bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowledge-Based Medical Image Analysis and Representation for Integrating Content Definition with the Radiological Report
Authors: Mezrich R. S. , Kulikowski C. A. , Gong L.
Published: March 2018

Technology breakthroughs in high-speed, high-capacity, and high performance desk-top computers and workstations make the possibility of integrating multimedia medical data to better support clinical decision making, computer-aided education, and research not only attractive, but feasible. To systematically evaluate results from increasingly automated image segmentation it is necessary to correlate them with the expert judgments of radiologists and other clinical specialists interpreting the images. These are contained in increasingly computerized radiological reports and other related clinical records. But to make automated comparison feasible it is necessary to first ensure compatibility of the knowledge content of images with the descriptions contained in these records. Enough common vocabulary, language, and knowledge representation components must be represented on the computer, followed by automated extraction of image-content descriptions from the text, which can then be matched to the results of automated image segmentation. A knowledge-based approach to image segmentation is essential to obtain the structured image descriptions needed for matching against the expert’s descriptions. We have developed a new approach to medical image analysis which helps generate such descriptions: a knowledge-based object-centered hierarchical planning method for automatically composing the image analysis processes. The problem-solving steps of specialists are represented at the knowledge level in terms of goals, tasks, and domain objects and concepts separately from the implementation level for specific representations of different image types, and generic analysis methods. This system can serve as a major functional component in incrementally building and updating a structured and integrated hybrid information system of patient data. This approach has been tested for magnetic resonance image interpretation, and has achieved promising results.
Searching for Answers on a Clinical Information System
Authors: Safran C.
Published: March 2018

We examined observational data on the use of a clinical computing system in an effort to develop an empirical model of clinicians’ information needs. Clinicians turn to information systems most often to review the results of diagnostic studies. After that clinicians turn to information systems most often for communication. Bibliographic retrieval is the third most frequent reason for use, but is an order of magnitude less frequent than either results inquiry or electronic mail. Secondary retrieval of aggregate data from a clinical database is two orders of magnitude less common than primary retrieval. In a study at our hospital, clinicians gained access to an information resource during 16% of all general medical visits of patients with human immunodeficiency virus (HIV) infection while the patient was present. Insofar as our narrow focus on the primary care of HIV infection models the larger context of clinical medicine, clinicians are most often looking at information relating to therapeutics. Whatever knowledge structures are adopted, they must accommodate this observed need for therapeutic information.
The CARE Telematics Network for the Surveillance of Influenza in Europe
Authors: Bensadon M. , Strauss A. , Snacken R.
Published: March 2018

Since the 1950s, national networks for the surveillance of influenza have been progressively implemented in several countries. New epidemiological arguments have triggered changes in order to increase the sensitivity of existent early warning systems and to strengthen the communications between European networks. The WHO project CARE Telematics, which collects clinical and virological data of nine national networks and sends useful information to public health administrations, is presented. From the results of the 1993-94 season, the benefits of the system are discussed. Though other telematics networks in this field already exist, it is the first time that virological data, absolutely essential for characterizing the type of an outbreak, are timely available by other countries. This argument will be decisive in case of occurrence of a new strain of virus (shift), such as the Spanish flu in 1918. Priorities are now to include other existing European surveillance networks.
Correction of Risk Estimates for Measurement Error in Epidemiology
Authors: Bashir S. A. , Duffy S. W.
Published: March 2018

Epidemiologists are under considerable pressure to acknowledge the presence of measurement error in the determination of risk factors. Repeatability and validation studies are often prescribed in conjunction with epidemiological studies. We describe some practical uses for repeatability and validation study data, in terms of correcting risk estimates for measurement error. Commonly available methods are described, with their advantages and shortcomings. A user-friendly computer program to carry out the analyses described accompanies the paper.
Managing Different Time Granularities of Clinical Information by an Interval-based Temporal Data Model
Authors: Pinciroli F. , Pozzi G. , Combi C.
Published: March 2018

In the field of databases, time management at different levels of granularity has been an issue for several years, for instance when dealing with clinical information from different databases using different time units, dealing with natural language expressions, or when dealing with temporal uncertainty. A temporal data model is proposed to manage the temporal aspect of data, presented at various and mixed levels of granularity. The concept of temporal assertions shapes the entire temporal information. The model provides a temporal dimension to the data by using intervals that can be specified at different granularities. The model supports a three-valued logic, where True, False and Undefined are the truth values. The temporal data model allows to manage some degrees of uncertainty when establishing temporal relationships between intervals or between temporal assertions, expressed at different granularities. The logical connectives and quantifiers can manage each of the three truth-values.

