 17.9]).
Discussion: The present retrospective, observational study confirmed that IFX treatment is associated with an elevated risk of psychiatric adverse events. Depending on the disease treated, physicians should be aware of these potential adverse events.},
	language = {eng},
	journal = {Frontiers in Pharmacology},
	author = {Thillard, Eve-Marie and Gautier, Sophie and Babykina, Evgeniya and Carton, Louise and Amad, Ali and Bouzillé, Guillaume and Beuscart, Jean-Baptiste and Ficheur, Grégoire and Chazard, Emmanuel},
	year = {2020},
	pmid = {32390850},
	pmcid = {PMC7188945},
	keywords = {Adverse event (AE), Database (DB), Depression, Infliximab (ifx), Pharmacovigilance, Psychiatry, adverse events, database, depression, infliximab, pharmacoepidaemiology, pharmacoepidemiology, pharmacovigilance, psychiatry},
	pages = {513},
}

Introduction: Infliximab (IFX) was the first anti-tumor necrosis factor (TNFα) antibody to be used in the treatment of severe chronic inflammatory diseases, such as Crohn's disease and rheumatoid arthritis. A number of serious adverse drug reactions are known to be associated with IFX use; they include infections, malignancies, and injection site reactions. Although a few case reports have described potential psychiatric adverse events (including suicide attempts and manic episodes), the latter are barely mentioned in IFX's summary of product characteristics. The objective of the present retrospective study was to detect potential psychiatric adverse events associated with IFX treatment by analyzing a national discharge abstract database. Materials and Methods: We performed an historical cohort study by analyzing data from the French national hospital discharge abstract database (PMSI) between 2008 and 2014. All patients admitted with one of the five diseases treated with IFX were included. Results: Of the 325,319 patients included in the study, 7,600 had been treated with IFX. The proportion of hospital admissions for one or more psychiatric events was higher among IFX-exposed patients (750 out of 7,600; 9.87%) than among non-exposed patients (17,456 out of 317,719; 5.49%). After taking account of potential confounders in the cohort as a whole, a semi-parametric Cox regression analysis gave an overall hazard ratio (HR) [95% confidence interval] (CI) of 4.5 [3.95; 5.13] for a hospital admission with a psychiatric adverse event during treatment with IFX. The HR (95%CI) for a depressive disorder was 4.97 (7.35; 6.68). Even higher risks were observed for certain pairs of adverse events and underlying pathologies: psychotic disorders in patients treated for ulcerative colitis (HR = 5.43 [2.01; 14.6]), manic episodes in patients treated for severe psoriasis (HR = 12.6 [4.65; 34.2]), and suicide attempts in patients treated for rheumatoid arthritis (HR = 4.45 [1.11; 17.9]). Discussion: The present retrospective, observational study confirmed that IFX treatment is associated with an elevated risk of psychiatric adverse events. Depending on the disease treated, physicians should be aware of these potential adverse events.

@article{caron_risk_2019,
	title = {Risk of {Pulmonary} {Embolism} {More} {Than} 6 {Weeks} {After} {Surgery} {Among} {Cancer}-{Free} {Middle}-aged {Patients}},
	issn = {2168-6262},
	doi = {10.1001/jamasurg.2019.3742},
	abstract = {Importance: The risk of postoperative pulmonary embolism has been reported to be highest during the first 5 weeks after surgery. However, how long the excess risk of postoperative pulmonary embolism persists remains unknown.
Objective: To assess the duration and magnitude of the late postoperative risk of pulmonary embolism among cancer-free middle-aged patients by the type of surgery.
Design, Setting, and Participants: Case-crossover analysis to compute the respective risks of pulmonary embolism after 6 types of surgery using data from a French national inpatient database, which covers a total of 203 million inpatient stays over an 8-year period between 2007 and 2014. Participants were cancer-free middle-aged adult patients (aged 45 to 64) with a diagnosis of a first pulmonary embolism.
Exposures: Hospital admission for surgery. Surgical procedures were classified into 6 types: (1) vascular surgery, (2) gynecological surgery, (3) gastrointestinal surgery, (4) hip or knee replacement, (5) fractures, and (6) other orthopedic operations.
Main Outcomes and Measures: Diagnosis of a first pulmonary embolism.
Results: A total of 60 703 patients were included (35 766 [58.9\%] male; mean [SD] age, 56.6 [6.0] years). The risk of postoperative pulmonary embolism was elevated for at least 12 weeks after all types of surgery and was highest during the immediate postoperative period (1 to 6 weeks). The excess risk of postoperative pulmonary embolism ranged from odds ratio (OR), 5.24 (95\% CI, 3.91-7.01) for vascular surgery to OR, 8.34 (95\% CI, 6.07-11.45) for surgery for fractures. The risk remained elevated from 7 to 12 weeks, with the OR ranging from 2.26 (95\% CI, 1.81-2.82) for gastrointestinal operations to 4.23 (95\% CI, 3.01-5.92) for surgery for fractures. The risk was not clinically significant beyond 18 weeks postsurgery for all types of procedures.
Conclusions and Relevance: The risk of postoperative pulmonary embolism is elevated beyond 6 weeks postsurgery regardless of the type of procedure. The persistence of this excess risk suggests that further randomized clinical trials are required to evaluate whether the duration of postoperative prophylactic anticoagulation should be extended and to define the optimal duration of treatment with regard to both the thrombotic and bleeding risks.},
	language = {eng},
	journal = {JAMA surgery},
	author = {Caron, Alexandre and Depas, Nicolas and Chazard, Emmanuel and Yelnik, Cécile and Jeanpierre, Emmanuelle and Paris, Camille and Beuscart, Jean-Baptiste and Ficheur, Grégoire},
	month = oct,
	year = {2019},
	pmid = {31596449},
}

Importance: The risk of postoperative pulmonary embolism has been reported to be highest during the first 5 weeks after surgery. However, how long the excess risk of postoperative pulmonary embolism persists remains unknown. Objective: To assess the duration and magnitude of the late postoperative risk of pulmonary embolism among cancer-free middle-aged patients by the type of surgery. Design, Setting, and Participants: Case-crossover analysis to compute the respective risks of pulmonary embolism after 6 types of surgery using data from a French national inpatient database, which covers a total of 203 million inpatient stays over an 8-year period between 2007 and 2014. Participants were cancer-free middle-aged adult patients (aged 45 to 64) with a diagnosis of a first pulmonary embolism. Exposures: Hospital admission for surgery. Surgical procedures were classified into 6 types: (1) vascular surgery, (2) gynecological surgery, (3) gastrointestinal surgery, (4) hip or knee replacement, (5) fractures, and (6) other orthopedic operations. Main Outcomes and Measures: Diagnosis of a first pulmonary embolism. Results: A total of 60 703 patients were included (35 766 [58.9%] male; mean [SD] age, 56.6 [6.0] years). The risk of postoperative pulmonary embolism was elevated for at least 12 weeks after all types of surgery and was highest during the immediate postoperative period (1 to 6 weeks). The excess risk of postoperative pulmonary embolism ranged from odds ratio (OR), 5.24 (95% CI, 3.91-7.01) for vascular surgery to OR, 8.34 (95% CI, 6.07-11.45) for surgery for fractures. The risk remained elevated from 7 to 12 weeks, with the OR ranging from 2.26 (95% CI, 1.81-2.82) for gastrointestinal operations to 4.23 (95% CI, 3.01-5.92) for surgery for fractures. The risk was not clinically significant beyond 18 weeks postsurgery for all types of procedures. Conclusions and Relevance: The risk of postoperative pulmonary embolism is elevated beyond 6 weeks postsurgery regardless of the type of procedure. The persistence of this excess risk suggests that further randomized clinical trials are required to evaluate whether the duration of postoperative prophylactic anticoagulation should be extended and to define the optimal duration of treatment with regard to both the thrombotic and bleeding risks.

@article{delrot_medical_2019,
	title = {Do {Medical} {Practitioners} {Trust} {Automated} {Interpretation} of {Electrocardiograms}?},
	volume = {264},
	issn = {1879-8365},
	doi = {10.3233/SHTI190280},
	abstract = {The objective is to study the way physicians use the ECG computerized interpretation (ECG-CI). Anonymous questionnaires were mailed to 282 primary care physicians (PCPs) and 140 cardiologists in France. 225 complete surveys were analyzed. PCPs performed a median of 5 ECGs per month, vs. 200 ECGs for cardiologists. Among PCPs with ECG, 57\% felt confident about their skills in interpreting ECGs. Whereas 91.7\% of cardiologists first interpreted the ECG by themselves, 27.9\% of PCPs first read the computerized interpretation. PCPs found that ECG-CI was more reliable than cardiologists did for atrial or ventricular hypertrophy. PCPs and cardiologists agreed that ECG-CI was reliable for conduction troubles and "normal ECG" statement, but was not for other rhythm or repolarization troubles. PCPs are less experienced with ECG interpretation, but are also more likely to trust the computerized interpretation, whereas those interpreters are not fully reliable.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Delrot, Cédric and Bouzillé, Guillaume and Calafiore, Matthieu and Rochoy, Michaël and Legrand, Bertrand and Ficheur, Grégoire and Chazard, Emmanuel},
	month = aug,
	year = {2019},
	pmid = {31437981},
	keywords = {Computer interpretation, Electrocardiography},
	pages = {536--540},
}

The objective is to study the way physicians use the ECG computerized interpretation (ECG-CI). Anonymous questionnaires were mailed to 282 primary care physicians (PCPs) and 140 cardiologists in France. 225 complete surveys were analyzed. PCPs performed a median of 5 ECGs per month, vs. 200 ECGs for cardiologists. Among PCPs with ECG, 57% felt confident about their skills in interpreting ECGs. Whereas 91.7% of cardiologists first interpreted the ECG by themselves, 27.9% of PCPs first read the computerized interpretation. PCPs found that ECG-CI was more reliable than cardiologists did for atrial or ventricular hypertrophy. PCPs and cardiologists agreed that ECG-CI was reliable for conduction troubles and "normal ECG" statement, but was not for other rhythm or repolarization troubles. PCPs are less experienced with ECG interpretation, but are also more likely to trust the computerized interpretation, whereas those interpreters are not fully reliable.

@article{bouzille_automated_2019,
	title = {An {Automated} {Detection} {System} of {Drug}-{Drug} {Interactions} from {Electronic} {Patient} {Records} {Using} {Big} {Data} {Analytics}},
	volume = {264},
	issn = {1879-8365},
	doi = {10.3233/SHTI190180},
	abstract = {The aim of the study was to build a proof-of-concept demonstratrating that big data technology could improve drug safety monitoring in a hospital and could help pharmacovigilance professionals to make data-driven targeted hypotheses on adverse drug events (ADEs) due to drug-drug interactions (DDI). We developed a DDI automatic detection system based on treatment data and laboratory tests from the electronic health records stored in the clinical data warehouse of Rennes academic hospital. We also used OrientDb, a graph database to store informations from five drug knowledge databases and Spark to perform analysis of potential interactions betweens drugs taken by hospitalized patients. Then, we developed a machine learning model to identify the patients in whom an ADE might have occurred because of a DDI. The DDI detection system worked efficiently and computation time was manageable. The system could be routinely employed for monitoring.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Bouzillé, Guillaume and Morival, Camille and Westerlynck, Richard and Lemordant, Pierre and Chazard, Emmanuel and Lecorre, Pascal and Busnel, Yann and Cuggia, Marc},
	month = aug,
	year = {2019},
	pmid = {31437882},
	keywords = {Computing Methodologies, Drug Interaction, Machine Learning},
	pages = {45--49},
}

The aim of the study was to build a proof-of-concept demonstratrating that big data technology could improve drug safety monitoring in a hospital and could help pharmacovigilance professionals to make data-driven targeted hypotheses on adverse drug events (ADEs) due to drug-drug interactions (DDI). We developed a DDI automatic detection system based on treatment data and laboratory tests from the electronic health records stored in the clinical data warehouse of Rennes academic hospital. We also used OrientDb, a graph database to store informations from five drug knowledge databases and Spark to perform analysis of potential interactions betweens drugs taken by hospitalized patients. Then, we developed a machine learning model to identify the patients in whom an ADE might have occurred because of a DDI. The DDI detection system worked efficiently and computation time was manageable. The system could be routinely employed for monitoring.

@article{mellot_what_2019,
	title = {What {Is} a {Chronic} {Disease}? {A} {Contribution} {Based} on the {Secondary} {Use} of 161 {Million} {Discharge} {Records}},
	volume = {264},
	issn = {1879-8365},
	shorttitle = {What {Is} a {Chronic} {Disease}?},
	doi = {10.3233/SHTI190224},
	abstract = {Several definitions of chronic diseases exist. The objective is to reuse a nationwide medical-administrative database (PMSI) to estimate the lifespan of diagnostic codes, hence the chronicity of the corresponding diseases. We analyzed 162 million inpatient stays from 2008 to 2014, and estimate the lifespan of every ICD-10 code for every patient, identified by a unique imprint. We calculated 200 indicators for different time and survival values, and selected the ones that maximized the area under the ROC curve (AUC) drawn by comparison against 4 chronic disease classifications: CCI, ALD, result from the analysis of ICD-10 labels, and a handmade list. The best indicator was the time to reach a survival of 4.5\%. It enables to get the following AUC: 78.9\% compared with CCI, 90.3\% compared with ALD, 75.1\% compared with labels analysis, and 91.5\% compared with the handmade list. This indicator enables to classify 23,349 ICD-10 codes from "most chronic" to "most acute". The 100 most chronic codes are listed.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Mellot, Emeric and Balcaen, Thibaut and Calafiore, Matthieu and Bouzillé, Guillaume and Beuscart, Jean-Baptiste and Ficheur, Grégoire and Chazard, Emmanuel},
	month = aug,
	year = {2019},
	pmid = {31437926},
	keywords = {Big data, Chronic disease, Patient discharge},
	pages = {263--267},
}

Several definitions of chronic diseases exist. The objective is to reuse a nationwide medical-administrative database (PMSI) to estimate the lifespan of diagnostic codes, hence the chronicity of the corresponding diseases. We analyzed 162 million inpatient stays from 2008 to 2014, and estimate the lifespan of every ICD-10 code for every patient, identified by a unique imprint. We calculated 200 indicators for different time and survival values, and selected the ones that maximized the area under the ROC curve (AUC) drawn by comparison against 4 chronic disease classifications: CCI, ALD, result from the analysis of ICD-10 labels, and a handmade list. The best indicator was the time to reach a survival of 4.5%. It enables to get the following AUC: 78.9% compared with CCI, 90.3% compared with ALD, 75.1% compared with labels analysis, and 91.5% compared with the handmade list. This indicator enables to classify 23,349 ICD-10 codes from "most chronic" to "most acute". The 100 most chronic codes are listed.

@article{negre_breast_2019,
	title = {Breast reconstruction in {France}, observational study of 140,904 cases of mastectomy for breast cancer},
	issn = {1768-319X},
	doi = {10.1016/j.anplas.2019.07.014},
	abstract = {OBJECTIVES: In France, there are few up-to-date epidemiological data on breast reconstruction after mastectomy for breast cancer. The objective of the present study was to measure immediate and delayed breast reconstruction (IBR and DBR, respectively) rates and thus the proportion of patients not benefiting from any reconstruction.
METHODS: We performed an observational study by assessing data from the French nationwide discharge summary database (Programme de Médicalisation des Systèmes d'Information) for the period 2008-2014. All women having undergone a total mastectomy for breast cancer during this period were included. We then searched for reconstructive surgery during the initial or subsequent hospital stays, and recorded the time interval between mastectomy and reconstruction.
RESULTS: Among the 140,904 mastectomies included, the IBR rate was 16.1\% on average, and increased over the study period. The time interval between mastectomy and DBR was≤3 years in 92\% of cases. For patients included in 2008 and 2009, the DBR rate was 17.8\%, and the non-reconstruction rate was 66.4\%.
CONCLUSION: The high proportion of women not undergoing breast reconstruction after mastectomy suggests that access to this procedure should be improved.},
	language = {eng},
	journal = {Annales De Chirurgie Plastique Et Esthetique},
	author = {Nègre, G. and Balcaen, T. and Dast, S. and Sinna, R. and Chazard, E.},
	month = aug,
	year = {2019},
	pmid = {31383624},
	keywords = {Breast cancer, Breast reconstruction, Cancer du sein, Epidemiology, Mastectomie, Mastectomy, PMSI, Reconstruction mammaire, Épidémiologie},
}

OBJECTIVES: In France, there are few up-to-date epidemiological data on breast reconstruction after mastectomy for breast cancer. The objective of the present study was to measure immediate and delayed breast reconstruction (IBR and DBR, respectively) rates and thus the proportion of patients not benefiting from any reconstruction. METHODS: We performed an observational study by assessing data from the French nationwide discharge summary database (Programme de Médicalisation des Systèmes d'Information) for the period 2008-2014. All women having undergone a total mastectomy for breast cancer during this period were included. We then searched for reconstructive surgery during the initial or subsequent hospital stays, and recorded the time interval between mastectomy and reconstruction. RESULTS: Among the 140,904 mastectomies included, the IBR rate was 16.1% on average, and increased over the study period. The time interval between mastectomy and DBR was≤3 years in 92% of cases. For patients included in 2008 and 2009, the DBR rate was 17.8%, and the non-reconstruction rate was 66.4%. CONCLUSION: The high proportion of women not undergoing breast reconstruction after mastectomy suggests that access to this procedure should be improved.

