PubMed Health⌕ Search

Biomedical subjects

F A Allaert

Publications and source records attributed to F A Allaert.

At least 55 records · Page 3Linked to original sources
PubMed1998

How to ensure data security of an epidemiological follow-up: quality assessment of an anonymous record linkage procedure.

A computerised record hash coding and linkage procedure is proposed to allow the chaining of medical information within the framework of epidemiological follow-up. Before their extraction, files are rendered anonymous using a one-way hash coding based on the standard hash algorithm (SHA) function, in order to respect the legislation on data privacy and security. To avoid dictionary attacks. two keys have been added to SHA coding. Once rendered anonymous, the linkage of patient information can be accomplished by means of a statistical model, taking into account several identification variables. Quality assessment of this anonymous record linkage procedure shows a specificity of 100% and a sensitivity of 95%.

Algorithms↗
PubMed1998

Security aspects of medical file regrouping for the epidemiological follow-up.

To carry out epidemiological studies at a regional level, one may need to link information collected by medical doctors working either in hospitals or in private offices or laboratories. The first problem is to respect the European legislation on nominal data processing, which does not allow the linkage of nominal files. As a consequence, we have developed an anonymous record linkage procedure, which ensures an irreversible transformation of identity and allows the linkage of rendered anonymous files. The second problem is to ensure data security during the transmission and we discuss the advantages of different methods of communication such as the norms X400 and Internet protocols.

Computer Communication Networks↗
PubMed1998

Psychosocial and occupational impact of chronic low back pain.

UNLABELLED: The significant psychosocial and occupational impact of low back pain is a risk factor for chronicization but remains difficult to be evaluated. METHODS: A cross-sectional study of acute and chronic low back pain patients managed by 1282 physicians was conducted using an 85-item questionnaire. Most items were composed of multiple or binary clauses. A semi quantitative six-point scale was used to evaluate effects of the pain on family and personal life. A total of 2741 completed questionnaires were sent in. The present study was conducted on the 1072 questionnaires completed for "active" (as opposed to retired) patients with chronic low back pain. Mean age was 44 years. RESULTS AND DISCUSSION: As compared to the general population, there were fewer blue-collar workers, executives, and skilled professionals and more intermediate professions (34% versus 19% according to an INSEE survey, p < 0.001). Twelve per cent of patients were able either to change jobs or to find lighter duties in their current job, but a similar proportion were completely incapacitated or awaiting a job modification. Significant negative effects on everyday life were reported by 80% of patients, on emotional life by 58%, and on sexual activity by 46%. Most patients had reduced their leisure and household activities. Psychological disorders were noted in 75% of patients. On the day of the visit, two-thirds of patients were given a prescription for analgesics, nonsteroidal antiinflammatory drugs, and/or muscle relaxants, whereas only 34% received advice regarding their diet and life style and only 4% were sent to a back school. Despite significant effects on everyday and personal experiences associated with an increased risk of chronicization, treatments given to low back pain patients consist mainly of symptomatic medication.

Adult↗
PubMed1998

Automatic record hash coding and linkage for epidemiological follow-up data confidentiality.

A protocol is proposed to allow linkage of anonymous medical information within the framework of epidemiological follow-up studies. The protocol is composed of two steps; the first concerns the irreversible transformation of identification data, using a one-way hash function which is used after spelling processing. To avoid dictionary attacks, two large random files of keys, called pads, are introduced. The second step consists in the linkage of files rendered anonymous. The weight given to each linkage field is estimated by a mixture model, the likelihood of which being maximized with the Expectation and Maximization (EM) algorithm. The performance of this method has been assessed by comparing record linkage, based on exclusive use of the automatic procedure, with a manual linkage, obtained by the Burgundy Registry of Digestive Cancers. The result of the linkage of a file of 2,847 cancers with a file of 388,614 hospitalization stays in the Dijon university hospital showed a sensitivity of 97% and a specificity of 93%.

