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Biomedical subjects

L Dusserre

Publications and source records attributed to L Dusserre.

At least 37 records · Page 2Linked to original sources
PubMed1996

Evaluation of an international telepathology system between Boston (USA) and Dijon: glass slides versus telediagnostic television monitor.

A telepathology network developed by Resintel (Dijon) has proved valuable in interactive situations, where two physicians converse by telephone, showing each other the part of the lesion they wish to discuss. In future this interactive process could be replaced by an electronic mailing service in which a limited number of images are taken from the slide, but this technique needs to be assessed in comparison with traditional microscopic diagnosis, when the pathologist can screen the entire slide. The present study compared diagnoses achieved through the traditional methods of current pathology practice with diagnoses achieved through a selection of images on a telediagnostic TV monitor. The kappa coefficient between the two protocols was 0.26 (SE = 0.06), which allows us to conclude that there is a fair reliability between video and glass slide diagnoses.

Boston↗
PubMed1996

Extraction and anonymity protocol of medical file.

To carry out the epidemiological study of patients suffering from a given cancer, the Department of Medical Informatics (DIM) has to link information coming from different hospitals and medical laboratories in the Burgundy region. Demands from the French department for computerized information security (Commission Nationale de l'Informatique et des Libertés: CNIL), in regard to abiding by the law of January 6, 1978, completed by the law of July 1st, 1994 on nominal data processing in the framework of medical research have to be taken into account. Notably, the CNIL advised to render anonymous patient identities before the extraction of each establishment file. This paper describes a recently implemented protocol, registered with the French department for computerized information security (Service Central de la Sécurité des Systèmes d'information : SCSSI) whose purpose is to render anonymous medical files in view of their extraction. Once rendered anonymous, these files will be exportable so as to be merged with other files and used in a framework of epidemiological studies. Therefore, this protocol uses the Standard Hash Algorithm (SHA) which allows the replacement of identities by their imprints while ensuring a minimal collision rate in order to allow a correct linkage of the different information concerning the same patient. A first evaluation of the extraction and anonymity software with regard to the purpose of an epidemiological survey is described here. In this paper, we also show how it would be possible to implement this system by means of the Internet communication network.

Computer Communication Networks↗
PubMed1995

[Telemedicine and medical responsibility].

Dealing with telemedicine including telediagnosis and teleassistance, we have to assess the legal and ethical components of medical liability. With medical telediagnosis, the dispersion of medical liabilities is the main risk: how can we ensure a clear identification of the medical liabilities involved in case of damage? From a legal point of view, the dispersion of the liabilities is not authorized and the use of telediagnosis must ensure a total transparence. As we cannot presently establish a separate amount for a medical act based on the cost of the image records and the cost of image interpretation, it is necessary to establish a contract. Today the most convenient is a contract similar to the usual contract between laboratories which implies that the liability belongs to the practitioner who has received the sample. In the future, other legal obligations may appear when telediagnosis develops. Indeed, the increase in reliability due to telediagnosis could be normally required as a part of the medical obligation to use the latest technology. On the opposite, the excessive use of teleassistance, when there is neither emergency nor medical isolation, is dangerous because it affects the integrity and the quality of the medical act. A medical practice without any clinical examination of the patient is contrary to medical ethics.

Computer Communication Networks↗
PubMed1995

Evaluation of a telepathology system between Boston (USA) and Dijon (France): glass slides versus telediagnostic TV-monitor.

The objective of this work was to compare diagnoses achieved through the traditional methods of current pathology practice versus diagnoses achieved through a selection of image on a telediagnostic TV-monitor. The Kappa coefficient between the two protocols of k = 0.26 SE(k) = 0.06 z = k/SE(k) = 4.3 (p < 0.001) allows us to conclude that there is a good reliability between video and glass slide diagnoses.

Boston↗
PubMed1995

Structural and conjunctural compensation method for hospital budgetary allocation on the basis of DRGs.

