02/25/2020 1 HARNESSING THE POWER OF INFECTIOUS DISEASE INFORMATION WITH A RELATIONAL DATABASE 02/25/2020
2 Presenter Disclosures I developed IDdx: Infectious Disease Queries which is currently a free download from Apple Store (iPhone or iPad) and Google Play (Android phone). 02/25/2020 Presented by
Jay A. Brown, MD, MPH Consultant for the U.S. National Library of Medicine 3 02/25/2020 4 Using infectious disease information is an
important priority in global public health. Medical Surveillance and Prevention Index & Map Disseminate On the Internet
Analyze & Interpret Control & Prevent Collect Data About one half of all deaths in developing
countries are caused by infectious diseases. Infectious diseases are no longer confined by geographical boundaries. An outbreak of SARS in China can become an outbreak in Toronto a few days later. A vast treasury of infectious disease knowledge has been discovered in the
last 150 years This knowledge, summarized in Control of Communicable Diseases Manual, includes signs & symptoms, diagnostic tests, geographical occurrence, mode of transmission, incubation period, and risk factors. With the current availability of fast hand-held computers, the Internet, and
easy-to-use relational database software, the stage is set for the eradication or control of many infectious diseases that have ravaged mankind for thousands of years. . . . some diseases are close to being eliminated or eradicated completely, among them poliomyelitis, leprosy, neonatal tetanus, guinea-worm infection and
Chagas disease." [WHO] A properly designed and updated relational database of infectious diseases can serve as a decisionsupport tool for physicians and other healthcare professionals. Information can be instantaneously updated for frontline doctors, who can query the database for all diseases that match specific symptoms, an
occupation, a region of the world, or an insect vector. The results of a query become a differential diagnosis list based on the criteria of the query. 02/25/2020 How AND Queries Work
23 For example, the user can find that 7 of 249 diseases match the criteria of "jaundice" and "ticks." In summary, all useful infectious disease information can be collected and indexed into a relational database to help practitioners quickly build differential diagnoses and find
details about specific diseases. 27 02/25/2020 Some Examples of Search Criteria for Zoom-Intersection FINDINGS ENTRY
Needle Mosquitoes Dogs Stiff Neck Sexual Ticks Fish
APPENDIX 02/25/2020 29 Medical Informatics Problem 1. There is an explosion of information about infectious diseases. 2. How can we find the specific
information we need when we need it? 02/25/2020 30 Public Health Informatics Solution 1. Use available technology. 2. Index and map the wealth of information. 3. Create an intelligent database to store the information in such a way that specific information can be easily
retrieved. 4. Use the Internet and mobile Apps to disseminate the information for improvement of medical practice and prevention. 02/25/2020 31 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. 02/25/2020
32 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; 02/25/2020 Indexes Used in IDdx Signs and Symptoms Endemic Regions of the World Epidemiological Factors Entry
Source Vector Reservoir Occupations Incubation Periods 33 02/25/2020
34 Sources of Information Best and most recent; Starting point is latest edition of Control of Communicable Diseases Manual (CCDM); Now available for full-text online access are CCDM, Principles and Practice of Infectious Diseases (PPID), Infectious Diseases (Cohen), and Tropical Infectious Diseases (Guerrant);
Disease findings in IDdx were checked by doing text searches for each finding in each of the online books. 02/25/2020 References in IDdx For a full list of all references used in IDdx, see the bibliography page at http://www.iddx.com/bibliography.html
35 02/25/2020 36 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.
[OCarroll 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. 02/25/2020 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; 37 38 02/25/2020
Categories of Findings Prefix Finding Category Prefix Finding Category > General O
Ophthalmologic C Cardiovascular R Respiratory E
S Skin G Ears, Nose & Throat Gastrointestinal
U Genitourinary H Hematologic X Chest X-ray
M Musculoskeletal * Complication 39
02/25/2020 Four Major Tables in the Database Findings Diseases Job Tasks Jobs
02/25/2020 Each Table Contains Records 249 Diseases 99 Findings 63 Job Tasks 94 Jobs 40
02/25/2020 41 Which Diseases Are Covered? The 249 diseases are very similar to those covered in the latest edition of Control of Communicable Diseases Manual (CCDM). Each disease is linked to high-risk job tasks (63), signs & symptoms (99), epidemiological factors (39), endemic
regions of the world (16), and incubation periods (7). The main categories of diseases are arthropod-borne, childhood, person-to-person, foodborne, gastroenteritis, localized infections, sapronoses, sexually-transmitted, and zoonoses. 02/25/2020 42 High-Risk Job Tasks and Prevention
Identify high risk groups. What are the specific job tasks that put workers at risk for the disease? Each hazardous job task links to one or more disease and one or more jobs. Examples of Hazardous Job Tasks Handle infected rodents (bite); Handle infected rodents (not bite); Handle dog or cat (bite or scratch);
Have dog or cat contact (fecal-oral); Handle needles or surgical instruments; Care for patients (fecal-oral pathogens); Work in a medical or research lab; Live together in close quarters; 02/25/2020 43 Examples of Hazardous Job Tasks
Plow or excavate soil in endemic area; Raise dust of excreta from rodents; Travel to endemic area; Work in building infested with fleas; Work or play in tick-infested area; For a summary of how jobs relate to infectious diseases through job tasks, see these two pages on the Haz-Map website: Occupational Infections and Skin Infections.
02/25/2020 44 02/25/2020 45 For More Information See "Using a Relational Database to Index Infectious
Disease Information" published in 2010 in the Int. J. Environ. Res. Public Health. The full-text article is available at: www.mdpi.com/1660-4601/7/5/2177/. See the IDdx website at www.iddx.com.
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