Comment mettre en application des recommandations de pratique clinique? L'exemple des dyslipidémies [How to apply clinical guidelines in medical practice? The example of dyslipidemia]

How to summarize and facilitate the implementation of national and international guidelines in clinical practice? To adress these issues, we present a summary of dyslipidemia management for general practitioners. To achieve these aims, we adopted strategies based on international and national guidelines and focused on clinical applications which implies to choose specific options, such as the use of cardiovascular risk score and specific therapies as first options.

Multimodal evaluation for medical image segmentation

This paper is a joint effort between five institutionsthat introduces several novel similarity measures andcombines them to carry out a multimodal segmentationevaluation. The new similarity measures proposed arebased on the location and the intensity values of themisclassified voxels as well as on the connectivity andthe boundaries of the segmented data. We showexperimentally that the combination of these measuresimprove the quality of the evaluation. The study that weshow here has been carried out using four differentsegmentation methods from four different labs applied toa MRI simulated dataset of the brain. We claim that ournew measures improve the robustness of the evaluation andprovides better understanding about the differencebetween segmentation methods.

An anonymous reputation mechanism for cloud computing networks using volunteer resources

One of the major problems when using non-dedicated volunteer resources in adistributed network is the high volatility of these hosts since they can go offlineor become unavailable at any time without control. Furthermore, the use ofvolunteer resources implies some security issues due to the fact that they aregenerally anonymous entities which we know nothing about. So, how to trustin someone we do not know?.Over the last years an important number of reputation-based trust solutionshave been designed to evaluate the participants' behavior in a system.However, most of these solutions are addressed to P2P and ad-hoc mobilenetworks that may not fit well with other kinds of distributed systems thatcould take advantage of volunteer resources as recent cloud computinginfrastructures.In this paper we propose a first approach to design an anonymous reputationmechanism for CoDeS [1], a middleware for building fogs where deployingservices using volunteer resources. The participants are reputation clients(RC), a reputation authority (RA) and a certification authority (CA). Users needa valid public key certificate from the CA to register to the RA and obtain thedata needed to participate into the system, as now an opaque identifier thatwe call here pseudonym and an initial reputation value that users provide toother users when interacting together. The mechanism prevents not only themanipulation of the provided reputation values but also any disclosure of theusers' identities to any other users or authorities so the anonymity isguaranteed.

Preventive medicine for epidemic outbreaks and risky behavior through mobile devices and ubiquitous computing

In this work, we have developed the first free software for mobile devices with the Android operating system that can preventively mitigate the number of contagions of sexually transmitted infections (STI), associated with risk behavior. This software runs in two modes. The normal mode allows the user to see the alerts and nearby health centers. The second mode enables the service to work in the background. This software reports the health risks, as well as the location of different test centers.

Low intensity vs. self-guided internet-delivered psychotherapy for major depression: a multicenter, controlled, randomized study.

BACKGROUND Major depression will become the second most important cause of disability in 2020. Computerized cognitive-behaviour therapy could be an efficacious and cost-effective option for its treatment. No studies on cost-effectiveness of low intensity vs self-guided psychotherapy has been carried out. The aim of this study is to assess the efficacy of low intensity vs self-guided psychotherapy for major depression in the Spanish health system. METHODS The study is made up of 3 phases: 1.- Development of a computerized cognitive-behaviour therapy for depression tailored to Spanish health system. 2.- Multicenter controlled, randomized study: A sample (N=450 patients) with mild/moderate depression recruited in primary care. They should have internet availability at home, not receive any previous psychological treatment, and not suffer from any other severe somatic or psychological disorder. They will be allocated to one of 3 treatments: a) Low intensity Internet-delivered psychotherapy + improved treatment as usual (ITAU) by GP, b) Self-guided Internet-delivered psychotherapy + ITAU or c) ITAU. Patients will be diagnosed with MINI psychiatric interview. Main outcome variable will be Beck Depression Inventory. It will be also administered EuroQol 5D (quality of life) and Client Service Receipt Inventory (consume of health and social services). Patients will be assessed at baseline, 3 and 12 months. An intention to treat and a per protocol analysis will be performed. DISCUSSION The comparisons between low intensity and self-guided are infrequent, and also a comparative economic evaluation between them and compared with usual treatment in primary. The strength of the study is that it is a multicenter, randomized, controlled trial of low intensity and self-guided Internet-delivered psychotherapy for depression in primary care, being the treatment completely integrated in primary care setting. TRIAL REGISTRATION Clinical Trials NCT01611818.

