bluuebunny/crossref_metadata_2025 huggingface dataset:
Order Creation and Communication in Healthcare
Authors: Lavelle M. B. , Ash J. S. , Gorman P. N.
Published: March 2018

Objectives: The aim of this paper is to examine the adequacy of the concept of Physician Order Entry (POE) as a model for clinical systems, and to suggest an alternative understanding of the order creation and communication process.

Methods: The study is based on an interpretative analysis of POE as a model for clinical systems and the results of our recent fieldwork.

Results: Observations from our recent fieldwork suggest that orders, like patient care in general, emerge from interactions among patients, physicians, nurses, family members, and others, employing a variety of technologies and information resources in the process. Orders as we have observed them originate, are negotiated, and are carried out in a dynamically evolving group with fluctuating membership and shifting role responsibilities. Furthermore, orders by themselves represent only a partial picture of what is done for the patient.

Conclusion: We argue that information systems are more likely to be helpful if they accommodate and facilitate POE as a multidisciplinary collaboration effort and fit better into the larger system of patient care.
Utility of the Charlson Comorbidity Index Computed from Routinely Collected Hospital Discharge Diagnosis Codes
Authors: Lim L. L.-Y. , O’Connell R. L.
Published: March 2018

This study aims to determine whether the Charlson comorbidity index computed from ICD-9-CM discharge diagnosis codes adds additional information to a model containing adjustment for more informed patient details (e.g., disease severity and history), besides solely age and sex, when predicting long-term survival. We conducted a retrospective cohort study of patients admitted to hospital for suspected acute myocardial infarction. Index scores were calculated by applying the D’Hoore et al. algorithm (1993). The index significantly improved the model fit (likelihood ratio test: p <0.001). The D’Hoore-adapted Charlson index is a useful comorbidity risk adjustment tool when applied to AMI and angina patients.
Statistical Support for Uncertainty in Radiological Diagnosis
Authors: Teather B. A. , Jeffery N. P. , du Boulay G. H. , du Boulay B. , Sharples M. , Teather D.
Published: March 2018

Radiological interpretation and diagnosis involves the comparison and classification of complex medical images and is typical of the categorisation tasks that have been the subject of observational studies in Cognitive Science. This paper considers the affinity between statistical modelling and theories of categorisation for naturally occurring categories. Statistical based measures of similarity and typicality with a probabilistic interpretation are derived. The utilisation of these measures in the support of diagnosis under uncertainty via interactive overview plots is described. The application of the methodology to magnetic resonance imaging of the head is considered. The methods detailed have application to other fields involving archiving and retrieving of image data.
Quantitative Blood Velocity Mapping in Glomerular Capillaries by in vivo Observation with an Intravital Videomicroscope
Authors: Takehara K. , Yamamoto T. , Hashimoto R. , Nakamoto H. , Kajiya F. , Ogasawara Y.
Published: March 2018

We have evaluated rat glomerular microcirculation under in-vivo condition with an intravital videomicroscope. To measure erythrocyte velocities, a line segment was set along the glomerular capillaries in time-sequential videotaped images and then a spatiotemporal image was constructed along that segment. The angle of striped pattern in the spatio-temporal image which reflects the erythrocyte velocity, was estimated to compute erythrocyte velocity vector mapping. We found that erythrocyte velocities in rat glomeruli were significantly faster in diabetic rats than in control rats (p <0.05). In conclusion, we have succeeded in quantitatively evaluating the in-vivo renal microcirculation with our videomicroscope system and by spatiotemporal image analyzing method.
Spatial Filtering Methods for Local Activation Determination in Fractionated Electrograms from Simulated Infarcted Hearts
Authors: Maglaveras N. , de Bakker J. , van Capelle F. J. L. , Pappas C. , Chouvarda I.
Published: March 2018

The purpose of this work is the enhancement of local activation in multiphasic extracellular recordings coming from infarcted myocardial tissue and, consequently, the distinction of local from distal activation. Deconvolution procedures are applied, in the form of spatial filtering, in order to estimate transmembrane currents from the extracellular recordings. Simulated data are used in order to test the methods. The current source estimates are compared to the actual transmembrane currents and to Laplacian estimates.
A Network Inversion Technique for Estimating Equivalent Dipole Description of Visual Evoked Potential
Authors: Kosugi Y. , He B. , Hayashi Y.
Published: March 2018

For the activation study of the brain, dipole localization from the scalp potential is one of the most promising techniques to realize a reasonable temporal resolution which cannot be realized in functional MR and PET. The goal of our study is to estimate inversely the electrical brain activity in the form of several dipoles from the scalp potential, using a network inversion technique. As a basic approach, we have inversely estimated several dipoles from the potential distribution on a spherical surface, in the homogeneous sphere model.

