bluuebunny/crossref_metadata_2025 huggingface dataset:
5.4 Future Directions in Distributed Computing
Authors: OHLY Martin J.
Published: February 2025

Several developments in distributed and related computing technologies can be identified that will in the near future have a large impact on patient care. Many of these have already been detailed in earlier chapters and are essential technologies for achieving the vision of an integrated clinical information management. These technologies include distributed object management systems, multimedia distributed document management, security, archiving and distributed database systems, mobile computing, intelligent agents and information filtering, network and distributed application management, and groupware and workflow management. The aim in this chapter is to bring together and summarize these developments. We concentrate on those being supported by industry and which we consider will provide the realistic and commercially viable basis for the building and operation of open distributed systems suitable for the needs of patient care.
Multimedia-Interfaces for Blind Computer Users
Authors: Strothotte Thomas  , Kurze Martin  , Fellbaum Klaus  , Krause Manfred  , Crispien Kai
Published: February 2025

This paper deals with selected aspects of blind peoples' access to graphical user interfaces of modern computers which are addressed by the GUIB Project. A new device for two-dimensional sound output to enable users to locate the position of a screen object acoustically is described. In a prototypical application, blind people are given access to a class of computer-generated graphics using the new device in an interactive process of exploration.
THE MARCUS INTELLIGENT HAND PROSTHESIS
Authors: Kyberd P  , Tregidgo R  , Sachetti R  , Schmidl H  , Snaith M  , Holland O  , Marchese S  , Bergamasco M  , Bagwell P  , Chappell P
Published: February 2025

The application of mechatronics principles to artificial hands has lagged a long way behind other areas of medical technology. Current provision uses simple open loop grippers that require concentration to be controlled successfully, and can only perform a limited range of tasks. By adding sensors and a microprocessor it is possible to control a more complex and functional hand with simpler instructions.
Evaluation of an epidemiological data set as an example of the application of neural networks to the analysis of large medical data sets
Authors: Waschulzik T.  , Quandt K.  , Lewis M.  , Hörmann A.  , Engelbrecht R.  , Brauer W.
Published: February 2025

The objective of this paper is to assess the suitability of neural networks for the analysis of large medical data sets. For this purpose, we used an epidemiological data set from the Augsburg MONICA study (MONItoring trends and determinants in CArdiovascular diseases). The method of perceptron analysis and the interpretation of the model established by the network are explained. The results of a predicition of survival or death of patients who suffered acute myocardial infarction show that even simple perceptrons yield good classification quality. Further, the analysis of the connections within the neural network leads to information about relations between input and output data which are of interest for future epidemiological research. The results of these investigations can also be applied to other medical data sets like data on the segmentation of CTs and ECG data for the diagnosis of myocardial infarction.
A Neural Network Modular System for Object Classification in Brain MR Images
Authors: Blonda P.  , Carella A.  , DeBlasi R.  , Dicuonzo F.  , LaForgia V.  , Milella D.  , Pasquariello G.  , Satalino G.
Published: February 2025

In this paper we present a modular system for segmentation and classification of brain Magnetic Resonance (MR) images. It consists of two Neural Network architectures, a Self Organizing Map and a Multilayer Perceptron. The objective of the work is to evaluate the effectiveness of a Neural Network approach for automatic recognition of anatomic structures in MR images. The system has been useful to discriminate 20 different anatomic classes.
Reasoning with Causal Networks at Variable Depths
Authors: Barahona Pedro  , Cruz Jorge  , Nascimento Susana
Published: February 2025

In medical problem solving two main subproblems can be identified, namely the selection of possible hypotheses from some initial data, and the evaluation of these hypothesis, possibly taking into account some additional evidence. In a number of model-based systems, more superficial knowledge is used for generating diagnostic hypotheses, whereas deeper knowledge is used to assess them, but these systems are usually domain specific. In this paper we present a generic methodology for representing causal knowledge, which enables diagnostic reasoning to be made at the appropriate knowledge depth. In particular, to obtain candidate diagnoses from easily observable findings (superficial knowledge) and to assess them subsequently via less easily observable findings (e.g. signs and results from complementary tests, usually associated with deeper domain entities).
Reading Characteristics of Normal Observers using Low Vision Aids
Authors: Bowers Alex  , Ackerley Roger
Published: February 2025

Eye movements were recorded whilst 16 young subjects read passages of standardised text. Four reading conditions were used: normal print with the habitual correction (HC), enlarged print with the habitual correction (EN), normal print with a +16D hand-held magnifier (HH) and normal print with a +16D spectacle-mounted magnifier (SM). There were no differences in eye movement characteristics for normal and enlarged print with the HC. When using the HH and SM magnifiers, the typical ‘staircase’ pattern of reading eye movements was modified to an ‘optokinetic nystagmus’ type of movement. There was also a reduction in the reading speed and an increase in the number of forward saccades on each line. There were no significant differences in the results for the two magnifiers.
Visual support to multiply visually impaired children in learning little tasks
Authors: ANDRIES Bea
Published: February 2025

