Investigación sobre plantas medicinales realizada por estudiantes de medicina en Perú / Investigação sobre plantas medicinais realizada por estudantes de medicina no Peru / Medicinal plant research conducted by medical students in Peru

Con el objetivo de determinar la contribución a la investigación sobre plantas medicinales por estudiantes de medicina en Perú se realizó un estudio bibliométrico, utilizando como fuente de análisis los libros de resúmenes de los Congresos Científicos Nacionales de estudiantes de Medicina realizados en Perú durante los años 2005 al 2011. Se seleccionaron las investigaciones en ciencias básicas que tuvieron como objeto las propiedades medicinales de las plantas. El 17,4% (95/546) de las investigaciones fueren sobre plantas medicinales, el modelo de experimentación en e173,7% era in vivo; en su mayoría el tipo de extracto usado fue el acuoso (29,5%), el alcohólico y/o hidroalcohólico (20,0%) y el aceite esencial (12,6%);se reportaron 21 posibles utilidades medicinales; e1 15,8% de las investigaciones fue pubflcada en alguna revista científica. Concluimos que existe interés hacia el estudio de plantas medicinales desde el pregrado médico, siendo necesario el apoyo de 103 centros educativos para su desarrollo y la comunicación de resultados a través de la publicación (AU)

Como objectivo de determinar a contribuiçao para a investigaçao de plantas medicinais realizada por estudantes de medicina no Peru foi feito um estudo bibliometrico, utilizando como fonte de anélise os livros de resumes dos Congressos Nacionais Cientificos de estudantes de medicina realizados no Peru durante os anos de 2005 a 2011. Foram selecionadas as investigaçoes em ciencias básicas que tiveram como objectivo as propriedades medicinais das plantas. Verificou-se que 17,4% (95/546) das investigaçoes foram sobre plantas medicinais, o modelo experimental em 73,7% foi in vivo; na sua maioria o tipo de extracto utilizado foi o aquoso (29,5%), o alcoólico e/ou hidroalcoólico (20,0%) e o oleo essencial (12,6%); reportaram-se 21 possiveis utilizaçoes medicinais; 15,8% das investigagoes foram publicadas em alguma revista científica. Concluiu-se que ha interesse no estudo de plantas medicinais desde a formaçao medica, sendo necessário o apoio dos centros educativos para o seu desenvolvimento e a comunicaçao de resultados atraves de publicaçoes (AU)

In order to determine the contribution in medicinal plant research conducted by medical students in Peru a bibliometric study was conducted, using as source of analysis the abstract books of the National Scientific Congress of medical students conducted in Peru during the years 2005 to 2011. Research in basic sciences which were aimed at the medicinal properties of plants were selected. As results, 17.4% (95/546) of the investigations were about medicinal plants, experimental model in vivo was 73.7%; mostly type used was the aqueous extract (29.5%), the alcohol-hidroalcohol (20.0%) and essential oil (12.6%); 21 reported possible medicinal utilities; 15.8% of all the investigations was published in a scientific journal. We conclude that there is interest in research on medicinal plants. We conclude that there is interest in the study of medicinal plants in undergraduate medical students. Support of schools for their development and communication of results through the publication is required (AU)

Use of an indicator to evaluate physician adherence to prescription guidelines for the treatment of heart failure

The aim of this study was to use indicators to evaluate physician adherence to prescription guidelines for heart failure treatment in a university hospital. This was a prospective cohort study conducted in a university hospital. The information collected at the time of patient admission, including therapeutic indication, absolute contra indications and intolerance, was utilised for the formulation of a guideline adherence indicator (GAI). This indicator was calculated as follows: (the number of patients who used the medication/the number of eligible patients) x 100. The percentage of eligible patients was calculated using the following formula: (the number of eligible patients/the total number patients) x 100. The GAI was applied to a population of 53 patients. Inhibitors of angiotensin-converting enzyme/angiotensin receptor blocker (ACE-I/ARB) combination therapy were used in the greatest percentage of eligible patients (92.4%) and demonstrated the largest GAI value (73.5%). The percentages of patients who were eligible for beta-blockers, spironolactone and digitalis treatments were 81.1%, 52.8% and 60.4%, respectively. The GAI values for the use of beta-blockers, spironolactone and digitalis were 60.4%, 57.1% and 56.2%, respectively. For the studied patient population, the GAI was consistent with the proportion of patients who were eligible to receive digitalis and spironolactone.

