Bénédicte Melot

Thirteen standardized reasons for e-visits were implemented in March 2024 on a French telemedicine platform to improve the analysis of needs in telemedicine, educate patients on what is possible in e-visit and adapt the offer. Patients could select 1 to 3 reasons for consultations among a list of 13 reasons. Our aim was to evaluate their impact on use of e-visits. The main reasons for consultations in teleconsultations were more linked to acute care, specifically involving a large majority of upper respiratory tract infections, back pain, and urinary tract infections. They were mostly concordant with the physician’s conclusion and they may have simplified the preparation of the e-visits.

Background: Recent regulatory and reimbursement changes facilitated the development of teleconsultation within primary care. French guidance advises against antibiotic prescribing in children in teleconsultation. We assessed paediatric antibiotic prescribing on a French teleconsultation platform. Methods: This cross-sectional observational study analysed paediatric (0–14 years) visits on a national direct-to-consumer teleconsultation platform between January 2018 and December 2021. Teleconsultations with complete information regarding diagnosis (ICD-10 coding) and prescriptions were included. We assessed antibiotic prescription rates per 100 visits across diagnoses and used logistic regression to identify factors associated with antibiotic prescribing. Results: In the 37 587 included paediatric teleconsultations (median age 3 years) performed by 713 general practitioners (GPs) and 89 paediatricians, antibiotics were prescribed for 12.1%. Respiratory tract infections (RTIs) accounted for 49.5% of antibiotic prescriptions. Antibiotic prescription rates per 100 visits were: sinusitis, 69.5%; urinary tract infections, 62.2%; pharyngitis, 59.0%; pneumonia, 45.5%; otitis, 46.6%; bronchitis, 19.6%; rhinitis, 11.6%; bronchiolitis 6.6%. Antibiotic prescription rates were higher in GPs than paediatricians [OR 2.21 (IC95% 2.07–2.35)], among physicians aged 45–54 and over 65 [OR 1.66 (1.48–1.85) and 1.48 (1.32–1.66), respectively], in female practitioners [OR 1.13 (1.05–1.21)], in children 3–6 years old [OR 1.41 (1.28–1.56)] and over 6 [OR 1.50 (1.35–1.66)], during winter [OR 1.28 (1.21–1.37)] and for RTIs [OR 1.99 (1.87–2.10)]. Antibiotic prescription rates were lower in doctors with extensive experience in teleconsultation [OR 0.92 (0.86–0.98)]. Conclusions: Despite current recommendations, paediatric patients were frequently prescribed antibiotics during acute care teleconsultations. Specific antibiotic stewardship campaigns should target paediatric teleconsultations.

The national teleconsultation platform Qare offers a promising tool to collect data in primary care by sharing the same EHR among teleconsultants. Conclusions for every teleconsultation are thus collected by a text using an ICD10 code or not. Nevertheless, the use of the ICD10 classification by primary care doctors is scarce. We developed an algorithm based on bags of words that associates an ICD10 code for each textual conclusion and evaluated it. It shows good performances (88 to 89% concordance) to assign ICD10 category. It could be used to enhance the volume of coded teleconsultations ready to be reused.

Antibiotic overprescribing in dentistry is a major concern that contributes to the emergence of antimicrobial resistance. It is due in part to the misuse of antibiotics by dentists but also by other practitioners who see patients in emergency for dental care. We used the Protégé software to create an ontology regarding the most common dental diseases and the most used antibiotics to treat them. It is an easy shareable knowledge base that could be used directly as decision support tool to improve the use of antibiotics in dental care.

Introduction: Eosinophilic meningitis is a rare form of meningitis with sequelae or death occurring in approximately 2–3% of cases. The most frequent etiological agent is the parasiteAngiostrongylus cantonensis. The aim of this study was to characterize New Caledonian cases and to assess the extent to which ofA.cantonensiswas involved.Material and methods: We performed a retrospective study of all cases of eosinophilic meningitis (EM) admitted to the Territorial Hospital of New Caledonia, from 2004 to 2019. We performed a descriptive and a multivariate analysis to identify association of variables with severe and fatal cases (or cases with sequelae).Conclusion: Angiostrongyliasis was confirmed as being responsible for 17 of the 92 reported EM cases in New Caledonia from 2004 to 2019 with most being young adults and non-walking infants, and with two peaks of incidence one during the dry season and one during the rainy season. Considering the high incidence and regularity of cases, the potential reservoirs should be identified to target prevention campaigns.

