Automatic Alerts for Methicillin-Resistant Staphylococcus aureus Surveillance and Control: Role of a Hospital Information System

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an escalating problem in hospitals worldwide. The hospital reservoir for MRSA includes recognized and unrecognized colonized or infected patients, as well as previously colonized or infected patients readmitted to the hospital. Early and appropriate infection control measures (ICM) are key elements to reduce MRSA transmission and to control the hospital reservoir. Objective: To describe the role of an expert system applied to the control of MRSA at a large medical center (1,600 beds) with high endemic rates. Methods: The University Hospital of Geneva has an extended hospital information system (HIS), DIOGENE, structured with an open distributed architecture. It includes administrative, medical, nursing, and laboratory applications with their relational databases. Among available patient databases, clinical microbiology laboratory and admission-discharge-transfer (ADT) databases are used to generate computer alerts. A laboratory alert (lab alert) is printed daily in the Infection Control Program (ICP) offices, listing all patients with cultures positive for MRSA detected within the preceding 24 hours. Patients might be either newly detected patients colonized or infected with MRSA, or previously recognized MRSA patients having surveillance cultures. The ICP nurses subsequently go to the ward or call the ward personnel to implement ICM. A second alert, the "readmission alert,” detects readmission to the hospital of any patient previously colonized or infected with MRSA by periodic queries (q 1 min) to the ADT database. The readmission alert is printed in the ICP offices, but also forwarded with added guidelines to the emergency room. Results: During the first 12 months of application (July 1994 to June 1995), the lab alert detected an average of 4.6 isolates per day, corresponding to 314 hospital admissions (248 patients); the use of this alert saved time for the ICP nurses by improving work organization. There were 438 readmission alerts (1.2 alerts per day) over the study period; of 347 patients screened immediately upon readmission, 114 (33%) were positive for MRSA carriage. Delayed recognition of readmitted MRSA carriers decreased significantly after the implementation of this alert; the proportion of MRSA patients recognized at the time of admission to the hospital increased from 13% in 1993 to 40% in 1995 (P<.001). Conclusions: Hospital information system-based alerts can play an important role in the surveillance and early prevention of MRSA transmission, and it can help to recognize patterns of colonization and transmissio

Telematics techniques for image based diagnosis, therapy planning and monitoring

This paper is intended to describe and illustrate some of the actual use of telematics related techniques together with modern biomedical imaging capabilities for helping in diagnosis, as well as for the planning and monitoring of therapy. To this end, most current imaging modalities are initially introduced. Then it is shown how telematics related techniques are necessary to improve the outcome of current image-based protocols. Such techniques allow data, means, or competencies - which may intrinsically be of a complementary nature or distributed at many different locations - to be integrated together and transcend the simple sum of individual expectations. Examples of actual implementations are given in the fields of radio-oncology, neurosurgery and orthopedics. To conclude, the papers and posters presented in the corresponding session of the MIE'97 symposium are summarized to provide further telematics references for the reader. This paper is intended to describe and illustrate some of the actual use of telematics related techniques together with modern biomedical imaging capabilities for helping in diagnosis, as well as for the planning and monitoring of therapy. To this end, most current imaging modalities are initially introduced. Then it is shown how telematics related techniques are necessary to improve the outcome of current image-based protocols. Such techniques allow data, means, or competencies - which may intrinsically be of a complementary nature or distributed at many different locations - to be integrated together and transcend the simple sum of individual expectations. Examples of actual implementations are given in the fields of radio-oncology, neurosurgery and orthopedics. To conclude, the papers and posters presented in the corresponding session of the MIE'97 symposium are summarized to provide further telematics references for the reader

ExPASy: un système expert pour l'analyse de séquences protéiques

Résumé : nous construisons un système hybride à base de connaissance pour le classement automatique de protéines dans des familles décrites au préalable, selon leur fonction cellulaire. Pour cela nous mettons en œuvre une synthèse des approches symbolique, incertaine, connexionniste et statistique. Ce travail commence par la mise à jour de procédures informatiques d'analyse de polypeptides, qui fournissent les données d'entrées de tout le système. Puis vient le développement d'une base de données de référence pour l'étude statistique de ces outils d'analyse. Les règles de classement de polypeptides provenant d'un expert humain constituent le noyau de la base de connaissances. Le moteur d'inférence les exploite selon un modèle de logique incertaine.Enfin nous optimisons l'efficacité globale des règles en utilisant une bonne combinaison des paramètres d'incertitude. La combinaison la meilleure pour la base de données de référence sera mise en évidence par des techniques automatiques de recherche, guidées par heuristiques