Informatics support to medical diagnosis. General information obtained from a first structured contact with the patient

BACKGROUND: The methods and characteristics of clinical data gathered at the initial steps of development of a computerized system to aid medical diagnosis are reported. The objectives of the study were as follows: to describe the overall method and to set a framework for developing an intellectual model of the medical diagnosis procedure. MATERIAL AND METHODS: A structured medical interview and physical examination using an informatic program on PC compatible portable computers were completed in a sample 1,238 patients attending the outpatient clinics of our institution. Data obtained were compared with information in the patient's medical record taking as reference pattern the record of physicians in charge of the patients. Diagnosis were codified according to WHO International Classification of Diseases (ICD-9-CM). RESULTS: The distribution of symptoms and signs corresponding to the different organs and systems was analyzed. Each subdivision afforded a range of 1.3 to 3.9 abnormal findings per patient. A total of 3,571 diagnoses were codified for the whole group 1,238 patients with a mean (standard deviation) of 3 (2) diagnoses per patient (range 0-12). The distribution of diagnostic groups varied depending on the consideration of the main diagnosis or the concomitant diagnoses that defined the patient's clinical context. The most frequent main diagnoses included tumors, cardiovascular diseases, gastrointestinal disorders, and genitourinary tract diseases. CONCLUSIONS: As shown by results obtained in a sample of 1,238 patients, there is a very complex situation in clinical practice due to the simultaneous occurrence of several clinical patterns. This finding should be taken into account when developing clinical decision making support systems. The use of a structured medical interview or a structured and standard medical visit may be an adequate tool to clarify this matter and to contribute to standardization of clinical concepts and situations.     

Posttraumatic stress disorders in Vietnam veterans: Selected bibliographical addendum to Fairbank et al., Silver, and Arnold.

J. A. Fairbank et al (see record 1982-12226-001), presented a selected bibliography on contributions relevant to posttraumatic stress disorder (PTSD) in Vietnam veterans. Their selection included research and clinical reports found in psychological and medical journals, books and government publications, which were pertinent to epidemiology, etiology, symptomatology, and treatment of PTSD in Vietnam veterans, plus narratives by Vietnam veterans and research germane to PTSD from other conflicts. S. M. Silver (see record 1983-03626-001) updated Fairbank et al., with 171 since-published articles, reports, and other references. A. Arnold's (1987) bibliograpy contains over 1,000 clinical references, as well as accounts of the Vietnam War. This addendum is an attempt to update the enormous body of PTSD literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical Records for Building Health Management

Medical records provide essential information for evaluating a patient’s health. Without them, it would be difficult for doctors to make accurate diagnoses. Similar to diagnoses in medical science, building health management also requires building medical records for making accurate diagnoses. At later stages of a building’s life cycle, when the budget is limited, organizations responsible for building repairs and maintenance are unable to digitalize building health diagnoses and keep complete medical records of buildings; as a result, maintenance crews usually cannot fully understand buildings’ overall health conditions and their medical histories, which may result in erroneous diagnoses directly or public safety dangers indirectly. Using the problem-oriented medical record adopted for the medical diagnosis of human diseases, this paper designs a building medical record (BMR), which allows simple electronic archiving, and evaluates its practicability with a case study of school buildings. The purpose of a BMR is to enable maintenance engineers (building doctors), building managers, and contractors of school buildings to have low-cost access to required information for making complete evaluations and maintenance suggestions for buildings.     

Establishing a research agenda for investigating alternative medical interventions for chronic pain

This article describes the University of Maryland School of Medicine's Center for Complementary Medicine Research approach to developing an agenda for investigating alternative medical treatments for chronic pain syndromes. This agenda includes conducting extensive literature searches and analyses to form a knowledge base for making clinical decisions on which chronic pain syndromes are in greatest need of better therapies, as well as which alternative medical therapies offer the greatest therapeutic promise for these specific chronic pain syndromes. To date, the Center has identified back pain, arthritis, and fibromyalgia as the chronic pain syndromes that contribute the greatest clinical and economic burden to overall chronic pain statistics. Not coincidentally, patients with these diagnoses are the greatest users of alternative therapies. The Center has identified acupuncture, homeopathy, manual/manipulative therapies, and mind-body therapies as the alternative medical therapies offering the greatest clinical potential for these three general chronic pain diagnoses. Preliminary data from the Center's ongoing clinical trials programs are presented.     

