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BACKGROUND The institutionalization of a patient with Alzheimer's disease or other dementia (ADOD) is the last resort for the latter's family and/or caregivers. We hypothesized that the degree of kinship between the patient and his/her caregiver would influence the likelihood of institutionalization. OBJECTIVE To assess the association between institutionalization of patients with ADOD and the degree of kinship with the family caregiver. METHODS A cross-sectional study of patients with ADOD aged 75 or over attending a memory center in France for the first time between 2011 and 2014, as recorded in the French National Alzheimer Database. Multivariable logistic regression was used to assess factors associated with institutionalization after adjustment for age, sex, the Mini-Mental State Examination score, educational level, and type of dementia. RESULTS A total of 52,874 patients were included. The primary caregiver was most often a child (54.8%) or the spouse (36.7%). Compared with the "spouse" reference category, all the other caregiver categories were associated with a significantly greater likelihood of institutionalization; the odds ratio [95% confidence interval] was 4.68 [3.67-5.92] when the carer was a grandchild, 5.48 [4.93-6.09] for a child, 4.93 [4.11-5.91] for a daughter-/son-in-law, 8.76 [7.15-10.70] for a sibling, and 8.93 [7.48-10.65] for a niece/nephew. CONCLUSION The likelihood of institutionalization of older patients with ADOD varied with the degree of kinship. Compared with the "spouse" reference category, the likelihood was higher for all other types of caregivers but was especially high when the caregiver was not a direct descendant of the patient.

Background consideration of the first hospital re-admission only and failure to take account of previous hospital stays, which are the two significant limitations when studying risk factors for hospital re-admission. The objective of the study was to use appropriate statistical models to analyse the impact of previous hospital stays on the risk of hospital re-admission among older patients. Methods an exhaustive analysis of hospital discharge and health insurance data for a cohort of patients participating in the PAERPA (‘Care Pathways for Elderly People at Risk of Loss of Personal Independence’) project in the Hauts de France region of France. All patients aged 75 or over were included. All data on hospital re-admissions via the emergency department were extracted. The risk of unplanned hospital re-admission was estimated by applying a semiparametric frailty model, the risk of death by applying a time-dependent semiparametric Cox regression model. Results a total of 24,500 patients (median [interquartile range] age: 81 [77–85]) were included between 1 January 2015 and 31 December 2017. In a multivariate analysis, the relative risk (95% confidence interval [CI]) of hospital re-admission rose progressively from 1.8 (1.7–1.9) after one previous hospital stay to 3.0 (2.6–3.5) after five previous hospital stays. The relative risk [95%CI] of death rose slowly from 1.1 (1.07–1.11) after one previous hospital stay to 1.3 (1.1–1.5) after five previous hospital stays. Conclusion analyses of the risk of hospital re-admission in older adults must take account of the number of previous hospital stays. The risk of death should also be analysed.

The use of international laboratory terminologies inside hospital information systems is required to conduct data reuse analyses through inter-hospital databases. While most terminology matching techniques performing semantic interoperability are language-based, another strategy is to use distribution matching that performs terms matching based on the statistical similarity. In this work, our objective is to design and assess a structured framework to perform distribution matching on concepts described by continuous variables. We propose a framework that combines distribution matching and machine learning techniques. Using a training sample consisting of correct and incorrect correspondences between different terminologies, a match probability score is built. For each term, best candidates are returned and sorted in decreasing order using the probability given by the model. Searching 101 terms from Lille University Hospital among the same list of concepts in MIMIC-III, the model returned the correct match in the top 5 candidates for 96 of them (95%). Using this open-source framework with a top-k suggestions system could make the expert validation of terminologies alignment easier.

Resume Introduction Les calculs biliaires sont un des motifs abdominaux d’admission hospitaliere les plus frequents. Le but de cette etude etait d’analyser les tendances et les suites des cholecystectomies pour pathologie biliaire, en France, de 2008 a 2014. Patients et methodes Nous avons mene une etude retrospective de cohorte, en utilisant des donnees extraites de la base de donnees nationale hospitaliere Francaise (PMSI). Nous avons inclus tous les patients ayant beneficie d’une cholecystectomie pour pathologie biliaire, de janvier 2008 a decembre 2014. Les caracteristiques demographiques, la voie d’abord, la duree de sejour, les complications et la mortalite intrahospitaliere ont ete analysees. Resultats Sur la periode etudiee, 807 307 cholecystectomies ont ete realisees en France, avec une augmentation du taux national d’incidence de 167,5 (IC95 % [166,5 ; 168,5]) a 182,6 (IC95 % [181,6 ; 183,6]) pour 100 000 habitants. Les femmes representaient 66,5 % des interventions (p Conclusion Nos resultats ont montre une augmentation significative du taux national d’incidence des cholecystectomies pour pathologie biliaire, de 2008 a 2014.

