bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of Clinical Trials — A Concern of Three Decades
Authors: Hemminki Elina
Published: March 2018

The purpose of this article is to summarize reviews on the quality of clinical trials. Altogether 29 reviews were found. Most clinical trials were judged to be uncontrolled or poorly controlled and/or otherwise poor. To study any change over time, reviews based on reports published 1943—1959, 1960—67, and 1968—77 were considered. The proportion of controlled trials was higher in 1943—59 than in 1968—77. The proportion of trials defined as »good« was lowest in the period 1960—1967. Since the material and definitions varied from one review to the other, the results should be interpreted to reflect the reviewers’ concern about quality rather than the actual quality of the trials themselves. In fact, in most reviews, in which the criteria and material used over time were comparable, the quality of trials had improved. But various factors guarantee that worries about the quality of clinical trials will continue.
Analysis of the Logical Structure of Diagnosis and Treatment of Primary Glaucoma
Authors: Romaniuk Irena , Wawrzyñczak R. , Czechowicz-Janicka Krystyna , Doroszewski J.
Published: March 2018

The authors analysed the diagnostic process and the therapy of primary glaucoma and set up a scheme of the different steps and essential components of the procedure. This scheme is to serve as a guide to action, in particular for the less experienced physician. It will also be of value in post-graduate training.
An Indexing System for SNOMED
Authors: Wingert F.
Published: March 2018

A system for automated indexing based on the Systematized Nomenclature of Medicine . (SNOMED) is described. The fundamental algorithms are independent of SNOMED and can also be implemented for other target languages.

The algorithms are implemented in a set of programs, the most important problems of which are discussed.
Discriminant Methods as Aids to the Diagnosis of Acute Coronary Heart Disease in the Emergency Room
Authors: Moussa M. A. A. , Bhatnagar S. K. , Al-Yusuf A. R.
Published: March 2018

Multivariate stepwise logistic regression and discriminant analyses were used to reduce emergency room data to the most relevant subset of variables that could improve the sensitivity and specificity of the diagnosis of acute coronary heart disease. Both procedures selected 5 out of 29 variables collected from 154 patients : abnormality of the ST segment in the electrocardiogram (ECG), shortness of breath, history of sublingual glyceryltrinitrate intake, chest pain duration >15 minutes, and previous history of a heart attack. The stepwise discriminant function selected additional variables: chest pain as the most important symptom, retrosternal site of chest pain and T wave abnormality on the ECG. The performance of the two methods was assessed by finding the classification matrix.
Modelling Medical Organizational Systems with Nets
Authors: Rothemund M.
Published: March 2018

In the medical area problems exist in documentation, in inter-personnel communication, in planning and consistently structuring medical organizational systems over the course of time. One possibility to moderate these problems seems to be the use of formal descriptive methods. Nets are selected as flexible tools fulfilling the demands made on such descriptive methods. In this article I suggest a technique for modelling medical organizational systems which is based on place/transition nets and predicate/transition nets.
The Effects of Computerized Medical Records on Provider Efficiency and Quality of Care
Authors: Garrett L. E. , Hammond W. E. , Stead W. W.
Published: March 2018

To study the effect of computerized medical records on the efficiency of providers and the quality of care, 245 patient visits were randomly assigned to manual (134 visits) or computerized (111 visits) records during the implementation of a comprehensive medical information system, TMR, in the renal clinic of the Durham VA Medical Center. Data were collected on the time required for the providers to perform their various functions in the clinic. With the exception of prescription writing, the computerized records resulted in significant reductions in the time required for the physicians to obtain data from and enter data into the record (p <0.01). A similar time reduction was noted for the nursing pre-interview (p <0.001) when the computerized records were employed. With the inclusion of the time required for clerical computer data entry, no overall difference in person hours per visit was noted. The clinician’s utilization of the recorded data was significantly better (p <0.001) for the computerized records. Significant reductions in medication errors were also noted (p <0.01).
Processing Medical Natural Language Data by the System WAREL
Authors: Dorda W. , Haidl B. , Sachs P.
Published: March 2018

Many clinical data are in natural language form (diagnoses, therapies, etc.). There is great interest in making these data retrievable to form samples of patients for scientific investigations (statistical analyses, courses of diseases, etc.). To perform this task, “medical natural language data” have to be prepared and stored in a retrieval-oriented database. In this paper, the advantages of processing textual data are shown in contrast to coding. Accordingly, in our system WAREL medical thesauri (like ICD 9 or SNOMED) are not used for codification; they are taken as a knowledge base during the retrieval and for testing the quality of the data during documentation. The fundamental methods (computerized textual analysis and different algorithms for comparing texts) are explained in detail, and their realization within the system WAREL is illustrated (WAREL stands for Wiener Allgemeines Relationenschema).
Three Graphic Representations to Aid Bayesian Inference
Authors: Cole W. G.
Published: March 2018

Visual representation may help physicians and patients interpret laboratory results, for example by aiding Bayesian reasoning. This paper is concerned with the psychological and formal properties of such visual representations. One popular way to present laboratory results is via signal detection curves. These curves represent many parameters of a laboratory test including parameters, such as distribution variance, that are not typically known. Such curves can be seriously misleading.