The effects of emotional behaviour on components of the respiratory cycle

Clinical guidelines can be viewed as generic skeletal-plan schemata that represent clinical procedural knowledge and that are instantiated and refined dynamically by care providers over significant time periods. In the Asgaard project, we are investigating a set of tasks that support the application of clinical guidelines by a care provider other than the guideline's designer. We are focusing on the application of the guideline, recognition of care providers' intentions from their actions, and critique of care providers' actions given the guideline and the patient's medical record. We are developing methods that perform these tasks in multiple clinical domains, given an instance of a properly represented clinical guideline and an electronic medical patient record. In this paper, we point out the precise domain-specific knowledge required by each method, such as the explicit intentions of the guideline designer (represented as temporal patterns to be achieved or avoided). We present a machine-readable language, called Asbru, to represent and to annotate guidelines based on the task-specific ontology. We also introduce an automated tool for the acquisition of clinical guidelines based on the same ontology, developed using the PROTEGE-II framework.     

Computerized patient record: are we prepared for our future practice?

OBJECTIVE: To survey members of The American Dietetic Association (ADA) regarding care documentation systems, computerization of patient care records, and factors to be considered in developing a documentation system compatible with a computer-based patient record. DESIGN: The survey instrument was developed in conjunction with a survey consultant/statistician, then mailed to the study sample. SUBJECTS/SETTING: The sample of 500 was drawn from three ADA dietetic practice groups expected to include a high percentage of clinical practitioners. STATISTICAL ANALYSIS PERFORMED: Basic frequency displays were used on all questionnaire items. Pearson correlation coefficients were used among numeric variables, and oneway analysis of variance was used for categoric variables with quantitative variables. RESULTS: A total of 171 usable surveys were returned (34%), primarily from dietitians working in an acute-care inpatient environment. The SOAP format (subjective, objective, assessment, and plan) was used by 60% of respondents to document nutrition assessments, although a number of other documentation formats were reported. Most commonly used data in nutrition decision making were medical diagnosis, diet order, anthropometric data, and laboratory values. Most commonly used outcomes measures included laboratory values, tolerance of the nutrition regimen, weight changes, and intake changes. Only 15% of respondents reported that they currently used a computerized patient record. Ninety-three percent of respondents favored standardized nutrition diagnoses, and 95% believed standardized nutrition interventions would prove useful. APPLICATIONS/CONCLUSIONS: We recommend that dietitians evaluate, standardize, and streamline their documentation to prepare for implementation of computerized systems. The diagnoses and interventions presented in this study could be a starting point.     

Minnesota Multiphasic Personality Inventory normal K+ and other unelevated profiles.

Compared empirical correlates of normal K+ and non-K+ unelevated Minnesota Multiphasic Personality Inventory (MMPI) profiles in a psychiatric inpatient setting. Case history (symptom ratings, demographic variables, and diagnoses) and psychometric data were obtained without knowledge of MMPI profile group membership from psychiatrists' discharge summaries on 84 male and female inpatients. Normal K+ and non- K+ unelevated profile groups were more similar to each other than either group was to a randomly selected inpatient control group of 50 Ss. Results generally support the contention of M. D. Gynther and P. J. Brilliant (see record 1969-00131-001) that applicability of empirical correlates of unelevated MMPI profiles should be determined in each clinical setting. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sumatriptan nasal spray (20 mg/dose) in the acute treatment of cluster headache

