[Development of a methodological guide on the implementation of a pharmaceutical decision support system: Feedback from a French university hospital]. / Élaboration d'un guide méthodologique sur l'implantation d'un système d'aide à la décision pharmaceutique : retour d'expérience d'un centre hospitalier universitaire français.

OBJECTIVE: Develop a methodological guide on the implementation of a PDSS (pharmaceutical decision support system). METHOD: Observational study, retrospective conducted at Lille University Hospital from May 2017 to December 2020, corresponding to the period of implementation and then use of the software. The different phases of the project are described as well as the methodology at each stage. RESULTS: Four stages seem necessary for the establishment of the PDSS: reflection and preparation of the project, contracting, implementation, use and evaluation. Based on these results and our experience, in particular the difficulties encountered, a methodological diagram of the various steps necessary for the implementation of a PDSS is proposed. CONCLUSION: The establishment of a PDSS, especially in the field of clinical pharmacy, is a long multidisciplinary process. Several steps, from project preparation to production start-up are necessary. Planning the different stages is essential for the proper implementation of the SADP so that the installation is as efficient as possible.

["Digital contributes to the improvement and modernization of the healthcare system"]. / « Le numérique contribue à l'amélioration et à la modernisation du système de santé ¼.

The modernization and development of information systems are major challenges for the hospital of the future. Driven by the public authorities, the "Hôpital numérique ouvert sur son environnement" (Digital Hospital open to its environment) program and the Ségur digital health program rely on digital technology to facilitate the exchange and sharing of information, and thus improve the quality of the service provided to users in terms of care, support, and treatment. At the National Agency for Supporting the Performance of Health and Medical-Social Establishments, Yves Beauchamp is working on proposing tools and methodological kits to help establishments achieve the objectives set by these national programs.

Household sampling through geocoded points and satellite view: A step-by-step approach to implement a spatial sampling method for demographic and health surveys in areas without population sampling frame and with limited resource settings.

INTRODUCTION: Spatial sampling is increasingly used in health surveys as it provides a simple way to randomly select target populations on sites where reliable and complete data on the general population are not available. However, the previously implemented protocols have been poorly detailed, making replication difficult or even impossible. To our knowledge, ours is the first document describing step-by-step an efficient spatial sampling method for health surveys. Our objective is to facilitate the rapid acquisition of the technical skills and know-how necessary for its deployment. METHODS: The spatial sampling design is based on the random generation of geocoded points in the study area. Afterwards, these points were projected on the satellite view of Google Earth Pro™ software and the identified buildings were selected for field visits. A detailed formula of the number of points required, considering non-responses, is proposed. Density of buildings was determined by drawing circles around points and by using a replacement strategy when interviewing was unachievable. The method was implemented for a cross-sectional study during the April-May 2016 period in Cotonou (Bénin). The accuracy of the collected data was assessed by comparing them to those of the Cotonou national census. RESULT: This approach does not require prior displacement in the study area and only 1% of identified buildings with Google Earth Pro™ were no longer extant. Most of the measurements resulting from the general census were within the confidence intervals of those calculated with the sample data. Furthermore, the range of measurements resulting from the general census was similar to those calculated with the sample data. These include, for example, the proportion of the foreign population (unweighted 8.9%/weighted 9% versus 8.5% in census data), the proportion of adults over 17 years of age (56.7% versus 57% in census data), the proportion of households whose head is not educated (unweighted 21.9%/weighted 22.8% versus 21.1% in census data). CONCLUSION: This article illustrates how an epidemiological field survey based on spatial sampling can be successfully implemented at low cost, quickly and with little technical and theoretical knowledge. While statistically similar to simple random sampling, this survey method greatly simplifies its implementation.

[Legitimate resistance without technophobia: Analysis of electronic medical records impacts on the medical profession]. / Résistance légitime sans technophobie : analyse des impacts de l'informatisation du dossier du patient sur le cœur du métier médical.

The objective of this short narrative literature review is to highlight the different difficulties encountered by medical doctor in the daily use of EMR. We show that these are not simple transitional phenomena related to a "resistance to change", but rather the fact of a deeper and unfinished transformation. Beyond the "perception of misfit with work processes" or the threat of a loss of autonomy, we propose to analyze this so-called "resistance" in relation to the formalization of medical work induced by EMR. Our question concerns the compatibility of the multiple objectives of EMR, the potential influence of computerization on the steps of entering and consulting medical information, the impact on the clinical reasoning, the reality of assistance to medical "performance". The question is not so much what EMRs do less well than the paper record, but to provide insights into how tomorrow's EMRs will do better than today's.

