bluuebunny/crossref_metadata_2025 huggingface dataset:
Data-Driven Medical Knowledge-Based Systems Based on Arden Syntax
Authors: Wigertz O.  , Hripcsak G.  , Shahsavar N.  , Bågenholm P.  , Åhlfeldt H.  , Gill H.
Published: February 2025

A great deal of research has been ongoing in the medical informatics community in an attempt to create medical knowledge-based systems (KBSs) to assist the health care provider in both diagnostic and management decisions. In order for these systems to have a significant impact on health care, sharing of knowledge among institutions must take place. There are many challenges to sharing, including differences in vocabularies, local medical practice, local prior probabilities, syntax of the knowledge-base (KB), evaluation, royalties, and liability. The Arden Syntax has recently become an approved standard for representing knowledge with the purpose of allowing multiple users to create, criticise and share knowledge modules. While providing a common syntax for sharing by itself does not solve most of the challenges, it allows institutions to begin sharing, to see which issues are the most important and the most difficult. It has been found that differences in clinical vocabularies and data schemas provide the greatest current challenge to sharing practical KBSs. Thus, in order for KBSs to succeed on a large scale, ways to coordinate vocabularies and schemas across institutions must be developed. As sharing increases, evaluation and maintenance will become greater challenges.
Legal Issues in Cognition, Knowledge Processing and Decision Making Techniques in the Health Sector
Authors: De Schutter Bart  , Laske Caroline
Published: February 2025

This paper examines the legal issues that may arise in the use of electronic support for cognition, knowledge processing and decision making in the medical field which encompasses a wide range of electronically based techniques simulating at least part of the processes so far considered to belong to the human intellect. It is essential that the legal aspects should be examined at the earliest possible stage so as to develop legal recommendations alongside technological progress rather than retroactively. Needless to say, the topic is extremely vast and this paper only tries to outline the fundamental legal and ethical issues, rather than to formulate detailed recommendations and guidelines.
Respiratory Modulation of Blood Pressure and Heart Rate Studied with a Computer Model of Baroreflex Control
Authors: TenVOORDE B.J.  , FAES Th.J.C.  , JANSSEN T.W.J.  , SCHEFFER G.J.  , ROMPELMAN O.
Published: February 2025

In order to study respiratory modulating effects on blood pressure and heart rate over a wide frequency range and in different autonomic states, we developed a computer model of the baroreflex blood pressure control system. The model combines simple beat-to-beat hemodynamics with detailed dynamic neural control of heart rate and vasomotor activity. The model is capable of simulating different heart rate and blood pressure steady-state values as a result of a changing sympathovagal balance, and accurately simulates beat-to-beat variability due to respiration and 0.1 Hz resonance. The model is a powerful instrument in formulating and testing hypothesis concerning the origin of RSA, frequency dependency of RSA, and short term blood pressure modulations. The main characteristics of the model are discussed, as well as its use in the interpretation of two experimental studies, standing versus supine posture, and sympathetic (spinal) lesions.
Case-Based Information Systems in Swedish Health Care
Authors: Paulson Eric M.
Published: February 2025

The paper gives a brief overview of some national case-based information systems in Swedish health care together with an application from the Stockholm County Council. A background section on the Swedish health care system is also included.
Case-Based Quality Management System for Surgery, A Bottom Up Approach
Authors: de Vries B.C.  , Hofdijk W.J.
Published: February 2025

Quality control has become a familiar concept in health care in The Netherlands in the last ten years, as it has elsewhere in the Western world. To achieve the goals of total quality, medical audit plays a central role in the process. An important issue for medical audit is to collect consistent and coherent data on the medical performance. As no widespread tradition exists to do this routinely using common widely accepted protocols and information technology, examples of routine quality control of medical services are scarce. In this paper a report is given of the process of collecting routine data on the surgical treatments and its complications in a Dutch general hospital. Based on the results of this and other local initiatives to control and improve the quality of surgical procedures the Dutch Association of Surgeons has recently adopted a policy document, which promotes to enhance quality Management. This paper presents also the increasing need among health care professionals to compare the results of treatment of similar patients. The role of Information Technology to achieve these goals is growing at an impressive pace. A more complete documentation of the care process will increasingly support a case based approach, which will be essential for a comprehensive analysis and Management of the care provided to patients. The paper supports a systematic collection of data documenting structure, process and outcome.
Analysis of Symmetry of Lumbar Muscular Forces Consequent to Lateral Spinal Curvature
Authors: STOKES Ian A.F.  , CHABAUD Magali  , ARMAND Jean-Luc
Published: February 2025