BACKGROUND: Family medicine predoctoral programs frequently have medical students record patient diagnoses in logbooks. Little is known about the accuracy of such logbooks. No studies have compared patient records dictated by students with cases recorded in logbooks. METHODS: Over 2 years, all patient encounters dictated by 79 medical students during their 8-week family medicine rotations were recorded and compared with information in the students' logbooks. RESULTS: Students dictated 2,520 patient encounters but only recorded 2,085 (82.7%) of them in their logbooks. Still, this rate of inclusion is higher than other studies where students did not dictate patient encounters. On the average, each student saw and dictated 32 patient encounters but omitted five to six from their logs. There were no significant differences between the 10 honors and 69 non-honors students in the proportion of patients omitted from logbooks. CONCLUSIONS: Medical students underreport patient encounters in clerkship logbooks. Keeping a record of the patients dictated by medical students was helpful in determining the accuracy of students' logbooks.     

The role of clinical autopsy in monitoring the quality of the clinical diagnosis in an emergency department

OBJECTIVE: A total of 61 autopsies performed in patients died in emergency department of a university hospital were retrospectively analysed and the findings were compared with clinical diagnoses. METHODS: Sensitivity and specificity of the clinical diagnoses and the correction of medical procedures were measured. The influence of age and sex of patients was analyzed using Fisher's exact test and chi-square-test. RESULTS: The most common causes of death were cardiovascular diseases (52.46%). Autopsy showed unexpected major findings in 44.26% of cases. Major discrepancies between the autopsy reports and the clinical diagnoses, were present in 26.22% of all cases. Absolute concordance between clinical and autopsy diagnoses was obtained in 44.26% of cases. The major sensitivity of clinical diagnosis was found in cerebrovascular disorders (100%), upper digestive hemorrhage (100%), and acute myocardial infarction (82.35%). The lowest sensitivity was found in malignant tumors (16.66%), hemorrhagic pancreatitis (0%) and bowel infarction (0%). The patient cares were correct in 68.85% of cases. No statistically significant differences were observed in relation to age and sex. CONCLUSIONS: We concluded that autopsy is a useful method for evaluate diagnostic procedures and quality of medical cares in emergency departments.     

Number of diagnoses in the final report and in the medical record

One hundred patient records of an internistic outpatient clinic were evaluated retrospectively for differences regarding the number of diagnoses in the documentation and the final report. Whereas the final or interim reports on the average contained 2.8 clinically relevant diagnoses, screening of the total documentation let the number rise to 3.5. Mainly the reports qualified as qualitatively poor led to overlooked or neglected relevant findings. Our results underline the importance of a meticulously kept medical record for a medical practice of high standards and responsibility.     

Imaging findings in patients with-right lower quadrant pain: alternative diagnoses to appendicitis

Patients with right lower quadrant (RLQ) pain referred for imaging studies with a clinical diagnosis of appendicitis may have other pathologic conditions mimicking appendicitis. Appropriate diagnostic imaging may establish other specific diagnoses and thereby play a significant role in determining proper medical or surgical treatment. In this pictorial essay, we present a spectrum of imaging findings in patients whose clinical features were suggestive of appendicitis, but the diagnoses of a broad spectrum of other diseases were established with the imaging studies. The differential diagnoses of diseases mimicking appendicitis are reviewed.     

Stress-disorder symptoms in Vietnam and Korean War veterans: Still no difference.

E. Carroll (see record 1983-32780-001), in response to an article by the present author and colleagues (see record 1982-28346-001), questions the study in the use of hospitalized veterans as Ss, the degree of their combat experience, use of medical records for analysis, validity of diagnoses, and the choice of control symptoms. The author maintains that Carroll's cautions do not significantly detract from the original assertion that the symptoms associated with stress disorder are neither unique nor inordinately common in Vietnam veteran psychiatric patients or their Korean war counterparts. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parents' perceptions of medical diagnoses and related issues for their high-risk infants

