bluuebunny/crossref_metadata_2025_split huggingface dataset:
Closing the Loop between Clinical Practice, Research, and Education: The Potential of Electronic Patient Records
Authors: van der Lei J. 
Published: March 2018

Summary
Objective: To discuss the possible contribution of electronic patient records in closing the loop among clinical practice, research and education.
Results and conclusions: Applying Information and Communication Technology (ICT) to a given medical domain is not merely adding a new technique. When introduced into an environment, ICT will initially often emulate or resemble the already existing processes. When workers and researchers in that domain begin to appreciate the potential of ICT, this initial stage is followed by more fundamental changes in that domain that take advantage of the potential of ICT. To understand the scope of the potential changes enabled by electronic records, three principle changes need to be understood. First, data recorded in computer memories can be readily retrieved and re-used for a variety of purposes. Second, once data are available in computer memories, the data can be transported easily. Third, as physicians (and patients) are using computers to record medical data, the same electronic record can be used to introduce other computer programs that interact with the user. New usage of data, however, generates additional requirements. Thus the experience in developing decision support systems and analyzing observational databases feeds back into the requirements for electronic medical records.Each patient-physician encounter, each investigation, each laboratory test, and each treatment in medical practice constitutes, in principle, an experiment. Ideally, we learn from each experiment. Electronic medical records will facilitate research that relies on data recorded in routine medical practice. The potential and challenge, however, of Medical Informatics lies in its ability to close the loop among clinical practice, research, and education.
An Anesthesia Information Management System (AIMS) as a Tool for Controlling Resource Management of Operating Rooms
Authors: Junger A. , Quinzio L. , Michel A. , Sciuk G. , Brammen D. , Marquardt K. , Hempelmann G. , Benson M. 
Published: March 2018

Summary
Objectives: In our department, we have been using an Anesthesia Information Management System (AIMS) for five years. In this study, we tested to what extent data extracted from the AIMS could be suitable for the supervision and time-management of operating rooms.
Methods: From 1995 to 1999, all relevant data from 103,264 anesthetic procedures were routinely recorded online with the automatic anesthesia record keeping system NarkoData. The program is designed to record patient related time data, such as the beginning of anesthesia or surgical procedure, on a graphical anesthesia record sheet. The total number of minutes of surgery and anesthesia for each surgical subspecialty per hour/day and day of the year was calculated for each of the more than 40 ORs, amounting to a total of 112 workstations.
Results: It was possible to analyze the usage and the utilization of ORs at the hospital for each day of the year since 1997. In addition, annual and monthly evaluations are made available. It is possible to scrutinize data of OR usage from different points of view: queries on the usage of an individual OR, the usage of ORs on certain days or the usage of ORs by a certain surgical subspecialty may be formulated. These data has been used repeatedly in our hospital for decision making in OR management and planning. Conclusions: In assessing the results of our study, it should be considered that the system used is not a specialized OR management tool. Despite these restrictions, the system contains data which can be used for an exact and relevant presentation of OR utilization
Evaluation of a Method that Supports Pathology Report Coding
Authors: de Bruijn L. M. , Arends J. W. , Hasman A. 
Published: March 2018

Summary

Objectives:
The paper focuses on the problem of adequately coding pathology reports using SNOMED. Both the agreement between pathologists in coding and the quality of a system that supports pathologists in coding pathology reports were evaluated.

Methods:
Six sets of three pathologists each received a different set of 40 pathology reports. Five different SNOMED code lines accompanied each pathology report. Three pathologists evaluated the correctness of each of these code lines. Kappa values and values for the reliability coefficients were determined to gain insight in the variance observed when coding pathology reports. The system that is evaluated compares a newly entered report, represented as a multi-dimensional word vector, with reports in a library, represented in the same way. The reports in the library are already coded. The system presents the code lines belonging to the five library reports most similar to the newly entered one to the pathologist in this way supporting the pathologist in determining the correct codes. A high similarity between two reports is indicated by a large value of the inproduct of the vector of the newly entered report and the vector of a report in the library.

Results:
Agreement between pathologists in coding was fair (average kappa of 0.44). The reliability coefficient varied from 0.81 to 0.89 for the six sets of pathology reports. The system gave correct suggestions in 50% of the reports. In another 30% it was helpful for the pathologists.

Conclusions:
On the basis of the level of the reliability coefficients it could be concluded that three pathologists are indeed sufficient for obtaining a gold standard for evaluating the system. The method used for comparing reports is not strong enough to allow fully automatic coding. It could be shown that the system induces a more uniform coding by pathologists. An evaluation of the incorrect suggestions of the system indicates that the performance of the system can still be improved.
Elaboration and Formalization of Current Scientific Knowledge of Risks and Preventive Measures Illustrated by Colorectal Cancer
Authors: Gouvernet J. , Dufour J. , Degoulet P. , Laugier R. , Quilichini F. , Fieschi M. , Giorgi R. 
Published: March 2018

Summary

Objectives:
Present the method used to elaborate and formalize current scientific knowledge to provide physicians with tools available on the Internet, that enable them to evaluate individual patient risk, give personalized preventive recommendations or early screening measures.

