bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Implementation of the Home Asthma Telemonitoring (HAT) System to Facilitate Asthma Self-Care
Authors: Finkelstein J.  , O'connor G.  , Friedman R.H.
Published: February 2025

National Asthma Education and Prevention Program (NAEPP) suggests using asthma action plans for patient self-care. Recent studies reported that many asthma patients had difficulties in following action plans on a daily basis and had low compliance to medication regimens. The goal of our study was to design and evaluate the Home Asthma Telemonitoring (HAT) system aimed to help asthma patients to follow their self-care plans according to the NAEPP recommendations. Our study resulted in the development of the system which provided patients with continuous individualized help in the daily routine of asthma self-care and notified heath care providers if certain clinical conditions occurred. This allowed early recognition of potentially dangerous situations and timely intervention. The evaluation of the HAT system underwent several stages. First we showed, that the HAT system provides reliable reciprocal exchange of all relevant information between a physician and asthma patient in home settings. Further evaluation demonstrated that lung function test results collected during home asthma telemonitoring are comparable to those collected under the supervision of trained professionals, and Internet-based home asthma telemonitoring can be successfully implemented in a group of patients without previous computer experience. Preliminary results of an on-going HAT evaluation showed higher patient compliance to asthma action plans in comparison to the compliance reported for patients in standard care. The clinical impact of HAT on asthma outcomes is being currently evaluated in a randomized clinical trial funded by NIH. HAT has a potential for improving clinical outcomes and quality of life in the studied patient population and may be a model for monitoring and self-management of patients with other chronic health conditions.
TeleMedMail: Free Software to Facilitate Telemedicine in Developing Countries
Authors: Fraser Hamish S.F.  , Jazayeri Darius  , Bannach Lech  , Szolovits Peter  , McGrath St John D
Published: February 2025

Telemedicine offers the potential to alleviate the severe shortage of medical specialists in developing countries. However lack of equipment and poor network connections usually rule out video-conferencing systems. This paper describes a software application to facilitate store-andforward telemedicine by email of images from digital cameras. TeleMedMail is written in Java and allows structured text entry, image processing, image and data compression, and data encryption. The design, implementation, and initial evaluation are described.
Haptic Reproduction and Interactive Visualization of a Beating Heart Based on Cardiac Morphology
Authors: Nakao Megumi  , Komori Masaru  , Oyama Hiroshi  , Matsuda Tetsuya  , Sakaguchi Genichi  , Komeda Masashi  , Takahashi Takashi
Published: February 2025

A goal of this work is proposal and construction of simulation methods of haptic reproduction and interactive visualization of a beating heart in cardiovascular surgical training and education. The data for the beating heart model was obtained from ECG-gated 3D MRI of a normal volunteer. The elastic information was assumed as a uniform value with clinically experienced elasticity. Using a real-time 3D graphics and a haptic device, a simulation environment of the beating heart was designed and implemented. After the construction, some cardiovascular surgeons evaluated the implemented system. Its visualization and haptic expression were scored excellent, but some details in haptic interface were remained to be improved. Finally, for more realistic cardiovascular surgical simulation, future development of the method is discussed.
Quantitative Image Analysis of the Cartilage in Virtual Reality
Authors: Englmeier K.-H.  , Siebert M.  , Stammberger T.  , Eisenhardt-Rothe R. v.  , Graichen H.  , Eckstein F.  , Reiser M.
Published: February 2025

The objective of this work is to develop image processing methods for analysing the morphology of the joint cartilage with magnetic resonance imaging. Quantitative data on the morphological distribution of the joint cartilage are of great interest for both research as well as for diagnosis. The cartilage thickness provides information on the local cartilage occurance and may therefore be helpful in early and objective diagnosing degenerative cartilage changes, monitoring the pathogenesis of osteoarthritis, and controlling the success of chondroprotective treatment. In biomechanics, the thickness distribution serves to analyse the functional adaptation or the compression of the cartilage under loading and may be used for numerical simulation of load transmission in the joint.
Nasal Airflow Diagnosis -Comparison of experimental Studies and Computer simulations
Authors: Müller-Wittig Wolfgang  , Mlynski Gunter  , Weinhold Ivo  , Bockholt Uli  , Voss Gerrit
Published: February 2025

