bluuebunny/crossref_metadata_2025 huggingface dataset:
A Flexible Architecture for Constructing and Executing Tutoring Processes
Authors: Martens A.  , Bernauer J.  , Illmann T.  , Scheuerer C.  , Seitz A.
Published: February 2025

The tutoring process of conventional case-oriented medical training systems can be characterised as either guided or unguided. In contrast to that, the aim of the system “Docs’n Drugs” is to distinguish between different levels of guidance.’The author can realise the tutoring case as a guided, a half guided or an unguided tutoring process. The system architecture distinguishes between an authoring system and a tutoring system. Fundaments of these are the tutoring process model and the case data model. This structure allows the reuse of elements of existing tutoring cases. The tutoring cases can be realised in different langugages, e.g. German and English.
Systematische Evaluierung der Anwenderzufriedenheit von Ärzten mit einem Krankenhausinformationssystem - Erste Ergebnisse
Authors: Boy O.  , Ohmann C.  , Aust B.  , Eich H.P.  , Koller M.  , Knode O.  , Nolte U.
Published: February 2025

Im November und Dezember 1999 wurden mit einem Fragebogenverfahren 335 ärztliche Anwender eines Moduls des Krankenhausinformationssystems (KIS) der Medizinischen Einrichtungen der Universität Düsseldorf befragt. Evaluiert wurden die allgemeinen Einstellungen zu Computern und zu KIS, die Zufriedenheit mit dem o.g. KIS-Modul sowie die von den Ärzten empfundene Arbeitsbelastung im Klinik-alltag. Die Rücklaufquote betrug 60,3% (202 von 335). Während die Befragten sich hinsichtlich ihrer allgemeinen Einstellungen zu Computem deutlich positiv äußerten, wurde der Einsatz von KIS grundsätzlich kritisch bewertet. Die Zufriedenheit mit dem in der täglichen Routine eingesetzten KIS-Modul war in den meisten Kategorien gering, das System wurde eher als zusätzliche Belastung, denn als Unter-stützung im klinischen Arbeitsalltag empfunden.
A Computerised Guideline for the Management of Diabetes
Authors: Barahona Pedro  , Azevedo Francisco  , Veloso Mário  , Estêvão Nuno  , Gallego Rosa
Published: February 2025

This paper describes an experience of computerising a clinical guideline for the management of Diabetes. This guideline is being used in a National Programme for Diabetes supported by the Health Ministry in Portugal, who is interested in supporting its use by General Practitioners. The prototype system was developed according to the Prestige Protocol Model that is briefly outlined. The main conclusions regarding practical design decisions are then reported, partly based on a preliminary evaluation of the system by GPs.
Archiving of Care Related Information in XML format
Authors: Olhede Torleif  , Peterson Hans E.
Published: February 2025

Patient related care information is important over long periods of time. Thus it cannot be stored in running systems handling day by day information exchange. In the future, when the demands arise to use patient related information, neither the programmes nor the databases, in which the information once was fed, will be available. These facts imply that electronically stored patient related information must be electronically accessible and searchable and thus the information must be stored in a time-invariant way. In future use of patient related information it is of extraordinary importance both nationally, in the EU and internationally to use a standardised way to handle and access archived patient related information.
Can we classify Medical Data Dictionaries ?
Authors: Bürkle Thomas
Published: February 2025

Medical Data Dictionaries enable a clinical information system to maintain a controlled vocabulary, to store descriptive knowledge about terms, to map between those terms and from those terms to external classifications. They support a variety of functions in the information system, ranging from structured documentation to knowledgebased functions.
Eine Methode zur Aufbereitung von Leitlinien für die computergestützte Entscheidungsfindung
Authors: Kaeding Ame-Kathrin  , Funkat Gert  , Hommel Joachim  , Detschew Vesselin
Published: February 2025

Die Verbreitung von Leitlinien in der Medizin erfolgt größtenteils über Veröffentlichung in Fachzeitschriften und -büchern. Um zu erreichen, daß die Arbeit des Arztes durch patientenspezifische, konkrete problembezogene Hinweise aus den Leitlinien unterstützt wird, ist eine Integration in den Klinikbzw. Praxisalltag notwendig. An dieser Stelle setzen Methoden der modernen Informationsverarbeitung an, die mit gezielt entworfene Verfahren des Knowledge Engineering die Erfassung, Analyse und Repräsentation des Expertenwissens ermöglichen. Am Beispiel der Problematik der Risikoklassifizierung von Patienten zur Thromboseprophylaxe wird eine solche methodische Herangehensweise vorgestellt. Die Methode basiert auf der Beschreibung des Entscheidungsprozesses mit Hilfe von Problemlösungsszenarien und stellt eine prozeßorientierte Vorgehensweise zur Wissensakquisition dar. Ergebnis sind Modelle der klinischmedizinischen Problemsituation, die dann Grundlage für einen effektiven Einsatz der Informationstechnologien darstellen.
Information Visualisation in Clinical Medicine Using 3D Parallel Diagrams: A Case History
Authors: Falkman Göran  , Jontell Mats  , Nazari Nader
Published: February 2025

