bluuebunny/crossref_metadata_2025 huggingface dataset:
Normal Voice Production: Computation of Driving Parameters from Endoscopic Digital High Speed Images
Authors: Braunschweig T. , Lohscheller J. , Eysholdt U. , Hoppe U. , Döllinger M.
Published: March 2018

Objectives: A central point for quantitative evaluation of pathological and healthy voices is the analysis of vocal fold oscillations. By means of digital High Speed Glottography (HGG), vocal fold oscillations can be recorded in real time. Recently, a numerical inversion procedure was developed that allows the extraction of physiological parameters from digital high speed videos and a classification of voice disorders. The aim of this work was to validate the inversion procedure and to investigate the applicability to normal voices.

Methods: High speed recordings were performed during phonation within a group of five female and five male persons with normal voices. By using knowledge based image processing algorithms, motion curves of the vocal folds were extracted at three different positions (dorsal, medial, ventral). These curves were used to obtain physiological voice parameters, and in particular the degree of symmetry of the vocal folds based upon a biomechanical model of the vocal folds.

Results: The highest degree of symmetry was observed for the medial motion curves. While the dor-sally and ventrally extracted motion curves exhibited similar results concerning the degree of symmetry the performance of the algorithm was less stable.

Conclusions: The inversion algorithm provides reasonable results for all subjects when applied to the medial motion curves. However, for dorsal and ventral motion curves, correct performance is reduced to 85 %.
Detection of Juvenile Sleep Deprivation by Stochastic Optimization of Pupillographic Records
Authors: Mercer P. , Sheldon S. , Kotsos T. , O’Neill W.
Published: March 2018

Objective: To address the challenging problem of measuring juvenile sleep deprivation, we test the hypothesis that a pupillographic method found successful for adult narcoleptics might also discriminate between sleep deprived juveniles acting as their own controls.

Methods: A linear, nonstationary model relating pupillary diameter and a random photic stimulus are estimated by recursive regressions from pupillographic records of 8 juveniles of median age 7 years acting as their own rested controls. The estimated pupillary impulse response noise functions are stochastically optimized using the Kullback divergence measure to maximally separate the sleep deprived records from the control records.

Results: Both the average and covariance statistics of the estimated pupillary noise functions exhibit statistically significant differences between sleep deprived and rested subjects. The main result is that sleep deprivation decreases pupillary noise variance; a finding consistent with a previous study of adult narcoleptics. Further, it was found that virtually the same stochastic parameters were optimal for the juvenile sleep deprived data and for the previous adult narcoleptic study.

Conclusions: Although our results are preliminary, the consistent reduction of pupillary noise appears to justify a comprehensive clinical trial across a broad range of age classes. In addition, the finding that the same parameters stochastically optimze both juvenile and adult recordings suggests the procedure holds promise as a clinical test which could produce sleep deprivation measures simultaneous with data collection.
Non-Linear Transform-Based Robust Adaptive Latency Change Estimation of Evoked Potentials
Authors: Wang H. , Zhang Y. , Bao H. , Qiu T.
Published: March 2018

Objectives: To improve the latency change estimation of evoked potentials (EP) under the lower order -stable noise conditions by proposing and analyzing a new adaptive EP latency change detection algorithm (referred to as the NLST).

Methods: The NLST algorithm is based on the fractional lower order moment and the nonlinear transform for the error function. The computer simulation and data analysis verify the robustness of the new algorithm.

Results: The theoretical analysis shows that the iteration equation of the NLST transforms the lower order α-stable process en (k) into a second order moment process by a nonlinear transform. The simulations and the data analysis showed the robustness of the NLST under the lower order α-stable noise conditions.

Conclusions: The new algorithm is robust under the lower order -stable noise conditions, and it also provides a better performance than the DLMS, DLMP and SDA algorithms without the need to estimate thevalue of the EP signals and noises.
Classification of EEG Mental Patterns by Using Two Scalp Electrodes and Mahalanobis Distance-Based Classifiers
Authors: Cincotti F. , Mattia D. , Babiloni C. , Carducci F. , Bianchi L. , Millán del R. , Mouriño J. , Salinari S. , Marciani M. G. , Babiloni F.
Published: March 2018

Objectives: In this paper, we explored the use of quadratic classifiers based on Mahalanobis distance to detect mental EEG patterns from a reduced set of scalp recording electrodes.

Methods: Electrodes are placed in scalp centro-parietal zones (C3, P3, C4 and P4 positions of the international 10-20 system). A Mahalanobis distance classifier based on the use of full covariance matrix was used.

Results: The quadratic classifier was able to detect EEG activity related to imagination of movement with an affordable accuracy (97% correct classification, on average) by using only C3 and C4 electrodes.

Conclusions: Such a result is interesting for the use of Mahalanobis-based classifiers in the brain computer interface area.
Two-Phase Study to Assess the Number of Cases Based on Claims Databases: Characteristics of the Validation Data Set
Authors: Rabilloud M. , Colin C. , Ecochard R. , Couris C. M.
Published: March 2018

Objective: In a two-phase study design, the characteristics of an external data set were studied for precision and bias of the number of incident or prevalent cases of a disease obtained from claims databases.

