bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transferring Data from One EPR to Another: Content – Syntax – Semantic
Authors: Bürkle T. , Schweiger R. , Altmann U. , Holena M. , Blobel B. , Dudeck J. 
Published: March 2018

AbstractWhen data are transmitted between electronic patient record (EPR) systems, we can distinguish several tasks. One task is the definition of structure and semantic content of the data in a message structure. Another task is the mapping of the sending EPR’s structure to this message structure. A third task is the mapping of the message structure to the receiving EPR’s structure. We describe an approach, which distinguishes clearly between these different tasks and activities. Using this approach we have implemented a data transfer procedure between a cancer registry application and a middleware for healthcare information systems. Our experience showed that the proposed systematic approach helped identify problems for data transfer in an early design phase. It also allowed us to limit modifications of the data exchange procedure to certain tasks or activities when one of the EPR applications was updated. In the end, we could even exchange the underlying message format without having to reimplement the complete interface.
Age-Related Reference Regions for Longitudinal Measurements of Growth Characteristics
Authors: Reinhard I. , Wellek S. 
Published: March 2018

AbstractMost studies on age-related reference centiles published up to now have adopted a strictly cross-sectional perspective. Clearly, the results of studies of that type do not provide a tool for the diagnostic assessment of whole series of measurements taken sequentially over time in the same individual. In this paper, the approach of Wellek & Merz (1995) to the construction of age-dependent reference ranges for cross-sectional measurements is generalized in such a way that data sets containing time series of arbitrary length varying between subjects can be accommodated. Since repeated measurements on the same subject are typically correlated, the regression function to be used as the central line for the reference band eventually obtained is determined by fitting a nonlinear mixed model describing the dependence of conditional means on age by growth functions of the same class we proposed in the case of cross-sectional data. Estimation of the parameters of this mixed model is done in a way closely related to the population-averaged GEE approach by Zeger et al. (1988). Given the regression line, the reference band is constructed by means of an iterative procedure guaranteeing that the proportion of observed profiles which nowhere leave the band, has some prespecified value (frequently set equal to 90% in practice). The approach is illustrated with two examples taken from child psychiatry and prenatal sonography.
Differentiation of Benign and Malignant Breast Tumors by Logistic Regression and a Classification Tree using Doppler flow signals
Authors: Madjar H. , Prömpeler H. J. , Sauerbrei W. 
Published: March 2018

AbstractIn breast examinations with Doppler, an increased flow is found in malignant tumors. With the relatively new color Doppler, we measured different flow values in 133 cancer patients and in 325 women with benign disease. These measurements were used to develop diagnostic rules. For the highly correlated flow values, we used a stepwise procedure to select a final logistic regression model and a tree-based approach, which is a different way of modeling. With both approaches we developed simple diagnostic rules of which the sensitivity and the specificity exceeded 90%. There are no differences between the two approaches concerning discriminative ability. As complex statistical modeling leads to an overoptimism in the assessment of the error rates, we applied sensitivity analysis, investigated the stability of the selected logistic regression model, and estimated the magnitude of the overoptimism of the diagnostic rules with resampling methods. The results indicate that the estimates of sensitivity and specificity are probably close to realistic values for a clinical setting.
Medical Work and the ComputerBased Patient Record: A Sociological Perspective
Authors: Berg M. 
Published: March 2018

AbstractThe computer-based patient record (CPR) is a tool likely to have great impact on the practice of medicine in the years to come. Yet, clinical settings with a fully integrated CPR are hard to find. This paper takes a sociological look at the attempts to construe and introduce CPRs. It is argued that part of the current trouble in getting these tools to work lies in the model of medical work that is inscribed in many (attempted) CPRs. A more sociological perspective on medical work should be able to offer points of departure for the construction of systems wh ich might fit the needs of health care workers better. Based on participatory observation, the paper outlines what it is medical work comes down to from a sociological perspective, and how the medical record figures in this work. Finally, some consequences this depiction has for current discussions on and (proposed) implementations of CPRs are described.
Use of the Unified Medical Language System in Patient Care at the Columbia-Presbyterian Medical Center
Authors: Cimino J. J. 
Published: March 2018

