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COVID’19 crisis management revealed several relationships problems due to missed collaboration between healthcare actors and socio-economic organizations. In fact, these actors didn’t work usually together indeed their interdependencies tasks. The government Healthcare authority asks to identify these types of problems. In this paper, first results of interviews with these actors are presented.This experience feedback formalization is focused on the influence of relationships between these actors and the consequences on the large sanitary crisis management as COVID’19 one.

Background In France, the number of emergency department (ED) admissions doubled between 1996 and 2016. To cope with the resulting crowding situation, redirecting patients to new healthcare services was considered a viable solution which would spread demand more evenly across available healthcare delivery points and render care more efficient. The objective of this study was to analyze the impact of opening new on-demand care services based on variations in patient flow at a large hospital emergency department. Methods We performed a before-and-after study investigating the use of unscheduled care services in the Aube region in eastern France, that focused on ED attendance at Troyes Hospital. A hierarchical clustering based on co-occurrence of diagnoses was applied which divided the population into different multimorbidity profiles. Temporal trends of the resultant clusters were also studied empirically and using regression models. A multivariate logistic regression model was constructed to adjust the periodic effect for appropriate confounders and therefore confirm its presence. Results In total, 120,722 visits to the ED were recorded over a 24-month period (2018–2019) and 16 clusters were identified, accounting for 94.76% of all visits. There was a decrease of 56.77 visits per week in seven specific clusters and an increase of use of unscheduled health care services by 328.12 visits per week. Conclusions Using an innovative and reliable methodology to evaluate changes in patient flow through the ED, these findings may help inform public health policy experts on the implementation of unscheduled care services to ease pressure on hospital EDs.

The aim of this study was to describe the predictive role of the modified SEGA frailty scale on nursing home admission, readmission to hospital, falls and mortality. Material and methods We performed a prospective, single-centre cohort study in patients discharged from a geriatric hospital ward between July 2016 and February 2017, with follow-up of six months. Patients aged 65 and over who were returning home from hospital were included. The primary outcome measure was admission to a nursing home at six months. We used a Cox model to explore the predictive nature of the variables. Results Thirty-three patients (18.4%) with a mean age of 80.9 years (± 6.5) were classified as not very frail and 146 (81.6%) with a mean age of 86 years (± 6.5) as frail/very frail. After six months, 13.5% of the frail/very frail patients and 1.2% of the not very frail patients had entered a nursing home (p = 0.169). Frailty status was significantly associated with readmission to hospital at three months (p = 0.026) and single or multiple falls at six months (p = 0.003). Conclusion The modified SEGA scale may predict the occurrence of adverse events and improve the transition to home.

During a crisis situation, the ability of emergency department to take reliable and quick decisions is the main feature that defines the success or failure of this organization in the course of its crisis management. Decision makers spend time on identifying the decisions that will be taken for the whole of the crisis management, and on anticipating the preparation of these decisions, ensuring that they have time to properly prepare all decisions to be taken and, be able to implement them as fast as possible. However, the context and the characteristics of the crisis make the decision process complicated because there is no specific methodology to anticipate these decisions and properly manage collaboration with the other protagonists. There is also the pressure of time, a significant stress and, the emotional impact on the decision maker that lead to losing objectivity in decision making. We understand so that the right decision will be greatly facilitated and enhanced by the development of an adequate tool and process for decision-making. This tool must respect methods of the emergency department considered, and highlight the importance of experience feedback referencing to past cases, especially success and failures. We propose in this paper, software in order to handle experience feedback as a support for decision-making in crisis management “Crisis Clever System”. Several dimensions are considered in this study, from one side: organization, communication and problem-solving activities and from the other side the presentation and finding of experience feedback thanks to an analogy technique.

International audience

International audience; À l’heure où les nouvelles technologies de l’information et de la communication (NTIC) bouleversent nos pratiques et influencent notre quotidien, il est nécessaire d’étudier leur impact dans le domaine hospitalier et de s’interroger sur leur usage futur.Logistique hospitalière et e-gouvernance présente un état des lieux du système d’information de santé et traite des enjeux informationnels et logistiques de l’information médicale.À travers deux cas d’études de collaboration avec la recherche universitaire, cet ouvrage examine la manière dont des outils d’aide à la décision performants améliorent la qualité de service aux patients et l’organisation logistique. Le premier traite de l’afflux de patients aux urgences ainsi que de l’organisation des services et le second de l’optimisation des tournées de collecte et de distribution des flux de produits.

International audience; Crisis management is a special type of collaborative approach in which the actors are subject to an uninterrupted stress. It is a quite significant issue because the consequences of crises can bring huge damages (human and economic loses). In order to learn from expertise and reduce consequences, we study how to represent emergency management situations based on experience feedback. Several dimensions are considered in this study, from one side: organization, communication and problem solving activities and from the other side the presentation of experience using GIS. We present in this paper our first results. This work is done with the collaboration of the Aube’ Emergency Department.