Methods: In the study population (first phase), incident or prevalent cases were counted whereas external data (second phase) provided sensitivity and specificity estimates to count cases in a claims database. Influence of potential differences in sensitivity and specificity between the two phases were evaluated. This was illustrated for 50-90% sensitivity and 99-99.99% specificity ranges.

Results and Conclusions: The impact of differences in sensitivity and specificity depends on the odds of disease in the study population. We provide advice on the choice of adequate data sets to correct claims database estimates.
Validation of ICTERUS, a Knowledge-based Expert System for Jaundice Diagnosis
Authors: Marzuoli M. , Molino F. , Battista S. , Bar F. , Torchio M. , Lavelle S. M. , Corless G. , Cappello N. , Molino G.
Published: March 2018

The study aimed to describe an example of the assessment and validation of knowledge-based clinical expert systems. The paper focuses on ICTERUS, an expert system for jaundice diagnosis. It describes system design, the methodology applied for upgrading and validating the program, and the most important outcomes of the validation procedure. The clinical validation of the system on a very large European database (Euricterus Project) shows that diagnostic conclusions are reliable in about 70% of eligible cases. This figure appears acceptable for a system which provides decision support only on the basis of clinical data, assuming that the final decision is achieved under user responsibility. Expected biases, limitations and inconsistencies in the practical application of the system are discussed.
Disaster Drills and Continuous Medical Education using Satellite-based Internet
Authors: Haruki Y. , Ogushi Y. , Okada Y.
Published: March 2018

We designed and evaluated a satellite-based Internet system for use in medical applications. Many experimental telemedicine projects use satellites, but we combined digital satellite communication with an ordinary telephone network to realize an economical countrywide network for emergency medicine and continuous medical education. The system appears to be a useful and practical technology for daily clinical activities.
Data Processing at the Anesthesia Workstation: from Data Entry to Data Presentation
Authors: Junger A. , Quinzio L. , Michel A. , Sciuk G. , Fuchs C. , Marquardt K. , Hempelmann G. , Benson M.
Published: March 2018

Main requirements for an Anesthesia Information Management System (AIMS) are the supply of additional information for the anesthesiologist at his workstation and complete documentation of the anesthetic procedure. With the implementation of an AIMS (NarkoData) and effective user support, the quality of documentation and the information flow at the anesthesia workstation could be increased. Today, more than 20,000 anesthesia procedures are annually recorded with the AIMS at 112 decentralized workstations. The network for data entry and the presentation and evaluation of data, statistics and results directly available at the clinical workstation was made operational.
Computer Simulation of Hemodynamic Parameter Changes by Mechanical Ventilation and Biventricular Circulatory Support
Authors: Darowski M. , Ferrari G. , Clemente F. , Guaragno M. , Lazzari De
Published: March 2018

When a Bi-Ventricular Assist Device (BVAD) is used in conjunction with mechanical ventilation (MV) of the lungs with positive intrathoracic pressure (Pt), the latter influences hemodynamics. The aim of our study was to assess the simultaneous influence of BVAD and MV on hemodynamics. We assumed ventricular pathological conditions as reduced elastances and increased rest volumes. Peripheral systemic arterial resistance was assumed to have different values. Data were obtained by computer simulation. Trends in main hemodynamic variables were compared with clinical data from literature. Simulation showed that systemic venous, pulmonary arterial and left atrial pressures are very sensitive to Pt (-2 to 5 mmHg).
Predicting Patient’s Long-Term Clinical Status after Hip Arthroplasty Using Hierarchical Decision Modelling and Data Mining
Authors: Demšar J. , Smrke D. , Boižkov K. , Stankovski V. , Bratko I. , Beck J. R. , Zupan B.
Published: March 2018

Construction of a prognostic model is presented for the long-term outcome after femoral neck fracture treatment with implantation of hip endoprosthesis. While the model is induced from the follow-up data, we show that the use of additional expert knowledge is absolutely crucial to obtain good predictive accuracy. A schema is proposed where domain knowledge is encoded as a hierarchical decision model of which only a part is induced from the data while the rest is specified by the expert. Although applied to hip endoprosthesis domain, the proposed schema is general and can be used for the construction of other prognostic models where both follow-up data and human expertise is available.
Imaging and the Human Brain Project: A Review
Authors: Rosse C. , Brinkley J. F.
Published: March 2018

Objectives: Survey current work primarily funded by the US Human Brain Project (HBP) that involves substantial use of images. Organize this work around a framework based on the physical organization of the body.

Methods: Pointers to individual research efforts were obtained through the HBP home page as well as personal contacts from HBP annual meetings. References from these sources were followed to find closely related work. The individual research efforts were then studied and characterized.

Results: The subject of the review is the intersection of neuroinformatics (information about the brain), imaging informatics (information about images), and structural informatics (information about the physical structure of the body). Of the 30 funded projects currently listed on the HBP web site, at least 22 make heavy use of images. These projects are described in terms of broad categories of structural imaging, functional imaging, and image-based brain information systems.

