bluuebunny/crossref_metadata_2025 huggingface dataset:
Objective Evaluation of Three-dimensional Image Registration Algorithms – Tools for Optimization and Evaluation
Authors: Morgenstern U. , Steinmeier R. , Uhlemann F.
Published: March 2018

Objective:
The registration of medical volume data sets plays an important role when different images or modalities are used during computer-assisted surgical procedures. Nevertheless, it is often questionable how robust and accurate the underlying algorithms really are. Therefore, the goal is to foster the establishment of methods for an objective evaluation.

Method:
To reliably calculate the accuracy of registration algorithms, a reference transformation must be known. Due to the unknown perfect registration for real clinical data, the simulation of realistic data and successive affine transformations are employed. The simulation is based on models of the respective imaging modality where the dominant physical effects are taken into account. This gives the user full control over all simulation and transformation parameters. Finally, suitable quality measures are applied which allow a systematic evaluation of image registration accuracy by comparing the known theoretical result and the transformation calculated by the algorithm under investigation.

Results:
During the development of a new registration algorithm, the presented method proved to be a very valuable tool for optimization and evaluation of registration accuracy, since it allows objective numerical comparison of the calculated results.

Conclusions:
The presented method can be used during the development of algorithms for optimization and for quantitative comparison of different registration schemes. The respective software tool can automatically generate and transform simulated but realistic data. Employing suitable numerical quality measures, an objective evaluation of registration results can be easily obtained. Still, the validity of the relatively simple models has to be verified to draw reliable conclusions with respect to real data.
Multimodal Retinal Image Registration for Optic Disk Segmentation
Authors: Skokan M. , Kubečka L. , Wolf M. , Donath K. , Jan J. , Michelson G. , Niemann H. , Chrástek R.
Published: March 2018

Objectives:
The analysis of the optic disk morphology with the means of the scanning laser tomography is an important step for glaucoma diagnosis. A method we developed for optic disk segmentation in images of the scanning laser tomograph is limited by noise, nonuniform illumination and presence of blood vessels. Inspired by recent medical research, we wanted to develop a tool for improving optic disk segmentation by registration of images of the scanning laser tomograph and color fundus photographs and by applying a method we developed for optic disk segmentation in color fundus photographs.

Methods:
The segmentation of the optic disk for glaucoma diagnosis in images of the scanning laser tomograph is based on morphological operations, detection of anatomical structures and active contours and has been described in a previous paper [1]. The segmentation of the optic disk in the fundus photographs is based on nonlinear filtering, Canny edge detector and a modified Hough transform. The registration is based on mutual information using simulated annealing for finding maxima.

Results:
The registration was successful 86.8% of the time when tested on 174 images. Results of the registration have shown a very low displacement error of a maximum of about 5 pixels. The correctness of the registration was manually evaluated by measuring distances between the real vessel borders and those from the registered image.

Conclusions:
We have developed a method for the registration of images of the scanning laser tomograph and fundus photographs. Our first experiments showed that the optic disk segmentation could be improved by fused information from both image modalities.
Registration of Biplane Angiography and Intravascular Ultrasound for 3D Vessel Reconstruction
Authors: Wawro M. , Müller H. , Wilke C. , Weichert F.
Published: March 2018

Abstract:
If planned and applied correctly, intra-vascular brachytherapy (IVB) can significantly reduce the risk of restenosis after interventional treatment of stenotic arteries.

Objectives:
In order to facilitate computer-based IVB planning, a three-dimensional reconstruction of the stenotic artery based on intravascular ultrasound (IVUS) sequences is desirable.

Methods:
To attain a 3D reconstruction, the frames of the IVUS sequence are properly aligned in space and completed with additional intermediate frames generated by interpolation. The alignment procedure uses additional information that is obtained from biplane X-ray angiography performed simultaneously during the capturing of the IVUS sequence. After IVUS images and biplane angiography data are acquired from the patient, the vessel-wall borders and the IVUS catheter are detected by an active contour algorithm. Next, the twist between adjacent IVUS frames is determined by a sequential triangulation method combined with stochastic analysis.

Results:
The above procedure results in a 3D volume-model of the vessel, which also contains information from the IVUS modality. This data is sufficient for computer-based intravascular brachytherapy planning.

Conclusion:
The proposed methodology can be used to improve the current state-of-the-art IVB treatment planning by enabling computerized dosage computations on a highly accurate 3D model.
Electronic Patient Information – Pioneers and MuchMore
Authors: Giere W.
Published: March 2018

Objectives:
This paper must fulfill three different tasks: First, to introduce the topic “Electronic Patient Information – Pioneers and MuchMore”, second, to introduce the invited authors of the symposium, and third, to serve as the author’s academic farewell lecture as professor emeritus.

