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PubMed1995

A semantic network model for the medical record of a rheumatology clinic.

For the development of a rheumatology information system, a medical data dictionary was developed that supports all phases of software development. In the design phase, the medical expert described his clinical environment and the rheumatology medical record in a semantic network structure. Causal relationships between different items of the medical record (e.g., a problem may be related to an adverse drug event caused by a particular drug) are also represented in the semantic network and transferred into referential integrity constraints of the patient database. Furthermore, by also integrating the domain management as a feature of the medical data dictionary, the elementary attributes of the medical record and the associated lists of valid attribute entries have also been defined within the semantic network. This structure allowed the automatic generation of data entry screens, thus making the clinical applications as independent from any hardcoded program module as possible.

Algorithms↗
PubMed1995

CQL: a database in smart card for health care applications.

The CQL-Card is the first smart card in the world to use Database Management Systems (DBMS) concepts. The CQL-Card is particularly suited to a portable file in health applications where the information is required by many different partners, such as health insurance organizations, emergency services, and General Practitioners. All the information required by these different partners can be shared with independent security mechanisms. Database engine functions are carried out by the card, which manages tables, views, and dictionaries. Medical Information is stored in tables and views are logical and dynamic subsets of tables. For owner-partners like MIS (Medical Information System), it is possible to grant privileges (select, insert, update, and delete on table or view) to other partners. Furthermore, dictionaries are structures that contain requested descriptions and which allow adaptation to computer environments. Health information held in the CQL-Card is accessed using CQL (Card Query Language), a high level database query language which is a subset of the standard SQL (Structured Query Language). With this language, CQL-Card can be easily integrated into Medical Information Systems.

France↗
PubMed1995

Retrieval from a large, integrated HIS-database through formal descriptions and SQL.

This paper outlines the realization of rich retrieval facilities and comprehensive data administration in an existing, large, integrated Hospital Information System (HIS) using SQL as a query-language and using a large collection of formal data descriptions stored in the Data Dictionary and Directory System (DD/DS). It is emphasized that the approach to enhance the access to the database is more important than the technology. Nevertheless, the facilities are presented that support non-routine retrieval. The Data Dictionary and Directory System functions as a catalog of the information system. The vehicle that facilitates the communication with the database is an implementation of SQL-in a number of appearances. It is stressed that only full benefit can be gained through a combined action of a large integrated HIS, a complete and correct DD/DS, and strong retrieval functions.

Hospital Information Systems↗
PubMed1995

Current trends with natural language processing.

Natural Language Processing in the medical domain becomes more and more powerful, efficient, and ready to be used in daily practice. The needs for such tools are enormous in the medical field, due to the vast amount of written texts for medical records. In the authors' point of view, the Electronic Patient Record (EPR) is achieved neither with Information Systems of all kinds nor with commercially available word processing systems. Natural Language Processing (NLP) is one dimension of the EPR, as well as Image Processing and Decision Support Systems. Analysis of medical texts to facilitate indexing and retrieval is well known. The need for a generation tool is to produce progress notes from menu driven systems. The computer systems of tomorrow cannot miss any single dimension. Since 1988, we've been developing an NLP system; it is supported by the European program AIM (Advanced Informatics in Medicine) within the GALEN and HELIOS consortium and the CERS (Commission d'Encouragement á la Recherche Scientifique) in Switzerland. The main directions of development are: a medical language analyzer, a language generator, a query processor, and dictionary building tools to support the Medical Linguistic Knowledge Base (MLKB). The knowledge representation schema is essentially based on Sowa's conceptual graphs, and the MLKB is multilingual from its design phase; it currently incorporates the English and the French languages; it will also continue using German. The goal of this demonstration is to provide evidence of what exists today, what will be soon available, and what is planned for the long term. Complete sentences will be processed in real time, and the browsing capabilities of the MLKB will be exercised. In particular, the following features will be presented: Analysis of complete sentences with verbs and relatives, as extracted from clinical narratives, with special attention to the method of "proximity processing" as developed in our group and the rule based approach to language description to resolve the specific surface language problems as well as the language independent semantic situations. Comparison of results for English, French, and German sentences, showing the commonalities between these languages and, therefore, the re-usable features and the language specific aspects. Generation of noun phrases in English and French, showing the opportunities for translation between these two languages. Application of the analyzer to build a knowledge representation of ICD under the form of conceptual graphs and presentation of the possibilities of a natural language encoding of diagnosis. Strategies for query processing through a sample of abdominal ultrasonography reports, which have been analyzed and stored under the form of conceptual graphs. Feeding in and browsing of the Medical Linguistic Knowledge Base and other Dictionary Building Tools, using the perspective of an international initiative to converge towards a multilingual universal solution, valid for the medical domain. The demonstration platform is Microsoft Windows 4 on a PC, with Microsoft Visual Basic as the GUI and Quintus Prolog as NLP tools language. The same programs were originally developed for Unix-based workstations and are available on multiple platforms under Motif and X11. .