An information visualisation tool was implemented and tested as a solu- tion to the problem of visualising clinical experience derived from large amounts of formalised clinical data. The tool was based on the idea of dynamic 3D parallel diagrams with support for direct manipulation, an idea similar to the notion of 3D parallel coordinates. The tool was tested on a knowledge base containing about 1500 examinations obtained from different clinics. Clinical practice showed that the basic idea is conceptually appealing to the involved clinicians as the tool can be used for generating and testing of hypothesis.
Healthcare Knowledge Acquisition: An Ontology-Based Approach Using the Extensible Markup Language (XML)
Authors: Yu-N Cheah  , Abidi Syed Sibte Raza
Published: February 2025

The healthcare enterprise requires a great deal of knowledge to maintain premium efficiency in the delivery of quality healthcare. We employ Knowledge Management based knowledge acquisition strategies to procure ‘tacit’ healthcare knowledge from experienced healthcare practitioners. Situational, problem-specific Scenarios are proposed as viable knowledge acquisition and representation constructs. We present a healthcare Tacit Knowledge Acquisition Info-structure (TKAI) that allows remote healthcare practitioners to record their tacit knowledge. TKAI employs (a) ontologies for standardisation of tacit knowledge and (b) XML to represent scenario instances for their transfer over the Internet to the server-side Scenario-Base and for the global sharing of acquired tacit healthcare knowledge.
Graphical tool for navigation within the semantic network of the UMLS metathesaurus on a locally installed database
Authors: Frankewitsch T.  , Prokosch H.U.
Published: February 2025

Knowledge in the environment of information technologies is bound to structured vocabularies. Medical data dictionaries are necessary for uniquely describing findings like diagnoses, procedures or functions. Therefore we decided to locally install a version of the Unified Medical Language System (UMLS) of the U.S. National Library of Medicine as a repository for defining entries of a medical multimedia database. Because of the requirement to extend the vocabulary in concepts and relations between existing concepts a graphical tool for appending new items to the database has been developed: Although the database is an instance of a semantic network the focus on single entries offers the opportunity of reducing the net to a tree within this detail. Based on the graph theorem, there are definitions of nodes of concepts and nodes of knowledge. The UMLS additionally offers the specification of sub-relations, which can be represented, too. Using this view it is possible to manage these 1:n-Relations in a simple tree view.
Knowledge acquisition, management and representation for the diagnostic support in human inborn errors of metabolism
Authors: Hofestädt Ralf  , Mischke Ulrike  , Scholz Uwe
Published: February 2025

The very complex and specific knowledge about inborn errors of metabolism increases rapidly and is spread worldwide. Therefore an Internet platform for the acquisition of statistical knowledge (PATDB) and for the collection of the experience of experts (Metabolic diseases database) has been established. The success of diagnostic support highly depends on the way of knowledge representation. An information retrieval system for physicians will offer first insights about useful user interfaces and handling properties. Furthermore information fusion of biomedical systems to a Biomedical Workbench for the simulation of biochemical reactions is described.
Rechnergestützte Pflegedokumentation in der klinischen Routine
Authors: Ammenwerth Elske  , Eichstädter Ronald  , Pohl Ulrike  , Haux Reinhold  , Rebel Simone  , Spieß-Holusa Regina
Published: February 2025

Im Universitätsklinikum Heidelberg wird zur Zeit der Einsatz eines rechnergestützten Pflegedokumentations- systems zur Unterstützung des Pflegeprozesses erprobt. Als Softwareprodukt wurde “PIK” ausgewählt. Seine Einführung wurde wissenschaftlich begleitet und systematisch evaluiert. Inzwischen wird PIK auf mehreren Stationen eingesetzt. In diesem Beitrag werden wir über organisatorische, technische und inhaltliche Voraussetzungen für rechnergestützte Pflegedokumentation sowie über deren Auswirkungen auf Arbeitsabläufe, Zeitbedarf, Qualität der Dokumentation und Kooperation zwischen den Berufsgruppen berichten.
Entwicklung einer integrierten Stationskommunikation im Umfeld des KIS des Universitätsklinikums Freiburg
Authors: Busch M.  , Sauer M.  , Marx R.  , Bucher S.  , Zaiss A.W.  , Klar R.
Published: February 2025

Das Klinische Informationssystem des Universitätsklinikums Freiburg basiert auf den eigenentwickelten zentralen Informationsservern PDV-FR für administrative Patientendaten und MIRAplus für Befunde und Arztbriefe. In diesem Umfeld wurde die Stationskommunikation MeDoc als “Thin Client” konzipiert und realisiert. Die gesamte Datenkommunikation mit den zentralen Informationsservern erfolgt “online” via HL7. Das seit 1996 ständig weiterentwickelte System wird tüglich auf mehreren hundert Arbeitsstationen eingesetzt; mehr als 100.000 Arztbriefe wurden bereits damit erstellt.
A regional health network supported by organisational change. Cross sectorial electronic referral and confirmation of booking
Authors: Kaae Tove
Published: February 2025

