[Evaluation of 114 abnormal Pap smear follow-up in ambulatory care.] / Évaluation du suivi de 114 femmes ayant présenté un frottis cervico-utérin pathologique en ambulatoire.

AIM: In France, cervical cancer screening has led to a decrease in mortality, though it could be optimized by improving the management of abnormal cytology. The aim was to evaluate the follow-up of women with abnormal Pap smear prescribed by an ambulatory health professional, compared to the ANAES guidelines of 2002. METHOD: Quantitative monocentric and retrospective study of 120 women with abnormal Pap smear performed before October 2014 in the French department of the Loire. RESULTS: 114 abnormal Pap smear follow-ups of women between the ages of 18 and 75 have been analyzed. Cytological abnormalities were spread among 90 ASC-US (79%), 16 LSIL (14%), 6 HSIL (5,3%) and 2 ASC-H (1,7%). Compared to the ANAES guidelines, 52% of follow-ups were incomplete, 24% were comprehensive with too long of a delay, and 24% were guidelines compliant. Women under 29 were more likely to have an incomplete follow-up: OR 0,306 [0,116-0,805]. CONCLUSION: In our sample, the analysis of the follow-ups of women with abnormal Pap smear has reflected over screening and lack of conformity, eventually allowing the screened lesion to progress towards cancer. A national screening program could help to improve the quality of a follow-up for these women.

[Automated grouping of terms associated to cardiac valve fibrosis in MedDRA]. / Groupement automatisé de termes liés aux valvulopathies médicamenteuses dans MedDRA.

AIM: To propose an alternative approach for building custom groupings of terms that complements the usual approach based on both hierarchical method (selection of reference groupings in medical dictionary for regulatory activities [MedDRA]) and/or textual method (string search), for case reports extraction from a pharmacovigilance database in response to a safety problem. Here we take cardiac valve fibrosis as an example. METHODS: The list of terms obtained by an automated approach, based on querying ontology of adverse drug reactions (OntoADR), a knowledge base defining MedDRA terms through relationships with systematized nomenclature of medicine-clinical terms (SNOMED CT) concepts, was compared with the reference list consisting of 53 preferred terms obtained by hierarchical and textual method. Two queries were performed on OntoADR by using a dedicated software: OntoADR query tools. Both queries excluded congenital diseases, and included a procedure or an auscultation method performed on cardiac valve structures. Query 1 also considered MedDRA terms related to fibrosis, narrowing or calcification of heart valves, and query 2 MedDRA terms described according to one of these four SNOMED CT terms: "Insufficiency", "Valvular sclerosis", "Heart valve calcification" or "Heart valve stenosis". RESULTS: The reference grouping consisted of 53 MedDRA preferred terms. Our automated method achieved recall of 79% and precision of 100% for query 1 privileging morphological abnormalities, and recall of 100% and precision of 96% for query 2 privileging functional abnormalities. CONCLUSION: An alternative approach to MedDRA reference groupings for building custom groupings is feasible for cardiac valve fibrosis. OntoADR is still in development. Its application to other adverse reactions would require significant work for a knowledge engineer to define every MedDRA term, but such definitions could then be queried as many times as necessary by pharmacovigilance professionals.

Does the distance between the patient's home and the laboratory influence laboratory monitoring of diabetes? / La distance entre domicile du patient et laboratoire influence-t-elle le suivi biologique du diabète ?

