bluuebunny/crossref_metadata_2025 huggingface dataset:
ICT in Health Care: Sociotechnical Approaches
Authors: Berg M. , Aarts J. , van der Lei J.
Published: March 2018

The importance of the social sciences for medical informatics is increasingly recognized. As ICT requires interaction with people and thereby inevitably affects them, understanding ICT requires a focus on the interrelation between technology and its social environment. Socio-technical approaches increase our understanding of how ICT applications are developed, introduced and become a part of social practices. Sociotechnical approaches share several starting points: 1) they see health care work as a social, ‘real life’ phenomenon, which may seem ‘messy’ at first, but which is guided by a practical rationality that can only be overlooked at a high price (i.e. failed systems). 2) They see technological innovation as a social process, in which organizations are deeply affected. 3) Through in-depth, formative evaluation, they can help improve system design and implementation.
Images of Health Technology in National and Local Strategies
Authors: Klecun-Dabrowska E. , Cornford T.
Published: March 2018

Objectives: This paper examines the potential of various models relating technology to society and institutional structures to inform health policy. Among the models discussed are various versions of technological determinism, social constructivism, actor network theory and critical theory.

Methods: The paper considers recent developments in policy and strategy that aim to shape the way the UK’s National Health Service (NHS) integrates Information and Communication Technologies (ICTs) into health care and considers what these alternative models highlight or emphasise, and how they might influence the activities of setting local implementation strategies.

Results and Conclusions: Contemporary ICTs are often presented as having a particular relevance and power in reforming or transforming the delivery of health care. Understanding how such technologies might be conceived of, implemented and become an integral part of some future health care system is an important and challenging task that requires innovative theoretical treatments.
Working IT Out in Medical Practice: IT Systems Design and Development as Co-Realisation
Authors: Hartswood M. J. , Rouchy P. , Rouncefield M. , Slack R. , Voss A. , Procter R. N.
Published: March 2018

Objectives: The paper explores possibilities for situating IT design and development work within the context of use so as to support the co-realisation of technology and ‘design in use’. The aim is to build a new understanding between IT professionals and users which is grounded upon what happens as the latter grapple with the problems of applying IT, appropriating its functionalities and affordances into their work practices and relations.

Methods: Following a discussion of participatory design and ethnomethodology, a novel method called co-realisation, which aims to provide a synthesis of the preceding methods, is suggested as an alternative. Through a discussion of findings from a case study of IT systems design and development in healthcare we show how the co-realisation approach might provide work-affording systems and how user-designer relations might be reformulated. We suggest that work-affording systems can be developed through the deployment of an engaged facilitator who works with the users to unpack the work site-specific potentialities of technology.

Results: The case study shows how risk of non-adoption might be minimised through the development of partnerships, and how the presence of the facilitator in the workplace capitalises on the mundane work undertaken therein and how the facilitator might work with the users to develop artefacts that support this work as opposed to reconfiguring it.

Conclusions: The case study illustrates co-realisation in action and how it might be seen to reconfigure relations between users and designers in a way that appears productive. Co-realisation can help address the widely observed problem of IT systems failures in healthcare.
Requirements for Speech Recognition to Support Medical Documentation
Authors: Mönnich G. , Wetter T.
Published: March 2018

Recent advances in the development of automated speech recognition (ASR) have made routine applications for medical documentation possible. To achieve this, ASR has to be optimally integrated into the specific documentation scenario. The classification presented in this paper allows the definition of specification requirements. For two different documentation scenarios the appropriate product selection has been done according to this classification. Two evaluation studies are presented, addressing the usefulness of applying automated speech recognition.
Standard Method for Describing an Electronic Patient Record Template: Application of XML to Share Domain Knowledge
Authors: Yamazaki S. , Satomura Y.
Published: March 2018

A Template Definition Language (TDL) was developed to share knowledge of how to construct an electronic patient record (EPR) template. Based on the extensible markup language XML, TDL has been designed to be independent of EPR platforms or databases. Our research of TDL was conducted through evaluation of the description of various templates in the currently available EPRs and through comparisons with some electronic clinical guidelines. We conclude that TDL is sufficient for the objective but still needs improvement of the algorithm for describing dynamic changes.
Reconstructing Bifurcation Diagrams of Dynamical Systems Using Measured Time Series
Authors: Pakdaman K. , Nomura T. , Sato S. , Bagarinao E.
Published: March 2018