European Union↗
PubMed1995

SQLGEN: a framework for rapid client-server database application development.

SQLGEN is a framework for rapid client-server relational database application development. It relies on an active data dictionary on the client machine that stores metadata on one or more database servers to which the client may be connected. The dictionary generates dynamic Structured Query Language (SQL) to perform common database operations; it also stores information about the access rights of the user at log-in time, which is used to partially self-configure the behavior of the client to disable inappropriate user actions. SQLGEN uses a microcomputer database as the client to store metadata in relational form, to transiently capture server data in tables, and to allow rapid application prototyping followed by porting to client-server mode with modest effort. SQLGEN is currently used in several production biomedical databases.

Computer Communication Networks↗
PubMed1997

[Some problems due to the questionable indication for prescribing drugs].

Once a diagnosis has been done, prescribers must take into account the indications and method of use of a product before prescribing it. The indications are given in the Product License and noted in the Summary of Product Characteristics. The "RMO" informs on what would be dangerous or useless to prescribe. From now on French prescribers will have in addition to take into account indications admitted to reimbursement by the Sécurité Sociale that might be different from the Product License indications. Various problems will follow: Necessity to establish standardised and classified indications to be used by all. Necessity that this standardisation be at a European level. The indications given in the Product License must be in strict accordance with what is in the dictionary. Necessity for the prescribers to be continuously kept up to date on this dictionary. Risk of differences between general practice and hospital where there is no such opposability. This will affect therapeutic research in France. These problems must be examined as a whole.

Clinical Nursing Research↗
PubMed1998

Clinical application of the UMLS in a computerized order entry and decision-support system.

Vanderbilt University Medical Center uses the UMLS as a dictionary, an interlingua, and a knowledge source within the WizOrder system. WizOrder provides direct care-provider order entry and integrated clinical decision-support capabilities. Linking the two functions enables efficient decision-support during the "normal" workflow of care providers, at the point where decisions are made. WizOrder uses the UMLS as a dictionary to encode free-text entries into controlled vocabularies such as ICD9. As an interlingua, the UMLS provides mapping between vocabularies, allowing to translate patient-specific information to MeSH terms and perform automated literature retrieval. WizOrder uses the tables of co-occurring concepts and the Semantic Network to provide sensible lists of potential drug interactions and adverse drug reactions, and generate fully-formed MEDLINE queries for PubMed.

Decision Support Systems, Clinical↗
PubMed1985

A model for teaching medical ethics.

The approach to teaching employed in the Dictionary of Medical Ethics (1) provides a model which might be adopted in other media. Most of the 150 authors were medical, but many represented other disciplines, and they wrote for similar professionals and for the general public. Medical ethics is derived from medical science and practice, moral philosophy, sociology, theology, the law and other disciplines, all of which make essential, distinctive and complementary contributions to knowledge and to teaching. Medical practitioners must play the primary role, because they are responsible for clinical ethical decisions, but they need the co-operation and guidance of others. All who are concerned should work towards the development of a general moral consensus among the profession and public, which keeps abreast of scientific and technical advances and to which all are committed.

Dictionaries as Topic↗
PubMed1975

Natural language storage and retrieval of medical diagnostic information. Experience at the UCLA hospital and clinics over a 10-year period.

A natural language storage and retrieval system initially designed for pathology reports has been in operation for ten years at UCLA Hospital and Clinics. The original system has been improved to provide a thesaurus processor with added capabilities for expanding search request terms and a newly developed set of search programs with user options that make complex and more accurate retrievals possible. Summarized diagnostic statements or impressions from five specialities (Surgical Pathology, Bone Marrow, Autopsy, Nuclear Medicine, and Neuroradiology), are automatically encoded by referencing a master computer dictionary containing a unique numeric code for each English word. Input and retrievals are batch, off-line operations in free text, and are currently processed on the IBM 370/145. User acceptance is high, quality of retrievals improved, and cost is nominal. This paper describes an expanded natural language system which in now providing a viable form of information storage and retrieval for research, medical education, patient care, quality control, statistics and administrative purposes.

