WO2016055050A1 - Procédé automatise de surveillance de l'état médical d'un patient - Google Patents

Procédé automatise de surveillance de l'état médical d'un patient Download PDF

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Publication number
WO2016055050A1
WO2016055050A1 PCT/DE2015/100340 DE2015100340W WO2016055050A1 WO 2016055050 A1 WO2016055050 A1 WO 2016055050A1 DE 2015100340 W DE2015100340 W DE 2015100340W WO 2016055050 A1 WO2016055050 A1 WO 2016055050A1
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microbiological
parameters
drug
database
pathogen
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PCT/DE2015/100340
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German (de)
English (en)
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Thomas LÖSER
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Löser Medizintechnik GmbH
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Publication of WO2016055050A1 publication Critical patent/WO2016055050A1/fr

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    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H70/00—ICT specially adapted for the handling or processing of medical references
    • G16H70/20—ICT specially adapted for the handling or processing of medical references relating to practices or guidelines
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H70/00—ICT specially adapted for the handling or processing of medical references
    • G16H70/40—ICT specially adapted for the handling or processing of medical references relating to drugs, e.g. their side effects or intended usage
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H70/00—ICT specially adapted for the handling or processing of medical references
    • G16H70/60—ICT specially adapted for the handling or processing of medical references relating to pathologies

Definitions

  • the invention relates to an automated method for monitoring the medical condition of a patient. It further relates to a computerized system suitable for carrying out the method.
  • Methods for analyzing and / or monitoring physiological and / or pathological parameters of a patient are known from the prior art.
  • EP 1 897 485 B1 describes a method in which a multidimensional feature space is formed on the basis of selected physiological and pathological parameters. Within this feature space, first and second spatial regions are determined, wherein the first spatial region comprises the target values of the selected parameters, while in the second spatial region, undesired values of these parameters are included. Measured values are regularly determined for the selected parameters. By means of these measured values, measuring points in the feature space which form a patient trajectory are determined.
  • a target trajectory is formed, which represents the shortest space curve between the first measuring point and the first spatial region.
  • a complication trajectory is formed, which represents the shortest space curve between the first measuring point and the second spatial area.
  • an action value is generated which indicates the parameters which have to be changed in order to return the patient trajectory to the first spatial area or to the target trajectory by the shortest path. The action value can be used to trigger an alarm to prompt the intervention of a physician.
  • EP 1 897 485 B1 mentions, inter alia, parameters which are characteristic of acute or past inflammations of the patient as parameters which can be selected for carrying out the method.
  • Laboratory medical examinations can provide readings for a variety of parameters that are determined in a laboratory.
  • relevant parameters include myoglobin, troponin I, and CKMB.
  • relevant parameters for example, parameters of the blood gas analysis, z. B. the pH of the blood, the oxygen partial pressure of the blood, the carbon dioxide partial pressure of the blood and the oxygen saturation of the blood.
  • Laboratory medical examinations also include the microbiological examination of specimens obtained from the patient for infections by pathogenic substances and / or organisms, for example germs such as bacteria, viruses, fungi, protists, parasites, viroids or prions.
  • Sepsis is defined as "the totality of life-threatening clinical manifestations and pathophysiological changes in response to the action of pathogenic germs and their products, which enter the blood stream from a focal point of infection, activate the large biological cascade systems and special cell systems and trigger the formation and release of humoral and cellular mediators "(Schuster, HP, and Müller-Werdan, U.: Definition and diagnosis of sepsis and multiple organ failure in sepsis and MODS, Berlin 2005.) If additionally an organ of the patient is acutely damaged, severe sepsis is present.
  • Typical pathogens of sepsis are Staphylococcus aureus, coagulase-negative staphylococci, enterococci, Escherichia coli, Klebsiella spp., Enterobacter ssp. and Pseudomonas aeruginosa.
  • a sample is taken from the patient at the beginning of intensive care treatment, which is examined for pathogenic germs.
  • This microbiological examination which is associated, for example, with the detection of antibodies or the genetic information of pathogens (eg species-PCR) or the cultivation of cell cultures, is carried out in specialized laboratories.
  • the results of this study are typically available after three days. The results indicate which pathogenic germs and which resistances are present in the patient. As soon as this is known, the medical treatment will be adapted to the actual condition of the patient.
  • the results of the laboratory medical are to be transferred to a patient data management system via standardized interfaces (in hospitals HL7, in practices xDT) and made available to the doctor on request.
