BMJ Open

OBJECTIVE: This study aims to evaluate whether the first wave of the COVID-19 pandemic resulted in a deterioration in the quality of care for socially and/or clinically vulnerable stroke and ST-segment elevation myocardial infarction (STEMI) patients. DESIGN: Two cohorts of STEMI and stroke patients in the Aquitaine neurocardiovascular registry. SETTING: Six emergency medical services, 30 emergency units, 14 hospitalisation units and 11 catheterisation laboratories in the Aquitaine region in France. PARTICIPANTS: This study involved 9218 patients (6436 stroke and 2782 STEMI patients) in the neurocardiovascular registry from January 2019 to August 2020. PRIMARY OUTCOME MEASURES: Care management times in both cohorts: first medical contact-to-procedure time for the STEMI cohort and emergency unit admission-to-imaging time for the stroke cohort. Associations between social (deprivation index) and clinical (age >65 years, neurocardiovascular history) vulnerabilities and care management times were analysed using multivariate linear mixed models, with an interaction on the time period (pre-wave, per-wave and post-first COVID-19 wave). RESULTS: The first medical contact procedure time was longer for elderly (p<0.001) and 'very socially disadvantaged' (p=0.003) STEMI patients, with no interaction regarding the COVID-19 period (age, p=0.54; neurocardiovascular history, p=0.70; deprivation, p=0.64). We found no significant association between vulnerabilities and the admission imaging time for stroke patients, and no interaction with respect to the COVID-19 period (age, p=0.81; neurocardiovascular history, p=0.34; deprivation, p=0.95). CONCLUSIONS: This study revealed pre-existing inequalities in care management times for vulnerable STEMI and stroke patients; however, these inequalities were neither accentuated nor reduced during the first COVID-19 wave. Measures implemented during the crisis did not alter the structured emergency pathway for these patients. TRIAL REGISTRATION NUMBER: NCT04979208

Evaluating a Public Health Information Service According to Users’ Socioeconomic Position and Health Status: Protocol for a Cross-Sectional Study

BackgroundThe increasing use of information technology in the field of health is supposed to promote users’ empowerment but can also reinforce social inequalities. Some health authorities in various countries have developed mechanisms to offer accurate and relevant information to health care system users, often through health websites. However, the evaluation of these sociotechnical tools is inadequate, particularly with respect to differences and inequalities in use by social groups. ObjectiveOur study aims to evaluate the access, understanding, appraisal, and use of the French website Santé.fr by users according to their socioeconomic position and perceived health status. MethodsThis cross-sectional study involves the entire French population to which Santé.fr is offered. Data will be collected through mixed methods, including a web-based questionnaire for quantitative data and interviews and focus groups for qualitative data. Collected data will cover users’ access, understanding, appraisal, and use of Santé.fr, as well as sociodemographic and socioeconomic characteristics, health status, and digital health literacy. A validation of the dimensions of access, understanding, appraisal, and use of Santé.fr will be conducted, followed by principal component analysis and ascendant hierarchical classification based on the 2 main components of principal component analysis to characterize homogeneous users’ profiles. Regression models will be used to investigate the relationships between each dimension and socioeconomic position and health status variables. NVivo 11 software (Lumivero) will be used to categorize interviewees’ comments into preidentified themes or themes emerging from the discourse and compare them with the comments of various types of interviewees to understand the factors influencing people’s access, understanding, appraisal, and use of Santé.fr. ResultsRecruitment is scheduled to begin in January 2024 and will conclude when the required number of participants is reached. Data collection is expected to be finalized approximately 7 months after recruitment, with the final data analysis programmed to be completed around December 2024. ConclusionsThis study would be the first in France and in Europe to evaluate a public health information service, in this case the Santé.fr website (the official website of the French Ministry of Health), according to users’ socioeconomic position and health status. The study could discover issues related to inequalities in access to, and the use of, digital technologies for obtaining health information on the internet. Given that access to health information on the internet is crucial for health decision-making and empowerment, inequalities in access may have subsequent consequences on health inequalities among social categories. Therefore, it is important to ensure that all social categories have access to Santé.fr. International Registered Report Identifier (IRRID)PRR1-10.2196/5112

