Preservation of information in terminology transcoding.

Linking interface terminologies (IT) to reference terminologies (RT) in flow of terminologies may allow health information system to be both usable and interoperable. Two French university hospitals worked independently on such a flow from the prescription of lab-test to the display of the corresponding results. The aim of this study was to evaluate the transmission of information in these two hospitals communication. An expert, supported by natural language processing tool, created the gold standard link between the 2 prescription ITs i.e. the terms that share the same meaning. A semantic pathway was defined to allow the mapping of one prescription IT to the other, through LOINC® and SNOMED®, the RT chosen by each hospital, respectively. The capacity of the semantic pathway to identify the correct links was computed. The expert found 218 links between the 2 prescription ITs (containing 580 and 374 terms that are linked to RT). The semantic pathway correctly identifies 96 of these links (44.0% [37.4-50.6]). The recall was not as good as expected, even though the semantic pathway was created in order to maximize it. Using different RT in different hospitals is not an efficient solution. The use of LOINC® seems to be preferable as a RT for prescription.

Implementation and management of a biomedical observation dictionary in a large healthcare information system.

OBJECTIVE: This study shows the evolution of a biomedical observation dictionary within the Assistance Publique Hôpitaux Paris (AP-HP), the largest European university hospital group. The different steps are detailed as follows: the dictionary creation, the mapping to logical observation identifier names and codes (LOINC), the integration into a multiterminological management platform and, finally, the implementation in the health information system. METHODS: AP-HP decided to create a biomedical observation dictionary named AnaBio, to map it to LOINC and to maintain the mapping. A management platform based on methods used for knowledge engineering has been put in place. It aims at integrating AnaBio within the health information system and improving both the quality and stability of the dictionary. RESULTS: This new management platform is now active in AP-HP. The AnaBio dictionary is shared by 120 laboratories and currently includes 50 000 codes. The mapping implementation to LOINC reaches 40% of the AnaBio entries and uses 26% of LOINC records. The results of our work validate the choice made to develop a local dictionary aligned with LOINC. DISCUSSION AND CONCLUSIONS: This work constitutes a first step towards a wider use of the platform. The next step will support the entire biomedical production chain, from the clinician prescription, through laboratory tests tracking in the laboratory information system to the communication of results and the use for decision support and biomedical research. In addition, the increase in the mapping implementation to LOINC ensures the interoperability allowing communication with other international health institutions.

Implementation of a platform dedicated to the biomedical analysis terminologies management.

BACKGROUND AND OBJECTIVES: Assistance Publique - Hôpitaux de Paris (AP-HP) is implementing a new laboratory management system (LMS) common to the 12 hospital groups. First step to this process was to acquire a biological analysis dictionary. This dictionary is interfaced with the international nomenclature LOINC, and has been developed in collaboration with experts from all biological disciplines. In this paper we describe in three steps (modeling, data migration and integration/verification) the implementation of a platform for publishing and maintaining the AP-HP laboratory data dictionary (AnaBio). MATERIAL AND METHODS: Due to data complexity and volume, setting up a platform dedicated to the terminology management was a key requirement. This is an enhancement tackling identified weaknesses of previous spreadsheet tool. Our core model allows interoperability regarding data exchange standards and dictionary evolution. RESULTS: We completed our goals within one year. In addition, structuring data representation has lead to a significant data quality improvement (impacting more than 10% of data). The platform is active in the 21 hospitals of the institution spread into 165 laboratories.

Construction of a dictionary of laboratory tests mapped to LOINC at AP-HP.

We report on the ongoing process implemented at Assistance Publique-Hôpitaux de Paris (AP-HP), the largest hospital system in Europe, to build a common reference for laboratory tests in French with LOINC mappings. At the time of writing, it contained 24,000 tests, covering all fields of biology, in use in 19 AP-HP hospitals, 30% of which had a mapping to LOINC with a peak of over 60% in biochemistry.

Features of the metabolic syndrome of "hypertriglyceridemic waist" and transplant coronary artery disease.

