Barriers encountered with clinical data warehouses: Recommendations from a focus group.

BACKGROUND AND OBJECTIVE: The increasing implementation and use of electronic health records over the last few decades has made a significant volume of clinical data being available. Over the past 20 years, hospitals have also adopted and implemented data warehouse technology to facilitate the reuse of administrative and clinical data for research. However, the implementation of clinical data warehouses encounters a set of barriers: ethical, legislative, technical, human and organizational. This paper proposes an overview of difficulties and barriers encountered during a clinical data warehouse (CDW) development and implementation project. METHODS: We conducted a focus group at the 2023 Medical Informatics Europe Conference and invited professionals involved in the implementation of CDW. These experts described their CDW and the difficulties and barriers they encountered at each phase: (i) launching of the data warehouse project, (ii) implementing the data warehouse and (iii) using a data warehouse in routine operations. They were also asked to propose solutions they were able to implement to address the barriers previously reported. RESULTS: After synthesis and consensus, a total of 26 barriers were identified, 10 pertained to tasks, 5 to tools and technologies, 4 to persons, 4 to organization, and 3 to the external environment. To address these challenges, a set of 15 practical recommendations was offered, covering essential aspects such as governance, stakeholder engagement, interdisciplinary collaboration, and external expertise utilization. CONCLUSIONS: These recommendations serve as a valuable resource for healthcare institutions seeking to establish and optimize CDWs, offering a roadmap for leveraging clinical data for research, quality enhancement, and improved patient care.

Midterm complications after primary obstetrical anal sphincter injury repair in France.

BACKGROUND: Incidence of complications following obstetrical anal sphincter injury (OASI) during vaginal delivery are poorly defined. They are only studied in high level maternities, small cohorts, all stages of perineal tear or in low-income countries. The aim of our study was to describe complications after primary OASI repair following a vaginal delivery in all French maternity wards at short and midterm and to assess factors associated with complication occurrence. METHODS: We conducted a historical cohort study using the French nationwide claim database (PMSI) from January 2013 to December 2021. All women who sustained an OASI repair following a vaginal delivery were included and virtually followed-up for 2 years. Then, we searched for OASIS complications. Finally, we evaluated factors associated with OASIS complication repaired or not and OASIS complication repairs. RESULTS: Among the 61,833 included women, 2015 (2.8%) had an OASI complication and 842 (1.16%) underwent an OASI complication repair. Women were mainly primiparous (71.6%) and 44.3% underwent an instrumental delivery. During a follow-up of 2 years, 0.6% (n = 463), 0.3% (n = 240), 0.2% (n = 176), 0.1% (n = 84), 0.06% (n = 43) and 0.01% (n = 5) of patients underwent second surgery for a perineal repair, a fistula repair, a sphincteroplasty, a perineal infection, a colostomy and a sacral nervous anal stimulation, respectively. Only one case of artificial anal sphincter was noticed. Instrumental deliveries (OR = 1.56 CI95%[1.29;1.9]), private for-profit hospitals (OR = 1.42 [1.11;1.82], reference group "public hospital"), obesity (OR = 1.36 [1;1.84]), stage IV OASIS (OR = 2.98 [2.4;3.72]), perineal wound breakdown (OR = 2.8 [1.4;5.48]), ages between 25 and 29 years old (OR = 1.59 [1.17;2.18], refence group "age between 13 and 24 years old") and 30 and 34 years old (OR = 1.57 [1.14; 2.16], refence group "age between 13 and 24 years old") were factors associated with OASIS complication repairs. CONCLUSIONS: Maternal age, stage IV OASIS, obesity, instrumental deliveries and private for-profit hospitals seemed to predict OASIS complications. Understanding factors associated with OASIS complications could be beneficial for the patient to inform them and to influence the patient's follow-up in order to prevent complications, repairs and maternal distress.

Variations in Dispensing Psychotropic Drugs to Adolescents Depending on School Periods: A French Nationwide Retrospective Study.

