Initializing a hospital-wide data quality program. The AP-HP experience.

International audienceBackground and objectives: Data Quality (DQ) programs are recognized as a critical aspect of new-generation research platforms using electronic health record (EHR) data for building Learning Healthcare Systems. The AP-HP Clinical Data Repository aggregates EHR data from 37 hospitals to enable large-scale research and secondary data analysis. This paper describes the DQ program currently in place at AP-HP and the lessons learned from two DQ campaigns initiated in 2017.Materials and methods: As part of the AP-HP DQ program, two domains - patient identification (PI) and healthcare services (HS) - were selected for conducting DQ campaigns consisting of 5 phases: defining the scope, measuring, analyzing, improving and controlling DQ. Semi-automated DQ profiling was conducted in two data sets - the PI data set containing 8.8 M patients and the HS data set containing 13,099 consultation agendas and 2122 care units. Seventeen DQ measures were defined and DQ issues were classified using a unified DQ reporting framework. For each domain, actions plans were defined for improving and monitoring prioritized DQ issues.Results: Eleven identified DQ issues (8 for the PI data set and 3 for the HS data set) were categorized into completeness (n = 6), conformance (n = 3) and plausibility (n = 2) DQ issues. DQ issues were caused by errors from data originators, ETL issues or limitations of the EHR data entry tool. The action plans included sixteen actions (9 for the PI domain and 7 for the HS domain). Though only partial implementation, the DQ campaigns already resulted in significant improvement of DQ measures.Conclusion: DQ assessments of hospital information systems are largely unpublished. The preliminary results of two DQ campaigns conducted at AP-HP illustrate the benefit of the engagement into a DQ program. The adoption of a unified DQ reporting framework enables the communication of DQ findings in a well-defined manner with a shared vocabulary. Dedicated tooling is needed to automate and extend the scope of the generic DQ program. Specific DQ checks will be additionally defined on a per-study basis to evaluate whether EHR data fits for specific uses

Psychophysical estimate of plantar vibration sensitivity brings additional information to the detection threshold in young and elderly subjects

Objective: Vibration detection threshold of the foot sole was compared to the psychophysical estimate of vibration in a wide range of amplitudes in young (20–34 years old) and elderly subjects (53–67 years old). Methods: The vibration detection threshold was determined on the hallux, 5th metatarsal head, and heel at frequencies of 25, 50 and 150 Hz. For vibrations of higher amplitude (reaching 360 μm), the Stevens power function (Ψ = k * Φn) allowed to obtain regression equations between the vibration estimate (Ψ) and its physical magnitude (Φ), the n coefficient giving the subjective intensity in vibration perception. We searched for age-related changes in the vibration perception by the foot sole. Results: In all participants, higher n values were measured at vibration frequencies of 150 Hz and, compared to the young adults the elderly had lower n values measured at this frequency. Only in the young participants, the vibration detection threshold was lowered at 150 Hz. Conclusion: The psychophysical estimate brings further information than the vibration detection threshold which is less affected by age. Significance: The clinical interest of psychophysical vibration estimate was assessed in a patient with a unilateral alteration of foot sensitivity. Keywords: Vibration sensitivity, Vibration detection threshold, Foot sole, Elderl

How to Improve Cancer Patients ENrollment in Clinical Trials From rEal-Life Databases Using the Observational Medical Outcomes Partnership Oncology Extension: Results of the PENELOPE Initiative in Urologic Cancers

