bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Language Processing applied to extract clinical information from Dutch medical documents
Authors: Spyns Peter  , Nhàn Ngô Thanh  , Baert Erik  , Sager Naomi  , De Moor Georges
Published: February 2025

In this paper, we want to show how an existing morpho-syntactic analyser for Dutch (Dutch Medical Language Processor - DMLP) has been extended in order to produce output that is compatible with the language independent modules of the LSPMLP system (Linguistic String Project - Medical Language Processor) of the New York University. The former can focus on idiosyncrasies for Dutch and take advantage of the language independent developments of the latter. This general strategy will be illustrated by a practical application, namely the extraction of clinical information from Dutch patient discharge summaries. Such an application can be of use for education, research and quality control purposes in a hospital environment.
Using Multimedia Virtual Patients to Enhance the Clinical Curriculum for Medical Students
Authors: McGee James B.  , Neill Jane  , Goldman Leon  , Casey Edward
Published: February 2025

Changes in the environment in which clinical medical education takes place in the United States has profoundly affected the quality of the learning experience. A shift to out-patient based care, minimization of hospitalization time, and shrinking clinical revenues has changed the teaching hospital or “classroom” to a degree that we must develop innovative approaches to medical education. One solution is the Virtual Patient Project. Utilizing state-of-the-art computer-based multimedia technology, we are building a library of simulated patient encounters that will serve to fill some of the educational gaps that the current health care system has created.
Curriculum Development and Courseware Implementation Using World Wide Web technology
Authors: Mantas John  , Diomidus Marianna
Published: February 2025

The curriculum development of medical informatics related courses and their adoption into the faculty curriculum is one of the main tasks of the present day educators. To this end the Internet technology has supported this task. The Internet was born in December of 1969 and has grown phenomenally since. Its graphically interactive, user-friendly modality, the World Wide Web (WWW), is younger and growing even more explosively. By its nature, the WWW is a tool ideally and uniquely suited for the advancement education. This paper describes the design, development and the implementation ofa Web Site for supporting the education of the students in the Facuity of Nursing at the University of Athens. The application will be used also in the European project Nightingale.
Concepts of a Web-based Open Distributed Textbook for the Multimodal Diagnostics of Gastrointestinal Tumours with MRI, CT and Video-endoscopy Addressing Students of Medicine and Students of Medical Informatics as two Different Target Groups
Authors: Horsch A.  , Hellerhoff P.  , Hogg M.  , Ahlbrink H.  , Balbacha T.  , Liß T.  , Minov K.  , Gerhardt P.
Published: February 2025

Multimodal diagnostics of gastrointestinal tumours with MRI, CT and video-endoscopy is a rapidly changing domain. The education at our universities should overcome the obstacles of traditional learning based on paper media and oral lectures with retention rates of 10-30% only. The paper presents the objectives and the results of the design phase of the project ODITEBl - Open Distributed TExt Book, for Computer-Assisted Instruction in the domain mentioned above. The main objective is to produce an electronic interactive textbook in order to shift education to more efficient learning settings with higher retention rates. The main concepts are 1) three-layer architecture (dynamic case layer, intermediate query layer, static instruction layer) 2) case pool distribution 3) active learners experience (interactive exploration of original image data).
Measuring and Improving Quality Using Information Systems
Authors: Bates David W.  , Pappius Elizabeth M.  , Kuperman Gilad J.  , Sittig Dean  , Burstin Helen  , Fairchild David  , Brennan Troyen A.  , Teich Jonathan M.
Published: February 2025

Information systems (IS) are increasingly important for measuring and improving quality. In this paper, we describe our integrated delivery system's plan for and experiences with measuring and improving quality using IS. Our approach is that for quality measurement to be practical, it must be integrated with the routine provision of care, and whenever possible should be done using IS. Thus, at one hospital, we now perform almost all quality measurement using IS. However, IS are not only useful for measuring care, but represent powerful tools for improving care using decision support. Specific areas in which IS has already been particularly effective include reducing the unnecessary use of laboratory testing, reporting important abnormalities to key providers rapidly, adverse drug event detection and prevention, initiatives to reduce the costs of drugs, and making critical pathways available to providers. The next wave of effort will be to promote widespread use of computerized guidelines, which is likely to prove more challenging. However, the advent of managed care in the U.S. has produced strong incentives to provide high quality care at low cost, and our perspective is that only with better IS than exist today will this be possible on a widespread basis. Such systems make feasible implementation of care improvement and cost reduction initiatives on a scale which could not previously be considered.
Activity Modelling for assessing the Usability of Telematics Applications in Healthcare
Authors: Beuscart-Zéphir M.C.  , Sockeel P.  , Bossard B.  , Beuscart R.
Published: February 2025

