[Show abstract][Hide abstract] ABSTRACT: Objectives
Consensus methods are increasingly used as alternatives to traditional assessment methods, because of their low cost and high efficiency. The objective of our study was to investigate whether the assessment of occupational hazards linked to the use of carcinogenic, mutagenic and reprotoxic chemicals differed when done by two consensus methods, the nominal group method (based on a face-to-face group meeting) and the Delphi method (a questionnaire-based method) in comparison to direct observation. The CMR’s have been chosen due to the specificity of substances used in the laboratories and due also to the lack of prevention practices.
119 professionals from 13 French research laboratories were randomly allocated to use either the Delphi or nominal group methods. Direct observation of the presence and use of chemicals was done by an external occupational hygienist who used a standardized protocol. After data collection, chemicals identified by consensus methods but not by observation were checked by local hygiene and safety correspondents. The final combined list of the present and used chemicals was defined as the reference. Sensitivities (Se) and specificities (Sp) were estimated to assess the performance of the three methods to identify the presence, and the actual use of chemicals. Characteristics associated with performance were assessed using logistic regression models.
The total number of chemicals listed in the initial lists was 360. Observation identified 50 additional chemicals, and consensus methods another two, which were neither on the lists nor observed. Performance of the nominal group (Se presence 0.57; Se use 0.86; Sp presence 0.65; Sp use 0.74) and Delphi method (Se presence 0.59; Se use 0.83; Sp presence 0.57; Sp use 0.57) was similar. Higher seniority of the participants was the main characteristic related to better performance.
Performance of both consensus methods was low. Because of their advantages over observation (local collective involvement and lower workload), these methods might be useful before and after a valid assessment based on observation, therefore contributing at presumably affordable cost to maintain accuracy of the list, as well as team awareness and prevention commitment.
Even if the observations are more burdensome to carry out, they make it possible to understand the complexity of the compromises made by operators when they face risks. In that perspective they can unearth accounts of incidents and strategies that would be otherwise difficult to verbalise through other methods. What is more, such observation methods can also help involve workers in a bottom-up approach and turn them into active stakeholders in the prevention process. It may thus be possible and relevant to develop an articulation between consensus methods and those centred on ergonomics observations.
[Show abstract][Hide abstract] ABSTRACT: Purpose of the study
Consensus methods meet the requirements and expectancies of global occupational risk prevention guidelines, in particular because they strongly involve field professionals. In addition, the nominal group technique may be easily implemented alone. The objective of our study was to compare three methods, among them two consensus methods, for identifying psychosocio-organizational (PSO) hazards in French research laboratories.
Sample and methods
Professionals were selected from 13 French research laboratories. The consensus methods were the Delphi and the nominal group techniques; the third technique was based on observations and interviews. Methods were independently implemented. The questionnaire was standardized and similar for the three methods. A descriptive presentation of PSO factors was performed. The concordance of the results across the three methods was analysed with Kappa coefficients. Polytomous logistic regression allowed to assess method performance adjusted to laboratory characteristics and operational modalities.
The 176 professionals belonged to all professional categories. The observation method identified 48 PSO factors, Delphi 74 and nominal group 102, in the 13 laboratories. Observation method provided 13% of undefined answers, Delphi 8% and nominal group 7%. The most frequent PSO categories were related to the individual's role within the organization, career plan definition and work time organization. The most frequent PSO factors were lack of workstation sheet, cases of career stagnation or uncertainty, insufficient promotion system, existence of interpersonal conflicts and achieving long working hours or working outside normal hours. Concordance between the methods was low: the PSO factors identified by each method were variable. The probability to identify PSO factors by the nominal group was significantly higher (OR = 2.4) than the one by the observation method. The academics/researcher identified significantly more PSO factors than the other professionals (OR = 1.57).
The nominal group technique might be a relevant tool for PSO factor assessment for French research laboratories. The results might also be used at an individual level during occupational medical visits, for focusing the interview and prioritizing preventive actions.
