bluuebunny/crossref_metadata_2025_split huggingface dataset:
On Priming Medical Students in Medical Informatics
Authors: Möhr J. R. , Sawinski R. 
Published: March 2018

SummaryAn introductory course in medical informatics (MI) for medical students in their second year of clinical education is described with respect to structure, contents and results. A positive effect was considered to have been obtained by offering a motivating course, comprising modest amounts of theory and practice and consisting of only four lectures of ninety minutes duration. The approach is discussed as an alternative to an attempt to provide a thorough theoretical basis for medical informatics to medical students in the current curricular context.
Automated Development of Clinical Strategies Using Multistage Decision Analysis
Authors: Glasziou P. 
Published: March 2018

SummaryThe development of investigative strategies by decision analysis has been achieved by explicitly drawing the decision tree, either by hand or on computer. This paper discusses the feasibility of automatically generating and analysing decision trees from a description of the investigations and the treatment problem. The investigation of cholestatic jaundice is used to illustrate the technique.Methods to decrease the number of calculations required are presented. It is shown that this method makes practical the simultaneous study of at least half a dozen investigations. However, some new problems arise due to the possible complexity of the resulting optimal strategy. If protocol errors and delays due to testing are considered, simpler strategies become desirable. Generation and assessment of these simpler strategies are discussed with examples.
Subjective Expected Utility and Referral Decisions in Obesity
Authors: Jennett P. A. , Elstein A. S. , Rothert Marilyn , Rovner D. R. , Black Necia 
Published: March 2018

SummaryReferral decisions of physicians dealing with long-term ambulatory problems are complex phenomena that are not clearly understood. This study was designed to assess the possible rationale behind such decisions in the management of obesity. It examined how well a subjective expected utility (SEU) model accounted for decisions of 45 primary care physicians regarding referral of obese female patients to an endocrinologist. Two patient goals, weight reduction and patient satisfaction, and a two-year time horizon were incorporated in the model.Data were collected using 24 written cases representing 12 patients approximately 100% overweight and 12 about 50% overweight, and a semi-structured interview in which subjective probabilities and importance weights were obtained. Values were calculated by transforming physicians’ ratings of risk of morbidity in the 24 cases into a utility scale.The SEU did not account for the primary care physicians’ referral behavior. Correlations between number of patient cases referred and SEU were analyzed and were not statistically significant, although there was substantial variation across physicians in number of cases referred. Mean subjective probabilities of weight loss and patient satisfaction were essentially identical for referral and non-referral.The formulation of the model, the design of the cases, and the method of value assessment are discussed as potential threats to the validity of the model as an account of referral decisions. Problems of constructing an adequate model are considered.
Zur Quantifizierung selektionsbedingter Gruppenunterschiede in der Epiderniologie
Authors: Höpker W.-W. 
Published: March 2018

Der von Mainland 1953 als Bebkson’s Fallacy bezeichnete Interpretationsfehler (bedingt durch Selektionseinflüsse verschiedener Art) wurde bereits von Lubabsch 1888 explizit und von v. Pfaundler und v. Seht 1921 implizit angegeben und beschrieben. Auch sind bis zur Beschreibung dieser Fehler-möglichkeiten von Bebkson 1946 eine ganze Reihe statistischer Erhebungen und Studien bekanntgewesen, in denen versucht wurde, durch eine geeignete Versuchs- und Vergleichsgruppenbildung diesen Fehler zu vermeiden.Es ist sinnvoll, die Gesamtheit möglicher Selektionsfaktoren in drei Gruppen zu beschreiben und sich an diese Systematik zu halten, um eine sachgerechte Interpretation zu ermöglichen und auch die Angriffspunkte gezielt erhobener Vergleichsgruppen zu definieren.Eine Unterscheidung von Haupt- und Nebenbefund ist im klinisch-ärztlichen Sektor und vor allem für die Totenscheine problematisch. Hier führt die Klassifizierung der Befunde in Haupt- und Nebenbefund zu anderen Ergebnissen als in der pathologischen Anatomie. Die Intention der Diagnose einerseits sowie die mangelnde Vollständigkeit der Datenerhebung andererseits verbieten eine Verallgemeinerung des Befundklassifizierungsprinzips.Es werden allgemeine Parameter zur Beschreibung von Untersuchungskollektiven beschrieben und für die pathologische Anatomie diskutiert. Sie reichen sehr wohl aus, quantitative Unterschiede anzugeben, Informationen für eine möglicherweise wirksam gewordene Eliminierung von Selektionsfaktoren geben sie jedoch nicht.Das erweiterte Rangzahlprinzip ist geeignet, clas Ausmaß von Selektionsemflüssen sowie die Wirksamkeit der Befundklassifikation zur Ausschaltung derselben zu beschreiben. Es wird empfohlen, dieses einfache Prinzip nicht durch weitergehende statistische Methoden zu überspannen.
The Collection and Processing of Medical History Data
Authors: Mclean E. R. , Foote Stefanie V. , Wagner G. 
Published: March 2018

