bluuebunny/crossref_metadata_2025 huggingface dataset:
The Influence of Crowds on Consumer Health Decisions: An Online Prospective Study
Authors: Lau Annie Y.S.  , Kwok Trevor M.Y.  , Coiera Enrico
Published: February 2025

This paper presents an online prospective study investigating whether the strength of social feedback, i.e. the proportion of persons who concur or do not concur with one's own answer to a question, influences the way one answers health-related questions. Two hundred and twenty-seven undergraduate students were recruited to use an online search engine to answer six health-related questions. Subjects recorded their pre- and post-search answers to each question and their level of confidence in these answers. After answering each question post-search, subjects were presented with a summary of post-search answers provided by previous subjects and were asked to answer the question again. There was a statistically significant relationship between the absolute number of others with a different answer (the crowd's opinion volume) and the likelihood of an individual changing an answer (P < .0001). Subjects' likelihood of changing answer increased as the percentage of others with a different answer (the crowd's opinion density) increased (P = 0.047). Overall, 98.3% of subjects did not change their answer when it concurred with the majority (i.e. > 50%) of subjects. When subjects had a post-search answer that did not concur with the majority, they were 24% more likely to change answer than those with answers that concurred (P < .0001). This study provides empirical evidence that strength of social feedback influences the way healthcare consumers answer health-related questions.
Experience Implementing OpenMRS to Support Maternal and Reproductive Health in Northern Nigeria
Authors: Thompson Adam  , Castle Evelyn  , Lubeck Paul  , Makarfi Provost Shehu
Published: February 2025

In Northern Nigeria a deteriorating health system has resulted in one of the World's highest rates of maternal and infant deaths. The dire situation in Northern Nigeria is only amplified by the lack of an effective health information system, leaving hospitals and clinics to make decisions about patient care with only uninformed guesses about medical history and access to unreliable and unintelligible patient registers and summary reports. In 2009 we implemented an electronic medical records system using OpenMRS for the Family Health Unit of the Shehu Idris College. The three-month process resulted in electronic forms for all clinical areas, greatly reduced data duplication and a monthly reporting process that takes minutes instead of days. This system provides not only access to the first patient-based health indicators in Nigeria (as opposed to previously error-prone aggregate data) but is also an example of the potential to overcome the harsh computing environment in Nigeria to implement eHealth systems that will improve the quality of patient care.
Key Common Determinants for Adoption of Wireless Technology in Healthcare for India and Pakistan: Development of a conceptual model
Authors: Hafeez-Baig Abdul  , Gururajan Raj
Published: February 2025

This study explores the perception and views of healthcare professionals in the subcontinent (India and Pakistan) towards the wireless handheld technology in the healthcare setting. A mixed methodology was adopted to explore the determinants of the wireless handheld devices in the healthcare setting. Interviews were conducted with 30 healthcare professionals to explore the initial themes. This was followed up with a survey instrument, specifically developed for this study, and distributed to 300 healthcare professionals in Pakistan and India. 200 useable surveys from India and 97 from Pakistan were received. The results of the study indicate that healthcare professionals felt that to use the wireless technology, the integration of the clinical and operational process is essential. Factor analysis through SPSS showed that any development of technological solutions for handheld devices would benefit, by considering the clinical, technological, and operational influences of the wireless technology in addition to clinical influences, clinical preference, training, and technical support. The study culminated in the development of an initial conceptual framework. The scope of this study is restricted to wireless handheld devices such as the smart phones, handheld PCs and PDAs.
A countrywide clinical informatics project in Uruguay
Authors: Margolis Alvaro  , Bessonart Lino  , Barbiel Ana  , Pazos Pablo  , Gil Juan  , Machado Heber  , Vero Alvaro
Published: February 2025

FEMI is a federation of 23 private not-for-profit health care organizations across Uruguay. It covers approximately 700 thousand people (20 percent of the Uruguayan population) and owns a tertiary center in Montevideo. Pressure from ongoing national changes in health funding and regulation have pushed FEMI to develop a project, in order to improve efficiency in health care through the use of information and communications technologies. In particular, a federal electronic health record and a strategic management system are pursued. This project is supported by the Inter American Development Bank. The project has four lines of action: Specification, construction and implementation of the systems; Alignment through the use of standards; Cultural change through training and prototype systems; and Infrastructure. Short term results include a federal balanced scorecard, federal identification and authorization services, a terminology service, telemedicine applications and massive training of interdisciplinary teams at the local level. The importance of collaboration at the regional level and the advantages of having a multi-institutional commitment are stressed.
Exploring new directions in disease surveillance for people with diabetes: Lessons learned and future plans
Authors: Botsis Taxiarchis  , Hartvigsen Gunnar
Published: February 2025

