bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Informatics and the Quality of Health: New Approaches to Support Patient Care
Authors: Haux R. , Kulikowski C. , Bohne A. , Brandner R. , Brigl B. , Fischer G. , Garde S. , Knaup P. , Ruderich F. , Schubert R. , Singer R. , Wolff A. C. , Ammenwerth E.
Published: March 2018

Objectives: The Yearbook of Medical Informatics is published annually by the International Medical Informatics Association (IMIA) and contains a selection of excellent papers on medical informatics research which have been recently published (www.yearbook.uni-hd.de). The 2003 Yearbook of Medical Informatics took as its theme the role of medical informatics for the quality of health care. In this paper, we will discuss challenges for health care, and the lessons learned from editing IMIA Yearbook 2003.

Results and Conclusions: Modern information processing methodology and information and communication technology have strongly influenced our societies and health care. As a consequence of this, medical informatics as a discipline has taken a leading role in the further development of health care. This involves developing information systems that enhance opportunities for global access to health services and medical knowledge. Informatics methodology and technology will facilitate high quality of care in aging societies, and will decrease the possibilities of health care errors. It will also enable the dissemination of the latest medical and health information on the web to consumers and health care providers alike. The selected papers of the IMIA Yearbook 2003 present clear examples and future challenges, and they highlight how various sub-disciplines of medical informatics can contribute to this.
World-Wide Web-Based Graphical User Interfaces for Laboratory Data
Authors: Keller D. , Schaller W. J. , Wong J. S. K. , de Groen P. C.
Published: March 2018

Objectives: Electronic medical record systems permit collection of large amounts of medical information. Usually, information is presented in a fixed format, either as text or tables. Health care providers have to navigate this fixed format in order to find information useful for a specific patient-provider interaction. The main objective of this work was to allow the provider immediate access to specific laboratory information through the development of a highly customizable, graphical user interface to the Mayo Clinic laboratory information system.

Methods – Results: Here we describe this platform-independent, World-Wide-Web-based graphical user interface that allows the provider to see all or a predetermined panel of essential laboratory data in graphical format. Advantages include availability at internet-based workstations, immediate recognition of trends over time, ability to zoom in and out of specific periods of time, and detailed analysis of patient values in relationship to normal values.

Conclusions: Web browser-based user interface allowing graphical display of laboratory data using Java technology was described. The connection to the Mayo Clinic laboratory information system combines cross-platform support for use on virtually any networked machine, interaction through a Web browser for ease of use, and a combination of the Perl and Java languages for powerful data processing and interactivity.
Developing a Public Key Infrastructure for a Secure Regional e-Health Environment
Authors: Mavridis I. , Ilioudis C. , Georgiadis C. , Pangalos G.
Published: March 2018

Objectives: Internet technologies provide an attractive infrastructure for efficient and low cost communications in regional health information networks. The advantages provided by the Internet come however with a significantly greater element of risk to the confidentiality and integrity of information. This is because the Internet has been designed primarily to optimize information sharing and interoperability, not security. The main objective of this paper is to propose the exploitation of public-key cryptography techniques to provide adequate security to enable secure healthcare Internet applications.

Methods: Public-key cryptography techniques can provide the needed security infrastructure in regional health networks. In the regional health-care security framework presented in this paper, we propose the use of state-of-art Public Key Infrastructure (PKI) technology. Such an e-Health PKI consists of regional certification authorities that are implemented within the central hospitals of each region and provide their services to the rest of the healthcare establishments of the same region.

Results: Significant experience in this area has been gained from the implementation of the PKI@AUTH project.

Conclusions: The developed PKI infrastructure already successfully provides its security services to the AHEPA university hospital. The same infrastructure is designed to easily support a number of hospitals participating in a regional health information network.
User Friendliness Aspects of Home Care Telematics
Authors: Mantzouranis E. C.
Published: March 2018

Objectives: Asthma is the most common chronic childhood disease with a high number of admissions and emergency room visits in pediatric hospitals. Treatment of asthmatic patients is best done by asthma specialists and requires the chronic use of prophylactic medications, additional treatment for acute exacerbations and regular check-ups. In Crete, a Greek island, there are many children with asthma who are not receiving care by an asthma specialist. The only specialty clinic for asthmatic children in Crete is in Heraklion, a city in the center of the island. We attempted to use telemedicine in order to reach and follow children with asthma who live in distant areas in Crete.

Methods: We set up a pilot telemedicine program with 10 asthmatic children already followed at the Specialty Clinic. Using teleconferencing techniques, we were able to obtain the medical history, examine the patients, educate them about the disease and adjust the treatment.

Results: The parents of patients accepted the tele-medicine service with a percentage of 90% and showed a special interest in this new service.

Conclusions: We conclude that telemedicine for asthmatic children performed by their specialist is feasible and accepted by the majority of patients.
Cooperative Knowledge Evolution: A Construction-Integration Approach to Knowledge Discovery in Medicine
Authors: Tschaitschian B. , Schmalhofer F. J.
Published: March 2018

In this paper, we perform a cognitive analysis of knowledge discovery processes. As a result of this analysis, the construction-integration theory is proposed as a general framework for developing cooperative knowledge evolution systems. We thus suggest that for the acquisition of new domain knowledge in medicine, one should first construct pluralistic views on a given topic which may contain inconsistencies as well as redundancies. Only thereafter does this knowledge become consolidated into a situation-specific circumscription and the early inconsistencies become eliminated. As a proof for the viability of such knowledge acquisition processes in medicine, we present the IDEAS system, which can be used for the intelligent documentation of adverse events in clinical studies. This system provides a better documentation of the side-effects of medical drugs. Thereby, knowledge evolution occurs by achieving consistent explanations in increasingly larger contexts (i.e., more cases and more pharmaceutical substrates). Finally, it is shown how prototypes, model-based approaches and cooperative knowledge evolution systems can be distinguished as different classes of knowledge-based systems.
Three Types of IS-A Statement in Diagnostic Classifications: Three Types of Knowledge Needed for Development and Maintenance
Authors: Flier F. J. , de Vries Robbé P. F. , Zanstra P. E.
Published: March 2018

Update mechanisms for diagnostic classifications should capture changes in medical knowledge but also allow for comparability across versions. This paper provides a basis for such a mechanism by describing types of IS-A statement and types of knowledge used in the construction of diagnostic classifications. Three types of IS-A statement are used: ‘A is by definition a 8’, ‘A is probably a 8’ and ‘A is in theory necessarily a 8’. Each relates to a different type of knowedge: knowledge of linguistic conventions, of probabilities, and of empirical theories and their status, respectively. Consequently, the development and maintenance of diagnostic classifications requires a collaboration of medical terminologists and medical scientists. The role of the latter is especially important during updating. Updating is necessitated by changing probabilities and by the introduction or changing status of empirical theories. The linguistic notion of hyponymy oversimplifies the issue.
The SNOMED DICOM Microglossary: Controlled Terminology Resource for Data Interchange in Biomedical Imaging
Authors: Dean Bidgood W.
Published: March 2018

This paper describes an authoritative, non-proprietary information resource that provides an efficient mechanism for embedding specialized clinical knowledge into the design of healthcare telecommunications systems. The resource marries two types of data interchange standards, a message/electronic-document standard and a terminology standard. In technical terms, it is part protocol and part database. Industry, academia, professional specialty societies, and the federal government participated in its development. The development of mUlti-specialty content has broadly engaged biomedical domain experts to an unprecedented degree in voluntary, non-proprietary message/document-standards development. The resource is the SNOMED DICOM Microglossary (SDM) [1], a message-terminology (or document-content) mapping resource. The message/electronicdocument standard is DICOM (Digital Imaging and Communications in Medicine) [2]. The terminology standard is SNOMED, (Systematized Nomenclature of Human and Veterinary Medicine) [31. The SDM specifies the mapping of multi-specialty imaging terminology from SNOMED to DICOM data elements. DICOM provides semantic constraints and a framework for discou rse that are lacking in SNOMED. Thus the message standard and the computerbased terminology both depend upon and complete each other. The combination is synergistic. By substitution of different templates of specialty terminology from the SDM, a generic message template, such as the DICOM Visible Light (Color Diagnostic) Image or the DICOM Structured Reporting specification can be reconfigured for diverse applications. Professional societies, with technical assistance from the College of American Pathologists, contribute and maintain their portions of the terminology, and can use SDM templates and term lists in clinical practice guidelines for the structure and content of computer-based patient records.
Metaphrase: An Aid to the Clinical Conceptualization and Formalization of Patient Problems in Healthcare Enterprises
Authors: Olson N. E. , Keck K. D. , Cole W. G. , Erlbaum M. S. , Sherertz D. D. , Chute C. G. , Elkin P. L. , Atkin G. E. , Kaihoi B. H. , Safran C. , Rind D. , Law V. , Tuttle M. S.
Published: March 2018

Patient descriptors, or “problems,” such as “brain metastases of melanoma” are an effective way for caregivers to describe patients. But most problems, e.g., “cubital tunnel syndrome” or “ulnar nerve compression,” found in problem lists in an Electronic Medical Record (EMR) are not comparable computationally – in general, a computer cannot determine whether they describe the same or a related problem, or whether the user would have preferred “ulnar nerve compression syndrome.” Metaphrase is a scalable, middleware component designed to be accessed from problemmanager applications in EMR systems. In response to caregivers' informal descriptors it suggests potentially equivalent, authoritative, and more formally comparable descriptors. Metaphrase contains a clinical subset of the 1997 UMLS Metathesaurus and some 10,000 “problems” from the Mayo Clinic and Harvard Beth Israel Hospital. Word and term completion, spelling correction, and semantic navigation, all combine to ease the burden of problem conceptualization, entry and formalization.
The Nature of Lexical Knowledge
Authors: McCray A. T.
Published: March 2018

