Medical record search engines, using pseudonymised patient identity: an alternative to centralised medical records

Purpose The purpose of our multidisciplinary study was to define a pragmatic and secure alternative to the creation of a national centralised medical record which could gather together the different parts of the medical record of a patient scattered in the different hospitals where he was hospitalised without any risk of breaching confidentiality. Methods We first analyse the reasons for the failure and the dangers of centralisation (i.e. difficulty to define a European patients' identifier, to reach a common standard for the contents of the medical record, for data protection) and then propose an alternative that uses the existing available data on the basis that setting up a safe though imperfect system could be better than continuing a quest for a mythical perfect information system that we have still not found after a search that has lasted two decades. Results We describe the functioning of Medical Record Search Engines (MRSEs), using pseudonymisation of patients' identity. The MRSE will be able to retrieve and to provide upon an MD's request all the available information concerning a patient who has been hospitalised in different hospitals without ever having access to the patient's identity. The drawback of this system is that the medical practitioner then has to read all of the information and to create his own synthesis and eventually to reject extra data. Conclusions Faced with the difficulties and the risks of setting up a centralised medical record system, a system that gathers all of the available information concerning a patient could be of great interest. This low-cost pragmatic alternative which could be developed quickly should be taken into consideration by health authorities.

An alternative approach to the prevention of doping in cycling

The article proposes an alternative approach to policies for preventing doping in cycling, based on in-depth analysis of the functioning of nine of the 40 world professional teams and the careers of the 2,351 riders who were or have been professionals since 2005. The first part shows that the instruments of prevention have been based on a questionable understanding of doping as an individual moral fault, and have not produced the expected results. The second part proposes to analyse the ways in which teams and riders produce their achievments, so as to put forward an alternative to the anti-doping policies used hitherto, which have little impact on riders. The study shows that it is more pertinent to examine the forms of employment and the business models, because these have important effects on cycling professionals' conditions of work. It makes it possible to identify three dimensions of the risk of doping on which organisations can act in their antidoping policies: team organisation, riders' preparation and workload, and the precarity of employment.

The evolution of alternative splicing patterns and regulatory mechanisms

Alternative splicing produces multiple isoforms from the same gene, thus increasing the number of transcripts of the species. Alternative splicing is a virtually ubiquitous mechanism in eukaryotes, for example more than 90% of protein-coding genes in human are alternatively spliced. Recent evolutionary studies showed that alternative splicing is a fast evolving and highly species- specific mechanism. The rapid evolution of alternative splicing was considered as a contribution to the phenotypic diversity between species. However, the function of many isoforms produced by alternative splicing remains unclear and they might be the result of noisy splicing. Thus, the functional relevance of alternative splicing and the evolutionary mechanisms of its rapid divergence among species are still poorly understood. During my thesis, I performed a large-scale analysis of the regulatory mechanisms that drive the rapid evolution of alternative splicing. To study the evolution of alternative splicing regulatory mechanisms, I used an extensive RNA-sequencing dataset comprising 12 tetrapod species (human, chimpanzee and bonobo, gorilla, orangutan, macaque, marmoset, mouse, opossum, platypus, chicken and frog) and 8 tissues (cerebellum, brain, heart, kidney, liver, testis, placenta and ovary). To identify the catalogue of alternative splicing eis-acting regulatory elements in the different tetrapod species, I used a previously defined computational approach. This approach is a statistical analysis of exons/introns and splice sites composition and relies on a principle of compensation between splice sites strength and the presence of additional regulators. With an evolutionary comparative analysis of the exonic eis-acting regulators, I showed that these regulatory elements are generally shared among primates and more conserved than non-regulatory elements. In addition, I showed that the usage of these regulatory elements is also more conserved than expected by chance. In addition to the identification of species- specific eis-acting regulators, these results may explain the rapid evolution of alternative splicing. I also developed a new approach based on evolutionary sequence changes and corresponding alternative splicing changes to identify potential splicing eis-acting regulators in primates. The identification of lineage-specific substitutions and corresponding lineage-specific alternative splicing changes, allowed me to annotate the genomic sequences that might have played a role in the alternative splicing pattern differences among primates. Finally, I showed that the identified splicing eis-acting regulator datasets are enriched in human disease-causing mutations, thus confirming their biological relevance.

