Comparing and evaluating terminology services application programming interfaces: RxNav, UMLSKS and LexBIG

To facilitate the integration of terminologies into applications, various terminology services application programming interfaces (API) have been developed in the recent past. In this study, three publicly available terminology services API, RxNav, UMLSKS and LexBIG, are compared and functionally evaluated with respect to the retrieval of information from one biomedical terminology, RxNorm, to which all three services provide access. A list of queries is established covering a wide spectrum of terminology services functionalities such as finding RxNorm concepts by their name, or navigating different types of relationships. Test data were generated from the RxNorm dataset to evaluate the implementation of the functionalities in the three API. The results revealed issues with various aspects of the API implementation (eg, handling of obsolete terms by LexBIG) and documentation (eg, navigational paths used in RxNav) that were subsequently addressed by the development teams of the three API investigated. Knowledge about such discrepancies helps inform the choice of an API for a given use case.The evolution of terminologies, across the spectrum of detailed nomenclatures and sophisticated classifications, has accelerated dramatically this decade,¹ and terminologies play a crucial role in applications including knowledge management, data integration and decision support.² To facilitate the integration of terminologies into applications, various terminology services application programming interfaces (API) have been developed in the recent past. In the biomedical domain, for example, such API for terminology services are a key component of the architecture of the cancer biomedical informatics grid (caBIG) developed under the auspices of the National Cancer Institute (NCI).³In practice, these API are tuned to efficiently and effectively provide a host of functional characteristics ranging from retrieving concept attributes such as definitions and synonyms, to navigating relationships between concepts (eg, finding sub or super-concepts of a given concept) and accessing information combinatorially (eg, list the immediate parent concepts of all concepts that have a term that contains the word infarction). In addition, the API provide various degrees of fault resilience (to ensure high availability of service), security (to prevent unauthorized alteration and/or disruption of content) and federation (to maintain linkages among components of a large terminology, or cross-references among related terminologies).As is true of interfaces in general, terminology service API integrated in biomedical applications have an impact on the overall quality of these applications. For example, the inability of a drug terminology API to serve the latest available data or to identify links between drug entities may cause a clinical decision support system (CDSS) relying on terminological information to make wrong inferences. For example, the following scenario illustrates the practical consequences on health care of suboptimal terminology services: A drug terminology service fails to identify the link between a brand name and its ingredients (eg, between Hamarin and allopurinol), which is used by the CDSS to identify drug–drug interactions among ingredients (eg, between allopurinol and warfarin). The CDSS, having failed to identify the proper interactions based on the information from the drug terminology service, fails to send an alert to the physician, and adverse events (eg, increased anticoagulation) occur in a patient as a consequence of the interaction between drugs (eg, metabolism of warfarin inhibited by allopurinol). Although hypothetical, this scenario illustrates the possible impact of terminology services on health care and motivates our investigation of terminology services.In some cases, multiple terminology services API deliver overlapping capabilities and mechanisms for querying the same information, thereby making it important to evaluate the consistency and accuracy of the functionalities provided. The goal of this study is to perform a functional evaluation of three publicly available terminology services API, RxNav, UMLSKS and LexBIG, with respect to the retrieval of information from one biomedical terminology, RxNorm, to which all three services provide access.     

病案利用人性化服务的探讨

目的进一步做好病案对外利用工作,确保病案利用工作的健康发展。方法对人性化服务的概念与特点进行了探讨,并提出了人性化服务具体措施。结果促进了病案对外利用工作的发展,实现了病案信息资源共享。结论病案利用人性化服务是病案管理工作的价值取向和追求的目标。     

An appraisal of the cost benefit of magnetic resonance imaging in Nigeria

Magnetic Resonance Scanning has revolutionized the imaging world since its invention about two decades ago. Despite its proven efficacy in patient care, it is largely non-available in the Nigeria healthcare system. This article discusses the worldwide distribution of this modality, highlights its diagnostic efficacy and emphasizes the need for Nigeria to join other countries of the world that are already utilizing this innovation in patient care. Measures at sustaining the availability of these services are suggested.     

