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PubMed2001

Building a text corpus for representing the variety of medical language.

Medical language processing has focused until recently on a few types of textual documents. However, a much larger variety of document types are used in different settings. It has been showed that Natural Language Processing (NLP) tools can exhibit very different behavior on different types of texts. Without better informed knowledge about the differential performance of NLP tools on a variety of medical text types, it will be difficult to control the extension of their application to different medical documents. We endeavored to provide a basis for such informed assessment: the construction of a large corpus of medical text samples. We propose a framework for designing such a corpus: a set of descriptive dimensions and a standardized encoding of both meta-information (implementing these dimensions) and content. We present a proof of concept demonstration by encoding an initial corpus of text samples according to these principles.

Documentation↗
PubMed2001

Information needs in primary care: a survey of rural and nonrural primary care physicians.

OBJECTIVE: To compare the self-reported information needs of rural and nonrural primary care physicians. DESIGN AND PARTICIPANTS: Mail survey of active non-academic primary care physicians. DATA COLLECTION: A 60 item questionnaire regarding 1) demographic and practice setting data; 2) medical information needs; 3) medical knowledge resource availability and use; and 4) physician information seeking behavior. MAIN RESULTS: The response rate was higher among rural than non-rural physicians (55% vs. 42%, p< 0.001) and among Family Physicians than others (Family Medicine 53%, Internal Medicine 43%, Pediatrics 48%, p=0.015.) Rural physicians reported working more hours per week (45.3 vs. 42.7, p=0.033,) and seeing more patients per day (24.6 vs. 22.3, p=0.005) than their nonrural counterparts. Both groups reported a median of about 1 question for every 10 patients they see, with great variance among responses. Both groups reported pursuing answers to about 57% of their questions, and finding answers to about 70% of those they pursue. Knowledge resource preferences of the two groups were similar. Both groups reported frequent use of consultants, drug compendia, colleagues, and textbooks, and little use of library- or computer-based sources. Compared to nonrural physicians, rural physicians reported less frequent use of consultants, colleagues, librarians, and bound journals. These differences were small, and paralleled differences in availability. The two groups had equal access to textbooks and drug compendia, but for rural physicians, other resources were locally available significantly less often. CONCLUSIONS: Rural and nonrural primary care physicians reported equal information needs, similar information seeking, and similar resource preferences. Rural physicians reported less access to some information resources, but little difference in use of resources. Further studies are needed to determine how these differences impact rural practitioners and their patients.

Data Collection↗
PubMed2001

Use of handheld computers as bedside information providers.

Access to clinical reference information at the point-of-care is a goal that is difficult to achieve by lack of really portable reference material. Handheld computers have matured to the point where they are powerful enough to be used as clients of a distributed knowledge system serving reference information and decision-aid applications in a highly portable form factor. We describe a pilot project launched at the Geneva University Hospital studying the use of handhelds and associated clinical applications in two internal medicine clinics. Results garnered by this study will help answer the many questions raised by the use of handhelds in medical practice, in term of cost, benefits, risk and change in workflow.

Hospitals, University↗
PubMedDate not supplied

Junior hospital doctors: a weighty issue.

We designed a study to ascertain the weight and type of items carried by junior hospital doctors in their white coats. Sixty consecutive doctors entering the hospital residence were invited to participate, 54 agreed. White coat contents were itemised and weighed. Mean weight carried was 1.63 Kg. Interns and SHOs carried significantly more than registrars (P<0.01) & (P<0.05). Medical specialties carried significantly more than surgical specialties (P<0.05). There were no statistical difference between males and females. 33% carried cigarettes. Junior hospital doctors carry the equivalent of almost two 1Kg bags of sugar with them in their white coats, this added weight may contribute to increased fatigue during long hours on duty. As doctors become more senior they carry less.

Career Mobility↗
PubMed2001

Carl von Rokitansky and the Italian translation of the Handbuch der Pathologischen Anatomie: a linguistic and doctrinal enigma.

Carl von Rokitansky was the author of a treatise that came out between 1842 and 1846 with the title Handbuch der Pathologischen Anatomie. A historical milestone in pathological anatomy, Rokitansky's work represented the first attempt to systematically classify pathological specimens. Its publication inevitably made a great impact on Vienna, at that time the major European medical centre. The Italian translation of Rokitansky's masterpiece, Trattato Completo di Anatomia Patologica, published in Venice in 1852, was carried out by Ricchetti and Fano: the former a philologist and the latter a Triestine physician who, in 1873, had worked at Simon Pertot's side, the first prosector to be assumed in Trieste. From the start, the two translators not only made no secret of the linguistic obstacles they came up against, but also how unconvincing Rokitansky's doctrines were; a scepticism emerged from their words that inevitably contributed to the realization of a translation difficult to read. Undoubtedly, Rokitansky elaborated a theory of disease containing a certain degree of unclarity and in this respect it is interesting to emphasize that even the English translation, Manual of Pathologic Anatomy (1849-1854), demonstrated similar conceptual problems. A convinced supporter of gross pathology, Rokitansky put forth a theory of disease, the so-called Krasenlehre, resting upon humoral doctrines. This new knowledge inevitably exerted a great influence over Viennese, as well as German, medicine. Rokitansky's humoral pathology survived until the 1850s, when it was attacked by young Virchow, the future, universally recognized, father of cellular pathology, who definitively extinguished speculative humoral pathology.

