bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimating Relative Risk from Heterogeneous Strata
Authors: Ahlborn W. , Tuz H.-J. , Überla K. 
Published: March 2018

SummaryThe uncritical use of risk estimators can lead to serious bias. The estimation of overall risk ratios for heterogeneous strata and the weights used have been discussed recently. This paper starts with the definition of relative risk in the population, considering heterogeneous strata and a cofactor, using weight functions. From this general formula four different weight functions leading to four different overall measures of relative risk (RR1, RR1, RR3, RR4
) are. derived as special cases. The estimability of the parameters in relation to the underlying sampling design is investigated. Consistent estimators are provided and the asymptotic distributions of the estimators are given for prospective cohort studies, case control studies with fixed strata and case control studies with given sample sizes. For some of the estimates the . asymptotic variances are given. It is shown that for case control studies with fixed strata neither the Mantel-Haenszel estimator nor another estimator of this class is consistent. An extension to more than two risk levels is provided and the relationships between various risk measures and other implications are commented on. A way is described to improve risk estimation by using information from the population. An example for cohort studies is given. Generally we propose to use RR3
, which lies between RR1
and RR2
and can be estimated more precisely using the sometimes available distribution of the cofactor in the population. If the relative risk across strata is heterogeneous, logistic models for the construction of a single risk indicator have some drawbacks.
Pro. M. D. - A Diagnostic Expert System Shell for Clinical Chemistry Test Result Interpretation
Authors: Pohl B. , Trendelenburg Chr. 
Published: March 2018

SummaryThe history and main features of the diagnostic expert system Pro. M. D. are presented. An illustrative case report from a knowledge base for the evaluation of disorders of lipid metabolism helps to explain Pro. M. D.’s functions. The knowledge representation syntax is explained for the different types of rules. Knowledge bases currently in development are outlined. A new concept of probability reasoning and other recent improvements are discussed briefly. Implementation details are described with special regard to the inference function. Evaluation problems are discussed and Pro. M. D. is compared to other known diagnostic computer systems.
Occupational Risks: A Follow-up Method Based on Individual Work History Records Including the Environmental Aspects of the Workplace
Authors: Martin J. M. , Robaux P. 
Published: March 2018

Abstract:This article analyzes the Curriculum Laboris or career reconstruction as a means of studying the occupational risks of employees. A type of Curriculum Laboris which makes the established record easier to use has been suggested. The authors point out some advantages to be expected from the proposed computerized method. The usefulness of the proposed Curriculum Laboris is largely conditioned by lack of standards for guiding data collection by physicians. Finally, the Curriculum Laboris has been considered as an element of a larger information system.
Tropical Epidemiology: A System for Continuous Demographic Monitoring of a Study Population
Authors: Stephens J. , Alonso P. L. , Byass P. , Snow R. W. 
Published: March 2018

Abstract:Epidemiologists in many developing countries, where official demographic services are unavailable, have to include some demographic functions in their work. The usual method of documenting a study population for epidemiological research in a developing country consists of three stages: mapping, enumeration and vital registration. This paper considers the last element of this process, detailing the development of a suitable data system and explaining how its implementation using microcomputers and a database management system can help in the creation of an on-line continuous vital registration system for a study population as an epidemiological tool. The issues covered are data collection, entry and analysis, and the advantages of such a system for use in epidemiological research in developing countries are also discussed.
An Automated Parsing Routine for Diagnostic Statements of Surgical Pathology Reports
Authors: Wong R. L. , Gaynon P. 
Published: March 2018

An automated parsing routine was written for extracting the »site«, »diagnostic«, and »modifier« components of the diagnostic statements of the diagnostic summary of surgical pathology reports. Such parsed reports appear to be suitable for input into an information retrieval system for the surgical pathology reports.Data was input through a key-to-tape device producing a computer compatible magnetic tape with a record size of 870 bytes. The statements were parsed through syntactic and morphological analysis utilizing the common prepositions, the common punctuations and the morphemal constructions common in medical terms. (A total of sixty-two delimiters were used). Certain suffix transformations were performed, converting some »site« adjective to »site« nouns, and some »diagnostic« nouns to »site« nouns. 1,108 diagnostic statements were processed with an error rate of 9.3% for the latest version on the last 493 statements.
Klartextanalyse pathologischer Biopsiebefunde mit Bildschirmabfrage
Authors: GELL G. , BECKER H. 
Published: March 2018