We applied the temporal data model by implementing an object-oriented database system for managing follow-up clinical data from patients who underwent percutaneous transluminal coronary angioplasty.
Evaluation of Techniques for the Presentation of Laboratory Data. I: Time Needed for Interpretation
Authors: Hoeke J. O. O. , Bonke B. , van Strik R. , Gelsema E. S. , Verheij R.
Published: March 2018

Four tabular and two graphical techniques for the presentation of laboratory test results were evaluated in a reaction-time experiment with 25 volunteers. Artificial variables and values were used to represent sets of 12 laboratory tests to eliminate the possible effects of clinical experience. Analyses focused on reaction times for correctly classified sets of data. For comparable data sets, Presentation Techniques (PT) that use color, always allow faster interpretation than PTs that do not use color, or use only a simple marker. Color-coded tables yielded an improvement in median reaction time of approximately six times or better, as compared to the reference PT (a tabular PT without any hints). For the color-coded graphs, the improvement rate was approximately 2.5 or better.
On the Optimization of Cholesterol Screening
Authors: Milsum J. H.
Published: March 2018

Total serum cholesterol is a major risk factor for Coronary Heart Disease (CHD). Some guidelines have been published regarding treatment levels. However, before implementing cholesterol screening, the costs and benefits should be analyzed as a function of cholesterol level. Analysis is readily implemented on microcomputer spreadsheets using decision tree analysis. Because it is very difficult to establish some of the costs satisfactorily, the facility of spreadsheets in performing sensitivity analysis is crucial. Here, plausible numerical values are used as “default” conditions for estimating in a preliminary way the costs and benefits of a putative screening-intervention program. The cost-benefit condition remains very close to optimal over the range 200-240 mg/dl for cholesterol marker level. The optimal condition may shift considerably when the default parameter values are altered. With the default values, the maximal net benefit is around 5% of the estimated current costs of CHD deaths without screening.
Algorithms for Bayesian Belief-Network Precomputation
Authors: Herskovits E. H. , Cooper G. F.
Published: March 2018

Bayesian belief networks provide an intuitive and concise means of representing probabilistic relationships among the variables in expert systems. A major drawback to this methodology is its computational complexity. We present an introduction to belief networks, and describe methods for precomputing, or caching, part of a belief network based on metrics of probability and expected utility. These algorithms are examples of a general method for decreasing expected running time for probabilistic inference.

We first present the necessary background, and then present algorithms for producing caches based on metrics of expected probability and expected utility. We show how these algorithms can be applied to a moderately complex belief network, and present directions for future research.
Maximum Likelihood Estimation and Testing of a Poisson Regression Model
Authors: Wan J. Y. , Galecki A. T.
Published: March 2018

A Poisson regression model is proposed for the analysis of incidence rates presented in a two-way table classified by two categorical variables. It is shown that the likelihood function is the same as that using Glasser’s exponential covariate model. An algorithm is given to solve the maximum likelihood estimates of the regression parameters. The model is evaluated via deviance and the method is illustrated with an example. Some extensions of the model are discussed.
Criteria for Screening Diabetes Mellitus Using Serum Fructosamine Level and Fasting Plasma Glucose Level
Authors: Kiyose H. , Ito K. , Iwatsuka T. , Kawai H. , Goto Y. , Kondo K. , Sasamori N. , Suzuki K. , Suzuki T. , Tanaka G. , Tamai M. , Yamazaki S. , Yoda T. , Kasezawa N.
Published: March 2018

A screening method using serum fructosamine level and the fasting plasma glucose level was used for screening patients with diabetes mellitus. The criteria for positive tests recommended by the Japanese Society of Multiphasic Health Testing and Services were evaluated. It was found that levels for the serum fructosamine of 290 µmol/l or higher (or, for the fasting plasma glucose of 110 mg/dl or higher) agreed with the standard oral glucose tolerance test in identifying patients with diabetes mellitus in 96.7% of cases, and the serum fructosamine test was simpler and less expensive.
Economic Evaluation of a Ninngen-Dokku (Medical Checkup)
Authors: Shimizu T. , Suzuki T.
Published: March 2018

An economic evaluation of a medical checkup center (Ninngendokku, “human dry dock”) was conducted from two perspectives: the cost for cancer checkup, and the cost for medical treatment after a diagnosis was obtained. We studied the cost of diagnosing cancer, compared with the cost required when cancer of an individual organ was detected through mass health testing, and studied the economics of a Ninngendokku according to Kawai’s method of medical judgment. Assuming that the cost of death is more than the cost of saving the lives of persons who undergo the Ninngen-dokku, the Ninngen-dokku will be affordable. In the group undergoing the Ninngen-dokku compared with the group which did not, the estimated cost of medical treatment was reduced. The Ninngendokku carries advantages that cannot be quantified in financial terms; therefore, a multi-layered economic analysis of the Ninngen-dokku was required.
Physiological Age-Related Changes: Cross-Sectional and Longitudinal Studies
Authors: Lengyel É , Regius O. , Beregi E.
Published: March 2018

Physiological age-related changes were investigated by cross-sectional and longitudinal studies. The data of the study were derived from volunteers admitted to the Gerontology Center in Budapest. In the follow-up study 864 subjects took part, and in the cross-sectional study 2,281 individuals. The 20-year longitudinal study and the cross-sectional examination showed that from a clinical standpoint the most important observation is that several biochemical data do not change with age. No changes were found in the values in erythrocyte sedimentation, hemoglobin, hematocrit, serum total protein, albumin, liver function, glucose, creatinine, triglyceride, and HDL-cholesterol levels. Changes were observed in the levels of HDL-cholesterol, immunoglobulins, rheumatoid factors, antinuclear factors, morphology of lymphocytes, serum TSH and T3 concentration, and systolic blood pressures.
Documenting an Event and its Evolving Meaning
Authors: van Ginneken A. M.
Published: March 2018

