bluuebunny/crossref_metadata_2025 huggingface dataset:
Isolated Lateral Meniscal Tear in the Dog
Authors: Johnson S. , Hulse D.
Published: March 2018

degenerative changes of the involved stifle joint associated with a “bucket handle” tear of the caudal body of the lateral meniscus. Surgical excision of the torn section of meniscus was beneficial in the first patient but this patient had persistant difficulty with the leg after exercise. Gross and microscopic pathology of the involved stifle in the second patient showed the meniscal lesion to be associated with severe cartilage fibrillation of the overlying lateral femoral condyle. As in human beings, the mechanism of injury may have been placement of the foot during vigorous external rotation of the femur with the stifle flexed. Extension of the limb from this position could have resulted in an isolated tear of the lateral meniscus.
Evaluation von Programmen zur integrierten psychiatrischen Versorgung
Authors: Kilian R.
Published: March 2018

Die Diskussion über die positiven und negativen Auswirkungen von Programmen zur integrierten psychiatrischen Versorgung leidet in erheblichem Umfang unter der Tatsache, dass keine verallgemeinerungsfähigen Ergebnisse wissenschaftlicher Evaluationsstudien vorliegen. Die Gründe für das weitgehende Fehlen einschlägiger wissenschaftlicher Studien zur Wirksamkeit und Effizienz von IV-Programmen liegen dabei in dem komplexen Charakter der zu bewertenden Intervention. Komplexe Interventionen zur Gesundheitsversorgung zeichnen sich dadurch aus, dass die von ihnen erwarteten Effekte erst durch das Zusammenwirken verschiedener Einflussfaktoren zustande kommen, die darüber hinaus in der Regel in hohem Maße durch Rahmenbedingungen beeinflusst werden unter denen die Intervention stattfindet. Im Rahmen dieses Beitrags werden die spezifischen Merkmale komplexer Interventionen im Gesundheitswesen dargelegt und die sich ergebenden methodischen Anforderungen und Probleme für eine wissenschaftliche Evaluation erörtert. Auf der Grundlage dieser allgemeinen Ausführungen werden die spezifischen Komplexitätsmerkmale von Programmen zur integrierten psychiatrischen Versorgung herausgearbeitet und ein Konzept zur Planung und Durchführung einschlägiger Evaluationsstudien entworfen.
Profitinteressen passen nicht zu einer sozialen Psychiatrie
Authors: Elgeti H.
Published: March 2018

Gegenstand und Ziel: Der Beitrag beschreibt den Kontext, der den viel kritisierten Selektivvertrag der AOK-Niedersachsen zur integrierten Versorgung für Schizophrenie ermöglichte. Behandlungskonzept und Probleme bei der Umsetzung werden skizziert.

Material und Methode: Die Darstellung stützt sich auf langjährige Begleitung der Reformbemühungen in Niedersachsen und eine kritische Auseinandersetzung mit den wenigen Protagonisten des Selektivvertrags aus der sozialpsychiatrischen Szene. Erfahrungsberichte der sozialpsychiatrischen Dienste wurden einbezogen.

Ergebnisse: Selektivverträge sind kein geeigneter Weg zur Qualitätsentwicklung in der Psychiatrie. Außerhalb befristeter und regional eingegrenzter Modellerprobungen dienen sie vor allem der Reduktion von Kosten und Realisierung von Profiten bei Krankenkassen, Investoren und Hilfsanbietern.

Schlussfolgerungen: Die Eroberung der Psychiatrie durch einen entzügelten Kapitalismus ist Folge mangelnder Verantwortung der Politik und der Kostenträger für eine flächendeckend bedarfsgerechte Versorgung. In dieser Situation ist es Aufgabe der Sozialpsychiatrie, weder zu resignieren noch den Verführungen des freien Marktes zu erliegen.
Schematherapie
Authors: Arntz A. , Jacob G. A.
Published: March 2018

Schematherapie ist ein integrativer psychotherapeutischer Ansatz insbesondere zur Behandlung von Persönlichkeitsstörungen (PS) und Patienten mit chronischen und komplexen psychischen Störungen. Er kombiniert Konzepte der Verhaltenstherapie, der Tiefenpsychologie sowie humanistischer Ansätze, insbesondere der Gestalttherapie. Schwerpunkte liegen auf dem Einsatz der Therapiebeziehung als korrektiver Erfahrung (begrenztes Nachbeeltern) sowie auf emotionsfokussierten Methoden. Neben einem allgemeinen störungsübergreifenden Konzept wurden störungsspezifische Modelle für verschiedene PS entwickelt. Mehrere randomisiert-kontrollierte Studien wurden bei Patienten mit Borderline-PS durchgeführt. Eine randomisierte, kontrollierte Studie wurde zudem bei Patienten mit anderen PS abgeschlossen, eine weitere große Studie läuft bei forensischen Patienten. Alle Studien zeigen eine gute Wirksamkeit, wobei eine ausreichende Dauer der Behandlung ausschlaggebend zu sein scheint. In diesem Artikel wird das klinische Vorgehen und der aktuelle Stand der
Expositionsbasierte kognitive Therapie bei Depressionen
Authors: Krieger T. , Grosse Holtforth M.
Published: March 2018

