bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapie von Erkrankungen der neuromuskulären Endplatte im Kindesund Jugendalter
Authors: Marina A. , Schara U.
Published: March 2018

Die Erkrankungen der neuromuskulären Endplatte im Kindes- und Jugendalter umfassen die juvenile autoimunvermittelte Myasthenia gravis und die kongenitalen myasthenen Syndrome. Die autoimmune kindliche und juvenile Myasthenia gravis (JMB) ist definiert mit dem Auftreten der ersten Symptome vor dem 19. Lebensjahr, Häufigkeit ist nicht genau bekannt, sie macht ca. 10–15% der Myasthenien aus. Die Symptomatik ist variabel. Wichtig für eine zeitnahe Einleitung der Therapie ist die frühestmögliche Diagnosestellung. Deswegen ist es wichtig, auf initiale Symptome zu achten, um diese in die Verdachtsdiagnose einordnen zu können. Im Gegensatz zu der antikörpervermittelten autoimmunjuvenilen Myasthenia gravis handelt es sich bei den kongenitalen myasthenen Syndromen um eine genetisch bedingte und klinisch heterogene Gruppe von Erkrankungen, die als Folge eine Störung der Struktur und der Funktion der muskulären Endplatte haben. Auch bei dieser Krankheitsgruppe ist eine frühestmögliche Diagnose mit Einleitung einer entsprechenden Therapie für den optimierten Ausgang notwendig.

In dieser Übersicht sollen die Leitsymptome, die möglichen und notwendigen Schritte der Diagnostik sowie die dann einzuleitende Therapie der unterschiedlichen Krankheitsbilder dargestellt werden.
Palliativtherapie neuromuskulärer Erkrankungen
Authors: Lorenzl S. , Reilich P.
Published: March 2018

Die palliativmedizinischen und hospizlichen Versorgungsstrukturen und Angeboten wurden in den vergangenen Jahren in Deutschland stark ausgebaut. Dem klinisch tätigen Neurologen steht ein weites Spektrum an palliativmedizinischen Maßnahmen zur Verfügung. In dieser Arbeit wollen wir eine Übersicht über die Therapiemöglichkeiten der wichtigsten Symptome in der letzten Lebensphase am Beispiel von Patienten mit amyotropher Lateralsklerose (ALS) stellvertretend für Menschen mit neuromuskulären Erkrankungen geben und uns an den internationalen Empfehlungen der European Academy of Neurology sowie der nationalen S3-Leitlinie “Palliativmedizin” aus dem onkologischen Leitlinienprogramm orientieren.
On Analysis of Two-Way Contingency Tables with some Sampling Zero Cell Counts — Application to Human Reproduction Wastage according to Age —
Authors: Moussa M. A. A.
Published: March 2018

A systematic procedure is described for the analysis of I x J cross-classifications with some nonstructural zeros. This includes (1) use of pseudo-Bayes estimators to remove zeros (2) fitting the smoothed array to all possible configurations of the log-linear models (3) fitting the data to the quasi -independence model after omitting counts of some anomalous cells — on the basis of standardized residuals to detect the cause of deviation from the null independence model. As a guide, a risk function value is computed for each array of smoothed pseudo-Bayesian estimates.

Real-life data (based on a sampling survey conducted on the population of female nurses in Kuwait) is used for illustration.
Economic Evaluation of Effectiveness in Health Care Delivery
Authors: Gottinger H. W.
Published: March 2018

This work focusses on two major aspects of public decision-making and policy analysis. First, to present a set-up for multi-criteria decision analysis (under certainty) based on interactive soul searching between the decision maker and the decision analyst (consultant) in which the decision maker repeatedly reveals his value judgement on a number of conflicting objectives and organizes his choice process in an adaptive fashion.

Second, to show the usefulness of this kind of approach for practical decision-making and resource planning. Multi-criteria decision analysis has found applications in diverse fields, related to public policy decisions. But this work is probably the first comprehensive attempt to apply multi-criteria decision analysis to the choice of modes of health care delivery as a public decision problem.
Knowledge and Skills Expected of Health Information Scientists: A Sample Survey of Prospective Employers
Authors: Protti D. J.
Published: March 2018

Potential employers of future health informatics graduates were surveyed as to their view of what informatics knowledge and skills were required to contribute to their organizations. 84 respondents clearly indicated that the most important of six areas of knowledge and skills was communications skills, followed by informatics knowledge, management knowledge, informa tics skills, analytic skills, and health services knowledge. The survey also revealed that the ranking of the six areas was the same for differing organizations and differing respondent groupings.
On the Analysis of Three-Dimensional Contingency Tables-Application to the Influence of Allergy and Age on Cancer
Authors: Moussa M. A. A. , Karnik A. M. , Omar Y. T. , Fenech F. F.
Published: March 2018

A procedure is described for the analysis of I × J × K cross-classifications. This includes 1. selecting the appropriate model by iterative proportional fitting of the data to relevant configurations of log-linear models; 2. assumptions underlying reduction of three-way tables to two dimensions; 3. the Mantel-Haenszel statistic with reference to its relation to log-linear models.

