Biomedical subjects

R Beuscart

Publications and source records attributed to R Beuscart.

At least 19 recordsLinked to original sources

PubMed2004

[Histological diagnosis after Pap smears detecting cancer or high-grade lesion of the cervix].

OBJECTIVE: The aim of the study is to analyze the histological-cytological correlations for Pap smears having detected cancer or high-grade squamous intra-epithelial lesion (HSIL) of the cervix. PATIENTS AND METHOD: The study about 311 women is retrospective. The average age is 36.4 years. Group 1 (histological diagnosis of high-grade or invasive lesion) includes 244 women (77.5%). Group 2 (histological diagnosis other than high-grade or invasive lesion) includes 37 women (11.9%) with a presumed diagnosis of HSIL. Group 3 (absence of histological follow-up) includes 30 women (9.6%) with a presumed diagnosis of HSIL. RESULTS: In group 1, the presumed cytological diagnosis is HSIL in 229 cases, squamous carcinoma in 11 cases and adenocarcinoma in two cases. In this group, the average delay between the Pap smear and the first histology is equal to two months. It is longer than 6 months in seven cases. The diagnosis of cancer or high-grade lesion is confirmed histologically on a first biopsy of the cervix in 196 cases, a second or a third biopsy in 10 cases, an endocervical curettage in six cases and a surgical specimen in 32 cases. In the group 2, the histological diagnosis is normal-benign in 14 cases (presumed cytological false positives) and condyloma-CIN 1 in 23 cases (presumed overevaluations). DISCUSSION AND CONCLUSION: Results highlight benefits of interactive exchanges between clinicians and pathologists, and the necessity of review of discordant cases by several pathologists in due time, with written comments and coding of the conclusions of the review. Histological follow-up is late or not done in some women.

Adolescent↗

PubMed2003

Communication of information in the homecare context.

Organizing the Homecare with new information technologies is nowadays an important challenge. Indeed, some medical evolutions as the improvement of the duration of life, the number of chronic diseases and some social evolutions, such as the quality of patient life, or economic evolutions, such as the reduction of hospitalisation costs, could benefit from homecare. In this paper, we present the problem of the communication of information in the homecare context. Some main phases have been described that compose the two homecare processes: a logistic process and a care process. The communication of information during homecare depends on the concerned phases: first, some exchanges of information from existing Information System to the Homecare Information System; then, some exchanges between the homecare system and the mobile health care actors; and then, some mails during the outcome phase. Coordination architecture is briefly described, and two different implementations for the communication of information during homecare are presented: one is using XML messages to exchange information between Information Systems; the other is using mobile tools for communicating with mobile actors.

Efficiency, Organizational↗

PubMed2003

A preprocessing method for improving data mining techniques. Application to a large medical diabetes database.

The Knowledge Discovery in Databases (KDD) methodology seems to be attractive on the analyze of large clinical databases. In the KDD process, the preprocessing step (data cleaning and handling of missing values) is paramount since it conditions the quality of the results obtained by data mining procedures and represents about 80% of the whole project time. The aims of the present study were to analyze this step and provide tools to handle inconsistent data and missing values. We have broken down the process into 3 main stages: data cleaning--explanatory study of missing values--choice of the procedure used for handling missing values. The data cleaning stage was based on a system of logical rules to correct mistakes and on cluster analysis to discard the poorly filled files. The missing-data mechanism was analyzed by means of multivariate statistical procedures. Two methods to deal with missing values were compared: imputation by the most common value (mode) and imputation using decision trees. This study was performed on a large medical diabetes database (23,601 patients) including numerous missing values. A system of logical rules allowed to correct mistakes on essential parameters (for example, the type of diabetes). Cluster analysis allowed to identify 10% of poorly filled files. After multivariate analysis, the missing-data mechanism could be considered as random. For variables with low number of missing values (< 10%) and categories (< 4), imputation using decision trees provided better results than imputation by mode.

Data Interpretation, Statistical↗

PubMed2003

SIGAPS: a prototype of bibliographic tool for medical research evaluation.

