hw1 - MED 264 Fall 2011 Homework #1 Due ...

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Unformatted text preview: MED 264 Fall 2011 Homework #1 Due October 7, 2011 11:00 PM PDT 1. In our first lecture, we highlighted some of the “revolutionary” contributions of Dr. Homer Warner and Dr. Larry Weed. The great body of their work was done in the 1960s and 1970s. We highlighted the importance of timing for successful revolution. a. (10 points): Give an example of a technological innovation or idea (not limited to biomedical) that had limited impact because the overall environment/market was not ready for it. b. (10 points): Requiring the implementation of electronic medical records has been a priority of the current federal administration in the United States. Discuss three significant technological innovations of the past decade that you believe significantly increase the usefulness/value of information technology for health care delivery. 2. (30 points): An important objective of biomedical informatics is to capture and represent data in a computable format. Not all computable data, however, is created equal. In general quantifying a variable is deemed superior to provide a categorical or ordinal description. By quantifying I mean assigning a numeric value that has a concept of distance. (Note that ordinal values can be ordered but there is no sense of distance. On an ordinal assessment, a teaching evaluation score of 8 is greater than a score of 4, but there isn’t a distance of 4 difference between the scores.) However, the mathematician William Byers warns against trying to quantify concepts that are inherently qualitative. Consider the following qualitative findings. State whether they could be quantified (and what the corresponding measure would be), or whether they are inherently qualitative or ordinal properties: a. “The patient reports being in severe pain.” b. “The tumor mass has decreased relative to the previous study.” c. “The mole shows an irregular border.” d. “A firm mass in the liver was appreciated on palpation.” e. “Mrs. White was very agitated.” f. “Skin color was flushed.” 3. (25 points): In the report below, note each data point on the patient. For each data point, create a template that contains the following: • metadata: the type of data – select from the UMLS semantic groups (column 2) or semantic types (column 4) shown below (make your best guess) • topic: the main topic of the data point • modifiers: modifiers used to describe the topic • source of the data: patient description, physician observation, test result, etc. Here is an example template for the bolded item in the sentence “He has lost about 200 pounds and was otherwise doing well until yesterday evening around 7:00- 8:00 when he developed nausea and right upper quadrant pain, which apparently wrapped around toward his right side and back.”: Metadata Disorder Topic Pain M1: Anatomic location Right upper quadrant M2: Existence Present M3: Radiation anatomic Right side and back location M4: time of onset Yesterday evening 7- 8 pm Source Patient report Take notes on questions/challenges you have about how to best represent or model the information, issues you think are particularly important, things you chose to leave out, etc. 4. (25 points): Based on different facets of the data identified in problem 3 (source of data, temporality, positive/negative findings/results, etc.) there are many ways this information could be organized or visualized in summary form. Select a method for summarizing, organizing, or visualizing the information that would potentially be more efficient for a clinical who is taking over care of the patient and wants to see what the admission report describes and create the summarization. You can do this on paper or electronically. Be creative. - - - - - - - - - - - - - - - - - - - Sample report: Sample Name: Admission History & Physical - Nausea Description: Patient status post gastric bypass surgery, developed nausea and right upper quadrant pain. (Medical Transcription Sample Report) CHIEF COMPLAINT: Nausea. PRESENT ILLNESS: The patient is a 28- year- old, who