The methods are applied to a data set based on a study recently conducted at the Cancer Control Centre, Kuwait to investigate the relation between allergy and cancer. It was concluded that the allergy rate is significantly lower in the cancer group which suggests that allergy could be a protective factor against cancer.
The Use of a Personal Computer in the Pulmonary Function Tests of Laboratory Rats
Authors: Massad E. , Furuie S. Sh. , de Assis Moura L. , Nascimento Saldiva P. H. , Nicolelis M. A. , Böhm G. M.
Published: March 2018

A system consisting of an 8-bit word microcomputer of the APPLE line equipped with an analog-to-digital converter, connected to a physiograph measuring pressures from a whole-body Plethysmograph, was used to perform pulmonary tests in rats. The system proved to be time-saving without loss in accuracy when compared to manual calculation methods. It allows measurement repetition during the same experiment, which is impossible by manual techniques, and permits to obtain flow/volume relationships without pneumotachographs or integrator and/or differentiator modules. This approach may be applied to humans and used by any physician.
Applying Decision Theory to Medical Decision-Making — Concept of Regret and Error of Diagnosis
Authors: Alperovitch A. , Minor M. , Knill-Jones R. P.
Published: March 2018

The aim of this study was to confront clinicians with the problem of expressing their intuitive evaluation of a diagnostic error by a numerical measure. The diagnosis of jaundice was used as a model and 6 experienced clinicians were included in the study. The results showed reasonable agreement between clinicians and evidence that values given by each clinician corresponded to his losses estimated by observing his decisionmaking on 50 diagnostic profiles.
A Computer-Assisted Register and Information System for Diabetes
Authors: Peacock I. , Jones R. B. , Hedley A. J. , Allison S. P. , Tattersall R. B.
Published: March 2018

A new computer-assisted follow-up register and information system has been developed for patients with diabetes. The task of collecting and coding clinical information has been simplified, and methods of working in clinics have been adjusted to fit closely with the design of the new system.

A flexible program suite includes statistical programs which allow clinical audit and evaluation of long term care to be carried out on demand. The system, which is on-line, operates under DSM 11 (DEC MUMPS) on a PDP 11/44 computer and, for hospital work, includes a video display unit and printer in the outpatient clinic and hospital ward.

Registration of patients in the system may be carried out from either a hospital clinic or general practice. The clinical data base, completed at registration or review for each patient, is used to generate three computer-printed structured medical records .for use by hospitals, general practitioners and patients.

The system can be used to provide (a) more reliable and effective record-keeping for patients and doctors, (b) automatic clinical audit for individuals or groups of patients, (c) data for long-term evaluation of care and other clinical research.
Effects of Prevalence and Test Diagnosticity upon Clinical Judgments of Probability
Authors: Balla J. I. , Elstein A. , Gates P.
Published: March 2018

The process of revising diagnostic probabilities was studied to examine the relative influence of prior probability and test diagnosticity at various levels of clinical experience. The aims were to show changes with increasing seniority, to explore the effects of perceived seriousness of a disease, and to demonstrate systematic biases in handling probabilistic information. To these ends, 4 case vignettes were presented to 169 medical students in the three final years of the medical course and 25 residents. The data presented included the prior probabilities of two diseases and the true positive fraction of a single clinical manifestation of the rarer disease.

Results showed a slightly increasing reliance on prior probability with increasing experience. The less experienced seemed most influenced by test results and by perceived seriousness of the disease. In some vignettes judgment seemed to depend on representativeness. In others, the most plausible explanation of the diagnostic choice would have been availability. Marked case-to-case variation was noted for individuals and there was a general lack of systematic biases. Revision of diagnostic opinion often depended on preconceived notions, and prior probabilities tended to be ignored. These are clear indications for teaching the basics of decision theory to medical students and early post-graduates.
On the Lead Time of a Periodic Screening Program
Authors: Maier Berthold
Published: March 2018

Many parameters are needed in the assessment of the benefits of a periodic screening program. In this paper we present formulas for two of them: the proportion SP of patients detected and the lead time of such a program. The lead time is the time by which the disease is detected earlier due to screening. We also give a lower bound for the mean lead time L in terms of the mean sojourn time in a certain preclinical state P and of the sensitivity of the screening test in this state P only. Finally, we indicate how the mean sojourn time and, under certain assumptions, even the sensitivity are estimated from the results during the initial phase of the screening program.
Microcomputers for Field Studies in Epidemiology: An Experience in Southern Italy
Authors: Bouckaert A. , Lechat M. F. , De bruycker M. , Kettenis Y. , Speeckaert C.
Published: March 2018

Microcomputers have been used for data entry, updating and checking during a field survey of health conditions after earthquake in Southern Italy.

Although the basic procedure of interview and processing is the same as with conventional paper archives, benefits were seen to result from local statistical processing, fastness of file construction, monitoring of the quality of information collection. Local temperature and electricity distribution are clearly a problem. The need for a general software framework that can be adapted to several epidemiological surveys is emphasized.
The Development of On-Line History-Taking Systems in Antenatal Care
Authors: Lilford R. J. , Bingham P. , Fawdry R. , Setchell M. , Chard T.
Published: March 2018

The main purpose of the first antenatal visit (booking visit) is to obtain a full history. This information is used to assess risk and plan further management. We have developed an on-line microcomputer system to obtain and reproduce this antenatal »booking« history. The study was designed to provide a formal evaluation of these programs by comparing the traditional and computerised methods. A cross-over study showed that the computer provided a much more complete history with an average of 16 additional items. Further analysis showed that much of this information was of such importance as to warrant specific action on the part of the clinician. Little extra time was required to obtain this improvement in detail and a high degree of consumer acceptance was recorded.
Revised Values for the Parameters of the Sets Technique for Monitoring the Incidence Rate of a Rare Disease
Authors: Chen Rina
Published: March 2018

Values recommended for the parameters of the sets technique are presented. These values are more accurate than the ones published earlier. The values are determined so as to enhance the detection of small levels of increase in the rate of a rare event.
Some Reflections on the Evaluation of Expert Systems in Medicine
Authors: Fieschi M. , Joubert M.
Published: March 2018