Objective: Laboratory tests play an important role in general practice. Access to a clinical laboratory is essential and can potentially influence whether or not these tests are performed. This study assessed the impact of the distance between the patient's home and the clinical pathology laboratory on laboratory monitoring of diabetes. Methods: This was a retrospective observational study conducted over a period of 3 years on a cohort of diabetic patients from 11 clinical pathology laboratories in the Saint-Etienne region. The primary endpoint was at least three HbA1c, one serum creatinine, one lipid profile and one microalbuminuria over a 12-month period. Statistical analysis was based on the following variables: distance between the patient's home and the clinical pathology laboratory, patient's age, their health insurance, type of urban area and the site of blood sampling. Results: Among the 12,773 subjects included, 1,889 (14.8%) complied with the monitoring procedure. The successful monitoring rate decreased by 38% when the distance from the laboratory was more than 5 km (OR 1.38 [1.18 to 1.61]). Monitoring compliance increased with age (OR 0.71 [0.61 to 0.83] for subjects 55-65 years old and 0.61 [0.53 to 0.71] for subjects over 65 years old). However, patients in rural areas and in urban areas with less than 10,000 inhabitants presented better compliance with monitoring than patients living in towns with more than 200,000 inhabitants. Conclusions: Compliance with laboratory monitoring decreased as the distance between the patient's home and the clinical pathology laboratory increased. These results raise the question of the possible role of home sampling and the availability of other relevant tests required for general practice.

Metabolic syndrome is associated with poor memory and executive performance in elderly community residents: the PROOF study.

OBJECTIVE: Aging is associated with a loss of cognitive performance and an increasing occurrence of cardiovascular events. Moreover, cardiovascular risk factors are linked to cognitive impairment and dementia. Whereas individual components of metabolic syndrome (Met S) have been reported to be linked to cognitive decline and dementia, there are very few studies on Met S as a whole. The present study aims to assess the relationship between Met S and its components and cognitive functioning in a cohort of elderly non-demented community residents. DESIGN: Population-based cohort study (PROOF study). Cross-sectional analysis. PARTICIPANTS: Dementia-free community-dwellers aged 65. MEASURES: The PROOF participants underwent an extensive neuropsychological battery at baseline. Summary cognitive measures including memory, attention, and executive performance were created by converting the individual test results to Z scores and computing the average scores within each domain. Each of the three cognitive scores was individually compared between groups as a function of Met S. The cognitive scores and the covariates which were significant in univariate analyses were then included in logistic regression models. RESULTS: A significant association was observed between the presence of metabolic syndrome, poor memory, and executive function even after adjusting for confounding factors (memory: odds ratio: 1.77, p = 0.008; executive functions: odds ratio: 1.91, p = 0.002). CONCLUSIONS: Our study showed that in a sample of elderly community dwellers, Met S was associated with poor memory and executive performance. These results underline the importance of detecting and managing metabolic syndrome components to prevent cognitive impairment and dementia.

Morphological and immunohistochemical analysis in ovaries and fallopian tubes of tamoxifen, letrozole and clomiphene-treated rats.

PURPOSE: Ovarian and tubal dysplasia may be precursors to ovarian cancer. The goal of this study was to check whether these histopathological lesions would be found after ovulation induction using tamoxifen, clomiphene citrate and letrozole. METHODS: Seventy-two rats were divided into four groups. In the first group, 24 rats received normal saline. The second group (16 rats) received clomiphene citrate for six cycles. The third group, divided into two sub-groups of eight rats each, were stimulated with tamoxifen for six cycles, with a dosage, respectively, of 0.4 and 0.8 mg/kg/day. In the last group, eight rats received letrozole 0.1 mg/kg/day and eight other rats received letrozole 0.5 mg/kg/day, for six cycles. Once the six cycles had been completed the rats were killed in order to remove ovaries and tubes for histopathological analysis (morphological, p53 and Ki67 immunohistochemical assessment). RESULTS: Histopathological lesions were found in both ovaries and tubes. The mean ovarian dysplasia score was significantly higher in the tamoxifen group whatever the dosage (p = 0.006 and 0.0002) and in the letrozole group with 0.5 mg/kg/day (p = 0.0002) compared with the control group. The mean tubal dysplasia score was significantly higher in all groups that received drug treatment compared with the control group, whatever the dosage used. The proliferation index (Ki67) was significantly higher in the tamoxifen and letrozole groups while no significant difference was found for apoptosis marker p53. CONCLUSIONS: Ovulation induction may induce histopathological abnormalities in ovaries and tubes with a different immunohistochemical profile in comparison with salpingo-oophorectomies for genetic risk.

