bluuebunny/crossref_metadata_2025 huggingface dataset:
TANCLICO: Tools for the Analysis of Inter-departmental Clinical Communications
Authors: Crippa F. , Combi C. , Reni G. , Fava D. , Pinciroli F.
Published: March 2018

Patient care management provided by healthcare organizations is complex, involving many different care providers. The information exchange between providers concerns a varying and considerable number of actors and a high transmission load. Based on models, used to characterize specific features of work processes, we propose a new method able to analyze and represent clinical communications inside hospitals. Software has been developed, providing tools for storing and retrieving information resulting from clinical communications. The method, together with data collected in actual situations, may constitute useful tools for health information systems developers.
ARCHIMED: A Network of Integrated Information Systems
Authors: Thurler G. , Borst F. , Bréant C. , Campi D. , Jenc J. , Lehner-Godinho B. , Maricot P. , Scherrer J. R.
Published: March 2018

ARCHIMED is a Network of Integrated Information Systems (NIIS). This novel concept of hospital information system has a major advantage over the currently used distributed systems. The normalized representation structure of its databases enable its Navigators to reach simultaneously not only the data coming from different hospital departments, laboratories, and other hospital facilities, but also the data from different hospitals associated in the network.
Heart Rate Signal Decomposition
Authors: Mizuta H. , Yana K.
Published: March 2018

This paper proposes a method for decomposing heart rate fluctuations into background, respiratory and blood pressure oriented fluctuations. A signal cancellation scheme using the adaptive RLS algorithm has been introduced for canceling respiration and blood pressure oriented changes in the heart rate fluctuations. The computer simulation confirmed the validity of the proposed method. Then, heart rate fluctuations, instantaneous lung volume and blood pressure changes are simultaneously recorded from eight normal subjects aged 20-24 years. It was shown that after signal decomposition, the power spectrum of the heart rate showed a consistent monotonic 1/fa
type pattern. The proposed method enables a clear interpretation of heart rate spectrum removing uncertain large individual variations due to the respiration and blood pressure change.
Simulation Evaluation of Cardiac Assist Devices
Authors: Bing Z. , Bai J.
Published: March 2018

During past decades, various cardiac assist devices were invented. These cardiac assist devices can be classified into two categories: parallel connected or sequentially connected to the natural heart. In the past, more attention was paid to the assistance of the device provided to the failing heart and most research was conducted towards that goal. While less attention was paid to the “dose” of the assistance for rehabilitation of the natural heart. In our study, the hemodynamic effects of parallel as well as sequential cardiac assist devices are investigated in terms of the working load to the natural heart, and the oxygen supply and consumption of the natural heart. Preliminary results show that the sequential assistance could reduce the working load of the natural heart as well as increase the coronary flow. The results also indicate that the control scheme of the cardiac assist device has effect on the oxygen supply and consumption of the natural heart. There is optimal “dose” of assistance for the rehabilitation of the natural heart.
Band-Suppressed Restoration of X-Ray Images Blurred by Body Movement
Authors: Saitoh Y. , Kiryu T. , Okamoto K. , Sakai K. , Hori J.
Published: March 2018

The restoration of X-ray images that have been blurred due to body movement are discussed. The observation system for these images is described using a mathematical model, and several restoration filters composed of a series of such models are proposed. These filters restore band-suppressed approximations of the original images. In addition, redundancy is introduced into these restoration filters in order to suppress additive noise. These filters are expanded to be applicable not only to parallel translations, but also to rotations by coordinate transformation. The proposed methods are applied to blurred X-ray images of a bone model of the elbow joint. The parameters of the restoration filter are estimated using a marker attached to the subject as a reference signal.
Health and Medical Informatics Competencies: Call to Participate in Updating the IMIA Recommendations
Authors: Douglas Judith , Hovenga Evelyn
Published: March 2018

Objectives:
On behalf of the International Medical Informatics Association (IMIA), its Working Group 1 (WG1) addresses health and medical informatics education.

Methods:
As part of its mission, WG1 developed recommendations for competencies, describing a three-dimension framework and defining learning outcomes.

Results:
Officially approved by IMIA in 1999, the recommendations have been translated into seven languages. In 2001, WG1 charged a small group with updating the recommendations and consider the work undertaken by others to develop competencies. Additional work underway in support of the recommendations includes a literature review to help extract the fundamental competencies from the recommendations. To ensure the highest quality of input in the updated recommendations, WG1 is issuing a call for participation to the international informatics community.

Conclusions:
Further work with the competencies will result in updated IMIA guidelines. These are expected to support the creation of a virtual university for health and medical informatics.
Comparison of Computer-based Information Support to Clinical Research in Chinese and Japanese Hospitals
Authors: Ogasawara K. , Endoh A. , Sakurai T. , Jiang G.
Published: March 2018

Objectives:
The objectives of this research are to examine the current situation of computer-based information support of clinical research in hospitals and to determine the expectations of clinicians toward clinical research support functions of hospital information systems (HISs) in both China and Japan.