Several examples are given to underline the difficulties of evaluating expert systems in order to demonstrate that in the medical domain in particular their routine applications have not yet been developed to a great extent.
Graphical Access to Medical Expert Systems: I. Design of a Knowledge Engineer’s Interface
Authors: Shortliffe E.H. , Tsuji S.
Published: March 2018

Optimal construction of medical expert systems demands a powerful interactive environment for knowledge base management by knowledge engineers. Key requirements include techniques for (a) examining existing information, (b) adding new knowledge and editing preexisting data structures, and (c) examining dynamic internal system behavior to facilitate debugging during consideration of actual cases. This article addresses design considerations in the development of such knowledge engineering tools. The emphasis is on the use of professional workstations with high density graphics interfaces since that technology is rapidly becoming a predominant environment for knowledge engineering activities. To illustrate the points made, examples are drawn from an experimental knowledge base management tool designed for knowledge engineers constructing the knowledge base of ONCOCIN, an expert system to advise in the management of cancer patients.
Graphical Access to Medical Expert Systems: II. Design of an Interface for Physicians
Authors: Lane C. D. , Walton Joan , Shortliffe E. H.
Published: March 2018

The ONCOCIN Interviewer program provides a graphical interface between physicians and an expert system that is designed to assist with therapy selection for patients receiving experimental cancer therapy. A principal goal has been to increase acceptance of advanced computer tools in a clinical setting. The interface has been developed for high-performance Lisp workstations and is tailored to the existing paper forms and practices of the outpatient clinic. To be flexible, the program makes use of a document formatting language to control a raster graphics display of medical forms, traditional paper versions of which have been used to track patient progress. The program utilizes a mouse input device coupled with a software-defined data entry approach that may be customized to the specific environment. The work described suggests ways in which high density graphics interfaces, with pointing devices rather than an emphasis on keyboards, may make decision support tools more useful to physicians and more acceptable to them.
Registration of Diagnoses in the Danish National Registry of Patients
Authors: Jürgensen H. J. , Frølund C. , Gustafsen J. , Mosbech H. , Guldhammer Birgitte , Mosbech J.
Published: March 2018

The data recorded in the National Registry of Hospitalized Patients in Denmark (Landspatient-registeret [LPR]) are based on reports from the somatic departments of hospitals throughout the country. For the purpose of evaluating the quality of these data, information from LPR concerning patient diagnoses was compared with corresponding information in the records from 924 consecutive admissions to the Frederiksborg County Hospital, Hiller0d. The diagnoses in these records were registered and given priority based on predetermined criteria for selection of primary and secondary diagnoses, respectively. For each hospitalized case a total of 4 primary and 4 secondary diagnoses might be registered. In order to show the variation in choice of diagnoses between physicians, all records from the two medical departments and 10% from the remaining departments were revised by two different physicians. In the medical “block” (medical departments B and F, and the departments of physical medicine, paediatrics, and neurology), there was agreement between the two physicians on at least one of the maximally 4 primary diagnoses which could be registered in 92% of the cases (2-digit code). For the surgical “block” (the departments of parenchymal surgery, orthopaedic surgery, gynaecology, and otology), the corresponding figure was 95%. If the two coders were in agreement on at least one primary diagnosis, this was identical with LPR’s primary diagnosis in 76% of the cases in the medical “block” and 85% of the cases in the surgical “block” (2-digit code). However, in the case of 15% of the medical and 7% of the surgical cases, the primary diagnosis, on which the two coders were in agreement, was not recorded at all by LPR (3-digit code).

It is to be emphasized that a certain variation between different physicians in their choice of diagnoses cannot be eliminated. In conclusion, the level of agreement between LPR and the study material found in the present study is in general satisfactory if LPR’s function as a basis of information for policy making in the hospital sector is taken into consideration. On the other hand, agreement (especially on medical records) is presumably not good enough in LPR to be used for research purposes.
A Graphic Method of Estimating the Specificity of Screening Programmes from Incomplete Follow-up Data
Authors: Brecht J. G. , Robra B.-P.
Published: March 2018

The specificity of a screening test determines, on the one hand, the extent of inconvenience and risk involved for healthy participants of a screening programme. This is, therefore, a possible determinant of programme acceptance. On the other hand, follow-up costs generally represent a considerable proportion of the total screening programme cost and are determined by the specificity. The specificity is thus an essential determinant of the efficiency of such a programme.

Under the rare disease assumption it is possible to assess the specificity of screening programmes from cross-sectional data. On the basis of this method, a simple graphic way of evaluating the specificity is also described and illustrated by data stratified by age and screening history from the German National Cancer Screening Programme.
HAZARD: An Expert System for Risk Assessment of Environmental Chemicals
Authors: Gottinger H. W.
Published: March 2018

The purpose of this paper is to report on an expert system in design that screens for potential hazards from environmental chemicals on the basis of structure-activity relationships in the study of chemical carcinogenesis, particularly with respect to analyzing the current state of known structural information about chemical carcinogens and predicting the possible carcinogenicity of untested chemicals. The structure-activity tree serves as an index of known chemical structure features associated with carcinogenic activity. The basic units of the tree are the principal recognized classes of chemical carcinogens that are subdivided into subclasses known as nodes according to specific structural features that may reflect differences in carcinogenic potential among chemicals in the class. An analysis of a computerized data base of known carcinogens (knowledge base) is proposed using the structure-activity tree in order to test the validity of the tree as a classification scheme (inference engine).
Affective State and Voice: Reproducibility and Sensitivity of Speech Parameters
Authors: Stassen H. H. , Bomben G.
Published: March 2018

In 1986, we started an extensive investigation into the nonverbal information transmitted in human speech. As part of this investigation, we had designed a study of healthy subjects -stratified according to sex, age and education - in order to gain valuable insights into the “typical” nonverbal activities of a speaker. The specific design of this study with 3 different types of texts and 2 repeated measurements at an interval of 14 days was used to test the stability of speech parameters over time as well as their sensitivity to form and content of text. In a first approach, we directed our efforts towards a set of major scalar quantities which earlier investigators had described as playing a key role in modelling affect in terms of directly measurable speech parameters.