Two alternative representations are suggested. Probability maps represent only the three laboratory test parameters most likely to be known: sensitivity, specificity and prevalence, and thus avoid the problems of the richer signal detection curves. Probability maps, however, do not remind the user of why there are false positives and false negatives nor of the nature of the criterion for positivity. Detection bars, a third type of representation, are a compromise between signal detection curves and probability maps.
When Are Additive Models Valid for Evaluating Proposed Research?
Authors: Cardús D. , Fuhrer M. J. , Thrall R. M. , Bunch D. S.
Published: March 2018

This paper is concerned with a comparison of two broad classes of mathematical models, additive and multiplicative, for selecting the best among a number of competing project proposals addressed to a defined research objective. The analysis is predicated on the view that, though additive models are widely utilized, they are theoretically inferior to multiplicative ones. In an effort to more clearly understand when the use of additive models might be acceptable despite their logical flaws, conditions are investigated under which they yield results that are essentially equivalent to those produced by multiplicative models.
Signalling Increases in Reporting in International Monitoring of Adverse Reactions to Therapeutic Drugs
Authors: Mandel S. P. H. , Levine A. , Beleno G. E.
Published: March 2018

The present »state of the art« of monitoring events based on spontaneous, voluntary, haphazard reporting is reviewed. Particular reference is made to the problem of signalling increases in reporting in the international monitoring of adverse reactions to therapeutic drugs. It is shown how a number of different avenues of research could be usefully pursued to provide signals for increases in reporting which are more specific and more sensitive than those which are currently available. In particular, the so-called »Centre-Batch« matrix is introduced, and it is shown that the information contained in it can be used with advantage to provide signals which are more informative than those which are obtained from data aggregated over several reporting centres. Other approaches introduced include methods for the detection of patterns of adverse events, the idea of using system measures for monitoring the performance of the monitoring system itself and the potentialities of signals based on quantitative data.
Biotelemetry and Computer Analysis of Electrocardiograms
Authors: Amlinger P. R.
Published: March 2018

Routine transmission of electrocardiograms and their computer interpretation via long-distance telephone lines has been proven feasible in the Automated Electrocardiogram Project of the Missouri Regional Medical Program. Though this Pilot Project — the first on a state-wide basis — is still viewed as an applied research effort rather than a service, such biotelemetry is rapidly gaining acceptance as a medium to bring modern medicine, through modern technology, to urban and remote rural areas as well, where it is most needed.

The computer executes all the wave measuraments and calculations with incredible speed. It takes over a most boring, repetitive part of the physician’s work. However, it can only follow the instructions of the diagnostic program, compiled by expert cardiologists. Thus, it is an ever-ready, never-tiring servant for the physician and his patients.
Aufnahme, Arcliivorganisation und Krankenblatt an den Kliniken der Universität Ulm
Authors: Wolf G. K.
Published: March 2018

In der vorliegenden Arbeit wird die Datenerfassung für die klinische Basisdokumentation unter Verwendung eines OCR-A-Klarschriftlesers und eines magnetbandbeschriftenden Kleincomputers beschrieben. Dabei wird besonders auf bessere Möglichkeiten zur Fehlervermeidung hingewiesen. Der Ablauf in der Aufnahme, die Organisation des Archives und die Formulare des Krankenblattes (Deckblatt und Epikrisenblatt) werden im einzelnen beschrieben.
Medizinische Dokumentation und elektronische Datenverarbeitung in einem Universitätsklinikum (Planungen Erfahrungen — Vorschläge)
Authors: Wersig G.
Published: March 2018

Das Krankenblatt muß einerseits der Sammlung aller materiellen Datenträger dienen, andererseits aber auch den selektiven Zugriff zu in ihm gespeicherten Daten erlauben. Aus diesen Funktionen können einige Anforderungen an die Krankenblätter und Grundsätze für die Gestaltung des Krankenblattwesens abgeleitet werden. Im Klinikum Steglitz der FU Berlin soll die Speicherfunktion prinzipiell durch ein Mikrofilmarcbiv erfüllt werden, während der selektive Zugriff über die computergeführte Basisdokumentation möglich sein soll. Einige dabei zu beachtende Arbeitsverfahren werden skizziert.
An Overview of Total Medical Information Systems
Authors: BALL M. J.
Published: March 2018

This paper is addressed to the practising physician, hospital administrator, and allied health professional. The function of a computerized information system in health care today is defined as a traffic controller, Factors justifying the implementation of a hospital information system will be discussed and the crucial considerations of competent management and long-range education explained. The paper describes various philosophies undertaken and reviews the approaches of a sampling of vendors and organizations endeavoring to implement computerized hospital information systems. Included in each system discussion is: 1.) a brief description of the functions undertaken, 2.) hardware and software used, type of terminal used for input at designated stations, 3.) a listing, where possible, of planned and/or present instillations, 4.) an approximate cost figure, where available, and 5.) a brief statement containing additional information.

The Appendix composes a list of locations of operational total systems should the reader desire either to arrange a site visit or obtain additional information.
Linear Discriminatory Analysis: A Patient Classifying for Research and Production Control
Authors: HALLEN B. , HALL P. , SELANDER H.
Published: March 2018

Administrative and medical information about the patient forms, in each case, a pattern, the complexity of which increases as the number of data grows. Even when the data are 4—5 in number, the human ability to recognize and distinguish between different patterns begins to fail, A mathematical method (linear discriminatory analysis) has been worked out. This system of analysis appears to provide opportunities of placing patients with the same or similar patterns in classes which are diagnostically, prognostically or therapeutically homogeneous.
The World Health Organization’s Programme for the Histopathoiogical Definition and Classification of Tumours
Authors: SOBIN L. H.
Published: March 2018

