French Hospitals Research Articles

Groundbreaking outpatient activity in medical entomology in France: An eight-year experience in a french university hospital

IntroductionArthropods are known to impair human health in various manners, acting as infectious disease vectors, or as simple nuisances. Even though considerable research is being produced in medical entomology, no reports on patient management in clinical entomology units are available in the literature. Patients and MethodsWe retrospectively surveyed all the records from patients having consulted in our outpatient clinical entomology unit in Nice University Hospital from 2012 to 2020. For each patient, physical examination findings and treatment data were analyzed. ResultsA total of 518 patients were analyzed in this study. Most were diagnosed with arthropod infestation (55.8%), the most common being Sarcoptes scabiei (35%), bedbugs (23%), Pyemotes dermatitis (17.6%) and flea infestation (15.9%). Along with symptomatic treatments, targeted environmental measures could be proposed for infested patients. For many of our patients, on the other hand, active infestation was ruled out. ConclusionGiven today’s lack of expertise in medical entomology, we advocate for the creation of medical entomology units in university hospitals, not only allowing fair and proportionate multidisciplinary management of patients in whom arthropod infestation is suspected, but also generating cost savings.

Characteristics and Prognosis of Patients With Hypertensive Encephalopathy: A French Nationwide Cohort Study.

Hypertensive encephalopathy (HE) constitutes a serious condition, usually observed in patients with long-lasting hypertension. Hypertension-associated HE is sometimes differentiated from the stroke-associated hypertensive emergency. Whether prognosis of hypertension-associated and stroke-associated HE is different is unclear. Characteristics and prognosis of HE were assessed in this nationwide retrospective cohort study in all patients with an administrative code of HE compared with age-, sex- and year of inclusion-matched controls admitted to French hospitals during the 2014 to 2022 period. HE was identified in 7769 patients. Chronic kidney disease (19.3%), coronary artery disease (13.8%), diabetes (22.1%), and ischemic stroke (5.2%) were frequent but thrombotic microangiopathy, hemolytic-uremic syndrome, systemic sclerosis or renal infarction were <1%. HE prognosis was poor (death: 10.4%/y, heart failure: 8.6%/y, end-stage kidney disease: 9.0%/y, ischemic stroke: 3.6%/y, hemorrhagic stroke: 1.6%/y, dementia: 4.1%/y). The risk of death was increased to a similar extent in patients with HE, regardless of the presence of known hypertension or concomitant stroke (versus patients without HE). Among patients with HE, known hypertension was significantly associated with increased risks of ischemic stroke, hemorrhagic stroke, heart failure, vascular dementia, and all-cause dementia and to a lesser extent with chronic dialysis in multivariable analyses including adjustment on concomitant stroke. HE remains a considerable health burden and is associated with a poor prognosis. The distinction between hypertension- versus stroke-associated HE is relevant as these 2 situations convey different risks of stroke, heart failure, vascular dementia, and end-stage kidney disease.

Relationships between the COVID-19 lockdown, socioeconomic factors and acute coronary syndrome hospitalisations in France.

Worldwide, the COVID-19 pandemic has been associated with an overall drop in acute coronary syndrome (ACS) hospitalizations. Additionally, there is a well-known association between ACS and socioeconomic status. This study aims to assess the COVID-19 effect on ACS admissions in France during the first national lockdown and investigate the factors associated with its spatial heterogeneity. In this retrospective study, we used the French hospital discharge database (PMSI) to estimate ACS admission rates in all public and private hospitals in 2019 and 2020. A negative binomial regression explored the nationwide change in ACS admissions during lockdown compared with 2019. A multivariate analysis explored the factors associated with the ACS admission incidence rate ratio (IRR, 2020 incidence rate/2019 incidence rate) variation at the county level. We found a significant but geographically heterogeneous nationwide reduction in ACS admissions during lockdown (IRR 0·70 [0·64-0·76]). After adjustment for cumulative COVID-19 admissions and the ageing index, a higher share of people on short-term working arrangements during lockdown at the county level was associated with a lower IRR, while a higher share of individuals with a high school degree and a higher density of acute care beds were associated with a higher ratio. During the first national lockdown, there was an overall decrease in ACS admissions. Local provision of inpatient care and socioeconomic determinants linked to occupation were independently associated with the variation in hospitalizations.