The consequences of lateral curvature for the laterally curved lumbar spine were analyzed in a static 3-D biomechanical model. The model used published anatomical data for the positions of the vertebrae and for the muscle insertions and muscle maximum contractile force. It was initially symmetric about the sagittal plane. Subsequently, three dimensional measurements of the spines of patients with lumbar scoliosis (mean Cobb angle 38� ) were used to create a new geometry representing the asymmetry of lumbar scoliosis. The model was used to calculate the maximum values of efforts in the three principal directions applied to the T12 vertebra, and subject to the following constraints: equilibrium of forces and moments acting on all vertebrae, muscle forces > 0, and less than a physiological maximum proportional to their cross-sectional area, and motion segment displacements due to elastic deformations. The maximum efforts were a linear function of the variables (muscle forces and joint forces) so linear programming was used to solve this indeterminate problem. The findings indicated that the overall magnitudes of effort for the three principal directions of effort would not change much in the presence of the spinal curvature. Asymmetric muscle activity would be necessary to perform these efforts, but the total activity (force) of all muscles would not differ much. However, the motion segments of the spine would be more symmetrically loaded in the scoliosis spine than that symmetric in the sagittal plane. This asymmetric loading may contribute to the progression of scoliosis by producing asymmetric growth in young patients, and asymmetric remodelling in skeletally mature patients.
Adolescent Idiopathic Scoliosis Transverse Plane Evolution
Authors: ASHER Marc A.  , COOK Larry T.
Published: February 2025

The theory that these deformities evolve as torsions, with the apex vertebra translating away from the upper end vertebra and at the same time following a clockwise angular pathway to the upper end vertebra of right apex curves and a counter clockwise angular pathology for left apex curves is generally supported.
Anatomical and Barycentremetric Three-Dimensional Conditions of Adult Lumbar and Thoraco-Lumbar Scoliosis
Authors: LEGAYE J.  , Duval-beaupÈRE G.  , HECQUET J.  , MARTY C.
Published: February 2025

An anatomical and barycentremetric study is performed on a series of adult lumbar and thoraco-lumbar cases. The data are compared with those of normal subject and analysed according to the clinical criterion’s. A difference for the pelvic and spinal parameters is observed. A most anterior location of the centers of masses is observed for the unfavourable group of scoliotic patients, compared to the favourable scoliotic cases and the normal subjects.
A Preliminary Report on the Surgical Realignment of Adolescent Idiopathic Scoliosis with Isola Instrumentation
Authors: GONDO Hiroshi  , ASHER Marc A.
Published: February 2025

Pre and postoperative conventional biplanar and limited sliced CT radiographic studies were performed on a series of thirteen adolescent idiopathic scoliosis patients. Utilizing the corrective instrumentation sequences taught with the Isola technique, some transverse plane correction was achieved without transverse plane or coronal plane decompensation, even while achieving an overall improvement in Cobb measurement of 70%.
Cardiopulmonary Performance in Patients with Severe Scoliosis - Outcome after Specific Rehabilitation
Authors: WEISS HR
Published: February 2025

Adult scoliosis patients with Cobb angles of more than 100 degrees have a high risk for right ventricular dysfunction or a chronic pulmonary heart. Adult scoliosis patients with Cobb angles of less than 90 degrees usually do not suffer from those cardiopulmonary impairment. They often however show significant decrease of general working capacity. Having found ECG-signs of right ventricular impairment in our adult scoliosis patients with curvatures of less than 90 degrees, we were interested in performing this study, looking whether those may be influenced by an in-patient rehabilitation program for scoliosis patients. 794 adult scoliosis patients, at least 25 years of age, have been assessed by electrocardiography before and after an in-patient rehabilitation program according to Schroth. The average age was 39 years (SD=12) with an average Cobb angle of 51 degrees. The average vital capacity before the start of the rehabilitation program was 2948 ccm (SD=920) with an average nominal value of 3405 ccm (SD=720). In the electrocardiogram we were looking for the signs of right ventricular hypertrophy and the signs of right ventricular strain before and after the rehabilitation program. After the rehabilitation program, there was a high significant decrease of the described signs which have been found even in patients with curvature angles of less than 90 degrees. These findings led us to the conclusion, that the described rehabilitation program may reduce right ventricular strain. Furtheron, the study shows, that a right ventricular strain is very common, even in scoliosis patients with Cobb angles of less than 90 degrees. This right ventricular strain may be the correlate for the decreased performance capacity as felt by adult scoliosis patients. This subjective feelings can be improved during the exercise program too. The increased performance capacity may be of great importance for a long-lasting working life.
Supporting System Development with Technology Assessment
Authors: Saranummi Niilo
Published: February 2025

The importance of quickly translating research into new products and improvements of existing ones is well recognized. Industry must be both efficient and effective. Consequently, demands for system development are growing. In developing systems for health care the challenge is to understand the problem space well enough to derive the right specifications for the right system. In the past it was enough to interview the actual users of the intended system to get the specifications. Nowadays, information technology (IT) is considered to be a strategic resource of the organisation, i.e. it can be used for more than just automating tasks and transferring data.
Olfactory Stimuli in Virtual Reality for Medical Applications
Authors: Krueger Myron W.
Published: February 2025