We present an algorithm for reconstructing the bifurcation structure of a dynamical system from time series. The method consists in finding a parameterized predictor function whose bifurcation structure is similar to that of the given system. Nonlinear autoregressive (NAR) models with polynomial terms are employed as predictor functions. The appropriate terms in the NAR models are obtained using a fast orthogonal search scheme. This scheme eliminates the problem of multiparameter optimization and makes the approach robust to noise. The algorithm is applied to the reconstruction of the bifurcation diagram (BD) of a neuron model from the simulated membrane potential waveforms. The reconstructed BD captures the different behaviors of the given system. Moreover, the algorithm also works well even for a limited number of time series.
Design and Implementation of a Computer Decision Support System for the Diagnosis and Management of Dementia Syndromes in Primary Care
Authors: Austin T. , Wilcock J. , Bryans M. , Turner S. , Downs M. , Iliffe S.
Published: March 2018

Background:
Diagnosis and management of dementia is a complex process and primary care physicians are under-equipped to deal with uncertainties in the provision of optimal care for the patient.

Objective:
To develop a computer decision support system (CDSS) which could assist physicians with diagnosis and management and improve patient care.
Methods:
A design group including general practitioners derived logic pathways for diagnosis and management of dementia and validated them with a multi-professional expert group. Logic pathways were used to construct a comprehensive CDSS rendered as a series of expert consultations. The CDSS was inserted into commercially available GP systems and bench and field-tested.

Results:
The complexity of dementia diagnosis and management can be captured in logic pathways which can be expressed as decision trees within existing electronic patient records. The resulting CDSS appears useable in routine practice.

Conclusion:
The impact of this CDSS will be evaluated in a randomised controlled trial of educational interventions in primary care.
Patient-doctor Concordance in Elderly Women’s Self-reported Health and Medical Records
Authors: Hjerppe M. , Timpka T. , Ockander M.
Published: March 2018

Objectives:
To compare the chronic diseases mentioned by elderly women in an interview study with those documented in their respective medical records.

Methods:
The prevalence of positive diagnoses, overall agreement, and the kappa-coefficient were calculated for each group of diagnoses.

Results:
The lowest overall agreement was observed for psychiatric diseases, followed by diseases of the gastrointestinal system. Poor chance-adjusted agreement was found concerning diseases of the gastrointestinal system and diseases of the skin.

Conclusions:
The results suggest that a main reason for discordance was that the elderly women feared »losing face« by reporting some diseases.
Ordinal Classification in Medical Prognosis
Authors: König J. , Feldmann U.
Published: March 2018

Objectives:
Medical prognosis is commonly expressed in terms of ordered outcome categories. This paper provides simple statistical procedures to judge whether the predictor variables reflect this natural ordering.

Methods:
The concept of stochastic ordering in logistic regression and discrimination models is applied to naturally ordered outcome scales in medical prognosis.

Results:
The ordering stage is assessed by a data-generated choice between ordered, partially ordered, and unordered models. The ordinal structure of the outcome is particularly taken into consideration in the construction of allocation rules and in the assessment of their performance. The specialized models are compared to the unordered model with respect to the classification efficiency in a clinical prognostic study.

Conclusions:
It is concluded that our approach offers more flexibility than the widely used cumulative-odds model and more stability than the multinomial logistic model. The procedure described in this paper is strongly recommended for practical applications to support medical decision-making.
Representing and Processing Medical Knowledge Using Formal Concept Analysis
Authors: Schnabel M.
Published: March 2018

Objectives:
The aim is to show the flexibility, adequateness, and generality of formal concept analysis (FCA) applied to expert systems in medicine.

Methods:
The basic idea of formal concept analysis is to look at a set of objects together with their attributes (formal context) under a definite mathematical view. This view leads to a mathematical structure, a complete lattice, which can be represented graphically.

Results:
Some examples show that this method is very general and can be used to describe diseases, relationships between diseases and findings, the inference process, and, among others, types of uncertainty. For many applications, the adequateness of this method, concerning the underlying semantics, can easily be made plausible.

Conclusions:
FCA can be used to analyze data that can be described by objects and attributes of any kind. The selected examples (diseases, patient cases, therapeutic decisions, rules) show the usefulness of this method. Although it is not difficult to transform the relevant semantics into a formal context in many cases, much more experience is necessary.
Recommendations of the International Medical Informatics Association (IMIA) on Education in Health and Medical Informatics
Authors: Knaup Petra , Haux Reinhold
Published: March 2018

The International Medical Informatics Association (IMIA) agreed on international recommendations in health informatics/medical informatics education. These should help to establish courses, course tracks or even complete programs in this field, to further develop existing educational activities in the various nations and to support international initiatives concerning education in health and medical informatics (HMI), particularly international activities in educating HMI specialists and the sharing of courseware.

The IMIA recommendations centre on educational needs for healthcare professionals to acquire knowledge and skills in information processing and information and communication technology. The educational needs are described as a three-dimensional framework. The dimensions are: 1) professionals in healthcare (physicians, nurses, HMI professionals, …), 2) type of specialisation in health and medical informatics (IT users, HMI specialists) and 3) stage of career progression (bachelor, master, …).

