Search

International audience; Objective: Waiting time for a consultation for chronic pain is a widespread health problem. This paper present the design of an ontology use to assess patients referred to a consultation for chronic pain. Methods: We designed OntoDol, an ontology of pain domain for patient triage based on priority degrees. Terms were extracted from clinical practice guidelines and mapped to SNOMED-CT concepts through the Python module Owlready2. Selected SNOMED-CT concepts, relationships, and the TIME ontology, were implemented in the ontology using Protégé. Decision rules were implemented with SWRL. We evaluated OntoDol on 5 virtual cases. Results: OntoDol contains 762 classes, 92 object properties and 18 SWRL rules to assign patients to 4 categories of priority. OntoDol was able to assert every case and classify them in the right category of priority. Conclusion: Further works will extend OntoDol to other diseases and assess OntoDol with real world data from the hospital.

International audience; Objective: Waiting time for a consultation for chronic pain is a widespread health problem. This paper presents the design of an ontology use to assess patients referred to a consultation for chronic pain. Methods: We designed OntoDol, an ontology of pain domain for patient triage based on priority degrees. Terms were extracted from clinical practice guidelines and mapped to SNOMED-CT concepts through the Python module Owlready2. Selected SNOMED-CT concepts, relationships, and the TIME ontology, were implemented in the ontology using Protégé. Decision rules were implemented with SWRL. We evaluated OntoDol on 5 virtual cases. Results: OntoDol contains 762 classes, 92 object properties and 18 SWRL rules to assign patients to 4 categories of priority. OntoDol was able to assert every case and classify them in the right category of priority. Conclusion: Further works will extend OntoDol to other diseases and assess OntoDol with real world data from the hospital.

International audience; Emergency phone triage aims at identifying quickly patients with critical emergencies. Patient triage is not an easy task, especially in situations involving children, mostly due to the lack of training and the lack of clinical guidelines for children. To overcome these issues, we aim at designing and assessing an interactive interface for displaying recommendations on emergency phone triage in pediatrics. Four medical students formalized local guidelines written by the SAMU of Paris, into a decision tree and designed an interface according to usability principles. The navigation within the interface was designed to allow the identification of critical emergencies at the beginning of the decision process, and thus ensuring a quick response in case of critical emergencies. The interface was assessed by 10 medical doctors: they appreciated the ergonomics (e.g., intuitive colors), and found easy to navigate through the interface. Nine of them would like to use this interface during phone call triage. In the future, this interface will be improved and implemented in emergency call centers.

International audience; In critical situations such as pandemic, medical students are often called to help in emergency call centers. However, they may encounter difficulties in phone triage because of a lack of medical skills. Here, we aim at developing a Clinical Decision Support System for helping medical students in phone call triage of pediatric patients. The system is based on the PAT (Pediatric Assessment Triangle) and local guidelines. It is composed of two interfaces. The first allows a quick assessment of severity signs, and the second provides recommendations and additional elements such as “elements to keep in mind” or “medical advice to give to patient”. The system was evaluated by 20 medical students, with two fictive clinical cases. 75% of them found the content useful and clear, and the navigation easy. 65% would feel more reassured to have this system in emergency call centers. Further works are planned to improve the system before implementation in real-life.

BackgroundThe Coronavirus disease 2019 (COVID‐19) has evolved as a pandemic infectious disease transmitted by the severe acute respiratory syndrome coronavirus (SARS‐CoV‐)2. Allergists and other health care providers (HCPs) in the field of allergies and associated airway diseases are in the front line, taking care of patients potentially infected with SARS‐CoV‐2. Hence, strategies and practices to minimize risks of infection for both HCPs and treated patients have to be developed and followed by allergy clinics.MethodThe scientific information on COVID‐19 was analyzed by a literature search in Medline, Pubmed, national and international guidelines from the European Academy of Allergy and Clinical Immunology (EAACI), the Cochrane Library and the Internet.ResultsBased on diagnostic and treatment standards developed by EAACI, on international information regarding COVID‐19, on guidelines of the World Health Organization (WHO) and other international organizations as well as on previous experience, a panel of experts including clinicians, psychologists, IT experts and basic scientists along with EAACI and the “Allergic Rhinitis and its Impact on Asthma (ARIA)” inititiative have developed recommendations for the optimal management of allergy clinics during the current COVID‐19 pandemic. These recommendations are grouped into nine sections on different relevant aspects for the care of patients with allergies.ConclusionsThis international Position Paper provides recommendations on operational plans and procedures to maintain high standards in the daily clinical care of allergic patients whilst ensuring necessary safety in the current COVID‐19 pandemic.