Methods:
The approach suggested in this article is in line with medical procedures based on levels of evidence (Evidence-based Medicine). A cyclical process for developing recommendations allows us to quickly incorporate current scientific information. At each phase, the analysis is reevaluated by experts in the field collaborating on the project. The information is formalized through the use of levels of evidence and grades of recommendations. GLIF model is used to implement recommendations for clinical practice guidelines.

Results:
The most current scientific evidence incorporated in a cyclical process includes several steps: critical analysis according to the Evidence-based Medicine method; identification of predictive factors; setting-up of risk levels; identification of prevention measures; elaboration of personalized recommendation. The information technology implementation of the clinical practice guideline enables physicians to quickly obtain personalized information for their patients. Cases of colorectal prevention illustrate our approach.

Conclusions:
Integration of current scientific knowledge is an important process. The delay between the moment new information arrives and the moment the practitioner applies it, is thus reduced.
Object-oriented Analysis and Design of an ECG Storage and Retrieval System Integrated with an HIS
Authors: Ohe K. , Sakurai T. , Nagase T. , Kaihara S. , Wang C. 
Published: March 2018

AbstractFor a hospital information system, object-oriented methodology plays an increasingly important role, especially for the management of digitized data, e.g., the electrocardiogram, electroencephalogram, electromyogram, spirogram, X-ray, CT and histopathological images, which are not yet computerized in most hospitals. As a first step in an object-oriented approach to hospital information management and storing medical data in an object-oriented database, we connected electrocardiographs to a hospital network and established the integration of ECG storage and retrieval systems with a hospital information system. In this paper, the object-oriented analysis and design of the ECG storage and retrieval systems is reported.
Supporting Multi-level Medical Education with Knowledge-Based Systems
Authors: Carstairs M. , King K. 
Published: March 2018

Abstract:Knowledge-based systems for medicine have enjoyed minimal success in developing countries as end-user systems. The reasons for this are complex. As funding agencies understandably tend to err on the side of caution, and knowledge-based systems are still (despite an almost 40 year history) seen as a new and untried technology, few have been implemented. Of those which have, most are inappropriately simple and thus do not fit in with the real-life clinical environment. In contrast to the sophisticated systems in use in developed countries which reflect a mature technology, the use of knowledge-based systems in medicine in developing countries has primarily revolved around simple ‘expert’ systems, where the program functions more as a ‘guru’ than as a support function. We propose the more appropriate use of these systems as educational tools in medicine. In this discussion paper we describe a multi-level programme to support medical education, focusing on patient information systems involving natural language generation, decision-support systems as educational aids for primary health-care workers and model-based reasoning tools which allow exploratory learning for physicans in training. Throughout this paper we refer to Knowledge-Based Medical Education Systems as KBMES.
The GP’s Dilemmas: A Study of Knowledge Need and Use During Health Care Consultations
Authors: Timpka T. , Arborelius Elisabeth 
Published: March 2018

AbstractFor use in system development, a method based on both qualitative and quantitative data was employed to study the difficulties – the dilemmas – a general practitioner (GP) faces during daily consultac tions. Video recordings were used for stimulated recall of the consultation. From 46 consultations, 262 dilemmas were identified by the 12 GPs involved. Medical dilemmas were encountered during three out of four consultations. Dilemmas in the communication with the patient occurred during two consultations out of three, while dilemmas in the organizational environment and dilemmas challenging the GP’s personal competence occurred during one consultation out of three, respectively. A phenomenological analysis of the comments showed that few dilemmas were described as problems during “hypothetico-deductive reasoning”. In many cases the GP found it difficult to understand the situation as a whole. Based on these qualitative data, a model of the GP’s management of ill-structured complex dilemmas is discussed and proposed, to be taken into account in the development of decision support systems for outpatient practice.
A Method for the Acquisition of Formalized Knowledge in Pathology
Authors: Jansen W. , Smeulders A. W. M. , van der Lei J. , Baak J. P. A. , van Ginneken Astrid 
Published: March 2018

