Biomedical subjects

K E Campbell

Publications and source records attributed to K E Campbell.

At least 19 recordsLinked to original sources

PubMed2001

Challenges in the development and testing of a reference terminology model for nursing interventions.

The purpose of this paper is to report the work of the Interventions Group of the first Nursing Terminology Summit (1999) and to describe the challenges and insights of this group as they have evolved a reference terminology model for nursing interventions. When the group began its work as part of the first meeting of the Nursing Terminology Summit, it had the overall objective of proposing the intervention component of a reference terminology model for nursing. Although there is not a definitive proposal for this to date, the group's exploration and analysis has clarified and explicated both the types of models of clinical information and the current " state of the art" of formal representations of nursing interventions as well as the relationship of nursing languages to these formal representations. In addition, it is our perspective that the work of this group is representative of the process and challenges facing many similar groups currently engaged in modeling efforts. Consequently, critical success factors of such efforts are identified and discussed. This paper reports both the specific outputs of the group related to progress in defining a terminology model of nursing interventions and observations and lessons learned regarding consensus modeling work.

Models, Theoretical↗

PubMed2001

Chronic wound caring ... a long journey toward healing.

Healthcare professionals use words like "frustrating," "expensive," and "time-consuming" to describe chronic wound care. Healing a wound that has been present for an extended period of time is difficult. Often the problem is not just the wound but also the "woundedness" of the individual with the wound. The patient's needs in chronic wound care often continue over months, years, or even a lifetime. This article addresses more than the wound--it offers healthcare professionals' accounts of patient stories and their active involvement in the long journey toward chronic wound healing.

Adaptation, Psychological↗

PubMed2000

Photographic assessment of the appearance of chronic pressure and leg ulcers.

The purpose of this paper was to examine the validity and reliability of using photographs of wounds to accurately assess wound status. The results of assessing wound appearance using wound photographs was compared to results obtained from a bedside assessment using the Pressure Sore Status Tool (PSST). The photographic wound assessment tool (PWAT) used in this comparison represents a modified version of the PSST and includes the six domains that can be determined from wound photographs. The PWAT was used on photographs of both chronic pressure ulcers (n = 56) and leg ulcers due to vascular insufficiency (n = 81). The photographic tool has excellent intrarater (ICC = 0.96) and interrater (ICC = 0.73) reliability and good concurrent validity (r = 0.70) compared with a full bedside assessment PSST. The PWAT has also shown to be sensitive to change in wound appearance of healing ulcers, but not nonhealing ulcers. These results would suggest that in the event that a full bedside assessment is not possible, wound photographs may be used to accurately assess wound appearance of both chronic pressure ulcers located on the trunk and vascular ulcers of the lower extremity. Establishing a valid and reliable assessment of wound healing using photographic images is of great relevance to the advancing fields of computer image analysis and telemedicine.

Chronic Disease↗

PubMed2000

An evaluation of ICNP intervention axes as terminology model components.

In this paper we evaluate selected axes of the International Classification of Nursing Practice (ICNP) as terminology model components for nursing actions by dissecting and categorizing two data sets of term phrases (Patient Care Data Set and Home Health Care Classification). Second, we critically analyze the relationships between the ICNP axes and terminology model components used to formally define procedures (including nursing actions) in SNOMED RT. Our findings demonstrate that the semantic categories represented by the ICNP intervention axes are relevant sources for terminology model components for nursing actions. In addition, our findings suggest that only minimal additions or extensions to the current semantic links of SNOMED RT are needed to support the formal definition of nursing actions such as those contained in PCDS and HHCC.

Models, Theoretical↗

PubMed1999

Pressure ulcer assessment instruments: a critical appraisal.

