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Lamé G, Liberati EG, Canham A, Burt J, Hinton L, Draycott T, Winter C, Dakin FH, Richards N, Miller L, Willars J, Dixon-Woods M. Why is safety in intrapartum electronic fetal monitoring so hard? A qualitative study combining human factors/ergonomics and social science analysis. BMJ Qual Saf 2024; 33:246-256. [PMID: 37945341 PMCID: PMC10982615 DOI: 10.1136/bmjqs-2023-016144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/16/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Problems in intrapartum electronic fetal monitoring with cardiotocography (CTG) remain a major area of preventable harm. Poor understanding of the range of influences on safety may have hindered improvement. Taking an interdisciplinary perspective, we sought to characterise the everyday practice of CTG monitoring and the work systems within which it takes place, with the goal of identifying potential sources of risk. METHODS Human factors/ergonomics (HF/E) experts and social scientists conducted 325 hours of observations and 23 interviews in three maternity units in the UK, focusing on how CTG tasks were undertaken, the influences on this work and the cultural and organisational features of work settings. HF/E analysis was based on the Systems Engineering Initiative for Patient Safety 2.0 model. Social science analysis was based on the constant comparative method. RESULTS CTG monitoring can be understood as a complex sociotechnical activity, with tasks, people, tools and technology, and organisational and external factors all combining to affect safety. Fetal heart rate patterns need to be recorded and interpreted correctly. Systems are also required for seeking the opinions of others, determining whether the situation warrants concern, escalating concerns and mobilising response. These processes may be inadequately designed or function suboptimally, and may be further complicated by staffing issues, equipment and ergonomics issues, and competing and frequently changing clinical guidelines. Practice may also be affected by variable standards and workflows, variations in clinical competence, teamwork and situation awareness, and the ability to communicate concerns freely. CONCLUSIONS CTG monitoring is an inherently collective and sociotechnical practice. Improving it will require accounting for complex system interdependencies, rather than focusing solely on discrete factors such as individual technical proficiency in interpreting traces.
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Affiliation(s)
- Guillaume Lamé
- Laboratoire Génie Industriel, CentraleSupélec, Gif-sur-Yvette, France
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Elisa Giulia Liberati
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | | | - Jenni Burt
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Francesca Helen Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Natalie Richards
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Lucy Miller
- University Division of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Janet Willars
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mary Dixon-Woods
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
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Lamé G, Komashie A, Sinnott C, Bashford T. Design as a quality improvement strategy: The case for design expertise. Future Healthc J 2024; 11:100008. [PMID: 38646045 PMCID: PMC11025066 DOI: 10.1016/j.fhj.2024.100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Bad design in safety-critical environments like healthcare can lead to users being frustrated, excluded or injured. In contrast, good design can make it easier to use a service correctly, with impacts on both the safety and efficiency of healthcare delivery, as well as the experience of patients and staff. The participative dimension of design as an improvement strategy has recently gained traction in the healthcare quality improvement literature. However, the role of design expertise and professional design has been much less explored. Good design does not happen by accident: it takes expertise and the specific reasoning that expert designers develop through practical experience and training. Here, we define design, show why poor design can be disastrous and illustrate the benefits of good design. We argue for the recognition of distinctive design expertise and describe some of its characteristics. Finally, we discuss how design could be better promoted in healthcare improvement.
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Affiliation(s)
- Guillaume Lamé
- Université Paris-Saclay, CentraleSupélec, Laboratoire Génie Industriel, Gif-sur-Yvette, France
| | - Alexander Komashie
- Health Systems Design Group, Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge, UK
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Carol Sinnott
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Tom Bashford
- Health Systems Design Group, Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge, UK
- Department Anaesthetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, UK
- Technology and Systems Theme, Cambridge Public Health Interdisciplinary Research Centre, University of Cambridge, UK
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Liberati EG, Martin GP, Lamé G, Waring J, Tarrant C, Willars J, Dixon-Woods M. What can Safety Cases offer for patient safety? A multisite case study. BMJ Qual Saf 2024; 33:156-165. [PMID: 37734957 PMCID: PMC10894827 DOI: 10.1136/bmjqs-2023-016042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The Safety Case is a regulatory technique that requires organisations to demonstrate to regulators that they have systematically identified hazards in their systems and reduced risks to being as low as reasonably practicable. It is used in several high-risk sectors, but only in a very limited way in healthcare. We examined the first documented attempt to apply the Safety Case methodology to clinical pathways. METHODS Data are drawn from a mixed-methods evaluation of the Safer Clinical Systems programme. The development of a Safety Case for a defined clinical pathway was a centrepiece of the programme. We base our analysis on 143 interviews covering all aspects of the programme and on analysis of 13 Safety Cases produced by clinical teams. RESULTS The principles behind a proactive, systematic approach to identifying and controlling risk that could be curated in a single document were broadly welcomed by participants, but was not straightforward to deliver. Compiling Safety Cases helped teams to identify safety hazards in clinical pathways, some of which had been previously occluded. However, the work of compiling Safety Cases was demanding of scarce skill and resource. Not all problems identified through proactive methods were tractable to the efforts of front-line staff. Some persistent hazards, originating from institutional and organisational vulnerabilities, appeared also to be out of the scope of control of even the board level of organisations. A particular dilemma for organisational senior leadership was whether to prioritise fixing the risks proactively identified in Safety Cases over other pressing issues, including those that had already resulted in harm. CONCLUSIONS The Safety Case approach was recognised by those involved in the Safer Clinical Systems programme as having potential value. However, it is also fraught with challenge, highlighting the limitations of efforts to transfer safety management practices to healthcare from other sectors.
