The FEM Wiki Project: A Conversion of a Training Resource for Field Epidemiologists into a Collaborative Web 2.0 Portal

While an ever increasing popularity of online wiki platforms, user-tagging tools, blogs, and forums is the core characteristic of the Web 2.0 era, converting an existing high-quality training module into a collaborative online space for an active community of practice (CoP) while preserving its quality approval processes is a challenging task. This is the aim of the ECDC-funded Field Epidemiology Manual (FEM) wiki project, based on training resources organized in 17 chapters developed for the European EPIET epidemiology training programme. This paper describes the challenges, solutions, and development processes behind the FEM wiki portal – an online collaborative Web 2.0 platform taking advantage of the user-generated input while preserving the structure, editorial processes and style of the existing FEM manual. We describe the need for ECDC-recognised content and discuss the editorial roles developed in this European project but applicable to any other training resource converted into an online wiki platform

An iconic language for the graphical representation of medical concepts

<p>Abstract</p> <p>Background</p> <p>Many medication errors are encountered in drug prescriptions, which would not occur if practitioners could remember the drug properties. They can refer to drug monographs to find these properties, however drug monographs are long and tedious to read during consultation. We propose a two-step approach for facilitating access to drug monographs. The first step, presented here, is the design of a graphical language, called VCM.</p> <p>Methods</p> <p>The VCM graphical language was designed using a small number of graphical primitives and combinatory rules. VCM was evaluated over 11 volunteer general practitioners to assess if the language is easy to learn, to understand and to use. Evaluators were asked to register their VCM training time, to indicate the meaning of VCM icons and sentences, and to answer clinical questions related to randomly generated drug monograph-like documents, supplied in text or VCM format.</p> <p>Results</p> <p>VCM can represent the various signs, diseases, physiological states, life habits, drugs and tests described in drug monographs. Grammatical rules make it possible to generate many icons by combining a small number of primitives and reusing simple icons to build more complex ones. Icons can be organized into simple sentences to express drug recommendations. Evaluation showed that VCM was learnt in 2 to 7 hours, that physicians understood 89% of the tested VCM icons, and that they answered correctly to 94% of questions using VCM (versus 88% using text, <it>p </it>= 0.003) and 1.8 times faster (<it>p </it>< 0.001).</p> <p>Conclusion</p> <p>VCM can be learnt in a few hours and appears to be easy to read. It can now be used in a second step: the design of graphical interfaces facilitating access to drug monographs. It could also be used for broader applications, including the design of interfaces for consulting other types of medical document or medical data, or, very simply, to enrich medical texts.</p

Degradation of HIF-1alpha under Hypoxia Combined with Induction of Hsp90 Polyubiquitination in Cancer Cells by Hypericin: a Unique Cancer Therapy

The perihydroxylated perylene quinone hypericin has been reported to possess potent anti-metastatic and antiangiogenic activities, generated by targeting diverse crossroads of cancer-promoting processes via unique mechanisms. Hypericin is the only known exogenous reagent that can induce forced poly-ubiquitination and accelerated degradation of heat shock protein 90 (Hsp90) in cancer cells. Hsp90 client proteins are thereby destabilized and rapidly degraded. Hsp70 client proteins may potentially be also affected via preventing formation of hsp90-hsp70 intermediate complexes. We show here that hypericin also induces enhanced degradation of hypoxia-inducible factor 1α (HIF-1α) in two human tumor cell lines, U87-MG glioblastoma and RCC-C2VHL−/− renal cell carcinoma and in the non-malignant ARPE19 retinal pigment epithelial cell line. The hypericin-accelerated turnover of HIF-1α, the regulatory precursor of the HIF-1 transcription factor which promotes hypoxic stress and angiogenic responses, overcomes the physiologic HIF-1α protein stabilization which occurs in hypoxic cells. The hypericin effect also eliminates the high HIF-1α levels expressed constitutively in the von-Hippel Lindau protein (pVHL)-deficient RCC-C2VHL−/− renal cell carcinoma cell line. Unlike the normal ubiquitin-proteasome pathway-dependent turnover of HIF-α proteins which occurs in normoxia, the hypericin-induced HIF-1α catabolism can occur independently of cellular oxygen levels or pVHL-promoted ubiquitin ligation of HIF-1α. It is mediated by lysosomal cathepsin-B enzymes with cathepsin-B activity being optimized in the cells through hypericin-mediated reduction in intracellular pH. Our findings suggest that hypericin may potentially be useful in preventing growth of tumors in which HIF-1α plays pivotal roles, and in pVHL ablated tumor cells such as renal cell carcinoma through elimination of elevated HIF-1α contents in these cells, scaling down the excessive angiogenesis which characterizes these tumors

