Béatrice Trombert-Paviot

Université Paris 13 Nord, Île-de-France, France

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Publications (31)14.95 Total impact

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    ABSTRACT: Evaluation and validation have become a crucial problem for the development of semantic resources. We developed Ci4SeR, a Graphical User Interface to optimize the curation work (not taking into account structural aspects), suitable for any type of resource with lightweight description logic. We tested it on OntoADR, an ontology of adverse drug reactions. A single curator has reviewed 326 terms (1020 axioms) in an estimated time of 120 hours (2.71 concepts and 8.5 axioms reviewed per hour) and added 1874 new axioms (15.6 axioms per hour). Compared with previous manual endeavours, the interface allows increasing the speed-rate of reviewed concepts by 68% and axiom addition by 486%. A wider use of Ci4SeR would help semantic resources curation and improve completeness of knowledge modelling.
    Studies in health technology and informatics 01/2014; 205:116-120.
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    ABSTRACT: Little is known about the relation of adverse drug reactions (ADRs) to self-use of medications. The aim of this study was to determine the frequency and severity of ADRs related to self-medication (ADR-SM) among emergency department (ED) patients and to describe their main characteristics. A prospective, cross-sectional, observational study was conducted over a period of 8 weeks (1 March to 20 April 2010), in the ED of 11 French academic hospitals. Adult patients presenting to the ED during randomization periods were included, with the exception of cases of self-drug poisoning, inability to complete self-medication questionnaire, or refusal. Clinical outcomes were assessed as well as history of self-medication behaviours and all drugs taken. All doubtful files and those related to ADR-SM were systematically reviewed by an expert committee. A total of 3,027 of 4,661 patients presenting to the ED met the inclusion criteria. Of these, 84.4 % declared a self-medication behaviour, 63.7 % took at least one non-prescribed drug during the previous 2 weeks and 59.9 % took a prescribed medication. A total of 296 patients experienced an ADR (9.78 %), of which 52 (1.72 %) were related to self-medication. Those ADRs related to self-medication included prescribed drugs (n = 19), non-prescribed drugs (n = 17), treatment discontinuation (n = 14), and interactions between non-prescribed and prescribed drugs (n = 2). The ADRs attributed to non-prescribed drugs represented 1 % of all patients taking non-prescribed drugs (n = 1,927). ADR severity was significantly lower for those related to self-medication (p = .032). Self-medication is frequent; its potential toxicity should not be neglected, taking into account the rate of adverse drug reactions in about 1 % of ED patient.
    Drug Safety 10/2013; · 2.62 Impact Factor
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    ABSTRACT: We studied academic and employment outcomes in 59 subjects who underwent allogeneic hematopoietic stem cell transplantation (a-HSCT) with fractionated total body irradiation (fTBI) for childhood leukemia, comparing them with, first, the general French population and, second, findings in 19 who underwent a-HSCT with chemotherapy conditioning. We observed an average academic delay of 0.98 years among the 59 subjects by Year 10 of secondary school (French class Troisième), which was higher than the 0.34-year delay in the normal population (P < .001) but not significantly higher than the delay of 0.68 years in our cohort of 19 subjects who underwent a-HSCT with chemotherapy. The delay was dependent on age at leukemia diagnosis, but not at fTBI. This delay increased to 1.32 years by the final year of secondary school (Year 13, Terminale) for our 59 subjects versus 0.51 years in the normal population (P = .0002), but did not differ significantly from the 1.08-year delay observed in our cohort of 19 subjects. The number of students who received their secondary school diploma (Baccalaureate) was similar to the expected rate in the general French population for girls (observed/expected = 1.02) but significantly decreased for boys (O/E = 0.48; CI: 95%[0.3-0.7]). Compared with 13.8% of the general population, 15.3% of the cancer survivors received no diploma (P = NS). Reported job distribution did not differ significantly between our cohort of childhood cancer survivors and the general population except that more female survivors were employed in intermediate-level professional positions. Academic difficulties after fTBI are common and their early identification will facilitate educational and professional achievement.
