bluuebunny/crossref_metadata_2025 huggingface dataset:
The Representation of Meaning in the UMLS
Authors: McCray A. T. , Nelson S. J.
Published: March 2018

The UMLS knowledge sources provide detailed information about biomedical naming systems and databases. The Metathesaurus contains biomedical terminology from an increasing number of biomedical thesauri, and the Semantic Network provides a structure that encompasses and unifies the thesauri that are included in the Metathesaurus. This paper addresses some fundamental principles underlying the design and development of the Metathesaurus and Semantic Network. It begins with a description of the formal properties of thesauri, including the Metathesaurus, and the formal properties of the Semantic Network. It continues with consideration of the principle of semantic locality and how this is reflected in the UMLS knowledge sources. The paper concludes with a discussion of the issues involved in attempting to re-use knowledge and the potential for re-use of the UMLS knowledge sources.
Uncertainty and Decisions in Medical Informatics
Authors: Szolovits P.
Published: March 2018

This paper presents a tutorial introduction to the handling of uncertainty and decision-making in medical reasoning systems. It focuses on the central role of uncertainty in all of medicine and identifies the major themes that arise in research papers. It then reviews simple Bayesian formulations of the problem and pursues the generalization to the Bayesian network methods that are popular today. Decision making is presented from the decision analysis viewpoint, with brief mention of recently-developed methods. The paper concludes with review of more abstract characterization of uncertainty, and anticipates the growing importance of analytic and “data mining” techniques as growing amounts of clinical data become widely available.
Age-Related Reference Ranges for Growth Parameters
Authors: Wellek S. , Merz E.
Published: March 2018

We propose an approach to the computation of age-related reference ranges which guarantees that the proportion of sampled data points covered by the reference band has an arbitrarily specified value. Unlike other approaches in the literature, this method does not have to rely on parametric distributional assumptions. The boundaries of the bands are given by smooth curves, and for modeling the mean as a function of age, a sufficiently flexible class of monotonically increasing functions is used, since in the applications all measured variables are biological growth parameters. The width of the reference band is allowed to be proportional to any suitably fixed function of age which we propose in practice to be taken linear. The approach is illustrated by examples from a large-scale study of the distribution of fetal size measurements obtained by routine prenatal sonography.
Hybrid Rendering of Multidimensional Image Data
Authors: Haubner M. , Lösch A. , Eckstein F. , Seemann M. D. , van Eimeren W. , Reiser M. , Englmeier K.-H.
Published: March 2018

The most important rendering methods applied in medical imaging are surface and volume rendering techniques. Each approach has its own advantages and limitations: Fast surface-oriented methods are able to support real-time interaction and manipulation. The underlying representation, however, is dependent on intensive image processing to extract the object surfaces. In contrast, volume visualization is not necessarily based on extensive image processing and interpretation. No data reduction to geometric primitives, such as polygons, is required. Therefore, the process of volume rendering is currently not operating in real time. In order to provide the radiological diagnosis with additional information as well as to enable simulation and preoperative treatment planning we developed a new hybrid rendering method which combines the advantages of surface and volume presentation, and minimizes the limitations of these approaches. We developed a common data representation method for both techniques. A preprocessing module enables the construction of a data volume by interpolation as well as the calculation of object surfaces by semiautomatic image interpretation and surface construction. The hybrid rendering system is based on transparency and texture mapping features. It is embedded in a user-friendly open system which enables the support of new application fields such as virtual reality and stereolithography. The efficiency of our new method is described for 3-D subtraction angiography and the visualization of morpho-functional relationships.
Bayesian Diagnostic Probabilities without Assuming Independence of Symptoms
Authors: Gammerman A. , Thatcher A. R.
Published: March 2018

The paper describes an application of Bayes’ Theorem to the problem of estimating from past data the probabilities that patients have certain diseases, given their symptoms. The data consist of hospital records of patients who suffered acute abdominal pain. For each patient the records showed a large number of symptoms and the final diagnosis, to one of nine diseases or diagnostic groups. Most current methods of computer diagnosis use the “Simple Bayes” model in which the symptoms are assumed to be independent, but the present paper does not make this assumption. Those symptoms (or lack of symptoms) which are most relevant to the diagnosis of each disease are identified by a sequence of chi-squared tests. The computer diagnoses obtained as a result of the implementation of this approach are compared with those given by the “Simple Bayes” method, by the method of classification trees (CART), and also with the preliminary and final diagnoses made by physicians.
Development of a Scoring System to Assist in the Diagnosis of Rheumatoid Arthritis
Authors: Rigby A. S.
Published: March 2018

During the last decade there has been a wealth of papers discussing the development of scoring systems in medicine, some of which have led to fully operational computer-aided diagnostic systems. In this paper we sketch the development of a simple scoring system for one of the more common rheumatic diseases, rheumatoid arthritis (RA) using a two-tier model, independence Bayes’ followed by logistic discrimination. The scoring system gives reasonably well calibrated probability estimates of RA which suggests ways in which the development of computerised systems in rheumatology might be approached.
Foundations for an Electronic Medical Record
Authors: Rector A. L. , Nowlan W. A. , Kay S.
Published: March 2018

