bluuebunny/crossref_metadata_2025 huggingface dataset:
A Computerized Medical Standards System to Help Place Impaired Employees
Authors: Halpern M.
Published: March 2018

The paper describes a knowledge-distribution system that supports decisions on placement of impaired employees. The knowledge base consists of job profiles and medical profiles. The job profiles list tasks and the physical abilities they require. Twenty-one abilities describe the task demands. Active workers rated the exertion, frequency and importance of the physical ability required for each task. Thirty-nine work conditions were rated this way. Using identical scales, experts assessed the impact of impairments on the physical abilities of individuals and the tolerance of work conditions. The screening matches the job profile against the impairment profile. This process has been automated. The program lists tasks and work conditions that may compromise an impaired employee. This information can be used to accommodate employees, restrict duties or design a rehabilitation program. Also, the paper discusses the impact of the system on the operations of medical services within an organization.
Machine Learning of Motor Vehicle Accident Categories from Narrative Data
Authors: Lehto M. R. , Sorock G. S.
Published: March 2018

Bayesian inferencing as a machine learning technique was evaluated for identifying pre-crash activity and crash type from accident narratives describing 3,686 motor vehicle crashes. It was hypothesized that a Bayesian model could learn from a computer search for 63 keywords related to accident categories. Learning was described in terms of the ability to accurately classify previously unclassifiable narratives not containing the original keywords. When narratives contained keywords, the results obtained using both the Bayesian model and keyword search corresponded closely to expert ratings (P(detection)≥0.9, and P(false positive)≤0.05). For narratives not containing keywords, when the threshold used by the Bayesian model was varied between p>0.5 and p>0.9, the overall probability of detecting a category assigned by the expert varied between 67% and 12%. False positives correspondingly varied between 32% and 3%. These latter results demonstrated that the Bayesian system learned from the results of the keyword searches.
Natural Language Processing in Medicine: An Overview
Authors: Spyns P.
Published: March 2018

An overview is given of natural language processing applications in medicine. An attempt has been made to enumerate the most important and known international projects and to summarize their goals, principles, methods and results. A section is devoted to projects involving the Dutch language. A more general discussion about the two fundamental approaches concerning medical language understanding is provided. An extensive bibliography may be useful for those wishing to explore this research domain.
Review Paper: Coding Systems in Health Care
Authors: Cimino J. J.
Published: March 2018

Computer-based patient data which are represented in a coded form have a variety of uses, including direct patient care, statistical reporting, automated decision support, and clinical research. No standard exists which supports all of these functions. Abstracting coding systems, such as ICD, CPT, DRGs and MeSH fail to provide adequate detail, forcing application developers to create their own coding schemes for systems. Some of these schemes have been put forward as possible standards, but they have not been widely accepted. This paper reviews existing schemes used for abstracting, electronic record systems, and comprehensive coding. It also discusses the remaining impediments to acceptance of standards and the current efforts to overcome them, including SNOMED, the Gabrieli Medical Nomenclature, the Read Clinical Codes, GALEN, and the Unified Medical Language System (UMLS).
Collaborating for Competency—A Model for Single Electronic Health Record Onboarding for Medical Students Rotating among Separate Health Systems
Authors: Pereira Anne , Kim Michael , Seywerd Marcus , Nesbitt Brooke , Pitt Michael ,   on behalf of the Minnesota Epic101 Collaborative
Published: March 2018

Background Use of the electronic health record (EHR) is widespread in academic medical centers, and hands-on EHR experience in medical school is essential for new residents to be able to meaningfully contribute to patient care. As system-specific EHR training is not portable across institutions—even when the same EHR platform is used—students rotating across health systems are often required to spend time away from clinical training to complete each system's, often duplicative, EHR training regardless of their competency within the EHR.

Methods We aimed to create a single competency-based Epic onboarding process that would be portable across all the institutions in which our medical students complete clinical rotations. In collaboration with six health systems, we created online EHR training modules using a systematic approach to curriculum development and created an assessment within the Epic practice environment.

Results All six collaborating health systems accepted successful completion of the developed assessment in lieu of standard site-specific medical student EHR training. In the pilot year, 443 students (94%) completed the modules and assessment prior to their clinical training and successfully entered clinical rotations without time consuming, often repetitive onsite training, decreasing the cumulative time as student might be expected to engage in Epic onboarding as much as 20-fold.

Conclusion Medical schools with multisystem training sites with a single type of EHR can adopt this approach to minimize training burden for their learners and to allow them more time in the clinical setting with optimized access to the EHR.
Die psychosoziale Belastung von Kindern in Frauenhäusern
Authors: Zwönitzer A. , Thurn L. , Fegert J. M. , Ziegenhain U. , Himmel R.
Published: March 2018

Kinder sind durch das Miterleben häuslicher Gewalt stark gefährdet. Dabei dürften insbesondere Frauen und Kinder, die in ein Frauenhaus fliehen, zuhause lange und massive Gewalt erlebt haben. Obwohl davon auszugehen ist, dass diese Frauen und Kinder psychisch hoch belastet sind, gibt es in Deutschland keinerlei systematische Studien, deren Ergebnisse helfen könnten, die Frauen und Kinder mit (spezifischen) Angeboten aus bestehenden Helfersystemen bei der Verarbeitung ihrer Gewalterlebnisse besser zu versorgen. Die vorliegende Pilotstudie untersuchte Kinder und ihre Mütter in fünf Frauenhäusern in Baden-Württemberg auf ihre psychische Belastung. Dabei wurden bei den Kindern Verhaltensauffälligkeiten, Symptome von Bindungsstörungen sowie traumatische Erlebnisse erfasst und bei den Müttern ihre psychische Belastung insbesondere hinsichtlich Depressivität. Es stellte sich heraus, dass der Großteil der Kinder und deren Mütter psychisch stark belastet waren.
Schulen stark machen gegen Suizidalität und Selbstverletzung
Authors: Groschwitz R. C. , Straub J.
Published: March 2018

