Clinical Terminology Research Articles

The U.S. National Library of Medicine and standards for electronic health records: Onething led to another.

When Donald A.B. Lindberg M.D. became Director in 1984, the U.S. National Library of Medicine (NLM) was a leader in the development and use of information standards for published literature but had no involvement with standards for clinical data. When Dr. Lindberg retired in 2015, NLM was the Central Coordinating Body for Clinical Terminology Standards within the U.S. Department of Health and Human Services, a major funder of ongoing maintenance and free dissemination of clinical terminology standards required for use in U.S. electronic health records (EHRs), and the provider of many services and tools to support the use of terminology standards in health care, public health, and research. This chapter describes key factors in the transformation of NLM into a significant player in the establishment of U.S. terminology standards for electronic health records.

The Meaning of Words Related to Orofacial Pain and Headache Conditions: The Need for a Single and Unified Classification Scheme in a People-Centered Language

The Meaning of Words Related to Orofacial Pain and Headache Conditions: The Need for a Single and Unified Classification Scheme in a People-Centered Language

American and European Guidelines on Disorders of Consciousness: Ethical Challenges of Implementation.

American and European Guidelines on Disorders of Consciousness: Ethical Challenges of Implementation.

Concept of Hyperlipidemia in Ayurveda

Hyperlipidemia is a clinical terminology represents excessive tiers of fat or lipids in the blood, which consist of cholesterol and triglycerides. Hyperlipidemia can be inherited due sedentary life lead. As opposed to the excessive cholesterol hyperlipidemia consists of hypertriglyceridemia and high rise of triglyceride and cholesterol indicates mixed hyperlipidemia. Meda is a very crucial component included in the category of Dhatu. It may be correlated with fats or lipids in modern medical parameters. Meda Dhatu has an extensive role for various metabolic disorders like obesity, Diabetes Mellitus in phrases of Sthaulya, Prameha due to excessive deposition of Meda. Aims & Objective: Etiology, pathophysiology and principle management of hyperlipidemia with correlation to Meda Roga. It also highlights the role Ayurveda fraternity for the sake of early diagnosis and correct management of diagnosed case of hyperlipidemia or Meda Roga through Ayurveda. Materials & Method: The literal review carried out by collecting the literature and research finding from various classical and modern text book, online reports and online research articles in Google Search and PubMed Database. Results: Hyperlipidemia or Meda Roga is a burning issue with underlying critical pathology correlated to Medabaha Sroto Dusti, lead to serious illnesses and ultimately death. Conclusion: Hyperlipidemia and Meda Roga in Ayurveda may be correlated. Hyperlipidemia stands for cardiovascular issues given that last decades as a result of lifestyle modification. Present study attempts to correlate the relation among lipids and Meda Dhatu

Development of Food Allergy Data Dictionary: Toward a Food Allergy Data Commons

Food allergy (FA) data lacks a common base of terminology and hinders data exchange among institutions. To examine the current FA concept coverage by clinical terminologies and to develop and evaluate a Food Allergy Data Dictionary (FADD). Allergy/immunology templates and patient intake forms from 4 academic medical centers with expertise in FA were systematically reviewed, and in-depth discussions with a panel of FA experts were conducted to identify important FA clinical concepts and data elements. The candidate ontology was iteratively refined through a series of virtual meetings. The concepts were mapped to existing clinical terminologies manually with the ATHENA vocabulary browser. Finally, the revised dictionary document was vetted with experts across 22 academic FA centers and 3 industry partners. A consensus version 1.0 FADD was finalized in November 2020. The FADD v1.0 contained 936 discrete FA concepts that were grouped into 14 categories. The categories included both FA-specific concepts, such as foods triggering reactions, and general health care categories, such as medications. Although many FA concepts are included in existing clinical terminologies, some critical concepts are missing. The FADD provides a pragmatic tool that can enable improved structured coding of FA data for both research and clinical uses, as well as lay the foundation for the development of standardized FA structured data entry forms.

