Stroke care in Brazil and France : national policies and healthcare indicators comparison

Objective: To identify the commonalities and discrepancies between national health policies to combat stroke in France and Brazil. Justification: Both healthcare systems were structured as universal access and comprehensive care attention, hierarchized by the level of care, politically and administratively decentralized. France is an industrialized, high-income country, with health care involving copayment and reimbursement of expenses, and spontaneous demand for services. Brazil is a member of the BRICs, of upper middle income with totally free health care, with an active search for hypertension and diabetes in the general population. Methods: Data regarding policies, risk factors, and health indicators about stroke care, from 2010 to 2017, were obtained from both countries (publicly accessible information or on request) from the respective Ministries of Health or international agencies. Results: About acute stroke hospitalizations, on average, Brazil has 0.75 per 1000 annual population hospitalizations versus 1.54 per 1000 in France. Brazil has 0.21 per 1000 population deaths per year versus 0.40 per 1000 in France. The in-hospital mortality rate in Brazil has 139 per 1000 hospitalized people versus 263 in France. The average length of stay of acute hospitalizations was 7.6 days in Brazil versus 12.6 in France. The prevalence of strokes by age group shows from 0 to 39 years old (this rate is stable); 40–59 years (it is increasing in both countries); and 60–79 and 80+ years (this rate has been increasing in France and decreasing in Brazil). Conclusion: No major differences were found about the health policies and the National Health Plans related to stroke. However, the data directly linked to the period of hospitalization differed substantially between countries. Subsequent studies can be implemented to identify the explanatory factors, notably among the risk factors and actions in primary care, and the moments after hospital care, such as secondary prevention and palliative care

TRAIECTORIILE PACIENTILOR CU CANCER DE SAN - COMPARAREA A DOUA REGIUNI DIN FRANȚA SI ROMANIA SIMILARE CA DIMENSIUNE A POPULATIEI (RHONE ALPES SI TRANSILVANIA)

The work presented in this article is part of a larger study that aims at comparing and putting together information about patients’ trajectories and resources allocation model, in order to suggest a more efficient and equitable way of organizing certain type of medical services within a region or even at national level. The objective of the study is to analyze the situation for beast cancer patients’ trajectories in 2 similar regions (population size) and see if similar or different conclusions related with the organization of the cancer network can be drawn, similar (or not) with those of the French colleagues analyzing the Rhone Alpes database (1).The methodology used was based on the availability for both countries and regions of (all) patients level data information, including standardized clinical and geographical information about patient and the medical facility where the patient sleeked care. Analysis was performed using the Microsoft Access data base made available for inpatient care in Romania (courtesy of the National School of Public health from Bucharest) and tracked with the help of the UPI (Unique Patient Identifier) the trajectory of the breast cancer patients (C50, World Health Organization International Classification of Diseases version 10) along the hospitals from Transylvania (16 counties) during year 2005 (January 1st, December 31st).In parallel, a literature and legislative and regulatory review made possible analysis of the existing cancer network formal organization within the Romanian health system and compare it with the results of the patients’ trajectories analysis.The results of the studies allow for two main conclusions: using similar standardized information systems to record medical activity allows comparisons of not only data, but concepts between population similar regions and trajectories of the breast cancer patients analyzed for Transylvania are a good predictor for the (re) organization of the cancer health care delivery network, especially of the resources allocation component is also taken into consideration. Keywords:Patients’ trajectory, hospitals network, breast cancer, classification system, regionLucrarea prezentata in acest articol este parte a unui studiu mai mare care are drept scop reunirea si compararea informatiilor despre traiectoriile pacientilor si modelul de alocare a resurselor, pentru a sugera un mod mai eficient si echitabil de a organiza anumite tipuri de servicii medicale intr-o regiune sau chiar la nivel national. Obiectivul de studiu este de a analiza situatia traiectoriilor pacientilor cu cancer de san in 2 regiuni similare (marimea populatiei) si a vedea daca pot fi trase concluzii similare sau diferite legate de organizarea retelelor de oncologie, similare (sau nu) cu cele ale colegilor francezi care au analizat baza de date din regiunea Rhône Alpes (1). Metodologia utilizata a fost bazata pe disponibilitatea pentru ambele tari si regiuni, a (tuturor) informatiilor privind datele la nivel de pacient, inclusiv informatiile clinice si geografice standardizate despre pacient si spitalul la care pacientul a primit ingrijiri. Analiza a fost efectuata folosind baza de date Microsoft Access existenta la nivel national continand datele pacientilor din spitalizare continua in Romania (prin bunavointa Școlii Nationale de Sanatate Publica, Management si Perfectionare in Domeniul Sanitar din Bucuresti, Romania), si urmarirea cu ajutorul Identificatorului Unic de Pacient (“Unique Patient Identifier”, UPI, IUP) a traiectoriei pacientilor cu cancer mamar (cod C50, Clasificatia Internationala a Maladiilor 10 a Organizatiei Mondiale a Sanatatii, CIM10 OMS) prin spitalele din Transilvania (16 judete) in cursul anului 2005 (1Ianuarie, 31Decembrie). Rezultatele studiilor permit doua concluzii principale: 1. folosirea sistemelor de informatica medicala standardizate si similare pentru inregistrarea activitatii medicale permite comparatia, nu numai a datelor, dar si a conceptelor intre regiunile similare ca populatie si 2. traiectoriile pacientilor cu cancer de san analizate pentru Transilvania permit o previziune buna pentru (re)organizarea retelei de oncologie, in special in conditiile in care componenta de alocare a resurselor este, de asemenea, luata in considerare. Cuvinte cheie: Traiectoria pacientilor, retea de spitale, cancer de san, sistem de clasificare, regiun

