bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Influencing Hospitalisation of Infants for Recurrent Gastroenteritis in Western Australia
Authors: Wang K. , Yau K. K. W. , Lee A. H.
Published: March 2018

Objective: To determine factors affecting length of hospitalisation of infants for recurrent gastroenteritis using linked data records from the Western Australia heath information system.

Methods: A seven-year retrospective cohort study was undertaken on all infants born in Western Australia in 1995 who were admitted for gastroenteritis during their first year of life (n = 519). Linked hospitalisation records were retrieved to derive the outcome measure and other demographic variables for the cohort. Unlike previous studies that focused mainly on a single episode of gastroenteritis, the durations of successive hospitalisations were analysed using a proportional hazards model with correlated frailty to determine the prognostic factors influencing recurrent gastroenteritis.

Results: Older children experienced a shorter stay with an increased discharge rate of 1.9% for each month increase in admission age. An additional comorbidity recorded in the hospital discharge summary slowed the adjusted discharge rate by 46.5%. Aboriginal infants were readmitted to hospital more frequently, and had an adjusted hazard ratio of 0.253, implying a much higher risk of prolonged hospitalisation compared to non-Aborigines.

Conclusions: The use of linked hospitalisation records has the advantage of providing access to hospital-based population information in the context of medical informatics. The analysis of linked data has enabled the assessment of prognostic factors influencing length of hospitalisations for recurrent gastroenteritis with high statistical power.
The Laryngectomee Substitute Voice: Image Processing of Endoscopic Recordings by Fusion with Acoustic Signals
Authors: Döllinger M. , Schuster M. , Eysholdt U. , Hoppe U. , Lohscheller J.
Published: March 2018

Objectives: The most radical cancer therapy of the throat is the total excision of the larynx which postoperatively results in the loss of voice. A widely-used method of voice rehabilitation is the insertion of a silicone valve, which establishes an unidirectional connection between trachea and esophagus. Thus, during exhalation, air can be directed from the trachea into the esophagus. This air stream excites tissue vibrations of the esophagus and the hypo-pharynx which act as a substitute voice generator. Purpose of the current study is to present a technique for visualizing the dynamics of the substitute voice generating element.

Methods: Digital high speed videos of the vibrating tissue are simultaneously recorded with the emitted acoustic signal. The high speed sequences are directly evaluated by a three-step knowledge based algorithm. It considers correlation between image and acoustic data, information about the gray value of each pixel, and continuity of tissue vibration. The temporal properties of an image series are investigated by evaluating the time dependent gray value at each pixel position.

Results: The applicability of the algorithm is exemplar-ily demonstrated using the data of one male patient. It enables the identification of the regions within an image series which are mainly responsible for the acoustic signal. Additionally, the dynamics of tissue vibrations are visualized. The main propagation direction can be clearly identified.

Conclusions: The new methodology summarizes the information about endoscopic and acoustic recordings of substitute voice into a single image. The results allow a first estimation of tissue velocity and elastic properties of oscillating tissue.
Individual Prognosis of Diabetes Long-term Risks: A CBR Approach
Authors: Palaudàries A. , Plaza E. , Armengol E.
Published: March 2018

We present DIRAS, an application to support physicians in determining the risk of complications for individual diabetic patients. The risk pattern of each diabetic patient is obtained using a Case-based Reasoning method called LID. Case-based Reasoning is an Artificial Intelligence technique based on solving new situations according to past experiences. For each patient, the LID method determines the risk of each diabetic complication according to the risk of already diagnosed patients. In addition, LID builds a description that can be viewed as an explanation of the obtained risk.
Characteristics of Consumer Terminology for Health Information Retrieval
Authors: Kogan S. , Ash N. , Greenes R. A. , Boxwala A. A. , Zeng Q.
Published: March 2018

Objectives: As millions of consumers perform health information retrieval online, the mismatch between their terminology and the terminologies of the information sources could become a major barrier to successful retrievals. To address this problem, we studied the characteristics of consumer terminology for health information retrieval.

Methods: Our study focused on consumer queries that were used on a consumer health service Web site and a consumer health information Web site. We analyzed data from the site-usage logs and conducted interviews with patients.

Results: Our findings show that consumers’ information retrieval performance is very poor. There are significant mismatches at all levels (lexical, semantic and mental models) between the consumer terminology and both the information source terminology and standard medical vocabularies.

Conclusions: Comprehensive terminology support on all levels is needed for consumer health information retrieval.
Health Risk Appraisal in the UK – Some Preliminary Results
Authors: Allaway S. , Robinson D.
Published: March 2018

Information about a subject's lifestyle, personal past history and family history of disease is obtained from a 70-item questionnaire. This information is then used to compute the subject's risk of dying from certain diseases, relative to the average risk for a person of the same age and sex.
Periodical Multiphasic Screening and Lung Cancer Prevention
Authors: Carel R. S.
Published: March 2018

