bluuebunny/crossref_metadata_2025 huggingface dataset:
Networking in Shared Care – First Steps towards a Shared Electronic Patient Record for Cancer Patients
Authors: Mludek V. , Wolff A. C. , Bülzebruck H. , Oetzel D. , Zierhut D. , Drings P. , Wannenmacher M. , Haux R. , van der Haak M.
Published: March 2018

Objectives: This paper aims at identifying the data protection and security requirements for a cross-institutional EPR. Three possible models and the first steps towards a cross-institutional EPR for the Thoraxklinik Heidelberg and the Department of Clinical Radiology of the University Medical Center of Heidelberg shall be discussed.

Methods: A comprehensive analysis of literature and legal documents supplied information for determining the data protection and security requirements. By means of information system analysis, the technical preconditions in both institutions as well as three possible models towards a cross-institutional EPR were identified.

Results: According to the German penal code it is only allowed to reveal patient information to external physicians in cases of so-called “treatment connection”. An extension of the written consent, signed by the patient, verifying the patient agreement that his/her patient data will be stored in a cross-institutional EPR is needed. Among the three models that we identified, the model that constitutes of a virtual EPR with distributed data capture in both institutions was favored. By means of SecuRemote™ software a secure connection between the Thoraxklinik Heidelberg and the Department of Clinical Radiology was established, allowing the physicians to view the complete cross-institutional health information of a jointly treated patient during the weekly consultation on radiotherapy.

Conclusions: Many requirements listed in this paper are requirements for electronic patient records in general. Besides these general requirements there are specific requirements for a cross-institutional EPR. The legal situation in Germany complicates the development and implementation of a cross-institutional EPR. However, we think that the efforts are reasonable, because a cross-institutional EPR will be able to improve the communication between health institutions, medical disciplines and persons involved in shared care processes. It provides them with more complete health information about the jointly treated patients. A cross-institutional EPR is, therefore, expected to improve the quality of patient care.
Heuristics for Identification of Acronym-Definition Patterns within Text: Towards an Automated Construction of Comprehensive Acronym-Definition Dictionaries
Authors: Wren J. D. , Garner H. R.
Published: March 2018

Objectives: To develop an automated, accurate and scalable method by which acronym-definition pairs can be identified within text. Its primary advantage is in enabling information processing methods to resolve author-defined acronyms, but it also allows an automated creation of a reference work on acronym definitions. This has several advantages over manual or semi-automated methods, besides time and effort saved, such as enabling identification of relative frequencies for alternate acronyms and definitions as well as spelling, phrasing and hyphenation variants for a unique acronym-definition pair. It also aids users in identifying acronym/ definition variants present in the literature that may not necessarily be in biomedical databases.

Methods: A set of heuristics to accurately locate and identify the boundaries of acronym-definition pairs was developed and refined in terms of precision and recall on subsets of MEDLINE records. These training sets were gradually increased in size and heuristics re-evaluated to ensure scalability.

Results: Our final set of Acronym Resolving General Heuristics (ARGH) had a sample-based estimated rate of 96.5 ±

0.4% precision and 93.0 ± 2.7% recall when tested on over 12 million MEDLINE records, identifying more than 174,000 unique acronyms and their 737,000 associated definitions.

Conclusions: We estimate that as much as 36% of the acronyms in MEDLINE are associated with more than one definition and, conversely, up to 10% of definitions are associated with more than one acronym. The number of unique acronyms in MEDLINE is increasing at a rate of approximately 11,000 per year, while the number of definitions associated with them is growing at approximately four times that rate. Access to the ARGH database is available online at http://lethargy.swmed.edu/ARGH argh.asp. The heuristic module and database are available upon request.
Evoked Potential Enhancement Using a Neurophysiologically-based Model
Authors: Balaji Kavaipatti A. , Markusson O. , Jansen B. H.
Published: March 2018

Objective:
Single trial evoked potentials (EP) are generally obscured by the much larger spontaneous or background electroencephalogram (EEG). A novel method was developed to enhance single trial EPs. The potential of this approach was explored using actual flash evoked visual EPs.

Method:
The basic procedure is a variant of the adaptive filtering approach. At the core of our method is a mathematical, but neurophysiologically-realistic, nonlinear model of the cortical structures involved in generating EEG and EP activity. The model parameters are adjusted by a genetic algorithm in such a way that the model output resembles the actually observed pre-stimulus EEG activity. When post-stimulus EEG is passed through the inverse model, enhancement of the single trial EP should, theoretically, occur.

Results:
Evidence was found that, in case of visual evoked potentials obtained by flashing light through closed eyelids, alpha activity continues to around 150 ms post-stimulus, at which point a low frequency potential arises, cresting 100 ms later and disappearing after another 100 ms or so. Also, it was found that an individual’s response varies considerably from trial to trial.