Archives des Maladies Professionnelles et de l Environnement 10/2009; 70(5):516-524. · 0.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Consensus-based studies are increasingly used as decision-making methods, for they have a lower production cost than other methods (observation, experimentation, modeling) and provide results more rapidly. The objective of this paper is to describe the principles and methods of the four main methods - Delphi, nominal group, consensus development conference and RAND/UCLA - their use as reported in peer-reviewed publications and validation studies published in the healthcare literature. METHODS: A bibliographic search was performed in PubMed/MEDLINE, banque de données santé publique (BDSP), The Cochrane Library, Pascal and Francis. Keywords, headings and qualifiers corresponding to a list of terms and expressions related to the consensus methods were searched for in the thesauri and used in the literature search. A search with the same terms and expressions was performed on Internet using the website Google Scholar. RESULTS: All methods, precisely described in the literature, are based on common basic principles such as definition of the subject, selection of experts and direct or remote interaction processes. They sometimes use quantitative assessment for ranking items. Numerous variants of these methods have been described. Few validation studies have been implemented. Not implementing these basic principles and failing to describe the methods used to reach the consensus were both frequent reasons raising suspicion regarding the validity of consensus methods. CONCLUSION: When it is applied to a new domain with important consequences in terms of decision-making, a consensus method should first be validated.
Revue d Épidémiologie et de Santé Publique 12/2008; · 0.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Consensus-based studies are increasingly used as decision making methods, for they have lower production cost than other methods (observation, experimentation, modelling) and provide results more rapidly. The objective of this paper is to describe the principles and methods of the four main methods, Delphi, nominal group, consensus development conference and RAND/UCLA, their use as it appears in peer-reviewed publications and validation studies published in the healthcare literature.
Revue d Épidémiologie et de Santé Publique 12/2008; 56(6):415-423. · 0.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Evans and Bernardis proposed the 'PNB classification', by which a fingertip injury is classified according to each structure: pulp P, nail N, bone B. The objective of this study was to assess the inter-observer reliability, repeatability and accuracy of PNB. One hundred patients presenting with a fingertip injury were included prospectively, photographed, then classified in randomly chosen orders by nine independent observers. A third were drawn randomly and classified a second time to measure repeatability. A reference classification was also provided by one of the authors of the PNB system. Classifications agreed with the reference in 59% of injuries for P, 55% for N and 54% for B. The Kappa values for inter-observer agreement were 0.520 for P, 0.512 for N, and 0.504 for B; for intra-observer agreement, they were 0.616 for P, 0.658 for N, and 0.577 for B. Although levels of agreement are comparable with results found for other classifications, they are insufficient for use of the PNB classification without improvement.
Journal of Hand Surgery (European Volume) 05/2007; 32(2):188-92. · 2.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess whether the use of the full logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) is superior to the standard additive EuroSCORE in predicting mortality in high-risk cardiac surgical patients.
Both the simple additive EuroSCORE and the full logistic EuroSCORE were applied to 14,799 cardiac surgical patients from across Europe, of whom there were 4293 high-risk patients (additive EuroSCORE of 6 or more). The systems were compared for absolute prediction and discrimination (area under the receiver operating characteristic (ROC) curve).
Actual mortality was 4.72%. The logistic model was closer to this than the additive model (4.84% (4.72-4.94) versus 4.21 (4.21-4.26)). Most of this difference was due to high-risk patients where actual mortality was 11.18% and predicted was 7.83% (additive) and 11.23% (logistic). Discrimination was similar in both systems as measured by the area under the ROC curve (additive 0.783, logistic 0.785).
The additive EuroSCORE model remains a simple "gold standard" for risk assessment in European cardiac surgery, usable at the bedside without complex calculations or information technology. The logistic model is a better risk predictor especially in high-risk patients and may be of interest to institutions engaged in the study and development of risk stratification.