The purpose of this work is to evaluate the utilization of information gathered by multiphasic screening with respect to lung cancer detection and smoking cessation techniques. A cohort (follow-up) study is reported in which cancer incidence and factors affecting its occurrence are evaluated in a group of about 20,000 presumably healthy adults along a period of approximately 10 years following comprehensive multiphasic health examinations. Lung cancer occurrence is primarily related to smoking. The risk is higher in smokers and is dose-dependent; OR = 0.21, (CI = 0.08,.53) in never smokers, OR = 1.53 (CI = 0.8,3.2) in past and current moderate smokers, OR = 4.92 (CI = 2.18,11.11) in current heavy smokers. Moreover, smokers with compromised pulmonary function (FEVI/FVC < 75%) are at an even higher risk of developing lung cancer OR = 4.22 (CI = 2.2, 8.2) for past and current moderate smokers; and OR = 10.7 (CI-2.5, 38.6) in current heavy smokers. Information gathered in periodical multiphasic health examinations could be utilized by health professionals to encourage smoking cessation and smoking prevention in the appropriate screenees. Various elements of the multiphasic test results could contribute to such prevention efforts. While every smoker should receive appropriate evaluation and consultation regarding nicotine dependence, smokers with reduced pulmonary function represent an extra high risk group to which special attention should be given.
Building Clinical Classifiers Using Incomplete Observations – A Neural Network Ensemble for Hepatoma Detection in Patients with Cirrhosis
Authors: Parmanto B. , Munro P. W. , Marino I. R. , Aldrighetti K. , Doria C. , McMichael J. , Fung J. J. , Doyle H. R.
Published: March 2018

One objective of liver transplant evaluation is to identify patients that harbor a hepatoma, but standard screening techniques are not sensitive enough. We trained neural network ensembles to predict the presence of hepatoma in patients with cirrhosis, based on information collected at the time of transplant evaluation. Network architecture and training were modified to handle missing observations. Three ensembles were trained: ensemble A using the subset with no missing observations (528 patients); ensemble B using the complete set, which included missing observations (853 patients); and ensemble C using the smaller subset, originally with complete data, but after a fixed number of observations were deleted (i. e., made “missing”). Ensemble performance on testing sets was very good. The areas under the ROC curves were 0.91, 0.89, and 0.90, for ensembles A. B, and C, respectively. Neural networks can successfully perform this classification task, and strategies can be developed that allow use of incomplete observations.
Development of a Computerized Information System in the Harare City Health Department
Authors: Woelk G. B. , Moyo I. M.
Published: March 2018

The experience is reported with the health information system of the Health Department of Harare City, five years after its introduction. The system was evaluated in terms of the implementation procedure and improvements in the management process. It is concluded that careful management of the implementation process itself is a key to the successful realization of a health information system in developing countries. The statement that the quality of information produced during a computerization process is only as good as the original data fed into it, is emphasized.
A Graph-Grammar Approach to Represent Causal, Temporal and Other Contexts in an Oncological Patient Record
Authors: Thews O. , Rohrbach C. , Sergl M. , Pommerening K. , Müller R.
Published: March 2018

The data of a patient undergoing complex diagnostic and therapeutic procedures do not only form a simple chronology of events, but are closely related in many ways. Such data contexts include causal or temporal relationships, they express inconsistencies and revision processes, or describe patient-specific heuristics. The knowledge of data contexts supports the retrospective understanding of the medical decision-making process and is a valuable base for further treatment. Conventional data models usually neglect the problem of context knowledge, or simply use free text which is not processed by the program. In connection with the development of the knowledge-based system THEMPO (Therapy Management in Pediatric Oncology), which supports therapy and monitoring in pediatric oncology, a graph-grammar approach has been used to design and implement a graph-oriented patient model which allows the representation of non-trivial (causal, temporal, etc.) clinical contexts. For context acquisition a mouse-based tool has been developed allowing the physician to specify contexts in a comfortable graphical manner. Furthermore, the retrieval of contexts is realized with graphical tools as well.
Linking Patient Information Systems to Bibliographic Resources
Authors: Cimino J. J.
Published: March 2018

Medical informatics researchers have explored a number of ways to integrate medical information resources into patient care systems. Particular attention has been given to the integration of on-line bibliographic resources. This paper presents an information model which breaks down the integration task into three components, each of which answers a question: what is the user’s question?, where can the answer be found?, and how is the retrieval strategy composed? Twelve experimental systems are reviewed and their methods for addressing one or more of these questions are described.
Medical Records and Other Stories: a Narratological Framework
Authors: Purves I. N. , Kay S.
Published: March 2018

A new model of the medical record is introduced which can incorporate context, structure, process and use of the medical record within a single narratological framework. It is claimed that the analysis of narrative and, in particular, the study of the story metaphor can provide a theoretical model which provides coherence within the broad discipline of Medical Informatics. It is argued that this framework maintains different levels of abstraction, is useful for teaching and clinical practice, and that its concepts can be readily understood by those in both lay and technical healthcare professions.
Computer-Assisted Elaboration of Job Histories
Authors: Mouaddib A. , Robaux P. , Martin J.M.
Published: March 2018

Three ways are proposed to help the occupational physician in constructing a worker’s job history or Curriculum Laboris (CL) with a PC. The quality and, therefore, the usefulness of any job history is greatly conditioned by the method and quality of data collection. The Curriculum Laboris method explained in a previous article has been briefly summarized as a basis of departure. Then, the workers who were submitted to special medical surveillance were considered. After this, the scrolling menu technique was applied in the elaboration of a job history. Finally, the authors show how the representation of company organization by means of a job exposure matrix (JEM) can help to efficiently elaborate job histories.
Development of a Computer-Aided Reference System for Differential Diagnostics Support
Authors: Wieding J. U. , Kretschmar T. , Schonle P. W.
Published: March 2018

In a situation of uncertain diagnosis, physicians may spend valuable time consulting relevant literature, often with unsatisfactory results. Therefore, our aim was to develop a computer system which supports differential diagnostics via rapid and comprehensive searches through information in literature. Based on entered signs and symptoms our prototype is able to offer probable diagnoses. Subsequently, further examinations and tests are suggested to confirm or exclude a certain disease. Thus, the final diagnosis is made gradually by differentiation of possible diseases.

