{"id":767,"date":"2016-04-30T15:36:55","date_gmt":"2016-04-30T14:36:55","guid":{"rendered":"http:\/\/lepcam.fr\/?page_id=767"},"modified":"2021-01-08T18:40:55","modified_gmt":"2021-01-08T17:40:55","slug":"quanti","status":"publish","type":"page","link":"https:\/\/lepcam.fr\/index.php\/les-etapes\/quanti\/","title":{"rendered":"III. Types d&rsquo;\u00e9tudes quantitatives"},"content":{"rendered":"<p><strong>Les exercices <\/strong><\/p>\n<div style=\"margin: auto; width: auto; \"><h3 class='azc_tsh_toggle' style='border: 0px solid #00F000; background-color: #ffffff; '><a href='#' style='color: #CC6666; font-family: inherit; font-size: 0.6em; '>Cliquez pour afficher<\/a><\/h3><div class='azc_tsh_toggle_container' style='border: 0px solid #00F000; background-color: #ffffff; color: #000000; font-family: inherit; font-size: 100%; font-weight: normal; '><\/p>\n<p><a href=\"https:\/\/formations.prescrire.org\/Fr\/0DB3CB30BE129FBFE7F9385D908BFA5E\/Download.aspx\">Exercice N\u00b01 &#8211; \u00c0 la recherche du crit\u00e8re pertinent\u2026 pour les patients<\/a><br \/>\n<a href=\"https:\/\/formations.prescrire.org\/Fr\/FC1E57E46571BBDE85B841C4DCFB6732\/Download.aspx\">Exercice N\u00b03 &#8211; Quand deux pr\u00e9cautions valent mieux qu\u2019une<\/a><br \/>\n<a href=\"https:\/\/formations.prescrire.org\/Fr\/576DFF3C098FCA73FDF2D4716484E3C9\/Download.aspx\">Exercice N\u00b04 &#8211; Distinguer \u00e9valuation de l\u2019efficacit\u00e9 et \u00e9valuation de l\u2019utilit\u00e9<\/a><br \/>\n<a href=\"https:\/\/formations.prescrire.org\/Fr\/B183D87B6B69F4E8138EB18657871122\/Download.aspx\">Exercice N\u00b08 &#8211; Gare aux extrapolations<\/a><br \/>\n<a href=\"https:\/\/formations.prescrire.org\/Fr\/2C622069AE1D1388CD43D587D4612E24\/Download.aspx\">Exercice N\u00b09 &#8211; Ne pas confondre observer et exp\u00e9rimenter<\/a><br \/>\n<a href=\"https:\/\/formations.prescrire.org\/Fr\/D2999A2B4BE27B81833756DD92B7A936\/Download.aspx\">Exercice N\u00b015 &#8211; Oeufs brouill\u00e9s<\/a><br \/>\n<a href=\"https:\/\/formations.prescrire.org\/Fr\/7B04205FF62355ED0E92C7CC50A2EDE6\/Download.aspx\">Exercice N\u00b019 &#8211; Ne pas fausser la balance b\u00e9n\u00e9fices-risques<\/a><br \/>\n<a href=\"https:\/\/formations.prescrire.org\/Fr\/B636315CE382A99421D6C52AC351F93A\/Download.aspx\">Exercice N\u00b021 &#8211; Un assemblage fragile<br \/>\n<\/a><a href=\"https:\/\/formations.prescrire.org\/Fr\/8376F985669D0D761623D94688D05076\/Download.aspx\">Exercice N\u00b028 &#8211; G\u00e9rer l&rsquo;incertitude dans l&rsquo;int\u00e9r\u00eat des patients<\/a><a href=\"https:\/\/formations.prescrire.org\/Fr\/B636315CE382A99421D6C52AC351F93A\/Download.aspx\"><br \/>\n<\/a><a href=\"https:\/\/formations.prescrire.org\/Fr\/9AE8CC16BAE0E51F87D26E1DE6FD1AB9\/Download.aspx\">Exercice N\u00b034 &#8211; Rapports de vraisemblance<\/a><br \/>\n<a href=\"https:\/\/formations.prescrire.org\/Fr\/53803BAF85A68B06B70637C4355DFA66\/Download.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Exercice N\u00b036 &#8211; Efficacit\u00e9 en poup\u00e9es russes<br \/>\n<\/a><a href=\"https:\/\/formations.prescrire.org\/Fr\/372E4A14DC3A3064D530CE3AA27371A3\/Download.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Exercice N\u00b038 &#8211; Pas de preuves sans essai\u00a0?<\/a><br \/>\n<a href=\"https:\/\/formations.prescrire.org\/Fr\/B6F0C41EEF13534EB9096721DFEA8774\/Download.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Exercice N\u00b040 &#8211; Un million en quatre semaines<\/a><br \/>\n<a href=\"https:\/\/formations.prescrire.org\/Fr\/82E7E369C89452F65907BAD001498CEC\/Download.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Exercice N\u00b045 &#8211; Ne pas prendre des vessies pour des lanternes<\/a><\/p>\n<p><\/div><\/div>\n<p>Je me permets de vous remettre l&rsquo;algorithme pour vous aider :<\/p>\n<div id=\"attachment_1128\" style=\"width: 639px\" class=\"wp-caption aligncenter\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-1128\" data-attachment-id=\"1128\" data-permalink=\"https:\/\/lepcam.fr\/index.php\/les-etapes\/type-etude\/type_etude\/\" data-orig-file=\"https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/02\/type_etude.png?fit=4005%2C2896&amp;ssl=1\" data-orig-size=\"4005,2896\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"type_etude\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Algorithme des \u00e9tudes quantitatives&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/02\/type_etude.png?fit=629%2C455&amp;ssl=1\" class=\"size-large wp-image-1128\" src=\"https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/02\/type_etude-1024x740.png?resize=629%2C455&#038;ssl=1\" alt=\"Algorithme des \u00e9tudes quantitatives\" width=\"629\" height=\"455\" srcset=\"https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/02\/type_etude.png?resize=1024%2C740&amp;ssl=1 1024w, https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/02\/type_etude.png?resize=300%2C217&amp;ssl=1 300w, https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/02\/type_etude.png?resize=600%2C434&amp;ssl=1 600w, https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/02\/type_etude.png?resize=900%2C651&amp;ssl=1 900w, https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/02\/type_etude.png?resize=1280%2C926&amp;ssl=1 1280w, https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/02\/type_etude.png?w=1887 1887w\" sizes=\"auto, (max-width: 629px) 100vw, 629px\" \/><p id=\"caption-attachment-1128\" class=\"wp-caption-text\">Algorithme des \u00e9tudes quantitatives<\/p><\/div>\n<h2 id=\"cas\">A. Cas, s\u00e9rie de cas<\/h2>\n<p>En anglais, case report ou case series, correspond \u00e0 la description d\u00e9taill\u00e9e d\u2019un cas ou de plusieurs cas cliniques d\u2019int\u00e9r\u00eat. Cette description comprend souvent les sympt\u00f4mes, les signes, le diagnostic, le traitement et le suivi.<\/p>\n<p><strong>Classification\u00a0: <\/strong><\/p>\n<p>Le BMJ Case Reports <span class=\"zp-InText-zp-ID--1093634-3VV856JH--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:3VV856JH}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>\u00a0propose de les classer en diff\u00e9rentes cat\u00e9gories \u00a0:<\/p>\n<ul>\n<li>Une association rare entre une pathologie et des sympt\u00f4mes<\/li>\n<li>Pr\u00e9sentation inhabituelle d\u2019une pathologie commune<\/li>\n<li>Rappel d\u2019une le\u00e7on clinique importante<\/li>\n<li>Apprentissage suite \u00e0 une erreur<\/li>\n<li>D\u00e9couverte d\u2019un nouveau lien entre la pathog\u00e9n\u00e8se d\u2019une maladie ou d\u2019un effet secondaire<\/li>\n<li>Nouvelle ou maladie rare<\/li>\n<li>\u00c9clatement d\u2019un mythe<\/li>\n<li>Nouvelle proc\u00e9dure diagnostique<\/li>\n<li>Nouveau traitement<\/li>\n<li>Une image<\/li>\n<li>La sant\u00e9 globale<\/li>\n<li>Cons\u00e9quence inattendue (positive ou n\u00e9gative) dont effet secondaire m\u00e9dicamenteux<\/li>\n<\/ul>\n<p><strong>Int\u00e9r\u00eat\u00a0<\/strong>:<\/p>\n<ul>\n<li>Avantages\u00a0:\n<ul>\n<li>D\u00e9couverte de nouvelles maladies\n<ul>\n<li>Ex\u00a0: VIH<\/li>\n<\/ul>\n<\/li>\n<li>D\u00e9couverte de nouveaux effets secondaires m\u00e9dicamenteux.\n<ul>\n<li><em>Ex\u00a0: William McBride d\u00e9crivit pour la 1<sup>\u00e8re<\/sup> fois une s\u00e9rie de cas de malformation f\u0153tale chez des patientes ayant re\u00e7u du thalidomide dans le Lancet de 1961<span class=\"zp-InText-zp-ID--1093634-MJFICS24--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:MJFICS24}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>.<\/em><\/li>\n<\/ul>\n<\/li>\n<li>D\u00e9couverte de nouveau traitement\n<ul>\n<li><em>Ex\u00a0: utilisation du propranolol dans l\u2019h\u00e9mangiome infantile<span class=\"zp-InText-zp-ID--1093634-QDSGVCVE--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:QDSGVCVE}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>.<\/em><\/li>\n<\/ul>\n<\/li>\n<li>Am\u00e9lioration de la connaissance des sympt\u00f4mes fr\u00e9quents d\u2019une maladie rare et de sympt\u00f4mes rares d\u2019une maladie fr\u00e9quente.<\/li>\n<li>Formation m\u00e9dicale\u00a0: apprentissage par l\u2019\u00e9tude de cas clinique<\/li>\n<li>Publication rapide.<\/li>\n<\/ul>\n<\/li>\n<li>D\u00e9savantage\u00a0:\n<ul>\n<li>Qualit\u00e9 m\u00e9thodologique souvent faible.\n<ul>\n<li><em>Ex\u00a0: sur 1316 cas de m\u00e9decine d\u2019urgence publi\u00e9s dans 4 journaux, la moiti\u00e9 manquaient d\u2019information sur le traitement que suivait le patient<span class=\"zp-InText-zp-ID--1093634-7FIQ89JX--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:7FIQ89JX}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span><\/em><em>. <\/em><\/li>\n<\/ul>\n<\/li>\n<li>Tr\u00e8s faible niveau EBM<\/li>\n<li>Pas de test statistique, nombreux biais<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Publication\u00a0: <\/strong><\/p>\n<p>Certains journaux sont sp\u00e9cialis\u00e9s dans la publication de case report (<em>Journal of Medical Case Reports, BMJ Case Reports\u2026<\/em>), d\u2019autres journaux publient quelques cas <em>(La Revue du Praticien, The Lancet\u2026).<\/em><\/p>\n<p>Incitez vos \u00e9tudiants \u00e0 en publier. \u00c7a peut \u00eatre rentable en termes d\u2019impact factor et la d\u00e9marche va stimuler l\u2019\u00e9tudiant pour faire de la recherche et publier (en plus c\u2019est sympa d\u2019avoir son nom sur PubMed\u2026).<\/p>\n<p><strong>Guide de r\u00e9daction.<\/strong><\/p>\n<p>Des recommandations <span class=\"zp-InText-zp-ID--1093634-AT9ZVA2M--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:AT9ZVA2M}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>\u00a0existent afin de r\u00e9diger un case report de qualit\u00e9.<\/p>\n<p>Vous pouvez les retrouver sur le site <a href=\"https:\/\/www.equator-network.org\/\">d\u2019Equator<\/a>.<\/p>\n<h2 id=\"transversale\">B. \u00c9tude transversale<\/h2>\n<p><strong>D\u00e9finition\u00a0<\/strong>:<\/p>\n<p>\u00c9tude qui mesure \u00e0 un m\u00eame moment la maladie ou le nombre de cas existants (pr\u00e9valence de la maladie) et le degr\u00e9 d\u2019exposition (6). On parle souvent de \u00ab\u00a0photographie\u00a0\u00bb \u00e0 un moment donn\u00e9.<\/p>\n<p>Synonyme\u00a0: \u00e9tude de pr\u00e9valence ou \u00ab survey \u00bb<\/p>\n<p>S\u2019oppose aux \u00e9tudes longitudinales.<\/p>\n<p><strong>Objectif\u00a0<\/strong>:<\/p>\n<p>Principalement descriptive, elle \u00e9tudie la distribution d\u2019un param\u00e8tre ou la pr\u00e9valence d\u2019une exposition ou d\u2019une maladie.<\/p>\n<p>Rarement \u00e9tiologique lorsqu\u2019on \u00e9tudie les marqueurs de l\u2019\u00e9tat de sant\u00e9 pour lesquels la pr\u00e9valence est un bon indicateur et dont l\u2019\u00e9tude ne modifiera pas le comportement vis-\u00e0-vis de l\u2019exposition \u00e9tudi\u00e9e<\/p>\n<p><strong>Principe<\/strong>\u00a0:<\/p>\n<ul>\n<li>Choix d\u2019un seul \u00e9chantillon repr\u00e9sentatif de la population g\u00e9n\u00e9rale.<\/li>\n<li>Recueil de la maladie et des expositions \u00e0 un instant donn\u00e9<\/li>\n<li>Pas de suivi dans le temps<\/li>\n<\/ul>\n<p><strong>Int\u00e9r\u00eat\u00a0:<\/strong><\/p>\n<ul>\n<li>Avantage\u00a0:\n<ul>\n<li>Calcul de la pr\u00e9valence et du risque relatif<\/li>\n<li>Rapide\u00a0: pas de suivi dans le temps (\u00e9vite les perdus de vue)<\/li>\n<li>Co\u00fbt faible (pas de suivi)<\/li>\n<li>Exploratoire, permettant de g\u00e9n\u00e9rer des hypoth\u00e8ses.<\/li>\n<\/ul>\n<\/li>\n<li>Inconv\u00e9nients\u00a0:\n<ul>\n<li>Association mais pas causalit\u00e9\u00a0: ne d\u00e9termine pas si la maladie est apparue apr\u00e8s l\u2019exposition.<\/li>\n<li>Pas d\u2019incidence\u00a0: manque la notion de dur\u00e9e.<\/li>\n<li>Nombreux biais<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Principaux biais\u00a0:<\/strong><\/p>\n<ul>\n<li>Biais de confusion\u00a0: peu de contr\u00f4le sur de potentiels facteurs de confusion.<\/li>\n<li>Biais de pr\u00e9valence\u00a0: les cas chroniques restent longtemps des cas pr\u00e9valents.<\/li>\n<li>Biais de s\u00e9lection\u00a0: \u00ab\u00a0healthy worker effect\u00a0\u00bb\u2026<\/li>\n<\/ul>\n<h2 id=\"diagno\">C. \u00c9tude diagnostique<\/h2>\n<p><strong>D\u00e9finition\u00a0<\/strong>: une \u00e9tude diagnostique permet d\u2019\u00e9valuer un nouvel outil diagnostique au niveau de ses performances diagnostiques ainsi que de l\u2019am\u00e9lioration du devenir des sujets diagnostiqu\u00e9s.<\/p>\n<p>En anglais\u00a0:\u00a0 Fiabilit\u00e9 = reliability, Reproducibility, Consistency, Stability, Repeatability.<\/p>\n<p>NB\u00a0: On parle souvent uniquement de \u00ab\u00a0test\u00a0\u00bb diagnostique mais il existe plusieurs \u00ab\u00a0outils\u00a0\u00bb diagnostiques tels que<\/p>\n<ul>\n<li><em>Ex : performance des D-Dim\u00e8res dans le diagnostic de l\u2019embolie pulmonaire.<\/em><\/li>\n<li>Score, algorithme. <em>Ex\u00a0: performance du score de Wells dans le diagnostic de la thrombose veineuse profonde.<\/em><\/li>\n<li>Signe clinique. <em>Ex\u00a0: performance du signe de Homans dans le diagnostic de la thrombose veineuse profonde des membres inf\u00e9rieurs.<\/em><\/li>\n<\/ul>\n<p><strong>Objectif\u00a0<\/strong>:<\/p>\n<ul>\n<li><strong>Performance<\/strong> (exactitude, validit\u00e9) : capacit\u00e9 d\u2019un test de diff\u00e9rencier des malades et non malades en fonction s\u2019ils ont le test positif ou n\u00e9gatif.<\/li>\n<li><strong>Fiabilit\u00e9<\/strong> (<strong>reproductibilit\u00e9<\/strong>)\u00a0: Capacit\u00e9 d&rsquo;un examen ou d&rsquo;un test de donner les m\u00eames r\u00e9sultats lorsqu&rsquo;il est r\u00e9p\u00e9t\u00e9 \u00e0 plusieurs reprises (et donc \u00e0 diff\u00e9rents moments) sur les m\u00eames sujets et exactement dans les m\u00eames conditions<span class=\"zp-InText-zp-ID--1093634-UM3AGQZ3--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:UM3AGQZ3}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>.<\/li>\n<li><strong>Co\u00fbt<\/strong><\/li>\n<li><strong>Acceptabilit\u00e9<\/strong><\/li>\n<\/ul>\n<p>Avant de pouvoir utiliser un outil\/test diagnostique dans la pratique courante, il faut d\u00e9montrer\u00a0:<\/p>\n<ul>\n<li>Qu\u2019il a de bonnes <strong>performances<\/strong> diagnostiques et qu\u2019il est fiable.<\/li>\n<li>Qu\u2019il <strong>am\u00e9liore le devenir des sujets<\/strong> ayant b\u00e9n\u00e9fici\u00e9 du test avec un co\u00fbt acceptable.<\/li>\n<\/ul>\n<p><strong>Formulation de l\u2019objectif\u00a0:<\/strong><\/p>\n<p>On retrouve le fameux PICO\u00a0:<\/p>\n<ul>\n<li>P\u00a0: population \u00e9tudi\u00e9e par le test<\/li>\n<li>I\u00a0: nouvel outil diagnostique<\/li>\n<li>C\u00a0: outil diagnostique de r\u00e9f\u00e9rence<\/li>\n<li>O\u00a0: crit\u00e8re de jugement<\/li>\n<\/ul>\n<p><em>Ex : \u00e9valuer la performance du test h\u00e9moccult\u00ae (I) par rapport \u00e0 la coloscopie (C) pour le d\u00e9pistage du cancer colorectal (O) chez les sujets de plus de 50 ans (P).<\/em><\/p>\n<p><strong>Type d\u2019\u00e9tude\u00a0: <\/strong><\/p>\n<p>Les principaux types d\u2019\u00e9tudes retrouv\u00e9s sont\u00a0:<\/p>\n<ul>\n<li><strong>Transversale\u00a0<\/strong>: si on n\u2019a pas besoin de suivre les sujets dans le temps<\/li>\n<li><strong>Cohorte\u00a0<\/strong>: si on veut analyser la survenue d\u2019un \u00e9v\u00e9nement dans le temps<\/li>\n<li><strong>Interventionnel\u00a0<\/strong>: lorsqu\u2019on cherche une influence du test sur le devenir du sujet.<\/li>\n<\/ul>\n<p><strong>Choix du test de r\u00e9f\u00e9rence\u00a0:<\/strong><\/p>\n<p>D\u00e9finition\u00a0: test de r\u00e9f\u00e9rence permettant d\u2019identifier v\u00e9ritablement les malades et les non-malades, qui va permettre d\u2019\u00e9valuer la performance du nouveau test.<\/p>\n<p>En anglais\u00a0: gold standard.<\/p>\n<p><strong>M\u00e9thodologie\u00a0<\/strong>:<\/p>\n<ul>\n<li>Sch\u00e9ma exp\u00e9rimental\u00a0:\n<ul>\n<li>Soit on a un <strong>test de r\u00e9f\u00e9rence<\/strong> (gold standard)\u00a0: \u00e9tude observationnelle transversale.\n<ul>\n<li>On choisit un \u00e9chantillon d\u2019individu qui vont subir les 2 tests\u00a0: gold standard + nouveau test.\u00a0<em>Ex : coloscopie vs hemoccult dans le d\u00e9pistage du cancer colorectal.<\/em><\/li>\n<\/ul>\n<\/li>\n<li>Soit on n\u2019a <strong>pas de test de r\u00e9f\u00e9rence\u00a0<\/strong>:\n<ul>\n<li>Et on veut pr\u00e9dire la survenue d\u2019un \u00e9v\u00e9nement\u00a0: \u00e9tude de <strong>cohorte<\/strong><\/li>\n<li>Et on recherche une influence du test sur le devenir du sujet\u00a0: \u00e9tude <strong>interventionnelle<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h4>a. Performance<\/h4>\n<p>La performance peut se d\u00e9composer en 2 cat\u00e9gories\u00a0:<\/p>\n<ul>\n<li>Performance <strong>intrins\u00e8que\u00a0<\/strong>:\n<ul>\n<li>D\u00e9finition\u00a0: c\u2019est la <strong>capacit\u00e9 informative propre du test<\/strong>, ne d\u00e9pendant pas de la pr\u00e9valence de la maladie.