bluuebunny/crossref_metadata_2025 huggingface dataset:
Fractures combination of the proximal antebrachium in an immature dog that resembles
Monteggia fracture
Authors: Prassinos N. N.
Published: March 2018

A 5-month-old German shepherd dog with a combination of a proximal radial physeal fracture and a proximal ulnar diaphyseal comminuted fracture, with cranial displacement of their distal fragment, was presented. This fractures combination resembles type I Monteggia fracture. After surgical reduction of the fractures, three full-cerclage wires were used to stabilize the ulnar fracture, and two positional screws were placed across the radius and ulna immediately distally to the growth plate to hold these bones in apposition. Four weeks post-operatively, the screws were removed since sufficient callus had been formed and the dog was free of lameness. It seems that if the appropriate conditions for a type I Monteggia fracture develop in an immature dog, proximal radial physeal fracture instead of radial head luxation may accompany ulnar diaphyseal fracture.
Severe acute inflammatory reaction (SAIR) of the fetlock joint after intraarticular hyaluronate injection in a horse
Authors: Kuemmerle J. M. , Uhlig H. , Kofler J.
Published: March 2018

Hyaluronate (HA) was administered by intra-articular injection to a 13-year-old Haflinger mare for treatment of metacarpophalangeal osteoarthritis. Ten hours after the injection, a severe inflammatory reaction developed in the treated joint. While awaiting results of synovial fluid analysis, treatment for iatrogenic infectious arthritis was initiated, but the analysis did not confirm sepsis. Clinical signs improved significantly following systemic non-steroidal anti-inflammatory medication and the horse was discharged three days later. Following an intravenous hyaluronate injection, four days after discharge, the synovitis recurred. Synovial fluid analysis did not show any abnormalities, but the clinical signs were severe. The severe acute inflammatory reaction required systemic non-steroidal anti-inflammatory and intra-articular corticosteroid treatment in order to resolve the problem.
Internal Fixation of Femoral Neck Fractures in the Dog -an in vitro Study
Authors: Lambrechts N. E. , Verstraete F. J.M. , Sumner-Smith G. , Raath A.D. , van der Linde M.J. , Groeneveld H. T.
Published: March 2018

The in vitro performances of four recognized fixation methods of femur neck fractures in the dog were evaluated. After a simulated basilar fracture, three multiple pin techniques and a lag screw method were applied to four groups of nine freshly dissected femurs. A standardized force was applied to all specimens as well as five intact femurs and the force-deformation curve and yield points were recorded. Radiographs were taken to determine the mode of failure. The results indicate that the lag screw and three-parallel-pin techniques were significantly stronger than the two-pin methods. The pin techniques failed by either bending and/or slippage, while the lag screw failed by bending and/or pulling in of the screw head into the lateral femoral cortex.

An in vitro study, comparing the mechanical performances of four fixation techniques for femoral neck fracture fixation, is presented. The lag screw and three-pin techniques were stronger than the two double-pin techniques. Fixation failure occurred through bending or slippage of the pins, or through bending of the screws or pulling of the screw head into the lateral femoral cortex.
A Case Series of 25 Dogs with Chondrosarcoma
Authors: Brash Marina , Atilola M. A. O. , Cockshutt Joanne , Sylvestre Anne
Published: March 2018

The purpose of this study was to examine clinical, radiographic and histological features as well as post-diagnosis survival times of 25 dogs with chrondrosarcoma (CS). The diagnoses were made on histological evaluation of surgical biopsies or post-mortem specimens. Mixed breed dogs were found to be at higher risk.

Chondrosarcoma of the proximal humerus was the most difficult to diagnose, clinically resembling a nerve sheath tumour and offering few gross abnormalities or radiographic changes. Chrondrosarcoma was transarticular in one case.

The histological grading used was not well correlated with survival times; location of the CS seemed to be a better indicator of prognosis. Dogs with CS on a limb had the best survival rates, whereas those with CS of the vertebrae had the worst outcome. Surgery was beneficial in the cases of CS located on facial bones and limbs.

The purpose of this paper was to examine the clinical and diagnostic features and survival rates of dogs with chondrosarcoma (CS). Histological diagnoses were made in all cases, mixed breeds were over represented. The location of the tumour was a better prognostic indicator than the histological grading. Dogs with CS on a limb had the longest survival times.
Investigation of Bioabsorbable Screw Usage for Longbone Fracture Repair in the Horse: Biomechanical Features
Authors: Hearn T. C. , Arighi M. , Field J. R.
Published: March 2018

The purpose of the study was to compare the biomechanical features of bioabsorbable, self-reinforced polyL-lactic acid (SR-PLLA) and stainless steel 4.5 mm ASIF screws. Paired extraction tests were conducted in matched third metacarpal bones and in a synthetic bone material composed of polyurethane foam. The tests were accomplished using a servohydraulic materials testing machine. From these tests the maximum value of tensile force, achieved during extraction, was recorded as the screw “holding strength‘.