We propose here a structural and conjunctural compensation method to improve budgetary allocation which could be based on Diagnosis Related Groups. This method consists in the determination of sub-group costs within DRGs. The specification of these sub-groups is possible by introducing clinical and social parameters in the statistical model. Hospitals could then compare their sub-group proportions and analyze their differences in relation to conjunctural factors (recruitment, medical practices) and structural factors (technical team, local medical structure). This method also allows an identification of specialty hospitals (outliers) and a compensation allocation for budgeting for these hospitals.

Budgets↗
PubMed1995

A one way public key cryptosystem for the linkage of nominal files in epidemiological studies.

An encryption method is proposed for nominal files to allow their linkage while respecting confidentiality rules. In contrast to most encryption algorithms, this encryption method must be non-reversible. The method is based on congruence, like the SAN MARCO algorithm, and satisfies the two following conditions. 1) Non-reversible enciphering, which implies the possibility of collisions. 2) The collision rate must be minimized, to allow file linkage. The security of this method is, in addition, guaranteed by a key, which is destroyed after enciphering and is not given to the recipient of the coded file.

Algorithms↗
PubMed1995

The emergence of international telemedicine: no ready-made solutions exist.

Sending images to the far end of the world and establishing a diagnosis that may save one human life is a technological success which is very extremely gratifying, scientifically. But it's only the first, though essential, stage towards developing an international telemedicine network. The difficulties of conforming the telemedicine network to technical standards, administrative regulations, and existent national and supranational legislations are presented in this paper; there are often no ready-made solutions to these problems.

Confidentiality↗
PubMed1995

Legal requirements for tele-assistance and tele-medicine.

In dealing with tele-medicine including tele-diagnosis and tele-assistance, the legal and ethical components of medical liability must be satisfied. With medical tele-diagnosis, the spreading of medical liability is the main risk. How can we ensure a clear identification of the medical liabilities involved in cases where damage occurs? From a legal point of view, the spreading of the liability is not allowed and the use of tele-diagnosis must ensure a total transparence. As we cannot presently estimate the cost of a medical act based on the cost of the image records and the cost of image interpretation, it is necessary to establish a contract. Today the most convenient contract is similar to the contract between laboratories which implies that the liability is on the practitioner who has received the sample. In the future, other legal obligations may appear as tele-diagnosis develops. Indeed, with the increase in reliability in tele-diagnosis it could become a part of the medical obligation to use the latest technology. However, the excessive use of tele-assistance, when there is neither emergency nor medical isolation, is dangerous because it may affect the integrity and the quality of the traditional medical act. In general, medical practice without any clinical examination of the patient is contrary to medical ethics.

Ethics, Medical↗
PubMed1992

Decision support system and medical liability.

Expert systems, which are going to be an essential tool in Medicine, are evolving in terms of sophistication of both knowledge representation and types of reasoning models used. The more efficient they are, the more often they will be used and professional liability will be involved. So after giving a short survey of configuration and working of expert systems, the authors will study the liabilities of people building and the using expert systems regarding some various dysfunctions. Of course the expert systems have to be considered only for human support and they should not possess any authority themselves, therefore the doctors must keep in mind that it is their own responsibility and as such keep their judgment and criticism. However other professionals could be involved, if they have participated in the building of expert systems. The different liabilities and the burden of proof are discussed according to some possible dysfunctions. In any case the final proof is inside the expert system by itself through re-computation of data.

Expert Systems↗
PubMed1992

A model for quality assessment in cervical cytology used as a screening test.

Although many reliability studies on cervical cytology have been carried out, measurements of sensitivity and specificity have rarely been made since biopsies are not often performed on patients with a negative smear result. This screening assessment was performed over 3 years, using a database of 230,167 smears from 177,051 women. It would seem that cervical cytology has a high specificity (over 99%) but a relatively low sensitivity (61%). Values for sensitivity (exceeding 95%) and specificity (exceeding 99%) for invasive carcinoma should be regarded as reasonably accurate as all incident cases of symptomatic cervical carcinoma are recorded in the Burgundy register. The sensitivity (57%) for pre-invasive lesions is underestimated while their prevalence is overestimated: the lack of organized screening leads to the loss of prevalent cases. The predictive value of a positive smear is 76% for moderate-severe dysplasia, 85% for in situ carcinoma and over 95% for invasive carcinoma.