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Affiliation(s)
- Elisa Giulia Liberati
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Graham P Martin
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Guillaume Lamé
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Laboratoire Genie Industriel, CentraleSupélec, Paris Saclay University, Gif-sur-Yvette, France
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Carolyn Tarrant
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Janet Willars
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Marty S, Lamé G, Guével E, Priou S, Chatellier G, Tournigand C, Kempf E. Impact of the Sars-Cov-2 outbreak on the initial clinical presentation of new solid cancer diagnoses: a systematic review and meta-analysis. BMC Cancer 2024; 24:143. [PMID: 38287348 PMCID: PMC10823607 DOI: 10.1186/s12885-023-11795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/25/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic might have delayed cancer diagnosis and management. The aim of this systematic review was to compare the initial tumor stage of new cancer diagnoses before and after the pandemic. METHODS We systematically reviewed articles that compared the tumor stage of new solid cancer diagnoses before and after the initial pandemic waves. We conducted a random-effects meta-analysis to compare the rate of metastatic tumors and the distribution of stages at diagnosis. Subgroup analyses were performed by primary tumor site and by country. RESULTS From 2,013 studies published between January 2020 and April 2022, we included 58 studies with 109,996 patients. The rate of metastatic tumors was higher after the COVID-19 outbreak than before (pooled OR: 1.29 (95% CI, 1.06-1.57), I2: 89% (95% CI, 86-91)). For specific cancers, common ORs reached statistical significance for breast (OR: 1.51 (95% CI 1.07-2.12)) and gynecologic (OR: 1.51 (95% CI 1.04-2.18)) cancers, but not for other cancer types. According to countries, common OR (95% CI) reached statistical significance only for Italy: 1.55 (1.01-2.39) and Spain:1.14 (1.02-1.29). Rates were comparable for stage I-II versus III-IV in studies for which that information was available, and for stages I-II versus stage III in studies that did not include metastatic patients. CONCLUSIONS Despite inter-study heterogeneity, our meta-analysis showed a higher rate of metastatic tumors at diagnosis after the pandemic. The burden of social distancing policies might explain those results, as patients may have delayed seeking care.
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Affiliation(s)
- Simon Marty
- Department of medical oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique - Hôpitaux de Paris, 1 rue Gustave Eiffel, 94000, Créteil, France
| | - Guillaume Lamé
- Laboratoire Genie Industriel, CentraleSupélec, Paris Saclay University, Gif-sur-Yvette, France
| | - Etienne Guével
- Assistance Publique - Hôpitaux de Paris, Innovation and Data, IT Department, Paris, France
| | - Sonia Priou
- Laboratoire Genie Industriel, CentraleSupélec, Paris Saclay University, Gif-sur-Yvette, France
| | - Gilles Chatellier
- Department of medical informatics, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Université de Paris, F-75015, Paris, France
| | - Christophe Tournigand
- Department of medical oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique - Hôpitaux de Paris, 1 rue Gustave Eiffel, 94000, Créteil, France
| | - Emmanuelle Kempf
- Department of medical oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique - Hôpitaux de Paris, 1 rue Gustave Eiffel, 94000, Créteil, France.
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France.
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Lamé G, Tako A, Kleinsmann M. Using participatory systems approaches to improve healthcare delivery. Health Syst (Basingstoke) 2024; 12:357-361. [PMID: 38235303 PMCID: PMC10791099 DOI: 10.1080/20476965.2023.2285555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Affiliation(s)
- Guillaume Lamé
- Paris-Saclay University, CentraleSupélec, Laboratoire de Génie Industriel
| | - Antuela Tako
- Loughborough Business School, Loughborough University
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Kempf E, Priou S, Lamé G, Laurent A, Guével E, Tzedakis S, Bey R, Fuks D, Chatellier G, Tannier X, Galula G, Flicoteaux R, Daniel C, Tournigand C. No changes in clinical presentation, treatment strategies and survival of pancreatic cancer cases during the SARS-COV-2 outbreak: A retrospective multicenter cohort study on real-world data. Int J Cancer 2023; 153:1988-1996. [PMID: 37539961 DOI: 10.1002/ijc.34675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 08/05/2023]
Abstract
The SARS-COV-2 pandemic disrupted healthcare systems. We assessed its impact on the presentation, care trajectories and outcomes of new pancreatic cancers (PCs) in the Paris area. We performed a retrospective multicenter cohort study on the data warehouse of Greater Paris University Hospitals (AP-HP). We identified all patients newly referred with a PC between January 1, 2019, and June 30, 2021, and excluded endocrine tumors. Using claims data and health records, we analyzed the timeline of care trajectories, the initial tumor stage, the treatment categories: pancreatectomy, exclusive systemic therapy or exclusive best supportive care (BSC). We calculated patients' 1-year overall survival (OS) and compared indicators in 2019 and 2020 to 2021. We included 2335 patients. Referral fell by 29% during the first lockdown. The median time from biopsy and from first MDM to treatment were 25 days (16-50) and 21 days (11-40), respectively. Between 2019 and 2020 to 2021, the rate of metastatic tumors (36% vs 33%, P = .39), the pTNM distribution of the 464 cases with upfront tumor resection (P = .80), and the proportion of treatment categories did not vary: tumor resection (32% vs 33%), exclusive systemic therapy (49% vs 49%), exclusive BSC (19% vs 19%). The 1-year OS rates in 2019 vs 2020 to 2021 were 92% vs 89% (aHR = 1.42; 95% CI, 0.82-2.48), 52% vs 56% (aHR = 0.88; 95% CI, 0.73-1.08), 13% vs 10% (aHR = 1.00; 95% CI, 0.78-1.25), in the treatment categories, respectively. Despite an initial decrease in the number of new PCs, we did not observe any stage shift. OS did not vary significantly.