Comparison of holding strengths in horse cadaver bones revealed a significant difference (p = 0.0002) between screw types. The axial tensile strength of the SR-PLLA screws (878 Newtons) was much lower than that achieved by the ASIF screws (8513 N). Subsequent testing in synthetic material again reflected significant differences (p <0.0001) between the screw types. The results may be accounted for by differences in the thread-to-core ratio between the screw types. Other factors, such as elastic deformation of the bioabsorbable screw, may also contribute through differences in the mechanical interface between screw and media.
Breed, Gender, and Age as Risk Factors for Canine Osteochondritis Dissecans
Authors: Scarlett Janet , Kaderly R. E. , Bonnett Brenda , Slater Margaret
Published: March 2018

A retrospective case-control study of canine osteochondritis dissecans (OCD) was conducted using the hospital records at the New York State College of Veterinary Medicine between January 1980 and December 1987 and at the Ontario Veterinary College between January 1983 and June 1988. Information was collected on 208 cases and 416 controls. Breed, gender, and age (at onset of clinical signs and at diagnosis) were evaluated as risk factors for OCD of the shoulder, elbow, stifle, and hock using logistic regression. A distinct pattern of risk for large and giant breeds and certain ages emerged from the analysis for each joint. Males were more commonly affected than females only for the shoulder joint.
Biological Fixation of a Porous-Coated, Metal-Backed Acetabular Component in Canine Total Hip Arthroplasty
Authors: Schatzker J. , Sumner-Smith G. , Fornasier V. L. , Cockshutt J. R.
Published: March 2018

A total hip surface replacement was successfully performed on eight adult dogs, using a porous-coated, cobalt-chromium- molybdenum alloy acetabular resurfacing component fixed to the acetabulum with 3.5 mm cortical screws. Functional, radiological, histological and fluorochrome labelling studies were used to assess tissue response to the implant. At four months after implantation, seven of the acetabular components were anchored with well organized fibrous tissue. Bone ingrowth had occurred in three components. Failures appeared to be due to technical difficulties encountered during the surgical procedure.
An Unusual Deformity of the Lateral Meniscus in a Dog
Authors: Robins G. M.
Published: March 2018

In the dog meniscal injuries are usually secondary to rupture of the cranial cruciate ligament. In man a discoid meniscus is a well recognised morphological anomaly of the knee (5). In contrast discoid meniscal lesions are rarely diagnosed in the dog (6). This paper presents the clinical findings in a dog with a bilateral ring-shaped lateral meniscal deformity and an abnormal location of the tendon of the m. popliteus.
Trans-ilial and transsacral brace fixation of sacral fractures and sacro-iliac luxations (seven cases)
Authors: Fitch R. B. , Kudnig S. T.
Published: March 2018

Trans-ilial brace fixation was used as the primary repair of two sacral fractures and in conjunction with a trans-sacral pin for the repair of a bilateral sacro-iliac luxation and a sacral fracture with contralateral sacroiliac luxation. Trans-ilial brace fixation was also used as a secondary fixation for two unilateral sacro-iliac luxations and a bilateral sacro-iliac luxation. Follow-up radiographic parameters were compared to post-operative radiographic parameters to assess the stability of the fixation and the progression of healing. There was not any morbidity associated with the trans-ilial brace technique and all of the cases healed uneventfully. Indications for the use of the trans-ilial brace include sacro-iliac injuries where an additional means of stability may be indicated, comminuted sacral fractures in which the landmarks for lag screw fixation are obscured and bilateral sacro-iliac injuries with the concurrent use of a trans-sacral pin.
A Meta-Model of Chemotherapy Planning in the Multi-Hospital/Multi-Trial-Center-Environment of Pediatric Oncology
Authors: Baumgarten B. , Basu O. , Graf N. , Haux R. , Herold R. , Kutscha U. , Schilling F. , Selle B. , Spiess C. , Wetter T. , Knaup P. , Garde S.
Published: March 2018

Objective:
Chemotherapy planning in pediatric oncology is complex and time-consuming. The correctness of the calculation according to state-of-the-art research is crucial for curing the child. Computer-assistance can be of great value. The objective of our research was to work out a meta-model of chemotherapy planning based on the Unified Modeling Language (UML). The meta-model is used for the development of an application system which serves as a knowledge-acquisition tool for chemotherapy protocols in pediatric oncology as well as for providing protocol-based care.

Methods:
We applied evolutionary prototyping, software re-engineering techniques and grounded theory, a qualitative method in social research. We repeated the following steps several times over the years: Based on a requirements analysis (i) a meta-model was developed or adapted, respectively (ii). The meta-model served as a basis for implementing evolutionary prototypes (iii). Further requirements were identified (i) from clinical use of the systems.

Results:
We developed a comprehensive UML-based meta-model for chemotherapy planning in pediatric oncology (chemoMM). We implemented it and introduced evolutionary prototypes (CATIPO and DOSPO) in several medical centers. Systematic validation of the prototypes enabled us to derive a final meta-model which covers the requirements that have turned out to be necessary in clinical routine.

