Biomedical subjects

M Fieschi

Publications and source records attributed to M Fieschi.

At least 19 recordsLinked to original sources

PubMed2005

[Regression models for crude and relative survival: a comparative review].

BACKGROUND: Statistical analysis of lifetime data is frequently used in the biomedical area. Our objective was to present a comparative review of the different regression models according to the survival concept (crude survival or relative survival) in order to express guidelines. METHODS: From a methodological point of view, we compared a regressive crude survival model (Cox model) and regressive relative survival models for grouped data (Hakulinen and Tenkanen) and for individuals data (Esteve et al.). We illustrated our work with an analysis of survival data of 3,355 incident cases of breast cancer identified by a hospital registry. Comportment of the models was studied in situation where censors rates ranged from 31.7 to 96.5%. RESULTS: Because relative survival analysis takes into account natural mortality, the risk of death was smaller for women older than 50 years than for women aged from 35 to 49; this was not demonstrated in the crude survival analysis (Cox). Estimations obtained from Cox model were more accurate than those obtained from both studied regressive relative survival models. Estimations obtained from Esteve et al. model were not very different from those obtained from Hakulinen and Tenkanen model and they were more accurate. CONCLUSION: By definition, analysis of relative survival is more appropriate to estimate survival to a specific cause of death. It is preferable to use models based on individual estimation when data set is small or when the number of individual per strata is small.

Adult↗

PubMed2003

Medical decision support systems: old dilemmas and new paradigms?

OBJECTIVES: The purpose of this paper is to examine past and present medical decision support systems and the environment in which they operate and to propose specific research tracks that improve integration and adoption of these systems in today's health care systems. METHODS: In preamble, we examine the objectives, decision models, and performances of past decision support systems. RESULTS: Medical decision support tools were essentially formulated from a technical capability perspective and this view has met limited adoption and slowed down new development as well as integration of these important systems into patient management work flows and clinical information systems. The science base of these systems needs to include evidence-based medicine and clinical practice guidelines and the paradigms need to be extended to include a collaborative provider model, the users and the organization perspectives. The availability of patient record and medical terminology standards is essential to the dissemination of decision support systems and so is their integration into the care process. CONCLUSION: To build new decision support systems based on practice guidelines and taking into account users preferences, we do not so much advocate new technological solutions but rather suggest that technology is not enough to ensure successful adoption by the users, the integration into practice workflow, and consequently, the realisation of improved health care outcomes.

Cooperative Behavior↗

PubMed2002

A preliminary study to assess a French code of ethics for health teaching resources on the Internet.

BACKGROUND: Constant assessment of the quality of health information on the Internet is an absolute necessity as peer review is often lacking in this media. OBJECTIVE: To develop a simple and easy French Code of Ethics, which will enable medical students to judge quality of health information in teaching material available on the Internet. DESIGN: Three medical informaticians selected ten criteria from previously established codes of ethics from Europe and the USA. This instrument was tested on a sample of 30 health Internet teaching resources. RESULTS: For the panel of experts, chance corrected inter-observer agreement (kappa) for quality rating ranged from k = -0.19 and k = 0.33, demonstrating poor agreement among the raters. CONCLUSION: If negative results of this preliminary study are confirmed by further research, this finding may detrimentally affect projects in Europe to accredit or certify Internet health resources.

Codes of Ethics↗

PubMed2001

Modelling health care processes for eliciting user requirements: a way to link a quality paradigm and clinical information system design.

Healthcare institutions are looking at ways to increase their efficiency by reducing costs while providing care services with a high level of safety. Thus, hospital information systems have to support quality improvement objectives. The elicitation of the requirements has to meet users' needs in relation to both the quality (efficacy, safety) and the monitoring of all health care activities (traceability). Information analysts need methods to conceptualise clinical information systems that provide actors with individual benefits and guide behavioural changes. A methodology is proposed to elicit and structure users' requirements using a process-oriented analysis, and it is applied to the blood transfusion process. An object-oriented data model of a process has been defined in order to organise the data dictionary. Although some aspects of activity, such as 'where', 'what else', and 'why' are poorly represented by the data model alone, this method of requirement elicitation fits the dynamic of data input for the process to be traced. A hierarchical representation of hospital activities has to be found for the processes to be interrelated, and for their characteristics to be shared, in order to avoid data redundancy and to fit the gathering of data with the provision of care.

Cost Control↗

PubMed2001

Issues in the design of medical ontologies used for knowledge sharing.

Recent work in Medical Informatics is exploring the development and the use of formal ontologies as a way of specifying content-specific agreements for the sharing and reuse of knowledge among several computer systems. We describe the role of ontologies in supporting knowledge sharing activities in medicine Principles for the design of ontologies have been proposed, mainly in other domains: these principles include parsimony, clarity, representation of categories versus terms, and coherence. We analyze how and why these principles can or cannot be applied from case studies from medical systems. Regarding the fact that most of medical concepts are empirical, selected design decisions are discussed. An alternative representation choice consists in mapping principled general core ontologies and domain ontologies.