Gallstones are one of the most common abdominal reasons for admission to hospital. The aim of this study was to analyze trends and outcomes in patients undergoing cholecystectomy with gallbladder related disease in France from 2008 to 2014.We carried out a population-based, retrospective cohort study using data extracted from the French nationwide hospital discharge database (PMSI). We included all patients having a cholecystectomy related to gallbladder disease from January 2008 to December 2014. Patients' demographics, primary diagnosis, procedure type, length of stay (LOS), admission in an intensive care unit, discharge disposition, complications, and in-hospital mortality were analyzed.Overall, 807,307 cholecystectomies were performed in France over the study period, with an increase in the national incidence rate from 167.5 (95%CI [166.5; 168.5]) to 182.6 (95%CI [181.6; 183.6]) per 100,000 inhabitants. Females accounted for 66.5% of procedures (P0.001). The mean age was lower for females than for males: 52.1 versus 60.2 (P0.001). The ratio of laparoscopic cholecystectomy significantly increased from 90% in 2008 to 94% in 2014 (P0.001). Average inpatient LOS decreased significantly from 6.5 days in 2008 to 4.7 days in 2014 (P0.001). Most common complication type was intra-abdominal (23.1%) for laparoscopic procedure (95%CI [22.7; 23.5]), and in-hospital mortality significantly decreased over time from 0.45% in 2008 to 0.38% in 2014 (P0.005).Our results showed that the national incidence rate of cholecystectomy related to gallbladder disease increased from 2008 to 2014.

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

The objective of this work was to investigate the risk of major osteoporotic fracture (MOF; hip, proximal humerus, wrist and distal forearm, and clinical spine) in bariatric surgery patients versus matched controls. Bariatric surgery is associated with an increase in fracture risk. However, it remains unclear whether the same degree of fracture risk is associated with sleeve gastrectomy, which has recently surpassed gastric bypass. Records from the French National Inpatient database were used from 2008 to 2018. Bariatric surgery patients, aged 40 to 65 years, with BMI ≥40 kg/m2 , hospitalized between January 1, 2010 and December 31, 2014, were matched to one control (1:1) by age, sex, Charlson comorbidity index, year of inclusion, and class of obesity (40 to 49.9 kg/m2 versus ≥50 kg/m2 ). We performed a Cox regression analysis to assess the association between the risk of any MOF and, respectively, (i) bariatric surgery (yes/no) and (ii) type of surgical procedure (gastric bypass, gastric banding, vertical banded gastroplasty, and sleeve gastrectomy) versus no surgery. A total of 81,984 patients were included in the study (40,992 in the bariatric surgery group, and 40,992 matched controls). There were 585 MOFs in the surgical group (2.30 cases per 1000 patient-year [PY]) and 416 MOFs in the matched controls (1.93 cases per 1000 PY). The risk of MOF was significantly higher in the surgical group (hazard ratio [HR] 1.22; 95% CI, 1.08-1.39). We observed an increase in risk of MOF for gastric bypass only (HR 1.70; 95% CI, 1.46-1.98) compared with the matched controls. In patients aged 40 to 65 years, gastric bypass but not sleeve gastrectomy or the other procedures increased risk of major osteoporotic fractures. © 2020 American Society for Bone and Mineral Research.

Objective Management of vitamin K antagonists (VKAs) is difficult, and overdoses can have dramatic hemorrhagic consequences. The adverse drug event (ADE) scorecards is a tool intended for the detection and description of adverse drug reaction/ADE developed during a European computerized medical data processing project. It is used in a quality assurance process. Our objective was to evaluate the performance of the ADE scorecards in the detection of the contributing factors for VKA overdoses, among the cases where a VKA overdose is observed. Methods Twenty-eight rules allow the detection of VKA treatment overdose related to drug or a clinical situation. They were applied on 14,748 electronic medical records from a community hospital. Among 582 records including a VKA prescription, 59 cases of VKA overdoses (international normalized ratio ≥ 5) during the hospital stay have been identified. The ADE scorecards detected 49 of them. We evaluated the positive predictive value and sensitivity of these rules, by an expert review of the cases. Results The expert review confirmed the contribution of a detected risk factor to the VKA overdose in 11 cases. Therefore, the precision of the rules is 22.4%. The sensitivity is 84.6%. The risk factors were mainly infection and amiodarone introduction. The 4 cases of clinical injury related to a drug were properly designated by the rules. Conclusions Our study shows the great potential of the ADE scorecards for detecting cofactors of VKA overdoses and gives an argument to include complex rules in the knowledge bases used for the detection and identification of ADEs in large medical databases.

