Biomedical subjects

Pascal Staccini

Publications and source records attributed to Pascal Staccini.

10 recordsLinked to original sources

PubMed2005

Mapping care processes within a hospital: from theory to a web-based proposal merging enterprise modelling and ISO normative principles.

Today, the economic and regulatory environment, involving activity-based and prospective payment systems, healthcare quality and risk analysis, traceability of the acts performed and evaluation of care practices, accounts for the current interest in clinical and hospital information systems. The structured gathering of information relative to users' needs and system requirements is fundamental when installing such systems. This stage takes time and is generally misconstrued by caregivers and is of limited efficacy to analysts. We used a modelling technique designed for manufacturing processes (IDEF0/SADT). We enhanced the basic model of an activity with descriptors extracted from the Ishikawa cause-and-effect diagram (methods, men, materials, machines, and environment). We proposed an object data model of a process and its components, and programmed a web-based tool in an object-oriented environment. This tool makes it possible to extract the data dictionary of a given process from the description of its elements and to locate documents (procedures, recommendations, instructions) according to each activity or role. Aimed at structuring needs and storing information provided by directly involved teams regarding the workings of an institution (or at least part of it), the process-mapping approach has an important contribution to make in the analysis of clinical information systems.

Computer Simulation↗

PubMed2005

Scanning electron microscopy analysis of experimental bone hacking trauma.

The authors report on their macro- and microscopy study of bone lesions made by a sharp force instrument (a single blade knife), and a sharp-blunt instrument classified as a chopping weapon (a hatchet). The aim of this work was to attempt to identify the instrument by analyzing the general class characteristics of the cuts. Each weapon was used on human bones. The results indicate that macroscopic analysis is more problematic. The microscopic analysis assessed that characteristics examined were effective in distinguishing sharp from sharp-blunt injury to the bone. The microscope facilitates analysis unachievable with macroscopic methods, some three-dimensional characteristics not visible to the naked eye being clearly defined with its use. Emphasis has been placed on the value of SEM as an anthropologist's tool in bone lesion injuries.

Femur↗

PubMed2005

Combining advanced networked technology and pedagogical methods to improve collaborative distance learning.

Making educational material be available on a network cannot be reduced to merely implementing hypermedia and interactive resources on a server. A pedagogical schema has to be defined to guide students for learning and to provide teachers with guidelines to prepare valuable and upgradeable resources. Components of a learning environment, as well as interactions between students and other roles such as author, tutor and manager, can be deduced from cognitive foundations of learning, such as the constructivist approach. Scripting the way a student will to navigate among information nodes and interact with tools to build his/her own knowledge can be a good way of deducing the features of the graphic interface related to the management of the objects. We defined a typology of pedagogical resources, their data model and their logic of use. We implemented a generic and web-based authoring and publishing platform (called J@LON for Join And Learn On the Net) within an object-oriented and open-source programming environment (called Zope) embedding a content management system (called Plone). Workflow features have been used to mark the progress of students and to trace the life cycle of resources shared by the teaching staff. The platform integrated advanced on line authoring features to create interactive exercises and support live courses diffusion. The platform engine has been generalized to the whole curriculum of medical studies in our faculty; it also supports an international master of risk management in health care and will be extent to all other continuous training diploma.

Cooperative Behavior↗

PubMed2004

Influence of operator experience on performance of ultrasound-guided percutaneous liver biopsy.

The purpose was to evaluate the influence of radiologist's experience on the diagnostic yield and complications of a percutaneous liver biopsy (PLB) method. Six hundred patients underwent an ultrasound-guided PLB by an inexperienced operator in 25.2% of cases (experience of less than 15 percutaneous liver biopsies performed alone--group I) or by an experienced operator (experience of more than 150 percutaneous liver biopsies--group II). The two groups were well-matched with respect to sex, age, percentage with viral hepatitis without histological cirrhosis, number of needle passes, history of liver biopsy and pain before the biopsy. A histological diagnosis was available in 97.3% of cases without any significant difference between the two groups ( P=0.25). However, group II samples were significantly longer and contained more portal tracts ( P=0.01). Pain was mild immediately and 6 h after the biopsy, without significant difference between both groups. Eight vasovagal reactions (five in group II) and one arteriobiliary fistula (in group II) occurred. With the method of PLB used for this study, operator's experience did not influence either the final histological diagnosis or the degree of pain suffered.

Adolescent↗

PubMed2004

Per os administration of 5-fluorocytosine is effective in the regression of CD-expressing liver metastases in rats.

The bacterial cytosine deaminase (CD) gene, associated to the 5-fluorocytosine (5-FC) prodrug, is one of the more widely used suicide systems in gene therapy. Introduction of the CD gene within a tumor induces, after 5-FC treatment of the animal, a local production of 5-fluorouracil (5-FU) resulting in intratumor chemotherapy. Destruction of the gene-modified tumor is then followed by the triggering of an anti-tumor immune reaction resulting in the regression of distant wild-type metastasis. In pre-clinical studies, 5-FC is generally administered by daily intraperitoneal injections. However, when used as an anti-fungal in humans, either IV or oral administration is used. In this study, we compared oral and intraperitoneal 5-FC administration in rats bearing a wild-type and a cytosine deaminase-expressing liver tumors. The results indicate that per os 5-FC administration is as efficient as intraperitoneal for the induction of CD-expressing tumor regression and the triggering of a distant bystander effect, acting on wild-type liver tumor and extra-hepatic metastasis.

Administration, Oral↗

PubMed2003

Assessing medical students' clinical sciences knowledge in France: a collaboration between the NBME and a consortium of French medical schools.