Conclusions: Understanding the most complex entity known (the brain) gives rise to many interesting and difficult problems in informatics and computer science. Although much progress has been made by HBP and other neuroinformatics researchers, a great many problems remain that will require substantial informatics research efforts. Thus, the HPB can and should be seen as an excellent driving application area for biomedical informatics research.
Requirements Engineering for Inter-Organizational Health Information Systems with Functions for Spatial Analyses: Modeling a WHO Safe Community Applying Use Case Maps
Authors: Hallberg N. , Timpka T. , Lindqvist K. , Ölvingson C.
Published: March 2018

Objectives: To evaluate Use Case Maps (UCMs) as a technique for Requirements Engineering (RE) in the development of information systems with functions for spatial analyses in inter-organizational public health settings.

Methods: In this study, Participatory Action Research (PAR) is used to explore the UCM notation for requirements elicitation and to gather the opinions of the users. The Delphi technique is used to reach consensus in the construction of UCMs.

Results: The results show that UCMs can provide a visualization of the system‘s functionality and in combination with PAR provide a sound basis for gathering requirements in inter-organizational settings. UCMs were found to represent a suitable level for describing the organization and the dynamic flux of information including spatial resolution to all stakeholders. Moreover, by using PAR, the voices of the users and their tacit knowledge is intercepted. Further, UCMs are found useful in generating intuitive requirements by the creation of use cases.

Conclusions: With UCMs and PAR it is possible to study the effects of design changes in the general information display and the spatial resolution in the same context. Both requirements on the information system in general and the functions for spatial analyses are possible to elicit when identifying the different responsibilities and the demands on spatial resolution associated to the actions of each administrative unit. However, the development process of UCM is not well documented and needs further investigation and formulation of guidelines.
Dietary Balance Chart for an On-line Computerized Graphical Support System inMHTS
Authors: Nishino R. , Nakazato R. , Takahashi T. , Matsumoto H. , Hori S. , Masuyama Y. , Hinohara S. , Horie M. , Robinson D. , Hinohara S.
Published: March 2018

Dietary habits are believed to play an important role in the etiology of adult disease. For this reason, it is necessary to include effective dietary guidance in multiphasic health testing and services (MHTS) programmes for primary disease prevention. We have developed such a programme of simple dietary advice, using a computer system for the MHTS. Examinees' dietary habits are checked using optical character record (OCR) questionnaire forms, and the results are displayed on the screen of a colour display terminal. They are required to prepare a menu of their usual daily dietary intake in terms of quantity and type of food. Thus the data collected relate to the nutritional composition of the examinee's usual diet. Nutritional requirements of the Japanese according to sex, height, and level of physical activity, in accordance with criteria set by the Japanese Ministry of Health and Welfare, are fed into the computer in advance. For each examinee, these criteria and the results of the assessment of the diet are displayed together on the screen in the form of colour graphs for comparison.
HRA Model for Hypercholesterolemia Based on a Longitudinal Health Database
Authors: Kishimoto T. , Iida Y. , Yoshida K. , Miyakawa M. , Sugimori H. , Izuno T. , Okazaki N. , Tamura M. , Hinohara S. , Takahashi E.
Published: March 2018

To evaluate the risk factors for hypercholesterolemia, we examined 4,371 subjects (3,207 males and 1,164 females) who received medical checkups more than twice at an AMHTS in Tokyo during the period from 1976 through 1991; and whose serum total cholesterol was under 250 mg/dl. The mean follow-up duration was 6.6 years. A self-registering questionnaire was administered at the time of the health checkup. The endpoint of this study was the onset of hypercholesterolemia when the level of serum total cholesterol was 250 mg/dl and over. We compared two prognosis groups (normal and hypercholesterol) in terms of age, examination findings and lifestyle. After assessing each variable, we employed Cox's proportional hazards model analysis to determine the factors related to the occurrence of hypercholesterolemia. According to proportional hazards model analysis, total cholesterol, triglyceride and smoking at the beginning, and hypertension during the observation period were selected in males; and total cholesterol at the beginning and age were selected in females to determine the factors related to the occurrence of hypercholesterolemia.
Interactive Video Assists in Clinical Decision Making
Authors: Waitzfelder B. E. , Gramlich E. P.
Published: March 2018

The Hawaii Quality and Cost Consortium began a project in 1993 to implement and evaluate interactive videodisk programs to assist in clinical decision-making for breast cancer. Communication problems between physicians and patients, limitations of available outcomes data and varying preferences of individual patients can result in treatment outcomes that are less than satisfactory. Shared Decision-making Programs (SDPs) were developed by the Foundation for Informed Medical Decision Making (FIMDM) in Hanover, New Hampshire, to assist in the treatment decision-making process. Utilizing interactive videodisks, the programs provide patients with clear, unbiased information about available treatment options. With this information, patients can become more active participants in making treatment decisions. The SDPs for breast cancer were implemented at two sites in Hawaii. Evaluation data from 103 patients overwhelmingly indicate that patients find the programs clear, balanced and very good or excellent in terms of the amount of information presented and overall rating.
Total Quality in Information Systems Management: Issues for the Health Care Industry
Authors: Leonard K. J.
Published: March 2018