Conclusion:
The inverse modeling approach presented here is effective at enhancing single trial EP activity. One potential application is to distinguish trials that contain a response from those that do not, which could result in improved ensemble averages.
Patient Acceptance of Educational Voice Messages: A Review of Controlled Clinical Studies
Authors: Boren S. A. , Maglaveras N. , Krishna S. , Balas E. A.
Published: March 2018

Objectives: The objective of this study was to evaluate controlled evidence on the impact of automated computer-based telephone messaging technology upon health outcomes, cost savings and acceptance by patients, caregivers and care providers.

Methods: Systematic searches of electronic databases were conducted to find controlled clinical studies of automated phone messaging used in patient care. Studies were selected based on the three criteria: 1) randomized controlled trials or controlled trials; 2) patients receiving health care related education, information, advice or reminder for a specific action to be taken in their home setting; and 3) use of automated computer-based phone technology to deliver the messages. Information abstracted from studies included information about the institution, persons targeted, intervention and its effect on health outcomes, costs and acceptance by patients and caregivers.

Results: A total of nineteen studies were identified for review. Sixteen studies were randomized controlled trials and three were controlled studies with no randomization. Studies were placed in two categories, preventive care education and chronic care studies. Preventive care education studies covered childhood immunizations, medication compliance, influenza vaccinations, tuberculosis and health prevention activities and chronic care studies were related to cholesterol, diabetes, hyper-tension and congestive heart failure. More than 80% of studies showed significant impact upon measurable health outcomes.

Conclusions: Controlled evidence substantiates the efficacy of automated telephone communication in improving the quality of care. Educational voice messages are acceptable to patients and represent an important opportunity to enhance telemedicine and telehealth applications.
Understanding, Navigating and Communicating Knowledge: Issues and Challenges
Authors: Kushniruk A. W. , Patel V. L.
Published: March 2018

This paper presents a psychological perspective on key issues related to medical vocabularies. There have been rapid advances in the development of computer technology underlying medical information systems. However, in keeping with technological progress, we must also take into account advances in our understanding of human behaviour and learn frOm failures in human performance. A central issue examined in this paper is the extent to which we can develop generic vocabularies that are also flexible and adaptable to specific situations. Empirical research indicates that variability in human performance is much greater than what current medical classifications take into account. A related challenge is that of how to best develop vocabularies that meet the needs of users. Based on theoretical perspectives and research emerging from the domain of cognitive psychology, we suggest that an understanding of the cognitive mechanisms underlying the comprehension and application of terminology is required. It is argued that rather than beginning with highly specified terminologies, i.e. the normative approach, we might instead begin by examining the natural context of how health care workers acquire, understand and negotiate knowledge in practice.
Concepts, Knowledge and Language in Healthcare Information Systems: Follow-up 30 Months Later
Authors: Scherrer J.-R.
Published: March 2018

The paper reviews the last IMIA-WG6 recommendations, issued along two themes: (1) how to better share common results and (2) how to conduct new research and development efforts. Some of the major discrepancies in the field are reviewed. The paper intends to offer insight into two areas, first, in the issue of knowledge representation and, second, in the science of meaning, incorporating the broad intersection of computational linguistics, semantics, conceptual approach, and denotation. The Ogden-Richards meaning triangle is used as a convenient organizing principle to maximize the scope of understanding among the different schools, particularly in areas of linguistics and semantics on the one side and denotation and conceptual approach on the other. In conclusion, there is a need for clarification and for more scientific pragmatism.
A General Model of Drug Prescription
Authors: Séné B. , Venot A. , de Zegher I. , Milstein C. , Errore S. , de Rosis F , Strauch G.
Published: March 2018

Currently, there is no widely accepted structured representation of drug prescription. Nevertheless, a structured representation is required for entering and storing drug prescriptions avoiding free text in computerized systems, and for drug prescription reviews. Derived from part of the work of the European OPADE project, we describe an object-oriented model of drug prescription which incorporates important concepts such as the phase and triggering event concepts. This model can be used to record all drug prescriptions, including infusions, in a structured way avoiding free text. The phase concept allows the storage of sequentially ordered dosage regimens for a drug within the same prescription. The prescription triggering event concept allows recording of the administration of a drug conditional to dates, symptoms and clinical signs, medical procedures, and everyday life events. This model has been implemented within the OPADE project; the corresponding aspects of the user interface are presented to show how this model can be used in practice. Even if other new attributes may be added to the described objects, the structure of this model is suitable for general use in software which requires the entry, storage and processing of drug prescriptions.
A Graphical Query Generator for Clinical Research Databases
Authors: Banhart F. , Klaeren H.
Published: March 2018

