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Falandry C, Bacchetta J, Doret-Dion M, Ferraro-Peyret C, Confavreux CB, Douplat M, Feugier P, Friggeri A, Bolze PA, Dargaud Y, Messager A, Wallon M, Geffroy L, Matillon Y, Bradwejn J. Tailoring a specific medical leadership development program for faculty members: the Lyon-Ottawa experience. Med Educ Online 2024; 29:2308955. [PMID: 38290044 PMCID: PMC10829808 DOI: 10.1080/10872981.2024.2308955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Abstract
The development of leadership skills has been the topic of several position statements over recent decades, and the need of medical leaders for a specific training was emphasized during the COVID-19 crisis, to enable them to adequately collaborate with governments, populations, civic society, organizations, and universities. However, differences persist as to the way such skills are taught, at which step of training, and to whom. From these observations and building on previous experience at the University of Ottawa, a team of medical professors from Lyon (France), Ottawa, and Montreal (Canada) universities decided to develop a specific medical leadership training program dedicated to faculty members taking on leadership responsibilities. This pilot training program was based on a holistic vision of a transformation model for leadership development, the underlying principle of which is that leaders are trained by leaders. All contributors were eminent French and Canadian stakeholders. The model was adapted to French faculty members, following an inner and outer analysis of their specific needs, both contextual and related to their time constraints. This pilot program, which included 10 faculty members from Lyon, was selected to favor interactivity and confidence in older to favor long-term collaborations between them and contribute to institutional changes from the inner; it combined several educational methods mixing interactive plenary sessions and simulation exercises during onescholar year. All the participants completed the program and expressed global satisfaction with it, validating its acceptability by the target. Future work will aim to develop the program, integrate evaluation criteria, and transform it into a graduating training.
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Affiliation(s)
- Claire Falandry
- Service de Gériatrie, Centre Hospitalier de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Laboratoire CarMeN de l’Université de Lyon, INSERM U.1060/Université Lyon1/INRA U. 1397/INSA Lyon/Hospices Civils Lyon, Pierre-Bénite, France
| | - Justine Bacchetta
- Néphrologie Rhumatologie Dermatologie Pédiatrique, Hopital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
- UMR 1033, INSERM, Lyon, France
| | - Muriel Doret-Dion
- Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Faculté De Médecine Et De Maïeutique Lyon Sud - Charles Mérieux, Université Lyon 1, Oullins, France
| | - Carole Ferraro-Peyret
- Centre de biopathologie des tumeurs, Hôpitaux Est, Hospices Civils de Lyon, Bron, France
- ISPB Faculté de pharmacie, INSERM 1052, CNRS5286, Centre de Recherche sur le Cancer de Lyon, Université de Lyon, Lyon, France
| | - Cyrille B. Confavreux
- Service de Rhumatologie Sud, Hôpital Lyon Sud, Hospices Civils de LyonPierre-Bénite, France
- Université Lyon 1, UFR médecine Lyon Est, INSERM UMR 1033, Lyon, France
| | - Marion Douplat
- Service des Urgences, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université de Lyon, Laboratoire RESHAPE - Research on Healthcare Performance, Université Lyon 1, Lyon, France
| | - Patrick Feugier
- Service de Chirurgie Vasculaire et Endovasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de LyonPierre-Bénite, France
- Université de Lyon, UFR médecine Lyon Est, Université Lyon1, Pierre-Bénite, France
| | - Arnaud Friggeri
- Service d’Anesthésie-Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université de Lyon, Faculté De Médecine Et De Maïeutique Lyon Sud - Charles Mérieux, Université Lyon 1, Oullins, France
| | - Pierre-Adrien Bolze
- Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Hôpital Lyon Sud, Hospices Civils de LyonPierre-Bénite, France
- Centre pour l’Innovation en Cancérologie de Lyon (CICLY EA3738), Université Lyon 1, Oullins, France
| | - Yesim Dargaud
- Centre d’Hémophilie de Lyon, Unité d’Hémostase clinique, Hôpital Louis Pradel, Bron, France
- Université de Lyon, Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
| | - Alexandre Messager
- Human Resources and Faculty/Clinical Leadership Development, Ottawa University, Ottawa, Canada
| | - Martine Wallon
- Service de Parasitologie et de Mycologie Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Waking Team, Centre de Recherche en Neurosciences de Lyon, Bron, France
| | - Loïc Geffroy
- Stratégie et management des organisations, Université Lyon 1, Lyon, France
| | - Yves Matillon
- Laboratoire Parcours Santé Systémique, Université Lyon 1, Lyon, France
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Touzet S, Buchet-Poyau K, Denis A, Occelli P, Jacquin L, Potinet V, Sigal A, Delaroche-Gaudin M, Fayard-Gonon F, Tazarourte K, Douplat M. Impact of the presence of a mediator on patient violent or uncivil behaviours in emergency departments: a cluster randomised crossover trial. Eur J Emerg Med 2024; 31:201-207. [PMID: 38329117 DOI: 10.1097/mej.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND IMPORTANCE Several studies reported that violent behaviours were committed by patients against healthcare professionals in emergency departments (EDs). The presence of mediators could prevent or resolve situations of tension. OBJECTIVE To evaluate whether the presence of mediators in EDs would have an impact on violent behaviours committed by patients or their relatives against healthcare professionals. Design, settings and participants A 6-period cluster randomised crossover trial was performed in 4 EDs during 12 months. Patients aged ≥18 and their relatives were included. INTERVENTION In order to prevent or resolve situations of tension and conflict, four mediators were recruited.Outcome measure and analysis Using a logistic regression mixed model, the rate of ED visits in which at least one act of violence was committed by a patient or their relatives, reported by healthcare professionals, was compared between the intervention group and the control group. RESULTS A total of 50 429 ED visits were performed in the mediator intervention group and 50 851 in the control group. The mediators reported 1365 interventions; >50% of the interventions were to answer questions about clinical management or waiting time. In the intervention group, 173 acts of violence were committed during 129 ED visits, and there were 145 acts of violence committed during 106 ED visits in the control group. The rate of ED visits in which at least one act of violence was committed, was 0.26% in the intervention group and 0.21% in the control group (OR = 1.23; 95% CI [0.73-2.09]); on a 4-level seriousness scale, 41.6% of the acts of violence were rated level-1 (acts of incivility or rudeness) in the intervention group and 40.0% in the control group. CONCLUSION The presence of mediators in the ED was not associated with a reduction in violent or uncivil behaviours committed by patients or their relatives. However, the study highlighted that patients had a major need for information regarding their care; improving communication between patients and healthcare professionals might reduce the violence in EDs. TRIAL REGISTRATION Clinicaltrials.gov (NCT03139110).
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Affiliation(s)
- Sandrine Touzet
- Hospices Civils de Lyon, Pôle de Santé Publique
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1
| | | | | | - Pauline Occelli
- Hospices Civils de Lyon, Pôle de Santé Publique
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1
| | - Laurent Jacquin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Accueil des Urgences
| | - Véronique Potinet
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'Accueil des Urgences
| | - Alain Sigal
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service d'Accueil des Urgences, Lyon, France
| | | | - Florence Fayard-Gonon
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service d'Accueil des Urgences, Lyon, France
| | - Karim Tazarourte
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Accueil des Urgences
| | - Marion Douplat
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'Accueil des Urgences
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Marie P, Romain-Scelle N, Potinet V, Schott AM, Douplat M. Assessment of health literacy in a French emergency department. BMC Health Serv Res 2024; 24:493. [PMID: 38649979 PMCID: PMC11034065 DOI: 10.1186/s12913-024-11003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Health literacy (HL) has become a subject of major interest in public health worldwide. It is known to be linked to self-efficacy in care use and to global health status, and a non-negligible frequency of problematic or inadequate levels of HL in populations worldwide is reported. As this has yet to be evaluated in France, the present study aimed to evaluate the HL level of patients in a French emergency department (ED). METHODS We conducted a descriptive, cross-sectional observational, single center study in the ED of the Lyon Sud hospital (Hospices civils de Lyon, Lyon, France). The primary endpoint was the HL level of the patients determined according to the score obtained using the 16-item European Health Literacy Survey Questionnaire. The secondary endpoint was the identification of sociodemographic factors associated with the HL level. RESULTS A total of 189 patients were included for analysis. 10% (95% CI [3%; 17%]) of the patients had an inadequate HL, 38% (95% CI [31%; 45%]) had a problematic HL, and 53% (95% CI [46%; 61%] had an adequate HL. In multivariate analysis, age and perceived health status were independent predictors of the HL level; OR =0.82 (95% CI [0.69; 0.97]; p=0.026) for a 10-year increase in age, and OR =1.84 (95% CI [1.22; 2.82]; p=0.004]). CONCLUSIONS The HL level of the patients in the ED studied herein was similar to that found in the population of France and other European countries and was influenced by age and perceived health status, which are both associated with care needs. It may be therefore interesting to explore in future studies how taking into consideration HL in the general population may lead to a better self-efficacy in care and optimize the use of the healthcare system.
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Affiliation(s)
- Pauline Marie
- Hospices Civils of Lyon, Hôpital Lyon Sud, Emergency department, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
| | - Nicolas Romain-Scelle
- Hospices Civils of Lyon, Hôpital Lyon Sud, Emergency department, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
- CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR, 5558, Villeurbanne, France
| | - Veronique Potinet
- Hospices Civils of Lyon, Hôpital Lyon Sud, Emergency department, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
| | - Anne Marie Schott
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM, U1290, Lyon, France
| | - Marion Douplat
- Hospices Civils of Lyon, Hôpital Lyon Sud, Emergency department, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France.
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM, U1290, Lyon, France.
- UMR ADéS 7268, Aix-Marseille Université/ EFS / CNRS, Espace éthique méditerranéen, Marseille, France.
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Shirreff G, Huynh BT, Duval A, Pereira LC, Annane D, Dinh A, Lambotte O, Bulifon S, Guichardon M, Beaune S, Toubiana J, Kermorvant-Duchemin E, Chéron G, Cordel H, Argaud L, Douplat M, Abraham P, Tazarourte K, Martin-Gaujard G, Vanhems P, Hilliquin D, Nguyen D, Chelius G, Fraboulet A, Temime L, Opatowski L, Guillemot D. Assessing respiratory epidemic potential in French hospitals through collection of close contact data (April-June 2020). Sci Rep 2024; 14:3702. [PMID: 38355640 PMCID: PMC10866902 DOI: 10.1038/s41598-023-50228-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/17/2023] [Indexed: 02/16/2024] Open
Abstract
The transmission risk of SARS-CoV-2 within hospitals can exceed that in the general community because of more frequent close proximity interactions (CPIs). However, epidemic risk across wards is still poorly described. We measured CPIs directly using wearable sensors given to all present in a clinical ward over a 36-h period, across 15 wards in three hospitals in April-June 2020. Data were collected from 2114 participants and combined with a simple transmission model describing the arrival of a single index case to the ward to estimate the risk of an outbreak. Estimated epidemic risk ranged four-fold, from 0.12 secondary infections per day in an adult emergency to 0.49 per day in general paediatrics. The risk presented by an index case in a patient varied 20-fold across wards. Using simulation, we assessed the potential impact on outbreak risk of targeting the most connected individuals for prevention. We found that targeting those with the highest cumulative contact hours was most impactful (20% reduction for 5% of the population targeted), and on average resources were better spent targeting patients. This study reveals patterns of interactions between individuals in hospital during a pandemic and opens new routes for research into airborne nosocomial risk.
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Affiliation(s)
- George Shirreff
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion, Université Paris Cité, Paris, France
- UVSQ, Inserm, CESP, Anti-Infective Evasion and Pharmacoepidemiology Team, Université Paris-Saclay, Montigny-Le-Bretonneux, France
- Modélisation, Épidémiologie Et Surveillance Des Risques Sanitaires (MESuRS), Conservatoire National Des Arts Et Métiers, Paris, France
| | - Bich-Tram Huynh
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion, Université Paris Cité, Paris, France
- UVSQ, Inserm, CESP, Anti-Infective Evasion and Pharmacoepidemiology Team, Université Paris-Saclay, Montigny-Le-Bretonneux, France
| | - Audrey Duval
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion, Université Paris Cité, Paris, France
| | - Lara Cristina Pereira
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion, Université Paris Cité, Paris, France
| | - Djillali Annane
- IHU PROMETHEUS, Raymond Poincaré Hospital (APHP), INSERM, Université Paris Saclay Campus Versailles, Paris, France
| | - Aurélien Dinh
- Service de Maladies Infectieuses Et Tropicales, AP-HP. Paris Saclay, Hôpital Raymond Poincaré, Garches, France
| | - Olivier Lambotte
- Service de Médecine Interne Et Immunologie Clinique, AP-HP. Paris Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- UMR1184, IMVA-HB, Inserm, CEA, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Sophie Bulifon
- Service de Pneumologie, AP-HP. Paris Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Magali Guichardon
- Service de Gériatrie, AP-HP. Paris Saclay, Hôpital Paul Brousse, Villejuif, France
| | - Sebastien Beaune
- Service Des Urgences Adultes, AP-HP. Paris Saclay, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Julie Toubiana
- Service de Pédiatrie Générale, AP-HP. Centre - Université Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - Elsa Kermorvant-Duchemin
- Service de Réanimation Néonatale, AP-HP. Centre - Université Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - Gerard Chéron
- Service Des Urgences Pédiatriques, AP-HP. Centre - Université Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - Hugues Cordel
- Service de Maladies Infectieuses Et Tropicales, AP-HP. Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Bobigny, France
| | - Laurent Argaud
- Service de Réanimation Adulte, Hospices Civils de Lyon - Université Claude Bernard, Hôpital Edouard Herriot, Lyon, France
| | - Marion Douplat
- Service Des Urgences Adultes, Hospices Civils de Lyon - Université Claude Bernard, Hôpital Lyon Sud, Pierre-Bénite, France
| | - Paul Abraham
- Service d'Anesthésie-Réanimation, Hospices Civils de Lyon - Université Claude Bernard, Hôpital Edouard Herriot, Lyon, France
| | - Karim Tazarourte
- Service Des Urgences Adultes, Hospices Civils de Lyon - Université Claude Bernard, Hôpital Edouard Herriot, Lyon, France
| | - Géraldine Martin-Gaujard
- Service de Gériatrie, Hospices Civils de Lyon - Université Claude Bernard, Hôpital Edouard Herriot, Lyon, France
| | - Philippe Vanhems
- Service Hygiène, Épidémiologie, Infectiovigilance Et Prévention, Hospices Civils de Lyon - Université Claude Bernard, Lyon, France
- Centre International de Recherche en Infectiologie, Team Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases (PHE3ID), Univ Lyon, Inserm, U1111, CNRS, UMR5308, ENS de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Delphine Hilliquin
- Service Hygiène, Épidémiologie, Infectiovigilance Et Prévention, Hospices Civils de Lyon - Université Claude Bernard, Lyon, France
| | - Duc Nguyen
- Service Des Maladies Infectieuses Et Tropicales, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | | | | | - Laura Temime
- Modélisation, Épidémiologie Et Surveillance Des Risques Sanitaires (MESuRS), Conservatoire National Des Arts Et Métiers, Paris, France
- PACRI Unit, Conservatoire National Des Arts Et Métiers, Institut Pasteur, Paris, France
| | - Lulla Opatowski
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion, Université Paris Cité, Paris, France
- UVSQ, Inserm, CESP, Anti-Infective Evasion and Pharmacoepidemiology Team, Université Paris-Saclay, Montigny-Le-Bretonneux, France
| | - Didier Guillemot
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion, Université Paris Cité, Paris, France.