Results:
The electronic patient record, with all its different kinds of patient information, can be structured in many ways. Here, an historical approach is presented with a primary focus on the development of an information system for in- and outpatients in Germany, especially in Frankfurt, but also in comparison with US systems. The “Stone Age” and “Bronze Age” of patient-related computer applications started with expensive and insufficient hardware, but some years later, the first systems for patient documentation, text generation, and data acquisition could be implemented. The “iron age” and “golden age” yielded until the mid-1970s, e.g. in Oakland, Boston, Salt Lake City, and Frankfurt, quite successful Hospital Information Systems with some special emphasis on natural language processing. The following dark years were filled primarily with administrative systems, but beginning in the early 1980s, an era of enlightenment started, e.g. with rather inexpensive and easy to use PC application, broadly distributed MUMPS systems, and improved thesaurus-based text analysis. Especially in modern times, the medical text processing and classifying has been extended and successfully applied.

Conclusions:
Somewhat in contrast to other approaches, in the future the use of medical linguistics for the development of a successful electronic patient record should be better supported. Electronic patient information should be available wherever and whenever needed. For this, intelligent and automated reporting and controlled data exchange is necessary. The computer should do all classification, coding, and administrative work, and the physician should get all relevant information necessary for decision making.
Research Opportunities and Challenges in 2005
Authors: Lindberg D. A. B.
Published: March 2018

Objectives:
Biomedical informatics practice and research have become so broad that I will comment on only three areas. These are the electronic health record; prospective population studies; and interactive publications.

Methods:
Review of the literature, Internet resources and material and reports generated by internal and external research projects.

Results:
Development of an electronic health record continues to be problematic in the U.S. A number of large-scale prospective cohort studies of normal populations are now actively occurring or in planning stages in a number of countries; these present special research opportunities in biomedical informatics. Although there are engineering challenges to the implementation of interactive publications, they have the potential to enhance understanding, learning, and memory of scientific and health concepts.

Conclusions:
Three areas of bio-medical informatics challenge us and offer interesting and worthy research opportunities. These include the electronic health record, prospective cohort studies, and interactive publications.
Creative and Innovative Statistics in Clinical Research and Development
Authors: Maurer W.
Published: March 2018

Objectives:
The aim of this paper is to show that even in a highly regulated area such as clinical research and development in pharmaceutical industry, there are needs and ample opportunities for statisticians and other medical informatics professionals to further creatively develop and implement methods in order to support the collection, analysis and interpretation of clinical data.

Methods:
The recently published “Critical Path” initiative of the US Food and Drug Administration discusses the decline in new drug submissions in the last decade and illustrates potential causes in the present clinical development process. Areas where statisticians can and have begun to look for new innovative ways to overcome these shortcomings are presented and examples of such novel approaches that have been developed by statistical methodologists in the pharmaceutical industry together with statisticians in academia are given.

Results:
In Early Development, i.e., in the first studies in man with a new compound, a combination of Bayesian methods and modeling approaches is particularly promising to increase the efficiency of decision making whereas in later phases (IIb and III) a marriage of modeling and classical frequentist approaches together with novel adaptive designs is expected to help to chose the right dose regimen and to perform the trials more efficiently in reduced time.

Conclusions:
The combination of known statistical methods and thinking and the development of new approaches are in line with the present paradigm of “learning and confirming” in regulated clinical development while increasing the efficiency of both.
Building Multivariable Regression Models with Continuous Covariates in Clinical Epidemiology
Authors: Sauerbrei W. , Royston P.
Published: March 2018

Objectives:
In fitting regression models, data analysts must often choose a model based on several candidate predictor variables which may influence the outcome. Most analysts either assume a linear relationship for continuous predictors, or categorize them and postulate step functions. By contrast, we propose to model possible non-linearity in the relationship between the outcome and several continuous predictors by estimating smooth functions of the predictors. We aim to demonstrate that a structured approach based on fractional polynomials can give a broadly satisfactory practical solution to the problem of simultaneously identifying a subset of 'important' predictors and determining the functional relationship for continuous predictors.

Methods:
We discuss the background, and motivate and describe the multivariable fractional polynomial (MFP) approach to model selection from data which include continuous and categorical predictors. We compare our results with those from other approaches in examples. We present a small simulation study to compare the functional form of the relationship obtained by fitting fractional polynomials and splines to a single predictor variable.

Results:
We illustrate the advantages of the MFP approach over standard techniques of model construction in two real example datasets analyzed with logistic and Cox regression models, respectively. In the simulation study, fractional polynomial models had lower mean square error and more realistic behaviour than comparable spline models.