Issues in Structured Knowledge Representation A Definitional Approach with Application to Case-Based Reasoning and Medical Informatics

Several issues concerned with structured knowledge representation based on definitional structures are discussed: the realisation of knowledge-based systems using declarative programming, similarity assessment in knowledge representation and case-based reasoning, and the importance of human-computer interaction and information visualisation in knowledge-based systems. To illustrate the basic ideas, real-world applications from the area of oral medicine are used. We present MedView, a project aiming at developing models, methods and tools to support clinicians within oral medicine in their everyday work and research. The definitional model used in MedView constitutes the main governing principle in the project, not only in the formalisation of clinical terms and concepts, but in visualisation models and in the design and implementation of individual tools and the system as a whole as well. In the context of case-based reasoning, a novel similarity framework based on definitional structures is presented. In this framework, a uniform definitional model is used for both case representation, similarity assessment and adaptation. The similarity model is general enough to capture many different types of similarity measures, e.g., ordinal, cardinal and asymmetric measures. We also describe how a uniform declarative model can be used as the basis for an interaction model and two information visualisation tools in the area of oral medicine. We describe how known visualisation techniques to a large extent can be modeled using the conceptual model of the underlying data, enabling close interaction with the user and tight coupling between two different visualisation tools

Issues in Structured Knowledge Representation A Definitional Approach with Application to Case-Based Reasoning and Medical Informatics

Several issues concerned with structured knowledge representation based on definitional structures are discussed: the realisation of knowledge-based systems using declarative programming, similarity assessment in knowledge representation and case-based reasoning, and the importance of human-computer interaction and information visualisation in knowledge-based systems. To illustrate the basic ideas, real-world applications from the area of oral medicine are used. We present MedView, a project aiming at developing models, methods and tools to support clinicians within oral medicine in their everyday work and research. The definitional model used in MedView constitutes the main governing principle in the project, not only in the formalisation of clinical terms and concepts, but in visualisation models and in the design and implementation of individual tools and the system as a whole as well. In the context of case-based reasoning, a novel similarity framework based on definitional structures is presented. In this framework, a uniform definitional model is used for both case representation, similarity assessment and adaptation. The similarity model is general enough to capture many different types of similarity measures, e.g., ordinal, cardinal and asymmetric measures. We also describe how a uniform declarative model can be used as the basis for an interaction model and two information visualisation tools in the area of oral medicine. We describe how known visualisation techniques to a large extent can be modeled using the conceptual model of the underlying data, enabling close interaction with the user and tight coupling between two different visualisation tools

Using Text Generation to Access Clinical Data in a Variety of Contexts

MedView is a joint project with participants from oral medicine and computer science. The aim of the project is to build a large database from patient examinations and produce computerised tools to access data in various ways. One way to access data is to read case descriptions generated from stored cases. We give a description of how documents are generated from data and how these are used in a variety of contexts to supply useful information

Declarative programming and clinical medicine: On the use of Gisela in the MedView project

Abstract. In 1995, the MedView project, based on a co-operation between computing science and clinical medicine was initiated. The overall aim of the project is to develop models, methods, and tools to support clinicians in their diagnostic work. Today, the system is in daily use at several clinics and the knowledge base created contains more than 2000 examination records from the involved clinics. Knowledge representation and reasoning within MedView uses a declarative model based on a theory of definitions. In order to be able to model knowledge declaratively and integrate reasoning into applications with GUIs a framework for definitional programming has been developed. We give an overview of the project and of how declarative programming techniques are integrated with industrial strength object-oriented programming tools to facilitate the development of real-world applications