bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic Proximal Ulnar Osteotomy for the Treatment of Ununited Anconeal Process in 17 Dogs
Authors: Turner B. M. , Abercromby R. H. , Innes J. , McKee W. M. , Ness M. G.
Published: March 2018

A prospective study was made of 17 dogs with ununited anconeal process treated by osteotomy of the proximal ulna. The effect of the surgery on lameness was evaluated subjectively and the elbows were assessed radiographically for evidence of anconeal fusion and healing of the osteotomy. Whilst clinical outcome was generally good and complications infrequent, relatively few cases achieved anconeal fusion. These results do not compare well with the results of a previous study but this disparity may be due in part to differences in patient population and radiographic evaluation.

Further work is required to establish how best to achieve predictable anconeal fusion.

Proximal ulnar osteotomy was used to treat 17 dogs with ununited anconeal process. Clinical results were good but anconeal fusion was not achieved consistently. Further work is needed to determine how best to achieve predictable anconeal fusion.
The Comparative Strengths of Orthopaedic Staples Versus a 2.7 mm T Plate in the Stabilisation of Distal Radial Osteotomies
Authors: Read R. A. , Day R. , Thomson M. J.
Published: March 2018

Distal radial osteotomies were performed in 20 limbs from ten cadaver specimens. Ten bones were stabilised with two × 1.6 mm surgical bone staples and ten were stabilised with a 2.7 mm T platea. The radii were removed and the osteotomies were biomechanically tested in torsion initially, and then to failure in bending. Statistically significant differences were not found between the two types of repair in torsional stiffness, bending stiffness, deflection to failure in bending, or load to failure in bending. Orthopaedic staples are a simple, cost-effective alternative to bone plates for stabilisation of distal radial osteotomies.

Bilateral distal radial osteotomies were created in dog cadavers and then repaired with either two bone staples or a 2.7 mm T plate. The limbs were then tested in vitro to compare the relative strengths of the repairs in torsion and bending. Statistically significant differences were not found between the two methods of stabilisation.
Polyostotic Fibrous Dysplasia in a Dog
Authors: Pepe M. , Mechelli L. , Spaterna A. , Di Meo A.
Published: March 2018

A young Dobermann Pincher dog with severe right hind leg lameness was admitted to our clinic. A complete radiographic examination showed the presence of cystic lesions in the right tibia and femur and polyostotic fibrous dysplasia was diagnosed.

The distal tibial lesion, associated with an incomplete cortical fracture, was treated by surgical curettage and drainage of the cyst cavity. The other cystic lesions were treated conservatively.

Radiological, morphological and histological examinations were then performed to evaluate the recovery phase. At six months, the surgically treated tibial lesion showed good ossification of the fibrous tissue. At twelve months, the examination showed complete healing of the tibial lesion but the femur lesions still had a cystic appearance.

It appeared that surgical curettage of the cystic cavity alone enables recovery to be achieved in a relatively short period of time.

Fibrous dysplasia in dogs is a seldom reported, condition which usually it has a benign outcome and mainly involves young subjects during their growth period. It is characterized by substitution of the bone with fibrous tissue thus favouring the occurrence of spontaneous fractures.

The diagnosis of this disorder is based on radiographic reports and histological examination. The lesion can be treated with conservative therapy or by surgery, but the latter significantly reduced the period of recovery.
Magnetic resonance imaging and arthroscopy of a discoid lateral meniscus in a dog
Authors: Scheidegger J. , Nötzli H. , Rytz U. , Ohlerth S. , Lang J.
Published: March 2018

For the first time in veterinary literature, magnetic resonance and arthroscopic features of a discoid lateral meniscus in a dog are described. A 15-monthold Labrador Retriever with a history of mild intermittent left hindlimb lameness was referred to our clinic. Physical examination revealed mild joint effusion of the left stifle and absence of a cranial drawer motion and tibial compression test. Survey radiographs demonstrated mild joint effusion and peri-articular new bone formation. Low-field magnetic resonance tomography of the left stifle joint demonstrated injury of the cranial cruciate ligament and a discoid lateral meniscus. Two weeks later, arthroscopy revealed a partial tear of the cranial cruciate ligament with mild synovitis. Furthermore, some fibres inserted abnormally cranial to the inter-meniscal and cranial tibial ligament of the medial meniscus. The lateral meniscus was discoid in shape. Subsequent arthrotomy confirmed the diagnoses. Discoid meniscus is a rare finding in the dog with unknown clinical relevance whereas it is well known in humans.