<\/li>\n<li>On l\u2019estime gr\u00e2ce \u00e0 la <strong>sensibilit\u00e9<\/strong> (Sn), la <strong>sp\u00e9cificit\u00e9<\/strong> (Sp), le <strong>rapport de vraisemblance<\/strong> <strong>positif<\/strong> (RVP) et <strong>n\u00e9gatif<\/strong> (RVN)<\/li>\n<\/ul>\n<\/li>\n<li>Performance <strong>extrins\u00e8que\u00a0<\/strong>:\n<ul>\n<li>D\u00e9finition\u00a0: c\u2019est la capacit\u00e9 informative du test en fonction de ses caract\u00e9ristiques intrins\u00e8ques et un contexte d\u2019utilisation (la <strong>pr\u00e9valence\u00a0<\/strong>= probabilit\u00e9 pr\u00e9test)<\/li>\n<li>On l\u2019estime gr\u00e2ce \u00e0 la <strong>valeur pr\u00e9dictive positive<\/strong> (VPP) et <strong>n\u00e9gative<\/strong> (VPN)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h5>i. Caract\u00e9ristiques intrins\u00e8ques<\/h5>\n<p>On va d\u00e9terminer si notre test a de bonnes capacit\u00e9s discriminantes M-\/M+. Ces indicateurs sont assez th\u00e9oriques car on ne prend pas en compte le contexte (de la pr\u00e9valence).<\/p>\n<p>Pour cela, il faut \u00e9tablir le <strong>tableau de contingence<\/strong>. C\u2019est un tableau \u00e0 double entr\u00e9e permettant d\u2019estimer la d\u00e9pendance entre 2 caract\u00e8res. Ici, on choisit comme variable le statut malade (M+ ou M-) et le r\u00e9sultat du test (T+ ou T-).<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"28\"><\/td>\n<td width=\"28\">T+<\/td>\n<td width=\"28\">T-<\/td>\n<\/tr>\n<tr>\n<td width=\"28\">M+<\/td>\n<td width=\"28\">VP<\/td>\n<td width=\"28\">FN<\/td>\n<\/tr>\n<tr>\n<td width=\"28\">M-<\/td>\n<td width=\"28\">FP<\/td>\n<td width=\"28\">VN<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Ce tableau nous permet de d\u00e9terminer 4 cat\u00e9gories de sujets\u00a0:<\/p>\n<ul>\n<li>VP\u00a0: Vrai Positif. Sujet malade ayant le test positif<\/li>\n<li>FN\u00a0: Faux N\u00e9gatif. Sujet malade ayant le test n\u00e9gatif<\/li>\n<li>FP\u00a0: Faux Positif. Sujet sain ayant le test n\u00e9gatif<\/li>\n<li>VN\u00a0: Vrai N\u00e9gatif. Sujet sain ayant le test n\u00e9gatif.<\/li>\n<\/ul>\n<p>Pour qu\u2019un test diagnostique soit de bonne qualit\u00e9, il faut qu\u2019on ait beaucoup de VP et VN et peu de FP et FP. On va pouvoir \u00e9tudier la relation entre ces 4 cat\u00e9gories gr\u00e2ce au calcul de diff\u00e9rents param\u00e8tres.<\/p>\n<ul>\n<li><strong>Sensibilit\u00e9\u00a0<\/strong>:\n<ul>\n<li>D\u00e9finition\u00a0:\n<ul>\n<li>Capacit\u00e9 d&rsquo;un diagnostic ou d&rsquo;un test de d\u00e9pistage \u00e0 identifier correctement des individus affect\u00e9s par une maladie vis\u00e9e ou par un probl\u00e8me de sant\u00e9.<\/li>\n<li>Probabilit\u00e9 que le test soit positif (T+) chez les personnes malades (M+) = p (T+\/M+)<\/li>\n<\/ul>\n<\/li>\n<li>Calcul\u00a0:\n<ul>\n<li>Sn = VP\/(VP+FN)<\/li>\n<\/ul>\n<\/li>\n<li>Rmq\u00a0: VP + FN = nombre total de sujets malades<\/li>\n<\/ul>\n<\/li>\n<li><strong>Sp\u00e9cificit\u00e9<\/strong>\n<ul>\n<li>D\u00e9finition\u00a0:\n<ul>\n<li>Capacit\u00e9 d&rsquo;un diagnostic ou d&rsquo;un test de d\u00e9pistage \u00e0 identifier correctement les individus non affect\u00e9s par une maladie vis\u00e9e ou par un probl\u00e8me de sant\u00e9.<\/li>\n<li>Probabilit\u00e9 que le test sera n\u00e9gatif (T-) parmi les personnes non malades (M-) = p (T-\/M-)<\/li>\n<\/ul>\n<\/li>\n<li>Calcul\u00a0:\n<ul>\n<li>Sp = VN\/(VN+FP)<\/li>\n<\/ul>\n<\/li>\n<li>Rmq\u00a0: VN + FP = nombre total de sujets non malades<\/li>\n<\/ul>\n<\/li>\n<li><strong>Efficacit\u00e9 diagnostique d\u2019un test<\/strong>\n<ul>\n<li>D\u00e9finition\u00a0:\n<ul>\n<li>Proportion de r\u00e9sultats corrects (VP et VN) dans l&rsquo;ensemble des r\u00e9sultats du test.<\/li>\n<\/ul>\n<\/li>\n<li>Calcul\u00a0:\n<ul>\n<li>E = (VN+VP)\/(VN+VP+FN+FP)<\/li>\n<\/ul>\n<\/li>\n<li>Interpr\u00e9tation\u00a0:\n<ul>\n<li>Valeur comprise entre 0 et 1<\/li>\n<li>0\u00a0: test inefficace<\/li>\n<li>1\u00a0: test parfait<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li><strong>Indice de Youden<\/strong>\n<ul>\n<li>D\u00e9finition\u00a0:\n<ul>\n<li>Indice permettant une mesure globale de la performance statistique d\u2019un test<\/li>\n<\/ul>\n<\/li>\n<li>Calcul\u00a0:\n<ul>\n<li>Y = Sn + Sp \u2013 1<\/li>\n<\/ul>\n<\/li>\n<li>Interpr\u00e9tation\u00a0:\n<ul>\n<li>Valeur comprise entre 0 et 1<\/li>\n<li>0\u00a0: test inefficace<\/li>\n<li>1\u00a0: test parfait<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li><strong>Courbe ROC<\/strong>\n<ul>\n<li>D\u00e9finition\u00a0: Un outil graphique permettant de repr\u00e9senter la capacit\u00e9 d&rsquo;un test \u00e0 discriminer entre la population des malades et des non malades.<\/li>\n<li>Objectifs :\n<ul>\n<li>\u00c9valuer la performance globale d\u2019un test diagnostique (\u00e0 variable de r\u00e9ponse quantitative continue)<\/li>\n<li>Comparer 2 tests diagnostiques<\/li>\n<li>D\u00e9finir le seuil de validit\u00e9 optimal d\u2019un test diagnostique.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li><strong>Rapport de vraisemblance\u00a0:<\/strong><\/li>\n<\/ul>\n<p>D\u00e9finition\u00a0: estimation du rapport entre la probabilit\u00e9 d\u2019avoir un test positif (ou n\u00e9gatif) chez les sujets malades et celui d\u2019avoir un test positif (ou n\u00e9gatif) chez les sujets sains<\/p>\n<p>Autrement dit, il correspond \u00e0 la probabilit\u00e9 post test de la maladie par rapport \u00e0 sa pr\u00e9valence.<\/p>\n<ul>\n<li>Rapport de vraisemblance<strong> positif<\/strong> (RVP ou RV+)\u00a0:\n<ul>\n<li>D\u00e9finition\u00a0: combien de fois est-il plus vraisemblable d\u2019\u00eatre M+ sachant qu\u2019on a le T+\u00a0?<\/li>\n<li>Calcul\u00a0: RVP = Se\/(1-Sp)<\/li>\n<li>Rmq\u00a0:\n<ul>\n<li>Le sujet a RVP fois plus de risque d\u2019avoir un test positif s\u2019il est malade que s\u2019il ne l\u2019est pas.<\/li>\n<li>Plus RVP est \u00e9lev\u00e9, plus on aura confiance dans le r\u00e9sultat d\u2019un test positif pour confirmer un diagnostic.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Rapport de vraisemblance<strong> n\u00e9gatif<\/strong> (RVN ou RV-)\u00a0:\n<ul>\n<li>D\u00e9finition\u00a0: combien de fois est-il plus vraisemblable d\u2019\u00eatre M- sachant qu\u2019on a le T-\u00a0?<\/li>\n<li>Calcul\u00a0: RVN = (1-Se)\/Sp<\/li>\n<li>Rmq\u00a0:\n<ul>\n<li>Le sujet a RVN fois plus de chance d\u2019avoir un test n\u00e9gatif s\u2019il est malade que s\u2019il ne l\u2019est pas.<\/li>\n<li>Plus RVN est \u00e9lev\u00e9, plus on aura confiance dans le r\u00e9sultat d\u2019un test n\u00e9gatif pour \u00e9liminer un diagnostic.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li><strong>Interpr\u00e9tation\u00a0<\/strong>: c\u2019est un ratio qui s\u2019interpr\u00e8te comme une RR<\/li>\n<li><strong>Nomogramme de Fagan<\/strong>:\n<ul>\n<li>Nomogramme = outil graphique de calcul constitu\u00e9 de courbes gradu\u00e9es entre lesquelles on place une r\u00e8gle. Le r\u00e9sultat de l&rsquo;op\u00e9ration se lit au croisement de la r\u00e8gle et de l&rsquo;une des courbes<\/li>\n<li>Int\u00e9r\u00eat\u00a0: il permet de calculer la probabilit\u00e9 post-test connaissant le RV et la pr\u00e9valence\u00a0: <strong>p (post-test) = p (pr\u00e9test) x RV<\/strong><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<table>\n<tbody>\n<tr>\n<td><strong>RVP<\/strong><\/td>\n<td><strong>RVN<\/strong><\/td>\n<td><strong>Apport diagnostique<\/strong><\/td>\n<\/tr>\n<tr>\n<td>&gt; 10<\/td>\n<td>&lt; 0,1<\/td>\n<td><strong>Tr\u00e8s fort<\/strong><\/td>\n<\/tr>\n<tr>\n<td>5 \u2013 10<\/td>\n<td>0,1 \u2013 0,2<\/td>\n<td><strong>Fort<\/strong><\/td>\n<\/tr>\n<tr>\n<td>2 \u2013 5<\/td>\n<td>0,2 \u2013 0,5<\/td>\n<td><strong>Mod\u00e9r\u00e9<\/strong><\/td>\n<\/tr>\n<tr>\n<td>1 &#8211; 2<\/td>\n<td>0,5 &#8211; 1<\/td>\n<td><strong>Faible<\/strong><\/td>\n<\/tr>\n<tr>\n<td>1<\/td>\n<td>1<\/td>\n<td><strong>nul<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h5>ii.\u00a0\u00a0 Caract\u00e9ristiques extrins\u00e8ques<\/h5>\n<p>On va d\u00e9terminer les qualit\u00e9s du test en prenant en compte la pr\u00e9valence de la maladie qu\u2019il va explorer. Un m\u00eame test aura des qualit\u00e9s extrins\u00e8ques diff\u00e9rentes en fonction de la maladie et de la population \u00e9tudi\u00e9e.<\/p>\n<p><em>Ex\u00a0: BNP dans le diagnostic de l\u2019insuffisance cardiaque chez la population g\u00e9n\u00e9rale vs une population g\u00e9riatrique.<\/em><\/p>\n<p><em>Ex\u00a0: CRP dans le diagnostic d\u2019une py\u00e9lon\u00e9phrite vs une rhinopharyngite.<\/em><\/p>\n<p><em>\u00a0<\/em><\/p>\n<p>Pour calculer ces indicateurs, on va prendre en compte les param\u00e8tres intrins\u00e8ques du test (Se, Sp) et de la pr\u00e9valence.<\/p>\n<p>Ils sont plus parlant pour le clinicien\u00a0:<\/p>\n<ul>\n<li>La pr\u00e9valence correspond \u00e0 la <strong>probabilit\u00e9 pr\u00e9-test <\/strong>: c\u2019est la probabilit\u00e9 d\u2019avoir la maladie avant d\u2019avoir fait le test.<\/li>\n<li>VPP et VPN correspondent \u00e0 la <strong>probabilit\u00e9 post-test\u00a0<\/strong>: c\u2019est la probabilit\u00e9 d\u2019avoir (ou pas) la maladie apr\u00e8s le test.<\/li>\n<\/ul>\n<ul>\n<li><strong>Valeur pr\u00e9dictive positive <\/strong>(VPP)\n<ul>\n<li>D\u00e9finition\u00a0(6):\n<ul>\n<li>Capacit\u00e9 du test de distinguer les personnes malades (vrais positifs) de l&rsquo;ensemble des personnes dont le r\u00e9sultat au test est positif (vrais positifs + faux positifs)<\/li>\n<li>Probabilit\u00e9 d\u2019\u00eatre malade (M+) si on a un test positif (T+)= p (M+\/T+)<\/li>\n<\/ul>\n<\/li>\n<li>Calcul\u00a0:\n<ul>\n<li>VPP = VP \/ (VP+FP)<\/li>\n<li>VPP = RVP x pr\u00e9valence<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li><strong>Valeur pr\u00e9dictive n\u00e9gative<\/strong> (VPN)\n<ul>\n<li>D\u00e9finition (6):\n<ul>\n<li>Capacit\u00e9 d&rsquo;un test \u00e0 distinguer les personnes saines (vrais n\u00e9gatifs) de l&rsquo;ensemble des personnes dont le r\u00e9sultat au test est n\u00e9gatif (vrais n\u00e9gatifs + faux n\u00e9gatifs)<\/li>\n<li>Probabilit\u00e9 de ne pas \u00eatre malade (M-) si on a un test n\u00e9gatif (T-) = p (M-\/T-)<\/li>\n<\/ul>\n<\/li>\n<li>Calcul\u00a0:\n<ul>\n<li>VPN = VN \/ (VN+FN)<\/li>\n<li>VPN = RVN x pr\u00e9valence<\/li>\n<\/ul>\n<\/li>\n<li>Rmq\u00a0:\n<ul>\n<li>VP + FP = nombre total de sujets ayant un test positif<\/li>\n<li>VN + FN = nombre total de sujets ayant un test n\u00e9gatif<\/li>\n<li>VPP et VPN d\u00e9pendent de la Sp, Se et la pr\u00e9valence de la maladie<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h4>b. Fiabilit\u00e9<\/h4>\n<p><strong>D\u00e9finition\u00a0: Fiabilit\u00e9<\/strong> (<strong>reproductibilit\u00e9<\/strong>)\u00a0: Capacit\u00e9 d&rsquo;un examen ou d&rsquo;un test de donner les m\u00eames r\u00e9sultats lorsqu&rsquo;il est r\u00e9p\u00e9t\u00e9 \u00e0 plusieurs reprises (et donc \u00e0 diff\u00e9rents moments) sur les m\u00eames sujets et exactement dans les m\u00eames conditions<span class=\"zp-InText-zp-ID--1093634-UM3AGQZ3--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:UM3AGQZ3}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>.<\/p>\n<p>Apr\u00e8s avoir d\u00e9montr\u00e9 que le test est efficace, on veut s\u2019assurer qu\u2019il donnera les m\u00eames r\u00e9sultats s\u2018il est r\u00e9p\u00e9t\u00e9<\/p>\n<ul>\n<li>Par un autre op\u00e9rateur\u00a0: <strong>reproductibilit\u00e9 inter op\u00e9rateur<\/strong><\/li>\n<li>Par un m\u00eame op\u00e9rateur\u00a0: <strong>reproductibilit\u00e9 intra op\u00e9rateur<\/strong><\/li>\n<\/ul>\n<p><strong>Coefficient de corr\u00e9lation Kappa<\/strong><\/p>\n<p>Il mesure l\u2019accord entre 2 jugements <strong>qualitatifs<\/strong>, en tenant compte de la part de concordance due au hasard.<\/p>\n<p>Il mesure la variabilit\u00e9 intra et interobservateur.<\/p>\n<p>Il est estim\u00e9 en rapportant le <strong>gain observ\u00e9<\/strong> (diff\u00e9rence entre la concordance observ\u00e9e test\/al\u00e9atoire) et le <strong>gain possible total<\/strong> (100\u00a0% &#8211; concordance al\u00e9atoire)<\/p>\n<ul>\n<li>Calcul\u00a0:\n<ul>\n<li>On doit \u00e9valuer la concordance interop\u00e9rateur (op\u00e9rateur 1 et op\u00e9rateur 2)<\/li>\n<li>C1\u00a0: nombre de tests positifs chez les 2 op\u00e9rateurs<\/li>\n<li>C2\u00a0: nombre de tests n\u00e9gatifs chez les 2 op\u00e9rateurs<\/li>\n<li>NC1\u00a0: nombre de tests positif chez l\u2019op\u00e9rateur 1 et n\u00e9gatif chez l\u2019op\u00e9rateur 2<\/li>\n<li>NC2\u00a0: nombre de tests n\u00e9gatifs chez l\u2019op\u00e9rateur 1 et positif chez l\u2019op\u00e9rateur 2<\/li>\n<li>C1 + C2\u00a0: nombre de tests concordants<\/li>\n<li>NC1 + NC2\u00a0: nombre de tests non concordants<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<table>\n<tbody>\n<tr>\n<td width=\"150\"><\/td>\n<td width=\"150\">Test positif par op\u00e9rateur 1<\/td>\n<td width=\"150\">Test n\u00e9gatif par op\u00e9rateur 2<\/td>\n<\/tr>\n<tr>\n<td width=\"150\">Test positif par op\u00e9rateur 2<\/td>\n<td width=\"150\">C1<\/td>\n<td width=\"150\">NC2<\/td>\n<\/tr>\n<tr>\n<td width=\"150\">Test n\u00e9gatif par op\u00e9rateur 2<\/td>\n<td width=\"150\">NC1<\/td>\n<td width=\"150\">C2<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li><strong>Interpr\u00e9tation<\/strong>\u00a0: les valeurs de r\u00e9f\u00e9rences d\u2019apr\u00e8s Landis-Koch 1977sont donn\u00e9s dans le tableau joint. En m\u00e9decine, on estime qu\u2019il doit \u00eatre &gt; 0.8<\/li>\n<\/ul>\n<table>\n<tbody>\n<tr>\n<td><strong>\u03ba<\/strong><\/td>\n<td><strong>concordance<\/strong><\/td>\n<\/tr>\n<tr>\n<td>1,00 \u2013 0,81<\/td>\n<td>Excellente<\/td>\n<\/tr>\n<tr>\n<td>0,80 \u2013 0,61<\/td>\n<td>Bonne<\/td>\n<\/tr>\n<tr>\n<td>0,60 \u2013 0,41<\/td>\n<td>Moyenne<\/td>\n<\/tr>\n<tr>\n<td>0,40 \u2013 0,21<\/td>\n<td>Faible<\/td>\n<\/tr>\n<tr>\n<td>0,20 \u2013 0,00<\/td>\n<td>Mauvaise<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h4>c. Principaux biais<\/h4>\n<ul>\n<li>Biais de v\u00e9rification\u00a0:\n<ul>\n<li>D\u00e9finition\u00a0: le test de r\u00e9f\u00e9rence n\u2019est r\u00e9alis\u00e9 que chez les ayant r\u00e9pondu positivement au nouveau test<\/li>\n<li>Anglais\u00a0: \u00ab\u00a0work up biais\u00a0\u00bb<\/li>\n<li>Cons\u00e9quence\u00a0: surestimation des performances du test<\/li>\n<\/ul>\n<\/li>\n<li>Biais de spectre\u00a0:\n<ul>\n<li>D\u00e9finition\u00a0: les patients s\u00e9lectionn\u00e9s ne refl\u00e8tent pas l\u2019ensemble des patients concern\u00e9s (biais de s\u00e9lection)<\/li>\n<\/ul>\n<\/li>\n<li>Biais de classement\u00a0:\n<ul>\n<li>D\u00e9finition\u00a0: biais lorsque l\u2019\u00e9valuateur est influenc\u00e9 par le r\u00e9sultat du premier test (non-respect de l\u2019aveugle)<\/li>\n<\/ul>\n<\/li>\n<li>Biais li\u00e9 \u00e0 un choix non pertinent du gold standard<\/li>\n<\/ul>\n<h4>d. Grille de lecture STARD<\/h4>\n<p>Une grille de lecture <a href=\"https:\/\/www.equator-network.org\/reporting-guidelines\/stard\/\">STARD<\/a> (<a href=\"https:\/\/www.sciencedirect.com\/user\/error\/ATN-20?errorContext=arp-ad16384b-cd50-432a-80a2-83ce11d8f2ce\">fran\u00e7ais<\/a>) <span class=\"zp-InText-zp-ID--1093634-4EMMWIVC--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:4EMMWIVC}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>\u00a0a \u00e9t\u00e9 d\u00e9velopp\u00e9e pour aider \u00e0 analyser et \u00e9crire une \u00e9tude diagnostique.<\/p>\n<div style=\"margin: auto; width: auto; \"><h3 class='azc_tsh_toggle' style='border: 0px solid #00F000; background-color: #ffffff; '><a href='#' style='color: #CC6666; font-family: inherit; font-size: 0.6em; '>Grille STARD en fran\u00e7ais<\/a><\/h3><div class='azc_tsh_toggle_container' style='border: 0px solid #00F000; background-color: #ffffff; color: #000000; font-family: inherit; font-size: 100%; font-weight: normal; '><br \/>\nTableau I. Traduction fran\u00e7aise originale de la liste de contr\u00f4le STARD 2003.<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"101\">Section et sujet<\/td>\n<td width=\"31\">Item<\/td>\n<td width=\"355\"><\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><strong>TITRE\/R\u00c9SUM\u00c9\/<\/strong><\/p>\n<p><strong>MOTS CLEFS<\/strong><\/td>\n<td width=\"31\">1<\/td>\n<td width=\"355\">Identifier l\u2019article comme une \u00e9tude sur la pr\u00e9cision d\u2019un test diagnostique (se r\u00e9f\u00e9rer \u00e0 la rubrique MeSH<sup>a<\/sup> \u00ab\u00a0sensibilit\u00e9 et sp\u00e9cificit\u00e9\u00a0\u00bb).