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The efficient management and maintenance of large-scale and high-quality vocabulary mapping is an operational challenge. The 3M Health Information Systems (HIS) Healthcare Data Dictionary (HDD) group developed an information management system to provide controlled mapping services, resulting in improved efficiency and quality maintenance.
Data Extraction and Longitudinal Time Analysis (DELTA) was developed to provide real-time safety monitoring of new devices in the domain of interventional cardiology. This field provides the necessary infrastructure for this type of endeavor. The American College of Cardiology National Cardiovascular Data Repository (ACC-NCDR) provides a national standardized data dictionary, and there is point of care data collection in many centers. The tool utilizes both Bayesian statistical updating and classical frequentist methods for automated event rate monitoring.
The 3M Healthcare Data Dictionary (HDD) group provides vocabulary mapping services for the Department of Defense (DoD). The process to manage changes in these mappings, the so-called "delta process," is complex and requires the exchange and management of large amounts of data. To aid in this process, the 3M HDD group has created and refined a vocabulary Mapping Environment (ME).
OBJECTIVES: To examine recent research work in the development and evaluation of controlled biomedical terminologies - especially, the representation of structured, controlled definitional knowledge about the terms themselves; such terminologies are often referred to as 'ontologies'. METHODS: A review of the published literature using PubMed, as well as full-text searches of recent Medinfo and American Medical Informatics Association (AMIA) Symposia proceedings, searching for the terms 'ontology' and 'ontologies' and for articles discussing specific, prominent ontological work. RESULTS: We summaries the ontologic aspects of twelve current terminology projects: Galen, the Unified Medical Language System (UMLS), the Medical Entities Dictionary (MED), SNOMED-CT, LOINC, the Foundational Model of Anatomy (FMA), the Gene Ontology (GO), ISO Reference Terminology Model for Nursing Diagnosis, NDF-RT, RxNorm, the NCI Thesaurus, and DOLCE+. We discuss the origins, domain, and ontologic representation of each of these and attempt to summarize the impact that each has had on terminologic work and biomedical applications. We also note the contributions of the Protégé tool to many of these efforts. CONCLUSION: Terminologic research and development have advanced significantly in the past 20 years, especially since the recent orientation toward controlled biomedical ontologies. This work has had significant impact on the development of terminologies themselves, their acceptance and dissemination as standards, and their use in supporting biomedical information systems.
UNLABELLED: This paper reports the features and relationships between standardizes nursing terminology sets used in Japan. First, we analyzed the common parts in five standardized nursing terminology sets: the Japan Nursing Practice Standard Master (JNPSM) that includes the names of nursing activities and is built by the Medical Information Center Development Center (MEDIS-DC); the labels of the Japan Classification of Nursing Practice (JCNP), built by the term advisory committee in the Japan Academy of Nursing Science; the labels of the International Classification for Nursing Practice (ICNP) translated to Japanese; the labels, domain names, and class names of the North American Nursing Diagnosis Association (NANDA) Nursing Diagnoses 2003-2004 translated to Japanese; and the terms included in the labels of Nursing Interventions Classification (NIC) translated to Japanese. Then we compared them with terms in a thesaurus dictionary, the Bunrui Goihyo, that contains general Japanese words and is built by the National Institute for Japanese Language. THE RESULTS: 1) the level of interchangeability between four standardized nursing terminology sets is quite low; 2) abbreviations and katakana words are frequently used to express nursing activities; 3) general Japanese words are usually used to express the status or situation of patients.
The use of nursing documents from different electronic health record (EHR) systems is challenging due to inconsistency in document naming across systems and institutions. Mapping each local document name to standard document ontology may enable health care professionals to navigate and retrieve documents efficiently for multiple purposes such as quality assurance, outcomes research or public health reporting. The purpose of this study was to evaluate the sufficiency of the Health Level 7 (HL7)/Logical Observation Identifiers, Names, and Codes (LOINC) document ontology for representing nursing document names. We collected 94 nursing document types from the Eclipsys Clinical Information System (CIS) and the Columbia Medical Entities Dictionary (MED) and mapped them to the components of the HL7/LOINC document ontology. Seventy-five (79.8%) nursing document names were completely represented and 19 (20.2%) document names were partially represented. In order for the HL7/LOINC document ontology to be of more use in implementing EHRs that support nursing documentation, Subject Matter Domain and Type of Service axes require extension and clarification.
Korean nursing terminology was standardized to improve sharing and exchange of nursing data and information. English nursing terms were collected from existing nursing terminology, journal articles, nursing records, text books, and nursing/medical dictionaries, translated into Korean and were tested for their validity. More than 9000 terms were standardized and published on a website for further feedback from the users. This study will contribute to communication within the nursing community and with other health care professionals.
In this paper we describe the approach to build a web-based clinical data management infrastructure on top of an entity-attribute-value (EAV) database which provides for flexible definition and extension of clinical data sets as well as efficient data handling and high performance query execution. A "mixed" EAV implementation provides a flexible and configurable data repository and at the same time utilizes the performance advantages of conventional database tables for rarely changing data structures. A dynamically configurable data dictionary contains further information for data validation. The online user interface can also be assembled dynamically. A data transfer object which encapsulates data together with all required metadata is populated by the backend and directly used to dynamically render frontend forms and handle incoming data. The "mixed" EAV model enables flexible definition and modification of clinical data sets while reducing performance drawbacks of pure EAV implementations to a minimum. The system currently is in use in an electronic patient record with focus on flexibility and a quality management application (www.healthgate.at) with high performance requirements.
