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BackgroundAdverse events are serious and frequent complications most often linked to the quality of nursing care.PurposeWe evaluated the compliance to traceability of nursing care at bedside using the Patient Smart Reader®, a personal digital assistant with a barcode.MethodsWe compared paper record forms, specific computer software in the hospital information system and the Patient Smart Reader®.ResultsThe Patient Smart Reader enhanced the recording of 90% of nursing care surveyed. Regarding the insertion of blood catheters, compliance rates increased from 44.19 % to 100%, and blood catheter monitoring has risen from 29.64% to 80.74%. Urinary catheter monitoring and insertion recording increased from 10.23% to 55.43% and from 16.67% to 100 % respectively.ConclusionsProviding to caregivers a nursing record system using barcoded implements at the point of care in real time significantly improved traceability of the nursing care.

International audience; IntroductionLes technologies de l’information et de la communication ont permis la naissance du web 2.0, caractérisé par la mise en place et l’utilisation de nouveaux outils collaboratifs de communication tels que les blogs, les wikis, les fils RSS et les réseaux sociaux. En s’appropriant ces outils, une médecine participative basée sur le partage d’informations et d’expériences entre professionnels, patients et tout acteur de la santé s’est développée. Depuis juin 2012, une communauté médicale échange sur Twitter avec le hashtag #DocTocToc et contribue à la naissance de la e-santé sur ce réseau social. L’objectif de cette étude est d’analyser les principales thématiques des demandes effectuées via le hashtag #DocTocToc par les médecins généralistes entre juin 2012 et mars 2017.MéthodesUne collecte de données par une méthode de « web scraping » a permis de constituer un corpus de tweets dont les auteurs ont été identifiés manuellement afin de procéder à un échantillonnage, de façon à ne conserver que les tweets émis par les médecins généralistes. Une étape de prétraitement a permis de transformer les formes potentiellement non reconnues par les logiciels de traitement du langage naturel. Le corpus a été appréhendé à l’aide de deux approches : une approche lexicale via le logiciel Iramuteq® et une indexation terminologique par l’extracteur de concepts multi-terminologiques (ECMT) du Catalogue et index des sites médicaux francophones (CISMeF).RésultatsSur les 12 716 tweets recueillis, 7366 étaient rédigés par des médecins généralistes et ont été analysés. L’approche lexicale détermine deux grands mondes lexicaux représentés sous forme de dendrogramme, l’un en lien avec les demandes médico administratives relatives à la gestion du cabinet et à la prise en charge sociale du patient, l’autre en lien avec les demandes d’ordre purement médicales. La méthode d’indexation terminologique met en évidence les spécialités médicales pourvoyeuses de demandes de télé-expertise : gynécologie, neurologie, infectiologie, pédiatrie, cardiologie, dermatologie ; et permet de les croiser avec l’objectif de la demande : diagnostic, thérapeutique.ConclusionSur Twitter®, le hashtag #DocTocToc est utilisé par les médecins généralistes comme un espace de partage informel d’informations en matière de santé mais aussi de gestion de problèmes administratifs et sociaux. Le DocsTocToc se présente comme un groupe d’échange de pratique à grande échelle ou le médecin compte sur l’avis de ses pairs.(Fig. 1)

