bluuebunny/crossref_metadata_2025 huggingface dataset:
Eltern-Kind-Projekt Chance zur Unterstützung von Kindern inhaftierter Eltern
Authors: Fegert J. M. , Ziegenhain U. , Zwönitzer A.
Published: March 2018

Kinder inhaftierter Eltern stellen eine Hochrisikogruppe dar. Sie wachsen häufig in Familien auf, die diversen Risikofaktoren ausgesetzt sind. Im Vergleich zur Normalpopulation weisen sie eine erhöhte Lebenszeitprävalenz für eine psychiatrische Erkrankung, v. a. von Persönlichkeitsstörungen auf und haben ein erhöhtes Risiko selbst straffällig zu werden.

Im “Eltern-Kind-Projekt Chance” werden erstmals Kinder von inhaftierten Eltern in Baden- Württemberg systematisch unterstützt. Diese Initiative ist seit 2011 Teil der regulären Arbeit der Straffälligenhilfe Baden-Württemberg. Sie wird von dem gemeinnützigen Verein “Projekt Chance e. V.” getragen und von der Baden-Württemberg Stiftung finanziert. Sie unterstützt im Rahmen dieses Projektes Kinder und deren Familien, die von der Inhaftierung eines Elternteils betroffen sind. Die wissenschaftliche Begleitung und Evaluation des Projektes erfolgte von 2011 bis 2016 durch die Universitätsklinik für Kinder- und Jugendpsychiatrie/ Psychotherapie Ulm.

Die Ergebnisse der Evaluationsstudie bilden eine erste systematische Datengrundlage zur Situation von Kindern inhaftierter Eltern in Deutschland. Es zeigt sich, dass die Kinder inhaftierter Eltern (n = 113/n = 165) psychisch hoch belastet (Beziehungsprobleme/Verhaltensauffälligkeiten) sind. Im Vergleich vor und nach der Betreuung im Eltern-Kind-Projekt kam es im Mittel jedoch zu einem Rückgang der Verhaltensauffälligkeiten und Symptomen bei den Kindern (n = 60).
Alternative Inventory and Distribution Policies for a Regional Blood Banking System
Authors: Page B.
Published: March 2018

This paper deals with the application of mathematical methods to the inventory of blood units in a regional supply system.

A complex simulation model was designed and implemented in the discrete simulation language SIMSCRIPT to investigate alternative inventory and distribution policies for blood units by means of defined objective criteria. These procedures include a method for inventory forecasting and blood donor call-up and a heuristic allocation model for blood units.

Empirical data was collected from the Berlin Blood Donor Service for model construction and validation.

The simulation results suggest that the inventory procedures presented may lead to a considerable cost reduction in a regional blood banking system.

A specific statistical testing procedure was employed to justify the simulation results statistically. In the final section it is suggested that the inventory methods described in this paper can be implemented within a computer information system providing the blood bank management with decision aids.
Effects of Observer Variation on Performance in Probabilistic Diagnosis of Jaundice
Authors: Llndberg G.
Published: March 2018

A system for probabilistic diagnosis of jaundice has been used for studying the effects of taking into account the unreliability of diagnostic data caused by observer variation. Fourteen features from history and physical examination were studied. Bayes’ theorem was used for calculating the probabilities of a patient’s belonging to each of four diagnostic categories.

The construction sample consisted of 61 patients. An equal number of patients were tested in the evaluation sample. Observer variation on the fourteen features had been assessed in two previous studies. The use of kappa-statistics for measuring observer variation allowed the construction of a probability transition matrix for each feature. Diagnostic probabilities could then be calculated with and without the inclusion of weights for observer variation. Tests of system performance revealed that discriminatory power remained unchanged. However, the predictions rendered by the variation-weighted system were diffident. It is concluded that taking observer variation into account may weaken the sharpness of probabilistic diagnosis but it may also help to explain the value of probabilistic diagnosis in future applications.
Principles and Practice of Recording Data in Toxicological Pathology
Authors: Naylor D. C.
Published: March 2018

A computer-assisted system for handling all data collected at autopsy and during the subsequent his-topathological examination of laboratory animals, used especially in chronic toxicity and carcinogenicity studies, is described. It is designed to be linked up to other systems used in toxicology so that data collected during toxicological, haematological and clinical-chemical examinations can be recalled by each pathologist. The system, while retaining its simplicity and flexibility, is a more refined version of one that was developed in another pharmaceutical company where it is still being used successfully. The present system is based on the Topography and Morphology Fields of the Systematized Nomenclature of Medicine (SNOMED); all morphological terms employed are carefully defined by the users, a factor contributing greatly to its success. Terminology is standardized, historical data can be recalled, and the system is able to comply with all other requirements of the regulatory authorities.
Long-Term Studies — A Challenge to Medical Informatics
Authors: Überla K.
Published: March 2018

The paper describes the aims of long-term studies and the problems involved for medical informatics and shows ways to their solution.
Clinical Estimation of the Duration of Pregnancy in Legal Abortion—Are Doctors Biased by their Knowledge of the Duration of Amenorrhoea?
Authors: Gjørup Th. , Saurbrey Nina , Hermann N.
Published: March 2018