This paper describes an ARPA sponsored project to add olfactory stimuli to virtual reality for medical applications. It will develop one delivery system for training surgeons and another for training dismounted medical personnel operating in the field. It will also perform a series of studies to ascertain the effect of odors on skill acquisition both in and out of virtual reality.
Diagramming Registration Connectivity and Structure
Authors: Lea John T.  , Peshkin Michael A.
Published: February 2025

Computer-assisted surgical systems must bring preoperative diagnostic images, surgical plans, patient anatomy, surgical tools, robots, and other components into accurate alignment with one another. Multi-step registration procedures have been devised, which are difficult to analyze, or even to describe concisely.
Virtual Computer Monitor for Visually Impaired Users
Authors: Zwerm Arthur L.  , Clark Michael R.
Published: February 2025

Conventional computer display products for the visually impaired limit the amount of enlarged imagery that can be displayed on a desktop monitor to as little as 1 % of a document page. Users also suffer disorientation with respect to cursor position on the page, and face unwieldy methods for navigating about the scene. These problems prevent productive computer access for over 1,000,000 Americans, and are highlighted as a major improvement area in the National Eye Institute's 1994 National Plan.
The CARE Telematics Project
Authors: Zöllner Herbert K.
Published: February 2025

CARE Telematics demonstrates the capability of tele-communications to improve the efficiency of national administrations with responsibility for health; environmental health; natural and man-made disaster management; medical care policy, planning, financing, administration and service delivery; surveillance and health.
OEDIPE: Open European Data Interchange and Processing for Electrocardiography
Authors: Rubel Paul  , Willems Jos L.  , Zywietz Christoph  , Fayn Jocelyne  , Assanelli Deodato  , Malossi Cesare  , Todd Stephen
Published: February 2025

The basic aim of the OEDIPE project was to increase the availability and compatibility of objective decision support in the field of Quantitative Electrocardiography by promoting Open European Data Interchange and Processing for Electrocardiography. The project has successfully developed several building blocks bringing generic solutions to the more general problem of distributed, cooperative processing of patient signals and other relevant data, some of which are stored in distant distributed cooperative databases. It has also designed several demonstration systems for the follow-up of cardiac diseased patients, integrating open networks of distributed, heterogeneous cooperative databases, means for interchanging electrocardiographic data, and methods for comparing serial patient records and providing decision support. These systems already prefigure large-scale monitoring of ambulatory or critical ill patients at home, during their transportation in an emergency car or during their stay in an hospital.
FEST: Framework for European Services in Telemedicine
Authors: Gerneth Marlene
Published: February 2025

Telemedicine and healthcare telematics services have the potential to enable improved healthcare in an ever faster integrating European community. However, conforming to the best practices of open systems may not be sufficient to guarantee their success, but more comprehensive guidance and support is needed to arrive at fit-for-purpose solutions. Thus, the main objective of FEST (A2011) has been to develop a Framework of common understanding which will assist those wishing to set up a telemedicine service by providing structured guidance to the information required for such an endeavour. The FEST Framework has been designed and developed as a set of four components, the Question Set, the Advice Component and Body of Information, the Clinical Context Model, and the Descriptive Model. Contributing to the establishment and validation of the Framework, a Telecardiology Demonstrator has been implemented. The FEST Telemedicine Framework has been used by various groups within and outside the project in different contexts, and has been favourably received.
Health informatics at Aalborg University Presentation of a curriculum
Authors: NØHR C.
Published: February 2025

The paper describes the contents and objectives of an educational programme in health informatics recently established at Aalborg University (Denmark). The programme emphasizes problem-oriented and project-organised distance learning.
Towards a Smart Card for the Elderly
Authors: Ruggiero C.  , Giacomini M.  , Sacile R.
Published: February 2025

We present a provisional implementation of a smart card for the integrated health and social care for the elderly. The presented card takes particularly into account both the suggestions resulting from the EPIC/AIM project as well as some aspects of the Italian way of life. The proposed card is divided into five sections: general and anagraphic information, health care information, social care information, income taxation information and insurance policy information.
A Health Ministry View from France of the Set Up of a Card System in Health Care
Authors: Sauret J.
Published: February 2025

The French Government has committed itself in favor of a card system, which should be generalized after January 1997. This paper presents the reasons having led to this commitment. They are administrative, medical and economic. Then, in relation to the specific situation of France and the field of healthcards, the Government exercises its classical functions as guardian of general interest, regulator of the health care system, and maker of the legal frame.
Initial Clinical Experience with an Interactive Volume Sonography Visualization System
Authors: Nelson Thomas R.  , Pretorius Dolores H.  , Davidson Thomas E.
Published: February 2025