O objetivo deste estudo foi utilizar indicadores para avaliar a adesão de médicos às diretrizes para tratamento da Insuficiência Cardíaca em um hospital universitário. Estudo de coorte prospectivo, conduzido em um hospital universitário. As variáveis coletadas na admissão do paciente foram: indicação terapêutica, contraindicações absolutas e intolerância, sendo utilizadas para elaboração de um indicador de adesão à diretriz (IAD). Este indicador foi calculado através da relação: (número de pacientes que utilizaram o medicamento/número de pacientes elegíveis) x 100. A % de pacientes elegíveis foi calculada da seguinte forma: (número de pacientes elegíveis/número total de pacientes) x 100. Os IAD foram aplicados para uma população de 53 pacientes. Os Inibidores da Enzima Conversora de Angiotensina/Bloqueadores dos Receptores de Angiotensina foram as classes farmacológicas que apresentaram maior % de pacientes elegíveis (92,4%) e apresentaram o melhor IAD (73,5%). A % de pacientes elegíveis para beta-bloqueadores, espironolactona e digitálicos foi de 81,1%, 52,8% e 60,4%, respectivamente. O IAD para beta-bloqueadores foi 60,4%, espironolactona 57,1% e digitálicos 56,2%. Na população estudada, o IAD foi compatível com a proporção de pacientes elegíveis para digitálicos e espironolactona.

Adaptation and validation of the Charlson Index for Read/OXMIS coded databases.

BACKGROUND: The Charlson comorbidity index is widely used in ICD-9 administrative data, however, there is no translation for Read/OXMIS coded data despite increasing use of the General Practice Research Database (GPRD). Our main objective was to translate the Charlson index for use with Read/OXMIS coded data such as the GPRD and test its association with mortality. We also aimed to provide a version of the comorbidity index for other researchers using similar datasets. METHODS: Two clinicians translated the Charlson index into Read/OXMIS codes. We tested the association between comorbidity score and increased mortality in 146 441 patients from the GPRD using proportional hazards models. RESULTS: This Read/OXMIS translation of the Charlson index contains 3156 codes. Our validation showed a strong positive association between Charlson score and age. Cox proportional models show a positive increasing association with mortality and Charlson score. The discrimination of the logistic regression model for mortality was good (AUC = 0.853). CONCLUSION: We have translated a commonly used comorbidity index into Read/OXMIS for use in UK primary care databases. The translated index showed a good discrimination in our study population. This is the first study to develop a co-morbidity index for use with the Read/OXMIS coding system and the GPRD. A copy of the co-morbidity index is provided for other researchers using similar databases.

Corpus-based error detection in a multilingual medical thesaurus.

Cross-language document retrieval systems require support by some kind of multilingual thesaurus for semantically indexing documents in different languages. The peculiarities of the medical sublanguage, together with the subjectivism of lexicographers' choices, complicates the thesaurus construction process. It furthermore requires a high degree of communication and interaction between the lexicographers involved. In order to detect errors, a systematic procedure is therefore necessary. We here describe a method which supports the maintenance of the multilingual medical subword repository of the MorphoSaurus system which assigns language-independent semantic identifiers to medical texts. Based on the assumption that the distribution of these semantic identifiers should be similar whenever comparing closely related texts in different languages, our approach identifies those semantic identifiers that vary most in distribution comparing language pairs. The revision of these identifiers and the lexical items related to them revealed multiple errors which were subsequently classified and fixed by the lexicographers. The overall quality improvement of the thesaurus was finally measured using the OHSUMED IR benchmark, resulting in a significant improvement of the retrieval quality for one of the languages tested.

