Using external data sources to improve audit trail analysis.
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Audit trail analysis is the primary means of detection of inappropriate use of the medical record. While audit logs contain large amounts of information, the information required to determine useful user-patient relationships is often not present. Adequate information isn't present because most audit trail analysis systems rely on the limited information available within the medical record system. We report a feature of the STAR (System for Text Archive and Retrieval) audit analysis system where information available in the medical record is augmented with external information sources such as: database sources, Light-weight Directory Access Protocol (LDAP) server sources, and World Wide Web (WWW) database sources. We discuss several issues that arise when combining the information from each of these disparate information sources. Furthermore, we explain how the enhanced person specific information obtained can be used to determine user-patient relationships that might signify a motive for inappropriately accessing a patient's medical record. (+info)
Knowledge-mediated retrieval of laboratory observations.
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Intelligent medical applications including agents, clinical decision support systems, and expert systems can benefit from components that expose the meanings of medical concepts. We have endeavored to create an ontology for laboratory observations and to make the ontology accessible in a distributed environment through a knowledge mediator offering several services. To date we have created two such services, one service to mediate the retrieval of laboratory observations and an auxiliary service to facilitate the mapping of units of measure to LOINC property-types. We report progress and insights on the development of our ontology and related knowledge mediator. (+info)
A large-scale evaluation of terminology integration characteristics.
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OBJECTIVE: To describe terminology integration characteristics of local specialty specific and general vocabularies in order to facilitate the appropriate inclusion and mapping of these terms into a large-scale terminology. METHODS: We compared the sensitivity, specificity, positive predictive value, and positive likelihood ratios for Automated Term Composition to correctly map 9050 local specialty specific (dermatology) terms and 4994 local general terms to UMLS using Metaphrase. Results were systematically combined among exact matches, semantic type filtered matches, and non-filtered matches. For the general set, an analysis of semantic type filtering was performed. RESULTS: Dermatology exact matches defined a sensitivity of 51% (57% for general terms) and a specificity of 86% (92% general terms). Including semantic type filtered matches increased sensitivity (75% dermatology; 88% general); as did inclusion of non-filtered matches (98% and 99%). These inclusions correspondingly decreased specificity (filtered: 82% and 74%; non-filtered: 52% and 32%). Positive predictive values for exact matches (93.0% dermatology, 97.6% general) were improved by small but significant (p < 0.001) margins by including filtered matches (95.1% dermatology, 98.4% general) but decreased with non-filtered matches (89.2% dermatology, 87.8% general). Adding additional semantic types to the filtering algorithm failed to improve the positive predictive value or the positive likelihood ratio of term mapping, in spite of a 2.3% improvement in sensitivity. CONCLUSIONS: Automated methods for mapping local "colloquial" terminologies to large-scale controlled health vocabulary systems are practical (ppv 95% dermatology, 98% general). Semantic type filtering improves specificity without sacrificing sensitivity and yields high positive predictive values in every set analyzed. (+info)
Toward a standard for guideline representation: an ontological approach.
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Guidelines for clinical practice are being introduced in an extensive way in more and more different fields of medicine They have the potentialities of improving the quality and cost-efficiency of care in an increasingly complex health care delivery environment. Computerization may increase the effectiveness of both the information retrieval of guidelines and the management of guideline-based care. The scenario is evolving from stand-alone workstations to telematics applications that enable guidelines development and dissemination. However, such a knowledge sharing requires the definition of formal models for guidelines representation. The models should have a clear semantics in order to avoid ambiguities. The role of ontologies is that of making explicit the conceptualizations behind a model. In this paper we present our library of ontologies and point out its role for integrating existing guideline models and defining standard representations. (+info)
Streamlining semantic interpretation for medical narratives.
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We introduce two abstraction mechanisms by which the process of semantic interpretation of medical narratives can be simplified and further optimized. One relates to generalized triggering conditions, the other to inheritance-based specifications of semantic rules. The proposed methodology leads to a parsimonious inventory of abstract, simple and domain-independent semantic interpretation schemata whose effectiveness has been evaluated on a medical text corpus. (+info)
In silico detection of control signals: mRNA 3'-end-processing sequences in diverse species.
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We have investigated mRNA 3'-end-processing signals in each of six eukaryotic species (yeast, rice, arabidopsis, fruitfly, mouse, and human) through the analysis of more than 20,000 3'-expressed sequence tags. The use and conservation of the canonical AAUAAA element vary widely among the six species and are especially weak in plants and yeast. Even in the animal species, the AAUAAA signal does not appear to be as universal as indicated by previous studies. The abundance of single-base variants of AAUAAA correlates with their measured processing efficiencies. As found previously, the plant polyadenylation signals are more similar to those of yeast than to those of animals, with both common content and arrangement of the signal elements. In all species examined, the complete polyadenylation signal appears to consist of an aggregate of multiple elements. In light of these and previous results, we present a broadened concept of 3'-end-processing signals in which no single exact sequence element is universally required for processing. Rather, the total efficiency is a function of all elements and, importantly, an inefficient word in one element can be compensated for by strong words in other elements. These complex patterns indicate that effective tools to identify 3'-end-processing signals will require more than consensus sequence identification. (+info)
Direct-to-consumer prescription drug advertising and the public.
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OBJECTIVE: Drug manufacturers are intensely promoting their products directly to consumers, but the impact has not been widely studied. Consumers' awareness and understanding of, attitudes toward, and susceptibility to direct-to-consumer (DTC) drug advertising were examined. DESIGN: Random-digit dialing telephone survey with a random household member selection procedure (completion and response rates, 58% and 69%, respectively). SETTING: Respondents were interviewed while they were at their residences. PARTICIPANTS: Complete data were obtained from 329 adults in Sacramento County, California. MEASUREMENTS AND MAIN RESULTS: Outcome measures included awareness of advertisements for 10 selected drugs, misconceptions about DTC advertising, attitudes toward DTC ads, and behavioral responses to such promotions. The influence of demographic characteristics, health status, attitudes, beliefs, and media exposure on awareness and behaviors was examined. On average, respondents were aware of advertisements for 3.7 of the 10 drugs; awareness varied from 8% for Buspar (buspirone) to 72% for Claritin (loratadine). Awareness was associated with prescription drug use, media exposure, positive attitudes toward DTC advertising, poorer health, and insurance status. Substantial misconceptions were revealed; e.g., 43% thought that only "completely safe" drugs could be advertised. Direct-to-consumer advertisements had led one third of respondents to ask their physicians for drug information and one fifth to request a prescription. CONCLUSIONS: Direct-to-consumer advertisements are reaching the public, but selectively so, and affecting their behaviors. Implications for public policy are examined. (+info)
The multidrug resistance protein family.
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The human multidrug resistance protein (MRP) family contains at least six members: MRP1, the godfather of the family and well known as the multidrug resistance protein, and five homologs, called MRP2-6. In this review, we summarize what is known about the protein structure, the expression in tissues, the routing in cells, the physiological functions, the substrate specificity, and the role in multidrug resistance of the individual members of the MRP family. (+info)