bluuebunny/crossref_metadata_2025 huggingface dataset:
Sonographic assisted diagnosis and treatment of bilateral gastrocnemius tendon rupture in a Labrador retriever repaired with fascia lata and polypropylene mesh
Authors: Fitch R. B. , Staatz A. , Lowery J. , Swiderski J.
Published: March 2018

This case report describes a four-year-old, eighty-five pound, male neutered Labrador retriever that was admitted with unilateral lameness and clinical findings consistent with a unilateral gastrocnemius tendon rupture. A prior history of trauma was not identified. Ultrasonagraphic evaluation revealed bilateral gastrocnemius tendon defects in which approximately 80% of the tendon was ruptured on the clinically normal side, yet mechanical function and anatomical length were not apparently altered. Bilateral surgical repair was performed utilizing primary tendon reconstruction, supported by fascia lata, autograft and polypropylene mesh. The repairs were protected with rigid casts for two weeks following surgery, and replaced with orthotics through the complete recovery period. Orthotics provided semi-rigid support and allowed removal for controlled intermittent physical therapy. This surgical repair technique, combined with orthotic support, allowed for early mobilization and good ultimate outcome for a complicated bilateral condition.
In vitro biomechanical comparison of limited contact dynamic compression plate and locking compression plate
Authors: Manos J. M. , Orlansky A. S. , Todhunter R. J. , Trotter E. J. , van der Meulen M. C. H. , Aguila A. Z.
Published: March 2018

The locking compression plate (LCP) supports biological osteosynthesis by functioning as an internal fixator, rather than as a full or limited contact bone plate which must be adequately contoured and affixed directly to the bone for stable internal fixation of the fracture. In order to help justify the use of the LCP in our veterinary patients, in vitro biomechanical testing was performed comparing the LCP to the conventional limited contact dynamic compression plate (LC-DCP) in canine femurs. We hypothesized that the LCP construct would be at least as stiff under bending and torsional loads as the LC-DCP. The LCP and LC-DCP were applied over a 20-mm osteotomy gap to contralateral bones within each pair of 14 femora. Non-destructive four-point bending and torsion, and cyclical testing in torsion were performed. The constructs were then loaded to failure in torsion. In medial-lateral and lateral-medial structural bending, significant differences were not found between the LCP and LC-DCP, however, at the gap, the LCP construct was stiffer than the LC-DCP in lateral-medial bending. Significant differences in behaviour over time were not noted between the plate designs during cyclical testing. When loading the constructs to failure in internal rotation, the LC-DCP failed at a significantly lower twist angle (P = .0024) than the LCP. Based on the similar performance with loading, the locking compression plate is a good alternative implant for unstable diaphyseal femoral fracture repair in dogs.
The Repair and Healing of Two Traumatic Ilial Body Fractures Adjacent to Cemented Total Hip Acetabular Components
Authors: Shires P. K. , Dew T. L.
Published: March 2018

This report has documented the repair and healing of two ilial fractures in dogs which were compounded by the presence of a cemented acetabular prosthesis. While specific recommendations can not be made from such a small number of cases, the information presented herein suggests that such fractures will heal without complication if aseptic surgical techniques and standard methods of internal fixation are employed. The authors strongly recommend the prophylactic use of intravenous antibiotics and the placement of cancellous bone graft when the repair of such fractures is attempted.

Two traumatic ilial fractures involving the cement/bone interface of acetabular prostheses were repaired using lag screws, cerclage wires, and autogenous bone grafts. The fractures healed and ambulatory function was regained.
Pelvic Canal Narrowing Caused by Triple Pelvic Osteotomy in the Dog
Authors: Holmberg D. L. , Binnington A. G. , Miller C. W. , Sukhiani H. R.
Published: March 2018

To reduce postoperative complications due to pelvic canal narrowing following triple pelvic osteotomy, it is important to minimize the length of the pubic remnant on the acetabular segment. Three different techniques for performing the pubic osteotomy were compared: a lateral wire saw technique, a lateral osteotome technique and a ventral osteotome ostectomy technique. The lateral wire saw and ventral ostectomy techniques resulted in significantly shorter pubic remnants than the lateral osteotome technique. The osteotomies performed with the wire saw were more accurate and precise than those performed with the osteotome. The lateral wire saw technique is a practical alternative to the ventral ostectomy technique for performing the pubic osteotomy.

