Дисертації з теми "Incertitude – Médecine"
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Messer, Laurent. "Incertitudes médicales en rhumatologie… : entre médecins et patients." Electronic Thesis or Diss., Strasbourg, 2024. http://www.theses.fr/2024STRAG010.
Повний текст джерелаDespite the phenomenal progress in science, the development of the internet and artificial intelligence, uncertainty remains an inherent component of medical practice. Rheumatology is no exception to the rule, and it concerns doctors as much as patients. This research proposes to observe the uncertainty in a medical specialty, rheumatology, and to identify its particularities, its representations, by questioning rheumatologists and rheumatists. Uncertainty is understood as a phenomenon experienced individually, but also as an element shaping the social. In a first phase, I conducted a cross-sectional, multicenter qualitative study, based on participant observation in the rheumatology department of Colmar and 17 semi-structured individual interviews with Alsatian rheumatologists with varied practices (liberal and hospital). To collect the feelings and opinions of patients, we carried out focus groups on a sample of 19 patients suffering from inflammatory rheumatism (Ankylosing Spondylitis, Psoriatic Rheumatism, Rheumatoid Arthritis) and followed within the Rheumatology department of Colmar. Uncertainty is recognized as an invariant in rheumatology. Different specific areas of uncertainty have been identified among doctors and patients. A third significant area has emerged, relational uncertainty between doctors and patients
Hubert, Hervé. "Décision médicale, incertitude et complexité : de la construction de modèles d'aide à la décision à la diffusion de "bonnes" pratiques médicales." Lille 1, 1998. https://pepite-depot.univ-lille.fr/LIBRE/Th_Num/1998/50374-1998-227.pdf.
Повний текст джерелаControlling health expenditures from a medical point of view implies the definition of "good" medical practices (gmp). Beyond their definitions, very few tools, allowing a systematic selection of these gmp, are put at the disposal of healthcare professionals. The analysis of the medical decision (md) is intended to enable the construction of models to assist decision making and the response to expectations of professionals of the sanitary sector. The md brings an action at the micro-social level of the physician-patient relationship. Our thesis therefore takes this relationship as a starting point, by using the theoretical limit of the "service relationship". The uncertainty and the complexity of the medical activity are the principal characteristics of this activity of service. We concentrate our attention on the central problem of reducing this uncertainty, often radical in this case, as regards the result of the service. The complexity of the activity derives from "the infinite diversity of case" that the physician meets. The emergence of gmp implies, considering the characteristics of the activity, the search for and the processing of a great deal of information, for which the therapist cannot be competent in the daily exercise of his activity. The construction of aid models for the md has to allow the production of information in far less quantity, entailing a substantial reduction in the inherent complexity of the medical activity. Multicriteria analyses of aid for the decision, based on the theoretical concepts of h. Simon's decision, have the ability to aggregate preferences without presumably reducing the field of the observable and seem well adapted to the aid for the md. This information, produced by these models of multicriterial inspiration, permits the creation of guides of gmp and may lead to the coordination of practitioners' behaviour, phenomenon comparable to the emergence of an economic "convention"
Godfroid, Philippe. "Deux essais sur la valeur économique de la prévention." Toulouse 1, 1996. http://www.theses.fr/1996TOU10064.
Повний текст джерелаBecause they often have in some respects the characteristics of a "public good", the economic value of many prevention activities cannot be assessed from markets. As a result, it is now common practice to use questionnaires in order to induce individuals to reveal their willingness to pay (wtp) for the reduction in the probability of an adverse event. The implicit value of prevention is then determined by adding the wtp's of all the individuals concerned by the activity. There is now a huge literature on various biases - mostly of a psychological or statistical nature - induced by the questionnaire technique. The purpose of this work is to stress and evaluate another potential source of bias, the nature of which is more financial. We compare the properties of two concepts that are often used to value risk transformations: the wtp and the risk premium. We show that - contrarily to a widespread belief-some properties of the risk premium are not shared by wtp. We propose in the second essay an adaptation in the health field of the famous Ehrlich Becker's paper
Boucand, Marie-Hélène. "Les maladies rares d'origine génétique : pour une médecine de l'adaptabilité et une éthique de subjectivation." Thesis, Lyon 3, 2015. http://www.theses.fr/2015LYO30048.
