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PubMed1998

Modeling concepts in medicine for medical language understanding.

Over the past two decades, the construction of models for medical concept representation and for understanding of the deep meaning of medical narrative texts have been challenging areas of medical informatics research. This review highlights how these two inter-related domains have evolved, emphasizing aspects of medical modeling as a tool for medical language understanding. A representation schema, which balances partially but accurately with complete but complex representations of domain-specific knowledge, must be developed to facilitate language understanding. Representative examples are drawn from two major independent efforts undertaken by the authors: the elaboration and the subsequent adjustment of the RECIT multilingual analyzer to include a robust medical concept model, and the recasting of a frame-based interlingua system, originally developed to map equivalent concepts between controlled clinical vocabularies, to invoke a similar concept model.

Artificial Intelligence↗
PubMed1998

Morpho-semantic parsing of medical expressions.

The task of editing, indexing, storing, and retrieving medical expressions within medical records remains the main objective for the years to come. Therefore, the need for a parser with semantic capabilities able to robustly extract an essential part of the knowledge embedded in the medical record is paramount. The minimal requirements before considering clinical trials are that such a system has to be in position to handle any source of medical information and to conveniently grasp the main key concepts with low silence, good recognition of modalities and acceptable noise. This paper shows that the potential of morpho-semantic parsing is high to meet these conditions. This technique is an important complement to the traditional lexical approach and to expression-oriented systems like controlled vocabularies.

Language↗
PubMed1998

Converting an integrated hospital formulary into an object-oriented database representation.

Controlled Medical Vocabularies (CMVs) have proven to be extremely useful in their support of the tasks of information sharing and integration, communication among various software applications, and decision support. Modeling a CMV as an Object-Oriented Database (OODB) provides additional benefits such as increased support for vocabulary comprehension and flexible access. In this paper, we describe the process of modeling and converting an existing integrated hospital formulary (i.e., set of pharmacological concepts) into an equivalent OODB representation, which, in general, we refer to as an Object-Oriented Healthcare Vocabulary Repository (OOHVR). The source for our example OOHVR is a formulary provided by the Connecticut Healthcare Research and Education Foundation (CHREF). Utilizing this source formulary together with the semantic hierarchy composed of major and minor drug classes defined as part of the National Drug Code (NDC) directory, we constructed a CMV that was eventually converted into its OOHVR form (the CHREF-OOHVR). The actual conversion step was carried out automatically by a program, called the OOHVR Generator, that we have developed. At present, the CHREF-OOHVR is running on top of ONTOS, a commercial OODB management system, and is accessible on the Web.

Databases as Topic↗
PubMedDate not supplied

Teaching new words to children with poor existing vocabulary knowledge: a controlled evaluation of the definition and context methods.

BACKGROUND: Children who have poor vocabulary knowledge are at risk of wider language weaknesses and reading comprehension difficulties, which will impact upon their educational achievement. The central question addressed in this paper is how best to teach new vocabulary items to these children. AIMS: To investigate the effects of two different methods of teaching vocabulary on both vocabulary knowledge and reading comprehension. METHODS & PROCEDURES: Twenty-four children (aged 7-8 years) with poor existing vocabulary knowledge took part in an intervention study. Half the children were taught new vocabulary items using definitions; the other half were taught a strategy for deriving meanings from written context. Tests of vocabulary knowledge were given before teaching, immediately after teaching and 3 months later. OUTCOMES & RESULTS: Immediately after teaching, both groups had improved equivalently in vocabulary knowledge for the taught words. However, 3 months later, the context group showed significantly better expressive vocabulary knowledge. The context group went on to show significantly better comprehension of text containing a number of the taught words and demonstrated that they could use the newly acquired strategy independently to derive meanings from written context. CONCLUSIONS: The context method developed is effective in increasing vocabulary knowledge and improving reading comprehension in children with poor existing vocabulary knowledge, and this is therefore recommended for use with children who require extra help developing vocabulary and comprehension skills.

Case-Control Studies↗
PubMed2004

The impact of matching the patient's vocabulary: a randomized control trial.

BACKGROUND: Research in general practice emphasizes the importance of matched models, beliefs and vocabulary in the consultation. OBJECTIVE: The present study aimed to explore the impact of matched and unmatched vocabulary on patient satisfaction with consultations. METHODS: The study took place in one inner city general practice. Patients (n=62) were randomized to either matched or unmatched vocabulary consultations when consulting for problems relating to sexual or bodily function or anatomy. Matched consultations required the doctor to use the same vocabulary as the patient. Unmatched consultations required the doctor to use medical vocabulary. Completed questionnaires were received from 60 patients. The main outcome measure was patient satisfaction (using the Medical Interview Satisfaction Scale). This assesses total satisfaction and has four subscales: distress relief; communication comfort; rapport; and compliance intent. Doctor satisfaction with the consultation was also assessed. RESULTS: The results showed that the two groups were comparable for demographic variables and doctor satisfaction. However, patients in the matched consultation group had significantly higher total satisfaction scores and higher ratings of rapport, communication comfort, distress relief and compliance intent than those in the unmatched group. CONCLUSION: The results indicate that a doctor's choice of vocabulary affects patient satisfaction immediately after a general practice consultation and that using the same vocabulary as the patient can improve patient outcomes.