Conclusions:
In many practical situations, the MFP approach can satisfy the aim of finding models that fit the data well and also are simple, interpretable and potentially transportable to other settings.
CSI-ISC
Authors: Wolff A. C. , Kutscha U. , Wetter T. , Knaup P. , Garde S.
Published: March 2018

Objectives:
The introduction of information system components (ISCs) usually leads to a change in existing processes, e.g. processes of patient care. These processes might become even more complex and variable than before. An early participation of end users and a better understanding of human factors during design and introduction of ISCs are key factors for a successful introduction of ISCs in health care. Nonetheless no specialized methods have been developed until now to systematically support the integration of ISCs in existing processes of patient care while taking into account these requirements. In this paper, therefore, we introduce a procedure model to implement Concepts for Smooth Integration of ISCs (CSI-ISC).

Methods:
Established theories from economics and social sciences have been applied in our model, among them the stress-strain-concept, the contrastive task analysis (KABA), and the phase model for the management of information systems.

Results:
CSI-ISC is based on the fact that while introducing new information system components, users experience additional workload. One essential aim during the introduction process therefore should be to systematically identify, prioritize and ameliorate workloads that are being imposed on human beings by information technology in health care. To support this, CSI-ISC consists of a static part (workload framework) and a dynamic part (guideline for the introduction of information system components into existing processes of patient care).

Conclusions:
The application of CSI-ISC offers the potential to minimize additional workload caused by information system components systematically. CSI-ISC rationalizes decisions and supports the integration of the information system component into existing processes of patient care.
Investigation on the Improvement of Prediction by Bootstrap Model Averaging
Authors: Augustin N. H. , Sauerbrei W. , Holländer N.
Published: March 2018

Objectives:
We illustrate a recently proposed two-step bootstrap model averaging (bootstrap MA) approach to cope with model selection uncertainty. The predictive performance is investigated in an example and in a simulation study. Results are compared to those derived from other model selection methods.

Methods:
In the framework of the linear regression model we use the two-step bootstrap MA, which consists of a screening step to eliminate covariates thought to have no influence on the response, and a model-averaging step. We also apply the full model, variable selection using backward elimination based on Akaike’s Information Criterion (AIC), the Bayes Information Criterion (BIC) and the bagging approach. The predictive performance is measured by the mean squared error (MSE) and the coverage of confidence intervals for the true response.

Results:
We obtained similar results for all approaches in the example. In the simulation the MSE was reduced by all approaches in comparison to the full model. The smallest values are obtained for bootstrap MA. Only the bootstrap MA and the full model correctly estimated the nominal coverage. The backward elimination procedures led to substantial underestimation and bagging to an overestimation of the true coverage. The screening step of bootstrap MA eliminates most of the unimportant factors.

Conclusion:
The new bootstrap MA approach shows promising results for predictive performance. It increases practical usefulness by eliminating unimportant factors in the screening step.
Same Systems, Different Outcomes
Authors: Berg M. , Aarts J.
Published: March 2018

Objectives:
To compare the outcome of the implementation of computerized physician order entry (CPOE) systems in two Dutch hospitals.

Methods:
Qualitative research methods, including interviews in both hospitals, observations of system in use, observations of staff meetings and document analysis were used to understand the implementation of CPOE. The transcribed texts and implementation documents were analyzed for relevant concepts.

The transcripts and field notes were analyzed using a heuristic success and failure model with medical work as the primary focus.

Results:
Occasions that determined the outcome of the implementation were classified according to factors that may influence the success or failure of implementing systems.

Conclusions:
The themes and patterns that emerged from the data helped validate the concept of medical work as the primary focus of our analysis model; in addition the concept of a support base necessary to accept changes in medical work that result from introducing CPOE may help to understand the different implementation outcomes.
Pre-operative Dynamic Interactive Exploration of Complex Articular Fractures Using a Novel 3D Navigation Tool
Authors: Teistler M. , Bott O. J. , Stuermer K. M. , Pretschner D. P. , Dresing K. , Marschollek M.
Published: March 2018

Objectives:
Trauma surgeons possess specific anticipative pathoanatomical and procedural domain knowledge that can be used for information extraction from original CT image data. This knowledge so far remains unused in clinical workflow and surgeons do not take an active part in the process of image generation and processing. The objectives of our work are to propose and employ a strategy to directly involve surgeons in a dynamic image exploration process and to exemplarily assess the clinical use of this appoach for pre-operative diagnosis of complex articular fractures.

Methods:
We used an interactive 3D navigation tool with a novel human-computer interface for the exploration of articular fractures of two selected anatomical structures. The system offers dynamic interaction with a virtual 3D reconstruction model and the possibility to create on-the-fly oblique multiplanar reformations by tracking hand movements. Three expert surgeons performed exemplary explorations and rated the use of the method for preoperative diagnosis in informal interviews.