Contextes organisationnels et managériaux des services hospitaliers : résultats d'une enquête transversale auprès de 36 services au moyen de l'outil Comet©

International audienc

Design and validation of a questionnaire to assess organizational culture in French hospital wards

International audienc

Design and validation of a questionnaire to assess organizational culture in French hospital wards

International audienc

Validité de construit d’un dispositif d’évaluation pédagogique pour des enfants de 9–11 ans en surpoids ou obèses

Introduction : L’évaluation des compétences acquises par l’enfant ayant une obésité est une étape importante de l’éducation thérapeutique du patient qui lui est proposée. Objectif : Cette étude vise à confirmer la validité de construit d’un dispositif d’évaluation pédagogique de 11 compétences auprès d’enfants de 9–11 ans en surpoids ou obèses. Le critère de validation retenu est la perception de l’utilité en termes de pertinence et de commodité. Méthode : En situation réelle d’évaluation, a été colligé l’avis d’enfants ayant un suivi éducatif et de soignants non concepteurs de l’outil. Des questionnaires, sur 12 items caractérisant la perception d’utilité, ont été administrés à une moyenne de 27 enfants par compétence et 18 soignants. Les résultats sont estimés valides à plus de 65 % d’accord par les enfants et les professionnels. Résultats : L’analyse des 352 questionnaires confirme la validité du dispositif. Pour la plupart des compétences, il est estimé attractif et adapté aux capacités cognitives de l’enfant, favorisant la production d’informations, l’auto-évaluation. Discussion : Le dispositif s’avère adapté aux potentialités de l’enfant, lui proposant un environnement didactique tout en respectant les principes de l’évaluation en ETP en termes d’approche formative. Les réajustements d’outils et les conditions d’utilisation proposés tendent à améliorer la qualité pédagogique de cette évaluation. Conclusion : L’étude montre l’utilité du dispositif. Il permet d’évaluer les compétences acquises par les enfants et d’adapter leurs suivis éducatifs

Validité de construit d’un dispositif d’évaluation pédagogique pour des enfants de 9–11 ans en surpoids ou obèses

International audienceIntroduction: Assessing the competencies acquired by obese children is an important step in the therapeutic patient education offered to them. Aim: The aim of this study was to confirm the construct validity of an educational assessment of eleven competencies in overweight and obese children ages 9–11 years. The validation criterion chosen was the perceived usefulness in terms of relevance and convenience.Methods: In real situation assessment, was collected the opinions of children with educational follow-up and those of care providers not involved in designing the tool. Questionnaires on 12 items characterizing the perception of usefulness were administered to a mean of 27 children per skill and to 18 care providers. The results were considered valid if there was more than 65% agreement by the children and the professionals.Results: The analysis of 352 questionnaires confirmed the validity of the assessment. For most of the competencies it was considered attractive and appropriate to the children’s cognitive abilities, encouraging information production and self-assessment.Discussion: The assessment proved appropriate to the capacities of children, offering them a learning environment while adhering to TPE principles in terms of formative assessment. The tools adjustments and proposed conditions of use tend to improve quality assessment.Conclusion: The study demonstrates the usefulness of the assessment technique. It can be used to assess the children’s acquired competencies and to adapt their educational follow-up.Introduction : L’évaluation des compétences acquises par l’enfant ayant une obésité est une étape importante de l’éducation thérapeutique du patient qui lui est proposée. Objectif : Cette étude vise à confirmer la validité de construit d’un dispositif d’évaluation pédagogique de 11 compétences auprès d’enfants de 9–11 ans en surpoids ou obèses. Le critère de validation retenu est la perception de l’utilité en termes de pertinence et de commodité. Méthode : En situation réelle d’évaluation, a été colligé l’avis d’enfants ayant un suivi éducatif et de soignants non concepteurs de l’outil. Des questionnaires, sur 12 items caractérisant la perception d’utilité, ont été administrés à une moyenne de 27 enfants par compétence et 18 soignants. Les résultats sont estimés valides à plus de 65 % d’accord par les enfants et les professionnels.Résultats : L’analyse des 352 questionnaires confirme la validité du dispositif. Pour la plupart des compétences, il est estimé attractif et adapté aux capacités cognitives de l’enfant, favorisant la production d’informations, l’auto-évaluation.Discussion : Le dispositif s’avère adapté aux potentialités de l’enfant, lui proposant un environnement didactique tout en respectant les principes de l’évaluation en ETP en termes d’approche formative. Les réajustements d’outils et les conditions d’utilisation proposés tendent à améliorer la qualité pédagogique de cette évaluation.Conclusion : L’étude montre l’utilité du dispositif. Il permet d’évaluer les compétences acquises par les enfants et d’adapter leurs suivis éducatifs

