bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Care Reorganization and Information System Building in Italy
Authors: De Rosis F. , Pizzutilo S.
Published: March 2018

Adapting the health care information systems to the evolving needs of prevention and decentralization generally implies a critical choice of the most suitable among existing technical solutions and, in some cases, also the demand for new methods of information organization and processing which respond better to such new needs.

This is especially true for Italy, for its present process of the construction of a National Health Service gives priority to primary prevention and decentralization to local authorities not merely of operational functions, but also of power in decision-making. Consequences of these choices are, first of all, the need to review this National Statistical System but also, at a local level, more weight on a specific form of a >system of experts<, the limiting of data banks to small geographic and administrative areas and serious criticism of computer-based population files.
A Modification of the Unilateral Type I External Skeletal Fixator Configuration for Primary or Secondary Support of Supracondylar Humeral and Femoral Fractures
Authors: Schwarz P. D. , Egger E. L. , Piermattei D. L. , Klause S. E.
Published: March 2018

A modification of the unilateral Type I external skeletal fixator was developed for use in repair of supracondylar femoral and humeral fractures. The application technique and the results of its use in five clinical cases are discussed. In comminuted supracondylar fractures with loss of cortical bone structure, the modified unilateral Type I external skeletal fixator appears to have advantages over other external skeletal fixator configurations and bone plating.

A modification of the unilateral Type I external skeletal fixator (ESF) was developed for use in repair of supracondylar femoral and humeral fractures. In comminuted supracondylar fractures with loss of cortical bone structure, the modified Type IESF appears to have advantages over other ESF configurations and bone plating.
Coordinating Medical Literature with Patient Care
Authors: Gustafson Joann , Nelson J. , Buller Ann
Published: March 2018

The contribution of a special library project to a computerized problem-oriented medical information system (PROMIS) is discussed. Medical information displays developed by the PROMIS medical staff are accessible to the health care provider via touch screen cathode terminals. Under PROMIS, members of the library project developed two information services, one concerned with the initial building of the medical displays and the other with the updating of this information. Information from 88 medical journals is disseminated to physicians involved in the building of the medical displays. Articles meeting predetermined selection criteria are abstracted and the abstracts are made available by direct selective dissemination or via a problem-oriented abstract file. The updating service involves comparing the information contained in the selected articles with the computerized medical displays on the given topic. Discrepancies are brought to the attention of PROMIS medical staff members who evaluate the information and make appropriate changes in the displays. Thus a feedback loop is maintained which assures the completeness, accuracy, and currency of the computerized medical information. The development of this library project and its interface with the computerized health care system thus attempts to deal with the problems in the generation, validation, dissemination, and application of medical literature.
Application of a Bayes Program for Classification of Coma
Authors: Mai N. , Henrich G. , von Cramon D.
Published: March 2018

In previous investigations two additive 5-step scales (Guttman-scales) for »susceptibility to stimulation« and »reactivity« were developed. Both scales have proved very reliable for the measurement of levels of coma. Compared to usual examinations they entail additional effort. The present paper examines the possible prediction of scale-values, using neurological signs which are easier to obtain than the scale scores. A Bayes procedure was developed and. tested. Results from classification demonstrate that reactivity is highly predictable. Sequential selection of neurological signs, dependent upon their information-content leads to additional simplification of the diagnostic procedure. In contrast, susceptibility to stimulation can only be inadequately predicted from neurological signs.
Data Screening Methods – Application to Differential Diagnosis in Pancreatic Pathology from Radiological Signs
Authors: Durbec J.-P. , Cornée Jaqueline , Berthezene P.
Published: March 2018

The practice of systematic examinations in hospitals and the increasing development of automatic data processing permits the storing of a great deal of information about a large number of patients belonging to different diagnosis groups.

To predict or to characterize these diagnosis groups some descriptors are particularly useful, others carry no information. Data screening based on the properties of mutual information and on the log cross products ratios in contingency tables is developed. The most useful descriptors are selected. For each one the characterized groups are specified.

This approach has been performed on a set of binary (presence—absence) radiological variables. Four diagnoses groups are concerned: cancer of pancreas, chronic calcifying pancreatitis, non-calcifying pancreatitis and probable pancreatitis. Only twenty of the three hundred and forty initial radiological variables are selected. The presence of each corresponding sign is associated with one or more diagnosis groups.
An On-line Computer System for a Rehabilitation Hospital
Authors: Vallbona C. , Spencer W. A. , Levy A. H. , Baker R. L. , Liss D. M. , Pope S. B.
Published: March 2018

An on-line computer system has been implemented for processing medical information at the Texas Institute for Rehabilitation and Research. The major objectives of the system are: 1. to improve the process of patient care by expediting the flow of information among members of the rehabilitation team, 2. to facilitate the utilization of medical data for research purposes, 3. to enhance efficient hospital management, and 4. to obtain accurate data for an effective study of the cost of hospitalization.

The system consists of the following interrelated programs: a) recording of physiological monitoring, b) on-line processing of data collected at the bedside, c) processing of laboratory data, d) on-line processing of results of physiological studies, e) processing of data pertaining to treatments administered to patients, f) on-line calculation of fluid and electrolyte requirements, and g) statistical analysis of the hospital census.

