bluuebunny/crossref_metadata_2025 huggingface dataset:
Enabling On-demand Real-time Functional MRI Analysis Using Grid Technology
Authors: Matsuo K. , Tanaka Y. , Sarmenta L. F. G. , Nakai T. , Bagarinao E.
Published: March 2018

Objectives:
The analysis of brain imaging data such as functional MRI often requires considerable computing resources, which in most cases are not readily available in many medical imaging facilities. This lack of computing power makes it difficult for researchers and medical practitioners alike to perform on-site analysis of the generated data. This paper presents a system that is capable of analyzing functional MRI data in real time with results available within seconds after data acquisition.

Methods:
The system employs remote computational servers to provide the necessary computing power. System integration is accomplished by an accompanying software package, which includes fMRI analysis tools, data transfer routines, and an easy-to-use graphical user interface. The remote analysis is transparent to the user as if all computations are performed locally.

Results:
The use of PC clusters in the analysis of fMRI data significantly improved the performance of the system. Simulation runs fully achieved real-time performance with a total processing time of 1.089 s per image volume (64 x 64 x 30 in size), much less than the per volume acquisition time set to 3.0 s.

Conclusions:
The results show the feasibility of using remote computational resources to enable on-demand real-time fMRI capabilities to imaging sites. It also offers the possibility of doing more intensive analysis even if the imaging site doesn’t have the necessary computing resources.
More Up-To-Date Monitoring of Long-Term Survival Rates by Cancer Registries: An Empirical Example
Authors: Gefeller O. , Stegmaier C. , Ziegler H. , Brenner H.
Published: March 2018

A few years ago, a new method of survival analysis, denoted period analysis, has been developed to derive more up-to-date estimates of long-term survival rates of cancer patients, but this method has rarely been applied so far. Using empirical examples from the Saarland Cancer Registry, we illustrate how seriously traditional long-term survival estimates may lag behind survival expectations of newly diagnosed cancer patients in the case of recent improvement in prognosis, and to what extent this problem may be reduced by period analysis of survival. We conclude that period analysis should be more widely used for deriving more up-to-date long-term survival estimates.
A Prospective Evaluation of the Medical Consultation System CADIAG-II/RHEUMA in a Rheumatological Outpatient Clinic
Authors: Kiener H. P. , Kolarz G. , Schuh C. , Graninger W. , Adlassnig K.-P. , Leitich H.
Published: March 2018

To evaluate the performance of CADIAG-II/RHEUMA as consultant in the primary evaluation of patients visiting a rheumatological outpatient clinic, a CADIAG-II/RHEUMA consultation was done for 54 patients and the list of generated diagnostic hypotheses was compared to each clinical discharge diagnosis. For 26 of a total of 126 rheumatological discharge diagnoses, no matching CADIAG-II/RHEUMA diagnosis was available. 94% of all other discharge diagnoses were found in the list of CADIAG-II/RHEUMA hypotheses, 82% among the first third of the list of hypotheses and 48% among the first five hypotheses. We identified the following factors limiting the ability of CADIAG-II/RHEUMA to generate a comprehensive and correctly ranked list of diagnostic hypotheses: (1) a large percentage of patients with early stages of not clearly identified rheumatological conditions; (2) the limited number of CADIAG-II/RHEUMA diagnoses compared to the large number of known rheumatological conditions; (3) the fact that rheumato-logical diseases are rarely characterized by a single pathognomonic feature but are usually diagnosed by combinations of rather unspecific findings.
Notions of Reliability
Authors: De Bont A. A. , Adams S. A.
Published: March 2018

Objectives: This article analyzes the efforts of three organizations to provide a standard that guides Internet users to reliable health care sites.

Methods: Comparison of health Internet sites, interviews and document studies.

Results: In comparing these approaches, three different constructions of reliability are identified.

Conclusions: The resulting possibilities and restrictions of these constructions for users that are searching for health information on the Internet are revealed.
Two Patient Care Information Systems in the Same Hospital: Beyond Technical Aspects
Authors: Solen I. , Hasman A. , Troost J. , Tange H. J. , van der Meijden M. J.
Published: March 2018

Objectives:
To compare two clinical workstations in one hospital with respect to technical, organizational, cultural and human factors. One clinical workstation was a GUI to the HIS. The other was an electronic patient record for stroke.

Methods:
Data were collected by means of in-depth interviews with end-users of both clinical workstations. The interviews were audio taped and transcribed for analysis.

Results:
End users assessed both clinical workstations as user friendly. Coordination between health care workers was perceived to be enhanced. However, in both situations poor communication between management, implementers and users resulted in uncertainty and skepticism about future perspectives. Furthermore, it appeared that inpatient and outpatient settings needed clinical workstations with different requirements for an optimal fit between work practices and information system.