This article attempts to trace the origin of tea. The author believes the ancient Chinese tea, "chia", is either Jicha (water extract from the pith of Acacia catechu that grows naturally in the mountainous border between the Yunnan province of China and southern Asian countries) or Jicha-Kagikazura (water extract from the young branches and leaves of Uncaris gambir, originally found in India/Sri Lanka). Both were pulverized after being kiln-dried and then mixed with water to produce a thick suspension, or tea. Although the drink is bitter and has an astringent property, it has a particular flavor with a refreshing after-taste. Its components with medicinal properties include tannin, catechin, and various flavonoids, making us believe it was worthwhile for the people at the time to consume the drink regularly. Generally speaking, tea cultivation in China flourished south of the Yangzi Jiang River including the present Zhejiang and Anhui provinces. Depending on the regions, there were words for tea in various languages, including the names of places where particular teas were grown. In addition to the names that appear in the famous Chajing book, it is interesting to note Da Fang pronounced tea as "TAH". Because the area south of the Yangzi Jiang has traditionally been active in foreign trade since the ancient and middle ages. People in this region consumed various foreign originated teas as well. This included Gambir, which was introduced to southern Asia (including present Malaysia and Indonesia) and was consumed as an herbal tea under names such as Guo Luo or Ju Luo teas. Paan, from India, also uses Gambir paste and was a popular chewing refreshment to prevent diseases caused by miasma as well as to keep one's mouth clean. The name A-sen-yaku used in Japan was taken from the plant name Acasia, and Gambir was used to dye Buddhist monks' Ke-Ra bags to a blackish yellow color. The Daikanwa dictionary states the Ra in the name, which means thin silk, was later replaced with "A". The official name for Ji-cha [Er Cha] in modern China is "Gaiji-cha", [Hal-Er Cha], which comes from the name of a variety of tea made by the Ai-Ni tribal subgroup of the ethnic Ha-Ni in Yunnan province. The [see character in text] character is pronounced "ni", which is a homophony of [character in text]. Based on these facts, "Ai-Ni" should be considered the same as "Hai-Ni". Because the ethnic groups in Yunnan province used primitive and tough tea leaves, which were eaten instead of being infused in water, the leaves were first fermented by being buried in the ground. Even today, people of these ethnic groups prefer fungus-fermented black tea with a particular flavor. In contrast, the ethnic Hans used and still use improved and softer young shoots of tea leaves to prepare mainly green tea. It has recently been discovered that Acapsia, as well as Gambir, has anti-oxidant properties, and that consumption over time is effective against many lifestyle-related adult diseases. It may be well worthwhile to cast fresh light upon ancient tea drinking customs.
It was customary both in China and Japan to serve medicinal teas before banquets, to which various spices and herbs including gambir, agalloch, and Saussureae radix were added, for the purpose of preparing the guest's physical condition before serving soups and entrees. Such medicinal teas were used as all-purpose remedies to cure upset stomach, intestinal disorders, bad temper, or melancholy. The author believes such usefulness is still valid even today, representing a gift introduced to Japan by Gangin. Gambir is sometimes substituted for tea in recipes; for example in Hoshintan from Kanazawa, but the reason for this is unclear now. Gambir was imported to Japan, as evidenced by an entry in a Japanese-Portuguese dictionary published in the 1590s in which gambir is referred to as "cacho" (cashew). At any rate, it is certain the recipe containing gambir, which Ganjin introduced to Japan, has helped improve people's health for 1,300 years.
If the iatrogenic acute muscular syndromes (rhabdomyolysis) and hepatic diseases following hypolipidemic drugs therapy are very well known, the other unwanted effects associated with fibrate therapy are not well established. It is the reason why we have selected, in the computerised data base of side effects from the French Network of "Centres de Pharmacovigilance" organisation, the pathological events associated with fibrate therapy during five years (1985 to 1989) (with exception for the acute muscular and hepatic diseases). The 277 side effects represent 67% of the side effects in which the product is regarded as "suspect" (S). These effects were observed in 132 men (mean age = 57 years) and 145 women (mean age = 61 years). The most frequently encountered products are: fénofibrate (Lipanthyl) for 30%; ciprofibrate (Lipanor); gemfibrozil (Lipur); bézafibrate (Befizal); each for about 10%. The mean doses used were the same that suggested in the french therapeutic dictionary ("Vidal"). The unwanted effects observed were: Skin reactions: 22.8% Blood disturbances (and hemorrhage): 9.8% Gl diseases (pancreatitis), Libido and psychic disturbances, nervous system disorders: about 6% each. All clotting disturbances (5.8%) are interactions with coumarin derivatives. The incidence of serious side effects was low and the recovery very good in 80.9% of cases: no death. In conclusion, the toxicity of fibrates (with exception for rhabdomyolysis and hepatic reaction) appears unimportant: the most frequently observed side effects are skin reactions and blood disturbances (interactions) and rarely nervous system, psychic or libido disturbances. The recovery is good, and the general toxicity of all products appear to be of the same order of magnitude.
