scholarly journals Are the French SAMU data relevant for health surveillance?

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Isabelle Pontais ◽  
Florian Franke ◽  
Barbara Philippot ◽  
François Valli ◽  
Gilles Viudes ◽  
...  
Keyword(s):  
Intensive Care ◽  
Pilot Study ◽  
Santé Publique ◽  
Syndromic Surveillance ◽  
Health Impact ◽  
Health Surveillance ◽  
Data Sources ◽  
Daily Data ◽  
Sante Publique

ObjectiveTo evaluate whether SAMU data could be relevant for health surveillance and proposed to be integrated into the French national syndromic surveillance SurSaUD® system.IntroductionThe syndromic surveillance SurSaUD® system developed by Santé publique France, the French National Public Health Agency collects daily data from 4 data sources: emergency departments (OSCOUR® ED network) [1], emergency general practioners (SOS Médecins network), crude mortality (civil status data) and electronic death certification including causes of death [2]. The system aims to timely identify, follow and assess the health impact of unusual or seasonal events on emergency medical activity and mortality. However some information could be missed by the system especially for non-severe (absence of ED consultation) or, in contrast, highly severe purposes (direct access to intensive care units).The French pre-hospital emergency medical service (SAMU) [3] represents a potential valuable data source to complete the SurSaUD® surveillance system, thanks to reactive pre-hospital data collection and a large geographical coverage on the whole territory. Data are still not completely standardized and computerized but a governmental project to develop a national common IT system involving all French SAMU is in progress and will be experimented in the following years.MethodsA pilot study was performed in the South of France PACA region, where data from the six local SAMU structures are centralized into an interconnected database. A minimal set of variables required for health monitoring (administrative and medical items) and modalities for data extraction and transmission to Santé publique France were defined.SAMU data were transmitted daily to Santé Publique France and the PACA regional team developed a Microsoft Access® application to import decrypted data, request database and analyze indicators.Retrospective part of the study was performed over a 2-year period (2013-2014) and the prospective part during 2015 was based on daily data collection. Completeness and quality of variables were analyzed. SAMU indicators including several level of specificity were built and compared to existing SurSaUD® indicators in different situations (for detection, seasonal follow-up and health impact assessment) using Spearman coefficient correlation.ResultsDuring the pilot study, data from five of the six SAMU structures of PACA region were structured enough to be analyzed. On the study period, almost 2,400,000 files were recorded and 89% contain medical information. Data completeness was high (87%) and stable during the whole period. The annual rate of SAMU solicitation was 16 for 100 inhabitants at the regional scale. 15% of the records were opened only for medical advice. In contrast, patients were evacuated directly in intensive care unit in 9.5% of cases without ED admission. Coding quality depended on the existence and the use of official thesauri and varied widely among SAMU structures. Despite coding variations, SAMU indicators for winter epidemics were significantly correlated with ED and SOS Médecins indicators. Respectively with ED flu, bronchiolitis and gastroenteritis indicators, the strongest correlations were found for SAMU lower respiratory infection (0.74), SAMU bronchiolitis (0.72) and SAMU gastroenteritis / diarrhea / vomiting (0.81).ConclusionsThis pilot study demonstrated the feasibility to collect daily SAMU activity data. The key strengths of SAMU data were a large geographic coverage, the subsidiarity with SurSaUD® system data sources, the follow-up of prehospital activity and for patients directly admitted into an intensive care unit. Some limitations were highlighted related to differences in coding practices especially for medical diagnosis. The generalization of this study will require the standardization of coding practices and homogenization of thesaurus. The implementation of the national SAMU information system should allow in a very next future to widely progressing on these topics.References[1] Fouillet A, Bousquet V, Pontais I, Gallay A and Caserio-Schönemann C. The French Emergency Department OSCOUR Network:Evaluation After a 10-year Existence. Online Journal of Public Health Informatics ISSN 1947-2579-7(1):e74, 2015[2] Caserio-Schönemann C, Bousquet V, Fouillet A, Henry V. Le système de surveillance syndromique SurSaUD (R). Bull Epidémiol Hebd 2014;3-4:38-44.[3] Baker, D.J.. The French prehospital emergency medicine system (SAMU): An introduction(2005) CPD Anaesthesia, 7 (1), pp. 20-25.

