Determining correspondences between high-frequency MedDRA concepts and SNOMED: a case study

<p>Abstract</p> <p>Background</p> <p>The Systematic Nomenclature of Medicine Clinical Terms (SNOMED CT) is being advocated as the foundation for encoding clinical documentation. While the electronic medical record is likely to play a critical role in pharmacovigilance - the detection of adverse events due to medications - classification and reporting of Adverse Events is currently based on the Medical Dictionary of Regulatory Activities (MedDRA). Complete and high-quality MedDRA-to-SNOMED CT mappings can therefore facilitate pharmacovigilance.</p> <p>The existing mappings, as determined through the Unified Medical Language System (UMLS), are partial, and record only one-to-one correspondences even though SNOMED CT can be used compositionally. Efforts to map previously unmapped MedDRA concepts would be most productive if focused on concepts that occur frequently in actual adverse event data.</p> <p>We aimed to identify aspects of MedDRA that complicate mapping to SNOMED CT, determine pattern in unmapped high-frequency MedDRA concepts, and to identify types of integration errors in the mapping of MedDRA to UMLS.</p> <p>Methods</p> <p>Using one years' data from the US Federal Drug Administrations Adverse Event Reporting System, we identified MedDRA preferred terms that collectively accounted for 95% of both Adverse Events and Therapeutic Indications records. After eliminating those already mapping to SNOMED CT, we attempted to map the remaining 645 Adverse-Event and 141 Therapeutic-Indications preferred terms with software assistance.</p> <p>Results</p> <p>All but 46 Adverse-Event and 7 Therapeutic-Indications preferred terms could be composed using SNOMED CT concepts: none of these required more than 3 SNOMED CT concepts to compose. We describe the common composition patterns in the paper. About 30% of both Adverse-Event and Therapeutic-Indications Preferred Terms corresponded to single SNOMED CT concepts: the correspondence was detectable by human inspection but had been missed during the integration process, which had created duplicated concepts in UMLS.</p> <p>Conclusions</p> <p>Identification of composite mapping patterns, and the types of errors that occur in the MedDRA content within UMLS, can focus larger-scale efforts on improving the quality of such mappings, which may assist in the creation of an adverse-events ontology.</p

Management of intra-articular fractures of distal end radius in adults

Background: Incidence of intra articular fracture L/3rd radius is significantly on rise due to high velocity accidents in young and adults. Painless wrist function is of vital importance for functioning of upper extremity in almost all activities of daily living and precise function of hand. Intra articular fracture of L/3rd radius has generally gross comminution and so also small articular fragments. Orthopaedic community differ about specific implants to fix this complex injury. The present study was undertaken to know efficacy of different modalities of treatment for different fracture pattern. Comminuted intra articular fracture geometry varies widely, to fix these small fragments to achieve stable anatomical reduction is a challenging task.   Methods: It is a combined i.e. retrospective and prospective study conducted at Hardikar Hospital, Pune, India from 1999 to December 2000. Patients of intra-articular fracture of distal end radius by different modes of treatment are included in the study. 1 patient with unilateral fracture was lost for follow-up. Thus 50 fractures, in 49 patients. were included in study. Clinico-radiological assessment was carried out by Lidstrom's (1959) criteria.Results: Satisfactory early functional end results with plaster treatment is 72.2% whereas with other modality of treatment it rises to 87.5%, indicating superiority of other modalities of treatment as far as early functional end results are concerned.Conclusions: Manipulation and plaster cast method continues to be the treatment of choice in the stable intra articular distal radial fractures. Hence there is a need for a "differentiated therapy for distal radial fractures". The treatment plan for patients must be based not only on fracture pattern identified on plain radiographs but also on factors such as bone quality, bone comminution, energy of injury and associated soft tissue damage. Additional factors to be considered in individual patient are-life style associated medical conditions and compliance

A Bayesian Network Approach to Making Inferences in Causal Maps

The main goal of this paper is to describe a new graphical structure called "Bayesian causal maps" to represent and analyze domain knowledge of experts. A Bayesian causal map is a causal map, i.e., a network-based representation of an expert's cognition. It is also a Bayesian network, i.e., a graphical representation of an expert's knowledge based on probability theory. Bayesian causal maps enhance the capabilities of causal maps in many ways. We describe how the textual analysis procedure for constructing causal maps can be modi®ed to construct Bayesian causal maps, and we illustrate it using a causal map of a marketing expert in the context of a product development decision.The research was supported by two University of Kansas School of Business PhD Summer Research Fund grants to both authors and by one Kansas University General Research Fund grant to Prakash P. Shenoy