Clinical research involves recording, storage and retrieval of disease-related patient data, typically using a database system. In order to facilitate ad hoc queries to clinical databases we have developed a query generator with a graphical interface. The query generator uses an object-oriented data model which is visualized by directed graphs. The main focus of our work was the definition of object-oriented user views to the partly complex data structures of a relational database. Furthermore, we tried to define graphical abstractions for all common types of queries. Thus, even for non-expert database users such as clinicians, it is easy to assemble highly complex queries for a thorough examination of the content of large research databases.
A Three-Level Graph-Based Model for the Management of Hospital Information Systems
Authors: Winter A. , Haux R.
Published: March 2018

Information processing in hospitals, especially in university hospitals, is currently faced with two major issues: low-cost hardware and progress in networking technology leads to a further decentralization of computing capacity, due to the increasing need for information processing in hospitals and due to economic restrictions, it is necessary to use, commercial software products. This leads to heterogeneous hospital information systems using a variety of software and hardware products, and to a stronger demand for integrating these products and, in general, for a dedicated methodology for the management of hospital information systems to support patient care and medical research. We present a three-level graph-based model (3LGM) to support the systematic management of hospital information systems. 3LGM can serve as a basis for assessing the quality of information processing in hospitals. 3LGM distinguishes between a procedural level for describing the information procedures (and their information interchange) of a hospital information system and thus its functionality, a logical tool level, focusing on application systems and communication links, and a physical tool level with physical subsystems (e.g., computer systems) and data transmission. The examples that are presented have been taken from the Heidelberg University Hospital Information System.
Modeling Drug Information for a Prescription – Oriented Knowledge Base on Drugs
Authors: de Zegher I. , Venot A. , Séné B. , Pietri P. , Dahlberg B. , Milstein C.
Published: March 2018

There exists little theoretical analysis how to represent knowledge on drugs required for computerized drug-prescription applications. A work package drug information modeling is described which was part of the European GPADE project. We describe the content and structure of a Drug Knowledge Base (DKB) designed to meet the requirements of decision-support systems in the domain of drug therapy, and to facilitate data transfer from various information sources. The definition of the DKB content is derived from the analysis of information requirements at the various stages of the process of the clinical usage of drugs (prescribing, administration, and follow-up). The DKB structure results from the classification of the various data items along two dimensions: (1) entities in the pharmaco-therapeutic domain for which information must be defined (the Pharmaco-Therapeutic Group, the Component, the Manufactured Preparation, and the Presentation), and (2) the validity score of the pharmaco-therapeutic information (international, national, or local).
Computer-Aided Diagnosis in Jaundice: Comparison of Knowledge-based and Probabilistic Approaches
Authors: Molino F. , Furia D. , Bar F. , Battista S. , Cappello N. , Molino G.
Published: March 2018

The study reported in this paper is aimed at evaluating the effectiveness of a knowledge-based expert system (ICTERUS) in diagnosing jaundiced patients, compared with a statistical system based on probabilistic concepts (TRIAL). The performances of both systems have been evaluated using the same set of data in the same number of patients. Both systems are spin-off products of the European project Euricterus, an EC-COMACBME Project designed to document the occurrence and diagnostic value of clinical findings in the clinical presentation of jaundice in Europe, and have been developed as decision-making tools for the identification of the cause of jaundice based only on clinical information and routine investigations. Two groups of jaundiced patients were studied, including 500 (retrospective sample) and 100 (prospective sample) subjects, respectively. All patients were independently submitted to both decision-support tools. The input of both systems was the data set agreed within the Euricterus Project. The performances of both systems were evaluated with respect to the reference diagnoses provided by experts on the basis of the full clinical documentation. Results indicate that both systems are clinically reliable, although the diagnostic prediction provided by the knowledge-based approach is slightly better.
Abductive Machine Learning for Modeling and Predicting the Educational Score in School Health Surveys
Authors: Mangoud A. M. , Abdel-Aal R. E.
Published: March 2018

The use of modern abductive machine learning techniques is described for modeling and predicting outcome parameters in terms of input parameters in medical survey data. The AIM® (Abductory Induction Mechanism) abductive network machine-learning tool is used to model the educational score in a health survey of 2,720 Albanian primary school children. Data included the child’s age, gender, vision, nourishment, parasite infection, family size, parents’ education, and educational score. Models synthesized by training on just 100 cases predict the educational score output for the remaining 2,620 cases with 100% accuracy. Simple models represented as analytical functions highlight global relationships and trends in the survey population. Models generated are quite robust, with no change in the basic model structure for a 10-fold increase in the size of the training set. Compared to other statistical and neural network approaches, AIM provides faster and highly automated model synthesis, requiring little or no user intervention.
Toward an Evaluation of an Integrated Clinical Imaging System: Identifying Clinical Benefits
Authors: Lundsgaarde H. P. , Kaplan B.
Published: March 2018