Learning outcomes are defined in terms of knowledge and practical skills for healthcare professionals in their role (a) as IT user and (b) as HMI specialist. Recommendations are given for courses/course tracks in HMI as part of educational programs in medicine, nursing, healthcare management, dentistry, pharmacy, public health, health record administration, and informatics/computer science as well as for dedicated programs in HMI (with bachelor, master or doctor degree).

To support education in HMI, IMIA offers to award a certificate for high quality HMI education and supports information exchange on programs and courses in HMI through a WWW server of its Working Group on Health and Medical Informatics Education (http://www.imia.org/wg1).
Positioning the Patient: Normative Analysis of Electronic Patient Records
Authors: van der Ploeg I.
Published: March 2018

Objective: This paper aims to take the current ethical research on electronic patient records beyond the ethical-legal issues of privacy to include contemporary issues of the ‘politics of technology’ and ‘value sensitive design’.

Methods: The paper employs an interpretive approach to analyze research on electronic patient records with concepts of the politics of technology and value sensitive design.

Results and Conclusions: The broad development towards computerization of patient records lacks needed attention to the potential effects of such systems on the patients. This paper argues for a broader understanding of the normative aspects involved in the design and implementation of electronic patient records (EPRs). It suggests three supplemental dimensions for normative analysis of EPR design relevant to the position of the patient: presence, agency, and identity. These dimension are discussed and illustrated as concepts connecting ethical dimensions of patienthood with design features of EPRs.
Quality of Health Care: Informatics Foundations
Authors: Safran C. , Takeda H. , Hasman A.
Published: March 2018

Objective:
To discuss in what ways computer systems can contribute to the quality of healthcare and on which principles of informatics successful systems are based.

Methods:
Part of the information was obtained via a literature search and part is based on the knowledge of the authors.

Results:
The results of the literature search are reported. The answers to the questions whether decision support is useful and which factors determine its success, the foundations of computerized guidelines systems and applications of physician order entry and medical risk management are presented. Conclusions: Despite many publications concerning diagnostic support systems their use in clinical practice is limited. Reminder systems do appear to have an impact on health outcomes. Standards for guideline models are being developed for effective sharing of guidelines across systems. Electronic patient records and physician order entry systems are useful aids in medical risk management.
Architecture Models to Facilitate Communication of Clinical Information
Authors: Kay S.
Published: March 2018

This is an account of the development and use of a context model for facilitating the communication of clinical information. Its function is to articulate the principle of context within a reference architecture for the Electronic Health Care Record (EHCR). The work required a re-examination of established models of communication, the purpose being to use them to support an architecture that could be reasonably expected to accommodate future, and by definition unforeseeable, developments in EHCR communication. The Context Model is built upon seven recognized constituents of communication. These constituents, although having their origin in the engineering of signal communication, have been found to be useful for explication both in the verbal and textual communication of narratives between people. The electronic health care record architecture supported by the model is the European prestandard ENV13606-1.
Clinical Terminology: Why Is it so Hard?
Authors: Rector A. L.
Published: March 2018

Despite years of work, no re-usable clinical terminology has yet been demonstrated in widespread use. This paper puts forward ten reasons why developing such terminologies is hard. All stem from underestimating the change entailed in using terminology in software for ‘patient centred’ systems rather than for its traditional functions of statistical and financial reporting. Firstly, the increase in scale and complexity are enormous. Secondly, the resulting scale exceeds what can be managed manually with the rigour required by software, but building appropriate rigorous representations on the necessary scale is, in itself, a hard problem. Thirdly, ‘clinical pragmatics’ – practical data entry, presentation and retrieval for clinical tasks – must be taken into account, so that the intrinsic differences between the needs of users and the needs of software are addressed. This implies that validation of clinical terminologies must include validation in use as implemented in software.
Development of a Health Guidance Support System for Lifestyle Improvement
Authors: Tanaka Y. , Shibata S. , Tohyama S. , Ohtsuka Y. , Hattori M. , Kashihara H. , Nasu S. , Usuda T. , Sasamori N. , Aoshima T.
Published: March 2018

Objective:
To provide automated advice for lifestyle adjustment based on an assessment of the results of a questionnaire and medical examination or health checkup data.

Methods:
A system was developed that gathers data based on questions regarding weight gain, exercise, smoking, sleep, eating habits, salt intake, animal fat intake, snacks, alcohol, and oral hygiene; body mass index, resting blood pressure, fasting blood sugar, total cholesterol, triglycerides, uric acid and liver function tests. Based on the relationships between the lifestyle data and the health checkup data, a health assessment sheet was generated for persons being allocated to a multiple-risk-factor syndrome group.

