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Codes, classifications, terminologies and nomenclatures: definition, development and application in practice.

The Primary Care Informatics Working Group of EFMI is working to help develop the core theory of primary care informatics (PCI). Codes, classifications, terminologies and nomenclatures form an important part of the science of PCI, as they allow clinical information to be readily stored and processed in information systems. This article provides definitions and a history of the International Classification for Primary Care (ICPC), and of the Read code and the Systematized Nomenclature for Medicine (SNOMED). The Working Group wishes to encourage shared definitions and an understanding of the practical application of structured data to improve quality in clinical practice.

Ambulatory Care Information Systems↗

Age terminology during the perinatal period.

Consistent definitions to describe the length of gestation and age in neonates are needed to compare neurodevelopmental, medical, and growth outcomes. The purposes of this policy statement are to review conventional definitions of age during the perinatal period and to recommend use of standard terminology including gestational age, postmenstrual age, chronological age, corrected age, adjusted age, and estimated date of delivery.

Gestational Age↗

Latino/"Hispanic"--who needs a name? The case against a standardized terminology.

Public health specialists, policy makers, social scientists, and politicians, for different reasons, have welcomed the "Hispanic" label. The label presumably identifies an ethnic group that is also a minority group (i.e., a group historically subject to economic exploitation and racial discrimination). Consequently, its consistent use by federal and state agencies would produce large quantities of comparable data useful for research, and for policy making and implementation. Critics have argued that the label is racist, it mystifies the real reasons for the disproportionately high proportion of people of Mexican and Puerto Rican descent in disadvantaged social and economic conditions, and stands in the way of a fair implementation of affirmative action. Latino, a race-neutral term with historical roots, has been suggested as an alternative to be used in conjunction with national origin or regional forms of self-identification. In this article, I argue that any standardized terminology is unavoidably flawed and conducive to the development of racist or, at best, trivial stereotypical analysis of the data thus produced. The "Hispanic" label does not identify an ethnic group or a minority group, but a heterogeneous population whose characteristics and behavior cannot be understood without necessarily falling into stereotyping. The label should be abandoned; social scientists and policy makers should, instead, acknowledge the existence of six aggregates, qualitatively different in their socioeconomic stratification, needs, and form of integration in the U.S. economy: two minority groups (people of Mexican and Puerto Rican descent), and four immigrant populations (Cubans, Central American refugees, Central American immigrants, and South American immigrants).

Ethnopsychology↗

Light-hearted negative terminology used in computer education and related skill of noncomputer users.

Theory suggests that light-hearted but negative phrases and terminology used in computer literature and course titles may have a negative effect on noncomputer users. This study tested the effect of providing the suggestion of a negative dimension of computer ability labelled with a category of "Computer Dummy" a also the relation between computer ability and computer anxiety. The study incorporated 37 noncomputer users, 17 men and 20 women whose mean age was 52.1 yr. Scores on a self-report questionnaire indicated that 23 of the nonusers responded on the negative dimension of computer ability and included themselves in the category of "Computer Dummy." Also, belief about ability and belief about computer training were associated with computer anxiety for noncomputer users.

Adult↗

Hypolactasia and lactase persistence. Historical review and the terminology.

Lactase (more precisely lactase-phlorizin hydrolase) is located in the brush border of the small intestinal enterocytes and is responsible for the hydrolysis of dietary lactose. The earliest studies on lactase activity in mammals were published around the turn of the century. In 1903, it was found that the dog had a very low lactase activity and therefore lactose remained unhydrolysed, causing diarrhoea. Human hypolactasia was demonstrated in 1963, and it was soon found that it is very common, commoner than lactase persistence in most parts of the world. In 1973, adult-type hypolactasia was shown to be inherited by an autosomal recessive single gene. This article reviews the early expansion of the knowledge on lactase and hypolactasia as well as the correct terminology.

Animals↗

Terminology for drug injection practices among intravenous drug users in Baltimore.

Terms for four discrete drug injection practices were obtained by presenting photographs and a brief description of practices to intravenous drug users who enrolled in a longitudinal study of HIV infection in Baltimore. The 2,921 respondents were predominantly male (81%) and Black (90%), the median age was 34 years (range: 18-68 years), and the median duration of intravenous drug use was 13 years (range 0-50 years). Forty-six different terms were used to characterize direct injection into a vein, 51 for the practice of repeatedly withdrawing and reinjecting one's own blood following injection of drug, 39 for subcutaneous injection, and 45 for transferring drug between different syringes. Terms tended to cluster by race and duration of drug use. These data indicate substantial variation in terminology for drug injection practices. Further, they augment prior research showing that photographs may be used as a useful aid in survey research on drug experiences in the population.