Conclusions:
We have developed an application system that fits well into clinical routine of pediatric oncology in Germany. Validation results have shown that the implementation of the meta-model chemoMM can adequately support the knowledge acquisition process for protocol-based care.
Meta-Analysis
Authors: Böhning D.
Published: March 2018

Objectives:
This contribution provides a unifying concept for meta-analysis integrating the handling of unobserved heterogeneity, study covariates, publication bias and study quality. It is important to consider these issues simultaneously to avoid the occurrence of artifacts, and a method for doing so is suggested here.

Methods:
The approach is based upon the meta-likelihood in combination with a general linear nonparametric mixed model, which lays the ground for all inferential conclusions suggested here.

Results:
The concept is illustrated at hand of a meta-analysis investigating the relationship of hormone replacement therapy and breast cancer. The phenomenon of interest has been investigated in many studies for a considerable time and different results were reported. In 1992 a meta-analysis by Sillero-Arenas et al. [1] concluded a small, but significant overall effect of 1.06 on the relative risk scale. Using the meta-likelihood approach it is demonstrated here that this meta-analysis is due to considerable unobserved heterogeneity. Furthermore, it is shown that new methods are available to model this heterogeneity successfully. It is argued further to include available study covariates to explain this heterogeneity in the meta-analysis at hand.

Conclusions:
The topic of HRT and breast cancer has again very recently become an issue of public debate, when results of a large trial investigating the health effects of hormone replacement therapy were published indicating an increased risk for breast cancer (risk ratio of 1.26). Using an adequate regression model in the previously published meta-analysis an adjusted estimate of effect of 1.14 can be given which is considerably higher than the one published in the meta-analysis of Sillero-Arenas et al. [1]. In summary, it is hoped that the method suggested here contributes further to a good meta-analytic practice in public health and clinical disciplines.
Propagation of EEG Activity in the Beta and Gamma Band during Movement Imagery in Humans
Authors: Ginter J. , Kamiński M. , Durka P. J. , Pfurtscheller G. , Neuper C. , Blinowska K. J.
Published: March 2018

Objectives:
The objective of the paper was the determination of electrical brain activity propagation in sensorimotor areas during hand movement imagery.

Methods:
Right-hand and left-hand movement imagination was studied in three subjects. The 10-channel Multivariate Autoregressive Model (MVAR) was fitted to EEG signals recorded from subsets of electrodes overlying central and related brain areas. By means of the Short-time Directed Transfer Function (SDTF) the propagation of brain activity as a function of frequency and time was found.

Results:
During imagery the relation between propagations in gamma and beta bands changed significantly for electrodes overlying sensorimotor areas, namely the increase in gamma was accompanied by the decrease in the beta band.

Conclusions:
The hypothesis was put forward that these kinds of changes in flow of electrical brain activity are connected with the specific information processing.
Containing Acute Disease Outbreak
Authors: Prince A. , Chen Xin , Lun K. C.
Published: March 2018

Objective:
The objectives of epidemiological surveillance and research of infectious diseases are to address disease prevention, identify outbreaks and monitor and evaluate control strategies. In this paper, we report on the development of a Geographical Information System (GIS) based on a novel Digital Ring Fence (DRiF) strategy for the containment of acute infectious diseases.

Method:
Data from probable cases are captured in a secure database. Postal codes of addresses facilitate precise mapping of the location of each probable case on a multi-layered GIS system. A digital ring fence is constructed around each location (hot-spot) using Non-Homogeneous Poisson Process (NHPP) modeling based on data of individuals coming into contact with each probable case. The radius of the DRiF gives the overall risk of infection from its epicenter, the probable case. By annotating the DRiF to a GIS, areas of population concentrations could be readily identified to direct outbreak containment efforts.

Results:
Simulation studies have demonstrated that the DRiF strategy could provide a novel approach to containment of acute disease outbreaks.

Conclusion:
SARS has provided convincing evidence that the key to tackling acute infectious disease outbreaks lies in containment and making disease containment one step ahead of its spread. The DRiF strategy achieves this by providing a zone to corral the spread of infection through person-to-person transmission. Other useful applications of the DRiF technique include demarcating culling zone for the containment of bird flu infection and containment of person-to-person transmission should it occur.
Methods for Evaluation of Medical Terminological Systems
Authors: Cornet R. , de Jonge E. , de Keizer N. F. , Arts D. G. T.
Published: March 2018

Objectives:
The usability of terminological systems (TSs) strongly depends on the coverage and correctness of their content. The objective of this study was to create a literature overview of aspects related to the content of TSs and of methods for the evaluation of the content of TSs. The extent to which these methods overlap or complement each other is investigated.