In 1990 the Arden Syntax was proposed as a first version of a standardized syntax for the representation of medical knowledge. For the evaluation of the practicability of this first release we have analyzed the medical and pharmacological knowledge applied in the process of drug prescription. The separation of declarative (e.g. in a semantic network) and procedural knowledge is a basic issue of our research. We therefore propose to further extend the Arden syntax with declarative knowledge representation facilities. One way to do this may be the incorporation of a standardized medical data dictionary (e.g. the UMLS Metathesaurus) which promotes the representation of medical terms in a semantic network. Furthermore the problem of 'institution-specific knowledge', which is especially important for the issue of knowledge sharing between different institutions, is analyzed based on examples of knowledge modules for monitoring drug allergies and drug-drug-interactions.
The LASTWORD hospital information system contains a clinical microbiology database which permits both review of patient reports and retrospective data searches using clinical and/or demographic criteria. The elements supporting this database are dictionary tables of coded phrases, a general purpose query language (Tandem ENFORM), an HL7 interface to a laboratory computer system, and long-term data storage of demographic, microbiology and other clinical data in a relational database.
In clinical research data is often studied by a particular method without previous analysis of quality or semantic contents which could link clinical database and data analytical (e.g. statistical) procedures. In order to avoid bias caused by this situation, we propose that the analysis of medical data should be divided into two main steps. In the first one we concentrate on conducting the quality, semantic and structure analyses. In the second step our aim is to build an appropriate dictionary of data analysis methods for further knowledge extraction. Methods like robust statistical techniques, procedures for mixed continuous and discrete data, fuzzy linguistic approach, machine learning and neural networks can be included. The results may be evaluated both using test samples and applying other relevant data-analytical techniques to the particular problem under the study.
Speech audiometry is a method for assessing the ability of the auditory system using speech sounds as stimuli. A list of phonemically balanced bisyllabic consonant-vowel-consonant-vowel (c-v-c-v) Malay words was produced. All the bisyllabic words (c-v-c-v) thought to be commonly used in everyday conversations were listed from the Dewan Bahasa dictionary and their suitability assessed. The chosen words were divided into 25 groups containing 10 words each. The list was then recorded by a professional male newscaster in a sound proof studio. A normal speech audiometry curve was obtained by testing 60 normal hearing subjects using the prerecorded speech material. The result of the study showed that the normal Malay speech audiometry curve was comparable to those of English and Arabic speech audiometry, in which it was sigmoidal with the optimum discrimination score of 40 dB and half peak level of 17.5 dB.
We compare categories of physical activity, based upon self-reported leisure time and occupational activity, with categories of activity based upon coded job titles using the Dictionary of Occupational Titles. For people under 65 years of age, self-reported total activity, total nonintense activity, and occupational activity were not strongly associated with coded occupational activity in men (Spearman r = 0.36, 0.27, and 0.32, respectively); even weaker associations were noted in women (r = 0.23, 0.27, and 0.10). Associations between total activity and coded occupational activity were generally weaker for people who were 65 or older. Despite these weak associations, all indicators of physical activity assessed were associated with a decreased risk for colon cancer in men. Comparing those in the highest category of activity with those in the lowest, the OR for total self-reported activity was 0.7; for self-reported occupational activity, 0.7; and for coded occupational activity, 0.6. Whereas self-reported total activity was associated with colon cancer among women, estimates of activity based upon occupation (both self-reported and coded from job titles) were not.
Calorie intake and the main nutrient contents were assessed in a population of 152 obese (OB) children (86 M; 66 F; age 7-11) and 153 normal weight (NW) peers (87 M; 66 F). The following method was used: a) an interview using a food dictionary to assess food intake during the 2 days prior to the study and on one holiday: and b) a weekly questionnaire. The mean food intake of OB did not exceed that of NW, but on the contrary was lower (OB: 1812.9 +/- 39.6 kcal/die; NW: 1928.5 +/- 39.4 kcal/die; p less than 0.05). The population studied consumed approximately 50% of calories as carbohydrates (CHO), 35% as fats (F) and 15% as protein (P), and no difference was noted between OB and NW. The percentage of CHO was lower than that recommended by LARN, whereas the percentages of F and P were higher. A significant increase with age was noted in F and P intake as was a significant reduction of CO. 70% of OB and 80% of NW matched or exceeded the calorie intake recommended by LARN. 30% of OB and 24% of NW consumed 30% less than the daily calorie intake recommended by LARN.
A new database developed by the Canadian Centre for Health Information (CCHI) contains 40 key health indicators and lets users select a range of disaggregations, categories and variables. The database can be accessed through CANSIM, Statistics Canada's electronic database and retrieval system, or through a package for personal computers. This package includes the database on diskettes, as well as software for retrieving and manipulating data and for producing graphics. A data dictionary, a user's guide and tables and graphs that highlight aspects of each indicator are also included.