Hôpital Fernand-Widal

Assessment of quality and safety indicators (QSIs) remains often based on time-consuming manual Electronic Health Record (EHR) review. As part of a pilot study to examine the feasibility of automating the calculation of French national QSIs using a Clinical Data Warehouse (CDW), we focused on the measure of door-to-imaging time (DTI time) in stroke management, i.e., the time interval between arrival at the hospital and the first stroke diagnostic imaging, through a retrospective observational study of patients hospitalized in the Greater Paris University Hospitals (AP-HP) for an acute stroke in 2022. We automatically computed the DTI time for more than 6,000 medical records in the CDW using a systematic approach and validated this method by matching the results against the manual AP-HP EHR review from the 2022 French national QSI audit. In this Matched population, CDW and manual EHR review methods agreed on estimating overall indicators, but showed discrepancies in the case-by-case analysis, mainly because of human variability both in EHR completion and manual reviewing. Automation looks promising in a context of limited professional resources but requires structured and validated data, interoperability in the case of inter-institutional stays, and validly measurable QSI.

Abstract Background and Objective Gut microbiota and social functioning are both substantially altered in individuals with severe alcohol use disorder (sAUD). Based on previous investigations of their relationship in autism spectrum disorder (ASD) and other psychiatric disorders, we investigated the interactions between gut-related measures and social functioning among sAUD patients. The social dimension has a crucial association with the risk of relapse after detoxification. Design Forty-six sAUD patients undergoing detoxification were categorized as dysbiotic or non-dysbiotic based on their gut microbiota composition, and compared with healthy controls in a cross-sectional study. Metabolomic profiles, inflammatory markers levels, dietary habits, psychological symptoms, and social functioning were compared. We applied a comprehensive assessment of social functioning combining sociodemographic data, an emotional intelligence questionnaire, a social cognition task and personal social networks (evaluated through mapping techniques). Results One third of the sAUD patients exhibited microbial alterations. The dysbiotic patients were younger, leaner, and reported higher alcohol craving compared to the non-dysbiotic patients. The dysbiotic subgroup also displayed altered metabolomic and nutritional profiles and a higher plasma IL-8 level. Interestingly, we observed a coherent profile of severe impairments across social functioning indexes in the dysbiotic group: they had lower sociability scores, displayed impairment in social cognition (with greater difficulty in spontaneously considering another’s perspective), were more often divorced/separated and unemployed, and had a smaller, less cohesive, and less diverse personal social network compared to the non-dysbiotic group. Conclusion As previously shown in ASD, we found a significant relationship between gut dysbiosis and various aspects of social functioning in sAUD. Targeting the gut microbiota could offer a novel approach to address social impairments that mediate the risk of relapse in psychiatric disorders.

BackgroundMost individuals self-excluding from gambling have lost control over their gambling behavior. Commercial solicitations are prohibited during the self-exclusion period, but resume immediately afterwards. The self-exclusion system appears insufficient, particularly for short self-exclusions and among the heaviest gamblers. We assessed the impact of extending suspension of commercial solicitations on gambling intensity.MethodsIn this parallel randomized study, we included 2548 French online gamblers who self-excluded for up to 3 months from May–November 2022. They were assigned 1:1 to optimized self-exclusion with extended commercial solicitations ban for 9 months or standard procedure. The primary outcome was the change in total loss over the past 4 weeks at Month 9. We also assessed total deposit, total stakes, compulsivity, number and duration of gaming sessions and subsequent self-exclusions at 6, 9, 12 and 18 months.ResultsParticipants were randomized to the optimized group (n = 1265) or standard group (n = 1283). The results didn’t show a significant difference in the reduction in total losses. The optimized group showed significantly reduced 4-week total deposits versus standard group at 6 months (455.68 euros vs. 319.65 euros, p = 0.017), 9 months (451.92 euros vs. 343.21 euros, p = 0.040), and 12 months (484.27 euros vs. 370.02 euros, p = 0.025). Significance was lost at 18 months (492.61 euros vs. 404.73 euros, p = 0.087).ConclusionsAn extended 9-month ban on direct commercial solicitations after self-exclusion significantly reduces gambling deposits during, and 3 months after, the ban. This supports the effectiveness of improving self-exclusion procedure. Future research should explore longer bans and indirect commercial solicitations.Trial registration: NCT05413564.