This paper wants to lend a helping hand in bringing about the multiply visually impaired child “to work on his own”. First of all the environmental and guidance elements have to be optimum. This is why the use of the Dark Room can be important in learning and automizing little tasks.
Social-emotional Aspects in a Sample of Young Persons with Usher’s Syndrome Type I
Authors: Vermeulen Lianne  , van Dijk Jan
Published: February 2025

Usher’s Syndrome Type I is characterized by profound congenital deafness in combination with balance problems and symptoms of Retinitis Pigmentosa, which manifest themselves before adolescence. By means of a Q-sort technique we investigated the social-emotional status of 16 young clients with Usher’s Syndrome. Norms for prelingually deaf persons for this Q-sort technique, which is called Nijmeegse California Kinder Sorteertechniek are available. This group with Usher’s Syndrome seems to have a high degree of ego-resilience and pro-social competence. They show a low level of assertiveness, a high amount of ego-overcontrol and a high self-esteem. These findings support our experiences with adult clients with Usher’s Syndrome in therapeutic settings.
Daily-Life Baroreflex Modulation: New Perspectives from Computer Analysis of Blood Pressure and Heart Rate Variability
Authors: PARATI G.  , DI RIENZO M.  , CASTIGLIONI P.  , FRATTOLA A.  , OMBONI S.  , PEDOTTI A.  , MANCIA G.
Published: February 2025

Computer analysis of blood pressure and heart rate fluctuations and the quantification of their interaction in the time (sequence method) or in the frequency domain (spectral analysis) offer a dynamic evaluation of the sensitivity of baroreflex control of the heart (BRS) in daily life conditions. Use of these techniques in the analysis of 24 hour intra-arterial blood pressure and heart rate recordings has shown that in real life BRS is continuously modulated over time and is characterized by a pronounced increase at night as compared to the daytime. In a number of pathophysiological states (hypertension, aging and autonomic failure), average 24 hour BRS is markedly lower than in normal subjects and its day-night modulation is blunted to a variable extent. These time domain and frequency domain techniques provide generally superimposable results and represent unique tools not only to quantify differences in BRS between different steady-state conditions, but also to track fast changes in BRS induced by behavioural stimuli on a minute-to- minute basis. They offer a deeper insight into daily life cardiovascular regulation in normal and diseased conditions with no need of external interventions.
Sympathectomy, Sinoaortic Denervation and Spectral Powers of Blood Pressure and Heart Rate in Lyon Rats
Authors: CERUTTI C.  , BARRES C.  , GUSTIN M.P.  , JULIEN C.  , LO M.  , PAULTRE C.  , VINCENT M.  , SASSARD J.
Published: February 2025

The mechanisms underlying arterial blood pressure (AP) and heart rate (HR) beat-to-beat variability were investigated using spectral analysis in conscious genetically normotensive (LN) adult rats from the Lyon strain. Basal AP and HR spectra exhibited peaks in low- (LF: 0.27-0.74 Hz) and high- (HF: 0.75-3.85 Hz) frequencies. The LF oscillations of systolic AP, and even more of diastolic AP, could be attributed to the sympathetic nervous system influence as, after destruction of the peripheral sympathetic nerves, the LF peak disappeared and the LF power spectral density (PSD) was highly reduced. Ganglionic blockade with chlorisondamine combined with a restoration of the basal mean arterial pressure (MAP) level decreased LF PSD of MAP in control rats in a larger extent than sympathectomy. No relationship was found between the MAP response to chlorisondamine, taken as an index of the sympathetic vasomotor tone, and the basal LF PSD. The role of the baroreflex in the spectral characteristics of MAP and HR was also investigated. In rats with a chronic sinoaortic baroreceptor denervation (SAD), PSD of MAP was reduced in the LF band. Transfer function analysis between MAP and HR showed that, in control rats, coherence was high for frequencies surrounding the LF and HF peaks. In SAD rats, coherence in the LF band was abolished but maintained in the HF band. In conclusion, nearly 80% of the LF PSD of AP depend upon the autonomic nervous system activity and the activation of the peripheral sympathetic nerves contributes mainly to the production of LF spectral power. The baroreflex accounts for half this power and for the coherence between MAP and HR oscillations in the LF band only.
Multi-Variate Identification and Spectral Decomposition for the Assessment of Cardiovascular Control
Authors: BASELLI G.  , PORTA A.  , FERRARI G.  , CERUTTI S.  , RIMOLDI O.  , PAGANI M.
Published: February 2025