Parmi le nombre important de patients consultant aux Urgences, le médecin urgentiste doit pouvoir repérer les patients nécessitant une surveillance rapprochée du fait de leur potentiel d’aggravation. Une meilleure identification de ces patients permettrait de diminuer le nombre de transferts secondaires en réanimation et ainsi leur durée d’hospitalisation et leur mortalité. Objectifs : l’objectif principal est de déterminer les facteurs prédictifs d’un transfert secondaire en réanimation dans les premières 72 heures d’une hospitalisation à partir des urgences. L’objectif secondaire est d’évaluer le délai d’aggravation de ces patients et les motifs de transfert. Méthodes : étude cas-témoins rétrospective monocentrique de 222 patients hospitalisés dans les suites de leur passage aux urgences au CHU de Nîmes. Les cas sont définis par un transfert secondaire en réanimation dans les premières 72 heures de leur hospitalisation dans un service de médecine ou de chirurgie. Les témoins sont des patients qui nécessitent une hospitalisation sur la totalité des services du CHU après leur passage aux urgences. Une analyse secondaire a été réalisée par rapport à un sous-groupe de témoins après retranchement des témoins hospitalisés directement en réanimation. Résulats : les patients transférés en réanimation ont une mortalité plus élevée et une durée d’hospitalisation allongée par rapport aux témoins. Les facteurs prédictifs d’un transfert secondaire en réanimation sont un antécédent d’insuffisance rénale modérée ou sévère, un traitement par chimiothérapie, un score CCI < 5, un tabagisme actif, un score de triage IAO à 5 et une CRP élevée. Les patients sont moins à risque de transfert secondaire en réanimation en cas de passage par la SAUV. Le délai médian avant transfert en réanimation est de 24,3 heures et 21 cas (18,9%) sont arrivés graves en service. Conclusion : une réévaluation au sein du SAU de tous les patients et d’autant plus si ceux-ci présentent ces facteurs prédictifs est primordiale. Ces patients pour qui l’évolution est incertaine et qui nécessitent une surveillance rapprochée présentent une indication à une hospitalisation en soins continus ou soins intensifs afin de limiter le délai avant transfert.

International audience; During spring 2020, SARS-CoV-2 pandemic induced shortage of medical equipment, hospital capacity and staff. To tackle this issue, medical students have been strongly involved in early patient triage through medical phone call regulation. Here, we present an intelligent web-based decision support system for COVID-19 phone call regulation, developed by and for, medical students to help them during this difficult but crucial task. The system is divided into 5 tabs. The first tab displays administrative information, clinical data related to life-threatening emergency, and personalized recommendations for patient management. The second tab displays a PDF report summarizing the clinical situation; the third tab displays the guidelines used for establishing the recommendations, and the fourth tab displays the overall algorithm in the form of a decision tree. The fifth tab provided a short user guide. The system was assessed by 21 medical staff. More than 90% of them appreciated the navigation and the interface, and found the content relevant. 90,5% of them would like to use it during the medical regulation. In the future, we plan to use this system during simulation-based medical learning for the initial medical training of medical students.

International audience; Background: In acute stroke, large vessel occlusion (LVO) should be promptly identified to guide patient's transportation directly to comprehensive stroke centers (CSC) for mechanical thrombectomy (MT). In many cases, prehospital multi-parameter scores are used by trained emergency teams to identify patients with high probability of LVO. However, in several countries, the first aid organization without intervention of skilled staff precludes the on-site use of such scores. Here, we assessed the accuracy of LVO prediction using a single parameter (i.e. complete hemiplegia) obtained by bystander's telephone-based witnessing.Patients and methods: This observational, single-center study included consecutive patients who underwent intravenous thrombolysis at the primary stroke center and/or were directly transferred to a CSC for MT, from January 1, 2015 to March 1, 2020. We defined two groups: patients with initial hemiplegia (no movement in one arm and leg and facial palsy) and patients without initial hemiplegia, on the basis of a bystander's witnessing.Results: During the study time, 874 patients were included [mean age 73 years (SD 13.8), 56.7% men], 320 with initial hemiplegia and 554 without. The specificity of the hemiplegia criterion to predict LVO was 0.88, but its sensitivity was only 0.53.Conclusion: Our results suggest that the presence of hemiplegia as witnessed by a bystander can predict LVO with high specificity. This single criterion could be used for decision-making about direct transfer to CSC for MT when the absence of emergency skilled staff precludes the patient's on-site assessment, especially in regions distant from a CSC.

