Using a Java Dynamic Tree to manage the terminology in a suite of medical applications.

OBJECTIVES: Now that the National Library of Medicine has made SNOMED-CT widely available, we are trying to manage the terminology of a whole suite of medical applications and map our terminology into that in SNOMED. METHODS: This paper describes the design and implementation of the Java Dynamic Tree that provides structure to our medical terminology and explains how it functions as the core of our system. RESULTS: The tree was designed to reflect the stages in a patient interview, so it contains components for identifying the patient and the provider, a large set of chief complaints, review of systems, physical examination, several history modules, medications, laboratory tests, imaging, and special procedures. The tree is mirrored in a commercial DBMS, which also stores multi-encounter patient data, disorder patterns for our Bayesian diagnostic system, and the data and rules for other expert systems. The DBMS facilitates the import and export of large terminology files. CONCLUSIONS: Our Java Dynamic Tree allows the health care provider to view the entire terminology along with the structure that supports it, as well as the mechanism for the generation of progress notes and other documents, in terms of a single hierarchical structure. Changes in terminology can be propagated through the system under the control of the expert. The import/ export facility has been a major help by replacing our original terminology by the terminology in SNOMED-CT.

Miscibility of small colloidal spheres with large polymers in good solvent.

Nearly athermal colloid-polymer mixtures were studied in the "protein limit." A fluid-fluid transition was observed in mixtures of stearyl-alcohol-coated silica particles and large polystyrene coils in toluene. The ratios of the polymer radius of gyration to the particle radii were q=4.1 and q=5.2. The binodal curves and the critical points were determined. Turbidity measurements and analysis for one set of particles allowed the systems to be mapped onto hard sphere-polymer mixtures. A comparison with recent predictions for the miscibility of model mixtures shows that the experimental binodals lie between the two extreme results for ideal and interacting polymers. The critical colloid volume fraction is also found to decrease with increasing size ratios.

An empirical study of the Health Status Questionnaire System for use in patient-computer interaction.

Patient involvement in the health care process is very important to any attempt to improve health care quality and patient satisfaction. Although many computerized medical record systems have been introduced, physicians are the only players in the process of data collection and interpretation. A computerized version of the Health Status Questionnaire has been developed to provide a simple, inexpensive method of direct patient entry into the medical record. The system philosophy emphasizes user-centered design and an empirical study was conducted with one hundred twelve outpatients to evaluate the interface aspects of the system as well as the hardware preference of the patients. Statistical analysis indicate that the patients involved in the study rated the user interface of the Health Status Questionnaire System highly. The study also revealed that a considerable number of the general population still have negative preconceptions about their ability to handle a computer or similar looking machinery. When they were asked to use a desktop computer with a mouse, 26 out of 50 patients refused, while 61 out of 62 agreed to use a hand-held pen computer.

Natural language processing in psychiatry. Artificial intelligence technology and psychopathology.

The potential benefit of artificial intelligence (AI) technology as a tool of psychiatry has not been well defined. In this essay, the technology of natural language processing and its position with regard to the two main schools of AI is clearly outlined. Past experiments utilizing AI techniques in understanding psychopathology are reviewed. Natural language processing can automate the analysis of transcripts and can be used in modeling theories of language comprehension. In these ways, it can serve as a tool in testing psychological theories of psychopathology and can be used as an effective tool in empirical research on verbal behavior in psychopathology.

Informatics Workup.

We introduce the concept of a Medical Informatics Workup performed by fourth year medical students working in a busy inner-city Emergency Room. These students use portable computers (Macintosh PowerBook 170s connected to a removable cartridge hard drive and CD-ROM drive) to do the patient workups. The PowerBook 170 contains the automated medical record entry software (IMR-E), five expert system software packages, and a program that allows the PowerBook to emulate a PC-compatible computer. With this configuration the student has a portable system that allows for the creation of a computerized medical record at the patient's bedside, along with the ability to analyze the data and generate a list of differential diagnoses.

A test selection module for MEDAS.

A test selection module to recommend proper tests to the physician during the diagnostic process has been added to MEDAS (the Medical Emergency Decision Assistance System). Test selection is an important part of the diagnostic process. This module can use either diagnostic hypotheses set up by the physician or derive its own diagnostic hypotheses from the differential diagnosis. This module recommends pertinent questions to be asked about the patient's history and physical examination and recommends laboratory and radiological tests. The recommended tests are presented in two different ways: as individual tests and as groups of sequential tests.

[Neonatal hyperammonemia]. / Neonatale hyperammoniëmie.

Experience with severe neonatal hyperammonaemia in the Newborn Intensive Care Unit of the Leuven University Hospital is reported and compared with the literature data. Among eleven patients seven presented with the transient neonatal hyperammonaemia-syndrome and four with a urea cycle defect. Prompt recognition of the transient neonatal hyperammonaemia syndrome is important because its prognosis is much better than that of the primary urea cycle defects presenting in the neonatal period.

[Tiapridal and alcoholic detoxication (author's transl)]. / Tiapridal et sevrage éthylique.

Is tiapride an effective and safe medication for general practitioners or psychiatrists to prescribe for the detoxication of alcoholics who refuse to be hospitalised or who have other ailments which require treatment? A 28-day survey was made at the Henri Chapelle Clinic on 30 alcoholics aged between 24 and 56 years, who were treated with tiapride I.M. for 3 days, then per os with 3 tablets per day, biological and medical tests being carried out on the first and last days. In the 8 serve cases with delirium tremens or pre-delirium, symptoms almost disappeared during the second week, with no complications. There were 2 cases of epileptic convulsions for which diazepam or phenobarbital was prescribed. One patient has spasmodic and hypertonia of the upper limbs (neuroleptic properties of tiapride). The other 22 patients were deprived of alcohol on admittance, but there was no delirium, and most psychiatric, neurological and digestive disorders disappeared during the first days of treatment. On the whole, since there was no somnolence and the desire for alcohol lessened, tiapride may be regarded as suitable for the above indications, although anti-epileptic medication may be required, and psycho-relaxant drugs may be necessary to relieve anxiety, irritability and sleep problems.