Clinical Terminology Research Articles

The clinical diagnosis of Achilles tendinopathy: a scoping review.

BackgroundAchilles tendinopathy describes the clinical presentation of pain localised to the Achilles tendon and associated loss of function with tendon loading activities. However, clinicians display differing approaches to the diagnosis of Achilles tendinopathy due to inconsistency in the clinical terminology, an evolving understanding of the pathophysiology, and the lack of consensus on clinical tests which could be considered the gold standard for diagnosing Achilles tendinopathy. The primary aim of this scoping review is to provide a method for clinically diagnosing Achilles tendinopathy that aligns with the nine core health domains.MethodologyA scoping review was conducted to synthesise available evidence on the clinical diagnosis and clinical outcome measures of Achilles tendinopathy. Extracted data included author, year of publication, participant characteristics, methods for diagnosing Achilles tendinopathy and outcome measures.ResultsA total of 159 articles were included in this scoping review. The most commonly used subjective measure was self-reported location of pain, while additional measures included pain with tendon loading activity, duration of symptoms and tendon stiffness. The most commonly identified objective clinical test for Achilles tendinopathy was tendon palpation (including pain on palpation, localised tendon thickening or localised swelling). Further objective tests used to assess Achilles tendinopathy included tendon pain during loading activities (single-leg heel raises and hopping) and the Royal London Hospital Test and the Painful Arc Sign. The VISA-A questionnaire as the most commonly used outcome measure to monitor Achilles tendinopathy. However, psychological factors (PES, TKS and PCS) and overall quality of life (SF-12, SF-36 and EQ-5D-5L) were less frequently measured.ConclusionsThere is significant variation in the methodology and outcome measures used to diagnose Achilles tendinopathy. A method for diagnosing Achilles tendinopathy is proposed, that includes both results from the scoping review and recent recommendations for reporting results in tendinopathy.

Glomerular Diseases - Part II

Some disease processes that affect the glomerulus are acute and self-limited, whereas others lead to progressive loss of renal function. Glomerular diseases cause more than half the cases of chronic kidney disease. This chapter first briefly reviews normal glomerular structure and function, clinical classifications, terminology, diagnosis, and epidemiology of glomerular disease. Pathogenesis of glomerular injury is discussed, and then more detailed approaches to diagnosis. General principles in the management of glomerular diseases are presented. Specific glomerular diseases and their management, discussed at length, are divided into nephritic, nephrotic, and nephritic-nephrotic syndromes. Figures illustrate the pathogenesis and findings on light microscopy, electron microscopy, and immunostaining of a variety of glomerular diseases, including poststreptococcal glomerulonephritis, IgA nephropathy, anti–glomerular basement membrane disease, focal and segmental glomerulosclerosis (FSGS), membranous nephropathy, and membranoproliferative glomerulonephritis (MPGN). This review contains 7 figures, 18 tables, and 70 references. Keywords: Glomerulonephritis, nephritic syndrome, nephrotic syndrome, microscopy, urinalysis, proteinuria, hematuria, nephropathy, Henoch-Schönlein purpura, nephritis

Interventions for great saphenous vein incompetence.

Interventions for great saphenous vein incompetence.

Commentary: Autism spectrum disorder and intellectual disability - an evolving landscape of clinical terminology - a commentary on Kehinde etal. (2021).

Diagnoses and words used are important. Terminology in autism spectrum disorders and intellectual disabilities is constantly changing in either diagnostic systems or everyday language. There are different pressures for terminological change from clinical, academic and societal perspectives. Clinically, the words are aligning in the 2 major diagnostic systems. This poses dilemmas for those with lived experience as well as professionals as to what words to use and when. An agreed set of words to use for diagnoses will improve understanding, respect and ensure needs are met appropriately.

