bluuebunny/crossref_metadata_2025 huggingface dataset:
C.A.S.M & C.A.S.T. Clinical Audit Structured Method & Clinical Audit Structured Toolset
Authors: Ellis Nicola T
Published: February 2025

This paper outlines a research project currently being conducted at the University of Central Lancashire. The project’s aims are to develop a detailed structured method for clinical audit and to construct a supporting computer based toolset to automate the process. A discussion of the background to the research and an outline of the method and toolset is portrayed.
Simulation applied to medical expert systems validation in absence of gold standard
Authors: Martin-Baranera M  , Sancho JJ  , Sanz F
Published: February 2025

An approach to medical experts system's validation in lack of gold standard is applied to the expert system PNEUMON-IA. Several human specialists' conclusions are compared to those proposed by the expert system on a random sample of cases. Different kinds of distances and a Kappa-like index are calculated to measure the agreement between pairs of experts. Simulation of non-experts is used as a lower limit reference to interpret the distance or concordance between human experts and the expert system.
Decision Support for Monitoring of Chronic Hepatitis C: Can Blood Laboratory Tests Help?
Authors: Babic Ankica  , Hedin Kristina  , Mathiesen Ulrik  , Franzén Lennart  , Frydén Aril  , Bodemar Göran  , Wigertz Ove
Published: February 2025

The activity and severity of disease in patients with chronic hepatitis C can only be reliably assessed by performing liver biopsy. Some of the histopathological changes found reflect the activity of disease (inflammation), while others represent the staging of disease (fibrosis, cirrhosis). As a complement to invasive technique, we studied the abilities of standard laboratory blood tests to monitor and assess histopathological changes in liver biopsy. Univariate and multivariate statistical analyses were applied on a clinical database to relate relevant sets of tests to inflammation, fibrosis and cirrhosis. Resulting extracted knowledge, with an ability to point out activity and severity, is used as a part of the Liver Guide, a corresponding knowledge-based decision support system, and can be propagated into clinical practice.
A Comprehensive Blood Recipient Information System - From User Requirements To Its Functions
Authors: Qiu Dan  , Junghans G.  , Kroll H.  , Reisacher A.  , Michel A.  , Marquardt K.  , Dudeck J.  , Mueller-Eckhardt C.
Published: February 2025

During developing a blood recipient information system, we have applied a special OOA method to discover objects and elicit user requirements. We find that not only those objects that are indispensable from the point of information-technical view but also those that are more familiar to the user and more interesting from the user's viewpoint should be discovered and dealt with because most of the important user requirements cluster round the latter kind of objects. In our practice, such objects are series of serological examinations and series of crossmatching tests, and the most important functions in the system have been also implemented on the basis of these objects so that the real-world situation and dynamics the system is intended to model can be tracked faithfully.
Exploring cell kinetic models within an integrated simulation environment
Authors: Werner Oliver  , Baur Hans-Jürgen  , Meinzer Hans-Peter
Published: February 2025

The understanding of the mechanisms controlling the normal (i.e. healthy) and abnormal (i.e. diseased) cell kinetic behaviour of epithelial tissues is a prerequisite for therapy. Complex control structures hierarchically organize the tissue's steady state as well as tissue response to external influences. Insight into the controls which mediate this exquisitely fine and (mostly) stable tuning is sought in cell kinetic experiments. While the hypotheses, derived from experimental observations are often very vague, consisting of informal and qualitative descriptions, a mathematical modeler, trying to formalize the experimental results, needs precise and explicit information in terms of parameters, relations etc. In order to fill this gap between informal and formal knowledge, we describe a modelling approach in which qualitative models of the tissue structure and dynamics can be built. Based on this approach a specification of a modelling and simulation environment for rapid prototyping and execution of models of cell kinetic hypotheses will be presented, supporting different states of the biological experiment, e.g. pre-experimental planning, like exploration of relevant experimental parameters, post-experimental model exploration to find new hypotheses etc. The use of the modelling and simulation environment allows a qualitative judgement of hypotheses about the cell kinetic behavior and control mechanisms.
The teaching of informatics to first-year students of Medicine and Nursing, through an interdisciplinary innovative methodology
Authors: Crudele Michele  , Binetti Paola  , Serio Angelo  , Tartaglini Daniela
Published: February 2025

Teaching informatics to first-year medical and nursing school students cannot be reduced to learning the basics of personal computer use. Students must become familiar as soon as possible with the complete information system. Through this interdisciplinary methodology they learned how to collect, structure and record data, to avoid errors and to control quality. Finally, they were able to analyze the data and discuss the results of their investigation.
Open Systems Frameworks for Health A Cross-Sector Common Approach?
Authors: Lloyd-Williams D.  , Sitruk R.  , Minter J.  , Haynes T.
Published: February 2025