Adolescent↗
PubMed1994

Formal properties of the Metathesaurus.

The Metathesaurus is a machine-created, human edited and enhanced synthesis of authoritative biomedical terminologies. Its formal properties permit it to be a) exploited by computers, and b) modified and enhanced without compromising that usage. If further constraints were imposed on the existence and identity of Metathesaurus relationships, i.e., if every Metathesaurus concept had a "genus" and a "differentia," then the Metathesaurus could be converted into an "Aristotelian Hierarchy." In this sense, a genus is a concept that classifies another concept, and a differentia is a concept that distinguishes the classified concept from all other concepts in the same class. Since, in principle, these constraints would make the Metathesaurus easier to leverage and maintain computationally, it is interesting to ask to what degree the maintenance and enhancement procedures now in place are producing a Metathesaurus that is also an "Aristotelian Hierarchy." Given a liberal interpretation of the current Metathesaurus schema, the proportion of the Metathesaurus that is "Aristotelian" in each annual version is increasing in spite of dramatic concurrent increases in the number of Metathesaurus concepts. Without formality there is no modifiability nor scalability. [1] We need formal methods and computer-based tools that can help us with the task [of controlled medical vocabulary construction]. We need research in which controlled vocabulary development is the focus rather than a stepping stone for work on other theories and applications. [2]

Subject Headings↗
PubMed1997

Semantic quality through semantic definition: refining the Read Codes through internal consistency.

Checks of internal consistency in controlled medical vocabularies facilitate their development and assist refinement of the underlying terminological model. Two simple checks of consistency between knowledge in the subtype hierarchy and that in semantic definitions of concepts are described. It is proposed that these checks are a helpful adjunct to, but not a replacement for, large-scale involvement of domain experts in construction of controlled vocabularies.

Classification↗
PubMed1999

A methodology for partitioning a vocabulary hierarchy into trees.

Controlled medical vocabularies are useful in application areas such as medical information systems and decision-support systems. However, such vocabularies are large and complex, and working with them can be daunting. It is important to provide a means for orienting vocabulary designers and users to the vocabulary's contents. We describe a methodology for partitioning a vocabulary based on an IS-A hierarchy into small meaningful pieces. The methodology uses our disciplined modeling framework to refine the IS-A hierarchy according to prescribed rules in a process carried out by a user in conjunction with the computer. The partitioning of the hierarchy implies a partitioning of the vocabulary. We demonstrate the methodology with respect to a complex sample of the MED, an existing medical vocabulary.

Models, Theoretical↗
PubMed1991

An interactive report generator for bone scan studies.

An interactive report generator for bone scintigraphy will be demonstrated. It comprises a controlled reporting vocabulary, an adaptive user interface, and a text generator. The controlled vocabulary represents the relevant concepts for bone scan reports: anatomical sites, scintigraphical phenomena, and diagnoses, and various attributes for these concept domains. Within the vocabulary selectional constraints are defined that restricts to meaningful combination of concepts. The interface provides intelligent views on the vocabulary, and presents only those terms that are relevant in a certain context. Through the interface the user may choose appropriate terms and combine them to complex findings. A German text generator for a restricted finding language transforms the entered data into morpho-syntactic surface structures and produces acceptable reports.

Bone and Bones↗
PubMed2001

Common medical terminology comes of age, Part One: Standard language improves healthcare quality.

It has become abundantly clear that standards of recording clinical terms in human-readable, computer-processable format are indispensable. Controlled medical terminology is the missing link in health information standards (in fact, medical terminology can be viewed as the mother of all standards); its absence interferes with the business of healthcare and impedes the core processes of healing and maintaining health. Medicine has lacked the controlled common medical vocabulary that would enable universal sharing of data at the point of care and ensure reliable information for determining health intervention effectiveness. Simple clinical and code content alone has proven insufficient for healthcare enterprises to successfully manage the terminology problem; the "lexical runtime engine," formerly called a vocabulary server (VOSER), which manages the vocabulary ontology and serves up the relevant vocabulary to users of applications in the clinical environment, has recently become a reality.

Database Management Systems↗
PubMed1997

Partitioning a vocabulary's IS-A hierarchy into trees.

