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PubMedDate not supplied

Natural language generation of surgical procedures.

A number of compositional Medical Concept Representation systems are being developed. Although these provide for a detailed conceptual representation of the underlying information, they have to be translated back to natural language for used by end-users and applications. The GALEN programme has been developing one such representation and we report here on a tool developed to generate natural language phrases from the GALEN conceptual representations. This tool can be adapted to different source modelling schemes and to different destination languages or sublanguages of a domain. It is based on a multilingual approach to natural language generation, realised through a clean separation of the domain model from the linguistic model and their link by well defined structures. Specific knowledge structures and operations have been developed for bridging between the modelling 'style' of the conceptual representation and natural language. Using the example of the scheme developed for modelling surgical operative procedures within the GALEN-IN-USE project, we show how the generator is adapted to such a scheme. The basic characteristics of the surgical procedures scheme are presented together with the basic principles of the generation tool. Using worked examples, we discuss the transformation operations which change the initial source representation into a form which can more directly be translated to a given natural language. In particular, the linguistic knowledge which has to be introduced--such as definitions of concepts and relationships is described. We explain the overall generator strategy and how particular transformation operations are triggered by language-dependent and conceptual parameters. Results are shown for generated French phrases corresponding to surgical procedures from the urology domain.

Linguistics↗
PubMed2003

Preoperative assessment of confrontation naming ability and interictal paraphasia production in unilateral temporal lobe epilepsy.

The present study examined the diagnostic utility of confrontation naming tasks and phonemic paraphasia production in lateralizing the epileptogenic region in patients with temporal lobe epilepsy (TLE). Further, the role of intelligence in moderating the diagnostic utility of confrontation naming tasks was assessed. Eighty patients with medically intractable complex partial seizures (40 left TLE, 40 right TLE) received the Boston Naming Test (BNT) and the Visual Naming subtest (VNT) of the Multilingual Aphasia Examination. The BNT was diagnostically more sensitive than the VNT in identifying left TLE (77.5% vs 17.5%, respectively). The utility of BNT performance and paraphasias was maximal in patients with Full Scale IQs >or=90 who were 6.8 times more likely to have left TLE than patients without paraphasias. Preoperative assessment of confrontation naming ability and phonemic paraphasia production using the BNT provided diagnostically useful information in lateralizing the epileptogenic region in left TLE.

Adult↗
PubMed1997

Quality of life assessment in patients receiving adjuvant therapy for breast cancer: the IBCSG approach. The International Breast Cancer Study Group.

BACKGROUND AND PURPOSE: The International Breast Cancer Study Group (IBCSG) has developed and approach for assessing the impact of adjuvant therapy on quality of life (QL) within the framework of international, multilingual clinical trials. The major steps are summarized. Conceptual, methodological and practical issues are discussed with reference to results of two trials closed to accrual (IBCSG VI, VII) and one subsequent ongoing trial (IBCSG IX). PATIENTS AND METHODS: QL was assessed in pre- and post-menopausal patients with operable breast cancer. Various single-item linear analogue self-assessment (LASA) scales were used as indicators of components of QL, including global indicators of well-being, functioning and health perception, and specific indicators of symptoms of disease and treatment. In trials VI and VII, QL was assessed at baseline, during adjuvant treatment and follow-up, and at recurrence. Based on this experience, the QL form was revised for subsequent trials and further investigated in a subsample of patients randomized into trial IX. RESULTS: In trials VI and VII, the QL indicators were responsive to the impact of biomedical factors at baseline, various adjuvant treatments, changes over the first 18 months, and recurrence. In trial IX, the revised QL form was well accepted by patients and staff. Completing this form did not exceed five minutes. QL differences between on and off cytotoxic treatment strengthen the claim that these measures are responsive. Correlations and logistic regression analyses show the expected relationship among the various global and specific indicators. CONCLUSION: Results from two trials closed to accrual and an ongoing trial confirm the feasibility, validity and clinical relevance of the IBCSG approach for studying the impact of adjuvant breast cancer therapy on QL in international clinical trials.

Breast Neoplasms↗
PubMed2003

Development of the Cystic Fibrosis Questionnaire (CFQ) for assessing quality of life in pediatric and adult patients.

