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Methods Inf Med 2001; 40(04): 323-330
DOI: 10.1055/s-0038-1634428
Original Article
Schattauer GmbH

Elaboration and Formalization of Current Scientific Knowledge of Risks and Preventive Measures Illustrated by Colorectal Cancer

R. Giorgi
1   Laboratoire d’Enseignement et de Recherche sur le Traitement de l’Information Médicale (LERTIM), Faculté de Médecine, Université de la Méditerranée, Marseille, France
,
J. Gouvernet
1   Laboratoire d’Enseignement et de Recherche sur le Traitement de l’Information Médicale (LERTIM), Faculté de Médecine, Université de la Méditerranée, Marseille, France
,
J. Dufour
1   Laboratoire d’Enseignement et de Recherche sur le Traitement de l’Information Médicale (LERTIM), Faculté de Médecine, Université de la Méditerranée, Marseille, France
,
P. Degoulet
2   Santé Publique et Informatique Médicale (SPIM), Faculté de Médecine Broussais-Hôtel-Dieu, Paris, France
,
R. Laugier
3   Service de Gastroentérologie,Marseille, France
,
F. Quilichini
4   Service de Chirurgie Générale et Digestive, Centre Hospitalier Universitaire de Marseille, Hôpital d’Adultes de la Timone, Marseille, France
,
M. Fieschi
1   Laboratoire d’Enseignement et de Recherche sur le Traitement de l’Information Médicale (LERTIM), Faculté de Médecine, Université de la Méditerranée, Marseille, France
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Publikationsverlauf

Received 15. Juni 2000

Accepted 29. Dezember 2000

Publikationsdatum:
08. Februar 2018 (online)

    Lizenzen und Reprints

Summary

Objectives: Present the method used to elaborate and formalize current scientific knowledge to provide physicians with tools available on the Internet, that enable them to evaluate individual patient risk, give personalized preventive recommendations or early screening measures.

Methods: The approach suggested in this article is in line with medical procedures based on levels of evidence (Evidence-based Medicine). A cyclical process for developing recommendations allows us to quickly incorporate current scientific information. At each phase, the analysis is reevaluated by experts in the field collaborating on the project. The information is formalized through the use of levels of evidence and grades of recommendations. GLIF model is used to implement recommendations for clinical practice guidelines.

Results: The most current scientific evidence incorporated in a cyclical process includes several steps: critical analysis according to the Evidence-based Medicine method; identification of predictive factors; setting-up of risk levels; identification of prevention measures; elaboration of personalized recommendation. The information technology implementation of the clinical practice guideline enables physicians to quickly obtain personalized information for their patients. Cases of colorectal prevention illustrate our approach.

Conclusions: Integration of current scientific knowledge is an important process. The delay between the moment new information arrives and the moment the practitioner applies it, is thus reduced.

Keywords

Evidence-based Medicine - Practice Guidelines - Primary Prevention - Mass Screening - Colorectal Neoplasm
 

