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Author: Emmanuel Chazard (45)


Feb
2018

Influenza epidemics are a major public health concern and require a costly and time-consuming surveillance system at different geographical scales. The main challenge is being able to predict epidemics. Besides traditional surveillance systems, such as the French Sentinel network, several studies proposed prediction models based on internet-user activity.

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Nov
2017

Background Although many anticholinergics are inappropriate in older patients, the prescription of these drugs in a hospital setting has not been extensively studied. Objective To describe prescriptions of anticholinergic drugs in terms of frequency, at risk situations and constipation in hospitalized, older adults. Setting Using a database from a French general hospital (period 2009-2013), we extracted information on 14,090 hospital stays by patients aged 75 and over.

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Dec
1969

The aim of this study was to identify factors associated with the results of smoking cessation attempts.
Data were collected in Clermont-Ferrand from a smoking cessation clinic between 1999 and 2009 (1,361 patients). Smoking cessation was considered a success when patients were abstinent 6 months after the beginning of cessation.

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Nov
2017

Potentially inappropriate prescriptions (PIPs) of antibiotics (antibiotic-PIPs) are generally detected by applying implicit definitions based on expert opinion. Explicit definitions are less frequently used, even though this approach would enable the automated detection of antibiotic-PIPs in electronic health records. Here, explicit definitions of antibiotic-PIPs used in studies of older adults were systematically reviewed.

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Nov
2017

Although many researchers in the field of health economics and quality of care compare the length of stay (LOS) in two inpatient samples, they often fail to check whether the sample meets the assumptions made by their chosen statistical test. In fact, LOS data show a highly right-skewed, discrete distribution in which most of the observations are tied; this violates the assumptions of most statistical tests.
To estimate the type I and type II errors associated with the application of 12 different statistical tests to a series of LOS samples.

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Sep
2017

Several studies have shown that the prescription of antiplatelet therapy (APT) is associated with an increased risk of oral anticoagulant (OAC) underuse in patients aged 75 years and over with atrial fibrillation (AF). An associated atheromatous disease may be the underlying reason for APT prescription. The objective of the study was to determine whether the association between underuse of OAC and APT prescription was explained by the presence of an atheromatous disease.

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Dec
1969

Although the current guidelines recommend anticoagulation up until 6 weeks after delivery in women at high risk of venous thromboembolism (VTE), the risk of VTE may extend beyond 6 weeks. Our objective was to estimate the risk of a pulmonary embolism in successive 2-week intervals during the postpartum period.
In a population-based, case-crossover study, we analyzed the French national inpatient database from 2007 to 2013 (n = 5,517,680 singleton deliveries).

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Dec
2016

Prophylactic anticoagulation is recommended up to 35days after total hip replacement (THR). Although several observational studies have assessed the incidence of thrombotic events or bleeding events after THR, the corresponding measures of association have never been studied concomitantly. Here, we evaluated the duration of the elevated risks (relative to the baseline risk) of both venous thromboembolic events and bleeding events after THR for coxarthrosis among middle-aged patients.

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Mar
2017

The significant risk of adverse events following medical procedures supports a clinical epidemiological approach based on the analyses of collections of electronic medical records. Data analytical tools might help clinical epidemiologists develop more appropriate case-crossover designs for monitoring patient safety.
To develop and assess the methodological quality of an interactive tool for use by clinical epidemiologists to systematically design case-crossover analyses of large electronic medical records databases.

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Jan
2016

Management of vitamin K antagonists (VKAs) is difficult, and overdoses can have dramatic hemorrhagic consequences. The adverse drug event (ADE) scorecards is a tool intended for the detection and description of adverse drug reaction/ADE developed during a European computerized medical data processing project. It is used in a quality assurance process.

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Dec
1969

The objective of the work is to implement and evaluate the automated computation of 9 healthcare quality indicators, by data reuse of electronic health records, in the field of elderly surgical patients.
Data are extracted from EHR, including administrative data, ICD10 diagnoses, laboratory results, procedures, administered drugs, and free-text letters. The indicators are implemented by a medical data reuse specialist.

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Dec
1969

The number of patients that benefit from remote monitoring of cardiac implantable electronic devices, such as pacemakers and defibrillators, is growing rapidly. Consequently, the huge number of alerts that are generated and transmitted to the physicians represents a challenge to handle. We have developed a system based on a formal ontology that integrates the alert information and the patient data extracted from the electronic health record in order to better classify the importance of alerts.

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Mar
2016

Remote monitoring of cardiac implantable electronic devices is a growing standard; yet, remote follow-up and management of alerts represents a time-consuming task for physicians or trained staff. This study evaluates an automatic mechanism based on artificial intelligence tools to filter atrial fibrillation (AF) alerts based on their medical significance.
We evaluated this method on alerts for AF episodes that occurred in 60 pacemaker recipients.