Depressionen können erfolgreich behandelt werden, doch die Nachhaltigkeit psychotherapeutischer Effekte ist weiterhin eine Herausforderung. Expositionsbasierte Kognitive Therapie (EBCT) versucht, gleichzeitig Symptomatik und Depressionsvulnerabilität durch verstärkte kognitiv-emotionale Verarbeitung zu verändern. Die EBCT umfasst drei Behandlungsphasen: Aufbauphase zur Stabilisierung und Stärkung inklusive Achtsamkeitsübungen, Expositionsphase zur Bearbeitung depressionsrelevanter Selbstanteile mit emotionsfokussierten Methoden und Konsolidierungsphase zum Transfer erworbener Fertigkeiten und Erkenntnisse in den Alltag. In empirischen Studien konnten Belege für die Umsetzbarkeit der Methodenintegration sowie Akzeptabilität der Behandlung erbracht werden. In einer Vergleichsstudie zeigten sich große und der kognitiven Verhaltenstherapie (KVT) vergleichbare Prä-Post-Effekte der EBCT. Die kognitiv-emotionale Verarbeitung erfolgte hauptsächlich in der Expositionsphase und sagte das Therapieergebnis vorher. Die EBCT ist ein Beispiel für die erfolgreiche Integration ursprünglich theoriefremder Interventionen in die KVT. Zukünftige Entwicklungen der Depressionstherapie werden diskutiert.
Neue Welle der Verhaltenstherapie
Authors: Fiedler P.
Published: March 2018

In den vergangenen Jahren sind eine Reihe neuer Therapieperspektiven in der Verhaltenstherapie diskutiert und teils als neuartige Konzepte eingeführt worden. Dieser Entwicklung entsprechend sind die Beiträge in diesem Themenheft ausgesucht und zusammengestellt worden. Nachfolgend sollen einige zentrale Gesichtspunkte dieser Entwicklung übergreifend kritisch beleuchtet werden. Die Konzepte dieser neuen Wellenbewegung in der Verhaltenstherapie zeichnen sich durch einige Gemeinsamkeiten aus, die als Fortschritt angesehen werden dürfen. Einerseits handelt es sich um die Wiederentdeckung des emotionalen Erlebens und unterbewusst angeregter emotionalen Prozesse und Handlungsroutinen. Andererseits erhält die Verhaltenstherapie auch mit dem Zulassen einer Psychodynamik der therapeutischen Beziehung ein neues Gesicht, weil die zwischen Therapeut und Patient aktivierten dysfunktionalen Handlungsroutinen ausdrücklicher als bisher üblich in die Reflexion zwischen Therapeut und Patient einbezogen werden. Damit finden nicht mehr nur das Störungsbild selbst, sondern auch die in der Übertragungsbeziehung aktualisierte Symptomatik und damit verknüpfte Kernbedürfnisse als therapeutischer Wegweiser ihre Berücksichtigung.
Evaluation of the Influence of Image Compression to the Automatic Discrimination of Histological Images of Skin Lesions
Authors: Gerger A. , Wagner C. , Bergthaler P. , Smolle J. , Wiltgen M.
Published: March 2018

Objectives:
Telemedicine offers the possibility to get the opinion of an expert within a short time. To reduce data transfer via a network image compression is recommended. The disadvantage of error-free compression is a low compression rate. On the other hand an increased compression rate affects the information content of the image. In this study we evaluated the influence of the compression rate on the automatic discrimination of histological skin lesions in dermatopathology.

Methods:
To be independent from subjective reviewing by a dermatopathologist we used tissue counter analysis (TCA) for automatic discrimination of skin tissue. TCA is based on the partition of the image into square elements where the features are calculated out of each square element. 40 cases of benign common nevi and 40 cases of malignant melanoma were used as the study set. First TCA was applied to the uncompressed images to check the discrimination power of the method. Then in the next steps the method was applied to the images with successively higher compression rates. For image compression the wavelet compression was used, where the compression rate was determined by neglecting wavelet coefficients with a magnitude below a given threshold. The number of remaining wavelet coefficients was used as criteria for the compression rate.

Results:
This study shows that TCA allows automated discrimination even at higher compression rates where only 6-18% of the wavelet coefficients are used for image reconstruction. The recognition rate at higher compression is better for malignant melanoma than for benign common nevi.

Conclusion:
The power of automated discrimination is not essential affected by wavelet image compression.
Abductive Network Committees for Improved Classification of Medical Data
Authors: Abdel-Aal R. E.
Published: March 2018

Objectives:
To introduce abductive network classifier committees as an ensemble method for improving classification accuracy in medical diagnosis. While neural networks allow many ways to introduce enough diversity among member models to improve performance when forming a committee, the self-organizing, automatic-stopping nature, and learning approach used by abductive networks are not very conducive for this purpose. We explore ways of overcoming this limitation and demonstrate improved classification on three standard medical datasets.

