Evaluating the Impact of Computerized Provider Order Entry on Medical Students Training at Bedside: A Randomized Controlled Trial

Objective: To evaluate the impact of computerized provider order entry (CPOE) at the bedside on medical students training. Materials and Methods We conducted a randomized cross-controlled educational trial on medical students during two clerkship rotations in three departments, assessing the impact of the use of CPOE on their ability to place adequate monitoring and therapeutic orders using a written test before and after each rotation. Students’ satisfaction with their practice and the order placement system was surveyed. A multivariate mixed model was used to take individual students and chief resident (CR) effects into account. Factorial analysis was applied on the satisfaction questionnaire to identify dimensions, and scores were compared on these dimensions. Results: Thirty-six students show no better progress (beginning and final test means = 69.87 and 80.98 points out of 176 for the control group, 64.60 and 78.11 for the CPOE group, p = 0.556) during their rotation in either group, even after adjusting for each student and CR, but show a better satisfaction with patient care and greater involvement in the medical team in the CPOE group (p = 0.035*). Both groups have a favorable opinion regarding CPOE as an educational tool, especially because of the order reviewing by the supervisor. Conclusion: This is the first randomized controlled trial assessing the performance of CPOE in both the progress in prescriptions ability and satisfaction of the students. The absence of effect on the medical skills must be weighted by the small time scale and low sample size. However, students are more satisfied when using CPOE rather than usual training

Incidence de l'onchocercose chez des sujets provenant de régions non endémiques et migrant dans une zone hyperendémique

The incidence of #Onchocerca volvulus$ infection was measured from 1992-93 to 1995 in six villages of initially uninfected migrants who settled in 1991 in the Vina Valley (Cameroon), an area of ongoing transmission of onchocerciasis. The mean annual incidence (MAI) exceeded 20 % in the three communities located in the first line, and fewer than 15 km from the hyperendemic areas of the Central African Republic. The MAI was lower than 16 % in the second line communities. As these populations are particularly at risk of developing ocular complications from onchocerciasis, it is recommended that repeated ivermectin distributions be organized in the migrant villages of the Vina Valley. (Résumé d'auteur

Impact of repeated large scale ivermectin treatments on the transmission of Loa loa

We have studied the impact of large-scale treatment with ivermectin on the transmission of loiasis in a forest village in south Cameroon where loiasis was highly endemic, with a prevalence of 30%. After one year of parasitological and entomological surveillance without treatment, all consenting residents aged > 5 years received ivermectin 200 microg/kg every 3 months. For ethical reasons, treatment was interrupted after 2 years, but parasitological and entomological surveillance continued for 18 months after the end of treatment. The prevalence of loiasis was reduced to < 10% and the mean microfilaraemia decreased by 90% in 2 years. The prevalence and average intensity of infection remained stable during the 18 months after treatment ended. Two vector species were identified, #Chrysops dimidiata$(representing about 90$. The infection rate (all stages) in #Chrysops$decreased by 75$ harbouring third-stage larvae of #Loa loa$in the head) decreased by 85$ and became zero in #C. silacea. After the end of treatment, the infection and infective rates increased gradually. Large-scale treatment seemed an efficient method for the control of #L. loa transmission provided high drug coverage was achieved. Nevertheless, because of the high risk of adverse effects when using the current microfilaricidal drugs, such a strategy remains unacceptable. (Résumé d'auteur

Impact of repeated large scale ivermectin treatments on the transmission of Loa loa

We have studied the impact of large-scale treatment with ivermectin on the transmission of loiasis in a forest village in south Cameroon where loiasis was highly endemic, with a prevalence of 30%. After one year of parasitological and entomological surveillance without treatment, all consenting residents aged > 5 years received ivermectin 200 microg/kg every 3 months. For ethical reasons, treatment was interrupted after 2 years, but parasitological and entomological surveillance continued for 18 months after the end of treatment. The prevalence of loiasis was reduced to < 10% and the mean microfilaraemia decreased by 90% in 2 years. The prevalence and average intensity of infection remained stable during the 18 months after treatment ended. Two vector species were identified, #Chrysops dimidiata$(representing about 90$. The infection rate (all stages) in #Chrysops$decreased by 75$ harbouring third-stage larvae of #Loa loa$in the head) decreased by 85$ and became zero in #C. silacea. After the end of treatment, the infection and infective rates increased gradually. Large-scale treatment seemed an efficient method for the control of #L. loa transmission provided high drug coverage was achieved. Nevertheless, because of the high risk of adverse effects when using the current microfilaricidal drugs, such a strategy remains unacceptable. (Résumé d'auteur

Comparison of methods for early-readmission prediction in a high-dimensional heterogeneous covariates and time-to-event outcome framework

