[Algorithms for the identification of hospital stays due to osteoporotic femoral neck fractures in European medical administrative databases using ICD-10 codes: A non-systematic review of the literature]. / Algorithmes d'identification des séjours pour fracture du col du fémur d'origine ostéoporotique dans les bases médico-administratives européennes utilisant la CIM-10 : revue non systématique de la littérature.

BACKGROUND: Osteoporotic hip fractures (OHF) are associated with significant morbidity and mortality. The French medico-administrative database (SNIIRAM) offers an interesting opportunity to improve the management of OHF. However, the validity of studies conducted with this database relies heavily on the quality of the algorithm used to detect OHF. The aim of the REDSIAM network is to facilitate the use of the SNIIRAM database. The main objective of this study was to present and discuss several OHF-detection algorithms that could be used with this database. METHODS: A non-systematic literature search was performed. The Medline database was explored during the period January 2005-August 2016. Furthermore, a snowball search was then carried out from the articles included and field experts were contacted. The extraction was conducted using the chart developed by the REDSIAM network's "Methodology" task force. RESULTS: The ICD-10 codes used to detect OHF are mainly S72.0, S72.1, and S72.2. The performance of these algorithms is at best partially validated. Complementary use of medical and surgical procedure codes would affect their performance. Finally, few studies described how they dealt with fractures of non-osteoporotic origin, re-hospitalization, and potential contralateral fracture cases. CONCLUSIONS: Authors in the literature encourage the use of ICD-10 codes S72.0 to S72.2 to develop algorithms for OHF detection. These are the codes most frequently used for OHF in France. Depending on the study objectives, other ICD10 codes and medical and surgical procedures could be usefully discussed for inclusion in the algorithm. Detection and management of duplicates and non-osteoporotic fractures should be considered in the process. Finally, when a study is based on such an algorithm, all these points should be precisely described in the publication.

Screening for diabetic retinopathy in a rural French population with a mobile non-mydriatic camera.

AIM: The aim of this study was to evaluate the yield of diabetic retinopathy (DR) screening in a rural population using a mobile non-mydriatic camera. METHODS: The 72 least medicalized areas of Burgundy were the target areas. An orthoptist took fundus photographs using a Topcon TRC-NW6S non-mydriatic camera (four fields: posterior pole; nasal; temporal; and upper). Interpretations were done in the Department of Ophthalmology according to the classification of the French Language Association for the Study of Diabetes and Metabolic Diseases (Alfediam). RESULTS: Between 2004 and 2006, 1974 diabetics were screened-676 the first year, and 1298 in the second. The rate of non-interpretable photographs was 13%. Of the 1974 screened patients, there were 103 cases of DR (5.2%), comprising 70 mild non-proliferative DR (68%), 21 moderate non-proliferative DR (20.4%) and 12 severe non-proliferative DR (11.6%). The mean age of the patients with a DR was 66.7+/-10.9 years, with a mean duration of diabetes of 16.5+/-9.8 years. Only 35 (34%) patients were aware of their HbA(1c), which had a mean value of 7.8% and 19 had visited an ophthalmologist in the year before screening (18.4%). After the initial screening, 90,5% of the patients consulted an ophthalmologist as recommended. CONCLUSION: Screening improved the quality of the ocular follow-up in diabetics in this rural area. However, improvements in management are needed to lower the cost of such a programme.

[Combined glaucoma and diabetic retinopathy screening in Burgundy]. / Dépistage itinérant du glaucome associé à celui de la rétinopathie diabétique en Bourgogne.

INTRODUCTION: The aim of this study was to evaluate the yield of glaucoma and ocular hypertension (OHT) screening in association with diabetic retinopathy (DR) screening in a rural population. PATIENTS AND METHODS: 676 patients were screened between 2004 and 2005. The four departments the Burgundy region were visited, divided into 39 areas with sparse medical services. Each patient had fundus photographs taken with a nonmydriatic camera and IOP measurement in each eye with a noncontact tonometer. Optic discs were classified into suspect or normal. RESULTS: On the 676 screened patients, 41 presented an anomaly (6.1%): 31 with OHT (4.6%), 7 with a suspect optic disc (1.0%), and 3 with both anomalies (0.4%). After further control, we finally found 4 cases of OHT (0.6%) and 8 cases of glaucoma (1.2%). This screening program allowed the diagnosis of 2 new cases of OHT (0.3%) and 4 new cases of glaucoma (0.6%). DISCUSSION: This screening improved the quality of the ophthalmic follow-up in rural areas for diabetics. Furthermore, it is a simple and not more expensive way to screen for OHT and glaucoma in these populations. CONCLUSION: The itinerant screening of OHT and glaucoma combined with a diabetic retinopathy screening is effective. The screening campaign was renewed for 2 years in semi-rural zones.

