bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Poor Precedent
Authors: Tuttle M. S. , Nelson S. J. 
Published: March 2018

Abstract:The single greatest impediment to the successful leveraging of computer-based patient records (CPRs) is the difficulty of creating and maintaining comparable patient descriptions. Specifically, it will be hard to justify the investment required to deploy CPRs widely if the patient descriptions they store are not comparable across successive releases of controlled health-care vocabularies. Thus, it is necessary to solve the controlled health-care vocabulary update problem for CPRs before the comparability of patient descriptions can be sustained. What may seem to be a narrow technical problem of interest only to maintainers of health-care enterprise systems is, instead, a central problem of medical informatics. Cimino’s “Formal descriptions and adaptive mechanisms for changes in controlled medical vocabularies” describes a classification of the changes appearing in the 1994 Edition of the International Classification of Diseases (ICD-9-CM). His paper describes the conversion of differences detected between the 1993 and 1994 releases of ICD-9-CM and a conversion of the elements of the classification into the required formal changes to the Medical Entities Dictionary (MED), part of the CPR in use at Columbia Presbyterian Medical Center. Because the process of detecting differences begins with an empirical analysis of the ASCII representations of the 1993 and 1994 releases of ICD-9-CM, it is impossible for a computer program to infer the intent of the changes that caused the differences; instead, a content expert must infer the intent and then update the MED accordingly. A typical task is to infer whether a change in naming also reflects a change in the meaning named. While Cimino’s methods and their execution are exemplary in every respect, they nevertheless constitute a kind of “reverse engineering” – an ad hoc attempt to infer intent from details. Reverse engineering of changes to controlled medical vocabularies is a poor precedent. Such methods should be viewed as necessary short-term expedients only, and all parties concerned should work toward an incremental plan by which the intent of changes to controlled health-care vocabularies can be made both explicit and machine processible. Only then can the comparability of patient descriptions be sustained.
Autoregressive Modeling with Exogenous Input of Middle-Latency Auditory-Evoked Potentials to Measure Rapid Changes in Depth of Anesthesia
Authors: Lindholm P. , Henneberg S. W. , Jensen E. W. 
Published: March 2018

Abstract:Obtaining an adequate depth of anesthesia is a continuous challenge to the anesthetist. With the introduction of muscle-relaxing agents the traditional signs of awareness are often obscured, or difficult to interpret. These signs include blood pressure, heart rate, pupil size, etc. However, these factors do not describe the depth of anesthesia (DA) in a cerebral activity sense. Hence, a better measure of the DA is required. It has been suggested that Auditory-Evoked Potentials (AEP) can provide additional information about the DA. The general method of extracting AEP is by use of a Moving Time Average (MTA). However, the MTA is time consuming because a large number of repetitions is needed to produce an estimate of the AEP. Hence, changes occurring over a small number of sweeps will not be detected by the MTA average. We describe a system-identification method, an autoregressive model with exogeneous input (ARX) model, to produce a sweep-by-sweep estimate of the AEP. The method was clinically evaluated in 10 patients anesthetized with alfentanil and propofol. The time interval between propofol induction and the time when the Na-Pa amplitude was decreased to 25% of the initial amplitude was measured. These measurements showed that ARX-estimated compared to MTA-estimated AEP was significantly faster in tracing transition from consciousness to unconsciousness during propofol induction (p <0.05).
Communication Services for a Distributed Hospital Information System
Authors: Graeber S. 
Published: March 2018

Abstract:Planning principles and development are described of a communication server which controls and performs all information exchange between distributed and heterogeneous applications in a hospital information system. The analysis is based on business process modeling. At present, the core of the server uses a commercial product (Cloverleaf). This allows to connect both old systems with no or few interface features and new systems with modern interface facilities (such as HL7). Prerequisites, functions, and configuration of the server software are described in detail. Experiences, advantages, and disadvantages are discussed.
Computer-based Training and Electronic Publishing in the Health Sector: Tools and Trends
Authors: Schrader U. , Klar R. , Schulz S. 
Published: March 2018