A 15-month-old Labrador Retriever with mild left hindlimb lameness, mild joint effusion of the left stifle but without signs of stifle instability is presented in this report. Low-field magnetic resonance tomography demonstrated injury of the cranial cruciate ligament and a discoid lateral meniscus. Subsequent arthroscopy and arthrotomy confirmed these findings. A literature review on discoid meniscus in humans and in dogs is presented.
Infection rates in surgical procedures: a comparison of cefalexin vs. a placebo
Authors: Fayolle P. , Yiguier E. , Viateau Y. , Moissonnier P. , Daude-Lagravei A. , Carozzo C.
Published: March 2018

The aim of this study was to evaluate the efficacy of antibiotic prophylaxis in small animal surgery. Three hundred and twenty-nine dogs and 544 cats were included in a prospective, randomised, blind trial to determine the frequency of wound infection after clean and cleancontaminated surgical procedures. The animals were allocated to one of two groups: group A received a placebo and group B received cefalexin. The infection rate was measured in each group and correlated with different criteria (age, duration and type of the operation, anaesthetic and Altemeier’s class, surgeon’s experience). Globally, seventyeight cases of infection were noted (8.9%). The infection rates in the two groups were not significantly different (9.4% in group A and 8.5% in group B). Infection rate was not affected by the different criteria studied. However, the percentage of animals infected in group B tended to be lower than that of group A as the surgeons’ experience increased.

The results of a study to evaluate the efficacy of the prophylactic use of antibiotics are described. The infection rates in animals that received the placebo and in those that received cefalexin were not significantly different (9.4% vs. 8.5%, p <0.05, respectively). We conclude that the antibiotic prophylaxis is not recommended for clean and clean-contaminated surgical procedures.
An in vitro biomechanical comparison between bone plate and interlocking nail
Authors: Diop A. , Maurel N. , Viguier E. , Bernardé A.
Published: March 2018

In order to compare the interfragmentary motion and bone strains in ostectomized canine femurs, stabilized with either an 8 mm interlocking nail system (IN) or a 10-hole 3.5 mm dynamic compression broad plate (DCP), ten pairs of adult canine femurs with a 25 mm mid-diaphyseal gap were used. The left femurs were implanted with a DCP and eight bi-cortical screws, and the right femurs were implanted with an IN and three screws. Eccentric axial loading and cranio-caudal bending were successively performed on every specimen. Employing an opto-electronic device, interfragmentary (axial, transverse and rotational) motion was measured during non-destructive tests. Bone strains were measured at three elective sites, with strain gauges in four pairs of the specimen. The mean values of axial and transverse motion were compared using a paired t-test within each group (P <0.05). Strain values were compared using a numerical scale and a qualitative analysis. Transverse motion was higher with DCP, whereas axial motion was higher with IN. Bone strain analysis demonstrated lower “stress protection” near the gap with IN. Those comparative results are interpretative: IN may be an interesting alternative implant for unstable diaphyseal femoral fracture repair in dogs.
A technique for the surgical repair of caudal peripheral detachment and longitudinal peripheral tears of the medial meniscus in dogs
Authors: Moses P. A.
Published: March 2018

Medial meniscal injuries are frequently encountered in dogs secondary to cranial cruciate ligament rupture. Treatment has been limited to partial or total meniscectomy, however removal of meniscal tissue inevitably results in degenerative change. This paper describes a modification of the “inside-out” technique used in human medicine for the repair of caudal peripheral detachment and longitudinal meniscal tears in the vascular zone. Horizontal mattress sutures are used to attach the meniscus to the caudal joint capsule. Six hundred and fifty-four meniscal injuries were found in 1126 stifle arthrotomies and 92 (14.4%) were considered suitable for surgical repair.
Gait analysis of dogs with hip dysplasia treated with gold bead implantation acupuncture
Authors: DeCamp C. E. , Stajich M. , Flo G. L. , Martinez S. A. , Bennett R. L. , Bebchuk T. , Bolliger C.
Published: March 2018

A “double blinded” prospective study was undertaken to determine whether gold bead implantation acupuncture alleviates lameness and pain in dogs, affected by moderate to severe hip dysplasia. Nineteen large-breed adult dogs, of various breeds with clinical and radiographic evidence of hip dysplasia, were randomly assigned to the acupuncture or the placebo group. The acupuncture treatment with gold bead implantation was performed by a licensed acupuncturist. Objective data were acquired, in the gait analysis laboratory, using kinetic and kinematic parameters before and at one and three months after treatment. In the acupuncture group there was a decrease in vertical and peak vertical impulse formation at one month, which indicated an increase in lameness, without any significant difference between groups at three months post-treatment.

Subjective data were gathered by radiographs as well as serial complete physical examinations by an experienced clinician and an owner questionnaire, before and at one and three months after treatment. Subjective grading of hip dysplasia radiographs did not show any difference in severity between the two groups. According to the physical examination, one dog in the acupuncture group improved, five stayed the same and three worsened. In the placebo group two dogs improved, four stayed the same and three worsened. According to the questionnaire, three dogs in the acupuncture group improved, four stayed the same and two worsened. In the placebo group three dogs improved and six stayed the same. Serial blood analyses were performed and the results were within normal limits at all times.
Force overlap in trotting dogs: a Fourier technique for reconstructing individual limb ground reaction force
Authors: Bertram J. E. A. , Todhunter R. J. , Williams A. J. , Lust G. , Lee D. V.
Published: March 2018

Time overlap of ground reaction forces from adjacent footfalls is a pervasive problem in clinical gait analysis. When overlap occurs, splitting the fore- and hindlimb force curves at the minimum point between them underestimates hindlimb impulse and contact time. A better alternative is to reconstruct the force curves that occur in the period of overlap. A Fourier method was used to quantify the shape of hindlimb force curves in Labrador Retrievers and Greyhounds. Fourier coefficients did not differ significantly (p <0.05) between those breeds, indicating that, on average, their shapes are quite similar. The technique reported here uses an empirically determined shape that is, subsequently, scaled to the duration and magnitude of the original hindlimb force curve. A segment of this approximated force curve is then inserted in order to reconstruct the portion of the curve that was obscured by the overlap. Subtracting the reconstructed hindlimb curve, from the original force record, yields a reconstructed forelimb force curve.
Comparison of the standing tangential radiographic projection of the hip with standard methods of evaluation for hip dysplasia in the dog
Authors: Armbrust L. J. , Renberg W. C.
Published: March 2018

The standing tangential radiographic position (STRP) of the hip is a technique that enables the clinician to visualize the femoral head and acetabulum in an unsedated patient in a weight-bearing stance. This study compared the technique to other radiographic methods of evaluating canine hips for the dysplasia. The methods were compared as to Norberg angle, Distraction Index and by use of novel measures of subluxation and coverage. A statistical significance of correlation was not seen between the STRP technique and other methods. Although a variety of explanations are discussed, the authors do not recommend the use of this technique for the evaluation of hip dysplasia.
An in vitro biomechanical study of the effects of surgical modification upon the canine lumbosacral spine
Authors: Bebchuk T. N. , Shmon C. L. , Watson L. G. , Steinmetz H. , Smith M. E. H.
Published: March 2018

The purpose of this study was to determine the impact of surgical decompressive procedures upon stiffness of cadaveric canine lumbosacral motion units in the dorsoventral plane. Thirty-four grossly normal lumbosacral specimens were potted, in aluminum channeling with polymethylmethacrylate, and subjected to four-point bending in dorsiflexion and ventroflexion, using a universal testing machine (Instron MA). In order to determine its yield point, each specimen was non-destructively tested before and after surgical modification and then tested to failure in ventroflexion. Dorsal laminectomy (L) did not have a significant effect upon stiffness of the lumbosacral motion unit in dorsiflexion or ventroflexion, when compared with the control group. Since this also involved excision of the interspinous and supraspinous ligaments, removal of these structures alone also did not have any significant effect upon dorsoventral stiffness in vitro. Compared with the control group, the stiffness in the other groups changed as follows: addition of discectomy (LD) did not have a statistically significant effect in dorsiflexion, but decreased mean stiffness 33.1% (95% CI 29.0 to 37.2) in ventroflexion. Dorsal laminectomy combined with bilateral facetectomy (LF) decreased stiffness 43.5% (95% CI 39.4 to 47.6) in dorsiflexion, and 30.9% (95% CI 26.8 to 35.0) in ventroflexion. The combination of dorsal laminectomy, facetectomy and discectomy (LFD) decreased the stiffness 47.9% (95% CI 43.8 to 52.0) in dorsiflexion and 56.4% (95% CI 52.3 to 60.5) in ventroflexion. This decrease in stiffness in ventroflexion was significantly greater than with laminectomy and facetectomy alone (25% less stiff; 95% CI 20.9 to 29.1).
Use of a titanium plate for novel fixation of a distal radius fracture in an Italian Greyhound
Authors: Syrcle J.A. , Cook J.L.
Published: March 2018

A three-year-old Italian Greyhound was admitted for an acute none-weight-bearing lameness of the left forelimb, due to a closed transverse fracture of the distal radius and ulna. Open reduction with internal fixation of the radius fracture was performed and the fracture was stabilized using a 2.0-mm 5-hole titanium Y-plate. External coaptation with a caudal splint was added for additional support. The fracture healed with clinical and radiographic union noted eight weeks postoperatively. Neither implant failure nor stress-protection osteopaenia occured during the 13-month follow-up period. The dog returned to full function without complications. Using this method, five additional dogs were also treated successfully.
Radiographic evaluation of mechanically tested cemented total hip arthroplasty femoral components retrieved post-mortem
Authors: Pluhar E. , Skurla C. P. , Egger E. L. , James S. P. , Frankel D. J.
Published: March 2018

Guidelines for assessing total hip arthroplasty (THA) radiographs for femoral implant stability have not been published; therefore, often the determination is subjective. The aim of this study was to identify radiographic criteria for veterinary clinicians to use when evaluating radiographs for femoral implant stability. Specific objectives were to: identify radiographic features associated with canine THA femoral implant loosening, evaluate whether technical recommendations for human femoral component implantation apply to dogs, and evaluate the effectiveness of radiographs for identifying canine THA implant loosening. Post-operative, follow-up, and post-mortem contact radiographs of canine implanted femora retrieved postmortem and mechanically tested for implant stability were evaluated. Based on the results, radiographic evaluation is not an effective means of assessing canine femoral implant stability; however, certain radiographic findings including implant retroversion, cement mantle cracks, or the appearance of cementmetal interface radiolucencies, may be indicative of implant loosening. It was also found that femoral implants completely surrounded by cement mantle of any thickness were less likely to loosen than those with an area lacking cement between the implant and bone. There was also a trend suggesting an association between inferior cement mantle quality and femoral implant loosening. In order to improve cement mantle quality and ensure that implants are completely surrounded by cement mantle, the use of modern cementing techniques is recommended.
Tibial tuberosity advancement in 65 canine stifles
Authors: Miller J. M. , Ober C. P. , Lanz O. I. , Martin R. A. , Shires P. K. , Hoffmann D. E.
Published: March 2018

