[Vaccination against influenza, pneumococcus and herpes zoster in the elderly Survey of prescribing physicians: assessment of knowledge and identification of obstacles to the prescription of vaccination]. / Vaccination contre la grippe, le pneumocoque et le zona chez les sujets âgés Enquête menée autour des médecins prescripteurs : état des lieux des connaissances et identification des freins à la prescription de la vaccination.

Vaccination coverage is insufficient for influenza, pneumococcus, and herpes zoster in people over the age of 65 in France, even though these are common infectious diseases. Using a computerised questionnaire, the aim of our study was to assess the knowledge of general practitioners, geriatricians, infectious diseases specialists and interns in the Loire region about the vaccination against these three diseases in elderly subjects, to identify the obstacles to vaccination, and to evaluate whether the provision of knowledge modifies the prescriptions and vaccination recommendations made to patients. Of the 125 responses from doctors and interns, 90.2 % are correct for influenza, 69.2 % for pneumococcus, and 32.8 % for herpes zoster, with no significant difference between specialities. By providing information, practitioners are more willing to vaccinate their patients against influenza (99 %), pneumococcus (93 %), and herpes zoster (39 %). The main obstacles to vaccination are the patient's refusal (85 %), the doctor's lack of knowledge and time (70 % and 41 % respectively), doubts about the vaccine's effectiveness (28 %), and fear of side effects (21 %).

Automated Coding in Case Mix Databases of Bacterial Infections Based on Antimicrobial Susceptibility Test Results.

Our objective was to improve the accuracy of bacteria and resistance coding in a hospital case mix database. Data sources consisted of 50,074 files on bacteriological susceptibility tests transmitted with the HPRIM protocol from laboratory management system to electronic health record of the University hospital of Saint Etienne in July 2017. An algorithm was implemented to detect susceptibility tests containing information corresponding to codes whose addition in the case mix database was susceptible to increase the severity level of a diagnosis related group. Among 132 hospital stays fulfilling the conditions, 27 were lacking bacteria and/or resistance codes, and the tariff was increased for 9 stays, with earnings of €54,612. Analyzing Antimicrobial susceptibility tests helps to improve clinical coding and optimize the financial gain.

Citizen consultation and organized breast cancer screening.

Scientific controversies on breast cancer screening have induced the French authorities to launch online citizen consultation. The objective of this netnography was to identify the knowledge and values underlying contributors' choices. The choice of supporters was often based on emotions: impression of disease severity and efficacy of screening, fearfulness stemming from personal experience and testimony from relatives. Opponents emphasized the risks of the screening and the doctors' perceived lack of relational and technical skills. The 'non-decision' profile was explained by information deemed simplistic, guilt-inducing and partial. Future research should focus on how to appeal to emotions to support shared decision.

Interest of a medical surgical geriatric unit in a district hospital: a retrospective study.

BACKGROUND: Orthogeriatric units have shown through several studies their effectiveness on reducing the morbidity and mortality after hip fracture. What about other emergency surgeries at the elderly? We evaluated the results of a small medical surgical geriatric unit (UMCG) for all the not sheduled surgeries. METHODS: A retrospective sudy has been done, analyzing management of patients over 75 years after an emergency surgery, between 1st January 2013 and 15 February 2014 for the surgical unit, and between 15 February 2014 and 15 April 2014 for the UMCG. 3-month mortality, 6-month mortality and the main early complications were compared between the two groups, by a multivariated analysis fitting on the data on patient characteristics. RESULTS: 3-month mortality was significantly lower in the UMCG group (odds ratio 0.07 [95%IC: 0.004-0.48]; p=0.02), while the patients in this unit were more likely with dementia, with fall antecedent and with more comorbidity. 6-month mortality as well was lower in the UMCG group (0.10 [0.02-0.36]; p=0.001). CONCLUSION: Management of not sheduled surgeries at the elderly in specific surgical geriatric unit is associated in a statistically significant reduction of 3-month mortality and 6-month mortality.

Inconsistencies Between Antiparkinsonian Drugs and ICD-10 Codes in Inpatients: A TOLBIAC Project Case Study.

In France, data derived from hospital information systems are adequate to feed the prospective payment system. The consistency between drugs prescribed to patients and their indications could solve difficulties related to the identification of ICD-10 undercoded chronic diseases as the Parkinson Disease. Our goal was to highlight patients' stays mentioning administration of antiparkinsonian drugs and not coded for Parkinson's disease. Our approach was to parameterize tables of associations between ICD-10 codes and drug identifiers in the Web100T® application that collects medical information in our hospital and displays related inconsistencies for patients' stays. Based on acute care patients' stays of the second semester of 2015, we identified 246 patients corresponding to 253 stays, for which 33% of stays were not coded with the ICD-10 G20 code of the Parkinson's disease. The precision of our approach was 29%. Based on these data we predict roughly 84 patient stays without mention of Parkinson Disease. We plan to extend this study to other drugs and other kinds of data available in the health information system, such as biology or medical devices in order to improve the coding of chronic diseases in our hospital.

Predicting Fluctuating Rates of Hospitalizations in Relation to Influenza Epidemics and Meteorological Factors.

INTRODUCTION: In France, rates of hospital admissions increase at the peaks of influenza epidemics. Predicting influenza-associated hospitalizations could help to anticipate increased hospital activity. The purpose of this study is to identify predictors of influenza epidemics through the analysis of meteorological data, and medical data provided by general practitioners. METHODS: Historical data were collected from Meteo France, the Sentinelles network and hospitals' information systems for a period of 8 years (2007-2015). First, connections between meteorological and medical data were estimated with the Pearson correlation coefficient, Principal component analysis and classification methods (Ward and k-means). Epidemic states of tested weeks were then predicted for each week during a one-year period using linear discriminant analysis. Finally, transition probabilities between epidemic states were calculated with the Markov Chain method. RESULTS: High correlations were found between influenza-associated hospitalizations and the variables: Sentinelles and emergency department admissions, and anti-correlations were found between hospitalizations and each of meteorological factors applying a time lag of: -13, -12 and -32 days respectively for temperature, absolute humidity and solar radiation. Epidemic weeks were predicted accurately with the linear discriminant analysis method; however there were many misclassifications about intermediate and non-epidemic weeks. Transition probability to an epidemic state was 100% when meteorological variables were below: 2°C, 4 g/m3 and 32 W/m2, respectively for temperature, absolute humidity and solar radiation. This probability was 0% when meteorological variables were above: 6°C, 5.8g/m3 and 74W/m2. CONCLUSION: These results confirm a good correlation between influenza-associated hospitalizations, meteorological factors and general practitioner's activity, the latter being the strongest predictor of hospital activity.