Multi-variate identification methods applied for the analysis of heart period (HP), systolic arterial pressure (SAP) and respiration beat-by-beat series are discussed. A method for multi-variate spectral decomposition and for a classification of rhythm sources is presented and applied in a preliminary study on conscious dogs during different manoeuvres of sympathetic stimulation and enhancement of low frequency (LF) waves. Different contributions to LF oscillations are detected at control and different activation modes are found depending on the kind of the stimulus: overall increase of disturbances during nitroglycerine infusion, increased rhythmicity of sinus node modulation during coronary artery occlusion and increased resonance of baroregulation during bilateral carotid occlusion. In conclusion, multi-variate spectral decomposition provides a classification of variability rhythms more complete than that provided by mono-variate methods, which is based only on the position on the frequency axis.
A Networked Patient-Based Integrated Care System as a Basis for the Achievement of Quality in Practice
Authors: Rigby Michael J.  , Robins Sally C.
Published: February 2025

Traditionally, telematics initiatives have mainly been used to link patients with specific conditions to monitoring services located in acute hospitals. However, latest application of telematics to the networking of integrated electronic records for ambulatory or community care has great potential to measure and assure the quality of health care delivery to a large sector of the population in a structured and comprehensive way. This paper categorises the major quality opportunities of a pioneering initiative now achieving operational status.
Towards a Fully Automated Photogrammetric Device to Discern Variations in Back Surface Shape
Authors: MITCHELL Harvey L.
Published: February 2025

A photogrammetric measuring device has been under development for automating the detection of variations in back surface shape, in order to discern improvements or deterioration in scoliotic patient conditions, for comparing one patient with another patient, or to collect statistical data on the condition. The system is designed to take into account as carefully as possible the requirements of the medical practitioner as the end-user of the results, especially by providing output that can be exploited. Careful consideration has been paid to clinical requirements, not only in terms of cost and accuracy, but also in terms of convenience to clinical staff and the patient. In this way, the instrumentation is designed to surmount apparent difficulties in having photogrammetric instrumentation accepted into routine clinical use. The surface measurement follows the widely-accepted photogrammetric configuration of a pair of stereoscopic digital cameras, with a projected light pattern to provide texturisation on the human body. It is intended to require no handling by a medical practitioner. The detection of features in the pattern, the determination of stereoscopic correspondence and the formation of the surface model, are carried out in an automated manner. The two images are collected within 0.1 seconds of each other. Although computations are not instantaneous, the current system operates in accordance with requirements, obtaining from 500 to 1000 points to define the back surface to an accuracy of about 1 mm. In addition, the hardware is currently being linked to software which enables one measured back surface to be compared with another by least squares matching methods, to detect differences between the two back shape surfaces. This component is seen as crucial for the acceptance of the instrument by medical specialists.
The Three Planar Evaluation of Spinal Position and Deformity Possible from Biplanar Radiographs
Authors: ASHER Marc A.
Published: February 2025

A framework for the determination of three planar spinal position and deformity is presented. The goal is to aid identification of clinically useful three planar measurements that can be made from currently available biplanar radiographs. The methods used are accepted spinal position terminology, measurement techniques based on comparing the positions of two right hand orthogonal coordinate systems, and a clear definition of normal spine position.
Impairment of Forward Flexion - Physiological or the Precursor of Spinal Deformity?
Authors: WEISS HR  , LAUF R
Published: February 2025

According to Sommerville and Dickson et al. loss of thoracic kyphosis seems to be the primary condition in the etiology of idiopathic scoliosis. The lordosis appears first before evidence of spinal asymmetry in coronal or transverse plane. Tomaschewski has found functional impairment of forward flexion (IFF) to be the precursor of structural spinal curves. In 16.5% of 686 healthy schoolchildren (9-10 years) she found IFF in at least one motion segment. 27% of those children developed an idiopathic scoliosis (defined as a structural spinal deformity in three planes) during the follow up of one year. This was assessed clinically as well as by a bending radiograph. Tomaschewski concludes impairment of forward flexion to be the preselection condition for the developement of idiopathic scoliosis. She postulated that the origin of this condition should be found in earlier childhood. To illuminate this aspect of scoliosis etiology we were looking for impairment of forward flexion of the spine in healthy children at the ages of 2, 4 and 5 years at the pediatric screening assessments routinely performed in Germany. 614 children have been assessed during one year. 250 children were screened at the age of 2, 190 at the age of 4 and 174 at the age of 5. Prevalence of impairment of forward flexion (IFF) in the 2-year group was 7.9%, in the 4-year group 78.9% and in the 5-year group 70.8%. There were no significant differences of prevalence in females and males who were distributed about equal in the three agegroups. In children at the age of 2 were crawling and creeping besides upright locomotion is still performed frequently IFF is rare, in the ages of 4 and 5 when upright locomotion becomes dominant IFF seems to be physiological, at the age of 10 however IFF is rare. In children with IFF of more than 3 motion segments IFF may be able to destabilize the spine so that progressive rotation and lateral deviation can occur during periods of fast growth. The transition to upright posture seems to be the origin of idiopathic scoliosis when IFF is aquired in too many motion segments or not lost again before pubertal growth spurt.
Evolution of Scoliosis by Optical Scanner I.S.I.S.
Authors: LEGAYE J.  , ORBAN C.
Published: February 2025