Methods:
172 clinicians from 42 major hospitals in China (2 groups), and 568 clinicians from 79 university hospitals in Japan (2 groups), were surveyed by postal questionnaire during July and August, 1999. The Kruskal-Wallis test was performed to analyze the differences among the groups.

Results:
The total response rate was 66.9%. The result shows that 94.8% of the Japanese clinicians, 3.5 times more than those in China, use computers almost every day. High significance was shown for the frequency of non-HIS based information resources used by clinicians between China and Japan (p <0.001), whereas no significance for the frequency of HIS use by clinicians between the China I and Japan I groups (p = 0.725) was found. 33.3% clinicians in China thought they could obtain 30-50% of the necessary patient data for clinical research from the HIS, about 2 times more than in Japan (p = 0.009).

Conclusions:
Although the degree of computer involvement among clinicians in Japan is much higher than in China, the computer-based hospital information systems have not been developed well for supporting clinical research in both countries. The clinicians expect comprehensive computerized patient records (CPRs) and full use of patient related information in the existing HISs to support their clinical research.
Evaluating the Impact of Primary Care Consultations on Teenage Lifestyle: A Pilot Study
Authors: Oakley L. L. , Townsend J. L. , Walker Z. A. K.
Published: March 2018

This study piloted an evaluation of the effectiveness of inviting teenagers to UK general practice consultations with health behaviour advice and appropriate follow-up care. 132 teenagers aged 14/15 years were randomised: intervention teenagers were invited to attend a health consultation with a practice nurse, the control group received usual care. Teenagers in two practices were consulted by postal survey and in focus groups to ensure the intervention met their needs. 56% of the teenagers invited attended for a consultation. 55% of the intervention group and 45% of the controls reported some positive change in health related behaviour at one month.
Point of Care Technology: A Sociotechnical Approach to Home Health Implementation
Authors: Struk C. M. , Stricklin M. L. V.
Published: March 2018

Objectives: This paper describes an ongoing evaluation study of the design and implementation of Point of Care (POC) technology in a home health agency. Methods: During the implementation of POC technology data about user acceptance were collected with the help of surveys and statistically analyzed. The survey also allowed for entering non-structured observations. A time series study was conducted to identify factors associated with technology change and its effect on professional competency.

Results and Conclusions: Healthcare markets and consumers are demanding that providers use sophisticated information technology to document, transmit and access clinical and financial information across all delivery points. Newly adapted Patient Care Information Systems (PCIS) are available for clinical use in home care. The factors associated with home care nurses’ end user acceptance and use of the POC technology in clinical work are described. A sociotechnical approach with selected change management strategies appears to have positively influenced the nurse end users’ POC technology adoption and use in clinical work.
Presenting XML-based Medical Discharge Letters According to CDA
Authors: Wolff A. , Hochlehnert A. J. , Bludau H. B.
Published: March 2018

The HL7 Clinical Document Architecture (CDA) is an important XML-based standard for the representation of clinical documents.

Objectives:
The use of Markup Languages could satisfy the demands of involved healthcare staff as well as the needs of patients, to receive an overview of the patient’s treatment during the hospital stay. The standardization efforts of different groups dealing with this problem have demonstrated progress, but have not, as yet, achieved a routinely usable result. In particular, differentiating information according to a hierarchical order has not been published to date.

Methods:
A retrospective analysis of 60 discharge letters from a cardiology ward (ward A) as well as 60 discharge letters from a gastroenterology ward (ward B) were extracted from the central hospital information system, by taking every fifth discharge letter issued over a one year period.

Results:
An XML-based prototype for medical discharge letters has been put in place representing the required information units and information elements. By means of an XSL-stylesheet, a detailed representation of the conventional discharge letter has been produced that is platform independent and permits the recurrent use of information units.