Background In 2017, New Caledonia experienced an outbreak of severe dengue causing high hospital burden (4379 cases, 416 hospital admissions, 15 deaths). We decided to build a local operational model predictive of dengue severity, which was needed to ease the healthcare circuit. Methods We retrospectively analyzed clinical and biological parameters associated with severe dengue in the cohort of patients hospitalized at the Territorial Hospital between January and July 2017 with confirmed dengue, in order to elaborate a comprehensive patient’s score. Patients were compared in univariate and multivariate analyses. Predictive models for severity were built using a descending step-wise method. Results Out of 383 included patients, 130 (34%) developed severe dengue and 13 (3.4%) died. Major risk factors identified in univariate analysis were: age, comorbidities, presence of at least one alert sign, platelets count 9/L, prothrombin time 10 N, and previous dengue infection. Severity was not influenced by the infecting dengue serotype nor by previous Zika infection. Two models to predict dengue severity were built according to sex. Best models for females and males had respectively a median Area Under the Curve = 0.80 and 0.88, a sensitivity = 84.5 and 84.5%, a specificity = 78.6 and 95.5%, a positive predictive value = 63.3 and 92.9%, a negative predictive value = 92.8 and 91.3%. Models were secondarily validated on 130 patients hospitalized for dengue in 2018. Conclusion We built robust and efficient models to calculate a bedside score able to predict dengue severity in our setting. We propose the spreadsheet for dengue severity score calculations to health practitioners facing dengue outbreaks of enhanced severity in order to improve patients’ medical management and hospitalization flow.

International audience; The current coronavirus disease 2019 (COVID-19) pandemic is forcing healthcare systems around the word to organise care differently than before. Prompt detection and effective triage and isolation of potentially infected and infectious patients are essential to preventing unnecessary community exposure. Since there are as yet no medications to treat or vaccines to prevent COVID-19, prevention focuses on self-management strategies, creating patient education challenges for physicians doing triage and testing. This article describes a five-step process for effectively educating, at discharge, patients who are suspected of being infectious and instructed to self-isolate at home. We are proposing the CEdRIC strategy as a practical, straightforward protocol that meets patient education and health psychology science requirements. The main goal of the CEdRIC process is to give patients self-management strategies aimed at preventing complications and disease transmission. The COVID-19 pandemic is challenging clinicians to rapidly teach their patients self-management strategies while managing the inherent pressures of this emergency situation. The CEdRIC strategy is designed to deliver key information to patients and standardize the discharge process. CEdRIC is currently being tested at triage centres in Belgium. Formal assessment of its implementation is still needed.

International audience; We highlight in this short article the side-effects of COVID-19 pandemic on the management of non-COVID patients, with potential detrimental and irreversible complications. We thus propose adjusted strategies to deal with both COVID and non-COVID patients.

International audience; Preparing for emerging respiratory pathogens is a fundamental requirement for enhancements of the safeguard in healthcare settings. We are facing an increasing pressure to be prepared more than before. Healthcare organizations should be ready to deal with such emerging infectious disease. Here, we share some points that are essential to be considered while we prepare our institutions to prevent the transmission of emerging respiratory pathogens such as MERS-CoV and the recently emerging pandemic of SARS-CoV-2, the causative agent of COVID-19.