Conclusions:
Regardless of the domain and content of a workstation, it can support coordination between disciplines. The communication concerning the information technology strategy deserves much attention. Finally, the requirements for inpatient and outpatient workstations differ.
From a Urinalysis Strategy to an Evaluated Urine Protein Expert System
Authors: Ogurol Y. , Hofmann W. , Guder W. G. , Ivandic M.
Published: March 2018

Urine single protein analysis has developed into a routine method for the screening and monitoring of kidney diseases. In order to support clinical decision making by an interpretative report, a urine protein expert system (UPES) has been developed.

Based on a database containing more than 500 excretion patterns, a modular knowledge base was extracted in production rules and implemented in a modern expert system shell. The resulting interpretation system has been thoroughly verified and validated. After the need of interpretation of the complex findings had been documented in a survey, its usability in routine and its knowledge representation was evaluated in 11 hospitals. A user conference confirmed a high quality level of the reports proposed by UPES. It revealed that the problem of automatic data transfer as well as the common definition of diagnostic terms by laboratorians and clinicians play a crucial role for the use of knowledge-based systems in laboratory medicine.
Spontaneous Fluctuations of Human Pupil Reflect Central Autonomic Rhythms
Authors: Censi F. , Lino S. , Cerutti S. , Calcagnini G.
Published: March 2018

Aim of this study is to assess whether and to what extent LF and HF rhythms contribute to spontaneous pupil diameter fluctuations at rest and during sympathetic activation by Head-Up Tilt Test 70°. ECG, Finapres and Respiration data from 10 normal subjects were recorded simultaneously to spontaneous pupil diameter fluctuations (SPDF). The respiratory rhythm and the LF component were clearly detected in all the SPDF series. The cross-spectrum analysis gave significant results (>0.5) in HF band. During tilt, a reduction in the total variability with a relative increase of the LF component was observed in HR, BP and SPDF signals. The multivariate analysis of the SPDF and of the cardiovascular variability series allows new insights into the physiology of pupil neural control. The effect of tilting on SPDF spectra and the physiological background of the pupil control are consistent with the hypothesis that pupil fluctuations reflect a generalized increase of the sympathetic tone.
AIDA – Experiences in Compensating the Mutual Weaknesses of Knowledge-based and Object-oriented Development in a Complex Dental Planning Domain
Authors: Weber R. , Haßfeld S. , Koke U. , Wetter T. , Finkeissen E.
Published: March 2018

Objectives:
Dentistry is a discipline with two properties that pose a serious challenge to knowledge based decision support: (1) It has to integrate six sub-disciplines ranging from conservative measures to invasive disciplines, such as implantology; (2) A plan may have to cover a complex treatment often lasting one year or more. It is the aim of the AIDA-project1 to set up a planning strategy that is suited to incorporate all dental peculiarities in one methodology.

Methods:
Generic tasks, that can be assigned to individual persons involved in dental treatment, have been designed with the help of KADS. They have been integrated into a planning super-structure for the planning of all dental solution alternatives, that can principally be applied on the basis of the given patient status.

Results:
Besides an evaluation of the implemented planning system itself, it has been evaluated how well the development is supported by (1) knowledge-engineering methods and (2) object-oriented methods.

Conclusion:
Common knowledge-based tools are not powerful enough for the planning of complex dental constructions. Therefore, a solution combining object-oriented and knowledge-based methods is proposed.
Virtual Rehabilitation – Benefits and Challenges
Authors: Burdea G. C.
Published: March 2018

Objectives:
To discuss the advantages and disadvantages of rehabilitation applications of virtual reality.

Methods:
VR can be used as an enhancement to conventional therapy for patients with conditions ranging from musculo-skeletal problems, to stroke-induced paralysis, to cognitive deficits. This approach is called “VR-augmented rehabilitation.” Alternately, VR can replace conventional interventions altogether, in which case the rehabilitation is “VR-based.” If the intervention is done at a distance, then it is called “telerehabilitation.” Simulation exercises for post-stroke patients have been developed using a “teacher object” approach or a video game approach. Simulations for musculo-skeletal patients use virtual replicas of rehabilitation devices (such as rubber ball, power putty, peg board). Phobia-inducing virtual environments are prescribed for patients with cognitive deficits.

Results:
VR-augmented rehabilitation has been shown effective for stroke patients in the chronic phase of the disease. VR-based rehabilitation has been improving patients with fear of flying, Vietnam syndrome, fear of heights, and chronic stroke patients. Telerehabilitation interventions using VR have improved musculo-skeletal and post-stroke patients, however less data is available at this time.

