Biomedical subjects

C Lovis

Publications and source records attributed to C Lovis.

At least 19 recordsLinked to original sources

PubMed2006

[Deployment of a computerized physician order entry: description of the process and challenges].

The introduction of a system of computerized physician order entry (CPOE) decreases medication error rates by formalizing the drafting of the orders and providing alarms which announce potential side effects, drug interactions and overly high doses. The quality of the CPOE does not insure its success. Its deployment must be preceded by an assessment and update of the available computer resources, by training of the users and setting up a help-desk attainable 24 hours a day. The project must be lead by senior medical and nursing staff. A joint effort is the key to ensure the success of CPOE and facilitate its acceptability. CPOE provides opportunities for improving: patient safety, training of professionals, quality and efficiency of care. CPOE systems are an ideal basis to set up clinical protocols and clinical pathways.

Medical Order Entry Systems↗

PubMed2006

Guarantying the quality of chemotherapy: from the order to the administration.

Ensuring the quality and security when prescribing drugs like chemotherapies is a complex task if one wants to cover the whole chain from the prescribing physician to the administrant nurse. At the University hospitals of Geneva, new applications covering the whole chain from the prescription up to and including the fabrication of the products have been developed in three phases and are being used in a production stage. In order to cover the "last yard" at the bed level, a fourth phase has been started with a pilot study based on labels containing RFID chips for preparations and for patients. The last phase will make use of all traceability data acquired from the prescription to the preparation to validate that the right product is administered to the right patient, and to record who is administrating it.

Drug Therapy↗

PubMed2005

The digital pen and paper. Evaluation and acceptance of a new data acquisition device in clinical settings.

OBJECTIVES: To evaluate the efficiency and acceptance of digital pen and paper technology for real-time clinical data acquisition. METHODS: A prospective interventional unblinded study involving consecutive patients in two clinical settings during a defined time-frame was proposed. The first trial was designed as a stress test to evaluate acceptance in a workload-intensive environment. Acceptance was assessed using observations and a satisfaction questionnaire. The second trial was intended to determine the reliability of data acquisition in a controlled environment. Reliability was assessed by comparing the performance of the digital pen against scanner analysis and a double human blinded acquisition. RESULTS: Overall, users were satisfied with the use of the digital pen (median 3 on a Likert-scale (-5, 5)). Without any specific user training, successful data acquisition was greater than 80%. Use of this technology required less adaptation than standard computer devices, and was easy to learn and use. Ergonomic problems shaded the perception of the technology by inducing an increased cognitive load. Digitalized data was missing either because of a bug or due to lack of data validation. The reliability obtained with the digital pen was significantly lower to that obtained with the scanner. CONCLUSIONS: Natural technology such as the digital pen proved to be a good tool in stressful clinical environments without interfering with the normal workload or increasing the time for data acquisition. However, in order to improve quality of data acquisition, designing acquisition forms specifically for the use of digital pens is of paramount importance.

Anesthesia, Obstetrical↗

PubMed2002

A humanist's legacy in medical informatics: visions and accomplishments of Professor Jean-Raoul Scherrer.

OBJECTIVE: To report about the work of Prof. Jean-Raoul Scherrer, and show how his humanist vision, his medical skills and his scientific background have enabled and shaped the development of medical informatics over the last 30 years. RESULTS: Starting with the mainframe-based patient-centered hospital information system DIOGENE in the 70s, Prof. Scherrer developed, implemented and evolved innovative concepts of man-machine interfaces, distributed and federated environments, leading the way with information systems that obstinately focused on the support of care providers and patients. Through a rigorous design of terminologies and ontologies, the DIOGENE data would then serve as a basis for the development of clinical research, data mining, and lead to innovative natural language processing techniques. In parallel, Prof. Scherrer supported the development of medical image management, ranging from a distributed picture archiving and communication systems (PACS) to molecular imaging of protein electrophoreses. Recognizing the need for improving the quality and trustworthiness of medical information on the Web, Prof. Scherrer created the Health-On-the-Net (HON) foundation. CONCLUSIONS: These achievements, made possible thanks to his visionary mind, deep humanism, creativity, generosity and determination, have made of Prof. Scherrer a true pioneer and leader of the human-centered, patient-oriented application of information technology for improving healthcare.