Contexte : Les conséquences de l’évolution démographique nous amènent à un vieillissement de la population qui conduit à une forte augmentation des demandes en réanimation des patients de plus de 80 ans. Ce constat soulève des questions sociétales, médicales mais aussi des questions éthiques et déontologiques. Les acteurs de la santé ne sont pas indemnes des représentations que renvoie le spectre du vieillissement. L'objectif de cette étude et de mettre en évidence comment les médecins qui interviennent dans les décisions d'admission en réanimation chez la personne âgée se positionnent et comment se basent leurs réflexions. Méthode : Il s'agit d'une étude qualitative observationnelle par focus groups. Résultats : Réalisation de quatre focus groupes en Ille et Vilaine entre Mars et Juillet 2019 à partir de trois populations de médecins différentes. Il s'agissait de médecins généralistes, de médecins réanimateurs et de médecins de soins palliatifs regroupant au total 27 participants sur la base du volontariat. De nombreux points de consensus ont été mis en évidence entre les médecins participants mettant au cœur du débat l’intérêt du patient et de ses proches. Ils ont fait part de leurs représentations personnelles et professionnelles ainsi que des paramètres divers qui pouvaient les influencer les décisions d'admission en réanimation. Enfin, le médecin traitant tient une place considérable auprès du patient et de sa famille mais également auprès des professionnels hospitaliers qui en attendent une véritable aide à la décision. Conclusion : La plupart des médecins donne de l'importance au temps qui permet à chaque acteur de la situation d'analyser différents paramètres qui amèneront à la décision la plus adaptée. Cette décision idéalement collégiale doit mesurer le risque double d'acharnement thérapeutique versus abandon de soins.

Introduction: in order to improve the emergency care pathway of patients, we wished to study the taking of the vital parameters by the triage nurse of patients with mechanical peripheral traumatology - measurements not subject to any recommendation - to answer the questions: what are the current practices? And does the measurement of these parameters change the medical care of patients? Material and methods: a retrospective study on a selection of patients of the emergency of La Pitié Salpêtrière in 2018. These patients were seen for mechanical traumatology concerning superior or inferior members only. The study consisted of an analysis of the vital parameters measured for these patients, as well as the analysis of the medical files to know the influence of these parameters on the following treatment. Results: the study showed that 53% of patients have at least one abnormal vital parameter but that the care of the patient is not influenced by this measurement. Regarding the secondary criteria, the elderly and diabetic populations were the best able to present parameters outside the norms. Conclusion: we suggest the possibility to dispense with the systematic measurement of vital parameters, except pain estimation, for patients consulting for peripheral traumatology of mechanical origin, excluding the elderly and diabetics.; Introduction : afin de fluidifier le parcours de soins des patients aux urgences, nous avons souhaité étudier la prise des paramètres vitaux à l’IOA des patients consultant pour de la traumatologie périphérique d’origine mécanique – mesures ne faisant l’objet d’aucune recommandation - pour répondre aux questions : Quelles sont les pratiques actuelles ? La mesure de ces paramètres modifie-t-elle la prise en charge médicale des patients ? Matériel et méthodes : étude rétrospective sur une sélection de patients ayant consulté au SAU de La Pitié Salpêtrière en 2018. Leur motif de consultation concernait de la traumatologie périphérique d’origine mécanique. L’étude consistait en une analyse des paramètres vitaux mesurés à l’IOA pour ces patients, ainsi qu’en l’analyse des dossiers médicaux pour connaître l’influence de ces paramètres sur la prise en charge. Résultats : l’étude a montré que 53% des patients présentent au moins un paramètre vital anormal mais que leur prise en charge au SAU n’en est pas influencée. Concernant les critères secondaires, les populations âgées et diabétiques étaient les plus à mêmes de présenter des paramètres hors des normes. Conclusion : nous suggérons la possibilité de se passer de la mesure systématique des paramètres vitaux, hors EN, pour les patients consultant pour de la traumatologie périphérique d’origine mécanique, à l’exclusion des personnes âgées et diabétiques.

Entre 2016 et 2017 une épidémie de dengue a eu lieu en Nouvelle Calédonie. Il s'agit d' une arbovirose transmise par le moustique Aedes aegypti, il existe 4 sérotypes. Au cours de cette épidémie un algorithme d’aide a l’orientation du patient suspect de dengue à destination des médecins de soins primaires, a été mis en circulation par l'équipe du service de maladies infectieuses. Le logigramme est une version remise à jour d'un document de 2012, basé en partie sur les critères OMS 2009. Dans un premier temps nous avons souhaité évaluer comment cet outils a été perçu et utilisé par les médecins de soins primaires et les urgentistes. Dans un second temps nous avons souhaité évaluer si la mise en circulation du logigramme avait modifié le profil des patients suspects de dengue hospitalisés. Nous avons mis en évidence que le logigramme a été apprécié globalement (>40 % de réponses) par l'ensemble des médecins interrogés. Le logigramme manque de performance, Sensibilité 62,28 % et Specificité 33,33 %. Il existe un intérêt à modifier ce logigramme et le compléter par un test de diagnostic rapide NS1, afin d'obtenir une meilleure spécificité c'est à dire un test de triage efficace en période épidémique.