Gegenstand und Ziel: Suizidalität und nicht suizidales selbstverletzendes Verhalten (NSSV) zeigen im Jugendalter hohe Prävalenzen. Mitarbeiter des Schulsystems verfügen häufig über unzureichendes Wissen im Umgang mit dieser Symptomatik. Ziel dieser Studie ist die Evaluation eines Workshops für Schulpersonal zu den genannten Themen. Material und Methoden: Es wurden 16 zweitägige Workshops angeboten, die von 257 Personen besucht wurden. Im Zuge von Prä-, Post- und Follow-up(FU)-Erhebungen wurde das Vertrauen in eigene Fähigkeiten, gefühltes und tatsächliches Wissen sowie Einstellungen hinsichtlich NSSV und Suizidalität erhoben. Zudem wurden Zufriedenheit mit dem Workshop und Verhaltensänderungen evaluiert. Ergebnisse: Es zeigte sich eine hohe Zufriedenheit mit dem Workshop. Zuversicht in eigene Fähigkeiten sowie gefühltes und tatsächliches Wissen verbesserten sich stark von Prä nach Post und blieben auch bei FU stabil. Zudem zeigten sich Verhaltensänderungen beim FU. Schlussfolgerungen/Klinische Relevanz: Verbessertes Wissen und Selbstwirksamkeit des Schulpersonals hinsichtlich NSSV und Suizidalität kann einen positiven Einfluss auf den Umgang mit betroffenen Schülern haben.
A Hierarchical Modular Design for Treatment Protocols
Authors: Ben-Bassat M. , Carlson R. W. , Puri V. K. , Weil M. H.
Published: March 2018

We view a treatment protocol as a hierarchical structure of therapeutic modules. The lowest level of this structure consists of individual therapeutic actions. Combinations of individual actions define higher level modules, which we call routines. Routines are designed to manage limited clinical problems, such as the routine for fluid loading to correct hypovolemia. Combinations of routines and additional actions, together with comments, questions, or precautions organized in a branching logic, in turn, define the treatment protocol for a given disorder.

Adoption of this modular approach may facilitate the formulation of treatment protocols, since the physician is not required to prepare complex flow charts. This hierarchical approach also allows protocols to be updated and modified in a flexible manner. By use of such a standard format, individual components may be fitted together to create protocols for multiple disorders. The technique is suited for computer implementation. We believe that this hierarchical approach may facilitate standardization of patient care as well as aid in clinical teaching. A protocol for acute pancreatitis is used to illustrate this technique.
Morphosemantic Analysis of -ITIS Forms in Medical Language
Authors: Pacak M. G. , Norton L. M. , Dunham G. S.
Published: March 2018

This paper describes an automated procedure for morphosemantic analysis and semantic interpretation of medical compound word forms ending in -ITIS. The requirements for morphosemantic analysis of -ITIS forms include : a) semantic classification of morphosemantic constituents forming -ITIS word forms, b) establishment of morphosemantic distribution patterns occurring in -ITIS forms, c) preparation of paraphrasing rules.
Statistical Recognition of Trends in Health Monitoring Systems
Authors: Brockett P. L. , Kemperman J. H. B.
Published: March 2018

The determination of when trends are present in an active health monitoring system is considered. The type of data collected is often voluntary response data usually of unknown, or perhaps of low quality or reliability. Often, even if the data themselves are perfectly reliable, the different monitoring stations are usually not comparable in size or scope, so aggregrate measures would tend to mask rather than detect trends for the whole system.

Examples of such monitoring systems are the World Health Organization’s Research Center for International Monitoring of Adverse Reactions to Drugs and the »Programa de Investigacion de Modelos Operacionales de Prestacion de Servicios de Salud« (PRIMOPS) operating in Cali, Columbia. We study a »Center-Batch matrix« by using a transformation to a matrix of ranks. It incorporates most of the relevant information. A relatively simple statistical technique is presented for generating a warning signal whenever a pattern of increasing adverse events does occur. This rank Center-Batch method avoids some of the pitfalls of the previous methods used and in fact is often quite superior.
A Computerized Health Hazard Appraisal System (CHAMP)
Authors: Laszlo C. A. , Varga L. E.
Published: March 2018

Health Hazard Appraisal (HHA) is a technique providing quantitative assessment of health risks assumed by individuals. This paper describes the structure and operation of CHAMP, a modularized computer package designed for widespread use of HHA. Thus its design incorporates stringent criteria which include flexibility, expandability, adaptability to varied populations, error corrective capability, and low-cost operation. The experience with CHAMP in service has been excellent.
Doctors’ Attitudes to a Computer-based Clinical Information System
Authors: Young D. W.
Published: March 2018

The results of a survey by questionary concerning user attitudes and views on the use of a computer-based clinical information system are reported. The 13 users, 8 house officers and 5 senior house officers, found the system helpful, felt that patient care was improved and that their knowledge about the investigation of acute medical problems had increased.
Screening for Cancer: Publications 1971—1980
Authors: Wagner G. , Tautu P. , Wolber U.
Published: March 2018

The number of publications dealing with different aspects of the problems of screening for cancer is growing so fast that only very few specialists can have a complete knowledge of the literature in this domain. For this reason, we are restricting our compilation to relevant publications from 1971—1980. We deliberately omitted short notes, abstracts, editorials, technical reports, letters to the editor as well as papers written in a language with restricted circulation (e. g. Russian and Japanese). Nevertheless, the bibliography includes almost 1,200 titles.