Methods:
We reviewed literature and composed definitions for aspects of the evaluation of the content of TSs. Of the methods described in literature three were selected: 1) Concept matching in which two samples of concepts representing a) documentation of reasons for admission in daily care practice and b) aggregation of patient groups for research, are looked up in the TS in order to assess its coverage; 2) Formal algorithmic evaluation in which reasoning on the formally represented content is used to detect inconsistencies; and 3) Expert review in which a random sample of concepts are checked for incorrect and incomplete terms and relations. These evaluation methods were applied in a case study on the locally developed TS DICE (Diagnoses for Intensive Care Evaluation).

Results:
None of the applied methods covered all the aspects of the content of a TS. The results of concept matching differed for the two use cases (63% vs. 52% perfect matches). Expert review revealed many more errors and incompleteness than formal algorithmic evaluation.

Conclusions:
To evaluate the content of a TS, using a combination of evaluation methods is preferable. Different representative samples, reflecting the uses of TSs, lead to different results for concept matching. Expert review appears to be very valuable, but time consuming. Formal algorithmic evaluation has the potential to decrease the workload of human reviewers but detects only logical inconsistencies. Further research is required to exploit the potentials of formal algorithmic evaluation.
Record Linkage in the Cancer Registry of Tyrol, Austria
Authors: Stühlinger W. , Oberaigner W.
Published: March 2018

Objective:
Record linkage of patient data originating from various data sources and record linkage for checking uniqueness of patient registration are common tasks for every cancer registry. In Austria, there is no unique person identifier in use in the medical system. Hence, it was necessary and the goal of this work to develop an efficient means of record linkage for use in cancer registries in Austria.

Methods:
We adapted the method of probabilistic record linkage to the situation of cancer registries in Austria. In addition to the customary components of this method, we also took into consideration typing errors commonly occurring in names and dates of birth. The method was implemented in a program written in DELPHITM with interfaces optimised for cancer registries.

Results:
Applying our record linkage method to 130,509 linkages results in 105,272 (80.7%) identical pairs. For these identical pairs, 88.9% of decisions were performed automatically and 11.1% semi-automatically. For results decided automatically, 6.9% did not have simultaneous identity of last name, first name and date of birth. For results decided semi-automatically, 48.4% did not have an identical last name, 25.6% did not have an identical date of birth and 83.1% did not have simultaneous identity of last name and date of birth and first name.

Conclusions:
The method implemented in our cancer registry solves all record linkage problems in Austria with sufficient precision.
Application of Resampling Techniques to the Statistical Analysis of the Brier Score
Authors: Itoh S. , Ishigaki T. , Yamauchi K. , Ikeda M.
Published: March 2018

We investigated the application of resampling techniques to the statistical analysis of the Brier score (B), and extended them to the statistical comparison of two Bs derived from the same set of patients. The re-sampling techniques are helpful in the statistical analysis of B, and there are almost no differences between the jackknife method and the bootstrap method in this analysis. Thus, we believe that B should be used more often as an index to evaluate probabilistic judgments in the case in which the data sets for the assessment are “degenerate” as the “receiver operating characteristic data sets.”
Graphic Representation of Sequential Bayesian Analysis
Authors: Heller I. , Topilsky M. , Shapira I. , Isakov A.
Published: March 2018

Previously undescribed algebraic transforms of Bayes’ theorem define families of operating points in the receiver operating characteristic (ROC) space which, at given pre-test probability, produce constant post-test probabilities. These isopredictive operating points form straight lines in the ROC space. The lines can be used to emulate Bayesian sequential analysis in a strictly graphic procedure, which can be applied in clinical work and medical education.
The Search for Synergy: Interrelating Medical Work and Patient Care Information Systems
Authors: Berg M.
Published: March 2018

Objectives: This article aims to search for the way patient care information systems can be most fruitfully put to work in health care.

Methods: Given the calls for improved health care quality, there is a need for IT’s coordination capacities in health care. Yet IT’s track record in this area is less than many expected. Moreover, many argue that the nature of health care work sets natural limits to the possibilities of IT to revolutionize this work. Starting with an analysis of the paper record, this article explores the way IT and professional work can be interrelated synergistically.

Results: Two principles are discussed: 1) The key to a fruitful operation of IT in health care work lies in the unraveling of the care process, and the redistribution of tasks between professionals and the IT application. 2) Professionals should be given the skills and resources to adapt the IT application’s demands to the needs of their work practices.