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Affiliation(s)
- Emmanuelle Kempf
- Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé (LIMICS), Université Sorbonne Paris Nord, Sorbonne Université, Inserm, Paris, France
- Department of Medical Oncology, Assistance Publique - Hôpitaux de Paris, Henri Mondor and Albert Chenevier Teaching Hospital, Université Paris Est Créteil, Créteil, France
| | - Sonia Priou
- IT Department, Assistance Publique - Hôpitaux de Paris, Innovation and Data, Paris, France
- Université Paris-Saclay, CentraleSupélec, Laboratoire Génie Industriel, Gif-sur-Yvette, France
| | - Guillaume Lamé
- Université Paris-Saclay, CentraleSupélec, Laboratoire Génie Industriel, Gif-sur-Yvette, France
| | - Alexis Laurent
- Department of Digestive Surgery, Assistance Publique - Hôpitaux de Paris, Henri Mondor and Albert Chenevier Teaching Hospital, Université Paris Est Créteil, Créteil, France
| | - Etienne Guével
- IT Department, Assistance Publique - Hôpitaux de Paris, Innovation and Data, Paris, France
| | - Stylianos Tzedakis
- Department of Digestive Surgery, Assistance Publique - Hôpitaux de Paris, Cochin Teaching Hospital, Université Paris City, Paris, France
| | - Romain Bey
- IT Department, Assistance Publique - Hôpitaux de Paris, Innovation and Data, Paris, France
| | - David Fuks
- Department of Digestive Surgery, Assistance Publique - Hôpitaux de Paris, Cochin Teaching Hospital, Université Paris City, Paris, France
| | - Gilles Chatellier
- Department of Medical Informatics, Assistance Publique - Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Université de Paris, Paris, France
| | - Xavier Tannier
- Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé (LIMICS), Université Sorbonne Paris Nord, Sorbonne Université, Inserm, Paris, France
| | - Gilles Galula
- Department of Medical Oncology, Assistance Publique - Hôpitaux de Paris, Tenon Teaching Hospital, Université Sorbonne, Paris, France
| | - Rémi Flicoteaux
- Department of Medical Information, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Christel Daniel
- IT Department, Assistance Publique - Hôpitaux de Paris, Innovation and Data, Paris, France
| | - Christophe Tournigand
- Department of Medical Oncology, Assistance Publique - Hôpitaux de Paris, Henri Mondor and Albert Chenevier Teaching Hospital, Université Paris Est Créteil, Créteil, France
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Guével E, Priou S, Flicoteaux R, Lamé G, Bey R, Tannier X, Cohen A, Chatellier G, Daniel C, Tournigand C, Kempf E. Development of a natural language processing model for deriving breast cancer quality indicators : A cross-sectional, multicenter study. Rev Epidemiol Sante Publique 2023; 71:102189. [PMID: 37972522 DOI: 10.1016/j.respe.2023.102189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES Medico-administrative data are promising to automate the calculation of Healthcare Quality and Safety Indicators. Nevertheless, not all relevant indicators can be calculated with this data alone. Our feasibility study objective is to analyze 1) the availability of data sources; 2) the availability of each indicator elementary variables, and 3) to apply natural language processing to automatically retrieve such information. METHOD We performed a multicenter cross-sectional observational feasibility study on the clinical data warehouse of Assistance Publique - Hôpitaux de Paris (AP-HP). We studied the management of breast cancer patients treated at AP-HP between January 2019 and June 2021, and the quality indicators published by the European Society of Breast Cancer Specialist, using claims data from the Programme de Médicalisation du Système d'Information (PMSI) and pathology reports. For each indicator, we calculated the number (%) of patients for whom all necessary data sources were available, and the number (%) of patients for whom all elementary variables were available in the sources, and for whom the related HQSI was computable. To extract useful data from the free text reports, we developed and validated dedicated rule-based algorithms, whose performance metrics were assessed with recall, precision, and f1-score. RESULTS Out of 5785 female patients diagnosed with a breast cancer (60.9 years, IQR [50.0-71.9]), 5,147 (89.0%) had procedures related to breast cancer recorded in the PMSI, and 3732 (72.5%) had at least one surgery. Out of the 34 key indicators, 9 could be calculated with the PMSI alone, and 6 others became so using the data from pathology reports. Ten elementary variables were needed to calculate the 6 indicators combining the PMSI and pathology reports. The necessary sources were available for 58.8% to 94.6% of patients, depending on the indicators. The extraction algorithms developed had an average accuracy of 76.5% (min-max [32.7%-93.3%]), an average precision of 77.7% [10.0%-97.4%] and an average sensitivity of 71.6% [2.8% to 100.0%]. Once these algorithms applied, the variables needed to calculate the indicators were extracted for 2% to 88% of patients, depending on the indicators. DISCUSSION The availability of medical reports in the electronic health records, of the elementary variables within the reports, and the performance of the extraction algorithms limit the population for which the indicators can be calculated. CONCLUSIONS The automated calculation of quality indicators from electronic health records is a prospect that comes up against many practical obstacles.
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Affiliation(s)
- Etienne Guével
- Assistance Publique - Hôpitaux de Paris, Innovation and Data, IT Department, 75012 Paris, France
| | - Sonia Priou
- Université Paris-Saclay, CentraleSupélec, Laboratoire Génie Industriel, 91192 Gif-sur-Yvette, France
| | - Rémi Flicoteaux
- Assistance Publique - Hôpitaux de Paris, Department of medical information, 75012 Paris, France
| | - Guillaume Lamé
- Université Paris-Saclay, CentraleSupélec, Laboratoire Génie Industriel, 91192 Gif-sur-Yvette, France
| | - Romain Bey
- Assistance Publique - Hôpitaux de Paris, Innovation and Data, IT Department, 75012 Paris, France
| | - Xavier Tannier
- Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, 75006 Paris, France
| | - Ariel Cohen
- Assistance Publique - Hôpitaux de Paris, Innovation and Data, IT Department, 75012 Paris, France
| | - Gilles Chatellier
- Université Paris CIté, Department of medical informatics, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), 75015 Paris, France
| | - Christel Daniel
- Assistance Publique - Hôpitaux de Paris, Innovation and Data, IT Department, 75012 Paris, France
| | - Christophe Tournigand
- Université Paris Est Créteil, Assistance Publique - Hôpitaux de Paris, Department of medical oncology, Henri Mondor and Albert Chenevier University Hospital, 94000 Créteil, France
| | - Emmanuelle Kempf
- Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, 75006 Paris, France; Université Paris Est Créteil, Assistance Publique - Hôpitaux de Paris, Department of medical oncology, Henri Mondor and Albert Chenevier University Hospital, 94000 Créteil, France.
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Guével E, Priou S, Lamé G, Wassermann J, Bey R, Uzan C, Chatellier G, Belkacemi Y, Tannier X, Guillerm S, Flicoteaux R, Gligorov J, Cohen A, Benderra M, Teixeira L, Daniel C, Hersant B, Tournigand C, Kempf E. Impact of the COVID-19 pandemic on clinical presentation, treatments, and outcomes of new breast cancer patients: A retrospective multicenter cohort study. Cancer Med 2023; 12:20918-20929. [PMID: 37909210 PMCID: PMC10709737 DOI: 10.1002/cam4.6637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/14/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The SARS CoV-2 pandemic disrupted healthcare systems. We compared the cancer stage for new breast cancers (BCs) before and during the pandemic. METHODS We performed a retrospective multicenter cohort study on the data warehouse of Greater Paris University Hospitals (AP-HP). We identified all female patients newly referred with a BC in 2019 and 2020. We assessed the timeline of their care trajectories, initial tumor stage, and treatment received: BC resection, exclusive systemic therapy, exclusive radiation therapy, or exclusive best supportive care (BSC). We calculated patients' 1-year overall survival (OS) and compared indicators in 2019 and 2020. RESULTS In 2019 and 2020, 2055 and 1988, new BC patients underwent cancer treatment, and during the two lockdowns, the BC diagnoses varied by -18% and by +23% compared to 2019. De novo metastatic tumors (15% and 15%, p = 0.95), pTNM and ypTNM distributions of 1332 cases with upfront resection and of 296 cases with neoadjuvant therapy did not differ (p = 0.37, p = 0.3). The median times from first multidisciplinary meeting and from diagnosis to treatment of 19 days (interquartile 11-39 days) and 35 days (interquartile 22-65 days) did not differ. Access to plastic surgery (15% and 17%, p = 0.08) and to treatment categories did not vary: tumor resection (73% and 72%), exclusive systemic therapy (13% and 14%), exclusive radiation therapy (9% and 9%), exclusive BSC (5% and 5%) (p = 0.8). Among resected patients, the neoadjuvant therapy rate was lower in 2019 (16%) versus 2020 (20%) (p = 0.02). One-year OS rates were 99.3% versus 98.9% (HR = 0.96; 95% CI, 0.77-1.2), 72.6% versus 76.6% (HR = 1.28; 95% CI, 0.95-1.72), 96.6% versus 97.8% (HR = 1.09; 95% CI, 0.61-1.94), and 15.5% versus 15.1% (HR = 0.99; 95% CI, 0.72-1.37), in the treatment groups. CONCLUSIONS Despite a decrease in the number of new BCs, there was no tumor stage shift, and OS did not vary.