  • Patient data management systems are used in healthcare, especially in clinics. These are systems where patient data is stored.
  • the patient data include the so-called master data of the patient such as name, first name and date of birth, the medical findings and initiated or already completed medical or nursing measures. Such measures are also referred to below as medical measures.
  • results of the microbiological examinations are not transferred from the laboratory to the doctor or the ward via one of the standardized interfaces. If these results are actually transmitted electronically to the doctor or the ward - in a surprising number of cases, the results are transmitted by fax - the results are transferred to the patient data management system in a non-standardized form, if that is the case Case is. The results are then in the patient data management system as a text file whose structure is arbitrary. It is also unknown what information the text file contains, apart from the fact that the text file should receive a microbiological result.
  • microbiological findings are also embedded embedded as text in an HL7 message. Then, the case number, the patient number of the patient or both can be clearly determined, but all other information of the findings must be extracted just as laboriously as from a text file.
  • the object of the invention is to eliminate the disadvantages of the prior art.
  • an automated method for monitoring the medical condition of a patient is to be specified, which automatically incorporates the results of microbiological examinations.
  • a computerized system suitable for carrying out the method should be specified.
  • an automated method for monitoring the medical condition of a patient by means of a patient data management and / or decision support system comprises the steps:
  • step (d) acquiring values of microbiological parameters when the need to detect microbiological parameters has been determined in step (c), each microbiological parameter being a microbiological agent which at least one active substance as the first value and the sensitivity of the pathogen against this active substance as a second value; wherein step (d) for detecting microbiological parameters comprises the sub-steps:
  • the method according to the invention ensures that microbiological findings are taken into account in the treatment of a patient. Such a finding is requested only if the monitoring of the first parameters or, if already existing values for microbiological parameters, the monitoring of the first parameters and of the microbiological parameters, the need to detect microbiological parameters, results. In this way, the unnecessary determination of microbiological parameters is prevented. If, on the other hand, a requested result does not arrive in time, an alarm is triggered.
  • the necessity of such a detection can be determined, for example, by specifying a triggering value or a triggering value range for at least one parameter of the first group. If the continuously recorded value of this predetermined parameter reaches the triggering value or the triggering value range, then it is necessary to have at least one microbiological one To determine parameters or a value of at least one microbiological parameter.
  • such an assay will detect more than one pathogen or detect first and / or second pathogens that have already been detected in previous biological samples from the patient.
  • a microbiological parameter is a microbiological agent which has at least one active substance as the first value and the susceptibility of the agent against this active substance as a second value.
  • Microbiological agents in the present invention are pathogens.
  • Exemplary microbiological agents are bacteria, viruses, fungi, protozoa, parasites, viroids and prions.
  • a microbiological parameter in the sense of the biological taxonomy is a genus, a group of species of a genus, a species or a subspecies, particularly preferably a species of a microorganism.
  • microbiological parameters are the bacterial subspecies Enterobacter ssp., The bacterial species Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli and Pseudomonas aeruginosa, the group of bacterial species of a genus Klebsiella spp. as well as the bacterial genera coagulase-negative staphylococci and enterococci.
  • Active substances are chemical substances that inhibit the growth of a pathogen or kill the pathogen. They include in particular antibiotics, antivirals, antifungals and antiprotozoics. Active substances are, for example, carbapenems, cephalosporins, monobactams, penicillins and tetracyclines.
  • the sensitivity of an In the microbiological finding, regulators against an active agent are typically assigned to one of the following categories: resistant, intermediate or sensitive, which are referred to as resistance categories.
  • the sensitivity of a pathogen to a drug can be given as an MIC value.
  • the MIC value is the minimum inhibitory concentration in this pathogen and this drug.
  • MIC values are usually given in powers of 2, ie 1/8, Vi, Vi, 1, 2, 4, 8,. , , Based on the MIC value, the assignment to the resistance categories can be resistant, intermediate or sensitive. The MIC value is more accurate than the resistance category. In most microbiological findings, however, no MIC values are given. However, physicians with microbiological background knowledge always demand the specification of MIC values, since these values can be used to detect emerging resistances at an earlier stage. It can therefore be provided that by means of the method according to the invention not or not only the resistance categories but also the MIC values in the microbiological finding are automatically determined.
  • Microbiological findings are preferably provided as text files in a computer-readable format.