UNLABELLED: To assess the impact of cystic fibrosis (CF) and treatment on quality of life (QOL) from childhood throughout adult age, two versions of the Cystic Fibrosis Questionnaire (CFQ), were developed and validated in France: the CFQ 14+ for teenagers and adults, the CFQ Child P, a parent-proxy evaluation for children aged 8-13. They include three modules for assessing QOL, symptoms and health perception. Nine QOL dimensions were identified: physical functioning, energy/well-being, emotions, social limitations, role, embarrassment, body image, eating disturbances and treatment burden. Items were derived from 33 interviews with patients and parents. Item reduction and assessment of internal consistency, convergent and discriminant validity were based on a large cross-sectional survey among 393 patients and parents. A second study was conducted among 124 patients and 85 parents to test reproducibility and responsiveness, confirm the subscale structure and assess scalar properties using Rasch analysis. All psychometric properties were successfully demonstrated and both the CFQ 14+ and the CFQ Child P French questionnaires are now well validated. German and Spanish validated adaptations are available, an English validation is in progress. CONCLUSION: The CFQ 14+ and CFQ Child P are well validated, multilingual measures which allow QoL assessment in children, teenagers and adults with CF.

Adolescent↗
PubMed2000

Development of psychometrically matched English and Spanish language neuropsychological tests for older persons.

Item response theory (IRT) methods were used to develop a neuropsychological test battery with matched English and Spanish language forms. Candidate items for 12 scales measuring core neuropsychological abilities were generated and administered to 200 community-dwelling elderly participants tested in Spanish and 208 tested in English. IRT methods were used to eliminate linguistically biased items and refine scales to assess broad ability ranges. Reasonably good psychometric matching of scales was achieved within and across English and Spanish language forms. All scales were sensitive to cognitive impairment as measured by the Mini-Mental State Examination (MMSE), with highly similar relationships between scale scores and MMSE across English and Spanish groups. The outcome supports the use of IRT methods in cross-cultural and multilingual test development and indicates that this strategy has potential for future neuropsychological test development.

Aged↗
PubMed2004

Spanish and English Neuropsychological Assessment Scales (SENAS): further development and psychometric characteristics.

The Spanish and English Neuropsychological Assessment Scales were devised to be a broad set of psychometrically matched measures with equivalent Spanish and English versions. Study 1 in this report used item response theory methods to refine scales. Results strongly supported psychometric matching across English and Spanish versions and, for most scales, within English and Spanish versions. Study 2 supported in both English and Spanish subsamples the 6-domain model of ability that guided scale construction. Study 3 examined differential item functioning (DIF) of one scale (Object Naming) in relation to education, ethnicity, gender, and age. Effects of DIF on scale-level ability scores were limited. Results demonstrate an empirically guided psychometric approach to test construction for multiethnic and multilingual test applications.

Cognition↗
PubMed1992

A European view of fluoride supplementation.

During the autumn of 1991 a meeting was convened in Brussels by Colgate entitled 'European view of fluoride supplementation'. Throughout Europe, product dosage and age related dose recommendations for fluoride supplements vary widely. With the advent of 1992, different instructions on the same packet would cause considerable confusion in a more integrated Europe with its mobile and multilingual society. Colgate therefore decided to convene a meeting of European experts to explore the possibility of reaching a consensus on a common dosage regime of fluoride tablets and drops for Europe. The meeting consisted of a series of short papers by European experts in the field followed by detailed discussion.

Dental Caries↗
PubMed1998

Attitudes of Chinese people toward obtaining dental care in the UK.

OBJECTIVE: To explore the attitudes of Chinese people regarding dentists and toward obtaining dental care in the UK. INTRODUCTION: Injudicious use of general health services has been reported among Chinese people in the UK. In relation to oral healthcare, the extent to which cultural beliefs and values affect use remains uncertain. SETTING: Chinese communities in the north east of England. SUBJECTS AND METHODS: A quota sample of 156 Chinese people was recruited in 1996. 50 elderly people, 56 adults, 50 teenagers were interviewed by 5 trained and standardised multilingual Chinese interviewers using a validated structured questionnaire. RESULTS: Access varied substantially according to age, with the younger generations more likely to obtain dental care without difficulty. Overall, the sample perceived that dentists possessed adequate technical competence, but their patient management skills lacked sensitivity. Older Chinese people placed less trust in dentists. Many elderly people reported problems in finding a UK dentist and would have preferred one of Chinese origin. Potential problems in follow-up prosthetic dental care were also apparent among this age group. Cost, communication problems, anxiety and cultural beliefs were identified as major barriers to dental care. CONCLUSIONS: There is a clear need to raise cultural awareness among dental professionals as well as to help Chinese people's positive attitudes toward dentists and dental care.