Conclusions:
Through the introduction of definitions like information elements and information units, progress in the development of CDA level two and three might be realized. We present a method by which discharge letters can be used by an Internal Medicine Department. This concept is implemented in a XML-based prototype allowing a special view on XML data to generate this document type.
Online Medical Records: A Decade of Experience
Authors: Sands D. Z. , Rind D. M. , Safran C.
Published: March 2018

The electronic patient record at the Beth Israel Deaconess Medical Center has fundamentally changed the practice of medicine in ways that its developers never foresaw. This type of highly interactive and work flow enabled program is creating new collaborative roles for computers in complex organizations [4]. With the system able to supervise and monitor care, computers are able to perform many care coordination and documentation functions, freeing people to concentrate more on interpersonal interactions and provision of health care services. One of the challenges in the design of electronic patient records to assist health care providers is how to support collaboration while not requiring that people meet face-to-face. Moreover, a greater challenge for each of us as clinicians is to use this technology as a bridge (rather than a barrier) towards better patient-doctor relationships.
Confidentiality Issues within a Clinical Information System: Moving from Data-driven to Event-driven Design
Authors: Joubert M. , Fieschi D. , Fieschi M. , Staccini P.
Published: March 2018

Within a hospital, the moving of medical information systems from retrospective data-gathering methods to prospective clinical information systems raises the question of the confidentiality of patient data. A method of improving the traditional matrix model usually used to achieve access controls is described. The event-driven model refers to the way a security system ensures that a given user has a valid »need-to« relationship to a given patient. Events are defined as the occurrence of specific data that trigger the creation or the updating of the relationship between the identity of a user and the identity of a patient (e. g., admission, discharge, transfer, prescription, and report). The creation and the deletion of the relationships between users and patients are based on numerous repositories and working lists of patients. This implementation requires an organization of the hospital activities which is able to manage, in a real-time manner, those repositories as closely as possible to the steps occurring during the patient’s care process. Although this approach seems to reasonably fit the dynamic of the care process, it adds significant organizational constraints.
Medical Narratives and Patient Analogs: The Ethical Implications of Electronic Patient Records
Authors: Kluge E.-H. W.
Published: March 2018

An electronic patient record consists of electronically stored data about a specific patient. It therefore constitutes a data-space. The data may be combined into a patient profile which is relative to a particular speciality as well as phenomenologically unique to the specific professional who constructs the profile. Further, a diagnosis may be interpreted as a path taken by a health care professional with a certain specialty through the data-space relative to the patient profile constructed by that professional. This way of looking at electronic patient records entails certain ethical implications about privacy and accessibility. However, it also permits the construction of artificial intelligence and competence algorithms for health care professionals relative to their specialties.
The Past, Present and Future of International Health Evaluation Association (IHEA)
Authors: Hinohara Shigeaki
Published: March 2018

In this paper I mention the 19-year history of International Health Evaluation Association (IHEA) which was started in Washington D.C. by the great effort of Dr. G. Gilbert in Hawaii. In 1973 three regions were organized in this Association: 1) U.S.A., 2) Europe and 3) Pan-Pacific including Asia.

I also mention the history of periodical health checkups in U.K., U.S.A. and Japan. In Japan it started in 1954, however, after adapting the system of Automated Multiphase Health Testing designed by the Kaiser Foundation of Auckland, Calif., in 1973, Japanese people paid much attention to this health screening system and the number of hospitals and clinics for health screening has increased tremendously and the number of examinees amounted to 2,875,449 in 2001.

Finally, I conclude that IHEA should create a multi-disciplinary system to sustain a lifestyle with a high level of Quality of Life (QOL) for the people who really want to live fruitful lives by the successive health education.
Medicine in the 21st Century: Global Problems, Global Solutions
Authors: Lindberg D.A.B.
Published: March 2018

Objectives:
To discuss application areas of information technology in medicine and health care on the occasion of the opening of the Private Universität für Medizinische Informatik und Technik Tirol/University for Health Informatics and Technology Tyrol (UMIT) at Innsbruck, Tyrol, Austria.

Results and Conclusions:
Important application areas of information technology in medicine and health are appropriate individual access to medical knowledge, new engineering developments such as new radiant imaging methods and the implantable pacemaker/ defibrillator devices, mathematical modeling for understanding the workings of the human body, the computer-based patient record, as well as new knowledge in molecular biology, human genetics, and biotechnology. Challenges and responsibilities for medical informatics research include medical data privacy and intellectual property rights inherent in the content of the information systems.
Analytical and Graphical Methods to Model the Association between Family History and Disease from a Case-control Study
Authors: Severi G. , Robertson C. , Hopper J. L. , Baglietto L.
Published: March 2018

Subjects within a family have a high probability of sharing environmental factors as well as genes. Without any previous hypothesis, familial aggregation cannot be attributed to genetic or environmental factors. In epidemiology a common measure of familial aggregation is the odds ratio (OR) evaluated from case-control studies which gives a measure of the increased risk associated with particular aspects of the family’s history of disease. An analytical method is presented to model the OR of case-control studies in the presence of risk factors, genetic or environmental, that are correlated between relatives. A graphical approach that can be used to link the parameters of the model with the values of the OR is also described. The method is illustrated using the example of familial aggregation in colorectal cancer.
Design Issues and Sample Size when Exposure Measurement is Inaccurate
Authors: Rippin G.
Published: March 2018