A comparison of three different pubic osteotomy techniques for the triple pelvic osteotomy showed that minimal pubic remnants can be achieved with either the lateral wire saw or ventral ostectomy technique. Osteotomies made by the wire saw were more accurate and precise than those made by the osteotome.
Control of Hereditary Elbow Disease in Pedigree Dogs
Authors: Bedford P.G.C.
Published: March 2018

One of the major activities of the World Small Veterinary Association over the past 12 months has been the investigation of potential international measures for the control of inherited disease in the pedigree dog. Three areas of concern are currently being examined: elbow dysplasia, hip dysplasia and ocular disease. The standardisation of diagnostic expertise on an international basis is high on the list of priorities for any scheme to prove successful, and with this intent in mind the first joint WSAVA/Kennel Clubs meeting was held in 1993 on the subject of elbow dysplasia. This report of the meeting was accepted as Association policy by the WSAVA Assembly at its annual meeting in October last year. A form of certification is currently being prepared and next a joint meeting to discuss hip dysplasia will take place in June of this year.
MRT-basierte Diagnostik von Demenzen
Authors: Mader I. , Klöppel S.
Published: March 2018

Die strukturelle Magnetresonanztomografie (MRT) spielt für die Abklärung von demenziellen Syndromen sowohl beim Ausschluss potenziell behandelbarer Ursachen als auch für die Differenzialdiagnose spezifischer Formen der Demenz eine zunehmende Rolle. T1-gewichtete Sequenzen erlauben eine gute Beurteilung der Atrophie, während FLAIR und T2*-Wichtung Aussagen zu Veränderungen der weißen Substanz und zu Mikroblutungen erlauben. Im Kontext klinischer Studien im Bereich der Alzheimer-Demenz (AD) dient die MRT als Verlaufsparameter mit enger Korrelation zu krankheitsspezifischen neuropathologischen Veränderungen und kognitiven Einschränkungen. Im Rahmen klinischer Studien dient sie zudem der Risikoabschätzung für die Entwicklung einer Demenz bei Patienten mit leichter kognitiver Störung (LKS). Eine Reihe vergleichsweise neuer MRT-Sequenzen, wie funktionelle MRT, diffusionsgewichteten Sequenzen und Arterial Spin Labelling werden auf ihren Nutzen für die klinische Routine hin geprüft.
Ketogene Diät in der Therapie pharmakoresistenter Epilepsien
Authors: Otten K. , Kurthen M. , Kröll J.
Published: March 2018

Die ketogene Diät (KD) ist eine seit mehr als hundert Jahren etablierte Therapie bei Kindern und Jugendlichen mit pharmakoresistenten Epilepsien. In den letzten Jahren hat das klinische Interesse an der KD durch Einführung weniger strenger und flexiblerer Therapieprotokolle wie der modifizierten Atkins-Diät (MAD) deutlich zugenommen. Aufgrund experimenteller Daten ergeben sich zunehmend Hinweise, dass die Wirksamkeit der Diät nicht auf eine antikonvulsive Wirkung beschränkt ist. Durch die Veränderung des zerebralen Energiestoffwechsels besitzt die KD auch ein mögliches neuroprotektives Potenzial, sodass im Rahmen wissenschaftlicher Studien zunehmend “neue” Indikationen der KD jenseits der Epilepsiebehandlung geprüft werden, z. B. der Einsatz bei neurodegenerativen Erkrankungen oder bei Hirntumoren.
Designing New Methodologies for Integrating Biomedical Information in Clinical Trials
Authors: García-Remesal M. , Billhardt H. , Alonso-Calvo R. , Pérez-Rey D. , Martín-Sánchez F. , Maojo V.
Published: March 2018

Objectives:
To propose a modification to current methodologies for clinical trials, improving data collection and cost-efficiency. To describe a system to integrate distributed and heterogeneous medical and genetic databases for improving information access, retrieval and analysis of biomedical information.

Methods:
Data for clinical trials can be collected from remote, distributed and heterogeneous data sources.

In this distributed scenario, we propose an ontology-based approach, with two basic operations: mapping and unification. Mapping outputs the semantic model of a virtual repository with the information model of a specific database. Unification provides a single schema for two or more previously available virtual repositories. In both processes, domain ontologies can improve other traditional approaches.

Results:
Private clinical databases and public genomic and disease databases (e.g., OMIM, Prosite and others) were integrated. We successfully tested the system using thirteen databases containing clinical and biological information and biomedical vocabularies.

Conclusions:
We present a domain-independent approach to biomedical database integration, used in this paper as a reference for the design of future models of clinico-genomic trials where information will be integrated, retrieved and analyzed. Such an approach to biomedical data integration has been one of the goals of the IST INFOBIOMED Network of Excellence in Biomedical Informatics, funded by the European Commission, and the new ACGT (Advanced Clinico-Genomic Trials on Cancer) project, where the authors will apply these methods to research experiments.
Changing Academic Roles
Authors: Bricknell L. , Hovenga E. J. S.
Published: March 2018

Objectives:
A primary objective of this study was to identify a valid method for academic workload allocation. This required the identification of significant variables that may be used to indicate and measure academic workload. A supporting objective was to illustrate how the adoption of a flexible learning mode and supporting technologies across one university with multiple campuses and an international student cohort has impacted upon academic roles and teaching delivery methods.

Methods:
An extensive literature review focusing primarily on the teaching aspects of academic roles was undertaken. These roles were defined as teaching, including curriculum development, undertaking research, provide professional and community services and undertake some administrative work. This review was followed by the documentation of a case study.

Results:
Significant changes to the roles and responsibilities of academics working in higher education are now discernable. The adoption of Web-based applications and other communication technologies have made it possible to not only extend traditional distance education offerings but also to teach large multicultural classes across multiple campuses simultaneously. This in turn necessitates a review of teaching strategies and of organization-wide student and staff support infrastructures to ensure that the teaching quality is maintained or improved whilst meeting individual student learning needs.