The tibial tuberosity advancement (TTA) procedure was developed to treat dogs with cranial cruciate ligament deficient stifles. A retrospective, descriptive study was performed on 57 dogs that underwent unilateral or bilateral TTA. Medical records were reviewed and pre-, postoperative and follow-up radiographs were evaluated for patellar ligament-tibial plateau angle (α), distance of the tibial tuberosity advancement and progression of degenerative joint disease. A questionnaire was sent to all owners to obtain their assessment of the procedural outcome. Sixty-five stifles in 57 dogs received a TTA. Mean age was 5.2 ± 2.5 years while mean weight was 39.7 ± 11.9 kg. Eighteen breeds were represented with Labrador retrievers and mixed breeds predominating. The mean duration of lameness prior to surgery was 6.2 ± 6.7 months, with a median lameness score of 3/4. Fifty-nine percent of cases encountered complications, the majority of which were minor. Major post-operative complications were uncommon but consisted of implant failure, tibial crest displacement and medial meniscal tears. The mean radiographic preoperative angle α was 100°, while the postoperative was 95.5°. Mean osteoarthrosis scores were significantly different between preoperative and follow-up radiographs with 67% of cases showing radiographic progression. Seventy percent of owners responded to the survey with overall outcome considered good to excellent in 90%. Activity level was improved in 90% of responses. TTA subjectively appears to be a useful alternative in the management of cranial cruciate ligament disease. Few severe complications were encountered. Good clinical outcome and owner satisfaction was reported with the procedure in this set of cases.
Utilization of a Dynamic Stifle Flexion Apparatus in Preventing Recurrence of Quadriceps Contracture: A Clinical Report
Authors: McDonald D. E. , Hulse D. A. , Wilkens B. E.
Published: March 2018

Quadriceps contracture is a well documented postoperative complication of femoral fractures, especially in immature animals. Historically, management of this condition has been difficult, and long-term prognosis has usually been poor. This case documents surgical correction of the quad-riceps contracture in a mixed breed dog, and the use of a dynamic stifle flexion apparatus postoperatively. The purpose of the dynamic stifle flexion apparatus was to encourage early, active use of the affected limb by the patient. Concurrent passive flexion and extension exercises, by the owner, were an integral component in preventing recurrence of pathological contracture of the quadriceps muscle group.

Quadriceps contracture of the left quadriceps muscle group was diagnosed in a sixteen-week-old mixed breed dog twelve weeks following repair of a femur fracture. Surgical correction of the contracture was undertaken, and a dynamic stifle flexion device was applied to prevent future recurrence of the contracture. Sixteen weeks following repair, function had returned to the limb with stifle and hock ranges of motion approaching the values measured immediately postoperatively.
Effects of Tendon Splitting on Experimentally-Induced Acute Equine Tendinitis
Authors: Bramlage L. R. , Bailey M. , Bertone A. L. , Weisbrode S. E. , Henninger R. W.
Published: March 2018

The objective of this study was to compare the early phases of healing between surgically split and unsplit (control) tendons in a superficial digital flexor tendinitis model. Tendinitis was induced in both forelimbs of six horses by injection with collagenase. One tendon from each horse was randomly chosen to undergo tendon splitting. In six horses, the tendons were evaluated by ultrasonography before (week 0) and after (week 1) the onset of tendinitis and at weeks two, three, and four following tendon splitting. Three horses were euthanatized at the end of week four. Three horses were maintained for an additional month and evaluated at week eight before euthanasia. Following euthanasia, microangiographic and histologic evaluations were performed. Ultrasonographic evaluation revealed a significant (p <0.05) decrease in mean tendon lesion area in the split tendons when compared to the controls at weeks three, four, and eight. By week eight, all lesions had resolved in the split but not the control tendons. Mean lesion grade was lower in the split tendons at weeks two, three, four, and eight. Tendon area was similar (p >0.05) between groups at all periods after surgery. There was a more mature vascular pattern and greater peritendinous vascular response in the split tendons compared to control tendons. Histological examination under plain and polarized light revealed more normal collagen orientation and wave formation in the repair tissue in the split tendons at weeks four and eight. The fibroblast nuclei density was significantly (p <0.05) lower in the split tendons at week eight. These findings suggest that during the time period of this study, tendon splitting results in a more rapid decrease in lesion size and superior repair tissue organization when compared to controls.

In a collagenase-induced tendinitis model, tendon splitting was shown to result in a greater reduction in tendon lesion size and superior repair tissue organization when compared to control tendons.
Structural Adaptations to Mechanical Usage. A Proposed “Three-Way Rule” for Bone Modeling
Authors: Frost H. M.
Published: March 2018

A collection of fundamental structural adaptations is defined for how compacta and spongiosa respond to overloading in compression, tension, and flexure, alone and in combinations. Those adaptations underlie most physiological tissue- and organ-level structural adaptations of healthy intact bones to mechanical usage. A biomechanical function called the Gamma function is then devised to predict from a structure’s net end loads and the strain history of any given small bone surface domain, whether mechanically induced formation, resorption or neither will occur in that domain. A separate function is devised to predict local rates of modeling from local strain histories. These functions correctly predict varied details of all of the fundamental adaptations and they also suggest new laws for the mechanical control of bone architecture, some of which are presented.
Results of Treatment of Degenerative Lumbosacral Stenosis in Dogs by Exploration and Excision
Authors: Selcer Barbara A. , Oliver J. E. , Chambers J. N.
Published: March 2018

Twenty-six dogs with degenerative stenosis of the lumbosacral spinal canal were treated by excision of the encroaching tissues. The most common singular lesion was type II disc herniation.

All of the dogs responded favourably to the surgery, but the dogs with only pain and lameness before surgery generally did better than those with incontinence.

Laminectomy and excision of the encroaching degenerated tissues is an effective and relatively uncomplicated method of treating lumbosacral stenosis in dogs.
Multiple Enchondromatosis in the Dog
Authors: Krauser K. , Schwartz-Porsche Dorothea , Putzer-Brenig Afra v. , Matis Ulrike
Published: March 2018

The clinical and radiological findings of three related Miniature Poodles with multiple enchondromatosis (Ollier’s disease) are presented. Persisting, in part ossified growth plate cartilage foci were found bilaterally in the humerus, radius, ulna, femur, tibia and fibula of each dog and in one dog in some metacarpal and metatarsal bones. The ribs and many vertebral bodies were also affected. There was evidently no bone formation in the sternebrae. All three dogs first attracted attention at the ages of four to six months, with spontaneous bilateral femoral neck fractures. The mode of inheritance of the condition is not yet clear, but based on the known pedigree data a dominant effect appears unlikely.
Osteochondritis Dissecans of the Medial Trochlear Ridge of the Talus in the Dog
Authors: Spaulding K. A. , Braden T. D. , Breur G. J.
Published: March 2018

The medical records of 12 dogs with osteochondritis dissecans (OCD) of the medial trochlear ridge of the talus were reviewed. Long-term treatment results were obtained from client questionnaires and clinical and radiographic re-examinations. After a mean follow-up time of 52 months, only three of 12 dogs treated for OCD of the medial trochlear ridge of the talus had regained full function of the affected joint(s). In all cases available for radiographic re-examination, osteoarthritic changes had progressed. The medial approach to the hock joint by osteotomy of the medial malleolus was associated with a high complication rate.

A meta-analysis of 38 cases (55 joints) of previous clinical studies and the present clinical study indicated that the Labrador Retriever and the Rottweiler were the most frequently affected breeds. Seventy-five percent of the affected Labrador Retrievers and Bull Terriers had bilateral involvement. The data suggested that in young dogs with an acute lameness, due to osteochondritis dissecans of the medial trochlear ridge in the talus, treatment resulted in 18% of the affected limbs in a normal limb function, in 27% in an intermittent lameness and in 55% in a chronic lameness. In dogs with a more chronic lameness, treatment results were better and approximately 40% of the affected limbs returned to normal function, while chronic lameness following treatment was unusual. In dogs older than a year at the time of treatment initiation, treatment became less successful because of the presence of severe osteoarthritic changes before treatment. Only 24% obtained normal limb function following treatment, while in 42% of the dogs treatment resulted in a chronic lameness.
Evaluation of Hip Joint Congruence and Range of Motion Before and After Triple Pelvic Osteotomy
Authors: Miller C. W. , McLaughlin R.
Published: March 2018

Fifteen dogs undergoing triple pelvic osteotomy (TPO) for bilateral hip dysplasia were evaluated prospectively. Ten dogs were treated bilaterally, five dogs were treated unilaterally. Hip joint palpation, radiography and goniometry were performed before surgery and at 5, 10, 15, and 28 weeks after surgery.

Joint congruence was significantly improved palpably and radiographically in treated hips while congruence deteriorated in untreated hips. Improvement in congruence was minimal after the five week evaluation. Goniometric measurements were variable but range of motion was generally not decreased after TPO.
Integrierte Versorgung Schizophrenie der AOK Niedersachsen
Authors: Poweleit N. , Preugschat F.
Published: March 2018

Gegenstand und Ziel: Der Beitrag zeigt auf, wie die positiven Erfahrungen aus regionalen Selektivverträgen in der psychiatrischen Versorgung genutzt worden sind, um daraus ein niedersachsenweites Behandlungsangebot zu entwickeln. Es werden die Herausforderungen bei der Umsetzung betrachtet und aufgezeigt, mit welchen Erfolgsfaktoren eine flächendeckende Versorgung realisiert werden kann.

Material und Methode: Der Beitrag basiert auf Ergebnissen aus den Pilotvorhaben, eigenen Erfahrungen beim Aufbau und der Umsetzung der Integrierten Versorgung Schizophrenie in Niedersachsen sowie von Rückmeldungen der an der Versorgung beteiligten Fachärzte, Fachkrankenpflegern und Angehörigenvertretern.

Ergebnisse: Die Versorgungsstruktur ist über ein Flächenland wie Niedersachsen sehr heterogen ausgeprägt. Bei der Umsetzung eines landesweiten Versorgungsmodells müssen die regionalen Besonderheiten berücksichtigt werden und ein enger Kontakt zu den regionalen Verbünden aufgebaut werden.

Schlussfolgerungen: Die Initiative zur Integrierten Versorgung Schizophrenie in Niedersachsen zeigt auf, dass es gut möglich ist, positive Erfahrungen aus kleinen Pilotierungsvorhaben auf ein ganzes Bundesland auszuweiten. Die wesentliche Erkenntnis ist, dass es Zeit braucht, um die Versorgungsstrukturen und ein auf den Patienten zentriertes Behandlungskonzept auf zu bauen. Die ersten positiven Reaktionen der teilnehmenden Patienten zeigen, dass der richtige Weg gewählt worden ist.
The International Partnership for Health Informatics Education
Authors: Gardner R. M. , Gatewood L. C. , Haux R. , Schmidt D. , Wetter T. , Jaspers M. W. M.
Published: March 2018

Objectives:
To inform the medical and health informatics community on the rational, goals, and the achievements of the International Partnership for Health Informatics Education – IPHIE, (IΦE), that was established at six universities in 1999.

Methods:
We elaborate on the overall goals of IΦE and describe the current state of affairs: the activities undertaken and faculty and student experience related to these activities. In addition we outline the lessons we have learned over these past six years and our plans for the future.

Results:
IΦE members first started to collaborate by supporting and encouraging the exchange of talented students and faculty and by establishing joint master classes for honors students. Following the success of these activities, new initiatives were undertaken such as the organization of student workshops at medical informatics conferences and a joint course on strategic information management in hospitals in Europe.

Conclusions:
International partnerships such as IΦE take time to establish, and, if they are to be successful, maintaining leadership continuity is critically important. We are convinced that IΦE promotes professionalism of future medical informatics specialists. There will be a continuing growth of globalization in higher education. It will therefore become increasingly important to offer educational programs with international components.
Integrated Software Suite for Magnetocardio-graphic Data Analysis
Authors: Mantini D. , Merlino B. , Reale M. , Di Luzio S. , Romani G. L. , Comani S.
Published: March 2018

Objectives:
This paper describes an integrated software suite (ISS) for the processing of magnetocardiographic (MCG) recordings obtained with super-conducting multi-channel systems having different characteristics. We aimed to develop a highly flexible suite including toolboxes for current MCG applications, organized consistently with an open architecture that allows function integrations and upgrades with minimal modifications; the suite was designed for the compliance not only of physicists and engineers but also of physicians, who have a different professional profile and are accustomed to retrieve information in different ways.

Methods:
The MCG-ISS was designed to work with all common graphical user interface operative systems. MATLAB was chosen as the interactive programming environment (IPE), and the software was developed to achieve usability, interactivity, reliability, modularity, expansibility, interoperability, adaptability and graphics style tailoring. Three users, already experienced in MCG data analysis, have intensively tested MCG-ISS for six months. A great amount of MCG data on normal subjects and patients was used to assess software performances in terms of user compliance and confidence and total analysis time.

Results:
The proposed suite is an all-in-one analysis tool that succeeded in speeding MCG data analysis up to about 55% with respect to standard reference routines; it consequently enhanced analysis performance and user compliance.

Conclusions:
Those results, together with the MCG-ISS advantage of being independent on the acquisition system, suggest that software suites like the proposed one could uphold a wider diffusion of MCG as a diagnostic tool in the clinical setting.
The Digital Pen and Paper
Authors: Landau R. , Rutschmann O. , Simon J. , Lovis C. , Despont-Gros C.
Published: March 2018

Objectives:
To evaluate the efficiency and acceptance of digital pen and paper technology for real-time clinical data acquisition.

Methods:
A prospective interventional unblinded study involving consecutive patients in two clinical settings during a defined time-frame was proposed. The first trial was designed as a stress test to evaluate acceptance in a workload-intensive environment. Acceptance was assessed using observations and a satisfaction questionnaire. The second trial was intended to determine the reliability of data acquisition in a controlled environment. Reliability was assessed by comparing the performance of the digital pen against scanner analysis and a double human blinded acquisition.

Results:
Overall, users were satisfied with the use of the digital pen (median 3 on a Likert-scale (–5, 5)). Without any specific user training, successful data acquisition was greater than 80%. Use of this technology required less adaptation than standard computer devices, and was easy to learn and use. Ergonomic problems shaded the perception of the technology by inducing an increased cognitive load. Digitalized data was missing either because of a bug or due to lack of data validation. The reliability obtained with the digital pen was significantly lower to that obtained with the scanner.