Based on a sample of 97 persons and with the help of a fully computerized digital approach to speech processing, we found that the four major speech parameters “mean vocal pitch”, “time duration of pauses”, “time duration of utterances”, and “energy” are sufficiently reproducible under constant experimental conditions, whereas some significant differences showed up with regard to the sensitivity of these parameters to form and content of the spoken text. No substantial impact originated from the external factors sex, age and education, except for the tonal shift of one octave between males and females.

On the other hand, the overwhelming variety of individual voice patterns obviously excludes any simple model (which applies in general) of the nonverbal component of human speech. However, our analyses offered some important clues as to how appropriate models may be derived by means of adaptive procedures.
A Statistical Model for Appraisal of Discrimination Performance in Closed Set Tests
Authors: Köppen L. , Quester R.
Published: March 2018

In the evaluation of discrimination performance in closed set tests, it is important to know what proportion of correct results may possibly be explained by chance. The present paper describes a statistical model for the calculation of confidence limits which appears suitable for standardization of the different methods of appraisal used throughout the world. It utilizes the matching model and Poisson distribution and, as an example, it is applied to discrimination performance tests of cochlear implant wearers.
The Enrollment File : A Key Module of a Clinical Data Base
Authors: Kaplan R. W. , Brunjes S.
Published: March 2018

This paper describes the contents, placement and maintenance of a data base module containing identification and administrative information about the users of a health care delivery organization. This module is a portion of a comprehensive collection of information used to manage the medical problems of a population as well as the operations of the organization. The contents and structure of each of the four portions of the module, called the Enrollment Files, are discussed. The collection of the data is described as is the use of the module in concert with other data base subsets.
Principles of Evaluating Roentgen Diagnostic Classifications
Authors: Koivisto Erkki
Published: March 2018

The utilization of computers has made the classification of roentgen diagnostic findings more important than ever. In the present paper principles of evaluating roentgen diagnostic classifications are considered on the basis of practical experience. In the appraisal of roentgen diagnostic classifications the following characteristics are considered essential:

1.) relative number of specific findings in a clinical collection;

2.) retrieval capability;

3.) percentage of specified diagnoses in relation to the total number of diagnoses contained in the classification system.
Medizinische Dokumentation und elektronische Datenverarbeitung in einem Universitätsklinikum (Planungen — Erfahrungen — Vorschläge)
Authors: FUCHS G. , SCHMIDT K.
Published: March 2018

Es wird ein Fragenkatalog vorgestellt, der die Beschreibung von medizinischen Dokumentationsvorhaben erleichtern und einen Vergleich zwischen ihnen ermöglichen soll.
The Computer Medical Record in Health Screening) )
Authors: COLLEN M. F. , DAVIS L. S. , VAN BRUNT E. E.
Published: March 2018

Computerized data banks require very complex patient record files. Our method of storing medical data from a multiphasic health screening program is described in detail, induding the mechanics for providing on-line medical record linkage.
Der Alterseinfluß auf die Korrelationen zwischen Blutsenkung, Körpermaßen und häufigen Dermatosen
Authors: Flörcken D.
Published: March 2018

Diese Betrachtung unternimmt den Versuch, die Blutsenkungsgeschwindigkeiten der in den Jahren 1954—1968 in der Universitäts-Hautklinik Kiel stationär behandelten Patienten hinsichtlich der Verteilung zu untersuchen. Mit Hilfe der graphischen Häufigkeitsanalyse nach Daeves
und Beckel
[6] gelingt im doppelten Wahrscheinlichkeitsnetz der Nachwels von Mischverteilungen: die Trennung des Gesamtkollektivs in zwei Teilkollektive, von denen das erste die normalen und das zweite die pathologischen Werte beinhaltet.

Die ebenfalls graphisch gefundene Altersabhängigkeit der Blutsenkung konnte mittels der Korrelationsrechnung in Zahlen gefaßt werden. Als weitere Variable wurden in dieser Berechnung noch Größe, Gewicht und Bauchumfang berücksichtigt und die bestehenden Beziehungen untereinander und zum Alter auf gezeigt und diskutiert.

Die Abhängigkeit der Blutsenkung vom Bauchumfang kennzeichnet sich dabei unter Anwendung der partiellen Korrelationsrechnung als Gemeinsamkeits-Korrelation mit dem Alter.

Aus den abschließenden Betrachtungen geht hervor, daß die Blutkörperchen-Senkungsgeschwindigkeit für die klinischen Krankheitsbegriffe in der Dermatologie kaum ein entscheidendes Kriterium darstellt und darum ihre Verwendung in statistischen Operationen — beispielsweise in der Faktorenanalyse — uninteressant ist, obwohl sie im Einzelfall nicht vernachlässigt werden darf.

