PubMed Health⌕ Search

Biomedical subjects

Frédéric Borie

Publications and source records attributed to Frédéric Borie.

8 recordsLinked to original sources
PubMed2005

How to teach evidence-based surgery.

The objectives of teaching evidence-based surgery (EBS) are to inform and convince that EBS is a method of interrogation, reasoning, appraisal, and application of information to guide physicians in their decisions to best treat their patients. Asking the right, answerable questions, translating them into effective searches for the best evidence, critically appraising evidence for its validity and importance, and then integrating EBS with their patients' values and preferences are daily chores for all surgeons. Teaching and learning EBS should be patient-centered, learner-centered, and active and interactive. The teacher should be a model for students to become an expert clinician who is able to match and take advantage of the clinical setting and circumstances to ask and to answer appropriate questions. The process is multistaged. Teaching EBS in small groups is ideal. However, it is time-consuming for the faculty and must be clearly and formally structured. As well, evidence-based medicine (EBM) courses must cater to local institutional needs, must receive broad support from the instructors and the providers of information (librarians and computer science faculty), use proven methodologies, and avoid scheduling conflicts. In agreement with others, we believe that the ideal moment to introduce the concepts of EBM into the curriculum of the medical student is early, during the first years of medical school. Afterward, it should be continued every year. When this is not the case, as in many countries, it becomes the province of the surgeon in teaching hospitals, whether they are at the university, are university-affiliated, or not, to fulfill this role.

Decision Making↗
PubMed2005

Patient's preference and randomization: new paradigm of evidence-based clinical research.

The limitations associated with the traditional randomized controlled design as applied to clinical surgical research must be recognized. The aim of randomization is to ensure initial comparability between groups of eligible patients for whom treatments are compared, thus eliminating their individual influence on outcome. Randomized controlled trials in the surgical literature are sparse; patient preferences might be a major obstacle to their performance. External validity of results of clinical trials depends on the representativity of patients who participate in trials: Compliance to participate through informed consent may act as a selection bias. In surgical randomized trials where it is not often possible for patients to remain blinded to the treatment to which they have been allocated, patient preferences can influence the effectiveness of treatments. In this setting, we need to look at alternatives and the potential advantages of adopting more flexible and clinically relevant approaches to the design of surgical trials. We have to accept the weight of the patient's individual decision in everyday practice. Hence, to negate the importance of these individual choices when evaluating surgical outcomes is unrealistic. An original design reported herein might become a new paradigm for surgical evaluation.

Ethics, Clinical↗
PubMed2004

Prognostic factors for early gastric cancer in France: Cox regression analysis of 332 cases.

Early gastric cancer (EGC) is defined as a lesion in which the depth of invasion is limited to the mucosa, submucosa, or both regardless of lymph node status; moreover, it has an excellent prognosis, with a 5-year survival rate of more than 90%. We aimed to determine the prognostic factors for EGC in a large Western series. Over a 10-year period from January 1979 to December 1988 a series of 332 patients (mean age 64 years) with EGC were operated on in 23 centers (two French Associations for Surgical Research). The clinicopathologic data retrospectively and screened it for prognostic effect. The mean follow-up for the 332 EGC patients was 80 months. Postoperative mortality was 4% among 243 partial and 89 total gastric resections. The overall 5- and 7-year survival rates were 82% and 72%, respectively. The cumulative 5- and 7-year survival rates (mean follow-up 80 months) were 92.0% and 87.5%, respectively, excluding both operative and unrelated mortality. There was no significant difference in survival between partial and total gastric resection for lesions located in the lower third of the stomach ( p > 0.6). When survival data (excluding postoperative deaths) were analyzed using univariate analysis and Cox's proportional hazards model, lymphatic involvement ( p = 0.01), the site of the tumor in the upper two-thirds of the stomach ( p = 0.02), and submucosal lesions ( p = 0.049) showed a significant effect on predicting a poor prognosis. These results suggest that because of its prognostic value lymphadenectomy should be performed in addition to gastric resection for adequate classification of EGCs. Follow-up might be required only for patients with at least one poor prognostic factor.

Adenocarcinoma↗
PubMed2004

Cost-effectiveness of two follow-up strategies for curative resection of colorectal cancer: comparative study using a Markov model.

