Representation of change in controlled medical terminologies

Computer-based systems that support health care require large controlled terminologies to manage names and meanings of data elements. These terminologies are not static, because change in health care is inevitable. To share data and applications in health care, we need standards not only for terminologies and concept representation, but also for representing change. To develop a principled approach to managing change, we analyze the requirements of controlled medical terminologies and consider features that frame knowledge-representation systems have to offer. Based on our analysis, we present a concept model, a set of change operations, and a change-documentation model that may be appropriate for controlled terminologies in health care. We are currently implementing our modeling approach within a computational architecture.     

Translating medical terminologies through word alignment in parallel text corpora

Developing international multilingual terminologies is a time-consuming process. We present a methodology which aims to ease this process by automatically acquiring new translations of medical terms based on word alignment in parallel text corpora, and test it on English and French. After collecting a parallel, English–French corpus, we detected French translations of English terms from three terminologies—MeSH, SNOMED CT and the MedlinePlus Health Topics. We obtained respectively for each terminology 74.8%, 77.8% and 76.3% of linguistically correct new translations. A sample of the MeSH translations was submitted to expert review and 61.5% were deemed desirable additions to the French MeSH. In conclusion, we successfully obtained good quality new translations, which underlines the suitability of using alignment in text corpora to help translating terminologies. Our method may be applied to different European languages and provides a methodological framework that may be used with different processing tools.     

Evaluation of alternative standardized terminologies for medical conditions within a network of observational healthcare databases

Large electronic databases of health care information, such as administrative claims and electronic health records, are available and are being used in a number of public health settings, including drug safety surveillance. However, because of a lack of standardization, clinical terminologies may differ across databases. With the aid of existing resources and expert coders, we have developed mapping tables to convert ICD-9-CM diagnosis codes used in some existing databases to SNOMED-CT and MedDRA. In addition, previously developed definitions for specific health outcomes of interest were mapped to the same standardized vocabularies. We evaluated how vocabulary mapping affected (1) the retention of clinical data from two test databases, (2) the semantic space of outcome definitions, (3) the prevalence of each outcome in the test databases, and (4) the reliability of analytic methods designed to detect drug-outcome associations in the test databases. Although vocabulary mapping affected the semantic space of some outcome definitions, as well as the prevalence of some outcomes in the test databases, it had only minor effects on the analysis of drug-outcome associations. Furthermore, both SNOMED-CT and MedDRA were viable for use as standardized vocabularies in systems designed to perform active medical product surveillance using disparate sources of observational data.     

Getting comfortable with RH blood group system terminologies and databases

The RH blood group system is the most important protein blood group system. Due to the high interest, often discoveries occurred in parallel and different groups used different nomenclatures. ISBT overtook the task to create nomenclatures both for antigens and alleles. Nevertheless, knowledge of internet resources is important to find the way among these alleles. Both general resources such as RESPIRE and gnomAD, allele‐oriented resource such as bloodantigens, erythrogene and HGMDB as well as dedicated resources such as the RHCE allele listing and the Human RhesusBase are presented.     

Ontology development for unified traditional Chinese medical language system

Traditional Chinese medicine (TCM) as a complete knowledge system researches into human health conditions via a different approach compared to orthodox medicine. We are developing a unified traditional Chinese medical language system (UTCMLS) through an ontology approach that will support TCM language knowledge storage, concept-based information retrieval and information integration. UTCMLS is a huge knowledge project, which is a broad collaboration of 16 distributed groups, most of them with no prior experience of formal ontology development. Therefore, the cooperative and comprehensive ontology engineering is crucial. We use Protégé 2000 for ontology development of concepts and relationships that represent the domain and that will permit storage of TCM knowledge. This paper focuses on the methodology, design and development of ontology for UTCMLS.     