The lack of suited diagnostic tools providing insight into patient specific flow characteristics of the nasal airflow is one of the main problems in functional diagnosis. Diagnostic methods currently used do not provide the necessary information for flow analysis. But the flow distribution is essential for a physiological respiration, in particular for cleaning, moistening and tempering of the inhaled air as well as for the olfactory function of the nose. To overcome this current situation a cooperation project of the ENT surgeons and computer graphic engineers was established to develop the computer assisted planning system STAN (Simulation Tool for Airflow in the human Nose) combining Computer Fluid Dynamics (CFD) with advanced Computer Graphic Technology. The idea of the STAN system is to perform patient specific airflow simulations in the patient's nasal cavities. Therefore a geometrical model of the nasal airways is derived from the patient's tomography scans. A discretization of the surrounded flow volume is made by a computational grid. To establish the flow simulation Finite Element Methods are performed on the grid. A tailored visualization is offered to the surgeon that overlaps the flow pattern to the patient's tomography data shown in the coronal, sagittal and transversal plane. The surgeon can not only analyze the patient's current respiratory situation he has also the possibility to describe the planned surgical intervention. The goal is to simulate the flow distribution that can be expected after the surgical intervention and to offer a possibility to validate various surgical strategies. To verify the simulation results experimental investigations and measurements are made in nasal models. Silicon Models of patient's nose channels are made to analyze- flow characteristics. The CT or MR scans of the same patients are used as input data for the simulation. The experimental outcome is compared to the simulation results to validate this diagnostic approach.
Virtual Image Grafting: Image Based Generation and Visualization of Virtual Skin Defects
Authors: Oppenheimer Peter  , Berkley Jeffrey  , Weghorst Suzanne  , Berg Dan
Published: February 2025

We have developed methods for rapidly generating 3d dermatologic datasets for use in education, training simulations and procedure planning. By compositing local surface features of cutaneous wounds onto patient images and 3d models, one can flexibly generate large patient variability from a small initial 3d library. The wound database is generated from clinically captured photographic images. The wound image is extracted from the image of the surrounding tissue. The 3d anatomy database is generated from MRI scans and from multiple photographic views. Extracted wound images can be moved rotated and scaled and blended in the final composite.
Application of Passive Transverse Forces in the Rehabilitation of Spinal Deformities A Randomized Controlled Study
Authors: Weiβ Hans-Rudolf  , Heckel Irina  , Stephan Carola
Published: February 2025

In our centre, physiotherapy and braces are the main approaches in the management of scoliosis and kyphosis as well. If a surgical intervention is necessary patients are guided to the appropriate centre for spine surgery. In order to avoid surgery, we are looking for possibilities to improve the conservative facilities of spinal deformities management. The aim of our study was to find out whether the use of passive transverse forces (PTF) applied on the deformed body is useful in the rehabilitation process of patients with spinal deformities.
Biology is the Future of Scoliosis Treatment
Authors: Burwell R.G.
Published: February 2025

’Prediction, especially in Medicine, is fraught with peril’ [25]
Comparison of Mechanical Behaviour of Normal and Scoliotic Vertebral Segment: a Preliminary Numerical Approach
Authors: Lafage V.  , Leborgne P.  , Mitulescu A.  , Dubousset J.  , Lavaste F.  , Skalli W.
Published: February 2025

Specific behaviour of the scoliotic spine has already been proven. The aim of this preliminary study is to evaluate if this behaviour is mainly due to geometrical deformities or to mechanical characteristics of soft tissues. We use a kriging technique to obtain a personalized finite element model of scoliotic spine from 3D reconstructions and from an existing detailed model of normal spine. To evaluate if deformed geometry has a share in specific behaviour of scoliotic spine, numerical simulations were performed on an apical segments extracted from normal and scoliotic models and the results were compared. Average mechanical properties of normal spine were considered in both models.
Torsional Deformity of Apical Vertebra in Adolescent Idiopathic Scoliosis
Authors: Kotwicki Tomasz  , Napiontek Marek
Published: February 2025

CT scans of structural thoracic idiopathic scoliosis were reviewed in nine patients admitted to our department for scoliosis surgery. The apical vertebra scans were chosen and the following parameters were evaluated: 1) alpha angle formed by the axis of vertebra and the axis of spinous process 2) beta concave and beta convex angle between the spinous process and the left and right transverse process, respectively, 3) gamma concave and gamma convex angle between the axis of vertebra and the left and right transverse process, respectively, 4) the rotation angle to the sagittal plane. The constant deviation of the spinous process towards the convex side of the curve was observed. The vertebral body itself was distorted towards the concavity of the curve. The angle between the spinous process and the transverse process was smaller on the convex side of the curve. The torsional, intravertebral deformity of the apical vertebra was a factor acting in the direction opposite to the rotation, in the sense to reduce the deformity of the spine in idiopathic scoliosis.
3-D Back Surface Analysis of Severe Idiopathic Scoliosis by Rasterstereography: Comparison of Rasterstereographic and Digitized Radiometric Data
Authors: Hackenberg L.  , Hierholzer E.
Published: February 2025

Rasterstereography has been shown to be a reliable method for three- dimensional surface measurement of idiopathic scoliosis with Cobb angles up to 50°. In this study, 25 patients with severe idiopathic scolioses (Cobb angles 47°-92°) were examined before and after operation (VDS instrumentation). The a.p. radiographs were digitized according to the Drerup method . The similarity of rasterstereographic and radiometric data was quantified by the rms. differences between the rasterstereographic and radiographic curves of lateral deviation and vertebral or surface rotation. The average rms. differences were 5.8 mm for lateral deviation and 4.4° for vertebral and surface rotation, which is about 40% higher than for mild to medium scolioses.
Cardiac digital image loops and multimedia reports over the internet using DICOM
Authors: Balogh N  , Kerkovits G  , Horváth L  , Punys J  , Punys V  , Jurkevicius R  , Eichelberg M  , Riesmeier J  , Jensh P  , Lemoine D
Published: February 2025