In 35 women referred for induced abortion, the duration of pregnancy was stated with an accuracy of one week on the basis of the gynaecologic examination. This was done by one doctor with knowledge of the duration of amenorrhoea (clinical estimate) and by one doctor without this knowledge (“blind” estimate). Agreement was found between the duration of amenorrhoea and the duration of pregnancy for 89% of the clinical estimates and for 46% of the “blind” estimates. Prior to the study the doctor who made the “blind” estimates had—with knowledge of the duration of amenorrhoea—examined 26 similar women and had obtained agreement as to 88% of her estimates. For the clinical estimates, the difference between the duration of amenorrhoea and the duration of pregnancy did not exceed one week, whereas for the “blind” estimates, it amounted to as much as 3 weeks. It is concluded that doctors’ clinical estimate of the duration of pregnancy is influenced by their knowledge of the duration of amenorrhoea.
Informatics to Improve Medical Care of a Nation
Authors: Subramanian M.
Published: March 2018

At the Thirtieth World Health Assembly in 1977 the Member States of the World Health Organization endorsed the policy of developing their health care systems through the primary health care approach. The present paper is concerned with the application of certain significant features of informatics for the development and improvement of health care management in different countries.
Reliability of History Taking and Physical Examination in Jaundice
Authors: Helmers C. , Lindberg G.
Published: March 2018

Four observers interviewed and examined 19 jaundiced patients, recording sixteen common symptoms and ten clinical signs that had been defined in advance. Kappa statistics were used for evaluating the data. All studied symptoms and seven signs showed agreement between observers significantly greater than expected by chance. The clinical significance of inter-observer variation was studied in a set of 144 jaundiced patients. The diagnostic value of studied symptoms and signs was calculated before and after correction for inter-observer variation. Only five symptoms: itching, loose bowels, ache, ache/pain description and alcohol intake, and three signs: spider naevi, palmar erythema and ascites retained more than 60% of their diagnostic value after correction for inter-observer variation.
Clinical Trial Size: Fixed versus Group-Sequential Designs
Authors: Moussa M. A. A.
Published: March 2018

This paper deals with the estimation of the size of clinical trials for comparing two binomial proportions in both fixed and group-sequential designs. In the fixed size approach, it focuses on 1.) equal sample size design; 2.) unequal allocation designs that either maximize the test power subject to fixed total cost or minimize the total expenditure subject to prespecified power using the simplex procedure for function minimization. Emphasis is also placed on group-sequential designs, based upon closed stopping rules, multiple testing and range of clinical equivalence. The efficiency of different allocation designs is assessed by computing the power of the exact conditional Fisher-Irwin test. Designs were applied in planning a clinical trial in which the drug Pancuronium Bromide was compared with a standard treatment to reduce intraventricular haemorrhage in preterm infants.
The Design of Computer Forms for Tropical Medical Research
Authors: Byass P.
Published: March 2018

The design of forms for recording medical research data in the field is discussed in the light of the computer hardware and software to be used for their subsequent analysis. In particular, the principles of relational database management systems are extrapolated to the structure of forms. Specific issues of subject identification, layout of forms, different types of data and coding methods are developed. Finally, the special problems of applying these principles in the tropics, and experiences of so doing, are considered.
Data Systems in Mental Health
Authors: Laska E. , Siegel Carole , Meisner M. , Bank Rheta , Zeitz Baila
Published: March 2018

The proper utilization of data information systems in mental health care can noticeably improve the quality and efficacy of such care. The World Health Organization is in a key position to encourage and assist governments in achieving the fullest possible application of knowledge in the development and utilization of such systems to the benefit of the greatest numbers of the world’s population.

This paper briefly delineates some of the common information needs of the providers of mental health care, discusses the feasibility of automated data systems, and describes some already existing psychiatric information systems. Finally, it proposes ways and means by which the WHO can more efficiently aid its member nations by coordinating efforts in establishing mental health information systems. Recommendations include establishment of an information clearinghouse on data systems, a group coordinating dissemination of this information, a common pool of specialists in the area, and development of regional computing facilities under the auspices of the WHO.
General Concepts for the Creation of a National Automated Information System for Policlinical Services
Authors: Tutuenkov N. G. , Kotchev L. N. , Rashkova K. R. , Kelbetcheva V. P.
Published: March 2018

The authors present a system which is designed to cover statistically the roughly 50 million policlinical services rendered annually in Bulgaria, for the purpose of planning and as proof of the activities in this field. The principle underlying the system was tested in the region of Plovdiv.
Occurrence of Disease and Syndrome Eponyms in the Titles of Medical Literature
Authors: Ghosh Jata S.
Published: March 2018

No quantitative data on the use of eponyms in medicine are available. This paper attempts to quantify the frequency of occurrence of 91 personalized disease and syndrome eponyms (DSE) in the titles of medical documents. By employing the subject heading-title word correlation technique of Montgomeryand Swansonit was found that 72.2 percent of the 2,435 papers listed in the 1973 Index Medicushad at least one of these 91 candidate DSEs in their titles; another 195 (8.0 percent) titles had the corresponding descriptive or non-eponymic synonyms, and the remaining 480 (19.8 percent) titles did not have either of these two matching elements. Thus, the ratio of occurrence of the personalized DSEs to their descriptive names in the titles of the medical literature examined appeared to be 9:1. It was further noted that, while about 80 percent of the pertinent literature could be retrieved on the basis of a title search with DSEs and their descriptive synonyms, about 20 percent of the relevant documents will be missed.
A Method of Analysing Hospital Surgical Waiting Lists
Authors: Kennedy T. C. S.
Published: March 2018

This paper discusses the meaning which can be derived from the careful analysis of surgical waiting lists.