Given the many efforts currently under way to develop standards for electronic medical records, it is important to step back and reexamine the fundamental principles which should underlie a model of the electronic medical record. This paper presents an analysis based on the experience in developing the PEN & PAD prototype clinical workstation. The fundamental contention is that the requirements for a medical record must be grounded in its use for patient care. The basic requirement is that it be a faithful record of what clinicians have heard, seen, thought, and done. The other requirements for a medical record, e.g., that it be attributable and permanent, follow naturally from this view. We use the criteria developed to re-examine Weed’s Problem Oriented Medical Record and also relate the criteria to secondary uses of the medical record for population data, communications and decision support.
Recommendations of the German Association for Medical Informatics, Biometry and Epidemiology for Education and Training in Medical Informatics
Authors: Dudeck J. , Gaus W. , Leven F. J. , Kunath H. , Michaelis J. , Pretschner D. P. , Sonntag H.-G. , Thurmayr R. , Wolters E. , Haux R. ,   On behalf of the Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (GMDS)
Published: March 2018

In the fields of health care and medicine there is an immense demand for a systematic application of methods of information processing and for the use of computers. Obviously, to that end well-trained scientists and qualified personnel must be available. With the present recommendations on education and training in medical informatics the German Association for Medical Informatics, Biometry and Epidemiology (GMDS) proposes structure and contents of medical informatics curricula and courses. The recommendations describe a 2-dimensional educational framework with different educational levels in one dimension and various types of educational needs and orientation in the other one. The recommendations comprise at the university level education as well specialized curricula covering the total spectrum of medical informatics as well as informatics curricula with medical informatics as integrated applied subject or subsidiary subject, respectively. Besides these informatics-oriented approaches medical-oriented programs of education in medical informatics are recommended, e.g., post-graduate education in medical informatics for physicians based on foundations in medical informatics as part of their initial training in medicine. At the level of polytechnical schools curricula of medical documentation and informatics and at the level of professional schools training in medical documentation are recommended. This report is a translation of its German original. Although considered by the GMDS as recommendations for the Federal Republic of Germany, the text may also contribute to the development of an international, especially European framework of training in medical informatics.
Testing the Gaussianity of the Human EEG During Anesthesia
Authors: Schultz B. , Schultz A. , Pichlmayr I. , Bender R.
Published: March 2018

The Gaussian properties of human EEGs, which were measured over various stages of general anesthesia, were tested. The basis of the method was to describe the EEG signals by autoregressive models and to test the normality of the regression residuals with the Shapiro-Wilk statistic. The results show that in general the human EEG during anesthesia can be considered as a realization of a Gaussian stochastic process.
Simple Computer-Assisted Diagnosis of Acute Myocardial Infarction in Patients with Acute Thoracic Pain
Authors: Pietsch-Breitfeld B. , Stein W. , Overkamp D. , Ickrath O. , Renn W. , Pfohl M. , Kiesenbauer U. , Jäck S. , Eggstein M. , Selbmann H. K. , Dilger J.
Published: March 2018

In order to minimize the initial diagnostic uncertainty in patients suspected of having acute myocardial infarction, we prospectively extracted predictive variables from previous history, ECG, and clinical chemical parameters of 87 patients, who were admitted for acute thoracic pain. The variables thus extracted were: Thoracic pain in previous history, duration of pain, white blood cell count, blood glucose, creatine-kinase, and S-T elevation in the ECG. These parameters were used for formulating a mathematical model based upon univariate and multivariate statistical methods. The sensitivity of the model in the study population was 95% and the specificity 77%. Correct classification was achieved in 89% of cases.

In a second phase, the prognostic index was prospectively evaluated in a second set of 122 consecutive patients. In this test population, the sensitivity was 89% and the specificity 86%. 87% of patients were classified correctly.
The Performance of Information-Theoretic Criteria in Detecting the Number of Independent Signals in Multilead ECGs
Authors: van Oosterom A. , Uijen G. J. H.
Published: March 2018

Three different methods to detect the number of independent signals in multilead ECGs were evaluated by using different ECG realizations with known specifications for signal and noise: a threshold method (TM), the minimum description length (MDL) and Akaike’s information criterion (AIC).

The fundamental assumption in this kind of signal processing is that both the signal and the noise stem from independent stochastic generators. The consequence is that the detection of the number of signals is only possible if the noise is white, or if the noise properties have been specified.

