Quels sont les patients atteints d'un cancer du sein dont la décision de prise en charge thérapeutique bénéficie de l'utilisation d'un système d'aide à la décision ? Un exemple utilisant la fouille de données et OncoDoc2

Session 2 : Utilisateurs et usagesNational audienceOncoDoc2 est un système d'aide à la décision (SAD) s'appuyant sur des recommandations de pratique clinique (RPC) pour la prise en charge des cancers du sein. Il a été utilisé comme intervention dans un essai randomisé contrôlé dont l'objectif principal était d'évaluer son impact sur la conformité des décisions des réunions de concertation pluridisciplinaire aux RPC. Nous avons utilisé un algorithme de fouille de données pour découvrir les régularités des profils patients, ou " motifs émergents " (ME), associées à la conformité et à la non-conformité des décisions selon que le système OncoDoc2 était ou non utilisé, afin d'évaluer quels profils patients pouvaient bénéficier de l'utilisation du système. Les ME associés à la non conformité des décisions prises sans le système sont associées à la conformité quand le système est utilisé sauf dans certaines situations cliniques pour lesquelles la force de la recommandation est faible

Interventions for the treatment of oral cavity and oropharyngeal cancer:chemotherapy

<b>Background:</b> Oral cavity and oropharyngeal cancers are frequently described as part of a group of oral cancers or head and neck cancer. Treatment of oral cavity cancer is generally surgery followed by radiotherapy, whereas oropharyngeal cancers, which are more likely to be advanced at the time of diagnosis, are managed with radiotherapy or chemoradiation. Surgery for oral cancers can be disfiguring and both surgery and radiotherapy have significant functional side effects, notably impaired ability to eat, drink and talk. The development of new chemotherapy agents, new combinations of agents and changes in the relative timing of surgery, radiotherapy, and chemotherapy treatments may potentially bring about increases in both survival and quality of life for this group of patients.<p></p> <b>Objectives:</b> To determine whether chemotherapy, in addition to radiotherapy and/or surgery for oral cavity and oropharyngeal cancer results in improved survival, disease free survival, progression free survival, locoregional control and reduced recurrence of disease. To determine which regimen and time of administration (induction, concomitant or adjuvant) is associated with better outcomes.<p></p> <b>Search strategy:</b> Electronic searches of the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE, AMED were undertaken on 28th July 2010. Reference lists of recent reviews and included studies were also searched to identify further trials.<p></p> <b>Selection criteria:</b> Randomised controlled trials where more than 50% of participants had primary tumours in the oral cavity or oropharynx, and which compared the addition of chemotherapy to other treatments such as radiotherapy and/or surgery, or compared two or more chemotherapy regimens or modes of administration, were included.<p></p> <b>Data collection and analysis:</b> Trials which met the inclusion criteria were assessed for risk of bias using six domains: sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting and other possible sources of bias. Data were extracted using a specially designed form and entered into the characteristics of included studies table and the analysis sections of the review. The proportion of participants in each trial with oral cavity and oropharyngeal cancers are recorded in Additional Table 1.<p></p> <b>Main results:</b> There was no statistically significant improvement in overall survival associated with induction chemotherapy compared to locoregional treatment alone in 25 trials (hazard ratio (HR) of mortality 0.92, 95% confidence interval (CI) 0.84 to 1.00). Post-surgery adjuvant chemotherapy was associated with improved overall survival compared to surgery +/- radiotherapy alone in 10 trials (HR of mortality 0.88, 95% CI 0.79 to 0.99), and there was an additional benefit of adjuvant concomitant chemoradiotherapy compared to radiotherapy in 4 of these trials (HR of mortality 0.84, 95% CI 0.72 to 0.98). Concomitant chemoradiotherapy resulted in improved survival compared to radiotherapy alone in patients whose tumours were considered unresectable in 25 trials (HR of mortality 0.79, 95% CI 0.74 to 0.84). However, the additional toxicity attributable to chemotherapy in the combined regimens remains unquantified.<p></p> <b>Authors' conclusions:</b> Chemotherapy, in addition to radiotherapy and surgery, is associated with improved overall survival in patients with oral cavity and oropharyngeal cancers. Induction chemotherapy is associated with a 9% increase in survival and adjuvant concomitant chemoradiotherapy is associated with a 16% increase in overall survival following surgery. In patients with unresectable tumours, concomitant chemoradiotherapy showed a 22% benefit in overall survival compared with radiotherapy alone.<p></p&gt