Intravesical injections of botulinum neurotoxin A to treat overactive bladder and/or detrusor overactivity related to multiple sclerosis: 5-Year continuation rate and specific risk factors for discontinuation—A study from the neuro-urology committee of the French Association of Urology

Background: While intravesical injections of botulinum neurotoxin A (BoNT-A) are currently recommended for patients experiencing refractory neurogenic overactive bladder and/or detrusor overactivity (OAB/DO), it is unclear how much this therapy is effective and sustainable in the long-term in patients with multiple sclerosis (MS). Objectives: To assess the mid-term continuation rate of BoNT-A injections to treat neurogenic OAB/DO in MS patients and to investigate MS-specific risk factors for discontinuation. Methods: This retrospective study involved 11 French university hospital centers. All MS patients who received BoNT-A to treat neurogenic OAB/DO between 2008 and 2013 and were subsequently followed up for at least 5 years were eligible. Results: Of the 196 MS patients included, 159 (81.1%) were still under BoNT-A 5 years after the first injection. The combination of the Expanded Disability Status Scale (EDSS < 6 or ⩾ 6) and of the MS type (relapsing–remitting vs progressive) predicted the risk of discontinuation. This risk was 5.5% for patients with no risk factor, whereas patients presenting with one or two risk factors were 3.3 and 5.7 times more likely to discontinue, respectively. Conclusion: BoNT-A is a satisfying mid-term neurogenic OAB/DO therapy for most MS patients. Combining EDSS and MS type could help predict BoNT-A discontinuation.

17th International Conference on Malignant Lymphoma, Palazzo dei Congressi, Lugano, Switzerland, 13 - 17 June, 2023.

Introduction: Follicular Lymphoma (FL) is the second most common non-Hodgkin lymphoma in adults and is heterogeneous with 20% of poor-outcome patients relapsing/progressing within 24 months (POD24) of first treatment start (Casulo et al., JCO 2015). Early identification of those POD24 patients is critical but remains elusive. We initiated a collaboration between the academic CALYM Carnot Institute and the private company Euranova aiming at developing interpretable artificial intelligence (AI) models based on Positron Emission Tomography (PET) images to predict POD24. Methods: The dataset was based on the LYSA group RELEVANCE (RE) trial (Morshhauser et al, NEJM 2018) and on real-life (RL) datasets from two french hospitals (Dijon, Toulouse). Patients with FL diagnosis confirmation on biopsy, high tumor burden criteria (GELF >0) and PET images were enrolled in this retrospective study (Table 1). The input data, including PET images, tumor segmentation masks if available, and clinical data, are hosted on CALYM’s cloud based data lake Lymphoma Data Hub. After quality controls and data preprocessing, several POD24 predictive models based on pretreatment images were developed. A deep convolutional neural network with 3D ResNet architecture pretrained on 3D medical images and enriched with clinical data was trained on PET images with a binary cross entropy loss. A machine learning (ML) model based on the XGBoost boosting algorithm was trained on tabular radiomics features after extraction of 851 radiomics features for each tumor and features aggregation at patient’s level by using only the 3 tumors with largest volumes. Models were cross-validated on the RE cohort with leave-one-out method and tested on the RL cohorts (Figure 1). Results: The ML approach achieved more promising results than the deep learning (DL) model on the RE cohort with an AUC of 0.61 for ML vs. 0.56 for DL. Interestingly, in this ML model, SUVmax and new radiomics features, such as major axis length, came out as the most predictive features. For now the external validation of the ML model on RL cohorts is slightly more limited with an AUC of 0.51. Improvement of this result is expected owing to the ongoing enrichment of the cohort with additional external data. Finally, regarding the treatment’s impact on the model’s performance, preliminary data showed better results when training on the R-CHOP cohort only. Validation is underway, and will be presented at the meeting. Keywords: Bioinformatics, Computational and Systems Biology, Indolent non-Hodgkin lymphoma, PET-CT No conflicts of interests pertinent to the abstract.