Rev Epidemiol Sante Publique

Contexte et objectif : Lors d'un accident vasculaire cérébral ischémique dû à une occlusion d'un gros vaisseau, plus la thrombectomie mécanique (TM) est réalisée rapidement, meilleur est le pronostic fonctionnel. Cependant, l'organisation des soins ne permet pas systématiquement un accès rapide à la TM. L'objectif de notre étude était de déterminer les facteurs cliniques et organisationnels associés au délai d'accès à la TM. Méthodes : Nous avons réalisé une étude de cohorte dans le département de la Gironde, en France. Les patients nécessitant une TM et régulés par les Services d'Aide Médicale Urgente (SAMU) de Gironde entre le 01/01/2017 et le 31/12/2018 ont été inclus. Le délai d'accès à la TM correspondait à la différence entre le premier appel au SAMU et la ponction de l'aine pour TM. Les principales variables explicatives étaient : le type de parcours de soins (mothership (MS), drip and ship (DS) avec imagerie cérébrale réalisée au centre hospitalier de proximité (CHP) et DS sans imagerie au CHP) ; le score NIHSS ; la distance kilométrique pour accéder à la TM ; le moment de survenue de l'AVC (week-end ou jour férié, vacances scolaires, autre) ; l'âge et le sexe. Des modèles de régression linéaire ont été utilisés pour expliquer le délai d'accès à la TM. Les données manquantes ont été gérées à l'aide d'une procédure d'imputation multiple (spécification conditionnelle complète, Mice R-Package) exécutée dans notre modèle de régression linéaire multivariable. Une analyse quantitative du biais a été réalisée en pondérant le délai imputé d'accès à la TM et en identifiant le poids qui modifie les conclusions de notre analyse. Résultats : Parmi les 314 patients inclus, 152 étaient des femmes (48,4 %), et le score NIHSS moyen à l'admission était de 16,4. Deux cent deux (64,3 %) patients ont été pris en charge dans parcours MS. Le délai moyen entre le premier appel au SAMU et la ponction fémorale pour TM était de 251 minutes. Dans l'analyse multivariable, le délai d'accès à la TM était plus long lorsque les patients étaient pris en charge dans le parcours DS avec imagerie dans le CHP (+106 min, p=0,03), et encore plus long dans le parcourd DS sans imagerie dans le CHP (+197 min, p=0,002), par rapport au parcours MS. Le délai d'accès à la TM diminuait avec l'augmentation du score NIHSS (-6 min par point NIHSS, p<.0001). Dans notre analyse quantitative des biais, nous avons multiplié le délai imputé d'accès à la TM dans les parcours DS uniquement (avec ou sans imagerie dans le CHP) par des poids variant de 0,9 à 0,2 (délais imputés réduits de 10 % à 80 %). Avec une réduction de 40 % ou plus, il n'y avait plus de différence de délai d'accès à la TM entre les trois parcours de soins étudiés. Conclusions : Le parcours DS peut encore être raccourci en généralisant l'accès à l'imagerie cérébrale au sein des CHP. L'optimisation de l'orientation pré-admission vers la TM est un point majeur dans la prise en charge des accidents vasculaires cérébraux ischémiques dûs à une occlusion d'un gros vaisseau.BACKGROUND AND PURPOSE: When an ischaemic stroke due to a large vessel occlusion occurs, the sooner Mechanical Thrombectomy (MT) is performed, the better the functional prognosis. However, the organisation of care does not systematically allow rapid access to MT. The aim of our study was to determine the clinical and organisational factors associated with the time to access to MT. METHODS: We conducted a cohort study in Gironde County, France. Patients admitted for MT and regulated by the Gironde Emergency Medical Services (EMS) between 01/01/2017 and 31/12/2018 were included. The time to access to MT was the difference between the first call to EMS and groin puncture for MT. The main explanatory variables were: type of pathway (mothership (MS), drip and ship (DS) with cerebral imaging performed in the local hospital centre (LHC), and DS without imaging in the LHC); NIHSS score; driving distance to MT; time of stroke onset (weekend or holiday, school holidays, other); age and sex. Linear regression models were used to explain time to access to MT. Missing data were handled using a multiple imputation procedure (Full conditional specification, Mice R-Package) carried out in our multivariable linear regression model. A quantitative bias analysis was performed by weighing the imputed time to access to MT and identifying the weight changing the conclusions of our analysis. RESULTS: Among the 314 included patients, 152 were women (48.4%), and the mean NIHSS score was 16.4. Two hundred and two (64.3%) patients were managed through the MS pathway. The average time from onset to femoral puncture was 251 minutes. In the multivariate analysis, the time to MT was longer when patients were managed DS with imaging in the LHC pathway (+106 min, p = 0.03), and even longer in the DS without imaging in the LHC pathway (+197 min, p = 0.002), compared with MS. Time from onset to MT decreased with increasing NIHSS score (-6 min per NIHSS point, p <.0001). In our quantitative bias analysis, we multiplied the imputed time in access to MT in the DS pathways only (with or without imaging in the LHC) by weights varying from 0.9 to 0.2 (imputed delays reduced from 10% to 80%). With reduction of 40% or more, there was no longer any difference in time to access to MT between the three studied pathways. CONCLUSIONS: The DS pathway can be shortened by generalizing access to cerebral imaging in LHCs. Optimizing pre-admission orientation toward MT is a major issue in LVOS management

