bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knowledge-based and Data-driven Models in Arrhythmia Fuzzy Classification
Authors: Vergassola R. , Zong W. , Berthold M. R. , Silipo R. 
Published: March 2018

Summary

Objectives:
Fuzzy rules automatically derived from a set of training examples quite often produce better classification results than fuzzy rules translated from medical knowledge. This study aims to investigate the difference in domain representation between a knowledge-based and a data-driven fuzzy system applied to an electrocardiography classification problem.

Methods:
For a three-class electrocardiographic arrhythmia classification task a set of fifteen fuzzy rules is derived from medical expertise on the basis of twelve electrocardiographic measures. A second set of fuzzy rules is automatically constructed on thirty-nine MIT-BIH database’s records. The performances of the two classifiers on thirteen different records are comparable and up to a certain extent complementary. The two fuzzy models are then analyzed, by using the concept of information gain to estimate the impact of each ECG measure on each fuzzy decision process.

Results:
Both systems rely on the beat prematurity degree and the QRS complex width and neglect the P wave existence and the ST segment features. The PR interval is not well characterized across the fuzzy medical rules while it plays an important role in the data-driven fuzzy system. The T wave area shows a higher information gain in the knowledge based decision process, and is not very much exploited by the data-driven system.

Conclusions:
The main difference between a human designed and a data driven ECG arrhythmia classifier is found about the PR interval and the T wave.
Introducing BF++: A C++ Framework for Cognitive Bio-Feedback Systems Design
Authors: Babiloni F. , Cincotti F. , Salinari S. , Marcian M.G. , Bianchi L. 
Published: March 2018

Summary
Objective: This paper addressed the issue of building-up a framework for the realization of several cognitive bio-feedback (CBF) systems. It minimizes the programming effort and maximizes the efficiency and the cross-platform portability so that it can be used with many platforms (either software or hardware).
Methods: A generic CBF system was decomposed into six modules: acquisition, kernel, feedback rule, patient feedback, operator user interface and persistent storage. The way in which these modules interact was defined by immutable software interfaces in a way that allows to completely substitute a module without the need to modify the others.
Results: Three Brain Computer Interface engines were developed with less than 40 lines of C++ code each. They can also be used under virtually any platform that supports an ANSI C++ compiler.
Conclusion: A framework for the implementation of a wide range of CBF systems was developed. Compared to the other approaches that are described in the literature, the proposed one is the most efficient, the most portable across different platforms, the most generic and the one that allows the realization of the cheapest final systems.
Medical Informatics: Searching for Underlying Components
Authors: Musen M. A. 
Published: March 2018

Abstract
Objective: To discuss unifying principles that can provide a theory for the diverse aspects of work in medical informatics. If medical informatics is to have academic credibility, it must articulate a clear theory that is distinct from that of computer science or of other related areas of study.
Results: The notions of reusable domain ontologies and problem-solving methods provide the foundation for current work on second-generation knowledge-based systems. These abstractions are also attractive for defining the core contributions of basic research in informatics. We can understand many central activities within informatics in terms defining, refining, applying, and evaluating domain ontologies and problem-solving methods.
Conclusion: Construing work in medical informatics in terms of actions involving ontologies and problem-solving methods may move us closer to a theoretical basis for our field.
Establishing an Agenda for Biomedical Informatics
Authors: Martin-Sanchez F. , Billhardt H. , Iakovidis I. , Kulikowski C. , Maojo V. 
Published: March 2018

Summary
Objective: To describe potential areas of collaboration between Medical Informatics (BI) and Bioinformatics (BI) and their effects on planning future work in both disciplines.
Methods: Some reflections on the objectives and rationale underpinning MI and BI are given, and preliminary results from the BIOINFOMED workgroup, supported by the European Commission, are introduced. Results: Applications from both subfields suggest topics for sharing and exchange between the subfields within the emerging field of Biomedical Informatics. Conclusions: We suggest how the nature and degree of collaboration between the sub-disciplines can impact future work in molecular medicine.
Internet Health Resources: from Quality to Trust
Authors: Doupi P. , van den Hoven Jeroen , Lampe K. 
Published: March 2018