AbstractA tool is introduced for the acquisition of pathology knowledge in a formalized form, directly by the expert. Formalization of the knowledge is intended to make descriptive pathology knowledge more suitable for computerized diagnostic support since a formal representation of knowledge allows more extensive indexing, hence more flexible access. The knowledge acquisition (KA) tool also provides a useful research instrument to investigate to what extent pathology knowledge can be made explicit, to what degree ambiguity is present, in what way experts differ when formalizing knowledge, and whether it is feasible to incrementally acquire decision criteria on the basis of the formalized descriptive knowledge.Crucial in the design of the KA tool is the incorporated meta-knowledge, which is reflected by the knowledge-base structure and is used to elicit knowledge from the expert. Knowledge is acquired from the expert via a menu-driven user interface, which follows the general steps of the pathologist when describing a case. The paper discusses the considerations underlying the design, the implementation of the KA tool, and the research goals.
Planning the Size of Clinical Trials with Allowance for Patient Noncompliance
Authors: Moussa M. A. A. 
Published: March 2018

AbstractVarious approaches are considered for adjustment of clinical trial size for patient noncompliance. Such approaches either model the effect of noncompliance through comparison of two survival distributions or two simple proportions. Models that allow for variation of noncompliance and event rates between time intervals are also considered. The approach that models the noncompliance adjustment on the basis of survival functions is conservative and hence requires larger sample size. The model to be selected for noncompliance adjustment depends upon available estimates of noncompliance and event rate patterns.
Information Exchange in a Patient-Physician Encounter. A Quantitative Approach
Authors: Ridderikhoff J. 
Published: March 2018

Abstract:The efficiency of data acquisition in a patient-physician encounter was investigated. In a simulation study, in which 60 family physicians and eight internists participated, the patient was replaced by an actor who used a structured set of patient data. The simulation model proved to be quite natural; data acquisition was primarily influenced by the amount of time available. Discerning between overall and diagnostic information, conclusions could be drawn on the effectiveness of data acquisition. Under time pressure, physicians tend to look for broadly defined symptoms rather than for details of the patient’s illness. The collection of patient data then has an inquisitive character, having implications for the quality of clinical judgement. The physician’s capabilities in eliciting relevant information from a patient appear to be of crucial importance for clinical problem-solving. The present study shows that patient-physician interviewing is effective insofar it concerns broad descriptions, but ineffective in eliciting specific data. If interviewing is laborious and time-consuming this may, therefore, affect the kind of information to be collected.
Predicting Fetal Chromosome Anomalies in the First Trimester Using Pregnancy Associated Plasma Protein-A: A Comparison of Statistical Methods
Authors: Brambati B. , Chard T. , Grudzinskas J. G. , Macintosh M. C. M. 
Published: March 2018

Abstract:The analysis of the clinical efficiency of a biochemical parameter in the prediction of chromosome anomalies is described, using a database of 475 cases including 30 abnormalities. A comparison was made of two different approaches to the statistical analysis: the use of Gaussian frequency distributions and likelihood ratios, and logistic regression. Both methods computed that for a 5% false-positive rate approximately 60% of anomalies are detected on the basis of maternal age and serum PAPP-A. The logistic regression analysis is appropriate where the outcome variable (chromosome anomaly) is binary and the detection rates refer to the original data only. The likelihood ratio method is used to predict the outcome in the general population. The latter method depends on the data or some transformation of the data fitting a known frequency distribution (Gaussian in this case). The precision of the predicted detection rates is limited by the small sample of abnormals (30 cases). Varying the means and standard deviations (to the limits of their 95% confidence intervals) of the fitted log Gaussian distributions resulted in a detection rate varying between 42% and 79% for a 5% false-positive rate. Thus, although the likelihood ratio method is potentially the better method in determining the usefulness of a test in the general population, larger numbers of abnormal cases are required to stabilise the means and standard deviations of the fitted log Gaussian distributions.
Virtual Reality in Medicine
Authors: Kaltenborn K.-F. , Rienhoff O. 
Published: March 2018

AbstractVirtual reality (VR), as part of computer science, allows computer-based models of the real world to be generated, and provides humans with a means to interact with these models through new human-computer interfaces and, thus, to nearly realistically experience these models. This contribution explores the technical requirements for VR, describes technological advances and deficits, and analyzes the framework for future technological research and development. Although some non-medical applications are discussed, this contribution focuses primarily on medical applications of VR and outlines future prospects of medical VR applications. Finally, possible hazards arising from the use of VR are discussed. The authors recommend an interdisciplinary approach to technology assessment of VR.
Representation of Medical Concepts of the Thyroid Gland by Physicians in Anatomy and Pathology
Authors: Bastien C. , Roux M. , Pellegrin L. 
Published: March 2018