With the development of Telematics Applications in Healthcare, it becomes obvious that the success of these services is tightly linked with their usability and their acceptance by users. That is why Users Requirements Analysis appears as an essential step before implementation of new computer services. In many cases, particularly when doctors are directly involved in the management of information, there is a strong interaction between their usual activity and the new tasks implied by the computer. In those cases, Activity Modelling can be useful to describe the way people are working, the motivations that underlie this activity, the place of information management in this activity. Moreover, these models can help to forecast possible difficulties or reasons for failure of the data management when computerised. Obviously, these models are highly depending on the healthcare organisation but some basic lines can be transferable. In this paper we illustrate the Activity Modelling Methodology by examples from Telematics exchanges between GPs and Hospitals.
The Electronic Patient Record in General Practice - A South-African Perspective
Authors: De Wet Lizette  , McDonald Theo  , Pistorius Gawie
Published: February 2025

A research project was undertaken to design an electronic medical record system which will cater for the specific needs of South African general practitioners and their unique requirements. The project was launched by sending out a questionnaire to general practitioners in the Free State, trying to determine their specific requirements and to gain insight into their attitudes and opinions regarding the use of computers, especially the computer-based patient record, in a general practice setting. The results indicated that there was a need to replace the current manual patient record with an electronic version, and that the attitudes of the general practitioners in South Africa were generally favourable regarding implementing and using such a system. Given these results, we can proceed to design a computer-based patient record system, specifically addressing the needs and requirements of the South African general practitioner.
The Millennium Bug: A Prescription for Action
Authors: Meador Lawrence  , Zimmerman Ernest C.  , Safran Charles
Published: February 2025

Healthcare delivery systems involving technology are vulnerable to year 2000 date problems. This paper describes the unique features of this problem as related to healthcare, proposes a classification to the problems, and structures an approach to begin resolving this looming disaster.
Chapter 8: Data Security and Privacy
Authors: Ferrer-Roca O.  , Allaert F.
Published: February 2025

The present chapter covers one of the most important issues in medical practice related to ethics, privacy and confidentiality of the data held by the Health professionals. Special emphasis is put on the EU directives that regulate those issues and on possible practical solutions for the forthcoming implementation of Telehealth applications.
Chapter 10: Economics and Strategic Planning
Authors: Strobl V.  , Ferrer-Roca O.
Published: February 2025

The present chapter gives an overview on economically relevant factors to be considered when planning to introduce telemedicine. The chapter covers the aspects of constraints, cost/benefits and possible indications for a widespread telemedicine use based on market demand and user needs as well as a comprehensive model for strategic planning. Failure to design telemedicine policies is an outstanding problem discussed in detail in the sections on re-engineering and hospital management. The rules of strategic planning and the process of formulating strategies and making decisions will be described.
Chapter 11: Social Aspects of Technology Transfer
Authors: Mairinger T.  , Ferrer-Roca O.
Published: February 2025

The present chapter contains information on the issues that could affect the implementation of Telemedicine in the everyday work. This is complemented with some definitions on the aspects of transfer technology, innovation and techniques. To finally summarise some possible schemes to overcome those problems.
Annex VII: Questionnaire on Telemedicine
Authors: Mairinger T.
Published: February 2025

Previous to introducing innovations, some qualitative parameters should be studied to understand the potential acceptance and impact of the new technology, work patterns and outcomes. This annex contains a model to evaluate user attitudes.
Common Sense as a Key Requirement for Promoting the Electronic Healthcare Record: Two Years of Experience in the Belgian National PROREC Centre
Authors: Ceusters Werner
Published: February 2025

PROREC-BE vzw is the first national PROREC centre that has been created to promote the use of high quality electronic healthcare records in line with European standards and insights. The mission of the centre is to satisfy the needs of all actors playing in the electronic healthcare record theatre. This is realised by setting up discussion fora and technical groups, and by adhering to common sense principles such as acceptance of each other's competence, looking at responsibilities instead of rights, and preferring win-win over zero-sum games. After two year of working, the Belgian PROREC centre has satisfactorily shown that working along these principles pays off, and is beneficial for all.
VIRTUAL REALITY: PAST, PRESENT AND FUTURE
Authors: Gobbetti Enrico
Published: February 2025

This report provides a short survey of the field of virtual reality, highlighting application domains, technological requirements, and currently available solutions. The report is organized as follows: section 1 presents the background and motivation of virtual environment research and identifies typical application domain, section 2 discusses the characteristics a virtual reality system must have in order to exploit the perceptual and spatial skills of users, section 3 surveys current input/output devices for virtual reality, section 4 surveys current software approaches to support the création of virtual reality systems, and section 5 summarizes the report.
VIRTUAL REALITY: A NEW CLINICAL SETTING LAB
Authors: Botella C  , Perpiñá C.  , Baños R.M  , Garcíu-Palacios A.
Published: February 2025

Virtual Reality (VR) is a new technology halfway between television and computer. It constitutes another step in the evolution of our use of a tool that allows us to see, to hear and to feel in a world created graphically in three dimensions, and to interact with it. VR is, mainly, a mental experience which makes the user believe that “he is there”, that he is present in the virtual worid. With this new tool, the user is no longer a mere observer of that which is happening on a screen, but he “feels” that he is immersed in that world and participates in it, in spite of the fact that they are spaces and objects that only exist in the memory of the computer and in the user's mind.
Acquisition of 3D Vertebral Displacement During Surgery
Authors: Dufour F.  , Chopin D.  , Godillon Maquinghen A.P.
Published: February 2025

