bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modeling Hospital Information Systems (Part 1): The Revised Three-layer Graph-based Meta Model 3LGM2
Authors: Brigl B. , Wendt T. , Winter A. 
Published: March 2018

Summary

Objectives:
Not only architects but also information managers need models and modeling tools for their subject of work. Especially for supporting strategic information management in hospitals, the meta model 3LGM2 is presented as an ontological basis for modeling the comprehensive information system of a hospital (HIS).

Methods:
In a case study, requirements for modeling HIS have been deduced. Accordingly 3LGM2 has been designed to describe HIS by concepts on three layers. The domain layer consists of enterprise functions and entity types, the logical tool layer focuses on application components and the physical tool layer describes physical data processing components. In contrast to other approaches a lot of inter-layer-relationships exist. 3LGM2 is defined using the Unified Modeling Language (UML).

Results:
Models of HIS can be created which comprise not only technical and semantic aspects but also computer-based and paper-based information processing. A software tool supporting the creation of 3LGM2 compliant models in a graphical way has been developed. The tool supports in detecting those shortcomings at the logical or the physical tool layers which make it impossible to satisfy the information needs at the domain layer. 3LGM2 can also be used as an ontology for describing HIS in natural language.

Conclusions:
Strategic information management even in large hospitals should be and can be supported by dedicated methods and tools. Although there have been good experiences with 3LGM2 concerning digital document archiving at the Leipzig University Hospital, which are presented in part 2, the benefit of the proposed method and tool has to be further evaluated.
Role of the Electronic Patient Record in the Development of General Practice in the Netherlands
Authors: Knottnerus J. A. 
Published: March 2018

AbstractFrom the end of the seventies practice computer systems have been introduced in Dutch general practice. In 1998 90% of the GPs had a practice computer and 60% used it for medical purposes, with good patient acceptance. Collaboration between pioneer GPs, professional organizations, academic institutions and software manufacturers has been of decisive importance. While the practice computer is early recognized as a powerful tool for administrative purposes, it is increasingly supporting clinical and preventive care, quality of care improvement, clinical training of students and vocational training of general practice trainees. Also for scientific research and practice supporting research, automatization has proven to be innovating. Much attention is paid to designing valid databases and database-related research. In addition, practice automatization has opened new perspectives for health policy and management. Further development of technical and methodological issues is needed, and, very importantly, of patients‘ and consumers’ involvement. EPR technology in general practice does not optimally work without good numerator and denominator data, and a good quality patient-doctor relationship over time. While the EPR is a useful tool to facilitate a better performance, it may enable the doctor to focus more on the health care essentials.
Design of a Decision Support System for Test Ordering in General Practice: Choices and Decisions to Make
Authors: Mosseveld M. , van der Lei J. , van Wijk M. 
Published: March 2018

AbstractThe increased availability of tests in the past years has been accompanied by an increased number of blood tests ordered by general practitioners. Dutch investigators report a lack of general practitioners’ knowledge concerning the indications for blood tests leading to inappropriate and inadequate use of diagnostic tests. Taking advantage of the use of electronic patient records by Dutch general practitioners, the authors replaced the traditional paper forms for test ordering by a decision-support system. The objective of the decision-support system is to change test-ordering behavior. Designing a system to change test-ordering behavior, however, required the selection of a method to provide support. To study different methods for changing test-ordering behavior, the authors developed two versions of the decision-support system BloodLink. The first version, Blood-Link-Restricted, is based on the notion of restricting the number of choices presented to the general practitioners. The second version, BloodLink-Guideline, is based on the guidelines provided by the Dutch college of general practitioners.
A Decision Support System for Diabetes Care: Ethical Aspects
Authors: Shahsavar N. , Gill H. , Collste G. 
Published: March 2018

AbstractIn this paper the design and implementation of a decision support system for diabetes care is examined from an ethical perspective. It is noted that the system creates potential for enhancing the realization of the principle of autonomy through improved information to patients and participation by patients. However, there is also potential for using the system in a way that is contrary to good health care. It may provide patients with information they are unable to interpret and handle, and it may be used by healthcare authorities for controlling their personnel in ways contrary to good quality working conditions. In order for a decision support system to function as a well-integrated element in ethically based health care, different ethical aspects have to be taken into account during the design of the system. The ethical aspects also constitute one perspective of a systematic re-evaluation and re-design process.
Changes regarding Age and Correlations between Serum Lipids and Body Mass Index in Humankind
Authors: Yamasawa I. , Kamohara S. , Shiota M. , Komori T. , Watanabe Y. , Nakano M. , Matsubara T. , Nagashima K. 
Published: March 2018

Summary

Objectives:
To improve insight into age and gender related distributions of serum lipids and their correlation with body mass index (BMI).