Local antibiotic therapy options for treating acute rhinosinusitis in children

The article presents various types of acute rhinosinusitis progression in pediatric practice depending on the duration of the disease, based on the available modern consensus papers and clinical guidelines. The main clinical terminology of the nosological forms of rhinosinusitis was determined, and aspects of their differential diagnosis and stages of the treatment were studied. The authors provided insight into disease pathogenesis, taking into account literature review data on the spectrum of the most common bacterial agents of the nose and paranasal sinuses pathologies. The available data on the treatment of rhinosinusitis are summarized from the perspective of consensus papers and modern clinical guidelines of the Ministry of Health of the Russian Federation, the use of which for the prescription of treatment is the most important quality criterion for medical care provided. A clinical case of the treatment of acute bacterial uncomplicated rhinosinusitis in a 12-year-old child is described. In this case, an aerosolized form of topical antibiotic therapy combined with a mucolytic component was used as a drug of choice alongside with the standard irrigation-elimination therapy and nasal decongestants, which gives an advantage in achieving the maximum effective concentration of the active substance at the site of inflammation. A drug with a mucoactive effect helps to decrease mucus viscosity and discharge, and at the same time facilitates the entry of an active substance into the tissues and inhibits bacterial adhesion to the epithelium of the respiratory tract. Antibacterial component – thiamphenicol, a derivative of chloramphenicol with a mechanism of action associated with inhibition of bacterial protein synthesis has a broad spectrum of action and a maximum degree of accumulation and action in the site of inflammation due to the method of delivery to the epithelium of the respiratory tract.

Is it possible to implement a rare disease case-finding tool in primary care? A UK-based pilot study

IntroductionThis study implemented MendelScan, a primary care rare disease case-finding tool, into a UK National Health Service population. Rare disease diagnosis is challenging due to disease complexity and low physician awareness. The 2021 UK Rare Diseases Framework highlights as a key priority the need for faster diagnosis to improve clinical outcomes.Methods and resultsA UK primary care locality with 68,705 patients was examined. MendelScan encodes diagnostic/screening criteria for multiple rare diseases, mapping clinical terms to appropriate SNOMED CT codes (UK primary care standardised clinical terminology) to create digital algorithms. These algorithms were applied to a pseudo-anonymised structured data extract of the electronic health records (EHR) in this locality to "flag" at-risk patients who may require further evaluation. All flagged patients then underwent internal clinical review (a doctor reviewing each EHR flagged by the algorithm, removing all cases with a clear diagnosis/diagnoses that explains the clinical features that led to the patient being flagged); for those that passed this review, a report was returned to their GP. 55 of 76 disease criteria flagged at least one patient. 227 (0.33%) of the total 68,705 of EHR were flagged; 18 EHR were already diagnosed with the disease (the highlighted EHR had a diagnostic code for the same RD it was screened for, e.g. Behcet’s disease algorithm identifying an EHR with a SNOMED CT code Behcet's disease). 75/227 (33%) EHR passed our internal review. Thirty-six reports were returned to the GP. Feedback was available for 28/36 of the reports sent. GP categorised nine reports as "Reasonable possible diagnosis" (advance for investigation), six reports as "diagnosis has already been excluded", ten reports as "patient has a clear alternative aetiology", and three reports as "Other" (patient left study locality, unable to re-identify accurately). All the 9 cases considered as "reasonable possible diagnosis" had further evaluation.ConclusionsThis pilot demonstrates that implementing such a tool is feasible at a population level. The case-finding tool identified credible cases which were subsequently referred for further investigation. Future work includes performance-based validation studies of diagnostic algorithms and the scalability of the tool.

The U.S. National Library of Medicine and Standards for Electronic Health Records: One Thing Led to Another.

When Donald A.B. Lindberg M.D. became Director in 1984, the U.S. National Library of Medicine (NLM) was a leader in the development and use of information standards for published literature but had no involvement with standards for clinical data. When Dr. Lindberg retired in 2015, NLM was the Central Coordinating Body for Clinical Terminology Standards within the U.S. Department of Health and Human Services, a major funder of ongoing maintenance and free dissemination of clinical terminology standards required for use in U.S. electronic health records (EHRs), and the provider of many services and tools to support the use of terminology standards in health care, public health, and research. This chapter describes key factors in the transformation of NLM into a significant player in the establishment of U.S. terminology standards for electronic health records.

Clinical veterinary terminology: specificities of formation and translation difficulties