Algorithms↗
PubMed1998

[Medico-economic aspects of the management of perennial allergic rhinitis in general medicine].

A cross sectorial epidemiologic study was conducted in daily medical practice on the cost of perannual rhinitis. This study on 2033 patients shows per consultation the following costs. Medical fees: 130 +/- 45 francs, pharmaceutical expenses: 141 +/- 59 francs, biological and imaging: 109 +/- 174 francs. The indirect costs link to the absent days are evaluated at 776 francs. This rhinitis costs 1156 francs or 380 francs according the fact that the patient stops working or not. The extrapolation of these results to the french population shows 3.42 billions francs for the direct costs and 6 billions for the indirect costs. By comparison to this total amount, medical and pharmaceutical expenses represent only 11.7% and 12.7%.

Absenteeism↗
PubMed1997

Basic rules for the security of frozen section diagnosis through image transmission between anatomo-pathologists.

Telemedicine can provide an alternative solution to the lack of medical resources in areas where the population is no longer dense enough to justify the temporary or permanent presence of certain specialists such as anatomo-pathologists. In the long run certain pre-operational frozen section examinations cannot be carried out without putting the quality of healthcare at stake. The telematic transmission of macro and microscopic images of lesions, under the supervision of a surgeon, to an anatomo-pathologist consultant located off premises allows for the maintenance of equitable care of acceptable quality.

Computer Security↗
PubMed1997

FOIN: a nominative information occultation function.

This article is intended to show that a great amount of work has to (and will) be done in terms of security for the healthcare information system community. Some very promising results have already been obtained in France, especially at CNAMTS, for providing the required security and privacy of nominative information in the context of future electronic exchanges between private/public hospital and CNAMTS, the french biggest mandatory healthcare insurance. FOIN, a robust anonymisation function, is just an example of such recent progress that traduces the french national engagement towards more flexible interconnection between various authorised healthcare information systems in close conjunction with more and more reliable and secure procedural and technical requirements. Firstly, the legal and medical needs for so strong anonymisation functions are described; secondly, the most important security requirements of these sensible functions are detailed and, lastly, the main security and implementation features of FOIN are globally indicated.

Algorithms↗
PubMed1997

[Sclerotherapy section of incompetent short saphenous veins: indications, technique, results].

UNLABELLED: Sclerotherapy section of the long consists of a combination of ligations, with section and injection of the proximal and distal segment of the long saphenous vein. This technique is performed under local anesthesia 10 centimeters from the saphenofemoral junction and can be performed as an outpatient procedure. MATERIALS AND METHODS: Inclusion criteria are incompetent long saphenous vein diameter over 9 millimeters in older patients whose Duplex-scan examination eliminated other leaking points such as anterior or posterior tributaries or the junction, reflux coming from superficial iliac circonflex veins or from vulvo-pudendal varicose veins. Our study concerned 75 patients. 78 limbs were operated, 72 were reviewed after 1 year and 65 after 3 years. RESULTS: 66 of the 72 limbs (91.6%) had an incompressibility without flux or reflux at the sapheno-femoral junction level after 1 year and 59 of the 65 limbs (90.8%) after 3 years. Sclerosis with incompressibility without flux or reflux was observed in the lower third of the thigh in 51 of the 72 limbs (70.8%) after 1 year and in 40 of the 65 limbs (61.5%) after 3 years, without any clinically detectable underlying varicose recurrence. DISCUSSION: This technique is ambulatory and economic and ensures control of sapheno-femoral junction reflux. In the majority of reflux cases, the reflux observed in the lower third of the thigh is related to a Hunter perforanting vein that can feed an underlying varicose network. They were treated by ultrasound-guided ossifying injection. CONCLUSION: The indications for this technique are incompetence of the sapheno-femoral junction in older patients with trophic disorders, allowing effective treatment of the source of the reflux with rapid healing of underlying trophic disorders.

Adult↗
PubMed1996

[Computerized medical record: deontology and legislation].

