scholarly journals Expressiveness of an International Semantic Standard for Wound Care: Mapping a Standardized Item Set for Leg Ulcers to the Systematized Nomenclature of Medicine–Clinical Terms

10.2196/31980 ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. e31980
Author(s):  
Jens Hüsers ◽  
Mareike Przysucha ◽  
Moritz Esdar ◽  
Swen Malte John ◽  
Ursula Hertha Hübner
Keyword(s):  
Information Exchange ◽  
Wound Care ◽  
Information Model ◽  
Coverage Rate ◽  
Clinical Usefulness ◽  
Leg Ulcers ◽  
Snomed Ct ◽  
Mapping Procedure ◽  
Wound Assessment ◽  
Systematized Nomenclature Of Medicine

Background Chronic health conditions are on the rise and are putting high economic pressure on health systems, as they require well-coordinated prevention and treatment. Among chronic conditions, chronic wounds such as cardiovascular leg ulcers have a high prevalence. Their treatment is highly interdisciplinary and regularly spans multiple care settings and organizations; this places particularly high demands on interoperable information exchange that can be achieved using international semantic standards, such as Systematized Nomenclature of Medicine–Clinical Terms (SNOMED CT). Objective This study aims to investigate the expressiveness of SNOMED CT in the domain of wound care, and thereby its clinical usefulness and the potential need for extensions. Methods A clinically consented and profession-independent wound care item set, the German National Consensus for the Documentation of Leg Wounds (NKDUC), was mapped onto the precoordinated concepts of the international reference terminology SNOMED CT. Before the mapping took place, the NKDUC was transformed into an information model that served to systematically identify relevant items. The mapping process was carried out in accordance with the ISO/TR 12300 formalism. As a result, the reliability, equivalence, and coverage rate were determined for all NKDUC items and sections. Results The developed information model revealed 268 items to be mapped. Conducted by 3 health care professionals, the mapping resulted in moderate reliability (κ=0.512). Regarding the two best equivalence categories (symmetrical equivalence of meaning), the coverage rate of SNOMED CT was 67.2% (180/268) overall and 64.3% (108/168) specifically for wounds. The sections general medical condition (55/66, 83%), wound assessment (18/24, 75%), and wound status (37/57, 65%), showed higher coverage rates compared with the sections therapy (45/73, 62%), wound diagnostics (8/14, 57%), and patient demographics (17/34, 50%). Conclusions The results yielded acceptable reliability values for the mapping procedure. The overall coverage rate shows that two-thirds of the items could be mapped symmetrically, which is a substantial portion of the source item set. Some wound care sections, such as general medical conditions and wound assessment, were covered better than other sections (wound status, diagnostics, and therapy). These deficiencies can be mitigated either by postcoordination or by the inclusion of new concepts in SNOMED CT. This study contributes to pushing interoperability in the domain of wound care, thereby responding to the high demand for information exchange in this field. Overall, this study adds another puzzle piece to the general knowledge about SNOMED CT in terms of its clinical usefulness and its need for further extensions.

The Expressiveness of SNOMED CT for Wound Care: Mapping a standardised Item Set for Leg Ulcers to SNOMED CT (Preprint)

2021 ◽  
Author(s):  
Jens Hüsers ◽  
Mareike Przysucha ◽  
Moritz Esdar ◽  
Swen Malte JOHN ◽  
Ursula Hertha Hübner
Keyword(s):  
Health Care Professionals ◽  
Information Exchange ◽  
Chronic Wounds ◽  
Wound Care ◽  
Information Model ◽  
Coverage Rate ◽  
Clinical Usefulness ◽  
Leg Ulcers ◽  
Snomed Ct ◽  
Mapping Procedure

