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The concise Oxford English Dictionary defines 'dilemma' as an argument forcing one to choose one of two alternatives, both of which are unfavourable. This is a situation that frequently confronts the general practitioner. This paper will present one practitioner's view on the subject of patients waiting to see the doctor.
Most diagnostic decision support (DDS) systems are used as stand-alone applications. At present, the physician can only benefit from the suggestions of a DDS system if he is sufficiently motivated to re-enter patient data and run a diagnostic case analysis. If data from a computer-based patient record (CBPR) could be made available electronically to a DDS system, the use of that DDS system may become much more practical. Integrating a CBPR with a DDS system requires a mapping between two different data structures and dictionaries. We have explored a strategy to create a mapping between our CBPR and QMR. Our research has provided more general insight in the potential and limitations of such a mapping.
A literature search is the first step of all scientific research, and must include both historic and contemporary articles. The search starts with "secondary literature", i.e. reference works such as dictionaries, encyclopedias, guides, theses, etc. References should be given according to international norms. The next step is to consult large international databases such as Index Medicus, Pascal, Excerpta Medica and summary compilations like Medexpress, Medactua and Current Contents. Most can be consulted through a system of key words or themes. With the advent of personal computers, they can be accessed either on-line, or in the form of CD-Rom. Organization is the cornerstone of an effective literature search. Fortunately there are several computer programs written specifically to deal with this problem. Remember that a well-conducted and well-organized literature search will gain a considerable amount of time when it comes to writing the manuscript.
The conceptualization of the concept mental discomfort formed only part of the research methodology. The goal was to conceptualize the concept mental discomfort in the conceptual frame of reference of Psychiatric Nursing. The concept was one of three concepts to be analyzed in this research. The combined approach of concept analysis was used. This was done as follows: Research dictionary and subject terminological definitions of the concept; Construct cases of the concept: a model and borderline case; Formulate criteria for the concept; Conduct internal dialogue; Reformulate and define the concept. After completion of the process the concept mental discomfort was conceptually defined.
The main assertion in this paper is that psychache (mental pain) has a life of its own and is separate from the study of the brain, the organ that cradles the processes of the mind. No amount of biologicizing or medicalizing suicide can gainsay the fact that the human impulse of self-destruction is a decision of mind to put an end to the flow of its own unbearable conscious contents, to stop the psychache. The explanations for suicidal actions lie in the Oxford English Dictionary, not in the Diagnostic and Statistical Manual of Mental Disorders. Unless suicidology asserts and maintains the position that suicide is essentially psychachical, that the main focus of suicidal action is in the mind (as opposed to the mind's somatic abode, the brain), it will lose its identity and its usefulness. This is not just a quarrel over professional territory, money, or power; it is a philosophic war, a fight for the very soul of suicidology--and of the mind.
Earlier research has maintained that the earliest passage of written information about acupuncture and moxibustion to Western Europe took place around the middle of the 17th century. But an investigation into the letters, 'historias', dictionaries, grammars, etc. of the Jesuit mission in Japan, which started in 1549, shows that the missionaries there already enjoyed a considerable knowledge of both methods of treatment. These sources also reveal indications of the use of needles and moxa on horses as well as the use of 'hammer-needles', a Japanese invention which was later described in detail by Willem ten Rhijne and Engelbert Kaempfer. Furthermore some central Sinojapanese terms of anatomy, physiology and pulse diagnosis in the light of their European interpretations, and a hitherto unknown outline of Japanese medicine found in an early French book on Chinese sphygmology are presented.
A program (LogStory) is described that was developed for the automatic semantic analysis of clinical narratives, stored in a computerized problem-oriented medical record (PROMED). The diagnoses were written in a free-text format during consultation, and later collected into diagnostic classes, e.g., diseases. A lexical parser automatically created dictionaries from the clinical narrative associated with each disease. Automatic (fuzzy) set operations were performed on the words associated with each class. The manifestations of 16 diseases were automatically extracted by pairwise operations on the word sets. The correlation between diseases and corresponding signs, symptoms and treatment was highly significant (p < 0.001). Applying the difference operation on diseases with disjunct sets of clinical findings allowed the recovery of disease-specific knowledge. The evolution of a disease was accounted for, and the system was able to generalize its findings. The PROMED-LogStory concept enables the processing of natural language and may be a powerful tool for knowledge acquisition and clinical research.