Abstract:CBT (computer-based training) applications and hypermedia publications are two different approaches to the utilisation of computers in medical education.Medical CBT software continues to playa minor role in spite of the increasing availability, whereas hypermedia have become very popular through the World Wide Web (WWW). Based on the HTML format they can be designed by non-programmers using inexpensive tools while the production of CBT applications requires programming expertise. HTML documents can be easily developed to be distributed by a web-server or to run as local applications.In developed countries CBT and hypermedia have to compete with an abundance of printed or audio-visual media and a wealth of lectures, conferences, etc., whereas in developing countries these media are scarce and expensive. Here CBT programs, and hypermedia publications in particular, may be a cost-effective way to improve quality of education in the health sector.
Comparative Diagnostic Performance of Three Radiological Procedures for the Detection of Lumbar Disk Herniation
Authors: Kardaun J. W. P. F. , Kardaun O. J. W. F. 
Published: March 2018

AbstractLiterature data on the diagnostic performance of phlebography, myelography, and CT scan applied to patients with suspected lumbar disk herniation (LDH) are analyzed to extract maximal information about their relative discriminatory power. Seventeen papers meeting the selection criteria contain 13 reports on myelography, 6 on phlebography, and 5 on CT. Sensitivity and specificity are considered simultaneously in logistic ROC space. The reports of each procedure are effectively summarized by a linear regression in logistic ROC space. Taking into account the individual confidence regions of sensitivity and specificity obtained from each report, the slope of the regression line is estimated by Generalized Least Squares (ML). This approach also allows to test the assumption of a common odds ratio (i.e., of a unit slope). The simply to determine common odds ratio as well as the perpendicular distance between the origin and the regression line (as a good approximation to the area under the ROC curve) are used as a measure for the discriminatory power of the procedures. For CT, homogeneity of sensitivity turns out to be much more likely than a common odds ratio. Based on the available, retrospective data, phlebography appears to have the highest performance in visualizing an LDH, followed by myelography and CT.
Some Comments on Teaching Biostatistics in Medical and Health Sciences
Authors: Sahai H. 
Published: March 2018

AbstractThe role of statistical methods is now well recognized in health sciences since these disciplines are concerned with the study of communities or populations where the principles of sampling and statistical inference are clearly applicable. However, many medical and health sciences teachers and students have been slower to perceive the need for knowledge of biostatistical methods, even though all aspects of medical diagnosis and prognosis are governed by the laws of probability. Some of them are still skeptical about the value and importance of biostatistical principles to their fields and raise questions about the meaning, content, and nature of biostatistics and relevance of its teaching to health sciences disciplines. The purpose of this essay is to address some of these issues with the hope to invoke comments and responses from other biostatistics instructors who have encountered similar predicaments in their teaching and consulting roles to health sciences students and professionals.
The Role of Computer Modeling in Electrocardiography
Authors: van Oosterom A. 
Published: March 2018

AbstractThis paper introduces some levels at which the computer has been incorporated in the research into the basis of electrocardiography. The emphasis lies on the modeling of the heart as an electrical current generator and of the properties of the body as a volume conductor, both playing a major role in the shaping of the electrocardiographic waveforms recorded at the body surface. It is claimed that the Forward-Problem of electrocardiography is no longer a problem. Several source models of cardiac electrical activity are considered, one of which can be directly interpreted in terms of the underlying electrophysiology (the depolarization sequence of the ventricles). The importance of using tailored rather than textbook geometry in inverse procedures is stressed.
Toward Normative Expert Systems: Part I The Pathfinder Project
Authors: Heckerman D. E. , Horvitz E. J. , Nathwani B. N. 
Published: March 2018

Abstract:Pathfinder is an expert system that assists surgical pathologists with the diagnosis of lymph-node diseases. The program is one of a growing number of normative expert systems that use probability and decision theory to acquire, represent, manipulate, and explain uncertain medical knowledge. In this article, we describe Pathfinder and our research in uncertain-reasoning paradigms that was stimulated by the development of the program. We discuss limitations with early decision-theoretic methods for reasoning under uncertainty and our initial attempts to use non-decision-theoretic methods. Then, we describe experimental and theoretical results that directed us to return to reasoning methods based in probability and decision theory.
Medical Database Security Policies
Authors: Pangalos G. J. 
Published: March 2018