Our first attempt consisted in representing knowledge in a rule-based PROLOG system. However, because nearly all information for a sign-oriented differential diagnosis can be represented with very few relations only, we turned to a fact-oriented representation of signs and diseases. Access was possible via PROLOG or an imperative programming language. The index-sequential access on a fact-oriented representation of knowledge was suitable to manage a large knowledge base, which is necessary for a thorough differential diagnosis. A pointer structure was recently examined in order to handle different object-to-object relations. Efficient information processing is now possible which provides short response times using even broad knowledge bases.
Costs in Pituitary Surgery: Racial, Socioeconomic, and Hospital Factors
Authors: Workman Alan , Kidwai Sarah , Goljo Erden , Signore Anthony , Iloreta Alfred , Genden Eric , Shrivastava Raj , Navathe Amol , Govindaraj Satish , Parasher Arjun
Published: March 2018

Objective To investigate the influence of patient demographic factors and hospital factors on cost and length of stay in patients undergoing pituitary surgery.

Design/Setting A retrospective cross-sectional study of the 2008 to 2012 Nationwide/National Inpatient Sample.

Participants Patient demographics and hospital characteristics for patients undergoing pituitary surgery were compared between white, black, and Hispanic patients.

Main Outcome Measures Variables associated with increased cost and increased length of hospital stay were ascertained and compared against each racial and ethnic group via multiple linear regression analysis.

Results Of 8,812 patients who underwent pituitary surgery, 5,924 (67.2%) patients were white, 1,590 (18.0%) were black, and 1,296 (14.7%) were Hispanic. Patient variables found to be significantly different between racial groups via univariate analysis were age, chronic conditions, gender, income, and primary payer. Hospital variables found to be significantly different were location/teaching status, region, and ownership. Hospitalization cost was significantly lower for whites (−$3,082, 95% confidence interval [CI] −$3,961 to −$2,202) and significantly higher for both blacks ($1,889, 95% CI $842–$2,937) and Hispanics ($2,997, 95% CI $1,842–$4,152). Length of hospital stay was also significantly lower in whites (−1.01, 95% CI −1.31 to −0.72) and significantly higher for both blacks (0.65, 95% CI 0.30 to 1.00) and Hispanics (0.96, 95% CI 0.57–1.35).

Conclusions Racial and ethnic factors contribute to differences in hospital utilization and cost for patients undergoing pituitary surgery. Further investigations are necessary to uncover the sources of these disparities in an effort to provide safer and more affordable care to all patients.
Auswirkungen von Missbrauch, Misshandlung und Vernachlässigung im Kindesalter auf die psychische und physische Gesundheit im Erwachsenenalter
Authors: Ignatius A. , Huber-Lang M. , Fegert J. M. , Plener P. L.
Published: March 2018

In der Gesamtbevölkerung stellen das Vorliegen einer Vorgeschichte von Vernachlässigung, Missbrauch oder Misshandlung im Kindes- und Jugendalter keineswegs seltene Phänomene dar. So werden schwere körperliche Misshandlungen von etwa 3%, sexueller Missbrauch von etwa 2%, schwere emotionale Vernachlässigung von knapp 7% und schwere körperliche Vernachlässigung von knapp 11% der Allgemeinbevölkerung in Deutschland berichtet. Wie die Forschungslage zeigt, werden durch das Erleben solcher Ereignisse in der Kindheit langdauernde Prozesse in Gang gesetzt, die im Erwachsenenalter zu psychischen oder physischen Folgeschäden führen können. Im Rahmen eines selektiven Reviews soll die aktuelle Literatur zu dieser Thematik aufgearbeitet werden. Studien, die vor allem innerhalb der letzten 10 Jahre publiziert wurden, zeigen sowohl funktionelle wie auch hirnmorphologische Veränderungen, die vor allem in Bereichen des emotionalen Erlebens und der emotionalen Regulation zu Veränderungen führen. Zusätzlich mehren sich die Hinweise für negative Konsequenzen auch auf somatischer Ebene. So konnten wiederholt Zusammenhänge mit chronischen Krankheiten gezeigt werden, wobei vor allem eine Einflussnahme über unser stressverarbeitendes System als mögliche Ursache diskutiert wurden. In Modellrechnungen wurde ein gesamtwirtschaftlicher Schaden von etwa 11 bis 30 Milliarden Euro pro Jahr als Folge von Vernachlässigung, Missbrauch und Misshandlung im Kindesalter errechnet. Der Prävention solcher Ereignisse sowie der frühzeitigen Erkennung und Behandlung kommt damit eine wesentliche gesellschaftliche Dimension zu.
An Adaptive and Learning System for Feedback-Controlled Evoked Response Studies
Authors: Wagner J. , Pfurtscheixer G.
Published: March 2018

