[Use of information technology to support the oral care of older people living at home]. / Gebruik van informatietechnologie ter ondersteuning van de mondzorg van thuiswonende ouderen.

The use of eHealth has increased rapidly in recent years and is also being deployed in several ways in care for older people. Little is still known, however, about the use and acceptance of oral care related applications of eHealth by older people. By means of interviews, qualitative research was carried out on the use of digital devices and the needs of older people living at home for oral care related information and instruction via eHealth. Results indicate that older people are technically capable of receiving and making use of this information via eHealth. Slightly more than half of those questioned were interested in receiving this information via an eHealth app. It was considered to be useful when reduced mobility hindered visits to the dentist. Furthermore, those questioned expressed the opinion that the healthcare they are familiar with and the personal contacts should not be replaced by unfamiliar digital alternatives.

The frequency of lung cancer in patients with pulmonary hamartomas: An evaluation of clinical, radiological, and pathological features and follow-up data of 96 patients with pulmonary hamartomas.

PURPOSE: To investigate the frequency of lung cancer in patients with pulmonary hamartomas and to evaluate clinical, radiological, and pathological characteristics of pulmonary hamartomas. BASIC PROCEDURES: We reviewed pathology records of pulmonary hamartomas diagnosed between 2003 and 2014. Medical records and the hospital electronic database were also reviewed for each patient to obtain clinical, radiological, and pathological characteristics of pulmonary hamartomas and accompanying malignancies. MAIN FINDINGS: Ninety-six patients with pulmonary hamartomas were identified. There were 26 females (27%) and 70 males (73%), with a mean age of 56.2 years (range 22-87 years). Malignancies were detected in 23 patients (24%), which developed previously in five patients (1 synchronous, 4 metachronous lesions), and concomitantly in 18 patients (with origin from the lung in 17 patients and from the pleura in 1 patient). PRINCIPAL CONCLUSIONS: Our results show that patients with pulmonary hamartomas may have coexisting lung malignancies.

Can contextualization increase understanding during man-machine communication? A theory-driven study.

The Internet offers unlimited possibilities for finding health information. However, the user is often faced with the problem of understanding it. Contextualization has a role to play in enhancing the user's comprehension. We report on a study which addresses this issue, using a theoretical model of communication whose central theme is that of context. A randomized controlled experimental design was chosen, using as a test-bed the website SeniorGezond we had previously developed. The study was composed of a pre-test, the intervention with the website and a post-test. Participants (n=40) were randomly assigned to exposure or no exposure to contextualization with the website. Results show that contextualization increases understanding for non-knowledgeable users. Furthermore, the participant's cognitive style was found to be a significant factor on understanding. We also found that participants bring their own contexts such as social context and psychological context to support their understanding.

Illness stories on the internet: what do breast cancer patients want at the end of treatment?

The study aims to elicit user requirements for internet-based applications disclosing fellow patients' illness stories for the benefit of breast cancer patients. Twenty-six breast cancer patients, recruited via the Dutch Patient Organization for Breast Cancer, were interviewed about their preferences with regards to content, appearance, and search options concerning fellow patients' illness stories online. The interviews were analysed quantitatively (SPSS) and qualitatively (NVivo). Participants were mainly interested in fellow patients' experiences about how to cope with emotions, the impact of cancer in daily life, and physical discomforts. Most participants preferred a section of an illness story in text format about a specific topic; some of them wanted to be able to click on to the corresponding complete story, comprising of text alone or supported by voice or video clip. A majority of participants wanted to be able to select illness stories on the basis of several authors' features, i.e. treatment underwent, age, presence of metastases, time since diagnosis, and whether or not caring for children. Participants gave arguments for their preferences. The findings of this study will be used for designing an online trial with breast cancer patients aiming at refining the user requirements.

Communication support: a challenge for ICT in health care.

Communication makes up a very important part of the daily practice of health professionals. Current trends in health care indicate that this will even increase. However, the explicit application of Information and Communication Technologies (ICT) in order to support communication is relatively rare. This leaves a great potential of ICT in health care unused. The clinical informatics group at the Leiden University Medical Centre has established a research program which aims at eliciting, analysing, and specifying requirements for communication supporting ICT-applications in health care. Several research projects are part of this program already. Two of these, that focus on supporting a specific kind of health professional/client communication, are discussed in this paper against the background of the research program.