Faced with rising costs, growing demand and declining funding, hospitals and others must either cut services or improve the efficiency and effectiveness of what they do. Neither solution can be implemented without adequate relevant information. Without understanding which services are providing the most value to its customers, sensible cutbacks will be difficult to make. Improving efficiency requires a knowledge of where there are inefficiencies, and improving effectiveness requires an understanding of what the outcomes of health care are. The solution, as many have documented, is to create, as a first step, a database containing detailed health care patient data. In this paper, we present continuous improvement techniques as a requirement for the design and development ofthis much needed database.
A Model to Control Data Flow in Multicenter Clinical Trials
Authors: Pampallona S.
Published: March 2018

A model for the data management procedures of multicenter clinical trials is proposed. Focus will be restricted to those trials in which data are collected over time depending on therapy and follow-up schedules. The requirements for the model are structured data collection forms and a theoretical data flow governing the submission of materials by the participating institutions. The existence of a coordinating center is assumed, but the model presented here can be applied irrespective of the organizational set up of the research environment. It is suggested that each data collection form (or any other piece of documentation) is seen as an independent information holder, irrespective of the actual data it contains. The status of each form, from when it is expected by the coordinating center to when it is accepted for statistical analysis, can be summarized by a single variable, maintained by the data manager. Depending on its value, certain activities can be initiated, such as requesting missing forms or corrections. The implementation of the described model within a database system as well as its relation to the requirements for reliable statistical evaluation of the study are discussed with reference to a real example.
Analysis of Physicians’, Pharmacists’, and Nurses’ Attitudes Toward the Use of Computers to Access Drug Information
Authors: Shumway J. M. , Jacknowitz A. I. , Abate M. A.
Published: March 2018

The appropriate utilization of computerized drug information systems is widely recognized as an area of concern by health care professionals. For this reason, attitudes of health care professionals in office-based practices toward computer-based drug information were examined. Sixty individuals in five different practice settings completed an attitude instrument. Of the 36 items categorized into five attitudinal categories, the answers to six items (in three distinct categories) were found to be statistically different among physicians, nurses, and pharmacists. These differences indicate that physicians and nurses are less knowledgeable about the benefits that can be obtained through the use of computerized information resources and, consequently, are more skeptical concerning the role of computer information systems in reducing the costs and improving the quality of health care. Of interest as well was the finding that pharmacists felt more strongly than physicians and nurses that computer information systems would readily fit into their daily work routine.
Computers in Health Care for the 21st Century
Authors: O’Desky R. I. , Ball M. J. , Ball E. E.
Published: March 2018

As the world enters the last decade of the 20th Century, there is a great deal of speculation about the effect of computers on the future delivery of health care. In this article, the authors attempt to identify some of the evolving computer technologies and anticipate what effect they will have by the year 2000. Rather than listing potential accomplishments, each of the affected areas: hardware, software, health care systems and communications, are presented in an evolutionary manner so the reader can better appreciate where we have been and where we are going.
DYNASCENE: An Approach to Computer-Based Intelligent Cardiovascular Monitoring Using Sequential Clinical “Scenes”
Authors: Cohnl A. I. , Rosenbauml S. , Factor M. , Millerl P. L.
Published: March 2018

Hemodynamic abnormalities such as hypovolemia typically progress through a sequence of discrete clinical phases or “scenes” (e. g., intravascular volume depletion, vasoconstriction, hypotension). Each scene can be defined by a cluster of hemodynamic trends. A natural approach to modeling the process of hemodynamic monitoring involves identifying these scenes and the temporal relationships among them. This approach has been utilized in the development of DYNASCENE, a parallel programming implementation of a computer-based intelligent hemodynamic monitor. This paper discusses: (1) The rationale for utilizing sequential clinical scenes to represent knowledge of hemodynamic behavior, (2) the design of the DYNASCENE system, and (3) preliminary tests of the DYNASCENE system.
Umsetzung des Teilhabeanspruchs auf inklusive Beschulung am Beispiel der Schulbegleitung
Authors: Himmel R. , Fegert J. M. , Ziegenhain U. , Henn K.
Published: March 2018

In der Folge der Ratifizierung der UN-Behindertenrechtskonvention wird bei immer mehr Kindern das Recht auf inklusive Bildung an Regelschulen umgesetzt. Bisher sind die Schulen für die vielfältigen Aufgaben, die durch die neuen Schüler mit Behinderungen auf sie zukommen, nicht ausreichend personell und strukturell ausgestattet. Daher werden Schulbegleiter, finanziert von den Eingliederungshilfen, als Einzelfallhilfe in den Schulen eingesetzt. Schulbegleiter sind sowohl pädagogisch Fachkräfte als auch Hilfskräfte oder Freiwillige. Es gibt für sie nur wenige systematische Fortbildungsangebote. Der Artikel gibt einen Überblick über die Datenlage zu Schulbegleitung und skizziert das von den Autoren entwickelte und erprobte Curriculum zur Fortbildung von Schulbegleitern.
ASpeKT – Schnittstellenkoordination bei psychisch erkrankten Kindern und Teenagern
Authors: Williams B. , Bülbül A. , Fegert J. M. , Boege I. , Schulze U. M. E.
Published: March 2018