scholarly journals Syndromic surveillance and UEFA Euro 2016 in France – Health impact assessment

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Erica Fougère ◽  
Céline Caserio-Schönemann ◽  
Jamel Daoudi ◽  
Anne Fouillet ◽  
Marc Ruello ◽  
...  
Keyword(s):  
Public Health ◽  
Impact Assessment ◽  
Santé Publique ◽  
Syndromic Surveillance ◽  
Health Impact Assessment ◽  
Health Impact ◽  
Health Surveillance ◽  
Syndromic Surveillance System ◽  
Health Event ◽  
Sante Publique

ObjectiveTo describe the surveillance indicators implemented for the healthimpact assessment of a potential health event occurring before, duringor after the UEFA Euro 2016 football matches in order to timelyimplement control and prevention measures.IntroductionFrance hosted 2016 UEFA European Football Championshipbetween June 10 and July 10. In the particular context of severalterrorist attacks occurring in France in 2015 [1], the French nationalpublic health agency « Santé publique France » (formerly FrenchInstitute for Public Health Surveillance-InVS) was mandated bythe Ministry of Health to reinforce health population surveillancesystems during the UEFA 2016 period. Six French regions and10 main stadiums hosted 51 matches and several official andnonofficial dedicated Fan Zones were implemented in many citiesacross national territory. Three types of hazard have been identified inthis context: outbreak of contagious infectious disease, environmentalexposure and terrorist attack.The objectives of health surveillance of this major sportingevent were the same as for an exceptional event including massgathering [2] : 1/ timely detection of a health event (infectiouscluster, environmental pollution, collective foodborne disease...)to investigate and timely implement counter measures (control andprevention), 2/ health impact assessment of an unexpected event.The French national syndromic surveillance system SurSaUD® wasone of the main tools for timely health impact assessment in thecontext of this event.MethodsFrench national syndromic SurSaUD® system has been setup in 2004 and supervised by Santé publique France for 12 years.It allows the daily automatic collation of individual data from over650 emergency departments (ED) involved in the OSCOUR®network and 61 emergency general practitioners’ (GPs) associations(SOS Médecins) [3]. About 60,000 attendances in ED (88% of thenational attendances) and 8,000 visits in SOS Médecins associations(95% of the national visits) are daily recorded all over the territoryand transmitted to Santé publique France.Medical information such as provisional medical diagnosiscoded according to the International Classification of Diseases, 10thRevision (ICD-10) for EDs and specific thesaurus for SOS Médecinsis routinely monitored through different syndromic indicators (SI).SI are defined by medically relevant clusters of one or severaldiagnoses, serving as proxies for conditions of public health interest.From June 10 to July 10, 19 SI were daily analyzed throughautomatic national and regional dashboards. SI were divided into3 groups of public health surveillance interest :1/ description of population health: injuries, faintness, myocardialinfarction, alcohol, asthma, heat-related symptoms, anxious troubles ;2/ infectious diseases/symptoms with epidemic potential ordiseases/symptoms linked with an environmental exposure: fever,fever associated with cutaneous rash, meningitis, pneumonia,gastroenteritis, collective foodborne disease ;3/ symptoms potentially linked with a CBRN-E exposure:influenza-like illness, burns, conjunctivitis, dyspnea/ difficultybreathing, neurological troubles, acute respiratory failure.Daily analysis were integrated into specific UEFA 2016surveillance bulletins and daily sent to the Ministry of Healthincluding week-ends.ResultsSI followed during the UEFA Euro 2016 period were nonspecificand potentially affected or influenced by several events appart fromthe championship. Between June 10 and July 10, two moderateheat-wave periods occurred on a large part of mainland France : thefirst one from June 22 to 25 (beginning in the West-South of Franceand then moving North and East of the country) and the secondone from July 8 to 11 in the East-South. An increase in heat-relatedindicators (hyperthermia/heat stroke, dehydration, hyponatremia andburns) has been observed during both periods in five French regionsincluding four hosting regions. Only minor increases in the other SIfollowed during the Euro 2016 period were observed.ConclusionsHealth surveillance implemented during 2016 UEFA EuropeanFootball Championship through a daily analysis of non-specificSI from the French syndromic surveillance system SurSaUD® didnot show any major variation associated with the sporting event.The observed variations were related with specific environmentalconditions (heat-waves). Together with the health surveillancesystem, preventive plans were set up during the event essentially byoffering flyers with information and useful tips on the main preventiveattitudes and measures to adopt in a summer festive context (risksassociated with alcohol and drug intake, injuries, heat and sunexposure, dehydration, unprotected sexual behaviour...).