Adolescent↗

Valuing neurosurgery services: part I. The historical development and interrelationships of current procedural terminology and the medicare fee schedule.

Current Procedural Terminology (CPT) standardizes medical procedure coding for billing and reimbursement. Since adoption of CPT coding as the basis for the Medicare Fee Schedule (MFS) in 1992, CPT coding policies and policy changes have been influenced not only by medical necessity and customary practice, but also increasingly by Medicare payment policies. The MFS created regulatory price control in the United States medical market based on widespread adoption of modified MFS by private payers and benchmark MFS fees governed by federal budget limitations and set annually by government agency (Centers for Medicare and Medicaid Services).

Fee Schedules↗

Toward an agreement on terminology of nuclear and subnuclear divisions of the motor thalamus.

The nomenclature most commonly applied to the motor-related nuclei of the human thalamus differs substantially from that applied to the thalamus of other primates, from which most knowledge of input-output connections is derived. Knowledge of these connections in the human is a prerequisite for stereotactic neurosurgical approaches designed to alleviate movement disorders by the placement of lesions in specific nuclei. Transfer to humans of connectional information derived from experimental studies in nonhuman primates requires agreement about the equivalence of nuclei in the different species, and dialogue between experimentalists and neurosurgeons would be facilitated by the use of a common nomenclature. In this review, the authors compare the different nomenclatures and review the cyto- and chemoarchitecture of the nuclei in the anterolateral aspect of the ventral nuclear mass in humans and monkeys, suggest which nuclei are equivalent, and propose a common terminology. On this basis, it is possible to identify the nuclei of the human motor thalamus that transfer information from the substantia nigra, globus pallidus, cerebellum, and proprioceptive components of the medial lemniscus to prefrontal, premotor, motor, and somatosensory areas of the cerebral cortex. It also becomes possible to suggest the principal functional systems involved in stereotactically guided thalamotomies and the functional basis of the symptoms observed following ischemic lesions in different parts of the human thalamus.

Afferent Pathways↗

Toward an agreement on terminology of nuclear and subnuclear divisions of the motor thalamus.

The nomenclature most commonly applied to the motor-related nuclei of the human thalamus differs substantially from that applied to the thalamus of other primates, from which most knowledge of input-output connections is derived. Knowledge of these connections in the human is a prerequisite for stereotactic neurosurgical approaches designed to alleviate movement disorders by the placement of lesions in specific nuclei. Transfer to humans of connectional information derived from experimental studies in nonhuman primates requires agreement about the equivalence of nuclei in the different species, and dialogue between experimentalists and neurosurgeons would be facilitated by the use of a common nomenclature. In this review, the authors compare the different nomenclatures and review the cyto- and chemoarchitecture of the nuclei in the anterolateral aspect of the ventral nuclear mass in humans and monkeys, suggest which nuclei are equivalent, and propose a common terminology. On this basis, it is possible to identify the nuclei of the human motor thalamus that transfer information from the substantia nigra, globus pallidus, cerebellum, and proprioceptive components of the medial lemniscus to prefrontal, premotor, motor, and somatosensory areas of the cerebral cortex. It also becomes possible to suggest the principal functional systems involved in stereotactically guided thalamotomies and the functional basis of the symptoms observed following ischemic lesions in different parts of the human thalamus.

Afferent Pathways↗

Clarifying adverse drug events: a clinician's guide to terminology, documentation, and reporting.

Adverse drug events cause substantial morbidity and mortality, yet they remain underappreciated and misunderstood. The terminology to describe errors and patient harm associated with medications causes much confusion. This article uses the case study of a patient with multiple adverse drug events to clarify key terms, such as adverse event, adverse drug reaction, adverse drug event, medication error, and side effect. The case discussion illustrates clinical approaches to analyzing the causal connection between a suspect drug and an adverse event. Examples and rationale for meaningful documentation of adverse drug events are provided, along with an outline of the types of events that should be reported to regulatory agencies.

Adverse Drug Reaction Reporting Systems↗

Epilepsy and seizure classification in 63 dogs: a reappraisal of veterinary epilepsy terminology.

