Philippe Massari

Group R streptococci: wild boars as a second reservoir.

Group R streptococci have caused many cases of septicaemia and meningitis in patients handling live or slaughtered pigs which were the only known reservoir of group R streptococci. A human case, due to a wild boar, is reported here and it is therefore concluded that there exist both a domestic (pig) and a wild (wild boar) reservoir of group R streptococci.

SETH: an expert system for the management on acute drug poisoning in adults.

The aim of SETH is to give end-users specific advice concerning treatment and monitoring of adult drug poisoning. SETH is developed with an off the shelf expert system shell (KBMS) and runs on a microcomputer. Technical choices were done according to this analysis, financial considerations and portability. Currently, the database contains 1000 French drugs from 75 different toxicological classes. The SETH expert system simulates the expert reasoning, taking into account for each toxicological class delay, signs and dose. Two phases of evaluation were performed. The experimental implementation of Seth began in April 1992 in our Poison Control Centre. Since then, 1100 cases inputted by residents were analysed by SETH. The extension of the knowledge base to child poisoning began in March 1993.

Functional Evaluation of SETH: An Expert System In Clinical Toxicology

The aim of SETH is to give end-users specific advice concerning treatment and monitoring of drug poisoning. It is developed with an off the shelf expert system shell and runs on a microcomputer. The SETH expert system simulates the expert reasoning, taking into account for each toxicological class delay, signs and dose. The implementation of Seth began in April 1992 in our Poison Control Centre (PCC). SETH is then daily used by residents as telephone response support on drug poisoning. Between April 1992 and October 1994, 2099 cases inputted by residents were analysed by SETH. In October 1994, a functional evaluation of SETH showed that its effect in the daily practise of our PCC is positive: the performance of the residents increased and they would agree to use it outside our University Hospital. An expert system in clinical toxicology is a valuable tool in the daily practise of a Poison Control Centre.

Improving information retrieval with multiple health terminologies in a quality-controlled gateway.

BackgroundThe Catalog and Index of French-language Health Internet resources (CISMeF) is a quality-controlled health gateway, primarily for Web resources in French (n=89,751). Recently, we achieved a major improvement in the structure of the catalogue by setting-up multiple terminologies, based on twelve health terminologies available in French, to overcome the potential weakness of the MeSH thesaurus, which is the main and pivotal terminology we use for indexing and retrieval since 1995. The main aim of this study was to estimate the added-value of exploiting several terminologies and their semantic relationships to improve Web resource indexing and retrieval in CISMeF, in order to provide additional health resources which meet the users’ expectations.MethodsTwelve terminologies were integrated into the CISMeF information system to set up multiple-terminologies indexing and retrieval. The same sets of thirty queries were run: (i) by exploiting the hierarchical structure of the MeSH, and (ii) by exploiting the additional twelve terminologies and their semantic links. The two search modes were evaluated and compared.ResultsThe overall coverage of the multiple-terminologies search mode was improved by comparison to the coverage of using the MeSH (16,283 vs. 14,159) (+15%). These additional findings were estimated at 56.6% relevant results, 24.7% intermediate results and 18.7% irrelevant.ConclusionThe multiple-terminologies approach improved information retrieval. These results suggest that integrating additional health terminologies was able to improve recall. Since performing the study, 21 other terminologies have been added which should enable us to make broader studies in multiple-terminologies information retrieval.

Motor abnormalities of digestive and urinary tracts in patients on ventilator for acute exacerbation of chronic obstructive pulmonary disease

The frequency of digestive motor abnormalities was evaluated in 30 consecutive patients ventilated for acute exacerbation of chronic obstructive pulmonary disease. Total and segmental colonic transit times were investigated by radiopaque marker transit time in all patients. Eleven patients also had rectoanal and esophageal manometries, combined with urodynamic study in eight cases. The results show that total radiopaque marker transit time was increased, 201±14 hr (mean±se), with two main regions of decreased transit rates: the right colon (42% of global transit time) and the rectosigmoid (36%). Delayed transit of radiopaque markers in nine of 11 cases was combined with esophageal motor dysfunction and absence of rectoanal inhibitory reflex. In three of eight cases there was disinhibition of urinary bladder contraction, and micturition was impossible in two of eight cases. We conclude that patients on ventilator for exacerbation of chronic obstructive pulmonary disease always have a delayed colonic transit time with diffuse digestive and bladder motor dysfunction.