Introduction : La permanence des soins ambulatoire (PDSA) correspond à la réponse apportée aux besoins de soins non programmés de la population aux heures de fermeture habituelle des cabinets libéraux et des centres de santé. Un état des lieux de la PDSA en Ille et Vilaine a été établi de 2009 à 2012 avec le cahier des charges de l’ARS Bretagne. Celui-ci soulevait plusieurs problèmes, notamment celui d’une démographie en hausse et vieillissante et d’une carence en médecin généraliste impliquant un développement des besoins et des inégalités en santé. L’objectif de ce travail était d’analyser les caractéristiques, sociodémographiques des usagers et leur pathologie, et des appels. Puis dans un second temps voir si la décision du régulateur était influencée par celles-ci, afin de proposer des axes d’améliorations. Méthode : étude descriptive analytique, rétrospective et unicentrique, menée du 1er septembre 2015 au 31 aout 2016. La population de l’étude était constituée des requérants ayant composés le 15 dans le département d’Ille et Vilaine, qui ont été dirigés vers le médecin régulateur de la permanence des soins (PDS) par l’assistant de régulation médicale (ARM). Résultats : 58 666 appels ont été analysés. La population était jeune (médiane à 28 ans), avec une prédominance féminine (53%). Les appels étaient plus fréquents dans le Nord-Ouest du département et en périphérie de Rennes. Les motifs d’appels les plus fréquents étaient la douleur (10%), la fièvre (9,6%) et « inquiétude sur la santé » (6,5%). 53% des appels avaient lieu le weekend, le reste était réparti équitablement sur la semaine. Le nombre d’appels par heure était plus conséquent le dimanche matin (29 appel/heure) dépassant le seuil d’efficience pour le régulateur. La décision du régulateur était dans 82 % des appels un conseil médical. Cette décision n’était pas influencée par les caractéristiques des usagers, ou des appels. La rédaction de certificat de décès était une activité fréquente pour les effecteurs mobiles et SOS médecins. Ils se déplaçaient majoritairement pour des patients de plus de 74 ans et donc potentiellement en EHPAD. Conclusion : La permanence des soins ambulatoires, a permis de pallier, en partie, à cette carence grandissante du nombre de médecin généraliste et d’un accroissement de la population. L’étude suggère un renforcement des campagnes d’informations du dispositif auprès d’une population brétilienne vieillissante et rurale. De plus, la décision du régulateur (conseil médical) requiert du temps et de l’attention, l’augmentation et la répartition du nombre de régulateurs en fonction de l’activité semble un point important. Enfin la mise en place de protocole dans les EHPAD et la rédaction des certificats de décès par les médecins traitants ou coordinateurs semblent de bons moyens pour permettre aux effecteurs mobiles et SOS médecins d’être plus disponible pour d’autres missions.

Background: Emergency Department (ED) use has been gradually increasing for several decades while the after-hours care has become deficient in the French department of Côtes d’Armor. To face this problem, a unit of mobile general practitioners (GP) has been established since 2012. The objectives of this study were to analyse the characteristics of the calls for mobile GP and to think about how the program could be improved. Method: Cross-sectional descriptive and analytic study based on a random sample of calls from the emergency call centre of Côtes d’Armor, resulting in a visit of the mobile GP, during the year 2015. Results: 419 patients were included. They were mainly elderly patients (76 ± 2 years) and female patients (56%). 60% of the visits took place at the patient’s home and 33% in nursing homes. The main activity took place during the week-end (daytime and evening). The most common reasons for the calls were deaths (22%), injuries caused by a fall (10%) and dyspneas (9%). 332 patients (79%) stayed home after the mobile GP visit while 87 patients (21%) were admitted to the emergency department. In bivariate analysis, women (p=0.0067), elderly patients (p= 0.0072) and those who lived in nursing home (p= 0.0021) were more likely to stay home after the mobile GP visit. However, in multivariate analysis, only the living space was a predictive factor for admission to the emergency department, the odds ratio between nursing home and patient’s home was 0.35, (IC95% [0.19; 0.64], p