A brief description is given of the efforts of the World Health Organization to facilitate international communication and comparability of data in oncology by developing uniform classifications and nomenclatures for the microscopic definition of tumours. This has involved the collaboration of over 200 pathologists in 46 countries, in a network of 19 International Reference Centres. Ten of these Centres have already completed their work. Reports have begun to appear in the literature of studies based on the classifications they have prepared.
Processing of Histopathological Data
Authors: GERARD-MARCHANT R. , WOLFF-TERROINE M. , RENAUD M. , AQARQ M.
Published: March 2018

A method is presented for processing data from the histopathological laboratory of a cancer hospital. Emphasis is laid on the ease of use, the connection of medical, administrative and financial data, and the strictness of control of patient’s identification number. The system can be used separately; it is also a module for a large integrated system covering all the activities of the hospital.
Real “Time Entry and Display of Clinical Data in an Intensive Care Unit)
Authors: JOLY H. , TROTTER J. , WEIL M. H. , SHUBIN H.
Published: March 2018

A system for entry, storage and retrieval of textual information on the patient’s history and physical examination, as well as the physician’s progress notes, has been designed for use in a critical care environment: The system, which utilizes a digital computer, concurrently monitors signals from sensors measuring physiological parameters.

Textual information on the history and physical examination is entered into the computer by the physician or nurse using a bedside terminal. Coded formats are used to enter the data. Provision is also made for entry of comments in natural language and for formal structuring of answers by the use of selected comments from lists of answers. The information is stored on a disk as textual summaries which are interwoven with analog summaries.

Data on current patients, or on previous patients, are displayed on the terminal on request of the physician. This method of handling textual information provides a practical means of acquiring detailed clinical data and correlating it with physiological measurements, thereby facilitating rapid interpretation of changes in the status of the critically ill patient.
Ein Wilcoxon-Vorzeichenrangtest für stratifizierte Stichproben
Authors: HUBER H. , LIENERT G. A.
Published: March 2018

Von Wilcoxons Vorzeichenrangtest für Lageunterschiede ausgehend wird die Frage untersucht, wie zu verfahren sei, wenn eine Stichprobe von Beobachtungspaaren bzw. ihrer Differenzen nicht homogen sondern geschichtet ist, wie z. B. bei Patienten mit verschiedenen Diagnosen. Es wird vorgeschlagen, für Wilcoxons Vorzeichenrangtest eine Stratifizierungsmodifikation der gleichen Art zu verwenden, wie sie für den Zweistichprobentest bereits existiert. Abschließend wird diskutiert, unter welchen Bedingungen die beiden rivalisierenden Tests — der stratifizierende Vorzeichenrangtest und der Vorzeichentest — indiziert sind.
An Evaluation of the Rheumatology Periodical Literature used in Britain and the USA
Authors: THORPE P.
Published: March 2018

An application of the Gross and Gross method for the evaluation of periodicals to the literature of rheumatology used by workers in the UK and USA, has shown that a relatively small number of English language periodicals, the majority of which are not specialist rheumatology ones, contain a high percentage of the relevant papers.

It is hoped that this data will be of value in the organization and administration of medical libraries and information units, and useful to the rheumatologist anxious to regularly scan those periodicals which are potentially of the most use to him.
PAULA: Programm zur Auswertung logischer Ausdrücke
Authors: WINGERT F.
Published: March 2018

In zunehmendem Maße werden in den Kliniken Markierungsbelege verwendet, die auf Fehler unter-sucht und ausgewertet werden miissen. Hieraus ergeben sich einige grundsätzliche Probleme und dem-entsprechend Möglichkeiten für generelle Auswertungsverfahren. Die Zustände der Positionen eines Mar-kierungsbeleges können interpretiert werden als logische Variablen. Kombinationen der Zustände von Positionen stellen sich dar als logische Ausdrücke. Die logischen Ausdrücke können Bedingungen sein, die bei fehlerfreien Markierungen der Belege erfüllt sein müssen (Plausibilitäten), oder Merkmale, die im Datenkollektiv gezählt werden sollen. Daneben können gekreuzte Häufigkeitszählungen mehrerer Merkmale und die Untersucbung der Abhängigkeit der Merkmale voneinander von Interesse sein. Es wird ein Verfahren beschrieben, das die Formulierung von Plausibilitäten, Auswertungsfragen und gekreuzten Häufigkeitszählungen in einer einfachen formalen Sprache zuläßt. Damit können solche Fehler in den Markierungsbelegen angezeigt und eliminiert werden, die zu Widersprücben in den Informa-tionen führen.

Das Programm PAULA zur Auswertung der logischen Ausdrücke ist in der Sprache PL/1 geschrieben und auf der Anlage IBM/360—67 getestet worden.
A System Approach to Medical Information
Authors: Davis Lou S.
Published: March 2018

Most effort using computers in medicine the past few years has been spent on optimizing the subsystems, e.g., the clinical laboratory, electrocardiogram analyses, business and administrative information, etc. While these areas are important, it is time more effort should be expended in terms of a system to integrate these subsystems. Goals and requirements for such a system are discussed. An operating system capable of handling and modularly adding all medical data, for the subsystems, in a systematized and standardized way is described. The system features a flexible, comprehensive and efficient computer medical record which has the capability of keeping all data over the lifetime of each patient.
The Role of the Physician-Computer Interaction Interpretation of Scintigraphic Data
Authors: Höhne H. K. , Pfeiffer G.
Published: March 2018