<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><strong>INTRODUCTION<\/strong><\/td>\n<td width=\"31\">2<\/td>\n<td width=\"355\">Formuler les questions de recherche ou les objectifs de l\u2019\u00e9tude, comme \u00e9valuer la pr\u00e9cision diagnostique ou comparer la pr\u00e9cision entre plusieurs tests ou sur divers groupes de participants.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"4\" width=\"101\"><strong>M\u00c9THODES<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><strong><em>Population<\/em><\/strong><\/td>\n<td width=\"31\">3<\/td>\n<td width=\"355\">Population \u00e9tudi\u00e9e\u00a0: crit\u00e8res d\u2019inclusion et d\u2019exclusion, contexte et lieux o\u00f9 les donn\u00e9es ont \u00e9t\u00e9 collect\u00e9es.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">4<\/td>\n<td width=\"355\">Recrutement des participants\u00a0: le recrutement \u00e9tait-il bas\u00e9 sur la pr\u00e9sentation de sympt\u00f4mes, sur des r\u00e9sultats d\u2019examens ant\u00e9rieurs, ou sur le fait que les participants avaient d\u00e9j\u00e0 subi les tests \u00e9tudi\u00e9s ou le test de r\u00e9f\u00e9rence\u00a0?<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">5<\/td>\n<td width=\"355\">\u00c9chantillonnage des participants\u00a0: la population de l\u2019\u00e9tude \u00e9tait-elle une s\u00e9rie cons\u00e9cutive de participants d\u00e9finis selon les crit\u00e8res de s\u00e9lection pr\u00e9cis\u00e9s dans les items 3 et 4\u00a0? Si non, sp\u00e9cifier la mani\u00e8re dont les participants ont alors \u00e9t\u00e9 s\u00e9lectionn\u00e9s.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">6<\/td>\n<td width=\"355\">Collecte des donn\u00e9es\u00a0: le recueil des donn\u00e9es \u00e9tait-il planifi\u00e9 avant que le test \u00e9tudi\u00e9 et le test de r\u00e9f\u00e9rence aient \u00e9t\u00e9 effectu\u00e9s (\u00e9tude prospective) ou apr\u00e8s (\u00e9tude r\u00e9trospective)\u00a0?<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><strong><em>M\u00e9thodes des tests<\/em><\/strong><\/td>\n<td width=\"31\">7<\/td>\n<td width=\"355\">Description et justification du test de r\u00e9f\u00e9rence.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">8<\/td>\n<td width=\"355\">Sp\u00e9cifications techniques du mat\u00e9riel et des m\u00e9thodes utilis\u00e9s, y compris comment et quand les mesures ont \u00e9t\u00e9 prises, et\/ou citer les r\u00e9f\u00e9rences relatives aux tests \u00e9tudi\u00e9s et au test de r\u00e9f\u00e9rence.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">9<\/td>\n<td width=\"355\">D\u00e9finition et justification des unit\u00e9s, des seuils et\/ou des cat\u00e9gories de r\u00e9sultats du test \u00e9tudi\u00e9 et du test de r\u00e9f\u00e9rence.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">10<\/td>\n<td width=\"355\">Nombre, formation et niveau d\u2019expertise des personnes ex\u00e9cutant et interpr\u00e9tant les tests \u00e9tudi\u00e9s et le test de r\u00e9f\u00e9rence.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">11<\/td>\n<td width=\"355\">Pr\u00e9ciser si les lectures des tests \u00e9tudi\u00e9s et du test de r\u00e9f\u00e9rence ont \u00e9t\u00e9 faites en aveugle (insu) des r\u00e9sultats de l\u2019autre test, et d\u00e9crire toute autre information clinique \u00e0 la disposition des personnes interpr\u00e9tant le test.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><strong><em>Analyses statistiques<\/em><\/strong><\/td>\n<td width=\"31\">12<\/td>\n<td width=\"355\">M\u00e9thodes de calcul ou de comparaison des mesures de pr\u00e9cision diagnostique et analyses statistiques utilis\u00e9es pour quantifier l\u2019incertitude (par exemple, intervalles de confiance de 95\u00a0%).<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">13<\/td>\n<td width=\"355\">M\u00e9thodes de calcul de la reproductibilit\u00e9 du test, si r\u00e9alis\u00e9.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"4\" width=\"101\"><strong>R\u00c9SULTATS<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><strong><em>Population<\/em><\/strong><\/td>\n<td width=\"31\">14<\/td>\n<td width=\"355\">Quand l\u2019\u00e9tude a \u00e9t\u00e9 r\u00e9alis\u00e9e, y compris dates de d\u00e9but et de fin de recrutement.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">15<\/td>\n<td width=\"355\">Caract\u00e9ristiques cliniques et d\u00e9mographiques de la population de l\u2019\u00e9tude (au minimum\u00a0: \u00e2ge, sexe, type de sympt\u00f4mes pr\u00e9sents).<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">16<\/td>\n<td width=\"355\">Nombre de participants r\u00e9pondant aux crit\u00e8res d\u2019inclusion qui ont subi ou non les tests \u00e9tudi\u00e9s et\/ou le test de r\u00e9f\u00e9rence\u00a0; expliquer pourquoi les participants n\u2019ont pas subi l\u2019un ou l\u2019autre test (un diagramme de flux est fortement recommand\u00e9).<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><strong><em>R\u00e9sultats pour les tests<\/em><\/strong><\/td>\n<td width=\"31\">17<\/td>\n<td width=\"355\">D\u00e9lai entre les tests \u00e9tudi\u00e9s et le test de r\u00e9f\u00e9rence, et de tout traitement administr\u00e9 entre deux.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">18<\/td>\n<td width=\"355\">R\u00e9partition des diff\u00e9rents degr\u00e9s de gravit\u00e9 de la maladie (d\u00e9finir les crit\u00e8res) des sujets remplissant les conditions cibl\u00e9es\u00a0; autres diagnostics chez les participants ne remplissant pas les conditions cibl\u00e9es.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">19<\/td>\n<td width=\"355\">Tableau crois\u00e9 comparant les r\u00e9sultats du test \u00e9tudi\u00e9 (y compris les r\u00e9sultats ind\u00e9termin\u00e9s et manquants) aux r\u00e9sultats du test de r\u00e9f\u00e9rence\u00a0; pour les donn\u00e9es continues, distribution des r\u00e9sultats du test \u00e9tudi\u00e9 par rapport aux r\u00e9sultats du test de r\u00e9f\u00e9rence.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">20<\/td>\n<td width=\"355\">\u00c9v\u00e8nements ind\u00e9sirables li\u00e9s \u00e0 la r\u00e9alisation des tests \u00e9tudi\u00e9s ou du test de r\u00e9f\u00e9rence.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><strong><em>Estimations<\/em><\/strong><\/td>\n<td width=\"31\">21<\/td>\n<td width=\"355\">Estimations de la pr\u00e9cision diagnostique et des mesures de l\u2019incertitude statistique (par exemple, intervalles de confiance de 95\u00a0%).<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">22<\/td>\n<td width=\"355\">Gestion des r\u00e9sultats ind\u00e9termin\u00e9s, des valeurs manquantes ou aberrantes des tests \u00e9tudi\u00e9s.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">23<\/td>\n<td width=\"355\">Estimations de la variabilit\u00e9 de la pr\u00e9cision diagnostique entre les sous-groupes de participants, entre les personnes interpr\u00e9tant le test ou entre les centres d\u2019\u00e9tude, si r\u00e9alis\u00e9e.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><\/td>\n<td width=\"31\">24<\/td>\n<td width=\"355\">Estimations de la reproductibilit\u00e9 du test, si r\u00e9alis\u00e9es.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<tr>\n<td width=\"101\"><strong>DISCUSSION<\/strong><\/td>\n<td width=\"31\">25<\/td>\n<td width=\"355\">Discuter l\u2019applicabilit\u00e9 clinique des r\u00e9sultats de l\u2019\u00e9tude.<\/td>\n<td width=\"73\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>a Note du traducteur\u00a0: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/mesh\">http:\/\/www.ncbi.nlm.nih.gov\/mesh<\/a>.<\/p>\n<p><\/div><\/div>\n<p>Traduction fran\u00e7aise du diagramme de flux STARD 2003<span class=\"zp-InText-zp-ID--1093634-4EMMWIVC--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:4EMMWIVC}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': 'comma', 'and': '' }\"><\/span>.<\/p>\n<div id=\"attachment_777\" style=\"width: 785px\" class=\"wp-caption aligncenter\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-777\" data-attachment-id=\"777\" data-permalink=\"https:\/\/lepcam.fr\/index.php\/les-etapes\/quanti\/flow-chart-fr-stard\/\" data-orig-file=\"https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/04\/flow-chart-fr-stard.png?fit=775%2C738&amp;ssl=1\" data-orig-size=\"775,738\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"flow chart fr stard\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/04\/flow-chart-fr-stard.png?fit=629%2C599&amp;ssl=1\" class=\"wp-image-777 size-full\" src=\"https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/04\/flow-chart-fr-stard.png?resize=629%2C599&#038;ssl=1\" alt=\"flow chart fr stard\" width=\"629\" height=\"599\" srcset=\"https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/04\/flow-chart-fr-stard.png?w=775&amp;ssl=1 775w, https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/04\/flow-chart-fr-stard.png?resize=300%2C286&amp;ssl=1 300w, https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/04\/flow-chart-fr-stard.png?resize=600%2C571&amp;ssl=1 600w\" sizes=\"auto, (max-width: 629px) 100vw, 629px\" \/><p id=\"caption-attachment-777\" class=\"wp-caption-text\">Diagramme de flux, STARD 2003<\/p><\/div>\n<h2 id=\"etio\">D. \u00c9tude \u00e9pid\u00e9miologique\/\u00e9tiologique<\/h2>\n<p>Les \u00e9tudes \u00e9tiologiques sont des \u00e9tudes qui \u00e9valuent l\u2019association entre un ou plusieurs facteurs de risque avec la survenue d\u2019une maladie. Elles font partie des \u00e9tudes observationnelles.<\/p>\n<p><strong>Formulation de l\u2019objectif\u00a0:<\/strong><\/p>\n<p>En reprenant le PICO\u00a0:<\/p>\n<ul>\n<li>P\u00a0: population concern\u00e9e<\/li>\n<li>I\u00a0: facteur de risque \u00e9tudi\u00e9<\/li>\n<li>C\u00a0: population de comparaison n\u2019ayant pas le facteur de risque<\/li>\n<li>O\u00a0: la maladie<\/li>\n<\/ul>\n<p><em>Ex\u00a0: \u00e9valuation du r\u00f4le de la consommation de viande rouge (I) dans l\u2019apparition de cancer colorectal (O) chez les personnes de plus de 50 ans (P). On sous-entend que l\u2019on compare \u00e0 ceux ne consommant pas de viande rouge (C).<\/em><\/p>\n<p><strong>Types d\u2019\u00e9tude\u00a0:<\/strong><\/p>\n<p>Ce sont des \u00e9tudes \u00e9pid\u00e9miologiques, observationnelles de type \u00e9tude\u00a0:<\/p>\n<ul>\n<li><strong>Cohorte\u00a0<\/strong>: on recrute des sujets indemnes de la maladie, qui sont expos\u00e9s \u00e0 des facteurs et sont suivis dans le temps afin d\u2019\u00e9valuer la survenue de la maladie.<\/li>\n<li><strong>Cas-t\u00e9moin\u00a0<\/strong>: on recrute des malades et des sujets indemnes de la maladie qui seront similaires sur certaines caract\u00e9ristiques aux malades (on les appelle les t\u00e9moins). On recherche dans le pass\u00e9 s\u2019ils ont \u00e9t\u00e9 expos\u00e9s \u00e0 certains facteurs de risque.<\/li>\n<\/ul>\n<table>\n<tbody>\n<tr>\n<td><\/td>\n<td><strong>\u00a0<\/strong><\/td>\n<td><strong>\u00c9<\/strong><strong>t<\/strong><strong>u<\/strong><strong>d<\/strong><strong>e<\/strong><strong>s de cohorte<\/strong><\/td>\n<td><strong>E<\/strong><strong>t<\/strong><strong>u<\/strong><strong>d<\/strong><strong>e<\/strong><strong>s cas-t\u00e9moins<\/strong><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"7\"><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>C<\/strong><strong>rit<\/strong><strong>\u00e8<\/strong><strong>r<\/strong><strong>e<\/strong><strong>s de choix<\/strong><\/td>\n<td>Facteur<\/td>\n<td><strong>Unique, rare<\/strong><\/td>\n<td><strong>Multiples, fr\u00e9quente<\/strong><\/td>\n<\/tr>\n<tr>\n<td>maladie<\/td>\n<td><strong>Multiples, f<\/strong><strong>r\u00e9<\/strong><strong>qu<\/strong><strong>e<\/strong><strong>n<\/strong><strong>t<\/strong><strong>e<\/strong><\/td>\n<td><strong>R<\/strong><strong>a<\/strong><strong>r<\/strong><strong>e, unique<\/strong><\/td>\n<\/tr>\n<tr>\n<td>exposition<\/td>\n<td><strong>r<\/strong><strong>a<\/strong><strong>r<\/strong><strong>e<\/strong><\/td>\n<td><strong>f<\/strong><strong>r\u00e9<\/strong><strong>qu<\/strong><strong>e<\/strong><strong>n<\/strong><strong>t<\/strong><strong>e<\/strong><\/td>\n<\/tr>\n<tr>\n<td>biais<\/td>\n<td>perdus de vue<\/td>\n<td>m\u00e9moire et s\u00e9lection,\u00a0 peu de suivi<\/td>\n<\/tr>\n<tr>\n<td>inconv\u00e9nient<\/td>\n<td>Gros \u00e9chantillon, long, co\u00fbt \u00e9lev\u00e9<\/td>\n<td>Rapide, co\u00fbt moindre<\/td>\n<\/tr>\n<tr>\n<td>niveau de preuve<\/td>\n<td>Niveau 2 (grade B)<\/td>\n<td>Niveau 3 (grade C)<\/td>\n<\/tr>\n<tr>\n<td>groupes<\/td>\n<td>expos\u00e9s vs. non-expos\u00e9s<\/td>\n<td>cas vs. t\u00e9moins<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"5\"><strong>P<\/strong><strong>r<\/strong><strong>o<\/strong><strong>t<\/strong><strong>o<\/strong><strong>c<\/strong><strong>o<\/strong><strong>l<\/strong><strong>e<\/strong><\/td>\n<td>crit\u00e8re de s\u00e9lection<\/td>\n<td><strong>e<\/strong><strong>xpo<\/strong><strong>s<\/strong><strong>iti<\/strong><strong>o<\/strong><strong>n<\/strong><\/td>\n<td><strong>maladie<\/strong><\/td>\n<\/tr>\n<tr>\n<td>comparaison<\/td>\n<td><strong>i<\/strong><strong>nc<\/strong><strong>i<\/strong><strong>de<\/strong><strong>n<\/strong><strong>c<\/strong><strong>e<\/strong> de la maladie<\/td>\n<td>c\u00f4tes d\u2019exposition au<\/p>\n<p>facteur (pas l\u2019incidence)<\/td>\n<\/tr>\n<tr>\n<td>Mesure de l\u2019association<\/td>\n<td>risque relatif<\/td>\n<td>odds ratio (pas le RR)<\/td>\n<\/tr>\n<tr>\n<td>Temporalit\u00e9<\/td>\n<td>Etude de la <strong>temporalit\u00e9<\/strong> entre l\u2019exposition et la maladie (interpr\u00e9tation possible d\u2019un sens causal)<\/td>\n<td>Adapt\u00e9 aux maladies ayant un long d\u00e9lai de latence (d\u00e9lais entre exposition et apparition de la maladie)<\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td><\/td>\n<td>Difficult\u00e9 de choix de t\u00e9moins<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Cas particulier\u00a0: Cas t\u00e9moins nich\u00e9e dans une cohorte<\/strong><\/p>\n<ul>\n<li>D\u00e9finition\u00a0: les cas et les t\u00e9moins sont recrut\u00e9s \u00e0 partir d\u2019une cohorte d\u00e9j\u00e0 existante.<\/li>\n<li>Avantages\u00a0:\n<ul>\n<li>Recueil <strong>prospectif<\/strong> des donn\u00e9es<\/li>\n<li>Diminution des <strong>biais de s\u00e9lection diff\u00e9rentiel<\/strong> entre cas et t\u00e9moins car les cas sont issus de la m\u00eame population que les t\u00e9moins.<\/li>\n<li>Diminution des <strong>biais de survie s\u00e9lective<\/strong>, on a potentiellement tous les cas incidents (exhaustivit\u00e9 des cas, sauf perdus de vue) comme dans une cohorte (on peut les avoir aussi dans un cas-t\u00e9moins incidente\u2026) et on a eu plus de possibilit\u00e9s pour limiter les perdus de vue.<\/li>\n<li>Diminution des <strong>biais de mesure <\/strong>de l\u2019exposition (biais de m\u00e9moire) car l\u2019exposition a \u00e9t\u00e9 recueillie avant la survenue de la maladie \u00e9tudi\u00e9e<\/li>\n<li><strong>Meilleure qualit\u00e9 des donn\u00e9es<\/strong>, on a des donn\u00e9es m\u00eame chez les cas d\u00e9c\u00e9d\u00e9s<\/li>\n<\/ul>\n<\/li>\n<li>Inconv\u00e9nient\u00a0: on manque parfois de certaines donn\u00e9es qui n\u2019avaient pas \u00e9t\u00e9 n\u00e9cessaires pour la cohorte, obligeant \u00e0 recontacter les sujets ou \u00e0 explorer les dossiers m\u00e9dicaux de mani\u00e8re r\u00e9trospective.<\/li>\n<\/ul>\n<h4>a. Cohorte<\/h4>\n<p><strong>D\u00e9finition\u00a0<\/strong>:<\/p>\n<p>\u00c9tude dans laquelle un groupe de personnes (saines ou ne pr\u00e9sentant pas de signe de la pathologie \u00e9tudi\u00e9e) est suivi pendant un certain temps. Les sujets choisis sont r\u00e9partis en diff\u00e9rents groupes d&rsquo;exposition, au d\u00e9but ou pendant l&rsquo;\u00e9tude. Cette population \u00e0 risque est suivie pendant une certaine p\u00e9riode et les incidents sont identifi\u00e9s<span class=\"zp-InText-zp-ID--1093634-UM3AGQZ3--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:UM3AGQZ3}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>.<\/p>\n<p>Anglais\u00a0: <em>cohort study<\/em><\/p>\n<p><strong>Choix de la population\u00a0:<\/strong><\/p>\n<p>Il existe 2 choix de population<\/p>\n<ul>\n<li><strong>Les cohortes en population\u00a0<\/strong>: on s\u00e9lectionne les sujets \u00e0 partir d\u2019une m\u00eame population afin d\u2019obtenir un \u00e9chantillon repr\u00e9sentatif.<\/li>\n<li><strong>Les cohortes expos\u00e9es -non-expos\u00e9es\u00a0: <\/strong>on recrute 2 cohortes, 1 cohorte de sujets expos\u00e9s \u00e0 un facteur de risque et 1 cohorte non expos\u00e9e au facteur de risque. Ces 2 cohortes auront un suivi identique.