The evaluation was performed with respect to the QRS complex of individual multilead ECG simulations and to the entire ensemble. In the simulated ECGs the number of independent signals was fixed (eight). It was found that, out of the three methods studied, the performance of MDL was the best, especially when the number of available observations in the noise (used to estimate the noise specifications) was moderate.
Benefits and Risks of Combined Oral Contraceptives
Authors: Vessey M. P.
Published: March 2018

The use of combined oral contraceptives carries a number of well-established major non-contraceptive benefits. Of these, the most important protective effects are suppression of the risk of epithelial cancer of the ovary and cancer of the endometrium. Also of great importance is a reduction in the risk of pelvic inflammatory disease. Needless to say, there are also some established risks of combined oral contraceptives. The most important of these are the vascular ones, comprising effects on acute myocardial infarction, thrombotic stroke, haemorrhagic stroke, and venous thrombosis and embolism. Possible risks which are still under evaluation include an adverse effect on breast cancer and, likewise, on carcinoma of the cervix. More information is needed about both these conditions. A number of authors have provided analyses of varying degrees of complexity in which they have attempted to weigh the benefits and risks of combined oral contraceptives. Results from some of these studies are presented in the paper. On the whole, the findings are reasonably reassuring.
Forecasting Survival in the Medical Intensive Care Unit: A Comparison of Clinical Prognoses With Formal Estimates
Authors: Cottrell J. J. , Murakami J. , Mackesy M. E. , Fetzer B. , Elstein A. S. , Christensen C.
Published: March 2018

Physicians often need to make prognostic judgments. In the present study, the accuracy was explored of survival estimates for patients in the Medical Intensive Care Unit (MICU). Estimates were made by physicians and nurses several times during each patient’s stay in the MICU and were compared to those of the APACHE II scale, a widely used quantitative index for critically ill patients. ROC curve and calibration curve analyses were performed to assess the accuracy of these estimates. Results revealed that MICU personnel were fairly accurate discriminators of patients who survived vs. who died, although there was a consistent tendency to underestimate survival. In addition, there was some relationship between the level of physician training and forecasting accuracy, but only within the patient’s first 24 hours in the MICU. Finally, the estimates of physicians did not differ significantly from those of the APACHE II scale. Physicians tended to be better calibrated in their predictions, while the APACHE II scale was slightly superior in terms of discrimination.
Event Detection on Patient Monitoring Data Using Causal Probabilistic Networks
Authors: Laursen P.
Published: March 2018

Applications are described of the knowledge-representation technique Causal Probabilistic Networks for the detection of events related to the patient and the monitoring equipment, in the context of intensive care patient monitoring. The purpose of the event detection is to reduce the number of false alarms generated by the patient monitor, and to generate alarms related to patient or equipment events rather than to threshold violation. A PC-based system has been developed and tested on patient data. A system for real-time use in patient monitoring is under development.
Model-Based Biosignal Interpretation
Authors: Andreassen S.
Published: March 2018

Two relatively new approaches to model-based biosignal interpretation, qualitative simulation and modelling by causal probabilistic networks, are compared to modelling by differential equations. A major problem in applying a model to an individual patient is the estimation of the parameters. The available observations are unlikely to allow a proper estimation of the parameters, and even if they do, the task appears to have exponential computational complexity if the model is non-linear. Causal probabilistic networks have both differential equation models and qualitative simulation as special cases, and they can provide both Bayesian and maximum-likelihood parameter estimates, in most cases in much less than exponential time. In addition, they can calculate the probabilities required for a decision-theoretical approach to medical decision support. The practical applicability of causal probabilistic networks to real medical problems is illustrated by a model of glucose metabolism which is used to adjust insulin therapy in type I diabetic patients.
Non-Linear Dynamics in the Beat-to-Beat Variability of Sympathetic Activity in Decerebrate Cats
Authors: Baselli G. , Montano N. , Gnecchi-Ruscone T. , Lombardi F. , Malliani A. , Cerutti S. , Porta A.
Published: March 2018

Non-linear interactions between low-frequency rhythms (0.1 Hz) of beat-to-beat variability series of sympathetic discharge and respiratory rhythm (0.3 Hz) are observed in decerebrate artificially ventilated cats. Simple graphical tools as Poincare and recurrence maps are used to detect, in a qualitative way, phase-locking phenomena. Non-parametric bispectral analysis is also carried out to quantify the degree of second-order coupling between oscillations at different frequencies.
Non-Linear Dynamics of Cardiovascular Variability Signals
Authors: Cerutti S. , Guzzetti S. , Parola R. , Signorini M.G.
Published: March 2018

Long-term regulation of beat-to-beat variability involves several different kinds of controls. A linear approach performed by parametric models enhances the short-term regulation of the autonomic nervous system. Some non-linear long-term regulation can be assessed by the chaotic deterministic approach applied to the beat-to-beat variability of the discrete RR-interval series, extracted from the ECG. For chaotic deterministic systems, trajectories of the state vector describe a strange attractor characterized by a fractal of dimension D. Signals are supposed to be generated by a deterministic and finite dimensional but non-linear dynamic system with trajectories in a multi-dimensional space-state. We estimated the fractal dimension through the Grassberger and Procaccia algorithm and Self-Similarity approaches of the 24-h heart-rate variability (HRV) signal in different physiological and pathological conditions such as severe heart failure, or after heart transplantation. State-space representations through Return Maps are also obtained. Differences between physiological and pathological cases have been assessed and generally a decrease in the system complexity is correlated to pathological conditions.
Case-Based Explanation for Medical Diagnostic Programs, with an Example from Gynaecology
Authors: Stamper R. , Todd B. S. , Macpherson P.
Published: March 2018