INTRODUCTION: The objectives of this study were (a) to compare maternal and paternal perceptions of infant medical diagnoses with hospital-chart diagnoses, (b) to examine whether parental perceptions of infant medical condition (using three variables) were related to eight other parental perceptions, and (c) to determine what medical diagnoses were associated with parental expectations that neonatal diagnoses were having current effects of would have future effects on their infant. METHOD: With a questionnaire format 76 parents reported information about medical diagnoses and their perceptions about eight other issues for their infants who had been hospitalized in an NICU. RESULTS: Parents reported approximately 62% of the medical diagnoses for their infants during NICU hospitalization; these significantly differed from hospital-chart diagnoses. Parents who reported current or future effects of neonatal diagnoses also (a) had fears for their infants while in the hospital or currently, (b) perceived prematurity as having current or future effects, (c) reported restrictions for their infants caused by neonatal diagnoses, and (d) gave less optimal ratings for their infants' current health status. Parents' perceptions of current or future effects of neonatal diagnoses appeared to be inaccurate given the actual diagnoses for their infants. DISCUSSION: The underreporting of diagnoses by parents raises several issues as to how accurately parents are perceiving their infants. Parents who perceived continued effects of neonatal diagnoses also had less optimal perceptions of other related issues. Parent's perceptions of continued effects of neonatal diagnoses appeared to be unwarranted with respect to the actual diagnoses assigned to their infants.     

"Repression-Sensitization and Medical Diagnosis": Erratum.

Reports an error in the original article by Mark S. Schwartz, Neal E. Krupp, and Donn Byrne (Journal of Abnormal Psychology, 1971[Dec], 78[3], 286-291). In Table 3 the number of female repressors in the 60-69 age group, with a purely organic diagnosis, should be 16 instead of 6. (The following abstract of this article originally appeared in record 1972-09554-001.) The transsituational consistency of trait measures can be demonstrated best through the establishment of relationships between personality test responses and nontest behaviors. The repression-sensitization scale shows promise as a correlate of both psychological disturbance and physiological malfunctioning. The association between repression-sensitization scale responses and medical diagnoses was investigated in 360 medical patients representing (a) 3 age levels (20-29, 40-49, and 60-69); (b) 3 repression-sensitization levels (repressors, neutrals, and sensitizers); and (c) both sexes, with 20 patients in each group. Repressors tended to have purely organic diagnoses, whereas sensitizers received diagnoses involving psychological components (p     

Modification of activation and evaluation properties of narratives by weak complex magnetic field patterns that simulate limbic burst firing

In two separate experiments a total of 71 volunteers were asked to generate spontaneous narratives that were scored automatically by the Whissell Dictionary of Affect. During the narratives, weak (1 microT; 10 mG) magnetic fields were applied briefly through the temporal planes. In Experiment I, subjects who were exposed to simple sine wave or pulsed fields generated more scorable words that indicated lower activation and evaluation than sham-field conditions. In Experiment II subjects exposed to a computer-generated wave form, designed to simulate neuronal burst firing, generated narratives dominated by more pleasantness and less activation than a reference group. The possibility that this approach could be utilized to study the affective dimension of language selection was indicated.     

A social interactionist account of developing decontextualized narrative skill.

The ability to produce decontextualized language is a crucial skill underlying literacy acquisition. This study investigated the role of parental interaction styles on children's developing skill at providing contextual orientation in one type of decontextualized discourse, personal experience narratives. A researcher elicited narratives monthly for 18 mo from 10 children age 26–43 mo. At intervals, mothers were asked to tape record "talk about past events" with their children. The children's increasing skill at independently providing context about when and where was correlated with mothers' frequencies of using specific types of prompts in their narrative elicitations. Cross-lagged correlations showed that parents who frequently prompted for context orientation had children who most frequently provided subsequent orientation to when and where in their stand-alone narratives when they were over 3 years of age. Results were interpreted in terms of Vygotskian theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of personal health information in the coroner''s inquiry

A pathologist appointed by the coroner may feel that his or her role is to review the medical notes, perform a post-mortem, examination and then interpret the findings in the light of clinical information and any other information received from the coroner, and include in the clinico-pathological summary a cause of death. We believe that such an approach is not in accordance with the legal position relating to coroners' inquests. The coroner has no automatic right to see the medical notes (and neither does the coroner's pathologist); where there is, or may be, dispute as to the circumstances leading to death, the proper way for information in the medical record to be presented at the coroner's inquest is for the maker of any note to give oral evidence. Where the cause of death requires interpretation of the clinical history or knowledge of any circumstantial evidence, a pathologist should refrain from giving a cause of death; such a task is for the court, having heard all the evidence-medical or not-relating to the death.     