- UVSQ, Inserm, CESP, Anti-Infective Evasion and Pharmacoepidemiology Team, Université Paris-Saclay, Montigny-Le-Bretonneux, France.
- Department of Public Health, Medical Information, Clinical Research, AP-HP. Paris Saclay, Paris, France.
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Benhamed A, Bonnet M, Miossec A, Mercier E, Hernu R, Douplat M, Gorincour G, L'Huillier R, Abensur Vuillaume L, Tazarourte K. Performance of the Fresno-Quebec Rule in identifying patients with concomitant fractures not requiring a radiograph before shoulder dislocation reduction: a multicenter retrospective cohort study. Eur J Emerg Med 2023; 30:438-444. [PMID: 37526102 DOI: 10.1097/mej.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND AND IMPORTANCE Although shoulder dislocation diagnosis is often solely based on clinical examination, physicians may order a radiograph to rule out a concomitant shoulder fracture before performing reduction. The Fresno-Québec decision rule aims to identify patients requiring a radiograph before reduction to avoid unnecessary systematic imaging. However, this novel approach needs further validation. OBJECTIVE To evaluate the performance of the Fresno-Québec rule in identifying patients who do not require a prereduction radiograph and assess the variables associated with a clinically significant fracture. DESIGN, SETTINGS, AND PARTICIPANTS A multicenter, retrospective cohort study from 2015 to 2021. Data were extracted from three ED university-affiliated tertiary-care centers. Patients aged ≥18 years with a final diagnosis of anterior glenohumeral dislocation were included. OUTCOMES MEASURE AND ANALYSIS Accuracy metrics [sensitivity (Se), specificity (Sp), positive (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR)] of the Fresno-Québec rule were measured. Multivariable logistic regression model was used to identify variables associated with the presence of a concomitant clinically significant fracture. MAIN RESULTS A total of 2129 patients were included, among whom 9.7% had a concomitant fracture. The performance metrics of the Fresno-Québec rule were as follows: Se 0.96 95% confidence interval (0.92-0.98), Sp 0.36 (0.34-0.38), PPV 0.14 (0.12-0.16), NPV 0.99 (0.98-0.99), PLR 1.49 (1.42-1.55) and NLR 0.12 (0.06-0.23). A total of 678 radiographs could have been avoided, corresponding to a reduction of 35.2%. Age ≥40 years, first dislocation episode [odds ratio (OR) = 3.18 (1.95-5.38); P < 0.001], the following mechanisms: road collision [OR = 6.26 (2.65-16.1)], low-level fall [OR = 3.49 (1.66-8.28)], high-level fall [OR = 3.95 (1.62-10.4)], and seizure/electric shock [OR = 10.6 (4.09-29.2)] were associated with the presence of a concomitant fracture. CONCLUSION In this study, the Fresno-Québec rule has excellent Se in identifying concomitant clinically significant fractures in patients with an anterior glenohumeral dislocation. The use of this clinical decision rule may be associated with a reduction of approximately a third of unnecessary prereduction radiographs.
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Affiliation(s)
- Axel Benhamed
- Emergency Department-SAMU 69, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Margot Bonnet
- Emergency Department-SAMU 69, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Auriane Miossec
- Emergency Department-SAMU 69, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Eric Mercier
- Centre de recherche, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Romain Hernu
- Emergency Department, Centre Hospitalier Universitaire de la Croix Rousse, Hospices Civils de Lyon, Lyon
| | - Marion Douplat
- Emergency Department, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Pierre Bénite
| | | | - Romain L'Huillier
- Department of Imaging, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon
| | | | - Karim Tazarourte
- Emergency Department-SAMU 69, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France
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Hugenschmitt D, Le Coz P, Lefort H, Tazarourte K, Douplat M. [Ethical issues surrounding death in pre-hospital medicine]. Rev Infirm 2023; 72:42-44. [PMID: 37952996 DOI: 10.1016/j.revinf.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Mobile emergency and resuscitation teams are confronted with death on a daily basis. In the home, the management of a death is complex. It raises ethical questions and sometimes destabilizes personal or collective values. Our single-center qualitative survey, conducted over a one-month period (2022), questioned 64/154 caregivers about the moral burden and challenges of such situations. The consequences of operational experience are discussed: time, fatigue, emotions and training. The quality of presence is an alternative to the success or failure of cardiac arrest care at home.
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Affiliation(s)
| | - Pierre Le Coz
- Umr Adés 7268, Espace éthique méditerranéen, boulevard Pierre-Dramard, 69015 Marseille, France
| | - Hugues Lefort
- Structure des urgences, Hôpital d'instruction des armées Laveran, 34 boulevard Laveran, 13013 Marseille, France
| | - Karim Tazarourte
- Samu/Smur, Hôpital Édouard-Herriot, 5 place d'Arsonval, 69003 Lyon, France; Structure des urgences, Hôpital Édouard-Herriot, 5 place d'Arsonval, 69003 Lyon, France; Reshape, Inserm U1290, 162 avenue Lacassagne, 69003 Lyon, France
| | - Marion Douplat
- Umr Adés 7268, Espace éthique méditerranéen, boulevard Pierre-Dramard, 69015 Marseille, France; Reshape, Inserm U1290, 162 avenue Lacassagne, 69003 Lyon, France; Structure des urgences, Hôpital Lyon-Sud, 69310 Pierre-Bénite, France
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Therond C, Saliba-Serre B, Le Coz P, Eon B, Michel F, Piriou V, Lamblin A, Douplat M. Ethical issues encountered by French intensive care unit caregivers during the first COVID-19 outbreak. Can J Anaesth 2023; 70:1816-1827. [PMID: 37749366 DOI: 10.1007/s12630-023-02585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE We aimed to describe the ethical issues encountered by health care workers during the first COVID-19 outbreak in French intensive care units (ICUs), and the factors associated with their emergence. METHODS This descriptive multicentre survey study was conducted by distributing a questionnaire to 26 French ICUs, from 1 June to 1 October 2020. Physicians, residents, nurses, and orderlies who worked in an ICU during the first COVID-19 outbreak were included. Multiple logistic regression models were performed to identify the factors associated with ethical issues. RESULTS Among the 4,670 questionnaires sent out, 1,188 responses were received, giving a participation rate of 25.4%. Overall, 953 participants (80.2%) reported experiencing issue(s) while caring for patients during the first COVID-19 outbreak. The most common issues encountered concerned the restriction of family visits in the ICU (91.7%) and the risk of contamination for health care workers (72.3%). Nurses and orderlies faced this latter issue more than physicians (adjusted odds ratio [ORa], 2.98; 95% confidence interval [CI], 1.87 to 4.76; P < 0.001 and ORa, 4.35; 95% CI, 2.08 to 9.12; P < 0.001, respectively). They also faced more the issue "act contrary to the patient's advance directives" (ORa, 4.59; 95% CI, 1.74 to 12.08; P < 0.01 and ORa, 10.65; 95% CI, 3.71 to 30.60; P < 0.001, respectively). A total of 1,132 (86.9%) respondents thought that ethics training should be better integrated into the initial training of health care workers. CONCLUSION Eight out of ten responding French ICU health care workers experienced ethical issues during the first COVID-19 outbreak. Identifying these issues is a first step towards anticipating and managing such issues, particularly in the context of potential future health crises.
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Affiliation(s)
- Corentin Therond
- (UMR) Unité mixte de recherche 7268 ADES (Anthropologie bioculturelle, Droit, Ethique et Santé), CNRS (Centre Nationale de Recherche Scientifique), EFS (Etablissement Français du Sang), Aix-Marseille University, Marseille, France.
| | - Bérengère Saliba-Serre
- (UMR) Unité mixte de recherche 7268 ADES (Anthropologie bioculturelle, Droit, Ethique et Santé), CNRS (Centre Nationale de Recherche Scientifique), EFS (Etablissement Français du Sang), Aix-Marseille University, Marseille, France
| | - Pierre Le Coz
- (UMR) Unité mixte de recherche 7268 ADES (Anthropologie bioculturelle, Droit, Ethique et Santé), CNRS (Centre Nationale de Recherche Scientifique), EFS (Etablissement Français du Sang), Aix-Marseille University, Marseille, France
| | - Béatrice Eon
- (UMR) Unité mixte de recherche 7268 ADES (Anthropologie bioculturelle, Droit, Ethique et Santé), CNRS (Centre Nationale de Recherche Scientifique), EFS (Etablissement Français du Sang), Aix-Marseille University, Marseille, France
- Direction Qualité Gestion des Risques/Cellule Qualité gestion des risques, AP-HM Hospital Timone, Marseille, France
| | - Fabrice Michel
- (UMR) Unité mixte de recherche 7268 ADES (Anthropologie bioculturelle, Droit, Ethique et Santé), CNRS (Centre Nationale de Recherche Scientifique), EFS (Etablissement Français du Sang), Aix-Marseille University, Marseille, France
- Service d'anesthésie et réanimation pédiatrique, AP-HM Hospital Timone, Marseille, France
| | - Vincent Piriou
- Service d'Anesthésie et de Réanimation, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, Lyon, France
| | - Antoine Lamblin
- (UMR) Unité mixte de recherche 7268 ADES (Anthropologie bioculturelle, Droit, Ethique et Santé), CNRS (Centre Nationale de Recherche Scientifique), EFS (Etablissement Français du Sang), Aix-Marseille University, Marseille, France
- Service civilo-militaire d'anesthésie-réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Marion Douplat
- (UMR) Unité mixte de recherche 7268 ADES (Anthropologie bioculturelle, Droit, Ethique et Santé), CNRS (Centre Nationale de Recherche Scientifique), EFS (Etablissement Français du Sang), Aix-Marseille University, Marseille, France
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, Lyon, France
- Service des Urgences de Lyon Sud, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
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8
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Schmidt L, Zabelberg S, Schlatter S, Adams I, Douplat M, Perchet C, Lilot M, Rey AE, Mazza S. The impact of shift work on pain recognition, a robust ability among intensive care nurses. Eur J Pain 2023; 27:1203-1215. [PMID: 37434490 DOI: 10.1002/ejp.2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Pain empathy is essential for high-quality of care. The cognitive ability to identify and understand the pain in others remains underexplored in the context of hospital shift work. This study aimed to observe the early subliminal ability to detect pain in other faces and to investigate pain intensity evaluations during day and night shifts. METHODS Twenty-one nurses (31 ± 7 years, 20 women) from cardio-paediatric intensive care participated in this study. Eighteen nurses completed all testing in the morning and evening hours, before and after the 12-hour day and night shift. In the first test, the nurses had to decide if facial stimuli presented subliminally showed pain or not. During the second test, they consciously determined the intensity of the painful faces on a numerical scale. Sleep, sleepiness and empathy were also measured. RESULTS Recognition accuracy and pain sensitivity remained stable over time, only sensitivity increased following the work shift (F(1,15) = 7.10, p = 0.018). Intensity ratings remained stable. Sleepiness at the end of the night shift was negatively correlated with accuracy (ρ = -0.51, p = 0.018) and positively correlated with prior night shifts (ρ = -0.50, p = 0.022). CONCLUSION The judgement of facial pain expressions seems robust across shift types, only individual factors such as sleepiness interfere with pain recognition. Pain sensitivity may be enhanced during working hours. SIGNIFICANCE STATEMENT Some professions need to know how to assess pain 24/7 and a lack of sleep can disrupt the cognitive processes necessary for this assessment. Night shifts provoke a bias in pain management, and sleep deprivation, a decrease in pain evaluation. By conducting a repeated measure study in the field that applied a different paradigm (subliminal recognition of facial cues) we add evidence to the understanding of pain recognition and the impact of sleep deprivation on the early processing of pain in others.
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Affiliation(s)
- Laura Schmidt
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, INSERM U1290, Lyon, France
| | | | - Sophie Schlatter
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, INSERM U1290, Lyon, France
- Université Claude Bernard Lyon 1, Centre Lyonnais d'enseignement par la simulation en Santé, CLESS, SimuLyon, Lyon, France
| | - Inga Adams
- Universität zu Köln, Psychologie, Cologne, Germany
| | - Marion Douplat
- Hospices Civils de Lyon, Département des Urgences, Hôpital Lyon Sud, Lyon, France
| | - Caroline Perchet
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, FORGETTING, F-69500, Bron, France
| | - Marc Lilot
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, INSERM U1290, Lyon, France
- Université Claude Bernard Lyon 1, Centre Lyonnais d'enseignement par la simulation en Santé, CLESS, SimuLyon, Lyon, France
- Hospices Civils de Lyon, Département d'Anesthésie-Réanimation, Hôpital Louis Pradel, Groupement Hospitalier Est, Lyon, France
| | - Amandine Eve Rey
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, FORGETTING, F-69500, Bron, France
| | - Stéphanie Mazza
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, FORGETTING, F-69500, Bron, France
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Rambaud S, Gavoille A, Economos G, Tazarourte K, Douplat M. Decision-making process of withholding or withdrawing life-sustaining treatments in French emergency departments during COVID-19 outbreak. Eur J Emerg Med 2023; 30:371-373. [PMID: 37650740 DOI: 10.1097/mej.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Severin Rambaud
- Emergency Department, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre Bénite
| | - Antoine Gavoille
- Service de Biostatistique, Hospices Civils de Lyon, Lyon
- Université de Lyon Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne
| | - Guillaume Economos
- Palliative Care Center, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre Bénite
- Université Claude Bernard Lyon 1, EA 3738 - CICLy, Centre d'Innovation en Cancérologie de Lyon, UFR Faculté de Médecin Lyon-Sud-Charles Mérieux BP1
| | - Karim Tazarourte
- Emergency Department, Edouard Herriot Hospital, Hospices Civils de Lyon
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon
| | - Marion Douplat
- Emergency Department, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre Bénite
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon
- UMR ADéS 7268, Aix-Marseille University/EFS/CNRS, Espace éthique méditerranéen, Marseille, France
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10
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Sagnol G, Haesebaert J, Termoz A, Michel P, Schott AM, Potinet V, Pomey MP, Tazarourte K, Douplat M. Assessing patient partnership among emergency departments in France: a cross-sectional study. BMC Health Serv Res 2023; 23:897. [PMID: 37612727 PMCID: PMC10463322 DOI: 10.1186/s12913-023-09905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVES This study aims to describe the use of patient partnership, as defined by the Montreal Model, in emergency departments (EDs) in France and report the perception of patient partnership from both the practitioner and patient perspectives. METHODS This cross-sectional study was conducted between July 2020 and October 2020. First, a survey was sent to 146 heads of EDs in both teaching hospitals and non-teaching hospitals in France to assess the current practices in terms of patient partnership in service organization, research, and teaching. The perceived barriers and facilitators of the implementation of such an approach were also recorded. Then, semi-structured telephone interviews were carried out with patients involved in a service re-organization project. RESULTS A total of 48 answers (response rate 32.9%) to the survey were received; 33.3% of respondents involved patients in projects relating to service re-organization, 20.8% involved patients in teaching projects, and 4.2% in research projects. Overall, 60.4% of the respondents were willing to involve patients in re-organization or teaching projects. The main barriers mentioned for establishing patient partnership were difficulties regarding patient recruitment and lack of time. The main advantages mentioned were the improvement in patient/caregiver relationship and new ideas to improve healthcare. When interviewed, patients mentioned the desire to improve healthcare and the necessity to involve people with different profiles and backgrounds. A too important personal commitment was the most frequently raised barrier to their engagement. All the patients recognized their positive role, and more generally, the positive role of patient engagement in service re-organization. CONCLUSION Although this preliminary study indicates a rather positive perception of patient partnership among heads of EDs in France and partner patients, this approach is still not widely applied in practice.
