bluuebunny/crossref_metadata_2025 huggingface dataset:
Electronically Signed Documents in Health Care
Authors: Brandner R. , Bess A. , Schmücker P. , Bergh B. , Hollerbach A.
Published: March 2018

Objectives:
Our objectives were to analyze and assess data formats for their suitability for conclusive and secure long-term archiving and to develop a concept for legally secure transformation of electronically signed documents that are not available in data formats appropriate for long-term archiving.

Methods:
On the basis of literature review and Internet searches we developed general evaluation criteria to assess data formats with regard to their suitability for conclusive and secure long-term archiving. The assessment of data formats refers to format specifications and available literature. For the analyses of the transformation of signed documents we analyzed legal requirements on the basis of laws and ordinances as well as technical requirements by means of literature reviews, Internet searches and technical specifications.

Results:
The following evaluation criteria are suited for this kind of assessment of data formats: transparency and standardization, stability, presentation and secuity According to our assessment the following data formats are most suitable for conclusive and secure long-term archiving: PDF for formatted and unstructured text documents, XML for markup languages, TIFF for images in general, DICOM for medical images and S/MIME for the storage of e-mail. To transform electronically signed documents we propose an elementary procedure and universal basic model in form of an XML schema definition that includes the necessary legal and technical information.

Conclusions:
If electronic documents are to replace paper-based documents in patient records, they have to conform to the criteria for secure long-term archiving. The analyzed data formats are to be extended by mechanisms to guarantee the long-term security of electronic signatures. To transform large quantities of documents in a legally secure way, our basic model has to be extended for automated procedures.
MorphoSaurus
Authors: Schulz S. , Hahn U. , Markó K.
Published: March 2018

Objectives:
We propose an interlingua-based indexing approach to account for the particular challenges that arise in the design and implementation of cross-language document retrieval systems for the medical domain.

Methods:
Documents, as well as queries, are mapped to a language-independent conceptual layer on which retrieval operations are performed. We contrast this approach with the direct translation of German queries to English ones which, subsequently, are matched against English documents.

Results:
We evaluate both approaches, interlingua-based and direct translation, on a large medical document collection, the OHSUMED corpus. A substantial benefit for interlingua-based document retrieval using German queries on English texts is found, which amounts to 93% of the (monolingual) English baseline.

Conclusions:
Most state-of-the-art cross-language information retrieval systems translate user queries to the language(s) of the target documents. In contradistinction to this approach, translating both documents and user queries into a language-independent, concept-like representation format is more beneficial to enhance cross-language retrieval performance.
An Alternative Proposal for “Mixed Randomization” by Schulz and Grimes
Authors: Kundt G.
Published: March 2018

Objective:
Randomization is an important part of clinical trials. Using permuted-block randomization for forcing equal group sizes potentially harms the unpredictability of treatment assignments. This can allow bias to creep into a trial. As an alternative, Schulz and Grimes suggest a “Mixed randomization” scheme which introduces more complexity to realize randomization. The objective of our research was to work out a model for randomization which is easier to handle than “Mixed randomization”, with an equal level of performance in unpredictability and balance.

Methods:
We analyzed a “Mixed randomization” procedure regarding the degree of unpredictability and balancing power and compared performance using permuted-block randomization with very large block size in a worst case scenario. Our work was done by the application of Blackwell-Hodges model for evaluation of the unpredictability of treatment assignments.

Results:
Regarding unpredictability, performance of permuted-block randomization with block size b = 36 was very similar to that of “Mixed randomization”. Regarding balancing power it was more favourable than “Mixed randomization”.

Conclusion:
Results of Schulz and Grimes are very important as they emphasized that mildly unequal sample sizes of therapy groups don’t cause problems. But the suggested scheme of “Mixed randomization” to a large extent adds complexity and we do not believe that this proposal is very feasible. Basically, we rather recommend the use of only one restricted randomization procedure in the best way. This can be permuted-block randomization with optimum choice of a large block size.
A Decision-support System for Real-time Risk Assessment of Airborne Spread of the Foot-and-Mouth Disease Virus
Authors: Fuchs K. , Rubel F.
Published: March 2018

Objectives:
The application of epidemic models during the first days following the confirmation of a virus outbreak should significantly contribute to minimize its costs. Here we describe the first version of a decision-support system for the calculation of the airborne spread of a virus and its application to foot-and-mouth disease (FMD). The goal is to provide geographical maps depicting infection risk for various animal species to support the national health authorities.

Methods:
The major tool of the decision-support system is a specific epidemic (or atmospheric) model: A so-called Gaussian dispersion model to calculate 3-dimensional virus plumes. Additional tools providing input data and visualizing the output are: A veterinary data base of geo-referenced premises, a geographical information system (GIS), and, as an external part running at the National Weather Service, a numerical weather prediction (NWP) model. To demonstrate the features of the decision-support system a pilot study in Styria, Austria, has been performed simulating an artificial FMD outbreak.