Endometrial biopsy performed before the first in vitro fertilization does not impact the early pregnancy rate.

Endometrial biopsy (EB) has been showed to increase the rate of clinical pregnancy in patients who underwent in vitro fertilization (IVF) failures. The purpose of this work was to assess the impact of an EB performed before the first in IVF on the early pregnancy rate. Be One study is a prospective, single-centre, randomized, open-label study. In this parallel study, patients were evenly split into two groups. In one group, patients underwent an EB between days 17 and 22 of the menstrual cycle that precedes the ovarian stimulation. In the other group (control), no EB was performed. The hCG-positive rate (early pregnancy rate) was evaluated on day 14 after the ovarian puncture. In total, 157 patients were randomized in the EB group and 154 patients were in the control group. The early pregnancy rate was 33.1% (52/157) in the EB group and 29.9% (46/154) in the control group (p = 0.54). Other parameters, including perforation, endometritis, or pain level were reassuring. An EB performed during the luteal phase of the menstrual cycle preceding the stimulation of the first IVF did not increase early pregnancy rate.

[The impact of a general practitioner training program on the colorectal cancer screening participation rate]. / Impact d'une formation pour les médecins généralistes sur la participation au dépistage du cancer colorectal.

AIM: Colorectal cancer mortality in France in 2011 was 13.8/100,000 men and 8.2/100,000 women. As participation in mass screening remains insufficient, training was proposed to general practitioners in the Drôme-Ardèche departments. The objective of this study was to assess the impact of this training after one year. METHODS: This study compared a group of trained volunteers with the other general practitioners in the two departments. The participation rate was measured in patients aged 50 to 74 years examined during the year following the training programme. The participation rate was then assessed on the total population of patients aged 50 to 74 seen by each practitioner, and the practitioner's degree of conviction (tests performed / test kits delivered) and the clarity of instructions (interpretable tests / tests performed) were assessed. RESULTS: Thirty-five general practitioners attended the training programme in Spring 2011. The number of tests performed in this group of trained GPs was 0.29 per target patient examined (vs 0.17 among the 604 practitioners who did not attend the training programme) with a significant difference (p < 0.0001). The number of tests performed on the total patient population aged 50 to 74 was 0.24 per patient (vs 0.14) with p < 0.001. The conviction index was 0.85 (vs 0.90) with p < 0.0008 and the clarity of instructions index was 0.94 (vs 0.93) (p not significant). CONCLUSION: The training programme had a limited impact on participation in colorectal cancer screening, but trained practitioners nevertheless distributed more test kits and more tests were performed.

Method for mapping the French CCAM terminology to the UMLS metathesaurus.

The French coding system of surgical procedures, the Classification Commune des Actes Médicaux (CCAM), is used in France for DRG databases and fee for services payment. Mapping between CCAM and other clinical procedures terminologies by the means of UMLS metathesaurus is essential in order to increase semantic interoperability between different healthcare terminologies and between different case mix systems. In a previous work the CISMeF team used an automatic approach to map CCAM descriptors to the French part of the UMLS metathesaurus. In another way for the French funded research project InterSTIS, we performed a mapping using MetaMap based on the top level semantic structure descriptors of anatomy and action of CCAM translated from French to English. This paper aims to present this new approach and to compare the results with the previous one. The combination of both approaches significantly improved the coverage of the mapping to 68 % for both descriptors and 95 % for at least one descriptor.

Fetal Movement Counting in Prolonged Pregnancies: The COMPTAMAF Prospective Randomized Trial.