Abstract:The Unified Medical Language System (UMLS) project at the United States National Library of Medicine contains and organizes a large number of terms from controlled medical vocabularies. This study examines the suitability of the UMLS for representing patient care information as it exists in the Columbia-Presbyterian Medical Center (CPMC) clinical information system. Comparisons were made between the semantic types, semantic relations and medical concepts of the UMLS and the data model entities, semantic classes, semantic relations and concepts in the CPMC system. Results of the comparison demonstrate that the UMLS structural model is appropriate for representing CPMC vocabularies and patient data and that the UMLS concepts provide excellent coverage of CPMC concepts in many areas. Recommendations are made for enhancing UMLS structure to provide additional coverage of the CPMC model. It is concluded that content expansion to provide better coverage of clinical terminology is possible within the current UMLS model.
Utilization of a Neural Network in the Elaboration of an Evaluation Scale for Pain in Cerebral Palsy
Authors: Jimeno M. T. , Collignon P. , Chau Y. , Giusiano B. 
Published: March 2018

Abstract:An interesting aspect of neural networks is shown in the elaboration of an evaluation scale for pain in cerebral palsy with severe mental retardation. Because of the diversity of cases, the number of items had to be limited in the final step of statistical validation. Classical analysis on prior data did not allow to decide whether the variability in results is more likely due to the type of disability (i. e., the possibility of pain expression) than to the actual presence of pain. A neural network was used to find implicit relations between the data, with the advantage of having total control on the variables’ status by applying variations in the network architecture. This allowed for the rapid identification more significant item combinations as a function of degree of relationship to pain in cerebral palsy.
Ontology and Terminology Servers in Agent-based Health-care Information Systems
Authors: Lanzola G. , Stefanelli M. , Falasconi S. 
Published: March 2018

Abstract:A new research paradigm is emerging based on the multi-agent system architectural framework, allowing human and software agents to interoperate and thus cooperate within common application areas. Within a multi-agent system, the different “views of the world” of knowledgeable agents are to be bridged through their commitment to common ontologies and terminologies. We developed a general methodology for the design or integration of new components into a Health-care Information System conceived as a network of software and human agents. In our view, ontological and terminological services are entrusted to dedicated agents, namely ontology and terminology servers, allowing the configuration of suitable application ontologies for distributed applications. The role is described that such servers, operatively coordinated in order to preserve semantic coherence, should play within a distributed Health-care Information System.
Record Linkage Strategies
Authors: Roos L. L. , Wajda A. 
Published: March 2018

AbstractRecord linkage techniques can help identify the same patient for matching diverse files (hospital discharge abstracts, insurance claims, registries, Vital Statistics data) which contain similar identifiers. Prior knowledge of whether a linkage is feasible is important to prevent wasted effort (additional data collection or data manipulation), which decreases the cost-effectiveness of the linkage. Using examples generated by linking the Manitoba Health Services Commission data with Vital Statistics files, a method of estimating the information in each data set is presented first. Further, the feasibility of several different record linkage strategies is described and tested, given varying amounts of information. At the margin, relatively small amounts of information (having just one more variable to match with) can make a great difference. Probabilistic linkage’s great advantage was found in those situations where only a moderate amount of extra information was available.By using the above techniques when working with one or both files in a proposed record linkage project, a much more informed judgement can now be made as to whether a linkage will or will not work. In facilitating record linkage, flexibility of both software and the strategy for matching is very important.
Elements of Significance Testing with Equivalence Problems
Authors: Wellek S. , Michaelis J. 
Published: March 2018