Measurement error often leads to biased estimates and incorrect tests in epidemiological studies. These problems can be corrected by design modifications which allow for refined statistical models, or in some situations by adjusted sample sizes to compensate a power reduction. The design options are mainly an additional replication or internal validation study. Sample size calculations for these designs are more complex, since usually there is no unique design solution to obtain a prespecified power. Thus, additionally to a power requirement, an optimal design should also fulfill the criteria of minimizing overall costs. In this review corresponding strategies and formulae are described and appraised.
Review of Biomedical Knowledge and Data Representation with Conceptual Graphs
Authors: Joubert M. , Fieschi M. , Volot F.
Published: March 2018

The basis of conceptual graphs theory is an ontology of types of concepts. Concepts issued from the ontology are interlinked by semantic relationships and constitute canonical conceptual graphs. Canonical graphs may be combined to derive new conceptual graphs by means of formation rules. This formalism allows to separate knowledge representation into a conceptual level and a domain-dependent level, and enables to share and reuse a representation. This paper presents conceptual graph applications to biomedical data and concept representation, classification systems, information retrieval, and natural language understanding and processing. A discussion on the unifying role conceptual graphs theory plays in the implementation of knowledge-based systems is also presented.
Generation of Correlated Logistic-Normal Random Variates for Medical Decision Trees
Authors: El-Taha M. , Clark D. E.
Published: March 2018

A Logistic-Normal random variable (Y) is obtained from a Normal random variable (X) by the relation Y = (ex)/(1 + ex). In Monte-Carlo analysis of decision trees, Logistic-Normal random variates may be used to model the branching probabilities. In some cases, the probabilities to be modeled may not be independent, and a method for generating correlated Logistic-Normal random variates would be useful. A technique for generating correlated Normal random variates has been previously described. Using Taylor Series approximations and the algebraic definitions of variance and covariance, we describe methods for estimating the means, variances, and covariances of Normal random variates which, after translation using the above formula, will result in Logistic-Normal random variates having approximately the desired means, variances, and covariances. Multiple simulations of the method using the Mathematica computer algebra system show satisfactory agreement with the theoretical results.
Toward a General Model for the Description of Multimedia Clinical Data
Authors: Pisanelli D. M. , Ricci F. L. , Consorti F. , Piermattei A. , Ferri F.
Published: March 2018

The patient folder integrates information originating from heterogeneous sources. For this reason computerized tools for patient data management should exploit the advantages of multimediality and offer an integrated environment for data presentation, and image and biosignal visualization. Object-oriented modeling is the best approach for designing systems for multimedia patient folder management.

We propose an object-oriented model, able to define the entities constituting the patient folder and their logical organization. This model has sufficient flexibility to adapt to the most varied clinical environments. It allows the physician to structure the information needed for his/her patient folder without employing a programming language.
Decision Support Systems from the Standpoint of Knowledge Representation
Authors: Fieschi M. , Chatellier G. , Degoulet P.
Published: March 2018

Relationships between decision-support systems and knowledge representation are examined from three different points of view: the characteristics of medical decisions that might influence the selection of appropriate knowledge representations, – the extent to which different knowledge representations can support efficient medical decisions and, – the validation of knowledge hypotheses through the practice of decision support systems. A three-level model of knowledge representation is proposed that includes a contextual, a conceptual and a computational level. Taking into consideration the context that leads to the selection of a given representation raises the issue of multiexpertise and multirepresentation modeling. Implementation of decision support systems as sets of cooperative agents and integration in the health information systems are considered.
Medical Language Processing: Applications to Patient Data Representation and Automatic Encoding
Authors: Sager N. , Lyman M. , Nhàn N. T. , Tick L. J.
Published: March 2018

A linguistic approach is presented to develop a representation of patient data. Semantic categories developed for computer processing of narrative clinical reports are shown to be similar to the Medical Concepts used manually to extract data from narrative in Exercises of the Computer-based Patient Record Institute. Clinical statement types composed of these categories are used in the Linguistic String Project (LSP) medical language processing (MLP) system to convert narrative information into relational database tables of patient information. A procedure for mapping the output of the LSP MLP system into SNOMED International codes was developed. Preliminary results and further requirements are discussed.
Naming Notes: Transitions from Free Text to Structured Entry
Authors: Gregory J. , Mattison J. E. , Linde C.
Published: March 2018

To practice medicine in the near future, health care providers in the USA need an information infrastructure they do not yet have. We offer a contribution from social science research to discussions of current medical records practices and how health care activity systems may be transformed by the advent of electronic health records. The goal of the paper is to set forth a framework that connects over-arching questions concerning medical informatics systems development with the practical, cultural and conceptual issues involved in transitions from handwritten and other free text documentation to structured entry of medical records to build patient profiles. The research is broadly framed by an interest in how reciprocal modifications of the design and use of an electronic health record are negotiated in an iterative prototyping project. It is conducted as part of a complex multi-disciplinary research and development effort to create an electronic health record prototype for use in the integrated health care delivery environment of the Southern California Kaiser Permanente Medical Care Program.
SNOMED-Based Knowledge Representation
Authors: Rothwell D. J.
Published: March 2018