This paper discusses recent progress by the Three-dimensional Ultrasound Imaging Group at The University of California, San Diego in developing a cost-effective 3D ultrasound system integrating clinical scanners and graphics workstations. We discuss the design features of an interactive system for acquiring, analyzing and displaying volume sonographic patient data incorporating stereoscopic viewing and initial clinical experience working with volume data in an interactive environment. We have developed an intuitive, easy-to-use interface with a rapid learning curve that facilitates physician operation of a system incorporating an interactive volume renderer permitting optimization of viewing orientation and data presentation. Target organ visualization is further enhanced using a 3D electronic scalpel we have developed to interactively extract tissues or organs of interest from the rest of the volume scanned. Incorporation of interactive stereo viewing with all studies has proven essential to improve user comprehension of complex anatomic structures.
The Teleos Virtual Environment Toolkit for Simulation-Based Surgical Education
Authors: Meglan Dwight A.  , Raju Rakesh  , Merril Gregory L.  , Merril Jonathan R.  , Nguyen Binh H.  , Swamy Shankar N.  , Higgins Gerald A.
Published: February 2025

In the past, surgical simulations have largely been created through the development of dedicated applications that require considerable programming and computer graphics skills. Advances in simulation-based surgical education have been limited by this dependence on computer graphics programming expertise. To lower barriers to the adoption of simulation-based training, we are developing tools based on Teleos™, software technology that allows a wide variety of medical content developers to author surgical training simulations without programming.
A Haptic Interface for Virtual Simulation of Endoscopic Surgery
Authors: Rosenberg Louis B.  , Stredney Don
Published: February 2025

Virtual reality can be described as a convincingly realistic and naturally interactive simulation in which the user is given a first person illusion of being immersed within a computer generated environment While virtual reality systems offer great potential to reduce the cost and increase the quality of medical training, many technical challenges must be overcome before such simulation platforms offer effective alternatives to more traditional training means. A primary challenge in developing effective virtual reality systems is designing the human interface hardware which allows rich sensory information to be presented to users in natural ways. When simulating a given manual procedure, task specific human interface requirements dictate task specific human interface hardware. The following paper explores the design of human interface hardware that satisfies the task specific requirements of virtual reality simulation of Endoscopic surgical procedures. Design parameters were derived through direct cadaver studies and interviews with surgeons. Final hardware design is presented.
Patient-Specific Anatomic Models
Authors: Cameron B.M.  , Manduca A.  , Robb R.A.
Published: February 2025

Virtual reality offers the promise of highly interactive, natural control of the visualization process, greatly enhancing the scientific value of the data produced by medical imaging systems. Due to the computational and real time update requirements of virtual reality interfaces, however, the complexity of polygonal surfaces which can be displayed is limited. In this paper, we present a novel method for the production of a polygonal surface containing a pre-specified number of polygons from volumetric data. To preserve surface detail, we extract a set of curvature weights from the volumetric data and use these weights as the input vectors to a 2-D Kohonen network. The adaptation of the network to the input vectors results in a display surface that preserves useful detail relative to the number of polygons used.
CAD Modeling of the Birth Process
Authors: Liu Y.  , Scudder M.  , Gimovsky M.L.
Published: February 2025

We are engaged in studying the process of human birth by developing a computer-based dynamic model that can be adapted to specific birth scenarios. The individual characteristics of a given pregnant woman and fetus, embedded in their clinical measurements and CT and MRI images, are captured in the model. One can thereby predict adverse events that might happen during labor and delivery. Based on our findings from a preliminary design and execution of this model, we believe it holds great promise as an accurate, cost-effective diagnostic and teaching tool that will help predict conditions during individual labor scenarios that might cause traumatic birth injuries, and thereby enable us to make the most informed clinical decisions possible.
Health Informatics Deontology Code
Authors: Callens S.  , Nys H
Published: February 2025

One main objective of SEISMED (Secure Environment for Information Systems in Medicine) is to develop a consistent, harmonised and transferable framework which can be used to efficiently implement security and data protection in computerised information systems throughout Europe. In order to provide guidelines for professional conduct and to promote international cooperation, it would be useful to have an international deontology code for the protection of medical data. The purpose of such a code would be to provide general guidelines as a foundation for national codes that may be developed within individual countries.
Communication Facilities in an Integrated HIS
Authors: Højslet Hans Christian
Published: February 2025

Electronic communication facilities which operate between different parts of the health care sector have become a reality. They operate primarily between General Practitioners and hospitals in which messages following EDIstandards are used, and secondarily between different departments in the hospital. There are many advantages linked to implementing communication facilities in an integrated HIS, and this article will elaborate on the need for increased use of eletronic communication in the health care sector in Denmark.
The European Health Telematics Observatory
Authors: De Moor Georges  , Laires Maria  , McCurry Mike  , Thayer Christine
Published: February 2025