@article{migaud_reponse_2019,
	title = {Réponse au courrier adressé au comité de rédaction d’{Orthopaedics} and {Traumatology}: {Surgery} and {Research} par {Federico} {Solla}, {Antoine} {Tran} et {Virginie} {Rampal}. {Rappel} sur les critères de choix du niveau de preuve : précisions sur le classement en niveau 3 ou 4 d’une étude thérapeutique},
	volume = {105},
	issn = {1877-0517},
	shorttitle = {Réponse au courrier adressé au comité de rédaction d’{Orthopaedics} and {Traumatology}},
	url = {http://www.sciencedirect.com/science/article/pii/S1877051719301522},
	doi = {10.1016/j.rcot.2019.04.017},
	language = {fr},
	number = {4},
	urldate = {2020-03-23},
	journal = {Revue de Chirurgie Orthopédique et Traumatologique},
	author = {Migaud, Henri and Chazard, Emmanuel and Seringe, Raphaël and Beaufils, Philippe},
	month = jun,
	year = {2019},
	pages = {537--539},
}

@article{migaud_reply_2019,
	title = {Reply to the letter set to the {OTSR} editorial board by {Federico} {Solla}, {Antoine} {Tran}, and {Virginie} {Rampal}. {Level} of evidence criteria: {Distinguishing} level 3 from level 4 therapeutic studies},
	issn = {1877-0568},
	shorttitle = {Reply to the letter set to the {OTSR} editorial board by {Federico} {Solla}, {Antoine} {Tran}, and {Virginie} {Rampal}. {Level} of evidence criteria},
	doi = {10.1016/j.otsr.2019.04.002},
	language = {eng},
	journal = {Orthopaedics \& traumatology, surgery \& research: OTSR},
	author = {Migaud, Henri and Chazard, Emmanuel and Seringe, Raphaël and Beaufils, Philippe},
	month = apr,
	year = {2019},
	pmid = {31006643},
}

@article{rochoy_epidemiology_2019,
	title = {Epidemiology of neurocognitive disorders in {France}},
	volume = {17},
	issn = {2115-7863},
	doi = {10.1684/pnv.2018.0778},
	abstract = {Neurocognitive disorders are common: every year, any physician or health professional comes into contact with patients or relatives with early symptoms of dementia. Nevertheless, their epidemiology remains difficult to estimate, due to real differences in risk factors within a country or region (average age, genetics, level of education, socio-economic level, etc.), differences in data collection, in the interpretation of these data with regard to scientific findings and changes in diagnostic criteria. In this review, we present a state of knowledge of the epidemiology of dementia in France. Epidemiological data on neurocognitive disorders in France come mainly from 3 sources: two prospective cohorts (PAQUID and 3C) and large databases (SNIIRAM, RSI data, PMSI). Neurocognitive disorders are estimated to directly affect more than 1.2 million people in France and about 2 out of 3 cases are attributed to Alzheimer's disease. The prevalence rate is estimated at about 40/1,000 people after 60 years of age and gradually increases to 180/1,000 after 75 years of age, reaching almost one in two people after 90 years of age. The incidence rate is estimated at between 13 and 19/1,000 person-years, and seems to decrease slightly over the decades. The PAQUID and 3C cohorts are coming to an end; despite the development of large databases (SNIIRAM, PMSI, etc.), it seems necessary to continue to set up new prospective cohorts in the general population to monitor the epidemiology of neurocognitive disorders in France.},
	language = {eng},
	number = {1},
	journal = {Geriatrie Et Psychologie Neuropsychiatrie Du Vieillissement},
	author = {Rochoy, Michaël and Chazard, Emmanuel and Bordet, Régis},
	month = mar,
	year = {2019},
	pmid = {30907374},
	keywords = {France, cohort studies, dementia, epidemiology, incidence, prevalence},
	pages = {99--105},
}

Neurocognitive disorders are common: every year, any physician or health professional comes into contact with patients or relatives with early symptoms of dementia. Nevertheless, their epidemiology remains difficult to estimate, due to real differences in risk factors within a country or region (average age, genetics, level of education, socio-economic level, etc.), differences in data collection, in the interpretation of these data with regard to scientific findings and changes in diagnostic criteria. In this review, we present a state of knowledge of the epidemiology of dementia in France. Epidemiological data on neurocognitive disorders in France come mainly from 3 sources: two prospective cohorts (PAQUID and 3C) and large databases (SNIIRAM, RSI data, PMSI). Neurocognitive disorders are estimated to directly affect more than 1.2 million people in France and about 2 out of 3 cases are attributed to Alzheimer's disease. The prevalence rate is estimated at about 40/1,000 people after 60 years of age and gradually increases to 180/1,000 after 75 years of age, reaching almost one in two people after 90 years of age. The incidence rate is estimated at between 13 and 19/1,000 person-years, and seems to decrease slightly over the decades. The PAQUID and 3C cohorts are coming to an end; despite the development of large databases (SNIIRAM, PMSI, etc.), it seems necessary to continue to set up new prospective cohorts in the general population to monitor the epidemiology of neurocognitive disorders in France.

@article{bray_augmentation_2019,
	title = {Augmentation de l’incidence des cholécystectomies associées à une pathologie biliaire en {France} : analyse de 807 307 cholécystectomies sur 7 ans},
	issn = {1878-786X},
	shorttitle = {Augmentation de l’incidence des cholécystectomies associées à une pathologie biliaire en {France}},
	url = {http://www.sciencedirect.com/science/article/pii/S1878786X1830411X},
	doi = {10.1016/j.jchirv.2017.12.008},
	abstract = {Résumé
Introduction
Les calculs biliaires sont un des motifs abdominaux d’admission hospitalière les plus fréquents. Le but de cette étude était d’analyser les tendances et les suites des cholécystectomies pour pathologie biliaire, en France, de 2008 à 2014.
Patients et méthodes
Nous avons mené une étude rétrospective de cohorte, en utilisant des données extraites de la base de données nationale hospitalière Française (PMSI). Nous avons inclus tous les patients ayant bénéficié d’une cholécystectomie pour pathologie biliaire, de janvier 2008 à décembre 2014. Les caractéristiques démographiques, la voie d’abord, la durée de séjour, les complications et la mortalité intrahospitalière ont été analysées.
Résultats
Sur la période étudiée, 807 307 cholécystectomies ont été réalisées en France, avec une augmentation du taux national d’incidence de 167,5 (IC95 \% [166,5 ; 168,5]) à 182,6 (IC95 \% [181,6 ; 183,6]) pour 100 000 habitants. Les femmes représentaient 66,5 \% des interventions (p{\textless}0,001). La moyenne d’âge était plus basse pour les hommes que pour les femmes : 52,1 contre 60,2 ans (p{\textless}0,001). Le taux de cœlioscopies a augmenté significativement de 90 \% en 2008 à 94 \% en 2014 (p{\textless}0,001). La durée moyenne de séjour a significativement diminué, de 6,5 en 2008 à 4,7jours en 2014 (p{\textless}0,001). Les complications les plus fréquentes étaient intra-abdominales (23,1 \% pour les coelioscopies (IC95 \% [22,7 ; 23,5]), la mortalité intra-hospitalière a significativement baissé, de 0,45 \% en 2008 à 0,38 \% en 2014 (p{\textless}0,005).
Conclusion
Nos résultats ont montré une augmentation significative du taux national d’incidence des cholécystectomies pour pathologie biliaire, de 2008 à 2014.
Summary
Purpose
Gallstones are one of the most common abdominal reasons for admission to hospital. The aim of this study was to analyze trends and outcomes in patients undergoing cholecystectomy with gallbladder related disease in France from 2008 to 2014.
Patients and methods
We carried out a population-based, retrospective cohort study using data extracted from the French nationwide hospital discharge database (PMSI). We included all patients having a cholecystectomy related to gallbladder disease from January 2008 to December 2014. Patients’ demographics, primary diagnosis, procedure type, length of stay (LOS), admission in an intensive care unit, discharge disposition, complications, and in-hospital mortality were analyzed.
Results
Overall, 807,307 cholecystectomies were performed in France over the study period, with an increase in the national incidence rate from 167.5 (95\%CI [166.5; 168.5]) to 182.6 (95\%CI [181.6; 183.6]) per 100,000 inhabitants. Females accounted for 66.5\% of procedures (P{\textless}.001). The mean age was lower for females than for males: 52.1 versus 60.2 (P{\textless}.001). The ratio of laparoscopic cholecystectomy significantly increased from 90\% in 2008 to 94\% in 2014 (P{\textless}.001). Average inpatient LOS decreased significantly from 6.5 days in 2008 to 4.7 days in 2014 (P{\textless}.001). Most common complication type was intra-abdominal (23.1\% for laparoscopic procedure (95\%CI [22.7; 23.5]), and in-hospital mortality significantly decreased over time from 0.45\% in 2008 to 0.38\% in 2014 (P{\textless}.005).
Conclusion
Our results showed that the national incidence rate of cholecystectomy related to gallbladder disease increased from 2008 to 2014.},
	urldate = {2019-01-14},
	journal = {Journal de Chirurgie Viscérale},
	author = {Bray, F. and Balcaen, T. and Baro, E. and Gandon, A. and Ficheur, G. and Chazard, E.},
	month = jan,
	year = {2019},
	keywords = {Cholecystectomy, Cholécystectomies, Coelioscopie, Epidemiology, Laparoscopic cholecystectomy, Laparotomie, Nationwide database, Open cholecystectomy, PMSI, Épidémiologie},
}

Résumé Introduction Les calculs biliaires sont un des motifs abdominaux d’admission hospitalière les plus fréquents. Le but de cette étude était d’analyser les tendances et les suites des cholécystectomies pour pathologie biliaire, en France, de 2008 à 2014. Patients et méthodes Nous avons mené une étude rétrospective de cohorte, en utilisant des données extraites de la base de données nationale hospitalière Française (PMSI). Nous avons inclus tous les patients ayant bénéficié d’une cholécystectomie pour pathologie biliaire, de janvier 2008 à décembre 2014. Les caractéristiques démographiques, la voie d’abord, la durée de séjour, les complications et la mortalité intrahospitalière ont été analysées. Résultats Sur la période étudiée, 807 307 cholécystectomies ont été réalisées en France, avec une augmentation du taux national d’incidence de 167,5 (IC95 % [166,5 ; 168,5]) à 182,6 (IC95 % [181,6 ; 183,6]) pour 100 000 habitants. Les femmes représentaient 66,5 % des interventions (p\textless0,001). La moyenne d’âge était plus basse pour les hommes que pour les femmes : 52,1 contre 60,2 ans (p\textless0,001). Le taux de cœlioscopies a augmenté significativement de 90 % en 2008 à 94 % en 2014 (p\textless0,001). La durée moyenne de séjour a significativement diminué, de 6,5 en 2008 à 4,7jours en 2014 (p\textless0,001). Les complications les plus fréquentes étaient intra-abdominales (23,1 % pour les coelioscopies (IC95 % [22,7 ; 23,5]), la mortalité intra-hospitalière a significativement baissé, de 0,45 % en 2008 à 0,38 % en 2014 (p\textless0,005). Conclusion Nos résultats ont montré une augmentation significative du taux national d’incidence des cholécystectomies pour pathologie biliaire, de 2008 à 2014. Summary Purpose Gallstones are one of the most common abdominal reasons for admission to hospital. The aim of this study was to analyze trends and outcomes in patients undergoing cholecystectomy with gallbladder related disease in France from 2008 to 2014. Patients and methods We carried out a population-based, retrospective cohort study using data extracted from the French nationwide hospital discharge database (PMSI). We included all patients having a cholecystectomy related to gallbladder disease from January 2008 to December 2014. Patients’ demographics, primary diagnosis, procedure type, length of stay (LOS), admission in an intensive care unit, discharge disposition, complications, and in-hospital mortality were analyzed. Results Overall, 807,307 cholecystectomies were performed in France over the study period, with an increase in the national incidence rate from 167.5 (95%CI [166.5; 168.5]) to 182.6 (95%CI [181.6; 183.6]) per 100,000 inhabitants. Females accounted for 66.5% of procedures (P\textless.001). The mean age was lower for females than for males: 52.1 versus 60.2 (P\textless.001). The ratio of laparoscopic cholecystectomy significantly increased from 90% in 2008 to 94% in 2014 (P\textless.001). Average inpatient LOS decreased significantly from 6.5 days in 2008 to 4.7 days in 2014 (P\textless.001). Most common complication type was intra-abdominal (23.1% for laparoscopic procedure (95%CI [22.7; 23.5]), and in-hospital mortality significantly decreased over time from 0.45% in 2008 to 0.38% in 2014 (P\textless.005). Conclusion Our results showed that the national incidence rate of cholecystectomy related to gallbladder disease increased from 2008 to 2014.

@article{robert_community-acquired_2019,
	title = {Community-{Acquired} {Acute} {Kidney} {Injury} {Induced} {By} {Drugs} {In} {Older} {Patients}: {A} {Multifactorial} {Event}},
	volume = {Volume 14},
	issn = {1178-1998},
	shorttitle = {Community-{Acquired} {Acute} {Kidney} {Injury} {Induced} {By} {Drugs} {In} {Older} {Patients}},
	url = {https://www.dovepress.com/community-acquired-acute-kidney-injury-induced-by-drugs-in-older-patie-peer-reviewed-article-CIA},
	doi = {10.2147/CIA.S217567},
	abstract = {Purpose: Community-acquired acute kidney injury (CA-AKI) is a frequent and severe adverse drug reaction (ADR) among older patients. The combination of drugs and other CA-AKI risk factors was barely evaluated. The objectives of our study were to both accurately identify CA-AKI induced by drugs in older patients, and to describe their combination with other risk factors. Patients and methods: We conducted a retrospective, single-center study in a general hospital over a two-year period. An automated detection identified CA-AKI according to KDIGO criteria, amongst 4,767 eligible inpatient stays among patients aged 75 years or older. Two independent experts reviewed all CA-AKI events to adjudicate drug involvement (Naranjo scale), identify inappropriate prescriptions (STOPP criteria), evaluate avoidability (Hallas criteria) and identify combined risk factors.
Results: An expert review confirmed 713 CA-AKI (15.0\% of inpatient stays) and determined that 419 (58.8\%) CA-AKI were induced by drugs. A multifactorial cause (i.e., at least one drug with a precipitating factor) was found in 63.2\% of drug-induced CA-AKI. Most of the drug-induced events were avoidable (66.8\%), mainly in relation to a multifactorial cause.
Conclusion: Drug-induced CA-AKI were frequent, multifactorial events in hospitalized older patients and their prevention should focus on combinations with precipitating factors.},
	language = {en},
	urldate = {2019-12-05},
	journal = {Clinical Interventions in Aging},
	author = {Robert, Laurine and Ficheur, Grégoire and Gautier, Sophie and Servais, Alexandre and Luyckx, Michel and Soula, Julien and Decaudin, Bertrand and Glowacki, François and Puisieux, François and Chazard, Emmanuel and Beuscart, Jean-Baptiste},
	month = dec,
	year = {2019},
	pages = {2105--2113},
}

Purpose: Community-acquired acute kidney injury (CA-AKI) is a frequent and severe adverse drug reaction (ADR) among older patients. The combination of drugs and other CA-AKI risk factors was barely evaluated. The objectives of our study were to both accurately identify CA-AKI induced by drugs in older patients, and to describe their combination with other risk factors. Patients and methods: We conducted a retrospective, single-center study in a general hospital over a two-year period. An automated detection identified CA-AKI according to KDIGO criteria, amongst 4,767 eligible inpatient stays among patients aged 75 years or older. Two independent experts reviewed all CA-AKI events to adjudicate drug involvement (Naranjo scale), identify inappropriate prescriptions (STOPP criteria), evaluate avoidability (Hallas criteria) and identify combined risk factors. Results: An expert review confirmed 713 CA-AKI (15.0% of inpatient stays) and determined that 419 (58.8%) CA-AKI were induced by drugs. A multifactorial cause (i.e., at least one drug with a precipitating factor) was found in 63.2% of drug-induced CA-AKI. Most of the drug-induced events were avoidable (66.8%), mainly in relation to a multifactorial cause. Conclusion: Drug-induced CA-AKI were frequent, multifactorial events in hospitalized older patients and their prevention should focus on combinations with precipitating factors.