In prolonged pregnancies, the risks of neonatal morbidity and mortality are increased. The aim of this trial was to assess the benefits of maternal information about fetal movement (FM) counting on neonatal outcomes in prolonged pregnancy. It was a prospective, single center, randomized, open-label study conducted from October 2019 to March 2022. Intention-to-treat analyses were performed on 278 patients randomized into two 1:1 groups (control group and FM counting group). The primary outcome was a composite score of neonatal morbidity (presence of two of the following items: fetal heart rate abnormality at delivery, Apgar score of <7 at 5 min, umbilical cord arterial pH of <7.20, and acute respiratory distress with mutation in neonatal intensive care unit). There was no significant difference between the two groups in the rate of neonatal morbidity (14.0% in the FM counting group versus 22.9% in the standard information group; p = 0.063; OR 0.55, 95% CI 0.29−1.0). In this study, fetal movement counting for women in prolonged pregnancy failed to demonstrate a significant reduction in adverse neonatal outcomes.

Prevalence of cardiovascular risk factors in a population of French firefighters.

Firefighters' activities increase the risk of sudden cardiac events. The main objective of this study was to describe the Loire firefighters' cardiovascular risk factors according to their cardiovascular risk and to their professional status. A retrospective study of the entire population of firefighters of the Loire department was conducted. Risk factors derived from the data collected during the occupational health follow-up medical examinations were described and the cardiovascular risk was assessed for 417 firefighters. The most frequent cardiovascular risk factors were: overweight and obesity (62.1%), high blood pressure (27.8%) and active smoking (16,1%). There were no significant differences between career firefighters and volunteers. The prevalence of risk factors for cardiovascular diseases is less than in the general population. Obesity remains the most common risk factor, especially among firefighters with high cardiovascular risk.

Sleep quality and sleep disturbances among volunteer and professional French firefighters: FIRESLEEP study.

BACKGROUND: Although insufficient sleep among firefighters reduces work efficiency and increases the risk of injury, little is known about the sleep quality of French firefighters in the Loire department. The aim of the FIRESLEEP study was to evaluate sleep quality and sleep disturbances among professional and voluntary French firefighters. METHODS: A cross-sectional observational study was conducted between November 2018 and May 2019. Firefighters were invited to complete a questionnaire on a secure platform including clinical questions and validated questionnaires (Pittsburgh Sleep Quality Index [PSQI], Epworth sleepiness scale [ESS], Insomnia Severity Index [ISI] and the STOP-Bang score) during their periodic medical examination. RESULTS: 193 firefighters were included in this study, of which 29% were of professional status and 71% were volunteer firefighters. Among them, 26.9% had poor sleep quality, 27.7% showed excessive daytime sleepiness (EDS), 18.8% reported moderate-to-severe symptoms of insomnia, and 1.6% had moderate-to-high risk of obstructive sleep apnea. Subgroup analysis revealed that professional firefighters had poorer sleep quality and higher sleep disturbances than volunteer firefighters. The independent risk factors associated with poor sleep quality were known sleep disorder, treated anxiety/depression, night calls, and insomnia symptoms. Moreover, the independent risk factors associated with EDS were short sleep duration, taking a nap, and insomnia symptoms; while older age was a protective factor for EDS. CONCLUSIONS: Poor sleep quality and sleep disturbances are highly frequent in French firefighters and underdiagnosed. Prevention through education and systematic screening could limit the impact of sleep disturbances on firefighters' global health.

Efficiency of an Optimized Care Organization in Fibromyalgia Patients: The From Intent to Move (FIMOUV) Study Protocol of a Randomized Controlled Trial.

