bluuebunny/crossref_metadata_2025 huggingface dataset:
Measurement of Bone Mineral Content to Facilitate an Objective Evalution of Limp Function in the Dog
Authors: Petersen M. M. , Wenck A. , Strøm Henriette , Svalastoga E.
Published: March 2018

The aim of this study was to evaluate the feasibility of using measurements of bone mineral content (BMC) and bone mineral density (BMD) by dual photon absorptiometry (DPA; Gadolinium-153), as an objective measure of limb functional status in the dog. The in vitro accuracy error expressed as the standard error of the estimate (SEE) for BMC and BMD measurements was 3.2% and 1.1% respectively, and the precision in vivo for measurements of BMC and BMD in the distal diaphysis of the tibia and fibula was 2.1% and 1.9% respectively. A significant difference in bone mineral between right and left leg was not found in normal dogs, and in these dogs the average percentage intra-individual difference, between bone mineral in the legs with the highest bone density and the legs with the lowest density, was 2.2% and 3.7% for BMC and BMD respectively. However the BMC and BMD in eight clinical cases of unilateral lameness were significantly decreased in the affected legs, when compared to the healthy contralateral legs, by 20.4% (P = 0.01) and 18.3% (P = 0.01)respectively. Measurements of BMC and BMD by DP A in weight-bearing extremities in the dog showed that bone mineral is highly sensitive to decreased loading of the extremity. This method might well be used not only as an objective measure of limb activity, but also for measurement of prospective changes in bone mineral, following treatment of musculoskeletal diseases and injuries.

The feasibility of using bone mineral measurements by dual photon absorptiometry, as an objective measure of limb functional status in the dog, was evaluated. Precision and accuracy were calculated from in vitro and in vivo studies. In eight cases of unilateral lameness bone mineral was significantly decreased (20%) in the affected legs when compared to the healthy contralateral legs.
Ischio-Ilial Pinning for Stabilization of Coxofemoral Luxations in Twenty-One Dogs: A Retrospective Evaluation
Authors: Lewis D. D. , Parker R. B. , Macpherson G. C. , Kuntz C. A. , Beale B. S.
Published: March 2018

Twenty-one dogs with craniodorsal coxofemoral luxation were managed with placement of an ischio-ilial pin. The overall success rate in maintaining reduction was 73%, with pins placed at a central position resulting in the lowest incidence of reluxation (p = 0.095). Postoperative complications included pin migration (n = 2), septic arthritis (n = 1), pressure sores n = 3), and decubital ulcers (n = 1).
The “Mixing” of Implant Systems
Authors: Baumgart F.
Published: March 2018

The so-called “mixing” of implants and instruments from different producers entertain certain risks.

The use of standardized implant materials (e.g. stainless steel ISO 5832/1) from different producers is necessary but is not sufficient to justify the use of an osteosynthesis plate from one source and a bone screw from another.

The design, dimensions, tolerances, manufacturing procedure, quality controls, and application technique of the instruments and implants also vary according to make. This can lead to damage, failure or fracture of the biomechanical system called “osteosynthesis” and hence the failure of the treatment undertaken. In the end, it is the patient who pays for these problems.

Some examples also illustrate the potential problems for the staff and institutions involved.

The use of a unique, consistent, well-tested, and approved set of implants and instruments is to be strongly recommended to avoid any additional risk.
Carmustin-Wafer in der multimodalen Therapie des Glioblastoma multiforme
Authors: Gutowski P. , Lemcke J. , Gräwe A. , Meier U. , Gölz L.
Published: March 2018

Ziel: Retrospektive Analyse über Nutzen und Risiken der Carmustin-Therapie in der multimodalen Therapie des Glioblastoma multiforme.

Material und Methoden: Patienten mit Glioblastoma multiforme wurden zwischen 2008 und 2011 unter Einsatz von Carmustin operiert. Es wurden unerwünschte Ereignisse protokolliert und retrospektiv die Sterbedaten eingeholt.

Ergebnisse: Von 88 operierten Patienten wurde bei 30 Carmustin-Wafer implantiert. 69 unerwünschte Ereignisse traten in beiden Therapiegruppen im postoperativen Verlauf bis zum Versterben der Patienten oder bis zum Untersuchungszeitpunkt auf. Die durchschnittliche Überlebenszeit in der Gruppe der mit Carmustin therapierten Patienten lag bei 385 Tagen versus 343 Tage ohne Carmustin-Therapie (p = 0,41).

Schlussfolgerung und klinische Relevanz: Durch den Einsatz von Carmustin konnte kein Überlebensvorteil, jedoch auch keine erhöhte Toxizität innerhalb des multimodalen Ansatzes für dieses Patientenkollektiv nachgewiesen werden. Trotz des zu erwartenden Nutzens für weniger als 20% aller Glioblastompatienten scheint es sinnvoll, die multimodale Therapie mit Carmustin-Wafern bei selektierten Patientengruppen weiter prospektiv zu erforschen.
Behandlung neuropsychiatrischer Störungen bei Demenz mit Antipsychotika
Authors: Gertz H. J.
Published: March 2018