@article{rochoy_factors_2019,
	title = {Factors associated with the onset of {Alzheimer}'s disease: {Data} mining in the {French} nationwide discharge summary database between 2008 and 2014},
	volume = {14},
	issn = {1932-6203},
	shorttitle = {Factors associated with the onset of {Alzheimer}'s disease},
	doi = {10.1371/journal.pone.0220174},
	abstract = {INTRODUCTION: Identifying modifiable risk factors for Alzheimer's disease (AD) is critical for research. Data mining may be a useful tool for finding new AD associated factors.
METHODS: We included all patients over 49 years of age, hospitalized in France in 2008 (without dementia) and in 2014. Dependent variable was AD or AD dementia diagnosis in 2014. We recoded the diagnoses of hospital stays (in ICD-10) into 137 explanatory variables.To avoid overweighting the "age" variable, we divided the population into 7 sub-populations of 5 years.
RESULTS: We analyzed 1,390,307 patients in the PMSI in 2008 and 2014: 55,997 patients had coding for AD or AD dementia in 2014 (4.04\%). We associated Alzheimer disease in 2014 with about 20 variables including male sex, stroke, diabetes mellitus, mental retardation, bipolar disorder, intoxication, Parkinson disease, depression, anxiety disorders, alcohol, undernutrition, fall and 3 less explored variables: intracranial hypertension (odd radio [95\% confidence interval]: 1.16 [1.12-1.20] in 70-80 years group), psychotic disorder (OR: 1.09 [1.07-1.11] in 70-75 years group) and epilepsy (OR: 1.06 [1.05-1.07] after 70 years).
DISCUSSION: We analyzed 137 variables in the PMSI identified some well-known risk factors for AD, and highlighted a possible association with intracranial hypertension, which merits further investigation. Better knowledge of associations could lead to better targeting (identifying) at-risk patients, and better prevention of AD, in order to reduce its impact.},
	language = {eng},
	number = {7},
	journal = {PloS One},
	author = {Rochoy, Michaël and Bordet, Régis and Gautier, Sophie and Chazard, Emmanuel},
	year = {2019},
	pmid = {31344088},
	pmcid = {PMC6657866},
	pages = {e0220174},
}

INTRODUCTION: Identifying modifiable risk factors for Alzheimer's disease (AD) is critical for research. Data mining may be a useful tool for finding new AD associated factors. METHODS: We included all patients over 49 years of age, hospitalized in France in 2008 (without dementia) and in 2014. Dependent variable was AD or AD dementia diagnosis in 2014. We recoded the diagnoses of hospital stays (in ICD-10) into 137 explanatory variables.To avoid overweighting the "age" variable, we divided the population into 7 sub-populations of 5 years. RESULTS: We analyzed 1,390,307 patients in the PMSI in 2008 and 2014: 55,997 patients had coding for AD or AD dementia in 2014 (4.04%). We associated Alzheimer disease in 2014 with about 20 variables including male sex, stroke, diabetes mellitus, mental retardation, bipolar disorder, intoxication, Parkinson disease, depression, anxiety disorders, alcohol, undernutrition, fall and 3 less explored variables: intracranial hypertension (odd radio [95% confidence interval]: 1.16 [1.12-1.20] in 70-80 years group), psychotic disorder (OR: 1.09 [1.07-1.11] in 70-75 years group) and epilepsy (OR: 1.06 [1.05-1.07] after 70 years). DISCUSSION: We analyzed 137 variables in the PMSI identified some well-known risk factors for AD, and highlighted a possible association with intracranial hypertension, which merits further investigation. Better knowledge of associations could lead to better targeting (identifying) at-risk patients, and better prevention of AD, in order to reduce its impact.

@article{rochoy_shift_2019,
	title = {Shift in {Hospitalizations} for {Alzheimer}'s {Disease} to {Related} {Dementias} in {France} between 2007 and 2017},
	volume = {6},
	issn = {2426-0266},
	doi = {10.14283/jpad.2019.5},
	abstract = {INTRODUCTION: Alzheimer's disease (AD) is the first cause of dementia. Diagnostic criteria have evolved: proposals to revise the NINCDS-ADRDA criteria were published in 2007. Our aim was to analyze the evolution in the coding of AD in the French nationwide exhaustive hospital discharge database (PMSI) between 2007 and 2017.
METHODS: We analyzed evolution of International Classification of Diseases and Related Health Problems, 10th edition (ICD-10) coding for AD and AD dementia in the PMSI database from 2008 to 2017 (285,748,938 inpatient stays).
RESULTS: We observed a 44\% decrease in the number of inpatient stays with a principal diagnosis of AD or AD dementia from 2007 (46,313 inpatient stays) to 2017 (25,856 inpatient stays) in France. Over the same period, we observed a 49\% increase in the number of inpatient stays with a principal diagnosis of related dementias (other organic mental disorders or other degenerative disorders). Overall, the number of inpatient stays for dementia remained stable despite the increase in the total number of inpatient stays: 95,377 in 2007 (0.409\% of inpatient stays) and 99,190 in 2017 (0.344\%).
CONCLUSION: We therefore note a shift from AD and AD dementia to other dementia diagnoses since 2007. This study suggests a more accurate use of AD related ICD-10 codes since the revised criteria in 2007.},
	language = {eng},
	number = {2},
	journal = {The Journal of Prevention of Alzheimer's Disease},
	author = {Rochoy, M. and Chazard, E. and Gautier, S. and Bordet, R.},
	year = {2019},
	pmid = {30756117},
	keywords = {Alzheimer disease, Data reuse, PMSI, big data, vascular dementia},
	pages = {108--111},
}

INTRODUCTION: Alzheimer's disease (AD) is the first cause of dementia. Diagnostic criteria have evolved: proposals to revise the NINCDS-ADRDA criteria were published in 2007. Our aim was to analyze the evolution in the coding of AD in the French nationwide exhaustive hospital discharge database (PMSI) between 2007 and 2017. METHODS: We analyzed evolution of International Classification of Diseases and Related Health Problems, 10th edition (ICD-10) coding for AD and AD dementia in the PMSI database from 2008 to 2017 (285,748,938 inpatient stays). RESULTS: We observed a 44% decrease in the number of inpatient stays with a principal diagnosis of AD or AD dementia from 2007 (46,313 inpatient stays) to 2017 (25,856 inpatient stays) in France. Over the same period, we observed a 49% increase in the number of inpatient stays with a principal diagnosis of related dementias (other organic mental disorders or other degenerative disorders). Overall, the number of inpatient stays for dementia remained stable despite the increase in the total number of inpatient stays: 95,377 in 2007 (0.409% of inpatient stays) and 99,190 in 2017 (0.344%). CONCLUSION: We therefore note a shift from AD and AD dementia to other dementia diagnoses since 2007. This study suggests a more accurate use of AD related ICD-10 codes since the revised criteria in 2007.

@article{rochoy_factors_2019-1,
	title = {Factors {Associated} with {Alzheimer}'s {Disease}: {An} {Overview} of {Reviews}},
	volume = {6},
	issn = {2426-0266},
	shorttitle = {Factors {Associated} with {Alzheimer}'s {Disease}},
	doi = {10.14283/jpad.2019.7},
	abstract = {Alzheimer's disease (AD) is a frequent pathology, with a poor prognosis, for which no curative treatment is available in 2018. AD prevention is an important issue, and is an important research topic. In this manuscript, we have synthesized the literature reviews and meta-analyses relating to modifiable risk factors associated with AD. Smoking, diabetes, high blood pressure, obesity, hypercholesterolemia, physical inactivity, depression, head trauma, heart failure, bleeding and ischemic strokes, sleep apnea syndrome appeared to be associated with an increased risk of AD. In addition to these well-known associations, we highlight here the existence of associated factors less described: hyperhomocysteinemia, hearing loss, essential tremor, occupational exposure to magnetic fields. On the contrary, some oral antidiabetic drugs, education and intellectual activity, a Mediterranean-type diet or using Healthy Diet Indicator, consumption of unsaturated fatty acids seemed to have a protective effect. Better knowledge of risk factors for AD allows for better identification of patients at risk. This may contribute to the emergence of prevention policies to delay or prevent the onset of AD.},
	language = {eng},
	number = {2},
	journal = {The Journal of Prevention of Alzheimer's Disease},
	author = {Rochoy, M. and Rivas, V. and Chazard, E. and Decarpentry, E. and Saudemont, G. and Hazard, P.-A. and Puisieux, F. and Gautier, S. and Bordet, R.},
	year = {2019},
	pmid = {30756119},
	keywords = {Alzheimer’s disease, early intervention, prevention, risk factors},
	pages = {121--134},
}

Alzheimer's disease (AD) is a frequent pathology, with a poor prognosis, for which no curative treatment is available in 2018. AD prevention is an important issue, and is an important research topic. In this manuscript, we have synthesized the literature reviews and meta-analyses relating to modifiable risk factors associated with AD. Smoking, diabetes, high blood pressure, obesity, hypercholesterolemia, physical inactivity, depression, head trauma, heart failure, bleeding and ischemic strokes, sleep apnea syndrome appeared to be associated with an increased risk of AD. In addition to these well-known associations, we highlight here the existence of associated factors less described: hyperhomocysteinemia, hearing loss, essential tremor, occupational exposure to magnetic fields. On the contrary, some oral antidiabetic drugs, education and intellectual activity, a Mediterranean-type diet or using Healthy Diet Indicator, consumption of unsaturated fatty acids seemed to have a protective effect. Better knowledge of risk factors for AD allows for better identification of patients at risk. This may contribute to the emergence of prevention policies to delay or prevent the onset of AD.

@article{rochoy_evolution_2018,
	title = {Evolution of {Dementia} {Related} to the {Use} of {Alcohol} in the {French} {Nationwide} {Discharge} {Summary} {Database} {Between} 2007 and 2017},
	issn = {1938-2731},
	doi = {10.1177/1533317518822043},
	abstract = {BACKGROUND:: The French nationwide exhaustive hospital discharge database (PMSI) is used for activity-based payment of hospital services. We hypothesized that the release of articles about alcohol and dementia could influence the identification of these diagnoses in PMSI.
METHODS:: We analyzed temporal evolution of coding for dementia and other persistent or late-onset cognitive impairment (OPLOCI) due to alcohol and other psychoactive substances in the PMSI database from 2007 to 2017 (285 748 938 inpatient stays). These codings use the International Classification of Diseases, 10th revision (ICD-10).
RESULTS:: The number of inpatient stays with dementia and OPLOCI due to alcohol increased from 34 to 1704 from 2007 to 2017. While the number of diagnosed dementias remained stable at around 400 from 2013, the number of OPLOCIs increased 10-fold from 2013 to 2017. This increase was not found with dementia or OPLOCI due to other psychoactive substances than alcohol.
CONCLUSION:: Notoriety of a diagnosis in the literature seems to have an impact on the coding.},
	language = {eng},
	journal = {American Journal of Alzheimer's Disease and Other Dementias},
	author = {Rochoy, Michaël and Gautier, Sophie and Béné, Johana and Bordet, Régis and Chazard, Emmanuel},
	month = dec,
	year = {2018},
	pmid = {30595024},
	keywords = {alcoholism, clinical coding, data reuse, database, dementia},
	pages = {1533317518822043},
}

BACKGROUND:: The French nationwide exhaustive hospital discharge database (PMSI) is used for activity-based payment of hospital services. We hypothesized that the release of articles about alcohol and dementia could influence the identification of these diagnoses in PMSI. METHODS:: We analyzed temporal evolution of coding for dementia and other persistent or late-onset cognitive impairment (OPLOCI) due to alcohol and other psychoactive substances in the PMSI database from 2007 to 2017 (285 748 938 inpatient stays). These codings use the International Classification of Diseases, 10th revision (ICD-10). RESULTS:: The number of inpatient stays with dementia and OPLOCI due to alcohol increased from 34 to 1704 from 2007 to 2017. While the number of diagnosed dementias remained stable at around 400 from 2013, the number of OPLOCIs increased 10-fold from 2013 to 2017. This increase was not found with dementia or OPLOCI due to other psychoactive substances than alcohol. CONCLUSION:: Notoriety of a diagnosis in the literature seems to have an impact on the coding.

@article{poirier_real_2018,
	title = {Real {Time} {Influenza} {Monitoring} {Using} {Hospital} {Big} {Data} in {Combination} with {Machine} {Learning} {Methods}: {Comparison} {Study}},
	volume = {4},
	issn = {2369-2960},
	shorttitle = {Real {Time} {Influenza} {Monitoring} {Using} {Hospital} {Big} {Data} in {Combination} with {Machine} {Learning} {Methods}},
	doi = {10.2196/11361},
	abstract = {BACKGROUND: Traditional surveillance systems produce estimates of influenza-like illness (ILI) incidence rates, but with 1- to 3-week delay. Accurate real-time monitoring systems for influenza outbreaks could be useful for making public health decisions. Several studies have investigated the possibility of using internet users' activity data and different statistical models to predict influenza epidemics in near real time. However, very few studies have investigated hospital big data.
OBJECTIVE: Here, we compared internet and electronic health records (EHRs) data and different statistical models to identify the best approach (data type and statistical model) for ILI estimates in real time.
METHODS: We used Google data for internet data and the clinical data warehouse eHOP, which included all EHRs from Rennes University Hospital (France), for hospital data. We compared 3 statistical models-random forest, elastic net, and support vector machine (SVM).
RESULTS: For national ILI incidence rate, the best correlation was 0.98 and the mean squared error (MSE) was 866 obtained with hospital data and the SVM model. For the Brittany region, the best correlation was 0.923 and MSE was 2364 obtained with hospital data and the SVM model.
CONCLUSIONS: We found that EHR data together with historical epidemiological information (French Sentinelles network) allowed for accurately predicting ILI incidence rates for the entire France as well as for the Brittany region and outperformed the internet data whatever was the statistical model used. Moreover, the performance of the two statistical models, elastic net and SVM, was comparable.},
	language = {eng},
	number = {4},
	journal = {JMIR public health and surveillance},
	author = {Poirier, Canelle and Lavenu, Audrey and Bertaud, Valérie and Campillo-Gimenez, Boris and Chazard, Emmanuel and Cuggia, Marc and Bouzillé, Guillaume},
	month = dec,
	year = {2018},
	pmid = {30578212},
	keywords = {Sentinelles network, big data, electronic health records, influenza, infodemiology, infoveillance, machine learning},
	pages = {e11361},
}

BACKGROUND: Traditional surveillance systems produce estimates of influenza-like illness (ILI) incidence rates, but with 1- to 3-week delay. Accurate real-time monitoring systems for influenza outbreaks could be useful for making public health decisions. Several studies have investigated the possibility of using internet users' activity data and different statistical models to predict influenza epidemics in near real time. However, very few studies have investigated hospital big data. OBJECTIVE: Here, we compared internet and electronic health records (EHRs) data and different statistical models to identify the best approach (data type and statistical model) for ILI estimates in real time. METHODS: We used Google data for internet data and the clinical data warehouse eHOP, which included all EHRs from Rennes University Hospital (France), for hospital data. We compared 3 statistical models-random forest, elastic net, and support vector machine (SVM). RESULTS: For national ILI incidence rate, the best correlation was 0.98 and the mean squared error (MSE) was 866 obtained with hospital data and the SVM model. For the Brittany region, the best correlation was 0.923 and MSE was 2364 obtained with hospital data and the SVM model. CONCLUSIONS: We found that EHR data together with historical epidemiological information (French Sentinelles network) allowed for accurately predicting ILI incidence rates for the entire France as well as for the Brittany region and outperformed the internet data whatever was the statistical model used. Moreover, the performance of the two statistical models, elastic net and SVM, was comparable.

