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Introduction Many recent studies have investigated the hospital volume-outcome relationship in surgery. In some cases, the results have prompted the centralization of surgical activity. However, the methodologies and interpretations differ markedly from one study to another. The objective of the present scoping review was to describe the various features used to assess the volume-outcome relationship: the analyzed datasets, study population, outcome, covariates, confounders, volume modalities, and statistical methods. Methods and analysis The review was conducted according to a study protocol published in BMJ Open in 2020. Two authors (both of whom had helped to design the study protocol) screened publications independently according to the title, the abstract and then the full text. To ensure exhaustivity, all the papers included by each reviewer went through to the next step. Interpretation The 403 included studies covered 90 types of surgery, 61 types of outcome, and 72 covariates or potential confounders. 191 (47.5%) studies focussed on oncological surgery and 37.8% focussed visceral or digestive tract surgery. Overall, 86.6% of the studies found a statistically significant volume-outcome relationship, although the findings differed from one type of surgery to another. Furthermore, the types of outcome and the covariates were highly diverse. The majority of studies were performed in Western countries, and oncological and visceral surgical procedures were over-represented; this might limit the generalizability and comparability of the studies’ results.

Introduction Medical students are reported to experience high rates of psychological distress, including depression, anxiety, stress, and suicide. However, there is no consensus on the tools used to detect these symptoms. This systematic review aims to explore the various tools available for assessing distress in medical students. Materials and methods A systematic literature review was conducted following an established protocol. Articles were included if they addressed anxiety, stress, or psychological distress in medical students and used validated assessment tools translated into English. A meta-analysis was also conducted on the prevalence of stress and anxiety. Results One hundred twenty-one articles were included, identifying 22 different tools. The Depression, Anxiety and Stress Scale was the most commonly used tool (21.7%), followed by the General Health Questionnaire and the Perceived Stress Scale (14.7%). Only two of the identified tools, the Medical Student Stressor Questionnaire (5.4%) and the Perceived Medical School Stress (3.9%), were specifically designed for medical students. The meta-analysis revealed a stress prevalence of 47.5% and an anxiety prevalence of 44.6%. Conclusion There are multiple tools available for assessing psychological distress that are already widely used. The use of a specific questionnaire may not be necessary for this population, as tools designed for the general population can also be used for this specific group. However, specific questionnaires may provide a more accurate indication of the causal factors that require action.

Background Eating disorders (EDs) are extreme eating behaviors with health consequences that sometimes require hospitalization. The prevalence of these disorders is difficult to estimate but appears to be increasing. The aim of this study was to analyze trends in hospitalizations for eating disorders in pediatric care in France over a ten-year period to determine whether these hospitalizations have increased and to characterize the nature of such changes. Methods We conducted a retrospective observational study based on the French National Health Insurance Database (SNDS) for patients aged 6–18 years who were hospitalized for an eating disorder. Data were collected for the years 2013, 2017, and 2022. The primary objective was to compare the number and duration of hospitalizations across different years. The secondary objectives include: characteristics of initial stays, characteristics of patients, rehospitalizations and/or death in the year. Results The study included 9,085 children aged 6 to 18 years who were hospitalized for eating disorders. The incidence doubled, increasing from 0.017% in 2013 to 0.036% in 2022. The duration of stays is generally longer than a few days (15 [5–43] vs 15 [5–50]). The median age was 15 years and showed an increasing trend, with a decreasing proportion of boys. Anorexia nervosa remains predominant with stable proportions, but there was a notable increase in \"other eating disorders\" between 2013 and 2022. Severe malnutrition increased, affecting more than 23% of patients in 2022, and anxiety disorders doubled, affecting 20.7% of patients in 2022. Emergency admissions rose (from 31% in 2013 to 37% in 2022), with a lower readmission rate. The role of psychiatric services increased, representing 25% of hospitalizations in 2022. All regions of France were affected. Conclusions This study revealed, between 2013 and 2022, a doubling of hospitalizations for EDs in children without a reduction in stay time. Patients have more anxiety and severe malnutrition. The diagnostic categories are changing, resulting in a more significant expansion of psychiatric services.

