Decision support for infectious diseases--a working prototype

A new software architecture proposal for an evidence-based Decision Support System in dentistry

BACKGROUND

in dentistry, clinical problems could be resolved using many therapeutic approaches that may results in very different therapies. In order to choose the best option, a good evaluation of therapy long-term survival and success rate is mandatory. The routine use of a decision support analysis software is nowadays limited due to the lack of software's flexibility especially when a variety of possible therapeutic option are present. The aim of this research was to develop a new algorithm model for a Decision Support System software to give diagnosis support in dentistry.

METHODS

Beta tests were designed to study the computer software in different clinical situations based on clinical data. The therapeutic options can be conservative/endodontic or extractive/prosthetic therapies. In two of clinical situation selected could be possible to choose both therapies.

RESULTS

in clinical situations tested, the DDS software correctly identified the several therapeutic options. When multiple treatments were possible the beta test showed an output mask that correctly showed a range of options with their corresponding survival and success rate.

CONCLUSIONS

The software architecture proposed by the authors is technically feasible, can support the clinician choices based on scientific evidence and up-to-date references and gain informed consent based on data easily understandable for the patient.

Use of computerized decision support systems to improve antibiotic prescribing

This decade will see the emergence of the electronic medical record, electronic prescribing and computerized decision support in the hospital setting. Current opinion from key infectious diseases bodies supports the use of computerized decision support systems as potentially useful tools in antibiotic stewardship programs. However, although antibiotic decision support systems appear beneficial for improving the quality of prescribing and reducing the costs of antibiotic prescribing, their overall cost-effectiveness, impact on patient outcome and antimicrobial resistance is much less certain. This review describes computerized decision support systems used to assist with antibiotic prescribing, the evidence for their effectiveness and the current and future roles.

Implementation of a novel on-ward computer-assisted surveillance system for device-associated infections in an intensive care unit

For the presented study a computer-based surveillance system for detecting nosocomial infections (NI) with direct data input from attending on-ward physicians was implemented. During a 12-month period surveillance of ventilator-associated pneumonia (VAP) and catheter-associated bloodstream infections (BSI) was performed prospectively by on-ward physicians guided by infection control specialists on an 11-bed medical intensive care unit in a German university hospital. In 603 patients 3282 patient days were assessed. Completeness of data entry during the routine phase was 94% for ventilator days and 88% for central venous catheter days. The concordance of infection detection by automated evaluation and evaluation based clinical considerations was fairly good and was quantified by kappa measures of 0.49 for VAP and 0.57 for BSI. Detected infection rates ranged within the German national reference data. Personnel costs for on-ward physicians and infection control personnel were 1.01 Euro per device day in the routine phase. Time expenditure of less than 3 min per device day, rendered in about equal parts by physicians and infection control personnel, was lower than in studies relying on on-ward assessment by infection control personnel.