bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Modified Method of Activity-based Costing for Objectively Reducing Cost Drivers in Hospitals
Authors: Toyabe S. , Kurashima S. , Okada M. , Akazawa K. , Cao P. 
Published: March 2018

Summary

Objectives:
Activity-based costing (ABC) is widely used to precisely allocate indirect costs to medical services. In the ABC method, the indirect cost is divided among the medical services in proportion to the volume of “cost drivers”, for example, labor hours and the number of hours of surgery. However, the workload of data collection of cost drivers can be time-consuming and a considerable burden if there are many cost drivers. The authors aim to develop a method for objectively reducing the cost drivers used in the ABC method.

Methods:
In the ABC method, the cost driver is assigned for each activity. We assume that these activities and cost drivers are the best combination. Our method, that is cost driver reduction (CDR), can objectively select surrogates of the cost drivers for each activity in ABC from candidate cost drivers. Concretely, the total indirect cost of an activity is temporarily allocated to the medical services using each candidate of cost drivers. The difference between the costs calculated by each candidate and the proper cost driver used in ABC is calculated to evaluate the similarity by the evaluation function.

Results:
We estimated the cost of laboratory tests using our method and revealed that the number of cost drivers could be reduced from seven in the ABC to four. Similarly, the results of cost estimation obtained by our method were as accurate as those calculated using the ABC.

Conclusions:
Our method provides two advantages compared to the ABC method: 1) it provides results that are as accurate as those of the ABC method, and 2) it is simpler to perform complicated estimation of hospital costs.
Computer-Assisted Analysis of 4D Cardiac MR Image Sequences after Myocardial Infarction
Authors: Ehrhardt J. , Stork A. , Bansmann M. P. , Lund G. K. , Handels H. , Säring D. 
Published: March 2018

Summary

Objectives:
Spatial-temporal MR image sequences of the heart contain information about shape and motion changes and pathological structures after myocardial infarction. In this paper a Heart Analysis Tool (HeAT) for the quantitative analysis of 4D MR image sequences of infarct patients is presented.

Methods:
HeAT supports interactive segmentation of anatomical and pathological structures. Registration of Cine- and DE-MR image data is applied to enable their combined evaluation during the analysis process. Partitioning of the myocardium in segments enables the analysis with high local resolution. Corresponding segments are generated and used for inter/intra-patient comparison. Quantitative parameters were extracted and visualized.

Results:
Parameters like endocard movement in the infarcted area of six infarct patients were computed in HeAT. Parameters in the infarct area show the expected dysfunctional characteristics. Based on theses parameters passive endocardial movement and myocardial areas with decreased contraction could be identified.

Conclusion:
In contrast to other software tools HeAT supports the combination of contour information of Cine-MR and DE-MR, local analysis with high resolution and inter/intra patient comparison. HeAT enables an observer-independent evaluation of the complex cardiac image data. Using HeAT in further studies can increase the understanding of left ventricle(LV) remodeling.
Statistical Methods for the Validation of Questionnaires
Authors: Schmidt M. E. , Steindorf K. 
Published: March 2018

Summary

Objectives:
Questionnaires used in epidemiological studies should be validated. However, unclarity exists about the appropriate statistical methods and interpretation of validation studies. Thus, we investigated the theory and practice of statistical evaluation approaches.

Methods:
Using three platforms, a literature review, own simulations, and a validation study performed by ourselves, we worked out relevant limitations, advantages, and new important aspects of evaluation methods.

Results:
Our systematic literature review, based on physical activity questionnaires, revealed that correlation coefficients are still the common approach in validation studies, found in 41 of 46 reviewed publications (89.1%). This practice has been criticized in the theoretically oriented literature for more than 20 years. Appropriate evaluation methods as recommended by Bland and Altman were found in only ten publications (21.7 %).We showed that serious bias in questionnaires can be revealed by Bland-Altman plots but may remain undetected by correlation coefficients. With our simulations we refuted the argument that correlation coefficients properly investigate whether a questionnaire ranks the subjects sufficiently well. Further, with Bland-Altman analyses we could evaluate differential errors with respect to case-control status in our validation study. Yet, this was not possible with correlation coefficients, because they generally do not identify systematic bias. In addition, we show a potential pitfall in the interpretation of Bland-Altman plots that might occur in specific rare instances.