Letztlich wird noch die Notwendigkeit eines altersabhängigen Normbereichs für die Meßwerte der Blutsenkung aus den Untersuchungen abgeleitet.
Zur Logik und Methodologie der ärztlichen Urteilsbildung
Authors: Sadegh-Zadeh K.
Published: March 2018

Der Arzt ist in der Situation der Krankheitserkennung und Krankenbehandlung mit Einzelfällen konfrontiert. Seine Erkenntnisund Entscheidungspraxis folgt jedoch allgemeinen Regeln, deren nähere Untersuchung die Begriffsverwirrungen in den Diskussionen über die Grundlagenprobleme des ärztlichen Handelns reduzieren könnte. Diese allgemeinen Regeln der ärztlichen Urteilsbildung lassen sich auf zwei logische Inferenzmodelle zurückführen, welche dem Akt der »Erklärung« zugrunde liegen. Die logische Analyse des Begriffes »Erklärung« stellt die vielerorts postulierte Heteromorphie zwischen »Intuition« und »diagnostischem Blick« einerseits und dem »Maschinendenken« andererseits als eine scheinbare heraus, läßt das verbreitete Vorurteil der Methodendichotomie »Verstehen — Erklären« korrigieren und regt nicht zuletzt zum Nachdenken über die methodologischen Voraussetzungen einer adäquaten Hypothesenkonstruktion in der medizinischen Forschung an.
Computer-Assisted Clinical Decision-Making
Authors: GOBRY G. A.
Published: March 2018

This paper discusses some research in computer-aided! clinical decision-making. Experience with formal (decision theory) models is discussed and the limitations of these models are noted.

It is argued that new approaches are needed to solve complex clinical problems, and one such approach is discussed.
Discriminant and Bayes Analysis in the Differential Diagnosis of Crohns Disease and Proctocolitis
Authors: Spicer C. C. , Jones J. , Jones J. E.
Published: March 2018

Proctocolitis and colonic Crohn’s disease have not yet been precisely differentiated and the existence of the latter is still disputed. The study reported here is concerned with identification of the clinical features characterising patients diagnosed clinically as suffering from one or other of these diseases.

A stepwise linear discriminant analysis of 91 possible indicants showed that seven were sufficient to discriminate between the two clinical groups. A further analysis of the patterns of these seven by a Bayesian method which takes account of the interdependence of the indicants showed that only five indicants were necessary for discrimination. The Crohn’s disease patients fell into a much greater variety of patterns than those with proctocolitis most of which fell into only one pattern.

It is suggested that this use of linear discrimination to reduce the number of indicants combined with a subsequent analysis of the patterns of these indicants might be useful in other diseases.
Observer Variation in Clinical Diagnosis - A Computer-Aided Assessment of its Magnitude and Importance in 552 Patients with Abdominal Pain
Authors: Gill P. W. , Leaper D. J. , Guillou P. J. , Staniland J. R. , Horhocks J. C. , de Dombal F. T.
Published: March 2018

This report describes an evaluation of »observer variation« in history taking and examination of patients with abdominal pain. After an initial survey in which the degree of observer variation amongst the present authors fully confirmed previous rather gloomy forecasts, a system of »agreed definitions« was produced, and further studies showed a rapid and considerable fall in the degree of observer variation between the data recorded by the same authors. Finally, experience with a computer-based diagnostic system using the same system of agreed definitions showed the maximum diagnostic error rate due to faulty acquisition of data to be low (4.7°/o in a series of 552 cases). It is suggested as a result of these studies that — at least in respect of abdominal pain — errors in data acquisition by the clinician need not be the prime cause of faulty diagnoses.
Zur Problematik der Interpretation von Studien über Arzneimittelnebenwirkungen
Authors: Hartmann E.
Published: March 2018

Nach, einer allgemeinen Diskussion der biometrischen Aspekte bei prospektiven und retrospektiven Arzneimittelprüfungen wird an konstruierten Beispielen gezeigt, daß nur. biometrisch geplante und prospektiv angelegte, kontrollierte Studien eindeutig interpretierbare Informationen zum Problem der Verursachung von Nebenwirkungen durch. Pharmaka liefern können. Die verallgemeinernde Interpretation von Ergebnissen aus nichtkontrollierten Untersuchungen, insbesondere retrospektiv angelegten Vergleichsstudien, ist fehlbar und daher im streng naturwissenschaftlichen Sinne abzulehnen.
Testen der partiellen Kontingenz mittels linearer Modelle
Authors: Rahlfs V. W.
Published: March 2018

Anknüpfend an den von E scher und L ienert vorgeschlagenen informationstheoretisdien Ansatz zum Testen einer partiellen Kontingenz werden zwei weitere Ansätze für die Problemlösung herangezogen:

1.) Ein Maximum-Likelihood-Verfahren zur Lösung eines multinominalen Reaktions-Modells (nach R. Darrel Bock)

2.) ein mittels gewichteter kleinster Quadrate erstelltes lineares Regressions-Modell (nach Grizzle, Starmer und Koch — GSK).

Wie gezeigt wird, sind die letzteren beiden Verfahren, wiewohl computerorientiert, bei Kenntnis der Arbeitsweise linearer Modelle leicht zu handhaben.