Response to: Buekens F, Ceusters W, De Moor G. The Explanatory Role of Events in Causal and Temporal Reasoning in Medicine. Meth Inform Med 1993; 32: 274.
Marking Up is Not Enough
Authors: Rector A. L.
Published: March 2018

Response to: Essin DJ. Intelligent processing of loosely structured documents as a strategy for organizing electronic health care records. Meth Inform Med 1993; 32: 265.
A New Method to Study Blood Pressure, Heart Rate and EEG as a Function of Reaction Time
Authors: Värri A. O. , Grote L. , Penzel T. , Cassel W. , Peter J. H. , Hasan J.
Published: March 2018

A new method is presented to study the relationship between reaction time and blood pressure, heart rate and EEG. The method consists of a simultaneous recording of continuous invasive or non-invasive arterial blood pressure, ECG, EEG, EMG and EOG in a sound-isolated chamber while a monotonous visual reaction time test is running for about 90 minutes. The signals are A/D-converted and analyzed digitally after recording. One second average amplitudes are computed. Systolic, mean and diastolic blood pressure values are calculated, and the EEG is divided into the delta, theta, alpha, sigma and beta frequency bands. The signal amplitudes are averaged in three different reaction time categories, i. e., when the reaction is normal, delayed or missing. Preliminary tests suggest that interesting differences can be observed in the studied variables in different reaction time classes. This method can also be applied to the investigation of autonomic control and to treatment studies.
DC-level Detection of Burst-Suppression EEG
Authors: Lipping T. , Loula P. , Jäntti V. , Yli-Hankala A
Published: March 2018

The EEG signal is usually recorded with low time constant analog prefilters to avoid low frequency artefacts. During this kind of recording the frequency components below the cutoff frequency of the analog prefilter (usually below about 1 to 3 Hz) are lost. By visual examination of some experimental recordings taken with a higher time constant, it was noticed that during burst-suppression EEG the DC-level of the signal rises sharply when the burst begins and falls when the burst ends. Thus, a burst actually consists of a mixed frequency discharge on a pulse-like DC-shift. We developed a filter algorithm to estimate the change in the DC-level during bursts as accurately as possible.
Detection of EEG Patterns Related to Nocturnal Hypoglycemia
Authors: Gade J. , Rosenfalck A. , Bendtson I.
Published: March 2018

The aim of the project was to detect specific EEG patterns related to hypoglycemia. EEG analysis was performed using a probabilistic classifier and unsupervised learning for the construction of learning sets for the classifier. Unsupervised learning and additional tools were used in the search for EEG patterns occurring when the blood-glucose level was below the hypoglycemic threshold. The rate of these specific EEG patterns was below 5% in normal nights. In patients who were known to have no or a reduced glucagon response to hypoglycemia, the rate increased to 20-80%.
How to Correct for Chance Agreement in the Estimation of Sensitivity and Specificity of Diagnostic Tests
Authors: Brenner H. , Gefeller O.
Published: March 2018

The traditional concept of describing the validity of a diagnostic test neglects the presence of chance agreement between test result and true (disease) status. Sensitivity and specificity, as the fundamental measures of validity, can thus only be considered in conjunction with each other to provide an appropriate basis for the evaluation of the capacity of the test to discriminate truly diseased from truly undiseased subjects. In this paper, chance-corrected analogues of sensitivity and specificity are presented as supplemental measures of validity, which pay attention to the problem of chance agreement and offer the opportunity to be interpreted separately. While recent proposals of chance-correction techniques, suggested by several authors in this context, lead to measures which are dependent on disease prevalence, our method does not share this major disadvantage. We discuss the extension of the conventional ROC-curve approach to chance-corrected measures of sensitivity and specificity. Furthermore, point and asymptotic interval estimates of the parameters of interest are derived under different sampling frameworks for validation studies. The small sample behavior of the estimates is investigated in a simulation study, leading to a logarithmic modification of the interval estimate in order to hold the nominal confidence level for small samples.
An International Health/Medical Informatics Programs Database
Authors: Protti D. J. , Douglas J. V. , Ball M. J.
Published: March 2018

The University of Maryland at Baltimore has established a database of health/medical informatics programs worldwide. Since 1991, IMIA’s Working Group on Education and Training in Medical Informatics has provided guidance on critical issues of policy and purpose. At the Heidel-berg/Heilbronn Working Conference in 1992 on Health/Medical Informatics education, representatives to WG1 and participants made suggestions regarding database intent, structure, and attributes.
Alternatives to Bayes?
Authors: Fox J. , Barber D. , Bardhan K. D.
Published: March 2018

Recent proposals have suggested that rule-based systems of diagnostic inference are an attractive medium for computer-aided diagnosis, in part because clinicians find their behaviour easy to understand. Bayesian systems have been more prominent in this field to date, but no direct comparison of their clinical abilities has been reported. A rule-based system that was closely modelled on clinical thinking is described and a quantitative comparison with a successful Bayesian system for the diagnosis of »dyspepsia« is presented. The results suggest that the rule-based approach may have considerable potential as an efficient alternative to Bayesian inference.
Knowledge Acquisition for Expert Systems: Experience in Leukaemia Diagnosis
Authors: Fox J. , Myers C. D. , Greaves M. F. , Pegram Susan
Published: March 2018