Abstract:An experimental study in cognitive psychology is described, concerning the categorization of medical concepts into specific classes, expressed by physicians specialized in anatomic pathology consultations of the thyroid gland. This study belongs to a medical computer science project, called ARISTOTLE, concerning Natural Language Processing of specialized medical reports in anatomic pathology of the thyroid gland. This research has been done for two reasons: first, to specify the characteristics of human expert categorization in an area of medical knowledge and, secondly, to validate the hierarchical organization of a prototype declarative knowledge base. In this experiment, physicians were asked to categorize 121 concepts into 10 proposed classes. These classes and concepts belong to expert knowledge represented in a conceptual graph that was constructed before the experiment. Results show variable semantic distances between concepts of a same class, and dynamic variations of these distances due to contextual representation.
How to Organize the Medical Data of Chronically Ill Patients in the Computer
Authors: Martin J. M. , Jabot F. , Marrel P. 
Published: March 2018

SummaryThe problems of aiding in the medical decision-making process are very important today, especially through the use of artificial intelligence methods. Before studying these problems, it is necessary to have an excellent availability of relevant medical patient health data as well as medical knowledge.The computer is well adapted for the task of satisfying this essential condition; but in order to accomplish this goal, it is necessary to develop an efficient system of data organization. The current system of sequential organization of medical histories is most likely not the best possible method of data filing. Furthermore, at the present time there are only a small number of relations (in the mathematical sense) between these health data. This situation is not favorable to the development of a relational data base.This article proposes an organization of health data which is relative to the patient. The organization is based on the notion of a medical entity and on the three-dimensionality of health data.
Selection and Assessment of Laboratory Tests for the Evaluation of Liver Functional Impairment
Authors: Belforte G. , Bona B. , Cravetto C. , Frediani S. , Milanese M. , Molino M. , Saitta L. , Tempo R. 
Published: March 2018

SummaryA large number of biochemical tests is at present available for the evaluation of the different aspects of the liver function. As a consequence, the requirement of laboratory investigations is generally increasing in clinical practice. However, the usefulness of such a tendency in liver investigation is questionable: the doubt concerns both the diagnostic efficacy of new individual tests and the opportunity of a progressive increase in tests requirement.This paper deals with the problem of selecting liver tests on the basis of their information content with respect to different aspects of liver function. The study was performed on 288 normal and pathological subjects. Two different methods were used: a classical statistical feature selection method, and a method based on the probability theory developed in the framework of the fuzzy sets theory. The ranking of the tests was based on the estimated misclassification rate.The results obtained appear quite relevant from a practical point of view: no effective improvement in liver functional assessment is reached by using more than 3 or 4 selected tests among the many available for each of the functional aspects considered.A reasonable compromise between diagnostic efficacy, feasibility, and costs indicates that the following groups of tests could be proposed for the functional assessment of liver diseases in clinical routine: Albumin, Pseudo-cholinesterase, and Prothrombin Time for biosynthesis and metabolism; Bilirubin, Gamma-glutamyl-transpeptidase, Bile Acids (fasting) for cholestasis; Aspartate Aminotransferase, Alanine Aminotransferase, Isocitrate-dehydrogenase, for cytolysis; Gamma-globulin, G, A and M Immunoglobulin for reactivity.
Hospital Information Systems in Japan
Authors: Lum K. C. , Watanabe R. , Kaihara S. 
Published: March 2018

SummaryHospital information systems have been in use in Japan since 1968. Yet, riot much is known in Western literature about Japanese HIS. This paper traces the historical development of HIS in e that country and discusses the strong influence of the Japanese social system. An attempt is e made to classify some of the existing varieties of HIS into four general models with examples given of each kind. Results of evaluations of some of these systems in terms of acceptance by doctors and of hospital and patient management efficiency are also discussed. ment, Japan
Use of Probability Estimates in Medical Communications and Decisions
Authors: Swets J. A. , Feehrer C. E. , Greenes R. A. , Bynum T. E. 
Published: March 2018

SummaryQuantitatively sophisticated physicians in general internal medicine gave a series of probability estimates about each of several cases, which consisted of a written case background and radiological test report. First, they estimated the three quantities of Bayes’ formula: the pretest probability based on the background, the likelihood ratio based on the test report, and the posttest probability based on both. They made two further estimates of the posttest probability, one after being informed of the consensus of expert radiologists on the likelihood ratio of the test and another after being told a consensus pretest probability formed by experts in the medical speciality relevant to the case backgrounds. They also stated how high (low) the posttest probability would have to be in order to confirm (rule out) the suspected disease and estimated the chances that the test report would serve to move the posttest probability across one of those thresholds.On average, the clinician subjects agreed quite well with the experts’ estimates and with Bayes’ formula. Information about experts’ consensuses influenced the subjects’ estimates in the appropriate direction and decreased the variation among subjects. These results are taken to indicate the feasibility and potential effectiveness of certain quantitative aids to clinical decision making. On the other hand, the variation among the subjects’ estimates, and among experts’ estimates, was substantial - enough to warrant attempts to understand it and to reduce it. Diagnostic criteria that the subjects reported using for case backgrounds and for test reports were analyzed as a way of accounting for some of the variation.