Comparison of terminology mapping methods for nursing wound care knowledge representation

BackgroundStandardized clinical terminologies are increasingly used to design and support advanced information systems. In order to examine the representativeness of these terminologies for different professional groups or clinical areas, researchers may perform different methods of terminology mapping. ObjectiveThe purpose of this study was to evaluate the ability of four mapping methods to identify concepts related to wound care in SNOMED CT. MethodsA class diagram of 107 concepts was developed to represent the nursing context of wound assessment, wound diagnosis, and goal of care for wound management. All concepts were mapped to SNOMED CT and identified as a direct match, a one-to-many match, or no match using four mapping methods (manual, automated, comparison, and concordance). The manual, automated and comparison methods produced candidate lists of SNOMED CT concepts, which were then used by two nursing wound care experts. The experts completed concordance mapping, which produced the final list. The SNOMED CT concepts from the manual, automated and comparison mappings were compared to the concordance mapping to generate a proportion of representation by each mapping method. ResultsThe manual, automated and comparison mappings produced partial lists of unique candidate concept matches not found in the other mapping methods. The concordance mapping produced a final list which included: 43 terms (40%) that had direct matches, 2 terms (2%) that had one-to-many matches, and 62 terms (58%) that had no matches to SNOMED CT. All mapping methods were necessary to achieve the representativeness captured in the final list. ConclusionTo increase the representativeness of candidate mapping lists, multiple mapping methods and considerations may be necessary.

COVID-19 Vaccination Is Safe and Effective in Patients With Inflammatory Bowel Disease: Analysis of a Large Multi-institutional Research Network in the United States

COVID-19 Vaccination Is Safe and Effective in Patients With Inflammatory Bowel Disease: Analysis of a Large Multi-institutional Research Network in the United States

Defining Skin Quality: Clinical Relevance, Terminology, and Assessment.

Flawless skin is one of the most universally desired features, and demand for improvements in skin quality is growing rapidly. Skin quality has been shown to substantially impact emotional health, quality of life, self-perception, and interactions with others. Although skin quality improvements are a common end point in studies of cosmeceuticals, they are rarely assessed in clinical studies of other aesthetic treatments and products. Descriptive terminology for skin quality parameters also varies considerably within the aesthetic field, relying on a range of redundant and occasionally contradictory descriptors. In short, skin quality has not been clearly defined. The goal of this review is to highlight the importance of skin quality to patients and physicians, explore known and unknown factors comprising skin quality, and provide clarity regarding terminology, descriptors, and evaluation tools for assessing skin quality. A review of the literature on skin quality was performed without limitation on publication date. Relevant articles are presented. We propose a framework of attributes contributing to skin quality rooted in 3 fundamental categories-visible, mechanical, and topographical-with the aim to provide information to help guide clinicians and inform future clinical studies.

Extraoral bite-wing radiographs: A universally accepted paradox

BackgroundThe development of specialized panoramic radiograph machine software has spawned the introduction of an innovative and promising dental radiographic examination type: extraoral bite-wings. But does this unconventional type of imaging belong in the bite-wing family? Is there any relationship at all to the conventional bite-wing radiograph? ObjectivesThe purpose of this article is not to make a case for the diagnostic effectiveness of one system over the other; this is best left to further clinical evaluation. Instead, the authors intend to provide an outline of a few key and distinguishing elements of the intraoral bite-wing radiographic examination followed by those of the extraoral panoramic substitute and draw attention to the importance of reimagining the increasingly universal naming convention of this novel radiographic examination, the paradoxical “extraoral bite-wing radiograph”, based on the fundamental principles of each of these imaging systems. Practical ImplicationsThe accuracy of clinical and technical terminology in oral radiography is of paramount importance to both the profession and patients, especially when considering emerging technologies.

Healthcare resource utilisation and mortality outcomes in international migrants to the UK: analysis protocol for a linked population-based cohort study using Clinical Practice Research Datalink (CPRD), Hospital Episode Statistics (HES) and the Office for National Statistics (ONS)