As D. M. Eddy noticed in 1980, the screening problem resembles many other problems in medicine: it is important, it is urgent, but it is also very complicated. We experienced this complexity when trying to fit the many aspects of our topic into a classification. This finally took the following shape:
Computers in Medical Care: A Review
Authors: Gottinger Hans W.
Published: March 2018

This survey provides an overview of major developments on the impact of computers in medical and hospital care over the last 25 years. Though the review emphasizes developments in the U. S. and their multi-faceted impacts upon resource allocation and regulation, a serious attempt is made to track those impacts being universally true in multinational environments.
Implementation of an International Information System on Kidney Transplantation
Authors: Hennige M.
Published: March 2018

Kidney transplantations are influenced by a number of factors which are as yet partly unknown or correlate, their mutual dependencies being again unknown. Some of these factors are of a regional or organisational nature. One possibility of gaining new knowledge consists in setting up and analysing an extensive database.

With the aid of the information system presented, which is part of a worldwide prospective study on kidney transplantations, it has been possible to build up such a database within a period of three years. It contains information on more than 16,000 kidney transplantations including follow-up data. 212 transplantation centers from all over the world participate in this study. First analyses already showed interesting correlations.
How to Detect and Prevent Errors in Computer-Supported Statistical Analysis: An Example
Authors: Haux R.
Published: March 2018

In statistical analysis systems data are stored in a database, and procedures or analysis methods, respectively, are stored in a method base. As will be shown in the present article, even in the case of a simple statistical test the detection of faulty data turns out to be deficient in weill-known statistical analysis systems like BMDP, SAS and SPSS. Suggestions are made to program methods and to design statistical analysis systems in such a way that careful error detection is possible to provide the user with more reliable results.
How Clinicians Recall Experiences
Authors: Kochen M.
Published: March 2018

Primary care physicians rely on their experience to a greater extent than on the literature, interaction -with colleagues, meetings, or what they have learned in medical school when making judgments about diagnosis and treatment. They use conventional files ordered most commonly by patient’s last name to aid in recall of specific experiences, though a patient’s name is not always remembered when necessary. Analysis of these hypotheses suggests the introduction of microcomputer-based information systems in physicians’ offices in order to augment the memory of clinicians for specific experiences.
A User-oriented Approach to Decision Making in Differential Diagnosis and Therapeutic Advice
Authors: Rao N.G. , Prasad B.E. , Guha S.K. , Reddy P.G.
Published: March 2018

A search for a user-oriented, computer-assisted expert system resulted in a simple method of simulation of a human consultant’s thinking and action. Making a quick decision in differential diagnosis and selection of the proper line of treatment when faced with a problematic patient has always been a challenging task for clinicians, especially those working in emergency wards, intensive care wards and acute wards. Consulting a vast memory of a number of past cases of a similar nature is near to the natural behaviour of a medical expert and well acceptable to most of the users and patients alike. In this method, the case details of an undiagnosed fresh patient are compared with the details of similar cases diagnosed and treated earlier by experienced consultants and stored in the computer memory. These old cases with confirmed final diagnoses, proven methods of treatment and correctly recorded outcomes enable the system to arrive at the most likely diagnosis, the next likely diagnosis and the most suitable treatment for the new case.

A check facility to ensure the accuracy of the decisions made by MEMCONSULT through comparison with a textbook description and any particular old case in the memory has been added in view of the education and training of newcomers in the field of medicine. A self revising capability depending on the changed clinical condition of the patient is also implemented to suit the basic requirements of an ideal expert system in medicine.
Computerization of the Patient History -Patient Answers Compared with Medical Records
Authors: Quaak M. J. , Westerman R. F. , Schouten J. A. , Hasman A. , Bemmel J. H.
Published: March 2018

Computerized medical history taking, in which patients answer questions by using a terminal, is compared with the written medical record for a group of 99 patients in internal medicine. Patient complaints were analysed with respect to their frequency of occurrence for all important tracts, such as the respiratory, the gastro-intestinal and the uro-genital tracts. About 36% of over 3,200 patient answers were identical in the patient record and the written record, but a considerable percentage of complaints (56%), that were present in the patient record, were missing in the written record; the reverse was true for 4.5%. A computerized patient record appears to contain more extensive information about patient complaints, still to be interpreted by the experienced physician.
Evaluation of Some Strategies for Treating Concomitant Factors in Randomized Trials
Authors: Commenges D.
Published: March 2018

In a randomized clinical trial, the design may or may not be stratified, the analysis may or may not be adjusted. The cross-classification of these alternatives leads to four different strategies. These strategies, plus another one, are evaluated within the framework of a linear model. A discussion about the conditional and unconditional points of view throws some light on the problem of bias in a randomized trial.
Basic Principles for the Creation of a National Automated System for Permanent Loss of Working Capacity
Authors: Peevsky T. D. , Gloutnikova Z. N. , Nicholova V. I.
Published: March 2018

The System for the Observation and Analysis of Disability is part of the Unified National System for Health Service in Bulgaria.