International audience; Crisis management is a special type of collaborative approach in which the actors are subject to an uninterrupted stress. It is a quite significant issue because the consequences of crises can bring huge damages (human and economic loses). In order to learn from expertise and reduce consequences, we present in this paper our first results related to the definition of structure and interfaces in order to handle experience of crisis management. The project aims to define the CCS (Crisis Clever System) as a decision making environment based on the emergency experience feedback (Experience representation and use).

International audience; The medical services have a key role when the crisis endangers lives. The surprising events and the time pressure render the decisions more crucial and interventions become more complex. A lot of progress has been made about this issue, such as improving emergency services in hospitals and establishing cell crises, defining general and specific plans of intervention and ministerial circulars awareness to deal with most common threats. But, challenges of optimality, decisions speed, and interventions effectiveness are still present. These problems have, in general, three issues; communication, coordination and loss of information. We present in this paper our results related to the definition of structure and interfaces in order to handle experience of crisis management. The aim is to define a decision making environment based on the emergency experience feedback (Experience representation and use).

International audience; Crisis management is a special type of collaborative situation in which the actors are subject to an uninterrupted stress. To deal with the important consequences (human and economic losses) of these situations, we study how to represent emergency management situations based on experience feedback. We use several techniques: situations representations, knowledge engineering techniques and scenarios definition. Several dimensions are considered in this study: organization, communication and problem solving activities. We present in this paper our first results related to the representation of a specific type of crisis management: a road accident. Our first concern is to define the structures and interface in order to handle experience of crisis management. This creates the necessary foundation to help the actors to make decisions during the management of crisis. This work is done with the collaboration of the Aube' Emergency Department

International audience

International audience; Crisis management is a special type of collaborative situation in which the actors are subject to an uninterrupted stress. To deal with the important consequences (human and economic losses) of these situations, we study how to represent emergency management situations based on experience feedback. We use several techniques: situations representations, knowledge engineering techniques and scenarios definition. Several dimensions are considered in this study: organization, communication and problem solving activities. We present in this paper our first results related to the representation of a specific type of crisis management: a road accident. Our first concern is to define the structures and interface in order to handle experience of crisis management. This creates the necessary foundation to help the actors to make decisions during the management of crisis. This work is done with the collaboration of the Aube' Emergency Department.

International audience

International audience; ObjectivesIn 2013, the French National Health Insurance set up a programme to help patients with heart failure to return home and stay there (PRADO). During a hospitalization for cardiac decompensation, the medical team decides on the inclusion of the patient in the programme based on eligibility criteria defined. The objective of this study was to identify the factors most associated with the inclusion of heart failure patients in the PRADO program.Materials and MethodsThis was a monocentric retrospective analytical stratified case-control study. It focused on the analysis of patient records hospitalized for cardiac decompensation between 01/01/2017 and 31/12/2018 in the cardiology department of the Centre Hospitalier de Troyes. For each patient included in the PRADO Heart Failure programme, one or two controls, not included in the PRADO Heart Failure programme were matched. The matching was exact without discounting. It was performed on the following criteria: age in 10-year increments, sex, main diagnosis of the stay, major category of diagnosis of the stay and its type (medical or surgical), the severity score of the Homogeneous Group of Patients of the stay and the Charlson score.ResultsA total of 40 patients included in PRADO Heart Failure were matched to 56 controls not included in PRADO Heart Failure. Patients with respiratory disease (3.77 [1.07 – 13.29]), as well as patients on renin-angiotensin system inhibitors (2.24 [1.61 – 5.31]) were more often included in the PRADO Heart Failure programme. The most frequent criteria for non-eligibility were the need to transfer the patient to a specialised institution and significant impairment of higher functions.ConclusionRespiratory comorbidity and renin-angiotensin system blocker treatment are the factors most associated with the inclusion of heart failure patients in the PRADO Heart Failure programme.; Objectifs : En 2013, l'Assurance Maladie a mis en place un "Programme d'aide au retour et maintien à domicile (PRADO)" pour les patients insuffisants cardiaques. Au cours d'une hospitalisation pour décompensation cardiaque, l’équipe médicale décide de l'inclusion du patient dans le programme en se basant sur des critères d’éligibilité définis par l'Assurance Maladie. L'objectif de cette étude était d'identifier les facteurs les plus associés à l'inclusion des patients insuffisants cardiaques dans le programme PRADO Insuffisance Cardiaque. Matériels et méthodes : Il s'agissait d'une étude cas-témoins rétrospective analytique monocentrique. Elle portait sur l'analyse de dossiers patients hospitalisés pour décompensation cardiaque entre le 01/01/2017 et le 31/12/2018 dans le service de cardiologie du Centre Hospitalier de Troyes. Pour chaque patient inclus dans le programme PRADO Insuffisance Cardiaque, un ou deux témoins, non inclus dans le programme PRADO Insuffisance Cardiaque ont été appariés. L'appariement était exact sans remise. Il a été réalisé sur les critères suivants : l’âge par tranches de 10 ans, le sexe, le diagnostic principal du séjour, la catégorie majeure de diagnostic du séjour et son type (médical ou chirurgical), le score de sévérité du Groupe homogène de malades du séjour et le score de Charlson. Résultats : Au total, 40 patients inclus dans le PRADO Insuffisance Cardiaque ont été appariés à 56 témoins non inclus dans le PRADO Insuffisance Cardiaque. Les patients présentant une pathologie respiratoire (3,77 [1,07 – 13,29]), ainsi que les patients sous inhibiteurs du système rénine-angiotensine (2,24 [1,61 – 5,31]) étaient plus souvent inclus dans le programme PRADO Insuffisance Cardiaque. Les critères de non-éligibilité les plus fréquents étaient la nécessité de transférer le patient vers une institution spécialisée et l'altération significative des fonctions supérieures.

