Biomedical subjects

F Kohler

Publications and source records attributed to F Kohler.

At least 19 recordsLinked to original sources

PubMed2005

[Requests for access to medical files at the Nancy University Hospital Center].

OBJECTIVE: Law 2002-303 of March 04, 2002, authorizes patients to have direct access to their medical record, without requiring a physician to serve as interme-diary. The aim of this study was to characterize these requests for a 23-month period. METHOD: A database was created to record information about these requests. The descriptive and quantitative analysis here covers 23 months. RESULTS: There were 942 requests in all, 64.5% by patients themselves and 18.5% by their heirs or assignees. The mean age of the patients seeking access to their medical file was 53 years, with a slight majority of men. Heirs and assignees av-eraged 49 years of age and were generally women. Thirty percent of them reported wanting some additional information, while 51% requested a copy of the entire file. Only 5.8% asked for a physician to help them understand the file, although that was systematically offered. CONCLUSION: Patients' new legal rights to direct access to their medical files imply that physicians will modify the way they maintain these files.

Adolescent↗

PubMed2002

Patient's permanent identification and PMSI chaining system. Complementary or competing methods?

In order to "chain" all the information concerning their patients' files, hospitals have set up their own identification system. This system is not easy to manage and can encounter several difficulties. When entering the hospital, each patient is given an identification number resulting mainly from his ID card, his Health Care card data and other data... The clerk who registers a patient seeks for possible prior hospital stays of this patient: should the patient be unknown, a new record of identification will be created; but should this patient be already registered, the clerk will link the patient's new hospital stay to the already existing file and update the permanent patient's identification data if necessary. In spite of all the care taken to carry out this process, some errors may occur: creation of "doubles", which means creating a new patient's file for an already existing patient, or conversely wrong chaining for an already existing patient. In order to track down these kinds of errors hospitals have set up a quality system. Moreover, since January 2001, in the frame of the Prospective Payment System (in French PMSI), a hospital stay chaining system based on a calculated key (H coding) has been designed. If the use of this key is meant to provide statistics concerning patients' cares and not patients' stays it may also become part of the quality policy of an establishment concerning patients' permanent identification data. Considering the 61 486 hospital stays at the C.H.U of Nancy for the first six months in 2001, it has been possible to compare the results in term of a patient population calculated from the permanent identification system of the hospital with the results obtained by the PMSI chaining system. No important differences have been detected and the results are very close. Besides, in order to track down possible doubles in the C.H.U patient identification system, chaining differences have been analysed. For the 22 detected cases, no identification management anomalies can be found; the doubles are the result of the calculating system of the chaining key used by the PMSI. A single interesting case can be mentioned: it concerns an anonymous registration stay; despite a previous stay in the hospital, the patient was given another identification number to ensure her complete confidentiality.

France↗

PubMed2001

Cross-linked poly(vinyl alcohol) as permanent hydrophilic column coating for capillary electrophoresis.

A fast method for the generation of permanent hydrophilic capillary coatings for capillary electrophoresis (CE) is presented. Such interior coating is effected by treating the surface to be coated with a solution of glutaraldehyde as cross-linking agent followed by a solution of poly(vinyl alcohol) (PVA), which results in an immobilization of the polymer on the capillary surface. Applied for capillary zone electrophoresis (CZE) such capillaries coated with cross-linked PVA exhibit excellent separation performance of adsorptive analytes like basic proteins due to the reduction of analyte-wall interactions. The long-term stability of cross-linked PVA coatings could be proved in very long series of CZE separations. More than 1000 repetitive CE separations of basic proteins were performed with stable absolute migration times relative standard deviation (RSD > 1.2%) and without loss of separation efficiency. Cross-linked PVA coatings exhibit a suppressed electroosmotic flow and excellent stability over a wide pH range.

Chymotrypsinogen↗

PubMed2001

Characterization of heart atrial fibrillation: proposal for a deterministic model.