Повний текст джерелаRare diseases have only recently been identified. They set up quite a lot of diagnostic difficulties because not well-known yet by the medical profession .They sometimes occure by (ou bien with? With symptoms we named as being disqualifying because mainly subjective and without any outbreak possibly objective or evident by biology or medical imaging.Our work is at the crossroad of philosophy and social psychology. Week-end worked on the base of actual experience of 16 sick patients cases who took part in our research through semi-managed talks. So,main themes of their actual current experience could be identified : the pathological of the suffering person, the models of representation,the images used to express the genetics and the rare case, the link with the medical profession and the social experience of the diseases. For the patients concerned,these rare diseases are neither diseases nor handicaps but in-between cases.Taking into account that 80% of rare diseases have a genetique genetic origine origin ,we explored how this theory involves in the way it is lived. The imaginary of genetics still is still very pregnant,calling forth the causal linear origin of the disease and all hopes for recovery .It is often connected to a representation of the error,the fault or the malformation that happened at the time of fecondation. It is with all these representations that patients will have to rebuild their life,upset by the disease against which unfortunately more often most of the time ,no therapy exists yet. This research lead us to view a therapy that would combine a therapy of uncertainty and admit the limits of medical knowledge. In the end, this therapy should be able to become the therapy of an adaptation supporting the adaptability work of the patient who has to find his way to keep being a human person. in spite of the limits compelled by the disease. All along this sometimes very long way, the exchange of knowledge and an amazing solidarity among the patients within the associations back up the patient's capacities to rebuild himself as a subject, giving him the possibility of living his fate as a destiny
Marino, Patricia. "L'évaluation économique des innovations thérapeutiques : enjeux méthodologiques : application à la cancérologie." Aix-Marseille 2, 2007. http://www.theses.fr/2007AIX24020.
Повний текст джерелаMost of therapeutic innovations in cancerology induce limited improvement of the expected health outcome but they are associated with an important increase in costs and toxicity of treatments. In this context, quality of life studies represent a key parameter in the evaluation of innovative treatments for cancer disease, and their articulation with economic evaluation is necessary to clarify the complex trade-offs implied by these innovations. Considering the example of a national program aimed to evaluate the clinical benefit of intensified chemotherapy in the treatment of breast cancer (PEGASE program), this work study methodological questions about the difficulty in handling economic or quality of life criteria for decision making in the context of uncertainty: clinical uncertainty about efficacy results, economic uncertainty in calculation of cost-effectiveness ratios, quality of life uncertainty when missing data occur. The question addressed in this work is to know whether the handling of uncertainty is necessary to clarify the results of economic evaluation and quality of life studies. In this context of uncertainty, using some more robust methodological approaches will permit in the future to place economic evaluation as a central component in medical decision making
Firmin, Édouard. "Démarches cindyniques en médecine générale : proposition d'une méthode pour élaborer une conduite à tenir pour chaque "résultat de consultation" du "Dictionnaire de la Société française de médecine générale" : test de faisabilité sur "arthopathie-périarthropathie", "dépression", "réaction à situation éprouvante", "rhinite", "toux"." Poitiers, 2016. http://nuxeo.edel.univ-poitiers.fr/nuxeo/site/esupversions/57cba4cf-3fae-45dd-8f10-c6da9623e4f4.
