bluuebunny/crossref_metadata_2025 huggingface dataset:
Empowering Patients: Total Product Life Cycle for Medical Devices
Authors: Ciarkowski Arthur A.
Published: February 2025

Patients today demand a stake in the care of their own health. The expectation is that patients who take responsibility for their own care will communicate more effectively with their health care team and be productive citizens in our society. Medical technology today and those products visible on the horizon, coupled in a telehealth network, provide promise to empower patients to participate fully in the management of their own health. Technology alone, however, will not integrate the elements required for an effective telehealth system. This chapter considers the non-technical matters of this issue such as trends in the medical device industry, trends in the point of care, public health care policies, and the role of government regulation, working together to achieve these public health goals.
Norms for Telematics in Health Care : Priorities in Belgium
Authors: Roger France F.H.  , Bangels M.
Published: February 2025

A Commission has been established by Royal Decree in order to make recommendations to Ministers of Social Affairs and Public Health in matters related to standards in telematics for the health care sector in Belgium. The present strategic plan has three priorities: (1) To obtain coherent information Systems allowing uniform data transfer between hospital and ambulatory care, using quality labels supported financially and taking in account long term archiving. (2) To develop secure and standardised communication Systems using electronic signature and standard messages in XML. The implementation of health professionals and patient identifiers is in progress. (3) To reinforce collaboration between health care services by using a health network prototype linked both to general practitioners and hospital institutions.
Architectural Decisions with Respect to the Introduction of PACS
Authors: Lodder H.  , Kalshoven M.  , Toussaint P.  , Zwetsloot-Schonk B.
Published: February 2025

In this paper we report on a study on the possible scenarios for the in- troduction of PACS that was conducted at the LUMC in 2002 by a workgroup. The results of this study should facilitate the decision on PACS to be taken by the management of the LUMC at a later stage. In this paper our main research question is to what extent the decisions to be made at the introduction of PACS can be derived from an information system architecture in place, and vice versa: how can these decisions help to refine an information system architecture that is still immature.
Trauma Team Training in a Distributed Virtual Emergency Room
Authors: Halvorsrud Ragnhild  , Hagen Simen  , Fagernes Siri  , Mjelstad Stig  , Romundstad Luis
Published: February 2025

A distributed simulation environment for training and evaluation of medical trauma teams is presented. Connected through the Internet, the geo-graphically remote team members can communicate and interact using the clinically realistic environment provided by the MATADOR simulator. The scenario demonstrates an injured person's arrival at the hospital, and the diagnostic and therapeutic challenges that must be met in order to stabilize the virtual patient. Experiences from a field trial indicate that the simulator is useful both for professionals and medical students.
Mixed Reality for Neurosurgery: A Novel Prototype
Authors: Alcañiz Raya Mariano  , Martinez Saez JoséMiguel  , Torres Sanchez Roque  , Juan Lizandra M. Carmen  , Monserrat Aranda Carlos  , Gil Gomez José Antonio
Published: February 2025

Microscopes and neuronavigators are often used in neurosurgical procedures. Our Mixed Reality prototype proposes to show neuronavigator imaging overlayed onto the surgical field of view. The proposal is to replace the traditional optical microscope with a digital one. The system is presented in this article. Firsts trials have been performed at the laboratory with satisfactory results.
A haptic sensor-actor-system based on ultrasound elastography and electro-rheological fluids for virtual reality applications in medicine
Authors: Khaled W.  , Ermert H.  , Bruhns O.  , Boese H.  , Baumann M.  , Monkman G.J.  , Egersdoerfer S.  , Meier A.  , Klein D.  , Freimuth H.
Published: February 2025

Mechanical properties of biological tissue represent important diagnostic information and are of histological relevance (hard lesions, “nodes” in organs: tumors; calcifications in vessels: arteriosclerosis). The problem is, that such information is usually obtained by digital palpation only, which is limited with respect to sensitivity. It requires intuitive assessment and does not allow quantitative documentation. A suitable sensor is required for quantitative detection of mechanical tissue properties. On the other hand, there is also some need for a realistic mechanical display of those tissue properties. Suitable actuator arrays with high spatial resolution and real-time capabilities are required operating in a haptic sensor actuator system with different applications. The sensor system uses real time ultrasonic elastography whereas the tactile actuator is based on electro- rheological fluids. Due to their small size the actuator array elements have to be manufactured by micro-mechanical production methods. In order to supply the actuator elements with individual high voltages a sophisticated switching and control concept have been designed. This haptic system has the potential of inducing real time substantial forces, using a compact lightweight mechanism which can be applied to numerous areas including intraoperative navigation, telemedicine, teaching, space and telecommunication.
A Haptic Needle Manipulation Simulator for Chinese Acupuncture
Authors: Leung Ka-Man  , Heng Pheng-Ann  , Sun Hanqiu  , Wong Tien-Tsin
Published: February 2025