This cohort study uses data from the French national hospitals database to compare the number of hip fractures among patients 50 years or older during the first nationwide COVID-19 lockdown in France in spring 2020 with the number during the same period in 2019., Key Points Question Was the first nationwide COVID-19 lockdown in France associated with a change in the absolute number of hip fractures among patients 50 years or older? Findings In this cohort study of 46 393 and 44 767 patients 50 years or older with hip fracture in France from January to July 2019 and January to July 2020, respectively, the absolute number of hip fractures decreased by 11% during the first nationwide COVID-19 lockdown from March 16 to May 10, 2020, compared with the same period in 2019. Meaning The findings suggest that the first nationwide COVID-19 lockdown in France was associated with a decrease in the absolute number of hip fractures., Importance The COVID-19 pandemic has posed a number of unprecedented challenges to the health care system in France, where hip fractures in the elderly population are a major public health concern. Objective To explore the association of the first nationwide COVID-19 lockdown in France with the absolute number of hip fractures among patients 50 years or older. Design, Setting, and Participants This retrospective cohort study used data from the French national hospitals database to identify patients 50 years or older who were hospitalized for hip fracture in France from January to July 2019 and January to July 2020. Exposures The first nationwide COVID-19 lockdown in France from March 16 to May 10, 2020. Main Outcomes and Measures The main outcome was the number of hospitalizations for hip fracture from January to July 2020 (study period) compared with the number of hospitalizations for hip fracture during the same period in 2019 (control period). Hospitalization rate ratios (HRRs) comparing the study period with the control period were calculated for 3 intervals (before lockdown [January 1 to March 15], during lockdown [March 16 to May 10], and after lockdown [May 11 to July 31]) and were stratified by gender, age and hospital type. Results The study included 46 393 patients hospitalized for hip fracture during January to July 2019 (34 589 [74.4%] women; mean [SD] age, 82.8 [10.5] years) and 44 767 patients hospitalized for hip fracture from January to July 2020 (33 160 [74.1%] women; mean [SD] age, 82.9 [10.5] years). During the lockdown in 2020, 10 429 patients (23.30%) were hospitalized for hip fracture compared with 11 782 patients (25.40%) during the same period in 2019 (HRR, 0.89; 95% CI, 0.86-0.91; P

Potentially inappropriate prescriptions (PIPs) of antibiotics (antibiotic-PIPs) are generally detected by applying implicit definitions based on expert opinion. Explicit definitions are less frequently used, even though this approach would enable the automated detection of antibiotic-PIPs in electronic health records. Here, explicit definitions of antibiotic-PIPs used in studies of older adults were systematically reviewed. The MEDLINE®, Scopus® and Web of ScienceTM core collection databases were searched with a combination of three terms and their synonyms: ‘potentially inappropriate prescription’ AND ‘antibiotic treatment’ AND ‘older patients’. Following standardised selection of publications, explicit definitions of antibiotic-PIPs were extracted and were classified into infectious diseases domains and subdomains. A total of 600 search queries identified 4270 records, 93 of which were selected for review. A total of 160 mentions of antibiotic-PIPs were found, corresponding to 62 distinct definitions in 19 infectious diseases domains. Nearly one-half of the definitions were related to upper respiratory tract infections (n = 11 definitions; 17.7%), lower respiratory tract infections (n = 8; 12.9%) and drug–drug interactions (n = 11; 17.7%). Almost 75% of definitions (n = 46) were mentioned in a single study only. Only three definitions concerned critically important antibiotics such as third-generation cephalosporins and fluoroquinolones. This systematic review identified 62 explicit definitions of antibiotic-PIPs. Most of the definitions were not found in more than one study and they varied in the degree of precision. We advocate the implementation of an expert consensus on explicit definitions of antibiotic-PIPs that correspond to today's challenges in public health.

Introduction The prescription of psychotropic drugs to older patients in a hospital setting has not been extensively characterized. The objective was to describe the inappropriate co-prescriptions of psychotropic drugs in hospitalized patients aged 75 and over. Methods By analysing the medical database from 222-bed general hospital in France, we reviewed a total of 11,929 stays of at least 3 days by patients aged 75 and over. Prescriptions and co-prescriptions of psychotropic drugs were identified automatically. Anticholinergic drugs with sedative effects were considered as psychotropic drugs. An expert review was performed for stays with the co-prescription of three or more psychotropic drugs to identify inappropriate co-prescriptions. Results Administration of a psychotropic drug was identified in 5475 stays (45.9% of the total number of stays), of which 1526 (12.8% of the total) featured at least one co-prescription. Co-prescriptions of three or more psychotropic drugs for at least 3 days were identified in 374 stays (3.1% of the total). Most of these co-prescriptions ( n =334; 89.2%) were considered inappropriate because of the combination of at least two drugs from the same psychotropic class ( n =269), the absence of a clear indication for a psychotropic drug ( n =173) and a history of falls ( n =86). However, the co-prescriptions were maintained after hospital discharge in 77.4% of cases. Conclusion The co-prescriptions of psychotropic drugs should be re-evaluated in older hospitalized patients.

