bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Information Systems and Improved Patient Outcomes: Do Nurses See the Connection?
Authors: Bichel-Findlay Jen  , Callen Joanne  , Sara Antony
Published: February 2025

A major focus of nurses is to improve patient outcomes, and any introduction of technology into their work environment should add value through enhancing patient care and contributing to the development of nursing intelligence. This study addressed whether nurses working in an emergency department (ED) perceived a relationship between using an emergency department information system (EDIS) and patient outcomes. A cross-sectional survey design was used, with data collected from the population (n=168) of nurses from five Australian metropolitan public hospital emergency departments (EDs). The questionnaire collected information on how EDIS impacted on patient outcomes in terms of waiting times, triage process, departmental accountability, documentation focus, computer interaction, and system purpose. Nurses acknowledged the value of an information system in improving the triage process and increasing the accountability of the ED, however failed to identify any impact on reducing overall ED waiting times or its relationship to improved care delivery. Over half the respondents could not identify negative effects such as compelling nurses to focus on documentation details or ‘treat the computer’ rather than the patient. The use of technology in this study evoked optimistic responses, however results indicated a lack of clarity about the impact of EDIS on patient outcomes.
The Impact of Health Information Technology (I-HIT) Scale: The Australian Results
Authors: Cook Robyn  , Foster Joanne
Published: February 2025

One of role of the nurse in the clinical setting is that of co-ordinating communication across the healthcare team. On a daily basis nurses interact with the person receiving care, their family members, and multiple care providers thus placing the nurse in the central position with access to a vast array of information on the person. Through this nurses have historically functioned as “information repositories”. With the advent of Health Information Technology (HIT) tools there is a potential that HIT could impact interdisciplinary communication, practice efficiency and effectiveness, relationships and workflow in acute care settings [1][3].
Home Care Decision Support Using an Arden Engine – Merging Smart Home and Vital Signs Data
Authors: Marschollek Michael  , Bott Oliver J.  , Wolf Klaus-H.  , Gietzelt Matthias  , Plischke Maik  , Madiesh Moaaz  , Song Bianying  , Haux Reinhold
Published: February 2025

The demographic change with a rising proportion of very old people and diminishing resources leads to an intensification of the use of telemedicine and home care concepts. To provide individualized decision support, data from different sources, e.g. vital signs sensors and home environmental sensors, need to be combined and analyzed together. Furthermore, a standardized decision support approach is necessary.
The Development of Method for Continuous Improvement of Master File of the Nursing Practice Terminology
Authors: Tsuru Satoko  , Okamine Eiko  , Takada Aya  , Watanabe Chitose  , Uchiyama Makiko  , Dannoue Hideo  , Aoyagi Hisae  , Endo Akira
Published: February 2025

Nursing Action Master and Nursing Observation Master were released from 2002 to 2008. Two kinds of format, an Excel format and a CSV format file are prepared for maintaining them. Followings were decided as a basic rule of the maintenance: newly addition, revision, deletion, the numbering of the management and a rule of the coding. The master was developed based on it. We do quality assurance for the masters using these rules.
Electronic Standard Care Plans of Home-visit Nursing for Patients of Euronal Intractable Diseases Based on PCAPS
Authors: Matsuki Mariko  , Tsuru Satoko  , Sano Kesami  , Kato Shogo  , Yamazaki Junko  , Izumiyama Akemi  , Yamaji Satoko  , Tanahashi Satsuki  , Yamamoto Ryuichi  , Kawamura Sawako
Published: February 2025

To improve the quality of home-visit nursing services for patients of neuronal intractable diseases, we first need to structuralize the care plans, and then to develop electronic contents that are implementable into IT systems. In this study, we develop electronic standard care plans of home-visit nursing for patients of neuronal intractable diseases based on PCAPS (Patient Conditions Adaptive Path System) by structuralizing the particular experience and knowledge of expert nurses.
The GLOBE 3D Genome Platform
Authors: Knoch Tobias A.  , Lesnussa Michael  , Kepper Nick  , Eussen Hubert B.  , Grosveld Frank G.
Published: February 2025

Genomes are tremendous co-evolutionary holistic systems for molecular storage, processing and fabrication of information. Their system-biological complexity remains, however, still largely mysterious, despite immense sequencing achievements and huge advances in the understanding of the general sequential, three-dimensional and regulatory organization. Here, we present the GLOBE 3D Genome Platform a completely novel grid based virtual “paper” tool and in fact the first system-biological genome browser integrating the holistic complexity of genomes in a single easy comprehensible platform: Based on a detailed study of biophysical and IT requirements, every architectural level from sequence to morphology of one or several genomes can be approached in a real and in a symbolic representation simultaneously and navigated by continuous scale-free zooming within a unique three-dimensional OpenGL and grid driven environment. In principle an unlimited number of multi-dimensional data sets can be visualized, customized in terms of arrangement, shape, colour, and texture etc. as well as accessed and annotated individually or in groups using internal or external data bases/facilities. Any information can be searched and correlated by importing or calculating simple relations in real-time using grid resources. A general correlation and application platform for more complex correlative analysis and a front-end for system-biological simulations both using again the huge capabilities of grid infrastructures is currently under development. Hence, the GLOBE 3D Genome Platform is an example of a grid based approach towards a virtual desktop for genomic work combining the three fundamental distributed resources: i) visual data representation, ii) data access and management, and iii) data analysis and creation. Thus, the GLOBE 3D Genome Platform is the novel system-biology oriented information system urgently needed to access, present, annotate, and to simulate the holistic genome complexity in a unique gateway towards a real understanding, educative presentation and curative manipulation planning of this tremendous evolutionary information grail – genomes.
Uncertainty in shallow foundations settlement analysis and its utilization in SLS design specifications
Authors: Paikowsky S.G.  , Fu Y.  , Amatya S.  , Canniff M.C.
Published: February 2025