Use of SNOMED CT to represent clinical research data: a semantic characterization of data items on case report forms in vasculitis research.

OBJECTIVE: To estimate the coverage provided by SNOMED CT for clinical research concepts represented by the items on case report forms (CRFs), as well as the semantic nature of those concepts relevant to post-coordination methods. DESIGN: Convenience samples from CRFs developed by rheumatologists conducting several longitudinal, observational studies of vasculitis were selected. A total of 17 CRFs were used as the basis of analysis for this study, from which a total set of 616 (unique) items were identified. Each unique data item was classified as either a clinical finding or procedure. The items were coded by the presence and nature of SNOMED CT coverage and classified into semantic types by 2 coders. MEASUREMENTS: Basic frequency analysis was conducted to determine levels of coverage provided by SNOMED CT. Estimates of coverage by various semantic characterizations were estimated. RESULTS: Most of the core clinical concepts (88%) from these clinical research data items were covered by SNOMED CT; however, far fewer of the concepts were fully covered (that is, where all aspects of the CRF item could be represented completely without post-coordination; 23%). In addition, a large majority of the concepts (83%) required post-coordination, either to clarify context (e.g., time) or to better capture complex clinical concepts (e.g., disease-related findings). For just over one third of the sampled CRF data items, both types of post-coordination were necessary to fully represent the meaning of the item. CONCLUSION: SNOMED CT appears well-suited for representing a variety of clinical concepts, yet is less suited for representing the full amount of information collected on CRFs.

Inter-patient distance metrics using SNOMED CT defining relationships.

BACKGROUND: Patient-based similarity metrics are important case-based reasoning tools which may assist with research and patient care applications. Ontology and information content principles may be potentially helpful tools for similarity metric development. METHODS: Patient cases from 1989 through 2003 from the Columbia University Medical Center data repository were converted to SNOMED CT concepts. Five metrics were implemented: (1) percent disagreement with data as an unstructured "bag of findings," (2) average links between concepts, (3) links weighted by information content with descendants, (4) links weighted by information content with term prevalence, and (5) path distance using descendants weighted by information content with descendants. Three physicians served as gold standard for 30 cases. RESULTS: Expert inter-rater reliability was 0.91, with rank correlations between 0.61 and 0.81, representing upper-bound performance. Expert performance compared to metrics resulted in correlations of 0.27, 0.29, 0.30, 0.30, and 0.30, respectively. Using SNOMED axis Clinical Findings alone increased correlation to 0.37. CONCLUSION: Ontology principles and information content provide useful information for similarity metrics but currently fall short of expert performance.

Interface terminologies: facilitating direct entry of clinical data into electronic health record systems.

Previous investigators have defined clinical interface terminology as a systematic collection of health care-related phrases (terms) that supports clinicians' entry of patient-related information into computer programs, such as clinical "note capture" and decision support tools. Interface terminologies also can facilitate display of computer-stored patient information to clinician-users. Interface terminologies "interface" between clinicians' own unfettered, colloquial conceptualizations of patient descriptors and the more structured, coded internal data elements used by specific health care application programs. The intended uses of a terminology determine its conceptual underpinnings, structure, and content. As a result, the desiderata for interface terminologies differ from desiderata for health care-related terminologies used for storage (e.g., SNOMED-CT), information retrieval (e.g., MeSH), and classification (e.g., ICD9-CM). Necessary but not sufficient attributes for an interface terminology include adequate synonym coverage, presence of relevant assertional knowledge, and a balance between pre- and post-coordination. To place interface terminologies in context, this article reviews historical goals and challenges of clinical terminology development in general and then focuses on the unique features of interface terminologies.

Using compound codes for automatic classification of clinical diagnoses.

