Programme De Research Articles

What are the leading causes of hospitalized traumatic brain injuries according to age? Results of the French home and leisure injuries study in 2016

Introduction Traumatic brain injury (TBI) is most often an acute event similar to other injuries. However, consequences of TBI can be very serious and affect all aspects of lives, including mental abilities and the personality of the victim. The impact on a person and his or her family can be devastating. The number of people suffering from TBI is difficult to assess accurately but can be approximate by the French medicalized information system program (“Programme de medicalisation des systems d’information” - PMSI): 130,000 patients are hospitalized for TBI each year in France. However, this database does not provide the causes of TBI yet, which is crucial for prevention purposes. The main objective of this work is to describe the causes of TBI induced by home and leisure injury (HLI) available in the “Enquete permanente sur les accidents de la vie courante” (EPAC) study. Methods The French HLI permanent survey, EPAC, started in France in 1986 in a dozen of hospital emergency departments (ED). All patients admitted in ED for HLI are included. After consenting, patients are included and detailed information is collected: where, when, how, who, what product is involved as well as the chronology of the injury and the care given. In this study, TBI was defined as: a brain commotion, a head contusion, a skull fracture or other brain injuries. All patients recorded in 2016, responding to TBI criteria and hospitalized at least one day were selected. The individual causes of TBI described in the free text were analyzed and recoded. Since causes of TBI are very different according to age, they were described separately for: Results In 2016, among the 119,260 patients victim of HLI, recorded in EPAC database, 2918 were hospitalized following their TBI (2.4%). They were more frequent among toddlers (7.3%) and elderly (8.6%) and less frequent among teenagers (0.7%) or young adults (0.8%). Among toddlers ( Conclusions TBI is a frequent reason of admission in ED, more particularly for young children and elderly. This study allows describing the causes of TBI, for which patients need hospitalization. Those causes are very different according to the age and need to be further explored to help building targeted prevention campaigns, more particularly for 65 years and over since causes are various and sometimes not well known.

Epidemiology of traumatic brain injuries based on hospital reports in mainland France

Introduction Traumatic brain injuries (TBI) are defined as an alteration in brain function or other evidence of brain pathology caused by an external force. Every year in mainland France, TBI are responsible for several hundreds of deaths and several thousands are treated at emergency departments. Among them, between 25% and 40% result in physical, psychological or social sequelae according to different estimations. TBI occur, most often, after a home and leisure injury or a traffic accident, which could have been avoided by appropriate prevention measures. Few epidemiological data on TBI at a large-scale exist in France. Thus, these analyses aim at gaining new insights into TBI epidemiology in France using data from the hospital nationwide database - “Programme de Medicalisation des Systemes d’Information” (PMSI). Methods The analysis was performed on all the first hospital stays in 2013 in mainland France registered in the PMSI database with a principal or associated diagnosis of TBI, coded in S06 in the International Classification of Diseases, 10th revision (ICD10). S06 codes are the only one specific to TBI in the ICD10. Data collected for patients whatever the age included: demographics, type of injury (concussion, edema, hemorrhage, etc.), vital status at the end of hospitalization. The evolution of two indicators (Incidence rate and lethality rate) was studied over the period 2011–2013. Results In 2013, 135,081 patients were hospitalized after the occurrence of TBI, mostly men (57% of patients) with a mean/median age of 49/53, presenting mostly mild TBI (77%). Incidence rate was 206 per 100,000 inhabitants, more elevated among men than among women (242 per 100,000 versus 172 per 100,000). TBI were more frequent among young and the elderly. Incidence rates varied according to the regions but remained stable over the period 2011–2013. 5,723 patients died during their hospitalization. The lethality rate was 4% (4.2% for men versus 3.7% for women). Lethality rate increased with age for men and women and remained stable over the period 2011–2013. Conclusions For the first time in France, this study provides results about TBI at a large-scale. Incidence rate measure in France is in the range of incidence rates calculated in studies based on hospital discharge. These results contribute to improve TBI epidemiological monitoring in France. Other sources of data, like emergency data, will be necessary in order to measure more accurately the number of victims of TBI and in particular of mild TBI. Furthermore, research aiming at improving knowledge about precise causes of TBI could be useful in order to expand effective TBI prevention measures.

