bluuebunny/crossref_metadata_2025_split huggingface dataset:
Holding Power of Orthopaedic Screws in Metacarpal and Metatarsal Bones of Young Calves
Authors: Jean G. , Roush J. K. , DeBowes R. M. , Gaughan E. M. , Kirpensteijn J. 
Published: March 2018

SummaryThe holding power and holding power per mm bone width of 4.5 mm and 5.5 mm cortical and 6.5 mm cancellous orthopaedic screws were obtained by tensile load-to-failure studies in excised metacarpal and metatarsal bones of young female Holstein calves. Holding power and holding power per mm bone width of 6.5 mm orthopaedic screws were significantly greater than those of 4.5 and 5.5 mm orthopaedic screws in the diaphysis and metaphysis. Significant differences were not detected between holding power and holding power per mm bone width of 4.5 and 5.5 mm orthopaedic screws. The holding power was not different between metacarpi and metatarsi. The limiting factor in all tests of holding power was the shear strength of the bone. We found that 6.5 mm orthopaedic screws have the greatest holding power in the metacarpal and metatarsal bones of young calves.This study compares the holding power of 4.5 mm and 5.5 mm cortical and 6.5 mm cancellous orthopaedic screws in excised metacarpal and metatarsal bones from young female Holstein calves. We found that 6.5 mm orthopaedic screws have the greatest holding power.
Multiple Enchondromatosis in the Dog
Authors: Krauser K. 
Published: March 2018

SummaryData is presented of the post-mortem macroscopic and microscopic examination of two Toy Poodles with multiple enchondromatosis (Oilier syndrome). In both animals opening and maturation disorders of the growth plates were found in several skeletal locations. Due to the dogs’ age difference at necropsy (14 and 4 months), some variation was also present in occurrence and appearance of primary and secondary alterations, which gave rise to some conclusions regarding development and progression of the disease. Chondrodysplasia, a characteristic of several breeds, is considered to be the essential factor in the pathogenesis of multiple enchondromatosis in the described cases.
Chronischer Tinnitus
Authors: Landgrebe M. , Langguth B. , Kreuzer P. M. 
Published: March 2018

ZusammenfassungEine Geräuschwahrnehmung ohne externen akustischen Stimulus wird als Tinnitus bezeichnet. Besonders durch Begleiterkrankungen des affektiven Spektrums kann chronischer Tinnitus zur Reduktion der Lebensqualität führen. Es existiert derzeit kein “Königsweg” bei der Behandlung von Tinnitus, jedoch sollte dies keinen Anlass zur Hilflosigkeit auf Seiten des Therapeuten darstellen. Vielmehr sind allgemeine therapeutische Optionen verfügbar, welche sich mit geringem Aufwand in die tägliche Praxis integrieren lassen. Behandlungsansätze erstrecken sich vom beratenden therapeutischen Gespräch über kognitive Verhaltenstherapie, Neurofeedback-Methoden und neuromodulatorischen Techniken bis hin zur pharmakologischen Behandlung, die besonders bei tinnitusassoziierten Symptomen wie Schlafund Konzentrationsstörungen indiziert sein kann. Aufgrund der zunehmenden Evidenz für die Beteiligung zentralnervöser Strukturen an der Pathogenese von chronischem Tinnitus sowie der hohen Komorbidität mit genuin psychiatrischen Krankheitsbildern, wie Depression und Angsterkrankungen, bestehen gute Gründe für Nervenärzte, sich eingehender mit Tinnitus zu beschäftigen.
Internetbasierte psychologische Behandlungen bei Depressionen und Angststörungen
Authors: Moritz S. , Berger T. , Klein J. P. 
Published: March 2018