"双诊制"的相关研究综述

为研究社区卫生服务与“双诊制”的关系,本文综述了双诊制的相关概念及其内涵、国外实施情况、我国研究进展及存在的问题。指出我国“双诊制”与国外“守门人”制概念上的差别,同时提出就诊制度、医疗保障体系、全科医生准入制度是“双诊制”实施的必要条件。     

National survey of HIV and hepatitis testing and vaccination services provided by drug and alcohol agencies in Australia

OBJECTIVES: To identify the prevalence of blood-borne viruses (BBVs) testing, counselling and vaccination services by drug and alcohol services for injecting drug users in Australia. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional survey of drug and alcohol agencies throughout Australia. OUTCOME MEASURES: Current availability of testing, counselling and vaccination services for hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV; availability of medical coverage; and barriers to greater provision of services. RESULTS: Survey responses were provided by 222 agencies nationally (61% response rate). About three-quarters of agencies provided some access to HIV, HBV, and HCV testing and HBV vaccinations, but only a third offered these services routinely on site. HBV vaccination availability differed depending on the primary function of the agency, with drug dependence units and needle and syringe programs more likely to provide vaccination on site. The major barriers preventing agencies from providing routine on-site BBV services are lack of access to medical staff and trained personnel; the cost of providing these services; and a lack of facilities. CONCLUSIONS: The restricted provision of BBV services represents missed opportunities to reduce individual and community morbidity and to maximise the potential savings from preventable disease in relation to HBV infection. To address key barriers and patient retention issues, it is necessary to expand the role of non-medical staff, increase the use of shorter HBV vaccination schedules, and identify and maintain local clinical partnerships between public and private service providers.     

Availability of personal counseling in medical schools

The deans of student affairs at 114 medical schools were surveyed about the availability of counseling services for medical students. There were 85 respondents (75 percent), all of whom indicated that some counseling services were available at their schools. One-third felt the services were not adequate. In addition, student representatives at these 114 schools were surveyed on the same topic, 53 responded (46 percent), and most said there was underutilization due to poor communication, problems resulting from initial contacts through the administration, and concern about confidentiality. Recommendations are made to help increase the utilization of counseling resources.     

Teaching medical students about fair distribution of healthcare resources

Healthcare package decisions are complex. Different judgements about effectiveness, cost-effectiveness and disease burden influence the decision-making process. Moreover, different concepts of justice generate different ideas about fair distribution of healthcare resources. This paper presents a decision model that is used in medical school in order to familiarise medical students with the different concepts of justice and the ethical dimension of making concrete choices. The model is based on the four-stage decision model developed in the Netherlands by the Dunning Committee and the discussion that followed its presentation in 1991. Having to deal with 10 medical services, students working with the model learn to discern and integrate four different ideas of distributive justice that are integrated in a flow chart: libertarian, communitarian, egalitarian and utilitarian.     

Open access radiology services: availability to general practitioners in the UK

A postal survey was carried out among secretaries of local medical committees to ascertain the availability of open access to radiology services in the United Kingdom. The results from different areas showed a wide variation of access, ranging from virtually none to complete access. General practitioner representatives on management teams might encourage open access to radiology services, and health authorities might be encouraged to introduce complete open access.     

Going the distance: the influence of practice location on the Ontario Maternal Serum Screening Program

BACKGROUND: The Ontario Maternal Serum Screening (MSS) Program was introduced by the Ontario Ministry of Health as a province-wide pilot project in 1993. The objective of this study was to determine the influence of practice location on Ontario health care providers' use of and opinions regarding MSS, access to follow-up services and recommendations about the program. METHODS: A questionnaire was mailed to a random sample of 2000 family physicians, all 565 obstetricians and all 62 registered midwives in Ontario between November 1994 and March 1995. RESULTS: Among providers who were eligible (those providing antenatal care or attending births) the response rates were 91.4% (778/851), 76.0% (273/359) and 78.0% (46/59) respectively. Fewer respondents in the Northwest region (71.4%) and in rural areas (81.9%) stated that they routinely offer MSS to all pregnant women in their practices compared with respondents in other regions (84.4%-91.5%) and urban centres (90.1%). Fewer respondents in the northern regions (Northeast 49.2%, Northwest 25.0%) than in the Central East region (includes Toronto) (76.6%) felt that follow-up services were readily available. Respondents in the northern regions had less favourable opinions of MSS than those in the other regions in terms of its complexity, cost, the time involved in counselling and the high false-positive rate. More respondents in the Central East region (64.6%) and in urban centres (52.9%) recommended not changing the MSS program than did those in the Northwest (7.1%) and rural areas (39.8%). After provider characteristics were controlled for in a logistic regression analysis, practice location was not the most important factor. Instead, the model showed that respondents who cared for 50 or more pregnant women in the previous year were more likely to offer MSS routinely (OR 2.00, 95% CI 1.21-3.27) and that those who felt that patient characteristics affect the offering of MSS (OR 0.42, 95% CI 0.26-0.67) or that follow-up services were not readily available (OR 0.33, 95% CI 0.20-0.55) were less likely to offer it. INTERPRETATION: Health care providers in northern and rural Ontario were less likely to offer MSS routinely than those in other regions and were more likely to recommend changing or eliminating the program. Providers' concerns about the social and cultural sensitivity of MSS and the availability of follow-up services affected use.     