Results:
Health assessment and useful advice for lifestyle improvement were automatically extracted with the system, toward the high risk group for lifestyle related diseases. The system is operational.

Conclusions:
We developed a health guidance support system for lifestyle improvement. In comparison with conventional, limited advice methods, we developed a practical system that defined the necessity for lifestyle improvement more clearly, and made giving advice easier.
Validity of the Framingham Risk Model Applied to Japanese Men
Authors: Sugimori H. , Yoshida K. , Suka M.
Published: March 2018

Objectives:
To examine whether the Framingham Risk Model can appropriately predict coronary heart disease (CHD) events detected by electrocardiography (ECG) in Japanese men.

Methods:
Using the annual health examination database of a Japanese company 5611 male workers, between the ages of 30 to 59, who were free of cardiovascular disease, were followed up to observe the occurrence of CHD events detected by ECG over a period of five to seven years. The probability of CHD was calculated for each individual from the equations of the Framingham risk model (with total cholesterol).

Results:
The incidence of CHD increased with the estimated CHD risk. The Hosmer-Lemeshow goodness of fit test showed an adequate fit of the risk model to the data of the study subjects. In the receiver operating characteristic analysis, the area under the curve reached 0.67 which indicated an acceptable discriminatory accuracy of the risk model.

Conclusions:
The Framingham risk model provides useful information on future CHD events in Japanese men.
EEG Frequency and Phase Coupling during Human Information Processing
Authors: Rappelsberger P. , Vath N. , Weiss S. , Möller E. , Grießbach G. , Witte H. , Schack B.
Published: March 2018

Neuronal activity during information processing is represented by oscillations within local or widespread neuronal networks. These oscillations may be recorded by the EEG (electroencephalogram). The oscillatory interaction between neuronal ensembles may be at one single frequency or at different frequencies due to non-linear coupling. The investigation of momentary coherence and phase enables the examination of synchronized oscillatory network activity during fast-changing cognitive processes. On this basis information transfer from occipital areas towards frontal areas could be described during processing of visual presented words. Non-linear phase coupling between oscillations with different frequencies during memory processing was detected by means of cross-bicoherence.
Flexible Two-Stage Designs: An Overview
Authors: Brannath W. , Posch M. , Bauer P.
Published: March 2018

In this overview we introduce the basic ideas behind a new flexible approach in sequential designs. The different concepts based on two-stage combination tests and conditional error functions are brought together. We sketch the construction of p-values, confidence intervals, and median unbiased estimates. Finally, recursive combination tests are introduced which extend the flexibility to the choice of the number of interim analyses.
Cooperative Problem Solving with Personal Mobile Information Tools in Hospitals
Authors: Buchauer A. , Werner R. , Haux R.
Published: March 2018

Health-care professionals have a broad range of needs for information and cooperation while working at different points of care (e.g., outpatient departments, wards, and functional units such as operating theaters). Patient-related data and medical knowledge have to be widely available to support high-quality patient care. Furthermore, due to the increased specialization of health-care professionals, efficient collaboration is required. Personal mobile information tools have a considerable potential to realize almost ubiquitous information and collaborative support. They enable to unite the functionality of conventional tools such as paper forms, dictating machines, and pagers into one tool. Moreover, they can extend the support already provided by clinical workstations. An approach is described for the integration of mobile information tools with heterogeneous hospital information systems. This approach includes identification of functions which should be provided on mobile tools. Major functions are the presentation of medical records and reports, electronic mailing to support interpersonal communication, and the provision of editors for structured clinical documentation. To realize those functions on mobile tools, we propose a document-based client-server architecture that enables mobile information tools to interoperate with existing computer-based application systems. Open application systems and powerful, partially wireless, hospital-wide networks are the prerequisites for the introduction of mobile information tools.
Randomized Observational Studies on the Economics of Therapies – Biometrical Experience of Two Trials
Authors: Högel J. , Rodloff A. C. , Büchele G. , Gaus W.
Published: March 2018

Economic studies in medicine are intended to investigate costs, associated with a particular problem dealing with the indication, diagnosis or therapy, for instance, whether the high costs involved in a highly intensive or innovative therapy could be balanced by the eventual savings made, due to the shorter periods of treatment. In such situations a randomized controlled trial is necessary to find out which therapy or which therapeutical strategy is least expensive in the long run. Economic studies do, however, present some specific problems. Making a list of all the cost-relevant treatment items can be very laborious, but the use of flat rates and lump sums alone cannot lead to a complete cost analysis. Often, costs between hospitals vary more than between treatment regimens.