\n<ul>\n<li>\u00c0 privil\u00e9gier lorsque l\u2019exposition est rare et la maladie assez fr\u00e9quente, notamment lors d\u2019\u00e9tude des facteurs de risque professionnels<\/li>\n<li>Inconv\u00e9nient\u00a0: ne permet pas d\u2019\u00e9tudier plusieurs expositions.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Classification\u00a0:<\/strong><\/p>\n<ul>\n<li>En fonction de <strong>l\u2019objectif\u00a0<\/strong>:\n<ul>\n<li><strong>Descriptive <\/strong>: d\u00e9terminer l\u2019incidence d\u2019une maladie sans \u00e9tude de causalit\u00e9. La s\u00e9lection des sujets en fonction de leur exposition se fait a posteriori de leur inclusion.\n<ul>\n<li>Synonyme\u00a0: type 1, \u00e9tude d\u2019incidence.<\/li>\n<li>Caract\u00e9ristique\u00a0: 1 seule cohorte appartient \u00e0 l\u2019\u00e9pid\u00e9miologie observationnelle descriptive<\/li>\n<\/ul>\n<\/li>\n<li><strong>Analytique <\/strong>: rechercher un lien et son intensit\u00e9 entre la survenue d\u2019une maladie (M) et l\u2019exposition \u00e0 un facteur (F). On constitue d\u2019embl\u00e9e un groupe expos\u00e9 et un groupe non expos\u00e9, avec au moins 2 cohortes.\n<ul>\n<li>Synonyme\u00a0: type 2, cohorte expos\u00e9e\/non-expos\u00e9e, comparative<\/li>\n<li>Caract\u00e9ristique\u00a0: au moins 2 cohortes, appartient \u00e0 l\u2019\u00e9pid\u00e9miologie observationnelle analytique<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>En fonction du <strong>temps\u00a0<\/strong>: inclusion des sujets\n<ul>\n<li><strong>Prospective<\/strong> (concourante)\u00a0: inclusion des sujets au d\u00e9but du suivi<\/li>\n<li><strong>R\u00e9trospective<\/strong> (historique)\u00a0: inclusion des sujets a posteriori<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>M\u00e9thodologie\u00a0<\/strong>:<\/p>\n<ul>\n<li>Principes\u00a0:\n<ul>\n<li>1 facteur explicatif\u00a0: \u00ab\u00a0l\u2019exposition\u00a0\u00bb\n<ul>\n<li>Soit un facteur de risque (FdR)<\/li>\n<li>Soit un facteur protecteur<\/li>\n<\/ul>\n<\/li>\n<li>1 facteur \u00e0 expliquer\u00a0: \u00ab\u00a0la maladie\u00a0\u00bb\n<ul>\n<li>Un \u00e9v\u00e9nement de sant\u00e9<\/li>\n<li>Une pathologie<\/li>\n<\/ul>\n<\/li>\n<li>2 groupes indemnes de la maladie\n<ul>\n<li>Les expos\u00e9s\u00a0: sujet ayant subi l\u2019exposition<\/li>\n<li>Les non-expos\u00e9s\u00a0: sujet n\u2019ayant pas \u00e9t\u00e9 expos\u00e9<\/li>\n<\/ul>\n<\/li>\n<li>Sch\u00e9ma exp\u00e9rimental\u00a0:\n<ul>\n<li>Inclusion de sujets indemne de la maladie (M -) pouvant \u00eatre expos\u00e9s (E+) ou non expos\u00e9s (E-)<\/li>\n<li>Suivi des sujets dans le temps avec recueil des nouveaux cas (M+)<\/li>\n<li>Comparaison de l\u2019incidence de la maladie chez les expos\u00e9s et non expos\u00e9s.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Int\u00e9r\u00eat\u00a0<\/strong>:<\/p>\n<ul>\n<li>Avantages\u00a0:\n<ul>\n<li>Mesure de l\u2019incidence<\/li>\n<li>Calcul du risque relatif<\/li>\n<li>Exposition rare<\/li>\n<li>Plusieurs maladies<\/li>\n<li>S\u00e9quence chronologique et relation causale<\/li>\n<\/ul>\n<\/li>\n<li>Inconv\u00e9nients\u00a0:\n<ul>\n<li>Dur\u00e9e et co\u00fbt<\/li>\n<li>Nombreux sujets inclus<\/li>\n<li>Perdus de vue<\/li>\n<li>Inadapt\u00e9 pour maladie \u00e0 faible incidence<\/li>\n<li>S\u00e9lection de la population avec repr\u00e9sentativit\u00e9 limit\u00e9e de la population g\u00e9n\u00e9rale<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><em>Ex\u00a0: La cohorte Framingham. \u00c9tude de cohorte ayant d\u00e9but\u00e9 en 1948 dans la ville de Framingham aux EU incluant initialement plus de 5000 sujets qui seront suivi sur 3 g\u00e9n\u00e9ration. Cette cohorte est la base de la notion de facteur de risque cardiovasculaire et de score de risque cardiovasculaire (Score de Framinghan).<\/em><\/p>\n<p><strong>Principaux biais\u00a0:<\/strong><\/p>\n<ul>\n<li><strong>Perdus de vue\u00a0<\/strong>: cela concerne les sujets dont on ne dispose pas des donn\u00e9es concernant le suivi.\n<ul>\n<li>S\u2019ils sont r\u00e9partis \u00e9quitablement entre les 2 groupes (rare en pratique), <strong>on perd en puissance.<\/strong><\/li>\n<li>S\u2019ils ne sont pas r\u00e9partis \u00e9quitablement (e nombre ou en termes de caract\u00e9ristique) et on s\u2019expose en plus \u00e0 un <strong>biais d\u2019attrition.<\/strong><\/li>\n<li>Si le nombre d\u2019\u00e9v\u00e9nements est sup\u00e9rieur au nombre de perdus de vue<\/li>\n<\/ul>\n<\/li>\n<li>Biais li\u00e9 \u00e0 un suivi diff\u00e9rent entre les 2 groupes<\/li>\n<li>Biais li\u00e9 \u00e0 une dur\u00e9e insuffisante de suivi permettant la survenue de la maladie<\/li>\n<\/ul>\n<h4>b. Cas t\u00e9moin<\/h4>\n<p><strong>D\u00e9finition\u00a0: <\/strong><\/p>\n<p>\u00c9tude qui compare le niveau d\u2019exposition \u00e0 un \u201cagent particulier\u201d ou \u00e0 un \u201cfacteur de risque\u201d d\u2019un groupe de personnes pr\u00e9sentant une maladie ou un \u00e9v\u00e8nement \u201ccas\u201d, \u00e0 un autre groupe de personnes, similaire autant que faire se peut au premier groupe, mais qui n\u2019est pas atteint par la maladie \u00e9tudi\u00e9e<span class=\"zp-InText-zp-ID--1093634-UM3AGQZ3--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:UM3AGQZ3}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>.<\/p>\n<p>En gros, on compare un groupe de malade (cas) \u00e0 un groupe de non malade (t\u00e9moin) qui ressemble au groupe malade.<\/p>\n<p><strong>Caract\u00e9ristiques\u00a0:<\/strong><\/p>\n<p>\u00c9tude observationnelle souvent r\u00e9trospective.<\/p>\n<p><strong>Objectif\u00a0:<\/strong><\/p>\n<p>On recherche un lien entre une maladie (M) et l\u2019exposition ant\u00e9rieur \u00e0 certains facteurs (F).<\/p>\n<p><strong>M\u00e9thodologie\u00a0:<\/strong><\/p>\n<ul>\n<li><strong>S\u00e9lection des cas\u00a0<\/strong>: sujet ayant la maladie (M+). Ils doivent \u00eatre repr\u00e9sentatifs de la population \u00e9tudi\u00e9e. On distingue 2 m\u00e9thodes de s\u00e9lection\u00a0:\n<ul>\n<li><strong>Cas incidents\u00a0<\/strong>: ils ne sont inclus dans l\u2019\u00e9tude que lorsqu\u2019ils deviennent malades. C\u2019est la m\u00e9thode \u00e0 privil\u00e9gier.<\/li>\n<li><strong>Cas pr\u00e9valents\u00a0<\/strong>: ils sont d\u00e9j\u00e0 malades avant d\u2019\u00eatre inclus dans l\u2019\u00e9tude. On introduit un <strong>biais de survie s\u00e9lective<\/strong> car on ne s\u00e9lectionne que les malades ayant surv\u00e9cu \u00e0 la date de d\u00e9but de l\u2019\u00e9tude.<\/li>\n<\/ul>\n<\/li>\n<li><strong>S\u00e9lection des t\u00e9moins\u00a0<\/strong>: sujet indemne (M-) ayant des caract\u00e9ristiques similaires aux cas (appariement) sauf pour les facteurs (F). Ils doivent \u00eatre repr\u00e9sentatifs de l\u2019ensemble des sujets M- de la population source. Le tableau suivant r\u00e9sume les principaux types de t\u00e9moins.<\/li>\n<li>Mesure de l\u2019exposition ant\u00e9rieure chez les cas et les t\u00e9moins, sans suivi dans le temps.<\/li>\n<li>Comparaison des fr\u00e9quences d\u2019exposition chez ces 2 groupes.<\/li>\n<\/ul>\n<table>\n<tbody>\n<tr>\n<td width=\"113\">T\u00e9moins<\/td>\n<td width=\"113\">Hospitalis\u00e9s ou famille<\/td>\n<td width=\"113\">Population<\/td>\n<\/tr>\n<tr>\n<td width=\"113\">Acc\u00e8s<\/td>\n<td width=\"113\">Facile<\/td>\n<td width=\"113\">Difficile, co\u00fbt<\/td>\n<\/tr>\n<tr>\n<td width=\"113\">Motivation<\/td>\n<td width=\"113\">Forte<\/td>\n<td width=\"113\">Faible (en bonne sant\u00e9)<\/td>\n<\/tr>\n<tr>\n<td width=\"113\">Taux de r\u00e9ponse<\/td>\n<td width=\"113\">Elev\u00e9e<\/td>\n<td width=\"113\">Faible<\/td>\n<\/tr>\n<tr>\n<td width=\"113\">Biais de s\u00e9lection<\/td>\n<td width=\"113\">Important<\/td>\n<td width=\"113\">Limit\u00e9<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Principaux biais\u00a0:<\/strong><\/p>\n<ul>\n<li><strong>De survie s\u00e9lective\u00a0<\/strong>: s\u00e9lection des cas pr\u00e9valents (cas d\u00e9j\u00e0 malades ayant surv\u00e9cu)<\/li>\n<li><strong>De m\u00e9morisation<\/strong> (sous-type classement)\u00a0: les cas se rappelleront plus facilement de l\u2019exposition. Il en r\u00e9sulte une majoration de l\u2019exposition des cas et une diminution de celle des t\u00e9moins.<\/li>\n<li><strong>De s\u00e9lection\u00a0<\/strong>: difficult\u00e9 d\u2019avoir des cas et t\u00e9moins similaires, mauvaise d\u00e9finition des cas, s\u00e9lection des t\u00e9moins non ind\u00e9pendante de l\u2019exposition.<\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>L\u2019appariement et l\u2019ajustement\u00a0:<\/strong><\/p>\n<p>Afin de limiter l\u2019apparition de potentiels facteurs de confusion, c\u2019est-\u00e0-dire de mesurer l\u2019association entre l\u2019exposition et la maladie ind\u00e9pendamment d\u2019autres facteurs, on peut utiliser 2 m\u00e9thodes particuli\u00e8res\u00a0:<\/p>\n<ul>\n<li>Appariement\u00a0: m\u00e9thode a priori.\n<ul>\n<li>D\u00e9finition\u00a0: m\u00e9thode consistant \u00e0 s\u00e9lectionner des paires de sujets (cas + t\u00e9moin) qui sont comparables sur certains facteurs (souvent l\u2019\u00e2ge et le sexe).<\/li>\n<li>Limite\u00a0: le nombre de facteurs d\u2019appariement est limit\u00e9<\/li>\n<\/ul>\n<\/li>\n<li>Ajustement\u00a0: m\u00e9thode statistique a posteriori permettant d\u2019isoler math\u00e9matiquement de potentiels facteurs de confusion.<\/li>\n<\/ul>\n<h4>c. Principaux biais des \u00e9tudes \u00e9tiologiques<\/h4>\n<table>\n<tbody>\n<tr>\n<td width=\"113\">Biais<\/td>\n<td width=\"113\">Type d\u2019\u00e9tude<\/td>\n<td width=\"180\">D\u00e9finition<\/td>\n<td width=\"197\">Limitation du biais<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"113\">S\u00e9lection<\/td>\n<td width=\"113\">Cohorte<\/td>\n<td width=\"180\">S\u00e9lection d\u2019un \u00e9chantillon non repr\u00e9sentatif de la population d\u2019int\u00e9r\u00eat<\/td>\n<td width=\"197\">Qualit\u00e9 de la s\u00e9lection des sujets<\/td>\n<\/tr>\n<tr>\n<td width=\"113\">Cas-t\u00e9moin<\/td>\n<td width=\"180\">Mauvaise d\u00e9finition des cas<\/p>\n<p>S\u00e9lection de t\u00e9moins d\u00e9pendant de l\u2019exposition<\/td>\n<td width=\"197\">D\u00e9finition claire et standardis\u00e9e des cas<\/p>\n<p>Qualit\u00e9 de la s\u00e9lection des t\u00e9moins<\/td>\n<\/tr>\n<tr>\n<td width=\"113\">Survie s\u00e9lective<\/p>\n<p>(sous-type de biais de s\u00e9lection)<\/td>\n<td width=\"113\">Uniquement dans les cas-t\u00e9moins<\/td>\n<td width=\"180\">S\u00e9lection des cas pr\u00e9valents<\/td>\n<td width=\"197\">S\u00e9lection de cas incidents<\/td>\n<\/tr>\n<tr>\n<td width=\"113\">Classement<\/td>\n<td width=\"113\">Cohorte<\/td>\n<td width=\"180\">L\u2019\u00e9valuateur peut \u00eatre influenc\u00e9 s\u2019il conna\u00eet le statut expos\u00e9\/non-expos\u00e9 du sujet<\/td>\n<td width=\"197\">Evaluation des crit\u00e8res en aveugle<\/td>\n<\/tr>\n<tr>\n<td width=\"113\">De m\u00e9moire<\/p>\n<p>(sous-type de biais de classement)<\/td>\n<td width=\"113\">Uniquement dans les cas-t\u00e9moins<\/td>\n<td width=\"180\">Les cas ont tendance \u00e0 majorer leur exposition<\/td>\n<td width=\"197\">Sujets en aveugle de la variable d\u2019int\u00e9r\u00eat (exposition)<\/p>\n<p>\u00c9valuation standardis\u00e9e, objective<\/td>\n<\/tr>\n<tr>\n<td width=\"113\">De confusion<\/td>\n<td width=\"113\"><\/td>\n<td width=\"180\">Pr\u00e9sence de facteur de confusion<\/td>\n<td width=\"197\">Analyse multivari\u00e9e avec ajustement<\/p>\n<p>Appariement si cas-t\u00e9moins<\/td>\n<\/tr>\n<tr>\n<td width=\"113\">D\u2019attrition<\/td>\n<td width=\"113\">Cohorte prospective<\/td>\n<td width=\"180\">Perdus de vue non comptabilis\u00e9s dans l\u2019analyse<\/td>\n<td width=\"197\">Limiter les perdus de vue<\/p>\n<p>Gestion des perdus de vue<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h4>d. Crit\u00e8re de causalit\u00e9 de Bradford Hill<\/h4>\n<p>Une association statistique ne justifie pas causalit\u00e9.<\/p>\n<p>Pour affirmer une causalit\u00e9, il faut que les 2 groupes ne diff\u00e8rent que par le facteur \u00e9tudi\u00e9 et soient comparables en tout point. En pratique, il faut r\u00e9aliser un essai contr\u00f4l\u00e9 randomis\u00e9. Ainsi, <strong>une \u00e9tude \u00e9pid\u00e9miologique ne permet pas d\u2019assurer un lien de causalit\u00e9<\/strong>. N\u00e9anmoins, certains crit\u00e8res en faveur d\u2019un lien causal ont \u00e9t\u00e9 d\u00e9velopp\u00e9s par <strong>Bardford-Hill<\/strong> en 1965. Les principaux crit\u00e8res sont\u00a0:<\/p>\n<ul>\n<li>Crit\u00e8res <strong>internes<\/strong> \u00e0 l\u2019\u00e9tude\u00a0:\n<ul>\n<li>Existence d\u2019une <strong>association statistiquement significative <\/strong>entre l\u2019exposition et la maladie.<\/li>\n<li><strong>Force de l\u2019association<\/strong>: le degr\u00e9 d\u2019association (RR ou OR) est tr\u00e8s grand il faudrait un fort effet de confusion pour faire disparaitre l\u2019association<\/li>\n<li><strong>Coh\u00e9rence chronologique<\/strong>: Exposition au facteur doit pr\u00e9c\u00e9der l&rsquo;apparition de la maladie : permet d\u2019exclure la relation inverse.<\/li>\n<li><strong>Relation dose-effet<\/strong>: si l\u2019exposition augmente, le risque augmente : quand ce crit\u00e8re est pr\u00e9sent, il est tr\u00e8s sp\u00e9cifique mais il n\u2019est pas vrai dans tous les cas.<\/li>\n<li><strong>Sp\u00e9cificit\u00e9 de l\u2019association<\/strong>: si un facteur de risque est constamment reli\u00e9 uniquement \u00e0 la maladie \u00e9tudi\u00e9e, il apparait vraisemblable qu\u2019une relation causale existe : ce crit\u00e8re d\u00e9coule d\u2019une analogie avec les maladies infectieuses mais son absence ne remet pas en question une relation causale.<\/li>\n<li>Minimisation des biais de s\u00e9lection, de classement et de confusion<\/li>\n<\/ul>\n<\/li>\n<li>Crit\u00e8res <strong>externes<\/strong>:\n<ul>\n<li><strong>Plausibilit\u00e9 biologique<\/strong>sur l&rsquo;histoire naturelle de la maladie, la physiopathologie, la biologie<\/li>\n<li><strong>Analogie avec d&rsquo;autres facteurs de risque d\u00e9montr\u00e9s<\/strong>: une hypoth\u00e8se causale est renforc\u00e9e par le fait qu\u2019une relation causale analogue est connue, rendant l\u2019hypoth\u00e8se plus cr\u00e9dible<\/li>\n<li><strong>Reproductibilit\u00e9<\/strong>: Constance de l&rsquo;association et reproductibilit\u00e9 des r\u00e9sultats de l\u2019\u00e9tude avec d&rsquo;autres \u00e9quipes, en diff\u00e9rents lieux, circonstances et temps.<\/li>\n<li><strong>Concordance\u00a0<\/strong>avec des exp\u00e9rimentations in vitro et chez l\u2019animal.<\/li>\n<li><strong>Gradients g\u00e9ographiques parall\u00e8les de l\u2019exposition et de la maladie<\/strong><\/li>\n<li><strong>Diminution de l\u2019incidence de la maladie lorsque l\u2019exposition est supprim\u00e9e ou r\u00e9duite.<\/strong><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h4>e. Grille de lecture STROBE<\/h4>\n<p>Une grille de lecture <a href=\"https:\/\/www.equator-network.org\/reporting-guidelines\/strobe\/\">STROBE<\/a> (<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1779012314004318\">fran\u00e7ais<\/a>) <span class=\"zp-InText-zp-ID--1093634-Z9XQSM5I--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:Z9XQSM5I}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>\u00a0a \u00e9t\u00e9 d\u00e9velopp\u00e9e pour aider \u00e0 analyser et \u00e9crire une \u00e9tude observationnelle.