Challenges for delivering healthcare education through telematics.

Within the context of the education of professional healthcare providers, the authors give an overview of the challenges faced by those wishing to introduce telematics as both a mechanism for content delivery and as subject content itself. After presenting a brief overview of the current state of telematics applications to healthcare education, focusing on the European sphere, the authors outline the challenges before discussing the collaborative and communicative issues in detail. The authors conclude by suggesting that, while the authors believe that telematics is a necessary direction for the future development of healthcare education for professionals, the collaboration and communication challenges are of greater importance than the technical and policy challenges and that there is a need to educate the majority of educators, based in the experiences of the enthusiasts.

Investigating a concept-based tool to enhance the process of curriculum development: an example for healthcare education.

This paper reports on a first exploration carried out in the CoMET (COncept Modelling Environment for Teachers) project to investigate the educational potential of a concept-based toolkit developed in the GALEN project. In particular, on whether such tools can offer a basis to support and enhance healthcare curriculum development. We first adapted part of the toolkit by developing a front-end user friendly interface to access the conceptual knowledge. We then collected data from an empirical study. Preliminary results suggest that the concept-based approach of the CoMET tools is viable and has several potential benefits for educational activities. Directions for further work in the use of the concept-based tool for teaching as well as learning are also discussed.

Representing clinical narratives using conceptual graphs.

The analysis of medical narratives and the generation of natural language expressions are strongly dependent on the existence of an adequate representation language. Such a language has to be expressive enough in order to handle the complexity of human reasoning in the domain. Sowa's Conceptual Graphs (CG) are an answer, and this paper presents a multilingual implementation, using French, English and German. Current developments demonstrate the feasibility of an approach to natural Language Understanding where semantic aspects are dominant, in contrast to syntax driven methods. The basic idea is to aggregate blocks of words according to semantic compatibility rules, following a method called Proximity Processing. The CG representation is gradually built, starting from single words in a semantic lexicon, to finally give a complete representation of the sentence under the form of a single CG. The process is dependent on specific rules of the medical domain, and for this reason is largely controlled by the declarative knowledge of the medical Linguistic Knowledge Base.

Toward a medical linguistic knowledge base.

This paper presents the design of a Medical Linguistic Knowledge Base (MLKB). This MLKB is intended to be the multilingual recipient for all the declarative knowledge about languages. It includes words, their syntax and their conceptual representation, typology of concepts of the domain, rules for semantic analysis and conceptual schemata. For that purpose, Sowa's conceptual graphs are considered as an adequate knowledge representation. The MLKB will be an enormous body of information, and the difficulty to feed it and to validate it appears immediately. Therefore, it is necessary to start an international initiative to merge efforts from different groups.

Constructing clinical applications: the GALEN approach.

A common problem for developers of clinical applications is coping with the diversity of medical language. Medical language as it is used all over the world varies widely, while the referents for these words stay essentially the same. Software developers must reconcile this diversity with the practical necessity of producing applications that are usable in a variety of hospitals, while ensuring that information can be shared between applications. Existing approaches center around coding and classification schemes, but these approaches must be supplemented by a range of sophisticated terminological services in order for the language barriers to be overcome. To address this, the GALEN project is developing an application called the Terminology Server to provide such a range of terminological services (e.g., conceptual and multilingual services). The software is built upon a re-usable core model of medical terminology. This paper reports on the development of a clinical application called the SCUI (Structured Clinical User Interface) which draws on these GALEN technologies and illustrates an innovative approach to the construction of future clinical applications. The SCUI was specifically developed and tested in the context of infectious diseases to satisfy the demands made by the medical intensive care unit on the Geneva Hospital's microbiology laboratory.

Modelling for natural language understanding.

Natural Language Understanding (NLU) is a rapidly growing field in medical informatics. Its potential for tomorrow's applications is important. However, it is limited by its ability to ground its components on a solid model of the domain. This opens the way for the emergence of the discipline of medical domain modelling, as part of the vast field of Knowledge Base (KB) engineering. This article aims at describing the current development of a multilingual natural language system, strongly oriented towards the semantics of the domain. Special emphasis is presently given to the task of building a domain model, and to establish direct links with the language platform. The result is a model-driven NLU system. Numerous benefits are expected in the long term.