Characteristics of Consumer Terminology for Health Information Retrieval

Objectives: As millions of consumers perform health information retrieval online, the mismatch between their terminology and the terminologies of the information sources could become a major barrier to successful retrievals. To address this problem, we studied the characteristics of consumer terminology for health information retrieval.

Methods: Our study focused on consumer queries that were used on a consumer health service Web site and a consumer health information Web site. We analyzed data from the site-usage logs and conducted interviews with patients.

Results: Our findings show that consumers’ information retrieval performance is very poor. There are significant mismatches at all levels (lexical, semantic and mental models) between the consumer terminology and both the information source terminology and standard medical vocabularies.

Conclusions: Comprehensive terminology support on all levels is needed for consumer health information retrieval.

Characteristics of consumer terminology for health information retrieval

OBJECTIVES

As millions of consumers perform health information retrieval online, the mismatch between their terminology and the terminologies of the information sources could become a major barrier to successful retrievals. To address this problem, we studied the characteristics of consumer terminology for health information retrieval.

METHODS

Our study focused on consumer queries that were used on a consumer health service Web site and a consumer health information Web site. We analyzed data from the site-usage logs and conducted interviews with patients.

RESULTS

Our findings show that consumers' information retrieval performance is very poor. There are significant mismatches at all levels (lexical, semantic and mental models) between the consumer terminology and both the information source terminology and standard medical vocabularies.

CONCLUSIONS

Comprehensive terminology support on all levels is needed for consumer health information retrieval.

Enzyme replacement therapy in the management of longstanding skeletal and soft tissue salmonella infection in a patient with Gaucher's disease

A splenectomised patient with Gaucher's disease who developed multiple foci of osteomyelitis and soft tissue abcesses, after a severe episode of group C salmonella sepsis, is described. Aggressive antibiotic treatment and surgical drainage had little effect and the patient's condition continued to deteriorate. With initiation of enzyme replacement therapy (ERT) in addition to specific antibiotic treatment, defervescence and gradual healing occurred. Complete resolution of the infection was seen after 15 months. The possible role of ERT in healing bacterial infections in Gaucher's disease is discussed.

Patient and clinician vocabulary: how different are they?

Consumers and patients are confronted with a plethora of health care information, especially through the proliferation of web content resources. Democratization of the web is an important milestone for patients and consumers since it helps to empower them, make them better advocates on their own behalf and foster better, more-informed decisions about their health. Yet lack of familiarity with medical vocabulary is a major problem for patients in accessing the available information. As a first step to providing better vocabulary support for patients, this study collected and analyzed patient and clinician terms to confirm and quantitatively assess their differences. We also analyzed the information retrieval (IR) performance resulting from these terms. The results showed that patient terminology does differ from clinician terminology in many respects including misspelling rate, mapping rate and semantic type distribution, and patient terms lead to poorer results in information retrieval.

Problems and challenges in patient information retrieval: a descriptive study

Many patients now turn to the Web for health care information. However, a lack of domain knowledge and unfamiliarity with medical vocabulary and concepts restrict their ability to successfully obtain information they seek. The purpose of this descriptive study was to identify and classify the problems a patient encounters while performing information retrieval tasks on the Web, and the challenges it poses to informatics research. In this study, we observed patients performing various retrieval tasks, and measured the effectiveness of, satisfaction with, and usefulness of the results. Our study showed that patient information retrieval often failed to produce successful results due to a variety of problems. We propose a classification of patient IR problems based on our observations.

Finding appropriate clinical trials: evaluating encoded eligibility criteria with incomplete data

We describe our work on creating a system that selects appropriate clinical trials by automating the evaluation of eligibility criteria. We developed a data model of eligibility for breast cancer clinical trials, upon which the criteria were encoded. Standard vocabularies are utilized to represent concepts used in the system, and retrieve their hierarchical relationships. The system incorporates Bayesian networks to handle missing patient information. Protocols are ranked by the belief that the patient is eligible for each of them. In a preliminary evaluation, we found good agreement (kappa 0.86) between the system and an independent physician in selection of protocols, but poor agreement (kappa 0.24) in protocol ranking. We conclude that our approach is feasible, and potentially useful in assisting both physicians and patients in the task of selecting appropriate trials.

GLIF3: the evolution of a guideline representation format

The Guideline Interchange Format (GLIF) is a language for structured representation of guidelines. It was developed to facilitate sharing clinical guidelines. GLIF version 2 enabled modeling a guideline as a flowchart of structured steps, representing clinical actions and decisions. However, the attributes of structured constructs were defined as text strings that could not be parsed, and such guidelines could not be used for computer-based execution that requires automatic inference. GLIF3 is a new version of GLIF designed to support computer-based execution. GLIF3 builds upon the framework set by GLIF2 but augments it by introducing several new constructs and extending GLIF2 constructs to allow a more formal definition of decision criteria, action specifications and patient data. GLIF3 enables guideline encoding at three levels: a conceptual flowchart, a computable specification that can be verified for logical consistency and completeness, and an implementable specification that can be incorporated into particular institutional information systems.