Conclusions:
Changes to academics’ roles are occurring due to the globalisation of higher education as well as the adoption of new educational delivery methods and the use of new technologies. The resulting complexity of academic workload measurement and the need to equitably allocate this workload to individual academics has become more challenging than ever. More traditional universities can learn from such experiences to better prepare for these inevitable changes.
Is Medical Informatics an Art or a Science?
Authors: Haux R. , Hasman A. , McCray A. T. , van der Lei J.
Published: March 2018

Objective:
To give an introduction to the special topic on ‘Medical Informatics: Art or Sciene?‘ in honor of Prof. Dr. Jan Hendrik van Bemmel.

Method:
Retrospective, personal review on his work.

Results and Conclusions:
Jan H. van Bemmel contributed exceptionally to research and education as well as to systematizing and promoting medical informatics. Details are provided in this and the other papers of this special topic of Methods of Information in Medicine.
SAP and Partners: IS-H™ and IS-H*MED™
Authors: Schmücker P. , Pedevilla M. , Leitner H. , Naumann J. , Fuchs H. , Pitz H. , Köle W. , Gell G.
Published: March 2018

Objectives: The Styrian Hospital Organization with 21 hospitals including the Graz University Hospital, and the Heidelberg University Hospital implemented a new HIS based on SAP/R3™, ISH™, ISH*MED™ with the objective to have an integrated system to support patient administration and management, patient care, clinical documentation, research etc.

Methods: Heidelberg University Hospital chose a step by step method for the introduction of the system, beginning with patient administration (ISH) and proceeding with clinical functions (ISH*MED). In Styria, the full functionality was implemented – as part of the selection process – in one peripheral hospital and in the Ear, Nose and Throat (ENT) Department of the Graz University Hospital, including special documents to support the processes in the highly specialized ENTunits.

Results and Conclusions: The standard modules are performant, stable and basically well accepted. Particularly in Graz, it has been shown that the requirements of highly specialized departments for work flow management, documentation and integration of subsystems and data from different sources can be fulfilled by special documents and programs – although at the expense of additional workload particularly in the initial phases of such a project.
Closing the Loop between Clinical Practice, Research, and Education: The Potential of Electronic Patient Records
Authors: van der Lei J.
Published: March 2018

Objective: To discuss the possible contribution of electronic patient records in closing the loop among clinical practice, research and education.

Results and conclusions: Applying Information and Communication Technology (ICT) to a given medical domain is not merely adding a new technique. When introduced into an environment, ICT will initially often emulate or resemble the already existing processes. When workers and researchers in that domain begin to appreciate the potential of ICT, this initial stage is followed by more fundamental changes in that domain that take advantage of the potential of ICT. To understand the scope of the potential changes enabled by electronic records, three principle changes need to be understood. First, data recorded in computer memories can be readily retrieved and re-used for a variety of purposes. Second, once data are available in computer memories, the data can be transported easily. Third, as physicians (and patients) are using computers to record medical data, the same electronic record can be used to introduce other computer programs that interact with the user. New usage of data, however, generates additional requirements. Thus the experience in developing decision support systems and analyzing observational databases feeds back into the requirements for electronic medical records.

Each patient-physician encounter, each investigation, each laboratory test, and each treatment in medical practice constitutes, in principle, an experiment. Ideally, we learn from each experiment. Electronic medical records will facilitate research that relies on data recorded in routine medical practice. The potential and challenge, however, of Medical Informatics lies in its ability to close the loop among clinical practice, research, and education.
An Anesthesia Information Management System (AIMS) as a Tool for Controlling Resource Management of Operating Rooms
Authors: Junger A. , Quinzio L. , Michel A. , Sciuk G. , Brammen D. , Marquardt K. , Hempelmann G. , Benson M.
Published: March 2018

Objectives: In our department, we have been using an Anesthesia Information Management System (AIMS) for five years. In this study, we tested to what extent data extracted from the AIMS could be suitable for the supervision and time-management of operating rooms.

Methods: From 1995 to 1999, all relevant data from 103,264 anesthetic procedures were routinely recorded online with the automatic anesthesia record keeping system NarkoData. The program is designed to record patient related time data, such as the beginning of anesthesia or surgical procedure, on a graphical anesthesia record sheet. The total number of minutes of surgery and anesthesia for each surgical subspecialty per hour/day and day of the year was calculated for each of the more than 40 ORs, amounting to a total of 112 workstations.

Results: It was possible to analyze the usage and the utilization of ORs at the hospital for each day of the year since 1997. In addition, annual and monthly evaluations are made available. It is possible to scrutinize data of OR usage from different points of view: queries on the usage of an individual OR, the usage of ORs on certain days or the usage of ORs by a certain surgical subspecialty may be formulated. These data has been used repeatedly in our hospital for decision making in OR management and planning. Conclusions: In assessing the results of our study, it should be considered that the system used is not a specialized OR management tool. Despite these restrictions, the system contains data which can be used for an exact and relevant presentation of OR utilization
Evaluation of a Method that Supports Pathology Report Coding
Authors: de Bruijn L. M. , Arends J. W. , Hasman A.
Published: March 2018

Objectives:
The paper focuses on the problem of adequately coding pathology reports using SNOMED. Both the agreement between pathologists in coding and the quality of a system that supports pathologists in coding pathology reports were evaluated.