Rehabilitation means 'to restore to previous condition, rights, privileges, to attain some degree of independence (New Oxford Dictionary). The general practitioner will inevitably be involved in deciding when and where the patient will go. With increasing care, understanding and effort, it is hoped that with the above in mind, an increasing number of seemingly incapable elderly people will be helped. Just as with other age groups, an increasing number of elderly will be able to continue making a worthwhile contribution to society and to solve their own problems in ways that they choose.
We have developed an approach to medical knowledge representation whereby simple medical concepts are combined to yield complex statements of testable medical logic. The logic is created from a small number of generic medical concepts that are instantiated and combined to create the rules. Rule writing is done through a rule editor and requires knowledge of the system's data dictionaries, though no programming is required. We have used the approach to create a large knowledge base including panic lab alerting rules, drug-laboratory interaction alerting rules, an adverse drug event monitor, and a drug-age interaction detection program. The rules have been used as part of an alerting system and for data collection to determine the frequency of events of interest. The scheme is extensible and yields a readable form of the created knowledge. The scheme holds great promise as a durable form of medical knowledge representation.
ASOP is a proposed method for future medical record notation. This permutation of the original POMR-SOAP method is necessary to provide the standardized workflow and medical nomenclature which will be essential for automated medical record systems and forms-based encounter recording. The development of an ASOP system is dependent on tools to map assessment to appropriate terminology within a universal medical dictionary and generate intelligent queries across the World-Wide-Web. In this study we intend to demonstrate the need for change in the POMR system and highlight some of the current tools in development to make the ASOP method the medical record notation system of choice.
To maximize the value of computerized medical records systems, an organizing structure is needed. That structure can be provided by a controlled medical terminology (CMT). At Columbia-Presbyterian Medical Center, we have been employing a controlled medical terminology, our Medical Entities Dictionary (MED), to mediate the storage and retrieval of patient data and enable decision support applications. This paper describes how the MED is actually used for data management in our distributed clinical information systems environment. Our system tools which access the MED for production purposes facilitate the mapping of terms from many sources to a uniform representation of concepts and also return information about the relationships between concepts. Applications which access a CMT for production purposes should be optimized for performance in high volume settings, fault tolerant, synchronizable, extensible, portable, and maintainable. We briefly describe our system architecture and then demonstrate how we utilize the MED for translation and semantic information as data is moved into and out of our patient database. We discuss our current tools and present a preview of the next generation of applications which will manage access to the MED for our production systems.
First, dictionary definitions of stress and stress-related terms are given. Next, a review of Cannon's, Selye's, and other early pioneers' stress definitions are given. Following this, current definitions are reviewed. Finally, using new findings, an up-dated version of the stress concept is presented.
Arden syntax is an ASTM standard defined a few years ago to represent rule-based knowledge in the medical domain in an application- and implementation-independent way. Knowledge is expressed as Medical Logic Modules (MLMs). So far, it has mainly been used for providing critique and reminders in data driven, medical decision support systems, where typically rules are evoked by certain database operations (e.g., "store systolic blood pressure"). The syntax is an important step towards a general medical knowledge representation, with version control, maintenance information, arithmetic operations, logic rule syntax, and temporal operations, but it is not yet complete. The standard does not define how medical concepts (e.g., "systolic blood pressure") are to be referenced. Existing coding schemes such as SNOMED and ICD10 may be used for this, but they have generally failed to provide the required level of detail. The use of Arden syntax to transfer knowledge between centers in the form of MLMs has been shown to be non-trivial [1,2]. GALEN (Generalized Architecture for Languages, Encyclopedias, and Nomenclatures in Medicine) is an EC AIM project aiming at a machine-readable system to represent medical concepts in a semantic network. The network allows for the combination and specialization of concepts to the required level of detail. The project has resulted in a notation (GRAIL: GALEN Representation and Integration Language) and several tools, such as browsers for manipulating medical concepts. In a GALEN subproject, we are exploring the potential utility of combining Arden syntax with semantics from the GALEN terminology, and we are developing tools to facilitate the creation of MLMs with terminology support. Our impression is that the combination is very useful: GALEN tools allow a domain expert to express her knowledge in purely medical terms, independent of an actual or intended patient database structure and data representation. They can also help a knowledge engineer or quite possibly an automatic interpreter to translate a well defined medical concept (expressed in GRAIL) to actual database queries (in SQL or other notation). This translation can be facilitated by a Data Dictionary describing the local patient database.