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Affiliation(s)
- Geoffrey Sagnol
- Hospices Civils de Lyon, Service d’Accueil des urgences, Hôpital Lyon Sud, 165 chemin du Grand Revoyet, Pierre Bénite, F-69495 France
| | - Julie Haesebaert
- Pôle de Santé Publique, service de recherche et d’épidémiologie cliniques, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon , U1290 Reshape, Lyon (Rhône), France
| | - Anne Termoz
- Pôle de Santé Publique, service de recherche et d’épidémiologie cliniques, Hospices Civils de Lyon, Lyon, France
| | - Philipe Michel
- University Claude Bernard Lyon , U1290 Reshape, Lyon (Rhône), France
- Hospices civils de Lyon, Lyon, 69002 France
| | - Anne-Marie Schott
- University Claude Bernard Lyon , U1290 Reshape, Lyon (Rhône), France
| | - Véronique Potinet
- Hospices Civils de Lyon, Service d’Accueil des urgences, Hôpital Lyon Sud, 165 chemin du Grand Revoyet, Pierre Bénite, F-69495 France
| | - Marie-Pascale Pomey
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montreal, Montreal, QC Canada
| | - Karim Tazarourte
- University Claude Bernard Lyon , U1290 Reshape, Lyon (Rhône), France
- Hospices Civils de Lyon, Service d’Accueil des urgences, Hôpital Edouard Herriot, 5 place d’Arsonval, Lyon, F-69003 France
| | - Marion Douplat
- Hospices Civils de Lyon, Service d’Accueil des urgences, Hôpital Lyon Sud, 165 chemin du Grand Revoyet, Pierre Bénite, F-69495 France
- University Claude Bernard Lyon , U1290 Reshape, Lyon (Rhône), France
- UMR 7268 ADéS, Aix-Marseille Université / EFS / CNRS, Espace éthique méditerranéen, Hôpital Adultes La Timone, 264 rue Saint Pierre, Marseille cedex 05, France
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Gibot S, Lafon T, Jacquin L, Lefevre B, Kimmoun A, Guillaumot A, Losser MR, Douplat M, Argaud L, De Ciancio G, Jolly L, Touly N, Derive M, Malaplate C, Luc A, Baumann C, François B. Soluble TREM-1 plasma concentration predicts poor outcome in COVID-19 patients. Intensive Care Med Exp 2023; 11:51. [PMID: 37574520 PMCID: PMC10423708 DOI: 10.1186/s40635-023-00532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND The immuno-receptor Triggering Expressed on Myeloid cells-1 (TREM-1) is activated during bacterial infectious diseases, where it amplifies the inflammatory response. Small studies suggest that TREM-1 could be involved in viral infections, including COVID-19. We here aim to decipher whether plasma concentration of the soluble form of TREM-1 (sTREM-1) could predict the outcome of hospitalized COVID-19 patients. METHODS We conducted a multicentre prospective observational study in 3 university hospitals in France. Consecutive hospitalized patients with confirmed infection with SARS-CoV-2 were enrolled. Plasma concentration of sTREM-1 was measured on admission and then at days 4, 6, 8, 14, 21, and 28 in patients admitted into an ICU (ICU cohort: ICUC) or 3 times a week for patients hospitalized in a medical ward (Conventional Cohort: ConvC). Clinical and biological data were prospectively recorded and patients were followed-up for 90 days. For medical ward patients, the outcome was deemed complicated in case of requirement of increased oxygen supply > 5 L/min, transfer to an ICU, or death. For Intensive Care Unit (ICU) patients, complicated outcome was defined by death in the ICU. RESULTS Plasma concentration of sTREM-1 at inclusion was higher in ICU patients (n = 269) than in medical ward patients (n = 562) (224 pg/mL (IQR 144-320) vs 147 pg/mL (76-249), p < 0.0001), and higher in patients with a complicated outcome in both cohorts: 178 (94-300) vs 135 pg/mL (70-220), p < 0.0001 in the ward patients, and 342 (288-532) vs 206 pg/mL (134-291), p < 0.0001 in the ICU patients. Elevated sTREM-1 baseline concentration was an independent predictor of complicated outcomes (Hazard Ratio (HR) = 1.5 (1.1-2.1), p = 0.02 in ward patients; HR = 3.8 (1.8-8.0), p = 0.0003 in ICU patients). An sTREM-1 plasma concentration of 224 pg/mL had a sensitivity of 42%, and a specificity of 76% in the ConvC for complicated outcome. In the ICUC, a 287 pg/mL cutoff had a sensitivity of 78%, and a specificity of 74% for death. The sTREM-1 concentrations increased over time in the ConvC patients with a complicated outcome (p = 0.017), but not in the ICUC patients. CONCLUSIONS In COVID-19 patients, plasma concentration of sTREM-1 is an independent predictor of the outcome, although its positive and negative likelihood ratio are not good enough to guide clinical decision as a standalone marker.
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Affiliation(s)
- Sébastien Gibot
- Médecine Intensive et Réanimation, Hôpital Central, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France.
- Service de Médecine Intensive et Réanimation, Hôpital Central, 29 Avenue de Lattre de Tassigny, 54035, Nancy Cedex, France.
| | - Thomas Lafon
- Emergency Department, Limoges University Hospital Center, 87000, Limoges, France
- Inserm CIC 1435, Limoges University Hospital Center, 87000, Limoges, France
| | - Laurent Jacquin
- Emergency Department, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003, Lyon, France
| | - Benjamin Lefevre
- Service des Maladies Infectieuses et Tropicales, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Antoine Kimmoun
- Médecine Intensive et Réanimation, Hôpital Brabois, Université de Lorraine, CHRU-Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Anne Guillaumot
- Département de Pneumologie, Hôpital Brabois, Université de Lorraine, CHRU-Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Marie-Reine Losser
- Réanimation Chirurgicale, Hôpital Brabois, Université de Lorraine, CHRU-Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Marion Douplat
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud Pierre Benite, 69000, Lyon, France
| | - Laurent Argaud
- Service de Médecine Intensive-Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003, Lyon, France
| | - Guillaume De Ciancio
- Département de Cardiologie, Hôpital Brabois, Université de Lorraine, CHRU-Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Lucie Jolly
- Inotrem Sa, Faculté de Médecine de Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Nina Touly
- Inotrem Sa, Faculté de Médecine de Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Marc Derive
- Inotrem Sa, Faculté de Médecine de Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Catherine Malaplate
- Laboratoire de Biochimie, Hôpital Brabois, Université de Lorraine, CHRU-Nancy, 54500, Vandoeuvre-Les-Nancy, France
- Centre de Ressources Biologiques Lorraine, CHRU Nancy, Hôpital Brabois, 54500, Vandoeuvre-Les-Nancy, France
| | - Amandine Luc
- Unité de Méthodologie, Data Management et Statistiques, Hôpital Brabois, Université de Lorraine, CHRU-Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Cédric Baumann
- Unité de Méthodologie, Data Management et Statistiques, Hôpital Brabois, Université de Lorraine, CHRU-Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Bruno François
- Réanimation Polyvalente et Inserm CIC-1435 & UMR-1092, CHU Limoges, 87000, Limoges, France
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12
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Roussel M, Bloom B, Taalba M, Choquet C, Douillet D, Fémy F, Marouk A, Gorlicki J, Gerlier C, Macrez R, Arnaud E, Bompard R, Montassier E, Hugli O, Czopik C, Eyer X, Benhamed A, Peyrony O, Chouihed T, Penaloza A, Marra A, Laribi S, Reuter PG, Behringer W, Douplat M, Guenezan J, Javaud N, Lucidarme O, Cachanado M, Aparicio-Monforte A, Freund Y. Temporal Trends in the Use of Computed Tomographic Pulmonary Angiography for Suspected Pulmonary Embolism in the Emergency Department : A Retrospective Analysis. Ann Intern Med 2023. [PMID: 37216659 DOI: 10.7326/m22-3116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Recently, validated clinical decision rules have been developed that avoid unnecessary use of computed tomographic pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) in the emergency department (ED). OBJECTIVE To measure any resulting change in CTPA use for suspected PE. DESIGN Retrospective analysis. SETTING 26 European EDs in 6 countries. PATIENTS Patients with CTPA performed for suspected PE in the ED during the first 7 days of each odd month between January 2015 and December 2019. MEASUREMENTS The primary end points were the CTPAs done for suspected PE in the ED and the number of PEs diagnosed in the ED each year adjusted to an annual census of 100 000 ED visits. Temporal trends were estimated using generalized linear mixed regression models. RESULTS 8970 CTPAs were included (median age, 63 years; 56% female). Statistically significant temporal trends for more frequent use of CTPA (836 per 100 000 ED visits in 2015 vs. 1112 in 2019; P < 0.001), more diagnosed PEs (138 per 100 000 in 2015 vs. 164 in 2019; P = 0.028), a higher proportion of low-risk PEs (annual percent change [APC], 13.8% [95% CI, 2.6% to 30.1%]) with more ambulatory management (APC, 19.3% [CI, 4.1% to 45.1%]), and a lower proportion of intensive care unit admissions (APC, -8.9% [CI, -17.1% to -0.3%]) were observed. LIMITATION Data were limited to 7 days every 2 months. CONCLUSION Despite the recent validation of clinical decision rules to limit the use of CTPA, an increase in the CTPA rate along with more diagnosed PEs and especially low-risk PEs were instead observed. PRIMARY FUNDING SOURCE None specific for this study.
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Affiliation(s)
- Melanie Roussel
- Sorbonne Université, UMR Inserm 1166, IHU ICAN, Paris; Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.R., Y.F.)
| | - Ben Bloom
- Emergency Department, Royal London Hospital, London, United Kingdom (B.B.)
| | - Mehdi Taalba
- Emergency Department, Rouen University Hospital, Rouen, France (M.T.)
| | - Christophe Choquet
- Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (C. Choquet)
| | - Delphine Douillet
- Department of Emergency Medicine, University Hospital of Angers, Angers; and UNIV Angers, UMR MitoVasc CNRS 6215 INSERM 1083, Angers, France (D.D.)
| | - Florent Fémy
- Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cite, Paris; and Toxicology and Chemical Risks Department, French Armed Forces Biomedical Institute, Brétigny-sur-Orge, France (F.F.)
| | - Alexis Marouk
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France (A. Marouk)
| | - Judith Gorlicki
- Emergency Department, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France (J. Golicki)
| | - Camille Gerlier
- Emergency Department, Hôpital Saint-Joseph, Paris, France (C.G.)
| | - Richard Macrez
- Emergency Department, CHU Caen Côte de Nacre, Normandie Université UNICAEN, INSERM PhIND Institut Blood and Brain, Caen, France (R.M.)
| | - Emilien Arnaud
- Department of Emergency Medicine, Amiens-Picardy University Hospital, Amiens, France (E.A.)
| | - Rudy Bompard
- Emergency Department, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France (R.B.)
| | | | - Olivier Hugli
- Emergency Department, Lausanne University Hospital Emergency Care Service, Lausanne, Switzerland (O.H.)
| | - Charlotte Czopik
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France (C. Czopik)
| | - Xavier Eyer
- Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (X.E.)
| | - Axel Benhamed
- Emergency Department, Hospices Civils de Lyon, Lyon, France (A.B., M.D.)
| | - Olivier Peyrony
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France (O.P.)
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, Nancy, France (T.C.)
| | - Andrea Penaloza
- Emergency Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium (A.P.)
| | - Alessio Marra
- Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy (A. Marra)
| | - Said Laribi
- Tours University, Emergency Medicine Department, Tours University Hospital, Tours, France (S.L.)
| | - Paul-Georges Reuter
- Emergency Department, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne; and Université Versailles-Saint Quentin en Yvelines, Boulogne, France (P.-G.R.)
| | - Wilhelm Behringer
- Department of Emergency Medicine, Medical University Vienna, Vienna General Hospital, Vienna, Austria (W.B.)
| | - Marion Douplat
- Emergency Department, Hospices Civils de Lyon, Lyon, France (A.B., M.D.)
| | - Jeremy Guenezan
- Emergency Department, University Hospital of Poitiers, Poitiers, France (J. Guenezen)
| | - Nicolas Javaud
- Emergency Department, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Colombes; and Reference Center for Bradykinin Angiodema (CReAk), Université Paris Cite, Colombes, France (N.J.)
| | - Olivier Lucidarme
- Sorbonne Université, UMR Inserm 1166, IHU ICAN, Paris; and Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale LIB, Paris, France (O.L.)
| | - Marine Cachanado
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France (M.C., A.A.)
| | - Ainhoa Aparicio-Monforte
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France (M.C., A.A.)
| | - Yonathan Freund
- Sorbonne Université, UMR Inserm 1166, IHU ICAN, Paris; Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.R., Y.F.)
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Savary T, Fieux M, Douplat M, Tournegros R, Daubie S, Pavie D, Denoix L, Pialat JB, Tringali S. Incidence of Underlying Abnormal Findings on Routine Magnetic Resonance Imaging for Bell Palsy. JAMA Netw Open 2023; 6:e239158. [PMID: 37079301 PMCID: PMC10119737 DOI: 10.1001/jamanetworkopen.2023.9158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/24/2023] [Indexed: 04/21/2023] Open
Abstract
Importance There is no consensus on the benefits of routine magnetic resonance imaging (MRI) of the facial nerve in patients with suspected idiopathic peripheral facial palsy (PFP) (ie, Bell palsy [BP]). Objectives To estimate the proportion of adult patients in whom MRI led to correction of an initial clinical diagnosis of BP; to determine the proportion of patients with confirmed BP who had MRI evidence of facial nerve neuritis without secondary lesions; and to identify factors associated with secondary (nonidiopathic) PFP at initial presentation and 1 month later. Design, Setting, and Participants This retrospective multicenter cohort study analyzed the clinical and radiological data of 120 patients initially diagnosed with suspected BP from January 1, 2018, to April 30, 2022, at the emergency department of 3 tertiary referral centers in France. Interventions All patients screened for clinically suspected BP underwent an MRI of the entire facial nerve with a double-blind reading of all images. Main Outcomes and Measures The proportion of patients in whom MRI led to a correction of the initial diagnosis of BP (any condition other than BP, including potentially life-threating conditions) and results of contrast enhancement of the facial nerve were described. Results Among the 120 patients initially diagnosed with suspected BP, 64 (53.3%) were men, and the mean (SD) age was 51 (18) years. Magnetic resonance imaging of the facial nerve led to a correction of the diagnosis in 8 patients (6.7%); among them, potentially life-threatening conditions that required changes in treatment were identified in 3 (37.5%). The MRI confirmed the diagnosis of BP in 112 patients (93.3%), among whom 106 (94.6%) showed evidence of facial nerve neuritis on the affected side (hypersignal on gadolinium-enhanced T1-weighted images). This was the only objective sign confirming the idiopathic nature of PFP. Conclusions and Relevance These preliminary results suggest the added value of the routine use of facial nerve MRI in suspected cases of BP. Multicentered international prospective studies should be organized to confirm these results.