The article describes the specifics of the formation, systematization, and translation of clinical veterinary terminology. The aim of the study is to analyze the lexical and structural features of clinical veterinary terminology, to determine the main ways of its reproduction in English-Ukrainian translations. The research results highlight the specifics of formation and lexical/semantic properties of clinical veterinary terminology. It has been established that the formation of clinical veterinary terminology is accomplished using term elements of Greek-Latin origin, which is the basis for the development of the term system of veterinary medicine. In addition, a phenomenon of replacing terms generated on the basis of other languages with English borrowings, and borrowings from other languages has recently been observed. It has been determined that the basis for the formation of clinical veterinary terms is the prefix method, in which the most commonly used prefixes are contra, anti-, in-(im), en-, ante-, pro-, ad-, de- , hyper-, hypo-, post-, meta-, con-, de- (des-), dis-, epi-, extra-, inter-, intra-, per-, re-, sub-, super-, supra-, trans-, ultra-, mono-, bi-, oligo -, para; a suffix method in which the most commonly used suffixes are-ac, -al , -an , -ar , -ary , -eal, -ic, -ine, -ous, -tic, -ectomy, –pexy, -plasty -stomy, -tomy, -centesis, -gram, -graph, -graphy, -lysis, -scope, -scopy, –therapy, -rrhagia or –rrhage, -rrhaphy, -rrhea, -rrhexis, -algia, -dynia, -itis, malacia, -megaly, -osis, -pathy, -sclerosis, -um; aswell as – root method, preferably using a combination of vowel sound and form combinations. The role of abbreviations and shortenings in clinical terminology and ways of their reproduction in the translation have been systematized and analyzed. Lexical, grammatical, and lexical-grammatical ways of translating clinical veterinary terminology into Ukrainian have been indicated. The necessity of a detailed study of clinical terminology for the development of adequate translation skills has been grounded.

A framework for selection of health terminology systems: A prerequisite for interoperability of health information systems

Health terminology systems (HTS) serve as the backbone for the interoperability of health information systems (HIS). Selecting appropriate terminologies is a universal concern for HTS stakeholders. The purpose of this study is to develop a framework for HTS selection. To do this, the study was designed in two stages: I) Developing an initial framework by running a systematic literature review (reviewing 100 articles selected based on the criteria from 10886 articles retrieved from PubMed, Scopus, Web of Science, and EMBASE), and II) Validation of the initial framework by the use of a modified Delphi Method (2 rounds). The proposed framework comprised four dimensions: terminology main group (TMG), important related terminologies (IRTs), message exchange standards (MES), and architecture of terminology standards (ATS). TMG includes “the committee for terminology selection”, “determination of the scope coverage”, and “requirement evaluation”. IRTs used during the creation and maintenance of terminologies for mapping purposes are classified into two groups: 1) administrative, financial and legal terminologies, and 2) clinical terminologies. The steps for applying MES for TMG include 1) need assessment for MES based on the objectives and scope of TMG, 2) reviewing MES at the national and international level, 3) choosing/developing the MES standard(s). Finally, the proposed ATS includes TMG, IRTs, health information systems, and standard-based programs like registries, and data-warehouses. The framework could be used as a foundation for policy-makers, and vendors to: 1) attain the goals of semantic interoperability, 2) ensure high-quality data exchange, and 3) increase data reusability.

Automated clinical pathway standardization using SNOMED CT- based semantic relatedness.

The increasing number of patients and heavy workload drive health care institutions to search for efficient and cost-effective methods to deliver optimal care. Clinical pathways are promising care plans that proved to be efficient in reducing costs and optimizing resource usage. However, most clinical pathways are circulated in paper-based formats. Clinical pathway computerization is an emerging research field that aims to integrate clinical pathways with health information systems. A key process in clinical pathway computerization is the standardization of clinical pathway terminology to comply with digital terminology systems. Since clinical pathways include sensitive medical terms, clinical pathway standardization is performed manually and is difficult to automate using machines. The objective of this research is to introduce automation to clinical pathway standardization. The proposed approach utilizes a semantic score-based algorithm that automates the search for SNOMED CT terms. The algorithm was implemented in a software system with a graphical user interface component that physicians can use to standardize clinical pathways by searching for and comparing relevant SNOMED CT retrieved automatically by the algorithm. The system has been tested and validated on SNOMED CT ontology. The experimental results show that the system reached a maximum search space reduction of 98.9% within any single iteration of the algorithm and an overall average of 71.3%. The system enables physicians to locate the proper terms precisely, quickly, and more efficiently. This is demonstrated using case studies, and the results show that human-guided automation is a promising methodology in the field of clinical pathway standardization and computerization.

Automatic SNOMED CT coding of Chinese clinical terms via attention-based semantic matching