The evolutions, not less than 2 years, of 46 teenagers patients with idiopathic scoliosis are analysed by optical scanner. An initial X-ray in standing position is performed in the beginning of the screening. The liability of the technique is confirmed. The sagittal shapes, related to the location and to the magnitude of the frontal deformities, are observed to change similarly within each group of frontal curve. The comparison of the graphs in standing and in sitting position evaluates the influence of the magnitude of the deformity on the flexibility of the lumbar spine. This mobility allows to appreciate the residual potential of evolutivity of the scoliosis, and to adapt the therapeutic procedures.
Integrating guidelines and the clinical record: the role of semantically constrained terminologies
Authors: Glowinski Andrzej
Published: February 2025

The extent to which protocols and guidelines will be used depends critically on how well they are integrated with existing medical records and each other. Effective integration requires consistent information structures and content, but if the union between components becomes too intimate it may restrict interaction with other applications. Such isolation leads to operational inefficiencies and can be financially unattractive. Systematic representation methods for protocols address part of the problem but are hampered by the unsuitability of existing medical terminologies; the effort required for bespoke development is prohibitive. Unifying and generalising terminological functions in a single “Terminology Server” that can support both construction of systems and their operational use promises to reduce development effort whilst allowing individual designers considerable independence. However, significant theoretical and practical questions remain about how far the problems of communication can be mitigated by a generalised, use-independent terminological system.
Knowledge engineering for drug prescribing guidelines
Authors: Walton Robert  , Ilic Zeljko
Published: February 2025

Prescribing drugs for the treatment of medical conditions is a very common activity for a doctor. Prescribing has enormous economic importance. Costs are rising quickly and there is an urgent need for doctors to have easy assess to advice about the cheapest, most effective therapy. On average 80% of GPs in the UK use a computer for their medical work and the figure is rising rapidly. Currently available systems provide only very simple checks and reminders. More sophisticated advice is provided by our prototype program. The program uses logic engineering to give advice, based on simple protocols for prescribing, tailored both to the condition being treated and the individual patient. The essential logical elements of the prescribing decision are discussed. These simple prescribing protocols may be the final common pathway for prescribing advice from many, more complex protocols for recommendations for drug treatment.
Introduction
Authors: van Gennip E.M.S.J.  , TALMON J.L.
Published: February 2025

This book presents the main end product of the first phase of ATIM: the Accompanying Measure on Assessment of information Technologies In Medicine in the AIM telematics programme. It aims to provide first guidelines for IT users and industry involved in validation of information technologies in health care. This introduction begins with background information concerning ATIM, why it was started and its activities between April 1993 - December 1994. Next a guided tour through the handbook is given to help readers in using this book.
Next-Generation 3D Videosystems May Improve Laparoscopic Task Performance
Authors: Jones Daniel B.  , Brewer Jerome D.  , Soper Nathaniel J.
Published: February 2025

Laparoscopic surgeons may be hindered during complex procedures by the two-dimensional (2-D) view provided by standard videosystems. First-generation three-dimensional (3-D) systems have been developed with the hope of improved laparoscopic manipulations. We assessed whether laparoscopic task performance was better in 2-D or 3-D among individuals with varying levels of laparoscopic experience. Five different tasks were performed in random order using 2-D and 3-D videosystems by medical students (N = 10), junior surgical residents (N = 10), and experienced laparoscopic attending surgeons (N = 10). Tasks were timed and repeated 3 times in a pelvic-trainer using a 0-degree laparoscope. The tasks included placing objects on a flat surface in a set pattern, passing objects through a suspended ring of 1.5 cm I.D., clipping suture with a Lapra-ty®, loop ligating a foam pedicle, and suturing with knot-tying. The participants then completed a questionnaire regarding relative system preference and perceived advantages or disadvantages of the two systems. The data were analyzed by ANOVA, Tukey's pairwise comparisons, and Chi-square. Attending surgeons performed all tasks faster than trainees. There were no significant differences in task performance times between 2-D and 3-D within any group; however, suturing/knot-tying was performed 12% faster (p=0.06) in 3-D by all groups. With repetition of some tasks, learning curves were identified in both 2-D and 3-D. Subjective enhancement of motor control in 3-D was reported by 60% of participants, yet 53% complained of inadequate illumination and 20% reported headache or eye strain. Our results suggest that first generation 3-D videosystems offer no significant advantage to the novice or expert surgeon performing laparoscopic tasks. Ongoing trials with the next generation of 3-D videosystems may support a trend showing 3-D beneficial for complex laparoscopic tasks such as suturing.
VR Medical Support System for Cancer Patients
Authors: Oyama Hiroshi  , Miyazawa Tatsuo  , Aono Masaki  , Ohbuchi Ryutarou  , Suda Susumu
Published: February 2025

