bluuebunny/crossref_metadata_2025 huggingface dataset:
The Multi-Trellis Software Architecture and the Intelligent Cardiovascular Monitor
Authors: Gelernter D. H. , Factor M. , Sittig D. F.
Published: March 2018

A real-time, intelligent cardiovascular monitor is complex. It must process multiple waveforms, recognize artifacts, extract pertinent parameters, recognize a patient’s clinical state, analyze the problem and formulate a response. This paper presents the multi-trellis (a collection of process trellises), a software architecture for building such a monitor. A process trellis is a uniform hierarchical framework for heterogeneous program modules. The multi-trellis extension allows one to compile several process trellis programs with widely varying run-time requirements into a single executable program that it is efficient, predictable and usable. Our prototype consists of two process trellises. The lower trellis contains processes to analyze three different analog signals: the blood pressure from a non-invasive monitor and an arterial catheter, and the ECG. The upper trellis contains processes to help detect evolving hemodynamic trends, identify abnormalities, and present a succinct summary to the clinician. Our prototype shows that the multi-trellis is a demonstrably useful software architecture for building these real-time, intelligent monitors.
An Intelligent Computer-Assisted Instruction System Designed for Rural Health Workers in Developing Countries
Authors: Auvert B. , Gilbos V. , Andrianiriana F. , Bertrand W. E. , Emmanuelli X. , Benillouche E. , Landre M. F. , Bos D. , Aegerter P.
Published: March 2018

This paper describes an intelligent computer-assisted instruction system that was designed for rural health workers in developing countries. This system, called Consult-EAO, includes an expert module and a coaching module. The expert module, which is derived from the knowledge-based decision support system Tropicaid, covers most of medical practice in developing countries. It allows for the creation of outpatient simulations without the help of a teacher. The student may practice his knowledge by solving problems with these simulations. The system gives some initial facts and controls the simulation during the session by guiding the student toward the most efficient decisions. All student answers are analyzed and, if necessary, criticized. The messages are adapted to the situation due to the pedagogical rules of the coaching module. This system runs on PC-compatible computer.
Automated Online Transition from the Medical Record to the Psychiatric Literature
Authors: Powsner S. M. , Miller P. L.
Published: March 2018

Psych Topix is a knowledge-based program which guides the clinician from an on-line clinical report to a search of the psychiatric literature or of other relevant databases. It provides this guidance by using an outline of key topics in a clinical field to provide “concept-based” links. Each topic is augmented with an activation expression to signal when that topic is potentially relevant to a case, and with database search expressions to allow focused retrieval of information. The bibliographic retrieval component of PsychTopix is currently operational as part of the daily, routine operation of a psychiatric consultation service. The system is also implemented in a demonstration mode to provide retrieval from three additional textual databases. The current PsychTopix system provides a working demonstration of the clinical feasibility of using concept-based links to facilitate the focused, automated transition between on-line medical databases.
Bone Density, Biochemistry and Life-Style
Authors: Robinson D. , Bailey A. R. , Hale A. C. , Allaway S. L.
Published: March 2018

We have assessed the relationship between bone density, biochemistry and life-style factors in a cross-sectional study of 434 pre- and 357 postmenopausal women. Bone-mineral content (BMC) was measured in the non-dominant forearm using single-photon densitometry. Bone mass was corrected for bone size (BMC2) in a sub-set of 263 subjects. Correlation statistics and multiple regression analyses were used to identify physical and biochemical measurements that could be used to best predict BMC or BMC2. These were combined with lifestyle factors, using multiple logistic regression analysis, to identify women at risk of low bone density. Cut-off values were taken as the 5th percentile of the bone density distributions in pre-menopausal women. In postmenopausal women, using BMC2 values to define “risk”, and using age, creatinine, alkaline phosphatase, thyroxine treatment, and calcium supplementation as predictors, a sensitivity of 73% and a specificity of 95% were achieved. Such a model may be of use as a “first pass” screening test for osteoporosis.
Cerebral and Functional Aging: First Results on Prevalence and Incidence of the Paquid Cohort
Authors: Jacqmin H. , Commenges D. , Barberger-Gateau P. , Dartigues J.-F. , Salamon R. , Letenneur L.
Published: March 2018

Paquid is an interdisciplinary study designed to investigate cerebral and functional aging. A cohort of 3,777 community residents living in two administrative areas of South-Western France was selected. A standardized questionnaire was administered at home by trained psychologists. The same procedure was applied one and three years after the baseline data collection. The identification of demented subjects was made with a two-step procedure. The first step is a systematic screening by the psychologists using the DSM-III criteria for dementia. Subjects who fulfilled the DSM-III criteria were examined by a neurologist. Diagnosis of dementia is confirmed according to the NINCDS-ADRDA criteria. The Paquid cohort is complemented by a random sample of 357 institutionalized subjects. First results of prevalence and incidence rates show an exponential increase of dementia with age.
A System for Integrated ECG Analysis
Authors: Zywietz Chr.
Published: March 2018

A system for combined analysis of resting, rhythm and exercise electrocardiograms has been developed. Also an “expert” module for rule-based processing with backward chaining for reasoning has been implemented. The system can be used for routine ECG analysis as well as for research and teaching in electrocardiography.
Pharmacological and Model-based Interpretation of Neuronal Dynamics Transitions during Sleep-Waking Cycle
Authors: Nakao M. , Mizutani Y. , Takahashi T. , Watanabe K. , Arai H. , Sasaki N. , Yamamoto M.
Published: March 2018