Early and sudden deaths incur low costs and may bias the results. Furthermore, costs are distributed with a long and heavy upper tail incltJding extreme outliers. This does, in fact, complicate the estimation of the sample size. In this article, these problems are outlined and, with the help ofthe data obtained from two randomized economic trials in health care, solutions are proposed and discussed.
The LYMFASIM Simulation Program for Modeling Lymphatic Filariasis and its Control
Authors: Subramanian S. , Das P. K. , Souza W. , Lapa T. , Furtado A. F. , Van der Ploeg C. P. B. , Habbema J. D. F. , van Oortmarssen G. J. , Plaisier A. P.
Published: March 2018

The LYMFASIM modeling framework for the transmission and control of the tropical parasitic disease lymphatic filariasis is described and its use in the context of an endemic community in north-eastern Brazil is illustrated. Lymphatic filariasis is a disease with a complex natural history with many unknowns. This complicates decision making with respect to control strategies. With LYMFASIM, a variety of hypotheses can be tested about the life history of the parasite Wuchereria bancrofti, its transmission from man to man through mosquitoes, the role of the immune system in regulating parasite numbers, the development of disease symptoms, and the effects of control measures (drug treatment or mosquito control). The implications of alternative assumptions and uncertainty about the quantification of parameters for the effectiveness of control strategies can be investigated. Thanks to the use of stochastic microsimulation, LYMFASIM is highly flexible and can be adapted and extended as new knowledge emerges.
Towards a National Patient Card System in Japan
Authors: Takahashi T. , Minato K. , Alkhateeb A.
Published: March 2018

Patient Card Systems (PCS) have been applied on a regional level to improve access to patient information. However, current projects lack a vision of future integration on a national level. In addition, Integrated Circuit cards and optical cards were introduced without considering that their cost and capacity limits impose significant constraints for future integration. The major arguments against PCS are the huge costs incurred by such a system and the limitations of the card capacities. In addition, standards and legislation have not been sufficiently developed. In this study, we propose a new model of PCS that employs recent communication and card technologies as a key to access a national medical information center. We demonstrate that PCS are feasible if implemented in several distinct phases and if the acceptance and cooperation of physicians and patients are achieved. However, political consensus about the necessity of reform in the health care sector must be established so that the necessary legislation can be enacted.
European Influenza Surveillance Scheme on the Internet
Authors: Manuguerra J. C. , Taylor P. , Snacken R.
Published: March 2018

In 1995, The European Influenza Surveillance Scheme was created with the participation of eight networks from seven countries. The main objectives were to continue the previous CARE Telematics Network and to adapt the project to the Internet environment as well as to improve substantially the quality of the surveillance according to new epidemiological requirements. Clinical and virological data from the general population and hospitals are collected in an interactive real-time database which can then be used for data entry, queries and consultations. Research programmes have been undertaken in various fields such as standardisation of clinical data and comparability between countries. Validation and security processes guarantee the quality assurance as well as regular assessment by the steering committee. Two additional countries will participate during the next influenza season (1997-98). This will represent an early warning system in a region of approximately 264 million inhabitants.
A Terminology Server for Medical Language and Medical Information Systems
Authors: Solomon W. D. , Nowlan W. A. , Rush T. W. , Zanstra P. E. , Claassen W. M. A. , Rector A. L.
Published: March 2018

GALEN is developing a Terminology Server to support the development and integration of clinical systems through a range of key terminological services, built around a language-independent, re-usable, shared system of concepts – the CORE model. The focus is on supporting applications for medical records, clinical user interfaces and clinical information systems, but also includes systems for natural language understanding, clinical decision support, management of coding and classification schemes, and bibliographic retrieval. The Terminology Server integrates three modules: the Concept Module which implements the GRAIL formalism and manages the internal representation of concept entities, the Multilingual Module which manages the mapping of concept entities to natural language, and the Code Conversion Module which manages the mapping of concept entities to and from existing coding and classification schemes. The Terminology Server also provides external referencing to concept entities, coercion between data types, and makes its services available through a uniform applications programming interface. Taken together these services represent a new approach to the development of clinical systems and the sharing of medical knowledge.
An Overview of Statistical Methods for the Classification and Retrieval of Patient Events
Authors: Chute C. G. , Yang Y.
Published: March 2018

Statistical methods that can support text retrieval are becoming an increasing focus of medical informatics activities. We overview our adaptation of existing knowlege sources to create pseudo-documents for concept based latent semantic indexing. Experience demonstrated this tack of limited practical value, since retrieval performance was invariably unsatisfactory. We discovered this was due in part to the introduction of a vocabulary gap between the queries and the cases we sought to retrieve. In part to address this problem, and to avail our large body of humanly coded text as a knowledge source, we developed a least squares fit alternative for the computer assisted indexing and retrieval of biomedical texts. This technique demonstrates equivalent or superior retrieval performance when compared to all other textual retrieval techniques. It does not depend upon elaborate knowledge bases, lexicons, or thesauri. It is a promising technique for classifying and retrieving the large volumes of clinical text.
Methodology for the Construction of a Disease Nomenclature and Classification System for Clinical Use
Authors: Ohashi Y. , Sato H. , Kaihara S. , Kiuchil T.
Published: March 2018