Chinese acupuncture is a traditional medical treatment in Chinese history. Recent evidence shows that this treatment is effective. However, acupuncture students can only practice on either real patients or mannequin. In this project, we propose a virtual reality training system for acupuncture. The system not just provides 3D stereo display, but also realistic haptic feedback in real-time. Since acupuncture usually in- volves thrust-and-lift needle motion, we also propose a bi-directional haptic model to tailor this application. Our results show that the novel haptic model confirms with practitioners' tactile experience.
A collaborative platform for consensus sessions in pathology over Internet
Authors: Zapletal Eric  , Le Bozec Christel  , Degoulet Patrice  , Jaulent Marie-Christine
Published: February 2025

The design of valid databases in pathology faces the problem of diagnostic disagreement between pathologists. Organizing consensus sessions between experts to reduce the variability is a difficult task. The TRIDEM platform addresses the issue to organize consensus sessions in pathology over the Internet. In this paper, we present the basis to achieve such collaborative platform. On the one hand, the platform integrates the functionalities of the IDEM consensus module that alleviates the consensus task by presenting to pathologists preliminary computed consensus through ergonomic interfaces (automatic step). On the other hand, a set of lightweight interaction tools such as vocal annotations are implemented to ease the communication between experts as they discuss a case (interactive step). The architecture of the TRIDEM platform is based on a Java-Server-Page web server that communicate with the ObjectStore PSE/PRO database used for the object storage. The HTML pages generated by the web server run Java applets to perform the different steps (automatic and interactive) of the consensus. The current limitations of the platform is to only handle a synchronous process. Moreover, improvements like re-writing the consensus workflow with a protocol such as BPML are already forecast.
Pragmatic Objects Modeling Environment for Electronic Health Records Systems
Authors: Ruelland Alan  , Jaulent Marie-Christine  , Ota Mario  , Frandji Bruno  , Degoulet Patrice
Published: February 2025

Customizable shared Electronic Health Care Records require new mechanisms to dynamically generate user defined objects. An object model based on a semantic network of concepts has been implemented (pragmatic database model). This model offers an easier way to represent “archetypes” of user objects including the concepts, their relationships and the specific organization and representation of the associated knowledge that are necessary to model the context of production of record elements. The aim of this paper is the presentation of this framework and its implementation in an online electronic health record system using Java Web Services technologies. A web-based registry on tobacco was implemented according to this framework and is today daily used in 150 tobacco addiction centers.
Delineation of drain Structures from Positron Emission Tomography Images with Deformable Models
Authors: Mykkänen Jouni  , Tohka Jussi  , Ruotsalainen Ulla
Published: February 2025

Segmentation of positron emission tomography (PET) images is a difficult task. In this study, we propose a new method for delineation of brain structures according to the tracer uptake. The method is based on a new deformable model which is particularly designed for extracting surfaces automatically from noisy images. The automation is achieved by using a global optimization algorithm for minimizing the energy of the deformable model. As an example, the coarse cortical structure was extracted from FDG PET brain images by delineating first the brain surface and then the white matter surface. We have tested the method with the image of the brain phantom and images from a small number (N=17) of FDG brain studies. The cortical structure was automatically and reliably found from all the images. The proposed method provides new opportunities for automatic and repeatable structure extraction applicable for regional quantification of the tracer uptake.
PropeR revisited
Authors: van der Linden Helma  , Tange Huibert  , Talmon Jan  , Hasman Arie
Published: February 2025

The PropeR EHR is a multidisciplinary EHR system that is built using existing open source components. This paper discusses the implementation of this system and the advantages and challenges encountered when using open source components.
Using Cross-Lingual Information to Cope with Underspecification in Formal Ontologies
Authors: Ceusters Werner  , Desimpel Ignace  , Smith Barry  , Schulz Stefan
Published: February 2025

Description logics and other formal devices are frequently used as means for preventing or detecting mistakes in ontologies. Some of these devices are also capable of inferring the existence of inter-concept relationships that have not been explicitly entered into an ontology. A prerequisite, however, is that this information can be derived from those formal definitions of concepts and relationships which are included within the ontology. In this paper, we present a novel algorithm that is able to suggest relationships among existing concepts in a formal ontology that are not derivable from such formal definitions. The algorithm exploits cross-lingual information that is implicitly present in the collection of terms used in various languages to denote the concepts and relationships at issue. By using a specific experimental design, we are able to quanta the impact of cross-lingual information in coping with underspecification in formal ontologies.
A Novel View on Information Content of Concepts in Extremely Large Ontologies
Authors: Van Buggenhout Carl  , Ceusters Werner
Published: February 2025

Semantic distance and semantic similarity are two important information retrieval measures used in word sense disambiguation as well as for the assessment of how relevant concepts are with respect to the documents in which they are found A variety of calculation methods have been proposed in the literature, whereby methods taking into account the information content of an individual concept outperform those that don’t. In this paper, we present a novel recursive approach to calculate a concept's information content based on the information content of the concepts to which it relates. The method is applicable to extremely large ontologies containing several million concepts and relationships amongst them. It is shown that a concept’s information content as calculated by this method provides additional information with respect to an ontology that cannot be approximated by hierarchical edge-counting or human insight. In addition, it is suggested that the method can be used for quality control within large ontologies.
Method for Automatic Management of the Semantic Network Ambiguity in the UMLS : Possible Application for Information Retrieval on the Web
Authors: Mary Vincent  , Le Duff Franck  , Mougin Fleur  , Le Beux Pierre
Published: February 2025