The authors define an open, scaleable telemedicine architecture to reduce the time of reports delivery and consultation; increasing their simplicity via introducing common image presentation, storage and telecommunication formats and methods for telecardiology. They’ve developed a software application to implement it introducing the most appropriate digital imaging methods and formats using the latest available technology.
Guideline Based Structured Documentation: The Final Goal?
Authors: Bürkle Thomas  , Ganslandt Thomas  , Tübergen Dirk  , Menzel Josef  , Kucharzik Torsten  , Neumann Klaus  , Schlüter Stefan  , Müller Marcel  , Veltmann Ursula  , Prokosch Hans-Ulrich
Published: February 2025

Structured documentation of medical procedures facilitates information retrieval for research and therapy and may help to improve patient care. Most medical documents until today however consist mainly of unstructured narrative text. Here we present an application for endoscopy which is not only fully integrated into a comprehensive clinical information system, but which also supports various degrees of structuring examination reports. The application is used routinely in a German University hospital since summer 2000. We present the first unstructured version which permits storage of a free text report together with selected examination images. The next step added improved structure to the document using a catalogue of index terms. The practical advantages of selective patient retrieval are described. Today we use a version which supports fully structured, guideline based documentation of endoscopy reports in order to automatically generate essential classification codes and the narrative examination report.
A Problem-Oriented, Knowledge-Based Patient Record System
Authors: Bayegan Elisabeth  , Nytrø Øystein
Published: February 2025

The concept of a problem-oriented patient record was presented in the late 1960s but has yet to gain wide acceptance. In this paper we suggest a distinction between the idea of problem orientation and the implementation of the idea. We argue that the problem-oriented patient record offers an intuitive and useful way to work with patient information. We show that the concept of problem-oriented patient records facilitates better care of patients by supporting continuity of care, removing redundant and confusing information, and enabling easy overview of and access to its content. We further propose a two-layer framework that has knowledge of its content and use and is able to better utilize information in the record by presenting relevant information to the user at a time when needed. Conceptually, this is done by adding a layer of knowledge to the patient record system: 1) Knowledge about physicians' way of thinking and working, 2) Their corresponding information use and need during patient care, and 3) Tools to determine information relevance in a given situation; such a knowledge-based system is able to reason with its content and use.
Developing a virtual patient record as a web-based workflow system
Authors: Malamateniou F.  , Vassilacopoulos G.
Published: February 2025

Virtual patient records provide a means for integrated access to patient information that may be scattered around different healthcare settings. Within the boundaries of a health district providing all levels of care, this concept can be implemented in a corporate Intranet environment to support longitudinal patient care activities across the participating healthcare providers. In this context, a virtual patient record implementation enables autonomous healthcare providers to operate in a cooperative working environment and apply continuity of care. Workflow systems bring this collaboration and cooperation into effect by automatically routing the medical information needed to authorized actors in a healthcare process. This paper presents a virtual patient record framework that allows integrating geographically dispersed medical information within a health district and enhancing collaboration and coordination of authorized workgroups by means of a web- based workflow system. An implementation of the proposed framework is also presented.
Information on Heart Repolarization Changes Obtained from Body Surface ECG Potentials
Authors: Tyšler M.  , Turzová M.  , Szathmáry V.
Published: February 2025

Possibility to obtain information about local changes of heart repolarization from body surface potentials was studied on a model. Activation-recovery intervals (ARI) in surface ECG leads were tested as indicators of changed repolarization in the underlying myocardium. ECG signals corresponding to activation of myocardium with normal and changed action potential duration were simulated on the surface of a realistic inhomogeneous torso. ARI intervals were derived from all ECG signals and displayed as surface ARI maps. Results suggest that shortening and prolongation of action potentials in anterior myocardial regions can be visible in corresponding areas on surface ARI maps while only prolongation in postero-lateral regions can be observed. Reproducibility of ARI maps was checked on real measurements using 63 and 192 surface ECG leads. Obtained ARI maps exhibited acceptable reproducibility with correlation of 0.73 to 0.87. Based on the model and experimental results it is hoped that ARI maps can give some insight into the myocardium repolarization and help to recognize tissue with changed properties, primarily in heart regions underlying the anterior chest.
Are quantitative methods sufficient to show why wards react differently to computer-based nursing documentation?
Authors: Ammenwerth Elske  , Mansmann Ulrich  , Mahler Cornelia  , Kandert Marianne  , Eichstädter Ronald
Published: February 2025

Computer-based documentation of the nursing process is being introduced into hospitals more and more. Frequently, the introduction is followed by an evaluation of positive and negative effects. However, the often-used quantitative evaluation methods cannot fully illuminate the different success factors of computer- based nursing documentation systems.
Relation between the Pelvis and the Sagittal Profile in Adolescent Idiopathic Scoliosis: the Influence of Curve Type
Authors: Charlebois Manon  , Mac-Thiong Jean-Marc  , Huot Marie-Pierre  , de Guise Jacques A.  , Skalli Wafa  , Labelle Hubert
Published: February 2025