The on-line computer facility is based on a time-shared teleprocessing system located at Baylor University College of Medicine and time-shared with various departments of the College. Remote terminal units installed at the Texas Institute for Rehabilitation and Research are connected by cable with the computer at the College of Medicine.
Computer-Based Exercises in Anemia Diagnosis (PlanAlyzer)
Authors: Beck J. , O´Donnell J. , Hirai F. , Simmons J. , Healy J. , Lyon H.
Published: March 2018

PlanAlyzer is a microcomputer-based, event-driven system for instructional research in medical education. Aimed at the second year medical student, PlanAlyzer elicits and critiques a student´s approach to the diagnosis of a common medical disorder. In this paper we discuss the concept, development, implementation and formative evaluation of the PlanAlyzer system for the evaluation of anemia.
Effect of a Computer-Assisted General Medicine Diagnostic Consultation Service on Housestaff Diagnostic Strategy
Authors: Bankowitz R. , McNeil M. , Challinor S. , Miller R.
Published: March 2018

Quick Medical Reference (QMR) is a microcomputer-based decision sup´port system designed to provide diagnostic assistance in the field of internal medicine. In addition to providing plausible diagnostic hypotheses based upon patient specific findings, the program highlights history, physical and laboratory items which are potentially useful in discriminating among the diagnoses under consideration. We have evaluated the impact of a computer-assisted diagnostic consultation service on the diagnostic and management strategy of a housestaff in a university internal medicine training program. Differential diagnoses were obtained before and after the use of the program, and a questionnaire was used to asses the educational value of the service and the effect of the service on the diagnosis and planned management. Over an eight week period, 31 cases were identified which met inclusion criteria. The QMR consultation added a diagnosis to the original list in 14 out of 31 cases. The consultation reordered the diagnosis in an additional 7 cases, and in 8 cases a diagnosis was ruled out by the use ofthe program. After the use of the program the housestaff reported they would obtain an additional lab test in 10 cases, change the order of planned tests. in two cases and eliminate a lab test in one case. The use of the program V)las rated as helpful educationally in 81 % of the cases, and helpful with respect to management in also 81 % of the cases.
Health Informatics Education in the Third World
Authors: Rienhoff O.
Published: March 2018

The state of the art is summarized showing many efforts but only few results which can serve as demonstration examples for developing countries. Education in health informatics in developing countries is still mainly dealing with the type of health informatics known from the industrialized world. Educational tools or curricula geared to the matter of development are rarely to be found. Some WHO activities suggest that it is time for a collaboration network to derive tools and curricula within the next decade.
The Postgraduate Medical Informatics Programme at the University of Cape Town
Authors: Hanmer Lynn A.
Published: March 2018

The Medical Informatics education programme at the University of Cape Town was developed as part of the postgraduate education programme run by the Department of Biomedical Engineering. The aim of the programme is twofold:

a) To give students a broad background in Medical Informatics, to enable them to participate in the development, planning and management of information systems to support health care in South Africa, and

b) To enable them to do a research project in a specialised area, thus learning research techniques, and contributing to the development of Medical Informatics as a discipline.

Students benefit from participating in a postgraduate programme in a multidisciplinary department, which is firmly linked to the health care environment. A more specialised Medical Informatics programme is planned, but the multidisciplinary nature of work in this field will continue to be emphasised.
Digital Storage and Simulation of EEG-Data Using a Linear EEG-Model
Authors: Pfurtscheller G. , Schuy S.
Published: March 2018

A digitized EEG can be reduced to a few parameters (< 15) if an autoregressive model is introduced. These parameters can be stored very economically.

With the aid of autoregressive parameters a recursive digital filter is realized which generates the EEG if a random number sequence is given to the filter input. Furthermore, the autoregressive parameters can be used for estimating power density distribution and for building up a non-recursive digital filter based on the inverse autoregressive model which will filter the EEG and detect spikes and other instationarities in the EEG.
After decomposition of the recursive filter into a series of filters of second order it is possible to calculate parameters such as peak frequency, bandwidth and amplitude, which describe the second order filter and thus characterize the frequency components of the EEG.
Computer Support of Medical Decisions in Ambulatory Care
Authors: Vallbona C. , Schade C. P. , Moffet C. L. , Speck C. D. , Osher W. J. , Tristan M. P.
Published: March 2018

Decision makers in health care systems are giving greater emphasis to ambulatory care because of its recognized magnitude (in terms of volume of services rendered) and its potential cost-effectiveness. A challenge to computer scientists is to develop and evaluate computer support systems for ambulatory care professionals at each one of several critical decision points of the care process. These decision points may be at the level of interaction between patient and physician at the time of each encounter, or at the institutional level where the effect is on the setting in which ambulatory care is delivered.