Power spectral analysis has been applied to spontaneous single neuronal activities during the sleep-waking cycle in various regions of the cat’s central nervous system. During slow-wave sleep (SWS), the spontaneous activities of many neurons had a white noise-like power-spectral density profile in a very low frequency range (0.01-1.0 Hz) whereas, during rapid-eye-movement sleep (REMS), they showed a 1/f-like spectral pattern. This spectral transition between SWS and REMS was hypothesized to depend on the influence of serotonergic and cholinergic neuronal activity which is considered to modulate various brain functions. According to both pharmacological experiments and simulation studies with a neural network model, it was concluded that the serotonergic system may have a function to eliminate slow fluctuations in neuronal activity in wide areas, from the reticulothalamo-neocortical to the limbic systems. Consequently, simple signal processing of spontaneous neuronal activity has elucidated an important neurophysiological fact, which may lead to a principle of the basic brain function and its mechanism.
Health and Medical Informatics Education
Authors: Haux R. , Leven F. J. , Moehr J. R. , Protti D. J.
Published: March 2018

Health and medical informatics education has meanwhile gained considerable importance for medicine and for health care. Specialized programs in health/medical informatics have therefore been established within the last decades.

This special issue of Methods of Information in Medicine contains papers on health and medical informatics education. It is mainly based on selected papers from the 5th Working Conference on Health/Medical Informatics Education of the International Medical Informatics Association (IMIA), which was held in September 1992 at the University of Heidelberg/Technical School Heilbronn, Germany, as part of the 20 years’ celebration of medical informatics education at Heidelberg/Heilbronn. Some papers were presented on the occasion of the 10th anniversary of the health information science program of the School of Health Information Science at the University of Victoria, British Columbia, Canada. Within this issue, programs in health/medical informatics are presented and analyzed: the medical informatics program at the University of Utah, the medical informatics program of the University of Heidelberg/School of Technology Heilbronn, the health information science program at the University of Victoria, the health informatics program at the University of Minnesota, the health informatics management program at the University of Manchester, and the health information management program at the University of Alabama. They all have in common that they are dedicated curricula in health/medical informatics which are university-based, leading to an academic degree in this field. In addition, views and recommendations for health/medical informatics education are presented. Finally, the question is discussed, whether health and medical informatics can be regarded as a separate discipline with the necessity for specialized curricula in this field.

In accordance with the aims of IMIA, the intention of this special issue is to promote the further development of health and medical informatics education in order to contribute to high quality health care and medical research.
Application of Indicators, Predictors and Diagnostic Indices in Coagulation Disorders
Authors: Wahlberg Th. , Blombäck Margareta , Hall P. , Axelsson G.
Published: March 2018

A recently described theoretical model for the evaluation of binary and continuous diagnostic variables by indicators and predictors, is in the present study applied to a self-administered-questionnaire for obtaining a medical history of different blood coagulation disturbanoies (binary variables).

The diagnostic power of each question is calculated by indicators and predictors. The total diagnostic capacity of the questionnaire is expressed by an anamnestic or summation index.

The questionnaire was shown to be able to separate healthy individuals from diseased ones. A rank order of the diagnostic capacity of the questions, built upon indicators and predictors, is presented.
An Interpreter for the Easy Creation of Graphic Displays of Experimental Data
Authors: Alberts S. , Meinzer H. P.
Published: March 2018

The graphic interpreter INSTANT PLOT describes a system for the easy creation and manipulation of graphic displays of experimental data. It is controlled by a command language. Commands are interpreted and executed immediately. The interpreter is based on the TEKTRONIX PLOT-10 software. The input can be entered via the usual alphanumeric terminals or via a TEKTRONIX terminal. The output can be directed to a graphic terminal or a plotter. If an interactive TEKTRONIX terminal is used, the commands immediately result in a graphic output. This feature also makes the system attractive for educational purposes.
Statistical Evaluation of the Respiratory Pattern as a Risk Factor for the Sudden Infant Death Syndrome
Authors: Pfeiffer K. P. , Haidmayer R. , Kerschhaggl P. , Kurz R. , Kenner T.
Published: March 2018

To evaluate the respiratory pattern of infants with regard to a possible risk for SIDS, two characteristic values (MA and GA) were computed from the distribution of apneas. For the computation of one of these characteristic values (GA), a weight function for apneas was used to consider the diagnostic information content of apneas of different durations. The distribution of apneas is approximately exponential where apneas up to 20 s and longer have been found. Using these characteristic numerical values of the respiratory pattern, infants of different age groups were classified into risk and non-risk cases. This classification was performed in the way that an optimal agreement between clinical and numerical classification was achieved. For both numerical values an agreement of about 90% with clinical classification was achieved.