Insgesamt treten bei fast 90% aller Demenzkranken im Verlauf der Erkrankung Verhaltensstörungen auf. Psychopharmaka werden zur Behandlung neuropsychiatrischer Symptome bei Demenz eingesetzt. Besonders häufig ist die Gabe von AP in dieser Indikation. In Umfragen sind die meisten Ärzte der Meinung AP würden in dieser Indikation gut wirken. Tatsächlich ist die Wirksamkeit von AP bei neuropsychiatrischen Störungen bei Demenz nicht sehr gut nachgewiesen und insgesamt erstaunlich gering. Demgegenüber sind die Risiken erheblich insbesondere bezüglich zerebrovaskulärer unerwünschter Arzneimittelwirkungen. Zielsymptome jeder Behandlung bei Patienten mit Demenz müssen klar benannt werden. An erster Stelle stehen verhaltens- und milieutherapeutische Maßnahmen. Der Einsatz von AP sollte die letzte Option sein und unter strenger Therapiekontrolle erfolgen.
Krankheitsmodifizierende Behandlungen
Authors: Jessen F. , Dodel R.
Published: March 2018

Die Demenz vom Alzheimer-Typ ist die häufigste neurodegenerative Erkrankung und mehr als 15 Millionen Menschen sind weltweit betroffen. Die Erkrankung ist klinisch charakterisiert durch eine progressive Gedächtnisstörung, kognitiven Abbau und Einbußen in den Aktivitäten des täglichen Lebens; histopathologisch ist die Erkrankung definiert durch den Nachweis von ²-Amyloidplaques (A²), die aus aggregiertem A²-Peptiden bestehen und neurofibrillären Bündeln, die aus hyperphophoryliertem Tau-Protein entstehen. Die zur Testung gelangenden Therapieansätze fußen überwiegend auf diesen beiden Mechanismen. Insbesondere Therapieansätze basierend auf der Amyloidkaskaden-Hypothese, wie ³-Sekretaseinhibitoren, Inhibitoren der ²-Sekretase und immuntherapeutische Ansätze standen in den letzten Jahren im Mittelpunkt der Entwicklung. Ziel dieses Artikels ist es, die in der klinischen Entwicklung befindlichen krankheitsmodifizierenden Therapieansätze, die auf der Amyloidkaskaden-Hypothese beruhen, kurz darzustellen.
Dystonie-Patienten unter der Behandlung mit Botulinumtoxin
Authors: Loh A. , Jost W. H.
Published: March 2018

Einleitung: Körperliche Beschwerden, psychosoziale Belastungen und Erwartungen der Patienten mit Dystonie sind hoch. Patientenzufriedenheit und Therapietreue wurden in einer Patientenbefragung untersucht.

Methoden: Internetbasierte Befragung mittels eines Fragebogens mit 28 Likert-skalierten und dichotomen Fragen, Ergebnisauswertung deskriptivstatistisch. Teilgenommen haben 183 Mitglieder der Deutschen Dystonie Gesellschaft (Rücklaufquote 38,1%). 66,7% werden aktuell mit Botulinumtoxin A behandelt.

Ergebnisse: Subjektive Belastungen sind hoch (74,4% der Patienten im Kontaktverhalten, 51,9% durch körperliche Beschwerden, 67,8% durch depressive Befindlichkeit, 77,0% durch Ängste vor dem Verlauf der Erkrankung, 88,5% durch funktionale Beeinträchtigungen). Die Patientenzufriedenheit lag bei einem Mittelwert von 2,1 (1, sehr zufrieden, 4, sehr unzufrieden). Die höchsten Belastungswerte haben Existenzängste und Ängste vor Arbeitsunfähigkeit (Mittelwert 1,0 auf einer Skala von 1 bis 4). 44,3% der Patienten erwarten zukünftig geringere Behandlungseffekte. 66,4% der Patienten geben an, die Behandlung sicher weiterzuführen zu wollen.

Diskussion: Die Patientenzufriedenheit ist trotz bestehender Belastungen insbesondere bezüglich Angst und depressiven Stimmungen hoch, die Inanspruchnahme der Patienten ist geringer. Das Thematisieren der Wirkungserwartungen im Verlauf und das Einbeziehen der Ängste vor der Behandlung sowie der depressiven Stimmungen kann die langfristige Inanspruchnahme erhöhen.
Intramuskuläre Verteilung von Botulinumtoxin im spastischen Muskel
Authors: Kasprian G. , Weber M. , Meyerspeer M. , Kranz G. , Linder C. , Auff E. , Prayer D. , Sycha T. , Elwischger K.
Published: March 2018

Gegenstand und Ziel: Ziel dieser Pilotstudie war die Visualisierung der Primärverteilung des Botulinumtoxin(BoNT)-Bolus bei Oberarmspastik (OAS) und unterschiedlicher Volumina beim Gesunden (K) mittels Magnetresonanztomografie (MRT).

Material und Methoden: Sagittale dynamische BFFE-Sequenzen überwachten die Injektion von 1 ml NaCl/BoNT-Bolus in den spastischen (n = 4), 1 ml NaCl in den rechten gesunden, bzw. 2 ml NaCl in den linken gesunden M. bizeps brachii bei K (n = 6).