Conclusions:
Natural technology such as the digital pen proved to be a good tool in stressful clinical environments without interfering with the normal workload or increasing the time for data acquisition. However, in order to improve quality of data acquisition, designing acquisition forms specifically for the use of digital pens is of paramount importance.
The Challenge of Ubiquitous Computing in Health Care: Technology, Concepts and Solutions
Authors: Ammenwerth E. , Brigl B. , Knaup P. , Lang E. , Pilgram R. , Pfeifer B. , Ruderich F. , Wolff A. C. , Haux R. , Kulikowski C. , Bott O. J.
Published: March 2018

Objectives:
To review recent research efforts in the field of ubiquitous computing in health care. To identify current research trends and further challenges for medical informatics.

Methods:
Analysis of the contents of the Yearbook on Medical Informatics 2005 of the International Medical Informatics Association (IMIA).

Results:
The Yearbook of Medical Informatics 2005 includes 34 original papers selected from 22 peer-reviewed scientific journals related to several distinct research areas: health and clinical management, patient records, health information systems, medical signal processing and biomedical imaging, decision support, knowledge representation and management, education and consumer informatics as well as bioinformatics. A special section on ubiquitous health care systems is devoted to recent developments in the application of ubiquitous computing in health care. Besides additional synoptical reviews of each of the sections the Yearbook includes invited reviews concerning E-Health strategies, primary care informatics and wearable healthcare.

Conclusions:
Several publications demonstrate the potential of ubiquitous computing to enhance effectiveness of health services delivery and organization.

But ubiquitous computing is also a societal challenge, caused by the surrounding but unobtrusive character of this technology. Contributions from nearly all of the established sub-disciplines of medical informatics are demanded to turn the visions of this promising new research field into reality.
Quality-assured Efficient Engineering of Feedforward Neural Networks (QUEEN)
Authors: Hensler K. , Waschulzik T. , Mönig S. P. , Maruyama K. , Hölscher A. H. , Bollschweiler E.
Published: March 2018

Objectives:
Lymph node metastasis (LNM) is an important prognostic indicator in patients with gastric carcinoma. However, the methods that have been established for preoperative diagnosis of LNM show insufficient accuracy.

Methods:
This study describes the use of the QUality Assured Efficient Engineering of Feedforward Neural Networks with Supervised Learning (QUEEN) technique to attempt optimization of the preoperative diagnosis of lymph node metastasis in patients with gastric carcinoma. The results were compared with the Maruyama Diagnostic System (MDS) for preoperative prediction of LNM, established at the National Cancer Center in Tokyo.

Results:
QUEEN is able to extract predictive variables from a case-based database. The combination of a development method, a special type of neural network and the corresponding encoding yielded an accuracy of 72.73%, which is notably higher than that of the MDS. Our system produced a nearly ten per cent higher sensitivity and around eighteen per cent higher specificity than MDS.

Conclusion:
Our results show that QUEEN is a reasonable method for the development of ANNs. We used the QUEEN system for prediction of LNM in gastric cancer. This system may allow more meaningful preoperative planning by gastric surgeons.
Protecting Genomic Sequence Anonymity with Generalization Lattices
Authors: Malin B. A.
Published: March 2018

Objectives:
Current genomic privacy technologies assume the identity of genomic sequence data is protected if personal information, such as demographics, are obscured, removed, or encrypted. While demographic features can directly compromise an individual’s identity, recent research demonstrates such protections are insufficient because sequence data itself is susceptible to re-identification. To counteract this problem, we introduce an algorithm for anonymizing a collection of person-specific DNA sequences.

Methods:
The technique is termed DNA lattice an-onymization (DNALA), and is based upon the formal privacy protection schema of k-anonymity. Under this model, it is impossible to observe or learn features that distinguish one genetic sequence from k-1 other entries in a collection. To maximize information retained in protected sequences, we incorporate a concept generalization lattice to learn the distance between two residues in a single nucleotide region. The lattice provides the most similar generalized concept for two residues (e.g. adenine and guanine are both purines).

Results:
The method is tested and evaluated with several publicly available human population datasets ranging in size from 30 to 400 sequences. Our findings imply the anonymization schema is feasible for the protection of sequences privacy.

Conclusions:
The DNALA method is the first computational disclosure control technique for general DNA sequences. Given the computational nature of the method, guarantees of anonymity can be formally proven. There is room for improvement and validation, though this research provides the groundwork from which future researchers can construct genomics anonymization schemas tailored to specific data-sharing scenarios.
Attitudes towards Information System Security among Physicians in Croatia
Authors: Kern J. , Švab I. , Markota M.
Published: March 2018