The main objective of this paper is to report our achievements in investigating new directions in the disease surveillance field. Targeting the vulnerable group of people with diabetes, we explored the possibility of early detection of infections using an electronic disease surveillance system (eDSS); this system could collect data for certain physiology indicators, e.g. blood glucose and white blood cell count, by incorporating specific point-of-care (POC) devices. We performed an analysis using the data of two large-scale clinical studies that involved people with type-1 and type-2 diabetes correspondingly; also, we conducted a feasibility study to examine the available POC technology. Even though the analyses provided us with some evidence for further investigation, the available technological solutions appeared to have significant limitations, mainly in terms of usability. Based on our firsthand findings we defined the next steps of our research, i.e. the data collection in a controlled study and the subsequent development of the eDSS. Furthermore, the lessons learned in our project could facilitate the related research for other vulnerable population groups.
Using a File Audit to Evaluate Retention in Care and Patient Outcomes in a Programme to Decentralise Antiretroviral Treatment to Primary Health Care Facilities in a High Prevalence Setting in KwaZulu-Natal, South Africa
Authors: Searle Catherine  , Ramkissoon Arthi  , Govender Thamandrie
Published: February 2025

HIV care and antiretroviral treatment (ART) provision is largely hospital-based with an over-reliance on doctors. Existing ART sites are reaching capacity and are increasingly unable to initiate new patients and also see follow up patients. In response, the Reproductive Health and HIV Research Unit (RHRU), has supported the KwaZulu-Natal provincial Department of Health with developing a model to decentralise services to primary health care (PHC) level. The programme has been in operation since 2006, and currently nine ART initiation sites down refer stable patients to 24 PHC clinics. Data on patient numbers, treatment outcomes and patient retention rates were collected through a file audit of 2071 adult patient files and analyzed. Results indicate that a file audit is a feasible mechanism to provide this data and can be used to identify gaps and improve quality of care. PHC sites in resource-constrained settings are able to manage stable patients on ART; however, sites need support with monitoring and evaluation and with tracking patients that have been down referred. In terms of quality of care, PHC sites need to ensure that clients receive CD4 count tests and viral load monitoring at six monthly intervals to ensure that treatment failure does not go undetected. Patients suspected of experiencing adverse events or treatment failure appear to be managed according to standard operating procedures, but there is a need to ensure that adverse events are clearly documented in patient files.
Information Needs in Home Based Healthcare in South Africa
Authors: de la Harpe Retha  , Barnes Jay  , Korpela Mikko
Published: February 2025

Home based health care (HBHC) is advocated by the WHO “to ensure better accessibility to effective and efficient health care in community and home-settings to improve health and well-being, and contribute to morbidity and mortality reduction”. In South Africa the government and many other role players see an increasingly important role for HBHC. Many researchers believe that the evolution of HBHC will follow the socio-technical network evolution. There can be no doubt that the focus is on using information and communication technologies (ICT) to implement HBHC solutions. The objective of this paper is to provide a rich picture of the current situation and needs for improvement in HBHC in South Africa today through descriptive research in one specific case. The longer-term purpose is to identify pain-points that require socio-technical solutions, including but not exclusively ICT-supported solutions.
Medical Education & Health Informatics: Time to join the 21
Authors: Shaw Nicola
Published: February 2025

This paper reports a component of a larger study, Informatics: enhancing the Clinical Experience? (ICE), which explored the impact on the therapeutic relationship of the implementation and use of Electronic Medical Records (EMR) in British Columbia, Canada. As anticipated, EMRs were found to negatively affect the relationship in many clinics. However, surprisingly paper-based clinics were as likely as EMR-based clinics to report problems with maintaining eye contact with their patients. This led to an interesting finding; that as a result of this difficulty few family care providers actually chart when their patients are with them, preferring to build rapport and chart at a later time. Consequently three recommendations are made: 1) Improve medical education in the area of charting (paper & EMR-based) with the patient present; 2) Explore the affect different technologies and skills have on the ability of providers to chart with the patient present and 3) Develop an understanding that unless the technology and training improve Canadian family medicine will never gain the asserted benefits of EMRs, and that other incentives are needed if Canada is to meet its target of delivering Electronic Health Records (EHR) to 100% of all Canadians by 2015.
Using the Virtual Reality World of Second Life to Teach Nursing Faculty Simulation Management
Authors: Weiner Elizabeth  , McNew Ryan  , Trangenstein Patricia  , Gordon Jeffry
Published: February 2025

Healthcare faculty members have come to depend on the advantages of teaching with clinical simulation, but not all faculty are competent in their ability to manage students during the simulation experience. This federally funded proposal provided the opportunity for nursing faculty to participate in a synchronous learning event using the virtual reality world of Second Life (SL). Based on competencies, faculty participants were guided through the simulation process by a “Master Teacher.” Participants then became the teacher and chose the settings, objectives, and clinical data to manage their own simulation using avatar role assignments. Feedback populated the participant informatics dashboard, so that progress towards their competencies was recorded. Another unique informatics application was the use of the Synthetic Derivative project to use de-identified patient data to promote better clinical realism. Additional evaluation activities regarding content, appropriate use of the technology, and design features were assessed. The development of the SL environment for this educational study provides the setting in which to pilot test the provision of actual clinical care that does not require “hands-on” interventions.
Teaching During a Pandemic Event: Are Universities Prepared?
Authors: Gordon Jeffry  , Weiner Elizabeth  , McNew Ryan  , Trangenstein Patricia
Published: February 2025