To consider the differing impact of misclassification, a weighted classification procedure was proposed.
What Does an Observed Relative Risk Convey about Possible Misclassification?
Authors: Blettner M. , Wahrendorf J.
Published: March 2018

Misclassification of exposure in epidemiological studies has the effect of distorting the results in various directions. We give quantitative information about the possible order of magnitude of misclassification and of “true” effects given the observations of an epidemiological study. It will be demonstrated that misclassification can also distort trends in relative risks. Real examples from the epidemiological literature are used for illustration.
A Comprehensive Model for Medical Information Processing
Authors: Bemmel J. H.
Published: March 2018

At first sight, the many applications of computers in medicine—from payroll and registration systems to computerized tomography, intensive care and diagnostics—do make a rather chaotic impression. The purpose of this article is to propose a scheme or working model for putting medical information systems in order. The model comprises six »levels of complexity«, running parallel to dependence on human interaction. Several examples are treated to illustrate the scheme. The reason why certain computer applications are more frequently used than others is analyzed. It has to be strongly considered that the differences in complexity and dependence on human involvement are not accidental but fundamental. This has consequences for research and education which are also discussed.
A Computer-based Diagnostic/Patient Management System for Isolated Environments
Authors: Robinson Karen , Ryack B. L. , Moeller G. , Post R. , Schroeder W.
Published: March 2018

Four studies were conducted to examine the data collection procedures and diagnostic accuracy of Navy Hospital Corpsmen for patients “with acute abdominal pain and to determine the compatibility of their skills with the requirements of a computer-aided diagnostic system for abdominal pain. Findings suggest that instruction in specific data collection procedures results in an increase in the amount of data collected. It does not appear to improve either the accuracy of the data collected or the diagnosis. The instructed corpsmen collected more of the required data for effective use of a computer-based diagnostic system for abdominal pain.
Descriptive Data Analysis: A Concept between Confirmatory and Exploratory Data Analysis
Authors: Abt K.
Published: March 2018

Confirmatory Data Analysis (CDA) in randomized comparative (“controlled”) studies with many variables and/or time points of interest finds its limitations in the multiplicity of desired inferential statements which leads to unfeasibly small adjusted significance levels (“Bon-ferronization”) and, thereby, to unduly increased risks of not rejecting false hypotheses. In general, analytical models adequate for such complex data structures and suitable for practical use do not exist as yet. Exploratory Data Analysis (EDA), on the other hand, is usually intended to generate hypotheses and not to lead to final conclusions based on the results of the study.

In this paper, it is proposed to fill the conceptual gap between CDA and EDA by “Descriptive Data Analysis” (“DDA”) which concept is mainly based on descriptive inferential statements. The results of a DDA in a controlled study are interpreted simultaneously on the basis of the investigator’s experience with respect to numerically relevant treatment effect differences and on “descriptive significances” as they appear in “near regular” patterns corresponding to the resulting relevant effect differences. A DDA may also contain confirmatory parts and/or tests on global hypotheses at a prechosen maximum risk α of erroneously rejecting true hypotheses. The paper is in parts expository and is addressed to investigators as well as statisticians.
Masking Artifacts in EEG Time Series
Authors: Stassen H. H.
Published: March 2018

The removal of artifacts from EEG time series by masking the concerned parts has been studied in order to derive error estimates which apply in general. For this purpose, we selected a sufficiently representative set of artifact-free time series registered from 81 individuals. These time series then served as error-free references. Subsequently, we used the same set of time series, simulated artifacts of 2-12 seconds length (each of which at 5 different positions within each epoch) and investigated the impact of masking procedures on spectrum analysis. Our interest focused particularly on clearing up possble sources of variation (e. g., the actual frequency composition of the signal or the actual position of the masked segment within the time series) in theerrors inherent in the masking process. A detailed error analysis yielded no indication that the inherent errors depend on such factors. Moreover, it turned out that any sufficiently representative set of, say, about 100 epochs of 20 seconds length can be used to reproduce all required estimates at an errorof less than 5 percent. Based on these findings, we developed a correction function which applies in general, thus simplifying the fully computerized processing of EEG time series.
Knowledge-Based Decision Support for Diagnosis and Therapy: On the Multiple Usability of Patient Data
Authors: Haux R.
Published: March 2018

Expert systems in medicine are frequently restricted to assisting the physician to derive a patient-specific diagnosis and therapy proposal. In many cases, however, there is a clinical need to use these patient data for other purposes as well. The intention of this paper is to show how and to what extent patient data in expert systems can additionally be used to create clinical registries and for statistical data analysis. At first, the pitfalls of goal-oriented mechanisms for the multiple usability of data are shown by means of an example. Then a data acquisition and inference mechanism is proposed, which includes a procedure for controlling selection bias, the so-called knowledge-based attribute selection. The functional view and the architectural view of expert systems suitable for the multiple usability of patient data is outlined in general and then by means of an application example. Finally, the ideas presented are discussed and compared with related approaches.
SARI : A User-Oriented Data Bank System for Medical Applications
Authors: Goldberg M. , Doyon B.
Published: March 2018

This paper describes a general data base management package, devoted to medical applications. SARI is a user-oriented system, able to take into account applications very different by their nature, structure, size, operating procedures and general objectives, without any specific programming. It can be used in conversational mode by users with no previous knowledge of computers, such as physicians or medical clerks.

As medical data are often personal data, the privacy problem is emphasized and a satisfactory solution implemented in SARI.

The basic principles of the data base and program organization are described ; specific efforts have been made in order to increase compactness and to make maintenance easy.

