Short-Term cost impact of compliance with clinical practice guidelines for initial sarcoma treatment

Background: The impact of compliance to clinical practice guidelines (CPG) on outcomes and/or costs of care has not been completely clarified.Objective: To estimate relationships between medical expenditures and compliance to CPG for initial sarcoma treatment.Research design: Selected cohorts of patients diagnosed with sarcoma in 2005 and 2006, and treated at the University hospital and/or the cancer centre of the Rhône-Alpes region, France (n=90). Main outcome measurements were: patient characteristics, compliance with CPG, health outcomes, and costs. Data were mainly extracted from patient records. The logarithm of treatment costs was modelled using linear and Tobit regressions.Results: Rates of compliance with CPG were 86%, 66%, 88%, 89%, and 95% for initial diagnosis, primary surgical excision, wide surgical excision, chemotherapy, and radiotherapy, respectively. Total average costs reached €24,439, with €1,784, €11,225, €10,360, and €1,016 for diagnosis, surgery (primary and wide surgical excisions), chemotherapy, and radiotherapy, respectively. Compliance of diagnosis with CPG decreased the cost of diagnosis, whereas compliance of primary surgical excision increased the cost of chemotherapy. Compliance of chemotherapy with CPG decreased the cost of radiotherapy.Conclusion: Since chemotherapy is one of the major cost drivers, these results support that compliance with guidelines increases medical care expenditures in short term.Oncology; Sarcoma; Cost; Clinical guidelines; Efficacy; Medical Practices; Government Policy; Regulation; Public Health

Incidence of Sarcoma Histotypes and Molecular Subtypes in a Prospective Epidemiological Study with Central Pathology Review and Molecular Testing

International audienceBACKGROUND: The exact overall incidence of sarcoma and sarcoma subtypes is not known. The objective of the present population-based study was to determine this incidence in a European region (Rhone-Alpes) of six million inhabitants, based on a central pathological review of the cases. METHODOLOGY/PRINCIPAL FINDINGS: From March 2005 to February 2007, pathology reports and tumor blocks were prospectively collected from the 158 pathologists of the Rhone-Alpes region. All diagnosed or suspected cases of sarcoma were collected, reviewed centrally, examined for molecular alterations and classified according to the 2002 World Health Organization classification. Of the 1287 patients screened during the study period, 748 met the criteria for inclusion in the study. The overall crude and world age-standardized incidence rates were respectively 6.2 and 4.8 per 100,000/year. Incidence rates for soft tissue, visceral and bone sarcomas were respectively 3.6, 2.0 and 0.6 per 100,000. The most frequent histological subtypes were gastrointestinal stromal tumor (18%; 1.1/100,000), unclassified sarcoma (16%; 1/100,000), liposarcoma (15%; 0.9/100,000) and leiomyosarcoma (11%; 0.7/100,000). CONCLUSIONS/SIGNIFICANCE: The observed incidence of sarcomas was higher than expected. This study is the first detailed investigation of the crude incidence of histological and molecular subtypes of sarcomas

Les consignes à l'école maternelle

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Aides à L'organisation du travail dans les ateliers : problèmes du décalage entre prévision et réalisation

La complexité croissante des systèmes de production, la nécessité de répondre rapidement aux demandes du marché ont conduit, entre autres, au développement de systèmes informatiques de gestion de production, regroupés sous la terminologie de Gestion de Production Assistée par Ordinateur (GPAO). Concernant les productions discrètes et diversifiées, ces systèmes informatiques assurent correctement les fonctions de gestion de données techniques (relatives aux produits à fabriquer), commerciales (commandes, ventes), de stocks (matières premières, composants, produits finis). Par contre leur utilité est beaucoup plus contestée pour la gestion du travail, c'est-à-dire la répartition de la réalisation d'un ensemble de produits dans le temps et l'espace. Selon certains auteurs (Doumeingts et al., 1983), cette déficience serait liée à la prédominance des facteurs humains dans cette fonction et à la fermeture des modèles utilisés. Notre propos est d'analyser quelques-uns des déterminants de cette sous utilisation. Cet examen s'appuie sur des études réalisées dans trois entreprises disposant de GPAO. La démarche commune à ces trois études est une démarche classique de psychologie ergonomique qui s'appuie sur l'analyse du travail des opérateurs chargés, à différents niveaux hiérarchiques, de l'organisation du travail. Dans cette analyse nous nous sommes attachés à saisir les écarts entre la tâche prescrite (par l'étude des contraintes inhérentes au fonctionnement des logiciels traditionnels) et la tâche effective des ateliers (Leplat & Hoc, 1983). L'utilisation d'une grille de lecture essentiellement issue de la psychologie cognitive, nous a conduit à décrire l'Organisation du Travail dans les Ateliers (OTA) en termes de traitement de l'information, en faisant référence à des concepts tels que planification (Sacerdoti, 1977 ; Hoc, 1987), résolution de problème (Richard, 1990), représentation mentale (Richard, 1985; Leplat, 1985). Au travers de la description du fonctionnement des logiciels traditionnels d'OTA nous montrerons ici que le modèle sous-jacent à leur conception fait de l'atelier un exécutant d'un plan prescripteur. Dans un deuxième temps, l'analyse des sources de décalages entre un ordonnancement et sa réalisation, nous permettra de mettre en évidence l'incompatibilité entre le rôle d'exécutant attribué à l'atelier et les caractéristiques réelles de la situation. La troisième étape consistera à dégager les processus d'élaboration de plan développés dans l'atelier. Le caractère hiérarchique de ce processus nous conduira au dernier paragraphe à proposer une nouvelle approche pour la conception d'aides à l'OTA dans laquelle l'atelier ne serait plus un simple exécutant, mais un concepteur de plan