    Pediatric Hematology and Oncology 10/2013; · 0.90 Impact Factor
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    ABSTRACT: Purpose: We compared long-term health effects induced by childhood cancer or its treatments as reported by young adult survivors and as noted in their medical records. Patients and Methods: We analyzed and compared health problems reported by 192 young adults treated for childhood cancer between 1987 and 1992 who were included in the population-based childhood cancer registry of the Rhône-Alpes region and those effects inventoried by their healthcare providers in medical records. Results: Of 14 types of late effects studied, each patient reported experience of 0 to 11 (average 2.8 ± 2.1), and their medical records indicated 0 to 8 (average 1.8 ± 1.7) (P < .001). No late effect was reported by 10.4% of the 192 patients and/or noted in the medical records of 21.9% (P = .048). Only eight patients reported and were observed to experience none of the 14. Nine of the 14 were reported significantly more frequently by survivors than their medical records. Only one of eight survivors with cardiomyopathy reported its presence (P = .008), whereas alopecia was reported 13 times by survivors, once by medical records, and three times by both (P = .001). Conclusion: The disparity between reports of late effects by survivors and medical records underscores the need for better communication between survivors and their health care providers. It is important to recognize the potential for bias from both under- and over-reporting in studies based only on survivor self-report. More thorough observation of late effects among survivors of childhood cancer might result from the implementation of a late-effects clinic.
    Pediatric Hematology and Oncology 04/2013; 30(3):195-207. · 0.90 Impact Factor
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    ABSTRACT: Impaired linear growth has been reported in patients treated during childhood with allogeneic stem cell transplantation and fractionated total body irradiation (fTBI). The objective of this study was to determine the final height and body mass index (BMI) achieved. Forty-nine patients with leukemia were included and surveyed for more than 5 years. Median age at follow-up was 24.3 years (range, 18.9-35.8) and median follow-up time from allograft was 14.4 years (range, 4.5-21.9). Mean height standard deviation score (s.d.s.) at final examination (-1.1 ± 1.3,) was significantly lower than at fTBI (0.3 ± 1.2; P = .001). Final height s.d.s. was significantly correlated with age at diagnosis, age at fTBI, and target height (P = .001; P < .001; P < .001, respectively). Final height was significantly lower in children transplanted before age 5 (P = .006). Growth hormone treatment (n = 6) had only a modest effect on growth velocity. Mean BMI at follow-up was normal at 19.6 kg/m(2) for boys and 21.2 for girls, but with a significant decrease since allograft only for boys (-1.2 ± 1.5 s.d.s.) (P = .003). In conclusion, final height is decreased; BMI is normal but decreased from fTBI in boys.
    Pediatric Hematology and Oncology 05/2012; 29(4):313-21. · 0.90 Impact Factor
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    ABSTRACT: In the United States, the Agency for Healthcare Research and Quality (AHRQ) has developed 20 Patient Safety Indicators (PSIs) to measure the occurrence of hospital adverse events from medico-administrative data coded according to the ninth revision of the international classification of disease (ICD-9-CM). The adaptation of these PSIs to the WHO version of ICD-10 was carried out by an international consortium. Two independent teams transcoded ICD-9-CM diagnosis codes proposed by the AHRQ into ICD-10-WHO. Using a Delphi process, experts from six countries evaluated each code independently, stating whether it was "included", "excluded" or "uncertain". During a two-day meeting, the experts then discussed the codes that had not obtained a consensus, and the additional codes proposed. Fifteen PSIs were adapted. Among the 2569 proposed diagnosis codes, 1775 were unanimously adopted straightaway. The 794 remaining codes and 2541 additional codes were discussed. Three documents were prepared: (1) a list of ICD-10-WHO codes for the 15 adapted PSIs; (2) recommendations to the AHRQ for the improvement of the nosological frame and the coding of PSI with ICD-9-CM; (3) recommendations to the WHO to improve ICD-10. This work allows international comparisons of PSIs among the countries using ICD-10. Nevertheless, these PSIs must still be evaluated further before being broadly used.