Anatomy↗
PubMed2001

Presentation of problem-specific, text-based medical knowledge: XML and related technologies.

Systematic reviews of the impact of clinical decision support systems on provider behavior and patient outcome have shown evidence of benefit. Knowledge-based functions for decision support or monitoring that are integrated in clinical information systems are a potentially effective way. But these concepts are restricted by the efforts required for development and maintenance of the information systems and the limited number of implemented medical rules. Physicians are familiar to get their information from text-based sources. It seems to be straight-forward to rely on a document-based solution in order to present problem-specific information at the point of care. We have developed a concept for context-sensitive retrieving and presentation of text-based medical knowledge (textbook of internal medicine) using the eXtensible Markup Language (XML) and related technologies. This concept can facilitate the electronic query and presentation of this resource. XML may replace narrative text as a storage format and allows to structure the data in a stepwise fashion. On the basis of structured data we are able to improve the search quality for clinical information and its presentation which forms a crucial pre-requisite for the use of the information and the implementation of evidence-based care in the clinical routine.

Decision Support Systems, Clinical↗
PubMed2001

PDA support for outpatient clinical clerkships: mobile computing for medical education.

This project provides educational support for students enrolled in a family practice clerkship by supplying PDA-based clinical references and tools to collect information about the patients they see and the seminars they attend. Each student is supplied with a Handspring Visor Deluxe to use during the clerkship. Supplied software includes a clinical reference (Five Minute Clinical Consult) and Lexidrugs drug reference and a medical calculator. The data collection software consists of a patient log for recording simple demographic and diagnostic information about each patient seen during the clerkship, a seminar evaluation module for recording student feedback about each didactic presentation during the course, and an evaluation form where they students supply their reactions to the use of the Visor. Despite encountering a number of problems, the devices appear to be beneficial tools. The applications provide useful references for students who do not have access to the resources of the University in their family medicine clerkship. They also provide an improved, though not perfect, means to capture data regarding patient encounters and course evaluations. However, the challenge remains to better integrate the PDA with the student s workflow in the clinic.

Ambulatory Care↗
PubMedDate not supplied

Practical aspects in drawing up a quality handbook in radiotherapy.

The quality and dimensions of the Quality Handbook in healthcare are shortly defined. Particular emphasis is put on the role of the quality of compliance and on certification (ISO 9000). The role of quality assessment in healthcare processes is described. It is not conceived as an inspection but rather as an incentive to a continuous quality improvement in healthcare processes. Within the quality of compliance, the role of the Quality Handbook and its modalities of definition, organization and implementation are illustrated.

Certification↗
PubMedDate not supplied

Quality handbook in radiotherapy: personal experience.

The Quality Handbook includes the description of the activities carried out in Radiotherapy and the methodology used to ensure the Quality Assurance according to the principles indicated in national and international documents of reference and the recommendations of accreditation agencies. The structure of the Quality Handbook, the main aspects of single chapters, the selected quality indicators undergoing inspections are analysed and procedures to be followed for changes and updating of the Quality Handbook are described. The Quality Assurance program is illustrated in another article of this issue.

Humans↗
PubMedDate not supplied

Quality handbook in radiotherapy. Brachytherapy: personal experience.

Brachytherapy is a conventional method of radiation therapy characterized by peculiar technical, clinical, operational and radioprotection problems. Therefore, the management of a service or department of brachytherapy requires a specific organization aimed at Quality Assurance. In this report, the personal experience with the drawing up of a Quality Handbook of brachytherapy with reference to the method used and the structure of the document, is described.

Brachytherapy↗
PubMed2002

Metabolic, nutritional, iatrogenic, and artifactual sources of urinary organic acids: a comprehensive table.

BACKGROUND: The determination of organic acids and glycine conjugates in urine is key for the diagnosis and follow-up of several inborn errors of metabolism (IEM). However, clinical interpretations may still be hindered by ambiguity in the sources of some urinary organic acids and acylglycines as well as in the relationship between their excretion and IEM. APPROACH: Relevant data have been compiled from major books and references on the topic and by exhaustive bibliographic searches through the Medline and Current Contents databases. CONTENT: A comprehensive table has been designed according to organic acids and conjugates. This table is intended to assist in the interpretation of organic acid profiles because, in addition to IEM, it also refers to other pathologic causes and to physiologic, nutritional, iatrogenic, and artifactual sources. Some preanalytical issues, including possible misinterpretations, are reviewed with regard to IEM.

Artifacts↗