Methods:
Two standard 2-class medical datasets (Pima Indians Diabetes and Heart Disease) and a 6-class dataset (Dermatology) were used to investigate ways of training abductive networks with adequate independence, as well as methods of combining their outputs to form a network that improves performance beyond that of single models.

Results:
Two- or three-member committees of models trained on completely or partially different subsets of training data and using simple output combination methods achieve improvements between 2 and 5 percentage points in the classification accuracy over the best single model developed using the full training set.

Conclusions:
Varying model complexity alone gives abductive network models that are too correlated to ensure enough diversity for forming a useful committee. Diversity achieved through training member networks on independent subsets of the training data outweighs limitations of the smaller training set for each, resulting in net gain in committee performance. As such models train faster and can be trained in parallel, this can also speed up classifier development.
Automated Tissue Analysis – a Bioinformatics Perspective
Authors: Boyce K. , Kriete A.
Published: March 2018

Objectives:
Recent progress in automated tissue analysis (tissomics) provides reproducible phenotypical characterization of histological specimens. We introduce informatics tools to cluster and correlate quantitative tissue profiles with gene expression data. The great potential of synergies between tissue analysis and bioinformatics and its perspectives in medical research and computational diagnostics are discussed.

Methods:
Key enablers in microscopic imaging and machine vision are reviewed to perform a high-throughput tissue analysis. Methodologies are described and results are demonstrated that support a combined analysis of tissue with gene expression profiles whereby the consideration of individual responses is key.

Results:
Comprehensive histomorphometric profiles, extracted using machine vision, provide information regarding the components and heterogeneity of a tissue in a reproducible format amenable to data mining and analysis. Tissue quantitative information can be placed in synergetic context with bioinformatics data, such as gene expression profiles, for a more comprehensive stratification of individual responses. From a bioinformatics point of view tissue data are co-variants that support the identification of candidate genes relevant in tissue injury or disease.

Conclusions:
Progress in automated analytics enables the generation of quantitative data about tissue previously limited to visual histopathology. Such reproducible data sets can be statistically correlated and clustered throughout the continuum of bioinformatics. The combined approach supports a system-wide view of biology and has a potential to accelerate developments for a personalized computational diagnosis.
Selection of Predictor Variables for Pneumonia Using Neural Networks and Genetic Algorithms
Authors: Gerber B. S. , Tape T. G. , Wigton R. S. , Heckerling P. S.
Published: March 2018

Background:
Artificial neural networks (ANN) can be used to select sets of predictor variable that incorporate nonlinear interactions between variables. We used a genetic algorithm, with selection based on maximizing network accuracy and minimizing network input-layer cardinality, to evolve parsimonious sets of variables for predicting community-acquired pneumonia among patients with respiratory complaints.

Methods:
ANN were trained on data from 1044 patients in a training cohort, and were applied to 116 patients in a testing cohort. Chromosomes with binary genes representing input-layer variables were operated on by crossover recombination, mutation, and probabilistic selection based on a fitness function incorporating both network accuracy and input-layer cardinality.

Results:
The genetic algorithm evolved best 10-variable sets that discriminated pneumonia in the training cohort (ROC areas, 0.838 for selection based on average cross entropy (ENT); 0.954 for selection based on ROC area (ROC)), and in the testing cohort (ROC areas, 0.847 for ENT selection; 0.963 for ROC selection), with no significant differences between cohorts. Best variable sets based on the genetic algorithm using ROC selection discriminated pneumonia more accurately than variable sets based on stepwise neural networks (ROC areas, 0.954 versus 0.879, p = 0.030), or stepwise logistic regression (ROC areas, 0.954 versus 0.830, p = 0.000). Variable sets of lower cardinalities were also evolved, which also accurately discriminated pneumonia.

Conclusion:
Variable sets derived using a genetic algorithm for neural networks accurately discriminated pneumonia from other respiratory conditions, and did so with greater accuracy than variables derived using stepwise neural networks or logistic regression in some cases.
In Vivo and Simulation Study of Artificial Ventilation Effects on Energetic Variables in Cardiosurgical Patients
Authors: Darowski M. , Wolski P. , Ferrari G. , Tosti G. , Pisanelli D. M. , De Lazzari C.
Published: March 2018

Objectives:
The analysis of energetic ventricular variable changes during artificial ventilation, obtained by numerical simulation was done. Twenty-one sets of hemodynamic parameters for eight cardiosurgical patients were used to estimate left and right stroke work. The data were collected for three methods of ventilation: conventional, lung-protective (with minute ventilation diminished by half) and high frequency ventilation (with frequency 5, 10, or 15 Hz).