Conclusions:
Virtual reality presents significant advantages when applied to rehabilitation of patients with varied conditions. These advantages include patient motivation, adaptability and variability based on patient baseline, transparent data storage, online remote data access, economy of scale, reduced medical costs. Challenges in VR use for rehabilitation relate to lack of computer skills on the part of therapists, lack of support infrastructure, expensive equipment (initially), inadequate communication infrastructure (for telerehabilitation in rural areas), and patient safety concerns.
How to Assess Prognostic Models for Survival Data: A Case Study in Oncology
Authors: Schumacher M. , Graf E. , Gerds T.
Published: March 2018

Objectives:
A lack of generally applicable tools for the assessment of predictions for survival data has to be recognized. Prediction error curves based on the Brier score that have been suggested as a sensible approach are illustrated by means of a case study.

Methods:
The concept of predictions made in terms of conditional survival probabilities given the patient’s covariates is introduced. Such predictions are derived from various statistical models for survival data including artificial neural networks. The idea of how the prediction error of a prognostic classification scheme can be followed over time is illustrated with the data of two studies on the prognosis of node positive breast cancer patients, one of them serving as an independent test data set.

Results and Conclusions:
The Brier score as a function of time is shown to be a valuable tool for assessing the predictive performance of prognostic classification schemes for survival data incorporating censored observations. Comparison with the prediction based on the pooled Kaplan Meier estimator yields a benchmark value for any classification scheme incorporating patient’s covariate measurements. The problem of an overoptimistic assessment of prediction error caused by data-driven modelling as it is, for example, done with artificial neural nets can be circumvented by an assessment in an independent test data set.
Postmarketing Surveillance Based on Electronic Patient Records: The IPCI Project
Authors: van der Lei J. , Mosseveld B. M. Th. , van Wijk M. A. M. , van der Linden P. D. , Sturkenboom M. C. J. M. , van Bemmel J. H. , Vlug A. E.
Published: March 2018

Researchers claim that data in electronic patient records can be used for a variety of purposes including individual patient care, management, and resource planning for scientific research. Our objective in the project Integrated Primary Care Information (IPCI) was to assess whether the electronic patient records of Dutch general practitioners contain sufficient data to perform studies in the area of postmarketing surveillance studies. We determined the data requirements for postmarketing surveil-lance studies, implemented additional software in the electronic patient records of the general practitioner, developed an organization to monitor the use of data, and performed validation studies to test the quality of the data. Analysis of the data requirements showed that additional software had to be installed to collect data that is not recorded in routine practice. To avoid having to obtain informed consent from each enrolled patient, we developed IPCI as a semianonymous system: both patients and participating general practitioners are anonymous for the researchers. Under specific circumstances, the researcher can contact indirectly (through a trusted third party) the physician that made the data available. Only the treating general practitioner is able to decode the identity of his patients. A Board of Supervisors predominantly consisting of participating general practitioners monitors the use of data. Validation studies show the data can be used for postmarketing surveillance. With additional software to collect data not normally recorded in routine practice, data from electronic patient record of general practitioners can be used for postmarketing surveillance.
Finding Ethical Principles and Practical Guidelines for the Controlled Flow of Patient Data
Authors: Draper R. , Hamilton I. , Rigby M.
Published: March 2018

The application of computing to health care, and particularly to electronic patient records, offers major benefits but raises issues of confidentiality and of potential misuse. Sound access control mechanisms are therefore important, but most models focus upon informed consent by the data subject. This raises challenges in mental health care, and for other vulnerable patients including those comatose, and the severely ill and temporarily distressed. Published algorithms which are used to control record access within a controlled environment therefore have value, as a means of ensuring an open and informed, yet ethically sound, solution. The paper describes the background and issues, and gives an example of such an algorithm.
The Multifarious Function of Medical Records: Ethical Issues
Authors: Spyropoulos B. , Papagounos G.
Published: March 2018

Medical records comprise history data, physical examination, biosignals, data acquired through in vitro diagnostic tests, images, therapeutic data, and administrative data. Beyond the use of records for therapy, they are also used in research, teaching, the allocation of resources, and for the construction of the patient’s personal history. These functions give rise to a number of important ethical issues. The most important ethical issues are the patient’s autonomy in decisions pertaining to proposed therapeutic interventions, the confidentiality of the information contained in the records, the reliability of the information for research, and questions related to healthcare policy and the distribution of healthcare resources.
Automated Semantic Indexing of Imaging Reports to Support Retrieval of Medical Images in the Multimedia Electronic Medical Record
Authors: Antipov I. , Hersh W. , Smith C. A. , Mailhot M. , Lowe H. J.
Published: March 2018