AbstractThe paper outlines an approach to the general methodological problem of equivalence assessment which is based on the classical theory of testing statistical hypotheses. Within this frame of reference it is natural to search for decision rules satisfying the same criteria of optimality which are customarily applied in deriving solutions to one- and two-sided testing problems. For three standard situations very frequently encountered in medical applications of statistics, a concise account of such an optimal test for equivalence is presented. It is pointed out that tests based on the well-known principle of confidence interval inclusion are valid in the sense 1 of guaranteeing the prespecified level of significance, but tend to have an unnecessarily low efficiency.
The Multi-Trellis Software Architecture and the Intelligent Cardiovascular Monitor
Authors: Gelernter D. H. , Factor M. , Sittig D. F. 
Published: March 2018

Abstract:A real-time, intelligent cardiovascular monitor is complex. It must process multiple waveforms, recognize artifacts, extract pertinent parameters, recognize a patient’s clinical state, analyze the problem and formulate a response. This paper presents the multi-trellis (a collection of process trellises), a software architecture for building such a monitor. A process trellis is a uniform hierarchical framework for heterogeneous program modules. The multi-trellis extension allows one to compile several process trellis programs with widely varying run-time requirements into a single executable program that it is efficient, predictable and usable. Our prototype consists of two process trellises. The lower trellis contains processes to analyze three different analog signals: the blood pressure from a non-invasive monitor and an arterial catheter, and the ECG. The upper trellis contains processes to help detect evolving hemodynamic trends, identify abnormalities, and present a succinct summary to the clinician. Our prototype shows that the multi-trellis is a demonstrably useful software architecture for building these real-time, intelligent monitors.
An Intelligent Computer-Assisted Instruction System Designed for Rural Health Workers in Developing Countries
Authors: Auvert B. , Gilbos V. , Andrianiriana F. , Bertrand W. E. , Emmanuelli X. , Benillouche E. , Landre M. F. , Bos D. , Aegerter P. 
Published: March 2018

Abstract:This paper describes an intelligent computer-assisted instruction system that was designed for rural health workers in developing countries. This system, called Consult-EAO, includes an expert module and a coaching module. The expert module, which is derived from the knowledge-based decision support system Tropicaid, covers most of medical practice in developing countries. It allows for the creation of outpatient simulations without the help of a teacher. The student may practice his knowledge by solving problems with these simulations. The system gives some initial facts and controls the simulation during the session by guiding the student toward the most efficient decisions. All student answers are analyzed and, if necessary, criticized. The messages are adapted to the situation due to the pedagogical rules of the coaching module. This system runs on PC-compatible computer.
Automated Online Transition from the Medical Record to the Psychiatric Literature
Authors: Powsner S. M. , Miller P. L. 
Published: March 2018

Abstract:Psych Topix is a knowledge-based program which guides the clinician from an on-line clinical report to a search of the psychiatric literature or of other relevant databases. It provides this guidance by using an outline of key topics in a clinical field to provide “concept-based” links. Each topic is augmented with an activation expression to signal when that topic is potentially relevant to a case, and with database search expressions to allow focused retrieval of information. The bibliographic retrieval component of PsychTopix is currently operational as part of the daily, routine operation of a psychiatric consultation service. The system is also implemented in a demonstration mode to provide retrieval from three additional textual databases. The current PsychTopix system provides a working demonstration of the clinical feasibility of using concept-based links to facilitate the focused, automated transition between on-line medical databases.
Bone Density, Biochemistry and Life-Style
Authors: Robinson D. , Bailey A. R. , Hale A. C. , Allaway S. L. 
Published: March 2018