[Screening diabetic retinopathy in Burgundy with an itinerant nonmydriatic camera]. / Dépistage de la rétinopathie diabétique en Bourgogne par un rétinographe non mydriatique itinérant.

INTRODUCTION: The aim of this study was to assess the suitability of screening diabetic retinopathy (DR) with an itinerant nonmydriatic camera. METHODS: This program required collaboration between ophthalmologists and general practitioners. Three professional organizations gave their support: L'union Professionnelle des Médecins Libéraux de Bourgogne (UPMLB), le Fonds d'Aide à la Qualité des Soins de Ville (FAQSV), et la Fédération des Associations des Diabétiques de Bourgogne (FADB). The screening programm took place from November 2004 to June 2005 throughout the Burgundy region. General practitioners, health professionals (pharmacists, nurses), local media, and health insurance offices informed patients of the DR screening. An orthoptist took photographs with a nonmydriatic digital camera. Each patient had four fundus photographs without pupillary dilatation. Photographs were analyzed in the Department of Ophthalmology of Dijon's General Hospital. RESULTS: In this study, 676 diabetic patients were screened. Among these patients, 58 had DR, exclusively nonproliferative retinopathies. Nine percent of the photographs were ungradable. The mean age of patients with DR was 65 years. The mean onset of diabetes was 18 years before the study. Insulin therapy was followed by 27 patients (46.6%). Hemoglobin A1c was known in 26 patients (44.8%), with a mean value of 8.14%. Nearly 60% of patients with DR did not have their recommended annual consultation. After screening, 84% of patients consulted an ophthalmologist. CONCLUSION: Screening DR with an itinerant nonmydriatic camera can improve ophthalmologic follow-up of diabetics in rural areas. This screening program has continued in 2006 with an adapted vehicle.

[Using discharge abstracts as a tool to assess a regional perinatal network]. / Evaluation régionale en périnatalité: mise en place d'un recueil continu d'indicateurs.

To assess the regional perinatal network of Burgundy (20 obstetrical units; 18,000 births/year), discharge abstracts are collected for all mothers and all neonates. Discharge abstracts are expanded with some additional data. According to the French law, data are rendered anonymous in each hospital before their transmission to the teaching hospital for statistical analysis. The linkage of all anonymous information concerning a patient is obtained. Moreover, this specific procedure allows the linkage of data concerning each mother and her corresponding neonate. This study shows that after an expanded data quality control, the linkage between data of the mothers and their infants is obtained in 99.8% of births.

[Current networks in perinatal care. From practice to theory...]. / Réseaux actuels en périnatalité. De la pratique à la théorie....

Perinatal care networks have been organized in a conventional way in six different French areas. This paper describes the four successive steps of this organization: description of the perinatal dysfunctions through survey(s), elaboration of medical recommendations, set up of a new organization, evaluation of the efficiency of the new organization.

[Modelling of length of stay and costs in 2 homogeneous groups of hematological and pneumological patients: clinical characterization of patients with long-stay and high costs]. / Modélisation de la distribution des durées de séjour et des coûts dans deux groupes homogènes de malades d'hématologie et de pneumologie: caractérisation clinique des patients de longue durée et de coût élevé.

After the implementation of the Medicare Prospective Payment System (PPS) in the USA, many European countries like France have introduced DRGs to curb hospital overspending. However, there has been some reluctance from hospital actors, especially because of the heterogeneous nature of DRG's. To analyse this situation, we propose a method based on distribution modelization of length of stays and costs within DRGs. For each DRG, the model is based on a mixture of Poisson and Weibull distributions identified as subgroups. The subgroups are characterized by their means and their proportions which are estimated by maximization of data likelihood. For a particular DRG, the proportion of long stay or high-cost patients can be explained by the introduction of clinical variables in the model. First the model was applied to the DRG "leukemia and lymphoma" (HCFA V.3), using 133 discharge abstract files from the Dijon public teaching hospital which were classified into this DRG in 1993. Among the studies parameters only acute leukemia, neutropenia < 500 PNN/mm3, high dose aplastic chemotherapy, central venous catheterization, parenteral nutrition, use of protected or laminar air flow room, septicemia, large spectrum intravenous antibiotherapy, and blood transfusion had a significant influence on the distribution of the patients in the long stay or costly subgroup. Second, for DRG "chronic bronchopneumopathies" (n = 220) the significant parameters were mechanical ventilation, antibiotherapy, post hospitalization medicalized care.