Several medical applications are now operational with SARI. The next steps will mainly consist in the implementation of highly sophisticated functions.
Dreidimensionale Darstellung von segmentweise berechneten EEG-Spektren
Authors: Drescher D. , Ferber G.
Published: March 2018

Leitet man ein EEG über ca. 20 Minuten ab und unterwirft es zwecks Untersuchung von Kurzzeiteffekten in Abschnitten von wenigen Sekunden einer Spektralanalyse, so erhält man eine Reihe von mehreren 100 Spektren. Dies ist eine Datenfülle, die am besten in dreidimensionaler Darstellung anschaulich gemacht wird. Damit rhythmische Veränderungen der Grundaktivität, z.B. Schwankungen der Alpha-Aktivität (7,5—12,5 Hz Bereich), nicht in der beträchtlichen Varianz der einzelnen Spektralschätzer untergehen, werden die Stützpunkte mit Hilfe einer digitalen Filterung nacheinander einer Quer- und einer Längsglättung unterworfen.

Ein besonderes Kennzeichen der hier präsentierten 3D-Darstellung ist, daß bei Eingabe verschiedener Dreh- und Kippwinkel die Zeitachse stets parallel zur Papierkante des Plotters verläuft, so daß dem Benutzer bzgl. der maximalen Anzahl der darstellbaren Spektren keine Beschränkungen auferlegt werden.
Clinical Decision Analysis
Authors: Taylor Th. R.
Published: March 2018

Attempts have been made for almost two decades to use computers to make clinical diagnoses. Interest in such techniques persists despite little practical success in their application to routine patient care. The explanation of this lack of success is complex and includes (i) lack of understanding of the decisionmaking process itself and (ii) the need for a theoretical framework within which such systems can be developed. A major objective of this paper is to illustrate the contribution that the concepts and techniques associated with Decision Theory can make to both of these problems.

After attempting to analyse the deficiencies of current approaches to computer-assisted diagnosis the paper discusses some of the basic concepts of decision theory. It then illustrates the role of decision theory in studies using different forms of clinical decision analysis.

Finally the paper indicates the relevance of decision analysis to medical education and to the provision of health care.
Das Zusammenwirken einiger Risikofaktoren in der Schwangerschaft
Authors: Wermuth Nanny
Published: March 2018

Die Auswirkungen verschiedener Risikofaktoren am Ende der Schwangerschaft auf die Gesundheit eines Neugeborenen werden anhand von 4098 Beobachtungen in einer seohsdimensionalen Kontingenztafel untersucht. Wahrscheinlichkeiten für einen schlechten Zustand des Neugeborenen bei der Geburt in Abhängigkeit von Gestosesymptomen werden angegeben. Es wird beschrieben, wie sich diese Wahrscheinlichkeiten mit Hilfe eines die Daten gut reproduzierenden logarithmisch-linearen Modells errechnen lassen und wie sich ein solches Modell auffinden läßt. Da wir für ein Zusammenhangsmodell annehmen, daß es sich gut an die Daten anpaßt, können Wahrscheinlichkeiten auch für solche Situationen geschätzt werden, in denen die Beobachfrungszahlen klein sind oder gar fehlen. Die Ergebnisse deuten darauf hin, daß die Gestosesymptomkombinationen sich deutlich unterschiedlich auf das neugeborene Kind auswirken. Es wird infolgedessen empfohlen, die möglichen Risikosituationen getrennt zu untersuchen.
Die Ergebnisse eines Fragebogens im Vergleich mit der ärztlichen Diagnose
Authors: Grüntzig A. , Galla J.
Published: March 2018

Der von G. Rose entwickelte und von der WHO empfohlene englische Fragebogen hat zur Schätzung der Prävalenz koronarer Herzkrankheiten (KHK) bereits bei einigen epidemiologischen. Studien (4, 19) Verwendung gefunden. Die Validität dieser Fragen ist vom Autor und einigen skandinavischen Arbeitsgruppen geprüft worden.

Die Einführung dieses Fragebogens in den deutschen Sprachbereich erfordert die Überprüfung seiner Reliabilität und Validität.

Nachdem ersteres in einem Test-Retest-Experiment bereits geschehen ist (11), wird in der vorliegenden Arbeit über den Versuch berichtet, durch den Vergleich der Fragebogen-Verdachtsdiagnose mit der Arztdiagnose als sogenannte Referenzdiagnose einen Überblick über die Validität zu erhalten.

117 Patienten im Alter von 30—65 Jahren wurden mit diesem Fragebogen interviewt. Auf Grund der Arztdiagnose litten 65 von ihnen an einem Herzinfarkt und/oder an Angina pectoris.

In 73% der positiven und 71% der negativen Fälle stimmte das Ergebnis des Fragebogens mit der Entscheidung der Ärzte überein.

Die im Vergleich mit der Referenzdiagnose falsch positiven und falsch negativen Bereiche der Verdachtsdiagnose KHK und der Einfluß der Prävalenz der Symptome auf die Spezifität und Sensitivität werden diskutiert.
SYS — Ein benutzerfreundliches System zur logischen Prüfung und Auswertung von Datenbeständen
Authors: LEISER E.
Published: March 2018

Mit der wachsenden Bedeutung der Datenverarbeitung in der Medizin entsteht die Notwendigkeit benutzerfreundlicher Software. SYS ist ein aus 3 Programmen bestehendes System, das für eine logische und statistische Analyse von Daten geeignet ist. Es wird durch eine Problemsprache gesteuert, die eine direkte Übersetzung vorliegender Probleme gestattet und dabei irgendwelche formalen oder syntaktischen Beschränkungen vermeidet, die dem Laien die Anwendung erschweren könnten. Das System hat sich in einer Vielzahl von Anwendungen bewährt.
Comparison of Information Collected by a Questionary with that in the Patient’s Hospital Record
Authors: YOUNG D. W.
Published: March 2018