Indexing method of digital audiovisual medical resources with semantic Web integration

Digitalization of audiovisual resources and network capability offer many possibilities which are the subject of intensive work in scientific and industrial sectors. Indexing such resources is a major challenge. Recently, the Motion Pictures Expert Group (MPEG) has developed MPEG-7, a standard for describing multimedia content. The goal of this standard is to develop a rich set of standardized tools to enable efficient retrieval from digital archives or the filtering of audiovisual broadcasts on the Internet. How could this kind of technology be used in the medical context? In this paper, we propose a simpler indexing system, based on the Dublin Core standard and compliant to MPEG-7. We use MeSH and the UMLS to introduce conceptual navigation. We also present a video-platform which enables encoding and gives access to audiovisual resources in streaming mode.     

Commentary: Coming to America: the integration of international medical graduates into the American medical culture.

This Commentary is a companion piece to two Research Reports appearing in this issue: "Behavioral Science Education and the International Medical Graduate," by Searight and Gafford, and "International Medical Graduates and the Diagnosis and Treatment of Late-Life Depression," by Kales et al. International medical graduates (IMGs) come to America from diverse cultures around the world to complete their graduate medical education (GME). These residents are and will continue to be a fundamental part of the American health care delivery system. IMGs' acculturation into the norms and standards of medicine as practiced in the U.S. is crucial to their education as well as to quality patient care. The time has come for GME to begin to systematically and effectively address the cultural challenges that IMGs face not only within the context of American medicine and GME, but in the larger context of American culture. Specific programs and strategies need to be developed and put in place early in the GME experience-or even before entry into GME-to assist IMGs in understanding the context for, and issues associated with, providing optimum health care in the United States. The author reflects on the findings of the two Research Reports, and calls for increased attention in the medical education community to acculturating and educating IMGs for optimal patient care.     

Role-playing in medical education: An experience from public role-players

ObjectiveWe aim to explore the lived experiences of public role-players from the aspects of benefits, barriers, and enablers of role-playing in a medical school in Malaysia.MethodsA mixed-method study was performed involving 15 community dwellers who been engaged as role-players with Newcastle University Medicine in Malaysia. Participants answered a brief questionnaire followed by taking part in semi-structured interview. The interviews were audio-recorded, transcribed verbatim, and analyzed using thematic approach.Results86.7% of the participants strongly agreed that they had better medical knowledge after participating. Seven themes emerged under the three categories of perceived benefits, challenges, and recommendations: understanding and medical knowledge, and practical application, other benefits of role-playing, emotional upheaval, understanding medical jargons, improving the role-playing quality, and translating the experience gained into the community setting.ConclusionThe public role-players acknowledged their role positively and recognized refinement in their interpretation of medical knowledge and health. The public role-players were enthusiastic in using their knowledge acquired by upskilling themselves for community health programs and initiatives.     

Computer-assisted dynamic integration of multiple medical thesauruses.

We have previously described a user-interactive rule-based computer program (Dyna-SaurI) designed for dynamic thesaurus integration, and demonstrated its efficacy on integrating dermatological subsets of the MeSH and SNOMED thesauruses. In the present study, we have refined our rules for merging and mapping multiple thesauruses and tested these rules. We then applied them with a set of optimized parameters to the integration of a third thesaurus, a subset of the International Coding Index for Dermatology, with the Integrated MeSH-SNOMED thesaurus. The parameter changes resulted in improved ranking of more specific and conceptually closer terms.     

A two-year experience with premedical postbaccalaureate students admitted to medical school

To determine how well premedical postbaccalaureate students performed in and adjusted to medical school, the author examined the records for all 123 matriculants to the Brown University Program in Medicine in 1987-88 and 1988-89 and sent each student a questionnaire. More than one-third of the first-year students admitted to Brown were from premedical postbaccalaureate programs (that is, they had taken the traditional premedical course requirements after graduating from college). The postbaccalaureate students were older than the rest of their classmates, on average, and were more likely to have been non-science majors in college. Academic performances over the first two years were comparable in the two groups, and there was no significant difference between the groups in their self-reports of adequacy of preparation or involvement in extracurricular activities. The author concludes that, faced with a smaller applicant pool, medical schools may wish to consider premedical postbaccalaureate students as a valuable resource.     