It is well known that the application of computers in scintigraphy largely improves the diagnostic value of scintigrams. The speed for finding the diagnosis and its reliability may be further enhanced by interactive data analysis, i.e. when different modes of data presentation and quantitative evaluation are offered to the physician without noticeable delay. As an example of the advantages of the interactive method some features of the system ISAAC (Interactive Scintigram Acquisition and Analysis with a Computer) are demonstrated.
Einführung in die Methoden der ätiologischen Forschung - Statistik und Dokumentation -
Authors: Koller S.
Published: March 2018

Der Begriff Einflußfaktor, der den Ursachenbegriff einschließt, wird erläutert. Ein Einflußfaktor muß statistisch nachweisbare Korrelationen (Assoziationen) zur Folge haben. Umgekehrt kann aus dem Vorliegen einer Korrelation zwischen einer Krankheit und einem Faktor nicht ohne weiteres geschlossen werden, daß der Faktor die Entstehung der Krankheit beeinflußt. Die Möglichkeiten für andere, nicht-kausale Deutungen werden ausführlich dargestellt. Die kausale Deutung wird erst durch den Ausschluß anderer Deutungen zwingend.

Ätiologische Untersuchungen bezwecken den Nachweis von Häufungen. Manchmal können zeitliche und örtliche Häufungen ohne spezielle Kontrollreihen nachgewiesen werden. Besonders wichtig sind retrospektive und prospektive Vergleichsreihen, bei denen Kontrollreihen unerläßlich sind. Voraussetzungen und Anforderungen an die Planung, die Beobachtungen und die Dokumentation, ohne deren Erfüllung die Ergebnisse nicht brauchbar sind, werden eingehend besprochen. Subjektive Einflüsse auf die Beobachtung können insbesondere bei retrospektiven Reihen erhebliche systematische Fehler verursachen. Prospektive Reihen sind weniger fehleranfällig, erfordern aber einen erheblich größeren Reihenumfang.

Besonderheiten treten auf, wenn viele Faktoren und Krankheiten systematisch auf Zusammenhänge überprüft werden sollen. Für die Untersuchung von Medikamenten auf Nebenwirkungen wird ein Stichprobenverfahren vorgeschlagen, bei dem jede x-te Packung als Prüfpackung gekennzeichnet wird. Die Ärzte, auf deren Verschreibung diese Packungen zufällig . ausgegeben werden, werden gebeten, das weitere Krankheitsschicksal dieser Patienten zu beobachten und einem sammelnden Institut mitzuteilen. Ein umfassendes Beobachtungssystem dieser Art enthält genügend Vergleichsmaterial, um etwaige Häufungen statistisch beurteilen zu können.

Zum Schlußwirddie Entscheidungslage für das praktische Handeln aufgrund statistisch bestätigter ätiologischer Hypothesen behandelt.
An Inspection of our Working Hypotheses in the Study of Pain and other Subjective Responses in Man
Authors: Beecher Henry
Published: March 2018

The working hypotheses of primary importance in our laboratory effort over the past 15 years have been set down. These hypotheses have been credited with playing a considerable part in the opening up of a new field in pharmacology: The quantitative study of the effects ;of drugs on the mind. Since this work has been carried out in man, usually sick man, it provides another example of the fundamental importance of the clinic in the advancement of special basic areas in pharmacology and psychology.
Transformations of Variables in Clinical-Therapeutical Research
Authors: Martin L.
Published: March 2018

When the clinician gets the figures of body measurements or laboratory and functional tests, he has to see if the results fall into the range of normal variability or outside. This may only be defined by reference to an alleged homogeneous population whose description implies statistical tools in order to specify the distribution of clinical features. In clinical-therapeutical research like clinical trials, a more elaborate knowledge of the kind of distributions of the characters under study is needed. Very often, for the validity of the statistical calculations, the raw data will not be used as such and appropriate transformations of the data will be used.

After recalling the importance of distribution functions in clinical research, the author gives the 1—99 or 2,5—97,5 percentile method of assessing the cases normally belonging to the population. The scale of coefficient of variation of clinical measurements goes from 0,5 % for the basal temperature to 65 % for the minimal effective dosis of digitalics.

To ensure the legality of statistical reduction of data and analysis, such as analysis of variance, it is often necessary to perform transformations of raw data. Some of these lead to useful graphical representations on special papers.

For continuous variables such as height, the author considers the probit transfpr-mation of percentages. The r ankit is used in the case of ordinal data. The logarithmic transformation of data such as body weight, survival time in leukaemia and other cancers, gives straight lines after probit transformation of the cumulated percentages.

For discontinuous variables or bi nomial variab 1 e s such as counts of improved patients by several treatments, the angular transformation gives a clear graphical representation of the results of clinical trials (binomial probability paper).

In biological assay, probits and logits are widely used. For Poisson variables like Thoma’s chamber and radioactive counts, the root square transformation is appropriate. A Poisson-sum probability paper allows a quick graphic test of the Poisson distribution.

Finally, for recurrent events such as the RR interval in ECG of complete arrhythmia by auricular fibrillation, the concept of imminence (MACREZ) of occurrence of a further systole involves a simple transformation of the frequency function of the RR interval and allows an easier dissection of this frequency function in several components.

In conclusion the author shows the necessity for the research clinician to have a good training in mathematics, statistics, sampling theory and practice and emphasizes the interest of collaboration amongst clinicians both at national and international levels.
A Multi-Terminal Cathode Ray Tube System for Man-Computer-Interfacing
Authors: Reichertz P. L. , Templeton A. W. , DeLurgio L. J.
Published: March 2018

A FORTRAN compatible, Physician-Computer-Interfacing System (FCMTS) has been developed utilizing up to 24 cathode-ray tube terminals with one set of programs. The system is designed for IBM 360 computers (Model 40 and upwards) under OS and IBM 2260 terminals. It is written for local operation and interrupt control. Time consuming polling is not necessary.