The Unified Medical Language System (UMLS) is an extensive collection of terms and concepts. The UMLS includes biomedical terms from standard classifications. The semantic network (SN) links the concepts, sometimes ambiguously. In this paper we try, on one hand to describe the relationship between concepts more efficiently and on the other hand to find new relationships. Assuming that re-usability and automatic extraction of knowledge from existing thesaurus enables an improvement of the metathesaurus, we cross the SN with linked concepts from the ADM (Assisted Medical Diagnosis). Results are presented and our discussion concerns firstly the use of the SN only; secondly the improvement that allows pre-selection of linked concepts, and thirdly the possibility to coincide with other developments that improve the metathesaurus.
Quality assurance and certification of Health IT-systems communicating data in primary and secondary health sector
Authors: Johansen Ib  , Henriksen Gitte  , Demkjær Karin  , Jensen Henrik Bjerregaard  , Jørgensen Lisbeth
Published: February 2025

Each year more than 70 % (25 mill) of all electronic health documents between secondary and primary health sector in Denmark are exchanged electronically using European EDI standards. Despite this widely use there have been several problems in showing the transferred data in correct and full context. These problems are solved in the 3 years MedCom certification and consolidation project.
Documenting Nursing Practice by Using ICNP on the Web
Authors: Liaskos Joseph  , Mantas John
Published: February 2025

This paper presents the design and implementation of an internet based nursing care planning system which helps nursing professionals and students to study ICNP beta 2 version and to create nursing diagnoses, interventions and outcomes by selecting relevant terms from ICNP. This advanced web-based ICNP browser enables the authentication of the user, and the creation of a type of nursing care plan through the use of ICNP. It provides different ways for creating nursing diagnoses, interventions and outcomes, by selecting relevant ICNP terms through the tree-structure view, index and search components of the tool. The created diagnoses, interventions and outcomes are stored to a secured database. The system provides to the user the facility to build and manage nursing care plans by using both the English and the translated Greek ICNP versions. The first results of the implementation of this internet based nursing care planning system are presented
About the Language of Hungarian Discharge Reports
Authors: Surján György  , Héja Gergely
Published: February 2025

Concerning use of terminological systems translated to any particular language or computer assisted translation of patient records the daily medical language has to be taken into account rather than the pure academic language. The aim of this study to investigate the language of the diagnoses of the Hungarian hospital discharge reports. Word of a collection of discharge diagnoses were categorised according to the language and form (normal words, abbreviations, acronyms). It was found that Latin is still a dominant, but the language is rather a mixture, where local jargon, non standardised abbreviations occur frequently. Some signs show, that discharge reports are not used primarily as a tool of communication of physicians, rather serve local administrative purposes.
Italian Telematics Initiatives and Achievements
Authors: Pinciroli Francesco
Published: February 2025

Depending on their legislation, the European countries have different telematics initiatives and different scenarios. Cultural roots cause differences even within a country or a region, and different organisational structures can cause further problems. With regard to the Italian telematics approach, the author intends to explain the basis and the main achievements in Italy and especially in the Lombaria region.
Java™-based Open Platform for Distributed Health Telematics Applications
Authors: Hoepner Petra  , Eckert Klaus-Peter
Published: February 2025

Within the European HARP project, a Java™-based Open Platform has been specified and implemented to support trustworthy distributed applications for health. Emphasis was put on security services for enabling both communication and application security. The Open Platform is Web-based and comprises the Client environment, Web/Application server, as well as Database and Archive servers. Servlets composed and executed according to the user’s authorisation create signed XML messages. From those messages, user-role-related applets are generated. The technical details of the realisation are presented. Possible future enhancements for user-centric, adaptable services based on next-generation mobile service environments are outlined.
Interactive Haptic Modeling of Colon and Colonoscope
Authors: Ahn Woo Jin  , Lee Doo Yong
Published: February 2025

This paper presents physics-based modeling for colonoscopy training simulator. The colon is modeled as a chain of beam along the medial axis for global bending motions. The Timoshenko’s beam theory is applied to the centerline of colon extracted from a medical image. The stiffness matrix of colon is formulated using the finite element method. The colonoscope model consists of rigid elements connected with torsional spring and damper. This modeling allows global bending motions to be simulated in real time.
Effect of Sensory Substitution on Suture Manipulation Forces for Surgical Teleoperation
Authors: Kitagawa Masaya  , Dokko Daniell  , Okamura Allison M.  , Bethea Brian T.  , Yuh David D.
Published: February 2025