    Revue d Épidémiologie et de Santé Publique 09/2011; 59(5):341-50. · 0.69 Impact Factor
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    ABSTRACT: Studies of second malignant neoplasms (SMNs) in childhood are generally conducted in old cohorts. The aim of this study was to determine the actual incidence of all SMNs in a recent cohort. The authors studied a cohort of 2907 children included in the population-based Childhood Cancer Registry of the Rhône-Alpes Region for a first cancer diagnosed between 1987 and 2004. Total follow-up was 22,722 person-years, with a median follow-up of 9.8 years (range, 00.0-22.8 years). Fifty-four SMNs were reported in 52 patients. Overall median latency was 5.9 years. Cumulative incidence rates were 2.2% at 10 years and 3.9% at 15, with an overall standardized incidence ratio (SIR) of 13.9 (95% confidence interval [CI], 10.4-18.3) and absolute excess risk of 2.2. The SMNs were 12 thyroid carcinomas (SIR 57.1); 9 bone tumors (SIR 32.0); 8 leukemias (SIR 11.9); 5 lymphomas, all related to Epstein-Barr virus following allograft, (SIR 6.7); 5 CNS tumors (SIR 10.5); 4 soft tissue sarcomas (SIR 17.4); 4 carcinomas (no breast cancer); and 7 other cancers. Twelve SMNs appeared after total body irradiation, 16 after focal radiotherapy, and 8 leukemias after chemotherapy. The risk of secondary cancer was highest after retinoblastomas (SIR 41.8), Hodgkin lymphomas (SIR 20.8), leukemias (SIR 18.4), soft tissue sarcomas, CNS tumors, and bone tumors. These recent cohort findings show, on one hand, a high incidence of SMNs but do not capture breast cancers because of the relatively short follow-up and, on the other hand, a different distribution of first and second cancers.
    Pediatric Hematology and Oncology 08/2011; 28(5):364-79. · 0.90 Impact Factor
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    ABSTRACT: BACKGROUND: Use of French Diagnosis Related Groups (DRGs) program databases, apart from financial purposes, has recently been improved since a unique anonymous patient identification number has been created for each inpatient in administrative case mix database. Based on the work of the group for cancer epidemiological observation in the Rhône-Alpes area, (ONC-EPI group), we review the remaining difficulties in the use of DRG data for epidemiological purposes and we consider a longitudinal approach based on analysis of database over several years. We also discuss limitations of this approach. DIFFICULTIES: The main problems are related to a lack of quality of administrative data, especially coding of diagnoses. These errors come from missing or inappropriate codes, or not being in accordance with prioritization rules (causing an over- or under-reporting or inconsistencies in coding over time). One difficulty, partly due to the hierarchy of coding and the type of cancer, is the choice of an extraction algorithm. In two studies designed to estimate the incidence of cancer cared in hospitals (breast, colon-rectum, kidney, ovaries), a first algorithm, including a code of cancer as principal diagnosis with a selection of surgical procedures less performed than the second one including a code of cancer as principal diagnosis only, for which the number of hospitalizations per patient ratio was stable across time and space. The chaining over several years allows, by tracing the trajectory of the patient, to detect and correct inaccuracies, errors and missing values, and for incidence studies, to correct incident cases by removing prevalent cases. DISCUSSION: However, linkage, complete only since 2007, does not correct data in all cases. Ways of future improvement certainly pass through improved algorithms for case identification and especially by linking DRG data with other databases.
    Revue d Épidémiologie et de Santé Publique 02/2011; 59(1):53-8. · 0.69 Impact Factor
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    ABSTRACT: Background Use of French Diagnosis Related Groups (DRGs) program databases, apart from financial purposes, has recently been improved since a unique anonymous patient identification number has been created for each inpatient in administrative case mix database. Based on the work of the group for cancer epidemiological observation in the Rhône-Alpes area, (ONC-EPI group), we review the remaining difficulties in the use of DRG data for epidemiological purposes and we consider a longitudinal approach based on analysis of database over several years. We also discuss limitations of this approach.
    Revue D Epidemiologie Et De Sante Publique - REV EPIDEMIOL SANTE PUBL. 01/2011; 59(1):53-58.
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    Energy Economics - ENERG ECON. 01/2011; 59(3):199-199.
  • Energy Economics - ENERG ECON. 01/2011; 59.
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    ABSTRACT: Following the WHO initiative named World Alliance for Patient Safety (PS) launched in 2004 a conceptual framework developed by PS national reporting experts has summarized the knowledge available. As a second step, the Department of Public Health of the University of Saint Etienne team elaborated a Categorial Structure (a semi formal structure not related to an upper level ontology) identifying the elements of the semantic structure underpinning the broad concepts contained in the framework for patient safety. This knowledge engineering method has been developed to enable modeling patient safety information as a prerequisite for subsequent full ontology development. The present article describes the semantic dissection of the concepts, the elicitation of the ontology requirements and the domain constraints of the conceptual framework. This ontology includes 134 concepts and 25 distinct relations and will serve as basis for an Information Model for Patient Safety.
    AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2011; 2011:1300-8.