Results:
One result of this simulation experiment is the determination of neighboring premises at which animals are at risk to be infected. Particular attention has been turned to cattle, sheep and swine. Using actual hourly NWP data from April 25, 2003, and a source of ten swine excreting a virus, cattle have been estimated to be at risk downwind 1,000-12,000 m, sheep 200-1,300 m, and swines 70-330 m.

Conclusions:
A system for real-time risk assessment of the airborne spread of a virus, applied to FMD, was introduced. Due to the forcing of the Gaussian dispersion model with NWP data, it is designed to run in both analysis and forecast mode. The system was applied for the first time during the Austrian real-time exercise on FMD, instructed by the European Union, in November 2004.
Scoring and Staging Systems Using Cox Linear Regression Modeling and Recursive Partitioning
Authors: Lee J. W. , Um S. H. , Lee J. B. , Mun J. , Cho H.
Published: March 2018

Objectives:
Scoring and staging systems are used to determine the order and class of data according to predictors. Systems used for medical data, such as the Child-Turcotte-Pugh scoring and staging systems for ordering and classifying patients with liver disease, are often derived strictly from physicians’ experience and intuition. We construct objective and data-based scoring/staging systems using statistical methods.

Methods:
We consider Cox linear regression modeling and recursive partitioning techniques for censored survival data. In particular, to obtain a target number of stages we propose cross-validation and amalgamation algorithms. We also propose an algorithm for constructing scoring and staging systems by integrating local Cox linear regression models into recursive partitioning, so that we can retain the merits of both methods such as superior predictive accuracy, ease of use, and detection of interactions between predictors. The staging system construction algorithms are compared by cross-validation evaluation of real data.

Results:
The data-based cross-validation comparison shows that Cox linear regression modeling is somewhat better than recursive partitioning when there are only continuous predictors, while recursive partitioning is better when there are significant categorical predictors. The proposed local Cox linear recursive partitioning has better predictive accuracy than Cox linear modeling and simple recursive partitioning.

Conclusions:
This study indicates that integrating local linear modeling into recursive partitioning can significantly improve prediction accuracy in constructing scoring and staging systems.
The M2DM Project
Authors: Bellazzi R. , Stefanelli M. , Ferrari P. , De Cata P. , Gazzaruso C. , Fratino P. , D’Annunzio G. , Hernando E. , Gomez E.J. , Larizza C.
Published: March 2018

Objectives:
This paper presents a multi-access service for the management of diabetes mellitus patients and the results of its assessment in two Italian clinical sites.

Methods:
The service was evaluated for one year in order to prove the advantages of these kind of systems from different points of view. In this paper the clinical, usability and technical outcomes are presented.

Results:
The evaluation results show that, thanks to the high flexibility of the implemented service, the tele-medicine management of diabetes patients is feasible, well accepted by patients and clinically effective. However, in Italy the problem of quantifying the reimbursement rate of telematic services and the impact they have on the organization are factors that may hamper their introduction in routine clinical practice.

Conclusions:
The evaluation study showed that the telemedicine intervention has been satisfactory both for physicians because it allows to constantly monitor the patients’ blood glucose level and for patients because it strengthens their motivation to self-monitor the metabolic situation.
Success and Failure Factors in the Regional Health Information System Design Process
Authors: Karimaa E. , Nykänen P.
Published: March 2018

Objectives:
To identify success and failure factors in the design process of a regional health information system.

Methods:
A constructive evaluation study including interviews, observations, usability study and document analysis.

Results:
Modelling was found to be a key element for the successful implementation of a health information system. The developed service chain model helped to define use cases and to implement seamless service chains. User participation in the design process was a success factor resulting in good user acceptance and signs of positive impacts on work practices. Evaluation study also helped system developers to guide the system’s further development. An important failure factor identified was the lack of semantic interoperability of the system components.

Conclusions:
The results emphasize the socio-technical nature of health information systems. The starting point for development should be thorough insight into the health care work practices where the information systems are to be used. Successful system design should start from modelling of work processes, data and information flows and definition of concepts and their relations. Health informatics as a scientific discipline provides theories and models for the design and development process.
An Experience of Microbiological Data Sharing
Authors: Nappo A. , Giacomini M.
Published: March 2018

Objectives:
The control of infections and their resistance to antibiotics in hospitals is a matter of vital importance in the follow-up of transplant patients. This project has the purpose of translating microbiological reports from an obsolete file structure to a system which could guarantee a more correct and quick transmission of data, a system of storage which reduces the possibility of errors, a smoother manipulation, consultation and updating of data and, at least, a simple way to compute the cost of analysis, based on the costs determined by the national’s DRG.