HypatiaSalud. Institucional Repository for the Andalusian Public Health System, Spain

HypatiaSalud will be the freely accessible institutional repository for the Public Health System in Andalucía, Spain. Open access and new technologies have changed dramatically the environment in which research is being conducted and disseminated. Traditionally University has been the universal research provider, but at present time there are Government Organizations, as Public Health Systems, which are large-producers of research. Meanwhile most universities are running institutional repositories or have plans of setting up institutional repositories in the short-term, there are not many Government Organizations working on that direction. In this sense, HypatiaSalud represents an innovative initiative. Objectives: - Enhancing institutional efficiency, effectiveness and opportunities for knowledge exchange. -Expanding access and greater use of research findings to a much wider range of users increasing the visibility and reputation of Andalusian Public Health System. - Providing the foundation for effective gathering and long-term preservation of research output. Methodology. Phase I: Researching and learning from other institutional repositories. Phase II: Designing and planning the financial, organizational, legal and technical underlying issues. Phase III: Launching the service. Phase IV: Running the service. Outcomes. Bibliometrics: catalog of the research output of the Institution, in order to determine the conditions to include this scientific output in the Institutional Repository: direct deposit, deposit after a period of embargo, or closed access when publisher will not grant permission. Promote a mandate for the deposit of all peer-reviewed final drafts (postprints) for institutional record-keeping purposes. Access to that immediate postprint deposit in HypatiaSalud may be set immediately as ‘Open Access’ if copyright conditions allows; otherwise access can be set as ‘Closed Access’. International Standards application: HypatiaSalud will support OAI-PMH and DRIVER, to allow that central repositories could harvest its content or metadata. Development of human resources strategies in order to foster self-archiving through merit acknowledge and accreditation. Conclusions. It seems likely that setting up an Institutional Repository for the Public Health System in Andalucía would have substantial net benefits in the longer term for the Institution, despite the lag between the costs and realisation of benefits.

Integrating Metalib and SFX into the BV-SSPA

Introduction To guarantee the success of a virtual library it is essential that all users can access all the library resources independently of the user’s location. Achieving this goal in the Andalusian Public Health System has been a particularly difficult task, due to it is made up of 10 research centers and 95.000 health-care professionals. Aims Since the BV-SSPA started three years ago, one of its mayor aims has been to provide remote access to all its resources in this complex scenario, as well as facilitate the access to the virtual library to both professionals and citizens. IP access was guaranteed because health-care professionals could access everything from their workplaces thanks to the intranet, but it was restricted when they were not there. The BV-SSPA solved this problem by installing a federated authentication and authorization system called PAPI and a PAPI rewriting proxy. After three years the BV-SSPA has met a new challenge: adapting its federated access system to Metalib and SFX, specifically the access management module PDS had to be connected with the existing PAPI system. This new challenge came along with the introduction of a new metasearcher and link resolver. Material and Methods Initially there were three independent systems: • A Metalib and SFX PDS module, • A federated authentication and authorization system: PAPI. • A PAPI Rewriting Proxy. The chosen solution went through the reutilization of the existing software. To achieve this goal, a PHP connector between these applications was developed and several modules in the PDS configuration were modified. On the other hand, providing a simplified access to Metalib has been solved using Xerxes and integrating it in a Drupal website. Results Thanks to this connector the BV-SSPA was able to get all its users remotely accessing its new metasearcher without changing the way they used to validate, or without having to remember a new username and password. Futhermore, thanks to Xerxes, it is possible to use Metalib from a simple interface and without having to leave the BV-SSPA website to go its native interface.

