x3.6.mlm

maintenance:
    title: Granulocytopenia and Trimethoprim/Sulfamethoxazole;;
    mlmname: anctms;;
    arden: Version 2;;
    version: 2.00;;
    institution: Columbia-Presbyterian Medical Center;;
    author: George Hripcsak, M.D.;;
    specialist: ;;
    date: 1991-05-28;;
    validation: testing;;   library:
    purpose:
        Detect granulocytopenia possibly due to trimethoprim/sulfamethoxazole;;
    explanation:
        This MLM detects patients that are currently taking trimethoprim/sulfamethoxazole whose absolute neutrophile count is less than 1000 and falling.;;
    keywords:
        granulocytopenia; agranulocytosis; trimethoprim; sulfamethoxazole;;
    citations:
        1. Anti-infective drug use in relation to the risk of agranulocytosis and aplastic anemia. A report from the International Agranulocytosis and Aplastic Anemia Study. Archives of Internal Medicine, May 1989, 149(5):1036-40.;;
    links:
        OTHER_LINK "CTIM" '.34.56.78';
        MESH_LINK  "MeSH" 'agranulocytosis/ci and sulfamethoxazole/ae';;
knowledge:
    type: data-driven;;
    data:
        /* capitalized text within curly brackets would be replaced with */
        /* an institution's own query                                    */
        let anc_storage be event {STORAGE OF ABSOLUTE_NEUTROPHILE_COUNT};
        let anc be read last 2 from ({ABSOLUTE_NEUTROPHILE_COUNT}
            where they occurred within past 1 week);
        let pt_is_taking_tms be read exist
            {TRIMETHOPRIM_SULFAMETHOXAZOLE_ORDER};
        ;;
evoke: anc_storage;;
    logic:
        if pt_is_taking_tms
        and last anc is less than 1000
        and last anc is less than first anc
         /* is anc falling? */
        then
            conclude true;
        else
            conclude false;
        endif;;
    action:
        write   "Caution: patient's relative granulocytopenia may be " ||
                "exacerbated by trimethoprim/sulfamethoxazole.";;
end: