bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of a Robotic Navigation and Fracture Fixation System
Authors: Fuechtmeier Bernd  , Egersdoerfer Stefan  , Tuma Georg  , Monkman Gerit J.  , Nerlich Michael
Published: February 2025

The use of robotics in surgery is nothing new. However, there are areas of surgery, such as in fracture fixation, where robots have yet to be implemented. This paper considers the choice of robot, gripper and ancillary equipment together with navigation systems necessary for their application.
A Readiness Model for Telehealth Is it possible to Pre-Determine How Prepared Communities are to Implement Telehealth?
Authors: Jennett Penny  , Bates Joanna  , Healy Theresa  , Ho Kendall  , Kazanjian Arminee  , Woollard Robert  , Jackson Andora  , Haydt Susan
Published: February 2025

Telehealth “readiness” can be defined as the degree to which users, health care organizations, and the health system itself are prepared to participate and succeed in its application. This project developed a readiness model for rural/remote locations in Canada. Specifîcally defined groups or communities with shared characteristics within a rural geographical Community (i.e. practitioners, patients, the public, and health care organizations) participated in key informant interviews, awareness sessions, focus groups, and face-to-face interviews. The data were examined and organized keeping in mind Weiss' Program's Theory of Change. This approach allowed concrete and abstract factors to be considered. The model that emerged suggests that there are four types of readiness for each of the defined communities: core, engagement, structural, and non-readiness. The “communities” share some readiness factors and risks, but also exhibit unique clements. This finding is critical to acknowledge when the goal is to implement a useful, effective, and sustainable telehealth system within remote settings. Study results hold a key to understanding why technology Systems have failed in the past, in spite of dedicating considerable human and financial resources towards their implementation. Notations of these findings will be helpful in future telehealth implementations within rural and isolated areas.
The Development of a VR System for the Cognitive & Behavioral Assessment of Schizophrenia
Authors: Ku Jeonghun  , Cho Won Geun  , Kim Jae Hun  , Kim Kwang Uk  , Kim Byoung Nyun  , Hahn Won Yong  , Kim Jae Jin  , Lee Jang Han  , Kim In Y.  , Kim Sun I
Published: February 2025

Patients with schizophrenia have many trouble in their life due to their thinking disorders such as delusion or hallucination. It is because they have a deficit in the ability which to systematize and integrate information. Therefore, they cannot integrate or systematize properly the integrated stimuli occurring frequently in a real situation. In this study, we suggest a virtual reality system for the assessment of their ability to integrate, memorize and react to integrated stimuli. The virtual reality system we developed provided multimodal stimuli, such as visual and auditory stimuli or visuo-spatial integration, and the patients was assessed and compared their thought flexibility and working memory abilities based on multi-modal manner by making the patient experience and react to multimodal stimuli. From this study, we could conclude that the VR could provide a patient with various stimuli in an immersive environment and allow the assessment of cognitive ability, and the identification of the relationships between cognitive functions.
Two-Handed Next Generation Suturing Simulator
Authors: Lindblad Alex J.  , Turkiyyah George M.  , Sankaranarayanan Ganesh  , Weghorst Suzanne J.  , Berg Daniel
Published: February 2025

A realistic two-handed surgical suturing simulation would have a broad impact on the way doctors are trained in the field of surgery. Current state-of-theart in suturing simulators do not accurately represent realistic suturing conditions, leaving many necessary components, i.e. two-handed interaction, skin undermining, skin repositioning etc., out of the model completely. The goal of this research is to develop a next generation immersive suturing simulator that uses an integrated twohanded tension based haptic device for tactile feedback, a hi-fidelity finite element model for more accurate skin, tissue and needle modeling and stereoscopic vision for depth-of-field.
In-Vivo Stereoscopic Imaging System with 5 Degrees-of-Freedom for Minimal Access Surgery
Authors: Miller Andrew  , Allen Peter  , Fowler Dennis
Published: February 2025

Endoscopic imaging for minimal access surgery has many limitations that include: 2D and narrow angle imaging, limited workspace of the endoscope caused by the fulcrum effect of the body wall, and the presence of the endoscope in the incision that prevents use of the incision for other instrumentation. We have designed a novel stereoscopic 3D imaging device with 5 DOF and remote control that can be inserted and attached in the body cavity. The device, contained within a 11/16" tube, includes two miniature cameras and five small motors that position the cameras to provide a stereoscopic view of the surgical site. When inserted the cameras are retracted and protected by an outer shell. After the device is fixed within the abdominal cavity, a motor rotates an inner shell to expose the cameras. Once exposed, the cameras can tilt in tandem, translate independently along the axis of the tube, and independently pan. The software controls the cameras to create new views for the surgeon, to move along the adjustable baseline, to verge for stereoscopic viewing, and to potentially track moving organs. We have completed a proof of concept design, which includes CAD models and animations of the device, and we are currently building a physical prototype. Once the prototype is completed, we will begin testing it in a surgical mock-up, followed by animal and clinical trials.
Evaluation of the benefit of VR simulation in a multi-media web-based educational tool
Authors: Moorthy K  , Mansoori M  , Bello F  , Hance J  , Undre S  , Munz Y  , Darzi A
Published: February 2025

WebSET is an Internet based educational tool that can be used on any standard personal computer. It has been developed by a European collaboration and integrates high quality multimedia learning materials with VR simulation. The aim of this study was to evaluate the benefit of the VR simulation on the learning of procedure based psychomotor skills. Subjects were divided into three groups. The group that used the entire package including the VR simulation were superior to the group that used only the multimedia component in terms of the their procedural skills in the post-training assessment. Both groups performed better than the controls.
Physics-Based Preoperative Approach Planning using Hybrid Virtual Bodies
Authors: Nakao Megumi  , Kuroda Tomohiro  , Komori Masaru  , Komeda Masashi  , Oyama Hiroshi
Published: February 2025

This paper proposes a hybrid model mixing geometry and volume data to improve representation of virtual bodies. This model applies object-oriented data models and rendering techniques to virtual organs, and enables both interactive VR simulation and detailed volume visualization of tissue of interest (e.g. coronary). Also, a physics-based framework interactively simulates estimated surgical fields which are used in preoperative discussion. Based on the proposed methods, a VR-based strategic planning system is developed. The system does not need high cost manual segmentation of patient dataset and efficiently supports planning of surgical approaches in cardiovascular surgery.
The Delivery Simulator: A New Application of Medical VR
Authors: Obst Tobias  , Burgkart Rainer  , Ruckhäberle Eugen  , Riener Robert
Published: February 2025

This paper presents an elementary overview of the potential of Multimodal Virtual Reality (MVR) techniques in medical education, e.g. obstetrics. The study shows how to transfer the concept of MVR from a time-independent environment, e.g. the Munich Knee Joint Simulator, to a time-critical simulation environment as it can be found in flight simulators.
Passive vs. Active Virtual Reality Learning: The Effects on Short- and Long-Term Memory of Anatomical Structures
Authors: Phelps Andrew  , Fritchle Alicia  , Hoffman Helene
Published: February 2025

This pilot study compares the differences in learning outcomes when students are presented with either an active (student-centered) or passive (teacher-centered) virtual reality-based anatomy lesson. The “active” lesson used UCSD's Anatomic VisualizeR and enabled students to interact with 3D models and control presentation of learning materials. The “passive” lesson used a digital recording of an anatomical expert's tour of the same VR lesson played back as a QuickTime™movie. Subsequent examination of the recal and retention studied anatomic objects were comparable in both groups. Issues underlying these results are discussed.
Catheter Simulation System Cathl: from Patient Data Generation to Cardiological Training Systems
Authors: Rebholz Philipp  , Kornmesser Ulrike  , Hesser Jürgen
Published: February 2025

In this paper we discuss a new approach to generate 3D models for a simulation system for training an angioplasty. The underlying data for these models are obtained from angiograms that are captured during routine interventions in cardiology. For the extraction of the arteries we use a non-linear classificatory with features based on vesselness information (using a scale-space approach), the gray value, and motion information of the arteries. As result we can correctly find 80 % of the arteries in the image and we have 4 % pixels incorrectly classified as arteries.
Enhancing Radiological Volumes with Symbolic Anatomy Using Image Fusion and Collaborative Virtual Reality
Authors: Silverstein Jonathan C.  , Dech Fred  , Kouchoukos Philip L.
Published: February 2025

Radiological volumes are typically reviewed by surgeons using cross-sections and iso-surface reconstructions. Applications that combine collaborative stereo volume visualization with symbolic anatomic information and data fusions would expand surgeons’ capabilities in interpretation of data and in planning treatment. Such an application has not been seen clinically. We are developing methods to systematically combine symbolic anatomy (term hierarchies and iso-surface atlases) with patient data using data fusion. We describe our progress toward integrating these methods into our collaborative virtual reality application. The fully combined application will be a feature-rich stereo collaborative volume visualization environment for use by surgeons in which DICOM datasets will selfreport underlying anatomy with visual feedback.
Study of Soft Tissue Cutting Forces and Cutting Speeds
Authors: Chanthasopeephan Teeranoot  , Desai Jaydev P.  , Lau Alan C.W.
Published: February 2025

A versatile equipment to study the cutting of soft tissue with surgery scalpel was designed and constructed. Experiments were performed with pig liver (ex-vivo) to measure the blade-tissue interaction forces at cutting speeds ranging from 0.1 cm/sec-2.54 cm/sec. The experimentally measured force-displacement curves reveal that the liver cutting process was made up of a sequence of repeating local units with similar features. Each local unit was comprised of a linear deformation phase followed by a crack growth phase. A method was developed to quantify the deformation resistance of the tissue during each local deformation phase in cutting. This deformation resistance was presented in the form of a selfconsistent local effective Young's modulus (LEYM), and was determined by postprocessing force-displacement data with finite element models. Values for LEYM were determined from plane-stress finite element model and plane-strain finite element model. The plane-stress LEYM values were within a close bound of the plane-strain values. Results of the self-consistent LEYM at different cutting speeds show that the tissue’s resistance to deformation decreased as the cutting speed increased.
Virtual Reality and Psychotherapy
Authors: Botella Cristina  , Quero Soledad  , Baños Rosa M.  , Perpiña Conxa  , García Palacios Azucena  , Riva Giuseppe
Published: February 2025

Virtual Reality (VR) is a new technology consisting on a graphic environment in which the user, not only has the feeling of being physically present in a virtual world, but he/she can interact with it. The first VR workstations were designed for big companies in order to create environments that simulate certain situations to train professionals. However, at this moment a great expansion of this technology is taking place in several fields, including the area of health. Especially interesting for us is the use of VR as a therapeutic tool in the treatment of psychological disorders. Compared to the “traditional” treatments, VR has many advantages (e.g., it is a protected environment for the patient, he/she can re-experience many times the feared situation, etc.). There are already data on the effectiveness of this technology in the treatment of different psychological disorders; here anxiety disorders, eating disorders and sexual disorders are reviewed. Finally, this chapter ends with some words about the limitations of VR and future perspectives.
Transforming Written Guidelines into Electronic Formats – International Perspectives
Authors: Marshall Catherine  , Rosenbrand Kitty  , Ollenschlaeger Guenter
Published: February 2025

The Guidelines International Network (G-I-N www.g-i-n.net) is a major new international initiative involving guideline-developing organisations from around the world. G-I-N seeks to improve the quality of health care by promoting systematic development of clinical practice guidelines and their application into practice.
Using a Guideline-Centered Approach for the Design of a Clinical Decision Support System To Promote Smoking Cessation
Authors: Shiffman Richard N.  , Michel George  , Essaihi Abdelwaheb  , Marcy Theodore W.
Published: February 2025

Knowledge acquisition for the design of clinical decision support systems can be facilitated when clinical practice guidelines serve as a knowledge source. We describe application of the Guideline Elements Model (GEM) in the design of a decision support system to promote smoking cessation. Following selection of relevant recommendations and markup of knowledge components with the GEM Cutter editor, the Extractor stylesheet was used to create a list of decision variables and actions for further processing. Decision variables and actions that reflect similar concepts were consolidated. Action types were identified. Extracting the critical concepts from the narrative text facilitates clarification of necessary content. The guideline-centric approach promotes accurate translation of guideline knowledge.
Biodynamic Ontology: Applying BFO in the Biomedical Domain
Authors: Grenon Pierre  , Smith Barry  , Goldberg Louis
Published: February 2025

We propose a modular formal ontology of the biomedical domain with two components, one for biological objects, corresponding broadly to anatomy, and one for biological processes, corresponding broadly to physiology. The result constitutes what might be described as a joint venture between two perspectives – of so-called three-dimensionalism and four-dimensionalism – which are normally regarded as incompatible. We outline an approach which allows them to be combined together, and provide examples of its application in biomedicine.
Bodily Systems and the Spatial-Functional Structure of the Human Body
Authors: Smith Barry  , Munn Katherine  , Papakin Igor
Published: February 2025

The human body is a system made of systems. The body is divided into bodily systems proper, such as the endocrine and circulatory systems, which are subdivided into many sub-systems at a variety of levels, whereby all systems and subsystems engage in massive causal interaction with each other and with their surrounding environments. Here we offer an explicit definition of bodily system and provide a framework for understanding their causal interactions. Medical sciences provide at best informal accounts of basic notions such as system, process, and function, and while such informality is acceptable in documentation created for human beings, it falls short of what is needed for computer representations. In our analysis we will accordingly provide the framework for a formal definition of bodily system and of associated notions.
Interactive Telemedicine as a Tool to Avoid a Digital Divide in the World
Authors: Graschew Georgi  , Roelofs Theo A.  , Rakowsky Stefan  , Schlag Peter M.
Published: February 2025

An efficient way of closing the gap in medical care between the EU and its Mediterranean partners is the use of satellite-based networks for telemedical applications. Using standard hardware components and specially designed communication software (WinVicos) various telemedical applications (teleconsultation, telementoring, teleteaching, etc.) have been realized.
Image-Based Modeling of Carotid Bifurcation Flows
Authors: Xu X.Y.  , Augst A.D.  , Glor F.P.  , Ariff B.  , Thom S.A.  , Hughes A.D.
Published: February 2025