ZusammenfassungInternetbasierte psychologische Behandlung gewinnt zunehmend an Bedeutung und wird intensiv beforscht. Vorteile dieser Form der Behandlung sind die leichte Verfügund Vervielfältigbarkeit. Grenzen werden beispielsweise in Krisensituationen der Patienten erreicht. Internetbasierte psychologische Interventionen werden eingeteilt nach der Intensität des therapeutischen Kontaktes, dem zugrunde liegenden Therapieansatz und der medialen Gestaltung der Intervention. Es liegen zahlreiche Studien und Metaanalysen zur Wirksamkeit internetbasierter psychologischer Behandlungen bei Angststörungen und Depression vor. Allerdings wurden die meisten Studien bei selbstselegierten Patientenstichproben außerhalb der Routineversorgung durchgeführt. Bei diesen Patienten haben sich insbesondere internetbasierte Interventionen, die einen therapeutischen Kontakt beinhalten (z. B. therapeutengeleitete Selbsthilfeprogramme), in vielen Studien als wirksam erwiesen. In Zukunft sollte vermehrt der Einsatz internetbasierter Interventionen in der Routineversorgung erforscht werden.
Simulation Based Analysis of Automated Classification of Medical Images
Authors: Adler W. , Hothorn T. , Lausen B. 
Published: March 2018

Summary

Objectives:
The ability of various classifiers to discriminate between normal and glaucomatous eyes based on features derived from automated analysis of laser scanning images of the eye background is investigated.

Methods:
To compare the classifiers without over-optimization for a given dataset, we use a simulation model to create topography images. We designed three different simulation setups as model of extreme situations and medical subgroups.

Results:
Neither linear nor tree-based classifiers are ideal for all setups. The most robust performance is obtained by a combination of both, so-called Double-Bagging. Classification of real data from a case-control study shows best results with Double-Bagging. All results obtained with the analysis method extracting features automatically are worse than those obtained by the same classifiers but with features derived from an analysis method that requires intervention of a physician.

Conclusions:
Robust classification results for classification of laser scanning images obtained with the Heidelberg Retina Tomograph are achieved by combined classifiers. The examined automated procedure causes an increased misclassification error compared to the established clinical routine requiring an expert physician’s intervention.
Approaches and Informatics Tools to Assist in the Integration of Similar Clinical Research Questionnaires
Authors: Cohen D. B. , Shifman M. A. , Miller P. L. , Nadkarni P. M. , Frawley S. J. , Brandt C. A. 
Published: March 2018

Summary

Objective:
The integration of similar clinical research questionnaires is a complex process that can benefit from informatics approaches and tools that provide a systematic structure for performing mapping and integration. This systematic approach is necessary to address complex issues in integration such as data heterogeneity, differing levels of granularity of questions and responses, and other issues involving semantic differences. Informatics tools and approaches have been successfully applied to various standard clinical vocabulary integration processes but not for questionnaire integration or mapping.

Methods:
A systematic approach to questionnaire integration was developed in the context of a collaboration of researchers using Trial/DB, a database designed to support clinical research. This approach was applied to the integration of questionnaires involving breast cancer risk factors from each of three research sites.

Results:
From 375 questions on the three original questionnaires, we identified 65 concepts that were measured by two or three of the sites. An algorithm was developed and used to formalize the process of mapping questions and answers across the questionnaires. The approach was applied to previously collected data and prospective data in disparate database systems to import and merge the data from these three sites into Trial/DB.

Conclusion:
Informatics tools that support a systematic approach to mapping questionnaires can be used throughout the research process from questionnaire integration and creation, legacy data integration to data library maintenance and curation.
Demand-driven Evolution of IT Systems in Healthcare
Authors: Buessecker F. , Herlofsen H. , Hinrichs F. , Zeiler T. , Kuhn K. A. , Lenz R. 
Published: March 2018

Summary

Objectives:
To analyze and to optimize interdisciplinary clinical processes, to introduce an IT-supported model for demand-driven system evolution in healthcare, and to demonstrate the feasibility of the approach for a clinical example and to present an evaluation.