To examine attitudes about information system security among Croatian physicians a cross-sectional study was performed on a representative sample of 800 Croatian physicians. An anonymous questionnaire comprising 21 questions was distributed and statistical analysis was performed using a chi-square test. A 76.2% response rate was obtained. The majority of respondents (85.8%) believe that information system security is a new area in their work. In general, physicians are not informed about European directives, conventions, recommendations, etc. Only a small number of physicians use personal computers at work (29%). Those physicians who have a personal computer use it mainly for administrative reasons. Most health-care institutions (89%) do not have a security manual and the area of information system security is left to individual interest and initiative. Only 25% of physicians who have a personal computer use any type of password. A high percentage of physicians (22%) has never thought about the problem of personal data being used by organizations (e.g. police, banks) without legal background; a small, but still significant percentage of physicians (5.6%) has even agreed with such use. Results indicate that for the vast majority of physicians, information system security is a new area in their daily work, one which is left to individual interest and initiative. They are not familiar with the ethical, technical and legal backgrounds which have been defined for that area within the Council of Europe and the European Union. New aspects: This is the first study performed in Central and Eastern Europe dealing with information system security, performed on a representative nationwide sample of all the physicians.
Advantages of Long Observation in Episode-oriented Electronic Patient Records in Family Practice
Authors: Groen A. , Oskam S. K. , Lamberts H. , Okkes I. M.
Published: March 2018

From 1985–2000, 58 Dutch family physicians (FPs) of the Transition Project collected ICPC-coded data on 47, 2451 episodes of care, first in paper records for direct encounters only, later with a complete electronic patient record (EPR) for all (direct and indirect) encounters. Based on these data, the effects of a long observation period and the inclusion of all encounters (both direct and indirect) in the EPR were studied. Long observation periods in EPRs appear to have important advantages for patient documentation and the assessment of the content of family practice. Comparison of data from a one-year versus a four-year observation period showed a shift in utilization rates. In a long observation period, visiting patients appeared to make less demand on care, while the content of the FP’s care for selected chronic diseases was reflected more realistically. The inclusion of all indirect encounters in an EPR (as compared to the previous inclusion of direct encounters only) resulted in more than twice the number of coded entries per listed patient, and thus led to a major shift in perspective on the FP’s involvement in patient care.
Retrieval-Oriented Design of Clinical Research Forms
Authors: Eigenbauer E. , Rasoul-Rockenschaub S. , Gall W.
Published: March 2018

Computerized clinical forms are subject to a wide variety of different requirements. They have to allow detailed documentation and must be user-friendly. State-of-the-art applications for design permit clinicians themselves to create their own forms as needed, with the various variables presented in different ways depending on their intended use. Often, however, only aspects of clinical documentation are considered, with no thought being given to subsequent data retrieval. This article presents guidelines for the retrieval-oriented design of clinical forms. It discusses where anticipatory measures for structuring forms are easier to accomplish than complex data linkage at the time of retrieval and analysis.
3D-VIEWER: An Atlas-Based System for Individual and Statistical Investigations of the Human Brain
Authors: Pohl G. , Keyserlingk D. Graf , Berks G.
Published: March 2018

3D-VIEWER is a new software tool for neurosurgical planning and population studies. It is based on digitized three-dimensional brain atlases derived from standard stereotactic atlases that can be adapted to an individual’s brain and shown as a series of displayed images. If the patient’s brain has been imaged in different modalities, the standardized anatomical information can be adapted to the individual images, which will bring the images into registration. The 3D-VIEWER can be used as a tool for combining multimodal information from the same patient. In addition, several tools are available that allow oblique views of anatomical structures or the view along the intended trajectory during a neurosurgical intervention. Furthermore, using the atlas transformation matrices, anatomical information can be determined when comparing an individual’s brain to the anatomy of the atlas brain. Thus, standardized anatomical information from the atlas can be introduced into individual images. This standardization is used to perform individual-group and group-by-group comparisons between patients and normal controls in anatomical studies.
Internet-Based Physician’s Workbench as User Interface for a Central Medical Case Repository
Authors: Baranov A. E. , Fliedner T. M. , Mall H. , Engelke A. , Densow D. , Kindler H.
Published: March 2018

Two World Health Organization Radiation Medical Emergency Preparedness and Assistance Network centers have constructed a standardized central repository of acute radiation syndrome case histories. The case histories are stored on a database server. Radiation protection centers can remotely access the database by user-friendly client software over the Internet. Physicians can use the medical information system to retrieve similar case histories for decision support, to improve their medical knowledge by inspecting real case histories, and for research on the acute radiation syndrome. The system architecture is presented and it is shown in detail how the information system can be employed to deliver medical decision support. Dialogue-response times over narrow-bandwidth Internet connections are better than when using conventional World-Wide-Web technology. However, the latter does not require the installation of client software other than a browser. A JavaTM applet as client could combine the advantages of the two approaches.
Evaluation of General Practice Computer Templates
Authors: See Tai S. , Donegan C. , Haines A. , Nazareth I.
Published: March 2018

We conducted a pilot randomised trial of computerised templates for the management of asthma and diabetes in general practice in six general practices in North London. Uptake of the guidelines by general practitioners and practice nurses was assessed using qualitative (semi-structured interviews designed to assess the users’ views) and quantitative (change in use of the template during the study period) outcome measures. The practice nurses used the templates frequently but general practitioners rarely used them. Several reasons were offered for non-use of the templates, such as the length of the template and non-involvement in the care of asthma or diabetes. Despite this, however, health professionals were favourably disposed to the use of templates for general clinical care. Pilot investigations of computerised templates are best achieved by observational or quasi-experimental methods rather than a randomised controlled trial. The use of both qualitative and quantitative methods in this study allowed exploration of the barriers to use of computers.