scholarly journals Increase of Scarlet fever in March 2017 in France: right or wrong signal?

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Isabelle Pontais ◽  
Anne Fouillet ◽  
Cecile Forgeot ◽  
Annie-Claude Paty ◽  
Celine Caserio-Schonemann
Keyword(s):  
Santé Publique ◽  
Scarlet Fever ◽  
Syndromic Surveillance ◽  
Regional Analysis ◽  
Data Sources ◽  
Syndromic Surveillance System ◽  
Paris Area ◽  
Paris Region ◽  
Sante Publique

Objective: Describe a case study of validation of a scarlet fever outbreak using syndromic surveillance data sources.Introduction: Since 2004, the French syndromic surveillance system SurSaUD® [1] coordinated by the French Public Health Agency (Sante publique France) daily collects morbidity data from two data sources: the emergency departments (ED) network Oscour® and the emergency general practitioners’ associations SOS Médecins. Almost 92% of the French ED attendances are recorded by the system. SOS Médecins network is a group of 62 associations of general practitioners, dispatched all over the territory. Sante publique France received data from 61 out of 62 associations. Both data sources collect medical diagnosis, using ICD10 codes in the ED network and specific medical thesaurus in SOS Médecins associations.These data are routinely analyzed to detect and follow-up various expected or unusual public health events all over the territory [2]. The system is also used for reassurance of decision makers. In that framework, in March 2017, the French Ministry of Health requested Santé publique France to validate a potential scarlet fever outbreak in France.Methods: ED attendances for scarlet fever were identified using the ICD10 code “A38”. SOS Médecins visits with the specific code corresponding to “scarlet fever” were considered.The weekly numbers of ED attendances and SOS Médecins visits for scarlet fever were analyzed from 02/01/2017 (week 5) to 03/31/2017 (week 13) by age group (all ages and less than 15 years old, scarlet fever affecting mainly children) and were compared to the numbers of attendances and visits registered during the same period of the two previous years.Analysis was conducted both at national and regional levels. In order to take into account the improvement of data quality during the study period, we also calculated proportion of attendances and visits for scarlet fever among the overall attendances (respectively visits) with medical coded information.Results: The number of SOS Médecins visits for scarlet fever started to increase in week 9 of 2017. Almost 95% of visits concerned children aged less than 15 years old. SOS Médecins visits for scarlet fever represented 0.24% of the overall visits for the 2 age groups for weeks 11, 13 and 14. This proportion was never reached in 2015 and was observed twice in 2016, but later in the year (weeks 25 and 26).The regional analysis showed that all French metropolitan regions contributed to the increase, even if Paris region was the most impacted. More specifically, cases were mainly located in the east part of the Paris region (in Seine-et-Marne).In the OSCOUR® network, the analysis of the number of attendances for scarlet fever at the national level shows a limited increase from week 9 to week 12. Weekly proportion of ED attendances for scarlet fever among the total coded attendances remained comparable to those observed the two previous years on the same period.The regional analysis also showed that 35% of attendances for scarlet fever during this period were observed in Paris area. But, number of attendances for scarlet fever in this region was comparable during this period to numbers observed the two previous years.Conclusions: The analysis of emergency syndromic data sources enables to confirm an increase of consultations for scarlet fever in SOS Médecins associations from weeks 9 to 14, mainly for children less than 15 years old.The large implementation of the SOS Médecins associations on the whole territory allowed us to provide a geographical location of the outbreak: mainly in the east part of Paris area. The temporal pattern of scarlet fever visits in this region may be in favor of a small cluster of cases.The availability of data collected routinely during a long period of time by the syndromic surveillance system enables to evaluate that the outbreak occurred earlier than the previous years, but the intensity of the outbreak was similar to those observed previously.Scarlet outbreak was not confirmed through the ED network, even if a limited increase was observed during the same period of time. The investigation of this outbreak in ED network revealed a miscoding practice in one ED structure, resulting locally in a larger number of attendances than in the other ED of Paris area.Finally, this case study led to improve data quality and highlighted the importance of the validation step of alarms by epidemiologists, even in an automatized system.