Alle drei Verfahren sind asymptotisch äquivalent, jedoch konnte bei dem speziellen Datensatz eine Übereinstimmung der Ergebnisse nur bezüglich des Bock-Verfahrens und des informationstheoretischen Modells erzielt werden. Das davon stark abweichende Resultat nach dem GSK-Vorgehen wird auf die in diesem Fall ungünstige Datenlage (geringe Zellenbesetzung) zurückgeführt.
Bitstring Processing for Statistical Evaluation of Large Volumes of Medical Data
Authors: Selbmann H. K.
Published: March 2018

The evaluation of large volumes of medical data mostly consists of the determination of different frequency information often followed by computing of test statistics. To permit the calculation of this frequency information and, consequently, the analysis of the data during a dialogue, a totally inverted file structure is recommended where the individual data items are stored in bitstrings. The utilization of such a file structure in a problem-oriented programming language—favorable for statistical analysis of the data—can be ensured by eight assembler procedures. These procedures also permit an easy implementation of any optional methods of statistical evaluation based on frequency information.
Decision Theory Applied to the Treatment of Deep Vein Thrombosis
Authors: Teather D. , Emerson P. A. , Handley A. J.
Published: March 2018

This paper describes a simple application of decision theory involving a balance between the subjectively estimated risks of death from a disease and its treatment in various circumstances. A treatment allocation rule is obtained and its application to a prospective series of 62 patients is reported.
Der Einsatz des Markierungsbelegverfahrens im Rahmen einer multizentrischen Studie über die multiple Sklerose
Authors: Poseb Sigrid , Brauns K.-H.
Published: March 2018

Ziel einer multizentrischen Studie über die Ätiologie und Pathogenese der multiplen Sklerose war die Verknüpfung klinischer und experimenteller Befunde. Die Erfassung der Grunddaten von 931 Patienten erfolgte über einen Markierungsbeleg, dessen Daten über einen Belegleser dem Computer (SIEMENS 4004/35) zur Verarbeitung eingegeben wurden. Die einzelnen Schritte der Dokumentation, Abspeicherung und Auswertung werden geschildert. Folgende Anwendungsbeispiele werden gegeben:

1. Selektion bestimmter Patientengruppen für Spezialuntersuchungen oder therapeutische Studien;

2. Vergleich bestimmter Merkmale und Symptome mit Statistiken aus der Literatur;

3. Zusammenhang zwischen Erkrankungsdauer und Arbeitsfähigkeit.

Die Fehlermöglichkeiten und Schwierigkeiten der Datenverarbeitung werden geschildert und mit ähnlichen Untersuchungen aus der Literatur verglichen. Möglichkeiten der Erweiterung des Systems werden aufgezeigt.
Weekly Subject Index to Current Contents®
Authors: Gabfibld E.
Published: March 2018

Four of the six editions of Current Contents® (CC®) now carry a title-word index called the Weelcly Subject Index (WSI). The WSI provides an adjunct to Current Contents®
which permits the editions to grow with the literature growth and still allows for rapid scanning and identification of relevant articles by the reader. The T’FSI alphabetically lists every significant word from every title announced in a given CC®
issue. The result is a new access tool for CC®
which makes weeldy searches for relevant information even faster, easier and more productive. The WSI also reinforces CC’s capability for filling the time gaps between regular issues of retrospective indexes.
Maschinelle Dokumentation von klinischen und EEG-Verlaufsbeobachtungen in einer Anfallsambulanz
Authors: Doose H. , Scheffner D.
Published: March 2018

Die Verfasser berichten über ein System für die maschinelle Dokumentation von EEG- und klinischen Befunden bei Langzeitbeobachtungen von Epileptikern. Auf drei verschiedenen, durch spaltengleiche Verlochung von Kennzahlen aufeinander abgestimmten Karten (IBM, 80 Spalten) werden Vorgeschichte und Befunde, Verlaufsbeobachtungen (jahrweise zusammengefaßt) und EEG-Befunde verlocht. Außer durch maschinelle Sortierung können Verlaufsbeobachtungen durch Tabellen ausgewertet werden: Maschinelle Sortierung des Kartenmaterials nach der zeitlichen Folge der Befunderhebung und anschließende Tabellierung. Bei der Bearbeitung von speziellen Fragestellungen kann das System durch weitere Karten ergänzt bzw. durch maschinelle Zusammenziehung von bestimmten Sachverhalten auf einer neuen Karte modifiziert werden.
Über die therapeutische Versuchsplanung bei der äußeren Behandlung von Hautkrankheiten
Authors: Heite H.-J.
Published: March 2018

Bei der klinisch-therapeutischen Prüfung äußerlich wirksamer Pharmaka kann durch verschiedene Behandlung zweier Hautbezirke die Arzneiprüfung und die notwendige Kontrolle am gleichen Patienten und gleichzeitig (simultan) stattfinden. Die Voraussetzungen für den verläßlichen Vergleich zweier Hautareale werden dargelegt; insbesondere ist exakt symmetrische Lage der Hautfelder zu fordern.

Vergleich von mehr als 2 externen Medikamenten erheischt eine Versuchsanlage in unvollständigen Blöcken (bei ausgewogener Anordnung). Die Vorteile und Nachteile verschiedener Ergebnis-Protokollierung (zwei, drei und fünf Bewertungsgruppen) werden diskutiert. Verschiedene in der Literatur beschriebene mathematisch-statistische Auswertungsmethoden werden kritisch gewürdigt. Dabei wird gezeigt, daß auch in den sog. „Null-Ergebnissen” (mit fehlenden Seitenunterschieden) eine Information enthalten ist, die bei der statistischen Beurteilung berücksichtigt werden sollte. Deshalb wird zur Auswertung die Benutzung von “scores” (Punktwerten) und Anwendung des t-Testes, gegebenenfalls der Varianzanalyse empfohlen.
Quantities and Units in Clinical Chemistry
Authors: Dybkfaer R.
Published: March 2018

The author describes the efforts of the »Commission on Clinical Chemistry« of IUPAC and IFCC to standardize the concepts, symbols and units used in the clinical laboratory which is a presupposition for an international comparability of laboratory data. The proposals of the commission have been published in a Recommendation 1966.
Humaris — An Automated Medical Data Management System
Authors: Minckleh T. M. , Ausman R. K. , Graham T. , Newell G. R. , Levine P. H.
Published: March 2018

The Human Materials .Resources information System (HUMARIS) is the computer-based automated medical data activity of the National Cancer Institute’s Human Tissue Procurement Program.