Trastuzumab-deruxtecan in HER2-low metastatic/unresectable breast cancer: Real life data in two Parisian centers.

e13130 Background: Trastuzumab-deruxtecan (TDXT) is an antibody-drug conjugate which has been approved for HER2-positive metastatic breast cancer (BC) treatment. DESTINY-Breast04 phase III clinical trial published in July 2022, TDXD was also shown to increase progression-free and overall survival in patients with HER2-low score metastatic/unresectable BC previously treated by 1 or 2 lines of chemotherapy, regardless of their hormone-receptor (HR) status. TDXD therefore has become a new therapeutic option in this population and has received an early access authorization in November 2022 in France. We report here our first experiences with TDXD in HER2-low patients to discuss some real-life data in this population. Methods: This retrospective descriptive study reports efficacy and safety data of TDXD use in pre-treated metastatic/advanced HER2-low (IHC + or IHC ++/ISH-) BC. Data from the medical records of all HER-2 low BC patients treated with TDXD (5.4 mg/kg, one intravenous injection every 21 days) until December 31, 2022 at Tenon and Pitié-Salpêtrière Hospitals were collected and analyzed. Efficacy was evaluated with PET-scanner comparison. Toxicity was graded using CTCAE 5.0 classification. End-point date for follow-up was February 09th, 2023. Results: We included a total of 22 patients (only women). They had already received several chemotherapy regimens (median 4 range 1-10), 50% had received radiotherapy and 22.7% underwent surgery. 18 (81%) were HR+ whereas 4 had triple negative (TN) cancer. Most commons metastatic sites were bones (73%), lymph nodes (68%) and liver (50%). At TDXD start, median age was 57.9 years. 82% patients had a ECOG score 0-1 and 18% ECOG 2. Median time between initial diagnosis and TDXD start was 77 months (range: 21-240) and from first chemotherapy in metastatic situation and TDXD start was 31 months (range: 3-89). The median duration of TDXD treatment was 5.9 months in HR+ patients and 5.7 months in TN patients. At the 3-month evaluation, 61.1% HR+ patients had a treatment response (50% partial and 11.1% complete), 27.8% a stabilization and 11.1% a progression. The longest treatment follow-up was 12.6 months. Among the 4 TN patients, there were 2 cases of partial response, 1 case of stabilization and one progression at the 3-month evaluation. The longest treatment response was 15.8 months. A total of 7 cancer-related deaths have occurred (6 RH+ and 1 RH-). Out of 22 patients, 86% experienced ≥ 1 adverse effect (AE). They were mainly grade I or II asthenia (63% patients) and nausea (58%). 2 cases of grade III effects (anemia and hepatic cytolysis) were reported. Finally, 3 cases of iatrogenic interstitial lung disease have been observed, one of them being a grade V toxicity. Conclusions: First cases of TDXD use in HER2-low BC patients in 2 French hospitals show promising results with a 54.5% response rate at 3 months. TDXD is globally well tolerated with 13.6% of grade ≥ 3 AE reported.

