bluuebunny/crossref_metadata_2025_split huggingface dataset:
ArchiMed: A Medical Information and Retrieval System
Authors: Wrba Th. , Duftschmid G. , Sachs P. , Gall W. , Rehnelt Ch. , Boldt G. , Premauer W. , Dorda W. 
Published: March 2018

Abstract:ArchiMed is a highly flexible medical data storage and retrieval system which adds sophisticated clinical research support to a standard hospital information system (HIS).Currently, the HIS of Vienna General Hospital-University Hospital (2000 beds) stores the clinical data of over 2 million patients. While this system supports patient care (e.g., ADT, clinical chemistry, diagnosis, procedures), it has no features to facilitate research, such as the management of clinical studies.ArchiMed is designed to support clinical research. It includes an independent database, which mirrors virtually all the information held in the HIS while also allowing new data to be collected independently and to be added to the database. Flexible retrieval and analysis of data contained in the database are then possible. Thus, existing patient data can be smoothly incorporated into a study together with data collected specifically for research purposes. The system has already been successfully installed in the departments of surgery and soon in other departments as well.
Distinction between Planned and Unplanned Readmissions following Discharge from a Department of Internal Medicine
Authors: Sarasin F. P. , Bolla F. , Gaspoz J.-M. , Borst F. , Kossovsky M. P. 
Published: March 2018

AbstractReadmission rate is often used as an indicator for the quality of care. However, only unplanned readmissions may have a link with substandard quality of care. We compared two databases of the Geneva University Hospitals to determine which information is needed to distinguish planned from unplanned readmissions. All patients readmitted within 42 days after a first stay in the wards of the Department of Internal Medicine were identified. One of the databases contained encoded information needed to compute DRGs. The other database consisted of full-text discharge reports, addressed to the referring physician. Encoded reports allowed the classification of 64% of the readmissions, whereas full-text reports could classify 97% of the readmissions (p <0.001). The concordance between encoded reports and full-text reports was fair (kappa = 0.40). We conclude that encoded reports alone are not sufficient to distinguish planned from unplanned readmissions and that the automation of detailed clinical databases seems promising.
Medical Record Management Systems: Criticisms and New Perspectives
Authors: Frénot S. , Laforest F. 
Published: March 2018

AbstractThe first generation of computerized medical records stored the data as text, but these records did not bring any improvement in information manipulation. The use of a relational database management system (DBMS) has largely solved this problem as it allows for data requests by using SQL. However, this requires data structuring which is not very appropriate to medicine. Moreover, the use of templates and icon user interfaces has introduced a deviation from the paper-based record (still existing). The arrival of hypertext user interfaces has proven to be of interest to fill the gap between the paper-based medical record and its electronic version. We think that further improvement can be accomplished by using a fully document-based system. We present the architecture, advantages and disadvantages of classical DBMS-based and Web/DBMS-based solutions. We also present a document-based solution and explain its advantages, which include communication, security, flexibility and genericity.
Term Domain Distribution Analysis: a Data Mining Tool for Text Databases
Authors: Chu W. W. , Parker D. S. , Goldman R. M. , Goldman J. A. 
Published: March 2018

AbstractIn this paper, we give a case history illustrating the real-world application of a useful technique for data mining of text databases. The technique, which we call Term Domain Distribution Analysis (TDDA), consists of keeping track of term frequencies for specific finite domains and announcing significant differences from standard frequency distributions over these domains as a hypothesis. TDDA is part of a larger framework, the Digital Filter Model, for data mining of text documents. In the case study presented, the domain of terms was the pair {right, left}, over which we expected a uniform distribution. In analyzing term frequencies in a thoracic lung cancer database, the TDDA technique led to the surprising discovery that primary thoracic lung cancer tumors appear in the right lung more often than the left lung, with a ratio of 3:2. Treating the text discovery as a hypothesis, we verified this relationship against the medical literature in which primary lung tumor sites were reported, using a standard χ2 statistic. We subsequently developed a working theoretical model of lung cancer that may explain the discovery. This discovery and our model may change how oncologists view the mechanisms of primary lung tumor location.
Level of Evidence as a Future Gold Standard for the Content Quality of Health Resources on the Internet
Authors: Amsallem E. , Haugh M. , Lukacs B. , Leroux V. , Thirion B. , Weber J. , Boissel J. P. , Darmoni S. J. 
Published: March 2018

