Regional disparities in acute and post-acute care of stroke patients in France, 2015.

OBJECTIVE: The aim of this study was to assess regional variations of the hospital management of stroke patients during acute and post-acute phases in France in 2015. MATERIAL AND METHODS: Hospitalized patients coded with stroke as their main diagnosis or, if hospitalized in several different wards, any main ward diagnosis were identified in the 2015 French national hospital discharge database for acute care. Rates of hospitalization in stroke units (SUs) were assessed at a national level and in all metropolitan and overseas regions. All stroke survivors discharged at the end of the acute phase were subsequently identified in the national database for post-acute rehabilitation hospitalization (PARH) within 3 months. RESULTS: In the acute phase, half the stroke patients hospitalized for intracerebral hemorrhage, cerebral infarction or unspecified stroke were admitted to SUs. However, there were variations across metropolitan regions (from 30% to 69%) and in overseas regions (from 1% to 59%); these rates correlated with regional ratios of SU beds/100,000 inhabitants. There were also regional differences in PARH rates-in hemiplegic stroke patients, 62% were admitted for PARH (range: 58% to 67%) in metropolitan regions and, overseas, from 8% to 67%-as well as geographical discrepancies in PARH rates to specialized rehabilitation units. Hospitalization rates of hemiplegic stroke patients in neurological rehabilitation centers were 30% for the whole country, but ranged from 23% to 36% in metropolitan regions and from 2% to 45% in overseas regions. CONCLUSION: This study focused on hospital-based management of stroke patients. In spite of the creation of new SUs over the past decade in France, there are persistent regional differences in the number of SU beds/100,000 inhabitants and, consequently, in the rate of stroke patients managed in SUs. However, rates continue to improve with the creation of new SUs and the expansion of existing ones. Regional variations were also noted for post-acute hospitalization rates and PARH beds/places.

[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.

[French modalities of myocardial revascularisation in 2001]. / Modalités de la revascularisation myocardique en France en 2001.

UNLABELLED: French modalities of myocardial revascularization were unknown, whereas beneficial effect on outcome was controversial. The study describes current practices in 2001 and analyzes those data according to regional coronary heart disease incidence and mortality. METHODS: Data are obtained from the French hospital national database (PMSI). Mortality is obtained from French mortality registry, and myocardial infarction incidence is estimated with French registries of MONICA project. RESULTS: Myocardial revascularization utilization fluctuate from 25% of patients hospitalized for coronary disease in Limousin to more than 40% of patients in Provence-Alpes-Côte d'Azur (PACA), Languedoc-Roussillon and Ile-de-France. Standardized rate per 100,000 individuals is 109 in Pays de la Loire and 309 in Corse. Medical care offers seem to influence the practice. In the six regions where the rates are the lower, the density of interventional unit and on-pump center are below the national average, and the cardiologist density is very low. Consequences on regional clinical outcome of coronary heart disease are discussed based on mortality rate and levels of evidenced based medicine in myocardial revascularization. CONCLUSION: For the first time, we describe a wide variation of regional practices for myocardial revascularization in France. A part of those variations can be attributed to regional differences in medical care offers. Finally, the impact on clinical outcome appears clearly but seems limited. Cardiovascular prevention strategy remains of first line importance and emphasizes this main mission of cardiologists.

A Web terminology server using UMLS for the description of medical procedures.

The Model for Assistance in the Orientation of a User within Coding Systems (MAOUSSC) project has been designed to provide a representation for medical and surgical procedures that allows several applications to be developed from several viewpoints. It is based on a conceptual model, a controlled set of terms, and Web server development. The design includes the UMLS knowledge sources associated with additional knowledge about medico-surgical procedures. The model was implemented using a relational database. The authors developed a complete interface for the Web presentation, with the intermediary layer being written in PERL. The server has been used for the representation of medico-surgical procedures that occur in the discharge summaries of the national survey of hospital activities that is performed by the French Health Statistics Agency in order to produce inpatient profiles. The authors describe the current status of the MAOUSSC server and discuss their interest in using such a server to assist in the coordination of terminology tasks and in the sharing of controlled terminologies.

[Prolonged clinical remission of cholangitis in early human immunodeficiency virus infection after surgical biliary derivation]. / Rémission clinique prolongée d'une cholangite observée à un stade précoce de l'infection par le virus de l'immunodéficience humaine après dérivation biliaire chirurgicale.

During the acquired immunodeficiency syndrome, most cases of cholangitis develop at an advanced stage of disease. We report a case of cholangitis in a 47-year-old homosexual man, stage IIa according to Center of Disease Control classification. An isolated jaundice was the first manifestation of the disease. The number of CD4 was 380/microL. Ultrasonography and endoscopic retrograde cholangiography showed a 7 cm stenosis of the common bile duct, and cystic duct stenosis, with associated intra-hepatic biliary duct dilatation. No infectious agent was found. Cholecystectomy and hepaticojejunostomy were performed. Pathological examination of liver biopsy and a sample of the resected common bile duct was consistent with sclerosing cholangitis. The postoperative course was uneventful. During a three year follow-up period, the patient was disease free but he suddenly died of uncontrolled bleeding from duodenal ulcer. In HIV-infected patients, surgical treatment can be performed in case of symptomatic long stenosis of the common bile duct.