Information about the medical history was collected from three sources: a) from a questionary, b) from an interview, and c) from the patient’s hospital record. The amount of information from these three sources was compared. The questionary, it was found, obtained about three times as many symptoms as were in the hospital record. Reasons for this are discussed, including the trivial nature of some of the symptoms found by the questionary. To obtain a better comparison, an attempt was made to divide the symptoms gathered by the questionary into significant and non-significant ones. On this basis, it is found that the questionary still collected twice as many symptoms as were in the patient’s hospital record.
Erfassung der Krankenhausleistungen, ihre Abrechnung und der Entlassungsvorgang bei stationären Patienten mit Hilfe einer Datenverarbeitungsanlage
Authors: BECHER H. , MATT K. H. , RETTENMAIER G.
Published: March 2018

Am Univ.-Krankenhaus Erlangen werden seit 1. 1. 1970 alle stationären Patienten mit Hilfe eines Prozeßrechners Siemens 305 aufgenommen. Jedem Patienten wird ein festes Plattenspeicherfeld zugeteilt, das der jeweiligen »Patienten-Nr.« entspricht. Während der Liegedauer eines Patienten laufen auf diesem Plattenspeicherfeld teils obligatorische, teils nicht obligatorische administrative Vorgänge ab. Diese werden im einzelnen dargestellt. Der Ablauf der obligatorischen Vorgänge ist conditio sine qua non für die Freigabe des Plattenspeicherfeldes bzw. der Patienten-Nr. und die Neuvergabe durch den Rechner an einen neuen Patienten. Die Organisation dieser Vorgänge sowohl bei Sozialversicherten als auch bei Selbstzahlern wird dargestellt.
Zur Auswahl von Datenbankund Retrieval-Systemen für den medizinischen Bereich Fragenkatalog an den Hersteller
Authors: Fabhicius W. , Seehusen J. , Thomas G.
Published: March 2018

Als Hilfsmittel für Auswahlund Entscheidungsprobleme wird ein Fragenkatalog zu Datenbanksystemen vorgestellt. Ausgehend von verschiedenen Benutzergruppen wird in dem Katalog auf verschiedene Strukturen und Funktionen eingegangen.
RIDIT-Analyse: Ein nicht-parametrisclies Verfahren zum Vergleich von Verteilungen
Authors: Basler H.-D.
Published: March 2018

Es wird ein statistisches Prüfverfahren für den Vergleich von Verteilungen vorgestellt, die am angemessensten auf einer Ordinalskala abgebildet werden können. Nach einer ausführlichen Darstellung des Rechenverfahrens wird auf Möglichkeiten der Interpretation der Ergebnisse, Vorund Nachteile der Methode sowie auf den Einsatz der Methode als Standardisierungsverfahren eingegangen.
Laboratory Simulator - A Study of Laboratory Activities by a Simulation Method
Authors: Väänänen I. , Kivirikko K. , Koskenniemi S. , Koskimies J. , Relander A.
Published: March 2018

A simulator has been designed for study of the activities in a hospital laboratory, the intention being that of producing a model which could be adapted to laboratories other than the one in which it was developed, by virtue of its being as generalized as possible. Consequently, only the basic pattern of work in the laboratory was included in the fixed simulator program, whereas details varying from one simtilated situation to another were left for use as »source data« for each separate simulation run.

The simulation program was written in the simidation language General Purpose Systems Simulator (GPSS) and runs on an IBM 7090 computer.

The functional basic unit for the simulator is a »transaction«, which moves in the model, and with functions that correspond to the specimen’s route in the laboratory. Each transaction is provided with parameters (data) which determine its functions and course within the model.

The validity of the program was tested by means of a simulation of an average working day, and the results were compared with the real situation. Following this, several tests were made, with examination of the way in which changes in the number of laboratory technicians and in the work load affected laboratory activities.

With the simulation method, the following aims are achievable:

— rationalization of laboratory activities,

— rational expansion of laboratory facilities,

— planning of personnel, equipment and working space for a new laboratory,

— comparison of the economic efficiency of different laboratories.

The Finnish Hospital League has initiated an attempt to use the model presented in the planning of laboratories for Health Centres called for by the recently renewed legislation for Public Health in Finland.
Die ärztliche Aufgabe und die Dokumentation
Authors: Proppe A.
Published: March 2018