One of the most accountable methods of providing machine assistance in medical diagnosis is to retrieve and display similar previously diagnosed cases from a database. In practice, however, classifying cases according to the diagnoses of their nearest neighbours is often significantly less accurate than other statistical classifiers. In this paper the transparency of the nearest neighbours method is combined with the accuracy of another statistical method. This is achieved by using the other statistical method to define a measure of similarity between the presentations of two cases. The diagnosis of abdominal pain of suspected gynaecological origin is used as a case study to evaluate this method. Bayes’ theorem, with the usual assumption of conditional independence, is used to define a metric on cases. This new metric was found to correspond as well as Hamming distance to the clinical notion of “similarity” between cases, while significantly increasing accuracy to that of the Bayes’ method itself.
Comparing Mortality and Morbidity in Hospitals: Theory and Practice of Quality Assessment in Peer Review
Authors: van Hemel O. J. S. , Elferink-Stinkens P. M. , Verloove-Vanhorick S. P. , Brand R.
Published: March 2018

The incidence of mortality in a specific hospital depends on many risk factors. These risk factors may be divided roughly into two categories. The intake category, consists of those risk factors for which the hospital has hardly any influence upon their incidence; and the care category being those for which the incidence depends partly or completely on the treatment policy of the hospital. A hospital with a high incidence of risk factors in the intake category will have a higher mortality rate than a hospital with a low incidence, even if their care is exactly the same (i. e., if they treat their infants equally well). Therefore, a fair comparison between one hospital and a reference cohort, or among several hospitals (using a national registry) should adjust e. g. correct for those risk factors belonging to the intake category. A practical method is proposed, based on logistic regression, to effectuate such a “fair” judgment. The regression technique enables to compare “observed” and “expected” rates in a specific hospital and to test whether a difference between these rates is statistically significant. Both clinical and statistical aspects of the method are discussed, as well as the actual implementation of an automated annual reporting system. The method has been implemented in the Netherlands as an annual peer review and quality assessment system in obstetric care.
Medical Office Automation Integrated into the Distributed Architecture of a Hospital Information System
Authors: Revillard C. , Borst F. , Berthoud M. , Lovis C. , Scherrer J.-R.
Published: March 2018

Patient histories, discharge summaries, and medical consultant reports are made up of written texts. Therefore, the gathering and archiving of these texts in machine-readable form has many characteristics of computer-based medical records. In Geneva, approximately 1,540 PCs are connected to the Hospital Information System DIOGENE 2, with the possibility of accessing all the functions offered by the system without losing any of their MS-DOS word processing capabilities. The UNIDOC system, presented in this paper, takes all these features into account, a real marriage of technologies between the MS-DOS environment and the distributed client-server architecture. The INGRES database management system supports the entire archiving process of the medical patient texts, structured by prelabelled paragraphs and automatically indexed. Both the quality and accessibility of the records are enhanced, while the archiving capacity is neither too limited nor too expensive.
The Need for Requirements Engineering in the Development of Clinical Decision-Support Systems: A Qualitative Study
Authors: Johansson M. , Timpka T.
Published: March 2018

Insufficient requirements analysis has recently been suggested as a problem in clinical decision-support systems development. Therefore, to explore knowledge, practices and attitudes, key professionals in the area from four countries were interviewed regarding the early phases in the development process. For data collection, semi-structured interviews were performed and video-taped. As reference, documentation of the Action Design requirements engineering methodology was used. Two separate qualitative analyses of the data were made. The first was to identify central concepts and attitudes related to requirements engineering. In the second anlysis, concrete circumstances surrounding decisions to use requirements engineering methods were investigated. This paper reports the results of the analyses and discusses changes in the planning and management of clinical decision-support projects in general, and it comments on development methods, using Action Design as reference. It is concluded that studies are needed to further investigate the problems real decision-support projects have to deal with. This knowledge can then be used to develop methods and tools which support design practices where existing structural, procedural and, building on this, technical obstacles are overcome.
Directions and Opportunities in Health Informatics in British Columbia
Authors: Thornton K.
Published: March 2018

The social changes, and changes in perceptions of the effectiveness of health care in British Columbia have resulted in a large number of recommendations in the report of the British Columbia Royal Commission on Health Care and Costs. Many of these recommendations have implications for health informatics. The British Columbia Government, in outlining a response, foresees a major change in the emphases of health care, which will involve four major areas of health informatics: network evolution, automation of the patient record, outcome- and other quality-related databases, and consumer health education. These themes are discussed, in the light of the opinions of academics, health care providers, and the health-informatics industry. The themes must be intercalated into the health informatics curriculum, to equip graduates for the challenges of B.C.’s changing health care system.
The Development of a Graduate Program in Health Information Management
Authors: Johns M. L.
Published: March 2018