Radiotherapy in the treatment of Graves ophthalmopathy—to do it or not?

To the objective of this study is to evaluate the role and toxicity of radiotherapy in the treatment of Graves ophthalmopathy. In the years 2000–2003, 121 patients with malignant exophthalmos were treated with radiotherapy of the retrobulbar area to the total dose of 20 Gy in ten fractions with a 6 MeV photon beam. The treatment was performed by the team of the Clinic of Oncology of the Jagiellonian University Medical College in Cracow. The radiotherapy was preceded by intravenous steroid therapy: methylprednisolone acetate administered at the dose of 2 g/week for four consecutive weeks. The highest efficacy, expressed as improvement of all ocular symptoms, was observed for the combined treatment. Female and non-diabetic patients responded positively to the combined treatment. Radiotherapy combined with steroid therapy in the treatment of Graves ophthalmopathy seems to be an effective treatment for strictly defined indications. In the treatment of Graves–Basedow disease, radiotherapy is a well-tolerated treatment modality. Diabetes is a factor that worsens prognosis in Graves ophthalmopathy and female sex is a favourable factor for this condition

Les dissolutions d'union en France, étudiées à partir des minutes de jugement

La fréquence du divorce dans la France contemporaine et sa répartition géographique sont assez bien connues, grâce à l'établissement de statistiques annuelles. Mais il n'en va pas de même en ce qui concerne ses principaux caractères sociologiques. La présente étude a été conçue pour tenter de combler une partie de cette ignorance, en utilisant les données contenues dans les minutes de jugement, que conservent les greffes des tribunaux. Elle porte sur la période de l'après-guerre, représentée par cinq années échelonnées de 1950 à 1968. La conception et la direction du travail ont été assurées par M. Louis Roussel, qui en a confié l'exploitation à Mlle Éliane Jaulerry actuellement chargée de recherche au laboratoire de sociologie juridique de l'Université de Paris II.Jaulerry Éliane. Les dissolutions d'union en France, étudiées à partir des minutes de jugement. In: Population, 26ᵉ année, n°2, 1971. pp. 143-172

Actividades comerciales con Jaulerry y Compañía

Cartas remitidas por Jaulerry y Cía. a Manuel María Mosquera sobre envío de mercancía desde Londres, y sobre la disolución de la sociedad Jaulerry y Cía. y su reemplazo por la casa comercial Mildred y Goyeneche. Fechadas en Londres

Accuracy of clinical data entry when using a computerized decision support system: a case study with OncoDoc2.

Some studies suggest that the implementation of health information technology (HIT) introduces unpredicted and unintended consequences including e-iatrogenesis. OncoDoc2 is a guideline-based clinical decision support system (CDSS) applied to the management of breast cancer. The system is used by answering closed-ended questions in order to document patient data while navigating through the knowledge base until the best patient-specific recommended treatments are obtained. OncoDoc2 has been used by three hospitals in real clinical settings and for genuine patients. We analysed 394 navigations, recorded on a 10-month period, which correspond to 6,025 data entries. The data entry error rate is 4.2%, spread over 52% of incorrect navigations (N-). However, the overall compliance rate of clinical decisions with guidelines significantly increased from 72.8% (without CDSS) to 87.3% (with CDSS). Although this increase is lowered because of N- navigations (compliance rates are respectively 95% and 80% for N+ and N- navigations), the benefits of HIT outweighted its disadvantages in our study