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Methods for semi-automated indexing for high precision information retrieval.

OBJECTIVE: To evaluate a new system, ISAID (Internet-based Semi-automated Indexing of Documents), and to generate textbook indexes that are more detailed and more useful to readers. DESIGN: Pilot evaluation: simple, nonrandomized trial comparing ISAID with manual indexing methods. Methods evaluation: randomized, cross-over trial comparing three versions of ISAID and usability survey. PARTICIPANTS: Pilot evaluation: two physicians. Methods evaluation: twelve physicians, each of whom used three different versions of the system for a total of 36 indexing sessions. MEASUREMENTS: Total index term tuples generated per document per minute (TPM), with and without adjustment for concordance with other subjects; inter-indexer consistency; ratings of the usability of the ISAID indexing system. RESULTS: Compared with manual methods, ISAID decreased indexing times greatly. Using three versions of ISAID, inter-indexer consistency ranged from 15% to 65% with a mean of 41%, 31%, and 40% for each of three documents. Subjects using the full version of ISAID were faster (average TPM: 5.6) and had higher rates of concordant index generation. There were substantial learning effects, despite our use of a training/run-in phase. Subjects using the full version of ISAID were much faster by the third indexing session (average TPM: 9.1). There was a statistically significant increase in three-subject concordant indexing rate using the full version of ISAID during the second indexing session (p < 0.05). SUMMARY: Users of the ISAID indexing system create complex, precise, and accurate indexing for full-text documents much faster than users of manual methods. Furthermore, the natural language processing methods that ISAID uses to suggest indexes contributes substantially to increased indexing speed and accuracy.

Abstracting and Indexing↗

An image retrieval system based on fractal dimension.

This paper presents a new kind of image retrieval system which obtains the feature vectors of images by estimating their fractal dimension; and at the same time establishes a tree-structure image database. After preprocessing and feature extracting, a given image is matched with the standard images in the image database using a hierarchical method of image indexing.

Abstracting and Indexing↗

Medicare program; schedule of limits on home health agency costs per visit for cost reporting periods beginning on or after July 1, 1989--HCFA. Final notice.

This final notice sets forth a revised schedule of limits on home health agency costs that may be paid under the Medicare program. This revised schedule of limits applies to cost reporting periods beginning on or after July 1, 1989 and before July 1, 1991. As required by section 6222 of the Omnibus Budget Reconciliation Act of 1989 (Pub. L. 101-239), the revised schedule of limits incorporates the hospital wage index in effect for cost reporting periods beginning prior to July 1, 1989.

Abstracting and Indexing↗

Health and efficiency.

Measuring efficiency is essential but purchasers and providers should treat the perverse incentives of the efficiency index with caution, warn John Appleby and Val Little.

Abstracting and Indexing↗

Medical care price indexes: theory, construction & empirical analysis of the US series 1927-1990.

The historical development of price indexes as wage adjustment mechanisms is reviewed, as is the theory of aggregation and methods for dealing with quality and technological change. The construction of the U.S. Bureau of Labor Statistics (BLS) Medical Care Price Index (MCPI) is detailed. ARIMA analysis of the MCPI for the period 1927-1990 indicates that; (i) the MCPI is largely a damped and delayed function of the CPI, with an average lag of 8 months; (ii) medical care prices rose 2-4 percent faster than the all-items CPI since 1950, but not for 1927-1950; (iii) health expenditures are affected primarily by the general CPI, with little independent effect of specifically medical prices. The MCPI is a reliable measure of changes in consumer prices with strong construct validity. However, it was not designed for use as a deflator of medical expenditures, and is misleading when erroneously employed in that unintended role. The price/quantity duality and linear expenditure function which form the basis of Laspeyres price indexes are not applicable to nonconcatenable goods such as insurance or medical care. In these complex transactions, quality dominates quantity, fixed prices are replaced by reimbursement and professional judgement, and the assumption of additive separability required to use the price index as a deflator of health expenditures is not valid.

Abstracting and Indexing↗

IndexFinder: a method of extracting key concepts from clinical texts for indexing.

Extracting key concepts from clinical texts for indexing is an important task in implementing a medical digital library. Several methods are proposed for mapping free text into standard terms defined by the Unified Medical Language System (UMLS). For example, natural language processing techniques are used to map identified noun phrases into concepts. They are, however, not appropriate for real time applications. Therefore, in this paper, we present a new algorithm for generating all valid UMLS concepts by permuting the set of words in the input text and then filtering out the irrelevant concepts via syntactic and semantic filtering. We have implemented the algorithm as a web-based service that provides a search interface for researchers and computer programs. Our preliminary experiment shows that the algorithm is effective at discovering relevant UMLS concepts while achieving a throughput of 43K bytes of text per second. The tool can extract key concepts from clinical texts for indexing.