A standardized vocabulary and a standardized representation for this vocabulary are necessary prerequisites for the development of a computer-based patient record. A standard conceptual scheme or data structure for this vocabulary must be in place to define clinical events and to share data. SNOMED International is a detailed, fine grained, semantically typed and comprehensive computer processable vocabulary encompassing both human and veterinary medicine. Each term is placed in a standardized data structure that shows the term relationship within its own and other related taxonomic hierarchies. SNOMED International is a standardized vocabulary and data structure suitable for use in the computer-based patient record.
The Separation of Reviewing Knowledge from Medical Knowledge
Authors: Musen M. A. , van der Lei J.
Published: March 2018

The developers of reviewing systems that rely on computer-based patient-record systems as a source of data need to model reviewing knowledge and medical knowledge. We simulate how the same medical knowledge could be entered in four different systems: CARE, the Arden syntax, Essential-attending and HyperCritic. We subsequently analyze how the original knowledge is represented in the symbols or syntax used by these systems. We conclude that these systems provide different alternatives in dealing with the vocabulary provided by the computer-based patient records. In addition, the use of computer-based patient records for review poses new challenges for the content of that record: to facilitate review, the reasoning of the physician needs to be captured in addition to the actions of the physician.
Medical Informatics: A Key to the Future of Medicine and Health Care?
Authors: Haux R.
Published: March 2018

Commenting on the paper of Heathfield and Wyatt (The Road to Professionalism in Medical Informatics: A Proposal for Debate. Methods of Information in Medicine 1995) argued that Medical Informatics as a scientific discipline has reached a professional status. However, depending on the geographic location and the field of research, education or applications, requirements for further “professionalization” differ. It is proposed that Medical Informatics and Health Informatics should be regarded as one discipline and that Medical Informatics has to contribute to research, education and to the practice of health care in order to improve diagnostics, therapy and health care organization. The future of Medical Informatics is strongly dependent on health care professionals, who must be well-educated in medical informatics; these may be physicians, nurses, health care administrators, specialists in medical informatics, or others. There is still a continuing need for the systematic processing of data, information and knowledge in medicine and in health care. Also, due to its essentially cross-sectional nature encompassing most other disciplines in medicine and health sciences, Medical Informatics must be regarded as a key to the future of medicine and health care.
Potholes in the Road to Professionalism in Medical Informatics
Authors: Miller R. A. , Giuse D. A.
Published: March 2018

Heathfield and Wyatt’s article in the current issue of Methods opens a debate about the status of Medical Informatics as a discipline and as a profession. While the desire for more professionalism of Medical Informatics is laudable, certain points in the article are debatable. Based on widely circulated definitions of profession and science, on the thousands of people who make medical informatics their main occupation, and on at least 10,000 peer-reviewed publications, the authors argue that the discipline is already a profession, albeit a fledgling one. Contrary to the positions of Heathfield and Wyatt, exemplary, long-lasting medical informatics applications demonstrate that the best artifacts of medical informatics already meet the most important requirement for professionalism, i. e., the commitment to clients and the public to perform a socially useful function.
Graphical Non-Linear Representation of Multi-Dimensional Laboratory Measurements in their Clinical Context
Authors: Hoeke J. O. O. , Gelsema E. S. , WuIkan R. W. , Leijnse B.
Published: March 2018

A polygon-based graphical representation of laboratory test results using non-linear scaling is described. It is argued that the non-linearity of the scale and the use of colors in the representation facilitates interpretation of the test result in its relationship to the standard reference range and critical clinical decision levels. Preliminary results suggest that this representation may be fruitfully used to enhance the efficiency of the information transfer from the clinical chemistry laboratory to clinicians. Other applications, inside as well as outside the medical field, may easily be imagined.
Combining Physiologic Models and Symbolic Methods to Interpret Time-Varying Patient Data*
Authors: Kahn M. G. , Fagan L. M. , Sheiner L. B.
Published: March 2018