A Virtual Reality (VR) technology is emerging as new application for a medical edutainment and psychotherapy as a treatment of acrophobia. We describe here two medical supporting programs for cancer patients: one is a Cancer Edutainment VR Theater (CEVRT) system and the other is a Psycho-oncological VR Therapy (POVRT) system. Both systems consist of two ONYX computers with Reality engine, head mounted display (HMD) and 100-inch wide screen on which 3D images or high definition television images can be presented. Cancer patients during hospitalization can experience a beautiful sight-seeing as a flying bird and feel as if they are not staying in a hospital. We conclude that VR technology contributes as a tool for treatment of psychological problems and improving the patient's amenity. We will discuss the preliminary trial of this new approach for resolving the clinical problems for cancer patients with VR technology.
Clinical Applications of a High-Performance Computing System for Visualizing and Monitoring Human Labor and Birth
Authors: Brennan John P.  , Brennan Jais A.
Published: February 2025

This paper describes the development of the “Delivery Room of the Future,” a project which utilizes virtual reality technology to enhance the clinical, educational and research functionalities of birthing rooms. Important features include the use of miniature wireless sensors for physiologic measurements, reconfigurable “virtual instruments” for information display which allow three-dimensional visualization of data, and a labor process monitor which represents the progress of the fetus down the birth canal using computer graphics.
Medical Image Segmentation Using Active Shape Models
Authors: Taylor C.J.  , Cootes T.F.  , Hill A.  , Haslam J.
Published: February 2025

This paper describes a technique for building compact models of the shape and appearance of flexible objects (such as organs) seen in 2D and 3D medical images. The models are derived from the statistics of sets of labelled images of examples of the objects. Each model consists of a flexible shape template, describing how important points of the objects can vary, and statistical models of the expected grey levels in regions around each model point. The shape models are parameterised in such a way as to allow only legal configurations. The models have proved useful in a wide variety of applications. We describe how they can be used in local image search and give examples of their application in medical image segmentation. We describe how 2D models can be used to segment 3D objects in volume images and to track structures in image sequences. We also describe how to generate full 3D models and illustrate their use to segment 3D Magnetic Resonance images of the brain.
Calcium Cycling Dependent and Independent Mechanisms of Relaxation in Mammalian Ventricular Myocardium
Authors: Hajjar Roger J.  , Schmidt Ulrich  , Gwathmey Judith K.
Published: February 2025

Calcium ions play a crucial role in the activation of working ventricular myocardium, however the effect of calcium on relaxation has not been well established. Both the sarcoplasmic reticulum [SR] and the myofilaments play a major role in relaxation. We investigated the effects of isoproterenol, ryanodine, diseased states and two Ca2+-sensitizers: EMD 57033 and ORG 30029 on relaxation in isolated myocardium. Isoproterenol, which enhances SR function and desensitizes the myofilaments to Ca lf, shortened relaxation of both the twitch and the Ca2+transient. Ryanodine and disease states such as cardiomyopathy and hypertrophy, which impair SR function, prolonged both the twitch and the Ca2+transient. In this situation, relaxation became directly related to [Ca2+]icycling. Both EMD 57033 and ORG 30029 increased force of contraction, and diastolic force and prolonged twitch relaxation to a great degree with little effect on the Ca2+transient.This would indicate that interactions at the level of the thin and thick filaments may affect relaxation without significant changes in intracellular calcium mobilization. We conclude that calcium mobilization can affect diastolic function in slowed muscle contractions, but time course changes of Ca2+transients cannot be used alone to elucidate mechanisms of cardiac relaxation.
Systolic and Diastolic Importance of Oblique Fiber Orientation in the Left Ventricle
Authors: Shapiro Edward P.  , Buffer Jr. Sam A.  , Rademakers Frank E.
Published: February 2025

MRI tagging is a powerful new method for non-invasively studying LV wall deformation. The counterclockwise spiral of epicardial fibers coupled with the clockwise spiral of endocardial fibers, provides a mechanism for extensive thickening. Epicardial deformation is in the direction of its fibers. Endocardium is forced to shorten mostly in the cross-fiber direction, a deformation that results in extensive thickening. Systolic torsion recoils rapidly before diastolic filling begins, likely representing release of restoring forces and augmenting filling. This recoil is diminished in LVH.
MAGNOBRAIN: Biomagnetic Methodologies for the Noninvasive Investigations of the Human Brain
Authors: Anogianakis G.  , Apostolakis M.  , Harding G.F.A.  , Nendidis G.  , Psaltikidou M.
Published: February 2025

MAGNOBRAIN is an applied research project which has been designed to integrate known radiological, anatomical and electrophysiological information about the human brain for use in localization of brain activity. The main aspects of MAGNOBRAIN include a mathematical approach to source localization which makes use of a priori information about the brain, the building of the Brain DataBase (BDB) which contains a multitude of data about the brain, and the development of software tools for Magnetic Resonance Image processing and for 3D visualization. It is expected that these tools will allow interactive navigation through the brain, as well as easy and inexpensive access to a huge amount of medical information. This expectation is borne out by the initial market surveys of the MAGNOBRAIN software.
Introduction to Project Line 7. Quality and Security
Authors: Kolitsi Zoi  , Davey John  , de Dombal F.T.
Published: February 2025