Introduction Le rapport hebdomadaire de surveillance epidemiologique du Burkina Faso agrege les donnees de 11 maladies transmissibles, ainsi que les donnees de deces maternels et neonataux. Initialement papier, il a ete informatise sous forme d’un formulaire electronique mobile capable d’alimenter directement l’entrepot de donnees national (ENDOS-BF). Ce projet denomme « initiative de Baskuy » a ete experimente dans le district sanitaire de Baskuy en 2013 et a ete etendu en 2015 a deux autres districts sanitaires du pays (Kongoussi et Gourcy). L’organisation pyramidale basee sur les missions et les entites a ete transformee en une organisation plus en reseau, axee sur le processus de partage de donnees. Nous avons realise une etude d’evaluation de cette configuration avec toutes les parties prenantes. Methode Nous avons evalue ce dispositif aupres : – des infirmiers chefs de postes de toutes les 87 structures sanitaires (SS) publiques des trois districts sanitaires (DS) ; – des medecins-chefs et des gestionnaires de donnees de ces trois districts ; – des trois gestionnaires de donnees des directions regionales de la sante (DRS) de ces DS ; – et dans trois directions centrales (DC) du ministere de la sante (MS) qui sont les utilisatrices de la plateforme. L’enquete a ete realisee de fevrier a avril 2016. L’ensemble des questions portaient sur l’utilisation du dispositif tout au long de l’annee 2015. Nous avons adopte le modele de l’outil « Tool for Assessing Level of Information » (TALI) developpe par « Health Information Systems Project » d’Afrique du Sud. Cet outil est structure en trois paliers : le fonctionnement du systeme d’information, l’analyse de l’information, et l’utilisation de l’information. Nous avons adopte les etapes d’evaluation des systemes d’information medicale utilisees par Ann Fruhling et Stacie Petter. Une echelle de Likert a sept options de choix a ete utilisee pour la majorite des items du questionnaire. Une question ouverte de satisfaction cloturait les items de chaque palier. Resultats Pour le fonctionnement correct du dispositif, il y avait « rarement » ou « jamais » : une transmission des donnees en dehors des delais ; un defaut de couverture du reseau ; une transmission incomplete des donnees ; ou une absence de transmission de donnees dans une semaine. Dans 73,6 % des structures sanitaires, il y avait une absence de feedback. L’information etait souvent analysee et discutee au niveau des DS. Les courbes de tendances des tableaux de bord dont tous les acteurs avaient acces ont permis aux trois DRS et aux trois DC d’identifier les alertes epidemiologies de meningites et de rougeole. Les indicateurs etaient « toujours » utilises pour l’elaboration des plans d’actions au niveau des DS, mais « jamais » utilises au niveau des DRS et des trois DC. La majorite (54 %) des SS avaient souhaite un acces aux informations des autres SS a travers l’application mobile. Des formations continues avaient ete demandees par 37 % des structures. Certains agents des SS (14 %) avaient exprime un besoin d’une plus grande implication des DS, des DRS et du MS. Conclusion Les resultats de cette etude ont montre que le dispositif de surveillance par la telephonie mobile au Burkina a permis d’identifier des alertes epidemiologiques. L’insuffisance d’implication des premiers acteurs constitue un frein pour ameliorer la transmission des donnees dans les delais et le suivi du fonctionnement correct des dispositifs mobiles.

International audience; BACKGROUND:In the field of epidemiological surveillance, no systematic literature review appears to exist of implemented projects using cellular phone technology.METHOD:We performed a systematic literature review using the Pubmed and Scopus databases to retrieve articles published up to December 2015. We analyzed information reported in these publications according to the mobile health (mHealth) evidence reporting and assessment (mERA) checklist, and complemented this work with specific items related to epidemiology, in order to clarify the types of results reported and summarized in this context.RESULTS:Thirty-three articles were selected and reviewed. Each article was related to a different project. Two mERA items were systematically and fully reported, while two others were never reported. Three projects were deployed in very specific zones. Most of the projects were implemented in Africa. Infectious diseases were the elements most monitored. Most projects were based on daily data collection and SMS transmission. Economic assessment was limited to SMS, mobile phone, and implementation costs.DISCUSSION-CONCLUSION:Although suitable for epidemiologic surveillance, the mERA checklist needs further interpretation. The technical and transmission modes of cellular phone use varied greatly from one study to another. No evaluation of the interoperability capabilities of cellular phones with other applications or sub-systems was possible.