The system was designed after a detailed analysis of the incoming documents and their circulation had been performed and after various models had been designed and tested.

Some of the basic tables describing the output of the system are shown. The information from these tables is designed for the various levels of administration which are the carriers of social activities in the country and for the management of the Boards of Experts on Industrial Medicine.
Decision-Making in Medical Research and Clinical Practice: Theory and Methodology of Laboratory Data Evaluation by Predictors, Indicators and Indices
Authors: Sebag J. , Hall P.
Published: March 2018

A method designed to aid clinical decision-making is described. Predictors and Indicators are criteria that reflect the likelihood of disease and health, based on a retrospective analysis of the frequencies of diseases or diagnoses associated with symptoms, signs, and tests (SST’s). The approach is primarily based upon the SST’s of an individual and how these vary over time. This differs from traditional approaches which operate primarily from a disease-or diagnostic-oriented perspective. Such approaches are, therefore, useful in areas of medical research, education, and paraclinical service units, but have a limited value for patient-care. Static and dynamic health indices aid clinical decision-making by summarizing the SST-oriented Predictor and Indicator evaluations into individualized indices that can be monitored over time.

The methodology of employing this approach for the evaluation of laboratory data is presented. The application of these techniques to a battery of laboratory tests will be presented in the near future.
Two Years Experience with a Medical Computer File in Insurance Medicine
Authors: Lahaye D. , Roosels D. , Viaene J.
Published: March 2018

The drafting of a medical computer file for pneumoconiosis at the Fund of Occupational Diseases was essentially based on an intuitive choice of medical information processing from a large experience. For statistical purposes, however, a more scientific selection of stored information is needed. Therefore, we checked out the medical data on 25,830 complete medical records. The frequency of all answer possib-ilities was tested question by question. A minority of questions had to be reexamined because the yled to insufficient answers. It will be possible in the future to improve the storage of medical information with this work method. A further investigation in which the results achieved by several physicians will be compared opens the possibility of rating the impact of subjective judgments in medical examinations.
Die vollautomatische Dokumentation und statistische Auswertung pathologisch-anatomischer Befundberichte
Authors: Röttger P. , Reul H. , Klein I. , Sunkel H.
Published: March 2018

Autopsieberichte (»pathologisch-anatomische Diagnosen«) schließen Grundleiden, Einzelorganbefunde, histologische Befunde, Körper- und Organgewichte, Personalien und klinische Diagnosen ein. Für die vollständige Auswertung dieser heterogenen Informationen wurde ein Verfahren entwickelt, das auf der Klartextanalyse basiert. Die im Routinebetrieb anfallenden Berichte werden anstatt auf einer nor-malen Schreibmaschine auf einem Flexowriter geschrieben. Dabei fällt ein Lochstreifen an, der automa-tiscch (IBM 1401) auf Magnetband übertragen wird. Dann werden die Berichte durch einen Computer (IBM 7094) mit einem eigens erstellten, die pathologisch-anatomische Nomenklatur in klassifizierter Form enthaltenden, zur Zeit 38 000 Einheiten umfassenden Thesaurus verglichen und standardisiert. In dieser Speicher-Form werden sie der statistischen Auswertung, für die eigene Programm-Systeme entwickelt worden sind (DRZ, System DL-ASEDC), zugeführt.

Nach Erstellung des Thesaurus und der Programme genügt das Verfahren zwei Idealforderungen: 1.) Die Dokumentation — hier die Erstellung des Lochstreifens — erfolgt in einem auch bisher notwen-digen Arbeitsgang ohne zusätzliche Belastung des Routinebetriebes. 2.) Die gespeicherten Informationen sind einer automatischen statistischen Auswertung zuganglich, die alle denkbaren Abfragungen ein-schliefilich der statistischen Sicherung zuläßt.
Zur Erfassung und Verarbeitung medizinischer Daten mittels Computer
Authors: Giere W. , Baumann H.
Published: March 2018

Es wird ein Programmsystem (DUSP) beschrieben, das die Dokumentation beliebiger Inhalte — kodiert und/oder frei formuliert — mit variablen Wortlängen bei rascher Wiederauffindbarkeit (direkter Zugriff) erlaubt. Die Eingabe erfolgt mit unterschiedlichen, dem Untersuchungsgang angepaßten Erhebungs-bögen über eine Korrespondenzschreibmaschine mit angescblossenem Lochstreifenstanzer. DUSP ermög-licht auch kleineren Abteilungen oder Praktikern in Zusammenarbeit mit einem Rechenzentrum preis-giinstige elektronische Datenverarbeitung. Fachkräfte sind zur Anwendung nicht: erforderlich.