Previous studies have shown a correlation between pelvic parameters and the lumbar lordosis in normal subjects and in scoliotic adults. This study investigates the relationship between pelvic and spinal geometries in the sagittal plane for adolescent idiopathic scoliosis (AIS) patients having various curve types. The study group was composed of 129 AIS patients classified according to their curve type: King I, King II, King III or lumbar curve. The SpineView software (Surgiview, France) was used to compute five parameters on sagittal x-rays: thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI). The TK was significantly lower for King I, II and III curves as compared to the lumbar curves. The LL tended to be higher for patients having a major lumbar scoliotic (King I and lumbar) curve, although not significantly. No significant change between the groups was observed for the SS, PT and PI. The PI was significantly correlated to the LL, SS and PT for all groups. The SS was strongly related to the LL in all cases. However, no relationship was found between the TK and the LL in any group. This study showed that the TK mostly depends on the thoracic scoliotic curve and therefore on the shape and orientation of the vertebrae, which explains that many King I, II and III patients are hypokyphotic. Conversely, the LL is mainly influenced by the pelvic configuration. Since the pelvic parameters are similar for all groups, these parameters are not likely to be important in the development of a specific type of scoliotic curve.
Transverse Plane Pelvic Rotation Measurement
Authors: Lucas Brennen  , Asher Marc  , Mclff Terrence  , Lark Dick  , Burton Doug
Published: February 2025

Aim: To determine how pelvic rotation in the transverse plane relates to coronal plane anatomical landmark location. The problem this addresses is the observation that iliac crest medial lateral width as seen in the coronal plane Cobb is often asymmetrical in patients with idiopathic scoliosis before treatment, and sometimes after treatment.
Three-dimensional shape analysis of the scoliotic spine using MR tomography and rasterstereography
Authors: Hierholzer Eberhard  , Hackenberg Lars
Published: February 2025

Rasterstereography delivers only indirect information about the three- dimensional shape of the spine. Therefore, validation with radiologic methods is necessary, in particular in severe scolioses above 50Æ Cobb. Comparison with conventional a.p. radiographs yielded satisfactory results for scolioses up to 50Æ Cobb, but only in frontal view, i.e. in two dimensions. A true three-dimensional validation is possible only with MR tomography, however this is difficult due to severe technical limitations.
Exercise efficiency of girls with idiopathic scoliosis based on the ventilatory anaerobic threshold
Authors: Durmala Jacek  , Dobosiewicz Krystyna  , Jendrzejek Hanna  , Pius Wieslaw
Published: February 2025

The aim of the study was to estimate the exercise efficiency in the group of girls with idiopathic scoliosis based on the ventilatory anaerobic threshold (VAT). Material and method. The investigation comprised 58 girls with idiopathic scoliosis, aged 10–6 years; 32 girls (55.20/0) with double major scoliosis and 26 girls (44.8%) with single scoliosis. The girls were conservatively treated using Dobosiewicz method. The control group consisted of 3 1 healthy girls aged 10-1 6 years. The exercise test was performed using cycle ergometer. During the exercise the gas exchange parameters were recorded (minute expiratory ventilation, minute oxygen consumption, carbon dioxide production). On the basis of recorded parameters VAT has been computed, using V-slope method. Results. The following VAT values were obtained in the group with scoliosis: 20.7+3.05 ml 02/min/kg b.m.; in control group: 21.9+3.50 ml 02/min/kg b.m. The differences between girls with idiopathic scoliosis and control group were not statistically significant. Conclusions. I. The exercise efficiency of girls with idiopathic scoliosis conservatively treated using Dobosiewicz method is normal. 2. Such high level of the exercise efficiency of the studied group probably was due to intensive 3-D respiratory exercises of these girls.
Intelligent Brace System for the Treatment of Scoliosis
Authors: Lou E.  , Benfield D.  , Raso J.  , Hill D.  , Durdle N.
Published: February 2025

Measurement of the biomechanical effectiveness of a brace for the treatment of scoliosis has been hampered by the lack of compressive information about wear characteristics. Orthotists and orthopaedic surgeons believe that the effectiveness of bracing is correlated with the strap tensions. If the strap tensions can be maintained at the optimal level while patients wear their braces, a better treatment outcome may be obtained. However, strap tensions vary significantly during different activities. An intelligent brace system has been developed to control the strap tension so that the optimal prescribed level is maintained at all time. This system consists of an innovative strap tension transducer, a microcomputer unit and a motorized unit. The strap transducer has been developed with an accuracy ±1.0N in the range of 0 to 100N. An instrumented Boston brace was built to test the concept. When the strap tension was below 80% of the prescribed level for a 15 minutes interval, the microcomputer unit signaled the motor to tighten the strap. While the strap tension level was above 120% of the prescribed level for a 15 minutes interval, the motor reversed the direction. Laboratory testing results showed that the strap tension could be maintained at the optimal prescribed level.
The Rib Hump after Surgery for Early Onset Spinal Deformity
Authors: Goldberg C.J.  , Moore D.P.  , Fogarty E.E.  , Dowling F.E.
Published: February 2025