Ergebnisse: Eine unmittelbar zunehmende Hyperintensität parallel der Muskelfasern war in der primären Längsausdehnung (Mittel: K: 1 ml: 5,3 cm; 2 ml 5,7 cm; OAS: 3,3 cm) in OAS vs. 1 ml K signifikant niedriger (p = 0,008). Die primäre Tiefenausdehnung (Mittel: K: 1 ml: 0,5 cm; 2 ml: 0,9 cm; OAS: 0,7 cm) war in 2 ml K vs. 1 ml K signifikant (p = 0,002), und in OAS vs. 1 ml K (nicht signifikant) erhöht.

Schlussfolgerungen: Im Gesunden verteilte sich der Hauptanteil längs der Muskelfasern. Im spastischen Muskel war die Längsausdehnung signifikant vermindert.

Klinische Relevanz: Der BoNT-Effekt könnte durch Verteilung in verschiedene Tiefen (Stichrichtung normal zu Muskelfasern) sowie bei OAS durch zusätzliche Injektionsstellen entlang des Muskelfaserverlaufs verbessert werden.
Angeborene ZNS-Fehlbildungen als Epilepsieursache bei Erwachsenen
Authors: Kurzbuch K. , Kasper B. S.
Published: March 2018

Unter Erwachsenen sind angeborene Fehlbildungen des Gehirns nicht selten die Ursache einer Epilepsie. Dieser Sachverhalt ist unterschätzt, die betreffenden Läsionen noch zu wenig bekannt. Dieser Artikel stellt wesentliche Gehirnfehlbildungen als Epilepsieursache vor, vor allem noduläre Heterotopien, Bandheterotopien, Polymikrogyrie, tuberöse Sklerose und fokale kortikale Dysplasie. Aspekte der Diagnostik, Beratung und Therapie werden erläutert.
Bifrontale transkranielle Gleichstromstimulation zur Behandlung der Schizophrenie
Authors: Hasan A. , Dehning S. , Keeser D. , Hummel I. , Falkai P. , Padberg F. , Palm U.
Published: March 2018

Gegenstand und Ziel: Die transkranielle Gleichstromstimulation (transcranial direct current stimulation, tDCS) wird als neues nicht invasives Hirnstimulationsverfahren für die Behandlung neurologischer und psychiatrischer Erkrankungen untersucht. Mittlerweile gibt es Fallberichte und eine randomisierte, kontrollierte Pilotstudie zur Behandlung akustischer Halluzinationen sowie der Negativsymptomatik bei Schizophrenie. Fallbericht: Im vorliegenden Fallbericht wurde ein Patient mit therapieresistenter Symptomatik bei paranoider Schizophrenie drei Wochen lang mit anodaler tDCS über dem linken dorsolateralen und kathodaler tDCS über dem rechten dorsolateralen Kortex behandelt. Ergebnisse: Es zeigte sich eine Verbesserung von Affektivität und Kognition, die Positivsymptome blieben jedoch nahezu unverändert. Klinische Relevanz: Die bifrontale tDCS stellt eine nebenwirkungsarme neue Behandlungsform dar und sollte in der Anwendung bei Erkrankungen aus dem schizophrenen Formenkreis weiter untersucht werden.
Neurostimulationsverfahren in der Epilepsiebehandlung
Authors: Lang N. , Meyne J.
Published: March 2018

Neurostimulationsverfahren zur Epilepsietherapie haben in den vergangenen Jahren eine rasche Weiterentwicklung erlebt. Neben der Vagusnervstimulation liegen nun auch für die tiefe Hirnstimulation des Nucleus anterior thalami und die responsive Fokusstimulation positive Ergebnisse aus Phase-III-Studien vor. Mit den transkutanen Stimulationsverfahren der externen trigeminalen Stimulation und der transkutanen Vagusnervstimulation stehen zudem auch nicht invasive Stimulationsmethoden zur Verfügung, welche jedoch noch einer weiteren klinischen Prüfung bedürfen. Der vorliegende Artikel soll die einzelnen Stimulationsverfahren beleuchten und ihren Einsatz in der Epilepsiebehandlung einordnen.
Thermoablation für fokale Epilepsien
Authors: Wörmann F. G. , Kopitzki K. , Kluge C. , Büntjen L. , Schmitt F. C.
Published: March 2018

Die Thermoablation wurde in der Epilepsiechirurgie bereits in den 1950er-Jahren vereinzelt angewandt, dann aber aufgrund der Überlegenheit resektiver Verfahren verlassen. Die Zunahme der Kenntnis über epileptische Netzwerke, über die Propagation und Semiologie von Anfällen sowie über die Pathophysiologie der Epilepsiesyndrome erlaubt inzwischen eine wesentlich differenziertere Hypothesenbildung bezüglich der Lokalisation des epileptischen Netzwerks. Thermoablation bietet im Vergleich zum klassischen resektiven Vorgehen zwei Vorteile. Zum einen ist sie weniger invasiv, zum anderen wiederholt anwendbar. Zudem ist ein nachfolgendes resektives epilepsiechirurgisches Verfahren im Rahmen eines abgestuften Therapiekonzeptes möglich. Die Thermoablation bietet – wie neuere Studien belegen für spezielle Epilepsiesyndrome eine Alternative zur klassischen resektiven Herangehensweise. Im Folgenden wird die aktuelle Datenlage zu diesem Verfahren zusammengefasst. Anhand von zwei Fallbeispielen soll gezeigt werden, dass eine gezielte Patientenauswahl die post-operative Prognose des Verfahrens wesentlich verbessern kann.
Physicians’ Choice in Using Internet and Fax for Patient Recruitment and Follow-up in a Randomized Controlled Trial
Authors: Morita S. , Fukui T. , Sakamoto J. , Rahman M.
Published: March 2018

Objective:
To examine the physicians’ preference between Web and fax-based remote data entry (RDE) system for an ongoing randomized controlled trial (RCT) in Japan.