Integrated clinical imaging systems can provide the foundation for future computer-based patient record systems as recommended by the Institute of Medicine. However, documenting the benefits of such systems is difficult. This paper reports an evaluation of a clinical imaging system that is integrated with an on-line electronic patient record. The evaluation used interviews and observations to identify what physicians thought were the benefits of this system. Reported benefits may be classified into patient care benefits, educational benefits, and productivity and cost-reduction benefits. Physicians said that the imaging system provided patient care benefits by: improving clinical communication and decision making, making care more patient-based, reducing the number of procedures and patient risks, and improving record keeping. Educational benefits they reported included: improving communication, providing broad “real” experience, and improving supervision. These benefits may be reflected in increased productivity and cost reduction by increasing time savings, reducing clerical work, improving morale, and reducing the costs of care. The approach described in this study was valuable in identifying potential benefits of a clinical information system. The findings point the way to realization of benefits for other systems, and, ultimately, for computer-based patient records.
Decision Support Systems in Health Care
Authors: Walus Y. E. , Hanmer L. , Ittmann H. W.
Published: March 2018

This paper delineates the application of decision support systems in the healthcare arena. An overview of decision support systems in the healthcare environment in the last three to five years, mostly in the USA and the UK is provided. Some reference is made to work in South Africa. Although this report endeavours to emphasise the decision support system side, some operations research issues are also addressed. This paper is divided into several sections: decision support systems definition, techniques used, the use of operations research in specific areas of healthcare, information systems, assessment of decision support systems, in-house development, decision support in South Africa and future of decision support systems.
The Use of Knowledge-based Systems in Medicine in Developing Countries: A Luxury or a Necessity?
Authors: du Plessis J. P. , Tolmie C. J.
Published: March 2018

Knowledge-based systems (KBSs) in medicine have received much attention over the past two decades, mainly because of the potential benefits that can be gained from using them. They may facilitate in increasing productivity in a medical environment, support the making of diagnoses and other types of medical decisions, assist in the training of medical professionals, and can even handle some routine tasks in a medical environment. However, some critical problems in this field have also been identified. For example, research indicated that some problems can be solved partially, but not completely, with existing artificial intelligence techniques. Another problem is that many of the existing medical information systems do not support the integration of KBSs in a natural way. Furthermore, the routine use of a medical KBS is complicated by legal issues. These and other problems contribute to what we experience today: a large proportion of the medical KB applications that are developed is never actually used in practice. This justifies questions such as: Should developing countries, having limited infrastructure and research resources, invest in medical KBSs research and development, or should this field be regarded as a luxury that only belongs to developed countries?, and: Can developing countries really benefit from the use of these systems? These questions are discussed in this paper. We highlight the main problems surrounding the development and use of medical KBSs. With the focus on developing countries we discuss potential benefits that could be obtained by investing in these systems and we offer guidelines for focusing research and development of medical KBSs.
Data-Screening and Retrieval of Medical Data by the System WAREL
Authors: Dorda W. G.
Published: March 2018

The paper presented here deals with the computer system WAREL, a system for analyzing medical patient data. It is a patientoriented medical data-screening system which automatically points out medical risk factors. Referring to all patients, it is a retrieval system for selecting groups of patients from the clinical data base; the explorative statistical analysis concerning medical data of these selected groups can give an essential impulse to clinical research. The most important components of the system such as the relational data base and the system for defining and activating logical conditions are discussed. These conditions (IF -THEN rules) are the basis of both the patient oriented data-screening and the retrieval of patient groups. They may refer to data in formatted or in natural language form; furthermore conditions of the course of illness can also be formulated. Thus, the data-screeni ng system may also indicate risk situations due to the course of an illness.
Information Content of Diagnostic Tests in the Medical Literature
Authors: Heckerling P. S.
Published: March 2018

Diagnostic tests provide information about the presence or absence of disease. However, even after application of diagnostic tests, significant uncertainty about the state of the patient often remains. This uncertainty can be quantified through the use of information theory. The “information” contained in diagnostic tests published in the medical literature of the years 1982 through 1986 was evaluated using Shannon information functions. Information content, averaged over all prior probabilities of disease, ranged from 0.002 bits to 0.720 bits of information; the tests therefore provided from 0.3% to 100% of the information needed for diagnostic certainty. Median average information was 0.395 bits, corresponding to only 55% of the information required for diagnostic certainty. Reclassifying test results into multiple mutually exclusive outcome categories allowed extraction of a median of 14% and a maximum of 109% more average information than that obtained using a dichotomous positive/negative classification. We conclude that the “information” provided by many of the tests published in the medical literature is insufficient to overcome diagnostic uncertainty. Information theory can quantify the uncertainty associated with diagnostic testing and suggest strategies for reducing this uncertainty.
Proposed Methodology for Knowledge Acquisition: A Study on Congenital Heart Disease Diagnosis
Authors: Leãot F. B. , Rocha F. A.
Published: March 2018