Spinal deformity presenting early in childhood has a poor prognosis, in that progression is probable and severe respiratory compromise is a real possibility. Treatment is difficult, since these patients frequently do not respond to bracing, and surgery is sometimes performed in childhood in an attempt to control relentless progression. This carries the risk of continued deformation during subsequent growth, and the surgical procedures have been adapted in an attempt to minimise this. 25 children undergoing spinal fusion for progressive and severe deformity have sequential topographic scans which show that, despite measures to control the rib hump, progression after surgery is the rule.
The incidence of idiopathic scoliosis in Greece
Authors: Grivas Theodoros B  , Koukos Konstantinos  , Koukou Urania I  , Maziotou Christina  , Polyzois Basilios D
Published: February 2025

Introduction. The aim of the study is the documentation of the national incidence of idiopathic scoliosis (IS) based on the School Screening programs performed at the various geographical departments of the country, and the estimation of the probable number of children who will need to be conservatively or surgically treated.
Towards Developing a Coherent Healthcare Information Infrastmcture
Authors: Dumay A.C.M.  , Freriks G.
Published: February 2025

A standard is a set of agreements between all parties involved. Delivering healthcare is a matter of co-operation: healthcare can only be delivered in a responsible fashion when parties involved comply to standards. This becomes evident when a healthcare information infrastmcture is under development. The authors dehver a comprehensive introduction to standards which apply to the Electronic Healthcare Record (EHR) , describe work in progress of relevant standardisation committees and argue about future work of such committees in order to pursue a coherent healthcare information infrastmcture.
Principles of Structured Data Entry Applied to Reference Sources
Authors: de Haan G.G.  , van Ginneken A.M.
Published: February 2025

Our Structured Data Entry application makes use of a domain specific data model. The principles governing the modeling of this data model, are similar to the requirements of the criteria underlying taxonomie Systems. Using the DSM-IV as reference source to create a data model for psychiatry, revealed a number of flaws in the criteria of this system, which potentially influence the reliability and validity of this taxonomie system. We conclude that the modeling process provides us with a powerful tool which can be used during the revision process of such Systems.
How to build an Information System Application to the Health Domain
Authors: Deliége D.  , Debacker Ch.  , Smeesters S.  , Knani H.  , Neirynck I.  , De Clercq E.
Published: February 2025

Computer based information Systems aim at improving knowledge, évaluation and management processes. Such tools are still developing in the non- profit sector. This paper aims at : a) reminding how to evolve from data to management information Systems b) describing how to build a population based health information System c) describing the concepts required for conceiving a retrieval System and a system for inserting data d) documenting the importance of conceiving the system not only from a user driven perspective, but also taking into account the requirements of an information management System.
Surface Transparency makes Stereo Overlays Unpredictable: The Implications for Augmented Reality
Authors: Johnson Laura G  , Edwards Philip  , Hawkes David
Published: February 2025

The principle of using stereoscopic displays is to present the viewer with an accurate perception of 3D space. Stereopsis is a powerful binocular cue that will supplement any monocular information in the scene. Our work with an optical augmented reality system has highlighted one scenario where an accurate sense of depth cannot be easily achieved from stereoscopic images. In our augmented reality system we use stereo images of anatomical structures overlaid on the patient for surgical guidance. It is essential that the surgeon can accurately localize the images during surgery. When the stereo images are presented behind the transparent physical surface the perception of the depth of the images can become unstable and ambiguous, despite good system calibration, registration and tracking. This paper reviews possible reasons for the failure in accurate depth perception and presents some ideas on how this might be corrected for in an optical augmented reality system.
Independent testing of soft tissue visco-elasticity using indentation and rotary shear deformations
Authors: Kalanovic Daniel  , Ottensmeyer Mark P.  , Gross Joachim  , Buess Gerhardt  , Dawson Steven L.
Published: February 2025

Numerous techniques exist to measure the mechanical properties, of soft tissues in vivo, such as mechanical stretching, indentation or shearing, as well as elastographic methods employing ultrasound or other imaging modes. Many groups have reported properties which do not necessarily correspond with each other due to differences in choice of technique, tissue model or other variations. This work deliberately makes use of the two independent modes of indentation and rotary shear, on the same material samples, employing similar modeling approximations, to attempt to determine the common, underlying material properties.
The augmented-feedback rehabilitation technique facilitates the arm motor recovery in patients after a recent stroke
Authors: Piron Lamberto  , Tonin Paolo  , Atzori Andrea Massimiliano  , Zucconi Carla  , Massaro Cristiano  , Trivello Elena  , Dam Mauro
Published: February 2025