@article{bray_increased_2018,
	title = {Increased incidence of cholecystectomy related to gallbladder disease in {France}: {Analysis} of 807,307 cholecystectomy procedures over a period of seven years},
	issn = {1878-7886},
	shorttitle = {Increased incidence of cholecystectomy related to gallbladder disease in {France}},
	doi = {10.1016/j.jviscsurg.2018.12.003},
	abstract = {PURPOSE: Gallstones are one of the most common abdominal reasons for admission to hospital. The aim of this study was to analyze trends and outcomes in patients undergoing cholecystectomy with gallbladder related disease in France from 2008 to 2014.
PATIENTS AND METHODS: We carried out a population-based, retrospective cohort study using data extracted from the French nationwide hospital discharge database (PMSI). We included all patients having a cholecystectomy related to gallbladder disease from January 2008 to December 2014. Patients' demographics, primary diagnosis, procedure type, length of stay (LOS), admission in an intensive care unit, discharge disposition, complications, and in-hospital mortality were analyzed.
RESULTS: Overall, 807,307 cholecystectomies were performed in France over the study period, with an increase in the national incidence rate from 167.5 (95\%CI [166.5; 168.5]) to 182.6 (95\%CI [181.6; 183.6]) per 100,000 inhabitants. Females accounted for 66.5\% of procedures (P{\textless}0.001). The mean age was lower for females than for males: 52.1 versus 60.2 (P{\textless}0.001). The ratio of laparoscopic cholecystectomy significantly increased from 90\% in 2008 to 94\% in 2014 (P{\textless}0.001). Average inpatient LOS decreased significantly from 6.5 days in 2008 to 4.7 days in 2014 (P{\textless}0.001). Most common complication type was intra-abdominal (23.1\%) for laparoscopic procedure (95\%CI [22.7; 23.5]), and in-hospital mortality significantly decreased over time from 0.45\% in 2008 to 0.38\% in 2014 (P{\textless}0.005).
CONCLUSION: Our results showed that the national incidence rate of cholecystectomy related to gallbladder disease increased from 2008 to 2014.},
	language = {eng},
	journal = {Journal of Visceral Surgery},
	author = {Bray, F. and Balcaen, T. and Baro, E. and Gandon, A. and Ficheur, G. and Chazard, E.},
	month = dec,
	year = {2018},
	pmid = {30573436},
	keywords = {Cholecystectomy, Epidemiology, Laparoscopic cholecystectomy, Nationwide database, Open cholecystectomy},
}

PURPOSE: Gallstones are one of the most common abdominal reasons for admission to hospital. The aim of this study was to analyze trends and outcomes in patients undergoing cholecystectomy with gallbladder related disease in France from 2008 to 2014. PATIENTS AND METHODS: We carried out a population-based, retrospective cohort study using data extracted from the French nationwide hospital discharge database (PMSI). We included all patients having a cholecystectomy related to gallbladder disease from January 2008 to December 2014. Patients' demographics, primary diagnosis, procedure type, length of stay (LOS), admission in an intensive care unit, discharge disposition, complications, and in-hospital mortality were analyzed. RESULTS: Overall, 807,307 cholecystectomies were performed in France over the study period, with an increase in the national incidence rate from 167.5 (95%CI [166.5; 168.5]) to 182.6 (95%CI [181.6; 183.6]) per 100,000 inhabitants. Females accounted for 66.5% of procedures (P\textless0.001). The mean age was lower for females than for males: 52.1 versus 60.2 (P\textless0.001). The ratio of laparoscopic cholecystectomy significantly increased from 90% in 2008 to 94% in 2014 (P\textless0.001). Average inpatient LOS decreased significantly from 6.5 days in 2008 to 4.7 days in 2014 (P\textless0.001). Most common complication type was intra-abdominal (23.1%) for laparoscopic procedure (95%CI [22.7; 23.5]), and in-hospital mortality significantly decreased over time from 0.45% in 2008 to 0.38% in 2014 (P\textless0.005). CONCLUSION: Our results showed that the national incidence rate of cholecystectomy related to gallbladder disease increased from 2008 to 2014.

@article{rochoy_vascular_2018,
	title = {Vascular dementia encoding in the {French} nationwide discharge summary database ({PMSI}): {Variability} over the 2007-2017 period},
	issn = {1768-3181},
	shorttitle = {Vascular dementia encoding in the {French} nationwide discharge summary database ({PMSI})},
	doi = {10.1016/j.ancard.2018.10.011},
	abstract = {OBJECTIVE: Vascular dementia (VaD) is the second leading cause of dementia. Diagnostic criteria have evolved from the concept of multiple infarctions to different subtypes: acute onset VaD, subcortical VaD, mixed cortical and subcortical VaD. Our aim was to analyze the evolution in the coding of these different subtypes of VaD in the French nationwide exhaustive hospital discharge database (PMSI) between 2007 and 2017.
METHOD: We included all principal diagnoses of VaD in the PMSI hospital stays from 2007 to 2017.
RESULTS: Between 2007 and 2017, we show a relative decrease in the number of hospital stays for VaD compared to all hospital stays (0.0437\% to 0.0404\%). The 11,654 hospital stays for VaD in 2017 represent 13.5\% of mental organic disorders. Subtype analysis shows a decrease in hospital stays for multiple infarctions between 2007 and 2017 (-50\%), an increase for subcortical or mixed VaD (+20\%), acute onset VaD (+184\%) and an increase in "other VaD" (+85\%).
CONCLUSION: These data suggest a slight decrease in hospital stays for VaD, possibly related to better control of cardiovascular risk factors. They also suggest that the coding should be consistent with the evolution of diagnostic criteria.},
	language = {eng},
	journal = {Annales De Cardiologie Et D'angeiologie},
	author = {Rochoy, M. and Chazard, E. and Gautier, S. and Bordet, R.},
	month = nov,
	year = {2018},
	pmid = {30409382},
	keywords = {Base de données, Clinical coding, Codage clinique, Database, Dementia, Diagnosis, Diagnostic, Démence vasculaire, Vascular},
}

OBJECTIVE: Vascular dementia (VaD) is the second leading cause of dementia. Diagnostic criteria have evolved from the concept of multiple infarctions to different subtypes: acute onset VaD, subcortical VaD, mixed cortical and subcortical VaD. Our aim was to analyze the evolution in the coding of these different subtypes of VaD in the French nationwide exhaustive hospital discharge database (PMSI) between 2007 and 2017. METHOD: We included all principal diagnoses of VaD in the PMSI hospital stays from 2007 to 2017. RESULTS: Between 2007 and 2017, we show a relative decrease in the number of hospital stays for VaD compared to all hospital stays (0.0437% to 0.0404%). The 11,654 hospital stays for VaD in 2017 represent 13.5% of mental organic disorders. Subtype analysis shows a decrease in hospital stays for multiple infarctions between 2007 and 2017 (-50%), an increase for subcortical or mixed VaD (+20%), acute onset VaD (+184%) and an increase in "other VaD" (+85%). CONCLUSION: These data suggest a slight decrease in hospital stays for VaD, possibly related to better control of cardiovascular risk factors. They also suggest that the coding should be consistent with the evolution of diagnostic criteria.

@article{robert_hospital-acquired_2018,
	title = {Hospital-acquired hyperkalemia events in older patients are mostly due to avoidable, multifactorial, adverse drug reactions},
	issn = {1532-6535},
	doi = {10.1002/cpt.1239},
	abstract = {Drug-induced hyperkalemia is a frequent and severe complication in hospital setting. Other risk factors may also induce hyperkalemia but the combination of drugs and precipitating factors has not been extensively studied. The aim was to identify drug-induced hyperkalemia events in hospitalized older patients and to describe their combinations with precipitating factors. Two experts analyzed independently retrospective data of patients aged 75 years or more. Experts identified 471 hyperkalemia events and concluded that 379 (80.5\%) were induced by drugs. The cause was multifactorial (i.e. at least one drug with a precipitating factor) in 300 (79.2\%) of the 379 drug-induced hyperkalemia. Most of the drug-induced hyperkalemia events were avoidable (79.9\%) - mainly because of the multifactorial cause (e.g. dosage adaptation during acute kidney injury). Drug-induced hyperkalemia events are frequently combined with precipitating factors in hospitalized older patients and their prevention should focus on these combinations. This article is protected by copyright. All rights reserved.},
	language = {eng},
	journal = {Clinical Pharmacology and Therapeutics},
	author = {Robert, Laurine and Ficheur, Grégoire and Décaudin, Bertrand and Gellens, Juliette and Luyckx, Michel and Perichon, Renaud and Gautier, Sophie and Puisieux, François and Chazard, Emmanuel and Beuscart, Jean-Baptiste},
	month = sep,
	year = {2018},
	pmid = {30242829},
	keywords = {Adverse drug reactions, Elderly, Prevention},
}

Drug-induced hyperkalemia is a frequent and severe complication in hospital setting. Other risk factors may also induce hyperkalemia but the combination of drugs and precipitating factors has not been extensively studied. The aim was to identify drug-induced hyperkalemia events in hospitalized older patients and to describe their combinations with precipitating factors. Two experts analyzed independently retrospective data of patients aged 75 years or more. Experts identified 471 hyperkalemia events and concluded that 379 (80.5%) were induced by drugs. The cause was multifactorial (i.e. at least one drug with a precipitating factor) in 300 (79.2%) of the 379 drug-induced hyperkalemia. Most of the drug-induced hyperkalemia events were avoidable (79.9%) - mainly because of the multifactorial cause (e.g. dosage adaptation during acute kidney injury). Drug-induced hyperkalemia events are frequently combined with precipitating factors in hospitalized older patients and their prevention should focus on these combinations. This article is protected by copyright. All rights reserved.

@article{bensmaine_irisin_2018,
	title = {Irisin levels in {LMNA}-associated partial lipodystrophies},
	issn = {1878-1780},
	doi = {10.1016/j.diabet.2018.08.003},
	abstract = {AIM: The adipo-myokine irisin regulates energy expenditure and fat metabolism. LMNA-associated familial partial lipodystrophy (FPLD2) comprises insulin resistance, muscle hypertrophy and lipoatrophy. The aim of this study was to investigate whether irisin could be a biomarker of FPLD2.
PATIENTS AND METHODS: This case control study included 19 FPLD2 subjects, 13 obese non-diabetic (OND) patients and 19 healthy controls (HC) of normal weight (median BMI: 26, 39 and 22 kg/m2, respectively). Serum irisin and leptin levels, body composition (DXA/MRI) and metabolic/inflammatory parameters were compared in these three groups.
RESULTS: BMI and MRI intra-abdominal fat significantly differed among these three groups, whereas DXA total fat mass and leptin levels were higher in the OND group, but did not differ between HC and FPLD2. Lipodystrophy patients had higher intra-abdominal/total abdominal fat ratios than the other two groups. Irisin levels were higher in FPLD2 and OND patients than in HC (medians: 944, 934 and 804 ng/mL, respectively). However, irisin/leptin ratios and lean body mass percentages were strikingly higher, and lean mass indices lower, in FPLD2 and HC than in the OND (median irisin/leptin ratios: 137, 166 and 21, respectively). In the entire study group, irisin levels positively correlated with BMI, lean body mass and index, intra-abdominal/total abdominal fat ratio, triglyceride, cholesterol, insulin, glucose and HbA1c levels. Also, intra-abdominal/total abdominal fat ratio and lean body mass better differentiated the three groups only in female patients.
CONCLUSION: Circulating irisin is similarly increased in FPLD2 and OND patients, who are characterized by higher lean body mass regardless of their clearly different fat mass. However, irisin/leptin ratios, strikingly higher in FPLD2 than in OND patients, could help to make the diagnosis and prompt genetic testing in clinically atypical cases.},
	language = {eng},
	journal = {Diabetes \& Metabolism},
	author = {Bensmaïne, F. and Benomar, K. and Espiard, S. and Vahe, C. and Le Mapihan, K. and Lion, G. and Lemdani, M. and Chazard, E. and Ernst, O. and Vigouroux, C. and Pigny, P. and Vantyghem, M.-C.},
	month = aug,
	year = {2018},
	pmid = {30165155},
	keywords = {Fat mass, Irisin, Lamin A, Lean mass, Leptin, Lipodystrophy, Muscle, Obesity},
}

AIM: The adipo-myokine irisin regulates energy expenditure and fat metabolism. LMNA-associated familial partial lipodystrophy (FPLD2) comprises insulin resistance, muscle hypertrophy and lipoatrophy. The aim of this study was to investigate whether irisin could be a biomarker of FPLD2. PATIENTS AND METHODS: This case control study included 19 FPLD2 subjects, 13 obese non-diabetic (OND) patients and 19 healthy controls (HC) of normal weight (median BMI: 26, 39 and 22 kg/m2, respectively). Serum irisin and leptin levels, body composition (DXA/MRI) and metabolic/inflammatory parameters were compared in these three groups. RESULTS: BMI and MRI intra-abdominal fat significantly differed among these three groups, whereas DXA total fat mass and leptin levels were higher in the OND group, but did not differ between HC and FPLD2. Lipodystrophy patients had higher intra-abdominal/total abdominal fat ratios than the other two groups. Irisin levels were higher in FPLD2 and OND patients than in HC (medians: 944, 934 and 804 ng/mL, respectively). However, irisin/leptin ratios and lean body mass percentages were strikingly higher, and lean mass indices lower, in FPLD2 and HC than in the OND (median irisin/leptin ratios: 137, 166 and 21, respectively). In the entire study group, irisin levels positively correlated with BMI, lean body mass and index, intra-abdominal/total abdominal fat ratio, triglyceride, cholesterol, insulin, glucose and HbA1c levels. Also, intra-abdominal/total abdominal fat ratio and lean body mass better differentiated the three groups only in female patients. CONCLUSION: Circulating irisin is similarly increased in FPLD2 and OND patients, who are characterized by higher lean body mass regardless of their clearly different fat mass. However, irisin/leptin ratios, strikingly higher in FPLD2 than in OND patients, could help to make the diagnosis and prompt genetic testing in clinically atypical cases.

@article{bouzille_drug_2018,
	title = {Drug safety and big clinical data: {Detection} of drug-induced anaphylactic shock events},
	issn = {1365-2753},
	shorttitle = {Drug safety and big clinical data},
	url = {https://hal-univ-rennes1.archives-ouvertes.fr/hal-01833093/document},
	doi = {10.1111/jep.12908},
	abstract = {RATIONALE, AIMS, AND OBJECTIVES: The spontaneous reporting system currently used in pharmacovigilance is not sufficiently exhaustive to detect all adverse drug reactions (ADRs). With the widespread use of electronic health records, biomedical data collected during the clinical care process can be reused and analysed to better detect ADRs. The aim of this study was to assess whether querying a Clinical Data Warehouse (CDW) could increase the detection of drug-induced anaphylaxis.
METHODS: All known cases of drug-induced anaphylaxis that occurred or required hospitalization at Rennes Academic Hospital in 2011 (n = 19) were retrieved from the French pharmacovigilance database, which contains all reported ADR events. Then, from the Rennes Academic Hospital CDW, a training set (all patients hospitalized in 2011) and a test set (all patients hospitalized in 2012) were extracted. The training set was used to define an optimized query, by building a set of keywords (based on the known cases) and exclusion criteria to search structured and unstructured data within the CDW in order to identify at least all known cases of drug-induced anaphylaxis for 2011. Then, the real performance of the optimized query was tested in the test set.
RESULTS: Using the optimized query, 59 cases of drug-induced anaphylaxis were identified among the 253 patient records extracted from the test set as possible anaphylaxis cases. Specifically, the optimal query identified 41 drug-induced anaphylaxis cases that were not detected by searching the French pharmacovigilance database but missed 7 cases detected only by spontaneous reporting.
DISCUSSION: We proposed an information retrieval-based method for detecting drug-induced anaphylaxis, by querying structured and unstructured data in a CDW. CDW queries are less specific than spontaneous reporting and Diagnosis-related Groups queries, although their sensitivity is much higher. CDW queries can facilitate monitoring by pharmacovigilance experts. Our method could be easily incorporated in the routine practice.},
	language = {eng},
	journal = {Journal of Evaluation in Clinical Practice},
	author = {Bouzillé, Guillaume and Osmont, Marie-Noëlle and Triquet, Louise and Grabar, Natalia and Rochefort-Morel, Cécile and Chazard, Emmanuel and Polard, Elisabeth and Cuggia, Marc},
	month = mar,
	year = {2018},
	pmid = {29532572},
	keywords = {adverse drug reaction reporting systems, drug-related side effects and adverse reactions, electronic health records, information storage and retrieval},
}

RATIONALE, AIMS, AND OBJECTIVES: The spontaneous reporting system currently used in pharmacovigilance is not sufficiently exhaustive to detect all adverse drug reactions (ADRs). With the widespread use of electronic health records, biomedical data collected during the clinical care process can be reused and analysed to better detect ADRs. The aim of this study was to assess whether querying a Clinical Data Warehouse (CDW) could increase the detection of drug-induced anaphylaxis. METHODS: All known cases of drug-induced anaphylaxis that occurred or required hospitalization at Rennes Academic Hospital in 2011 (n = 19) were retrieved from the French pharmacovigilance database, which contains all reported ADR events. Then, from the Rennes Academic Hospital CDW, a training set (all patients hospitalized in 2011) and a test set (all patients hospitalized in 2012) were extracted. The training set was used to define an optimized query, by building a set of keywords (based on the known cases) and exclusion criteria to search structured and unstructured data within the CDW in order to identify at least all known cases of drug-induced anaphylaxis for 2011. Then, the real performance of the optimized query was tested in the test set. RESULTS: Using the optimized query, 59 cases of drug-induced anaphylaxis were identified among the 253 patient records extracted from the test set as possible anaphylaxis cases. Specifically, the optimal query identified 41 drug-induced anaphylaxis cases that were not detected by searching the French pharmacovigilance database but missed 7 cases detected only by spontaneous reporting. DISCUSSION: We proposed an information retrieval-based method for detecting drug-induced anaphylaxis, by querying structured and unstructured data in a CDW. CDW queries are less specific than spontaneous reporting and Diagnosis-related Groups queries, although their sensitivity is much higher. CDW queries can facilitate monitoring by pharmacovigilance experts. Our method could be easily incorporated in the routine practice.