In the training phase, by expanding the neural network input dimensions being redundant, the network can easily learn the forward mapping. In the inversion phase, the space of the expanded-network-input-vector can be narrowed by introducing a penalty term. Additionally, a consensus term was used to force several dipoles to have a similar orientation. We estimate that this is applicable to the localization of several dipoles that reflect the actual brain activity, especially in the visual evoked potentials.
Systems Analysis in Health Care: Framework and Example
Authors: Ehlers F. , Eichstädter R. , Haux R. , Pohl U. , Resch F. , Ammenwerth E.
Published: March 2018

Objectives:
Due to the high complexity of structures and processes in health care, thorough systems analyses in health care run the risk of becoming very complex and difficult to handle. Therefore, we aimed to support systematic systems analysis in health care by developing a comprehensive framework that presents and describes potential areas of analysis.

Methods:
A framework for systems analysis in health care was developed and applied in a health care setting. To provide a clear structure, the framework describes the potential views and levels of systems analyses in a health care environment.

Results:
The framework comprises five views (roles and responsibilities, information processing and tools, communication, business processes, teams structure and cooperation) and five levels of analysis (overall organization, organizational unit, staff member, role, task). The framework was successfully applied in an analysis of the structures and processes of the Department of Child and Adolescent Psychiatry of the University Medical Center Heidelberg.

Conclusions:
The proposed comprehensive framework aims to structure the views and levels of systems analysis in the complex health care environment. Our first experiences support the usefulness of such a framework.
Lifestyle Change Improves Individual Health and Lowers Healthcare Costs
Authors: Koyama W.
Published: March 2018

In 1996 the Japanese Ministry of Health and Welfare discontinued the use of the term “Adult onset diseases” used for almost 40 years, and replaced it by “Lifestyle-related diseases”; a meaningful change.

Lifestyle is one of the greatest problems facing Japan today. Considering the rapid aging of Japanese society and the continuing increase in medical costs, it is important for all citizens to be concerned not only about their own health but also about the impact on the financial health of the nation as a whole.

Our data indicate that the greatest determining factor for increased health-care costs is the percentage of patients hospitalized, and the variable with the greatest influence on this is the relative number of hospital beds available. On the other hand, the variable with the greatest inhibitory effect on the growth of healthcare costs is the availability of guidance to improve lifestyle factors.
Primary Care-based Evaluation of Patient Education for Osteoarthritis of the Knee
Authors: Triggs E. , Ross F. , Axford J. , Victor C.
Published: March 2018

Primary healthcare research in the UK has expanded in conjunction with the wider agenda of a primary care led National Health Service (NHS). This reflects international reconsideration of the place of primary healthcare within national healthcare systems. However the role and standing of research in primary care tends to be marginal and less influential than that originating in research establishments or medical schools pursuing biomedical investigations. There are many reasons for this, some of which this paper attempts to elucidate. We address the perspectives and relationships between ‘stakeholder’ groups in the field of primary care and highlight the ways in which such relationships affect research in this area. The development of a primary care research project concerned with osteo-arthritis of the knee (the OAK project) is used as an exemplar of these stresses and we suggest ways in which the difficulties encountered may be overcome.
Significance of Brain Natriuretic Peptide Measurement as a Diagnostic Indicator of Cardiac Function
Authors: Iida N. , Ishihara T. , Waku S.
Published: March 2018

Brain natriuretic peptide (BNP) is increased in patients with heart failure due to myocardial infarction and cardiac hypertrophy, in proportion to the severity of left ventricular dysfunction. The aims of this study were to clarify the clinical features of BNP and to determine the diagnostic value of BNP for mass screening.

The subjects were 818 office workers (565 males and 253 females; mean age 47 ± 12 years) who participated in a 1996 routine health check at Kansai University All individuals were examined for blood pressure, serological findings, ECG and plasma BNP level. Thirty-three males underwent 2-D echocardiography. Plasma BNP levels were measured using IRMA (immunoradiometric assay).

The results were as follows: (1) BNP levels in females were higher than those in males for healthy subjects (N = 551), in each age group from 20 to 60 years. (2) BNP levels increased with age. (3) There were significant correlations between BNP level and systolic blood pressure and creatinine level. (4) There were significant differences in BNP level between the hypertensive groups with and without hypertensive ECG changes and the age-matched healthy control group. (5) Marked correlations were observed between BNP level and left ventricular wall thickness, fractional shortening, deceleration time and peak early filling velocity. (6) A BNP cut-off-point of 25 pg/ml was best for detecting LV diastolic dysfunction and LV hypertrophy. Measurement of BNP is useful for detecting asymptomatic heart failure in the general population, and is a clinical marker useful in preventing symptomatic heart failure.
Risk Factors for Ischemic Heart Disease in an Urban Area of Japan: A Case-Control Study in AMHTS
Authors: Ohno H. , Tamura M. , Kawakubo K. , Gunji A. , Kashihara H.
Published: March 2018