Early experiences of computer applications in ambulatory medicine are helping to delineate areas where there is promise of widespread implementation. One of these areas is the computerization of summary ambulatory medical records such as the health-illness profile. This document serves the dual purpose of facilitating medical decisions at the time of each patient encounter, and administrative decisions made by the clinic directors to meet the health needs of the community.
The IMIA WGI Database on Health and Medical Informatics Programs and Courses: A Call for Participation
Authors: Haux R. , Frank J. , Knaup P.
Published: March 2018

Working Group 1 on health and medical informatics education of the International Medical Informatics Association (IMIA) has established a WWW site (http://ix.urz.uni-heidelberg.de/ ~ d16) to provide up-to-date information about its work. The core of the site is an underlying database providing information on health and medical informatics (HMI) programs and courses worldwide. To be able to have a database of high quality and value we encourage all teachers and institutions to submit information about courses and programs on HMI education offered and to set pointers to their own WWW sites. In addition, a mailing list was installed to facilitate communication between all persons interested in HMI education. For subscription a message has to be sent to “listserv@listserv.net”. The body of the message should read “SUBSCRIBE IMIA-WG1”. Messages to the IMIAWG1 list have to be sent to “imia-wg1@urzinfo.urz.uni-heidelberg.de”.
A Comparison of Body Surface Laplacian and Potential Maps During Paced Ventricular Activation
Authors: Ono K. , Hosaka H. , He B.
Published: March 2018

The objective of this study is to evaluate the spatial resolution of body surface Laplacian maps (BSLMs) in localizing ventricular electrical activity by means of computer simulation. A 3-D computer heart-torso model was used to simulate cardiac electrical activity and the body surface maps. A two-site pacing protocol was used to generate two simultaneously activated myocardial events on the anterior epicardial wall and the anterior endocardial wall. Following the pacing, the BSLMs and the body surface potential maps (BSPMs) were calculated and compared with the known activation pattern. As a result, the BSLMs showed superior resolution than the BSPMs for localized initial ventricular activity. In summary, the present study suggests that body surface Laplacian mapping may provide a useful methodology for the clinical diagnosis of cardiac electrical abnormalities.
Arrhythmia Curve Interpretation Using a Dynamic System Model of the Myocardial Pacemaker
Authors: Takayanagi K. , Takeuchi A. , Nara Y. , Miyahara H. , Ikeda N.
Published: March 2018

A problem of identifying the phase response curve of the myocardial pacemaker was investigated using a simple dynamic system model of cardiac arrhythmia. A hybrid optimization method of a genetic algorithm and a local optimization technique was employed to obtain a solution of the model fitting. The method was applied to two categories of arrhythmias, ventricular parasystole and high-degree AV block. The present study offered a new insight into the mechanism of cardiac arrhythmias.
Detection of “Noisy” Chaos in a Time Series
Authors: Kanters J. K. , Cohen R. J. , Holstein-Rathlou N.-H. , Chon K. H.
Published: March 2018

Time series from biological system often displays fluctuations in the measured variables. Much effort has been directed at determining whether this variability reflects deterministic chaos, or whether it is merely “noise”. The output from most biological systems is probably the result of both the internal dynamics of the systems, and the input to the system from the surroundings. This implies that the system should be viewed as a mixed system with both stochastic and deterministic components. We present a method that appears to be useful in deciding whether determinism is present in a time series, and if this determinism has chaotic attributes. The method relies on fitting a nonlinear autoregressive model to the time series followed by an estimation of the characteristic exponents of the model over the observed probability distribution of states for the system. The method is tested by computer simulations, and applied to heart rate variability data.
Fractal Analyses of HRV Signals: A Comparative Study
Authors: Fischer R. , Akay M.
Published: March 2018

In this paper, we have investigated the scaling behavior of the heart rate variability signals using the power spectral density (PSD), the discrete wavelet transform (DWT), and dispersive analysis (DA), and the maximum likelihood estimator (MLE) method. Results suggested the lowest variance for the MLE method, greatest variance for the PSD methods, the other methods somewhere in between.
Nonlinear Analysis of Visual Evoked Potentials Elicited by Color Stimulation
Authors: Momose K. , Komiya K. , Uchiyama A.
Published: March 2018

The relationship between chromatically modulated stimuli and visual evoked potentials (VEPs) was considered. VEPs of normal subjects elicited by chromatically modulated stimuli were measured under several color adaptations, and their binary kernels were estimated. Up to the second-order, binary kernels obtained from VEPs were so characteristic that the VEP-chromatic modulation system showed second-order nonlinearity. First-order binary kernels depended on the color of the stimulus and adaptation, whereas second-order kernels showed almost no difference. This result indicates that the waveforms of first-order binary kernels reflect perceived color (hue). This supports the suggestion that kernels of VEPs include color responses, and could be used as a probe with which to examine the color visual system.
Study of the Lyapunov Exponents in Heart Rate Variability Signals
Authors: Casaleggio A. , Cerutti S. , Signorini M. G.
Published: March 2018