Abstracting and Indexing↗

An automatic indexing method for medical documents.

This paper describes MetaIndex, an automatic indexing program that creates symbolic representations of documents for the purpose of document retrieval. MetaIndex uses a simple transition network parser to recognize a language that is derived from the set of main concepts in the Unified Medical Language System Metathesaurus (Meta-1). MetaIndex uses a hierarchy of medical concepts, also derived from Meta-1, to represent the content of documents. The goal of this approach is to improve document retrieval performance by better representation of documents. An evaluation method is described, and the performance of MetaIndex on the task of indexing the Slice of Life medical image collection is reported.

Abstracting and Indexing↗

Mapping the literature of health education.

Health education is a relatively new multidisciplinary field concerned with educational programs that empower individuals and communities to play active roles in achieving, protecting, and sustaining their health. Its practitioners have bachelor's, master's, or doctoral degrees and work in educational, worksite, health facility, or agency settings. This bibliometric study was part of the Medical Library Association (MLA) Nursing and Allied Health Resources Section's Project for Mapping the Literature of Allied Health. It sought to identify the core journals in health education and to determine the extent to which these titles are covered by the standard indexing sources. Cited references appearing from 1991 through 1993 in articles of four journals published by the major professional associations in the field were analyzed. It was found that only thirteen journals supply one-third of all references in the study. Another eighty journals provide the second third. MEDLINE gives the best indexing coverage with nearly 69% of the journals receiving indexing for at least half of their articles, followed by EMBASE (52%) and PsycINFO (43%). Limited coverage is given by the Cumulative Index to Nursing and Allied Health Literature (16%) and ERIC (14%). The findings name titles that should be added by indexing services and those that should have more complete coverage.

Abstracting and Indexing↗

Development and testing of a systemic lupus-specific risk adjustment index for in-hospital mortality.

OBJECTIVE: Valid comparison of patient outcomes among hospitals requires adjustment for differences in the severity of patients' illness. Disease-specific indexes of severity of illness may permit more accurate risk adjustment than generic indexes. The objective of this study was to develop a systemic lupus-specific risk adjustment index for in-hospital mortality, and to compare its performance to that of the generic Charlson index. METHODS: A systemic lupus-specific risk adjustment index was developed using discharge abstract data from a 50% random sample (n = 4994) of patients with systemic lupus erythematosus (SLE) hospitalized on an emergent or urgent basis in California from 1991 to 1994 (n = 9989). The index was tested on the remaining members of the sample. Candidate variables for the index were the diagnoses included in the original Charlson index, and nephritis, chronic renal failure, pericarditis, pleuritis, psychosis, seizures, hemolytic anemia, and thrombocytopenia. Multivariate logistic regression analysis was used to identify the set of variables that best differentiated those patients who died in the hospital from those who survived, and to provide the weights for construction of the index. RESULTS: In the derivation set of patients, the SLE-specific index accurately predicted in-hospital mortality (area under the receiver operating characteristic curve c = 0.79). In the test set, the SLE-specific index (c = 0.72) was similar to the original Charlson index (c = 0.74) in its ability to predict in-hospital mortality (p = 0.32). However, the SLE-specific index accounted for substantially more variation in the risk of mortality among patients (R2 = 0.069) than did the Charlson index (R2 = 0.036). Use of the SLE-specific index rather than the Charlson index for risk adjustment did not alter the association between hospital experience and the probability of in-hospital mortality. Results were similar in the subgroups of patients with emergent hospitalizations and those with emergent hospitalizations due to SLE. CONCLUSION: The SLE-specific risk adjustment index developed from diagnoses recorded in administrative discharge abstracts performed similarly to the generic Charlson index in correctly classifying mortality outcomes, but the SLE-specific index stratified patients by their level of risk of mortality better than the Charlson index. Adjustment for SLE-specific risks of mortality did not alter the association between hospital experience and the risk of in-hospital mortality.

Adolescent↗

Relationship between serum sex hormones and the glucose-insulin-lipid defect in men with obesity.