Methods:
Six sets of three pathologists each received a different set of 40 pathology reports. Five different SNOMED code lines accompanied each pathology report. Three pathologists evaluated the correctness of each of these code lines. Kappa values and values for the reliability coefficients were determined to gain insight in the variance observed when coding pathology reports. The system that is evaluated compares a newly entered report, represented as a multi-dimensional word vector, with reports in a library, represented in the same way. The reports in the library are already coded. The system presents the code lines belonging to the five library reports most similar to the newly entered one to the pathologist in this way supporting the pathologist in determining the correct codes. A high similarity between two reports is indicated by a large value of the inproduct of the vector of the newly entered report and the vector of a report in the library.

Results:
Agreement between pathologists in coding was fair (average kappa of 0.44). The reliability coefficient varied from 0.81 to 0.89 for the six sets of pathology reports. The system gave correct suggestions in 50% of the reports. In another 30% it was helpful for the pathologists.

Conclusions:
On the basis of the level of the reliability coefficients it could be concluded that three pathologists are indeed sufficient for obtaining a gold standard for evaluating the system. The method used for comparing reports is not strong enough to allow fully automatic coding. It could be shown that the system induces a more uniform coding by pathologists. An evaluation of the incorrect suggestions of the system indicates that the performance of the system can still be improved.
Elaboration and Formalization of Current Scientific Knowledge of Risks and Preventive Measures Illustrated by Colorectal Cancer
Authors: Gouvernet J. , Dufour J. , Degoulet P. , Laugier R. , Quilichini F. , Fieschi M. , Giorgi R.
Published: March 2018

Objectives:
Present the method used to elaborate and formalize current scientific knowledge to provide physicians with tools available on the Internet, that enable them to evaluate individual patient risk, give personalized preventive recommendations or early screening measures.

Methods:
The approach suggested in this article is in line with medical procedures based on levels of evidence (Evidence-based Medicine). A cyclical process for developing recommendations allows us to quickly incorporate current scientific information. At each phase, the analysis is reevaluated by experts in the field collaborating on the project. The information is formalized through the use of levels of evidence and grades of recommendations. GLIF model is used to implement recommendations for clinical practice guidelines.

Results:
The most current scientific evidence incorporated in a cyclical process includes several steps: critical analysis according to the Evidence-based Medicine method; identification of predictive factors; setting-up of risk levels; identification of prevention measures; elaboration of personalized recommendation. The information technology implementation of the clinical practice guideline enables physicians to quickly obtain personalized information for their patients. Cases of colorectal prevention illustrate our approach.

Conclusions:
Integration of current scientific knowledge is an important process. The delay between the moment new information arrives and the moment the practitioner applies it, is thus reduced.
Object-oriented Analysis and Design of an ECG Storage and Retrieval System Integrated with an HIS
Authors: Ohe K. , Sakurai T. , Nagase T. , Kaihara S. , Wang C.
Published: March 2018

For a hospital information system, object-oriented methodology plays an increasingly important role, especially for the management of digitized data, e.g., the electrocardiogram, electroencephalogram, electromyogram, spirogram, X-ray, CT and histopathological images, which are not yet computerized in most hospitals. As a first step in an object-oriented approach to hospital information management and storing medical data in an object-oriented database, we connected electrocardiographs to a hospital network and established the integration of ECG storage and retrieval systems with a hospital information system. In this paper, the object-oriented analysis and design of the ECG storage and retrieval systems is reported.
Supporting Multi-level Medical Education with Knowledge-Based Systems
Authors: Carstairs M. , King K.
Published: March 2018

Knowledge-based systems for medicine have enjoyed minimal success in developing countries as end-user systems. The reasons for this are complex. As funding agencies understandably tend to err on the side of caution, and knowledge-based systems are still (despite an almost 40 year history) seen as a new and untried technology, few have been implemented. Of those which have, most are inappropriately simple and thus do not fit in with the real-life clinical environment. In contrast to the sophisticated systems in use in developed countries which reflect a mature technology, the use of knowledge-based systems in medicine in developing countries has primarily revolved around simple ‘expert’ systems, where the program functions more as a ‘guru’ than as a support function. We propose the more appropriate use of these systems as educational tools in medicine. In this discussion paper we describe a multi-level programme to support medical education, focusing on patient information systems involving natural language generation, decision-support systems as educational aids for primary health-care workers and model-based reasoning tools which allow exploratory learning for physicans in training. Throughout this paper we refer to Knowledge-Based Medical Education Systems as KBMES.
The GP’s Dilemmas: A Study of Knowledge Need and Use During Health Care Consultations
Authors: Timpka T. , Arborelius Elisabeth
Published: March 2018