A Bibliography of Manual, Automated, and Computer-Processed Techniques E. R. McLean, Stefanie Y. Foote, G. WagnekThe taking of a patient’s history, which has always played a central part in the practice of medicine, is one of the physician’s most time—consuming activities. As a consequence, the resultant history occasionally suffers from this time pressure and is not as complete and thorough as it might be. Over the years, a number of techniques have been developed to aid the physician in this task. The first attempt at systematizing medical history taking dates back to Martinet in 1825. In the most simple approach, the doctor collects the history data by interviewing the patient himself; alternatively, he can use the assistance of a resident, nurse, or other assistant. After the Second World War, attempts were made to improve the process by means of pencil-and-paper questionnaires. These were filled out by the patient and then reviewed by the physician upon completion.With the advent of the computer, it has become possible to key-punch or optically scan these question-naires; and then, using batch processing, to provide the examining doctor with a computer-summarized report. By making use of remote terminals, patients can be interviewed by means of conversational, interactive computer programs which both ask questions and records responses. These time-shared systems, while the ijiost costly and complex, offer the greatest potential for multi-level branching and comprehensive questioning.Since this aspect of the delivery of medical care is still in the developmental stage, a number of approaches are being tried, each with respective strengths and weaknesses. The accompanying biblio-graphy, comprising 720 citations, offers a comprehensive review of these techniques. It is a combination of two distinct research efforts: one, compiled by G. Wagner and B. Schwan, Heidelberg, in 19(39 and published in Anamnese, Hans-J. Heite (Ed.), F. Κ. Schattauer Verlag, Stuttgart 1971; and the other compiled by Ε. R. McLean and S. V. Foote in 1974 at the Center for Information Studies, Graduate School of Management, University of California, Los Angeles. This composite bibliography mainly restricts itself to the literature of the last 30 years. References to older literature can be taken from standard works, such as G. Grund and E. Stevenson.
Adapting a General Purpose Information Processing System UDC 68L3 01 MEDATA to a New Environment
Authors: Yoder R. D. 
Published: March 2018

General Purpose Information Processing Systems provide the capabilities of filing and retrieving discrete data. These capabilities are independent of the source or nature of the data, and of the format and content of the reports to be generated from it. MEDATA is an example of such a system. The concepts of the MEDATA system were written at UCSD in PL/1, for processing on a time-shared interactive utility computing service.PL/1 proved to be a desirable programming language for this application.-The service provided by the time-shared utility has been satisfactory and the concept of performing this type of data processing on such a utility appears to be sound. The system is now operational on a service basis and is being used for a variety of purposes. In addition to providing service, it will serve as a model for teaching, and as a basis for further research into information processing systems.
Eine jugendpsychiafrische Befundkarfe für erziehungsschwierige Minderjährige
Authors: Eberhard K. , Hartmann K. 
Published: March 2018

