Global Access to infectious disease information

1. Global Access to infectious disease information

2. Presenter Disclosures The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: I have developed two infectious disease applications for PDAs (personal digital assistants) that are available for sale through US Biomedical Information Systems, Inc.

3. Presented byJay A. Brown, MD, MPHConsultant for the U.S. National Library of Medicine

4. Outline • What is the public health problem? • What is the medical informatics problem? • What is the concept of knowledge mapping? • What is an intelligent database? • Is it time to be “exhaustive”?

5. Public Health Problem About one half of all deaths in poor countries are caused by infectious diseases. Infectious diseases are no longer confined by geographical boundaries.

6. No Easy Fix for Global Health • Quick access to summarized up-to-date infectious disease information is just one of many requirements. • Other requirements are food, water, sanitation, housing, education, human rights, and access to health facilities. • See www.globalizationandhealth.com/content/6/1/19for Figures 1 and 2 at the end of the paper “Rethinking the ‘global’ in global health: a dialectic approach.”

7. Medical Informatics Problem There is an explosion of information about infectious diseases. How can we find the specific information we need when we need it?

8. Public Health Informatics Solution • Use available technology. • Index and map the wealth of information. • Create an intelligent database to store the information in such a way that specific information can be easily retrieved. • Use the Internet to disseminate the information for improvement of medical practice and prevention.

9. Medical Surveillance and Prevention

10. Relational Database: A New Tool for Indexing and Mapping Information • Like a company database of employees, customers, products, and invoices, information is stored in tables that are linked together. • Indexing is done first by developing a controlled vocabulary specific for the knowledge domain. • Queries allow finding information by search criteria (the indexes) including “OR” and “AND” searches. • Categories are used to “drill down” to find information.

11. How AND Queries Work

12. Indexing: At the Heart of Intelligence • “Indexing is a major problem at the heart of intelligence.” [Roger Schank. Tell Me a Story, p. 11] • “No intelligent system is likely to function effectively if it cannot find what it knows when it needs to know it.” [Schank, p. 112] • Show all diseases that match one or more criteria: • Central Africa AND petechial rash; • Cat contact AND diarrhea; • Tick exposure AND anemia;

13. Indexes Used in OutbreakID • See www.outbreakid.com for: • Categories • Signs and Symptoms • Syndromes • Endemic Regions of the World • Epidemiological Factors

14. Examples of AND Queries on Web • Query www.hazmap.nlm.nih.gov for diseases associated with the job “veterinarian” and the symptom “stiff neck.” • Query for the job “registered nurse” and the finding “hemoptysis.” • Query for the job “registered nurse” and the finding “liver function test, abnormal.”

15. The Internet: A New Tool for Disseminating Information • See the BBC site on mapping the growth of the Internet: http://news.bbc.co.uk/2/hi/8552410.stm

16. Pulling Current Information Together from the Best Available Sources

17. References in OutbreakID and IDdx • See the bibliography page at www.outbreakid.com/bibliography.htm • Also see "Using a Relational Database to Index Infectious Disease Information" published this year in the Int. J. Environ. Res. Public Health. The full-text article is available at: www.mdpi.com/1660-4601/7/5/2177/

18. Knowledge Mapping

19. World Map in 1570

20. Knowledge Mapping • “Decision support systems can provide preliminary analysis that allows scarce human resources to focus on the key problems while ignoring a vast sea of irrelevancy.” [O’Carroll et al. 2003] • Knowledge is information in context. • Mapping means pulling together and sifting information from a lot of different sources. • Knowledge mapping is comprehensively collecting and systematically indexing a knowledge domain.

21. Knowledge Mapping • Begins with the big picture; • Helps one not to get lost in the details; • Keeps all information in context of the whole; • Distills the facts from the vast sea of data; • Most useful in information-intensive specialties;

22. Starting with the Big Picture

23. Zooming In and Out

24. Keeping Everything in Perspective

25. What Is an Intelligent Database? Intelligent databases are “databases that manage information in a natural way, making information easy to store, access and use.” [Parsaye and Chignell]

26. Some Examples of Search Criteria

27. Categories of Findings

28. Zoom-Intersection • See www.outbreakid.com/overview.htm

29. Four Major Tables in the Database Findings Diseases Job Tasks Jobs

30. Each Table Contains Records • 201 Diseases • 135 Findings • 101 Job Tasks • 102 Jobs

31. High-Risk Job Tasks and Prevention • Identify high risk groups. • What are the specific job tasks that put workers at risk for the disease?

32. Examples of Hazardous Job Tasks • Handle infected rodents (bite); • Handle infected rodents (not bite); • Handle dog or cat (bite or scratch); • Handle domestic animals (inhale or skin); • Have dog or cat contact (fecal-oral); • Handle animal carcasses or placentas; • Handle needles or surgical instruments; • Care for patients (fecal-oral pathogens); • Care for patients (bloodborne pathogens);

33. Examples of Hazardous Job Tasks • Work in a medical or research lab; • Live together in close quarters; • Plow or excavate soil in endemic area; • Raise dust of excreta from rodents; • Swim in contaminated water (ingestion); • Swim in contaminated water (skin); • Travel to endemic area; • Work in building infested with fleas; • Work or play in tick-infested area;

34. Examples of Hazardous Job Tasks • Ingest infectious agents in food/water; • Eat soil containing infective eggs; • Consume unpasteurized milk/cheese; • Eat undercooked meat or fish;

35. Is It Time to Be Exhaustive? • See Cohen et al., p. 1085 in the chapter on “Jaundice in a returned traveler from Nepal.” • “Potential infectious causes of jaundice are listed in Table PP51.2. This is not meant to be exhaustive.” 8 Viral, 11 Bacterial, and 4 Parasitic causes. • CCDM: 10 Viral, 2 Bacterial, and 4 Parasitic; • 37 in IDdx (29 for India & S. Asia: 12V, 14B, 10P); • 94 in Gideon (50 in Nepal: 13V, 26B, 8P);

36. Decision-Support, Not Decision-Replacement • More than one disease may be causing symptoms; • The cause of the fever may be non-infectious; • Symptoms may be missed or wrongly named; • Symptoms may be due to a complication of the infection rather than the infection itself; • Disease may be endemic to only one part of a region or country; • Situation awareness is critical for making the proper diagnosis with or without decision-support software;