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PubMedDate not supplied

Automated diagnostic indexing by natural language processing.

Developing tools for natural language understanding by computers represents an important and intense field of research. This paper describes a system developed for interpreting medical natural language in the domain of symptoms and diagnoses from complete discharge summaries and locating the correspondent category into the International Classification of Diseases, through indexing by the Systematized Nomenclature of Medicine. The indexing program makes use of the MEID dictionary and some auxiliary semantic databases for identifying adjectival forms, synonyms, hypernyms and other semantic relations while searching for the longest consistent match into SNOMED. A further subdivision of the SNOMED structure was also proposed in order to find the hierarchically superior representative of a conceptual class when this association is not assigned by the related SNOMED code number. The system can be used by any language that possesses a translation of SNOMED and ICD. The knowledge base was built using a conversion file that maps the terms of the nomenclature into the classification, which can be improved by learning from users.

Abstracting and Indexing↗
PubMedDate not supplied

A database manager of biomedical images.

In order to allow an efficient archiving and retrieval of biomedical images, PACS would include an image DBMS. As biomedical images have complex structures we developed a specific DBMS over a relational one. The medical image database manager ensures a data description that takes into account data semantics so that consistency or existential constraints may be verified. It provides a unique language to retrieve images no matter what their storage format. It encompasses the queries of the user which constitute a filter over associated data. The manager can handle changes in the environment of the image. We implemented a manager prototype to show the validity of logical access possibilities. The user need no longer know the structure of the image database to access data. The logical access allows retrieval of images, whatever the architecture of the base. An automatic query construction consists of three functional levels including the interfaces towards the external environment which ensure a logical independence from the database, a query generator which creates the correspondence between the user's query and physical access queries, a dictionary which contains the structure of the image data and consistency constraints.

Computer Systems↗
PubMedDate not supplied

Data model management in a clinical service: application in an echography unit for tocho-gynaecology.

The organization and management of clinical information must take place according to the classical concept of department section or specialty area. Traditional organization and communication models must be respected, and those to be executed by the computer system must be developed on top of them. Information models that describe the organic structure of any specialty area must be proposed independently from the content and with the possibility of particularizing in each case. Taking these specifications into account and using our general entity relationship model for a specialty service, we present the description of the 'central clinical services function, particularizing for an echography unit within a tocho-gynaecology area. We present entity and relationship tables, data dictionary and organization and description of the basic user views.

Hospital Information Systems↗
PubMedDate not supplied

A web-based data collection system for clinical studies using Java.

Data collection in multi-centre controlled clinical trials is a major problem. We describe a web-based documentation system for data collection via the Internet we have developed in Java. It keeps both the platform independent program (a Java applet) and the database on a single server to which the participating centres have access at any time. It is based on a three-tier model where client requests are handled and monitored by an application server (a Java application). We show the advantages such a system has over the HTML/CGI combination which is often used for database access, as well as possible extensions, e.g. connection to a data dictionary. Finally, we discuss the security problems which arise by the use of the Internet for data collection.

Data Collection↗
PubMed2005

Tablet computers in the veterinary curriculum.

Tablet computers offer a new method of information management in veterinary medical education. With the tablet computer, students can annotate class notes using electronic ink, search for keywords, and convert handwriting to text as needed. Additional electronic learning resources, such as medical dictionaries and electronic textbooks, can be readily available. Eleven first-year veterinary students purchased tablet computers and participated in an investigation of their working methods and perceptions of the tablet computer as an educational tool. Most students found the technology useful. The small size and portability of the tablet allowed easy transport and use in a variety of environments. Most students adapted to electronic notetaking by the second week of classes; negative experiences with the tablet centered on a failure to become comfortable with taking notes and navigating on the computer as opposed to writing and searching on paper. A few performance-related problems, including short battery life, were reported. Tablet software allowed conversion of faculty course notes from a variety of original formats, meaning that instructors could maintain their original methods of note preparation. Adopting a consistent naming convention for files helped students to locate the files on their computers, and smaller file sizes helped with computer performance. Collaboration between students was fostered by tablet use, which offers possibilities for future development of collaborative learning environments.

Attitude to Computers↗
PubMed2006

Anagram software for cognitive research that enables specification of psycholinguistic variables.