Bilateral telemanipulation, which applies haptic feedback to the operator, is not yet available in most commercial robot-assisted surgical systems. We have shown in previous work that the lack of haptic (force or tactile) feedback is detrimental in applications requiring fine suture manipulation. In this paper, we study the effect of substituting direct haptic feedback with visual and auditory cues. Using the da Vinci robot from Intuitive Surgical, we observed the difference between applied forces during a knot tying procedure for four different sensory feedback substitution scenarios: no feedback, auditory feedback, visual feedback, and a combination of auditory and visual feedback. Our results indicate that visual feedback, which provides continuous force information, would improve robotassisted performance during complex surgical tasks such as knot tying with fine sutures. Discrete auditory feedback gives additional useful support to the surgeon.
THUMP: An Immersive Haptic Console for Surgical Simulation and Training
Authors: Niemeyer Günter  , Kuchenbecker Katherine J.  , Bonneau Raymond  , Mitra Probal  , Reid Andrew M.  , Fiene Jonathan  , Weldon Grant
Published: February 2025

Telerobotic systems are revolutionizing minimally invasive surgery (MIS), giving the surgeon complete control over precise dexterous movements of tiny robotic instruments. Such ‘surgery-by-wire’ approaches also create unique opportunities for simulation and training, as the surgeon operates at a computer-mediated haptic console. Possible extensions include offline training in simulated environments and advanced guidance and mentoring during actual operations. To explore these options and further improve telerobotic interfaces, we have constructed a two-handed, fully articulating haptic console that provides force and torque feedback as well as a stereoscopic display.
Novel Force Resolver Designs for a Haptic Surgery Simulator
Authors: Zivanovic Aleksandar  , Dibble Edward  , Davies Brian
Published: February 2025

This paper presents the results of an investigation into the design of low cost, four degree of freedom force/torque resolvers for use in compact haptic devices for surgical training. Two designs using piezo-resistive sensors are described and one using strain gauges. The advantages and disadvantages of each approach are stated and conclusions presented.
Real-time synchronization of kinematic and video data for the comprehensive assessment of surgical skills
Authors: Dosis Aristotelis  , Bello Fernando  , Moorthy Krishna  , MÜNz Yaron  , Gillies Duncan  , Darzi Ara
Published: February 2025

Surgical dexterity in operating theatres has traditionally been assessed subjectively. Electromagnetic (EM) motion tracking systems such as the Imperial College Surgical Assessment Device (ICSAD) have been shown to produce valid and accurate objective measures of surgical skill. To allow for video integration we have modified the data acquisition and built it within the ROVIMAS analysis software. We then used ActiveX 9.0 DirectShow video capturing and the system clock as a time stamp for the synchronized concurrent acquisition of kinematic data and video frames. Interactive video/motion data browsing was implemented to allow the user to concentrate on frames exhibiting certain kinematic properties that could result in operative errors. We exploited video-data synchronization to calculate the camera visual hull by identifying all 3D vertices using the ICSAD electromagnetic sensors. We also concentrated on high velocity peaks as a means of identifying potential erroneous movements to be confirmed by studying the corresponding video frames. The outcome of the study clearly shows that the kinematic data are precisely synchronized with the video frames and that the velocity peaks correspond to large and sudden excursions of the instrument tip. We validated the camera visual hull by both video and geometrical kinematic analysis and we observed that graphs containing fewer sudden velocity peaks are less likely to have erroneous movements. This work presented further developments to the well-established ICSAD dexterity analysis system. Synchronized real-time motion and video acquisition provides a comprehensive assessment solution by combining quantitative motion analysis tools and qualitative targeted video scoring.
Technological Background of VR
Authors: Alcañiz Mariano  , Lozano José Antonio  , Rey Beatriz
Published: February 2025

User interface (UI) design is a critical component of any virtual environment (VE) application, and especially for VE applied to medicine. User interfaces for VE are becoming more diverse. Mice, keyboards, windows, menus, and icons - the standard parts of traditional WIMP interfaces- are still prevalent, but nontraditional devices and interface components are proliferating rapidly. These include spatial input devices such as trackers, 3-D pointing devices, and whole-hand devices allowing gestural input. Three-dimensional, multisensory output technologies -such as stereoscopic projection displays, head-mounted displays (HMDs), spatial audio systems, and haptic devices- are also becoming more common. In this chapter we present a brief overview of 3-D interaction and user interfaces technologies for VE.
The use of VR in the treatment of panic disorders and agoraphobia
Authors: Botella Cristina  , Villa Helena  , Garcia-Palacios Azucena  , Quero Soledad  , Banos Rosa M.  , Alcaniz Mariano
Published: February 2025