In-Hospital Clinical Features, Morbidity, and Mortality of Patients with Neurofibromatosis 1 in France: A Nationwide, Population-Based Retrospective Cohort Study

Neurofibromatosis 1 (NF1) is a multisystem disease that can affect nearly every organ system. The aim of our study was to describe the in-hospital population with NF1 in France. We conducted a nationwide retrospective cohort study using the French hospital administrative database. A total of 11,425 patients with NF1 (53.4% female, 19,080 person years) were identified from January 2013 to December 2019. A total of 23% had at least one diagnosis of a comorbidity or NF1-associated complication or disease, and it was highest in the age group of 10-15 years. A total of 2,601 (22.8%) had a diagnosis of cancer. There were 366 (3.2%) in-hospital deaths, and we observed a standardized mortality ratio of 4.14 (95% confidence interval= 3.71-4.56), with a higher standardized mortality ratio in women and in the age group of 10-15 years. The standardized incident ratio (SIR) of cancer was 10.3 (95% confidence interval= 9.6-11.1). We observed high SIR values for cancer in childhood, with a decrease toward that of the general population by age 70 years. We observed high SIRs for NF1-associated cancers: CNS SIR of 195.4 (95% confidence interval= 172.2-220.9) and small intestine SIR of 102.9 (95% confidence interval= 71.7-143.2). The study provides a better understanding of the prognosis in people living with NF1.

Tocilizumab versus anakinra in COVID-19: results from propensity score matching.

Tocilizumab and anakinra are anti-interleukin drugs to treat severe coronavirus disease 2019 (COVID-19) refractory to corticosteroids. However, no studies compared the efficacy of tocilizumab versus anakinra to guide the choice of the therapy in clinical practice. We aimed to compare the outcomes of COVID-19 patients treated with tocilizumab or anakinra. Our retrospective study was conducted in three French university hospitals between February 2021 and February 2022 and included all the consecutive hospitalized patients with a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection assessed by RT-PCR who were treated with tocilizumab or anakinra. A propensity score matching was performed to minimize confounding effects due to the non-random allocation. Among 235 patients (mean age, 72 years; 60.9% of male patients), the 28-day mortality (29.4% vs. 31.2%, p = 0.76), the in-hospital mortality (31.7% vs. 33.0%, p = 0.83), the high-flow oxygen requirement (17.5% vs. 18.3%, p = 0.86), the intensive care unit admission rate (30.8% vs. 22.2%, p = 0.30), and the mechanical ventilation rate (15.4% vs. 11.1%, p = 0.50) were similar in patients receiving tocilizumab and those receiving anakinra. After propensity score matching, the 28-day mortality (29.1% vs. 30.4%, p = 1) and the rate of high-flow oxygen requirement (10.1% vs. 21.5%, p = 0.081) did not differ between patients receiving tocilizumab or anakinra. Secondary infection rates were similar between the tocilizumab and anakinra groups (6.3% vs. 9.2%, p = 0.44). Our study showed comparable efficacy and safety profiles of tocilizumab and anakinra to treat severe COVID-19.

Use of artesunate in the treatment of severe imported malaria in France: review of the effectiveness and real-life safety in two French university hospitals

BackgroundIntravenous artesunate (AS) is the first-line treatment for patients with severe imported malaria (SIM) worldwide. However, after 10 years of use in France, AS hasn’t yet received marketing authorization.The purpose of this study was to assess the real-life effectiveness and safety of AS in the treatment of SIM in two Hospitals in France.MethodsWe performed a bicenter retrospective and observational study. All patients treated with AS for SIM between 2014 and 2018 and 2016–2020 were included. The effectiveness of AS was evaluated by parasite clearance, number of deaths, and the length of hospital stay. The real-life safety was assessed by related adverse events (AE) and monitoring of biological blood parameters during the hospital stay and follow-up period.Results110 patients were included during the six-year study period. 71.8% of patients were parasite-negative of their day 3 thick and thin blood smears after AS treatment. No patients discontinued AS due to an AE and no serious AE were declared. Two cases of delayed post-artesunate hemolysis occurred and required blood transfusions.ConclusionThis study highlights effectiveness and safety of AS in non-endemic areas. Administrative procedures must be accelerated in order to obtain full registration and facilitate access to AS in France.