BACKGROUND Chronic health conditions are on the rise and are putting high economic pressure on health systems as they require well-coordinated prevention and treatment. Among chronic conditions, chronic wounds such as cardiovascular leg ulcers have a high prevalence. Their treatment is highly interdisciplinary and regularly spans multiple care settings and organizations, thus placing particularly high demands on interoperable information exchange that can be achieved using international semantic standards such as SNOMED CT. OBJECTIVE This study aims to investigate the expressiveness of SNOMED CT in the domain of wound care, and thereby its clinical usefulness and the potential need for extensions. METHODS A clinically consented and profession independent wound care item set, the German National Consensus for the Documentation of Leg Wounds (NKDUC), was mapped onto the international reference terminology SNOMED CT. Prior to the mapping, the NKDUC was transformed into an information model that served to systematically identify the relevant items. The mapping process itself was carried out in accordance with the formalism of ISO/TR 12300. As a result, the reliability, equivalence, and coverage rate were determined. RESULTS The developed information model revealed 268 items to be mapped. Conducted by three health care professionals, the mapping resulted in “moderate” reliability (K=0.512). Regarding the two best equivalence categories, the coverage rate of SNOMED CT was 67.2% overall and 64.3% specifically for wounds. CONCLUSIONS The results yielded acceptable reliability values for the mapping procedure. The overall coverage rate shows that two-thirds of the items could be mapped symmetrically, which is a substantial portion of the source item set. Some wound care sections, such as general medical condition and wound assessment, were covered better than other sections (wound status, diagnostics, and therapy). These deficiencies can be mitigated either by post-coordination or the inclusion of new concepts in SNOMED CT. This study contributes to pushing interoperability in the domain of wound care and thereby responds to the high demand for information exchange in this field. Overall, this study adds another puzzle piece to the general knowledge about SNOMED CT in terms of its clinical usefulness and its need for further extensions.

scholarly journals Expressiveness of SNOMED CT for wound Care – Mapping a Standardised item Set for Leg Ulcers to SNOMED CT

2020 ◽  
Author(s):  
Jens Hüsers ◽  
Mareike Przysucha ◽  
Lisa Nolte ◽  
Anne Paul ◽  
Philipp Matysek ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Information Exchange ◽  
Chronic Wounds ◽  
Medical Condition ◽  
Wound Care ◽  
Information Model ◽  
Coverage Rate ◽  
Clinical Usefulness ◽  
Leg Ulcers ◽  
Snomed Ct

Abstract Background: Chronic health conditions are on the rise and are putting high economic pressure on health systems as they require well-coordinated prevention and treatment. Among chronic conditions, chronic wounds such as cardiovascular leg ulcers have a high prevalence. The interdisciplinary and multiorganisational character of wound care demands interoperable information exchange that can be achieved by using international semantic standards such as SNOMED CT. This study, therefore, aimed to investigate the expressiveness of SNOMED CT in this medical domain, and thereby its clinical usefulness and the potential need for its extension.Methods: In this study, a consented wound care item set, the National Consensus for the Documentation of Leg Wounds (NKDUC), was mapped to the international reference terminology SNOMED CT. In order to derive the relevant items of the wound domain, an information model was developed that served as the foundation for the mapping. The mapping itself was guided by the procedural formalism of ISO TR 12300. As a result, the reliability, equivalence and coverage rate were determined.Results: The developed information model revealed 268 items to be mapped. Conducted by three health care professionals, the mapping resulted in “moderate” reliability (K=0.512). Regarding a symmetric match, the coverage rate of SNOMED CT was 67.2% overall, and 64.3% specifically for wounds. Conclusion: The results show acceptable reliability values. The overall coverage rate shows that two-thirds of the items found a symmetric map, which is a substantial portion of the source item set. As the differences in the coverage rates between different wound care sections demonstrate, some areas, such as “general medical condition” and “wound assessment”, in particular, were covered better than other areas (“wound status”, “diagnostics” and “therapy”). These deficiencies can be mitigated either by post-coordination or the inclusion of new terms in SNOMED CT. In general, this study adds another puzzle piece to the general knowledge about SNOMED CT in terms of its clinical usefulness and its need for further extensions.