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Affiliation(s)
- Etienne Guével
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
| | - Sonia Priou
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
- CentraleSupélec, Laboratoire Génie IndustrielUniversité Paris‐SaclayGif‐sur‐YvetteFrance
| | - Guillaume Lamé
- CentraleSupélec, Laboratoire Génie IndustrielUniversité Paris‐SaclayGif‐sur‐YvetteFrance
| | - Johanna Wassermann
- Assistance Publique–Hôpitaux de Paris, Department of medical oncology, Pitié Salpétrière University HospitalSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
| | - Romain Bey
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
| | - Catherine Uzan
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Department of gynecology, Pitié Salpétrière University HospitalSorbonne UniversitéParisFrance
| | - Gilles Chatellier
- Department of medical informatics, Assistance Publique Hôpitaux de Paris, Centre‐Université de Paris (APHP‐CUP)Université Paris CItéParisFrance
| | - Yazid Belkacemi
- Assistance Publique–Hôpitaux de Paris, Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | - Xavier Tannier
- Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e‐Santé, LIMICSParisFrance
| | - Sophie Guillerm
- Assistance Publique–Hôpitaux de Paris, Department of radiation therapy, Saint Louis University HospitalUniversité Paris CitéCréteilFrance
| | - Rémi Flicoteaux
- Assistance Publique–Hôpitaux de ParisDepartment of medical informationParisFrance
| | - Joseph Gligorov
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Department of medical oncology, Tenon University HospitalSorbonne UniversitéParisFrance
| | - Ariel Cohen
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
| | - Marc‐Antoine Benderra
- Assistance Publique–Hôpitaux de Paris, Institut Universitaire de cancérologieSorbonne UniversitéParisFrance
- Assistance Publique–Hôpitaux de Paris, Department of medical oncology, Tenon University HospitalSorbonne UniversitéParisFrance
| | - Luis Teixeira
- Assistance Publique–Hôpitaux de Paris, Department of senology, Saint Louis Teaching HospitalUniversité Paris CitéParisFrance
| | - Christel Daniel
- Assistance Publique–Hôpitaux de Paris, Innovation and Data, IT DepartmentParisFrance
- Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e‐Santé, LIMICSParisFrance
| | - Barbara Hersant
- Assistance Publique – Hôpitaux de Paris, Department of plastic surgery, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | - Christophe Tournigand
- Assistance Publique – Hôpitaux de Paris, Department of medical oncology, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
| | - Emmanuelle Kempf
- Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e‐Santé, LIMICSParisFrance
- Assistance Publique – Hôpitaux de Paris, Department of medical oncology, Henri Mondor and Albert Chenevier University HospitalUniversité Paris Est CréteilCréteilFrance
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9
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Priou S, Lamé G, Zalcman G, Wislez M, Bey R, Chatellier G, Cadranel J, Tannier X, Zelek L, Daniel C, Tournigand C, Kempf E. Influence of the SARS-CoV-2 outbreak on management and prognosis of new lung cancer cases, a retrospective multicenter real-life cohort study. Eur J Cancer 2022; 173:33-40. [PMID: 35843177 PMCID: PMC9234022 DOI: 10.1016/j.ejca.2022.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 11/04/2022]
Abstract
Introduction The SARS-CoV-2 pandemic has impacted the care of cancer patients. This study sought to assess the pandemic’s impact on the clinical presentations and outcomes of newly referred patients with lung cancer from the Greater Paris area. Methods We retrospectively retrieved the electronic health records and administrative data of 11.4 million patients pertaining to Greater Paris University Hospital (AP-HP). We compared indicators for the 2018–2019 period to those of 2020 in regard to newly referred lung cancer cases. We assessed the initial tumour stage, the delay between the first multidisciplinary tumour board (MTB) and anticancer treatment initiation, and 6-month overall survival (OS) rates depending on the anticancer treatment, including surgery, palliative systemic treatment, and best supportive care (BSC). Result Among 6240 patients with lung cancer, 2179 (35%) underwent tumour resection, 2069 (33%) systemic anticancer therapy, 775 (12%) BSC, whereas 1217 (20%) did not receive any treatment. During the first lockdown, the rate of new diagnoses decreased by 32% compared with that recorded in 2018–2019. Initial tumour stage, repartition of patients among treatment categories, and MTB-related delays remained unchanged. The 6-month OS rates of patients diagnosed in 2018–2019 who underwent tumour resection were 98% versus 97% (HR = 1.2; 95% CI: 0.7–2.0) for those diagnosed in 2020; the respective rates for patients who underwent systemic anticancer therapy were 78% versus 79% (HR = 1.0; 95% CI: 0.8–1.2); these rates were 20% versus 13% (HR = 1.3; 95% CI: 1.1–1.6) for those who received BSC. COVID-19 was associated with poorer OS rates (HR = 2.1; 95% CI: 1.6–3.0) for patients who received systemic anticancer therapy. Conclusions The SARS-CoV-2 pandemic has not exerted any deleterious impact on 6-month OS of new lung cancer patients that underwent active anticancer therapy in Greater Paris University hospitals.
