[Artificial intelligence for medical information departments : construction and evaluation of a decision-making tool to identify and prioritize stays of which the PMSI coding could be optimized, and to ensure the revenues generated by activity-based pricing]. / L'intelligence artificielle au service des départements d'information médicale : construction et évaluation d'un outil d'aide à la décision pour cibler et prioriser les séjours à contrôler et fiabiliser les recettes hospitalières générées par la tarification à l'activité.

BACKGROUND: Medical Information Departments help to optimize the hospital revenues generated by activity-based pricing. A review of medical files, selected after the targeting of coding summaries, is organized. The aim is to make any corrections to the diagnoses or coded procedures with a potential impact on the pricing of the stay. Targeting is of major importance as a means of concentrating resources on the files for which coding can be effectively improved. The tools available for targeting can be optimized. We have developed a decision-making support tool to make targeting more efficient. The objective of our study was to evaluate the performance of this tool. METHODS: The tool combines an artificial intelligence module with a rule-based expert module. A predictive score is assigned to each coding summary that reflects the probability of a revalued stay. Evaluation of the performance of this tool was based on a sample of 400 stays of at least 3 nights of patients hospitalized at the Paris Saint-Joseph Hospital from 1st November to 31st December 2019. Each stay was reviewed by a coding expert, without knowledge of the score assigned and without help from expert queries. Two main assessment criteria were used: area under the ROC curve and positive predictive value (PPV). RESULTS: The area under the ROC curve was 0.70 (CI 95% [0.64-0.76]). With a revalued coding rate of 32%, PPV was 41% for scores above 5, 65% for scores above 8, 88% for scores above 9. CONCLUSION: The study made it possible to validate the performance of the tool. The implementation of new variables could further increase its performance. This is an area of development to be considered, particularly with in view of generalizing individual invoicing in hospitals.

Patients with atherosclerotic peripheral arterial disease have a high risk of lung cancer: Systematic review and meta-analysis of literature.

PURPOSE: Lung cancer and atherosclerosis share common risk factors. Literature data suggest that the prevalence of lung malignancy in patients with peripheral arterial disease (PAD) is higher than in the general population. Our goal was to determine, through a systematic literature review, the prevalence of lung cancer in patients with PAD. METHODS: We consulted available publications in the Cochrane library, MEDLINE, PUBMED, EMBASE, and ClinicalTrials.gov. We included all articles, written in English or French, published between 1990 and 2020 reporting the prevalence of lung cancer in patients with PAD (atherosclerotic aortic aneurysm or peripheral occlusive diseases). Patients with coronary artery disease, cardiac valvulopathy or carotid stenosis were not included. We did not include case reports. We performed a critical analysis of each article. Data were collected from two independent readers. A fixed effect model meta-analysis allowed to estimate a summary prevalence rate. RESULTS: We identified 303 articles, and selected 19 articles according to selection criteria. A total of 16849 patients were included (mean age 68.3 years, 75.1% of males). Aortic aneurysms were found in 29% of patients and atherosclerotic occlusive disease in 66% of patients. Lung cancer was identified in 538 patients, representing a prevalence of 3%. DISCUSSION: Lung cancer is found in 3% of patients with atherosclerotic PAD. This prevalence is higher than that found in lung cancer screening programs performed in the general population of smokers and former smokers. These patients should be screened for lung cancer. Their selection may dramatically increase the benefit of lung cancer screening.

[Contamination by aspergillosis: evaluation of preventive measures and monitoring of the environment]. / Contamination aspergillaire: évaluation des mesures de prévention et surveillance de l'environnement.

Aspergillosis has become a major fungal infection in hospitals since the advent of immunosuppressive therapy in the last fifteen years. Aspergilli are saprophytic and ubiquitous fungi and are associated with pulmonary and disseminated infections in immunodepressed patients with a mortality rate of about 85%. Aspergillosis is an air-borne infection, thus intensive care units should be conceived so as to decrease the outer risk of contamination. In the first part of this chapter the conception of such a unit is presented, taking the bone marrow transplantation unit of St-Louis Hospital as an example. A prospective study of the quality of the environment is a complementary and necessary information. In the second part of this chapter, the methods of airborn control of Aspergillus sp. are investigated. According to the literature, commun concepts can be drawn to evaluate nosocomial risks of aspergillosis. Nevertheless in the absence of a defined and accepted methodology, it is not possible up to that date to propose norms and acceptable norms of levels of contamination adapted to the degree of immunodepression of patients.