Numerous evaluation tools have been developed to document various aspects of wound status or appearance of pressure ulcers. These include the Pressure Sore Status Tool (PSST), Pressure Ulcer Scale for Healing (PUSH Tool), Sussman Wound Healing Tool (SWHT), Sessing scale, and the Wound Healing Scale (WHS). A critical appraisal of the literature was undertaken to examine the purpose and methods for the development of each instrument, the extent to which the instruments have been validated to date, the practicality of their use, and the work that remains to be done to establish their suitability for clinical and/or research purposes. All of these instruments have been developed to describe and evaluate change in pressure ulcer status over time with the exception of the WHS, which was developed as an alternative to reverse staging. More of the validation parameters have been addressed for the PSST and the Sessing scale than for the PUSH Tool, the SWHT, and the WHS. All of the instruments can be completed within approximately 5 minutes except the PSST, which requires 10 to 15 minutes to complete. For all instruments, experience with wounds and training in the use of the instrument are required to improve reliability. For each of the measurement instruments, suggestions are made that would complete necessary validation procedures and thus prepare the instruments for clinical and/or research purposes.

Humans↗

PubMed1999

Choosing an adjunctive therapy for the treatment of chronic wounds.

Adjunctive therapies such as ultrasound, laser, ultraviolet light, superficial heating, pulsed electromagnetic fields, and electrical stimulation have all been indicated in the treatment of chronic wounds. The purpose of this article is to outline the issues a healthcare professional must consider when choosing the best adjunctive therapy for a chronic wound. It summarizes the effects of therapeutic modalities on the wound healing process, analyzes the clinical research evidence, discusses practical considerations, and reviews indications, contraindications, precautions, and safety considerations. Finally, an algorithm is presented to help guide the clinician in selecting a modality. In summary, research evidence exists in the literature that suggests these adjunctive therapies can directly stimulate new tissue growth, augment wound tissue strength, improve local circulation and oxygenation, reduce edema, and/or inhibit bacterial growth. Electrical stimulation and ultrasound are the only therapeutic modalities that currently have sufficient clinical research evidence to support their use in the treatment of chronic wounds. Practical issues such as cost, time and training required, and patient and therapist safety concerns, will ultimately influence the selection of these modalities.

Algorithms↗

PubMed1998

In vitro patch-clamp studies in skin fibroblasts.

We have conducted single-channel patch-clamp experiments in skin fibroblasts maintained in culture. Two different cell lines, a mouse 3T3-L1 cell line and a human B17 cell line, were selected for these pilot studies. Recordings were made from both cell-attached and excised inside-out patches at room temperature. In the case of the 3T3-L1 cells, the success rate in obtaining good seals (> 1Gomega) was low, and channel openings in either cell-attached or excised patches were rare. We have, however, identified a channel in a cell-attached configuration with a slope conductance of 39 pS in symmetrical K+ solutions. In the case of the human B17 cells, good quality seals were more readily obtained. One principal type of channel opening was identified. In cell-attached patches, the prevalent type of channel in symmetrical K+ solutions had a conductance of 187 pS. This channel was activated by strong depolarization, and there was usually more than one active channel in the patch. It was blocked by extracellular tetraethylammonium (20 mM), and persisted when external Cl- was replaced by aspartate. In excised inside-out patches bathed in symmetrical K+, this channel was activated by an increase in Ca+ applied to the intracellular face. A large conductance channel (175 pS) was also observed in excised inside-out patches, with a reverse physiological K+ gradient. This channel had a reversal potential > 40 mV and appeared not to be voltage-dependent under these recording conditions (2 mM Ca(2+)i). We conclude that the channel we have identified in these cells belongs to the maxi-K+ channel class.

3T3 Cells↗

PubMed1998

Scalable methodologies for distributed development of logic-based convergent medical terminology.

As the size and complexity of medical terminologies increase, terminology modelers are increasingly hampered by lack of tools and methods to manage the development process. This paper presents our use and ongoing evaluation of a description-logic classifier to support cognitive scalability of the underlying terminology and our enhancements to that classifier to support concurrent development utilizing semantics-based concurrency control methods. Our enhancements, collectively referred to as the Gálapagos, consist of several applications that take locally-developed terminology enhancements from multiple sites, identify conflicting design decisions, support the modelers' reconciliation of the conflicting designs, and efficiently disseminate updates tailored for locally enhanced terminologies. We have tested our ideas through concurrent evolutionary enhancement of SNOMED International at three Kaiser Permanente regions and the Mayo Clinic. We have found that the underlying environment has met our design objectives, and supports semantic-based concurrency control, and identification and resolution of conflicting design decisions.