EMYCIN was used to develop an expert system for the interpretation of immunological data obtained in the cell surface phenotyping of leukaemia. Access to a recognised expert, and a large quantity of data on the leukaemias, has facilitated a systematic study of knowledge acquisition and knowledge base refinement based on tape recorded commentaries made by the expert. System performance was analysed at six stages in its development, and ways in which it differed from that of the human diagnostician were identified. Among the most suggestive observations were differences in the way that “undiagnosable” patients were treated and a failure of the elicitation technique to reveal structural aspects of the task. The tools and techniques of knowledge engineering are a significant advance, but a better methodology for developing high quality knowledge bases is needed.
Formal Education in Medical Informatics
Authors: Möhr J. R. , Leven F. J. , Rothemund M.
Published: March 2018

A specialized curriculum for education in medical informatics at university level was initiated jointly by the University of Heidelberg and the Polytechnical School of Heilbronn in 1972. The experience gained during the past decade is reviewed as an example of a curriculum of applied informatics in general and of medical informatics in particular. For this purpose, the underlying basic concept is described and its realization in the current third version of the curriculum specified in some detail. In particular, its practice-oriented didactic concepts are emphasized. The concept and its realization are discussed on the basis of a review of the experience of 51 graduates.
The Biomedical EDP User—his Expectations and Impressions from the Use of Terminals
Authors: Pilgrim J.
Published: March 2018

Having outlined the problems and characteristics of the user’s attitude toward EDP, results are presented attempting to assess the effects of display-oriented computer use by biomedical staff. Expectations and real effects of terminal use obtained from three different user groups have been taken as a basis. The mental and physical load experienced by them and factors of personality are discussed, and conclusions are drawn. It has become evident that the design of communicative relations is essential for more effective EDP use in biomedical research.
A Curriculum for Documentalists in the Biosciences
Authors: Wolters E.
Published: March 2018

At the Hannover Polytechnic (Fachhochschule Hannover, Fachbereich BID) curricula for documentalists and librarians have been established in 1980. The main goal of the course “Bioscientific Documentation” has been the integration of traditional document handling techniques with modern information management in the biosciences, so creating a new type of profession.

After graduation of the first classes of students, fine tuning of the curricula took place according to the experience gained.
Treatment of Uncertainty in an Oncology Protocol by Probabilistic and Artificial Intelligence Approaches
Authors: de Rosis Fiorella , Steve G. , Biagini C. , Maurizi-Enrici R.
Published: March 2018

The decision process for diagnosis and treatment of Hodgkin’s disease at the Institute of Radiology of Rome has been modelled integrating the guidelines of a protocol with uncertainty aspects. Two models have been built, using a PROSPECTOR-like Expert System shell for microcomputers: the first of them treats the uncertainty by the inferential engine of the shell, the second is a probabilistic model. The decisions suggested in a group of simulated and real cases by a section of the two models have been compared with an “objective” final diagnosis; this analysis showed that, in some cases, the two models give different suggestions and that “approximations” of the shell’s inferential engine may induce wrong conclusions. A sensitivity analysis of the probabilistic model showed that the outputs are greatly influenced by variations of parameters, whose subjective estimation appears to be especially difficult. This experience gives the opportunity to consider the risks of building clinical decision models based on Expert System shells, if the assumptions and approximations hidden in the shell have not been previously analyzed in a careful and critical way.
Measuring the Certainty of a Decision Rule with Applications in Electrocardiography
Authors: Lesaffre E. , Willems J. L.
Published: March 2018

As an extension of recent work, several types of uncertainty involved in a decision process are further clarified in this paper. The concept of allocation with ß-confidence and the ß-doubt matrix are illustrated by two electrocardiographic data sets. These data sets illustrate the importance and the novelty of the above concepts. We argue for augmenting the classical correct classification rate with an interval estimate. We think that interval estimates are essential in the area of prediction modelling to refrain the user from being too optimistic.
Dynamics and Administrative Behavior of a Multi-Disciplinary Medical Center
Authors: Engelbrecht R. , Schmeetz H.-D. , Laude G. , Gaertner H.-O. von , Reichertz P. L.
Published: March 2018

The organizational structure of the Medical School Hannover is described. Information flow connects the different clinical structures. Existing EDP-based systems, the functional characteristics of which are described, are able to determine part of this flow. Characteristic parameters are found from the measurements for single organizational units. These parameters allow first descriptions of the system. They also provide an entry point for a possible steering and tuning of the system. First results of such an intervention are discussed.
Practical Application of Computer-Assisted Decision-Making in an Antenatal Clinic — A Feasibility Study
Authors: Anderson G. , Llerena C. , Davidson D. , Taylor T. R.
Published: March 2018

A feasibility study is described involving the use of a computer program in an antenatal clinic whose decisions were based on the observed policies of the group of obstetricians running that clinic. In 200 test cases the programme successfully detected all »at risk« cases at the first visit. Abnormalities appearing at later visits were all detected and appropriate investigations ordered by the programme. The programme ordered rather more investigations than the obstetrician and this difference has been investigated, in some detail with reference to the full blood count, glucose tolerance test and the ultrasonogram.