  • References

  • 1 Hibbel A, Kanka D, Pencheon D, Pooles F. Guidelines in general practice: the new tower of babel?. BMJ 1998; 307 7162 862-3.
    PubMedGoogle Scholar
  • 2 Freemantle N, Harvey EL, Grinshaw JM. et al. The effectiveness of printed educational materials in changing the behaviour of healthcare professionals. In: The Cochrane Database of Systematic Reviews. The Cochrane Collaboration 1996. issue 3. Oxford: Update Software.
    Google Scholar
  • 3 Vissers MC, Biert J, Van Der Linden CJ, Hasman A. Effects of a supportive protocol processing system (Proto VIEW) on clinical behaviour of residents in the accident and emergency department. Comput Method Program Biomed 1996; 49: 177-84.
    PubMedGoogle Scholar
  • 4 Shea S, DuMouchel W, Bahamonde L. A meta-analysis of 16 controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. JAMIA 1996; 3: 99-409.
    PubMedGoogle Scholar
  • 5 ANAES. http://www.anaes.fr
    PubMed
  • 6 Giorgi R, Gouvernet J, Jougla E. et al. Using personalised probability of death in decision making. Comput Biomed Res, 2000; 33 (Suppl. 01) 75-83.
    CrossrefPubMedGoogle Scholar
  • 7 Oxman AD, Sackett DL, Guyatt GH. Users’ guides to the medical literature. I. How to get started. JAMA 1993; 270 (Suppl. 17) 2093-5.
    CrossrefPubMedGoogle Scholar
  • 8 Sérousi B, Bouaud J, Antoine EC, Khayat D, Boisvieux JF. Aide à la prescription par la consultation télématique de “bonnes pratiques thérapeutiques” dans une démarche centrée-patient. In: L’informatisation du cabinet médical du futur. Degoulet P, Fieschi M. (eds). Informatique et Santé 11. Paris: Springer-Verlag; 1999: 47-58.
    Google Scholar
  • 9 Lobach DF, Gadd CS, Hales JW. Structuring clinical practice guidelines in a relational database model for decision support on the Internet. Proc AMIA Annu Fall Symp. 1997: 158-62.
    PubMedGoogle Scholar
  • 10 Lobach DF, Gadd CS, Hales JW, Baskaran P. Siegfried: System for interactive electronic guidelines with feedback and resources for instructional and educational development. Medinfo. 1998: 827-31.
    PubMedGoogle Scholar
  • 11 Herbert SI. Informatics for care protocols and guidelines: towards a European knowledge model. Stud Health Technol Inform 1995; 16: 27-42.
    PubMedGoogle Scholar
  • 12 Ohno-Machado L, Gennari JH, Murphy SN. et al. The guidelines interchange format: a model for representing guidelines. J Am Med Inform Assoc 1998; 5 (Suppl. 04) 357-72.
    CrossrefPubMedGoogle Scholar
  • 13 Ménégoz F, Chérié-Challine L. Le cancer en France : incidence et mortalité. Situation en 1995. Evolution entre 1975 et 1995. Ministère de l’emploi et de la solidarité.; Paris: 1999
    Google Scholar
  • 14 Manouvrier-Hanu S, Laurent-Puig P. Le conseil génétique en gastro-entérologie. 1998 www.fmcgastro.org/GASTRO/postu98manouv.html.
    PubMedGoogle Scholar
  • 15 Anderson KM, Odell PM, Wilson PW, Kannel WB. Cardiovascular disease risk profiles. Am Heart J 1991; 121: 293-8.
    CrossrefPubMedGoogle Scholar
  • 16 Wolf PA, D’Agostino RB, Belanger AJ, Kannel WB. Probability of stroke: a risk profile from the Framingham Study. Stroke 1991; 22 (Suppl. 03) 312-8.
    CrossrefPubMedGoogle Scholar
  • 17 Gail MH, Brinton LA, Byar DP. et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annualy. J Natl Cancer Inst 1989; 81 (Suppl. 24) 1879-86.
    CrossrefPubMedGoogle Scholar
  • 18 ANAES.. Prevention, screening, and management of cancer of the colon. Bull Cancer 1998; 85 (Suppl. 04) 307-12.
    PubMedGoogle Scholar
  • 19 Byers T, Levin B, Rothenberger D, Dodd GD, Smith RA. American cancer society guidelines for screening and surveillance for early detection of colorectal polyps and cancer: 1997 update 1997. CA Cancer J Clin 1997; 47 (Suppl. 03) 156-60.
    PubMedGoogle Scholar
  • 20 Winawer SJ, Fletcher RH, Miller L. et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 1997; 112 (Suppl. 02) 594-642.
    CrossrefPubMedGoogle Scholar