Defining the expected benefits from an intended change, development and/or investment has been recognized for some time as being an integral part of a decision making process. A dictionary definition of Benefit is: "A favorable or helpful factor or circumstance, advantage, profit." A definition of Realization is: "Convert into actuality; acquire; convert into money; achieve."
The deployment and maintenance of multiple point-to-point interfaces between a clinical information system, such as a laboratory information system, and other systems within a healthcare enterprise is expensive and time consuming. Moreover, the demand for such interfaces is increasing as hospitals consolidate and clinical laboratories participate in the development of regional laboratory networks and create host-to-host links with laboratory outreach clients. An interface engine, also called a hub, is an evolving technology that could replace multiple point-to-point interfaces from a laboratory information system with a single interface to the hub, preferably HL7 based. The hub then routes and translates laboratory information to other systems within the enterprise. Changes in application systems in an enterprise where a centralized interface engine has been implemented then amount to thorough analysis, an update of the enterprise's data dictionary, purchase of a single new vendor-supported interface, and table-based parameter changes on the hub. Two other features of an interface engine, support for structured query language and information store-and-forward, will facilitate the development of clinical data repositories and provide flexibility when interacting with other host systems. This article describes the advantages and disadvantages of an interface engine and lists some problems not solved by the technology. Finally, early developmental experience with an interface engine at the University of Michigan Medical Center and the benefits of the project on system integration efforts are described, not the least of which has been the enthusiastic adoption of the HL7 standard for all future interface projects.
Rosenthal's spiral canal of the modiolus of the cochlea is mentioned numerous times in the literature, but there are few references to both the man who discovered it and the article in which it was first described. Standard medical dictionaries attribute its discovery to the wrong Rosenthal. The correct Rosenthal is identified and his original description is referred to. The possibility of an even earlier description of the canal is discussed. This description links the origins of the electric telegraph and multiple-channel cochlear prostheses.
Speech perception tests are an important part of procedures for diagnosing pre-verbal hearing loss. Merely establishing a child's hearing threshold with and without a hearing aid is not sufficient to ensure an adequate evaluation with a view to selecting cases suitable for cochlear implants because it fails to indicate the real benefit obtained from using a conventional hearing aid reliably. Speech perception tests have proved useful not only for patient selection, but also for subsequent evaluation of the efficacy of new hearing aids, such as tactile devices and cochlear implants. In clinical practice, the tests most commonly adopted with small children are: The Auditory Comprehension Test (ACT), Discrimination after Training (DAT), Monosyllable, Trochee, Spondee tests (MTS), Glendonald Auditory Screening Priocedure (GASP), Early Speech Perception Test (ESP), Rather than considering specific results achieved in individual cases, reference is generally made to the four speech perception classes proposed by Moog and Geers of the CID of St. Louis. The purpose of this classification, made on the results obtained with suitably differentiated tests according to the child's age and language ability, is to detect differences in perception of a spoken message in ideal listening conditions. To date, no italian language speech perception test has been designed to establish the assessment of speech perception level in children with profound hearing impairment. We attempted, therefore, to adapt the existing English tests to the Italian language taking into consideration the differences between the two languages. Our attention focused on the ESP test since it can be applied to even very small children (2 years old). The ESP is proposed in a standard version for hearing-impaired children over the age of 6 years and in a simplified version for younger children. The rationale we used for selecting Italian words reflect the rationale established for the original version, but the choice of single words follows different criteria from the original version. In fact, the two languages differ in important linguistic features so that the test can not be not adapted to the Italian language by simply translating the words involved. As currently there is no children's language dictionary in Italian arranged according to age bracket, we chose words used in children and in pre-school reading material.
With increasing consumer awareness of the innovative procedures available for cosmetic dentistry, this area of practice is growing rapidly and has become an excellent source for patient referrals. Unfortunately, it can also be a large source of stress for the practitioner. Esthetics has been described by The Pocket Oxford Dictionary as "the philosophy of beautiful"; its perception varies from individual to individual. In the field of dentistry, there are criteria which define one tooth as being more esthetic than another and one individual's smile as more pleasing than another. However, that which is esthetically pleasing to the clinician may not be esthetically pleasing to the patient.