Adolescent↗
PubMed1991

[Prognostic factors in hemorrhagic cerebrovascular accidents in a population register].

Since 1985, cases of acute vascular cerebral diseases observed among the inhabitants of the city of Dijon have been systematically recorded: 88 cerebral haemorrhages were reported from 1985 to 1988. Twenty-five variables have been defined from antecedents, clinical and para-clinical data. Seven variables, were statistically associated with death at the end of the first month: age, severity of neurological palsy, meningeal syndrome, coma or comatose state, hyperglycemia and mass effect on CAT-scan. Using a step-down variable selection procedure, two prognostic factors were found: loss of consciousness and advanced age.

Adult↗
PubMed1989

[Epidemiology of cerebrovascular accidents. According to Dijon's registry (1985-1988)].

The results of a 4-year prospective study of stroke in a community of 140,000 people are reported. Eight hundred and forty-two strokes were recorded, 70 per cent in University Hospitals, 20 per cent in private hospitals and 10 per cent at home. Ninety-four per cent of the patients had a CT scan. The annual incidence of stroke was 145/100,000 people, whereas the incidences of infarct, cerebral haemorrhage and subarachnoid haemorrhage were 121, 21 and 6.6/100,000 people respectively. These results, compared with those of other registers, clearly show the superiority of population-based registers over hospital-based registers.

Adolescent↗
PubMed1989

Stroke in a French prospective population study.

Since 1985 there has been a Stroke Registry in Dijon to record every stroke occurring in the population of a city of 140,000 inhabitants. The survey has been exhaustive and included the numerous sources of information as well as CT scanning. The annual incidence is 145/100,000 with an annual specific incidence of 170/100,000 in men, 126/100,000 in women. The annual specific incidence shows a female preponderance until 30 years of age, after which the males lead from the age of 30 to 80, when the rates become equal. Sixty-eight percent of strokes produced by infarct, 12% by lacunae, 5% by subarachnoid hemorrhage and 15% by cerebral hemorrhage. Differences exist in this distribution, with the preponderance of young people in subarachnoid hemorrhage, and cerebral hemorrhage is commoner in the 5th decade while infarct increases with age in both sexes. Infarct appears commoner during winter, transient ischemic attacks during summer, while cerebral hemorrhage has a constant incidence during the year. Mortality is high mainly during the 1st month with 12.5% during the 1st week, 21.5% the 1st month and 30% the 1st year. Our results are in the mean similar to white occidental countries, but opposite to those observed in Japan; they emphasize the importance of the lacunar syndrome, and the seasonal variations in different types of stroke.

Adult↗
PubMed1989

[Cerebral vascular complications in the population of Dijon. Incidence-breakdown-mortality].

Since 1985, a stroke registry has registered every stroke in this town, of about 140,000 inhabitants. A CT Scan and numerous sources of information have allowed to achieve an exhaustive survey. The annual incidence of stroke has been 145/100,000. The annual specific incidence for age is 170/100,000 in men, 126/100,000 in women. The annual specific incidence for age and sex has shown a female preponderance until 30 and a male preponderance after this age. At 80, the rates became equal. Sixty-eight per cent of stroke were due to an infarct, 12 p. 100 to lacunae, 5 p. 100 to subarachnoid hemorrhage and 15% to cerebral hemorrhage. A preponderance of young people was found in subarachnoid hemorrhage, of the fifth decade in cerebral hemorrhage, while infarct rose up with age in the 2 sexes. Infarcts appeared predominantly during winter, while transient ischemic attacks appeared more often during summer. Cerebral hemorrhage had a constant incidence over the year. Mortality was high, mainly during the first month with 12.5 p. 100 during the first week, 21.5 p. 100 during the first month, and 30 p. 100 the first year. Our results appear to set in the mean of white occidental countries as opposed to Japan. They emphasize the important and underestimated place of lacunae and the seasonal variations of several causal varieties of stroke.