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10
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Kempf E, Priou S, Lamé G, Daniel C, Bellamine A, Sommacale D, Belkacemi Y, Bey R, Galula G, Taright N, Tannier X, Rance B, Flicoteaux R, Hemery F, Audureau E, Chatellier G, Tournigand C. Impact of two waves of Sars-Cov2 outbreak on the number, clinical presentation, care trajectories and survival of patients newly referred for a colorectal cancer: A French multicentric cohort study from a large group of university hospitals. Int J Cancer 2022; 150:1609-1618. [PMID: 35001364 PMCID: PMC9015603 DOI: 10.1002/ijc.33928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 12/17/2022]
Abstract
The SARS‐Cov2 may have impaired care trajectories, patient overall survival (OS), tumor stage at initial presentation for new colorectal cancer (CRC) cases. This study aimed at assessing those indicators before and after the beginning of the pandemic in France. In this retrospective cohort study, we collected prospectively the clinical data of the 11.4 million of patients referred to the Greater Paris University Hospitals (AP‐HP). We identified new CRC cases between 1 January 2018 and 31 December 2020, and compared indicators for 2018‐2019 to 2020. pTNM tumor stage was extracted from postoperative pathology reports for localized colon cancer, and metastatic status was extracted from CT‐scan baseline text reports. Between 2018 and 2020, 3602 and 1083 new colon and rectal cancers were referred to the AP‐HP, respectively. The 1‐year OS rates reached 94%, 93% and 76% for new CRC patients undergoing a resection of the primary tumor, in 2018‐2019, in 2020 without any Sars‐Cov2 infection and in 2020 with a Sars‐Cov2 infection, respectively (HR 3.78, 95% CI 2.1‐7.1). For patients undergoing other kind of anticancer treatment, the percentages are 64%, 66% and 27% (HR 2.1, 95% CI 1.4‐3.3). Tumor stage at initial presentation, emergency level of primary tumor resection, delays between the first multidisciplinary meeting and the first anticancer treatment did not differ over time. The SARS‐Cov2 pandemic has been associated with less newly diagnosed CRC patients and worse 1‐year OS rates attributable to the infection itself rather than to its impact on hospital care delivery or tumor stage at initial presentation.
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Affiliation(s)
- Emmanuelle Kempf
- Department of Medical Oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.,Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Paris, France
| | - Sonia Priou
- IT Department, Assistance Publique-Hôpitaux de Paris, Innovation and Data, Paris, France
| | - Guillaume Lamé
- Laboratoire Génie Industriel, Université Paris-Saclay, CentraleSupélec, Gif-sur-Yvette, France
| | - Christel Daniel
- Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Paris, France.,IT Department, Assistance Publique-Hôpitaux de Paris, Innovation and Data, Paris, France
| | - Ali Bellamine
- IT Department, Assistance Publique-Hôpitaux de Paris, Innovation and Data, Paris, France
| | - Daniele Sommacale
- Department of Digestive Surgery, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Yazid Belkacemi
- Department of Radiation Oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Romain Bey
- IT Department, Assistance Publique-Hôpitaux de Paris, Innovation and Data, Paris, France
| | - Gilles Galula
- Department of Chronic Diseases and Cancer, Assistance Publique-Hôpitaux de Paris, Head Office, Paris, France
| | - Namik Taright
- Department of Medical Information, Assistance Publique-Hôpitaux de Paris, Head Office, Paris, France
| | - Xavier Tannier
- Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Paris, France
| | - Bastien Rance
- Department of Medical Informatics, Centre-Université de Paris (APHP-CUP), Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Rémi Flicoteaux
- Department of Medical Information, Assistance Publique-Hôpitaux de Paris, Head Office, Paris, France
| | - François Hemery
- Department of Medical Information, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Etienne Audureau
- Clinical Research Unit, Henri Mondor and Albert Chenevier Teaching Hospital, Université Paris Est Créteil, INSERM, IMRB, CEpiA Team, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Gilles Chatellier
- Department of Medical Informatics, Centre-Université de Paris (APHP-CUP), Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Christophe Tournigand
- Department of Medical Oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Université Paris Est Créteil, INSERM, IMRB, Assistance Publique-Hôpitaux de Paris, Créteil, France
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11
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Noel-Storr AH, Redmond P, Lamé G, Liberati E, Kelly S, Miller L, Dooley G, Paterson A, Burt J. Crowdsourcing citation-screening in a mixed-studies systematic review: a feasibility study. BMC Med Res Methodol 2021; 21:88. [PMID: 33906604 PMCID: PMC8077753 DOI: 10.1186/s12874-021-01271-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crowdsourcing engages the help of large numbers of people in tasks, activities or projects, usually via the internet. One application of crowdsourcing is the screening of citations for inclusion in a systematic review. There is evidence that a 'Crowd' of non-specialists can reliably identify quantitative studies, such as randomized controlled trials, through the assessment of study titles and abstracts. In this feasibility study, we investigated crowd performance of an online, topic-based citation-screening task, assessing titles and abstracts for inclusion in a single mixed-studies systematic review. METHODS This study was embedded within a mixed studies systematic review of maternity care, exploring the effects of training healthcare professionals in intrapartum cardiotocography. Citation-screening was undertaken via Cochrane Crowd, an online citizen science platform enabling volunteers to contribute to a range of tasks identifying evidence in health and healthcare. Contributors were recruited from users registered with Cochrane Crowd. Following completion of task-specific online training, the crowd and the review team independently screened 9546 titles and abstracts. The screening task was subsequently repeated with a new crowd following minor changes to the crowd agreement algorithm based on findings from the first screening task. We assessed the crowd decisions against the review team categorizations (the 'gold standard'), measuring sensitivity, specificity, time and task engagement. RESULTS Seventy-eight crowd contributors completed the first screening task. Sensitivity (the crowd's ability to correctly identify studies included within the review) was 84% (N = 42/50), and specificity (the crowd's ability to correctly identify excluded studies) was 99% (N = 9373/9493). Task completion was 33 h for the crowd and 410 h for the review team; mean time to classify each record was 6.06 s for each crowd participant and 3.96 s for review team members. Replicating this task with 85 new contributors and an altered agreement algorithm found 94% sensitivity (N = 48/50) and 98% specificity (N = 9348/9493). Contributors reported positive experiences of the task. CONCLUSION It might be feasible to recruit and train a crowd to accurately perform topic-based citation-screening for mixed studies systematic reviews, though resource expended on the necessary customised training required should be factored in. In the face of long review production times, crowd screening may enable a more time-efficient conduct of reviews, with minimal reduction of citation-screening accuracy, but further research is needed.