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Affiliation(s)
- Thibault Savary
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Maxime Fieux
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Université de Lyon, Université Lyon 1, Lyon, France
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Mondor Institute for Biomedical Research (IMRB), Créteil, France
- Centre National de la Recherche Scientifique (CNRS) Equipe Mixte de Recherche 7000, Créteil, France
| | - Marion Douplat
- Université de Lyon, Université Lyon 1, Lyon, France
- Service des Urgences, Hospices Civils of Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Research on Healthcare Performance, Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
- Unité Mixte de Recherche (UMR) Adés 7268, Aix-Marseille University, Etablissement Français du Sang–CNRS, Espace Éthique Méditerranéen, Marseille, France
| | - Romain Tournegros
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Sophie Daubie
- Service d’Imagerie Médicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Dylan Pavie
- Service d’Imagerie Médicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Luna Denoix
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Jean-Baptiste Pialat
- Université de Lyon, Université Lyon 1, Lyon, France
- Service d’Imagerie Médicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Creatis CNRS UMR 5220, INSERM U1294, Université Lyon 1, Villeurbanne, France
| | - Stephane Tringali
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Université de Lyon, Université Lyon 1, Lyon, France
- UMR 5305, Laboratoire de Biologie Tissulaire et d’Ingénierie Thérapeutique, Institut de Biologie et Chimie des Protéines, CNRS Université Claude Bernard Lyon 1, Lyon, France
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Jacquin L, Battault M, Mewton N, Mantout A, Bergerot C, Tazarourte K, Douplat M. Outcome of patients admitted with oxygen mismatch and myocardial injury or infarction in emergency departments. J Cardiovasc Med (Hagerstown) 2023; 24:159-166. [PMID: 36753723 DOI: 10.2459/jcm.0000000000001443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
AIMS To describe the outcomes and associated factors in a population of patients admitted to emergency departments with at least one condition of oxygen supply/demand imbalance, regardless of the troponin result or restrictive criteria for type 2 myocardial infarction. METHODS We constituted a retrospective cohort of 824 patients. Medical records of patients having undergone a troponin assay were reviewed for selection and classification, and data including in-hospital stay and readmissions were collected. The reported outcomes are in-hospital mortality, 3-year mortality, and major adverse cardiovascular events. RESULTS Patients with myocardial infarction or injury, either chronic or acute, were older, with more history of hypertension and chronic heart or renal failure but not for other cardiovascular risk factors and medical history. Acute myocardial injury and type 2 myocardial infarction were significantly associated with in-hospital mortality [odds ratio (OR) 3.71 95% confidence interval (CI) 1.90-7.33 and OR 3.15 95% CI 1.59-6.28, respectively]. However, the long-term mortality does not differ in comparison with patients presenting chronic myocardial injury or nonelevated troponin, ranging from 26.9 to 34.3%. Patients with chronic myocardial injury and type 2 myocardial infarction had more long-term major cardiovascular events (39.3 and 38.8%), but only for acute heart failure, and none was associated with this outcome after adjustment. CONCLUSION Among patients admitted to emergency departments with an oxygen supply/demand imbalance, acute myocardial injury and type 2 myocardial infarction are strongly associated with in-hospital mortality. However, they are not associated with higher long-term mortality or major cardiovascular events after discharge, which tend to occur in elderly people with comorbidities.
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Affiliation(s)
- Laurent Jacquin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'accueil des urgence.,Université Lyon-1, CarMeN Team 3 Ischemia-Reperfusion Syndromes (IRIS), INSERM UMR 1060
| | - Marion Battault
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'accueil des urgence
| | - Nathan Mewton
- Université Lyon-1, CarMeN Team 3 Ischemia-Reperfusion Syndromes (IRIS), INSERM UMR 1060.,Hospices Civils de Lyon, Hôpital Louis Pradel, Centre d'investigation clinique, INSERM 1407, Lyon.,Hospices Civils de Lyon, Hôpital Louis Pradel, Service de cardiologie, Bron
| | - Adrien Mantout
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'accueil des urgences, Pierre Bénite
| | - Cyrille Bergerot
- Hospices Civils de Lyon, Hôpital Louis Pradel, Centre d'investigation clinique, INSERM 1407, Lyon.,Hospices Civils de Lyon, Hôpital Louis Pradel, Service de cardiologie, Bron
| | - Karim Tazarourte
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'accueil des urgence.,Université Lyon-1, Laboratoire Health Services and Performance Research (HESPER) EA 7425, Lyon, France
| | - Marion Douplat
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'accueil des urgences, Pierre Bénite.,Université Lyon-1, Laboratoire Health Services and Performance Research (HESPER) EA 7425, Lyon, France
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15
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Foucaud A, Gilbert T, Vincent A, Jomard N, Comte B, Porthault S, Comte G, Theurey O, Gueugniaud PY, Bourelly L, Rabilloud M, Boutitie F, Douplat M, Tassa O, Haesebaert J, Termoz A, Schott AM. Evaluation of a training program for emergency medical service physician dispatchers to reduce emergency departments visits. J Am Geriatr Soc 2023; 71:484-495. [PMID: 36317929 DOI: 10.1111/jgs.18101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/08/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Emergency Departments (ED) have seen an increasing number of older patients who are mostly referred following a call to the Emergency Medical Services (EMS). Long waiting times in settings, which are not designed to meet older patients' needs, may increase the risk of hospital-acquired complications. Unnecessary visits should therefore be avoided as much as possible. The objective of the study was to evaluate whether a program to provide geriatric knowledge and tools to the dispatching physicians of the EMS could decrease ED referrals of older patients. METHODS Design: Before-and-after study with two 6-month periods before and after intervention. PARTICIPANTS All calls received by a dispatching physician of the Rhône EMS from 8 am to 6 pm concerning patients aged 75 years or above during the study period. INTERVENTION A program consisting of training dispatching physicians in the specific care of older patients and the developing, with a multidisciplinary team, of specific tools for dispatching physicians. OUTCOME Proportion of ED referrals of patients aged 75 years or above after a call to the EMS. RESULTS A total of 2671 calls to the Rhône EMS were included corresponding to 1307 and 1364 patients in the pre-and post-intervention phases, respectively. There was no significant difference in the proportion of referrals to the ED between the pre-intervention (61.7%) and the post-intervention (62.8%) phases (p = 0.57). Contact of the patients with their General Practitioner (GP) in the month preceding the call was associated with a 22% reduced probability of being referred to an ED. CONCLUSIONS No beneficial effect of the intervention was demonstrated. This strategy of intervention is probably not effective enough in such time-constraint environment. Other strategies with a specific parallel dispatching of geriatric calls by geriatricians should be tested to avoid these unnecessary ED referrals. TRIAL REGISTRATION ClinicalTrials NCT02712450.
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Affiliation(s)
- Amandine Foucaud
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Gériatrie, Pierre Bénite, France
| | - Thomas Gilbert
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Gériatrie, Pierre Bénite, France.,Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Adélaïde Vincent
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Gériatrie, Lyon, France
| | - Nathalie Jomard
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Gériatrie, Pierre Bénite, France
| | - Brigitte Comte
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Gériatrie, Lyon, France
| | - Sylvie Porthault
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Hôpital Edouard Herriot, SAMU, Lyon, France
| | - Gaële Comte
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Hôpital Edouard Herriot, SAMU, Lyon, France
| | - Odile Theurey
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Hôpital Edouard Herriot, SAMU, Lyon, France
| | - Pierre-Yves Gueugniaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Hôpital Edouard Herriot, SAMU, Lyon, France
| | - Laura Bourelly
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Gériatrie, Lyon, France
| | - Muriel Rabilloud
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France.,Laboratoire de Biométrie et Biologie Évolutive, CNRS, UMR 5558, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Florent Boutitie
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
| | - Marion Douplat
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service des Urgences, Pierre Bénite, France
| | - Ouazna Tassa
- Hospices Civils de Lyon, Pôle de Sante Publique, Service Recherche et Épidémiologie Cliniques, Lyon, France
| | - Julie Haesebaert
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Service Recherche et Épidémiologie Cliniques, Lyon, France
| | - Anne Termoz
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Service Recherche et Épidémiologie Cliniques, Lyon, France
| | - Anne-Marie Schott
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Service Recherche et Épidémiologie Cliniques, Lyon, France
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16
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Tinelli M, Guler N, Goetz C, Aim P, Marchionni S, Ouamara N, Cipolat L, Demarquet M, Seris E, Moreau A, Durand G, Douplat M, Lavignon JP, Hingray C, Abensur Vuillaume L. Study protocol: hypnosis versus standard care for shoulder dislocation reduction in the emergency department - a multicentre, randomised, controlled study protocol. BMJ Open 2022; 12:e062278. [PMID: 36600368 PMCID: PMC9730355 DOI: 10.1136/bmjopen-2022-062278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Anterior shoulder dislocation is a common reason for consultation at the emergency department (ED). Hypnosis could be a safe and effective alternative therapy for pain relief during shoulder dislocation reduction but nowadays, evidence is not sufficient. The main objective of this study is to show that reduction under hypnosis is associated with a decrease in the use of analgesic compared with usual care. METHODS AND ANALYSIS We will conduct an interventional, controlled, multicentre, randomised study. A total of 44 patients with shoulder dislocation will be randomised in two groups: the hypnosis group (N=22) and the usual care group (N=22). The primary endpoint will be the comparison of morphine equivalent analgesic consumption during a shoulder dislocation reduction manoeuvre. Secondary endpoints will include haemodynamic parameters monitoring, patient and practitioner satisfaction using a Likert scale, use of coanalgesic or sedative drugs, number of reduction attempts and time spent at ED. Adverse events will be recorded. Statistical analysis will include parametric tests, multivariate linear regression and descriptive statistics. ETHICS AND DISSEMINATION This study has received ethics approval from the Comité de Protection des Personnes of Sud-Est IV on 03/11/2021 (ANSM informed on 19 November 2021). The results will be published in scientific articles and communicated in national and international conferences. TRIAL REGISTRATION NUMBER ClinicalTrial.gov: NCT04992598; National Clinical trial no ID RCB : 2021-A01382-39.
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Affiliation(s)
| | - Nazmine Guler
- Emergency Department, CHR Metz-Thionville, Metz, France
| | - Christophe Goetz
- Clinical Research Support Unit, CHR Metz-Thionville, Metz, France
| | | | | | | | | | | | | | | | | | - Marion Douplat
- Service d'urgences médicales et chirurgicales - Centre hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Coraline Hingray
- Pole de psychiatrie universitaire du grand Nancy, CPN, Laxou, France
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17
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Galzin E, Roche L, Vlachomitrou A, Nempont O, Carolus H, Schmidt-Richberg A, Jin P, Rodrigues P, Klinder T, Richard JC, Tazarourte K, Douplat M, Sigal A, Bouscambert-Duchamp M, Si-Mohamed SA, Gouttard S, Mansuy A, Talbot F, Pialat JB, Rouvière O, Milot L, Cotton F, Douek P, Duclos A, Rabilloud M, Boussel L. Additional value of chest CT AI-based quantification of lung involvement in predicting death and ICU admission for COVID-19 patients. Res Diagn Interv Imaging 2022; 4:100018. [PMID: 37284031 PMCID: PMC9716289 DOI: 10.1016/j.redii.2022.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
Objectives We evaluated the contribution of lung lesion quantification on chest CT using a clinical Artificial Intelligence (AI) software in predicting death and intensive care units (ICU) admission for COVID-19 patients. Methods For 349 patients with positive COVID-19-PCR test that underwent a chest CT scan at admittance or during hospitalization, we applied the AI for lung and lung lesion segmentation to obtain lesion volume (LV), and LV/Total Lung Volume (TLV) ratio. ROC analysis was used to extract the best CT criterion in predicting death and ICU admission. Two prognostic models using multivariate logistic regressions were constructed to predict each outcome and were compared using AUC values. The first model ("Clinical") was based on patients' characteristics and clinical symptoms only. The second model ("Clinical+LV/TLV") included also the best CT criterion. Results LV/TLV ratio demonstrated best performance for both outcomes; AUC of 67.8% (95% CI: 59.5 - 76.1) and 81.1% (95% CI: 75.7 - 86.5) respectively. Regarding death prediction, AUC values were 76.2% (95% CI: 69.9 - 82.6) and 79.9% (95%IC: 74.4 - 85.5) for the "Clinical" and the "Clinical+LV/TLV" models respectively, showing significant performance increase (+ 3.7%; p-value<0.001) when adding LV/TLV ratio. Similarly, for ICU admission prediction, AUC values were 74.9% (IC 95%: 69.2 - 80.6) and 84.8% (IC 95%: 80.4 - 89.2) respectively corresponding to significant performance increase (+ 10%: p-value<0.001). Conclusions Using a clinical AI software to quantify the COVID-19 lung involvement on chest CT, combined with clinical variables, allows better prediction of death and ICU admission.
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Affiliation(s)
- Eloise Galzin
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
| | - Laurent Roche
- Department of Biostatistics, Hospices Civils de Lyon, Lyon F-69003, France
- Université de Lyon, Lyon F-69000, France
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, CNRS, UMR5558, Equipe Biostatistique-Santé, Villeurbanne F-69622, France
| | - Anna Vlachomitrou
- Philips France, 33 rue de Verdun, CS 60 055, Suresnes Cedex 92156, France
| | - Olivier Nempont
- Philips France, 33 rue de Verdun, CS 60 055, Suresnes Cedex 92156, France
| | - Heike Carolus
- Philips Research, Röntgenstrasse 24-26, Hamburg D-22335, Germany
| | | | - Peng Jin
- Philips Medical Systems Nederland BV (Philips Healthcare), the Netherlands
| | - Pedro Rodrigues
- Philips Medical Systems Nederland BV (Philips Healthcare), the Netherlands
| | - Tobias Klinder
- Philips Research, Röntgenstrasse 24-26, Hamburg D-22335, Germany
| | - Jean-Christophe Richard
- Department of Critical Care Medicine, Hôpital De La Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Lyon U1294, France
| | - Karim Tazarourte
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Emergency department and SAMU 69, Hospices civils de Lyon, France
| | - Marion Douplat
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Emergency department and SAMU 69, Hospices civils de Lyon, France
| | - Alain Sigal
- Emergency department and SAMU 69, Hospices civils de Lyon, France
| | - Maude Bouscambert-Duchamp
- Laboratoire de Virologie, Institut des Agents Infectieux de Lyon, Centre National de Référence des virus respiratoires France Sud, Centre de Biologie et de Pathologie Nord, Hospices Civils de Lyon, Lyon F-69317, France
- Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, Lyon F-69372, France
| | - Salim Aymeric Si-Mohamed
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Lyon U1294, France
| | | | - Adeline Mansuy
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
| | - François Talbot
- Department of Information Technology, Hospices Civils de Lyon, Lyon, France
| | - Jean-Baptiste Pialat
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Lyon U1294, France
| | - Olivier Rouvière
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
- LabTAU INSERM U1032, Lyon, France
| | - Laurent Milot
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
- LabTAU INSERM U1032, Lyon, France
| | - François Cotton
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Lyon U1294, France
| | - Philippe Douek
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Lyon U1294, France
| | - Antoine Duclos
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Muriel Rabilloud
- Department of Biostatistics, Hospices Civils de Lyon, Lyon F-69003, France
- Université de Lyon, Lyon F-69000, France
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, CNRS, UMR5558, Equipe Biostatistique-Santé, Villeurbanne F-69622, France
| | - Loic Boussel
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Lyon U1294, France
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Douplat M, Termoz A, Subtil F, Haesebaert J, Jacquin L, Durand G, Potinet V, Hernu R, Nohales L, Mazza S, Berthiller J, Tazarourte K. Changes over time in anxiety, depression, and stress symptoms among healthcare workers in French emergency departments during the first COVID-19 outbreak. J Affect Disord 2022; 316:194-200. [PMID: 35981626 PMCID: PMC9376978 DOI: 10.1016/j.jad.2022.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/25/2022] [Accepted: 08/11/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVE Assess the changes in anxiety, depression, and stress levels over time and identify risk factors among healthcare workers in French emergency departments (EDs) during the first COVID-19 outbreak. METHOD A prospective, multicenter study was conducted in 4 EDs and an emergency medical service (SAMU). During 3 months, participants completed fortnightly questionnaires to assess anxiety, depression, and stress using the Hospital Anxiety and Depression and the Chamoux-Simard scale. The changes in anxiety, depression, and stress levels over time were modelled by a linear mixed model including a period effect and a continuous time effect within periods. RESULTS A total of 211 respondents (43.5 %) completed the survey at inclusion. There was a decrease in mean anxiety (from 7.33 to 5.05, p < 0.001), mean depression (from 4.16 to 3.05, p = 0.009), mean stress at work (from 41.2 to 30.2, p = 0.008), and mean stress at home (from 33.0 to 26.0, p = 0.031) at the beginning of each period. The mean anxiety level was higher for administrative staff (+0.53) and lower for paramedics (-0.61, p = 0.047) compared to physicians. The anxiety level increased with the number of day and night shifts (0.13/day, p < 0.001, 0.12/night, p = 0.025) as did stress at work (1.6/day, p < 0.001, 1.1/night, p = 0.007). Reassigned healthcare workers were at higher risk of stress particularly compared to SAMU workers (stress at work: p = 0.015, at home: p = 0.021, in life in general: p = 0.018). CONCLUSION Although anxiety, depression, and stress decreased over time, anxiety was higher among physicians and administrative staff. Reassignment and working hours were identified as potential risk factors for mental health distress in EDs.