Introduction: Specialized neurorehabilitation has been demonstrated to be very effective in the care of post-acute phase of stroke. However, only 33% of stroke patients were admitted for rehabilitation in France, among which, 23% in general or geriatric rehabilitation and only 10% in neurorehabilitation center (NRC).Objectives: The aim of this study is to analyze the representations of neurologists (NV) and of physical and rehabilitation specialists (MPR), along with their practices concerning the referral of stroke patients. A reflection on the allocation of NRC beds and on the ethical issues inherent to this matter is also presented.Method: Two surveys were sent to MPR and NV. The questions were about the availability of NRC beds, the referral choices and the admission criteria of stoke patient. Four clinicals stickers were given for illustrating complex situations.Results: NV (91%) and MPR (63%) responded that they perceive an insufficient number of NRC beds. They pointed out that the lack of space is major for certain patients who are more difficult to refer (severe stroke, patient with psycho-social fragility, severe psychiatric pathology ...). A difficulty of patient orientation is reported by 80% of MPR and 58% of NV. In the free comments, societal constraints with the increasing emphasis on cost control in care delivery are highlighted.Discussion: The physicians perceived a scarcity of NRC beds. This study showed that physicians have to make choices, involving sorting practices, for patient admission in NRC. These sorting practices depend on the role and perception of each physician. These difficult and complex choices are guided by the ethical approach of theses medical decisions.; Introduction : La rééducation neurologique spécialisée a prouvé son efficacité dans la prise en charge des patients après un AVC. Pourtant en France, tous les patients victimes d’un AVC ne peuvent être admis en Soins de Suite et Réadaptation (SSR) neurologique (seuls 10% le sont) et ce pour des raisons multiples et complexes.L’objectif de cette étude est d’analyser les pratiques et les représentations des médecins neurologues (NV) et rééducateurs (MPR) sur l’orientation des patients après un AVC et d’apporter une réflexion sur l’allocation des lits en SSR neurologique en Ile-de-France et d’en discuter les enjeux éthiques.Méthode : Deux questionnaires portant sur la rareté de la ressource et les choix d’orientation, avec 4 vignettes cliniques illustrant des situations complexes et des questions ouvertes ont été envoyés aux médecins par mails.Résultats : Les NV (91%) et les MPR (63%) disent percevoir un nombre de lits insuffisant en SSR neurologique. Ils soulignent que le manque de place est majeur pour certains profils de patients qui sont plus difficiles à orienter (AVC sévère, patient avec fragilité psycho-sociale, pathologie psychiatrique sévère,…). Les MPR (80%) et les NV (58%) rapportent une difficulté d’orientation des patients après un AVC, en particulier pour les patients précédemment cités. Dans les commentaires libres, les contraintes sociétales sont mises en avant avec l’importance croissante accordée à la maîtrise des coûts dans la prestation de soin.Discussion : Les médecins de la filière perçoivent une certaine rareté de la ressource. Les médecins sont donc amenés à faire des choix qui nécessitent un triage plus ou moins implicite à l’entrée des SSR neurologique. L'approche éthique de ces décisions médicales, permet de guider ces choix difficiles et complexes.

Objective.The benefits of early intensive treatment of inflammatory arthritis (IA) are dependent on timely and accurate case identification. In our study, a scoring algorithm for a self-administered IA detection tool was developed and validated for the rheumatology triage clinical setting.Methods.A total of 143 consecutive consenting adults, newly referred to 2 outpatient rheumatology practices, completed the tool. A scoring algorithm was derived from the best-fit logistic regression model using age, sex, and responses to the 12 tool items as candidate predictors of the rheumatologists' blinded classification of IA. Bootstrapping was used to internally validate and refine the model.Results.The 30 IA cases were younger than the 113 non-cases (p < 0.0001) and included clinical diagnoses of early IA (n = 10), rheumatoid arthritis (n = 9), and spondyloarthropathies (n = 11). Non-cases included osteoarthritis (n = 46), pain syndromes (n = 19), systemic lupus erythematosus (n = 5), and miscellaneous, noninflammatory musculoskeletal complaints (n = 43). The best-fit model included younger age, male sex, “trouble making a fist,” “morning stiffness,” “ever told you have RA,” and “psoriasis diagnosis.” The overall predictive performance (standard error, SE) of the derivation model was 0.91 (0.03). Internal validation of the derivation model across 200 bootstrap samples resulted in a mean predictive performance (SE) of 0.904 (0.002). The refined tool had a mean predictive performance (SE) of 0.915 (0.002), a sensitivity of 0.855 (0.005), and specificity of 0.873 (0.003).Conclusion.A simple, self-administered tool was developed and internally validated for the sensitive and specific detection of IA in a rheumatology waiting list sample. The tool may be used to triage IA from rheumatology referrals.