The goal of the Funen Health Care Network is to ensure a fast correct communication between the Health Care professionals. Since 1993 electronic links have been established from all clinical hospital departments, radiology departments, laboratories, the clinical microbiology department and the pathology department to the general practitioners. Recently, the electronic referral and a confirmation of the booking has been implemented, and this will be followed by structured clinical e-mail service.
Chapter 3.6 - The Sleep Tutorial
Authors: Paiva Teresa  , Guilleminault Christian  , Sagalés Teresa  , Billiard Michel  , Zulley Juergen  , Challamel Marie Jo  , Louis Jacqueline  , Besset Alain  , Philip Pierre  , Levy Patrik  , Rosa Agostinho  , Penzel Thomas
Published: February 2025

A multimedia Sleep tutorial for General Practitioners was implemented from scratch. The implementation had into account the following features: 1) Specific needs of GPs evaluated in 3 different countries, related with Tutorial contents and technical features; 2) Multinational authorship from European experts; 3) Multilingual possibilities; 4) User friendliness and easy navigation. The tutorial was implemented and tested and its gama version is now available for commercialization.
A Comparative Statistical Analysis of Neuronavigation Systems in a Clinical Setting
Authors: Abbasi Hamid Reza  , Hariri Sanaz  , Martin David  , Shahidi Ramin
Published: February 2025

The use of neuronavigation (NN) in neurosurgery has become ubiquitous. A growing number of neurosurgeons are utilizing NN for a wide variety of purposes, including optimizing the surgical approach (macrosurgery) and locating small areas of interest (microsurgery). The goal of our team is to apply rapid advances in hardware and software technology to the field of NN, challenging and ultimately updating current NN assumptions. To identify possible areas in which new technology may improve the surgical applications of NN, we have assessed the accuracy of neuronavigational measurements in the Radionics™ and BrainLab™ systems. Using a phantom skull, we measured how accurate the visualization of a navigational probe's tip was in these systems, taking a total of 2180 measurements. We found that, despite current NN tenets, error is maximal at the six marker count and minimal in the spreaded marker setting; that is, placing less markers around the area of interest maximizes accuracy and active tracking does not necessarily increase accuracy. Comparing the two systems, we also found that accuracy of NN machines differs both overall and in different axes. As researchers continue to apply technological advances to the NN field, an increasing number of currently held tenets will be revised, making NN an even more useful tool in neurosurgery.
Intracorporeal Suturing and Knot Tying in Surgical Simulation
Authors: Larsson Anders
Published: February 2025

Intracorporeal suturing and knot tying is one of the most difficult tasks to perform during minimally invasive surgery. To master these tasks the student requires extensive training in a real or simulated environment. Realistic simulation of suturing and knot tying is a challenging task, the dynamic behaviors of the needle and thread are complicated to calculate efficiently in real time. We present our approach to simulated training of intracorporeal suturing and knot tying as well as our method for performance assessment. Different algorithms for physical modeling of suture thread dynamics are examined and evaluated.
Virtual Eye Muscle Surgery Based Upon Biomechanical Models
Authors: Mayr Herwig
Published: February 2025

Within our research project “SEE-KID”, a Software Engineering Environment for Knowledge-based Interactive Eye Motility Diagnostics, we focus on virtual reality training for the surgery of human eye muscles of - mostly - children age 1 to 3. Our report gives details on the sound integration of biomechanical muscle data into our virtual reality models in order to evaluate the quality of specific techniques for eye motility surgery regarding real-world pathologies. We illustrate the usefulness of our software system describing some of the possible medical applications, like optimized transposition surgery of the musculus obliquus superior.
An Experiment on Fear of Public Speaking in Virtual Reality
Authors: Pertaub D-P.  , Slater M.  , Barker C.
Published: February 2025

Can virtual reality exposure therapy be used to treat people with social phobia? To answer this question it is vital to know if people will respond to virtual humans (avatars) in a virtual social setting in the same way they would to real humans. If someone is extremely anxious with real people, will they also be anxious when faced with simulated people, despite knowing that the avatars are computer generated? In [17] we described a small pilot study that placed 10 people before a virtual audience. The purpose was to assess the extent to which social anxiety, specifically fear of public speaking, was induced by the virtual audience and the extent of influence of degree of immersion (head mounted display or desktop monitor. The current paper describes a follow up study conducted with 40 subjects and the results clearly show that not only is social anxiety induced by the audience, but the degree of anxiety experienced is directly related to the type of virtual audience feedback the speaker receives. In particular, a hostile negative audience scenario was found to generate strong affect in speakers, regardless of whether or not they normally suffered from fear of public speaking.
Development of a Multi-Modal Virtual Human Knee Joint for Education and Training in Orthopaedics
Authors: Riener R.  , Hoogen J.  , Burgkart R.  , Buss M.  , Schmidt G.
Published: February 2025

