Recording and podcasting of lectures for students of medical school.

Information and communication technology (ICT) becomes an important way for the knowledge transmission, especially in the field of medicine. Podcasting (mobile broadcast content) has recently emerged as an efficient tool for distributing information towards professionals, especially for e-learning contents.The goal of this work is to implement software and hardware tools for collecting medical lectures at its source by direct recording (halls and classrooms) and provide the automatic delivery of these resources for students on different type of devices (computer, smartphone or videogames console). We describe the overall architecture and the methods used by medical students to master this technology in their daily activities. We highlight the benefits and the limits of the Podcast technologies for medical education.

An open repositories network development for medical teaching resources.

The lack of interoperability between repositories of heterogeneous and geographically widespread data is an obstacle to the diffusion, sharing and reutilization of those data. We present the development of an open repositories network taking into account both the syntactic and semantic interoperability of the different repositories and based on international standards in this field. The network is used by the medical community in France for the diffusion and sharing of digital teaching resources. The syntactic interoperability of the repositories is managed using the OAI-PMH protocol for the exchange of metadata describing the resources. Semantic interoperability is based, on one hand, on the LOM standard for the description of resources and on MESH for the indexing of the latter and, on the other hand, on semantic interoperability management designed to optimize compliance with standards and the quality of the metadata.

An ECG analysis interactive training system for understanding arrhythmias.

The ECG remains a daily diagnostic tool for the detection of numerous cardiovascular diseases. Our goal was to use a computerized qualitative model (QM) of heart in order to build cases of simple arrhythmias dedicated to initial and more advanced medical teaching. The original QM is able to generate videograms of many cardiac disturbances. A Flash player is used to view ECG, synchronous Lewis diagram and chromatic 2D cardiac animation of a specific case. OAAT is a standardized 18 yes/no answers questionnaire which allows the learner to diagnose five main types of arrhythmias that can be compared with normal sinus rhythm (NSR) analysis. This new tool has been recently used by medical students during practical sessions. Based on medical reasoning learning on NSR video and upon trying to recognize an abnormal cardiac rhythm, all users can reach the 100% winning score since they can perform as many attempts as they like. We believe that unlimited case review with questionnaire answering, ECG and Lewis diagram replay and step-by-step visualization of the abnormal propagation of the cardiac impulse on the 2D heart videos are a highly efficient means to help students understand even complex arrhythmic mechanisms.

Managing an emergency department by analysing HIS medical data: a focus on elderly patient clinical pathways.

INTRODUCTION: The objective of this paper is to present complementary views of the activity of the emergency department for a specific group of patients. Once validated, these views will be used as decision support tools for better managing the department and providing better care delivery for this population. The views are produced from the data stored in Healthcare Information Systems that correspond potentially to a vast source of information for supporting decisions on management or public health issues. METHOD: The study focuses on two groups of patients: the elderly population (over 75-years-old) and the under 75-year-old patients, at the Rennes hospital. The validation of the views is performed by comparing results for the two distinct groups. Relevant data were extracted from the Emergency Department database. Several analysis (like cusum chart) and representation tools (Graphviz) were used to study the patients' pathways, the dynamics of arrivals and the patients' characteristics. RESULTS: The representations provided a synthetic, global and comprehensive view of the department activities, to the satisfaction of the clinicians. The study showed that ICD-10 coding, assigned at the patient's departure from the emergency department hence from all available known clinical data, is not appropriate for the elderly population as these patients are mainly diagnosed by "symptoms" and several solutions are proposed. Finally, it is stressed out that a proper delivery of care to elderly patients should require some level of scheduling in the emergency department that is by essence characterized by its non scheduled activity.

Modelling access to renal transplantation waiting list in a French healthcare network using a Bayesian method.