Summary
Objective: An assessment of the quality of health information on the Internet is an absolute necessity. In this study ‘sensitive’ information was defined as information found in documents published on the Internet, which could be used in a medical decision. For sensitive information, the main criterion chosen for the quality of the information was an indication of the level of evidence. A survey was conducted using the CISMeF health catalogue to assess how often a score of the level of evidence is mentioned in the information accessible on the Internet in French-language health resources.
Methods: Since 1999, members of the CISMeF team have systematically been searching for all documents containing ‘sensitive’ information and verifying whether the level of evidence was explicitly indicated as a score at least once in the document.
Results: As of June 2001, 10,190 resources were included in CISMeF; including 2964 textual ‘sensitive’ resources (29.1%). Out of all these resources, only 4.7% (95% confidence interval: 4.0 - 5.5%) indicated the level of evidence. A statistically significant difference in the prevalence of indicating the level of evidence according to resource types (e.g., 18.1% for guidelines compared to 0.0% for teaching material), year of publication (almost three times greater in 1997-2001 compared with 1990-1996) and publishers was observed.
Conclusion: As the number of people accessing the growing amount of information on the Internet is increasing daily, publishers have an ethical obligation to inform their readers about the validity of ‘sensitive’ information their sites contain. However, the vast majority of the French language Internet resources that were surveyed do not mention a score of the level of evidence for their sensitive information.
Representation of Practice Guidelines with XML – Modeling with XML Schema
Authors: Schweiger R. , Dudeck J. , Hoelzer S. 
Published: March 2018

Summary
Objectives: Data and information in medicine are mainly represented in slightly structured or even unstructured, narrative text documents. It is nearly impossible to detect and handle relationships between data elements within narrative documents or to retrieve parts of documents that contain specific information. But information access and retrieval are essential to serve the delivery and application of evidence-based medicine.
Methods: The eXtensible Markup Language (XML) provides a standard means to explicitly describe a document‘s structure and to identify meaningful elements inside textual narrations. Information about the state-of-the-art medical care can be delivered to the physician by different means and media. Clinical practice guidelines are thought to be one possible solution to summarize and present current medical evidence.
Results: The structuring of resources containing medical information with XML can facilitate the provision of problem-specific medical information at the point of care by improving content retrieval and presentation. In our project, the XML Schema is used for the electronic representation in order to structure guidelines (and other text-based resources) in a standardized way.
Conclusion: The transition from unstructured textual data towards structured and coded data will be a migration process. One of the premises of our approach is that the structure that is defined by the information model doesn‘t restrict the content of the documents. This approach may fill the gap between computerized, algorithmic guideline recommendations and text-based guideline distributions.
Medical Decision Support Systems: Old Dilemmas and new Paradigms?
Authors: Dufour J.-C. , Staccini P. , Gouvernet J. , Bouhaddou O. , Fieschi M. 
Published: March 2018

Summary
Objectives: The purpose of this paper is to examine past and present medical decision support systems and the environment in which they operate and to propose specific research tracks that improve integration and adoption of these systems in today’s health care systems.
Methods: In preamble, we examine the objectives, decision models, and performances of past decision support systems.
Results: Medical decision support tools were essentially formulated from a technical capability perspective and this view has met limited adoption and slowed down new development as well as integration of these important systems into patient management work flows and clinical information systems. The science base of these systems needs to include evidence-based medicine and clinical practice guidelines and the paradigms need to be extended to include a collaborative provider model, the users and the organization perspectives. The availability of patient record and medical terminology standards is essential to the dissemination of decision support systems and so is their integration into the care process.
Conclusion: To build new decision support systems based on practice guidelines and taking into account users preferences, we do not so much advocate new technological solutions but rather suggest that technology is not enough to ensure successful adoption by the users, the integration into practice workflow, and consequently, the realisation of improved health care outcomes.
An Architecture for a Brain-Image Database
Authors: Herskovits E. H. 
Published: March 2018

Abstract:The widespread availability of methods for noninvasive assessment of brain structure has enabled researchers to investigate neuroimaging correlates of normal aging, cerebrovascular disease, and other processes; we designate such studies as image-based clinical trials (IBCTs). We propose an architecture for a brain-image database, which integrates image processing and statistical operators, and thus supports the implementation and analysis of IBCTs. The implementation of this architecture is described and results from the analysis of image and clinical data from two IBCTs are presented. We expect that systems such as this will play a central role in the management and analysis of complex research data sets.
Evaluation of Three Swedish ICD-10 Primary Care Versions: Reliability and Ease of Use in Diagnostic Coding
Authors: Petersson H. , Åhlfeldt H. , Strender L.-E. , Nilsson G. 
Published: March 2018

Abstract:If computer-stored information is to be useful for purposes other than patient care, reliability of the data is of utmost importance. In primary healthcare settings, however, it has been found to be poor. This paper presents a study on the influence of coding tools on reliability and user acceptance. Six general practitioners coded 152 medical problems each by means of three versions of ICD-10, one with a compositional structure. At code level the reliability was poor and was almost identical when the three versions were compared. At aggregated level the reliability was good and somewhat better in the compositional structure. Ideas for improved user acceptance arose, and the study explored the need for several different tools to retrieve diagnostic codes.
WEB-Enabled Medical Databases: a Threat to Security?
Authors: Dempsey B. J. , Herrin J. 
Published: March 2018