International audience; Healthcare-associated infection (HCAI) in hospitals mainly results from unsolved but well-identified causes such as hand hygiene, overuse of catheters, and to a lesser extent, the airborne transmission of infectious agents caused by the misuse of respiratory precautions. The aims of the Institut Hospitalo-Universitaire Méditerranée Infection are to develop new approaches to fight HCAIs. Among them, new technologies that allow for the traceability of care and good practices reminders have been developed concomitantly to an anthropological approach, facilitating acceptability by healthcare workers. While the automated continuous monitoring system is validated and commercially available, some other technologies are still under clinical evaluation or in the early development phase. Quorum sensing-based biotechnologies are developed with the aims to fight against wound colonization.

International audience; Background: Health care-associated infections are a major worldwide public health issue. Hand hygiene is a major component in the prevention of pathogen transmission in hospitals, and hand hygiene adherence by health care workers is low in many studies. We report an intervention using text messages as reminders and feedback to improve hand hygiene adherence. Materials and methods: The study is a historical comparison proof-of-concept study. Eighteen health care workers were monitored during 12 months by a radiofrequency identification system. Afterward we sent 2 types of text messages, congratulation or encouragement, and we studied the evolution of hand hygiene adherence. Results: We recorded 15,723 hand hygiene opportunities, 8,973 before intervention and 6,750 during and after the intervention. Using a multilevel logistic regression analysis, we found a significant increase in hand hygiene adherence during the intervention (odds ratio, 1.68) compared with the historical period. Discussion: Despite limitations due to the type of study, a text message encouraging personnel to be more vigilant is effective in increasing hand hygiene adherence in health care workers. Conclusions: Text message feedback should be incorporated into multimodal approaches for improving hand hygiene compliance. (C) 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

International audience; Background: Hand hygiene is a major means for preventing healthcare-associated infections. One critical point in understanding poor compliance is the lack of relevant markers used to monitor practices systematically. Methods: This study analysed hand hygiene compliance and associated factors with a radiofrequency-identification-based real-time continuous automated monitoring system in an infectious diseasewardwith 17 single bedrooms. Healthcareworkers (HCWs) were trackedwhile performing routine care over 171 days. Amulti-levelmulti-variate logisticsmodelwas used for data analysis. The main outcome measures were hand disinfection before entering the bedroom (outside use) and before entering the patient care zone, defined as the zone surrounding the patient's bed (inside/bedside use). Variables analysed included HCWs' characteristics and behaviour, patients, room layouts, path chains and duration of HCWs' paths. Findings: In total, 4629 paths with initial hand hygiene opportunities when entering the patient care zone were selected, of which 763 (16.5%), 285 (6.1%) and 3581 (77.4%) were associated with outside use, inside/bedside use and no use, respectively. Hand hygiene is caregiver-dependent. The shorter the duration of the HCW's path, the worse the bedside hand hygiene. Bedside hand hygiene is improved when one or two extra HCWs are present in the room. Interpretation: Hand hygiene compliance at the bedside, as analysed using the continuous monitoring system, depended upon the HCW's occupation and personal behaviour, number of HCWs, time spent in the room and (potentially) dispenser location. Meal tray distribution was a possible factor in the case of failure to disinfect hands. (C) 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

International audience; Purpose: The goal of this study was to identify clinical and imaging ă variables that are associated with an unfavorable outcome during the 30 ă days following transjugular intrahepatic portosystemic shunt (TIPS) ă placement. ă Material and methods: Fifty-four consecutive patients with liver ă cirrhosis (Child-Pugh 6-13, Model for End-stage Liver Disease 7-26) ă underwent TIPS placement for refractory ascites (n = 25), recurrent or ă uncontrolled variceal bleeding (n = 23) or both (n = 6). Clinical, ă biological and imaging variables including type of stent (covered n = ă 40; bare-stent n = 14), presence of spontaneous portosystemic shunt (n = ă 31), and variations in portosystemic pressure gradient were recorded. ă Early severe complication was defined as the occurrence of overt hepatic ă encephalopathy or death within the 30 days following TIPS placement. ă Results: Sixteen patients (30%) presented with early severe ă complication after TIPS placement. Child-Pugh score was independently ă associated with complication (HR = 1.52, P < 0.001). Among the imaging ă variables, opacification of spontaneous portosystemic shunt during TIPS ă placement but before its creation was associated with an increased risk ă of early complication (P = 0.04). The other imaging variables were not ă associated with occurrence of complication. ă Conclusion: Identification of spontaneous portosystemic shunt during ă TIPS placement reflects the presence of varices and is associated with ă an increased risk of early severe complication.