Epidemiological surveillance of falls in the elderly in France

Introduction Falls in the elderly (65 years and over) are responsible for a great part of morbidity and mortality in all countries and represent a major public health issue. As stated by the demographic previsions, the proportion of elderly in population will grow in the next decades and will therefore emphasize this public health issue. Methods Epidemiological surveillance of falls is based on several data sources, each one having its own objectives: French Health Barometer Surveys, the Permanent Home and Leisure Injury Survey (“Enquete permanente sur les accidents de la vie courante” - EPAC), the French medicalized information system program (“Programme de medicalisation des systems d’information” - PMSI), data based on death certificates. Results In 2010, according to the Health Barometer Survey, nearly one out of twelve people aged 55 to 85 years old (7.8%) reported at least one injury during the last twelve months, followed by a medical or hospital consultation. Those victims reported mostly falls (56.5%). In 2010, according to the EPAC Survey, among 65 years old and over, 85% of emergency visits for home and leisure injuries (HLI) were due to a fall. This proportion increases with age: 71% from 65 to 69 years, up to 95% at 90 years and over. According to the PMSI, in 2014, 76,100 hospitalizations were due to a fracture of the upper femur among patients aged 65 years old and over, three times more often in women than in men. Nine times out of ten, these fractures happened as a result of a fall. In 2013, in Metropolitan France, according to the death certificates, 9334 people over 65 years old died as a result of an accidental fall (11.2/100,000), including 3737 men (13.1/100,000) and 5597 women (10.1/100,000). Mortality rates due to falls increase with age. Conclusion Currently available surveys provide the overall epidemiological monitoring of falls, although they do not contribute to the design of targeted prevention actions. In the future, data from the OSCOUR-SURSAUD French Network may partially meet the demand for measurement of trends in the use of emergency services due to falls. The Survey on falls of the elderly at home (“Chutes des personnes âgees a domicile” - ChuPADom) will establish the profiles of fallers aged 65 years and over based on their sociodemographic and economic characteristics, the presence of chronic diseases and/or multiples diseases, their mental health, their (multiple) medication, pre-fall autonomy, home care, extrinsic risk factors (housing, products involved in the fall, activity before falling, etc.), physical and psychological sequelae, and the quality of life one year after the fall. This survey may significantly contribute to targeted prevention actions.

Causes of burn based on hospitals reports in mainland France in 2014

Introduction Burns are defined as an injury to the skin or other organic tissue primarily caused by thermal or other acute trauma. Every year in France, burns are responsible for several hundreds of deaths and about 11,500 hospitalizations. Furthermore, burns often result in heavy physical, psychological or social sequelae. They are one of the most expensive traumatic injuries due to costly wound treatment and very long care (hospitalization and rehabilitation). Prevention of burns is therefore a necessity. In order to prevent burns, knowledge about their causes is essential. There is a lack of large-scale results about causes of burns in France. Therefore, the aim of this work it to analyze causes of burns in mainland France in 2014, using data from the hospital nationwide database - “Programme de medicalisation des systemes d’information (PMSI)”. Coding of causes is expected to present high-quality because three French agencies “Agence technique de l’information sur l’hospitalisation” - (ATIH), “Societe francaise de brulologie” (SFB) [formerly “Societe francaise d’etude et de traitement des brulures” (SFETB)] and “Sante publique France” [formerly “Institut de veille sanitaire” (InVS)] implemented in 2011 a thesaurus of burns causes in order to facilitate and harmonize the coding in the PMSI and make it mandatory in 2013. Methods Analyses were performed on first hospital stays in a burn center, in 2014 in mainland France, registered in the PMSI database with a principal diagnosis of burns, coded from T20 to T32 in the International Classification of Diseases, 10th revision (ICD10), and at least one associated diagnosis mentioning a cause of burn. Data collected for patients whatever the age included: demographics, circumstances (accident, assault, suicide attempt), etiology (scald, contact, fire and flames, radiation, electrical, chemical). Results In 2014 in mainland France, 2712 patients were hospitalized in a burn center and presented information regarding the cause of burn, 61.5% were men, mean/median age of 31/28 years. Burns occurred mostly in accidental circumstances (93.7% of patients) and are more rarely due to suicide attempt (4.9%) or assault (1.4%). Half of accidental burns were scald (50.8%), 27.2% fire and flame burns, 8% contact burns, 4.5% chemical burns, other etiologies are scarcer. Causes of burns varied according to age and sex. Scald was the first cause of burns for children (83.8% for boys and 88.2% for girls among 0–4 years) and for women whatever the age. Fire and flames burns were the first cause of burns for men after 15 (42.6% among 15–59 years, 56% among 60 years and older). Conclusions For the first time in France, this study provides results about causes of burns at a large-scale. In spite of numerous prevention measures, burns and in particular scald, are very frequent in France. Further research aiming at improving knowledge about causes of burns could be useful to better target prevention measures. Moreover, a precise evaluation of prevention measures already implemented could be useful.