Die wesentlichen Charakteristika von DUSP sind:

1.) Steuerung der Speicherungsart durch den Benutzer, unabhangig vom Inhalt,

2.) Beliebiger Inhalt und beliebige Reihenfolge der Formulare,

3.) Zeilenweise Speidierung mit Trennung von evtl. kodiertem »Inhalt« und klartextlichem »Zusatz«,

4.) Wirksame Priitung auf formale Riditigkeit beim Einlesen,

5.) Nachträgliche Möglichkeit der Korrektur des gespeicherten Inhalts,

6.) Wirtschaftlichkeit.
Sequential Analysis of Variance for Medical Trials
Authors: Jones R. D. H. , Hinkelmann K.
Published: March 2018

The analysis of variance is one of the most widely used tools for analyzing quantitative data. It is shown here how this technique can be applied sequentially. Different sampling and test procedures are described in terms of a simple example. An attempt is made to show how these methods can be used in analyzing medical trials where the observations become available sequentially over a period of time. It is argued that sequential analysis is also applicable and practical for experiments that are performed only once, if only one would specify »properly« the hypotheses to be tested.
Use of a Computer for Compiling and Holding a Medical Thesaurus
Authors: Wolff-Terroine M. , Simon N. , Rimbert D.
Published: March 2018

A method is described to compile and hold a medical thesaurus through a combination of intellectual effort and the widest possible use of computerization. Various techniques, such as the automatic generation of relationships among terms, are discussed.

Certains suggestions are offered as to the kind of assistance a computer can provide.
Computer Processing of Medical Text Information**)
Authors: Barnett G. O. , Greenes R. A. , Grossman J. H.
Published: March 2018

The present form of the medical record evolved when patient care was primarily a single physiciansingle patient relationship. However, in recent decades, there have been radical changes in the needs and patterns of health care delivery, and this scrap-book format for a medical record is grossly deficient.

The largest portion of the medical record consists of narrative or free text which is hand-written in relatively unstructured, and often illegible, prose. Although the computer can be used for medical record processing by the unmodified entry of data in prose form, there are very critical limitations in such applications. A more challenging approach is to collect the information in an interactive, conversational technique between the user and the computer, where there is a predetermined branching structure of the data and a fixed vocabulary. The information is entered by the user selecting the desired items from a list on a display screen. The presentation of the particular display by the computer is determined by all the previous choices made by the user. This style of collecting information not only insures clear and unambiguous data, but also facilitates continuing medical education, medical audit, and clinical investigation.
Daily Treatment Planning with an On-Line Shared Computer System
Authors: Gotcher S. B. , Caerick J. , Vallbona C. , Spencer W. A. , Carter R. E. , Cornell S.
Published: March 2018

For six months the treatment plans of an average of 30 patients have been scheduled through the use of remote terminals on-line to a computer. Updated schedules of the treatment plan for each patient, department, and nursing unit have been produced daily and are used by the physicians, departmental directors, allied health professionals, and supportive personnel. A preliminary assessment of the usefulness of the system has indicated that it has: (a) assisted personnel in coordination and implementation of the required treatment plan, (b) provided an effective method of analysis of the total care program, (c) improved utilization of space and personnel, (d) helped the patients gain a better understanding of their care program, and (e) provided an excellent teaching tool and valuable resources for research and cost analysis.
An Approach to an Automatic Pattern Recognition of the Electroencephalogram: Background Rhythm and Paroxysmal Elements
Authors: Goldberg P. , Samson-Dollfus D. , Grémy F.
Published: March 2018

The automatic analysis program for one derivation of E.E.G. described here is made up of two parts:

1.) The first part consists of the study of background rhythm. A temporal analysis is made of the signal to identify the waves of which it is composed. Bursts of rhythms are recognised. Then the principal background rhythms are determined by the analysis of histograms of amplitude and frequency. The results are given as the percentage of the total waves, the mean frequency and amplitude and the coefficient of variation of these quantities.

2.) The second part is the recognition of paroxysmal patterns. By successive applications of a set of criteria the parts of the E.E.G. which may contain spikes or spike-and-waves are extracted. The criteria are:

— existence of large amplitude or slow waves,

— comparison of the frequency of these suspect patterns with the background frequency,

— comparison of the amplitude of these waves with the mean amplitude of the E.E.G.,

— study of the rapid rhythms which, are superimposed on the show waves.

This analysis is concluded by the printing of the number of isolated spikes or spike-and-waves that were observed.

This program, orientated towards pattern recognition, is suitable for the study of the background patterns as well as the pattern recognition of paroxysmal bursts.
Practical Considerations in Cooperative Therapeutic Trials
Authors: Williams John , Freis Edward
Published: March 2018

Various practical problems associated with cooperative therapeutic trials are discussed from the experience obtained during the U. S. Veterans Administration Cooperative Study on Antihypertensive Agents. The problems discussed include stratification of patients on the basis of severity, methods and precautions for achieving double-blind _ therapeutic regimens, methods for obtaining uniformity of data in different hospitals, and the need for inserting modifications in the protocol to take care of the patients developing life threatening complications.

Other practical problems discussed include the need for obtaining the cooperation of the ward physicians and the problem associated with defaulters and those who do not follow the prescribed regimens. Experimental design helps to restrict errors introduced by variance between hospitals. Cooperative trials have goals and use methods which are somewhat different from the classical methods and aims of laboratory research, and should be evaluated in their proper frame of reference.
Befunddokumentation in der Pathologie: Erfahrungen mit einer Maschinenlochkartei
Authors: Becker H.
Published: March 2018

Die Dokumentation pathologisch-anatomischer Befunde (Obduktionen und Untersuchungen an Operationsmaterial) zeigt im deutschsprachigen Raum nicht die Fortschritte, die auf klinischem Gebiete zu verzeichnen sind. Die Gründe hierfür sind in den Eigenheiten des pathologisch - anatomischen Untersuchungsgutes zu suchen; insbesondere ist es die Fülle der auf ein Obduktionsprotokoll entfallenden Sachverhalte, die den Rahmen einer Lochkarte meist sprengen. Auch die bisher vorhandenen nationalen und internationalen Diagnosenschlüssel werden den besonderen Anliegen der pathologischen Anatomie nicht hinreichend gerecht.