Conclusion: IT can bring true process support to health care when taking the two principles discussed here into account.
Structured Representation of Drug Indications: Lexical and Semantic Analysis and Object-Oriented Modeling
Authors: Duclos C. , Venot A.
Published: March 2018

No standardized representation of drug indications is currently available that could be used in drug knowledge bases. We describe an object-oriented representation of indications that should make it possible to develop new tools for selecting drugs and checking prescriptions in computerized drug prescription systems. The model was developed using the results of a lexical and semantic analysis of drug indications, collected into a single file and processed using natural language processing software. It distinguishes both the diseases for which the drug may be given and the efficiency of the drug for a given indication. Two aspects of the model were evaluated: the differences if two independent evaluators filled the attributes independently and the loss of information induced by the use of the model. A system based on this model, making it possible for the physician to select all the drugs satisfying various criteria, is also presented.
An End-to-End Secure Patient Information Access Card System
Authors: Singer H. , Yakami M. , Takahashi T. , Alkhateeb A.
Published: March 2018

The rapid development of the Internet and the increasing interest in Internet-based solutions has promoted the idea of creating Internet-based health information applications. This will force a change in the role of IC cards in healthcare card systems from a data carrier to an access key medium. At the Medical Informatics Department of Kyoto University Hospital we are developing a smart card patient information project where patient databases are accessed via the Internet. Strong end-to-end data encryption is performed via Secure Socket Layers, transparent to transmit patient information. The smart card is playing the crucial role of access key to the database: user authentication is performed internally without ever revealing the actual key. For easy acceptance by healthcare professionals, the user interface is integrated as a plug-in for two familiar Web browsers, Netscape Navigator and MS Internet Explorer.
A Process View of Medical Practice by Modeling Communicative Acts
Authors: van Reijswoud V. E. , Toussaint P. J. , Harms E. H. , Zwetsloot-Schonk J. H. M. , Maij E.
Published: March 2018

The need of an electronic patient record with a process view on medical care is widely acknowledged. Characteristics of DEMO (Dynamic Essential Modeling of Organizations) suggest that with this methodology an adequate process view of medical practice can be obtained. In applying DEMO to the care process of the emergency department at the University Medical Centre Utrecht, it was investigated if DEMO fulfilled our expectations. This practical application showed that DEMO yields an adequate process view by a clear and comprehensible view of the core processes, responsibilities, co-ordination of activities, and a clear description of causal and conditional relations between activities.
Understanding Terminological Systems I: Terminology and Typology
Authors: Abu-Hanna A. , Zwetsloot-Schonk J. H. M. , de Keizer N. F.
Published: March 2018

Terminological systems are an important research issue within the field of medical informatics. For precise understanding of existing terminological systems a referential framework is needed that provides a uniform terminology and typology of terminological systems themselves. In this article a uniform terminology is described by putting relevant fundamental notions and definitions used by standard organizations such as CEN and ISO into perspective, and interrelating them to arrive at a useful typology of terminological systems. This typology is illustrated by applying it to five well-known existing terminological systems.
CISMeF: A Structured Health Resource Guide
Authors: Leroy J. P. , Baudic F. , Douyère M. , Piot J. , Thirion B. , Darmoni S. J.
Published: March 2018

In 1999, the Internet has become a major source of health information. The objective of CISMeF is to catalogue and index the main French-speaking health resources. In September 1999, the number of indexed resources totaled over 7,100 with a mean of 75 new sites per week. CISMeF uses two standard tools for organizing information: the Medline bibliographic database MeSH thesaurus and the Dublin Core metadata format. Resources included in CISMeF are described by the following: title, author or creator, subject and keywords, description, publisher, date, resource type, format, identifier, and language. To index resources, CISMeF uses five levels of hierarchy: “meta-term”, category, keyword, subheading, and resource type. CISMeF contains a thematic index, including medical specialities and an alphabetic index. CISMeF respects the Net Scoring, criteria to assess the quality of health information on the Internet. The CISMeF project offers a valuable tool for the French-speaking health community: 2,500 computer users visit the Web site each working day.
Injury Detection for Central Nervous System via EEG with Higher Order Crossing-based Methods
Authors: Qiu T. , Kong X.
Published: March 2018

Higher order crossing (HOC) is a powerful tool for time series analysis. Two HOC-based EEG analysis methods are developed for brain injury detection and quantification. The first method explores EEG spectrum characteristics via an estimate of the dominant frequency of a pre-processed EEG signal. The second method is based on the norm of the AHOC, an HOC obtained from the -filter prefiltered EEG signal. Both methods are shown to be effective in detecting hypoxic/asphyxic injuries as well as assessing the severity of the injury.
Appropriateness and Necessity Research on the Internet: Using a “Second Opinion System”
Authors: Faisst K. , Kapetanios E. , Wyss P. , Norrie M. C. , Gutzwiller F. , Schilling J.
Published: March 2018

Appropriateness and necessity research of various procedures in medicine may be the most complex field of innovation in healthcare and technology assessment. Nevertheless, the appropriateness of the indication of any medical intervention is probably more important than the outcome since even ideal quality components of structures, processes and outcomes become irrelevant without a proper indication. The first part of our appropriateness initiative in interventional cardiology and gynecology was to formulate guidelines. To define the appropriateness for coronary angiography, coronary revascularization and hysterectomy, literature-based consensus methods were used. The second part was to disseminate the guidelines in a user-friendly manner via the Internet. Therefore, we relied on a system-driven query facility for propositional (experts) rules. The next part of the appropriateness initiative may be a user-friendly Internet-based data collection system to validate the national accepted guidelines. Most important may be that only data that is needed can be collected using a refined database technology. The described Second Opinion System can be found under: http://sos.inf.ethz.ch. Research on indications with data on clinical outcome may open new opportunities to validate indication guidelines using Inter-net/database technology for data analysis and browsing of decision graphs concerning clinical decision-making. This new technology facilitates the evaluation of appropriateness and necessity criteria in combination with clinical outcomes.
Sociotechnical Requirements Analysis for Clinical Systems
Authors: Pratt W. , Dourish P. , Shabot M. M. , Reddy M.
Published: March 2018

