bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transforming a Hospital through Growing, not Building, an Electronic Patient Record System
Authors: Atkinson C. J. , Peel V. J. 
Published: March 2018

AbstractThe benefits for any health care provider of successfully introducing an Electronic Patient Record System (EPRS) into their organisation can be considerable. It has the potential to enhance both clinical care and managerial processes, as well as producing more cost-effective care and care programmes across clinical disciplines and health care sectors. However, realising an EPRS's full potential can be a long and difficult process and should not be entered into lightly. Introducing an EPR System involves major personnel, organisational and technological changes. These changes must be interwoven and symbiotic and must be managed so that they grow together in stages towards a vision created and shared by all clinical professional staff, other staff, and managers in that process. The use of traditional “building” or “journey” metaphors inadequately reflects the complexity, uncertainty and, therefore, the unpredictability of the process. We propose that a more useful metaphor may be of “growing” a progressively more united, unified information system and health care organisation. We suggest this metaphor better recognises that the evolutionary process appears to be more organic than predictable and more systemic than mechanistic. An illustration is given of how these organisational clinical and technical issues might evolve and interweave in a hospital setting through a number of stages.
Read Codes Version 3: A User Led Terminology
Authors: O’Neil M. , Payne C. , Read J. 
Published: March 2018

Abstract:Version 3 of the Read Codes was designed in response to a new set of requirements generated by three new terming initiatives in the UK, the Clinical Terms Project, the Professions Allied to Medicine Terms Project and the Nursing Terms Project. The challenge was to cope with the detail required by clinical specialists for maintaining a computerised record, to capture the natural language used by clinicians in their everyday work, and to support efficient analysis across medical records required to extract information from clinicians’ individual patient data. The structure of Version 3 allows a directed acyclic graph to replace the traditional hierarchy; permits multiple such graphs if necessary; introduces qualifiers, embedding these in an information model to support analysis; introduces one-to-many mapping to external classifications where this is necessary; and maintains the tradition of a dynamic terminology that stresses the inclusion of natural clinical terms.
The Representation of Meaning in the UMLS
Authors: McCray A. T. , Nelson S. J. 
Published: March 2018

Abstract:The UMLS knowledge sources provide detailed information about biomedical naming systems and databases. The Metathesaurus contains biomedical terminology from an increasing number of biomedical thesauri, and the Semantic Network provides a structure that encompasses and unifies the thesauri that are included in the Metathesaurus. This paper addresses some fundamental principles underlying the design and development of the Metathesaurus and Semantic Network. It begins with a description of the formal properties of thesauri, including the Metathesaurus, and the formal properties of the Semantic Network. It continues with consideration of the principle of semantic locality and how this is reflected in the UMLS knowledge sources. The paper concludes with a discussion of the issues involved in attempting to re-use knowledge and the potential for re-use of the UMLS knowledge sources.
Uncertainty and Decisions in Medical Informatics
Authors: Szolovits P. 
Published: March 2018

Abstract:This paper presents a tutorial introduction to the handling of uncertainty and decision-making in medical reasoning systems. It focuses on the central role of uncertainty in all of medicine and identifies the major themes that arise in research papers. It then reviews simple Bayesian formulations of the problem and pursues the generalization to the Bayesian network methods that are popular today. Decision making is presented from the decision analysis viewpoint, with brief mention of recently-developed methods. The paper concludes with review of more abstract characterization of uncertainty, and anticipates the growing importance of analytic and “data mining” techniques as growing amounts of clinical data become widely available.
Age-Related Reference Ranges for Growth Parameters
Authors: Wellek S. , Merz E. 
Published: March 2018

Abstract:We propose an approach to the computation of age-related reference ranges which guarantees that the proportion of sampled data points covered by the reference band has an arbitrarily specified value. Unlike other approaches in the literature, this method does not have to rely on parametric distributional assumptions. The boundaries of the bands are given by smooth curves, and for modeling the mean as a function of age, a sufficiently flexible class of monotonically increasing functions is used, since in the applications all measured variables are biological growth parameters. The width of the reference band is allowed to be proportional to any suitably fixed function of age which we propose in practice to be taken linear. The approach is illustrated by examples from a large-scale study of the distribution of fetal size measurements obtained by routine prenatal sonography.
Hybrid Rendering of Multidimensional Image Data
Authors: Haubner M. , Lösch A. , Eckstein F. , Seemann M. D. , van Eimeren W. , Reiser M. , Englmeier K.-H. 
Published: March 2018