Повний текст джерелаIntroduction: In 70% of cases, the general practitioner ends up in a situation of diagnostic uncertainty at the end of a consultation. He must remain vigilant concerning two dangers: in one hand, making a mistake in the diagnosis, and on the other, failing to detect a serious disease. The “résultat de consultation” (RC) concept helpsdefine the most frequent clinical situations, to designate them precisely and thus control the first danger. We focused our work on managing the second danger; that is to say, failing to detect a serious disease. By creating a risk management method called “démarches cindyniques“, we tried to answer the following question: Is it possible to draft approaches to risk analysis that are adapted to the most frequent clinical situations in general medicine? Materials and methods : The work has been carried out by a group of eight general practitioners, and has been divided into four steps: a thorough review of articles, the development of a method to create approaches to risk analysis, their application to 20 CRs, and lastly, its evaluation done by 785 general practitioners using the Likert scale. Results: Through this work, we developed theapproaches of risk analysis of 5 out of the 20 RC: "arthopathie-périarthropathie", "dépression", "réaction à situation éprouvante", "rhinite" and "toux". The analysis of the approaches' evaluations shows an extensive support from the general practitioners. Three-quarters of them evaluate the interest of these approaches at 7/9 and 84% find them useful in their daily work, rating their interest over 7/9. General practitioners using the Dictionnaire des Résultats de consultation® (DRC) generally give better evaluations. Conclusion: The creation of these approaches to risk analysis is feasible and is widely welcomed by general practitioners. The next steps will be the generalization of this method for the whole DRC and then forpolypathology which represents the core of our profession
Sene, Alsane. "Modélisation et structuration des connaissances dans les processus de télémédecine dédiés aéronautique." Thesis, Toulouse 3, 2018. http://www.theses.fr/2018TOU30251/document.
Повний текст джерелаThere is an inherent risk in the practice of medicine that can affect the conditions of medical activities (diagnostic or therapeutic purposes). The management of uncertainty is also an integral part of decision-making processes in the medical field. In the case of a medical incident during an air travel, this uncertainty includes three additional sources: (1) variability of the aeronautical conditions, (2) individual variability of the patient's conditions, (3) individual variability of the intervener's skills. Presently, medical incidents in the plane are estimated worldwide at 350 per day and when they occur, they are handled in 95 \% of cases by health professionals who are passengers. It is often for them a first experience. The main reason for the reluctance of health professionals to respond to the aircraft captain's call is the need to improvise; having to make a diagnosis and assess the severity of the patient's condition under difficult conditions. Apart from telemedicine with remote assistance, the intervener, often alone in the face of his doubts and uncertainty, has no other decision aid tool on board. Civil aviation also has feedback systems to manage the complexity of such processes. Event collection and analysis policies are put in place internationally, for example ECCAIRS (European Co-ordination Center for Accident and Incident Reporting Systems) and ASRS (Aviation Safety Reporting System). In this work, we first propose a semantic formalization based on ontologies to clarify conceptually the vocabulary of medical incidents occurring during commercial flights. Then, we implement a knowledge extraction process from the data available on existing databases to identify the patterns of the different groups of incidents. Finally, we propose a Clinical Decision Support System (CDSS) architecture that integrates the management of the uncertainties present on both the collected data and the skill levels of the medical professionals involved
Mokhtari, Mostafa. "Processus décisionnel de fin de vie en réanimation néonatale : arbitrer entre le certain et l'incertain." Thesis, Université Paris-Saclay (ComUE), 2019. http://www.theses.fr/2019SACLS431/document.
Повний текст джерелаThe end-of-life (EOL) decision-making process remains a particular event that confronts health care teams with their doubts and uncertainties. Indeed, for such a decision to made, there must be some doubt and uncertainty, otherwise, instead of being a conscious “decision”, it becomes a simple application of prior knowledge. EOL decisions are not simply a case of the decision-maker overcoming his or her indecisiveness. In this work, I examine the role of the doctor as an arbitrator in the conflict between the certain and the uncertain in EOL situations in the neonatal period. I have based my work on the analysis of the trajectories of six clinical observations drawn from my own experience, which illustrate, better than a long speech, the notion of the certain and the uncertain, and give these abstract concepts a concrete and practical meaning.To explore the notion of the uncertain during the decision-making process in EOL situations, is to accept to go against the dominant medical culture that values certainty, because uncertainty is negatively perceived amongst caregivers. However, doubt can have a beneficial effect on the decision-making process itself, and on the consequences of the decision taken, since it encourages discussion between caregivers and allows time for decision-making. Thus, he or she who doubts is not ignorant, but cautious in the Aristotelian sense, when trying to deliberate a choice by subjecting it to the criticism of others as part of a procedure of collegial reflection.In this work, I also show that doubt and uncertainty compel the decision-maker to confront his or her personal convictions, which constitutes ethical ethics, with his or her responsibility, which is teleological ethics. It is only in the tension between these two ethics that the caregiver can decide with peace of mind
Dumas, Estelle. "Recherche biomédicale et journalisme en situation d'incertitude : validité des résultats de la recherche biomédicale et couverture médiatique." Thesis, Bordeaux, 2017. http://www.theses.fr/2017BORD0737/document.