Methods:
The computer simulator (CARDIOSIM©) of the cardiovascular system, was used as a tool to calculate values of energetic ventricular variables for conditions that corresponded to these during in vivo measurements. Different methods of ventilation caused differences of intrathoracic pressure, haemodynamic and finally energetic ventricular variables. The trends of these variable changes were the same in in vivo and simulation studies, in the whole range of intrathoracic pressure changes (Pt = 1.5-3.5 mmHg).

Results:
As values of main hemodynamic variables like cardiac output or arterial, systemic and pulmonary pressures were very close in both studies. Cardiac index and left ventricular stroke work also differed less than 10% for all examined patients and computer simulation. In a case of right ventricular stroke work the difference between in vivo data and simulation was a bit greater than 10% for two of eight patients under study.

Conclusions:
Our comparative analysis proved that numerical simulation is a very useful tool to predict changes of main hemodynamic and energy-related ventricular variables caused by different levels of positive Pt. It means that it can help an anesthesiologist to choose an appropriate method of artificial ventilation for cardiosurgical patients.
Design and Analysis of Two-color Microarray Experiments Using Linear Models
Authors: Landgrebe J. , Brunner E. , Bretz F.
Published: March 2018

Objectives:
A variety of linear models have recently been proposed for the design and analysis of micro-array experiments. This article gives an introduction to the most common models and describes their respective characteristics.

Methods:
We focus on the application of linear models to logarithmized and normalized microarray data from two-color arrays. Linear models can be applied at different stages of evaluating microarray experiments, such as experimental design, background correction, normalization and hypothesis testing. Both one-stage and two-stage linear models including technical and possibly biological replicates are described. Issues related to selecting robust and efficient microarray designs are also discussed.

Results:
Linear models provide flexible and powerful tools, which are easily implemented and interpreted. The methods are illustrated with an experiment performed in our laboratory, which demonstrates the value of using linear models for the evaluation of current microarray experiments.

Conclusions:
Linear models provide a flexible approach to properly account for variability, both across and within genes. This allows the experimenter to adequately model the sources of variability, which are assumed to be of major influence on the final measurements. In addition, design considerations essential for any well-planned microarray experiments are best incorporated using linear models. Results from such experimental design investigations show that the widely used common reference design is often substantially less efficient than alternative designs and its use is therefore not recommended.
The Use of a Structured Form during Urology Out-patient Consultations
Authors: Emberton M. , Reeves B. , Thomas K.
Published: March 2018

Objectives:
To compare the completeness of documentation in the medical record using a structured form (SF) versus a traditional medical record (TMR).

Methods:
Randomised controlled trial comparing the use of SF and TMR in urology out-patient clinics for documentation of 15 items of clinical information, time taken to complete and acceptability to clinicians assessed by a self-completion questionnaire. in a teaching and district general hospitals

Results:
Four hundred new urology patient consultations, 11 clinicians. Completeness of information was compared between groups based on the medical record alone (SF vs. TMR), medical record plus letter to GP and letter alone. SFs were significantly (p<0.0001) more complete than TMRs for the majority of the items in all three groups. There was no significant difference in the time taken to document information using either type of record. The clinicians generally found the SF acceptable for routine use.

Conclusions:
Structured forms significantly improved the completeness of documentation for new out-patient consultations in urology.
Paradigms for Recording Cognitive Brain Electrical Activity
Authors: McAllister H. G. , Howard R. , Hong Neo L. , McCullagh P. J.
Published: March 2018

Human event-related potentials reflect cognitive processing, and are normally elicited by external events, such as acoustic sounds or visual stimuli. As such they provide an opportunity to study normal and abnormal brain function noninvasively, at sub-second resolution. Advances in multimedia technology permit specialists in informatics and neuropsychology to co-operate in the design and implementation of paradigms, which influence ERP components. The paper illustrates the progression from standard paradigms such as the auditory oddball, which can be used to study memory update through to contingent negative variation and three condition, visual paradigms which can be used to study cognitive and emotional responses. Data from a study investigating the comparative processing of target pictures and words illustrate how external stimuli influence the later cognitive potentials.
Partitioning an Object-Oriented Terminology Schema
Authors: Perl Y. , Halper M. , Geller J. , Kuo F. , Cimino J. J. , Gu H.
Published: March 2018

Controlled medical terminologies are increasingly becoming strategic components of various healthcare enterprises. However, the typical medical terminology can be difficult to exploit due to its extensive size and high density. The schema of a medical terminology offered by an object-oriented representation is a valuable tool in providing an abstract view of the terminology, enhancing comprehensibility and making it more usable. However, schemas themselves can be large and unwieldy. We present a methodology for partitioning a medical terminology schema into manageably sized fragments that promote increased comprehension. Our methodology has a refinement process for the subclass hierarchy of the terminology schema. The methodology is carried out by a medical domain expert in conjunction with a computer. The expert is guided by a set of three modeling rules, which guarantee that the resulting partitioned schema consists of a forest of trees. This makes it easier to understand and consequently use the medical terminology. The application of our methodology to the schema of the Medical Entities Dictionary (MED) is presented.
An Object-Oriented Framework for the Development of Computer-Based Guideline Implementations
Authors: Corb G.J , Liaw Y. , Brandt C.A. , Shiffman R.N.
Published: March 2018