Computer Systems↗

PubMed2001

Elaboration and formalization of current scientific knowledge of risks and preventive measures illustrated by colorectal cancer.

OBJECTIVES: Present the method used to elaborate and formalize current scientific knowledge to provide physicians with tools available on the Internet, that enable them to evaluate individual patient risk, give personalized preventive recommendations or early screening measures. METHODS: The approach suggested in this article is in line with medical procedures based on levels of evidence (Evidence-based Medicine). A cyclical process for developing recommendations allows us to quickly incorporate current scientific information. At each phase, the analysis is reevaluated by experts in the field collaborating on the project. The information is formalized through the use of levels of evidence and grades of recommendations. GLIF model is used to implement recommendations for clinical practice guidelines. RESULTS: The most current scientific evidence incorporated in a cyclical process includes several steps: critical analysis according to the Evidence-based Medicine method; identification of predictive factors; setting-up risk levels; identification of prevention measures; elaboration of personalized recommendation. The information technology implementation of the clinical practice guideline enables physicians to quickly obtain personalized information for their patients. Cases of colorectal prevention illustrate our approach. CONCLUSIONS: Integration of current scientific knowledge is an important process. The delay between the moment new information arrives and the moment the practitioner applies it, is thus reduced.

Colorectal Neoplasms↗

PubMed2001

From paper-based to electronic guidelines: application to French guidelines.

In order to develop an internet-based decision support system, making available for French general practitioners several prevention guidelines is was necessary to implement paper based guideline. We propose a framework allowing to transform paper based practice guideline into their electronic form. Three different problems were identified: computability (e.g. determinism of the eCPG), logic (e.g. ambiguities when combining Booleans operators) and external validity (i.e. stability of decision for variations around thresholds and proportion of subjects classified in the various terminal nodes). The last problem concerned documentation of evidence: the level of evidence was associated only with the terminal decision node and not with the pathway through the decision tree. We concluded that computerisation of guidelines is not possible without expertise or authors advice. To improve computability it is necessary to provide authors with a framework that checks ambiguities, and logical errors.

Algorithms↗

PubMed2001

ARIANE: a mediation framework with health information sources.

OBJECTIVES: to design and implement mediators dedicated to access heterogeneous information sources in a homogeneous way. METHOD: processes translate a query into the syntax of a target source built thanks to the UMLS knowledge sources and a catalog of information sources. Communication services connect users with information sources at the point they deliver results. RESULTS: examples show the benefits healthcare professionals may found in searching information in this way. DISCUSSION: improvements on the current developments may be done according to the current architecture of ARIANE. Specially, the user interface should be easier to use than the present one.

Information Services↗

PubMed2001

Guideline development: focus on breast cancer screening in the EsPeR project.

We describe in this paper, the implementation of a clinical practice guideline focused on breast cancer screening. Our aim in conceiving such a computerized guideline was first to help general practitioners in appreciating the risks their female patients might develop breast cancer and secondly to suggest them the screening measures adapted to each particular case. This implementation enables us to present our general methodology to elaborated and promulgate guidelines within the EsPeR project. This methodology aims at providing guidelines based on knowledge validated according to the EBM principles, that can be used in real time and updated according to current knowledge.

Algorithms↗

PubMed2001

An adaptive medical e-learning environment: the MEDIDACTE project.

Most e-learning systems offer the same tools and resource materials to students who are different in terms of motivations, training backgrounds, technical skills and learning objectives. Adaptive systems development is a challenge intended to improve the efficiency of these systems. This communication presents the design and implementation of an adaptive medical e-learning environment. The authors describe the MEDIDACTE architecture developed in three levels namely, the educational resource, educational project and user level. Current MEDIDACTE implementation and integration in Marseille Medical University curriculum are presented.

Computer Literacy↗

PubMed2001

Designing and implementing medical web portals: spreading educational and research materials on the Internet.

OBJECTIVES: To design and implement a medical web portal providing access to well qualified and high-quality information in the framework of universities and hospitals. METHOD: Based on the authors experience and the published literature, a model is proposed which describes the properties of documents in an object-oriented way. This model clearly separates from usual properties: the subject of a document as keywords, and information concerning its type, format, and location. RESULTS: An implementation has been done with an existing software that allows the capability to organize and index a web site according to the model. Experiments have been conducted which demonstrate the feasibility and the utility of such an approach. DISCUSSION: The benefits for the users, both designers and end users, of using such a portal are discussed. Forthcoming works are described.

Education, Medical↗

PubMed2001

Towards health care process description framework: an XML DTD design.

The development of health care and hospital information systems has to meet users needs as well as requirements such as the tracking of all care activities and the support of quality improvement. The use of process-oriented analysis is of-value to provide analysts with: (i) a systematic description of activities; (ii) the elicitation of the useful data to perform and record care tasks; (iii) the selection of relevant decision-making support. But paper-based tools are not a very suitable way to manage and share the documentation produced during this step. The purpose of this work is to propose a method to implement the results of process analysis according to XML techniques (eXtensible Markup Language). It is based on the IDEF0 activity modeling language (Integration DEfinition for Function modeling). A hierarchical description of a process and its components has been defined through a flat XML file with a grammar of proper metadata tags. Perspectives of this method are discussed.