International audience; Objective : The aim of this study is to evaluate the hand hygiene and isolation precaution adhesion of the healthcare workers in routine cares.Methods : In an infectious diseases care unit of a university hospital in Marseille, France, we designed an observational study at evaluating the hand hygiene and isolation precaution adhesion of the healthcare workers in routine cares by remote video recording. The care team including nurses, assistant nurses, housekeepers and physicians was monitored from November 30th (2012) to February 13th (2013). From a video camera was placed inside patient room, healthcare workers paths were recorded from entrance to exit of the patient’s room. Hand hygiene disinfection as well as gloves and mask wearing in isolation precautions were observed. A video camera was placed inside patient room. Healthcare workers paths were recorded from entrance to exit of the patient’s room. A nurse and a sociologist analyzed further videos. Hand hygiene disinfection as well as gloves and mask wearing in isolation precaution were observed.Results : A total of 756 videos were captures. 249 were rejected because they were not contributive and 507 videos (811 Healthcare workers paths) were analyzed. Healthcare workers had hand disinfection at least one time in the path in 28.2%. Hand disinfection at entrance and exit of the bedroom is respected in 6.2%. The meal tray delivery is associated with a lower hand hygiene practice. The glove wearing adhesion is 51.2% in Clostridium difficile contact precaution, and conformity to protocol is 17.5%. Wearing gloves impairs hand disinfection especially in situation where gloves are not part of the protocol (38.7%). Adhesion to mask wearing in airborne precaution is 90.7%.

Introduction Le respect des regles d’hygiene des mains par les professionnels de sante est un element majeur pour prevenir les infections nosocomiales et pour la protection des professionnels eux-memes. Dans le cadre d’une recherche interventionnelle, pour etre en mesure d’ameliorer l’hygiene des mains il faut : (1) pouvoir apprecier objectivement, et idealement de maniere continu, l’hygiene des mains ; (2) degager les determinants sur lesquels il est possible d’agir ; (3) mettre en œuvre des mesures qui vont agir sur ces determinants ; (4) evaluer l’effet de ces mesures. Notre objectif est de mettre en œuvre un dispositif technologique permettant, d’une part, de generer les donnees necessaires pour les points 1, 2 et 4 et, d’autre part, integrant certaines solutions originales repondant au point 3. Methode Au sein du service « Maladies infectieuses et tropicales » de l’hopital Nord de Marseille, nous avons developpe et utilise le systeme « MediHandTrace ». Ce systeme utilise la technologie RFID passive pour enregistrer les parcours des soignants dans les chambres et leurs utilisations des solutions hydro-alcooliques (SHA) avant et apres l’approche du lit du patient (grâce a des microcontacteurs integres aux distributeurs fixes de SHA). Chaque chambre est equipee de quatre antennes de sol (sous le SHA interieur et exterieur, sur le pas de la porte, autour du lit du patient) et tous les soignants du service MIT sont equipes de sabots integrant un puce RFID (un consentement explicite de leur part et une declaration CNIL ont ete obtenus). Toutes les chambres sont reliees a une application centralisant les donnees et capable de restituer en temps reel les resultats concernant l’hygiene des mains des soignants. Initialement pensee comme un outil d’audit, la base de donnees de cette application a ete utilisee pour explorer de nombreuses solutions susceptibles d’influencer positivement le respect de l’hygiene des mains. Resultats A partir de simples signaux horodates binaires RFID (contact/pas contact), il a ete possible de categoriser les parcours en differentes classes en fonction du respect du protocole d’hygiene des mains et de generer egalement un ensemble de variables d’interets (ex. : duree du parcours, nombre d’intervenants simultanees, activites globales dans le service, laps entre les parcours, etc.). Ce dispositif permet egalement de tester des hypotheses d’interventions : soit directement integrees au dispositif « MediHandTrace » (alarmes integrees aux distributeurs de SHA, envois de SMS recapitulatifs au personnel) ; soit organisationnelles couplees avec le dispositif technique (reorganisation du service, utilisation de kits de soins pour eviter les multiples entrees-sorties dans une chambre). Conclusion Les dispositifs technologiques sont de plus en plus utilises pour leurs capacites a automatiser et faciliter le recueil de donnees utiles a la recherche en sante. De par le fait qu’ils sont generalement implantes au plus proche du sujet et qu’ils sont aussi capables d’integrer des fonctionnalites interactives, ils sont particulierement adaptes a certains types de recherches dans lesquels, au-dela de l’observation, une intervention est souhaitee. « MediHandTrace » est un exemple d’integration d’innovations technologiques formant un dispositif utile a la recherche clinique. Ce projet est le fruit d’un travail multidisciplinaire associant cliniciens, informaticiens, statisticiens, anthropo-sociologues, infirmiers et industriels du domaine.