AIM Project Line 7, has encompassed a total of nine projects, with a focus on quality aspects in Health Care. Concertration activity has focused on the elaboration, testing and validation of an implementation model for quality that, notwithstanding contextual differences, will permit the necessary generalization and will operate effectively at the various levels of organization, thus promoting a common understanding, especially when quality is addressed within multidisciplinary professional teams. The validation, with concurrent evolution of the model is seen as an on-going process. In support of this objective, a multimedia demonstrator of this work has been developed, in a form that can be widely distributed outside the AIM community boundaries, to a broader audience, in order both to disseminate this result and also to invite mapping of a large number of projects and contexts, in a continuous update process.
PROCAS: Profiles of Care System
Authors: Cammelli Lorenzo  , Di Loreto Paolo
Published: February 2025

At the basis of the PROCAS Project is an effort to identify an effective approach of quality improvement and resource management based on the monitoring of the clinical process. The chosen strategy was the implementation of these concepts inside the clinical information system with a real time and effortless capture of all the relevant information through a specialised and innovative “Order Entry” module, to make feasible for the medical world the use of the PROCAS approach in every hospital reality. With this premise, the clue problem of the project became the standardisation of the medical process, the identification of all the successive steps involved in every health care problem, and finally the listing of the diagnostic and therapeutic procedures associated with every step. The second point was the realisation of the order Entry software. In this complex context, Profiles of Care are sets of options developed through medical advice which could include “official” guidelines, used for a better management of the hospital organization and for the medical Audit activity though the comparison of the effective profiles chosen on the real patients.
ORATEL: Telematic Systems for Quality Assurance in Oral Health Care
Authors: Stæhr Johansen K.  , Møller I.J.  , Petersen P.E.
Published: February 2025

The main objective of the ORATEL project has been to develop a telematic system which would facilitate daily monitoring and evaluation of a dental practice, support the transfer of knowledge and goal setting and stimulate and orient oral health providers towards a quality assurance approach through a proactive clinical/quality assurance reminder system, and self-education. The ORATEL system comprises the following elements: (a) PROACT: a chairside decision support tool for diagnosis and clinical management which interacts with an electronic patient dental record system (EPRS); (b) TEACH: an interactive multimedia teachware on quality assurance in oral health care for continuous and postgraduate education; and (c) REVAL, a harmonized set of software modules for monitoring and self-assessment by oral health care providers at the clinical level and for data aggregation and statistical analyses at the regional, national and supra-national levels. One of the most important objectives of the ORATEL project is to monitor quality achievement on a European level through the collective efforts of all countries in Europe. This achievement will be monitored through a network of national telematic information systems which will be linked to the Health for All (HFA) data-base terminal in the Regional Office for Europe of the World Health Organization in Copenhagen.
Health Priorities and Telematics: Telematics for Health
Authors: Gott Marjorie
Published: February 2025

A research project explored the potential of telematic services for health. Drawing on European and North American Case Studies a new, and potentially more rewarding way forward was identified; a way that can be accessed (in part) by new technologies, but not exclusively medical ones. It was found that the social technologies (television, telephone, videophone) have an important role to play in promoting health and wellbeing. Not only are these technologies more acceptable to people than medical “solutions”, they may also be lower cost social care options than those that have been pursued in the past.
Plenary IV: User and Industry Round Table Implementation of the Information Society in Health Care
Authors: Rossing Niels
Published: February 2025

A rationale is outlined for the establishment of a Forum to support the projects and the users of the EU Health Telematics programme.
Experiences in Implementation of a Standardized Emergency Card
Authors: Schroeder-Boersch H.
Published: February 2025

Worldwide, many different approaches exist to the delivery of emergency-relevant patient medical information for prevention and treatment in emergency situations. The variety of these systems is determined by the variety of health care systems, EMS systems, and the technical stage of development of the respective countries. Therefore, unfortunately, no specific system has gained enough weight to set minimum international standards, leaving the undesirable situation to doctors and EMS staff of either having no reliable information when needed, or of being served by paper-devices carrying inadaquate or too much information, being too extensive, too time consuming, not protected against transmission errors, etc.
The Smart Card - the Key for Telemedicine
Authors: Schipplick F.
Published: February 2025

The wider use of Information and Telecommunication Technology like multimedia-systems in the health care leads to new potentialities for medical services. One major application of this technology is Telemedicine. Telemedicine offers new chances and services and provides benefits for all partners in Health Care Systems. On the other hand Information- and Telecomrnunicationsystems impact the risks regarding the security and the protection of patient’s data. To minimize these risks secure and effective methods and technologies have to be implemented. Smart Cards are an important component for secure telecommunication solutions in the health care.
Using Microprocessor-Cards (Smart Cart Bull CP8) for the Transmission of Information in Diabetes Care
Authors: Cimino A.  , Valentini U.  , Girelli A.  , Rocca L.  , Corsini R.
Published: February 2025