Triage in Complex, Coordinated Terrorist Attacks.

INTRODUCTION: Terror attacks have increased in frequency, and tactics utilized have evolved. This creates significant challenges for first responders providing life-saving medical care in their immediate aftermath. The use of coordinated and multi-site attack modalities exacerbates these challenges. The use of triage is not well-validated in mass-casualty settings, and in the setting of intentional mass violence, new and innovative approaches are needed. METHODS: Literature sourced from gray and peer-reviewed sources was used to perform a comparative analysis on the application of triage during the 2011 Oslo/Utoya Island (Norway), 2015 Paris (France), and 2015 San Bernardino (California USA) terrorist attacks. A thematic narrative identifies strengths and weaknesses of current triage systems in the setting of complex, coordinated terrorist attacks (CCTAs). DISCUSSION: Triage systems were either not utilized, not available, or adapted and improvised to the tactical setting. The complexity of working with large numbers of patients, sensory deprived environments, high physiological stress, and dynamic threat profiles created significant barriers to the implementation of triage systems designed around flow charts, physiological variables, and the use of tags. Issues were identified around patient movement and "tactical triage." CONCLUSION: Current triage tools are inadequate for use in insecure environments, such as the response to CCTAs. Further research and validation are required for novel approaches that simplify tactical triage and support its effective application. Simple solutions exist in tactical triage, patient movement, and tag use, and should be considered as part of an overall triage system.

[Differences by geographical information system in prevalence of disease in a farm animal practise]. / Räumliche Unterschiede in der Prävalenz von Rinderkrankheiten in einer Nutztierpraxis.

INTRODUCTION: In the present study, the incidence of diseases in cattle in the area of a veterinary practice was analyzed spatially. Furthermore, the relationship between the incidence of diseases and the distance to geographical elements was investigated. For this study, all cattle farms that were customers of the ambulatory clinic of the animal hospital in Zurich (Tierspital Zürich) were exactly localized on a map. From clinical and treatment data program (Oblon Data®) all services and drugs between January 1st 2013 and December 31st 2013 were evaluated and added as attributes to the according farm. Along with the data of the animals kept on the respective farm, the relationship between prevalences and geographical elements was analyzed. Using these data, it was possible to define fifteen diseases of which incidences were spatially analyzed using a geographic information system (GIS). The results indicate that also on the level of a veterinary practice there are spatial differences in the incidence of diseases to find. However, the majority of diseases occur mainly in regions where the density of animals is also very high. As in earlier findings, this suggests that the size, the management and the proximity of a farm to the next farm (density) have a strong impact. A connection could be found between the distance to the geographical elements street, water and forest and the incidences of gastrointestinal parasitosis, claw disorders, reproduction disorders and cryptosporidiosis.

INTRODUCTION: Dans la présente étude, l'incidence des maladies chez les bovins à l'intérieur d'une clientèle rurale a été analysée spatialement. En outre, la relation entre l>incidence des maladies et les éléments géographiques a été étudiée. Pour cette étude, toutes les exploitations d'élevage clientes de la clinique ambulatoire de l'hôpital vétérinaire de Zurich (Tierspital Zürich) ont été exactement localisées sur une carte. Toutes les interventions facturées et les médicaments prescrits entre le 1er janvier 2013 et le 31 décembre 2013 ont été évalués et liés en tant qu'attributs à chaque exploitation. À l'aide de ces données, il a été possible de définir quinze maladies dont les incidences ont été analysées spatialement à l'aide d'un système d'information géographique (SIG). Les résultats indiquent que, également au niveau de la pratique vétérinaire, il existe des différences spatiales dans l'incidence des maladies. Cependant, la plupart des maladies surviennent principalement dans des régions où la densité animale est également très élevée. Comme dans les conclusions précédentes, cela suggère que la taille, la gestion et la proximité d'une exploitation à l'autre (densité) ont un impact important. Un lien pourrait être trouvé entre la distance aux éléments géographiques route, cours d'eau et forêts et les incidences de parasitoses gastro-intestinales, de corps étrangers, de pathologie des onglons, de troubles de la reproduction et de cryptosporidiose.