<\/p>\n<div style=\"margin: auto; width: auto; \"><h3 class='azc_tsh_toggle' style='border: 0px solid #00F000; background-color: #ffffff; '><a href='#' style='color: #CC6666; font-family: inherit; font-size: 0.6em; '>Grille STROBE en fran\u00e7ais<\/a><\/h3><div class='azc_tsh_toggle_container' style='border: 0px solid #00F000; background-color: #ffffff; color: #000000; font-family: inherit; font-size: 100%; font-weight: normal; '><\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"120\"><\/td>\n<td width=\"31\"><strong>Item N\u00b0<\/strong><\/td>\n<td width=\"438\"><strong>Recommandation<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"120\"><strong>Titre et r\u00e9sum\u00e9<\/strong><\/td>\n<td width=\"31\">1<\/td>\n<td width=\"438\">(a) Indiquer dans le titre ou dans le r\u00e9sum\u00e9 le type d\u2019\u00e9tude r\u00e9alis\u00e9e en termes couramment utilis\u00e9s<\/td>\n<\/tr>\n<tr>\n<td width=\"120\"><\/td>\n<td width=\"31\"><\/td>\n<td width=\"438\">(b) Fournir dans le r\u00e9sum\u00e9 une information synth\u00e9tique et objective sur ce qui a \u00e9t\u00e9 fait et ce qui a \u00e9t\u00e9 trouv\u00e9<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" width=\"120\"><strong>Introduction<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Contexte\/justification<\/td>\n<td width=\"31\">2<\/td>\n<td width=\"438\">Expliquer le contexte scientifique et la l\u00e9gitimit\u00e9 de l\u2019\u00e9tude en question<\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Objectifs<\/td>\n<td width=\"31\">3<\/td>\n<td width=\"438\">Citer les objectifs sp\u00e9cifiques, y compris toutes les hypoth\u00e8ses <em>a priori<\/em><\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" width=\"120\"><strong>M\u00e9thodes<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Conception de l\u2019\u00e9tude<\/td>\n<td width=\"31\">4<\/td>\n<td width=\"438\">Pr\u00e9senter les \u00e9l\u00e9ments cl\u00e9s de la conception de l\u2019\u00e9tude en tout d\u00e9but de document<\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Contexte<\/td>\n<td width=\"31\">5<\/td>\n<td width=\"438\">D\u00e9crire le contexte, les lieux et les dates pertinentes, y compris les p\u00e9riodes de recrutement, d\u2019exposition, de suivi et de recueil de donn\u00e9es<\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Population<\/td>\n<td width=\"31\">6<\/td>\n<td width=\"438\">(a) <em>\u00c9tude de cohorte<\/em>\u00a0\u2013\u00a0Indiquer les crit\u00e8res d\u2019\u00e9ligibilit\u00e9, et les sources et m\u00e9thodes de s\u00e9lection des sujets. D\u00e9crire les m\u00e9thodes de suivi<\/p>\n<p><em>\u00c9tude cas-t\u00e9moin<\/em>\u00a0\u2013\u00a0Indiquer les crit\u00e8res d\u2019\u00e9ligibilit\u00e9, et les sources et m\u00e9thodes pour identifier les cas et s\u00e9lectionner les t\u00e9moins. Justifier le choix des cas et des t\u00e9moins.<\/p>\n<p><em>\u00c9tude transversale<\/em>\u00a0\u2013\u00a0Indiquer les crit\u00e8res d\u2019\u00e9ligibilit\u00e9 et les sources et m\u00e9thodes de s\u00e9lection des participants<\/td>\n<\/tr>\n<tr>\n<td width=\"120\"><\/td>\n<td width=\"31\"><\/td>\n<td width=\"438\">(b) <em>\u00c9tude de cohorte<\/em>\u00a0\u2013\u00a0Pour les \u00e9tudes appari\u00e9es, indiquer les crit\u00e8res d\u2019appariement et le nombre de sujets expos\u00e9s et non expos\u00e9s.<\/p>\n<p><em>\u00c9tude cas-t\u00e9moin<\/em>\u00a0\u2013\u00a0Pour les \u00e9tudes appari\u00e9es, indiquer les crit\u00e8res d\u2019appariement et le nombre de t\u00e9moins par cas<\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Variables<\/td>\n<td width=\"31\">7<\/td>\n<td width=\"438\">D\u00e9finir clairement tous les crit\u00e8res de r\u00e9sultats, les expositions, les facteurs de pr\u00e9diction, les facteurs de confusion potentiels, et les facteurs d\u2019influence. Indiquer les crit\u00e8res diagnostiques, le cas \u00e9ch\u00e9ant<\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Sources de donn\u00e9es\/mesures<\/td>\n<td width=\"31\">8*<\/td>\n<td width=\"438\">Pour chaque variable d\u2019int\u00e9r\u00eat, indiquer les sources de donn\u00e9es et les d\u00e9tails des m\u00e9thodes d\u2019\u00e9valuation (mesures). D\u00e9crire la comparabilit\u00e9 des m\u00e9thodes d\u2019\u00e9valuation s\u2019il y a plus d\u2019un groupe<\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Biais<\/td>\n<td width=\"31\">9<\/td>\n<td width=\"438\">D\u00e9crire toutes les mesures prises pour \u00e9viter les sources potentielles de biais<\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Taille de l\u2019\u00e9tude<\/td>\n<td width=\"31\">10<\/td>\n<td width=\"438\">Expliquer comment a \u00e9t\u00e9 d\u00e9termin\u00e9 le nombre de sujets \u00e0 inclure<\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Variables quantitatives<\/td>\n<td width=\"31\">11<\/td>\n<td width=\"438\">Expliquer comment les variables quantitatives ont \u00e9t\u00e9 trait\u00e9es dans les analyses. Le cas \u00e9ch\u00e9ant, d\u00e9crire quels regroupements ont \u00e9t\u00e9 effectu\u00e9s et pourquoi<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"5\" width=\"120\">Analyses statistiques<\/td>\n<td width=\"31\">12<\/td>\n<td width=\"438\">(a) D\u00e9crire toutes les analyses statistiques, y compris celles utilis\u00e9es pour contr\u00f4ler les facteurs de confusion<\/td>\n<\/tr>\n<tr>\n<td width=\"31\"><\/td>\n<td width=\"438\">(b) D\u00e9crire toutes les m\u00e9thodes utilis\u00e9es pour examiner les sous-groupes et les interactions<\/td>\n<\/tr>\n<tr>\n<td width=\"31\"><\/td>\n<td width=\"438\">(c) Expliquer comment les donn\u00e9es manquantes ont \u00e9t\u00e9 trait\u00e9es<\/td>\n<\/tr>\n<tr>\n<td width=\"31\"><\/td>\n<td width=\"438\">(d) <em>\u00c9tude de cohorte<\/em>\u00a0\u2013\u00a0Le cas \u00e9ch\u00e9ant, expliquer comment les perdus de vue ont \u00e9t\u00e9 trait\u00e9s.<\/p>\n<p><em>\u00c9tude cas-t\u00e9moin<\/em>\u00a0\u2013\u00a0Le cas \u00e9ch\u00e9ant, expliquer comment l\u2019appariement des cas et des t\u00e9moins a \u00e9t\u00e9 r\u00e9alis\u00e9.<\/p>\n<p><em>\u00c9tude transversale<\/em>\u00a0\u2013\u00a0Le cas \u00e9ch\u00e9ant, d\u00e9crire les m\u00e9thodes d\u2019analyse qui tiennent compte de la strat\u00e9gie d\u2019\u00e9chantillonnage<\/td>\n<\/tr>\n<tr>\n<td width=\"31\"><\/td>\n<td width=\"438\">(e) D\u00e9crire toutes les analyses de sensibilit\u00e9<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" width=\"120\"><strong>R\u00e9sultats<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Population<\/td>\n<td width=\"31\">13*<\/td>\n<td width=\"438\">(a) Rapporter le nombre d\u2019individus \u00e0 chaque \u00e9tape de l\u2019\u00e9tude\u00a0\u2013\u00a0par exemple\u00a0: potentiellement \u00e9ligibles, examin\u00e9s pour l\u2019\u00e9ligibilit\u00e9, confirm\u00e9s \u00e9ligibles, inclus dans l\u2019\u00e9tude, compl\u00e8tement suivis, et analys\u00e9s<\/td>\n<\/tr>\n<tr>\n<td width=\"120\"><\/td>\n<td width=\"31\"><\/td>\n<td width=\"438\">(b) Indiquer les raisons de non-participation \u00e0 chaque \u00e9tape<\/td>\n<\/tr>\n<tr>\n<td width=\"120\"><\/td>\n<td width=\"31\"><\/td>\n<td width=\"438\">(c) Envisager l\u2019utilisation d\u2019un diagramme de flux<\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Donn\u00e9es descriptives<\/td>\n<td width=\"31\">14*<\/td>\n<td width=\"438\">(a) Indiquer les caract\u00e9ristiques de la population \u00e9tudi\u00e9e (par exemple\u00a0: d\u00e9mographiques, cliniques, sociales) et les informations sur les expositions et les facteurs de confusion potentiels<\/td>\n<\/tr>\n<tr>\n<td width=\"120\"><\/td>\n<td width=\"31\"><\/td>\n<td width=\"438\">(b) Indiquer le nombre de sujets inclus avec des donn\u00e9es manquantes pour chaque variable d\u2019int\u00e9r\u00eat<\/td>\n<\/tr>\n<tr>\n<td width=\"120\"><\/td>\n<td width=\"31\"><\/td>\n<td width=\"438\">(c) <em>\u00c9tude de cohorte<\/em>\u00a0\u2013\u00a0R\u00e9sumer la p\u00e9riode de suivi (par exemple\u00a0: nombre moyen et total)<\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Donn\u00e9es obtenues<\/td>\n<td width=\"31\">15*<\/td>\n<td width=\"438\"><em>\u00c9tude de cohorte<\/em>\u00a0\u2013\u00a0Rapporter le nombre d\u2019\u00e9v\u00e8nements survenus ou les indicateurs mesur\u00e9s au cours du temps<\/td>\n<\/tr>\n<tr>\n<td width=\"120\"><\/td>\n<td width=\"31\"><\/td>\n<td width=\"438\"><em>\u00c9tude cas-t\u00e9moin<\/em>\u00a0\u2013\u00a0Reporter le nombre de sujets pour chaque cat\u00e9gorie d\u2019exposition, ou les indicateurs du niveau d\u2019exposition mesur\u00e9<\/td>\n<\/tr>\n<tr>\n<td width=\"120\"><\/td>\n<td width=\"31\"><\/td>\n<td width=\"438\"><em>\u00c9tude transversale<\/em>\u00a0\u2013\u00a0Reporter le nombre d\u2019\u00e9v\u00e8nements survenus ou les indicateurs mesur\u00e9s<\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Principaux r\u00e9sultats<\/td>\n<td width=\"31\">16<\/td>\n<td width=\"438\">(a) Indiquer les estimations non ajust\u00e9es et, le cas \u00e9ch\u00e9ant, les estimations apr\u00e8s ajustement sur les facteurs de confusion avec leur pr\u00e9cision (par exemple\u00a0: intervalle de confiance de 95\u00a0%). Expliciter quels facteurs de confusion ont \u00e9t\u00e9 pris en compte et pourquoi ils ont \u00e9t\u00e9 inclus.<\/td>\n<\/tr>\n<tr>\n<td width=\"120\"><\/td>\n<td width=\"31\"><\/td>\n<td width=\"438\">(b) Indiquer les valeurs borne des intervalles lorsque les variables continues ont \u00e9t\u00e9 cat\u00e9goris\u00e9es<\/td>\n<\/tr>\n<tr>\n<td width=\"120\"><\/td>\n<td width=\"31\"><\/td>\n<td width=\"438\">(c) Selon les situations, traduire les estimations de risque relatif en risque absolu sur une p\u00e9riode de temps (cliniquement) interpr\u00e9table<\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Autres analyses<\/td>\n<td width=\"31\">17<\/td>\n<td width=\"438\">Mentionner les autres analyses r\u00e9alis\u00e9es\u2013par exemple\u00a0: analyses de sous-groupes, recherche d\u2019interactions, et analyses de sensibilit\u00e9<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" width=\"120\"><strong>Discussion<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"120\">R\u00e9sultats cl\u00e9s<\/td>\n<td width=\"31\">18<\/td>\n<td width=\"438\">R\u00e9sumer les principaux r\u00e9sultats en se r\u00e9f\u00e9rant aux objectifs de l\u2019\u00e9tude<\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Limitations<\/td>\n<td width=\"31\">19<\/td>\n<td width=\"438\">Discuter les limites de l\u2019\u00e9tude, en tenant compte des sources de biais potentiels ou d\u2019impr\u00e9cisions. Discuter du sens et de l\u2019importance de tout biais potentiel<\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Interpr\u00e9tation<\/td>\n<td width=\"31\">20<\/td>\n<td width=\"438\">Donner une interpr\u00e9tation g\u00e9n\u00e9rale prudente des r\u00e9sultats compte tenu des objectifs, des limites de l\u2019\u00e9tude, de la multiplicit\u00e9 des analyses, des r\u00e9sultats d\u2019\u00e9tudes similaires, et de tout autre \u00e9l\u00e9ment pertinent<\/td>\n<\/tr>\n<tr>\n<td width=\"120\">\u00ab\u00a0G\u00e9n\u00e9ralisabilit\u00e9\u00a0\u00bb<\/td>\n<td width=\"31\">21<\/td>\n<td width=\"438\">Discuter la \u00ab\u00a0g\u00e9n\u00e9ralisabilit\u00e9\u00a0\u00bb (validit\u00e9 externe) des r\u00e9sultats de l\u2019\u00e9tude<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" width=\"120\"><strong>Autre information<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"120\">Financement<\/td>\n<td width=\"31\">22<\/td>\n<td width=\"438\">Indiquer la source de financement et le r\u00f4le des financeurs pour l\u2019\u00e9tude rapport\u00e9e, le cas \u00e9ch\u00e9ant, pour l\u2019\u00e9tude originale sur laquelle s\u2019appuie l\u2019article pr\u00e9sent\u00e9.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>*Indiquer l\u2019information s\u00e9par\u00e9ment pour les cas et les t\u00e9moins dans les \u00e9tudes cas-t\u00e9moins et, le cas \u00e9ch\u00e9ant, pour les groupes expos\u00e9s et non expos\u00e9s dans les \u00e9tudes de cohorte et les \u00e9tudes transversales.<\/p>\n<p><\/div><\/div>\n<h2 id=\"eco\">E. \u00c9tude \u00e9cologique<\/h2>\n<p><strong>D\u00e9finition\u00a0<\/strong>:<\/p>\n<p>Une \u00e9tude \u00e9cologique est une \u00e9tude \u00e9pid\u00e9miologique dans laquelle les facteurs \u00e9tudi\u00e9s proviennent de population et non pas d\u2019individu, d\u00e9finie \u00e0 partir de caract\u00e9ristiques temporelles ou g\u00e9ographiques. Elle permet d\u2019\u00e9mettre des hypoth\u00e8ses avant de r\u00e9aliser une \u00e9tude de cohorte ou cas-t\u00e9moin.<\/p>\n<p><em>Ex\u00a0: on veut \u00e9tudier le cancer du poumon chez les tabagiques dans diff\u00e9rents pays. On utilisera les donn\u00e9es de cancer de poumon et de tabagisme dans les populations, \u00e0 partir de statistiques d\u00e9j\u00e0 \u00e9tablies. On n\u2019\u00e9tudiera pas ces variables chez chaque individu.<\/em><\/p>\n<p><strong>Int\u00e9r\u00eat\u00a0:<\/strong><\/p>\n<ul>\n<li>Avantage\u00a0<strong>:<\/strong>\n<ul>\n<li>Permet de g\u00e9n\u00e9rer des hypoth\u00e8ses<\/li>\n<li>Rapide, peu on\u00e9reux.<\/li>\n<li>Nombreuses variables analysables et nombreux sujets recrut\u00e9s<\/li>\n<\/ul>\n<\/li>\n<li>Inconv\u00e9nients\u00a0:\n<ul>\n<li>Faible niveau EBM<\/li>\n<li>Erreur \u00e9cologique\u00a0: erreur de raisonnement dans l&rsquo;interpr\u00e9tation de r\u00e9sultats statistiques au niveau individuel \u00e0 partir de donn\u00e9es agr\u00e9g\u00e9es<span class=\"zp-InText-zp-ID--1093634-N789G4S4--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:N789G4S4}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><em>Ex\u00a0: en 1981, R. Edgar Hope-Simpson \u00e9met l\u2019hypoth\u00e8se qu\u2019un \u00ab\u00a0stimulus saisonnier\u00a0\u00bb associ\u00e9 \u00e0 l\u2019exposition solaire pourrait expliquer le caract\u00e8re saisonnier des infections \u00e0 Haemophilus. Un essai interventionnel confirmera cette hypoth\u00e8se en proposant une suppl\u00e9mentation en vitamine D \u00e0 vis\u00e9e pr\u00e9ventive<span class=\"zp-InText-zp-ID--1093634-5T57SXVW--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:5T57SXVW}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span><\/em><em>.<\/em><\/p>\n<h2 id=\"prono\">F. \u00c9tude pronostique<\/h2>\n<p><strong>D\u00e9finition\u00a0: <\/strong><\/p>\n<p>Type d\u2019article dont l\u2019objectif est de montrer qu\u2019un <strong>facteur va influencer le devenir de la maladie<\/strong>, c\u2019est-\u00e0-dire l\u2019apparition d\u2019un crit\u00e8re de jugement (\u00ab\u00a0positif\u00a0\u00bb comme la gu\u00e9rison ou \u00ab\u00a0n\u00e9gatif\u00a0\u00bb comme le d\u00e9c\u00e8s). En identifiant certains facteurs de bon ou mauvais pronostiques, on pourra proposer une prise en charge plus adapt\u00e9e.<\/p>\n<p>\u00c0 la diff\u00e9rence d\u2019une \u00e9tude \u00e9tiologique, on ne cherche pas \u00e0 montrer un lien de causalit\u00e9.<\/p>\n<p>De plus, la diff\u00e9rence entre un facteur de risque et un facteur pronostic est que le facteur de risque aura une influence sur la survenue de la maladie alors que le facteur pronostic aura une influence sur le devenir de la maladie.<\/p>\n<p><strong>Formulation de l\u2019objectif\u00a0:<\/strong><\/p>\n<p>On retrouve le PICO\u00a0:<\/p>\n<ul>\n<li>P\u00a0: population concern\u00e9e<\/li>\n<li>I\u00a0: facteur pronostic \u00e9valu\u00e9<\/li>\n<li>C\u00a0: population de comparaison n\u2019ayant pas le facteur pronostic<\/li>\n<li>O\u00a0: crit\u00e8re de jugement (maladie, gu\u00e9rison\u2026)<\/li>\n<\/ul>\n<p><em>Ex\u00a0: \u00e9valuer si la d\u00e9pression(I) est un facteur de mauvais pronostique, pr\u00e9dictif de d\u00e9c\u00e8s (O) chez les patients ayant un cancer(P). On sous-entend par rapport aux patients non d\u00e9prim\u00e9s (C).<\/em><\/p>\n<p><strong>Objectifs\u00a0<\/strong>:<\/p>\n<ul>\n<li><strong>Descriptif : r\u00e9partition spatio-temporelle des ph\u00e9nom\u00e8nes\u00a0de sant\u00e9 et leurs d\u00e9terminants.<\/strong> Ex : <em>\u00a0\u00e9tude de la survie des sujets ayant un m\u00e9lanome.<\/em><\/li>\n<li><strong>Explicatif : explorant des facteurs pronostiques <\/strong>influen\u00e7ant sur l&rsquo;\u00e9volution d&rsquo;une maladie. Cela permet d&rsquo;am\u00e9liorer la compr\u00e9hension de la maladie pour pr\u00e9dire plus justement son devenir et proposer une th\u00e9rapeutique en fonction du risque (d\u00e9finition de groupes \u00e0 risque. <em>Ex : stade TNM pour les cancers<\/em>). En fonction de la capacit\u00e9 \u00e0 ma\u00eetriser le facteur, on pourra r\u00e9aliser :\n<ul>\n<li>soit des \u00e9tudes interventionnelles. <em>Ex : le repos strict est-il adapt\u00e9 dans la lombalgie aig\u00fce commune ?<\/em><\/li>\n<li>soit des \u00e9tudes observationnelles. <em>Ex : le tabac augmente-t-il le risque de parodontopathie ?<\/em><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2>F bis. Analyse de survies<\/h2>\n<p>Les \u00e9tudes de survie ne correspondent pas \u00e0 un type d&rsquo;\u00e9tude en particulier comme les \u00e9tudes de cohorte ou cas-t\u00e9moins. Ce type d&rsquo;\u00e9tude t\u00e9moigne plus de l&rsquo;utilisation d&rsquo;une <strong>m\u00e9thode statistiques particuli\u00e8re : l&rsquo;analyse de survie<\/strong>. Ces m\u00e9thodes permettent d&rsquo;\u00e9tudier le <strong>d\u00e9lai de survenue d&rsquo;un \u00e9v\u00e9nement dont la survenue n&rsquo;est pas constante.