For use in system development, a method based on both qualitative and quantitative data was employed to study the difficulties – the dilemmas – a general practitioner (GP) faces during daily consultac tions. Video recordings were used for stimulated recall of the consultation. From 46 consultations, 262 dilemmas were identified by the 12 GPs involved. Medical dilemmas were encountered during three out of four consultations. Dilemmas in the communication with the patient occurred during two consultations out of three, while dilemmas in the organizational environment and dilemmas challenging the GP’s personal competence occurred during one consultation out of three, respectively. A phenomenological analysis of the comments showed that few dilemmas were described as problems during “hypothetico-deductive reasoning”. In many cases the GP found it difficult to understand the situation as a whole. Based on these qualitative data, a model of the GP’s management of ill-structured complex dilemmas is discussed and proposed, to be taken into account in the development of decision support systems for outpatient practice.
A Method for the Acquisition of Formalized Knowledge in Pathology
Authors: Jansen W. , Smeulders A. W. M. , van der Lei J. , Baak J. P. A. , van Ginneken Astrid
Published: March 2018

A tool is introduced for the acquisition of pathology knowledge in a formalized form, directly by the expert. Formalization of the knowledge is intended to make descriptive pathology knowledge more suitable for computerized diagnostic support since a formal representation of knowledge allows more extensive indexing, hence more flexible access. The knowledge acquisition (KA) tool also provides a useful research instrument to investigate to what extent pathology knowledge can be made explicit, to what degree ambiguity is present, in what way experts differ when formalizing knowledge, and whether it is feasible to incrementally acquire decision criteria on the basis of the formalized descriptive knowledge.

Crucial in the design of the KA tool is the incorporated meta-knowledge, which is reflected by the knowledge-base structure and is used to elicit knowledge from the expert. Knowledge is acquired from the expert via a menu-driven user interface, which follows the general steps of the pathologist when describing a case. The paper discusses the considerations underlying the design, the implementation of the KA tool, and the research goals.
Planning the Size of Clinical Trials with Allowance for Patient Noncompliance
Authors: Moussa M. A. A.
Published: March 2018

Various approaches are considered for adjustment of clinical trial size for patient noncompliance. Such approaches either model the effect of noncompliance through comparison of two survival distributions or two simple proportions. Models that allow for variation of noncompliance and event rates between time intervals are also considered. The approach that models the noncompliance adjustment on the basis of survival functions is conservative and hence requires larger sample size. The model to be selected for noncompliance adjustment depends upon available estimates of noncompliance and event rate patterns.
Information Exchange in a Patient-Physician Encounter. A Quantitative Approach
Authors: Ridderikhoff J.
Published: March 2018

The efficiency of data acquisition in a patient-physician encounter was investigated. In a simulation study, in which 60 family physicians and eight internists participated, the patient was replaced by an actor who used a structured set of patient data. The simulation model proved to be quite natural; data acquisition was primarily influenced by the amount of time available. Discerning between overall and diagnostic information, conclusions could be drawn on the effectiveness of data acquisition. Under time pressure, physicians tend to look for broadly defined symptoms rather than for details of the patient’s illness. The collection of patient data then has an inquisitive character, having implications for the quality of clinical judgement. The physician’s capabilities in eliciting relevant information from a patient appear to be of crucial importance for clinical problem-solving. The present study shows that patient-physician interviewing is effective insofar it concerns broad descriptions, but ineffective in eliciting specific data. If interviewing is laborious and time-consuming this may, therefore, affect the kind of information to be collected.
Is the Computer-Based Patient Record an Analog or a Model of the Patient?
Authors: Timmers T.
Published: March 2018

Response to: Kluge E-HW Advanced patient records: some ethical and legal considerations touching medical information space. Meth Inform Med 1993; 32: 95-103.
Predicting Fetal Chromosome Anomalies in the First Trimester Using Pregnancy Associated Plasma Protein-A: A Comparison of Statistical Methods
Authors: Brambati B. , Chard T. , Grudzinskas J. G. , Macintosh M. C. M.
Published: March 2018

The analysis of the clinical efficiency of a biochemical parameter in the prediction of chromosome anomalies is described, using a database of 475 cases including 30 abnormalities. A comparison was made of two different approaches to the statistical analysis: the use of Gaussian frequency distributions and likelihood ratios, and logistic regression. Both methods computed that for a 5% false-positive rate approximately 60% of anomalies are detected on the basis of maternal age and serum PAPP-A. The logistic regression analysis is appropriate where the outcome variable (chromosome anomaly) is binary and the detection rates refer to the original data only. The likelihood ratio method is used to predict the outcome in the general population. The latter method depends on the data or some transformation of the data fitting a known frequency distribution (Gaussian in this case). The precision of the predicted detection rates is limited by the small sample of abnormals (30 cases). Varying the means and standard deviations (to the limits of their 95% confidence intervals) of the fitted log Gaussian distributions resulted in a detection rate varying between 42% and 79% for a 5% false-positive rate. Thus, although the likelihood ratio method is potentially the better method in determining the usefulness of a test in the general population, larger numbers of abnormal cases are required to stabilise the means and standard deviations of the fitted log Gaussian distributions.
Virtual Reality in Medicine
Authors: Kaltenborn K.-F. , Rienhoff O.
Published: March 2018