Design of shallow foundations on soils is most often governed by settlement or Service Limit State (SLS) rather than the bearing capacity restrictions, i.e. Ultimate Limit State (ULS). In an effort to develop the SLS design specifications under the National Cooperative Highway Research Program NCHRP project 12-66 (AASHTO LRFD specifications for the serviceability in the design of bridge foundation), a large database of case histories of shallow foundation load tests has been assembled in MS ACCESS platform. Out of the 329 case histories compiled, only those related to granular materials and which include Standard Penetration Test (SPT) results have been utilized. These cases, being most relevant to bridge foundation design (soil type and site investigation), have been used for analyzing the uncertainty in the relationship between the measured to calculated loads for given displacements.
Assessment of field stabilization methods to prevent recurring surficial failures
Authors: Puppala A.J.  , Dronamraju V.S.  , Perrin L.  , McCleskey K.L.
Published: February 2025

Surficial failures are shallow slope failures with an average depth of failure ranging from 0.30 m to 1.20 m and frequently occur on several earthfill dams. One of the principal causes of such shallow failures is attributed to desiccation cracking in soils. Infiltration of rain water causes saturation and loss of strength of surficial soil. Hence, shrinkage crack control will be a key factor in controlling the surficial slope failures. Field test sections were constructed at Joe Pool Dam site with various combinations of admixtures including lime, polypropylene fibers and compost. The dam site was heavily instrumented. The test sections were monitored for more than one year and the results indicated that the treatment of top soil with admixtures was effective in preventing desiccation cracking.
Modelling of cementation bonds in clay – laboratory and numerical model
Authors: Trhlíková J.  , Mašín D.  , Boháč J.
Published: February 2025

Artificial cementation bonds were created in a model clayey material by adding 4% of Portland cement to kaolin clay. The mechanical behaviour of the model material was compared with the behaviour of the pure reconstituted kaolin clay. Submersible LVDT's and bender elements were used in identifying the elastic stiffness and the destructuration of the specimens. The triaxial CIUP tests were carried out in determining the shear strength. The aim of the laboratory study was to obtain a complete picture of the mechanical behaviour of the model material, which can be used for calibration, evaluation and further development of constitutive models.
Cyclic behavior of diatomaceous soils
Authors: Díaz-Rodríguez J.A.  , López-Molina J.A.
Published: February 2025

There are several sites in the world where diatom microfossils have been detected in the soil, these natural deposits have singular physical and mechanical properties. However, the specialized literature on the topic is very scarce. To evaluate the influence of microfossils on the cyclic response of clayey soils, this paper presents the experimental results of two series of cyclic simple shear tests using an artificially prepared mixture of kaolin and diatom microfossils (K+D). Tests were carried out on normally consolidated and overconsolidated samples. Based on the available literature and the obtained results, an attempt was made to explain the influence of diatom microfossils on the cyclic behavior of fine-grained soils.
Slope stability of cover systems of hazardous waste landfills
Authors: Datta M.
Published: February 2025

Cover systems of hazardous waste landfills consist of multiple layers of soils and geosynthetics. Steep slopes of covers are desirable to maximize the volume of waste stored in such landfills but low interface shearing strength can limit the inclination of such slopes. In this paper the influence of various parameters such as interface shear angle, slope height, slope inclination, seepage forces, seismic forces and reinforcement on slope stability are examined. The choice of factors of safety for different conditions – static, seismic, seepage as well as seismic with seepage - is discussed. Through a case study it is demonstrated that with proper analysis and design, it is feasible to attain a slope inclination in the range of 2.5 : 1.0 to 3.0 : 1.0 with adequate safety.
Deformation characteristics of clay at slip lines in repetitive type landslides
Authors: Ohtsuka S.  , Isobe K.
Published: February 2025

Landslides commonly occur as the result of pore water pressure increase in slopes from rainfall and melted snow. The shear strength of clay in slopes is generally determined by strain-controlled ring shear tests under fully drained conditions. These tests give peak and residual strength parameters, but no information on shear deformation properties. This paper reports empirical results of ring shear tests to clarify the deformation behavior of clay with increasing pore water pressure. Clay in slopes is subjected to shear stress by the slope inclination. With the increase in pore water pressure, stress approaches a failure threshold at which it deforms significantly. The stress-controlled tests were used rather than the more commonly employed strain-controlled tests in this study. Deformation property of clay was clarified for both virgin type and re-sliding type landslides.
3-D elasto-plastic model of tunnel performance under shadow of case history
Authors: Mazek S.A.  , El-Ghamrawy M.K.  , Law K.T.
Published: February 2025

