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2. La cochrane en médecine d’urgence et en réanimation : activités et adaptation pendant la pandémie COVID-19

Author

Virginie Lvovschi, Harald Herkner, Julie Dumouchel, Sébastien Beroud, Nordine Nekhili, Patrick Miroux, Yannick Auffret, Teo Quay, Andrew Smith, Kirk Magee, Daniel Meyran, and Patricia Jabre

Subjects
Emergency Medicine, Emergency Nursing
Abstract

Les activités de la Cochrane sont polymorphes et reposent toutes sur le volontariat de personnes scientifiquement indépendantes. L’approche traditionnelle de diffusion de la connaissance basée sur la publication de revues systématiques Cochrane n’est pas suffisante, en particulier en médecine d’urgence et en réanimation. Une démarche de Knowledge Translation (KT) est indispensable. Le réseau des soins aigus et d'urgence de la Cochrane est particulièrement engagé dans cette activité via le review group Cochrane Emergency and Critical Care, qui produit des revues systématiques ciblées sur les malades en soins critiques et via le field Cochrane Pre-hospital and Emergency Care qui assure la diffusion de l’information médicale produite par la Cochrane et recense les priorités scientifiques liées au terrain. Cet article expose la méthodologie utilisée par les deux groupes car elle est standardisée et articule des étapes individuelles et collectives (pour la rédaction des revues systématiques comme pour le travail de priorisation). Une démarche active d’optimisation de la connexion entre production scientifique et terrain est indispensable dans des situations sanitaires d’exception (SSE) comme la pandémie COVID-19. Une démarche « d’Integrated Knowledge Translation » (IKT) s’est mise en place pour compléter les activités traditionnelles des groupes. Cet article fait le point sur les adaptations opérées dans ce contexte scientifique particulier. Rendre transparente la méthodologie de travail des deux groupes Cochrane permet d’assurer leur fiabilité scientifique, y compris en SSE. Cette transparence permet également de proposer un modèle de fonctionnement reproductible dans d’autres secteurs qui nécessitent une démarche de KT et d’IKT.

Published
2022
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6. TRUST-tPA trial: Telemedicine for remote collaboration with urgentists for stroke-tPA treatment

Author

Elena Meseguer, Florence Tubach, Mikael Mazighi, Pierre Amarenco, Julien Labreuche, Catherine Le Gall, Patricia Roy, and Patrick Miroux

Subjects
Adult, Male, Telemedicine, medicine.medical_specialty, Health Informatics, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Fibrinolytic Agents, Modified Rankin Scale, Outcome Assessment, Health Care, Medicine, Humans, 030212 general & internal medicine, Cooperative Behavior, Stroke, Aged, Intracerebral hemorrhage, Aged, 80 and over, Univariate analysis, business.industry, Random assignment, Middle Aged, medicine.disease, Clinical trial, Tissue Plasminogen Activator, Physical therapy, Observational study, Female, Nervous System Diseases, business, 030217 neurology & neurosurgery
Abstract

Background Previous observational studies have shown that telemedicine is feasible and safe to deliver intravenous (IV) recombinant tissue plasminogen activator (rt-PA). However, implementation of telemedicine may be challenging. To illustrate this fact, we report a study showing that telemedicine failed to improve clinical outcome and analyze the reasons for this shortcoming. Methods We established a tele-stroke network of 10 emergency rooms (ERs) of community hospitals connected to a stroke center to perform a randomized, open-label clinical trial with blinded outcome evaluation. Eligible patients were randomly assigned to either a usual care arm (i.e. immediate transfer to the stroke center and administration of IV rt-PA if indication was confirmed upon stroke arrival) or tele-thrombolysis arm (i.e. immediate administration of IV rt-PA in ER and transfer to the stroke center). The primary efficacy outcome was an excellent outcome (modified Rankin scale (mRS) 0–1 at 90 days). Secondary endpoints included favorable outcome (90-day mRS 0–2) and early neurological improvement (NIHSS score 0–1 at 24 hours or a decrease of ≥ 4 points within 24 hours). Safety outcomes included symptomatic intracerebral hemorrhage (ICH) per ECASS II definition, any ICH and all-cause mortality. Results During an accrual time of 48 months, because of a slow enrollment rate, only 49 of 270 patients initially planned for inclusion were randomized into usual care ( n = 23) and tele-thrombolysis ( n = 26). Despite random assignment, patients allocated to tele-thrombolysis were older and had more severe stroke than patients allocated to usual care. The median duration of video-conference was 23 minutes in the usual care arm and 73 minutes in the tele-thrombolysis arm. Eighty-four percent of patients in the tele-thrombolysis arm were treated by IV rt-PA in comparison to 18% in the usual care arm. In univariate analysis but not after adjustment for age and baseline NIHSS, patients allocated in the usual care arm had a higher rate of excellent or favorable outcome. There were no differences in safety outcomes, with only one symptomatic ICH occurring in the tele-thrombolysis arm. Conclusions Stroke patients included in the telemedicine arm of the TRUST-tPA trial increased their rt-PA eligibility five-fold. However, the efficacy and safety remains to be determined (ClinicalTrials.org, NCT00279149).

