ABSTRACT
[This corrects the article DOI: 10.2196/29174.].
ABSTRACT
BACKGROUND: Since the creation of the problem-oriented medical record, the building of problem lists has been the focus of many studies. To date, this issue is not well resolved, and building an appropriate contextualized problem list is still a challenge. OBJECTIVE: This paper aims to present the process of building a shared multipurpose common problem list at the Geneva University Hospitals. This list aims to bridge the gap between clinicians' language expressed in free text and secondary uses requiring structured information. METHODS: We focused on the needs of clinicians by building a list of uniquely identified expressions to support their daily activities. In the second stage, these expressions were connected to additional information to build a complex graph of information. A list of 45,946 expressions manually extracted from clinical documents was manually curated and encoded in multiple semantic dimensions, such as International Classification of Diseases, 10th revision; International Classification of Primary Care 2nd edition; Systematized Nomenclature of Medicine Clinical Terms; or dimensions dictated by specific usages, such as identifying expressions specific to a domain, a gender, or an intervention. The list was progressively deployed for clinicians with an iterative process of quality control, maintenance, and improvements, including the addition of new expressions or dimensions for specific needs. The problem management of the electronic health record allowed the measurement and correction of encoding based on real-world use. RESULTS: The list was deployed in production in January 2017 and was regularly updated and deployed in new divisions of the hospital. Over 4 years, 684,102 problems were created using the list. The proportion of free-text entries decreased progressively from 37.47% (8321/22,206) in December 2017 to 18.38% (4547/24,738) in December 2020. In the last version of the list, over 14 dimensions were mapped to expressions, among which 5 were international classifications and 8 were other classifications for specific uses. The list became a central axis in the electronic health record, being used for many different purposes linked to care, such as surgical planning or emergency wards, or in research, for various predictions using machine learning techniques. CONCLUSIONS: This study breaks with common approaches primarily by focusing on real clinicians' language when expressing patients' problems and secondarily by mapping whatever is required, including controlled vocabularies to answer specific needs. This approach improves the quality of the expression of patients' problems while allowing the building of as many structured dimensions as needed to convey semantics according to specific contexts. The method is shown to be scalable, sustainable, and efficient at hiding the complexity of semantics or the burden of constraint-structured problem list entry for clinicians. Ongoing work is analyzing the impact of this approach on how clinicians express patients' problems.
ABSTRACT
This article provides an overview of 10 important articles published in year 2013 in the field of ambulatory general internal medicine. The newest guidelines about glaucoma screening are detailed. In the midst of the lung cancer screening controversy, an article summarizes new guidelines for the management of solitary pulmonary nodules. Cohort studies are detailed, which have shown association between high calcium intake and cardiovascular mortality, grade 2 or 3 obesity and mortality, aspirin use and lower melanoma incidence, and a reduction of the prevalence of dementia in last 20 years. Finally, 2 publications clarify the optimal length of corticoid treatment for COPD exacerbations and the most appropriate treatment regimen for Helicobacter Pylori eradication.
Subject(s)
Ambulatory Care/trends , General Practice/trends , Internal Medicine/trends , Humans , Periodicals as Topic , Practice Guidelines as TopicABSTRACT
BACKGROUND: Medical students' limited access to patients induces a shift of learning activities from clinical wards to classrooms. AIM: Identify clinical competencies specifically acquired during real-life contextual clerkship added to case-based tutorials, by a prospective, controlled study. METHODS: Students entering our eight-week internal medicine (IM) clerkship attended paper case-based tutorials about 10 common presenting complaints and were assigned to an IM specialty ward. For each tutorial case, two groups of students were created: those assigned to a ward, the specialty of which was unrelated to the case (case-unrelated ward, CUW) and those assigned to a ward, the specialty of which was related to the case (case-related ward, CRW). RESULTS: Forty-one students (30 CUW and 11 CRW) volunteered for the study. Both groups had similar previous experiences and pre-clerkship exam scores. The CRW students collected more relevant clinical information from the patient (69% vs. 55% of expected items, p=0.001) and elaborated charts of better quality (47% vs. 39% of expected items, p=0.05). Clinical-knowledge mean score was similar (70%) in both groups (p=0.92). CONCLUSIONS: While paper-case tutorials did provide students with clinical knowledge, real contextual experience brought additional, specific competencies. This supports the preservation of clinical exposure with supervision and feedback.