European Journal of Cardio-Thoracic Surgery 06/2003; 23(5):684-7; discussion 687. · 2.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although rates for coronary and valve surgery vary between northern and southern Europe, differences in the features of valve disease leading to surgery in Europe are poorly documented. The study aim was to compare demographics, risk factors, procedures and outcome in valve surgery between European regions, using the EuroSCORE database.
Between September and December 1995, information on 98 variables (risk factors, procedures and outcome) were collected on valve surgery patients in 128 European centers. Patients were allocated to two geographic subgroups (north, n = 1,990; south, n = 3,682). The distribution of variables was assessed. Subsequently, the impact of preoperative and operative risk factors on mortality was analyzed in both groups using a bivariate analysis. Risk-adjusted outcomes were then compared according to the EuroSCORE.
Significant differences were identified for clinical features, risk factors and procedures. In northern Europe, surgery was performed on older patients with more severe coronary or associated disease, whilst in the south the cardiac status seemed more severely compromised. Degenerative aortic disease prevailed in the north (aortic valve replacement in 72.7% of cases), whilst in the south mitral surgery accounted for 46.1% of procedures. Despite differences in crude mortality (6.9% north versus 5.7% south), outcomes (when adjusted to risks) seemed comparable (observed-to-expected mortality ratio 0.90 for north versus 0.84 for south). The impact of individual risk factors on mortality was similar, except for atrial fibrillation.
Despite large epidemiological differences between northern and southern Europe in terms of valve surgery, performances and outcomes were similar when individual risk factors and overall risk profiles were taken into account.
The Journal of heart valve disease 02/2003; 12(1):1-6. · 0.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the performance of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) when applied in a North American cardiac surgical population.
The simple additive EuroSCORE model was applied to predict operative mortality (in-hospital or 30-day) in 401684 patients undergoing coronary or valve surgery in 1998 and 1999 as well as in 188913 patients undergoing surgery in 1995 in the Society of Thoracic Surgeons (STS) database.
The proportion of isolated coronary artery bypass grafting (CABG) was greater in STS patients (84%) than in Europe (65%). STS patients were also older (mean age 65.3 versus 62.5), and had more diabetes (30 versus 17%) and prior cardiac surgery (11 versus 7%). Other comorbidity was also significantly more prevalent in STS patients. EuroSCORE predicted overall mortality was virtually identical to the observed mortality (1998/1999: predicted 3.994%, observed 3.992%; 1995: observed and predicted 4.156%). Predicted mortality also closely matched observed mortality across the risk groups. Discrimination was good to very good for the population overall and for isolated CABG in both time periods, with the area under the receiver operating characteristic curve between 0.75 and 0.78.
Despite substantial demographic differences between Europe and North America, EuroSCORE performs very well in the STS database, and can be recommended as a simple, additive risk stratification system on both sides of the Atlantic.
European Journal of Cardio-Thoracic Surgery 08/2002; 22(1):101-5. · 2.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The characteristics of valve surgery are evolving. The study aim was to explore its demographics and risk factors in Europe in the 1990s, using the EuroSCORE database.
For the EuroSCORE program, information on 98 variables regarding risk factors, procedures and outcome were collected for 5,672 patients undergoing valve surgery under cardiopulmonary bypass in 128 European centers. Bivariate (i.e. Mann-Whitney test or chi-square when appropriate), then logistic regression analyses were carried out to identify risk factors for early mortality. The predictive value of EuroSCORE was analyzed using the Hosmer-Lemershow test and by computing the area under the receiver operating characteristic (ROC) curve.
Aortic valve stenosis was the most common diagnosis (47.6%), whilst mitral valve surgery accounted for 42% of procedures. Coronary surgery was performed concomitantly in 21% of cases. Hospital mortality was 6.1%. Predictive factors for early mortality were: age (p = 0.0001), preoperative serum creatinine >200 micromol/l (p = 0.014), previous heart surgery (p = 0.0001), poor left ventricular function (p = 0.008), chronic congestive heart failure (p = 0.0001), pulmonary hypertension (p = 0.0001), active acute endocarditis (p = 0.0001), emergency procedure (p = 0.05), critical preoperative status (p = 0.0001), tricuspid surgery (p = 0.015), aortic and mitral surgery (p = 0.002), combined thoracic surgery (p = 0.0001), and combined coronary surgery (p = 0.0001). The predictive value of EuroSCORE for mortality was good (area under the ROC curve = 0.75).