Objective: We explore sociotechnical requirements by examining the use of a computerized patient record system in an intensive care unit of a U.S. hospital and present two sociotechnical requirements, awareness and coordination, embedded in the users’ work.

Method: The study is based on observation during seven months of the use of a computerized patient record system in a surgical intensive care unit. During that period semi-formal interviews, informal interviews were held.

Results and Conclusions: A key step in the design of clinical systems is the development and analysis of requirements. However, traditional requirements analysis is based on a set of assumptions that break down in the highly collaborative, exception-filled clinical domain. Sociotechnical requirement analysis enabled the designers to gather a much richer description of the environment surrounding the computer system, highlighting awareness and coordination, embedded in the users’ work.
Integrating Quantitative and Qualitative Methods in Patient Care Information System Evaluation
Authors: Berg M. , Stoop A. P.
Published: March 2018

Objective: The aim of this paper is twofold. First, we describe two important dimensions of patient care information systems (PCIS) evaluation: the domain of evaluation and the different phases of the PCIS implementation. Second, we claim that, though Randomized Controlled Trials (RCTs) are often still seen as the standard approach, this type of design hardly generates relevant information for the organizational decision maker.

Method: Interpretive study of evaluation literature. Results and Conclusions: The field of evaluation is scattered and the types of questions that can be asked and methods that can be used seem infinite and badly demarcated. Different stakeholders, moreover, often have different priorities in evaluating ICT. The most important reason for the lack of relevance of RCTs is that they are ill suited for investigating why and how a PCIS is being used, or not, and what the (often unplanned) effects and consequences are. Subsequently, our aim is to contribute to the discussion about the viability of qualitative versus quantitative methods in PCIS evaluation, by arguing for a specific integration of quantitative and qualitative research methods. The joint utilization of these methods, we claim, yields the richest results.
Medical Informatics Specialists: What Are their Job Profiles?
Authors: Knaup P. , Frey W. , Haux R. , Leven F. J.
Published: March 2018

Objectives:
Since 1972, the University of Heidelberg and the University of Applied Sciences Heilbronn have jointly been running a medical informatics program. To continuously provide high quality education, the curriculum is regularly evaluated among its graduates. The objectives of this study were to assess the job situation of the graduates and to evaluate the curriculum from their viewpoint.

Method:
Anonymous inquiry of all medical informatics graduates, having finished their studies before March 31, 2001 (n = 1024) using a structured questionnaire.

Results:
The questionnaire was answered by 446 (compliance: 45.5%) graduates. About one third (146 of 444 valid cases) are working in software/ hardware companies. 179 (43.0% of 416 valid cases) graduates are working within medical informatics, 214 (51.4%) are working outside of medical informatics, but within other informatics. 23 (5.5%) graduates are working neither in medical nor in other informatics. 15 percent of the responding graduates have received a doctor’s degree. Software engineering, database and information systems are regarded as most important parts of the education. The majority of the graduates are satisfied with their education as well as with their personal career.

Conclusions:
The variety of jobs, the job profiles, and the high level of our graduates’ satisfaction with their education indicate the relevance of specialized medical informatics programs with a curricular profile like the one in Heidelberg/Heilbronn. Investigations like this can help to adjust the contents of the curriculum to professional needs.
ORCA: The Versatile CPR
Authors: Stam H. , van Mulligen E. M. , de Wilde M. , van Mastrigt R. , van Bemmel J. H. , van Ginneken A. M.
Published: March 2018

The introduction of computer-based patient records (CPRs) that fully replace paper records proves especially difficult in specialized care, despite the potential advantages of CPRs for patient care and research. Improved data legibility, availability, sharing of records, and decision support may directly benefit patient care. Barriers to the introduction of CPR applications at institutions may be caused by lack of infrastructure, or by financial or organizational issues. To have clinicians interactively enter data at the point of care is still a big challenge. This paper presents an overview of ORCA (Open Record of CAre): a generic CPR, designed for integration with existing systems, presentation of multi-media patient data, and the collection of structured data, directly by clinicians. ORCA can easily be tailored to the needs of a variety of medical specialists without the need for changes to its data model, functionality, or interface. The paper describes the essence of the architecture of ORCA and the user benefits with emphasis on the support of structured data entry.
Transferring Data from One EPR to Another: Content – Syntax – Semantic
Authors: Bürkle T. , Schweiger R. , Altmann U. , Holena M. , Blobel B. , Dudeck J.
Published: March 2018

