Biomedical subjects

A Hasman

Publications and source records attributed to A Hasman.

At least 91 records · Page 5Linked to original sources

PubMed1997

Can we solve current problems with nursing information systems?

Dutch nurses are confronted with health care information systems quite often. However, they do not take full advantage of electronic support for their care activities and professional development. The nursing process is often considered the core of nursing care delivery and guides the documentation of care. Currently, this process can be supported electronically. However, the actual use of nursing information systems (NISs) in the Netherlands is limited to a few sites. Therefore, it is timely to analyse the problems that exist in the development and use of NISs and to look for solutions to solve them. This paper proposes both the nursing information reference model (NIRM), and structured discussions for a proper course of action in the development and use of NISs.

Database Management Systems↗

PubMed1997

Automatic SNOMED classification--a corpus-based method.

This paper presents a method of automatic classification of clinical narrative through text comparison. A diagnosis report can be classified by searching archive texts that show a high textual similarity, and the 'nearest neighbor classifies the case. This paper describes the method's theoretical background and gives implementation details. Large scale simulation experiments were run with a wide range of histology reports. Results showed that for 80-84% of the trials, relevant classification lines were included among the first five alternatives. In 5% of the cases, retrieval was unsuccessful due to the absence of relevant archive reports. From the results it is concluded that the method is a versatile approach for finding potentially good classifications.

Algorithms↗

PubMed1997

Evaluation of automatically learned intelligent alarm systems.

In this contribution it is investigated whether a combination of mathematical simulation and inductive machine learning can replace the usual knowledge elicitation techniques. To test this a domain was selected for which knowledge based systems had a high performance: intelligent alarm systems. A mathematical model of a breathing circuit and ventilated patient was implemented in PSpice. Airway pressure, gas flows and CO2 concentration were simulated with this model, during normal functioning of the breathing circuit and during several mishaps, for a wide range of simulated patients. With an inductive machine learning program, classification trees were created from the simulated patient data. The classification trees described each breathing circuit mishap in terms of changes in signal feature values with respect to the normal situation and were implemented as alarm system knowledge bases. The alarm systems were tested with data measured at 17 mechanically ventilated animals. During ventilation of the animals several mishaps were introduced. For each animal, 93-100% of all mishaps could be detected correctly by the alarm systems. The false alarm rate ranged on average from one false alarm per h to one false alarm every 2.5 h. It was concluded that the suggested approach to knowledge elicitation was successful.

Animals↗

PubMed1997

Education and training in health informatics: guidelines for European curricula.

Guidelines are suggested for European curricula in Health Informatics that apply to both healthcare professionals and health administrative staff. These guidelines are the results of in-depth discussions and thoughts of the EU-EDUCTRA concerted action. Emphasis is placed on the way information is generated in the health domain. The guidelines also consider the various actors, their position and role in the healthcare structure. Characteristics of and operations on health information are discussed. Data quality control, ethical issues, benefits and potential caveats related to health information are also outlined. The article concludes with a list of possible applications.

Administrative Personnel↗

PubMed1997

Medical narratives in electronic medical records.

In this article, we describe the state of the art and directions of current development and research with respect to the inclusion of medical narratives in electronic medical-record systems. We used information about 20 electronic medical-record systems as presented in the literature. We divided these systems into 'classical' systems that matured before 1990 and are now used in a broad range of medical domains, and 'experimental' systems, more recently developed and, in general, more innovative. In the literature, three major challenges were addressed: facilitation of direct data entry, achieving unambiguous understandability of data, and improvement of data presentation. Promising approaches to tackle the first and second challenge are the use of dynamic data-entry forms that anticipate sensible input, and free-text data entry followed by natural-language interpretation. Both these approaches require a highly expressive medical terminology. How to facilitate the access to medical narratives has not been studied much. We found facilitating examples of presenting this information as fluent prose, of optimising the screen design with fixed position cues, and of imposing medical narratives with a structure of indexable paragraphs that can be used in flowsheets. We conclude that further study is needed to develop an optimal searching structure for medical narratives.

Database Management Systems↗

PubMed1997

Robustness metrics for measuring the influence of additive noise on the performance of statistical classifiers.

This paper presents a novel quality measure called robustness. The robustness measure quantifies the influence of measurement noise in the attribute values on the credibility of the classification of a case. It is assumed that the type of distribution of the noise-generating process is known. It is not simple to measure the robustness in the general situation where the noise-free distribution of the attributes is unknown. Therefore, two approximations are suggested and compared with the robustness measure based on the noise-free distribution of the attributes. The usefulness of the suggested robustness measure is explored in a simulation experiment.

Bayes Theorem↗

PubMed1997

Information retrieval: an overview of system characteristics.