California↗
PubMed1981

The language of Psychiatry.

The knowledge explosion of recent years has generated a language explosion in every field, especially in the behavioral sciences. In addition, existing terms are often used in new, jargonistic, or contradictory ways, and some words have become so popularized that they no longer have validity for scientists. The editor of the fifth edition of the Psychiatric Dictionary tells how terms gain entry into its pages, why some are eliminated, and why some definitions are revised. He discusses how the new categories and nomenclature of the third edition of the Diagnostic and Statistical Manual of Mental Disorders were handled, particularly since clinicians throughout the world have been accustomed to the terminology of DSM-II.

Dictionaries, Medical as Topic↗
PubMed1977

On-line computerized data handling system for treating patients with renal disease.

Some patients with renal disease accrue 6,000 to 8,000 individual data items relating to symptoms, signs, laboratory information, and treatment in one year. To deal with the problem of handling so many data items, the following steps were taken: (1) a dictionary of terms peculiar to nephrology was created; (2) manual time-oriented records for nephrology were constructed; and (3) an on-line data processing system, using a PDP-11/70 computer and remote teleprocessing terminal, was developed. On the terminal screen, up to 11 consecutive patient visits can be displayed horizontally, with 18 data items displayed vertically. Up to 30 of the most recent patient visits are easily accessible. For patient treatment, a special feature allows a rearrangement and instantaneous display of any combination of data, thus permitting review of essential feedback relationships between clinical events and treatment.

Data Display↗
PubMed1984

The adaptation in various languages of standardized periodontal terminology to recent acquisitions.

Before nomenclatorial translation can be begun, an approved definition of the term concerned is required, as is a systematic classification of related designations. Existing sources are bi- or multi-lingual dictionaries and glossaries but relatively few of these cover oral biology and dentistry in adequate detail. Much of the terminology developed for specialized fields of medicine is applicable to dentistry in general and periodontology in particular but the proliferation of new terms in English/American cannot always be matched appropriately in other languages. Examples of a uniform periodontal terminology in English, French and German--prepared for the impending revision of the FDI Dental Lexicon--are tabulated.

Anatomy↗
PubMed1981

An international glossary for primary care. Report of the Classification Committee of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA).

Precise definitions of terms that describe the process of primary care are essential to the collection of primary health care data. Whenever possible, these definitions should be uniform and unambiguous. Research workers who wish to collaborate with or interpret work of colleagues from other countries can benefit from a standard glossary of commonly used health terms. In response to these needs, the Classification Committee of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians present this international glossary for primary care. Consensus on the definitions was reached by the Classification Committee with consultation from general practice-family practice organizations and individuals. Existing primary care glossaries from several countries and the World Health Organization were also consulted. The definitions provided are intended as guidelines, rather than absolute dicta, for primary care providers and researchers who desire comparability. New knowledge, drifts in use of language with time, and new processes will inevitably require revision of definitions and the addition of new terms. A comprehensive dictionary is not intended, but rather terms most commonly used are included. Equivalent terms are enclosed in parentheses with the country or origin bracketed. It should be understood, however, that exact equivalence may not be present. It was not always possible to include fine shades of differences of meaning. For convenience, the male pronouns have been used throughout.

Dictionaries, Medical as Topic↗
PubMed2004

Blinking Sam: the ocular afflictions of Dr. Samuel Johnson.

The poor health of Samuel Johnson (1709-1784) has fascinated the public for more than 200 years. The illnesses of few famous men, with the possible exception of Napoleon, have attracted more speculation. Johnson was an outstanding 18th-century literary figure, an essayist, novelist, and poet, and is particularly famous as the creator of the first important dictionary of the English language. His writings and those of his physicians and friends, particularly his biographer, James Boswell, provide an intimate account of a cultural icon.

Dictionaries as Topic↗
PubMed1994

Mid-term report on the Arden Syntax in a clinical event monitor.

In implementing a clinical event monitor (CEM), a decision-support system, we worked with an existing repository of clinical data (Keystone), fed from ancillary systems using HL7. The rules are written in the Arden Syntax, an ASTM standard for expressing medical knowledge as medical logic modules (MLMs). The Arden Syntax leaves unspecified the clinical data model and deductive database access language; we briefly describe our query language and the related medical concepts dictionary (MCD). This paper gives an overview of our implementation of the Arden Syntax, the MCD and the deductive database access language, with reasons for the major design decisions. Overall, less than a quarter of the development effort has gone into the Arden compiler and interpreter; the rest has focused on accessing the data and integrating with other systems. We feel that the Arden Syntax has proved its worth in writing rules; effort should now be focused on medical vocabularies and data models.

