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PubMed2002

Virtual reality for health care: the status of research.

As information technology has advanced and costs have declined over the past decade, there has been a steady growth in the use of virtual reality (VR) in health care. According to the data of the two leading clinical databases--MEDLINE and PSYCINFO--the research in the virtual reality field is moving fast: under the "virtual reality" keyword, there are 739 papers listed in MEDLINE and 569 in PSYCINFO (accessed 6 December 2001). Much of this growth, however, has been in the form of feasibility studies and pilot trials. In fact, many researchers tried to use VR, but only a few were able to deepen their study. According to MEDLINE, only 16 research groups published more than three papers related to health care applications of VR. This number lowers to 12 for papers included in PSYCLIT. Therefore, apart from surgical training and some behavioral treatments, there is little convincing evidence coming from controlled studies of the clinical and economical advantages of this approach. This paper discusses recent evidence and outlines some guidelines for future research in this area.

Delivery of Health Care↗

PubMed2004

Content-based image retrieval in medical applications.

OBJECTIVES: To develop a general structure for semantic image analysis that is suitable for content-based image retrieval in medical applications and an architecture for its efficient implementation. METHODS: Stepwise content analysis of medical images results in six layers of information modeling incorporating medical expert knowledge (raw data layer, registered data layer, feature layer, scheme layer, object layer, knowledge layer). A reference database with 10,000 images categorized according to the image modality, orientation, body region, and biological system is used. By means of prototypes in each category, identification of objects and their geometrical or temporal relationships are handled in the object and the knowledge layer, respectively. A distributed system designed with only three core elements is implemented: (i) the central database holds program sources, processing scheme descriptions, images, features, and administrative information about the workstation cluster; (ii) the scheduler balances distributed computing; and (iii) the web server provides graphical user interfaces for data entry and retrieval, which can be easily adapted to a variety of applications for content-based image retrieval in medicine. RESULTS: Leaving-one-out experiments were distributed by the scheduler and controlled via corresponding job lists offering transparency regarding the viewpoints of a distributed system and the user. The proposed architecture is suitable for content-based image retrieval in medical applications. It improves current picture archiving and communication systems that still rely on alphanumerical descriptions, which are insufficient for image retrieval of high recall and precision.

Databases as Topic↗

PubMed1995

Informatics management: process model application.

The purpose of this paper is to share the results of a conceptual model application in informatics management and re-engineering. This theoretical construct is a four phase problem solving process shell which has distinct actions, descriptions, and deliverables with evaluation as an ongoing bridge. The process shell was used as a tool for a retrospective assessment of Nursing Informatics developmental waves and for prospective planning of the re-engineering wave. The authors feel this tool can be an invaluable guide for development, an instrument for planned change, and a paradigm for strategic planning.

Medical Informatics↗

PubMed2002

Anatomical informatics: Millennial perspectives on a newer frontier.

One of the most ancient of sciences, anatomy has evolved over many centuries. Its methods have progressively encompassed dissection instruments, manual illustration, stains, microscopes, cameras and photography, and digital imaging systems. Like many other more modern scientific disciplines in the late 20th century, anatomy has also benefited from the revolutionary development of digital computers and their automated information management and analytical capabilities. By using newer methods of computer and information sciences, anatomists have made outstanding contributions to science, medicine, and education. In that regard, there is a strong rationale for recognizing anatomical informatics as a proper subdiscipline of anatomy. A high-level survey of the field reveals important anatomical applications of computer sciences methods in imaging, image processing and visualization, virtual reality, modeling and simulation, structural database processing, networking, and artificial intelligence. Within this framework, computational anatomy is a developing field focusing on data-driven mathematical models of bodily structures. Mastering such computer sciences and informatics methods is crucial for new anatomists, who will shape the future in research, clinical knowledge, and teaching.

Anatomy↗

PubMed2000

Terminology Query Language: a server interface for concept-oriented terminology systems.

Designers of medical computing applications increasingly require terminology support for their systems. Yet, terminology systems today lack standard methodologies for providing terminology support. This invariably means increased implementation time and expense for system developers who need to use terminologies in their applications. We introduce Terminology Query Language (TQL), a simple query language interface to server implementations of concept-oriented terminologies. TQL is a declarative, set-based query language built on a generic entity-relationship (E/R) schema. TQL defines a common query-based mechanism for accessing terminology information from one or more terminology servers over a network connection.

Medical Informatics Applications↗

PubMed1994

A networked patient-based integrated care system as a basis for the achievement of quality in practice.