This paper describes preliminary work evaluating automated semantic indexing of radiology imaging reports to represent images stored in the Image Engine multimedia medical record system at the University of Pittsburgh Medical Center. The authors used the SAPHIRE indexing system to automatically identify important biomedical concepts within radiology reports and represent these concepts with terms from the 1998 edition of the U.S. National Library of Medicine’s Unified Medical Language System (UMLS) Metathesaurus. This automated UMLS indexing was then compared with manual UMLS indexing of the same reports. Human indexing identified appropriate UMLS Metathesaurus descriptors for 81% of the important biomedical concepts contained in the report set. SAPHIRE automatically identified UMLS Metathesaurus descriptors for 64% of the important biomedical concepts contained in the report set. The overall conclusions of this pilot study were that the UMLS metathesaurus provided adequate coverage of the majority of the important concepts contained within the radiology report test set and that SAPHIRE could automatically identify and translate almost two thirds of these concepts into appropriate UMLS descriptors. Further work is required to improve both the recall and precision of this automated concept extraction process.
The Need for Open Geographical Information Systems in Medicine
Authors: Friebe J. , Grawunder M. , Wellmann I. , Appelrath H.-J.
Published: March 2018

This paper presents a promising approach of using component-oriented geographical information systems (GIS) to facilitate improved medical and ecological applications. The integration of administrative geographical and medical data (map overlay) allows sophisticated and advanced analysis. This can serve as a basis to detect undiscovered relationships. We hope to increase the usage of geographical information by the creation of a general framework. This approach is mainly supported by two advances in recent years. Geographical data (e.g. administrative areas) is up-to-date, consistent and covers Germany completely. In addition, enormous technological improvements in the area of high-bandwidth networks and component-based software development have been made. These advances allowed to define our general framework for the integration of GIS functions into existing and already accepted applications.
Medical Informatics and Problem-based Learning
Authors: Hasman A. , Boshuizen H. P. A.
Published: March 2018

Problem-based learning (PBL) is an educational method that can be considered as an alternative to the traditional, discipline-based, approach to teaching. In this paper the characteristics of both approaches are discussed and compared. Some background knowledge concerning the principles that determine the success of instructional methods is presented. Finally, it is discussed how medical informatics can be taught in a PBL environment.
A Model and Application for Estimating Completeness of Registration
Authors: Stronegger W.-J. , Wernecke K.-D. , Berghold A.
Published: March 2018

Completeness of population-based registration systems is recognized to be an important aspect of the quality of information in registries which has to be examined. In this paper a model is presented which was used to estimate completeness of reporting of Down syndrome data notified to the Styrian Malformation registry between 1985-92. The model introduced is based on the two-source capture-recapture method allowing for time-varying parameters. For estimation of the parameters a discrete-time filtering algorithm was developed. For the used data set, an estimate of completeness derived from this model was in good agreement with an independent estimator based on demographic data and maternal age-specific Down syndrome risks whereas the usual two-source capture-recapture method gave a higher estimate.
Determining First Admissions in a Hospital Discharge File via Record Linkage
Authors: Langley J. D. , Alsop J. C.
Published: March 2018

The aim of this study was to identify first admissions in a public hospital discharge file with the greatest possible accuracy. Computerised data linkage was used to link injury events. This involved the use of “internal” data linkage (unduplication) which, in data linkage terms, is equivalent to matching two identical files. Admission status indicators obtained from deterministic and probabilistic linkages were compared with those obtained from a manual review. Small absolute reductions in error were obtained using a probabilistic linkage over a deterministic linkage. However, these reflected large relative reductions in error. A validity check confirmed initial results and discounted against possible bias due to the subjective nature of the probabilistic linking procedure.
Automatic Record Hash Coding and Linkage for Epidemiological Follow-up Data Confidentiality
Authors: Bouzelat H. , Allaert F. A. , Benhamiche A. M. , Faivre J. , Dusserre L. , Quantin C.
Published: March 2018

A protocol is proposed to allow linkage of anonymous medical information within the framework of epidemiological follow-up studies. The protocol is composed of two steps; the first concerns the irreversible transformation of identification data, using a one-way hash function which is used after spelling processing. To avoid dictionary attacks, two large random files of keys, called pads, are introduced. The second step consists in the linkage of files rendered anonymous. The weight given to each linkage field is estimated by a mixture model, the likelihood of which being maximized with the Expectation and Maximization (EM) algorithm. The performance of this method has been assessed by comparing record linkage, based on exclusive use of the automatic procedure, with a manual linkage, obtained by the Burgundy Registry of Digestive Cancers. The result of the linkage of a file of 2,847 cancers with a file of 388,614 hospitalization stays in the Dijon university hospital showed a sensitivity of 97% and a specificity of 93%.
Evolution of Artificial Neural Network Architecture: Prediction of Depression after Mania
Authors: Pendleton N. , Lucas C. P. , Lucas S. B. , Horan M. A. , Jefferson M. F.
Published: March 2018

Artificial neural networks (ANNs) are compared to standard statistical methods for outcome prediction in biomedical problems. A general method for using genetic algorithms to "evolve" ANN architecture (EANN) is presented. Accuracy of logistic regression, a fully interconnected ANN, and an EANN for predicting depression after mania are examined. All methods showed very good agreement (training set accuracy, chi-square all p <0.01). However, significant differences were found for stability (test set accuracy); logistic regression being the most unstable and EANN being significantly more stable than a fully interconnected ANN (McNemar p <0.01). We conclude that the EANN method enhances ANN stability. This approach may have particular relevance for biomedical prediction problems, such as predicting depression after mania.
On the Heuristic Nature of Medical Decision-Support Systems
Authors: Aliferis C. F. , Miller R. A.
Published: March 2018