History, 20th Century↗

PubMed2002

Controlling the vocabulary for anatomy.

When confronted with the representation of human anatomy, natural language processing (NLP) system designers are facing an unsolved and frequent problem: the lack of a suitable global reference. The available sources in electronic format are numerous, but none fits adequately all the constraints and needs of language analysis. These sources are usually incomplete, difficult to use or tailored to specific needs. The anatomist's or ontologist's view does not necessarily match that of the linguist. The purpose of this paper is to review most recognized sources of knowledge in anatomy usable for linguistic analysis. Their potential and limits are emphasized according to this point of view. Focus is given on the role of the consensus work of the International Federation of Associations of Anatomists (IFAA) giving the Terminologia Anatomica.

Anatomy↗

PubMed2001

Prospective evaluation of patients with syncope: a population-based study.

PURPOSE: To determine the diagnostic yield of a standardized sequential evaluation of patients with syncope in a primary care teaching hospital. PATIENTS AND METHODS: All consecutive patients who presented to the emergency department with syncope as a chief complaint were enrolled. Their evaluation included initial and routine clinical examination, including carotid sinus massage, as well as electrocardiography and basic laboratory testing. Targeted tests, such as echocardiography, were used when a specific entity was suspected clinically. Other cardiovascular tests (24-hour Holter monitoring, ambulatory loop recorder ECG, upright tilt test, and signal-averaged electrocardiography) were performed in patients with unexplained syncope after the initial steps. Electrophysiologic studies were performed in selected patients only as clinically appropriate. Follow-up information on recurrence and mortality were obtained every 6 months for as long as 18 months for 94% (n = 611) of the patients. RESULTS: After the initial clinical evaluation, a suspected cause of syncope was found in 69% (n = 446) of the 650 patients, including neurocardiogenic syncope (n = 234, 36%), orthostatic hypotension (n = 156, 24%), arrhythmia (n = 24, 4%), and other diseases (n = 32, 5%). Of the 67 patients who underwent targeted tests, suspected diagnoses were confirmed in 49 (73%) patients: aortic stenosis (n = 8, 1%), pulmonary embolism (n = 8, 1%), seizures/stroke (n = 30, 5%), and other diseases (n = 3). Extensive cardiovascular workups, which were performed in 122 of the 155 patients in whom syncope remained unexplained after clinical assessment, provided a suspected cause of syncope in only 30 (25%) patients, including arrhythmias in 18 (60%), all of whom had abnormal baseline ECGs. The 18-month mortality was 9% (n = 55, including 8 patients with sudden death); syncope recurred in 15% (n = 95) of the patients. CONCLUSION: The diagnostic yield of a standardized clinical evaluation of syncope was 76%, greater than reported previously in unselected patients. Electrocardiogram-based risk stratification was useful in guiding the use of specialized cardiovascular tests.

Adult↗

PubMed2001

Elevation of creatine kinase in acute severe asthma is not of cardiac origin.

OBJECTIVE: To study prospectively if, when plasma creatine kinase (CK) and plasma myoglobin are elevated, the origin of these abnormalities is cardiac or not, by measuring cardio-specific troponin T (cTT). METHOD: Fifteen patients with acute severe bronchial asthma (ASBA) were prospectively studied in the intensive care unit (ICU) with continuous electrocardiograph (ECG). Plasma CK, CK-MB, myoglobin and cTT were measured at 0, 4, 8, 12, 16 and 20 h in the ICU. RESULTS: Five out of 15 ASBA patients had elevated CK, four of them presenting with an increase in CK-MB. Plasma cTT was normal in every patient, including those with CK and/or myoglobin elevation. At admission to the ICU, myoglobin and CK were positively correlated (r = 0.760; p < 0.001). No patient was intubated. There was no difference in clinical signs or symptoms, medical history, laboratory values or ECG in patients with or without CK elevation. CONCLUSION: Patients admitted to an ICU for ASBA may present with an elevation of plasma CK, CK-MB and myoglobin not related to any heart injury. CK and CK-MB are not good markers of myocardial injury in ASBA patients due to the multitude of potential confounders. Therefore, troponin should be measured instead.

