How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines

<p>Abstract</p> <p>Background</p> <p>Clinical practice guidelines give recommendations about what to do in various medical situations, including therapeutical recommendations for drug prescription. An effective way to computerize these recommendations is to design critiquing decision support systems, <it>i.e</it>. systems that criticize the physician's prescription when it does not conform to the guidelines. These systems are commonly based on a list of "if conditions then criticism" rules. However, writing these rules from the guidelines is not a trivial task. The objective of this article is to propose methods that (1) simplify the implementation of guidelines' therapeutical recommendations in critiquing systems by automatically translating structured therapeutical recommendations into a list of "if conditions then criticize" rules, and (2) can generate an appropriate textual label to explain to the physician why his/her prescription is not recommended.</p> <p>Methods</p> <p>We worked on the therapeutic recommendations in five clinical practice guidelines concerning chronic diseases related to the management of cardiovascular risk. We evaluated the system using a test base of more than 2000 cases.</p> <p>Results</p> <p>Algorithms for automatically translating therapeutical recommendations into "if conditions then criticize" rules are presented. Eight generic recommendations are also proposed; they are guideline-independent, and can be used as default behaviour for handling various situations that are usually implicit in the guidelines, such as decreasing the dose of a poorly tolerated drug. Finally, we provide models and methods for generating a human-readable textual critique. The system was successfully evaluated on the test base.</p> <p>Conclusion</p> <p>We show that it is possible to criticize physicians' prescriptions starting from a structured clinical guideline, and to provide clear explanations. We are now planning a randomized clinical trial to evaluate the impact of the system on practices.</p

Cold atoms in space: community workshop summary and proposed road-map

We summarise the discussions at a virtual Community Workshop on Cold Atoms in Space concerning the status of cold atom technologies, the prospective scientific and societal opportunities offered by their deployment in space, and the developments needed before cold atoms could be operated in space. The cold atom technologies discussed include atomic clocks, quantum gravimeters and accelerometers, and atom interferometers. Prospective applications include metrology, geodesy and measurement of terrestrial mass change due to, e.g., climate change, and fundamental science experiments such as tests of the equivalence principle, searches for dark matter, measurements of gravitational waves and tests of quantum mechanics. We review the current status of cold atom technologies and outline the requirements for their space qualification, including the development paths and the corresponding technical milestones, and identifying possible pathfinder missions to pave the way for missions to exploit the full potential of cold atoms in space. Finally, we present a first draft of a possible road-map for achieving these goals, that we propose for discussion by the interested cold atom, Earth Observation, fundamental physics and other prospective scientific user communities, together with the European Space Agency (ESA) and national space and research funding agencies

Cold atoms in space: community workshop summary and proposed road-map

We summarise the discussions at a virtual Community Workshop on Cold Atoms in Space concerning the status of cold atom technologies, the prospective scientific and societal opportunities offered by their deployment in space, and the developments needed before cold atoms could be operated in space. The cold atom technologies discussed include atomic clocks, quantum gravimeters and accelerometers, and atom interferometers. Prospective applications include metrology, geodesy and measurement of terrestrial mass change due to, e.g., climate change, and fundamental science experiments such as tests of the equivalence principle, searches for dark matter, measurements of gravitational waves and tests of quantum mechanics. We review the current status of cold atom technologies and outline the requirements for their space qualification, including the development paths and the corresponding technical milestones, and identifying possible pathfinder missions to pave the way for missions to exploit the full potential of cold atoms in space. Finally, we present a first draft of a possible road-map for achieving these goals, that we propose for discussion by the interested cold atom, Earth Observation, fundamental physics and other prospective scientific user communities, together with the European Space Agency (ESA) and national space and research funding agencies

Cold atoms in space: community workshop summary and proposed road-map

We summarise the discussions at a virtual Community Workshop on Cold Atoms in Space concerning the status of cold atom technologies, the prospective scientific and societal opportunities offered by their deployment in space, and the developments needed before cold atoms could be operated in space. The cold atom technologies discussed include atomic clocks, quantum gravimeters and accelerometers, and atom interferometers. Prospective applications include metrology, geodesy and measurement of terrestrial mass change due to, e.g., climate change, and fundamental science experiments such as tests of the equivalence principle, searches for dark matter, measurements of gravitational waves and tests of quantum mechanics. We review the current status of cold atom technologies and outline the requirements for their space qualification, including the development paths and the corresponding technical milestones, and identifying possible pathfinder missions to pave the way for missions to exploit the full potential of cold atoms in space. Finally, we present a first draft of a possible road-map for achieving these goals, that we propose for discussion by the interested cold atom, Earth Observation, fundamental physics and other prospective scientific user communities, together with the European Space Agency (ESA) and national space and research funding agencies.publishedVersio

Quelle place pour la télémédecine en médecine générale en France en 2010 ?

Malgré une présence dans les textes officiels de plus en plus grande, la télémédecine n'est encore que peu développée en France. En effet, notre panorama ne recense qu'une vingtaine d'expériences, même s'il est difficile de toutes les recueillir du fait du manque de coordination en la matière. L'analyse de quatre de ces projets montre qu'il est possible, sous réserve de respecter certains critères (dont le plus important est la collaboration entre médecins et politiques), d'implanter avec succès la télémédecine en médecine générale en France. Perspective intéressante car elle pourrait s'accorder avec certaines des problématiques actuelles de santé publique qui mènent à la nécessité de réorganiser notre système de santé de premiers secours. À ce titre, on peut citer les dispositifs mobiles utilisés en zones sous-médicalisées. Mais pour favoriser et accompagner cette diffusion il convient de bien cerner les besoins des généralistes et développer des études médico-économiques fiables.RENNES1-BU Santé (352382103) / SudocSudocFranceF

Comparison of statistical frameworks to study the relationship between landscape features and pest insect abundance

National audienc

Relative influence of climate and agroenvironmental factors on wireworm damage risk in maize crops

A large-scale survey was carried out in 336 French fields to investigate the influence of soil characteristics, climate conditions, the presence of wireworms and the identity of predominant species, agricultural practices, field history and local landscape features on the damage caused by wireworms in maize. Boosted regression trees, a statistical model originating from the field of machine learning, were fitted to survey data and then used to hierarchize and weigh the relative influence of a large set of variables on the observed damage. Our study confirmed the relevance of an early assessment of wireworm populations to forecast crop damage. Results have shown that climatic factors were also major determinants of wireworm damage, especially the soil temperature around the sowing date, with a strong decrease in damage when it exceeds 12 °C. Soil characteristics were ranked third in importance with a primary influence of pH, but also of organic matter content, and to a lesser extent of soil texture. Field history ranked next; in particular, our findings confirmed that a long-lasting meadow appeared favourable to wireworm damage. Finally, agriculture practices and landscape context (especially the presence of a meadow in the field vicinity) were also shown to influence wireworm damage but more marginally. Overall, the predicted damage appeared highly correlated with the observed one allowing us to produce the framework of a decision support system to forecast wireworm risk in maize crop

Taupins sur maïs: importance relative des facteurs de risque

National audienc

The French Society of Young Radiation Oncologists: History, goals and perspective

The SFjRO was created ten years ago to promote radiation oncology teaching in France. Our society has now more than 120 members from all around the country. Each year, two national courses are organized where all members are invited