The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

What do a seventeenth-century mortality table (whose causes of death include "fainted in a bath," "frighted," and "itch"); the identification of South Africans during apartheid as European, Asian, colored, or black; and the separation of machine- from hand-washables have in common? All are examples of classification -- the scaffolding of information infrastructures. In Sorting Things Out, Geoffrey C. Bowker and Susan Leigh Star explore the role of categories and standards in shaping the modern world. In a clear and lively style, they investigate a variety of classification systems, including the International Classification of Diseases, the Nursing Interventions Classification, race classification under apartheid in South Africa, and the classification of viruses and of tuberculosis. The authors emphasize the role of invisibility in the process by which classification orders human interaction. They examine how categories are made and kept invisible, and how people can change this invisibility when necessary. They also explore systems of classification as part of the built information environment. Much as an urban historian would review highway permits and zoning decisions to tell a city's story, the authors review archives of classification design to understand how decisions have been made. Sorting Things Out has a moral agenda, for each standard and category valorizes some point of view and silences another. Standards and classifications produce advantage or suffering. Jobs are made and lost; some regions benefit at the expense of others. How these choices are made and how we think about that process are at the moral and political core of this work. The book is an important empirical source for understanding the building of information infrastructures.

https://www.reciis.icict.fiocruz.br/index.php/reciis/article/download/794/1436

Sorting Things Out: Classification and Its Consequences

The UMLS Metathesaurus, the largest thesaurus in the biomedical domain, provides a representation of biomedical knowledge consisting of concepts classified by semantic type and both hierarchical and non-hierarchical relationships among the concepts. This knowledge has proved useful for many applications including decision support systems, management of patient records, information retrieval (IR) and data mining. Gaining effective access to the knowledge is critical to the success of these applications. This paper describes MetaMap, a program developed at the National Library of Medicine (NLM) to map biomedical text to the Metathesaurus or, equivalently, to discover Metathesaurus concepts referred to in text. MetaMap uses a knowledge intensive approach based on symbolic, natural language processing (NLP) and computational linguistic techniques. Besides being applied for both IR and data mining applications, MetaMap is one of the foundations of NLM's Indexing Initiative System which is being applied to both semi-automatic and fully automatic indexing of the biomedical literature at the library.

Effective mapping of biomedical text to the UMLS Metathesaurus: the MetaMap program

This introduction presents the main motivations for the development of Description Logics (DLs) as a formalism for representing knowledge, as well as some important basic notions underlying all systems that have been created in the DL tradition. In addition, we provide the reader with an overview of the entire book and some guidelines for reading it. We first address the relationship between Description Logics and earlier semantic network and frame systems, which represent the original heritage of the field. We delve into some of the key problems encountered with the older efforts. Subsequently, we introduce the basic features of DL languages and related reasoning techniques. DL languages are then viewed as the core of knowledge representation systems, considering both the structure of a DL knowledge base and its associated reasoning services. The development of some implemented knowledge representation systems based on Description Logics and the first applications built with such systems are then reviewed. Finally, we address the relationship of Description Logics to other fields of Computer Science.We also discuss some extensions of the basic representation language machinery; these include features proposed for incorporation in the formalism that originally arose in implemented systems, and features proposed to cope with the needs of certain application domains.

https://assets.cambridge.org/97805218/76254/frontmatter/9780521876254_frontmatter.pdf

The Description Logic Handbook

https://www.acilci.net/wp-content/uploads/2014/02/Guidelines-for-reporting-reliability-and-agreement-studies-GRRAS-were-proposed.pdf

Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed.

Antimicrobial resistance is an important patient safety issue related to inappropriate antibiotic use. As part of the Infobutton project we examined antibiotic prescribing-related information needs of clinicians while they were using the clinical information system (CIS). During 3 hours of observation, 20 information needs related to antibiotic prescribing were observed, 74% of these needs were met during the observation time. Understanding the information needs of clinicians related to antibiotic prescribing may help identify methods to meet information needs via the Infobutton manager and thereby improve the judicious use of antibiotics. Background Antimicrobial resistance is an important patient safety issue related to inappropriate antibiotic use 1 . The Infobutton project is an ongoing project examining the information needs of clinicians while using CPOE. 2 The purpose of this study was to identify antibiotic prescribing-related information needs of clinicians while they were using the clinical information system (CIS).