治安民警的职业倦怠及其与社会支持、应对方式及自我效能的关系

目的:调查治安民警的职业倦怠状况,研究其社会支持、应对方式及自我效能与职业倦怠的关系。方法:采用自制的一般情况调查表、Maslach倦怠量表(MBI-HSS)、社会支持评定量表(SSRS)、特质应对方式问卷(TCSQ)和一般自我效能感量表(GSES)对221名基层派出所治安民警进行问卷调查。结果:①不同的性别、婚姻状况、工作年限民警的职业倦怠水平有显著差异;②主观支持对情绪衰竭、人格解体有显著的负向预测作用;消极应对对情绪衰竭有显著的正向预测作用,而对个人成就感有显著的负向预测作用;利用度和积极应对对个人成就感有显著的正向预测作用;自我效能对个人成就感有显著的正向预测作用,对人格解体有显著的负向预测作用。结论:性别、婚姻状况、工作年限、社会支持、应对方式及自我效能对治安民警的职业倦怠均有不同程度的影响,须采取相应的措施进行干预。     

什么是成功和健康的老龄

发展中国老龄事业包括设计适宜的卫生服务和老年保健服务，其前提条件是必须要清楚老年人是怎样理解成功和健康的老龄。老年人是中国社区卫生服务的主要服务对象，为了达到社区卫生服务最大的效率和效益，需要把社区卫生服务目标与老年人的期望和个人目标联系起来。本文通过对成功和健康老龄概念的文献研究，发现研究老年人自己对成功和健康老龄理解的报告很少，而且针对不同文化背景的老年人群的研究更少。目前，中国和澳大利亚学者合作在两国开展了一项跨文化研究，研究不同文化背景下的老年人对成功和健康老龄的理解，为完善老龄化和社区卫生服务政策提供证据。[编者按]     

The future of medical thoracoscopy in the Kingdom of Saudi Arabia

Medical thoracoscopy (MT) has changed how we manage exudative pleural effusion. It is a minimally invasive procedure used as a diagnostic and therapeutic tool in pleural disease. Here, we report a case of a lymphocytic exudative pleural effusion that needed a pleural biopsy for diagnosis. Medical thoracoscopy was performed, a biopsy was taken, and adhesiolysis was performed. Medical thoracoscopy has been practiced for a while worldwide, but it has not been utilized in the Kingdom of Saudi Arabia and as we believe that it is useful in diagnosing exudative pleural effusions. It limits patients in hospital-stay and it may be less costly than surgical procedures. It is especially helpful in diagnosing and treating pleural effusions in elderly patients with multiple comorbidities. Such procedures are needed to ease ongoing financial constraints, and with the 2019 coronavirus disease (COVID-19) pandemic, less time in the hospital means better utilization of beds during the pandemic. Spreading the knowledge about this procedure and its availability in the country will improve the health services provided to the patients.     

新医改背景下医院软实力构建的路径探讨

软实力是医院综合实力的重要组成部分,主要包括医院的价值观念、文化感召力、医疗服务水平、品牌影响力、管理水平等。新医改的推行是为了解决群众“看病难,看病贵”的问题,使医疗回归公益性,增强医院的吸引力。医院应该树立正确的价值观、塑造优良文化、完善医疗服务体系、加强医院品牌建设、改进医院管理模式,加强医院软实力建设。     

Pathways to services for children with cerebral palsy in Selangor and the Federal Territory, Kuala Lumpur

Cerebral Palsy (CP) describes a group of chronic conditions affecting body movement and muscle coordination caused by damage to one or more areas of the brain, occurring at any time during foetal development to infancy. This research was carried out to learn how parents of children with cerebral palsy (CP) had found and accessed services provided for them in Selangor and Kuala Lumpur. It was based in the Spastic Children's Association of Selangor and Federal Territory (SCAS&FT) among 96 of 201 parents of children who use the facilities and services provided by the SCAS&FT through questionnaires and face-to-face interviews. There was a satisfactory level of availability and accessibility of contacting and using the services provided by SCAS&FT in terms of respondent satisfaction. However, parents had varying levels of awareness of the different classes and activities carried out by the school. Efforts to improve knowledge regarding the services available for children with CP in the general population and among parents of these children should be promoted.     