International audience; Emergency department is a key component of the health system where the management of crowding situations is crucial to the well-being of patients. This study proposes a new machine learning methodology and a queuing network model to measure and optimize crowding through a congestion indicator, which indicates a real-time level saturation.

International audience

International audience; The problem addressed in this paper was motivated by a real optimization problem of supply chain of the hospital center of Troyes (HCT). The HCT is currently seeking to review and improve its logistics processes. The implementation of techniques and methods of operational research must provide solutions to improve the efficiency of logistics activities. In this work, the studied problem focuses on the catering component of the hospital logistics. A novel mathematical model for the production scheduling of multi-products and multi-stages food processes in hospital catering is proposed. This mathematical model has been implemented in commercial solver CPLEX and it has been tested on real instances of HCT and from the literature. The implementation results of the mathematical model proposed have proved its efficiency for the scheduling of the food production process.

Objective: The present study aimed to evaluate the prevalence of traumatic experienced seizures (TES) and of postepileptic seizure PTSD (PS-PTSD) in patients with pharmacoresistant focal epilepsy and to explore the determining factors of TES.Methods: We conducted an observational study enrolling 107 adult refractory epilepsy patients. We used the DSM-5 criteria of traumatic events and PTSD to define TES and PS-PTSD. We assessed all traumatic life events unrelated to epilepsy, general and specific psychiatric comorbidities, and quality of life.Results: Nearly half (n = 48) of the 107 participants reported at least one TES (44.85%). Among these, one-third (n = 16) developed PS-PTSD. The TES group was more likely to experience traumatic events unrelated to epilepsy (p < 0.001), to have generalized anxiety disorder (p = 0.019), and to have specific psychiatric comorbidities [e.g., interictal dysphoric disorder (p = 0.024) or anticipatory anxiety of seizures (p = 0.005)]. They reported a severe impact of epilepsy on their life (p = 0.01). The determining factors of TES according to the multifactorial model were the experience of trauma (p = 0.008), a history of at least one psychiatric disorder (p = 0.03), and a strong tendency toward dissociation (p = 0.03).Significance: Epileptic seizures may be a traumatic experience in some patients who suffer from pharmacoresistant epilepsy and may be the source of the development of PS-PTSD. Previous trauma unrelated to epilepsy and psychiatric history are determining factors of TES. These clinical entities should be explored systematically.

International audience; Introduction: Given the complexity of the therapeutic management of irritable bowel syndrome (IBS), alternative non-pharmacological therapies are frequently offered to patients. The aim of this study was to conduct a systematic review in order to establish the current evidence base for non-pharmacological interventions (body-directed and mind-body therapies) in the management of IBS.Materials and methods: The literature was searched in several electronic databases (PubMed (including Medline), Web of Science (Clarivate Analytics), Scopus (Elsevier), ScienceDirect (Elsevier), Cochrane Library (Wiley), and Wiley Online Library (Wiley)) for randomized controlled trials (RCTs) published in the English language from 1990 to 2020. Effectiveness outcomes were examined through the change in overall IBS symptoms or abdominal pain up to 12 months after treatment.Results: 11 studies (parallel-group RCTs) were identified that enrolled 1590 participants in total. Body-directed therapies (acupuncture and osteopathic medicine) showed a beneficial effect compared with standard medical treatment for overall IBS symptoms at 6 months follow-up, while no study found any difference between body-directed and sham therapies for abdominal pain or overall IBS symptoms. It was not possible to conclude whether hypnotherapy was superior to standard medical treatment or supportive therapy for overall IBS symptoms or abdominal pain due to discordant results.Conclusions: Although body-directed therapies such as acupuncture and osteopathic medicine may be beneficial for overall IBS symptoms, higher-quality RCTs are needed to establish the clinical benefit of non-pharmacological interventions for IBS. An important challenge will be the definition of the optimal control groups to be used in non-pharmacological trials.