Adolescent↗
PubMed2000

Tense and temporality: a comparison between children learning a second language and children with SLI.

This study compares the morphosyntax of children with SLI to the morphosyntax of children acquiring a second language (L2) to determine whether the optional infinitive phenomenon (M. Rice, K. Wexler, & P. Cleave, 1995; K. Wexler, 1994) is evident in both learner groups and to what extent cross-learner similarities exist. We analyzed spontaneous production data from French-speaking children with SLI, English-speaking L2 learners of French, and French-speaking controls, all approximately 7 years old. We examined the children's use of tense morphology, temporal adverbials, agreement morphology, and distributional contingencies associated with finiteness. Our findings indicate that the use of morphosyntax by children with SLI and by L2 children has significant similarities, although certain specific differences exist. Both the children with SLI and the L2 children demonstrate optional infinitive effects in their language use. These results have theoretical and clinical relevance. First, they suggest that the characterization of the optional infinitive phenomenon in normal development as a consequence of very early neurological change may be too restrictive. Our data appear to indicate that the mechanism underlying the optional infinitive phenomenon extends to normal (second) language learning after the primary acquisition years. Second, they indicate that tense-marking difficulty may not be an adequate clinical marker of SLI when comparing children with impairment to both monolingual and bilingual peers. A more specific clinical marker would be more effective in diagnosing disordered populations in a multilingual context.

Child↗
PubMed2001

A controlled vocabulary for nursing and allied health in Norway.

Nursing and allied health libraries at educational institutions in Norway have generally indexed their book collections with uncontrolled terms. With the reorganization of higher education in 1994, the majority of these libraries joined BIBSYS, which is a joint library system for higher education and research in Norway. This has led to chaos when searching the joint catalogue for literature on nursing and related fields. A term such as 'behaviour problems' may have up to five synonyms. In an attempt to improve the quality of searching the health literature, BIBSYS appointed a working group in the Spring of 1999 to find a suitable controlled vocabulary for this subject area, and to see how this vocabulary could be integrated into BIBSYS. The group presented its recommendations in October 1999. The report has been well received by the BIBSYS Board and by user groups. There are no Norwegian vocabularies that are suitable for use in nursing and allied health, therefore it will be necessary to translate and combine existing thesauri. The group has looked at the Nordic Multilingual Thesaurus on Health Promotion, the Swedish Spriline Thesaurus, MeSH (Medical Subject Headings) and CINAHL Subject Heading List. Other relevant thesauri are AMED/CATS Thesaurus, Bioethics Thesaurus (Bioethicsline) and the RCN thesaurus. The group recommends the development of a Norwegian thesaurus based on a translation of parts of MeSH and CINAHL Subject Heading List.

Abstracting and Indexing↗
PubMed1999

Can medical students contribute to quality assurance programmes in day surgery?

CONTEXT AND OBJECTIVES: Health care delivery has undertaken a major shift from inpatient management to ambulatory surgical care with increasing emphasis on quality assurance (QA) processes. Educational opportunities for medical undergraduate programmes are being sought in the day surgery environment. Our study was undertaken to explore ways in which senior medical students can actively contribute to QA processes as part of an undergraduate day surgery educational programme. SUBJECTS AND METHODS: Health care delivery has undertaken a major shift from inpatient management to ambulatory surgical care with increasing emphasis on quality assurance (QA) processes. Educational opportunities for medical undergraduate programmes are being sought in the day surgery environment. Our study was undertaken to explore ways in which senior medical students can actively contribute to the QA processes as part of an undergraduate day surgery educational programme. SUBJECTS AND METHODS: Fifty-nine final year medical students followed allocated patients with common surgical conditions through all phases of the day surgery process. Students kept records about each case in a log book and also presented their cases at weekly Problem Based Learning tutorials. An audit of student log books and review of tutorial records was conducted for the 1996 and 1997 academic years, in order to evaluate student contribution to QA. RESULTS: Students followed 621 cases, representing a sampling of 14. 1% day surgery cases. Categories of problems highlighted by students included inappropriate patient and procedure selection, inadequate pain management, discharge, communication and resource issues. Students made a number of recommendations including the development of multilingual videotapes and patient information sheets for non-English speaking patients, avoidance of bilateral surgical procedures and improved links with local medical officers. They also developed new guidelines and protocols. CONCLUSIONS: Our study confirms that students are able to identify QA issues and propose solutions. We recommend that students have a formally recognized place in day surgery QA programmes, to close the QA loop and to adequately prepare them for medical practice in the 21st century.