Due to limited simultaneous access to a greater pool of patients an effective training of medical students or young orthopedic physicians is difficult. A knee joint simulator that comprises the properties of a healthy or pathological knee can support medical education and training. In this paper a mechatronic system is presented that provides visual, acoustic, and haptic (force) feedback so that it allows a user to touch and move a virtual shank, bones or muscles within the leg, and simultaneously observe the generated movement, feel the contact force, and hear sounds. These and further features enable the user to study and assess the properties of the knee, e.g. by testing the joint laxity and end-point stiffness in six degrees-of-motion (DOF) and by grasping and pulling at muscles, rupturing ligaments or changing muscle/ligament paths. Such a tool can support training of physical knee evaluation required for diagnosis and therapeutic planning, since any kind of pathology of any subject type can be tested at any time. Furthermore, it can provide a better understanding of functional anatomy, e.g. for the education of medical students.
A New Concept for Intraoperative Matching of 3D Ultrasound and CT
Authors: Schorr Oliver  , Wörn Heinz
Published: February 2025

Matching of ultrasound images with CT or MRI scans is an awkward and unsatisfactory task when using conventional methods. Wide ranging differences in modality of ultrasound and CT/MRI require new techniques to be explored for successful alignment. Ultrasound images characteristically show comparable high noise ratio due to scattering inside the region of interest and the surrounding area. Additionally, shadowing and tissue dependent echo response time produce geometric artifacts. These image distortions are sophisticated to recover. Though image quality and geometric relationship are poor, ultrasound images show the potential for fast, low-cost, non-invasive and flexible image acquisition, predestinated for intraoperative application. The fusion of intraoperative ultrasound and preoperatively acquired CT/MRI images provides both, geometric invariance and flexible fast image acquisition, merging in a powerful tool for augmented three dimensional reality. In this paper we describe a completely new concept for alignment with abstaining from direct rigid or elastic matching of ultrasound to CT/MRI. Instead of placing those images in direct relationship, our approach involves a simulation of ultrasound wave behavior in order to predict B-mode images.
Human Perception of Haptic Information in Minimal Access Surgery Tools for Use in Simulation
Authors: Seehusen A.  , Brett P.N.  , Harrison A.
Published: February 2025

This paper describes research on human perception of haptic information in minimal access surgery (MAS) instruments, for use in a MAS simulator. Understanding the thresholds of human perception is important in determining which haptic information must be provided for realistic feedback and which information can be ignored without compromising the immersive quality of the simulator. Initially this research has determined the limits of perception for non-continuous change of force amplitude and frequency in a scissors-grasping position.
Web-based Educational Tool for Cleft Lip Repair using XVL
Authors: Tanaka Daigo  , Kobayashi Masahiro  , Chiyokura Hiroaki  , Nakajima Tatsuo  , Fujino Toyomi
Published: February 2025

Recent web-based technologies have brought a variety of new possibilities to the field of medical information. Nevertheless, transferring 3D patient models through usual low-band-width networks is difficult because of the large size of data file. XVL (eXtensive VRML with Lattice), a new framework for 3D Data representation with high quality surface shape, has solved this problem. In cooperation with Lattice Technology Inc., we have created XVL-formatted patient 3D models. The XVL model takes less than 100 kilobytes, whereas the same quality model in Virtual Reality Modeling Language(VRML) format requires more than 5 megabytes. Because of the many advantages of XVL, we have created a 3D web-based educational tool for repair of cleft lip – plastic surgery for congenital defects of the lips that requires complex incisions and reconstruction. Our system can interact with the model and 3D .vi sualization of the incision lines, displacement of skin flaps, and suturing. Our educational tool for cleft lip repair has demonstrated that the XVL model and its web-based application can open up new possibilities for 3D medical information systems. We are currently refining the XVL model and developing XVL-based applications to simulate the actual surgery on the World Wide Web.
Is Workflow Management Appropriate for Therapy Planning?
Authors: Miksch Silvia  , Kosara Robert  , Seyfang Andreas
Published: February 2025

The need to improve the quality of health care has led to a strong demand for clinical protocols and computer systems supporting both their creation and execution. We need to build complex protocols, but also to reason about them in different ways in order to verify, select, and modify protocols, to consider the effects of different protocols over time, and to monitor the patient's health conditions and the protocols' execution in parallel. Techniques, like Workflow Management Systems or Planning are appropriate to implement well-structured observations and processes, but are not suitable for the dynamically changing nature of therapy planning. Because of the limitations of existing approaches, we propose plan management consisting of fully integrated and inter-leaved tasks, namely plan design (authoring and/or generating), verification, validation, selection, adaptation, execution, monitoring, modification, evaluation, critiquing, and visualization. The Asgaard-Asbru project outlines task-specific problem-solving methods to support design, implementation, and execution of clinical protocols represented as time-oriented, skeletal plans. We illustrate how the idea of plan management is implemented in our Asgaard-Asbru project.
Comparing Student Attitudes to Different Models of the Same Virtual Patient
Authors: Bearman Margaret  , Cesnik Branko
Published: February 2025