Methods:
The proposed solution is a semiautomatic interface which translates these data into a relational database on a daily basis, interprets the requests coming from external centers and produces reports. The prospective to use this tool for several centers indicates to us the need to choose an HL7 output for the interface.

Results:
A prototype version of this program was installed in February 2004. In this period, routine work has been recorded with an average of 6.5 samples per day, with a maximum of 23 samples. Moreover, historical data from 1998 has been translated. The main source of errors in these data was due to patient identification problems with an average occurrence of 4.06% in the virology section and of 4.16% in the microbiological division.

Conclusions:
A complete reorganization of the system would be desirable but at the moment it is not realistic because of obvious budget problems. The proposed approach, mainly the HL7 interface, seems to be a reasonable compromise.
Reproducible Statistical Analysis in Microarray Profiling Studies
Authors: Ruschhaupt M. , Huber W. , Mansmann U.
Published: March 2018

Objectives:
Microarrays are a recent biotechnology that offers the hope of improved cancer classification. A number of publications presented clinically promising results by combining this new kind of biological data with specifically designed algorithmic approaches. But, reproducing published results in this domain is harder than it may seem.

Methods:
This paper presents examples, discusses the problems hidden in the published analyses and demonstrates a strategy to improve the situation which is based on the vignette technology available from the R and Bioconductor projects.

Results:
The tool of a compendium is discussed to achieve reproducible calculations and to offer an extensible computational framework. A compendium is a document that bundles primary data, processing methods (computational code), derived data, and statistical output with textual documentation and conclusions. It is interactive in the sense that it allows for the modification of the processing options, plugging in new data, or inserting further algorithms and visualizations.

Conclusions:
Due to the complexity of the algorithms, the size of the data sets, and the limitations of the medium printed paper it is usually not possible to report all the minutiae of the data processing and statistical computations. The technique of a compendium allows a complete critical assessment of a complex analysis.
Gaining Insight from Flexible Models
Authors: Pitha J. , Podrapska I. , Poledne R. , Valenta Z.
Published: March 2018

Objectives:
We present results from a secondary prevention trial of coronary heart disease (CHD) in the Czech male population from northern Bohemia with the history of myocardial infarction (MI) and high prevalence of metabolic syndrome. We compare several approaches to analyzing survival data from our study in terms of respective model assumptions.

Methods:
While both the Cox and Weibull survival regression models assume proportionality of the hazard functions over time, in many instances this assumption appears incompatible with the data at hand. Gray’s implementation of flexible models using penalized splines allows for a more realistic assessment of the covariate effects which may vary over time.

Results:
Gray’s model results revealed a steady decline in the age-adjusted intervention effect over time, which remained significant until about 2.7 years of follow-up. This was in contrast with the results obtained from the Cox and Weibull models which suggested an overall risk reduction due to intervention during the total follow-up of 6.7 years. Survival estimates based on the Cox and Gray models are shown for the two treatment groups and selected sample quantiles of the age distribution for illustration.

Conclusions:
Gray’s time-varying coefficients model facilitated a more realistic assessment of the intervention effect. Using suitable historical controls with MI history the effect of intervention was found to gradully diminish over time.
The New Features of the ExaMe Evaluation System and Reliability of Its Fixed Tests
Authors: Zvára K. , Zvárová J. , Zvára K. , Martinková P.
Published: March 2018

Objectives:
The ExaMe system for the evaluation of targeted knowledge has been in development since 1998. The new features of the ExaMe system are introduced in this paper. Especially, the new three-layer architecture is described.

Besides the system itself, the properties of fixed testsin the ExaMe system are studied. In special detail, the reliabilityof the fixed tests is discussed. The theory background is explained and some limitations of the reliability are pointed out.

Methods for Estimation of the Reliability:
Three characteristics used for estimation of reliability of educational tests are discussed: Cronbach’s alpha, standardized item alphaand split half coefficient. The relation between these characteristics and reliability and between characteristics themselves is investigated. In more detail, the properties of Cronbach’s alpha, the characteristics mostly used for the estimation of reliability, are discussed. A confidence interval is introduced for the characteristics.

Results and Conclusions:
Since 2000, the serviceability of the ExaMe evaluation system as the supporting evaluation tool has been repeatedly shown at the courses of Ph.D. studies in biomedical informatics at Charles University in Prague. The ExaMe system also opens new possibilities for self-evaluation and distance learning, especially when connected with electronic books on the Internet.

The estimation of reliability of tests contains some limitations. Keeping them in mind, we can still get some information about the quality of certain educational tests. Therefore, the estimation of reliability of the fixed tests is implemented in the ExaMe system.
Quality Assurance of Medical Ontologies
Authors: Rogers J. E.
Published: March 2018

Objective:
To review the literature concerning the quality assurance of medical ontologies.