Tunneling in cohesionless soil leads to ground movement. In urban environment, the ground movement may adversely affect surface or subsurface constructions. In the present study, the ground movement under the impact of tunnel construction is studied using a 3-D finite element analysis (FEA). The analysis utilizes an elasto-plastic stress-strain relationship, a yielding function of the Mohr-Coulomb type and a plastic potential function of the Drucker-Prager type. The ground movement due to tunneling is also calculated using the surface displacement equation (SDE) proposed by Peck and Schmidt (1969). For assessing the reliability of the FEA and the SDE, a case history along the Greater Cairo Metro tunnel Line 2 has been considered. A comparison between the field measurements and those obtained by the FEA and the SDE is made. The FEA has been found to give better estimate of the actual surface settlements than the SDE. Both methods of analysis have been extended to other sandy soils. The results show that the surface settlement profiles using the SDE agree reasonably well with those obtained with the FEA for loose to medium sandy soils. However, for dense to very dense sand soils, the results from the SDE do not agree well with those of the FEA. This is due to the SDE does not take into account the difference in soil denseness.
Foundation reinforcement and performance of tall building in Brazil
Authors: Gusmão A.D.  , Gusmão Filho J.A.  , Maia G.B.  , Oliveira Jr. R.F.
Published: February 2025

This article presents a case of monitoring of settlement in order to identify the performance of the foundation of a building with 26 stories built in the Metropolitan Area of Recife, Brazil. From the results of the monitoring of the building, reinforcement was conceived and executed for its foundations with dangerous settlement. The reinforcement was performed while the building remained occupied and stabilization of the settlement was obtained.
Foundation subsidence due to trenching of diaphragm walls and deep braced excavations in alluvium soils
Authors: Abdel-Rahman Ahmed Hosny  , El-Sayed Sayed Mohamed
Published: February 2025

This paper presents a case history in Giza, Egypt in which the settlements of existing structures founded on shallow and deep foundations surrounding a deep excavation retained by strutted diaphragm walls were monitored. The presented case history comprised inclusive settlement monitoring during the different stages of construction including diaphragm wall trenching and the stages of excavation to the foundation level. The measured settlements were back-analyzed using two and three dimensional numerical models to evaluate the different deformation patterns associated with wall and pit excavation stages. The analyses showed that foundation settlements, during the different stages of deep excavations including the diaphragm wall trenching, are substantially influenced by the foundation type and depth and its relation to the depth of excavation.
Measurement of soil suction using soil's resistivity
Authors: Perez N.  , Garnica P.  , Landaverde N.
Published: February 2025

During several years, the analyses of geotechnical problems have been dominated by solutions developed in the classical soil mechanics where the soil is considered completely saturated or dry, conditions that make the analyses less complicated. However, in many geotechnical problems, the engineer has to deal with unsaturated soils which properties are complex due to the fact that now two fluids are involved in their performance (water and air). One of the main concepts in unsaturated soils theory is “suction” that can be determined in laboratory or field. In soil science, the soil resistivity has been studied widely to determine the capacity of the soil to retain water, however, in geotechnical engineering has not been taken much advantage of such parameter. The authors of this paper present a study on soil resistivity and its relationship to suction. It is shown how the density, degree of saturation and volumetric water content can affect the resistivity. In addition, the results show that there is not a unique relationship between suction and soil resistivity.
A soil and groundwater remediation program using risk analysis as a design tool
Authors: Nobre R.C.M.  , Nobre M.M.M.
Published: February 2025

A risk-based remediation approach was developed as a design tool to support the decision-making process and re-examine remediation goals at an industrial site contaminated with chlorinated organics. This strategy is becoming a common practice in Brazil, as enforced by most environmental agencies and regulators. The risk-based approach demanded the assessment of contaminant exposure pathways as well as groundwater mass transport analysis, taking into account the intrinsic degradation pathways and other natural attenuation mechanisms. It was also emphasized the premise that groundwater transport modeling is inherently complex due to geological matrix and DNAPL characterization which determines the final contaminant concentrations at points of compliance and/or exposure. The Domenico's analytical solution for the advective-dispersive transport equation was used and its input parameters were assumed to be normally distributed. Risk analysis results indicate that vinyl chloride is responsible for the most elevated calculated risk at the site. Therefore, the understanding of the mechanisms of formation of this compound is a key factor to promote the best remedial action to be adopted. As the pump-and-treat system is not sufficient to eliminate the free-phase DNAPL source and achieve site closure, other remediation alternatives are being considered, such as soil vapor extraction and enhanced bioremediation in order to achieve the calculated SSTLs (site specific target levels).
Evaluation of gravity dependence of lunar surface bearing capacity
Authors: Kobayashi T.  , Omine K.  , Suyama Y.  , Ishikura R.
Published: February 2025