  • a microbiological finding should at least contain the following information:
  • the microbiological findings preferably contain information that makes it possible to assign an active substance as the first value to a pathogen.
  • a pathogen can have several first values. Typically, a pathogen is associated with ten to thirty drugs.
  • the term "assigning" is to be understood as meaning that the microbiological finding indicates that sensitivity tests have been used to determine whether the pathogen is sensitive to the specified active substance, which is referred to below as first assignment data.
  • the microbiological findings preferably contain information which makes it possible to assign the information on the susceptibility of a pathogen to an active substance as a second value to a pathogen and an active substance.
  • the term "assigning" is to be understood as meaning that the microbiological finding indicates how the pathogen is sensitive to the specified active substance, namely whether it is resistant to the active substance, behaves as an intermediate or is sensitive referred to as second allocation data.
  • the microbiological finding may contain further information such as the date of removal of the biological sample; the date of creation of the microbiological findings; Information on the identification of the medical facility, that is, for example, a clinic or department of a clinic; Details of the laboratory that produced the microbiological findings; contain a diagnostic number and so on.
  • the Department of the Clinic may be an intensive care unit.
  • indications that enable an identification of the patient whose biological sample is the subject of the microbiological finding are a case number, a patient number, the name of the patient, including his first name and surname, and combinations thereof, the case number being preferred because It allows a clear identification of the patient .. It can not be specified in each case, which microbiological parameters are to be determined. According to the invention, it is therefore provided that the Mood microbiological parameters is caused, without being predetermined, which genus or species of a microorganism is determined. On the other hand, each identified species or genus can represent a microbiological parameter.
  • microbiological parameters are important for a patient's health disorder. It can be provided that any species or, if the nature of a microorganism is unknown, its genus, which are listed in a microbiological finding, each form a microbiological parameter.
  • At least one microbiological parameter ie at least one pathogen
  • all microbiological parameters ie all pathogens, each have at least one active substance as the first value and the sensitivity of the pathogen to this active substance or these active substances as a second value. That is not necessary.
  • a microbiological finding contains no information on the sensitivity of a pathogen mentioned there to any active substance.
  • pathogens are listed in a microbiological finding without mentioning an active substance with which susceptibility tests have been performed for this pathogen. It may therefore happen that a microbiological parameter has only a first value but no second value.
  • a microbiological parameter has neither a first value nor a second value.
  • the mere existence of the pathogen in the biological sample is already a microbiological parameter within the meaning of the invention, because the pathogen occurs in the patient.
  • one or more parameters of the first group are linked together, so that trigger values or trigger value ranges for two or more more of these parameters must be achieved before the need is determined (step (d)) to determine values for microbiological parameters.
  • the microbiological parameters detected may be included in the continuous determination of step (c). It may be provided that one or more parameters of the first group are linked to one or more microbiological parameters, wherein the parameter or parameters of the first group specific trigger value or tripping range can be specified when a certain second parameter has been detected, for example Staphylococcus epider- midis, or this second parameter has a particular first value and / or second value, for example Staphylococcus epidermidis is resistant to the active substance cefaclor.
  • the term "specific” here means the specification of a trigger value or trigger value range that is matched to at least one second parameter or its values.
  • the alarm triggered in step (d2) may be an audible or visual alarm.
  • Such an alarm may, for example, be displayed on a display device, for example the display of a client computer of the patient data management and / or decision support system.
  • the display provided in step (d2) of an indication that the microbiological finding has been received can be displayed on a display device, for example the display of a client computer of the patient data management and / or decision support system.
  • step (d) may further comprise the substeps:
  • step (d4) determining the first and second values given in the microbiological finding for the microbiological parameters determined in step (d3).
  • These sub-steps can directly follow sub-step (d2).
  • Sub-steps (d3) and (d4) can be carried out successively or in parallel with each other.
  • Sub-steps (d3) and (d4) are used to determine the microbiological parameters and, if indicated, their first and second values listed in the microbiological finding. Thus, it is no longer necessary for a doctor to study the microbiological findings themselves.
  • the inventively provided patient data management and / or decision support system provides for an automated evaluation of the microbiological findings.
  • substep (d3) comprises the steps:
  • the first database contains keywords that are typically used to identify pathogens. Such keywords are also referred to as exciter keywords. A keyword does not have to be a single word, it can span several consecutive words. Several keywords may be provided to designate one and the same exciter. In this way, it is ensured that the designation of a pathogen in a microbiological finding can be reliably determined even if it is not exactly designated.