Clinical practice guidelines provide a means of directing medical care towards clinically appropriate and cost-effective interventions. A direct relationship exists between the integration of a guideline into clinical workflow and the effectiveness of the guideline in influencing clinicians’ behavior. Computer-based guideline implementations, used at the point-of-care, accomplish this integration. Employing object-oriented technologies, we propose a framework of reusable components for the development of guideline implementation systems. We have identified eight information management services that are common to such systems. Our framework integrates these services and their respective reusable components into clinical workflow to promote the development of comprehensive guideline implementation systems, which should ultimately enhance guideline compliance and the overall quality of care.
Trusting the Record
Authors: Clarke K. , Hartswood M. , Procter R. , Rouncefield M. , Slack R.
Published: March 2018

Objectives: This paper aims to contribute to a longstanding interest in documents and paperwork in healthcare work through an examination of everyday work with patient records in a clinic.

Methods: An ethnographic study of record keeping practices in a deliberate self harm clinic was conducted to consider the role that document work plays in the development of trust in the routine social interactions of a working division of labor.

Results and conclusions: Issues of trust are seen to play central roles within the complexities of organizational working and some consequent implications for the deployment and use of electronic medical record systems are considered.
Big is Beautiful: Electronic Patient Records in Large Norwegian Hospitals 1980s – 2001
Authors: Ellingsen G. , Monteiro E.
Published: March 2018

Objectives: This paper aims to describe and analyze the prolonged efforts – spanning close to two decades – of developing and using electronic patient records in the large, university-based hospitals in Norway.

Methods: This study belongs to an interpretative approach to the development and use of information systems.

Results: The increase in organizational, institutional, political and technological complexity has been seriously underestimated. This paper describes and analyses the prolonged efforts – spanning close to two decades – of developing and using EPRs in the large, university-based hospitals in Norway. The investments involved were considerable, implying that a crucial aspect of these efforts has been the way alliances have been forged with public institutions and agendas.

Conclusions: The conditions for small-scale, bottom-up and evolutionary approaches never succeeded in constructing themselves as a viable alternative to the larger, more sweeping electronic patient record initiative, reiterating a more general tendency to privilege the more comprehensive and daring projects.
“Computers can land people on Mars, why can’t they get them to work in a hospital?”
Authors: Jones M. R.
Published: March 2018

Objectives: This paper aims to describe and interpret the implementation of a hospital information system in a large UK hospital.

Methods: The paper is based on a longitudinal case study over a three-year period in which a cross section of hospital staff involved with the information system were interviewed.

Results and Conclusions: Ambitious government targets for the use of Information Technology in the UK National Health Service sit alongside a history of notable project failures. The decision by a UK hospital to install an advanced, integrated electronic patient record system therefore faced conflicting demands and expectations. This paper suggests that its simple categorisation as either a success or failure is problematic. Rather, the differing viewpoints that lead some clinicians to express “disappointment” with its performance, while others described its features as “tremendous” and managers suggested that the system had become “taken for granted” are explored. A number of broader phenomena relating to the organisational processes surrounding information systems implementation are also identified.
Measuring the Completeness and Currency of Codified Clinical Information
Authors: Williams J. G.
Published: March 2018

Objectives: The paper describes how an objective score (CCscore) of the ‘completeness’ and ‘currency’ of codified clinical information relevant to the management of diabetes mellitus may be derived for individual practices.

Methods: A questionnaire was developed and administered to 35 practices and statistical methods were used to test for correlation between the prevalence for diabetes mellitus and the relevant CCscores

Results: No significant correlation could be found. Conclusions: The ‘quality’ of computer-stored information varies widely across English General practices for reasons that are incompletely understood. We demonstrated how CCscores may be calibrated for different ‘views’ of ‘relevance’, ‘completeness’, and ‘currency’ and yet be consistent across practices for a given ‘view’. The potential value of this score and how it may contribute to our understanding of variation in ‘information quality’ are discussed.
A Telemedicine Management Model Based on Message-Trigger Service
Authors: Hu B. , Ye D. , Bai J.
Published: March 2018

A telemedicine system model, based on a message-trigger service, is described. This model distributes system applications on multiple computers and establishes a communication platform to exchange messages among all applications. By broadcasting event messages, an application is able to trigger a set of local and remote services. At the same time, a protocol for message exchange is proposed to fulfill cooperation of applications. To validate the model, a teleconsultation system is designed. The results indicate that the model has good compatibility and that the characteristics are easy to implement.
Modeling the Recovery from Depressive Illness by an Exponential Model with Mixed Effects
Authors: Friede T. , Miller F. , Kieser M.
Published: March 2018