The 'valve' subset of the EuroSCORE database provides an instant picture of European valve surgery in the 1990s that can be used either for individual assessment, or for country- or institution-based epidemiological studies of risk factors and practices.
The Journal of heart valve disease 09/2001; 10(5):572-7; discussion 577-8. · 0.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Because of national epidemiological differences in adult heart surgery in Europe, the effectiveness and desirability of a pan-European score for the assessment of quality of surgical care remains controversial. We assessed the predictive value of EuroSCORE in national subsets of the EuroSCORE database.
The EuroSCORE development data set was divided into national subsets of which those with 500 or more patients were selected for analysis. The Hosmer-Lemeshow goodness-of-fit test was applied to assess the calibration of the EuroSCORE model on individual national samples and the areas under the receiver operating characteristic (ROC) curve were measured to analyse the EuroSCORE discriminative power on individual death prediction.
There were 18676 patients in the six largest national samples: Germany, United Kingdom, Spain, Finland, France and Italy (mean: 3113 patients; range: Finland 1266 to France 4507). Major differences were observed in national distribution of procedures: coronary artery bypass grafting accounted for 77.7% of procedures in Finland but only 46.2% in Spain. The EuroSCORE model goodness-of-fit was satisfactory in all countries (P-value overall: 0.4; UK: 0.34; Finland: 0.87; no values less than 0.05). Areas under ROC curves were 0.81 in Germany, 0.79 in the UK, 0.74 in Spain, 0.87 in Finland, 0.82 in France and 0.82 in Italy.
Despite epidemiological differences between European countries, the discriminative power of EuroSCORE was good in Spain and excellent in all other countries. The system, developed from a merged European database, can therefore be used to assess improvement in quality of care achieved by surgeons and institutions as well as for international European comparison in adult heart surgery.
European Journal of Cardio-Thoracic Surgery 08/2000; 18(1):27-30. · 2.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare the national samples of patients who underwent isolated coronary artery bypass grafting (CABG) during the European System for Cardiac Operative Risk Evaluation (EuroSCORE) trial in order to evaluate national differences in epidemiology, patient risk profile and surgical methods.
From September to November 1995, 11731 patients had CABG in the six largest contributing nations to the EuroSCORE project: Germany, UK, Spain, Finland, France and Italy. The Chi-square and Kruskal-Wallis tests were applied to obtain an international comparison of patient general status, including pre-operative risk factors, cardiac status, critical pre-operative states, rare conditions, urgency of surgery, angina status, coronary lesions, procedures and EuroSCORE risk assessment.
Large national samples (from 984 patients in Finland to 3138 in Germany) identified significant differences in epidemiology, risk profile and surgical practice. Regarding epidemiology, CABG accounted for 62.8% of adult cardiac surgery, with a range of 46.2 in Spain to 77.7% in Finland (P<0.001). The mean age was 62.9 years (61.4 in Britain to 64.4 in France, P<0.001). The mean body mass index was 26.8 (26 in France to 27.5 in Finland, P<0.001). With regard to risk profile, diabetes was present in 20.3% of patients (11.8% in Britain to 27.7% in Spain, P<0.001). Chronic renal failure was present in 8.3% (6.8% in Germany to 10.6% in Spain, P<0.001). Chronic airway disease affected 3.8% (1.9% in Italy to 5. 1% in Germany, P<0.001). The mean ejection fraction was 0.56 (0.48 in Britain to 0.58 in Finland, P<0.001). The mean predicted mortality (according to EuroSCORE) was 3.3% (2.8% in Finland to 3.6% in France, P<0.001). The prevalence of chronic congestive heart failure, unstable angina and recent myocardial infarction also showed statistically significant differences. No differences were found for some critical preoperative states (such as immediate preoperative cardiac massage and pre-operative intubation), or for surgery for catheter laboratory complication. Regarding surgical practice, major differences were noted in preoperative intra-aortic balloon use (mean 1%, Finland 0%, Spain 2.3%, P<0.001), the number of mammary artery conduits used (mean 0.9, Spain 0.7, France 1.1, P=0.0001) and the number of distal anastomoses (mean 3, France 2.7, Finland 3.8, P=0.001).