Classification of diagnoses (a.k.a. coding) is the central part of current concept based medical IR systems. Some classification systems contain over 30,000 distinct codes which makes classifying clinical documents a time consuming labor intensive and error prone process. This paper presents a simple methodology for cleaning up and reusing existing manually coded diagnostic statements mainly extracted from clinical notes to build predictive models using a sparse-feature implementation of a Naïve Bayes classifier. One of the problems addressed is that diagnostic statements often contain several diagnoses and are assigned several codes resulting in a multi-class classification problem. We investigate one possible way of addressing this problem by introducing compound (multiple code) categories. We present experimental results of classifying >16,000 randomly selected diagnostic strings into 19 top level categories. A small improvement (3%) with using compound categories over simple categories indicates that using multiple code categories is a promising solution, although clearly in need of further research and refinement.

Rational and irrational clinical strategies for collaborative medicine.

Individual practitioners and health care systems/organizations increasingly understand the rationale for collaborative medicine. An absence of collaboration can compromise the quality and safety of patient care. But having a rationale to provide collaborative medicine without also having a rational clinical strategy can be equally compromising to the quality and safety of patient care. Reasonable evidentiary criteria must be used to determine whether specific therapies merit inclusion or exclusion in a collaborative medicine model. Ranking therapies hierarchically on the basis of their risk-benefit ratio simplifies matching of therapies with the needs of the patient. A unifying taxonomy that categorizes all therapies (complementary/alternative and conventional) on the basis of how we think they work (presumed mechanisms of action) facilitates development of a clinical strategy for collaborative medicine. On the basis of these principles, a rational clinical strategy for collaborative medicine is described to help optimize the quality and safety of patient care.

The SNOMED RT Procedure Model.

BACKGROUND: SNOMED RT represents a fundamental change from prior versions of SNOMED. The logic-based structure of SNOMED RT enables concepts to be defined more explicitly, providing an opportunity to address inconsistencies and ambiguities present in prior SNOMED concept definitions. OBJECTIVES: Create a unifying organizational strategy for all SNOMED RT procedures, and remove ambiguities in procedure concept definitions. METHODS: A comprehensive model of procedures was developed, based on a set of guiding principles and a review of known existing models. RESULTS: All SNOMED RT procedures are categorized by a common set of "root procedures" (high level atomic actions), and are more explicitly defined by a shared set of defining relationships. CONCLUSIONS: While the objectives have largely been met, open issues continue to be addressed. The similarity between procedure models of SNOMED RT and the U.K. s Clinical Terms Version 3 is proving to greatly facilitate the full integration of the two terminologies into a merged vocabulary to be known as SNOMED Clinical Terms (SNOMED CT), slated to be released in the near future.

Description of a drug hierarchy in a concept-based reference terminology.

A concept-based reference terminology that covers all aspects of healthcare is essential in developing the Electronic Health Record (EHR). SNOMED Clinical Terms (CT), scheduled for release in December 2001, integrates the relative strengths of SNOMED RT, and the United Kingdom s Clinical Terms Version 3, formerly known as the Read Codes Version 3. It promises to be the most comprehensive terminology available. Since a significant portion of the EHR can be drug-related information, we describe here some of the background information and rationale for the structure and scope of the merged drug hierarchy within SNOMED CT. A controlled drug terminology within a reference terminology has the potential to support a number of functions within healthcare practice. One of the functions proposed is to serve as the bridge between reference terminology and drug knowledge bases.

Culling a clinical terminology: a systematic approach to identifying problematic content.

The College of American Pathologists and the National Health Service (NHS) in the United Kingdom are merging their respective clinical terminologies, SNOMED RT and Clinical Terms Version 3, into a new terminology, SNOMED CT. This requires mapping concept descriptions between the two existing terminologies. During the mapping process, many descriptions were identified as being potentially problematic. They require further review by the SNOMED editorial process before either (1) being incorporated into SNOMED CT, or (2) retired from active use. This article presents data on the concept descriptions that were identified as needing further review during the early phases of SNOMED CT development. Based on this work, we describe fourteen types of problematic terminology content. Identifying problematic terminology content can be approached in a systematic manner.