The purpose of the EUROPEAN HEALTH TELEMATICS OBSERVATORY (EHTO) is to collect, analyse and make available in a coherent and user-friendly form a wide range of information on developments in the field of health telematics. The Observatory by virtue of its multi-faceted approach to health telematics, will rapidly constitute a European pole of information and activity and a starting point for health telematics deployment. Diffusion of the information collected is the raison d'être of the Observatory
Integrating CSCW and Video-Conferencing in Telemedicine
Authors: Barth A.  , Eichelberg M.  , von Gehlen S.  , Hewett A.  , Jensch P.
Published: February 2025

This paper describes the integration of a narrow-band video-conference system and a computer supported coopertive work (CSCW) application in the medical environment. During a consultation a general practitioner and a specialist of a remote medical competence centre exchange patient information, opinions, and treatment suggestions. Analogue image information on film can be transmitted and discussed with a video-conference facility. The physicians can deliberate about digital data (digital modalities, patient data) with a CSCW application. The information is displayed using the WYSIWIS (what you see is what I see) paradigm. In addition to the conference facilities an integration to open PACS systems is provided by a DICOM interface.
Synergy between User Groups in EU projects
Authors: Bernstein Knut  , d'Angelantonio Marco  , Weser Andreas  , Ceinos Carmen  , Boydells Leslie  , Reilly Tony
Published: February 2025

Five projects in the 4th Framework Health Care Telematics Application Programme address the issue of Regional Health Care Networks from different angles. WISE ($\underbar(W)$orking $\underbar(I)$n $\underbar(S)$ynergy for $\underbar(E)$urope) is a proposal for a EU project aimed at maximising the impact of contribution from these projects. Three action lines for cooperation are defined: The most important is support for a consensus process between user groups in each project. The other action lines are Synergy Promotion and External promotion.
Continuity and coordination of care by implementation of a European Health Care Network
Authors: Bernstein Knut  , Jensen Henrik Bjerregaard  , Johansen Ib  , Orsi Giorgio
Published: February 2025

This paper emphasizes the electronic communication as a means for fulfilling new requirements for the Health Care: the demand for continuity and coordination in the provided services. Regional Health Care Networks can interconnect different computer systems for health care, and support cross sectorial communication. The barriers for implementation of such networks are discussed. A European project - CoCo - which aims at reducing the barriers and improvingthe continuity and coordination of health care and social services, is presented.
The middleware-based architectural approach for opening and evolving healthcare information systems
Authors: Ferrara Fabrizio Massimo
Published: February 2025

The integration of legacy systems represents one of the most urgent priorities of healthcare information systems in order to allow the whole information system to meet the evolving clinical organisational and managerial needs of the healthcare organisation. This paper discusses how the introduction of a middleware of common services providing functionalities addressing specific needs of the healthcare business domain reduces the effort necessary for allowing existing systems to interwork, and automatically establishes a functional and information basis common to the whole organisation, on top of which also new applications can be rapidly developed, natively integrated with the rest of the system.
Assessing NHS Managers' IM&T Competence
Authors: Seeley Monica E.  , Mordue Alan
Published: February 2025

This paper describes how Checkpoint, a self-assessment questionnaire, is helping managers in the UK's NHS identify their strengths and weaknesses with respect to their use and management of IM&T, and hence implement development plans to become fitter in the IM&T arena. This paper presents the trends and benefits which are resulting from Checkpoints use and their implication for the future education and development of managers in the NHS.
The Development of an Organisational Audit for Health Informatics in the NHS
Authors: Mordue Alan
Published: February 2025

This paper describes a project that is developing organisational audit to aid the improvement cycle in the domain of health informatics. It outlines the rationale behind the project, relating it to the national IM&T strategy of the NHS. The paper discusses in detail the development of a baseline, establishing the status of IM&T in the target domain and the development of a questionnaire to identify success criteria. The paper goes on to present the results of the research undertaken. It concludes that the research itself has delivered useful benefits and that the organisational audit is capable of delivering substantial benefits.
Danish Centre for Health Telematics
Authors: Mariboe Steen  , Jensen Henrik Bjerregaard  , Lehrmann Tove  , Bernstein Knut
Published: February 2025

This paper describes the Danish approach to developing and implementing solutions to create a coherent Health Care Data Network
COMPUTERIZED MONITORING OF DIALYSIS REMOTE SITES AND FOLLOW-UP OF CHRONIC PATIENTS USING SMART-PHONES
Authors: Contini E.  , Costantino G.P.  , Harti R.  , Quarello F.  , Sancipriano G.  , Selwood N.H.
Published: February 2025

This paper briefly describes a possible structure for a complete dialysis monitoring system currently being developed at CSELT with the aim of eventually satisfying the needs of nephrology for telemonitoring.
Abstraction of Data and Time for Prognoses of the Kidney Function in a Case-Based Reasoning System
Authors: Schmidt Rainer  , Gierl Lothar  , Heindl Bernhard  , Pollwein Bernhard
Published: February 2025