This paper sets out to show that a common approach is needed for IT in health and that through Open Systems this will provide the basis for a more effective utilisation of information technology to support the business processes of health. There is a direct relationship between IT implementations, the information models and the organisational models of the hospital or health care unit. The IT implementation must reflect and support these models and this paper sets out to show how the adoption of a common approach to frameworks and architectures can enable these implementations to be put in place effectively and at the pace and budget available to the business. The key to this is the effective use of external expertise and experience, and the effective representation of the consensus of health requirements in IT to the supplier and service industries.
THE CHALLENGE OF INSTRUCTING HEADS OF MEDICAL DEPARTMENTS IN ISRAELI HOSPITALS IN THE USE OF INFORMATION SYSTEMS
Authors: Gilad Ora  , Bregman David  , Ronen Maya  , Levi Leon
Published: February 2025

Hospitals are facing a system revolution and department heads require the tools to enable them to cope with the new realities. The Ministry of Health conducted a survey to identify in-service training and instruction needs among 88 heads of medical departments in 10 hospitals. The results showed that most of them agreed that they lack managerial skills, mainly in using medical information systems. This paper describes the challenge of developing and conducting a training program on medical Informatics. The target population has unique characteristics that influence the structure of this training program. A multi-disciplinary team was assembled and it designed the course. Case studies, discussions and frontal lectures as well as demonstrations, are integrated into the course. An external professional evaluation was performed during the courses and on the filled questionnaires of the participants. The program layout was suitable and gained high satisfaction scores by the participants. The main topics that the course participation improved were the knowledge and skill of using IS in managerial processes, acquaintance with IT and its terminology, thus improving the communication with IS/IT experts. Since this experience was so fruitful, the MOH intends to expand the number of participants, to modify it to include other health care providers and to develop complementary modules which deal with other aspects of medical management.
An ontology-based framework for building economic evaluation models in health care
Authors: Quaglini S.  , Dazzi L.  , Falasconi S.  , Marchetti M.  , Stefanelli M.  , Barosi G.
Published: February 2025

This paper describes a framework which provides health care professionals with a set of tools for building decision-theory based support systems for resource management optimization of health care policies in selected areas. The generated models share a common ontology underlying the different types of represented knowledge needed to tackle budget-related decisions. Each chunk of knowledge is maintained by a specific professional, i.e. a physician, a hospital administrator, an economist, etc. Thus the resulting systems will facilitate the communication among them, allowing the physician to weigh his own opinions with constraints outlined by the administrator, and vice-versa. Another advantage is the improvement of result presentation in a standard format, that is one of the most recognized problems in the reusability of cost-effectiveness studies within different settings. The proposed framework is designed to be integrated into a distributed Health Care Information System.
Exploitation of Fuzzy Sets to Evaluation of the Concentration of Cholesterol in Persons Aged 18-65, Exemplified by the Population of a Big City
Authors: Gerstenkorn Andrzej  , Gerstenkorn Joanna
Published: February 2025

In the district Górna of Lódz (Poland), a city of nearly one million inhabitants, tests were carried out to find the concentration of cholesterol in persons aged 18-65. The evaluation of the concentration in this population was accomplished by means of the fuzzy set theory method and compared with the probability method. Interesting conclusions can incline one to apply the presented method to evaluating other epidemiological tests, as well.
Reactivity of Skin Blood Flow to Thermal Stimulation in Adults and Newborn Infants
Authors: Lindqvist Ari  , Jahnukainen Timo  , Jalonen Jarmo  , Välimäki Ilkka
Published: February 2025

We describe a method which makes it is possible to synchronise spontaneous oscillations of skin blood flow to the rhythm of an external thermal oscillatory stimulus. This test can be done totally noninvasively both in adults and newborn infants to study cardiovascular control system in health and disease.
Vertebral Wedging due to Asymmetric Loading
Authors: Mente P.L.  , Spence H.  , Stokes I.A.F.  , Aronsson D.D.
Published: February 2025

In order to study the effect of angulation and asymmetric loading on the progression of spinal curvature a rat tail model was used to apply asymmetric loading across an isolated vertebra and to measure its growth response. Two 25 mm external ring fixators were glued to pins which had been inserted percutaneously into the 8th and 10th caudal vertebra of 6-week old Sprague-Dawley rats. Calibrated springs and 15° wedges mounted on stainless steel threaded rods passing through holes distributed around the rings imposed a 30° curvature and axially loaded the vertebrae in the instrumented tail region. Fluorochrome labels and radiographs were used to document the progression of vertebral wedging. Initially the wedging was entirely in the intervertebral discs, but by 6 weeks the discs and vertebrae were approximately equally wedged. Fluorochrome labeling confirmed that the vertebral wedging resulted from asymmetrical growth in the physes. The amount of longitudinal growth in these tails was similar to that occurring during human adolescent growth.
Torsion in Lower Limb Bones of Patients with Adolescent Scoliosis (AIS) Treated Surgically
Authors: Burwell R.G.  , Kirby A.S.  , Cole A.A.  , Moulton A.  , Pratt R.K.  , Webb J.K.
Published: February 2025