Evaluation of adult candidates for kidney transplantation diverges from one centre to another. Our purpose was to assess the suitability of Bayesian method for describing the factors associated to registration on the waiting list in a French healthcare network. We have found no published paper using Bayesian method in this domain. Eight hundred and nine patients starting renal replacement therapy were included in the analysis. The data were extracted from the information system of the healthcare network. We performed conventional statistical analysis and data mining analysis using mainly Bayesian networks. The Bayesian model showed that the probability of registration on the waiting list is associated to age, cardiovascular disease, diabetes, serum albumin level, respiratory disease, physical impairment, follow-up in the department performing transplantation and past history of malignancy. These results are similar to conventional statistical method. The comparison between conventional analysis and data mining analysis showed us the contribution of the data mining method for sorting variables and having a global view of the variables' associations. Moreover theses approaches constitute an essential step toward a decisional information system for healthcare networks.

Design of an automatic coding algorithm for a multi-axial classification in pathology.

An algorithm for automatic coding of pathology reports using a multi-axial codification (ADICAP) is described and evaluated. It extracts << significant words >> or expressions from a corpus and records the statistical relationships between them and the modalities of the different axes. Different weighting functions are evaluated. With the best settings, in more than two cases out of three the correct modality was found among the top 5 list of candidates, except for the << organ >> axis. Several ways of improvement are discussed especially regarding the poor results on the << organ >> axis. Perspectives of a two stages assembling algorithm completing this first step are proposed.

Towards a decision support system for optimising clinical pathways of elderly patients in an emergency department.

UNLABELLED: Data stored in Healthcare Information Systems correspond potentially to a vast source of information for supporting decisions in management or public health issues. The presented study illustrates clinical data valuation, through the analysis of clinical pathways of elderly patients at the Emergency Department (ED) of Rennes hospital. METHOD: Relevant data were extracted from the Emergency Department database. Several analysis (e.g., cusum method) and representation tools (e.g., Graphviz) were used to study the patients' pathways, the dynamics of flows and the patients' characteristics. RESULTS: 4951 admissions were analysed and visualized. The representations provided a synthetic, global and comprehensive view of the department activities, to the satisfaction of the clinicians. Limitations of the ICD-10 coding of the diagnoses at the ED were pointed out as well as syntax and semantic interoperability issues. A solution is proposed for automating and scaling the Decision Support System.

A model for a regional health information network sharing clinical information between professionals in Britanny.

The purpose of this paper is to present a generic model of information system supporting healthcare networks for health professionals in Brittany. This model is aimed to develop cooperation between hospital professionals, primary care and practitioners whatever the specific pathology, by providing tools for exchanging and sharing medical-related data. The model is designed based on the heterogeneity factors revealed by a prospective survey. It includes secured exchange of nominative medical data, all other information and activities being accessible by a Web portal. Other associated tools are a synchronous collaborative platform, and a e-learning module. The first implementation, currently in use by the professionals, is presented for the existing neurology healthcare networks.

Multimedia and physiology: a new way to ensure the quality of medical education and medical knowledge.

BACKGROUND: since the eighties and the existence of virtual campuses, the value of computers in distance education has been acknowledged. The development of information and communication technologies is driving at discriminating distance education and on-line education. PURPOSE: the aim of the "Campus Numérique de Physiologie" is not to reproduce an on-line copy of classical textbooks but to put at students' and physicians' disposal the huge possibilities of multimedia resources for an active and easier understanding of complex physiopathological phenomena. METHODS: the on-line course materials were created using both original IBC-made and registered trade-mark software tools. Multiscale modelling and corresponding knowledge bases were implemented by mathematicians, biologists and software engineers from Rennes. The website, which is accessible through a server of the French Virtual Medical University, was developed in the language HTML/PHP connected to a MySQL database. RESULTS: the content managing system is consistent with classical home page facilities and multicriteria browser. Interactive resources are freely available for the site's users. Two- and three-dimensional simulations born out of mathematical qualitative and quantitative models at the molecular, cellular or organic level keep students active with regards to fundamental mechanisms by interactively manipulating the simulation environment. CONCLUSION: authors comment the already available course materials which should stimulate the creation of new documents following a validation by a qualified commission of the "Société de Physiologie". Providing evaluation tests, teachers anticipate that the increasing content of this virtual campus will allow users to gain a complete understanding and an integrative view of many physiopathological mechanisms.

Grepator: accents & case mix for thesaurus.