International audience; BACKGROUND: Whether proadrenomedullin (ProADM) improves the performance of the Risk of Early Admission to ICU (REA-ICU) score in predicting early, severe community-acquired pneumonia (ESCAP) has not been demonstrated. METHODS: Secondary analysis was completed of the original data from 877 consecutive patients with community-acquired pneumonia (CAP) enrolled in the Procalcitonin-Guided Antibiotic Therapy and Hospitalization in Patients With Lower Respiratory Tract Infections (ProHOSP) study, a multicenter trial in EDs of six tertiary-care hospitals in Switzerland. ESCAP was defined by either the requirement for mechanical ventilation or vasopressive drugs or occurrence of death within 3 days of ED presentation. RESULTS: Eighty patients (9.1%) developed ESCAP (47 required mechanical ventilation, 19 vasopressive drugs, and 16 died) within 3 days of ED presentation. They had a higher median ProADM value (2.18 nmol/L vs 1.15 nmol/L, P < .001). Combining ProADM testing with the REA-ICU score improved the area under the curve (0.81) compared with either parameter (ProADM [0.73] or REA-ICU score [0.76], P < .001) and resulted in a net reclassification improvement of 0.20 (P < .001). A ProADM value ≥ 1.8 nmol/L or assignment to REA-ICU risk classes III-IV predicted ESCAP with a sensitivity of 76.3% and a negative predictive value of 96.7%. Excluding 21 patients with major criteria of severe CAP on presentation showed similar results. CONCLUSION: These study findings demonstrate that the addition of ProADM to the REA-ICU score improves the classification of a substantial proportion of patients in the ED at intermediate or high risk for ESCAP, which may translate into better triage decisions.

International audience

International audience; The development of an epidemic of avian influenza will have a major impact on the organisation and structure of the facilities for treatment. This paper, the product of collaboration between the six learned societies concerned, analyses the impact of a possible pandemic on the various aspects of management of patients requiring intensive care. It describes the organisation of hospital pathways for flu and non-flu patients with, in particular, the necessary actions in terms of separation of care facilities, the triage of patients and the cancellation of non-urgent activities. It analyses the preconditions necessary for the efficient functioning of intensive care and the predictable limiting factors. It underlines the importance of training of medical and paramedical personnel. Finally, it tackles the specific problems of paediatric intensive care: organisation, capacity for admissions and training.

International audience; OBJECTIVE: Cancer patients requiring mechanical ventilation are widely viewed as poor candidates for intensive care unit (ICU) admission. We designed a prospective study evaluating a new admission policy titled The ICU Trial. DESIGN: Prospective study. SETTING: Intensive care unit. PATIENTS: One hundred eighty-eight patients requiring mechanical ventilation and having at least one other organ failure. INTERVENTIONS: Over a 3-yr period, all patients with hematologic malignancies or solid tumors proposed for ICU admission underwent a triage procedure. Bedridden patients and patients in whom palliative care was the only cancer treatment option were not admitted to the ICU. Patients at earliest phase of the malignancy (diagnosis < 30 days) were admitted without any restriction. All other patients were prospectively included in The ICU Trial, consisting of a full-code ICU admission followed by reappraisal of the level of care on day 5. MEASUREMENTS AND MAIN RESULTS: Among the 188 patients, 103 survived the first 4 ICU days and 85 died from the acute illness. Hospital survival was 21.8% overall. Among the 103 survivors on day 5, none of the characteristics of the malignancy were significantly different between the 62 patients who died and the 41 who survived. Time course of organ dysfunction over the first 6 ICU days differed significantly between survivors and nonsurvivors. Organ failure scores were more accurate on day 6 than at admission or on day 3 for predicting survival. All patients who required initiation of mechanical ventilation, vasopressors, or dialysis after 3 days in the ICU died. CONCLUSIONS: Survival was 40% in mechanically ventilated cancer patients who survived to day 5 and 21.8% overall. If these results are confirmed in future interventional studies, we recommend ICU admission with full-code management followed by reappraisal on day 6 in all nonbedridden cancer patients for whom lifespan-extending cancer treatment is available.