Data quality evaluation in medical database watermarking

The use of watermarking in the protection of medical relational databases requires that the introduced distortion does not hinder records interpretation. In this paper, we present the preliminary results of a watermarked data quality evaluation protocol developed so as to analyze the perception the practitioner has of the watermark. These results show that some attributes are more appropriate for watermarking than others and also that incoherent or unlikely records resulting from careless watermarking are easily identified by an expert.

F-MTI: outil d’indexation muititerminologique: application à l’indexation automatique de la SNOMED International

Background SNOMED is becoming a major health terminology to index electronic medical records. Most of developed countries have chosen SNOMED CT. France has chosen SNOMED International which is already translated in French. We developed the F-MTI tool, a generic automatic indexing tool able to index documentation in several health terminologies written in French (CCAM, TUV) or translated in French (MeSH, ICD-lO, SNOMED International).

REX: Extralaboratory cycle of information processing from laboratories to care units

REX, developed in the Rouen University hospital, allows the complete computerization of extralaboratory cycle of lab test numerical results from laboratories to care units. This cycle includes a real time transmission on terminals a soon as the test is realized and a batch print every evening. In laboratories, most of the lab tests results are directly acquired from automated devices. This application i integrated into our hospital information system. It is operational since the second semester of 1989. Every day, 18 000 lab tests results are transmitted by REX and 10 000 transactions by health professionals are done. Beyond amelioration of speed and reliability of the extralaboratory cycle of lab test results, REX decreases work time linked to phone transmission in laboratories and care units.

Un modèle de données adapté à la recherche d’information dans le dossier patient informatisé: Étude, conception et évaluation

Background: Electronic Health Records (EHRs) have an important role in medical decision making and are considered as being a major part of medical support system. To ensure this role effectively, the information must be easily found, even in voluminous and large number of EHRs. This requires to develop search capabilities for EHR information retrieval (IR). Methods: To perform this, we propose a data model adapted to IR. The data analysis of EHRs of the Rouen University Hospital led us to consider them as being a set of informational elements linked by temporal and conceptual relationships. This model consists of two main entities to manage the information elements and their metadata. After implementation, we have evaluated the capacity of the proposed model to take into account all data from the EHRs and its adaptation to IR. Results: We have performed 25 queries on EHR (20 correspond to single patient and 5 to multi-patients). The results in 19 cases (including 3 partial results) were evaluated as successful. These results confirm the ability of the model to take into account most of relevant data of EHR in IR and clearly show the differences in complexity of queries between the initial and our model of IR. Conclusion: The preliminary evaluation of the data model we have developed has shown its adaptation to IR in EHR. Nevertheless, further work on larger sets is needed to confirm this.

Relevance of Google-customized search engine vs. CISMeF quality-controlled health gateway.

CISMeF (acronym for Catalog and Index of French Language Health Resources on the Internet) is a quality-controlled health gateway conceived to catalog and index the most important and quality-controlled sources of institutional health information in French. The goal of this study is to compare the relevance of results provided by this gateway from a small set of documents selected and described by human experts to those provided by a search engine from a large set of automatically indexed and ranked resources. The Google-Customized search engine (CSE) was used. The evaluation was made using the 10th first results of 15 queries and two blinded physician evaluators. There was no significant difference between the relevance of information retrieval in CISMeF and Google CSE. In conclusion, automatic indexing does not lead to lower relevance than a manual MeSH indexing and may help to cope with the increasing number of references to be indexed in a controlled health quality gateway.