In this paper we describe an approach to utilize Case- Based Reasoning techniques for trend prognoses of the kidney function for intensive care patients. We apply two abstraction methods. First, the measured and calculated parameters of the kidney monitoring system NIMON are abstracted to daily kidney function states. As common methods of reasoning over time do not fit for course predictions without a complete domain theory, we developed an abstraction method for time course prognoses suitable to be integrated into our Case-Based Reasoning system ICONS.
Metabolic Emergencies: Informatic Management, Diagnosis and Treatment Assistance
Authors: Ionescu-Tirgoviste Constantin  , Stanciu Emilia  , Alecu Simona  , Necula Andrei  , Dragomirescu Cornelia  , Mogos Viorel  , Limbaseanu Ioana  , Mincu Iulian
Published: February 2025

This paper presents the computerized system MetEmerg, a result of interdisciplinary cooperation, designed to assist the physician in the management of metabolic emergencies and in their correct diagnosis and treatment. The system offers the following functions: patient recording, patient surveillance, diagnosis assistance, treatment assistance, statistical analysis and system administration. The system is being validated at the Intensive Care Unit of the Institute of Nutrition and Metabolic Diseases in Bucharest.
A WWW-based Decision-Support System using Medical Logic Modules and Hypertext
Authors: Karlsson Daniel  , Ekdahl Christer  , Shahsavar Nosrat  , Gill Hans  , Forsum Urban  , Wigertz Ove
Published: February 2025

We have designed and developed a knowledge-based decision support system using World Wide Web technology. The system uses both rule-based and hypertext knowledge to give support in clinical medicine. We use Arden Syntax for representing rule-based knowledge and HTML for representing hypertext documents. The two representations are integrated to provide extended explanation to the advice produced by the Arden Syntax rules and to find hypertext documents relevant to a specific question and to a specific patient. This way we believe that the usability of decision-support systems can be enhanced.
Provision of healthcare security information services using the World-Wide Web
Authors: Furnell Steven  , Sanders Peter  , Warren Matthew
Published: February 2025

The paper considers the continuing need for information security and associated awareness methods within modern European Healthcare Establishments (HCEs). It presents details of a novel security information dissemination service that will soon be offered as part of the new European Union ISHTAR (Implementing Secure Health Telematics Applications in Europe) project. The objective of the project is to increase the awareness of both the public and healthcare personnel on issues related to health data protection, by way of seminars and worldwide dissemination. The selected means of achieving the latter is to promote healthcare security issues over the Internet, utilising a dedicated server on the World-Wide Web.
Interpretation of Oscillations in Heart Rate and Blood Pressure
Authors: Novak Vera  , Novak Peter  , Low Phillip A.
Published: February 2025

Fluctuations of heart rate and blood pressure reflect dynamic control over tonic neuronal activity. A number of confounding factors have to be considered before cardiovascular rhythms can be used as a reliable index of autonomic nervous system integrity. The temporal profile of nonrespiratory oscillations (0.01 to 0.15 Hz with a dominant ≈0.05 Hz rhythm) (NONRF) and oscillations at respiratory frequencies (RF) (0.01 to 0.5 Hz) were analyzed by modified Wigner distribution (WD). Both RF and NONRF were continuously present during supine rest and in the upright position in normal young and elderly subjects. However, the pattern of NONRF oscillations in BP and R-R interval (RRI) becomes unstable in orthostatically intolerant patients, e.g. with vasodepressor syncope or orthostatically intolerant patients. Typically, large transient NONRF oscillations in BP occur after tilt-up and disappear with impending syncope. In patients with severe symptoms of postural tachycardia, both NONRF and RF in RRI are reduced. Loss of rhythmicity over the whole range from 0.01 to 0.5 Hz is associated with severe central lesions (like in brain stem injury). The profile of cardiovascular rhythms provides information about the integrity of the autonomic neural pathways. It could provide insights into the timing and processing of afferent impulses in the brainstem network.
Heart Rate and Blood Pressure Spectra during Mental Stress
Authors: Elghozi J-L.  , Laude D.  , Girard A.  , Mounier-Vehier C.
Published: February 2025