Methods:
We conducted a survey among all the collaborating physicians (n = 512) of the CASE-J (Candesartan Antihypertensive Survival Evaluation in Japan) trial, who have been recruiting patients and sending follow-up data using the Web or a fax-based RDE system. The survey instrument assessed physicians’ choice between Web and fax-based RDE systems, their practice pattern, and attitudes towards these two modalities.

Results:
A total of 448 (87.5%) responses were received. The proportions of physicians who used Web, fax, and the combination of these two were 45.9%, 33.3% and 20.8%, respectively. Multivariate logistic regression analyses revealed that physicians 55 years or younger [odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.1-3.3] and regular users of computers (OR = 4.2, 95% CI = 2.1-8.2) were more likely to use the Web-based RDE system.

Conclusions:
This information would be useful in designing an RCT with a Web-based RDE system in Japan and abroad.
Application of a Prediction Model for Identification of Individuals at Diabetic Risk
Authors: Edington D. W. , Park J.
Published: March 2018

As a follow-up to our preceding paper, we attempted to extract features of health risk progression for diabetes in Sequential Multi Layered Perceptron (SMLP) via inverse processing of the learned structure. The time-varying risk progress was assessed with risk trajectory and conditional mixture model.

Overall risk cut along with the prediction was stable over time and high body mass index (BMI) tops the health behavioral risks predicting the onset of diabetes. For the initial prediction, high BMI (obesity), high blood pressure (BP), high cholesterol, and diet in fatty food were significant. Over time, variations in trajectory were due to changes in BMI, stress, BP, cholesterol, and fatty food intake.

We tested the effectiveness of identifying prediabetics by the SMLP by applying the implemented SMLP to a test population of employees from a large manufacturing company, where an early worksite health promotion was initiated (1984). This resulted in a potential sensitivity (71.4%) although there were issues like mapping corresponding risks and large time lags.

A secondary test on the similar population as in the previous paper showed a promising sensitivity (86.5%) over 3 years.

When combining with targeted screening such as impaired glucose tolerance test only for those predicted to be diabetics, the presented prediction model and extracted features can be used in implementing an effective disease prevention and management program.
Statistical Linkage of Treatment to Diagnosis for Research and Monitoring of Practice Patterns
Authors: Falkoe E. , Maclure M. , Schroll H. , Rasmussen K. B.
Published: March 2018

Objectives:
At each patient contact general practitioners enter information about the diagnoses and the interventions in the electronic medical record (EMR) system. If there is only one diagnosis during a single patient-physician contact, then a causal connection between the diagnosis and the intervention is established. Otherwise it is uncertain what may have been the cause of the intervention.

Methods:
Ideally the general practitioners would record a match between each intervention and the diagnosis that justifies it. However, most EMR software is not capable of recording explanatory matches. Furthermore, supplying the matches is a resource-demanding task. In this study the general practitioners were supplied with a matching module for the EMR, so data with full matching between intervention and diagnosis was collected (our “gold standard“). The study models how close the full matching can be recreated by model linkage using different kinds of simple assumptions.

Results:
The modeling demonstrates a raise in the measure of prediction (sensitivity) from 41.9 percent for a completely random linkage to 90.9 percent based on simple assumptions in the model. The small substantial potential further gain makes it less attractive to apply more intricate assumptions or use more complex modeling (including neural networks).

Conclusions:
The perspective of the study lies in the support of the general practitioners with software for comparison of their decisions with those of their peers and also with guidelines. Thus a system for simple quality assurance and awareness to untypical decisions could be incorporated into the electronic medical record systems.
Grid Requirements for the Integration of Biomedical Information Resources for Health Applications
Authors: Oliveira J. L. , Sanchez J. P. , López-Alonso V. , Martin-Sanchez F. , Maojo V. , Sousa Pereira A. , Oliveira I. C.
Published: March 2018

Objectives:
The goal of this paper is to identify how Grid technology can be applied for the development and deployment of integration systems, bringing together distributed and heterogeneous biomedical information sources for medical applications.

Methods:
The integration of new genetic and medical knowledge in clinical workflows requires the development of new paradigms for information management in which the ability to access and relate disparate data sources is essential. We adopt a requirements perspective based on the user needs we have identified in the development of the INFOGENMED system to assess current Grid technology against those requirements.

Results:
The gap between Grid features and distributed biomedical information integration needs is characterized. Results from prospective studies are also reported.

Conclusions:
Grid infrastructures offer advanced features for the deployment of collaborative computational environments across virtual organizations. New Grid developments are in line with the problem of multiple site information integration. From the INFOGENMED point of view, Grid infrastructures need to evolve to implement structured data access services and semantic content description and discovery.
Interoperability and HealthGRID
Authors: Schmitt D. , Kass J. , García-Barbero M. , Kantchev P. , Bescos C.
Published: March 2018

Objectives:
GRID technology, with initiatives like the GGF, will have the potential to allow both competition and interoperability not only among applications and toolkits, but also among implementations of key services.