“Knowledge and human power are synonymous, since the ignorance of the cause frustrates the effect:…“

Francis Bacon1

This paper proposes a methodology for knowledge acquisition (KA) from multiple experts, in an attempt to elicit the heuristic rules followed by the physician in diagnosing twelve frequently occurring congenital heart diseases (CHD). Twenty-two pediatric cardiologists and twenty-three general cardiologists were interviewed with this technique; 274 interviews were conducted, 169 with the 22 experts, 105 with the 23 non-experts. A graph formalism was employed to represent their reasoning model, leading to the construction of a “mean reasoning model” for each diagnosis, separately for experts and non-experts. The results indicate that experts, compared to non-experts, tend to build knowledge representation models (KRM) that are smaller and less complex. Qualitative differences in information utilization between the two groups were also observed. Entropy analysis suggests a greater objectivity and cohesion of the experts’ model.
BRAINDEX: An Interactive, Knowledge-Based System Supporting Brain Death Diagnosis
Authors: Schwarz G. , Grims R. , Rumpl E. , Rom G. , Pfurtscheller G. , Haase V.
Published: March 2018

BRAINDEX (Brain-Death Expert System) is an interactive, knowledge-based expert system offering support to physicians in decision making concerning brain death. The physician is given the possibility of communicating in almost natural language and, therefore, in terms with which he is familiar. This updated version of the system is implemented on an IBM-PC/AT with the expert system shell PC-PLUS and consists of about 430 rules. The determination of brain death is realized with backward chaining and for the optional coma-scaling a forward-chaining mechanism is used.
A Brief History of Computer-Assisted Electrocardiography
Authors: Macfarlane P. W.
Published: March 2018

This paper reviews the history of the development of computer methods for ECG interpretation. Selected highlights are presented which indicate how technological advances have paralleled the growth of the application of the technique to a point where globally over 100 million ECGs per annum are now interpreted by computer.
Methodology of ECG Interpretation in the Louvain Program
Authors: Brohet C. R. , Derwael C. , Robert A. , Fesler R.
Published: March 2018

The Louvain program performs the analysis and interpretation of the vectorcardiogram (VCG) to increase the clinical utility of ECG analysis. Among its original features, there are (1) a high-resolution vector-loop display for visual analysis, (2) quantitative analysis of the spatial VCG using age-sex stratified limits, (3) separate software for adult and pediatric series and (4) complementary deterministic and statistical methods of diagnostic classification. Using objective, ECG-independent evidence as a reference standard, the Louvain program has shown satisfactory levels of diagnostic accuracy in most basic categories. However, its usefulness is especially marked in “borderline” or “complex” situations, where the 12-lead ECG cannot provide a clear answer. It corresponds to the concept of “computer-assisted ECG interpretation” as opposed to “computer ECG analysis”.
A Medical Text Analysis System for German - Syntax Analysis
Authors: Pietrzyk P. M.
Published: March 2018

Much information about patients is stored in free text. Hence, the computerized processing of medical language data has been a well-known goal of medical informatics resulting in different paradigms. In Gottingen, a Medical Text Analysis System for German (abbr. MediTAS) has been under development for some time, trying to combine and to extend these paradigms. This article concentrates on the automated syntax analysis of German medical utterances. The investigated text material consists of 8,790 distinct utterances extracted from the summary sections of about 18,400 cytopathological findings reports. The parsing is based upon a new approach called Left-Associative Grammar (LAG) developed by Hausser. By extending considerably the LAG approach, most of the grammatical constructions occurring in the text material could be covered.
Validation, Clinical Trial, and Evaluation of a Radiology Expert System
Authors: Kahn C. E.
Published: March 2018

The PHOENIX Radiology Consultant is a rule-based expert system which assists physicians in planning radiological work-up strategies. This article describes the methods used to create and validate the system’s knowledge base. The feasibility and acceptability of PHOENIX were tested for two years in a clinical trial. During this period, the system was used 1,421 times, an average of 13.7 times per week, primarily by medical students and nonradiologist physicians. Much of the system’s use occurred at night and on weekends, when the radiology department was not fully staffed. Several physicians were enlisted to further evaluate the utility of the system. The results of their evaluation indicate that an expert system that helps physicians select diagnostic-imaging studies can serve as a useful and informative component of a radiology information system, and is particularly useful for medical students and physicians in training.
Data Modeling for Immunological and Clinical Data of Leukemia and Myasthenia Patients
Authors: Haux R. , Müller’ C. A. , Gerneth F.
Published: March 2018