In the realm of medical decision-support systems, the term “heuristic systems” is often considered to be synonymous with “medical artificial intelligence systems” or with “systems employing informal model(s) of problem solving”. Such a view may be inaccurate and possibly impede the conceptual development of future systems. This article examines the nature of heuristics and the levels at which heuristic solutions are introduced during system design and implementation. The authors discuss why heuristics are ubiquitous in all medical decision-support systems operating at non-trivial domains, and propose a unifying definition of heuristics that encompasses formal and ad hoc systems. System developers should be aware of the heuristic nature of all problem solving done in complex real world domains, and characterize their own use of heuristics in describing system development and implementation.
Sharing of Worldwide Spread Knowledge Using Hypermedia Facilities & Fast Communication Protocols (Mosaic and World Wide Web): The Example of ExPASy
Authors: Appel R. D. , Golaz O. , Pasquali Ch. , Sanchez J.-C. , Bairoch A. , Hochstrasser D. F.
Published: March 2018

The sharing of knowledge worldwide using hypermedia facilities and fast communication protocols (i.e., Mosaic and World Wide Web) provides a growth capacity with tremendous versatility and efficacy. The example of ExPASy, a molecular biology server developed at the University Hospital of Geneva, is striking. ExPASy provides hypermedia facilities to browse through several up-to-date biological and medical databases around the world and to link information from protein maps to genome information and diseases. Its extensive access is open through World Wide Web. Its concept could be extended to patient data including texts, laboratory data, relevant literature findings, sounds, images and movies. A new hypermedia culture is spreading very rapidly where the international fast transmission of documents is the central element. It is part of the emerging new “information society”.
The ICD Family of Classifications
Authors: Gersenovic M.
Published: March 2018

The history from the Sixth to the Ninth Revisions of the ICD is described. The 10th revision is presented as the 21st Century classification. The preparation of the ICD-10 included a long process with two expert committee meetings. A classification of diseases can be defined as a system of categories to which morbid entities are assigned according to established criteria. The pupose of the ICD is to permit the systematic analysis, interpretation and comparison of mortality and morbidity data collected in different countries or areas and at different times. In practice, the ICD has become the international standard diagnostic classification for all general epidemiological and many health management purposes. It was felt that the main ICD (the three- and four-character classification), covered by three volumes of ICD-10, could not incorporate all this additional information and remain accessible, and relevant to its traditional users, so the idea arose of a “family” of disease and health-related classifications, including volumes published separately form the main ICD, to be used as required. A statistical classification of diseases must be confined to a limited number of mutually exclusive categories, able to encompass the whole range of morbid condition, and must have well defined place in the list of categories. Consequently, throughout the classification, there will be residual categories for other and miscellaneous conditions that cannot be allocated to the more specific categories. As few conditions as possible should be classified to residual categories. Consequently, throughout the classification, there will be residual categories for other and miscellaneous conditions that cannot be allocated to the more specific categories. As few conditions as possible should be classified to residual categories. A broad description of ICD-10 itself, including information on applications, conventions, and general principles for use are described.
Distribution-Free Confidence Bounds for ROC Curves
Authors: Hilgers R. A.
Published: March 2018

ROC curves are widely used for the evaluation of diagnostic tests to decide between “healthy” and “diseased” individuals when the measurements are on a continuous scale. These curves are graphical displays of the interdependence between specificity and sensitivity of the test varying with the cut-off point chosen for the decision. Up to now only point estimators derived from the empirical distribution functions are used which may be misleading if they are based on rather small samples. In this paper we propose reasonable confidence bounds for ROC curves and a corresponding point estimator. Our bounds are strongly related to two-sided distribution-free tolerance regions because they are can, structed from minimum and maximum coverages which at a given value.t can be guaranteed with a confidence (2π* - 1). The interpretation of the bounds is that if a cut-off-point is chosen on the basis of the ROC curve then with a nominal confidence of at least (2π* -1)2 the real sensitivity and specificity will be within a rectangle.
Surveillance of Occupational Risks Using Job-Exposure Matrices
Authors: Mouaddib A. , Huy-Simon C. , Robaux P. , Martin J. M.
Published: March 2018

This article deals with the problem of surveillance of occupational risks of workers. Computer-assisted elaboration of the job history (JH) for each worker was achieved by means of a job-exposure matrix (JEM) for each company. The final aim of the project is to find correlations between the exposure data of JHs and the health data of corresponding medical records.