Evaluation of research activity is extremely important but remains a complex domain. There's no standardized methods and evaluation is often based on the scientific publications. It is easy to identify, for a researcher, all the publications realized over a given period of time. At the level of an important establishment like an University Hospital, with about 500 researchers, this sort of inventory is very difficult to realize: we have to list the researchers, to list their publications, to determine the quality of articles produced, to store retrieved data and to calculate summary statistics. We have developed a full-Web prototype, using free software which, for a given researchers' list, interrogates the Pubmed server, downloads the found references and stores them in a local database. They are then enriched with local data which allow the realization of more or less complex analyses, the automatic production of reports, or keyword search. This tool is very easy to use, allowing for immediate analysis of publications of a researcher or a research team. This tool will allow to identify those active teams to be maintained or emergent teams to be supported. It will also allow to compare candidate profiles for appointments to research posts.

Biomedical Research↗

PubMed2003

Personalising e-learning modules: targeting Rasmussen levels using XML.

The development of Internet technologies has made it possible to increase the number and the diversity of on-line resources for teachers and students. Initiatives like the French-speaking Virtual Medical University Project (UMVF) try to organise the access to these resources. But both teachers and students are working on a partly redundant subset of knowledge. From the analysis of some French courses we propose a model for knowledge organisation derived from Rasmussen's stepladder. In the context of decision-making Rasmussen has identified skill-based, rule-based and knowledge-based levels for the mental process. In the medical context of problem-solving, we apply these three levels to the definition of three students levels: beginners, intermediate-level learners, experts. Based on our model, we build a representation of the hierarchical structure of data using XML language. We use XSLT Transformation Language in order to filter relevant data according to student level and to propose an appropriate display on students' terminal. The model and the XML implementation we define help to design tools for building personalised e-learning modules.

Academic Medical Centers↗

PubMed2002

A resource server for medical training.

OBJECTIVES: We have developed a RESOURCE SERVER to collect and store various elements used by a professor during his lecture. METHODS: The server manages four types of objects: ELEMENTS, RESOURCES (set of elements referring to a given topic), INDEXES (to organize the resources for further search and use), and USERS (to identify providers, users, and access rights). If an ELEMENT s modified, the RESOURCE is automatically updated. RESULTS: An example (preparation of an anatomy lecture) explains how the RESOURCE SERVER works in three steps: organization of the training material, indexing, and retrieval. CONCLUSIONS: The RESOURCE SERVER will help instructors develop, update and share pedagogic resources for supporting their training courses, lessons and conferences. Moreover, these techniques, based on Internet technologies for easy handling of and access to these resources, allow local and distant access. Within the general framework of the French-speaking Virtual Medical University, the RESOURCE SERVER will represent an important link between data collection and its use in intelligent pedagogic training.

Computer Storage Devices↗

PubMed2002

Security in the French-speaking Virtual Medical University.

The Medical Virtual French-Speaking University (UMVF) is a government sponsored program. The participating medical schools will share Web accessible scientific contents and develop their own teaching strategies and learner-trainer interactions. An e-learning platform will manage the access to the UMVF and its various resources. This access will require a unique identification/authentication. Users will then be guided toward those resources adapted to their profile. We recommend the use of a smart card for the identification/authentication. The connection should be secured via a SSL protocol when using critical resources such as assessment of a student, discussion between a student and a teacher and creation or modification of resources by a teacher. In other cases, secure connection will not be required. Usage rights of resources will be explicated. Critical data will be ciphered.

Access to Information↗

PubMed2002

Information and logistics for homecare.

TELECOS is a regional project whose ambition is to use new cooperation tools, in the context of homecare, in order to facilitate the coordinated cooperative work of health actors. Homecare can improve the quality of life for the patient and reduce costs but it also induces a lot of difficulties during organisation and care. We aim at knowing more about the activity of cooperation in the homecare context and proposing a cooperation platform which answers to the specific needs generated during homecare and which integrates new applications. In this paper, we present the results of our study of homecare. The activity analysis leads us to determine two specific processes: one concerns the implementation of human and material resources and design of the homecare protocol (the logistics process) and the other concerns the coordination of the healthcare actors during effective homecare (the care process). The first process is composed of five main phases during which an healthcare professional is required as coordinator. We then present the Worklow model used to represent the cooperation activity in homecare. We describe the activity: the tasks and subtasks are represented in a declarative way. We then briefly present our prototype, devoted to homecare management, implementing the different phases of the information process, developed in JAVA.

Home Care Services↗

PubMed2001

Higher carbohydrate intake is associated with decreased incidence of newborn macrosomia in women with gestational diabetes.