In this study it was investigated whether and to what extent semantic data models and their methods for data modeling are useful for adequate representation and integration of immunological and clinical data. To that end the special research program in leukemia research and immunogenetics (SFB 120) of the University of Tübingen was taken as an example. Based on the semantic data model RIWT we propose the design of a database system, report on its realization, and discuss this approach. Using a semantic data model, the quality of data increased considerably. This means, for instance, that the integration of the molecular-biological knowledge allows a better control of the person-related results. Hence, the decisions based of these data may have greater validity and the treatment on leukemia patients can be improved. Furthermore, the elucidation of immune mechanisms concerning auto-immune diseases could be improved.
Eurosentinel: Development of an International Sentinel Network of General Practitioners
Authors: Leurquin P. , van Casteren V.
Published: March 2018

The Eurosentinel project was a European concerted action. It started in June 1988 and ended in June 1991. Its purpose was to coordinate activities in the field of sentinel practices with GPs and the ultimate goal was to establish a real European network of sentinel practices. This paper deals with the purposes of the project, the studies carried out in the frame of the project, and an evaluation of three years Eurosentinel.
Possibilities of Software Phantoms for Quality Control of KBS in Nuclear Medicine
Authors: Kotzke K. , Pretschner D.-P.
Published: March 2018

The assessment of the results of a “knowledge-based system” (KBS) for quality control is a basic requirement for clinical application: Large numbers of test studies are necessary in order to cover as widely as possible the spectrum of cases to be analyzed by the KBS. The use of original patient data as test data is one possibility, but real data are provided unevenly. This is due to the set of characteristics which are relevant to the analysis. Data are available in a limited quantity only. This implies a remaining set of unvalidated cases which are not represented in the data pool. The software phantom is an approach towards systematically guided validation. It permits the generation of test data adjusted to the demands of the validation.
A New Method to Assess the Difficulty of a Medical Diagnosis: Application to Electrocardiographic Interpretation
Authors: Willems J. L. , Girard P. , Morlet D. , Arnaud P.
Published: March 2018

A new method to assess the relative difficulty of a medical diagnosis and the efficacy of a diagnostic procedure is described. The cases within a population are classified by N independent interpreters, i. e., medical experts or computer programs. The percentages of correctly diagnosed cases by N (unanimity), N-1, N-2, ..., zero interpreters, respectively, are calculated. These Nl + 1 percentages are presented in a histogram. A cumulative plot is derived from the “unanimity” value. The ratio “unanimity value”/“zero value” is proposed as an index of diagnostic performance. An application to the CSE database is presented which is composed of 1,220 electrocardiographic tracings interpreted by 13 cardiologists and 15 computer programs. The cumulative plots, the performance index and Log (index) values, established for eight different diagnostic statements, clearly show the relative degree of diagnostic difficulty for each of them and the particular efficacy of each approach, i. e., electrocardiography versus vectorcardiography, and computerized versus human interpretation.
Developmental Toxicity Risk Assessment: A Rough Sets Approach
Authors: Jelovsek F. R. , Razzaghi M. , Hashemi R. R.
Published: March 2018

A rough-sets approach was applied to a data set consisting of animal study results and other compound characteristics to generate local and global (certain/possible) sets of rules for prediction of developmental toxicity in human subjects. A modified version of the rough-sets approach is proposed to allow the construction of an approximate set of rules to use for prediction in a manner similar to that of discriminant analysis. The modified rough-sets approach is superior in predictability to the original form of rough-sets methodology. In comparison to discriminant analysis, modified rough sets (approximate rules) appear to be better in overall classification, sensitivity, positive and negative predictive values. The findings were supported by applying the modified rough sets and discriminant analysis on a test data set generated from the original data set by using a resampling plan.
Advanced Patient Records: Some Ethical and Legal Considerations Touching Medical Information Space
Authors: Kluge E.-H. W.
Published: March 2018

The application of advanced computer-based information technology to patient records presents an opportunity for expanding the informational resource base that is available to health-care providers at all levels. Consequently, it has the potential for fundamentally restructuring the ethics of the physician/patient relationship and the ethos of contemporary health-care delivery. At the same time, the technology raises several important ethical problems. This paper explores some of these implications. It suggests that the fundamental ethical issue at stake in these developments is the status of the electronic record which functions as the analog of the health-care consumer in health-care decision making. Matters such as control and patient dignity are implicated. Other important ethical issues requiring solution include data ownership, data liability, informed consent to use and retrieval, security and access. The paper suggests that the ethical problems that arise cannot be solved in piecemeal fashion and on a purely national basis. They should be addressed in a coordinated international fashion and receive appropriate legal expression in the relevant countries and be incorporated into appropriate codes of ethics.
Automatic Knowledge Acquisition from MEDLINE
Authors: Barnett G. O. , Cimino J. J.
Published: March 2018