  • the causative terms "Staphylococcus aureus”, “S. aureus” or “aureus” can be deposited as the causative cue for the identification of Staphylococcus aureus.
  • a keyword is preferably chosen, which designates a pathogen which is very frequently listed in microbiological findings, for example Staphylococcus aureus.
  • another first keyword may be chosen, for example, if the existence of a particular agent in the biological sample is expected, for example, because this agent has already been found in a previous biological sample.
  • the specification of the first keyword can be automated. It can also be determined by a doctor. It can be provided that sub-step (d3) further comprises the steps:
  • step (d37) repeating steps (d35) to (d37) to identify further pathogens, unless step (d36) did not result in the identification of another pathogen.
  • step (d33) By means of the identification string or similar strings, patterns, for example numberings, in the microbiological finding are to be used to detect further pathogens.
  • sub-step (d3) further comprises the steps:
  • sub-step (d4) comprises the steps:
  • the first database contains keywords that are typically used to identify drugs. Such keywords are also referred to as drug keywords.
  • a keyword does not have to be a single word, it can span several consecutive words. There may be several keywords to designate one and the same agent. In this way, it is ensured that the designation of an active substance in a microbiological finding can be reliably determined even if it is not exactly designated.
  • the active substance keywords "Cefaclor” "Cefaclorum” or "Cefac” can be deposited as an active ingredient keyword for the identification of the active substance cefaclor.
  • the first active ingredient keyword is preferably selected a keyword that names an active ingredient that is very often listed in microbiological findings, such as penicillin.
  • another first keyword may be chosen, for example, if the mention of a particular active ingredient in the microbiological finding is expected, for example, because this drug has already been found in a previous microbiological finding, or if the existence of a particular pathogen in the expected and a susceptibility test with a particular drug against which this pathogen is possibly sensitive is standard.
  • the specification of the first keyword can be done automatically. It can also be determined by a doctor. It can be provided that sub-step (d4) further comprises the steps:
  • step (d47) repeating steps (d45) to (d47) to identify additional active ingredients, unless step (d46) did not lead to the identification of another active substance.
  • step (d43) By means of the identification string or similar strings, patterns, for example numbering, in the microbiological finding are to be used to detect further active substances.
  • sub-step (d4) further comprises the steps:
  • the phrase "sensitivity of the active substance" in steps (d46) and (d49) and the term “its sensitivity” refer to the sensitivity of a pathogen to this active ingredient.
  • a microbiological finding for each drug is given a sensitivity, which refers to the sensitivity of a pathogen also indicated against this drug.
  • the inventive method may further comprise steps of identifying first and second mapping information if that information does not already arise from the locations where the pathogens and the agents were found. The latter is typically the case.
  • the method of the invention may further comprise the steps of:
  • step (e) providing a third electronic database containing, for each active ingredient, one or more drugs containing that active substance; (f) selecting at least one drug from the third database containing an agent against which the agent determined in step (d2) is sensitive or at least not insensitive, based on the first and second values determined in step (d3); and (g) displaying the at least one drug as a treatment recommendation.
  • the display in step (g) may be on a display device, for example the display of a client computer of the patient data management and / or decision support system. This indication facilitates a physician's choice of a suitable drug to treat the patient's infectious health disorder caused by the identified pathogen.
  • steps (f) and (g) are repeated for each of these pathogens and the selected medicines can be displayed together as a treatment recommendation. It can be provided that a drug is displayed only once, even if it is proposed for the treatment of two pathogens.
  • the third database further information for the drug of the drug are contained for each drug and that, if the third database contains several drugs against the pathogen determined in step (d2) sensitive or at least not insensitive is selected from those drugs whose site of action, relative to the body of the patient, corresponds to the site affected by the disorder or from which the biological sample originates. For example, if the patient suffers from inflammation of a knee, this ensures that the active ingredient can actually act at the site of the inflammation. The administration of a drug that contains the same active ingredient, but is transported to the lungs and is ineffective in the treatment of the knee is thus avoided.
  • step (h) providing a fourth electronic database containing information about medications that have been or are being administered to the patient; and (i) comparing the drug selected in step (f) and, if the drug is not listed in the fourth database, suggesting a first dose many times greater than the dose recorded in the third database.
  • an initial therapy in which the patient is given a drug for the first time and a maintenance therapy in which the patient has already been given the drug.