There are important epidemiological differences in the national cohorts of CABG patients in the EuroSCORE database. Any international comparison of European surgical results must therefore take into account the risk profile of patients by using a compatible risk stratification system.
European Journal of Cardio-Thoracic Surgery 04/2000; 17(4):396-9. · 2.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In 1996, experts from the Société Française d'Anesthésie et de Réanimation published guidelines about difficult intubation. We aimed to assess the effectiveness of two diffusion methods of these guidelines, media versus direct mailing plus media diffusion, and the relation between reading of the guidelines and practice behavior and training willingness.
Data were collected in two different samples of 300 anesthetists from three regions for pre and post-intervention surveys (E1 and E2 samples). Half of the anesthetists from E2, randomly chosen, received a direct mailing of the guidelines (E2a sample). The remaining constituted the E2b sample. Three assessment criteria were used, two concerning practice behavior and one training willingness. Relationship between these criteria and diffusion methods and reading was tested using logistic regression.
The response rates were respectively 91%, 80% and 78% in the E1, E2a and E2b samples. The socio-professional features were not statistically different between the three samples. There was no relationship between the criteria and the diffusion methods. The direct mailing did not increase the reading rate (81% and 82% respectively in the E2a and E2b samples). The rate of anesthetists who routinely screened for predictive signs of difficult intubation (one of the practice criteria) was higher in E2a than in E2b (28% and 12% respectively). In the multivariate analysis, the difference only appeared among the sub-group of anesthetists who did not receive the direct mailing. The private practice was associated with a lower rate of routine screening.
No impact of the diffusion methods on practice behavior and training willingness was found. Reading was inconstantly associated with practice behavior.
Revue d Épidémiologie et de Santé Publique 10/1999; 47(4):353-60. · 0.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To analyse the management of difficult intubation (DI) by French anaesthetists and the impact of the French experts' conference (EC) on this topic.
Prospective, comparative, before/after study by questionnaire carried out in Aquitaine, Provence-Alpes-Côte d'Azur and Alsace-Lorraine.
A questionnaire on demographical data, detection of DI, management techniques and desiderata for continuing education on DI, was sent three months before the publication of the EC to 100 randomly selected anaesthetists, in each region (group PRE). Three months after the diffusion of the EC, the questionnaire completed by a survey on the impact of the EC was sent to 100 other randomly selected anaesthetists in each region (group POST). In the latter group, anaesthetists who considered the EC were compared to those who did not.
The participation rate was 91% for the group PRE and 79% for the group POST respectively. Both groups were not significantly different for age, gender, position and seniority. Most used techniques that included blind nasal intubation (84%), intubation through laryngeal mask (82%), and intubation with fibrescope (53%). Demands for additional training were for translaryngeal ventilation (68%), intubation with fibrescope (64%), retrograde intubation (52%), and intubation through a laryngeal mask (46%). The EC was known by 71% of anaesthetists. In this group, the EC improved the assessment rate of the three recommended predictive criteria for DI from 12 to 28% (P < 0.02), but neither the management policy, nor the desiderata for additional training.
Currently, the search of predictive indicators for DI is not systematically applied. The EC has only slightly modified the practice patterns. The need for additional training is important.
Annales Françaises d Anesthésie et de Réanimation 09/1999; 18(7):719-24. · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To construct a scoring system for the prediction of early mortality in cardiac surgical patients in Europe on the basis of objective risk factors.