OBJECTIVE: To study the influence of energy and macronutrient intake on infant birthweight in women with gestational diabetes mellitus undergoing intensive management. DESIGN: This prospective study evaluated the impact of intensive management of gestational diabetes on maternal and fetal morbidity, and addressed the relationship between food intake and infant birthweight. SETTING: Fifteen maternity hospitals in northern France. SUBJECTS: Ninety-nine women with gestational diabetes or gestational mild hyperglycemia diagnosed between 24 and 34 weeks of gestation were surveyed. After 1 was excluded because of a premature birth and 18 were excluded as underreporters, 80 women were included in the final analysis. Diet intake was assessed by a dietary history at the first interview, and by two 3-day diet records at the 3rd and 7th week after diagnosis. RESULTS: In a forward-stepwise regression analysis (controlling for maternal age; smoking; parity; prepregnancy BMI; pregnancy weight gain; gestational duration; infant sex; fasting and 2-hour postprandial serum glucose; insulin therapy; and energy, fat, protein and carbohydrate intake during treatment) infant birthweight was positively associated with gestational duration (beta = +0.34, P<.002), and negatively with smoking (beta = -0.27, P<.02) and carbohydrate intake (beta = -0.24, P<.03). There were no large-for-gestational-age infants among women whose carbohydrate intake exceeded 210 g/day. CONCLUSION: For women with gestational diabetes undergoing intensive management, higher carbohydrate intake is associated with decreased incidence of macrosomia. APPLICATION: These findings suggest that nutrition counseling in gestational diabetes must be directed to maintain a sufficient carbohydrate intake (at least 250 g per day), which implies a low-fat diet to limit energy intake. A careful distribution of carbohydrate throughout the day and the use of low-glycemic index foods may help limit postprandial hyperglycemia.

Adult↗

PubMed2001

Social and health status of arrivals in a French prison: a consecutive case study from 1989 to 1995.

BACKGROUND: To assess the demographic, socioeconomic and health status of male arrivals in French jails and to analyze the time trends of these characteristics. METHODS: The study was carried out in a prison for detained persons and short term prisoners. Using a standardized questionnaire, we recorded the characteristics of all male detainees and prisoners arriving in the prison between 1989 and 1995. The information collected concerned: demographic data, level of education and professional status, reasons for detention or imprisonment, social and family background, lifestyle, medical and psychiatric history, suicide attempts and illicit use of drugs. The characteristics of the study population were compared with those found in the general regional population. We analyzed developing trends in the health status of the prison population as well as their socio-economic profile over a period of seven years (1989 to 1995). RESULTS: A total of 14,785 questionnaires were analyzed. Of the study population, 56% had no professional qualification, and 62% was unemployed. About two-thirds of the inmates presented psychiatric problems or problems with illicit drug use (one or several drugs). Amongst these, 70% had not had any form of care -neither therapeutic nor educational- before their arrival in prison. Between 1989 and 1995, the proportion of drug users increased by 30%. A parallel increase was observed in the level of unemployment and in the frequency of mental problems. CONCLUSIONS: Our results suggest a need for therapeutic and educational care to be provided for prison inmates. This poses a problem which needs to be addressed in terms of public health. The study also illustrates the usefulness of a standardised questionnaire for each arrival. The systematic use of such a tool would make it possible to identify inmates'needs and to propose adapted care solutions.

Adolescent↗

PubMed2001

Impact of a modelization of the task allocation problem on the design of a prescription management software for intensive care units.

After having studied the coordination in Intensive care Units we have proposed a dynamic model for improving coordination in respect of human control over the work. We have performed simulations for analysing the impact of different strategies on coordination and we have found that our task centred coordination model could be efficient to improve the health care actors coordination and the efficiency of care delivery. We have built a first prototype based on this model. This implementation uses Internet technologies.

Computer Simulation↗

PubMed2001

From data collection to knowledge data discovery: a medical application of data mining.

Prison inmates are exposed to a variety of major risk factors (psychiatric disorders, suicide attempts, illicit drug use). From 1986 to 1996, the USA prison population more than doubled while in France, it increased from 35655 in 1980 to 51623 in 1995. In spite of these findings, very little information concerning the inmates population is available. At the present time, there is a desire to adopt a policy based on the prevention of recidivism, on adequate release planning and referrals to community-based services. The aim of the RAPPEL project was to build an information system for assessing the social and health status of prison inmates. The pilot project was set up at the prison of Loos and allowed the collection and analysis of nearly 15000 records. The aim of this paper is to present the extension of the project consisting in developing a regional network grouping 11 jails. Information locally available will serve as the basis for the information system of regional jails. Data mining techniques will provide solutions for the extraction of new information. Three data mining tools were experimented : association rules, classification trees and clustering. Further extension consists in a distributed approach allowing direct access to the information system by WEB tools.