When data are transmitted between electronic patient record (EPR) systems, we can distinguish several tasks. One task is the definition of structure and semantic content of the data in a message structure. Another task is the mapping of the sending EPR’s structure to this message structure. A third task is the mapping of the message structure to the receiving EPR’s structure. We describe an approach, which distinguishes clearly between these different tasks and activities. Using this approach we have implemented a data transfer procedure between a cancer registry application and a middleware for healthcare information systems. Our experience showed that the proposed systematic approach helped identify problems for data transfer in an early design phase. It also allowed us to limit modifications of the data exchange procedure to certain tasks or activities when one of the EPR applications was updated. In the end, we could even exchange the underlying message format without having to reimplement the complete interface.
Age-Related Reference Regions for Longitudinal Measurements of Growth Characteristics
Authors: Reinhard I. , Wellek S.
Published: March 2018

Most studies on age-related reference centiles published up to now have adopted a strictly cross-sectional perspective. Clearly, the results of studies of that type do not provide a tool for the diagnostic assessment of whole series of measurements taken sequentially over time in the same individual. In this paper, the approach of Wellek & Merz (1995) to the construction of age-dependent reference ranges for cross-sectional measurements is generalized in such a way that data sets containing time series of arbitrary length varying between subjects can be accommodated. Since repeated measurements on the same subject are typically correlated, the regression function to be used as the central line for the reference band eventually obtained is determined by fitting a nonlinear mixed model describing the dependence of conditional means on age by growth functions of the same class we proposed in the case of cross-sectional data. Estimation of the parameters of this mixed model is done in a way closely related to the population-averaged GEE approach by Zeger et al. (1988). Given the regression line, the reference band is constructed by means of an iterative procedure guaranteeing that the proportion of observed profiles which nowhere leave the band, has some prespecified value (frequently set equal to 90% in practice). The approach is illustrated with two examples taken from child psychiatry and prenatal sonography.
Differentiation of Benign and Malignant Breast Tumors by Logistic Regression and a Classification Tree using Doppler flow signals
Authors: Madjar H. , Prömpeler H. J. , Sauerbrei W.
Published: March 2018

In breast examinations with Doppler, an increased flow is found in malignant tumors. With the relatively new color Doppler, we measured different flow values in 133 cancer patients and in 325 women with benign disease. These measurements were used to develop diagnostic rules. For the highly correlated flow values, we used a stepwise procedure to select a final logistic regression model and a tree-based approach, which is a different way of modeling. With both approaches we developed simple diagnostic rules of which the sensitivity and the specificity exceeded 90%. There are no differences between the two approaches concerning discriminative ability. As complex statistical modeling leads to an overoptimism in the assessment of the error rates, we applied sensitivity analysis, investigated the stability of the selected logistic regression model, and estimated the magnitude of the overoptimism of the diagnostic rules with resampling methods. The results indicate that the estimates of sensitivity and specificity are probably close to realistic values for a clinical setting.
Medical Work and the ComputerBased Patient Record: A Sociological Perspective
Authors: Berg M.
Published: March 2018

The computer-based patient record (CPR) is a tool likely to have great impact on the practice of medicine in the years to come. Yet, clinical settings with a fully integrated CPR are hard to find. This paper takes a sociological look at the attempts to construe and introduce CPRs. It is argued that part of the current trouble in getting these tools to work lies in the model of medical work that is inscribed in many (attempted) CPRs. A more sociological perspective on medical work should be able to offer points of departure for the construction of systems wh ich might fit the needs of health care workers better. Based on participatory observation, the paper outlines what it is medical work comes down to from a sociological perspective, and how the medical record figures in this work. Finally, some consequences this depiction has for current discussions on and (proposed) implementations of CPRs are described.
Use of the Unified Medical Language System in Patient Care at the Columbia-Presbyterian Medical Center
Authors: Cimino J. J.
Published: March 2018

The Unified Medical Language System (UMLS) project at the United States National Library of Medicine contains and organizes a large number of terms from controlled medical vocabularies. This study examines the suitability of the UMLS for representing patient care information as it exists in the Columbia-Presbyterian Medical Center (CPMC) clinical information system. Comparisons were made between the semantic types, semantic relations and medical concepts of the UMLS and the data model entities, semantic classes, semantic relations and concepts in the CPMC system. Results of the comparison demonstrate that the UMLS structural model is appropriate for representing CPMC vocabularies and patient data and that the UMLS concepts provide excellent coverage of CPMC concepts in many areas. Recommendations are made for enhancing UMLS structure to provide additional coverage of the CPMC model. It is concluded that content expansion to provide better coverage of clinical terminology is possible within the current UMLS model.
Utilization of a Neural Network in the Elaboration of an Evaluation Scale for Pain in Cerebral Palsy
Authors: Jimeno M. T. , Collignon P. , Chau Y. , Giusiano B.
Published: March 2018