is status post gastric bypass surgery nearly one year ago. He has lost about 200 pounds and was otherwise doing well until yesterday evening around 7:00- 8:00 when he developed nausea and right upper quadrant pain, which apparently wrapped around toward his right side and back. He feels like he was on it but has not done so. He has overall malaise and a low- grade temperature of 100.3. He denies any prior similar or lesser symptoms. His last normal bowel movement was yesterday. He denies any outright chills or blood per rectum. PAST MEDICAL HISTORY: Significant for hypertension and morbid obesity, now resolved. PAST SURGICAL HISTORY: Gastric bypass surgery in December 2007. MEDICATIONS: Multivitamins and calcium. ALLERGIES: None known. FAMILY HISTORY: Positive for diabetes mellitus in his father, who is now deceased. SOCIAL HISTORY: He denies tobacco or alcohol. He has what sounds like a data entry computer job. REVIEW OF SYSTEMS: Otherwise negative. PHYSICAL EXAMINATION: His temperature is 100.3, blood pressure 129/59, respirations 16, heart rate 84. He is drowsy, but easily arousable and appropriate with conversation. He is oriented to person, place, and situation. He is normocephalic, atraumatic. His sclerae are anicteric. His mucous membranes are somewhat tacky. His neck is supple and symmetric. His respirations are unlabored and clear. He has a regular rate and rhythm. His abdomen is soft. He has diffuse right upper quadrant tenderness, worse focally, but no rebound or guarding. He otherwise has no organomegaly, masses, or abdominal hernias evident. His extremities are symmetrical with no edema. His posterior tibial pulses are palpable and symmetric. He is grossly nonfocal neurologically. STUDIES: His white blood cell count is 8.4 with 79 segs. His hematocrit is 41. His electrolytes are normal. His bilirubin is 2.8. His AST 349, ALT 186, alk- phos 138 and lipase is normal at 239. ASSESSMENT: Choledocholithiasis, ? cholecystitis. PLAN: He will be admitted and placed on IV antibiotics. We will get an ultrasound this morning. He will need his gallbladder out, probably with intraoperative cholangiogram. Hopefully, the stone will pass this way. Due to his anatomy, an ERCP would prove quite difficult if not impossible unless laparoscopic assisted. Dr. X will see him later this morning and discuss the plan further. The patient understands. - - - - - - - UMLS Semantic Groups & Types: Nickname|Semantic Group|Code|Semantic Type ACTI|Activities & Behaviors|T052|Activity ACTI|Activities & Behaviors|T053|Behavior ACTI|Activities & Behaviors|T056|Daily or Recreational Activity ACTI|Activities & Behaviors|T051|Event ACTI|Activities & Behaviors|T064|Governmental or Regulatory Activity ACTI|Activities & Behaviors|T055|Individual Behavior ACTI|Activities & Behaviors|T066|Machine Activity ACTI|Activities & Behaviors|T057|Occupational Activity ACTI|Activities & Behaviors|T054|Social Behavior ANAT|Anatomy|T017|Anatomical Structure ANAT|Anatomy|T029|Body Location or Region ANAT|Anatomy|T023|Body Part, Organ, or Organ Component ANAT|Anatomy|T030|Body Space or Junction ANAT|Anatomy|T031|Body Substance ANAT|Anatomy|T022|Body System ANAT|Anatomy|T025|Cell ANAT|Anatomy|T026|Cell Component ANAT|Anatomy|T018|Embryonic Structure ANAT|Anatomy|T021|Fully Formed Anatomical Structure ANAT|Anatomy|T024|Tissue CHEM|Chemicals & Drugs|T116|Amino Acid, Peptide, or Protein CHEM|Chemicals & Drugs|T195|Antibiotic CHEM|Chemicals & Drugs|T123|Biologically Active Substance CHEM|Chemicals & Drugs|T122|Biomedical or Dental Material CHEM|Chemicals & Drugs|T118|Carbohydrate CHEM|Chemicals & Drugs|T103|Chemical CHEM|Chemicals & Drugs|T120|Chemical Viewed Functionally CHEM|Chemicals & Drugs|T104|Chemical Viewed Structurally CHEM|Chemicals & Drugs|T200|Clinical Drug CHEM|Chemicals & Drugs|T111|Eicosanoid CHEM|Chemicals & Drugs|T196|Element, Ion, or Isotope CHEM|Chemicals & Drugs|T126|Enzyme CHEM|Chemicals & Drugs|T131|Hazardous or Poisonous Substance CHEM|Chemicals & Drugs|T125|Hormone CHEM|Chemicals & Drugs|T129|Immunologic Factor CHEM|Chemicals & Drugs|T130|Indicator, Reagent, or Diagnostic Aid