Gravité des suicides et des tentatives de suicide des patients de plus de 65 ans (à propos d'un collectif de 424 patients sur une cohorte de 15089 cas de suicidants)

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Evaluation de pratiques professionnelles sur la prise en charge du paludisme d'importation à Plasmodium falciparum chez l'adulte aux urgences du centre hospitalier de Tourcoing, de novembre 2007 à septembre 2013 (impact du protocole médical instauré, d'après la conférence de consensus française de 1999, révisée en 2007)

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Représentation des consultations inappropriées dans un service d'urgence (proposition de réorganisation du système de soins ambulatoires)

Contexte La fréquentation des services d urgences est en constante augmentation, engendrant une dégradation des conditions de travail pour le personnel médical et paramédical, et une augmentation directe de l attente pour les patients. L objectif de cette étude est de déterminer le profil des patients admis aux urgences pour une demande de consultation de médecine générale et de déterminer des stratégies de réorientation de ces patients vers la médecine ambulatoire. Méthodes Nous avons réalisé une étude prospective descriptive unicentrique à l aide d un questionnaire validé distribué aux patients se présentant au service d accueil des urgences de Tourcoing, durant 14 jours. Ce questionnaire regroupait les données socio-démographiques et motivationnelles des patients, complétées par les données médicales. Les patients relevant de la médecine ambulatoire ont été définis comme appartenant au groupe CCMU1 , selon la classification clinique des malades aux urgences. Résultats 961 patients ont été inclus dans l étude, dont 454 patients consultants aux heures ouvrables des cabinets médicaux. Parmi eux 86 patients ont été évalués comme relevant de la médecine ambulatoire. Ces patients différaient des autres patients (p<0,05) concernant l âge (20,1 ans), la durée de leur séjour (95 minutes) et leur évaluation de la capacité du médecin traitant à prendre en charge leur pathologie (39,7%). Conclusion L augmentation du nombre de consultations relevant de la médecine ambulatoire dans les services d urgences met en avant la nécessité d une réévaluation de l offre de soins non programmés, en ambulatoire. L approche pédagogique des patients concernant la gravité de leur pathologie et la maîtrise du système de santé doit être optimisée.LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

ARCH type bilinear weakly dependent models

International audienceGiraitis and Surgailis (2002) introduced $ARCH$-type bilinear models for their specific long range dependence properties. We rather consider weak dependence properties of these models. The computation of mixing coefficients for such models does not look as an accessible objective. So, we resort to the notion of weak dependence introduced by Doukhan and Louhichi (1999), whose use seems more relevant here. The decay rate of the weak dependence coefficients sequence is established under different specifications of the model coefficients. This implies various limit theorems and asymptotics for statistical procedures. We also derive bounds for the joint densities of this model in the case of regular inputs

Weak Dependence Beyond Mixing for Infinite ARCH-type Bilinear Models

Weak dependence properties of ARCH-type bilinear models as introduced by Doukhanand Louhichi (1999) is investigated here. Those models are usually considered for their longrange dependence properties, see Giraitis and Surgailis (2002). Decay of the weak dependencecoefficient sequence are established under different specifications of the model’s coefficients.This implies various limit theorems and asymptotics for statistical procedures.We also derivejoint densities for such models in case of regular inputs.

Abstract 19974: Medicalized Prehospital Care in the Elderly: Facing Age Discrimination

Introduction: Few studies report results on cardiac arrests (CA) care in the elderly. Even if age is not considered as an essential prognostic factor some studies questioned if cardiopulmonary resuscitation (CPR) in the elderly could be futile. Nevertheless in daily clinical practice, age seems to be an important factor conditioning CA care. Hypothesis: The aim of this case-control study was to compare out of hospital cardiac arrest care and outcome between young (&lt;65 years old) and elderly patients. Methods: We performed a prospective case-control study based on data extracted from the French National CA registry. All adult patients (&gt;18 years old) with CA recorded between July 2011 and May 2014 were included. Each elderly (&gt;=65 years old) patient (case) was matched on 3 criteria: sex, initial cardiac rhythm, and the no-flow duration. Results: We studied 4,347 pairs. We significantly found less BLS starting, ACLS duration, mobile medical team (MMT) automated chest compression, MMT ventilation and MMT epinephrine injection in the elderly. Statistical differences were also observed for return of spontaneous circulation (ROSC) (OR=0.84[0.77-0.92]), transport to hospital (OR=0.58[0.51-0.61]), vital status at hospital admission (OR=0.55[0.50-0.60]), vital status at Day 30 (OR=0.42[0.35-0.50]), and Cerebral Performance Category (CPC) at Day 30 (OR=0.44[0.37-0.53]). Conclusions: All CA guidelines, ethical statement, clinical procedures do not propose age as a discrimination criterion in OHCA care. However, our study shows that with similar CA conditions, elderly patients are victims of medical discrimination by a shorter duration and less intensive care leading to a lower survival rate compared to young people. </jats:p