<\/strong><\/p>\n<p>Initialement utilis\u00e9es pour \u00e9tudier la survie des patients (d\u00e9lais de survenue d&rsquo;un d\u00e9c\u00e8s), ces m\u00e9thodes permettent d&rsquo;\u00e9tudier plus g\u00e9n\u00e9ralement des <strong>donn\u00e9es dites \u00ab\u00a0censur\u00e9es \u00e0 droite\u00a0\u00bb<\/strong>, c&rsquo;est-\u00e0-dire des \u00e9v\u00e9nements<strong> qualitatifs binaires <\/strong>(pr\u00e9sence\/absence)<strong> survenant au cours du temps de mani\u00e8re non r\u00e9currente<\/strong>. <em>Ex : d\u00e9c\u00e8s, m\u00e9tastase, r\u00e9cidive, maladie\u2026<\/em><\/p>\n<p>Ce type d&rsquo;\u00e9tude n\u00e9cessite le recueil de donn\u00e9es particuli\u00e8res :<\/p>\n<ul>\n<li>En rapport avec la <strong>date\u00a0<\/strong>:\n<ul>\n<li><strong>Date d\u2019origine\u00a0<\/strong>(<strong>DO)<\/strong>\u00a0: date d\u2019entr\u00e9e du patient dans l\u2019\u00e9tude (<em>ex : au moment de la randomisation, diagnostic,\u00a0op\u00e9ration\u2026)<\/em><\/li>\n<li><strong>Date de point (DP)\u00a0<\/strong>: date butoir pour laquelle on cherchera \u00e0 conna\u00eetre l\u2019\u00e9tat de chaque sujet.<\/li>\n<li><strong>Date de derni\u00e8re nouvelle\u00a0(DDN)\u00a0<\/strong>: date la plus r\u00e9cente \u00e0 laquelle on a pu\n<div data-canvas-width=\"136.92296515974414\">avoir des nouvelles\u00a0du sujet quant au crit\u00e8re \u00e9tudi\u00e9 <em>(d\u00e9c\u00e8s\/survie\u2026)<\/em>. Elle correspond \u00e0 la date de d\u00e9c\u00e8s pour les sujets d\u00e9c\u00e9d\u00e9s et \u00e0 la date de la derni\u00e8re consultation pour les sujets vivants.<\/div>\n<\/li>\n<\/ul>\n<\/li>\n<li>En rapport avec l&rsquo;<strong>intervalle de temps<\/strong> entre la DO, DP et DDN :\n<ul>\n<li><strong>Temps de participation (TP)\u00a0<\/strong>: d\u00e9lai correspondant \u00e0 toute la dur\u00e9e de surveillance du sujet. Elle permet de construire la courbe de survie.\n<ul>\n<li>Si DDN &lt; DP alors TP = DDN &#8211; DO<\/li>\n<li>Si DDN &gt; DP alors TP = DP &#8211; DO<\/li>\n<\/ul>\n<\/li>\n<li><strong>Recul\u00a0<\/strong>: d\u00e9lai \u00e9coul\u00e9 entre la date d&rsquo;origine et la date de point. Les reculs minimum et maximum d&rsquo;une s\u00e9rie de sujets participant \u00e0 une \u00e9tude d\u00e9finissent donc \u00ab l&rsquo;anciennet\u00e9 \u00bb de la s\u00e9rie.\n<ul>\n<li>Recul = DP \u2013 DO<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>En rapport avec le <strong>sujet\u00a0<\/strong>:\n<ul>\n<li><strong>D\u00e9c\u00e9d\u00e9<\/strong> ou survivant \u00e0 la DP<\/li>\n<li>Si le sujet est <strong>vivant\u00a0\u00e0 la DP<\/strong>, on dit que les donn\u00e9es sont <strong>censur\u00e9es\u00a0\u00e0 droite. <\/strong>Les sujets peuvent \u00eatre qualifi\u00e9s de\u00a0\u00a0:\n<ul>\n<li><strong>Perdu de vue\u00a0<\/strong>: on ne conna\u00eet pas son \u00e9tat \u00e0 la DP mais toujours vivant \u00e0 la DDN.<\/li>\n<li><strong>Exclu-vivant\u00a0<\/strong>: vivant \u00e0 la DP.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Interpr\u00e9tations\u00a0:<\/strong><\/p>\n<p>Les \u00e9tudes pronostiques utilisent des donn\u00e9es censur\u00e9es.<\/p>\n<p>Cette particularit\u00e9 implique des analyses statistiques particuli\u00e8res sp\u00e9cifiques aux variables censur\u00e9es.<\/p>\n<h2 id=\"interventionnelle\">G. \u00c9tude interventionnelle<\/h2>\n<p><strong>D\u00e9finition\u00a0:<\/strong><\/p>\n<p>Mise en \u0153uvre syst\u00e9matique d&rsquo;un programme (visant par exemple la promotion de la sant\u00e9 ou la pr\u00e9vention des maladies, ou encore une intervention m\u00e9dicale), en direction d&rsquo;individus ou d&rsquo;une population, en vue de mesurer les r\u00e9sultats de ce programme \u00e0 des fins de recherche<span class=\"zp-InText-zp-ID--1093634-UM3AGQZ3--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:UM3AGQZ3}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>.<\/p>\n<p>En gros, cherche l\u2019impact d\u2019une intervention (m\u00e9dicament, chirurgie, programme\u2026) sur un \u00e9tat (maladie, gu\u00e9rison, connaissance\u2026).<\/p>\n<p>En anglais\u00a0: <em>intervention study<\/em><\/p>\n<p><strong>Formulation de l\u2019objectif\u00a0:<\/strong><\/p>\n<p>En reprenant le PICO\u00a0:<\/p>\n<ul>\n<li>P\u00a0: population concern\u00e9e<\/li>\n<li>I\u00a0: Intervention<\/li>\n<li>C\u00a0: groupe contr\u00f4le<\/li>\n<li>O\u00a0: crit\u00e8re de jugement (\u00e9tat)<\/li>\n<\/ul>\n<p><em>Ex\u00a0: \u00e9valuation de l\u2019efficacit\u00e9 \u00e0 30 jours (O) du parac\u00e9tamol (I) par rapport \u00e0 un placebo (C) dans la lombalgie aig\u00fce (O).<\/em><\/p>\n<p><strong>Type d\u2019\u00e9tude\u00a0:<\/strong><\/p>\n<ul>\n<li><strong>ECR\u00a0<\/strong>(Essai contr\u00f4l\u00e9 randomis\u00e9) : les sujets sont tir\u00e9s au sort quant \u00e0 l\u2019allocation de l\u2019intervention. C\u2019est la m\u00e9thode de <strong>r\u00e9f\u00e9rence<\/strong>.\n<ul>\n<li><strong>\u00c9tude pragmatique<\/strong> : \u00e9tudie le b\u00e9n\u00e9fice de l\u2019intervention dans des conditions pratiques (\u00ab\u00a0in vivo\u00a0\u00bb).<\/li>\n<li><strong>\u00c9tude explicative\u00a0<\/strong>: \u00e9tudie l\u2019efficacit\u00e9 th\u00e9orique de l\u2019intervention dans des conditions id\u00e9ales (\u00ab\u00a0in vitro\u00a0\u00bb)<\/li>\n<\/ul>\n<\/li>\n<li><strong>ECnR<\/strong> (Essai contr\u00f4l\u00e9 non randomis\u00e9)\u00a0:\n<ul>\n<li><strong>\u00c9tude ici-ailleurs\u00a0<\/strong>: on compare 2 groupes distincts g\u00e9ographiquement, l\u2019un re\u00e7oit l\u2019intervention, l\u2019autre pas. Risque de biais de s\u00e9lection.<\/li>\n<li><strong>\u00c9tude avant-apr\u00e8s\u00a0<\/strong>: on compare un m\u00eame groupe avant et apr\u00e8s une intervention. Risque de biais de confusion notamment d\u00fb \u00e0 l\u2019\u00e9volution naturelle de la maladie.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Comparaison \u00e9tude pragmatique et explicative <\/strong><span class=\"zp-InText-zp-ID--1093634-TZ8FG25T--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:TZ8FG25T}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>\u00a0:<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"150\"><\/td>\n<td width=\"150\">Essai <strong>pragmatique<\/strong><\/td>\n<td width=\"150\">Essai <strong>explicatif<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"150\"><strong>Objectif<\/strong><\/td>\n<td width=\"150\">Documenter le b\u00e9n\u00e9fice qu\u2019apportera le traitement aux patients qui seront trait\u00e9s en pratique<\/td>\n<td width=\"150\">Evaluer et expliquer l\u2019effet du traitement dans des conditions tr\u00e8s pr\u00e9cises<\/td>\n<\/tr>\n<tr>\n<td width=\"150\"><strong>Finalit\u00e9<\/strong><\/td>\n<td width=\"150\">Pratique\u00a0: valider une pratique m\u00e9dicale<\/td>\n<td width=\"150\">Cognitive\u00a0: connaissance et explication<\/td>\n<\/tr>\n<tr>\n<td width=\"150\"><strong>Population<\/strong> vis\u00e9e<\/td>\n<td width=\"150\">Repr\u00e9sentative des futurs patients qui seront trait\u00e9s<\/td>\n<td width=\"150\">La plus homog\u00e8ne possible afin de contr\u00f4ler au maximum l\u2019influence d\u2019autres facteurs<\/td>\n<\/tr>\n<tr>\n<td width=\"150\"><strong>Crit\u00e8res de s\u00e9lection<\/strong><\/td>\n<td width=\"150\">Simples<\/p>\n<p>Correspondant aux crit\u00e8res utilis\u00e9s en pratique pour d\u00e9cider de traiter<\/p>\n<p>Mesur\u00e9s par des examens de routine<\/td>\n<td width=\"150\">Pr\u00e9cis<\/p>\n<p>D\u00e9finissant parfaitement les patients cibl\u00e9s<\/p>\n<p>Mesur\u00e9s par des techniques sophistiqu\u00e9es<\/td>\n<\/tr>\n<tr>\n<td width=\"150\"><strong>Pertinence clinique<\/strong><\/td>\n<td width=\"150\">Forte<\/td>\n<td width=\"150\">Faible<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Rappel des grandes phases de d\u00e9veloppement d\u2019un m\u00e9dicament.<\/strong><\/p>\n<p><em>En cours de r\u00e9daction<\/em><\/p>\n<p><strong>Choix du comparateur\u00a0:<\/strong><\/p>\n<p>Pour choisir le groupe de comparaison, on a 2 choix en fonction de la pathologie\u00a0:<\/p>\n<ul>\n<li>Soit on dispose d\u2019un traitement efficace, le comparateur sera le <strong>traitement de r\u00e9f\u00e9rence<\/strong><\/li>\n<li>Soit on de dispose pas de traitement efficace, on utilisera un <strong>placebo<\/strong><\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>Taille d\u2019effet\u00a0:<\/strong><\/p>\n<ul>\n<li><strong>Risque de base\u00a0:\u00a0<\/strong>A = survenue (%) du crit\u00e8re principal dans le groupe contr\u00f4le (placebo ou Tt de r\u00e9f\u00e9rence).<\/li>\n<\/ul>\n<ul>\n<li><strong>Risque avec traitement\u00a0:\u00a0<\/strong>B = survenue (%) du crit\u00e8re principal pour le Tt exp\u00e9rimental<\/li>\n<\/ul>\n<ul>\n<li><strong>R\u00e9duction absolue du risque (RAR)\u00a0:\u00a0<\/strong>RAR = A-B<\/li>\n<\/ul>\n<ul>\n<li><strong>R\u00e9duction Relative du Risque (RRR)\u00a0:\u00a0<\/strong>RRR = (A-B) \/ A<\/li>\n<\/ul>\n<ul>\n<li><strong>Nombre de sujets N\u00e9cessaires \u00e0 Traiter (NNT<\/strong>,\u00a0\u00ab\u00a0number needed to treat\u00a0\u00bb)\u00a0:\n<ul>\n<li>d\u00e9finition: nombre de sujets \u00e0 traiter pour \u00e9viter la survenue d\u2019un \u00e9v\u00e8nement\u00a0sur une <strong>dur\u00e9e donn\u00e9e<\/strong>.<\/li>\n<li>Calcul\u00a0: NNT = 1 \/ RAR = 1 \/ (A-B)<\/li>\n<li><em>ex: A = 20\u00a0% et B = 10\u00a0%: NST = 1\/0.01 = 10 patients<\/em><\/li>\n<li><em>Interpr\u00e9tation\u00a0: \u00ab il faut traiter 10 patients pendant 1 an pour \u00e9viter 1 d\u00e9c\u00e8s \u00bb<\/em><\/li>\n<\/ul>\n<\/li>\n<li><strong>Diff\u00e9rence de risques <\/strong>: il correspond au nombre d\u2019\u00e9v\u00e9nements \u00e9vit\u00e9s gr\u00e2ce au nouveau traitement.\n<ul>\n<li>Calcul: \u00e0 partir du b\u00e9n\u00e9fice absolu qui repr\u00e9sente la diff\u00e9rence des risques absolus.<\/li>\n<li>= incidence de l\u2019\u00e9v\u00e9nement dans le groupe 1 \u2013 incidence dans le groupe B<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3>1. Plan exp\u00e9rimental<\/h3>\n<h4>a. Sup\u00e9riorit\u00e9, \u00e9quivalence et non-inf\u00e9riorit\u00e9<\/h4>\n<p>Lors d\u2019un essai de sup\u00e9riorit\u00e9, l\u2019absence de diff\u00e9rence significative entre les 2 interventions ne permet pas de d\u00e9terminer s\u2019ils sont comparables. Pour cela on a d\u00e9velopp\u00e9 un nouveau type d\u2019essai permettant de d\u00e9terminer si 2 traitements sont \u00e9quivalents ou si le nouveau m\u00e9dicament n\u2019est pas inf\u00e9rieur \u00e0 celui de r\u00e9f\u00e9rence.<\/p>\n<p>Dans les essais interventionnels, on distingue 3 grands types de sch\u00e9mas exp\u00e9rimentaux\u00a0:<\/p>\n<ul>\n<li><strong>Essai de sup\u00e9riorit\u00e9\u00a0:<\/strong>\n<ul>\n<li><strong>Objectif\u00a0<\/strong>: \u00ab\u00a0le traitement A est-il sup\u00e9rieur au traitement B ou le traitement B est-il sup\u00e9rieur au traitement A\u00a0?\u00a0\u00bb (si analyse bilat\u00e9rale)<\/li>\n<li>Soit <strong>\u2206\u00a0: la diff\u00e9rence d\u2019efficacit\u00e9<\/strong> entre les 2 traitements. \u2206 = \u00b5<sub>A<\/sub> &#8211; \u00b5<sub>B<\/sub><\/li>\n<li>On pose <strong>les hypoth\u00e8ses\u00a0: <\/strong>\n<ul>\n<li>H0\u00a0: efficacit\u00e9 du traitement A (\u00b5<sub>A<\/sub>) = efficacit\u00e9 du traitement B (\u00b5<sub>B<\/sub>),<\/li>\n<li>la diff\u00e9rence d\u2019efficacit\u00e9 entre les 2 traitements\u00a0: |\u2206| = |\u00b5<sub>A<\/sub> &#8211; \u00b5<sub>B<\/sub>| = 0<\/li>\n<li>H1\u00a0: |\u2206| \u2260 0<\/li>\n<\/ul>\n<\/li>\n<li><strong>Interpr\u00e9tation\u00a0<\/strong>: si la diff\u00e9rence d\u2019efficacit\u00e9 est non significative, on peut supposer que l\u2019un des traitements n\u2019est pas sup\u00e9rieur \u00e0 l\u2019autre mais pas que les traitements sont \u00e9quivalents.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li><strong>Essai d\u2019\u00e9quivalence\u00a0:<\/strong>\n<ul>\n<li><strong>Objectif\u00a0<\/strong>: \u00ab\u00a0le traitement A est-il \u00e9quivalent au traitement B et vis-versa\u00a0? \u00bb<\/li>\n<li>Soit<strong> \u2206<sub>L<\/sub>: la borne d\u2019\u00e9quivalence<\/strong>. C\u2019est la plus petite diff\u00e9rence cliniquement pertinente.<\/li>\n<li>On veut que |\u00b5<sub>A<\/sub> &#8211; \u00b5<sub>B<\/sub>| &lt; \u2206<sub>L<\/sub><\/li>\n<li>On pose les hypoth\u00e8ses\n<ul>\n<li>H0\u00a0: \u2206 \u2264 \u2206<sub>L<\/sub> ou \u2206 \u2265 \u2206<sub>L <\/sub>(c\u2019est la non-\u00e9quivalence)<\/li>\n<li>H1\u00a0: -\u2206<sub>L<\/sub> &lt; \u2206 &lt; +\u2206<sub>L <\/sub>(c\u2019est l\u2019\u00e9quivalence)<\/li>\n<\/ul>\n<\/li>\n<li>Interpr\u00e9tation\u00a0: si la diff\u00e9rence comprend la borne d\u2019\u00e9quivalence, on consid\u00e8re que les traitements sont \u00e9quivalents.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Essai de non-inf\u00e9riorit\u00e9\u00a0:<\/strong>\n<ul>\n<li>Objectif\u00a0: \u00ab\u00a0le traitement A est-il au moins aussi efficace que le traitement B\u00a0?\u00a0\u00bb<\/li>\n<li>Soit <strong>\u2206<sub>L\u00a0<\/sub>: la borne de non-inf\u00e9riorit\u00e9<\/strong><\/li>\n<li>On veut que \u00b5<sub>A<\/sub> &#8211; \u00b5<sub>B <\/sub>&gt; -\u2206<sub>L<\/sub><\/li>\n<li>On pose les hypoth\u00e8ses (analyse unilat\u00e9rale)\u00a0:\n<ul>\n<li>H0\u00a0: \u2206 \u2264 -\u2206<sub>L <\/sub>(le traitement A est &lt; au traitement B)<\/li>\n<li>H1\u00a0: \u2206 &gt; -\u2206<sub>L <\/sub>(le traitement A est \u2265 au traitement B)<\/li>\n<\/ul>\n<\/li>\n<li>Interpr\u00e9tation\u00a0: si la diff\u00e9rence comprend la borne de non-inf\u00e9riorit\u00e9, on consid\u00e8re que le traitement A est au moins aussi efficace que le traitement B.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><em>\u00a0<\/em><\/p>\n<p><strong>Pourquoi faire un essai de non-inf\u00e9riorit\u00e9 plut\u00f4t qu\u2019un essai de sup\u00e9riorit\u00e9\u00a0? <\/strong>(ECN 2012)<\/p>\n<ul>\n<li>L\u2019analyse unilat\u00e9rale et pas bilat\u00e9rale permet de <strong>diminuer le nombre de sujets n\u00e9cessaire<\/strong> (NSN) permettant d\u2019augmenter la puissance pour un m\u00eame nombre de sujets.<\/li>\n<li>Lorsqu\u2019il est <strong>difficile de montrer une am\u00e9lioration du traitement de r\u00e9f\u00e9rence<\/strong> (chirurgie, traitement d\u00e9j\u00e0 tr\u00e8s efficace)<\/li>\n<li>Lorsque le <strong>nouveau traitement a d\u2019autres avantages<\/strong> en termes de co\u00fbt (<em>prix<\/em>), de tol\u00e9rance (<em>moins d\u2019effets secondaires<\/em>) ou de facilit\u00e9 d\u2019utilisation (<em>per os plut\u00f4t qu\u2019injectable<\/em>), rapport b\u00e9n\u00e9fice-risque.<\/li>\n<\/ul>\n<p><strong>Borne d\u2019\u00e9quivalence et de non-inf\u00e9riorit\u00e9\u00a0:<\/strong><\/p>\n<p>En r\u00e9alit\u00e9, il est impossible de prouver que les 2 traitements sont parfaitement \u00e9quivalents en termes d\u2019efficacit\u00e9. On va s\u2019accorder une petite marge d\u2019erreur (classique en statistique\u2026) et montrer qu\u2019ils ne sont pas trop diff\u00e9rents. Pour cela on d\u00e9finit une borne d\u2019\u00e9quivalence ou de non-inf\u00e9riorit\u00e9. Ainsi, si la diff\u00e9rence entre ces 2 traitements (son intervalle de confiance \u00e0 95\u00a0%) comprend cette borne, on pourra conclure \u00e0 l\u2019\u00e9quivalence ou la non-inf\u00e9riorit\u00e9.<\/p>\n<p><strong>Comment distinguer un essai de sup\u00e9riorit\u00e9 d\u2019un essai de non-inf\u00e9riorit\u00e9\u00a0?<\/strong><\/p>\n<p>En regardant dans la partie analyse statistique\u00a0:<\/p>\n<ul>\n<li>Si sup\u00e9riorit\u00e9\u00a0: analyse souvent bilat\u00e9rale avec une diff\u00e9rence attendue<\/li>\n<li>Si non-inf\u00e9riorit\u00e9\u00a0: analyse unilat\u00e9rale avec une borne de non-inf\u00e9riorit\u00e9<\/li>\n<\/ul>\n<p><strong>Pourquoi r\u00e9aliser un essai de non-inf\u00e9riorit\u00e9 plut\u00f4t qu\u2019un essai d\u2019\u00e9quivalence\u00a0?<\/strong><\/p>\n<p>En cas d\u2019\u00e9quivalence, la zone de significativit\u00e9 est plus \u00e9troite n\u00e9cessitant un nombre de sujets n\u00e9cessaires plus important.<\/p>\n<p>De plus, dans les essais de non-inf\u00e9riorit\u00e9, le nouveau m\u00e9dicament peut \u00eatre plus efficace.<\/p>\n<p>On pratique, les essais de non-inf\u00e9riorit\u00e9 sont largement dominants dans la recherche.<\/p>\n<h4>b. Cross-over et bras parall\u00e8le<\/h4>\n<p>D\u00e9finition\u00a0: essai durant lequel les sujets vont \u00eatre leur propre t\u00e9moin et recevoir les 2 traitements.<\/p>\n<p>La randomisation d\u00e9termine l\u2019ordre d\u2019attribution des traitements.