Повний текст джерелаMany academic publications are devoted to the « reproducibility crisis » in biomedical sciences. Their authors distinguish this lack of reproducibility from fraud or plagiarism. This “crisis” deals with a much larger phenomenon encompassing many scientific disciplines: a large amount of scientific results are disconfirmed by subsequent studies.This lack of reproducibility is to be expected: knowledge production is an incremental process where early, promising yet tentative findings are validated through replication. Indeed, scientific results are uncertain per se. The problem, however, is that this uncertainty does not seem to be taken into consideration when science “meets” the public, especially through the media.In this dissertation we studied how the media presented this uncertainty when dealing with biomedical findings. To do so we first created a large, original database of scientific studies investigating the association between risk factors (genetic, biochemical, environmental) and pathologies from three biomedical domains; psychiatry, neurology and a set of four somatic diseases. We evaluated the validity of each initial study by comparing their results to the result of meta-analyses on the same subject. The replication validity is low: 65% of initial studies are disconfirmed by corresponding meta-analysis even when they were published in high-ranking journals. We then identified which studies were selected by the press: initial studies published in prestigious journals and relevant to the readers were preferentially covered. Their validity was nonetheless poor with more than 50% being subsequently invalidated. The press rarely mentioned these frequent invalidations. Analysing the newspaper article contents, we found that journalists and their editors do not deal with scientific uncertainty. Indeed, the majority of newspaper articles referred to the study as being an initial study but only 21% indicated that the results needed to be replicated. Moreover those statements were made by scientists and have become scarce in most recent articles. A survey of 21 science journalists confirmed that journalists still consider high-ranking scientific journals to be reliable sources of information. However, these journalists were not familiar with the incremental process of knowledge production: two-thirds did not know that early findings were uncertain, or confused uncertainty with fraud. The other third knew about the uncertainty of initial results but found it hard to take it into account in their articles because of their respective hierarchy.More generally, the dissertation discusses the influence of extra-scientific factors upon the production of scientific knowledge. We conclude that the scientific assessment process based on the number of papers published in high impact factor journals, combined with the scientific institutions’ orientation towards the media, might undermine the reliability of scientific results, and this in academic publications as well as in the media. Indeed, journalists’ working conditions are deteriorating and most do not seem to properly grasp how scientific facts are produced. This might be damaging for public trust in biomedical research and public debate about health-related issues
Morel, Pierre. "Représentation et gestion de l'incertitude pour l'action." Phd thesis, Université Claude Bernard - Lyon I, 2011. http://tel.archives-ouvertes.fr/tel-00925848.
Повний текст джерелаLambert, Benjamin. "Quantification et caractérisation de l'incertitude de segmentation d'images médicales pardes réseaux profonds." Electronic Thesis or Diss., Université Grenoble Alpes, 2024. http://www.theses.fr/2024GRALS011.