The paper gives an overview of characteristics of information retrieval (IR) systems. The characteristics are identified from the descriptions of 23 IR systems. Four IR models are discussed: the Boolean model, the vector model, the probabilistic model and the connectionistic model. Twelve other characteristics of IR models are identified: search intermediary, domain knowledge, relevance feedback, natural language interface, graphical query language, conceptual queries, full-text IR, field searching, fuzzy queries, hypertext integration, machine learning, and ranked output. Finally, the relevance of IR systems for the World Wide Web is established.

Algorithms↗

PubMed1997

Challenges for medical informatics in the 21st century.

This paper introduces the topic of this special issue: challenges for medical informatics in the 21st century. This paper discusses the nature of medical informatics. Some descriptions and definitions of medical informatics are reviewed. Then the research aspects of medical informatics are discussed. It is argued that the more mundane aspects of medical informatics like system development and implementation are important and need further consideration, especially concerning social aspects and correctness.

Computer Literacy↗

PubMed1997

Education and training in health informatics. The IT EDUCTRA Project.

In this contribution the AIM project EDUCTRA and the Telematics Applications Programme IT-EDUCTRA will be described. EDUCTRA has as its aim to investigate what gaps in knowledge health professionals have about health informatics and to provide educational material to fill these gaps. It was believed that a basic understanding of health informatics was present and that educational material should only cover the knowledge necessary for appreciating the products of the AIM programme. It appeared that the knowledge with respect to health informatics was deplorable. Guidelines for curricula were developed to change the situation. In IT-EDUCTRA the necessary course material will be developed.

Curriculum↗

PubMed1997

Introduction of a computerised protocol in clinical practice: is there anything to gain?

OBJECTIVES: To assess the potential benefit of a protocol for the diagnostic work-up and management of patients with obstructive jaundice, by comparing its recommendations with the policies actually followed in patients and to compare local expertise with diagnostic and therapeutic procedures with that described in published reports. DESIGN: A retrospective analysis of patients' records. SETTING: University hospital, The Netherlands. SUBJECTS: 49 consecutive patients who presented to the departments of internal medicine and surgery between June 1990 and June 1992 with serum alkaline phosphatase activities > 125 mumol/L, and serum bilirubin concentrations > 17 mumol/L. MAIN OUTCOME MEASURES: The proportions of diagnostic and therapeutic decisions that deviated from the recommendations, and the success rates of diagnostic and therapeutic procedures. RESULTS: In patients with bile duct stones the treatment strategies did not deviate from those recommended in the protocol. In patients with cancer 38 (30%) of the 128 diagnostic decisions and 4 (11%) of the 37 therapeutic decisions deviated from the protocol. Success rates of all diagnostic investigations were comparable with those reported, and success rates of endoscopic biliary drainage tended to be lower than those reported. CONCLUSIONS: The introduction of a protocol for the diagnostic work-up of patients with obstructive jaundice may reduce unnecessary investigations and diagnostic omissions by half. Because local expertise of some of the procedures seems to be significantly less than reported elsewhere it may be necessary to modify the protocol to better fit local circumstances.

Aged↗

PubMed1996

A new clinical laboratory information system architecture from the OpenLabs project offering advanced services for laboratory staff and users.

The OpenLabs project aims to improve the efficiency and effectiveness of clinical laboratory services by integrating decision support systems with laboratory information systems and equipment. Standards for electronic data interchange between laboratories and other medical systems using the EUCLIDES/OpenLabs coding scheme and an open architecture for clinical laboratory information systems have been specified. This article gives an account of the proposed architecture and outlines new software applications being developed using the architecture which provide advanced services for ordering and reporting of laboratory tests, advanced instrument workstation and laboratory management services, including an OpenLabs Service Manager application which co-ordinates the available services.

Chemistry, Clinical↗

PubMed1996

On the generation of short-axis and radial long-axis slices in thallium-201 myocardial perfusion single-photon emission tomography.

We tried to develop fully automatic reorientation algorithms in thallium-201 myocardial perfusion single-photon emission tomography, and tested a method to evaluate the quality of reorientation. The left ventricle was automatically segmented using count density information, contours generated with Laplacian operators in both transaxial and sagittal slices, and morphological and positional characteristics of the contours. Reorientation was automatically performed based on knowledge of the long axis of a second degree surfac fitted to the myocardial wall. We tried to achieve improvement in reorientation without relying on any functional description of left ventricular shape. Quality of reorientation was evaluated and improved using interactive tools in combination with radial long-axis slices. Two groups of 50 patients, after stress and rest, were analysed using the traditional manual and the fully automatic procedures. Automatic segmentation was successful in 98 out of 100 cases, and automatic reorientation was of reasonable quality. Reorientation obtained with the radial long-axis slices tool was better than after traditional manual or automatic reorientation. Automatic reorientation based on second degree surface fitting was in our hands less successful than reported in the literature. The tool using radial long-axis slices provides a better standard for testing reorientation algorithms than the traditional manual method.