The Outpatient Developmental Services Project: integration of pediatric psychology with primary medical care for children infected with HIV.

OBJECTIVE: To present a model in which pediatric psychology services are programmatically integrated into the primary care of children seen in a special immunology program. The program centers around serial neurodevelopmental/neuropsychological evaluation of children infected with HIV. METHOD: We describe the population served and the particular services provided, with specific focus on how the program was developed. We include a discussion of the barriers to service provision that have been encountered and the strategies employed to overcome these challenges. CONCLUSIONS: This approach, while not ideal, serves as a good example of how pediatric psychology can merge with primary medical care to maximize the benefits of both specialties for a patient population that is underserved in many respects.     

Development of an undergraduate medical curriculum: the McGill experience.

In 1997 the Faculty of Medicine at McGill University received a grant from the Molson Foundation. The primary project deliverable, which the authors describe, was an online, multimedia-enhanced, undergraduate medical curriculum. The decision to develop an electronic curriculum was predicated on the belief that the integration of educational technology within mainstream material delivered a "value added" component to both students and faculty, which would, in turn, facilitate teaching and learning. Pedagogical values were deemed to include: (1) the ability to use the media to implement adult learning principles such as learner-centered, self-directed and guided learning, (2) the inherent interactivity of the technology, (3) the potential of the technology to provide a powerful means for fostering forms of "termless" learning that students will need to practice medicine, (4) recognition that use of multimedia can address, in part, the variety of learning styles evidenced by students in the lecture hall and classroom, and (5) the provision of opportunities for horizontal and vertical curricular integration. In addition, it was anticipated that an electronic curriculum would permit: (1) easy incorporation of informatics within mainstream curricula, (2) centralization and standardization of curricular material, (3) editorial functionality for revisions and updates, (4) wide accessibility of material irrespective of venue, (5) search functionality for faculty and students, (6) the ability to perform curriculum inventory, and (7) the potential for use to compensate for decreased faculty time. The ongoing experience at McGill has shown that the merging of technology and pedagogy requires a substantial commitment of resources and recognition of faculty time and change-management issues.     

The missing curriculum: experience with emotional competence education and training for premedical and medical students

Medical education has long overlooked teaching the normal psychodynamics of everyday adult life (psychonormality) in favor of training in psychopathology. Proficiency in psychonormality skills (i.e., emotional competence) includes skilled management of internal emotions, external situations and relationships, and promotes patient satisfaction and healthcare outcomes as well as better mental health for practitioners. In particular, teaching psychonormality skills can be helpful to underrepresented minority (URM) students whose psychonormality experiences may differ from the culture of mainstream medical education. This paper outlines a clinically derived, pragmatic, five-step course designed to educate and train students for emotionally competent medical practice. A real-life example taken from an introductory workshop presentation of this course at a Student National Medical Association meeting is presented to illustrate the student-oriented application of the concepts. The enthusiastic reception accorded such workshops suggests an unmet need for this type of training in medical curricula. Benefits could include improved doctor-patient relationships and associated healthcare outcomes as well as higher retention of competent, professional, satisfied and healthier physicians, particularly URMs. Medical schools and residencies are encouraged to carefully evaluate the impact of incorporating psychonormality education and emotional competence training into their present curricula and faculty development.     

The Baylor experience in teaching medical ethics

This paper describes the activities of the Center for Ethics, Medicine, and Public Issues, a joint project of Baylor College of Medicine, the Institute of Religion of the Texas Medical Center, and Rice University. The center focuses on the clinical teaching of medical ethics, collaborative teaching and research involving ethicists and clinicians, and the training of future practitioners in the field. Problems as well as achievements in each of these areas are discussed.