According to the intended application, a FORTRAN program set has to be supplied. It must consist of a sub-executive and application oriented task routines. The sub-executive controls the logic followed by the individual terminals. The task routines perform the different tasks of the application. FCMTS has been developed for ‘RADIATE’, a system for the synthesis, formatting and transmission of radiology reports. In its current version, up to 8 CRTs may be used at the same time. FCMTS may be utilized for diagnostic routines, for compilation of patient histories and data of physical examinations, and for any other dialogue between physician and computer.
A Method of Calculating Intracranial Thermal Neutron Isodose Curves
Authors: Robertson J. S. , Levine D. A. , Fare L. E.
Published: March 2018

A method is described for obtaining by numerical integration a modified geometry factor that takes into account build-up and non-uniform source distribution patterns for use in calculating radiation doses for thermal neutrons.
Zur Klassifizierung der Geschwulstkrankheiten. Der »gesicherte« TNM-Schlüssel (Erweiterungsvorschlag zu den »General Rules« der UICC)
Authors: Arnal M.-L. , Dold U. , Ehlers C. Th. , Gögler E. , Hamperl H. , Karrer K. , Oberhoffer G. , Ott G. , Pascher W. , Proffe A. , Schmolling E. , Spiessl B. , Thurmayr R. , Wildner E. P. , Scheibe O.
Published: March 2018

Eine Erweiterung des TNM-Schlüssels für menschliche Tumoren um den Sicherungsmodus wird als Diskussionsgrundlage vorgelegt. Die Erweiterung erscheint zweckmäßig, da bei der Erfassung schwer zugänglicher Krebse bisher subjektive wie objektive Untersuchungsbefunde gleichrangig verwendet wurden. Angaben zur Topik, Histologie und das Befundungsdatum ergänzen die Tumorbeschreibung. Der gesicherte TNM-Schlüssel sollte Teil jeder maschinell auswertbaren Krankengeschichte sein.
Datenverarbeitung im Krankenhaus — Krankenhaus-Informations-System
Authors: Hollberg N. , Fehler J.
Published: March 2018

Das Krankenhaus ist heute eine hochtechnisierte, in ihrem Betriebsablauf stark differenzierte Ein- ■ richtung. Die Kosten, sowohl des laufenden Betriebs als auch der notwendigen Investitionen, sind vor allem aufgrund der Personalintensität beträchtlich gestiegen. Dies sind Gründe, die zu einer Neuorientierung in der betrieblichen Organisation unserer Krankenhäuser führen müssen. Grundlage dafür muß eine vollständige Erfassung des Geschehens und — daraus abgeleitet — eine Darstellung dieser Daten sein. Allerdings steht der technisierte Ablauf des Rechnungswesens dabei nicht im Vordergrund, das Krankenhaus-Informations-System — KIS — soll Spiegelbild des gesamten Geschehens sein, über das einzelne Krankenhaus hinaus sollte es die Basis für ein allgemeines Informationswesen sein, das alle Krankenhäuser eines Bezirkes, eines Landes, im Endziel alle Krankenhäuser der Bundesrepublik erfaßt. Dadurch könnte eine sinnvolle Abstimmung und Planung in allen Bereichen — wirtschaftlichen wie medizinischen — ermöglicht werden.
Prüfung der Zuverlässigkeit medizinischer Fragen in der epidemiologischen Forschung
Authors: Grüntzig A. , Blohmke M. , Depner R. , Augsburger W.
Published: March 2018

Mit der Test-Retest-Methode wurde eine Reliabilitätsprüfung medizinischer Fragen durchgeführt. Die Doppelbefragung fand im Sommer 1967 im Abstand von 14 Tagen an einer Probandengruppe von 100 Bediensteten der Deutschen Bundesbahn statt. Der so getestete Fragebogen enthält die Fragen nach der Angina pectoris (effort pain) und die Frage nach einem- möglichen Herzinfarkt (possible infarction) des von der Weltgesundheitsorganisation empfohlenen Chest-pain questionnaire. Die übrigen Fragen wurden neu entwickelt. Der Fragebogen wird in der-Epidemiologie der Herz-Kreislauferkrankungen angewendet. Die Reliabilität der-Antworten auf medizinische Fragen, insbesondere die aus dem Engliscben übersetzten, wird diskutiert.
Ätiologische Untersuchungen bei Mißbildungen
Authors: Degenhardt K.-H.
Published: March 2018

Ätiologische Untersuchungen bei angeborenen Mißbildungen des Menschen setzen eine sorgfältige Einarbeitung in die morphologischen Gegebenheiten und entwicklungsphysiologischen Gesetzmäßigkeiten vor allem der frühembryonalen Entwicklungsstufen voraus. Ursächlich auslösende Faktoren einer Entwicklungsentgleisung sind in der Regel vielfältig und wirken zusammen. Nur durch eine Kombination retro- und prospektiver Untersuchungen unter kritischer Beachtung möglichst vieler Fehlerquellen ist es möglich, einzelne teratogene Faktoren zu eliminieren und deren Wirksamkeit zu ergründen. Kritische epidemiologische und demographische Untersuchungen über die Frequenzen angeborener Mißbildungen auf breiter Basis sind in unserem Lande noch recht spärlich. Es ist dringend erwünscht, die Arbeiten auf diesem speziellen Gebiet zu intensivieren. Die Einführung der Meldepflicht für alle angeborenen Entwicklungsstörungen und die Einrichtung zentraler Erfassungsstellen in den einzelnen Ländern würden dazu beitragen, ätiologische Untersuchungen in größerem Umfang durchzuführen und uns dem Ziel einer Prophylaxe angeborener Entwicklungsstörungen näherzubringen.
A Trace Metals, Radiobiology, and Cancer Information Retrieval System (Tracirs)
Authors: Lunin Lois
Published: March 2018