This paper considers the nature of lexical knowledge and its role in language and information processing. The lexicon is the central component of language and plays a pivotal role in current linguistic theory [3, 4] and, increasingly, in natural language processing systems [5-7]. The lexicon embodies information aboutthe lexical items ofthe language and serves as the foundation for morphologic, syntactic, and semantic processing. The differences as well as commonalities among dictionaries, thesauri, and lexicons are discussed, and distinctions between words, lexical items, and terms are drawn. Next, the scope and content ofthe SPECIALIST lexicon are presented, followed by a discussion of certain writing conventions that can be troublesome for text processing applications. One approach to handling orthographic and other lexical variation is discussed in a section that reports on the design and implementation of the SPECIALIST lexical programs. The paper concludes with a discussion of controlled terminologies for the medical domain. Throughout the discussion, examples are drawn from the SPECIALIST lexicon and from the other UMLS knowledge sources [8,9].
A Quantitative Ranking of the Biomedical Informatics Serials
Authors: Kaalaas-Sittig J. , Sittig D. F.
Published: March 2018

We have developed a quantitative serial ranking system based on multiple citation analysis techniques, library use statistics, expert opinion, and selected distinguishing publication characteristics. Evaluation criteria categories include: average Science Citation Index (Impact Factor, Immediacy Index, Total citations) rankings from 1987 to 1992; citation source counts of multiple “core” biomedical informatics publications; a questionnaire sent to American College of Medical Informatics Fellows; publication delay; distinguishing characteristics (e. g., subscription cost, total circulation, year established, places indexed, affiliation with a professional society, major biomedical resource library holdings); and the total number of interlibrary loan requests to the U. S. National Library of Medicine. The top serials were Computers and Biomedical Research, MD Computing, Methods of Information in Medicine, Medical Decision Making and Computers in Biology and Medicine.
Experiences Using New Zealand’s Hospital Based Surveillance System for Injury Prevention Research
Authors: Langley J. D.
Published: March 2018

The focus of this paper is the Injury Prevention Research Unit’s (IPRU’s) experience in analysing New Zealand’s national inpatient public hospital injury data set. The existence of the national inpatient data management system has enabled the IPRU to develop an injury morbidity data set for the period of 1979-1992. The IPRU, thus, has data on over 250,000 injury events that were serious enough to warrant admission to a hospital. This data set has been used extensively by the IPRU to address a wide range of injury issues from demographic, environment, activity, product, and injury perspectives. Apart from the demographic variables, those variables that have proved most useful in our work have been: length of stay, readmission indicator, a personal identifier code number, WHO International Classification of Disease coding for diagnoses and external cause of injury (E-code), and written descriptions of external cause of injuries and location of injury event. Practical examples of IPRU’s use of each of these variables are given. These examples demonstrate how invaluable New Zealand’s inpatient injury data set is for documenting resource utilisation, accurately determining the incidence of events, undertaking analytical epidemiological studies including evaluations, and addressing shortcomings in E-codes. A key aspect of the system is the narrative information. Evidence is produced demonstrates that the electronic recording of narratives of the circumstances of injury is an invaluable tool for conducting epidemiological research which has direct implications for injury prevention policy and practice. Given the numerous objections that are raised about E-coding, injury prevention personnel would be well served to encourage health authorities to electronically record narratives as a first step towards uniform coding.
A Computerised Implementation of a Minimum Set of Health Indicators
Authors: Blignaut P. J. , McDonald T.
Published: March 2018

Three alternative approaches to computerise primary health care services as provided in clinics in South Africa are compared. The first approach implements a system based on a head-count approach using a minimum set of indicators. This system resembles the current manual system of tally sheets. The second and third approaches implement computer systems based on patient records. The second approach is based on a very limited data set, and the third utilizes a comprehensive demographic and clinical data set. The three alternatives are compared with regard to practicality, flexibility, ease of use, accuracy and completeness of statistical reports, and time utilisation. It is concluded that the flexibility of a patientrecord approach, although more time consuming, is preferred. The second alternative is more feasible in a developing country with mostly computerilliterate nurses. Ways in which such a system can be implemented in an environment with limited hardware resources are also proposed.
Development of a Primary Health Care Information System in Ghana: Lessons Learned
Authors: Campbell B. C. , Heywood A. B.
Published: March 2018

In Ghana, between January 1990 and September 1993, a series of steps were undertaken to review the existing vertical reporting procedures and to develop an integrated Health Management Information System (HMIS) for Primary Health Care (PHC).

These steps included a situation analysis of the existing reporting systems; participatory design of tools for planning, data collection, feedback and reporting; field test and revision of the modified system; training of staff at all levels; development of tools for self-assessment and stimulation of routine feedback to lower levels and reporting of analysed indicators to higher levels.