The scoliosis is a 3D spinal deformation which, according to the gravity, requires a surgical intervention. It consists to replace and maintain the spine in a normal geometrical configuration with the help of osteosynthesis system. To value the Colorado instrumentation efficiency and to help the surgeon in his work, a quantification of vertebral displacement during surgery is realised from radiographs and the use of an optoelectronic system. The technical part of this work is described in this paper and first preliminary results are presented.
3D Geometrical Analysis of the CTM Brace Effect on Scoliotic Patient
Authors: Périé D.  , Hobatho M.C.  , De Gauzy J.sales  , Sévely A.  , Montéan A.  , Peuchot B.
Published: February 2025

The effect of the braces or instrumentation was studied using stereoradiography or axial tomography. The CTM brace was only studied clinically using frontal radiography. This study addresses a 3D analysis of the immediate effect of initial CTM brace wearing on the scoliotic spine using an MRI method developed previously. The MRI examination had been performed on eight scoliotic children wearing a first CTM brace. The MRI protocol was performed first with the brace and then without the brace. Using an in house processing software SIP and the pre and post processor Patran, two geometrical models of the vertebral bodies and intervertebral discs, with and without brace, were obtained. Different geometrical parameters for CTM brace effect analysis were computed. Seven braces decrease the scoliosis, transforming a C shape in the top view into a S or I shape and correcting the maximum deformity plane. One brace do not correct the scoliosis and aggravated this plane. Three braces aggravated and five corrected the maximum deviation plane. The intervertebral disc shift forward is corrected by the brace. Three braces rotated the apical vertebra and translated the end vertebrae. Two braces translated the apical vertebra and rotated the end vertebrae. Two braces translated the three vertebrae. One brace translated and rotated the three vertebrae. The method developed using MRI gave quantitative and qualitative data for understanding the CTM brace effect on the scoliotic spine. Our results show that the CTM brace has a local and global three dimensional action. This method is limited to small curvatures and to braces only worn at night. In the future, double curvatures will be analysed and the brace effect simulated using mechanical modelling.
Modeling the Human Spine for a New Treatment of Scoliosis
Authors: Hirsch Robert S.C.  , Craig Kevin  , Carl Allen
Published: February 2025

The intervertebral disc has received much attention during the last thirty years in the quest for developing an accurate model of the spine. Lumped-parameter models, as well as finite-element models, have both been used to describe the behavior of this vital part of the spine. Each analysis method has clear advantages and disadvantages.
Outcome Measurement of Scoliosis Rehabilitation by Use of Surface Topography
Authors: Weiss Hans Rudolf  , Verres CH.  , Steffan K.  , Heckel I.
Published: February 2025

The aim of this study was to investigate whether it is possible to show the result of a rehabilitation program by means of surface reconstruction of the trunk. In our rehabilitation center we used the Formetric system to measure 1454 patients with scoliosis without brace before and after a 4-6 week rehabilitation period. The ratio male:female was about 1:5 with a curvature angle of 37° according to Cobb and an average age of 21 years. We compared the Formetric data for average lateral deviation, maximal deviation, average rotation, maximal rotation, and of the trunk index (measure for all curves) before and after the rehabilitation with the t-test. The values for average and maximal lateral deviation showed a highly significant decrease after the in-patient rehabilitation phase from 12.4 / 22.6 to 11.5 / 21.4 mm. The same applies for the trunk index as a measure for the correction of all existing curves. The average surface rotation was not significantly reduced (from 6.4° to 6.3°), whereas maximal rotation did decrease significantly from 12.1° to 12.0°. Automated surface measurement of the trunk seems to be appropriate for quality management in the rehabilitation of patients with spinal deformities, although one cannot exclude errors, and thus small changes in the posture cannot be quantified in individual cases
Valuation of Body Surface Measurements: Accuracy Rating of Anatomical Landmarks
Authors: Hierholzer Eberhard
Published: February 2025

The detection of anatomical landmarks on the body surface measured by rasterstereography is based on the analysis of surface curvatures. Landmarks such as the vertebra prominens or the lumbar dimples are localised at points of maximum convex or concave curvature. It is shown that the accuracy (reproducibility) of landmark localisation correlates with the magnitude of local curvature. This finding makes it possible to estimate the accuracy of a landmark a priori from a single record, instead of determining the statistical scatter from a large number of records taken in the same posture.
Evaluation of a Registration Technique for Intraoperative Tracking of the Spine
Authors: Mac-Thiong J.-M.  , Aubin C.-É.  , Dansereau J.  , Brodeur P.  , De Guise J.A.  , Labelle H.
Published: February 2025