BackgroundA considerable amount of meaningful information is routinely recorded in Chinese clinical data in text format, referred to as Chinese clinical terms. The lack of coding is a major difficulty hindering the application of clinical terms. SNOMED CT is a widely used and comprehensive clinical health care terminology collection because of its coverage, granularity, clinical orientation, and logical underpinning. It is useful and efficient for automatically assigning SNOMED CT codes to Chinese clinical terms, but it still faces several problems. Current cross-language clinical term matching studies rely on external resources, such as machine translation and rule-based methods. Semantic matching methods have achieved strong performance on text matching, but few studies have been done on cross-language clinical term matching. We present an effective attention-based semantic matching algorithm to automatically cross-language code Chinese clinical terms with SNOMED CT. MethodFirstly, BERT was used to turn the input into word embedding. Then, the word embeddings were encoded through a BiLSTM with self-attention to focus on capturing distant relationships among words with different weights depending on their contribution to semantic matching. Then, decomposable attention was used to make semantic matching trivially parallelizable to speed up calculation. Finally, fully connected layers and a sigmoid were utilized to output matching results. ResultsThe 29,960 manually coded Chinese clinical terms, 30,040 unmatched Chinese clinical terms and SNOMED CT codes were collected to evaluate the proposed method. Compared with the existing semantic matching method, the proposed approach achieves state-of-the-art results demonstrating the effectiveness of the method with an accuracy of 0.905, a precision of 0.856, a recall of 0.518, and an F-measure of 0.645. The proposed Chinese-English bilingual term mapping, Chinese character-level and word-level encoder, English word-level encoder, BERT model, and attention mechanism performed better than other methods. ConclusionThe proposed automatic SNOMED CT coding approach of Chinese clinical terms via attention-based semantic matching can improve the performance of automated SNOMED CT code assignment for Chinese clinical terms and improve the efficiency of the code assignment.

Mapping of Wound Infection Concepts.

Wound infection is a serious health care complication. Standardized clinical terminologies could be leveraged to support the early identification of wound infection. The purpose of this study was to evaluate the representation of wound infection assessment and diagnosis concepts (N=26) in SNOMED CT and ICNP, using a synthesized procedural framework. A total of 13/26 (50%) assessment and diagnosis concepts had exact matches in SNOMED CT and 2/7 (29%) diagnosis concepts had exact matches in ICNP. This study demonstrated that the source concepts were moderately well represented in SNOMED CT and ICNP; however, further work is necessary to increase the representation of diagnostic infection types. The use of the framework facilitated a systematic, transparent, and repeatable mapping process, with opportunity to extend.

Ensuring a safe(r) harbor: Excising personally identifiable information from structured electronic health record data.

Recent findings have shown that the continued expansion of the scope and scale of data collected in electronic health records are making the protection of personally identifiable information (PII) more challenging and may inadvertently put our institutions and patients at risk if not addressed. As clinical terminologies expand to include new terms that may capture PII (e.g., Patient First Name, Patient Phone Number), institutions may start using them in clinical data capture (and in some cases, they already have). Once in use, PII-containing values associated with these terms may find their way into laboratory or observation data tables via extract-transform-load jobs intended to process structured data, putting institutions at risk of unintended disclosure. Here we aim to inform the informatics community of these findings, as well as put out a call to action for remediation by the community.

DCC Terminology Service—An Automated CI/CD Pipeline for Converting Clinical and Biomedical Terminologies in Graph Format for the Swiss Personalized Health Network

One goal of the Swiss Personalized Health Network (SPHN) is to provide an infrastructure for FAIR (Findable, Accessible, Interoperable and Reusable) health-related data for research purposes. Semantic web technology and biomedical terminologies are key to achieving semantic interoperability. To enable the integrative use of different terminologies, a terminology service is a important component of the SPHN Infrastructure for FAIR data. It provides both the current and historical versions of the terminologies in an SPHN-compliant graph format. To minimize the usually high maintenance effort of a terminology service, we developed an automated CI/CD pipeline for converting clinical and biomedical terminologies in an SPHN-compatible way. Hospitals, research infrastructure providers, as well as any other data providers, can download a terminology bundle (currently composed of SNOMED CT, LOINC, UCUM, ATC, ICD-10-GM, and CHOP) and deploy it in their local terminology service. The distributed service architecture allows each party to fulfill their local IT and security requirements, while still having an up-to-date interoperable stack of SPHN-compliant terminologies. In the future, more terminologies and mappings will be added to the terminology service according to the needs of the SPHN community.

Anatomical Terms in Jurgis Žilinskas’ Short Textbook of Osteology and Syndesmology