Virtual reality (VR), as part of computer science, allows computer-based models of the real world to be generated, and provides humans with a means to interact with these models through new human-computer interfaces and, thus, to nearly realistically experience these models. This contribution explores the technical requirements for VR, describes technological advances and deficits, and analyzes the framework for future technological research and development. Although some non-medical applications are discussed, this contribution focuses primarily on medical applications of VR and outlines future prospects of medical VR applications. Finally, possible hazards arising from the use of VR are discussed. The authors recommend an interdisciplinary approach to technology assessment of VR.
Representation of Medical Concepts of the Thyroid Gland by Physicians in Anatomy and Pathology
Authors: Bastien C. , Roux M. , Pellegrin L.
Published: March 2018

An experimental study in cognitive psychology is described, concerning the categorization of medical concepts into specific classes, expressed by physicians specialized in anatomic pathology consultations of the thyroid gland. This study belongs to a medical computer science project, called ARISTOTLE, concerning Natural Language Processing of specialized medical reports in anatomic pathology of the thyroid gland. This research has been done for two reasons: first, to specify the characteristics of human expert categorization in an area of medical knowledge and, secondly, to validate the hierarchical organization of a prototype declarative knowledge base. In this experiment, physicians were asked to categorize 121 concepts into 10 proposed classes. These classes and concepts belong to expert knowledge represented in a conceptual graph that was constructed before the experiment. Results show variable semantic distances between concepts of a same class, and dynamic variations of these distances due to contextual representation.
Data Management in an Epidemiological Study : Experiences from the Iowa 500 Field Follow-up and Family Study
Authors: Woolson R. F. , Tsuang M. T. , Urban L. R.
Published: March 2018

We are now conducting a forty-year follow-up and family study of 200 schizophrenics, 325 manic-depressives and 160 surgical controls. This study began in 1973 and has continued to the present date. Numerous data handling and data management decisions were made in the course of collecting the data for the project. In this report some of the practical difficulties in the data handling and computer management of such large and bulky data sets are enumerated.
Formal and Simulation Models for a Phlebotomy Station Service System
Authors: Whitcomb C. C.
Published: March 2018

The behavior of a central phlebotomy station for an out-patient medical care facility is analyzed by a formal service system model (queuing theory) and by a computer simulation model. Although the distributions of the intervals between successive patient arrivals and the duration of individual phlebotomies do not conform to the requirements of the formal model, some calculated system characteristics, such as the efficiencies of individual phlebotomists, agree quite closely with the results generated by simulation. The two models yield different values for the optimal number of phlebotomists in an econometric analysis, however.
How to Organize the Medical Data of Chronically Ill Patients in the Computer
Authors: Martin J. M. , Jabot F. , Marrel P.
Published: March 2018

The problems of aiding in the medical decision-making process are very important today, especially through the use of artificial intelligence methods. Before studying these problems, it is necessary to have an excellent availability of relevant medical patient health data as well as medical knowledge.

The computer is well adapted for the task of satisfying this essential condition; but in order to accomplish this goal, it is necessary to develop an efficient system of data organization. The current system of sequential organization of medical histories is most likely not the best possible method of data filing. Furthermore, at the present time there are only a small number of relations (in the mathematical sense) between these health data. This situation is not favorable to the development of a relational data base.

This article proposes an organization of health data which is relative to the patient. The organization is based on the notion of a medical entity and on the three-dimensionality of health data.
Selection and Assessment of Laboratory Tests for the Evaluation of Liver Functional Impairment
Authors: Belforte G. , Bona B. , Cravetto C. , Frediani S. , Milanese M. , Molino M. , Saitta L. , Tempo R.
Published: March 2018

A large number of biochemical tests is at present available for the evaluation of the different aspects of the liver function. As a consequence, the requirement of laboratory investigations is generally increasing in clinical practice. However, the usefulness of such a tendency in liver investigation is questionable: the doubt concerns both the diagnostic efficacy of new individual tests and the opportunity of a progressive increase in tests requirement.

This paper deals with the problem of selecting liver tests on the basis of their information content with respect to different aspects of liver function. The study was performed on 288 normal and pathological subjects. Two different methods were used: a classical statistical feature selection method, and a method based on the probability theory developed in the framework of the fuzzy sets theory. The ranking of the tests was based on the estimated misclassification rate.

The results obtained appear quite relevant from a practical point of view: no effective improvement in liver functional assessment is reached by using more than 3 or 4 selected tests among the many available for each of the functional aspects considered.