As the threat of pandemic events streaks across the planet, the question then becomes can universities, particularly health science centers charged with producing the next generation of health care providers, continue their teaching and educational mission by offering classes in a distance environment, completely uncentralized, away from the traditional centralized campus? A sampling of campus websites were reviewed to gather a sense of how well prepared we are, followed up with a survey administered to faculty and staff in the School of Nursing at Vanderbilt University. The concern being that if a technology rich environment such as Vanderbilt is not fully prepared to continue teaching in a pandemic event, what concerns should we have for other institutions providing health care provider education that may not have access to the resources a Vanderbilt has? Finally, a set of recommendations to schools is presented, based on the findings.
An Analysis of Nursing Education's Immersion into Second Life, a Multi-user Virtual Environment (MUVE)
Authors: Trangenstein Patricia A.  , Weiner Elizabeth E.  , Gordon Jeffry S.  , McNew Ryan
Published: February 2025

Second Life (SL) is a multi-user virtual environment (MUVE) using 3-D modeling to replicate real world settings and experiences. However, little is known of the extent to which nursing education is involved in SL activities. This study used four different search strategies to conduct a comprehensive review of print, blog, web and media sources. Twenty-nine unique nursing communities, groups or educational activities were identified. This study identified a number of barriers identified that made the analysis both difficult and time-consuming.
Enhanced Notification of Infusion Pump Programming Errors
Authors: Scott Evans R.  , Carlson Rick  , Johnson Kyle V.  , Palmer Brent K.  , Lloyd James F.
Published: February 2025

Hospitalized patients receive countless doses of medications through manually programmed infusion pumps. Many medication errors are the result of programming incorrect pump settings. When used appropriately, smart pumps have the potential to detect some programming errors. However, based on the current use of smart pumps, there are conflicting reports on their ability to prevent patient harm without additional capabilities and interfaces to electronic medical records (EMR). We developed a smart system that is connected to the EMR including medication charting that can detect and alert on potential pump programming errors. Acceptable programming limits of dose rate increases in addition to initial drug doses for 23 high-risk medications are monitored. During 22.5 months in a 24 bed ICU, 970 alerts (4% of 25,040 doses, 1.4 alerts per day) were generated for pump settings programmed outside acceptable limits of which 137 (14%) were found to have prevented potential harm. Monitoring pump programming at the system level rather than the pump provides access to additional patient data in the EMR including previous dosage levels, other concurrent medications and caloric intake, age, gender, vitals and laboratory results.
Analysis of data captured by barcode medication administration system using a PDA; aiming at reducing medication errors at point of care in Japanese Red Cross Kochi Hospital
Authors: Akiyama Masanori  , Koshio Atsushi  , Kaihotsu Nobuyuki
Published: February 2025

Preventing medication errors by using a barcode administration system has become prevalent in patient safety. Analyses of data captured by bar code systems provide opportunities to understand the actual situation at the point of care. Our study aims at understanding issues of medication safety as well as investigating measures taken to prevent medication accidents, by analyzing data captured by a bar code system and a personal digital assistant (PDA). The barcode administration system named Point-of-Act-System implemented in Japanese Red Cross Kochi Hospital was designed to capture every activity at the bedside. Complete activity data captured by the system, which included injections, treatment and other nursing activity, as well as injection warning data, were used for our analyses. We describe the data and analyze them statistically to find potentially times of risk and to ascertain the relation between busyness and error. The injection warning rate as a whole was 6.1% on average. The results showed there was a negative correlation between the number of injections given and the injection warning rate (−0.48, p < 0.05). The warning rate was low during the hours when a large number of injections were administered. The data also showed that a variation in activities being performed has a negative effect on medication safety. A bar code administration system is quite an effective way not only to prevent medication error at point of care, but also to improve patient safety through analyses of data captured by such a system.
Factors Affecting Physicians Compliance with Enrollment Suggestions into a Clinical Reminders Intervention
Authors: Vashitz Geva  , Meyer Joachim  , Parmet Yisrael  , Liebermann Niki  , Gilutz Harel
Published: February 2025

Clinical reminders can promote adherence with evidence-based clinical guidelines, but they may also have unintended consequences such as alert fatigue, false alarms and increased workload, which cause clinicians to ignore them. The described clinical reminder system identifies patients eligible for primary prevention of cardiovascular diseases and lets the physician to choose which patients will be included in the reminders intervention. We analyzed data of 87,165 visits of 35,699 patients and evaluated factors which may affect clinicians' decision to enroll patients to the intervention. The physicians included most of the patients suggested for inclusion (85.7%). Yet, they skipped the enrollment suggestion in 62.6% of the visits. Patients with a cardiovascular disease, dyslipidemia, diabetes, or hypertension were more likely to be included in the intervention, while older patients were less likely to be included. Insights regarding the usability of clinical reminders are discussed.
Need for a New Care Model – Getting to Grips with Collaborative Home Care
Authors: Winge Monica  , Johansson Lars-Åke  , Nyström Monica  , Lindh-Waterworth Eva  , Wangler Benkt
Published: February 2025

