Pediatric Informatics: Computer Applications in Child Health (Health ...

13 Managing Pediatric Knowledge Resources in Practice 189
with diseases or syndromes, based on statistical knowledge of the presence of
these combinations in diagnosed patients, are part of the knowledge that clinicians
develop with exposure and experience.
Information resources that support clinical decisions associate clinical findings
to diseases by using: (1) logical inference based on epidemiologic prevalence of
findings and diseases or (2) bibliometric linkages. Discussion of the former appears
elsewhere in this book, and this discussion will be restricted to the latter.
Bibliometric linkages measure the frequency with which a conceptual entity
(finding, disease or other term) is associated with another entity within a set of
documents, such as the chapters in a book or articles within a journal. Bibliometric
linkages do NOT reflect epidemiologic frequencies, but may be important conceptually.
For example, many reports, about a single case of a rare disease may associate
it with a specific finding. The strength of this approach depends on the relevance
of the set of documents, the query, the linkage rules (“search engine”) and the user/
clinician’s expertise in interpreting the results. Two tools discussed here are Isabel,
designed to assist diagnosis by increasing recall of diagnostic possibilities, and the
familiar search engine Google.
Isabel (www.isabel.org.uk/) is a subscription-based online/mobile-accessible
resource that may be integrated into an electronic medical record (from Isabel
Health Care) that provides links to a pediatric knowledge base in response to
clinical features entered using natural language. The system, using a proprietary
natural language tool/engine, searches the knowledge base for similar terms and
related concepts (diseases) to create differential diagnoses. It is not an expert
system and does not prioritize diagnoses, but rather expands the list of relevant
diagnoses to consider. 10
Google (www.Google.com/) is a popular Web search engine that uses a mathematical
algorithm called “PageRank” 11 as a measure of authority of a given
World Wide Webpage in response to an entered query. In addition, Google has
created access to scholarly journals that are incorporated into general searches
(Google scholar: http://scholar.google.com/) across many journals and disciplines
(including medicine) (see Case Study).
13.3.3 General Information on Diseases
Often, all a clinician needs or wants is a quick overview/review of a disease to make
a clinical decision or to update his/her personal knowledge. This type of information
(disease manifestations, history, diagnosis, etc.) usually does not change drastically
over time and may be found in standard textbooks (print or electronic). Many publishers
now provide time-limited subscription to online, CD-ROM and PDA versions
of traditional textbooks with search features and automated update capabilities. Webbased
textbooks are often bundled as part of a collection of books and standard journals
in a particular specialty (such as general pediatrics). Most collections have electronic
enhancements that allow simultaneous searching across multiple textbooks.