Previous studies have shown that the motor training in a virtual- environment with the augmented feedback promotes motor learning in normal subjects and in long-term post-stroke patients. We evaluated whether this approach could be useful also for treating patients with arm motor deficits due to a recent stroke. Twenty-four patients were included in the study within 3 months from an ischemic stroke in the territory of the middle cerebral artery. Twelve subjects received virtual-environment-training (VET) therapy for the arm, and twelve patients received an equal amount of a conventional rehabilitation therapy focused to the upper limb. Before and after therapy, the autonomy of daily living activities were assessed with the Functional Independence Measure and the degree of motor impairment was measured with the Fugl-Meyer scale for the upper extremity. For both groups the therapy lasted from 5 to 7 weeks, 1 hour daily for five days a week. The VET therapy group showed 20,2% and 12,4% improvements in the Fugl-Meyer and the Functional Independence Measure scale mean scores respectively. In a comparable way, the conventional therapy determined significant, but smaller scores improvements: 11,3% and 9,1%, respectively. These data indicate that the recovery of arm motor function in patients after a recent stroke is promoted by an augmented feedback strategy applied through a virtual-environment.
A Conceptual Model for Documentation of Clinical Information in the EHR
Authors: Asp Lone  , Petersen Jan
Published: February 2025

At a national level in Denmark the development of a Conceptual Model for Communication in Electronic Health Records (EHR) has moved towards a twofolded structure, i.e. a conceptual model for documentation of clinical information, the Clinical Process, and a Reference Information Model.
How to Identify and Assess Tasks and Challenges of Medical Image Processing
Authors: Horsch Alexander  , Thurmayr Rudolf
Published: February 2025

Research in Medical Image Processing (MIP) is mainly driven by a technologyoriented point of view. However, as an application-oriented field, MIP research should always be able to give an answer to the question of what is the potential benefit of a solved MIP problem or a newly developed MIP-based system supporting a diagnostic or therapeutic process, in terms of outcome criteria like e.g. Quality Adjusted Life Years (QALYs) for the patient or cost savings in health care. As one subtask of establishing a Reference Image Database for MIP R&D Groups, the Working Group on Medical Image Processing of the European Federation for Medical Informatics (EFMI WG MIP) works on an answer. This paper presents the concept and the strategy of how the Most Relevant MIP problems (MRMIP) shall be identified and assessed in the context of improving evaluation of MIP solutions.
ECG Mapping and Imaging of Cardiac Electrical Function
Authors: Seger Michael  , Tilg Bernhard  , Modre-Osprian Robert  , Fischer Gerald  , Hanser Friedrich  , Messnarz Bernd
Published: February 2025

Inverse electrocardiography has been developed for several years. By coupling electrocardiographic mapping and 3D-time anatomical data, the electrical excitation sequence can be imaged completely non-invasively in the human heart. In this study, a bidomain theory based surface heart model activation time imaging approach was applied to single beat data of atrial and ventricular depolarization. For sinus and paced rhythms, the sites of early activation and the areas with late activation were estimated with sufficient accuracy. In particular for focal arrhythmias, this model-based imaging approach might allow the guidance and evaluation of antiarrhythmic interventions, for instance, in case of catheter ablation or drug therapy.
Modelling of a case-based retrieval system for oncology
Authors: Rossille Delphine  , Laurent Jean-François  , Burgun Anita
Published: February 2025

When a new patient does not comply with the guidelines, experts base their therapeutic decisions on similar patients’ cases they have treated in the past. The case-based reasoning decision-support system we propose will automatically compare the patient’s case to the structured guideline, then to other cases, and retrieve similar cases. The general structure of the system is presented here, the domain of application being oncology. As the patients’ records are not stored in the current database in a format directly exploitable, an object-oriented model is proposed, that includes prognosis factors currently tested in clinical trials, wellestablished ones, and a description of the illness’ episodes. Such system does not exist in the literature. It can be viewed as a data warehouse. Future work consists in defining the similarity measures, and connecting the system to the current database.
A Framework for Evaluation of Medical Information Systems
Authors: Turunen Pekka
Published: February 2025

The evaluation of information systems, especially in the health care field, is a complex task While in the general information system science field there have been several attempts to build frameworks and models to understand better the evaluation of information systems, in health care such models have been non-existent. Unfortunately general frameworks cannot be exactly applied for the evaluation of medical information systems, because they do not recognise the specific nature of the medicine. This article represents an attempt at formulating conceptual models to understand the evaluation of the different impacts of medical information systems.
Simulation and management games for training command and control in emergencies
Authors: Levi Leon  , Bregman David
Published: February 2025

The aim of our project was to introduce and implement simulation techniques in a problematic field of increasing health care system preparedness for disasters. This field was chosen as knowledge is gained by few experienced staff members who need to disperse it to others during the busy routine work of the system personnel.
Improving the DRG system in Hungary
Authors: Daragó László
Published: February 2025