Heart rate variability signals obtained from 24 h recordings are analyzed for normal and pathological subjects. This time series contains information about the autonomic nervous system action regulating the beat-to-beat heart rate. Nonlinear contributions to the long period variability have been assessed by the calculation of the entire spectrum of Lyapunov exponents, after the system trajectory reconstruction, starting from the original variability signal. The positivity of Lyapunov exponent values, obtained from an unknown process, can establish whether the structure generating it shows nonlinear chaotic characteristics. This is what happens for the cardiovascular signals. Moreover, the different values obtained for the Lyapunov exponents operate a classification among the considered pathophysiological cases.
Validity of Neuropsychological Testing in Young African Children Affected by HIV
Authors: Laughton Barbara , Ratswana Mmule , Familiar Itziar , Fairlie Lee , Vhembo Tichaona , Kamthunzi Portia , Kabugho Enid , Joyce Celeste , Zimmer Bonnie , Ariansen J. , Jean-Philippe Patrick , Boivin Michael , Chernoff Miriam
Published: March 2018

Introduction Western-constructed neuropsychological tests have been used in low- and middle-income countries to assess the impact of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and other chronic illnesses. We explore using such instruments cross-culturally in a sub-Saharan African setting.

Methods IMPAACT P1104S was a 2-year observational study performed at six clinical sites (South Africa—three sites, Malawi, Uganda, and Zimbabwe) to assess and compare neuropsychological outcomes in three cohorts of children between the ages of 5 and 11 years: HIV-infected (HIV), HIV-exposed but uninfected (HEU), and HIV unexposed and uninfected (HU). Descriptive statistics compared sociodemographic characteristics among children at sites. Instruments included the Kaufman Assessment Battery for Children, 2nd edition (KABC-II) cognitive ability, Test of Variables of Attention (TOVA) attention/impulsivity, Bruininks–Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2) motor proficiency tests, and Behavior Rating Inventory for Executive Function (BRIEF) executive function problems. Test characteristics were assessed using intraclass and Spearman's nonparametric correlations, linear regression, and principal factor analyses.

Results Of the 611 participants, 50% were males and mean age ranged from 6.6 to 8 years. In Malawi, Uganda, and Zimbabwe, substantial proportions of families lived in rural settings in contrast to the South African sites. Intraclass correlation coefficients between weeks 0 and 48 were highest for the KABC scores, ranging between 0.42 and 0.71. Correlations among similar test domains were low to moderate but significant, with positive correlation between KABC sequential and TOVA scores and negative correlation between BRIEF and KABC scores. TOVA response time scores correlated negatively with the BOT-2 total points score. Strong and significant associations between individual measures of growth, disability, and development with all test scores were observed. Performance-based measures were markedly lower for HIV compared with HEU and HU participants, even after controlling for age, sex, and site. Factor analyses confirmed the underlying theoretical structure of the KABC scaled item scores.

Conclusion The KABC, TOVA, BRIEF, and BOT-2 were valid and reliable tools for assessing the neuropsychological impact of HIV in four sub-Saharan African countries.
E-Health Strategies Worldwide
Authors: Lorenzi N. M.
Published: March 2018

Healthcare worldwide is in a state of constant change. The multitude of changes require creative solutions that range from restructuring healthcare to provide better services to the effective use of information technology (e-health). Both are daunting tasks in any individual organization let alone on a national or international level. To completely cover the many e-health initiatives worldwide would require a more comprehensive document than is possible within this article. Therefore, this article represents a sample of the e-health efforts that are occurring simaltenously throughout the world.
A review of Primary Care Informatics: past progress, present reality, future prospects
Authors: Teasdale S.
Published: March 2018

Primary care informatics is beginning to find its feet as a scientific discipline, as evidenced by the increasing number of scientific papers published on the topic over the last three years, particularly those trying to establish the features that distinguish primary care informatics from health informatics more broadly. This paper provides a review of over a hundred scientific papers relating to primary care informatics, and speculates on future directions for primary care informatics.
History of Medical Informatics: Fifty Years in Medical Informatics
Authors: Collen Morris
Published: March 2018

An overview of personal experiences in medical informatics based on Dr. Morris Collen’s 50 years of research in the field.

A personal reminiscence and historical overview, focusing on the first two decades of medical informatics, when Dr. Collen began working with Dr. Sidney Garfield, the founder of Kaiser Permanente, leading to his involvement in computer-based medical care, through the development of the pioneering Automated Multiphasic Health Testing (AMHT) system, which they introduced into Kaiser clinics in Oakland and San Francisco.

Statistical models for medical decision-making based on consultations with Jerzy Neyman and George Dantzig were incorporated into the AMHT, and tested on a large database of cases. Meetings with other pioneers in medical informatics at the Karolinska Institute led to the formation of the early society Salutas Unitas, and the many national and international collaborations which followed during the first two decades helped coalesce the field as clinicians and researchers investigated problems of medical data, decision support, and laboratory, hospital, and library information systems.

Dr. Collen’s research and his many medical informatics activities significantly contributed to the growth of the field. The U.S. contributions are covered extensively in his book, A History of Medical Informatics in the United States, 1950-1990. Washington, DC: Am Med Informatics Association 1995.
Evaluation – The Cinderella Science of ICT in Health
Authors: Rigby M.
Published: March 2018

Information systems are expensive to create, and consume resources in their operation. They are justified in order to achieve clearly defined objectives in health service quality and efficiency. To ensure that these objectives are being met, and in order to build up an evidence-base to support well focused policies, systems, and practice, evaluation would seem to be fully justified and indeed essential. However, there are major factors jeopardising good evaluation practice, ranging from reluctance to commit resources or expose decisions to scrutiny, through to lack of appreciation of the full range of dimensions which should be studied. This paper seeks to create fuller appreciation of the issues and their importance.