Panic disorder with agoraphobia (PDA) is considered an important public health problem [1-3]. The efficacy of cognitive-behavioral therapy (CBT) for PDA has been widely demonstrated [4, 5]. The American National Institute of Health [6] recommended Cognitive-Behavioral programs as the treatment of choice for this disorder. This institution also recommended that researchers develop treatments whose mode of delivery increases the availability of these programs. Virtual Reality based treatments can help to achieve this goal. VR has several advantages compared with conventional techniques. One of the essential components to treat these disorders is exposure. In VR the therapist can control the feared situations at will and with a high degree of safety for the patient, as it is easier to grade the feared situations. Another advantage is that VR is more confidential because treatment takes place in the therapist's office. It is also less time consuming as it takes place in the therapist's office. Considering the wide number of situations and activities that agoraphobic patients use to avoid, VR can save time and money significantly. Another advantage in treating PDA using VR is the possibility of doing VR interoceptive. VR could be a more natural setting for interoceptive exposure than the consultation room because we can elicit bodily sensations while the patient is immerse in VR agoraphobic situations. Finally, we think that VR exposure can be a useful intermediate step for those patients who refuse in vivo exposure because the idea of facing the real agoraphobic situations is too aversive for them.
Non-Compliance with Guidelines: Motivations and Consequences in a case study
Authors: Quaglini Silvana  , Ciccarese Paolo  , Micieli Giuseppe  , Cavallini Anna
Published: February 2025

Guidelines are often based on a mixture of evidence-based and consensus-based recommendations. It is not straightforward that providing a series of “good” recommendations result in a guideline that is easily applicable, and it is not straightforward that acting according to such recommendations leads to an effective and efficient clinical practice. In this paper we summarize our experience in evaluating both the usability and the impact of a guideline for the acute/subacute stroke management. A computerised version of the guideline has been implemented and linked to the electronic patient record. We collected data on 386 patients. Our analysis highlighted a number of non-compliances. Some of them can be easily justified, while others depend only on physician resistance to behavioural changes and on cultural biases. From our results, health outcomes and costs are related to guideline compliance: a unit increase in the number of non-compliance results in a 7% increase of mortality at six months. Patients treated according to guidelines showed a 13% increase in treatment effectiveness at discharge, and an average cost of 2929 $\euro$ vs 3694 $\euro$ for the others.
Robotic Technology Applied to Meet the Requirements of Tools to Support Microsurgery and Cellular Surgery
Authors: Brett Peter  , Ma Xianghong  , Tritto Giuseppe
Published: February 2025

Microsurgery and processes involving cell manipulation or cell surgery are clinical practices where the operator works at or beyond the threshold of human dexterity. Current tools available are conventional in their design, and this limits consistency and the level of reliability and achievement. Surgical robotic devices have been explored to improve precision in minimal access surgical procedures to augment control of tool points in tissues, and have enabled feedback of sensory data from which the operator is able to deduce information on the tool at the working site. In this paper, relevant technologies are described that can be harnessed to improve perception of tool point interaction with tissues at the working site and to improve tool control at the small scale required in clinical practice for microsurgery and for cell surgery.
EARLY DETECTION OF SKIN CANCER (EDISCIM)$^{\ast}$ THROUGH THE USE OF NON-INVASIVE CONFOCAL IMAGING
Authors: Eberhardt C  , Percy S.R.  , Brânzan A.L.  , Bäumler W.  , Szeimies R.-M.  , Calzavara-Pinton P  , Venturini M  , Sala R.  , Adelh D
Published: February 2025

In the past 15 years the number of malignant melanomas and non-melanoma skin cancer, (i.e. squamous cell carcinoma, basal cell carcinoma), have increased dramatically throughout the whole world, in particular among people with white skin. For example, in Germany the number of new cases of melanoma is about 10 to 12 per 100,000 people, (for basal cell carcinoma as a non-melanoma skin cancer 140 per 100,000), the absolute number of annual new cases of melanoma is an estimated 9,000 to 10,000, and the increasing rate is 5 to 10%.
The French Language Virtual Medical University
Authors: Morin A.  , Benhamou A.C.  , Spector M.  , Bonnin A.  , Debry C.
Published: February 2025

The work program of the French Language Virtual Medical University started about 2 years ago, and entered into a real active phase of development and implementation in 2002. Various national programs and organizational initiatives should accelerate and facilitate further appropriation of modern pedagogical approaches by knowledge providers and all users of the FSVMU, so as to advance on the way of virtual education.
MobiHealth: Ambulant Patient Monitoring Over Next Generation Public Wireless Networks
Authors: Van Halteren Aart  , Konstantas Dimitri  , Bults Richard  , Wac Katarzyna  , Dokovsky Nicolai  , Koprinkov George  , Jones Val  , Widya Ing
Published: February 2025

The wide availability of high bandwidth public wireless networks as well as the miniaturisation of medical sensors and network access hardware allows the development of advanced ambulant patient monitoring systems. The MobiHealth project developed a complete system and service that allows the continuous monitoring of vital signals and their transmission to the health care institutes in real time using GPRS and UMTS networks. The MobiHealth system is based on the concept of a Body Area Network (BAN) allowing high personalization of the monitored signals and thus adaptation to different classes of patients. The system and service has been trialed in four European countries and for different patient cases. First results confirm the usefulness of the system and the advantages it offers to patients and medical personnel.
E-Health Tools and Social Workers
Authors: Parker Oliver Debra  , Demiris George
Published: February 2025