A method is described which was designed to retrieve key facts as well as references in a computer-based pathology information system. The facts appear in the form of miniature abstracts which also serve as a machine-searchable index. This combined index-abstract provides a form suitable both for computer storage and retrieval as well as for a desk reference guide. One product of the system is the pilot edition of the Trace Metals Literature Index-Handbook which supplies data and references on elements, mostly trace metals, as they may be related to normal and pathologic conditions.
Syntropie von Krankheiten
Authors: Lange H.-J.
Published: March 2018

Die Bezeichnung Syntropie geht auf den Pädiater Pfaundler zurück. Syntropie bedeutet, daß zwischen zwei Krankheiten eine Art gegenseitiger »Anziehung«, Dystropie hingegen, daß eine Art »Abstoßung« besteht. Erster Schritt der Syntropieforschung ist die statistische Prüfung, ob beobachtete Koinzidenzen von Krankheiten als zufällige Phänomene betrachtet werden müssen. Viele Ansätze auf dem Gebiet der Syntropieforschung sind falsch. Die Fehler beruhen — abgesehen von Fragen der Dokumentation und der Definition von Krankheitseinheiten — nicht selten auf der Nichtbeachtung folgender Punkte:

1. Es ist oft sehr schwierig, die Vergleichsgruppen bzw. die Populationen sinnvoll abzugrenzen.

2. »Statistisch gesicherte« Assoziierungen oder Dissoziierungen zwischen zwei Krankheiten können ohne dahinterstehende biologische Realität gleichsam als artifizielle statistische Effekte entstehen:

a) Durch verschieden große Selektion der zu untersuchenden Krankheitsfälle, z. B. durch frühere Sterblichkeit, durch unterschiedliche Einweisungshäufigkeiten und verschieden intensive Diagnostik bei klinischem Krankheitsgut oder durch unterschiedliche Letalität bzw. verschieden große Sektionshäufigkeiten bei Obduktionsmaterial.

b) Als Heterogenitätseffekt (illusory associations by amalgamation of subgroups).

3. Durch Nichtbeachtung des Zeitablaufs beim Auftreten der Krankheiten (incidence, prevalence, competition of risks).

Es gibt keine Standardverfahren zur Uberwindung dieser Schwierigkeiten. Die Methoden müssen der Materialgewinnung und den Besonderheiten der betrachteten Krankheiten in den zu vergleichenden Gruppen angepaßt werden.
Klassifizierung evozierter Potentiale durch lichtgriffelausgewertete Helligkeitsmuster von EEG-FFT-Spektren
Authors: Spreng M. , Vollmar R.
Published: March 2018

Voreilencle und begleitende EEG-Abschnitte von Rohdatensätzen, welche jeweils einen reizsynchronen EEG-Abschnitt und ein verborgenes evoziertes Emzelpotential enthalten, werden einer Fast-Fourier-Transformation (FFT) unterworfen. Auf einem grafischen Bildschirm des Rechners PDP-15 erscheinen ihre Spektren dargestellt als Gesamtmuster bestehend aus Linien mehr oder weniger ausgeprägter Helligkeit entsprechend den Gipfelwerten der berechneten Spektren.

Die lichtgriffelgestützte Beurteilung von relativen Helligkeitsunterschieden erlaubt leicht die Berechnung von Geraden, welche die Verschiebungstendenz relativer Gipfel innerhalb der EEG-Spektren repräsentieren. Unter Benützung von Steigungen, Ordinatenwerten und Winkeln liefern diese Geraden verschiedene Klassen für separierte Mittelungsprozesse der Rohdatensätze.

Erste Ergebnisse dieser Klassifizierungsart zeigen differenziertes Verhalten der späten Hauptkomponenten und der Amplitudenvariabilität von gemittelten akustisch evozierten Potentialen sowie den Einfluß unterschiedlicher Vigilanzlage.
Short-lived Technical Literatures: A Bibliometric Analysis
Authors: Worthen D. B.
Published: March 2018

Much work has been completed on the application of quantitative measures to literatures dealing with the subject area devoted to ideas or concepts. Little or no work has been reported on the use of these techniques in an applied situation, on a literature devoted to a scientific product. This study attempts to apply the quantitative measures to such a literature and examine some of the implications of the results in terms of professional action on the part of the librarian or information scientist. Bibliometric techniques developed on long-lived literatures are applicable to short-lived literatures devoted to a sample of two pharmaceutical products.
Medizinische Kinderschutz-Hotline
Authors: Clemens V. , Witt A. , von Moers A. , von Aster M. , Kölch M. , Plener P. , Fegert J. M. , Berthold O.
Published: March 2018

Fragen des Kinderschutzes berühren, angesichtsder Angaben der Weltgesundheitsorganisationfür die europäische Region, fast jedePerson, die im Gesundheitswesen tätig istund lösen nicht selten Fragen und Unsicherheiten bei den damit befassten Angehörigender Heilberufe aus. Durch das Bundeskinderschutzgesetzund die dort festgeschriebeneBefugnisnorm für Berufsgeheimnisträger wieAngehörige der Heilberufe wurden Rechtssicherheitund neue Handlungsmöglichkeitengeschaffen.