The human definitions of epilepsy and seizure classification were applied rigidly to epileptic dogs to investigate whether the distribution of the seizure types and epilepsies of dogs is comparable to that of human beings. Sixty-three dogs were referred because of recurrent (> 2) epileptic seizures. Only dogs without previous or ongoing antiepileptic treatment were included. All dogs had a physical and neurologic examination and blood work that included a CBC and a biochemical profile. All owners were asked to complete a questionnaire, focusing on seizure development. In addition, video recordings of suspected seizure episodes were analyzed if available. In the majority of dogs where an intracranial lesion was suspected, a computerized tomography scan was performed. Sixty-five percent of the dogs experienced partial seizures with or without secondary generalization and 32% exhibited primary generalized seizures; in 3% of the dogs the seizures could not be classified. Twenty-five percent of these cases were classified as idiopathic, 16% as symptomatic, and 45% as cryptogenic epilepsy; in 14% of these a classification was not possible. Applying human definitions, the distribution of seizure types and epilepsy classifications in these dogs differed widely from those in previous reports of canine epilepsy, where generalized seizures and idiopathic epilepsy were most frequently reported. However, our findings are consistent with the results of several large studies of human epilepsy patients. In dogs with epilepsy, closer attention must be given to the detection of a partial onset of seizures. In this study, detailed questioning of the owners and when possible analysis of video recorded seizures, proved to be sufficient for diagnosing seizures with a partial onset in a significant number of dogs. Partial onset of seizures may be an indication of underlying cerebral pathology. Some adjustments of veterinary epilepsy terminology are suggested.

Animals↗

Computer-based medical terminology and knowledge representation.

This paper briefly summarizes the characteristics of a computer-based medical terminology constructed by the author. Its size is around 140,000, systematized by meaning using a single attribute as key: similarity among instances covered by the term. This systematization resulted in a single hierarchical tree. Initial term typing was based on the knowledge patterns of the terms, represented by the arcs (relationships) among terms (nodes). Six different types of medical terms could be identified. For coding of a medical term, its position on the hierarchical tree was used, the semantic address. It is recommended that the semantic address should be used for worldwide compatibility.

Artificial Intelligence↗

Models for representation of terminologies and coding systems in medicine.

Unification of medical coding systems is a perceived need involving a long-term task. Standards will support convergence of present coding systems towards a coherent set of tools. The Project Team "Model for Representation of Semantics" (CEN/TC251/PT003-MOSE) modeled existing tools to obtain a vocabulary apt to describe coding systems and terminologies. Requirements on faithfulness and safety, usefulness and purposiveness, coherence and integration were worked out, and the MOSE's 10 key principles for Standards in Medical Semantics were established.

Disease↗

A compositional approach to nursing terminology.

The development of standardised vocabularies within nursing has been an important research activity for a number of years. Current representations generally take the form of taxonomic vocabularies. These are seen as important as they provide a structure for retrieving and analysing data from automated systems. However, there is increasing evidence to show that traditional taxonomic vocabularies are unsuitable for capturing detailed clinical data. This paper describes how GRAIL (GALEN Representation and Integration Language) is being used within the TELENURSE project to develop a representation of nursing terminology which is sufficiently expressive for documenting detailed clinical data while retaining the benefits of traditional taxonomic vocabularies.

Classification↗

[Fibrous dysplasia of renal arteries (terminology, classification, clinical aspects and diagnosis)].

The examination was conducted in 72 patients with renovascular hypertension caused by fibromuscle dysplasia of the renal arteries. According to the authors, fibromuscle dysplasia of the renal arteries stands third after atherosclerosis and non-specific aorto-arteritis. Among the preliminary diagnostic measures of importance are such as intravenous urography, isotope renography, scintigraphy, but their value is much lower than in cases of atherosclerotic stenosis or stenosis due to non-specific aorto-arteritis, which is attributed to a good collateral circulation in the kidney. The diagnosis is made on the basis of serial angiography data. Of importance is also the method of selective renal angiography with functional tests with acetylcholoine and adrenalin. To characterize the form of renal artery pathology, three types of stenosis are distinguished: monofocal, multifocal, tubular. The terminology and classification are discussed, and a new term is suggested: "fibrous dysplasia of renal arteries".

Adolescent↗

[Disinfection chambers: Classification and terminology].

To draw up a scientifically-grounded classification of and terminology for the chamber-type disinfection equipment a classificational scheme of notions has been worked out, the most essential characteristics were laid at its basis, such as operational conditions, the shape of the working chamber, the method of charging and disinfection, as well as heating the chamber.

Classification↗

[Surgical sepsis-definition of the notion. Problems of terminology].

The problems of terminology are discussed, as well as classification and definition of sepsis. Comparative analysis of traditional for our country and up-to-date foreign classifications is carried out. The criteria for diagnosis of sepsis are discussed. On the basis of 20-year experience in examination and treatment of patients with sepsis, the authors set forth their own stand, suggesting two varieties of sepsis for consideration: common complication of surgical infection, a rare disease.

Humans↗