Simple Summary TUMOSPEC was designed for estimating the risk of cancer for carriers of a predicted pathogenic variant (PPV) in a gene usually tested in a hereditary breast and ovarian cancer context. Index cases are enrolled consecutively among patients who undergo genetic testing as part of their care plan in France. First- and second-degree relatives and cousins of PPV carriers are invited to participate whether they are affected by cancer or not, and are tested for the familial PPV. Genetic, clinical, family and epidemiological data are centralized at the coordinating centre. The three-year feasibility study included 4431 prospective index cases, with 19.1% of them carrying a PPV. This showed that the study logistics are well adapted to clinical and laboratory constraints, and collaboration between partners (clinicians, biologists, coordinating centre and participants) is smooth. Hence, TUMOSPEC is being pursued, with the aim of optimizing clinical management guidelines specific to each gene. Abstract Assessment of age-dependent cancer risk for carriers of a predicted pathogenic variant (PPV) is often hampered by biases in data collection, with a frequent under-representation of cancer-free PPV carriers. TUMOSPEC was designed to estimate the cumulative risk of cancer for carriers of a PPV in a gene that is usually tested in a hereditary breast and ovarian cancer context. Index cases are enrolled consecutively among patients who undergo genetic testing as part of their care plan in France. First- and second-degree relatives and cousins of PPV carriers are invited to participate whether they are affected by cancer or not, and genotyped for the familial PPV. Clinical, family and epidemiological data are collected, and all data including sequencing data are centralized at the coordinating centre. The three-year feasibility study included 4431 prospective index cases, with 19.1% of them carrying a PPV. When invited by the coordinating centre, 65.3% of the relatives of index cases (5.7 relatives per family, on average) accepted the invitation to participate. The study logistics were well adapted to clinical and laboratory constraints, and collaboration between partners (clinicians, biologists, coordinating centre and participants) was smooth. Hence, TUMOSPEC is being pursued, with the aim of optimizing clinical management guidelines specific to each gene.

International audience

International audience; Emergency departments (ED) face significant challenges to deliver high quality and timely patient care while facing rising costs. Prediction models in healthcare are becoming a trend allowing healthcare institutions to better manage the flow of patients through the services. In this work, a Generalized Stochastic Petri net (GSPN) simulation engine is used as a simulator (and performance evaluation) and a waiting time prediction model for the ED of Troyes hospital in France. Compared to existing literature, this work puts more emphasis on using features on GSPN (time, hierarchy, concurrency, parallelism) to capture the complex nature of the system. A new concept of real-time estimation of waiting time is presented. We validated the simulation model with a gap less than 10% between real and simulated performances. To the best of our knowledges, this work is the first to use a GSPN model as a management and waiting time’s forecasting tool for emergency departments.

Assessing the health profiles of populations is a crucial task to create a coherent healthcare offer. Emergency Departments (EDs) are at the core of the healthcare system and could benefit from this evaluation via an improved understanding of the healthcare needs of their population. This paper proposes a novel hierarchical agglomerative clustering algorithm based on multimorbidity analysis. The proposed approach constructs the clustering dendrogram by introducing new quality indicators based on the relative risk of co-occurrences of patient diagnoses. This algorithm enables the detection of multimorbidity patterns by merging similar patient profiles according to their common diagnoses. The multimorbidity approach has been applied to the data of the largest ED of the Aube Department (Eastern France) to cluster its patient visits. Among the 120,718 visits identified during a 24-month period, 16 clusters were identified, accounting for 94.8% of the visits, with the five most prevalent clusters representing 63.0% of them. The new quality indicators show a coherent and good clustering solution with a cluster membership of 1.81 based on a cluster compactness of 1.40 and a cluster separation of 0.77. Compared to the literature, the proposed approach is appropriate for the discovery of multimorbidity patterns and could help to develop better clustering algorithms for more diverse healthcare datasets.

Objective Fear of having a seizure called anticipatory anxiety of epileptic seizure (AAS), constitutes a daily life burden but has been rarely studied. Our aim was to assess the prevalence and the determining factors of AAS in patients with drug-resistant focal epilepsy, a dimension that has not been thoroughly investigated before. Methods We conducted an observational, prospective study enrolling patients with drug-resistant focal epilepsy. The psychiatric assessment aimed to evaluate psychiatric comorbidities, trauma history, and quality of life using hetero-evaluation and self-assessment tools. Dimensions of anxiety specifically related to epilepsy (peri-and-inter-ictal) were explored as exhaustively as possible. Results AAS was found in 53 % of the 87 patients. We compared the two groups of patients: with or without AAS. Patients with AAS had a significantly shorter duration of epilepsy (p = 0.04). There was no difference between groups with respect to psychiatric disorders, except for cannabis dependence, more frequent in patients with AAS (p = 0.02). Compared to patients without AAS, those with AAS presented more subjective ictal anxiety (p = 0.0003) and postictal anxiety (p = 0.02), were more likely to avoid outdoor social situations due to seizure fear (p = 0.001), and had a poorer quality of life (QOLIE emotional well-being; p = 0.03). Additionally, they had experienced more traumatic events in their lifetime (p = 0.005) and reported more frequently a feeling of being unsafe during their seizures (p = 0.00002). Significance AAS is a specific dimension of anxiety, possibly linked to trauma history. AAS is strongly linked to subjective ictal anxiety but not to the objective severity of seizures or frequency.