Seasonality patterns are reported for various psychiatric disorders. Concerning adolescents, there is an increased frequency of general emergency department visits for mental health disorders observed between March and May, as well as in October and November. We conducted a retrospective cohort study using the French health insurance medico-administrative database. We extracted psychotropic drug deliveries occurring between 2015 and 2019 for patients aged between 12 and 18 years old. Each drug delivery was classified as occurring during a school period (Sc), the summer holidays (SumH) or other shorter holidays periods (ShH). We compared the number of distinct patients, as well as the proportion of new consumers, according to week status. Anxiolytics and hypnotics were more frequently dispensed during the school periods and short breaks than during the summer holidays. Conversely, antidepressants were more commonly dispensed during the short breaks rather than school periods and summer holidays. The stressful effects induced by schooling appear to be addressed in the first line by anxiolytics and hypnotics, while antidepressants are more frequently introduced during school holidays.

Data Lake, Data Warehouse, Datamart, and Feature Store: Their Contributions to the Complete Data Reuse Pipeline.

Unlabelled: The growing adoption and use of health information technology has generated a wealth of clinical data in electronic format, offering opportunities for data reuse beyond direct patient care. However, as data are distributed across multiple software, it becomes challenging to cross-reference information between sources due to differences in formats, vocabularies, and technologies and the absence of common identifiers among software. To address these challenges, hospitals have adopted data warehouses to consolidate and standardize these data for research. Additionally, as a complement or alternative, data lakes store both source data and metadata in a detailed and unprocessed format, empowering exploration, manipulation, and adaptation of the data to meet specific analytical needs. Subsequently, datamarts are used to further refine data into usable information tailored to specific research questions. However, for efficient analysis, a feature store is essential to pivot and denormalize the data, simplifying queries. In conclusion, while data warehouses are crucial, data lakes, datamarts, and feature stores play essential and complementary roles in facilitating data reuse for research and analysis in health care.

Prolonged increase in psychotropic drug use among young women following the COVID-19 pandemic: a French nationwide retrospective study.

BACKGROUND: The COVID-19 pandemic has had a significant impact on mental health, with evidence suggesting an enduring mental health crisis. Studies worldwide observed increased usage of antidepressants, anxiolytics, and hypnotics during the pandemic, notably among young people and women. However, few studies tracked consumption post-2021. Our study aimed to fill this gap by investigating whether the surge in the number psychotropic drug consumers in France persisted 2 years after the first lockdown, particularly focusing on age and gender differences. METHODS: We conducted a national retrospective observational study based on the French national insurance database. We retrieved all prescriptions of anxiolytics, hypnotics, and antidepressants dispensed in pharmacies in France for the period 2015-2022. We performed interrupted time series analyses based on Poisson models for five age classes (12-18; 19-25; 26-50; 51-75; 76 and more) to assess the trend before lockdown, the gap induced and the change in trend after. RESULTS: In the overall population, the number of consumers remained constant for antidepressants while it decreased for anxiolytics and hypnotics. Despite this global trend, a long-term increase was observed in the 12-18 and 19-25 groups for the three drug classes. Moreover, for these age classes, the increases were more pronounced for women than men, except for hypnotics where the trends were similar. CONCLUSIONS: The number of people using antidepressants continues to increase more than 2 years after the first lockdown, showing a prolonged effect on mental health. This effect is particularly striking among adolescents and young adults confirming the devastating long-term impact of the pandemic on their mental health.

Home Care Nursing on Long-Term Illness Management in the French Healthcare System.

This study explores the role of home care nurses in managing long-term illnesses (L-TI) within the French healthcare system, utilizing data from the SNDS. Focused on data from 2022, it categorizes nursing actions into medical procedures, care procedures, and nursing processes, revealing significant involvement in patient care. The findings highlight the crucial, evolving role of home care nurses in addressing the complex needs of millions suffering from chronic conditions like diabetes and cardiovascular diseases in France.

Proton pump inhibitors, bone and phosphocalcic metabolism.