There were some notable achievements which included promotion of self-reliance, improved data relevance and accuracy, as well as strengthened supervision and support. However, it was difficult to identify the most appropriate institutional location for the HMIS; over-emphasis on process leads to reduced implementation; reporting was still given greater priority than analysis and use of data, and systems for collection and use were still cumbersome and time consuming. It is also difficult to prove that having better information really improves decision-making, or even coverage and quality of PHC service delivery.

These issues, as well as lessons learned, are discussed in the paper.
Development of an HIV Clinical and Research Database for South Africa
Authors: Spencer D. C. , Steinberg M. H. , Kanter A. S.
Published: March 2018

Health service restructuring in South Africa provides an opportunity to introduce appropriate Health Information System (HIS) technology. This is particularly relevant given the emerging HIV epidemic and the need to capture, translate and disseminate new experiences in HIV/AIDS care, support and clinical research. In 1994, a number of clinicians and health-care providers working in South Africa had begun to establish basic computerized databases to assist in research on HIV, but no standardized nomenclature or framework for collaboration was created. This paper describes a clinical and research database that could be used as an example for a standardized system by clinicians working in South Africa. The authors, with assistance from the National AIDS Research Programme of the Medical Research Council, created a prototype relational database using Microsoft Access™. To test the prototype, 1057 HIV-positive patients from the Infectious Disease Clinic at Johannesburg General Hospital were entered.
Fault Diagnosis in an Expert System for Health Services Management in the Tropics
Authors: Asoh D. A. , Boyom S. F. , Kwankam S. Y.
Published: March 2018

An integrated large-scale expert system called Health-2000, for the management of health services in regions where tropical diseases are endemic, has been designed. This system combines knowledge and databases, the contents of which are operated upon by an inference engine, to produce usable information. The system allows a host of applications, ranging from medical diagnosis to fault detection and preventive maintenance of biomedical equipment.

The theoretical background and approach used in the development of the fault diagnosis and equipment maintenance sub-system of Health-2000 is presented. Model-based knowledge acquisition, and an extension of the Failure Modes, Effects and Criticality Analysis are two methodologies applied to build its knowledge bases. The inference engine which supports backward and forward chaining, operates on numerical and non-numerical facts, and uses fuzzy logic to handle vague and uncertain knowledge. Fault isolation proceeds in a top-down fashion, from equipment sub-system, to modules and components.
Health Informatics: Handle with Caution
Authors: Leroy V. , Maurice-Tison S. , Le Blanc B. , Salamon R.
Published: March 2018

The increased use of computers is a response to the considerable growth in information in all fields of activities. Related to this, in the field of medicine a new component appeared about 40 years ago: Medical Informatics. Its goals are to assist health care professionals in the choice of data to manage and in the choice of applications of such data. These possibilities for data management must be well understood and, related to this, two major dangers must be emphasized. One concerns data security, and the other concerns the processing of these data. This paper discusses these items and warns of the inappropriate use of medical informatics.
Health-2000: An Integrated Large-scale Expert System for the Hospital of the Future
Authors: Boyom S. F. , Asoh D. A. , Asaah C. , Kengne F. , Kwankam S. Y.
Published: March 2018

Decision making and management are problems which plague health systems in developing countries, particularly in Sub-Saharan Africa where there is significant waste of resources. The need goes beyond national health management information systems, to tools required in daily micromanagement of various components of the health system. This paper describes an integrated expert system, Health-2000, an information-oriented tool for acquiring, processing and disseminating medical knowledge, data and decisions in the hospital of the future. It integrates six essential features of the medical care environment: personnel management, patient management, medical diagnosis, laboratory management, propharmacy, and equipment management. Disease conditions covered are the major tropical diseases. An intelligent tutoring feature completes the package. Emphasis is placed on the graphical user interface to facilitate interactions between the user and the system, which is developed for PCs using Pascal, C, Clipper and Prolog.
National Health Management Information System: Issues of Funding and Support
Authors: Soriyan H. A. , Makanjuola R. O. A. , Akinde A. D.
Published: March 2018

Information Technology has made a substantial inroad into Nigerian society, particularly since the late 1980s. It is, however, already being applied in the health sector.

The Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria has adopted a systematic approach to the development of a Health Information System (HIS) for a typical specialist hospital. A review of the existing HIS in OAUIHC is presented, highlighting its attributes, problems, and limitations. In addition, the options of funding HIS on a national scale are identified and discussed.