Ambulatory Surgical Procedures↗
PubMed1999

Sharpening the focus on populations: an intentional community health nursing approach. Part II.

An interpretive study conducted in a Midwestern metropolitan area was designed to examine expertise in everyday community health nursing (CHN) practice. Twenty-five nurses from three practice areas (traditional, nontraditional, and program development) participated in group and individual interviews and field observations, sharing stories of their practice. Transcribed interviews and field observation notes were analyzed as a text. One of the major findings of the study focused on experiences of the nurses as they developed the population aspects of their everyday practice. Part I describes the natural development of a population focus of CHN generalists whose care most often targeted individuals and families. The stories of how their practices evolved and were supported by their institutions provided insights into how nurses develop a broad population-focused practice perspective. Part II examines the practice of those CHN specialists who nurse their target populations from an intentional perspective. Their population-focused practice, in which they repeatedly displayed what the research team terms multilingual and multiperspectival skills, was solidly based in their prior individual and family-focused experience and expertise in program planning and evaluation.

Attitude of Health Personnel↗
PubMed2000

Minimal standard terminology for digestive endoscopy: results of prospective testing and validation in the GASTER project.

BACKGROUND AND STUDY AIMS: Standardization of the endoscopic report is a key issue for future research in the field of digestive endoscopy. The Minimal Standard Terminology (MST) has been proposed by the European Society for Gastrointestinal Endoscopy (ESGE) as a structured language for production of computerized endoscopic reports. The aim of this study was to validate version 1.0 of this terminology prospectively, by collecting cases in a multicenter, multilingual trial. METHODS: Endoscopic cases (esophagogastroduodenoscopy [EGD], colonoscopy, endoscopic retrograde cholangiopancreatography [ERCP]) were prospectively collected in nine university hospitals in Europe, using the same software. Reports were produced in the local language, but the software allowed comparison of reports between languages, and global analysis of the database. Outcome measures were the adequacy of terms proposed in the MST to describe "reasons for performing an endoscopy", "findings", and "endoscopic diagnoses", frequency of use and content of free-text fields, and types of lesions described. RESULTS: A total of 6,232 reports were analyzed, including 3,447 gastroscopies, 1,743 colonoscopies, and 1,042 ERCPs. Overall, terms originally contained in the MST were adequate to describe fully 91.0% of all examinations where "reasons for endoscopy" were described, 99.5 % of examinations where "findings" were described, 95.8% of all examinations containing descriptions of "endoscopic diagnosis", 98.9% of examinations containing descriptions of "additional diagnostic procedures", and 94.8 % of examinations containing descriptions of "additional therapeutic procedures". Free-text fields were only used in the other cases (less than 5% of cases in average). CONCLUSIONS: The MST appeared adequate to cover a large part of routine endoscopy reports, and could thus be used as a tool for standardization of endoscopic reports in clinical practice. The latter could be significantly improved by the use of a structured and standardized terminology for the production of endoscopic reports.

Clinical Trials as Topic↗
PubMed1990

Clinical trials in Europe and the development of new psychotropics as viewed by European manufacturers.

A number of external and internal (industry-specific) difficulties and problems related to clinical trials and the development of new psychotropics in Europe, are reviewed. These can be classified into 3 interdependent categories of problems: 1. strategy-related; 2. implementation-related; 3. time-related. Apart from ethical and methodological issues, the external problems are: a) diversity of country-specific regulations and requirements for registration and drug approval; b) differences in culture, traditions, education and training background of investigators and patients; c) high competition for good trial centers; d) increasing pressure and negative attitude from public media with respect to clinical testing of drugs. In the strategic planning of the development of a new drug, resources and heavy/costly logistic commitments for each individual study have to be taken into consideration. For the manufacturers it is therefore imperative to fix the plans and the kind of the studies to be performed sometimes several years in advance. Conflict often arises with respect to the developmental changes, both in environmental conditions and in the state of the art. Implementation of the clinical, particularly multicenter/multinational trials poses problems of multilingual documentation, heavy logistics of drug supply, quality control and monitoring of the studies. Inherent to these European problems is a unproportional high time expenditure which has important consequences for scientific progress and economy. Possible solutions for these problems are discussed. The initial steps in this direction will be the establishment of European standards for clinical trials, and uniform requirements for drug registration and approval.

Clinical Trials as Topic↗
PubMed1995

Toward the ultimate synthesis/recognition system.