The pyramid of eHealth interoperability should be achieved from standards in communication and data security, storage and processing, to the policy initiatives, including organizational protocols, financing procedures, and legal framework.

The open challenges for GRID use in clinical fields illustrate the potential of the combination of grid technologies with medical routine into a wider inter-operable framework.

Methods:
The Telemedicine Alliance is a consortium (ESA, WHO and ITU), initiated in 2002, in building a vision for the provision of eHealth to European citizens by 2010. After a survey with more that 50 interviews of experts, interoperability was identified as the main showstopper to eHealth implementation.

Results:
There are already several groups and organizations contributing to standardization. TM-Alliance is supporting the “e-Health Standardization Coordination Group” (eHSCG).

Conclusions:
It is now, in the design and development phase of GRID technology in Health, the right moment to act with the aim of achieving an interoperable and open framework. The Health area should benefit from the initiatives started at the GGF in terms of global architecture and services definitions, as well as from the security and other web services applications developed under the Internet umbrella. There is a risk that existing important results of the standardization efforts in this area are not taken up simply because they are not always known.
Security and Confidentiality Approach for the Clinical E-Science Framework (CLEF)
Authors: Singleton P. , Milan J. , MacKay J. , Detmer D. , Rector A. , Ingram D. , Kalra D.
Published: March 2018

Objectives:
CLEF is an MRC sponsored project in the E-Science programme that aims to establish methodologies and a technical infrastructure for the next generation of integrated clinical and bioscience research.

Methods:
The heart of the CLEF approach to this challenge is to design and develop a pseudonymised repository of histories of cancer patients that can be accessed by researchers. Robust mechanisms and policies have been developed to ensure that patient privacy and confidentiality are preserved while delivering a repository of such medically rich information for the purposes of scientific research.

Results:
This paper summarises the overall approach adopted by CLEF to meet data protection requirements, including the data flows, pseudonymisation measures and additional monitoring policies that are currently being developed.

Conclusion:
Once evaluated, it is hoped that the CLEF approach can serve as a model for other distributed electronic health record repositories to be accessed for research.
Interactive Volume Reconstruction and Measurement on the Grid
Authors: Osorio A. , Texier R. , Germain-Renaud C.
Published: March 2018

Objectives:
To prove the advantages of integrating grid computing within medical image analysis software, and to discuss the technological, sociological and health care-related issues.

Methods:
Presentation of an instant volume reconstruction and measurement tool (PTM3D) used in clinical practice, including percutaneous nephrolithotomy examples; description of a parallel implementation of volume reconstruction, evaluation of this implementation on lung and body reconstruction, presentation of the technical limitations for clinical use and description and discussion of a prototype grid implementation.

Results:
Volume reconstruction can broaden its medical scope and use by accessing high-performance computing systems; interactive exploration of medical images can co-exist with the usual batch workload of grid systems; the EGEE grid middleware offers some of the required core services; a fully adequate computing environment needs further evolution to integrate real-time constraints.

Conclusions:
Clinical experiments of a grid-enabled PTM3D become possible. Widespread adoption of grid technology in the medical images analysis field will benefit from this “early user” project. Convergences appear between two broadly different fields, high energy physics and medical image, towards the need of a smooth integration of the new resources offered by grid systems into the everyday tools of their respective end-users. It can be expected that the convergence will mature towards truly interactive grids, able to serve the needs of the medical community.
A Procedural Model for Planning and Evaluating Behavioral Interventions
Authors: Hyner G. C.
Published: March 2018

Objective:
A model for planning, implementing and evaluating health behavior change strategies is proposed. Variables are presented which can be used in the model or serve as examples for how the model is utilized once a theory of health behavior is adopted.

Results:
Examples of three innovative strategies designed to influence behavior change are presented so that the proposed model can be modified for use following comprehensive screening and baseline measurements. Three measurement priorities: clients, methods and agency are subjected to three phases of assessment: goals, implementation and effects.

Conclusion:
Lifestyles account for the majority of variability in quality-of-life and premature morbidity and mortality. Interventions designed to influence healthy behavior changes must be driven by theory and carefully planned and evaluated. The proposed model is offered as a useful tool for the behavior change strategist.
Cancer Screening Beliefs and Reactions to an Innovative Colorectal Cancer Screening Kit among Chinese Worksite Population
Authors: Chen P. , Hou S.
Published: March 2018

Objectives:
This study assessed the relationships between cancer screening beliefs (perceived pros, cons, and susceptibility) and reactions (acceptance, self-efficacy, intention to purchase) to an innovative home-administered kit (HAK) for fecal occult blood test (FOBT) among Chinese worksite population.

Methods:
A total of 450 Chinese people aged 40 and older were recruited from ten worksites in Taiwan (2002), with response rate of 83% (375/450).

Results:
All the belief scales of cancer screening in general showed good internal consistency (Cronbach alphas >0.70). Perceived benefits and barriers to-wards cancer screening were significantly correlated with the acceptance, self-efficacy, and order intention towards the FOBT-HAK (p-values <0.001). Perceived susceptibility of cancer was associated with intention to purchase. After taking gender into consideration, the regression analyses showed similar relationships.