This paper describes a methodology for representing and using medical knowledge about temporal relationships to infer the presence of clinical events that evolve over time. The methodology consists of three steps: (1) the incorporation of patient observations into a generic physiologic model, (2) the conversion of model states and predictions into domain-specific temporal abstractions, and (3) the transformation of temporal abstractions into clinically meaningful descriptive text. The first step converts raw observations to underlying model concepts, the second step identifies temporal features of the fitted model that have clinical interest, and the third step replaces features represented by model parameters and predictions into concepts expressed in clinical language. We describe a program, called TOPAZ, that uses this three-step methodology. TOPAZ generates a narrative summary of the temporal events found in the electronic medical record of patients receiving cancer chemotherapy. A unique feature of TOPAZ is its use of numeric and symbolic techniques to perform different temporal reasoning tasks. Time is represented both as a continuous process and as a set of temporal intervals. These two temporal models differ in the temporal ontology they assume and in the temporal concepts they encode. Without multiple temporal models, this diversity of temporal knowledge could not be represented.
Correspondence Analysis for Quantification in Electron Energy Loss Spectroscopy and Imaging
Authors: Beckers A. L. D. , Sorber C. W. J. , de Bruijn W. C. , Gelsema E. S.
Published: March 2018

Electron energy loss spectroscopy (EELS) is a technique to investigate the physical properties of material. Using this technique it is possible to detect the presence of a specific element in a specimen. When used in combination with an electron microscope, energy filtered images may be obtained, which in principle may be used to quantify the local element concentration. This involves a process of background correction, conventionally performed assuming a specific parametric behavior of the spectral intensity as a function of electron energy loss. In this article a parameter-free method is described for background correction based on the formalism of correspondence analysis. Such a method may be used in parts of the spectrum where the functional dependence of the spectral intensity is unknown. Use of this method for element detection has been suggested before. This article reports simulation experiments suggesting its suitability for quantitative determination of element distributions and element concentrations.
Test Selection in Jaundice: A Comparison between Physician Behavior and a Diagnostic Model
Authors: Wilson J. H. P. , Habbema J. D. F. , Segaar R. W.
Published: March 2018

The results of an observational study aimed at a formal assessment of clinicians’ test-selection behavior are presented. We first make a proposal for diagnostic test usage in the latter phases of jaundice diagnosis. Next we compute a probabilistic estimate of the patient diagnosis, based on the COMIK algorithm. From the proposal and the probabilistic estimate we can predict the “test-selection behavior” of clinicians. The assessment follows from a tabulation of the predicted behavior against the tests selected by clinicians. It is shown that for most tests, the predictions are consistent with the observed test-selection behavior at a statistically significant level. Discussions of discrepancies between prediction and observation, and reasons for deviations from general guidelines, provide new dimensions for medical education. The methodology applied is a useful tool to improve medical care for the jaundiced patient.
Graphic Summaries of Expert Knowledge for the Medical Curriculum: An Experiment in Second-Year Nephrology
Authors: Preiss B. , Black R. , Caron C. , Shapcott D.
Published: March 2018

This study was conducted to test the effects of Concept Graphics on learning in clinical nephrology. Second-year medical students were exposed to summaries of the major renal pathologies presented as text with, or without Concept Graphics for 30 minutes, followed by a quiz. Concept Graphics summarize diagnoses using icons that are metaphors of objects or processes. Of nine quiz questions, five were classified as correlation questions and four as memorization questions. The experimental group (n = 39) performed better than the controls (n = 33) in answering the correlation questions (p = 0.018). The experimental group mentioned more frequently than the controls two pathognomonic criteria of the nephritic syndrome (p = 0.02). Results of an opinion poll of the students, comparing sources used in their studies of nephrology were treated by correspondence analysis; the Concept Graphics ranked closest to the classification “very useful”.
Study and Applications of an Informational Measure of Dependence in Survival Models
Authors: EI Hasnaoui A. , Jais J. P.
Published: March 2018

In survival models, when the factor of interest is a continuous variable or is expressed through a group of several variables, the classical measures of risk, i. e. relative risk and odds ratio, are not appropriate and there is no standard measure of dependence between survival and the considered factor. The Information Gain has been proposed by Linfoot (1957) and Kent (1983), giving any parametric model as a generalization of the squared product-moment correlation coefficient of the linear regression model with normal errors. By using simulation methods, we studied the statistical properties of the information gain as a measure of dependence, in the particular case of survival regression models. We suggest several efficient applications of this informational concept to some classical problems of regression analysis and prognostic analysis. Our ideas are illustrated through an example on the prognosis of idiopathic dilated cardiomyopathy.
Athletes as Health Testing Examinees
Authors: Miura K. , Miyakawa S. , Narayama S. , Hirano H. , Kanai K. , Miwa T.
Published: March 2018