  • 21 Schatzkin A, Lanza E, Corle D. et al. Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. N Eng J Med 2000; 342: 1149-55.
    CrossrefPubMedGoogle Scholar
  • 22 Alberts DS, Martinez ME, Roe DJ. et al. Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. N Eng J Med 2000; 342: 1156-62.
    CrossrefPubMedGoogle Scholar
  • 23 Hardcastle JD, Chamberlain JO, Robinson MH. et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996; 348 9040 1472-7.
    CrossrefPubMedGoogle Scholar
  • 24 Kronborg O, Fenger C, Olsen J, Jorgensen OD, Sondergaard O. Randomised study of screening for colorectal cancer with feacal-occult-blood test. Lancet 1996; 348 9040 1467-71.
    CrossrefPubMedGoogle Scholar
  • 25 Gotzshe P. Correspondence. Lancet 1997; 349 9048 356.
    CrossrefPubMedGoogle Scholar
  • 26 Winawer SJ, Zauber AG, Ho MN. et al. Prevention of colorectal cancer by colonoscopic polypectomy. The national polyp study work-group. N Engl J Med 1993; 329: 1977-81.
    CrossrefPubMedGoogle Scholar
  • 27 Johnson CD, Hara AK, Reed JE. Computed tomographic colonography (Virtual colonoscopy): a new method for detecting colorectal neoplasms. Endoscopy 1997; 29 (Suppl. 06) 454-61.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 28 Fenlon HM, Nunes DP, Schroy PC, Barish MA, Clarke PD, Ferrucci JT. A comparison of virtual and conventional colonoscopy for the detection of colorectal polyps. N Engl J Med 1999; 341: 1496-503.
    CrossrefPubMedGoogle Scholar
  • 1a La Vecchia C, Ferraroni M, Mezzetti M. et al. Attribuable risks for colorectal cancer in northern Italy. Int J cancer 1996; 66: 60-4.
    CrossrefPubMedGoogle Scholar
  • 2a Sandler RS. Epidemiology and risk factors for colorectal cancer. Gastroenterol Clin North Am. 1996; 25 (Suppl. 04) 717-35.
    CrossrefPubMedGoogle Scholar
  • 3a Manouvrier-Hanu S, Laurent-Puig P. Le conseil génétique en gastro-entérologie. 1998 http://www.fmcgastro.org/GASTRO/postu98/manouv.html.
    PubMedGoogle Scholar
  • 4a Benhamiche AM. Le cancer du côlon: épidémiologie descriptive et groupes à risque élevé. In: Prévention, dépistage et prise en charge des cancers du colon. Conférence de consensus. ANAES; Paris: 1998
    Google Scholar
  • 5a Kroser JA, Bachwich DR, Lichtenstein GR. Risk factors for the development of colorectal carcinoma and their modification. Hematol Oncol Clin North Am. 1997; 11 (Suppl. 04) 547-77.
    CrossrefPubMedGoogle Scholar
  • 6a Lynch HT, Smyrk T. An update on Lynch syndrome. Curr Opin Oncol 1998; 10 (Suppl. 04) 349-56.
    CrossrefPubMedGoogle Scholar
  • 7a Karlen P, Lofberg R, Brostrom O, Leijonmarck CE, Hellers G, Persson PG. Increased risk of cancer in ulcerative colitis: a population-based cohort study. Am J Gastroenterol 1999; 94 (Suppl. 04) 1047-52.
    CrossrefPubMedGoogle Scholar
  • 8a Fuchs CS, Giovannucci EL, Colditz GA, Hunter DJ, Speizer FE, Willett WC. A prospective study of family history and the risk of colorectal cancer. N Engl J Med 1994; 331 (Suppl. 25) 1669-74.
    CrossrefPubMedGoogle Scholar
  • 9a St John DJ, McDermott FT, Hopper JL, Debney EA, Johnson WR, Hughes ES. Cancer risk in relatives of patients with common colorectal cancer. Ann Intern Med 1993; 118 (Suppl. 10) 785-90.
    CrossrefPubMedGoogle Scholar
  • 10a Stryker SJ, Wolff BG, Culp CE, Libbe SD, Ilstrup DM, MacCarty RL. Natural history of untreated colonic polyps. Gastroenterology 1987; 93 (Suppl. 05) 1009-13.
    CrossrefPubMedGoogle Scholar
  • 11a Winawer SJ, Zauber AG, Gerdes H. et al. Risk of colorectal cancer in the families of patients with adenomatous polyps. National polyp study workgroup. N Engl J Med 1996; 334 (Suppl. 02) 82-7.
    CrossrefPubMedGoogle Scholar
  • 12a Ahsan H, Neugut AI, Garbowski GC. et al. Family history of colorectal adenomatous polyps and increased risk for colorectal cancer. Ann Intern Med 1998; 128 (Suppl. 11) 900-5.
    CrossrefPubMedGoogle Scholar
  • 13a Sandler RS, Sandler DP. Radiation induced colorectal cancer: assessing the risk. Gastroenterology 1983; 84: 51-7.
    PubMedGoogle Scholar