For many years patients suffering from chronic disease who need a continuous follow-up treatment and whose illness might suddenly become acute again making immediate hospitalization necessary, have been given a card on which their disease is recorded, to be used in case of need. It would be of great importance for a perfect and quick medical help, if not just the kind of disease but a complete hospital file could be recorded on this card, to be used in real time where the patient happens to be. Such cards would be very useful not just in an emergency, but also for the ordinary medical and social welfare, assuring a transmission of information among different health services. Patients suffering from diabetes receive ordinary medical care from general practitioners, while as regards to the diabetes they are often sent for advice or treatment to specialized clinics. Moreover, diabetics must regulary resort to other medical services. Thus an information processing system that allows a quick and complete transmission of the information, however respecting individual peculiarities and medical needs, will certainly improve hospital treatment and might also bring about savings in sanitary costs by avoiding the repetition of useless and expensive check-ups. This aim can be achieved by using and by developing microprocessor-cards. So medical information would circulate and come back again to the starting point after having been used and completed with new data; the information is so improved and becomes more useful. In 1989 an experiment was undertaken in Brescia in order to check the opportunity of using microprocessor-cards for this purpose in diabetological care. The card used for the experiment undertaken in Brescia is based upon the technology of the Smart Card Bull CP8, which has the same size and thickness of a cash-point card with a memory capacity of 64K bits. This card can be recorded and read only by means of suitable equipment provided to all services involved in this experiment. A Diabware computerized hospital file has been created. The most significant administrative and personal data, an exhaustive and remote pathological case history, all the admissions to hospital, the check-up list together with the results, all the remedies normally used, grouped in different sets, can be recorded on the micro-card.
Optical Memory Card for Community Health and Welfare in Isehara
Authors: Horie M.  , Ogushi Y.  , Okada Y.  , Sakashita Y.  , Ota Y.  , Hayashi Y.  , Suzuki S.
Published: February 2025

This paper reports four years experience of the optical card system that carries health and welfare data of elder people in Isehara city (pop. 90,000). 2,775 elder people have the cards and 24 health and welfare offices have the terminals. A card holds health check and welfare service data as well as therapeutic data including medical images for whole life long. This experience reveals importance of co-operation of related partners.
Working Group: Datastructure
Authors: Schaefer O.P.
Published: February 2025

The preliminary result of the Working Group of the Joint Panel on Health Cards are presented. The importance of an agreement on a minimal data-set is emphasized. Ten statements outline the basic challenges. Remarkable conformity is observed between the EUROCARD Working Group 4 and the preparatory work amongst the German card providers.
Documentation and Communication in Oncology - Shared Care System by Hybrid Cards
Authors: Ellsässer K.-H.  , Zimpelmann B.  , Hertwig U.  , Köhler C.O.
Published: February 2025

The care of cancer patients will be carried out increasingly by different partners in the Health Care System (Shared Care). The base for the communication between these partners is an exhaustive, structered and standardised documentation. The technical realization is possible by using a hybrid card.
DIABCARD - A Smart Card for Patients with Chronic Diseases
Authors: Engelbrecht R.  , Hildebrand C.  , Blecher M.  , Brenner G.  , Corcoy R.  , Reith A.  , Gapp C.  , Henn H.  , Klepser G.  , de Leiva A.  , Massi-Benedetti M.  , Mechtler R.  , Piwernetz K.  , Sembritzki J.  , Thiery J.
Published: February 2025

DIABCARD, a project sponsored by the European Union, has developed the core of a Chip card Based Medical Information System for chronic diseases in ambulatory and hospital care. This includes the specifications for the software (operating system on the chip card, interface between chip card and application, the application at the GP, at the lab, etc.) as well as for the hardware (processor and the memory of the chip card, data structure, security functions, system architecture). It is now at the testing stage. This paper shows the approach of the project, the benefits expected and the results achieved up-to-date.
How to assure security: CEN standards, Directives, or European Guidelines?
Authors: Louwerse Kees
Published: February 2025

It is argued, that to assure security, we need to make use of all three vehicles mentioned in the title, provided we select carefully which type to use in what circumstances. Many useful activities in these areas are under way. There is an important danger, however: if we do not take into account the needs of practical applicability, the net result of all efforts might be an increase of the gap between theory and practice, and thus a contrary effect of the intended one.
The SEISMED Guidelines for Host Systems Security
Authors: Furnell Steven M.  , Sanders Peter W.
Published: February 2025

The increasing use of and reliance upon information technology within modern healthcare establishments underlines a need for adequate security controls to protect the confidentiality, integrity and availability of systems and data. Whilst the consideration of security is now generally accepted as part of the design and implementation of new systems, many systems are already in operation in which these needs have not been adequately addressed. This paper presents a summary of the recommendations arising from the AIM SEISMED (Secure Environment for Information Systems in MEDicine) project relating to the addition and enhancement of security in existing healthcare systems. The paper is based upon material originally presented at the SEISMED Workshop “Security and Legal Aspects of Advanced Health Telematics”, Brussels, 11 July 1994. The content has been revised in light of the workshop discussion and the further development of the guidelines since that time.
An Overview of SEISMED
Authors: Treacher Alison  , Bleumer Gerrit
Published: February 2025