Proton pump inhibitors (PPIs) are widely used for acid-related gastrointestinal disorders; however, concerns have arisen about their prolonged and inappropriate use. Although generally considered safe, recent evidence has linked PPI use with an increased risk of kidney disease, stomach cancer, pneumonia, dementia, cardiovascular events and potential bone health problems. This systematic review examines the effects of PPIs on bone health, including osteoporosis and changes in phosphocalcic and magnesium metabolism, through a comprehensive analysis of the recent literature. The relationship between PPIs, bone mineral density and fracture risk, especially in populations with comorbidities, is complex and we propose a focus based on recent data. Studies of the effect of PPI use on bone mineral density have shown mixed results and require further investigation. Observational studies have indicated an increased risk of fractures, particularly vertebral fractures, associated with PPI use. Recent meta-analyses have confirmed an association between PPI use and hip fractures with a dose-dependent effect. More recently, PPIs have been associated with serious disturbances in phosphocalcic and magnesium metabolism that require careful management and discontinuation. Proton pump inhibitor-induced hypomagnesemia (PPIH) is a well-established phenomenon. In addition, hypocalcemia secondary to severe hypomagnesemia has been described. Despite growing evidence of PPI-related risks, further research is essential to better understand the complex mechanisms, as most data are from observational studies and do not establish a causal relationship. This review emphasizes the need for judicious prescription practices, particularly in long-term use scenarios and rheumatological contexts.

Pattern of encounters to emergency departments for suicidal attempts in France: Identification of high-risk days, months and holiday periods.

INTRODUCTION: Seasonal change in patterns of suicidal attempts is not well known in France and may differ from other western countries. We aimed to determine the peak times (days, months and holiday periods) of suicidal attempts in France. METHODS: We carried out a multicentre retrospective epidemiological study, using data from the Organization for Coordinated Monitoring of Emergencies (OSCOUR®) network. We aggregated daily data from January 1, 2010, to December 31, 2019. Variations in suicidal attempts on specific days were investigated by comparing their frequencies (ad hoc Z-scores). RESULTS: 114,805,488 ED encounters were recorded including 233,242 ED encounters regarding suicidal attempts. Men accounted for 45.7%. A significantly higher frequency of ED encounters for suicidal acts were found on Sundays in the months of May-June for both sexes and on New Year's Day for all genders and age groups. An increased risk was also noted on July 14th (National Day) and June 22nd (Summer Solstice). A protective effect was noted on the day after Valentine's Day, on Christmas Day and Christmas time (in particular December 24 and 26). CONCLUSION: Sundays, June, New Year's Day were at increased risk of suicidal attempts in France requiring a strengthening of prevention.

Association between sarcopenia and risk of major adverse cardiac and cerebrovascular events-UK Biobank database.

BACKGROUND: Few studies on the risk of incident major adverse cardiac and cerebrovascular events (MACCEs) in sarcopenia have been reported. The objective was to assess the association between presarcopenia and sarcopenia and a higher risk of MACCEs. METHODS: This study on the UK Biobank prospective cohort, used data collected between 2006 and 2021. Community-dwelling Caucasian participants aged 37 to 73 years were included if values for Handgrip Strength (HGS) and Skeletal Muscle Index (SMI) were available and if no history of MACCEs was reported. Exposure was assessed using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle strength was measured using HGS, and muscle mass using the SMI. Presarcopenia was defined through the two definitions available in the literature, as low HGS with normal SMI and as normal HGS with low SMI, whereas sarcopenia was defined as low HGS with low SMI. The main outcome was to determine whether presarcopenia and/or sarcopenia were predictors of MACCEs (composite events). RESULTS: A total of 406,411 included participants (women: 55.7%) were included. At baseline, there were 18,257 (4.7%) presarcopenics-subgroup n°1 (low HGS only), 7940 (2.1%) presarcopenics-subgroup n°2 (low SMI only), and 1124 (0.3%) sarcopenics. Over a median follow-up of 12.1 years (IQR: [11.4; 12.8]), 28,300 participants (7.0%) were diagnosed with at least one event. Compared to NonSarc, presarcopenic (subgroups n°1 and n°2) and sarcopenic status were significantly associated with a higher risk of MACCEs (respectively fully adjusted HRs: HR = 1.25 [95% CI: 1.19; 1.31], HR = 1.33 [95% CI: 1.23; 1.45] and HR = 1.62 [95% CI: 1.34; 1.95]). CONCLUSIONS: In a community-dwelling population, the risk of MACCEs was higher in both presarcopenic and sarcopenic participants.