Abstract:The most important rendering methods applied in medical imaging are surface and volume rendering techniques. Each approach has its own advantages and limitations: Fast surface-oriented methods are able to support real-time interaction and manipulation. The underlying representation, however, is dependent on intensive image processing to extract the object surfaces. In contrast, volume visualization is not necessarily based on extensive image processing and interpretation. No data reduction to geometric primitives, such as polygons, is required. Therefore, the process of volume rendering is currently not operating in real time. In order to provide the radiological diagnosis with additional information as well as to enable simulation and preoperative treatment planning we developed a new hybrid rendering method which combines the advantages of surface and volume presentation, and minimizes the limitations of these approaches. We developed a common data representation method for both techniques. A preprocessing module enables the construction of a data volume by interpolation as well as the calculation of object surfaces by semiautomatic image interpretation and surface construction. The hybrid rendering system is based on transparency and texture mapping features. It is embedded in a user-friendly open system which enables the support of new application fields such as virtual reality and stereolithography. The efficiency of our new method is described for 3-D subtraction angiography and the visualization of morpho-functional relationships.
Foundations for an Electronic Medical Record
Authors: Rector A. L. , Nowlan W. A. , Kay S. 
Published: March 2018

AbstractGiven the many efforts currently under way to develop standards for electronic medical records, it is important to step back and reexamine the fundamental principles which should underlie a model of the electronic medical record. This paper presents an analysis based on the experience in developing the PEN & PAD prototype clinical workstation. The fundamental contention is that the requirements for a medical record must be grounded in its use for patient care. The basic requirement is that it be a faithful record of what clinicians have heard, seen, thought, and done. The other requirements for a medical record, e.g., that it be attributable and permanent, follow naturally from this view. We use the criteria developed to re-examine Weed’s Problem Oriented Medical Record and also relate the criteria to secondary uses of the medical record for population data, communications and decision support.
Recommendations of the German Association for Medical Informatics, Biometry and Epidemiology for Education and Training in Medical Informatics
Authors: Dudeck J. , Gaus W. , Leven F. J. , Kunath H. , Michaelis J. , Pretschner D. P. , Sonntag H.-G. , Thurmayr R. , Wolters E. , Haux R. ,   On behalf of the Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (GMDS)
Published: March 2018

Abstract:In the fields of health care and medicine there is an immense demand for a systematic application of methods of information processing and for the use of computers. Obviously, to that end well-trained scientists and qualified personnel must be available. With the present recommendations on education and training in medical informatics the German Association for Medical Informatics, Biometry and Epidemiology (GMDS) proposes structure and contents of medical informatics curricula and courses. The recommendations describe a 2-dimensional educational framework with different educational levels in one dimension and various types of educational needs and orientation in the other one. The recommendations comprise at the university level education as well specialized curricula covering the total spectrum of medical informatics as well as informatics curricula with medical informatics as integrated applied subject or subsidiary subject, respectively. Besides these informatics-oriented approaches medical-oriented programs of education in medical informatics are recommended, e.g., post-graduate education in medical informatics for physicians based on foundations in medical informatics as part of their initial training in medicine. At the level of polytechnical schools curricula of medical documentation and informatics and at the level of professional schools training in medical documentation are recommended. This report is a translation of its German original. Although considered by the GMDS as recommendations for the Federal Republic of Germany, the text may also contribute to the development of an international, especially European framework of training in medical informatics.
Testing the Gaussianity of the Human EEG During Anesthesia
Authors: Schultz B. , Schultz A. , Pichlmayr I. , Bender R. 
Published: March 2018

Abstract:The Gaussian properties of human EEGs, which were measured over various stages of general anesthesia, were tested. The basis of the method was to describe the EEG signals by autoregressive models and to test the normality of the regression residuals with the Shapiro-Wilk statistic. The results show that in general the human EEG during anesthesia can be considered as a realization of a Gaussian stochastic process.
Simple Computer-Assisted Diagnosis of Acute Myocardial Infarction in Patients with Acute Thoracic Pain
Authors: Pietsch-Breitfeld B. , Stein W. , Overkamp D. , Ickrath O. , Renn W. , Pfohl M. , Kiesenbauer U. , Jäck S. , Eggstein M. , Selbmann H. K. , Dilger J. 
Published: March 2018

Abstract:In order to minimize the initial diagnostic uncertainty in patients suspected of having acute myocardial infarction, we prospectively extracted predictive variables from previous history, ECG, and clinical chemical parameters of 87 patients, who were admitted for acute thoracic pain. The variables thus extracted were: Thoracic pain in previous history, duration of pain, white blood cell count, blood glucose, creatine-kinase, and S-T elevation in the ECG. These parameters were used for formulating a mathematical model based upon univariate and multivariate statistical methods. The sensitivity of the model in the study population was 95% and the specificity 77%. Correct classification was achieved in 89% of cases.In a second phase, the prognostic index was prospectively evaluated in a second set of 122 consecutive patients. In this test population, the sensitivity was 89% and the specificity 86%. 87% of patients were classified correctly.
The Performance of Information-Theoretic Criteria in Detecting the Number of Independent Signals in Multilead ECGs
Authors: van Oosterom A. , Uijen G. J. H. 
Published: March 2018