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Dec
1969

In 722 cities of Minas Gerais (Brazil), primary care patients can have their ECGs remotely interpreted by cardiologists of the Telehealth Network of Minas Gerais (TNMG), a public telehealth service. As of December 2014, more than 1.9 million ECGs were interpreted.

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Dec
1969

The aim of this study was to provide a definition of big data in healthcare.
A systematic search of PubMed literature published until May 9, 2014, was conducted. We noted the number of statistical individuals (n) and the number of variables (p) for all papers describing a dataset.

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Dec
1969

The objective of the work is to extract healthcare process quality indicators from the literature, and to evaluate which of them could be automatically computed using routinely collected data from electronic health records (EHRs). A minimal set of data commonly available in EHRs is first defined. The initial bibliographic query enables to identify 8,744 papers, among which 126 papers describe 440 process indicators.

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Dec
1969

Incompleteness of epidemiological databases is a major drawback when it comes to analyzing data. We conceived an epidemiological study to assess the association between newborn thyroid function and the exposure to perchlorates found in the tap water of the mother's home. Only 9% of newborn's exposure to perchlorate was known.

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Dec
1969

Adverse events may increase the hospital length of stay (LOS). As a consequence, computing the mean difference of LOS between two inpatient groups, with or without event, is a convenient way to evaluate their severity. Conversely, some adverse events are time-dependent: this leads to overestimate the consequences of the adverse event when statistical tests are performed.

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Dec
1969

Diagnoses and medical procedures collected under the French system of information are recorded in a nationwide database, the "PMSI national database", which is accessible for exploitation. Quality of the data in this database is directly related to the quality of coding, which can be of poor quality. Among the proposed methods for the exploitation of health databases, data mining techniques are particularly interesting.

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Dec
1969

Administrative data can be used for the surveillance of the outcomes of implantable medical devices (IMDs). The objective of this work is to build a web-based tool allowing for an exploratory analysis of time-dependent events that may occur after the implementation of an IMD. This tool should enable a pharmacoepidemiologist to explore on the fly the relationship between a given IMD and a potential outcome.

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Dec
1969

Under-prescription of anticoagulants in the elderly with atrial fibrillation (AF) has been described in several studies, showing that only 15 to 44% of them receive anticoagulants. However, the European Society of Cardiology recommendations state that anticoagulants should be systematically prescribed. In case of refusal of the treatment by the patient, a platelet aggregation inhibitor should be prescribed in monotherapy or bitherapy according to the HAS-BLED bleeding risk score.

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Feb
2016

In France, over 20% of hospitalizations of elderly people are a result of adverse drug events, of which 50% are considered preventable. Tools have been developed to detect inappropriate prescriptions. The Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria are innovative and adapted to French prescriptions.

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Sep
2014

Adverse drug reactions and adverse drug events (ADEs) are major public health issues. Many different prospective tools for the automated detection of ADEs in hospital databases have been developed and evaluated. The objective of the present study was to evaluate an automated method for the retrospective detection of ADEs with hyperkalaemia during inpatient stays.

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Apr
2014

Medical free-text records enable to get rich information about the patients, but often need to be de-identified by removing the Protected Health Information (PHI), each time the identification of the patient is not mandatory. Pattern matching techniques require pre-defined dictionaries, and machine learning techniques require an extensive training set. Methods exist in French, but either bring weak results or are not freely available.

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Sep
2013

The prevention of adverse drug events (ADEs) demands co-ordination of different health care professionals. ADE scorecards are a novel approach to raise the team awareness regarding ADE risks and causes. It makes information on numbers and on possible causes of possible ADE cases available to the clinical team.

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Dec
1969

Management of vitamin K antagonists (VKA) is difficult, and overdoses can have dramatic hemorrhagic consequences. These works form part of a European computerized medical data processing project, which aims to develop IT tools for describing adverse drug events (ADEs). Materials and methods A tool enabling retrospective research of potential ADE cases was developed, using complex ADE detection rules taking into account chronological parameters: the ADE scorecards.

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Dec
1969

Retrospective detection of Adverse Drug Events (ADEs) is challenging, notably because ADEs result from complex interactions between many factors. Data mining techniques have recently emerged in the field of automated retrospective ADE detection. The "ADE Scorecards" are a research application based on data-mining that has been built in the framework of the PSIP European Project, and potentially enables automated ADE retrospective detection.

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Dec
1969

Hospitals have at their disposal large databases that may be considered for reuse. The objective of this work is to evaluate the impact of a drug on a specific laboratory result by analyzing these data. This analysis first involves building a record of temporal patterns, including medical context, of drug prescriptions.

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Dec
1969

Dehydration secondary to gastroenteritis is one of the most common reasons for office visits and hospital admissions. The indicator most commonly used to estimate dehydration status is acute weight loss. Post-illness weight gain is considered as the gold-standard to determine the true level of dehydration and is widely used to estimate weight loss in research.