This study evaluates a registration technique for intraoperative tracking of the spine which consists in matching intraoperative measurements with specific surfaces defined on a 3-D preoperative model. The validation study was undertaken on a cadaveric spine. The accuracy for four approaches combining different tracking systems and 3-D reconstruction techniques were compared. The accuracy resulting from the combination of a radiographic 3-D reconstruction and a magnetic digitizer was 5.9±2.7mm. The corresponding errors on vertebral rotations were 4.4±3.3°, 6.7±5.8° and 5.0±3.8° in frontal, sagittal and transverse planes, respectively. This approach is minimally invasive (only 2 X-rays) and may provide sufficient accuracy for certain clinical applications. With CT scan 3-D reconstruction, the accuracy was increased by about 2mm, but the high radiation exposure associated with CT scan imaging for long spinal segments makes it unfavorable to most clinical use. As for the mechanical arm, considering the small increase in accuracy and its awkwardness, its use during surgery is not suggested.
Surface Topography and Cobb Angles in Idiopathic Scoliosis
Authors: Goldberg C.J.  , Moore D.P.  , Fogerty E.E.  , Dowling F.E.
Published: February 2025

Surface topography is used in spinal deformity to monitor cosmetic change. In order to be useful, it must not only yield values that correlate with radiological data, but must reliably change in tandem with radiological change. Using the average of 4 consecutive repeat scans to reduce error margins in a Quantec Imaging System, changes on radiograph and in several parameters of contemporary scans were analysed to estimate their agreement. Enough correlation was found to encourage further study.
Analysis of Intravertebral Axial Rotation in Adolescent Idiopathic Scoliosis Using Three-Dimensional MRI
Authors: Birchall Daniel  , Hughes David G.  , Robinson Lesley  , Williamson J.Bradley
Published: February 2025

This paper reports a pilot study analysing axial rotation in patients with adolescent idiopathic scoliosis using three-dimensional MR. The objective was to define the proportion of segmental axial rotation that occurs due to intravertebral deformity in patients with adolescent idiopathic scoliosis. Ten patients with adolescent idiopathic scoliosis with right thoracic curve (Cobb angle 44° – 78°) selected sequentially from clinic were included in the study. Patients were imaged with a Siemens IT Impact scanner using dual echo steady state gradient echo T2-weighting (TR 30msec/ TE 9/45 msec/ 40°). Three-dimensional volume images of the apical ten vertebrae were obtained in the axial plane and were post-processed through multiplanar reconstruction, allowing axial reconstructions to be obtained in the plane of each endplate. Axial rotation was measured, and an absolute value determined by reference to a neutrally-rotated vertebra. The proportion of intravertebral and intervertebral deformity within each scoliotic curve was subsequently determined. Overall change in observed axial rotation from end vertebra to apical vertebra ranged from 20° to 34°, with a mean of 28°. The mean proportion of axial rotation within the overall scoliotic curve occurring due to intravertebral basis was 34%, with a range of 9% – 76%. It was concluded that a significant but variable amount of the overall scoliotic deformity in patients with adolescent idiopathic scoliosis occurs as a result of intravertebral rotation, contributing over 45% of the total scoliotic axial rotation in half of the patients imaged. This study implies that assessment of axial rotation in the plane of individual endplates with three-dimensional MRI may be a useful means for identifying a subgroup of patients in whom derotational surgery is likely to be of limited benefit.
Analysis of Posterior Trunk Symmetry Index (POTSI) in Scoliosis. Part 1
Authors: Suzuki N.  , Inami K.  , Ono T.  , Kohno K.  , Asher M.A.
Published: February 2025

A new indicator to assess trunk asymmetry in scoliosis patients is introduced. The medio-lateral length difference index at the axilla and the waist, and off balance index at C7 were defined as Frontal Asymmetry Index (FAI-C7, FAI-A, FAI-T). The height difference at the shoulder, the axilla and the waist were defined as Height Difference Index (HDI-S, HDI-A, HDI-T). The total sum of these six indices was defined as Posterior Trunk Symmetry Index (POTSI). The average intra-observer and inter-observer error of POTSI were 5.5 and 6.4 respectively. Slight trunk asymmetries were detected in normal children, whereas POTSI were significantly larger in scoliosis patients than those in normal children. This measurement of trunk asymmetry defined as POTSI is valid for the clinical assessment of scoliosis and to evaluate objectively the effect of surgery on trunk deformity.
Broad Band Spectral Analysis: Pathophysiological and Clinical Relevance
Authors: Parati Gianfranco  , Di Rienzo Marco  , Castiglioni Paolo  , Frattola Alessandra  , Pedotti Antonio  , Mancia Giuseppe
Published: February 2025

Background. Blood pressure fluctuations over the 24 hours include both fast and slow changes. While most studies have focused on the former components, recent evidence suggests that also slower blood pressure variations may have physiological and clinical relevance. A method recently proposed to quantify these slower blood pressure components is broad band spectral analysis.
Strategies of the German-speaking ICNP User Group for the promotion of nursing terminology
Authors: Hinz Matthias  , Dörre Frank  , König Peter
Published: February 2025