The nature and problems of the linguistic representation of clinical data are discussed, using the linguistic theory of Ferdinand de Saussure. Based on the conclusions, a methodology for the construction of a disease nomenclature and a classification system, suitable for use in clinical information systems, is developed using set theory.
A Method for Assessing the Impact of a Computer-Based Decision Support System on Health Care Outcomes
Authors: Lave J. R. , McNeil M. A. , Bankowitz R. A.
Published: March 2018

The wide variation in utilization of diagnostic resources has not been decreased by the proliferation of new diagnostic technologies. We wish to test the hypothesis that the introduction of a medical decision support system into clinical practice could potentially lead to more efficient use of diagnostic information, and therefore lead to a reduction in overall laboratory use and cost of care. We have devised and are currently implementing a randomized controlled trial of a computer based decision support system, the University of Pittsburgh version of Quick Medical Reference (QMR).The main purpose of the study is to determine the effect of the QMR program on specific outcome measures: length of hospital stay, number and types of diagnostic tests ordered, and overall charges. An important part of this evaluation is relating the initial level of diagnostic uncertainty expressed by the admitting housestaff team to utilization of diagnostic resources. The purpose of this paper is to describe the methodology for carrying out this controlled trial, and to describe our initial experiences with its implementation.
On the Detection of the Number of Signals in Multilead ECGs
Authors: van Oosterom A. , Uijen G. J. H.
Published: March 2018

New methods which have been developed in the field of signal processing to detect the number of intrinsic source signals in a set of multiple signals have been studied in their application to the analysis of multilead ECGs (body surface maps). All these methods are based on the analysis of the eigenvalues of the covariance matrix related to the observed data. By using artificial multilead ECGs in which the properties of the signal and noise parts were known, the effect of taking into account these properties was investigated. It was found that the method based on information-theoretic criteria was superior in detecting the number of signal components, in the case that the noise in the data is non-white, as compared to a simple threshold method.
Repeated Multiphasic Screening Examinations: Evaluating the Process
Authors: Meyased-Kfir M. , Carel R. S.
Published: March 2018

There are sound clinical and epidemiological reasons to promote and emphasize early detection efforts and disease prevention services. A large body of scientific literature supports the notion that detection and intervention early in the course of many diseases is beneficial both to the afflicted individual and to society at large. Several publications deal with the evaluation of multiphasic screening examinations (MSE) as a tool for simultaneous early detection and prevention of multiple risk factors and various diseases. Usually, this technology is evaluated based on data from a single (cross-sectional) comprehensive screening study. However, frequently MSE are performed periodically, resulting in repeated test results of the same individuals. The health impact of such repeated (longitudinal) MSE has not been studied extensively. Similarly, many of the unique theoretical, technical, and epidemiological features characteristic of consecutive (periodical) comprehensive screening examinations are not well-documented. The purpose of this study was to compare the test results of two MSE, performed 3.5 years apart, in order to demonstrate certain characteristics of multiphasic health testing (MHT) technology related to repeated (longitudinal) multiphasic examination of the same individuals.
Serum Lipid Values and Age in Healthy Women: A Preliminary Report on Cholesterol
Authors: Williams G. Z.
Published: March 2018

In a 20-year prospective study of the influence of lifestyle and age on health parameters in men’s and women’s serum cholesterol, tryiglycerides and high density and low density lipoproteins were measured periodically to determine each person’s longitudinal profile. The accumulated data for 1008 women of 20 to 70 years is averaged by five-year age brackets. Scatter plots and simple regression of these five-year group means for ages 20 to 45 years, reveals a gradual increase in serum cholesterol, increasing from 176 mg/dl to 196 with a slope of 0.61 mg/dl per year. Between ages 45 and 70, the slope increases substantially to 1.91 mg/dl per year, and the five-year group means rise from 196 at age 45 to 239 at age 70 in rather uniform increments. The data have been analyzed for the other lipids and the relationship to estrogen replacement, nutritional, and exercise habits.
A New Architecture for Integration of Heterogeneous Software Components
Authors: Timmers T. , van Bemmel J. H. , van Mulligen E. M.
Published: March 2018