Dennoch gibt es hinsichtlich der Kooperationzwischen Gesundheitswesen und Jugendhilfenach wie vor deutlichen Verbesserungsbedarf.Es bleibt eine zentrale Aufgabe, zu einergemeinsamen Sprache zwischen den Berufsgruppenzu finden.

Daher fördert das Bundesministerium für Familie,Senioren, Frauen und Jugend (BMFSFJ)seit 1. Oktober 2016 für drei Jahre das Projekt“Medizinische Kinderschutz-Hotline für ärztlichesund heilberufliches Fachpersonal” desUniversitätsklinikums Ulm in Kooperation mitden DRK Kliniken Berlin und der MedizinischenHochschule Brandenburg.

Seit 1. Juli 2017 bietet die Hotline bundesweiteine kollegiale Beratung durch Ärztinnen undÄrzte mit spezifischem Hintergrundwissen inKinderschutzfragen und einer speziellen Ausbildungzu Strukturen und Hilfemöglichkeitenim Bereich der Jugendhilfe.

Unter der Rufnummer 0800 19 210 00 ist dieMedizinische Kinderschutz-Hotline rund umdie Uhr an sieben Tagen in der Woche, kostenfreiund bundesweit zu erreichen.
Dokumentations- und Auswertprobleme bei der Definition von Kon trollgruppen in epidemiologischen Studien
Authors: Netter Petra
Published: March 2018

Die methodischen Besonderheiten epidemiologischer Studien im Vergleich zum Experiment werden am Modell der für jede Ursachenforschung gültigen Beziehung zwischen Reiz—Organismus variable— Reaktion erläutert. Drei Fehlerquellen, die sich auf die Planung, Dokumentation, Auswertung und Ergebnisinterpretation epidemiologischer Untersuchungen auswirken, werden an Hand von Beispielen aus der Studie »Schwangerschaftsverlauf und Kindesentwicklung« hervorgehoben:

1. Ein Einflußfaktor kann durch organismusdeterminierte Selektionsprozesse entweder untrennbar oder — aufgrund fehlender Dokumentation von Begleitumständen — unkontrollierbar an zusätzliche Bedmgungsfaktoren geknüpft sein. Dadurch lassen sich Zahl und Art der zu bildenden Kontrollgruppen oft nicht den theoretischen Forderungen anpassen. Diese Situation betrifft vor allem die Prüfung von an Indikationen und Gegenindikationen gebundenen Therapiemaßnahmen.

2. Die zeitliche Koinzidenz zwischen Einflußund Zielereignis kann Scheinassoziationen stiften oder wahre Korrelationen verdecken, wenn bei der exponierten und der Kontrollgruppe nicht streng vergleichbare Beobachtungsabschnitte zur Beurteilung herangezogen werden.

3. Einfluß und Zielmerkmal können mit einzelnen oder mehreren, ursächlich untereinander verknüpften DrittgröJ3en assoziiert sein. Dadurch verursachte Heterogenitätseffekte müssen 1. durch zweidimensionales Tabellen-Screening aufgedeckt und 2. durch Stratifikation bzw. Matched-pairTechnik ausgeschaltet oder mit Hilfe von multivariaten Verfahren auf ihre Zusammenhangsstrukturen untersucht werden.
A Suggestion for an Effective Use of a Computer-aided Diagnosis System in Screening for Hyperthyroidism
Authors: Alpérovitch A. , Fragu P.
Published: March 2018

A computer-assisted program for diagnosing hyperthyroidism, specially devoted to the screening of functional thyroid status, has been written using data provided by 359 patients, 282 euthyroid and 77 hyperthyroid. The model is based on Bayes’ theorem.

Using only 9 clinical signs and the free thyroxin index, the program achieved, on a test-sample of 117 new patients, an overall accuracy of 90% ; 10% of the cases were in the zone of uncertainty, and none was misdiagnosed.

Different screening strategies are examined and their results discussed.
Contents Page Format in Scientific Journals Effect on Efficiency and Ease of Scanning
Authors: Kallner H. , Modan M. , Modan B. , Wolman M.
Published: March 2018

The effect of contents page format on the efficiency and ease of scanning by 54 medical scientists, was tested using 14 different format patterns. Significant differences were found between formats with respect to speed of scanning, rate of missed key words, and subjective appeal to the reader. These three criteria were not necessarily related, but some formats were better than others in all three. The results seem to indicate that when the material directly related to the immediate purpose of the scanner is separated from unrelated material, such as in a separate column, and when the unrelated material is more concentrated spatially, efficiency of scanning is increased. Study of newly devised formats may lead to an optimal one with considerable gain in total scanning time and rate of key words located, as well as reduction in fatigue.
A Method for Analyzing Mortality Data Collected in Follow-up Studies
Authors: Woolson R. F. , Tsuang M. T. , Fleming J. A.
Published: March 2018

An approach to the analysis of mortality data gathered in long-term follow-up studies is described. The methodology is appropriate for situations in which it is of interest to contrast a study sample to a larger reference population. The main advantage of the approach is the ability to handle the age heterogeneity of the study group. Two variations of the general method are developed: the unconditional and conditional methods. The conditional approach is illustrated by application to data which arose in a study in psychiatric epidemiology.
Statistical Problems in Monitoring Adverse Drug Reactions
Authors: Moussa M. A. A.
Published: March 2018

This paper proposes a probabilistic basis for monitoring adverse reactions to drugs, with allowance for the heterogeneities and irregularities inevitable among spontaneously submitted reports. The model partitions the population of reports into subpopulations. Each subpopulation includes clusters, a cluster being defined as a homogeneous group of reports on one drug set from one subpopulation in unit time. Signals from clusters can be more informative than those obtainable from data aggregated over the whole population.