International audiencePURPOSE To compare the computability of Observational Medical Outcomes Partnership (OMOP)–based queries related to prescreening of patients using two versions of the OMOP common data model (CDM; v5.3 and v5.4) and to assess the performance of the Greater Paris University Hospital (APHP) prescreening tool.MATERIALS AND METHODS We identified the prescreening information items being relevant for prescreening of patients with cancer. We randomly selected 15 academic and industry-sponsored urology phase I-IV clinical trials (CTs) launched at APHP between 2016 and 2021. The computability of the related prescreening criteria (PC) was defined by their translation rate in OMOP-compliant queries and by their execution rate on the APHP clinical data warehouse (CDW) containing data of 205,977 patients with cancer. The overall performance of the prescreening tool was assessed by the rate of true- and false-positive cases of three randomly selected CTs.RESULTS We defined a list of 15 minimal information items being relevant for patients' prescreening. We identified 83 PC of the 534 eligibility criteria from the 15 CTs. We translated 33 and 62 PC in queries on the basis of OMOP CDM v5.3 and v5.4, respectively (translation rates of 40% and 75%, respectively). Of the 33 PC translated in the v5.3 of the OMOP CDM, 19 could be executed on the APHP CDW (execution rate of 58%). Of 83 PC, the computability rate on the APHP CDW reached 23%. On the basis of three CTs, we identified 17, 32, and 63 patients as being potentially eligible for inclusion in those CTs, resulting in positive predictive values of 53%, 41%, and 21%, respectively. CONCLUSION We showed that PC could be formalized according to the OMOP CDM and that the oncology extension increased their translation rate through better representation of cancer natural history

AP-HP Health Data Space (AHDS) to the Test of the Covid-19 Pandemic

Sharing observational and interventional health data within a common data space enables university hospitals to leverage such data for biomedical discovery and moving towards a learning health system. Objective: To describe the AP-HP Health Data Space (AHDS) and the IT services supporting piloting, research, innovation and patient care. Methods: Built on three pillars – governance and ethics, technology and valorization – the AHDS and its major component, the Clinical Data Warehouse (CDW) have been developed since 2015. Results: The AP-HP CDW has been made available at scale to AP-HP both healthcare professionals and public or private partners in January 2017. Supported by an institutional secured and high-performance cloud and an ecosystem of tools, mostly open source, the AHDS integrates a large amount of massive healthcare data collected during care and research activities. As of December 2021, the AHDS operates the electronic data capture for almost +840 clinical trials sponsored by AP-HP, the CDW is enabling the processing of health data from more than 11 million patients and generated +200 secondary data marts from IRB authorized research projects. During the Covid-19 pandemic, AHDS has had to evolve quickly to support administrative professionals and caregivers heavily involved in the reorganization of both patient care and biomedical research. Conclusion: The AP-HP Data Space is a key facilitator for data-driven evidence generation and making the health system more efficient and personalized

Improving the accuracy of personal radiofrequency measurements to enable a better understanding of existing data

International audienceHuman exposure to radiofrequency electromagnetic fields (RF-EMF) is often measured by personal exposimeters. However, available portable devices are compromised by the presence of the human body and have large measurement uncertainties. The aim of this study was to compare measurement results of a newly developed prototype of a multi-band body-worn distributed-exposimeter (BWDM) with two commercially available personal exposimeters (EXPOM and EME SPY 200). The BWDM prototype has been developed for simultaneous measurement of the incident power density in 11 frequency bands (LTE 800 and 2600 MHz, 900 MHz, 1800 MHz, 2100 MHz, DECT, Wi-Fi 2 GHz and 5 GHz, including uplink and downlink bands). The BWDM consists of 22 textile antennas integrated in a garment, distributed in an optimal way on the front and back of the human torso as well as right and left hips. For all frequency bands, antenna pairs are placed on diametrically opposite locations on body, for minimizing body-shielding. Since 2016, field measurements are being conducted in various indoor and outdoor microenvironments in Belgium, Spain, France, Netherlands and Switzerland. In each country, a trained research assistant is using the BWDM in parallel with EXPOM and EME SPY 200 exposimeters by walking along pre-defined measurement routes, comparing different characteristic microenvironments such as urban, suburban and rural areas, public transport infrastructure, and public areas such as universities, parks and shopping centres. In a first step of data analysis, the results of the measurement in Switzerland from November and December 2016 will be used to compare the measurements of the three different exposimeters. The results of the device comparisons will enable a better understanding and interpretation of existing epidemiological research results, as well as improved risk assessment and communication strategies