Für die Erfassung der Obduktionsbefunde wurde daher ein eigener fünfstelliger Diagnosenschlüssel entwickelt. Das am Grazer Pathologischen Institut aufgebaute System der maschinellen Befunddokumentation wird kurz geschildert.
Über die Selektivität der sog. I-Zahl im „Allgemeinen Krankenblattkopf” und die Brauchbarkeit ihrer einzelnen Komponenten
Authors: Stutzer G. , Wagner G.
Published: March 2018

Die im „Allgemeinen Krankenblattkopf” empfohlene 9 stellige Identifikationszahl (sog. I-Zahl) wurde anhand eines Krankengutes von über 19 000 Patienten der Universitäts-Hautklinik Kiel auf ihre Selektivität hin geprüft. Der methodische Weg der hierfür erforderlichen Materialaufbereitung und -kontrolle wird geschildert. Insgesamt ergaben sich 63/19 378 (= 0.325 %) Doppelbesetzungen, d. h. auf 1000 Patienten kamen rund 3 mal je 2 Personen mit gleicher I-Zahl vor. Die gute Brauchbarkeit der I-Zahl als selektive Patienten-Kennzahl in der Klinik ist damit zahlenmäßig unter Beweis gestellt.

Von den einzelnen Komponenten der I-Zahl ist der Kombinationsschlüssel für die Erfassung von Geschlecht -|- Mehrlingseigenschaft als unvorteilhaft zu bezeichnen, da die zusätzliche Erfassung der Mehrlingseigenschaft nichts zu einer Verbesserung der Selektivität der I-Zahl beiträgt. Eine solche würde erst erreicht, wenn statt der Mehrlingseigenschaft die Geburtsrangfolge registriert würde. Es ist aber fraglich, ob der mit jedem derartigen Kombinationsschlüssel zwangsläufig verbundene Mehraufwand an Arbeit überhaupt lohnt.

Der im „Allgemeinen Krankenblattkopf” empfohlene Namensschlüssel hat sich dagegen sehr bewährt. Sein Anteil an der Gesamtselektivität der I-Zahl ist eine Funktion der Besetzungsstärke der Geburtsjahre, die sich in Form einer Binomial Verteilung darstellen läßt. Diese Formel wird entwickelt und anhand der eigenen Zahlen getestet, wobei sich eine sehr gute Übereinstimmung zwischen Theorie und Praxis ergibt.

Aus Archivierungsgründen wäre es vorzuziehen, die I-Zahl statt mit der Codeziffer für das Geschlecht mit dem Geburtsdatum beginnen zu lassen.
Zur Methodik der statistischen Bearbeitung des Therapieverlaufs depressiver Krankheitsbilder
Authors: Angst J , Battegay R. , Pöldinger W.
Published: March 2018

Mit dem Ziel einheitlicher Bewertungskriterien in der Depressionsbehandlung wird ein Schema zur Erfassung der Befunde und für die Bewertung der Therapieergebnisse vorgeschlagen. Das skizzierte Vorgehen basiert auf einem Erhebungsbogen für die Datenerfassung, welcher die hauptsächlichen Fragen bei der Prüfung von Antidepressiva berücksichtigt und gleichzeitig den allgemeinen Anforderungen bei der klinischen Prüfung neuer Stoffe Rechnung trägt.
Untersuchungen über Strahlen als Krankheitsursache )
Authors: Diethelm L.
Published: March 2018

Die Erkenntnismöglichkeiten der Statistik im Hinblick auf die Strahlen als Krankheitsursache werden an Hand von einigen Spezialproblemen diskutiert, so an der kritischen Grenze der Schädigung der Augenlinse unter dem Einfluß des Alters, der Dosishöhe und des Beobachtungstermins, an der Auswirkung einer einmaligen oder mehrfachen Mutation auf eine Population, an der Beziehung zwischen Strahleneinwirkung und Leukämiegenese, wobei, auf die Unsicherheit bei der Bewertung kleiner Strahlendosen hingewiesen wird, und schließlich an der Beziehung zwischen letalen Strahlendosen und dem Zeitpunkt des Todeseintrittes. Gegenüber diesen statistisch erfaßbaren Modellen wird am Beispiel der Strahlenreaktion der Milz auf Lokal- und Ganzkörperbestrahlung dargestellt, daß hier neben Treffereffekten auch humorale Wirkungen zum Tragen kommen müssen, und daß für die beobachteten Wirkungsunterschiede außerhalb der statistischen Methoden keine Aussagemöglichkeit gegeben ist. Schließlich wird darauf hingewiesen, daß man die normale Fähigkeit der Milz, Erythrocyten zu zerstören, mit Hilfe der Isotopentechnik nachweisen kann, die gewissermaßen auch ein statistisches Verfahren darstellt, und daß auf diese Weise unter anderem auch Strahlenschädigungen der Milz erfaßt werden können. Abschließend wird die Notwendigkeit betont, bei der Beurteilung von Strahlen als Krankheitsursache auch andere Noxen mit ähnlicher Wirkung in die Betrachtung mit einzubeziehen.
A Country-Wide System for Automatic Health Data Processing
Authors: Vransky V. K. , Pascalev T. G. , Baykushevand B. P. , Borov G. I.
Published: March 2018