A reasonable compromise between diagnostic efficacy, feasibility, and costs indicates that the following groups of tests could be proposed for the functional assessment of liver diseases in clinical routine: Albumin, Pseudo-cholinesterase, and Prothrombin Time for biosynthesis and metabolism; Bilirubin, Gamma-glutamyl-transpeptidase, Bile Acids (fasting) for cholestasis; Aspartate Aminotransferase, Alanine Aminotransferase, Isocitrate-dehydrogenase, for cytolysis; Gamma-globulin, G, A and M Immunoglobulin for reactivity.
Comments on the Logistic Function in ROC Analysis: Applications to Breast Cancer Detection
Authors: Haberman Joann , Goin J. E.
Published: March 2018

ROC analysis is rapidly becoming the method of choice for determining the performance of diagnostic imaging techniques. This discussion is intended to provide scientists working in diagnostic imaging with a more in-depth view of the detection task analysis than is currently available in the statistical methodology literature. The logistic function is defined and its utility is illustrated by analyzing two breast cancer detection modalities.
Measuring the Change in Contingency Tables Using Markov Models — Application to the Effect of Preceding Conception on the Next one
Authors: Saleh A. K. , Moussa M. A. A. , Hathout H. , Kasraoui R.
Published: March 2018

A method is described for the analysis of time sequence data viewed as contingency tables. This includes 1.) determining the maximum likelihood estimates of stationary and transition probabilities; 2.) testing stationarity of transition probabilities in first and second order Markov models by fitting the data to the appropriate configuration of log-linear models; 3.) assessing the order of dependence through fitting log-linear models. Data based on a study recently conducted on women delivered in the Principal Maternity Hospital in Kuwait is used for illustration. It is concluded that conception outcome depends on pregnancy order as well as on at least two previous pregnancy outcomes.
Hospital Information Systems in Japan
Authors: Lum K. C. , Watanabe R. , Kaihara S.
Published: March 2018

Hospital information systems have been in use in Japan since 1968. Yet, riot much is known in Western literature about Japanese HIS. This paper traces the historical development of HIS in e that country and discusses the strong influence of the Japanese social system. An attempt is e made to classify some of the existing varieties of HIS into four general models with examples given of each kind. Results of evaluations of some of these systems in terms of acceptance by doctors and of hospital and patient management efficiency are also discussed. ment, Japan
Use of Probability Estimates in Medical Communications and Decisions
Authors: Swets J. A. , Feehrer C. E. , Greenes R. A. , Bynum T. E.
Published: March 2018

Quantitatively sophisticated physicians in general internal medicine gave a series of probability estimates about each of several cases, which consisted of a written case background and radiological test report. First, they estimated the three quantities of Bayes’ formula: the pretest probability based on the background, the likelihood ratio based on the test report, and the posttest probability based on both. They made two further estimates of the posttest probability, one after being informed of the consensus of expert radiologists on the likelihood ratio of the test and another after being told a consensus pretest probability formed by experts in the medical speciality relevant to the case backgrounds. They also stated how high (low) the posttest probability would have to be in order to confirm (rule out) the suspected disease and estimated the chances that the test report would serve to move the posttest probability across one of those thresholds.

On average, the clinician subjects agreed quite well with the experts’ estimates and with Bayes’ formula. Information about experts’ consensuses influenced the subjects’ estimates in the appropriate direction and decreased the variation among subjects. These results are taken to indicate the feasibility and potential effectiveness of certain quantitative aids to clinical decision making. On the other hand, the variation among the subjects’ estimates, and among experts’ estimates, was substantial - enough to warrant attempts to understand it and to reduce it. Diagnostic criteria that the subjects reported using for case backgrounds and for test reports were analyzed as a way of accounting for some of the variation.
Decision Analysis in Individual Clinical Decision Making : A Real-World Application in Treatment of Renal Disease
Authors: Pliskin J. S. , Beck C. H.
Published: March 2018

The methodological framework of decision analysis is applied to a given physician’s decision making process with respect to a given, identified patient. The paper demonstrates how some of the subjective assessments and value judgments can be systematically incorporated and applied in a real-world setting. Direct subjective assessment of all probabilities was necessary because the specific characteristics of the given patient did not enable use of data in the literature. Explicit tradeoffs between longevity and quality of life were elicited from the decision maker and used in quantifying his relative preferences for the possible outcomes. The paper demonstrates the usefulness of decision analysis in structuring and analyzing a real-world problem, especially one where little or no data are available.
Methodology for International Drug Monitoring
Authors: ROYALL B. W. , VENULET J.
Published: March 2018

Because of increasing evidence that the adverse effects of therapeutic drugs often present serious hazards to patients and that available knowledge and experience in this field were not considered to be sufficiently well developed to provide adequate protection against such situations in the future, WHO has been requested to undertake a feasibility study in the field of international co-operation in drug monitoring.

The present paper includes (1) the exploratory activities which preceded and led to the implementation of the WHO Pilot Research Project for International Drug Monitoring, (2) the basic concept and description of methodological research and development undertaken during the pilot phase.
Eine maschinelle Methode zur EEG-Klassifikation
Authors: PFURTSCHELLER G. , KOCH W.
Published: March 2018

Bei der automatischen EEG-Klassifikation wird ein Zeichen, bestehend aus mehreren EEG-Parametern, einer bestimmten Klasse (z. B. Bewußtseinszustand oder pathologischer Gehirnzustand) zugeordnet. Voraussetzung dafür ist die Festlegung jeder Klasse durch eine -möglichst große Zahl bereits erkannter Zeichen. Zweckmäßigerweise wird man für die Gewinnung der Parameter eine EEG-Analyse durchführen, wobei z.B. die Band-Leistungen oder mittleren Dauern einzelner Rhythmen in den Untersuchungsintervallen errechnet werden.