Since all of the basic data in the proposed clinic would be collected by the clerical staff or midwives, a comparison was made between two midwives and an obstetrician in estimating fundal height. The small number of discrepancies found was not regarded as serious from the viewpoint of the proposed clinic.

This preliminary study suggests that the technique described might play a useful part in some areas of ante-natal care by relieving the obstetricians of much of the workload associated with routine cases and enabling the midwife to play a larger role in ante-natal care.
Evaluation of a Questionary
Authors: YOUNG D. W.
Published: March 2018

A description is given of the construction and contents of a general medical questionary. The questionary is designed as a screening device, to localize the areas of the patients history which are of most interest. The evaluation of the questionary involves interviewing patients, to determine, as far as possible, their complaints, and then comparing this information with that obtained by the questionary. The results obtained are expressed according to certain properties of questions and questionaries. These values are used to show to what extent the questionary is successful as a screening instrument.
Beitrag zur Datenverarbeitung in der Anaesthesiologie
Authors: Wawersik J. , Köhler C. , Wagner G.
Published: March 2018

Die Arbeit stellt einen in praxi bewährten Narkose-Dokumentationsbogen vor, der dazu dienen soll, den Betriebsablauf einer Anaesthesie-Abteilung und ihre Inanspruchnahme in verschiedenen medizinischen Fachbereichen zu erfassen, über die Angemessenheit der angewendeten Narkosetechnik und Allgemeinbehandlung und ihre Beziehungen zum Risiko des Patienten und zur Komplikationshäufigkeit während der Narkose Auskunft zu geben sowie Zusammenhangsfragen zwischen Narkosetechnik, Narkotika und Komplikationen zu untersuchen. Dabei wird auch das Problem einer sinnvollen Datenreduktion unter dem Aspekt einer zweckmäßigen Tabellenauswahl für Ort und Art des operativen Eingriffs, Narkotika und Komplikationen während der Narkose diskutiert.
An Evaluation of Index Medicus in Rheumatology: Coverage, Currency and Efficiency
Authors: Thorpe P.
Published: March 2018

This study shows that Index Medicus provides good coverage of the rheumatology periodical literature, and that there is a median time delay of 4.5 months between the appearance of the original article, and the appearance of the index entry. An analysis of the recall and precision ratios applicable to Index Medicus in this field proved rather difficult because of the experimental conditions. However, the results obtained were considered reasonable.
Datenerhebung und Datenfixierung beim computerunterstützten Arztbrief
Authors: Fuchs G. , Walter H.
Published: March 2018

Die freiformulierten Arztbriefe der Krankenhausärzte sind im allgemeinen keine geeignete Grundlage zur Gewinnung von Daten für eine medizinische Basisdatei. Auf der Suche nach einem EDV-gerechten Eingabebeleg, der den Arzt nicht zu sehr überfordert, wurden eine größere Zahl von Arztbriefen bzw. Epikrisen aus den verschiedenen Fachabteilungen eines Klinikums hinsichtlich ihres Inhalts und ihres logischen Aufbaus analysiert. Die Ergebnisse legen nahe, den Ärzten die herkömmliche Arztbrieferstellung zu ersparen und ihnen stattdessen für ihre Stichworte zur Epikrise einen teilformatierten Bogen zur Hand zu geben. Aus den Daten dieses Bogens muß es möglich sein, ohne größere Rückfragen den Eingabebeleg für die medizinische Basisdatei zu erstellen.
Evaluation of a Periodic Multiphasic Health Checkup
Authors: Dales L. G. , Friedman G. D. , Collen M. F.
Published: March 2018

A controlled trial aimed at testing the efficacy of periodic Multiphasic Health Checkups in preventing or postponing morbidity, disability, and death has been in progress since 1964. After seven years of follow-up the most striking findings are: 1) a reduction in self-reported disability among men aged 45—54 at entry who were urged to take the periodic checkups; and 2) in the urged group as a whole, a reduction in mortality from a collection of causes deemed beforehand to be potentially postponable through use of periodic checkups. There are no strong indications that chance fluctuation, selective loss to follow-up, selective under-reporting, or initial health status discrepancies can explain the mortality difference.
Consequence Evaluation in Decision Analytic Models of Medical Screening, Diagnosis, and Treatment
Authors: Hershey J. C.
Published: March 2018

This paper examines the problem of assigning values, or utilities, to separate consequences in decision analytic models of medical screening, diagnosis, and treatment. Several important issues related to this problem are studied, and a number of methodologies proposed for various applications are reviewed in relation to these issues. Finally, suggestions for future research in this area are proposed.
Systemanalyse in einem Universitätskrankenhaus als Vorbereitung für den Aufbau eines klinischen Informationssystems
Authors: Esser K. J. , Repges R.
Published: March 2018

Im Rahmen der Umstellung einer Klinik auf elektronische Datenverarbeitung mit dem Ziel des Aufbaus eines klinischen Informationssystems wird über das Ergebnis einer Systemanalyse berichtet.

Die Analyse der Daten führt zu der Aufstellung von Dringlichkeitslisten für die einzelnen Abteilungen. Aufgrund dieser Kriterien konnte ein Konzept für die geordnete Entwicklung aufgestellt werden.
Automation Techniques in Personality Assessment: A Frontier in Behavioral Science and Medicine
Authors: Pearson J. S. , Swenson W. M.
Published: March 2018

A program is described for the development and implementation of a scoring and interpretation technique for the Minnesota Multiphasic Personality Inventory through the use of an electronic computer. Depending upon the configural pattern of the MMPI profile, the computer automatically draws from a statement library of over 70 descriptive statements a personality summary of the salient characteristics of the patient. This summary is used by the medical consultant in dealing with his patient.