During the development of a minicomputer-based hospital administration system at Southend Hospital, such an analysis has become a routine part of the administrative procedures applied within the hospital. In the event of a more widespread use of computer systems it is argued that the type of analysis proposed could have a wide application since it can cut across environmental and other boundaries which generally prevent a comparison of different situations. This in turn could lead to a more uniform application of resource allocation policies on a regional and national scale.
Methods for Computer Linkage of Hospital Admission-Separation Records into Cumulative Health Histories
Authors: Smith Martha E. , Newcombe H. B.
Published: March 2018

A study involving the design and testing of a computer system for linking hospital admission-separation records into longitudinal health histories is described. Although this study is based on a sample of the machine-readable files for a single Canadian province, essentially similar punch cards are prepared routinely across Canada as part of a system of universal health care. No data are included in the study that are not already recorded by provincial authorities.

The essential step in the linkage is the recognition of whether two or more independently derived records relate to the same person. The methods are designed to extract and use the maximum amount of discriminating power inherent in items of personal identifying information, which may be incompletely reported or variant on some of the records. A statistical weighting system is employed to indicate the degree of assurance that two records should or should not be linked.

The computer successfully matched over 99% of all pairs of potentially linkable records, at a rate of 3000 incoming records per minute. These methods are being used as part of an overall operation in which vital and health records are being integrated into individual and family health histories.
Schwankungen der Mortalität in Beziehung zur Luftverschmutzung
Authors: Hecker H. , Basler H.-D. , Wolf Ellen
Published: March 2018

Es wird ein mathematisches Modell vorgestellt, welches die Abhängigkeit der Mortalität von der Jahreszeit, von äußeren Einflußgrößen (wie z.B. Luftverschmutzung, Temperatur) und von den Sterbezahlen der nahen Vergangenheit beschreibt. Das Modell ist auf Gebiete abgestimmt, in denen die Abweichungen der äußeren Variablen vom je\yeils aufgrund der Jahreszeit zu erwartenden Wertnicht extrem sind. Für den kurzzeitigen Einfluß solcher Schwankungen sowie für den Einfluß der Saisonkomponenten auf die Mortalität werden einfache Testverfahren angegeben. Das Modéll wird anschließend auf ein Beispiel aus Hannover angewandt, in dem als äußere Einfluß-große die SO2-Konzentration als Ladikator für die Luftverschmutzung betrachtet wird.
Anschluß und On-line-Betrieb eines Szintiscanners an einem Digitalrechner
Authors: Habermehl A. , Eisenhauer P. , Joseph K. , Graul E. H.
Published: March 2018

Das Betriebssystem enthält 2 Arten von Wiedergabeprogrammen: Wiedergaben am Sichtgerät und Druckausgaben. Beide werden durch ein Codewort vom Teletype aus aufgerufen.

Bei dem Programm SSWE werden auf dem Sichtgerät alle Werte dargestellt, die über einer bestimmten Schwelle liegen. Diese Schwelle wird bei diesem Programm mit der Hand eingestellt, während sie bei dem Programm SASW automatisch angehoben wird und so einen Bilderzyklus liefert. Weitere Programme zeichnen die Höhenschichtlinien und liefern eine perspektivische Darstellung des Aktivitätsgebirges.

Bei den Druckausgaben liefert das Programm FSWE eine Schwellendarstellung, während das Programm FVZE eine Darstellung der verschiedenen Niveaus mit verschiedenen Druckzeichen ausgibt. Ein ähnliches Programm ergibt eine Darstellung in mehrfachen Niveaugruppen. Außerdem ist in dem Betriebssystem noch ein Programm zur Druckausgabe von Höhenschichtlinien enthalten.
Versuchspläne zur Testung auf Arzneimittelsicherheit vor Beginn der klinischen Prüfung
Authors: Fink H.
Published: March 2018

Bevor eine neu synthetisierte oder isolierte und biologisch aktive Forschungssubstanz in die klinische Prüfung gegeben wird, muß sie nach dem derzeitigen Stand der Wissenschaft auf Sicherheit getestet werden. Dies erfolgt im Probandenversuch, wobei das Prinzip der Freiwilligkeit bei voller Aufklärung gewährleistet sein muß. Die Zahl der Probanden soll möglichst klein, aber groß genug für eine verläßliche Urteilsfindung gewählt werden.

Zielvariable sind Laborgrößen und Größen der Vitalfunktionen. Da die Zahl der Zielvariablen zu der Zahl der Probanden in ein vertretbares Verhältnis gebracht werden muß, muß eine Variablenvorauswahl an Hand der Vorinformation aus pharmakologischen und toxikologischen Tierversuchen erfolgen. Eine zusätzliche Variablenreduktion wird durch Selbstversuche oder Probandenstichversuche erreicht. Hierzu müssen zusätzlich Meßwerte vor Applikation der Substanz erhoben werden, damit diese Entscheidung nicht nur auf die wenig allgemeinverbindlichen klinischen Normbereiche, sondern auch auf die individuelle Ausgangslage gegründet werden kann.

Das endgültige Urteil wird aus einem im biometrischen Sprachgebrauch »kontrollierten« Versuch gewonnen. Kontrolliert werden müssen Zeittrends, die sich aus vielerlei Gründen bei den Probanden, bei den Untersuchern und in den Labors einschleichen und die biologische Aktivität der Forschungssubstanz nach beiden Richtungen verfälschen können. Zur Gewinnung einer verläßlichen Nullinie der Wirkung ist die Einbeziehung von Placebo-Applikationen unerläßlich. Damit die Probandenzahl nied. rig gehalten werden kann, sollte der Individualvergleich dem Gruppenvergleich vorgezogen werden. Für untersucheroder laborabhängige Zielvariable müssen mehr als ein Untersucher oder ein Labor einbezogen werden.