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Affiliation(s)
- Marion Douplat
- Hospices Civils of Lyon, Lyon Sud Hospital, Emergency Department, Pierre, Bénite, F-69495, France; UMR ADéS 7268, Aix-Marseille University/EFS/CNRS, Espace éthique méditerranéen, Marseille, France; Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM, U1290 Lyon, France.
| | - Anne Termoz
- Pôle de Santé Publique, service de recherche et d'épidémiologie cliniques, Hospices Civils de Lyon, France.
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Université de Lyon Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive, UMR, 5558 Villeurbanne, France.
| | - Julie Haesebaert
- Pôle de Santé Publique, service de recherche et d'épidémiologie cliniques, Hospices Civils de Lyon, France; Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM, U1290 Lyon, France.
| | - Laurent Jacquin
- Hospices Civils of Lyon, Edouard Herriot Hospital, Emergency Department, Lyon F-69003, France.
| | | | - Veronique Potinet
- Hospices Civils of Lyon, Lyon Sud Hospital, Emergency Department, Pierre, Bénite, F-69495, France.
| | - Romain Hernu
- Hospices Civils of Lyon, Croix Rousse Hospital, Emergency Department, Lyon F-69004, France.
| | - Ludivine Nohales
- Service de Médecine et Santé au Travail, Pôle de Santé Publique, Hospices Civils de Lyon, France.
| | - Stéphanie Mazza
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM, U1290 Lyon, France.
| | - Julien Berthiller
- Pôle de Santé Publique, service de recherche et d'épidémiologie cliniques, Hospices Civils de Lyon, France.
| | - Karim Tazarourte
- Hospices Civils of Lyon, Edouard Herriot Hospital, Emergency Department, Lyon F-69003, France; Hospices Civils of Lyon, Emergency department, Edouard Herriot Hospital, Lyon F-69003, France; Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM, U1290 Lyon, France.
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Douplat M, Gavoille A, Subtil F, Haesebaert J, Jacquin L, Durand G, Lega JC, Perpoint T, Potinet V, Berthiller J, Perreton N, Tazarourte K. Management and Outcome of COVID-19 Positive and Negative Patients in French Emergency Departments During the First COVID-19 Outbreak: A Prospective Controlled Cohort Study. West J Emerg Med 2022; 23:897-906. [DOI: 10.5811/westjem.2022.7.57135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022] Open
Abstract
ntroduction: Few studies have investigated the management of COVID-19 cases from the operational perspective of the emergency department (ED), We sought to compare the management and outcome of COVID-19 positive and negative patients who presented to French EDs.
Methods: We conducted a prospective, multicenter, observational study in four EDs. Included in the study were adult patients (≥18 years) between March 6–May 10, 2020, were hospitalized, and whose presenting symptoms were evocative of COVID-19. We compared the clinical features, management, and prognosis of patients according to their confirmed COVID-19 status.
Results: Of the 2,686 patients included in this study, 760 (28.3%) were COVID-19 positive. Among them, 364 (48.0%) had hypertension, 228 (30.0%) had chronic cardiac disease, 186 (24.5%) had diabetes, 126 (16.6%) were obese, and 114 (15.0%) had chronic respiratory disease. The proportion of patients admitted to intensive care units (ICU) was higher among COVID-19 positive patients (185/760, 24.3%) compared to COVID-19 negative patients (206/1,926, 10.7%; P <0.001), and they required mechanical ventilation (89, 11.9% vs 37, 1.9%; P <0.001) and high-flow nasal cannula oxygen therapy (135, 18.1% vs 41, 2.2%; P < 0.001) more frequently. The in-hospital mortality was significantly higher among COVID-19 positive patients (139, 18.3% vs 149, 7.7%; P <0.001).
Conclusion: Emergency departments were on the frontline during the COVID-19 pandemic and had to manage potential COVID-19 patients. Understanding what happened in the ED during this first outbreak is crucial to underline the importance of flexible organizations that can quickly adapt the bed capacities to the incoming flow of COVID-19 positive patients.
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Affiliation(s)
- Marion Douplat
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hospices Civils de Lyon, Lyon Sud Hospital, Department of Emergency Medicine, Pierre Bénite, France
| | - Antoine Gavoille
- Université de Lyon Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon France
| | - Fabien Subtil
- Université de Lyon Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon France
| | - Julie Haesebaert
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Pôle de Santé Publique, Service de Recherche et d’Epidémiologie Cliniques, Hospices Civils de Lyon, France
| | - Laurent Jacquin
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Emergency Medicine, Lyon, France
| | - Guillaume Durand
- Villefranche Hospital, Department of Emergency Medicine, Gleize, France
| | - Jean-Christophe Lega
- Hospices Civils de Lyon, Lyon Sud Hospital, Department of Internal and Vascular Medicine, Pierre Bénite, France
| | - Thomas Perpoint
- Service de Maladies Infectieuses et Tropicales, Hôpital Croix-Rousse Hospices Civils de Lyon, Lyon, France
| | - Veronique Potinet
- Hospices Civils de Lyon, Lyon Sud Hospital, Department of Emergency Medicine, Pierre Bénite, France
| | - Julien Berthiller
- Pôle de Santé Publique, Service de Recherche et d’Epidémiologie Cliniques, Hospices Civils de Lyon, France
| | - Nathalie Perreton
- Pôle de Santé Publique, Service de Recherche et d’Epidémiologie Cliniques, Hospices Civils de Lyon, France
| | - Karim Tazarourte
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Emergency Medicine, Lyon, France
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20
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Picot S, Perpoint T, Chidiac C, Sigal A, Javouhey E, Gillet Y, Jacquin L, Douplat M, Tazarourte K, Argaud L, Wallon M, Miossec C, Bonnot G, Bienvenu AL. Diagnostic accuracy of fluorescence flow-cytometry technology using Sysmex XN-31 for imported malaria in a non-endemic setting. Parasite 2022; 29:31. [PMID: 35638753 PMCID: PMC9153516 DOI: 10.1051/parasite/2022031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Malaria diagnosis based on microscopy is impaired by the gradual disappearance of experienced microscopists in non-endemic areas. Aside from the conventional diagnostic methods, fluorescence flow cytometry technology using Sysmex XN-31, an automated haematology analyser, has been registered to support malaria diagnosis. The aim of this prospective, monocentric, non-interventional study was to evaluate the diagnostic accuracy of the XN-31 for the initial diagnosis or follow-up of imported malaria cases compared to the reference malaria tests including microscopy, loop mediated isothermal amplification, and rapid diagnostic tests. Over a one-year period, 357 blood samples were analysed, including 248 negative and 109 positive malaria samples. Compared to microscopy, XN-31 showed sensitivity of 100% (95% CI: 97.13–100) and specificity of 98.39% (95% CI: 95.56–100) for the initial diagnosis of imported malaria cases. Moreover, it provided accurate species identification asfalciparumor non-falciparumand parasitaemia determination in a very short time compared to other methods. We also demonstrated that XN-31 was a reliable method for patient follow-up on days 3, 7, and 28. Malaria diagnosis can be improved in non-endemic areas by the use of dedicated haematology analysers coupled with standard microscopy or other methods in development, such as artificial intelligence for blood slide reading. Given that XN-31 provided an accurate diagnosis in 1 min, it may reduce the time interval before treatment and thus improve the outcome of patient who have malaria.
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Affiliation(s)
- Stéphane Picot
- Service de Parasitologie et Mycologie Médicale, Groupement Hospitalier Nord, Hospices Civils de Lyon,69004 Lyon,France - Université de Lyon, Université Lyon 1, CNRS, INSA, CPE-Lyon, ICBMS, UMR 5246,69100 Villeurbanne,France
| | - Thomas Perpoint
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon,69004 Lyon,France
| | - Christian Chidiac
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon,69004 Lyon,France - CIRI Équipe PH3ID - INSERM - U1111- UCBL Lyon 1 - CNRS - UMR5308 - ENS de Lyon,69007 Lyon,France
| | - Alain Sigal
- Service d'accueil des urgences, Hôpital de la Croix-Rousse, Hospices Civils de Lyon,69004 Lyon,France
| | - Etienne Javouhey
- Service de Réanimation et Urgences Pédiatriques, Hôpital Femme-Mere-Enfant, Hospices Civils de Lyon,69500 Lyon,France
| | - Yves Gillet
- Service de Réanimation et Urgences Pédiatriques, Hôpital Femme-Mere-Enfant, Hospices Civils de Lyon,69500 Lyon,France
| | - Laurent Jacquin
- Service d'accueil des urgences, Hôpital Edouard Herriot, Hospices Civils de Lyon,69008 Lyon,France
| | - Marion Douplat
- Service d'accueil des urgences, Hôpital Lyon Sud, Hospices Civils de Lyon,69310 Lyon,France - Université de Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425,69008 Lyon,France
| | - Karim Tazarourte
- Service d'accueil des urgences, Hôpital Edouard Herriot, Hospices Civils de Lyon,69008 Lyon,France - Université de Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425,69008 Lyon,France
| | - Laurent Argaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation,69008 Lyon,France
| | - Martine Wallon
- Service de Parasitologie et Mycologie Médicale, Groupement Hospitalier Nord, Hospices Civils de Lyon,69004 Lyon,France
| | - Charline Miossec
- Service de Parasitologie et Mycologie Médicale, Groupement Hospitalier Nord, Hospices Civils de Lyon,69004 Lyon,France
| | - Guillaume Bonnot
- Université de Lyon, Université Lyon 1, CNRS, INSA, CPE-Lyon, ICBMS, UMR 5246,69100 Villeurbanne,France
| | - Anne-Lise Bienvenu
- Université de Lyon, Université Lyon 1, CNRS, INSA, CPE-Lyon, ICBMS, UMR 5246,69100 Villeurbanne,France - Service Pharmacie, Groupement Hospitalier Nord, Hospices Civils de Lyon,69004 Lyon,France
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21
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Isnard F, Termoz A, Haesebaert J, Viprey M, Tazarourte K, Bravant E, Perreton N, Cakmak S, Meyran S, Ossedat C, Ducreux B, Pidoux C, Bony T, Douplat M, Potinet V, Sigal A, Derex L, Nighoghossian N, Schott-Pethelaz AM, Mechtouff L. Temporal Trend of Transient Ischemic Attack Management over a 10-Year Period: Data from the Rhône County, France. Cerebrovasc Dis 2022; 51:517-524. [PMID: 35350011 DOI: 10.1159/000520840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Timely recognition and management of transient ischemic attack (TIA) offer the greatest opportunity to prevent subsequent stroke. But variability of TIA management quality exists across hospitals. Under the impetus of national plans, measures were adopted to improve TIA management, including a structured local pathway. Our objective was to compare TIA management between two periods over 10 years, before and after the implementation of these measures. METHODS A before-and-after study was conducted with two identical population-based cohort studies in 2006-2007 (AVC69) and 2015-2016 (STROKE69) including all patients with TIA diagnosis over a 7-month period in six public and private hospitals in the Rhône county in France. The primary outcome was the adequate TIA management defined as brain and vessel imaging within 24 h of admission and the prescription of antithrombotic treatment at discharge. RESULTS We identified 109 patients TIA patients in 2006-2007, and 458 over the same period in 2015-2016. A higher proportion of patients were adequately managed in 2015-2016 compared to 2006-2007 (14/96 [15%] in 2006-2007 vs. 306/452 [68%] in 2015-2016, p < 0.001). This difference was mainly driven by a marked increase of vessel imaging performed within 24 h of admission, most often by computed tomography angiography. Furthermore, patients called more often emergency medical dispatch before admission, were admitted with a shorter delay after symptom onset, and were more likely discharged to home in 2015-2016 compared to 2006-2007. CONCLUSION Our study demonstrated an increasing rate of adequate TIA management, mainly driven by a marked increase of vessel imaging within 24 h of admission, over a 10-year period in the Rhône county in France.
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Affiliation(s)
- Florent Isnard
- Emergency Department - HEH, Hospices Civils de Lyon, Lyon, France
| | - Anne Termoz
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Julie Haesebaert
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Marie Viprey
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Karim Tazarourte
- Emergency Department - HEH, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, Lyon, France
| | - Estelle Bravant
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | | | - Serkan Cakmak
- Stroke Unit, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - Sylvie Meyran
- Emergency Department, Hôpital St Joseph St Luc, Lyon, France
| | | | - Bruno Ducreux
- Emergency Department, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - Christelle Pidoux
- Emergency Department, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - Thomas Bony
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - Marion Douplat
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - Veronique Potinet
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - Alain Sigal
- Emergency Department, Hospices Civils de Lyon, Hôpital Croix Rousse, Lyon, France
| | - Laurent Derex
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, Lyon, France.,Hospices Civils de Lyon, Stroke Center, Hôpital Pierre Wertheimer, Bron, France
| | | | - Anne-Marie Schott-Pethelaz
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Laura Mechtouff
- Hospices Civils de Lyon, Stroke Center, Hôpital Pierre Wertheimer, Bron, France
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22
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Chabbert P, Lamboley L, Souquet O, Haesebaert J, Termoz A, Schott AM, Lecoanet A, Douplat M, Benhamed A, Nighoghossian N, Mechtouff L. Effect of the Implementation of a Local Care Pathway on the Transient Ischemic Attack Management in Emergency Departments. Neurologist 2021; 27:46-50. [PMID: 34842566 DOI: 10.1097/nrl.0000000000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies have demonstrated that urgent care decreases the risk of subsequent stroke after transient ischemic attack (TIA). In response to heterogeneous TIA management observed in our area, we developed a structured pathway, in accordance with current guidelines and adapted to local resources. We aim to assess the effect of local implementation of this care pathway on TIA management in emergency departments (EDs) in the Rhône area (France). PATIENTS AND METHODS EDs of 5 centers that had a minimum of 30 TIA/year in Lyon and Bourgoin-Jallieu participated. The first 30 consecutive patients who had a TIA as main diagnosis admitted to one of these EDs from January 1 to December 31, 2013 and from January 1 to December 31, 2016, that is, before-and-after care pathway implementation, respectively, were retrospectively included in the study. The primary outcome was the adequate management of TIA defined as having had appropriate workup and antithrombotic treatment within 24 hours. RESULTS A total of 141 patients were included in 2013 and 150 in 2016. There was a significant increase of complete (intracrania and extracranial) vessel imaging from 2013 to 2016 (n=42, 29.8% in 2013 vs. n=118, 78.7% in 2016; P<0.001). Computed tomography angiography was more often performed to assess intracranial and/or extracranial vessel imaging in 2016 compared with 2013 (n=54, 34.8% in 2013 vs. n=116, 77.3% in 2016; P<0.001). Overall, the rate of patients receiving adequate management significantly increased from 2013 to 2016 (n=36, 25.5% in 2013 vs. n=101, 67.3% in 2016; P<0.001). CONCLUSIONS Implementation of a local care pathway, in accordance with current guidelines and adapted to local resources, improved TIA management in EDs, mostly by increasing the rate of vessel imaging by computed tomography angiography.