Health-testing examination data of 91 male and 54 female athletes were studied, together with age-matched controls, on serum biochemistry, ECG findings, hematology, and some data on gynecological physiology. Analysis of serum biochemical values revealed statistically significant differences in 14 of 18 routine test items as compared with the age-matched controls. In ECG findings, the combination of bradycardia and left ventricular hypertrophy was most frequently found in male athletes, whereas that of bradycardia and sinus arrythmia was observed predominantly in female athletes. The incidence of anemia and menstrual dysfunction was higher in female athletes than in controls, especially in the basketball team. In the same team, a high rate of deviant ECG records and a different distribution of the age at menarche were also observed.
Defining Normality – Art or Science?
Authors: Robinson D. , Bevan E. A.
Published: March 2018

The problem of defining normality, and in particular the establishment of reference ranges, is discussed. A so-called “objective” method of determining such ranges is described. It is suggested, however, that all currently used methods for defining “normal” ranges rely ultimately on a subjective choice. We propose the use of “How Often That Happens” (HOTH) graphs as an alternative to the conventional reference range. Such graphs show the frequency of results at least as extreme as any observed value. We have used such graphs, along with computer simulation models, in an attempt to describe how the frequency distribution of a given parameter changes as a population ages. Finally, an analogy is drawn between the states of “health”, “illness” and “death”, and the attractors which arise in non-linear dynamic systems. We conclude that the definition of normality is in fact more of an art than a science.
HEALTH WATCH: Health Promotion and Disease Prevention in Primary Care
Authors: Schmidt R. M.
Published: March 2018

Health Watch, a longitudinal prospective study of healthy aging, was designed to characterize a healthy population of 2,200 men and women, ages 20-80 years in 1970. Biochemical, hematological, and physiological tests are performed annually over three weekly visits, combined with a self-administered Health Watch questtionnaire to measure health status and behaviors in seven areas (with over 1,330 variables). In 1988, the Health Watch study was modified to assess characteristics of an oldest old “productive aging” cohort in Kauai, Hawaii. Nutrition, physical activity, extended family, and spirituality were found to be major health determinants. During 1989 to 1991 a controlled intervention study (ten local primary care physicians and their patients, aged 65-89 years) was completed in the Sun Cities, Arizona. These studies provide evidence that primary care physicians can promote positive health outcomes in patients of any chronological age and baseline health status through active healthy aging interventions.
Heart Rate Response to Exercise in Normal Women
Authors: Bowyer A. F. , Thomas R. A. , Bowyer S. R.
Published: March 2018

Heart rate is known to increase under the influence of increased sympathetic stimulation rates during exertion or stress. Few data are available regarding the rate response to exercise near the fatigue limit, for normal women. The effects on heart rate were studied of fatigue limiting exercise in 87 asymptomatic, normal female subjects employing a bicycle ergometer exercise protocol. The heart rate response to imposed exercise power closely followed a monotonic increasing, negative exponential function. Different age groups followed the same form of function but differed in parameter values. Group fitting was useful to develop parameters with which one group may be compared to another, establish referent ranges, and gain insight into cardiovascular models of exercise physiology.
Probability Graphics Support for Medical Reasoning
Authors: Yoder J. W. , Littell E. , Williams B. T.
Published: March 2018

Graphic displays of data from clinical observations and laboratory testing provide important support to the health practitioner in managing an increasing amount of complex information. A graphic display program is described that preserves much of the context of data that is important to their evaluation, and that maintains a sense of the strength of the signal when aberrant data are encountered.
Computer-Assisted Instruction in Probabilistic Reasoning During the Inpatient Medicine Clerkship
Authors: Lancaster D. J. , McClish D. K. , Smith W. R.
Published: March 2018

The acceptability and utility of computer-assisted instruction in probabilistic reasoning was assessed for medicine clerkship students. After a pretest, the experimental (n = 40), but not the control students (n = 39), completed a program that we designed. The program contained the test and its answers. After program exposure, experimental students rated their knowledge of the program’s content significantly higher (p = 10−4) than control students. On the identical posttest, experimental students also scored significantly higher than control students (p = 10−4) and improved their scores significantly more (p = 10−3). They rated ease-of-use items significantly higher than content-relevance items (p = 1CT−4). We conclude that computer-assisted instruction in probabilistic reasoning is acceptable to clerkship students, and that it may improve their knowledge and skills in this area. However, students may rate the vehicle of this instruction more highly than its content.
Reconstructing Medical Problem Solving Competence: MACCORD
Authors: Petkoff B. , Mannebach H. , Kirkby S. , Kraus D.
Published: March 2018

The building of medical knowledge-based systems involves the reconstruction of methodological principles and structures within the various subdomains of medicine. ACCORD is a general methodology of knowledge-based systems, and MACCORD its application to medicine. MACCORD represents the problem solving behavior of the medical expert in terms of various types of medical reasoning and at various levels of abstraction. With MACCORD the epistemic and cognitive processes in clinical medicine can be described in formal terminology, covering the entire diversity of medical reasoning. MACCORD is close enough to formalization to make a significant contribution to the fields of medical knowledge acquisition, medical didactics and the analysis and application of medical problem solving methods.
Ambulatory Recording and Power Spectral Analysis by Autoregressive Modelling of Polygraphic Sleep Signals in Patients Suffering from Chronic Pain
Authors: Drewes A.M. , Svendsen L. , Bjerregård K. , Taagholt S. , Nielsen K.D.
Published: March 2018