  • the medicament according to step (i) is given in a dose that is many times higher than in a maintenance therapy.
  • the multiple may be a dose that is two times or more, preferably three times or more, more preferably four times or more, and most preferably five times or more above the dose provided in a maintenance therapy, lies.
  • the dose at which the drug is to be given in maintenance therapy is recorded in step (i) in the third database.
  • the dose at which the drug is given during the initial therapy is the first dose in the meaning of the invention.
  • the amount of the first dose can also be recorded in the third database. It may be provided that the proposal of a first dose in step (i) further includes the suggestion of a first period over which the first dose is to be given and a second dose which is below the first dose when the first period has expired , includes. Preferably, in the third database also the first period, with which a drug is to be given in an initial therapy, is recorded. The second dose may be the dose at which the drug is to be given for maintenance therapy. The second dose may also be recorded in the third database.
  • the first and second dose, as well as the first period, are recommendations made by the patient data management and / or decision support be automatically generated. These recommendations are not guidelines that should bind the doctor.
  • the method according to the invention in the treatment of several patients in a clinical facility comprises the steps:
  • step (f) Comparison of the drug selected in step (f) and, if the drug is listed in the fifth database, suggesting another drug containing an active agent against which the causative agent determined in step (d2) is sensitive or at least not insensitive if such other drug is included in the third database.
  • the method according to the invention may comprise the steps:
  • step (m) selecting at least one combination of the third database against which the pathogen determined in step (d2) is sensitive or at least not insensitive, based on the first and second values determined in step (d3);
  • (n) display the at least one combination as a treatment recommendation. If, for example, a methicillin-resistant Staphylococcus aureus is found to be a pathogen, then this pathogen is resistant to all known active substances. In such a case, combinations of drugs may be used to combat this pathogen, for example, a combination of drugs containing various active ingredients. Such combinations are listed in the third database.
  • the method comprises the steps:
  • step (p) triggering an alarm when a pathogen detected in step (d2) is recorded in the sixth electronic database.
  • the alarm triggered in step (p) may be an audible or visual alarm.
  • Such an alarm may, for example, be displayed on a display device, for example the display of a client computer of the patient data management and / or decision support system.
  • step (d) the detection of values of mycotic parameters is initiated if the necessity of detecting microbiological parameters was determined at least once in step (c) and none for a predetermined period after the first detection of microbiological parameters Improvement of the health status of the patient could be determined by the parameters of the first group.
  • a mycotic parameter is meant a microbiological parameter in which the pathogen is a fungus. Typical microbiological findings do not contain information on fungi.
  • step (c) the continuous determination of the need to detect microbiological parameters is additionally performed on the basis of a second group of physiological and / or pathological parameters which are predetermined and intended to be determined discontinuously.
  • the second group of parameters expediently includes those parameters which are determined in the previous medical practice at intervals of 24 hours or more, for example laboratory medical parameters.
  • the second group of parameters includes, for example, parameters obtained by means of blood analyzes.
  • a parameter which was originally assigned to the second group must be continuously determined.
  • This parameter can then be transferred from the second to the first group.
  • a parameter of the second group is automatically transferred to the first group if it is determined in step (c) that determinations of this parameter were necessary in two or more successive intervals of less than 24 hours.
  • a parameter is assigned to the first group if it is continuously detected.
  • Continuous detection is understood to mean the continuous acquisition of values of the parameter or the detection of values of the parameter at intervals of 24 hours or less.
  • physiological and / or pathological parameter of the first or second group is understood in particular to mean a value which (a) indicates the measured value of a measured physiological parameter of a patient or of an indicator substance (eg the oxygen partial pressure in a patient) Blood gas analysis, respiratory rate, body temperature, CKMB concentration); and (b) a classification of a physiological condition of a patient (eg yellowing of the facial skin, restlessness of the patient).
  • the term "indicator substance” refers to compounds or elements which, depending on their nature, are produced in biological systems or introduced into biological systems and whose presence or concentration (eg, in a particular organ) is a characteristic of Such compounds and elements include, for example, those produced by tumor cells, induced by a tumor in other body cells and / or altered as tumor-specific substances in their concentration by a tumor Macromolecules, such as proteins, or trace elements Such compounds and elements further include Bonemarker, which are characteristic of bone degradation processes such as osteoporosis, or enzymes that are important for the assessment of the function of organs.