The increasing spread of antifungal-resistant dermatophytosis caused by Trichophyton indotineae has become a major public health and therapeutic concern. Consequently, antifungal susceptibility testing in routine clinical laboratories is essential for effective patient management. Itraconazole is currently the recommended treatment for these infections. However, few molecular or phenotypic tools are available to assess susceptibility to azoles. In this context, we evaluated the itraconazole and posaconazole MICs obtained using gradient concentration strips (GCS), in comparison with the EUCAST reference method. A total of 73 clinical isolates belonging to the Trichophyton mentagrophytes complex, including 64 T. indotineae isolates, were analyzed. MIC readings for both methods were performed on days 5 and 7 at partial (80%) and complete (100%) inhibition. We found that the optimal reading frame is on day 5 at 100% growth inhibition. Essential agreement within ±1 dilution (and ±2 dilutions) for the GCS method versus the EUCAST method was 65.8% (89%) for itraconazole and 57.5% (83.6%) for posaconazole. The GCS test appears to be a valuable method for susceptibility screening of T. indotineae clinical isolates, providing a practical option for routine laboratories despite essential agreement values below the ideal 90% threshold for method validation.

BackgroundThe appropriate antithrombotic regimen for patients with chronic coronary syndrome who are at high atherothrombotic risk and receiving long-term oral anticoagulation remains unknown.MethodsWe conducted a multicenter, double-blind, randomized, placebo-controlled trial in France involving patients with chronic coronary syndrome who had undergone a previous stent implantation (>6 months before enrollment) and were at high atherothrombotic risk and currently receiving long-term oral anticoagulation. The patients were randomly assigned in a 1:1 ratio to receive aspirin (100 mg once daily) or placebo; all the patients continued to receive their current oral anticoagulation therapy. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, stroke, systemic embolism, coronary revascularization, or acute limb ischemia. The key safety outcome was major bleeding.ResultsA total of 872 patients underwent randomization; 433 were assigned to the aspirin group, and 439 to the placebo group. The trial was stopped early at the advice of the independent data and safety monitoring board after a median follow-up of 2.2 years because of an excess of deaths from any cause in the aspirin group. A primary efficacy outcome event occurred in 73 patients (16.9%) in the aspirin group and in 53 patients (12.1%) in the placebo group (adjusted hazard ratio, 1.53; 95% confidence interval [CI], 1.07 to 2.18; P=0.02). Death from any cause occurred in 58 patients (13.4%) in the aspirin group and in 37 (8.4%) in the placebo group (adjusted hazard ratio, 1.72; 95% CI, 1.14 to 2.58; P=0.01). Major bleeding occurred in 44 patients (10.2%) in the aspirin group and in 15 patients (3.4%) in the placebo group (adjusted hazard ratio, 3.35; 95% CI, 1.87 to 6.00; P<0.001). A total of 467 and 395 serious adverse events were reported in the aspirin group and placebo group, respectively.ConclusionsAmong patients with chronic coronary syndrome at high atherothrombotic risk who were receiving an oral anticoagulant, the addition of aspirin led to a higher risk of cardiovascular death, myocardial infarction, stroke, systemic embolism, coronary revascularization, or acute limb ischemia than placebo, as well as higher risks of death from any cause and major bleeding. (Funded by the French Ministry of Health and Bayer Healthcare; ClinicalTrials.gov number, NCT04217447.)

ABSTRACTPurposeArtificial urinary sphincter (AUS) is the gold standard treatment for severe male stress urinary incontinence (SUI). While survival outcomes after primary implantation are now well established, the prognosis following reintervention remains poorly understood. We aimed to assess long-term reintervention-free survival after a second AUS implantation and to compare outcomes between device replacement and reimplantation after removal.Materials and MethodsWe performed a nationwide, population-based, retrospective cohort study including all men aged ≥18 years in France who underwent a second AUS implantation between 2006 and 2018 for SUI following prostate cancer or benign prostatic hyperplasia treatment. AUS procedures were identified through a unique device identifier. Of 5,132,311 eligible men, 8,475 received a first AUS and 1,619 a second AUS: 1,165 after device replacement and 454 after reimplantation following removal. The primary outcome was reintervention-free survival, estimated by Kaplan–Meier analysis. Secondary outcomes included replacement and removal rates. Predictors of reintervention were identified using multivariable Cox regression.ResultsMedian follow-up was 53 months (IQR 26–81). Reintervention-free survival after second AUS was 81% (95% CI 79–83) at 2 years, 68% (95% CI 65–71) at 5 years, and 61% (95% CI 57–64) at 10 years. Device replacement achieved significantly better survival than reimplantation after removal (p < 0.001). Notably, only 21% of patients whose first AUS was removed underwent reimplantation.ConclusionsSecond AUS implantation provides durable long-term outcomes, approaching those of primary implants. The indication for reintervention critically influences prognosis, with replacement outperforming reimplantation after removal. The low reimplantation rate after AUS removal provides a clinically relevant piece of information to counsel patients requiring device removal.