The cardiovascular reactivation to a recently described videogame task i.e. a maze test was evaluated in the frequency-domain using finger blood pressure (BP) measurement in 27 untreated subjects including 5 mild hypertensives. Age ranged from 23 to 52. BP was measured with a Finapres device. Breathing was analyzed by respiratory inductance plethysmography with a Respitrace. The test consisted of a series of video displayed mazes which had to be solved within short periods of time. The recording session was divided into resting, test and recovery periods. A detrending procedure was applied to each recording prior to the fast Fourier transform (FFT), using a moving average over 20 sec. The mid-frequency (MF, 0.1 Hz) component was increased during the test for SBP and HR as well. Since a large variability was observed between individuals, we calculated the relative changes for this MF component. Increases of 33 % and 54 % in the SBP and HR MF components were observed. These MF changes could depend on the autonomic activation occuring during the performance of the mental task. In addition, the test determined a reduction of the absolute systolic BP (SBP) and heart rate (HR) high-frequency (HF, respiratory-linked) components. However these changes were associated with a modified breathing pattern characterized by a moderate tachypnea and a reduced breathing amplitude (−14%). A statistical adjustment of HF components for breathing amplitude was used to test whether changes in these HF components were due to respiration or to specific mechanisms. Therefore, the relative changes in the SBP or HR HF components were divided by the relative changes in the respiratory amplitude. This procedure demonstrated the SBP or HR HF changes during stress were entirely due to respiration since no significant changes in the normalized indices were detected during the test. This study demonstrates the applicability of this new paradigm to induce cardiovascular reactivity.
The Role of the Baroreceptor Reflex in Comparison to Nitric Oxide in Buffering Spontaneous Fluctuations of Blood pressure
Authors: Nafz B.  , Persson P.B.
Published: February 2025

The baroreflex constitutes the only hitherto known buffer of rapid arterial blood pressure fluctuations. In order to investigate the influence of sinoaortic and cardiopulmonary baroreflex pathways and nitric oxide (NO) on the dynamic properties of short- term blood pressure control, we determined the power spectra of 24h- blood pressure time series of adult, conscious, freely moving foxhounds under a normal sodium diet. This was done in the intact state (N=6), during blockade of NO-synthesis via a bolus injection of the false substrate NG-nitro-L-arginine ((L-NNA), 16.5±2mg/kg body weight i.v., N=5) and in animals devoid of baroreceptor and cardiopulmonary reflexes (N=5). After L-NNA, blood pressure (BP) increased from 116±4 to 137±6mmHg (P<0.01), heart rate decreased by roughly 30beats/min to 68±3beats/min (P<0.01). The power of spontaneous fluctuations in blood pressure within the frequency range of 0.1Hz - 0.5Hz was tripled by L-NNA (P<0.05). By comparison, total sinoaortic and cardiopulmonary denervation increased power of slower oscillations (<0.1Hz) by a factor of 4.7 (P<0.05), whereas the power within 0.1Hz- 0.5Hz was not significantly different from the control values.
Information: The Cornerstone of Medical Sciences
Authors: Sosa-Iudicissa Marcelo
Published: February 2025

In this chapter I will give a personal vision of the relationship between information sciences, their concepts, techniques and tools, on one hand, and their relationship with bio-medicine and health, and their professions, on the other. However, before tackling the matter, I want to put the discussion into the context of a wider conceptual framework of knowledge, man and medicine. I believe that these reflections, from a humanistic and philosophic perspective, are necessary in a book that is centred in a technological revolution like the one represented by the Internet.
Telemedicine Services through Cable TV and Interactive TV Networks
Authors: Torres Daniel  , Valero Miguel Angel  , Arredondo Maria Teresa  , Del Pozo Francisco
Published: February 2025

Recent technological advances in Cable TV (CATV) networks foster the development of new telemedicine applications based on such technologies. CATV networks offer a broadband communication path in their trunk section as well as in the local loop, thus allowing to establish real time, interactive video and audio channels. These opportunities are giving rise to several medical services at home, such as: 1) medical tele-visiting for chronic patients, disabled and elderly people; 2) tele-rehabilitation and distance learning; 3) hospital tele emergencies and first aid. The implementation of these services requires a detailed study of its characteristics, such as, for example, CATV network requirements, suitable topologies, home requirements and health centre requirements.
Trunk Deformity in Relation to Breathing. A Comparative Analysis with the Formetric System
Authors: Weiss H.-R.  , Lohschmidt K.  , El Obeidi N.
Published: February 2025

Differences of the trunk surface in spinal deformities depending on breathing have already been described in literature. The aim of our study was to find out if these surface changes caused by breathing essentially influence surface measurements. 77 patients with idiopathic scoliosis and an average curvature angle of 38 degrees were first investigated with the Formetric System in endexpiratory position and then in maximal inspiration. The Formetric System itself supplies factors like trunk length, dimples distance, vertical deviation, pelvic obliquity, plevic torsion, axial deviation, lateral deviation, surface rotation, kyphotic angle, lordotic angle, Fl,che cervicale and lombair. All parameters were checked in the t-test referring significant differences. Obvious differences showed in trunk length (VP-DM and VP-SP). In inspiration, higher values were obtained, the differences however are not significant. The maximal and lateral deviation also didn't show significant differences, however the tendency of a higher exspiration measurement value. The average rotation showed nearly a complete conformity with a p-value of 0.983. In maximal rotation, also in exspiration slightly higher values were recorded without being significant. Significant differences presented especially measuring the maximal and average kyphotic angle (T = 7.6; p < 0.001. respectively t = 6.9; p < 0.001). The same significant differences were seen in both Fl,che values and lordotic angle. During exspiration also a highly significant change of the relative spinal length (trunk index) was seen. These results show, that measurements of trunk surface should be done in exspiration in order to avoid breathing artefacts as far as possible.
The Pathogenesis of Idiopathic Scoliosis is of Skeletal Origin
Authors: Sevastik J.A.
Published: February 2025