Experiential and literature reviews form the basis of an exposition of principles, methods, and key current activities.

A summary has been produced of the key challenges to health ICT evaluation, and its adverse comparison with other sectors. An explanation of the viewpoints and levels of health information evaluation is followed by a short history of principal milestones, current scientific methodology activity, and key collaborative activities.

The need for a stronger commitment to health ICT evaluation is demonstrated if the application of health informatics systems is to receive due recognition as scientifically and empirically justified. Commitment of resources and scientific endeavour are needed, and thus the recent Declaration of Innsbruck, arising out of an event sponsored by the European Science Foundation, is timely and fully justified.
Special Section: Assessing Information Technologies for Health: Evaluation and Implementation: A Call for Action
Authors: Talmon J. L.
Published: March 2018

To raise awareness for actions that are urgently needed to accompany the large scale implementations of ICT in Health Care that are currently taking place in many countries around the world.

An analysis of a few studies that have recently been described in the literature guided by recent suggestions for research and development of evaluation of health ICT.

Six specific recommendations for action are specified:

Development of good implementation practice,

Development of an experience base of implementation of ICT in health care,

Setting up a surveillance system for unintended effects,

Build an evidence base of best evaluation practice,

Developing guidelines for proper reporting of evaluation studies,

Education of clinicians and decision makers.
IMIA and its Members: On Balancing Continuity and Transition in Biomedical and Health Informatics
Authors: Reichertz Peter L.
Published: March 2018

Objective To report on major past (2008) and future (2009 and beyond) activities of IMIA, the International Medical Informatics Association.

Method Summarizing discussions and planning activities within IMIA, in particular with respect to its Board and General Assembly meetings in 2008; looking at recent progress of biomedical and health informatics by commenting on IMIA Yearbook surveys and best paper selections.

Results Major recent IMIA efforts include preparatory work for Medinfo 2010, global partnership activities in collaboration with WHO, planning activities for shifting to a biennial Medinfo cycle and setting up an IMIA office, all in accordance with IMIA’s longterm strategic plan ‘Towards IMIA 2015’. The IMIA Yearbook of Medical Informatics, published annually since 1992, can be regarded as an important observatory for progress in health and biomedical informatics. Future activities include conference events in 2009 and IMIA’s world congress, Medinfo 2010, finalizing a revision of IMIA’s recommendations on education in biomedical and health informatics, and publication activities to stimulate the transfer of knowledge from theory to practice

Conclusions Since its inception in 1967, IMIA has evolved into a truly global organization, in a world where medical informatics has gained in significance and importance for supporting high-quality, efficient health care and for research in biomedicine and in the health sciences. Now in its 5th decade, IMIA’s responsibilities, as well as opportunities, as a global, independent organization have both increased. Finding the right balance between continuity and transition, in order to appropriately support, stimulate, and, to some extent enable high-quality translational communication, research, education, and practice in biomedical and health informatics is a key IMIA challenge.
Imaging Informatics: from Image Management to Image Navigation
Authors: Ratib O.
Published: March 2018

Objective To review the rapid evolution of imaging informatics dealing with issues of management and communication of digital images starting from the era of simple storage and transfer of images to today’s world of interactive navigation in large sets of multidimensional data.

Methods This paper will review the initial concepts of Picture Archiving and Communication Systems (PACS) and the early developments and standardization efforts that lead to the deployment of large intra-institutional networks of image distribution allowing radiologists and physicians to access and review images digitally. With the deployment of PACS came along the need for advanced tools for image visualization and image analysis.

Results Review of the history of PACS and Imaging Informatics clearly shows that the early developments were focused on the radiologist’s requirements for diagnosis and image interpretation. These early developments lagged behind the rapid adoption of digital imaging in areas outside radiology. Only recently, imaging informatics shifted toward the development of new tools geared toward the needs of other users such as surgeons, referring physicians and care-providers, and even for the patients themselves. Also in the recent years, the development of multimedia and communication tools in the consumer market has influenced the design and strategic development of image management platforms inside and outside healthcare institutions.