Artificial Intelligence↗

PubMed1998

Compositional concept representation using SNOMED: towards further convergence of clinical terminologies.

This paper describes several approaches to the expression and coding of clinical concepts as composites of elementary entities, and describes an approach based on SNOMED RT that may permit further convergence of clinical terminology efforts. We explain the shortcomings of previous approaches to compositional concept representation, as well as the reasons for SNOMED's current approach, which adopts a foundation based in description logics (DLs). The DL model has many advantages: it establishes a formal semantics for SNOMED assertions and suggests a syntax; it provides a basis for understanding expressiveness and computational complexity, through correspondence with known results from DLs; and it helps to clarify the relationships among existing concept representation methods in SNOMED, NHS Clinical Terms (formerly the Read Codes), and GALEN, making a path to convergence more clear.

Models, Theoretical↗

PubMed1998

A "lexically-suggested logical closure" metric for medical terminology maturity.

Medical Terminologies are becoming increasingly expressive secondary to their increase in size, and are becoming increasingly difficult to analyze secondary to inconsistencies in their use and complex interrelationships that are often not explicitly defined. To address these problems, SNOMED-RT is being developed to allow consistent use, and to define explicitly interrelationships between terms. Ensuring the quality of a terminology system like SNOMED-RT presents new challenges which we are trying to address with theoretically-grounded methodologies for quality management. Here we describe an initial metric toward achieving this goal called "lexically-suggested logical closure." We explain how this metric can be useful for tracking the maturity and quality of a terminology, and apply this metric to track the progress of SNOMED-RT development over a portion of its life-cycle.

Algorithms↗

PubMed1998

Reproducibility of interpreting "and" and "or" in terminology systems.

High quality terminologies are a fundamental requirement in a range of health care applications. To ensure high quality terminologies we should reflect about the understandability, reproducibility and utility criteria within a terminology. This paper describes efforts to improve the understandability of SNOMED. We describe the problem related to the grammatical conjunctions "and" and "or" and how we applied basic semantic rules defined by the SNOMED Editorial Board. The results show that the meaning of "and" and "or" in SNOMED can be made explicit in almost all cases and can be done in a reasonable, reliable, and reproducible manner.

Semantics↗

PubMed1998

Computer-facilitated collaboration: experiences building SNOMED-RT.

Collaborative development involving both individuals and groups is often less efficient than independent development because of communication overhead and integration costs. Despite the decreased development efficiency, collaborations promise more general-purpose products because of the opportunity for integration, with negotiation and reconciliation of diverse perspectives. Collaborations are also perhaps less costly when considered in contexts where there is significant duplication of effort. Computer-facilitated collaboration can reduce the communication and integration burden such that the increased effort required to manage a successful collaboration focuses primarily on the development of shared conceptual model among the developers by requiring that the work product be independently reproducible. This reproducibility requirement incorporates formal quality assurance processes into the development process. In this paper, we describe our initial experiences developing SNOMED-RT using such a computer-facilitated collaborative process. We quantify the extra costs incurred to achieve consistency in our efforts and reproducibility of our results.

Cooperative Behavior↗

PubMed1997

SNOMED RT: a reference terminology for health care.

We describe the framework for SNOMED RT (Reference Terminology), designed to complement the broad coverage of medical concepts in SNOMED with a set of enhanced features that significantly increases its value as a reference terminology for representing clinical data. We describe what is meant by a reference terminology, and differentiate SNOMED RT from specialized terminologies that enable user interfaces, electronic messaging, or natural language processing, as well as from other specialized reference terminologies whose primary purpose is for representing data that is not primarily clinical in nature. We then describe how SNOMED RT represents multiple hierarchies and incorporates description logic. We believe that such a comprehensive set of concepts at multiple levels of granularity, with multiple logic-based subsumption hierarchies can meet the requirements of a reference terminology for health care.

Terminology as Topic↗

PubMed1996

Gálapagos: computer-based support for evolution of a convergent medical terminology.