Beschrieben wird die maschinelle EEG-Klassifikation (computerunterstützte EEG-Diagnose) nach einem Verfahren der Mustererkennung anhand eines praktischen Beispiels, über die Voraussetzung dafür, nämlich die computergerechte Datenaufbereitung und die Gewinnung der EEG-Parameter über eine PeriodenAmplitudenanalyse, wird kurz berichtet.
Untersuchungen an einem diagnostischen Simulationsmodell
Authors: KOLLEB S. , MICHAELIS J. , SCHEIDT E.
Published: March 2018

Es wird ein Simulationsverfahren für eine Krankheit und eine Vergleichsgruppe Nichtkranker dargestellt, bei dem aus 10 Zufallszahlen 20 Alternativ-Symptome unter Nachahmung pathophysiologischer Verflechtungen abgeleitet wurden. An diesem Modell wird die Brauchbarkeit des Simulationsverfahrens zur Analyse von Problemen der algorithmischen Diagnostik demonstriert. Die Ergebnisse gelten nur für das Modell; die Prüfung ihrer Verallgemeinerungsfähigkeit erfordert weitere Untersuchungen.

Die diagnostischen Verfahren ohne Berücksichtigung der Symptomkorrelationen (Linearkombinationen mit verschiedenen Symptom-Gewichtungen) ergaben bei 600 Fällen und Anwendung des diagnostischen Algorithmus auf dieselben Fälle Erfolgsquoten um 92%. Die einzelnen Gewichtungsverfahren unterschieden sich relativ wenig voneinander. Die Berücksichtigung der Korrelationen zwischen den Symptomen erfolgte mittels der linearen und quadratischen Diskriminanzanalyse, die mit 93% die besten Ergebnisse überhaupt ergab.

Die Verfahren waren unerwartet robust gegenüber Verletzungen der mathematischen Voraussetzungen, insbesondere hinsichtlich der Unabhängigkeit der Symptome bei den linearen Gewichtungsverfahren und der Normalverteilung bei der Diskriminanzanalyse. Die Probleme der diagnostischen Entscheidung im Unsicherheitsbereich wurden modellmäßig erörtert; sie sind methodisch noch nicht befriedigend geklärt.

Das Simulationsmodell erlaubt die Untersuchung der Unterschiede der Erfolgsquote bei Rediagnostik der zur Parameterschätzung benutzten Fälle und bei Neudiagnostik anderer Fälle in Abhängigkeit von der Fallzahl. •

Verschiedene Modifikationen der Gewichte, u. a. auch die Zusammenfassung mehrerer Variabler und die Verwendung geeigneter, als Klassen quantitativer Merkmale definierter Symptome als quantitative Größen ergaben keine Verbesserung der Trefferquoten.

In mehreren Ansätzen wurde der diagnostische Lernprozeß simuliert, indem mit einer unzulänglichen Krankheitsdefinition bei wenigen Merkmalen eine Einteilung in »Krank« — »Nichtkrank« begonnen wurde. Dann wurden die bei dieser Gliederung für die beiden Gruppen gefundenen Symptomhäufigkeiten einem algorithmischen Verfahren für eine neue diagnostische Stufe zugrunde gelegt; dieses Verfahren wurde mehrfach wiederholt. Die Abweichungen von den richtigen Parametern wurden nicht in den Prozeß eingeführt. Es zeigte sich, daß in diesem selbstgesteuerten Lernprozeß schon nach wenigen Schritten eine von der »richtigen« nur wenig abweichende Krankheitsdefinition und die im Modell maximal mögliche Trefferquote erreicht wird.
Modell zur Dimensionierung und Optimierung von Medizinischen Forschungsund Ausbildungsstätten (Klinika)
Authors: FUCHS G. , GRASTRUP-HANSEN K.
Published: March 2018

Es wird ein mathematisches Modell vorgestellt, welches erlaubt, bei Vorgabe einer großen, aber festgelegten Anzahl von Parametern die erforderliche Grundrißfläche und die Kosten für die Errichtung und Ausgestaltung einer medizinischen Forschungsund Ausbildungsstätte (eines Klinikums) zu berechnen. Die Parameter betreffen zahlenmäßige Angaben zu Studentenzahlen für die einzelnen Studienjahre, Angaben über das wissenschaftliche und nicht-wissenschaftliche Personal der einzelnen Fachabteihmgen, Art und Zahl von Forschungsräumen und Räumen für die ärztliche Versorgung ambulanter und stationärer Patienten usw. Die Bestimmungen der neuen Approbationsordnung sind dabei berücksichtigt worden. Da alle Angaben sich auf einen bestimmten Ausbauzeitpunkt beziehen, ist eine rechnerische Ermittlung von optimalen Ausbaustufen möglich. Das Modell liegt in der Form eines FORTRAN-IV-Programms vor, die Rechnungen können somit von jeder größeren EDV-Anlage durchgeführt werden.