Results:
The approach and the system were well received by the three surgeons. The dynamic interaction was rated to be helpful in understanding fracture morphology. Two examples – a radius and a calcaneal fracture – are presented.

Conclusions:
Surgeons with their specific domain knowledge should be involved in the process of image processing. The benefit of using oblique multiplanar reformations for pre-operative planning in articular fractures appears to be substantial and they should therefore be included in radiological and surgical textbooks. Further evaluation is necessary to assess the use of interactive exploration systems in routine diagnosis.
Practical Considerations on the Use of Extreme Sib-pairs for Obesity
Authors: Barth N. , Coners H. , Mayer H. , Hebebrand J. , Ziegler A.
Published: March 2018

Objectives:
The extreme sib-pair approach has been shown to be a powerful strategy to identify susceptibility loci linked to quantitative traits. The body mass index is the usually assessed trait in genetic studies on human obesity. Environmental factors clearly play an important role for this trait. We hypothesized that the low weight of most sibs who were seemingly discordant to the obese index proband was influenced by other environmental and/or genetic factors like restrained eating or psychiatric disorders.

Methods:
A screening questionnaire was sent to parents of all consecutively admitted patients three weeks prior to referral of index probands for inpatient treatment of obesity. The first 320 families were further investigated. Twenty-seven seemingly extremely discordant sib-pairs (ED) were identified and examined in detail.

Results:
The low weight of most sibs who were seemingly discordant to the obese index proband was influenced by factors like restrained eating or psychiatric disorders. Only 20% of the interviewed ED could be considered as genuine ED.

Conclusion:
We conclude that extensive medical evaluation is necessary if the aim is to guarantee genuine ED in family studies for human obesity. Non-paternity deserves specific attention in ED studies.
Computed Critiquing Integrated into Daily Clinical Practice Affects Physicians’ Behavior
Authors: Kuilboer M. M. , Mosseveld M. , van der Does E. , de Jongste J. C. , Overbeek S. E. , Ponsioen B. , van der Lei J. , van Wijk M. A. M.
Published: March 2018

Objective:
We developed AsthmaCritic, a non-inquisitive critiquing system integrated with the general practitioners’ electronic medical records. The system is based on the guidelines for asthma and chronic obstructive pulmonary disease (COPD) as issued by the Dutch College of General Practitioners. This paper assesses the effect of AsthmaCritic on monitoring and treatment of asthma and COPD by Dutch general practitioners in daily practice.

Methods:
A randomized clinical trial in 32 practices (40 Dutch general practitioners) using electronic patient records. An intervention group was given the use of AsthmaCritic, a control group continued working in the usual manner. Both groups had the disposal of the asthma and COPD guidelines routinely distributed by the Dutch College of General Practitioners. We measured the average number of contacts, FEV1 (forced ex-piratory volume), and peak-flow measurements per asthma/COPD patient per practice; and, the average number of antihistamine, cromoglycate, deptropine, and oral bronchodilator prescriptions per asthma/COPD patient per practice.

Results:
The number of contacts increased in the age group of 12-39 years. The number of FEV1, peak-flow measurements, and the ratio of coded measurements increased, whereas the number of cromoglycate prescriptions decreased in the age group of 12-39 years.

Conclusions:
Our study shows that the guideline-based critiquing system AsthmaCritic changed the manner in which the physicians monitored their patients and, to a lesser extent, their treatment behavior. In addition, the physicians changed their data-recording habits.
A Rational Request Behavior: The Development of Prediction Instruments regarding Thyroid Function Tests in Primary Care
Authors: Pop P. , Hasman A. , Schouten H. J. A. , Dupuits F. M. H. M.
Published: March 2018

A prospective study was performed to encourage a rational thyroid-stimulating hormone (TSH) test request behavior of physicians, using prediction instruments. The latter give direct feedback about request adequacy on the basis of pretest probabilities of hyperthyroidism using patients’ signs and symptoms. For instrument design, stepwise logistic regression was used on diagnostic data acquired through questionnaires, answered by 80 physicians and 668 patients for whom physicians requested a TSH test. Instruments were designed for clinical and subclinical hyperthyroidism and for clinical hyperthyroidism alone. Use of the instrument for clinical or subclinical hyperthyroidism on the selected group, at a 5% probability threshold, can result in a 37% reduction of unnecessary TSH test requests. With the instrument for clinical hyperthyroidism at a 5% probability threshold, the number of unnecessary test requests can be reduced by 57%. Therefore, it can be concluded that the instruments can determine TSH test request adequacy and encourage a rational TSH test request behavior of physicians at low pretest probability thresholds.
Functional Requirements for a HIS-RIS-PACS-Interface Design, Including Integration of “Old” Modalities
Authors: Nissen-Meyer S. , Pistitsch C. , Fink U. , Reiser M. , Adelhard K.
Published: March 2018