Aims: Two types of virtual patient designs can be distinguished – a ‘narrative’ structure and a ‘problem-solving’ structure (1). This study assesses attitudes of students with respect to learning communication skills via a virtual patient; and compares acceptability of the two different types of virtual patient designs. Methods: Two virtual patients were constructed around the same case, each emphasising a narrative or problem-solving model. Undergraduate medical students used the simulations as part of a communication skills program. A computer-based survey was used to assess attitude. Results: There was general acceptance of the use of the computer-based simulated patient. Students who generally performed better at communication skills, were more positive towards the virtual patient. There was no quantitative difference in acceptability between the two designs, but there were clear qualitative differences. Conclusions: While students were moderately positive about both simulations, qualitative data indicated that their were clear differences in attitude between the two different designs.
A Forum Dedicated to Case Based Discussions for Continuing Medical Education
Authors: Joiron Céline  , Leclet Dominique  , Caron François-Marie
Published: February 2025

This poster aims to present the DIACOM forum (interactive case base discussions for medical training) and its experimentation in continuing medical education (CME) for pediatric pain management. DIACOM constitutes a training system that allows physicians to learn from each other and to interact with other physicians who have had similar experiences. Its principle is to enable the description of clinical cases and then make a comparison between these in order to incite the authors to interact.
Simulation of a Stroke Unit Careflow
Authors: Quaglini Silvana  , Caffi Ezio  , Cavallini Anna  , Micieli Giuseppe  , Stefanelli Mario
Published: February 2025

This paper describes the development and use of a simulation model representing part of the medical practice within a Stroke Unit. In particular, we modelled the medical activities as described in a guideline for the ischemic stroke treatment, adopted by the Stroke Unit of our hospital. The Petri net formalism has been chosen for the model representation. The numerical parameters have been estimated both using a database of about 100 patients collected during the last two years, and eliciting knowledge from the neurologists. A commercial tool was used for performing simulations, while ad-hoc routines were written for tailoring the result presentation to the specific context. We consider simulation a very useful preliminary step for the subsequent implementation of a patient workflow (careflow) management system. In fact, simulation is based on the process model (the clinical practice guideline) and on the organisation model (human and technological resources), so allowing to detect bottlenecks in the care delivery organisation and to find the optimal resource allocation. For example, we show that simulation has been able to find some of the causes of the delay in the patients treatment, and accordingly, to suggest changes in the organisation.
The Electronic Physician Practice: Present and Future Information Technologies to Effectuate Care Delivery
Authors: Kiel Joan M.
Published: February 2025

As the healthcare sector moves from the inpatient arena to the outpatient arena, information technology must follow suit. With this transition though, comes social, legal, ethical and economic implications. This research will analyze the utilization of information technology in the physician practice setting. It follows patients through the events occurring before, during, and after the visits and demonstrates how technology is utilized to effectuate the delivery of outpatient healthcare.
Statistical Properties of Ambulatory BP and HR Records
Authors: Orosz Miklós  , Keresztfalvi László  , Kékes Ede  , Kozmann György
Published: February 2025

We calculated the correlation coefficients between the heart rate, blood pressure and heart rate power spectral density. Low values of the correlation matrix elements show low level of interdependence of the signals.
Towards Second-generation Smart Card-Based Authentication in Health Information Systems: The Secure Server Model
Authors: Hallberg Jonas  , Hallberg Niklas  , Timpka Toomas
Published: February 2025

Conventional smart card-based authentication systems used in health care alleviate some of the security issues in user and system authentication. Existing models still do not cover all security aspects. To enable new protective measures to be developed, an extended model of the authentication process is presented. This model includes a new entity referred to as secure server. Assuming a secure server, a method where the smart card is aware of the status of the terminal integrity verification becomes feasible. The card can then act upon this knowledge and restrict the exposure of sensitive information to the terminal as required in order to minimize the risks. The secure server model can be used to illuminate the weaknesses of current approaches and the need for extensions which alleviate the resulting risks.
The Construction of a Public Key Infrastructure for Healthcare Information Networks in Japan
Authors: Sakamoto Norihiro
Published: February 2025

The digital signature is a key technology in the forthcoming Internet society for electronic healthcare as well as for electronic commerce. Efficient exchanges of authorized information with a digital signature in healthcare information networks require a construction of a public key infrastructure (PKI).
Privacy of Genetic Information: A Review of the Laws in the United States
Authors: Fuller Barbara  , Ip Miranda
Published: February 2025

This paper examines the privacy of genetic information and the laws in the United States designed to protect genetic privacy. While all 50 states have laws protecting the privacy of health information, there are many states that have additional laws that carve out additional protections specifically for genetic information. The majority of the individual states have enacted legislation to protect individuals from discrimination on the basis of genetic information, and most of this legislation also has provisions to protect the privacy of genetic information. On the Federal level, there has been no antidiscrimination or genetic privacy legislation. Secretary Donna Shalala of the Department of Health and Human Services has issued proposed regulations to protect the privacy of individually identifiable health information. These regulations encompass individually identifiable health information and do not make specific provisions for genetic information. The variety of laws regarding genetic privacy, some found in statutes to protect health information and some found in statutes to prevent genetic discrimination, presents challenges to those charged with administering and executing these laws.
Logistic Regression Model: An Assessment of Variability of Predictions
Authors: Colombet Isabelle  , Jaulent Marie-Christine  , Degoulet Patrice  , Chatellier Gilles
Published: February 2025