Controlled medical vocabularies are useful in application areas such as medical information-systems and decision-support. However, such vocabularies are large and complex, and working with them can be daunting. It is important to provide a means for orienting users to the vocabulary's contents. This paper introduces a methodology for partitioning a vocabulary into small, meaningful pieces. The partitioning is done with respect to the vocabulary's IS-A hierarchy. The methodology, based on a set of rules for refining the IS-A hierarchy, is a process carried out by a user in conjunction with the computer. The methodology is demonstrated on a complex portion of a vocabulary.

Classification↗
PubMed2002

Representations of health concepts: a cognitive perspective.

OBJECTIVE: This paper studies the differences between controlled medical vocabularies that are designed as external artifacts and the mental concepts that are inside users' heads and used by users for reasoning, decision making, diagnosis, and treatment. DESIGN: The major theories of concept representations developed in cognitive science were reviewed, analyzed, and compared with the major controlled medical vocabularies developed in medicine. RESULTS: It was found that there are significant mismatches between controlled medical vocabularies that are designed as external artifacts and the mental concepts that are inside users' heads and used by users for reasoning, decision making, diagnosis, and treatment. CONCLUSIONS: Controlled medical vocabularies should be designed with systematical considerations of the cognitive structures and processes of the users. Without such considerations, the designed vocabularies will not be appropriate for people because they are hard to use, although they may or may not be appropriate for machine processing.

Attitude to Health↗
PubMedDate not supplied

Updating the Read Codes: user-interactive maintenance of a dynamic clinical vocabulary.

The Read Codes are a hierarchically-arranged controlled clinical vocabulary introduced in the early 1980s and now consisting of three maintained versions of differing complexity. The code sets are dynamic, and are updated quarterly in response to requests from users including clinicians in both primary and secondary care, software suppliers, and advice from a network of specialist healthcare professionals. The codes' continual evolution of content, both across and within versions, highlights tensions between different users and uses of coded clinical data. Internal processes, external interactions and new structural features implemented by the NHS Centre for Coding and Classification (NHSCCC) for user interactive maintenance of the Read Codes are described, and over 2000 items of user feedback episodes received over a 15-month period are analysed.

Computer Systems↗
PubMed1998

Concept-oriented standardization and statistics-oriented classification: continuing the classification versus nomenclature controversy.

Nowadays, most activities on controlled medical vocabularies focus on the provision of a sufficient atomic-level granularity for representing clinical data. Amongst others, clinical vocabularies should be concept oriented, compositional and should also reject "Not Elsewhere Classified". We strongly share the opinion that there is a need to deal with serious deficits of existing manually created vocabularies and with new demands for computer-based advanced processing and exchange of medical language data. However, we do not share the opinion that methodological requirements like observational and structural comparability needed for sound statistics should not be included in desiderata of controlled medical vocabularies. Statistical-oriented classifications are not developed for representing detailed clinical data but for providing purpose-dependent classes where cases of interest are assigned uniquely. Either statistical classifications are not included into the set of controlled medical vocabularies in the sense of Cimino, or his desiderata are misleading. We argue that statistical classifications should be linked to (formal) concept systems, but again this linkage does not change their different natures. With this article we continue the "classification versus nomenclature" controversy referring to Coté.

Data Interpretation, Statistical↗
PubMed2004

Semantics and the medical web: a review of barriers and breakthroughs in effective healthcare query.

This paper provides an overview of the research into current medical vocabularies and their impact on searching the Web for health information. The Web provides growing opportunities for laypersons to gain knowledge about specific health conditions, though research to date has been incomplete. Many studies have examined aspects of controlled medical vocabularies. Other studies have examined aspects of medical Web searching vocabularies. In this context, there is a growing need to examine more closely laypersons' Web queries using controlled medical vocabularies that were designed to serve the needs of medical professionals. It may be the case that the average consumer of Web health services is not able to use correct medical terminology, and may not be able to choose analogous or synonymous terms from a search result list. Our review suggests a growing need for studies to examine the current applicability of controlled medical vocabularies as well as alternatives to semantic query by Web search engine users.

Humans↗
PubMed1995

Fifteen years of medical encoding in the Diogene HIS.

Obtaining good quality encoded medical information is a major issue for patient documentation, hospital management, and epidemiological statistics. In this paper, the experience of encoding medical information in Geneva since 1978 is described, following 1988 IMIA WG6 recommendations: "There is a need to enhance the involvement of physicians and other health care professionals in the original entry of medical and other relevant data to increase its accuracy and quality".

Hospital Information Systems↗
PubMed2000

A method for vocabulary development and visualization based on medical language processing and XML.

A comprehensive controlled clinical vocabulary is critical to the effectiveness of many automated clinical systems. Vocabulary development and maintenance is an important aspect of a vocabulary, and should be linked to terms physicians actually use. This paper presents a method to help vocabulary builders capture, visualize, and analyze both compositional and quantitative information related to terms physicians use. The method includes several components: an MLP system, a corpus of relevant reports and a visualization tool based on XML and JAVA.

Humans↗