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    ABSTRACT: The population of survivors of childhood cancer is currently growing. Studies from other countries have shown an increased risk of late mortality. In order to measure this risk within a French cohort, the mortality of children who had survived five years from a cancer diagnosis were compared to the mortality of the general population, according to follow-up interval and cancer and treatment characteristics. The study population consisted of 635 children diagnosed with cancer before the age of 15 who had survived at least five years, and were registered in the Rhone-Alpes region cancer registry from 1987 to 1992. Mortality was compared with general population rates of the Rhone-Alpes region to assess age and sex standardized mortality ratio (SMR) and absolute excess risk of death. The median follow-up of children was 14.0 years. Among the 42 observed deaths, 71.4% were attributed to a recurrence of the original cancer, 9.5% to a second cancer. The 15-year cumulative risk of death, all causes, was 7.1%. The overall mortality of the cohort was 20.7 fold greater than the general population (95% CI: 14.9-27.9), and the absolute excess risk of 6.9 per 1000 persons-years. The long term excess-mortality was higher in case of recurrence of original cancer (SMR=99.9, 95% CI: 67.9-141.9, absolute excess risk 35.4 per 1000 persons-years); it was raised during the five to nine years follow-up interval after diagnosis (SMR=33.8, 95% CI: 23.2-47.3) mainly due to the primary malignancy, and decreased after (10-14 years follow-up interval SMR=6.5, 95% IC 2.4-14.2). The late mortality of childhood cancer is significantly increased during the five to nine years following diagnosis and decreases after, but the cohort follow-up has to be extended in order to assess outcome beyond 15 years after diagnosis.
    Revue d Épidémiologie et de Santé Publique 12/2008; 56(6):383-90. · 0.69 Impact Factor
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    ABSTRACT: We assessed the number and causes of treatment-related deaths (TRDs) in childhood cancer over time and correlated them with adherence to therapeutic guidelines. We compared two cohorts of children of the Childhood Cancer Registry of the Rhône-Alpes Region: Cohort I (1987-1992, 909 patients) and Cohort II (1996-1999, 648 patients). In all cancers together, 75 TRDs were reported in Cohort I and 24 in Cohort II (P = 0.001). Cumulative incidence at 5 years declined from 7.9% to 4.1%, and overall survival (OS) increased from 71.0% to 77.2%. TRDs declined by nearly 10-fold in patients with solid malignant tumors (P = 0.02) and central nervous system tumors (P = 0.001), but OS improved for patients with solid malignant tumors only (P = 0.01). No difference was observed in treatment- and transplantation-related deaths in patients with acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML), but OS was better in patients with AML (P = 0.02). Between the two cohorts, transplantation-related mortality did not decrease and was higher at 5 years in patients with ALL who received unrelated-matched donor transplants (41.3%) than in those receiving sibling-matched donor transplants (18.7%). OS improved in the respective transplant groups (37.0% and 64.2%). Severe graft-versus-host disease was also observed among patients with ALL (P = 0.036). The decrease in TRDs was correlated with compliance to therapeutic guidelines. Although mortality declined, improved adherence to therapeutic guidelines and more restricted indications of allograft are needed to preclude further treatment- and transplantation-related deaths, particularly among those with leukemia.
    Pediatric Blood & Cancer 07/2008; 50(6):1213-20. · 2.35 Impact Factor
  • Revue D Epidemiologie Et De Sante Publique - REV EPIDEMIOL SANTE PUBL. 01/2008; 56(1):33-33.
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    ABSTRACT: Objective: The Agency for Healthcare Research and Quality (AHRQ) developed Patient Safety Indicators (PSIs) for use with ICD-9-CM data. Many countries have adopted ICD-10 for coding hospital diagnoses. We conducted this study to develop an internationally harmonized ICD-10 coding algorithm for the AHRQ PSIs. Methods: The AHRQ PSI Version 2.1 has been translated into ICD-10-AM (Australian Modification), and PSI Version 3.0a has been independently translated into ICD-10-GM (German Modification). We converted these two country-specific coding algorithms into ICD-10-WHO (World Health Organization version) and combined them to form one master list. Members of an international expert panel—including physicians, professional medical coders, disease classification specialists, health services researchers, epidemiologists, and users of the PSI—independently evaluated this master list and rated each code as either “include,” “exclude,” or “uncertain,” following the AHRQ PSI definitions. After summarizing the independent rating results, we held a face-to-face meeting to discuss codes for which there was no unanimous consensus and newly proposed codes. A modified Delphi method was employed to generate a final ICD-10 WHO coding list. Results: Of 20 PSIs, 15 that were based mainly on diagnosis codes were selected for translation. At the meeting, panelists discussed 794 codes for which consensus had not been achieved and 2,541 additional codes that were proposed by individual panelists for consideration prior to the meeting. Three documents were generated: a PSI ICD-10-WHO version-coding list, a list of issues for consideration on certain AHRQ PSIs and ICD-9-CM codes, and a recommendation to WHO to improve specification of some disease classifications. Conclusion: An ICD-10-WHO PSI coding list has been developed and structured in a manner similar to the AHRQ manual. Although face validity of the list has been ensured through a rigorous expert panel assessment, its true validity and applicability should be assessed internationally.