It has been hypothesized that an alteration in the sex hormone milieu may underlie coronary heart disease (CHD) and its risk factors. Leading to this hypothesis and important to it was the observation that serum testosterone level correlated negatively and the estradiol to testosterone ratio (E/T) correlated positively with serum insulin and glucose levels in non-obese men. As a test of the validity of this observation, the present study was conducted to investigate these correlations in men with obesity. Obesity in men is associated with hyperestrogenemia, hypotestosteronemia, hyperinsulinemia, hyperglycemia, and CHD. To determine whether the relationships between sex hormone levels and insulin and glucose levels found in non-obese men also occur in obese men independent of obesity, fasting levels of these substances, as well as free testosterone (FT) and sex-hormone-binding globulin (SHBG), were measured in 55 obese men aged 21 to 70. Correlation coefficients of sex hormones with other risk factors for CHD, ie, cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), blood pressure, and waist to hip circumference ratio (W/H), were also calculated. As found previously, testosterone level correlated negatively with insulin (r = -.31, P = .01) and glucose (r = -.23, P < .05) levels and the insulin to glucose ratio ([I/G] r = -.26, P < .05), and E/T correlated positively with insulin (r = .41, P = .001) and glucose (r = .24, P < .05) levels and I/G (r = .37, P < .005). The above correlations were controlled for body mass index (BMI) and age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Medicare program; limited additional opportunity to request certain hospital wage data revisions for FY 1999--HCFA. Final rule with comment period.

This final rule with comment period provides hospitals with a limited additional opportunity to request certain revisions to their wage data used to calculate the FY 1999 hospital wage index. In addition, it explains the criteria that must be met to request a revision, the types of revisions that will be considered, the procedures for requesting a revision, the implementation of wage index revisions, and other related issues. Requests for wage data revisions must be received by the date and time specified in the "DATES" section of this preamble. We will implement revisions to the hospital wage index in accordance with this final rule with comment period on a prospective basis only.

Abstracting and Indexing↗

Mapping the literature of dental hygiene.

Despite the long history of the dental hygiene profession, little research has been conducted on the characteristics of its literature. In this study, the bibliometric method was used to identify the core journals in the discipline and the extent of indexing of these journals. The study was a part of the Medical Library Association (MLA) Nursing and Allied Health Resources Section's project to map the allied health literature. Five journals were found to provide one-third of all references studied. Forty-two journals yielded an additional one-third of the references. MEDLINE had the best indexing coverage with 87% of the journals receiving indexing for at least one-half of the articles included. Limited coverage was provided by EMBASE/Excerpta Medica (11%) and the Cumulative Index to Nursing and Allied Health Literature (9%). The findings identified titles that should be added by indexing services as well as those that should have more complete coverage.

Abstracting and Indexing↗

Mapping the literature of occupational therapy.

Occupational therapy, formally organized in the United States in 1917, is considered an allied health field. Mapping occupational therapy literature is part of a bibliometric project of the Medical Library Association's Nursing and Allied Health Resources Section's project for mapping the literature of allied health. Three core journals were selected from the years 1995 and 1996 and a determination was made of the extent to which the cited journal references were covered by standard indexing sources. Using Bradford's Law of Scattering three zones were created, each containing approximately one-third of the cited journal references. The results showed that three journals made up the first zone, 117 journals the second, and 657 the third. The most cited journal was the American Journal of Occupational Therapy. In the second zone, journals from twelve disciplines were identified. While MEDLINE provided the best overall indexing, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) was the only database that indexed the three most cited journals plus nine of the currently active titles in occupational therapy. MEDLINE could improve its coverage of occupational therapy by indexing the journals of the British, Canadian, and Australian national associations.

Abstracting and Indexing↗

Combining voice recognition and automatic indexing of medical reports.

Medical records have been evolving from the traditional paper-based records to digital ones, from the method of dictating reports and transcription to voice recognition systems. The transition to digital operations will not be complete until we have the ability to combine voice recognition with automated indexing of texts. This paper introduces the methods we used to evaluate existing voice recognition software programs and presents NOMINDEX, a system that turns a medical text into MeSH codes, using the French ADM lexical database. Those systems were applied to 28 patient discharge summaries in French, produced after a coronarography, and extracted from the MENELAS corpus of texts. Using the best configuration for voice recognition, the rate of accurate recognition exceeds 98 percent. Among the indexing concepts assigned by NOMINDEX, 25 percent were not pertinent and 12 percent of the relevant concepts were missing. Most errors were related to confusion between common language and medical language, and to the coverage of the ADM lexical database. Best results would be expected with a more comprehensive lexical resource In addition, only 3 percent of the errors generated by inadequate voice recognition that remained in the configuration that performed better, impacted on automatic indexing by NOMINDEX.

Abstracting and Indexing↗