Current controlled medical terminologies fall short of the needs of informatics application developers. To overcome the limitations of current medical terminologies, many groups are independently enhancing existing terminologies to meet their local needs. With proper computer-based support, local enhancements can be used as evolutionary stepping stones toward a convergent medical terminology. Gálapagos is a collection of applications that can take local enhancements from multiple sites, identify conflicting design decisions, allow developers to reconcile the conflicting designs, and efficiently disseminate updates tailored specifically for compatibility with locally enhanced terminologies. This paper describes an initial proof-of-concept of the Gálapagos programs using data generated during concurrent SNOMED enhancement by Kaiser Permanente and the Mayo Clinic.

Medical Informatics Computing↗

PubMed1995

Development of a controlled medical terminology: knowledge acquisition and knowledge representation.

The creation of controlled medical terminologies is a central challenge in the development of electronic patient records. In the T-Helper patient-record system, designed for the care of patients with HIV disease, the IVORY module allows health-care workers to compose textual progress notes by making selections from menus generated automatically from a controlled medical terminology. Construction of this IVORY terminology required extensive design sessions with a team of computer scientists and an expert physician. Refinement of the terminology was only possible when the design team could envision how the completed T-Helper system would be used in the context of clinical practice. Development of controlled medical terminologies is a significant problem in knowledge acquisition. Techniques used to acquire and represent clinical concepts for the purpose of building decision-support systems also are appropriate for the construction of controlled terminologies such as the one in T-Helper.

Artificial Intelligence↗

PubMed1994

Variations in quantity-frequency measures of alcohol consumption from a general population survey.

This paper examines differences in quantity-frequency (QF) measures of alcohol consumption from the 1988 US National Health Interview Survey. Three methods--global QF, beverage-specific QF, and beverage-specific QF with drink size (QFS)--were used to estimate the average daily ethanol consumption (ADC) of current drinkers. These ADC estimates then were used to categorize drinkers into light, moderate or heavier drinking levels. Total prevalence estimates of heavier drinking were not significantly different among men, but were significantly higher with the QFS measure among women. All mean ADC scores were significantly different for both sexes. The global QF showed the lowest mean consumption, followed by the higher beverage-specific QF and QFS measures. Adding beverage type and drink size to the QF measures increased mean ADC scores for both men and women. However, moderately high correlations (0.84 for men and 0.88 for women) were found with ADC scores from the beverage-specific QF and QFS measures.

Alcohol Drinking↗

PubMed1994

Formal properties of the Metathesaurus.

The Metathesaurus is a machine-created, human edited and enhanced synthesis of authoritative biomedical terminologies. Its formal properties permit it to be a) exploited by computers, and b) modified and enhanced without compromising that usage. If further constraints were imposed on the existence and identity of Metathesaurus relationships, i.e., if every Metathesaurus concept had a "genus" and a "differentia," then the Metathesaurus could be converted into an "Aristotelian Hierarchy." In this sense, a genus is a concept that classifies another concept, and a differentia is a concept that distinguishes the classified concept from all other concepts in the same class. Since, in principle, these constraints would make the Metathesaurus easier to leverage and maintain computationally, it is interesting to ask to what degree the maintenance and enhancement procedures now in place are producing a Metathesaurus that is also an "Aristotelian Hierarchy." Given a liberal interpretation of the current Metathesaurus schema, the proportion of the Metathesaurus that is "Aristotelian" in each annual version is increasing in spite of dramatic concurrent increases in the number of Metathesaurus concepts. Without formality there is no modifiability nor scalability. [1] We need formal methods and computer-based tools that can help us with the task [of controlled medical vocabulary construction]. We need research in which controlled vocabulary development is the focus rather than a stepping stone for work on other theories and applications. [2]

Subject Headings↗

PubMed1993

A computer-based tool for generation of progress notes.

IVORY, a computer-based tool that uses clinical findings as the basic unit for composing progress notes, generates progress notes more efficiently than does a character-based word processor. IVORY's clinical findings are contained within a structured vocabulary that we developed to support generation of both prose progress notes and SNOMED III codes. Observational studies of physician participation in the development of IVORY's structured vocabulary have helped us to identify areas where changes are required before IVORY will be acceptable for routine clinical use.

Humans↗