Entsprechende Versuchspläne, die sich in der Praxis als durchführbar erwiesen und bewährt haben, werden vorgeschlagen und Hinweise zu ihrer Auswertung gegeben. Nimmt man hierbei einen möglichen Autokorrelationsfehler in Kauf, liegt man in der Deutung der Versuchsergebnisse auf der Seite der Arzneimittelsicherheit.
Formal Considerations on Text Analysis in Anatomic Pathology
Authors: Kayser K. , Höpker W.-W.
Published: March 2018

The different steps for medical text analysis from the examination of the object to the codification of diagnoses are outlined and formally described. Three types of methods are differentiated according to the point in the procedure at which the computer is used: the manual, the semi-automatic and the fully automatic methods. It is shown that the objective gain in information and the possible control are at maximum in the semi-automatic method when the examining doctor undertakes not only the writing of the summary of findings but also the extraction of the relevant diagnoses. The semi-automatic method is, in this case, as valuable as the fully automatic method with respect to completeness of information when using a thoroughly up-to-date thesaurus.
Arzneimittelschäden, ihre Erfassung und Dokumentation Gedanken und Lösungsvorschläge vom Standpunkt der ärztlichen Selbstverwaltung
Authors: Homann G.
Published: March 2018

Es wird über die gut zweijährigen Erfahrungen der Arzneimittelkommission der Deutschen Ärzteschaft mit der Sammlung und Auswertung von in Praxis und Klinik zur Beobachtung kommenden Arzneimittel schaden berichtet. Ziel dieser Sammlung ist, das Risiko der Arzneitherapie weitmöglichst herabzusetzen, d. h. das zusammengetragene Material über die aufgezeigten verschiedenen Wege für die ärztliche Praxis wieder nutzbar zu machen. — Für die mit einfachsten Mitteln durchgeführte Erfassung von Rohmaterial kommt weder die Anwendung eines besonderen Dokumentationsverfahrens noch eine statistische Auswertung in Frage. Hierfür sind nur die gezielten breiten Umfragen geeignet, die aber nur zur Klärung dringlicher Fragen ergänzend herangezogen werden sollten.
Die Lochkarte in der Kjrankenhausverwaltung
Authors: Fehler Joachim
Published: March 2018

Die wirtschaftliche Lage zwingt die Krankenhäuser, sich in allen Bereichen, die es von der Aufgabenstellung her zulassen, technischer Hilfsmittel zu bedienen. Zur Sammlung und Aufbereitung der betrieblichen und medizinischen Daten bietet sich heute der Einsatz von Lochkarten und datenverarbeitenden Maschinen an.

Das hier geschilderte System zeigt, wie sich im Bereich der Erlösarten- und Erlösstellenrechnung der Krankenhäuser durch Übernahme der Grunddaten eines jeden Patienten auf Lochkarten die personalintensive und zeitaufwendige Arbeit der Zusammenstellung dieser Daten nach den verschiedensten Gesichtspunkten wesentlich erleichtern läßt. Das Ziel einer zukünftigen Entwicklung sollte die Einführung eines umfassenden Krankenhaus-Informationssystems auf elektronischer Basis sein, in dem auch die Belange der Krankenhausverwaltungen zu berücksichtigen wären.
Dokumentation der Krankheiten und Todesursachen in der Medizinalstatistik
Authors: Ebbing H. C.
Published: March 2018

In dieser Darstellung werden einige typische Dokumentationsprobleme am Beispiel der Todesursachen statistik aufgezeigt. Die Erhebung kann bezüglich der Dokumentation der Krankheiten, Verletzungen und Todesursachen weiter verbessert werden. Die Unterweisung von Ärzten und Medizinstudenten ist hinsichtlich der Dokumentation tödlicher Krankheiten noch mangelhaft. Es fehlt eine Standardnomenklatur für das deutsche Sprachgebiet. Das Leichenschauwesen sollte weiter verbessert werden. Es sind methodologische Studien zur Mortalitätsstatistik zu fordern. Schließlich ist eine enge Zusammenarbeit aller, die sich mit Klassifikationsfragen befassen, notwendig.
Die Versuchsplanung bei den bösartigen Tumoren
Authors: Oberhoffer G.
Published: March 2018

Es werden die methodischen Gesichtspunkte erörtert, die bei der klinisch-empirischen Beurteilung der Therapie maligner Tumoren von Bedeutung sind, um ein möglichst irrtumsfreies Urteil zu gewinnen. Im einzelnen werden besprochen: I. die Bildung vergleichbarer, homogener Patientenkollektive und das Problem der klinischen Stadieneinteilung, II. die Auswahl repräsentativer und empfindlicher Beurteilungskriterien, die Art sinnvoller Mittelwerte für tlberlebenszeit und Krankheitsdauer beim „kollektiven Vergleich”, III. die Auswahl der optimalen und informationsergiebigsten speziellen Vergleichsanordnung und IV. die Auswahl statistischer Kennzeichen (Parameter) zur numerischen statistischen Prüfung der beobachteten Unterschiede der verschieden behandelten Patientenkollektive. Hierbei wird auf das Problem einer notwendigen logarithmischen Transformation der Zeitwerte (Überlebenszeit und Krankheitsdauer und auch Anamnesenzeit) eingegangen.
Die Planung therapeutischer Untersuchungen bei den akuten Pneumonien
Authors: Heymer A.
Published: March 2018