Atrial Fibrillation (AFib) has been shown (e.g. Framingham Study) to increase stroke risk and to induce low cardiac output in patients. It is generally accepted that the mechanism of Atrial Fibrillation is reentry. In order to ease the study of AFib's, we propose a deterministic model that could be used in the characterization cardiac signals. The model is based on a linear combination of several "Atrial Flutter"-like signals. We therefore obtained AFib-like aspects. To demonstrate its usefulness we performed a power spectrum transform (i.e. scalar Fast Fourier Transform) of this model. As a result we found that this transform could not be used as is, could lead to errors in the interpretation of results. We expect that this model will help us to evaluate the relevance of mathematical transforms. This may lead to new findings in the classification of AFib, as well as to improvements in patients treatment, follow-up and survival.

Atrial Fibrillation↗

PubMed2001

Method to determine the bed capacity, different approaches used for the establishment planning project in the University Hospital of Nancy.

In France hospital bed capacity is determined according to a national and regional authorization which has been established by the regional hospital agency. The bed capacity evolution in a hospital is fixed by considering the different proposals of the hospital in negotiation with the regional hospital agency. Types of beds are differentiated according to the patients' needs : medicine, surgery and obstetrics. The first approach is taken at the national level and then at the regional level using a specific ratio of beds for 100,000 inhabitants in each category. For a given hospital, the authorized number of beds takes into consideration their occupation. Target bed occupation ratios were fixed in 1992 and are still in use. In the establishment project of the University Hospital of Nancy (developed over a five year period) four approaches have been formulated and their results have been compared. In this study, the two traditional methods of bed ratio per 100,000 inhabitants and target bed occupation have been updated according to the present conditions of hospitalisation; the third method is based on the reapportionment of the present patients and the possible risk to the hospital for refusing patients. The last method consists of determining the expected pathologies five years in advance in Lorraine and the beds needed to treat them. These four methods have given consistent results under the accepted revised target occupation bed ratios in accordance with the reduction of the length of stay between 1992 and 1999.

France↗

PubMed2000

Atrial heart fibrillation modeling: a tool for adequate choice of signal processing functions.

Framingham Study showed that Atrial Fibrillation (AF) exposes the patient to an increased stroke risk and to low cardiac output. It is well known that the mechanism of Atrial Fibrillation is reentry. In order to facilitate AF's studies, we propose a deterministic model that can be used for cardiac signal characterization. The model is based on a linear combination of several "Atrial Flutter-like signals. We obtained AF-close aspects. To demonstrate its usefulness we performed a power spectrum transform (i.e. scalar Fast Fourier Transform) of this model. Thanks to the model we show that this transform cannot be used as is, and may induce errors in results interpretation. We also show based on the same example how to overcome the limitation with help of the model. We expect that this model will help in mathematical transforms relevance evaluation. This may lead to new findings in AF classification, and to improvement in patients' treatment, follow-up and survival.

Atrial Fibrillation↗

PubMed2000

The French Virtual Medical University.

This paper is the description of a French Virtual Medical University based on the federation of existing or currently being developed resources in several Medical Schools in France. The objectives of the project is not only to share experiences across the country but also to integrate several resources using the New Information and Communication Technologies to support new pedagogical approaches for medical students and also for continuing medical education. The project includes: A virtual Medical Campus using secure access from several sites, The Integration of new interactive resources based on pedagogical methods, Implementation of new indexing and search engines based on medical vocabularies and ontologies, The definition of general and specific portals, the evaluation of the system for ergonomics and contents.

Computer-Assisted Instruction↗

PubMed1999

Postural control of ballet dancers: a specific use of visual input for artistic purposes.

Dance is a specific expression of human motor behaviour. This artistic physical activity depends upon an effective technical training with important postural components and necessitates the codification of sensory inputs to build mental representations of the action to be produced. Proprioception and vision being two fundamental sensory modalities in classical ballet, this study attempted to determine the importance of the visual input for postural control during the practice of this activity. First, this work compared the performances of 18 professional ballet dancers and 46 non-dancers on a platform of forces during static posturographic tests in open or closed eyes situation. Then, we studied how professional dancers achieve balance in postures specific of classical ballet: on demi-pointe and on pointe. The results indicate that visual inputs are important in classical ballet since dancers only performed better than controls in eyes open conditions. The similar results obtained on pointe with eyes open or closed conversely suggest that training in classical ballet develops specific modalities of balance which are not transferable to posture control in daily life situations.