Real life management of patients hospitalized with multiple myeloma in France.

BackgroundPatients with multiple myeloma included in prospective clinical trials are highly selected and therefore are expected not to be representative of the entire patient population. Additionally recommendations based on literature data and randomized trials are not systematically implemented in all patients. We sought to determine how patients hospitalized with a diagnosis of multiple myeloma are currently treated in France.Methods and findingsWe performed a nation-wide search using the Programme de Médicalisation des Systèmes d’Information (PMSI) database which includes anonymous data for all patients hospitalized in France. We identified newly diagnosed cases in 2012 and analyzed the number and duration of hospital stays, coexisting conditions and treatment modalities with data available until the end of 2015. A diagnosis of multiple myeloma was determined for the first time during a hospitalization in France in 2012 in 6,282 patients (3,234 males and 3,048 females). The median age at diagnosis was 74 years (72 in males and 76 in females). A majority (55.3%) of patients were diagnosed and treated in a single heath center, including 37% in a university hospital and 52% in a non-university public hospital. Comorbidities potentially impacting on myeloma treatment were present in 57.5% of patients at diagnosis, and 15% had an associated diagnosis of another neoplasia. Intensive therapies with stem cell transplants were performed in 1033 patients (16% of total), the majority of which were aged less than 65 (881 patients, 85.3%). Stem cell transplants were performed more frequently in males while the distance between the site of residence and the transplant center had no impact on likelihood of receiving a transplant. Only 60% of patients less than 65 years old who were treated for their disease underwent intensification with stem cell transplant within the 4-year follow-up period.ConclusionsA large majority of patients hospitalized with a diagnosis of multiple myeloma are elderly, in particular females, and not eligible for transplants. Among the patients aged less than 65 and receiving therapy for their disease, 40% do not undergo transplants. These data emphasize the need for alternative therapies.

CULTURAL ADAPTATIONS OF EVIDENCE-BASED HOME-VISITATION MODELS IN TRIBAL COMMUNITIES.

The Tribal Maternal, Infant, and Early Childhood Home Visiting (Tribal MIECHV) Program provides federal grants to tribes, tribal consortia, tribal organizations, and urban Indian organizations to implement evidence-based home-visiting services for American Indian and Alaska Native (AI/AN) families. To date, only one evidence-based home-visiting program has been developed for use in AI/AN communities. The purpose of this article is to describe the steps that four Tribal MIECHV Programs took to assess community needs, select a home-visiting model, and culturally adapt the model for use in AI/AN communities. In these four unique Tribal MIECHV Program settings, each program employed a rigorous needs-assessment process and developed cultural modifications in accordance with community strengths and needs. Adaptations occurred in consultation with model developers, with consideration of the conceptual rationale for the program, while grounding new content in indigenous cultures. Research is needed to improve measurement of home-visiting outcomes in tribal and urban AI/AN settings, develop culturally grounded home-visiting interventions, and assess the effectiveness of home visiting in AI/AN communities.

APPROACHES TO THE EVALUATION OF CULTURAL ADAPTATIONS OF HOME VISITING IN TRIBAL COMMUNITIES.

The research that underlies evidence-based practices is often based on relatively homogenous study samples, thus limiting our ability to understand how the study findings apply in new situations as well as our understanding of what might need to be adapted. In a preliminary effort to address those gaps, the requirements for the Tribal Maternal Infant and Early Childhood Home Visiting Program (MIECHV) included the expectation that grantees design and implement rigorous evaluations to address local priorities and to help build the knowledge base regarding the use of evidence-based home-visiting programs in tribal communities. A priority that emerged across many Tribal MIECHV grantees was to determine the added benefit of the cultural adaptations that they were making to their home-visiting programs. While there is literature to describe recommended processes for making cultural adaptations to evidence-based programs themselves, there are very few guidelines for evaluating these adaptations. In this article, we review the varied evaluation approaches utilized by Tribal MIECHV grantees and provide three case examples of how evaluators and tribal communities worked together to articulate evaluation questions and choose appropriate and feasible evaluation designs. The lessons derived from these Tribal MIECHV evaluation experiences have implications for the role of the evaluator in diverse communities across the country evaluating home visiting and other evidence-based practices in settings characterized by unique cultural contexts.