Handling cases should be a profitable endeavour for the hospitals, but high caseloads have them running in the red The reason for this may very well be the way the weighting is structured in the DRG system. The current way of thinking is that the indirect costs of the hospital care must be distributed on the case's days and the average of the direct costs can be added into the calculation of the DRG class’s weighting factor. A dissenting opinion calls for creating the total weight proportionally by the direct costs. This paper shows an alternative, which balances both opinions by implementing corrective measures for the DRG class weigh, and thus is able to make complicated cases profitable.
From DRG databases to an epidemiological observatory for colorectal cancer in a French small area oncology network
Authors: Paviot Beatrice Trombert  , Martin Caroline  , Clavel Lucienne  , Laroche Guy De  , Rodrigues Jean Marie
Published: February 2025

Following a request from the local health authority, we have organised the permanent linkage of DRG/MBDS databases from different tertiary care hospitals from Saint- Etienne urban area. To made anonymous the MBDS, we used the asymmetric hashing and encrypting software developed and registered by the University hospital of Dijon. In each hospital, the selection of acute care stay MBDS is performed on the presence of at least one malignant tumour ICD code. The output is an anonymous but personal 20 000 patients register. We are presenting the method to estimate the incidence of colorectal cancer (CRC) cured between 1996 and 2000 from DRG databases of four hospitals and checking the validity against the figures coming from a cancer registry. Among the 1953 CRC patients observed, 156 patients have followed a CRC surgical excising in 1999. The DRG activity of the 4 observatory hospitals is 33,5 % of the total hospital activity for people of the area recorded by the 1999 regional DRG PMSI data bases. The estimation of the incidence is 465 for 1999. the estimation of the same incidence by applying the incidence rate by sex and age from the Isère cancer register to the population of the Loire area, is 504. The under estimation is 7,7 % with the observatory method. It is rather difficult to check an estimation by another estimation but in France the evaluation of oncology care strategies is impeded by the lack of cancer registries. The conclusion of this study is a good feasibility and acceptability of the linking procedure when used with a clear healthcare goal. The use of DRG data bases within an oncology network by linking the mandatory MBDS data bases gives the opportunity to share some clinical data between healthcare professionals
Health Informatics for Improving the Dutch Healthcare System
Authors: (Kees) Louwerse C.P.
Published: February 2025

Some recent developments around the organisation of ICT applications in healthcare in the Netherlands are discussed, in relation with the installation of a new National ICT Institute for Healthcare (NICTIZ). Some examples are given, especially from the field of Quality Assurance and Information Security.
Information Technology in Action: The Example of Norway
Authors: Reith Albrecht  , Olsen Dag Rune  , Bruland Øvind  , Bernder Åsmund  , Risberg Bjørn
Published: February 2025

In Europe, Norway has played since the 1990 a pioneering role in applying telemedicine in healthcare services. 4.5 millions occupy a country nearly as large as the former West Germany with a coast line as long as the equator and stretching 2500 km from the south to the north. The most northern counties are very sparsely populated. Therefore the government decided to build a national research centre for telemedicine at the regional hospital of Tromsø north of the polar circle with the aim of exploring the new telemedicine techniques in the different branches of medicine. Later political support was based on the wish to increase quality and safety of diagnostic and therapeutic procedures and of saving costs.
The German Electronic Doctor's License: The Introduction of a Health Professional Card
Authors: Wenzlaff Paul
Published: February 2025

The rapid increase of the. use of electronic communication in the healthcare sector in the last decade made it more and more important to implement an appropriate general security infrastructure. Improved security is necessary for both patients and health professionals. One corner stone in all these concepts is the introduction of the so-called Health Professional Card as an important security tool. Accordingly, the professional organisations for physicians in Germany started to introduce a standardised electronic identity card for their members at the end of the nineties. The existing physicians' identity paper will be transformed into an electronic identity document as a prototype for a Health Professional Card for all German health professionals. The main goal is to achieve a high level of standardisation and interoperability. Thus, all activities were carried out in close co-operation with different national and international institutions, organisations and working groups.
Clinical Studies' Assessment
Authors: Kropf Siegfried  , Schmidt Uwe
Published: February 2025

The paper gives some more general remarks on clinical studies from the perspective of a biometrician. Prospective randomised clinical trials are the study type with highest evidence. But there are other study types, too, which have their legitimacy in the process of medical knowledge finding and quality assurance. It is important to use each type in the right place and in the right way. Analysis and interpretation have to take care for the study type.
The Magdeburg Clinical Studies' Network for Pediatric Diseases
Authors: Mohnike Klaus  , Empting Susann  , Roehl Friedrich-Wilhelm
Published: February 2025

New pharmaceutical technologies had created either enthusiastic hope for major improvements in the medical treatment or major doubts on the use of research data and wrongdoing in clinical trials. Clinical investigators have to consider methodological and scientific principles, to stick to ethical rules, national law and international guidelines. With the invention of General Clinical Research Centres the necessary infrastructure in hospitals with well-trained personnel and the availability of laboratory, clinical and supporting service has been created in the US.
Clinical Document Architecture
Authors: Heitmann Kai
Published: February 2025