Gegenstand und Ziel: Schnittstellen zwischen stationärer Krankenhausversorgung und außerklinischen Strukturen stellen oftmals Soll-Bruchstellen in der für psychisch erkrankte Kinder und Jugendliche dringend notwendigen Behandlungskontinuität dar. Methoden: In eine vergleichende Untersuchung an zwei Modellstandorten konnten 108 Kinder und Jugendliche und ihre Eltern eingeschlossen und bei Aufnahme (T1) sowie zum Entlasszeitpunkt (T2) befragt werden. Zur Erfassung involvierter Schnittstellen und des Schnittstellenmanagements wurde ein semi-strukturiertes Interview eingesetzt, während der HoNOSCA sowie der ZUF-8 der Ermittlung der psychosozialen Belastung und Behandlungszufriedenheit dienten. Ergebnisse: Es liegen vor allem bei den Eltern wenig Wissen um Hilfsstrukturen und bezüglich der Behandlungszufriedenheit keine signifikanten Unterschiede zwischen beiden Standorten vor. Schlussfolgerung: Die Etablierung eines individuellen Schnittstellenmanagements ist zu fordern. Klinische Relevanz: Der Bedarf einer Optimierung der Kommunikation zwischen den Hilfestrukturen und intensiven Aufklärung der Familien zu vorhandenen Möglichkeiten ist hoch.
Evidenzbasierte Therapie des idiopathischen Normaldruckhydrozephalus
Authors: Rot S. , Meier U. , Lemcke J.
Published: March 2018

Die klinische Forschung zum idiopathischen Normaldruckhydrozephalus erfolgt auf steigendem methodischem Niveau und ermöglicht die evidenzbasierte Therapie der Patienten. Die jährliche Inzidenz von Patienten mit einem diagnostizierten und therapierten idiopathischen Normaldruckhydrozephalus beträgt in den westlichen Ländern nach epidemiologischen Untersuchungen ca. 1/100 000 Einwohner. Non-invasive Methoden spielen in der Diagnostik eine zunehmend wichtigere Rolle, können allerdings die invasiven Methoden noch nicht ersetzen. Die grundsätzliche Effektivität von Liquorshunts zur Therapie des idiopathischen Normaldruckhydrozephalus konnte nachgewiesen werden. In weiteren Untersuchungen konnte gezeigt werden, dass die Komplikationsrate durch die Implantation von programmierbaren Ventilen mit Gravitationsventilen deutlich minimiert wird. Programmierbare Gravitationseinheiten wurden im Rahmen einer prospektiven Studie untersucht. Ihre Effektivität wird in einer prospektiv randomisierten Studie geprüft.
A Perinatal Database Management System
Authors: Kooi R. , Pillay S. , Hirsch J. , Zador I. , Chik L. , Sokol J.
Published: March 2018

Obstetric services have long recognized the need for ongoing evaluation of their experiences. Manual »departmental statistics« systems sufficed, but with the advent of more sophisticated care, perinatal re-gionalization and increased research activity, the potential usefulness of computer technology became obvious. At Cleveland Metropolitan General Hospital, a laboratory computer based patient information file system was designed and implemented beginning in 1974. Over the succeeding six years, data have been collected and stored for all delivered pregnancies. There are now over 61,000 files for more than 20,000 consecutively delivered patients. The system provides over 40,000 clinical reports per year. However, the use of a file-oriented system has limited our ability to respond to specific research queries. The application of a relational database management system, INGRES, for perinatal information is reported here. Examples of its use for efficiently »answering questions« are presented, as are guidelines for the development and implementation of computer-based perinatal record systems.
Reliability Factors in Adverse Drug Reaction Reporting
Authors: Marlin R. L.
Published: March 2018

In the process of utilizing marketed pharmaceutical preparations, a primary concern of researchers, physicians, industry and government agencies is the occurrence of adverse reactions.

The purpose of this research was to devise and test a method of evaluating the FDA’s voluntary system for collection of adverse reactions that occur during hospitalization, as a form of communicating valid data. The Federal Government generates data and as such becomes an originator of instructions, specifications/ directives for job and/or projects within its bureaucratic structure. These descriptions (»Guidelines«) of responsibilities regulate the activities of all systems.

The objectives of this study were to determine whether the guidelines established by the issuing agency (FDA) were interpreted in a uniform manner with those individuals who generate the data (hospital coordinators) and to determine if factors external to the system affect the reporting.

Three phases were employed:

1. Review of data in a baseline year,

2. A survey questionnaire to all hospital coordinators and FDA personnel involved in the system,

3. Interviews with a conveniently selected sample of coordinators.

The findings showed that the guidelines were interpreted differently by the coordinators and the FDA personnel. The study also demonstrated that the external factors such as legality, »defensive medicine«, various definitions of the term »adverse drug reaction«, individual bias and FDA feedback all affect participation in the program. It is also affected by the poorly coordinated education and orientation programs of the FDA and attitudes affecting patient care.