Adolescent↗

PubMed1999

Paediatric case-mix of the Lorraine regional database in 1994 and 1995.

In the region, there is a need to predict the necessary number of paediatric beds. Paediatric discharge data from the 1994-95 Lorraine regional database of Anonymous Discharge Summaries (ADS) are used for this study. We analyse the concentration and specialisation of the hospital activity types and we estimate the numbers of paediatric beds needed for the year 2,000. For the same percentage of the case-mix by hospital group, concentration of the activity is more important in the small District General Hospital (DGH) than in the Teaching Hospital (TH). In the most important Medical Diagnosis Categories (MDC), the case-mix variation by age class can't be characterised inside of the MDC group. The different methods we use to estimate the need of paediatric beds, give similar estimations for the year 2,000.

Adolescent↗

PubMed1998

Peer-mediated social intervention for young children with autism.

In this paper, we trace the history of peer-mediated intervention for young children with autism. Special attention is paid to outcomes achieved, implementation strategies, practicality, combining peer-mediation and naturalistic teaching, and overall conclusions from 20 years of study.

Autistic Disorder↗

PubMed1998

Integration of the analytical and alphabetical ICD10 in a coding help system. Proposal of a theoretical model for the ICD representation.

UNLABELLED: In French hospitals, medical diagnosis coding with the ICD10 is commonly performed and the use of effective tools would help coders in their task. AIM OF THIS WORK: To ameliorate an existing coding help system. This system, which already consists of the ICD10 analytical index, would be increased with the terms of the alphabetical index that includes lexical variants and additional terms as well. The addition of the second volume of the ICD would allow the coding of more terms and would lessen documentary silence. METHODS: The first step of this work was a careful study of a theoretical model of the ICD content. Then the alphabetical index file was submitted to a lexical analysis, and it was automatically transformed to be integrated into the existing coding help system. RESULTS: Compromise had to be made between a theoretical model and between what could be obtained in practice by an automatic processing of the file. Finally the alphabetical index was added to the initial thesaurus, which represents 42,000 terms and 4,000 additional words. Links between words and codes were also considerably increased, which has enhanced the searching possibilities of the tool and lessen documentary silence. Conversely the research time has been increased. CONCLUSION: Difficulties have to be encountered when trying to turn a manual tool into an automatic research tool.

Abstracting and Indexing↗

PubMed1998

Differences of case-mix according to the type of hospital: methodological aspects and results.

This study has brought to the fore variations of case-mix according to the type of French hospitals taken into consideration. The GHM line-up in the French classification of the hospital stays (French DRG) have also been studied and variations linked to the type of hospitals have been noticed too. This survey has been carried out thanks to the anonymous discharge summary issued by the national and the regional databases.

Diagnosis-Related Groups↗

PubMed1998

Evaluating a computerized tool for coding patient information.

OBJECTIVE: Computerized tools may be useful in speeding up and facilitating the laborious task of coding patient information. This paper describes a method of objectively evaluating their efficiency. DESIGN: 38 study subjects were randomly assigned to a manual coding group or an automated coding group, with stratification according to two variables (used to coding yes/no, physician yes/no). Subjects then coded the same standardized set of diagnoses in a limited time. The numbers of exact codes retrieved were compared using a global analysis of variance model. RESULTS: The two groups were not significantly different with regard to the number of physicians (p = 0.74) and the number of usual coders (p = 0.52) they included. Significantly more exact codes were achieved in the group using automated coding than among the manual group (p = 0.04). Physicians were significantly more efficient at coding than non-physicians (p = 0.02). CONCLUSION: This study describes an objective means of evaluating the performance of an automated coding tool. It shows that better results were achieved with the computerised compared to the manual method, even when the superior abilities of physicians were taken into account.