Medical terminology has an extensive and rich history in Latin and Greek languages. When Romans conquered Greece, the knowledge and language of both cultures merged, resulting in new medical concepts regarding disease treatment and containment. Medical records were chronicled by hand, creating medical terms and books. Although medical terms have been drawn from many languages, a large majority originate from Greek and Latin. Terms of Greek origin occur mainly in clinical terminology, while Latin terms make up the majority of anatomical terminology. Another reason for a large number of Greek medical terms is that the Greek language is quite suitable for building compound words. The article discusses the current state of anatomical terminology in Lithuania. The history of the Lithuanian nomenclature of anatomy dates back several centuries, during which the most frequently used Lithuanian anatomical terms were gradually developed. Every time, writing and publishing textbooks, methodological aids, and other anatomy books in the Lithuanian language, the authors interpreted various Latin anatomy terms in their own way and introduced new equivalents in the Lithuanian language. However, they often did not agree on the translation of various Latin terms into Lithuanian and their application to define various structures. The development and perfection of medical terminology is a long process. The most significant contribution in regulating Lithuanian anatomical terminology was made by Jurgis Žilinskas. The terms that we currently use can be found in his textbooks “Osteologija ir syndesmologija” (“Osteology and syndesmology”) (1932) and “Splanchnologija” (“Splanchnology”) (1934) (Litevkiene, Korosteliova 2012, 208). He initiated term regulation in his first textbook, “Lectures of Neurology” (1923), containing only Latin terms, well-formed according to Baseler’s nomenclature. The nomenclature of anatomy compiled by him was applied in other anatomy textbooks and the Dictionary of Medical Terms.

Criminalization of Care: Drug Testing Pregnant Patients.

This article reveals how law and legal interests transform medicine. Drawing on qualitative interviews with medical professionals, this study shows how providers mobilize law and engage in investigatory work as they deliver care. Using the case of drug testing pregnant patients, I examine three mechanisms by which medico-legal hybridity occurs in clinical settings. The first mechanism, clinicalization, describes how forensic tools and methods are cast in clinical terminology, effectively cloaking their forensic intent. In the second, medical professionals informally rank the riskiness of illicit substances using both medical and criminal-legal assessments. The third mechanism describes how gender, race, and class inform forensic decision-making and criminal suspicion in maternal health. The findings show that by straddling both medical and legal domains, medicine conforms to the standards and norms of neither institution while also suspending meaningful rights for patients seeking care.

Peculiarities of Phonetic and Orthographic Adaptation of Latin Terms in English Clinical Terminology: On the Issue of Latin Terminological Competence Formation of Foreign Medical Students

Summary The article deals with the phonetic and orthographic adaptation of Latin terms in English clinical terminology in the context of Latin terminological competence formation of foreign medical students with English as the language of instruction. About 8,000 of the most common clinical terms selected from various lexicographic English sources have been studied on the basis of etymological and comparative approaches to demonstrate the grade of inconsistency in the reflection of Latin terms in modern English medical terminology. The quantitative analysis allowed us to determine and classify the main tendencies in the process of phonetic and orthographic development of Latin terms: (1) imitation of classical Latin spelling; (2) ‘simplification’ of classical Latin spelling; (3) syncretism of the first and second tendencies (parallel use of classical Latin and ‘simplified’ variants as synonyms). The analysis has also identified in some cases the phenomenon of ‘hypercorrectness’. The lack of a unified norm is reflected in all the analyzed reference sources, complicating the lexicographic description of medical terms as well as the process of teaching / learning the medical terminology. The proposed solution is to develop and implement some unified criteria for phonetic and orthographic adaptation of Latin terms in English. The possible ways to solve the problem are either to adhere to the etymological principle, returning ad fontes of medical terminology, and to use only non-monophthongized and non-simplified forms or to use monophthongized and phonetically and graphically simplified forms following the norms of modern English. Consistent adherence to one system of rules for the development of Latin terms is a needed requirement for the proper formation of terminological competence in medical students and correct use of terminology in their further professional activity.

Anesthesiologist's Perspective on the Standardization of Clinical Terminology in Electronic Health Records.

Anesthesiologist's Perspective on the Standardization of Clinical Terminology in Electronic Health Records.

Prof. M. Ya. Breitman. Dictionary of clinical terminology based on the latest Russian and foreign sources. Issue IV. Ed. Practical Medicine 1929. Price 4 rubles

With the publication of the 4th edition of the dictionary by prof. Breitman, we have completed a great work on medical lexicography. One can disagree with the author's peculiar spelling like "gynecology", "Pasteur", etc., but one can in no way dispute the value and necessity of this manual for our time. The absence of such reference books on the book market, as well as the doctor's ignorance of a foreign language, often puts him in a difficult position when he wants to establish the exact pronunciation, spelling or meaning of a clinical term. Therefore, the dictionary of prof. Breitman will undoubtedly serve for a long time to be a reliable reference in all matters concerning clinical terminology. It is very good that the author also gives an indication of the pronunciation of surnames and proper names. At this point, everyone may be puzzled. The dictionary will solve them. In this note, we will allow ourselves to note some errors and controversies regarding terms in the interest of correcting them for the 2nd edition.