Sedation versus general anaesthesia in endovascular therapy for anterior circulation acute ischaemic stroke: the multicentre randomised controlled AMETIS trial study protocol

Introduction Endovascular thrombectomy is the standard of care for anterior circulation acute ischaemic stroke (AIS) secondary to emergent large vessel occlusion in patients who qualify. General anaesthesia (GA) or conscious sedation (CS) is usually required to ensure patient comfort and avoid agitation and movement during thrombectomy. However, the question of whether the use of GA or CS might influence functional outcome remains debated. Indeed, conflicting results exist between observational studies with better outcomes associated with CS and small monocentric randomised controlled trials favouring GA. Therefore, we aim to evaluate the effect of CS versus GA on functional outcome and periprocedural complications in endovascular mechanical thrombectomy for anterior circulation AIS.Methods and analysis Anesthesia Management in Endovascular Therapy for Ischemic Stroke (AMETIS) trial is an investigator initiated, multicentre, prospective, randomised controlled, two-arm trial. AMETIS trial will randomise 270 patients with anterior circulation AIS in a 1:1 ratio, stratified by centre, National Institutes of Health Stroke Scale (≤15 or &gt;15) and association of intravenous thrombolysis or not to receive either CS or GA. The primary outcome is a composite of functional independence at 3 months and absence of perioperative complication occurring by day 7 after endovascular therapy for anterior circulation AIS. Functional independence is defined as a modified Rankin Scale score of 0–2 by day 90. Perioperative complications are defined as intervention-associated arterial perforation or dissection, pneumonia or myocardial infarction or cardiogenic acute pulmonary oedema or malignant stroke evolution occurring by day 7.Ethics and dissemination The AMETIS trial was approved by an independent ethics committee. Study began in august 2017. Results will be published in an international peer-reviewed medical journal.Trial registration number NCT03229148

Outcomes After Endovascular Therapy With Procedural Sedation vs General Anesthesia in Patients With Acute Ischemic Stroke The AMETIS Randomized Clinical Trial

International audienceImportance General anesthesia and procedural sedation are common practice for mechanical thrombectomy in acute ischemic stroke. However, risks and benefits of each strategy are unclear. Objective To determine whether general anesthesia or procedural sedation for anterior circulation large-vessel occlusion acute ischemic stroke thrombectomy are associated with a difference in periprocedural complications and 3-month functional outcome. Design, Setting, and Participants This open-label, blinded end point randomized clinical trial was conducted between August 2017 and February 2020, with final follow-up in May 2020, at 10 centers in France. Adults with occlusion of the intracranial internal carotid artery and/or the proximal middle cerebral artery treated with thrombectomy were enrolled. Interventions Patients were assigned to receive general anesthesia with tracheal intubation (n = 135) or procedural sedation (n = 138). Main Outcomes and Measures The prespecified primary composite outcome was functional independence (a score of 0 to 2 on the modified Rankin Scale, which ranges from 0 [no neurologic disability] to 6 [death]) at 90 days and absence of major periprocedural complications (procedure-related serious adverse events, pneumonia, myocardial infarction, cardiogenic acute pulmonary edema, or malignant stroke) at 7 days. Results Among 273 patients evaluable for the primary outcome in the modified intention-to-treat population, 142 (52.0%) were women, and the mean (SD) age was 71.6 (13.8) years. The primary outcome occurred in 38 of 135 patients (28.2%) assigned to general anesthesia and in 50 of 138 patients (36.2%) assigned to procedural sedation (absolute difference, 8.1 percentage points; 95% CI, −2.3 to 19.1; P = .15). At 90 days, the rate of patients achieving functional independence was 33.3% (45 of 135) with general anesthesia and 39.1% (54 of 138) with procedural sedation (relative risk, 1.18; 95% CI, 0.86-1.61; P = .32). The rate of patients without major periprocedural complications at 7 days was 65.9% (89 of 135) with general anesthesia and 67.4% (93 of 138) with procedural sedation (relative risk, 1.02; 95% CI, 0.86-1.21; P = .80). Conclusions and Relevance In patients treated with mechanical thrombectomy for anterior circulation acute ischemic stroke, general anesthesia and procedural sedation were associated with similar rates of functional independence and major periprocedural complications. Trial Registration ClinicalTrials.gov Identifier: NCT0322914

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