Conclusions The focus of imaging informatics has clearly shifted in the last decade from basic infrastructure design to complete data and image navigation systems. While the challenge of storing and managing large volumes of imaging data have slowly vanished with the rapid development if information technology, the new challenge emerged from the new requirements of image manipulation and analysis in clinical practice.
Health informatics 3.0
Authors: Kalra Dipak
Published: March 2018

Web 3.0 promises us smart computer services that will interact with each other and leverage knowledge about us and our immediate context to deliver prioritised and relevant information to support decisions and actions. Healthcare must take advantage of such new knowledge-integrating services, in particular to support better cooperation between professionals of different disciplines working in different locations, and to enable well-informed co-operation between clinicians and patients. To grasp the potential of Web 3.0 we will need well-harmonised semantic resources that can richly connect virtual teams and link their strategies to real-time and tailored evidence. Facts, decision logic, care pathway steps, alerts, education need to be embedded within components that can interact with multiple EHR systems and services consistently. Using Health Informatics 3.0 a patient’s current situation could be compared with the outcomes of very similar patients (from across millions) to deliver personalised care recommendations. The integration of EHRs with biomedical sciences (‘omics) research results and predictive models such as the Virtual Physiological Human could help speed up the translation of new knowledge into clinical practice. The mission, and challenge, for Health Informatics 3.0 is to enable healthy citizens, patients and professionals to collaborate within a knowledge-empowered social network in which patient specific information and personalised real-time evidence are seamlessly interwoven.
Biomedical and Health Informatics Education and Research at the Information Technology Institute in Egypt
Authors: Khalifa A. , Hussein R.
Published: March 2018

During the last decade, Egypt has experienced a revolution in the field of Information and Communication Technology (ICT) that has had a corresponding impact on the field of healthcare.

Since 1993, the Information Technology Institute (ITI) has been leading the development of the Information Technology (IT) professional training and education in Egypt to produce top quality IT professionals who are considered now the backbone of the IT revolution in Egypt. For the past five years, ITI has been adopting the objective of building high caliber health professionals who can effectively serve the ever-growing information society.

Academic links have been established with internationally renowned universities, e.g., Oregon Health and Science University (OHSU) in US, University of Leipzig in Germany, in addition those with the Egyptian Fellowship Board in order to enrich ITI Medical Informatics Education and Research.

The ITI Biomedical and Health Informatics (BMHI) education and training programs target fresh graduates as well as lifelong learners. Therefore, the program’s learning objectives are framed within the context of the four specialization tracks: Healthcare Man- agement (HCM), Biomedical Informatics Research (BMIR), Bioinformatics Professional (BIP), and Healthcare Professional (HCP). The ITI BMHI research projects tackle a wide-range of current chal- lenges in this field, such as knowledge management in healthcare, providing tele-consultation services for diagnosis and treatment of infectious diseases for underserved regions in Egypt, and exploring the cultural and educational aspects of Nanoinformatics.

Since 2006, ITI has been positively contributing to de- velop the discipline of BMHI in Egypt in order to support improved healthcare services .
People and Ideas in Medical Informatics - A Half Century Review
Authors: van Bemmel J. H.
Published: March 2018

Reviewing the onset and the rapid changes to make realistic predictions on the future of medical informatics.

Pointing to the contributions of the early pioneers, who had their roots in other disciplines and by illustrating that from the onset an interdisciplinary approach was characteristic for our field.

Some of the reasons for the changes in medical informatics are that nobody was able to predict the advent of the personal computer in the 1970s, the world-wide web in 1991, and the public start of the Internet in 1992, but foremost that nobody expected that it was not primarily the hardware or the software, but human factors that would be crucial for successful applications of computers in health care. In the past sometimes unrealistic expectations were held, such as on the impact of medical decision-support systems, or on the overly optimistic contributions of electronic health records. Although the technology is widely available, some applications appear to be far more complex than expected. Health care processes can seldom be fully standardized. Humans enter at least in two very different roles in the loop of information processing: as subjects conducting care - the clinicians - and as subjects that are the objects of care - the patients.

Medical informatics lacks a specific methodology; methods are borrowed from adjacent disciplines such as physics, mathematics and, of course, computer science. Human factors play a major role in applying computers in health care. Everyone pursuing a career in biomedical informatics needs to be very aware of this. It is to be expected that the quality of health care will increasingly be assessed by computer systems to fulfill the requirements of medical evidence.
Leitlinie zur Diagnostik und Therapie des Krampfaderleidens
Authors: Kluess H. G. , Noppeney T. , Gerlach H. , Braunbeck W. , Ehresmann U. , Fischer R. , Hermanns H.-J. , Langer C. , Nüllen H. , Salzmann G. , Schimmelpfennig L.
Published: March 2018

Leitlinien sind systematisch erarbeitete Empfehlungen, um den Arzt in Klinik und Praxis bei Entscheidungen über eine angemessene Versorgung des Patienten im Rahmen spezi-fischer klinischer Umstände zu unterstützen. Leitlinien gelten für Standardsituationen und berücksichtigen die aktuellen, zu den entsprechenden Fragestellungen zur Verfügung stehenden wissenschaftlichen Erkenntnisse. Leitlinien bedürfen der ständigen Überprüfung und eventuell der Änderung auf dem Boden des wissenschaftlichen Erkenntnisstandes und der Praktikabilität in der tägli-chen Praxis. Durch die Leitlinien soll die Methodenfreiheit des Arztes nicht eingeschränkt werden. Ihre Beachtung garantiert nicht in jedem Fall den diagnostischen und therapeutischen Erfolg. Leitlinien erheben keinen Anspruch auf Vollständigkeit. Die Entscheidung über die Angemessenheit der zu ergreifenden Maßnahmen trifft der Arzt unter Berücksichtigung der individuellen Problematik.
Leitlinien zur peripheren Gefäßdiagnostik mit der direktionalen continuous-wave (CW) Doppler-Sonographie
Authors: Gerlach H. , Hertel T. , Kahle B. , Kluess H. G. , Marshall M. , Rabe E.
Published: March 2018