Ferritins and iron accumulation in plant tissues

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Réduction de la complexité temporelle dans le contrôle d'un micro-monde dynamique

International audienceDealing with dynamic environments is a situation that can be characterized by different complexity sources. In this paper, we are particularly interested in the temporal dimension. We will try to answer the following question : how do operators manage to reduce the temporal complexity of a dynamic environment ? The idea of the construction of a functional and dynamic representation of the situation has been discussed in the literature. This representation can be used as a base for anticipation. Indeed, reducing temporal complexity may be done by way of constructing a * frame-model » of the situation including temporal information, that will help operators ù organize their own actions with regard to the process. Then, there is the more specific question : what might be the base of such a representation ? Several studies in time psychology have shown the significance of the temporal structure of the environment in duration estimation, anticipation, or more generally, in adapting human behaviour to time. The representation of regular events, sequences and cycles allows humans to adapt to the immediate or more distant future. We hypothesized that in order to adapt themselves to the numerous temporal requirements of a dynamic environment, operators search for signs of a temporal structure. On the basis of observations concerning the temporal characteristics of events in the environment -in terms of order and duration -, they construct a temporal representation allowing them to anticipate and organize their actions in time. A micro-world experiment simulating a water purification plant was carried out. Three complexity conditions were created for this experiment, and subjects controlled the process during three one-hour sessions. Results show that subjects reduce complexity ; their performance is better in the last control session. They seem to organize their actions by gathering them together, on the basis of regularities observed in the process (co-occurrences, occurrence order of events), and on the perception of « temporal extent » rather than metric duration. This organization of actions is a strategy that allows subjects to « get in tune » with the dynamic structure of the environment. This study emphasizes the importance of identifying empirical regularities for constructing a mental representation of the temporal structure of the environment.Les opérateurs en charge du contrôle d'environnements dynamiques doivent faire face à de nombreuses exigences. La dimension temporelle constitue un des facteurs de complexité caractérisant ce type d'environnement. Dans une tâche d'apprentissage du contrôle d'un micro-monde dynamique, cette étude montre que les sujets parviennent à réduire la complexité liée l'aspect temporel. Sur la base de régularités observées dans l'occurrence des événements, les sujets construisent une représentation mentale de la structure temporelle de l'environnement (sorte de « modèle-cadre » ) basée sur l'ordonnancement partiel d'extensions temporelles. Cette représentation temporelle leur permet d'organiser leurs actions dans le temps (synchronisation, planification), et de construire des stratégies de gestion

Molecular and Physiological Responses to Water Deficit in Drought-Tolerant and Drought-Sensitive Lines of Sunflower : Accumulation of Dehydrin Transcripts Correlates with Tolerance

To investigate correlations between phenotypic adaptation to water limitation and drought-induced gene expression, we have studied a model system consisting of a drought-tolerant line (R1) and a drought-sensitive line (S1) of sunflowers (Helianthus annuus L.) subjected to progressive drought. R1 tolerance is characterized by the maintenance of shoot cellular turgor. Drought-induced genes (HaElip1, HaDhn1, and HaDhn2) were previously identified in the tolerant line. The accumulation of the corresponding transcripts was compared as a function of soil and leaf water status in R1 and S1 plants during progressive drought. In leaves of R1 plants the accumulation of HaDhn1 and HaDhn2 transcripts, but not HaElip1 transcripts, was correlated with the drought-adaptive response. Drought-induced abscisic acid (ABA) concentration was not associated with the varietal difference in drought tolerance. Stomata of both lines displayed similar sensitivity to ABA. ABA-induced accumulation of HaDhn2 transcripts was higher in the tolerant than in the sensitive genotype. HaDhn1 transcripts were similarly accumulated in the tolerant and in the sensitive plants in response to ABA, suggesting that additional factors involved in drought regulation of HaDhn1 expression might exist in tolerant plants

Ajustement temporel à la dynamique des situations

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