[Clinical and radiological aspects of tuberculous splenic abscesses. Presentation of 3 cases]. / Aspects cliniques et radiologiques des abcès spléniques tuberculeux. Présentation de trois cas.

Tuberculous splenic abscess is an exceptional disease with silent presentation in disseminated tuberculosis infection. Imaging procedures allow to suspect this diagnosis in case of multilocular nodules of the spleen, or unilocular pseudotumoral macronodule. We report three cases of tuberculous splenic abscesses in two patients with acquired immunodeficiency syndromes and one with polycythemia vera. Under antituberculous treatment, clinical evolution was good with regression of the radiological features.

[Benign mucus-secreting tumors of the appendix. Six cases]. / Tumeurs mucosécrétantes bénignes de l'appendice. Six observations.

The authors report six cases of mucus-secreting tumor of the vermicular appendix, in four women and two men (mean age 59 years). All were benign. Pain in the right lower quadrant was the initial sign in 4 cases, while the mucus-secreting tumor was an incidental finding in the other two cases. A mass was palpated in the right lower quadrant in one case. A barium enema was performed in four cases and showed an extrinsic compression of the caecal base in one case, and of the right colon in another case. Four appendectomies, one associated with removal of the adjacent caecal tissues and two right colectomies were performed. Analysis of these six cases and a review of the literature allow us to recall the histologic classification of these tumors, which determines the prognosis and to emphasize the sonographic and CT scan findings which might lead to earlier preoperative diagnosis in the future. Management depends upon the circumstances under which the tumor is discovered, the local anatomy, and the type of tumor. Appendectomy is the treatment most often performed. Faced with a tumor of the appendix, without histologic proof or when the local anatomic conditions increase the risk of opening an abscess, right colectomy is recommended.

A collaborative approach to building a terminology for medical procedures using a Web-based application: from specifications to daily use.

The MAOUSSC (Model for Assistance in the Orientation of a User within Coding Systems) Web server supports a collaborative work on the description of medical procedures. The specifications for the MAOUSSC application are conceptual modeling, definition of semantically fully described procedures, re-use of an existing vocabulary, the UMLS, and sharability. This paper reports on some difficulties in applying those principles in a networked building and updating of the terminology. The users are physicians who have to represent procedure terms in the MAOUSSC formalism. They must apply the constraints of the underlying model, and re-use the representation of the UMLS knowledge base. In our experience, we found that the implementation of syntactic and semantic constraints was not sufficient. Guidelines for pragmatical aspects in representation are required to make a collaborative approach in terminology building more operational.

[Therapeutic attitude in choledocoduodenal fistulas complicating duodenal ulcer]. / L'attitude thérapeutique dans les fistules cholédocoduodénales compliquant l'ulcère duodénal.

The authors present 5 observations of choledocoduodenal fistula complicating chronic duodenal ulcer disease. Four cases were observed in Central Africa, the other in France. After a study of the frequency, and especially of the higher incidence in Africa, the authors review the problems associated with the pathology, clinical and diagnostic aspects of this complication. Moreover, they evoke the essential problems of management, as based on their experience and a review of the literature: medical vs. surgical treatment, should and how they treat the biliary lesions. Their individual results are criticized. A policy for the management of this complication is considered.

[Fascicular nailing of the femur and tibia. 14 years' experience. Report of 275 cases (author's transl)]. / L'enclouage fasciculé du fémur et du tibia. 14 ans d'expérience. A propos de 275 clous.

The use of the fascicular four-pin nail has been introduced to correct certain inadequacies revealed by the rigid nailing according to Kuntscher's method; made up of four tiny pins soldered at each end, it fits the curve of the bone; its elasticity allows a much greater resistance to repeated strain as compared to other nails; an experimental study which compares the stability of fresh femurs cut then nailed according to different methods, reveals a definite superiority for the fascicular nail. The clinical use for 14 years (275 nailings among which 92 cases werefresh closed fractures of the femur) confirms that such a method provides the advantage of nailing without reaming as well as the possibility of immediate weight bearing ambulation for most patients (75% in the cases of resh femur or tibia fractures).

[Splenic rupture in chronic pancreatitis. Study of 2 cases and review of the literature]. / Les ruptures spléniques au cours des pancréatites chroniques. Etude de 2 cas et revue de la littérature.

The authors have observed 2 new cases of splenic rupture due to pancreatic pseudocyst and have made a review of the literature on the subject (40 cases). The clinical, diagnostic and therapeutic approaches of this rare but sometimes dramatic complication of chronic pancreatitis have been analyzed. Diagnosis should be suspected in the case of abdominal pain, mass and anemia in the male subject with previously known chronic pancreatic or alcoholic disease. Sonography completed by either angiography or CT scan if time permits are the best diagnostic methods. Ideal management should include treatment (excision or drainage) of the pseudocyst and splenectomy.

[Treatment of perforated duodenal ulcers (author's transl)]. / Le traitement des perforations d'ulcère duodénal.

No single therapeutic procedure exists for the treatment of perforated duodenal ulcers, and a marked degree of bias is found in published results. These studies are analysed, and a therapeutic schedule proposed which takes into account the chronicity of the ulcer lesion before perforation, the open or covered nature of the ulcer as shown by radiographic examination with a water-soluble medium, and the general condition of the patient.