scholarly journals Hospital post-intensive management of major trauma: a pilot study in Internal Medicine

2013 ◽  
pp. 30-34
Author(s):  
Valerio Verdiani ◽  
Chiara Lombardo ◽  
Elisabetta Catini ◽  
Alberto Camaiti ◽  
Alberto Conti ◽  
...  
Keyword(s):  
Intensive Care ◽  
Pilot Study ◽  
Hospital Mortality ◽  
Clinical Pathway ◽  
Hospital Readmission ◽  
Major Trauma ◽  
Hospital Nurses ◽  
Tracheotomy Tube ◽  
Medical Wards

BACKGROUND Major trauma is the fourth cause of death in Western countries, and the first one in patients aged 35 years or younger. In-hospital post-intensive care represents a crucial step in the comprehensive medical assistance for these patients, but no data is available. AIM OF THE STUDY To evaluate an hospital post-intensive clinical pathway for patients with major trauma discharged from Intensive Care Unit (ICU). PATIENTS AND METHODS We designed a clinical pathway project for patients with major trauma discharged from an ICU at Careggi Hospital, in Florence. Patients were admitted in two Internal Medical wards of the same hospital. Nurses and physicians were trained to the management of devices and essential critical problems. We analysed characteristics of patients, APACHE score, devices, clinical and biochemical parameters. We determined medical complicances, ICU readmissions and hospital mortality. After a three months follow-up we evaluated hospital readmission, mortality and residual disability. RESULTS AND DISCUSSION We studied 92 patients (mean age 41 ± 20 years; 70 male) with major trauma discharged from ICU (82.6% of patients underwent invasive mechanic ventilation). On admission, tracheotomy tube was present in 21 patients (22.8%). During internal wards stay, tracheotomy tube was removed in 16 patients. Medical complicances were identified and treated in more than 80% of patients. Four patients (4.3%) were readmitted to ICU, one patient (1.1%) died. Mean internal medical ward stay was 13 ± 9.6 days. After three months follow-up: three patients (3.2%) died; the rate of planned hospital readmission for orthopedic or surgery interventions was 14.7%; 70% of patients did not have any disability. CONCLUSIONS Patients with major trauma discharged from ICU often have medical complications and are managed by the use of multiple devices. Results of our pilot study suggest that a post-intensive clinical pathway in internal wards for patients with major trauma is feasible and could reduce ICU readmissions and hospital mortality.

scholarly journals Administrative and syndromic surveillance data can enhance public health surveillance

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Tara C. Anderson ◽  
Hussain Yusuf ◽  
Amanda McCarthy ◽  
Katrina Trivers ◽  
Peter Hicks ◽  
...  
Keyword(s):  
Public Health ◽  
Administrative Data ◽  
Syndromic Surveillance ◽  
Health Surveillance ◽  
Local State ◽  
Surveillance Data ◽  
Data Sources ◽  
Urgent Care ◽  
American Hospital ◽  
State Regional