Introduction: Fibromyalgia (FM) is characterized by multiple symptoms including pain, fatigue, and sleep disorders, altering patient's quality of life. In the absence of effective pharmacological therapy, the last European guidelines recommend a multidisciplinary management based on exercise and education. Thus, our main objective was to measure the effectiveness of a healthcare organization offering a specific program of adapted physical activity combined with a therapeutic education program for FM patients. Methods and Analysis: The From Intent To Move (FIMOUV) study will recruit 330 FM patients randomized into two groups: test and control. The test group will benefit from a 1-month mixed exercise training program supervised at the hospital, followed by 2 months in a community-based relay in a health-sport structure. In addition, each of the two groups will benefit from therapeutic patient education sessions. The main endpoint is the measurement of the level of physical activity by accelerometry at 1 year. The secondary endpoints concern adherence to the practice of physical activity, impact on lifestyle, state of health, and physical capacity, as well as an estimate of the budgetary impact of this management strategy. Discussion: This interventional research will allow us to assess the evolution of behaviors in physical activity after an FM syndrome management based solely on patient education or based on a supervised and adapted practice of physical activity associated with this same therapeutic education program. It seems to be the first study evaluating the impact of its intervention on objective data for measuring physical activity and sedentary behavior via accelerometry among FM patients. Trial registration: ClinicalTrials.gov NCT04107948.

Primary central nervous system lymphoma: immunohistochemical profile and prognostic significance.

Primary central nervous system lymphoma (PCNSL) is a rare subtype of non-Hodgkin lymphoma (NHL) with extranodal location affecting only the CNS, meninges and eye, without visceral or lymph node involvement. Its incidence has increased sharply over the past three decades, especially in immunocompetent subjects. Most PCNSL cases are diffuse large B-cell lymphomas (DLBCLs). However, it differs from nodal DLBCL in that it has a worse prognosis. DLBCLs are a heterogeneous entity and according to new genomic discoveries, classifications into prognostic subgroups have been embarked upon. Two prognostic algorithms were then prepared using a panel of immunohistochemical markers (CD10, Bcl6, MUM1/IRF-4, and Bcl2), thus categorizing DLBCL into two subgroups, GCB (germinal centre B-cell-like) or non-GCB, and into Group 1 or Group 2. Our goal is to apply both of these two sub-classifications to 39 PCNSLs, in order to assess their usefulness and prognostic relevance. 74.3% of our PCNSLs were of a non-GCB phenotype, corresponding to an activated postgerminal origin. They were evenly distributed across G1 and G2. Two- and 5-year overall survival rates were 34.8% and 19.6%, respectively. Younger age (<65) and a therapeutic combination of chemotherapy and radiotherapy significantly improved our patients' survival rates. The other clinical or biological markers tested had no prognostic impact. The two classifications did not reveal any significant survival difference. The recent discovery of a specific "transcriptional signature" of PCNSL, marking them out of DLBCL could account for the irrelevance of such prognostic classifications to PCNSL.

Immediate Benefit of Art on Pain and Well-Being in Community-Dwelling Patients with Mild Alzheimer's.

OBJECTIVE: The present report aims to evaluate whether singing intervention can bring an immediate benefit that is greater than the one provided by painting intervention on pain and well-being. METHODS: Fifty-nine mild patients with Alzheimer disease were randomized to a 12-week singing (n = 31) or painting group (n = 28). In the present analysis, the immediate evolution of pain and well-being was compared across sessions between the 2 groups using mixed-effects models. RESULTS: We observed a significant improvement in well-being for both singing and painting groups immediately after sessions, compared to the assessment before the sessions. We did not observe this improvement across the sessions for pain intensity measurement. DISCUSSION: Our results revealed that both painting and singing interventions provide an immediate benefit on the patients' well-being.

Using the CEN/ISO standard for categorial structure to harmonise the development of WHO international terminologies.

Semantic interoperability (SIOp) is a major issue for health care systems having to share information across professionals, teams, legacies, countries, languages and citizens. The World Health Organisation (WHO) develops and updates a family of health care terminologies (ICD, ICF, ICHI and ICPS) and has embarked on an open web-based cooperation to revise ICD 11 using ontology driven tools. The International Health Terminology Standard Development Organisation (IHTSDO) updates, translates and maps SNOMED CT to ICD 10. We present the application of the CEN/ISO standard on categorial structure to bind terminologies and ontologies to harmonise and to map between these international terminologies.