Detailed instructions to participants on the procedures, purposes and goals of a collection program, with communication feedback to and from the agency and the generators, are important facts in maintaining voluntary participation.
A Method for Estimating Prognosis Based on Physician’s Decision-Making Process
Authors: Peev Ch. P. , Kaihara S.
Published: March 2018

Different diagnostic rules for computer-aided diagnosis are based on different mathematically precise statistical models. In practice, however, the medical data cannot meet the requirements set for the models and, in some cases, the model precision loses its advantages. On the other hand, physicians make their decisions without mathematical precision according to some statistics based on their own experiences.

In this study, the physician’s process of estimating prognosis of diseases was analyzed and a method for estimating prognosis based on the physician’s decision-making process was proposed. Problems such as collection of informative symptoms, their estimation and weighting, and physician’s decision were considered. The decisionmaking function obtained from the analysis was applied for estimating the prognosis of cerebrovascular diseases. The choice of informative symptoms was based on Kullback’s information measure. Error estimation was made by using the minimum empirical risk method. The proposed method seemed to provide a smaller error rate, as compared to discriminant analysis under identical conditions (same sample, same informative symptoms).
KRAZTUR — A Generator for Medical Documentation and Information Systems
Authors: Ellsässer K.-H. , Köhler CO. , Wagner G.
Published: March 2018

KRAZTUR, a generator for the generation of programs or systems for clinical documentation and data processing, is described in its essential functions.
Use of Posterior Probabilities to Evaluate Methods of Discriminant Analysis
Authors: Hermans J. , van Zomeren B. , Raatgever J. W. , Sterk P. J. , Habbema J. D. F.
Published: March 2018

By means of a case study the choice between several methods of discriminant analysis is presented. Experimental data of a two-groups problem with one or two variables is analysed. The different methods are compared according to posterior probabilities which can be computed for each subject and which are the basis of discriminant analysis. These posterior probabilities are analysed graphically as well as numerically.
A Non-homogeneous Markov Chain Model for Follow-up Studies with Application to Epilepsy
Authors: Commenges D. , Barberger-Gateau P. , Dartigues J. F. , Loiseau P. , Salamon R.
Published: March 2018

A non-homogeneous Markov chain model is proposed for diseases involving several pathological states. An estimator of the probability of being in a given state at a given time is presented together with an estimator of its variance. A method combining the Mantel-Haenszel and the sum of χ2 procedures enables us to test-whether two groups can be described by the same non-homogeneous Markov chain. Failure time data can be described by a system with two states, one being absorbing. In this case the proposed estimator reduces itself to the actuarial estimator and the test method to the logrank test. Applied to epilepsy this method is a useful tool for analysing the history of children suffering from typical absences (TA) and who can experience other forms of the disease such as grand mal (GM) and remission of TA or GM.
Entity-directed Coding of Medical Nomenclature
Authors: Fenna D. , Wartak J.
Published: March 2018

A new approach to the coding of medical nomenclature is described: According to this approach, medical terms would be coded in a free-standing fashion similarly as entries in most dictionaries. A general or master catalogue would serve as the operational basis for specialty field catalogues, each containing medical terms closely related. Thus, a symptom catalogue would contain only those terms which are used to describe patient complaints. Specific disease entities would have “blue prints” listed in a so-called “Lexicon”. The disease code would be appended by a digit indicating the accuracy of diagnosis and generated by comparing the patient’s data with the disease’s blue print. The proposed scheme could eliminate many shortcomings of presently employed coding systems.
Evaluation of an Automatic Blood Pressure Device for Use in Blood Pressure Screening Programs
Authors: Döring Angela , Filipiak Birgit
Published: March 2018

An automatic blood pressure recorder (Bosch Tonotest) was evaluated on a subsample of the study population of the Munich Blood Pressure Study I (MBS I). The purpose of this evaluation was to test an automatic device for its usability in screening programs like the Munich Blood Pressure Program (MBP). For all subjects in MBS I three blood pressure measurements were taken using the random-zero sphygmomanometer. For a subsample of subjects, in addition to the three blood pressure measurements with the random-zero sphygmomanometer, two measurements were made, one again with the random-zero sphygmomanometer and one with the automatic device. These last measurements were made in alternating sequence (cross-over design).

The automatic device tends to underestimate the systolic blood pressure while the diastolic blood pressure readings agree well. The ability to identify people with high blood pressure was worse for the automatic device. The differences between the automatic device and the random-zero sphygmomanometer in sensitivity, specificity, error rates and their implications for a screening program are discussed.
An Information Theory Approach to the Diagnosis of the Presence and Severity of Coronary Artery Disease
Authors: Eeckhoudt L. , Melin J. , Vanbutsele R. , Sailly J. C. , Robert A. , Brohet C. , Lebrun Th. , Detry J. M.
Published: March 2018

Non-invasive testing for the diagnosis of coronary artery disease (CAD) is usually based on the exercise ECG alone or combined with thallium scintigraphy, while coronary angiography generally represents the final work-up.