The development of a graduate program in Health Information Management is described. The purpose of the program is to prepare individuals to assume executive level roles in a variety of health-care enterprises in health information resources management. The curriculum is based on empirical findings of a role delineation study of chief information officers (ClOs) in the USA. A model of professional practice of the CIO was developed from study findings which describes the role of the CIO from the standpoint of functional areas of entrepreneur, resource allocator, negotiator, information disseminator, information monitor, leader, and operations manager.
Computer-Assisted Bayesian Diagnosis of Connective Tissue Diseases
Authors: Walsh T. R. , Lindberg D. A. B. , Klink E. J. , Sharp G. C.
Published: March 2018

Bayes’ Theorem was applied interactively with a microcomputer to a rheumatology data base to provide a differential diagnosis of six primary connective tissue diseases. This diagnosis was evaluated in terms of the clinical diagnosis reached by a consensus of at least two of three rheumatologists. For each patient case, the diagnosis having the highest likelihood, after taking into account disease prevalence and combined symptom frequencies, was selected by the computer. The diagnostic model was trained by data from thoroughly studied clinical cases, for each of which 44 clinical and laboratory findings were collected according to a standard data base protocol. Each case received one of six diagnoses based on full clinical appraisal. Comparison of the diagnoses revealed 100 per cent agreement between the computer and the clinicians for the training population of 137 cases, and 94.4 per cent agreement for an independent, thoroughly studied test set of 89 cases. During testing, we observed the system had a genuine educational value for medical students and non-rheumatologists. In addition, there appeared to be a potential future use in facilitating actual clinical problem solving.
MIRACLE: A Time-oriented Data Validation and Analysis System for Clinical Research
Authors: Sinn H. P. , Altendorf A. , Estelmann A.
Published: March 2018

MIRACLE is a medical information system designed to validate and analyse time-oriented data. The chronological patient database is composed of user-defined repeating groups stored in numerically coded character records of variable length. A flexible query language gives access to semantic validation, cross-sectional and mixed-longitudinal analysis. The main application is at present a large hospital-based tumor register.
Skull X-Ray Assessment of Head Injuries: A Decision Analytic Approach
Authors: Balla J. I. , Elstein A. S.
Published: March 2018

We demonstrate the value of skull x-rays in the assessment of head injured patients. With the use of the simple decision analytic technique of 2 x 2 tables and literature derived figures, it is shown that in patients with a normal neurological examination following head injuries, skull x-rays are a cost-effective method of detecting preventable complications. The positive predictive value (PVP) of skull x-rays in these patients is. 03, in contrast to .001 of the group as a whole. Such cases should then have a CT scan to detect early cases of intracranial haematoma (ICH). The presence of abnormal neurological signs has a high PVP of .2 for complications; in these patients, skull x-rays do not improve the detection of ICH and CT scanning alone should be carried out.
A Medical Microcomputer Database Management System
Authors: Naddaf-Dezfbli A. R. , Davenport Sandra L. H. , Joyce A.
Published: March 2018

The Patient Data Handler (PDH) is an interactive, microcomputer-based database management system. It is written in DEC BASIC-11 and runs on a DEC compatible LSI-11/03. The PDH is a relational database specifically designed to handle a very large number of attributes per patient. The retrieval program is capable of performing any combination of Boolean operations on the patient records. Data security is provided by several levels of password protection. The current application has 3,500 attributes associated with a research project on deaf-blind syndromes. Specific retrieval examples are shown from this database.
Graphical Access to Medical Expert Systems: III. Design of a Knowledge Acquisition Environment*)
Authors: Walton Joan , Musen M. A. , Combs D. M. , Lane C. D. , Shortliffe E. H. , Fagan L. M.
Published: March 2018

Knowledge acquisition for expert systems typically is a tedious, iterative process involving long hours of consultation between the domain experts and the computer scientists who serve as knowledge engineers. For well-understood domains, however, it may be possible to facilitate the knowledge acquisition process by allowing domain experts to develop and edit a knowledge base directly. Administration of protocol-directed cancer chemotherapy is such a well-understood application area, and a knowledge acquisition system, called OPAL, has been developed for eliciting chemotherapy-protocol knowledge directly from expert oncologists. OPAL’s knowledge acquisition approach is based on the interactive graphics environment available on current generation workstations. The use of graphics improves the interface by reducing typing, avoiding natural language interpretations, and allowing flexibility in entry sequence. The knowledge in OPAL is displayed using an arrangement of hierarchically related, graphical forms. The position of a particular form in the hierarchy defines the context of the knowledge contained in the form. Intelligent editing programs such as OPAL can streamline the knowledge engineering process for highly structured domains requiring repetitive knowledge entry.
A Computer-based Clinical Information System
Authors: El-Gamal S. S.
Published: March 2018

Modern information technology offers new opportunities for the storage and manipulation of hospital information. A computer-based hospital information system, dedicated to urology and nephrology, was designed and developed in our center. It involves in principle the employment of a program that allows the analysis of non-restricted, non-codified texts for the retrieval and processing of clinical data and its operation by non-computer-specialized hospital staff.