ObjectiveThis roundtable will address how multiple data sources, includingadministrative and syndromic surveillance data, can enhance publichealth surveillance activities at the local, state, regional, and nationallevels. Provisional findings from three studies will be presented topromote discussion about the complementary uses, strengths andlimitations, and value of these data sources to address public healthpriorities and surveillance strategies.IntroductionHealthcare data, including emergency department (ED) andoutpatient health visit data, are potentially useful to the publichealth community for multiple purposes, including programmaticand surveillance activities. These data are collected through severalmechanisms, including administrative data sources [e.g., MarketScanclaims data1; American Hospital Association (AHA) data2] andpublic health surveillance programs [e.g., the National SyndromicSurveillance Program (NSSP)3]. Administrative data typically becomeavailable months to years after healthcare encounters; however, datacollected through NSSP provide near real time information nototherwise available to public health. To date, 46 state and 16 localhealth departments participate in NSSP, and the estimated nationalpercentage of ED visits covered by the NSSP BioSense platform is54%. NSSP’s new data visualization tool, ESSENCE, also includesadditional types of healthcare visit (e.g., urgent care) data. AlthoughNSSP is designed to support situational awareness and emergencyresponse, potential expanded use of data collected through NSSP(i.e., by additional public health programs) would promote the utility,value, and long-term sustainability of NSSP and enhance surveillanceat the local, state, regional, and national levels. On the other hand,studies using administrative data may help public health programsbetter understand how NSSP data could enhance their surveillanceactivities. Such studies could also inform the collection and utilizationof data reported to NSSP.

Pilot Study Assessing the Impact of Bereavement Support on Families of Deceased Intensive Care Unit Patients

2018 ◽  
Vol 27 (5) ◽  
pp. 372-380 ◽  
Author(s):  
Jennifer L. McAdam ◽  
Kathleen Puntillo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pilot Study ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Family Members ◽  
Satisfaction With Care ◽  
Prolonged Grief ◽  
Anxiety Depression

Background Family members of patients who die in an intensive care unit (ICU) may experience negative outcomes. However, few studies have assessed the effectiveness of bereavement care for families. Objective To evaluate the effectiveness of bereavement follow-up on family members’ anxiety, depression, posttraumatic stress, prolonged grief, and satisfaction with care. Methods A cross-sectional, prospective pilot study of 40 family members of patients who died in 2 tertiary care ICUs. Those in the medical-surgical ICU received bereavement follow-up (bereavement group); those in the cardiac ICU received standard care (nonbereavement group). Both groups completed surveys 13 months after the death. Surveys included the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, Family Satisfaction With Care in the Intensive Care Unit, Prolonged Grief Disorder, and a bereavement survey. Results Of 30 family members in the bereavement group and 10 in the nonbereavement group, most were female and spouses, with a mean (SD) age of 60.1 (13.3) years. Significantly more participants in the nonbereavement group than in the bereavement group had prolonged grief. Posttraumatic stress, anxiety, depression, and satisfaction with care were not significantly different in the 2 groups. However, overall posttraumatic stress scores were higher in the nonbereavement group than the bereavement group, indicating a higher risk of posttraumatic stress disorder. Conclusions Bereavement follow-up after an ICU death reduced family members’ prolonged grief and may also reduce their risk of posttraumatic stress disorder. This type of support did not have a measurable effect on depression or satisfaction with ICU care.

scholarly journals Approach to Onboarding Emergency Medical Services (EMS) Data Into a Syndromic Surveillance System

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Samurl P. Prahlow ◽  
David Atrubin ◽  
Allison Culpepper ◽  
Janet J. Hamilton ◽  
Joshua Sturms ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Medical Services ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Health Surveillance ◽  
Use Cases ◽  
Data Sources ◽  
Medical Services ◽  
Emergency Medical ◽  
Data Elements