ACL-1; International audience; INTRODUCTION: We sought to determine whether there was evidence of supplier-induced demand in mainland France, where health care is mainly financed by a public and compulsory health insurance and provided by both for-profit and not-for-profit hospitals. METHODS: Using a dataset of all admissions to French hospitals for 2009 and 2010, we calculated department-level age-adjusted and sex-adjusted per capita admission rates for hip replacement, knee replacement, and hip fracture for 2 age groups (45-64 and 65-99 y old), for-profit and not-for-profit hospitals. We used spatial regression analysis to examine the relationship between ecological variables, procedure rates, and supply of surgeons or sector-specific surgical beds. RESULTS: The large majority of hip and knee replacement surgeries were performed in for-profit hospitals, whereas the large majority of hip fracture admissions were in not-for-profit hospitals; nonetheless, we found approximately 2-fold variation in per capita rates of hip and knee replacement surgery in both age groups and settings. Spatial regression results showed that among younger patients, higher incomes were associated with lower admission rates; among older patients, higher levels of reliance on social benefits were associated with lower rates of elective surgery in for-profit hospitals. Although overall surgical bed supply was not associated with admission rates, for-profit-specific and not-for-profit-specific bed supply were associated with higher rates of elective procedures within a respective hospital type. DISCUSSION: We found evidence of supplier-induced demand within the French for-profit and not-for-profit hospital systems; however, these systems appear to complement one another so that there is no overall national supplier-induced effect.

OBJECTIVE: Data from electronic healthcare records (EHR) can be used to monitor drug safety, but in order to compare and pool data from different EHR databases, the extraction of potential adverse events must be harmonized. In this paper, we describe the procedure used for harmonizing the extraction from eight European EHR databases of five events of interest deemed to be important in pharmacovigilance: acute myocardial infarction (AMI); acute renal failure (ARF); anaphylactic shock (AS); bullous eruption (BE); and rhabdomyolysis (RHABD). DESIGN: The participating databases comprise general practitioners' medical records and claims for hospitalization and other healthcare services. Clinical information is collected using four different disease terminologies and free text in two different languages. The Unified Medical Language System was used to identify concepts and corresponding codes in each terminology. A common database model was used to share and pool data and verify the semantic basis of the event extraction queries. Feedback from the database holders was obtained at various stages to refine the extraction queries. MEASUREMENTS: Standardized and age specific incidence rates (IRs) were calculated to facilitate benchmarking and harmonization of event data extraction across the databases. This was an iterative process. RESULTS: The study population comprised overall 19 647 445 individuals with a follow-up of 59 929 690 person-years (PYs). Age adjusted IRs for the five events of interest across the databases were as follows: (1) AMI: 60-148/100 000 PYs; (2) ARF: 3-49/100 000 PYs; (3) AS: 2-12/100 000 PYs; (4) BE: 2-17/100 000 PYs; and (5) RHABD: 0.1-8/100 000 PYs. CONCLUSIONS: The iterative harmonization process enabled a more homogeneous identification of events across differently structured databases using different coding based algorithms. This workflow can facilitate transparent and reproducible event extractions and understanding of differences between databases.