Vaccination is among the most important areas of progress in the worldwide history of public health. However, a crescent wave of anti-vaccine groups has grown in Western countries, especially in It...

Three New Cases of Melioidosis, Guadeloupe, French West Indies

Les Antilles-Guyane (AG) sont les départements français du continent américain, situés en zone intertropicale. La diversité des écosystèmes ainsi que le climat tropical à très forte pluviosité exposent à un vaste panel de pathologies infectieuses. Ces territoires sont de plus l’objet de mouvements importants de populations, voyageurs ou migrants, ce qui joue un rôle significatif dans le développement d’épidémies et/ou de pathologies émergentes. Ces pathologies infectieuses dites « tropicales » peuvent nécessiter une prise en charge en réanimation. Nous rapportons ici les principales données récentes concernant ces pathologies (hors infection liée au VIH) ainsi que les stratégies diagnostiques et thérapeutiques, à l’usage des réanimateurs amenés à exercer en zone tropicale AG ou recevant en métropole des patients issus de cette région.

Objective: By the end of 2014, 23% of people living with HIV (PWHIV) who had had a scheduled appointment at our outpatient clinic had not attended. We implemented an SMS reminder service and assessed its impact on medical consultation-attendance rate. Methods: The intervention was directed at all PWHIV with a scheduled appointment between March and April 2015 at our infectious diseases department. Two days before the scheduled visit, an appointment reminder SMS was sent to every other patient at random. On the visit day, a questionnaire was used to determine patient perceptions regarding the SMS. Results: A total of 224 patients (126 males, 98 females, mean age 52 years, 94% taking antiretroviral therapy) were selected to take part in the study. The medical consultation-attendance rate was 76% in the SMS reminder read group (87 patients) and 72% in the SMS reminder not sent or not read group (137 patients, P=0.6). Among the 66 SMS reminder read patients who attended their consultation and answered the questionnaire, 51% reported that the SMS had contributed to their attendance. Conclusion: Sending an SMS reminder had no significant impact on clinic attendance rates. This may have been due in part to the sociocultural characteristics of our patients. Further research should investigate other tools to improve attendance rates.

OBJECTIVES: To develop a diagnostic predictive model for the identification of patients with presumptive pulmonary tuberculosis (PTB) at high risk for active disease and those requiring nucleic acid amplification (NAAT) testing and/or preventive respiratory isolation in low-incidence, high-income countries.DESIGN: A 1:1 case-control study was conducted in consecutive immunocompetent patients with presumed PTB hospitalised between 2009 and 2012 in Paris, France. Cases were defined as individuals with culture-confirmed PTB, regardless of smear result. Those with presumed PTB and three smear- and culture-negative samples were selected as controls. A score was derived using conditional logistic regression. Internal validity of the score was assessed using the bootstrap method.RESULTS: A total of 354 patients were included in the analysis (177 cases, 177 controls). Among the 177 cases, 74 (42%) were smear-negative but culture-positive. Factors independently associated with PTB were age 15 days (aOR 3.5, 95%CI 1.3–9.5), apical infiltration without cavity (aOR 3.4, 95%CI 1.4–8.5) and cavitation or miliary pattern (aOR 19.7, 95%CI 7.6–51.1). Score C-index was 0.84 (95%CI 0.79–0.88). Calibration for the overall population (P = 0.770) and in smear-negative patients (P = 0.980) was appropriate. A score of 3.3 had 90% sensitivity, 50% specificity and 79% (IQR 28–95) median probability of PTB.CONCLUSIONS: This score could be used to build an algorithm to determine the need for respiratory isolation and/or NAAT use in PTB disease.