In this paper we report preliminary findings in which real-time ultrasound methods was used to measure femoral anteversion (FAV) and tibial torsion (TT) in 67 operative AIS patients (54 girls and 15 boys) with a mean age of 15 years. There are 48 thoracic curves, 15 thoracolumbar curves and 4 lumbar curves. Standard deviation scores (SDSs) of FAVs and TTs were calculated using means and standard deviations from 67 normals of the same age and sex (Kirby et al this meeting). In the femora there is no detectable asymmetry of FAV and FAVs SDSs are not significantly different from the controls. In the 67 AIS patients there is TT asymmetry (mean & SD 4±9°, p<0.001) with the right TT SDSs (but not the left TT SDSs), being greater than controls. In 37 AIS girls with right thoracic curves TT asymmetry is also significantly greater than controls (p = 0.006). There is no statistical association between scoliosis curve severity (thoracic and lumbar) and each of FAV SDSs, (left and right), FAV asymmetry, TT SDSs (left and right) and TT asymmetry. Comparing 48 thoracic with 15 thoracolumbar curves, the mean left FAV SDS is significantly greater for TL than for thoracic curves (p = 0.018). The findings are discussed in relation to the neural control of proximal and distal limb musculature and spinal musculature in health, AIS subjects and school screening referrals.
Digital X-ray Image Processing Algorithms for Clinical Parameters Extraction
Authors: D'Amico M.  , D'Amico G.  , Roncoletta P.
Published: February 2025

In the clinical field a very common problem relative to the monitoring of scoliosis status and progression is the extraction of the main characteristics from a xray image. In fact, the Cobb as well as Lordosis and Kyphosis angles are world-wide used parameters to quantify scoliosis and spine deformities severity level. The measure of these parameters is usually manually obtained by the orthopaedic surgeon. This leads to a series of problems and to a great variability of the measurements obtained due to the quality of the x-ray measurements, the experience of the surgeon, the media used for the computation and so on [1]. The aim of the paper is to present an image processing procedure based on a computer vision methodology in order to reduced the uncertainty and the variability of the measure of the various angles of interest.
Shape Analysis of the Lateral and Frontal Projection of Spine Curves Assessed from Rasterstereographs
Authors: Drerup B.  , Hierholzer E.  , Ellger B.
Published: February 2025

Rasterstereographic back shape measurement and spine reconstruction (FORMETRIC system) provides frontal and sagittal projections of the symmetry line on the back and an estimate of the vertebral body line. From these curves shape parameters such as kyphotic angle, lordotic angle and scoliotic angle can be derived. However, curves and derived parameters depend on posture, i.e. posture variations may deteriorate the reliability of the measurements. This is commonly inhibited by standardization of posture. Alternatively, effects due to posture may be measured and corrected. This requires several measurements to be carried out in a series to cover a wide range of postures - though by varying one parameter of posture only. For the example of trunk inclination and its effects on the kyphotic and lordotic angle the method is demonstrated to provide superior results. The situation is more complicated in scoliosis.
Accuracy and Repeatability of Spinal Asymmetry Measurements using Surface Topography With and Without Upper Body Fixation
Authors: Griffiths C.J.  , FitzGerald J.E.  , Tweedie R.J.  , Gibson M.  , Leonard M.A.
Published: February 2025

Surface topography imaging may provide an alternative to regular radiographic evaluation of spinal deformities and may assist in evaluating the result of their surgical correction. The aim of our study was to measure the accuracy and repeatability of measurements from a commercial imaging system (Quantec, UK) in patients with scoliosis. 8 subjects were measured on 3 different occasions and 6 images were obtained during each visit, 3 with arms hanging freely and 3 with hand fixation. Skin markers were placed over the spinous process of the first thoracic vertebra (T1), the line of spinous processes, and the posterior superior iliac spines. Thoracic kyphosis and lumbar lordosis curves were measured from a sagittal plane view. Thoracic and lumbar curves, pelvic tilt and vertical alignment of the spine were measured from a frontal plane view. Initially, significant errors were found in the accuracy of the equipment but following rectification of problems with the software, accuracy was better than ±5% (or ±2 mm, if larger) over the region of interest. Variance analysis of the data demonstrated that for a single reading, over half the repeatability error was attributable to the visit (probably inconsistency in placing skin markers), and the remainder with the individual image (patient movement and inconsistency in analyzing an image). Use of hand holds to attempt to stabilise the upper body did not improve the repeatability. For our normal procedure, taking the mean of measurements from 3 images, we deduced the 95% confidence interval to be:- frontal plane: upper curve 8.0°, lower curve 6.5°, pelvic tilt 5.5°, vertical alignment 2.0°; sagittal plane: thoracic kyphosis 7.0°, lumbar lordosis 6.5°.
A Computer Vision System for Real-Time Intra-Operative Monitoring of Scoliosis Surgery
Authors: Durdle N.G.  , Bhalla K.  , Raso V.J.  , Hill D.L.
Published: February 2025