AbstractDatabase security plays an important role in the overall security of medical information systems. Security does not only involve fundamental ethical principles such as privacy and confidentiality, but is also an essential prerequisite for effective medical care. The general framework and the requirements for medical database security are presented. The three prominent proposals for medical database security are discussed in some detail, together with specific proposals for medical database security. A number of parameters for a secure medical database development are presented and discussed, and guidelines are given for the development of secure medical database systems.
Revising a Display of Multidimensional Laboratory Measurements to Improve Accuracy of Perception
Authors: Hoaglin D. C. 
Published: March 2018

AbstractTo display multidimensional laboratory measurements, Hoeke et al. (1991) proposed a technique that uses plotting axes radiating from a point, assigns each test to a separate axis, and links the test results with line segments. A special nonlinear scaling ensures that a patient whose results all fall in the normal range is represented by a regular polygon of middle size, and colored zones emphasize more serious departures from the normal range. Results of research in graphical perception, however, point to potential difficulties in clinical applications. Those results also suggest a revision of the display that should overcome the difficulties. The new version plots the test results on parallel horizontal lines and links the points for adjacent tests by line segments, while retaining the special scaling and the colored bands.
Liquordiagnostik bei Demenzen
Authors: Schipke C. G. , Peters O. 
Published: March 2018

ZusammenfassungBislang erfolgt die Diagnose einer Demenz-Erkrankung unter Einbeziehung, neuropsychometrischer Testverfahren und einer kraniellen Bildgebung, welche im Ergebnis mit der Diagnose vereinbar sein muss. Die Liquordiagnostik kann jedoch, insbesondere bei der Alzheimer-Erkrankung, wichtige Informationen zur Sicherung der Diagnose beitragen. Im Liquor befinden sich bei einer neurodegenerativen Erkrankung eine Anzahl von Proteinen in veränderter Konzentration. Die erhöhte Rate des neuronalen Zelltodes, die sich bei allen neurodegenerativen Demenzen findet, spiegelt sich meistens in einer Erhöhung der Konzentration des Tau-Proteins im Liquor wider. Differenzialdiagnostisch leistet die Liquordiagnostik wichtige Hilfestellung bei der Abgrenzung gegenüber kognitiven Defiziten, welche im Kontext depressiver Störungen entstehen und keinem neurodegenerativen Prozess zugrunde liegen. Zur Sicherung der Diagnose einer Alzheimer-Erkrankung sollte die Analyse des Amyloidstoffwechsels im Liquor erfolgen. Die Alzheimer-Erkrankung zeigt in sehr frühen Stadien eine erniedrigte Konzentration des Peptides Aβ1-42, wohingegen das Peptid Aβ1-40 unverändert bleibt.
Therapie metabolischer Myopathien
Authors: Debska-Vielhaber G. , Motlagh L , Zierz S. , Vielhaber S. , Lehmann D. 
Published: March 2018

ZusammenfassungMetabolische Myopathien sind seltene Erbkrankheiten die primär die Muskulatur betreffen und hauptsächlich auf Störungen des muskulären Energiestoffwechsels beruhen. Das Krankheitsspektrum beinhaltet Störungen der Fettsäurenoxidation, der Glykogenbzw. Glykolyse und der mitochondrialen Atmungskette des Muskels. Klinisch manifestieren sich diese Erkrankungen mit einer Reihe von Symptomen wie infantile Hypotonie, Myalgien, Belastungsintoleranz, chronische oder akute Muskelschwäche, Muskelkrämpfen und Spasmen bis hin zu schwerwiegenden Komplikationen, meist der fulminanten Rhabdomyolyse. Durch verbesserte Untersuchungsalgorithmen und Einsatz neuer Techniken wie der Next-Generation-Sequenzierung werden einzelne Erkrankungen frühzeitiger diagnostiziert. Dieser Umstand ermöglicht den frühen Einsatz hochwirksamer Therapien wie bei der Pompe-Krankheit. In diesem Beitrag sollen anhand ausgewählter praxisrelevanter Erkrankungen aus dem breiten Spektrum der metabolischen Myopathien die wesentlichen Prinzipien des therapeutischen Managements dargestellt werden.
Therapie der Muskeldystrophien/das Deutsche Muskeldystrophie- Netzwerk (MD-NET)
Authors: Vorgerd M. , Kirschner J. , Walter M. C. 
Published: March 2018