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Affiliation(s)
| | | | | | - Julie Haesebaert
- Pôle de santé publique, Service de recherche et épidémiologie clinique
- HESPER EA 7425, Université Claude Bernard Lyon 1
| | - Anne Termoz
- Pôle de santé publique, Service de recherche et épidémiologie clinique
- HESPER EA 7425, Université Claude Bernard Lyon 1
| | - Anne-Marie Schott
- Pôle de santé publique, Service de recherche et épidémiologie clinique
- HESPER EA 7425, Université Claude Bernard Lyon 1
| | | | | | | | - Norbert Nighoghossian
- Stroke Unit, Hôpital Pierre Wertheimer, Hospices Civils de Lyon
- CarMeN Laboratory, University Lyon 1, INSERM U1060, Lyon, France
| | - Laura Mechtouff
- Stroke Unit, Hôpital Pierre Wertheimer, Hospices Civils de Lyon
- CarMeN Laboratory, University Lyon 1, INSERM U1060, Lyon, France
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23
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Tan BK, Mainbourg S, Friggeri A, Bertoletti L, Douplat M, Dargaud Y, Grange C, Lobbes H, Provencher S, Lega JC. Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis. Thorax 2021; 76:970-979. [PMID: 33622981 PMCID: PMC7907632 DOI: 10.1136/thoraxjnl-2020-215383] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/07/2020] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prevalence of venous thromboembolic event (VTE) and arterial thromboembolic event (ATE) thromboembolic events in patients with COVID-19 remains largely unknown. METHODS In this meta-analysis, we systematically searched for observational studies describing the prevalence of VTE and ATE in COVID-19 up to 30 September 2020. RESULTS We analysed findings from 102 studies (64 503 patients). The frequency of COVID-19-related VTE was 14.7% (95% CI 12.1% to 17.6%, I2=94%; 56 studies; 16 507 patients). The overall prevalence rates of pulmonary embolism (PE) and leg deep vein thrombosis were 7.8% (95% CI 6.2% to 9.4%, I2=94%; 66 studies; 23 117 patients) and 11.2% (95% CI 8.4% to 14.3%, I2=95%; 48 studies; 13 824 patients), respectively. Few were isolated subsegmental PE. The VTE prevalence was significantly higher in intensive care unit (ICU) (23.2%, 95% CI 17.5% to 29.6%, I2=92%, vs 9.0%, 95% CI 6.9% to 11.4%, I2=95%; pinteraction<0.0001) and in series systematically screening patients compared with series testing symptomatic patients (25.2% vs 12.7%, pinteraction=0.04). The frequency rates of overall ATE, acute coronary syndrome, stroke and other ATE were 3.9% (95% CI 2.0% to to 3.0%, I2=96%; 16 studies; 7939 patients), 1.6% (95% CI 1.0% to 2.2%, I2=93%; 27 studies; 40 597 patients) and 0.9% (95% CI 0.5% to 1.5%, I2=84%; 17 studies; 20 139 patients), respectively. Metaregression and subgroup analyses failed to explain heterogeneity of overall ATE. High heterogeneity limited the value of estimates. CONCLUSIONS Patients admitted in the ICU for severe COVID-19 had a high risk of VTE. Conversely, further studies are needed to determine the specific effects of COVID-19 on the risk of ATE or VTE in less severe forms of the disease.
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Affiliation(s)
- Boun Kim Tan
- Department of Intensive Care Unit, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Sabine Mainbourg
- Department of Internal and Vascular Medecine, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Equipe Evaluation et Modélisation des Effets Thérapeutiques, UMR - CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, Claude Bernard University Lyon 1, VIlleurbanne, France
| | - Arnaud Friggeri
- Department of Intensive Care Unit, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de Saint-Étienne, Saint-Étienne, France
- Université Jean-Monnet, UMR 1059, SAINBIOSE; INSERM CIC 1408, Saint-Étienne, France
| | - Marion Douplat
- Service d'accueil des urgences, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Yesim Dargaud
- Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques, Hospices Civils de Lyon, Lyon, France
- Unité d'Hémostase Clinique, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Claire Grange
- Department of Internal and Vascular Medecine, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Hervé Lobbes
- Department of Internal and Vascular Medecine, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Department of Internal Medicine, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Steeve Provencher
- Pulmonary Hypertension Research Group, Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Québec, Canada
| | - Jean-Christophe Lega
- Department of Internal and Vascular Medecine, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Equipe Evaluation et Modélisation des Effets Thérapeutiques, UMR - CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, Claude Bernard University Lyon 1, VIlleurbanne, France
- Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques, Hospices Civils de Lyon, Lyon, France
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24
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Charrier P, Occelli P, Buchet-Poyau K, Douplat M, Delaroche-Gaudin M, Fayard-Gonon F, Jacquin L, Potinet V, Sigal A, Tazarourte K, Touzet S. Strategies used by emergency care professionals to handle interpersonal difficulties with patients: a qualitative study. BMJ Open 2021; 11:e042362. [PMID: 33558353 PMCID: PMC7871700 DOI: 10.1136/bmjopen-2020-042362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Identify the strategies implemented by emergency care professionals when facing tension and interpersonal violence from patients and their friends and family. DESIGN Descriptive qualitative study based on 38 semidirective interviews. PARTICIPANTS Doctors, nurses, nursing assistants and administrative staff. SETTING Four emergency departments (EDs) from three French university hospitals. RESULTS According to the medical professionals interviewed, the difficulties that they encounter with patients or their accompanying family members can be explained by a lack of understanding of the functioning of EDs, by a general increase in individualistic behaviours leading to a lack of civility or by deviant behaviours (related to toxic substance abuse or mental illness). While managing deviant behaviours may sometimes require a collective intervention, ED staff also implement what are essentially individual communication strategies (with the use of rational explanation, seduction and empathy), confrontation or flight to deal with interpersonal difficulties. CONCLUSIONS Strategies used by staff members tend to be individualised for the most part, and some, such as confrontational or escape strategies, may not be adapted to all situations. In the face of difficulties between staff and patients, mediators, specialised in resolving conflict, could entrust some cases to professionals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03139110).
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Affiliation(s)
- Philippe Charrier
- Centre Max Weber (UMR 5283), University Lumière Lyon 2, F-69007 Lyon, France
- Public Health Department, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Pauline Occelli
- Public Health Department, Hospices Civils de Lyon, F-69003 Lyon, France
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
| | | | - Marion Douplat
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
- Emergency Department, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite, France
| | | | | | - Laurent Jacquin
- Emergency Department, Edouard Herriot Hospital, F-69008 Lyon, France
| | - Véronique Potinet
- Emergency Department, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite, France
| | - Alain Sigal
- Emergency Departement, Croix-Rousse Hospital, F-69004 Lyon, France
| | - Karim Tazarourte
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
- Emergency Department, Edouard Herriot Hospital, F-69008 Lyon, France
| | - Sandrine Touzet
- Public Health Department, Hospices Civils de Lyon, F-69003 Lyon, France
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
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25
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Schott AM, Termoz A, Viprey M, Tazarourte K, Vecchia CD, Bravant E, Perreton N, Nighoghossian N, Cakmak S, Meyran S, Ducreux B, Pidoux C, Bony T, Douplat M, Potinet V, Sigal A, Xue Y, Derex L, Haesebaert J. Short and long-term impact of four sets of actions on acute ischemic stroke management in Rhône County, a population based before-and-after prospective study. BMC Health Serv Res 2021; 21:12. [PMID: 33397363 PMCID: PMC7783982 DOI: 10.1186/s12913-020-05982-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background Optimizing access to recanalization therapies in acute ischemic stroke patients is crucial. Our aim was to measure the short and long term effectiveness, at the acute phase and 1 year after stroke, of four sets of actions implemented in the Rhône County. Methods The four multilevel actions were 1) increase in stroke units bed capacity and development of endovascular therapy; 2) improvement in knowledge and skills of healthcare providers involved in acute stroke management using a bottom-up approach; 3) development and implementation of new organizations (transportation routes, pre-notification, coordination by the emergency call center physician dispatcher); and 4) launch of regional public awareness campaigns in addition to national campaigns. A before-and-after study was conducted with two identical population-based cohort studies in 2006–7 and 2015–16 in all adult ischemic stroke patients admitted to any emergency department or stroke unit of the Rhône County. The primary outcome criterion was in-hospital management times, and the main secondary outcome criteria were access to reperfusion therapy (either intravenous thrombolysis or endovascular treatment) and pre-hospital management times in the short term, and 12-month prognosis measured by the modified Rankin Scale (mRS) in the long term. Results Between 2015–16 and 2006–7 periods ischemic stroke patients increased from 696 to 717, access to reperfusion therapy increased from 9 to 23% (p < 0.0001), calls to emergency call-center from 40 to 68% (p < 0.0001), first admission in stroke unit from 8 to 30% (p < 0.0001), and MRI within 24 h from 18 to 42% (p < 0.0001). Onset-to-reperfusion time significantly decreased from 3h16mn [2 h54-4 h05] to 2h35mn [2 h05-3 h19] (p < 0.0001), mainly related to a decrease in delay from admission to imaging. A significant decrease of disability was observed, as patients with mild disability (mRS [0–2]) at 12 months increased from 48 to 61% (p < 0.0001). Pre-hospital times, however, did not change significantly. Conclusions We observed significant improvement in access to reperfusion therapy, mainly through a strong decrease of in-hospital management times, and in 12-month disability after the implementation of four sets of actions between 2006 and 2016 in the Rhône County. Reducing pre-hospital times remains a challenge.
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Affiliation(s)
- A M Schott
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France. .,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France.
| | - A Termoz
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - M Viprey
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - K Tazarourte
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Emergency Department - HEH, Hospices Civils de Lyon, Lyon, France
| | - C Della Vecchia
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France
| | - E Bravant
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - N Perreton
- Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - N Nighoghossian
- Hospices Civils de Lyon, Comprehensive Stroke Center, Hôpital Pierre Wertheimer, Bron, France
| | - S Cakmak
- Hôpital Nord Ouest, Primary Stroke Center, Villefranche-sur-Saône, France
| | - S Meyran
- Emergency Department, Hôpital St Joseph St Luc, Lyon, France
| | - B Ducreux
- Emergency Department, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - C Pidoux
- Emergency Department, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - T Bony
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - M Douplat
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - V Potinet
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - A Sigal
- Emergency Department, Hospices Civils de Lyon, Hôpital Croix Rousse, Lyon, France
| | - Y Xue
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - L Derex
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Comprehensive Stroke Center, Hôpital Pierre Wertheimer, Bron, France
| | - J Haesebaert
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.,Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
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Douplat M, Fraticelli L, Claustre C, Peiretti A, Serre P, Bischoff M, Jacquin L, Freyssenge J, Schott AM, Tazarourte K, Frugier S, Khoury CEL, Grezard M, Antoine JD, Dumont O, Lhuillier E, Pierro L, Blain S, Prost C, Sen-Brachet P, Khaldi A. Management of decision of withholding and withdrawing life-sustaining treatments in French EDs. Scand J Trauma Resusc Emerg Med 2020; 28:52. [PMID: 32513282 PMCID: PMC7282105 DOI: 10.1186/s13049-020-00744-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Decisions of withholding or withdrawing life sustaining-treatments in emergency department are part of current practice but the decision-making process remains poorly described in the literature.
Study objective
We conducted a study in two phases, the first comprising a retrospective chart review study of patients dying in the ED and the second comprising survey study of health care workers at 10 urban emergency departments in France.
Method
In a first step, we analyzed medical records based on fifteen criteria of the decision-making process grouped into four categories: the collegiality, the traceability, the management and the communication as recommended by the international guidelines. In a second step, we conducted an auto-administrated survey to assess how the staff members (medical, paramedical) feel with the decision-making process.
Results
There were 273 deaths which occurred in the ED over the study period and we included 145 (53.1%) patients. The first-step analysis revealed that the traceability of the decision and the information given to patient or the relatives were the most reported points according to the recommendations. Three of the ten emergency departments had developed a written procedure. The collegial discussion and the traceability of the prognosis assessment were significantly increased in emergency department with a written procedure as well as management of pain, comfort care, and the communication with the patient or the relatives. In the second-step analysis, among the 735 staff members asked to take part in the survey, 287 (39.0%) answered. The medical and paramedical staff expressed difficult experience regarding the announcement and the communication with the patient and the relatives.
Conclusion
The management of the decision to withhold or withdraw life-sustaining treatments must be improved in emergency departments according to the guidelines. A standard written procedure could be useful in clinical practice despite the lack of experienced difference between centers with and without procedures.
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Plumereau C, Cho TH, Buisson M, Amaz C, Cappucci M, Derex L, Ong E, Fontaine J, Rascle L, Riva R, Schiavo D, Benhamed A, Douplat M, Bony T, Tazarourte K, Tuttle C, Eker OF, Berthezène Y, Ovize M, Nighoghossian N, Mechtouff L. Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network. J Neurol 2020; 268:2314-2319. [PMID: 32902732 PMCID: PMC7479751 DOI: 10.1007/s00415-020-10199-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 01/13/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic would have particularly affected acute stroke care. However, its impact is clearly inherent to the local stroke network conditions. We aimed to assess the impact of COVID-19 pandemic on acute stroke care in the Lyon comprehensive stroke center during this period. Methods We conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). The volume of reperfusion therapies and pre and intra-hospital delays were compared during both periods. Results A total of 208 patients were included. The volume of IVT significantly decreased during the COVID-period [55 (54.5%) vs 74 (69.2%); p = 0.03]. The volume of MT remains stable over the two periods [72 (71.3%) vs 65 (60.8%); p = 0.14], but the door-to-groin puncture time increased in patients transferred for MT (237 [187–339] vs 210 [163–260]; p < 0.01). The daily number of Emergency Medical Dispatch calls considerably increased (1502 [1133–2238] vs 1023 [960–1410]; p < 0.01). Conclusions Our study showed a decrease in the volume of IVT, whereas the volume of MT remained stable although intra-hospital delays increased for transferred patients during the COVID-19 pandemic. These results contrast in part with the national surveys and suggest that the impact of the pandemic may depend on local stroke care networks.
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Affiliation(s)
- Cécile Plumereau
- Emergency Department, Hospices Civils de Lyon, Lyon, France.,Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Marielle Buisson
- Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Camille Amaz
- Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Matteo Cappucci
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,EA 7425 HESPER, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France
| | - Elodie Ong
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Julia Fontaine
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Lucie Rascle
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Roberto Riva
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - David Schiavo
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Axel Benhamed
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Marion Douplat
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Thomas Bony
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Karim Tazarourte
- Emergency Department, Hospices Civils de Lyon, Lyon, France.,EA 7425 HESPER, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France
| | - Célia Tuttle
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Omer Faruk Eker
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France.,CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | - Michel Ovize
- CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France.,Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Laura Mechtouff
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France. .,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France.