In clinical trials of antidepressant treatments, a depression rating score is usually measured at several points of time for each patient. We propose an approach to fit data from this type of clinical trial using an exponential mixed-effects model. Compared to previous proposals, this approach has the advantage that individual recovery curves are fitted rather than curves of means. Furthermore, no artificial fixing of model parameters is needed as in other approaches. The flexibility of the proposed model is shown for various situations. The approach is illustrated by an example from a placebo-controlled study for the treatment of depression with St. John’s Wort (Hypericum perforatum).
Simulation of Body Surface Laplacian Maps during Ventricular Pacing in a 3D Inhomogeneous Heart-Torso Model
Authors: Ono K. , Hosaka H. , He B. , Wu D.
Published: March 2018

A computer simulation study has been conducted to investigate the performance of body surface Laplacian maps (BSLMs) in localizing and imaging spatially separated myocardial electrical events. A cellular automaton model of ventricles simulates cardiac electrical activity using a two-site pacing protocol to induce dual simultaneously active myocardial electrical events. The heart model is embedded in a realistically shaped inhomogeneous volume conductor. The BSLMs are numerically computed from the induced electrical activity in the heart model. The present computer simulation results show that the BSLM can provide better separation and localization of two regional myocardial electrical events as compared with the body surface potential map (BSPM).
Bifurcation in a Simple Model of the Cardiovascular System
Authors: Akselrod S. , Eyal S.
Published: March 2018

A simple nonlinear beat-to-beat model of the human cardiovascular system has been studied. The model, introduced by DeBoer et al. was a simplified linearized version. We present a modified model which allows to investigate the nonlinear dynamics of the cardiovascular system. We found that an increase in the -sympathetic gain, via a Hopf bifurcation, leads to sustained oscillations both in heart rate and blood pressure variables at about 0.1 Hz (Mayer waves). Similar oscillations were observed when increasing the -sympathetic gain or decreasing the vagal gain. Further changes of the gains, even beyond reasonable physiological values, did not reveal another bifurcation. The dynamics observed were thus either fixed point or limit cycle. Introducing respiration into the model showed entrainment between the respiration frequency and the Mayer waves.
The Care Information System PIK – the Fit between User and System
Authors: Herbig B. , Büssing A.
Published: March 2018

Objectives:
The presented laboratory study explores the relationship between the care information system PIK and its users, focusing on intuitive program usage, occurring errors, the usefulness of the evaluation method, and the role of person related variables.

Methods:
Three studies were conducted. While thinking aloud, a sample of 26 participants performed certain tasks, which were recorded in protocols. In addition, the occurring errors were rated in an error taxonomy.

Results:
While the actual use of the program proved quite easy, conceptual structuring caused the participants difficulties. These difficulties stemmed mainly from problems encountered in generating a clear mental picture of the system, and the consequences of the actions. Over time, the program showed a positive development.

Conclusions:
Discussion of the results focuses on implementation processes in the context of usability research. The need to train users in the conceptual structure of the program and to build realistic expectations are the focus of our outline.
Assessing the Implementation of Workplace Health Programs Outside of Controlled Environments
Authors: Walker E.
Published: March 2018

The study explored the implementation of workplace health programmes in 14 NHS Trusts (hospitals). It sought to identify different approaches to implementation and measures that could be used to guide future development. The study comprised inter-related elements examining the process of implementing workplace health and the impact on staff. An innovative action research approach was applied to the evaluation. The aims of the evaluation were to generate activity and learning within the organisations which was sustainable (long term) and transferable outside the study organisations. The study is described in terms of the multiple methods and the ways in which these have been brought together in the analysis. The approach has been informed by a shift from an individualistic perspective towards one which sees the health of workers within the broader context of organisational development and management. The research identified a number of dilemmas for workplace health with its focus on the health of the individual. A typology was developed which describes different approaches to workplace health and their impact on sustaining such initiatives. It suggests that for workplace health to be successful it must address the organisational context as well as individual staff needs. Results from a survey of staff in the 14 trusts seems to demonstrate an association between the approaches, described in the typology, and an impact on staff. Workplace health programmes need to shift towards approaches where the individual’s health is seen within the wider context of the organisation.
Standard Protocol for Exchange of Health-checkup Data Based on SGML: The Health-checkup Data Markup Language (HDML)
Authors: Yoshida K. , Hara S. , Furumi K. , Tofukuji I. , Kubodera T. , Yoda T. , Kawai M. , Sugimori H.
Published: March 2018

Objectives:
To develop a health/medical data interchange model for efficient electronic exchange of data among health-checkup facilities.

Results:
A Health-checkup Data Markup Language (HDML) was developed on the basis of the Standard Generalized Markup Language (SGML), and a feasibility study carried out, involving data exchange between two health checkup facilities. The structure of HDML is described.

Results:
The transfer of numerical lab data, summary findings and health status assessment was successful.