Reports in one cluster on a particular event (drug-reaction association) are assumed to conform to a Bernoulli distribution, with a parameter varying between clusters of the same subpopulation according to a two-parameter beta distribution and a cluster size that follows a negative binomial distribution. The four parameters of the compound model are estimated by maximum likelihood. The one-sided numerical cumulative sum test (NCST) is proposed as a signalling procedure; its performance characteristics are studied by Monte Carlo sampling. Data from the UK Committee on Safety of Medicines are used in an example.
The Notion of Time in Medical Records — Structure of Chronology, Validation and Calculation of a Time Interval
Authors: Martin J. M. , Pointel J. P. , Martin J. , Debry G.
Published: March 2018

The reasons for and requirements of collecting chronological information in a chronic progressive disease are considered. The authors discuss the rules for writing the chronology together with the algorithms permitting full validation. They show from examples the kinds of studies made possible by the chronology. Taking the progressive nature of the disease into consideration, its chronicity and numerous degenerations necessitate the structuration of different occurrences of the same notion. Hence, there results the development of chronological axes relative to each notion. Our procedures used operationally for several years are only limited in their efficacy by the time the doctor can spare to use them.
J 5 — A Data Processing System for Medical Information
Authors: Hall P. , Mellner Ch. , Danielsson T.
Published: March 2018

A system for medical information has been developed. The system is a general and flexible one which without reprogramming or new programs can accept any alphabetic and/or numeric information. Coded concepts and natural language can be read, stored, decoded and written out. Medical records or parts of records (diagnosis, operations, therapy, laboratory tests, symptoms etc.) can be retrieved and selected. The system can process simple statistics but even make linear pattern recognition analysis.

The system described has been used for in-patients, outpatients and individuals in health examinations.

The use of computers in hospitals, health examinations or health care systems is a problem of storing information in a general and flexible form. This problem has been solved, and now it is possible to add new routines like booking and follow-up-systems.
MARS — Its Tenth Anniversary of Operation and its Future
Authors: Lodwick G. S. , Wickizer C. R. , Dickhaus R. E.
Published: March 2018

The Missouri Automated Radiology System recently passed its tenth year of clinical operation at the University of Missouri. This article presents the views of a radiologist who has been instrumental in the conceptual development and administrative support of MARS for most of this period, an economist who evaluated MARS from 1972 to 1974 as part of her doctoral dissertation, and a computer scientist who has worked for two years in the development of a Standard MUMPS version of MARS. The first section provides a historical perspective. The second deals with economic considerations of the present MARS system, and suggests those improvements which offer the greatest economic benefits. The final section discusses the new approaches employed in the latest version of MARS, as well as areas for further application in the overall radiology and hospital environment. A complete bibliography on MARS is provided for further reading.
The Value of Subjective Appreciation in the Medical Record — I. The Evaluation of Dyspnoea
Authors: Lahaye D. , Roosels D. , Viaene J.
Published: March 2018

In this paper the authors assess the value of some subjective appreciations of physicians based on patients’ history and clinical examination. The feature »dyspnoea« has been chosen for analysis by APL system of a standardized population of pneumoconiosis patients. On this sample (n = 11,728) the dyspnoea stage was correlated with the F.E.V. 1 value. Although the interindividual variation between physicians’ evaluations is evident, the subjective dyspnoea staging shows a good correlation with the corresponding F.E.V. 1 alteration. Because of the large spread of the F.E.V. 1 results in each dyspnoea stage, however, the predictive value in the individual case is reduced.
Current Status of the World Health Card Systems
Authors: Takahashi T.
Published: March 2018

The perspective of our health card project has progressively changed from that of a pilot within a local environment (hospital, practice, community, etc.) to a large and national dimension. The interest of the many actors involved in health cards (health care authorities, insurance companies, social security agencies, standardization bodies, manufacturers, system integrators, etc.) is focusing increasingly on the role that the health card may have as an enabling component within the global communication and information system that will interconnect all points of care and services in a national healthcare system.
Section 1: Health and Clinical Management: Leveraging Information Technology to Improve Quality and Safety
Authors: Bates D. W. , Einbinder J. S.
Published: March 2018

To examine five areas that we will be central to informatics research in the years to come: changing provider behavior and improving outcomes, secondary uses of clinical data, using health information technology to improve patient safety, personal health records, and clinical data exchange.

Potential articles were identified through Medline and Internet searches and were selected for inclusion in this review by the authors.

We review highlights from the literature in these areas over the past year, drawing attention to key points and opportunities for future work.

Informatics may be a key tool for helping to improve patient care quality, safety, and efficiency. However, questions remain about how best to use existing technologies, deploy new ones, and to evaluate the effects. A great deal of research has been done on changing provider behavior, but most work to date has shown that process benefits are easier to achieve than outcomes benefits, especially for chronic diseases. Use of secondary data (data warehouses and disease registries) has enormous potential, though published research is scarce. It is now clear in most nations that one of the key tools for improving patient safety will be information technology— many more studies of different approaches are needed in this area. Finally, both personal health records and clinical data exchange appear to be potentially transformative developments, but much of the published research to date on these topics appears to be taking place in the U.S.— more research from other nations is needed.