The Sauvé-Kapandji procedure for post-traumatic distal radio-ulnar arthrosis: Long-term results and analysis of risks factors for revision surgery.

INTRODUCTION: The Sauvé-Kapandji (SKp) procedure is a frequently used surgery for the management of post-traumatic sequelae of the distal radio-ulnar joint (DRU). Series evaluating long-term outcomes and the risk of complications are rare. The main objective was to describe the long-term clinical and radiographic results after SKp performed in a post-traumatic context. The secondary objectives were to identify postoperative complications, surgical revisions, and their risk factors for occurrence. Our hypothesis was that although SKp confers good clinical results, identifiable risk factors for complications exist. PATIENTS AND METHODS: This monocentric retrospective study included all patients for whom an SKp was performed in a post-traumatic context from 2008 to 2018. Pain, satisfaction, range of motion and pre- and postoperative radiographic measurements were recorded. All complications were sought and described, as well as surgical revisions. Several variables were analysed to identify risk factors for revision surgery after SKp: age, sex, initial traumatic mechanism, initial non-surgical or surgical treatment and type of surgery, time until revision surgery with SKp after the initial trauma. RESULTS: Thirty-seven patients were included. At a median follow-up of 9.5 years (min 7.3-max 11.5), 22 patients (60%) had a VAS of 0. Range of motion was significantly improved for all the patients (p<0.001). Seventeen (46%) patients had a complication, including 5 (13.4%) cases of ossification, 4 (10.8%) cases of discomfort related to the hardware and 4 (10.8%) painful instability at the proximal ulnar stump. Thirteen (35%) patients required revision surgery. Two risk factors for revision surgery after SKp were found: time period between initial treatment and SKp of less than 7.2 months and an age of less than 53.5 years; the combination of the two factors having a sensitivity of 97.5 and a specificity of 56.7. CONCLUSION: SKp in a post-traumatic context significantly improved range of motion and allowed pain control at long follow-up. Revision surgery seemed more frequent in patients under 53.5 years of age and when SKp was performed less than 7.2 months after the initial trauma. LEVEL OF EVIDENCE: IV, retrospective study.

Management of medial femorotibial osteoarthritis: Epidemiology, and survival of unicompartmental knee arthroplasty versus valgus high tibial osteotomy in France. Study of 108,007 cases from the French National Hospitals Database.

INTRODUCTION: Unicompartmental knee arthroplasty (UKA) and valgus high tibial osteotomy (HTO) are two options for isolated medial femorotibial osteoarthritis in genu varum. In the absence of registries for osteotomies and for arthroplasty in the knee, epidemiological data are hard to obtain in France. We therefore performed a retrospective study, with the aims of: 1) estimating UKA and HTO survival without revision by total knee arthroplasty (TKA), and 2) assessing risk factors for revision according to treatment group. HYPOTHESIS: Medium-term survival is better with HTO than UKA in under-70-year-olds. MATERIALS AND METHOD: All elderly patients undergoing HTO or UKA in the French National Hospitals Database for the period 2011-2020 were included: i.e., 108,007 patients; 43,537 HTO (29,330 male, 14,207 female; mean age 49.7 years, 95% CI 49.6-49.8) and 64,470 UKA (31,181 male, 33,289 female; mean age 60.5 years, 95% CI 60.5-60.6). RESULTS: Survival free of revision by TKA was 75.8% (95% CI=75.2-76.4) for UKA and 80.6% (95% CI=80.0-81.3) for HTO (p<0.00001). In UKA, revision risk factors comprised: low annual center volume (<17 UKAs per year) (HR=1.50; 95% CI=1.41-1.59), obesity (HR=1.25; 95% CI=1.18-1.32), and age <60years, with maximum risk for 50-59years (HR=2.41; 95% CI=1.83-3.16 in 50-59 year-olds). In HTO, revision risk factors comprised: obesity (HR=1.42; 95% CI=1.31-1.53), rheumatoid arthritis (HR=2.75; 95% CI=1.37-5.51), joint chondrocalcinosis (HR=2.01; 95% CI=1.18-3.39), and age >60years (HR=8.81; 95% CI=7.23-19.73 in 60-69-year-olds). Male gender was a protective factor against revision in both groups: UKA, HR=0.75 (95% CI=0.72-0.79); HTO, HR=0.73 (95% CI=0.69-0.77). The number of UKAs increased over the years, matching the increase in arthroplasty in France, with a decrease in HTOs until 2019. CONCLUSION: HTO showed better medium-term survival than UKA in under-70-year-olds in France. Even so, indications decreased in favor of UKA, although the respective risk factors differ. These findings suggest that conservative surgery still has a role, depending on osteoarthritis stage. LEVEL OF EVIDENCE: III; retrospective comparative study.