Traditionally, telematics initiatives have mainly been used to link patients with specific conditions to monitoring services located in acute hospitals. However, latest application of telematics to the networking of integrated electronic records for ambulatory or community care has great potential to measure and assure the quality of health care delivery to a large sector of the population in a structured and comprehensive way. This paper categorizes the major quality opportunities of a pioneering initiative now achieving operational status.

Computer Communication Networks↗

PubMed1987

[Current computerized support for vestibular function tests.I. Expert systems and their clinical applications].

Expert Systems are a new method developed by the branch of Computer Science known as Artificial Intelligence in order to make available the knowledge and the expertise of the specialists in a certain domain of the science to other operators in the same field. Most of their applications belong to the medical domain. In this paper the main features of the expert systems are briefly described. As an example the structure and the characteristics of the shell EXPERT (Weiss and Kulikowski, 1979) are presented in detail. This shell has already been used to develop several expert systems. It is the tool by which we constructed a consultation system (VERTIGO) aimed to classify different types of vertigo.

Expert Systems↗

PubMed1994

Using Videotex in public health in Belgium.

In public health, access to information is more and more felt to be an urgent need. In this matter Videotex has shown to be a good working tool, though its utilisation in Belgium is not widespread yet. The Institute for Hygiene and Epidemiology has implemented EPITEL, a databank allowing for consultation of data on health and environment. The rationale for the choice of Videotex as a consulting tool is analysed here. Though very user-friendly, its high technicality allows for certain applications to function in real time mode, generate graphics, or even to consult an expert system, as the one used in the application on immunisations. In this way Videotex can also be a helpful tool in primary prevention, besides its data consulting function. This demonstration will present the five applications: health and travelling, health indicators, allergenic pollen, biological quality of the swimming waters at the coast, air pollution data. It shortly presents the hardware and software supporting the system, as well as a few results of a two-year experience running the system. Some shortcomings of the actual system may be highlighted, and possible evolutions might be discussed.

Belgium↗

PubMed2006

Health inequalities and emerging themes in compunetics.

Inequalities in health have been documented for hundreds of years. The causes of these inequalities are complex and related to social, medical, environmental, class, healthcare system and behavioral determinants. Currently governments and healthcare systems are struggling to effectively reduce these differences. In addition, the number of individuals with chronic diseases is rapidly growing, particularly in developed nations. Most of the care needed for effective management of these chronic diseases is performed outside of the hospital setting by non-physicians. However the world's healthcare systems are primarily oriented toward acute, hospital based emergency care and therefore currently largely unable to effectively and consistently provide high quality care to every person. Recent developments in the computer industry have led to major advances in scientific research capabilities and in like manner will, in the future, likely enable significant advances in the field of compunetics. By enabling the instantaneous capture and utilization of large amounts of diverse data, IT will facilitate a population level orientation in compunetics in addition to the current focus on individual patient applications. Similarly the development of behavioral compunetics or a focus innovative uses of technology to influence health behaviors of patients and physicians are on the verge of occurring. In so doing, these and other advances in compunetincs may significantly increase our ability to provide high quality community oriented care, improve the health of individuals and populations and thereby help reduce health inequalities.

Chronic Disease↗

PubMed2004

A reliable and efficient method for cerebral ventricular volumetry in pediatric neuroimaging.

OBJECTIVES: Cerebral ventricular volume has the potential to become an important parameter in quantitative neurological diagnosis. However, no accepted methodology for routine clinical use exists to date. We sought a robust, reproducible, and fast technique to evaluate cerebral ventricular volume in young children. METHODS: We describe a novel volumetric methodology to segment and visualize intracerebral fluid spaces and to quantify ventricular volumes. The method is based on broadly available T1 weighted volumetric magnetic resonance (MR) imaging, an interactive watershed transform, and a fully automated histogram analysis. We evaluated this volumetric methodology with 34 clinical volumetric MR datasets from non-sedated children (age 6-7 y) with a history of prematurity and low birth weight (< or = 1500 g) obtained during a prospective study. RESULTS: The methodology, with adaptation for small ventricular size, was capable of evaluating all 34 of the pediatric datasets for cerebral ventricular volume. The method was a) robust for normal and pathological anatomy, b) reproducible, c) fast with less than five minutes for image analysis, and d) equally applicable to children and adults. CONCLUSIONS: Clinical brain ventricular volume calculations in non-sedated children can be performed using routine MR imaging besides efficient three-dimensional segmentation and histogram analysis with results that are robust and reproducible.

Algorithms↗

PubMed2004

Sjunet--the national IT infrastructure for healthcare in Sweden.