Et comment nous voilà moins épais by Anne Portugal

Reviewed by: et comment nous voilà moins épais by Anne Portugal Aaron Prevots Portugal, Anne. et comment nous voilà moins épais. P.O.L, 2017. ISBN 978-2-8180-3761-4. Pp. 122. These poems feature theatrical dialogue between a hermit and a lion ("la colocation" 7), brief stanzas of varying lengths about artists and authors of the past with whom to lie down ("le bon air a de beaux draps" 47, 88), and block paragraphs that use leisure activities as a framework to address the puzzle of existence ("j'ai plein air" 89, 116). Portugal asks how we might share a bed with others in order to metaphorically savor an "agencement d'amis" (93), a convivial and rejuvenating aesthetic experience. The fluid, eloquent style has gentle ironies, for example the description of this "programme de fidélisation" as a "vie augmentée," one where club members can be reimbursed if the merchandise does not quite satisfy them, but also can enjoy the scenery wherever they might lie down and productively participate in the creative process by means of each "ligne autre avec un espace à remplir" (11). As in her other collections, Portugal shows a knack for catchy, effortlessly streaming verse that invites further attention, as when the hermit states "à ma vue me passionnent/des détails pressant là sous les ombrages et services" (14). True to the P.O.L mission, she favors an intellectually engaging, exploratory tone, in this case a "je détaché d'actualité d'affect singulier" (16). However, the semantic breaks and gaps, as in the lines"tu me fabriques comment profits précautions une/série mal identifiée" (23), could prove unsettling for those seeking clear blocks of meaning and not a"maniement qui s'improvise" (24) or a self-consciousness regarding"flux régulier" (43). In the second section, a dialogue with painters and poets has appeal thanks to its intertextuality and the postmodern motif of communicating with the dead electronically:"@baudelaire" (49),"@mallarmé" (50),"@poussin" (51). This part introduces greater variety to the collection, encouraging us to interpret across eras and forms, to invest ourselves still more in this artistic project by taking pleasure in comparisons across genres and in the playful conceit of accompanying influential dead figures in their sleep. A refreshing aspect is the ease with which imagery emerges as regards each person, with occasional surprises that embed themselves well: "ah mon coco tu cueilles/des fleurs qui forment/des lois intervenant/dans le révélateur oxy/dant modèle à la dissolu/tion de l'argent libéré [...] @flaubert" (62); "je me fais/un plan d'air une saison de santé et en extra/un aisément pourquoi coloré régulier respiré/à l'autre et comment nous voilà moins épais//@grimm" (76). [End Page 217] In the final section, Portugal toys with sensuously tangible tensions between reality and how it is felt and communicated, for instance the idea of anticipating a "guirlande promise" (93) despite looking around from within "rien de concret [...] qu'un objet roulant" while "dans le rétro il n'y a rien" (95). In sum, these lively, often elliptical poems convey the "grande souplesse" (103) of literature and art, of the words and images that inhabit us as much as we inhabit them. Aaron Prevots Southwestern University (TX) Copyright © 2018 American Association of Teachers of French

Positive predictive values of peripheral arterial and venous thrombosis codes in French hospital database.

French hospital database, called Programme de Médicalisation des Systèmes d'Information (PMSI), covers all hospital stays in France (>66 million inhabitants). The aim of this study was to estimate the positive predictive values (PPVs) of primary diagnosis codes of peripheral arterial and venous thrombosis codes in the PMSI, encoded with the International Classification of Diseases, 10th revision. Data were extracted from the PMSI database of Toulouse University Hospital, south of France. We identified all the hospital stays in 2015 with a code of peripheral arterial or venous thrombosis as primary diagnosis. We randomly selected 100 stays for each category of thrombosis and reviewed the corresponding medical charts. The PPV of peripheral arterial thrombosis codes was 83.0%, 95% confidence interval (CI): 73.9-89.1, and the PPV of correct location of thrombosis was 81.0%, 95% CI: 72.2-87.5. The PPV of pulmonary embolism was 99.0%, 95% CI: 93.8-99.9. The PPV of peripheral venous thrombosis was 95.0%, 95% CI: 88.2-98.1, and the PPV of correct location of thrombosis was 85.0%, 95% CI: 76.7-90.7. Primary diagnoses of peripheral arterial and venous thrombosis demonstrated good PPVs in the PMSI.