Acute Disease↗

PubMed2001

Conceptual search in electronic patient record.

Search by content in a large corpus of free texts in the medical domain is, today, only partially solved. The so-called GREP approach (Get Regular Expression and Print), based on highly efficient string matching techniques, is subject to inherent limitations, especially its inability to recognize domain specific knowledge. Such methods oblige the user to formulate his or her query in a logical Boolean style; if this constraint is not fulfilled, the results are poor. The authors present an enhancement to string matching search by the addition of a light conceptual model behind the word lexicon. The new system accepts any sentence as a query and radically improves the quality of results. Efficiency regarding execution time is obtained at the expense of implementing advanced indexing algorithms in a pre-processing phase. The method is described and commented and a brief account of the results illustrates this paper.

Artificial Intelligence↗

PubMed2001

Paragraph-oriented structure for narratives in medical documentation.

The authors present a 6 years experiment using a document- centered electronic patient record, based on a central document repository. The document management system is paragraph oriented and all documents are built automatically before editing using predefined ordered sets of para-graphs. Paragraphs can be preloaded with templates, text or images. Once edited, signed and printed, documents are again decomposed in paragraphs and permanently stored. This system, though the compositional aspect of paragraphs is limited and their semantic content wide, offers numerous advantages. The typology is easy to build and to maintain, it has been implemented widely in our hospitals without need for any natural language processing techniques and is used daily within commercially available text editors. The actual state of the system is discussed, emphasizing the structure of the documents, the various attributes and properties that have been needed in order to meet user's needs.

Documentation↗

PubMed2001

Experience with an XML/HTTP-based federative approach to develop a hospital-wide clinical information system.

The authors present a two-year experience with an approach aimed at federating applications into a component-based hospital-wide clinical information system. Recognizing the need for better integration, clearer separation of knowledge from applications, as well as the necessity to respect and integrate the diversity of roles in a healthcare network, a strategy was implemented that included the development of a shared vision, organizational changes to promote appropriation at all levels, and the elaboration and maintenance of a common architecture and terminology by an instrumental technical group. Choices for federative technologies were in part based on their level of acceptance and potential to evolve. XML was used as the syntactic framework and HTTP as the transfer protocol. Within twelve months, the shared vision was developed, the architecture was specified, the key central components implemented, incorporated into the applications, and applications teams started producing shareable services using XML and HTTP.

Hospital Information Systems↗

PubMed2001

A light knowledge model for linguistic applications.

Content extraction from medical texts is achievable today by linguistic applications, in so far as sufficient domain knowledge is available. Such knowledge represents a model of the domain and is hard to collect with sufficient depth and good coverage, despite numerous attempts. To leverage this task is a priority in order to benefit from the awaited linguistic tools. The light model is designed with this goal in mind. Syntactic and lexical information are generally available with large lexicons. A domain model should add the necessary semantic information. The authors have designed a light knowledge model for the collection of semantic information on the basis of the recognized syntactical and lexical attributes. It has been tailored for the acquisition of enough semantic information in order to retrieve terms of a controlled vocabulary from free texts, as for example, to retrieve Mesh terms from patient records.

Information Storage and Retrieval↗

PubMed2001

Looking back or looking all around: comparing two spell checking strategies for documents edition in an electronic patient record.

We report on the comparison of two systems for correcting spelling errors resulting in non-existent words (i.e. not listed in any lexicon). Both systems aim at improving edition of medical reports. Unlike traditional systems, based on word language models, both semantic and syntactic contexts are considered here. Both systems share the same string-to-string edit distance module, and the same contextual disambiguation principles. The differences between the two systems are located at the user interaction level: while the first system is using exclusively the left context, simulating the underlining of every mis-spelling at the end of every word typing, the second system uses the left as well as the right context and simulate a post-edition correction, when asked by the author. Our conclusion shows the improvements brought by the second approach.