Different cardiovascular profiles of three melanocortins in conscious rats; evidence for antagonism between γ(2)-MSH and ACTH-(1–24)

1. We investigated the effects of [Nle(4),D-Phe(7)]α-melanocyte-stimulating hormone (NDP-MSH), adrenocorticotropin-(124) (ACTH-(124)) and γ(2)-MSH, three melanocortins with different agonist selectivity for the five cloned melanocortin receptors, on blood pressure and heart rate in conscious, freely moving rats following intravenous administration. 2. As was previously found by other investigators as well as by us, γ(2)-MSH, a peptide suggested to be an agonist with selectivity for the melanocortin MC(3) receptor, caused a dose-dependent, short lasting pressor response in combination with a tachycardia. Despite the fact that NDP-MSH is a potent agonist of various melanocortin receptor subtypes, among which the melanocortin MC(3) receptor, it did not affect blood pressure or heart rate, when administered i.v. in doses of up to 1000 nmol kg(−1). 3. ACTH-(124) caused a dose-dependent decrease in blood pressure in combination with a dose-dependent increase in heart rate in a dose-range from 15 to 500 nmol kg(−1). The cardiovascular effects of ACTH-(124) were independent of the presence of the adrenals. 4. Pretreatment with ACTH-(124) caused a pronounced, dose-dependent parallel shift to the right of the dose-response curve for the pressor and tachycardiac effects of γ(2)-MSH. The antagonistic effect of ACTH-(124) was already apparent following a dose of this peptide as low as 10 nmol kg(−1), which when given alone had no intrinsic hypotensive activity. 5. These results form further support for the notion that it is not via activation of one of the as yet cloned melanocortin receptors that γ-MSH-like peptides increase blood pressure and heart rate. The cardiovascular effects of ACTH-(124) seem not to be mediated by the adrenal melanocortin MC(2) receptors, for which ACTH-(124) is a selective agonist, or by adrenal catecholamines. 6. There appears to be a functional antagonism between ACTH-(124) and γ(2)-MSH, two melanocortins derived from a common precursor, with respect to their effect on blood pressure and heart rate. Whether this antagonism plays a (patho)physiological role remains to be shown

External validation of prognostic scores for COVID-19: a multicenter cohort study of patients hospitalized in Greater Paris University Hospitals

International audiencePurposeThe Coronavirus disease 2019 (COVID-19) has led to an unparalleled influx of patients. Prognostic scores could help optimizing healthcare delivery, but most of them have not been comprehensively validated. We aim to externally validate existing prognostic scores for COVID-19.MethodsWe used “COVID-19 Evidence Alerts” (McMaster University) to retrieve high-quality prognostic scores predicting death or intensive care unit (ICU) transfer from routinely collected data. We studied their accuracy in a retrospective multicenter cohort of adult patients hospitalized for COVID-19 from January 2020 to April 2021 in the Greater Paris University Hospitals. Areas under the receiver operating characteristic curves (AUC) were computed for the prediction of the original outcome, 30-day in-hospital mortality and the composite of 30-day in-hospital mortality or ICU transfer.ResultsWe included 14,343 consecutive patients, 2583 (18%) died and 5067 (35%) died or were transferred to the ICU. We examined 274 studies and found 32 scores meeting the inclusion criteria: 19 had a significantly lower AUC in our cohort than in previously published validation studies for the original outcome; 25 performed better to predict in-hospital mortality than the composite of in-hospital mortality or ICU transfer; 7 had an AUC > 0.75 to predict in-hospital mortality; 2 had an AUC > 0.70 to predict the composite outcome.ConclusionSeven prognostic scores were fairly accurate to predict death in hospitalized COVID-19 patients. The 4C Mortality Score and the ABCS stand out because they performed as well in our cohort and their initial validation cohort, during the first epidemic wave and subsequent waves, and in younger and older patients

Obesity Doubles Mortality in Patients Hospitalized for Severe Acute Respiratory Syndrome Coronavirus 2 in Paris Hospitals, France: A Cohort Study on 5,795 Patients

International audienc