The system is designed to process, store, and retrieve the clinical and investigative information from as many as 1,500 surgical and autopsy cases per year, providing diagnostic lists, case summaries, inventories, statistical reports, bactériologie resumes, and extensive administrative records as routine machine output. The opportunity for research utilization of data is unlimited.

A relatively simple but effective medical data acquisition system is described.
Der Vergleich von Überlebensquoten bei tödlichen Erkrankungen mittels eines modifizierten BO AG -Verfährens
Authors: Kaufmann H.
Published: March 2018

Eine Analyse von mehreren in der Literatur mitgeteilten und nach dem Verfahren von Boag dargestellten Behandlungsergebnissen bei tödlich verlaufenden Erkrankungen ergibt, daß die Streuungen der zugrunde liegenden Verteilungen nicht wesentlich verschieden sind. Unter Annahme einer gemeinsamen Streuung von 0,45 wird ein Nomogramm für einen orientierenden Signifikanztest mit α = 0.05 entwickelt.
Analyse der wissenschaftlichen Aktivität verschiedener Länder auf dem Gebiet der Immunologie anhand einer Literaturdokumentation
Authors: Hummel K. , Rau J.
Published: March 2018

13 264 Referate von wissenschaftlichen Arbeiten auf dem Gebiet der Immunologie und Serologie der Jahrgänge 1953-64 von »Excerpta Medica« wurden nach Sachgebiet, Art des Herkunftslaboratoriums, Anzahl der beteiligten Autoren und Herkunftsland statistisch ausgewertet. Unter den Themen (ohne die über Poliomyelitis-Serologie) nehmen solche über Blutgruppenserologie und die Serologie der Bluttransfusion mit 26% den breitesten Raum ein; an zweiter Stelle, mit 16%, stehen Arbeiten über Antigene, Antikörper und Autoimmunisierung.

Die meisten Arbeiten stammen aus theoretischen Instituten; der Anteil aus Kliniken ist geringer. Industrielaboratorien sind vor allem in den USA an der Forschung beteiligt. Teamarbeit wird bevorzugt in den USA geleistet. Ein Zusammenhang zwischen der Verbreitung der Teamarbeit und der Intensität der Forschung ist nicht nachweisbar, doch nimmt die Teamarbeit ständig zu, besonders die aus verschiedenen Häusern.

Im Verlauf der 12 Jahre konnten die USA ihren Anteil an der Zahl referierter Arbeiten von 22% auf 40% erhöhen. Der Anteil Europas an den referierten Arbeiten fiel in der gleichen Zeit ab, vor allem durch einen Schwund des Beitrags aus den romanischen und deutschsprachigen Ländern. Aus Deutschland (BRD + DDR) wurde über 1 Jahrzehnt lang eine etwa gleichgroße Zahl Arbeiten referiert; erst 1963/64 scheint sich ein Anstieg bemerkbar zu machen. 1960-63 wurden aus der DDR mehr Arbeiten pro Kopf der Bevölkerung referiert als aus der BRD.

Die Reihenfolge der Länder Deutschland (BR), Frankreich, Großbritannien, Italien, Schweden, USA ist etwa die gleiche, ob nach Zahl referierter Arbeiten/Einwohner, nach Zahl Arbeiten/Ärzte oder nach Zahl Arbeiten/Medizinstudenten geordnet wird: 1953 bildeten Frankreich, Italien und die Bundesrepublik die Spitze, 1962 Schweden, die USA und Großbritannien. — Der Wert einer Wissenschaftsanalyse aus der quantitativen Literaturdokumentation wird diskutiert.
Computer Processing of Routine Psychiatric Records
Authors: Richman A.
Published: March 2018

The feasibility of computer processing of routine medical records is described. This can be done centrally with existing computer facilities. In the peripheral component of a reporting system, an efficient manual processing system can be provided by use of the PABLUM-1 system.
Das Problem der klinischen Befunddokumentation in der Sicht der mathematischen Logik
Authors: Fuchs G.
Published: March 2018

Drei Hauptprobleme der klinischen Befunddokumentation sind:

1. die zweckmäßige Auswahl der zu codierenden Informationen

2. optimale Codierung

3. Anpassung an die maschinellen Hilfsmittel

In Anlehnung an frühere Empfehlungen wird eine Informations aus wähl für eine Patienten-Leitkarte vorgeschlagen. Mit den Hilfsmitteln der mathematischen Logik läßt sich zeigen, daß alle denkbaren Verknüpfungen dieser Informationen sich auf die Grundverknüpfungen Negation (»nicht«) und Konjunktion (»sowohl als auch«) reduzieren lassen. Dazu müssen allerdings die Fragestellungen in logi-stischer Schreibweise formuliert und nach den Regeln der Boole-Algebra umgeformt werden. Anhand von 2 Beispielen wird das Verfahren erläutert.
False-Positive and False-Negative Misclassification of Liver Scans
Authors: Barnett V.
Published: March 2018

Liver scans are used in the study of hepatic cancer. Changes in the size of perfusion defects may prompt the judgment of progression or regression of the disease. Assessments of change of size are usually made subjectively and there is the possibility that different investigators may differ in their assessments of a perfusion defect or that a particular investigator may not be consistent in his assessment from one time to another. Various possibilities of misclassification exist. A defect which is unchanged may be adjudged to have progressed or regressed (false-positive misclassification); true progression (or regression) may fail to be discerned (false-negative misclassification).