Methods:
scholar.google.com was searched using the search strings (+ontology +”quality assurance”) and (+ontology +”evaluation/evaluating”). Relevant publications were selected by manual review. Other work already familiar to the author, or suggested by other researchers contacted by the author, were included. The papers were analysed for common themes.

Results:
Four broad properties of an ontology were identified that may be quality-assured: philosophical validity, compliance with meta-ontological commitments, ‘content correctness’, and fitness for purpose. Each published methodology addressed only a subset of these properties. ‘Content’ may be divided into domain knowledge content, and metadata describing either the provenance of domain knowledge content, or relationships between it and lexical information (e.g. for display and retrieval). ‘Correctness’ (whether of domain knowledge content or metadata) may also be further subdivided into truth, completeness, parsimony and internal consistency.

Conclusions:
Understanding of how to assure the quality of ontologies, or evaluate their fitness for specific purposes, is improving but remains poor. A combination of methodologies is required, but tools to support a comprehensive quality assurance programme remain lacking.

Perfect quality of an ontology is not provable and may not be desirable: an ontology compliant with all current philosophical theories, following necessary ontological commitments, and with entirely ‘correct’ content, may be too complex to be directly usable or useful.

The extent to which an ontology’s fitness for purpose is predicted or influenced by its other properties remains to be determined. Field studies of ontologies in use, including interrater effects, are required.
The Attributable Risk in a Multifactorial Situation
Authors: Gefeller O. , Rabe C.
Published: March 2018

Objectives:
Different approaches to partition the attributable risk into exposure-specific components are methodologically evaluated.

Methods:
Two methods of partitioning the attributable risk in a multifactorial situation have been suggested. One is based on a solution adopted from game theory, the Shapley value, whereas the other recently suggested approach uses a heuristically motivated proportional weighting scheme. These two concepts are reviewed and compared in a situation with three exposure factors. A hypothetical numerical example is discussed illustrating differences in the case of complex interaction structures.

Results:
The two methods are found to differ in two critical features that affect the outcome of partitioning: i) including or ignoring the full interaction structure between exposure factors involved in the partitioning, ii) using an equal or proportional weighting scheme for the marginal excess risks of the exposures. As a result, not only the individual partial attributable risks for the exposure factors may be quantitatively different between the methods, but also their ranking depends on the partitioning approach.

Conclusions:
The epidemiologic properties of the partitioning procedure based on the Shapley value are known and fit to the needs of epidemiologic applications. The alternative approach recently suggested can lead to considerably different results. As long as its epidemiologic properties are not fully understood, the traditional partitioning method should be given preference in practical applications.
Markov Models for Repeated Ordinal Data
Authors: Wellmann J.
Published: March 2018

Objectives:
To demonstrate the application of Markov models, especially for ordinal outcomes, within the context of regression models for correlated data.

Methods:
A brief review of regression methods for correlated data is given. A proportional odds model and a continuation ratio model is applied to repeated measurements of macular pigment density, obtained in an intervention study on the supplementation of macular carotenoids. The correlation between repeated assessments is assumed to follow a first-order Markov model. The models are implemented with standard statistical software.

Results:
Both models, though not directly comparable, provide a similar conclusion. The application of these models with standard statistical software is straightforward.

Conclusions:
Markov models can be valuable alternatives to random effects modes or procedures based on generalized estimation equations.
Evaluation of Medical Internet Sites
Authors: Obst O. , Adelhard K.
Published: March 2018

A huge amount of medical information is available on the Internet for both experts and laypersons. These resources are frequently used to answer current medical questions and are thus likely to influence the behavior of the users. Criteria for assessing the quality of medical Internet resources have been established by a number of authors and institutions to provide reliable medical information on the Internet for both patients and physicians. Clinical studies on the impact of information on the Internet are still lacking. The next step is to evaluate the outcome of such information services and to prove that they affect health-related parameters. Due to different constraints, classical strategies of controlled clinical trials can only be partly applied. New methods have to be developed and validated in practice.
Discussing Anomalous Situations using Decision Trees: A Head Injury Case Study
Authors: McQuatt A. , Andrews P. J. D. , Corruble V. , Jones P. A. , Sleeman D.
Published: March 2018

Objectives:
Predicting the outcome of seriously ill patients is a challenging problem for clinicians.

Methods:
One alternative to clinical trials is to analyse existing patient data in an attempt to predict the several outcomes, and to suggest therapies. In this paper we use decision tree techniques to predict the outcome of head injury patients. The work is based on patient data from the Edinburgh Royal Infirmary which contains both background (demographic) data and temporal (physiological) data.