Conclusions:
The commonly used correlation approach can yield misleading conclusions in validation studies. A more frequent and proper use of the Bland-Altman methods would be desirable to improve epidemiological data quality.
A Note on Testing for Intervention Effects on Binary Responses
Authors: Henderson R. , Kao C.-F. , Friede T. 
Published: March 2018

Summary

Objectives:
In some circumstances controlled trials are not feasible and treatments can only be evaluated using clinical databases. Here we consider the situation where treatment is introduced at a particular calendar time and can only be evaluated by comparison with historical controls. In these circumstances Heuer and Abel recommended using change-point methods to search for change in characteristics over the whole study period rather than simply comparing treated and untreated patients. Their recommendation is to only conclude that the intervention had an effect if a change-point could be demonstrated close in time to the introduction of the new treatment. This reduces the risk of false positives caused by confounding changes in population characteristics or changes in patient management. For binary data we develop a method that follows their philosophy and apply it to an observational study in the treatment of pin sites after orthopaedic surgery.

Methods:
Tests for change in binomial probabilities based on Brownian bridge and Hansen’s approximation for maximally selected X
2 statistics are compared to an exact test by Worsley. The approximate method is generalized to logistic regression models allowing for covariates.

Results:
The agreement of the exact and approximate method is good for sample sizes of 100 or more. The actual test size of the Hansen approximate test allowing for covariates is close to the nominal level, whereas the Brownian bridge approximation is slightly conservative. The change in pin site treatment significantly reduces the risk of infection for both adults and children.

Conclusions:
We consider the Hansen approximation to provide a very good and very simple method for obtaining the p-value when testing for a change in binary data event probabilities, with or without covariates.
Extended Cooperation in Clinical Studies through Exchange of CDISC Metadata between Different Study Software Solutions
Authors: Wiegelmann S. , Verplancke P. , Ohmann C. , Kuchinke W. 
Published: March 2018

Summary

Objectives:
Our objectives were to analyze the possibility of an exchange of an entire clinical study between two different and independent study software solutions. The question addressed was whether a software-independent transfer of study metadata can be performed without programming efforts and with software routinely used for clinical research.

Methods:
Study metadata was transferred with ODM standard (CDISC). Study software systems employed were MACRO (InferMed) and XTrial (XClinical). For the Proof of Concept, a test study was created with MACRO and exported as ODM. For modification and validation of the ODM export file XML-Spy (Altova) and ODM-Checker (XML4Pharma) were used.

Results:
Through exchange of a complete clinical study between two different study software solutions, a Proof of Concept of the technical feasibility of a system-independent metadata exchange was conducted successfully. The interchange of study metadata between two different systems at different centers was performed with minimal expenditure. A small number of mistakes had to be corrected in order to generate a syntactically correct ODM file and a “vendor extension” had to be inserted. After these modifications, XTrial exhibited the study, including all data fields, correctly. However, the optical appearance of both CRFs (case report forms) was different.

Conclusions:
ODM can be used as an exchange format for clinical studies between different study software. Thus, new forms of cooperation through exchange of metadata seem possible, for example the joint creation of electronic study protocols or CRFs at different research centers. Although the ODM standard represents a clinical study completely, it contains no information about the representation of data fields in CRFs.
Optimizing Diagnostic Test Sequences: The Probability Modifying Plot
Authors: Vries Robbé P. F. de , Verbeek A. L. M. , Severens J. L. 
Published: March 2018

Abstract:The problem of deciding the optimal sequence of diagnostic tests can be structured in decision trees, but unmanageable bushy decision trees result when the sequence of two or more tests is investigated. Most modelling techniques include tests on the basis of gain in certainty. The aim of this study was to explore a model for optimizing the sequence of diagnostic tests based on efficiency criteria. The probability modifying plot shows, when in a specific test sequence further testing is redundant and which costs are involved. In this way different sequences can be compared. The model is illustrated with data on urinary tract infection. The sequence of diagnostic tests was optimized on the basis of efficiency, which was either defined as the test sequence with the least number of tests or the least total cost for testing. Further research on the model is needed to handle current limitations.
Stepwise Evaluation of Information Systems in an University Hospital
Authors: Kuch R. , Prokosch H.-U. , Dudeck J. , Bürkle T. 
Published: March 2018

Abstract:A prospective intervention study with historical control has been performed at Giessen University Hospital, Germany, to investigate the influence of electronic data processing systems on nurses’ working environment. Two wards of the medical department were selected for this study, using the combined approach of work-sampling methods and questionnaires. In the first intervention a central information system with restricted functions was introduced. For the second intervention an additional nursing information system was installed. The distribution of nurses’ worktime into the fields of general nursing care, specific nursing care and administrative activities was not influenced by electronic data processing. No time saving could be measured. Results of the questionnaires did, however, indicate a positive influence of the hospital information system on nurses’ working environment.
Comparison of Genetic Algorithms and Other Classification Methods in the Diagnosis of Female Urinary Incontinence
Authors: Juhola M. , Lammi S. , Viikki K. , Laurikkala J. 
Published: March 2018