Methods:
System evolution and change management are viewed as two sides of the same coin, thus formal methods for process analysis and IT system evolution were embedded into a goal-oriented change management model. Based on a process model, a Failure Mode and Effects Analysis (FMEA) and a computer simulation were performed. A tool for rapid application development (RAD) was used to incrementally improve the healthcare information system according to newly arising needs.

Results:
Each of the formal methods used contributed to the successful reorganization of the interdisciplinary clinical process. An evaluation demonstrated significant improvements. An integrated IT application was implemented to support the optimized process.

Conclusions:
Process improvement is feasible and effective when formal methods for process analysis and requirements specification are used in a reasonable and goal-oriented way. It might be necessary to trade off costs and benefits or simplify a given method in the context of a particular project. As the same information is utilized in different tools, it is supposed that the efforts for process analysis, documentation and implementation of adapted applications could be reduced if different tools were integrated and based on a single coherent reference model for description of clinical processes.
A Methodological Framework for the Conversion of Procedure Classifications
Authors: Dahmen B. , Drösler S. , Stausberg J. 
Published: March 2018

Summary

Objectives:
During the adaptation of the Australian Refined Diagnosis Related Groups for Germany mapping tables between procedure classifications were needed. The mapping between the German OPS-301 2.0 and the Australian MBS-Extended should transfer the Australian expertise by keeping a well-established terminology system.

Methods:
A methodological framework for the development of mapping tables had been developed based on the model for representation of semantics provided by the European Committee of Standardization. Two approaches were used; the concept-based approach from OPS-301 2.0 to MBS-Extended and the class-based approach the other way round. A conversion had to be identified between 23,160 classes of the OPS-301 2.0 and 6,328 classes of the MBS-Extended in two asymmetrical mapping tables.

Results:
The class-based approach leads to a low number of 6,980 conversions but misses 82.6% of the classes of the OPS-301. Because of domain incongruencies and missing domain completeness of the OPS-301 2.0 for non-operative procedures 15.7% of the MBS-Extended-classes remain without conversion. The concept-based approach leads to a slightly higher mean number of conversions per class of 1.35 in comparison to 1.31 with the class-based approach. But it was possible to find conversions for 99.5% of the OPS-301 2.0-classes. 16.3% of the DRG-relevant classes of the MBS-Extended were missed.

Conclusions:
The class-based approach was not useful, because the MBS-Extended is significantly broader than the OPS-301 2.0. An external validation study for the direction OPS-301 2.0 to MBS-Extended revealed a satisfactory quality. The empirical and the reference-based approach are important alternatives to the ones used in this project. There are clear criteria about the appropriate application area for the methodological approaches presented here.
AdaptFlow: Protocol-based Medical Treatment Using Adaptive Workflows
Authors: Mueller R. , Rahm E. , Ramsch J. , Heller B. , Loeffler M. , Greiner U. 
Published: March 2018

Summary

Objectives:
In many medical domains investigator-initiated clinical trials are used to introduce new treatments and hence act as implementations of guideline-based therapies. Trial protocols contain detailed instructions to conduct the therapy and additionally specify reactions to exceptional situations (for instance an infection or a toxicity). To increase quality in health care and raise the number of patients treated according to trial protocols, a consultation system is needed that supports the handling of the complex trial therapy processes efficiently. Our objective was to design and evaluate a consultation system that should 1) observe the status of the therapies currently being applied, 2) offer automatic recognition of exceptional situations and appropriate decision support and 3) provide an automatic adaptation of affected therapy processes to handle exceptional situations.

Methods:
We applied a hybrid approach that combines process support for the timely and efficient execution of the therapy processes as offered by workflow management systems with a knowledge and rule base and a mechanism for dynamic workflow adaptation to change running therapy processes if induced by changed patient condition.