Finally, strategies to ensure ongoing support of a national HIS are presented.
Detection of Aberrant Observations in a Background of an Unknown Multidimensional Gaussian Distribution
Authors: Gelsema E. S. , Leijnse B. , Wulkan R. W.
Published: March 2018

An exploratory iterative technique for the detection of aberrant observations on a background of a multidimensional Gaussian distribution is described. Its development was motivated by the analysis of a set of three measurements reflecting the acid-base metabolism in the blood of 2,402 intensive care patients. This new, three-dimensional treatment of such data yields a meaningful description. A technical evaluation of the method, using artificially generated data is also presented. It is shown that the model parameters of the underlying Gaussian distributions are determined with good accuracy and that the accuracy with which the contamination is estimated increases with increasing distance of the contaminating observations from the mean.
Methodology of ECG Interpretation in the Nagoya Program
Authors: Okamoto N. , Yokoi M. , Iwatsuka T. , Ohsawa N. , Okajima M.
Published: March 2018

The outline of the Nagoya Program, the most representative software package for computerized electrocardiography in Japan, is described. First, the history and current status of research and its transfer to commercial products for computerized interpretation of electrocardiograms is briefly reviewed. Second, development and testing of the Nagoya Program is depicted, referring to a gold standard for evaluation and the database being used for this purpose, and to its participation in the CSE study. Third, a description of signal acquisition and wave identification is given, followed by the detection of rhythm disturbances. Next, algorithms for contour classification, which consist of decision-tree logic established through trial and error and making use of the database of ECGs, are described. Finally, special features and future plans of the Nagoya Program are mentioned.
The Design and Management of National Morbidity Surveys
Authors: Fleming D. M.
Published: March 2018

This paper describes the three major morbidity surveys in general practice which have been conducted in England and Wales. In it, the evolution of the recording method is traced from the patient summary card of the first survey to the diagnostic index of the second and third surveys and finally, to the fully computerised recording programme to be used in the fourth survey due to start in September, 1991. Issues relating to the capture of social data, the use of diagnostic terms and the value of obtaining data over a 12 month period are discussed.
The octave approach to EEG analysis
Authors: Stassen H. H.
Published: March 2018

A “tonal” approach to EEG spectral analysis is presented which is compatible with the concept of physical octaves, thus providing a constant resolution of partial tones over the full frequency range inherent to human brain waves, rather than for equidistant frequency steps in the spectral domain. The specific advantages of the tonal approach, however, mainly pay off in the field of EEG sleep analysis where the interesting information is predominantly located in the lower octaves. In such cases the proposed method reveals a fine structure which displays regular maxima possessing typical properties of “overtones” within the three octaves 1-2 Hz, 2-4 Hz and 4-8 Hz. Accordingly, spectral patterns derived from tonal spectral analyses are particularly suited to measure the fine gradations of mutual differences between individual EEG sleep patterns and will therefore allow a more efficient investigation of the genetically determined proportion of sleep EEGs. On the other hand, we also tested the efficiency of tonal spectral analyses on the basis of our 5-year follow-up data of 30 healthy volunteers. It turned out that 28 persons (93.3%) could be uniquely recognized after five years by means of their EEG spectral patterns. Hence, tonal spectral analysis proved to be a powerful tool also in cases where the main EEG information is typically located in the medium octave 8-16 Hz.
A Framework for Modelling the Electronic Medical Record
Authors: Nowlan W. A. , Kay S. , Goble C. A. , Howkins T. J. , Rector A. L.
Published: March 2018

This paper presents a model for an electronic medical record which satisfies the requirements for a faithful and structured record of patient care set out in a previous paper in this series. The model underlies the PEN & PAD clinical workstation, and it provides for a permanent, completely attributable record of patient care and the process of medical decision making. The model separates the record into two levels: direct observations of the patient and meta-statements about the use of observations in decision making and the clinical dialogue. The model is presented in terms of “descriptions” formulated in the Structured Meta Knowledge (SMK) formalism, but many of its features are more general than the specific implementation. The use of electronic medical records based on the model for decision support and the analysis of aggregated data are discussed along with potential use of the model in distributed information systems.
Clinical Decisions for Psychiatric Inpatients and Their Evaluation by a Trained Neural Network
Authors: Stoler M. , Inbar-Saban N. , Saban N. , Modai I.
Published: March 2018

Ninety-two consecutive treatment decisions regarding psychotic and depressed inpatients were evaluated by a trained neural network. Simultaneous evaluations according to the Brief Psychiatric Rating Scale (BPRS), the Hamilton scale, and the neural network were performed. A 15-point decrease in the BPRS for psychotic patients or a 10-point decrease in the Hamilton scale for depressed patients was the cut-off point for treatment success. The neural network performed similarly to the clinicians. The combined clinician-network success rate reached 79% and was significantly higher than that for each alone. Clinicians and neural network disagreed on 62% of decisions made for depressed patients and on 55% of decisions made for psychotic patients. The proportion of agreement was lower in both diagnostic groups than expected by chance. However, the high success of the combined clinician and neural network decisions and the high rate of mutual disagreement may imply that a combined decision is fruitful.
Risk Adjustment in Outcome Assessment: the Charlson Comorbidity Index
Authors: Sicotte C. , Tilquin C. , D’Hoore W.
Published: March 2018