Normal forms for description logic expressions of clinical concepts in SNOMED RT.

Modern clinical terminologies organize concepts into multi-hierarchy structures that are defined by logic-based expressions, enabling compositional representation of clinical statements and supporting more complete and consistent retrieval of clinical data. The Systematized Nomenclature of Medicine, Reference Terminology (SNOMED RT) gives each concept code a semantic definition stated in description logic. The process of development, testing and distribution of these definitions has highlighted the fact that a concept definition may take many different but logically equivalent forms, and has revealed a need for a set of normal forms for authoring, distribution, and other purposes. This paper describes the difference between a choice of syntax and a choice of normal form, and defines several different normal forms, including a short canonical form, a long canonical form, and a distribution normal form.

SNOMED clinical terms: overview of the development process and project status.

Two large health care reference terminologies, SNOMED RT and Clinical Terms Version 3 , are in the process of being merged to form a comprehensive new work referred to as SNOMED Clinical Terms. The College of American Pathologists and the United Kingdom s National Health Service have entered into a collaborative agreement to develop this new work. Both organizations have extensive terminology development and maintenance experience. This paper discusses the process and status of SNOMED CT development and how the resources and expertise of both organizations are being used to develop this new terminological resource. The preliminary results of the merger process, including mapping, the merger of upper levels of each hierarchy, and attribute harmonization are also discussed.

Development of an ontology to model medical errors, information needs, and the clinical communication space.

Medical errors are common, costly and often preventable. Work in understanding the proximal causes of medical errors demonstrates that systems failures predispose to adverse clinical events. Most of these systems failures are due to lack of appropriate information at the appropriate time during the course of clinical care. Problems with clinical communication are common proximal causes of medical errors. We have begun a project designed to measure the impact of wireless computing on medical errors. We report here on our efforts to develop an ontology representing the intersection of medical errors, information needs and the communication space. We will use this ontology to support the collection, storage and interpretation of project data. The ontology's formal representation of the concepts in this novel domain will help guide the rational deployment of our informatics interventions. A real-life scenario is evaluated using the ontology in order to demonstrate its utility.

Mapping between SNOMED RT and Clinical terms version 3: a key component of the SNOMED CT development process.

SNOMED RT and Clinical Terms Version 3 are two large, controlled medical terminologies that are being merged to form a new work titled SNOMED Clinical Terms (SNOMED CT). One of the first steps in this process was to create maps between semantically equivalent and proximate concepts in the two terminologies. Same-as and is-a relationships were used to map the descriptions from one terminology to concepts in the other terminology. The objectives were to identify semantically equivalent concepts in the two terminologies, to find the most semantically proximate is-a relationships for non-equivalent concepts, and to evaluate the synonymy in the source terminologies. The results suggest that the rate of semantic overlap between descriptions in SNOMED RT and CTV3 is approximately 28%. This article discusses the methodology, issues, and findings of the description mapping process.

Read Code quality assurance: from simple syntax to semantic stability.

As controlled clinical vocabularies assume an increasing role in modern clinical information systems, so the issue of their quality demands greater attention. In order to meet the resulting stringent criteria for completeness and correctness, a quality assurance system comprising a database of more than 500 rules is being developed and applied to the Read Thesaurus. The authors discuss the requirement to apply quality assurance processes to their dynamic editing database in order to ensure the quality of exported products. Sources of errors include human, hardware, and software factors as well as new rules and transactions. The overall quality strategy includes prevention, detection, and correction of errors. The quality assurance process encompasses simple data specification, internal consistency, inspection procedures and, eventually, field testing. The quality assurance system is driven by a small number of tables and UNIX scripts, with "business rules" declared explicitly as Structured Query Language (SQL) statements. Concurrent authorship, client-server technology, and an initial failure to implement robust transaction control have all provided valuable lessons. The feedback loop for error management needs to be short.