This paper gives the background and an introduction to the present activities and results of the German-speaking ICNP User Group. The importance of the involvement of healthcare professionals, e.g. nurses, in the standardisation process in nursing informatics is stressed. The paper emphases the need for increased awareness for the standardisation efforts in order to accomplish a higher degree of commitment in healthcare professionals. The strategies and activities of the German-speaking ICNP User Group are described.
An Analysis of the ICNP Alpha Version Demonstrated by Selected Examples
Authors: Gebert Barbara  , van Maanen Hanneke
Published: February 2025

In this content analysis of the ICNP Alpha version we demonstrate some inconsistencies and incompatibilities with nursing practice - in its application to the German speaking culture. The line of thinking of the ICNP seems to be closer related to the needs to the computer programmers than to nurses' frame of reference. The basis of this content analysis is the translation of the English ICNP Alpha Version into the German language. In the translation process we found terminology sometimes unknown and sometimes irrelevant to German nurse practitioners. The conceptual frame of reference is partially German nursing theory. We identified some omissions which may lead to a reduced concept of nursing. This concept analysis is based on three categories analysis of content, logic and congruence in terminology.
Virtual Reality on the web: the potentials of different methodologies and visualization techniques for scientific research and medical education
Authors: Kling-Petersen Torben  , Pascher Ragnar  , Rydmark Martin
Published: February 2025

Academic and medical imaging are increasingly using computer based 3D reconstruction and/or visualization. Three-dimensional interactive models play a major role in areas such as preclinical medical education, clinical visualization and medical research. While 3D is comparably easy to do on a high end workstations, distribution and use of interactive 3D graphics necessitate the use of personal computers and the web. Several new techniques have been demonstrated providing interactive 3D via a web browser thereby allowing a limited version of VR to be experienced by a larger majority of students, medical practitioners and researchers. These techniques include QuickTimeVR2 (QTVR), VRML2, QuickDraw3D, OpenGL and Java3D.
Semi-Automated Analysis for MRI of Breast Tumors
Authors: Partridge SC  , Heumann EJ  , Hylton NM
Published: February 2025

Magnetic resonance imaging (MRI) techniques have the potential to greatly improve breast cancer detection, diagnosis, and treatment. Currently, a major problem associated with breast MRI is the overwhelming amount of data acquired during an exam, and the time-intensive analysis required to evaluate the images. We have developed a software platform for semi-automated analysis to assess both the tumor extent and overall grade or severity based on our diagnostic criteria. In a test subset of over 50 patients, the automated program produced results more accurate overall than those measurements taken manually, with a reduction in time for analysis from approximately 45 minutes down to 5 minutes per patient study.
A TELEMENTORED TRANS-RECTAL ULTRASOUND GUIDED PROSTATE BIOPSY
Authors: Purkable Terry L.  , Bauer John J.
Published: February 2025

The purpose of this project was to demonstrate the efficacy and feasibility of a real-time telementored transrectal ultrasound-guided prostate biopsy. The physician (P) was located at a remote site while the physician’s extender (PE) was with the patient at another location. The (P) directed and guided the (PE) through the biopsy procedures utilizing video and audio contact, and viewing electronically transmitted ultrasound images. This procedure occurred at Walter Reed Army Medical Center in Washington, DC where the patient and (PE) were located in a surgical suite, and the (P) was located in another part of the hospital. Audio, video and ultrasound images were transmitted via a simulated Tl line.
CATHSIM$^{\™}$: AN INTRAVASCULAR CATHETERIZATION SIMULATOR ON A PC
Authors: Ursino Michele  , Tasto Joseph L.  , Nguyen Binh H.  , Cunningham Richard  , Merril Gregory L.
Published: February 2025

The development of a medical simulator that incorporates substantial training value and realism into an affordable product has been a huge challenge for the simulation community. A large hurdle to making an inexpensive simulator has been the high cost of the computers needed for adequate realism. We have met this challenge by developing CathSim™, a low-cost medical simulator that integrates force feedback, multimedia, and 3D graphics simulation technology on an industry standard PC. This product is commercially available and is currently being used by numerous training institutions and hospitals. The CathSim™system includes software and a force feedback interface device. The platform and device can be used to train health care providers to perform needle-stick medical procedures. Our first module teaches users the techniques of peripheral intravenous (IV) catheterization. Other training modules that will be added to the CathSim™platform include central venous catheter (CVC) insertion and peripherally inserted central catheter (PICC) placement. This paper discusses the challenges of this project and the trade-offs and solutions that we developed to overcome them. We describe our process of analyzing and prioritizing the medical tasks necessary to correctly perform peripheral intravenous catheterization. This analysis and prioritization was used to decide which tasks would be included in the simulator and how the included tasks would be replicated. We discuss the method by which we obtained the needed realism in the 3D graphics rendering and in the tactile feedback of the input device. We illustrate how we blended together simulation and multimedia technology to ensure adequate immersion and training efficacy, while keeping the system cost to a minimum.
Virtual reality and women’s health: A breast biopsy system
Authors: Vahora Farida  , Ternkin B.  , Marcy W.  , Gorman Paul J.  , Krummel Thomas M.  , Heinrichs Wm. LeRoy
Published: February 2025