Objectives: In Japan controversy exists as to whether or not the risk factors for ischemic heart disease (IHD) are the same as in western countries. We conducted a case-control study on IHD to clarify the risk factors in males in an urban area of Japan using our automated multiphasic health testing and services (AMHTS) system. Method: Cases were the clients who took the health check-up between January 1987 and July 1994 and had onset of IHD after the check-up. For each case five clients were selected as controls by conditional matching. The check-up data were compared between cases and controls 11 years, 6 years and just before the onset of the heart diseases. Results: The statistically significant items were as follows: (1) Eleven years before the onset: Total cholesterol (T-Chol) for myocardial infarction (MI), and fasting blood sugar (FBS) for angina pectoris (AP). (2) Six years before the onset: T-Chol, electrocardiographic (ECG) findings and the complaint of palpitation or breathlessness for MI, and FBS and palpitation or breathlessness for AP. (3) Just before the onset: T-Chol, the complaint of chest pain, FBS, smoking index and hypertensive status for MI and palpitation or breathlessness, ECG findings, chest pain, systolic blood pressure and erythrocyte sedimentation rate at 60 minutes for AP. In conclusion, the risk factors for MI in males in an urban area of Japan are the same as in western countries. The most significant risk factor for AP in males in an urban area of Japan is fasting blood sugar.
Applications of Virtual Environments in Medicine
Authors: Riva G.
Published: March 2018

Objectives:
This paper intends to investigate the role of virtual reality (VR) in medicine. In particular it outlines the current state of research and technology that is relevant to the development of effective virtual environments in medicine.

Methods:
After describing the two different visions of VR we can find in medicine – the presentation of virtual objects to all of the human senses in a way identical to their natural counterpart, and a new human-computer interaction paradigm in which users are active participants within a computer-generated three-dimensional virtual world – the paper presents some of the most interesting applications actually developed in the area. Finally, it discusses the clinical principles, technological devices and safety issues associated with the use of VR in medicine.

Results:
With more than 1,000 VR papers already indexed in Medline, VR is a reality health care. Even if the number of controlled studies is still limited, its merging with emerging technologies like Ambient Intelligence and wireless communication will further improve its diffusion.

Conclusions:
The possible impact of VR on health care could be even higher than the one offered by the new communication technologies like Internet. In fact, VR is at the same tima technology, a communication interface and an experience: a communication interface based on interactive 3D visualization, able to collect and integrate in single real-like experience different inputs and data sets. However, significant efforts are still required to move VR into commercial success and therefore routine clinical use.
Comparison of Fuzzy Inference, Logistic Regression, and Classification Trees (CART)
Authors: Nagata T. , Mattern D. , Schmelzeisen R. , Schumacher M. , Schwarzer G.
Published: March 2018

Objectives:
In this paper three statistical methods [logistic regression, classification and regression tree (CART), and fuzzy inference] for the prediction of lymph node metastasis in carcinoma of the tongue are compared.
Methods:
A retrospective collection of data in 75 patients treated for tongue cancer was carried out at the Clinic and Policlinic for Oral and Maxillo-facial Surgery at the University Hospital of Freiburg in Germany between January 1990 and December 1999; biopsy material was used for laboratory evaluations. Statistical methods for the prediction of lymph node metastasis were compared using ROC curves and accuracy rates.
Results:
All three methods show similar results for the prediction of lymph node metastasis with slightly superior results for fuzzy inference and CART. A great overlap is apparent in the ROC curves. The best result observed for fuzzy inference and CART was a sensitivity of 79.2% [95% confidence interval: (57.8%; 92.9%)] and a specificity of 86.3% (73.7%; 94.3%); the best result for predictions based on the logistic regression was a sensitivity of 66.7% (44.7%; 84.4%) and a specificity of 80.4% (66.9%; 90.2%). Accuracy rates of fuzzy method and CART were higher [accuracy rate for fuzzy method and CART: 84% (73.7%; 91.4%), for logistic regression method: 73.3%, 95%-CI: (61.9%; 82.9%)].
Conclusions:
From a clinical point of view, the predictive ability of the three methods is not sufficiently large to justify use of these methods in daily practice. Other factors probably on the molecular level are needed for the prediction of lymph node metastasis.
An Inventory of Publications on Electronic Patient Records
Authors: van der Lei J. , Moorman P. W.
Published: March 2018

This study describes an analysis of 1832 papers dealing with electronic patient records, and indexed in NLM’s MEDLINE. Of each retrieved publication the country of origin and the journal in which it was published was determined. Furthermore, insight into the subjects of the publication was obtained by analysing the MeSH terms by which it was indexed. Since 1990 the number of publications on electronic patient records has increased. Publications originated from 43 different countries representing all continents. However, 75% stemmed from only 4 countries. The publications appeared in 379 different journals, of which 26 journals had 10 or more publications. Of all publications, 5.3% had appeared in journals with an impact factor of at least 4.5. The topics most often dealt with were: Hospital Information Systems, Computer Communication Networks, User-Computer Interface, Confidentiality and Computer Security. No obvious trends, other than an increased interest in confidentiality and computer security, were observed.
Health Informatics and Community Health: Support for Patients as Collaborators in Care
Authors: Brennan P. F.
Published: March 2018