The results of a series of experimental and clinical studies provide accumulated evidence that asymmetrical rib growth triggers the scoliotic deformity. The set of presented data, when analysed in relation to one another, gives support to the thoracospinal theory of the pathogenesis of at least the right convex, thoracic, idiopathic scoliosis, with the apex at T7-T8 level, in adolescent girls and better than any other previously propounded hypothesis explains the peculiar characteristics of this form of scoliosis.
Implementing ICNP in the Swiss version of NUREC, a nursing module of an electronic healthcare record
Authors: Assimacopoulos André  , de Roulet Anne-Marie  , Kruezsely Attila  , Borgazzi André  , Balahoczky Mireille  , Brennenstuhl Pierre
Published: February 2025

The α version of ICNP has been translated into french. It has also been loaded into a computer based patient record designed as a support to the nursing care process. The initial structure of ICNP is found to be a sound basis for future refinements of an International Classification for Nursing Practice. The number of level and the coding schema should be improved when ICNP will reach a more mature state. The lack of operational definitions on top of the hierarchical ones is also evidenced.
ICNP in SONHO
Authors: Ribeiro João Vasco  , Geirinhas Pedro Miguel
Published: February 2025

The main scope of this paper is to describe the Portuguese Hospital Information System, developed by IGIF, and how his connection with ICNP will be made.
ICNP: Towards Second and Third Generation Terminology Systems
Authors: Rossi Mori Angelo
Published: February 2025

The features of a new generation of terminological systems are introduced: they are computerbased, multihierarchical, extensible, mappable. This performance is achieved by a compositional approach: each phrase of a reference nomenclature is represented systematically by predefined descriptors from a thesaurus, according to a “categorial structure” (a model of semantic categories and their relations).
Patient Records from a Synapses Point of View
Authors: Moen Anne
Published: February 2025

This paper is a presentation of the Synapses project for the First TELENURSE conference. The presentation gives an overview of the project, expected outcome and approach to achieve the objectives and outcome. Synapses sets out to solve problems of sharing record information between autonomous information systems consistently, simply, comprehensibly and securely. The results of the Synapses will be in the public domain in the form of a set of specifications and guidelines for electronic record information exchange between autonomous systems. This presentation also gives an example of one of the declared verifications; the nursing summary where also ICNP can be included when desired.
Aided Learning Expert System to Diagnosis and Treatment of Dental Traumatism in Odontology Clinical Practical Class
Authors: Soares Fernandes Ana Paula  , Bastos Rogério Cid
Published: February 2025

This paper proposes the development of an aided learning expert system to dental traumatism in odontology clinical practical class. This system aims to give the odontology student more security, accuracy and speed, when he meets by chance some of the dental traumatism, avoiding that the patient returns home without that he has been attended, or that the patient has attended, but with some insecurity of the student to obtain the correct diagnosis, because of the practical experience fault, or because of the expert's absence in that moment. This paper emphasizes the importance of these systems in different health areas, and gives us a vision about these systems.
Rubrics to Dissections to GRAIL to Classifications
Authors: Rogers JE  , Solomon WD  , Rector AL  , Pole P  , Zanstra P  , van der Haring E
Published: February 2025

This paper summarises the process in the GAIEN-IN-USE project by which rubrics from traditional medical coding schemes are analysed into an intermediate, relatively informal conceptual representation which is then automatically translated into the GRAIL formalism and its Canmen Reference Model.
SMART: a System Supporting Medical Activities in Real-Time
Authors: Pisanelli Domenico M.  , Consorti Fabrizio  , Merialdo Paolo
Published: February 2025

This paper describes the system SMART whose goal is real-time assistance to physicians who execute diagnostic or therapeutic protocols in a clinical context. SMART is able to retrieve a protocol from its knowledge base and to monitor its execution step by step for a single patient. Different protocols for different patients can be followed at the same time in a health care structure. The prototype realized supports the execution of protocols for evaluating surgical risks. It has been implemented according to the specifications given by the 4th Surgical Clinic of “Policlinico Umberto I” and reflects the activities actually performed in that hospital. However, the protocol model defined is general-purpose and we envisage an easy application to other contexts and therefore to the informatization of other protocols.
Browsing and Querying Multimedia Report Collections
Authors: Consorti F.  , Merialdo P.  , Sindoni G.
Published: February 2025

In this paper a system and new methodologies that enable efficient exploration of distributed collections of multimedia reports are described. A conceptual model for the report and a method to semi-automatically create a hypermedia report network have been defined. The main issues addressed in this project were to exploit the textual component of a report to give a more evident semantic meaning to the data produced during the relative exam and to provide users with new interaction paradigms based on Internet technologies.