Methods:
Serum lipids embracing atherogenic index (AI) and BMI were analyzed from the results obtained in 19,823 men and 14,788 women undergoing a health examination between 1986 and 1996.

Results:
The changes in total cholesterol (TC), triglyceride (TG), AI and BMI differed regarding gender. Although high-density lipoprotein-cholesterol (HDL-C) showed a flat pattern for all ages in both genders, its level in women was higher than in men. The ratio of the number in the unsuitable range to those in the suitable range increased with age as to TC in both sexes, then more than half of the population have an unsuitable level in the sixth decade. As for the correlation between serum lipids and BMI: TC, TG and AI correlated positively, but HDL-C correlated negatively. There were significant gaps between both age and gender.

Conclusions:
We suggest that the normal range of values of serum lipids needs to be revised according to gender and age to evaluate the risk status for a cardio-cerebrovascular disease more precisely in the field of preventive medicine. Simpler guidelines are preferable in specialized care as well as in general practice, particularly since computer technology is not yet universally adapted. In the near future, when computed information technology will be as common as the electricity and the telephone are current on the whole earth, all guidelines will have to be computed on the spot and personally.
Vicissitudes of Preventive Medicine and a New Challenge
Authors: Collen M. F. 
Published: March 2018

Summary

Objectives:
Significant changes in mortality patterns are part of the changing population demographics. This paper explores their implications for health evaluation and screening programs.

Methods:
A review of selected age-adjusted mortality rates from the National Vital Statistics Reports of the USA was undertaken and their change over the last five decades analyzed.

Results:
The review shows a continued decline in mortality rates from leading causes of death, such as heart disease, cancer, stroke, pneumonia and influenza, and a sharp rise in the death rates from Alzheimer’s disease. Available means for detection of Alzeimer’s disease are summarized.

Conclusion:
Given the emerging possibilities for the treatment and prevention of the progression of Alzheimer’s disease, tests for early detection of Alzheimer’s should be included in health screening examinations.
A Humanist’s Legacy in Medical Informatics: Visions and Accomplishments of Professor Jean-Raoul Scherrer
Authors: Lovis C. , Spahni S. , Appel R. D. , Ratib O. , Boyer C. , Hochstrasser D. F. , Baud R. , Geissbühler A. 
Published: March 2018

Summary

Objective:
To report about the work of Prof. Jean-Raoul Scherrer, and show how his humanist vision, his medical skills and his scientific background have enabled and shaped the development of medical informatics over the last 30 years.

Results:
Starting with the mainframe-based patient-centered hospital information system DIOGENE in the 70s, Prof. Scherrer developed, implemented and evolved innovative concepts of man-machine interfaces, distributed and federated environments, leading the way with information systems that obstinately focused on the support of care providers and patients. Through a rigorous design of terminologies and ontologies, the DIOGENE data would then serve as a basis for the development of clinical research, data mining, and lead to innovative natural language processing techniques. In parallel, Prof. Scherrer supported the development of medical image management, ranging from a distributed picture archiving and communication systems (PACS) to molecular imaging of protein electrophoreses. Recognizing the need for improving the quality and trustworthiness of medical information on the Web, Prof. Scherrer created the Health-On-the-Net (HON) foundation.

Conclusions:
These achievements, made possible thanks to his visionary mind, deep humanism, creativity, generosity and determination, have made of Prof. Scherrer a true pioneer and leader of the human-centered, patient-oriented application of information technology for improving healthcare.
A Randomized Evaluation of a Computer-Based Nursing Documentation System
Authors: Eichstädter R. , Haux R. , Pohl U. , Rebel S. , Ziegler S. , Ammenwerth E. 
Published: March 2018

AbstractA two-month randomized, controlled trial based on 60 patients has been performed on a ward of the Department of Psychiatry at Heidelberg University Medical Center, Germany, to investigate the influence of computer-based nursing documentation on time investment for documentation, quality of documentation and user acceptance. Time measurements, questionnaires, documentation analysis and interviews were used to compare patients documented with the computer-based system (PIK group) with the control group (patients documented with the paper-based system). The results showed the advantages and disadvantages of computer-based nursing documentation. Time needed for nursing care planning was lower in the PIK group. Some formal aspects of quality were considerably better in the PIK group. On the other hand, time required for documentation of tasks and for report writing was greater in the PIK group. User acceptance increased significantly during the study. The interviews indicated a positive influence of PIK on the cooperation between nurses and physicians.
Intranet Meets Hospital Information Systems: The Solution to the Integration Problem?
Authors: Kuhn K. A. , Lenz R. 
Published: March 2018