The efficiency of modern health care relies more and more upon a computerised infrastructure. Open distributed IT-systems have started to bring professionals together from all over the world. On the one hand easy processing and communication of images, sounds, and texts will help to represent and treat illnesses and diseases efficiently, on the other hand they may threaten the privacy of patients, and the accountability and professional secrecy of health care professionals. The European Union has initiated a multi disciplinary project to come up with practical guidelines how to achieve a Secure Environment for Information Systems in MEDicine (SEISMED). This project has taken into account the traditional and proven principles of health care data processing, the various data protection legislations within the EU, the enormous and subtle risks of health care information systems, and the cost of changing existing technology. Four Reference Centres in Europe have validated most of the guidelines.
Medical Device Accident Reporting: Does it Improve Patient Safety?
Authors: Nobel Joel J.
Published: February 2025

A significant number of patient injuries and deaths are associated with the use of medical devices. After several decades of experience in device evaluation and accident investigation, ECRI believes that many of these adverse effects could not be predicted in advance, even with the most sophisticated design validation techniques. Reporting networks with investigational capability that identify problem devices and provide feedback about adverse effects to manufacturers and medical device users are essential to meet the health communities obligation to provide safe and effective products and patient care.
Low End Interactive Image-Directed Neurosurgery
Authors: Doyle Werner K.
Published: February 2025

Our experience with a very low end interactive image-directed (IIDS) neurosurgical system is presented. The system was developed by the author and consists of a personal desktop computer and a magnetic field digitizer. This low cost solution was pursued as an alternative to available commercial devices which were expensive and not readily modifiable for novel ideas and new applications targeted for Epilepsy surgery. The rationale and description of the system was presented last year at Medicine Meets Virtual Reality III. Included in that detailed report were the fundamental mathematics forming the basics of transformation between the surgical and the digital data spaces. Since then the system has been used in an additional 20 cases now totaling 40 in all. Its advantages and short comings will be described. The theoretical advantages of magnetic field technology over other localization methods is reviewed. Also, our experience with alternative low cost off-the-shelf interfacing devices and other related modifications are described. We have accumulated clinical data to suggest that craniotomy sizes have been reduced, electrode placement has been improved, and that interactive image-directed techniques offer advantages over other common intra-operative localization modalities such as ultrasound. Our conclusion is that interactive image-directed techniques improve neurosurgery and that inexpensive enabling technology is already available providing the technological substrate for low cost devices using virtual reality notions for surgery and medicine. This particular technology offers advantages to traditional surgical techniques demonstrating the attractiveness of rudimentary virtual reality medical applications.
Computer-Assisted Planning of Oral Implant Surgery
Authors: Verstreken K.  , Van Cleynenbreugel J.  , Marchal G.  , van Steenberghe D.  , Suetens P.
Published: February 2025

A planning system for oral implant surgery is described. This system allows the interactive placement and adjustment of models representing oral implants on CT volume data. These CT data can be shown as two-dimensional (2D) slices, or as a three-dimensional (3D) surface-rendered model. The viewpoint is fully adaptable, and stereoscopy results in an enhanced insight in the interrelation between implants and structures. This approach offers many advantages when compared with the traditional manual planning or with a 2D computer based planning. Clinical trials are being performed.
Surgical Simulation of Facial Paralysis
Authors: Konno T.  , Mitani H.  , Chiyokura H.  , Tanaka I.
Published: February 2025

We are developing a prototype of a surgical simulation system for restoring facial expression lost in cases of facial paralysis. Correcting facial paralysis requires careful planning of surgery procedures and accurate prediction of the surgical results. So far techniques to perform this task largely relied on the physician’s experience, and there were few quantitative data to refer to. The system we propose is finally aimed at helping the surgeon plan the surgery and predict the results. The 3D model of the face used in our system is generated directly from the CT scan of the patient. The face model consists of skin, skull and selected facial muscles based on anatomy. The mass and spring lattice approach is used to give physical attributes to the face model. The present prototype system lets the user directly manipulate graphical representations of facial expression.
Assessing a Virtual Reality Surgical Skills Simulator
Authors: Johnston Rob  , Bhoyrul Sunil  , Way Lawrence  , Satava Richard  , McGovern Kevin  , Dexter Fletcher J.  , Rangel Shawn  , Loftin R.Bowen
Published: February 2025

The Institute for Defense Analyses (IDA) was contracted to perform a military standard task analysis of laparoscopic cholecystectomy, and to study the effectiveness of a virtual reality surgical skills simulator as a tool for surgical training and as a method for recording psychomotor behavior. This report describes the purpose of the study, its design, initial results, and implications for the field of medical education.