In this paper we discuss the fact that more and more patients are treated in their homes by a set of organizations, sometimes with different ownership, and how this fact places new and severe demands on health care and home service staff to communicate and collaborate. We point to the need for managers in different organizations to agree on ways of communicating and collaborating on the operational level and how this aspect needs to be considered during procurement of home care services. Most importantly, by reasoning around a set of problematic areas, we derive a set of related problems and suggest solutions for dealing with them. The solutions are a mix of organizational/administrative measures and IT support for communication and coordination.
Expanding the Use of Simulators as Assessment Tools: The New Pop Quiz
Authors: Kaye Abby R.  , Salud Lawrence H.  , Domont Zachary B.  , Blossfield Iannitelli Katherine  , Pugh Carla M.
Published: February 2025

This study introduces a novel way to implement simulation in medical education. We investigated the feasibility of integrating a newly developed breast examination simulator into a breast exam technique lecture while also collecting detailed data on medical students' breast exam skills. Results indicate that it is feasible to integrate simulation technology into the classroom environment and collect detailed performance data that can be analyzed and used for skills assessment.
Patient-Specific Cases for an Ultrasound Training Simulator
Authors: Petrinec Kresimir  , Savitsky Eric  , Hein Cheryl
Published: February 2025

We present a laptop-based ultrasound training simulator and a novel method for creation of patient-specific training datasets. The simulator consists of a laptop computer, a peripheral probe interface device with an embedded three-degree-of-freedom orientation sensor, a virtual US probe, a virtual patient model, a simulated US brightness scan (B-scan). Simulated B-scans are rendered from US volumes, which are synthesized using volume reconstruction methods from two-dimensional US imagery captured in a data acquisition stage from clinical patients. This methodology enables creation of patient-specific ultrasound simulation datasets for training purposes.
Visualization of Probabilistic Fiber Tracts in Virtual Reality
Authors: Rick Tobias  , von Kapri Anette  , Caspers Svenja  , Amunts Katrin  , Zilles Karl  , Kuhlen Torsten
Published: February 2025

Understanding the connectivity structure of the human brain is a fundamental prerequisite for the treatment of psychiatric or neurological diseases. Probabilistic tractography has become an established method to account for the inherent uncertainties of the actual course of fiber bundles in magnetic resonance imaging data. This paper presents a visualization system that addresses the assessment of fiber probabilities in relation to anatomical landmarks. We employ real-time transparent rendering strategy to display fiber tracts within their structural context in a virtual environment. Thereby, we not only emphasize spatial patterns but furthermore allow an interactive control over the amount of visible anatomical information.
A Method of Synchronization for Haptic Collaborative Virtual Environments in Multipoint and Multi-level Computer Performance Systems
Authors: Tagawa Kazuyoshi  , Bito Tatsuro  , Tanaka Hiromi T.
Published: February 2025

We have developed a novel volume-based haptic communication system. It allows participants at remote sites on a network to simultaneously interact with the same target object in virtual environments presented by multi-level computer performance systems. It does this by only exchanging a small set of manipulation parameters for the target object and an additional packet to synchronize the status of the binary tree and the deformation of the local region of the shared volume model. We first developed online-remesh volume models, which we call dynamic adaptive grids, to simulate deformable objects such as soft tissues at remote sites. Then, haptic sensation during interaction with the target object was achieved by rendering the reflection force from the object, which was simulated with the online-remesh volume model from the manipulation parameters and additional packets exchanged among all remote sites. We investigated the efficiency of our system via experiments at remote locations on a WAN between Tokyo, Osaka, and Kyoto.
Terahertz Imaging of Biological Tissues
Authors: Tewari Priyamvada  , Taylor Zachary D.  , Bennett David  , Singh Rahul S.  , Culjat Martin O.  , Kealey Colin P.  , Hubschman Jean Pierre  , White Shane  , Cochran Alistair  , Brown Elliott R.  , Grundfest Warren S.
Published: February 2025

A reflective THz imaging system sensitive to small variations in water concentrations has been developed. Biological tissues such as skin, eyes and teeth were imaged to ascertain the systems response to tissue hydration. Difference in water concentrations translated to contrast in the THz images. Contrast was also seen in THz images of skin cancer and burns suggesting the potential diagnostic capability of THz imaging system in clinical settings. All specimens analyzed were freshly excised ex-vivo tissues. These encouraging preliminary results have motivated us to explore the in vivo potential of our imaging system.
Fast Adaptation of Pre-Operative Patient Specific Models to Real-Time Intra-Operative Volumetric Data Streams
Authors: Cameron Bruce M.  , Rettmann Maryam E.  , Holmes III David R.  , Robb Richard A.
Published: February 2025