Procedural Skills of a General Internist - Informed by the Front Line.

Procedural Skills of a General Internist - Informed by the Front Line.

Hospital Costs Associated With Dedicated Vascular Endoprosthesis Versus Prosthetic Bypass In Popliteal Artery Aneurysm Treatment In France

To assess hospital costs of patients with popliteal artery aneurysm (PAA) treated by dedicated vascular endoprosthesis versus prosthetic bypass. All hospital stays with PAA treated by endoprosthesis and prosthetic bypass were extracted from the French medical information system (Programme de Médicalisation des Systèmes d’Information, PMSI) 2013 database: implant code was used for endoprosthesis and the combination of both procedure and implant codes for prosthetic bypass. Patients were followed during one year from their first stay (March 2013/March 2014). An algorithm and a medical review excluded rehospitalisations not related to follow up for either treatment. To control confounding factors, patients from both arms were matched according to their age, gender, hospital status (public/private) and principal diagnosis ICD-10 (International Classification of Diseases) code. Associated costs during this period were added up both for the initial surgery and the related rehospitalisations: the mean 1-year cost per patient was estimated and compared between both arms. Valuation was performed considering French official tariffs. In 2013, 573 patients with endoprosthesis and 3,976 patients with prosthetic bypass were identified: 456 patients in each arm could be matched. Patients were 72±10 years old on average, 89% were men. 54% of stays occurred in public hospitals. Median length of initial stay was 3 days [2-6] for endoprosthesis implantation and 8 days [6-13] for prosthetic bypass surgery. 42% of endoprosthetic patients and 41% of bypass patients had at least one rehospitalization: respectively, 72% versus 74% of them occurred within 6 months after treatment. The mean 1-year cost was €12,714 ± €9,486 per endoprosthesis patient versus €14,038 ± €11,021 per bypass patient (difference statistically significant; p=0.0014). Using endoprosthesis instead of prosthetic bypass for the treatment of PAA led to a lower mean 1-year cost per patient.

Hémorragies intracrâniennes et anticoagulantes orales de patients traités entre 2011 à 2013. Étude descriptive au CHRU de Nancy

ObjectiveTo perform a descriptive analysis of intracranial hemorrhages of patients treated with an antivitamin K (fluindione, acenocoumarol or warfarin) or a direct oral anticoagulant (dabigatran, rivaroxaban or apixaban) at the Nancy Regional University Hospital. Material and methodThe study period was from January 2011 to December 2013 and the computerized data (Programme de Médicalisation des Systèmes d’Information) of our hospital was accessed to identify the patients. Clinical data were obtained from the patients’ files. Regional healthcare system was queried for reimbursement data. ResultsAmong the 157 identified cases of intracranial hemorrhage, 153 were related to antivitamin K, primarily fluindione (n=127), and only 4 to a direct oral anticoagulant (3 dabigatran and 1 rivaroxaban). During the same period, regional data indicated that 65,345 patients had had at least one reimbursement of antivitamin K and 20,983 patients one reimbursement of an oral direct anticoagulant. In our series, the most frequent intracranial hemorrhages were subdural hematoma (chronic in 65 cases, acute in 50 cases) and intraparenchymal hemorrhage (20 cases). The global mortality rate was 20.2% but varied with the site of hemorrhage. In multivariate analysis, the two risk factors of fatal outcome were coma on admission (OR 6.2; 95%CI: 2.6–15.0) and a history of previous intracranial hemorrhage (OR 13,4; 95% CI: 1,6–114,9). ConclusionDuring the 2011–2013 period, antivitamin K, especially fluindione, was the most frequently involved anticoagulants in intracranial hemorrhages with hospitalization at our Regional University Hospital. Coma on admission and a history of previous intracranial hemorrhage were the two main risk factors for fatal outcome.

