Results of a 1-year quality-improvement process to reduce door-to-needle time in acute ischemic stroke with MRI screening.

OBJECTIVE: To determine the effects of a 1-year quality-improvement (QI) process to reduce door-to-needle (DTN) time in a secondary general hospital in which multimodal MRI screening is used before tissue plasminogen activator (tPA) administration in patients with acute ischemic stroke (AIS). METHODS: The QI process was initiated in January 2015. Patients who received intravenous (iv) tPA<4.5h after AIS onset between 26 February 2015 to 25 February 2016 (during implementation of the QI process; the "2015 cohort") were identified (n=130), and their demographic and clinical characteristics and timing metrics compared with those of patients treated by iv tPA in 2014 (the "2014 cohort", n=135). RESULTS: Of the 130 patients in the 2015 cohort, 120 (92.3%) of them were screened by MRI. The median DTN time was significantly reduced by 30% (from 84min in 2014 to 59min; P<0.003), while the proportion of treated patients with a DTN time≤60min increased from 21% to 52% (P<0.0001). Demographic and baseline characteristics did not significantly differ between cohorts, and the improvement in DTN time was associated with better outcomes after discharge (patients with a 0-2 score on the modified rankin scale: 59% in the 2015 cohort vs 42.4% in the 2014 cohort; P<0.01). During the 1-year QI process, the median DTN time decreased by 15% (from 65min in the first trimester to 55min in the last trimester; P≤0.04) with a non-significant 1.5-fold increase in the proportion of treated patients with a DTN time≤60min (from 41% to 62%; P=0.09). CONCLUSION: It is feasible to deliver tPA to patients with AIS within 60min in a general hospital, using MRI as the routine screening modality, making this QI process to reduce DTN time widely applicable to other secondary general hospitals.

MACVIA-LR (Fighting Chronic Diseases for Active and Healthy Ageing in Languedoc-Roussillon): A Success Story of the European Innovation Partnership on Active and Healthy Ageing.

The Région Languedoc Roussillon is the umbrella organisation for an interconnected and integrated project on active and healthy ageing (AHA). It covers the 3 pillars of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA): (A) Prevention and health promotion, (B) Care and cure, (C) and (D) Active and independent living of elderly people. All sub-activities (poly-pharmacy, falls prevention initiative, prevention of frailty, chronic respiratory diseases, chronic diseases with multimorbidities, chronic infectious diseases, active and independent living and disability) have been included in MACVIA-LR which has a strong political commitment and involves all stakeholders (public, private, patients, policy makers) including CARSAT-LR and the Eurobiomed cluster. It is a Reference Site of the EIP on AHA. The framework of MACVIA-LR has the vision that the prevention and management of chronic diseases is essential for the promotion of AHA and for the reduction of handicap. The main objectives of MACVIA-LR are: (i) to develop innovative solutions for a network of Living labs in order to reduce avoidable hospitalisations and loss of autonomy while improving quality of life, (ii) to disseminate the innovation. The three years of MACVIA-LR activities are reported in this paper.

[Coding problems in medical information in the framework of the medicalization of the hospital information system]. / Problèmes posés par le codage de l'information médicale dans le cadre du programme de médicalisation du système d'information hospitalier.

The authors review the difficulties presented by the description of medical data, on the basis of the french experience with the programme to medicalize the hospital information system. They explain the different steps in preparing a hospital discharge abstract, and the difficulties presented by each one. They particularly stress the phase of hierarchization in choosing the principal diagnosis. They propose some solutions to improve data quality and an approach based on medical practice patterns.

[Prediction of the response to basic treatment in rheumatoid polyarthritis. Retrospective study apropos of 140 patients]. / Prédiction de la réponse au traitement de fond au cours de la polyarthrite rhumatoïde. Etude rétrospective à propos de 140 patients.

In order to isolate prognostic factors of the response to basic treatment in the course of rheumatoid arthritis (RA), the authors are comparing, within the scope of a retrospective study of 140 patients, the initial clinical, biological and radiological characteristics of two populations of 70 "responding" and "non responding" patients at the end of a mean course of 48.8 months. As there are significantly more males in the "responding" group, two different statistical studies are conducted for male and female patients. The first stage of the analysis enables to select a certain number of average variables or of very different distribution between "responding" and "non responding". The second stage enables, with the help of these variables, to conduct an analysis of the main components: a satisfactory discrimination between "responding and non responding" may thus be obtained for male patients; this is not confirmed for female patients, probably because this population is heterogeneous. The last stage consists in a discriminating, step-by-step ascending analysis conducted on the male population; a discriminating function is then established, permitting to differentiate correctly 82 p. cent of the patients between "responding" and "non responding". Finally, a prognostic index, easier to use, is also established, using five discriminating variables for male patients, permitting to differentiate correctly 87 p. cent of the patients.