As a basic study for future lunar/planetary exploration missions, a series of model tests of shallow footing systems on a simulated lunar soil were conducted in partial gravity fields. Moreover, to rationally explain the dependence of ultimate bearing capacity on gravity, theoretical evaluations were attempted in the framework of the upper bound method. The proposed calculation method not only makes it possible to quantitatively correlate the failure mode with dependence on gravity, but also may allow us to predict the ultimate bearing capacity in the lunar surface environment.
Deformability of gypseous soil in Iraq
Authors: Al-Khafaji A.N.  , Al-Musawe M.J.  , Khorshid N.S.  , Al-Obaid B.M.
Published: February 2025

The main aim of this paper is to find the effect of soaking and to evaluate and document the natural and soaked deformabilities of compact Iraqi natural and soaked gypsiferous soils. In the text of this paper the two words gypseous and gypsiferous and the two words deformability and stiffness modulus are used interchangeably.
The reinforcement mechanism and effect of potassium silicate solutions in an unsaturated loess soil subjected to saturation
Authors: Li L.  , Wang S.J.  , Chen R.  , Ng C.W.W.  , Li Z.X.
Published: February 2025

Solutions of potassium silicate (PS) have been applied to reinforce ancient unsaturated earthen structures in arid regions in northwest China in recent years. Some technical challenges in this reinforcement method still require further study. The performance of PS-reinforced loess soil after rainfall is of great concern. This study investigates the permeability and shear strength of PS-reinforced loess soil from the ancient city of Jiaohe upon saturation. Saturated loess specimens reinforced by 3% PS and 7% PS show higher peak shear strength by 90% and 360%, respectively, as compared with unreinforced specimens. The addition of 3% PS and 7% PS reinforcement also results in higher residual shear strength by about 50% and 250%, respectively. These results suggest that PS reinforcement should be effective under saturation conditions due to rainfall. SEM and TEM analysis reveals that the effectiveness of PS reinforcement is related to reticulardense structures in PS-reinforced soil. The structure of PS-reinforced soil results from non-crystalline and crystalline mixtures produced t from the interaction between PS and clay minerals.
Implementation of SNOMED CT to the Medicines Database of a General Hospital
Authors: Farfán Sedano Francisco J.  , Terrón Cuadrado Marta  , García Rebolledo Eva M.  , Castellanos Clemente Yolanda  , Serrano Balazote Pablo  , Gómez Delgado Ángel
Published: February 2025

A concept-based terminology that covers all features of healthcare is essential for the development of an Electronic Health Record (EHR). Since a significant percentage of the EHR can be drug related information, we decided to implement the controlled drug terminology provided by SNOMED CT to achieve the potential benefit to promote Patient Safety that a fully functional pharmacy system can offer. One of the expected advantages of our Project is to establish a bridge between reference terminology and the drug knowledge databases. There is also an economic advantage of implementing a “clinical drug product”, the one defined by the drug name, its strength and dose form, instead of the manufactured drug product. The Pharmacy economic management of stocks and response to the offers from the pharmaceutical companies is another expected asset of the Project. This Project is intended as well to give support to a more widespread objective of interoperability with the Primary Care systems.
The Problem of Defensive Medicine: Two Italian Surveys
Authors: Catino Maurizio  , Celotti Simona
Published: February 2025

Defensive medicine takes place when healthcare personnel modify their behaviour with the aim of reducing their exposure to legal challenges from patients. The phenomenon is directly related to the significant growth in medical malpractice litigation over recent years. This article presents the results of two research surveys aimed at measuring the extent of defensive behaviours on the part of doctors in Italy and at understanding the reasons for them. The first study (the National Study (NS) was conducted in respect of a nation-wide sample of general practitioners, while the second (the Local Study (LS) was conducted in respect of two groups of specialists (surgeons and anaesthetists) in a regional hospital. 77.9% of the general practitioners interviewed for the NS (responses were received from 37% of the 1000 GPs to whom the questionnaire was sent) declared that they had practiced at least one form of defensive medicine during the previous working month. The figure for the LS was 83.3%. This article discusses the factors, such as the blame culture and the increase in medical malpractice litigation, that may lead to defensive behaviours and result in negative effects both in terms of costs and patient safety. A clear need emerges for a different approach to the problem of medical error – at a cultural, organizational and legal level – just as in the case of other organizations subject to high risk. The deterrent of punishment does not increase the reliability of such organizations, nor does it improve the level of safety in them.
Integrating Clinical Theory and Practice in an Epilepsy-Specific Electronic Patient Record
Authors: Breen Patricia  , McQuaid Louise  , Grimson Jane  , Delanty Norman  , Dunne Mary  , Dunleavy Brendan  , Normand Charles  , Fitzsimons Mary
Published: February 2025