To measure the burden of comorbid diseases using the MED-ECHO database (Quebec), the so-called Charlson index was adapted to International Classification of Disease (ICD-9) codes. The resulting comorbidity index was applied to the study of inpatient death in a group of 62,456 patients having one of the following conditions: ischemic heart disease, congestive heart failure, stroke, or bacterial pneumonia. Multiple logistic regression was used to relate inpatient death to its predictors, including gender, principal diagnosis, age, and the comorbidity index. Various transformations of the comorbidity score were performed, and their effect on predictive accuracy was assessed. The comorbidity index was constantly and strongly associated with death. When gender, age, comorbidity and the principal diagnoses were taken into account, the area under the receiver-operating curve was 0.83. Therefore, the Charlson Index is a useful approach to risk adjustment in outcomes research from administrative databases.
An Integrated Knowledge-Based System to Guide the Physician During Structured Reporting
Authors: Zemmler T. , Reichert M. , Rösner D. , Baumiller O. , Knapp H. , Kuhn K.
Published: March 2018

A routinely used system for report generation, based on direct physician data entry, has been combined with a knowledge-based module. The knowledge-based system is operating in the background, and guides the user by dynamically suggesting diagnoses and generating hints regarding the actual and possible further diagnostic procedures. Hybrid technology with neural networks and rules is used. A laboratory evaluation has shown good agreement between diagnoses suggested by the system and confirmed diagnoses, with a kappa coefficient of 0.85 and an area under the ROC curve of 0.92. In a survey following a 14-day test period, physicians stated that the system was both sensible and helpful. The current application domain is ultrasound reporting.
An Intelligent Computer-Assisted Instruction System for Clinical Case Teaching
Authors: Fontaine D. , Riou C. , Jacquelinet C. , Le Beux P.
Published: March 2018

The use of computers in the field of medical education is common. Our purpose is to present a Computer-Assisted Instruction system which has been developed over ten years at the University of Compiegne and the University of Rennes Medical School. This system can be used to help the student to solve clinical cases by analyzing and critiquing their answers and by using a knowledge base which has been previously structured in a rule network. It is an intelligent Computer-Assisted Instruction system comprising an author module, a pedagogical module and a student module. The CAI system can be used as a simulation model for any type of diagnostic or therapeutic problem. In this paper we present the author and pedagogical module which have been built using our previous work on intelligent computer-assisted instruction systems.
A Model for Structured Data Entry Based on Explicit Descriptional Knowledge
Authors: van Ginneken A. M. , van der Lei J. , van Bemmel J. H. , Moorman P. W.
Published: March 2018

Clinical narratives in patient records are usually recorded in free text, limiting the use of this information for research, quality assessment, and decision support. This study focuses on the capture of clinical narratives in a structured format by supporting physicians with structured data entry (SDE). We analyzed and made explicit which requirements SDE should meet to be acceptable for the physician on the one hand, and generate unambiguous patient data on the other. Starting from these requirements, we found that in order to support SDE, the knowledge on which it is based needs to be made explicit: we refer to this knowledge as descriptional knowledge. We articulate the nature of this knowledge, and propose a model in which it can be formally represented. The model allows the construction of specific knowledge bases, each representing the knowledge needed to support SDE within a circumscribed domain. Data entry is made possible through a general entry program, of which the behavior is determined by a combination of user input and the content of the applicable domain knowledge base. We clarify how descriptional knowledge is represented, modeled, and used for data entry to achieve SDE, which meets the proposed requirements.
Mixed Bayesian Networks: A Mixture of Gaussian Distributions
Authors: Chevrolat J. P. , Rutigliano F. , Golmard J. L.
Published: March 2018

Mixed Bayesian networks are probabilistic models associated with a graphical representation, where the graph is directed and the random variables are discrete or continuous. We propose a comprehensive method for estimating the density functions of continuous variables, using a graph structure and a set of samples. The principle of the method is to learn the shape of densities from a sample of continuous variables. The densities are approximated by a mixture of Gaussian distributions. The estimation algorithm is a stochastic version of the Expectation Maximization algorithm (Stochastic EM algorithm). The inference algorithm corresponding to our model is a variant of junction three method, adapted to our specific case. The approach is illustrated by a simulated example from the domain of pharmacokinetics. Tests show that the true distributions seem sufficiently fitted for practical application.
Modeling the Relational Complexities of Symptoms
Authors: Dolin R. H.
Published: March 2018

Realization of the value of reliable codified medical data is growing at a rapid rate. Symptom data in particular have been shown to be useful in decision analysis and in the determination of patient outcomes. Electronic medical record systems are emerging, and attempts are underway to define the structure and content of these systems to support the storage of all medical data. The underlying models upon which these systems are being built continue to be strengthened by a deeper understanding of the complex information they are to store. This report analyzes symptoms as they might be recorded in free text notes and presents a high-level conceptual data model representation of this domain.
Neues aus der neuromuskulären Grundlagenforschung
Authors: Schröder R. , Gautel M.
Published: March 2018