Abstract:We have assessed the relationship between bone density, biochemistry and life-style factors in a cross-sectional study of 434 pre- and 357 postmenopausal women. Bone-mineral content (BMC) was measured in the non-dominant forearm using single-photon densitometry. Bone mass was corrected for bone size (BMC2) in a sub-set of 263 subjects. Correlation statistics and multiple regression analyses were used to identify physical and biochemical measurements that could be used to best predict BMC or BMC2. These were combined with lifestyle factors, using multiple logistic regression analysis, to identify women at risk of low bone density. Cut-off values were taken as the 5th percentile of the bone density distributions in pre-menopausal women. In postmenopausal women, using BMC2 values to define “risk”, and using age, creatinine, alkaline phosphatase, thyroxine treatment, and calcium supplementation as predictors, a sensitivity of 73% and a specificity of 95% were achieved. Such a model may be of use as a “first pass” screening test for osteoporosis.
Cerebral and Functional Aging: First Results on Prevalence and Incidence of the Paquid Cohort
Authors: Jacqmin H. , Commenges D. , Barberger-Gateau P. , Dartigues J.-F. , Salamon R. , Letenneur L. 
Published: March 2018

Abstract:Paquid is an interdisciplinary study designed to investigate cerebral and functional aging. A cohort of 3,777 community residents living in two administrative areas of South-Western France was selected. A standardized questionnaire was administered at home by trained psychologists. The same procedure was applied one and three years after the baseline data collection. The identification of demented subjects was made with a two-step procedure. The first step is a systematic screening by the psychologists using the DSM-III criteria for dementia. Subjects who fulfilled the DSM-III criteria were examined by a neurologist. Diagnosis of dementia is confirmed according to the NINCDS-ADRDA criteria. The Paquid cohort is complemented by a random sample of 357 institutionalized subjects. First results of prevalence and incidence rates show an exponential increase of dementia with age.
Pharmacological and Model-based Interpretation of Neuronal Dynamics Transitions during Sleep-Waking Cycle
Authors: Nakao M. , Mizutani Y. , Takahashi T. , Watanabe K. , Arai H. , Sasaki N. , Yamamoto M. 
Published: March 2018

Abstract:Power spectral analysis has been applied to spontaneous single neuronal activities during the sleep-waking cycle in various regions of the cat’s central nervous system. During slow-wave sleep (SWS), the spontaneous activities of many neurons had a white noise-like power-spectral density profile in a very low frequency range (0.01-1.0 Hz) whereas, during rapid-eye-movement sleep (REMS), they showed a 1/f-like spectral pattern. This spectral transition between SWS and REMS was hypothesized to depend on the influence of serotonergic and cholinergic neuronal activity which is considered to modulate various brain functions. According to both pharmacological experiments and simulation studies with a neural network model, it was concluded that the serotonergic system may have a function to eliminate slow fluctuations in neuronal activity in wide areas, from the reticulothalamo-neocortical to the limbic systems. Consequently, simple signal processing of spontaneous neuronal activity has elucidated an important neurophysiological fact, which may lead to a principle of the basic brain function and its mechanism.
Health and Medical Informatics Education
Authors: Haux R. , Leven F. J. , Moehr J. R. , Protti D. J. 
Published: March 2018

Abstract:Health and medical informatics education has meanwhile gained considerable importance for medicine and for health care. Specialized programs in health/medical informatics have therefore been established within the last decades.This special issue of Methods of Information in Medicine contains papers on health and medical informatics education. It is mainly based on selected papers from the 5th Working Conference on Health/Medical Informatics Education of the International Medical Informatics Association (IMIA), which was held in September 1992 at the University of Heidelberg/Technical School Heilbronn, Germany, as part of the 20 years’ celebration of medical informatics education at Heidelberg/Heilbronn. Some papers were presented on the occasion of the 10th anniversary of the health information science program of the School of Health Information Science at the University of Victoria, British Columbia, Canada. Within this issue, programs in health/medical informatics are presented and analyzed: the medical informatics program at the University of Utah, the medical informatics program of the University of Heidelberg/School of Technology Heilbronn, the health information science program at the University of Victoria, the health informatics program at the University of Minnesota, the health informatics management program at the University of Manchester, and the health information management program at the University of Alabama. They all have in common that they are dedicated curricula in health/medical informatics which are university-based, leading to an academic degree in this field. In addition, views and recommendations for health/medical informatics education are presented. Finally, the question is discussed, whether health and medical informatics can be regarded as a separate discipline with the necessity for specialized curricula in this field.In accordance with the aims of IMIA, the intention of this special issue is to promote the further development of health and medical informatics education in order to contribute to high quality health care and medical research.
Application of Indicators, Predictors and Diagnostic Indices in Coagulation Disorders
Authors: Wahlberg Th. , Blombäck Margareta , Hall P. , Axelsson G. 
Published: March 2018