A portable digital recording system and the Nightingale sleep analyser have been applied to record polygraphical sleep signals in patients suffering from chronic pain. Using ambulatory recording the patient can sleep at home making the sleep more natural and reducing the costs. The recording system gives digital recordings of very good quality. It is shown that the Nightingale sleep analyser performs automatic sleep analysis with a quality comparable to visual interrater performance on disordered sleep. It furthermore provides means for extraction of spectral information useful for the description of the sleep-wakefulness processes and for diagnosing the sleep disorders. Using AR-model-based power spectral analysis, it is also shown that the power content in the alpha band relative to the delta power is significantly higher in patients suffering from non-specific chronic pain as compared to normal persons.
ARX Filtering of Single-Sweep Movement-Related Brain Macropotentials in Mono- and Multi-Channel Recordings
Authors: Liberati D. , Cerutti S. , Babiloni F. , Fattorini L. , Urbano A. , Capitanio L. , Filligoi G. C.
Published: March 2018

A technique of stochastic parametric identification and filtering is applied to the analysis of single-sweep event-related potentials. This procedure, called AutoRegressive with n exogenous inputs (ARXn), models the recorded signal as the sum of n+1 signals: the background EEG activity, modeled as an autoregressive process driven by white noise, and n signals, one of which represents a filtered version of a reference signal carrying the average information contained in each sweep. The other (n-1) signals could represent various sources of noise (i.e., artifacts, EOG, etc.). An evaluation of the effects of both artifact suppression and accurate selection of the average signal on mono- or multi-channel scalp recordings is presented.
Change in Impulse Response of Heart Rate to Instantaneous Lung Volume
Authors: Mizuta H. , Iida Y. , Saul J. P. , Cohen R. J. , Yana K.
Published: March 2018

A method is presented that relates the heart rate variability (HRV) to the change in instantaneous lung volume (ILV) under non-stationary conditions. Methods utilizing a recursive least squares (RLS) algorithm and a modified Widrow LMS algorithm are proposed to keep track of changes in impulse response of HRV to ILV. Results are presented of real data analysis and a dedicated system is proposed utilizing DSP chips for the real time data processing.
Interference Removal with an Improved Incremental Estimation Filter
Authors: Kors J. A.
Published: March 2018

Mains interference in digitized electrocardiographic signals is often removed with a nonlinear filter, the so-called incremental estimaton filter. A prerequisite for proper functioning of the filter is that the variation of the signal is considerably slower than that of the disturbing interference. This condition will often not be true, especially during wave deflections. As a result, the filter will not fully remove the interference when present, or, alternatively, it may generate a sine wave in the absence of interference. These effects are analyzed and different solutions proposed, one of which is the use of new, very simple filters based on the incremental estimation technique.
Microprocessor-Based Memory Device for Ambulatory Heart Rate and Physical Activity Recording
Authors: Makikawa M. , Imai K. , Shindoi T. , Tanooka K. , Iizumi H. , Mitani H.
Published: March 2018

Using microprocessor techniques, a portable digital memory device has been designed for the ambulatory monitoring of heart rate and physical activity. The device consists of a microprocessor, an ECG amplifier to record the heart rate and an accelerometerto detect the physical activity. This accelerometer is piezoresistive and is suitable for ambulatory physical activity recording, because this sensor requires low electrical power, has high durability and wide frequency response (DC~1.2 kHz). Changes in hearti rates and physical activity in daily life have been successfully recorded.
Non-invasive Ultrasonic Urination Sensor for Ambulatory Patient Support
Authors: Kodama H. , Hieda I. , Kuchinomachi Y. , Takeichi H. , Matsumoto H.
Published: March 2018

It is estimated that, in Japan, several million people suffer from urinary incontinence caused by, e.g., cerebrovascular disease, abdominal operations, spinal-cord damage, etc. Urinary incontinence is said to be a ‘hidden’ disease. When no adequate treatment is given, a serious situation may arise for both patients and their family. A non-invasive and unconstrained ultrasonic sensor has been designed enabling patients to discretely manage urination. The major problem of the sensor is how to maintain a proper irradiation angle to obtain an anteroposterior bladder diameter which corresponds to the actual bladder volume. Many types of ultrasonic probe holders have been tested and promising results have been obtained. The most practical, but as yet experimental, method is a four-element ultrasonic sensor, embedded in a flat probe.