Abstract:An increasing number of clinical databases are being adapted to allow access through Internet protocols, particularly Hypertext Transfer Protocol (HTTP). The World Wide Web (WWW) provides a user-friendly, standardized, broadly distributed database interface; at the same time, it may also present a threat to the security and confidentiality of patient data. However, there is little empirical evidence concerning such threats. Using publicly available records we estimate the additional risk of security violations due to web-enabling a database. The evidence, though limited, suggests that the additional risk may be small relative to more traditional security threats.
Identification of Patients at High Cardiovascular Risk: a Critical Appraisal of Applicability of Statistical Risk Prediction Models
Authors: Colombet I. , Degoulet P. , Chatellier G. , Dréau H. 
Published: March 2018

AbstractAssessment of cardiovascular risk is widely proposed as a basis for taking management decisions about patients presenting with hypertension or hypercholesterolemia. Our aim was to critically assess the use of risk equations derived from epidemiological studies for the purpose of identifying high-risk patients.Risk equations were retrieved from the MEDLINE database and then applied to a data set of 118 patients. This data set was an evaluation study of the clinical value of the World Health Organization 1993 hypertension guidelines for the decision to treat mild hypertensive patients. We calculated agreement: 1) between equations and 2) between equations and the decision to treat taken by the physician.Most models were not applicable to our population, mainly because the original population had a narrow age range or comprised only males. Between-model agreement was better for the lower and upper risk quintiles than for the three other risk quintiles (0.58, 0.33, 0.34, 0.45, 0.70, from the lower to the upper risk quintile). When using an arbitrary threshold for defining high-risk patients (i.e. >2% per year), we observed a huge variation of the proportion of patients classified at high risk (from 0 to 17%). There was a poor agreement between risk models and the decision to treat taken by the physician. These results suggest that risk-based guidelines should be validated before their diffusion.
Evaluation of Complication Rates after Coronary Artery Bypass Surgery using Administrative Data
Authors: Hall R. E. , Ash A. S. , Rosen A. K. , Moskowitz M. A. , Ghali W. A. 
Published: March 2018

AbstractOur objectives were (1) to determine if studying hospital complication rates after coronary artery bypass graft (CABG) surgery provides information not available when only mortality is studied, and (2) to reexplore the utility of ICD-9-CM administrative data for CABG outcomes assessment. Using data from Massachusetts, we identified CABG cohorts from 1990 and 1992 to respectively develop and validate multivariate risk adjustment models predicting in-hospital mortality and complications. The resulting models had good discrimination and calibration. In 1992, adjusted hospital complication rates ranged widely from 13.0% to 57.6%, while mortality rates ranged from 1.4% to 6.1 %. Hospitals with high complication rates tended to have high mortality (r = 0.74, P = 0.006), but 2 of the 12 hospitals studied ranked quite differently when judged by complications rather than mortality. We conclude that (1) complications after CABG occur frequently and may provide information about hospital quality beyond that obtained from hospital mortality rates, and that (2) administrative data continue to be a promising resource for outcomes research.
Informatics Methodologies for Evaluation Research in the Practice Setting
Authors: Buteau M. , Richards Y. , Delisle E. , Laplante P. , Niyonsenga T. , Xhignesse M. , Grant A. 
Published: March 2018

AbstractA continuing challenge in health informatics and health evaluation is to enable access to the practice of health care so that the determinants of successful care and good health outcomes can be measured, evaluated and analysed. Furthermore the results of the analysis should be available to the health care practitioner or to the patient as might be appropriate, so that he or she can use this information for continual improvement of practice and optimisation of outcomes. In this paper we review two experiences, one in primary care, the FAMUS project, and the other in hospital care, the Autocontrol project. Each project demonstrates an informatics approach for evaluation research in the clinical setting and indicates ways in which useful information can be obtained which with appropriate feed-back and education can be used towards the achievement of better health. Emphasis is given to data collection methods compatible with practice and to high quality information feedback, particularly in the team context, to enable the formulation of strategies for practice improvement.
Utilizing Data Systems to Develop and Monitor Occupational Health Programs in a Large Canadian Hospital
Authors: Yassi A. 
Published: March 2018