Minimally invasive procedures are becoming much more common in surgical practice because of the many advantages for patient comfort and convenience, and improved surgical access. However some of the major problems leading to occasional surgical errors with this minimal access method are restricted vision, limited sense of touch, difficulties in identification in 3D space of the position of the instrument tips, and their handling during delicate, short-distance movements toward the surgical target area. These factors emphasize the need for computer simulated training in surgical manipulations and procedures in preparation for conducting them in patients. The key new feature of our proof-of-concept training simulator is a preventive mechanism that serves at least two functions. As the surgical target (or a critical structure) is approached, a haptically generated preventive force forewarns the surgeon, making it possible to abort those maneuvers that may lead to adverse results. By announcing a potential collision of a virtual instrument tip with a surgical target, the time used for searching for the target is shortened, and the haptic signal minimizes the potential of tissue damage. This real-time, interactive, virtual reality based, haptic breast biopsy-training simulation is a PC/NT based multitasking, multithreading system. It is based upon an advanced force feedback device. The system monitors and indirectly guides the surgeon’s movements, while providing high fidelity visual and force feedback cues as the area of surgical interest is approached. Our first application is with human breast.
Integration of Quality Programs by Telemedicine in Surgical Services
Authors: Merrell Ronald  , Rosser James
Published: February 2025

Surgical procedures can be performed and monitored in operating rooms physically isolated, but electronically linked to a parent medical center, and certainly from distant consultation. Quality of surgical care has been measured in retrospect rather than in real time, and outcomes have generally not had the benefit of immediate consultation and group analysis. However, telemedicine can connect consultants, surgeons, patients, and databases. The Yale Telemedicine Center has developed network schemes, which connect the OR of trainees with the laboratory of the teacher, and has opened a continuum between pedagogy and product. The program has connected regional hospitals, connected components of hospital systems, and has been used in international testbeds. The particular operative procedures studied have been laparoscopic procedures. The consultant is based at Yale and is connected with the distant OR to share the laparoscopic surgical field. Connection includes real time video, audio and the ability to draw instruction on the OR screen. Bandwidths as low as 12kbs(POTS) have been employed with modification with effective intervention. The potential for quality improvement is substantial, and inclusion in quality programs is strongly recommended.
ByOPHTEL: A Bavarian Project for Rapid Telemedical Exchange of Knowledge, Files and Skills between Practitioners and Hospitals in Eye Care
Authors: Mertz Manfred
Published: February 2025

ByOPHTEL, part of the Bavarian initiative Bayern Online, derived its name from the European project OPHTEL, to which it is closely linked and which, in Bavaria, is more or less worked out and performed by identical persons and institutions. It provides a group of 7 practitioners in and around the city of Munich with the possibility of exchanging general ophthalmologic knowledge as well as patient-related information with anyone in the group, or with the related ophthalmologic, internal, resp. scientific centers at the T U Munich and the GSF Neuherberg. Connections are routinely performed in the asynchronous or in the synchronous mode, and all partners participate in the scientific projects Knowledge Based Information System, Glaucoma Monitor, and Diabetic Retinopathy Monitor-- as well as in the enhancement of a trustful patient- physician relationship (“second opinion”) and a closer cooperation in out-patient and in- patient ophthalmical surgery and medical treatment.
Are Dermatologists in Private Practice Interested in Teledermatological Services?
Authors: Glaessl Alexander  , Schiffner Roman  , Walther Thomas  , Landthaler Michael  , Stolz Wilhelm
Published: February 2025

Diagnosing dermatologic skin conditions can be difficult, especially in pigmented skin lesions. Therefore, the consultation of an expert via teledermatology could prove vital. For this purpose, a rapid transfer of medical data including high resolution images is essential. This transfer can be performed with a variety of modern telecommunication technologies, including ISDN, highspeed-ISDN, Internet, and Intranet. As the levels of both communication software and camera-systems can be quite different, our survey investigated the equipment of 84 dermatologists in private practice. A questionaire was distributed on computer equipment, operating system software, and any image documentation systems used, as well as required telecommunications equipment and possible applications of teledermatology. This survey showed a response rate of 54% and proves that dermatologists in private practice are interested in telemedicine services. Most dermatolgists surveyed use Windows 95 operating software and 74% have access to modern ISDN modems or PC-cards. Dermatologists currently prefer applications with low- tech communication hardware and software requirements. Consultation of dermatological centers was the favored application with 59%. Our survey clearly demonstrates that a high percentage of dermatologists in private practice would use teledermatology. In our experience, for the excellence of this service an image documentation system is essential to provide the teledermatolocical expert with standardized images with constant illumination.
Southern Health Board - Advanced Telematic / Telemedicine in Healthcare Services in the South West Of Ireland
Authors: O'Sullivan U.M  , Somers Jack
Published: February 2025