Le Recueil d’information médicalisé en psychiatrie (RIM-P) : un outil nécessaire pour la surveillance des hospitalisations suite à une tentative de suicide

BackgroundEpidemiological surveillance of suicide attempts is essential for monitoring indicator trends in the evaluation of prevention actions. As part of this surveillance, analysis of data from hospitalization for suicide attempts is particularly useful. MethodsFor the first time, data from two national hospital discharge databases, the “Programme de médicalisation des systèmes d’information en médecine, chirurgie, obstétrique” (PMSI-MCO) and the “ Recueil d’information médicalisé en psychiatrie” (RIM-P) have been analyzed jointly. All patients aged 10 or more hospitalized in 2012 in medicine, surgery or psychiatry departments in metropolitan France have were included. ResultsThrough 2012, 89,072 patients (62% females and 38% males) totalized 134,051 hospital stays following a suicide attempt, with 93.4% (n=83,196) in medicine or surgery wards and 32.1% (n=28,594) in psychiatry wards (solely or transferred after a stay in medicine or surgery). However, among the patients transferred to psychiatry after hospitalization in medicine or surgery for suicide attempt, 82.4% had no suicide attempt code noted at their discharge from psychiatry. One or more psychiatric diagnoses were observed in 75% of the patients hospitalized for suicide attempt. The most common diagnoses in men and in women were mood disorders (46%), particularly depression (42%; 44% in women and 38% in men). Mental disorders related to alcohol use were noted in more than a quarter of the patients, more frequently in men (37%) than in women (21%). Some diagnoses were rarely noted in medicine or surgery, such as anxiety disorders and disorders of adult personality and behavior. ConclusionImprovement of the epidemiological surveillance of suicide attempts requires a systematic coding of hospitalizations in psychiatry as well as in medicine and surgery. Data from hospitalization in psychiatry yield a more precise identification of psychiatric co-morbidities associated with suicide attempts. The frequent presence of mental problems associated with suicide attempts should encourage clinicians to search for these symptoms systematically as soon as possible after admission of the patient.

Burden of cytomegalovirus disease in solid organ transplant recipients: a national matched cohort study in an inpatient setting.

We investigated the impact of early- (E-CMV) and late onset (L-CMV) cytomegalovirus disease on the probability of graft rejection, graft failure, mortality, and healthcare resource use, following solid organ transplantation (SOT) in France. A retrospective analysis of data from the French 'Programme de Médicalisation des Systèmes d'Information' database (2007-2011) was conducted to identify SOT recipients who developed CMV disease in an inpatient setting. Recipients were stratified by time to CMV disease onset: E-CMV (≤3months), L-CMV-3M (>3-24months), and L-CMV-6M (>6-24months). Data were analyzed by comparing recipients with CMV disease or without (controls) in a 1:2 ratio, matched according to age, gender, target organ, and previous/simultaneous occurrence of graft rejection. Graft failure, graft rejection, all-cause in-hospital mortality, and resource utilization (including hospitalization costs) were assessed over 12months following CMV disease diagnosis. Among 20473 SOT recipients, 2430 (11.86%) were reported to have CMV disease within 24months after transplantation. CMV disease was significantly associated with an increased risk of graft rejection and mortality, as indicated by logistic regression analysis. Odd ratios (ORs) for the risk of graft rejection were E-CMV=1.43, L-CMV-3M=1.50, and L-CMV-6M=1.61 (all P<.05), while ORs for mortality were E-CMV=2.85, L-CMV-3M=4.22, and L-CMV-6M=4.77 (all P<.0001). Only L-CMV was significantly correlated with a higher risk of graft failure: E-CMV=1.18 (P=.1906), L-CMV-3M=1.77 (P=.0013), and L-CMV-6M=3.12 (P<.0001). Hospitalization costs increased by €7078 (range €6270-€22111), €6523 (range €5328-€10 295), and €6311 (range €5295-€9184) in recipients with E-CMV, L-CMV-3M, and L-CMV-6-M, respectively. This study, based on French national data, demonstrates the considerable burden of CMV disease in SOT recipients and highlights the importance of developing new strategies to prevent and manage CMV disease and improve clinical outcomes for SOT patients.