Artificial Intelligence↗
PubMed2005

Experience using MedDRA for global events coding in HIV clinical trials.

OBJECTIVES: To assess the feasibility of coding with MedDRA, the Medical Dictionary for Regulatory Activities, not only serious adverse events required for notification but also all other events usually reported in HIV clinical trials. To develop an approach for MedDRA implementation within an institutional research unit that contributes to an efficient, concise and reproducible event coding. To evaluate the impact of the maintenance and the versioning of this new medical terminology. METHODS: MedDRA versions 3.0 and 5.0 were used for coding hundreds of events reported through two HIV clinical trials. The implementation of MedDRA consisted in the setup of a training program, guidelines to clinical investigators, coding rules and medical validation process. MedDRA version 6.1 was applied to the coding made with the MedDRA version 5.0 in order to identify the assignments affected by the new version and to determine the impact of versioning. RESULTS: Coding with MedDRA all types of events in HIV clinical trials was feasible even though coders experienced some difficulties due mainly to the lack of precision in the investigator verbatim and the high specificity and sensitivity of MedDRA. The addition of appropriate tools to support the use of MedDRA improved significantly the coding of all types of events in HIV clinical trials. The impact of MedDRA versioning was limited and did not result in significant issues. The global implementation process of MedDRA required important resources in terms of qualified personnel, organisation and maintenance. CONCLUSIONS: Guidelines for investigators, coding rules and medical validation appeared to be mandatory for a successful implementation of MedDRA. The use of MedDRA, with the addition of the mentioned support tools, should ensure coding consistency and facilitate the clinical and tolerance analyses and meta-analyses in clinical trials.

Adverse Drug Reaction Reporting Systems↗
PubMed2005

Implementation of automated signal generation in pharmacovigilance using a knowledge-based approach.

Automated signal generation is a growing field in pharmacovigilance that relies on data mining of huge spontaneous reporting systems for detecting unknown adverse drug reactions (ADR). Previous implementations of quantitative techniques did not take into account issues related to the medical dictionary for regulatory activities (MedDRA) terminology used for coding ADRs. MedDRA is a first generation terminology lacking formal definitions; grouping of similar medical conditions is not accurate due to taxonomic limitations. Our objective was to build a data-mining tool that improves signal detection algorithms by performing terminological reasoning on MedDRA codes described with the DAML+OIL description logic. We propose the PharmaMiner tool that implements quantitative techniques based on underlying statistical and bayesian models. It is a JAVA application displaying results in tabular format and performing terminological reasoning with the Racer inference engine. The mean frequency of drug-adverse effect associations in the French database was 2.66. Subsumption reasoning based on MedDRA taxonomical hierarchy produced a mean number of occurrence of 2.92 versus 3.63 (p < 0.001) obtained with a combined technique using subsumption and approximate matching reasoning based on the ontological structure. Semantic integration of terminological systems with data mining methods is a promising technique for improving machine learning in medical databases.

Adverse Drug Reaction Reporting Systems↗
PubMed2002

The role of French-language contributors to the development of medical geography (1782-1933).

In the literature it is L. L. Finke's three volume work Versuch einer aligemeinen medicinisch-praktischen Geographie, 1792-1795, that is commonly cited as the first to use the term "medical geography". However, Rofort's investigations on the 18th and 19th century development of medical topography in France (1987, 1988) has revealed that a French physician, Dehorne, used the term a decade earlier, and in 1784 Dehorne suggested that a project be undertaken by the Royal Medical Society of Paris on a "Medical Geography of France". The proposal was debated in the Journal de Médecine Militaire in 1786. This correspondence probably is the earliest critique of the concept of medical geography. It was also the French who were the first to have entries on medical geography in dictionaries and encyclopedias. Dr. Jean-Noël Hallé wrote a lengthy piece conceptually placing medical geography as a foundation for medical hygienics in Encyclopédie Méthodique (1787, 1792). In 1817 Julien Virey wrote a 66 page entry on medical geography in the Dictionnaire des Sciences Médicales. Throughout the nineteenth century authors writing in the French language continued to make advances and in 1933 the French geographer Max Sorre suggested new directions for the field in the light of bacteriological discoveries and the re-orientation of medicine.

Dictionaries, Medical as Topic↗