Die neuromuskuläre Forschung hat revolutionäre Erweiterungen des technischen Repertoires erlebt. Die vorliegende Arbeit diskutiert die wesentlichen Entwicklungen auf den Gebieten der genetischen Diagnostik, der “Omics”-Anwendungen vom Epigenom bis zum Proteom, der Genom-Editierung in Tierund Zellmodellen sowie neue optische Bildgebungsverfahren, die sowohl die neuromuskuläre Grundlagenforschung als auch die translationale und klinische Forschung transformieren.
Update Muskelbiopsiediagnostik neuromuskulärer Erkrankungen
Authors: Weis J. , Stenzel W.
Published: March 2018

Die Muskelbiopsie ist ein wichtiges Instrument in der Diagnostik von Krankheiten der Muskulatur und des Nervensystems. Die histologischen, immunhistochemischen, elektronenmikroskopischen und molekularpathologischen Methoden der Aufarbeitung von Muskelbiopsien sind stetig optimiert worden. Zusammen mit den verbesserten klinischen, elektrophysiologischen, laborchemischen und molekulargenetischen Methoden und den bildgebenden Verfahren trägt diese Entwicklung dazu bei, dass neuromuskuläre Krankheiten heute wesentlich differenzierter diagnostiziert werden als noch vor wenigen Jahren. Die Indikation einer Muskelbiopsie sollte sorgfältig erörtert werden, da es sich um einen rein diagnostischen, invasiven Eingriff handelt. Die Biopsien sollten ausschließlich von Personen entnommen und weiterverarbeitet werden, die in der Auswahl des zu biopsierenden Muskels und den anzuwendenden Techniken erfahren sind.
Charcot-Marie-Tooth-Erkrankungen
Authors: Young P. , Dräger B.
Published: March 2018

Die Gruppe der hereditären Neuropathien (Charcot-Marie-Tooth-Erkrankungen, CMT) ist eine klinisch und genetisch heterogene Gruppe von peripheren Neuropathien. Die Prävalenz beträgt 1:2 500, womit die CMT zu den seltenen Erkrankungen zählen. In der klinischen Neurologie stellen sie die häufigste neurogenetische Erkrankung dar. Die CMTFormen mit sensiblen und motorischen Symptomen sind am häufigsten. Neben diesen Formen gibt es rein sensible Formen, mit oder ohne autonome Symptome (HSAN), rein motorische Neuropathien (dHMN) und die besondere Form der hereditären Neuropathie mit Neigung zu Druckparesen (HNPP). Die molekulargenetische Diagnostik wurde zunehmend weiterentwickelt. Die Gendiagnostik ist integraler Bestandteil der Diagnostik für Patienten mit dem klinischen Verdacht auf das Vorliegen einer hereditären Neuropathie. Die klinische und genetische Zuordnung ist durch die große Heterogenität des Phänotyps bei über 80 potenziell krankheitsverursachenden Genen oft sehr erschwert. Trotzdem werden über 90% aller genetisch gesicherten CMT durch Mutationen in vier Genen (PMP22, Cx32, MPZ und MFN2) geklärt. Diese stellen die klinisch relevanten Kandidatengene im klinischen Alltag dar.
Long Range Medical Follow-up and Updating of Computerized Records
Authors: Martin J. M. , Pointel J. P. , Martin J. , Debry G.
Published: March 2018

In order to follow the clinical course of patients with chronic diseases, it is necessary to have a system for updating their computerized record.

To achieve this objective, it is necessary to minimize the length of time devoted to information collecting and to feed the data into the computer in a manner which satisfies two essential criteria:

— easy filing process,

— easy access to the data for searches.

In this article we will consider five aspects of the updating process of a computerized record : a file of records, any record, any elementary item, the lexicon of notions, the results of questioning before and after updating.

With such a tool in hand, one can perform longitudinal studies using the data contained in the records. The approach of the authors is not only a formal one. They set up some basic formal principles from an existing experience of processing the data of several thousands of patients with diabetes and give a condensed description of the existing system.
»Hands on« Computer Tabulation of a Cumulative Case Register
Authors: Grad de Alarcon Jacqueline , Evans J.
Published: March 2018

A method of interrogating a continuously updated psychiatric case register via a flexible user-access package is described. Users request cross-tabulations and case-listings direct from the machine using natural language to specify their own cross-tabulation keys and table selections. Tabulation facilities include both event-based and person-based counts. Time-axis keys cover the whole period of the register’s lifetime. Analysis may take place within customary prevalence models of care or within experimental conceptual models, periodicities and spell constructs developed by users.

The paper explains how complex cumulative register information can be organised to enable these analytic facilities to be made directly available to lay users.

The package circumvents the programming barrier which hinders full exploitation of computerised registers, allowing lay users to extract their own epidemiological and service-evaluation data, without specialist programmer intervention.
Power and Sample Size Determination in Survival Time Studies with Special Regard to the Censoring Mechanism
Authors: Schumacher M.
Published: March 2018

When calculating the power and sample size in survival time studies for the comparison of two treatments censoring has to be taken into account.