Engaging the Audience in a Digitised Television Production Process

This article discusses producer practices and the reasons why they engage their audience in the production process. In a digitised media context, audiences have become more visible, mainly through social media, and have more means to participate. Our research deconstructs the production process of a particular television programme by means of the “hierarchy of influences” model, which separates micro and macro levels that influence production. It draws on in-depth interviews with all editors of Flemish current affairs programme De Afspraak (The Appointment) and on a three-month participatory observation. We conclude that immersive ways of engaging the audience are applied in our specific case. More broadly, we argue that although practices change, pre-existing norms and values about the television audience remain central to how producers engage their audience through digital and social media.

Cost analysis of adverse events associated with non-small cell lung cancer management in France.

BackgroundAdverse events (AEs) related to medical treatments in non-small cell lung cancer (NSCLC) are frequent and need an appropriate costing in health economic models. Nevertheless, data on costs associated with AEs in NSCLC are scarce, particularly since the development of immunotherapy with specific immune-related AEs.ObjectiveTo estimate the costs of grades 3 and 4 AEs related to NSCLC treatments including immunotherapy in France.MethodsGrades 3 and 4 AEs related to treatment and reported in at least 1% of patients in Phase III clinical trials for erlotinib, ramucirumab plus docetaxel, docetaxel, pemetrexed plus carboplatin plus bevacizumab, platinum-based chemotherapies, nivolumab and pembrolizumab were identified. When no cost evaluation was reported in literature, estimates on standard treatments and medical resource use for each AE were obtained thanks to an expert panel. Total cost per AE was calculated from a French national health insurance perspective and updated in 2017 Euros. Hospital stay costs were estimated based on public and private weighted tariffs and data from the French Medical Information System (Programme de Médicalisation des Systèmes d’Information). Costs of tests, consultations and treatments were calculated based on national reimbursement tariffs.ResultsOverall, costs of grades 3 and 4 AEs related to treatment ranged from €46 per event to €7,742 per year. Fourteen out of 24 AEs identified had a mean estimated cost over €2,000. The highest mean costs were related to type 1 diabetes (€7,742 per year) followed by pneumonitis (€5,786 per event), anemia (€5,752 per event), dehydration (€5,207 per event) and anorexia (€4,349 per event). Costs were mostly driven by hospitalization costs.ConclusionAmong the AEs identified, a majority appeared to have an important economic impact, with a management cost of at least €2,000 per event mainly driven by hospitalization costs. This study may be of interest for economic evaluations of new interventions in NSCLC.

Prevalence of fibrodysplasia ossificans progressiva (FOP) in France: an estimate based on a record linkage of two national databases

BackgroundFibrodysplasia ossificans progressiva (FOP) is a rare, severely disabling, and life-shortening genetic disorder that causes the formation of heterotopic bone within soft connective tissue. Previous studies found that the FOP prevalence was about one in every two million lives. The aim of this study is to estimate the FOP prevalence in France by probabilistic record-linkage of 2 national databases: 1) the PMSI (Programme de médicalisation des systèmes d’information), an administrative database that records all hospitalization activities in France and 2) CEMARA, a registry database developed by the French Centres of Reference for Rare Diseases.ResultsUsing a capture-recapture methodology to adjust the crude number of patients identified in both data sources, 89 FOP patients were identified, which results in a prevalence of 1.36 per million inhabitants (CI95% = [1.10; 1.68]). FOP patients’ mean age was 25 years, only 14.9% were above 40 years, and 53% of them were males. The first symptoms – beside toe malformations- occurred after birth for 97.3% of them. Mean age at identified symptoms was 7 years and above 18 years for only 6.9% of patients. Mean age at diagnosis was 10 years, and above 18 years for 14.9% of the patients. FOP patients were distributed across France.ConclusionsDespite the challenge of ascertaining patients with rare diseases, we report a much higher prevalence of FOP in France than in previous studies elsewhere. We suggest that efforts to identify patients and confirm the diagnosis of FOP should be reinforced and extended at both national and European level.