International audience; The discrepancy between patient demand and the emergency departments (ED) capacity, that mainly depends on human resources and on beds available for patients, often lead to ED's overcrowding and to the increase in waiting time. In this paper, we focus on the optimization of the human (medical and paramedical staff) and material resources (beds) in the ED of the hospital center of Troyes, France (CHT). We seek to minimize the total number of waiting patients from their arrival to their discharge. We propose a mixed integer linear program solved by a sample average approximation (SAA) approach. The program has been tested on a set of real data gathered from the ED information system. Numerical results show that the optimization of human and material resources leads to a decrease of total number of waiting patients.

International audience

Objective To study the impact of COVID-19 pandemic lockdown on avoided emergency department visits and consequent hospitalizations. Study design An observational retrospective design was used to investigate avoided visits and hospitalizations of an departmental emergency department combined with a clustering approach on multimorbidity patterns. Methods A multimorbidity clustering technique was applied on the emergency department diagnostics to segment the population in diseases clusters. Global visits and hospitalizations from an emergency department during the 2020 lockdown were put in perspective with the same period during 2019. Using a comparison with the five previous years, avoided hospitalizations per inhabitants during the lockdown were estimated for each diseases cluster. Results During the 8 weeks of lockdown, the number of emergency department visits have been reduced by 41.47% and resultant hospitalizations by 28.50% compared to 2019. The retrospective study showed that 14 of 17 diseases clusters had a statistically significant reduction in hospitalizations with a pronounced effect on lower acuity diagnoses and middle-aged patient, leading to 293 avoided hospitalizations per 100,000 inhabitants compared to the 5 previous years and to the 85.8 COVID-19 hospitalizations per 100,000 inhabitants. Conclusion Although specific to a regional context of pandemic containment, the study suggest that COVID-19 lockdown had beneficial effects on the crowding situation of the emergency departments and hospitals with avoidance effects primarily link to reduced risks.

International audience

Smart Health International Conference; International audience

International audience; Objective: The purpose of this prospective study was to identify predictive factors of the evolution of the number of seizures.Methods: We included 85 individuals with a diagnosis of Psychogenic Nonepileptic Seizure (PNES) who completed at least two clinical interviews spaced by 6 months during a 24-month follow-up. Participants underwent a structured interview with an experimented clinician in PNES to complete standardized evaluation and validated scales. We collected sociodemographic and clinical data on PNES (number of seizures, duration of the disease), anxiety, depression, history of traumas, alexithymia, dissociation, and post-traumatic stress disorder (PTSD). We used a multivariate linear regression analysis to predict the characteristics independently associated with the evolution of the number of seizures in percentage.Results: Dissociation score was significantly associated with a negative evolution of the number of seizures (p < 0.002). Conversely, the diagnosis of PTSD at inclusion was correlated to a positive evolution of the number of seizures (p < 0.029).Conclusion: Dissociation was related to a more pejorative evolution of the number of seizures while PTSD diagnosis was associated with a decreased number of seizures. It is therefore essential to improve detection and treatment of post-traumatic dissociation. Further studies are required to understand the impact of PTSD on the evolution of the number of seizures.

International audience; Objective: Previous studies showed that patients with Psychogenic Non-Epileptic Seizures (PNES) have poor quality of life (QoL). This study explored the explicative factors of the QoL at the time of diagnosis and monitored changes over the two years of follow-up.Methods: We evaluated 107 participants with a diagnosis of Psychogenic Non-Epileptic Seizure (PNES), every 6 months for 24 months. Quality of life (QoL) was evaluated using the QOLIE-31 and SF-36 scales (respectively specific and generic scales of QoL). Positive evolution of QoL was defined by the increase in the score of overall QoL using QOLIE-31 sub-scale from baseline to the last interview of the patient. We also collected for each patient data on psychiatric dimensions (childhood abuse, history of traumatic events, post-traumatic stress disorder (PTSD), depression, anxiety, alexithymia, and dissociation), clinical evolution of seizures and the number of mental health consultations.Results: According to the QOLIE-31 and the SF-36, depression (p ≤ 0.001), anxiety (p < 0.001), alexithymia (p ≤ 0.001), and dissociation (p ≤ 0.004) were related to QoL at the time of the diagnosis. According to SF-36 (mental and physical), PTSD was also significantly associated with QoL (p < 0.05). The number of seizures or the co-occurrence of epilepsy did not influence QoL. Positive evolution of QoL was linked to the number of consultations for mental health issues (p = 0.02).Significance: Post-traumatic dimensions (PTSD, dissociation), alexithymia and psychiatric comorbidities (depression and anxiety disorders) seem to alter QoL in people with PNES. The current study suggests that mental health care improves QoL of patients with PNES.