Risk prediction models available for cardiovascular prevention are statistical or based on machine learning methods. This paper investigates whether the logistic regression method can be considered as reference for validation of other methods. In order to test the stability of the predictions using this method, we performed two types of analyses on 50 random training and test samples drawn from the same database. In first analyses three models were obtained by forced entry of different sets of four variables. In second analyses, models were built with increasing number of predictive variables. The predictive performance was assessed by the area under the ROC curve. Although across-samples variability is low for a given model, it is large enough to lead to wrong conclusions when comparing different prediction methods. We also suggest that a low events-per-variable ratio alters the stability of a model’s coefficients but does not affect the variability of prediction performance.
Record Linkage of Healthcare Insurance Claims
Authors: Victor Timothy W.  , Mera Robertino M.
Published: February 2025

Limitations of current record linkage techniques include difficulty in handling large and heterogeneous data sets, low sensitivity in deterministic matching, the necessity to provide a priori weights for probabilistic matching, low computational efficiency, and complex software. This paper provides a detailed description of a method developed for purposes of linking records of individuals across time and geography. The procedure for record-linkage consists of three major components: data standardization, weight estimation, and matching. The proposed method was designed to incorporate a combination of exact and probabilistic matching techniques. The procedure was validated using convergent, divergent, and criterionvalidity measures. The authors feel that the procedure outlined in this paper is a first step in addressing the current trend toward larger and more complex databases.
Patterns of Usage of Internet Resources by Persons with Post Coronary Arterial Bypass Graft
Authors: Hamilton Kamisha  , Rogers Michelle  , Ground Anita  , Gustafson David H.  , Flatley Brennan Patricia
Published: February 2025

The purpose of this study is to describe the patterns of usage of defined Internet resources by persons following coronary arterial bypass graft surgery. Three different methods of measuring usage were employed: counts of accesses, duration of accesses and persistence of activity during the study. Four different patterns of usage were identified.
Epidemiological Database Management System for Community Oral Health
Authors: Morikawa Tomiaki  , Nishino Mizuho  , Arita Kenji
Published: February 2025

In not a few countries prevalence of dental caries is very high. Individual oral health status is affected by individuallevel variables and system-level variables. Where prevention has been introduced into the system the approach has tended to be simply technical and not based on a sound understanding of the dental and behavioral scientific bases of prevention and oral health educations. The establishment of an epidemiological database, which can serve as the database for realistic planning, monitoring and evaluation of present and fixture oral health care services is indispensable. The purposes of this research were to establish the computer program named as the Internet-Dental Epidemiology-system produced by Nishino in Tokushima-University(i-DENT) and to evaluate its usefulness in the ongoing community program called Ishiitown preschool Children Oral Health Care Study (ICOHCS). Ishii-town is in the suburbs of Tokushima city, Japan. ICOHCS started in 1986 and the i-DENT was established in 2000. i-DENT has used the Internet, dentists and people in public health center work in cooperation with each other. The i-DENT showed numerous advantages for oral health care services.
An Evaluation of the Utility of the CEN Categorial Structure for Nursing Diagnoses as a Terminology Model for Integrating Nursing Diagnosis Concepts into SNOMED
Authors: Bakken Suzanne  , Warren Judith J.  , Lundberg Cynthia  , Casey Anne  , Correia Carol  , Konicek Debra  , Zingo Christine
Published: February 2025

We evaluated the utility of the CEN Categorial Structure for Nursing Diagnoses as a terminology model for integrating nursing diagnosis concepts into SNOMED. First, we dissected nursing diagnosis term phrases from two source terminologies (North American Nursing Diagnosis Association (NANDA) Taxonomy 1 and Omaha System) into the semantic categories of the CEN categorial structure. Second, we critically analyzed the similarities between the semantic links in the CEN model and the semantic links used to formally define diagnostic concepts in SNOMED RT and SNOMED CT. Our findings demonstrated that focus, bearer, and judgment were present in 100% of the NANDA and Omaha term phrases. The Omaha term phrases contained no additional descriptors beyond those considered mandatory in the CEN model. In contrast, at least 3% of NANDA diagnoses included a term in each semantic category of the categorial structure. The comparison among the semantic links showed that neither SNOMED RT and SNOMED CT currently contain all the semantic links needed to model the two source terminologies for integration. In conclusion, our findings support the potential utility of the CEN categorial structure as a terminology model for dissecting nursing diagnostic concepts for integration into SNOMED RT and SNOMED CT. However, in order to accomplish this task, appropriate semantic links must be added to SNOMED RT and SNOMED CT.
Delivering the Electronic Healthcare Record: A Software Engineering Perspective
Authors: Grimson Jane
Published: February 2025