Advances in computer hardware and modeling software have made it possible to simulate pulsatile blood flow in anatomically faithful arterial models derived from non-invasively acquired angiographic images. Such studies require the combination of multidisciplinary techniques ranging from medical imaging, image processing, to computational fluid and solid mechanics. Over the last few years, there has been a rapid surge of interest in combining computational fluid dynamics (CFD) with in vivo imaging techniques for more detailed investigation of haemodynamics in specific arteries of individual subjects or patients. This presentation will be focused on the modeling of blood flow at carotid artery bifurcations, using in vivo anatomical and flow data acquired by means of magnetic resonance imaging (MRI) and ultrasound. Techniques and methods required for this integrated imaging/modeling approach will be described. Subject-specific simulations of flow at the carotid bifurcation will be demonstrated, and examples will be shown for both normotensive and hypertensive subjects. Accuracy and reproducibility of this combined modeling approach will be addressed and potential applications of this tool for clinical studies will be highlighted.
Quantitative analysis of vascular images, in particular of abdominal aorta aneurysms from 3D CTA data sets
Authors: Schaap J.A.  , De Koning P.J.H.  , Janssen J.P.  , Van Der Geest R.J.  , Reiber J.H.C.
Published: February 2025

This article presents a combination of well known image processing techniques to automatically segment CTA images of the Abdominal Aortic Aneurysm. Current results are that about 80% of the contours need no manual corrections. The remaining 20% fail due to calcified plaque close to the lumen border. After correction a 3D surface model is created from the 2D contours which is used as input for flow simulations and for parameter extraction of the AAA by clinicians for selecting the proper size and shape endograft, and to plan the placement procedure of this endograft in the patient.
Healthcare Compunetics
Authors: Marsh Andy  , Laxminarayan Swamy  , Bos Lodewijk
Published: February 2025

Changes in life expectancy, healthy life expectancy and health seeking behaviour are having an impact on the demand for care. Such changes could occur across the whole population, or for specific groups. Changes for specific groups will be particularly affected by policy initiatives, while both these and wider changes will be affected by people's levels of engagement with their health and the health service itself Levels of education, income and media coverage of health issues are also important. These factors could also encourage an increase in people caring for themselves and their families or community.
Mobile Patient Monitoring: the MobiHealth System
Authors: Konstantas Dimitri  , Van Halteren Aart  , Bults Richard  , Wac Katarzyna  , Widya Ing  , Dokovsky Nicolai  , Koprinkov George  , Jones Val  , Herzog Rainer
Published: February 2025

The forthcoming wide availability of high bandwidth public wireless networks will give rise to new mobile health care services. Towards this direction the MobiHealth ) project has developed and trialed a highly customisable vital signals’ monitoring system based on a Body Area Network (BAN) and an m-health service platform utilizing next generation public wireless networks. The developed system allows the incorporation of diverse medical sensors via wireless connections, and the live transmission of the measured vital signals over public wireless networks to healthcare providers. Nine trials with different health care cases and patient groups in four different European countries have been conducted to test and verify the system, the service and the network infrastructure for its suitability and the restrictions it imposes to mobile health care applications.
Ambulatory Monitoring for Chronic Cardiac and Pulmonary Patients
Authors: Zarakovitis Konstantinos  , Angelidis Pantelis  , Kourtidou-Papadeli Chrysoula  , Psymarnou Markela
Published: February 2025

In the Greek pilot of the e-Vital project, remote telemedicine services are provided to chronic cardiac and pulmonary patients who are not confined to a hospital (i.e. receiving home/ambulatory health care) with the aim of exploring the dynamics of interactive continuous chronic patient monitoring, particularly focusing on the impact on patient's quality of life, the patient's active involvement in their own care and according impact on the overall quality of healthcare provision, as well as the benefits for healthcare providers (time management, patient management, savings, etc).
Development of an Expert System for Differentiating Tension Type Headaches from Migraines
Authors: Kopec D.  , Shagas G.  , Selman J.  , Reinharth D.  , Tamang S.
Published: February 2025

We created a program, written in the CLIPS language for expert systems, to distinguish migraines from headaches. The system can be web-based, takes seconds to input data and quickly converges to the correct diagnosis. Over time such an application can result in enormous savings to doctors, patients, and health care institutions.
Education and Distance Learning: Changing the Trends
Authors: Merrell Ronald C.
Published: February 2025

Training and instruction are activities deeply ingrained in human relations and derive from the critical need for the young to learn survival skills. The responsibility in primitive society for such training almost certainly fell to parents who continued their pedagogical role after childhood issues to include hunting, gathering, fine motor activities and other life skills needed for personal or family survival. Such instruction only ended when the young were ready for independent life and contribution to tribal well-being. Delegation of teaching to others was inevitable. Teaching has become a specialty and has at least one interesting story in ancient literature. Ulysses was certain to be away at the Trojan War and subsequent adventures for many years. He would not be able to provide his son, Telemachus, with the guidance and training to prepare him for adulthood [1]. Therefore, he asked Mentor to act In Loco Parentis and instruct the young man toward competence and adult success. Teaching as a profession and discipline has been through many stages and many controversies. Socrates was a great teacher with a distinct technique for learning by questioning. His influence on his students was profound. Plato was such a good student he recorded all the master's works. Socrates has never been credited with even the briefest lecture note. As great as he was Socrates was forced to drink the bitter hemlock because his teaching was considered a corruption of youth rather than a proper preparation for effective adulthood [2].
Telehealth: The Backbone of Healthcare Financing
Authors: Suleiman Abu Bakar
Published: February 2025

Malaysia, like many other countries faces major challenges in meeting increasing demands with limited resources. Changes in demography, life-style diseases, increasing consumer expectations, new medical technologies and rapid economic growth all fuel demand for more healthcare services. There are problems related to the distribution and delivery of healthcare services, and there is inadequate integration of healthcare delivery and continuity of care is a major concern. Resources tend to be concentrated in the very expensive hospital sector, although services would be cost-effectively and conveniently delivered at primary care level. There is no ideal healthcare system, and how healthcare is supported and organized for service delivery influences the country's social, economic and political well-being. Like many other countries, Malaysia is undergoing health reform in meeting these challenges, and is becoming more reliant on telemedicine and telehealth.
Telepresence and Telemedicine in Trauma and Emergency Care Management
Authors: Latifi Rifat  , Peck Kim  , Porter John M.  , Poropatich Ron  , Geare III Ted  , Nassi Richard B.
Published: February 2025

The use of telemedicine is long-standing, but only recently has been applied to the specialties of trauma, emergency care, and surgery. Subsequently the concepts of teletrauma, telepresence, and telesurgery have evolved and are being integrated into modern care of trauma and surgical patients. This chapter will review the current applications and future endeavors of telemedicine and telepresence to trauma and emergency care as the new frontiers of telemedicine application.
E-Health in the Scandinavian Countries
Authors: Duedal Pedersen Claus
Published: February 2025

For more than 10 years the Scandinavian countries have been focusing on utilizing information technology to increase efficiency in the delivery of healthcare services. Over the last 3 years all three countries have built closed secure IP-based healthcare networks that cover nearly all aspects of the national healthcare sector. The next step is to connect the national networks and integrate them into one large Scandinavian healthcare network. This paper describes the history of e-health in the Scandinavian Countries, the challenges and emerging trends.
UMIN - Current Status and Future Perspectives
Authors: Kiuchl Takahiro  , Igarashi Tetsuya
Published: February 2025

UMIN, fully funded by the Japanese government, is the largest and most versatile public academic information center for biomedical sciences in the world, and is considered as indispensable information infrastructure for the Japanese medical community. As of April 1st2004, all Japanese national universities, including UMIN, will be incorporated as independent administrative entities. After the incorporation, each national university will have authority to determine its own budget, organization, etc. by itself, and will also be able to carry out profit-making business related to its activities under certain constraints. Thus we suspect that UMIN will inevitably befaced with a strong demand to undertake profit-making business at an early stage. Even in this case, we believe that UMIN should continue to provide its information services to the Japanese medical community free of charge as it has done, utilizing earnings from its profit-making business that services commercial companies, because the success of UMIN has depended on the cooperation and sympathy of the community in the past, and will continue to do so.
Restoring the patient therapeutic history from prescription data to enable computerized guideline-based decision support in primary care
Authors: Bouaud Jacques  , Séroussi Brigitte  , Touzet Baptiste
Published: February 2025

The application of a guideline-based therapeutic strategy in the context of a chronic disease requires a clear picture, at the appropriate level of abstraction, of a patient’s particular therapeutic history. However, like most clinical data, information on past treatments is often incompletely specified. We propose temporal abstraction mechanisms based on a simple and heuristic treatment of temporal indeterminacy on period bounds. Applied to prescription data, continuity and simultaneousness of treatments have to be characterized. Even if limited, our method restores the therapeutic history of a patient, with episodes of mono-, bi-, and tritherapies in order to adequately position her within the guideline therapeutic strategy.
Collection and Integration of Clinical Data for Surveillance
Authors: Lober William B.  , Baer Atar  , Karras Bryant T  , Duchin Jeffery S
Published: February 2025

Objective: The syndromic surveillance project at Public Health – Seattle & King County incorporates several data sources, including emergency department and primary care visit data collected and normalized through an automated mechanism. We describe significant changes made in this “second generation” of our system to improve data quality while complying with privacy and state public health reporting regulations. Methods/Results: The system uses de-identified visit and patient numbers to assure data accuracy, while shielding patient identity. Presently, we have 124,000 basic visit records (used to generate stratified denominators), and 29,000 surveillance records, from four emergency departments and a primary care clinic network. The system is capable of producing syndrome-clustered data sets for analysis. Discussion: We have incorporated data collection techniques such as automated querying, report parsing, and HL7 electronic data interchange. We are expanding the system to include greater population coverage, and developing an understanding how to implement data collections more rapidly at individual hospital sites, as well as how best to prepare the data for analysis.
A Comparison of Different Heterogeneous Proximity Functions and Euclidean Distance
Authors: Lumijärvi Janne  , Laurikkala Jorma  , Juhola Martti
Published: February 2025