There is a real need among researchers and students for pedagogical resources. In France, information retrieval techniques have been developed, for example in the Doc'CISMeF web site. As Pubmed, documents are indexed with (French) MeSH terms, one of the problems discovered, in quality studies, is the inadequacies between the user requests and the MeSH controlled vocabulary. Moreover, French (but also Greek or Spanish), pose specific problems for indexing, due to the diacritic characters.In this article, we present the Grepator project. The main goal is to transform any thesaurus (or any entry) in case mix and accentuated characters, for a specific domain. Furthermore, Grepator has to complete MeSH terms according to their usual form in natural language and finally, to correct user spelling mistakes. Grepator is based on a statistical approach. A large French medical corpus has been constituted from pedagogical resources indexed in CISMeF. Using regular expressions, Grepator searches the more usual ways to spell the word.. Seventy five percent of MeSH terms are found in the corpus, using this method, with less than one mistake for a hundred words. This first evaluation of the tools is analyzed and we discuss further steps that might be developed.

Construction of an instrument for measuring medical student satisfaction with virtual campus.

In France, the virtual campus became a pedagogical tool used in the medical education in year 2000. Therefore, it is appropriate to measure the student satisfaction, user of virtual campus. The objective of this research was to develop a student satisfaction instrument adapted to the medical field. Based on the literature, we obtained 36-item questionnaire, using 5-point Likert-type scale. 80 students in the Faculty of Medicine at the Nantes University participated to this survey. In this study, two analyses were conducted, the first included all the items and the second excluded items for which a high rate of non response were found. The results show that the instrument contains three dimensions: 'self evaluation - tutorial', 'appropriateness of content' and 'user-friendliness'. Nevertheless, this exploratory study need to be validated with a greater sample of students.

Indexing method of digital audiovisual medical resources with semantic Web integration.

Digitalization of audiovisual resources and network capability offer many possibilities which are the subject of intensive work in scientific and industrial sectors. Indexing such resources is a major challenge. Recently, the Motion Pictures Expert Group (MPEG) has developed MPEG-7, a standard for describing multimedia content. The goal of this standard is to develop a rich set of standardized tools to enable efficient retrieval from digital archives or the filtering of audiovisual broadcasts on the Internet. How could this kind of technology be used in the medical context? In this paper, we propose a simpler indexing system, based on the Dublin Core standard and compliant to MPEG-7. We use MeSH and the UMLS to introduce conceptual navigation. We also present a video-platform which enables encoding and gives access to audiovisual resources in streaming mode.

MeSH and specialized terminologies: coverage in the field of molecular biology.

There is real need among researchers for data in molecular biology, due to the explosive development in this field. Information extraction techniques have been developed in this specific domain, to extract structured information from the literature. The National Library of Medicine provides access to 12 million MEDLINE citations, accessible via PubMed. Information retrieval techniques which are used to select documents that are relevant according to user request. As other domains in medicine, biomolecular scientific literature is indexed by MeSH terms. Automatic identification of protein and gene names in scientific articles is an important step in the indexing process, since proteins and genes are often associated with multiple names, and authors alternate between these synonyms. In this article we assess the contribution of specialized terminologies in the field of molecular biology compared to MeSH.

Towards the automatic generation of biomedical sources schema.

Biologists and physicians need to access biological and medical data for their experimentations and researches. This information is available on the Internet and is scattered over many heterogeneous data sources. Collecting information is consequently tedious, time consuming and must be improved. To cope with this difficulty, our overall objective is to realize a mediator-based system to integrate heterogeneous biomedical data sources. This requires first an automatic generation of source schema, which is the goal of this work. For that, we describe an algorithm which is based on information extraction. It consists of the extraction of meta-information from each source to infer their schema. Our system enables users to access relevant and specific data, which are up-to-date. To solve the semantic heterogeneity of data sources, we are considering the creation of an ontology. Finally, the management of source evolution is discussed

Experiments in cross-language medical information retrieval using a mixing translation module.