AbstractBased on the results of an extensive market analysis and technology assessment, this paper summarizes the state of the art in web technology and compares it with the needs of integration in hospital information systems. Web technology and intranet have evolved to a core technology for distributed computing and distributed information systems. The advantage of platform independent distribution of information has led to euphoric visions of future integrated systems. However, true integration takes more than transparent access to heterogeneous information sources. To overcome the essential problems related to integration of autonomous systems it is important to find a common ontological basis for future component based systems.
Childhood Leukaemia Clustering – Fact or Artefact?
Authors: Bithell J. F. 
Published: March 2018

AbstractThere is a general belief that the clustering of childhood leukaemia is a widespread phenomenon and that it provides evidence for appreciable environmental influence on the incidence of the disease. We discuss this issue critically, identifying different kinds of clustering and their possible aetiological mechanisms and examining some analyses of British data. We argue that, in some cases, analyses have been used which lead to dubious conclusions, and that, allowing for multiple testing and anecdotal reporting, the total evidence for clustering is at best weak.
Deficits and Remedy of the Standard Random Effects Methods in Meta-analysis
Authors: Koch A. , Victor N. , Ziegler S. 
Published: March 2018

AbstractThe random effects model is often used in meta-analyses. A corresponding significance test based on a normal approximation has been established. Its type I error is derived in this article by theoretical considerations and computer simulations. The test can be conservative as well as unacceptably anti-conservative. The anti-conservatism increases with the increasing number of patients and the decreasing number of studies. A modification is proposed, which keeps the nominal level asymptotically as the number of patients approaches infinity. Simulations show that the modified test is often conservative, but its conservatism is small in those situations where the standard test is highly anti-conservative.
Best-Link Matching of Scottish Health Data Sets
Authors: Douglas M. M. , Gardner D. , Hucker D. , Kendrick S. W. 
Published: March 2018

Abstract:Methods are described used to link the Community Health Index and the National Health Service Central Register (NHSCR) in Scotland to provide a basis for a national patient index. The linkage used a combination of deterministic and probability matching techniques. A best-link principle was used by which each Community Health Index record was allowed to link only to the NHSCR record with which it achieved the highest match weight. This strategy, applied in the context of two files which each covered virtually the entire population of Scotland, increased the accuracy of linkage approximately a thousand-fold compared with the likely results of a less structured probability matching approach. By this means, 98.8% of linkable records were linked automatically with a sufficient degree of confidence for administrative purposes.
Diagnosis of Acute Appendicitis in Two Databases. Evaluation of Different Neighborhoods with an LVQ Neural Network
Authors: Ohmann C. , Eskelinen M. , Juhola M. , Pesonen E. 
Published: March 2018

Abstract:The use of an artificial neural network system was studied in the diagnosis of acute abdominal pain, especially acute appendicitis, with patients from Finland and Germany. Separate Learning Vector Quantization (LVQ) neural networks were trained with a training set from each database and also with a combined database. Each neural network was evaluated separately with a test set of cases from each database. With the combined database different neighborhood methods were compared to find the optimal choice for this decision-making problem. The acute appendicitis cases of the Finnish test data set were classified well with all the networks, but the cases of the German test set were difficult to classify for the Finnish network. The use of larger neighborhoods increased the sensitivity of the classification by nearly 10%. The differences in the results of the Finnish and German databases suggest that there are differences in the data collection or patient populations between centers. Therefore, care must be taken when using decision-support systems which have been developed in other centers. Neural networks offer a method to evaluate differences between databases. With the use of larger neighborhoods, the effects of the differences on the accuracy of the classification can be partly diminished.
Effects of Record Linkage Errors on Disease Registration
Authors: Schmidtmann I. , Brenner H. 
Published: March 2018

Abstract:Reliable record linkage is a prerequisite for high-quality population-based disease registration. Rapid developments in computer processing have made record linkage both more efficient and more reliable in recent years. At the same time, concerns about confidentiality increasingly hinder record linkage in many disease registries. This paper provides basic algebraic models describing the effects of record linkage errors on monitoring disease incidence. Homonym errors, that is, erroneous linkage of records that pertain to distinct individuals, lead to underestimation of incidence in the registry population. The degree of underestimation strongly depends on the discriminating power of personal identifiers and the record linkage procedure on the one hand, and the number of registered cases on the other hand. Synonym errors, that is, failure to link notifications on the same individual, lead to overestimation of incidence in the population base. The combined effects of record linkage errors are illustrated with empirical examples. We conclude that it is the largest and most informative disease registries that are potentially affected most by impediments of record linkage procedures due to unduly restrictive confidentiality rules.
Implementing HL7: from the Standard's Specification to Production Application
Authors: Föhring U. , Tolxdorff Th. , Schadow G. 
Published: March 2018