Radiology, Information Systems (RIS) and Picture Archiving Systems (PACS), have the potential for immense rationalization of operations in radiology and hence for the improvement of health care, as well as the return of investments. These systems must, however, be carefully designed such that they support routine work rather than being an additional burden to radiology staff. Analyses show that comprehensive communication of patient demographic and clinical data between RIS, PACS and Hospital Information Systems (HIS) are necessary prerequisites to achieve cost effectiveness. Based on analyses of radiology operations in a large university primary care hospital, functional requirements and data structures for designing HIS/RIS/PACS interfaces are presented. These concern communication of past examinations, associated written reports and images, appointment scheduling, requests of new examinations, digitizing old analog X-ray films, access from RIS/PACS to other clinical data, and transfer of new radiology reports and relevant images. Consistency of all redundant data stored in the three systems is essential. A pragmatic, safe and inexpensive method of electronically integrating “old” modalities not fully ”PACS capable“ in the HIS/RIS/PACS world is presented.
A Review of Database Management Systems Suitable for Neuroimaging
Authors: Diallo B. , Travere J.-M. , Mazoyer B.
Published: March 2018

This study comprises a technical assessment of Database Management Systems (DBMS), which may be of use in the analysis of data obtained from human brain mapping procedures. Due to the large expansion of the neuroimaging field, the use of specialized database software to store and process neuroimages and their attached components is inevitable. The advent of multiple software products, a wealth of technical terms and a wide variety of other applications make the choice of a suitable program sometimes difficult. Through the inclusion of some basic and pertinent criteria (e.g., performance, ease of opening, standardization and portability), we present a descriptive comparison of 12 DBMSs currently available in the commercial and public domain. We have compared and tested three main architecture models which are currently available and assessed their potential applications for imaging purposes: relational, object-oriented, and hybrid. The findings of our study demonstrated that the Illustra™ software was the best suited for a neuroimaging environment because of its intrinsic ability to handle complex and large objects, such as 3D volumes or geometric structures.
A Multistate Kalman Filter for Neonatal Clotting Time Prediction and Early Detection of Coagulation Disturbances
Authors: van der Velde J. , Geven W. B. , Festen C. , Verbeek A. L. M. , de Haan A. F. J.
Published: March 2018

The multistate Kalman filter was applied to develop a heparin dose proposal system and to detect coagulation disturbances during neonatal extracorporeal membrane oxygenation (ECMO). A system containing this filter was based on the activated clotting time (ACT) values and the heparin doses administered every hour during ECMO. If the ACT value can be predicted accurately from the previous heparin dose, a heparin dose proposal can be given to achieve or maintain the required ACT level. The analysis was done on 6,356 ACT level measurements in 44 ECMO neonates. The multistate Kalman filter technique showed an unbiased prediction of ACT, with a standard deviation of 23 seconds. Two out of three cases of disseminated intravascular coagulation (DIC) were detected. ACT values were predicted sufficiently accurately by the multistate Kalman filter technique to justify a prospective study on the performance of the heparin dose proposal system and its ability to detect DIC.
A Generic Model of Clinical Practice
Authors: Dietz J. L. G. , Hasman A. , de Vries Robbé P. F. , Tange H. J.
Published: March 2018

Objectives: Many shared-care projects feel the need for electronic patient-record (EPR) systems. In absence of practical experiences from paper record keeping, a theoretical model is the only reference for the design of these systems. In this article, we review existing models of individual clinical practice and integrate their useful elements. We then present a generic model of clinical practice that is applicable to both individual and collaborative clinical practice.

Methods: We followed the principles of the conversation-for-action theory and the DEMO method. According to these principles, information can only be generated by a conversation between two actors. An actor is a role that can be played by one or more human subjects, so the model does not distinguish between inter-individual and intra-individual conversations.

Results: Clinical practice has been divided into four actors: service provider, problem solver, coordinator, and worker. Each actor represents a level of clinical responsibility. Any information in the patient record is the result of a conversation between two of these actors. Connecting different conversations to one another can create a process view with meta-information about the rationale of clinical practice. Such process view can be implemented as an extension to the EPR.

Conclusions: The model has the potential to cover all professional activities, but needs to be further validated. The model can serve as a theoretical basis for the design of EPR-systems for shared care, but a successful EPR-system needs more than just a theoretical model.
Entering the Black Box of Neural Networks
Authors: Gerber B. S. , Tape T. G. , Wigton R. S. , Heckerling P. S.
Published: March 2018

Objectives: Artificial neural networks have proved to be accurate predictive instruments in several medical domains, but have been criticized for failing to specify the information upon which their predictions are based. We used methods of relevance analysis and sensitivity analysis to determine the most important predictor variables for a validated neural network for community-acquired pneumonia.