Summary
Objectives: Quality of online health resources remains a much debated topic, despite considerable international efforts. The lack of a systematic and comprehensive conceptual analysis is hindering further progress. Therefore we aim at clarifying the origins, nature and interrelations of pertinent concepts. Further, we claim that quality is neither a necessary nor a sufficient condition for Internet health resources to produce an effect offline. As users’ trust is also required, we examine the relation of quality aspects to trust building online.
Methods: We reviewed and analyzed the key documentation and deliverables of quality initiatives, as well as relevant scientific publications. Using the insights of philosophy, we identified the elementary dimensions which underlie the key concepts and theories presented so far in the context of online health information quality. We examined the interrelations of various perspectives and explored how trust as a phenomenon relates to these dimensions of quality.
Results: Various aspects associated with the quality of online health resources originate from four conceptual dimensions: epistemic, ethical, economic and technological. We propose a conceptual framework that incorporates all these perspectives. We argue that total quality exists only if all four dimensions have been addressed adequately and that high total quality is conducive to warranted trust.
Conclusions: Quality and trust are intertwined, but distinct concepts, and their relation is not always straightforward. Ideally, trust should track quality. Apprehending the composition of these concepts will help to understand and guide the behavior of both users and providers of online information, as well as to foster warranted trust in online resources. The framework we propose provides a conceptual starting point for further deliberations and empirical work.
Model Driven Therapy
Authors: Troccaz J. , Cinquin P. 
Published: March 2018

Summary
Objectives: Taking into account a priori knowledge is a key issue to meet the medical, scientific and industrial challenges of the progresses of Minimally Invasive Surgery. We propose an overview of these challenges.
Methods: Models play a major role in representing the relevant knowledge to plan and realize complex medical and surgical interventions. We analyze the three basic steps of Perception, Decision and Action, and illustrate by some instances how models may be integrated in these steps.
Results: We propose a selection of the results obtained in Model Driven Therapy. These results illustrate the issues of Perception (models allow accurate reconstruction of 3D objects from a limited set of X-ray projections), Decision (models allow to take into account elastic and dynamic characteristics of muscles), and Action (models allow to design innovative navigational and robotics aids to the realization of complex interventions). Likewise, models play a major role in the process of surgeon’s education, which leads to the concept of Virtual Orthopedic University.
Conclusions: Model Driven Therapy emerges as the way to perform optimal medical and surgical interventions, providing physicians and surgeons with the possibility to augment their capacities of sensing multi-modal information, of combining them to define optimal strategies, and of performing accurate and safe actions.
Networking in Shared Care – First Steps towards a Shared Electronic Patient Record for Cancer Patients
Authors: Mludek V. , Wolff A. C. , Bülzebruck H. , Oetzel D. , Zierhut D. , Drings P. , Wannenmacher M. , Haux R. , van der Haak M. 
Published: March 2018

Summary
Objectives: This paper aims at identifying the data protection and security requirements for a cross-institutional EPR. Three possible models and the first steps towards a cross-institutional EPR for the Thoraxklinik Heidelberg and the Department of Clinical Radiology of the University Medical Center of Heidelberg shall be discussed.
Methods: A comprehensive analysis of literature and legal documents supplied information for determining the data protection and security requirements. By means of information system analysis, the technical preconditions in both institutions as well as three possible models towards a cross-institutional EPR were identified.
Results: According to the German penal code it is only allowed to reveal patient information to external physicians in cases of so-called “treatment connection”. An extension of the written consent, signed by the patient, verifying the patient agreement that his/her patient data will be stored in a cross-institutional EPR is needed. Among the three models that we identified, the model that constitutes of a virtual EPR with distributed data capture in both institutions was favored. By means of SecuRemote™ software a secure connection between the Thoraxklinik Heidelberg and the Department of Clinical Radiology was established, allowing the physicians to view the complete cross-institutional health information of a jointly treated patient during the weekly consultation on radiotherapy.
Conclusions: Many requirements listed in this paper are requirements for electronic patient records in general. Besides these general requirements there are specific requirements for a cross-institutional EPR. The legal situation in Germany complicates the development and implementation of a cross-institutional EPR. However, we think that the efforts are reasonable, because a cross-institutional EPR will be able to improve the communication between health institutions, medical disciplines and persons involved in shared care processes. It provides them with more complete health information about the jointly treated patients. A cross-institutional EPR is, therefore, expected to improve the quality of patient care.
Heuristics for Identification of Acronym-Definition Patterns within Text: Towards an Automated Construction of Comprehensive Acronym-Definition Dictionaries
Authors: Wren J. D. , Garner H. R. 
Published: March 2018