This study's objective was to assess the usability of the epilepsy history module of the electronic patient record, developed at Beaumont Hospital, and to identify opportunities for improvement. Observation, interview and document analysis methods were used. Results indicated that the module was useable but the design did not work as well in practice as anticipated by theory. The next iteration of the module included identified enhancements; this iteration is currently in use.
Solutions for Deploying Multi-Architecture EHRs on a Single EHR Educational Portal
Authors: Armstrong Brian  , Kushniruk Andre  , Borycki Elizabeth
Published: February 2025

In this paper technical issues are discussed related to the development and implementation of a remotely accessible portal that allows users to interact with a range of electronic health records (EHRs). The Portal (known as the UVic EHR Educational Portal) was designed to allow for the hosting of a range of types of EHRs, ranging from thick client systems to web-browser-based systems. The portal has been successfully deployed to allow simultaneous access by hundreds of users (i.e., health professional students) in order to work with representative EHRs for educational purposes. The overall architecture is described and issues related to the challenges in allowing for the hosting of systems of divers designs.
Building Interoperable Health Information Systems Using Agent and Workflow Technologies
Authors: Koufi Vassiliki  , Malamateniou Flora  , Vassilacopoulos George
Published: February 2025

Healthcare is an increasingly collaborative enterprise involving many individuals and organizations that coordinate their efforts toward promoting quality and efficient delivery of healthcare through the use of interoperable healthcare information systems. This paper presents a mediator-based approach for achieving data and service interoperability among disparate and geographically dispersed healthcare information systems. The proposed system architecture enables decoupling of the client applications and the server-side implementations while it ensures security in all transactions. It is a distributed system architecture based on the agent-oriented paradigm for communication and life cycle management while interactions are described according to the workflow metaphor. Thus robustness, high flexibility and fault tolerance are provided in an environment as dynamic and heterogeneous as healthcare.
Projection and Inheritance of SNOMED CT Relations between MeSH Terms
Authors: Merabti Tayeb  , Letord Catherine  , Abdoune Hocine  , Lecroq Thierry  , Joubert Michel  , Darmoni Stéfan J.
Published: February 2025

This paper proposes a methodology to achieve the automatic inheritance of SNOMED CT relations applied to MeSH preferred terms using UMLS as knowledge source server. We propose an interoperability wildcard to achieve this objective. A quantitative and a qualitative analysis were performed on top four SNOMED CT relations inherited between MeSH preferred terms. A total of 12,030 couples of MeSH preferred terms are in relation via at least one SNOMED CT relationship. For the top-four relations inherited between MeSH preferred terms, overall 79.25% of them are relevant, 16.25% as intermediate and 4.5% as irrelevant, as judged by a medical librarian. This work should lead to an optimization of multi-terminology indexing tools, multi-terminology information retrieval and navigation among a multi-terminology server.
The Use of SNOMED CT for Representing Concepts Used in Preoperative Guidelines
Authors: Ahmadian Leila  , De Keizer Nicolette F.  , Cornet Ronald
Published: February 2025

The use of guidelines to improve quality of care depends on presenting them in a standard machine-interpretable form and using common terms in guidelines as well as in patient records. In this study, the use of SNOMED CT for representing concepts used in preoperative assessment guidelines was evaluated. Terms used in six of these guidelines were mapped to this terminology. Mappings were presented based on three scores: no match, partial match, and complete match. As eleven of the terms were repeatedly used in different guidelines, we analyzed the results based on “token” and “type” coverage. Of 133 extracted terms from guidelines, 107 terms should be covered by SNOMED CT of which 87% was completely represented by this terminology. Our study showed that SNOMED CT content should be extended before preoperative assessment guidelines can be completely automated.
On Signal Analysis of Three-Dimensional Nystagmus
Authors: Juhola Martti  , Aalto Heikki  , Hirvonen Timo
Published: February 2025

Nystagmus needs to be stimulated for healthy subjects, but in patients it can also be spontaneous. By recording spontaneous nystagmus it is possible to reveal underlying disorders of the semicircular canals of the inner ear. We developed a signal analysis technique for this purpose and tested it with 28 otoneurological patients who had disorders in their semicircular canals. Our test results support the postulate how nystagmus should appear under these conditions and agree with results presented in the otoneurological literature.
Research, Forensics, Public Health, Injury Prevention and Policy Development
Authors: Ranson David
Published: February 2025

This chapter gives an educational overview of:
Evidence-based medicine
Authors: McGinnis J. Michael
Published: February 2025

Whether for the generation or application of evidence to guide healthcare decisions, the success of evidence-based medicine is grounded in principles common to engineering. In the Learning Healthcare System envisioned by the Institute of Medicine's (IOM) Roundtable on Evidence-Based Medicine, evidence emerges as a natural by-product of care delivery, which is thoroughly documented, pooled for continuous monitoring and analysis, integrated with insights from related studies, and fed back seamlessly to improve the consistency and appropriateness of care decisions by clinicians and their patients. Drawing from lessons shared at the IOM/NAE symposium, Engineering a Learning Healthcare System, this paper provides an overview of the state-of-play in health care today, some of its key challenges, the vision and features of a learning healthcare system, applicable commonalties and principles from engineering, and potential collaborative opportunities moving forward to the benefit of both fields.
CEN EN13606 Normalisation Framework Implementation Experiences
Authors: Moner David  , Maldonado José A.  , Boscá Diego  , Angulo Carlos  , Robles Montserrat  , Pérez Daniel  , Serrano Pablo
Published: February 2025