Results and Conclusions:
This approach has been implemented in the AdaptFlow prototype. We performed several evaluation studies on the practicability of the approach and the usefulness of the system. These studies show that the AdaptFlow prototype offers adequate support for the execution of real-world investigator-initiated trial protocols and is able to handle a large number of exceptions.
Genomic Profiling
Authors: Mansmann U. 
Published: March 2018

Summary

Objectives:
The current literature on the use of micro-arrays to generate prognostic profiles is still a methodological wasteland. Many valid questions, such as how profiling studies should be evaluated and what conclusions can be drawn, remain unanswered. Or how can flaws in the collection, analysis and interpretation of data be detected? Undiscovered imperfections can lead to a waste of valuable resources as well as be a latent source of false conclusions.

Methods:
Three seminal papers on the prognosis of breast cancer using genomic profiling will be discussed. Six principles of good experimental design will be used for methodological guidance: defining relevant endpoints, avoiding systematic bias, generalizability of results, appropriately sized samples to achieve sufficient power, simple design to improve interpretability, and avoiding artificial assumptions.

Results:
Severe violations of at least one of the six principles of good experimental design can be found in each of the three papers. A strategy is presented to assess whether a study has achieved a high level of methodological quality. This strategy also helps to establish a suitable protocol for future profiling projects.

Conclusions:
Determining the design of a study in a protocol is a first step to avoid impending pitfalls. The protocol should deal with the problem of understanding the complex reality behind genomic profiling. There are basic guiding principles which can help handle the complex task of designing prognostic studies to find genomic signatures.
Computationally Efficient Noninvasive Cardiac Activation Time Imaging
Authors: Pfeifer B. , Seger M. , Hintermüller C. , Hanser F. , Modre R. , Tilg B. , Trieb T. , Kremser C. , Roithinger F. X. , Hintringer F. , Fischer G. 
Published: March 2018

Summary

Objective:
The computer model-based computation of the cardiac activation sequence in humans has been recently subject of successful clinical validation. This method is of potential interest for guiding ablation therapy of arrhythmogenic substrates. However, computation times of almost an hour are unattractive in a clinical setting. Thus, the objective is the development of a method which performs the computation in a few minutes run time.

Methods:
The computationally most expensive part is the product of the lead field matrix with a matrix containing the source pattern on the cardiac surface. The particular biophysical properties of both matrices are used for speeding up this operation by more than an order of magnitude. A conjugate gradient optimizer was developed using C++ for computing the activation map.

Results:
The software was tested on synthetic and clinical data. The increase in speed with respect to the previously used Fortran 77 implementation was a factor of 30 at a comparable quality of the results. As an additional finding the coupled regularization strategy, originally introduced for saving computation time, also reduced the sensitivity of the method to the choice of the regularization parameter.

Conclusions:
As it was shown for data from a WPW-patient the developed software can deliver diagnostically valuable information at a much shorter span of time than current clinical routine methods. Its main application could be the localization of focal arrhythmogenic substrates.
Improving Model Robustness with Bootstrapping
Authors: Le Teuff G. , Venot A. , Walter E. , Coste J. , Quantin C. 
Published: March 2018

Summary

Objective:
Recent results published by Coste et al. in discriminant analysis with ordinal responses showed the superiority of optimal discriminating analysis for ordinal responses (ODAO) both in terms of classification and simplicity of implementation compared to classic methods (Fisher’s discrimination, logistic regression) applied to medical data (prognostics of burns) and to simulated data. Nevertheless, the solutions obtained by ODAO may be sensitive to re-sampling (i.e the estimated coefficients by ODAO may show excessive sensitivity to the training sample). This study proposes some solutions to control the fluctuations of sampling and to ensure model stability.

Methods:
We used intensive computational methods and bootstrapping, at the outset of model building in order to reduce the sampling variability of estimated coefficients. Thus, the estimation of the coefficients was not based on the minimization of a classification criterion of the training sample, but on the minimization of an aggregate criterion of bootstrapped replications of a classification criterion. Five aggregate criteria were studied.

Results:
The improvement in terms of robustness appeared in 30% of the test cases with moderate training sample size and 55% of those with small training sample size.