This Hospital Information System now plays a vital role in the efficient provision of a good quality service and is used in daily routine and research work in this hospital. This paper describes this specialized Hospital Information System.
Bivariate Structural Regression Analysis: A Tool for the Comparison of Analytic Methods
Authors: Feldmann U. , Schneider B.
Published: March 2018

This paper introduces the concept of bivariate structural regression analysis, a new technique which offers some advantages compared to the well-known structural relationship approach. The concept is not restricted to multivariate normal distribution, and without additional constraints the model remains identifiable in the bivariate case. A bivariate calibration line is developed first by the maximum likelihood method and then also distribution-free by applying rank statistics. Both estimation procedures coincide, if the distribution assumption is satisfied. Hence, the distribution-free approach has an efficiency of 100%. Our concept of analysis is applied to the comparison of analytical methods in clinical chemistry. Appropriate statistical tests concerning accuracy and precision as well as the model fit are offered.
Monitoring Intervals between Rare Events: A Cumulative Score Procedure Compared with Rina Chen’s Sets Technique
Authors: Wolter Chr
Published: March 2018

A cumulative score procedure (cuscore) is compared with Rina Chen’s sets technique. Cumulative score procedures make a faster detection of subtle epidemics of rare diseases possible. Besides, the implementation of this new sequential technique is very simple. Therefore, the use of the cuscore procedure instead of the sets technique is recommended.
A Nonparametric Law of Initial Values (LIV) Test for Comparing Spreads in Two Paired Samples
Authors: Lienert G. A. , von Eye A.
Published: March 2018

Wilder’s law of initial values suggests that treatments lead to an increase of originally low and a decrease of originally high scores. The paper proposes a nonparametric test to determine whether in pre-post designs measurements differ in their relative dispersion. The test is based on a similar rationale as Westenberg’s interquartile range test for comparing unpaired samples. Modifications and applications are discussed. The test is illustrated using a biomedical data example.
Modeling Hospital Information Systems with Petri Nets
Authors: Peimann C.-J.
Published: March 2018

In the development of hospital information systems it is difficult to describe data and activities simultaneously and equivalently. Most of the methods used so far are only suitable for either data structures or functional modeling. In particular, it is not possible to comprehend the functional interdependence of hospital procedures.

In this paper it is shown that Petri Nets are well suited for the development of complex software systems. Their exceptional properties are, on the one hand, the simulative capacities which allow to visualize interlinked and interdependent procedures of the real world. On the other hand, it is pointed out that Petri Nets comply with the demands of software engineering. In order to make these characteristics clear, two models from real developments are used: Firstly the organizational model of a small hospital and secondly the model of the data entry in the follow-up of tumor patients.
Recall of Injury Events by Thirteen Year Olds
Authors: Cecchi J. C. , Williams S. M. , Langley J. D.
Published: March 2018

The level of under-reporting of injury events which resulted in medical treatment was determined for a group of 631 thirteen-year olds. Two-year recall data was compared with the medical records of an accident and emergency department. Thirty-nine percent of all visits to the accident and emergency department were not recalled. Recall was shown to be related to the number of injury events, time elapsed since an injury event, type and severity of injury but not to whether the victim was hospitalized. Logistic regression analysis suggested that the recall of injury events depended on the type of injury sustained, time elapsed since the injury event, the number of injury events, and an interaction effect between the time and the number of injuries.
Discriminating Powers of Partial Agreements of Names for Linking Personal Records
Authors: Newcombe H. B. , Fair M. E. , Lalonde P.
Published: March 2018

Machines have difficulty when using people’s names to link medical and other records pertaining to the same individuals because of nicknames, ethnic synonyms, truncations, misspellings and typographical errors. Present algorithms used to compute the discriminating powers (or ODDS) associated with partial agreements of names are based, inappropriately, on the degrees of outward similarity alone. They are particularly ineffective in dealing with names that look alike but are unrelated, and with related names that have little apparent similarity. A fundamentally different rationale is, therefore, proposed which, like the human mind, assesses the relatedness of two alternative forms of a name in terms of how often they are used, interchangeably in practice. This must be taken into account if the associated discriminating powers (ODDS) are to be correctly computed. A way of implementing this more precise approach is described and illustrated, using the given names on linked records from an earlier epidemiological study. This first study of two describes the logical basis for record linkage, a second one the empirical test.
The Data Dictionary – A Controlled Vocabulary for Integrating Clinical Databases and Medical Knowledge Bases
Authors: Linnarsson R. , Wigertz O.
Published: March 2018

The medical information systems of the future will probably include the entire medical record as well as a knowledge base, providing decision support for the physician during patient care. Data dictionaries will play an important role in integrating the medical knowledge bases with the clinical databases.