Prediction of early death after atrial fibrillation diagnosis: a french nationwide study

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is associated with important mortality. Dedicated clinical scores to predict mortality have been developed but perform modestly and are not specific for this population. Machine learning models are developing in the field of AF and may be able to outperform existing tools for the prediction of mortality. Purpose This study aimed to train and evaluate machine learning models for the prediction death occurrence within this critical period of the year following atrial fibrillation diagnosis and to compare predictive ability to usual clinical scores. Methods We used for this purpose a nationwide cohort of 2,435,541 newly diagnosed atrial fibrillation patients seen in all the French hospitals from 2011 to 2019. Three ML models (logistic regression, random forests, deep neural networks) were trained to predict mortality within the first year on a train set (70% of the cohort). The best model was selected to be evaluate on the test set (30% of the cohort). Discrimination of the best model was evaluated using the C index. We finally compared our best model with previously published scores. Results Within the first year following AF diagnosis, 342,005 patients (14.4%) died after a mean time of 83 (SD 98) days in whom 107,715 were from cardiovascular deaths (31.5%). Among 110 variables, the 18 most predictive variables were identified and selected using a Random Forest algorithm: age, metastasis, resuscitated cardiac arrest, cancer, congestive heart failure, decubitus ulcers, renal failure, pneumonia, lung disease, difficulty in walking, malnutrition, anemia, impaired mobility, liver disease, renal disease, blood transfusion and urinary tract infection. After training 3 ML algorithms, the best ML model selected was a deep neural network with a C index of 0.785 (95% CI, 0.781-0.789) on the test set. The incidence of all cause death at one year rises in a stepwise fashion from 13.8 per 1000 patients for the first quintile to 352.4 per 1000 for the fifth quintile. Compared to traditional clinical risk scores, the selected model was significantly superior to the CHA2DS2-VASc and HAS-BLED scores, and dedicated scores such as Charlson Comorbidity Index and Hospital Frailty Risk Score to predict death within the year following AF diagnosis (C indexes: 0.597; 0.562; 0.643; 0.626 respectively. P&amp;lt;0.0001) (Figure 1). The ability to predict AF was improved as shown by the net reclassification index and integrated discriminatory improvement increase (P&amp;lt;0.0001, respectively) and decision curve analysis (Figure 2). Conclusion Machine learning algorithms predict early death after AF diagnosis with a better ability than previously developed traditional clinical risk scores. A ML approach may help clinicians to better risk stratify AF patients at high risk of mortality.

Validation and optimization of the French Generic Adherence for Chronic Diseases Profile (GACID-P) using classical test and item response theory

BackgroundThe Generic Adherence for Chronic Diseases Profile is a French generic scale (GACID-P) developed to measure adherence in several disease areas such as cardiology, rheumatology, diabetes, cancer and infectiology.MethodWe aimed to study the measurement invariance of the Generic Adherence for Chronic Diseases Profile by an item response model, optimize the new instrument version from item response model and qualitative content analyses results, and validate the instrument. The metric properties of the optimized version were studied according to classical test theory and item response model analysis.ResultsA sample of 397 patients consulting at two French hospitals (in diabetes, cardiology, rheumatology, cancerology and infectiology) and in four private practices was recruited; 314 (79%) patients also completed the questionnaire 15 days later. Factor analyses revealed four dimensions: “Forgetting to take medication”, “Intention to comply with treatment”, “Limitation of risk-related consumer habits” and “Healthy lifestyle”. The item response model and content analyses optimized these four dimensions, regrouping 32 items in four dimensions of 25 items, including one item conditioned on tobacco use. The psychometric properties and scale calibration were satisfactory. One score per dimension was calculated as the sum of the items for the dimensions “Forgetting to take medication” and “Intention to comply with treatment” and as a weighted score according to the item response model analysis for the two other dimensions because of differential item functioning found for two items.ConclusionFour adherence profile scores were obtained. The instrument validity was documented by a theoretical approach and content analysis. The Generic Adherence for Chronic Diseases Profile is now available for research targeting adherence in a broad perspective.