Conclusions:
Screening beliefs were significantly associated with reactions toward the innovative FOBT-HAK. Intervention programs addressing these beliefs could potentially promote positive reactions to innovative CRC screening strategies.
Effective Prevention of Carotid Artery Atherosclerosis by Following this Motto for Healthy Habits: “Give Up One, Reduce Two, and Increase Three”
Authors: Fujishiro K. , Fukumoto T. , Joki M. , Wada T.
Published: March 2018

Objectives:
Lifestyle has a major influence on the development and progression of atherosclerosis. Our motto for healthy habits is “give up one, reduce two, and increase three”. The one thing that is to be given up is smoking. The two things that are to be reduced are intake of food and alcohol. The three things that are to be increased are exercise, rest and enjoyable activities. We assessed correlation between these six-health habits and plaque score indicating degree of atherosclerosis in the carotid artery.

Methods:
Subjects were divided into unfavorable (practicing zero to three habits) and optimal (practicing four to six habits) healthy habits groups.

Results:
Plaque score was significantly higher in the unfavorable group (7.6 ± 5.8) than in the optimal group (4.9 ± 4.2) (P<0.001).

Conclusions:
The healthy habits that significantly contributed to prevention of atherosclerosis were quitting smoking and increasing rest and enjoyable activities.
Induction of Similarity Measures and Medical Diagnosis Support Rules through Separable, Linear Data Transformations
Authors: Bobrowski L.
Published: March 2018

Objectives:
To improve the medical diagnosis support rules based on comparisons of diagnosed patients with similar cases (precedents) archived in a clinical database. The case-based reasoning (CBR) or the nearest neighbors (K-NN) classifications, which operate on referencing (learning) data sets, belong to this scheme.

Methods:
Inducing similarity measure through special linear transformations of the referencing sets aimed at the best separation of these sets. Designing separable transformations can be based on dipolar models and minimization of the convex and piecewise linear (CPL) criterion functions in accordance with the basis exchange algorithm.

Results:
Separable linear transformations allow for some data sets to decrease the error rate of the K-NNclassification rule based on the Euclidean distance. Such results can be seen on the example of data sets taken from the Heparsystem of diagnosis support.

Conclusions:
Medical diagnosis support based on the CBRor the K-NNrules can be improved through separable transformations of the referencing sets.
Using Computer and Internet-based Resources to Teach Health Care Planning and Administration in an Undergraduate Medical Program
Authors: Bordin R. , Fisher P. D. , Klück M. M. , Rosa R. S.
Published: March 2018

Objective:
We describe the teaching methods, involving computer and Internet-based resources, used in the “Administration and Planning in Health Care” course of the undergraduate medical program at the Federal University of Rio Grande do Sul.

Method:
Description on how the curriculum guidelines for the undergraduate medical education in Brazil have been implemented at this university. The guidelines specify that graduates should be skilled and knowledgeable in health care administration and management, understand the market dynamics of health care services, and be prepared to contribute to the development of health policy.

Results:
A required 60-hour course provides students with an opportunity to learn about the structure, planning and administration of the Brazilian and of other health care systems, and their roles, as health care professionals, within those systems. The course is also intended to allow students to develop the minimal skill set required for manipulation of health care data available from national and international databases, and to use the Internet as a source of information in health care. The curriculum includes: Module 1 – basic computer skills, an introduction to networks as an infrastructure for management, the use of spreadsheets and databases for data processing and system modelling, retrieval of Internet-based health data and on-line bibliographic searches; Module 2 – health system financing and service quality management, using a university hospital as a case study; and Module 3 – a comparison of the Brazilian public health care system (SUS) with other national health systems resulting in a term paper formatted for journal submission and presented at a simulated conference at the end of the course.

Conclusion:
Progressive shift in emphasis from theory to practice in this course has resulted in better development of the skill set required for the students.
Medical Informatics Education Needs Information System Practicums in Health Care Settings
Authors: Ammenwerth E. , Häber A. , Hübner-Bloder G. , Knaup-Gregori P. , Lechleitner G. , Leiner F. , Weber R. , Winter A. , Wolff A. C. , Haux R.
Published: March 2018

Objectives:
To report about the themes and about experiences with practicums in the management of information systems in health care settings (health information management) for medical informatics students.

Methods:
We first summarize the topics of the health information management practicums/projects that the authors organized between 1990 and 2003 for the medical informatics programs at Heidelberg/ Heilbronn, Germany, UMIT, Austria, as well as for the informatics program at the University of Leipzig, Germany. Experiences and lessons learned, obtained from the faculty that organized the practicums in the past 14 years, are reported.

Results:
Thirty (of 32) health information management practicums focused on the analysis of health information systems. These took place inside university medical centers. Although the practicums were time-intensive and required intensively tutoring students with regard to health information management and project management, feedback from the students and graduates was mainly positive.

Discussion:
It is clearly recommended that students specializing in medical informatics need to be confronted with real-world problems of health information systems during their studies.
Medical Informatics and Bioinformatics: Integration or Evolution through Scientific Crises?
Authors: Kulikowski C. , Maojo V.
Published: March 2018

Objectives:
To contribute a new perspective on recent investigations into the scientific foundations of medical informatics (MI) and bioinformatics (BI). To support efforts that could generate synergies and new research directions.