Evaluation of the Content Coverage of SNOMED CT Representing ICNP Seven-axis Version 1 Concepts

2011 ◽  
Vol 50 (05) ◽  
pp. 472-478 ◽  
Author(s):  
C. Lundberg ◽  
A. Coenen ◽  
D. Konicek ◽  
H. A. Park
Keyword(s):  
Coverage Rate ◽  
Snomed Ct ◽  
Validation Process ◽  
The Third ◽  
Model Version ◽  
Content Coverage ◽  
Systematized Nomenclature Of Medicine ◽  
Mapping Result

SummaryObjectives: The purpose of this study is to evaluate the ability of SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) to represent the concepts of the ICNP version 1 – the seven-axis model.Methods: The first author mapped 1658 concepts of the ICNP version 1 to SNOMED CT using CLUE browser 5.0. The second author from SNOMED Terminology Solutions – with a team of SNOMED CT experts – and the third author from the ICN with a team of ICNP experts validated the mapping result. If there was any disagreement during the validation process, the three of us convened online meetings to reach a consensus.Results: In total, SNOMED CT covered 1331 out of 1658 (80%) ICNP seven-axis model concepts ranging from a 61% coverage rate of the Actions Axis concepts to a 94% coverage rate of the Judgment axis concepts.Conclusions: SNOMED CT can represent most (80%) of the ICNP version 1 concepts. However, improvements in the ICNP version 1 in terms of concept naming and definition, and the addition of missing concepts to SNOMED CT, would lead to a greater harmonization of the ICNP seven-axis model version 1 concepts with SNOMED CT.

Experience of negative pressure wound therapy over sternal wound healing: A retrospective review

WCET Journal ◽  
2019 ◽  
Vol 39 (2) ◽  
pp. 9-18
Author(s):  
Wai Sze Ho ◽  
Wai Kuen Lee ◽  
Ka Kay Chan ◽  
Choi Ching Fong
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Assessment Tool ◽  
Wound Care ◽  
Wound Therapy ◽  
Treatment Pathways ◽  
Wound Assessment ◽  
One Year

Objectives The aim of this study was to retrospectively review the effectiveness of negative pressure wound therapy (NPWT) in sternal wound healing with the use of the validated Bates-Jensen Wound Assessment Tool (BWAT), and explore the role of NPWT over sternal wounds and future treatment pathways. Methods Data was gathered from patients' medical records and the institution's database clinical management system. Seventeen subjects, who had undergone cardiothoracic surgeries and subsequently consulted the wound care team in one year were reviewed. Fourteen of them were included in the analysis. Healing improvement of each sternal wound under continuous NPWT and continuous conventional dressings was studied. In total, 23 continuous NPWT and 13 conventional dressing episodes were analysed with the BWAT. Results Among conventional dressing episodes, sternal wound improvement was 2.5–3% over 10 days to 3.5 weeks, whereas 4–5% sternal healing was achieved in 5 days to 2 weeks with sternal wire presence. Better healing at 11% in 1 week by conventional dressing was attained after sternal wire removal. In NPWT episodes, 8–29%, 13–24%, and 15–46% of healing was observed in 2 weeks, 3.5 to 5 weeks and 6 to 7 weeks, respectively. Only 39% wound healing was acquired at the 13th week of NPWT in one subject. With sternal wire present, 6%–29% wound healing progress was achieved by NPWT in 1–4 weeks, and 16–23% wound improvement in 2 to 4.5 weeks by NWPT after further surgical debridement. After sternal wire removal, 6–34% sternal wound healing occurred by continuous NPWT for 1–2 weeks, and maximum healing at 46% after 2.5 weeks of NPWT were observed. Conclusions Better wound healing was achieved in the NPWT group in comparison to conventional dressings alone. However, suboptimal sternal wound healing by NPWT alone was observed. Removal of sternal wire may improve the effectiveness of NPWT. Successful tertiary closure after NPWT among subjects supports the important bridging role of NPWT in sternal wound healing. Factors causing stagnant sternal wound healing by NPWT alone are discussed.

scholarly journals An exploration of the properties of the CORE problem list subset and how it facilitates the implementation of SNOMED CT

2015 ◽  
Vol 22 (3) ◽  
pp. 649-658 ◽  
Author(s):  
Kin Wah Fung ◽  
Julia Xu
Keyword(s):  
Electronic Health Records ◽  
Growth Pattern ◽  
Problem List ◽  
Snomed Ct ◽  
Health Records ◽  
The Core ◽  
Core Subset ◽  
Electronic Health ◽  
Systematized Nomenclature Of Medicine ◽  
Core Problem