Methods: We studied a feed-forward, back-propagation neural network trained to predict pneumonia among patients presenting to an emergency department with fever or respiratory complaints. We used the methods of full retraining, weight elimination, constant substitution, linear substitution, and data permutation to identify a consensus set of important demographic, symptom, sign, and comorbidity predictors that influenced network output for pneumonia. We compared predictors identified by these methods to those identified by a weight propagation analysis based on the matrices of the network, and by logistic regression.

Results: Predictors identified by these methods were clinically plausible, and were concordant with those identified by weight analysis, and by logistic regression using the same data. The methods were highly correlated in network error, and led to variable sets with errors below bootstrap 95% confidence intervals for networks with similar numbers of inputs. Scores for variable relevance tended to be higher with methods that precluded network retraining (weight elimination) or that permuted variable values (data permutation), compared with methods that permitted retraining (full retraining) or that approximated its effects (constant and linear substitution).

Conclusion: Methods of relevance analysis and sensitivity analysis are useful for identifying important predictor variables used by artificial neural networks.
The Index as a New Concept towards an Integrated Framework for the Electronic Patient Record
Authors: Clercq De
Published: March 2018

Objective: To overcome some classical limitations of the POMR (Problem-Oriented Medical Record), including the management of divergent opinions between health professionals, in order to construct a common patient record across multiple disciplines in hospital settings and professional networks.

Methods: Using a complex clinical case, we improved a POMR model previously used by GPs in order to translate it into a hospital setting. The enhanced model has been assessed through use in various ongoing clinical cases and through extended discussion with professional end-users (physicians, nurses, general practitioners, and social workers).

Results: The Index concept (flexible structural link) is proposed as a major improvement in the construction of a POMR in a shared care environment.

Conclusions: The Index introduces interesting new perspectives. Following its implementation in the Belgian pilot site in the CORINES project, further studies remain to be carried out in order to develop a cost/benefit assessment.
Discrete Event Simulation in the Health Policy and Management Program
Authors: Groothuis S. , Merode van
Published: March 2018

Students in Health Policy and Management at the Faculty of Health Sciences of Maastricht University must learn to analyze and design workflow processes in health care. To attain this, a discrete event simulation training, using MedModel™ is used. This paper describes the training in two consecutive years. In both years the training was evaluated systematically. The evaluation results demonstrate that the simulation training increased the students’ knowledge about analyzing and designing workflow processes in healthcare. Students considered the training as a very important part of their program.
High Speed Digital Circuits for Medical Communication; the MINCS-UH Project
Authors: Takahashi T. , Kiuchi T.
Published: March 2018

In Japan, a high speed, bidirectional digital satellite communication system called Medical Information Network by Communications Satellite for University Hospitals is currently available in 30 national universities, and many programs, including clinical conferences, lectures and tutorials, have been broadcasted. Its characteristics are: (1) a state-of-the-art digital high-definition television system, (2) excellent security protection using digital encryption (3) bidirectional communications using two satellite circuits simultaneously, and (4) easy operability. High-quality motion images, and security protection mechanisms are essential for use in clinical medicine.
A Data Mining System for Infection Control Surveillance
Authors: Brossette S. E. , Sprague A. P. , Jones W. T. , Moser S. A.
Published: March 2018

Nosocomial infections and antimicrobial resistance are problems of enormous magnitude that impact the morbidity and mortality of hospitalized patients as well as their cost of care. The Data Mining Surveillance System (DMSS) uses novel data mining techniques to discover unsuspected, useful patterns of nosocomial infections and antimicrobial resistance from the analysis of hospital laboratory data. This report details a mature version of DMSS as well as an experiment in which DMSS was used to analyze all inpatient culture data, collected over 15 months at the University of Alabama at Birmingham Hospital.
Robust Outcome Prediction for Intensive-Care Patients
Authors: Sebastiani P. , Dybowski R. , Ramoni M.
Published: March 2018

Missing data are a major plague of medical databases in general, and of Intensive Care Unit databases in particular. The time pressure of work in an Intensive Care Unit pushes the physicians to omit randomly or selectively record data. These different omission strategies give rise to different patterns of missing data and the recommended approach of completing the database using median imputation and fitting a logistic regression model can lead to significant biases. This paper applies a new classification method, called robust Bayes classifier, which does not rely on any particular assumption about the pattern of missing data and compares it to the median imputation approach using a database of 324 Intensive Care Unit patients.
Redefining and Improving Patient Safety
Authors: Ball M. J. , Douglas J. V.
Published: March 2018

Objectives: The Institute of Medicine (IOM) has focused attention on patient safety in the united States. Other countries share these concerns.