Повний текст джерелаIn recent years, artificial intelligence algorithms have demonstrated outstanding performance in a wide range of tasks, including the segmentation and classification of medical images. The automatic segmentation of lesions in brain MRIs enables a rapid quantification of the disease progression: a count of new lesions, a measure of total lesion volume and a description of lesion shape. This analysis can then be used by the neuroradiologist to adapt therapeutic treatment if necessary. This makes medical decisions faster and more precise.At present, these algorithms, which are often regarded as black boxes, produce predictions without any information concerning their certainty. This hinders the full adoption of artificial intelligence algorithms in sensitive areas, as they tend to produce errors with high confidence, potentially misleading human decision-makers. Identifying and understanding the causes of these failures is key to maximizing the usefulness of AI algorithms and enabling their acceptance within the medical profession. To achieve this goal, it is important to be able to distinguish between the two main sources of uncertainty. First, aleatoric uncertainty, which corresponds to uncertainty linked to intrinsic image noise and acquisition artifacts. Secondly, epistemic uncertainty, which relates to the lack of knowledge of the model.The joint aim of Pixyl and GIN is to achieve better identification of the sources of uncertainty in deep neural networks, and consequently develop new methods for estimating this uncertainty in routine, real-time clinical use.In the context of medical image segmentation, uncertainty estimation is relevant at several scales. Firstly, at the voxel scale, uncertainty can be quantified using uncertainty maps. This makes it possible to superimpose the image, its segmentation and the uncertainty map to visualize uncertain area. Secondly, for pathologies such as Multiple Sclerosis, the radiologist's attention is focused on the lesion rather than the voxel. Structural uncertainty estimation, i.e. at the lesion scale, enables the radiologist to quickly control uncertain lesions that may be false positives. Thirdly, high-level metrics such as volume or number of lesions are commonly extracted from segmentations. Being able to associate predictive intervals with these metrics is important so that the clinician can take this uncertainty into account in his analysis. Finally, uncertainty can be quantified at the scale of the whole image, for example to detect out-of-distribution images that present a significant anomaly that could bias their analysis.In this thesis, the development of uncertainty quantification tools operating at each of these levels is proposed. More generally, the desired and expected methods should enable Pixyl to improve its current models, services and products. For clinical application, inference time is particularly critical: decision support is only useful if it is fast enough to be applied during patient consultation (i.e. in less than 5 minutes). What's more, innovative solutions will need to maintain a high level of performance even when applied to small image databases, as is generally the case in the medical field
Charoy, Marie. "Incertitudes des traitements des lésions hépatiques en radiothérapie stéréotaxique avec asservissement à la respiration." Thesis, Lille 1, 2014. http://www.theses.fr/2014LIL10037/document.
Повний текст джерелаOscar Lambret Center treated with Cyberknife®, since June 2007, liver lesions in stereotactic conditions with respiratory tracking using external LEDs correlated with seeds implanted near the target. Clinical results show excellent local control but there are still uncertainties in the preparation and delivery of treatment. The aims of this thesis are to identify and quantify these uncertainties, to define solutions and/or alternatives and to assess their added value. As a first step, the method of the target definition by the radiation oncologist is evaluated. Improvement of the method currently used in routine is considered, including the choice of the most appropriate imaging and the intervention of a second operator, expert in imaging (radiologist). The organ at risk and target motion induced by the respiratory is not taken into account in the treatment planning step, performed on the 3D images (the so-called planning CT). The dosimetric impact associated with this type of planning is evaluated using 4D Monte Carlo simulations that take into account patient and linear accelerator movements and the synchrony between both movements. The question of 4D planning as prospect of improvement is then investigated. Movements and deformations of the liver due to respiration are also implicated in the uncertainties involved in the treatment. The correlation model of external markers with the target, used for respiratory tracking, ignores eventual deformations and rotations within the liver. A study of the impact on the target tracking is performed
Raz, Michal. "La production des évidences sur l'intersexuation : savoirs et pratiques médicales autour de l'hyperplasie congénitale des surrénales (France, 1950-2018)." Thesis, Paris, EHESS, 2019. http://www.theses.fr/2019EHES0115.