Since the approval of the CEN EN13606 norm for the electronic health record communication, a growing interest around the application of this specification has emerged. The main objective of the norm is to serve as a mechanism to achieve the semantic interoperability of clinical data. This will require an effort to use common terminologies, to normalise the clinical knowledge domain and to combine all these formalisations with the existing information systems. This paper presents a methodology and developed tools to reach the seamless semantic interoperability of health data in legacy systems and several study cases where the developed framework has been applied.
A Communication Standards Ontology Using Basic Formal Ontologies
Authors: Oemig Frank  , Blobel Bernd
Published: February 2025

Working interoperability not only requires harmonized system's architectures, but also the same interpretation of technical specifications in order to guide the development process. This paper analyses the commonly used structures of communication standards elaborated with HL7 Version 3 and proposes an ontological structure resulting in the so-called Communication Standards Ontology (CSO). As such a solution has to be developed within an architectural framework, the approach is aligned with the Generic Component Model (GCM).
Setting Core Standards: Privacy, Identity & Interoperability
Authors: Manning B.  , Benton S.
Published: February 2025

This position paper focuses on strategic developments and underlying concepts emerging out of the standards and associated domains. It addresses the issue of personal privacy in the wider context of interoperability across an ever-growing range of e-health and social care support systems and processes. These will increasingly be driven by major growth in the elderly segment of national populations where unambiguous identification of both patients and care staff both in hospitals and the community will become significant issues. This is particularly so where remote patient monitoring and access control to personal data is concerned, and is further complicated where racial, cultural and linguistic barriers are prevalent.
Organizational Considerations for the Implementation of a Computerized Physician Order Entry
Authors: Pelayo Sylvia  , Beuscart-Zephir Marie-Catherine
Published: February 2025

Several studies stressed that the introduction of CPOE applications deteriorates the doctor-nurse communication. But there are many factors that might influence communication behaviors, as for example the way these communications are organized. The present study aims at showing that the impact of a CPOE system on the cooperative activities can be controlled given that a good understanding of the cooperative workflows support the implementation. By analyzing the doctors-nurses communications during the medication use process, the study demonstrates that the technical system has no impact on the cooperative activities within a given organization. CPOE does not induce differences in the dialogs' durations and contents.
Issue Orders and Discontinued EPR
Authors: Forsell Anne  , Karsten Helena  , Vuokko Riikka
Published: February 2025

Users gave us 104 different reasons for the failure of implementing an EPR in a surgical clinic. We classify the reasons with the issue order model, where the first issue level is for simple and technical issues, the second one for more complex and combined issues, and the third one for political or ideological issues. However, what appears as a first order issue to a manager might be seen as an insurmountable third order issue for a worker and vice versa. The issues are interrelated, and solving one issue might have a substantial influence on other issues. Also, the issues seemed to accumulate and concentrate on points. The analysis helps focus on key problems, with consideration to related issues.
The Role of Posteriorly Directed Shear Loads Acting on a Pre-rotated Growing Spine: a Hypothesis on the Pathogenesis of Idiopathic Scoliosis
Authors: Janssen Michiel M.A.  , Kouwenhoven Jan-Willem M.  , Castelein René M.
Published: February 2025

Despite years of extensive research, the etiology of idiopathic scoliosis still has not been resolved. A hypothesis on the role of posteriorly directed shear loads was studied in several biomechanical and imaging studies. So far, it has been shown that: on the human erect spine these posteriorly directed shear loads act; these loads decrease the rotational stability of the spine vitro and in vivo; once rotation occurs, it logically follows an already built-in vertebral rotational pattern, that is pre-existent in the human spine; this pre-existent rotational pattern is related to organ anatomy, and not to handedness; certain areas in the female spine are more subject to posteriorly directed shear loads as certain areas in the female spine are more backwardly inclined. Although it is appreciated that the cause of idiopathic scoliosis is multi-factorial, we believe that the delicate upright spinal sagittal balance and the unique posteriorly directed shear loads acting on the erect human spine play a crucial role in the rotational stability of the human spine, and thus in the pathogenesis of idiopathic scoliosis.
Factors affecting Distal End & Global Decompensation in Coronal/Sagittal Planes 2 years after Fusion
Authors: Miller Daniel J.  , Jameel Omar  , Matsumoto Hiroko  , Hyman Joshua E.  , Schwab Frank J.  , Roye Jr. David P.  , Vitale Michael G.
Published: February 2025