The shape, latency and amplitude of changes in electrical brain activity related to a stimulus (Evoked Potential) depend both on the stimulus parameters and on the background EEG at the time of stimulation. An adaptive, learnable stimulation system is introduced, whereby the subject is stimulated (e.g. with light), whenever the EEG power is subthreshold and minimal. Additionally, the system is conceived in such a way that a certain number of stimuli could be given within a particular time interval. Related to this time criterion, the threshold specific for each subject is calculated at the beginning of the experiment (preprocessing) and adapted to the EEG power during the processing mode because of long-time fluctuations and trends in the EEG. The process of adaptation is directed by a table which contains the necessary correction numbers for the threshold. Experiences of the stimulation system are reflected in an automatic correction of this table. Because the corrected and improved table is stored after each experiment and is used as the starting table for the next experiment, the system >learns<. The system introduced here can be used both for evoked response studies and for alpha-feedback experiments.
The Computer in the Doctor’s Office
Authors: Möhr J. R.
Published: March 2018

Conclusions from an IMIA working conference on »The Computer in the Doctor’s Office« which took place in Hannover (FRG) in April 1980 are presented. The basis for these conclusions is outlined as a synthesis of the conference proceedings. Reasons for EDP application, basic approaches, achievable results and further trends are treated in detail.
Explanations of Statistical Concepts: Can they Penetrate the Haze of Bayes?
Authors: Politser P. E.
Published: March 2018

This experiment tested the ability of logical explanations to promote the use of statistical concepts. Sixty physicians in four experimental groups, matched for level of medical statistical training, were given a questionnaire that assessed their ability to rank the diagnosticity of various diagnostic test results. Each question was designed to test physician understanding of the impact of a particular statistical parameter, e.g., sensitivity and specificity, test-retest reliability. Logical explanations of the sources of test error increased the percentage of answers judged to be correct on the basis of published data. This was confirmed for a variety of questions. They tended to be less useful, however, when physicians expressed misinterpretations of statistical concepts or test patterns were not correctly perceived. The implications of these findings for medical education and for the design of computer-based explanation systems are clarified.
Morphologic Analysis of Compound Words
Authors: Wingert F.
Published: March 2018

Algorithms for morphologic analysis of compound words and related dictionary structures are described’ on the basis of different word models. The algorithms are formulated in Backus-Naur form as well as Augmented Transition Networks. The results of applying the algorithms to the 56,509 different words of the “Systematisierte Nomenklatur der Medizin” (SNOMED) are presented.
On Priming Medical Students in Medical Informatics
Authors: Möhr J. R. , Sawinski R.
Published: March 2018

An introductory course in medical informatics (MI) for medical students in their second year of clinical education is described with respect to structure, contents and results. A positive effect was considered to have been obtained by offering a motivating course, comprising modest amounts of theory and practice and consisting of only four lectures of ninety minutes duration. The approach is discussed as an alternative to an attempt to provide a thorough theoretical basis for medical informatics to medical students in the current curricular context.
SPHINX — A System for Computer-Aided Diagnosis
Authors: Fieschi M. , Joubert M. , Fieschi D. , Roux M.
Published: March 2018

This paper presents a system for computer-aided diagnosis, the SPHINX system, based on methods of inference and pattern matching used in artificial intelligence and on various heuristic features: fuzzy heuristics in relation to the suggestion power of the signs and heuristics based on the costs of complementary investigations. The first application was made in the diagnosis of epigastric pain. Its results are presented and discussed.
Comparison of Multivariate Discrimination Techniques for Clinical Data— Application to the Thyroid Functional State
Authors: Broeckaert I. , Coomans D. , Jonckheer M. , Massart D. L.
Published: March 2018

In this paper sixteen discrimination techniques are compared on the basis of a data base concerning the thyroid function. Five laboratory tests are available for 215 patients divided into three diagnostic classes, i. e. euthyroidism, hypothyroidism and hyperthyroidism. For all techniques correct classification rates were determined using the leave-one-out procedure. Moreover, for the probabilistic techniques, the quality of the obtained probabilities was evaluated. It has been shown that most of the techniques perform well. However, the probabilistic techniques are to be preferred.
Automated Development of Clinical Strategies Using Multistage Decision Analysis
Authors: Glasziou P.
Published: March 2018

The development of investigative strategies by decision analysis has been achieved by explicitly drawing the decision tree, either by hand or on computer. This paper discusses the feasibility of automatically generating and analysing decision trees from a description of the investigations and the treatment problem. The investigation of cholestatic jaundice is used to illustrate the technique.