Proximity functions evaluate distances or similarities between objects. Unlike the Euclidean distance, heterogeneous proximity functions process variables differently according to their scale. The correct evaluation of nominal variables, whose values are unordered, is especially important. We compared five heterogeneous functions with the Euclidean distance to study whether functions sensitive to scale are better than a function assuming the same scale. In addition, we were interested of the relative performance of the five heterogeneous functions. The performance of the functions was measured with a nearest neighbor classifier that was applied to 12 medical data sets characterized with different scales. Unexpectedly, the performance of heterogeneous functions did not differ significantly from that of the Euclidean distance. As expected, significant differences between the Heterogeneous Value Difference Metric (HVDM) and the four value-matching-based heterogeneous functions favored HVDM. Additional research is needed to explain why heterogeneous functions did not outperform the Euclidean distance.
The Informatics Collaboratory: Building an online community to support health care informatics students
Authors: Skiba Diane J.  , Barton Amy J.  , Howard Audrey  , Fields Leeann  , McCullar Wendy
Published: February 2025

For the past decade, the School of Nursing has examined the role of computer mediated communication and virtual environments in both health care and educational systems. This recent project, the I-Collaboratory, draws upon previous work and builds on recent studies examining the role of social presence in learning communities. The I-Collaboratory creates a virtual infrastructure to support a collaborative learning environment for Master level students in a web-based health care informatics program. This innovative and supportive environment allows students to learn through collaborative interactions and have access to a cadre of professionals associated with nursing, informatics and health care.
A Usability Study of the PubMed on Tap User Interface for PDAs
Authors: Alexander Gregory L.  , Hauser Susan  , Steely Karen  , Ford Glenn  , Demner-Fushman Dina
Published: February 2025

Healthcare providers are challenged by the availability of information at the point of care. Overcoming these challenges requires access to current, reliable, and accurate information. The purpose of the PubMed on Tap project is to discover and implement design principles to facilitate healthcare practitioners' access to medical information at the point-of-care, related to user interface design, organization and performance. The PubMed on Tap prototype was developed for personal digital assistants (PDAs) as a testbed to study these design principles. Usability testing was used to derive conclusions regarding the functionality of PubMed on Tap. Participant events (n = 323) mostly occurred in navigational ability (31%) and perceivedfunctionality (33%). A strong correlation (r = 0.87) was observed between total time and the sum of negative events in locating functions and navigational categories. Researchers concluded the basic functionality of the PubMed on Tap interface was valuable to users. However, there was room for improvement in the navigational and functional characteristics, such as placing labels on icons, which affected the users' ability to use the research tool.
Ubiquitous Computing Technology for Just-in-Time Motivation of Behavior Change
Authors: Intille Stephen S.
Published: February 2025

This paper describes a vision of health care where “just-intime” user interfaces are used to transform people from passive to active consumers of health care. Systems that use computational pattern recognition to detect points of decision, behavior, or consequences automatically can present motivational messages to encourage healthy behavior at just the right time. Further, new ubiquitous computing and mobile computing devices permit information to be conveyed to users at just the right place. In combination, computer systems that present messages at the right time and place can be developed to motivate physical activity and healthy eating. Computational sensing technologies can also be used to measure the impact of the motivational technology on behavior.
Participatory Design and Infrastructures for Coordination and Communication in Interdisciplinary Mobile Health Teams
Authors: Smørdal Ole  , Moen Anne  , Kristiansen Tove  , Refseth Yngve  , Mortensen Berit  , Osnes Terje
Published: February 2025

This paper reports on a current project exploring how wireless and mobile technologies, in this case Personal Digital Assistants (PDAs) and Tablet PCs, may be useful in clinical practices. In particular, the support and practices for coordination and communication among members in highly mobile health teams are focused. Their practice can be pictured as just-in-time access to information for coordination of care and treatment related to, but also different from, information traditionally stored in the patients' health records and clinical information systems (CIS). To facilitate discussion among and participation from various stakeholders, and between organizational contexts and responsibilities, we developed four video scenarios. The paper describes how development of these scenarios can be used in an organizational development setting to facilitate analysis and design of tools mindful of the relationships between complex and interwoven infrastructures of communication on one hand and just-in-time aspects ofa mobile clinical practice on the other.
Modeling Guidelines for Integration into Clinical Workflow
Authors: Tu Samson W.  , Musen Mark A.  , Shankar Ravi  , Campbell James  , Hrabak Karen  , McClay James  , Huff Stanley M.  , McClure Robert  , Parker Craig  , Rocha Roberto  , Abarbanel Robert  , Beard Nick  , Glasgow Julie  , Mansfield Guy  , Ram Prabhu  , Ye Qin  , Mays Eric  , Weida Tony  , Chute Christopher G.  , McDonald Kevin  , Mohr David  , Nyman Mark A  , Scheitel Sidna  , Solbrig Harold  , Zill David A  , Goldstein Mary K
Published: February 2025

