Explore the vast range of titles available.

The massive increase in the number of published scientific articles enhances knowledge but makes it more complicated to summarize results. The Medical Subject Headings (MeSH) thesaurus was created in the mid-20th century with the aim of systematizing article indexing and facilitating their retrieval. Despite the advent of search engines, few studies have questioned the relevance of the MeSH thesaurus, and none have done so systematically. The objective of this study was to estimate the added value of using MeSH terms in PubMed queries for systematic reviews (SRs). SRs published in 4 high-impact medical journals in general medicine over the past 10 years were selected. Only SRs for which a PubMed query was provided were included. Each query was transformed to obtain 3 versions: the original query (V1), the query with free-text terms only (V2), and the query with MeSH terms only (V3). These 3 queries were compared with each other based on their sensitivity and positive predictive values. In total, 59 SRs were included. The suppression of MeSH terms had an impact on the number of relevant articles retrieved for 24 (41%) out of 59 SRs. The median (IQR) sensitivities of queries V1 and V2 were 77.8% (62.1%-95.2%) and 71.4% (42.6%-90%), respectively. V1 queries provided an average of 2.62 additional relevant papers per SR compared with V2 queries. However, an additional 820.29 papers had to be screened. The cost of screening an additional collected paper was therefore 313.09, which was slightly more than triple the mean reading cost associated with V2 queries (88.67). Our results revealed that removing MeSH terms from a query decreases sensitivity while slightly increasing the positive predictive value. Queries containing both MeSH and free-text terms yielded more relevant articles but required screening many additional papers. Despite this additional workload, MeSH terms remain indispensable for SRs.

Identifying modifiable risk factors for Alzheimer's disease (AD) is critical for research. Data mining may be a useful tool for finding new AD associated factors. We included all patients over 49 years of age, hospitalized in France in 2008 (without dementia) and in 2014. Dependent variable was AD or AD dementia diagnosis in 2014. We recoded the diagnoses of hospital stays (in ICD-10) into 137 explanatory variables.To avoid overweighting the \"age\" variable, we divided the population into 7 sub-populations of 5 years. We analyzed 1,390,307 patients in the PMSI in 2008 and 2014: 55,997 patients had coding for AD or AD dementia in 2014 (4.04%). We associated Alzheimer disease in 2014 with about 20 variables including male sex, stroke, diabetes mellitus, mental retardation, bipolar disorder, intoxication, Parkinson disease, depression, anxiety disorders, alcohol, undernutrition, fall and 3 less explored variables: intracranial hypertension (odd radio [95% confidence interval]: 1.16 [1.12-1.20] in 70-80 years group), psychotic disorder (OR: 1.09 [1.07-1.11] in 70-75 years group) and epilepsy (OR: 1.06 [1.05-1.07] after 70 years). We analyzed 137 variables in the PMSI identified some well-known risk factors for AD, and highlighted a possible association with intracranial hypertension, which merits further investigation. Better knowledge of associations could lead to better targeting (identifying) at-risk patients, and better prevention of AD, in order to reduce its impact.

The objective of our study was to assess whether the initial antidepressant deliveries in France from 2017 to 2021 adhered to current guidelines regarding the types of antidepressants prescribed and the duration of treatment. We conducted a retrospective cohort study using the French national health insurance database. Antidepressant prescriptions dispensed between January 1, 2016, and December 31, 2023, were extracted. A gap in a sequence of antidepressant treatments was defined as an interval of more than 56 days between two successive dispensations. Guideline recommendations were generally followed for the choice of antidepressant class. However, only 27.5% of sequences had durations within the recommended range of 9 to 24 months. Introducing the continuity criterion reduces the proportion of sequences adhering to the recommendations to only 4.1%. These results align with existing literature, underscoring the need to encourage adherence to guidelines, particularly concerning treatment duration, to help prevent recurrence of depressive episodes. •National study of 6.7 M antidepressant treatment sequences in France (2017–2021).•81% of initial prescriptions followed guideline-recommended antidepressant class.•Only 27.5% of sequences met recommended treatment duration (9–24 months).•54% could be considered stopped too early.•Only 4.1% of sequences were both guideline-compliant and free of discontinuation.