Als Hauptprinzipien jeder empirisch-klinischen Prüfung der Arzneimittelwirkung werden die Beobachtung, der Vergleich und die Ausschaltung von Mitursachen und Zufälligkeiten angesehen. Die sich hieraus ergebenden Konsequenzen für die Planung und Durchführung klinisch-therapeutischer Vergleichsbeobachlungen bei den akuten Pneumonien werden besprochen. Als adäquate Vergleichsanordnung wird der kollektive Vergleich (MARTINI) angesehen. Bei der Bildung vergleichbarer, homogener Patientenkollektive müssen hei den akuten Pneumonien insbesondere die unterschiedliche Aetiologie (Bakterien, Viren), die spezielle pathologische Ausprägungsform der Pneumonie bei Beginn des therapeutischen Vergleichs, wie auch die Ergebnisse der bakteriologischen Resistenzbestimmung durch Bildung entsprechender Untergruppen (substrata) berücksichtigt werden. Die sich aus den Schwierigkeiten der klinischen und aetiologischen Diagnosestellung ergebenden Probleme der praktischen Durchführung therapeutisch-klinischer Vergleiche werden besprochen, insbesondere die Schwierigkeiten der Ausschaltung aller möglicherweise störenden Mitursachen (MARTINI). Als zweiter Hauptabschnitt werden die Beurteilungskriterien besprochen, die den Krankheitsverlauf und den eingetretenen therapeutischen Effekt kennzeichnen und messen können, Als wertvollste Kriterien, stehen bei den akuten Pneumonien zur Verfügung: Fieber, physikalischer Lungenbefund, Atemfrequenz und Pulsfrequenz, Röntgenbefunde und bakteriologische Befunde. Als Konsequenz aus diesen Überlegungen ergibt sich die praktische Forderung einer geplanten Zusammenarbeit mehrerer Krankenhäuser bei der therapeutischen Erforschung der akuten Pneumonien.
Die Versuchsplanung bei der therapeutischen Forschung im Bereich der Leukämien
Authors: Schumacher K. , Lange J.
Published: March 2018

Die therapeutische Versuchsplanung bei Leukämien bietet in Anbetracht der sehr variablen Spontanabläufe besondere Probleme. Einem individuellen Vergleich sind vorzugsweise die chronischen Formen zugänglich. Er bietet bei der Vielzahl objektiver Kriterien relativ geringe Schwierigkeiten, wenn genügend lange Therapie-Perioden geplant und durchgeführt wurden. Die Kriterien für die Herstellung homogener Kollektive als Basis des sehr viel schwierigeren Gruppenvergleichs werden besprochen. Mangels einer Stadieneinteilung kann die Anamnesendauer als Ersatz-Kriterium herangezogen werden. Inhomogenität in dieser Beziehung führt — wie ein praktisches Beispiel zeigt — zu falschen Resultaten. Wichtig ist auch die Beachtung therapeutischer und nicht-therapeutischer Mitursachen, die bereits in der Planung zu berücksichtigen sind. Die Befunddokumentation sollte in einem speziellen Formular erfolgen; ein eigener Entwurf wird zur Diskussion gestellt, Abschließend werden die Notwendigkeit der Zusammenarbeit mehrerer Kliniken auf therapeutischem Sektor und die spezielle Problematik eines solchen Vorhabens erörtert.
Abstracting and Indexing in the Medical Sciences
Authors: Welt Isaac
Published: March 2018

Abstracts and indexes constitute the most popular means of assuring adequate retrieval of the many thousands of papers published every year in the ever expanding field of medicine. Different types of abstracts and indexes are available for different purposes and to meet varying user requirements. The problem of “keeping up” with developments in one’s own field of endeavour can usually be solved by qualified abstractors. Most indexes serve the purpose of assuring the retrieval of pertinent documents. However, in order to retrieve specific pieces of information which are absolutely indispensible to the medical practitioner or scientist, a new approach is needed. This technique, which is termed the “combined index-abstract” method, has been employed successfully for the handling of a large body of specific items of information in a restricted area of experimental and clinical pharmacology.
Applications of Digital Computers in Human Genetics
Authors: Chung C. S.
Published: March 2018

The use of digital computers in genetic analysis of human family and population data is assuming increased importance in recent years. It is now possible to approach problems which would have proved too tedious to be feasible in the past.

The application of digital computers in this field may be roughly classified into two aspects: one in which the storage and retrieval of inforrmation constitutes the major operation, and another in which computation for the solution of complex mathematical and statistical problems plays the more important role. A review has been presented on the uses of computers in these areas.