Disease↗

PubMed1997

Case mix of elderly in-patients in the 29 hospitals in Lorraine in 1994 and 1995.

The creation of regional standardized medical information databases in relation with the French anonymous discharge dataset allows the study of the geriatric case mix processed in the Lorraine region for patients over 69. The age histogram (69 to 107 years) presents a two mode distribution with an important dip centered on 79 years probably in connection with the demography of Lorraine and the consequences of the First World War. These geriatric patients represent 17% of hospitalisations in public and private hospitals participating in the public sector. The case mix is related to the size of the hospital and to its juridical status. The bigger the size of an hospital, the less its activity is concentrated on a small number of disorders. Lung and heart diseases represent the first cause of hospitalisation in all hospitals. It is necessary to underline the limitation of an approach which uses the patients' individual hospitalisations, and which does not allow different stays of a given patient on the same hospital or between different hospitals to be linked. This approach prevents from appreciating the care network for this elderly population suffering from chronic diseases.

Aged↗

PubMed1996

Methodology for using the UMLS as a background knowledge for the description of surgical procedures.

The Unified Medical Language System (UMLS) contains and organizes a large number of terms from a variety of biomedical terminology systems. This study examines the relevance of the UMLS content and structures to the specific purpose of the conceptual representation of medical procedures. The MAOUSSC modelling is a compositional formalism with a description of elementary procedures in terms of elementary concept entities and combinations of such descriptions into more complex ones. The UMLS knowledge base is expected to provide semantically categorized medical concepts and interconcept relations. A method to reuse the UMLS has been developed. Quantitative and qualitative results are presented. Some difficulties in reusing the UMLS as a background knowledge are related to the preeminence of some terminology sources and to the instanciation of interconcept links. Other ones suggest that purpose-independence in categorization cannot be achieved.

Artificial Intelligence↗

PubMed1995

Knowledge acquisition from the UMLS sources: application to the description of surgical procedures.

The re-usability of lexicons and knowledge in medicine is a crucial challenge. The Unified Medical Language System (UMLS) project has attempted to provide a repository of concepts, semantically categorized for biomedical domain. This paper describes some results about the relevance of UMLS structures for specific purposes. We have focused on the description of surgical procedures. Discussion concerns synonymy of terms, granularity of concepts, and ontology. A preliminary work on the exploitation of interconcept links by a computerized application reveals a heterogeneous implementation of those relationships. However, the UMLS provides a powerful knowledge base for developers.

General Surgery↗

PubMed1994

Factors associated with low cognitive performance in general practice.

In the preparatory phase of a randomised controlled trial data were collected to assess the magnitude of changes on cognitive functions in 1628 volunteers (age range 45-75 years) that were recruited from general practitioners' patient population. Subjects were administered a short neuropsychological battery of tests including three paper-and-pencil tests, which assessed immediate recall, delayed memory, and attention. Being on antihypertensive medication was associated with low results for all three tests in every age group, and in all strata according to blood pressure levels. Psychotropic drug use was correlated with low results for all three tests. Differences between psychotropic drug users and nonusers increased with age. Antihypertensive treatment and psychotropic drug use seem to be important to consider in longitudinal studies of cognitive decline in aging.

Aged↗

PubMed1994

Designing a sub-set of the UMLS knowledge base applied to a clinical domain: methods and evaluation.

The UMLS is a complex collection of interconnected biomedical concepts derived from standard nomenclatures. Designing a specific subset of the UMLS knowledge base relevant to a medical domain is a prerequisite for the development of specialized applications based on UMLS. We have developed a method based on the selection of the appropriate terms in original nomenclatures and the capture of a set of UMLS terms that are linked to them in the network to a certain degree. We have experimented it as the foundation for a concept base applied to urology. Results depend on the exhaustiveness of the relationships between the Metal concepts. A preliminary analysis of the sub-base reveals that some adaptations of vocabulary and ontology are required for clinical applications.

Algorithms↗