Given the ever-increasing scale and diversity of medical literature widely published in English on the Internet, improving the performance of information retrieval by cross-language is an urgent research objective. Cross-language medical information retrieval (CLMIR) consists of providing a query in one language and searching medical document collections in one or more different languages. Our users of CLMIR are users who are able to read biomedical texts in English, but have difficulty formulating English queries. This paper proposes a French/English CLMIR system as a mixing model for supporting the retrieval of English medical documents. Methods fall into the category of query translation approach in which we use a hybrid machine translation that combines a pattern-based module with a rule-based translator and includes three steps from pre- to- post-translation. In parallel to this hybrid machine translation, we use multilingual UMLS Methasaurus as a complementary translator. The results show that using a mixing translation module outperforms machine translation-based method and thesaurus-based method used separately.

Beds Simulator 1.0: a software for the modelisation of the number of beds required for a hospital department.

The determination of the number of beds needed for a hospital department is a complex problem that try to take into account efficiency, forecasting of needs, appropriateness of stays. Health authority used methods based on ratios that do not take into account local specificities and use rather to support an economic decision. On the other side, the models developed are too specific to be applied to all type of hospital department. Moreover, all the solutions depend on the LoS (Length of Stay). We have developed a non parametric method to solve this problem. This modelisation was successfully tested in teaching and non teaching hospitals, for an Intensive Care Unit, two Internal Medicine and a surgical departments. A software easy to use was developed, working on Windows available on our website www.sante.univ-nantes.fr/med/stat/.

A frame-based representation of ICD-10.

UNLABELLED: Physicians are required to code information concerning a patient's stay in order to measure the medical activity in hospitals. They use the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). Coding is usually performed manually and computerized tools may be useful in speeding up and facilitating the tedious task of coding patient information. The aim of this work is to build a surface semantic model of ICD-10 in order to ameliorate a coding help system. METHODS: This work was focused on chapter XI of the ICD-10, Diseases of the Digestive System. Each term from both analytical and alphabetical indexes about this chapter were submitted to a morphological analysis in order to extract the medical concepts within. After a statistical analysis of these concepts and the way they connect themselves, a semantic model based on a "semantic frame" approach was built. RESULTS: Although this model could represent a reasonable amount of medical knowledge within chapter XI of the ICD-10 in a quite satisfactory way, it shows lack of efficiency for some other chapters. CONCLUSION: Difficulties have to be overcome when modelling a classification meant for manual utilisation, and a lot of work still has to be done to obtain an effective coding help system using the ICD-10.

A contextual coding system for transplantation and end stage diseases.

The Establissement français des Greffes (EfG) is a state agency dealing with Public Health issues related to organ, tissue and cell transplantation in France. EfG maintains a national information system (EfG-IS) for the evaluation of organ transplantation activities. The EfG-IS is moving toward a new n-tier architecture comprising a terminological server. Because this terminological server is shared by various kind of transplant teams and dialysis centers to record patients data at different time point, contextualisation of terms appeared as a functional requirement. We report in this paper various contexts for medical terms and how they have been taken into account.

Method for automatic management of the semantic network ambiguity in the UMLS: possible application for information retrieval on the Web.

The Unified Medical Language System (UMLS) is an extensive collection of terms and concepts. The UMLS includes biomedical terms from standard classifications. The semantic network (SN) links the concepts, sometimes ambiguously. In this paper we try, on one hand to describe the relationship between concepts more efficiently and on the other hand to find new relationships. Assuming that re-usability and automatic extraction of knowledge from existing thesaurus enables an improvement of the metatheasaurus, we cross the SN with linked concepts from the ADM (Assisted Medical Diagnosis). Results are presented and our discussion concerns firstly the use of the SN only; secondly the improvement that allows pre-selection of linked concepts, and thirdly the possibility to coincide with other developments that improve the metathesaurus.

Medical pedagogical resources management.

The main objective of this work is to help the management of training resources for students using a pedagogical network available at the Medical School of Rennes. With the increase of the number of connections and the number of medical documents available on this network, the management of new contents requires a lot of efforts for the webmaster. In order to improve the management of the resources, we implemented an automatic web engine for teachers, able to manage the links for the most interesting resources for their practice.