The technique has been used on over 20,000 patients at the Mayo Clinic and is currently a routine test in the medical sections. The program has undergone many modifications since its inception in 1961.

The process is described whereby the current library of descriptive statements was developed and some of the difficulties involved. It summarizes the authors’ subjective feelings about this method of personality evaluation as well as the opportunities for future research and expansion in this area.
Statistische Modelle und Versuchspläne in der Medizin
Authors: Hinkelmann K.
Published: March 2018

Am Ablaufsschema einer medizinischen Untersuchungsreihe werden Funktion und Bedeutung der Versuchsplanung und die Beziehung zu statistischen Modellen aufgezeigt. Nach einigen grundsätzlichen Bemerkungen zur Versuchsplanung werden die gebräuchlichsten Pläne mit den zugehörigen Modellen anhand von Beispielen näher beschrieben, und zwar Pläne mit zufälliger Zuordnung, Blockversuchspläne, Lateinische Quadrate, unvollständige Blockversuchspläne, faktorielle Versuche ohne und mit Vermengen und fraktionierte faktorielle Pläne.
Der individuelle therapeutische Vergleich bei chronischen Formen der Lungentuberkulose
Authors: Tünnerhoff K.
Published: March 2018

Die methodische klinische Prüfung tuberkulostatischer Substanzen vor Freigabe dieser Substanzen an die Praxis erweist sich als unbedingt notwendig. Eine bei chronischen Formen der Lungentuberkulose anwendbare Methode der Testung ist die des individuellen therapeutischen Vergleichs. Sie ermöglicht es zu entscheiden, ob 1. ein Medikament oder eine Medikamentenkombination röntgenologisch und klinisch wirksam oder unwirksam war, und 2. ob ein weiteres in der 2. Behandlungsphase angewandtes Mittel dem ersteren oder der zunächst angewandten Kombination über- oder unterlegen oder ebenfalls unwirksam geblieben war. Hierbei wird zugleich die dem ärztlichen Ethos entsprechende Forderung nach sofortiger Behandlung erfüllt wie auch die nach methodischer. Forschung, d. h. Objektivierung von Arzneimittelerfolgen.

Voraussetzung ist allerdings, daß eine gewisse Konstanz im Erscheinungsbild der Lungentuberkulose nach klinischen, laboratoriumstechnischen und röntgenologischen Kriterien eingetreten ist. Daher führt das Verfahren bei vor der fibrösen Umwandlung stehenden miliaren Tuberkulosen, bei exsudativ-kavernösen und produktiv-cirrhotischen Erkrankungsformen zum Ziel, nicht jedoch bei akuten Miliartuberkulosen, Hilusperforationen und deren rasch ablaufenden Folgeerscheinungen und bei akut verlaufenden exsudativen Tuberkuloseformen. Ebenso wird es durch interkurrent auftretende Sekundärerkrankungen und bei ungenügender Vorbehandlung gegenstandslos.

Der individuelle therapeutische Vergleich ist eine Prüfmethode, die im Rahmen der gezeigten Grenzen eine fundierte Aussage über die Wirksamkeit von Tuberkulostatika gestattet.
Modelluntersuchungen zur Genauigkeit der Schätzung von direkt nicht meßbaren Größen mit Hilfe der Faktorenanalyse
Authors: Ubebla K.
Published: March 2018

Zunächst wird der faktorenanalytische Ansatz in Form von fünf Gleichungssystemen in Matrixschreibweise dargestellt. Das erste Modellbeispiel geht davon aus, daß Factor Scores von zwei Faktoren und 200 Personen sowie daß Factor Pattern bekannt sind. Daraus wird die Datenmatrix errechnet und an ihr eine Faktorenanalyse nach der Hauptachsenmethode mit anschließender Rotation nach dem Varimaxkriterium durchgeführt. Dann werden die Factor Scores geschätzt und ihre Korrelation mit den tatsächlichen Werten (= die Validität der Schätzung) wird ermittelt. Dies wird 50mal mit verschiedenen Ausgangsdaten durchgerechnet, wobei die Korrelationen der Variablen mit den beiden Faktoren um den Wert 10,40 | schwanken. Die errechneten Validitäten der Schätzung von Factor Scores schwanken dann bei einem ersten Faktor, der durch sechs Variable repräsentiert wird, um 0,726 (Standardabweichung 0,033) und bei einem zweiten Faktor, der durch vier Variable repräsentiert wird, um 0,628 (Standardabweichung 0,051). Die Höhe der Validität der Schätzung korreliert stark mit der durchschnittlichen Korrelation der Variablen mit den Faktoren, wie sie vorgegeben sind (r = 0,91). An einem weiteren Beispiel, dem Variable aus der Bevölkerungsstatistik zugrunde liegen, wird gezeigt, daß die Schätzung von nicht meßbaren Größen mit Hilfe der Faktorenanalyse fast so genau sein kann wie die optimale Schätzung durch multiple Regression. Die Beispiele zeigen, daß es grundsätzlich möglich ist, nicht meßbare Größen zu schätzen, wenn sie mit einer Anzahl von meßbaren Variablen korreliert sind. Dies dürfte für verschiedene Anwendungen in der Medizin und Biologie wichtig sein. Eine weitere genaue Abklärung der Voraussetzungen und Bedingungen der Methodik ist geplant.
Versuch einer medizinischen Kybernetik
Authors: Schneider B.
Published: March 2018

Die Grundbegriffe, Aufgaben und Ziele der Kybernetik werden erklärt. Es wird (nach Fhank) zwischen einer technischen, materialen und formalen Kybernetik unterschieden. Alle drei Bereiche sind für die Medizin von Bedeutung.