Age Factors↗
PubMed1988

[Incidence of cerebrovascular accidents in a medium-sized French town].

Beginning in 1985, the Dijon Stroke Registry has identified every case of stroke occurring in this city of 140,000 inhabitants. The systematic use of a CT scan and multiple other sources of information ranging from hospital doctors to general practitioners make it possible for us to have virtually exhaustive data on stroke incidence. The gross incidence was 170 per 100,000 among men and 126 per 100,000 among women. Specific incidence by age and sex shows female predominance up to 30 years of age, and male predominance among victims from 30 to 80 years old. Beyond 80, rates were identical for both sexes. In 68% of the cases, the strokes were caused by infarct; in 12%, by lacunae; in 15%, by cerebral hemorrhage; in 5%, by subarachnoid hemorrhage. Significant differences existed in this distribution according to age, with a clear predominance of young people among those having subarachnoid hemorrhage, while, for those over 40, cerebral hemorrhages were frequent; the proportion of infarct increased with age for both sexes. A peak of incidence for infarct appeared during winter, while transient ischemic accident was more frequent in summer. Cerebral hemorrhage had a similar incidence throughout the year. Mortality was high during the first month (12.5% during the first week, 21.5% during the first month), and reached 30% during the first year. These results are comparable to those generally observed among white occidental populations. They confirm the limited incidence of hemorrhages (contrary to what has been observed in Japan), emphasize the important and often underestimated role of lacunar syndromes, and the seasonal variations specific to each mechanism.

Adolescent↗
PubMed1987

[Hyperglycemia in the initial phase of cerebral vascular complication. Index of bad prognosis].

The short-term prognostic value of hyperglycemia in acute stroke has been evaluated from the results of the first year of activity of the Stroke Registration unit in Dijon. In 188 patients admitted to hospital for acute hemiplegia blood glucose levels were measured on admission and daily for 7 days thereafter, and a CT scan was performed within a fortnight. Mortality was significantly higher in hyperglycemic patients (more than 2 g of glucose per litre) than in normoglycemic patients. In hyperglycemic patients the increase in blood glucose level was correlated with the initial disturbances of consciousness, the severity of hemiplegia and the presence at CT of an haemorrhage or an infarct with oedematous reaction. Thus, hyperglycemia in acute stroke is related to the severity of the cerebral damage. As a factor of bad prognosis, it is as sensitive as disturbances of consciousness or severe brain lesions at CT.

Aged↗
PubMed1986

[Weight indices during the first 18 months of life in low birthweight infants].

A prospective study was carried out among 190 low birthweight neonates (less than 2,500 g) in order to assess their ratio of total body fat by 2 adiposity indices: Weight/Height3 (W/H3) at birth and Weight/Height2 (W/H2) subsequently. Adequate for gestational age (AGA) girls with weight indices (W/H3) above the 10th percentile (AGA/I+) had a lower height than AGA/I- girls on the 6th (p less than 0.01) and 9th (p less than 0.05) months of corrected chronological ages. Mean weight and height of small for gestational age (SGA) neonates with weight indices (W/H3) lower than the 10th percentile (SGA/I-) were similar to the SGA/I+ as soon as 3 months of corrected chronological age. SGA/I+ infants experienced a progressive increase in low weight indices (W/H2) until 15-18 months without significant differences with SGA/I- at 3, 6, 9 months of corrected chronological age. Meanwhile, low indices (W/H2) were more frequently observed in SGA/I- at 15-18 months. Thus the early characteristics in weight indices disclose a lower ratio of body fat in SGA infants than in normal children, at least up to age 15-18 months.

Adipose Tissue↗