Health informatics has much to offer community health care. Computer networks and telecommunications provide particular support that can enhance the collaboration among clinicians, care providers and patients. Special-purpose computer tools referred to as Consumer Health Informatics (CHI) represent the application of computer and information technologies specifically to support the health information and communication needs of patients and lay persons. Research projects like ComputerLink and CHESS demonstrate that CHI is acceptable to patients and promotes self-care and disease management. Three grand challenges must be faced to insure realization of the promise of health informatics to community health care: development of knowledge management and information discovery tools for patients, insurance of health information literacy for all persons, and re-engineering clinical practice to capitalize on patients as full partners in health care.
Clinical Judgment Revisited
Authors: Weed L. L.
Published: March 2018

It is widely recognised that accessing and processing medical information in libraries and patient records is a burden beyond the capacities of the physician’s unaided mind in the conditions of medical practice. Physicians are quite capable of tremendous intellectual feats but cannot possibly do it all. The way ahead requires the development of a framework in which the brilliant pieces of understanding are routinely assembled into a working unit of social machinery that is coherent and as error free as possible – a challenge in which we ourselves are among the working parts to be organized and brought under control.

Such a framework of intellectual rigor and discipline in the practice of medicine can only be achieved if knowledge is embedded in tools; the system requiring the routine use of those tools in all decision making by both providers and patients.
Effective Multidisciplinary Communication in Healthcare: Cooperative Documentation Systems
Authors: Wastell D. G. , Schoop M.
Published: March 2018

To support multidisciplinary communication and cooperation in healthcare, cooperative documentation systems (CDSs) have been developed. However, in the current generation of systems, communication problems that can pose a serious threat to smooth and effective cooperation have occurred and remain to be addressed. This paper presents a set of features that need to be considered in the design of a new generation of CDSs to avoid breakdowns in communication and cooperation. Our approach is solidly grounded in linguistic and social theories and based on empirical investigations of communication patterns in multidisciplinary healthcare. It is argued that this work provides a theoretically rigorous approach to the design of CDSs that will enable effective multidisciplinary communication and cooperation in healthcare.
Theoretical Considerations on the Health Checkup Accuracy of Combination Testing
Authors: Shibata S.
Published: March 2018

Objectives:
To find basic theoretical evidence for an optimum combination of multi-phasic health checkup testing obtained by considering how the health checkup accuracy changes with the number of tests (n) and kinds of combination methods (A, B, C, D and E).

Methods:
To find how the health checkup accuracy changes with the number of tests and type of combination method, generalized formulas as functions of the number of tests, are obtained to calculate the over-all health checkup accuracy which is defined by sensitivity ( ), specificity ( ) and odds-ratio ( ), based on the two-by-two table. Five kinds of combination methods were considered: A) Sequential tests. B) Sequential tests after changing the order in A. C) Simultaneous tests using the Believe-the-Negative Rule. D) Simultaneous tests using the Believe-the-Positive Rule. E) Simultaneous tests using the Believe-all-Positive-all-Negative Rule.

Results:
It was provend that combination methods A, B and C are “equivalent” for health checkup accuracy. Therefore, the five methods could be summarized into three patterns. For A, B and C:andincreased but a decreased with increasing n. For D:increased butanddecreased with n. For E:,andincreased with n.

Conclusion:
Health checkup accuracy of combination testing is the best in case of E, although problems exist concerning how to judge the borderline subjects.
Guidelines, the Internet, and Personal Health
Authors: Moehr J. R.
Published: March 2018

Objectives:
To summarize the insights gained in collaborative research in a Canadian Network of Centres of Excellence, devoted to the promotion of evidence-based practice, and to relate this experience to Internet support of health promotion and consumer health informatics.

Methods:
A subjective review of insights is undertaken.

Results:
Work directed the development of systems incorporating guidelines, care maps, etc., for use by professionals met with limited acceptance. Evidence-based tools for health care consumers are a desirable complement but require radically different content and delivery modes. In addition to evidence-based material offered by professionals, a wide array of Internet-based products and services provided by consumers for consumers emerged and proved a beneficial complement.