An estimated 14.2% (9.34 million people) of people living in the UK in 2019 were international migrants. Despite this, there are no large-scale national studies of their healthcare resource utilisation and little is known about how migrants access and use healthcare services. One ongoing study of migration health in the UK, the Million Migrants study, links electronic health records (EHRs) from hospital-based data, national death records and Public Health England migrant and refugee data. However, the Million Migrants study cannot provide a complete picture of migration health resource utilisation as it lacks data on migrants from Europe and utilisation of primary care for all international migrants. Our study seeks to address this limitation by using primary care EHR data linked to hospital-based EHRs and national death records. Our study is split into a feasibility study and a main study. The feasibility study will assess the validity of a migration phenotype, a transparent reproducible algorithm using clinical terminology codes to determine migration status in Clinical Practice Research Datalink (CPRD), the largest UK primary care EHR. If the migration phenotype is found to be valid, the main study will involve using the phenotype in the linked dataset to describe primary care and hospital-based healthcare resource utilisation and mortality in migrants compared to non-migrants. All outcomes will be explored according to sub-conditions identified as research priorities through patient and public involvement, including preventable causes of inpatient admission, sexual and reproductive health conditions/interventions and mental health conditions. The results will generate evidence to inform policies that aim to improve migration health and universal health coverage.

A Review of Anatomical Terminology Variation for the Bony Pelvis

Introduction There is a history of attempting to standardize anatomical terminology; primarily to create a link between clinical and anatomical terminology. However, differences in anatomical terminology between disciplines and over time have not been well explored. The objective of this study was to perform a thorough literature review, using multiple databases to examine the variation in anatomical terminology relating to the pelvis, a complex bony structure often referred to with multiple anatomical terms. Method Searches for scientific articles were conducted from PubMed, JSTOR, and EBSCO using six search terms: “innominate bone,” “os coxa,” “os coxae,” “ossa coxae,” “os innominatum,” and “coxal bone.” All journal articles, review articles, and conference proceedings available on these databases were examined from their earliest inclusions through December 2020. Initial search results were individually screened, duplicated entries were removed, and the remaining results were analyzed (n=1255). Descriptive statistics and plots were created in order to examine trends in term usage over time and between disciplines. A Random Forest Model (RFM; k=1000) was also used to examine the ability to correctly classify term using year, journal title, and journal audience. Results There were clear differences in terminology used to describe the bony pelvis. The term “innominate bone” (n=468) was the most commonly used term, followed by “os coxae” (n=366). The other terms were used less frequently: “os innominatum” (n=129), “os coxa” (n=124), “coxal bone” (n=106), and “ossa coxae” (n=62). Trends related to the usage of certain terms over time were also observed. For example, use of the term “coxal bone” began recently, while the term “innominate bone” has been the primarily favored term, steadily increasing overtime since the late 1800s. The term “os innominatum” was used relatively infrequently, with its peak usage in the late 1800s. The main disciplinary audiences were medicine (n=374), anthropology and archaeology (n=236), forensic science (n=155), general science (n=115), and biology (n=83). Forensic science began using these terms with high frequency beginning in the early 2000s, while medicine, anthropology, and archaeology have longer, more steady usage histories. Publications related to medicine (to include anatomy) were the most frequent users of innominate (46%), “coxal bone” (36%), “os innominatum” (30%), and “ossa coxae” (21%) while forensic science most commonly used “os coxa” (38%) and “os coxae” (21%). Due to the large variability in term usage over time, between journals, and journal audience, the RFM did not perform well (accuracy of 35%). Importantly, this was largely due to misclassifying other terms as either “innominate bone”; “os coxae”; or to a lesser extent “os innominatum”. Conclusions Variation in the terminology used to describe the bony pelvis exists both within and between disciplines, as well as over time. Significance and implications The language used to refer to the bony pelvis reflects a lack of consistency within and between disciplines, as well as shifts in term usage over time. Due to the often-interdisciplinary nature of research, it is important to standardize terminology.

Boundary Crossers: How Providers Facilitate Ethnic Minority Families' Access to Dementia Services.

Providers who work closely with ethnic minority people with dementia and their families are pivotal in helping them access services. However, few studies have examined how these providers actually do this work. Using the concept of "boundary crossers," this article investigates the strategies applied by these providers to facilitate access to dementia services for ethnic minority people with dementia and their families. Between 2017 and 2020, in-depth video-recorded interviews were conducted with 27 health, aged care, and community service providers working with ethnic minority people living with dementia across Australia. Interviews were conducted in one of seven languages and/or in English, then translated and transcribed verbatim into English. The data were analyzed thematically. Family and community stigma associated with dementia and extra-familial care were significant barriers to families engaging with services. To overcome these barriers, participants worked at the boundaries of culture and dementia, community and systems, strategically using English and other vernaculars, clinical and cultural terminology, building trust and rapport, and assisting with service navigation to improve access. Concurrently, they were cognizant of familial boundaries and were careful to provide services that were culturally appropriate without supplanting the families' role. In negotiating cultural, social, and professional boundaries, providers undertake multidimensional and complex work that involves education, advocacy, negotiation, navigation, creativity, and emotional engagement. This work is largely undervalued but offers a model of care that facilitates social and community development as well as service integration across health, aged care, and social services.