A recently described theoretical model for the evaluation of binary and continuous diagnostic variables by indicators and predictors, is in the present study applied to a self-administered-questionnaire for obtaining a medical history of different blood coagulation disturbanoies (binary variables).The diagnostic power of each question is calculated by indicators and predictors. The total diagnostic capacity of the questionnaire is expressed by an anamnestic or summation index.The questionnaire was shown to be able to separate healthy individuals from diseased ones. A rank order of the diagnostic capacity of the questions, built upon indicators and predictors, is presented.
Statistical Evaluation of the Respiratory Pattern as a Risk Factor for the Sudden Infant Death Syndrome
Authors: Pfeiffer K. P. , Haidmayer R. , Kerschhaggl P. , Kurz R. , Kenner T. 
Published: March 2018

SummaryTo evaluate the respiratory pattern of infants with regard to a possible risk for SIDS, two characteristic values (MA and GA) were computed from the distribution of apneas. For the computation of one of these characteristic values (GA), a weight function for apneas was used to consider the diagnostic information content of apneas of different durations. The distribution of apneas is approximately exponential where apneas up to 20 s and longer have been found. Using these characteristic numerical values of the respiratory pattern, infants of different age groups were classified into risk and non-risk cases. This classification was performed in the way that an optimal agreement between clinical and numerical classification was achieved. For both numerical values an agreement of about 90% with clinical classification was achieved.To consider the differing impact of misclassification, a weighted classification procedure was proposed.
What Does an Observed Relative Risk Convey about Possible Misclassification?
Authors: Blettner M. , Wahrendorf J. 
Published: March 2018

SummaryMisclassification of exposure in epidemiological studies has the effect of distorting the results in various directions. We give quantitative information about the possible order of magnitude of misclassification and of “true” effects given the observations of an epidemiological study. It will be demonstrated that misclassification can also distort trends in relative risks. Real examples from the epidemiological literature are used for illustration.
Descriptive Data Analysis: A Concept between Confirmatory and Exploratory Data Analysis
Authors: Abt K. 
Published: March 2018

SummaryConfirmatory Data Analysis (CDA) in randomized comparative (“controlled”) studies with many variables and/or time points of interest finds its limitations in the multiplicity of desired inferential statements which leads to unfeasibly small adjusted significance levels (“Bon-ferronization”) and, thereby, to unduly increased risks of not rejecting false hypotheses. In general, analytical models adequate for such complex data structures and suitable for practical use do not exist as yet. Exploratory Data Analysis (EDA), on the other hand, is usually intended to generate hypotheses and not to lead to final conclusions based on the results of the study.In this paper, it is proposed to fill the conceptual gap between CDA and EDA by “Descriptive Data Analysis” (“DDA”) which concept is mainly based on descriptive inferential statements. The results of a DDA in a controlled study are interpreted simultaneously on the basis of the investigator’s experience with respect to numerically relevant treatment effect differences and on “descriptive significances” as they appear in “near regular” patterns corresponding to the resulting relevant effect differences. A DDA may also contain confirmatory parts and/or tests on global hypotheses at a prechosen maximum risk α of erroneously rejecting true hypotheses. The paper is in parts expository and is addressed to investigators as well as statisticians.