Beschreibung eines Klartextsystems zur Dokumentation von Befunden in der Pathologie, das sich seit 1. 1. 1971 im Testbetrieb befindet und bisher 8 000 Biopsiebefundberichte analysiert und gespeichert hat. Der zugrundeliegende Thesaurus verfügt über 39 000 Eingangsworte; weitere 10 000 Worte werden demnächst eingefügt.Das entwickelte System ist das erste Dokumentationssystem mit Bildschirmabfrage, das in der Pathologie eingesetzt wird.In der Diskussion werden Hinweise auf den notwendigen Aufwand an Maschinenkonfiguration und Manpower gegeben und die verschiedene Struktur der in der Pathologie verwendeten Thesauri erörtert.Die Analyse der Möglichkeiten eines Klartextsystems ergibt drei Stufen der Entwicklung von der wortweise erfolgenden Erfassung bis zur Erfassung des Begriffsinhaltes; praktisch alle Klartextsysteme in der Pathologie befinden sich auf der ersten Stufe dieser Entwicklung, ‘
The Patient Data Bank in a Medical Information System – Tasks, Requirements, Planning and Design
Authors: Sauteh K. 
Published: March 2018

Tasks, requirements, planning and design of the central data bank in a patient information system are demonstrated by the model of the »Medical System Hanover« (MSH).The Terms »Information System«, in particular »Patient Information System« and »Data Bank« are defined. Based on the ultimate goals of MSH, the task set is formulated and a catalogue of the most important basic requirements of a data bank management system is given as typical for application in a hospital environment. Finally, various points of view that are of essential importance for system planning and design, such as selection of data and structurization of files, are discussed.
Validity of Simple Indicators of Emotional I11-Health for Use in Epidemiological Studies
Authors: Abramson J. H. , Epstein L. M. , Flug D. , Jarus A. 
Published: March 2018

The validity of simple symptom inventories as indicators of emotional ill-health was tested by a comparison with clinical appraisals of emotional health status. The indices tested were the Health Opinion Survey Index, an index based on ten »key« questions from the Cornell Medical Index, and the anxiety index used in the Israel Ischemic Heart Disease Project. The test was conducted in a household sample and a sample of patients attending a psychiatric clinic.All the indices were found to be of moderate validity as indicators of the presence or absence of emotional disturbance. All were weakly correlated with the degree of disturbance. The indices did not differ significantly in their validity. Educational level significantly affected the responses to the Health Opinion Survey Index.It was concluded that when superior methods are not feasible, but only then, it is justifiable to use simple indices of this sort for the measurement of emotional health in epidemiological studies. The indices should not be regarded as being of more than moderate validity, and due attention should be paid to the possible confounding influence of factors other than emotional health.
Planning of a Therapeutic Comparison by Consideration of Objective and Subjective Responses
Authors: von Eiff A. W. 
Published: March 2018

Often in drug trialg only the objective or the subjective responsef of the subjects are investigated, depending on the kind of drug. It i s, however, desirable to check both the objective and the subjective responses in every drug trial.The investigation of the objective symptoms which is especially necessary in psycho-pharmacological trials, presents great difficulties. When a bodily function is found which reflects the emotional reactions which it is desired to investigate, it is necessary to plan the trial in a way that allows the results to be seen as proof of the effects of the drugs. Proposals for such a therapeutic trial are made.In the checking of the subjective responses the questionnaire is reckoned to be the best method. Problems of how the questionnaires are made and how they are used in the trials are discussed.By checking the subjective reactions, not only the side effects of the drug are demonstrated, but also their therapeutic effects.The author does not agree with the opinion that the double blind test is better than the single blind test in every case. Appropriate investigations should be made to clarify these questions.
An Automated Clinical Information System
Authors: Yoder D. , Swearingen R. , Schenthal E. , Sweeney W. , Nettleton J. 
Published: March 2018

An automated clinical record system must have the following characteristics: as far as the physician is concerned it must operate in natural language on standard sized paper; it must be able to accept information from the physician at a time when he is oriented to clinical terminology and a clinical mode of thinking; it must have an output which is clinically useful for the care and management of a patient; each item of information must be addressable so that it may act as an index for scientific information retrieval; it must be capable of accepting quantative and natural language information.Clinical information constitutes a mathematical set, only a few members of which are applicable to any particular clinical situation, and to which new members are constantly being added. The members of this set are seldom mutually exclusive. An acceptable system which is capable of processing this type of information has been designed utilizing the concepts of self-encoding forms and variable-field, variable-length records. Applications of these principles will expedite hospital automation, the establishment of drug evaluation information systems, and of regional and nationwide medical record systems.
Computer Evaluation of Statistical Properties of Clinical Information in the Differential Diagnosis of Chest Pain
Authors: Klingemanand J. D. , Cosma J. , Pipbergee H. V. 
Published: March 2018