Included in the first category are rcord linkage and the calculation of inbreeding coefficients for small isolate populations. However, applications in the second category have been more diverse than in the first. They encompass genetic linkage, segregation analysis, genetic selection and equilibrium, gene frequency analysis, and multivariate procedures. The advantages of these techniques are discussed, and some findings of genetic interest are presented. Undoubtedly, the future use of digital computers in human genetic analysis is not limited to these phases, and further applications are expected.
Risk Analysis in Cohort Studies with Heterogeneous Strata. A Global χ2-Test for Dose-Response Relationship, Generalizing the Mantel-Haenszel Procedure
Authors: Überla K. , Ahlborn W. , Tuz H.-J.
Published: March 2018

In cohort studies the Mantel-Haenszel estimator OR̂

MH
is computed from sample data and is used as a point estimator of relative risk. Test-based confidence intervals are estimated with the help of the asymptotic chi-squared distributed MH-statistic χ2

MHS
. The Mantel-exten-sion-chi-squared is used as a test statistic for a dose-response relationship. Both test statistics – the Mantel-Haenszel-chi as well as the Mantel-extension-chi – assume homogeneity of risk across strata, which is rarely present. Also an extended nonparametric statistic, proposed by Terpstra, which is based on the Mann-Whitney-statistics assumes homogeneity of risk across strata.

We have earlier defined four risk measures RR

k

j
(k = 1,2,...,4) in the population and considered their estimates and the corresponding asymptotic distributions. In order to overcome the homogeneity assumption we use the δ-method to get “test-based” confidence intervals. Because the four risk measures RR

k

j
are presented as functions of four weights gik
we give, consequently, the asymptotic variances of these risk estimators also as functions of the weights g

ik
in a closed form. Approximations to these variances are given.

For testing a dose-response relationship we propose a new class of χ2(1)-distributed global measures Ĝk and the corresponding global χ2-test. In contrast to the Mantel-extension-chi homogeneity of risk across strata must not be assumed. These global test statistics are of the Wald type for composite hypotheses. The Mantel-extension-chi is a special case of the global-chi statistic and it is further shown that the Mantel-extension-chi can be expressed as a special weighted Terpstra statistic. Formulas for computing estimators of the global measures are provided. Three elaborated examples with hypothetical data of varying structure show, that the Mantel-extension-chi is systematically biased, generally overestimates the dose-response relation and leads to wrong conclusions, when heterogeneity is present. This is consistent with our theoretical considerations. In case of heterogeneity, when one wants to test an association between exposure and effect, or a dose-response relationship, the new global-χ2-test should be used in cohort studies.
Objective evaluation of total hip replacement in 127 dogs utilizing force plate analysis
Authors: Olivier N. B. , Blaiset M. A. , Averill S. M. , Bolliger C. , DeCamp C. E. , Braden T. D.
Published: March 2018

Clinical evaluation of total hip replacement surgery has varied from a low of 30% to a high of 91.2% of return to good or excellent function. The goal of the project reported hereafter, was to obtain an objective evaluation, via the force plate analysis of a large number of dogs receiving total hip replacement as treatment for spontaneous coxarthrosis. Every surgical candidate was trotted across a force plate before replacement surgery and at an average of six months post-operative. The results were obtained from 127 dogs. For the entire group of dogs, the Zp (vertical peak force) improved 0.394 (10−2 N/kg) or 10.6%. The Zi (vertical impulse) improved an average of 13.6%. The improvements in Zp and Zi were statistically significant (p < 0.001).
A novel axial pattern skin flap based on the lateral thoracic artery in the dog
Authors: Charlesworthi T. C. , White R. A. S. , Anderson D. M.
Published: March 2018

The cutaneous distribution and anatomical landmarks of the lateral thoracic artery in the dog are reported. Perfusion studies in cadavers showed a variable distribution, but a skin flap capable of rotation through 90° could be created. The successful use of an axial pattern skin flap based on the lateral thoracic artery for reconstruction of a major skin deficit over the caudal elbow of a Greyhound is reported.
Examination of an equine wobble twelve years after surgical placement of a Bagby basket
Authors: Robertson J. T. , Bertone A. L. , Samii V. F. , Rosol T. J. , Dukti S. A.
Published: March 2018

Case report describing histological and radiographic examination of a stainless steel basket packed with autogenous bone graft at C5-C6 ten years prior to evaluation. The horse was ataxic prior to surgery and post-operatively competed at his intended performance level despite a non-osseous union in the cranial endplate of C6.
Pattern Signalling in Health Information Monitoring Systems
Authors: Levine A. , Mandel S. P. H. , Santamaria A.
Published: March 2018

Two examples of active health hazard monitoring systems are compared and contrasted, namely the World Health Organization’s Research Centre for International Monitoring of Adverse Reactions to Drugs which monitors side-effects of therapeutic drugs, and the »Programma de Investigaciön de Modelos de Prestaciön de Servicios de Salud« (PRIMOPS) which operates in Cali, Colombia, and monitors the activities, services and coverage of a community health system and its impact on the health of the community. These are just two examples of rapidly proliferating monitoring systems in which reports on adverse events are being submitted to a central clearing house by a network of reporting stations. It is shown how a Centre-Batch matrix constructed from the information contained in these reports can be analyzed to extract from it latent patterns. The detection of such patterns generates a warning signal, which in turn provides the incentive for further investigative action to be undertaken. These studies open up other areas of research, including the identification of the philosophical relationships between suspicion, evidence, statistical inference and action.
Towards Systematization
Authors: Reichertz P. L.
Published: March 2018

Data processing has become an important tool in theoretical and clinical medicine. The main categories of applications are: information analysis, (bio)signal processing and the field of information logistics (information systems).

The problems encountered lie in the discrepancy of the basic methods of a formal approach to an empirical science, the complexity of the target system and the system ecology, i.e. the involvement of the user and the system environment during system construction and utilization.

Possible solutions to these problems are the application of system techniques, inductive planning, development of medical methodology, development of methods and techniques for user involvement and assessment of motivation and education and educational planning.

