Assessing the conversion of electronic medical record data into antibiotic stewardship indicators.

BACKGROUND: Measuring the appropriateness of antibiotic use is crucial for antibiotic stewardship (ABS) programmes to identify targets for interventions. OBJECTIVES: To assess the technical feasibility of converting electronic medical record (EMR) data into ABS indicators. METHODS: In this observational feasibility study covering a period of 2 years, the EMRs of patients hospitalized at a large non-university hospital network and receiving at least one dose of a systemic antibiotic were included. ABS indicators measuring steps in the process of antibiotic prescription proposed by the literature were collected and rephrased or defined more specifically to be calculable if needed. Algorithms were programmed in R to convert EMR data into ABS indicators. The indicators were visualized in an interactive dashboard and the plausibility of each output value was assessed. RESULTS: In total, data from 25 337 hospitalizations from 20 723 individual patients were analysed and visualized in an interactive dashboard. Algorithms could be programmed to compute 89% (25/28) of all pre-selected indicators assessing treatment decisions automatically out of EMR data, with good data quality for 46% (13/28) of these indicators. According to the data quality observed, the most important issues were (i) missing or meaningless information on indication (e.g. 'mild infection') and (ii) data processing issues such as insufficiently categorized metadata. CONCLUSIONS: The calculation of indicators assessing treatment decisions from EMRs was feasible. However, better data structure and processing within EMR systems are crucial for improving the validity of the results.

Reactivated Moraxella osteitis presenting as granulomatous disease.

Granulomatous infections are commonly associated with mycobacteria, brucellosis, actinomycosis, nocardiosis, spirochetes, and fungi. Rarely, granuloma formation is a host response to other bacterial infection. Osteomyelitis and osteitis that reactivate many years after the primary episode is a known phenomenon. A reactivation that presents as a granulomatous disease is rare. We present a case of reactivated osteitis due to Moraxella osloensis with consecutive granuloma formation.

Imported aseptic meningitis due to Toscana virus acquired on the island of Elba, Italy, August 2008.

We describe a case of aseptic meningitis due to Toscana Virus imported to Switzerland and discuss the epidemiological situation. To our knowledge this is the first description of this infection acquired on the Island of Elba.

Modifications of stereological correction methods for precipitate parameters using transmission microscopy.

Energy filtered transmission electron microscopy (EFTEM), dark field imaging and light microscopy are well established methods to evaluate size, volume fraction and number density of precipitates on different size scales. The stereological problems are well known and analogous for all methods. Many evaluation methods can be found in literature, each of them valid for special sample geometries or special size distributions. Despite this variety, serious errors can occur if the assumptions do not exactly represent the real situation. In this paper, available and newly developed correction methods are tested for evaluating these parameters for different precipitate size distributions in a sample of arbitrary topography. It is shown that the newly proposed methods produce significantly lower deviations and are more assessable regarding their systematic errors.