基于云计算理念与技术的医疗信息化

云计算技术和理念改变了传统的计算资源的应用模式.分析影响医疗卫生信息化建设与快速发展的主要因素,简要介绍云计算的概念和典型应用,提出了医疗信息化中基于云计算技术的软件服务和云存储服务的应用模型,探讨云计算技术在医疗信息化应用中面临的挑战.     

Assuring the quality of health care for older persons. An expert panel's priorities

To select topics for quality assurance activities focusing on older patients, we convened a 14-member panel of physicians and experts in quality assurance. In two rounds of ratings, panelists rated 42 medical conditions (eg, pneumonia) in terms of their effects on patient outcomes, the availability of beneficial interventions, and the health benefits from improving current quality. They rated 27 health services (eg, adult day-care) on similar dimensions. The feasibility of doing quality assurance work on each condition and service also was rated. Using the ratings, the conditions selected for quality assurance work were congestive heart failure, hypertension, pneumonia, breast cancer, adverse effects of drugs, incontinence, and depression. Health care services selected were hospital discharge planning, acute inpatient care for the frail elderly, long-term-care facilities (intermediate-care facilities and skilled nursing facilities), home health care services, and case management.     

How to Measure the QoS of a Web-based EHRs System: Development of an Instrument

The quality of service (QoS) can be treated as a set of concepts whose satisfaction/dissatisfaction generates a global positive/negative vision about the service provided by any application. The different nature of the services and its features require an analysis of the factors that have the greatest influence on the users' opinion and, therefore, measuring the quality of service in each application requires a specific instrument. This paper will introduce an instrument to measure the QoS offered to users by a general Web application for Electronic Health Records (EHRs). The collection of opinions from a pilot sample and the performance of an explanatory factor analysis will bring together the factors that best sum up the quality of an EHRs application. Subsequently, a confirmatory factor analysis will be performed to make the study reliable and, as its name suggests, to confirm that indeed the structure of the instrument developed measures the QoS in accordance with the requirements of the users.     

Local advocacy for the medically indigent. Strategies and accomplishments in one county

Access to health care for the medically indigent has emerged as a major policy issue throughout the United States. Because no national health program ensures entitlement to basic services, practitioners and patients must cope with barriers to access on the local level. We report several separate but integrated strategies that a community-based coalition has used to achieve improvements in indigent care within a single county. Research strategies have involved short-term investigations of barriers to needed services so that local awareness of the problem would increase rapidly. Political strategies have attempted to improve the county government's administrative procedures and financial support of services for the poor, to modify the practices of local health care institutions, and to influence state and national policies that affect local conditions. Legal strategies have involved the participation of attorneys who represent clients unable to receive care and who could initiate litigation as appropriate. Each of these strategies contains weaknesses as well as strengths. Although such advocacy efforts do not achieve a coherent system that guarantees access, they can substantially improve the availability of local services.     

试论片医礼仪在社区卫生服务中的应用

目的:总结在社区卫生服务工作中开展规范化片医礼仪服务的工作经验。方法:将片医礼仪服务运用于社区日常工作中,如在接待社区居民、入户家庭访视、慢病随访、接听电话。结果:通过推广统一形象设计、管理模式、服务理念、工作流程、设备配备、技术指导、交通工具、服装设计、工作环境、优惠政策"十统一",打造"郑州片医"形象。结论:通过规范片医礼仪服务,使片医真正做到了"以人为本",以真情换理解,主动服务居民,使社区居民积极主动配合工作,取得较好的社会效果。     

Hospital ownership and psychiatric services

Dramatic increases have occurred in the proportion of for-profit hospitals in the general hospital sector; even more pronounced increases have occurred within the psychiatric sector. Concomitant with this changing mix of ownerships, revised reimbursement plans are being proposed for psychiatry. Thus, providers of acute psychiatric inpatient care, although loosely aggregated, constitute a service system that is experiencing dynamic revision. This article examines the implications of these changes for health policy analysts and planners in the design of hospital payment mechanisms and in planning for resources to meet the needs of the public. The state of California is viewed as a system, and data from the state are examined to test traditional assumptions of economic behavior when less costly substitute services are available. The availability of services such as outpatient clinics, emergency psychiatric services, and partial hospitalization are found to vary according to hospital ownership. Differences in availability of these services influence the access to inpatient care experienced by various populations within the defined system. Although these services may permit earlier discharge from the hospital, the poor insurance coverage of ambulatory psychiatric care relative to inpatient hospitalization^1–3 distorts this effect. The implications of these findings for public policy are discussed.