Methods:
MI and BI are compared and contrasted from a philosophy of science perspective. Historical examples from MI and BI are analyzed based on contrasting viewpoints about the evolution of scientific disciplines.

Results:
Our analysis suggests that the scientific approaches of MI and BI involve different assumptions and foundations, which, together with largely non-overlapping communities of researchers for the two disciplines, have led to different courses of development. We indicate how their respective application domains, medicine, and biology may have contributed to these differences in development.

Conclusions:
An analysis from the point of view of the philosophy of science is characteristic of established scientific disciplines. From a Kuhnian perspective, both disciplines may be entering a period of scientific crisis, where their foundations are questioned and where new ideas (or paradigm shifts) and a progressive research programme are needed to advance them scientifically. We discuss research directions and trends both supporting and challenging integration of the subdisciplines of MI and BI into a unified field of biomedical informatics (BMI), centered around the evolution of information cybernetics.
Modeling End-users’ Acceptance of a Knowledge Authoring Tool
Authors: Del Fiol G. , Rocha R. A. , Hulse N. C.
Published: March 2018

Objectives:
Knowledge bases comprise a vital component in the classic medical expert system model, yet the knowledge acquisition process by which they are created has been characterized as highly iterative and labor-intensive. The difficulty of this process underscores the importance of knowledge authoring tools that satisfy the demands of end-users. The authors hypothesize that the acceptability of a knowledge authoring tool for the creation of medical knowledge base content can be predicted by an accepted model in the information technology (IT) field, specifically the Technology Acceptance Model (TAM).

Methods:
An online survey was conducted amongst knowledge base authors who had previously established experience with the authoring tool software. The Likert-based questions in the survey were patterned directly after accepted TAM constructs with minor modifications to particularize them to the software being used. The results were analyzed using structural equation modeling.

Results:
The TAM performed well in predicting end-users’ behavioral intentions to use the knowledge authoring tool. Five out of seven goodness-of-fit statistics indicate that the model represents the behavioral intentions of the authors well. All but one of the hypothesized relationships specified by the TAM were significant with p values less than 0.05.

Conclusions:
The TAM provides an adequate means by which development teams can anticipate and better understand what aspects of a knowledge authoring tool are most important to their target audience. Further research involving other behavioral models and an expanded user base will be necessary to better understand the scope of issues that factor into acceptability.
Time-variant Analysis of Fast-fMRI and Dynamic Contrast Agent MRI Sequences as Examples of 4-dimensional Image Analysis
Authors: Leistritz L. , Hesse W. , Wüstenberg T. , Fitzek C. , Reichenbach J. R. , Witte H.
Published: March 2018

Objectives:
Image sequences with time-varying information content need appropriate analysis strategies. The exploration of directed information transfer (interactions) between neuronal assemblies is one of the most important aims of current functional MRI (fMRI) analysis. Additionally, we examined perfusion maps in dynamic contrast agent MRI sequences of stroke patients. In this investigation, the focus centers on distinguishing between brain areas with normal and reduced perfusion on the basis of the dynamics of contrast agent inflow and washout.

Methods:
Fast fMRI sequences were analyzed with time-variant Granger causality (tvGC). The tvGC is based on a time-variant autoregressive model and is used for the quantification of the directed information transfer between activated brain areas. Generalized Dynamic Neural Networks (GDNN) with time-variant weights were applied on dynamic contrast agent MRI sequences as a nonlinear operator in order to enhance differences in the signal courses of pixels of normal and injured tissues.

Results:
A simple motor task (self-paced finger tapping) is used in an fMRI design to investigate directed interactions between defined brain areas. A significant information transfer can be determined for the direction primary motor cortex to supplementary motor area during a short time period of about five seconds after stimulus. The analysis of dynamic contrast agent MRI sequences demonstrates that the trained GDNN enables a reliable tissue classification. Three classes are of interest: normal tissue, tissue at risk for death, and dead tissue.

Conclusions:
The time-variant multivariate analysis of directed information transfer derived from fMRI sequences and the computation of perfusion maps by GDNN demonstrate that dynamic analysis methods are essential tools for 4D image analysis.
Knowledge-based and Data-driven Models in Arrhythmia Fuzzy Classification
Authors: Vergassola R. , Zong W. , Berthold M. R. , Silipo R.
Published: March 2018

Objectives:
Fuzzy rules automatically derived from a set of training examples quite often produce better classification results than fuzzy rules translated from medical knowledge. This study aims to investigate the difference in domain representation between a knowledge-based and a data-driven fuzzy system applied to an electrocardiography classification problem.

Methods:
For a three-class electrocardiographic arrhythmia classification task a set of fifteen fuzzy rules is derived from medical expertise on the basis of twelve electrocardiographic measures. A second set of fuzzy rules is automatically constructed on thirty-nine MIT-BIH database’s records. The performances of the two classifiers on thirteen different records are comparable and up to a certain extent complementary. The two fuzzy models are then analyzed, by using the concept of information gain to estimate the impact of each ECG measure on each fuzzy decision process.

Results:
Both systems rely on the beat prematurity degree and the QRS complex width and neglect the P wave existence and the ST segment features. The PR interval is not well characterized across the fuzzy medical rules while it plays an important role in the data-driven fuzzy system. The T wave area shows a higher information gain in the knowledge based decision process, and is not very much exploited by the data-driven system.