Computerization of medical records is making headway for patients' follow-up, scientific research, and health expenses control, but it must not alter the guarantees provided to the patients by the medical code of ethics and the law of January 6, 1978. This law, modified on July 1, 1994, requires to register all computerized records of personal data and establishes rights to protect privacy against computer misdemeanor. All medical practitioners using computerized medical records must be aware that the infringement of this law may provoke suing in professional, civil or criminal court.

Ethics, Medical↗
PubMed1996

The use of personal health information for controlling the costs of delivering health care: does the end justify the means?

With the increasing costs of medical care many countries are seeking ways of controlling costs. Two approaches are discussed; the accounting control of costs and the medicalised control of costs. The former provides a very blunt and insensitive instrument while the latter can support best practice and reduce unnecessary examinations. However, the medicalised approach requires limited access to the patients' medical files thus breaching the medical secret. The paper discusses the strict controls necessary to make this approach work in an acceptable fashion.

Computer Security↗
PubMed1996

Telepathology diagnosis by means of digital still images: an international validation study.

Telepathology affords the means to provide pathological diagnosis and consultation to remote sites. However, before telepathology can become an acceptable medical tool, it will be vital to determine the diagnostic accuracy of this technology. We report the results of a single-blind study of the accuracy of diagnosis performed using computerized still images obtained from a telepathology workstation used in a French telepathology network. Four pathologists, each working alone, reviewed a total of 200 cases of routine surgical pathology (50 cases each), and performed diagnosis based on both computer CD-ROM still images (CD) and conventional glass slides (GS). Concordance between GS and CD diagnosis, as well as accuracy, were determined. Other factors related to performance were also measured, including diagnostic certainty, reasons for uncertainty, and causes of diagnostic error. Overall, there was good agreement between CS and CD diagnosis. There was 87.5% concordance between CS and CD diagnosis, and comparison to consensus (correct) diagnosis showed accuracy of 95.5% and 88.5% for GS and CD diagnosis, respectively. Marked variability in accuracy of CD diagnosis was observed among the four pathologists, and issues related to image selection and/or quality appeared responsible for 60% of the diagnostic errors. The lack of sufficient images and clinical information were frequently cited as reasons for diagnostic uncertainty, as well as feelings of insufficient expertise. It is likely that the opportunity for interaction with the referring pathologist and the use of subspecialty consultants would likely improve the performance of telepathology.

CD-ROM↗
PubMed1996

An ambulatory treatment of varicose veins associating surgical section and sclerotherapy of large saphenous veins (3S technique). Preliminary study with results at one year.

BACKGROUND: The 3S technique enables treatment of large incontinent greater saphenous veins in patients who, for medical or social reasons, refuse traditional surgical methods. It associates phlebectomy with section-ligation and injection of a sclerosing solution in the proximal and distal segments. The 3S technique is merely one stage in the treatment of the saphenous vein, aimed at suppressing reflux, and associated with sclerosis of the junction. It must always be combined with later sclerotherapy sessions. METHODS: One hundred and eight patients were operated on by the 3S technique, of which 100 had 1-year follow-up. Each patient was checked by duplex scan examination before treatment, and 1 month and 1 year after. RESULTS: We obtained good results without reflux in 96% at the sapheno-femoral junction at 1 year. CONCLUSIONS: Superficial venous insufficiency is a chronic disease with evolution or recurrences. To appreciate the efficiency of 3S technique, it will be better to have 5 years worth of follow-up. This is a preliminary study with a short follow-up.

Aged↗
PubMed1996

Evaluation of an international telepathology system between Boston (USA) and Dijon: glass slides versus telediagnostic television monitor.