International audience

International Conference in Optimization and Learning; International audience

International audience

Background Frailty detection and remote monitoring are of major importance for slowing down, and/or even stopping the frailty process in home-dwelling older people. Taking the Fried’s criteria as a reference, this work aims to compare the results produced by a technological set (ARPEGE Pack) with those obtained by usual clinical tests, as well as to discuss the ability of the Pack to be used for long-run frailty remote monitoring. Methods 194 participants were given a number of geriatric tests and asked to make use of the ARPEGE technological tools as well as reference clinical tools to feed Fried’s indicators. Spearman or Pearson’s correlation coefficients were used to compare the ARPEGE results to the reference ones, depending on data statistical characteristics. Results Good correlations were obtained for measurements of weight (0.99), grip strength (0.89) and walking speed (0.79). Results are much less satisfactory for evaluation of physical activity and exhaustion (Spearman correlation coefficients 0.25 and 0.41, respectively). Conclusion Correlations regarding weight, grip strength and walking speed confirm the validity of the data produced by the ARPEGE Pack to feed Fried’s criteria. Assessing activity level and exhaustion from an abbreviated questionnaire is still questionable. However, for long-run monitoring other methods of evaluation can be explored. Beyond the quantitative results, the ARPEGE Pack has been proved to be acceptable and motivating in such a long-term frailty monitoring.

Background and aims We reported the validation of the 18-item version of the ‘Inconforts des Patients de REAnimation (IPREA)’ questionnaire that includes 2 new items exploring feeling depressed and shortness of breath during an intensive care unit (ICU) stay. Methods The validation process was integrated in a multicenter, cluster-randomized, controlled, two-parallel group study built to assess the effectiveness of a tailored multicomponent program for reducing self-perceived discomfort in the ICU. All patients aged 18 years or older who survived an ICU stay of 3 calendar days or more were eligible for inclusion. Data collection included demographics (sex, age), type of admission (medical and surgical), health status scores at admission (Knaus score and McCabe index, Simplified Acute Physiology Score (SAPS) II), specific ICU therapeutics such as mechanical ventilation (MV), noninvasive ventilation (NIV), use of vasopressors, or renal replacement therapy (RRT), and ICU stay duration. Results A total of 994 patients were included. The initial structure of IPREA was confirmed using confirmatory factor analysis showing satisfactory fit (RMSEA at 0.042, CFI at 0.912). No multidimensional structure was identified, allowing the calculation of an overall discomfort score. The three highest discomforts were sleep deprivation, thirst, and perfusion lines and other devices, and the 3 lowest discomforts were limited visiting hours, hunger, and isolation. The overall discomfort score of the 18-item version of IPREA did not differ between men and women. Higher age was significantly correlated with a lower overall discomfort score. While MV was not linked to self-reported discomfort, patients treated by NIV reported higher overall discomfort scores than patients not treated by NIV. Conclusion The 18-item version of IPREA is easy to use and possesses satisfactory psychometric properties. The availability of a reliable and valid French questionnaire asking about patients’ self-perceived ICU discomforts enables feedback from the health care team to be incorporated in a continuous quality health care improvement strategy. Trial registration clinicaltrial.gov NCT02442934 (registration date: May 18, 2015, retrospectively registered).

International audience; As new information and communication technologies (NICTs) increasingly reorganize our practices and influence our daily lives, there is a pressing need to study their impact in the field of hospital logistics and to question their future use. Hospital Logistics and e-Management presents an inventory of the health information system, and deals with informational and logistical issues with regard to medical information. Through two case studies of hospital logistics systems which have drawn on academic research, this book examines how powerful decision support tools can improve the quality of patient service and logistics organization. The first case study deals with the influx of patients to emergency services and service organization, and the second with the optimization of product collection and distribution flows.

International audience; In recent years, health care organizations, in particular emergency department (ED), have come under increasing pressure to provide quality care. In this context, human resources are a central aspect: a good utilization of health worker could improve quality of care. In this paper, a simulation model is proposed. The model represents an ED coupled with an optimization method to optimize the allocation of medical and para-medical human resources in the hospital center of Troyes. We aim to improve the quality of services offered to patients through the minimization of Average Waiting Time (AWT) and Average Inpatient Stay (AS). The proposed approach has proved to be effective to reduce AWT and AS by 12 minutes and 21 minutes respectively.