Medical Records Systems, Computerized↗

PubMed2000

Power of expression in the electronic patient record: structured data or narrative text?

This paper presents the authors' experience with the development and use of a document-centered electronic patient record (EPR) in a large teaching hospital. The development of the document-centered EPR began with the formulation of a set of critical hypotheses to facilitate both the continuation of the best medical practice and the implementation and use of the EPR. An alternate and more conventional approach - the data-centered EPR - is compared with the document-centered EPR. Various benefits and pitfalls are discussed. Finally, the choice was to offer both solutions in a tightly linked system. The need for an EPR which combines the document and data centered approaches is a reflection of the more general discussion of what the medical record will be in the future. All too often, the need for structured data conflicts with the need for free texts and the power of expression. It is not easy to evaluate the consequences of this initial decision. However, changing the foundations of the EPR after its implementation is difficult and expensive. Therefore, the selection of the correct orientation in a given hospital requires a broad-based discussion.

Hospitals, Teaching↗

PubMed2000

Extending the VA CPRS electronic patient record order entry system using natural language processing techniques.

An automated practitioner order entry system was recently implemented at the VA Puget Sound Health Care System. Since the introduction of this system, we have experienced various problems, among them an increase in time required for practitioners to enter orders. In order to improve usability and acceptance of the order entry, an alternate pathway was built within CPRS that allows direct natural language based order entry. Implementation of the extension in CPRS has been made possible because of the three layers CPRS architecture and its strong object oriented models. This paper discusses the advantages and needs for a natural language based order entry system and its implementation within an existing order entry system.

Humans↗

PubMed2000

Semantic handling of medical compound words through sound analysis and generation processes.

Compound words are frequently encountered in the medical domain. Their conciseness complies with the telegraphic style usually adopted by clinicians in daily practice. This amplifies the need for clarifying their semantic interpretation and representation through respectively the analysis and generation processes. While highlighting the peculiarities of medical compound words, this paper shows how model-driven linguistic tools accurately deal with the compositionality of medical language. These statements are illustrated by means of examples, stemming from the handling of surgical procedures as part of the GALEN-IN-USE project.

Linguistics↗

PubMed2000

A toolset for medical text processing.

The processing of medical texts is a burden in the absence of a toolset designed for simple operations such as recognizing morphological variants, updating and accessing a word dictionary of the domain and segmenting words with multiple morpho-semantems. The apparent simplicity of these basic operations is an illusion because it soon becomes clear that quality implementation is a long-term task. Coherency between subtasks may be lacking unless strict rules are enforced. In fact, good tools are rarely available or have not been tailored for the medical profession. This paper aims at defining a complete toolset for medical word processing. In addition, it provides relevant examples of the inherent difficulties of this task. It reports on typical results that can be expected from an industry-standard implementation.

Artificial Intelligence↗

PubMed1999

The power and limits of a rule-based morpho-semantic parser.

The venue of Electronic Patient Record (EPR) implies an increasing amount of medical texts readily available for processing, as soon as convenient tools are made available. The chief application is text analysis, from which one can drive other disciplines like indexing for retrieval, knowledge representation, translation and inferencing for medical intelligent systems. Prerequisites for a convenient analyzer of medical texts are: building the lexicon, developing semantic representation of the domain, having a large corpus of texts available for statistical analysis, and finally mastering robust and powerful parsing techniques in order to satisfy the constraints of the medical domain. This article aims at presenting an easy-to-use parser ready to be adapted in different settings. It describes its power together with its practical limitations as experienced by the authors.

Humans↗

PubMed1999

Document versus data centred approach to the EPR.

This paper presents the document centred Electronic Patient Record (EPR) as currently in production in a large university hospital and subject to multiple additional developments in the coming years. A number of basic hypothesis have been developed in order to reach the best medical practice and the success of this application. In addition, the alternative approach of data centred EPR is compared, and different benefits and pitfalls are highlighted. It is not easy to evaluate the consequences of such an initial trend, but changing one's mind after having a system in daily production is anyway costly and difficult. Therefore, the selection of the right orientation in a given hospital necessitates a scientific debate.

Data Collection↗