Classification↗

PubMed2000

A modelization of the task allocation problem for prescribing activity in an ICU.

The improvement of coordination between Health Care Professionals belonging different specialities and who are extremely mobile, is a crucial problem in Medicine. A workflow System is one example of the new informatics tools which facilitate the transfer of information and responsibility between health care providers. Medical informatics systems in particular should be reactive enough to cope with the flexibility of real work situations: in this paper, we present the task allocation problem. We distinguish between the workflow control process and the notifying process, which concerns the sharing out of the tasks between the actors concerned. We focus on the impact of strategies of notification on the progress of coordinated work. We propose a simulator to model and study the different ways of sharing tasks between actors in an Intensive Care Unit's activity of prescription.

Computer Simulation↗

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↗

PubMed2000

Professional communication for coordination of care: inter-mediation for a better management of patients.

The communication of data through telecommunication networks between Healthcare professionals and particularly Hospitals and family doctors is a fundamental challenge for the next decade. Some experiences are demonstrating the feasibility of this approach and give clear insight of the potentials, difficulties and constraints of the problem. Different technical solutions are proposed following a centralised or a distributed architecture, security and confidentiality obligations, and the users requirements. We propose an original solutions based on the principle of inter-mediation to provide intelligent treatments and services on the messages that are exchanged between the network participants. This approach proved to be successful in the experimental field of Armentières (France) where more than 30,000 messages were exchanged between the hospital and the General Practitioners during 1999. Following this experimental phase, the prototype is currently customised and industrialised to fulfil the requirements and needs of an healthcare sector.

Computer Communication Networks↗

PubMed1999

Telecommunication in healthcare for a better coordination between hospitals and GP's: routine application of the "ISAR-Telematics" project.

With the development of new information and communication technologies, the nature of data exchange between healthcare professionals is modified by the use of telematics tools. With the implementation of the "Réseau Santé Social" of the smart cards CPS and Sesam-Vitale, hospitals and private clinics are installing their hospital information systems, while general practitioners are computing their patient records. The environment is therefore suitable for the installation and diffusion of telematics services, allowing a better exchange of information between the physicians of a geographical sector. The RITHME intercommunication platform was developed in the ISAR-Telematics and IRISI European projects. It ensures several communication functions, such as movements of patients (in/out/inside) the hospital, management and mailing of letters and reports, specific information on prescribed treatments, or data concerning the hospital structure. This platform is tested in the town of Armentières in the large city of Lille (North of France). It is currently being routinely used to accelerate and secure data exchanges between all the physicians working in this area.

Family Practice↗

PubMed1999

A simulation of dynamic tasks routing to improve cooperation in intensive care units.

Cooperation between Health Care Professionals is essential for the quality of care. Workflow systems could improve the transfer of informations and responsibilities within Health Care Actors. We have proposed a conversation-based Workflow in order to modelize the therapeutics plan in the ICU. In such a complex field, the flexibility of the workflow system is essential for the system to be usable. We have introduced some dynamicity by adding roles in the model. With the use of roles, the dynamicity of the workflow is assumed by the routing process. We need to use simulation to be able to study the impact of routing algorythms on the efficiency of the coordination.

Algorithms↗

PubMed1999

A prototype of an information system for assessing the health status of prison inmates.

A research-action program was established in 1996 between the Loos-Lez-Lille prison psychiatric unit and the Department of Medical Informatics of the University Hospital of Lille (France):--(1) to investigate the health status and the general characteristics of the prison population--(2) to develop an Information System for improving the prison health care and to facilitate social rehabilitation of convicts. Starting off 1988, all new prisoners are interviewed on their arrival using a standard questionnaire. The transfer of all the information recorded in this questionnaire into a computer base was initiated in 1996, when the research action program began. A statistical analysis was performed on 15,200 records (1989-1995) to identify the most informative parameters: 50% of inmates were less than 24 years old; 57% were unemployed; 60% had no professional qualification. 31% of inmates had a psychiatric history and 16% had made a previous suicide attempt. The rate of drug abuse has increased from 24% in 89 to 53% in 95. To analyze the time trends of these parameters, a prototype of Information System was then developed. The system uses the database to product standard reports in real time.

Adolescent↗