Information needs related to antibiotic prescribing while using CPOE.

Computer systems in clinical medicine are often integrated to facilitate data sharing, but the terminologies they use are typically not integrated. There is rarely any centralized repository of terms used in various systems, and no widely accepted standards exist. An exception is the Medical Entities Dictionary (MED) at the New York Presbyterian Hospital (NYPH) in New York. The NYPH clinical computing environment includes a centralized database of coded patient information collected from various ancillary sources and translated into codes provided by the MED. The MED includes all terms used in the ancillary departments and, as such, changes in the source terminologies must be maintained in the MED. In order to support the maintenance tasks, the MED includes knowledge about the terms themselves, arranged in a semantic network. This knowledge base is used to support sophisticated maintenance tools to facilitate additions and changes to the MED and verify their consistency and appropriateness. This chapter describes the design and development of the terminology and two case examples demonstrating some of the advantages to our approach: addition of a new terminology of laboratory terms and maintenance of an existing drug terminology.

Knowledge-based terminology management in medicine

As part of preliminary studies for the development of a digital library, we have studied the possibility of using the UMLS Information Sources Map (ISM) database to provide the means to connect and map different terminologies, as well as to facilitate access to available information sources. The main issues discussed are the indexing of and connection to relevant online sources. We found the features of the ISM to be consistent with the need to support automated source selection and retrieval. However, attention should be paid to three aspects of the information: granularity, completeness, and accuracy. We found the ISM to be potentially useful; however, significant modifications will be required if the ISM is to be able to support automated source selection and retrieval.

Evaluation of the Information Sources Map.

Objective To develop a general method for using the alerting function of an electronic health record (EHR) system to warn prescribers when a drug order may be in conflict with the restrictions of a patient's research protocol Methods We examined a sample of clinical research protocols at the National Institutes of Health (NIH) to identify the frequency with which drugs were excluded by protocols We analyzed two protocols and modeled the exclusions they contained We then developed a data model to represent the exclusions, expanded the terminology in the NIH's Biomedical Translational Research Information System (BTRIS) to include relevant drug concepts, and wrote a medical logic module (MLM) for the EHR to match terms for ordered drugs with the drug concepts in the protocol Results We found that 50% of protocols in our sample included drug exclusions Our model represented exclusion concepts and also concepts related to exemptions from the exclusions The MLM was deployed in a test environment where it successfully detected orders for excluded drugs and delivered messages to users explaining the exclusion, providing information about the clinical setting and timing where the exclusion applies BTRIS reports using the same terminology information were able to identify instances where protocol exceptions occurred Conclusions Drug exclusions are frequent components of research protocols; nonadherenece to these exclusions could result in harm to subjects, erroneous study results or inefficiencies due to disqualification of research subjects Our approach uses an MLM and a simple knowledge base, together with a controlled terminology, to provide a solution to the detection and prevention of possible protocol violations Further work is needed to model additional aspects of the exclusions, such as timing and co-occurring conditions, to improve MLM accuracy

Improving adherence to research protocol drug exclusions using a clinical alerting system.

At Columbia-Presbyterian Medical Center, a clinical information system (CIS) called WebCIS is used by health care providers. We have developed a palm-based extension to WebCIS, called PalmCIS, which provides physicians access to clinical data through a wireless connection. As part of PalmCIS, we have added links to two on-line information resources: PubMed and Micromedex.

James J. Cimino

Papers

Information needs related to antibiotic prescribing while using CPOE.

Knowledge-based terminology management in medicine

Evaluation of the Information Sources Map.

Improving adherence to research protocol drug exclusions using a clinical alerting system.

Development of infobuttons in a wireless environment.