Повний текст джерелаThis dissertation traces the transformations of biomedical knowledge and practice on intersex in France. It studies the 20th century emergence and development of a new apparatus consisting in early medicalization of children with atypical sex. It specifically examines the example of the management the intersex variation CongenitalAdrenal Hyperplasia (CAH). This normalizing apparatus was based on a paradigm shiftinstituted by a new protocol developed at the Johns Hopkins Hospital in the 1950s. Thisresearch analyzes the way this protocol was received and implemented in France. Examining the systematic medical management of “CAH girls” from this historical pointof view reveals a process of medical knowledge production that creates several ideas that come to be self-evident: their unequivocal female sex and the presumed necessity of early medical interventions. These “obvious” ideas are supported by new biomedical techniques as well as by psychological theories on gender and sexuality. Drawing on archives of scientific publications and interviews with key actors in this medical process, this dissertation shows that the multiplication of knowledge and medical intervention technologies paradoxically produces forms of ignorance and resistance within the current French medical field to abandon this paradigm that has now long been criticized. By studying two areas of medical action and knowledge production (prenatal diagnosis and long term follow-up studies), this dissertation focuses on the way these obvious ideas about sex persist despite the uncertain and complex nature of this knowledge that intersexuality destabilizes. This phenomenon can be understood in light of the contemporary context where medicine enjoys social legitimacy and exclusive control over the subject and deploys a variety of mechanisms to reject alternative forms of expertise
Thibeau, Raphaël. "Entre "comment" et "si" : incertitudes et engagements professionnels entourant les chirurgies génitales précoces chez les clinicien.ne.s du développement sexuel atypique." Thesis, Paris, EHESS, 2019. http://www.theses.fr/2019EHES0039.
Повний текст джерелаThis PhD dissertation analyzes from a sociological point of view the evolutions in clinical care of atypical sex development, or intersex. It focuses mainly on the different ways specialized clinicians approach the controversy surrounding genitals normalization surgeries in pediatrics. From the observation of highly contrasted stances between, on one hand, movements of intersex people and national or international institutions defending human rights; and, on the other hand, dominant clinical discourses, this dissertation questions the conditions of the upholding or challenging of clinical practices, in a given time and location. The research is based on a qualitative inquiry and cross-analysis of hospital teams’ discourses and practices in France, the United-States and Switzerland, as well as on medical publications. It mainly shows that even though we tend towards a fair homogenization of medical discourses about “how” to proceed (protocols to use, care and techniques to offer, medical teams organization), the question of “whether” or not clinicians and parents should use the available techniques in order to change a child’s body, is subject to high internal tensions within the medical community, however often made invisible by consensus building. It shows how professional commitments, including on moral grounds, are tying clinicians to certain practices, as well as the specific dilemmas and uncertainties to which these practices confront them. This dissertation also shows that both supportive and critical views about those practices coexist most of the time in clinicians’ discourses. By comprehending clinical approaches of early genital surgeries from the point of view of their diversity and of the tensions that characterize them, this research highlights that the conceptions of what makes “good” care and of who is the patient are subject to variable interpretations, some of which question fundamentally the mandate granted exclusively to medicine until now
Cazal, Julien. "Prévenir la maladie cardiovasculaire : socio-éthnologie du risque et de l'incitation sanitaire." Toulouse 3, 2012. http://thesesups.ups-tlse.fr/1727/.
Повний текст джерелаPrevention of cardiovascular disease is a major public health issue. The aim of the management is to train the patient so that he could adopt healthy behavior to reduce the risk of serious complications. Medical institution act in this direction on the development of self-government. From an ethnographic study conducted in two devices support (detection, rehabilitation) and interviews (n = 59) with professional and patient, research shows how to build "the self-caregiver" by training in risk and promoting change in lifestyle. The first part characterizes the intervention logic specific to each device and shows that the self-government is considered as an individualized or collective approach to risk depending on whether the detection or rehabilitation. The second part is, following an interactionist perspective, the construction of the risk and self-government within the devices. It shows that detection prevails risk learning through a comprehensive, multifactorial health, while in rehabilitation it is learning to live with the risk by a physical discipline. Finally, the third part shows, following a cultural approach to risk, how the medical establishment and the patient think the risk symmetrically. Three positions are determined in relation to the social positions of patients: the "admnistered" who is in the delegation to the medical community, the "medical helper" partner device that adheres to a model of prevention, "the patient-citizen "who is critical of the medical institution
Basset, Pierre. "Aspects éthiques des situations de refus et arrêt de traitement." Thesis, Université Paris-Saclay (ComUE), 2016. http://www.theses.fr/2016SACLS015/document.