@article{bouzille_leveraging_2018,
	title = {Leveraging hospital big data to monitor flu epidemics},
	volume = {154},
	copyright = {All rights reserved},
	issn = {1872-7565},
	doi = {10.1016/j.cmpb.2017.11.012},
	abstract = {BACKGROUND AND OBJECTIVE: Influenza epidemics are a major public health concern and require a costly and time-consuming surveillance system at different geographical scales. The main challenge is being able to predict epidemics. Besides traditional surveillance systems, such as the French Sentinel network, several studies proposed prediction models based on internet-user activity. Here, we assessed the potential of hospital big data to monitor influenza epidemics.
METHODS: We used the clinical data warehouse of the Academic Hospital of Rennes (France) and then built different queries to retrieve relevant information from electronic health records to gather weekly influenza-like illness activity.
RESULTS: We found that the query most highly correlated with Sentinel network estimates was based on emergency reports concerning discharged patients with a final diagnosis of influenza (Pearson's correlation coefficient (PCC) of 0.931). The other tested queries were based on structured data (ICD-10 codes of influenza in Diagnosis-related Groups, and influenza PCR tests) and performed best (PCC of 0.981 and 0.953, respectively) during the flu season 2014-15. This suggests that both ICD-10 codes and PCR results are associated with severe epidemics. Finally, our approach allowed us to obtain additional patients' characteristics, such as the sex ratio or age groups, comparable with those from the Sentinel network.
CONCLUSIONS: Conclusions: Hospital big data seem to have a great potential for monitoring influenza epidemics in near real-time. Such a method could constitute a complementary tool to standard surveillance systems by providing additional characteristics on the concerned population or by providing information earlier. This system could also be easily extended to other diseases with possible activity changes. Additional work is needed to assess the real efficacy of predictive models based on hospital big data to predict flu epidemics.},
	language = {eng},
	journal = {Computer Methods and Programs in Biomedicine},
	author = {Bouzillé, Guillaume and Poirier, Canelle and Campillo-Gimenez, Boris and Aubert, Marie-Laure and Chabot, Mélanie and Chazard, Emmanuel and Lavenu, Audrey and Cuggia, Marc},
	month = feb,
	year = {2018},
	pmid = {29249339},
	keywords = {Clinical data warehouse, Health Information Systems, Health big data, Influenza, Information retrieval system, Sentinel Surveillance, Sentinel surveillance},
	pages = {153--160},
}

BACKGROUND AND OBJECTIVE: Influenza epidemics are a major public health concern and require a costly and time-consuming surveillance system at different geographical scales. The main challenge is being able to predict epidemics. Besides traditional surveillance systems, such as the French Sentinel network, several studies proposed prediction models based on internet-user activity. Here, we assessed the potential of hospital big data to monitor influenza epidemics. METHODS: We used the clinical data warehouse of the Academic Hospital of Rennes (France) and then built different queries to retrieve relevant information from electronic health records to gather weekly influenza-like illness activity. RESULTS: We found that the query most highly correlated with Sentinel network estimates was based on emergency reports concerning discharged patients with a final diagnosis of influenza (Pearson's correlation coefficient (PCC) of 0.931). The other tested queries were based on structured data (ICD-10 codes of influenza in Diagnosis-related Groups, and influenza PCR tests) and performed best (PCC of 0.981 and 0.953, respectively) during the flu season 2014-15. This suggests that both ICD-10 codes and PCR results are associated with severe epidemics. Finally, our approach allowed us to obtain additional patients' characteristics, such as the sex ratio or age groups, comparable with those from the Sentinel network. CONCLUSIONS: Conclusions: Hospital big data seem to have a great potential for monitoring influenza epidemics in near real-time. Such a method could constitute a complementary tool to standard surveillance systems by providing additional characteristics on the concerned population or by providing information earlier. This system could also be easily extended to other diseases with possible activity changes. Additional work is needed to assess the real efficacy of predictive models based on hospital big data to predict flu epidemics.

@article{dhaenens_clinmine:_2018,
	title = {{ClinMine}: {Optimizing} the {Management} of {Patients} in {Hospital}},
	issn = {1959-0318},
	shorttitle = {{ClinMine}},
	url = {https://hal.inria.fr/hal-01692197/document},
	doi = {10.1016/j.irbm.2017.12.002},
	abstract = {Context
A better understanding of “patient pathway” thanks to data analysis can lead to better treatments for patients. The ClinMine project, supported by the French National Research Agency (ANR), aims at proposing, from various case studies, algorithmic and statistical models able to handle this type of pathway data, focusing primarily on hospital data.
Methods
This article presents two of these case studies, focusing on the integration of temporal data within analysis. First, the hypothesis that some aspects of the patient pathway can be described, even predicted, from the management process of the hospital medical mail is studied. Therefore a specific functional data analysis is driven, and several types of patients have been detected. The second case study deals with the detection of profiles through a biclustering of the patients. The difficulty to simultaneously deal with heterogeneous data, including temporal data is exposed and a method is proposed.
Results
Experiments are driven on real data coming from a hospital. Results on these data show the effectiveness of the two proposed methods.
Conclusion
The project ClinMine aimed at dealing with hospital data in order to provide a better understanding of “patient pathway”. The two methods proposed here show their ability to simultaneously deal with heterogeneous data, including temporal aspects, and manages to give information for the understanding of “patient pathway” (identification of interesting clusters of patients).},
	journal = {IRBM},
	author = {Dhaenens, C. and Jacques, J. and Vandewalle, V. and Vandromme, M. and Chazard, E. and Preda, C. and Amarioarei, A. and Chaiwuttisak, P. and Cozma, C. and Ficheur, G. and Kessaci, M. -E. and Perichon, R. and Taillard, J. and Bordet, R. and Lansiaux, A. and Jourdan, L. and Delerue, D. and Hansske, A.},
	month = jan,
	year = {2018},
	keywords = {Electronic Health Records, Heterogeneous data, Hospital information system, Optimization algorithms, Patient pathway, Temporal data, statistical analysis},
}

Context A better understanding of “patient pathway” thanks to data analysis can lead to better treatments for patients. The ClinMine project, supported by the French National Research Agency (ANR), aims at proposing, from various case studies, algorithmic and statistical models able to handle this type of pathway data, focusing primarily on hospital data. Methods This article presents two of these case studies, focusing on the integration of temporal data within analysis. First, the hypothesis that some aspects of the patient pathway can be described, even predicted, from the management process of the hospital medical mail is studied. Therefore a specific functional data analysis is driven, and several types of patients have been detected. The second case study deals with the detection of profiles through a biclustering of the patients. The difficulty to simultaneously deal with heterogeneous data, including temporal data is exposed and a method is proposed. Results Experiments are driven on real data coming from a hospital. Results on these data show the effectiveness of the two proposed methods. Conclusion The project ClinMine aimed at dealing with hospital data in order to provide a better understanding of “patient pathway”. The two methods proposed here show their ability to simultaneously deal with heterogeneous data, including temporal aspects, and manages to give information for the understanding of “patient pathway” (identification of interesting clusters of patients).

@article{engelmann_comparison_2018,
	title = {Comparison of two commercial quantitative {PCR} assays and correlation with the first {WHO} {International} {Standard} for human {CMV}},
	issn = {1879-0070},
	doi = {10.1016/j.diagmicrobio.2017.12.021},
	abstract = {Comparability between CMV assays could be facilitated by the first WHO International Standard for human CMV (standard). Standard dilutions were submitted to nucleic acid extraction with Versant kPCR Molecular systems SP or MagNA Pure LC System followed by the kPCR PLX™ CMV DNA (kPCR) or the CMV R-gene™ assay (R-gene), respectively; 139 clinical specimens were tested. Both assays correlated well with the standard (R2{\textgreater} 0.96) and a matrix effect was observed. Quantitative results correlated reasonably between both assays for whole blood (R2= 0.79) and well for other specimen types (R2= 0.93). Quantification differences were within one log10of the averaged log10results for 25/27 blood specimens and for 32/33 other specimens. Calibration to the standard did not increase this percentage. In conclusion, results of both assays showed reasonable correlation with each other and good correlation with the standard. Calibration to the standard did not improve comparability of quantitative results.},
	language = {eng},
	journal = {Diagnostic Microbiology and Infectious Disease},
	author = {Engelmann, Ilka and Alidjinou, Enagnon Kazali and Lazrek, Mouna and Ogiez, Judith and Pouillaude, Jean-Marie and Chazard, Emmanuel and Dewilde, Anny and Hober, Didier},
	month = jan,
	year = {2018},
	pmid = {29463426},
	keywords = {CMV, Molecular testing, PCR, Viral load, WHO standard, molecular testing, viral load},
}

Comparability between CMV assays could be facilitated by the first WHO International Standard for human CMV (standard). Standard dilutions were submitted to nucleic acid extraction with Versant kPCR Molecular systems SP or MagNA Pure LC System followed by the kPCR PLX™ CMV DNA (kPCR) or the CMV R-gene™ assay (R-gene), respectively; 139 clinical specimens were tested. Both assays correlated well with the standard (R2\textgreater 0.96) and a matrix effect was observed. Quantitative results correlated reasonably between both assays for whole blood (R2= 0.79) and well for other specimen types (R2= 0.93). Quantification differences were within one log10of the averaged log10results for 25/27 blood specimens and for 32/33 other specimens. Calibration to the standard did not increase this percentage. In conclusion, results of both assays showed reasonable correlation with each other and good correlation with the standard. Calibration to the standard did not improve comparability of quantitative results.

@article{sylvestre_combining_2018,
	title = {Combining information from a clinical data warehouse and a pharmaceutical database to generate a framework to detect comorbidities in electronic health records},
	volume = {18},
	issn = {1472-6947},
	url = {https://hal-univ-rennes1.archives-ouvertes.fr/hal-01709604/document},
	doi = {10.1186/s12911-018-0586-x},
	abstract = {BACKGROUND: Medical coding is used for a variety of activities, from observational studies to hospital billing. However, comorbidities tend to be under-reported by medical coders. The aim of this study was to develop an algorithm to detect comorbidities in electronic health records (EHR) by using a clinical data warehouse (CDW) and a knowledge database.
METHODS: We enriched the Theriaque pharmaceutical database with the French national Comorbidities List to identify drugs associated with at least one major comorbid condition and diagnoses associated with a drug indication. Then, we compared the drug indications in the Theriaque database with the ICD-10 billing codes in EHR to detect potentially missing comorbidities based on drug prescriptions. Finally, we improved comorbidity detection by matching drug prescriptions and laboratory test results. We tested the obtained algorithm by using two retrospective datasets extracted from the Rennes University Hospital (RUH) CDW. The first dataset included all adult patients hospitalized in the ear, nose, throat (ENT) surgical ward between October and December 2014 (ENT dataset). The second included all adult patients hospitalized at RUH between January and February 2015 (general dataset). We reviewed medical records to find written evidence of the suggested comorbidities in current or past stays.
RESULTS: Among the 22,132 Common Units of Dispensation (CUD) codes present in the Theriaque database, 19,970 drugs (90.2\%) were associated with one or several ICD-10 diagnoses, based on their indication, and 11,162 (50.4\%) with at least one of the 4878 comorbidities from the comorbidity list. Among the 122 patients of the ENT dataset, 75.4\% had at least one drug prescription without corresponding ICD-10 code. The comorbidity diagnoses suggested by the algorithm were confirmed in 44.6\% of the cases. Among the 4312 patients of the general dataset, 68.4\% had at least one drug prescription without corresponding ICD-10 code. The comorbidity diagnoses suggested by the algorithm were confirmed in 20.3\% of reviewed cases.
CONCLUSIONS: This simple algorithm based on combining accessible and immediately reusable data from knowledge databases, drug prescriptions and laboratory test results can detect comorbidities.},
	language = {eng},
	number = {1},
	journal = {BMC medical informatics and decision making},
	author = {Sylvestre, Emmanuelle and Bouzillé, Guillaume and Chazard, Emmanuel and His-Mahier, Cécil and Riou, Christine and Cuggia, Marc},
	year = {2018},
	pmid = {29368609},
	pmcid = {PMC5784648},
	keywords = {Billing codes, Clinical data warehouse, Comorbidity, Databases, Drug prescriptions, Laboratory test results, Pharmaceutical},
	pages = {9},
}

BACKGROUND: Medical coding is used for a variety of activities, from observational studies to hospital billing. However, comorbidities tend to be under-reported by medical coders. The aim of this study was to develop an algorithm to detect comorbidities in electronic health records (EHR) by using a clinical data warehouse (CDW) and a knowledge database. METHODS: We enriched the Theriaque pharmaceutical database with the French national Comorbidities List to identify drugs associated with at least one major comorbid condition and diagnoses associated with a drug indication. Then, we compared the drug indications in the Theriaque database with the ICD-10 billing codes in EHR to detect potentially missing comorbidities based on drug prescriptions. Finally, we improved comorbidity detection by matching drug prescriptions and laboratory test results. We tested the obtained algorithm by using two retrospective datasets extracted from the Rennes University Hospital (RUH) CDW. The first dataset included all adult patients hospitalized in the ear, nose, throat (ENT) surgical ward between October and December 2014 (ENT dataset). The second included all adult patients hospitalized at RUH between January and February 2015 (general dataset). We reviewed medical records to find written evidence of the suggested comorbidities in current or past stays. RESULTS: Among the 22,132 Common Units of Dispensation (CUD) codes present in the Theriaque database, 19,970 drugs (90.2%) were associated with one or several ICD-10 diagnoses, based on their indication, and 11,162 (50.4%) with at least one of the 4878 comorbidities from the comorbidity list. Among the 122 patients of the ENT dataset, 75.4% had at least one drug prescription without corresponding ICD-10 code. The comorbidity diagnoses suggested by the algorithm were confirmed in 44.6% of the cases. Among the 4312 patients of the general dataset, 68.4% had at least one drug prescription without corresponding ICD-10 code. The comorbidity diagnoses suggested by the algorithm were confirmed in 20.3% of reviewed cases. CONCLUSIONS: This simple algorithm based on combining accessible and immediately reusable data from knowledge databases, drug prescriptions and laboratory test results can detect comorbidities.

@article{berkhout_randomized_2018,
	title = {Randomized controlled trial on promoting influenza vaccination in general practice waiting rooms},
	volume = {13},
	issn = {1932-6203},
	doi = {10.1371/journal.pone.0192155},
	abstract = {BACKGROUND: Most of general practitioners (GPs) use advertising in their waiting rooms for patient's education purposes. Patients vaccinated against seasonal influenza have been gradually lessening. The objective of this trial was to assess the effect of an advertising campaign for influenza vaccination using posters and pamphlets in GPs' waiting rooms.
METHODS AND FINDINGS: Registry based 2/1 cluster randomized controlled trial, a cluster gathering the enlisted patients of 75 GPs aged over 16 years. The trial, run during the 2014-2015 influenza vaccination campaign, compared patient's awareness from being in 50 GPs' standard waiting rooms (control group) versus that of waiting in 25 rooms from GPs who had received and exposed pamphlets and one poster on influenza vaccine (intervention group), in addition to standard mandatory information. The main outcome was the number of vaccination units delivered in pharmacies. Data were extracted from the SIAM-ERASME claim database of the Health Insurance Fund of Lille-Douai (France). The association between the intervention (yes/no) and the main outcome was assessed through a generalized estimating equation. Seventy-five GPs enrolled 10,597 patients over 65 years or suffering from long lasting diseases (intervention/control as of 3781/6816 patients) from October 15, 2014 to February 28, 2015. No difference was found regarding the number of influenza vaccination units delivered (Relative Risk (RR) = 1.01; 95\% Confidence interval: 0.97 to 1.05; p = 0.561).
CONCLUSION: Effects of the monothematic campaign promoting vaccination against influenza using a poster and pamphlets exposed in GPs' waiting rooms could not be demonstrated.},
	language = {eng},
	number = {2},
	journal = {PloS One},
	author = {Berkhout, Christophe and Willefert-Bouche, Amy and Chazard, Emmanuel and Zgorska-Maynard-Moussa, Suzanna and Favre, Jonathan and Peremans, Lieve and Ficheur, Grégoire and Van Royen, Paul},
	year = {2018},
	pmid = {29425226},
	pages = {e0192155},
}

BACKGROUND: Most of general practitioners (GPs) use advertising in their waiting rooms for patient's education purposes. Patients vaccinated against seasonal influenza have been gradually lessening. The objective of this trial was to assess the effect of an advertising campaign for influenza vaccination using posters and pamphlets in GPs' waiting rooms. METHODS AND FINDINGS: Registry based 2/1 cluster randomized controlled trial, a cluster gathering the enlisted patients of 75 GPs aged over 16 years. The trial, run during the 2014-2015 influenza vaccination campaign, compared patient's awareness from being in 50 GPs' standard waiting rooms (control group) versus that of waiting in 25 rooms from GPs who had received and exposed pamphlets and one poster on influenza vaccine (intervention group), in addition to standard mandatory information. The main outcome was the number of vaccination units delivered in pharmacies. Data were extracted from the SIAM-ERASME claim database of the Health Insurance Fund of Lille-Douai (France). The association between the intervention (yes/no) and the main outcome was assessed through a generalized estimating equation. Seventy-five GPs enrolled 10,597 patients over 65 years or suffering from long lasting diseases (intervention/control as of 3781/6816 patients) from October 15, 2014 to February 28, 2015. No difference was found regarding the number of influenza vaccination units delivered (Relative Risk (RR) = 1.01; 95% Confidence interval: 0.97 to 1.05; p = 0.561). CONCLUSION: Effects of the monothematic campaign promoting vaccination against influenza using a poster and pamphlets exposed in GPs' waiting rooms could not be demonstrated.