Diffusion-Weighted Imaging Lesion Reversal in Older Patients With Stroke Treated With Mechanical Thrombectomy.

Diffusion-weighted imaging lesion reversal (DWIR) is frequently observed after mechanical thrombectomy for acute ischemic stroke, but little is known about age-related differences and impact on outcome. We aimed to compare, in patients <80 versus ≥80 years old, (1) the effect of successful recanalization on DWIR and (2) the impact of DWIR on functional outcome. We retrospectively analyzed data of patients treated for an anterior circulation acute ischemic stroke with large vessel occlusion in 2 French hospitals, who underwent baseline and 24-hour follow-up magnetic resonance imaging, with baseline DWI lesion volume ≥10 cc. The percentage of DWIR (DWIR%), was calculated as follows: DWIR%=(DWIR volume/baseline DWI volume)×100. Data on demographics, medical history, and baseline clinical and radiological characteristics were collected. Among 433 included patients (median age, 68 years), median DWIR% after mechanical thrombectomy was 22% (6-35) in patients ≥80, and 19% (interquartile range, 10-34) in patients <80 (P=0.948). In multivariable analyses, successful recanalization after mechanical thrombectomy was associated with higher median DWIR% in both ≥80 (P=0.004) and <80 (P=0.002) patients. In subgroup analyses performed on a minority of subjects, collateral vessels status score (n=87) and white matter hyperintensity volume (n=131) were not associated with DWIR% (P>0.2). In multivariable analyses, DWIR% was associated with increased rates of favorable 3-month outcomes in both ≥80 (P=0.003) and <80 (P=0.013) patients; the effect of DWIR% on outcome was not influenced by the age group (P interaction=0.185) Conclusions: DWIR might be an important and nonage-dependent effect of arterial recanalization, as it seems to beneficially impact 3-month outcomes of both younger and older subjects treated with mechanical thrombectomy for acute ischemic stroke and large vessel occlusion.

Comparison of serum progesterone levels on the day of frozen embryo transfers according to type of endometrial preparation: a single centre, retrospective study.

The live birth rate following embryo transfer is comparable between spontaneous, stimulated and artificial cycles. However, the pregnancy loss rate appears elevated with hormonal therapy, possibly due to luteal insufficiency. This study aimed to determine whether the serum progesterone level on transfer day differed according to the endometrial preparation method for frozen embryo transfer (FET). Twenty spontaneous cycles (SC), 27 ovarian stimulation cycles (OS) and 65 artificial cycles (AC) were retrospectively studied from May to December 2019 in a single French hospital. The primary endpoint was the level of serum progesterone on the day of FET between the three endometrial preparation methods. The mean serum progesterone level on transfer day was 29.47 ng/ml in the OS group versus 20.03 ng/ml in the SC group and 14.32 ng/ml AC group (P < 0.0001). Progesterone levels remained significantly different after logistic regression on age and anti-Müllerian hormone (AMH) level. There was no significant difference in demographic and hormone characteristics (age, body mass index, embryo stage of embryo, type of infertility, basal follicle stimulating hormone, luteinizing hormone, estradiol and AMH levels), endometrial thickness, number and type of embryos transferred, duration of infertility, pregnancy rate, live birth rate and pregnancy loss rate. No difference was found in serum progesterone levels between clinical pregnancy with fetal heartbeat and no clinical pregnancy (no pregnancy or pregnancy loss, 17.49 ng/ml vs 20.83 ng/ml, respectively, P = 0.07). The lower serum progesterone level found on FET day in the AC group should be further investigated to see whether this difference has a clinical effect on the live birth rate.

Hidradenitis suppurativa and social disadvantage: A nationwide administrative data study of the French hospitalized population.