Technologies for capturing and analysing animal health data in near real time.

Information technologies are rapidly advancing the way in which animal health data and information are collected, analysed and shared in order to support animal health management, disease surveillance and response, and decision-making. However, the full potential of these technologies for early detection and response to natural or intentional disease events has not been fully realised in animal health at the global level. This paper discusses advances made in these technologies and examples of how they have been applied in animal health for near real-time data collection and analysis. The technologies reviewed include: i) mobile health (mHealth) technologies, wireless sensors and biosensors for remote data collection; ii) crowdsourced and Internet-based data collection; and iii) electronic health (eHealth) technologies for data integration and analysis. Experiences of implementing these technologies, and challenges with their use, are also discussed so as to provide recommendations on their future application in animal health. The world is ripe with opportunities to develop and enhance mHealth and eHealth technologies that are cost effective and capable of near real-time data collection and analysis. Such technologies have been shown to be valuable and capable of being implemented in both developing and developed countries, and ultimately will strengthen disease surveillance and reporting across the globe. International mechanisms and data standards are needed to facilitate the sharing and analysis of animal and human health data between countries. Identifying ways in which animal and human health data collection and analysis can be better integrated within a 'One Health' approach will enhance the coordination and capability of disease detection and response at the human-animal interface.

Les technologies de l'information font rapidement progresser la façon dont les données et l'information sur la santé animale sont recueillies, analysées et partagées afin de soutenir la gestion de la santé animale, les activités de surveillance et de réponse en cas de maladies et les processus de décisions. Toutefois, le potentiel de ces technologies n'a pas encore été entièrement exploité au niveau mondial dans le but d'assurer la détection précoce et d'organiser la réponse du secteur de la santé animale à des événements sanitaires dus à des causes naturelles ou intentionnelles. Les auteurs examinent les avancées accomplies par ces technologies, en particulier les exemples d'applications en santé animale pour la collecte et l'analyse de données en temps quasi réel. L'article aborde les technologies suivantes : i) les technologies mobiles de santé, les capteurs sans fil et biocapteurs pour la collecte de données à distance ; ii) la collecte de données via l'internet ou des initiatives de masse ; et iii) les technologies numériques de santé pour l'intégration et l'analyse des données. Les auteurs examinent également des exemples de mise en place de ces technologies, font état des difficultés rencontrées lors de leur utilisation et formulent quelques recommandations sur les applications futures en santé animale. Le moment est venu de saisir les possibilités de développement et d'amélioration de technologies mobiles et numériques de santé qui soient à la fois rentables et capables d'assurer la collecte et l'analyse des données en temps quasi réel. L'utilité de ces technologies a été démontrée, ainsi que leur aptitude à être appliquées dans les pays développés et en développement, ce qui à terme renforcera la surveillance des maladies et leur notification à l'échelle planétaire. Le monde doit se doter de mécanismes internationaux et de normes sur les données afin de faciliter le partage et l'analyse des données relatives à la santé humaine et animale entre les pays. Les modalités d'intégration de la collecte et l'analyse des données de santé publique et de santé animale dans une approche « Une seule santé ¼ permettront d'améliorer la coordination et les capacités de détection et de lutte à l'interface humains-animaux.