Methods: Governmental agencies and professional organizations are redefining approaches to safety, calling upon the use of information and communication technology as an enabler and expanding the range of evidence admissible in documenting success.

Results: Efforts to understand medical errors have used retrospective chart review, incident reporting, and computerized surveillance; the result is an evolving picture of the number, nature, and cause of errors. Approaches used to prevent errors include computerized physician order entry, decision support tools, computerized monitoring, and evidence-based practice; varying levels of evidence document their success.

Conclusions: Technology offers challenging capabilities, not simple solutions. New evidence and new tools demand new approaches and attention to human factors.
A Health Condition Survey of Japanese People in the Prime of Life, Based on National MHTS and Human Dry Dock Statistics
Authors: Sasamori N.
Published: March 2018

A health condition survey was made of Japanese persons in the prime of life regarding six abnormalities (obesity, impaired glucose tolerance, hypertension, hypercholesterolemia, hypertriglyceridemia, liver dysfunction) occurring with high frequency. It was demonstrated that impaired liver function and elevation in blood cholesterol are the main causes of health deterioration in persons in the prime of life. The survey results suggest that the deterioration of their health is associated with their lifestyle.
Elimination of Inter-Institutional Discrepancies in Health Check-up Results: Standardization of Diagnostic Decision Level and Uniformity of Examination Data
Authors: Tamura M.
Published: March 2018

In Japan, more people are taking AMHTS and the number of medical institutions where it is provided is also increasing. AMHTS is expected to continue to expand in scope and importance from now on. People do not necessarily take AMHTS at the same medical institutions year after year. For AMHTS to be truly useful from the viewpoint of preventive medicine and be able to continue its development, it is imperative that the level of diagnosis be standardized and the compatibility of examination data be established among different institutions.

The Japan Society of MHTS is conducting pilot studies of reversed quality control (RQC) as part of its activities with the aim of clearly understanding inter-institution gaps regarding AMHTS and to establish uniformity in examination data.
Informatics in the Service of Health, a Look to the Future
Authors: Moehr J. R.
Published: March 2018

The paper attempts a balanced look at the directions of health informatics required in the future. In a high level review of impediments to health and health care a number of issues are identified that may be amenable to improvement by contributions from health informatics. Attention is drawn to the improvement ofthe collection and dissemination of knowledge in addition to the analysis of morbid conditions as a focus for health informatics. On this basis a review of the current state of health information systems is undertaken. The importance of adaptable user interfaces for end users and systems personnel, privacy and confidentiality protection, and linkage among clinical support systems and knowledge repositories is stressed. These improvements hinge on advancements in medical concept representation. Canadian contributions to these developments, particularly the instigation of Evidence Based Medicine (EBM) are briefly reviewed.
Obstruction of Valid Race/Ethnicity Data Acquisition by Current Data Collection Instruments
Authors: Rubin L. , Dakis P.
Published: March 2018

Methods of collecting race/ethnicity data affect the validity of conclusions based on them as do other factors such as lack of consensus and inadequate definitions for terminology; and misclassification or miscounting of patients. Current data collection instruments do not identify mixed heritage. We propose improving data measurement and collection by including a quantified multiracial/multiethnic heritage category for persons of mixed heritage; a don't know category; and a refuse to reveal category. The resulting problems affect all uses of racial and ethnic data, including health care provision, research, and health planning. More precise race/ ethnicity categories should be encouraged by such means as a 16-category checklist (with instructions to check all which apply) currently in development. The Methods section of all clinical, epidemiologic, and pharmacologic reports should include descriptions of racial measurement and reasons for including or excluding clearly defined populations.
Integrating Legacy Laboratory Information Systems into a Client-Server World: The University of Minnesota Clinical Workstation (CWS) Project
Authors: Willard K. E. , Sielaff B. H. , Connelly D. P.
Published: March 2018

The development of an innovative clinical decision-support project such as the University of Minnesota’s Clinical Workstation initiative mandates the use of modern client-server network architectures. Preexisting conventional laboratory information systems (LIS) cannot be quickly replaced with client-server equivalents because of the cost and relative unavailability of such systems. Thus, embedding strategies that effectively integrate legacy information systems are needed. Our strategy led to the adoption of a multi-layered connection architecture that provides a data feed from our existing LIS to a new network-based relational database management system. By careful design, we maximize the use of open standards in our layered connection structure to provide data, requisition, or event messaging in several formats. Each layer is optimized to provide needed services to existing hospital clients and is well positioned to support future hospital network clients.
Methods for Improving the Repeatability of Automated ECG Analysis
Authors: Aitchison T. C. , Macfarlane P. W. , McLaughlin S. C.
Published: March 2018