Conclusion:
The consumer-driven products and services provided via the Internet are a potentially important and beneficial complement of traditional health services. They affect the health consumer-provider roles and require changes in healthcare practices.
Simulation of Hip Operations and Design of Custom-made Endoprostheses using Virtual Reality Techniques
Authors: Ehrhardt J. , Plötz W. , Pöppl S. J. , Handels H.
Published: March 2018

In this paper a system for the virtual planning of hip operations with endoprosthetic reconstruction and its application in bone tumor surgery is described. The system enables the simulation of the operation and the construction of a custom-made implant depending on the chosen resection planes and the patient’s anatomy. During the planning process integrated virtual reality techniques facilitate the interaction with the three-dimensional (3D) medical objects. Stereo viewing improves the perception of the 3D nature of bone structures and tumors. In comparison to conventional planning procedures, different operation strategies and their influence on the geometry of the custom-made endoprosthesis can be easily compared. Furthermore, the combination of multi-modal image information (CT and MR) enables an accurate 3D visualization of the bone tumor within the bone.
Information Processing in Healthcare at the Start of the third Millennium: Potential and Limitations
Authors: Haux R. , Knaup P. , Bauer A. W. , Herzog W. , Reinhardt E. , Überla K. , van Eimeren W. , Wahlster W.
Published: March 2018

The 21st century is said to be a century of the information society. We should be aware that continuing progress in information processing methodology (IPM) and information and communication technology (ICT) is changing our societies, including medicine and health care. At the start of the third Millennium we should ask ourselves, what progress can we expect from modern IPM/ICT for healthcare in the coming decade, what concerns does the information society have to face, and what steps have to be taken. These questions were addressed by clinicians, researchers and industrial representatives in a panel discussion at the joint conference ISCB-GMDS-99 of the International Society of Clinical Biostatistics and the German Society for Medical Informatics, Biometry and Epidemiology. Important aspects raised by the panelists and in the subsequent discussion were: (1) the main goal of expanding IPM/ICT should be to further improve quality of care, while maintaining reasonable costs; (2) with the support of modern IPM and ICT the boundaries between inpatient and outpatient care will fade away enabling a more efficient, patient-centered health care; (3) cooperation between health-care professionals will increase; there will be different ways of communication between them and with the patient, including modern ICT and the Internet; (4) society must be concerned with achieving equal opportunities in being informed about and in using new ICT; (5) misuse of data will remain a serious problem and can become an obstacle to progress.
On the Necessity of Systematically Planning Clinical Tumor Documentation
Authors: Harkener S. , Ellsässer K.-H. , Haux R. , Wiedemann T. , Knaup P.
Published: March 2018

Tumor documentation is an important task for both clinical research and patient care. Documentation systems for these purposes have to be planned systematically and should be goal oriented. We applied the method of a so-called ‘standardized documentation protocol’ for systematically planning two documentation systems in oncology: one for the tumor center Heidelberg/Mannheim and the other for a nationwide project in the field of documentation and therapy planning in pediatric oncology. The method proved to be helpful in both cases even though the resulting documentation protocols are completely different and although they served different objectives. Therefore, the aim of the paper is to motivate and help medical informatics professionals to systematically plan other documentation systems using this method.
An Integrated Approach for a Knowledge-based Clinical Workstation: Architecture and Experience
Authors: Ringleb P. , Steiner T. , Knaup P. , Hacke W. , Haux R. , Brigl B.
Published: March 2018

Today, the demand for medical decision support to improve the quality of patient care and to reduce costs in health services is generally recognized. Nevertheless, decision support is not yet established in daily routine within hospital information systems which often show a heterogeneous architecture but offer possibilities of interoperability. Currently, the integration of decision support functions into clinical workstations is the most promising way. Therefore, we first discuss aspects of integrating decision support into clinical workstations including clinical needs, integration of database and knowledge base, knowledge sharing and reuse and the role of standardized terminology. In addition, we draw up functional requirements to support the physician dealing with patient care, medical research and administrative tasks. As a consequence, we propose a general architecture of an integrated knowledge-based clinical workstation. Based on an example application we discuss our experiences concerning clinical applicability and relevance. We show that, although our approach promotes the integration of decision support into hospital information systems, the success of decision support depends above all on an adequate transformation of clinical needs.
Extracting Findings from Narrative Reports: Software Transferability and Sources of Physician Disagreement
Authors: Kuperman G.J. , Friedman C. , Hripcsak G.
Published: March 2018

While natural language processing systems are beginning to see clinical use, it remains unclear whether they can be disseminated effectively through the health care community. MedLEE, a general-purpose natural language processor developed for Columbia-Presbyterian Medical Center, was compared to physicians' ability to detect seven clinical conditions in 200 Brigham and Women's Hospital chest radiograph reports. Using the system on the new institution's reports resulted in a small but measurable drop in performance (it was distinguishable from physicians at p = 0.011). By making adjustments to the interpretation of the processor's coded output (without changing the processor itself), local behavior was better accommodated, and performance improved so that it was indistinguishable from the physicians. Pairs of physicians disagreed on at least one condition for 22% of reports; the source of disagreement appeared to be interpretation of findings, gauging likelihood and degree of disease, and coding errors.
Indicators for the Automated Analysis of Drug Prescribing Quality
Authors: Séné B. , Milstein C. , Bouée S. , Venot A. , Coste J.
Published: March 2018