Suicide and All-Cause Mortality Within 1 Year After a Suicide Attempt in the VigilanS Cohort.

Objective: Obtaining better knowledge on the outcomes of patients who attempt suicide is crucial for suicide prevention. The aim of our study was to determine the causes of death 1 year after a suicide attempt (SA) in the VigilanS program, mortality rates, and risk factors associated with any cause of death and suicide.Methods: A prospective cohort of 7,406 people who had attempted suicide between January 1, 2017, and December 31, 2018, was included in the study. The vital status of each participant was sought, and the cause of death was established through a phone call to their general practitioner or psychiatrist. Second, the relationship between sociodemographic and clinical factors and death by suicide within 1 year of an SA was assessed using a multivariable Cox model.Results: At 1 year, 125 (1.7%) participants had died, 77 of whom died by suicide. Half of the deaths occurred within the first 4 months after an SA. Hanging (20.3%; 24/125) and self-poisoning (19.5%; 23/125) were the methods the most often used for suicide. We demonstrated that male sex (HR = 1.79 [1.13-2.82], P = .01) and being 45 years of age or older (between 45 and 64 years old, HR = 2.08 [1.21-3.56], P < .01; 65 years or older, HR = 5.36 [2.72-10.54], P < .01) were associated with a higher risk of death by suicide 1 year after an SA and that being younger than 25 years was associated with a lower risk (HR = 0.22 [0.07-0.76], P = .02).Conclusions: One out of 100 people who attempted suicide died by suicide within 1 year after an SA. Greater vigilance is required in the first months following an SA, especially for males older than 45 years.Trial Registration: ClinicalTrials.gov identifier: NCT03134885.

Association Between Sarcopenia and Fracture Risk in a Population From the UK Biobank Database.

Studies on the fracture risk in presarcopenic and sarcopenic patients report contradictory results. The objective was to assess whether presarcopenia and sarcopenia are associated with an increase in fracture risk. We conducted a retrospective study using the UK Biobank cohort and the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle strength was evaluated using hand-grip strength (HGS) and muscle mass using the skeletal muscle index (SMI; from bioimpedance analysis). Presarcopenia was defined through the two definitions available in the literature, as low HGS with normal SMI and as normal HGS with low SMI, and sarcopenia as low HGS and low SMI. Fracture events were recorded as "fracture" (location compatible with an osteoporotic origin) and "major osteoporotic fracture" (MOF), as listed in the FRAX tool. Associations were assessed using Cox proportional hazards models, adjusted for sarcopenia and osteoporosis risk factors. Adjusted hazard ratios (HRa ) and their 95% confidence intervals (CI) were reported. A total of 387,025 participants (women 54.4%; median age 58.0 years; interquartile range [IQR] 51.0-63.0 years) were included. At baseline, there were 18,257 (4.7%) presarcopenic participants-subgroup 1 (low HGS only), 7940 (2.1%) presarcopenic participants-subgroup 2 (low SMI only), and 1124 (0.3%) sarcopenic participants. Over a median follow-up of 12.0 years (IQR 11.4-12.6 years), 18,300 (4.7%) participants were diagnosed with at least one incident fracture. Presarcopenic (subgroups 1 and 2) and sarcopenic status were significantly associated with a higher risk of fracture (respectively adjusted HRs: HR = 1.26 [1.19-1.33], HR = 1.20 [1.11-1.30], HR = 1.30 [1.08-1.56]) and with a higher risk of MOF (respectively adjusted HRs: HR = 1.30 [1.21-1.40], HR = 1.19 [1.08-1.72], HR = 1.18 [0.93-1.49]). In a middle-aged population, the fracture and MOF risks were higher in both presarcopenic and sarcopenic participants compared with nonsarcopenic participants. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Migration of di(2-ethylhexyl) phthalate, diisononylcyclohexane-1,2-dicarboxylate and di(2-ethylhexyl) terephthalate from transfusion medical devices in labile blood products: A comparative study.

