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

Suivi et analyse des parcours de santé de patients vulnérables dépistés positifs pour les infections virales chroniques

Introduction: Véritable enjeu de santé publique, le dépistage du VIH et des hépatites B et C doit être facilité et étendu à la population générale, notamment pour les personnes en situation de vulnérabilité. Dans le cadre d'un programme de recherche/action nommé PRECA VIR et mené au sein du Pôle d'Accès au Soins de Créteil, un dépistage des infections virales chroniques a été proposé à tous les primo-consultants. La première partie de cette étude a montré la bonne acceptabilité et la forte prévalence chez ces patients fragilisés. Ce travail a consisté à étudier les caractéristiques du parcours de santé des patients dépistés positifs. Matériel et méthodes: Il s'agit d'une étude analytique et descriptive incluant les 96 patients dépistés positifs sur une période de 32 mois, dans le cadre de la première partie de l'étude PRECAVIR. Cette cohorte a été prise en charge à la Permanence d'Accès aux Soins de Santé du Centre Hospitalier Intercommunal de Créteil. Nous avons recueilli les données concernant le suivi médical et le suivi socio-économique à l'inclusion puis à 6 et 12 mois. Résultats: L'étude confirme l'intérêt du dépistage systématiquement proposé à ces personnes vulnérables. Celui-ci permet l'accès aux soins pour plus de 80% des patients de la cohorte. La dynamique d'accè aux soins s'accompagne de l'amélioration de la protection sociale permettant à 63 % des patients une prise en charge médicale dans la durée, avec à terme un relai assuré par les professionnels de santé de ville, pour un suivi partagé. Conclusion: Ce travail montre qu'avec le soutien d'un réseau, le dépistage conduit le plus souvent à l'accès effectif, dans la durée, à un suivi partagé ville/hôpital. Ce programme PRECA VIR doit être poursuivi, renforcé et valorisé.PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF

Photonic crystal patterning of luminescent sol-gel films for light extraction

International audienceStructured luminescent thin films are investigated in the context of improved light extraction of phosphors for solid-state-lighting applications. Thin films composed of a sol-gel titania matrix doped with europium chelates are studied as a model system. These films, patterned with a square photonic lattice by soft nanoimprint lithography, are characterized by angle-resolved fluorescence. Modeling of this simple technique is shown to fit well the experimental data, revealing in great detail the guided modes of the film and their extraction parameters. An eightfold extraction enhancement factor of the film emission is measured. To further improve the extraction efficiency, we investigate the role of an additional low-index mesoporous silica underlayer through its influence on the guided modes of different polarizations and their interactions with the photonic crystal. Results obtained on model systems open the way towards the optimization of light-emitting devices, using a strategy of dielectric microstructure engineering using the sol-gel process

Courbe d'apprentissage de la transplantation utérine chez la brebis

communication libre en Gynécologie Thème: Procréation Médicalement Assistée- CNGOFNational audienc

Factors affecting medical file documentation during telephone triage at an emergency call centre: a cross-sectional study of out-of-hours home visits by general practitioners in France

Background: In France, general practitioners (GPs) perform out-of-hours home visits (OOH-HVs) after physician-led telephone triage at the emergency call centre. The quality of a systematic physician-led triage has not been determined in France and may affect the efficiency of the OOH-HV process. The objectives of this study were first, to evaluate the quality of reporting in the electronic patient's file after such triage and second, to analyse the factors associated with altered reporting. Methods: Cross-sectional study in a French urban emergency call centre (district of Paris area) from January to December 2015. For a random selection of 30 days, data were collected from electronic medical files that ended with an OOH-HV decision. Missing key quality criteria (medical interrogation, diagnostic hypothesis or ruled-out severity criteria) were analysed by univariate then multivariate logistic regression, adjusted on patient, temporal and organizational data. Results: Among 10,284 OOH-HVs performed in 2015, 748 medical files were selected. Reasons for the encounter were digestive tract symptoms (22%), fever (19%), ear nose and throat symptoms, and cardiovascular and respiratory problems (6% each). Medical interrogation was not reported in 2% of files (n = 16/748) and a diagnostic hypothesis in 58% (n = 432/748); ruled-out severity criteria were not reported in 60% (n = 449/748). On multivariate analysis, altered reporting was related to the work overload of triage assistants (number of incoming calls, call duration, telephone occupation rate; p < 0.03). Conclusion: In the electronic files of patients requiring an OOH-HV by a GP in a French urban area, quality in medical reporting appeared to depend on organizational factors only, especially the triage assistants-related work factors. Corrective measures are needed to ensure good quality of triage and care

Critical steps for initiating an animal uterine transplantation model in sheep: experience from a case serie.

