Medical informatics and digital health multilingual ontology (MIMO): A tool to improve international collaborations.

BACKGROUND: Even if English is the leading language for international communication, it is essential to keep in mind that research runs at the local level by local teams generally communicating in their local/national language, especially in Europe among European projects. OBJECTIVE: Therefore, the European Federation for Medical Informatics - Working Group on Health Informatics for Inter-regional Cooperation" has one objective: To develop a multilingual ontology focusing on Health Informatics and Digital Health as a collaboration tool that improves international and, in particular, European collaborations. RESULTS: We have developed the Medical Informatics and Digital Health Multilingual Ontology (MIMO). Hosted on the Health Terminology/Ontology Portal (HeTOP), MIMO contains around 1,000 concepts, 460 MeSH Descriptors, 220 MeSH Concepts, and more than 300 newly created concepts. MIMO is continuously updated to comprise as recent as possible concepts and their translations in more than 30 languages. Moreover, the MIMO's development team constantly improves MIMO content and supporting information. Thus, during workshop discussions and one-on-one exchanges, the MIMO team has collected domain experts' opinions about the community's interests and suggestions for future enhancements. Moreover, MIMO will be integrated to support the annotation and categorization of research products into the HosmartAI European project involving more than 20 countries around Europe and worldwide. CONCLUSION: MIMO is hosted by HeTOP (Health Terminology/Ontology Portal), which integrates 100 terminologies and ontologies in 55 languages. MIMO is freely available online. MIMO is portable to other knowledge platforms as part of MIMO's main aims to facilitate communication between medical librarians, translators, and researchers as well as to support students' self-learning.

Impact of Compliance with a Sepsis Resuscitation Bundle in a Portuguese Emergency Department.

INTRODUCTION: Severe sepsis and septic shock are common conditions with high levels of morbi-mortality surpassing those of coronary heart disease or stroke. The reality of hospital treated sepsis is largely unknown outside of the intensive care unit. We therefore aimed to evaluate the level of compliance with the Surviving Sepsis Campaign 6-hour bundle in a Portuguese emergency department and to relate it to the patient clinical outcomes. MATERIAL AND METHODS: We conducted a retrospective, observational cohort study with 178 severe sepsis/septic shock patients admitted to the intensive and intermediate care unit between January 1st 2012 and December 31st 2012. RESULTS: In the study, period septic shock was diagnosed in 100 patients (56.2%) and severe sepsis in 78 patients (43.8%). Compliance with the sepsis bundle was: (1) 62.9% for lactate measurement; (2) 62.9% for blood cultures before antibiotics; (3) 41.6% for antibiotics in the first 3 hours; (4) 76.4% for fluid administration; (5) 25% for vasopressor administration; (6) 37% for central venous pressure measurement and (7) 39% for central venous oxygen saturation measurement. Full compliance was observed in 22% of the patients. The individual bundle measure - Blood cultures before antibiotics - was significantly associated with a decreased risk of both intensive care unit mortality and 28-day mortality. There was also a trend for an inverse correlation between increased compliance with the full bundle and the intensive care unit and 28-days hospital mortality. DISCUSSION: There was a low compliance with the Surviving Sepsis Campaign 6-hour bundle, a result that replicates the findings in similar international studies. The explanation is complex but it may include the lack of institutional quality monitoring in the emergency department. CONCLUSIONS: The compliance with a sepsis resuscitation bundle starting in the emergency department was positively associated with the outcomes of the septic patients. Nonetheless the bundle was unreliably performed.

Introdução: A sépsis severa e o choque sético são entidades clínicas frequentes com elevada morbi-mortalidade que superam os da doença cardíaca coronária ou do acidente vascular cerebral. A realidade da sépsis tratada no hospital fora das unidades de cuidados intensivos é amplamente desconhecida. Pretende-se neste trabalho estimar o cumprimento da bundle das 6-horas da Surviving Sepsis Campaign num serviço de urgência português e os resultados clínicos dos doentes. Material e Métodos: Estudo retrospetivo, observacional de coorte com 178 pacientes com sépsis severa/choque sético internados na unidade de cuidados intensivos e intermédios entre 1 de Janeiro de 2012 e 31 de Dezembro de 2012. Resultados: Durante o período estudado foi diagnosticado choque sético em 100 pacientes (56,2%) e sépsis severa em 78 pacientes (43,8%). O cumprimento com a bundle foi: (1) 62,9% para a medição de lactatos; (2) 62,9% para a colheita hemoculturas antes da antibioterapia; (3) 41,6% para a administração de antibióticos nas primeiras 3 horas; (4) 76,4% para a administração de fluidos; (5) 25% para a administração de vasopressores; (6) 37% for medição da pressão venosa central; (7) 39% para a medição da saturação venosa central de oxigénio. O cumprimento de todas as medidas foi observado em 22% dos pacientes. A medida 'colheita hemoculturas antes da antibioterapia' esteve significativamente associada a um menor risco de mortalidade na unidade de cuidados intensivos e aos 28 dias. Também se verificou uma tendência para uma correlação inversa entre cumprimento crescente da bundle e a mortalidade na unidade de cuidados intensivos e aos 28 dias. Discussão: A baixa adesão à bundle das 6-horas da Surviving Sepsis Campaign é um resultado que replica o de estudos internacionais semelhantes. A explicação para este fenómeno é complexa mas pode incluir a falta de monitorização da qualidade dos cuidados no serviço de urgência. Conclusões: O cumprimento da bundle de ressuscitação da sépsis desde a chegada do doente ao serviço de urgência está associado positivamente com os resultados clínicos do paciente sético. O cumprimento das medidas não foi no entanto muito elevado.