An architecture is described that integrates existing applications in a network-wide system. The architecture follows the new open software paradigm, and defines kernel and application services that collaboratively solve the tasks of end-users and provide them with an intuitive user-interface. This paper describes the message language and the kernel mechanism for addressing application services. The architecture has been developed as much as possible to conform with current standards.
Stratified Initial Values and Change Scores
Authors: Lachenbruch P. A. , Wilson T. W. , Cohen R. D.
Published: March 2018

A common question that is encountered in many studies is relating a change in a variable to the variable’s initial value. It is well known that regressing the change on the initial value creates a spurious association and misleads the unwary. One attempt to cope with this problem has been to stratify that data based on the initial value. We show that this approach does not solve the problem. Theoretical and simulation results for independent normal and independent exponential random variables are provided.
Management of Serial ECGs and Control Strategies for the Comparison Process
Authors: Rubel P. , Willems J. L. , Fayn J.
Published: March 2018

Serial ECG management and control of the comparison process should be dynamically driven by patient data. The functional architecture requirements are specified for a computerized ECG processing system integrating serial analysis. The concepts of reference investigations and temporal events are first explained. A conceptual reference model is proposed which stratifies the serial analysis process into a few generic strategies which will be instantiated into several types of serial comparison processing tasks as a function of the clinical evolution of the patient. This model is an extension of the OEDIPE core data model developed and implemented during the AIM #2026 project.
Waveform and Latency Estimation from Neuroelectric Signals Using the Bispectrum
Authors: Nakamura M.
Published: March 2018

A technique based on bispectra and cross-bispectra is described for estimating waveform and latency from a set of noisy signals with variable latency. Waveform estimation is performed by averaging bispectra of observed noisy signals. Latency estimation is performed by using the product function of a function derived from the cross-bispectrum and the cross-correlation. The method is numerically assessed by simulations, using a signal with uniformly distributed latency and computer-generated noise sequences.
An Information Network for Community Medical Care
Authors: Sorachi K.
Published: March 2018

An information network for community medical care was established by the Himeji Medical Association in 1987. The network interconnects through public telephone a central computer located at the office of the Medical Association with personal computers installed in the offices of members of the Association. An overview of the network, which is in full operation, is given, and current problems and future directions are discussed.
Curriculum for Medical Informatics at the University of Heidelberg/School of Technology Heilbronn
Authors: Leven F. J.
Published: March 2018

The specialized university curriculum for medical informatics at the University of Heidelberg/School of Technology Heilbronn described in this paper is one of the oldest educational approaches in the field of medical informatics, and has been successful for more than 20 years with more than 600 graduates (Diplom-lnformatiker der Medizin). It is based on the concept of medical informatics as an independent medical discipline, and covers the total spectrum ranging from health care economics, biosignal and medical image processing, model building in medicine, to information and knowledge processing in medicine. It is a program of 4.5 years duration with a strong emphasis on the methodological foundations of medical informatics and on practical education in a number of specific laboratories. Thirty-five students are admitted each semester, and in total about 390 students enrolled. The faculty consists of 17 full-time members and about 25 part-time lecturers.
Graduate Program in Medical Informatics at the University of Utah
Authors: Warner H. R.
Published: March 2018

The graduate student program in medical informatics at the University of Utah described in this paper comprises a Master of Science degree (since 1976) and a Ph.D. degree (since 1962). The average program length is 2 years for M.Sc. and 3-5 years for Ph.D. The aims of the program are to prepare graduates for careers in medical informatics in academic, hospital or industrial settings. There are several different courses of study, or tracks, within the department ranging from Expert Systems, Genetic Epidemiology, Health Care Quality, Hospital Information Systems, Medical Imaging, Medical Physics, to an intensive one-year M.Sc. degree course for physicians. After the first three quarters the students are required to take a qualifying examination in which they qualify for a Masters or Ph.D. degree. The program covers the total spectrum of medical informatics. About 10 students are admitted each year. There are 14 full-time faculty and 9 adjunct faculty. The total number of graduates is 151.
Observations on Health Information in Developing Countries
Authors: Hull C.
Published: March 2018

Based on personal experiences, observations are offered on health information in developing countries, ways in which information systems can be strengthened, and opportunities for health-information science graduates. Although data collection consumes a significant portion of the health worker’s day, information systems are often a low priority in developing countries. Health-information systems can be strengthened by focusing on local solutions, by building skills in health workers, by utilizing appropriate technology, and by integrating information systems into health programs. Health-information science graduates can assist in improving systems in developing countries, but this will require a broad and flexible definition of health information science, which is much more than computing technology; it is supporting health workers to define, manage, and apply the information they need.
Chance Significances in Case-Control Studies when Using a Long Questionnaire
Authors: Scherg H.
Published: March 2018