BACKGROUND AND OBJECTIVES: Polyvinyl chloride (PVC) plasticized with di(2-ethylhexyl) phthalate (DEHP) is a widely used material for medical transfusion devices. Not covalently bound to PVC, DEHP can migrate into blood products during storage. Recognized as an endocrine disruptor and raising concerns about its potential carcinogenicity and reprotoxicity, DEHP is gradually being withdrawn from the medical device market. Therefore, the use of alternative plasticizers, such as diisononylcyclohexane-1,2-dicarboxylate (DINCH) and di(2-ethylhexyl) terephthalate (DEHT), as potential candidates for the replacement of DEHP in medical transfusion devices has been investigated. The purpose of this study was to evaluate the quantity of PVC-plasticizers in the blood components according to their preparation, storage conditions and in function of the plasticizer. MATERIALS AND METHODS: Whole blood was collected, and labile blood products (LBPs) were prepared by the buffy-coat method with a PVC blood bag plasticized either with DEHP, DINCH or DEHT. DINCH and DEHT equivalent concentrations were quantified in LBPs by liquid chromatography-tandem mass spectrometry or coupled with UV and compared to DEHP equivalent concentrations. RESULTS: The plasticizer equivalent concentration to which a patient is exposed during a transfusion depends on the preparation of LBPs as well as their storage conditions, that is, temperature and storage time. At day 1, for all LBPs, the migration of DEHP is 5.0 and 8.5 times greater than DINCH and DEHT, respectively. At the end of the 49 days storage period, the DEHP equivalent concentration in red blood cells concentrate is statistically higher when compared to DINCH and DEHT, with maximal values of 1.85, 1.13 and 0.86 µg/dm2 /mL, respectively. CONCLUSION: In addition to lower toxicity, transfused patients using PVC-DEHT or PVC-DINCH blood bags are less exposed to plasticizers than using PVC-DEHP bags with a ranging exposure reduction from 38.9% to 87.3%, due to lower leachability into blood components.

Standardized Description of the Feature Extraction Process to Transform Raw Data Into Meaningful Information for Enhancing Data Reuse: Consensus Study.

BACKGROUND: Despite the many opportunities data reuse offers, its implementation presents many difficulties, and raw data cannot be reused directly. Information is not always directly available in the source database and needs to be computed afterwards with raw data for defining an algorithm. OBJECTIVE: The main purpose of this article is to present a standardized description of the steps and transformations required during the feature extraction process when conducting retrospective observational studies. A secondary objective is to identify how the features could be stored in the schema of a data warehouse. METHODS: This study involved the following 3 main steps: (1) the collection of relevant study cases related to feature extraction and based on the automatic and secondary use of data; (2) the standardized description of raw data, steps, and transformations, which were common to the study cases; and (3) the identification of an appropriate table to store the features in the Observation Medical Outcomes Partnership (OMOP) common data model (CDM). RESULTS: We interviewed 10 researchers from 3 French university hospitals and a national institution, who were involved in 8 retrospective and observational studies. Based on these studies, 2 states (track and feature) and 2 transformations (track definition and track aggregation) emerged. "Track" is a time-dependent signal or period of interest, defined by a statistical unit, a value, and 2 milestones (a start event and an end event). "Feature" is time-independent high-level information with dimensionality identical to the statistical unit of the study, defined by a label and a value. The time dimension has become implicit in the value or name of the variable. We propose the 2 tables "TRACK" and "FEATURE" to store variables obtained in feature extraction and extend the OMOP CDM. CONCLUSIONS: We propose a standardized description of the feature extraction process. The process combined the 2 steps of track definition and track aggregation. By dividing the feature extraction into these 2 steps, difficulty was managed during track definition. The standardization of tracks requires great expertise with regard to the data, but allows the application of an infinite number of complex transformations. On the contrary, track aggregation is a very simple operation with a finite number of possibilities. A complete description of these steps could enhance the reproducibility of retrospective studies.