Bereits im Corpus Hippocraticum sind statistisch auswertbare Krankengeschichten dokumentiert. An den einfachen, fast immer im Kranken journal aufgezeichneten Daten des Lebensalters, des Körpergewichts, der Größe und der Menarche wird dargetan, welche weitreichenden Schlüsse gezogen werden könnten, wenn solche Daten allgemein einer maschinell auswertbaren Dokumentation zugeführt würden. Die überraschend hohe Fehlerhaftigkeit und Unzulänglichkeit in der Erfassung und Aufzeichnung der Befunde, die durch eine maschinengerechte Dokumentation offenkundig geworden sind, beeinflussen in starkem Maße die Kliniksführung, zwingen allgemein zu einer Demokratisierung des Verhältnisses zwischen Arzt und Kranken und fordern Maßnahmen zur Verbesserung der Zuverlässigkeit in der Erkennung und Behandlung krankhafter Zustände, was an einer maschinell durchgeführten Falsifizierung der These von der Disposition des jugendlichen Alters zur Lupuserkrankung, an der maschinellen Rationalisierung der modernen Routihediagno-stik, an der laufenden Überwachung von Gesundheitsschäden in der Bevölkerung und am Schutz vor allergischen Reaktionen durch maschinell abrufbare personale Allergen- oder Unverträglichkeits-Kataster im einzelnen erläutert wird.
Methodische Probleme in der Beurteilung des routinemäßig erstellten weißen Blutbildes
Authors: Schireen M.
Published: March 2018

Einer Auswertung von routinemäßig in den Jahren 1951-1959 erstellten weißen Blutbildern in Bezug auf ihren klinischen Wert stellten sich methodische Schwierigkeiten grundsätzlicher Art entgegen. Darunter ist die Ungenauigkeit in der Bestimmung der Leukozytenzahl durch Zählung im Routineverfahren von durchaus störender und nicht zu eliminierender Größe. Die Häufigkeit der Leukozytenarten zu bestimmen, erscheint weniger schwierig; jedoch haben sich in der Erkennung der Monozyten mit der Leukozytenzahl zunehmende fundamentale Fehlurteile ergeben. Die Umwandlung des qualitativen Blutbildes in quantitative Größen mittels der Leukozytenzahl ist des Problems der Streuungsfortpflanzung wegen — auch als Paradoxon der Mittelwerte bei Reihenverschmelzung gefürchtet — nicht korrekt. Die Grundsätzlichkeit dieser methodischen Schwierigkeit wird in vielfältiger Hinsicht an Beispielen veranschaulicht.

Für die Bewertung der Leukozytenarten am Krankenbett kann — worauf schon Schillingbestand -— daher nur das prozentische (indexierte) Verteilungsbild herangezogen werden.

Im Interesse der weiteren Forschung bleibt — außer der unmittelbaren Zählung der einzelnen Zellarten — der Versuch, an Hand einer mittleren nosologischen Rangfolgeordnung, die sich aus den>ver-schiedenen Parametern einer Häufigkeitsverteilung der Leukozytenarten ableitet, zunehmende- öder abnehmende Tendenzen der untersuchten Leukozytenarten in Bezug auf eine korrelative klinische Wertung zu erkennen. Er führt aber nur bei extremen Zahlenpositionen zu eindeutigen Ergebnissen.
Microsociology of Automation: Medical Sector
Authors: Rome H. P.
Published: March 2018

The introduction of automation technics into clinical medicine has multidimensional sociological effects. The present paper discusses in some detail three of the main problems implicated in such an important innovation: 1. the reasons for the acceptance of or the resistance to the general idea of data-processing as a useful organizational system for clinical medicine; 2. the potential consequences for the hierarchical structure of medical institutions; 3. the effects on thè habits and practices of the individual physician and the consequences for his patients. — Finally the problem of a central big general purpose computer versus decentralized independent special purpose equipment is stressed.
A Diagnostic Assistance Program
Authors: Bonner R. E. , Evangelisti C. J. , Steinbeck H. D. , Cohen L.
Published: March 2018

A doctor must determine the specific diseases in a patient by judgment based on observation of any availble number of findings. Such, diagnoses can be assisted materially by computers through statistical analysis. Far more than statistics is involved; the mass of information in textbooks and in the minds of specialists is at .the heart of a successful diagnosis.

Diagnostic assistance can be obtained by encoding the disease process itself. Then, all available known signs and symptoms of a disease and related conditions as observed by the physician are encoded for entry into a computer. Here the data is evaluated, and an output report is printed to show the effective relationship between the physician’s findings and the specific diseases.. When the result is inconclusive, new findings are obtained and entered into the computer. This process is repeated until satisfactory results axe obtained.

The paper includes an example of diagnostic support by a computer, together with an illustration of the method used for developing the program.
Statistische Analyse von Symptomenkorrelationen bei Syndromen
Authors: Lange H.-J. , Vogel Th.
Published: March 2018

Probleme der statistischen Analyse von Symptomenkorrelationen werden modellmäßig demonstriert. Der Eindruck einer Symptomenkorrelation bei einer bestimmten Krankheit kann im Rahmen der ärztlichen Gesamterfahrung durch die Heterogenität zwischen der Häufigkeitsverteilung der Symptome bei Fällen der betreffenden Krankheit und Gesunden bzw. anders Kranken zustande kommen. Auch in den weiteren diagnostischen Stufen ist eine echte Korrelation zwischen den Symptomen von Hetero-genitätseffekten uneinheitlichen Materials zu unterscheiden. Man erwartet das überzufällige Auftreten einer als Syndrom angesprochenen Symptomenkombination im Rahmen einer übergeordneten Krankheitseinheit.