An interesting aspect of neural networks is shown in the elaboration of an evaluation scale for pain in cerebral palsy with severe mental retardation. Because of the diversity of cases, the number of items had to be limited in the final step of statistical validation. Classical analysis on prior data did not allow to decide whether the variability in results is more likely due to the type of disability (i. e., the possibility of pain expression) than to the actual presence of pain. A neural network was used to find implicit relations between the data, with the advantage of having total control on the variables’ status by applying variations in the network architecture. This allowed for the rapid identification more significant item combinations as a function of degree of relationship to pain in cerebral palsy.
Ontology and Terminology Servers in Agent-based Health-care Information Systems
Authors: Lanzola G. , Stefanelli M. , Falasconi S.
Published: March 2018

A new research paradigm is emerging based on the multi-agent system architectural framework, allowing human and software agents to interoperate and thus cooperate within common application areas. Within a multi-agent system, the different “views of the world” of knowledgeable agents are to be bridged through their commitment to common ontologies and terminologies. We developed a general methodology for the design or integration of new components into a Health-care Information System conceived as a network of software and human agents. In our view, ontological and terminological services are entrusted to dedicated agents, namely ontology and terminology servers, allowing the configuration of suitable application ontologies for distributed applications. The role is described that such servers, operatively coordinated in order to preserve semantic coherence, should play within a distributed Health-care Information System.
Extensions to the Time-Oriented Database Model to Support Temporal Reasoning in Medical Expert Systems
Authors: Kahn M. G. , Fagan L. M. , Tu S.
Published: March 2018

Physicians faced with diagnostic and therapeutic decisions must reason about clinical features that change over time. Database-management systems (DBMS) can increase access to patient data, but most systems are limited in their ability to store and retrieve complex temporal information. The Time-Oriented Databank (TOD) model, the most widely used data model for medical database systems, associates a single time stamp with each observation. The proper analysis of most clinical data requires accounting for multiple concurrent clinical events that may alter the interpretation of the raw data. Most medical DBMSs cannot retrieve patient data indexed by multiple clinical events. We describe two logical extensions to TOD-based databases that solve a set of temporal reasoning problems we encountered in constructing medical expert systems. A key feature of both extensions is that stored data are partitioned into groupings, such as sequential clinical visits, clinical exacerbations, or other abstract events that have clinical decision-making relevance. The temporal network (TNET) is an object-oriented database that extends the temporal reasoning capabilities of ONCOCIN, a medical expert system that provides chemotherapy advice. TNET uses persistent objects to associate observations with intervals of time during which “an event of clinical interest” occurred. A second object-oriented system, called the extended temporal network (ETNET), is both an extension and a simplification of TNET. Like TNET, ETNET uses persistent objects to represent relevant intervals; unlike the first system, however, ETNET contains reasoning methods (rules) that can be executed when an event “begins”, and that are withdrawn when that event “concludes”. TNET and ETNET capture temporal relationships among recorded information that are not represented in TOD-based databases. Although they do not solve all temporal reasoning problems found in medical decision making, these new structures enable patient database systems to encode complex temporal relationships, to store and retrieve patient data based on multiple clinical contexts and, in ETNET, to modify the reasoning methods available to an expert system based on the onset or conclusion of specific clinical events.
Record Linkage Strategies
Authors: Roos L. L. , Wajda A.
Published: March 2018

Record linkage techniques can help identify the same patient for matching diverse files (hospital discharge abstracts, insurance claims, registries, Vital Statistics data) which contain similar identifiers. Prior knowledge of whether a linkage is feasible is important to prevent wasted effort (additional data collection or data manipulation), which decreases the cost-effectiveness of the linkage. Using examples generated by linking the Manitoba Health Services Commission data with Vital Statistics files, a method of estimating the information in each data set is presented first. Further, the feasibility of several different record linkage strategies is described and tested, given varying amounts of information. At the margin, relatively small amounts of information (having just one more variable to match with) can make a great difference. Probabilistic linkage’s great advantage was found in those situations where only a moderate amount of extra information was available.

By using the above techniques when working with one or both files in a proposed record linkage project, a much more informed judgement can now be made as to whether a linkage will or will not work. In facilitating record linkage, flexibility of both software and the strategy for matching is very important.
Elements of Significance Testing with Equivalence Problems
Authors: Wellek S. , Michaelis J.
Published: March 2018

The paper outlines an approach to the general methodological problem of equivalence assessment which is based on the classical theory of testing statistical hypotheses. Within this frame of reference it is natural to search for decision rules satisfying the same criteria of optimality which are customarily applied in deriving solutions to one- and two-sided testing problems. For three standard situations very frequently encountered in medical applications of statistics, a concise account of such an optimal test for equivalence is presented. It is pointed out that tests based on the well-known principle of confidence interval inclusion are valid in the sense 1 of guaranteeing the prespecified level of significance, but tend to have an unnecessarily low efficiency.