  • 14a Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Speizer FE. Relation of meat, fat, and fiber intake to the risk of colon cancer in a prospective study among women. N Engl J Med 1990; 323 (Suppl. 24) 1664-72.
    CrossrefPubMedGoogle Scholar
  • 15a Potter JD. Nutrition and colorectal cancer. Cancer causes and control 1996; 7: 127-46.
    PubMedGoogle Scholar
  • 16a Giovannucci E. Insulin and colon cancer. Cancer causes control 1995; 6: 164-79.
    CrossrefPubMedGoogle Scholar
  • 17a Slattery ML, Caan BJ, Potter JD. et al. Dietary energy sources and colon cancer risk. Am J Epidemiol 1997; 145: 199-210.
    CrossrefPubMedGoogle Scholar
  • 18a Le Marchand L, Wilkens LR, Kolonel LN, Hankin JH, Lyu LC. Associations of sedentarity lifestyle, obesity, smoking, alcohol use, and diabetes with the risk of colorectal cancer. Cancer research 1997; 57: 4787-94.
    PubMedGoogle Scholar
  • 19a Wurzelmann JI, Silver A, Schreinemachers DM, Sandler RS, Everson RB. Iron intake and the risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev 1996; 5 (Suppl. 07) 503-7.
    PubMedGoogle Scholar
  • 20a Giovannucci E, Colditz GA, Stampfer MJ. A meta-analysis of cholecystectomy and risk of colorectal cancer. Gastroenterology 1993; 105 (Suppl. 01) 130-41.
    CrossrefPubMedGoogle Scholar
  • 21a Ekbom A, Yuen J, Adami HO. et al. Cholecystectomy and colorectal cancer. Gastroenterology 1993; 105 (Suppl. 01) 142-7.
    CrossrefPubMedGoogle Scholar
  • 22a Todoroki I, Friedman GD, Slattery ML, Potter JD, Samowitz W. Cholecystectomie and the risk of colon cancer. Am J Gastroenterol 1999; 94 (Suppl. 01) 41-6.
    CrossrefPubMedGoogle Scholar
  • 23a Schoen RE, Weissfeld JL, Huller LH. Are women with breast, endometrial, or ovarian cancer at increased risk for colorectal cancer?. Am J Gastroenterology 1994; 107: 1675-9.
    PubMedGoogle Scholar
  • 24a Colditz GA, Carolyn C, Frazier LA. Physical activity and reduced risk of colon cancer: implications for prevention. Cancer causes and control 1997; 8: 649-67.
    PubMedGoogle Scholar
  • 25a Stürmer T, Glynn RJ, Lee IM, Manson JE, Buring JE, Hennekens CH. Apsirin use and colorectal cancer: post-trial follow-up data from the physicians’ health study. Ann Intern Med 1998; 128 (Suppl. 09) 713-20.
    CrossrefPubMedGoogle Scholar
  • 26a Benamouzig R. La consommation d’aspirine ou d’anti-inflammatoires non-stéroïdiens diminue t-elle le risque de cancer colique?. In: Prévention, dépistage et prise en charge des cancers du colon. Conférence de consensus. ANAES; Paris: 1998
    Google Scholar
  • 27a Negri E, Franceschi S, Parpinel M, La Vecchia C. Fiber intake and risk of colorectal cancer. Cancer epidemiology, biomarkers & prevention 1998; 7: 667-71.
    PubMedGoogle Scholar
  • 28a Hébert-Croteau N. A meta-analysis of hormone replacement therapy and colon cancer in women. Cancer epidemiology, biomarkers & prevention 1998; 7: 653-59.
    PubMedGoogle Scholar
  • 29a Garland C, Barrett-Connor E, Rossof A, Shekelle R, Criqui M, Paul O. Dietary vita-mine D and calcium and risk of colorectal cancer: a 19-year prospective study in men. Lancet 1985; 1 8424 307-9.
    PubMedGoogle Scholar
  • 30a La Vecchia C, Braga C, Negri E. et al. Intake of selected micronutrients and risk of colorectal cancer. Int J Cancer 1997; 73: 525-30.
    CrossrefPubMedGoogle Scholar
  • 31a Kim YI, Salomon RN, Graeme-Cook F. et al. Dietary folate protects against the development of macroscopic colonic neoplasia in a dose responsive manner in rats. Gut 1996; 39 (Suppl. 05) 732-40.
    CrossrefPubMedGoogle Scholar
  • 32a Giovannucci E, Stampfer MJ, Golditz GA. et al. Multivitamin use, folate, and colon cancer in women in the nurses’ health study. Ann Intern Med 1998; 129 (Suppl. 07) 517-24.
    CrossrefPubMedGoogle Scholar
  • 33a Nomura A, Heilbrun LK, Morris JS, Stemmermenn GN. Serum selenium and the risk of cancer, by specific sites: case-control analysis of prospective data. J Natl Cancer Inst 1987; 79: 103-8.
    PubMedGoogle Scholar