Methods to decrease the number of calculations required are presented. It is shown that this method makes practical the simultaneous study of at least half a dozen investigations. However, some new problems arise due to the possible complexity of the resulting optimal strategy. If protocol errors and delays due to testing are considered, simpler strategies become desirable. Generation and assessment of these simpler strategies are discussed with examples.
Subjective Expected Utility and Referral Decisions in Obesity
Authors: Jennett P. A. , Elstein A. S. , Rothert Marilyn , Rovner D. R. , Black Necia
Published: March 2018

Referral decisions of physicians dealing with long-term ambulatory problems are complex phenomena that are not clearly understood. This study was designed to assess the possible rationale behind such decisions in the management of obesity. It examined how well a subjective expected utility (SEU) model accounted for decisions of 45 primary care physicians regarding referral of obese female patients to an endocrinologist. Two patient goals, weight reduction and patient satisfaction, and a two-year time horizon were incorporated in the model.

Data were collected using 24 written cases representing 12 patients approximately 100% overweight and 12 about 50% overweight, and a semi-structured interview in which subjective probabilities and importance weights were obtained. Values were calculated by transforming physicians’ ratings of risk of morbidity in the 24 cases into a utility scale.

The SEU did not account for the primary care physicians’ referral behavior. Correlations between number of patient cases referred and SEU were analyzed and were not statistically significant, although there was substantial variation across physicians in number of cases referred. Mean subjective probabilities of weight loss and patient satisfaction were essentially identical for referral and non-referral.

The formulation of the model, the design of the cases, and the method of value assessment are discussed as potential threats to the validity of the model as an account of referral decisions. Problems of constructing an adequate model are considered.
Zur Quantifizierung selektionsbedingter Gruppenunterschiede in der Epiderniologie
Authors: Höpker W.-W.
Published: March 2018

Der von Mainland 1953 als Bebkson’s Fallacy bezeichnete Interpretationsfehler (bedingt durch Selektionseinflüsse verschiedener Art) wurde bereits von Lubabsch 1888 explizit und von v. Pfaundler und v. Seht 1921 implizit angegeben und beschrieben. Auch sind bis zur Beschreibung dieser Fehler-möglichkeiten von Bebkson 1946 eine ganze Reihe statistischer Erhebungen und Studien bekanntgewesen, in denen versucht wurde, durch eine geeignete Versuchs- und Vergleichsgruppenbildung diesen Fehler zu vermeiden.

Es ist sinnvoll, die Gesamtheit möglicher Selektionsfaktoren in drei Gruppen zu beschreiben und sich an diese Systematik zu halten, um eine sachgerechte Interpretation zu ermöglichen und auch die Angriffspunkte gezielt erhobener Vergleichsgruppen zu definieren.

Eine Unterscheidung von Haupt- und Nebenbefund ist im klinisch-ärztlichen Sektor und vor allem für die Totenscheine problematisch. Hier führt die Klassifizierung der Befunde in Haupt- und Nebenbefund zu anderen Ergebnissen als in der pathologischen Anatomie. Die Intention der Diagnose einerseits sowie die mangelnde Vollständigkeit der Datenerhebung andererseits verbieten eine Verallgemeinerung des Befundklassifizierungsprinzips.

Es werden allgemeine Parameter zur Beschreibung von Untersuchungskollektiven beschrieben und für die pathologische Anatomie diskutiert. Sie reichen sehr wohl aus, quantitative Unterschiede anzugeben, Informationen für eine möglicherweise wirksam gewordene Eliminierung von Selektionsfaktoren geben sie jedoch nicht.

Das erweiterte Rangzahlprinzip ist geeignet, clas Ausmaß von Selektionsemflüssen sowie die Wirksamkeit der Befundklassifikation zur Ausschaltung derselben zu beschreiben. Es wird empfohlen, dieses einfache Prinzip nicht durch weitergehende statistische Methoden zu überspannen.
The Collection and Processing of Medical History Data
Authors: Mclean E. R. , Foote Stefanie V. , Wagner G.
Published: March 2018

A Bibliography of Manual, Automated, and Computer-Processed Techniques E. R. McLean, Stefanie Y. Foote, G. Wagnek

The taking of a patient’s history, which has always played a central part in the practice of medicine, is one of the physician’s most time—consuming activities. As a consequence, the resultant history occasionally suffers from this time pressure and is not as complete and thorough as it might be. Over the years, a number of techniques have been developed to aid the physician in this task. The first attempt at systematizing medical history taking dates back to Martinet in 1825. In the most simple approach, the doctor collects the history data by interviewing the patient himself; alternatively, he can use the assistance of a resident, nurse, or other assistant. After the Second World War, attempts were made to improve the process by means of pencil-and-paper questionnaires. These were filled out by the patient and then reviewed by the physician upon completion.

With the advent of the computer, it has become possible to key-punch or optically scan these question-naires; and then, using batch processing, to provide the examining doctor with a computer-summarized report. By making use of remote terminals, patients can be interviewed by means of conversational, interactive computer programs which both ask questions and records responses. These time-shared systems, while the ijiost costly and complex, offer the greatest potential for multi-level branching and comprehensive questioning.