Commentary on Defining Skin Quality: Clinical Relevance, Terminology, and Assessment.

Commentary on Defining Skin Quality: Clinical Relevance, Terminology, and Assessment.

International veterinary canine dyskinesia task force ECVN consensus statement: Terminology and classification

Movement disorders are a heterogeneous group of clinical syndromes in humans and animals characterized by involuntary movements without changes in consciousness. Canine movement disorders broadly include tremors, peripheral nerve hyperexcitability disorders, paroxysmal dyskinesia, and dystonia. Of these, canine paroxysmal dyskinesias remain one of the more difficult to identify and characterize in dogs. Canine paroxysmal dyskinesias include an array of movement disorders in which there is a recurrent episode of abnormal, involuntary, movement. In this consensus statement, we recommend standard terminology for describing the various movement disorders with an emphasis on paroxysmal dyskinesia, as well as a preliminary classification and clinical approach to reporting cases. In the clinical approach to movement disorders, we recommend categorizing movements into hyperkinetic vs hypokinetic, paroxysmal vs persistent, exercise‐induced vs not related to exercise, using a detailed description of movements using the recommended terminology presented here, differentiating movement disorders vs other differential diagnoses, and then finally, determining whether the paroxysmal dyskinesia is due to either inherited or acquired etiologies. This consensus statement represents a starting point for consistent reporting of clinical descriptions and terminology associated with canine movement disorders, with additional focus on paroxysmal dyskinesia. With consistent reporting and identification of additional genetic mutations responsible for these disorders, our understanding of the phenotype, genotype, and pathophysiology will continue to develop and inform further modification of these recommendations.

Definition and validation of SNOMED CT subsets using the expression constraint language

BackgroundSNOMED CT Expression Constraint Language (ECL) is a declarative language developed by SNOMED International for the definition of SNOMED CT Expression Constraints (ECs). ECs are executable expressions that define intensional subsets of clinical meanings by stating constraints over the logic definition of concepts. The execution of an EC on some SNOMED CT substrate yields the intended subset, and it requires an execution engine able to receive an EC as input, execute it, and return the matching concepts. An important issue regarding subsets of clinical concepts is their use in terminology binding between clinical information models and terminologies for defining the set of valid values of codified data. ObjectiveTo define and implement methods for the simplification, semantic validation and execution of ECs over a graph-oriented SNOMED CT database, and to provide a method for the visual representation of subsets in order to explore, understand and validate its content, as well as to develop an EC execution platform, called SNQuery, which makes use of these methods. MethodsSince SNOMED CT is a directed and acyclic graph, we have used a graph-oriented database to represent the content of SNOMED CT, where the schema and instances are represented as graphs and the data manipulation is expressed by graph-oriented operations. For the execution of ECs over the graph database, it is performed a translation process in which ECs are translated into a set of Cypher Query Language queries. We have defined some EC simplification methods that leverage the logic structure underlying SNOMED CT. The purpose of these methods is to reduce the complexity of ECs and, in turn, its execution time, as well as to validate them from a SNOMED CT Concept Model and logical definition points of view. We also have developed a graphic representation based on the circle packing geometrical concept, which allows validating subsets, as well as pre-defined refsets and the terminology itself. ResultsWe have developed SNQuery, a platform for the definition of intensional subsets of SNOMED CT concepts by means of the execution of ECs over a graph-oriented SNOMED CT database. Additionally, we have incorporated methods for the simplification and semantic validation of ECs, as well as for the visualization of subsets as a mechanism to understand and validate them. SNQuery has been evaluated in terms of EC execution times. ConclusionIn this paper, we provide methods to simplify, semantically validate and execute ECs over a graph-oriented database. We also offer a method to visualize the intensional subsets obtained by executing ECs to explore, understand and validate them, as well as refsets and the terminology itself. The definition of intensional subsets is useful to bind content between clinical information models and clinical terminologies, which is a necessary step to achieve semantic interoperability between EHR systems.