Mefloquine at the crossroads? Implications for malaria chemoprophylaxis in Europe.

Since its introduction to the market in 1985, mefloquine has been used for malaria chemoprophylaxis by more than 35 million travellers. In Europe, in 2014, the European Medicines Agency (EMA) issued recommendations on strengthened warnings, prescribing checklists and updates to the product information of mefloquine. Some malaria prevention advisors question the scientific basis for the restrictions and suggest that this cost-effective, anti-malarial drug will be displaced as a first-line anti-malaria medication with the result that vulnerable groups such as VFR and long-term travellers, pregnant travellers and young children are left without a suitable alternative chemoprophylaxis. This commentary looks at the current position of mefloquine prescribing and the rationale of the new EMA recommendations and restrictions. It also describes the new recommendations for malaria prophylaxis that have been adapted by Switzerland, Germany, Austria and Italy where chemoprophylaxis use is restricted to high-risk malaria-endemic areas.

Towards an alternative testing strategy for nanomaterials used in nanomedicine: Lessons from NanoTEST.

In spite of recent advances in describing the health outcomes of exposure to nanoparticles (NPs), it still remains unclear how exactly NPs interact with their cellular targets. Size, surface, mass, geometry, and composition may all play a beneficial role as well as causing toxicity. Concerns of scientists, politicians and the public about potential health hazards associated with NPs need to be answered. With the variety of exposure routes available, there is potential for NPs to reach every organ in the body but we know little about the impact this might have. The main objective of the FP7 NanoTEST project ( www.nanotest-fp7.eu ) was a better understanding of mechanisms of interactions of NPs employed in nanomedicine with cells, tissues and organs and to address critical issues relating to toxicity testing especially with respect to alternatives to tests on animals. Here we describe an approach towards alternative testing strategies for hazard and risk assessment of nanomaterials, highlighting the adaptation of standard methods demanded by the special physicochemical features of nanomaterials and bioavailability studies. The work has assessed a broad range of toxicity tests, cell models and NP types and concentrations taking into account the inherent impact of NP properties and the effects of changes in experimental conditions using well-characterized NPs. The results of the studies have been used to generate recommendations for a suitable and robust testing strategy which can be applied to new medical NPs as they are developed.

Phimose : Sind topische Kortikosteroide eine Alternative zur chirurgischen Behandlung [Phimosis : are topical corticosteroids an alternative to surgical treatment?]

Hintergrund: Die physiologische Phimose ist bereits bei der Geburt vorhanden und wächst sich in den meisten Fällen aus. Während 10% der Knaben im Alter von drei Jahren noch eine Phimose haben, nimmt diese Prävalenz auf 6-8% im Alter von sieben Jahren und 1% im Alter von 16 Jahren ab. Man spricht von einer pathologischen Phimose, wenn die Vorhaut Vernarbungen infolge von wiederholten Entzündungen oder forcierten Retraktionsversuchen aufweist. Dennoch ist die Unterscheidung zwischen pathologischer und physiologischer Phimose schwierig, und eine chirurgische Behandlung (Zirkumzision, Vorhautplastik) ist häufig. Eine topische Kortikosteroidbehandlung wird seit mehreren Jahren wegen seiner anti-inflammatorischen und immunsuppressiven Wirkung (Verminderung der Kollagenproduktion) angewendet. Es gibt aber keine Evidenz bezüglich Wirksamkeit und Sicherheit dieser Behandlung.

Phimosis et corticostéroïdes topiques : une alternative au traitement chirurgical? : revue Cochrane pour le praticien

Question clinique: Une mère vous consulte avec son fils âgé de 6 ans, en bonne santé habituelle mais connu pour un phimosis. Il ne présente pas de troubles mictionnels, ni d'antécédents de balanite ou de paraphimosis. Sa mère est inquiète de voir le phimosis persister et vous demande s'il existe une alternative au traitement chirurgical. Contexte: Présent dès la naissance, le phimosis physiologique se résout spontanément dans la majorité des cas. Alors que 10% des garçons présentent un phimosis à l'âge de 3 ans, cette prévalence diminue à 6-8% à l'âge de 7 ans, pour atteindre 1% à l'âge de 16 ans. On parle de phimosis pathologique lorsque le prépuce présente des cicatrices fibreuses suite à des inflammations répétées ou des décalottages forcés. Cependant, la distinction clinique entre un phimosis pathologique et physiologique est difficile et le traitement chirurgical reste fréquent. Un traitement par corticostéroïdes topiques est utilisé depuis de nombreuses années pour son action anti-inflammatoire et immunosuppressive (diminution de la production de collagène). Pourtant, il n'existe pas de preuve quant à l'efficacité et la sécurité de ce traitement.