This paper describes an operating room vision system developed to assist in surgery for scoliotic correction. This system uses a stereo pair of CCD cameras and markers mounted on the spine during surgery to define the three-dimensional location of selected vertebra. The system permits the monitoring and recording of the three-dimensional progress of the surgery. The cameras are calibrated using the direct linear transformation and the collinearity equations of photogrammetry. Up to six markers are fixed to the spinous processes of selected vertebra. Stereo images are acquired, enhanced and analyzed using an IBM RISC6000 computer system. Image analysis consists of the detection of the markers and the rejection of the background blood, bone and instrumentation. A matching algorithm, based on camera parameters, identifies the corresponding point features (markers) between the stereo images. The system was tested during three surgical procedures at various stages of surgery. All visible features were detected with a better accuracy than could be done manually. The accuracy and robustness of the complete system is being assessed. In addition we have developed software systems to display and manipulate a 3D model of the spine. We plan to integrate these systems to provide real-time graphical feedback to the surgeon of the effects his manipulations on the spine.
L4-L5 Disc Herniation in Spontaneous Fusion of L5-S1: A Biomechanical and Clinical Study
Authors: Tranquilli Leali P.  , Aulisa L.  , Valassina A.  , Merolli A.
Published: February 2025

Anatomical structures at L5-S1 level may be subjected to extremely high stresses and, then, a clinical lesion may arise. Rupture of the annulus fibrosus may lead to L5-S1 disc herniation: actually this is the most common site of occurrence. A clinical direct evidence of the biomechanical nature of lumbar disc herniation is reported by describing rare cases where a spontaneous L5-S1 fusion has been followed, in the long tern, by L4-L5 disc herniation. As L5-S1 fused, L4-L5 took over becoming the functional lumbo-sacral mechanical passage.
Accuracy Requirements in Opto-Electronic 3D Measurements. What is Enough for the Clinic?
Authors: D'Amico M.
Published: February 2025

Modern measurement systems for non-ionising 3D evaluation of spinal deformities are progressively moving from the research environment to enter as complementary investigation tools in clinical activity. In fact their routinely use demonstrates the high level of reliability and accuracy in the measurements reached by this approach, as well as an high flexibility in designing new tests in order to investigate in an ever increasing deepness the 3D nature of spinal deformities joined with its functional evaluation. However it must be stressed the concept that accuracy in the measurement process is a necessary but not sufficient condition to obtain useful, accurate and reliable clinical parameters extraction. In fact to achieve this latter it is necessary a further signal processing and data elaboration step that could greatly affect the quality of the results. So in order to correctly quantify the trustworthiness of the clinical outcome all the steps starting from acquisition accuracy till the final clinical accomplishment should be included in the device performance evaluation. A discussion about this topic will be presented in this paper.
Is it Possible to Use Surface Topography in Operation Planning and Therapy Control?
Authors: Hierholzer E.
Published: February 2025

Rasterstereographic back shape measurement and analysis provides detailed information of scoliotic asymmetry and its relation to spinal deformity. Due to a certain lack of accuracy, it appears to be useful only for follow-up examinations and assessment of cosmesis. Detailed operation planning must still rely on radiographs.
Pelvis Asymmetry in Idiopathic Scoliosis. Evidence of Whole Torsional Body Deformity?
Authors: Rigo M.
Published: February 2025

The purpose of this study was to asses the relationship between iliac rotational asymmetry and the magnitude and pattern of the lumbar curve in patients with idiopathic scoliosis. We used the bisacro-iliac-ischial angle to differenciate between IRA and intra-pelvic torsional deformity. The results of this study supports the concept that the pelvis may be involved in the pathogenesis of idiopathic scoliosis.
ICNP as an Abstraction Tool for Clinical Databases
Authors: Nielsen Tommy M.
Published: February 2025

In the area of nursing, national and international clinical databases are practically non-existing, The lack of common nomenclatures and classifications is the main reason for this unsound situation, in nursing as in many other areas. Additionally, the limited use of clinical nursing record systems by nurses in their daily work makes the provision of structured and standardised nursing data almost impossible. Consequently, the definition of a commonly approved set of indicators on nursing activities has not yet been formulated. However, the TELENURSE project will address the need for structured information about clinical nursing practice, and it will among others develop a clinical nursing database in which to store the clinical data collected from operational nursing record systems. The ideas and concepts behind the design of the clinical nursing database are the subject of this article.
Electronic Feed-Back of Nursing Care Data
Authors: Vanden Boer G.
Published: February 2025

Feed-back is the essential element in any information system. Electronic feed-back of nursing care data relates to the type of questions that are essential in managing patient care : questions about effectiveness and efficiency regarding the total care path, in which nursing is one of the contributing services. Illustrations are ginven based on the Nursing Minimum Data Set in Belgium.
National Database for Clinical Nursing Outcome a Nursing Manager's Point of View
Authors: Thrane Susanne
Published: February 2025