AbstractWith rapid change in health care requiring greater emphasis on productivity and quality management, occupational health hazards in hospitals have been receiving increasing recognition, now not only focusing on controlling infection, but also on chemical, physical, mechanical as well as psychosocial hazards. Reducing costly time loss from musculoskeletal injuries is a particular imperative. The Department of Occupational and Environmental Medicine at Winnipeg's Health Sciences Centre, developed databases to help priorize, monitor and improve occupational health programs for its 6,000 employees. Risk assessment/risk management models were adopted to identify hazards, quantify risks and priorize intervention. Using the databases permitted the targeting of groups requiring immunization, resulting in increased coverage. New safety products were introduced and found to be cost-beneficial. A return-to-work post-injury program was particularly cost-beneficial. Over the five years following the implementation of occupational health programs, workers' compensation assessment reductions resulted in savings of more than half-a-million dollars annually. The databases were invaluable in affecting these changes.
The SNOMED Model: A Knowledge Source for the Controlled Terminology of the Computerized Patient Record
Authors: Rothwell D. J. , Côté R. A. , Lussier Y. A. 
Published: March 2018

AbstractThis article will present a description ofthe semi-implicit semantic properties of the Systematized Nomenclature of Human and Veterinary Medicine, also called SNOMED International. It will focus on the formalism of SNOMED and its computational properties using the disease definition as an example. Additional information will be provided in order to convert semi-implicit links found between SNOMED concepts into explicit computational semantic links.
A Psychiatric Diagnostic System Integrating Probabilistic and Categorical Reasoning
Authors: Satomura Y. , Honda M. , Sato T. , do Amaral M. B. 
Published: March 2018

Abstract:We describe a diagnostic support system for clinical psychiatry and its evaluation results. The system has two inter-related components: a rule-based reasoning part associated with uncertainty, and a deterministic part, that uses heuristics to perform categorical reasoning. The system includes the 30 groups of psychiatric diagnoses which are classified under the categories 290 to 319 of the DSM-III-R and the ICD-9. There are, in fact, 1508 rules relating 208 clinical findings with 257 diagnoses. The reasoning strategy is based on selecting and differentiating diagnostic categories in a hierarchical classification tree. The system is intended to be used for education of medical students, and to help non-specialist clinicians, residents in psychiatry, or experts with few years of experience in decision making. We tested the diagnostic performance of the system using case reports extracted from a specialized journal. In 52.8% of the cases, the correct diagnosis was ranked as the first hypothesis using only the rule-based part. In combination with the deterministic strategy, the correct diagnosis could be made for 73.6% of the analyzed cases.
Attitudes of Community Pharmacists, University-Based Pharmacists, and Students Toward On-Line Information Resources
Authors: Jacknowitz A. I. , Abate M. A. , Shumway J. M. 
Published: March 2018

AbstractThe study sought to explore the attitudes of community pharmacists, university-based pharmacists, and pharmacy students before and after exposure to computerized systems of on-line information services. A 42-item attitudinal survey was administered to 21 community pharmacists, 7 university clinical pharmacist faculty, and 17 senior pharmacy students, prior to and at the end of a year of access to Grateful Med® and BRS Colleague®. Few significant differences were noted among the participants at baseline. No significant interaction-effect differences for type of participant or system used were found. Participants were generally positive about computers in general, the accuracy of on-line information services, their impact on knowledge and confidence, and their usefulness for pharmacists.
Coding Clinical Information: Analysis of Clinicians Using Computerized Coding
Authors: Kadlec P. , Puerner F. , Hohnloser J. H. 
Published: March 2018

AbstractData are presented of a controlled experiment with a computerized browsing and encoding tool. Eighteen practicing clinicians extracted medical concepts from two narrative exercise cases using two approaches, traditional and computer-assisted use of ICD-9.Our results indicate that by using a computerized coding tool the completeness of coding can be improved by up to 55%, that by enforcing mandatory as opposed to optional modifier codes results in lower rates of incomplete coding (0 and 55%, respectively), higher rates of correct coding (41 to 92%) and no change in incorrect code, and that manual coding takes twice as long than coding with the help of the computerized coding tool. Clinicians need 59% more time for processing the whole set of codes than is suggested by the sum of individual codes. We conclude that the use of a computerized coding tool can save time and result in higher quality codes. However, the real time spent on coding may be underestimated when looking at individual coding times, instead of the whole task of processing a clinical scenario.
A Computerized Medical Standards System to Help Place Impaired Employees
Authors: Halpern M. 
Published: March 2018

Abstract:The paper describes a knowledge-distribution system that supports decisions on placement of impaired employees. The knowledge base consists of job profiles and medical profiles. The job profiles list tasks and the physical abilities they require. Twenty-one abilities describe the task demands. Active workers rated the exertion, frequency and importance of the physical ability required for each task. Thirty-nine work conditions were rated this way. Using identical scales, experts assessed the impact of impairments on the physical abilities of individuals and the tolerance of work conditions. The screening matches the job profile against the impairment profile. This process has been automated. The program lists tasks and work conditions that may compromise an impaired employee. This information can be used to accommodate employees, restrict duties or design a rehabilitation program. Also, the paper discusses the impact of the system on the operations of medical services within an organization.