@article{chazard_secondary_2018,
	title = {Secondary {Use} of {Healthcare} {Structured} {Data}: {The} {Challenge} of {Domain}-{Knowledge} {Based} {Extraction} of {Features}},
	volume = {255},
	issn = {0926-9630},
	shorttitle = {Secondary {Use} of {Healthcare} {Structured} {Data}},
	abstract = {Secondary use of clinical structured data takes an important place in healthcare research. It was first described by Fayyad as "knowledge discovery in databases". Feature extraction is an important phase but received little attention. The objectives of this paper are: 1) to propose an updated representation of data reuse in healthcare, 2) to illustrate methods and objectives of feature extraction, and 3) to discuss the place of domain-specific knowledge.
MATERIAL AND METHODS: an updated representation is proposed. Then, a case study consists of automatically identifying acute renal failure and discovering risk factors, by secondary use of structured data. Finally, a literature review published par Meystre et al. is analyzed.
RESULTS: 1) we propose a description of data reuse in 5 phases. Phase 1 is data preprocessing (cleansing, linkage, terminological alignment, unit conversions, deidentification), it enables to construct a data warehouse. Phase 2 is feature extraction. Phase 3 is statistical and graphical mining. Phase 4 consists of expert filtering and reorganization of statistical results. Phase 5 is decision making. 2) The case study illustrates how time-dependent features can be extracted from laboratory results and drug administrations, using domain-specific knowledge. 3) Among the 200 papers cited by Meystre et al., the first and last authors were affiliated to health institutions in 74\% (68\% for methodological papers, and 79\% for applied papers).
DISCUSSION: features extraction has a major impact on success of data reuse. Specific knowledge-based reasoning takes an important place in feature extraction, which requires tight collaboration between computer scientists, statisticians, and health professionals.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Chazard, Emmanuel and Ficheur, Grégoire and Caron, Alexandre and Lamer, Antoine and Labreuche, Julien and Cuggia, Marc and Genin, Michaël and Bouzille, Guillaume and Duhamel, Alain},
	year = {2018},
	pmid = {30306898},
	keywords = {Data reuse, data transformation, feature extraction},
	pages = {15--19},
}

Secondary use of clinical structured data takes an important place in healthcare research. It was first described by Fayyad as "knowledge discovery in databases". Feature extraction is an important phase but received little attention. The objectives of this paper are: 1) to propose an updated representation of data reuse in healthcare, 2) to illustrate methods and objectives of feature extraction, and 3) to discuss the place of domain-specific knowledge. MATERIAL AND METHODS: an updated representation is proposed. Then, a case study consists of automatically identifying acute renal failure and discovering risk factors, by secondary use of structured data. Finally, a literature review published par Meystre et al. is analyzed. RESULTS: 1) we propose a description of data reuse in 5 phases. Phase 1 is data preprocessing (cleansing, linkage, terminological alignment, unit conversions, deidentification), it enables to construct a data warehouse. Phase 2 is feature extraction. Phase 3 is statistical and graphical mining. Phase 4 consists of expert filtering and reorganization of statistical results. Phase 5 is decision making. 2) The case study illustrates how time-dependent features can be extracted from laboratory results and drug administrations, using domain-specific knowledge. 3) Among the 200 papers cited by Meystre et al., the first and last authors were affiliated to health institutions in 74% (68% for methodological papers, and 79% for applied papers). DISCUSSION: features extraction has a major impact on success of data reuse. Specific knowledge-based reasoning takes an important place in feature extraction, which requires tight collaboration between computer scientists, statisticians, and health professionals.

@article{lamer_data_2018,
	title = {From {Data} {Extraction} to {Analysis}: {Proposal} of a {Methodology} to {Optimize} {Hospital} {Data} {Reuse} {Process}},
	volume = {247},
	issn = {0926-9630},
	shorttitle = {From {Data} {Extraction} to {Analysis}},
	abstract = {In the Lille University Hospital (North of France), data from the Anesthesia Information Management System (Diane® are linked to the Hospital Information System and stored in a dedicated data warehouse since 2010. These electronic medical records need to be reused and analyzed for observational studies. The aim of this paper is to describe the framework developed to structure the operation of that anesthesia data warehouse for research purposes. The presented framework is structured around three meetings between clinicians, computer scientists, and statisticians. The data scientist acts as a coordinator, leads meetings, and checks each milestone. Reuse of anesthesia-related electronic medical record for research purposes is only allowed through this framework. The aim of the first meeting is to decide the primary and secondary objectives of the study. The aim of the second meeting is to validate the statistical protocol. The data are extracted and the statistical analyses are performed. Finally, the results are presented, explained and discussed during the third meeting. During a 6 months period, 27 projects were included in the framework leading to 5 scientific communications. As a result, case studies with extraction and/or analysis situations are presented. This collaboration led to an empowerment process between all three actors, which increased efficiency of the workflow. Implementation of this framework will keep encouraging collaborative publication in order to provide reproducible research evidence.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Lamer, Antoine and Ficheur, Grégoire and Rousselet, Louis and van Berleere, Marine and Chazard, Emmanuel and Caron, Alexandre},
	year = {2018},
	pmid = {29677919},
	keywords = {Data Science, Electronic Medical Records, Healthcare Data Reuse, Reproducible Research, Statistical Analysis},
	pages = {41--45},
}

In the Lille University Hospital (North of France), data from the Anesthesia Information Management System (Diane® are linked to the Hospital Information System and stored in a dedicated data warehouse since 2010. These electronic medical records need to be reused and analyzed for observational studies. The aim of this paper is to describe the framework developed to structure the operation of that anesthesia data warehouse for research purposes. The presented framework is structured around three meetings between clinicians, computer scientists, and statisticians. The data scientist acts as a coordinator, leads meetings, and checks each milestone. Reuse of anesthesia-related electronic medical record for research purposes is only allowed through this framework. The aim of the first meeting is to decide the primary and secondary objectives of the study. The aim of the second meeting is to validate the statistical protocol. The data are extracted and the statistical analyses are performed. Finally, the results are presented, explained and discussed during the third meeting. During a 6 months period, 27 projects were included in the framework leading to 5 scientific communications. As a result, case studies with extraction and/or analysis situations are presented. This collaboration led to an empowerment process between all three actors, which increased efficiency of the workflow. Implementation of this framework will keep encouraging collaborative publication in order to provide reproducible research evidence.

@article{georges_enhancing_2018,
	title = {Enhancing {Nationwide} {Medico}-{Administrative} {Databases} {Analysis} with {SAF4SUHAD}: {A} {Statistical} {Analysis} {Framework} for {Secondary} {Use} of {Healthcare} {Administrative} {Databases}},
	volume = {255},
	issn = {0926-9630},
	shorttitle = {Enhancing {Nationwide} {Medico}-{Administrative} {Databases} {Analysis} with {SAF4SUHAD}},
	abstract = {Many epidemiological studies now rely on the reuse of large healthcare administrative databases. In those studies, most of the time is consumed in managing data and performing basic statistical analyses and is not available anymore for complex statistical and medical analysis, therefore the potential of such databases is sometimes underexploited. The objective of this work is to build SAF4SUHAD, a statistical analysis framework for secondary use of healthcare administrative databases, using literature-based specifications. A literature review was performed on PubMed in four different medical domains: caesarian deliveries, cholecystectomies, hip replacement surgeries and bariatric surgeries. We identified 22 papers relating analyses of large databases. They reported epidemiological indicators (e.g. mean age), that were abstracted to features (e.g. univariate description of a quantitative variable), and then were implemented through 32 functions available for the user in R programming language. For instance, a function will draw a histogram, compute the mean with confidence interval, quantiles, etc. Those functions comprehend 4 functions for data management, 9 for univariate analysis, 8 for bivariate analysis, 11 for multivariate analysis, and many other intermediate functions. Those functions were successfully used to analyze a French database of 250 million discharge summaries. The set of R ready-to-use functions defined in this work could enable to secure repetitive tasks, and to refocus efforts on expert analysis.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Georges, Alexandre and Balcaen, Thibaut and Caron, Alexandre and Ficheur, Gregoire and Chazard, Emmanuel},
	year = {2018},
	pmid = {30306900},
	keywords = {Healthcare epidemiology, Medico-administrative databases, Statistics},
	pages = {25--29},
}

Many epidemiological studies now rely on the reuse of large healthcare administrative databases. In those studies, most of the time is consumed in managing data and performing basic statistical analyses and is not available anymore for complex statistical and medical analysis, therefore the potential of such databases is sometimes underexploited. The objective of this work is to build SAF4SUHAD, a statistical analysis framework for secondary use of healthcare administrative databases, using literature-based specifications. A literature review was performed on PubMed in four different medical domains: caesarian deliveries, cholecystectomies, hip replacement surgeries and bariatric surgeries. We identified 22 papers relating analyses of large databases. They reported epidemiological indicators (e.g. mean age), that were abstracted to features (e.g. univariate description of a quantitative variable), and then were implemented through 32 functions available for the user in R programming language. For instance, a function will draw a histogram, compute the mean with confidence interval, quantiles, etc. Those functions comprehend 4 functions for data management, 9 for univariate analysis, 8 for bivariate analysis, 11 for multivariate analysis, and many other intermediate functions. Those functions were successfully used to analyze a French database of 250 million discharge summaries. The set of R ready-to-use functions defined in this work could enable to secure repetitive tasks, and to refocus efforts on expert analysis.

@article{dezetree_comparison_2018,
	title = {Comparison of {Changes} in the {Number} of {Included} {Patients} {Between} {Interventional} {Trials} and {Observational} {Studies} {Published} from 1995 to 2014 in {Three} {Leading} {Journals}},
	volume = {255},
	issn = {0926-9630},
	abstract = {INTRODUCTION: Since the late 1990s, research and administrative institutions have been developing health data warehouses and increasingly reusing claims data. The impact of these changes is not yet completely quantified. Our objective was to compare the change in the number of patients included per study between observational and interventional studies over a 20-year period starting in 1995.
MATERIALS AND METHODS: We extracted all abstracts from studies published in three leading medical journals over the period 1995-2014 (18,107 studies). Then, we divided our study into two steps. First, we constructed an SVM-based predictive model to categorize each abstract into "observational", "interventional" or "other" studies. In a second step, we built an algorithm based on regular expressions to automatically extract the number of included patients.
RESULTS: During the investigated period, the median number of enrolled patients per study increased for interventional studies, from 282 in 1995-1999 to 629 in 2010-2014. In the same time, the median number of patients increased more for observational studies, from 368 in 1995-1999 to 2078 in 2010-2014.
DISCUSSION: The routine storage of an increasing amount of data (from data warehouses or claims data) has had an impact in recent years on the number of patients included in observational studies. The recent development of "randomized registry trials" combining, on the one hand, an intervention and, on the other hand, the identification of the outcome through data reuse, may also have an impact, over the next decade, on the number of patients included in randomized clinical trials.},
	language = {eng},
	journal = {Studies in Health Technology and Informatics},
	author = {Dezetree, Arnaud and Chazard, Emmanuel and Schlegel, Daniel R. and Sakilay, Sylvester and Elkin, Peter L. and Ficheur, Grégoire},
	year = {2018},
	pmid = {30306905},
	keywords = {Data reuse, claims data, data warehouse, support vector machine},
	pages = {50--54},
}

INTRODUCTION: Since the late 1990s, research and administrative institutions have been developing health data warehouses and increasingly reusing claims data. The impact of these changes is not yet completely quantified. Our objective was to compare the change in the number of patients included per study between observational and interventional studies over a 20-year period starting in 1995. MATERIALS AND METHODS: We extracted all abstracts from studies published in three leading medical journals over the period 1995-2014 (18,107 studies). Then, we divided our study into two steps. First, we constructed an SVM-based predictive model to categorize each abstract into "observational", "interventional" or "other" studies. In a second step, we built an algorithm based on regular expressions to automatically extract the number of included patients. RESULTS: During the investigated period, the median number of enrolled patients per study increased for interventional studies, from 282 in 1995-1999 to 629 in 2010-2014. In the same time, the median number of patients increased more for observational studies, from 368 in 1995-1999 to 2078 in 2010-2014. DISCUSSION: The routine storage of an increasing amount of data (from data warehouses or claims data) has had an impact in recent years on the number of patients included in observational studies. The recent development of "randomized registry trials" combining, on the one hand, an intervention and, on the other hand, the identification of the outcome through data reuse, may also have an impact, over the next decade, on the number of patients included in randomized clinical trials.

@phdthesis{chazard_reutilisation_2017,
	address = {Lille, France},
	type = {Habilitation à {Diriger} des {Recherches}},
	title = {Réutilisation et fouille de données massives de santé produites en routine au cours du soin},
	url = {http://www.chazard.org/emmanuel/pdf_articles/thesis_HDR_2017_chazard.pdf},
	language = {Fr},
	school = {Université de Lille},
	author = {Chazard, Emmanuel},
	month = dec,
	year = {2017},
}

@article{ferret_inappropriate_2017,
	title = {Inappropriate anticholinergic drugs prescriptions in older patients: analysing a hospital database},
	copyright = {All rights reserved},
	issn = {2210-7703, 2210-7711},
	shorttitle = {Inappropriate anticholinergic drugs prescriptions in older patients},
	url = {https://link.springer.com/article/10.1007/s11096-017-0554-z},
	doi = {10.1007/s11096-017-0554-z},
	abstract = {Background Although many anticholinergics are inappropriate in older patients, the prescription of these drugs in a hospital setting has not been extensively studied. Objective To describe prescriptions of anticholinergic drugs in terms of frequency, at risk situations and constipation in hospitalized, older adults. Setting Using a database from a French general hospital (period 2009–2013), we extracted information on 14,090 hospital stays by patients aged 75 and over. Methods Anticholinergic drug prescriptions were automatically detected, with a focus on prescriptions in three well-known at-risk situations: falls, dementia, and benign prostatic hyperplasia. Cases of constipation that might have been causally related to the administration of anticholinergic drugs were screened for and reviewed. Main outcome measure Prescriptions with a high associated risk of anticholinergic related adverse reactions. Results Administration of an anticholinergic drug was detected in 1412 (10.0\%) of the hospital stays by older patients. At-risk situations were identified in 413 (36.5\%) of these stays: 137 (9.7\%) for falls, 243 (17.2\%) for dementia, and 114 (8.1\%) for benign prostatic hyperplasia; 78 (18.9\%) of these 413 stays featured a combination of two or three at-risk situations. Cases of constipation induced by anticholinergic drug administration were identified in 188 (13.3\%) patient stays by using validated adjudication rules for adverse drug reactions: 85 and 103 cases were respectively evaluated as “possible” or “probable” adverse drug reactions. Conclusions Anticholinergic drugs prescription was found in 10.0\% of hospitalized, older patients. More than one third of these prescriptions occurred in at-risk situations and more than one in ten prescriptions induced constipation.},
	language = {en},
	urldate = {2017-11-17},
	journal = {International Journal of Clinical Pharmacy},
	author = {Ferret, Laurie and Ficheur, Gregoire and Delaviez, Emeline and Luyckx, Michel and Quenton, Sophie and Beuscart, Regis and Chazard, Emmanuel and Beuscart, Jean-Baptiste},
	month = nov,
	year = {2017},
	pages = {1--7},
}

Background Although many anticholinergics are inappropriate in older patients, the prescription of these drugs in a hospital setting has not been extensively studied. Objective To describe prescriptions of anticholinergic drugs in terms of frequency, at risk situations and constipation in hospitalized, older adults. Setting Using a database from a French general hospital (period 2009–2013), we extracted information on 14,090 hospital stays by patients aged 75 and over. Methods Anticholinergic drug prescriptions were automatically detected, with a focus on prescriptions in three well-known at-risk situations: falls, dementia, and benign prostatic hyperplasia. Cases of constipation that might have been causally related to the administration of anticholinergic drugs were screened for and reviewed. Main outcome measure Prescriptions with a high associated risk of anticholinergic related adverse reactions. Results Administration of an anticholinergic drug was detected in 1412 (10.0%) of the hospital stays by older patients. At-risk situations were identified in 413 (36.5%) of these stays: 137 (9.7%) for falls, 243 (17.2%) for dementia, and 114 (8.1%) for benign prostatic hyperplasia; 78 (18.9%) of these 413 stays featured a combination of two or three at-risk situations. Cases of constipation induced by anticholinergic drug administration were identified in 188 (13.3%) patient stays by using validated adjudication rules for adverse drug reactions: 85 and 103 cases were respectively evaluated as “possible” or “probable” adverse drug reactions. Conclusions Anticholinergic drugs prescription was found in 10.0% of hospitalized, older patients. More than one third of these prescriptions occurred in at-risk situations and more than one in ten prescriptions induced constipation.