In this paper, we evaluate the relative merits of each diagnostic strategy in terms of its financial cost and of the reduction in diagnostic uncertainty. The uncertainty level before and after test is measured with the help of concepts used in information theory. The basic inputs of the program are:

1) the prior probability of CAD (p) and of its severity, obtained from a large data bank (CADENZA);

2) conditional probabilities of the presence and severity of CAD according to exercise ECG and thallium scintigraphy results obtained from the Louvain data bank; and

3) the financial cost of each technique as well as society’s willingness to pay (WTP) for a reduction in diagnostic uncertainty.

We present a graph showing the optimal strategy in terms of p and WTP. When information is sought only about the presence of CAD, arteriography is hardly ever the preferred test. However, once the severity of CAD also matters, it is the best procedure for values of p exceeding .75. Below this level, thallium scintigraphy is the most effective approach.
Computer Implementation of the Hierarchical-Modular Approach to Treatment Protocols
Authors: Michelson S. , Ben-Bassat M. , Macneil A. , Weil M. H.
Published: March 2018

A computer implementation of the hierarchical modular approach to treatment protocols [1] is presented. By this approach the clinical treatment is defined in terms of a hierarchical structure composed of several substructures each varying with the complexity of treatment-related action that is required.

The treatment protocol software consists of two major components. The first elicits treatment protocols from experts and stores them in the system’s knowledge base. The second component accesses those elements of the knowledge base relevant to the disorders and specific features (medical findings) of the patient, and drives the display of treatment information tailored specifically to the particular patient. The system interacts with the user in a friendly and very simple language. Displays are formatted in a structured manner and contain as much or as little detail as necessary. This system may find application in various areas, including generation of nursing and life support protocols as well as treatment protocols for critical care and other medical disciplines.
An Operational Approach to Record Linkage
Authors: Mi M. P. , Kagawa J. T. , Earle M. E.
Published: March 2018

An operational approach to computerized record linkage has been developed based on the concept of probability of chance match in two groups of records brought together for comparison. Tolerance levels can be readily derived from these records for decision-making in accepting or rejecting a linked pair. This approach is especially suitable for iteration when linked pairs are removed in successive cycles. An application of linkage for death clearance of the 1942 resident population of 437,967 registered in Hawaii during a 38-year period from 1942 to 1979 is presented. The reliability of linkage and rate of failure were analyzed.
AURA: Routine Documentation of Medical Texts
Authors: Gell G.
Published: March 2018

At the Department of Radiology of the University of Graz the free text documentation system AURA has been in use for more than ten years. All reports from special examination in radiology and surgical reports from neurosurgery are routinely stored and processed for retrieval. The system is used as a data base for case retrieval, for the immediate display of patient information from previous examinations and to provide feedback by linking the results of different examinations. The role of free text processing in the development of a Hospital Information System is discussed.
CEDI — ein Computerprogramm zur praeoperativen Artdiagnostik hirnorganischer Prozesse
Authors: Kolberg T. , Virnich H. , Winkler C.
Published: March 2018

Es wird ein Computer-Verfahren beschrieben, das auf der Basis eines verallgemeinerten Bayes’schen Theorems eine Artdiagnostik von hirnorganischen Prozessen ermöglicht ; dabei können Abhängigkeiten unter den Symptomen explizite Berücksichtigung finden.

Aufgrund der programmtechnischen Konzeption, allediagnosespezifischen Eigenschaften durch ein besonderes Generatorprogramm mittels eines Masterstapels in den Kalkül einzubringen, entstand ein sehr anpassungsfähiges Diagnostik-Programm, das ohne weiteres auch in anderen medizinischen Bereichen zur Anwendung gelangen kann.

Geeignete Satelliten-Programme erleichtern die Durchführung statistischer Analysen bzw. wirken in Rückkoppelung auf die Inzidenzmatrizen ein, welche die Grundlage der wahrscheinlichkeitstheoretischen Auswertung sind. Dadurch erhält das Programm eine lernende Struktur. Bereits jetzt führen die Berechnungen in ca. 90% der untersuchten Fälle zu befriedigenden Resultaten, obwohl die pro-grammtechnischen Möglichkeiten wegen z.T. noch unzulänglicher statistischer Unterlagen bislang nicht voll ausgeschöpft werden konnten.
Optical Scanning for Large-Scale Studies
Authors: Schach Elisabeth
Published: March 2018

Data reporting the experience with an optical mark page reader is presented (IBM 1231Ν1). Information from 52,000 persons was gathered in seven countries, decentrally coded and centrally processed. Reader performance rates (i.e. sheets read per hour, sheet rejection rates, reading error rates) and costs (coding, verification, reading, etc.) are given.
Automatic Detection of Dysrhythmias in the Coronary Care Unit
Authors: Rey W. , Bernard R. , Vainsel H. , Douny B. , Demeester M. , Boothroyd M. , Musoglu E. , Bousin L.
Published: March 2018

An on-line dysrhythmia monitoring system which uses simultaneously peripheral and intra-auricular leads has been developed.