The national database of clicical nursing outcome is a quality development and research tool. The database is most effective in daily use, when it is working in combination with an electronic patient record(EPR). In the electronic record data from the health care teams are accumulated and at disposal for all relevant purposes. In this way you illuminate dubble registration and you promote re-use of data. A nursing care section with specific nursing care data such as nursing phenomina, nursing interventions and nursing outcome is part of the EPR. The national database and the electronic patient record are based on a nationally and an internationally approved classification system ICNP to fulfil the intention to make data compatible for the use of quality development and research. The health care managers and the politicians are interestet in the outcome-quality and the diverted economical expenses.
More Real-Time Visual and Haptic Interaction with Anatomical Data
Authors: Reinig Karl D.  , Spitzer Victor M.  , Pelster Helen L.  , Johnson Travis B.  , Mahalik Tom J.
Published: February 2025

The University of Colorado's Center for Human Simulation has developed fundamental algorithms for real-time visual and haptic interaction with polygonal and voxel based data sets, including those derived from the Visible Human Dataset™ These algorithms are currently being used to create prototype simulators for surgery, needle insertion (anesthesiology, radiology, and rheumatology), dentistry, and ophthalmology. This paper briefly discusses our segmentation and classification effort as well as our ability to create texturemapped polygonal models directly from the data: both are fundamental to the creation of anatomically based simulators.
Hyper Hospital on the Satellite Multi-Media Network
Authors: Yamaguchi Takami
Published: February 2025

We have been developing the Hyper Hospital, a network based VR mediated medical care system. The Hyper Hospital is composed of two seamlessly integrated environments, that is, the virtual and the real worlds. Of them, its virtual environment expands the conventional medical care system using the virtual reality technology as a principal human interface and a collaboration tool. in the present study, an attempt to extend the Hyper Hospital system to various modalities of communication network is reported. A satellite communication based multi-media network using Internet protocols with the WWW interface is used. Data transmission rate and other performances were measured under various conditions and the satellite network was shown to be suitable to the Hyper Hospital network.
Applications of Virtual Reality Technology in Pathology
Authors: Grimes Gary J.  , McClellan Stan A.  , Goldman Jay  , Vaughn Gregg L.  , Conner David A.  , Kujawski Ed  , McDonald Jay  , Winokur Thomas  , Fleming Wayne
Published: February 2025

TelePath(SM) a telerobotic system utilizing virtual microscope concepts based on high quality still digital imaging and aimed at real-time support for surgery by remote diagnosis of frozen sections. Many hospitals and clinics have an application for the remote practice of pathology, particularly in the area of reading frozen sections in support of surgery, commonly called anatomic pathology. The goal is to project the expertise of the pathologist into the remote setting by giving the pathologist access to the microscope slides with an image quality and human interface comparable to what the pathologist would experience at a real rather than a virtual microscope. A working prototype of a virtual microscope has been defined and constructed which has the needed performance in both the image quality and human interface areas for a pathologist to work remotely. This is accomplished through the use of telerobotics and an image quality which provides the virtual microscope the same diagnostic capabilities as a real microscope. The examination of frozen sections is performed a two-dimensional world. The remote pathologist is in a virtual world with the same capabilities as a “real” microscope, but response times may be slower depending on the specific computing and telecommunication environments. The TelePath system has capabilities far beyond a normal biological microscope, such as the ability to create a low power image of the entire sample using multiple images digitally matched together; the ability to digitally retrace a viewing trajectory; and the ability to archive images using CD ROM and other mass storage devices.
Medical Electronic Link (MEL): Providing Telemedicine on the World Wide Web
Authors: Moncur Joel T.  , Rosen Joseph M.  , Zhu Shunhui  , Limonadi Farhad M.
Published: February 2025

Many tertiary care centers in the USA have attempted to implement interactive television (IATV) or dynamic telemedicine systems. The advantage these systems provide is real-time interaction. The biggest disadvantage is cost: expensive hardware, band-width and personnel. An alternative to IATV is Medical Electronic Link (MEL); a low cost, store-forward, internet-based physician consultation system. MEL allows physicians in remote locations to consult physicians at the Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire by using the World Wide Web. The Benefits of MEL are low hardware and band-width costs, accessibility, a self-explanatory interface, convenience, and its use of the case record. This system has been implemented at a family practice clinic in Manchester, NH and at the Tribhuvan University Teaching Hospital in Kathmandu, Nepal.
Spatial Perception During Laparoscopy: Implementing Action-Perception Coupling
Authors: Voorhorst F.A.  , Overbeeke C.J.  , Smets G.J.F.
Published: February 2025

Laparoscopy is a telepresence task since the surgeon has no direct contract with the patient. Performance of the surgeon will increase if his sense of telepresence is improved. This can be achieved by restoring the hampered action perception coupling. With respect to visual perception this means that the surgeon should be informed about the spatial lay-out of the environment; depth information and information about the location of observation. Both types of information can be provided by allowing the surgeon to explore.
A Distributed Virtual Environment Prototype for Emergency Medical Procedures Training
Authors: Stytz Martin R.  , Garcia Brian W.  , Godsell-Stytz Gayl M.  , Banks Sheila B.
Published: February 2025