Irrational and inconsistent drug prescription has considerable impact on morbidity, mortality, health service utilization, and community burden. However, few studies have addressed the methodology of processing the information contained in these drug orders used to study the quality of drug prescriptions and prescriber behavior. We present a comprehensive set of quantitative indicators for the quality of drug prescriptions which can be derived from a drug order. These indicators were constructed using explicit a priori criteria which were previously validated on the basis of scientific data. Automatic computation is straightforward, using a relational database system, such that large sets of prescriptions can be processed with minimal human effort. We illustrate the feasibility and value of this approach by using a large set of 23,000 prescriptions for several diseases, selected from a nationally representative prescriptions database. Our study may result in direct and wide applications in the epidemiology of medical practice and in quality control procedures.
Towards the Unification of Inference Structures in Medical Diagnostic Tasks
Authors: Rives J. , Delgado A. E. , Martínez R. , Mira J.
Published: March 2018

The central purpose of artificial intelligence applied to medicine is to develop models for diagnosis and therapy planning at the knowledge level, in the Newell sense, and software environments to facilitate the reduction of these models to the symbol level. The usual methodology (KADS, CommonKADS, GAMES, HELIOS, Protégé, etc.) has been to develop libraries of generic tasks and resuable problem-solving methods with explicit ontologies. The principal problem which clinicians have with these methodological developments concerns the diversity and complexity of new terms whose meaning is not sufficiently clear, precise, unambiguous and consensual for them to be accessible in the daily clinical environment. As a contribution to the solution of this problem, we develop in this article the conjecture that one inference structure is enough to describe the set of analysis tasks associated with medical diagnoses. To this end, we first propose a modification of the systematic diagnostic inference scheme to obtain an analysis generic task and then compare it with the monitoring and the heuristic classification task inference schemes using as comparison criteria the compatibility of domain roles (data structures), the similarity in the inferences, and the commonality in the set of assumptions which underlie the functionally equivalent models. The equivalences proposed are illustrated with several examples. Note that though our ongoing work aims to simplify the methodology and to increase the precision of the terms used, the proposal presented here should be viewed more in the nature of a conjecture.
Conceptual Analysis for Knowledge-Base Design
Authors: Sowa J. F.
Published: March 2018

Knowledge-base design requires a thorough analysis of the concepts to be represented. If the analysis is incomplete or inaccurate, the resulting knowledge base may contain arbitrary restrictions, inconsistent data, or limitations that make future extensions impossible. Conceptual analysis is even more critical for sharing knowledge bases between heterogeneous systems. Analyses that are adequate for independent systems may cause incompatibilities when the systems share data. This paper discusses the kinds of problems that require a careful conceptual analysis and the difficulties caused by an incorrect or incomplete analysis. It also shows how independently developed knowledge bases can be related to one another by reanalyzing and redefining the basic concepts and relations. Such analysis is essential for sharing knowledge between systems developed for different purposes, such as relational and object-oriented databases or expert systems and natural language processors.
Development of a Controlled Medical Terminology: Knowledge Acquisition and Knowledge Representation
Authors: Musen M. A. , Wieckert K. E. , Miller E. T. , Campbell K. E. , Fagan L. M.
Published: March 2018

The creation of controlled medical terminologies is a central challenge in the development of electronic patient records. In the T-HELPER patient-record system, designed for the care of patients with HIV diease, the IVORY module allows health-care workers to compose textual progress notes by making selections from menus generated automatically from a controlled medical terminology. Construction of this IVORY terminology required extensive design sessions with a team of computer scientists and an expert physician. Refinement of the terminology was only possible when the design team could envision how the completed T-HELPER system would be used in the context of clinical practice. Development of controlled medical terminologies is a significant problem in knowledge acquisition. Techniques used to acquire and represent clinical concepts for the purpose of building decision-support systems also are appropriate for the construction of controlled terminologies such as the one in T-HELPER.
Navigating to Knowledge
Authors: Tuttle M. S. , Cole W. G. , Sherertz D. D. , Nelson S. J.
Published: March 2018

One way to fulfill point-of-care knowledge needs is to present caregivers with a visual representation of the available “answers”. Using such a representation, caregivers can recognize what they want, rather than have to recall what they need, and then navigate to an appropriate answer. Given selected pieces of information from a computer-based patient record, an interface can anticipate certain knowledge needs by initializing caregiver navigation in a semantic neighborhood of answers likely to be relevant to the patient at hand. These notions draw heavily on two collaborative projects – the U.S. National Library of Medicine Unified Medical Language System® and the U.S. National Cancer Institute Knowledge Server. Both of these projects support navigation because they make the structure of medical knowledge explicit in a way that can be exploited by human interfaces.
A Real Time Control Architecture for Continuously Managing Patients in a Care Unit
Authors: Seroussi B. , Boisvieux J. F. , Morice V.
Published: March 2018