Published
2015

7. Liste des collaborateurs

Author

Ismaël Hssain, Isabelle Piedade, Raphaëlle Benveniste, Bernard Marc, Patrick Miroux, Cyril Boraud, Hélène Braux, Christel Broccoli, Loïc Coutry, Sandra Crassus, Damien Desmasures, Agnès Doherty Bigara, Daniel Epain, Alexandra Fetsch, Alexia Garel, Adeline Grosser, Isis Hanafy, Anne-Sophie Hebincq, Jérôme Jurkowski, Pauline Koch, Johan Leclerc, Hugues Lefort, Frédéric Lepetit, Ghislaine Marc, Nadine Mazerand, Lydiane Miran, Linda Rethaber, Anne-Laure Roulon, Marie-Christine Roux, Alexandre Sery, Nagi Souaiby, François Templier, Laetitia Verdis, Johann Villain, Yasmina Yahia, Latifa Zerouki, Frédéric Zumbiehl, Charles Jeleff, Dominique Pateron., Marc Andronikof, Miloud Arabi, Gilles Arlie, Philippe Autret, Jannick Barrois, Yolande Barthélémy, Omar Belkhodja, Cindy Belle, Abdel Bellou, Bruno Bernot, Ludivine Berton, Isabelle Biguet, Gwenaëlle Bossard, Hélène Brakni, Loïc Cadiou, Gilles Cadot, Cécile Chassaignon, Geraldine Coste, Benoît Coudert, Muriel Daout, Erwan Debuc, Nadine Delaplace, Françoise Delfour, Dominique Deneux, Céline Desandes, Faiza Dib, Karine Dorange, Lydie Dulou, Sylvie Dumont, Sylviane Dutertre, Yannick François, Céline Gicquel, Carole Grillot, Betty Hacquart, Laurence Harant, Gaëtane Henry, Etienne Hinglais, Claire Jullien, Véronique Klein, Muriel Kizika, Luce Klopp, Côme Légaut, Jean-Luc Letexier, Reine Letupe, Carine Liennard, Catherine Mahieu, Cécile Manaouil, Françoise Maréchal, Antoine Martis, Nabiha Merabet, Dominique Montpellier, Céline Moreau, Emilie Musserotte, Valérie Nouyrigat, Dalila Oufella, Fabrice Péronnet, Jean-Philippe Perreau, Benjamin Planquette, Christian Poiret, Emmanuelle Pottier, Marc Prével, Maurice Raphael, Valérie Raphael, Pierre-Joseph Raynaud, Philippe de Revière, Sylvie Ricouard-Bocquet, Chakib Riad, Véronique Riad, Mireille San Jullian, Valérie Savoia, Ghislaine Simon, Esther Simon-Libchaber, Catherine Souchet, Frédérik Staikowsky, Pascale Sujka, Michel Tambon, Laurent Vergnon, and Véronique Vincelet.

Published
2015
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8. Describing localized diseases in medical ontology: an FMA-based algorithm

Author

Jean, Charlet, Laurent, Mazuel, Gunnar, Declerck, Patrick, Miroux, and Pierre, Gayet

Subjects
Vocabulary, Controlled, Terminology as Topic, Hospital Information Systems, Electronic Health Records, Information Storage and Retrieval, Disease, France, Anatomy, Emergency Service, Hospital, Natural Language Processing, Semantics
Abstract

OntolUrgences is a termino-ontological resource developed to index and retrieve information in electronic Emergency Medical Record. In this project, we improved the ontology coverage to accommodate both anatomical and pathophysiological concepts in emergency medicine. This work lead to the automatic addition of 3,470 concepts and their underlying semantic formalization. In our method, we reuse and select the anatomical concepts relevant to emergency from FMA: To capture the anatomical specific concepts, (i) we involved Emergency practitioners and identified the key concepts from this domain; (ii) we applied an automatic algorithm to define the semantic relationships and integrated the result in the existing ontology.