Algorithms↗

PubMed1996

Building intelligent alarm systems by combining mathematical models and inductive machine learning techniques.

In this article a technique is described to develop knowledge-based alarm systems for ventilator therapy, using mathematical modeling and machine learning. With a mathematical model airway pressure, expiratory gas flow and CO2 concentration at the endotracheal tube are simulated for patients, undergoing volume-controlled ventilation with constant ventilator settings, during normal functioning of the breathing circuit and during breathing circuit mishaps (leaks and obstructions). Simulations were performed for 94 physiologically different 'patients', by varying airway resistance and lung/thorax compliance values in the model. Each simulated breath was described by a set of derived signal features and a label that constituted during which event (normal function or mishap) the breath was recorded. With an inductive machine learning algorithm rules, linking signal feature values to breathing circuit events, were created from data of 54 of the simulated patients. The resulting set of rules was able to classify 99% of events in the data of the remaining 40 patients correctly. Of signals, measured at a ventilated lung simulator, 100% of events were classified correctly.

Airway Resistance↗

PubMed1996

Care for records for care.

In this contribution the topic of this special issue is introduced: electronic patient records (EPRs). The characteristics of EPRs are presented. A number of problems that have to be solved before EPRs can be used on a large scale is discussed.

Computer Security↗

PubMed1996

Impact of a protocol processing system (ProtoVIEW) on clinical behaviour of residents and treatment.

A protocol processing system (ProtoVIEW), containing therapeutic trauma protocols, was used in the Accident and Emergency (A and E) department for a period of 7 months to investigate the impact of automated protocols on firstly, medical decision making of physicians and secondly, on quality of treatments eventually received by the patients. A randomized controlled trial showed that mandatory use of the system led to a more uniform working strategy while fracture treatment only seemed to improve in a subgroup of patient for whom residents established a correct diagnosis.

Adolescent↗

PubMed1996

From medical record to patient record through electronic data interchange (EDI).

In this contribution the role of Electronic Data Interchange (EDI) for patient records is discussed. It is our opinion that unlimited access to patient records of different care provides is not a wise thing to do and may even not be acceptable legally. The exchange of EDI messages may be a solution in that the relevant information is exchanged on a need to know basis under the responsibility of the care provider that generated the information. The state of the art with respect to the availability of EDI messages in Europe is presented.

Communication↗

PubMed1996

Building intelligent alarm systems by combining mathematical models and inductive machine learning techniques Part 2--sensitivity analysis.

In an earlier study an approach was described to generate intelligent alarm systems for monitoring ventilation of patients via mathematical simulation and machine learning. However, ventilator settings were not varied. In this study we investigated whether an alarm system could be created with which a satisfactory classification performance could be obtained under a wide variety of ventilator settings, by varying inspiratory to expiratory time (I:E) ratio, tidal volume and respiratory rate. In a first experiment three patient data sets were modeled, each with a different I:E ratio. A part of each data set was used to construct an alarm system for each I:E ratio. The remaining part was used to test the performance of the alarm systems. The three training sets were also combined to construct one alarm system, which was tested with the three test sets. Finally, all alarm systems were tested with data generated by a patient simulator. Similar experiments were performed for the tidal volume and the respiratory rate. It was concluded that an optimally functioning alarm system should contain a library of rule sets, one for each set of ventilator settings. A second best alternative is to take all possible settings into consideration when constructing the training set. Classification performance of the trees that were trained with multiple ventilator settings ranged from 98 to 100% for all test sets. When tested with the independent patient simulator data the classification performance of these trees ranged from 80 to 100%.

Airway Resistance↗

PubMed1996

Effects of a supportive protocol processing system (ProtoVIEW) on clinical behaviour of residents in the accident and emergency department.

A randomized two period crossover trial was performed at the Accident and Emergency (A & E) department of the University Hospital in Nijmegen (The Netherlands). We assessed what the impact was of (mandatory) consultation of a protocol for the management of isolated traumas on treatment decisions of residents. All eight surgical residents who regularly worked in the A & E department participated in the trial. All patients who entered the A & E department between October 13, 1992 and June 9, 1993, of age 16 years or older with an isolated fracture without concomitant lesions were admitted to the study. During the experimental periods, the management protocol was available on computer (using ProtoVIEW) and during the control periods on paper. Main measurements were treatment adjustments made by residents (after consulting different information sources), and their opinion about ProtoVIEW as an information source assessed by means of a questionnaire. When protocol consultation was mandatory, residents changed their treatments almost four times more often towards the protocol than during the control periods (P = 0.01 Chi-square test). Most residents found ProtoVIEW easy to use, liked it as a useful training source while half of them said they would use the system in daily clinical practice. We conclude that mandatory protocol consultation using ProtoVIEW influenced protocol adherence positively.

Attitude↗