Social workers have been using telemedicine technologies since the late 1950's. The use of telemedicine has been most common in mental health practice. Psychotherapy using telephones, interactive video and more recently the Internet have gained in popularity with social workers in these settings. However, the use of e-health tools in medical social work is limited and worthy of further investigation. This paper will report promising projects with medical social workers and discuss the potential application of e-health tools for these practitioners. The purpose of the paper is to advocate for research measuring effectiveness of e-health interventions in social work practice.
The RODS Open Source Project: Removing a Barrier to Syndromic Surveillance
Authors: Espino Jeremy U.  , Wagner Michael M.  , Tsui Fu-Chang  , Su Hoah-Der  , Olszewski Robert T.  , Liu Zhen  , Chapman Wendy  , Zeng Xiaoming  , Ma Lili  , Lu Zhong Wei  , Dara Jagan
Published: February 2025

The goal of the Real-time Outbreak and Disease Surveillance (RODS) Open Source Project is to accelerate deployment of computer-based syndromic surveillance. To this end, the project has released the RODS software under the GNU General Public License and created an organizational structure to catalyze its development. This paper describes the design of the software, requested extensions, and the structure of the development effort.
Convergence on a Standard for Representing Clinical Guidelines: Work in Health Level Seven
Authors: Jenders Robert A.  , Sailors R. Matthew
Published: February 2025

Concern regarding patient safety and practice variation has focused attention on clinical guidelines as a way of influencing the behavior of health care providers in order to improve patient outcomes. Despite the abundant number of guidelines produced, their use has been limited, in part because the necessary knowledge is relatively inaccessible at the point of care.
Cancer-related Complementary and Alternative Medicine Online: Factors Affecting Information Retrieval
Authors: Walji Muhammad  , Sagaram Smitha  , Meric-Bernstam Funda  , Johnson Craig  , Bernstam Elmer
Published: February 2025

Cancer patients increasingly turn to the Internet for health information. As the use of complementary and alternative medicine (CAM) is also increasing, we studied the likelihood that consumers will incidentally encounter CAM information while searching the Internet and the factors that influence CAM information retrieval. We evaluated results retrieved from ten cancer-related searches in six common search engines, and found that 16.2% of 1121 results contained CAM information. Sponsored (i.e. paid) results contained more CAM information than non-sponsored results (38% vs. 7.5%, p<0.001). Sponsored results in the Overture and Google search engines accountedfor 51% and 39% of results on the first page. These search engines also retrieved the most CAM web pages. The type of cancer used as the search keyword did not influence the number of CAM-related web pages retrieved. However, the synonyms of cancer used as search keywords differed in their retrieval of CAM web pages (p<0.001). We conclude that clinicians should help consumers recognize sponsored listings and encourage search engines to clearly identify sponsored results.
Actions in Health Care Organizations: An Ontological Analysis
Authors: Vizenor Lowell
Published: February 2025

In order to ensure that the information and knowledge needed for the management of healthcare is appropriately shared, human behavior within health care organizations (HCOs) needs to be carefully analyzed. Hence, guidelines, protocols, and messaging standards must be combined with models of resources and processes of patient care that are based on a sound ontology of organizations. This requires a general theory of the ontology of social institutions. Among the many groups attempting to develop efficient ways of sharing information across healthcare systems and organizations is Health Level 7 (HL7). Here I address the question whether HL7 reflects a sound analysis of behavior within HCOs on the basis of a sound ontology of organizations. I then apply ontological principles designed to show how the Reference Information Model (RIM) might be modified in such a way as to support efficient communication of medical information within and between healthcare organizations.
PubMed on Tap: Discovering Design Principles for Online Information Delivery to Handheld Computers
Authors: Hauser Susan E.  , Demner-Fushman Dina  , Ford Glenn  , Thoma George R.
Published: February 2025

Online access to biomedical information from handheld computers will be a valuable adjunct to other popular medical applications if information delivery systems are designed with handheld computers in mind. The goal of this project is to discover design principles to facilitate practitioners' access to online medical information at the point-of-care. A prototype system was developed to serve as a testbed for this research. Using the testbed, an initial evaluation has yielded several user interface design principles. Continued research is expected to discover additional user interface design principles as well as guidelines for results organization and system performance.
An Ethnographic Study of Collaborative Clinical Trial Protocol Writing
Authors: Gennari John H.  , Weng Chunhua  , McDonald David W.  , Benedetti Jacqueline  , Green Stephanie
Published: February 2025

Clinical trial protocol documents play an important role in clinical research. However, clinical protocol writing remains a complex and relatively un-studied process. Protocols are often written by teams of people, yet little prior research has captured the problems or analyzed the collaboration support needs of protocol writers. Here we present the results of an initial ethnographic study into the clinical trial protocol writing processes at a representative cooperative clinical trial group funded by National Cancer Institute (NCI). We analyzed the collaborative nature of the writing process, identified common problems, derived information and communication support needs of collaborative clinical protocol writers, and provided recommendations to streamline the process. We believe that this paper contributes useful implications for the design of future collaborative clinical protocol writing tools.
Development of computerized guidelines for the management of chronic diseases allowing to position any patient within recommended therapeutic strategies
Authors: Séroussi Brigitte  , Bouaud Jacques  , Chatellier Gilles  , Venot Alain
Published: February 2025