Blood Transfusion↗

PubMed2000

The use of the personalized estimate of death probabilities for medical decision making.

Data coming from the French national statistics on the cause of deaths are used to calculate the probabilities of death from pathologies. These probabilities are calculated according to age, sex, and place of residence of the patient to "personalize" the estimate. This individual prediction of the risk of death is proposed for pathologies for which the feasibility and the utility of prevention measures had been demonstrated. Relative risks of death according to the socioprofessional category, which are coming from the scientific literature, are used to adjust the probabilities of death as a function of the patient socioprofessional category. The aim of this work is to guide a scientist toward a prevention strategy according to the age and characteristics of patient. The use of computers by the scientists will make possible the diffusion of such tool of prediction to improve a personalized prevention.

Cause of Death↗

PubMed2000

[From knowledge to clinical practice: the introduction of evidence-based medicine].

INTRODUCTION: The paper presents the new paradigm for medical practice which has been emerging for a decade: evidence-based medicine. CURRENT KNOWLEDGE AND KEY POINTS: The paradigm proposes new skills for the physicians, de-emphasizing intuition and empiricism in medical practice, and proposes the intensive use of medical literature for the medical practice. FUTURE PROSPECTS AND PROJECTS: The article presents the main characteristics of the approach which is raising new important questions about the evolution of medical practice and the validity of the paradigm.

Delivery of Health Care↗

PubMed2000

[Computer-based hospital transfusion process: why and how does one establish a link between continuous quality improvement and clinical information system?].

Within a hospital, the need for a computer-based transfusion system has became mandatory. It facilitates the tracing of healthcare activities, which is the basis of the security of the care and a functional element of continuous quality improvement procedures. In order to implement this traceability, reactive and real-time information systems are needed close to healthcare participants, which is not the case of current information systems which rely on a recorded collection of data, far from the needs of the caregiver, and mainly answering to an objective evaluation of results. In the context of continuous quality improvement programmes started in our hospital, hemovigilance was the first to use a process analysis approach, from the prescription of blood units to their administration and follow-up. Several questions arise from this: 1) how to use the process analysis work to specify the users' needs of a generalized and real-time transfusion information system? 2) how to spread this model to other healthcare activities? 3) how to integrate or interface the whole of these quality programmes with a clinical information system? A user-centered methodology was used, based on 'usage cases'. For each step of the transfusion process, this method allowed us to specify participants, data necessary for an activity (observed, deduced or decision-support data), data issuing from the activity, roles (the interaction between user and activity) and functions (the result of the interaction between user and activity).

Blood Transfusion↗

PubMed2000

Mediation services with health information sources.

OBJECTIVES: To design and implement mediators dedicated to access various kinds of information sources in the framework of the project ARIANE. METHOD: Mediators are dynamically built thanks to three components: pieces of knowledge issued from the UMLS knowledge sources and from a catalog of information sources, processes that translate a query into the syntax of a target source, and communication services provided by operating systems. RESULTS: A scenario details the complete mediation process with an indexed web site. CONCLUSION: This approach mixes knowledge and software engineering. It benefits from services provided by operating systems and allows scalability and reusability of software components.

Computer Communication Networks↗

PubMed2000

DI2ADEM: an adaptive hypermedia designed to improve access to relevant medical information.

The World Wide Web (web) provides the same type of information to widely different users and these users must then find the information suitable for their use in the package offered. The authors present the DI2ADEM project designed to take the user into account and intended to provide this user with appropriate medical information. To do that, DI2ADEM is suggesting an adaptive hypermedia based on the management of a meta-knowledge of the user and a knowledge of the information that can be circulated. An adaptive hypermedia prototype devoted to paediatric oncology was implemented on the intranet network of a university hospital.

Diffusion of Innovation↗

PubMed2000

Integration of health care process analysis in the design of a clinical information system: applying to the blood transfusion process.

Hospital information systems have to support quality improvement objectives. The requirements of the system have to meet users' needs in relation to both the quality (efficacy, conformity, safety) and the monitoring of all health care activities (traceability). Information analysts need complementary methods to conceptualize clinical information systems that provide actors with immediate individual benefits and guide collective behavioral changes. A methodology is proposed to elicit users' needs using a process-oriented analysis, and it is applied to the field of blood transfusion. We defined a process data model, the main components of which are: activities, resources, constrains, guidelines and indicators. Although some aspects of activity, such as "where", "what else", and "why" are poorly represented by the data model alone, this method of requirement elicitation fits the dynamic of data input for the process to be traced. A hierarchical representation of hospital activities has to be found for this approach to be generalised within the organisation, for the processes to be interrelated, and for their characteristics to be assessed.

Blood Transfusion↗