This paper predicts speech synthesis, speech recognition, and speaker recognition technology for the year 2001, and it describes the most important research problems to be solved in order to arrive at these ultimate synthesis and recognition systems. The problems for speech synthesis include natural and intelligible voice production, prosody control based on meaning, capability of controlling synthesized voice quality and choosing individual speaking style, multilingual and multidialectal synthesis, choice of application-oriented speaking styles, capability of adding emotion, and synthesis from concepts. The problems for speech recognition include robust recognition against speech variations, adaptation/normalization to variations due to environmental conditions and speakers, automatic knowledge acquisition for acoustic and linguistic modeling, spontaneous speech recognition, naturalness and ease of human-machine interaction, and recognition of emotion. The problems for speaker recognition are similar to those for speech recognition. The research topics related to all these techniques include the use of articulatory and perceptual constraints and evaluation methods for measuring the quality of technology and systems.

Communication↗
PubMed1995

Linguistic aspects of speech synthesis.

The conversion of text to speech is seen as an analysis of the input text to obtain a common underlying linguistic description, followed by a synthesis of the output speech waveform from this fundamental specification. Hence, the comprehensive linguistic structure serving as the substrate for an utterance must be discovered by analysis from the text. The pronunciation of individual words in unrestricted text is determined by morphological analysis or letter-to-sound conversion, followed by specification of the word-level stress contour. In addition, many text character strings, such as titles, numbers, and acronyms, are abbreviations for normal words, which must be derived. To further refine these pronunciations and to discover the prosodic structure of the utterance, word part of speech must be computed, followed by a phrase-level parsing. From this structure the prosodic structure of the utterance can be determined, which is needed in order to specify the durational framework and fundamental frequency contour of the utterance. In discourse contexts, several factors such as the specification of new and old information, contrast, and pronominal reference can be used to further modify the prosodic specification. When the prosodic correlates have been computed and the segmental sequence is assembled, a complete input suitable for speech synthesis has been determined. Lastly, multilingual systems utilizing rule frameworks are mentioned, and future directions are characterized.

Communication↗
PubMed1996

Does naming contribute to memory self-report in temporal lobe epilepsy?

The present study evaluated the hypothesis (Mayeux et al., 1980) that visual confrontation naming deficits may underlie the memory complaint in patients with temporal lobe epilepsy (TLE). Thirty-nine patients with medically refractory left (n = 23) and right (n = 16) TLE were compared with an epilepsy control group with idiopathic primary generalized epilepsy (n = 38). All subjects completed selected subtests of the Multilingual Aphasia Examination and Wechsler Memory Scale (Form 1) together with a measure specifically designed for quantification of the memory complaint in TLE. Objective verbal memory test performance, confrontation naming, repetition, and comprehension were unrelated to memory self-report. Controlled Oral Word Association was the only measure to exert an influence on memory self-ratings, and this relationship was specific to the TLE group. The hypothesis of Mayeux et al. (1980) was not specifically supported, but the present findings do suggest that cognitive processes reflected in orthographically based and internally generated word retrieval play a role in memory self-report.

Adult↗
PubMed1999

Interventions to improve uptake of breast screening in inner city Cardiff general practices with ethnic minority lists.

OBJECTIVE: To increase the uptake of breast screening in three inner city GP practices with a high proportion of ethnic minority patients. SETTING: The study was carried out in May and June 1997 in the South East Wales division of Breast Test Wales (BTW). Three inner city general practices in Cardiff, with a low uptake in the previous round of breast screening and a high proportion of ethnic minority women on their lists, were targeted to receive interventions to increase uptake. This preliminary study was not randomized but sought to offer insights into the interventions which may be worth pursuing and the groups that are harder to reach. DESIGN INTERVENTIONS: identification of ethnic language groups; GP endorsement letter; translated literature including: multilingual leaflet, GP letter, screening invitation; transport to the screening centre; language support. RESULTS: Of 369 women invited, 187 attended for screening. This gives an uptake of 50.7% compared with an uptake of 35.2% in the previous screening round, a statistically significant increase of 15.5%. (95% CI +8.2% to +22.5%). CONCLUSION: Findings show that translated literature, GP endorsement letter and language support by linkworkers were beneficial. The provision of free transport was ineffective and under-utilized. Uptake was highest amongst Urdu and Gujarati speaking groups and lowest for Bengali and Somali speakers which are hardest to reach. There is scope for improving the attendance rate amongst ethnic minority groups but this can costly.

Breast Neoplasms↗