Es wird über eine jugendpsychiatrische Befundkaxte für verwahrlosungsgefährdete bzw. verwahrloste Minderjährige berichtet. Die Befundkarte ist auf männliche Minderjährige spezifiziert, aber mit sinngemäßen Abänderungen und Ergänzungen auch für weibliche Minderjährige zu verwenden. Sie soll sowohl der gutachtlichen Beurteilung des einzelnen Verwahrlosten als auch der statistischen Analyse größerer Verwahrlostenkollektive dienen.Für die gutachterliche Beurteilung des einzelnen Verwahrlosten enthält die Befundkarte einen Katalog von Verwahrlosungsmerkmalen, auf welchem der Untersucher die jeweils erhobenen Befunde registrieren und ihre Anzahl und Valenz ablesen kann.Für die statistische Analyse größerer Verwahrlostenkollektive ist die Befundkarte mit einer Lochkarte kombiniert, auf welcher alle ermittelten Befunde abgelocht und für statistische Berechnungen ausgezählt werden können.Das methodische Prinzip der Befundkarte wird auch für die gutachtliche Beurteilung und statistische Analyse anderer psychopathologischer Syndrome empfohlen.
Fracture stabilization with type II external fixator vs. type I external fixator with IM pin
Authors: Shani Y. , Shahar R. 
Published: March 2018

SummaryBilateral external fixator frames are frequently preferred over unilateral frames due to their superior rigidity. The objective of this study was to compare the biomechanical features of bilateral external fixators with those of unilateral external fixators that are combined with an intra-medullary pin. Three-dimensional, solid models were created of several unilateral and bilateral external fixator frames. The callus in the fracture gap was also modeled. Biomechanical analyses of all constructs were performed by the finite element method. This modeling approach allows the determination of stresses, displacements, and strains in the components of the various constructs, and thus the calculation of their relative stiffness. In addition, local shear strain values in the fracture gap, currently thought to be one of the deciding factors in the process of bone healing, can also be determined. The concept of equivalent stiffness modulus, which represents a weighed average stiffness of a construct to various loads, was defined. Using this concept, it was shown that when the intramedullary pin is well seated in the epiphyseal bone, the various unilateral frames have an equivalent stiffness modulus that is similar or even greater than that of bilateral frames with a similar arrangement of transcortical pins.
Prothrombin Complex Concentrate for Major Bleeding on Factor Xa Inhibitors: A Prospective Cohort Study
Authors: Gross Peter , Ritchie Bruce , Nahirniak Susan , Lin Yulia , Lieberman Lani , Carrier Marc , Crowther Mark , Ghosh Indy , Lazo-Langner Alejandro , Zondag Michelle , Schulman Sam ,   On Behalf of the Study Investigators
Published: March 2018

AbstractOral factor Xa inhibitors are increasingly used for anticoagulation, but there is no approved reversal agent. Prothrombin complex concentrate (PCC) for the management of Xa-inhibitor–associated bleeding has been described in small case series and one cohort study. Patients on apixaban or rivaroxaban, suffering a major bleed, were treated at nine Canadian hospitals as per existing hospital protocol with a fixed dose of PCC 2,000 units and subsequently recruited for a 30-day follow-up. The treating physician evaluated the haemostatic effectiveness as observed during the first day as good, moderate or poor/none, using an assessment guide. Safety outcomes were thromboembolism or death. We recruited 66 patients with major bleeding who were treated with PCC and who were receiving rivaroxaban (56%) or apixaban (44%). The effectiveness was assessed as good in 65% (95% confidence interval [CI], 53–77), moderate in 20% (95% CI, 10–30) and poor/none in 15% (95% CI, 6–24). For the 36 patients with intracranial haemorrhage, the corresponding ratings were 67, 17 and 17%, and for 16 patients with gastrointestinal bleeding they were 69, 12 and 19%, respectively. There were nine deaths (14%) by 30 days, and five (8%) major thromboembolic events. In a post hoc analysis, according to International Society on Thrombosis and Haemostasis criteria, reversal was effective in 68% and ineffective in 32%. For major bleeding associated with oral Xa inhibitors, PCC may have a beneficial effect. The risk of thromboembolism after reversal of anticoagulation in patients with a prothrombotic background has to be taken into account.
Index for Rating Predictive Accuracy of Screening Tests
Authors: Choi B. C. K. 
Published: March 2018