Abstract:A C++ implementation of the HL7 health-care data interchange standard was developed by automatic methods applied to the authoritative specification of the standard. The reusable class library th us created presents an intuitive, flexible, and easy-to-use application programming interface to the HL7 protocol. This allows HL7 applications to be developed quickly while a high conformance to the standard is ensured.
Automatic Coding of Diagnostic Reports
Authors: Hasman A. , Arends J. W. , de Bruijn L. M. 
Published: March 2018

AbstractA method is presented for assigning classification codes to pathology reports by searching similar reports from an archive collection. The key for searching is textual similarity, which estimates the true, semantic similarity. This method does not require explicit modeling, and can be applied to any language or any application domain that uses natural language reporting. A number of simulation experiments was run to assess the accuracy of the method and to indicate the role of size of the archive and the transfer of document collections across laboratories. In at least 63% of the simulation trials, the most similar archive text offered a suitable classification on organ, origin and diagnosis. In 85 to 90% ofthe trials, the archive's best solution was found within the first five similar reports. The results indicate that the method is suitable for its purpose: suggesting potentially correct classifications to the reporting diagnostician.
Computer-based Decision Support in the Management of Primary Gastric non-Hodgkin Lymphoma
Authors: Boot H. , Taal B. G. , Lucas P. J. F. 
Published: March 2018

AbstractPrimary non-Hodgkin lymphoma of the stomach is a rare disorder for which clinical management has not yet been settled completely. Faced with the many uncertainties associated with the selection of a treatment for a patient with this disorder, it is difficult to determine the treatment that is optimal for the patient, as well as the prognosis to be expected. The development of a decision-theoretic model of non-Hodgkin lymphoma of the stomach is described. The model aims to assist the clinician in exploring various clinical questions, among others questions concerning prognosis and optimal treatment. Central to the model is a probabilistic network that offers an explicit representation of the uncertainties underlying the decision-making process. The model has been incorporated in a decisionsupport system. Preliminary evaluation results indicate that the performance ofthe model in its present form matches the performance of experienced clinicians.
Formalising and Acquiring Modelbased Hypertext in Medicine: an Integrative Approach
Authors: Spreckelsen C. , Spitzer K. 
Published: March 2018

AbstractCombining a knowledge acquisition methodology with a powerful data model we present an approach to the acquisition, maintenance and browsing of scientific medical hypertext. The hypergraph-based data model supports the consistent treatment of cyclic data structures, the nesting of complex object and provides an elegant way of path declaration to represent time-dependent medical processes or large hypertext tours. It encourages a stepwise schema design and therefore supports a spiral-shaped acquisition process. We formally define view mechanisms on the basis of a rule-based query and modification language. The views enable a context-sensitive presentation of medical knowledge according to the informational needs of the physician.Our approach has been applied to the implementation of an authoring and tutoring environment for a computer-based hypermedia reference book for cerebrovascular diseases (NeuroN). During the acquisition process the expressive power and flexibility of the representational formats have been evaluated.
Risk Perception during Information System Development in Non-Profit Health Care Organizations
Authors: Timpka T. , Ljunggren M. , Vimarlund V. 
Published: March 2018

AbstractThe perception of risk exposure among design team members during the early phases of information system development projects can provide valuable strategic information for clinical organizations. To develop a typology of perceived risks during information system development projects in health care, interviews were performed with key team members from a specialist clinic, primary health care, and an informatics research group, during the requirements specification. Phenomenological data analysis and secondary integration of the results in available theories were performed. System objectives, the user requirements definition procedure, the communication pattern between design team members and project management were found to be perceived as the main risk areas. In the secondary analysis, the technical factors, identified as preventing a maximization of the use of the resources, were lack of informatics knowledge among economic decision makers and differences between customers and suppliers regarding their views on the nature of system design. During the implementation of a given strategy, decision makers may consider the requests of their own sponsors in the first place and maximize the use ofthe project resources in the second place. Informatics knowledge plays a key role in risk perception during the development of an information system in health care. Political considerations by team members are important to take into regard, since these may influence technical and economic decisions.