A telepathology network developed by Resintel (Dijon) has proved valuable in interactive situations, where two physicians converse by telephone, showing each other the part of the lesion they wish to discuss. In future this interactive process could be replaced by an electronic mailing service in which a limited number of images are taken from the slide, but this technique needs to be assessed in comparison with traditional microscopic diagnosis, when the pathologist can screen the entire slide. The present study compared diagnoses achieved through the traditional methods of current pathology practice with diagnoses achieved through a selection of images on a telediagnostic TV monitor. The kappa coefficient between the two protocols was 0.26 (SE = 0.06), which allows us to conclude that there is a fair reliability between video and glass slide diagnoses.

Boston↗
PubMed1996

[Course of ischemic risk in treated atheromatous hypertensive patients. The PRIHAM study (Prognosis of Ischemic Risk in Atheromatous Patients under Mediatensyl)].

Hypertension is one of the major cardiovascular risk factors. However it seldom occurs alone in a patient and the antihypertensive treatment should be taken into account when assessing global cardiovascular status. The PRIHAM study was an open study which enrolled 3,216 hypertensive atheromatous patients who already has had a clinical ischaemic accident. Patients were followed-up for 3 years. The lowering effect on cardiovascular risk, starting from the fifteenth month was confirmed to the end of 36-month study. The effect on blood pressure was observed from the third month. Stabilized blood pressure observed within the first year persisted throughout the three years without tachyphylaxis. It was effective on SBP (-14.4%) and on DBP (-15%) while maintaining a stable heart rate both in the supine position or immediately upon standing or after 3 minutes in the standing position. Tolerance was globally judged as good or very good by the investigating practitioners and the patients expressed an improvement in their feeling of well-being. In conclusion, from the level of effectiveness obtained and the low incidence of adverse effects, urapidil appears well adapted and easy to manage in a population with a particularly high cardiovascular risk.

Adult↗
PubMed1995

A survey of pressure sore prevalence in hospitals in the greater Paris region.

In 1993 a preliminary survey was conducted in the Hospital of Gonesse to examine pressure sore prevalence. The averages obtained showed that 5.4% of patients in hospital suffer from pressure sores. This prompted a further investigation involving 12,050 patients: 5.2% were found to have pressure sores. Patients with pressure sores were significantly older (76.4 +/- 14 years) than the average age of patients in the study, and 42% of pressure sores were found in patients with neurological pathology. The majority of patients (57%) had a single pressure sore. Most were grade I lesions (38%). The greatest number of pressure sores were found on the medium and long-stay wards. A nationwide complementary survey is now being undertaken to confirm these overall results.

Aged↗
PubMed1995

[Telemedicine and medical responsibility].

Dealing with telemedicine including telediagnosis and teleassistance, we have to assess the legal and ethical components of medical liability. With medical telediagnosis, the dispersion of medical liabilities is the main risk: how can we ensure a clear identification of the medical liabilities involved in case of damage? From a legal point of view, the dispersion of the liabilities is not authorized and the use of telediagnosis must ensure a total transparence. As we cannot presently establish a separate amount for a medical act based on the cost of the image records and the cost of image interpretation, it is necessary to establish a contract. Today the most convenient is a contract similar to the usual contract between laboratories which implies that the liability belongs to the practitioner who has received the sample. In the future, other legal obligations may appear when telediagnosis develops. Indeed, the increase in reliability due to telediagnosis could be normally required as a part of the medical obligation to use the latest technology. On the opposite, the excessive use of teleassistance, when there is neither emergency nor medical isolation, is dangerous because it affects the integrity and the quality of the medical act. A medical practice without any clinical examination of the patient is contrary to medical ethics.

Computer Communication Networks↗
PubMed1995

Evaluation of a telepathology system between Boston (USA) and Dijon (France): glass slides versus telediagnostic TV-monitor.

The objective of this work was to compare diagnoses achieved through the traditional methods of current pathology practice versus diagnoses achieved through a selection of image on a telediagnostic TV-monitor. The Kappa coefficient between the two protocols of k = 0.26 SE(k) = 0.06 z = k/SE(k) = 4.3 (p < 0.001) allows us to conclude that there is a good reliability between video and glass slide diagnoses.

Boston↗