Preprocessing hardware converts the ECG signals to pulses related to the P and QRS waves. The pulses are transmitted to and processed by the computer using a program which studies pulse chronological features. Important informations on the basic rhythm and on differential diagnosis of the APC and VPC are displayed in the unit at request. Interactive procedures have been designed to provide great flexibility. The acceptance of the computer system by the clinical staff is discussed and assessment of the routine use is reported.
A Small But Versatile Hospital Inforlnation System
Authors: Reece P.
Published: March 2018

A hospital information system is described. The system is built up of three divisions :modules, which initialize the system to various data types;modes, which manipulate data bases for the user; andsegments, which divide the software up into blocks of core of equal length. Each utility in the system is accessible through five modes—a scan mode through which a user may view data subsets, a select mode in which logical ›anding‹ is performed between data subsets, a system mode in which user transparent operations are performed, a statistics mode for analysis, and a data entry mode. With these divisions as building blocks, we have developed an inexpensive and flexible information system operable on a variety of host computer and data bases.
Kontingenztafelanalyse unabhängiger Daten in der Arzneimittelprüfung
Authors: Fink H.
Published: March 2018

Zur statistischen Analyse vierclimensionaler kategorialer Daten aus kontrollierten Arzneimittelprüfungen wird eine problemadäquate additive Zerlegung der Unabhängigkeitshypothese vorgeschlagen. Mehrfachassoziationen werden mittels der Hypothesen von Babtlett und Roy-Kastenbaum geprüft. Das Problem ihrer Übertragbarkeit auf entsprechende Randtafeln wird durch Prüfung ausschließender Hypothesen nach Ku und Kullback umgangen. Ein Anwendungsbeispiel wird gegeben.
Computer Applications in a Hospital Pharmacy
Authors: Willems J. , Raymakers A. , Daneels F. , Nelemans H. , De Maesschalck A.
Published: March 2018

The basic aims and the implementation of a computerized pharmacy system in a 900-bed university hospital are briefly described. The system was designed in and around a conventional pharmacy structure. Development of a pharmacy data base, computerized floor stock control, management of the central pharmacy and integration in the overall hospital information system are presently the main features of the new medication system. More clinically oriented objectives are aimed at in the continuing development of the system.
Medical Record Linkage))
Authors: Acheson E. D.
Published: March 2018

Die kurzgefaßte Ubersicht versucht die Vorstellung zu reditfertigen, daß es möglicb., ökonomisch und im öffentlichen Interesse sei, einem Teil der Fülle versctaiedenartigster medizinischer Informationen, die über jeden einzelnen Mensdien schriftlich niedergelegt sind, in einem einzigen Satz von stetig ergänzten Unterlagen für ganze Populationen zusammenzufassen.

Die Arbeit behandelt die praktisdien Gesichtspunkte hinsichtlich der Auswahl und der Gültigkeit der Angaben, die Probleme der Personenidentifikation und Beispiele für den Nutzen von derartigen Daten-Verbund-Systemen für den Dienst am Patienten und für die medizinische und die betriebswirtschaftliche Forsdiung. Diskutiert werden weiterhin die mit dem entscheidenden Angelpunkt des Schutzes der persönlichen Sphäre in Zusammenhang stehenden Fragen.

Ein medizinisches Daten-Verbund-System erscheint als die logische Erweiterung des Krankenblatt-Systems der Einzelklinik beziiglich der Bereitstellung von geeigneten Informationen fiir ein integriertes System der Gesundheitsbetreuung der Allgemeinheit. Ein solches System medizinischer Informationen wird in der zweiten Hälfte des 20. Jahrhunderts ebenso notwendig sein wie die Registrierung der Sterbefälle und die Meldung ansteckender Krankheiten im 19. Jahrhundert.
Organisation einer Datenbank auf Magnetbändern für die Hautklinik Kiel
Authors: Jainz M.
Published: March 2018

Die Arbeit beschreibt ein Speichersystem, mit dessen Hilfe die in der Universitäts-Hautklinik Kiel anfallenden, auf Lochkarten dokumentierten Daten auf Magnetbänder übertragen werden. Da bei einer Sichtung des vorhandenen Datenmaterials von den sich auf den Bändern befindenden Records meist nur ein Teil der Informationen benötigt wird, werden die Daten von vornherein so gespeichert, daß nur dieser Teil gelesen zu werden braucht. Gleichzeitig werden dadurch unnötige Spulund Suchzeiten eingespart.
Ein klinikorientiertes System für die Meßdatenverarbeitung mit dem Digitalrechner
Authors: Lorenzutti W. , Schuy S. , Fueger G. F. , Gell G.
Published: March 2018

Es wird über ein System für die Erfassung und Verarbeitung von Meßdaten in der klinischen Untersuchungsstation berichtet, das mit dem Bedarf an Datenverarbeitung wachsen kann. Die off-line auf Magnetband gespeicherten Daten werden mittels eines Terminals über eine Datenleitung zur Digitalrechenanlage übertragen und verarbeitet. Auf den klinischen Anwendungsbereich und die Grenzen dieses Konzepts wird hingewiesen.