EuReCa ONE—27 Nations, ONE Europe, ONE Registry A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe

AbstractIntroductionThe aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.MethodsThis was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.ResultsData on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.ConclusionThe results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events

External validation of prognostic models predicting pre-eclampsia : individual participant data meta-analysis

Abstract Background Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity. Early identification of women at risk during pregnancy is required to plan management. Although there are many published prediction models for pre-eclampsia, few have been validated in external data. Our objective was to externally validate published prediction models for pre-eclampsia using individual participant data (IPD) from UK studies, to evaluate whether any of the models can accurately predict the condition when used within the UK healthcare setting. Methods IPD from 11 UK cohort studies (217,415 pregnant women) within the International Prediction of Pregnancy Complications (IPPIC) pre-eclampsia network contributed to external validation of published prediction models, identified by systematic review. Cohorts that measured all predictor variables in at least one of the identified models and reported pre-eclampsia as an outcome were included for validation. We reported the model predictive performance as discrimination (C-statistic), calibration (calibration plots, calibration slope, calibration-in-the-large), and net benefit. Performance measures were estimated separately in each available study and then, where possible, combined across studies in a random-effects meta-analysis. Results Of 131 published models, 67 provided the full model equation and 24 could be validated in 11 UK cohorts. Most of the models showed modest discrimination with summary C-statistics between 0.6 and 0.7. The calibration of the predicted compared to observed risk was generally poor for most models with observed calibration slopes less than 1, indicating that predictions were generally too extreme, although confidence intervals were wide. There was large between-study heterogeneity in each model’s calibration-in-the-large, suggesting poor calibration of the predicted overall risk across populations. In a subset of models, the net benefit of using the models to inform clinical decisions appeared small and limited to probability thresholds between 5 and 7%. Conclusions The evaluated models had modest predictive performance, with key limitations such as poor calibration (likely due to overfitting in the original development datasets), substantial heterogeneity, and small net benefit across settings. The evidence to support the use of these prediction models for pre-eclampsia in clinical decision-making is limited. Any models that we could not validate should be examined in terms of their predictive performance, net benefit, and heterogeneity across multiple UK settings before consideration for use in practice. Trial registration PROSPERO ID: CRD42015029349

Indications et résultats de l'induction du travail par gels de prostaglandines E2 (comparaison des pratiques entre 1996-1997, 111 cas et 1999-2000, 170 cas)

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Être mère ici et là-bas : une parentalité complexe

Meeting pregnant migrant women who have had to leave children behind in their home country has led to exploratory research in order to better understand the issues surrounding their parenthood experience. The main objective of this work is to explore these women’s subjective experiences and to focus on their representations of motherhood, concerning both the child they are expecting here and the ones they left behind. The data was gathered from semi-structured interviews with nine participants and analyzed using the IPA methodology (Interpretative Phenomenological Analysis). The analysis allowed three main meta-themes to be identified, highlighting the separation and loss that are felt on various levels by these women, and the different ways of creating links between the present and the past. The image of motherhood provided by these women is complex, entailing adjustments and changes as they explore and reappraise the traditions of childcare and fostering. The furthering and broadening of this area of research is essential for improving the perinatal care of migrant women.La rencontre au cours d’une grossesse de femmes migrantes ayant des enfants restés dans leur pays d’origine incite à mieux comprendre les enjeux de leur parentalité. L’objectif principal de la recherche présentée ici est d’explorer l’expérience subjective de la maternité chez ces femmes. Il s’agit d’une étude exploratoire des représentations maternelles fondée sur une démarche qualitative à partir d’entretiens semi-directifs analysés ensuite selon la méthodologie IPA (interpretative phenomenological analysis). Les entretiens ont été réalisés auprès de neuf participantes. Les résultats présentés ici développent deux des trois méta-thèmes retrouvés. Ceux-ci donnent à voir que la séparation et la perte s’expriment à plusieurs niveaux chez ces femmes et que les différentes façons d’être en lien s’articulent entre ici et là-bas. La maternité donnée à voir par ces femmes est complexe et suppose des remaniements et des aménagements, venant à la rencontre des traditions de confiage des enfants et les réinterrogeant. La poursuite et l’élargissement de ce champ de recherche sont nécessaires pour améliorer la prise en charge périnatale des femmes migrantes

Autour de l'accueil du bébé : intérêt d'une consultation transculturelle en maternité

International audienc

Psychosocial deprivation in women with gestational diabetes mellitus is associated with poor fetomaternal prognoses: an observational study

International audienceObjective: To evaluate the prognoses associated with psychosocial deprivation in women with gestational diabetes mellitus (GDM). Design: Observational study considering the 1498 multiethnic women with GDM who gave birth between January 2009 and February 2012. Setting: Four largest maternity units in the northeastern suburban area of Paris. Participants: The 994 women who completed the Evaluation of Precarity and Inequalities in Health Examination Centers (EPICES) questionnaire. Main outcome measure: Main complications of GDM (large infant for gestational age (LGA), shoulder dystocia, caesarean section, pre-eclampsia). Results: Psychosocial deprivation (EPICES score >= 30.17) affected 577 women (56%) and was positively associated with overweight/obesity, parity and non-European origin, and negatively associated with family history of diabetes, fruit and vegetable consumption and working status. The psychosocially deprived women were diagnosed with GDM earlier, received insulin treatment during pregnancy more often and were more likely to have LGA infants (15.1% vs 10.6%, OR=1.5 (95% CI 1.02 to 2.2), p<0.05) and shoulder dystocia (3.1% vs 1.2%, OR=2.7 (0.97 to 7.2), p<0.05). In addition to psychosocial deprivation, LGA was associated with greater parity, obesity, history of GDM, ethnicity, excessive gestational weight gain and insulin therapy. A multivariate analysis using these covariates revealed that the EPICES score was independently associated with LGA infants (per 10 units, OR=1.12 (1.03 to 1.20), p<0.01). Conclusions: In our area, psychosocial deprivation is common in women with GDM and is associated with earlier GDM diagnoses and greater insulin treatment, an increased likelihood of shoulder dystocia and, independently of obesity, gestational weight gain and other confounders with LGA infants