Leitlinien sind systematisch erarbeitete Empfehlungen, um Kliniker und Praktiker bei Entscheidungen zur Versorgung ihrer Patienten im Rahmen spezifischer Umstände zu unterstützen. Leitlinien gelten für »Standardsituationen« und berücksichtigen die aktuellen, zu den entsprechenden Fragestellungen zur Verfügung stehenden wissenschaftlichen Erkenntnisse. Leitlinien bedürfen der ständigen Überprüfung und eventuell der Ände-rung auf dem Boden des wissenschaftlichen Erkenntnisstandes und der Praktikabilität in der täglichen Anwendung. Leitlinien entbinden den Arzt nicht von seiner Sorgfaltspflicht und der Beachtung der individuell angepassten diagnostischen und therapeutischen Maßnahmen. Leitlinien erheben keinen Anspruch auf Vollständigkeit.
Folgetherapien werden verzögert
Authors: Arnheim Katharina
Published: March 2018

Beim Non-Hodgkin-Lymphom (NHL) hat sich die Erstlinientherapie mit Bendamustin/ Rituximab (BR) als langfristig effektiv und sicher erwiesen: Im Vergleich zum Regime CHOP-Rituximab (CHOP-R) wird das Intervall bis zur nächsten Therapie erheblich verlängert; die 10-Jahres-Überlebensrate liegt bei 70 %, berichtete Prof. Dr. Mathias Rummel, Gießen, auf dem diesjährigen ASCO.
Höhere Überlebensraten als mit der Chemotherapie
Authors: Arnheim Katharina
Published: March 2018

Die Immuncheckpoint-Blockade hat sich jetzt auch beim fortgeschrittenen kleinzelligen Lungenkarzinom (SCLC) als effektiv erwiesen: Etwa jeder fünfte Patient spricht auf die Kombination von Nivolumab mit Ipilimumab an, jeder vierte ist nach zwei Jahren noch am Leben.
Bimodale Strategie verlängert das Überleben
Authors: Krome Susanne
Published: March 2018

Die Leitlinien empfehlen für Patienten mit metastasierten Karzinomen des Magens und gastroösophagealen Übergangs die palliative Chemotherapie. In der Phase-IIStudie AIO-FLOT3 erhielten Patienten ohne Metastasen, mit begrenzter und extensiver Metastasierung neoadjuvant die FLOT-Chemotherapie mit dem Ziel der anschließenden Tumorresektion. Die Gruppe mit einer begrenzten Metastasierung profitierte mit längeren Überlebenszeiten von dem Konzept.
Infektionen bei Tumorpatienten: Wie vermeiden, wie behandeln?
Authors: Arnheim Katharina
Published: March 2018

Trotz aller Verbesserungen in der Supportivtherapie tragen Infektionen wesentlich zur Morbidität und Mortalität von Tumorpatienten bei. Auf der DGHO-Jahrestagung diskutierte man auch über den aktuellen Erkenntnis- und Empfehlungsstand für die klinische Praxis zur Verhinderung febriler Neutropenien. Hier hat sich die prophylaktische Gabe von G-CSF-Präparaten, nicht jedoch die antibakterielle Prophylaxe bewährt. Bei Hochrisikopatienten mit neutropenischem Fieber gilt Piperacillin/Tazobactam als Mittel der Wahl.
Beschreibung eines Malnutrition-Management-Programms für
onkologische Patienten
Authors: Kritzinger Silvia , Auer Johann
Published: March 2018

Mangelernährung kann im Kontext einer Tumorerkrankung auftreten und ist unter
onkologischen Patienten weit verbreitet. Der Wechsel vom stationären zum
ambulanten Versorgungssektor muss vielfältigen Ansprüchen gerecht werden und
kann mit Informationsverlusten verbunden sein. Um dieser
Schnittstellenproblematik mit einem effektiven Konzept zu begegnen, sollten
Faktoren für ein nachhaltiges Ernährungsprogramm für mangelernährte onkologische
Patienten eines akademischen Lehrkrankenhauses bestimmt werden.
Homöopathische Therapie einer ungewöhnlich verlaufenden Purpura Schönlein-Henoch
Authors: Lucae Christian
Published: March 2018

Anhand einer Kasuistik wird die homöopathische Behandlung einer Purpura Schönlein-Henoch bei einem 12 Jahre alten Jungen demonstriert. Die Diagnosestellung wurde aufgrund des späten Auftretens der typischen Effloreszenzen deutlich verzögert. Komplikationen in Form abdomineller Koliken und einer Nierenbeteiligung mit Proteinurie konnten dann aber positiv durch die homöopathische Therapie beeinflusst werden.
Retention nach kieferorthopädischer Behandlung – eine Literaturübersicht
Authors: Lanzer Birgit
Published: March 2018