Anagram tasks are frequently used in cognitive research, and the generation of new scrambled letter combinations is a task well suited to a software solution. Most available programs, however, do not allow experimenters to generate new anagrams flexibly or to characterize existing anagrams using psycholinguistic criteria. They also do not provide detailed information on their source dictionaries. We present anagram software that interfaces with CELEX2, an internationallyrecognized psycholinguistic database. This software allows users to capitalize on lexical variables and thus enables direct control of psycholinguistic features that may influence the cognitive processes involved in anagram solution.

Cognition↗
PubMed2005

Risk of anaphylaxis after reexposure to intravenous lepirudin in patients with current or past heparin-induced thrombocytopenia.

OBJECTIVE: To retrospectively assess the signs and symptoms indicative of adverse reactions to repeated exposures to lepirudin in patients with heparin-induced thrombocytopenia who received at least 2 courses of lepirudin therapy. PATIENTS AND METHODS: Medical records were retrospectively assessed from adult patients who received at least 2 courses of lepirudin therapy separated by at least 1 week between January 1999 and June 2002 at The Cleveland Clinic, Cleveland, Ohio. We evaluated the list of 289 low-level terms for possible signs and symptoms of anaphylactic reactions In the medical dictionary for regulatory activities as well as patient vital signs to detect manifestations of immediate hypersensitivity reactions. Vital signs from the day before initiation of lepirudin therapy were compared with those from days 1 and 2 after exposure. RESULTS: No cases of anaphylaxis or allergic reaction related to lepirudin administration were identified among 43 adult patients. On day 1 of lepirudin, 10 patients had lower systolic blood pressures (by > or =20 mm Hg) than pre-lepirudin values, and 4 patients had systolic blood pressures of less than 100 mm Hg. CONCLUSIONS: Isolated asymptomatic decreases in blood pressure after patient reexposure to lepirudin most likely do not reflect anaphylaxis due to lepirudin. We believe that isolated and uncommon cases of anaphylaxis temporally related to lepirudin exposure should not preclude its use in patients with heparin-induced thrombocytopenia and past lepirudin exposure.

Adult↗
PubMed2002

The two faces of medical evidence.

The dictionary definition of "evidence" is given. The meaning of evidence in the history of science is described. Clinical examples are presented to illustrate different aspects of evidence, i.e. the mechanistic versus the semiotic points of view. Evidence is explained in the light of constructivism, and suggestions are presented as to how evidence can be applied in a biopsychosocial model of medicine.

Evidence-Based Medicine↗
PubMed1993

Outcome analysis of work-hardening programs.

The competitive marketplace and the demand for accountability by health care payers are strongly influencing the need for work hardening programs to participate in program evaluation and produce outcome data. This study compiled program performance data on 22 work programs in Wisconsin over an 11-month period. Client data related to demographics of gender, age, occupation, insurance coverage, diagnosis, services clients received, patterns of attendance, and outcomes upon discharge were collected. Results described the majority of the clients treated in the work hardening programs to be men, aged 26 to 46 years, with occupations classified in the miscellaneous category according to the Dictionary of Occupational Titles. The reimbursement source for the majority of work program clients was worker's compensation. The most frequent condition treated was injury to the lumbar spine. Most clients were treated and discharged within a 3-week period. More than half of the clients served returned to their usual and customary jobs.

Accidents, Occupational↗
PubMed2004

Structure-based functional discovery of proteins: structural proteomics.

The discovery of biochemical and cellular functions of unannotated gene products begins with a database search of proteins with structure/sequence homologues based on known genes. Very recently, a number of frontier groups in structural biology proposed a new paradigm to predict biological functions of an unknown protein on the basis of its three-dimensional structure on a genomic scale. Structural proteomics (genomics), a research area for structure-based functional discovery, aims to complete the protein-folding universe of all gene products in a cell. It would lead us to a complete understanding of a living organism from protein structure. Two major complementary experimental techniques, X-ray crystallography and NMR spectroscopy, combined with recently developed high throughput methods have played a central role in structural proteomics research; however, an integration of these methodologies together with comparative modeling and electron microscopy would speed up the goal for completing a full dictionary of protein folding space in the near future.

Animals↗
PubMed2005

Time-frequency-space localization of epileptic EEG oscillations.