CHEM|Chemicals & Drugs|T197|Inorganic Chemical CHEM|Chemicals & Drugs|T119|Lipid CHEM|Chemicals & Drugs|T124|Neuroreactive Substance or Biogenic Amine CHEM|Chemicals & Drugs|T114|Nucleic Acid, Nucleoside, or Nucleotide CHEM|Chemicals & Drugs|T109|Organic Chemical CHEM|Chemicals & Drugs|T115|Organophosphorus Compound CHEM|Chemicals & Drugs|T121|Pharmacologic Substance CHEM|Chemicals & Drugs|T192|Receptor CHEM|Chemicals & Drugs|T110|Steroid CHEM|Chemicals & Drugs|T127|Vitamin CONC|Concepts & Ideas|T185|Classification CONC|Concepts & Ideas|T077|Conceptual Entity CONC|Concepts & Ideas|T169|Functional Concept CONC|Concepts & Ideas|T102|Group Attribute CONC|Concepts & Ideas|T078|Idea or Concept CONC|Concepts & Ideas|T170|Intellectual Product CONC|Concepts & Ideas|T171|Language CONC|Concepts & Ideas|T080|Qualitative Concept CONC|Concepts & Ideas|T081|Quantitative Concept CONC|Concepts & Ideas|T089|Regulation or Law CONC|Concepts & Ideas|T082|Spatial Concept CONC|Concepts & Ideas|T079|Temporal Concept DEVI|Devices|T203|Drug Delivery Device DEVI|Devices|T074|Medical Device DEVI|Devices|T075|Research Device DISO|Disorders|T020|Acquired Abnormality DISO|Disorders|T190|Anatomical Abnormality DISO|Disorders|T049|Cell or Molecular Dysfunction DISO|Disorders|T019|Congenital Abnormality DISO|Disorders|T047|Disease or Syndrome DISO|Disorders|T050|Experimental Model of Disease DISO|Disorders|T033|Finding DISO|Disorders|T037|Injury or Poisoning DISO|Disorders|T048|Mental or Behavioral Dysfunction DISO|Disorders|T191|Neoplastic Process DISO|Disorders|T046|Pathologic Function DISO|Disorders|T184|Sign or Symptom GENE|Genes & Molecular Sequences|T087|Amino Acid Sequence GENE|Genes & Molecular Sequences|T088|Carbohydrate Sequence GENE|Genes & Molecular Sequences|T028|Gene or Genome GENE|Genes & Molecular Sequences|T085|Molecular Sequence GENE|Genes & Molecular Sequences|T086|Nucleotide Sequence GEOG|Geographic Areas|T083|Geographic Area LIVB|Living Beings|T100|Age Group LIVB|Living Beings|T011|Amphibian LIVB|Living Beings|T008|Animal LIVB|Living Beings|T194|Archaeon LIVB|Living Beings|T007|Bacterium LIVB|Living Beings|T012|Bird LIVB|Living Beings|T204|Eukaryote LIVB|Living Beings|T099|Family Group LIVB|Living Beings|T013|Fish LIVB|Living Beings|T004|Fungus LIVB|Living Beings|T096|Group LIVB|Living Beings|T016|Human LIVB|Living Beings|T015|Mammal LIVB|Living Beings|T001|Organism LIVB|Living Beings|T101|Patient or Disabled Group LIVB|Living Beings|T002|Plant LIVB|Living Beings|T098|Population Group LIVB|Living Beings|T097|Professional or Occupational Group LIVB|Living Beings|T014|Reptile LIVB|Living Beings|T010|Vertebrate LIVB|Living Beings|T005|Virus OBJC|Objects|T071|Entity OBJC|Objects|T168|Food OBJC|Objects|T073|Manufactured Object OBJC|Objects|T072|Physical Object OBJC|Objects|T167|Substance OCCU|Occupations|T091|Biomedical Occupation or Discipline OCCU|Occupations|T090|Occupation or Discipline ORGA|Organizations|T093|Health Care Related Organization ORGA|Organizations|T092|Organization ORGA|Organizations|T094|Professional Society ORGA|Organizations|T095|Self- help or Relief Organization PHEN|Phenomena|T038|Biologic Function PHEN|Phenomena|T069|Environmental Effect of Humans PHEN|Phenomena|T068|Human- caused Phenomenon or Process PHEN|Phenomena|T034|Laboratory or Test Result PHEN|Phenomena|T070|Natural Phenomenon or Process PHEN|Phenomena|T067|Phenomenon or Process PHYS|Physiology|T043|Cell Function PHYS|Physiology|T201|Clinical Attribute PHYS|Physiology|T045|Genetic Function PHYS|Physiology|T041|Mental Process PHYS|Physiology|T044|Molecular Function PHYS|Physiology|T032|Organism Attribute PHYS|Physiology|T040|Organism Function PHYS|Physiology|T042|Organ or Tissue Function PHYS|Physiology|T039|Physiologic Function PROC|Procedures|T060|Diagnostic Procedure PROC|Procedures|T065|Educational Activity PROC|Procedures|T058|Health Care Activity PROC|Procedures|T059|Laboratory Procedure PROC|Procedures|T063|Molecular Biology Research Technique PROC|Procedures|T062|Research Activity PROC|Procedures|T061|Therapeutic or Preventive Procedure ...
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