@article{putman_epidemiologie_2017,
	series = {92e {Réunion} annuelle de la {SOFCOT}},
	title = {Épidémiologie des prothèses de hanche en {France} : analyse de la base nationale du {PMSI} de 2008 à 2014},
	volume = {103},
	issn = {1877-0517},
	shorttitle = {Épidémiologie des prothèses de hanche en {France}},
	url = {http://www.sciencedirect.com/science/article/pii/S1877051717304525},
	doi = {10.1016/j.rcot.2017.09.158},
	abstract = {Introduction
L’incidence des arthroplasties de hanche est en augmentation en France. L’objectif de ce travail était d’étudier l’épidémiologie de la pose de prothèses de hanche en France de 2008 à 2014.
Matériel et méthodes
En utilisant la base de données hospitalière nationale du Programme de médicalisation des systèmes d’information (PMSI) pour les années 2008 à 2014, nous avons identifié tous les patients opérés d’une pose de prothèse de hanche en utilisant la Classification commune des actes médicaux (CCAM). Nous avons analysé les données démographiques des patients, la durée de séjour, le diagnostic principal, le type d’hôpital, le type de prothèse et la mortalité hospitalière.
Résultats
De 2008 à 2014, il y a eu 1 049 637 arthroplasties de hanche (incluant les arthroplasties primaires par prothèse totale, les hémiarthroplasties primaires, et les arthroplasties de remplacement). Le taux d’incidence annuel est passé de 222 en 2008 à 241 pour 100 000 habitants en 2014. L’âge moyen des patients était de 72,8 ans. Soixante pour cent des arthroplasties de la hanche ont été effectuées chez des femmes. Les principales causes de pose de prothèses de hanche étaient l’arthrose (62 \%), les fractures (23,8 \%) et les complications mécaniques des prothèses (8,3 \%). Il y a eu 72,1 \% d’arthroplasties primaires par prothèses totales de la hanche, 16,7 \% d’hémiarthroplasties primaires et 11,6 \% d’arthroplasties de révision. La durée moyenne de séjour des patients hospitalisés était de 11,2jours et 1,28 \% des patients a passé au moins une journée dans une unité de soins intensifs. Dans l’ensemble, 45,6 \% des arthroplasties de hanche ont été effectuées dans des hôpitaux sans but lucratif. La mortalité intrahospitalière est passée de 1,26 \% en 2008 à 0,96 \% en 2014.
Discussion
L’incidence des prothèses de hanche, bien qu’en augmentation en France, reste inférieur aux États-unis et en Angleterre. L’augmentation de l’incidence des prothèses de hanche était principalement le résultat de l’augmentation des arthroplasties de hanches.
Conclusion
L’incidence des prothèses de hanche est en augmentation, avec une diminution de la durée de séjour et une diminution de la mortalité hospitalière.},
	number = {7, Supplement},
	journal = {Revue de Chirurgie Orthopédique et Traumatologique},
	author = {Putman, Sophie and Girier, Nicolas and Girard, Julien and Pasquier, Gilles and Migaud, Henri and Chazard, Emmanuel},
	month = nov,
	year = {2017},
	pages = {S90},
}

Introduction L’incidence des arthroplasties de hanche est en augmentation en France. L’objectif de ce travail était d’étudier l’épidémiologie de la pose de prothèses de hanche en France de 2008 à 2014. Matériel et méthodes En utilisant la base de données hospitalière nationale du Programme de médicalisation des systèmes d’information (PMSI) pour les années 2008 à 2014, nous avons identifié tous les patients opérés d’une pose de prothèse de hanche en utilisant la Classification commune des actes médicaux (CCAM). Nous avons analysé les données démographiques des patients, la durée de séjour, le diagnostic principal, le type d’hôpital, le type de prothèse et la mortalité hospitalière. Résultats De 2008 à 2014, il y a eu 1 049 637 arthroplasties de hanche (incluant les arthroplasties primaires par prothèse totale, les hémiarthroplasties primaires, et les arthroplasties de remplacement). Le taux d’incidence annuel est passé de 222 en 2008 à 241 pour 100 000 habitants en 2014. L’âge moyen des patients était de 72,8 ans. Soixante pour cent des arthroplasties de la hanche ont été effectuées chez des femmes. Les principales causes de pose de prothèses de hanche étaient l’arthrose (62 %), les fractures (23,8 %) et les complications mécaniques des prothèses (8,3 %). Il y a eu 72,1 % d’arthroplasties primaires par prothèses totales de la hanche, 16,7 % d’hémiarthroplasties primaires et 11,6 % d’arthroplasties de révision. La durée moyenne de séjour des patients hospitalisés était de 11,2jours et 1,28 % des patients a passé au moins une journée dans une unité de soins intensifs. Dans l’ensemble, 45,6 % des arthroplasties de hanche ont été effectuées dans des hôpitaux sans but lucratif. La mortalité intrahospitalière est passée de 1,26 % en 2008 à 0,96 % en 2014. Discussion L’incidence des prothèses de hanche, bien qu’en augmentation en France, reste inférieur aux États-unis et en Angleterre. L’augmentation de l’incidence des prothèses de hanche était principalement le résultat de l’augmentation des arthroplasties de hanches. Conclusion L’incidence des prothèses de hanche est en augmentation, avec une diminution de la durée de séjour et une diminution de la mortalité hospitalière.

@article{ghenassia_generic_2017,
	title = {A generic method for improving the spatial interoperability of medical and ecological databases},
	volume = {16},
	copyright = {All rights reserved},
	issn = {1476-072X},
	doi = {10.1186/s12942-017-0109-5},
	abstract = {BACKGROUND: The availability of big data in healthcare and the intensive development of data reuse and georeferencing have opened up perspectives for health spatial analysis. However, fine-scale spatial studies of ecological and medical databases are limited by the change of support problem and thus a lack of spatial unit interoperability. The use of spatial disaggregation methods to solve this problem introduces errors into the spatial estimations. Here, we present a generic, two-step method for merging medical and ecological databases that avoids the use of spatial disaggregation methods, while maximizing the spatial resolution.
METHODS: Firstly, a mapping table is created after one or more transition matrices have been defined. The latter link the spatial units of the original databases to the spatial units of the final database. Secondly, the mapping table is validated by (1) comparing the covariates contained in the two original databases, and (2) checking the spatial validity with a spatial continuity criterion and a spatial resolution index.
RESULTS: We used our novel method to merge a medical database (the French national diagnosis-related group database, containing 5644 spatial units) with an ecological database (produced by the French National Institute of Statistics and Economic Studies, and containing with 36,594 spatial units). The mapping table yielded 5632 final spatial units. The mapping table's validity was evaluated by comparing the number of births in the medical database and the ecological databases in each final spatial unit. The median [interquartile range] relative difference was 2.3\% [0; 5.7]. The spatial continuity criterion was low (2.4\%), and the spatial resolution index was greater than for most French administrative areas.
CONCLUSIONS: Our innovative approach improves interoperability between medical and ecological databases and facilitates fine-scale spatial analyses. We have shown that disaggregation models and large aggregation techniques are not necessarily the best ways to tackle the change of support problem.},
	language = {eng},
	number = {1},
	journal = {International Journal of Health Geographics},
	author = {Ghenassia, A. and Beuscart, J. B. and Ficheur, G. and Occelli, F. and Babykina, E. and Chazard, E. and Genin, M.},
	month = oct,
	year = {2017},
	pmid = {28974262},
	keywords = {Change-of-support problem, Data reuse, Interoperability, Spatial analysis},
	pages = {36},
}

BACKGROUND: The availability of big data in healthcare and the intensive development of data reuse and georeferencing have opened up perspectives for health spatial analysis. However, fine-scale spatial studies of ecological and medical databases are limited by the change of support problem and thus a lack of spatial unit interoperability. The use of spatial disaggregation methods to solve this problem introduces errors into the spatial estimations. Here, we present a generic, two-step method for merging medical and ecological databases that avoids the use of spatial disaggregation methods, while maximizing the spatial resolution. METHODS: Firstly, a mapping table is created after one or more transition matrices have been defined. The latter link the spatial units of the original databases to the spatial units of the final database. Secondly, the mapping table is validated by (1) comparing the covariates contained in the two original databases, and (2) checking the spatial validity with a spatial continuity criterion and a spatial resolution index. RESULTS: We used our novel method to merge a medical database (the French national diagnosis-related group database, containing 5644 spatial units) with an ecological database (produced by the French National Institute of Statistics and Economic Studies, and containing with 36,594 spatial units). The mapping table yielded 5632 final spatial units. The mapping table's validity was evaluated by comparing the number of births in the medical database and the ecological databases in each final spatial unit. The median [interquartile range] relative difference was 2.3% [0; 5.7]. The spatial continuity criterion was low (2.4%), and the spatial resolution index was greater than for most French administrative areas. CONCLUSIONS: Our innovative approach improves interoperability between medical and ecological databases and facilitates fine-scale spatial analyses. We have shown that disaggregation models and large aggregation techniques are not necessarily the best ways to tackle the change of support problem.

@article{baclet_explicit_2017,
	title = {Explicit definitions of potentially inappropriate prescriptions of antibiotics in older patients: a compilation derived from a systematic review},
	copyright = {All rights reserved},
	issn = {1872-7913},
	shorttitle = {Explicit definitions of potentially inappropriate prescriptions of antibiotics in older patients},
	doi = {10.1016/j.ijantimicag.2017.08.011},
	abstract = {CONTEXT: Potentially inappropriate prescriptions (PIPs) of antibiotics (antibiotic-PIPs) are generally detected by applying implicit definitions based on expert opinion. Explicit definitions are less frequently used, even though this approach would enable the automated detection of antibiotic-PIPs in electronic health records. Here, we systematically reviewed explicit definitions of antibiotic-PIPs used in studies of older adults.
METHOD: We searched the MEDLINE(®), Scopus(®) and Web of Science(TM) core collection databases with a combination of three terms and their synonyms: "potentially inappropriate prescription" AND "antibiotic treatment" AND "older patients". After the standardized selection of publications, explicit definitions of antibiotic-PIPs were extracted and classified into infectious disease domains and sub-domains.
RESULTS: A total of 600 search queries identified 4,270 records, 93 of which were selected for review. We found 160 mentions of antibiotic-PIPs, corresponding to 62 distinct definitions in 19 infectious disease domains. Nearly half of the definitions were related to upper respiratory tract infections (n=11 definitions; 17.7\%), lower respiratory tract infections (n=8; 12.9\%) and drug-drug interactions (n=11; 17.7\%). Almost 75\% of the definitions (n=46) were mentioned in a single study only. Only three definitions concerned critically important antibiotics, such as third-generation cephalosporins and fluoroquinolones.
CONCLUSION: Our systematic review identified 62 explicit definitions of antibiotic-PIPs. Most of the definitions were not found in more than one study, and they varied in the degree of precision. We advocate the implementation of an expert consensus on explicit definitions of antibiotic-PIPs that correspond to today's challenges in public health.},
	language = {eng},
	journal = {International Journal of Antimicrobial Agents},
	author = {Baclet, Nicolas and Ficheur, Grégoire and Alfandari, Serge and Ferret, Laurie and Senneville, Eric and Chazard, Emmanuel and Beuscart, Jean-Baptiste},
	month = aug,
	year = {2017},
	pmid = {28803931},
	keywords = {Antibiotics, Elderly, Potentially Inappropriate Prescription},
}

CONTEXT: Potentially inappropriate prescriptions (PIPs) of antibiotics (antibiotic-PIPs) are generally detected by applying implicit definitions based on expert opinion. Explicit definitions are less frequently used, even though this approach would enable the automated detection of antibiotic-PIPs in electronic health records. Here, we systematically reviewed explicit definitions of antibiotic-PIPs used in studies of older adults. METHOD: We searched the MEDLINE(®), Scopus(®) and Web of Science(TM) core collection databases with a combination of three terms and their synonyms: "potentially inappropriate prescription" AND "antibiotic treatment" AND "older patients". After the standardized selection of publications, explicit definitions of antibiotic-PIPs were extracted and classified into infectious disease domains and sub-domains. RESULTS: A total of 600 search queries identified 4,270 records, 93 of which were selected for review. We found 160 mentions of antibiotic-PIPs, corresponding to 62 distinct definitions in 19 infectious disease domains. Nearly half of the definitions were related to upper respiratory tract infections (n=11 definitions; 17.7%), lower respiratory tract infections (n=8; 12.9%) and drug-drug interactions (n=11; 17.7%). Almost 75% of the definitions (n=46) were mentioned in a single study only. Only three definitions concerned critically important antibiotics, such as third-generation cephalosporins and fluoroquinolones. CONCLUSION: Our systematic review identified 62 explicit definitions of antibiotic-PIPs. Most of the definitions were not found in more than one study, and they varied in the degree of precision. We advocate the implementation of an expert consensus on explicit definitions of antibiotic-PIPs that correspond to today's challenges in public health.

@article{chazard_how_2017,
	title = {How to {Compare} the {Length} of {Stay} of {Two} {Samples} of {Inpatients}? {A} {Simulation} {Study} to {Compare} {Type} {I} and {Type} {II} {Errors} of 12 {Statistical} {Tests}},
	volume = {20},
	copyright = {All rights reserved},
	issn = {1524-4733},
	shorttitle = {How to {Compare} the {Length} of {Stay} of {Two} {Samples} of {Inpatients}?},
	doi = {10.1016/j.jval.2017.02.009},
	abstract = {BACKGROUND: Although many researchers in the field of health economics and quality of care compare the length of stay (LOS) in two inpatient samples, they often fail to check whether the sample meets the assumptions made by their chosen statistical test. In fact, LOS data show a highly right-skewed, discrete distribution in which most of the observations are tied; this violates the assumptions of most statistical tests.
OBJECTIVES: To estimate the type I and type II errors associated with the application of 12 different statistical tests to a series of LOS samples.
METHODS: The LOS distribution was extracted from an exhaustive French national database of inpatient stays. The type I error was estimated using 19 sample sizes and 1,000,000 simulations per sample. The type II error was estimated in three alternative scenarios. For each test, the type I and type II errors were plotted as a function of the sample size.
RESULTS: Gamma regression with log link, the log rank test, median regression, Poisson regression, and Weibull survival analysis presented an unacceptably high type I error. In contrast, the Student standard t test, linear regression with log link, and the Cox models had an acceptable type I error but low power.
CONCLUSIONS: When comparing the LOS for two balanced inpatient samples, the Student t test with logarithmic or rank transformation, the Wilcoxon test, and the Kruskal-Wallis test are the only methods with an acceptable type I error and high power.},
	language = {eng},
	number = {7},
	journal = {Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research},
	author = {Chazard, Emmanuel and Ficheur, Grégoire and Beuscart, Jean-Baptiste and Preda, Cristian},
	month = aug,
	year = {2017},
	pmid = {28712630},
	keywords = {Length of Stay, METHODOLOGY, Statistics, length of stay, methodology, outcome measurement, statistics},
	pages = {992--998},
}

BACKGROUND: Although many researchers in the field of health economics and quality of care compare the length of stay (LOS) in two inpatient samples, they often fail to check whether the sample meets the assumptions made by their chosen statistical test. In fact, LOS data show a highly right-skewed, discrete distribution in which most of the observations are tied; this violates the assumptions of most statistical tests. OBJECTIVES: To estimate the type I and type II errors associated with the application of 12 different statistical tests to a series of LOS samples. METHODS: The LOS distribution was extracted from an exhaustive French national database of inpatient stays. The type I error was estimated using 19 sample sizes and 1,000,000 simulations per sample. The type II error was estimated in three alternative scenarios. For each test, the type I and type II errors were plotted as a function of the sample size. RESULTS: Gamma regression with log link, the log rank test, median regression, Poisson regression, and Weibull survival analysis presented an unacceptably high type I error. In contrast, the Student standard t test, linear regression with log link, and the Cox models had an acceptable type I error but low power. CONCLUSIONS: When comparing the LOS for two balanced inpatient samples, the Student t test with logarithmic or rank transformation, the Wilcoxon test, and the Kruskal-Wallis test are the only methods with an acceptable type I error and high power.