Delivering the electronic healthcare records (EHCR) in the sense of the cradle-to-grave longitudinal record has proved to be much more difficult that the pioneers in Medical Informatics could have predicted in the 1960’s. Yet this is certainly not due to a lack of effort by researchers in the field. A vast number of papers, articles, and books have been written on the subject, and thousands of prototypes developed. Yet the goal of the paperless hospital, let alone the paperless health service, seems to remain as distant as ever. The information that contributes to the EHCR is distributed across a vast range of diverse systems using different software, hardware, formats, terminologies, architectures, access protocols, etc. To provide integrated access to these islands of information is indeed a serious technical challenge that requires a state-of-the-art software engineering approach. Nevertheless, the very reason why such seamless engineering of healthcare information is required — supporting the healthcare process- points to another range of challenges which include awareness, business process engineering, ownership of data, etc. There are a number of examples of successful implementations, in particular for specific clinical domains, which have delivered significant benefits within a single organisation, but these solutions do not in general scale up to a national or even regional setting.
New Approaches To Evaluation: Alternatives To The Randomized Controlled Trial Qualitative Approaches to Design and Evaluation: Theory and Practice
Authors: Kaplan Bonnie  , Aarts Jos  , Hebert Marilynne  , Klecun-Dabrowska Ela  , Lewis Deborah  , Vimarlund Vivian  , Elis Niki
Published: February 2025

New information and communication technologies being used in health care are complex and diverse. This session provides an overview of newer approaches by presenting examples of evaluations using qualitative methods. Examples are drawn from how different evaluation frameworks, models, and theories were used in a variety of projects.
Visualizing Complex Notions of Time
Authors: Kosara Robert  , Miksch Silvia
Published: February 2025

Time plays an important role in medicine. Conditions are not just evaluated at single instants in time, but traced over periods. Medications must be administered within specified temporal limits, and their effects observed with regard to time.
Information Needs in Primary Care: A Survey of Rural and Nonrural Primary Care Physicians
Authors: Gorman Paul
Published: February 2025

$\underline{Objective:}$ To compare the self-reported information needs of rural and nonrural primary care physicians.
ARIANE: A Mediation Framework with Health Information Sources
Authors: Joubert Michel  , Aymard Sylvain  , Fieschi Dominique  , Fieschi Marius
Published: February 2025

Objectives: to design and implement mediators dedicated to access heterogeneous information sources in a homogeneous way. Method: processes translate a query into the syntax of a target source built thanks to the UMLS knowledge sources and a catalog of information sources. Communication services connect users with information sources at the point they deliver results. Results: examples show the benefits healthcare professionals may found in searching information in this way. Discussion: improvements on the current developments may be done according to the current architecture of ARIANE. Specially, the user interface should be easier to use than the present one.
Cancer Clinical Trials Treatment Management Application
Authors: London Jack W.  , Mervis Steven
Published: February 2025

Cancer clinical trials are rigorously defined clinical studies designed to establish the safety and comparative efficacy of a proposed treatment protocol. The protocol specifies all treatment events that are to occur, and precisely when they are to occur. Cancer clinical trials therefore require very detailed treatment calendars for each individual patient enrolled on a study. Creating and maintaining these calendars is a tedious, time-consuming task for protocol nurses. “TreatmentCal” is a software package for cancer treatment management which allows the calendars to be automatically generated and updated. This Web-accessible database application can also produce output for handheld computers. “TreatmentCal” has reduced the workload of protocol nurses.
RASTA: A Distributed Temporal Abstraction System to Facilitate Knowledge-Driven Monitoring of Clinical Databases
Authors: O'connor Martin J.  , Grosso William E.  , Tu Samson W.  , Musen Mark A.
Published: February 2025

The time dimension is very important for applications that reason with clinical data. Unfortunately, this task is inherently computationally expensive. As clinical decision support systems tackle increasingly varied problems, they will increase the demands on the temporal reasoning component, which may lead to slow response times. This paper addresses this problem. It describes a temporal reasoning system called RASTA that uses a distributed algorithm that enables it to deal with large data sets. The algorithm also supports a variety of configuration options, enabling RASTA to deal with a range of application requirements.
Building an Explanation Function for a Hypertension Decision-Support System
Authors: Shankar Ravi D.  , Martins Susana B.  , Tu Samson W.  , Goldstein Mary K.  , Musen Mark A.
Published: February 2025

ATHENA DSS is a decision-support system that provides recommendations for managing hypertension in primary care. ATHENA DSS is built on a component-based architecture called EON. User acceptance of a system like this one depends partly on how well the system explains its reasoning and justifies its conclusions. We addressed this issue by adapting WOZ, a declarative explanation framework, to build an explanation function for ATHENA DSS. ATHENA DSS is built based on a component-based architecture called EON. The explanation function obtains its information by tapping into EON’s components, as well as into other relevant sources such as the guideline document and medical literature. It uses an argument model to identify, the pieces of information that constitute an explanation, and employs a set of visual clients to display that explanation. By incorporating varied information sources, by mirroring naturally occurring medical arguments and by utilizing graphic visualizations, ATHENA DSS's explanation function generates rich, evidence-based explanations.
The MOSORIOT Medical Record System (MMRS) Phase I to Phase II Implementation: An Outpatient Computer-based Medical Record System in Rural Kenya
Authors: Hannan Terry J.  , Tierney William M.  , Rotich Joseph K.  , Odero Wilson W.  , Smith Frances  , Mamlin Joseph J.  , Einterz Robert M.
Published: February 2025