Abstract Objective Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) is the emergent international health terminology standard for encoding clinical information in electronic health records. The CORE Problem List Subset was created to facilitate the terminology’s implementation. This study evaluates the CORE Subset’s coverage and examines its growth pattern as source datasets are being incorporated. Methods Coverage of frequently used terms and the corresponding usage of the covered terms were assessed by “leave-one-out” analysis of the eight datasets constituting the current CORE Subset. The growth pattern was studied using a retrospective experiment, growing the Subset one dataset at a time and examining the relationship between the size of the starting subset and the coverage of frequently used terms in the incoming dataset. Linear regression was used to model that relationship. Results On average, the CORE Subset covered 80.3% of the frequently used terms of the left-out dataset, and the covered terms accounted for 83.7% of term usage. There was a significant positive correlation between the CORE Subset’s size and the coverage of the frequently used terms in an incoming dataset. This implies that the CORE Subset will grow at a progressively slower pace as it gets bigger. Conclusion The CORE Problem List Subset is a useful resource for the implementation of Systematized Nomenclature of Medicine Clinical Terms in electronic health records. It offers good coverage of frequently used terms, which account for a high proportion of term usage. If future datasets are incorporated into the CORE Subset, it is likely that its size will remain small and manageable.

Wound Care for Venous Ulceration

2021 ◽  
Vol 38 (02) ◽  
pp. 194-201
Author(s):  
Sarah E. Schroeppel DeBacker ◽  
Julie C. Bulman ◽  
Jeffrey L. Weinstein
Keyword(s):  
Wound Care ◽  
Treatment Success ◽  
Scoring Systems ◽  
Venous Hypertension ◽  
Disease Classification ◽  
Venous Disease ◽  
Leg Ulcers ◽  
Venous Ulceration ◽  
Ultrasound Evaluation ◽  
Careful Clinical Examination

AbstractVenous leg ulcers (VLUs) affect as many as 20% of patients with advanced chronic venous insufficiency and are associated with significant morbidity and health care costs. VLUs are the most common cause of leg ulcers; however, other etiologies of lower extremity ulcerations should be investigated, most notably arterial insufficiency, to ensure appropriate therapy. Careful clinical examination, standardized documentation, and ultrasound evaluation are needed for diagnosis and treatment success. Reduction of edema and venous hypertension through compression therapy, local wound care, and treatment of venous reflux or obstruction is the foundation of therapy. As key providers in venous disease, interventional radiologists should be aware of current standardized disease classification and scoring systems as well as treatment and wound care guidelines for venous ulcers.

Developing building information models (BIM) for building handover, operation and maintenance

2019 ◽  
Vol 17 (3) ◽  
pp. 301-316 ◽  
Author(s):  
Marjan Sadeghi ◽  
Jonathan Weston Elliott ◽  
Nick Porro ◽  
Kelly Strong
Keyword(s):  
Information Exchange ◽  
Model Development ◽  
Information Model ◽  
Content Type ◽  
Operation And Maintenance ◽  
Information Models ◽  
Building Information ◽  
Essential Input ◽  
Construction Operation

PurposeThis paper aims to represent the results of a case study to establish a building information model (BIM)-enabled workflow to capture and retrieve facility information to deliver integrated handover deliverables.Design/methodology/approachThe Building Handover Information Model (BHIM) framework proposed herein is contextualized given the Construction Operation Information Exchange (COBie) and the level of development schema. The process uses Autodesk Revit as the primary BIM-authoring tool and Dynamo as an add-in for extending Revit’s parametric functionality, BHIM validation, information retrieval and documentation in generating operation and maintenance (O&M) deliverables in the end-user requested format.FindingsGiven the criticality of semantics for model elements in the BHIM and for appropriate interoperability in BIM collaboration, each discipline should establish model development and exchange protocols that define the elements, geometrical and non-geometrical information requirements and acceptable software applications early in the design phase. In this case study, five information categories (location, specifications, warranty, maintenance instructions and Construction Specifications Institute MasterFormat division) were identified as critical for model elements in the BHIM for handover purposes.Originality/valueDesign- and construction-purposed BIM is a standard platform in collaborative architecture, engineering and construction practice, and the models are available for many recently constructed facilities. However, interoperability issues drastically restrict implementation of these models in building information handover and O&M. This study provides essential input regarding BIM exchange protocols and collaborative BIM libraries for handover purposes in collaborative BIM development.