ObjectiveTo describe the strategy and process used by the Florida Department of Health (FDOH) Bureau of Epidemiology to onboard emergency medical services (EMS) data into FDOH’s syndromic surveillance system, the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL).IntroductionSyndromic surveillance has become an integral component of public health surveillance efforts within the state of Florida. The near real-time nature of these data are critical during events such as the Zika virus outbreak in Florida in 2016 and in the aftermath of Hurricane Irma in 2017. Additionally, syndromic surveillance data are utilized to support daily reportable disease detection and other surveillance efforts. Although syndromic systems typically utilize emergency department (ED) visit data, ESSENCE-FL also includes data from non-traditional sources: urgent care center visit data, mortality data, reportable disease data, and Florida Poison Information Center Network (FPICN) data. Inclusion of these data sources within the same system enables the broad accessibility of the data to more than 400 users statewide, and allows for rapid visualization of multiple data sources in order to address public health needs. Currently, the ESSENCE-FL team is actively working to incorporate EMS data into ESSENCE-FL to further increase public health surveillance capacity and data visualization.MethodsThe ESSENCE-FL team worked collaboratively with various public health program stakeholders to bring EMS data, aggregated by the FDOH Bureau of Emergency Medical Oversight Emergency Medical Services Tracking and Reporting System (EMSTARS) team, into ESSENCE-FL. The ESSENCE-FL team met with the EMSTARS team to discuss use cases, demonstrate both systems, and to obtain project buy-in and support. Initial project meetings included review of ESSENCE-FL system support, user types (roles and access), as well as data security and compliance. An overall project timeline was established, and deliverables were added into system support contracts. Multiple stakeholders, across disciplines representing each key use case, reviewed the Florida version of the National Emergency Medical Services Information System (NEMSIS) version 3.4 data dictionary to identify program-specific data element needs. An element scoring spreadsheet was returned to the ESSENCE-FL team. These scores were aggregated and discordant scores were reviewed by the ESSENCE-FL team. A one-month extract of EMS data was reviewed to assess variable completeness and relevance. Monthly team meetings facilitated the final decisions on the data elements by leveraging lessons learned through onboarding other data sources, findings from the analysis of the one-month extract, stakeholder comments, and advice from other states known to be leveraging EMS data for public health surveillance.ResultsThrough a collaborative and broad approach with partners, the ESSENCE-FL team attained stakeholder buy-in and identified 81 data elements to be included in the EMS feed to ESSENCE-FL. The final list of data elements was determined to best support health surveillance of this population prior to presenting to the ED. The inclusion of the EMS data in ESSENCE-FL will increase the epidemiologic characterization and analysis of the opioid epidemic in Florida. Additional key use cases identified during this project included enhanced injury surveillance, enhanced occupational health surveillance, and characterization of potential differences between EMS and ED visits.ConclusionsThis comprehensive approach can be used by other jurisdictions considering adding EMS data to their syndromic surveillance systems. When considering onboarding a new data source into a surveillance system, it is important to work closely with stakeholders from disciplines representing each of the key use cases to broaden buy-in and support for the project. Through employing this comprehensive approach, syndromic surveillance systems can be better developed to include data that are widely utilizable to many different stakeholders in the public health community.

Short- and long-term follow-up of intensive care unit patients after sedation with isoflurane and midazolam—A pilot study*

2008 ◽  
Vol 36 (3) ◽  
pp. 801-806 ◽  
Author(s):  
Peter V. Sackey ◽  
Claes-Roland Martling ◽  
Christine Carlswärd ◽  
Örjan Sundin ◽  
Peter J. Radell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pilot Study ◽  
Long Term Follow Up ◽  
Short And Long Term

Santé publique

2013 ◽  
Vol 12 (102) ◽  
pp. 6
Keyword(s):  
Santé Publique ◽  
Sante Publique

Santé publique

2019 ◽  
Vol 18 (138) ◽  
pp. 6-7
Keyword(s):  
Santé Publique ◽  
Sante Publique
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