ZusammenfassungMuskeldystrophien (MD) bilden eine klinisch heterogene Gruppe genetisch determinierter, progredienter Erkrankungen des Muskels. Gemeinsames Symptom aller MD ist eine fortschreitende Muskelschwäche und Muskelatrophie, die sich in Verteilungsmuster und Schweregrad zwischen den MD-Formen deutlich unterscheidet. Die ständig zunehmende Anzahl bekannter Genorte, spezifischer Gene und Genprodukte machen eine exakte Diagnostik schwierig, jedoch ist eine präzise Diagnose wichtig für Verlauf und Prognose der Erkrankung. Bislang stehen überwiegend symptomatische Therapieformen zur Verfügung. Allerdings sind in den letzten Jahren innovative kausale molekulartherapeutische Ansätze entwickelt worden, die hoffentlich in naher Zukunft eine wirksame Therapie ermöglichen. Das deutsche Muskeldystrophie-Netzwerk (MD-NET), eine deutschlandweite vom BMBF geförderte Arbeitsgemeinschaft zur Verbesserung der medizinischen Versorgung von Menschen mit neuromuskulären Erkrankungen, hat es sich seit 2003 zum Ziel gesetzt, zielgerichtete Forschung zu Prävention, Diagnose und Therapie von Muskeldystrophien zu leisten und die medizinische Versorgung von Patienten nachhaltig zu verbessern.
Diagnose und Therapie von chronischen Atmungsstörungen bei neuromuskulären Erkrankungen
Authors: Winterholler M. , Boentert M. 
Published: March 2018

ZusammenfassungNeuromuskuläre Erkrankungen gehen mit einem erhöhten Risiko für die Entwicklung schlafbezogener Atmungsstörungen (SBAS) einher. Hierzu zählen die alveoläre Hypoventilation auf dem Boden einer Zwerchfellparese und die obstruktive Schlafapnoe als Folge einer muskulären Hypotonie des oberen Atemwegs. SBAS treten bei unterschiedlichen neuromuskulären Erkrankungen mit unterschiedlicher Häufigkeit auf und stellen einen klinisch hoch relevanten Faktor für die Morbidität und Mortalität der betroffenen Patienten dar. Der vorliegende Übersichtsartikel beschreibt die gängigen diagnostischen Verfahren zur Messung von Atemmuskelkraft und Atmungsstörungen im Schlaf. Ferner wird auf die nicht invasive Beatmung und die Bedeutung eines qualifizierten Sekretmanagements bei klinisch relevanter Hustenschwäche eingegangen.
A Review of Computer Systems in Blood Banks and Discussion of the Applicability of Mathematical Decision Methods
Authors: Page B. 
Published: March 2018

The fast progress of transfusion medicine is leading to higher requirements in blood donor and transfusion services which can only be met by EDP in the long run.This article gives an overview on the state of EDP system development in blood banks. The emphasis is on EDP systems in blood donor services. However, some transfusion medical EDP applications are also mentioned. The functional application areas of EDP are shown. The cost-benefit ratio of computer systems in this field is discussed and systems in operation or under development are compared in tabulated, form. Of particular interest in this comparison is the aspect of the applicability of mathematical decision methods for providing decision aids in blood banks by the computer.The cost-efficiency of systems providing improved medical services at the same time leads to the conclusion that a fast growth of EDP applications in blood donor and transfusion services can be expected.
An Interactive Computerised Protocol for the Management of Hypertension
Authors: Evans A. R. , Wilkes E. R. , Absolon P. J. , Denner T. J. , Kaye G. 
Published: March 2018