The success of clinical decision-support systems requires that they are seamlessly integrated into clinical workflow. In the SAGE project, which aims to create the technological infrastructure for implementing computable clinical practice guidelines in enterprise settings, we created a deployment-driven methodology for developing guideline knowledge bases. It involves (1) identification of usage scenarios of guideline-based care in clinical workflow, (2) distillation and disambiguation of guideline knowledge relevant to these usage scenarios, (3) formalization of data elements and vocabulary used in the guideline, and (4) encoding of usage scenarios and guideline knowledge using an executable guideline model. This methodology makes explicit the points in the care process where guideline- based decision aids are appropriate and the roles of clinicians for whom the guideline-based assistance is intended. We have evaluated the methodology by simulating the deployment of an immunization guideline in a real clinical information system and by reconstructing the workflow context of a deployed decision-support system for guideline-based care. We discuss the implication of deployment-driven guideline encoding for sharability of executable guidelines.
EyePACS: An Open Source Clinical Communication System For Eye Care
Authors: Cuadros Jorge  , Sim Ida
Published: February 2025

Purpose: EyePACS is an application for communicating and archiving eye-related patient information, images, and diagnostic data. We studied how users adopted the system in diverse clinical settings. Methods: 53 clinicians and 142 students uploaded cases over 2.5 years from 6 pilot sites: a university teaching clinic, a university glaucoma clinic, an urban private optometric practice, a rural elderly care facility, a diabetic management program, and an eye hospital in India. Results: Eye- PACS collected 1 122 cases. Users employed it for informal "curbside " consults in 17% of cases. Other uses of the system were: 1) to replace telephone and fax referrals to a retinal specialist (10%), 2) as part of ocular teleconsultations and diabetic retinopathy screening (31%), 3) for education via digital grand rounds and evaluation of students (32%), and 4) for research (10%). Conclusion: EyePACS has been used successfully for consults and education in diverse settings. The resulting database of digital cases serves as a searchable reference for clinicians.
Validation of a web-based prognostic system for breast cancer
Authors: Lundin Johan  , Lundin Mikael  , Isola Jorma  , Joensuu Heikki
Published: February 2025

A website has been published which allows the user to enter information on prognostic factors for a patient with breast cancer, and instantly obtain a survival curve based on outcome data of prior cases with a matching prognostic factor profile. The source for the survival data is a Finnish nationwide series (the FinProg series) of 2,842 women diagnosed with breast cancer in 1991-2. The purpose of this study was to compare survival estimates based on the FinProg database, with estimates for breast cancer patients from the US, obtained from the SEER public-use database and the same time period. Results show that a reasonable level of agreement between estimates can be reached, by the use of large, unselected databases, and that significantly different estimates were obtained in only 2 of 19 analyzed prognostic profiles. The current system could be used to share important knowledge on outcome between researchers and clinicians at different institutions, and be used in the decision-making process concerning treatment of patients with breast cancer.
e-clinic: An Electronic Triage System in the Management of Type 2 Diabetes Mellitus
Authors: Rahman Yusof  , Knape Thomas  , Gargan Mark  , Power Gordon  , Hederman Lucy  , Wade Vinny  , Nolan John  , Grimson Jane
Published: February 2025

Diabetes Mellitus represents a heterogeneous group of metabolic disorders and its complications are associated with increased morbidity and early mortality. The explosive increase of the number of patients with diabetes, and several recommendations from milestone studies such as the United Kingdom Prospective Study (UKPDS), the Diabetes Prevention Program (DPP) and the Finnish Prevention Study place further constraint on an already overstretched service. This paper examines the care flow process in the current diabetes management and explores the potential role of new technologies and methodologies currently available to support the highly complex clinical requirements. The paper proposes a concept of e-clinic as an electronic triage system with integrated healthcare record, embedded with a decision support system to analyse patients' data and provide a continuous monitoring system according to agreed clinical guidelines.
Text Mining Functional Keywords Associated with Genes
Authors: Liu Ying  , Brandon Martin  , Navathe Shamkant  , Dingledine Ray  , Ciliax Brian J.
Published: February 2025