This article presents an infological data model of such an integrated medical information system. Medical events, medical terms, and medical facts are the basic concepts that constitute the model. To allow the transfer of information and knowledge between systems, the data dictionary should be organized with regard to several common classification schemes of medical nomenclature.
A Microfilm-Oriented Central Archive for Patient Records in a Large Patient Care Installation
Authors: Möhr J. R. , Tramp H. J.
Published: March 2018

The Central Archive for Patient Records (CAFPR) of the Medical School Hannover, which includes a large, highly centralized patient care facility, is described. Special emphasis is placed upon environment, concept and development, functional organization and requirements. On the basis of this description, the advantages of a microfilm-oriented archive over a conventional archive are discussed.
Neue Auswertungsmöglichkeiten pathologisch-anatomischer Befundberichte. Klartextanalyse durch Elektronenrechner
Authors: Röttgeb P. , Reul H. , Sunkel H. , Klein I.
Published: March 2018

Die Klartextanalyse ist eine neue Methode der automatischen statistischen Auswertung des Sektionsgutes. Sie wurde mit folgenden Ergebnissen an einem vollständigen Jahrgang von Befundberichten erstmals erprobt:

Die Überprüfung der Vollständigkeit der Befunderfassung am Beispiel der »Lungenembolie« ergab

die gleiche Zuverlässigkeit wie die Auswertung von Hand.

Die statistische Auswertung konnte bei Bedarf sofort mit einer Wahrscheinlichkeitsberechnung kombiniert werden.

Befunde wie »Arteriosklerose«, »Karzinom«, »Tuberkulose«, »Lungenembolie«, »Cholelithiasis« und »Myokardinfarkt« konnten auf ihre Häufigkeit sowohl einzeln als auch in Kombination ausgezählt werden.

Zusatzinformationen zu diesen Befunden, wie Angaben über Lokalisationen, Intensität, Befundalter und morphologische Varianten, konnten gleichfalls statistisch erfaßt werden.

Numerische Daten aus den Befundberichten (z. B. Patientenalter) konnten in Korrelation zu Befunden wie »Karzinom« und deren weitere Einengungen, wie »Lungenkarzinom« oder »Magenkarzinom«, gebracht werden.

Auch Informationen, die erst durch die automatische Standardisierung zusätzlich in die primären Texte eingebracht worden waren, konnten ausgewertet werden. Als Beispiel für solche Notationen des Facetten-Thesaurus wurden Krankheitsobergruppen, die nach allgemein-pathologischen Gesichtspunkten zusammengestellt worden waren (»Kreislaufleiden«, »bösartige Geschwülste« usw.), in Korrelation zu einem bestimmten Befund (»Lungenembolie«) ausgezählt.

Die Auszählergebnisse stimmten im wesentlichen mit den Resultaten konventionell durchgeführter statistischer Untersuchungen am Sektionsgut überein. Sie ergaben außerdem Anregungen zu weiteren, mit der gleichen Methode durchzuführenden Untersuchungen.
Toward Standardizing the Facesheet of Medical Charts
Authors: Cook G. B.
Published: March 2018

Concerned by the diversity of content and arrangement of data recorded in medical charts from different hospitals, the author sought to find areas of agreement from which to set standards. As a beginning, the facesheet of the record was studied and is reported here. Ninety-seven hospitals in Missouri were queried. All contents of the facesheets were compared and given a frequency rank. A computation was then made to show which input was used most often by most hospitals.
Current Status of a Medical Information System
Authors: Van Brunt E. , Davis L. S. , Terdiman J. F. , Singer S. , Besag E. , Collen M. F.
Published: March 2018

A pilot medical information system is being implemented and currently is providing services for limited categories of patient data. In one year, physicians’ diagnoses for 500,000 office visits, 300,000 drug prescriptions for outpatients, one million clinical laboratory tests, and 60,000 multiphasic screening examinations are being stored in and retrieved from integrated, direct access, patient computer medical records.

This medical information system is a part of a long-term research and development program. Its major objective is the development of a multifacility computer-based system which will support eventually the medical data requirements of a population of one million persons and one thousand physicians. The strategy employed provides for modular development. The central system, the computer-stored medical records which are therein maintained, and a satellite pilot medical data system in one medical facility are described.
Medizinische Dokumentation und elektronische Datenverarbeitung in einem Universitätsklinikum (Planungen —Erfahrungen—Vorschläge)
Authors: Schmidt K.
Published: March 2018

Im Klinikum Steglitz wird eine medizinische Befunddokumentation (Basisdokumentation) aufgebaut, die pro Krankengeschichte 2 bis 38 Lochkarten umfaßt und zunächst auf Magnetband gespeichert wird. Neben 2 Programmen zur Kontrolle, Zusammenführung und Speicherung der Daten gibt es ein Programm zum sachbezogenen Durchmustern des Datenbestandes. Dabei können mehrere Aspekte durch die logischen Verknüpfungen UND sowie UND NICHT zu einer Suchanfrage verbunden werden. Die Ergebnisse der Suchanfrage werden wahlweise in einer Kurzfassung (1 Zeile/Krankengeschichte) oder in einer Langfassung (1 Seite/Krankengeschichte) gedruckt. Diese enthält die Angaben zur Person, Diagnosen, besondere diagnostische und besondere therapeutische Maßnahmen. Danach kann der Anfragende entscheiden, welche Krankenakten er anfordern will.
Ein informationsanalytischer Test auf partielle Kontingenz in Dreiwegtafeln
Authors: Escher H. , Lienert G. A.
Published: March 2018