A lower socioeconomical status (SES) has been reported in patients suffering from hidradenitis suppurative (HS). However, limitations in the available studies prevent drawing definitive conclusions. The objective of this study was to assess the SES of HS patients using a specific SES indicator, the French DEPrivation index (FDep), specifically designed and validated for the French population. This cross-sectional cohort study compared the HS hospitalized population with the general hospitalized population without HS. Data were extracted from the French national hospital discharge database, an exhaustive database on all reimbursed hospital stay in the country with a rolling 10-year history (2012-2021). We included all patients aged 7-75 years with at least one stay in a French hospital. A 1:40 propensity score matching, adjusted for age, sex, smoking status and obesity, was performed to create 2 groups of comparable patients. Subgroup analysis was done in the minor (7-17 years) and major (25-75 years) populations independently. In the overall population, we identified 33,880 patients with HS and 24,445,337 patients without HS. After propensity score matching, logistic regression showed a significant association between HS and social disadvantage. There is a 22.5% increased risk of developing HS for individuals being in quintile 5 (the most disadvantaged quintile) versus quintile 1 (the least disadvantaged quintile) (p < 0.0001). After propensity score matching, the logistic regression showed no association between HS and social disadvantage in the 7-17 subgroup. In this minor population, an association between HS and social disadvantage was observed when propensity score matching was performed on age and sex only. We demonstrate a significant association between HS and low SES in the adult population. In children between 7 and 17, low SES was associated with obesity and tobacco consumption, but not with HS when the populations were matched on these confounding factors.

Standard precautions should include 'safe ventilation' to minimise far-afield airborne transmission in health and social care settings.

Standard precautions should include 'safe ventilation' to minimise far-afield airborne transmission in health and social care settings.

Effect of rectus sheath anaesthesia versus thoracic epidural analgesia on postoperative recovery quality after elective open abdominal surgery in a French regional hospital: the study protocol of a randomised controlled QoR-RECT-CATH trial

IntroductionEnhanced recovery after surgery (ERAS) protocols increase patient well-being while significantly reducing mortality, costs and length-of-stay after surgery. A key component is multimodal analgesia that prevents postoperative pain and facilitates...

Césariennes « code rouge » : création d’une grille de pertinence par méthode Delphi permettant l’analyse de pratique

ObjectiveIn France, C-sections are classified through a color code according to their degree of urgency. A red-classified C-section is triggered when life of mother or fetus is immediately threatened These cases happen very rarely and represent less than 1% of total deliveries. Many French maternity hospitals are above this rate. This risky procedure should remain an exception. The main purpose of this study is to develop a new tool enabling to determine the relevance of red C-sections in order to improve obstetrical practices. MethodsEleven national obstetrical experts were submitted with relevant-estimated indications of red C-sections. A two-round Delphi methodology was then used to reach a consensus on a new table of relevance. ResultsFive different groups of indications were proposed to the panel of experts. After two rounds, four groups achieved a consensus by being qualified “very relevant” or “relevant” by more than 80% of the 11 experts. ConclusionThe aim of this new consensual table of relevance is to improve quality of care. It allows to evaluate the relevance of red C-sections and determine when red C-sections are non-relevant but it particularly helps teams to identify ways of improvements. Finally, this tool enables a reproductible analysis that can be further intra- or inter-hospitals developed towards harmonization of practices.

Access to perinatal healthcare in minority Anglophones: Hospital type and birth outcomes.

We assessed the relationship between hospital characteristics and risk of adverse birth outcomes among minority Anglophones in Montreal, Canada. The study included 124,670 births among Anglophones in metropolitan Montreal between 1998 and 2019. We estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between hospital characteristics, including residential proximity to hospitals and language in which medical services are provided, and risks of preterm birth and stillbirth. Models were adjusted for maternal socioeconomic status and other characteristics. In this study, 8% of Anglophones had a preterm birth and 0.4% a stillbirth. Anglophone women who delivered at a farther French hospital had a greater risk of stillbirth (RR 1.67, 95% CI 1.28-2.18) than preterm birth (RR 1.21, 95% CI 1.14-1.30), compared with delivery at hospitals closer to home. In contrast, delivery at a farther English hospital was associated with similar risks of stillbirth (RR 1.36, 95% CI 1.08-1.71) and preterm birth (RR 1.36, 95% CI 1.29-1.44). The greater risk of stillbirth with delivery at a farther French hospital, versus greater risk of preterm birth at a farther English hospital, remained present in analyses stratified by maternal age, education, material deprivation, and region of origin. Minority Anglophones in Montreal who travel to a farther French hospital for delivery have a greater risk of stillbirth than Anglophones who travel to a farther English hospital. This novel observation suggests the need to determine if access to perinatal healthcare in a woman's language may help reduce the risk of stillbirth.