The monitoring and treatment of patients in a care unit is a complex task in which even the most experienced clinicians can make errors. A hemato-oncology department in which patients undergo chemotherapy asked for a computerized system able to provide intelligent and continuous support in this task. One issue in building such a system is the definition of a control architecture able to manage, in real time, a treatment plan containing prescriptions and protocols in which temporal constraints are expressed in various ways, that is, which supervises the treatment, including controlling the timely execution of prescriptions and suggesting modifications to the plan according to the patient’s evolving condition. The system to solve these issues, called SEPIA, has to manage the dynamic, processes involved in patient care. Its role is to generate, in real time, commands for the patient’s care (execution of tests, administration of drugs) from a plan, and to monitor the patient’s state so that it may propose actions updating the plan. The necessity of an explicit time representation is shown. We propose using a linear time structure towards the past, with precise and absolute dates, open towards the future, and with imprecise and relative dates. Temporal relative scales are introduced to facilitate knowledge representation and access.
The Road to Professionalism in Medical Informatics: A Proposal for Debate
Authors: Wyatt J. , Heathfield H. A.
Published: March 2018

Medical Informatics has not as yet reached professional status. However, as an expanding and increasingly important discipline in the delivery of healthcare, it is important that it strives towards professionalisation. In this article we consider the nature of professionalism, its potential benefits and associated costs. We examine the potential for Medical Informatics to become a professional discipline and how far it has succeeded in this to date, describing three possible scenarios for the future of the discipline. We suggest steps towards the professionalisation of Medical Informatics and the roles of key players, including academia, system developers, purchasers and users, and professional societies. We also put forward some possible criteria for a Medical Informatics Professional. Finally, we make some general observations concerning the way forward.
Affective State and Voice: The Specific Properties of Overtone Distributions
Authors: Stassen H. H.
Published: March 2018

Motivated by psychiatric interests and as part of our investigations into the basic properties of human speech, we carried out a normative study with 192 healthy subjects - stratified according to sex, age and education - in order to derive reference values of the general population and to learn to distinguish between normal fluctuations and significant changes over time. In the present investigation, our interest focused on the individual sound characteristics of speakers (“timbre”) rather than on speech behavior. Accordingly, we determined the optimum parameter setting for a problem-specific, reliable estimation of time dependent spectra. An interval of one second length was found to be optimum for reproducibly assessing formants and corresponding band-widths for more than 95% of the cases. Based on these findings, we adapted the concept of “spectral patterns” to speech analysis. It turned out that spectral voice patterns are stable over time and measure the fine graduations of mutual differences between human voices. A highly reliable computerized recognition of persons was possible by means of these quantities, on the basis of 16-32 s time series: 93% of persons could be uniquely recognized after a 14-day interval. Hence, we succeeded in developing specific means for modelling intra-individual changes of voice timbres over time. This is of particular interest for investigations of the speech characteristics of affectively disturbed patients, since the tonal expressiveness of human voices, or the lack thereof, essentially depends on the actual distribution of overtones and the corresponding variabilities.
Global Schistosomiasis Database: Practical Considerations in the Design of a User-friendly Database
Authors: Mort K. E. , Yoon S. S.
Published: March 2018

A computerized database for monitoring global schistosomiasis data is discussed. The potential target users include schistosomiasis program managers, Ministries of Health of endemic countries, consultants, and WHO Regional Offices. The concept behind the design of the database structure, the user interface and the query interface is addressed along with a brief description of the hardware and software used. The database, holding information on 76 schistosomiasis endemic countries around the world, has been tested in the WHO Regional Offices with positive results.
Problem Area Formation as an Element of Computer Aided Diagnosis: A Comparison of Two Strategies Within Quick Medical Reference (QMR)
Authors: Berman L. , Miller R. A.
Published: March 2018

INTERNIST-I’s use of “partitioning” to group related diagnoses into problem areas (for competitive consideration and elimination during case analysis) is felt to be the source of many of its strengths as well as some of its weaknesses. QMR, INTERNIST-I’s successor program, embodies a homology function which can act as an alternative to the partitioner for problem area formation. This study undertakes a comparison of the problem areas generated by the INTERNIST-I partitioning algorithm, the QMR homology function, and expert clinicians; it finds the correlation to be poor. The authors then discuss another method of problem area formation which might better mimic a human clinician and provide an alternative approach in diagnostic computer-aided decision making.
Robust Trend Analysis in Predicting Histamine Provocation Concentration
Authors: Krusińska E. , Liebhart J. , Woźniak M.
Published: March 2018

Trend analysis is used to predict the histamine provocation concentration PC20 during the so-called challenge test, where increasing doses of the bronchoconstricting agent are given to a patient and the spirometric examination is subsequently performed. Classical least-squares analysis of trends as well as least absolute deviations analysis are compared. The results are interesting and promising from a statistical as well as medical point of view. The methods presented can be applied to many practical problems in medicine.
Structured Reporting of Medical Findings: Evaluation of a System in Gastroenterology
Authors: Gaus W. , Wechsler J. G. , Janowitz P. , Tudyka J. , Kratzer W. , Swobodnik W. , Ditschuneit H. , Kuhn K.
Published: March 2018