Chronic diseases are complex to manage. One reason comes from the difficulty to synchronize a patient's therapeutic history with the guideline-based sequence of treatments. We represent guideline knowledge as a two-level decision tree, a clinical level describing theoretical clinical situations and a therapeutic level formalizing the different steps of corresponding recommended therapeutic strategies. Guideline-based strategies are first represented as bidimensional matrices structured in lines of therapy and levels of therapeutic intention. A revised version introducing levels of therapeutic combination is then developed. The therapeutic level is operationalized for any patient therapeutic history to provide the next best step of treatment. Evaluated on actual patient records, our system proved to impact physicians' decisions in 78% of the cases and led to a significant improvement of their compliance with recommendations.
Description and Status Update on GELLO: a Proposed Standardized Object-Oriented Expression Language for Clinical Decision Support
Authors: Sordo Margarita  , Boxwala Aziz A.  , Ogunyemi Omolola  , Greenes Robert A.
Published: February 2025

A major obstacle to sharing computable clinical knowledge is the lack of a common language for specifying expressions and criteria. Such a language could be used to specify decision criteria, formulae, and constraints on data and action. Although the Arden Syntax addresses this problem for clinical rules, its generalization to HL7's object-oriented data model is limited.
Knowledge Management in Pediatric Pain: Mapping On-Line Expert Discussions to Medical Literature
Authors: Abidi Syed Sibte Raza  , Finley Allen  , Milios Evangelos  , Shepherd Michael  , Zitner David
Published: February 2025

Clinical decision-making can be vastly improved with the availability of the right medical knowledge at the right time. This concept paper presents a knowledge management research program to (a) identify, capture and organize the tacit knowledge inherent within on-line problem-solving discussions between pediatric pain practitioners; (b) establish linkages between topic-specific pediatric pain discussions and corresponding published medical literature on children's pain available at PubMed–i.e. linking tacit expert knowledge to explicit medical literature; and (c) make these knowledge resources available to pediatric pain practitioners via the WWW for timely access to various modalities of clinical knowledge.
Kaiser Permanente's Convergent Medical Terminology
Authors: Dolin Robert H.  , Mattison John E.  , Cohn Simon  , Campbell Keith E.  , Wiesenthal Andrew M.  , Hochhalter Brad  , Laberge Diane  , Barsoum Rita  , Shalaby James  , Abilla Alan  , Clements Robert J.  , Correia Carol M.  , Esteva Diane  , Fedack John M.  , Goldberg Bruce J.  , Gopalarao Sridhar  , Hafeza Eza  , Hendler Peter  , Hernandez Enrique  , Kamangar Ron  , Khan Rafique A.  , Kurtovich Georgina  , Lazzareschi Gerry  , Lee Moon H.  , Lee Tracy  , Levy David  , Lukoff Jonathan Y.  , Lundberg Cyndie  , Madden Michael P.  , Ngo Trongtu L.  , Nguyen Ben T.  , Patel Nikhilkumar P.  , Resneck Jim  , Ross David E.  , Schwarz Kathleen M.  , Selhorst Charles C.  , Snyder Aaron  , Umarji Mohamed I.  , Vilner Max  , Zer-Chen Roy  , Zingo Chris
Published: February 2025

This paper describes Kaiser Permanente’s (KP) enterprise-wide medical terminology solution, referred to as our Convergent Medical Terminology (CMT). Initially developed to serve the needs of a regional electronic health record, CMT has evolved into a core KP asset, serving as the common terminology across all applications. CMT serves as the definitive source of concept definitions for the organization, provides a consistent structure and access method to all codes used by the organization, and is KP's language of interoperability, with cross-mappings to regional ancillary systems and administrative billing codes.
Evaluation of Reliability in the Use of Endoscopic Terminology
Authors: Logan Judith R.  , Mccashland Timothy  , Lieberman David A.
Published: February 2025

Variability in the reporting of gastrointestinal endoscopic findings may affect the validity of analyses of data collected from clinical reports of those findings. In this project, images of 10 endoscopic findings were collected from the data repository of the Clinical Outcomes Research Initiative (CORI), all of which had been described by the reporting endoscopist. These images were presented to 52 experienced endoscopists recruited from the clinical affiliates of CORI who were asked to assign each a term from the Minimal Standard Terminology for Digestive Endoscopy. Proportion of agreement with the endoscopist varied by finding from 84.3% to 51.0% (overall 67.6% with 95% CI 63.4-71.8%). Proportion of agreement among the subjects varied by finding from 76.3% to 38.5%. (overall 55.6% with 95% CI 52.4-58.8%). Possible reasons for this lack of agreement are discussed.
A Corpus Driven Approach Applying the “Frame Semantic” Method for Modeling Functional Status Terminology
Authors: Ruggieri Alexander P.  , Pakhomov Serguei V.  , Chute Christopher G.
Published: February 2025