Systematic Analysis of Extracting Data on Advance Directives from Patient Electronic Health Records (EHR) in Terminal Oncology Patients

Advance directives are legal documents that include living wills and durable health care power of attorney documents. They are critical components of care for seriously ill patients which are designed to be implemented when a patient is terminally ill and incapacitated. We sought to evaluate potential reasons for why advance directives were not appropriately implemented, by reviewing the electronic health record (EHR) in patients with terminal cancer. A retrospective analysis of the EHR of 500 cancer patients from 1/1/2013 to 12/31/2016 was performed. Data points were manually collected and entered in a central database. Of the 500 patients, 160 (32%) had an advance directive (AD). The most common clinical terminology used by physicians indicating a terminal diagnosis was progressive (36.6%) and palliative (31%). The most common clinical terminology indicating incapacity was altered mental status (25.6%), and not oriented (14%). 34 (6.8%) patients met all criteria of having a terminal diagnosis, a documented AD, and were deemed incapacitated. Of these patients who met all of these data points, their ADs were implemented on average 1.7 days (SD: 4.4 days) after which they should have been. This resulted in a total of 58 days of additional care provided. This study provided insight on to how ADs are managed in day to day practice in the hospital. From our analysis it appears that physicians are able to identify when a patient is terminal, however, it is typically later than it should have been recognized. Further studies should be performed focusing on harnessing the power of the EHR and providing physicians formative and evaluative feedback of practice patterns to ensure that ADs are honored when appropriate.

Impact of the Coronavirus Disease 2019 Pandemic on Gastrointestinal Procedures and Cancers in the United States: A Multicenter Research Network Study

Impact of the Coronavirus Disease 2019 Pandemic on Gastrointestinal Procedures and Cancers in the United States: A Multicenter Research Network Study

Clinical Term Normalization Using Learned Edit Patterns and Subconcept Matching: System Development and Evaluation.

BackgroundClinical terms mentioned in clinical text are often not in their standardized forms as listed in clinical terminologies because of linguistic and stylistic variations. However, many automated downstream applications require clinical terms mapped to their corresponding concepts in clinical terminologies, thus necessitating the task of clinical term normalization.ObjectiveIn this paper, a system for clinical term normalization is presented that utilizes edit patterns to convert clinical terms into their normalized forms.MethodsThe edit patterns are automatically learned from the Unified Medical Language System (UMLS) Metathesaurus as well as from the given training data. The edit patterns are generalized sequences of edits that are derived from edit distance computations. The edit patterns are both character based as well as word based and are learned separately for different semantic types. In addition to these edit patterns, the system also normalizes clinical terms through the subconcepts mentioned within them.ResultsThe system was evaluated as part of the 2019 n2c2 Track 3 shared task of clinical term normalization. It obtained 80.79% accuracy on the standard test data. This paper includes ablation studies to evaluate the contributions of different components of the system. A challenging part of the task was disambiguation when a clinical term could be normalized to multiple concepts.ConclusionsThe learned edit patterns led the system to perform well on the normalization task. Given that the system is based on patterns, it is human interpretable and is also capable of giving insights about common variations of clinical terms mentioned in clinical text that are different from their standardized forms.

Health system wide \u201cbig data\u201d analysis of rheumatologic conditions and scleritis