The EuroSCORE database was divided into developmental and validation subsets. In the former, risk factors deemed to be objective, credible, obtainable and difficult to falsify were weighted on the basis of regression analysis. An additive score of predicted mortality was constructed. Its calibration and discrimination characteristics were assessed in the validation dataset. Thresholds were defined to distinguish low, moderate and high risk groups.
The developmental dataset had 13,302 patients, calibration by Hosmer Lemeshow Chi square was (8) = 8.26 (P < 0.40) and discrimination by area under ROC curve was 0.79. The validation dataset had 1479 patients, calibration Chi square (10) = 7.5, P < 0.68 and the area under the ROC curve was 0.76. The scoring system identified three groups of risk factors with their weights (additive % predicted mortality) in brackets. Patient-related factors were age over 60 (one per 5 years or part thereof), female (1), chronic pulmonary disease (1), extracardiac arteriopathy (2), neurological dysfunction (2), previous cardiac surgery (3), serum creatinine >200 micromol/l (2), active endocarditis (3) and critical preoperative state (3). Cardiac factors were unstable angina on intravenous nitrates (2), reduced left ventricular ejection fraction (30-50%: 1, <30%: 3), recent (<90 days) myocardial infarction (2) and pulmonary systolic pressure >60 mmHg (2). Operation-related factors were emergency (2), other than isolated coronary surgery (2), thoracic aorta surgery (3) and surgery for postinfarct septal rupture (4). The scoring system was then applied to three risk groups. The low risk group (EuroSCORE 1-2) had 4529 patients with 36 deaths (0.8%), 95% confidence limits for observed mortality (0.56-1.10) and for expected mortality (1.27-1.29). The medium risk group (EuroSCORE 3-5) had 5977 patients with 182 deaths (3%), observed mortality (2.62-3.51), predicted (2.90-2.94). The high risk group (EuroSCORE 6 plus) had 4293 patients with 480 deaths (11.2%) observed mortality (10.25-12.16), predicted (10.93-11.54). Overall, there were 698 deaths in 14,799 patients (4.7%), observed mortality (4.37-5.06), predicted (4.72-4.95).
EuroSCORE is a simple, objective and up-to-date system for assessing heart surgery, soundly based on one of the largest, most complete and accurate databases in European cardiac surgical history. We recommend its widespread use.
European Journal of Cardio-Thoracic Surgery 08/1999; 16(1):9-13. · 2.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the costs of headache-related absenteeism of community-dwelling migraineurs, and to compare the amount of absenteeism between migraineurs aged 18 and older and age, sex, and occupation-matched nonheadache-prone subjects.
Follow-up over a 3-month period.
385 migraineurs and 313 nonheadache subjects representative of the setting.
Every day, the participants recorded the presence of headache, if any, and the work situation (unemployment, holiday, weekend, medical reason, nonmedical reason). Sickness-related absenteeism was the number of workdays missed or interrupted for medical reasons. Headache-related absenteeism was the sickness-related absenteeism during workdays with headaches. The annual headache-related absenteeism costs in France were extrapolated from these data in accordance with the mean income per occupational category. The incremental absenteeism and related costs were the difference between the two samples.
Of working migraineurs, 20% had at least one period of absenteeism. During the 3 months, they missed or interrupted on average 1.4 days for medical reasons, 0.25 of which for headaches. Sickness-related absenteeism was statistically higher in migraineurs than in nonheadache-prone subjects. This difference was due to a higher absenteeism for comorbidity reasons, not for headache reasons, representing 20% of all sickness-related absenteeism. Migraineurs avoided sick leave for headache reasons. As an incremental total, 1.68 days or approximately 0.7% of the annual number of working days are lost on average per individual with migraine. The annual incremental headache-related absenteeism cost was 5.22 billions, i.e. 1,551 FF (US$240) per migraineur.
[Show abstract][Hide abstract] ABSTRACT: To assess risk factors for mortality in cardiac surgical adult patients as part of a study to develop a European System for Cardiac Operative Risk Evaluation (EuroSCORE).