Modern experimental techniques provide the ability to gather vast amounts of biological data in a single experiment (e.g. DNA microarray experiment), making it extremely difficult for the researcher to interpret the data and form conclusions about the functions of the genes. Current approaches provide useful information that organizes or relates genes, but a major shortcoming is they either do not address specific functions of the genes or are constrained by functions predefined in other databases, which can be biased, incomplete, or out-of-date. We extended Andrade and Valencia's method [1] to statistically mine functional keywords associated with genes from MEDLINE abstracts. The MEDLINE abstracts are analyzed statistically to score and rank keywords for each gene using a background set of words for baseline frequencies. We generally got very good functional keyword information about the genes we tested, which was confirmed by searching for the individual keywords in context. The keywords extracted by our algorithm reveal a wealth of potential functional concepts, which were not represented in existing public databases. We feel that this approach is general enough to apply to medical and biological literature to find other relationships: drugs vs. genes, risk factors vs. genes, etc.
On Parts and Holes: The Spatial Structure of the Human Body
Authors: Donnelly Maureen
Published: February 2025

Spatial representation and reasoning is a central component of medical informatics. The spatial concepts most often used in medicine are not the quantitative, point-based concepts of classical geometry, but rather qualitative relations among extended objects such as body parts. A mereotopology is a formal theory of qualitative spatial relations, such as parthood and connection. This paper considers how an extension of mereotopology which includes also location relations can be used to represent and reason about the spatial structure of the human body.
U.S. Department of Veterans Affairs Enterprise Reference Terminology Strategic Overview
Authors: Lincoln Michael J.  , Brown Steven H.  , Nguyen Viet  , Cromwell Tim  , Carter John  , Erlbaum Mark  , Tuttle Mark S.
Published: February 2025

The Veterans Health Affairs (VHA) branch of the Department of Veterans Affairs has undertaken an Enterprise Reference Terminology (ERT). VHA, arguably the largest integrated healthcare provider in the United States, has completely computerized virtually all clinical transactions, including physician orders and documentation. The VA is now integrating its clinical records across hundreds of sites of care by means of a Health Data Repository (HDR) project. ERT has been designed to provide a terminology development environment, terminology services, and maintenance services for the clinical and business content in HDR and other VHA applications. Drug, laboratory observations, and clinical document title files have been developed, and the ERT will encompass all HDR domains by 2008. Commercial tools are used to host the VHA’s ERT terminology development and server environments. We will select and adopt both opensource and licensable terminology systems to provide ERT content, as well as reuse existing VA-specific terminology content.
Modeling, the essential step to consolidate and integrate a national NMDS
Authors: Junger Alain  , Berthou Anne  , Delaney Connie
Published: February 2025

How to develop a nursing minimum data set (NMDS) as a part of a nursing information system, which is itself a part of a health information system, this is the challenge presented in this paper and realized in Switzerland through the NURSING data project. The development of the CH-NMDS is not just a selection of data but a real conceptual work consisting in making the link between the information system and the terminology system and this for any level of aggregation.
Representing Public Health Nursing Intervention Concepts with HHCC and NIC
Authors: Lee Nam-Ju  , Bakken Suzanne  , Saba Virginia
Published: February 2025

Purpose: It is imperative that public health nurses define their services and provide evidence supporting the effectiveness of interventions. The purpose of this paper is to examine the extent to which two standardized nursing terminologies –Home Health Care Classification (HHCC) and Nursing Interventions Classification (NIC) represent public health nursing practice according to core public health function in Public Health Nursing Intervention model. Methods: First, we divided all HHCC and NIC interventions into intervention focus levels: individual/ family focused, community focused, and system focused. Second, we categorized HHCC and NIC interventions according to core public health functions: assessment, policy development, and assurance and the categories of interventions in the PHI Model. Results: We identified HHCC and NIC Nursing interventions that represented public health nursing concepts across core public health functions and categories of the PHI model. Analysis of the findings demonstrated that HHCC and NIC have terms for the concepts in the PHI model. Conclusion: Although HHCC and NIC cover many concepts in public health nursing practice, additional research is needed to extend these terminologies and to evaluate other standardized terminologies that can reflect more comprehensively public health nursing interventions.
Design of a Standards-Based External Rules Engine for Decision Support in a Variety of Application Contexts: Report of a Feasibility Study at Partners HealthCare System
Authors: Greenes Robert A.  , Sordo Margarita  , Zaccagnini Davide  , Meyer Mark  , Kuperman Gilad J.
Published: February 2025

This project explored functional requirements for an institution-wide method, at Partners HealthCare, for interpreting clinical knowledge for decision support. Such knowledge is currently incorporated in a variety of clinical applications, yet the methods of representation and of execution vary and the ability to author/ edit the rules by human experts is limited. We expanded on a 2002 “Knowledge Inventory” at Partners to evaluate feasibility of designing a single representation approach entailing: (a) exploration of specific needs of different applications, in terms of kinds of response required (synchronous/asynchronous, time criticality, etc.), context (e.g., implied patient, time frame, or episode) , and kinds of actions to be triggered; (b) kind of representation of knowledge and feasibility of casting knowledge in the form of if${\ldots}$ then statements; and (c) data and knowledge resources used (implied data model, and particular knowledge sources and terminology sources). The result of analysis was to design an architecture to accomplish this goal. We also did preliminary analysis of requirements for authoring for such a representation, and for implementation.