Results:
The focus of this paper is the discussion of the anomalous cases in the decision trees with the domain experts (the clinicians).

Conclusions:
These analyses led to the detection of several situations where both the data analysis and patient data collection should be enhanced, which in turn should lead to improved patient care.
On the Design of Active Contours for Medical Image Segmentation
Authors: Bredno J. , Spitzer K. , Lehmann T.M.
Published: March 2018

Objectives: To provide a comprehensive bottom-up categorization of model-based segmentation techniques that allows to select, implement, and apply well-suited active contour models for segmentation of medical images, where major challenges are the high variability in shape and appearance of objects, noise, artifacts, partial occlusions of objects, and the required reliability and correctness of results.

Methods: We consider the general purpose of segmentation, the dimension of images, the object representation within the model, image and contour influences, as well as the solution and the parameter selection of the model. Potentials and limits are characterized for all instances in each category providing essential information for the application of active contours to various purposes in medical image processing. Based on prolaps surgery planning, we exemplify the use of the scheme to successfully design robust 3D-segmentation.

Results: The construction scheme allows to design robust segmentation methods, which, in particular, should avoid any gaps of dimension. Such gaps result from different image domains and value ranges with respect to the applied model domain and the dimension of relevant subsets for image influences, respectively.

Conclusions: A general segmentation procedure with sufficient robustness for medical applications is still missing. It is shown that in almost every category, novel techniques are available to improve the initial snake model, which was introduced in 1987.
A UK Operational Practitioner View – some Challenges of Health Informatics are Trans-national
Authors: Roberts J.
Published: March 2018

Objective: To explore the relevance of catalysts and inhibitors to the achievement of an inclusive identity for health informatics; particularly from an operational perspective in the UK.

Methods: Consideration of the different dimensions of health informatics, as practised in a working healthcare delivery environment; specifically commenting on the synergy and disjunctions with academic and scientific practitioners in the same domain.

Results and Conclusions: There appear to be common ground and internationally applicable issues across the domain. Recognising the differences and similarities will contribute towards harmonisation of the field and its ultimate elevation to a mature discipline and profession.
Informatics United
Authors: Wiemer J. , Schubert F. , Granzow M. , Ragg T. , Fieres J. , Mattes J. , Eils R.
Published: March 2018

Objectives: Medical informatics, neuroinformatics and bioinformatics provide a wide spectrum of research. Here, we show the great potential of synergies between these research areas on the basis of four exemplary studies where techniques are transferred from one of the disciplines to the other.

Methods: Reviewing and analyzing exemplary and specific projects at the intersection of medical informatics, neuroinformatics, and bioinformatics from our experience in an interdisciplinary research group. Results: Synergy emerges when techniques and solutions from medical informatics, bioinformatics, or neuroinformatics are successfully applied in one of the other disciplines. Synergy was found in 1. the modeling of neurophysiological systems for medical therapy development, 2. the use of image processing techniques from medical computer vision for the analysis of the dynamics of cell nuclei, and 3. the application of neuroinformatics tools for data mining in bioinformatics and as classifiers in clinical oncology. Conclusions: Each of the three different disciplines have delivered technologies that are readily applicable in the other disciplines. The mutual transfer of knowledge and techniques proved to increase efficiency and accuracy in a manifold of applications. In particular, we expect that clinical decision support systems based on techniques derived from neuro- and bioinformatics have the potential to improve medical diagnostics and will finally lead to a personalized delivery of healthcare.
DataGrid, Prototype of a Biomedical Grid
Authors: Medina R. , Montagnat J. , Breton V.
Published: March 2018

Background: The availability of large amounts of data in heterogeneous formats and the rapid progress in fields such as computer based drug design, medical imaging and medical simulations have lead to a growing demand for large computational power and easy accessibility to heterogeneous data sources. Objectives: The goal is to address these needs by deploying computing grids. Grids provide both large scale and distributed storage facilities and an increased computing power. Moreover, Grids are a promising tool to foster the synergy between bioinformatics and computerised medical imaging.

Methods: A first biomedical grid is being deployed within the framework of the DataGrid IST project (www.edg.org). The goal of the project is to provide a novel environment to support globally distributed scientific exploration involving up to multi-Perabyte datasets.

Results and Conclusions: The first biomedical applications deployed inside the project demonstrate the relevance of the grid paradigm for genomics and medical image processing. They also highlight the specific requirements of the biomedical community.
Building a Controlled Health Vocabulary in Japanese
Authors: Satomura Y. , Liu Y.
Published: March 2018

Objectives:
This study is aimed at developing a controlled clinical vocabulary for use in electronic patient record (EPR) systems.