Objectives The aim of this research was to automate the search of publications concerning adverse drug reactions (ADR) by defining the queries used to search MEDLINE and by determining the required threshold for the number of extracted publications to confirm the drug/event association in the literature. Methods We defined an approach based on the medical subject headings (MeSH) ‘descriptor records’ and ‘supplementary concept records’ thesaurus, using the subheadings ‘chemically induced’ and ‘adverse effects’ with the ‘pharmacological action’ knowledge. An expert-built validation set of true positive and true negative drug/adverse event associations (n=61) was used to validate our method. Results Using a threshold of three of more extracted publications, the automated search method presented a sensitivity of 90% and a specificity of 100%. For nine different drug/event pairs selected, the recall of the automated search ranged from 24% to 64% and the precision from 93% to 48%. Conclusions This work presents a method to find previously established relationships between drugs and adverse events in the literature. Using MEDLINE, following a MeSH approach to filter the signals, is a valid option. Our contribution is available as a web service that will be integrated in the final European EU–ADR project (Exploring and Understanding Adverse Drug Reactions by integrative mining of clinical records and biomedical knowledge) automated system.

Resume Objectifs Nous avons realise un modele humain permettant de scorer les attentes initiales (E1), la realisation finale (E2) et les moyens impliques (E3) dans l’elaboration d’un systeme d’information (SI) en cancerologie. Methodes Notre etude de terrain s’effectue a partir de questionnaires (Q1, Q2 et Q3) bases sur un modele construit a l’aide de quatre principes ethiques universels : autonomie–bienfaisance–non-malfaisance–justice que nous croisons avec des parametres environnementaux du reel. Nous avons interroges 14 concepteurs de SI qui ont respectivement mis en place leur SI au sein d’une structure de sante prenant en charge les cancers dans les Bouches-du-Rhone. A partir des scores E1, E2 et E3, un degre de desordre (entropie : S) pour un SI est mesure. Resultats Quelle que soit la nature du SI, le score E1 est toujours plus eleve que E2. Le score E3 est considere comme insuffisant sauf dans le depistage organise des cancers du sein. Le degre d’applicabilite des moyens (M) mis en œuvre est correle avec le degre de desordre existant au sein du SI. Discussion Fort de ses 14 participants, notre etude ne peut avoir qu’une valeur qualitative en raison d’une puissance statistique trop reduite. Il faudrait elargir l’effectif des personnes interrogees afin d’augmenter la puissance intrinseque effective de l’analyse et ainsi conforter la tendance de nos resultats. Conclusion Un comportement ethique illustre par les moyens utilises diminuerait l’entropie puisqu’il rendrait l’information plus signifiante, tandis qu’un accroissement de l’entropie serait nefaste.

The overall objective of the eu-ADR project is the design, development, and validation of a computerised system that exploits data from electronic health records and biomedical databases for the early detection of adverse drug reactions. Eight different databases, containing health records of more than 30 million European citizens, are involved in the project. Unique queries cannot be performed across different databases because of their heterogeneity: Medical record and Claims databases, four diffirent terminologies for coding diagnoses, and two languages for the information described in free text. The aim of our study was to provide database owners with a common basis for the construction of their queries. Using the UMLS, we provided a list of medical concepts, with their corresponding terms and codes in the four terminologies, which should be considered to retrieve the relevant information for the events of interest from the databases.