The technique of data processing offers very large possibilities for further considerable perfection of the organization and directing of public health service as well as its further development on a scientific basis. Therefore a united system for collecting, transporting and processing of medical and health information from all public health services on a country-wide scale is proposed. For that purpose at suitable spots in the country local computing centres for the data collection and primary processing for about one million inhabitants must be built. Every local centre should be connected by direct channels for transport of ordinary and express information with the national medical computing centre. Thus, the Ministry for Public Health could continuously dispose on actual and precise information about the health state all over the country, the development of epidemics and other diseases, the utilization of the hospital beds, the distribution and activity of the medical workers etc. It would further have a permanent feedback from and connection with all health services in the country resp. from selected parts of them using the channels for express information. An approximate estimation of the volume of such an activity is given on the basis of a population of ten millions.
Charakterisierung des Elektrokardiogramms mittels TschebyschefPscher Polynome
Authors: Spindelberger W.
Published: March 2018

In dem vorliegenden Artikel wird über eine Computer-Methode zur maschinellen Dokumentation von Elektrokardiogrammen berichtet. — Es wurden Computer-Programme entwickelt, welche den Kurvenverlauf der EKG-Ableitungen mittels Tschebyscheff’scher Polynome approximieren und die Koeffizienten dieser Polynome zusammen mit den verkodeten EKG-Beurteilungen auf Magnetband speichern. Die Tschebyscheff’schen Polynome haben den Vorteil, daß wenige Koeffizienten für eine gute Approximation genügen.

Für die Verkodung von EKG-Beurteilungen wurde ein Schema entwickelt, mit welchem auch komplexe Beurteilungen numerisch verkodet werden können. Das Verfahren, welches an kein bestimmtes Ableitungssystem gebunden ist, enthält keine Kriterien für die Beurteilung von EKGs. Die maschinell gespeicherten Daten können jedoch für die EKG-Beurteilung verwendet werden. Hat man eine hinreichend große Anzahl von EKGs nach dieser Methode gespeichert, so können mit geeigneten Suchprogrammen für ein neu zu beurteilendes EKG ähnliche EKGs aus den gespeicherten Datenbeständen herausgesucht werden.
Über die Auswertung von Radioisotop-Szintigrammdaten durch Computer
Authors: Tauxe W. N.
Published: March 2018

Der Autor beschreibt eine Methode der Digitalisierung von Radioisotop-Szintigramm-Matrizen zum Zwecke der Verarbeitung auf einem Computer. Bis jetzt wurde hierfür ein digitalisierendes 8-Kanal-Magnetband-Aufnahmegerät benutzt, welches die Zählraten der verschiedenen Impulshöhen-Analysa-toren, x-y-Achsen-orientierte Signale und andere Informationen in computerverträglicher Form auf Magnetband aufzeichnet. Die digitalisierten Zählraten werden dann wieder in Matrizen umgewandelt. Jeder Meßpunkt wird entsprechend dem Auflösungsvermögen des Datensammlungs-Systems analysiert, wobei ein »Weichzeichner«-Effekt wirksam wird. Sodann wird der höchste Meßwert der Matrix aufgesucht und dieser in 20 Zählbereiche unterteilt. Der Ausdruck erfolgt auf einem Schnelldrucker, wobei die 20 verschiedenen Zählbereiche durch unterschiedliche Symbole charakterisiert werden, oder über einen x-y-Plotter, der Linien gleicher Zählraten-Intensität miteinander verbindet. Diese Art der Auswertung und Darstellung der Meßergebnisse hat sich sehr bewährt. Abnorme Befunde konnten damit besser demonstriert werden als auf den üblichen Photoscan-Matrizen. Außerdem ist die Methode bequemer und billiger.
Periosteal surgery
Authors: Bellenger C. R. , Rackard S. M.
Published: March 2018

Periosteal section influences bone development in many species. Long bone growth has been stimulated and limb deviations have been created and corrected by surgically manipulating the periosteum. This paper reviews clinical and experimental findings following different types of periosteal surgery on the immature long bone and considers what mechanisms may be involved in these effects.
A radiographic study of joint angles in standing dogs
Authors: Milgram J. , Slonim E. , Kass P. H. , Shahar R.
Published: March 2018

The purpose of this study was to develop a reliable and repeatable radiographic protocol for the measurement of joint angles in the standing dog, and to use this protocol to determine all standing joint angles for dogs over a wide range of body weights. The radiographic technique and the method of joint angle measurements were found to be highly repeatable, suggesting that the technique is reliable. Most joint angles did not vary between dogs of different weights. In those few instances where significant differences (p<0.05) were found, certain trends were followed and represent differences in conformation. This paper presents a complete description of the angles defining the position of the joints in a standing dog. This information is important for biomechanical studies, for clinical assessment of dogs, and for the design of surgical procedures such as arthrodesis.
Intraprosthetic Dislocation of Modular Dual-Mobility Total Hip Arthroplasty Components During Closed Reduction: A Report of Two Cases
Authors: Johal Ovninder , Eyberg Blake , Meldrum Russell , Walker J.
Published: March 2018