A Causal Mapping Approach to Constructing Bayesian Networks

This paper describes a systematic procedure for constructing Bayesian networks (BNs) from domain knowledge of experts using the causal mapping approach. We outline how causal knowledge of experts can be represented as causal maps, and how the graphical structure of causal maps can be modified to construct Bayes nets. Probability encoding techniques can be used to assess the numerical parameters of the resulting Bayes nets. We illustrate the construction of a Bayes net starting from a causal map of a systems analyst in the context of an information technology application outsourcing decision.The research has been supported by two grants from the Kansas University Business School PhD Summer Research Fund to both authors and by a grant from the Kansas University General Research Fund to Prakash P. Shenoy

Web-browser encryption of personal health information

<p>Abstract</p> <p>Background</p> <p>Electronic health records provide access to an unprecedented amount of clinical data for research that can accelerate the development of effective medical practices. However it is important to protect patient confidentiality, as many medical conditions are stigmatized and disclosure could result in personal and/or financial loss.</p> <p>Results</p> <p>We describe a system for remote data entry that allows the data that would identify the patient to be encrypted in the web browser of the person entering the data. These data cannot be decrypted on the server by the staff at the data center but can be decrypted by the person entering the data or their delegate. We developed this system to solve a problem that arose in the context of clinical research, but it is applicable in a range of situations where sensitive information is stored and updated in a database and it is necessary to ensure that it cannot be viewed by any except those intentionally given access.</p> <p>Conclusion</p> <p>By developing this system, we are able to centralize the collection of some patient data while minimizing the risk that protected health information be made available to study personnel who are not authorized to use it.</p

Baryonic and Gluonic Correlators in Hot QCD

We extend our earlier work on static color singlet correlators in high T QCD (DeTar correlators) to baryonic and gluonic sources, and estimate the corresponding screening masses using the dimensionally reduced theory. We discuss spin and polarization dependence of meson and baryon masses in the $T \rightarrow \infty$ limit, and possible nonperturbative effects at non-asymptotic temperatures.Comment: 20 pages, USITP-94-1 (SUNY-NTG-93-12

Preclinical Evaluation of Anticancer Efficacy and Pharmacological Properties of FBA-TPQ, a Novel Synthetic Makaluvamine Analog

We have recently designed and synthesized a novel iminoquinone anticancer agent, 7-(4-fluorobenzylamino)-1,3,4,8-tetrahydropyrrolo[4,3,2-de]quinolin-8(1&lt;em&gt;H&lt;/em&gt;)-one (FBA-TPQ) and initiated its preclinical development. Herein we investigated its efficacy, safety, and pharmacokinetics in &lt;em&gt;in vitro&lt;/em&gt; and &lt;em&gt;in vivo&lt;/em&gt; models of human pancreatic cancer. Our results demonstrated that FBA-TPQ inhibited pancreatic cancer cell growth, induced apoptosis,&lt;em&gt; &lt;/em&gt;and caused cell cycle arrest &lt;em&gt;in vitro&lt;/em&gt;. It inhibited the growth of xenograft tumors with minimal host toxicity. To facilitate future preclinical and clinical development of the agent, we also developed and validated a Rapid Resolution Liquid Chromatography (RRLC) method for quantitative analysis of FBA-TPQ in plasma and tissue samples. The method was found to be precise, accurate, and specific. Using this method, we carried out &lt;em&gt;in vitro&lt;/em&gt; and &lt;em&gt;in vivo&lt;/em&gt; evaluations of the pharmacological properties of FBA-TPQ, including stability in plasma, plasma protein binding, metabolism by S9 enzymes, plasma pharmacokinetics, and tissue distribution. Our results indicate that FBA-TPQ is a potential therapeutic agent for pancreatic cancer, providing a basis for future preclinical and clinical development

Preclinical Pharmacology of BA-TPQ, a Novel Synthetic Iminoquinone Anticancer Agent

Marine natural products and their synthetic derivatives represent a major source of novel candidate anti-cancer compounds. We have recently tested the anti-cancer activity of more than forty novel compounds based on an iminoquinone makaluvamine scaffold, and have found that many of the compounds exert potent cytotoxic activity against human cancer cell lines. One of the most potent compounds, BA-TPQ [(11,12),7-(benzylamino)-1,3,4,8-tetrahydropyrrolo[4,3,2-de]quinolin-8(1H)-one], was active against a variety of human cancer cell lines, and inhibited the growth of breast and prostate xenograft tumors in mice. However, there was some toxicity noted in the mice following administration of the compound. In order to further the development of BA-TPQ, and in a search for potential sites of accumulation that might underlie the observed toxicity of the compound, we accomplished preclinical pharmacological studies of the compound. We herein report the in vitro and in vivo pharmacological properties of BA-TPQ, including its stability in plasma, plasma protein binding, metabolism by S9 enzymes, and plasma and tissue distribution. We believe these studies will be useful for further investigations, and may be useful for other investigators examining the use of similar compounds for cancer therapy