AbstractGalactica, a newly developed machine-learning system that utilizes a genetic algorithm for learning, was compared with discriminant analysis, logistic regression, k-means cluster analysis, a C4.5 decision-tree generator and a random bit climber hill-climbing algorithm. The methods were evaluated in the diagnosis of female urinary incontinence in terms of prediction accuracy of classifiers, on the basis of patient data. The best methods were discriminant analysis, logistic regression, C4.5 and Galactica. Practically no statistically significant differences existed between the prediction accuracy of these classification methods. We consider that machine-learning systems C4.5 and Galactica are preferable for automatic construction of medical decision aids, because they can cope with missing data values directly and can present a classifier in a comprehensible form. Galactica performed nearly as well as C4.5. The results are in agreement with the results of earlier research, indicating that genetic algorithms are a competitive method for constructing classifiers from medical data.
Labeling and Filtering of Medical Information on the Internet
Authors: Diepgen T. L. , Eysenbach G. 
Published: March 2018

AbstractInternet information undergoes no quality controls and virtually anybody can publish anything. Because of this, it is difficult for searchers to take information retrieved from the Internet at face value. A related problem is the uncontrolled promotion of medical products on the Internet. A further problem of today’s Internet is that authors use no uniform keywords and other descriptive labels, which deteriorates the quality of search results. A solution for all these problems could be widespread use of descriptive and evaluative metainformation associated with medical Internet information. Our concept is based on a recently established infrastructure for assigning metadata to Internet information, the so-called PICS Standard (Platform for Internet Content Selection). We prototyped a PICS-based rating vocabulary for medical information (med-PICS), containing descriptive and evaluative categories, to be used by the webauthor and third-party label services (such as medical associations), respectively. We propose an international effort to assign metadata to medical Internet information.
Managers Reports of Automated Coding System Adoption and Effects on Data Quality
Authors: Jameson R. , Lorence D. P. 
Published: March 2018

Summary
Objective: Assessment of the adoption of automated classification (encoder) systems in healthcare settings and related effects on perceived data quality.
Methods: Survey of all U.S. accredited medical records managers, summarizing their reports of automated encoding systems and data quality change following adoption of systems.
Results: Significant improvement in data was seen from adoption of automated encoding systems, though variation existed across regions and key demographic variables.
Conclusion: At a national level, there is a need to minimize data quality variation and ensure some degree of nationwide uniformity in the performance of coding systems. If healthcare providers are expected to trust coded data for comparative purposes, there will be a like need for more uniform and standardized system-based performance benchmarks.
Legal Pitfalls in Teleneuropathology
Authors: Walter K. F. J. P. , Walter G. F. 
Published: March 2018

Summary
Objectives: This study aims to emphasize legal pitfalls, especially the often underestimated liability issues for both clients of telemedicine and “tele-doctors”. The main relevance of telemedicine lies in its capability to link medical practitioners and remote hospitals to larger or specialized facilities in a very fast electronic manner. This may become even more important due to current increases in subspecialization and the demand for more precise diagnosis and consultation in difficult cases. However, every potential user or client of telemedicine should keep in mind that several questions of law are involved.
Methods: In this paper, two case studies representative of practical teleneuropathology scenarios are described. The assessment of the legal implications is focused on the personal liability of the teleneuropathologist.
Results: The far-reaching personal liability of the teleneuropathologist can lead to situations in which neither the insurance of the hospital nor the private professional liability insurance could be called on to refund possible damages for health impairments of a patient.
Conclusions: In Germany, a contractual exclusion of liability in health matters is not admissible. With regard to the European situation, international agreements such as a European telemedicine law could be conducive to the future border-crossing development of telemedicine though, to date, the legal competencies remain with the single member countries of the European Community.
Electronic Signature for Medical Documents – Integration and Evaluation of a Public Key Infrastructure in Hospitals
Authors: van der Haak M. , Hartmann M. , Haux R. , Schmücker P. , Brandner R. 
Published: March 2018