Methods:
In this paper, we propose a model for building the vocabulary. The model is composed of a Canonical Term Dictionary, an Atom Dictionary, a Composite Atom Dictionary, and an Index. Parsing and composing functions are included in this model. Canonical terms were extracted from reference terminologies. Atoms were extracted from the Canonical Term Dictionary and reduced to a set from which the Composite Atom Dictionary can be built. The index was built to link these two dictionaries. For testing the model, we compiled a sample vocabulary and applied the model to a SNOMED translation system (English to Japanese) and a term similarity estimation system.

Results:
The sample vocabulary consisted of 15,600 atomic terms and 4,450 composite terms. 33,441 SNOMED terms were translated by the SNOMED translation system. The system gave adequate Japanese candidates in 56.3% of cases. The similarity estimation system found an average of 5.4 candidates when the equality ratio was over 50%.

Conclusions:
The trial applications produced good results. The model seems promising for building a standard clinical vocabulary system. This system can be applied in certain other Asian countries, such as China and Korea.
A Requirements Index for Information Processing in Hospitals
Authors: Buchauer A. , Haux R. , Ammenwerth E.
Published: March 2018

Objectives: Reference models describing typical information processing requirements in hospitals do not currently exist. This leads to high hospital information system (HIS) management expenses, for example, during tender processes for the acquisition of software application programs. Our aim was, therefore, to develop a comprehensive, lasting, technology-independent, and sufficiently detailed index of requirements for information processing in hospitals in order to reduce respective expenses.

Methods: Two-dozen German experts established an index of requirements for information processing in university hospitals. This was done in a consensus-based, top-down, cyclic manner. Each functional requirement was derived from information processing functions and sub-functions of a hospital.

Results: The result is the first official German version of a requirements index, containing 233 functional requirements and 102 function-independent requirements, focusing on German needs. The functional requirements are structured according to the primary care process from admission to discharge and supplemented by requirements for handling patient records, work organization and resource planning, hospital management, research and education. Both the German version and its English translation are available in the Internet.

Conclusions: The index of requirements contains general information processing requirements in hospitals which are formulated independent of information processing tools, or of HIS architectures. It aims at supporting HIS management, especially HIS strategic planning, HIS evaluation, and tender processes. The index can be regarded as a draft, which must, however, be refined according to the specific aims of a particular project. Although focused on German needs, we expect that it can also be useful in other countries. The high amount of interest shown for the index supports its usefulness.
Concept-oriented Standardization and Statistics-oriented Classification: Continuing the Classification versus Nomenclature Controversy
Authors: Giere W. , Ingenerf J.
Published: March 2018

Nowadays, most activities on controlled medical vocabularies focus on the provision of a sufficient atomic-level granularity for representing clinical data. Amongst others, clinical vocabularies should be concept oriented, compositional and should also reject “Not Elsewhere Classified” [1]. We strongly share the opinion that there is a need to deal with serious deficits of existing manually created vocabularies and with new demands for computer-based advanced processing and exchange of medical language data. However, we do not share the opinion that methodological requirements like observational and structural comparability needed for sound statistics should not be included in desiderata of controlled medical vocabularies. Statistical-oriented classifications are not developed for representing detailed clinical data but for providing purposedependent classes where cases of interest are assigned uniquely. Either statistical classifications are not included into the set of controlled medical vocabularies in the sense of Cimino, or his desiderata are misleading. We argue that statistical classifications should be linked to (formal) concept systems, but again this linkage does not change their different natures. With this article we continue the “classification versus nomenclature” controversy referring to Cote [2].
Exploring the Ontology of Surgical Procedures in the Read Thesaurus
Authors: O'Neil M. , Bentley T. E. , Brown P. J. B. , Price C.
Published: March 2018

The Read Thesaurus is a comprehensive user-led clinical vocabulary developed from earlier, and structurally simpler, versions of the Read Codes, with substantial input from United Kingdom health care professionals. A constituent template table underpins a range of functions, including semantic definition of concepts using object-attribute-value triples. Concept representation for surgical procedures has been investigated by a number of groups and a standard European structure has been proposed. Over 50% ofthe surgical procedures in the Read Thesaurus have been fully characterised using a number of attributes each with a defined concept field. We report progress to date and, based on our large-scale experience, examine the applicability of the European model to a user-defined terminology.
From Text to Knowledge: a Unifying Document-Centered View of Analyzed Medical Language
Authors: Bouaud J. , Bachimont B. , Charlet J. , Séroussi B. , Boisvieux J.-F. , Zweigenbaum P.
Published: March 2018

Although medical language processing (MLP) has achieved some success, the actual use and dissemination of data extracted from free text by MLP systems is still very limited. We claim that the adoption of an ‘enricheddocument’ paradigm (or ‘document-centered’ view) can help to address this issue. We present this paradigm and explain how it can be implemented, then discuss its expected benefits both for end-users and MLP researchers.
Semi-automated Database Design by the End-user
Authors: d’Hollosy W. , Walrave M. H. F. , Hendriks B. Th. , Debruyne F. M. J. , Wijkstra H.
Published: March 2018