The necessary general strategy in the development in medical informatics is seen in the continuing systematization of the theoretical and practical approach. It is estimated that this will eventually contribute to the systematization of medical science and practice.
Utility Estimation of a Set of States of Health
Authors: Card W. I. , Rusinkiewicz M. , Phillips C. I.
Published: March 2018

A decision maker was presented with three states of health, such that an imaginary patient was in the middle state «‘hile the two other states could be described as more preferred and less preferred. The decision maker was then asked to choose the minimal odds at which he would advise an operation which would result in success, the patient moving into the more preferred state, or failure, the patient moving into the less preferred state. Eight decision makers were tested in this way and each made 24 such wagers on a set of three states chosen from a total set of eight; each of these states differed unidimen-sionally only in the visual acuity of the remaining eye in the imaginary patient. If the utility of 1 is arbitrarily assigned to the state of perfect vision, and the utility of 0 to the state of non-perception of light, estimates of the utilities of the intervening states can then be made. The utility function for each decision maker was constructed and was found to be linear against the logarithm of the visual acuity. From this it follows that if all decision makers, e.g. ophthalmic surgeons, show such linearity, they will all choose the same odds before deciding whether to operate and these odds are independent of the utilities which the individual decision maker attaches to the different states of health.
Towards Systematization
Authors: Reichertz P. L.
Published: March 2018

Data processing has become an important tool in theoretical and clinical medicine. The main categories of applications are : information analysis, (bio)signal processing and the field of information logistics (information systems).

The problems encountered lie in the discrepancy of the basic methods of a formal approach to an empirical science, the complexity of the target system and the system ecology, i.e. the involvement of the user and the system environment during system construction and utilization.

Possible solutions to these problems are the application of system techniques, inductive planning, development of medical methodology, development of methods and techniques for user involvement and assessment of motivation and education and educational planning.

The necessary general strategy in the development in medical informatics is seen in the continuing systematization of the theoretical and practical approach. It is estimated that this will eventually contribute to the systematization of medical science and practice.
In Vitro Effects of Homeopathic Drugs on Cultured Escherichia coli
Authors: Kurmann Carmen , Imbach Esther , Amsler Felix , Pannek-Rademacher Susanne , Pannek Jürgen
Published: March 2018

Background Recurrent urinary tract infections (UTIs) are one of the most common morbidities in persons with neurogenic lower urinary tract dysfunction (NLUTD). Repetitive antibiotic treatment increases the risk of selecting multi-resistant bacteria. Homeopathic treatment has been reported to be effective in these patients. The mechanism of action, however, has not been clarified. Recently, a direct bactericidal effect of homeopathic remedies was shown. Such an effect is not in accordance with the general principles of homeopathy. To test this paradigm, we assessed the in vitro effects of homeopathic drugs on Escherichia coli derived from patients with NLUTD.

Methods E. coli bacteria were harvested from 28 consecutive urine cultures. Standard antibiotic resistance testing and simultaneous resistance testing to homeopathic drugs (Apis mellifica, Cantharis, Causticum hahnemanni, Staphysagria, Nux vomica, Berberis vulgaris, and Lycopodium clavatum) in high (C30) potency were performed.

Results No significant inhibitory effect of any of the tested homeopathic drugs on any E. coli population could be found, irrespective of their sensitivity to antibiotic treatment.

Conclusion Based on our results, effects of homeopathic treatment of UTI are not based on direct bactericidal or bacteriostatic effects. These findings are in concordance with the hypothesis that homeopathy is based on host effects: for example, activation of the immune system, rather than effects on pathogens.
Staged Surgical Palliation for HLHS in a Girl with Severe Factor X Deficiency
Authors: Elmahrouk Ahmed , Ismail Mohamed , Bugis Abdulbadee , Badawy Nashwa , Aboelghar Hesham , Hamouda Tamer , Jamjoom Ahmed
Published: March 2018

Background Factor X deficiency (also known as Stuart–Prower factor deficiency) is an autosomal recessive extremely rare hereditary hematologic disorder, affecting around 1:1,000,000 of the general population.

Case Presentation This case report describes a patient with hypoplastic left heart syndrome and severe factor X deficiency, who underwent staged surgical palliation. From stage 1 Norwood palliation, through superior cavopulmonary anastomosis and ending with total cavopulmonary connection with satisfactory hemostasis and no significant perioperative bleeding complication.

Conclusion The need to maintain hemostasis while aiming to prevent intracardiac thrombosis requires multidisciplinary team approach including hematologist, cardiac surgeon, pediatric cardiac intensivist, and anesthesiologist along with meticulous hemostasis during surgery and careful monitoring of coagulation profile in the postoperative period.
Medical Informatics Education at the University of Manchester
Authors: Hillier V.F. , Rector A.L. , Taylor C.J. , Kay S.
Published: March 2018

Manchester University offered the first full time, undergraduate Medical Informatics degree programme in the UK. The B.Sc. in Medical Informatics was conceived in 1992 and its first cohort of students, taking the three year version, graduated in 1996; those students taking the four year version of the undergraduate degree will graduate in July 1997. The paper describes our somewhat turbulent experience of the first four years, highlighting both the difficulties and successes of launching an inter-disciplinary degree. First, the story of the programme’s development is given by way of an introduction and to establish a suitable context for describing the programme in more detail. Then, after presenting the aim and objectives of the programme, we describe the overall structure of the course, and reflect upon certain key issues for establishing Medical Informatics as a distinct, academic discipline.
Multimedia Workstations: Electronic Assistants for HealthCare Professionals
Authors: Degoulet P. , Jean F-C. , Safran C.
Published: March 2018