Epithelial ovarian cancer is mostly discovered at the stage of peritoneal carcinosis. Complete cytoreductive surgery improves overall survival. The Fagotti score is a predictive score of resectability based on peritoneal laparoscopic exploratory. Our aim was to study the inter-observer concordance in an external validation of the Fagotti score. An observational, prospective, multicenter study was conducted using the Francogyn research network. The primary outcome was inter-observer concordance of the Fagotti score. 15 patients in which an ovarian mass was discovered were included. For each patient, the first exploratory laparoscopy before any treatment/chemotherapy was recorded. This bank of 15 videos was subject to blind review accompanied by a Fagotti score rating by 11 gynecological surgeons specializing in oncology. A total of 165 blind reviews were performed. Inter-observer concordance was very good for the Fagotti score with an intraclass correlation coefficient (ICC) of 0.83 [95% CI 0.71; 0.93]. Inter-observer concordance for the adjusted Fagotti score, which accounts for unexplorable areas with extensive carcinomatosis, resulted in an ICC of 0.64 [95% CI 0.46; 0.82]. According to the reviewers, the three least explorable parameters were mesentery involvement, stomach infiltration and liver damage. The ICC of the explorable Fagotti score, i.e. score with deletion of the parameters most often unexplored by laparoscopy, was 0.86 [0.75–0.94]. This study confirms the reproducibility of the Fagotti score during first assessment laparoscopies in cases of advanced ovarian cancer. The explorable Fagotti score has an equivalent or better inter-observer concordance than the Fagotti score.

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.

IntroductionEven if a positive volume-outcome correlation in surgery is mostly admitted in many surgical fields, the various ways to assess this relationship make it difficult for researchers and policymakers to use it. Our aim is therefore to provide an overview of the way hospital volume-outcome relationship was assessed. Through this overview, our goal is to identify potential gaps in the assessment of this relationship, to help researchers who want to pursue work in this field and, ultimately, to help policy makers interpret such analyses.Methods and analysisThis review will be conducted using the six stages of the scoping review method: identifying the research question, searching for relevant studies, selecting studies, data extraction, collating, summarising and reporting the results and concluding. This review will address all the key questions used to assess the volume-outcome relationship in surgery.Primary research papers investigating the hospital volume-outcome relationship from 2009 will be included. Studies only looking at surgeons’ volume-outcome relationship or studies were the volume variable is not individualisable will be excluded.Both MEDLINE and Scopus will be searched along with grey literature. Two researchers will perform all the stages of the review: screen the titles and abstracts, review the full text of selected articles to determine final inclusions and extract the data. The results will be summarised quantitatively using numerical counts.Ethical considerations and disseminationReviews of published articles are considered secondary analysis and do not need ethical approval. The findings will be disseminated through multiple channels like conferences and peer-reviewed journals.

Background Hip arthroplasty is a frequently performed procedure in orthopedic surgery, carried out in almost all health structures for two main issues: fracture and coxarthrosis. Even if volume–outcome relationship appeared associated in many surgeries recently, data provided are not sufficient to set surgical thresholds neither than closing down low-volumes centers. Question With this study, we wanted to identify surgical, health care-related and territorial factors influencing patient’ mortality and readmission after a HA for a femoral fracture in 2018 in France. Patients and methods Data were anonymously collected from French nationwide administrative databases. All patients who underwent a hip arthroplasty for a femoral fracture through 2018 were included. Patient outcome was 90-day mortality and 90-day readmission rate after surgery. Results Of the 36,252 patients that underwent a HA for fracture in France in 2018, 0.7% died within 90-day year and 1.2% were readmitted. Male and Charlson comorbidity index were associated with a higher 90-day mortality and readmission rate in multivariate analysis. High volume was associated with a lower mortality rate. Neither time of travel nor distance upon health facility were associated with mortality nor with readmission rate in the analysis. Conclusion Even if volume appears to be associated with lower mortality rate even for longer distance and time of travel, the persistence of exogenous factors not documented in the French databases suggests that regionalization of hip arthroplasty should be organized with caution. Clinical relevance As volume–outcome relationship must be interpreted with caution, policy makers should not regionalize such surgery without further investigation.

Previous studies have shown a negative impact of the COVID-19 pandemic and its associated sanitary measures on mental health, especially among adolescents and young adults. Such a context may raise many concerns about the COVID-19 pandemic long-term psychological effects. An analysis of administrative databases could be an alternative and complementary approach to medical interview-based epidemiological surveys to monitor the mental health of the population. We conducted a nationwide study to describe the consumption of anxiolytics, antidepressants and hypnotics during the first year of the COVID-19 pandemic, compared to the five previous years. A historic cohort study was conducted by extracting and analysing data from the French health insurance database between 1 January 2015 and 28 February 2021. Individuals were classified into five age-based classes. Linear regression models were performed to assess the impact of the COVID-19 pandemic period on the number of drug consumers, in introducing an interaction term between time and COVID-19 period. Since March 2020, in all five age groups and all three drug categories studied, the number of patients reimbursed weekly has increased compared to the period from January 2015 to February 2020. The youngest the patients, the more pronounced the magnitude. Monitoring the consumption of psychiatric medications could be of great interest as reliable indicators are essential for planning public health strategies. A post-crisis policy including reliable monitoring of mental health must be anticipated.