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At least 19 recordsLinked to original sources

Linking clinical data using XML topic maps.

Most clinical data is narrative text and often not accessible and searchable at the clinical workstation. We have therefore developed a search engine that allows indexing, searching and linking different kinds of data using web technologies. Text matching methods fail to represent implicit relationships between data, e.g. the relationship between HIV and AIDS. The international organization for standardization (ISO) topic maps standard provides a data model that allows representing arbitrary relationships between resources. Such relationships form the basis for a context sensitive search and accurate search results. The extensible markup language (XML) standards are used for the interchange of data relationships. The approach has been applied to medical classification systems and clinical practice guidelines. The search engine is compared to other XML retrieval methods and the prospect of a "semantic web" is discussed.

Databases, Factual↗

Accurate searching using XML and topic maps.

Most clinical data is narrative text and often not accessible and searchable at the clinical workstation. We have therefore developed a search engine that allows indexing, searching and linking different kinds of data using web technologies. Text matching methods fail to represent implicit relationships between data, e.g. the relationship between HIV and AIDS. The ISO topic maps standard provides a data model that allows representing arbitrary relationships between resources. Such relationships form the basis for context sensitive searching and accurate search results. XML standards are used for the interchange of data relationships. Our approach has been applied to medical classification systems and clinical practice guidelines with promising results.

Germany↗

Mapping topics and topic bursts in PNAS.

Scientific research is highly dynamic. New areas of science continually evolve; others gain or lose importance, merge, or split. Due to the steady increase in the number of scientific publications, it is hard to keep an overview of the structure and dynamic development of one's own field of science, much less all scientific domains. However, knowledge of "hot" topics, emergent research frontiers, or change of focus in certain areas is a critical component of resource allocation decisions in research laboratories, governmental institutions, and corporations. This paper demonstrates the utilization of Kleinberg's burst detection algorithm, co-word occurrence analysis, and graph layout techniques to generate maps that support the identification of major research topics and trends. The approach was applied to analyze and map the complete set of papers published in PNAS in the years 1982-2001. Six domain experts examined and commented on the resulting maps in an attempt to reconstruct the evolution of major research areas covered by PNAS.

Algorithms↗

Synthesis of methods, rules, and issues of standardizing nursing intervention language mapping.

TOPIC: Nursing language mapping. PURPOSE: To synthesize the methods, rules and issues described in two studies that mapped nonstandardized nursing orders/interventions into the Nursing Interventions Classification (NIC). SOURCES: The methods and results of studies conducted by Moorhead & Delaney and Coenen et al. CONCLUSIONS: Results indicate that the NIC is an effective classification of mapping nursing orders/interventions to support across-site comparisons of nursing treatments. A set of decision rules to support mapping of interventions to the NIC is outlined.

Decision Support Techniques↗

Computerized methods of pace-mapping for topical diagnosis of ventricular arrhythmias.

Surgical treatment of ventricular arrhythmias (VAs) is an effective method of solving sudden cardiac death. The important problem of surgical treatment of VAs is the topical diagnosis of the origin of arrhythmia. The precise localization of this area is extremely important for effectiveness of operation. The method of epicardial mapping of the heart during the induced paroxysm of VA is widely used for solving this problem. This problem is difficult when it is impossible to induce tachycardia during the operation. The method of pace-mapping was developed for such cases. This method includes sequential electrical stimulation of ventricles with ECG recording and comparison between intraoperative and preoperative ECG. The goal is the identification of the area of ventricles closed to preoperative ECG with VA. Manual processing of these data is difficult and takes time. The results of such processing have a low precision. That is why we propose using computerized methods. The goal of this investigation is to develop computerized methods of topical ECG diagnosis of VA. We propose a method of computer comparative analysis of ECG morphology for spontaneous and stimulated ECG. The goal is the determination with stimulated ECG the point of ventricles with ECG closest to spontaneous ECG during ventricular tachycardia. Nine patients (15-57 years old) with VA were studied. The main result of this investigation is that computerized pace-mapping method is an effective tool for topical diagnostics of different forms of VAs, which is impossible to induce by electrical programmed stimulation.

Adolescent↗

Topic variability and linguistic convergence in marital couples' speech as related to specific attachment style.