Dual-mobility bearing total hip arthroplasty offers several advantages over traditional prosthesis designs in the treatment of degenerative hip disease. Over decades of use, they have shown proven benefits in both durability and stability. However, despite their practical and theoretical advantages, they present a unique mode of failure not seen with other implants. In this report, the authors present two patients who sustained intraprosthetic dislocation of their dual-mobility total hip arthroplasty components during closed reduction of a hip dislocation.
Unterschiedliches Dokumentationsverhalten: Frei formulierter versus standardisiert dokumentierter psychopathologischer Befund (AMP-Beleg 3)
Authors: Busch H. , Vogel H.-P.
Published: March 2018

Der unter Routinebedingungen abgefaßte, frei formulierte psychopathologische Aufnahmebefund und der AMP-Beleg 3 wurden bei 111 Patienten miteinander verglichen. Auf der Symptomebene fand sich eine Übereinstimmung von 35,5%. Es wird diskutiert, daß ein Vergleich auf der Synclromebene eine höhere Übereinstimmung ergeben hätte. Auf dem AMP-Beleg wurden nicht nur zum Teil andere, sondern auch mehr Symptome markiert. Dies unterstreicht die Bedeutung des Dokumentationssystems für die Schätzung von Symptomhäufigkeiten; Zahl und Strukturzusammenhang der auf AMP angebotenen Symptome, das erhöhte Risiko falsch positiver Dokumentation bei Benutzung einer Symptomliste und das falsch negativer bei frei formulierter Befunddokumentation dürften für die gefundenen Unterschiede von wesentlicher Bedeutung sein. In gewissem Umfang ließ sich ein diagnosenabhängiger Einfluß auf die Symptomdokumentation nachweisen. Auch ein deutlicher untersucherabhängiger Einfluß wurde gefunden. Dieser korrelierte jedoch nicht mit der klinisch-psychiatrischen Erfahrung, was auf persönlichkeitsspezifische Einflüsse und die nur begrenzte Trainierbarkeit des psychiatrischen Dokumentationsverhaltens hinweist.
Education in Medical Informatics in the Federal Republic of Germany))
Authors: Koeppe P.
Published: March 2018

The paper deals with the present situation of education at the academic level in Medical Informatics (or Medical Information Science, Electronic Data Processing applied to medicine and the health care service etc.) in the Federal Republic of Germany.

Following some introductory remarks about definitions, tasks, and prospects, the different types of education and their availability at certain universities are described. The current capacity is about 100 graduations per year.

It is estimated by the author that in future the average number of positions to be occupied by medical computer scientists will be in the order of 50 per year for the Federal Republic of Germany including Berlin (West).

It is, therefore, concluded that the present capacity in regard to graduations is sufficient. More emphasis should be laid on developing and organizing curricula for further qualification as well as refresher courses for those already engaged in the field of medical informatics.
An Interhospital Problem-Oriented and Automated Discharge Summary
Authors: Roger F. H. , Joos Monique , Haxhe J. J.
Published: March 2018

A problem-oriented medical record summary is described with special emphasis on patient profiles and on coding features that enable providers of care to have access to the computerized data base implemented by them. Input selection resulted from a Belgian interuniversity agreement in order to best serve physician’s purposes in the delivery of health care as well as in clinical research and medical education.

Such a summary permits an output validation that is public health- as well as patient care-oriented in a coordinated interhospital system. Specialized records (autopsy, hemodialysis, . . .) can be linked to the centralized interdepartmental summary. Results from experience on nearly 30,000 medical records are discussed. Programs have been written in COBOL and FORTRAN for an IBM 370/158 computer system in batch processing.
Medical Image Processing in an Era of High-Performance Computing
Authors: Gong Leiguang , Kulikowski Casimir A.
Published: March 2018

Advanced radiology practices are already benefiting from powerful and increasingly more economical computing and networking facilities. Medical image processing methods have improved dramatically over the past five years, with sophisticated 3D display, visualization and analysis techniques allowing increased integration of multiple modalities of imaging, flexible environments for imaging analysis, and P ACS (picture archiving and communication systems) for ease of transmission and retrieval. Emerging directions involve teleradiology and telesurgery virtual reality applications, the development of new image database techniques, and the building of large visual databases like that of the Visible Human Project. Challenging problems of image segmentation, registration, and multimodal image fusion are still with us. Building dynamic, flexible electronic atlases will have a profound effect on the understanding of structure and function from the level of cellular physiology to gross anatomy, but requires the development of new techniques of visual knowledge representation and more standardized ways of defining the conceptual and linguistic constructs of visual objects in biomedicine, for linkage to medical records, research results, and educational materials. Methods for reasoning with visual information in the context of multimedia information systems present an inviting challenge to the upcoming generation of researchers in medical informatics.
Nursing Informatics: State of the Science
Authors: Grobe S. J.
Published: March 2018

Nursing informatics is a combination of computer science, information science and nursing science designed to support the practice and delivery of patient care. Using the informatics model of data, information and knowledge, the nature of automated systems to support clinicians in their delivery of high-quality care are described from their inception to their current state, and the importance of research to advance the state of nursing know ledge are emphasized. The evolution of clinical care systems and nursing management systems are viewed, as is the progress of the scientific work relative to nursing informatics. Milestones in the advancing state of the science are identified and the conclusion is drawn that although nursing informatics has evolved, much scientifically based work remains. Key nursing informatics resources identified in the paper support this conclusion about what remains to be accomplished.