PURPOSE: The French government, as part of medical education reforms, has affirmed that an examination program for national residency selection will be implemented by 2004. The purpose of this study was to develop a French multiple-choice (MC) examination using the National Board of Medical Examiners' (NBME) expertise and materials. METHOD: The Evaluation Standardisée du Second Cycle (ESSC), a four-hour clinical sciences examination, was administered in January 2002 to 285 medical students at four university test sites in France. The ESSC had 200 translated and adapted MC items selected from the Comprehensive Clinical Sciences Examination (CCSE), an NBME subject test. RESULTS: Less than 10% of the ESSC items were rejected as inappropriate to French practice. Also, the distributions of ESSC item characteristics were similar to those reported with the CCSE. The ESSC also appeared to be very well targeted to examinees' proficiencies and yielded a reliability coefficient of.91. However, because of a higher word count, the ESSC did show evidence of speededness. Regarding overall performance, the mean proficiency estimate for French examinees was about 0.4 SD below that of a CCSE population. CONCLUSIONS: This study provides strong evidence for the usefulness of the model adopted in this first collaborative effort between the NBME and a consortium of French medical schools. Overall, the performance of French students was comparable to that of CCSE students, which was encouraging given the differences in motivation and the speeded nature of the French test. A second phase with the participation of larger numbers of French medical schools and students is being planned.

Clinical Medicine↗

PubMed2003

[Transposition of an American-designed comprehensive medical student examination within the framework of the forthcoming French nationwide comprehensive examination. A preliminary study].

Medical training is undergoing extensive revision in France. A nationwide comprehensive clinical competency examination will be administered for the first time in 2004, relying exclusively on essay-questions. Unfortunately, these questions have psychometric shortcomings, particularly their typically low reliability. High score reliability is mandatory in a high-stakes context. The National Board of Medical Examiners-designed multiple choice-questions (MCQ) are well adapted to assess clinical competency with a high reliability score. The purpose of this study was to test the hypothesis that French medical students could take an American-designed and French-adapted comprehensive clinical knowledge examination with this MCQ format. Two hundred and eighty five French students, from four Medical Schools across France, took an examination composed of 200 MCQs under standardized conditions. Their scores were compared with those of American students. This examination was found assess French students' clinical knowledge with a high level of reliability. French students' scores were slightly lower than those of American students, mostly due to a lack of familiarity with this particular item format, and a lower motivational level. Another study is being designed, with a larger group, to address some of the shortcomings of the initial study. If these preliminary results are replicated, the MCQ format might be a more defendable and sensible alternative to the proposed essay questions.

Adult↗

PubMed2003

Mapping care processes within a hospital: a web-based proposal merging enterprise modelling and ISO normative principles.

Today, the economic and regulatory environment are pressuring hospitals and healthcare professionals to account for their results and methods of care delivery. The evaluation of the quality and the safety of care, the traceability of the acts performed and the evaluation of practices are some of the reasons underpinning current interest in clinical and hospital information systems. The structured collection of users' needs and system requirements is fundamental when installing such systems. This stage takes time and is generally misconstrued by caregivers and is of limited efficacy to analysis. We used a modelling technique designed for manufacturing processes (SADT: Structured Analysis and Design Technique). We enhanced the initial model of activity of this method and programmed a web-based tool in an object-oriented environment. This tool makes it possible to extract the data dictionary from the description of a given process and to locate documents (procedures, recommendations, instructions). Aimed at structuring needs and storing information provided by teams directly involved regarding the workings of an institution (or at least part of it), the process mapping approach has an important contribution to make in the analysis of clinical information systems.

Critical Pathways↗

PubMed2003

A full XML-based approach to creating hypermedia learning modules in web-based environments: application to a pathology course.

Nowadays, web-based learning services are a key topic in the pedagogical and learning strategies of universities. While organisational and teaching requirements of the learning environment are being evaluated, technical specifications are emerging, enabling educators to build advanced "units of learning". Changes, however, take a long time and cost-effective solutions have to be found to involve our institutions in such actions. In this paper, we present a model of the components of a course. We detail the method followed to implement this model in hypermedia modules with a viewer that can be played on line or from a CD-ROM. The XML technology has been used to implement all the data structures and a client-side architecture has been designed to build a course viewer. Standards of description of content (such as Dublin Core and DocBook) have been integrated into the data structures. This tool has been populated with data from a pathology course and supports other medical contents. The choice of the architecture and the usefulness of the programming tools are discussed. The means of migrating towards a server-side application are presented.

CD-ROM↗

PubMed2002

Naked DNA injection for liver metastases treatment in rats.

The cytosine deaminase (CD) gene converts the nontoxic prodrug, 5-fluorocytosine (5-FC), into 5-fluorouracil (5-FU). We previously showed that injection of CD-bearing cancer cells followed by 5-FC treatment can act as an autologous tumor vaccine in a syngenic liver metastasis model in rats. In the present work, we analyzed the antitumor efficiency of a direct intratumoral injection of a CD-expressing plasmid. In rats bearing microscopic or macroscopic metastases in right and left liver lobes, an injection of a CD-expressing plasmid was performed in the left lobe tumor, followed by 5-FC treatment of the animals. A significant regression of the DNA-injected tumor was observed in 5-FC-treated rats, both in microscopic (P =.007) or advanced (P <.0001) tumor models. Moreover, this treatment also induced a potent distant bystander effect on untreated controlateral liver tumors and extrahepatic metastases, resulting in an increased survival compared with control animals in both tumor models (P <.05). In conclusion, these data suggest that direct intratumoral injection of a CD-expressing plasmid, associated to 5-FC administration, can constitute a powerful and innocuous alternative treatment for unresectable liver metastases from colon carcinoma.

Animals↗