GPs' interest in integrated care for frail older adults and corresponding consulting and prescribing data: qualitative and quantitative analyses of the PAERPA integrated care project.

BACKGROUND: Integrated care pathways can help to avoid unnecessary admissions to hospital and improve the overall quality of care for frail older patients. Although these integrated care pathways should be coordinated by GPs their level of commitment may vary. AIM: To profile GPs who had participated or had declined to participate in the Personnes Agées En Risque de Perte d'Autonomie (PAERPA) integrated care project (ICP) in the Valenciennois-Quercitain area of France between 2014 and 2019. DESIGN AND SETTING: A combined qualitative and quantitative analysis of GPs who were participating in or had declined to participate in the PAERPA ICP. METHOD: Both GPs participating in the ICP and GPs who chose not to participate in the ICP were interviewed, and then consultation and prescription profiles for these two groups were compared. RESULTS: Some GPs were interested in the PAERPA ICP, whereas others were opposed. The 48 qualitative interviews revealed four issues that influenced participation in the PAERPA ICP: 1) awareness of issues in care of older adults and the value of collaborative work; 2) time saving; 3) task delegation; and 4) advantages of coordination. The level of interest in the ICP for frail older adults was indirectly reflected by the data on consulting and prescribing. In GPs who participated in the PAERPA ICP there was a greater proportion of older (aged ≥70 years) patients (P<0.05), a larger number of consultations per year (P<0.05), and a larger number of home visits (P<0.01), relative to GPs who declined to participate. CONCLUSION: The level of interest in the PAERPA ICP for frail older adults varied widely among GPs. These findings suggest that commitment to an integrated care pathway could be increased by customising the recruitment strategy as a function of the GP's profile.

Data Management for Health Data Reuse: Proposal of a Standard Workflow and a R Tutorial with Jupyter Notebook.

The data collected in the clinical registries or by data reuse require some modifications in order to suit the research needs. Several common operations are frequently applied to select relevant patients across the cohort, combine data from multiple sources, add new variables if needed and create unique tables depending on the research purpose. We carried out a qualitative survey by conducting semi-structured interviews with 7 experts in data reuse and proposed a standard workflow for health data management. We implemented a R tutorial based on a synthetic data set using Jupyter Notebook for a better understanding of the data management workflow.

Formative Assessment of Diagnostic Testing in Family Medicine with Comprehensive MCQ Followed by Certainty-Based Mark.

INTRODUCTION: The choice of diagnostic tests in front of a given clinical case is a major part of medical reasoning. Failure to prescribe the right test can lead to serious diagnostic errors. Furthermore, unnecessary medical tests are a waste of money and could possibly generate injuries to patients, especially in family medicine. METHODS: In an effort to improve the training of our students to the choice of laboratory and imaging studies, we implemented a specific multiple-choice questions (MCQ), called comprehensive MCQ (cMCQ), with a fixed and high number of options matching various basic medical tests, followed by a certainty-based mark (CBM). This tool was used in the assessment of diagnostic test choice in various clinical cases of general practice in 456 sixth-year medical students. RESULTS: The scores were significantly correlated with the traditional exams (standard MCQ), with matched themes. The proportion of "cMCQ/CBM score" variance explained by "standard MCQ score" was 21.3%. The cMCQ placed students in a situation closer to practice reality than standard MCQ. In addition to its usefulness as an assessment tool, those tests had a formative value and allowed students to work on their ability to measure their doubt/certainty in order to develop a reflexive approach, required for their future professional practice. CONCLUSION: cMCQ followed by CBM is a feasible and reliable evaluation method for the assessment of diagnostic testing.