A system using structured reporting of findings was developed for the preparation of medical reports and for clinical documentation purposes in upper abdominal sonography, and evaluated in the course of routine use. The evaluation focussed on the following parameters: completeness and correctness of the entered data, the proportion of free text, the validity and objectivity of the documentation, user acceptance, and time required. The completeness in the case of two clinically relevant parameters could be compared with an already existing database containing freely dictated reports. The results confirmed the hypothesis that, for the description of results of a technical examination, structured data reporting is a viable alternative to free-text dictation. For the application evaluated, there is even evidence of the superiority of a structured approach. The system can be put to use in related areas of application.
The Role of Genetics in Defining Reference Values and Health Status
Authors: Siest G. , Zaiou M. , Régis A. , Jaid M. , Steinmetz J. , Herbeth B. , Artur Y. , Schiele F. , Gueguen R. , Galteau M. M. , Henny J. , Deschamps J. P. , Visvikis S.
Published: March 2018

Since its establishment, the Center for Preventive Medicine in Vandoeuvre-les-Nancy, France, performed specific studies on healthy humans, and its approach was very useful for defining reference values. Prevention should extend its interest to chronic diseases. The majority of important adult disorders are partially genetically determined. Genetic markers are also useful as exclusion or as partition criteria in the production of reference values. Results are presented that were obtained for apolipoproteins E, B and AIV, frequencies of these polymorphisms in the Lorraine population, and relationships between these polymorphisms and lipid metabolism-related parameters. Health checkup centers, in particular those involved in family screening, are well suited for reassembling many data concerning environmental factors: tobacco consumption, alimentation habits, or alcohol and drug consumption. Simultaneous determination of genetic markers could allow the determination of an individual’s susceptibility or resistance to developing a disease and to prepare a preventive action.
AR (q, v) Modeling of Normal Lung Sounds
Authors: Schreur H. J. W. , Vanderschoot J.
Published: March 2018

A model for the dependence of normal lung sounds upon airflow and air volume recorded at the mouth, is proposed and investigated. Data from 8 healthy subjects and 2 sessions have been analysed. Test statistics give very strong support for the adequacy of the model. This opens possibilities for diagnostic application of the model to normal lung sounds. Several suggestions are given for still further improvement of the model.
Interactions between Respiratory, Cardiac and Stepping Rhythms in Decerebrated Cats: Functional Hierarchical Structures of Biological Oscillators
Authors: Kawahara K. , Yamauchi Y. , Niizeki K. , Yoshioka T.
Published: March 2018

Interactions are described of central origin between respiratory, cardiac and stepping rhythms during fictive locomotion in paralyzed, vagotomized, and decerebrated cats. Fictive locomotion was induced by tonic electrical stimulation of the mesencephalic locomotor region (MLR). The coherence between heart beat fluctuation, the efferent discharges of the phrenic, and the lateral gastrocnemius nerves was used to evaluate the strength of the coupling between those three rhythms. The heart beat rhythm was modulated by the centrally generated respiratory and stepping rhythms. The central respiratory rhythm was modulated by the centrally generated stepping rhythm. Based on the present findings, we have proposed a new model concerning the functional hierarchical structures of the three biological oscillators.
Portable Cardiac Mapping Assessment of Acute Ischaemic Injury
Authors: Cullen C. , MacKenzie G. , Adgey A. A. J. , Anderson J. McC. , Dempsey G. J. , Wright G. T. H. , Crawley M. , McAdams E. T. , McLaughlin J.
Published: March 2018

A portable cardiac mapping system is used to improve the accuracy of diagnosis of acute ischaemic injury outside hospital. Patients presenting chest pain suggestive of myocardial infarction (Ml) were mapped by attendant medical personnel operating from a mobile coronary unit. These first Ml maps were compared against average normal maps using QRS and ST-T isointegral values. Discriminant function analysis performed on the parameters achieved a sensitivity of 90% and a specificity of 96%.
Time-Varying Properties of Respiratory Fluctuations in Pupil Diameter of Human Eyes
Authors: Yana K. , Okuyama F. , Tokoro Takashi , Yoshida H.
Published: March 2018

The time varying properties have been investigated of respiratory components in fluctuations of the pupil diameter (PDF) of the human eye. PDF and instantaneous lung volume were simultaneously measured for 45 minutes under natural binocular viewing conditions. The short-term Fourier transform and the autoregressive signal modeling together with the recursive least squares algorithm have been applied for the estimation of nonstationary power spectra. Data analysis showed a bursting type non-sta-tionarity in the appearance of the respiratory component in PDF.