Summary
Objectives: To develop an automated, accurate and scalable method by which acronym-definition pairs can be identified within text. Its primary advantage is in enabling information processing methods to resolve author-defined acronyms, but it also allows an automated creation of a reference work on acronym definitions. This has several advantages over manual or semi-automated methods, besides time and effort saved, such as enabling identification of relative frequencies for alternate acronyms and definitions as well as spelling, phrasing and hyphenation variants for a unique acronym-definition pair. It also aids users in identifying acronym/ definition variants present in the literature that may not necessarily be in biomedical databases.
Methods: A set of heuristics to accurately locate and identify the boundaries of acronym-definition pairs was developed and refined in terms of precision and recall on subsets of MEDLINE records. These training sets were gradually increased in size and heuristics re-evaluated to ensure scalability.
Results: Our final set of Acronym Resolving General Heuristics (ARGH) had a sample-based estimated rate of 96.5 ±0.4% precision and 93.0 ± 2.7% recall when tested on over 12 million MEDLINE records, identifying more than 174,000 unique acronyms and their 737,000 associated definitions.
Conclusions: We estimate that as much as 36% of the acronyms in MEDLINE are associated with more than one definition and, conversely, up to 10% of definitions are associated with more than one acronym. The number of unique acronyms in MEDLINE is increasing at a rate of approximately 11,000 per year, while the number of definitions associated with them is growing at approximately four times that rate. Access to the ARGH database is available online at http://lethargy.swmed.edu/ARGH argh.asp. The heuristic module and database are available upon request.
Evoked Potential Enhancement Using a Neurophysiologically-based Model
Authors: Balaji Kavaipatti A. , Markusson O. , Jansen B. H. 
Published: March 2018

Summary

Objective:
Single trial evoked potentials (EP) are generally obscured by the much larger spontaneous or background electroencephalogram (EEG). A novel method was developed to enhance single trial EPs. The potential of this approach was explored using actual flash evoked visual EPs.

Method:
The basic procedure is a variant of the adaptive filtering approach. At the core of our method is a mathematical, but neurophysiologically-realistic, nonlinear model of the cortical structures involved in generating EEG and EP activity. The model parameters are adjusted by a genetic algorithm in such a way that the model output resembles the actually observed pre-stimulus EEG activity. When post-stimulus EEG is passed through the inverse model, enhancement of the single trial EP should, theoretically, occur.

Results:
Evidence was found that, in case of visual evoked potentials obtained by flashing light through closed eyelids, alpha activity continues to around 150 ms post-stimulus, at which point a low frequency potential arises, cresting 100 ms later and disappearing after another 100 ms or so. Also, it was found that an individual’s response varies considerably from trial to trial.

Conclusion:
The inverse modeling approach presented here is effective at enhancing single trial EP activity. One potential application is to distinguish trials that contain a response from those that do not, which could result in improved ensemble averages.
Patient Acceptance of Educational Voice Messages: A Review of Controlled Clinical Studies
Authors: Boren S. A. , Maglaveras N. , Krishna S. , Balas E. A. 
Published: March 2018

Summary
Objectives: The objective of this study was to evaluate controlled evidence on the impact of automated computer-based telephone messaging technology upon health outcomes, cost savings and acceptance by patients, caregivers and care providers.
Methods: Systematic searches of electronic databases were conducted to find controlled clinical studies of automated phone messaging used in patient care. Studies were selected based on the three criteria: 1) randomized controlled trials or controlled trials; 2) patients receiving health care related education, information, advice or reminder for a specific action to be taken in their home setting; and 3) use of automated computer-based phone technology to deliver the messages. Information abstracted from studies included information about the institution, persons targeted, intervention and its effect on health outcomes, costs and acceptance by patients and caregivers.
Results: A total of nineteen studies were identified for review. Sixteen studies were randomized controlled trials and three were controlled studies with no randomization. Studies were placed in two categories, preventive care education and chronic care studies. Preventive care education studies covered childhood immunizations, medication compliance, influenza vaccinations, tuberculosis and health prevention activities and chronic care studies were related to cholesterol, diabetes, hyper-tension and congestive heart failure. More than 80% of studies showed significant impact upon measurable health outcomes.
Conclusions: Controlled evidence substantiates the efficacy of automated telephone communication in improving the quality of care. Educational voice messages are acceptable to patients and represent an important opportunity to enhance telemedicine and telehealth applications.
Understanding, Navigating and Communicating Knowledge: Issues and Challenges
Authors: Kushniruk A. W. , Patel V. L. 
Published: March 2018

AbstractThis paper presents a psychological perspective on key issues related to medical vocabularies. There have been rapid advances in the development of computer technology underlying medical information systems. However, in keeping with technological progress, we must also take into account advances in our understanding of human behaviour and learn frOm failures in human performance. A central issue examined in this paper is the extent to which we can develop generic vocabularies that are also flexible and adaptable to specific situations. Empirical research indicates that variability in human performance is much greater than what current medical classifications take into account. A related challenge is that of how to best develop vocabularies that meet the needs of users. Based on theoretical perspectives and research emerging from the domain of cognitive psychology, we suggest that an understanding of the cognitive mechanisms underlying the comprehension and application of terminology is required. It is argued that rather than beginning with highly specified terminologies, i.e. the normative approach, we might instead begin by examining the natural context of how health care workers acquire, understand and negotiate knowledge in practice.
Concepts, Knowledge and Language in Healthcare Information Systems: Follow-up 30 Months Later
Authors: Scherrer J.-R. 
Published: March 2018