Conclusions:
The main difference between a human designed and a data driven ECG arrhythmia classifier is found about the PR interval and the T wave.
Introducing BF++: A C++ Framework for Cognitive Bio-Feedback Systems Design
Authors: Babiloni F. , Cincotti F. , Salinari S. , Marcian M.G. , Bianchi L.
Published: March 2018

Objective: This paper addressed the issue of building-up a framework for the realization of several cognitive bio-feedback (CBF) systems. It minimizes the programming effort and maximizes the efficiency and the cross-platform portability so that it can be used with many platforms (either software or hardware).

Methods: A generic CBF system was decomposed into six modules: acquisition, kernel, feedback rule, patient feedback, operator user interface and persistent storage. The way in which these modules interact was defined by immutable software interfaces in a way that allows to completely substitute a module without the need to modify the others.

Results: Three Brain Computer Interface engines were developed with less than 40 lines of C++ code each. They can also be used under virtually any platform that supports an ANSI C++ compiler.

Conclusion: A framework for the implementation of a wide range of CBF systems was developed. Compared to the other approaches that are described in the literature, the proposed one is the most efficient, the most portable across different platforms, the most generic and the one that allows the realization of the cheapest final systems.
Medical Informatics: Searching for Underlying Components
Authors: Musen M. A.
Published: March 2018

Objective: To discuss unifying principles that can provide a theory for the diverse aspects of work in medical informatics. If medical informatics is to have academic credibility, it must articulate a clear theory that is distinct from that of computer science or of other related areas of study.

Results: The notions of reusable domain ontologies and problem-solving methods provide the foundation for current work on second-generation knowledge-based systems. These abstractions are also attractive for defining the core contributions of basic research in informatics. We can understand many central activities within informatics in terms defining, refining, applying, and evaluating domain ontologies and problem-solving methods.

Conclusion: Construing work in medical informatics in terms of actions involving ontologies and problem-solving methods may move us closer to a theoretical basis for our field.
Establishing an Agenda for Biomedical Informatics
Authors: Martin-Sanchez F. , Billhardt H. , Iakovidis I. , Kulikowski C. , Maojo V.
Published: March 2018

Objective: To describe potential areas of collaboration between Medical Informatics (BI) and Bioinformatics (BI) and their effects on planning future work in both disciplines.

Methods: Some reflections on the objectives and rationale underpinning MI and BI are given, and preliminary results from the BIOINFOMED workgroup, supported by the European Commission, are introduced. Results: Applications from both subfields suggest topics for sharing and exchange between the subfields within the emerging field of Biomedical Informatics. Conclusions: We suggest how the nature and degree of collaboration between the sub-disciplines can impact future work in molecular medicine.
Internet Health Resources: from Quality to Trust
Authors: Doupi P. , van den Hoven Jeroen , Lampe K.
Published: March 2018

Objectives: Quality of online health resources remains a much debated topic, despite considerable international efforts. The lack of a systematic and comprehensive conceptual analysis is hindering further progress. Therefore we aim at clarifying the origins, nature and interrelations of pertinent concepts. Further, we claim that quality is neither a necessary nor a sufficient condition for Internet health resources to produce an effect offline. As users’ trust is also required, we examine the relation of quality aspects to trust building online.

Methods: We reviewed and analyzed the key documentation and deliverables of quality initiatives, as well as relevant scientific publications. Using the insights of philosophy, we identified the elementary dimensions which underlie the key concepts and theories presented so far in the context of online health information quality. We examined the interrelations of various perspectives and explored how trust as a phenomenon relates to these dimensions of quality.

Results: Various aspects associated with the quality of online health resources originate from four conceptual dimensions: epistemic, ethical, economic and technological. We propose a conceptual framework that incorporates all these perspectives. We argue that total quality exists only if all four dimensions have been addressed adequately and that high total quality is conducive to warranted trust.

Conclusions: Quality and trust are intertwined, but distinct concepts, and their relation is not always straightforward. Ideally, trust should track quality. Apprehending the composition of these concepts will help to understand and guide the behavior of both users and providers of online information, as well as to foster warranted trust in online resources. The framework we propose provides a conceptual starting point for further deliberations and empirical work.
Model Driven Therapy
Authors: Troccaz J. , Cinquin P.
Published: March 2018

Objectives: Taking into account a priori knowledge is a key issue to meet the medical, scientific and industrial challenges of the progresses of Minimally Invasive Surgery. We propose an overview of these challenges.

Methods: Models play a major role in representing the relevant knowledge to plan and realize complex medical and surgical interventions. We analyze the three basic steps of Perception, Decision and Action, and illustrate by some instances how models may be integrated in these steps.

Results: We propose a selection of the results obtained in Model Driven Therapy. These results illustrate the issues of Perception (models allow accurate reconstruction of 3D objects from a limited set of X-ray projections), Decision (models allow to take into account elastic and dynamic characteristics of muscles), and Action (models allow to design innovative navigational and robotics aids to the realization of complex interventions). Likewise, models play a major role in the process of surgeon’s education, which leads to the concept of Virtual Orthopedic University.

Conclusions: Model Driven Therapy emerges as the way to perform optimal medical and surgical interventions, providing physicians and surgeons with the possibility to augment their capacities of sensing multi-modal information, of combining them to define optimal strategies, and of performing accurate and safe actions.