As a first experiment, some JEMs were computed using rectangular arrays even though it was realized that this simple structure was not really adequate. Later on, the structure of the computerized JEM included the following questions: (1) what types of information are involved; (2) how can the job-exposure correspondence be represented in the computer; (3) what characteristics of a company should be used for the elaboration of a JEM; (4) who is to construct each JEM, and how? This article shows the inadequacy of some occupational names for evoking the appropriate risks, a drawback which can be surmounted if the company organization is included in the JEM. Based on our analysis, several specifications useful for JEM computerization have been suggested.
Dilemmas at a Primary Health Care Center: a baseline study for Computer-Supported Cooperative Health Care Work
Authors: Timpka T. , Nyce J. M.
Published: March 2018

For the development of computer-supported cooperative health care work this study investigated, based upon activity theory, daily dilemmas encountered by the members of interprofessional primary health care work groups. The entire staff at four Swedish primary health care centers were surveyed, 199 personal interviews being conducted by the Critical Incident Technique. Medical dilemmas were mainly reported by general practitioners and nurses, organizational dilemmas by laboratory staff, nurses’ aides, and secretaries, and dilemmas in the patient-provider relation by nurses, nurses’ aides, and secretaries. Organizational and communication dilemmas reported by nurses, nurses’ aides, and secretaries often had their cause outside the control of the individual professional. These dilemmas were often “caused” by other group members (general practitioners or nurses), e.g., by not keeping appointment times or by not sharing information with patients. The implication for computer-supported cooperative health care work is that computer support should be planned on two levels. Collective work activity as a whole should benefit from individual clinical decision support for general practitioners and nurses. However, since most patient communication and organizational problems occurred at group level, group process support is required in these areas.
Towards an Essential Data Set: Applicability in the Domain of Maternal Health Services
Authors: Singh A. K. , Boström K. , Chowdhury S. , Trell E. , Wigertz O. , Kjessler B. , Moidu K.
Published: March 2018

There is a need for consensus on the quantity of data that must be available in a computer-based information system of a health care organization. In this paper we take up the issue of defining the data content of an information system and introduce the concept of Essential Data Sets with an explicit methodology which was applied to define a data set for the Maternal Health Services program. A key step in the method was a recognized technique used in systems development process called data modelling, in this case infological modelling, by an interdisciplinary group. A preliminary set of 86 data elements was identified and it provided the foundation for development of an application software for discussion and a real-world testing framework. The acceptability of the data set was tested in a laboratory perspective by retrospective data entry from records of 94 pregnant women registered at a maternal health care center in Sweden. Data from a total of 1,318 prenatal visits, an outcome visit, and a postnatal visit for each woman was entered into a computer using the software, with no loss of information. Thus, in a short-term perspective the acceptability of the data set was demonstrated. The software has since been implemented for pilot prospective studies at sites in India and Sweden. The use of a common data protocol is an essential foundation for patient outcome research, especially as the trend of health care management has changed from a “process of care” orientation to an “outcome of care” orientation.
Validation of the AI/RHEUM Knowledge Base with Data from Consecutive Rheumatological Outpatients
Authors: Moens H. J.
Published: March 2018

The diagnostic accuracy of AI/RHEUM, an experimental expert system for support in the diagnosis of rheumatic diseases, was assessed using a collection of data in a cohort of 1,570 consecutive outpatients of a Dutch rheumatological clinic. Computer diagnoses based on these data and diagnostic predictions made by rheumatologists were compared with reference diagnoses that had been obtained by consensus of rheumatologists after 6-12 months follow-up.

Performance of the tested version of the AI/RHEUM knowledge base is presented by various methods. Sensitivity varied between 29% and 100% for different rheumatological diseases. Average sensitivity and specificity for all 26 diagnoses present in the knowledge base were 67% and 98%, respectively. Performance according to the level of confidence indicated that 78% of the “definite”, 65% of the “probable”, and 33% of the “possible” conclusions made by AI/RHEUM were in agreement with the reference diagnoses. These results approximated the predictions made by rheumatologists after a single, initial examination. The system was less accurate than it had appeared in previous evaluation studies with complex clinical cases. The AI/RHEUM knowledge base needed refining to diagnose early rheumatic complaints. This study further illustrates the need for objective and informative parameters for expressing accuracy of diagnostic support systems.
Fitness in a U. K. Screening Sample – A Comparison with the Canadian Population
Authors: Robinson D. , Hale A. , Pearl A.
Published: March 2018