Image-guided catheter ablation therapy is becoming an increasingly popular treatment option for atrial fibrillation. Successful treatment relies on accurate guidance of the treatment catheter. Integration of high-resolution, pre-operative data with electrophysiology data and positional data from tracked catheters improves targeting, but lacks the means to monitor changes in the atrial wall. Intra-operative ultrasound provides a method for imaging the atrial wall, but the real-time, dynamic nature of the data makes it difficult to seamlessly integrate with the static pre-operative patient-specific model. In this work, we propose a technique which uses a self-organizing map (SOM) for dynamically adapting a pre-operative model to surface patch data. The surface patch would be derived from a segmentation of the anatomy in a real-time, intra-operative ultrasound data stream. The method is demonstrated on two regular geometric shapes as well as data simulated from a real, patient computed tomography dataset.
Critical Care Providers Refer to Information Tools Less During Communication Tasks After a Critical Care Clinical Information System Introduction
Authors: Ballermann Mark  , Shaw Nicola T.  , Mayes Damon C.  , Gibney R.T. Noel
Published: February 2025

Electronic documentation methods may assist critical care providers with information management tasks in Intensive Care Units (ICUs). We conducted a quasi-experimental observational study to investigate patterns of information tool use by ICU physicians, nurses, and respiratory therapists during verbal communication tasks. Critical care providers used tools less at 3 months after the CCIS introduction. At 12 months, care providers referred to paper and permanent records, especially during shift changes. The results suggest potential areas of improvement for clinical information systems in assisting critical care providers in ensuring informational continuity around their patients.
Design of Adverse Drug Events-Scorecards
Authors: Marcilly Romaric  , Chazard Emmanuel  , Beuscart-Zéphir Marie-Catherine  , Hackl Werner  , Băceanu Adrian  , Kushniruk Andre  , Borycki Elizabeth M.
Published: February 2025

This paper presents the design of Adverse Drug Event-Scorecards. The scorecards described are innovative and novel, not having previously been reported in the literature. The Scorecards provide organizations (e.g. hospitals) with summary information about Adverse Drug Events (ADEs) using a Web-based platform. The data used in the Scorecards are routinely updated and report on ADEs detected through data mining processes. The development of the ADE Scorecards is ongoing and they are currently undergoing clinical testing.
Detection of Nicotine Content Impact in Tobacco Manufacturing Using Computational Intelligence
Authors: Begic Fazlic Lejla  , Avdagic Zikrija
Published: February 2025

A study is presented for the detection of nicotine impact in different cigarette type, using recorded data and Computational Intelligence techniques. Recorded puffs are processed using Continuous Wavelet Transform and used to extract time-frequency features for normal and abnormal puffs conditions. The wavelet energy distributions are used as inputs to classifiers based on Adaptive Neuro-Fuzzy Inference Systems (ANFIS) and Genetic Algorithms (GAs). The number and the parameters of Membership Functions are used in ANFIS along with the features from wavelet energy distributionare selected using GAs, maximising the diagnosis success. GA with ANFIS (GANFIS) are trained with a subset of data with known nicotine conditions. The trained GANFIS are tested using the other set of data (testing data). A classical method by High-Performance Liquid Chromatography is also introduced to solve this problem, respectively. The results as well as the performances of these two approaches are compared. A combination of these two algorithms is also suggested to improve the efficiency of this solution procedure. Computational results show that this combined algorithm is promising.
An Approach to ‘Dynamic – DDD (Defined Daily Dose) Monitoring’ to Reduce Adverse Clinical Outcomes and Increase Patient Safety: Information Repositories and Event Triggers in Clinical Practice
Authors: Eryilmaz Esat N.
Published: February 2025

The goal of every effort and actions/interventions in almost all healthcare settings throughout the world's health systems -primary care, inpatient, outpatient encounters, diagnostic and therapeutic interventions, peri-operative settings- is and has been to achieve a well defined outcome (a kind of improvement in health status of the patient under consideration, an observable and significant change(s) in selected set(s) of clinical parameters confirmed by laboratory results and pathology findings, improvements in clinical outcomes). Clinical inefficiencies, in this context, should be addressed very systematically and scientifically. This is achieved through a continuously monitoring approach to adverse drug events based on information repositories and evidence-based rule sets. For monitoring drug-related outcomes and clinical outcomes in general, the concept of DDD (Defined Daily Dose) compliance is explained in this article to eliminate and avoid adverse clinical outcomes.
The ADE Scorecards: A Tool for Adverse Drug Event Detection in Electronic Health Records
Authors: Chazard Emmanuel  , Băceanu Adrian  , Ferret Laurie  , Ficheur Grégoire
Published: February 2025