Agreement between hospital discharge diagnosis codes and medical records to identify metastatic colorectal cancer and associated comorbidities in elderly patients

BackgroundQuality of coding to identify cancers and comorbidities through the French hospital diagnosis database (Programme de médicalisation des systèmes d’information, PMSI) has been little investigated. Agreement between medical records and PMSI database was evaluated regarding metastatic colorectal cancer (mCRC) and comorbidities. MethodsFrom 01/01/2013 to 06/30/2014, 74 patients aged≥65years at mCRC diagnosis were identified in Bordeaux teaching hospital. Data on mCRC and comorbidities were collected from medical records. All diagnosis codes (main, related and associated) registered into the PMSI were extracted. Agreement between sources was evaluated using the percent agreement for mCRC and the kappa (κ) statistic for comorbidities. ResultsAgreement for primary CRC and mCRC was higher using all types of diagnosis codes instead of the main one exclusively (respectively 95% vs. 53% for primary CRC and 91% vs. 24% for mCRC). Agreement was substantial (κ 0.65) for cardiovascular diseases, notably atrial fibrillation (κ 0.77) and hypertension (κ 0.68). It was moderate for psychiatric disorders (κ 0.49) and respiratory diseases (κ 0.48), although chronic obstructive pulmonary disease had a good agreement (κ 0.75). Within the class of endocrine, nutritional and metabolic diseases (κ 0.55), agreement was substantial for diabetes (κ 0.91), obesity (κ 0.82) and hypothyroidism (κ 0.72) and moderate for hypercholesterolemia (κ 0.51) and malnutrition (κ 0.42). ConclusionThese results are reassuring with regard to detection through PMSI of mCRC if all types of diagnosis codes are considered and useful to better choose comorbidities in elderly mCRC patients that could be well identified through hospital diagnosis codes.

Outcomes of Hospitalised Muscular Dystrophy Patients.

In France, referral centres in teaching hospitals were created 10 years ago to provide MD patients with treatments and follow-up designed to prevent complications and improve outcomes. Respiratory failure is a major cause of death among subjects with MD, and its prevention and treatment can serve as a touchstone for assessing the effectiveness of MD care pathways. We report data from a preliminary study of admissions of MD patients in France and of factors associated with mortality, with special emphasis on respiratory failure [RF]. Retrospective analysis of the data from the French nationwide hospital database [Programme de M é dicalisation des syst é mes d'information, PMSI] for 2009 and 2010. 7187 admissions of patients with MD were included in the study. Most admissions were to teaching hospitals [5913/7187, 82.3%]. 302 [4.2%] patients were admitted for RF requiring invasive ventilation, 924 [12.9%] for RF requiring only NIV or high-flow oxygen therapy, and 5961 [82.9%] required no respiratory assistance. 494 [6.9%] admissions occurred on an emergency basis. 77/7187 [1.1%] patients died while hospitalised. Teaching-hospital admission was associated with lower frequencies of emergency admission [3.08% vs. 24.5%, p < 0.01] and in-hospital death [0.71% vs. 2.75%, p < 0.01]. Our data suggest that there is room for improvement in care pathways for MD patients requiring admission. Admission to referral centres may provide the best outcomes.Further studies are needed to assess associations between healthcare pathways and outcomes of MD subjects.

Natural History of Adjustable Gastric Banding: Lifespan and Revisional Rate: A Nationwide Study on Administrative Data on 53,000 Patients.

The aim of this study was to analyze the adjustable gastric banding (AGB) natural history on a national basis. Adjustable gastric banding represented the most common bariatric procedure in France until 2010. Since then, the number of AGBs has decreased and the rate of band removal and revisional surgeries has progressively increased. For analysis, we included all adult patients operated on with AGB in France between 2007 and 2013. Data were extracted from a national administrative database ("Programme De Médicalisation des Systèmes d'Information," PMSI), which is an exhaustive source of all surgical procedures performed in France. The Cox proportional hazard model was used to test univariate and multivariate associations with band survival and revisional rate. To control for center-specific effects, we performed a frailty analysis, in which each center was assumed to have a random effect indicating the possibility of different baseline risks for patients at different centers. During the study period, 52,868 patients underwent AGB, and 10,815 bands were removed. The removal rate at 5, 6, and 7 years was 28%, 34%, and 40%, respectively. Female sex, body mass index >50 kg/m, type 2 diabetes, hypertension, dyslipidemia, and sleep apnea were found to be significantly associated with band removal by multivariate analysis. A significant center effect was also found, but this did not change the impact of the highly significant factors already identified. After band removal, the median time to revisional surgery was 1 year (95% confidence interval 1.0-1.1) and the conversion rate at 7 years was 71%. With a removal rate of about 6% annually and the need for revisional surgery for more than two-thirds of patients after removal, AGB does not appear to provide a long-term solution for obesity.