Abstract:Three different methods to detect the number of independent signals in multilead ECGs were evaluated by using different ECG realizations with known specifications for signal and noise: a threshold method (TM), the minimum description length (MDL) and Akaike’s information criterion (AIC).The fundamental assumption in this kind of signal processing is that both the signal and the noise stem from independent stochastic generators. The consequence is that the detection of the number of signals is only possible if the noise is white, or if the noise properties have been specified.The evaluation was performed with respect to the QRS complex of individual multilead ECG simulations and to the entire ensemble. In the simulated ECGs the number of independent signals was fixed (eight). It was found that, out of the three methods studied, the performance of MDL was the best, especially when the number of available observations in the noise (used to estimate the noise specifications) was moderate.
Benefits and Risks of Combined Oral Contraceptives
Authors: Vessey M. P. 
Published: March 2018

Abstract:The use of combined oral contraceptives carries a number of well-established major non-contraceptive benefits. Of these, the most important protective effects are suppression of the risk of epithelial cancer of the ovary and cancer of the endometrium. Also of great importance is a reduction in the risk of pelvic inflammatory disease. Needless to say, there are also some established risks of combined oral contraceptives. The most important of these are the vascular ones, comprising effects on acute myocardial infarction, thrombotic stroke, haemorrhagic stroke, and venous thrombosis and embolism. Possible risks which are still under evaluation include an adverse effect on breast cancer and, likewise, on carcinoma of the cervix. More information is needed about both these conditions. A number of authors have provided analyses of varying degrees of complexity in which they have attempted to weigh the benefits and risks of combined oral contraceptives. Results from some of these studies are presented in the paper. On the whole, the findings are reasonably reassuring.
Forecasting Survival in the Medical Intensive Care Unit: A Comparison of Clinical Prognoses With Formal Estimates
Authors: Cottrell J. J. , Murakami J. , Mackesy M. E. , Fetzer B. , Elstein A. S. , Christensen C. 
Published: March 2018

AbstractPhysicians often need to make prognostic judgments. In the present study, the accuracy was explored of survival estimates for patients in the Medical Intensive Care Unit (MICU). Estimates were made by physicians and nurses several times during each patient’s stay in the MICU and were compared to those of the APACHE II scale, a widely used quantitative index for critically ill patients. ROC curve and calibration curve analyses were performed to assess the accuracy of these estimates. Results revealed that MICU personnel were fairly accurate discriminators of patients who survived vs. who died, although there was a consistent tendency to underestimate survival. In addition, there was some relationship between the level of physician training and forecasting accuracy, but only within the patient’s first 24 hours in the MICU. Finally, the estimates of physicians did not differ significantly from those of the APACHE II scale. Physicians tended to be better calibrated in their predictions, while the APACHE II scale was slightly superior in terms of discrimination.
Event Detection on Patient Monitoring Data Using Causal Probabilistic Networks
Authors: Laursen P. 
Published: March 2018

Abstract:Applications are described of the knowledge-representation technique Causal Probabilistic Networks for the detection of events related to the patient and the monitoring equipment, in the context of intensive care patient monitoring. The purpose of the event detection is to reduce the number of false alarms generated by the patient monitor, and to generate alarms related to patient or equipment events rather than to threshold violation. A PC-based system has been developed and tested on patient data. A system for real-time use in patient monitoring is under development.
Model-Based Biosignal Interpretation
Authors: Andreassen S. 
Published: March 2018

Abstract:Two relatively new approaches to model-based biosignal interpretation, qualitative simulation and modelling by causal probabilistic networks, are compared to modelling by differential equations. A major problem in applying a model to an individual patient is the estimation of the parameters. The available observations are unlikely to allow a proper estimation of the parameters, and even if they do, the task appears to have exponential computational complexity if the model is non-linear. Causal probabilistic networks have both differential equation models and qualitative simulation as special cases, and they can provide both Bayesian and maximum-likelihood parameter estimates, in most cases in much less than exponential time. In addition, they can calculate the probabilities required for a decision-theoretical approach to medical decision support. The practical applicability of causal probabilistic networks to real medical problems is illustrated by a model of glucose metabolism which is used to adjust insulin therapy in type I diabetic patients.
Non-Linear Dynamics in the Beat-to-Beat Variability of Sympathetic Activity in Decerebrate Cats
Authors: Baselli G. , Montano N. , Gnecchi-Ruscone T. , Lombardi F. , Malliani A. , Cerutti S. , Porta A. 
Published: March 2018