An experiment was conducted to examine the assessment of perfusion defect areas by a group of experienced oncologists examining a set of liver scans. Misclassification probabilities were estimated and their extent gives grounds for concern. False attribution of progression (or regression) at the 50% level occurs with probabilities in the range 0.23 to 0.37. Failure to adjudge progression (regression) at the 50% level, where there is true progression at the 100% level, arises with an estimated probability in the range 0.20 to 0.26. The higher values refer to cases where different investigators examine the scans on two occasions; the lower values when one investigator makes both assessments. Unjustified rounding-off of measured values seems an important factor in the occurrence of misclassification.
Accuracies of Computer versus Manual Linkages of Routine Health Records
Authors: Smith Martha E. , Newcombe H. B.
Published: March 2018

Empirical tests of the application of computer record linkage methods versus the use of routine clerical searching, for bringing together various vital and ill-health records, have shown that the success rate for the computer operation was higher (98.3 versus 96.7 per cent) and the proportion of false linkages very much lower (0.1 versus 2.3 per cent). The rate at which the ill-health records were processed by the computer was approximately 14,000 per minute of central processor time, representing a cost of a half a cent apiece.

Factors affecting the speed, accuracy and cost of computerized record linkage are discussed.
Ein benutzerfreundliches Auswerte- und Archivierungssystem für die Computerszintigraphie
Authors: Schmidlin P.
Published: March 2018

Auf der zentralen Rechenanlage des Deutschen Krebsforschungszentrums Heidelberg wurde ein System für die Auswertung und Archivierung von digital gespeicherten Szintigrammen entwickelt. Das System vereinigt Flexibilität mit leichter Handhabung. Es ermöglicht eine weitgehende Automatisierung der Abläufe bei der Szintigrammverarbeitung. Auf diese Weise kann auch ein großer Datenanfall mit geringem Arbeitsaufwand erledigt werden. Der Ablauf wird durch die Kennung der Szintigramme festgelegt und durch vorgespeicherte Verarbeitungspläne gesteuert. Zur Korrektur von Fehlern in der Kennung sowie zur Durchführung von speziellen Verarbeitungswünschen kann in den Ablauf eingegriffen werden. Während des Laufs werden die jeweils aktuellen Verarbeitungszustände festgehalten, so daß die Verarbeitung nach einer Programmunterbrechung unmittelbar fortgesetzt werden kann.
Indikationsstellung für die zerebrale Angiographie. Entwicklung eines Bayes-Programms zur Entsclieidungsliilfe
Authors: von Cramon D. , Mai N. , Hachmann E. , Henrich G. , Brinkmann R.
Published: March 2018

Die Anwendung der zerebralen Angiographie bei Patienten mit raumfordernden oder vaskulären Hirnprozessen ist mit einer Reihe von Risiken verbunden. Es wurde ehi Bayes-Programm entwickelt, das den Arzt bei der Indikationsstellung zur zerebralen Angiographie unterstützen soll. In das Programm gehen nur Daten ein, die vor einer Angiographie relativ leicht erhoben werden können. Das Programm basiert auf der Auswertung von 328 Krankengeschichten von Fällen mit abschließend überprüfter Diagnose. Reklassifikationsergebnisse sowie weitere Daten über die Klassifikationsleistung demonstrieren die mögliche Verbesserung der Indikationsentscheidungen.
Ein einfaches Programm zur Abspeicherung und Auswertung medizinischer Daten auf einem Prozeßrechner
Authors: Smidt U.
Published: March 2018

Es wird ein Daten-Abspeicherungs- und Auswerteprogramm für einen Prozeßrechner PDP-12 beschrieben, dessen Benutzung auch für den EDV-ungeübten Mediziner sehr einfach ist. Pro Magnetband können 896 Fälle mit je bis zu 128 Daten — als Querschnitt oder Längsschnitt — abgespeichert werden. Als Auswertung werden Häufigkeiten, einfache und partielle Korrelationen some Vierfeldertafeln berechnet. Außer der numerischen Ausgabe auf einem Fernschreiber ist auch eine graphische Ausgabe auf einem Speicherbildschirm als Punktediagramm, Säulendiagramm oder — vor allem bei Längsschnitten — als Vektordiagramm möglich. Aus jedem Patientenkollektiv können durch Angabe von bis zu 6 Bedingungen entsprechende Untergruppen für die Auswertung selektiert werden.
HECLINET — Health Care Literature Information Network
Authors: Schaad R. , Swertz P.
Published: March 2018

In the field of hospital care there lias been cooperation between various European hospital institutes in the last few years. Since 1970, a working party for information and documentation has been in operation, which was institutionalized as a Study Committee of the International Hospital Federation in 1973.

A survey of this Study Committee showed a large degree of parallel and multiple work being done in the European documentation centers for hospital care. With a view to avoiding this duplication of work, a sensible division of labour has been initiated since 1968 by the Institute for Hospital Building of the Technical University of Berlin and the German Hospital Institute — an institute affiliated to the University of Düsseldorf. Thereby the national hospital literature is being indexed in the individual countries, but centrally collected, suitable for EDP. A magnetic tape service and an on-line access to a data bank in Düsseldorf are offered to the hospital institutes concerned.

Within the framework of the network system, the original literature cited is made available to the partners on microfiche.

For official institutionalization of the documentation network, an organizational concept has been developed, termed HECLINET (.Health Care. Literature information JVeiwork), which is at present being discussed with all the institutions concerned.