Development of ICF code selection tools for mental health care.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) has been available as a means of coding life functions but the coding process is cumbersome due to the large number of ICF codes. In the current study, we developed ICF code selection tools to support the coding of activity and participation data recorded in domiciliary mental health care reports. METHODS: We first developed a search system to facilitate the selection of ICF codes by tracking back through codes' conceptual trees using a directory tool. We performed a morphological analysis on the training data set to correlate nouns with the ICF codes and obtained an analysis corpus to which numerical scores representing the frequencies of associated ICF codes for each noun were assigned. Based on the obtained corpus we developed a full-text search tool, which could simplify ICF coding relative to that performed using the directory tool. We then evaluated the usefulness of the former tool on the test data set. RESULTS: Using the full-text search tool, correct ICF codes were recorded in the first candidate list for only 54.2% of sentences. However, correct ICF codes appeared on the combined candidate lists for 90.1% of sentences and on the top three candidate lists for 71.7%. In a specific case (General Tasks and Demands), 100% of the correct codes were included on the combined candidate lists. CONCLUSION: We developed selection tools that effectively supported ICF coding, although it was impossible to fully automate ICF coding. This indicated that ICF codes could more effectively be applied to mental health care.

Alert system for inappropriate prescriptions relating to patients' clinical condition.

OBJECTIVES: Because information of contraindication and careful indication of medication is vast, there have been numerous cases of prescribing medication inappropriately. Our goal is to have a clinical decision support system (CDSS) combined with a computerized physician order entry (CPOE) to aid physicians in prescribing medication appropriately. In this study we developed an alert system for evaluating renal function and checking doses of medication according to the patient's renal function. In addition, we developed functions of extracting target problems from the raw data and verifying if contraindicated medication has being prescribed. METHODS: This system scrutinizes data handled in the CPOE system. It picks up the data needed to ascertain problems and the data of medication entered from the order entry system. First we made an alert system for renal dysfunction. Creatinine clearance (Ccr) of a patient was calculated by the estimate equation of Cockcroft and Gault. If a patient data fulfills the condition of impaired renal function, the alert message is sent to the database. The alert system also checks the dosage of each medication according to a patient's renal function. When the dosage is over-prescribed, an alert is sent. Next, we made an alert system targeting contraindication for liver diseases, renal diseases and diabetes mellitus. The criteria of these problems were set in the knowledge base. If a patient's data meets the criteria, that fact is stored in the problem database. The system also keeps a prescription check master and checks whether the patient has a problem which is a contraindication of the prescribed medication. If a problem exists, an alert is sent to the alert message database. The alert-presenting module is a web system. After accepting patients' ID indicated by a user, the system searches the alerts concerning the patients from the database and constructs pages presenting the alert message. RESULTS: We compared the period during which the contraindicated medication was prescribed before and after the alert system was put into operation. Of the patients with renal dysfunction who were prescribed the contraindicated medication, 24% had their medication discontinued before the alert system was put into operation. In contrast, the rate significantly increased to 54% after the alert system began to function. CONCLUSION: We developed an alert system for inappropriate prescriptions for each patient's clinical condition. The alerts generated by this system were effective for discontinuing contraindicated medication.

The application of an institutional clinical data warehouse to the assessment of adverse drug reactions (ADRs). Evaluation of aminoglycoside and cephalosporin associated nephrotoxicity.

OBJECTIVES: To apply an institutional clinical data warehouse (CDW) to the assessment of adverse drug reactions (ADRs) and demonstrate its utility through a specific example. METHODS: We modeled the process for assessing ADRs through retrospective cohort design by using CDW at the Osaka University Hospital as follows: 1) We defined a drug X, an adverse drug reaction (ADR) Y, and a laboratory measurement Z to assess Y during a given study period; 2) we excluded those whose Z value exceeded the defined criteria or were not available at the inception of the cohort; 3) we divided the patients into two groups based on exposure or non-exposure to X; 4) we matched the patient characteristics between the two groups through stratification and randomization; and 5) we compared the frequency of patients who presented Y during the study period between the two groups. Aminoglycoside and Cephalosporin associated nephrotoxicity in pediatric inpatients was used as an example to demonstrate the usefulness of this approach. RESULTS: Our evaluation indicates that there is an increased risk of nephrotoxicity for pediatric inpatients who were prescribed cephalosporin either alone or in combination with aminoglycoside; further, aminoglycoside tends to increase the cephalosporin-associated nephrotoxicity. CONCLUSIONS: Our findings are consistent with those drawn from other studies, indicating that the method of applying an institutional CDW is useful for assessing ADRs.

Solution-phase parallel synthesis of an isoflavone library for the discovery of novel antigiardial agents.

Combinatorial chemistry has become a dramatically useful tool for the development of new medicinal agents. In the search to discover a novel and effective lead for the treatment of giardiasis, solution-phase synthesis of a library of isoflavone derivatives has been accomplished. Of the products screened, several compounds such as P(A1,B1) and P(A1,B11) exhibited potent antigiardial activity. The details of synthesis, in vitro antigiardial assay, and preliminary structure-activity relationships of these compounds are described.

[A case of mitral regurgitation from non-penetrating chest trauma].

An 18-year-old boy, with no evidence of cardiac murmurs in the past, was admitted to our hospital after steering wheel injury on Nov 22, 1987. He immediately became in shock state. Physical examination revealed a grade 3/6 apical holosystelic murmur and moist rales in lungs. Two-dimensional echocardiography showed a prolapsed anterior leaflet and a lot of pericardial effusion. He recovered soon after subxiphoid pericardiotomy, then we obtained bloody fluid of 200 microliters. In cardiac catheterization study, the pulmonary artery wedge pressure was elevated with a V-wave of 31 mmHg. Coronary angiogram, right ventriculogram, and aortogram were normal, but left ventriculography revealed grade 4 (Seller's) mitral regurgitation. Mitral valve replacement was performed with a Bjork-Shiley prosthesis on Feb 8, 1988. Anterior papillary muscle was in a white necrosis, but not ruptured. Mitral valve leaflets and chordae tendineae were intact. 12 cases of mitral regurgitation from non-penetrating blunt chest trauma were reported in Japan, but we first report a case of mitral regurgitation due to non-ruptured papillary muscle dysfunction.