Untersuchungen über die Häufigkeit des kennedy-Syndroms bei Stirnhirntumoren bzw. Tumoren der vorderen Schädelgrube ergaben, daß das kennedy-Syndrom, das für solche Fälle typisch sein soll, nur im Rahmen des Zufalls auftritt. Für diese Analyse wurden 63 Fälle des Patientenmaterials der Uni-versitäts-Nervenklinik in Bonn nach ätiologischen Gesichtspunkten zur Untersuchung herangezogen. Als Vergleichsgruppe dienten 35 Fälle mit Tumoren im Keilbeinbereich, für die das sog. Keilbein-Syndrom typisch sein soll. Auch bei diesen Fällen lag die als Syndrom angesprochene Symptomenkombination im Zufallsbereich.
Theorie und Praxis stochastischer Modelle für die Entwicklung von in vitro isolierten Kriochenmarkpopulationen
Authors: Fuchs G.
Published: March 2018

Ausgehend von den heutigen Erkenntnissen der Haematocytopoese wird ein allgemeines stochastisches Modell für die Entwicklung von Knochenmarkpopulationen aufgebaut. Zur experimentellen Ermittlung der Parameter dieses Modells (Ubergangswahrscheinlichkeiten usw.) sind zwei Wege möglich: a). Verfolgung markierter Zellgruppen während ihrer Weiterentwicklung und b) Ermittlung der Verteilungsfunktionen zu verschiedenen Zeitpunkten durch Auszählung. Obwohl die Lösung des Problems in allgemeinster Form zur Zeit aus verschiedenen Gründen unmöglich ist, sind einzelne Teilprobleme erfolgreich bearbeitet worden. Zwei dieser Versuche, die mathematischen Ansätze von Fihescuund Tautu(Bukarest) und die Berechnungen von Fuchs(Berlin) werden in ihren Grundgedanken, ihrer praktischen Anwendbarkeit und ihren Grenzen diskutiert.
Collection, Evaluation, and Transmission of Hospital Laboratory Data
Authors: Lindberg D. A. B.
Published: March 2018

A computer system has been described by which, the results of all clinical laboratory determinations are collected, evaluated, and transmitted. A special feature is the complex of medical considerations called LIMITS by which reports are evaluated. The system has been effective as a hospital service device and also has been heuristic in raising questions concerning the recognition of patterns amongst clinical laboratory reports.
On the Optimum Choice of Categories for the Classification of Biomedical Data Patterns
Authors: Hess C. F. , Brodda K.
Published: March 2018

The optimum choice of categories for pattern recognition problems is on the one hand determined by the requirement of a low rate of misclassification. On the other hand, the classification of a pattern should result in an information gain as high as possible. A criterion for an optimum choice of categories which is the best compromise between the demands mentioned above is worked out. The Bayes rule is used as a decision function. The alteration of the Bayes risk as indicator for the rate of malrecognition is examined for different choice of categories concerning the very same classification problem. As the calculation of the Bayes risk is commonly difficult, an estimation using the Bhattacharyya coefficient is given. The information content of a choice of categories is defined using Shannon’s information measure. The alteration of the information contents is analyzed by putting together certain categories, i.e. a coarser choice of categories. With the aid of the relative information loss and the relative reduction of the Bayes risk coefficient, a criterion on the goodness of a choice of categories can be given. The criterion also serves as an optimum choice of classes. The extension of the latter criterion to a generalized decision rule is possible.
Medical Diagnosis from a Clinician’s Point of View
Authors: De Dombal F. T.
Published: March 2018

This paper discusses medical diagnosis from the clinicians point of view. The aim of the paper is to identify areas where computer science and information science may be of help to the practising clinician. Collection of data, analysis, and decision-making are discussed in turn. Finally, some specific recommendations are made for further joint research on the basis of experience around the world to date.
“Desktop Knowledge”: A New Focus for Medical Education and Decision Support
Authors: Greenes R.
Published: March 2018

Physicians today are faced with “data overload” and, paradoxically, “information underload” - the inability to locate pertinent, needed knowledge in a sea of data with which they are inundated. Increasingly, the professional functions of the physician are becoming focused on the desktop workstation, in terms of its ability to provide “windows” into local databases and knowledge resources, and to serve as an. access port to other networked resources. A challenge we now face is to develop means for structuring the vast potentially available knowledge resources in such a manner that access to pertinent knowledge can be facilitated, and to develop acceptable interfaces to the knowledge resources so that a user can effectively navigate through them. The complexity of this task is due to the nature of the knowledge resources - knowledge can be in a variety of forms; ranging from textual and pictorial material, to structured representations, to more dynamic embodiments in the form of procedures. In the Decision Systems Group we have focused on the development of a prototype desktop knowledge management environ- . ment known as Explorer-2, with the objective of providing a consistent interface for access to a wide variety of knowledge. Our accomplishments to date encompass the incorporation into the Explorer-2 environment of adaptations of textbook chapters and books, image data bases, simulations, and expert systems. Navigational aids are provided by a semantic net browser using both MeSH and augmented taxonomies and by a graphical overview map. User response to the predecessor system, Explorer-1, has been strongly positive. Our experience to date suggests a number of observations about the characteristics that knowledge management systems should possess, and the next steps for further research and development.
Computers in a Human Perspective: an Alternative Way of Teaching Informatics to Health Professionals
Authors: Schneider W.
Published: March 2018

An alternative way of teaching informatics, especially health informatics, to health professionals of different categories has been developed and practiced. The essentials of human competence and skill in handling and processing information are presented parallel with the essentials of computer-assisted methodologies and technologies of formal language-based informatics. Requirements on how eventually useful computer-based tools will have to be designed in order to be well adapted to genuine human skill and competence in handling tools in various work contexts are established.