Повний текст джерелаAbstract : The objective of this work is to study what brings a sick person to formulate a refusal of treatment, based on a three-pronged approach. One of the patient and his relatives, one of professionals faced with this refusal, and one of a multi-professional ethics reflection group, bringing together representatives of humanities and social sciences, as well as “ordinary citizens”, bringing the outside eye of the city. Looking for the meaning of a refusal consists of analyzing and decoding a willingness of the person that something happens or does not happen, and corresponds to the dialectic of the gift and acceptance of the care. To refuse a treatment doesn’t mean refusing care. Situations of refusal pave the way for reflection about our individual and collective behavior, our doubts, our uncertainties as well as conflicting values. This work explores the complexity of such problems encountered in daily clinical practice, in order to deepen the questioning about the interaction played between the different actors. It also shows how important it is to working methods that promote the ethics of dialogue. Considering the choices faced by those who assume the responsibility for the decision, the question arises of which resources to use to promote ethical reflection, avoiding the arbitrary nature of personal convictions
Yang, Yingyu. "Analyse automatique de la fonction cardiaque par intelligence artificielle : approche multimodale pour un dispositif d'échocardiographie portable." Electronic Thesis or Diss., Université Côte d'Azur, 2023. http://www.theses.fr/2023COAZ4107.
Повний текст джерелаAccording to the 2023 annual report of the World Heart Federation, cardiovascular diseases (CVD) accounted for nearly one third of all global deaths in 2021. Compared to high-income countries, more than 80% of CVD deaths occurred in low and middle-income countries. The inequitable distribution of CVD diagnosis and treatment resources still remains unresolved. In the face of this challenge, affordable point-of-care ultrasound (POCUS) devices demonstrate significant potential to improve the diagnosis of CVDs. Furthermore, by taking advantage of artificial intelligence (AI)-based tools, POCUS enables non-experts to help, thus largely improving the access to care, especially in less-served regions.The objective of this thesis is to develop robust and automatic algorithms to analyse cardiac function for POCUS devices, with a focus on echocardiography (ECHO) and electrocardiogram (ECG). Our first goal is to obtain explainable cardiac features from each single modality respectively. Our second goal is to explore a multi-modal approach by combining ECHO and ECG data.We start by presenting two novel deep learning (DL) frameworks for echocardiography segmentation and motion estimation tasks, respectively. By incorporating shape prior and motion prior into DL models, we demonstrate through extensive experiments that such prior can help improve the accuracy and generalises well on different unseen datasets. Furthermore, we are able to extract left ventricle ejection fraction (LVEF), global longitudinal strain (GLS) and other useful indices for myocardial infarction (MI) detection.Next, we propose an explainable DL model for unsupervised electrocardiogram decomposition. This model can extract interpretable information related to different ECG subwaves without manual annotation. We further apply those parameters to a linear classifier for myocardial infarction detection, which showed good generalisation across different datasets.Finally, we combine data from both modalities together for trustworthy multi-modal classification. Our approach employs decision-level fusion with uncertainty, allowing training with unpaired multi-modal data. We further evaluate the trained model using paired multi-modal data, showcasing the potential of multi-modal MI detection to surpass that from a single modality.Overall, our proposed robust and generalisable algorithms for ECHO and ECG analysis demonstrate significant potential for portable cardiac function analysis. We anticipate that our novel framework could be further validated using real-world portable devices. We envision that such advanced integrative tools may significantly contribute towards better identification of CVD patients
Iqbal, Muhammad Sohail. "Continuum robot modeling with guaranteed approach." Thesis, Paris Est, 2010. http://www.theses.fr/2010PEST1027.