Las tecnologías de la información están haciendo progresar con rapidez los procedimientos con que se obtienen, analizan y ponen en común la información y los datos de sanidad animal que sirven para respaldar las labores de gestión zoosanitaria, vigilancia de enfermedades, respuesta a ellas y adopción de decisiones. Sin embargo, en el ámbito de la sanidad animal aún no se aprovechan plenamente, a escala mundial, todas las posibilidades que ofrecen estas tecnologías para detectar con prontitud episodios infecciosos de origen natural o intencionado y responder rápidamente a ellos. Los autores describen los progresos realizados en estas tecnologías y ofrecen ejemplos de cómo se han aplicado en sanidad animal para reunir y analizar datos en tiempo casi real, deteniéndose especialmente en las siguientes grandes familias: i) tecnologías móviles de salud, biosensores y sensores inalámbricos para la obtención de datos a distancia; ii) obtención de datos por sistemas de participación popular o por Internet; y iii) tecnologías de cibersalud para la integración y el análisis de datos. Los autores también examinan la experiencia adquirida hasta ahora con la aplicación de estas tecnologías y los problemas que plantea su utilización, y a partir de ahí formulan recomendaciones sobre su aplicación futura en la sanidad animal. El mundo rebosa de oportunidades para desarrollar y perfeccionar tecnologías móviles de salud y tecnologías de cibersalud que sean eficaces en relación con el costo y permitan obtener y analizar datos en tiempo casi real. Está demostrado que estas tecnologías son interesantes y pueden implantarse en países tanto desarrollados como en desarrollo, y que a la larga servirán para reforzar la vigilancia y notificación de enfermedades en todo el planeta. Para facilitar el intercambio y el análisis de datos sanitarios y zoosanitarios entre los países hacen falta mecanismos y normas internacionales referidos a estos datos. Abordando la cuestión desde los postulados de «Una sola salud¼ es posible dar con fórmulas para integrar en mayor medida entre sí la obtención y el análisis de los datos de salud humana y de los de sanidad animal, cosa que servirá para mejorar la coordinación y la capacidad de detección y respuesta ante las enfermedades en la interfaz del hombre con los animales.

[Consequences of increasing and ageing population of Basse-Normandie on gynecology and obstetrics activity]. / Effet de l'augmentation et du vieillissement de la population de Basse-Normandie sur l'activité de gynécologie-obstétrique.

INTRODUCTION: In Basse-Normandie, the population over 65 years old will expend more rapidly between 2007 and 2042 (+11.6%) than the rest of the French population (+9.2%). The same population of Basse-Normandie will get old in the 15 years to come. The impact of these demographic changes over the activity in the gynecology-obstetrics field is not clearly identified. Although we cannot predict the technical and scientific developments in the next 15 years, we are presenting a model allowing to hypothesize about changes of gynecology and obstetrics according to population's aging. MATERIALS AND METHODS: We have established a projection model for the realizable surgical acts in obstetrics and gynecology in accordance with the aging of the population in Basse-Normandie. The study was realized based on the acts concerning the cesarean sections (C-section), tubal sterilization, hysteroscopy and hysterectomy as well as ovarectomy and breast surgery. For each activity branch, the codes of the Classification commune des actes médicaux (CCAM) were selected and then removed from the Programme médicalisé des systèmes d'information (PMSI) database. We have used and adapted the Omphale model of the National Statistics and Economical Studies Institute and we have applied it for the period of 2009-2025. RESULTS: Our projection model has permeated to show a 5.5% regression of the C-section acts, a 2% incretion of the hysterectomies and hysteroscopies, 7.7% of ovarectomies as well as a 9.8% augmentation of the breast surgeries. However, we predict a 11.8% diminution of the sterilizations by tubal implants. Globally, the activity in obstetrics and gynecology will remain constant with an insignificant augmentation of 46 acts (0.01%). CONCLUSION: In Basse-Normandie, the surgical activity in gynecology-obstetrics will moderately increase in the next 15 years. This constant activity signifies that there is no need to form more residents than the number of practitioner to retire. The interest of this model is that it is applicable at a national level and it permits to confront the demographic data and the projections of different activities.

[Health and social information systems in support of local health planning: issues and challenges]. / Les systemes d'information sociosanitaire a l'appui de la planification locale de la sante: defis et enjeux.

Health information is indispensable for monitoring the progress that has been made in improving and maintaining population health and health system functions. In the context of health reforms aiming to bring health systems closer to populations and with the objective of consistent health services planning at the community level, access to reliable social and health data has become a major issue. The need to develop specific treatment tools and the appropriation of results by the various actors involved (decision makers, planners, researchers and consumers) are central to the presentations and exchanges in this symposium.

[Comparing results of methicillin-resistant Staphylococcus aureus (MRSA) surveillance using the French DRG-based information system (PMSI)]. / État des lieux et évaluation de la surveillance des Staphylococcus aureus résistants à la méticilline (SARM) : PMSI versus surveillance Raisin.