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Affiliation(s)
- Anna H Noel-Storr
- Cochrane Dementia and Cognitive Improvement Group, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK.
| | - Patrick Redmond
- NIHR ACL in General Practice, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - Guillaume Lamé
- Laboratoire Genie Industriel, CentraleSupélec, Université Paris-Saclay, 91190, Gif-sur-Yvette, France
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Elisa Liberati
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Sarah Kelly
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Lucy Miller
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- University Division of Anaesthesia at Addenbrooke's, University of Cambridge, Cambridge, UK
| | - Gordon Dooley
- Metaxis Ltd, Elmbank Offices, Main Road Curbridge, Witney, Oxfordshire, OX29 7NT, UK
| | - Andy Paterson
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Jenni Burt
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
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12
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Priou S, Lamé G, Chatellier G, Tournigand C, Kempf E. Effect of the COVID-19 pandemic on colorectal cancer care in France. Lancet Gastroenterol Hepatol 2021; 6:342-343. [PMID: 33857441 DOI: 10.1016/s2468-1253(21)00095-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Sonia Priou
- Information Technology Department, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Lamé
- Laboratoire Génie Industriel, CentraleSupélec, Université Paris-Saclay, Gif-sur-Yvette 91190, France.
| | - Gilles Chatellier
- Information Technology Department, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Christophe Tournigand
- IMRB, Université Paris-Est Créteil, INSERM, Créteil, France; Assistance Publique-Hôpitaux de Paris, Department of Medical Oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Créteil, France
| | - Emmanuelle Kempf
- Assistance Publique-Hôpitaux de Paris, Department of Medical Oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Créteil, France
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13
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Huynh Dagher S, Lamé G, Hubiche T, Ezzedine K, Duong TA. The Influence of Media Coverage and Governmental Policies on Google Queries Related to COVID-19 Cutaneous Symptoms: Infodemiology Study. JMIR Public Health Surveill 2021; 7:e25651. [PMID: 33513563 PMCID: PMC7909455 DOI: 10.2196/25651] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/15/2020] [Accepted: 01/22/2021] [Indexed: 12/29/2022] Open
Abstract
Background During COVID-19, studies have reported the appearance of internet searches for disease symptoms before their validation by the World Health Organization. This suggested that monitoring of these searches with tools including Google Trends may help monitor the pandemic itself. In Europe and North America, dermatologists reported an unexpected outbreak of cutaneous acral lesions (eg, chilblain-like lesions) in April 2020. However, external factors such as public communications may also hinder the use of Google Trends as an infodemiology tool. Objective The study aimed to assess the impact of media announcements and lockdown enforcement on internet searches related to cutaneous acral lesions during the COVID-19 outbreak in 2020. Methods Two searches on Google Trends, including daily relative search volumes for (1) “toe” or “chilblains” and (2) “coronavirus,” were performed from January 1 to May 16, 2020, with the United States, the United Kingdom, France, Italy, Spain, and Germany as the countries of choice. The ratio of interest over time in “chilblains” and “coronavirus” was plotted. To assess the impact of lockdown enforcement and media coverage on these internet searches, we performed an interrupted time-series analysis for each country. Results The ratio of interest over time in “chilblains” to “coronavirus” showed a constant upward trend. In France, Italy, and the United Kingdom, lockdown enforcement was associated with a significant slope change for “chilblain” searches with a variation coefficient of 1.06 (SE 0.42) (P=0.01), 1.04 (SE 0.28) (P<.01), and 1.21 (SE 0.44) (P=0.01), respectively. After media announcements, these ratios significantly increased in France, Spain, Italy, and the United States with variation coefficients of 18.95 (SE 5.77) (P=.001), 31.31 (SE 6.31) (P<.001), 14.57 (SE 6.33) (P=.02), and 11.24 (SE 4.93) (P=.02), respectively, followed by a significant downward trend in France (–1.82 [SE 0.45]), Spain (–1.10 [SE 0.38]), and Italy (–0.93 [SE 0.33]) (P<.001, P=0.004, and P<.001, respectively). The adjusted R2 values were 0.311, 0.351, 0.325, and 0.305 for France, Spain, Italy, and the United States, respectively, suggesting an average correlation between time and the search volume; however, this correlation was weak for Germany and the United Kingdom. Conclusions To date, the association between chilblain-like lesions and COVID-19 remains controversial; however, our results indicate that Google queries of “chilblain” were highly influenced by media coverage and government policies, indicating that caution should be exercised when using Google Trends as a monitoring tool for emerging diseases.
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Affiliation(s)
- Solene Huynh Dagher
- Assistance Publique des Hôpitaux de Paris (AP-HP), Département de dermatologie, Hôpital Henri Mondor, Créteil, France
| | - Guillaume Lamé
- Laboratoire Génie Industriel, CentraleSupélec, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Thomas Hubiche
- Département de dermatologie, Centre hospitalier universitaire de Nice, Nice, France
| | - Khaled Ezzedine
- Assistance Publique des Hôpitaux de Paris (AP-HP), Département de dermatologie, Hôpital Henri Mondor, Créteil, France.,EA 7379, EpidermE, Université Paris-Est Créteil, Créteil, France
| | - Tu Anh Duong
- Assistance Publique des Hôpitaux de Paris (AP-HP), Département de dermatologie, Hôpital Henri Mondor, Créteil, France.,Chaire Avenir Santé numérique, Équipe 8 IMRB U955, INSERM, Université Paris-Est Créteil, Créteil, France
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14
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Kempf E, Lamé G, Layese R, Priou S, Chatellier G, Chaieb H, Benderra MA, Bellamine A, Bey R, Bréant S, Galula G, Taright N, Tannier X, Guyet T, Salamanca E, Audureau E, Daniel C, Tournigand C. New cancer cases at the time of SARS-Cov2 pandemic and related public health policies: A persistent and concerning decrease long after the end of the national lockdown. Eur J Cancer 2021; 150:260-267. [PMID: 33940350 PMCID: PMC7904473 DOI: 10.1016/j.ejca.2021.02.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/15/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The dissemination of SARS-Cov2 may have delayed the diagnosis of new cancers. This study aimed at assessing the number of new cancers during and after the lockdown. METHODS We prospectively collected the clinical data of the 11.4 million patients referred to the Assistance Publique Hôpitaux de Paris Teaching Hospital. We identified new cancer cases between 1st January 2018 and 31st September 2020 and compared indicators for 2018 and 2019 to 2020 with a focus on the French lockdown (17th March to 11th May 2020) across cancer types and patient age classes. RESULTS Between January and September, 28,348, 27,272 and 23,734 new cancer cases were identified in 2018, 2019 and 2020, respectively. The monthly median number of new cases reached 3168 (interquartile range, IQR, 3027; 3282), 3054 (IQR 2945; 3127) and 2723 (IQR 2085; 2,863) in 2018, 2019 and 2020, respectively. From March 1st to May 31st, new cancer decreased by 30% in 2020 compared to the 2018-19 average; then by 9% from 1st June to 31st September. This evolution was consistent across all tumour types: -30% and -9% for colon, -27% and -6% for lung, -29% and -14% for breast, -33% and -12% for prostate cancers, respectively. For patients aged <70 years, the decrease of colorectal and breast new cancers in April between 2018 and 2019 average and 2020 reached 41% and 39%, respectively. CONCLUSION The SARS-Cov2 pandemic led to a substantial decrease in new cancer cases. Delays in cancer diagnoses may affect clinical outcomes in the coming years.