This paper proposes a new pair of indices, the »predictive powers«, for measuring the predictive accuracy (predictivity) of screening tests.Sensitivity and specificity are indices for measuring the validity of a test. They give the probability of a certain test result given a substance of known condition (a carcinogen or a non-carcinogen). They do not describe the predictive accuracy of a test, which is the probability of a certain condition (a carcinogen or a non-carcinogen) given a known test result. Predictive values are unsuitable measures for characterizing a test since they are seriously affected by the prevalence of carcinogens. However, the predictive powers do not have this limitation and are shown to be useful indices for the purpose of rating the predictive accuracies of various screening tests.
Intracranial Hemorrhage and Early Mortality in Patients Receiving Extracorporeal Membrane Oxygenation for Severe Respiratory Failure
Authors: Arachchillage Deepa , Passariello Maurizio , Laffan Michael , Aw TC , Owen Leah , Banya Winston , Trimlett Richard , Morgan Cliff , Patel Brijesh , Pepper John , Ledot Stephane 
Published: March 2018

AbstractIntracranial hemorrhage (ICH) is a serious complication in patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO) and is associated with high mortality. It is unknown whether ICH may be a consequence of the ECMO or of an underlying disease. The authors first aimed to assess the incidence of ICH at initiation and during the course of VV-ECMO and its associated mortality. The second aim was to identify clinical and laboratory measures that could predict the development of ICH in severe respiratory failure. Data were collected from a total number of 165 patients receiving VV-ECMO from January, 2012 to December, 2016 in a single tertiary center and treated according to a single protocol. Only patients who had a brain computed tomography within 24 hours of initiation of ECMO (n = 149) were included for analysis. The prevalence and incidence of ICH at initiation and during the course of VV-ECMO (at median 9 days) were 10.7% (16/149) and 5.2% (7/133), respectively. Thrombocytopenia and reduced creatinine clearance (CrCL) were independently associated with increased risk of ICH on admission; odds ratio (95% confidence interval): 22.6 (2.6–99.5), and 10.8 (5.6–16.2). Only 30-day (not 180-day) mortality was significantly higher in patients with ICH on admission versus those without (37.5% [6/16] vs 16.4% [22/133]; p = 0.03 and 43.7% [7/16] vs 26.3% [35/133]; p = 0.15, respectively). Reduced CrCL and thrombocytopenia were associated with ICH at initiation of VV-ECMO. The higher incidence of ICH at initiation suggests it is more closely related to the severity of the underlying lung injury than to the VV-ECMO itself. ICH at VV-ECMO initiation was associated with early mortality.
Off-Pump Coronary Artery Bypass Grafting and Stroke—Exploratory Analysis of the GOPCABE Trial and Methodological Considerations
Authors: Zacher Michael , Boergermann Jochen , Kappert Utz , Hilker Michael , Färber Gloria , Albert Marc , Holzhey David , Conradi Lenard , Riess Friedrich , Veeckman Philippe , Strauch Justus , Diegeler Anno , Böning Andreas , Reents Wilko 
Published: March 2018

Background Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (off-pump CABG) may reduce severe adverse events including stroke.
Methods In the German Off-Pump Coronary Artery Bypass Grafting in Elderly patients trial, the rate of major adverse cardiovascular events was compared in 2,394 elderly (≥ 75 years) patients undergoing CABG with (on-pump) or without (off-pump) cardiopulmonary bypass. This exploratory post-hoc analysis investigated the impact of surgical aortic manipulation on the rate of stroke.
Results There was no significant difference in the rate of stroke within 30 days after surgery between both groups (off-pump: 2.2%; on-pump: 2.7%; odds ratio [OR]: 0.83 [0.5–1.38]; p = 0.47). Within the off-pump group, different degrees of aortic manipulation did not lead to significant different stroke rates (tangential clamping: 2.3%; OR 0.86 [0.46–1.60]; clampless device: 1.8%; OR 0.67 [0.26–1.75]; no aortic manipulation: 2.4%; OR 0.88 [0.37–2.14]). An aggregate analysis including more than 10,000 patients out of the four recent major trials also yielded comparable stroke rates for on- and off-pump CABG (off-pump: 1.4%; on-pump: 1.7%; OR 0.87 [0.64–1.20]).
Conclusion Within recent prospective randomized multicenter trials off-pump CABG did not result in lower stroke rates. The possible intrinsic benefit of off-pump CABG may be offset by the complexity of the operative therapy as well as the multiple pathomechanisms involved in perioperative stroke.
Collaboration Technology for Rural Health-care
Authors: Raman R. S. , agannathan V.J , Srinivas K. , Reddy S. , Cleetus K.J. , Reddy R. 
Published: March 2018