Introduction: Decompensation of un-fused vertebrae is a potential complication of spinal instrumentation performed for adolescent idiopathic scoliosis (AIS). This can result in problems requiring revision surgery. The purpose of this study was to compare patients who decompensated in the sagittal/coronal plane and those who do not and to identify risk factors. Methods: The Spinal Deformity Study Group data-base for AIS identified 908 patients at 2 years post-op. Coronal measures analyzed included coronal balance (CB), coronal position of the lower instrumented vertebra (CPL) and LIV tilt angle (LTA). Sagittal measures included sagittal balance (SB) and distal-junctional kyphosis (DJK). The incidence of decompensation at 2 years was: CB-16.83%, LTA-37.53%, CPL-21.17%, negative SB-51.88%, positive SB-7.62%, DJK-6.8%. Decompensated patients were compared to those who were not using preoperative, and 4-16 weeks post-op values. Results: Numerous significant differences were found between patients who decompensated at 2 years and those who did not. CB was significantly influenced by larger height/weight, increased Cobb, preexisting CB and a thoracic LIV. In addition to other factors LTA decompensation was more likely to occur in JIS. CPL was associated with pelvic-obliquity and thoracic LIV. Post-operative sagittal balance could be predicted by pre-operative sagittal balance. DJK was also associated with larger weight and preoperative sagittal measures. Discussion and Conclusion: Less correction in sagittal/coronal planes is a risk factor for decompensation. Curve correction was significant in predicting coronal decompensation. Failure to control sagittal alignment was a risk factor in sagittal decompensation.
Super Hybrid Method of Scoliosis Correction: Minimum 2-Year Follow-up
Authors: Suzuki Nobumasa  , Kono Katsuki
Published: February 2025

We applied a new surgical technique utilizing conventional hybrid instrumentation to achieve better correction of trunk deformity in adolescent idiopathic scoliosis. The purpose of this study is to introduce our “Super Hybrid Method” and to analyze the results at minimum 2-year follow-up. The technique consists of rib mobilization (2006), a rod rotation maneuver (1997) and a hook rotation maneuver (2007). Forty-four idiopathic cases (female: 43) with minimum 2-year follow-up were reviewed (24-39months, average 32). The average age at surgery was 20.4 years (12-57). The average pre-operative Cobb angle was 56.7 degrees (40-93). The average pre-operative rib hump was 23.2mm in height and 14.3 degrees by scoliometer. The average post-op Cobb angle was 13.3 degrees at 3 weeks and 18.1 degrees at follow-up. The average initial overall correction at 3 weeks post-op was 78% (83% for age<18, 73% for age ≤18) and 70% at later follow up (75% for age<18, 67% for age ≤18). The average rib hump 2 years post-operatively was 12.4mm in height and 7.3 degrees. Sixty nine percent of patients (18/26) with a pre-operative rib hump ≤20mm (20-49) had a decrease in hump height by more than 10mm (10-34). In Moiré analysis, the hump-sum measure (Suzuki) showed a statistically significant decrease from 13.4 preoperatively to 9.2 at 1 year post-op (p<0.001). Correction of deformity was excellent with our new technique. It is a less expensive procedure and carries little inherent risks.
Developmental Spondylolisthesis: Is Slip Angle Related to Quality of Life?
Authors: Tanguay Frédéric  , Mac-Thiong Jean-Marc  , Wang Zhi  , Joncas Julie  , De Guise Jacques A.  , Labelle Hubert
Published: February 2025

Lumbosacral kyphosis (LSK) is considered to be an important aspect of the deformity in adolescent developmental spondylolisthesis, but its clinical impact is not known. The purpose of this study was to clarify if slip angle (SA), a parameter commonly used to measure LSK, has a significant impact on the quality of life of patient with spondylolisthesis. Eighty-six patients with lumbosacral developmental spondylolisthesis were evaluated. There were 67 low-grade and 19 high-grade spondylolisthesis. All patients completed the SF-12v2 questionnaires. The score of the mental and physical component summary (MCS and PCS) of SF-12v2 were correlated with the slip angle. The correlation of SA was only significant with PCS and not with MCS. PCS decreased significantly with increasing SA (Spearman's rho=-0.40, p<0.001). LSK has a significant impact on the physical aspect of the quality of life of adolescent with spondylolisthesis. LSK is an important part of the deformity in developmental spondylolisthesis and should be included in the routine radiological evaluation of patient with spondylolisthesis.
Comparisons of Trunk and Spine Deformity in Adolescent Idiopathic Scoliosis
Authors: Carlson Brandon B.  , Burton Douglas C.  , Asher Marc A.
Published: February 2025

Introduction: Standing radiograph Cobb measurement is the standard for clinical assessment of coronal spinal deformity. Angle of trunk inclination (ATI) is an accepted clinical measurement of transverse plane trunk deformity, and has variable reported correlations with Cobb angles. Transverse plane spine deformity is most accurately measured using axial computed tomography (RAsag). To our knowledge no study has correlated ATI with RAsag.
Fast 3D Reconstruction of the Spine by Non-expert Users Using a Statistical Articulated Model
Authors: Moura Daniel C.  , Boisvert Jonathan  , Barbosa Jorge G.  , Tavares João Manuel R.S.  , Labelle Hubert
Published: February 2025