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Dec
1969

Several papers propose to take contexts into account for adverse drug events (ADE) detection and prevention, notably to decrease over-alerting of clinical decision support systems (CDSS). However, no statistical argument has been published till now. This works demonstrates, based on statistical analysis, that contextualization is necessary for ADE detection and prevention by 3 steps.

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Dec
1969

In hospital information systems, laboratory results are stored using specific terminologies which may differ between hospitals. The objective is to create a tool helping to build a mapping between a target terminology (reference dataset) and a new one. Using a training sample consisting of correct and incorrect correspondences between parameters of different hospitals, a match probability score is built.

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Nov
2011

Adverse drug events (ADEs) are a public health issue. Their detection usually relies on voluntary reporting or medical chart reviews. The objective of this paper is to automatically detect cases of ADEs by data mining.

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Dec
1969

Although several methods exist for Adverse Drug events (ADE) detection due to past hospitalizations, a tool that could display those ADEs to the physicians does not exist yet. This article presents the ADE Scorecards, a Web tool that enables to screen past hospitalizations extracted from Electronic Health Records (EHR), using a set of ADE detection rules, presently rules discovered by data mining. The tool enables the physicians to (1) get contextualized statistics about the ADEs that happen in their medical department, (2) see the rules that are useful in their department, i.

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Nov
2010

A knowledge-based approach is proposed that is employed for the construction of a framework suitable for the management and effective use of knowledge on Adverse Drug Event (ADE) prevention. The framework has as its core part a Knowledge Base (KB) comprised of rule-based knowledge sources, that is accompanied by the necessary inference and query mechanisms to provide healthcare professionals and patients with decision support services in clinical practice, in terms of alerts and recommendations on preventable ADEs. The relevant Knowledge Based System (KBS) is developed in the context of the EU-funded research project PSIP (Patient Safety through Intelligent Procedures in Medication).

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Dec
1969

This paper presents the design of Adverse Drug Event-Scorecards. The scorecards described are innovative and novel, not having previously been reported in the literature. The Scorecards provide organizations (e.

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Dec
1969

Adverse Drug Events (ADEs) endanger the patients. Their detection and prevention is essential to improve the patients' safety. In the absence of computerized physician order entry (CPOE), discharge summaries are the only source of information about the drugs prescribed during a hospitalization.

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Dec
1969

Every year adverse drug events (ADEs) are known to be responsible for 98,000 deaths in the USA. Classical methods rely on report statements, expert knowledge, and staff operated record review. One of our objectives, in the PSIP project framework, is to use data mining (e.

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Dec
1969

Adverse drug events are a public health issue (98,000 deaths in the USA every year). Some computerized physician order entry (CPOEs) coupled with clinical decision support systems (CDSS) allow to prevent ADEs thanks to decision rules. Those rules can come from many sources: academic knowledge, record reviews, and data mining.

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Dec
1969

An important part of adverse drug events (ADEs) detection is the validation of the clinical cases and the assessment of the decision rules to detect ADEs. For that purpose, a software called "Expert Explorer" has been designed by Ideea Advertising. Anonymized datasets have been extracted from hospitals into a common repository.

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Dec
1969

Adverse drug events (ADEs) are a public health issue. The objective of this work is to data-mine electronic health records in order to automatically identify ADEs and generate alert rules to prevent those ADEs. The first step of data-mining is to transform native and complex data into a set of binary variables that can be used as causes and effects.

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Dec
1969

Our main objective is to detect adverse drug events (ADEs) in former hospital stays. As ADEs are rare, that supposes to screen thousands of electronic health records (EHRs). For that purpose, we need to define a data model that has two main objectives: (1) being able to describe hospital stays from various hospitals (2) being tuned so as to prepare the data mining process: as ADEs are not flagged in the datasets, the data model must be optimized for ADE detection.

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Dec
1969

Adverse Drug Events (ADE) due to medication errors and human factors are a major public health issue. They endanger patient safety and cause considerable extra healthcare costs. The European project PSIP (Patient Safety through Intelligent Procedures in medication) aims to identify and prevent ADE.

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Oct
2007

Representing the patient flow through the hospital is quite a difficult task, considering the amount of data to be taken into account. In this article, some usual visual representations are first shown, then new charts are proposed. Several real examples are given.

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Dec
1969

We developed a completely secured teleradiology solution tailored for e-mail teleradiology applications at low-cost. Data processing consists in creating a couple of files with an encrypted and compressed image archive and a 128 bits decoding key file. No proprietary file format or encryption scheme is used.

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Dec
1969

Confronted with the inadequacy of traditional charts, we tested the contribution of Treemaps to the representation of medical data. Treemap charts allow description of large hierarchical collections of quantitative data, on a synthetic way. Treemaps were implemented using PHP5, and were tested in the field of DRG-mining and other medical informations.

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