The problem of getting per chance significant differences in case—control studies mostly arises when using a long questionnaire or when comparing a large number of characteristics. The number of chance significances increases with the number of statistical tests carried out. Chance significance is demonstrated on a set of empirically collected data divided into two nonsense groups. The variation of chance significances is shown in several random samples from this data set. Chi square analysis of 2 × 2 contingency tables and stepwise discriminant analysis are applied. Suggestions for avoiding chance significances are made. Attention is called to the hazards of stepwise discriminant analysis.
CRITLEVEL: An Exploratory Procedure for the Evaluation of Quantitative Prognostic Factors
Authors: Abel U. , Berger Jutta , Wiebelt H.
Published: March 2018

CRITLEVEL is a simple but efficient graphic tool for determining those levels of quantitative prognostic factors at which the most pronounced deterioration of prognosis takes place.
Information Analysis for Medical Expert Systems
Authors: Glasziou P. , Vermeir D.
Published: March 2018

Much attention has been given to the deductive methods appropriate for medical diagnosis, but much less has been paid to the data structures required to support them. In this paper we apply the linguistically oriented information analysis technique NIAM to the problem and demonstrate how such a conceptual approach could be used for history taking, knowledge acquisition, and diagnosis. We outline the underlying structures in which medical knowledge is traditionally expressed, and use cardiorespiratory disorders as examples. The acyclic network structure of diagnostic categories suggested by this analysis is compared to traditional hierarchical approaches.
NONLIN: A New Version for Simplified Use in BASIC Computer Systems
Authors: Meystre A. , Leishman B. , Eckert M.
Published: March 2018

A translation of the well-established program NONLIN into the BASIC language is presented. This modified (simplified) version can be used by clinicians and others interested in pharmacokinetics without extra assistance.

The models are programmed in the same way as the DFUNC subroutines of the FORTRAN version. The most widely used pharmacokinetic models are stored as a small library and are accessible under their names.
Analysis of Two-Way Contingency Tables : Log-Linear Models and Dual Scaling
Authors: Moussa M. A. A.
Published: March 2018

The paper focuses upon the measurement of association in two-way contingency tables, using the log-linear models and dual scaling approaches. The former comprises [1] the use of pseudo-Bayes estimators to remove zeros, [2] fitting the resulting smoothed array to all possible configurations of log-linear models, [3] fitting the quasi-independence model to detect anomalous cells that caused deviation from the null-independence model. The latter includes [1] estimation of the optimal weights that maximize the canonical correlation between the two categorical variables by an optimization iterative method, [2] testing the discriminability of the estimated scoring scheme. The two approaches were applied to a set of real data for the study of the association between maternal age at marriage and types of reproductive wastage in a sampling survey conducted in the population of female nurses in Kuwait.
A Knowledge Representation Concept Facilitating Construction and Maintenance of Large Knowledge Bases
Authors: Puppe B. , Puppe F.
Published: March 2018

Since diagnostic competence cannot be easily divided, the practical value of diagnostic consultation systems increases considerably with the diversity of problems they can handle. However, since initial construction and subsequent maintenance of large knowledge bases are extremely time-consuming, few have been built so far.

The knowledge representation concept we developed (implemented in the expert system shell MED2) to help resolve this dilemma contains as its main structural element the Question/ Finding-Set as a representational unit comprising findings usually collected and interpreted together. It allows representation of findings at multiple levels of detail and their local interpretation by data base reasoning, thereby supporting simulation of two powerful human problem-solving strategies: Symptom analysis at greater detail and stepwise formation of conceptual abstractions. Resulting knowledge base modularity facilitates initial knowledge base building by multiple cooperating teams and later easy refinement and extension.
Development of a Decision Guide — Optimal Discriminators for Meningitis as Determined by Statistical Analysis
Authors: Levi S. , Grant J. Rebecca , Westphal M. C. , Lurie Dan
Published: March 2018

Recently physician extenders (pediatric nurse practitioners, corpsmen) have been assuming increased clinical responsibilities in primary health care delivery. To assure that certain medical standards are being met, decision guides (clinical algorithms) offer one acceptable mechanism. In developing a decision guide for meningitis in children, 193 cases were reviewed and statistically analyzed to determine optimal clinical discriminators for this disease. A statistical technique was used to assign numerical weights to various signs and symptoms so that the sum of the weights for present symptoms produces a discriminant equation for the diagnosis of meningitis. Optimal clinical discriminators as determined through the statistical techniques reveal a close association with presently known signs and symptoms indicative of meningitis in children. The optimal clinical discriminators were : nuchal rigidity, bulging fontanel, altered sensorium, seizure, and fever plus Kernig/Brudzinski sign. It is reasoned that this statistical technique has applicability for developing optimal clinical discriminators for diseases and that this technique will also lead to the development of more reliable decision guides.