Ontological representation of adverse drug reactions using the Foundational Model of Anatomy.

In a previous work we proposed a categorial structure for the representation of adverse drug reactions consisting of 16 semantic categories and 20 relations. We present an implementation of this categorial structure in Protégé based on four WHO-ART system organ classes: Gastro-intestinal system disorders, Liver and biliary system disorders, Central & peripheric nervous system disorders, and Psychiatric disorders. We compared classification according to anatomy using SNOMED CT within the PharmARTS tool and the FMA with the Pellet reasoner. This ontology contains 210 concepts for Gastroenterology, 66 concepts for Psychiatry and 85 concepts for Neurology. Classification of disorders located in the upper gastro intestinal tract was similar using both SNOMED CT and the FMA. This work is a first step towards the comparison of two models of anatomy within a common ontology of adverse drug reactions.

A prospective, randomized study evaluating the pain felt during intrauterine device insertion by the direct technique vs conventional technique.

OBJECTIVE: To assess the value of the direct insertion technique compared to the conventional insertion technique in reducing the pain experienced during placement of an intrauterine device (IUD). METHODS: A prospective, controlled, randomized, single-blind trial was conducted in women eligible for IUD insertion. Participants were randomized into two groups: "conventional placement" and "direct placement". The primary endpoint was the percentage of women reporting pain scored as ≥ 4 on the Numerical Verbal Rating Scale (NVRS) at IUD release. Secondary endpoints comprised the number of immediate incidents (insertion failure, vasovagal reaction, and IUD expulsion), the correct positioning of the IUD, checked by ultrasound, the occurrence of incidents within the week following IUD insertion, and the operators' evaluation of the procedure. RESULTS: A total of 60 patients were enrolled. During IUD insertion, 27 women (45.8%) reported an NVRS score ≥ 4, 32.1% in the "direct placement" group and 58.1% in the "conventional placement" group (p = 0.07). The median NVRS pain scores in the "direct placement" and "classic placement" groups were 2 and 4, respectively (p = 0.01). No statistically significant between-group differences were found with regard to the secondary endpoints. CONCLUSION: Use of the direct technique reduced the pain experienced during IUD placement. We observed a trend towards a decreased proportion of patients reporting an NVRS pain score ≥ 4 at IUD release with use of the direct technique and the median pain intensity scored on the NVRS was significantly lower in this group. The two techniques did not differ with respect to complications.

Standards and biomedical terminologies: the CEN TC 251 and ISO TC 215 categorial structures. A step towards increased interoperability.

Among different biomedical terminologies standardisation strategies the European Standard Body CEN TC 251 followed by the ISO TC 215 have stated that it was not possible to convince the different European or international member states using different national languages to agree on a reference clinical terminology or to standardise a detailed language independent biomedical ontology. Since 1990, they have developed an approach named categorial structure as a step standardising only the terminologies model structure. The methodology and the review of the different existing categorial structures are presented as a step towards increased interoperability between biomedical terminologies thanks to conformity to a minimum set of ontological requirements.

Scrutinizing SNOMED CT's Ability to Reconcile Clinical Language Ambiguities with an Ontology Representation.

An important SNOMED CT use case is to support semantic interoperability between electronic health records and aggregation terminologies such as ICD. From the ongoing alignment exercise between SNOMED CT and the new version of ICD, now in its pre-final form, we studied whether the ambiguity of clinical language as displayed by SNOMED CT synonyms hampers the quality of SNOMED CT axioms following the SNOMED CT "concept model". We measure the rate of synonyms in the semantic misalignment between classes from the chapter on circulatory diseases of the ICD-11 beta version and SNOMED CT concepts with the same description names. Our study confirms that SNOMED CT synonyms are ambiguous and that there is a need to increase the number of SNOMED CT fully defined representations of Fully Specified Names (FSN), and of synonyms independently of their relations.