@article{averlant_underuse_2017,
	title = {Underuse of {Oral} {Anticoagulants} and {Inappropriate} {Prescription} of {Antiplatelet} {Therapy} in {Older} {Inpatients} with {Atrial} {Fibrillation}},
	copyright = {All rights reserved},
	issn = {1179-1969},
	doi = {10.1007/s40266-017-0477-3},
	abstract = {BACKGROUND: Several studies have shown that the prescription of antiplatelet therapy (APT) is associated with an increased risk of oral anticoagulant (OAC) underuse in patients aged 75 years and over with atrial fibrillation (AF). An associated atheromatous disease may be the underlying reason for APT prescription. The objective of the study was to determine whether the association between underuse of OAC and APT prescription was explained by the presence of an atheromatous disease.
METHODS AND RESULTS: We performed a retrospective, observational, single-centre study between 2009 and 2013 based on administrative data. Patients aged 75 years and over with non-valvular AF were identified in a database of 72,090 hospital stays. Prescriptions of anti-thrombotic medications and their association with the presence of atheromatous disease were evaluated by the mean of a logistic regression. A total of 2034 hospital stays were included (mean age 84.3 ± 5.2 years). The overall prevalence of known atheromatous disease was 25.9\%. OAC underuse was observed in 58.5\% of the stays. In multivariable analysis, the prescription of an APT was associated with an increased risk of OAC underuse [odds ratio (OR) 6.85; 95\% confidence interval (CI) 5.50-8.58], independently of the presence of a concomitant known atheromatous disease (OR 0.78; 95\% CI 0.60-1.01). Among the 692 stays with APT monotherapy (34.0\%), 232 (33.5\%) displayed an atheromatous disease.
CONCLUSIONS: The underuse of OAC is associated with the prescription of APT in older patients with AF, regardless of the presence or absence of known atheromatous disease. Our results suggest that APT is often inappropriately prescribed instead of OAC.},
	language = {eng},
	journal = {Drugs \& Aging},
	author = {Averlant, Lorette and Ficheur, Grégoire and Ferret, Laurie and Boulé, Stéphane and Puisieux, François and Luyckx, Michel and Soula, Julien and Georges, Alexandre and Beuscart, Régis and Chazard, Emmanuel and Beuscart, Jean-Baptiste},
	month = jul,
	year = {2017},
	pmid = {28702928},
}

BACKGROUND: Several studies have shown that the prescription of antiplatelet therapy (APT) is associated with an increased risk of oral anticoagulant (OAC) underuse in patients aged 75 years and over with atrial fibrillation (AF). An associated atheromatous disease may be the underlying reason for APT prescription. The objective of the study was to determine whether the association between underuse of OAC and APT prescription was explained by the presence of an atheromatous disease. METHODS AND RESULTS: We performed a retrospective, observational, single-centre study between 2009 and 2013 based on administrative data. Patients aged 75 years and over with non-valvular AF were identified in a database of 72,090 hospital stays. Prescriptions of anti-thrombotic medications and their association with the presence of atheromatous disease were evaluated by the mean of a logistic regression. A total of 2034 hospital stays were included (mean age 84.3 ± 5.2 years). The overall prevalence of known atheromatous disease was 25.9%. OAC underuse was observed in 58.5% of the stays. In multivariable analysis, the prescription of an APT was associated with an increased risk of OAC underuse [odds ratio (OR) 6.85; 95% confidence interval (CI) 5.50-8.58], independently of the presence of a concomitant known atheromatous disease (OR 0.78; 95% CI 0.60-1.01). Among the 692 stays with APT monotherapy (34.0%), 232 (33.5%) displayed an atheromatous disease. CONCLUSIONS: The underuse of OAC is associated with the prescription of APT in older patients with AF, regardless of the presence or absence of known atheromatous disease. Our results suggest that APT is often inappropriately prescribed instead of OAC.

@article{caron_it-cares:_2017,
	title = {{IT}-{CARES}: an interactive tool for case-crossover analyses of electronic medical records for patient safety},
	volume = {24},
	issn = {1527-974X},
	shorttitle = {{IT}-{CARES}},
	doi = {10.1093/jamia/ocw132},
	abstract = {Background: The significant risk of adverse events following medical procedures supports a clinical epidemiological approach based on the analyses of collections of electronic medical records. Data analytical tools might help clinical epidemiologists develop more appropriate case-crossover designs for monitoring patient safety.
Objective: To develop and assess the methodological quality of an interactive tool for use by clinical epidemiologists to systematically design case-crossover analyses of large electronic medical records databases.
Material and Methods: We developed IT-CARES, an analytical tool implementing case-crossover design, to explore the association between exposures and outcomes. The exposures and outcomes are defined by clinical epidemiologists via lists of codes entered via a user interface screen. We tested IT-CARES on data from the French national inpatient stay database, which documents diagnoses and medical procedures for 170 million inpatient stays between 2007 and 2013. We compared the results of our analysis with reference data from the literature on thromboembolic risk after delivery and bleeding risk after total hip replacement.
Results: IT-CARES provides a user interface with 3 columns: (i) the outcome criteria in the left-hand column, (ii) the exposure criteria in the right-hand column, and (iii) the estimated risk (odds ratios, presented in both graphical and tabular formats) in the middle column. The estimated odds ratios were consistent with the reference literature data.
Discussion: IT-CARES may enhance patient safety by facilitating clinical epidemiological studies of adverse events following medical procedures. The tool's usability must be evaluated and improved in further research.},
	language = {eng},
	number = {2},
	journal = {Journal of the American Medical Informatics Association: JAMIA},
	author = {Caron, Alexandre and Chazard, Emmanuel and Muller, Joris and Perichon, Renaud and Ferret, Laurie and Koutkias, Vassilis and Beuscart, Régis and Beuscart, Jean-Baptiste and Ficheur, Grégoire},
	month = mar,
	year = {2017},
	pmid = {27678461},
	pmcid = {PMC5391728},
	keywords = {Cross-Over Studies, Databases, Factual, Electronic Health Records, Epidemiologic Methods, Hemorrhage, Humans, Medical Informatics, Patient Safety, Patient safety, Risk, Software, Thromboembolism, adverse event, big data, clinical epidemiology, data analytics, medical informatics},
	pages = {323--330},
}

Background: The significant risk of adverse events following medical procedures supports a clinical epidemiological approach based on the analyses of collections of electronic medical records. Data analytical tools might help clinical epidemiologists develop more appropriate case-crossover designs for monitoring patient safety. Objective: To develop and assess the methodological quality of an interactive tool for use by clinical epidemiologists to systematically design case-crossover analyses of large electronic medical records databases. Material and Methods: We developed IT-CARES, an analytical tool implementing case-crossover design, to explore the association between exposures and outcomes. The exposures and outcomes are defined by clinical epidemiologists via lists of codes entered via a user interface screen. We tested IT-CARES on data from the French national inpatient stay database, which documents diagnoses and medical procedures for 170 million inpatient stays between 2007 and 2013. We compared the results of our analysis with reference data from the literature on thromboembolic risk after delivery and bleeding risk after total hip replacement. Results: IT-CARES provides a user interface with 3 columns: (i) the outcome criteria in the left-hand column, (ii) the exposure criteria in the right-hand column, and (iii) the estimated risk (odds ratios, presented in both graphical and tabular formats) in the middle column. The estimated odds ratios were consistent with the reference literature data. Discussion: IT-CARES may enhance patient safety by facilitating clinical epidemiological studies of adverse events following medical procedures. The tool's usability must be evaluated and improved in further research.

@article{balcaen_validite_2017,
	series = {{XXXe} {Congrès} national Émois, {Nancy}, 23 et 24 mars 2017},
	title = {Validité de la mesure de l’incidence des cancers en {France} à partir de la base de données du {Programme} de médicalisation des systèmes d’information : revue systématique de la littérature de 2001 à 2015},
	volume = {65, Supplement 1},
	issn = {0398-7620},
	shorttitle = {Validité de la mesure de l’incidence des cancers en {France} à partir de la base de données du {Programme} de médicalisation des systèmes d’information},
	url = {http://www.sciencedirect.com/science/article/pii/S039876201730069X},
	doi = {10.1016/j.respe.2017.01.066},
	abstract = {Introduction
L’incidence des cancers est estimée à partir des données des registres des cancers qui couvrent environ 20 \% de la population. La base de données du Programme de médicalisation des systèmes d’information (PMSI) contient des données médico-administratives liées aux hospitalisations pour cancer. Le PMSI est potentiellement exploitable pour mesurer leur incidence. L’objectif de ce travail est de réaliser une revue systématique de la littérature sur l’utilisation de la base PMSI pour mesurer l’incidence des cancers en France.
Méthodes
=Une recherche bibliographique systématique, selon les recommandations PRISMA, a été faite à partir des thèmes « incidence », « cancer » et « pmsi ». Nous avons exploré plusieurs bases de données bibliographiques, dont Pubmed, Web of science, Springer Link, Science Direct. Nous avons retenu les articles qui comparaient la mesure de l’incidence des cancers à partir du PMSI à une mesure de référence. Les critères d’inclusion étaient : une année de production de la base PMSI postérieure à 2000, la nature du cancer (primitif uniquement) et des données issues de la base nationale du PMSI. Une synthèse qualitative des articles inclus a été réalisée.
Résultats
Sur 1428 références analysées, 12 études originales ont été retenues. L’année médiane de production des bases était 2004, une seule étude a analysé les bases postérieures à 2007. Les résultats des études montrent une fiabilité satisfaisante du PMSI, surtout pour les années de production les plus récentes.
Discussion/conclusion
Ceci est en faveur de l’exploitation des données PMSI dans un cadre de recherche épidémiologique destiné à documenter les incidences de cancers. Toutefois, il est important de prendre en compte les contraintes inhérentes à la production de ces données dans les analyses. Il sera nécessaire de compléter ce travail avec des données plus récentes afin de confirmer cette fiabilité. Le développement d’algorithmes utilisant l’ensemble des informations disponibles (les diagnostics, les actes et le croisement des données des différents séjours d’un même patient) améliorerait certainement la détection des cas.},
	journal = {Revue d'Épidémiologie et de Santé Publique},
	author = {Balcaen, T. and Chazard, E. and Ganry, O. and Caillet, P.},
	month = mar,
	year = {2017},
	keywords = {Epidémiologie, PMSI, ésCancer},
	pages = {S28},
}

Introduction L’incidence des cancers est estimée à partir des données des registres des cancers qui couvrent environ 20 % de la population. La base de données du Programme de médicalisation des systèmes d’information (PMSI) contient des données médico-administratives liées aux hospitalisations pour cancer. Le PMSI est potentiellement exploitable pour mesurer leur incidence. L’objectif de ce travail est de réaliser une revue systématique de la littérature sur l’utilisation de la base PMSI pour mesurer l’incidence des cancers en France. Méthodes =Une recherche bibliographique systématique, selon les recommandations PRISMA, a été faite à partir des thèmes « incidence », « cancer » et « pmsi ». Nous avons exploré plusieurs bases de données bibliographiques, dont Pubmed, Web of science, Springer Link, Science Direct. Nous avons retenu les articles qui comparaient la mesure de l’incidence des cancers à partir du PMSI à une mesure de référence. Les critères d’inclusion étaient : une année de production de la base PMSI postérieure à 2000, la nature du cancer (primitif uniquement) et des données issues de la base nationale du PMSI. Une synthèse qualitative des articles inclus a été réalisée. Résultats Sur 1428 références analysées, 12 études originales ont été retenues. L’année médiane de production des bases était 2004, une seule étude a analysé les bases postérieures à 2007. Les résultats des études montrent une fiabilité satisfaisante du PMSI, surtout pour les années de production les plus récentes. Discussion/conclusion Ceci est en faveur de l’exploitation des données PMSI dans un cadre de recherche épidémiologique destiné à documenter les incidences de cancers. Toutefois, il est important de prendre en compte les contraintes inhérentes à la production de ces données dans les analyses. Il sera nécessaire de compléter ce travail avec des données plus récentes afin de confirmer cette fiabilité. Le développement d’algorithmes utilisant l’ensemble des informations disponibles (les diagnostics, les actes et le croisement des données des différents séjours d’un même patient) améliorerait certainement la détection des cas.

@article{martincic_chirurgie_2017,
	series = {{XXXe} {Congrès} national Émois, {Nancy}, 23 et 24 mars 2017},
	title = {La chirurgie bariatrique en {France} de 2008 à 2014 : triplement de l’activité et fort recul de l’anneau gastrique},
	volume = {65, Supplement 1},
	issn = {0398-7620},
	shorttitle = {La chirurgie bariatrique en {France} de 2008 à 2014},
	url = {http://www.sciencedirect.com/science/article/pii/S0398762017300470},
	doi = {10.1016/j.respe.2017.01.044},
	abstract = {Introduction
La chirurgie de l’obésité augmente sans cesse en France. Les techniques chirurgicales évoluent. L’objectif est de décrire les patients et les interventions.
Méthodes
La base nationale du PMSI de 2008 à 2014 est analysée à l’aide du langage de programmation en statistiques R. Les séjours d’un même patient sont chaînés. Des analyses descriptives et multivariées sont réalisées (Cox, régressions logistiques et arbres de décision).
Résultats
Le nombre d’intervention passe de 17 659 en 2008 à 47 544 à 2014. Les interventions sont des sleeve gastrectomies (45,2 \%), des bypass gastriques (29,8 \%), des anneaux gastriques (23,0 \%) et des dérivations biliopancréatiques (0,81 \%) ; 66 \% sont réalisées en établissement lucratif (diminue, p = 0). Les patients sont pour 83 \% des femmes, l’âge moyen est de 40 ans L’IMC est compris entre 40 et 50 kg/m2 dans au moins 59,1 \% des cas, mais diminue régulièrement (p = 0). Les patients sont hospitalisés en médiane six journées consécutives. L’hospitalisation ambulatoire passe de 1 \% en 2008 à 3,4 \% en 2014 (p = 0), principalement dans le secteur lucratif (p = 0) et pour les anneaux gastriques (p = 0) ; 4,5 \% des patients passent en réanimation ou soins intensif, mais cette proportion diminue (p = 0) ; 98,2 \% rentrent directement à domicile. L’anneau gastrique passe de 55,4 \% en 2008 à 9,2 \% en 2014, tandis que la sleeve gastrectomie passe de 16,9 à 60,7 \%. En 2014, 25,7 \% des patients opérés en lucratif, âgés de moins de 30 ans et d’IMC \< 40 ont bénéficié d’un anneau, contre 8,3 \% chez les autres. En 2014, 41 \% des patients âgés de plus de 40 ans et diabétiques ont reçu une technique créant une malabsorption, contre 28,5 \% chez les autres. Les réhospitalisations sont fréquentes et se répartissent ainsi : complications mécaniques d’anneaux (27,1 \%), occlusions (22,6 \%), hernies ou éventrations (15,3 \%), fistules (12,7 \%), infections (9,6 \%), saignements (7,6 \%) et abdominoplasties (5,7 \%). La mortalité observée en court séjour est de 0,18 \% à 1 an et 0,55 \% à 5 ans.
Discussion/conclusion
L’accès direct aux bases nationales à l’aide d’outils d’analyse choisis par les chercheurs eux-mêmes est dans l’intérêt général.},
	journal = {Revue d'Épidémiologie et de Santé Publique},
	author = {Martincic, C. and Balcaen, T. and Georges, A. and Baro, E. and Ficheur, G. and Chazard, E.},
	month = mar,
	year = {2017},
	keywords = {Base nationale du PMSI, big data, ésChirurgie bariatrique},
	pages = {S20},
}

Introduction La chirurgie de l’obésité augmente sans cesse en France. Les techniques chirurgicales évoluent. L’objectif est de décrire les patients et les interventions. Méthodes La base nationale du PMSI de 2008 à 2014 est analysée à l’aide du langage de programmation en statistiques R. Les séjours d’un même patient sont chaînés. Des analyses descriptives et multivariées sont réalisées (Cox, régressions logistiques et arbres de décision). Résultats Le nombre d’intervention passe de 17 659 en 2008 à 47 544 à 2014. Les interventions sont des sleeve gastrectomies (45,2 %), des bypass gastriques (29,8 %), des anneaux gastriques (23,0 %) et des dérivations biliopancréatiques (0,81 %) ; 66 % sont réalisées en établissement lucratif (diminue, p = 0). Les patients sont pour 83 % des femmes, l’âge moyen est de 40 ans L’IMC est compris entre 40 et 50 kg/m2 dans au moins 59,1 % des cas, mais diminue régulièrement (p = 0). Les patients sont hospitalisés en médiane six journées consécutives. L’hospitalisation ambulatoire passe de 1 % en 2008 à 3,4 % en 2014 (p = 0), principalement dans le secteur lucratif (p = 0) et pour les anneaux gastriques (p = 0) ; 4,5 % des patients passent en réanimation ou soins intensif, mais cette proportion diminue (p = 0) ; 98,2 % rentrent directement à domicile. L’anneau gastrique passe de 55,4 % en 2008 à 9,2 % en 2014, tandis que la sleeve gastrectomie passe de 16,9 à 60,7 %. En 2014, 25,7 % des patients opérés en lucratif, âgés de moins de 30 ans et d’IMC < 40 ont bénéficié d’un anneau, contre 8,3 % chez les autres. En 2014, 41 % des patients âgés de plus de 40 ans et diabétiques ont reçu une technique créant une malabsorption, contre 28,5 % chez les autres. Les réhospitalisations sont fréquentes et se répartissent ainsi : complications mécaniques d’anneaux (27,1 %), occlusions (22,6 %), hernies ou éventrations (15,3 %), fistules (12,7 %), infections (9,6 %), saignements (7,6 %) et abdominoplasties (5,7 %). La mortalité observée en court séjour est de 0,18 % à 1 an et 0,55 % à 5 ans. Discussion/conclusion L’accès direct aux bases nationales à l’aide d’outils d’analyse choisis par les chercheurs eux-mêmes est dans l’intérêt général.