  • value or "measured value” of a parameter of the first or second group refers here to all numerical values for a parameter occurring in the medical field (a) (eg an oxygen partial pressure in a blood gas analysis in the amount of 81.2 mmHg , a respiratory rate of 15 breaths per minute, a body temperature of 36.8 ° C, CKMB concentration of 152 ng / ml) or (b) on classification results of a physiological condition of a patient (eg yellow color of the facial skin: no, where classifications by means of statements such as "no" should be assigned a numerical value, for example "0").
  • a parameter occurring in the medical field eg an oxygen partial pressure in a blood gas analysis in the amount of 81.2 mmHg , a respiratory rate of 15 breaths per minute, a body temperature of 36.8 ° C, CKMB concentration of 152 ng / ml
  • classification results of a physiological condition of a patient eg yellow color of the facial skin: no, where classifications
  • At least the values of one of the physiological parameters of the first or second group that are characteristic of the presence of a health disorder are determined using an indicator substance.
  • physiological parameters should be selected, which are assumed on the basis of medical knowledge, that they are related to a particular health disorder, such as respiratory failure.
  • physiological parameters are used, which are obtained by means of a blood gas analysis.
  • the physiological parameters obtained by means of blood gas analysis may include the pH of the blood, the partial pressure of oxygen of the blood, the partial pressure of carbon dioxide of the blood and the oxygen saturation of the blood.
  • Other physiological parameters which can be used in addition to the blood gas analysis values for estimating the medical risk of respiratory insufficiency in the method according to the invention include the respiratory rate (AF) of the patient and the age and sex of the patient.
  • AF respiratory rate
  • the number of parameters of the first group whose values are detected in step (a) should be at least 2. If parameters of a second group are determined, then the number of parameters of the second group should be at least 1, preferably at least 2.
  • the specification of the parameters of the first group and, if present, the parameter of the second group can be made by a physician. However, it may also be provided that such parameters are automatically proposed by the system, whereby the proposal is based on the stated or suspected health disorder under which the patient suffers.
  • a system for monitoring the medical condition of a plurality of patients in accordance with the method of the present invention.
  • the system comprises a processor, a memory, an input device and a display device, wherein the input device allows the user to specify the medical measures taken for each patient; in the memory, the microbiological parameters, their values, the continuously acquired values of parameters of the first group and, if provided, the discontinuously acquired values of the second group of parameters of a plurality of patients and the medical measures taken are stored for each of these patients; the processor determines the need to determine microbiological parameters and / or its values (step (c)) and, if provided, evaluates the microbiological findings received (step (d)); the display device represents the detected microbiological parameters.
  • inventively provided databases may be stored in the memory.
  • the system can be a computer-implemented system.
  • the system may be patient data management and / or decision support system.
  • FIG. 1 shows a schematic representation of a first embodiment of the method according to the invention
  • FIG. 2 shows a schematic representation of a screen image of the display device according to the invention
  • FIG. 3 shows a further schematic representation of a screen image of the display device according to the invention
  • FIG. 4 shows a further schematic representation of a screen image of the display device according to the invention.
  • Fig. 5 is a further schematic representation of a screen image of the display device according to the invention.
  • FIGS to ld flow diagrams are shown for illustrating an embodiment of the automated method according to the invention for monitoring the medical condition of a patient by means of a patient data management and / or decision support system 51.
  • the system 51 is a computerized system that allows the user to specify a first set of parameters of the patient that are indicative of the existence of a health disorder 101 (see FIG. 1a).
  • the parameters of the first group should be determined continuously. Values are subsequently acquired 102 continuously for the given parameters. On the basis of these values, the necessity of detecting microbiological parameters is continuously determined 103. If such a need is established, microbiological parameters are recorded 104. Details of step 104 are shown in FIGS to ld shown.
  • system 51 requests the provision of a biological sample and its transmission to a laboratory for the preparation of a microbiological finding at 105.
  • System 51 determines an expected time at which the arrival of the microbiological sample will begin microbiological findings is expected. The input of the microbiological findings is checked by System 51. 106. If the microbiological findings are not received by the expected time, an alarm is triggered 107. By contrast, if the microbiological result is received by the expected time, a corresponding indication is displayed on the display device of the system 108.
  • the first values are the active substances
  • the second values are the sensitivity of the pathogen to each of the active substances.