scholarly journals Health service pathways for patients with chronic leg ulcers: identifying effective pathways for facilitation of evidence based wound care

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Helen Edwards ◽  
Kathleen Finlayson ◽  
Mary Courtney ◽  
Nick Graves ◽  
Michelle Gibb ◽  
...  
Keyword(s):  
Health Service ◽  
Wound Care ◽  
Evidence Based ◽  
Leg Ulcers ◽  
Chronic Leg Ulcers

A Mobile Application for Wound Assessment and Treatment

2016 ◽  
Vol 15 (4) ◽  
pp. 344-353 ◽  
Author(s):  
Young Joon Jun ◽  
Donghyeok Shin ◽  
Whan Jun Choi ◽  
Ji Hyeon Hwang ◽  
Hoon Kim ◽  
...  
Keyword(s):  
Mobile Application ◽  
Wound Care ◽  
Treatment Plan ◽  
Care Providers ◽  
Treatment Protocols ◽  
Mobile Phone Application ◽  
Wound Assessment ◽  
Reasonable Solution ◽  
Assessment And Treatment ◽  
The Status

The D+Wound Solution is a mobile phone application (app) that assists users in the assessment and treatment of the wound. The app has 6 components for assessment: need for debridement, infection control, revascularization, and exudate control; whether it is chronic; and finally, the top surface of the skin. These components are named D.I.R.E.C.T. The app makes you review these components as an algorithm to provide a reasonable solution for dressing. It is designed to understand the status of the wound and provide a practical treatment idea for wound care providers. A total of 118 nurses were divided into 2 groups, designated as experienced and less-experienced groups, and surveyed. Both groups found the app to be helpful in making a treatment plan. However, the less-experienced group found it to be significantly more useful in assessing the wound ( P = .026) but difficult to understand the logic. The experienced group found the logic to be significantly easier to understand ( P = .018) and had significantly higher similarities ( P = .015) in treatment protocols compared with the less-experienced group. We may conclude that this app has a logical algorithm resembling experienced wound caregivers and is more useful in the less-experienced group.

A systems information model for managing electrical, control, and instrumentation assets

2015 ◽  
Vol 5 (3) ◽  
pp. 278-289 ◽  
Author(s):  
Peter E.D. Love ◽  
Jingyang Zhou ◽  
Jane Matthews ◽  
Chun-Pong Sing ◽  
Brad Carey
Keyword(s):  
Data Collection ◽  
Asset Management ◽  
Information Exchange ◽  
Object Oriented ◽  
Information Model ◽  
Construction Operations ◽  
Content Type ◽  
Electrical Control ◽  
Building Information ◽  
Special Approach

Purpose – The purpose of this paper is to present a systems information model (SIM) that is akin to a building information model (BIM) and can be used by asset managers and staff to make more informed and quicker decisions about maintenance. Design/methodology/approach – The problems associated with managing assets are examined alongside recent international efforts to standardize methods of data collection for meeting the objectives of owners. A case study in the domain of electrical, control and instrumentation (ECI) documentation is examined in detail, with particular reference to the amelioration of errors and omissions in “as built” drawings in order to provide the underlying foundation to support effective asset management (AM). Findings – The findings show that object oriented data models such as SIM provide a robust structure for effective and efficient AM and associated leverage of benefits throughout the entire facility lifecycle of a project. In particular object oriented data enables appropriate and reliable information to be created as a project progresses through its lifecycle, at little cost to the creators. Originality/value – The above special approach to enabling data collection at the point of creation is in alignment with recent Government initiatives such as Construction Operations Building Information Exchange, which are beginning to gather traction within the industry. While the potential benefits for AM of such systems are espoused throughout the industry, there are few successful examples in existence with measurable realization of benefits.

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