A pilot study was undertaken to determine quantitatively from a large number of signs, symptoms and laboratory tests of patients with, the differential diagnosis of chest pain, which information items could serve as optimal descriptors and/or discriminators of disease. Data were obtained from 1238 patients. For each subject 429 questions of the »yes-no« type were answered and 69 numerical data collected. Incidence rates of signs and symptoms were considered as descriptors. Out of those exceeding an incidence rate of 25 percent, between 60 and 95 percent referred to medical history, depending upon the disease entity under study.Contingency table analysis and chi-square tests were used first to determine the discriminative power of various items. Historical data predominated again. Out of the total of 498 information items tested only 46 reached a chi-square level of 40 which was considered the minimum for efficient separation of diseases. Many items with high incidence rates contributed little or nothing to disease differentiation.To test the discriminative power of the identified signs, symptoms and laboratory data, discriminant function analysis was used. The number of items could be further reduced to less than 10. More than 95 percent of the 1000 patients with Coronary Artery Disease and Pneumonia could be classified correctly with this reduced set.Data reduction and identification of optimal descriptors and discriminators can be considered as one of the most important preliminary steps in computer analysis of clinical information.
A Procedure for Comparing Groups of Time-Dependent Measurements
Authors: Prestele H. , Gaus W. , Horbach L. 
Published: March 2018

A three step procedure is proposed for the comparison of groups, where for each individual a process is investigated on the basis of repeated measurements (e.g. 3 up to about 15 time points).1. A natural cubic spline function is fitted to the time-dependent measurements of each individual. A cubic spline is a function which is composed of piecewise polynomials, continuous up to and including second derivatives; it has a minimal »curvature«, so that a »smooth« curve is generated.2. For each individual the value of a problem-oriented parameter is estimated from the spline function.3. The values of the problem-oriented parameter are evaluated with standard, not necessarily longitudinal methods for estimating and hypothesis testing.The proposed procedure requires neither an equal number of measurements for each individual, nor the same time points of measurement for all individuals, nor equal length of the time intervals. Splines can be fitted to very different patterns of curves. They can be used for a more exact calculation of parameters adequate to the problem concerned. The procedure necessitates the use of a computer; programs are available and do not demand excessive arithmetic precision and computing time.
Evaluation of a Field Test of Computers for the Doctor’s Office*
Authors: Reichertz P. L. , Möhr J. R. , Schwarz B. , Schlatter A. , von Gärtner-Holthoff G. , Filsinger E. 
Published: March 2018

Based on extensive analysis of functions and structures in general practices and the resulting definitions of needs and possibilities for a computer support; six installations of dedicated computer systems in offices of private physicians were evaluated. The installations involved practices for gynecology, ENT, ophthalmology, and general medicine.The study comprised detailed analyses of the functional characteristics of each office before, during and after the computer installation, especially in regard to work load and work distribution, cost, time performance and motivation.The results of computer support vary in regard to the different types of practices and the pre-test organizational structure of the offices. An increased systematization of recording and claim processing could be achieved. Time gam could only be seen in the registration of new patients or >repeaters< with extensive updates. Retrieval of administrative data was slightly longer in normal >repeaters< than in the manual process. The frequency of diagnoses, recorded procedures and the measurements of various time parameters are reported. The actual set of codes used is manageable in regard to volume and differentiation in the individual office.Evaluation by the physicians themselves reveals different emphasis on priorities of the administrative area, of medical documentation, tune gain or quality. The results of cost analysis vary depending upon the type of practice. In some offices time gain and shift in work load led to an economic gain. The calculations were based on a monthly rental of DM 2,000. However, system architecture and hardware of the experimental system were not yet optimal.Cost/effectiveness and motivational satisfaction relate to the classification of the practices under scrutiny by methods developed in earlier studies.General aspects of the experiment and resulting design criteria for a possible product for the doctor’s office are discussed.
Diabetes des Kindes- und Jugend- alters im Zeitalter von Technik und Telemedizin
Authors: Kapellen T. M. , Kiess W. , Klamt S. 
Published: March 2018