Links between mental working models, attachment style, and linguistic strategies were analyzed in the present research, which focused on linguistic choices made by marital couples. Eight couples (16 Italian subjects, M age=49.1, SD=0.4) with drug-addicted sons and undergoing systemic therapeutic treatment were recruited. Conversational transcripts were coded by two judges. The research analyzed (a) the definition of a topics map derived from the Adult Attachment Interview, using the discursive level of the topic; (b) the systemic-functional analysis of the topics, through both the micro- and macro-unit levels and the lexical/semantic indexes of the discourse; (c) the within-couple convergence in terms of linguistic moves, and, more generally, of their cognitive strategies. Specifically, a hierarchical model of the topic organization was used to explain the recursivity of the thematic choices made by the participants. Secondly, the characterization of the topics in terms of their cognitive/emotive values (high/low "critical" topics) was explained, especially through some "linguistic markers" as disfluency or lexical/semantic indexes (i.e., linguistic variety and completeness indexes). Third, it was found that different and specific linguistic strategies were adopted by the couples in order to reiterate their internal working models. The high convergence of linguistic patterns inside the marital couple was discussed as representative of "dysfunctional" working models, from both the communicative and relational points of view.

Adolescent↗

Promoting collaboration and transparency in patient safety.

BACKGROUND: The Minnesota Alliance for Patient Safety (MAPS) collaborative was founded in 2000 by the Minnesota Hospital Association (MHA), the Minnesota Medical Association, and the Minnesota Department of Health. CREATING A CULTURE OF LEARNING, JUSTICE, AND ACCOUNTABILITY: MAPS made it a priority to make the health care workplace one that encourages learning from adverse events. MAPS is pioneering a statewide model of a "just" culture--one that supports learning yet holds individuals accountable for errors. LEGISLATIVE CHANGES: In 2001, MAPS helped revise the Minnesota peer review law to allow hospitals to share key safety information through electronic databases such as the MHA Patient Safety Registry. The revisions paved the way for the 2003 landmark Minnesota Adverse Health Care Event Reporting Act, which encourages reporting of root cause investigations and steps taken by facilities to prevent recurrence. In 2003 the Patient Safety Registry, an electronic database, was expanded to serve as a confidential clearinghouse for facilities' reporting of adverse events. PATIENT SAFETY TOPICS: MAPS serves as catalyst for developing and disseminating best practices on topics such as health literacy, falls prevention, culture of safety, engaging patients, and consumers' medication tracking. CONCLUSION: The six-year collaborative effort by the many organizations comprising MAPS has led to a transformation in Minnesota's health care safety culture.

Awards and Prizes↗

Effects of Ruscus extract on the internal diameter of arterioles and venules of the hamster cheek pouch microcirculation.

In the present study, we investigated (a) the effects of the extract of Ruscus aculeatus, which is used to increase peripheral venous tone, on the diameter of arterioles (ID range 10-70 microns) and venules (ID range 20-135 microns) of hamster cheek pouch microvasculature in vivo and (b) the influence of temperature on the observed effects. For microcirculatory measurements, the preparations were placed under an intravital microscope and coupled to a closed-circuit TV (ccTV) system. The TV monitor display was used to obtain arteriolar and venular ID recordings (always at the same site) by an image shearing device. For systemic intravenous (i.v.) administration, the measurements were performed every 10 min, before (control) and after injection of the extract (5 mg/kg). During topical application, the extract was tested, in different concentrations, at 25 degrees, 36.5 degrees, and 40 degrees C. Systemic i.v. administration of Ruscus extract evoked venular constriction and did not affect the arteriolar diameter or mean arterial pressure (MAP). Topical application of Ruscus extract elicited concentration- and temperature-dependent responses in the vessels. At 25 degrees C, arterioles and venules dilated; at 36.5 degrees C, the arterioles remained unchanged while the venules constricted, and at 40 degrees C, the arterioles remained unchanged or constricted depending on the concentration used while the venules further constricted. The effects of Ruscus extract observed in vivo at the microcirculatory level further support the data previously reported on larger vessels and on patients with venous insufficiency.

Administration, Topical↗

Formation of glomerular maps in the olfactory system.

Sensory perception relies on the decoding of external stimuli into an internal neuronal representation, which requires precise connections between the periphery and the brain. In the olfactory system the axons of chemosensory neurons with the same odorant receptor coalesce into common glomeruli in the olfactory bulb, forming a receptor-topic map. The creation of this map begins prenatally when axons navigate towards the bulb, resort in a receptor-specific manner and terminate in a broad area interdigitated with other axon populations; distinct glomeruli form postnatally. While the initial process of glomerulization requires mainly molecular determinants, activity-dependent processes lead to a refinement of glomerular organization.

Animals↗

Getting to the (c)ore of knowledge: mining biomedical literature.