  • a first pathogen keyword is selected 110 from the first database 109. Subsequently, the microbiological finding is searched for this pathogen keyword 111. If the microbiological finding contains the first pathogen keyword, the first pathogen could be included in the finding 112. However, if the first causative keyword is not found, steps 110 through 112 are repeated until a first pathogen has been identified. At the position where the first pathogen is listed in the microbiological finding, an identification string adjacent to the found first exciter keyword is determined 113, for example a multi-digit alphanumeric code, with which the line is initiated, in the the first pathogen in microbiological findings is called. Subsequently, the finding for the identification string or a similar string is searched 114.
  • the first similar string may be 102.
  • the finding once again contains the identification sequence or if it contains the first similar string, a second pathogen can be identified at the position of the recurrence of the identification string or at the position of occurrence of the similar string 115.
  • step 114 is repeated to determine a third occurrence of the identification string or similar string, the similar string now being 103.
  • Step 114 is repeated until no pathogen can be identified. If all pathogens are now identified, then a first active substance keyword is selected from a second database 116 and the finding for this active substance keyword is searched. If the microbiological finding contains the first active substance keyword, the first active ingredient in the finding could be identified. 119. If, on the other hand, the first active ingredient keyword is not found, steps 117 to 119 are repeated until a first active ingredient has been identified.
  • an identification string which is adjacent to the found first active substance keyword is determined 120, for example a multi-digit alphanumeric code with which the line is introduced, in which the first active ingredient in microbiological findings is called.
  • the finding for the identification string or a similar string is searched 121. For example, if the identification string is 506, the first similar string may be 507. If the finding once again contains the identification sequence or if it contains the first similar string, a second active substance can be identified at the position of the recurrence of the identification string or at the position of occurrence of the similar string 122.
  • step 121 is repeated to determine a third occurrence of the identification string or similar string, the similar string now being 508.
  • Step 122 is repeated until no pathogen can be identified.
  • the data on the susceptibility of the agent to this active substance are determined in the microbiological findings.
  • the system 51 proposes for each pathogen at least one drug which contains an active substance against which this pathogen is sensitive or, if such an active substance does not exist.
  • the term is 124. Available drugs and their active ingredients are listed in the third database 123. If there is no drug in the database 123 with an agent against which the agent is at least intermediate, the system may suggest a combination of drugs. Such combinations are also recorded in the third database 123.
  • Screen 1 shown in FIG. 2 illustrates how the results of the method according to the invention can be presented to a doctor by means of the system according to the invention.
  • the results refer to a patient identified by case number 2.
  • the previously recorded microbiological findings 3 are listed in a table 4, wherein in each case a report number, the date of taking a biological sample, the receipt of the microbiological findings and internal numbers of the laboratory are given.
  • multidrug-resistant microbes are reported for each microbiological finding, for example, 15 MRSA (Methicillin-Resistant Staphylococcus aureus), 3-MRGN (Multidrug-resistant Gram-negative rods resistant to three of the four antibiotic groups) and 4-MRGN (Multidrug-resistant Gram-negative rods with resistance to four of the four antibiotic groups).
  • FIG. 2 shows the finding 3a with the finding number 15 from the previously received findings 3, so that details of this finding are displayed.
  • the physician can also use button 5 to display the microbiological findings transmitted by the laboratory in its original form.
  • the displayed details include a list 6 which lists the pathogens 7 indicated in the finding 3a. Each pathogen 7 is identified by its name. From the list 6, the pathogen 7a is selected, which is the bacterium Staphylococcus epidermidis.
  • Table 8 shows the active ingredients that were tested in susceptibility tests to determine the susceptibility of pathogen 7a to these drugs.
  • the sensitivity of the pathogen is assigned to the classes "resistant”, “intermediate” or “sensitive”, whereby the classes are visually separated by a colored coding in table 8. Red stands for resistant, yellow for intermediate, green for sensitive.
  • MIC values may be given for at least one, preferably all listed active ingredients.
  • the drugs 9 are shown, which are used to inhibit or kill the selected pathogen.
  • the presentation is made as a diagram in which the administrations of the drugs 9 are plotted as a function of time.
  • the physician may refer to the screens shown in Figures 4 and 5.
  • the screen shown in Figure 4 allows the physician to enter and edit prescriptions. In particular, it may determine the nature of the active ingredient, the drug containing this active ingredient, the dose and the periods of administration of the drug. For this he can use the suggestions that automatically generate the method according to the invention.