Construction of medical knowledge bases for use in expert systems is an arduous task. We propose a procedure for obtaining medical knowledge via automated analysis of citations found in the National Library of Medicine’s Medline
® database. In this method, simple pattern of keywords and subheading co-occurrences are detected in the keyword descriptor portion of the citations. Each pattern corresponds to a fact, expressed as a semantic relationship between medical concepts. We have constructed a set of 504 pattern-matching rules and applied it to a set of 673 Medline
® citations to produce 2,795 such facts. The results are presented of an analysis of the syntactic and semantic features of these facts to understand the kinds of knowledge than can be obtained through our method and speculate on the potential uses and pitfalls for knowledge of this type.
Constructing a Minimal Diagnostic Decision Tree
Authors: McGorry P. D. , Wallace C. S. , Low L. H. , Copolov D. L. , Singh B. S. , McKenzie D. P.
Published: March 2018

Classification trees and discriminant function analysis were employed in order to ascertain whether a small number of diagnostic decision rules could be extracted from a large inventory of items. Several models, involving up to 17 symptoms, that led to a broad psychiatric diagnosis were then tested on a small validation sample of 53 patients. All methods, with the exception of CART used without any pruning, generated identical trees involving four items. Almost 90% of the validation sample was able to be correctly classified by all methods although poor classification performance was noted in the case of one particular diagnosis, Schizoaffective Psychosis. In contrast, stepwise linear discriminant analysis originally selected 17 items, although three out of the first four items selected were identical to those chosen by the tree-building methods. Although more research is required, there are indications that the latter methods may be usefully employed in constructing parsimonious decision trees.
A Temporal Query System for Protocol-Directed Decision Support
Authors: Das A. K. , Musen M. A.
Published: March 2018

Chronus is a query system that supports temporal extensions to the Structured Query Language (SQL) for relational databases. Although the relational data model can store time-stamped data and can permit simple temporal-comparison operations, it does not provide either a closed or a sufficient algebra for manipulating temporal data. In this paper, we outline an algebra that maintains a consistent relational representation of temporal data and that allows the type of temporal queries needed for protocol-directed decision support. We also discuss how Chronus can translate between our temporal algebra and the relational algebra used for SQL queries. We have applied our system to the task of screening patients for clinical trials. Our results demonstrate that Chronus can express sufficiently all required temporal queries, and that the search time of such queries is similar to that of standard SQL.
Evaluation of a Decision-Support System for Inoperable Non-Small Cell Lung Cancer
Authors: Kolari P. , Wigren T.
Published: March 2018

The purpose of this study was to find out whether a decision-support system is able to assist a clinician in predicting patient outcome and in selecting optimal treatment in oncology. The domain of the evaluated decision-support prototype was primary therapeutic decision making in inoperable non-smali cell lung cancer. The performance of the prototype was tested on retrospective material consisting of 112 patients treated by radiotherapy. Survival was the endpoint for examining whether the treatment decision proposed by the system was more accurate than the decision actually made by the clinician. Certain prognostic variables were used by the system to classify patients into two treatment groups, radical or palliative radiotherapy. The median survival times of these groups were 15 and 7 months, respectively, compared with 9 and 8 months in the corresponding groups classified by the clinician. Our results indicate that clinicians need support in treatment selection and that decision-support systems could be a potential answer.
Human Performance Evaluation of a Metaphor Graphic Display for Respiratory Data
Authors: Stewart J. G. , Cole W. G.
Published: March 2018

Metaphor graphics are data displays designed to look like corresponding variables in the real world, but in a non-literal sense of “look like”. Evaluation of the impact of these graphics on human problem solving has twice been carried out, but with conflicting results. The present experiment attempted to clarify the discrepancies between these findings by using a complex task in which expert subjects interpreted respiratory data. The metaphor graphic display led to interpretations twice as fast as a tabular (flowsheet) format, suggesting that conflict between earlier studies is due either to differences in training or to differences in goodness of metaphor, Findings to date indicate that metaphor graphics work with complex as well as simple data sets, pattern detection as well as single number reporting tasks, and with expert as well as novice subjects.
MEDUSA: A Fuzzy Expert System for Medical Diagnosis of Acute Abdominal Pain
Authors: Fathi-Torbaghan M. , Meyer D.
Published: March 2018