Since this aspect of the delivery of medical care is still in the developmental stage, a number of approaches are being tried, each with respective strengths and weaknesses. The accompanying biblio-graphy, comprising 720 citations, offers a comprehensive review of these techniques. It is a combination of two distinct research efforts: one, compiled by G. Wagner and B. Schwan, Heidelberg, in 19(39 and published in Anamnese, Hans-J. Heite (Ed.), F. Κ. Schattauer Verlag, Stuttgart 1971; and the other compiled by Ε. R. McLean and S. V. Foote in 1974 at the Center for Information Studies, Graduate School of Management, University of California, Los Angeles. This composite bibliography mainly restricts itself to the literature of the last 30 years. References to older literature can be taken from standard works, such as G. Grund and E. Stevenson.
Adapting a General Purpose Information Processing System UDC 68L3 01 MEDATA to a New Environment
Authors: Yoder R. D.
Published: March 2018

General Purpose Information Processing Systems provide the capabilities of filing and retrieving discrete data. These capabilities are independent of the source or nature of the data, and of the format and content of the reports to be generated from it. MEDATA is an example of such a system. The concepts of the MEDATA system were written at UCSD in PL/1, for processing on a time-shared interactive utility computing service.

PL/1 proved to be a desirable programming language for this application.-The service provided by the time-shared utility has been satisfactory and the concept of performing this type of data processing on such a utility appears to be sound. The system is now operational on a service basis and is being used for a variety of purposes. In addition to providing service, it will serve as a model for teaching, and as a basis for further research into information processing systems.
Anschluß und On-line-Betrieb eines Szintiscanners an einem Digitalrechner
Authors: Habermehl A , Eisenhauer P. , Joseph K. , Graul E. H.
Published: March 2018

Das Betriebssystem BSC 1 steuert sowohl die Übernahme der Scanner-Informationen und die Eingaben vom Teletype als auch die verschiedenen Wiedergabemöglichkeiten eines Szintigramms. Bei der Aufnahme werden zunächst Patientennamen und verschiedene Scan-Parameter eingegeben. Vor Beginn des übemahmeprogramms errechnet das Programm Größen für eine möglichst optimale Ausnutzung des Speichers. Nach der Scan-Aufnahme werden Parameter für die Wiedergabeprogramme bestimmt. Danach geht der Rechner in die Warteschleife, in der er auf Wiedergabekommandos wartet. Das Betriebssystem enthält weiter Programmteile, mit denen der Inhalt des Datenspeichers als Lochstreifen ausgegeben, ein solcher Lochstreifen wieder eingelesen werden kann und Möglichkeiten zur zusätzlichen Beschriftung der Sichtgerätausgaben.
Mechanized Processing and Retrieval of Bio-Medical Information
Authors: Southern W. A.
Published: March 2018

A report is given on the mechanized information retrieval system in operation in the Abbott Laboratories’ Science Information Services which is used for the biomedical periodical literature;i Q’ The system uses a random 12-digit number coding system and an IBM Electronic Statistical Machine 101. The following subjects are discussed in detail: the dictionary; abstracting, coding, and machine searching procedure; uses of the Abbott Abstracts; limitations of the system, and future plans for an improved system.
Spezielle Erfassungsbögen für Glaukom und Katarakt
Authors: Deaeger J.
Published: March 2018

Ergänzend zu den Angaben des »Allgemeinen Krankenblattkopfes« wurden spezielle Erhebungs-bögen für die Krankheitsbilder Glaukom und Katarakt entwickelt, über deren Aufbau in der vorliegenden Arbeit kurz berichtet wird. Probeauswertungen an über 200 Fällen haben die Brauchbarkeil der vorgelegten Konzeption bewiesen. Die Verwendung derartiger, auf bestimmte Krankheitsbilder speziell zugeschnittener Erfassungsbögen bedeutet einen Fortschritt für die Dokumentation und statistische Analyse des Krankengutes und eröffnet die Möglichkeit eines nach einheitlichen Kriterien ausgerichteten Team-works mehrerer Kliniken.
The Evaluation of Therapeutic Procedures used in the Management of Essential Hypertension
Authors: Grollman A.
Published: March 2018

The nature of essential hypertension, its pathogenesis and the disturbances which it induces are reviewed as a basis for an evaluation of the procedures and drugs used in the treatment of this common disorder. The therapeutic measures now available aim at lowering the blood pressure which is only one manifestation of hypertensive disease but fail to counteract the fundamental disturbance responsible for the disorder except in the small group of patients amenable to surgical correction. The procedures used in the experimental evaluation of the blood-pressure-reducing effects of drugs and other measures are outlined and the sources of error in such evaluations are emphasized. The methods now available for the management of essential hypertensionare outlined and their inadequacies discussed.
Controlled Trials: Nuisance or Necessity?
Authors: Lasagna L.
Published: March 2018

Placebos can mimic in many ways the characteristics of active drugs. The importance of placebo controls in clinical trials in the evaluation of therapeutic efficacy and side action liability of drugs is exemplified by specific examples from human experimentation. It is concluded that controlled trials will prevent many of the errors inherent in uncontrolled therapeutic observations.
Die Versuchsplanung bei akuten Infektionskrankheiten, speziell die Bedeutung der „ausgleichenden Alternierung”, dargestellt am Beispiel des Scharlachs
Authors: Blittersdorf F.
Published: March 2018