Background The COVID-19 pandemic has had a significant impact on mental health, with evidence suggesting an enduring mental health crisis. Studies worldwide observed increased usage of antidepressants, anxiolytics, and hypnotics during the pandemic, notably among young people and women. However, few studies tracked consumption post-2021. Our study aimed to fill this gap by investigating whether the surge in the number psychotropic drug consumers in France persisted 2 years after the first lockdown, particularly focusing on age and gender differences. Methods We conducted a national retrospective observational study based on the French national insurance database. We retrieved all prescriptions of anxiolytics, hypnotics, and antidepressants dispensed in pharmacies in France for the period 2015–2022. We performed interrupted time series analyses based on Poisson models for five age classes (12–18; 19–25; 26–50; 51–75; 76 and more) to assess the trend before lockdown, the gap induced and the change in trend after. Results In the overall population, the number of consumers remained constant for antidepressants while it decreased for anxiolytics and hypnotics. Despite this global trend, a long-term increase was observed in the 12–18 and 19–25 groups for the three drug classes. Moreover, for these age classes, the increases were more pronounced for women than men, except for hypnotics where the trends were similar. Conclusions The number of people using antidepressants continues to increase more than 2 years after the first lockdown, showing a prolonged effect on mental health. This effect is particularly striking among adolescents and young adults confirming the devastating long-term impact of the pandemic on their mental health.

The aim of this study was to identify factors associated with the results of smoking cessation attempts. Data were collected in Clermont-Ferrand from a smoking cessation clinic between 1999 and 2009 (1,361 patients). Smoking cessation was considered a success when patients were abstinent 6 months after the beginning of cessation. Multivariate logistic regression was used to investigate the association between abstinence and different factors. The significant factors were a history of depression (ORadjusted = 0.57, p = 0.003), state of depression at the initial consultation (ORa = 0.64, p = 0.005), other psychoactive substances (ORa = 0.52, p<0.0001), heart, lung and Ear-Nose-Throat diseases (ORa = 0.65, p = 0.005), age (ORa = 1.04, p<0.0001), the Richmond test (p<0.0001; when the patient's motivation went from insufficient to moderate, the frequency of abstinence was twice as high) and the Prochaska algorithm (p<0.0001; when the patient went from the 'pre-contemplation' to the 'contemplation' level, the frequency of success was four times higher). A high score in the Richmond test had a greater impact on success with increasing age (significant interaction: p = 0.01). In exclusive smokers, the contemplation level in the Prochaska algorithm was enough to obtain a satisfactory abstinence rate (65.5%) whereas among consumers of other psychoactive substances, it was necessary to reach the preparation level in the Prochaska algorithm to achieve a success rate greater than 50% (significant interaction: p = 0.02). The psychological preparation of the smoker plays a critical role. The management of smoking cessation must be personalized, especially for consumers of other psychoactive substances and/or smokers with a history of depression.