ZusammenfassungDiabetes mellitus Typ 1 bleibt die häufigste Stoffwechselerkrankung im Kindes- und Jugendalter. Dementsprechend überschlagen sich seit Jahren Meldungen in der Presse bezüglich Neuigkeiten im Diabetes-Management und der Diabetes-Therapie. Hochbrisant ist derzeit vor allem die seit dem GB-A-Beschluss im Juni 2016 nun für nahezu jedermann zugängliche kontinuierliche Glukosemessung, die einen weiteren Meilenstein auf dem Weg zur künstlichen Bauchspeicheldrüse darstellt. Schon jetzt steht fest: Die real-time kontinuierliche Glukosemessung wird für einen bedeutenden Teil unserer kleinen Patienten eine Verbesserung der Stoffwechseleinstellung, Verminderung unbemerkter bzw. schwerer Hypoglykämien und eine Verbesserung der Lebensqualität bedeuten. Dennoch sollte beachtet werden, dass diese Form der Glukosemessung nicht für jedermann geeignet ist und durchaus auch Nachteile haben kann. Indikation und Therapieziele sollten daher individuell mit den Patienten und deren Angehörigen besprochen und festgelegt werden. Des Weiteren sollte der Einsatz einer rt- CGM immer auch vor dem Hintergrund möglicher psychischer Konsequenzen für die Patienten und deren Familien gesehen werden. Ständig wird versucht, Patienten das tägliche Management mit ihrer Diabetes-Erkrankung etwas zu erleichtern, so z. B. mit Apps zur Berechnung von Kohlenhydraten. Es bleibt allerdings abzuwarten, wie hilfreich und vor allem individuell diese Apps wirklich für unsere Patienten sind.Es gibt Ergebnisse von Studien mehrerer Forschergruppen zu Heilungsansätzen für Patienten mit Typ-1-Diabetes. Die Ergebnisse beruhen bisher jedoch in der Regel auf Tiermodellen mit geringen Fallzahlen und kurzer Beobachtungsdauer, sodass hier weiterer Forschungsbedarf besteht und wir auch im Jahr 2017 bis zur Möglichkeit der Heilung des Typ- 1-Diabetes noch einen weiten Weg vor uns haben.Auch deshalb wird aktuell der Früherkennung des Typ-1-Diabetes eine entscheidende Bedeutung zugeschrieben. Oberstes Ziel ist neben der Früherkennung vor allem die Reduktion schwerer Stoffwechselentgleisungen bei Manifestation der Erkrankung. In Sachsen gibt es bereits die Möglichkeit, Neugeborene auf Risiko- Gene untersuchen zu lassen. Inwieweit die erhofften Ziele erreicht werden und wir den hohen Anforderungen im Fall positiver Befunde gerecht werden, müssen die nächsten Jahre zeigen.
Patient Scheduling — (Bibliography)
Authors: Köhler C. O. , Wagner G. , Wolber U. 
Published: March 2018

The entire field of information processing in medicine is today already spread out and branched to such an extent that it is no longer possible to set up a survey on relevant literature as a whole. But even in narrow parts of medical informatics it is hardly possible for the individual scientist to keep up to date with new literature. Strictly defined special bibliographies on certain topics are most helpful.In our days, problems of optimal patient scheduling and exploitation of resources are gaining more and more importance. Scientists are working on the solution of these problems in many places.The bibliography on »Patient Scheduling« presented here contains but a few basic theoretical papers on the problem of waiting queues which are of importance in the area of medical care. Most of the papers cited are concerned with practical approaches to a solution and describe current systems in medicine.In listing the literature, we were assisted by Mrs. Wieland, Mr. Dusberger and Mr. Henn, in data acquisition and computer handling by Mrs. Gieß and Mr. Schlaefer. We wish to thank all those mentioned for their assistance.
Fundamentals of Controlled Clinical Trials
Authors: Martini P. 
Published: March 2018

SummaryThe result of therapeutic research should, if possible, also benefit the recovery of the patient. The basic rule for every therapeutic-clinical trial must involve a comparison of therapeutic approaches. In acute conditions, such as acute infectious diseases, infarcts, etc., comparisons should be made between two or more groups: the collective therapeutic comparison, i.e. the between-patients trial. The formation of groups to be compared one with the other can be justified only if one is reasonably sure that a pathogenic condition does indeed exist. In chronic diseases, which extend essentially unchanged over a lengthy period but are nevertheless reversible, therapeutic comparisons may be made between two or more time intervals within the course of the disease in the same individual. This type of therapeutic trial rests primarily upon a (refined!) type of specious reasoning and secondarily upon modified statistics: the individual therapeutic comparison, i.e. the within-patient trial. The collective therapeutic comparison on the one hand and the individual therapeutic comparison on the other hand overlap somewhat in scope. The immediate therapeutic effect is not always an indication of its true value which may become evident only upon long-term treatment. The short-term trials of therapeutic regimens in an individual must, therefore, be frequently supplemented by long-term trials which can only be carried out by comparing two groups. For many clinical investigations the joint efforts of numerous hospitals are, therefore, absolutely necessary.The second basic rule of therapeutic research is the elimination of secondary causes. The difficulties introduced by these secondary considerations are far greater in therapeutic trials carried out on ambulatory patients than has hitherto been realized. In order to remove subjective secondary causes, the author demanded in 1931 the use of hidden or illusory media (placebos, dummies), i.e. unconscious causative agents. The double blind procedure is indispensible in all experiments, especially where psychological processes and problems are of foremost importance. Therefore, it is absolutely necessary that convincing tests be finally carried out with the double blind procedure on the one hand and the simple blind procedure on the other hand in order to determine the range and limitations of both. Therapeutic research of the future is threatened by the hazard of self-satisfaction which produces a sense of accomplishment merely as the result of obeying formal conditions and of following formal standards of accuracy.