Agenda Database Structure & Information Retrieval Lisa Traditi, MLS, AHIP April 2008 Medical data Database structure Controlled vocabulary vs. natural language Medical Subject Headings (MeSH) Medical data “Scientific disciplines generally develop precise terminology or notation that is standardized and accepted by all workers in the field. Medicine is remarkable for its failure to develop a standardized vocabulary and nomenclature….” -Ted Shortliffe, M.D., Ph.D., Stanford University School of Medicine Medical Coding Schemes Which ones are you using? ICD-10 (World Health Organization) ICD-10-CM (Health Care Financing Admin.) z SNOMED (American College of Pathology) z CPT (American Medical Association) z z Data-to-Knowledge spectrum Datum z Single observational point described objectively Information z Gained from the formal or informal analysis/interpretation of data Knowledge z Organized data + information that has been synthesized Database structure Records Definition of a Database? …Collection of data organized especially for rapid searching and retrieval Unstructured Record 9236556 NLM Schwartz, L M. Fisher, E S. Tosteson, N A. Woloshin, S. Chang, C H. Virnig, B A. Plohman, J. Wright, B. Department of Veterans Affairs Medical Center, White River Junction, Vt, USA. Treatment and health outcomes of women and men in a cohort with coronary artery disease. Archives of Internal Medicine. 157(14):1545-51, 1997 Jul 28. Arch Intern Med. 157(14):1545-51, 1997 Jul 28. Print 0372440, 7fs AIM, IM UNITED STATES Age Factors. Aged. Cohort Studies. Coronary Disease/di [Diagnosis]. Coronary Disease/px [Psychology]. *Coronary Disease/th [Therapy]. Female. Health Status. Hospitalization. Humans. Linear Models. Male. Research Support, Non-U.S. Gov't. *Sex Factors. Socioeconomic Factors. Treatment Outcome. BACKGROUND: Women with coronary artery disease are treated differently than men. Although mortality has been studied, functional outcomes for women and men have not been prospectively compared. METHODS: The Manitoba Health Reform Impact Study used hospital databases to identify all residents aged 45 years and older in Manitoba who were hospitalized for a myocardial infarction between October 1, 1991, and September 30, 1992. Cohort members were interviewed twice, an average of 16 and 25 months after hospitalization. Baseline and follow-up measures included treatments (eg, physician visits, diagnostic testing, revascularization, and cardiac medications), physical health status (physical component summary [PCS] score derived from the Medical Outcomes Study Short Form 36), reinfarction, and mortality. RESULTS: Of the 820 patients who completed the initial survey, 31 died during the follow-up period, and 734 completed the follow-up survey. Data were complete for the primary outcome (PCS score) and all relevant covariates for the 677 patients who were included in this study Women constituted 34% of this cohort. Although women had more physician visits during follow-up, they were less likely to have undergone treadmill testing or angiography (odds ratio, 0.68; 95% confidence interval, 0.46-0.99). Women were equally likely to report taking beta-adrenergic blocking agents, but were less likely than men to report the use of aspirin (odds ratio, 0.69; 95% confidence interval, 0.48-0.98). After adjusting for baseline differences in PCS scores, age, income, social supports, and the levels of angina and dyspnea, the PCS score for women declined by 1.4 points, while the score for men improved by 0.2 points (P = .03). During the follow-up period, reinfarction and mortality rates were low overall, but were not different in men and women. CONCLUSIONS: In this cohort of patients with known coronary artery disease, we found less aggressive treatment of coronary artery disease and less use of aspirin among women than among men during 1 year of observation. After controlling for baseline differences, women with coronary artery disease experienced a more rapid decline in physical health status than did men during 1 year of follow-up. 0003-9926 Journal Article. English 19970814 20041117 1997 20041220 Structured Record Unique Identifier 9236556 Record Owner NLM Authors Schwartz LM. Fisher ES. Tosteson NA. Woloshin S. Chang CH. Virnig BA. Plohman J. Wright B. Institution Department of Veterans Affairs Medical Center, White River Junction, Vt, USA. Title Treatment and health outcomes of women and men in a cohort with coronary artery disease. Source Archives of Internal Medicine. 157(14):1545-51, 1997 Jul 28. Abbreviated Source Arch Intern Med. 157(14):1545-51, 1997 Jul 28. Publishing Model Print NLM Journal Code 0372440, 7fs Journal Subset AIM, IM Country of Publication UNITED STATES MeSH Subject Headings Age Factors Aged Cohort Studies Coronary Disease / di [Diagnosis] Coronary Disease / px [Psychology] *Coronary Disease / th [Therapy] Female Health Status Hospitalization Humans Linear Models Male Research Support, Non-U.S. Gov't *Sex Factors Socioeconomic Factors Treatment Outcome Abstract BACKGROUND: Women with coronary artery disease are treated differently than men. Although mortality has been studied, functional outcomes for women and men have not been prospectively compared. …. ISSN 0003-9926 Publication Type Journal Article. Language English Entry Date 19970814 Revision Date 20041117 Year of Publication 1997 Update Date 20041220 Database structure Records Fields z Indexes z Exercise: What MeSH terms would you assign? Differential response to antidepressants in women with premenstrual syndrome/premenstrual dysphoric disorder – A randomized controlled trial BACKGROUND: Studies show that selective serotonin reuptake inhibitors are effective for severe premenstrual