Introduction L’encombrement et la demande croissante des activites des services d’urgences des hopitaux allongent le temps d’attente des patients et impacte l’usage optimal des ressources qui garantissent la qualite des soins. Structurellement, le service d’accueil des urgences de Troyes est adosse a la maison medicale de garde, avec une infirmiere d’accueil et d’orientation, et differents circuits patients (court, long, entrees directes dans les services). Dans ce contexte local, nous avons developpe une approche d’optimisation basee sur la simulation. Notre objectif est de tester et de valider plusieurs strategies afin de minimiser le temps moyen d’attente et le temps de prise en charge et de planifier les ressources au Centre hospitalier de Troyes (CHT). Methodes Un modele de simulation a evenements discrets est cree et developpe sur le logiciel de simulation ARENA. Les previsions d’arrivees journalieres des patients sont prises en compte dans ce modele, qui servira d’outil d’evaluation des performances des services d’urgences (temps moyen d’attente et temps de prise en charge des patients). Ce modele de simulation est couple avec une approche d’optimisation (algorithme genetique) visant a optimiser l’allocation des ressources humaines. Resultats L’ecart entre les temps moyens d’attente reels et les temps de prise en charge et ceux simules varie de 1 % a 9 %, un ecart considere comme acceptable pour validation. Sans aucun changement dans le nombre actuel de ressources humaines, notre algorithme genetique couple avec le modele de simulation peut reduire le temps d’attente et le temps de prise en charge respectivement de 12 minutes et 21 minutes. Les resultats sur l’impact de l’ajout de personnel medical et paramedical montrent que l’ajout d’une infirmiere diminue de 25 minutes le temps moyen d’attente des patients. Discussion/Conclusion Notre approche a prouve qu’il etait possible de reduire temps d’attente et temps de prise en charge en analysant et en evaluant differents scenarios associes a l’approche genetique afin d’optimiser les facteurs cles influencant la qualite des services d’urgences.

International audience; Purpose: Reducing discomfort in the intensive care unit (ICU) should have a positive effect on long-term outcomes. This study assessed whether a tailored multicomponent program for discomfort reduction was effective in reducing post-traumatic stress disorder (PTSD) symptoms at 1 year in general ICU survivors.Methods: This study is a prospective observational comparative effectiveness cohort study involving 30 ICUs. It was an extension of the IPREA3 study, a cluster-randomized controlled trial designed to assess the efficacy of a tailored multicomponent program to reduce discomfort in critically ill patients. The program included assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to the healthcare team, and site-specific tailored interventions. The exposure was the implementation of this program. The eligible patients were exposed versus unexposed general adult ICU survivors. The prevalence of substantial PTSD symptoms at 1 year was assessed based on the Impact of Event Scale-Revised (IES-R).Results: Of the 1537 ICU survivors included in the study, 475 unexposed patients and 344 exposed patients had follow-up data at 1 year: 57 (12.0%) and 21 (6.1%) presented with PTSD at 1 year, respectively (p = 0.004). Considering the clustering and after adjusting for age, gender, McCabe classification, and ICU-related self-perceived overall discomfort score, exposed patients were significantly less likely than unexposed patients to have substantial PTSD symptoms at 1 year (p = 0.015).Conclusions: Implementation of a tailored multicomponent program in the ICU that has proved to be effective for reducing self-perceived discomfort in general adult ICU survivors also reduced the prevalence of substantial PTSD symptoms at 1 year.

International audience; In order to improve coordination in the care pathway, an experimental project called “population-based responsibility” is being run in 5 regions in France. The project has a triple objective: better health for the population, better patient experience, and a lower cost for society. It is based on an integrated approach to health, a more holistic approach to the patient and on the commitment of all the actors involved, so that they can collectively work in the same direction to serve the population. One of the challenges is a better cooperation between primary care and hospital care. What is envisaged is a better understanding and considering of the needs of general practitioners and their patients, and to give GPs more capacity of action, including the one of organizing the care pathway around the patient within the ecosystem of healthcare actors. This position paper describes the first participatory workshop held in Aube and Sézannais experimental area, which brought together professionals of different types and stakeholders from civil society , to co-create the ideal care pathway scenario. This workshop allowed to trigger participation (hopefully leading to coordination) in a positive and optimistic spirit, and to gather the first insights concerning expectations and needs of different stakeholders.

International audience; Emergency department (ED) has become the patient’s main point of entrance in modern hospitals causing it frequent overcrowding. Thus hospital managers are increasingly giving attention to the ED in order to provide better quality service for patients. One of the key elements for a good management strategy is demand forecasting. In this case, forecasting patients flow, which will help decision makers to optimize human(doctors, nurses...) and material (beds, boxs...) resources allocation. The main interest of this research is forecasting daily attendance at an emergency department. The study was conducted on the Emergency Department of the Hospital of Troyes city, France, in which we propose a new practical ED patients classification that consolidate the CCMU and GEMSA into one single category and an innovative time-series based forecasting models to predict long and short term daily attendance. The models we developed for this case study shows very good performances (up to 92, 29% for the annual Total flow forecast) and robustness to epidemic periods.

Critically ill patients are exposed to stressful conditions and experience several discomforts. The primary objective was to assess whether a tailored multicomponent program is effective for reducing self-perceived discomfort. In a cluster-randomized two-arm parallel trial, 34 French adult intensive care units (ICUs) without planned interventions to reduce discomfort were randomized, 17 to the arm including a 6-month period of program implementation followed by a 6-month period without the program (experimental group), and 17 to the arm with an inversed sequence (control group). The tailored multicomponent program consisted of assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to healthcare teams, and site-specific tailored interventions. The primary outcome was the overall discomfort score derived from the 16-item IPREA questionnaire (0, minimal, 100, maximal overall discomfort) and the secondary outcomes were the discomfort scores of each IPREA item. IPREA was administered on the day of ICU discharge with a considered timeframe from the ICU admission until ICU discharge. During a 1-month assessment period, 398 and 360 patients were included in the experimental group and the control group, respectively. The difference (experimental minus control) of the overall discomfort score between groups was − 7.00 (95% CI − 9.89 to − 4.11, p