BACKGROUND: The surveillance of methicillin-resistant Staphylococcus aureus (MRSA) is a national priority. The rate of MRSA infections is one of six indicators tracked by the Department of Health. Since 2002, the French institute for public health surveillance (InVS) has monitored MRSA infections to estimate incidence density. Today, the use of the French administrative database (PMSI) could facilitate this surveillance. The aim of this study was to compare MRSA incidence density computed at a national level using PMSI databases with the results from the InVS taken as the reference. METHODS: PMSI databases for the years 2006 to 2009 were used. The reference results were those published by the InVS from 2006 to 2009. MRSA density defined as the number of MRSA infections recorded per year over 1000 hospital stays was computed. It was then compared with the MRSA incidence density measured by InVS. The time course of MRSA incidence in the PMSI records was modeled using a Poisson regression. RESULTS: The incidence density measured by the InVS was higher than the MRSA density computed using the PMSI, but this difference appeared to decrease over time. The PMSI density/InVS MRSA incidence density ratio was 0.8% in 2006 and about 9.2% in 2009. We observed inverted trends with a growing trend in MRSA density identified by the PMSI. Furthermore, the year of study was significantly associated with incidence density (P=0.01). CONCLUSION: Using PMSI data as an additional source of information in the hospital MRSA surveillance process makes it possible to detect and analyze patient repeats at the regional and national levels with linkage facilities. Estimation of incidence density for hospitals not participating to this surveillance system will be the next step.

Informação profissional e orientação para a carreira mediadas por computador: uma revisão da literatura / Career information and career guidance: a literature revision / Information professionnelle et orientation professionelle: une révision littéraire / Información profesional y orientación para la carrera mediadas por ordenador: una revisión de la bibliografía

A Informação Profissional, um dos componentes do processo de Orientação Profissional Vocacional ou para a Carreira, visa fornecer dados da realidade do mundo ocupacional de forma a auxiliar pessoas em processos de tomada de decisão. Este estudo objetiva sistematizar e analisar a produção do conhecimento sobre a temática Informação Profissional com base na revisão da literatura. Os dados foram organizados em três categorias, com base em Robinson e colaboradores: (1) modelos de recursos impressos, (2) programas e sistemas de informação e (3) sites na internet. Os resultados mostram que as novas Tecnologias da Informação e Comunicação (TICs) aliadas às estratégias tradicionais representam inúmeras oportunidades de desenvolvimento da Informação Profissional, com desafios e limites a serem enfrentados em um campo que não para de evoluir. O estudo evidencia o papel da Informação Profissional, com seus limites e possibilidades, no contexto brasileiro bem como nos países desenvolvidos.

Career Information, which is one of the constituents of the career guidance process, aims at supplying data from the occupational world in order to help people make their career decision. This study aims to systematize and analyze the production of knowledge about career information based on a literature review. The data was organized into three categories as based on Robinson and coll.: (1) printed resources; (2) information program and systems; and (3) internet sites. The results showed that the new Information and Communication Technologies (ICT’s) together with traditional strategies constitute a way of developing Career Information in the context of career guidance, pose challenges and limits to be faced in an ever evolving field. The study highlights the role of Professional Information, with its limitations and possibilities in the Brazilian context as well as in the developed countries.

L’Information Professionnelle, l’un des composants du processus d’Orientation de Carrière, dont l’objet est de révéler les données réelles du monde du travail de manière à aider les personnes dans le processus de prise de decisions. Cette étude vise à systematiser et analyser la production des connaissances sur le thème de l’Information Professionnelle basée sur la révision littéraire. Les données ont été organisées en trois catégories, selon les bases de Robinson et ses collaborateurs: (1) des modèles de ressources imprimées, (2) des logiciels et (3) sites sur internet. Les nouvelles Technologies de l’Information et de la Communication (TICs) associées aux stratégies traditionelles représentent de nombreuses oportunités de developpement de l’Information Professionnelle dans le contexte d’Orientation de Carrière, avec des défis et des limites à affronter dans un domaine en constante évolution. L'étude met en évidence le rôle du professionnel de l'information, avec ses limites et les possibilités dans le contexte brésilien, ainsi que les pays développés.

