Semantic Queries Expedite MedDRA Terms Selection Thanks to a Dedicated User Interface: A Pilot Study on Five Medical Conditions

Background: Searching into the MedDRA terminology is usually limited to a hierarchical search, and/or a string search. Our objective was to compare user performances when using a new kind of user interface enabling semantic queries versus classical methods, and evaluating term selection improvement in MedDRA.Methods: We implemented a forms-based web interface: OntoADR Query Tools (OQT). It relies on OntoADR, a formal resource describing MedDRA terms using SNOMED CT concepts and corresponding semantic relations, enabling terminological reasoning. We then compared time spent on five examples of medical conditions using OQT or the MedDRA web-based browser (MWB), and precision and recall of the term selection.Results: OntoADR Query Tools allows the user to search in MedDRA: One may enter search criteria by selecting one semantic property from a dropdown list and one or more SNOMED CT concepts related to the range of the chosen property. The user is assisted in building his query: he can add criteria and combine them. Then, the interface displays the set of MedDRA terms matching the query. Meanwhile, on average, the time spent on OQT (about 4 min 30 s) is significantly lower (−35%; p < 0.001) than time spent on MWB (about 7 min). The results of the System Usability Scale (SUS) gave a score of 62.19 for OQT (rated as good). We also demonstrated increased precision (+27%; p = 0.01) and recall (+34%; p = 0.02). Computed “performance” (correct terms found per minute) is more than three times better with OQT than with MWB.Discussion: This pilot study establishes the feasibility of our approach based on our initial assumption: performing MedDRA queries on the five selected medical conditions, using terminological reasoning, expedites term selection, and improves search capabilities for pharmacovigilance end users. Evaluation with a larger number of users and medical conditions are required in order to establish if OQT is appropriate for the needs of different user profiles, and to check if conclusions can be extended to other kinds of medical conditions. The application is currently limited by the non-exhaustive coverage of MedDRA by OntoADR, but nevertheless shows good performance which encourages continuing in the same direction

Analyse des actes de chirurgie coronarienne et de cardiologie interventionnelle en Rhône-Alpes

Pour décrire les variations infra-régionales des taux d'interventions de chirurgie coronarienne et de cardiologie interventionnelle chez les patients hospitalisés pour une cardiopathie ischémique en fonction de facteurs socio-sanitaires, de besoins et d'offre de soins, une comparaison entre les différents secteurs sanitaires de la région Rhône Alpes a été réalisée. Le croisement des informations de morbidité du PMSI avec les données de population, les indicateurs socio-économiques et les statistiques de mortalité montre que l'accès aux deux types de traitement (chirurgie, cardiologie interventionnelle) ne semble pas dépendre de l'éloignement géographique du patient, mais plutôt du contexte socio-sanitaire et des liens existant entre les professionnels de santé des différents secteurs. L'efficience de l'offre paraît donc variable selon les zones et l'équité pour les populations n'est pas assurée entre les différents secteurs.To describe inter-regional variations in rates of heart surgery and interventional cardiology amongst hospital patients suffering from ischaemic heart disorders in relation to different socio-heatth factors, and to the supply and demand for healthcare, a comparison has been made of the various health sectors of the Rhône-Alpes region. The correlation of hospital data on morbidity with population statistics, socio-economic indicators, and mortality data shows that access to these two forms of treatment does not seem to be related to the distance of the patient from the hospital but rather to the socio-health context and the relationships between the medical staff of different sectors. The efficiency of the supply of services appears, therefore, to vary between different zones and equity of access for patients is not guaranteed between different sectors

General practitioners' management of patients consulting for "mental distress at work"

BACKGROUND: Mental distress at work is a complex multifactorial phenomenon liable to impact health and personal life.OBJECTIVE: To assess the proportion of general practice consultations for mental distress at work and determine how general practitioners (GPs) manage these patients and the factors leading to consultation.METHODS: The frequency of consultations for mental distress at work was assessed on a self-administered questionnaire sent to the general practitioners (GPs) of the Loire administrative Département (France). Information on factors leading to consultation on management was obtained by a self-administered questionnaire in a sample of GPs and patients.RESULTS: Twenty-two patients were included by 16 GPs. 27% of patients were referred to an occupational physician. The frequency of consultations for mental distress at work was about 2%. Patients may wait several weeks or months before consulting, although a majority reported an impact on family life and health. A triggering event was often present, but no work accident procedure was undertaken.CONCLUSION: This study highlights the importance of better identifying adverse experience of working conditions and impaired mental health and reporting this to an occupational physician who can undertake preventive measures. Communication between occupational physician, employee and GP needs to be improved

Automated Coding in Case Mix Databases of Bacterial Infections Based on Antimicrobial Susceptibility Test Results

International audienceOur objective was to improve the accuracy of bacteria and resistance coding in a hospital case mix database. Data sources consisted of 50,074 files on bacteriological susceptibility tests transmitted with the HPRIM protocol from laboratory management system to electronic health record of the University hospital of Saint Etienne in July 2017. An algorithm was implemented to detect susceptibility tests containing information corresponding to codes whose addition in the case mix database was susceptible to increase the severity level of a diagnosis related group. Among 132 hospital stays fulfilling the conditions, 27 were lacking bacteria and/or resistance codes, and the tariff was increased for 9 stays, with earnings of €54,612. Analyzing Antimicrobial susceptibility tests helps to improve clinical coding and optimize the financial gain

Automated Control of Codes Accuracy in Case-Mix Databases by Evaluating Coherence with Available Information in the Electronic Health Record.

Coding accuracy in case-mix databases enables efficient funding of health facilities and accurate epidemiological statistics based on patients' stays information. We assume that the data collected in the electronic health record, especially drug prescriptions and medical reports are relevant for checking the consistency of the coding of diagnoses. We evaluated a new coding control tool, "TOLBIAC control", embedded in the Web100T coding assistant. This tool interacts with the Vidal Application Programming Interface and the electronic health record of the University Hospital of Saint-Etienne. The micro-average F-measure was 0.76 for drug prescriptions and 0.55 for free text medical reports. This initial evaluation has revealed that drug prescriptions in EHRs can successfully be used to develop an automated ICD-10 code-control tool. Nevertheless the "TOLBIAC control" tool is not yet fully effective for widespread use because of its limited performance in text analysis, a feature that is currently undergoing improvements

Admissions des sujets âgés aux Services d'Accueil des Urgences pour effets indésirables médicamenteux

Objectif. Étudier les caractéristiques des effets indésirables médicamenteux (EIM) ayant motivé l'entrée des sujets âgés dans des Services d'Accueil des Urgences (SAU) français. Méthodes. Les données de deux études prospectives menées en 1999 et 2003 selon un protocole identique ont été regroupées. La part des EIM dans les motifs d'admission, leur gravité et leur degré d'évitabilité ont été évalués chez les patients $\geq$ 70 ans (groupe A) et comparés à ceux observés chez des patients < 70 ans (groupe B). Résultats. Sur les 2907 patients inclus, 1158 (39,8 %) avaient $\geq$ 70 ans. Dans ce groupe, l'incidence des EIM atteignait 17,1 % vs. 13,2 % dans le groupe B (p = 0,004). Les EIM apparaissaient plus sévères dans le groupe A que dans le groupe B. La proportion d'EIM évitables ne différait pas significativement entre le groupe A (48,9 %) et le groupe B (43,7 %). Conclusion. Les EIM sont une cause fréquente – souvent évitable – d'admission aux SAU, en particulier dans la population âgée