<\/p>\n<p>Les 2 traitements sont espac\u00e9s par une p\u00e9riode de wash-out (lavage) permettant d\u2019effacer l\u2019effet du 1<sup>er<\/sup> traitement, appel\u00e9 effet r\u00e9manent (carry-over effect)<\/p>\n<ul>\n<li>Avantages\u00a0:\n<ul>\n<li><strong>Am\u00e9lioration de la comparabilit\u00e9 des groupes<\/strong> en diminuant la variabilit\u00e9 interindividuelle<\/li>\n<li><strong>Am\u00e9lioration de la puissance<\/strong> car on a besoin de 2 fois moins de sujets qu\u2019avec une \u00e9tude en groupe parall\u00e8le<\/li>\n<\/ul>\n<\/li>\n<li>Conditions :\n<ul>\n<li><strong>Maladie chronique stable dans le temps<\/strong> afin que l\u2019am\u00e9lioration observ\u00e9e ne soit pas influenc\u00e9e par l\u2019\u00e9volution naturelle de la maladie<em> (ex\u00a0: asthme, migraine, \u00e9pilepsie\u2026)<\/em><\/li>\n<li>Les traitements \u00e9valu\u00e9s doivent \u00eatre des <strong>traitements symptomatiques<\/strong> et doivent agir de mani\u00e8re <strong>non d\u00e9finitive<\/strong> <em>(ex\u00a0: la fi\u00e8vre est adapt\u00e9e mais pas la chirurgie)<\/em><\/li>\n<li>Le crit\u00e8re de jugement peut \u00eatre r\u00e9p\u00e9t\u00e9 <em>(ex\u00a0: la douleur est adapt\u00e9e mais pas la mortalit\u00e9)<\/em><\/li>\n<li><strong>P\u00e9riode de wash-out\u00a0<\/strong><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3>2. \u00c9tude de d\u00e9pistage<\/h3>\n<p><strong>D\u00e9finition\u00a0: <\/strong><\/p>\n<p>\u00c9tude interventionnelle qui vise \u00e0 identifier une maladie ou un haut risque pathologique dans une population a priori en bonne sant\u00e9<\/p>\n<p><strong>Formulation de l\u2019objectif\u00a0:<\/strong><\/p>\n<p>En reprenant le PICO\u00a0:<\/p>\n<ul>\n<li>P\u00a0: population concern\u00e9e<\/li>\n<li>I\u00a0: proc\u00e9dure de d\u00e9pistage<\/li>\n<li>C\u00a0: population d\u00e9pist\u00e9e<\/li>\n<li>O\u00a0: crit\u00e8re de jugement (la maladie)<\/li>\n<\/ul>\n<p><em>Ex\u00a0: \u00e9valuation de l\u2019efficacit\u00e9 de d\u00e9pistage du frottis cervico-vaginale (I) chez les femmes de plus de 25 ans (P) en termes de mortalit\u00e9 (O). On sous-entend que l\u2019on compare \u00e0 une population non d\u00e9pist\u00e9e (C). <\/em><\/p>\n<p><strong>Types de d\u00e9pistage\u00a0:<\/strong><\/p>\n<ul>\n<li><strong>Opportuniste<\/strong> ou <strong>individuel\u00a0<\/strong>: sur proposition du m\u00e9decin ou \u00e0 la demande du patient<\/li>\n<li><strong>Organis\u00e9<\/strong> ou <strong>de masse\u00a0<\/strong>: mis en place par les pouvoirs publics<\/li>\n<\/ul>\n<p><strong>Type d\u2019\u00e9tude\u00a0:<\/strong><\/p>\n<p>On va privil\u00e9gier une <strong>\u00e9tude contr\u00f4l\u00e9e randomis\u00e9e<\/strong>. L\u2019intervention correspond \u00e0 la proc\u00e9dure de d\u00e9pistage.<\/p>\n<p><strong>Int\u00e9r\u00eats\u00a0<\/strong>:<\/p>\n<ul>\n<li>Avantages\u00a0:\n<ul>\n<li>Diminution de la morbi-mortalit\u00e9<\/li>\n<li>Traitements moins lourds<\/li>\n<li>R\u00e9assurances des sujets n\u00e9gatifs<\/li>\n<\/ul>\n<\/li>\n<li>Inconv\u00e9nients\u00a0:\n<ul>\n<li>Faux n\u00e9gatif\u00a0: fausse r\u00e9assurance<\/li>\n<li>Faux positif\u00a0: exploration inutile<\/li>\n<li>Iatrog\u00e9nie des tests de d\u00e9pistage ou des explorations<\/li>\n<li>Allongement de la dur\u00e9e de la maladie (diagnostic plus t\u00f4t)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Quand r\u00e9aliser un d\u00e9pistage organis\u00e9\u00a0?<\/strong><\/p>\n<p>Un d\u00e9pistage est dit organis\u00e9 lorsqu\u2019il r\u00e9pond \u00e0 l\u2019ensemble des dix crit\u00e8res de l\u2019Organisation mondiale de la sant\u00e9 (OMS)\u00a0:<\/p>\n<ul>\n<li><strong>Probl\u00e8me majeur de sant\u00e9 publique<\/strong> (s\u00e9v\u00e9rit\u00e9, impact socio-\u00e9conomique, fr\u00e9quence)<\/li>\n<li>Un <strong>traitement efficace<\/strong> est disponible<\/li>\n<li>Des moyens de <strong>diagnostic<\/strong> et de <strong>traitement<\/strong> sont <strong>disponibles<\/strong><\/li>\n<li><strong>L\u2019histoire naturelle<\/strong> de la maladie est bien <strong>connue<\/strong><\/li>\n<li>La maladie doit pouvoir \u00eatre <strong>d\u00e9tect\u00e9e pendant sa phase de latence<\/strong> asymptomatique ou au tout d\u00e9but des sympt\u00f4mes.<\/li>\n<li>Le <strong>test<\/strong> de d\u00e9pistage doit \u00eatre <strong>simple<\/strong> et <strong>bien accept\u00e9<\/strong> par la population.<\/li>\n<li>Il existe un <strong>test de d\u00e9pistage<\/strong> <strong>performant (<\/strong>et le programme de d\u00e9pistage est efficace)<\/li>\n<li>Il n\u2019existe <strong>pas de facteur de risque accessible \u00e0 la pr\u00e9vention primaire<\/strong>.<\/li>\n<li>Le <strong>choix des sujets qui recevront un traitement<\/strong> est op\u00e9r\u00e9 selon des <strong>crit\u00e8res pr\u00e9\u00e9tablis<\/strong>.<\/li>\n<li>Le <strong>co\u00fbt de la recherche des cas<\/strong> (y compris les frais de diagnostic et de traitement des sujets reconnus malades) n\u2019est <strong>pas disproportionn\u00e9 par rapport au co\u00fbt global<\/strong> des soins m\u00e9dicaux.<\/li>\n<li><strong>La recherche des cas est un processus continu<\/strong> et elle n\u2019est pas consid\u00e9r\u00e9e comme une op\u00e9ration ex\u00e9cut\u00e9e \u00ab\u00a0une fois pour toutes\u00a0\u00bb.<\/li>\n<\/ul>\n<h3>3. Grille de lecture CONSORT<\/h3>\n<p>Une grille de lecture <a href=\"https:\/\/www.equator-network.org\/reporting-guidelines\/consort\/\">CONSORT<\/a> (<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1779012314004306\">fran\u00e7ais<\/a> et son <a href=\"http:\/\/www.consort-statement.org\/Media\/Default\/Downloads\/Translations\/French_fr\/French%20CONSORT%20Flow%20Diagram.pdf\">flow chart<\/a>) <span class=\"zp-InText-zp-ID--1093634-9F3XXNFT--wp767 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{1093634:9F3XXNFT}', 'format': '(%num%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span> a \u00e9t\u00e9 d\u00e9velopp\u00e9e pour aider \u00e0 analyser et \u00e9crire une \u00e9tude randomis\u00e9e.<\/p>\n<div style=\"margin: auto; width: auto; \"><h3 class='azc_tsh_toggle' style='border: 0px solid #00F000; background-color: #ffffff; '><a href='#' style='color: #CC6666; font-family: inherit; font-size: 0.6em; '>Grille CONSORT en fran\u00e7ais<\/a><\/h3><div class='azc_tsh_toggle_container' style='border: 0px solid #00F000; background-color: #ffffff; color: #000000; font-family: inherit; font-size: 100%; font-weight: normal; '>\n<table width=\"92%\">\n<thead>\n<tr>\n<td width=\"15%\"><strong>Section\/sujet<\/strong><\/td>\n<td width=\"5%\"><strong>Item N\u00b0<\/strong><\/td>\n<td width=\"78%\"><strong>DESCRIPTION<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td colspan=\"3\" width=\"100%\"><strong>TITRE &amp; RESUME<\/strong><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"15%\"><\/td>\n<td width=\"5%\">1a<\/td>\n<td width=\"78%\">Identification en tant qu\u2019\u201cessai randomis\u00e9\u201c dans le titre<\/td>\n<\/tr>\n<tr>\n<td width=\"5%\">1b<\/td>\n<td width=\"78%\">R\u00e9sum\u00e9 structur\u00e9 du plan d\u2019essai, m\u00e9thodes, r\u00e9sultats et conclusions (pour une aide sp\u00e9cifique voir CONSORT pour Abstract)<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" width=\"100%\"><strong>INTRODUCTION<\/strong><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"15%\">Contexte et objectifs<\/td>\n<td width=\"5%\">2a<\/td>\n<td width=\"78%\">Contexte scientifique et explication du bien-fond\u00e9<\/td>\n<\/tr>\n<tr>\n<td width=\"5%\">2b<\/td>\n<td width=\"78%\">Objectifs sp\u00e9cifiques et hypoth\u00e8ses<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" width=\"100%\"><strong>M\u00c9THODES<\/strong><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"15%\">Plan de l\u2019essai<\/td>\n<td width=\"5%\">3a<\/td>\n<td width=\"78%\">Description du plan de l\u2019essai (tel que\u00a0: groupes parall\u00e8les, plan factoriel) en incluant les ratios d\u2019allocation<\/td>\n<\/tr>\n<tr>\n<td width=\"5%\">3b<\/td>\n<td width=\"78%\">Changements importants de m\u00e9thode apr\u00e8s le d\u00e9but de l\u2019essai(tel que les crit\u00e8res d\u2019\u00e9ligibilit\u00e9), en expliquer la raison<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"15%\">Participants<\/td>\n<td width=\"5%\">4a<\/td>\n<td width=\"78%\">Crit\u00e8res d\u2019\u00e9ligibilit\u00e9 des participants<\/td>\n<\/tr>\n<tr>\n<td width=\"5%\">4b<\/td>\n<td width=\"78%\">Structures et lieux de recueil des donn\u00e9es<\/td>\n<\/tr>\n<tr>\n<td width=\"15%\">Interventions<\/td>\n<td width=\"5%\">5<\/td>\n<td width=\"78%\">Interventions pour chaque groupe avec suffisamment de d\u00e9tails pour pouvoir reproduire l\u2019\u00e9tude, en incluant comment et quand elles ont \u00e9t\u00e9 v\u00e9ritablement conduites<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"15%\">Crit\u00e8res de jugement<\/td>\n<td width=\"5%\">6a<\/td>\n<td width=\"78%\">Crit\u00e8res \u00ab\u00a0\u00e0 priori\u00a0\u00bb de jugement principal et secondaires enti\u00e8rement d\u00e9finis, en incluant comment et quand ils ont \u00e9t\u00e9 \u00e9valu\u00e9s<\/td>\n<\/tr>\n<tr>\n<td width=\"5%\">6b<\/td>\n<td width=\"78%\">Changement quelconque de crit\u00e8res de jugement apr\u00e8s le d\u00e9but de l\u2019essai, en expliquer la raison<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"15%\">Taille de l\u2019\u00e9chantillon<\/td>\n<td width=\"5%\">7a<\/td>\n<td width=\"78%\">Comment la taille de l\u2019\u00e9chantillon a-t-elle \u00e9t\u00e9 d\u00e9termin\u00e9e\u00a0?<\/td>\n<\/tr>\n<tr>\n<td width=\"5%\">7b<\/td>\n<td width=\"78%\">Quand cela est applicable, explication des analyses interm\u00e9diaires et des r\u00e8gles d\u2019arr\u00eat<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" width=\"100%\"><strong>RANDOMISATION<\/strong><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"15%\">Production de la s\u00e9quence<\/td>\n<td width=\"5%\">8a<\/td>\n<td width=\"78%\">M\u00e9thode utilis\u00e9e pour g\u00e9n\u00e9rer la s\u00e9quence d\u2019allocation par tirage au sort<\/td>\n<\/tr>\n<tr>\n<td width=\"5%\">8b<\/td>\n<td width=\"78%\">Type de randomisation, en incluant les d\u00e9tails relatifs \u00e0 une m\u00e9thode de restriction (comme par ex.\u00a0: par\u00a0 blocs, avec la taille des blocs)<\/td>\n<\/tr>\n<tr>\n<td width=\"15%\">M\u00e9canisme d\u2019assignation secr\u00e8te<\/td>\n<td width=\"5%\">9<\/td>\n<td width=\"78%\">M\u00e9canisme utilis\u00e9 pour mettre en \u0153uvre la s\u00e9quence d\u2019allocation randomis\u00e9e (comme par exemple\u00a0: l\u2019utilisation d\u2019enveloppes num\u00e9rot\u00e9es s\u00e9quentiellement), en d\u00e9crivant chaque mesure prise pour masquer l\u2019allocation jusqu\u2019\u00e0 l\u2019assignation des interventions.<\/td>\n<\/tr>\n<tr>\n<td width=\"15%\">Mise en oeuvre<\/td>\n<td width=\"5%\">10<\/td>\n<td width=\"78%\">Qui a\u00a0 g\u00e9n\u00e9r\u00e9 la s\u00e9quence d\u2019allocation, qui a enr\u00f4l\u00e9 les participants et qui a assign\u00e9 les participants \u00e0 leurs groupes<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"15%\">Aveugle<\/td>\n<td width=\"5%\">11a<\/td>\n<td width=\"78%\">Au cas o\u00f9, d\u00e9crire qui a \u00e9t\u00e9 en aveugle apr\u00e8s l\u2019assignation des interventions (par exemple, les participants, les administrateurs de traitement, ceux qui \u00e9valuent les r\u00e9sultats) et comment ont-ils \u00e9t\u00e9 emp\u00each\u00e9s de savoir<\/td>\n<\/tr>\n<tr>\n<td width=\"5%\">11b<\/td>\n<td width=\"78%\">Si appropri\u00e9, description de la similitude des interventions<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"15%\">M\u00e9thodes statistiques<\/td>\n<td width=\"5%\">12a<\/td>\n<td width=\"78%\">M\u00e9thodes statistiques utilis\u00e9es pour comparer les groupes au regard des crit\u00e8res de jugement principal et secondaires<\/td>\n<\/tr>\n<tr>\n<td width=\"5%\">12b<\/td>\n<td width=\"78%\">M\u00e9thodes utilis\u00e9es pour des analyses suppl\u00e9mentaires, telles que des analyses de sous-groupes ou des analyses ajust\u00e9es<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" width=\"100%\"><strong>\u00a0<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" width=\"100%\"><strong>RESULTATS<\/strong><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"15%\">Flux des participants (un diagramme est fortement conseill\u00e9)<\/td>\n<td width=\"5%\">13a<\/td>\n<td width=\"78%\">Pour chaque groupe, le nombre de participants qui ont \u00e9t\u00e9 assign\u00e9s par tirage au sort, qui ont re\u00e7u le traitement qui leur \u00e9tait destin\u00e9, et qui ont \u00e9t\u00e9 analys\u00e9s pour le crit\u00e8re de jugement principal.<\/td>\n<\/tr>\n<tr>\n<td width=\"5%\"><\/td>\n<td width=\"78%\">Pour chaque groupe, abandons et exclusions apr\u00e8s la randomisation, en donner les raisons<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"15%\">Recrutement<\/td>\n<td width=\"5%\">14a<\/td>\n<td width=\"78%\">Dates d\u00e9finissant\u00a0 les p\u00e9riodes de recrutement et de suivi<\/td>\n<\/tr>\n<tr>\n<td width=\"5%\">14b<\/td>\n<td width=\"78%\">Pourquoi l\u2019essai a-t-il pris fin ou a \u00e9t\u00e9 interrompu<\/td>\n<\/tr>\n<tr>\n<td width=\"15%\">Donn\u00e9es initiales<\/td>\n<td width=\"5%\">15<\/td>\n<td width=\"78%\">Une table d\u00e9crivant les caract\u00e9ristiques initiales d\u00e9mographiques et cliniques de chaque groupe<\/td>\n<\/tr>\n<tr>\n<td width=\"15%\">Effectifs analys\u00e9s<\/td>\n<td width=\"5%\">16<\/td>\n<td width=\"78%\">Nombre de participants (d\u00e9nominateur) inclus dans chaque analyse en pr\u00e9cisant si l\u2019analyse a \u00e9t\u00e9 faite avec les groupes d\u2019origine<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"15%\">Crit\u00e8res de jugement et estimations<\/td>\n<td width=\"5%\">17a<\/td>\n<td width=\"78%\">Pour chaque crit\u00e8re de jugement principal et secondaire, donner les r\u00e9sultats pour chaque groupe, et la taille estim\u00e9e de l\u2019effet ainsi que sa pr\u00e9cision (comme par ex.\u00a0: intervalles de confiance \u00e0 95\u00a0%)<\/td>\n<\/tr>\n<tr>\n<td width=\"5%\">17b<\/td>\n<td width=\"78%\">Pour les variables binaires, une pr\u00e9sentation de la taille de l\u2019effet en valeurs absolues et relatives est recommand\u00e9e<\/td>\n<\/tr>\n<tr>\n<td width=\"15%\">Analyses accessoires<\/td>\n<td width=\"5%\">18<\/td>\n<td width=\"78%\">R\u00e9sultats de toute analyse suppl\u00e9mentaire r\u00e9alis\u00e9e, en incluant les analyses en sous-groupes et les analyses ajust\u00e9es, et en distinguant les analyses sp\u00e9cifi\u00e9es \u00e0 priori des analyses exploratoires<\/td>\n<\/tr>\n<tr>\n<td width=\"15%\">Risques<\/td>\n<td width=\"5%\">19<\/td>\n<td width=\"78%\">Tous les risques importants ou effets secondaires inattendus dans chaque groupe (pour un conseil d\u00e9taill\u00e9 voir \u2018<em>CONSORT for harms<\/em>\u2019)<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" width=\"100%\"><strong>DISCUSSION<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"15%\">Limitations<\/td>\n<td width=\"5%\">20<\/td>\n<td width=\"78%\">Limitations de l\u2019essai, en tenant compte des sources de biais potentiels ou d\u2019impr\u00e9cision, et au cas o\u00f9, en tenant compte de la multiplicit\u00e9 des analyses<\/td>\n<\/tr>\n<tr>\n<td width=\"15%\">\u201cG\u00e9n\u00e9ralisabilit\u00e9\u201d<\/td>\n<td width=\"5%\">21<\/td>\n<td width=\"78%\">\u201cG\u00e9n\u00e9ralisabilit\u00e9\u201c (validit\u00e9 externe, applicabilit\u00e9) des r\u00e9sultats de l\u2019essai<\/td>\n<\/tr>\n<tr>\n<td width=\"15%\">Interpr\u00e9tation<\/td>\n<td width=\"5%\">22<\/td>\n<td width=\"78%\">Interpr\u00e9tations\/conclusions coh\u00e9rentes avec les r\u00e9sultats, en tenant compte du ratio-b\u00e9n\u00e9fices\/risques et de possibles autres faits pertinents<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" width=\"100%\"><strong>INFORMATIONS SUPPLEMENTAIRES<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"15%\">Enregistrement<\/td>\n<td width=\"5%\">23<\/td>\n<td width=\"78%\">Num\u00e9ro d\u2019enregistrement de l\u2019essai en pr\u00e9cisant le registre utilis\u00e9<\/td>\n<\/tr>\n<tr>\n<td width=\"15%\">Protocole<\/td>\n<td width=\"5%\">24<\/td>\n<td width=\"78%\">O\u00f9 le protocole complet de l\u2019essai peut-il \u00eatre consult\u00e9, si possible<\/td>\n<\/tr>\n<tr>\n<td width=\"15%\">Financement<\/td>\n<td width=\"5%\">25<\/td>\n<td width=\"78%\">Sources de financement et autres ressources (par ex.