BACKGROUND: Geographical variations in Crohn's disease (CD) suggest that the environment has a role in the pathogenesis of this condition. OBJECTIVE: To describe the spatial distribution and the clustering of CD cases in France, and to assess the relationship between the prevalence of CD and environmental risk factors. METHODS: We identified all patients with CD included in the French hospital discharge database from 2007 to 2014. Age- and gender-smoothed standardised prevalence ratios over this period were computed for 5610 spatial units. An ecological regression analysis was used to assess the relationship between the risk of CD and ecological variables (health care, latitude, socio-economic deprivation, urbanisation, proportion of agricultural surfaces and density of industries). Local spatial clusters of high-CD prevalence were searched for using elliptic spatial scan statistics and characterised in a hierarchical ascendant classification based on the same ecological variables. RESULTS: About 129 089 patients with CD were identified, yielding a crude prevalence of 203 per 100 000 inhabitants. The overall spatial heterogeneity was statistically significant (P

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

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

Résumé : Nous avons étudié l'association entre l'incidence des fractures de la hanche et les caractéristiques du lieu de vie en France. La répartition spatiale de l'incidence des fractures de la hanche était hétérogène et il existait une relation significative entre la privation sociale, l'urbanisation, l'accès à la santé et le risque de fracture de la hanche. Objectif : Plusieurs études ont montré de grandes disparités dans la répartition spatiale des fractures de hanche (FH). L'objectif de l'étude était d'analyser l'association entre l'incidence des FH et les caractéristiques du lieu de vie. Méthodes : Tous les patients âgés de 50 ans ou plus, résidant en France, qui ont été hospitalisés pour une HF entre 2012 et 2014 ont été inclus, en utilisant la base de données nationale française des sorties d'hôpital. Les ratios d'incidence standardisés (SIR) ont été calculés pour chaque unité spatiale et ajustés sur l'âge et le sexe. Une régression écologique a été réalisée pour analyser l'association entre l'incidence standardisée de l'HF et les variables écologiques. Nous avons ajusté le modèle pour la structure spatiale du quartier. Nous avons utilisé trois variables pour caractériser les zones de vie : un indice de privation (French-EDI) ; l'accès aux soins (indice standardisé français) ; l'utilisation du sol (pourcentage de surfaces artificialisées). Résultats : 236 328 HF ont été enregistrées dans la base de données nationale des hôpitaux français, conduisant à une incidence annuelle d'HF de 333/100 000. L'analyse spatiale a révélé des variations géographiques de l'incidence de l'HF avec un SIR variant de 0,67 [0,52 ; 0,85] à 1,45 [1,23 ; 1,70]. Il y avait une association significative entre les taux d'incidence de l'HF et : (1) l'indice French-EDI (tendance p=0,0023) ; (2) l'accessibilité des médecins généralistes et des infirmières (tendance p=0,0232 et p=0,0129, respectivement) ; (3) le pourcentage de surfaces artificialisées (p

Prophylactic anticoagulation is recommended up to 35days after total hip replacement (THR). Although several observational studies have assessed the incidence of thrombotic events or bleeding events after THR, the corresponding measures of association have never been studied concomitantly. Here, we evaluated the duration of the elevated risks (relative to the baseline risk) of both venous thromboembolic events and bleeding events after THR for coxarthrosis among middle-aged patients. This was a population-based, cross-over cohort study of data extracted from the French national inpatient database between 2007 and 2013. We included middle-aged patients (aged 45 to 69) having undergone THR for coxarthrosis. We compared the numbers of pulmonary embolisms (PEs) (respectively upper gastrointestinal bleedings (UGIBs)) following the THR with the numbers occurring during three unexposed periods one year later. This enabled us to estimate the odds ratio (OR) [95% confidence interval (CI)] for each of six successive 35-day intervals. The study included 108,099 patients. The ORs for PE were respectively 12.4 (95% CI, 8.6-17.8) (absolute risk difference rate per 100,000 (ARD/100,000)=130) and 5.0 (95% CI, 3.4-7.4) (ARD/100,000=52) for the first two 35-day intervals, and the risk was close to 1 thereafter. The risk of UGIB fell quickly, with an OR of 6.5 (95% CI, 4.6-9.1) (ARD/100,000=83) and 0.8 (95% CI, 0.4-1.6) for the first two 35-day intervals, respectively. The majority of UGIBs occurred during the inpatient stay for THR. Among middle-aged patients, the risk of a PE remains elevated beyond 35days after THR for coxarthrosis, whereas the risk of a UGIB remains elevated for the first 35days only.