International audienceRecent reports have demonstrated uterus transplantation as a relevant solution to treat absolute uterine infertility. Training on animal models is a prerequisite to set up a uterine transplantation program in humans. Sheep have been used as an optimal model for training and research as they display similar vessels size to human. While the ovine model might seem easy there are many difficulties in performing this complex surgery. In this study we describe through our experience the critical initial steps toward building a learning curve toward an optimal ovine uterine transplantation model. We performed nine orthotopic uterine autotransplantations using end-to-side anastomoses to the external iliac vessels in sheep. We recorded the duration of all surgical steps and pointed out specific difficulties and solution found. We were able to perform optimal uterine dissection after the first 5 cases and optimal bilateral arterial and venous anastomoses, after 7 and 9 cases respectively. The main factors associated to success rate were optimal exposure, appropriate equipment, careful vessel preparation and modification of the anastomosis technique. As uterine transplantation research programs are expanding, setting up an ovine model to train and perform research is critical. Such model is complex and requires optimized multidisciplinary approach to build an efficient learning curve

Association between location of out-of-hospital cardiac arrest, on-scene socioeconomic status, and accessibility to public automated defibrillators in two large metropolitan areas in Canada and France

International audienceAimTo compare walking access times to automated external defibrillators (AEDs) between area-level quintiles of socioeconomic status (SES) in out-of-hospital cardiac arrest (OHCA) cases occurring in 2 major urban regions of Canada and France.MethodsThis was an international, multicenter, retrospective cohort study of adult, non-traumatic OHCA cases in the metropolitan Vancouver (Canada) and Rhône County (France) regions that occurred between 2014 and 2018. We calculated area-level SES for each case, using quintiles of country-specific scores (Q5=most deprived). We identified AED locations from local registries. The primary outcome was the simulated walking time from the OHCA location to the closest AED (continuous and dichotomized by a 3-minute 1-way threshold). We fit multivariate models to analyze the association between OHCA-to-AED walking time and outcomes (Q5 vs. others).ResultsA total of 6,187 and 3,239 cases were included from the Metro Vancouver and Rhône County areas, respectively. In Metro Vancouver Q5 areas (vs. Q1-Q4), areas, AEDs were farther from (79% over 400m from case vs. 67%, p<0.001) and required longer walking times to (97% above 3min vs. 91%, p<0.001) cases. In Rhône Q5 areas, AEDs were closer than in other areas (43% over 400m from case vs. 50%, p=0.01), yet similarly poorly accessible (85% above 3min vs. 86%, p=0.79). In multivariate models, AED access time ≥ 3min was associated with decreased odds of survival at hospital discharge in Metro Vancouver (odds ratio 0.41, 95% CI [0.23-0.74], p=0.003).ConclusionsAccessibility of public AEDs was globally poor in Metro Vancouver and Rhône, and even poorer in Metro Vancouver’s socioeconomically deprived areas

Analysis of blood parameters and molecular endometrial markers during early reperfusion in two ovine models of uterus transplantation

International audienceThe dissection of the veins is the trickiest step of Uterine transplantation (UTx). Performing the anastomosis of a single uterine vein could bring a therapeutic benefit and simplification of surgery and serve for managing unilateral venous thromboses. The objectives of this project were to evaluate the expression of early markers of ischemia-reperfusion and to compare findings following one or two vein anastomoses. Orthotopic uterine auto-transplantations were performed on an ovine model with anastomosis of either two (group 1) or one utero-ovarian veins (group 2). Blood gases, histology and ischemia- reperfusion markers transcripts ( PTGS2 , IL6 , IL8 , SOD2 , C3 , BAX/BCL2 and TLR4) were analyzed as well as PTGS2 protein expression using Western Blot and fluorescence immunolocalization on endometrial biopsies after 3h of reperfusion. Ten ewes were included in the experimentation, 4 were in group1, 3 in group 2, the others being sham operated controls. No significant differences were observed between the two phenotypes. Based on these results, the anastomosis of one single uterine vein appears to be an approach consistent with short-term graft survival. Further experiments will be needed to confirm the reliability of this approach, especially the long-term follow-up of the uterine graft including its ability to support gestation to term

Temporal Trends of Out-of-Hospital Cardiac Arrests Without Resuscitation Attempt by Emergency Medical Services

International audienceBackground: Significant improvements in survival from out-of-hospital cardiac arrest (OHCA) have been reported; however, these are based only on data from OHCA in whom resuscitation is initiated by emergency medical services (EMS). We aimed to assess the characteristics and temporal trends of OHCA without resuscitation attempt by EMS. Methods: Prospective population-based study between 2011 and 2016 in the Greater Paris area (6.7 million inhabitants). All cases of OHCA were included in collaboration with EMS units, 48 different hospitals, and forensic units. Results: Among 15 207 OHCA (mean age 70.7±16.9 years, 61.6% male), 5486 (36.1%) had no resuscitation attempt by EMS. Factors that were independently associated with increase in likelihood of no resuscitation attempt included: age of patients (odds ratio, 1.06 per year [95% CI, 1.05–1.06], P <0.001), female sex (odds ratio, 1.21 [95% CI, 1.10–1.32], P =0.002), OHCA at home location (odds ratio, 3.38 [95%CI, 2.86–4.01], P <0.001), and absence of bystander (odds ratio, 1.94 [95% CI, 1.74–2.16], P <0.001). Overall, the annual number of OHCA increased by 9.1% (from 2923 to 3189, P =0.028). This increase was related to an increase of the annual number of OHCA without resuscitation attempt by EMS by 26.3% (from 993 to 1253, P =0.012), while the annual number of OHCA with resuscitation attempt by EMS did not significantly change (from 1930 to 1936, P =0.416). Considering only cases with resuscitation attempt, survival rate at hospital discharge increased (from 7.3% to 9.5%, P =0.02). However, when considering all OHCA, survival improvement did not reach statistical significance (from 4.8% to 5.7%, P =0.17). Conclusions: We demonstrated an increase of the total number of OHCA related to an increase of the number of OHCA without resuscitation attempt by EMS. This increasing proportion of OHCA without resuscitation attempt attenuates improvement in survival rates achieved in EMS-treated patients