syndrome and premenstrual dysphoric disorder. This study compares the efficacy of a selective serotonin reuptake inhibitor with that of a tricyclic antidepressant to determine whether efficacy for premenstrual syndrome/premenstrual dysphoric disorder is a general or more serotonergic effect of antidepressants. METHODS: After 3 screening months, 189 subjects were randomized to sertraline hydrochloride, desipramine hydrochloride, or placebo for 3 months of double-blind treatment. The flexible dosage range was 50 to 150 mg/d. The outcome measures included the Penn Daily Symptom Report (DSR), the Hamilton Depression Rating Scale, the Clinical Global Impressions-Severity Scale, the Quality of Life Scale, and Patient Global Ratings of Functioning and Improvement. Analyses included all subjects with treatment data, with the last observation carried forward. RESULTS: Sertraline was significantly more effective than placebo or desipramine; desipramine was not better than placebo (F2,163 = 12.47, P<.001). All DSR factors were more improved with sertraline compared with desipramine and placebo; the factors for mood (P<.001) and pain (P = .05) were significant, and the results of all outcome measures were consistent. A history of depression, postmenstrual symptom levels, and other diagnostic variables added individually as covariates did not alter the treatment results. At end point analysis, DSR symptoms had decreased by more than 50% in 40 subjects (65%) in the sertraline group, 18 subjects (36%) in the desipramine group, and 16 subjects (29%) in the placebo group (P<.001). CONCLUSIONS: The comparison of 2 classes of antidepressants strongly favored the serotonergic drug, which effectively reduced symptoms and improved functioning and was well tolerated by women with severe premenstrual syndrome. A history of depression did not alter the treatment results. MeSH (Medical Subject Headings) Overview of Vocabulary Development & Changes for 2008 MeSH http://www.nlm.nih.gov/pubs/techbull/nd07/nd07_mesh.html z z z MeSH – for notes 456 Descriptors were added for 2008 MeSH 288 Descriptor terms were replaced with more up-to-date terminology 46 Descriptors were deleted Totals by Type of Terminology z z z z 24,767 Descriptors 83 Subheadings/Qualifiers 172,451 Supplementary Concept Records (SCRs) ftp://nlmpubs.nlm.nih.gov/online/mesh/.newterms/mshnew2008.txt Previous Years Comparison: 24,357 Descriptors in 2007 494 Descriptors added for 2007 MeSH z z z z 933 new terms added in ’06 487 new terms added in ’05 666 new terms added in ‘04 1250 new terms added in ‘03 There was a major reclassification and retreeing of the Leukemia and Lymphoma terms … The following new headings were added: Leukemia, Prolymphocytic, B-Cell Leukemia, Large Granular Lymphocytic Precursor Cell Lymphoblastic LeukemiaLymphoma Precursor B-Cell Lymphoblastic LeukemiaLymphoma Leukemia, Myeloid, Chronic, Atypical, BCRABL Negative Leukemia, Myelomonocytic, Juvenile Lymphoma, Extranodal NK-T-Cell Lymphoma, Primary Cutaneous Anaplastic Large Cell Examples: Heart Failure (with entry term of Heart Failure, Congestive) Heart Failure, Diastolic Heart Failure, Systolic Extensively Drug-Resistant Tuberculosis (not to be confused with Tuberculosis, Multidrug-Resistant) Four new specific strains of E. coli added Enterohemorrhagic Escherichia coli Enteropathogenic Escherichia coli Enterotoxigenic Escherichia coli Shiga-Toxigenic Escherichia coli There were also significant changes related to the Coronary Disease tree. … The following new terms were added New Disaster-Related Headings to the Coronary Disease tree: Coronary Artery Disease (with entry terms of Coronary Arteriosclerosis and Coronary Atherosclerosis) Coronary Occlusion (do not confuse with Coronary Stenosis) Acute Coronary Syndrome Disaster Medicine Mass Casualty Incidents Weapons of Mass Destruction A new entry term of note for the MeSH term Civil Defense is Emergency Preparedness. MeSH Tools Annotated, alphabetic Trees, hierarchical Permuted, rotated MeSH Major principle = specificity indexers assign the most specific terms z indexers do not routinely assign more general terms as well z MeSH Publication types Check tags Geographics Subheadings Reasons to Use MeSH Allows for more precise MEDLINE queries Takes advantage of high quality indexing Takes advantage of Ovid’s mapping Can combine with textword searching to approach (but never achieve) comprehensive retrieval Vocabulary Issues: Controlled vs. Natural Language Controlled Vocabulary Advantages: consistent and dependable z documented z arranged alphabetically, hierarchically, etc. z Disadvantages: out of date expensive z human error z z Vocabulary Issues: Vocabulary Issues Controlled vs. Natural Language Natural Language Advantages: z must use lots of synonyms z must know vocabulary of discipline z simplifies searching z z cheap up to date z simplifies searching z z Solutions -- real and potential: Disadvantages: Educate searchers Improve database design z Systems/software to assist z z http://www.nlm.nih.gov/research/umls/umlsmain.html MeSH Recall = sensitivity # of relevant citations retrieved by a search # of relevant citations in the database z ability of the search to retrieve relevant citations from the database Ovid mapping UMLS MeSH Precision = specificity # of relevant citations retrieved total # of citations retrieved z ability of the search to discriminate between relevant and irrelevant citations Major searching goal Unambiguous retrieval = sensitive, specific, reliable Sensitive = all the data I want z Specific = only the data I want z Reliable = same data for every query Questions? Comments? z Database Structure & Information Retrieval Lisa Traditi, MLS, AHIP