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Douplat M, Jacquin L, Frugier S, Tazarourte K, Le Coz P. Difficulty of the ethical decision-making process in withholding and withdrawing life-sustaining treatments in French EDs during COVID pandemic. Scand J Trauma Resusc Emerg Med 2020; 28:78. [PMID: 32792005 PMCID: PMC7424240 DOI: 10.1186/s13049-020-00772-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Marion Douplat
- Emergency Department, Lyon Sud Hospital, University Hospital, Hospices Civiles of Lyon, 165 chemin du Grand Revoyet, F-69495, Pierre Bénite, France. .,UMR ADéS 7268, Aix-Marseille University/ EFS / CNRS, Espace éthique méditerranéen, Timone Adulte's Hospital, Marseille, France.
| | - Laurent Jacquin
- Emergency Department, Édouard-Herriot Hospital, Lyon University Hospital, Hospices Civiles of Lyon, 5 place d'Arsonval, F-69003, Lyon, France
| | - Soizic Frugier
- Emergency Department, Lyon Sud Hospital, University Hospital, Hospices Civiles of Lyon, 165 chemin du Grand Revoyet, F-69495, Pierre Bénite, France
| | - Karim Tazarourte
- Emergency Department, Édouard-Herriot Hospital, Lyon University Hospital, Hospices Civiles of Lyon, 5 place d'Arsonval, F-69003, Lyon, France
| | - Pierre Le Coz
- UMR ADéS 7268, Aix-Marseille University/ EFS / CNRS, Espace éthique méditerranéen, Timone Adulte's Hospital, Marseille, France
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29
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Charrier P, Buchet-Poyau K, Delaroche-Gaudin M, Douplat M, Jacquin L, Occelli P, Fayard-Gonon F, Potinet V, Tazarourte K, Touzet S. [Mediators in emergency services: what missions according to the staff?]. Sante Publique 2020; 31:797-807. [PMID: 32550662 DOI: 10.3917/spub.196.0797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Violence in emergency services has become a central issue in the daily work of hospital employees. While the use of video surveillance and the training of professionals in conflict management are the most common methods used, there are few cases using the setting up of a third part such as a mediator. We conducted a qualitative study with professionals to examine their representations associated with mediation. METHOD Semi-directive interviews were conducted with professionals from four emergency units. The topics discussed in interviews were the definition of mediation and the missions that the mediators should fulfil. The content of 38 semi-directive interviews was analysed according to the inductive approach of the grounded theory. A content analysis was made, followed by an analysis aiming to bring out types and convergences/divergences. RESULTS Professionals were not aware of the definition of mediation and of its missions. They linked to it an instrumental theme, making mediation a tool for conflict prevention and management, a tool for communication with patients about their care, and about the organisation of emergency unit. The upcoming presence of mediators was seen as an help. A potential competition between professionals and mediators in the tasks performed was identified. CONCLUSION The study shows a favourable opinion towards mediation. It has allowed to identify obstacles to the well-functioning of the missions assigned to mediators. One of the challenges is the integration of this new actor, the mediator.
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Borges FK, Bhandari M, Guerra-Farfan E, Patel A, Sigamani A, Umer M, Tiboni ME, Villar-Casares MDM, Tandon V, Tomas-Hernandez J, Teixidor-Serra J, Avram VRA, Winemaker M, Ramokgopa MT, Szczeklik W, Landoni G, Wang CY, Begum D, Neary JD, Adili A, Sancheti PK, Lawendy AR, Balaguer-Castro M, Ślęczka P, Jenkinson RJ, Nur AN, Wood GCA, Feibel RJ, McMahon SJ, Sigamani A, Popova E, Biccard BM, Moppett IK, Forget P, Landais P, McGillion MH, Vincent J, Balasubramanian K, Harvey V, Garcia-Sanchez Y, Pettit SM, Gauthier LP, Guyatt GH, Conen D, Garg AX, Bangdiwala SI, Belley-Cote EP, Marcucci M, Lamy A, Whitlock R, Le Manach Y, Fergusson DA, Yusuf S, Devereaux PJ, Veevaete L, le Polain de Waroux B, Lavand'homme P, Cornu O, Tribak K, Yombi JC, Touil N, Reul M, Bhutia JT, Clinckaert C, De Clippeleir D, Reul M, Patel A, Tandon V, Gauthier LP, Avram VRA, Winemaker M, de Beer J, Simpson DL, Worster A, Alvarado KA, Gregus KK, Lawrence KH, Leong DP, Joseph PG, Magloire P, Deheshi B, Bisland S, Wood TJ, Tushinski DM, Wilson DAJ, Kearon C, Le Manach Y, Adili A, Tiboni ME, Neary JD, Cowan DD, Khanna V, Zaki A, Farrell JC, MacDonald AM, Conen D, Wong SCW, Karbassi A, Wright DS, Shanthanna H, Coughlin R, Khan M, Wikkerink S, Quraishi FA, Lawendy AR, Kishta W, Schemitsch E, Carey T, Macleod MD, Sanders DW, Vasarhelyi E, Bartley D, Dresser GK, Tieszer C, Jenkinson RJ, Shadowitz S, Lee JS, Choi S, Kreder HJ, Nousiainen M, Kunz MR, Tuazon R, Shrikumar M, Ravi B, Wasserstein D, Stephen DJG, Nam D, Henry PDG, Wood GCA, Mann SM, Jaeger MT, Sivilotti MLA, Smith CA, Frank CC, Grant H, Ploeg L, Yach JD, Harrison MM, Campbell AR, Bicknell RT, Bardana DD, Feibel RJ, McIlquham K, Gallant C, Halman S, Thiruganasambandamoorth V, Ruggiero S, Hadden WJ, Chen BPJ, Coupal SA, McMahon SJ, McLean LM, Shirali HR, Haider SY, Smith CA, Watts E, Santone DJ, Koo K, Yee AJ, Oyenubi AN, Nauth A, Schemitsch EH, Daniels TR, Ward SE, Hall JA, Ahn H, Whelan DB, Atrey A, Khoshbin A, Puskas D, Droll K, Cullinan C, Payendeh J, Lefrancois T, Mozzon L, Marion T, Jacka MJ, Greene J, Menon M, Stiegelmahr R, Dillane D, Irwin M, Beaupre L, Coles CP, Trask K, MacDonald S, Trenholm JAI, Oxner W, Richardson CG, Dehghan N, Sadoughi M, Sharma A, White NJ, Olivieri L, Hunt SB, Turgeon TR, Bohm ER, Tran S, Giilck SM, Hupel T, Guy P, O'Brien PJ, Duncan AW, Crawford GA, Zhou J, Zhao Y, Liu Y, Shan L, Wu A, Muñoz JM, Chaudier P, Douplat M, Fessy MH, Piriou V, Louboutin L, David JS, Friggeri A, Beroud S, Fayet JM, Landais P, Leung FKL, Fang CX, Yee DKH, Sancheti PK, Pradhan CV, Patil AA, Puram CP, Borate MP, Kudrimoti KB, Adhye BA, Dongre HV, John B, Abraham V, Pandey RA, Rajkumar A, George PE, Sigamani A, Stephen M, Chandran N, Ashraf M, Georgekutty AM, Sulthan AS, Adinarayanan S, Sharma D, Barnawal SP, Swaminathan S, Bidkar PU, Mishra SK, Menon J, M N, K VZ, Hiremath SA, NC M, Jawali A, Gnanadurai KR, George CE, Maddipati T, KP MKP, Sharma V, Farooque K, Malhotra R, Mittal S, Sawhney C, Gupta B, Mathur P, Gamangati S, Tripathy V, Menon PH, Dhillon MS, Chouhan DK, Patil S, Narayan R, Lal P, Bilchod PN, Singh SU, Gattu UV, Dashputra RP, Rahate PV, Turiel M, De Blasio G, Accetta R, Perazzo P, Stella D, Bonadies M, Colombo C, Fozzato S, Pino F, Morelli I, Colnaghi E, Salini V, Denaro G, Beretta L, Placella G, Giardina G, Binda M, Marcato A, Guzzetti L, Piccirillo F, Cecconi M, Khor HM, Lai HY, Kumar CS, Chee KH, Loh PS, Tan KM, Singh S, Foo LL, Prakasam K, Chaw SH, Lee ML, Ngim JHL, Boon HW, Chin II, Kleinlugtenbelt YV, Landman EBM, Flikweert ER, Roerdink HW, Brokelman RB, Elskamp-Meijerman HF, Horst MR, Cobben JHMG, Umer M, Begum D, Anjum A, Hashmi PM, Ahmed T, Rashid HU, Khattak MJ, Rashid RH, Lakdawala RH, Noordin S, Juman NM, Khan RI, Riaz MM, Bokhari SS, Almas A, Wahab H, Ali A, Khan HN, Khan EK, Nur AN, Janjua KA, Orakzai SH, Khan AS, Mustafa KJ, Sohail MA, Umar M, Khan SA, Ashraf M, Khan MK, Shiraz M, Furgan A, Ślęczka P, Dąbek P, Kumoń A, Satora W, Ambroży W, Święch M, Rycombel J, Grzelak A, Gucwa J, Machala W, Ramokgopa MT, Firth GB, Karera M, Fourtounas M, Singh V, Biscardi A, Iqbal MN, Campbell RJ, Maluleke ML, Moller C, Nhlapo L, Maqungo S, Flint M, Nejthardt MB, Chetty S, Naidoo R, Guerra-Farfan E, Tomas-Hernandez J, Garcia-Sanchez Y, Garrido Clua M, Molero-Garcia V, Minguell-Monyart J, Teixidor-Serra J, Villar-Casares MDM, Selga Marsa J, Porcel-Vazquez JA, Andres-Peiro JV, Aguilar M, Mestre-Torres J, Colomina MJ, Guilabert P, Paños Gozalo ML, Abarca L, Martin N, Usua G, Martinez-Ripol P, Gonzalez Posada MA, Lalueza-Broto P, Sanchez-Raya J, Nuñez Camarena J, Fraguas-Castany A, Balaguer-Castro M, Torner P, Jornet-Gibert M, Serrano-Sanz J, Cámara-Cabrera J, Salomó-Domènech M, Yela-Verdú C, Peig-Font A, Ricol L, Carreras-Castañer A, Martínez-Sañudo L, Herranz S, Feijoo-Massó C, Sianes-Gallén M, Castillón P, Bernaus M, Quintas S, Gómez O, Salvador J, Abarca J, Estrada C, Novellas M, Torra M, Dealbert A, Macho O, Ivanov A, Valldosera E, Arroyo M, Pey B, Yuste A, Mateo L, De Caso J, Anaya R, Higa-Sansone JL, Millan A, Baños V, Herrera-Mateo S, Aguado HJ, Martinez-Municio G, León R, Santiago-Maniega S, Zabalza A, Labrador G, Guerado E, Cruz E, Cano JR, Bogallo JM, Sa-ngasoongsong P, Kulachote N, Sirisreetreerux N, Pengrung N, Chalacheewa T, Arnuntasupakul V, Yingchoncharoen T, Naratreekoon B, Kadry MA, Thayaparan S, Abdlaziz I, Aframian A, Imbuldeniya A, Bentoumi S, Omran S, Vizcaychipi MP, Correia P, Patil S, Haire K, Mayor ASE, Dillingham S, Nicholson L, Elnaggar M, John J, Nanjayan SK, Parker MJ, O'Sullivan S, Marmor MT, Matityahu A, McClellan RT, Comstock C, Ding A, Toogood P, Slobogean G, Joseph K, O'Toole R, Sciadini M, Ryan SP, Clark ME, Cassidy C, Balonov K, Bergese SD, Phieffer LS, Gonzalez Zacarias AA, Marcantonio AJ, Devereaux PJ, Bhandari M, Borges FK, Balasubramanian K, Bangdiwala SI, Harvey V, McGillion MH, Pettit SM, Vincent J, Vincent J, Harvey V, Dragic-Taylor S, Maxwell C, Molnar S, Pettit SM, Wells JR, Forget P, Borges FK, Landais P, Sigamani A, Landoni G, Wang CY, Szczeklik W, Biccard BM, Popova E, Moppett IK, Lamy A, Whitlock R, Ofori SN, Yang SS, Wang MK, Duceppe E, Spence J, Vasquez JP, Marcano-Fernández F, Conen D, Ham H, Tiboni ME, Prada C, Yung TCH, Sanz Pérez I, Neary JD, Bosch MJ, Prystajecky MR, Chowdhury C, Khan JS, Belley-Cote EP, Stella SF, Marcucci M, Heidary B, Tran A, Wawrzycka-Adamczyk K, Chen YCP, Tandon V, González-Osuna A, Patel A, Biedroń G, Wludarczyk A, Lefebvre M, Ernst JA, Staffhorst B, Woodfine JD, Alwafi EM, Mrkobrada M, Parlow S, Roberts R, McAlister F, Sackett D, Wright J. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. Lancet 2020; 395:698-708. [PMID: 32050090 DOI: 10.1016/s0140-6736(20)30058-1] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. METHODS HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). FINDINGS Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4-9) in the accelerated-surgery group and 24 h (10-42) in the standard-care group (p<0·0001). 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died, with a hazard ratio (HR) of 0·91 (95% CI 0·72 to 1·14) and absolute risk reduction (ARR) of 1% (-1 to 3; p=0·40). Major complications occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care, with an HR of 0·97 (0·83 to 1·13) and an ARR of 1% (-2 to 4; p=0·71). INTERPRETATION Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care. FUNDING Canadian Institutes of Health Research.
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Xue Y, Haesebaert J, Derex L, Viprey M, Termoz A, Della Vecchia C, Tassa O, Kerd H, Cakmak S, Meyran S, Ducreux B, Pidoux C, Du Besset M, Bony T, Gueugniaud PY, Douplat M, Potinet V, Jacob X, Sigal A, Tazarourte K, Lablanche C, Melaine R, Nighoghossian N, Schott AM. Choice of Initial Brain Imaging in Patients with Suspected Acute Stroke: STROKE69, a Population-Based Study. Cerebrovasc Dis 2020; 49:110-118. [PMID: 32097908 DOI: 10.1159/000505960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In patients with suspected stroke, brain imaging is recommended in the acute phase for appropriate management and treatment. Both computed tomography (CT) and magnetic resonance imaging (MRI) are considered reasonable choices for initial brain imaging. When both techniques are available, choosing one or the other might be associated with specific factors related either to patients, stroke symptoms, and severity or management organization. METHODS The study was performed within the STROKE 69 database, a population-based cohort of all adult patients with suspected stroke admitted in one of the emergency departments (ED), primary stroke center, or stroke center of the Rhône County, from November 2015 to December 2016. Patients were included if they were admitted within 24 h following either symptom onset or last known normal. To identify factors potentially associated with the choice of initial brain imaging, a multivariate logistic regression was performed. RESULTS Among the 3,244 patients with suspected stroke enrolled in the STROKE69 cohort, 3,107 (95.8%) underwent brain imaging within the first 24 h after admission. Among those 74.6% underwent CT as initial imaging while 25.4% had an MRI. In multivariate analyses, several factors were associated with a lower probability of having an MRI as initial brain imaging versus CT. These were either patient characteristics: older age (>80 years old, OR 0.39 [95% CI 0.28-0.54]), preexisting disability (OR 0.55 [95% CI 0.36-0.84]), use of anticoagulants (OR 0.52 [95% CI 0.33-0.81]), stroke characteristics: stroke of unknown onset (OR 0.42 [95% CI 0.31-0.58]) or factors associated with overall management: onset-to-door time (>6 h, OR 0.38 [95% CI 0.23-0.60]), initial admission to ED (OR 0.02 [95% CI 0.02-0.04]) or intensive care unit (OR 0.01 [95% CI 0.001-0.08]), personal transport (OR 0.66 [95% CI 0.45-0.96]), and admission during working hours (OR 0.65 [95% CI 0.51-0.84]). CONCLUSIONS Besides CT or MRI availability, a number of other parameters could influence the choice of first imaging in case of stroke suspicion. These are related to patient characteristics, type of stroke symptoms, and type of organization.