This paper presents a hybrid method for localization of oscillatory EEG activity. It consists of two steps: multichannel matching pursuit with complex Gabor dictionary, and LORETA inverse solution. Proposed algorithm was successfully applied to the localization of epileptogenic EEG in a single patient.

Algorithms↗
PubMed1999

It takes chutzpah: oncology nurse leaders.

Chutzpah, according to the Oxford Dictionary of Current English (1996) is a slang term from the Yiddish language which means shameless audacity. Chutzpah has been used to identify people with courage who take on situations that others avoid and somehow achieve the impossible. Tim Porter-O'Grady (1997) recently wrote that management is dead, and has been replaced by process leadership. Health care organizations have made shifts from hierarchical structures to process or program models where people have dual/multiple reporting/communication relationship. In this new orientation, management functions of controlling, directing, organizing and disciplining are replaced by process leadership functions of coordinating, facilitating, linking and sustaining (Porter O'Grady, 1997). Herein lies the challenge for oncology nurse leaders: "what lies behind us and what lies before us are tiny matters compared to what lies within us" (Ralph Waldo Emerson). Leadership is not a function of job title. The evidence for this is clear in current practice.... There are no/few positions of nurse leaders. Titles have changed to eliminate the professional discipline, and reflect a non-descript orientation. The new titles are process leaders, program leaders, professional practice leaders. Nurse leaders need new points of reference to take in the challenges of influencing, facilitating and linking. Those points of reference are: principle-centered leadership, integrity and chutzpah. This presentation will focus on examining current thinking, defining key characteristics and attributes, and using scenarios to illustrate the impact of leadership. We, as leaders in oncology nursing, must use chutzpah to make positive change and long-term gains for patient care and the profession of nursing.

Canada↗
PubMedDate not supplied

Samuel Johnson: his ills, his pills and his physician friends.

Samuel Johnson (1709-1784) was one of the greatest men of his age. Although famed for his writings, especially his Dictionary and his folio on Shakespeare, he is remembered for his tavern conversations, his literary clubs and the great biography of his life by Boswell. He always enjoyed having physicians as his friends, and took a great interest in all branches of medicine. He would advise and prescribe for friends who regularly consulted him, and he was not unhappy when mistaken for a physician. Particularly in his last years he had need of physicians for his own care, but held his own distinct views on whether to take their medicines and in what dose--usually much higher than prescribed. His many illnesses and his knowledge and views on medicine make him of continuing interest to physicians and give us insight into medical practice and beliefs in the Age of Enlightenment.

Famous Persons↗
PubMed1999

Evaluating patients for return to work.

The family physician is often instrumental in the process of returning a patient to the workplace after injury or illness. Initially, the physician must gain an understanding of the job's demands through detailed discussions with the patient, the patient's work supervisor or the occupational medicine staff at the patient's place of employment. Other helpful sources of information include job demand analysis evaluations and the Dictionary of Occupational Titles. With an adequate knowledge of job requirements and patient limitations, the physician should document specific workplace restrictions, ensuring a safe and progressive reentry to work. Occupational rehabilitation programs such as work hardening may be prescribed, if necessary. If the physician is unsure of the patient's status, a functional capacity evaluation should be considered. The family physician should also be familiar with the Americans with Disabilities Act as it applies to the patient's "fitness" to perform the "essential tasks" of the patient's job.

Algorithms↗
PubMedDate not supplied

The power of product integrity.

In the dictionary, integrity means wholeness, completeness, soundness. In products, integrity is the source of sustainable competitive advantage. Products with integrity perform superbly, provide good value, and satisfy customers' expectations in every respect, including such intangibles as their look and feel. Consider this example from the auto industry. In 1987, Mazda put a racy four-wheel steering system in a five-door family hatchback. Honda introduced a comparable system in the Prelude, a sporty, two-door coupe. Most of Honda's customers installed the new technology; Mazda's system sold poorly. Potential customers felt the fit--or misfit--between the car and the new component, and they responded accordingly. Companies that consistently develop products with integrity are coherent, integrated organizations. This internal integrity is visible at the level of strategy and structure, in management and organization, and in the skills, attitudes, and behavior of individual designers, engineers, and operators. Moreover, these companies are integrated externally: customers become part of the development organization. Integrity starts with a product concept that describes the new product from the potential customer's perspective--"pocket rocket" for a sporty, subcompact car, for example. Whether the final product has integrity will depend on two things: how well the concept satisfies potential customers' wants and needs and how completely the concept has been embodied in the product's details. In the most successful development organizations, "heavyweight" product managers are responsible for leading both tasks, as well as for guiding the creation of a strong product concept.