Ausgehend von der medizinischen Bedeutung partieller Korrelationen wird ein informationstheoretischer. Test für dreidimensionale Kontingenztafeln dazu benutzt, die Kontingenz zweier qualitativer bzw. Die Korrelation zweier quantitav-gruppierter Zielmerkmale unabhängig von dem Einfluß eines dritten, die Zielmerkmale beeinflussenden Kontrollmerkmals auf Signifikanz zu prüfen. Der Test wird anhand eines psychopharmakologischen Beispiels durchgerechnet und seine Ergebnisse interpretiert. Für Fälle, in denen das Kontrollmerkmal stetig verteilt ist, werden andere Methoden der partiellen Kontingenzprüfung empfohlen und vergleichend gewürdigt.
Zur Erfassung und Verarbeitung medizinischer Daten mittels Computer
Authors: Gieee W.
Published: March 2018

Das Dekodierungsund Text-Ausgabe-Programm (DUTAP) wird beschrieben. DUTAP dient der weiteren Verarbeitung der Daten, die nach dem in den früheren Mitteilungen beschriebenen System DUSP erfaßt wurden.

Basis des Programmsystems ist eine leicht verständliche, problemorientierte Programmiersprache in Form einer sogenannten »Meta-Sprache«. Die Umwandlung der Befehle durch den Sprachübersetzer ergibt das Benutzerprogramm mit einem der Erhebungsbogenstruktur entsprechenden Ablaufteil und den aus Gründen der’ Verarbeitungsgeschwindigkeit im Programm formulierten Textkonstanten. Mehrere problemorientierte DUTAP-Moduln in Uberlagerungsstruktur werden durch die systemorientierten DUTAP-Moduln zu einem Programm großer Flexibilität ergänzt. Ein gemeinsamer Verständigungsbereich dient der Übergabe von Information aus der jeweils aktuellen -Problemin die Systemphase und vice versa.

Die Anwendung des DUSP/DUTAP-Systems ermöglicht es einerseits den Ärzten, sich zur Befundung im Regelfall mit einer Art Kurzschrift zu begnügen, andererseits läßt sich die Programmierung der Kurzschrift-Entschlüsselung zur allgemein verständlichen Langtextausgabe in der DUTAP-Programmiersprache nach kurzer Einarbeitungszeit von Hilfskräften erledigen.
Automated Management of Routine Medical Records in General Practice
Authors: CLARKE A. H. , DIXON R. A. , RICKARDS D. F. , SAXBY N. V.
Published: March 2018

Out-dated methods for recording details of routine consultations in general practice in England and Wales indicate the need for a more logically structured and automatically summarised patient record, particularly as large group practices increase in number.

Progress is reported of a flexible phased programme for the construction of computer-stored, long-term medical histories of individual patients. These are derived from details of every consultation in a group general practice, recorded in structured narrative form on paper tape. No additional work is required of the doctor, and the additional work of the secretarial staff is minimised by the use of program tapes and punched cards bearing patient identification. Lists giving full details of all doctor/patient contacts can be produced. The corresponding master tapes can be searched and subsidiary lists printed out.
Automated Multiphasic Health Testing and Services. Total Systems Analysis and Design
Authors: FLAGLE Ch. D.
Published: March 2018

The design of a multiphasic health testing centet must be based simultaneously upon knowledge of the population to be served and upon the capabilities of the medical services available to those who are tested. Multiphasic testing may be regarded as a regulator of patient flow from the population into a variety of health services, where rate of patient referral is a function of the rate of testing, the prevalence of medical conditions requiring service, and the sensitivity and specificity of tests used. Rules are given for choice of tests to be administered, and the needs of data banks, including results of follow-up examinations are described.

Given the selection of a sequence of tests and the daily , range of rate of testing of individuals, the design of the facility is influenced by the service times required in each test station. Suggestions are given for arrangement of the testing sequence and continuous evaluation of the multiphasic health testing process.
Aufnahme von stationären Patienten mit Hilfe einer Datenverarbeitungsanlage
Authors: RETTENMAIER G. , BECHER H. , MATT K. H. , DITTMEYER R. , MÜller K.
Published: March 2018

Am Universitätskrankenhaus Erlangen (4 Kliniken, ca. 1000 Betten) werden seit 1. 1. 1970 die stationären Patienten zentral mit Hilfe eines Prozeßrechners Siemens 305 aufgenommen. Alle Patientendaten werden im Dialogverkehr zwischen Blattschreibern und Rechner eingegeben. Korrekturmöglichkeiten und formale Prüfungen sind im Programm enthalten. Die Patienten-Datei baut sich aus fest numerierten Plattenspeicherfeldern auf, die einer »Patienten-Nr.« entsprechen. Aufgrund der fehlergeprüften Daten werden obligatorisch und ohne besondere Anforderung für Verwaltungs- und ärztliche Zwecke zahlreiche Arbeitsmittel über Schnelldrucker ausgedruckt.