Повний текст джерелаUnlike conventional robots, continuum robots do not contain any rigid link or any rotational joint but present a continuous bending in the structure through smooth motion. Development of this class of robot for their medical application presents a common set of problems : optimization of design, kinematic modeling, sensing choice, and their control in real time. Existing techniques for the modeling of continuum robots do not take system uncertainties into account. A proper handling of these uncertainties becomes of crucial importance for the certification of such robots used as medical devices. For our research, we consider a continuum robot that has been developed for the treatment of aortic aneurysm by Minimal Invasive Surgery (MIS), in LISSI Lab. In the context of MIS, it is very important to develop a guaranteed kinematic model of robot taking into account the different types of un-certainties. To handle this problem, we use the techniques of interval analysis. These techniques are capable of performing the global optimization and solving CSPs while taking into account the different uncertainties ; no matter, whether these uncertainties are random or systematic. Contribution of this thesis is proposal of a continuum robot's kinematic model that can take system uncertainties due to different factors such as rounding errors, parametric errors, and errors due to modeling assumptions. Initially, we develop the forward and inverse kinematics of the continuum robot in closed-form formulas. These derived formulas are used for the characterization of different properties of the robot such as manipulability. To find optimized guaranteed kinematics, we retained and applied an enhanced version of branch and bound algorithm. The inverse kinematics was formulated and resolved as a constrained optimization problem for robot's orientation. The proposed approaches are validated through simulations. The results of this thesis give rise to a general framework that is valid to handle the system uncertainties for the entire class of continuum robot that are shaped by continuously bending actuators
Godfroid, Tiphaine. "Le patient acteur dans la prise en charge du cancer : attentes normatives et travail du malade." Thesis, Université Grenoble Alpes (ComUE), 2017. http://www.theses.fr/2017GREAH014/document.
Повний текст джерелаThe patient actor in the management of cancer : normative expectations and patient workIn the context of a humanisation of care that enhances the figure of the individual as an actor in his or her health, this thesis questions the positioning of patients affected by cancer and their caregivers and close relatives in the care and experience of this pathology from the point of view of their "becoming actor". It highlights the disease management work done by the affected individuals, notably by analyzing how they deal with the uncertain dimensions of the experience of cancer. It also shows how the ethical considerations of the "right to information", the patient "associated with decisions" or even "at the heart of care" and the fight against cancer policy centered on "health education" contribute to bring to the foreground normative expectations that weigh on the sick. Through four stages of the disease - the discovery and announcement of cancer, the treatment period, the experience of remission and end-of-life trajectories - it more specifically examines the differences between the expected and prescribed roles and the roles effectively endorsed, the strategies of cooperation, negotiation or resistance between the actors and the elements that underpin the decision-making of the patients and their commitment to the actions they take to face cancer on a daily basis. The underlying questioning thus focuses on the actions and strategies undertaken by the actors affected in an attempt to control a trajectory of illness marked by uncertainty and how the latter integrate - or not the expectations of " the individual actor of his health and his disease "
Bourdon, Marie-Claude. "Le médecin est-il aussi un guérisseur?" Thèse, 2007. http://hdl.handle.net/1866/7336.
Повний текст джерелаGorgos, Andreea. "Parental projections of developmental outcome, quality of life and coping in children who require neonatal intensive care." Thèse, 2015. http://hdl.handle.net/1866/13019.
Повний текст джерелаIn the neonatal intensive care unit, professionals and parents prognosticate about developmental and quality of life (QOL) outcomes. The purpose of this thesis is to understand how parents predict future QOL for their babies during the neonatal period. In a qualitative study using grounded theory, ten interviews with parents were conducted. The main findings indicate that developmental prognosis influences parental predictions of QOL but it is not sufficient in defining it, since QOL is a multidimensional construct. Parents use a variety of coping mechanisms in dealing with the adversity arising from the illness and hospitalization. Parents who believed that they and their child would be able to adapt to an eventual poor developmental outcome predicted a re-framed QOL. Neurodevelopmental prognosis and future QOL are not easily estimated and health professionals should be acutely aware of this. Helping parents identify coping mechanisms might lead to more positive prognosis of future QOL.