  • the screen shown in Fig. 5 gives him an overview of the prescription of the drug in a time-lapse chart as abscissa.
  • multiresistant pathogens 10 On the screen 1 additionally indicated in the microbiological findings multiresistant pathogens 10 are shown. Details of these multidrug-resistant pathogens, the doctor can be found in the screen shown in Fig. 4.
  • details 11 of the biological sample namely, material, sampling location, sampling mode and purpose of sampling are shown.
  • the specification of the material identifies the type of biological sample.
  • the purpose of the removal referred to in Fig. 2 as a question, is the study of the sample on microorganisms and their resistance to drugs.
  • the infections already diagnosed in the patient 12 are also shown. Details of these infections, the doctor can be found in the screen shown in Fig. 3.

Abstract

L'invention concerne un procédé automatisé de surveillance de l'état médical d'un patient au moyen d'un système de gestion de données de patient et/ou d'aide à la décision. Selon l'invention, le procédé comprend les étapes consistant à : (a) prescrire un premier groupe de paramètres physiologiques et/ou pathologiques du patient qui sont caractéristiques de la présence d'un problème de santé ch, les paramètres du premier groupe devant être déterminés en continu, (b) détecter en continu des valeurs de paramètres du premier groupe; (c) déterminer en continu la nécessité de détecter des paramètres microbiologiques sur la base de valeurs de paramètres du premier groupe qui ont été précédemment détectées ou sur la base de valeurs de paramètres du premier groupe qui ont été précédemment détectées et de valeurs de paramètres microbiologiques qui ont été précédemment détectées; et (d) détecter des valeurs de paramètres microbiologiques si à l'étape (c) la nécessité de détecter des paramètres microbiologiques a été constatée, chaque paramètre microbiologique étant un agent pathogène microbiologique qui comporte au moins une substance active comme première valeur et la sensibilité de l'agent pathogène vis-à-vis cette substance active comme seconde valeur.
PCT/DE2015/100340 2014-10-07 2015-08-14 Procédé automatise de surveillance de l'état médical d'un patient WO2016055050A1 (fr)

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DE102014114560.7A DE102014114560B3 (de) 2014-10-07 2014-10-07 Automatisiertes Verfahren zur Überwachung des medizinischen Zustandes eines Patienten
DE102014114560.7 2014-10-07

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7010522B1 (en) * 2002-06-17 2006-03-07 At&T Corp. Method of performing approximate substring indexing
EP1897485A1 (fr) 2006-09-08 2008-03-12 Thomas Löser Procédé d'analyse et/ou de surveillance de paramètres physiologiques et/ou pathologiques d'un patient
US20080081957A1 (en) * 2006-09-29 2008-04-03 Searete LLC, a limited liability corportatio of Computational systems for biomedical data
WO2011012678A1 (fr) * 2009-07-29 2011-02-03 Löser Medizintechnik GmbH Procédé pour contrôler l'état médical d'un patient
WO2012022335A2 (fr) * 2010-07-16 2012-02-23 Löser Medizintechnik GmbH Procédé de surveillance de l'état médical d'un patient

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7010522B1 (en) * 2002-06-17 2006-03-07 At&T Corp. Method of performing approximate substring indexing
EP1897485A1 (fr) 2006-09-08 2008-03-12 Thomas Löser Procédé d'analyse et/ou de surveillance de paramètres physiologiques et/ou pathologiques d'un patient
EP1897485B1 (fr) 2006-09-08 2011-09-21 Löser Medizintechnik GmbH Procédé d'analyse et/ou de surveillance de paramètres physiologiques et/ou pathologiques d'un patient
US20080081957A1 (en) * 2006-09-29 2008-04-03 Searete LLC, a limited liability corportatio of Computational systems for biomedical data
WO2011012678A1 (fr) * 2009-07-29 2011-02-03 Löser Medizintechnik GmbH Procédé pour contrôler l'état médical d'un patient
DE102009035250A1 (de) 2009-07-29 2011-02-03 Löser Medizintechnik GmbH Verfahren zur Überwachung des medizinischen Zustandes eines Patienten
WO2012022335A2 (fr) * 2010-07-16 2012-02-23 Löser Medizintechnik GmbH Procédé de surveillance de l'état médical d'un patient

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
SCHUSTER, H. P.; MÜLLER-WERDAN: "U.: Defmition und Diagnose von Sepsis und Multiorganversagen", SEPSIS UND MODS, 2005

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