\u00a0: fourniture de m\u00e9dicaments), r\u00f4le des donateurs<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><\/div><\/div><br \/>\n<strong>Flowchart CONSORT :<\/strong><\/p>\n<div id=\"attachment_778\" style=\"width: 784px\" class=\"wp-caption aligncenter\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-778\" data-attachment-id=\"778\" data-permalink=\"https:\/\/lepcam.fr\/index.php\/les-etapes\/quanti\/flowchart-consort-fr\/\" data-orig-file=\"https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/04\/flowchart-consort-fr.png?fit=774%2C808&amp;ssl=1\" data-orig-size=\"774,808\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"flowchart consort fr\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Diagramme de flux CONSORT&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/04\/flowchart-consort-fr.png?fit=629%2C657&amp;ssl=1\" class=\"size-full wp-image-778\" src=\"https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/04\/flowchart-consort-fr.png?resize=629%2C657&#038;ssl=1\" alt=\"Diagramme de flux CONSORT\" width=\"629\" height=\"657\" srcset=\"https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/04\/flowchart-consort-fr.png?w=774&amp;ssl=1 774w, https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/04\/flowchart-consort-fr.png?resize=287%2C300&amp;ssl=1 287w, https:\/\/i0.wp.com\/lepcam.fr\/wp-content\/uploads\/2016\/04\/flowchart-consort-fr.png?resize=600%2C626&amp;ssl=1 600w\" sizes=\"auto, (max-width: 629px) 100vw, 629px\" \/><p id=\"caption-attachment-778\" class=\"wp-caption-text\">Diagramme de flux CONSORT<\/p><\/div>\n<hr \/>\n\n<div id='zp-InTextBib-zotpress-f3c380b6283efa9da3a6c339eb54c7a1' class='zp-Zotpress zp-Zotpress-InTextBib wp-block-group zp-Post-767'>\r\n\t\t<span class=\"ZP_ITEM_KEY ZP_ATTR\">{1093634:3VV856JH};{1093634:MJFICS24};{1093634:QDSGVCVE};{1093634:7FIQ89JX};{1093634:AT9ZVA2M};{1093634:UM3AGQZ3};{1093634:UM3AGQZ3};{1093634:4EMMWIVC};{1093634:4EMMWIVC};{1093634:UM3AGQZ3};{1093634:UM3AGQZ3};{1093634:Z9XQSM5I};{1093634:N789G4S4};{1093634:5T57SXVW};{1093634:UM3AGQZ3};{1093634:TZ8FG25T};{1093634:9F3XXNFT}<\/span>\r\n\t\t<span class=\"ZP_STYLE ZP_ATTR\">vancouver<\/span>\r\n\t\t<span class=\"ZP_SORTBY ZP_ATTR\">default<\/span>\r\n\t\t<span class=\"ZP_ORDER ZP_ATTR\">asc<\/span>\r\n\t\t<span class=\"ZP_TITLE ZP_ATTR\"><\/span>\r\n\t\t<span class=\"ZP_SHOWIMAGE ZP_ATTR\"><\/span>\r\n\t\t<span class=\"ZP_SHOWTAGS ZP_ATTR\"><\/span>\r\n\t\t<span class=\"ZP_DOWNLOADABLE ZP_ATTR\"><\/span>\r\n\t\t<span class=\"ZP_NOTES ZP_ATTR\"><\/span>\r\n\t\t<span class=\"ZP_ABSTRACT ZP_ATTR\"><\/span>\r\n\t\t<span class=\"ZP_CITEABLE ZP_ATTR\"><\/span>\r\n\t\t<span class=\"ZP_TARGET ZP_ATTR\"><\/span>\r\n\t\t<span class=\"ZP_URLWRAP ZP_ATTR\"><\/span>\r\n\t\t<span class=\"ZP_FORCENUM ZP_ATTR\">0<\/span>\r\n\t\t<span class=\"ZP_HIGHLIGHT ZP_ATTR\"><\/span>\r\n\t\t<span class=\"ZP_POSTID ZP_ATTR\">767<\/span><div class='zp-List loading'>\n<div class=\"zp-SEO-Content\">\t\t\t\t<span class=\"ZP_JSON 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id=\"zp-ID-767-1093634-WSNAV6FU\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">3.7\u2013.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-5C83BXKP\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">13.4% of participants fell within the KDIGO 2012 moderate risk CKD, 0.9\u20135.6% within the high-risk group and 0.3\u20134.8% within the very high-risk group.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-U7VZZSRR\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">Orlandi PF, Huang J, Fukagawa M, et al. A collaborative, individual-level analysis compared longitudinal outcomes across the International Network of Chronic Kidney Disease (iNETCKD) cohorts. Kidney Int. 2019;96:1217\u201333.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-QHKDBIRN\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">Fig. 3 Prevalence of each KDIGO 2012 category in general population samples.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-3AV944QR\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">Applying KDIGO criteria, 450 (50%) were defined as moderate risk, 86 (10%) high risk and 69 (8%) very high risk. 33% did not have a uACR recorded to determine risk.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-SV3FU3SI\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">905 patients met the inclusion criteria (6% of the population).<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-A5AQC9BH\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">14,525 patients.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-89KGJRJM\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">Primary Care software to extract data.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-DBQ2BIYD\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">Introducing a Cardiovascular Renal Metabolic Service to Optimise the\u00a0 Management of Chronic Kidney Disease in Primary Care. An Interface\u00a0 Project.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-5JGW36MF\" data-zp-author-date='Linden-et-al.-2025-04-09' data-zp-date-author='2025-04-09-Linden-et-al.' data-zp-date='2025-04-09' data-zp-year='2025' data-zp-itemtype='journalArticle' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">Linden P, Leonard N, Conlan J. Introducing a Cardiovascular Renal Metabolic Service to Optimise the Management of Chronic Kidney Disease in Primary Care. An Interface Project. | International Journal of Integrated Care. 2025 Apr 9 [cited 2025 Sept 24]; Available from: <a class='zp-ItemURL' href='https:\/\/ijic.org\/articles\/10.5334\/ijic.ICIC24496'>https:\/\/ijic.org\/articles\/10.5334\/ijic.ICIC24496<\/a><\/div>\n  <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-NVMSN59U\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">public and private facilities.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-LCD6B632\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">Risk profile, quality of life and care of patients with moderate\u00a0 and advanced CKD: The French CKD-REIN Cohort Study.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-HNV9NLBN\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">Overall distribution according to KDIGO 2012 risk groups showed 7.4% at low or moderate, 15.8% at high and 65.5% at very high risk, while 11.2% were unclassified due to missing albuminuria (Figure 1.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-PWNAZUB3\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">23. Stengel B, Metzger M, Combe C, et al. Risk profile, quality of life and care of patients with moderate and advanced CKD: the French CKD-REIN Cohort Study. Nephrol Dial Transplant. 2019;34:277\u201386.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-N3XZWQ6Z\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">participants fell within the KDIGO 2012 lowrisk group, 3.7\u201313.4% within the moderately increased risk group, 0.9\u20135.6% within the highrisk group and 0.3\u20134.8% within the very highrisk group.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-4UVS3FK9\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">ost fell within the KDIGO 2012 low-risk or moderate-risk groups, with 0.9\u20135.6% in the high-risk and 0.3\u20134.8% in the very high-risk groups.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-5HMBESS2\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">revalence of CKD (GFR categories G3\u20135), ranging from 2% to 17%.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-NV9HSB6Q\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">Adv Ther (2021).<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-MGJR4HRT\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">Burden of Chronic Kidney Disease by KDIGO Categories of Glomerular Filtration Rate and Albuminuria: A Systematic Review.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-DU57T8ZR\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">1.1).<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-ZFMNHDA9\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">6.5.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-N76RFVZP\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">23.8.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-GBEQF7IT\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">68.6.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-BI3X9KPE\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">CKD stage at first qualifying eGFR measurement.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-CJTBKVAG\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">testing within 6 months of CKD diagnosis.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-H4QWENIJ\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">6529 patients with CKD (18.4%) received follow-up urine albumin to creatinine ratio (UACR.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-LGFJ5SMF\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">With Diabetes and Hypertension (n = 14 859 [32.2%]).<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-9S49AALH\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">With Diabetes (n = 6770 [14.7%]).<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-K3T2S85Z\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">6770 (14.7%) had diabetes without\u00a0 hypertension, 16 930 (36.7%) had hypertension only, and 14 859 (32.2%) had both diabetes and\u00a0 hypertension.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-UG4DEHZK\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">56.0).<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-4QZLLW6E\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">69.2 (14.0).<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-BNCZ2LB4\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">6 162 patients (mean [SD] age, 69.2 [14.0] years; 25 855\u00a0 [56.0%] female) from primary care practices.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-CGQT4G2Q\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">Only 6529 patients (18.4%) with CKD received a urine albumin test within 6\u00a0 months of CKD diagnosis,.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-TUV5J634\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">with stage 3 to 5 CKD.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-CUF55GJJ\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">46 162 patients (mean [SD] age, 69.2 [14.0].<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-DJBBP6YY\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">2019.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-6W74YU8A\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">Quality of Chronic Kidney Disease Management\u00a0 in Canadian Primary Care.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-8QNE6QDR\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">Electronic medical\u00a0 record.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-G88L2LIA\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">\u2022 The estimated prevalence of CKD in France at 8%\u201310% is close to that expected.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-WZ4EFDPU\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">n France, the MONALISA study using three representative cross-sectional surveys in subjects aged 35\u201374.9 years estimated the CKD prevalence at 8.2% (95% CI, 7.4\u20138.9%).<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-2XNSCD9A\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">18% of individuals treated for diabetes.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-MX9VFK4H\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">54% women.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-AFM6WFE2\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">in the \u2018likely\u2019 group.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-L4NFTMBB\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">in the \u2018certain\u2019 group, 68 years.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-XHQDQ6SU\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">The median age was 67 years.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-AWDYR4TG\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">n 2021, representing an estimated prevalence in the general population increasing from 8.1% to 10.5%.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-HLH5VSDX\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">RENALGO-EXPERT algorithm identified 4.5% of the volunteers in the CONSTANCES as CKD.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-6KVQUSUJ\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">the estimated prevalence in the SNDS increased from 8.1% to 10.5%.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-7PEZ4939\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">CONSTANCES.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem -->\t\t\t\t<div id=\"zp-ID-767-1093634-XJRBALW5\" data-zp-author-date='-0000-00-00' data-zp-date-author='0000-00-00-' data-zp-date='0000-00-00' data-zp-year='0000' data-zp-itemtype='annotation' class=\"zp-Entry zpSearchResultsItem\">\n<div class=\"csl-bib-body\" style=\"line-height: 1.35; \">\n  <div class=\"csl-entry\" style=\"clear: left; \">\n    <div class=\"csl-left-margin\" style=\"float: left; padding-right: 0.5em; text-align: right; width: 1em;\">1.<\/div><div class=\"csl-right-inline\" style=\"margin: 0 .4em 0 1.5em;\">SNDS.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem --><\/div><!-- .zp-zp-SEO-Content -->\n<\/div><!-- .zp-List --><\/div><!--.zp-Zotpress-->\n\n\n<p><code><script src=\"https:\/\/www.draw.io\/js\/embed-static.min.js\" type=\"text\/javascript\"><\/script><\/code><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Les exercices Je me permets de vous remettre l&rsquo;algorithme pour vous aider : A. Cas, s\u00e9rie de cas En anglais, case report ou case series, correspond \u00e0 la description d\u00e9taill\u00e9e d\u2019un cas ou de plusieurs cas cliniques d\u2019int\u00e9r\u00eat. Cette description comprend souvent les sympt\u00f4mes, les signes, le diagnostic, le traitement et le suivi. Classification\u00a0: Le [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":147,"menu_order":11,"comment_status":"open","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-767","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Les \u00e9tudes quantitatives des articles m\u00e9dicaux - LEPCAM<\/title>\n<meta name=\"description\" content=\"Analysez les principaux types d&#039;articles quantitatifs : interventionnel, \u00e9pid\u00e9miologique, diagnostic, cohorte, cas-t\u00e9moins...\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/lepcam.fr\/index.php\/les-etapes\/quanti\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Les \u00e9tudes quantitatives des articles m\u00e9dicaux - LEPCAM\" \/>\n<meta property=\"og:description\" content=\"Analysez les principaux types d&#039;articles quantitatifs : interventionnel, \u00e9pid\u00e9miologique, diagnostic, cohorte, cas-t\u00e9moins...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/lepcam.fr\/index.php\/les-etapes\/quanti\/\" \/>\n<meta property=\"og:site_name\" content=\"LEPCAM\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/lepcam.fr\/\" \/>\n<meta property=\"article:modified_time\" content=\"2021-01-08T17:40:55+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/lepcam.fr\/wp-content\/uploads\/2016\/02\/type_etude-1024x740.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:site\" content=\"@Lepcam_site\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"52 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/lepcam.fr\\\/index.php\\\/les-etapes\\\/quanti\\\/\",\"url\":\"https:\\\/\\\/lepcam.fr\\\/index.php\\\/les-etapes\\\/quanti\\\/\",\"name\":\"Les \u00e9tudes quantitatives des articles m\u00e9dicaux - LEPCAM\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/lepcam.fr\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/lepcam.fr\\\/index.php\\\/les-etapes\\\/quanti\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/lepcam.fr\\\/index.php\\\/les-etapes\\\/quanti\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/lepcam.fr\\\/wp-content\\\/uploads\\\/2016\\\/02\\\/type_etude-1024x740.png\",\"datePublished\":\"2016-04-30T14:36:55+00:00\",\"dateModified\":\"2021-01-08T17:40:55+00:00\",\"description\":\"Analysez les principaux types d'articles quantitatifs : interventionnel, \u00e9pid\u00e9miologique, diagnostic, cohorte, cas-t\u00e9moins...\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/lepcam.fr\\\/index.php\\\/les-etapes\\\/quanti\\\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/lepcam.fr\\\/index.php\\\/les-etapes\\\/quanti\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\\\/\\\/lepcam.fr\\\/index.php\\\/les-etapes\\\/quanti\\\/#primaryimage\",\"url\":\"https:\\\/\\\/lepcam.fr\\\/wp-content\\\/uploads\\\/2016\\\/02\\\/type_etude-1024x740.png\",\"contentUrl\":\"https:\\\/\\\/lepcam.fr\\\/wp-content\\\/uploads\\\/2016\\\/02\\\/type_etude-1024x740.png\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/lepcam.fr\\\/index.php\\\/les-etapes\\\/quanti\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Accueil\",\"item\":\"https:\\\/\\\/lepcam.fr\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Les \u00e9tapes\",\"item\":\"https:\\\/\\\/lepcam.fr\\\/index.php\\\/les-etapes\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"III. 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