AbstractHealth-care is a collaborative endeavor involving a number of individuals and organizations with diverse perspectives. Computer-supported collaboration technologies have great potential to enable health-care providers to improve the quality of care provided to their patients. Such technologies have the potential to overcome barriers to quality health-care in the small, scattered populations of rural areas. Rapid changes in technology are making it more and more possible for collaborative telemedicine to be a part of the practice of medicine. The World Wide Web has amply demonstrated that the globe has shrunk and information from afar is a mere mouse click away. However, the ease with which information is accessed along with the potential disclosure and misuse of personal information has raised serious concerns about the ability to restrict such information to legitimate accesses by duly authorized health-care providers. The authors present their experience in developing a health-care collaboration facility, ARTEMIS, which enabled Web-based access to electronic medical records, and provide a vision of their experiment to provide secure telemedicine for rural health-care practitioners.
Strategy for Medical Informatics Education at the University of Medicine and Pharmacy in Timisoara
Authors: Lungeanu V. , Mihalas G.I. 
Published: March 2018

AbstractOur strategy for adapting a curriculum in medical informatics for medical students is presented. After a brief overview, some specific conditions are addressed, which account for some peculiarities of the objectives of our courses and of the design of the curriculum, including its integration in the overall medical curriculum. Some efforts concerning examinations and some specific educational tools are then discussed. The paper also deals with particular features concerning medical informatics education for dentistry and pharmacy students as well as for postgraduate courses, paying special attention to the doctoral level. Finally, future perspectives of medical informatics education are discussed.The paper does not present a list of successes and achievements. We had, and still have several difficulties (not always related to financial drawbacks), which required a particular approach; the word “strategy”; in the title is also meant to cover these aspects.
The Structure of Data in Medical Records
Authors: Astrid M. 
Published: March 2018

Abstract:With the growing complexity of health care, patient data are more and more in demand for purposes such as research, education, postmarketing surveillance, quality assessment, and outcome analysis. Many of these purposes require patient data to be available in a structured, electronic format. Despite the rapid advances in computer technology, which allow patient data to be organized, analyzed, and shared, the majority of physicians still use paper medical records. Apparently, most physicians still perceive the paper record as being more suitable for their task than present day computerized versions. Both the shortcomings and the strengths of paper medical records have been identified and it proves difficult to design a computerized medical record that exploits the strengths of computers without loosing the advantages of the paper chart. The structure of patient data is an area of high interest, since structure determines how physicians, other health care workers, and patients may benefit from these data. An overview of research efforts in structuring patient data will offer insight in the problems that still impede a widespread use of the computerized patient record in clinical practice.
Coding Systems in Health Care
Authors: Cimino J. J. 
Published: March 2018

Abstract:Computer-based patient data which are represented in a coded form have a variety of uses, including direct patient care, statistical reporting, automated decision support, and clinical research. No standard exists which supports all of these functions. Abstracting coding systems, such as ICD, CPT, DRGs and MeSH fail to provide adequate detail, forcing application developers to create their own coding schemes for systems. Some of these schemes have been put forward as possible standards, but they have not been widely accepted. This paper reviews existing schemes used for abstracting, electronic record systems, and comprehensive coding. It also discusses the remaining impediments to acceptance of standards and the current efforts to overcome them, including SNOMED, the Gabrieli Medical Nomenclature, the Read Clinical Codes, GALEN, and the Unified Medical Language System (UMLS).