Die Probleme der materialen medizinischen Kybernetik werden am Beispiel der Blutdruckregelung erläutert. Charakteristisch für medizinische Regelprozesse ist die Komplexität der Systeme und ihre Vermaschung mit anderen Systemen.

Die verschiedenen Möglichkeiten und Verfahren der formalen Kybernetik werden vorgestellt. Ausgehend von den einfachen Differentialgleichungen zur Beschreibung der Bevölkerungsentwicklung (aucb bei konkurrierenden Populationen) werden die wichtigsten mathematischen Methoden zur Beschreibung von biologischen kybernetischen Systemen erörtert. Die Methode der Fourier-Analyse wird am Beispiel der Blutdruckregelung demonstriert.

Abschließend wird die Bedeutung und Realisationsmöglichkeit der kybernetischen Methoden für die Klinik behandelt. Es wird gezeigt, daß diese Methoden in der Medizin analoge Aufgaben wie die chemischen und ‘physikalischen Analysemethoden übernehmen können, nämlich die Erfassung und Analyse des Informationsflusses im menschlichen Körper und in Wechselwirkung zur Umwelt. Aufgabe der kybernetischen Methoden ist es, den Arzt bei der »Informationsverarbeitung« zu unterstützen. Hierzu können technische Hilfsmittsl, wie Datenerfassungsgeräte und Computer, nützliche und unentbehrliche Hilfsfunktionen übernehmen.
Computers and Iatrocomplexities
Authors: Faer L. E.
Published: March 2018

Developments of disease hypotheses and conceptions of disease as philosophic entities have shown bursts of great advance. One just concluded includes emergence of bacteriology and virology culminating in Koch’s Postulates, which in the twentieth century were primary bases for disease study and colored all approaches to medicine.

With recent extraordinary advances in technology, medicine faces great new obligations demanding fresh approaches and untrammeled thinking for solution of problems posed. It is clear that any approach to diseases and disabilities induced by exposures to environmental pollutants must take multiple etiology into account. For example, contributing to causation of lung malignancies one must list usual dusts, radioactivity, smog, auto exhausts, cigarette smoke and genetic composition. Consideration of plural factors in genesis of environmentally associated disease leads to the hypothesis of the incremental insult, a complex and difficult conception in which must be included provision for multiple causative agents, each contributing but a fraction toward total etiology^ Computers developed to their present refinement provide necessary tools for whatever complexity required to spawn and fructify hypotheses of inter-relating associations of incremental insults leading to pathology.
Vorschläge zur Durchführung einer Befunddokumentation im Gerinnungslabor
Authors: Harms W.
Published: March 2018

Es wird ein Vorschlag für die routinemäßige Dokumentation von Gerinnungsuntersuchungen im Labor unterbreitet. Das erarbeitete Schlüsselsystem ist in seiner Konzeption entsprechend weit gestaltet, um für klinikseigene Belange freien Raum zu bieten. Der im Dokumentationsablauf Verwendung findende Belegbogen ist abgebildet. Abschließend wird die praktische Durchführung der Gerinnungsdokumentation kurz geschildert.
Syndrom und Syndromatologie in der ärztlichen Diagnose
Authors: Leiber B.
Published: March 2018

In der klinischen Krankheitslehre haben in den vergangenen Jahrzehnten die Syndrome als vorläufiges Ordnungsprinzip eine stark zunehmende Bedeutung gewonnen. Ihre ständig wachsende Zahl ist zugleich Folge und Ausdruck der gewaltigen Veränderungen, die die klinische Medizin in dieser Zeit in allen Bereichen durchgemacht hat. Sie bringen den tatsächlichen Stand unseres Wissens (oder Unwissens) besser (und ehrlicher) zum Ausdruck als der auf weiten Bereichen in voller Auflösung befindliche alte Krankheitsbegriff. Insofern dürfte der zunehmende Gebrauch des Syndrombegriffes auch möglicherweise den Beginn einer wirklich neuzeitlichen Nosologie darstellen, die inmitten eines ungemeinen Wissenszuwachses besonders auf begriffliche und definitorische Klarheit bedacht sein muß. Nach der gegebenen Definition ist ein Syndrom ein symptomatologisch einheitliches Krankheitsbild, dessen Auslösungs- und Gestaltungsfaktoren unbekannt, vieldeutig oder plurikausal sind. In diesem Sinne lassen sich je nach dem Grad des Wissens über diese Faktoren ätiologische, pathogenetische und morphologische, sowie im Sinne der Plurikausalität polyätiologische und polypathogenetische Syndrome unterscheiden. Wie bei den klassischen Krankheiten gibt es auch organische und funktionelle Syndrome. In der ärztlichen Praxis ist das Syndrom als noch deutungs- und voraussetzungsfreier Begriff mehr und mehr unentbehrlich geworden, wenngleich gerade auf dieser Begriffsebene gegenwärtig und in der Zukunft noch ständige Veränderungen eintreten werden, die aber nichts anderes bedeuten als die notwendige, fortwährende Anpassung der Begriffe an den wachsenden Erkenntnisstand.
Caveat Computator
Authors: Kuhtzke J. F.
Published: March 2018