International audience; Falls are a major cause of death in older people. One method used to predict falls is analysis of Centre of Pressure (CoP) displacement, which provides a measure of balance quality. The Balance Quality Tester (BQT) is a device based on a commercial bathroom scale that calculates instantaneous values of vertical ground reaction force (Fz) as well as the CoP in both anteroposterior (AP) and mediolateral (ML) directions. The entire testing process needs to take no longer than 12 s to ensure subject compliance, making it vital that calculations related to balance are only calculated for the period when the subject is static. In the present study, a method is presented to detect the stabilization period after a subject has stepped onto the BQT. Four different phases of the test are identified (stepping-on, stabilization, balancing, stepping-off), ensuring that subjects are static when parameters from the balancing phase are calculated. The method, based on a simplified cumulative sum (CUSUM) algorithm, could detect the change between unstable and stable stance. The time taken to stabilize significantly affected the static balance variables of surface area and trajectory velocity, and was also related to Timed-up-and-Go performance. Such a finding suggests that the time to stabilize could be a worthwhile parameter to explore as a potential indicator of balance problems and fall risk in older people.

Introduction La prevision de l’afflux des patients d’une structure d’urgences au sein d’un centre hospitalier est un enjeu crucial limitant l’attente des patients et ameliorant la qualite des soins. Dans ce contexte, l’exploitation de l’ensemble des donnees composant l’historique des consultations du service permet de modeliser et prevoir ce flux. L’objectif de notre etude consiste a developper un modele predictif afin d’ameliorer la reponse des structures aux besoins lies a l’activite de soins. Methodes Il s’agit d’une etude transversale analytique constituee a partir des « Resumes de passage aux urgences : RPU » collectes du 01/01/2010 au 31/12/2014. Une nouvelle classification des patients des urgences croisant les classifications CCMU (Classification clinique des malades aux urgences) et GEMSA (Groupes d’etude multicentrique des services d’accueil) dans une seule categorie : Etat Patient (EP). Cette variable a permis de grouper les patients presentant des similarites comportementales (gravite, plateau technique necessaire, affiliation apres traitement). Une analyse de prevision des series chronologiques est realisee pour etablir un modele predictif base sur une approche par un Modele additif adapte, un modele ARMA et un Modele de serie de Fourrier Hybride. Resultats Une performance de 91,2 % pour la prevision annuelle du flux total est obtenue a court terme (MAPD = 0,087). Les modeles presentent une robustesse lors des periodes d’epidemies a cause de la faible correlation entre les residus du modele a court terme et le nombre de cas epidemiologiques, celle-ci est egale a 0,055 pour les cas grippaux et 0,05 pour les cas de diarrhee aigue. Discussion/conclusion Les modeles developpes font preuve de performance et de robustesse meme en periode d’epidemie. La mise en place du modele permet de creer une meteo des urgences. Cela permet au personnel de planifier les activites du service l’accueil en fonction de l’afflux prevu ameliorant ainsi l’accueil des patients et les conditions de travail des professionnels.

Tuteur methodologique D. Jolly. Tuteur thematique R. Mahmoudi. Etat de la question La fragilite du sujet âge est associee a la survenue d’evenement de sante negatif. L’objectif de cette etude etait de comparer les capacites predictives de deux echelles de fragilite (phenotype de Fried et la grille SEGAm : « Short Emergency Geriatric Assessment modified ») en termes d’hospitalisations et de perte d’independance a un an dans une population âgee ambulatoire. Materiel et methodes Etude prospective multicentrique, realisee chez des sujets âges de 70 ans et plus. Des variables cliniques et celles de l’evaluation geriatriques standardisee ont ete recueillies. Une regression logistique binaire univariee et multivariee a ete realisee avec comme variables d’interet l’hospitalisation et la perte d’independance a un an. Resultats Le risque d’hospitalisation a un an n’etait pas lie au statut de fragilite evalue par le phenotype de Fried et la grille SEGAm. Concernant la perte d’independance, selon le phenotype de Fried il existait une augmentation du risque chez les pre-fragiles et fragiles (respectivement OR : 2,29 IC 95 % [1,05–5,00] ; OR : 9,33 IC 95 % [2,07–42,05]) qui n’etait plus significative apres ajustement (respectivement OR ajuste : 1,11 IC 95 % [0,49–2,47] ; OR ajuste : 2,66 IC 95 % [0,67–10,46]). Selon SEGAm, les sujets fragiles et tres fragiles etaient significativement plus a risque de perte d’independance (OR : 2,91 IC 95 % [1,21–6,98] ; OR ajuste : 3,27 [1,40–7,60]). Conclusion La capacite predictive des echelles de fragilite du sujet âge depend des evenements d’interet. La grille SEGAm peut etre utilisee dans une strategie de prevention dans une population âgee ambulatoire.