Literature mining is the process of extracting and combining facts from scientific publications. In recent years, many computer programs have been designed to extract various molecular biology findings from Medline abstracts or full-text articles. The present article describes the range of text mining techniques that have been applied to scientific documents. It divides 'automated reading' into four general subtasks: text categorization, named entity tagging, fact extraction, and collection-wide analysis. Literature mining offers powerful methods to support knowledge discovery and the construction of topic maps and ontologies. An overview is given of recent developments in medical language processing. Special attention is given to the domain particularities of molecular biology, and the emerging synergy between literature mining and molecular databases accessible through Internet.

Abstracting and Indexing↗

[Quantification of functional retinal damage in branch retinal vein thromboses].

PURPOSE: Branch retinal vein occlusion (BRVO) induces variable functional deficits depending on the grade of vascular occlusion and its localisation. Theses deficiences are not easily defined by visual acuity measurements. However, microperimetry offers topical mapping of retinal function, allowing precise documentation of the intensity and dimension of retinal functional loss in BRVO. METHODS: Retinal sensitivity was examined using a Rodenstock Scanning Laser Ophthalmoscope (SLO). A standardized grading system of stimuli ranging from 0 to 32 dB was used to document the retinal threshold in three different areas: regions presenting vascular occlusion, the collateral edematous zone and adjacent areas with intact perfusion. Absolute and relative scotomas as well as the fixation behavior were studied. RESULTS: Forty-two patients with isolated BRVO within the vascular arcades were examined with microperimetry and angiography. At initial presentation with BRVO the retinal sensitivity in the area of occlusion on average diminished to 4.1 dB. In the collateral edematous zone retinal threshold was reduced to 21.5 dB; area with intact perfusion demonstrated a threshold of 23.2 dB. Within the occluded area itself defects of significantly differing intensity were found which only partially correlated with the angiographic evidence. Intense scotomas (0 dB) were observed in 59% of the eyes examined: angiographically nonperfused areas or extended intraretinal hemorrhage were present. Relative scotomas (12.1 dB) were seen in 19.1% and minimal, non-significant defects (19.5 dB) were documented in 21.4% of the BRVO. The level of angiographically documented leakage did not correlate with the functional deficits present in these two groups. Measurements performed after 6-8 weeks revealed noticeable spontaneous recovery of retinal sensitivity, unless an additional progressive closure occurred. The average functional improvement in the area of leakage found after laser therapy was less than the results shown in spontaneous resolution of edema. CONCLUSIONS: BRVO may lead to significant reductions of central and paracentral retinal function. Angiographically observed leakage is not always directly correlated to the magnitude of retinal sensitivity loss. As spontenous remission is frequent in one group and intact retinal function can be shown in areas of angiographic leakage, therapeutic interventions, e.g., laser treatment, should be carefully considered. Scanning laser ophthalmoscopy provides additional information for precise evaluation and follow-up of the retinal damage in BRVO.

Adult↗

Implementing health care systems using XML standards.

Most healthcare data is narrative text and often not accessible and easy to find at the clinical workstation. XML related standards (XML schema, XForms, XSL, Topic Maps, etc.) provide an infrastructure that might change the situation. Yet, it is up to the application developers to combine the given standards and tools into a running system. The cost of development is often underestimated and may explain the absence of comprehensive XML applications. Our goal is the clinical application of these standards. We have, therefore, implemented the idea of "plug-and-play XML", i.e. the development of new applications by means of XML standards. This paper will communicate our experience using such an approach at the example of a clinical drug information system.

Drug Information Services↗

[Micro-perimetric documentation of retinal function in photodynamic therapy of choroid neovascularizations].

PURPOSE: Photodynamic therapy provides occlusion of choroidal neovascularization by intravascular endothelial damage. The photodynamic approach offers the potential to occlude choroidal neovascularization selectively without altering adjacent sensory retina and therefore to preserve visual acuity. To determine the selectivity of photodynamic therapy photoreceptor function was measured by microperimetry allowing topic mapping of retinal function. METHODS: A Rodenstock scanning laser ophthalmoscope was used to document preservation of central visual fields before and after photodynamic therapy. Single photodynamic therapy without known efficient parameters was performed in 13 patients and repeated photodynamic therapy using optimised light doses was performed in 10 patients with subfoveal choroidal neovascularization using benzoporphyrin derivate (verteporfin). Intensity and dimension of central scotomas were measured, using a grading system of stimuli ranging from 0-32 dB. Areas of absolute and relative defect were defined and fixation localisation was monitored. Perimetric testing was done pre photodynamic therapy, one week, one month and three months post photodynamic therapy. RESULTS: Postoperative scotomas after single photodynamic therapy were smaller in 8%, identical in 61% and larger in 31% compared with preoperative findings. After repeated photodynamic therapy postoperative scotomas were smaller in 70%, identical in 30% and larger in no case. The observed increase was less than 25% of the original size. Postoperative defects were always significantly smaller than the entire size of the irradiated area. No new scotomas were found after photodynamic therapy. Angiographically visible occlusion post photodynamic therapy was in general larger than scotoma size. CONCLUSION: Documentation of the retinal function by microperimetry after photodynamic therapy of subfoveal choroidal neovascularization shows no new scotoma in the treated area. This can also be documented in the hypofluorescent area around the lesion one week after the treatment. After repeated treatment a reduced scotoma size due to choroidal neovascularization could be seen in 2/3 of the patients after 3 months. No initial vision loss as seen in conventional photocoagulation could be documented after photodynamic therapy.