Traditional local medicines in the republic of Palau and non-communicable diseases (NCD), signs of effectiveness.

ETHNOPHARMACOLOGICAL RELEVANCE: The aim of this survey was to describe which traditional medicines (TM) are most commonly used for non-communicable diseases (NCD - diabetes, hypertension related to excess weight and obesity) in Pacific islands and with what perceived effectiveness. NCD, especially prevalent in the Pacific, have been subject to many public health interventions, often with rather disappointing results. Innovative interventions are required; one hypothesis is that some local, traditional approaches may have been overlooked. MATERIALS AND METHODS: The method used was a retrospective treatment-outcome study in a nation-wide representative sample of the adult population (about 15,000 individuals) of the Republic of Palau, an archipelago of Micronesia. RESULTS: From 188 respondents (61% female, age 16-87, median 48,), 30 different plants were used, mostly self-prepared (69%), or from a traditional healer (18%). For excess weight, when comparing the two most frequent plants, Morinda citrifolia L. was associated with more adequate outcome than Phaleria nishidae Kaneh. (P=0.05). In case of diabetes, when comparing Phaleria nishidae (=Phaleria nisidai) and Morinda citrifolia, the former was statistically more often associated with the reported outcome "lower blood sugar" (P=0.01). CONCLUSIONS: Statistical association between a plant used and reported outcome is not a proof of effectiveness or safety, but it can help select plants of interest for further studies, e.g. through a reverse pharmacology process, in search of local products which may have a positive impact on population health.

Rectal enema is an alternative to full mechanical bowel preparation for primary rectal cancer surgery.

AIM: According to the French GRECCAR III randomized trial, full mechanical bowel preparation (MBP) for rectal surgery decreases the rate of postoperative morbidity, in particular postoperative infectious complications, but MBP is not well tolerated by the patient. The aim of the present study was to determine whether a preoperative rectal enema (RE) might be an alternative to MBP. METHODS: An analysis was performed of 96 matched cohort patients undergoing rectal resection with primary anastomosis and protective ileostomy at two different university teaching hospitals, whose rectal cancer management was comparable except for the choice of preoperative bowel preparation (MBP or RE). Prospective databases were retrospectively analysed. RESULTS: Patients were well matched for age, gender, body mass index and Charlson index. The surgical approach and cancer characteristics (level above anal verge, stage and use of neoadjuvant therapy) were comparable between the two groups. Anastomotic leakage occurred in 10% of patients having MBP and in 8% having RE (P = 1.00). Pelvic abscess formation (6% vs 2%, P = 0.63) and wound infection (8% vs 15%, P = 0.55) were also comparable. Extra-abdominal infection (13% vs 13%, P = 1.00) and non-infectious abdominal complications such as ileus and bleeding (27% and 31%, P = 0.83) were not significantly different. Overall morbidity was comparable in the two groups (50% vs 54%, P = 0.83). CONCLUSION: A simple RE before rectal surgery seems not to be associated with more postoperative infectious complications nor a higher overall morbidity than MBP.

Adjusting for the environment in DEA: a comparison of alternative models based on empirical data

Due to the existence of free software and pedagogical guides, the use of Data Envelopment Analysis (DEA) has been further democratized in recent years. Nowadays, it is quite usual for practitioners and decision makers with no or little knowledge in operational research to run their own efficiency analysis. Within DEA, several alternative models allow for an environmental adjustment. Four alternative models, each user-friendly and easily accessible to practitioners and decision makers, are performed using empirical data of 90 primary schools in the State of Geneva, Switzerland. Results show that the majority of alternative models deliver divergent results. From a political and a managerial standpoint, these diverging results could lead to potentially ineffective decisions. As no consensus emerges on the best model to use, practitioners and decision makers may be tempted to select the model that is right for them, in other words, the model that best reflects their own preferences. Further studies should investigate how an appropriate multi-criteria decision analysis method could help decision makers to select the right model.