Consumer Behavior↗
PubMed1991

Standards for the electronic transfer of clinical data: progress and promises.

Data exchange standards have two components: the message format or syntax and the dictionary of codes (semantics). For many applications, message standards already have been developed. For a few kinds of clinical entities, such as drugs, these code systems (e.g., the National Drug Code) are virtually complete, but a few gaps must be filled and an agreement must be reached about the level of granularity needed. The available codes for clinical descriptors are inadequate but the National Library of Medicine's Universal Medical Language (UML) project will do much to redress this deficiency. Codes for clinical variables such as blood pressure and blood glucose which have methods, units, normal ranges, and physiologic correlates are very inadequate. CPT4 provides some of the needed codes but has huge gaps. An early effort to extend CPT4 is included in ASTM 1238. Work being done by ASTM E31.12 and the Euclides project will offer robust codes for clinical laboratory measurements. If we want to pool data from different institutions for clinical and policy research, universal codes for observations are prerequisite. And agreement of an international coding system for observation-bearing variables should be a major agenda item for standards groups in the next year. Our goal has been to standardize the communication of clinical data between clinical systems, not the systems themselves or their internal operation. In fact, standardizing the internals of clinical application could be counterproductive at the present. It would deflect energy from, and delay the spread of, CDI standards. Moreover, it gives undue attention to computer systems, rather than the data they contain. The data are the most expensive part of any data system. They are the raison d'être for such systems. Computer systems come and go. The data last forever. Yet we have been mesmerized by the computer system while ignoring its contents. As a result, most computer-stored clinical data must live like the tragic boy in the bubble. They cannot "live" outside of the computer system in which they were born. So, we find at every hospital the bizarre rituals of humans reading computer-generated reports so they can type this information in another computer. Electronic (e.g., stored clinical) data should not depend upon the internals of a particular program, language, or machine for its interpretation. The clinical data entered into one computer system should be directly available to any other computer system that now receives them through manual transcription. Data interchange standards give life to our data--independent of the source system.

Abstracting and Indexing↗
PubMed1992

Techniques for dataset design: a utilization management system model.

Designing a clinical information system offers a sense of accomplishment similar to that of a dramatic performance. The development of the data dictionary and proposed system description requires the same attention to detail as stage directions in a script. The people involved in daily system operation are of key importance in developing a clear understanding of how things actually happen in the information flow and decision process. Once the business rules are defined and edits and conditions are developed to ensure data integrity, it is time to step back and let the performance begin. The real power of the user-designed system, like that of a performance before a live audience, comes with the ability to query the data for answers to issues and problems decision makers did not face at the time of the initial system design.

Clinical Medicine↗
PubMed1992

Power to the portables.

Portable computing devices generally are classified into four categories: laptop, palmtop, notebook, and pen-based computers. If a portable unit weighs over eight pounds, call it a laptop. If a stylus is used to input data, call it pen-based or a pen computer. Palmtops frequently are electronic organizers or resources: Sharp's Wizard line stores appointments and addresses; Franklin's Med-Spell contains Stedman's medical dictionary. Notebooks often incorporate a QWERT keyboard, and sometimes include a pointing device. NEC's notebooks in 1988 were the first sub-laptop computers. According to a 1992 report from Market Intelligence Research Corp., Mountain View, Calif., 4.6 million sub-laptops were sold in 1991 for $2.6 billion. By 1998 the market may reach $25 billion. The report predicts that one sub-category of pen computers, which are designed to be held in one hand while information is input with a pen-like stylus, will prove most useful to the health-care industry. Pen tablets, as opposed to pen clipboards, use faster, more expensive processors, store more data, and "are expected to allow [caregivers] to carry full patient charting with them ... and allow information to be recorded directly to patient files." Sub-laptops are on-line in many healthcare facilities: Greenwich hospital, Stanford University Medical Clinic, Humana Hospital Audubon, Rancho Los Amigos Medical Center, and others.

Catalogs, Commercial as Topic↗