Biomedical subjects

Thierry Dart

Publications and source records attributed to Thierry Dart.

4 recordsLinked to original sources

PubMed2004

Massive tears of the rotator cuff treated with a deltoid flap.

We retrospectively reviewed the charts of 29 patients younger than 65 years at surgery treated with deltoid flap reconstruction for massive postero-superior rotator cuff tears. All tears involved supraspinatus and infraspinatus tendons and were associated with tendon stump retraction to the glenoid rim, a preservable long biceps tendon, and an intact subscapularis tendon. Mean follow-up was 10.5 years. Patient satisfaction rate was 89%. Mean global Constant score improved from 43 to 71.5 points, mean pain score from 6.3 to 13.2, mean anterior flexion from 100 to 157 degrees, and force in elevation from 2.3 to 3 kg. Two thirds of patients had no humeral head migration. Of the 18 patients whose flap was examined by magnetic resonance imaging, 15 had no tear and 12 had a flap signal of muscle intensity; mean flap thickness was 5 mm. Pre-operative factors associated with poorer outcomes were upwards humeral head migration with a subacromial space smaller than 6 mm, presence of glenohumeral osteoarthritis, and supraspinatus amyotrophy greater than 40%. Deltoid flap reconstruction is a valid option in this patient population.

Aged↗

PubMed2003

A computer decision aid for medical prevention: a pilot qualitative study of the Personalized Estimate of Risks (EsPeR) system.

BACKGROUND: Many preventable diseases such as ischemic heart diseases and breast cancer prevail at a large scale in the general population. Computerized decision support systems are one of the solutions for improving the quality of prevention strategies. METHODS: The system called EsPeR (Personalized Estimate of Risks) combines calculation of several risks with computerisation of guidelines (cardiovascular prevention, screening for breast cancer, colorectal cancer, uterine cervix cancer, and prostate cancer, diagnosis of depression and suicide risk). We present a qualitative evaluation of its ergonomics, as well as it's understanding and acceptance by a group of general practitioners. We organised four focus groups each including 6-11 general practitioners. Physicians worked on several structured clinical scenarios with the help of EsPeR, and three senior investigators leaded structured discussion sessions. RESULTS: The initial sessions identified several ergonomic flaws of the system that were easily corrected. Both clinical scenarios and discussion sessions identified several problems related to the insufficient comprehension (expression of risks, definition of familial history of disease), and difficulty for the physicians to accept some of the recommendations. CONCLUSION: Educational, socio-professional and organisational components (i.e. time constraints for training and use of the EsPeR system during consultation) as well as acceptance of evidence-based decision-making should be taken into account before launching computerised decision support systems, or their application in randomised trials.

Attitude to Computers↗

PubMed2003

Analysis of hospitalised patient flows using data-mining.

UNLABELLED: Face to the development of hospital information system in the "Hôpital Européen George Pompidou" (HEGP), computerized patients records made medical data easier to analyse than before. We use data-mining technology to analyse intra-hospital patients' paths with one year of PMSI data (a French medical information system similar to Diagnosis Related Group). METHODS: 1. "sequential patterns mining" was used to analyse the most frequent patients' paths, 2. an integrated framework of "association rules mining" and "classification rule mining" was used to build prediction rules of patients' paths. RESULT: We construct a rule based prediction model, which gives the tendency of the patient's paths between the different medical units.

Computer Communication Networks↗

PubMed2003

Combining risks estimations and clinical practice guidelines in a computer decision aid: a pilot study of the EsPeR system.

Many preventable diseases such as ischemic heart diseases or breast cancer are still not adequately managed in the population. Computerized decision support systems are one of the solutions for improving the quality of prevention strategies. We designed a system called EsPeR (Personalised Estimate of Risks) combining calculation of several risks and computerisation of guidelines (cardio-vascular prevention, screening for breast cancer, colorectal cancer, uterine cervix cancer, and prostate cancer, diagnosis of depression and suicide risk). We present a qualitative evaluation of its ergonomics, its understanding and acceptance by a group of general practitioners. We organised 4 focus groups comprising 6-11 general practitioners. Physicians worked on several structured clinical scenario with help of EsPeR, and 3 senior investigators leaded structured discussion sessions. Initial sessions identified several ergonomics flaws that were easily corrected. Both clinical scenari and discussion sessions identified several problems of insufficient comprehension (expression of risks, definition of familial history of disease), lack of knowledge, and acceptance of recommendation by both the physician. Educational and organisational components (i.e. time constraints) as well as acceptance of evidence-based decision-making should be taken into account before launching computerised decision support system, or testing them in randomised trials.

Attitude of Health Personnel↗