Organizational and managerial factors associated with clinical practice guideline adherence: a simulation-based study in 36 French hospital wards

International audienceObjectives: To identify managerial and organizational characteristics of multi-specialty medicine wards and individual characteristics of health professionals that are most strongly associated with clinical practice guidelines (CPG) adherence.Design: Cross-sectional stratified cluster sample design.Setting: Data were gathered from 36 randomly selected multi-specialty medicine wards.Participants: The study population included all health professionals involved in patient care working in the participating wards.Main outcome measures: The degree of CPG adherence was measured using clinical vignettes on three topics: pain management, managing heart failure and managing diabetes. Responses from each professional to each clinical case were quantified using a 10-point scale. Managerial and organizational characteristics of medical department and individual characteristics of health professionals were obtained using three questionnaires.Results: The study sample consisted of 859 professionals (362 orderlies, 361 nurses and 136 physicians). Factors independently and positively associated with CPG adherence were (i) individual factors: low age of professionals, expertise in diabetology and activity in cardiology; (ii) organizational and managerial factors: good understanding between physicians and other personnel; and (iii) structural factors: computer-based test results and prescriptions, presence of medical specialists, inter-department mobility of orderlies, medium-length stay (between 7 and 10 days) and large bed capacity.Conclusions: Good CPG adherence in general medicine needs institutional dynamism, availability of clinical competence and team culture based on cooperation

Rev Neurol

The objectives were to analyze changes from 2012 to 2017 in different management times of stroke patients included in the Aquitaine stroke Observatory (ObA2). The studied times (onset-to-needle time-ONT, onset-to-door time-ODT, door-to-imaging time-DIT, door-to-needle time-DNT and imaging-to-needle time-INT) were described as median, interquartile ranges and proportion of patients within the recommended median time goals (ODT under 4hours, DIT within 20min; for thrombolyzed patients, DIT under 20min and a ONT under 4:30) to be compared with an objective of 50% of patients within said time goal. Globally, ODT was 160min, with 43.6% to 59.6% of patients within the ODT goal along the study period. With no improvement over time, the proportion of patients within the DIT goal stayed stable and at a low level (range: 5.5-7.0%) for all patients, decreasing from 25.2% to 11.4% for thrombolyzed patients. The proportion of thrombolyzed patients within the DNT goal varied from 15.1% to 30.3% during study period. These results highlight the urgent need for action to improve in-hospital management of stroke patients, focusing on delays between admission and imaging