The increasing costs of health care and the economic reality has produced an interesting paradox for the health professional to perform more clinical work with fewer support personnel. Moreover, an explosion of the knowledge-base that underlies sound clinical care not only makes effective time management critical, but also knowledge management compelling. A multimedia workstation is an electronic assistant for the busy health professional that can help with administrative tasks and give access to clinical information and knowledge networks. The multimedia nature of processed information reflects an evolution of medical technologies that involve more and more complex objects such as video sequences or digitized signals. Analysis of the 445 Medline-indexed publications for the January 1991 to December 1994 period, that included the word “workstation” either in their title or in their abstract, helps in refining objectives and challenges both for health professionals and decision makers. From an engineering perspective, development of a workstation requires the integration into the same environments of tools to localize, access, manipulate and communicate the required information. The long-term goal is to establish an easy access in a collaborative working environment that gives the end-user the feeling of a single virtual health enterprise, driven by an integrated computer system when the information system relies on a set of heterogeneous and geographically distributed components. Consequences in terms of migration from traditional client/server architectures to more client/network architectures are considered.
Medical Images in Integrated Health Care Workstations
Authors: Engelmann U. , Meinzer H-P.
Published: March 2018

The difference between an invention and a discovery is discussed, before turning to the sources of medical images. Next, the ongoing integration of image modalities in clinical routine is reviewed, as well as improvements in diagnosis and therapy planning with the help of better images in inter-connected distributed systems. Current shortcomings of image processing, and the attempts to overcome these shortcomings are presented. Examples of image processing are given, together with a vision on future systems and procedures.
Medical Informatics Training at Yale University School of Medicine
Authors: Shiffman R.N. , Silverstein S. , Frawley S.J. , Nadkarni P.M. , Miller P.L.
Published: March 2018

The Yale Center for Medical Informatics has offered Medical Informatics training since 1986. The paper describes the overall structure of the training program, focusing primarily on the postdoctoral fellowship, a major component of which involves an independent project which the fellow carries out under faculty supervision. The paper outlines a number of areas in which such projects have been performed, describes the previous backgrounds and post-training career directions of the trainees, and discusses certain observations based on our experience with the program.
Molekulares Verstehen des Hörens – Was ändert sich für den Patienten?
Authors: Moser Tobias
Published: March 2018

Das Innenohr und die Hörbahn mit ihren vergleichsweise geringen Zellzahlen haben sich einigen molekularen Ansätzen bislang beharrlich entzogen. Gleichzeitig vollbringt das Hören Spitzenleistungen, die sehr spezialisierte biologische Mechanismen nahelegen. Dies bedeutet einerseits, dass Analogieschlüsse zur molekularen Anatomie und Physiologie der Zellen des Hörsystems auf der Grundlage von Erkenntnissen aus molekular besser zugänglichen Systemen von beschränktem Nutzen sind. Andererseits legt eine solche Spezialisierung Gendefekte nahe, die von der Evolution toleriert wurden, weil sie nicht zur Fehlfunktion von essentiellen Körperprozessen führen. Technologische Fortschritte in der Humangenetik und der molekularen Analyse des Innenohrs im Tier bestätigen beide Annahmen und beleuchten den faszinierenden Mikrokosmos der Cochlea. Auf kleinstem Raum werden hier in konsequenter Arbeitsteilung herausragende Leistungen im Ionentransport, der Mechanotransduktion, der aktiven Zellmotilität und der synaptischen Verarbeitung erbracht. Einige der zugrundeliegenden molekularen Maschinen, z. B. das Motorprotein Prestin und das an synaptischer Fusion beteiligte Otoferlin, sind ausschließlich im Ohr aktiv. Dementsprechend führen ihre Defekte zu spezifischen nicht-syndromalen Schwerhörigkeiten, wie etwa bei der auditorischen Synaptopathie durch autosomal rezessive Mutationen im Otoferlin-Gen. Andere Mutationen, wie die den cochleären Kalium-Zyklus betreffenden, bedingen einen globalen Funktionsverlust der Cochlea. Viele genetische Defekte führen schließlich zur Degeneration des Innenohrs. Letztlich führt die molekulare Analyse sowohl beim Menschen, als auch im Tier-Innenohr aber auch zu neuen Erkenntnissen für häufige Formen der Schwerhörigkeit. So wurde der immunhistochemische Nachweis des Verlusts von Bandsynapsen der inneren Haarzellen zum Biomarker für „hidden hearing loss“ im Tiermodell. Die moderne Hochdurchsatz-Sequenzierung (sog. Next Generation Sequencing – NGS) bietet Zugang zu bislang nicht bekannten Taubheitsgenen, Mutationsspektren von bekannten Taubheitsgenen und zu einem genetischen Profil der individuellen Schwerhörigkeit, ihre Interpretation erfordert jedoch große humangenetische Expertise und umfangreiche tierexperimentelle Einsichten. Eine kausale Therapie etwa durch viralen Genersatz, der im Tier-Innenohr und bei einzelnen Formen der humanen Blindheit bereits erfolgreich ist, steht für die Schwerhörigkeit in der Klinik noch nicht zur Verfügung. Bereits jetzt ermöglichen molekulare Ansätze aber schon eine verbesserte Beratung von schwerhörigen Patienten.