Introduction and hypothesisThe surgical treatment of pelvic organ prolapse (POP) is associated with specific complications. Our primary objective was to assess the recurrence requiring reoperation after prolapse surgery, and our secondary objectives were to assess the early complications and secondary surgery for urinary incontinence.MethodsRetrospective study of a population-based cohort of all hospital or outpatient stays including POP surgery from 2008 to 2014, using the French nationwide discharge summary database. We calculated the rates of hospital readmission following surgery as well as the rates of reoperation for recurrent prolapse and subsequent procedures performed for urinary incontinence.ResultsA total of 310,938 patients had undergone surgery for POP. Two hundred fourteen (0.07%) patients died, and 0.45% were admitted to an intensive care unit; 4.4% of the patients underwent surgery for the recurrence of prolapse. Concomitant hysterectomy in the first surgery was associated with a significantly lower risk of POP surgery recurrence: (hazard ratio (HR) [95% confidence interval (CI)] = 0.51 [0.49; 0.53]). A total of 1386 (2.5%) patients were readmitted to the hospital for early (30-day) complications of prolapse surgery. The most frequent reasons for early readmission were local infection (32.8%), hemorrhage (21.4%) and pain (17.2%). Risk factors for complications were obesity, hospitals with low levels of activity and associated incontinence surgery; 4.6% of the patients required secondary surgery for urinary incontinence; obesity was a risk factor (HR [95% CI] = 1.12 [1.01; 1.24]), and the vaginal route was a protective factor (odds ratio = 1.86 for laparoscopy, 1.44 for laparotomy and 1.25 for multiple approaches).ConclusionsPOP surgery is associated with low rates of complication and recurrence. Complications occurred most commonly following combined surgeries for both prolapse and incontinence and in hospitals with low surgical volumes. Concomitant hysterectomy appears to be protective for the need for additional prolapse surgery, and the vaginal route leads to a lower frequency of secondary surgery for urinary incontinence.

Background In most countries, the official statistics for the coronavirus disease 2019 (COVID-19) take account of in-hospital deaths but not those that occur at home. The study’s objective was to introduce a methodology to assess COVID-19 home deaths by analysing the French national out-of-hospital cardiac arrest (OHCA) registry (RéAC). Methods We performed a retrospective multicentre cohort study based on data recorded in the RéAC by 20 mobile medical teams (MMTs) between March 1st and April 15th, 2020. The participating MMTs covered 10.1% of the French population. OHCA patients were classified as probable or confirmed COVID-19 cases or as non-COVID-19 cases. To achieve our primary objective, we computed the incidence and survival at hospital admission of cases of COVID-19 OHCA occurring at home. Cardiac arrests that occurred in retirement homes or public places were excluded. Hence, we estimated the number of at-home COVID-19-related deaths that were not accounted for in the French national statistics. Results We included 670 patients with OHCA. The extrapolated annual incidence of OHCA per 100,000 inhabitants was 91.9 overall and 17.6 for COVID-19 OHCA occurring at home. In the latter group, the survival rate after being taken to the hospital after an OHCA was 10.9%. We estimated that 1322 deaths were not accounted in the French national statistics on April 15, 2020. Conclusions The ratio of COVID-19 out-of-hospital deaths to in-hospital deaths was 12.4%, and so the national statistics underestimated the death rate.

[This corrects the article DOI: 10.3389/fphar.2020.00513.].