Abstract:Non-linear interactions between low-frequency rhythms (0.1 Hz) of beat-to-beat variability series of sympathetic discharge and respiratory rhythm (0.3 Hz) are observed in decerebrate artificially ventilated cats. Simple graphical tools as Poincare and recurrence maps are used to detect, in a qualitative way, phase-locking phenomena. Non-parametric bispectral analysis is also carried out to quantify the degree of second-order coupling between oscillations at different frequencies.
Non-Linear Dynamics of Cardiovascular Variability Signals
Authors: Cerutti S. , Guzzetti S. , Parola R. , Signorini M.G. 
Published: March 2018

Abstract:Long-term regulation of beat-to-beat variability involves several different kinds of controls. A linear approach performed by parametric models enhances the short-term regulation of the autonomic nervous system. Some non-linear long-term regulation can be assessed by the chaotic deterministic approach applied to the beat-to-beat variability of the discrete RR-interval series, extracted from the ECG. For chaotic deterministic systems, trajectories of the state vector describe a strange attractor characterized by a fractal of dimension D. Signals are supposed to be generated by a deterministic and finite dimensional but non-linear dynamic system with trajectories in a multi-dimensional space-state. We estimated the fractal dimension through the Grassberger and Procaccia algorithm and Self-Similarity approaches of the 24-h heart-rate variability (HRV) signal in different physiological and pathological conditions such as severe heart failure, or after heart transplantation. State-space representations through Return Maps are also obtained. Differences between physiological and pathological cases have been assessed and generally a decrease in the system complexity is correlated to pathological conditions.
Case-Based Explanation for Medical Diagnostic Programs, with an Example from Gynaecology
Authors: Stamper R. , Todd B. S. , Macpherson P. 
Published: March 2018

Abstract:One of the most accountable methods of providing machine assistance in medical diagnosis is to retrieve and display similar previously diagnosed cases from a database. In practice, however, classifying cases according to the diagnoses of their nearest neighbours is often significantly less accurate than other statistical classifiers. In this paper the transparency of the nearest neighbours method is combined with the accuracy of another statistical method. This is achieved by using the other statistical method to define a measure of similarity between the presentations of two cases. The diagnosis of abdominal pain of suspected gynaecological origin is used as a case study to evaluate this method. Bayes’ theorem, with the usual assumption of conditional independence, is used to define a metric on cases. This new metric was found to correspond as well as Hamming distance to the clinical notion of “similarity” between cases, while significantly increasing accuracy to that of the Bayes’ method itself.
Comparing Mortality and Morbidity in Hospitals: Theory and Practice of Quality Assessment in Peer Review
Authors: van Hemel O. J. S. , Elferink-Stinkens P. M. , Verloove-Vanhorick S. P. , Brand R. 
Published: March 2018

Abstract:The incidence of mortality in a specific hospital depends on many risk factors. These risk factors may be divided roughly into two categories. The intake category, consists of those risk factors for which the hospital has hardly any influence upon their incidence; and the care category being those for which the incidence depends partly or completely on the treatment policy of the hospital. A hospital with a high incidence of risk factors in the intake category will have a higher mortality rate than a hospital with a low incidence, even if their care is exactly the same (i. e., if they treat their infants equally well). Therefore, a fair comparison between one hospital and a reference cohort, or among several hospitals (using a national registry) should adjust e. g. correct for those risk factors belonging to the intake category. A practical method is proposed, based on logistic regression, to effectuate such a “fair” judgment. The regression technique enables to compare “observed” and “expected” rates in a specific hospital and to test whether a difference between these rates is statistically significant. Both clinical and statistical aspects of the method are discussed, as well as the actual implementation of an automated annual reporting system. The method has been implemented in the Netherlands as an annual peer review and quality assessment system in obstetric care.
Medical Office Automation Integrated into the Distributed Architecture of a Hospital Information System
Authors: Revillard C. , Borst F. , Berthoud M. , Lovis C. , Scherrer J.-R. 
Published: March 2018

Abstract:Patient histories, discharge summaries, and medical consultant reports are made up of written texts. Therefore, the gathering and archiving of these texts in machine-readable form has many characteristics of computer-based medical records. In Geneva, approximately 1,540 PCs are connected to the Hospital Information System DIOGENE 2, with the possibility of accessing all the functions offered by the system without losing any of their MS-DOS word processing capabilities. The UNIDOC system, presented in this paper, takes all these features into account, a real marriage of technologies between the MS-DOS environment and the distributed client-server architecture. The INGRES database management system supports the entire archiving process of the medical patient texts, structured by prelabelled paragraphs and automatically indexed. Both the quality and accessibility of the records are enhanced, while the archiving capacity is neither too limited nor too expensive.