Statistically-based smoothing techniques are described which have been applied to the existing framework of the Glasgow ECG Analysis program. These methods have been designed with the aim of improving repeatability in the computer interpretation of ECGs which have been recorded either several minutes or 24 hours apart from patients in a clinically stable condition. With respect to the ECG diagnosis of Left Ventricular Hypertrophy (LVH), these flexible methods have the effect of reducing the number of inconsistent day-to-day interpretations by 36% from 33 to 21 in

330 pairs of ECGs recorded one day apart. Similarly, when comparing agreement in the diagnosis of LVH in 249 pairs of ECGs which were recorded several minutes apart, the number of discordant computer interpretations was 6 using the new methodology, compared with 13 using conventional criteria, i. e. there was a 54% reduction in disagreements.
Improving Coded Data Entry by an Electronic Patient Record System
Authors: Puerner F. , Soltanian H. , Hohnloser J. H.
Published: March 2018

Data are presented on the use of a browsing and encoding utility to improve coded data entry for an electronic patient record system. Traditional and computerized discharge summaries were compared: during three phases of coding ICD-9 diagnoses phase I, no coding; phase II, manual coding, and phase III, computerized semiautomatic coding. Our data indicate that (1) only 50% of all diagnoses in a discharge summary are encoded manually; (2) using a computerized browsing and encoding utility this percentage may increase by 64%; (3) when forced to encode manually, users may “shift” as much as 84% of relevant diagnoses from the appropriate coding section to other sections thereby “bypassing” the need to encode, this was reduced by up to 41 % with the computerized approach, and (4) computerized encoding can improve completeness of data encoding, from 46 to 100%. We conclude that the use of a computerized browsing and encoding tool can increase data quality and the percentage of documented data. Mechanisms bypassing the need to code can be avoided.
Pseudonyms for Cancer Registries
Authors: Miller M. , Schmidtmann I. , Michaelis J. , Pommerening K.
Published: March 2018

In order to conform to the rigid German legislation on data privacy and security we developed a new concept of data flow and data storage for population-based cancer registries. A special trusted office generates a pseudonym for each case by a cryptographic procedure. This office also handles the notification of cases and communicates with the reporting physicians. It passes pseudonymous records to the registration office for permanent storage. The registration office links the records according to the pseudonyms. Starting from a requirements analysis we show how to construct the pseudonyms; we then show that they meet the requirements. We discuss how the pseudonyms have to be protected by cryptographic and organizational means. A pilot study showed that the proposed procedure gives acceptable synonym and homonym error rates. The methods described are not restricted to cancer registration and may serve as a model for comparable applications in medical informatics.
Instantiating and Monitoring Skeletal Treatment Plans
Authors: Uckun S.
Published: March 2018

Current emphasis on protocol-based care has stirred interest in planning research as applied to clinical medicine. However, many assumptions made in designing traditional planners and plan-execution algorithms do not hold in medical domains. The problems include the unpredictable nature of the domain, uncertainty and the variability in the utility of available actions, and the need for parallel and continuous execution of treatment plans. In the context of our research on intelligent monitoring and control, we developed an approach for plan instantiation and execution which takes advantage of readily available treatment protocols. The system, named SPIN, instantiates treatment protocols based on current context, executes plans and closed-loop control actions, monitors the execution of plans and actions, and modifies plan execution as necessitated by patient response. The system is incorporated in the Guardian system for intensive-care patient monitoring and control. We address the strengths and limitations of the representation and the execution framework and discuss how the methodology may be improved and used in clinical practice.
Inter-Observer Variation in Decision-Making Regarding Patients on Chronic Hemodialysis: A Study Using the Kappa Index
Authors: Timpka T. , Buur T.
Published: March 2018

To examine inter-observer variation in the monitoring of patients with chronic disease, four nephrologists independently assessed 62 patients on maintenance hemodialysis. Deviation from normal was determined for adequacy of dialysis, protein intake, and metabolic state. The kappa-index, which allows to adjust for chance agreement, was used to analyze each monitoring diagnosis. Low agreement was found on decisions concerning adequacy of dialysis (kappa 0.12-0.26), while agreement was higher about protein intake (kappa 0.21-0.46), and metabolic state (kappa 0.24-0.52). Two physicians classified no patient as overdialyzed, while 16-18% were thus categorized by the other two. Routines for review of recent medical history also differed significantly between the physicians. Measures are needed to increase the reliability of decisions regarding the monitoring of chronic hemodialysis. A long lasting physician-patient relationship is not a sufficient prerequisite for diminishing decision variation. Medical audit as part of the clinical routine, and use of additional sources of information, exemplified by urea kinetic modeling, are discussed.