BackgroundThe development of scleritis in the setting of autoimmune conditions has been well documented. Prior series have assessed the relationship between systemic autoimmune disorders and scleritis only in patients referred for rheumatologic or ocular inflammation. This can lead to a referral bias. We reviewed all charts within the electronic medical record (EMR) of a health system for patients with systemic autoimmune and scleritis diagnoses to determine the prevalence of both and which disorders had the highest relative risk of developing scleritis.MethodsThe EMR was searched for scleritis and systemic inflammatory diagnoses in the past medical history and diagnosis tabs, and for associated disease specific laboratory values. The intersection of scleritis and systemic inflammatory conditions was assessed through searching both SNOMED Clinical Terminology and ICD-10 codes for diagnoses. The prevalence of each autoimmune disorder, scleritis prevalence, the percentage of patients with an autoimmune condition having scleritis, the percentage of patients with scleritis having an autoimmune condition; the relative risk (RR) of scleritis patients having a specific autoimmune disorder were calculated.ResultsA total of 5.9 million charts were searched with autoimmune conditions identified in 148,993 patients. The most common autoimmune conditions overall were HLA-B27-associated diseases (n = 26,680; prevalence 0.45%); rheumatoid arthritis (RA)(N = 19,923; prevalence 0.34%). Conversely, 2702 patients were identified with scleritis (prevalence 0.05%), of which 31.4% had an associated autoimmune condition. Patients with RA represented the highest percentage of patients with an autoimmune condition having scleritis. Granulomatosis with polyangiitis (GPA) represented the highest the percentage of patients with scleritis having an autoimmune condition. Sjogrens was the third most common condition associated with scleritis- making up 4.5% of cases. An association with juvenile idiopathic arthritis (JIA) was seen in 0.3% of patients.ConclusionsWhile this is the largest retrospective review examining the association between autoimmune disease and scleritis, the findings are similar to prior studies with nearly a third of scleritis patients having an underlying autoimmune diagnosis. Limitations of the study included accurate chart coding; having laboratory results within the searchable EMR. Future research is needed to delineate associations of systemic disease with the anatomic location of scleritis using EMR.

Inclusion of the Brisbane 2000 Terminology of Liver Anatomy and Resections Within SNOMED Clinical Terminology

Introduction: At the IHPBA meeting in Brisbane in 2000 the Brisbane 2000 Terminology of Liver Anatomy and Resections was accepted as the official terminology of the IHPBA. SNOMED-CT (Systematized Nomenclature of Medicine - Clinical Terminology) is the most comprehensive, multilingual clinical healthcare terminology in the world, and is an important standard in the recording and interchange of coded clinical information. It was initially released in 2002, and is in use in over 80 countries. Up until now SNOMED-CT hasn´t included all of the clinical terms and concepts contained within the Brisbane nomenclature. Methods: The clinical terms and concepts contained within the Brisbane terminology are mapped to the current SNOMED-CT clinical terms. New SNOMED-CT terms and relationships are proposed to enable a full representation of the Brisbane terminology within SNOMED-CT. Results: The new terms and relationships are presented and the process for endorsement by SNOMED International is discussed. Conclusions: Clinical information is increasingly stored electronically. Standards for clinical information exchange such as FHIR (Fast Healthcare Interoperability Resources) depend heavily on SNOMED-CT for coded clinical information. It is important therefore that the consensus of wisdom encapsulated within the Brisbane terminology is represented in SNOMED-CT.

Should COVID-19 be branded to viral thrombotic fever?

Coronaviruses can cause a diverse array of clinical manifestations, from fever with symptoms of the common cold to highly lethal severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS). SARS-CoV-2, the coronavirus discovered in Hubei province, China, at the end of 2019, became known worldwide for causing coronavirus disease 2019 (COVID-19). Over one year’s time period, the scientific community has produced a large bulk of knowledge about this disease and countless reports about its immune-pathological aspects. This knowledge, including data obtained in postmortem studies, points unequivocally to a hypercoagulability state. However, the name COVID-19 tells us very little about the true meaning of the disease. Our proposal is more comprehensive; it intends to frame COVID-19 in more clinical terminology, making an analogy to viral haemorrhagic fever (VHF). Thus, we found irrefutable evidence in the current literature that COVID-19 is the first viral disease that can be branded as a viral thrombotic fever. This manuscript points out that SARS-CoV-2 goes far beyond pneumonia or SARS. COVID-19 infections promote remarkable interactions among the endothelium, coagulation, and immune response, building up a background capable of promoting a “thrombotic storm,” much more than a “cytokine storm.” The importance of a viral protease called main protease (Mpro) is highlighted as a critical component for its replication in the host cell. A deeper analysis of this protease and its importance on the coagulation system is also discussed for the first time, mainly because of its similarity with the thrombin and factor Xa molecules, as recently pointed out by structural comparison crystallographic structures.