Although several methods exist for Adverse Drug events (ADE) detection due to past hospitalizations, a tool that could display those ADEs to the physicians does not exist yet. This article presents the ADE Scorecards, a Web tool that enables to screen past hospitalizations extracted from Electronic Health Records (EHR), using a set of ADE detection rules, presently rules discovered by data mining. The tool enables the physicians to (1) get contextualized statistics about the ADEs that happen in their medical department, (2) see the rules that are useful in their department, i.e. the rules that could have enabled to prevent those ADEs and (3) review in detail the ADE cases, through a comprehensive interface displaying the diagnoses, procedures, lab results, administered drugs and anonymized records. The article shows a demonstration of the tool through a use case.
Exploring the Relationship between Usability and Technology-Induced Error: Unraveling a Complex Interaction
Authors: Kushniruk Andre  , Borycki Elizabeth
Published: February 2025

The effective evaluation of the usability of health information systems is currently a major challenge. It is essential that the applications we develop are not only usable, but that they are also shown to be safe and do not inadvertently introduce errors. Furthermore, to provide appropriate feedback to designers of systems new methods for evaluation are needed as applications become more complex and distributed. To ensure system usability and safety a variety of methods have emerged from the area of usability engineering that have been adapted to healthcare. The authors have applied and adapted methods of usability engineering, working with hospitals and other healthcare organizations for designing and evaluating a range of health information systems over a number of years. We describe a methodological framework for considering some of these advances and show how a range of usability evaluations can be used to evaluate both the usability and safety of healthcare information systems both in artificial mocked up and real clinical settings using in-situ testing approaches. We conclude with a discussion of recent trends in the area of usability engineering in healthcare that have potential for improving the safety of healthcare information systems.
Between Cyberplace and Cyberspace: the Researcher's Role in Virtual Setting Research
Authors: Galimberti Carlo  , Brivio Eleonora  , Cantamesse Matteo
Published: February 2025

Disciplines such as Internet Research, the Psychology of Cyberspace and the Social Psychology of Cyberplaces call for an epistemological reflection not merely on the universe of objects they deal with, but also, and perhaps especially, on the research settings used to investigate them. With this work, we intend to make a contribution to the debate on three issues: psychosocial interpretation of the new environments, the “mediated” nature of the researcher-setting-study object relationship, and cyberplaces as settings for mediated interaction research.
Interweaving Interactions in Virtual Worlds: a Case Study
Authors: Cantamesse Matteo  , Galimberti Carlo  , Giacoma Gianandrea
Published: February 2025

The aim of this study was to examine the effect of playing the online game World of Warcraft (WoW), both on adolescent's (effective) social interaction and on the competence they developed on it. Social interactions within the game environment have been investigated by integrating qualitative and quantitative methods: conversation analysis and social network analysis (SNA). From a psychosocial point of view, the in-game interactions, and in particular conversational exchanges, turn out to be a collaborative path of the joint definition of identities and social ties, with reflection on in-game processes and out-game relationship.
A Generic System for Critiquing Physicians' Prescriptions: Usability, Satisfaction and Lessons Learnt
Authors: Lamy Jean-Baptiste  , Ebrahiminia Vahid  , Seroussi Brigitte  , Bouaud Jacques  , Simon Christia  , Favre Madeleine  , Falcoff Hector  , Venot Alain
Published: February 2025

Clinical decision support systems have been developed to help physicians to take clinical guidelines into account during consultations. The ASTI critiquing module is one such systems; it provides the physician with automatic criticisms when a drug prescription does not follow the guidelines. It was initially developed for hypertension and type 2 diabetes, but is designed to be generic enough for application to all chronic diseases. We present here the results of usability and satisfaction evaluations for the ASTI critiquing module, obtained with GPs for a newly implemented guideline concerning dyslipaemia, and we discuss the lessons learnt and the difficulties encountered when building a generic DSS for critiquing physicians' prescriptions.
Knowledge-based Surveillance for Preventing Postoperative Surgical Site Infection
Authors: Shaban-Nejad Arash  , Rose Gregory W.  , Okhmatovskaia Anya  , Riazanov Alexandre  , Baker Christopher J.O.  , Tamblyn Robyn  , Forster Alan J.  , Buckeridge David L
Published: February 2025

At least one out of every twenty people admitted to a Canadian hospital will acquire an infection. These hospital-acquired infections (HAIs) take a profound individual and system-wide toll, resulting in thousands of deaths and hundreds of millions of dollars in additional expenses each year. Surveillance for HAIs is essential to develop and evaluate prevention and control efforts. In nearly all healthcare institutions, however, surveillance for HAIs is a manual process, requiring highly trained infection control practitioners to consult multiple information systems and paper charts. The amount of effort required for discovery and integration of relevant data from multiple sources limits the current effectiveness of HAIs surveillance. In this research, we apply knowledge modeling and semantic technologies to facilitate the integration of disparate data and enable automatic reasoning with these integrated data to identify events of clinical interest. In this paper, we focus on Surgical Site Infections (SSIs), which account for a relatively large fraction of all hospital acquired infections.
Validation of the openEHR Archetype Library by using OWL Reasoning
Authors: Menárguez-Tortosa Marcos  , Fernández-Breis Jesualdo Tomás
Published: February 2025