Electronic data processing by computers is playing an increasing role in medicine as elsewhere in our society. The use of computers in medical research too often leads to the presentation of conclusions impossible to substantiate from the text. Computers require even more attention to research design and »quality control« of data-handling than non-electronic measures, since the basic data are often too massive for presentation, and the »black box« nature of the computer effectively hides the transitions between input and output. Electronic retrieval of data from narrative medical reports appears to be unfeasible in any routine setting, and medical diagnosis by computer appears totally impractical: as exemplified in multiple sclerosis, the responses of the body to varied noxae are too limited to provide sufficiently discriminatory signs and symptoms or patterns of same to permit computer appraisal.
A Computer System with Central Support for Multiple Use in General Hospitals of Varying Sizes
Authors: Haase H.
Published: March 2018

The concept of an EDP system with central support for the use in general hospitals of various sizes for the collection, storage and presentation of data for patient admission, administration and laboratory services is presented. It is an economic concept with a software independent from the size of the computer system, and it shows a simple linear growth of user demands with an increase in hardware and operating costs. It is reported that the application software can be run on various computers of different manufacturers. Data processing for administrative functions (billing etc.) is handled by an external data processing center.
Evaluation of the Symptoms of Treated Hypertensive Patients
Authors: Bulpitt C. J. , Dollery C. T.
Published: March 2018

A descriptive method has been presented to identify the symptoms of patients treated for hypertension and to determine the features producing these symptoms, including the treatment given, psychological features, the level of blood pressure, renal function, the plasma concentration of potassium, and obesity.

The study used a self-administered questionnaire, and as an illustration five symptoms have been fully analysed for 859 treated patients and the effects of obesity, impaired renal function and a low plasma potassium evaluated in a further 21 symptoms. Statistical methods included the comparison of a stepwise multiple regression approach and a maximum likelihood solution using a logistic transformation. Having selected >significant< variables from a stepwise multiple regression program, the two methods gave very similar measures of treatment and other effects.

Obesity was associated with vertigo, nocturia and palpitations. The complaints of dry mouth and a slow walking pace were more common in patients with a raised plasma urea, but no symptom could be associated with a low plasma potassium.
Computer-assisted Scheduling of Elective Admissions
Authors: Roubke T. A. , Rogebs A. C. N. , Chow M. C. , Mcfadden E. T. , Nikodem D.
Published: March 2018

This paper describes the results of calculating hospital admission dates by computer using a relatively simple scheduling process. The scheduling process was developed as an extension to an existing computer-assisted waiting list system being used in a department of Urology. Results were obtained by observing the behaviour of the system over periods of 6 months before and after extension, and by running the extended system as part of a simulation model. It is shown that the relatively simple computer scheduling process can be used to satisfactorily replace a substantial part of the former manual scheduling, and that the quality of data present in the computer-assisted waiting list system prior to extension was adequate to support the new process. The extension results in a significant saving of clinicians' time with negligible increase in running costs.
Correction of Misspellings and Typographical Errors in a Free-Text Medical English Information Storage and Retrieval System
Authors: Joseph D. M. , Wong Ruth L.
Published: March 2018

The errors studied are misspellings and typographical errors made by the physician house staff, surgical pathologists, and secretary/typists of a large teaching hospital. The 6,019 errors studies were encountered in the compilation of a LEXICON now containing 24,135 medical and non-medical terms (including errors) from Tissue Examination Request Forms and Surgical Pathology Reports. An automated error correction algorithm was sought to reduce the tedious task of manual encoding of errors, and eliminate the need for storing errors occupying 24.9% of the LEXICON storage space. The errors were classified into 23 types, and it was found that 84.2% of the errors were in the 11 first order categories.

Existing error correction algorithms were analyzed with respect to possible application to our medical sample. Two were selected for experimentation, the Baskin-Selfridge algorithm and SOUNDEX. Results showed that Baskin-Selfridge worked quite well, but was too slow to be applied singularly. SOUNDEX was reasonable in speed, but had too many mismatches to be applied singularly in a non-interactive application. SOUNDEX was modified phonologically and with respect to code length in various ways and some experimental data showed improvements.

The optimal design for the medical LEXICON sample appears to be a two-step process. The modified version of SOUNDEX will quickly select the most likely corrections for the error (experimental average is 2.38 choices/error). Then the Baskin-Selfridge will decide which, if any, is the actual correct form of the error. By only considering a very small number of choices, the time required for the Baskin-Selfridge algorithm becomes trivial.

On the basis of experimental results, it is estimated that this combination will reduce manual encoding of errors by 60—70% and reduce the storage required for the LEXICON by approximately 15%.