From September to November 1995, information on risk factors and mortality was collected for 19030 consecutive adult patients undergoing cardiac surgery under cardiopulmonary bypass in 128 surgical centres in eight European states. Data were collected for 68 preoperative and 29 operative risk factors proven or believed to influence hospital mortality. The relationship between risk factors and outcome was assessed by univariate and logistic regression analysis.
Mean age (+/- standard deviation) was 62.5+/-10.7 (range 17-94 years) and 28% were female. Mean body mass index was 26.3+/-3.9. The incidence of common risk factors was as follows: hypertension 43.6%, diabetes 16.7%, extracardiac arteriopathy 2.9%, chronic renal failure 3.5%, chronic pulmonary disease 3.9%, previous cardiac surgery 7.3% and impaired left ventricular function 31.4%. Isolated coronary surgery accounted for 63.6% of all procedures, and 29.8% of patients had valve operations. Overall hospital mortality was 4.8%. Coronary surgery mortality was 3.4% In the absence of any identifiable risk factors, mortality was 0.4% for coronary surgery, 1% for mitral valve surgery, 1.1% for aortic valve surgery and 0% for atrial septal defect repair. The following risk factors were associated with increased mortality: age (P = 0.001), female gender (P = 0.001), serum creatinine (P = 0.001), extracardiac arteriopathy (P = 0.001), chronic airway disease (P = 0.006), severe neurological dysfunction (P = 0.001), previous cardiac surgery (P = 0.001), recent myocardial infarction (P = 0.001), left ventricular ejection fraction (P = 0.001), chronic congestive cardiac failure (P = 0.001), pulmonary hypertension (P = 0.001), active endocarditis (P = 0.001), unstable angina (P = 0.001), procedure urgency (P = 0.001), critical preoperative condition (P = 0.001) ventricular septal rupture (P = 0.002), noncoronary surgery (P = 0.001), thoracic aortic surgery (P = 0.001).
A number of risk factors contribute to cardiac surgical mortality in Europe. This information can be used to develop a risk stratification system for the prediction of hospital mortality and the assessment of quality of care.
European Journal of Cardio-Thoracic Surgery 07/1999; 15(6):816-22; discussion 822-3. · 2.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Prospective studies of precipitating factors in migraine are rare. Mig Access is a national control-matched survey conducted to evaluate the access of migraineurs to health care in France. This study allowed us to screen prospectively some precipitating factors of headache in migraineurs and in nonmigraineurs. Three hundred eighty-five migraineurs (group 1) and 313 nonmigraineurs (group 2) kept a diary for a 3-month period (a total of 35,805 day in group 1 and 29,109 days in group 2). Precipitating factors were reported for each headache period. Headache intensity was self-assessed during each headache period using a visual analog scale of 0 to 100. Headache was reported on 4274 days (12%) in group 1 and on 602 days (2%) in group 2. Headache intensity was greater in group 1 (39 +/- 20 versus 32 +/- 19, P < .05). The most frequent precipitating factors (reported at least once by more than 10% of subjects [range 18% to 80%] in both groups) were fatigue and/or sleep, stress, food and/or drinks, menstruation, heat/cold/weather, and infections in both groups. All these factors except infections were reported to cause headache more frequently in migraineurs than in nonmigraineurs. Mean intensity of headache related to fatigue and/or sleep, stress, food and/or drinks, hot/cold weather, and menstruation varied from 37 to 43 in migraineurs and from 29 to 35 in nonmigraineurs. Headache with the highest mean intensity was due to infections in the two groups (47 +/- 20 in group 1, 45 +/- 23 in group 2). Our results support that endogenous factors are the most frequent triggers of headache in migraineurs. The most frequent precipitating factors of headache appear identical in migraineurs and in nonmigraineurs. Our results suggest that similar triggers could precipitate headache of different type in these two populations.
Headache The Journal of Head and Face Pain 05/1999; 39(5):335-8. · 3.19 Impact Factor