Fitness measurements were compared from approximately 12,000 men and 5,000 women attending the BUPA Health Screening Centre, London, with published Canadian levels. The mean (±SD) predicted VO2-max values in the BUPA group were 35.1 (±9.2) and 30.0 (±8.4) ml/kg/min for men and women aged 15-64 years, respectively. These compare with means of 44.1 and 34.3 in men and women of the same age in Canada. A comparison of flexibility measurements showed that in all age groups the BUPA subjects were less flexible than their Canadian counterparts, on average 28.7% and 25.1% lower for men and women, respectively. Comparison of grip strength showed BUPA values to be on average 8.1% lower in men and 9.5% lower in women than the Canadian levels. Analysis of variance showed that the fitness measurements reflect the recorded physical activity in the BUPA sample, and in particular the predicted VO2-max and flexibility exhibit linear relationships with age and exercise levels.
Health-Risk Appraisal Applied to Ordinary AMHTS
Authors: Okazaki N. , Hinohara S. , Sugiyama J. , Nakamura A. , Iwashimizu Y. , Kitagawa T. , Yoshida K.
Published: March 2018

The main purpose of an automatic health testing system (AMHTS) has changed from early detection to primary prevention. Health-risk appraisal is now widely available as a tool of health education aiming at the modification of unhealthy lifestyles. However, the opportunity to offer appropriate health education was less frequent for those who had no particular findings during AMHTS. The results of an AMHTS should be evaluated from the viewpoint of health-risk appraisal, because the system is expected to supply useful information regarding one’s lifestyle. Our system consists of two health-risk appraisal subsystems. One subsystem estimates the degree of improvement in medical indicators after a patient’s lifestyle has been modified. The other subsystem predicts the occurrence of abnormal findings in medical indicators. These health-risk appraisal subsystems provide patients with information about their health-risks, based on their AMHTS results. Our health-risk appraisal subsystems should play an important role in future health education through the application of ordinary AMHTS.
Modelling Domain-Knowledge: a Step toward Intelligent Data Management
Authors: van Ginneken A. M.
Published: March 2018

Response to: Essin DJ. Intelligent processing of loosely structured documents as a strategy for organizing electronic health care records. Meth Inform Med 1993; 32: 265-8.
Monitoring Vigilance during Single and Serial Visual Evoked Potentials
Authors: Pottinger R.
Published: March 2018

Full- and half-field visual evoked potentials (VEPs) are used to evaluate functional effects of optic chiasm compression by pituitary tumours. Reduction in VEP amplitude, typically from the temporal fields of vision, can occur even without demonstrable clinical deficit. An inherent problem of prolonged or serial testing is that changing levels of vigilance may affect the VEP. Gradual decrease in vigilance during a test sequence or with serial testing may cause a reduction in amplitude of the response mimicking the abnormality sought. This has serious implications when monitoring the effect of medical treatment since it may give a false impression of tumour growth requiring urgent surgery to prevent blindness. This report illustrates the nature of the problem and describes techniques using electroencephalograms (EEG), which have been used in an attempt to monitor vigilance. The ultimate aim is to produce a system to automate such monitoring during VEP recording.
The Value to the Anaesthetist of Monitoring Cerebral Activity
Authors: Langford R. M. , Thomsen C. E.
Published: March 2018

The administration rate of general anaesthetic drugs is at present guided by clinical experience, and indirect indicators such as haemodynamic parameters. In the presence of muscle relaxants most of the clinical signs of inadequate anaesthesia are lost and accidental awareness may occur. A number of monitoring modalities, primarily based on analysis of the electroencephalogram (EEG), have been proposed for measurement of the anaesthetic depth. Moreover intraoperative cerebral monitoring may also provide the anaesthetist with early warning of cerebral ischaemia, or information on specific neurological pathways. To facilitate this, it is essential to combine analysis of the spontaneous EEG with recording of evoked potentials, to assess both cortical and subcortical activity/events. None of the reviewed methods, however promising, can alone meet all of the requirements for intraoperative monitoring of cerebral function. We suggest that the future direction should be to integrate several modalities in a single device, to provide valuable new information, upon which to base clinical management decisions.
A Comparative Summary of Six Health/Medical Informatics Programs
Authors: Dickhaus H.
Published: March 2018

This paper tries to compare six Health Informatics/Medical Informatics (HI/MI) programs by a number of attributes in standardized form. The different programs and their curricula were summarized at the 5th IMIA Working Conference on HI/MI Education at Heidelberg/Heilbronn. The presentation is condensed to a synoptical scheme. Most of the information used for this purpose is taken from five individual papers about the programs presented in this special issue of Methods of Information in Medicine.
Can Health/Medical Informatics be Regarded as a Separate Discipline?
Authors: Protti D. J. , van Bemmel J. H. , Gunzenhäuser R. , Haux R. , Warner H. , Douglas J. V. , Lang E.
Published: March 2018

The participants of the panel on education and training in Medical Informatics, concurred that health/medical informatics is today thriving as a separate discipline, despite inevitable uncertainties regarding the future. Conferees discussed the distinctions between physician-built systems and those designed by medical informaticians, focusing on methodology as critical to medical informatics.
Decision Making in a Case of Multiple Sclerosis — Preliminary Note
Authors: John I.
Published: March 2018

Decision making was studied in a case of multiple sclerosis with the aim of understanding what sort of decision rules may be used to accept the final hypothesis in coming to a diagnosis. 17 persons, including 4 expert neurologists, 1 senior resident and 12 medical students interviewed a simulated patient.