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Affiliation(s)
- Yufeng Xue
- Université de Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, Lyon, France.,Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Julie Haesebaert
- Université de Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, Lyon, France.,Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Laurent Derex
- Université de Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, Lyon, France.,Hospices Civils de Lyon, Comprehensive Stroke Center, Hôpital Pierre Wertheimer, Bron, France
| | - Marie Viprey
- Université de Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, Lyon, France.,Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Anne Termoz
- Université de Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, Lyon, France.,Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Claire Della Vecchia
- Université de Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, Lyon, France
| | - Ouazna Tassa
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Hela Kerd
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Serkan Cakmak
- Hôpital Nord Ouest, Primary Stroke Center, Villefranche-sur-Saône, France
| | - Sylvie Meyran
- Department of Emergency, Hôpital St Joseph St Luc, Lyon, France
| | - Bruno Ducreux
- Department of Emergency, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - Christelle Pidoux
- Department of Emergency, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - Marc Du Besset
- Department of Emergency, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - Thomas Bony
- Department of Emergency, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, France
| | | | - Marion Douplat
- Department of Emergency, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, France
| | - Veronique Potinet
- Department of Emergency, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, France
| | - Xavier Jacob
- Department of Emergency, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, France
| | - Alain Sigal
- Department of Emergency, Hospices Civils de Lyon, Hôpital Croix Rousse, Lyon, France
| | - Karim Tazarourte
- Université de Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, Lyon, France.,Department of Emergency, Hospices Civils de Lyon, HEH, Lyon, France
| | | | - Regis Melaine
- Department of Emergency, Hôpital Desgenettes, Lyon, France
| | - Norbert Nighoghossian
- Hospices Civils de Lyon, Comprehensive Stroke Center, Hôpital Pierre Wertheimer, Bron, France
| | - Anne-Marie Schott
- Université de Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, Lyon, France, .,Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France,
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Douplat M, Daoud K, Berthiller J, Schott AM, Potinet V, Le Coz P, Tazarourte K, Jacquin L. Poor Involvement of General Practitioners in Decisions of Withholding or Withdrawing Life-Sustaining Treatment in Emergency Departments. J Gen Intern Med 2020; 35:177-181. [PMID: 31686289 PMCID: PMC6957665 DOI: 10.1007/s11606-019-05464-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Decisions of withholding or withdrawing life-sustaining treatment are frequent in emergency departments (ED) and patients are often unable to communicate their wishes concerning end of life desires. OBJECTIVE To evaluate the participation of general practitioners (GPs) during the decision-making process of withholding or withdrawing life-sustaining treatments in ED. DESIGN Prospective observational multicenter study. PATIENTS We included patients for whom a decision of withdrawing or withholding life-sustaining treatments was made in ED. For each patient, we enrolled one general practitioner. MAIN MEASURES GPs were interviewed about their perception of end of life patient's management and the communication with ED and families. KEY RESULTS There were 109 potential patient participants. We obtained answers from 54 (49.5%) of the patient's associated GPs. Only 4 (7.4%) GPs were involved during the decision-making process of withholding or withdrawing life-sustaining treatments. Among GPs, 29 (53.7%) were contacted by family after the decision, most often to talk about their difficult experience with the decision. A majority (94%) believed their involvements in these decisions were important and 68% wished to "always" participate in end of life decisions despite the fact that they usually don't participate in these decisions. Finally, 66% of GPs believed that management of end of life in the emergency department was a failure and should be anticipated. CONCLUSIONS GPs would like to be more involved and barriers to GP involvement need to be overcome. We do not have any outcome data to suggest that routine involvement of GPs in all end of life patients improves their outcomes. Moreover, it requires major system and process-based changes to involve all primary care physicians in ED decision-making. NIH TRIAL REGISTRY NUMBER NCT02844972.
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Affiliation(s)
- Marion Douplat
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’Accueil des urgences, 165 chemin du Grand Revoyet, F-69495 Pierre Bénite, France
- Aix-Marseille Université/EFS/CNRS, UMR 7268 ADéS, Faculté de Médecine, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Khadidja Daoud
- Hôpital de Vienne, Service d’Accueil des urgences, Montée du Dr Chapuis, 38209 Vienne, France
| | - Julien Berthiller
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon/University Claude Bernard Lyon 1 /HESPER EA 7425, Lyon, France
| | - Anne-Marie Schott
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon/University Claude Bernard Lyon 1 /HESPER EA 7425, Lyon, France
| | - Véronique Potinet
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’Accueil des urgences, 165 chemin du Grand Revoyet, F-69495 Pierre Bénite, France
| | - Pierre Le Coz
- Aix-Marseille Université/EFS/CNRS, UMR 7268 ADéS, Faculté de Médecine, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Karim Tazarourte
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d’Accueil des urgences, 5 place d’Arsonval, F-69003 Lyon, France
| | - Laurent Jacquin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d’Accueil des urgences, 5 place d’Arsonval, F-69003 Lyon, France
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Douplat M, Berthiller J, Schott AM, Potinet V, Le Coz P, Tazarourte K, Jacquin L. Difficulty of the decision-making process in emergency departments for end-of-life patients. J Eval Clin Pract 2019; 25:1193-1199. [PMID: 31287201 DOI: 10.1111/jep.13229] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND In emergency departments, for some patients, death is preceded by a decision of withholding or withdrawing life-sustaining treatments. This concerns mainly patients over 80, with many comorbidities. The decision-making process of these decisions in emergency departments has not been extensively studied, especially for noncommunicating patients. AIM The purpose of this study is to describe the decision-making process of withholding and withdrawing life-sustaining treatments in emergency departments for noncommunicating patients and the outcome of said patients. DESIGN We conducted a prospective multicenter study in three emergency departments of university hospitals from September 2015 to January 2017. RESULTS We included 109 patients in the study. Fifty-eight (53.2%) patients were coming from nursing homes and 52 (47.7%) patients had dementia. Decisions of withholding life-sustaining treatment concerned 93 patients (85.3%) and were more frequent when a surrogate decision maker was present 61 (65.6%) versus seven (43.8%) patients. The most relevant factors that lead to these decisions were previous functional limitation (71.6%) and age (69.7%). Decision was taken by two physicians for 80 patients (73.4%). The nursing staff and general practitioner were, respectively, involved in 31 (28.4%) and two (1.8%) patients. A majority of the patients had no advance directives (89.9%), and the relatives were implicated in the decision-making process for 96 patients (88.1%). Death in emergency departments occurred for 47 patients (43.1%), and after 21 days, 84 patients (77.1 %) died. CONCLUSION There is little anticipation in end-of-life decisions. Discussion with patients concerning their end-of-life wishes and the writing of advance directives, especially for patients with chronic diseases, must be encouraged early.
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Affiliation(s)
- Marion Douplat
- Hospices Civils de Lyon, Service d'Accueil des urgences, Hôpital Lyon Sud, 165 chemin du Grand Revoyet, Pierre Bénite, F-69495, France.,UMR 7268 ADéS, Faculté de Médecine, Aix-Marseille Université/EFS/CNRS, 27 boulevard Jean Moulin, Marseille, 13005, France
| | - Julien Berthiller
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - Anne-Marie Schott
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - Véronique Potinet
- Hospices Civils de Lyon, Service d'Accueil des urgences, Hôpital Lyon Sud, 165 chemin du Grand Revoyet, Pierre Bénite, F-69495, France
| | - Pierre Le Coz
- UMR 7268 ADéS, Faculté de Médecine, Aix-Marseille Université/EFS/CNRS, 27 boulevard Jean Moulin, Marseille, 13005, France
| | - Karim Tazarourte
- Hospices Civiles de Lyon, Hôpital Edouard Herriot, Service d'Accueil des urgences, 5 place d'Arsonval, Lyon, F-69003, France
| | - Laurent Jacquin
- Hospices Civiles de Lyon, Hôpital Edouard Herriot, Service d'Accueil des urgences, 5 place d'Arsonval, Lyon, F-69003, France
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Douplat M, Jacquin L, Tazarourte K, Le Coz P. Answer to the reply letter to: Physician's experience in decisions of withholding, withdrawing life-sustaining treatments: A multicentre survey in emergency departments. Anaesth Crit Care Pain Med 2019; 38:519-520. [PMID: 30807877 DOI: 10.1016/j.accpm.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Marion Douplat
- Hospices civils de Lyon, hôpital Lyon Sud, service d'accueil des urgences, 65, chemin du Grand Revoyet, Pierre-Bénite 69495, France; UMR 7268 ADéS, Aix-Marseille Université/EFS/CNRS, Faculté de Médecine, 27, boulevard Jean-Moulin, Marseille 13005, France.
| | - Laurent Jacquin
- Hospices Civils de Lyon, Hôpital Edouard-Herriot, Service d'Accueil des urgences, 5, place d'Arsonval, Lyon 69003, France.
| | - Karim Tazarourte
- Hospices Civils de Lyon, Hôpital Edouard-Herriot, Service d'Accueil des urgences, 5, place d'Arsonval, Lyon 69003, France.
| | - Pierre Le Coz
- UMR 7268 ADéS, Aix-Marseille Université/EFS/CNRS, Faculté de Médecine, 27, boulevard Jean-Moulin, Marseille 13005, France.
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Douplat M, Jacquin L, Tazarourte K, Michelet P, Le Coz P. Physicians' experience in decisions of withholding and withdrawing life-sustaining treatments: A multicenter survey into emergency departments. Anaesth Crit Care Pain Med 2018; 37:633-634. [PMID: 30268527 DOI: 10.1016/j.accpm.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/16/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Marion Douplat
- Hospices civils de Lyon, hôpital Lyon sud, service d'accueil des urgences, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; UMR 7268 ADéS Aix-Marseille université, EFS, CNRS, efaculté de médecine de Marseille , hôpital adultes La Timone, 27, boulevard Jean-Moulin 13005 Marseille, France.
| | - Laurent Jacquin
- Hospices civils de Lyon, hôpital Édouard-Herriot, service d'accueil des urgences, 5, place d'Arsonval, 69003 Lyon, France.
| | - Karim Tazarourte
- Hospices civils de Lyon, hôpital Édouard-Herriot, service d'accueil des urgences, 5, place d'Arsonval, 69003 Lyon, France.
| | - Pierre Michelet
- Assistance publique-Hôpitaux de Marseille, hôpital de la Timone, service d'accueil des urgences, 265, rue Saint-Pierre, 13005 Marseille, France.
| | - Pierre Le Coz
- UMR 7268 ADéS Aix-Marseille université, EFS, CNRS, efaculté de médecine de Marseille , hôpital adultes La Timone, 27, boulevard Jean-Moulin 13005 Marseille, France.
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Ponce C, Kaczorowski F, Perpoint T, Miailhes P, Sigal A, Javouhey E, Gillet Y, Jacquin L, Douplat M, Tazarourte K, Potinet V, Simon B, Lavoignat A, Bonnot G, Sow F, Bienvenu AL, Picot S. Diagnostic accuracy of loop-mediated isothermal amplification (LAMP) for screening patients with imported malaria in a non-endemic setting. ACTA ACUST UNITED AC 2017; 24:53. [PMID: 29251261 PMCID: PMC5734902 DOI: 10.1051/parasite/2017054] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/29/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND Sensitive and easy-to-perform methods for the diagnosis of malaria are not yet available. Improving the limit of detection and following the requirements for certification are issues to be addressed in both endemic and non-endemic settings. The aim of this study was to test whether loop-mediated isothermal amplification of DNA (LAMP) may be an alternative to microscopy or real-time PCR for the screening of imported malaria cases in non-endemic area. RESULTS 310 blood samples associated with 829 suspected cases of imported malaria were tested during a one year period. Microscopy (thin and thick stained blood slides, reference standard) was used for the diagnosis. Real-time PCR was used as a standard of truth, and LAMP (Meridian Malaria Plus) was used as an index test in a prospective study conducted following the Standards for Reporting Diagnosis Accuracy Studies. In the 83 positive samples, species identification was P. falciparum (n = 66), P. ovale (n = 9), P. vivax (n = 3) P. malariae (n = 3) and 2 co-infections with P. falciparum + P.malariae. Using LAMP methods, 93 samples gave positive results, including 4 false-positives. Sensitivity, specificity, positive predictive value and negative predictive value for LAMP tests were 100%, 98.13%, 95.51%, and 100% compared to PCR. CONCLUSION High negative predictive value, and limit of detection suggest that LAMP can be used for screening of imported malaria cases in non-endemic countries when expert microscopists are not immediately available. However, the rare occurrence of non-valid results and the need for species identification and quantification of positive samples preclude the use of LAMP as a single reference method.
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Affiliation(s)
- Camille Ponce
- Institute of Parasitology and Medical Mycology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Flora Kaczorowski
- Institute of Parasitology and Medical Mycology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Thomas Perpoint
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Patrick Miailhes
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Alain Sigal
- Service d'accueil des Urgences, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Etienne Javouhey
- Service d'accueil des Urgences Pédiatriques, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, 69677 Bron, France
| | - Yves Gillet
- Service d'accueil des Urgences Pédiatriques, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, 69677 Bron, France
| | - Laurent Jacquin
- Service d'accueil des urgences, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Marion Douplat
- Service d'accueil des urgences, Hôpital Lyon Sud, Hospices Civils de Lyon, Hôpital Lyon Sud, 69310 Pierre-Bénite, France
| | - Karim Tazarourte
- Service des urgences/SAMU 69, Hospices Civils de Lyon, Lyon, 69003, France - Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, 69008 Lyon, France
| | - Véronique Potinet
- Service d'accueil des urgences, Hôpital Lyon Sud, Hospices Civils de Lyon, Hôpital Lyon Sud, 69310 Pierre-Bénite, France
| | - Bruno Simon
- Institute of Parasitology and Medical Mycology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Adeline Lavoignat
- Malaria Research Unit, SMITh, ICBMS, UMR 5246 CNRS-INSA-CPE-University Lyon1, 69100 Villeurbanne, France
| | - Guillaume Bonnot
- Malaria Research Unit, SMITh, ICBMS, UMR 5246 CNRS-INSA-CPE-University Lyon1, 69100 Villeurbanne, France
| | - Fatimata Sow
- Malaria Research Unit, SMITh, ICBMS, UMR 5246 CNRS-INSA-CPE-University Lyon1, 69100 Villeurbanne, France
| | - Anne-Lise Bienvenu
- Malaria Research Unit, SMITh, ICBMS, UMR 5246 CNRS-INSA-CPE-University Lyon1, 69100 Villeurbanne, France - Laboratoire d'Hématologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Stéphane Picot
- Institute of Parasitology and Medical Mycology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France - Malaria Research Unit, SMITh, ICBMS, UMR 5246 CNRS-INSA-CPE-University Lyon1, 69100 Villeurbanne, France
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Treille J, Bessereau J, Douplat M, Treille JM, Michelet P, de La Coussaye JE, Claret PG. Physiopathologie et prise en charge de l’hypotension post-intubation en séquence rapide. Ann Fr Med Urgence 2017. [DOI: 10.1007/s13341-017-0756-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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