Summary
Objectives: Our objectives were to determine the user-oriented and legal requirements for a Public Key Infrastructure (PKI) for electronic signatures for medical documents, and to translate these requirements into a general model for a signature system. A prototype of this model was then implemented and evaluated in clinical routine use.
Methods: Analyses of documents, processes, interviews, observations, and of the available literature supplied the foundations for the development of the signature system model. Eight participants of the Department of Dermatology of the Heidelberg University Medical Center evaluated the implemented prototype from December 2000 to January 2001, during the course of an intervention study. By means of questionnaires, interviews, observations and database analyses, the usefulness and user acceptance of the electronic signature and its integration into electronic discharge letters were established.
Results: Since the major part of medical documents generated in a hospital are signature-relevant, they will require electronic signatures in the future. A PKI must meet the multitude of responsibilities and security needs required in a hospital. Also, the signature functionality must be integrated directly into the workflow surrounding document creation. A developed signature model, fulfilling user-oriented and legal requirements, was implemented using hard and software components that conform to the German Signature Law. It was integrated into the existing hospital information system of the Heidelberg University Medical Center. At the end of the intervention study, the average acceptance scores achieved were x = 3,90; sD = 0,42 on a scale of 1 (very negative attitude) to 5 (very positive attitude) for the electronic signature procedure. Acceptance of the integration into computer-supported discharge letter writing reached x = 3,91; sD = 0,47. On average, the discharge letters were completed 7.18 days earlier.
Conclusion: The electronic signature is indispensable for the further development of electronic patient records. Application-independent hard and software components, in accordance with the signature law, must be integrated into electronic patient records, and provided to certification services using standardized interfaces. Signature-oriented workflow and document management components are essential for user acceptance in routine clinical use.
Implications of Nondifferential Misclassification on Estimates of Attributable Risk
Authors: Vogel C. , Gefeller O. 
Published: March 2018

Summary
Objectives: Only the effects of isolated nondifferential misclassification of exposure or disease on the estimates of attributable risk have been discussed in the literature. The aim of this paper is to broaden the spectrum of scenarios for which implications of misclassification are available.
Methods: For this purpose, a matrix-based approach allowing a comprehensive, unified analysis of various structures of misclassification is introduced. The relative bias or – in the situation of covariate misclassification – the relative adjustment are presented for the different misclassification scenarios.
Results: Under nondifferential misclassification of exposure or disease, the attributable risk is biased towards the null with the only exception of perfect sensitivity of exposure classification or perfect specificity of disease classification both leading to an unbiased attributable risk. From these two marginal effects, the consequences of simultaneous nondifferential independent misclassification of exposure and disease on the attributable risk are derived in the matrix-based approach. Misclassification of a dichotomous covariate leads to partial adjustment.
Conclusions: To a large extent, the results for the attributable risk are in accordance with the well-known results for the relative risk. The algebraic differences between the two risk measures, however, make it necessary to repeat the methodological considerations for the attributable risk.
An Inventory of Publications on Computer-Based Medical Records: An Update
Authors: van der Lei J. , Moorman P. W. 
Published: March 2018

Summary
Objectives: In 1998, we reported a steady increase in the number of publications indexed in MedLine with the MeSH term ‘Medical Records Systems, Computerized’. No signs indicating an increasing interest of high-impact medical journals to publish on the computer-based patient record could be determined. In this review we provide an update.
Methods: We retrieved and analyzed all English publications indexed before Feb 22 2002 in PubMed with the MeSH term ‘Medical Records Systems, Computerized’.
Results: We retrieved a total of 5856 publications, of which 1824 (31%) appeared in a journal with an impact factor in the year of publication. The total impact-score shows an upward trend.
Conclusions: The results show that the earlier observed increase in number of publications did not persist in the second half of the nineteen-nineties. Since the mid-nineties, there has been a steady yearly production of publications indexed with the MeSH term, reflecting a sustained interest in the domain. However, the volume of publications appearing in journals with higher impact factors is increasing. Furthermore, high-impact journals, such as the “British Medical Journal”, the “Lancet” and “Annals of Internal Medicine” regularly publish on the subject, reflecting an interest well beyond the medical informatics community.
Change Management of Shared and Local Versions of Health-Care Terminologies
Authors: Shahar Y. , Oliver D. E. 
Published: March 2018

Abstract:Local sites that adopt a shared health-care terminology for computer-based systems have local needs that prompt the local-terminology maintainers to make changes to the local version of the shared terminology. If the local site is motivated to conform to the shared terminology, then the burden lies with the local site to manage its own changes and to incorporate the changes of the shared version at periodic intervals. We call this process synchronization. We survey current approaches that address problems of sharing and local modification, and we present the CONCORDIA model, which supports carefully controlled divergence of a local version from a shared terminology. CONCORDIA provides the underlying design and methodology for the implementation of a synchronization-support tool.
Realization of Security Concepts for DICOM-based Distributed Medical Services
Authors: Thiel A. , Tolxdorff T. , Bernarding J. 
Published: March 2018

Abstract:Exploiting distributed hard- and software resources for tele-medicine requires a fast, secure, and platform-independent data exchange. Standards without inherent security mechanisms such as DICOM may ease non-authorized data access. Therefore, exemplary telemedical data streams were analyzed within the Berlin metropolitan area network using specialized magnetic resonance imaging techniques and distributed resources for data postprocessing. For secure DICOM communication both the Secure Socket Layer Protocol and a DICOM-conform partial encryption of patient-relevant data were implemented. Partial encryption exhibited the highest transfer rate and enabled a secure long-term storage. Different data streams between secured and unsecured networks were realized using partial encryption.