Association of Organizational Pathways With the Delay of Emergency Surgery

Delayed admission of patients with surgical emergencies to the operating room occurs frequently and is associated with poor outcomes. In France, where 3 distinct organizational pathways in hospitals exist (a dedicated emergency operating room and team [DET], a dedicated operating room in a central operating theater [DOR], and no dedicated structure or team [NOR]), neither the incidence nor the influence of delayed urgent surgery is known, and no guidelines are available to date. To examine the overall frequency of delayed admission of patients with surgical emergencies to the operating room across the 3 organizational pathways in hospitals in France. This prospective multicenter cohort study was conducted in 10 French tertiary hospitals. All consecutive adult patients admitted for emergency surgery from October 5 to 16, 2020, were included and prospectively monitored. Patients requiring pediatric surgery, obstetrics, interventional radiology, or endoscopic procedures were excluded. Emergency surgery. The main outcome was the global incidence of delayed emergency surgery across 3 predefined organizational pathways: DET, DOR, and NOR. The ratio between the actual time to surgery (observed duration between surgical indication and incision) and the ideal time to surgery (predefined optimal duration between surgical indication and incision according to the Non-Elective Surgery Triage classification) was calculated for each patient. Surgery was considered delayed when this ratio was greater than 1. A total of 1149 patients were included (mean [SD] age, 55 [21] years; 685 [59.9%] males): 649 in the DET group, 320 in the DOR group, and 171 in the NOR group (missing data: n = 5). The global frequency of surgical delay was 32.5% (95% CI, 29.8%-35.3%) and varied across the 3 organizational pathways: DET, 28.4% (95% CI, 24.8%-31.9%); DOR, 32.2% (95% CI, 27.0%-37.4%); and NOR, 49.1% (95% CI, 41.6%-56.7%) (P < .001). The adjusted odds ratio for delay was 1.80 (95% CI, 1.17-2.78) when comparing NOR with DET. In this cohort study, the frequency of delayed emergency surgery in France was 32.5%. Reduced delays were found in organizational pathways that included dedicated theaters and teams. These preliminary results may pave the way for comprehensive large-scale studies, from which results may potentially inform new guidelines for quicker and safer access to emergency surgery.

Empathy of dental students and educators in French hospitals: A cross-sectional study.

Empathy is a key factor in the dentist-patient relationship. The aim of this study was to determine empathy in dental students and educators in French hospital dental services. A cross-sectional study was conducted among dental students and educators who practiced in 10 hospital dental services affiliated with the Faculty of Dentistry of the University of Lorraine in France. A questionnaire was self-administered online using the Jefferson Scale of Physician Empathy (JSPE). The study included 209 participants comprising 50 students in fourth year, 66 students in fifth year, 48 students in sixth year, and 45 educators. Participants were 63.6% females, aged 27 ± 8 years. The mean empathy score was 109.40 ± 11.65. The sub-scores of the three dimensions were 57.02 ± 6.64 for Perspective Taking, 42.56 ± 6.22 for Compassionate Care, and 9.78 ± 2.61 for Walking in the Patient's Shoes. Females showed significant higher empathy scores than males (111.36 vs. 105.84). The empathy score was correlated with age and insignificantly decreased during clinical training (from 110.06 in fourth year to 106.63 in sixth year). French dental students and educators showed high levels of empathy.