Because of the increasing complexity of emergency medical care, medical staffs require increasingly sophisticated training systems. Virtual environments offer a low cost means to achieve a widely usable yet sophisticated training capability. We describe the Virtual Emergency Room (VER) project, a simulation system designed to enable emergency department personnel within level I and II emergency rooms to practice emergency medical procedures and protocols. Because emergency rooms are manned by a wide variety of medical professionals, we are developing a simulation facility that uses a distributed virtual environment architecture to enable real-time, multi-participant simulations. The potential advantages of this system include the ability to evaluate and refine treatment skills, and the ability to provide scenario-specific training for mobile military field hospital teams. These advantages will ultimately improve the readiness of emergency department staffs for a wide variety of trauma situations. This paper describes the VER and the major components of its distributed virtual environment. The current capabilities of our system are described followed by a discussion of recommended follow-on work.
Internet Image Database: Development and Implementation
Authors: Buenting John E.  , Spencer E. Brooke  , Holmes Douglas K.
Published: February 2025

The widespread acceptance of World Wide Web (WWW) hypermedia protocols allows rapid crossplatform development of database interfaces. Using the WWW as the interface promotes easy integration of databases with other publicly available Internet resources. We present our experience with an image database search program (IDBS) developed on the PC platform using freely available UNIX development tools. The database routines were written in PERL. The image database program provides a familiar user interface to a collection of clinical images stored in digital form, either on local media or on the Internet. The design goals of the project and the strategies used to meet them are presented. The source code and a demonstration database are available on the Internet at http://www.webmedix.com/idbs.
Computer Assisted Therapy for Multiple Sclerosis and Spinal Cord Injury Patients Application of Virtual Reality
Authors: Steffin Morris
Published: February 2025

For patients with multiple sclerosis and spinal cord injury, virtual reality systems provide new methods of assistance with dysmetria, tremor, spasticity, and weakness. Robust mechanisms exist within the central nervous system to produce neuroplastic adaptive responses operative in retraining motor activities. Haptic systems cued by the patient's visual environment can produce force corridors to guide a patient's wrist and hand in the performance of specific tasks. Such haptic application can substantially reduce motor instability and improve performance. Preliminary clinical approaches, using video tremor tracking and manual force application, indicate the extent of the expected improvements attainable with this approach. Refinement of these techniques is proceeding to development of VR systems that will allow more extensive application to the problems of dysmetria, more general instances of tremor, spasticity, and weakness.
Patient Safety and Efficacy as Measured by Clinical Trials and Regulatory Policy
Authors: Harvey Brian E.  , Alpert Susan
Published: February 2025

Virtual Reality and other technological innovations in medicine provide new challenges to the regulatory framework of the premarket review process for medical devices. By reinventing the governmentacademia-industry partnership, clinical trial data necessary for a medical device to enter the market can be more efficiently obtained.
High Definition 3D Ultrasound Imaging
Authors: Morimoto Alan K.  , Krumm J.C.  , Kozlowski D.M.  , Kuhlmann J.L.  , Wilson C.  , Little C.  , Dickey F.M.  , Kwok K.S.  , Rogers Bill  , Walsh Nicolas
Published: February 2025

We have demonstrated high definition and improved resolution using a novel scanning system integrated with a commercial ultrasound machine. The result is a volumetric 3D ultrasound data set that can be visualized using standard techniques. Unlike other 3D ultrasound images, image quality is improved from standard 2D data. Image definition and bandwidth is improved using patent pending techniques. The system can be used to image patients or wounded soldiers for general imaging of anatomy such as abdominal organs, extremities, and the neck. Although the risks associated with x-ray carcinogenesis are relatively low at diagnostic dose levels, concerns remain for individuals in high risk categories. In addition, cost and portability of CT and MRI machines can be prohibitive. In comparison, ultrasound can provide portable, low-cost, non-ionizing imaging.
Anatomical Variation Of Human Cancellous Bone Mechanical Properties In Vitro
Authors: Hobatho Marie-Christine  , Rho Jae Y.  , Ashman Richard B.
Published: February 2025

The aim of the study was to assess mechanical properties of human cancellous bone in vitro. Six hundred cubic specimens of cancellous bone were obtained from the tibia, femur, patella, lumbar spine and humerus of eight subjects. The elastic properties were assessed using an ultrasonic transmission technique developed and validated by Ashman (1). The results showed that differences exist between subjects significantly (p<0.05) and that the mechanical properties vary along the length and the periphery (about a factor 3 to 5). Cancellous bone should be considered heterogeneous and as orthotropic materials exhibiting degrees of anisotropy varying from 2 to 4. Linear and power fit elationships for cancellous bone were found approximately equal. Powers vary from 1.3 to 1.7 for axial modulus versus density and 1.3 and 2.3 for strength versus density.
The Quality of Trabecular Bone Evaluated with Micro-Computed Tomography, FEA and Mechanical Testing
Authors: Ulrich Dieter  , Hildebrand Tor  , Van Rietbergen Bert  , Müller Ralph  , Rüegsegger Peter
Published: February 2025