Electronic Health Record architectures based on the dual model architecture use archetypes for representing clinical knowledge. Therefore, ensuring their correctness and consistency is a fundamental research goal. In this work, we explore how an approach based on OWL technologies can be used for such purpose. This method has been applied to the openEHR archetype repository, which is the largest available one nowadays. The results of this validation are also reported in this study.
Using a Robotic Arm to Assess the Variability of Motion Sensors
Authors: Gorzelniak Lukas  , Dias André  , Soyer Hubert  , Knoll Alois  , Horsch Alexander
Published: February 2025

For the assessment of physical activity, motion sensors have become increasingly important. To assure a high accuracy of the generated sensor data, the measurement error of these devices needs to be determined. Sensor variability has been assessed with various types of mechanical shakers. We conducted a small feasibility study to explore if a programmable robotic arm can be a suitable tool for the assessment of variability between different accelerometers (inter-device variability). We compared the output of the accelerometers GT1M and GT3X (both ActiGraph) and RT3 (Stayhealthy) for two different movement sequences.
A Cloud-Based Semantic Wiki for User Training in Healthcare Process Management
Authors: Papakonstantinou D.  , Poulymenopoulou M.  , Malamateniou F.  , Vassilacopoulos G.
Published: February 2025

Successful healthcare process design requires active participation of users who are familiar with the cooperative and collaborative nature of healthcare delivery, expressed in terms of healthcare processes. Hence, a reusable, flexible, agile and adaptable training material is needed with the objective to enable users instill their knowledge and expertise in healthcare process management and (re)configuration activities. To this end, social software, such as a wiki, could be used as it supports cooperation and collaboration anytime, anywhere and combined with semantic web technology that enables structuring pieces of information for easy retrieval, reuse and exchange between different systems and tools. In this paper a semantic wiki is presented as a means for developing training material for healthcare providers regarding healthcare process management. The semantic wiki should act as a collective online memory containing training material that is accessible to authorized users, thus enhancing the training process with collaboration and cooperation capabilities. It is proposed that the wiki is stored in a secure virtual private cloud that is accessible from anywhere, be it an excessively open environment, while meeting the requirements of redundancy, high performance and autoscaling.
Medication Decision-Making on Hospital Ward-Rounds
Authors: Baysari Melissa  , Westbrook Johanna  , Day Richard
Published: February 2025

This research explored the decision-making process of selecting medicines for prescription on hospital ward-rounds. We aimed to determine when and with whom medications were discussed, and in particular, whether shared decision making (SDM) occurred on ward-rounds. As a low level of computerized decision support was in place in the hospital at the time, we also examined whether the decision support aided in any medication discussions. Fourteen specialty teams (46 doctors) were shadowed by the investigator while on ward-rounds and all verbal communication about medications was noted. Most medication discussions took place away from the patient bedside and the majority took place between two or more doctors. While a great deal of doctor-patient communication regarding medications took place on ward-rounds, very little of this comprised SDM. More frequently, doctors informed patients of the medications they would be or were currently taking. The computerized decision support had little impact on treatment decision-making. While the value of SDM is often acknowledged in the literature, it appears to be rarely practiced on hospital ward-rounds.
NLPAD: Natural Language Processing of Patient Discharge Summaries — Extraction Prototype
Authors: Zweigenbaum Pierre  , Cavazza Marc  , Doré Laurent  , Bouaud Jacques  , Sedlock David
Published: February 2025

The overall goal of the NLPAD project was to provide better access to information about the patients' medical history contained in narrative patient discharge summaries. This was achieved through the development of a natural language processing system applying medical knowledge to perform two kinds of services: a) intelligent automatic extraction of the data from the summaries in order to store them in an appropriate database, and b) intelligent retrieval of medical data from that database, thus allowing users to access quickly and easily the information. Here we present the objectives, the methodology and the main results obtained by the extraction part of NLPAD.
AVICA: Advanced Video Endoscopy Image Communication and Analysis
Authors: Adelh D.  , Van Velthoven R.  , Coibion M.  , Kiss R.  , Chassery J.M.  , Bartholomai G.
Published: February 2025

The AVICA project was concerned with the processing and manipulation of digitalized medical images. As pilot areas endoscopy and cystoscopy in gyneacology and urology were chosen. Investigation of methods for image enhancement and parallel processing are described. The conditions for an electronic transfer of images, and its possible benefits in medical practise are analyzed. A demonstrator was developed, in this phase including digitization, archiving and analysis techniques.
COVIRA: COmputer VIsion in RAdiology
Authors: Kuhn Michael H.  , Carlsen Ingwer C.  , Menhardt Wido  , Ottenberg Karsten  , Schmidt Karl-Heinrich  , Imme Martin  , Elliott Peter  , Knapman John  , Brelstaff Gavin  , Ibison Mike  , Brendergast David  , Page David  , Dellepiane Silvana  , Vemazza Gianni  , Ronco Marco  , Vio Roberto  , Stiehl H. Siegfried  , Neumann Heiko  , Gabrielidis Gabriel  , Schelkle Peter  , Galvez-Galan Francisco  , Christobal Benito  , Desco Manuel  , Garcia.Segura Juan
Published: February 2025