AbstractThe paper reviews the last IMIA-WG6 recommendations, issued along two themes: (1) how to better share common results and (2) how to conduct new research and development efforts. Some of the major discrepancies in the field are reviewed. The paper intends to offer insight into two areas, first, in the issue of knowledge representation and, second, in the science of meaning, incorporating the broad intersection of computational linguistics, semantics, conceptual approach, and denotation. The Ogden-Richards meaning triangle is used as a convenient organizing principle to maximize the scope of understanding among the different schools, particularly in areas of linguistics and semantics on the one side and denotation and conceptual approach on the other. In conclusion, there is a need for clarification and for more scientific pragmatism.
A General Model of Drug Prescription
Authors: Séné B. , Venot A. , de Zegher I. , Milstein C. , Errore S. , de Rosis F , Strauch G. 
Published: March 2018

Abstract:Currently, there is no widely accepted structured representation of drug prescription. Nevertheless, a structured representation is required for entering and storing drug prescriptions avoiding free text in computerized systems, and for drug prescription reviews. Derived from part of the work of the European OPADE project, we describe an object-oriented model of drug prescription which incorporates important concepts such as the phase and triggering event concepts. This model can be used to record all drug prescriptions, including infusions, in a structured way avoiding free text. The phase concept allows the storage of sequentially ordered dosage regimens for a drug within the same prescription. The prescription triggering event concept allows recording of the administration of a drug conditional to dates, symptoms and clinical signs, medical procedures, and everyday life events. This model has been implemented within the OPADE project; the corresponding aspects of the user interface are presented to show how this model can be used in practice. Even if other new attributes may be added to the described objects, the structure of this model is suitable for general use in software which requires the entry, storage and processing of drug prescriptions.
A Graphical Query Generator for Clinical Research Databases
Authors: Banhart F. , Klaeren H. 
Published: March 2018

Abstract:Clinical research involves recording, storage and retrieval of disease-related patient data, typically using a database system. In order to facilitate ad hoc queries to clinical databases we have developed a query generator with a graphical interface. The query generator uses an object-oriented data model which is visualized by directed graphs. The main focus of our work was the definition of object-oriented user views to the partly complex data structures of a relational database. Furthermore, we tried to define graphical abstractions for all common types of queries. Thus, even for non-expert database users such as clinicians, it is easy to assemble highly complex queries for a thorough examination of the content of large research databases.
A Three-Level Graph-Based Model for the Management of Hospital Information Systems
Authors: Winter A. , Haux R. 
Published: March 2018

Abstract:Information processing in hospitals, especially in university hospitals, is currently faced with two major issues: low-cost hardware and progress in networking technology leads to a further decentralization of computing capacity, due to the increasing need for information processing in hospitals and due to economic restrictions, it is necessary to use, commercial software products. This leads to heterogeneous hospital information systems using a variety of software and hardware products, and to a stronger demand for integrating these products and, in general, for a dedicated methodology for the management of hospital information systems to support patient care and medical research. We present a three-level graph-based model (3LGM) to support the systematic management of hospital information systems. 3LGM can serve as a basis for assessing the quality of information processing in hospitals. 3LGM distinguishes between a procedural level for describing the information procedures (and their information interchange) of a hospital information system and thus its functionality, a logical tool level, focusing on application systems and communication links, and a physical tool level with physical subsystems (e.g., computer systems) and data transmission. The examples that are presented have been taken from the Heidelberg University Hospital Information System.
Modeling Drug Information for a Prescription – Oriented Knowledge Base on Drugs
Authors: de Zegher I. , Venot A. , Séné B. , Pietri P. , Dahlberg B. , Milstein C. 
Published: March 2018

Abstract:There exists little theoretical analysis how to represent knowledge on drugs required for computerized drug-prescription applications. A work package drug information modeling is described which was part of the European GPADE project. We describe the content and structure of a Drug Knowledge Base (DKB) designed to meet the requirements of decision-support systems in the domain of drug therapy, and to facilitate data transfer from various information sources. The definition of the DKB content is derived from the analysis of information requirements at the various stages of the process of the clinical usage of drugs (prescribing, administration, and follow-up). The DKB structure results from the classification of the various data items along two dimensions: (1) entities in the pharmaco-therapeutic domain for which information must be defined (the Pharmaco-Therapeutic Group, the Component, the Manufactured Preparation, and the Presentation), and (2) the validity score of the pharmaco-therapeutic information (international, national, or local).