The Clinical Document Architecture (CDA), a standard developed by the Health Level Seven organisation (HL7), is an ANSI approved document architecture for exchange of clinical information using XML. A CDA document is comprised of a header with associated vocabularies and a body containing the structural clinical information.
Security, Safety and Quality in Health Information Systems
Authors: Barber Barry
Published: February 2025

The issues of Safety and Security are closely intertwined in Health information Systems. The paper explores the development of interest in these issues and looks to the next steps in the development of Safety standards. These efforts are compatible with the wider activities aimed at avoiding “adverse incidents” in the delivery of Healthcare.
Development of a novel surgical support instrument and virtual system incorporating new tactile sensor technology
Authors: Omata Sadao  , Murayama Yoshinobu  , Constantinou Christos E.
Published: February 2025

Surgical practice would be significantly enhanced with robotic systems incorporating tactile sensors. Current tactile sensor technology consists mainly of strain gauge elements having a limited bandwidth. A novel tactile sensor system, has been developed using a piezoelectric transducer(PZT), to simulate the properties of the human hand for use as a surgical support instrument and a palpation probe. Visualization of tactile information as an audio signal is provided, representing tissue properties in terms of an amplitude and frequency modulated signal. Representative data measured from pig brain, lung, pancreas, tongue and liver show that the changes in frequency corresponds to tissues stiffness and contact pressure. The technology developed in this new surgical support system has potential applications in virtual systems or robotic tele-medical care.
A Prototype Virtual Reality System for Preoperative Planning of Neuro-Endovascular Interventions
Authors: Subramanian Navneeth  , Kesavadas T  , Hoffmann Kenneth R.
Published: February 2025

This paper describes our efforts at creating a system with real time acquisition and geometric processing of the patients vascular anatomy, supplemented by a framework to simulate catheter vasculature interaction. Our system uses biplane angiograms coupled with an algorithm for generation of 3D vascular trees for patient data acquisition. Surface reconstruction and processing of this data is performed to provide novel decision aids to the interventionalist. The processed data can be loaded in a virtual environment to simulate guidance of the catheter through the patient's vasculature. With our combination of techniques, a patient specific visualization and simulation environment can be prepared within the narrow time window available for this procedure.
New Technologies for Providing Remote Psychological Treatments
Authors: Rey Beatriz  , Alcañiz Mariano  , Lozano José Antonio
Published: February 2025

New technologies lead us to a series of new applications that we could not imagine just a few years before.
An Integrated Approach to the Ergonomic Analysis of VR in Psychotherapy: Panic Disorders, Agoraphobia and Eating Disorders
Authors: Galimberti Carlo  , Belloni Gloria  , Cattaneo Alberto  , Grassi Maddalena  , Manias Valentina  , Menti Luca
Published: February 2025

To face the aspects connected with VR environments' usability for psychotherapeutic applications means to dare a double challenge from a methodological point of view: from one side, the need to adapt and to integrate on a heuristic basis classic usability evaluation methods to specific artefacts such as 3D Virtual Environments for clinical applications; from the other hand, the problems arisen by integration of expert evaluation of VR environments user-based tests carried out in real context of use. The theoretical background of our analytical stance is based upon an ethnometodological approach, a perspective that gives evidence of how people, in specific social situations, are able to solve complex tasks producing shared meanings and achieving their goals during interaction. According to this perspective, the methodological objective consisted also in the identification of the usability requirements of the specific community of practice. The virtual environments considered were two of the four VR modules in the framework of the VEPSY project: Panic Disorders – Agoraphobia and Eating Disorders.
Immersive Virtual Telepresence: Virtual Reality meets eHealth
Authors: Riva Giuseppe  , Morganti Francesca  , Villamira Marco
Published: February 2025

Immersive Virtual Telepresence (IVT) tools are virtual reality environments combined with wireless multimedia facilities - real-time video and audio – and advanced input devices – tracking sensors, biosensors, brain-computer interfaces. For its features IVT can be considered an innovative communication interface based on interactive 3D visualization, able to collect and integrate different inputs and data sets in a single real-like experience.
Protocure: Supporting the Development of Medical Protocols through Formal Methods
Authors: Balser Michael  , Coltell Oscar  , van Croonenborg Joyce  , Duelli Christoph  , van Harmelen Frank  , Jovell Albert  , Lucas Peter  , Marcos Mar  , Miksch Silvia  , Reif Wolfgang  , Rosenbrand Kitty  , Seyfang Andreas  , ten Teije Annette
Published: February 2025

Medical guidelines and protocols describe the optimal care for a specific group of patients and therefore, when properly applied, improve the quality of patient care. During the last decade, a large number of medical guidelines and protocols have been published. However, the work done on developing and disseminating them far outweighs the efforts on guaranteeing their quality. Indeed, anomalies like ambiguity and incompleteness are frequent in medical guidelines and protocols. An approach grounded on a formal representation, can answer these needs, as we have demonstrated in the Protocure project. The Protocure II project will aim at integrating formal methods in the life cycle of guidelines.