This paper presents the main results achieved by the COVIRA consortium project during a 15-months period under the AIM Exploratory Action programme. The prime result of the project is a specification of a system for knowledge based interpretation of cranial MR images as a means of computer assistance in diagnostic radiology, radiation therapy planning and stereotactic neurosurgery. This specification is based on demonstrated results from prototypical implementations and an analysis of the state-of-the-art and of the clinical requirements.
DOES AUTONOMIC MODULATION EXPLAIN HEART RATE VARIABILITY IN ALL CONDITIONS?
Authors: Bernardi Luciano  , Perlini Stefano  , Salvucci Fabrizio  , Soldá Pier L.  , Piepoli Massimo  , Calciati Alessandro  , Radaelli Alberto  , Finardi Giorgio
Published: February 2025

Heart rate variability is thought to be mediated by both vagal and sympathetic activity, through both phasic and tonic stimulation of the sino-atrial node. Decomposition of heart rate variability by power spectral analysis techniques has shown fluctuations related to the respiratory pattern, expression of respiratory sinus arrhythmia (RSA) and oscillations related to blood pressure (between 0.03 and 0.15 Hz). Under physiologic conditions, low- and high frequency peaks can be considered as relative markers of sympathetic and parasympathetic activity, respectively.
CENTRAL PROGRAMMING OF “SIMPLE” VOLUNTARY MOVEMENTS
Authors: Gottlieb Gerald L.
Published: February 2025

Discrete movements of a limb about a single joint are a widely studied experimental paradigm for the investigation of voluntary movement. Never-the-less, the literature on this apparently “simple” task does not reveal a consensus on how such movements are controlled. Rather, a diversity of control rules exist, one of which must be selected depending upon specific aspects of the task. For example, movements that vary in distance appear to be controlled according to different rules from those that vary only in speed. Since natural movements as well as experimentally contrived ones usually vary from each other in several “parameters”, this appears to complicate the task of any central motor controller which is first, to select a control rule for a movement and then to apply it to the peripheral neuromuscular mechanisms.
ELECTRICAL IMPEDANCE TOMOGRAPHY APPLIED POTENTIAL TOMOGRAPHY
Authors: Barber D.C.
Published: February 2025

(a) Established links between active groups within the Electrical Impedance Tomography community in Europe.
TECHNOLOGY AND BLINDNESS
Authors: Emiliani Pier Luigi
Published: February 2025

This paper describes the main achievements of the Concerted Action on “Technology and Blindness”, active from 1988 to 1991. After a brief introduction to the methodology used to meet the multidisciplinary objectives of the project, the main results and conclusions are presented with reference to the discussions held in several workshops and in the coordinated research projects. The fundamental effect of the Concerted Action as a catalyst of activities in other European and national research projects is emphasized.
OBJECTIVE MEDICAL DECISION MAKING ACUTE ABDOMINAL PAIN
Authors: de Dombal F.T.  , de Baere H  , van Elk P J  , Fingerhut A  , Henriques J  , Lavelle S.M.  , Malizia G  , Ohmann C  , Pera C  , Sitter H.  , Tsiftsis D
Published: February 2025

This Concerted Action has dealt with Objective Medical Decision Making in relation to Acute Abdominal Pain. Over 450 clinicians and scientists in 64 institutions in 19 different countries have participated in a network of collaborating centres, along with input from 18 national and international societies. Agreement has been reached (after wide consultation with the above participants) concerning a minimum dataset of information to be collected from patients presenting to hospital with acute abdominal pain, together with definitions of terminology for each clinical feature and criteria for diagnosis of each specific disease. On this basis a data collection instrument (a structured proforma) has been developed and translated into most major European languages for the purposes of quality controlled, reproducible data collection.
5.1 Integrated Clinical Information Management
Authors: OHLY Martin J.  , MENDE Detlef  , PAPARODITIS Demetrios  , OGRODOWCZYK Heidi  , PETERSEN Rainer
Published: February 2025

Although for the most part the technology required to achieve the computer-based patient record is probably available, no existing system that we know of, including that developed in BERMED, comes close to realizing the promised visions. Despite the rapid advances in computer hardware and software technologies, the tools of information management available for the majority of health professionals have not progressed much further than past the telephone, the paging system, the word processor, the multitude of paper forms, the local archive, and the post or courier service. Computer support for most clinical procedures means the local collection and storage of data, automatic report generation, and possibly the remote printing of results. Based on the BERMED experiences, this chapter provides an overview of our vision and basic requirements for integrated clinical information management and associated medical information services.