Guideline classification to assist modeling, authoring, implementation and retrieval

The National Guideline Clearinghouse (NGC) and its guideline classification system are significant contributions to the study of clinical practice guidelines (CPGs) and their incorporation into routine clinical care. The NGC classification system is primarily designed to support guideline retrieval. We believe that a guideline classification system should also support identification of features that relate to incorporation of executable CPGs into computer-based applications for sharing and delivering guideline-based advice. We have developed a proposed expansion of the NGC guideline classification for this purpose. The axes of the proposed scheme have implications for designing formal models and structures for representing and authoring CPGs. This scheme also has implications for future research.

Field treatment of snakebites in the Israel Defense Forces

Eight species of venomous snakes capable of inflicting bites dangerous or fatal to humans inhabit the State of Israel. Soldiers in the Israel Defense Forces (IDF) routinely serve under field conditions, and are at greater risk for contact with venomous snakes than are their civilian counterparts. Every year scores of military personnel are bitten by poisonous snakes. The IDF has developed a protocol for field-level treatment of snakebite victims, which we present in this article. Employment of a number of simple therapeutic measures for early treatment of snakebite can prevent or significantly reduce venom-induced morbidity and mortality.

Poisonous animal bites in the Israel Defense Forces

INTRODUCTION

Soldiers in field units of the Israel Defense Forces (IDF) are susceptible to injury by various poisonous animals during training and operations. Bites and envenomations by animals such as snakes, scorpions, and spiders can be painful and debilitating, and at times life-threatening. We have examined the extent of exposure of IDF soldiers to snake and arthropod bites and the morbidity resulting from these encounters.

METHODS

All reports of IDF soldiers who sought medical attention for snake or arthropod bites between the years 1993-1997 were reviewed at the IDF Medical Corps Headquarters. Monthly distribution of cases was noted for all years, and geographic distribution was studied for all 1997 cases.

RESULTS

Over the period 1993-1997 there was a yearly rate of 32-52 physician visits per 100,000 soldiers due to snakebites (mean 43.6/100,000), and 1370-1729 physician visits per 100,000 soldiers due to arthropod bites (mean 1478/100,000). There is a clear overall increase in snake and arthropod bites during the spring and summer months, with a peak in snakebites in May and in arthropod bites in August. 58% of all snakebites in Israel were reported in the central region, with 33% occurring in the south, and 9% in the north of the country. No fatalities due to envenomations have been reported in the IDF in recent years.

CONCLUSION

Poisonous animal species pose a significant threat to the soldiers of the IDF. Overall, envenomation is a common and widespread problem that has significant impact on the military medical system, especially during the spring and summer months. It is possible through institution of proper preventive measures to decrease the exposure of IDF personnel to this environmental hazard.

Primary psoas abscess due to methicillin-resistant Staphylococcus aureus concurrent with septic arthritis of the hip joint

We report an unusual case of a primary psoas abscess due to community acquired methicillin-resistant Staphylococcus aureus in an immunocompetent man. The course of the disease was indolent, expressed as septic arthritis of the hip joint. When the diagnosis was made, 3 months after symptoms began, the patient was treated by surgical evacuation of the abscess and appropriate antibiotics. Full recovery and return to his usual activity followed total hip replacement.

[Atrial septal defects and embolic stroke in young adults]

The mechanism of embolic stroke in young adults remains unidentified in about 35% of cases. In recent years defects in the atrial septum have been described as an important route for cerebral and retinal embolism. These include classical atrial septal defect and patent foramen ovale, as well as the less well-recognized entity of atrial septal aneurysm, with or without interatrial communication. The combined incidence of these defects in the general population is between 20-35%. The introduction of transesophageal echocardiography and the use of echogenic contrast have lead to significant improvement in identification. We describe 3 patients in whom atrial defects were identified as possible routes for cerebral embolism: The first presented with recurrent stroke and combined atrial septal aneurysm and patent foramen ovale. In the second, patent foramen ovale was found in a patient with 2 prosthetic values. The third was a soldier in whom patent foramen ovale was found following transient loss of consciousness. Based on our modest experience and review of the literature we believe that transesophageal and contrast echocardiography should be performed in every young patient with unexplained cerebral ischemia.

Suprascapular neuropathy after intensive progressive resistive exercise: case report

A healthy 30-year-old man developed pain in the posterior shoulder region approximately one month after initiating an intensive weightlifting program to increase upper extremity strength. This program especially emphasized shoulder abduction exercises. The pain intensified as he continued and finally he noted weakness of the involved shoulder, which led him to seek medical advice. Examination was normal except for atrophy of the infraspinatus muscle on the involved side and decreased strength of shoulder abduction and external rotation. Electromyographic examination demonstrated 3+ positive sharp waves in the infraspinatus muscle, delayed conduction to the supraspinatus muscle, and absence of an evoked response to the infraspinatus muscle. Surgical decompression of the suprascapular nerve within the suprascapular notch was then performed. Two weeks after surgery the pain was much less and the conduction velocities had improved. Eight months after surgery the patient was free of pain, the conduction velocities had returned to normal, and electromyography revealed reinnervation of the denervated muscle fibers. Intensive shoulder exercise, especially involving repeated forceful abduction movements, should be considered in the etiology of suprascapular neuropathy.