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Designers of medical computing applications increasingly require terminology support for their systems. Yet, terminology systems today lack standard methodologies for providing terminology support. This invariably means increased implementation time and expense for system developers who need to use terminologies in their applications. We introduce Terminology Query Language (TQL), a simple query language interface to server implementations of concept-oriented terminologies. TQL is a declarative, set-based query language built on a generic entity-relationship (E/R) schema. TQL defines a common query-based mechanism for accessing terminology information from one or more terminology servers over a network connection.
Terminological systems are an important research issue within the field of medical informatics. For precise understanding of existing terminological systems a referential framework is needed that provides a uniform terminology and typology of terminological systems themselves. In this article a uniform terminology is described by putting relevant fundamental notions and definitions used by standard organizations such as CEN and ISO into perspective, and interrelating them to arrive at a useful typology of terminological systems. This typology is illustrated by applying it to five well-known existing terminological systems.
Terminologies have traditionally been considered as static datasets held in books or databases. The GALEN Terminology Server presents a prototype for a new view of terminologies delivered as a set of functions and services provided to other applications. This facilitates their development and integration as part of a strategy for sharing and re-using information and knowledge. The essential features of the Terminology server are the functions which it can perform; questions which it can answer and statements which it can be told. The GALEN Terminology Server supports these operations through a modular architecture and uniform applications programming interface which allows client applications to ignore the internal structure and simply use the Server for terminological, coding, and linguistic functions.
The initial efforts of the Federal Institute for Health Protection of Consumers and Veterinary Medicine (BgVV) and the Free University of Berlin to standardise terminology in the field of developmental toxicology began in 1995. Procedures were undertaken to harmonise the terminology used by the International Federation of Teratology Societies (IFTS) and the International Programme on Chemical Safety (IPCS). This article reflects these activities and is a report on the Third Workshop on the Terminology in Developmental Toxicology held in September 2000. This Workshop served as a forum to discuss the results of a survey on the classification of skeletal anomalies that had been previously sent to scientists active in the field. Although high agreement was reached among the evaluators for several terms, the use of a number of terms was rather variable. Therefore, the discussions at the workshop among the experts from research institutions, regulatory agencies, and industry were mainly focussed on those terms for which there was disagreement and/or uncertainties and the possible reasons. Pictures provided by the participants for the illustration of "grey zone" anomalies constituted the basis for detailed discussions. In many of the cases with lower agreement, decisions were facilitated by the provision of the corresponding picture. The main reasons for lower agreement were imprecise terms, insufficient knowledge on postnatal consequences, theoretical terms that are unlikely to occur in isolation, and the possibility of observing a range of severity that might be decisive for the classification of either a malformation or variation. The attendees concluded that "grey-zone" anomalies will never disappear completely and that for the assessment, the grade of severity and/or the frequency of the observation can be decisive for the terminology chosen. A Joint IPCS/IFTS Project was proposed to further consensus of terminology and classification and to link these anomalies to pictures at different skeletal sites. In order to support the harmonisation of regulatory decisions, it was proposed to establish a "Clearinghouse" System under the umbrella of the IPCS. The Clearinghouse could be contacted either by the regulatory authorities or by any company to clarify their queries, particularly with regard to registration or authorisation processes. Finally, it was recommended to also carry out a similar survey on "soft tissue anomalies" and "external findings." The results of this survey will be discussed at a Joint IPCS/IFTS Workshop in Berlin in 2002.
A number of clinical coding and vocabulary schemes are in use in healthcare enterprises today. Most of them are weak in light of the qualities that characterize adequate controlled medical terminologies, as outlined in Part One of this review. Here we look at the major code and terminology sets with a critical eye, as well as suggest practical steps to enable health industry information system purchasers and users to move forward with their effort to use common terminology to improve the quality, service, and knowledge in their enterprise.
Terminology used by health professionals in everyday written discourse was compared with terminology in a standardized medical vocabulary, the Medical Subject Headings (MeSH). Fifty written hospital charts were selected at random and analyzed by a computer program that identified MeSH terms in the charts. The charts were analyzed against two related MeSH vocabularies--one containing MeSH terms and one containing both MeSH terms and backwards cross-reference terms. When small words such as articles and prepositions were disregarded, approximately 50% of the words in a medical chart were found to be MeSH-related terminology. In addition, about 40% of MeSH-related words in the charts were either MeSH terms or backwards cross-reference terms.
In an attempt to overcome the confusion that exists in the terminology of cancer (tumour) etiology, the author has analysed the current situation and proposed terms which, he hopes, will stimulate international discussion and lead eventually to an agreed standard terminology.
Conventional terminology of three-dimensional description of spinal deformity is ambiguous and mostly tied to either a frontal or sagittal plane view of the spine. The article proposes a rationalized system for describing the shape of the spine. The spine is viewed as a line in space ('vertebral body line') with three 'angulations' specifying the orientation of each vertebra. Four axis systems are defined for the whole body, the spine, curve regions, and individual vertebrae, respectively. These in turn define the principal planes of the body, spine, curve regions, and vertebrae. Curvature can be defined as a local measure at a point on the vertebral body line, or as a regional measure between specified end vertebrae. Torsion is defined both as a local geometric property of the vertebral body line, and as measure of the relative axial plane angulations between specified vertebrae. Linear distance measures define the deviations of specified vertebrae from the local, regional, spinal, and global axis systems. Practical recommendations for positioning patients are made. This new system of terminology recognizes the 3-dimensional nature of scoliosis and other spinal deformities and is intended to rationalize communication in both research and clinical practice.
Lacking a standardized terminology of eye injury types, it is impossible to fulfill a very basic requirement in medicine: that all communications be unambiguous. Accurate interpretation of published research results, which plays an absolutely crucial role in determining how an individual patient with an eye injury is treated, becomes difficult. This article presents an internationally standardized system that finally allows accurate description of eye injuries of all types.
This report deals with recommendations on terminology related to neuromuscular dysfunction of the lower urinary tract with particular reference to classification of the neuropathic bladder. These standards are proposed to facilitate comparison of results by investigators who use urodynamic methods. It is recommended that the acknowledgement of these standards in written publications be indicated by a footnote to the section "Methods and Material" or its equivalent: "Methods, definitions and units conform to the standards proposed by the International Continence Society except where specifically noted".
The Committee on International Collaborative Activities (CICA) of the International Union Against Cancer (UICC) has decided to attempt to provide a current international standardized terminology in cancer (tumor) etiology, in cooperation with the International Agency for Research on Cancer (IARC) and the Worlk Health Organization (WHO). As a first stage of this attempt and to encourage international discussion, CICA has requested one of its members, the author, to formulate and publish under his responsibility the present analysis and proposals. The present paper to be published in a number of cancer journals outdates all of its previous versions or drafts.
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