The follow-up of patients with curative resection of colorectal cancer is still controversial. The means mobilized for postoperative monitoring come at a high cost. However, the modalities are neither formalized nor validated with regard to an improved 5-year survival rate. To compare the cost-effectiveness of both strategies for patient follow-up during the 7 years following curative resection of colorectal cancer, we performed a costeffectiveness analysis adjusted for quality of life. Using data from the literature and a population study, a simulation of follow-up on patients who had undergone curative resection of colorectal cancer was carried out over a 7-year period using a Markov model. Two Markov processes were modeled to compare the cost-effectiveness ratio adjusted for quality of life in patients with a follow-up in accordance with the recommendations of the 1998 French Consensus Conference (standard follow-up) with the carcinoembryonic antigen (CEA) assay and a simplified follow-up. The influence of standard follow-up on the quality-adjusted life expectancy of patients who had Duke's stage A and B colorectal cancer appears to be modest, with increases of 2.5 months and 1.3 months, respectively; it is more acceptable for patients who had had Duke's stage C, with an increase of 11 months. The high variability of cost-effectiveness ratios (> 7 years) of +/- 44,830 and 180,195 Euro per quality-adjusted life-years (QALY), respectively) did not favor the standard follow-up. The cost-effectiveness ratio (> 7 years) of patients having had Duke's stage C colorectal cancer was 1,058 (sd: 2746) Euro per QALY and could favor the standard follow-up. This study showed that standard follow-up with CEA assay tended to preferentially improve the survival of Duke's stage C patients. The type of examination needed and the frequency with which it has to be carried out should take account of the stage, treatment for the initial illness, and the patient's age.

Aged↗
PubMed2002

Influence of environment and healthcare structures on the survival of patients with colorectal cancer: a French population-based study.

BACKGROUND AND OBJECTIVES: Colorectal cancer is one of the highest-ranking cancers in France, both sexes combined, with 33000 new cases per year. To report on the practice and the efficiency of the healthcare system, an evaluation of the therapeutic management of colorectal cancer was carried out in the department of the Herault, in the south of France. METHODS: Cases of colorectal cancer in 1992 (344 colorectal cancer incidental cases) in the department of the Herault were reviewed. The diversity of the therapeutic choices and survival were evaluated for the different types of healthcare facilities (private hospitals, nonspecialized and specialized hospitals) and residential areas (rural, semi-urban, urban). RESULTS: Two hundred seventy-one patients with colorectal cancer (78.8%) and 234 patients with colorectal cancer (67.7%) were respectively diagnosed and treated in the private sector. Sixteen cases (23.5%) in the public sector (29.7% in the university hospital) and 24 cases (19%) in the private sector involved surgical emergencies (peritonitis, intestinal obstructions) (P = 0.003). Radiotherapy was performed in 59% of patients with rectal cancer. Preoperative radiotherapy was used primarily in specialized hospitals (80% of radiated rectal cancer; P = 0.002), as opposed to postoperative radiotherapy, which was used predominantly in private hospitals (P = 0.005). Forty-five percent of the patients with colorectal cancer who had lymph node involvement have been treated with chemotherapy. In multivariate analysis, lymph node metastasis and the presence of metastases (Dukes stage) were the most important independent pejorative prognostic factors, followed by the initial treatment in nonspecialized hospitals, complicated colorectal cancer (intestinal obstruction, peritonitis), lack of histological differentiation, and rural and urban residential areas. CONCLUSIONS: Apart from independent prognostic factors, such as parietal, ganglionic, or metastatic extensions, the lack of histological differentiation, and the complicated forms, heterogeneity and inequality persist in the distribution, treatment for, and the survival of patients with colorectal cancer based on the type of healthcare facility and the living area of this French population.

Adult↗
PubMedDate not supplied

Cost and effectiveness of follow-up examinations in patients with colorectal cancer resected for cure in a French population-based study.

The cost of follow-up examinations for patients having undergone potentially curative surgery for colorectal cancer is considerable. The aim of this study was to provide a thorough assessment of the cost and effectiveness of the follow-up tests used during the 5 years after surgical resection for colorectal cancer and its recurrences. We studied medical and economic data from the records of 256 patients registered in the Herault Tumor Registry who underwent potentially curative surgical resection in 1992. Recurrence, curative recurrence, survival, and the cost of follow-up tests were assessed respectively for at least 5 years. We analyzed the cost and effectiveness of follow-up tests in patients who received either follow-up with carcinoembryonic antigen (CEA) monitoring as advocated by the 1998 French consensus conference recommendations (standard follow-up) or a more minimal follow-up schedule. Nine patients died in the postoperative period. The 5-year survival rates in the standard and minimal follow-up groups were 85% and 79%, respectively (p=0.25). Cost-effectiveness ratios were 2123 in Dukes' stage A patients, 4306 in Dukes' stage B patients, and 9600 in Dukes' stage C patients. Cost-effectiveness ratios for CEA monitoring and abdominal ultrasonography per patient alive in the standard follow-up group were 1238 and 2261.5, respectively. Cost-effectiveness ratios for CEA monitoring and abdominal ultrasonography per patient alive in the minimal follow-up group were 1478 and 573, respectively. There were no survivors 5 years after a recurrence when the recurrence was detected by physical examination, chest X-ray, and colonoscopy in either follow-up group. Dukes' classification is a poor indicator of patient selection. The follow-up tests should only include CEA monitoring and abdominal ultrasonography for the diagnosis of recurrence.

Adult↗