Conclusions:
HDML is an improvement to laboratory data exchange. Further work has to address the exchange of qualitative and textual data.
Conversion Problems concerning Automated Mapping from lCD-10 to lCD-9
Authors: Zaiss A. , Brunner R. , Spinner D. , Klar R. , Schulz S.
Published: March 2018

The increasing parallel use of ICD-9 and ICD-10 complicates the comparability of coded diagnoses. This is the reason why we developed a symmetric table for interactive conversion between ICD-9 and ICD-10, based on a vector space text-retrieval method that resulted in unambiguous mapping from ICD-9 to ICD-10 in 64%, from ICD-10 to ICD-9 in 87% of all three- and four-character classes of the tabular list. Out of the remaining 13% of multi-valued relations, a table for automated mapping from ICD-10 to ICD-9 was created. In 9% of cases, the selection offered no problems. A compromise between preserving information content and maintaining the logical integrity had to be found in 2.4%; in 1.6% automated mapping was impossible because of newly defined concepts and structural differences between ICD-9 and ICD-10 that are not counterbalanced by a consistent system of residual categories. We recommend that in a future revision of the ICD, compatibility with the then existing classification system should be considered.
Using a WWW-based Mail User Agent for Secure Electronic Mail Service for Health Care Users
Authors: Ohe K. , Kaihara S. , Kiuchi T.
Published: March 2018

WWW-based user interface is presented for secure electronic mail service for healthcare users. Using this method, communications between an electronic mail (WWW) server and users (WWW browsers) can be performed securely using Secure Socket Layer protocol-based Hypertext Transfer Protocol (SSL-HTIP). The mail can be encrypted, signed, and sent to the recipients and vice versa on the remote WWW server. The merit of this method is that many healthcare users can use a secure electronic mail system easily and immediately, because SSL-compatible WWW browsers are widely used and this system can be made available simply by installing a WWW-based mail user agent on a mail server. We implemented a WWWbased mail user agent which is compatible with PEM-based secure mail and made it available to about 16,000 healthcare users. We believe this approach is effective in facilitating secure network-based information exchange among medical professionals.
Issues in the Structuring and Acquisition of an Ontology for Medical Language Understanding
Authors: Bachimont B. , Bouaud J. , Charlet J. , Boisvieux J.-F. , Zweigenbaum P.
Published: March 2018

Medical natural language understanding basically aims at representing the contents of medical texts in a formal, conceptual representation. The understanding process itself increasingly relies on a body of domain knowledge, generally expressed in the same conceptual formalism. The design of such a conceptual representation is a key knowledge-acquisition issue. When representing knowledge, the most important point is to ensure that the formal exploitation of the knowledge representation conforms to its meaning in the domain. We examined some methodological and theoretical principles to enforce this conformity. These principles result from our experience in MENELAS, a medical language understanding project.
Natural Language Processing, Lexicon and Semantics
Authors: Wehrli E. , Clark R.
Published: March 2018

While the design of a fully general procedure for semantico-pragmatic interpretation of natural language texts does not seem to be feasible with current scientific knowledge and technology, the more practical micro-world based approaches lack generality and portability. A compromise between generality and practicality might lie in the use of an intermediate level of representation (“pseudo-semantics”), which can be derived from syntactic representations and lexical information by means of a general procedure. Domain-dependent rules for semantico-pragmatic interpretation can then be applied to these representations, insulating syntactic processing, from details of the application domain.
Objects and Domains for Managing Medical Data and Knowledge
Authors: Wiederhold G.
Published: March 2018

This paper assesses the object-oriented data paradigm, and describes an algebraic approach which permits the generation of data objects from relational data, based on the knowledge captured in a formal Entity-Relationship model, the Structural Model. The advantage is that now objects can be created that satisfy a variety of particular views, as long as the hierarchies represented by the views are subsumed in the network represented by the overall structural model.

The disadvantage of creating view-objects dynamically is that the additional layering has performance implications, so that the speedup expected from object-oriented databases versus relational databases, due to their hierarchical object storage, cannot be realized. However, scalability of systems is increased since large systems tend to have multiple objectives, and hence often multiple valid hierarchical views over the data. This approach has been implemented in the Penguin project, and recently some commercial successors are emerging.

In truly large systems new problems arise, namely that now not only multiple views will exist, but also that the domains to be covered by the data will be autonomous and hence heterogeneous. One result is that ontologies associated with the multiple domains will differ as well. This paper proposes a knowledge-based algebra over the ontologies, so that the domain knowledge can be partitioned for maintenance. Only the articulation points, where the domains intersect, have to be agreed upon as defined by matching rules which define the shared ontologies.
Digital Optical Archiving of Medical Records in Hospital Information Systems – A Practical Approach Towards the Computer-based Patient Record?
Authors: Dujat C. , Haux R. , Schmücker P. , Winter A.
Published: March 2018