Conclusion:
Simulated test cases showed that bootstrapping can help construct more robust models in difficult classification situations and small training samples which are particularly frequent.
Putting the Pieces Together: Using “Off-The-Shelf” Software to Safely Transfer Medical Data
Authors: Göttler M. , Zinnhobler K. , Hasford J. , Swoboda W. J. 
Published: March 2018

Abstract:We describe a new computer-based, network-driven system for administering, transferring, and evaluating reports of spontaneous adverse drug reactions and serious adverse events. The system consists of three regional centers, one coordinating center, and a central database at the national drug regulatory authority. In view of its high level of data security, reliability, easy expandability, and inexpensiveness due to the use of standard shareware products, the system can serve as a model for a clinical health information network.
Toward a Framework for Computer-Mediated Collaborative Design in Medical Informatics
Authors: Kaufman D.R. , Allen V.G. , Shortliffe E.H. , Cimino J.J. , Greenes R.A. , Patel V.L. 
Published: March 2018

AbstractThe development and implementation of enabling tools and methods that provide ready access to knowledge and information are among the central goals of medical informatics. The need for multi-institutional collaboration in the development of such tools and methods is increasingly being recognized. Collaboration involves communication, which typically involves individuals who work together at the same location. With the evolution of electronic modalities for communication, we seek to understand the role that such technologies can play in supporting collaboration, especially when the participants are geographically separated. Using the InterMed Collaboratory as a subject of study, we have analyzed their activities as an exercise in computer- and network-mediated collaborative design. We report on the cognitive, sociocultural, and logistical issues encountered when scientists from diverse organizations and backgrounds use communications technologies while designing and implementing shared products. Results demonstrate that it is important to match carefully the content with the mode of communication, identifying, for example, suitable uses of E-mail, conference calls, and face-to-face meetings. The special role of leaders in guiding and facilitating the group activities can also be seen, regardless of the communication setting in which the interactions occur. Most important is the proper use of technology to support the evolution of a shared vision of group goals and methods, an element that is clearly necessary before successful collaborative designs can proceed.
Rescuing the Emergency – Multiple Expertise and IT in the Emergency Field
Authors: Darcy S. , Dardelet B. 
Published: March 2018

Summary
Objectives: The rapid growth, both in technical and social approaches to the innovation phenomenon in health care suggests that profound changes are occurring. The focus of the project was to evaluate these changes through the case study of the French emergency field.
Methods: The consequences of information technology implementations in the Emergency Services are presented as models to investigate the importance of technical expertise, with both the involvement of all the stakeholders from the beginning of the design and the test of the new tool in real settings.
Results and Conclusion: A new form of work resulted for the management of the crisis, which questioned the status of the actors and their actions, and the characteristics of the protocols of rescue. The outcome of this project was a new model built for the rescue of the emergency field which encompasses alternative forms of expertise.
TANCLICO: Tools for the Analysis of Inter-departmental Clinical Communications
Authors: Crippa F. , Combi C. , Reni G. , Fava D. , Pinciroli F. 
Published: March 2018

Abstract:Patient care management provided by healthcare organizations is complex, involving many different care providers. The information exchange between providers concerns a varying and considerable number of actors and a high transmission load. Based on models, used to characterize specific features of work processes, we propose a new method able to analyze and represent clinical communications inside hospitals. Software has been developed, providing tools for storing and retrieving information resulting from clinical communications. The method, together with data collected in actual situations, may constitute useful tools for health information systems developers.
ARCHIMED: A Network of Integrated Information Systems
Authors: Thurler G. , Borst F. , Bréant C. , Campi D. , Jenc J. , Lehner-Godinho B. , Maricot P. , Scherrer J. R. 
Published: March 2018

Abstract:ARCHIMED is a Network of Integrated Information Systems (NIIS). This novel concept of hospital information system has a major advantage over the currently used distributed systems. The normalized representation structure of its databases enable its Navigators to reach simultaneously not only the data coming from different hospital departments, laboratories, and other hospital facilities, but also the data from different hospitals associated in the network.