Published
2014

9. LISTE DES COLLABORATEURS

Author

Bernard Marc, Patrick Miroux, Charles Jeleff, Marc Andronikof, Miloud Arabi, Gilles Arlie, Philippe Autret, Isabelle Piedade, Raphaëlle Benveniste, Dominique Pateron, Jannick Barrois, Yolande Barthélémy, Omar Belkhodja, Cindy Belle, Abdel Bellou, Bruno Bernot, Ludivine Berton, Isabelle Biguet, Gwenaëlle Bossard, Hélène Brakni, Loïc Cadiou, Gilles Cadot, Cécile Chassaignon, Geraldine Coste, Benoît Coudert, Muriel Daout, Erwan Debuc, Nadine Delaplace, Françoise Delfour, Dominique Deneux, Céline Desandes, Damien Desmasures, Faiza Dib, Karine Dorange, Lydie Dulou, Sylvie Dumont, Sylviane Dutertre, Yannick François, Céline Gicquel, Carole Grillot, Betty Hacquart, Laurence Harant, Gaëtane Henry, Etienne Hinglais, Claire Jullien, Véronique Klein, Muriel Kizika, Luce Klopp, Johan Leclerc, Côme Légaut, Jean-Luc Letexier, Reine Letupe, Carine Liennard, Catherine Mahieu, Cécile Manaouil, Françoise Maréchal, Antoine Martis, Nabiha Merabet, Dominique Montpellier, Céline Moreau, Emilie Musserotte, Valérie Nouyrigat, Dalila Oufella, Fabrice Péronnet, Jean-Philippe Perreau, Benjamin Planquette, Christian Poiret, Emmanuelle Pottier, Marc Prével, Maurice Raphael, Valérie Raphael, Pierre-Joseph Raynaud, Philippe de Revière, Sylvie Ricouard-Bocquet, Chakib Riad, Véronique Riad, Mireille San Jullian, Valérie Savoia, Ghislaine Simon, Esther Simon-Libchaber, Catherine Souchet, Frédérik Staikowsky, Pascale Sujka, Michel Tambon, Laurent Vergnon, and Véronique Vincelet

Published
2013
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11. Solutés d'urgence

Author

Charles Jeleff, Isabelle Piedade, Bernard Marc, Patrick Miroux, Raphaelle Benveniste, and Dominique Pateron

Published
2008
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13. Glypressine

Author

Bernard Marc, Isabelle Piedade, Patrick Miroux, Dominique Pateron, Charles Jeleff, and Raphaelle Benveniste

Published
2008
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20. Corps étranger ORL

Author

Charles Jeleff, Dominique Pateron, Patrick Miroux, Isabelle Piedade, Raphaelle Benveniste, and Bernard Marc

Published
2008
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23. Morphine

Author

Isabelle Piedade, Charles Jeleff, Patrick Miroux, Bernard Marc, Raphaelle Benveniste, and Dominique Pateron

Published
2008
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27. Fractures du nez

Author

Isabelle Piedade, Patrick Miroux, Raphaelle Benveniste, Charles Jeleff, Bernard Marc, and Dominique Pateron

Published
2008
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29. Fièvre

Author

Isabelle Piedade, Charles Jeleff, Raphaelle Benveniste, Dominique Pateron, Patrick Miroux, and Bernard Marc

Published
2008
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31. Isuprel

Author

Raphaelle Benveniste, Patrick Miroux, Bernard Marc, Charles Jeleff, Isabelle Piedade, and Dominique Pateron

Published
2008
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34. Traumatismes du coude

Author

Bernard Marc, Charles Jeleff, Patrick Miroux, Dominique Pateron, Raphaelle Benveniste, and Isabelle Piedade

Subjects
business.industry, Medicine, business
Published
2008
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37. Brûlures

Author

Charles Jeleff, Isabelle Piedade, Bernard Marc, Patrick Miroux, Dominique Pateron, and Raphaelle Benveniste

Published
2008
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38. Adrénaline

Author

Patrick Miroux, Charles Jeleff, Dominique Pateron, Raphaelle Benveniste, Bernard Marc, and Isabelle Piedade

Published
2008
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42. Rivotril

Author

Patrick Miroux, Raphaelle Benveniste, Charles Jeleff, Dominique Pateron, Bernard Marc, and Isabelle Piedade

Published
2008
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46. Œdèmes

Author

Dominique Pateron, Raphaelle Benveniste, Isabelle Piedade, Patrick Miroux, Bernard Marc, and Charles Jeleff

Published
2008
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