Most standard methods to predict bone quality are merely based on apparent density measurements. However, apparent density alone does neither explain all variation of the mechanical properties nor does it account for the structural anisotropy of trabecular bone. Thus, apparent density alone might not be sufficient to accurately predict the quality of bone. This study investigates if a new approach based on microstructural computer models can provide additional and relevant information on bone quality.
Systemic Approach - Its Relevance to Education in Health Informatics
Authors: Michel J.  , Cammann H.  , Hasman A.  , Klar R.
Published: February 2025

The restrictions implied in the reductionist (mechanistic) method, still predominant even at the advanced levels of textbook medicine, have caused grate disproportionalities across all areas of medicine. This has given rise to severe problems in health care. For example, highly comprehensive knowledge has been accumulated on the smallest components of the organism, such as molecules and cells, whereas insufficient consideration is given to the integrative functions of the human organism as a biopsychosocial entity and its interactions with the natural and social environment, despite its major importance to human health. If those limitations and their critical consequences are to be overcome, modern medicine will have to be enlarged by the systemic approach. This will decisively depend on new methods of integrative information and knowledge processing and system-analytical diagnostics on the basis of modern information technologies. Health informatics, therefore, has to play a specific role in the development of a systemic approach and its introduction to medicine and health care. This is a new responsibility for which the health informatics expert must be effectively prepared in the course of education. An account is given of a concept for appropriate teaching of the underlying principles, including an integrative presentation of the human organism as an information-processing system and as source of information in permanent interaction with the natural and social environment. This concept provides for ways and means to devise new, reasonable diagnostic strategies and to build a properly tuned system of health-supporting, preventive, therapeutic and rehabilitative measures. Individual health must be supported, last but not least, by social and political action. The systemic approach quite obviously may as well provide a key for major cost containment in health care.
Nursing Informatics Education and Training Activities in Europe
Authors: Therkelsen Lise
Published: February 2025

This paper is about three aspects:
Evolution of a Regional Health-care Information System - the design phase
Authors: Balkányi László  , Magyar Gábor  , Lakner Géza  , Orosz Éva
Published: February 2025

In 1996 a program of the Soros Foundation was launched to study a regional health care model Main stake holders of health care financing and providing in three counties in South-Western Hungary. found the idea appealing and the Soros Model Region Program was started. This paper outlines the activity of the second sub project of the model region program: the development of a regional health care information system. The build-up of a data and knowledge base serving the differing needs of mentioned goals is based on international standards. Availability and user involvement is based on different media for presenting the information as printed publications, CD-ROM data bases and World Wide Web availability. A congruency and coherency principle is maintained by a unified data model used for different purposes and a planned unified communication protocol among all participants in the model region program. Studies regarding health care status, economics and financing on regional level show that a better fitting health care services profile and a more flexible resource management might be achieved based on the mentioned regionality principle.
Basic rules for the security of frozen section diagnosis through image transmission between anatomo-pathologists
Authors: Dusserre P.  , Allaert F.-A.  , Dusserre L.
Published: February 2025

Telemedicine can provide an alternative solution to the lack of medical resources in areas where the population is no longer dense enough to justify the temporary or permanent presence of certain specialists such as anatomo-pathologists. In the long run certain preoperational frozen section examinations cannot be carried out without putting the quality of healthcare at stake. The telematic transmission of macro and microscopic images of lesions, under the supervision of a surgeon, to an anatomo-pathologist consultant located off premises allows for the maintenance of equitable care of acceptable quality.
Investment Appraisal of the Protection, Confidentiality and Security Arrangements of Patient Data
Authors: Loftus Denise  , Carroll Tony
Published: February 2025

Data Protection and Security issues are reviewed in relevant literature. Policies implemented in relation to the subject matter are discussed in detail. Findings from a review of data protection and security arrangements at a major hospital are presented. Future data protection and security recommendations are outlined.
A Sentinel Network Of General Practitioners For Epidemiologic Surveillance In Italy
Authors: Capozzi C.  , Buonomo E  , Fusiello S  , Lucchetti G  , Mariotti S  , Noce A  , Palombi L
Published: February 2025

A Computer Network of General Practitioners (GP's) has been established connecting 110 general practitioners representing a statistically selected national sample, homogeneously distributed all over Italy. The purpose of the network is to increase the epidemiologic surveillance on the health status of the Italian community, to collect useful data on the routine activity of the GP's, to promote computer use among them, and to organize some “ad hoc” investigations on specific subjects (case-control studies). To this purpose, a specific software was developed both to meet the requirements of epidemiological research and to manage general practitioners' clinical files. A working prototype of health card using micro-computer technology is also being experimented on a subset of the GP's.
From Hospital Information System Components to the Medical Record and Clinical Guidelines & Protocols
Authors: Veloso Mário  , Estevão Nuno  , Ferreira Pedro  , Rodrigues Rui  , Costa César Telmo  , Barahona Pedro
Published: February 2025