Für die therapeutische Untersuchung bei den akuten Infektionskrankheiten kommt nur die alternierende Behandlung in Frage. Durch ihre Modifikation in Form der „ausgleichenden Alternierung” (P. MARTINI) lassen sich die Homogenität und Vergleichbarkeit der beiden Patientengruppen wesentlich erhöhen. Die Versuchsplanung beginnt also mit der Festlegung derjenigen 2, 3 oder 4 Einteilungskriterien, in denen die Patientengruppen soweit wie möglich übereinstimmen sollen; beispielsweise Alter, Krankheitstag und Ernährungszustand. Die während der schematischen Alternierung auftretenden Unterschiede in der Zusammensetzung beider Kollektive werden in bestimmten, nicht zu großen Abständen durch die „Ausgleichungen” beseitigt, und zwar entsprechend ihrer Wertigkeit und Rangordnung. Dadurch ist es möglich, bei therapeutischen Untersuchungen mit einem kleineren Krankengut auszukommen als bei der klassischen schematischen Alternierung, ohne daß die Zuverlässigkeit der Schlußfolgerungen leidet.
Eine jugendpsychiafrische Befundkarfe für erziehungsschwierige Minderjährige
Authors: Eberhard K. , Hartmann K.
Published: March 2018

Es wird über eine jugendpsychiatrische Befundkaxte für verwahrlosungsgefährdete bzw. verwahrloste Minderjährige berichtet. Die Befundkarte ist auf männliche Minderjährige spezifiziert, aber mit sinngemäßen Abänderungen und Ergänzungen auch für weibliche Minderjährige zu verwenden. Sie soll sowohl der gutachtlichen Beurteilung des einzelnen Verwahrlosten als auch der statistischen Analyse größerer Verwahrlostenkollektive dienen.

Für die gutachterliche Beurteilung des einzelnen Verwahrlosten enthält die Befundkarte einen Katalog von Verwahrlosungsmerkmalen, auf welchem der Untersucher die jeweils erhobenen Befunde registrieren und ihre Anzahl und Valenz ablesen kann.

Für die statistische Analyse größerer Verwahrlostenkollektive ist die Befundkarte mit einer Lochkarte kombiniert, auf welcher alle ermittelten Befunde abgelocht und für statistische Berechnungen ausgezählt werden können.

Das methodische Prinzip der Befundkarte wird auch für die gutachtliche Beurteilung und statistische Analyse anderer psychopathologischer Syndrome empfohlen.
Elektronisches Analyse-Sysfem zur Testung, Erfassung und Selektion von Therapeutika )
Authors: Weis Und P. , Schmidlin P.
Published: March 2018

Für klinische Prüfungen werden die Voraussetzungen diskutiert im Hinblick auf eine systematische Auswertung auf elektronischem Wege. Das vorgestellte System berücksichtigt die Notwendigkeit einer vielseitigen Befunderhebung und der Vergleichbarkeit der Resultate. Dazu sind einheitliche Prüfungsplanung, Befundregistrierung und Datenauswertung wichtig. Für die Befundregistrierung wird ein Erhebungsbogen aufgestellt, der für die einzelnen Fachgebiete und für spezielle Fragen ausgebaut werden kann. Die Rechnungsmodelle berücksichtigen vorerst Rechnungen mit Meßwerten, Alternativdaten, sowie seltene Ereignisse und Dosis-Wirkungsbeziehungen; weitere Rechnungen werden bei Bedarf angegliedert.
Fracture stabilization with type II external fixator vs. type I external fixator with IM pin
Authors: Shani Y. , Shahar R.
Published: March 2018

Bilateral external fixator frames are frequently preferred over unilateral frames due to their superior rigidity. The objective of this study was to compare the biomechanical features of bilateral external fixators with those of unilateral external fixators that are combined with an intra-medullary pin. Three-dimensional, solid models were created of several unilateral and bilateral external fixator frames. The callus in the fracture gap was also modeled. Biomechanical analyses of all constructs were performed by the finite element method. This modeling approach allows the determination of stresses, displacements, and strains in the components of the various constructs, and thus the calculation of their relative stiffness. In addition, local shear strain values in the fracture gap, currently thought to be one of the deciding factors in the process of bone healing, can also be determined. The concept of equivalent stiffness modulus, which represents a weighed average stiffness of a construct to various loads, was defined. Using this concept, it was shown that when the intramedullary pin is well seated in the epiphyseal bone, the various unilateral frames have an equivalent stiffness modulus that is similar or even greater than that of bilateral frames with a similar arrangement of transcortical pins.
Prothrombin Complex Concentrate for Major Bleeding on Factor Xa Inhibitors: A Prospective Cohort Study
Authors: Gross Peter , Ritchie Bruce , Nahirniak Susan , Lin Yulia , Lieberman Lani , Carrier Marc , Crowther Mark , Ghosh Indy , Lazo-Langner Alejandro , Zondag Michelle , Schulman Sam ,   On Behalf of the Study Investigators
Published: March 2018