The Southern Health Board has been involved in Telematic Healthcare services for the past number of years. Our involvement in a number of EU funded projects has given us extensive experience and expertise in this area. The primary focus of our telematic applications is optimising health services delivery with a particular emphasis towards people who are isolated due to social and physical boundaries and limitations. Our main projects are:
Remote Communities Services Telecentre Project
Authors: Robbins Carl W.
Published: February 2025

The delivery of teleservices to rural communities is challenged by the high cost of infrastructure and maintenance. This is compounded if land-based telecommunication links are absent or if bandwidth is limited, as is the case in many areas of the world.
2.3 Statistical Methods
Authors: Mantas John
Published: February 2025

The purpose of this chapter is to present a conceptual framework that applies to almost all statistical procedures discussed so far in this text. We also describe briefly, using a conceptual framework only, some of the more advanced techniques used in medicine.
Metabolic Drug Pointing and Information Processing
Authors: Hofestädt Ralf  , Mischke Ulrike  , Prüß Manuela  , Scholz Uwe
Published: February 2025

Computer supported drug design is based on the biochemical information for the prediction of alternative bio-chemical pathways. Molecular information on genes, proteins, biochemical reactions, mutations, inborn errors and metabolic diseases are available via internet. Based on this information we developed an information retrieval and processing concept combining knowledge about metabolic diseases and biochemical effects.
Transtelephonic ECG in Slovenia
Authors: Gorjup Vojka  , Jazbec Anja  , Geršak Borut
Published: February 2025

Transtelephonic ECG has been introduced in Slovenia in 1996. It has been operating on a regular basis since September 1997. Users of the system are health institutions and patients with C V diseases. They use portable 12- channel ECG weighing less then 200 grams. Diagnostic center is located in medical ICU in Clinical Center Ljubljana. In the first 20 months of regular operation we have received 852 calls, 450 of them being diagnostic. The most common reasons for calling were: ischaemic chest pain, atypical chest pain, palpitations and dyspnoea. Most common diagnoses made on the basis of history and ECG were: AMI, angina pectoris, paroxysmal tachycardias and atypical chest pain. In 186 cases the cardiologist's advice sufficed, 171 patients were reffered to the ER, 142 immediately and 29 only if suggested therapy hadn't been successful. To 82 patients new medication or chenged dosage of previous medication was suggested. With the intent to evaluate accuracy of the diagnoses made on the basis of history and transtelephonic ECG evaluation we followed up the patients who were sent to ER in Ljubljana upon our cardiologists' advice. On the basis of preliminary results we can conclude that TTE is as diagnostic as the conventional ECG and its' use shortens time from onset of symptoms to initiation of treatment, it lowers disability and mortality due to CV diseases and improves cost benefit.
The Telemedicine and Second Medical Opinion
Authors: Gersak Borut  , Gorjup Vojka  , Jazbec MD; Anja
Published: February 2025

Telemedicine is declared as delivery of care to patients anywhere in the world by combining communications technology, with medical expertise. The well established applications of telemedicine are in the field of teleradiology, pathology, cardiology. In some cases video-conferencing (VC) may be applied. Second medical opinion is an important additional viewpoint on the patient diagnosis and treatment. The established network of consultant hospitals and worldwide Second opinion centers enable a fast (24 - 72 hours response) second medical opinion consultation service with the telemedicine application. The consultant hospitals at present time are: UCSF - San Franscisco, Stanford Medical Center, Bowman Gray School of Medicine, The Brigham Radiology Foundation , Emory University Hospital, University of Pennsylvania Medical Center. The second opinion centers are located worldwide, just to mention some of them: London, Budapest, Ljubljana, Tel Aviv, Bombay, Athens, Milano, Seoul.
A computerised study on the results of In-Vitro-Fertilisation
Authors: Cadman J  , Richards B  , D'Souza S  , Lieberman B A  , Buck P  , Rivlin E
Published: February 2025

This project has been concerned with the comparison of children born as a result of fresh embryo transfer (IVF) with children conceived and born via the natural process. The former included children who were the single outcome of the birth (singletons) and children who were the result of a multiple birth (eg twins, triplets). A computer database was established into which was put 23 items of data on each child, making a total of 12788 items overall. There were 278 “normally conceived” children (controls), 150 IVF Singletons, and 128 children from multiple births. The results show interesting differences in the gestational age at birth, the birth weight, the mode of delivery and the degrees of birth abnormalities and malformations.
Computer EEG-monitoring of laserotherapy effects in patients with asteno-depressive syndrome
Authors: Omelchenko V.P.  , Baranchook I.S.  , Dmitriev M.N.
Published: February 2025