This paper introduces an ongoing project towards the development of a new generation HIS, aiming at the integration of clinical and administrative information within a common framework. Its design incorporates explicit knowledge about domain objects and professional activities to be processed by the system together with related knowledge management services and act management services. The paper presents the conceptual model of the proposed HIS architecture, that supports a rich and fully integrated patient data model, enabling the implementation of a dynamic electronic patient record tightly coupled with computerised guideline knowledge bases.
Human fluid balance modelling and its treatment simulation with HIDION
Authors: Trica Alexandru  , Jitaru Elena  , Litarczek George  , Teodorescu Octavian  , Moisil Ioana
Published: February 2025

HIDION is a tandem system composed of an expert system for diagnosis of the water and electrolytic balance disturbance and a modelling program for simulation and suggestion of the needed correction. The expert system attempts to make a diagnosis mainly based on clinical symptoms and on patient history, as they are generally available for most physicians. The treatment module assists the user to establish a right strategy for re-equilibration of the fluid balance. The first aim of the system is to achieve a correct diagnosis of the disturbances of the fluid balance and a choice of therapy tactics. The second aim of the system is an educational one for both physicians and nurses. The entire system. including the expert module as well as the modelling module is developed in Turbo Prolog.
Use of Wavelet Analysis for Contrast Enhancement in Mammography
Authors: Sakellaropoulos P.  , Costaridou L.  , Cavouras D.  , Bezerianos A.  , Panayiotakis G.
Published: February 2025

A wavelet analysis approach to contrast enhancement in mammography is presented. The approach consists of application of non-linear enhancement of multiscale gradient magnitudes utilising edge location information. The performance of wavelet analysis is evaluated by means of a breast phantom. Preliminary results indicate the value of the approach in contrast enhancement and edge preservation for both simulated tumours and microcalcifications.
Computer Image Analysis of Ultrasound Images for Discriminating and Grading Liver Parenchyma Disease Employing a Hierarchical Decision Tree Scheme and the Multilayer Perceptron Neural Network Classifier
Authors: Cavouras D.  , Kandarakis I.  , Theotokas I.  , Kanellopoulos E.  , Triantis D.  , Behrakis I.  , Manesis E.K.  , Vafiadi-Zoumpouli I.  , Zoumpoulis P.
Published: February 2025

Differential diagnosis of liver parenchyma disease and grading of the hepatic disease on ultrasound is a common radiological problem that influences patient management. The aim of this study was to apply image analysis methods on ultrasound images for discriminating liver cirrhosis from fatty liver infiltration and for grading hepatic disease, which is important in the management of the patients. Ultrasound images of histologically confirmed 18 livers with cirrhosis, 37 livers with fatty infiltration, and 24 normal livers of healthy volunteers were selected and were digitized for further computer processing. Twenty two textural features were calculated from small matrix samples selected from the ultrasound image matrix of the liver parenchyma. These features were used in the design a three level hierarchical decision tree classification scheme, employing the multilayer perceptron neural network classifier at each hierarchical tree level. At the first tree level, classification accuracy for distinguishing normal from abnormal livers was 93.7%, at the second level the accuracy for discriminating cirrhosis from fatty infiltration was 90.9%, and at the third level the accuracy in distinguishing between low and high grading liver cirrhosis or fatty infiltration was 94.1% and 84.9% respectively. The proposed computer software system may be of value to the radiologists in assessing liver parenchyma disease.
Adaptive Reduction of Heart Sounds from Lung Sounds Using a Wavelet-Based Filter
Authors: Hadjileontiadis Leontios J.  , Panas Stavros M.
Published: February 2025

A new adaptive method for heart sounds reduction from lung sounds, based on wavelet transform, is presented in this paper. The use of a wavelet transform domain filtering technique as an adaptive de-noising tool, implemented in lung sounds analysis, is introduced. The multiresolution representations of the signal, produced by wavelet transform, are used for signal structure extraction. Experimental results have shown that implementation of this wavelet-based filter in lung sound analysis results in an efficient reduction of heart sounds from lung sounds, producing an almost noise-free output signal.
An Integrated Model of Sleep Regulation
Authors: Ruggiero Carmelina  , Giacomini Mauro  , Schiavi Giuliano  , Nobili Lino  , Ferrillo Franco
Published: February 2025

We present a new model of sleep regulation which integrates the two process model and the limit cycle reciprocal interaction model. In the two process model the interaction of a homeostatic process (S signal) and of a circadian process determines the timing of sleep and waking. In the limit cycle model, the NREM - REM sleep cycle is generated by the reciprocal interaction of two coupled cell population. The present model integrates the two considered models introducing the trigger REM - NREM generated by the REM-ON signal and activated when REM-ON overcomes the S signal.