The authors of this paper describe the second phase of the implementation of the Mosoriot Medical Record System (MMRS) in a remote health care facility on the outskirts of Eldoret, Kenya, located in sub-Saharan Africa.
A Web-based Rapid Prototyping and Clinical Conversational System that Complements Electronic Patient Record System
Authors: Kim Ju Han  , Ferziger Reuven  , Kowaloff Hollis B.  , Sands Daniel Z.  , Safran Charles  , Slack Warner V.
Published: February 2025

Even the most extensive hospital information system cannot support all the complex and ever-changing demands associated with a clinical database, such as providing department or personal data forms, and rating scales. Welldesigned clinical dialogue programs may facilitate direct interaction of patients with their medical records. Incorporation of extensive and loosely structured clinical data into an existing medical record system is an essential step towards a comprehensive clinical information system, and can best be achieved when the practitioner and the patient directly enter the contents. We have developed a rapid prototyping and clinical conversational system that complements the electronic medical record system, with its generic data structure and standard communication interfaces based on Web technology. We believe our approach can enhance collaboration between consumeroriented and provider-oriented information systems.
Integrating Medical Applications in an Open Architecture Through Generic and Reusable Components
Authors: Xu Yigang  , D'Alessio Ludovic  , Jaulent Marie-Christine  , Sauquet Dominique  , Spahni Stephane  , Degoulet Patrice
Published: February 2025

Allowing exchange of information and cooperation among network-wide distributed and heterogeneous applications is a major need of current health care information systems. It forces the development of open and modular integration architectures. Major issues in the development include defining a flexible and robust federation model, developing interaction and communication facilities as well as the mechanism insuring semantic interoperability.
Portable Patient Record Model (PPRM) for the Introducing of Smart Card System and Preparation of the Interactive Database Network
Authors: Simon Pál  , Kellner Dénes  , Békési László  , Loványi István  , Schiszler István
Published: February 2025

The purpose of medical informatics is to follow patients within the health care system, to analyse care data, and evaluate the results in the interest of quality care and controlling. The portable patient medical record model (PPRM) is platform-independent and it is suitable for smart card applications. This model includes the conception of a big-quickness database network and ‘virtual-workshops’ for the patient and a management oriented analysis of health care. At the moment the structure of the records and the cards are ready and the physician professional card is functioning.
Designing an ICD-10 based Diagnostic Code Set for Use as a Key Element of a Patients Electronic Dental Record
Authors: Tamagawa Hiroo  , Hayashi Naoji  , Nozaki Kazunori  , Sogo Motofumi  , Maeda Yoshinobu
Published: February 2025

In this report, we describe an extension of the international statistical classification of disease and related health problem's tenth revision (ICD-10) to adapt it to the practical activities of a university dental hospital. Extensions varied from 12.5 % to 92.7 % (mean, 57.8%) according to the target organ of the named disease. There was a relationship between the ratio of extensions of ICD-10, and the ratios of usage of the extended disease numbers to the total disease numbers. This research report proposes new indexes that evaluate the granularity of disease names.
Development of an Electronic Patient Record System for Supporting Informed Consent
Authors: Uchiyama Yoshikazu  , Ishikawa Kiyomu  , Tsukuma Hidehiko  , Tsuru Satoko  , Morimoto Noriaki  , Amano Hideaki  , Tanaka Takeshi
Published: February 2025

Although the order entry systems have contributed to the efficient work of medical accounting in almost all university hospital in Japan, they cannot play an important role of medical record as information sharing between patient and health care providers. In order to improve patient care, the electronic patient record system with the aim of supporting informed consent is proposed.
Experiences from Development of Home Health Care Applications based on Emerging Java Technology
Authors: Lind Leili  , Sundvall Erik  , Åhlfeldt Hans
Published: February 2025

Home health care is an expanding area within the health care system. The idea of moving parts of the health care process from expensive specialised hospital care to primary health care and home health care might be attractive in a cost perspective. The introduction of home health care applications must be based on a rigorous analysis of necessary requirements to secure a safe and reliable health care. This article reports early experiences from the development of a home health care application based on emerging Java technologies such as the OSGi platform. A pilot application for follow-up of diabetes patients is presented and discussed in relation to a list of general requirements on home health care applications.
Biomedical Image Skeletonization: A Novel Method Applied to Fibrin Network Structures
Authors: Chang Sukmoon  , Kulikowski Casimir A.  , Dunn Stanley M.  , Levy Saul
Published: February 2025

To understand the rheological behavior of fibrin clots, we must obtain quantitative measurements of morphometric parameters of the networks formed under various conditions. The networks are so complex that researchers must currently manually segment the images of network samples and estimate the parameters from them. Skeletonization is a promising tool for automating this task. We here propose a method that rapidly constructs a coarse representation of a skeleton graph and, using the snake model, deforms the graph to obtain smooth skeletons. Unlike many existing approaches, our method does not involve explicit object boundary information or high order derivatives. Since our method processes a given image as a whole, the presence of multiple objects in an image is automatically detected and the skeletons of these objects are computed simultaneously.