Oral factor Xa inhibitors are increasingly used for anticoagulation, but there is no approved reversal agent. Prothrombin complex concentrate (PCC) for the management of Xa-inhibitor–associated bleeding has been described in small case series and one cohort study. Patients on apixaban or rivaroxaban, suffering a major bleed, were treated at nine Canadian hospitals as per existing hospital protocol with a fixed dose of PCC 2,000 units and subsequently recruited for a 30-day follow-up. The treating physician evaluated the haemostatic effectiveness as observed during the first day as good, moderate or poor/none, using an assessment guide. Safety outcomes were thromboembolism or death. We recruited 66 patients with major bleeding who were treated with PCC and who were receiving rivaroxaban (56%) or apixaban (44%). The effectiveness was assessed as good in 65% (95% confidence interval [CI], 53–77), moderate in 20% (95% CI, 10–30) and poor/none in 15% (95% CI, 6–24). For the 36 patients with intracranial haemorrhage, the corresponding ratings were 67, 17 and 17%, and for 16 patients with gastrointestinal bleeding they were 69, 12 and 19%, respectively. There were nine deaths (14%) by 30 days, and five (8%) major thromboembolic events. In a post hoc analysis, according to International Society on Thrombosis and Haemostasis criteria, reversal was effective in 68% and ineffective in 32%. For major bleeding associated with oral Xa inhibitors, PCC may have a beneficial effect. The risk of thromboembolism after reversal of anticoagulation in patients with a prothrombotic background has to be taken into account.
DARR: A Free-text Analysis System for the Automatic Documentation of Radiological Reports
Authors: Vaccari E. , Delaney W. , Chiesa A.
Published: March 2018

A software system for the automatic free-text analysis and retrieval of radiological reports is presented. Such software involves: (1) automatic translation of the specific natural language in a formalized metalanguage in order to transform the radiological report in a »normalized report« analyzable by computer; (2) content processing of the normalized report to select desired information. The approach used to accomplish point (1) is described in detail referring to a specific application.
Postoperative Verlaufskontrollen des carcinoembryonalen Antigens — Elektronische Datenverarbeitung bei der Überwachung von Patienten mit Adenokarzinomen des Gastrointestinaltraktes
Authors: Wehrle E.
Published: March 2018

Es wird ein Computerprogramm in der Sprache >SIMULA< vorgestellt, das zur laufenden Überwachung der Werte des carcinoembryonalen Antigens (CEA) in Seren von Patienten mit Adenokarzinomen des Gastrointestinaltrakts entwickelt wurde. Das Programm zeichnet individuelle Diagramme mit CEA-Verlaufskurven, die Prognosen hinsichtlich Metastasierung und Rezidivierung erlauben. Ferner erstellt das Programm Patientenstatistiken, Spezifikationslisten sowie individuelle Krankenblätter mid übernimmt die briefliche Einbestellung von Patienten zu Routineuntersuchungen im 2-Monatsabstand bzw. bei rasch steigendem CEA-Wert die sofortige Wiedereinbestellung. Das Programm erlaubt die Überwachung einer großen Zahl von Patienten und eignet sich auch für andere Überwachungsaufgaben mit einem oder mehreren Meßparametern.
Index for Rating Predictive Accuracy of Screening Tests
Authors: Choi B. C. K.
Published: March 2018

This paper proposes a new pair of indices, the »predictive powers«, for measuring the predictive accuracy (predictivity) of screening tests.

Sensitivity and specificity are indices for measuring the validity of a test. They give the probability of a certain test result given a substance of known condition (a carcinogen or a non-carcinogen). They do not describe the predictive accuracy of a test, which is the probability of a certain condition (a carcinogen or a non-carcinogen) given a known test result. Predictive values are unsuitable measures for characterizing a test since they are seriously affected by the prevalence of carcinogens. However, the predictive powers do not have this limitation and are shown to be useful indices for the purpose of rating the predictive accuracies of various screening tests.
Intracranial Hemorrhage and Early Mortality in Patients Receiving Extracorporeal Membrane Oxygenation for Severe Respiratory Failure
Authors: Arachchillage Deepa , Passariello Maurizio , Laffan Michael , Aw TC , Owen Leah , Banya Winston , Trimlett Richard , Morgan Cliff , Patel Brijesh , Pepper John , Ledot Stephane
Published: March 2018

Intracranial hemorrhage (ICH) is a serious complication in patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO) and is associated with high mortality. It is unknown whether ICH may be a consequence of the ECMO or of an underlying disease. The authors first aimed to assess the incidence of ICH at initiation and during the course of VV-ECMO and its associated mortality. The second aim was to identify clinical and laboratory measures that could predict the development of ICH in severe respiratory failure. Data were collected from a total number of 165 patients receiving VV-ECMO from January, 2012 to December, 2016 in a single tertiary center and treated according to a single protocol. Only patients who had a brain computed tomography within 24 hours of initiation of ECMO (n = 149) were included for analysis. The prevalence and incidence of ICH at initiation and during the course of VV-ECMO (at median 9 days) were 10.7% (16/149) and 5.2% (7/133), respectively. Thrombocytopenia and reduced creatinine clearance (CrCL) were independently associated with increased risk of ICH on admission; odds ratio (95% confidence interval): 22.6 (2.6–99.5), and 10.8 (5.6–16.2). Only 30-day (not 180-day) mortality was significantly higher in patients with ICH on admission versus those without (37.5% [6/16] vs 16.4% [22/133]; p = 0.03 and 43.7% [7/16] vs 26.3% [35/133]; p = 0.15, respectively). Reduced CrCL and thrombocytopenia were associated with ICH at initiation of VV-ECMO. The higher incidence of ICH at initiation suggests it is more closely related to the severity of the underlying lung injury than to the VV-ECMO itself. ICH at VV-ECMO initiation was associated with early mortality.