Aged↗

Transparent ICD and DRG coding using information technology: linking and associating information sources with the eXtensible Markup Language.

With the introduction of ICD-10 as the standard for diagnostics, it becomes necessary to develop an electronic representation of its complete content, inherent semantics, and coding rules. The authors' design relates to the current efforts by the CEN/TC 251 to establish a European standard for hierarchical classification systems in health care. The authors have developed an electronic representation of ICD-10 with the eXtensible Markup Language (XML) that facilitates integration into current information systems and coding software, taking different languages and versions into account. In this context, XML provides a complete processing framework of related technologies and standard tools that helps develop interoperable applications. XML provides semantic markup. It allows domain-specific definition of tags and hierarchical document structure. The idea of linking and thus combining information from different sources is a valuable feature of XML. In addition, XML topic maps are used to describe relationships between different sources, or "semantically associated" parts of these sources. The issue of achieving a standardized medical vocabulary becomes more and more important with the stepwise implementation of diagnostically related groups, for example. The aim of the authors' work is to provide a transparent and open infrastructure that can be used to support clinical coding and to develop further software applications. The authors are assuming that a comprehensive representation of the content, structure, inherent semantics, and layout of medical classification systems can be achieved through a document-oriented approach.

Diagnosis-Related Groups↗

Methods of mortality (incidence) rates interpretation assessment in small populations.

Findings and procedures include in this article have been realized at Regional Public Health Office in Hradec Králové (Czech Republic) within the period from August 1999 to February 2000. The model sample used in this article dealed only with events of neoplasms incidence in men's population in the region of Eastern Bohemia within the period from 1986 to 1997. The original experimental part concerned to the use of procedures for demographical data standardization for target group of "small populations" including of their selection and spatial distribution. As the result of it, there are topical maps of spatial distribution of incidence (event. mortality) of selected diagnoses according to sex with target area units delimitated by methods of regional geography with around 120 km2 and total average number about 10000 inhabitants. Thanks to using of cluster analysis these maps include inside aggregated information about standardized ratio value, expression of its reliability rate. The original system has been tested thanks to software application and methodical procedures developed by author of this article in the connection with progressive information technology of geographical information system GIS SPANS which all allow quite easily to carry out the detection of another diagnoses spatial distribution within selected resolution and provided data. Mentioned above conclusions may be suggested as a basic descriptive method for the health risk assessment. Another analytical procedures can follow this original method in next phases. The method has brought essentially new view of the disease spatial distribution which has not been used in the Czech Republic in such a range and detail yet. There are being uncovered great possibilities that could in the end contribute to discovering of causal connections - mainly diseases with unfavourable development in time series. At the same time the introductory premise about spatial distribution of events to "skip" with the change of resolution has been confirmed.

Adolescent↗

Lidocaine as topical anesthesia for bladder mappings and cold-cup biopsies.

We describe the use of lidocaine as a topical anesthetic for 35 patients undergoing random bladder biopsies (bladder mappings) and cold-cup resection of small bladder lesions. Serum lidocaine levels were measured 7 to 10 minutes after instillation of the anesthetic using fluorescent polarization immunoassay. Adequate pain control was noted in 33 of 35 patients (94%), with negligible serum lidocaine levels noted in all 35. One patient had a 2 cm. tumor on the anterior wall of the bladder making resection with topical anesthesia suboptimal and 1 patient required 1 mg. supplemental intravenous midazolam hydrochloride to complete the procedure. We conclude that topical lidocaine is a safe, inexpensive and effective mode of anesthesia for bladder mappings and cold-cup biopsies of small bladder lesions. However, it may be inadequate for lesions large enough to require resection rather than cold-cup biopsy and those at poorly accessible regions of the bladder.

Aged↗