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    ABSTRACT: Since 2001, the French national case mix program is allowed by law to use an enciphering algorithm named "FOIN" to produce a unique anonymous identifier in order to crosslink, within and across hospitals, discharge abstracts from a given patient. This algorithm "thrashes" the person's health insurance number, date of birth and gender. Before using information produced by the case mix program, either for case mix payment or for epidemiology research or for assessing care approaches, the quality of linkage must be evaluated. Foin error flags were first assessed in the 2002 Rhône-Alpes regional case mix database. Second, for the two university hospitals of Lyon and Saint-Etienne, double identifiers (two or more Foin identifiers for the same patient) and collisions (a single Foin identifier for at least two patients) were compared with others identifiers: administrative identifier and an anonymous identifier produced by Anonymat software from name, forename and date of birth. Third, Foin error flags are crossed with Foin double identifier or collision mistakes. First, among 1,668,971 hospital discharge abstracts from the regional case mix database, 206,710 (12.4%) had at least one Foin error flag. The most frequent error flag (93026 [5.5%] stays) was due to the lack of the three identifying variables. The greatest number for error flags concerned the stays of newborns (38.5%) and those of public hospitals (17.3%). Second, Foin created a few double identifiers: 1.2% among 137,236 patients from university hospital of Lyon and 0.3% among 39512 patients from university hospital of Saint-Etienne. The collisions concerned 7776 (5.7%) patients from Lyon and 460 (1.2%) from Saint-Etienne. The identifier produced by Anonymat performed better than the one produced by Foin: 99.6% from the two university hospitals. Third, less than 3% of stays without Foin error flag nevertheless had mistakes on Foin when compared with others identifiers. The overall assessment is not in favour of a quality threshold using the Foin identifier on a routine basis except in some areas and if certain activities like neonatology are excluded. There are several ways to improve the linkage of health data.
    Revue d Épidémiologie et de Santé Publique 07/2007; 55(3):203-11. · 0.69 Impact Factor
  • Caroline Martin, Béatrice Trombert-Paviot, Paul Vercherin, Jean-Marie Rodrigues
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    ABSTRACT: In order to identify and describe the organisation of specialist hospitals' technical services and activities for patients with cardiovascular disease, we applied the classification method of Barrubes et al. to their in-patients' hospitalisation period for a duration of 24 hours or more. Technical activities are defined as the state-of-the-art medicine for extremely complex diseases requiring specifically skilled attention. This simple method enabled the identification of specialist technical activities for treating patients with cardiovascular disease and to learn more about the role of the public and private providers of hospital care, roles which vary according to French geographic areas and regions.
    Santé Publique 01/2007; 19(3):193-202. · 0.24 Impact Factor
  • Finite Elements in Analysis and Design - FINITE ELEM ANAL DESIGN. 01/2007; 20(1):24-24.
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    ABSTRACT: To investigate the characteristics of adverse drug events (ADE) causing emergency medical admissions in the elderly. Data were obtained from two prospective cross sectional studies with similar experimental design which were carried out in seven French emergency departments in 1999 and 2003. The proportion of ADE leading to admission, their severity and preventability were assessed in patients aged > or =70 (group A) and compared to those of patients < 70 years (group B). Out of a total of 2907 patients, 1158 (39.8%) were > or =70 years of age. Among these, 17.1% were admitted as a result of an ADE vs. 13.2% in group B (p = 0.004). ADE appeared to be more severe in group A than in group B. The part of preventable ADE did not significantly differ between the two groups (48.9% vs. 43.7%, respectively). ADE are a common preventable cause of unplanned admissions, especially in the elderly.
    Thérapie 01/2007; 62(5):437-41. · 0.37 Impact Factor