Nowadays the low-intensive laserotherapy is shown to be an effective and non-hazardous method of asteno-depressive syndrome treatment. The differences of EEG-reactions to laser influences have been revealed in patients of different age groups. And the close negative correlation between the therapy effect, on the one hand, and the patient's age and the disease duration, on the other hand, has been shown. No significant changes of the patient's state or integrative EEG-indices have been evoked by a placebo application. The results showed the advantages of the low- intensive laserotherapy in asteno-depressive syndrome treatment and confirmed the significance of computer EEG-monitoring for prediction, control and correction of the state of the patient.
An Orthopaedic Discussion Group, linking and teaching the Orthopaedic Community
Authors: Callanan Ian  , Gormalley Ursula  , O'Brien Tim
Published: February 2025

Since its inception, the Internet has created many new opportunities for the dissemination of knowledge between individuals. One of the areas most affected by these changes has been healthcare, both in terms of service provision and in the arena of medical education. Other healthcare professionals have described the educational resources available on the Net but few have illustrated the advantages of educational and conversant interaction between members of a surgical speciality or the maturing process that takes place within that group. We describe how the initiation and continued development of an Internet-based discussion group has benefited the orthopaedic profession in Ireland. We identify problems detected to date and possible difficulties in the future of the discussion group.
Analysis of free MEDLINE on the WWW
Authors: Klemenčič Eva  , Todorovski Ljupčo
Published: February 2025

In the paper, a survey of free MEDLINE access on the WWW is given. We compared five different vendors that provide free unlimited access to MEDLINE. The comparison of different search parameters was made: number of search statements, number of search fields, ability to combine search statements, number of search limits. The possibilities of using MESH thesaurus during the search are also explored. At last, we compared and evaluated the results of two search queries, obtained with searching MEDLINE, provided by five vendors mentioned above.
Java-based Framework for the Secure Distribution of Electronic Medical Records
Authors: Goh Alwyn
Published: February 2025

In this paper, we present a Java-based framework for the processing, storage and delivery of Electronic Medical Records (EMR). The choice of Java as a developmental and operational environment ensures operability over a wide-range of client-side platforms, with our on-going work emphasising migration towards Extensible Markup Language (XML) capable Web browser clients. Telemedicine in support of womb-to-tomb healthcare as articulated by the Multimedia Supercorridor (MSC) Telemedicine initiative—which motivated this project—will require high-volume data exchange over an insecure public-access Wide Area Network (WAN), thereby requiring a hybrid cryptosystem with both symmetric and asymmetric components. Our prototype framework features a pre-transaction authentication and key negotiation sequence which can be readily modified for client-side environments ranging from Web browsers without local storage capability to workstations with serial connectivity to a tamper-proof device, and also for point-to-multipoint transaction processes.
Healthcare Users and Computerised Resources
Authors: Stephens Gaye  , Gaffhey Peter  , Grimson Jane
Published: February 2025

This paper concerns users' views on computerised resources. The focus concerns a software tool that could be used to allow safety conscious user manipulation of the combination of these computerised resources. It is of concern to the authors that computerised resources used in healthcare should reflect users' working practices rather than working practices being changed to reflect computerised resources.
Hierarchical Multi-Attribute Decision Models and Their Application in Health Care
Authors: Bohanec Marko  , Zupan Blaž  , Rajkovič Vladislav
Published: February 2025

Hierarchical decision models are developed through decomposition of complex decision problems into smaller and less complex subproblems. They are aimed at the classification or evaluation of options and can be used for analysis, simulation and explanation. This paper presents a set of methods for the construction and application of qualitative hierarchical decision models in health care. We present the results of four ongoing projects in oncology, radiology, community nursing and diabetic foot treatment.
A Model for Integration and Continuous Development of Standards for Tumour Documentation Using Relational Database Techniques and Extensible Markup Language
Authors: Altmann Udo  , Wächter Werner  , Tafazzoli Ali Gerhard  , Katz Frank Rüdiger  , Schweiger Ralf  , Dudeck Joachim
Published: February 2025

In oncology various international and national standards exist for different aspects of a disease. These standards, maintained by different organisations, have multiple relationships with each other. A common data dictionary like UMLS would facilitate the reorganisation of such relationships when a new version of a standard is published. While the modelling of relationships usually is restricted to types having a relevant frequency, there are often relationships which are expressed in texts like definitions or explanations. Such texts are a very important supplement for the acceptance and the safe use of coding systems, but often are neglected when implementing coding systems in computerised systems, because they are costly to implement. This paper discusses potentials when integrating various sources in a common, database based dictionary enhanced by XML (Extensible Markup Language) techniques.
A Tutor For Nursing Process Education
Authors: Habjanic Ana  , Brumec Viljem
Published: February 2025

Computer managed instruction (CMI) has been used in nursing education since the late 1960’s. It is due to the accessibility and self paced format that CMI is very well suited for both students and practicing nurses, while learning can occur at the learner's own pace and time. In addition CMI supports also continuing education and distant learning. The aim of this paper is to present CArE - a software package for Computer Aided Nurse Education in particular for teaching the basics of the nursing care process, developed as a result of the Phare TEMPUS project called NICE (Nursing Informatics and Computer Aided Education).