In most medical applications only vague information about the shape of the underlying distributions is available. Thus, a distribution-free procedure based on the McNemar test is proposed and compared with other methods.
Analyzing Medicine by Means of Reprint Requests
Authors: Onuigbo W. I. B.
Published: March 2018

Authors are commonly asked for reprints of their publications. There is need to promote awareness of the usefulness of such requests in gathering medical information. By way of illustration, this study focusses on how requests from the United States of America enabled an African author to collect interesting data on that country’s military medicine with reference to such parameters as the specialties of the requesters, the selective nature of their requests, and even women’s inferior position in science. It is concluded that the reprint request is a neglected tool which has research potentialities in medical informatics.
Automated Indexing Based on SNOMED
Authors: Wingert F.
Published: March 2018

Structure and content of SNOMED are described with special consideration of the German edition. An introduction into the problems of automated indexing and the related structural elements of SNOMED is given because they are the basis of algorithms for automated indexing to be published in subsequent papers.
Present State of the Medical Expert System CADIAG-2
Authors: Adlassnig K.-P. , Kolarz G. , Scheithauer W.
Published: March 2018

Uncertainty of knowledge about the patient and about medical relationships is generally accepted and considered to be an inherent concept in medicine. The physician, however, is quite capable of drawing conclusions from this information. Naturally, these conclusions are approximate rather than precise.

Fuzzy set theory provides the possibility of defining imprecise medical entities as fuzzy sets. It offers a linguistic concept with excellent approximation to medical texts. In addition, fuzzy logic presents powerful reasoning methods that can handle approximate inferences. These facts make fuzzy set theory highly suitable for the development of computer-based medical diagnostic systems.

The medical expert system CADIAG-2 provides evidence that fuzzy set theory is a suitable mathematical tool for formalizing medical processes.

CADIAG-2/RHEUMA is being extensively tested on cases from a rheumatological hospital. Results from 327 cases are presented. In 265 cases, i.e. 81%, the clinical diagnosis could be either confirmed (223 cases, i.e. 68.2%) or established as a diagnostic hypothesis (42 cases, i.e. 12.8%).

CADIAG-2/PANCREAS was tested on 47 cases of pancreatic diseases. In 43 cases, i.e. 91.5%, the clinical diagnosis was either confirmed by CADIAG-2 or established as one of the hypotheses with the highest or second highest number of points in a ranked list of hypotheses.
Data Quality Assurance for a Health Monitoring Program
Authors: Finkelstein S. M. , Budd J. R. , Ewing Lisa B. , Catherine L. , Warwick W. J. , Kujawa Sue J.
Published: March 2018

Abstract

The objective of data quality assurance procedures in clinical studies is to reduce the number of data errors that appear on the data record to a level which is acceptable and compatible with the ultimate use of the recorded information. A semi-automatic procedure has been developed to detect and correct data entry errors in a study of the feasibility and efficacy of home health monitoring for patients with cystic fibrosis. Daily self-measurements are recorded in a diary, mailed to the study coordinating center weekly, and entered into the study’s INSIGHT clinical database. A statistical error detection test has been combined with manual error correction to provide a satisfactory, reasonable cost procedure for such a program. Approximately 76% of the errors from a test diary entry period were detected and corrected by this method. Those errors not detected were within an acceptable range so as not to impact the clinical decisions derived from this data. A completely manual method detected SS% of all errors, but the review and correction process was four times more costly, based on the time needed to conduct each procedure.
Sources of Information for Biomedical Decision-Making
Authors: Osiobe St. A.
Published: March 2018

Sources of information used by health professionals for research, teaching, patient care and miscellaneous information demands were determined by means of a questionnaire survey. The results of the survey indicate that, for purposes of research, scientific and technical journals are the most frequently -used sources, followed by abstracts and indexes, private information files and monographs/textbooks. For teaching purposes, monographs/textbooks are the most frequently used source, followed by private information files, scientific/technical journals and seminars, workshops, and conferences. Patient care information needs are most frequently satisfied by use of scientific/technical journals, personal contact with colleagues, and monographs/textbooks, while miscellaneous information demands are satisfied by use of scientific/technical journals, private information files, and non-academic journals and newspapers.
Comparison of Hospitals Supporting Quality Assurance
Authors: Warncke W. , Selbmann H. K. , Eissner H.J.
Published: March 2018

In 1980, 159 obstetric departments took part in the Bavarian Perinatal Survey. For each newborn a questionnaire comprising about 100 items was filled in. The main objective of the Bavarian Perinatal Survey is the quality assurance of obstetric care. This objective is to be supported by appropriate hospital comparisons permitting each hospital a determination of its position relative to the other hospitals. For special subgroups of patients, hospital profiles were developed. The indirect standardization of rates and the logistic regression were used for a global comparison of hospitals. A procedure was defined to detect remarkable deviations between hospitals. These deviations should be considered as signals for clarifying discussions between the participating obstetricians.