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Affiliation(s)
- Emmanuelle Kempf
- Assistance Publique - Hôpitaux de Paris, Department of Medical Oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Créteil, France.
| | - Guillaume Lamé
- Université Paris-Saclay, CentraleSupélec, Laboratoire Génie Industriel, Gif-sur-Yvette, France
| | - Richard Layese
- Université Paris Est Créteil, INSERM, IMRB, CEpiA Team, Assistance Publique - Hôpitaux de Paris, Clinical Research Unit, Henri Mondor and Albert Chenevier Teaching Hospital, Créteil, France
| | - Sonia Priou
- Assistance Publique - Hôpitaux de Paris, IT System Department, Paris, France
| | - Gilles Chatellier
- Université de Paris, Department of Medical Informatics, Assistance Publique Hôpitaux de Paris.Centre-Université de Paris (APHP-CUP), Paris, F-75015, France
| | - Hedi Chaieb
- Assistance Publique - Hôpitaux de Paris, IT System Department, Paris, France
| | - Marc-Antoine Benderra
- Assistance Publique - Hôpitaux de Paris, Department of Medical Oncology, Tenon Teaching Hospital, Paris, France
| | - Ali Bellamine
- Assistance Publique - Hôpitaux de Paris, IT System Department, Paris, France
| | - Romain Bey
- Assistance Publique - Hôpitaux de Paris, IT System Department, Paris, France
| | - Stéphane Bréant
- Assistance Publique - Hôpitaux de Paris, IT System Department, Paris, France
| | - Gilles Galula
- Assistance Publique - Hôpitaux de Paris, Head Office, Department of Chronic Diseases and Cancer, Paris, France
| | - Namik Taright
- Assistance Publique - Hôpitaux de Paris, Head Office, Department of Medical Information, Paris, France
| | - Xavier Tannier
- Sorbonne Université, Laboratoire D'informatique Médicale et D'ingénierie des Connaissances en e-Santé, Paris, France
| | - Thomas Guyet
- Agrocampus-Ouest / IRISA - Inria, Rennes, France
| | - Elisa Salamanca
- Assistance Publique - Hôpitaux de Paris, IT System Department, Paris, France
| | - Etienne Audureau
- Université Paris Est Créteil, INSERM, IMRB, CEpiA Team, Assistance Publique - Hôpitaux de Paris, Clinical Research Unit, Henri Mondor and Albert Chenevier Teaching Hospital, Créteil, France
| | - Christel Daniel
- Assistance Publique - Hôpitaux de Paris, IT System Department, Paris, France
| | - Christophe Tournigand
- Université Paris Est Créteil, INSERM, IMRB, Assistance Publique - Hôpitaux de Paris, Department of Medical Oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Créteil, France
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15
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Kelly S, Redmond P, King S, Oliver‐Williams C, Lamé G, Liberati E, Kuhn I, Winter C, Draycott T, Dixon‐Woods M, Burt J. Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta‐analysis. BJOG 2021. [PMCID: PMC8359372 DOI: 10.1111/1471-0528.16619] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Sub‐optimal classification, interpretation and response to intrapartum electronic fetal monitoring using cardiotocography are known problems. Training is often recommended as a solution, but there is lack of clarity about the effects of training and which type of training works best. Objectives Systematic review of the effects of training healthcare professionals in intrapartum cardiotocography (PROSPERO protocol: CRD42017064525). Search strategy CENTRAL, Cochrane Library, MEDLINE, EMBASE, PsycINFO, British Nursing Database, CINAHL, ERIC, Scopus, Web of Science, ProQuest, grey literature and ongoing clinical trials were searched. Selection criteria Primary studies that reported impact of training healthcare professionals in intrapartum cardiotocography. Title/abstract, full‐text screening and quality assessment were conducted in duplicate. Data collection and analysis Data were synthesised both narratively and using meta‐analysis. Risk of bias and overall quality were assessed with the Mixed Methods Appraisal Tool and GRADE. Main results Sixty‐four studies were included. Overall, training and reporting were heterogeneous, the outcomes evaluated varied widely and study quality was low. Five randomised controlled trials reported that training improved knowledge of maternity professionals compared with no training, but evidence was of low quality. Evidence for the impact of cardiotocography training on neonatal and maternal outcomes was limited, showed inconsistent effects, and was of low overall quality. Evidence for the optimal content and method of delivery of training was very limited. Conclusions Given the scale of harm and litigation claims associated with electronic fetal monitoring, the evidence‐base for training requires improvement. It should address intervention design, evaluation of clinical outcomes and system‐wide contexts of sub‐optimal practice. Tweetable abstract Training in fetal monitoring: systematic review finds little evidence of impact on neonatal outcomes. Training in fetal monitoring: systematic review finds little evidence of impact on neonatal outcomes.
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Affiliation(s)
- S Kelly
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - P Redmond
- School of Population Health and Environmental Sciences King’s College London London UK
| | - S King
- Independent consultant Cambridge UK
| | - C Oliver‐Williams
- Cardiovascular Epidemiology Unit Department of Public Health and Primary Care University of Cambridge Cambridge UK
- Homerton CollegeUniversity of Cambridge Cambridge UK
| | - G Lamé
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - E Liberati
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - I Kuhn
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - C Winter
- PROMPT Maternity Foundation Southmead Hospital Bristol UK
| | - T Draycott
- Translational Health Sciences University of Bristol Bristol UK
| | - M Dixon‐Woods
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - J Burt
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care University of Cambridge Cambridge UK
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Abstract
Despite an increasing number of papers reporting applications of operational research (OR) to problems in healthcare, there remains little empirical evidence of OR improving healthcare delivery in practice. Without such evidence it is harder both to justify the usefulness of OR to a healthcare audience and to learn and continuously improve our approaches. To progress, we need to build the evidence-base on whether and how OR improves healthcare delivery through careful empirical evaluation. This position paper reviews evaluation standards in healthcare improvement research and dispels some common myths about evaluation. It highlights the current lack of robust evaluation of healthcare OR and makes the case for addressing this. It then proposes possible ways for building better empirical evaluations of OR interventions in healthcare.