The large number of inpatients and outpatients in university hospitals leads to high costs of medical documentation and to an increasing number of medical documents. Due to legal regulations, these medical records have to be stored for 30 years. This implies spatial, organizational, and economical problems. At present, conventional archiving in hospitals often does not satisfy the need to make medical records available for healthcare professionals in a systematic and timely manner. From 1989 to 1993 a pilot study on “digital optical archiving of medical records” was carried out at Heidelberg University Hospital. The study has shown the feasibility of digital optical archiving in hospitals if done under certain conditions. In 1995, Heidelberg University Hospital adopted a procedure for“ digital optical archiving of medical records”. The digital optical archive will first be filled with the medical records of the department of neurosurgery and the endoscopic and echographic images and reports of the department of internal medicine. It is to be expected that this procedure will gradually lead to an integrated functionality on health-care professional workstations, to a hospital-wide use of an electronic patient record, and to media-independent document management systems. The paper focusses on the potentials of digital optical archiving as an integral part of hospital information systems, and on the requirements for the systematic managements of hospital information systems with respect to digital optical archives.
A Method to Derive the Time of Onset of Infection from Serological Findings
Authors: Steimann F. , Hayde M.
Published: March 2018

Among the diagnostic problems requiring a retrospective assessment of the time an event occurred is that of screening for primary infection with Toxoplasma gondii acquired during pregnancy. We suggest a method to derive the possible times of onset of infection from a small sequence of serological samples by matching them against the knowledge about possible courses of infection. Special care is taken to properly address the relative change of consecutive samples, a nontrivial problem when reasoning about sparsely sampled time courses. To investigate the practicability of our approach we conducted a retrospective and a simulated prospective evaluation based on the samples of 394 pregnancies, randomly selected from our toxoplasmosis database; we could demonstrate an overall accuracy of 95.7%.
Study of Situation-dependent Clinical Cognition: a Meta-analysis and Preliminary Method
Authors: Westergren V. , Hallberg N. , Forsum U. , Timpka T.
Published: March 2018

An integrated method was constructed for the study of in situ clinical reasoning. A meta-analysis of existing theories and an exploratory case study were performed. Twelve physicians at the department of otorhinolaryngology, and three physicians and three biomedical technologists at the clinical microbiological laboratory of an 800-bed university hospital were involved in the evaluation of the method. The meta-analysis identified situations where practitioners face assignments for which they follow no routine strategy as suitable starting points for the development of the method, in which organizational processes are presented as workflow graphs. Using the critical incident technique, problem situations in the processes are identified, and stimulated recall interviews are employed to construct a model of the situation-dependent logic used in decision-making. The case study showed thatthe first levels of the method could easily be used by physicians without training in organizational development or cognitive psychology. It is concluded that the method can be a means for case construction in problem-oriented learning programs that have an empirical background. It can also be used in the development of clinical organization, where training is combined with the establishment of critical paths and computer support.
A Local Area Network for Medical Research; Planning, Realization and Experience
Authors: Schosser R. , Weiss C. , Messmer K.
Published: March 2018

This report focusses on the planning and realization of an interdisciplinary local area network (LAN) for medical research at the University of Heidelberg. After a detailed requirements analysis, several networks were evaluated by means of a test installation, and a cost-performance analysis was carried out. At present, the LAN connects 45 (IBM-compatible) PCs, several heterogeneous mainframes (IBM, DEC and Siemens) and provides access to the public X.25 network and to wide-area networks for research (EARN, BITNET). The network supports application software that is frequently needed in medical research (word processing, statistics, graphics, literature databases and services, etc.). Compliance with existing “official” (e.g., IEEE 802.3) and “de facto” standards (e.g., PostScript) was considered to be extremely important for the selection of both hardware and software. Customized programs were developed to improve access control, user interface and on-line help. Wide acceptance of the LAN was achieved through extensive education and maintenance facilities, e.g., teaching courses, customized manuals and a hotline service. Since requirements of clinical routine differ substantially from medical research needs, two separate networks (with a gateway in between) are proposed as a solution to optimally satisfy the users’ demands.
Adjusting for Recall Bias with the Proportional Hazards Model
Authors: Reinsch S. , MacRae P. G. , Tobis J. S. , Lachenbruch P. A.
Published: March 2018

In studying falling frequency in the elderly, we observed that having subjects keep a diary led to a larger number of falls reported than had been noted in a previous study in the same population. The previous study asked subjects to report any falls in the previous three months. We considered two related explanations for the observation of lower incidence reports with a 3-month recall survey. First, there may have been under-reporting of falls due to recall bias. Second, the less severe falls (which did not result in injuries) may not be reported. We suggest that the proportional hazards model may be used to adjust studies in which recall is used to determine incidence and time to falls.
Quantitative Evaluation of English-Japanese Machine Translation of Medical Literature
Authors: Kiuchi T. , Kaihara S.
Published: March 2018

Although many machine-translation programs are currently available, few evaluation methods of such translation exist for any given application area. It is difficult to evaluate machine-translation systems objectively because the quality of a translation depends on the combination of three factors: the translation program, the dictionary, and the original document. In this study, we developed a quantitative evaluation method for assessing machine translation, which evaluates these three factors separately. We applied this method to the translation of English to Japanese for medical literature and the method proved to be a good indicator for further system improvement. Using this method we also discovered other important points for machine translation, such as the examination of target documents for the construction of a better application dictionary.