An information system was developed to manage the data for a large number of research projects simultaneously. The system, called URIS, has facilitated the management of research data in an academic urological department. It enables end-users, who are not necessarily skilled computer scientists, to design their own databases semi-automatically, by supporting data entry screen design and the specification of research items. The system creates the database tables automatically after these activities. The specification of research items is the most important but also most difficult part in this process.
Cardiological Database Management System as a Mediator to Clinical Decision Support
Authors: Mavromatis A. , Maglaveras N. , Tsikotis A. , Pangalos G. , Ambrosiadou V. , Pappas C.
Published: March 2018

An object-oriented medical database management system is presented for a typical cardiologic center, facilitating epidemiological trials. Object-oriented analysis and design were used for the system design, offering advantages for the integrity and extendibility of medical information systems. The system was developed using object-oriented design and programming methodology, the C++ language and the Borland Paradox Relational Data Base Management System on an MS-Windows NT environment. Particular attention was paid to system compatibility, portability, the ease of use, and the suitable design of the patient record so as to support the decisions of medical personnel in cardiovascular centers. The system was designed to accept complex, heterogeneous, distributed data in various formats and from different kinds of examinations such as Holter, Doppler and electrocardiography.
The Questions of Medical Informatics
Authors: Dimitrov I.
Published: March 2018

Each science is identified with the questions it raises with respect to its object of study. This paper discusses the formulation of the basic questions of medical informatics. From a historical point of view, it first dealt with the problems of medical computing. Thereby, three classical questions arose: How can existing computers and information technologies assist in medical activities? Which components of the mathematical apparatus of informatics can be used for solving medical problems, and how and what activities of a physician are subject to algoritmization? The present time raises a new circle of questions centered around the basic one: How is the information system of the human organism structured and how does it function? This question and others form the basis of a new trend in medical informatics.
A Poor Precedent
Authors: Tuttle M. S. , Nelson S. J.
Published: March 2018

The single greatest impediment to the successful leveraging of computer-based patient records (CPRs) is the difficulty of creating and maintaining comparable patient descriptions. Specifically, it will be hard to justify the investment required to deploy CPRs widely if the patient descriptions they store are not comparable across successive releases of controlled health-care vocabularies. Thus, it is necessary to solve the controlled health-care vocabulary update problem for CPRs before the comparability of patient descriptions can be sustained. What may seem to be a narrow technical problem of interest only to maintainers of health-care enterprise systems is, instead, a central problem of medical informatics. Cimino’s “Formal descriptions and adaptive mechanisms for changes in controlled medical vocabularies” describes a classification of the changes appearing in the 1994 Edition of the International Classification of Diseases (ICD-9-CM). His paper describes the conversion of differences detected between the 1993 and 1994 releases of ICD-9-CM and a conversion of the elements of the classification into the required formal changes to the Medical Entities Dictionary (MED), part of the CPR in use at Columbia Presbyterian Medical Center. Because the process of detecting differences begins with an empirical analysis of the ASCII representations of the 1993 and 1994 releases of ICD-9-CM, it is impossible for a computer program to infer the intent of the changes that caused the differences; instead, a content expert must infer the intent and then update the MED accordingly. A typical task is to infer whether a change in naming also reflects a change in the meaning named. While Cimino’s methods and their execution are exemplary in every respect, they nevertheless constitute a kind of “reverse engineering” – an ad hoc attempt to infer intent from details. Reverse engineering of changes to controlled medical vocabularies is a poor precedent. Such methods should be viewed as necessary short-term expedients only, and all parties concerned should work toward an incremental plan by which the intent of changes to controlled health-care vocabularies can be made both explicit and machine processible. Only then can the comparability of patient descriptions be sustained.
Autoregressive Modeling with Exogenous Input of Middle-Latency Auditory-Evoked Potentials to Measure Rapid Changes in Depth of Anesthesia
Authors: Lindholm P. , Henneberg S. W. , Jensen E. W.
Published: March 2018