The predictive value of psychological assessment of candidates for gastric bypass: A medical chart review

Background and Objectives: Guidelines for bariatric surgery demand a psychological evaluation of applicants. The aim of this study was to evaluate if the presence of "psychological risk factors" predicts postoperative weight loss after gastric bypass. Methods: Medical records of obese women who underwent bariatric surgery between 2000 and 2004 were reviewed. Psychological assessment consisted of a one-hour semi-structured interview, summarized in a written report. Anthropometric assessment at baseline and 6,12,18 and 24 months after surgery included body weight, height and body mass index. Results: The mean BMI of included patients (N = 92) was 46.2 + 6,3 kg/m(2) (range 38.4-69.7). Based on the psychological assessment, 27% (N = 25) of the patients were classified as having "psychological risk factors" and 28% (N = 26) were diagnosed with a psychiatric diagnosis, most often major depression. Two years after gastric bypass, 16% of patients with "psychological risk factors" achieved an excellent result (%EWL > 75) versus 39% of those without (p < 0.05). About 1 out of 4 patients was in postoperative psychiatric treatment, but only half of them were identified as having "psychological risk factors" at baseline. Weight loss of patients initiating a psychiatric treatment only after surgery was less than of patients who continued psychiatric treatment already initiated before surgery (55.7 + 14.8 versus 66.5 + 14.2 %EWL). Conclusions: A single semi-structured psychological interview may identify patients who are at risk for diminished postoperative weight loss; however, psychological assessment did not identify those patients who were in need of a psychiatric postoperative treatment.

An electronic portfolio for quantitative assessment of surgical skills in undergraduate medical education.

BACKGROUND We evaluated a newly designed electronic portfolio (e-Portfolio) that provided quantitative evaluation of surgical skills. Medical students at the University of Seville used the e-Portfolio on a voluntary basis for evaluation of their performance in undergraduate surgical subjects. METHODS Our new web-based e-Portfolio was designed to evaluate surgical practical knowledge and skills targets. Students recorded each activity on a form, attached evidence, and added their reflections. Students self-assessed their practical knowledge using qualitative criteria (yes/no), and graded their skills according to complexity (basic/advanced) and participation (observer/assistant/independent). A numerical value was assigned to each activity, and the values of all activities were summated to obtain the total score. The application automatically displayed quantitative feedback. We performed qualitative evaluation of the perceived usefulness of the e-Portfolio and quantitative evaluation of the targets achieved. RESULTS Thirty-seven of 112 students (33%) used the e-Portfolio, of which 87% reported that they understood the methodology of the portfolio. All students reported an improved understanding of their learning objectives resulting from the numerical visualization of progress, all students reported that the quantitative feedback encouraged their learning, and 79% of students felt that their teachers were more available because they were using the e-Portfolio. Only 51.3% of students reported that the reflective aspects of learning were useful. Individual students achieved a maximum of 65% of the total targets and 87% of the skills targets. The mean total score was 345 ± 38 points. For basic skills, 92% of students achieved the maximum score for participation as an independent operator, and all achieved the maximum scores for participation as an observer and assistant. For complex skills, 62% of students achieved the maximum score for participation as an independent operator, and 98% achieved the maximum scores for participation as an observer or assistant. CONCLUSIONS Medical students reported that use of an electronic portfolio that provided quantitative feedback on their progress was useful when the number and complexity of targets were appropriate, but not when the portfolio offered only formative evaluations based on reflection. Students felt that use of the e-Portfolio guided their learning process by indicating knowledge gaps to themselves and teachers.