In an effort to unearth semantic models that could prove fruitful to functional-status terminology development we applied the “frame semantic” method, derived from the linguistic theory of thematic roles currently exemplified in the Berkeley “FrameNet” Project. Full descriptive sentences with functionalstatus conceptual meaning were derived from structured content within a corpus of questionnaire assessment instruments commonly used in clinical practice for functional-status assessment. Syntactic components in those sentences were delineated through manual annotation and mark-up. The annotated syntactic constituents were tagged as frame elements according to their semantic role within the context of the derived functionalstatus expression. Through this process generalizeable “semantic frames” were elaborated with recurring “frame elements”. The “frame semantic” method as an approach to rendering semantic models for functional-status terminology development and its use as a basis for machine recognition of functional status data in clinical narratives are discussed.
A surgeon can operate or approach a complicated integral calculus instead of a renal one: Implications for conceptual and lexical semantic disambiguation.
Authors: Jacquelinet Christian
Published: February 2025

This paper approaches lexical semantic disambiguation and polysemy in the context of medical language understanding. These issues have been addressed as linguistic and cognitive requirements to build a knowledge extraction tool that turns natural language input into conceptual graphs. Previous results obtained with semantic analysis of medical terms in the domain of transplantation and organ failure prompt us to check the capabilities of our prototype to deal with ambiguities and polysemy. We attempt to demonstrate how the respect of ambiguities when the co-text is not sufficient for disambiguation implies to introduce a void type in the concept type lattice. Then we show how the “creative use of words” imposes to dynamically allocate type, categories and roles with the co-text.
A Comparative Study on Concept Representation between the UMLS and the Clinical Terms in Korean Medical Records
Authors: Han Seung-Bin  , Kwak Miyoung  , Kim Seunghee  , Yoo Sooyoung  , Park Heekyung  , Kijoo Jeun  , Kim Jeapil  , Choi Myoungsun  , Choi Jinwook
Published: February 2025

The Unified Medical Language System (UMLS) is a rich source of knowledge in the biomedical domain. In this paper, we evaluated the coverage of UMLS as compared with Korean medical terms and identified differences in concept representation between two vocabulary sets. We measured the concept coverage by mapping clinical terms extracted from the discharge records of Seoul National University Hospital (SNUH) and the UMLS ‘Sign or Symptom’ and ‘Disease or Syndrome’ concepts. Thirtyfive percent of the complaints in the SNUH were conceptually matched with the UMLS ‘Sign or Symptom’ concept. Fifty-eight percent were found to be matched with the UMLS Disease or Syndrome’ concept rather than the ‘Sign or Symptom’ concept. The remaining seven percent were not found in the UMLS concepts mapped above or those terms that used to special circumstances of a tertiary hospital in Korea. We then analyzed some of different expression patterns used by the two vocabulary sets and addressed issues to be taken into consideration.
Automatic Generation of Repeated Patient Information for Tailoring Clinical Notes
Authors: Meng Frank  , Taira Ricky K.  , Bui Alex A. T.  , Kangarloo Hooshang  , Churchill Bernard M.
Published: February 2025

Dictating clear, readable, and accurate clinical notes can be a time-consuming task for physicians. Clinical notes often contain information concerning the patient’s medical history and current medical condition which is propagated from one clinical note to all follow-up clinical notes for the same patient. In this paper, we present a system which, given a clinical note, automatically determines what information should be repeated, and then generates this information for the physician for a new clinical note. We use semantic patterns for capturing the rhetorical category of sentences, which we show to be useful for determining whether the sentence should be repeated. Our system is shown to perform better than a baseline metric based on precision/ recall results. Such a system would allow clinical notes to be more complete, timely, and accurate.
Content-Based Image Retrieval for Large Biomedical Image Archives
Authors: Antani Sameer  , Long L. Rodney  , Thoma George R.
Published: February 2025

Content-Based Image Retrieval (CBIR) has been a topic of research interest for nearly a decade. Approaches to date use image features for describing content. A survey of the literature shows that progress has been limited to prototype systems that make gross assumptions and approximations. Additionally, research attention has been largely focused on stock image collections. Advances in medical imaging have led to growth in large image collections. At the Lister Hill National Center for Biomedical Communication, an R&D division of the National Library of Medicine, we are conducting research on CBIRfor biomedical images. We maintain an archive of over 17,000 digitized x-rays of the cervical and lumbar spine from the second National Health and Nutrition Examination Survey (NHANES II). In addition, we are developing an archive of a large number of digitized 35mm color slides of the uterine cervix. Our research focuses on developing techniques for hybrid text/image query-retrieval from the survey text and image data. In this paper we present the challenges in developing CBIR of biomedical images and results from our research efforts.