SummaryThe management of hypertension using a computer within a hospital environment is well documented [4, 5, 6, 11, 15]. This paper describes the background, structure and use of an interactive care system designed to be used by general medical practitioners in their consulting rooms.A management plan (protocol) for the care of an “ideal hypertensive” patient was defined by a group of general practitioners. The method by which this plan was adapted and converted for use on the computer is described. The computer handles patient information according to the protocol, prompting and interacting with the physician in attempting to improve the delivery of care to his hypertensive patients.The physicians’ acceptance of and compliance with such a care system is examined, and the implications for the future are discussed.
Medical Literature Searches -How Many Bibliographic Databases are Needed for Sufficient Retrieval in Medical Topics?
Authors: John K. 
Published: March 2018

SummaryAs many bibliographic services in medicine are offered, literature searches in eight databases at DIMDI were performed to find out which database is most important in medicine. The distribution of publications from members of the medical faculty of Frankfurt University was examined. No save prediction is possible as to which database will yield most articles. Overlapping from different databases is often rather low. The selection of an appropriate database mix for sufficient recall and in a cost-effective manner.is a task for an experienced searcher.
Kernel Estimation Techniques for the Analysis of Clinical Curves
Authors: Müller H.-G. , Ihm P. 
Published: March 2018

SummaryKernel estimation procedures for the comparison of samples of longitudinal clinical curves are discussed. We show how samples of curves can be compared by means of “empirical parameters” and how a typical longitudinal curve can be defined by “longitudinal averaging”. This method allows to summarize the information in a sample of monotonous curves and to derive local confidence bands for the longitudinal mean curve. Under specific assumptions, this procedure is strongly consistent.As an example, we analyze and compare the long-term behavior of two types of heart pacemakers. Special consideration is given to the practically relevant choice of kernels and of bandwidths (smoothing parameters).
Group Theory Approach to Computer Translation of Medical German
Authors: Moore G. W. , Riede U. N. , Polacsek R. A. , Miller R. E. , Hutchins G. M. 
Published: March 2018

SummaryComputer translators have been studied for almost four decades, but recent advances in speed and storage capabilities have made such translators accessible to small computer users. We obtained the computer typesetting file for a German language medical textbook and wrote computer software sufficient to obtain a draft quality English language translation of the entire book, at a speed of 9,671 words per hour. This translator uses two external tables, namely a word and idiom list and a list of grammatical rules, which completely specify the behavior of the translator. The grammatical rule table satisfies the properties of a mathematical group, and the inverse operation for this group allows one in principle to convert this German to English translator into an English to German translator. For the larger problem of creating multilingual computer translators, the group theory inversion property may allow one to substantially reduce the effort of creating a separate translator for each language pair. Future development of computer translators will depend upon the wider availability of computer-readable documents and will be aided by use of vocabulary and grammatical rule tables with group theory properties which permit the invertability between language pairs.
A Method of Medical Knowledge Base Augmentation
Authors: Lester S. , Rada R. 
Published: March 2018

SummaryThe Medical Subject Headings (MeSH) of the National Library of Medicine may be viewed as a semantic network. The relationships in this semantic network are of a broader-than/narrower-than type. A knowledge base of this type may be augmented by adding new terms and new relationships to the network. The Current Medical Information and Terminology (CMIT) of the American Medical Association represents a rich source of relationships for the disease terms of MeSH. A subset of MeSH was augmented with the knowledge from a subset of CMIT using a matching and similarity strategy. The matching portion of the experiment showed that about half of CMIT may be directly merged with MeSH based on exact and partial matches and utilization of alternate and synonym terms from CMIT. The similarity portion of the experiment showed that a method of merging based on similarity of features is a workable approach to incorporating knowledge into MeSH when lexical matches are not available. Evaluation of the resulting merged knowledge base suggested that the etiology property of CMIT was the most highly inherited property. The augmented knowledge base was used as a basis for an automatic indexer. The indexer was less accurate after augmentation than before. One key difficulty stemmed from the way that CMIT was encoded into MeSH. More powerful encodings of CMIT into MeSH are being pursued. Building on MeSH, CMIT, and other such knowledge bases that already exist on the computer is one way to try to develop intelligent medical computer systems.