International audienceBackground: Choosing the most performing method in terms of outcome prediction or variables selection is a recurring problem in prognosis studies, leading to many publications on methods comparison. But some aspects have received little attention. First, most comparison studies treat prediction performance and variable selection aspects separately. Second, methods are either compared within a binary outcome setting (where we want to predict whether the readmission will occur within an arbitrarily chosen delay or not) or within a survival analysis setting (where the outcomes are directly the censored times), but not both. In this paper, we propose a comparison methodology to weight up those different settings both in terms of prediction and variables selection, while incorporating advanced machine learning strategies.Methods: Using a high-dimensional case study on a sickle-cell disease (SCD) cohort, we compare 8 statistical methods. In the binary outcome setting, we consider logistic regression (LR), support vector machine (SVM), random forest (RF), gradient boosting (GB) and neural network (NN); while on the survival analysis setting, we consider the Cox Proportional Hazards (PH), the CURE and the C-mix models. We also propose a method using Gaussian Processes to extract meaningfull structured covariates from longitudinal data.Results: Among all assessed statistical methods, the survival analysis ones obtain the best results. In particular the C-mix model yields the better performances in both the two considered settings (AUC =0.94 in the binary outcome setting), as well as interesting interpretation aspects. There is some consistency in selected covariates across methods within a setting, but not much across the two settings.Conclusions: It appears that learning withing the survival analysis setting first (so using all the temporal information), and then going back to a binary prediction using the survival estimates gives significantly better prediction performances than the ones obtained by models trained “directly” within the binary outcome setting

Effets secondaires du traitement de la loase hypermicrofilarémique par l'ivermectine

Au cours des dernières années, le traitement de la loase par l'ivermectine était apparu comme une alternative à la diéthylcarbamazine par son efficacité et sa bonne tolérance. Or plusieurs cas de réactions sévères au traitement par l'ivermectine ont été décrits au Cameroun depuis 1991 chez des sujets atteints de loase hypermicrofilarémique. L'étude a porté sur 112 personnes de 19 à 60 ans, présentant une loase avec microfilarémie supérieure à 3300 microfilaires/ml. Ces sujets ont tous été hospitalisés dans le service de médecine interne de l'Hôpital central de Yaoundé pour étudier leurs réactions cliniques et biologiques au traitement. Ils recevaient une dose unique d'ivermectine de 200 microg/kg. La tolérance globale du traitement est assez bonne mais des troubles cliniques bénins sont fréquents : fièvre, arthralgies, myalgies, céphalées, prurit, troubles digestifs. Les symptômes apparaissent avec un décalage de 24 à 36 heures après la prise d'ivermectine et durent deux à trois jours. Nous avons observé 1 cas grave associant une réaction générale algique et fébrile, une glomérulonéphrite oligoanurique transitoire et des troubles sévères de la conscience. L'ensemble des troubles de ce patient ont régressé trois semaines. Pour l'ensemble des sujets, on note une chute rapide de la parasitémie les trois premiers jours, et une élévation de la protéine C réactive. Chez une partie des malades, on voit apparaître une hématurie, une protéinurie, un passage de microfilaires dans les urines et le liquide céphalorachidien. De nombreux signes cliniques ou biologiques apparaissent corrélés à l'importance de la charge parasitaire initiale. D'autre part, il existe des signes d'atteinte rénale glomérulaire transitoire fréquents chez les sujets à forte charge parasitaire. Toutes ces informations conduisent à évoquer un mécanisme de réaction inflammatoire immunoallergique par lyse parasitaire massive. Le niveau de parasitémie au-dessus duquel on peut craindre la survenue d'effets secondaires graves peut être évalué par cette étude à 30000 mf/ml de sang. La confirmation de l'existence de ces effets secondaires neurologiques graves doit rendre prudent dans la mise en oeuvre des traitements à large échelle des filarioses dans les régions d'endémie à $Loa loa#. (Résumé d'auteur

Neurological complications of varicella zoster virus reactivation: Prognosis, diagnosis, and treatment of 72 patients with positive PCR in the cerebrospinal fluid

Abstract Background VZV infection can involve every level of the neurologic system: from the central nervous system (CNS) to the peripheral nervous system (PNS), including aseptic meningitis. Prognosis seems to differ between these neurological involvements. Prognostic factors remain unknown. Methods This is a retrospective multicenter study including all patients with a positive VZV polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF) from eight centers in Paris (France) between 2011 and 2018. Unfavorable outcome was defined as mortality linked to VZV or incomplete recovery. Modified Rankin Scale (mRS) evaluated disability before and after the infection, with the difference designated as Rankin Delta. Results Seventy‐two patients were included (53% male, median age 51 years, median mRS 0). Immunosuppression was reported in 42%. The clinical spectrum included 26 cases of meningitis, 27 instances of CNS involvement, 16 of PNS involvement, and 3 isolated replications (positive PCR but no criteria for neurological complications from VZV). Antiviral treatment was administered to 69 patients (96%). Sixty‐two patients completed follow‐up. Death linked to VZV occurred in eight cases. Unfavorable outcome (UO) occurred in 60% and was significantly associated with a higher prior mRS (Odd‐ratio (OR) 3.1 [1.4–8.8] p = .012) and the presence of PNS or CNS manifestations (OR 22 [4–181] p = .001, OR 6.2 [1.3–33] p = .03, respectively, compared to meningitis). In the CSF, higher protein level (p < .0001) was also significantly associated with a higher Rankin Delta. Conclusions Neurological complications of VZV with evidence of CSF viral replication are heterogeneous: aseptic meningitis has a good prognosis, whereas presence of CNS and PNS involvement is associated with a higher risk of mortality and of sequelae, respectively