On the basis of such a balanced knowledge methods for work analysis are introduced. These include how the existing problems at a workplace can be identified and analyzed in relation to the goals to be achieved. Special emphasis is given to new ways of information analysis, i.e. methods which even allow the comprehension and documentation ofthose parts of the actually practiced ´human´ information handling and processing which are normally overlooked, as e. g. non-verbal communication processes and so-called ´tacit knowledge´ based information handling and processing activities. Different ways of problem solving are discussed involving in an integrated human perspective - alternative staffing, enhancement of the competence of the staff, optimal planning of premises as well as organizational and technical means. The main result of this alternative way of education has been a considerably improved user competence which in turn has led to very different designs of computer assistance and man-computer interfaces.

It is the purpose of this paper to give a brief outline of the teaching material and a short presentation of the above mentioned results. Special emphasis is given to that part of the course where computer assisted interactive media technology presently is introduced due to the fact that this is the only way of adequately presenting some of the most important parts of human performance in handling and processing information, including communication.
Teaching Medical Informatics to Medical Students in the Federal Republic of Germany
Authors: Michaelis J.
Published: March 2018

The medical curriculum in the Federal Republic of Germany (FRG) is regulated by federal legislation. Medical informatics is part of this curriculum and is therefore taught by all 27 medical faculties in the FRG, 24 of which have related departments. The teaching situation in general and the specific approach at the author´s department are described.
Teaching Medical Informatics: Teaching on the Seams of Disciplines, Cultures, Traditions
Authors: Möhr J.
Published: March 2018

This paper reviews different concepts of medical informatics and identifies two families of approaches to education in it: a “specialist” approach, whereby medical informatics is taught as a specialization track for established disciplines like medicine, computer science, nursing, engineering, etc., and a “generalistic” approach, whereby it is taught as an integrated discipline incorporating essential traits of the aforementioned disciplines. The pros and cons of these approaches are outlined. The need to accommodate specific requirements of education is emphasized and these are identified, together with an outline of particular challenges that we are facing.
Data Management for an Efficacy Trial of a Vaccine in the Gambia
Authors: Mulholland E. K. , Hilton S. , Fegan G. , Inskip G. , Yuuni O. , Bangali J. E. , Greenwood B. M. , Lahai G. P.
Published: March 2018

An individually randomised double-blind trial of PRP-T Hib conjugate vaccine was conducted in the Gambia between 1993 and 1995, in which 42,848 children were randomised into one of 10 groups, five corresponding to vaccine and five to placebo. Basic demographic data were collected on all children, and administration details of all doses of EPI vaccines were recorded. In addition, details on all doses of vaccines were recorded on each child’s home-based health card; 2,681 episodes of possible Hib disease were investigated and for each episode detailed clinical data were collected. These investigations yielded 50 cases of confirmed Hib disease, which formed the basis of the final efficacy results. In all 50 cases, the data on the children’s health card, describing the doses of study vaccine received exactly, matched the vaccination database which was filled with data returned from the clinics. The data-management procedures are described in detail in this paper.
Knowledge-Based System ADNEXPERT to Assist the Sonographic Diagnosis of Adnexal Tumors
Authors: Brüning J. , Becker R. , Entezami M. , Loy Y. , Vonk R. , Weitzel H. , Tolxdorff Th.
Published: March 2018

ADNEXPERT is a knowledge-based system for the computer- assisted ultrasound diagnosis of adnexal tumors. In a case-based approach, ADNEXPERT used histopathologic and sonographic data from 2,290 adnexal tumors. After an ultrasound examination, the gynecologist interacts with the system. A maximum of 15 questions are posed; all but one question (age) relate to the sonographic findings. The help system gives online access to an ultrasound image library. Once the dialogue is complete, ADNEXPERT assesses the adnexal tumor pathology and makes a histological classification. A certainty factor (CF) model is used for knowledge representation. The CFs of the knowledge base are computed from the case database. During system evaluation, the accuracy of ADNEXPERT was tested by 69 new adnexal tumor cases, for which verified histopathological diagnoses were available. ADNEXPERT accurately assessed pathology in 49 cases (71%); in 10 cases (14%) correct indications to pathology were given; no diagnostic hints were attained in 2 cases (3%); and 8 cases (12%) were falsely diagnosed. Based on the positive results of the evaluation, ADNEXPERT will be tested under clinical conditions.
An Interpretation of the Internal Desynchronizations Based on Dynamics of the Two-process Model
Authors: Nakao M. , Sakai H. , Yamamoto M.
Published: March 2018

Daan’s two-process model is known to be one of the most powerful models, covering various situations from free-running to sleep deprivation. In this study, bifurcation properties of the model dynamics are clarified using a circle map. In addition, the two-process model is applied to simulate the two distinct patterns (the period-prolonged: I and the period-shortened: II) of sleep-wake cycles during internal desynchronizations. We propose the novel interpretation that types I and II could be regarded as mutual entrainments between the body temperature rhythm and the sleep-wake cycle with the period ratios 3:4 and 3:2, respectively. From the bifurcation properties of the two-process model obtained above, the model is shown to be able to generate the respective type of mutual entrainment with an appropriate range of a parameter value, i.e, a gap between thresholds. The variable behavior of human circadian rhythm is suggested to be systematically understood based on the bifurcation properties of the two-process model.