La Información Profesional, uno de los componentes del proceso de Orientación Profesional, Vocacional y para la Carrera, busca suministrar datos de la realidad del mundo ocupacional para auxiliar a personas en proceso de toma de decisión. Este estudio pretende sistematizar y analizar la producción del conocimiento sobre el tema Información Profesional basándose en la revisión de la bibliografía. Los datos fueron organizados en tres categorías teniendo como fundamento a Robinson y colaboradores: (1) modelos de recursos impresos, (2) programas y sistemas de información y (3) sitios en la internet. Se concluye que las nuevas Tecnologías de la Información y Comunicación (TICs) aliadas a las estrategias tradicionales representan innumerables oportunidades de desarrollo de la Información Profesional en el contexto de la Orientación para la Carrera, con desafíos y límites a ser enfrentados en un campo que no para de evolucionar. El estudio evidencia el papel de la Información Profesional, con sus límites y posibilidades, en el contexto brasileño como en el de los países desarrollados.

Informação profissional e orientação para a carreira mediadas por computador: uma revisão da literatura / Career information and career guidance: a literature revision / Information professionnelle et orientation professionelle: une révision littéraire / Información profesional y orientación para la carrera mediadas por ordenador: una revisión de la bibliografía

A Informação Profissional, um dos componentes do processo de Orientação Profissional Vocacional ou para a Carreira, visa fornecer dados da realidade do mundo ocupacional de forma a auxiliar pessoas em processos de tomada de decisão. Este estudo objetiva sistematizar e analisar a produção do conhecimento sobre a temática Informação Profissional com base na revisão da literatura. Os dados foram organizados em três categorias, com base em Robinson e colaboradores: (1) modelos de recursos impressos, (2) programas e sistemas de informação e (3) sites na internet. Os resultados mostram que as novas Tecnologias da Informação e Comunicação (TICs) aliadas às estratégias tradicionais representam inúmeras oportunidades de desenvolvimento da Informação Profissional, com desafios e limites a serem enfrentados em um campo que não para de evoluir. O estudo evidencia o papel da Informação Profissional, com seus limites e possibilidades, no contexto brasileiro bem como nos países desenvolvidos.(AU)

Career Information, which is one of the constituents of the career guidance process, aims at supplying data from the occupational world in order to help people make their career decision. This study aims to systematize and analyze the production of knowledge about career information based on a literature review. The data was organized into three categories as based on Robinson and coll.: (1) printed resources; (2) information program and systems; and (3) internet sites. The results showed that the new Information and Communication Technologies (ICT’s) together with traditional strategies constitute a way of developing Career Information in the context of career guidance, pose challenges and limits to be faced in an ever evolving field. The study highlights the role of Professional Information, with its limitations and possibilities in the Brazilian context as well as in the developed countries.(AU)

L’Information Professionnelle, l’un des composants du processus d’Orientation de Carrière, dont l’objet est de révéler les données réelles du monde du travail de manière à aider les personnes dans le processus de prise de decisions. Cette étude vise à systematiser et analyser la production des connaissances sur le thème de l’Information Professionnelle basée sur la révision littéraire. Les données ont été organisées en trois catégories, selon les bases de Robinson et ses collaborateurs: (1) des modèles de ressources imprimées, (2) des logiciels et (3) sites sur internet. Les nouvelles Technologies de l’Information et de la Communication (TICs) associées aux stratégies traditionelles représentent de nombreuses oportunités de developpement de l’Information Professionnelle dans le contexte d’Orientation de Carrière, avec des défis et des limites à affronter dans un domaine en constante évolution. L'étude met en évidence le rôle du professionnel de l'information, avec ses limites et les possibilités dans le contexte brésilien, ainsi que les pays développés.(AU)

La Información Profesional, uno de los componentes del proceso de Orientación Profesional, Vocacional y para la Carrera, busca suministrar datos de la realidad del mundo ocupacional para auxiliar a personas en proceso de toma de decisión. Este estudio pretende sistematizar y analizar la producción del conocimiento sobre el tema Información Profesional basándose en la revisión de la bibliografía. Los datos fueron organizados en tres categorías teniendo como fundamento a Robinson y colaboradores: (1) modelos de recursos impresos, (2) programas y sistemas de información y (3) sitios en la internet. Se concluye que las nuevas Tecnologías de la Información y Comunicación (TICs) aliadas a las estrategias tradicionales representan innumerables oportunidades de desarrollo de la Información Profesional en el contexto de la Orientación para la Carrera, con desafíos y límites a ser enfrentados en un campo que no para de evolucionar. El estudio evidencia el papel de la Información Profesional, con sus límites y posibilidades, en el contexto brasileño como en el de los países desarrollados.(AU)