Performance of Indocyanine Green Compared to 99mTc-Nanocolloids for Sentinel Lymph Node Detection in Early Vulvar Cancer

Study objective: The aim of this study was to evaluate the performance of indocyanine green (ICG) compared to that of the gold standard 99mtechnetium (99mTc-nanocolloids) in detecting sentinel lymph nodes (SLN) in early vulvar cancer. Material and Methods: A single-center retrospective cohort study comparing SLN detection by 99mTc-nanocolloids and ICG was performed in patients presenting early vulvar cancer (T1/2), with clinically negative nodes. All SLN showing a radioactive and/or fluorescent signal were resected. The primary endpoints were the sensitivity, positive predictive value (PPV) and false negative (FN) rate of ICG in detecting SLN compared to 99mTc-nanocolloids. Results: Thirty patients were included and 99 SLN were identified in 43 groins. Compared to 99mTc-nanocolloids, ICG had a sensitivity of 80.8% (95% CI [72.6; 88.6%]), a PPV of 96.2% (95% CI [91.8; 100%]) and a FN rate of 19.1% in detecting SLN. Seventeen (17.1%) infiltrated (positive) SLN were identified out of the 99 SLN detected. Compared to 99mTc-nanocolloids, ICG showed a sensitivity of 82.3% (95% CI [73.1; 91.5%]), a PPV of 100% and a FN rate of 17.6% (3/17) in detecting infiltrated SLN. Conclusion: Despite its many advantages, ICG cannot be used as the sole tracer for the detection of SLN in early vulvar cancer and should be employed in conjunction with 99mTc-nanocolloids

Stroke care in Brazil and France : national policies and healthcare indicators comparison

Objective: To identify the commonalities and discrepancies between national health policies to combat stroke in France and Brazil. Justification: Both healthcare systems were structured as universal access and comprehensive care attention, hierarchized by the level of care, politically and administratively decentralized. France is an industrialized, high-income country, with health care involving copayment and reimbursement of expenses, and spontaneous demand for services. Brazil is a member of the BRICs, of upper middle income with totally free health care, with an active search for hypertension and diabetes in the general population. Methods: Data regarding policies, risk factors, and health indicators about stroke care, from 2010 to 2017, were obtained from both countries (publicly accessible information or on request) from the respective Ministries of Health or international agencies. Results: About acute stroke hospitalizations, on average, Brazil has 0.75 per 1000 annual population hospitalizations versus 1.54 per 1000 in France. Brazil has 0.21 per 1000 population deaths per year versus 0.40 per 1000 in France. The in-hospital mortality rate in Brazil has 139 per 1000 hospitalized people versus 263 in France. The average length of stay of acute hospitalizations was 7.6 days in Brazil versus 12.6 in France. The prevalence of strokes by age group shows from 0 to 39 years old (this rate is stable); 40–59 years (it is increasing in both countries); and 60–79 and 80+ years (this rate has been increasing in France and decreasing in Brazil). Conclusion: No major differences were found about the health policies and the National Health Plans related to stroke. However, the data directly linked to the period of hospitalization differed substantially between countries. Subsequent studies can be implemented to identify the explanatory factors, notably among the risk factors and actions in primary care, and the moments after hospital care, such as secondary prevention and palliative care

Can maintaining cognitive function at 65 years old predict successful ageing 6 years later? The PROOF study

Methods: nine hundred and seventy-six questionnaires were sent by mail to a sample of healthy and voluntary French pensioners. Successful ageing was defined through health status and well-being. Cognitive abilities had been assessed 6 years earlier according to an objective method (Free and Cued Selective Recall Reminding Test (FCSRT), the Benton visual retention test and the similarities subtest of the Wechsler Adult Intelligence Scale-Revised) and a subjective one (Goldberg's anxiety scale, Mac Nair's scale and a Visual Analogue Scale to evaluate memory abilities change in the last 5 years). Results: six hundred and eighty-six questionnaires could be analysed. The mean age was 72.9 +/- 1.2 years old with 59% of women and 99% lived at home. Well-being was negatively correlated with the FCSRT (r = -0.08, P = 0.0318) but positively related with the Benton (r = 0.09, P = 0.0125) and the similarities tests (r = 0.09, P = 0.0118). There is a negative correlation between anxious and cognitive complaints measured at baseline, and successful ageing indicators 6 years later. Conclusion: preservation of cognitive abilities at the age of retirement can predict a successful ageing 6 years later. ClinicalTrials.gov Identifier: NCT00759304

An Ontology driven collaborative development for biomedical terminologies:from the French CCAM to the Australian ICHI coding system

The CCAM French coding system of clinical procedures was developed between 1994 and 2004 using, in parallel, a traditional domain expert's consensus method on one hand, and advanced methodologies of ontology driven semantic representation and multilingual generation on the other hand. These advanced methodologies were applied under the framework of an European Union collaborative research project named GALEN and produced a new generation of biomedical terminology. Following the interest in several countries and in WHO, the GALEN network has tested the application of the ontology driven tools to the existing reduced Australian ICHI coding system for interventions presently under investigation by WHO to check its ability and appropriateness to become the reference international coding system for procedures. The initial results are presented and discussed in terms of feasibility and quality assurance for sharing and maintaining consistent medical knowledge and allowing diversity in linguistic expressiveness of end users