It was found that the final hypothesis depended on the examination of a relatively small number of aspects (clinical features). Little search was made for aspects of choice alternatives other than the favoured one, namely multiple sclerosis. The results thus did not support pattern recognition as being important in decision making, and one may speculate that elimination by aspect or simple dominance rules may have been used in this case. The findings emphasise the apparent need to look for important distinguishing criteria in coming to a diagnosis.

This may have significant implications for medical education in that students may have to concentrate on learning heavily weighted distinguishing cues rather than long lists of individual clinical features of diseases.
INTERNIST-1/CADUCEUS: Problems Facing Expert Consultant Programs
Authors: Miller R. A.
Published: March 2018

INTERNIST-1 is an experimental computer program for consultation in general internal medicine. On a series of test cases, its performance has been shown to be similar to that of staff physicians at a university hospital. Despite INTERNIST-1’s apparent success in dealing with complex cases involving multiple diagnoses in the same patient, many shortcomings in both its knowledge representation schemes and its diagnostic algorithms still remain. Among the known problems are lack of anatomical and temporal reasoning, inadequate representation of degrees of severity of findings and illnesses, and failure to reason properly about causality. These drawbacks must be corrected before INTERNIST-1’s successor program, CADUCEUS, can be used. It is estimated that CADUCEUS will not be ready for release to the general medical community for five to ten years.

Broader problems faced by all medical diagnostic consultant systems are: design of an efficient human interface; development and completion of medical knowledge bases; expansion of diagnostic algorithms from simple heuristic rules to include a range of complex reasoning strategies, and development of a method for validating computer programs for clinical use.
Information System for Post-marketing Drug Surveillance Scheme on Small Computers
Authors: Moussa M. A. A.
Published: March 2018

A drug information system (DARIS) has been created for handling reports on suspected drug reactions. The system is suitable for being run on desktop computers with a minimum of hardware requirements: 187 K read/write memory, flexible or hard disc drive and a thermal printer. The data base (DRUG) uses the QUERY and IMAGE programming capabilities for data entry and search. The data base to statistics link program (DBSTAT) enables data transfer from the data base into a file for statistical analysis and signalling suspected adverse drug reactions.

The operational, medical and statistical aspects of the general population voluntary adverse drug reaction monitoring programme—recently initiated in the State of Kuwait—are described.
The Child Psychiatric Patient Database System of the Chinese University of Hong Kong
Authors: Wong C K.
Published: March 2018

An original child psychiatric patient database system developed in Hong Kong is reported. The system was developed mainly to meet the dilemma of the local working setting, namely heavy clinical and teaching commitments on the one hand and, on the other hand, the failure to make use of the massive and invaluable clinical materials for research purposes because there was no proper collection of data. The system was designed for routine clinical purposes with strong emphasis on practicability, and yet it also allows the systematic, comprehensive and prospective collection of clinical data. The first part of the system is a semistructured interview schedule which reflects the author’s usual style of interview, especially his preference for the family approach. Data are collected in two forms - a precoded and readily analyzable form, and a descriptive and non-coded form. The second part of the system is a computer program for converting the raw data to medical records. Some preliminary experience of using the system is also discussed. The system may easily be modified to suit different clinical styles and settings.
Decision Support Based on Laboratory Data
Authors: O’Moore Rory R.
Published: March 2018

Medical decision support systems dealing with multiple diseases are presently in a phase of development or revision and, in the immediate future, are likely to be utilized only as part of ongoing research projects or in the field of medical education. Those decision support systems (DSS) which are in routine use have one major factor in common. They are applied in a single narrow domain or series of overlapping narrow domains. Blois and Wagner predicted this, suggesting that computer-based medical decision aids were inherently limited in their ability to assist clinicians in reaching decisions about undifferentiated patients, i. e., those for whom an initial high level general classification had not already been made. To be useful, the domain should be narrowed by the clinical acumen of the physician. A thoughtful working diagnosis on a laboratory request form provides a good example of this process.
Distribution of Variables Extracted from Spectral EEG-Analysis
Authors: Ferber G. , Eichholz G.
Published: March 2018

For 1000 variables extracted from auto- and cross-spectra of two 12-channel montages, the empirical density function is investigated. Only a small group of them may be considered to have a univariate normal distribution. Another important group including the absolute and the relative power in the four classical frequency bands has distribution functions that may be more or less accurately approximated by gamma-type functions.

A third group including some of the peak frequencies shows distribution functions with two peaks not assignable to any natural classification of the EEG.

The power of discrimination between the four samples is investigated for each variable by means of Bayes-classification and by a quasi-Kolmogorov-statistic. Its quality is demonstrated using linear discriminant analysis.

Correlations were computed to complete basic statistical information.