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Affiliation(s)
- Guillaume Lamé
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
- Laboratoire Génie Industriel, Université Paris-Saclay, CentraleSupélec, Gif-sur-Yvette, France
| | - Sonya Crowe
- Clinical Operational Research Unit, University College London, London, UK
| | - Matthew Barclay
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
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17
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Lamé G, Dixon-Woods M. Using clinical simulation to study how to improve quality and safety in healthcare. BMJ Simul Technol Enhanc Learn 2020; 6:87-94. [PMID: 32133154 PMCID: PMC7056349 DOI: 10.1136/bmjstel-2018-000370] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/03/2018] [Accepted: 09/06/2018] [Indexed: 01/17/2023]
Abstract
Simulation can offer researchers access to events that can otherwise not be directly observed, and in a safe and controlled environment. How to use simulation for the study of how to improve the quality and safety of healthcare remains underexplored, however. We offer an overview of simulation-based research (SBR) in this context. Building on theory and examples, we show how SBR can be deployed and which study designs it may support. We discuss the challenges of simulation for healthcare improvement research and how they can be tackled. We conclude that using simulation in the study of healthcare improvement is a promising approach that could usefully complement established research methods.
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Affiliation(s)
- Guillaume Lamé
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
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Abstract
OBJECTIVE To identify and learn from efforts to design and implement a standardised policy for labelling of invasive tubing and lines across a regional health system. DESIGN Single case study involving qualitative interviews and documentary analysis. SETTING A devolved health system in the UK National Health Service (NHS). PARTICIPANTS NHS staff (n=10) and policy-makers (n=8) who were involved in the design and/or implementation of the standardised policy. RESULTS Though standardising labelling of invasive tubing and lines was initially seen as a common-sense technical change, challenges during the process of developing and implementing the policy were multiple and sociotechnical in nature. Major challenges related to defining the problem and the solution, limited sustained engagement with stakeholders and users, prototyping/piloting of the solution, and planning for implementation. Some frontline staff remained unconvinced of the need for or value of the policy, since they either did not believe that there was a problem or did not agree that standardised labelling was the right solution. Mundane practical issues such authorisation and resourcing, supply chains for labels, the need to restructure work practices to accommodate the new standard, and the physical features of the labels in specific clinical settings all had important impacts. CONCLUSIONS Newly standardised tools and practices have to fit within a system of pre-existing norms, practices and procedures. We identified a number of practical, social and cultural challenges when designing and implementing a standardised policy in a regional healthcare system. Taking account of both sociocultural and technical aspects of standardisation, combined with systems thinking, could lead to more effective implementation and increase acceptability and usability of new standards.
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Affiliation(s)
- Natasha Marie Kriznik
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Guillaume Lamé
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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Lamé G, Liberati E, Burt J, Draycott T, Winter C, Ward J, Dixon-Woods M. IMproving the practice of intrapartum electronic fetal heart rate MOnitoring with cardiotocography for safer childbirth (the IMMO programme): protocol for a qualitative study. BMJ Open 2019; 9:e030271. [PMID: 31256041 PMCID: PMC6609047 DOI: 10.1136/bmjopen-2019-030271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Suboptimal electronic fetal heart rate monitoring (EFM) in labour using cardiotocography (CTG) has been identified as one of the most common causes of avoidable harm in maternity care. Training staff is a frequently proposed solution to reduce harm. However, current approaches to training are heterogeneous in content and format, making it difficult to assess effectiveness. Technological solutions, such as digital decision support, have not yet demonstrated improved outcomes. Effective improvement strategies require in-depth understanding of the technical and social mechanisms underpinning the EFM process. The aim of this study is to advance current knowledge of the types of errors, hazards and failure modes in the process of classifying, interpreting and responding to CTG traces. This study is part of a broader research programme aimed at developing and testing an intervention to improve intrapartum EFM. METHODS AND ANALYSIS The study is organised into two workstreams. First, we will conduct observations and interviews in three UK maternity units to gain an in-depth understanding of how intrapartum EFM is performed in routine clinical practice. Data analysis will combine the insights of an ethnographic approach (focused on the social norms and interactions, values and meanings that appear to be linked with the process of EFM) with a systems thinking approach (focused on modelling processes, actors and their interactions). Second, we will use risk analysis techniques to develop a framework of the errors, hazards and failure modes that affect intrapartum EFM. ETHICS AND DISSEMINATION This study has been approved by the West Midlands-South Birmingham Research Ethics Committee, reference number: 18/WM/0292. Dissemination will take the form of academic articles in peer-reviewed journals and conferences, along with tailored communication with various stakeholders in maternity care.
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Affiliation(s)
- Guillaume Lamé
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
| | - Elisa Liberati
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
| | - Jenni Burt
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
| | - Tim Draycott
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Women and Children's Health, North Bristol NHS Trust, Westbury on Trym, UK
| | - Cathy Winter
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Women and Children's Health, North Bristol NHS Trust, Westbury on Trym, UK
| | - James Ward
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | - Mary Dixon-Woods
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
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20
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Lamé G, Simmons RK. From behavioural simulation to computer models: how simulation can be used to improve healthcare management and policy. BMJ STEL 2018; 6:95-102. [PMID: 35516085 PMCID: PMC8936879 DOI: 10.1136/bmjstel-2018-000377] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/18/2018] [Accepted: 09/22/2018] [Indexed: 11/04/2022]
Abstract
Simulation is a technique that evokes or replicates substantial aspects of the real world, in order to experiment with a simplified imitation of an operations system, for the purpose of better understanding and/or improving that system. Simulation provides a safe environment for investigating individual and organisational behaviour and a risk-free testbed for new policies and procedures. Therefore, it can complement or replace direct field observations and trial-and-error approaches, which can be time consuming, costly and difficult to carry out. However, simulation has low adoption as a research and improvement tool in healthcare management and policy-making. The literature on simulation in these fields is dispersed across different disciplinary traditions and typically focuses on a single simulation method. In this article, we examine how simulation can be used to investigate, understand and improve management and policy-making in healthcare organisations. We develop the rationale for using simulation and provide an integrative overview of existing approaches, using examples of in vivo behavioural simulations involving live participants, pure in silico computer simulations and intermediate approaches (virtual simulation) where human participants interact with computer simulations of health organisations. We also discuss the combination of these approaches to organisational simulation and the evaluation of simulation-based interventions.
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Affiliation(s)
- Guillaume Lamé
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Rebecca K Simmons
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
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