BACKGROUND: This study evaluated the prevalence of the atherogenic metabolic triad and the hypothesis that waist circumference and fasting triglyceride concentrations could be used as screening tools for identification of the atherogenic metabolic triad in a population of heart transplant men. It also evaluated the relationship between the atherogenic metabolic triad and coronary artery disease (CAD). METHODS: In the study group of 83 consecutive male heart transplant patients having their routine annual coronarography, 23 patients (28%) were characterized by the atherogenic metabolic triad defined by the presence of elevated fasting insulin and apolipoprotein B concentrations and by small low-density lipoprotein (LDL) particles. RESULTS: Seventy-seven per cent of patients with waist circumference values >/= 90 cm and with elevated triglyceride levels (>/=2.0 mmol/liter) were characterized by this atherogenic metabolic triad. Patients with the atherogenic metabolic triad were at markedly increased risk of CAD (odds ratio of 25.3, 95% CI: 1.11-577.3, p < 0.04) compared to heart transplant patients without the atherogenic metabolic triad. CONCLUSIONS: About 30% of heart transplant patients showed the features of the atherogenic metabolic triad. Measurement and interpretation of waist circumference and fasting triglycerides could be used among heart transplant patients to early identify men characterized by the presence of elevated fasting insulin and apolipoprotein B concentrations and small LDL particles. The presence of the atherogenic metabolic triad identified patients at high risk of CAD even in the heart transplant population.

Tumor antigen markers for the detection of solid cancers in inflammatory myopathies.

Dermatomyositis and polymyositis patients have an increased risk of developing cancers. We have assessed the diagnostic values of serum tumor markers for the detection of solid cancer in dermatomyositis/polymyositis patients. Serum carcinoembryonic antigen, CA15-3, CA19-9, and CA125 were assayed by immunoradiometric methods in 102 dermatomyositis/polymyositis patients. All the patients had complete physical examination, chest X-ray, echocardiogram, gastrointestinal tract endoscopic explorations, thoracoabdomino-pelvic computed tomography scan, and all women had gynecologic examination and mammogram. Exclusion criteria for study were childhood dermatomyositis, inclusion body myositis, myositis associated with a connective tissue disease, prior history of cancer, and the presence of benign conditions known to elevate serum tumor markers. After a median follow-up of 59 months, 10 (9.8%) patients had a solid cancer. Initial elevation of CA125 was associated with an increased risk of developing solid cancer [P = 0.0001 by Fisher's exact test; odds ratio (OR), 29.7; 95% confidence interval (95% CI), 8.2-106.6]. For CA19-9, there was a trend towards a significant association (P = 00.7; OR, 4.5; 95% CI, 1-18.7, respectively). Diagnostic values of elevated CA125 and CA19-9 at screening increased when the study analysis was restricted to patients who developed a cancer within 1 year (P < 0.0001 and P = 0.018, respectively) or to patients without interstitial lung disease (P = 0.00001; OR, 133; 95% CI, 6.5-2733 and P = 0.027; OR, 9; 95% CI, 1.5-53, respectively). Individual comparisons of the baseline and the second CA125 value showed that three of the eight patients with cancers versus 3 of the 76 patients without, displayed an increase of their CA125 level (P = 0.01 by Fisher's exact test). We conclude that CA125 and CA19-9 assessment could be useful markers of the risk of developing tumors for patients with dermatomyositis and polymyositis and should therefore be included in the search for cancer in dermatomyositis/polymyositis patients, especially for patients without interstitial lung disease.

Cortisol diurnal variation in blood and saliva of patients with metastatic colorectal cancer: relevance for clinical outcome.

BACKGROUND: In healthy humans, cortisol displays marked 24-hour rhythms in serum and saliva, with a strong correlation between both fluids; the circadian variation of salivary cortisol is prognostic of longer survival in patients with metastatic breast cancer. In order to confirm these results in a non-hormone-dependent cancer, cortisol concentrations in serum and saliva were compared at different circadian stages, in patients with metastatic colorectal cancer. PATIENTS AND METHODS: A first study consisted of round-the-clock sampling for two 24-hour periods, in 18 patients. A second study consisted of blood and salivary sampling at 8:00h and 16:00h, on 2 consecutive days, in 192 patients. RESULTS: Group circadian variations were validated in both body fluids. Cortisol concentrations in the serum and in saliva were significantly correlated in only 62% of the 18 patients in the first study. In the second study, the average cortisol concentrations were higher at 8:00h than at 16:00h, in serum as well as in saliva. Measures from both body fluids were correlated in patients with a marked 24-hour rhythm, but plasma and salivary cortisol did not correlate in patients with a damped diurnal variation. The patient's performance status and extent of liver involvement, as well as the patient's rest activity cycle were influential on cortisol average concentration, but not on its circadian variation. The circadian variation in cortisol was prognostic of neither response, nor survival. CONCLUSION: These results indicate that the assessment of salivary cortisol cannot substitute for that of serum cortisol in metastatic colorectal cancer. This study suggests that the clinical relevance of cortisol circadian rhythm for patient outcome may differ according to the hormonal dependency of the tumor.