Agreement between administrative files and written medical records: a case of the Department of Veterans Affairs

OBJECTIVES: This study examined the reliability of Department of Veterans Affairs' health information databases concerning patient demographics, use of care, and diagnoses. METHODS: The Department of Veterans Affairs' Patient Treatment files for Main, Bed-section (PTF) and Outpatient Care (OCF) were compared with medical charts and administrative records (MR) for a random national sample of 1,356 outpatient visits and 414 inpatient discharges to Department of Veterans Affairs' facilities between July 1 and September 30, 1995. Records were uniformly abstracted by a focus group of utilization review nurses and medical record coders blinded to administrative file entries. RESULTS: Reliability was adequate for demographics (kappa approximately 0.92), length of stay (agreement=98%), and selected diagnoses (kappa ranged 0.39 to 1.0). Reliability was generally inadequate to identify the treating bedsection or clinic (kappa approximately 0.5). Compared with medical charts, Patient Treatment Files/Outpatient Care Files reported an additional diagnosis per discharge and 0.8 clinic stops per outpatient visit, resulting in higher estimates of disease prevalence (+39% heart disease, +19% diabetes) and outpatient costs (+36% per unique outpatient per quarter). CONCLUSIONS: In the absence of pilot work validating key data elements, investigators are advised to construct health and utilization data from multiple sources. Further validation studies of administrative files should focus on the relation between process of data capture and data validity.     

Functional and molecular analysis of T cell receptors used by pancreatic- and breast tumor- (mucin-) specific cytotoxic T cells

RATIONALE AND OBJECTIVES: Appropriateness criteria and practice guidelines are being developed in attempts to improve the cost-effectiveness of medical care. The authors sought to make a set of radiology appropriateness criteria usable for education, computer-based decision support, and utilization review. MODEL DEVELOPMENT: Sixty clinical conditions from the American College of Radiology's appropriateness criteria were selected. To make the information more suitable for automation, the names of the imaging procedures were standardized. Indexing terms were assigned to identify clinical conditions and to distinguish between each condition's variants. Semantic relationships between terms were defined. Information about the clinical conditions and variants, radiologic procedures, indexing terms, and relationships was encoded into a standardized language for document interchange. IMPLEMENTATION: The 1,956 rows in the appropriateness criteria tables for the 60 clinical conditions and their 212 variants were mapped into references to 163 distinct imaging procedures. The system's knowledge base included 301 indexing terms and 569 additional terms. CONCLUSION: Radiology appropriateness criteria can be indexed and encoded into a form that facilitates their use and interchange. The use of open, internationally accepted standards is an important step to make such knowledge portable and suitable for integration with evolving computer-based patient record systems.     

Hindsight bias among physicians weighing the likelihood of diagnoses.

Examines findings showing that (1) those who know an event has occurred tend to claim that, if they had been asked to predict the event in advance, they would have been likely to do so; and (2) such Ss demonstrate hindsight bias to the extent that their "prediction" accuracy exceeds the accuracy of others who actually make the prediction without knowledge of the outcome. 75 practicing physicians were divided into 5 equal groups and given the same medical case history. The foresight group was asked to assign a probability estimate to each of 4 possible diagnoses. The 4 hindsight groups were asked to do the same, but each was told that a different 1 of the 4 possible diagnoses was correct. The hindsight groups, who were told that the least likely diagnoses were correct, assigned far greater probability estimates to these "correct" diagnoses than did the foresight group. Implications for physicians are discussed with respect to overconfident 2nd opinions, overconfidence in diagnostic accuracy, and inadequate appreciation of the original difficulty of diagnoses. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)