Triage errors in emergency departments (EDs), including undertriage and overtriage, pose significant risks to patient safety and resource allocation. With increasing patient volumes and staffing challenges, artificial intelligence (AI) integration into triage protocols has gained attention as a potential solution. This study aims to develop and compare 3 AI models-natural language processing (NLP), large language model (LLM), and Joint Embedding Predictive Architecture (JEPA)-for predicting triage outcomes according to the French Emergency Nurses Classification in Hospital (FRENCH) scale and to assess their performance relative to nurse triage and clinical expert consensus. We conducted a retrospective analysis of prospectively collected data from adult patients triaged at Roger Salengro Hospital ED (Lille, France) over 7 months (June-December 2024). Three AI models were developed: TRIAGEMASTER (NLP with Doc2Vec + MLP), URGENTIAPARSE (LLM with FlauBERT + Extreme Gradient Boosting [XGBoost]), and EMERGINET (JEPA with variance-invariance-covariance regularization). Of 73,236 ED visits, 657 (0.90%) had complete audio recordings and structured data. Data were split 80:20 into training and validation sets with stratification. Gold-standard labels were established by senior clinician consensus (minimum 5 years of ED experience). The primary outcome was concordance with the gold-standard FRENCH triage level, assessed using weighted κ, Spearman correlation, F1-score, area under the receiver operating characteristic (AUC-ROC) curve, mean absolute error (MAE), and root mean square error (RMSE). Secondary analyses evaluated Groupes d'Etude Multicentrique des Services d'Accueil (GEMSA) prediction and performance by input data type. URGENTIAPARSE demonstrated superior performance, with a composite z score of 2.514 compared with EMERGINET (0.438), TRIAGEMASTER (-3.511), and nurse triage (-4.343). URGENTIAPARSE achieved an F1-score of 0.900 (95% CI 0.876-0.924), an AUC-ROC of 0.879 (95% CI 0.851-0.907), a weighted κ of 0.800 (P<.001), a Spearman correlation of 0.802 (P<.001), an MAE of 0.228, and an RMSE of 0.790. Exact agreement was 90.0%, with near-agreement (+1 or -1 level) of 92.8%. However, training showed perfect accuracy (1.0) with poor validation performance (~0.5), indicating overfitting. EMERGINET achieved moderate performance (F1-score=0.731, AUC 0.686), while TRIAGEMASTER and nurse triage performed poorly (F1-score=0.618 and 0.303, respectively). For GEMSA prediction, URGENTIAPARSE maintained superiority (κ=0.863, Spearman=0.864, P<.001). Class 1 (highest acuity) was underrepresented (4/657, 0.61%), limiting undertriage risk assessment. The LLM-based architecture (URGENTIAPARSE) demonstrated the highest accuracy for ED triage prediction among the tested models, outperforming traditional NLP, JEPA, and current nurse triage practices. However, severe overfitting, extreme selection bias (657/73,236, 0.90%, inclusion), a monocentric design, and sparse high-acuity representation limit clinical applicability. Before deployment, the model requires regularization, external validation across diverse EDs, prospective testing, and comprehensive safety evaluation, particularly for undertriage detection. Integration of AI triage support systems shows promise but demands rigorous validation, bias mitigation, and transparent uncertainty quantification to ensure patient safety.

Background Incidence of complications following obstetrical anal sphincter injury (OASI) during vaginal delivery are poorly defined. They are only studied in high level maternities, small cohorts, all stages of perineal tear or in low-income countries. The aim of our study was to describe complications after primary OASI repair following a vaginal delivery in all French maternity wards at short and midterm and to assess factors associated with complication occurrence. Methods We conducted a historical cohort study using the French nationwide claim database (PMSI) from January 2013 to December 2021. All women who sustained an OASI repair following a vaginal delivery were included and virtually followed-up for 2 years. Then, we searched for OASIS complications. Finally, we evaluated factors associated with OASIS complication repaired or not and OASIS complication repairs. Results Among the 61,833 included women, 2015 (2.8%) had an OASI complication and 842 (1.16%) underwent an OASI complication repair. Women were mainly primiparous (71.6%) and 44.3% underwent an instrumental delivery. During a follow-up of 2 years, 0.6% ( n  = 463), 0.3% ( n  = 240), 0.2% ( n  = 176), 0.1% ( n  = 84), 0.06% ( n  = 43) and 0.01% ( n  = 5) of patients underwent second surgery for a perineal repair, a fistula repair, a sphincteroplasty, a perineal infection, a colostomy and a sacral nervous anal stimulation, respectively. Only one case of artificial anal sphincter was noticed. Instrumental deliveries (OR = 1.56 CI95%[1.29;1.9]), private for-profit hospitals (OR = 1.42 [1.11;1.82], reference group “public hospital”), obesity (OR = 1.36 [1;1.84]), stage IV OASIS (OR = 2.98 [2.4;3.72]), perineal wound breakdown (OR = 2.8 [1.4;5.48]), ages between 25 and 29 years old (OR = 1.59 [1.17;2.18], refence group “age between 13 and 24 years old”) and 30 and 34 years old (OR = 1.57 [1.14; 2.16], refence group “age between 13 and 24 years old”) were factors associated with OASIS complication repairs. Conclusions Maternal age, stage IV OASIS, obesity, instrumental deliveries and private for-profit hospitals seemed to predict OASIS complications. Understanding factors associated with OASIS complications could be beneficial for the patient to inform them and to influence the patient’s follow-up in order to prevent complications, repairs and maternal distress.