Eine Form von Retention nach abgeschlossener kieferorthopädischer Behandlung ist empfehlenswert, um ein mögliches Rezidiv zu verhindern. Ein Rezidiv kann bspw. als Folge von gedehnten parodontalen Fasern auftreten, die dazu neigen die Zähne in ihre ursprüngliche Position zurück zu bewegen, oder auch aufgrund ungünstiger okklusaler Kontakte nach Abschluss der Behandlung. Unerwünschte Zahnbewegungen ergeben sich aber auch durch den physiologischen Alterungsprozess, wobei es sich hierbei nicht um ein Rezidiv handelt, sondern um Veränderungen, die auch bei Patienten, die nie kieferorthopädisch behandelt wurden auftreten.
Purpura Schönlein-Henoch – Belladonna
Authors: Holzapfel Klaus
Published: March 2018

Behandlung eines Kleinkindes mit Purpura Schönlein-Henoch und Asthma bronchiale mit Belladonna und Rhus toxicodendron unter Benutzung der General Analysis von C. M. Boger und unter Hinzuziehung der Familienanamnese.
Onsager’s variational principle for the dynamics of a vesicle in a Poiseuille flow
Authors: Oya Yutaka , Kawakatsu Toshihiro
Published: March 2018

We propose a systematic formulation of the migration behaviors of a vesicle in a Poiseuille flow based on Onsager’s variational principle, which can be used to determine the most stable steady state. Our model is described by a combination of the phase field theory for the vesicle and the hydrodynamics for the flow field. The dynamics is governed by the bending elastic energy and the dissipation functional, the latter being composed of viscous dissipation of the flow field, dissipation of the bending energy of the vesicle, and the friction between the vesicle and the flow field. We performed a series of simulations on 2-dimensional systems by changing the bending elasticity of the membrane and observed 3 types of steady states, i.e., those with slipper shape, bullet shape, and snaking motion, and a quasi-steady state with zig-zag motion. We show that the transitions among these steady states can be quantitatively explained by evaluating the dissipation functional, which is determined by the competition between the friction on the vesicle surface and the viscous dissipation in the bulk flow.
Rortex—A new vortex vector definition and vorticity tensor and vector decompositions
Authors: Liu Chaoqun , Gao Yisheng , Tian Shuling , Dong Xiangrui
Published: March 2018

A vortex is intuitively recognized as the rotational/swirling motion of the fluids. However, an unambiguous and universally accepted definition for vortex is yet to be achieved in the field of fluid mechanics, which is probably one of the major obstacles causing considerable confusions and misunderstandings in turbulence research. In our previous work, a new vector quantity that is called vortex vector was proposed to accurately describe the local fluid rotation and clearly display vortical structures. In this paper, the definition of the vortex vector, named Rortex here, is revisited from the mathematical perspective. The existence of the possible rotational axis is proved through real Schur decomposition. Based on real Schur decomposition, a fast algorithm for calculating Rortex is also presented. In addition, new vorticity tensor and vector decompositions are introduced: the vorticity tensor is decomposed to a rigidly rotational part and a non-rotationally anti-symmetric part, and the vorticity vector is decomposed to a rigidly rotational vector which is called the Rortex vector and a non-rotational vector which is called the shear vector. Several cases, including the 2D Couette flow, 2D rigid rotational flow, and 3D boundary layer transition on a flat plate, are studied to demonstrate the justification of the definition of Rortex. It can be observed that Rortex identifies both the precise swirling strength and the rotational axis, and thus it can reasonably represent the local fluid rotation and provide a new powerful tool for vortex dynamics and turbulence research.
Eradication of endemicBrachyspira pilosicoliinfection from a farrowing herd: a case report
Authors: Fossi M. , Heinonen M. , Pohjanvirta T. , Pelkonen S. , Peltoniemi O.A.T.
Published: March 2018

Brachyspira pilosicoliandB. innocenswere isolated repeatedly from a herd of 60 sows which mostly produced feeder pigs but also raised some fattening pigs. Postweaning diarrhea had been a severe problem in this herd for years. TheB. pilosicolieradication plan was based on the general guidelines for elimination ofB. hyodysenteriae, with some modifica-tions. The eradication measures were run in August 1997. In-feed medication with 200p.p.m. tiamulin lasted for 18–30 days, depending on the age group. The piggery unit was emptied, cleaned, disinfected and dried, and all worn surfaces were repaired. The animals were removed to temporary sheds situated 0–100m from the piggery unit. Only the sows and the boar returned to the piggery unit. All other pigs were sold from the sheds within 3 months after the eradication. Immediately after the eradication, the clinical postweaning diarrhea disappeared. The success of the program was monitored four times bacteriologically, and the last control sampling was in December 1999, 7 months after the total withdrawal of antimicrobial feed additives. The primary cultures from the last three samplings were also analysed withB. pilosicoli-specific PCR. All the samples were negative forB. pilosicoli. However,B. innocenscould be isolated from each batch of samples. The analysis ofB. inno-censisolates by pulsed-field gel electrophoresis indicated that at least one genotype persisted in the herd. The clinical and laboratory findings suggest that the eradication ofB. pilosicolihad succeeded in this herd