Even today, the diagnosis of acute abdominal pain represents a serious clinical problem. The medical knowledge in this field is characterized by uncertainty, imprecision and vagueness. This situation lends itself especially to be solved by the application of fuzzy logic. A fuzzy logic-based expert system for diagnostic decision support is presented (MEDUSA). The representation and application of uncertain and imprecise knowledge is realized by fuzzy sets and fuzzy relations. The hybrid concept of the system enables the integration of rulebased, heuristic and casebased reasoning on the basis of imprecise information. The central idea of the integration is to use casebased reasoning for the management of special cases, and rulebased reasoning for the representation of normal cases. The heuristic principle is ideally suited for making uncertain, hypothetical inferences on the basis of fuzzy data and fuzzy relations.
Patient Records: from Single Events to Elements for Health Planning
Authors: Pisanelli D. M. , Ricci F. L.
Published: March 2018

Data collected in patient records are not only the kernel of a ward information system, but also the groundwork for planning and evaluating services in health care. The aim of this study was to analyze the problem of aggregate data generation starting from separate items in patient records. After describing the different uses of patient record data, we outline the process which generates aggregate data starting from individual records. This process leads to the definition of the “view on aggregation” as an intermediate step between patient records and aggregate data.

A simplified schema is presented based on the Entity-Relationship model representing a conceptual model of the integration of aggregate data and patient record items. Finally, the role is discussed of automation in this process and the perspectives for its implementation.
The PEN & PAD Medical Record Model: Development of a Nursing Record for Hospital-based Care of the Elderly
Authors: Heathfield H. A. , Hardiker N. , Kirby J. , Tallis R. , Gonsalkarale M.
Published: March 2018

The PEN & PAD Medical Record model describes a framework for an information model, designed to meet the requirements of an electronic medical record. This model has been successfully tested in a computer-based record system for General Practitioners as part of the PEN & PAD (GP) Project.

Experiences of using the model for developing computer-based nursing records are reported. Results show that there are some problems with directly applying the model to the nursing domain. Whilst the main purpose of the nursing record is to document and communicate a patient’s care, it has several other, possibly incompatible, roles. Furthermore, the structure and content of the information contained within the nursing record is heavily influenced by the need for the nursing profession to visibly demonstrate the philosophical frameworks underlying their work. By providing new insights into the professional background of nursing records, this work has highlighted the need for nurses to clarify and make explicit their uses of information, and also provided them with some tools to assist in this task.
Privacy: a Real-World Problem with Fuzzy Boundaries
Authors: Lincoln T. L.
Published: March 2018

Response to: Kluge E-H W. Advanced patient records: some ethical and legal considerations touching medical information space. Meth Inform Med 1993; 32: 95-103
Application of Circular Statistics in Pulmonary Diseases by Blood Gas Analysis
Authors: Kraemer R. , Kläy M.
Published: March 2018

Attention is focused on the presentation of circular statistics with directional data, since biologists and physicians are often confronted with such statistical problems. The methodological properties of circular statistics are elaborated by means of data of arterial blood gas changes during exercise in children with cystic fibrosis. The present study demonstrates that performance and discrimination into different severity groups in this chronical disease can be achieved by this statistical method and that analogous problems in biology and medicine could be resolved in the same way.
On the Selectivity of the Identification Number in the Patient Data Base of the Medical System Hannover
Authors: Feldmann U. , Reichertz P. L. , Sauter K.
Published: March 2018

The clinical data of patients at the Medical School of Hannover is collected in a central patient data base by the Medical System Hannover. A 9-digit »ID-number« is used to identify each patient.

At the end of the year 1978 the data base contained data of 137,474 patients and 5.1% of the new admissions in the year 1978 hit upon a previously issued ID-number.

The selectivity of the ID-number is presented according to empirical frequency distributions of the ID-number’s components and it is evaluated with the aid of information theory.

A method, derived from occupancy theory, for quantitively estimating the ID-number multiples depending on the number of patients and considering the frequency distributions of the individual IDnumber components is presented and successfully proven.
The Information System of Experimental Pathology of the German Cancer Research Center
Authors: Komitowski D. , Köhler C. O. , Naumann D. , Lance B.
Published: March 2018

The information system of experimental oncopathology of the German Cancer Research Center is a computerized data processing program for studying the etiology, pathogenesis and therapy of experimental cancer. This program is adapted to correlate stored data with those from the thesaurus of human pathology. The system is developed and administered by the histodiagnostic facility which serves to collect and register standardized, centralized and current data from all sources. These are: individual investigators, animal laboratory, and central histodiagnostic facility. To record uniform data, a standardized protocol is introduced which entails data sets for information about animals, substances under study, experimental design, and necropsy and histological changes. The data entry takes place semi-automatically by using different codes grouped into three files: for substances, for animals, and for pathological changes. The code for pathological findings is based on SNOP. For data processing the system ALIS is employed which permits input, check and update; reorganisation and confirmation; evaluation.

The information system is adapted to the organization and research programs of the German Cancer Research Center. It is a flexible system applicable for different conditions in registering and processing diverse information about animal experiments.