Introduction: Three-dimensional spine reconstruction methods currently used to study scoliosis require manual identification of several anatomical features, which is time-consuming, costly and error-prone.
A Study on the Validity and Reliability of the Chinese Version of Spinal Appearance Questionnaire
Authors: Lam T.P.  , Lau Ajax H.Y.  , Liu K.L.  , Tse Y.K.  , Yeung H.Y.  , Ng B.K.W.  , Cheng J.C.Y.
Published: February 2025

Introduction: Scoliosis is a highly prevalent condition with onset and curve progression occurring at puberty when cosmetic problems are major concerns. Evaluating patient's perception of spinal appearances is mandatory. Spinal Appearance Questionnaire(SAQe) is a validated and popular tool to meet this need.
Enabling Secure, Distributed Collaborations for Adrenal Tumor Research
Authors: Stell Anthony  , Sinnott Richard  , Jiang Jipu
Published: February 2025

Many e-Health strategies rely on the secure integration of datasets that have previously resided in isolated locations, but can now in principle be accessed over the Internet. Of paramount importance in the health domain is the need for the security and privacy of data that is transmitted across these networks. One such collaboration, which spans several specialist centres across France, Germany, Italy and the UK, is ENSAT – the European Network for the Study of Adrenal Tumors. The rarity of the tumors under study means the value of accessing, aggregating and comparing data from many centres is great indeed. However this is especially challenging given that ENSAT require clinical and genomic data to be seamlessly linked, but in such a way that the information governance, ethics and privacy concerns of the patients and associated stakeholders involved are visibly satisfied. Key to this is the clear separation of clinical and genomic data sets and support for rigorous patient-identity protecting access control. This is especially challenging when such data sets exist across different organisational boundaries. In this paper we describe a prototype solution offering a security-oriented tailored portal supported by a layered encryption-driven linkage technology (VANGUARD) that offers precisely such patient-privacy protecting capabilities. We describe the architecture, implementation and use to date of this facility to support the ENSAT adrenal cancer research network.
Facilitating Secondary Use of Medical Data by Using openEHR Archetypes
Authors: Kohl Christian D.  , Garde Sebastian  , Knaup Petra
Published: February 2025

Clinical trials are of high importance for medical progress. But even though more and more clinical data is available in electronic patient records (EPRs) and more and more electronic data capture (EDC) systems are used in trials, there is still a gap which makes EPR / EDC interoperability difficult and hampers secondary use of medical routine data. The openEHR architecture for Electronic Health Records is based on a two level modeling approach which makes use of ‘archetypes’. We want to analyze whether archetypes can help to bridge this gap by building an integrated EPR / EDC system based on openEHR archetypes. We used the ‘openEHR Reference Framework and Application’ (Opereffa) and existing archetypes for medical data. Furthermore, we developed dedicated archetypes to document study meta data. We developed a first prototype implementation of an archetype based integrated EPR / EDC system. Next steps will be the evaluation of an extended prototype in a real clinical trial scenario. Opereffa was a good starting point for our work. OpenEHR archetypes proved useful for secondary use of health data.
Usefulness of the functionalities of an Electronic Medical Record on a Latinamerican Medical Web Portal
Authors: Flichtentrei Daniel  , Braga Florencia  , García Darío  , Jamsech Jorge  , Otero Carlos  , Waldhorn Martín  , Luna Daniel  , de Quiros Fernan Gonzalez Bernaldo
Published: February 2025

The medical record is a key component in the modern health systems, a fundamental basis of higher functionalities that guaranties quality care and the possibility of improved clinical management. The dissemination of information systems for the electronic medical record (EMR) has a growing acceptance and use in developed countries. This type of recognition however has not been widespread in Latin America. Realizing this we conducted a web survey to users of a Latin American medical portal to assess their perception of the EMRs usefulness. Among the results we found that over 90% of respondents were in favor of its use, with values that exceed 80% in the analysis of the utilities by categories. More in-depth studies are needed to determine the reasons for the lack of dissemination and implementation of EMR in our region.
Adopting the National Structure of Nursing Documentation is Consequential in the Development of Care
Authors: Ala-Hiiro Tapio  , Lemmetty Kaisa  , Pitkänen Satu  , Häyrinen Eija
Published: February 2025

When healthcare units adopt the national structure of electronic nursing documentation, the process requires managerial support in nursing development as well as theoretical education arranged prior to the implementation. According to the experiences of the pilot units in the Central Finland Health Care District, nursing core data documentation in accordance with the national structure promotes care planning, clarifies and constructs documentation and furthermore unifies the documentation system. The change process gives rise to juridical aspects of documentation as well as a critical evaluation of the documentation contents. The early period of implementing the new theoretical aspect and proceeding from paper-based to electronic documentation required learning, training and agreement on common policy. In health care practice, there is at present one collective structure and model for nursing documentation based on national guidelines. A documented nursing plan is available when a patient is transferred between units or even into extended care. The structured care plan is also helpful when new nurses are introduced to praxis. The continuity of care is at stake when employees are transferred between units to meet the demands of resource allocation.