Obtaining an adequate depth of anesthesia is a continuous challenge to the anesthetist. With the introduction of muscle-relaxing agents the traditional signs of awareness are often obscured, or difficult to interpret. These signs include blood pressure, heart rate, pupil size, etc. However, these factors do not describe the depth of anesthesia (DA) in a cerebral activity sense. Hence, a better measure of the DA is required. It has been suggested that Auditory-Evoked Potentials (AEP) can provide additional information about the DA. The general method of extracting AEP is by use of a Moving Time Average (MTA). However, the MTA is time consuming because a large number of repetitions is needed to produce an estimate of the AEP. Hence, changes occurring over a small number of sweeps will not be detected by the MTA average. We describe a system-identification method, an autoregressive model with exogeneous input (ARX) model, to produce a sweep-by-sweep estimate of the AEP. The method was clinically evaluated in 10 patients anesthetized with alfentanil and propofol. The time interval between propofol induction and the time when the Na-Pa amplitude was decreased to 25% of the initial amplitude was measured. These measurements showed that ARX-estimated compared to MTA-estimated AEP was significantly faster in tracing transition from consciousness to unconsciousness during propofol induction (p <0.05).
Communication Services for a Distributed Hospital Information System
Authors: Graeber S.
Published: March 2018

Planning principles and development are described of a communication server which controls and performs all information exchange between distributed and heterogeneous applications in a hospital information system. The analysis is based on business process modeling. At present, the core of the server uses a commercial product (Cloverleaf). This allows to connect both old systems with no or few interface features and new systems with modern interface facilities (such as HL7). Prerequisites, functions, and configuration of the server software are described in detail. Experiences, advantages, and disadvantages are discussed.
Computer-based Training and Electronic Publishing in the Health Sector: Tools and Trends
Authors: Schrader U. , Klar R. , Schulz S.
Published: March 2018

CBT (computer-based training) applications and hypermedia publications are two different approaches to the utilisation of computers in medical education.

Medical CBT software continues to playa minor role in spite of the increasing availability, whereas hypermedia have become very popular through the World Wide Web (WWW). Based on the HTML format they can be designed by non-programmers using inexpensive tools while the production of CBT applications requires programming expertise. HTML documents can be easily developed to be distributed by a web-server or to run as local applications.

In developed countries CBT and hypermedia have to compete with an abundance of printed or audio-visual media and a wealth of lectures, conferences, etc., whereas in developing countries these media are scarce and expensive. Here CBT programs, and hypermedia publications in particular, may be a cost-effective way to improve quality of education in the health sector.
Comparative Diagnostic Performance of Three Radiological Procedures for the Detection of Lumbar Disk Herniation
Authors: Kardaun J. W. P. F. , Kardaun O. J. W. F.
Published: March 2018

Literature data on the diagnostic performance of phlebography, myelography, and CT scan applied to patients with suspected lumbar disk herniation (LDH) are analyzed to extract maximal information about their relative discriminatory power. Seventeen papers meeting the selection criteria contain 13 reports on myelography, 6 on phlebography, and 5 on CT. Sensitivity and specificity are considered simultaneously in logistic ROC space. The reports of each procedure are effectively summarized by a linear regression in logistic ROC space. Taking into account the individual confidence regions of sensitivity and specificity obtained from each report, the slope of the regression line is estimated by Generalized Least Squares (ML). This approach also allows to test the assumption of a common odds ratio (i.e., of a unit slope). The simply to determine common odds ratio as well as the perpendicular distance between the origin and the regression line (as a good approximation to the area under the ROC curve) are used as a measure for the discriminatory power of the procedures. For CT, homogeneity of sensitivity turns out to be much more likely than a common odds ratio. Based on the available, retrospective data, phlebography appears to have the highest performance in visualizing an LDH, followed by myelography and CT.
Some Comments on Teaching Biostatistics in Medical and Health Sciences
Authors: Sahai H.
Published: March 2018

The role of statistical methods is now well recognized in health sciences since these disciplines are concerned with the study of communities or populations where the principles of sampling and statistical inference are clearly applicable. However, many medical and health sciences teachers and students have been slower to perceive the need for knowledge of biostatistical methods, even though all aspects of medical diagnosis and prognosis are governed by the laws of probability. Some of them are still skeptical about the value and importance of biostatistical principles to their fields and raise questions about the meaning, content, and nature of biostatistics and relevance of its teaching to health sciences disciplines. The purpose of this essay is to address some of these issues with the hope to invoke comments and responses from other biostatistics instructors who have encountered similar predicaments in their teaching and consulting roles to health sciences students and professionals.
The Role of Computer Modeling in Electrocardiography
Authors: van Oosterom A.
Published: March 2018

This paper introduces some levels at which the computer has been incorporated in the research into the basis of electrocardiography. The emphasis lies on the modeling of the heart as an electrical current generator and of the properties of the body as a volume conductor, both playing a major role in the shaping of the electrocardiographic waveforms recorded at the body surface. It is claimed that the Forward-Problem of electrocardiography is no longer a problem. Several source models of cardiac electrical activity are considered, one of which can be directly interpreted in terms of the underlying electrophysiology (the depolarization sequence of the ventricles). The importance of using tailored rather than textbook geometry in inverse procedures is stressed.