Sjunet is the Swedish Health Care Network comprising an infrastructure for communication between hospitals, primary care centres and home care. It is also hosting a wide range of services from national authorities and health care service providers and vendors of health care systems. Sjunet allows secure transmission of health care data and applications on an IP-network separate from the Internet. The network is used for telemedical videoconferences, teleradiology, remote access to applications, database access, secure e-mail, EDI-messages and IP telephony. It is also useful for e-learning in medical education and further training for health personnel. Carelink is responsible for Sjunet in close co-operation with the county councils and other actors within Sjunet. Hence, Sjunet is as much a co-operative network as it is a technical communication platform for Swedish health care.

Computer Communication Networks↗

PubMedDate not supplied

Expert systems integrated with information systems.

Amongst the users of the AIDA applications there is a rapidly growing interest in the use of expert systems, not as independent systems, but as logical extensions of their already existing information systems. In this paper a prototype system (IDEA) will be described that consists of a set of utilities for the construction of an expert system within the context of an AIDA application. Although IDEA does not excel in sophisticated knowledge representations nor in search strategies (the development of which was not our primary concern) it is able to demonstrate that the facilities provided by AIDA together with the IDEA facilities result in an expert system which is characterized by a high degree of integration with the already operational information system.

Artificial Intelligence↗

PubMed2006

An object-oriented framework for medical image registration, fusion, and visualization.

An object-oriented framework for image registration, fusion, and visualization was developed based on the classic model-view-controller paradigm. The framework employs many design patterns to facilitate legacy code reuse, manage software complexity, and enhance the maintainability and portability of the framework. Three sample applications built a-top of this framework are illustrated to show the effectiveness of this framework: the first one is for volume image grouping and re-sampling, the second one is for 2D registration and fusion, and the last one is for visualization of single images as well as registered volume images.

Algorithms↗

PubMed1989

Cognitive match interface design, a base concept for guiding the development of user friendly computer application packages.

The authors present a base concept which unites the various prescriptions for creating and implementing a user friendly computer system. Making the system operate and interact with the user in a manner which parallels the flow of the user's own thought processes is the key issue. The authors illustrate this concept with examples from a system they recently developed to create and store patient records for the health care industry. Additionally they outline a procedure for creating patient/client data storage systems.

Cognition↗

PubMed1998

Computer applications in dental diagnosis.

Formerly, computer applications in the dental office were restricted mainly to administration and organization. The revolutionary potential of digital applications does not halt at other fields, however. Besides applications in dental therapy, computerized methods have entered all levels of classic dental diagnosis: acquisition of findings, evaluation, and categorization. All three components have a new quality, worthy of being reevaluated if not redefined. New systems are described and evaluated in relation to relevant practice requirements, from both the practitioner's and the scientific clinician's points of view.

Databases as Topic↗

PubMed2005

The law of attrition.

In an ongoing effort of this Journal to develop and further the theories, models, and best practices around eHealth research, this paper argues for the need for a "science of attrition", that is, a need to develop models for discontinuation of eHealth applications and the related phenomenon of participants dropping out of eHealth trials. What I call "law of attrition" here is the observation that in any eHealth trial a substantial proportion of users drop out before completion or stop using the application. This feature of eHealth trials is a distinct characteristic compared to, for example, drug trials. The traditional clinical trial and evidence-based medicine paradigm stipulates that high dropout rates make trials less believable. Consequently eHealth researchers tend to gloss over high dropout rates, or not to publish their study results at all, as they see their studies as failures. However, for many eHealth trials, in particular those conducted on the Internet and in particular with self-help applications, high dropout rates may be a natural and typical feature. Usage metrics and determinants of attrition should be highlighted, measured, analyzed, and discussed. This also includes analyzing and reporting the characteristics of the subpopulation for which the application eventually "works", ie, those who stay in the trial and use it. For the question of what works and what does not, such attrition measures are as important to report as pure efficacy measures from intention-to-treat (ITT) analyses. In cases of high dropout rates efficacy measures underestimate the impact of an application on a population which continues to use it. Methods of analyzing attrition curves can be drawn from survival analysis methods, eg, the Kaplan-Meier analysis and proportional hazards regression analysis (Cox model). Measures to be reported include the relative risk of dropping out or of stopping the use of an application, as well as a "usage half-life", and prediction models reporting demographic usage discontinuation in a population. Differential dropout or usage rates between two interventions could be a standard metric for the "usability efficacy" of a system. A "run-in and withdrawal" trial design is suggested as a methodological innovation for Internet-based trials with a high number of initial dropouts/nonusers and a stable group of hardcore users.

Delivery of Health Care↗

PubMed2000

Big issues, small systems: managing with information in medical research.

This subject of this article is the design of a database system for handling files related to the work of the Molecular Genetics Department of the International Blood Group Reference Laboratory. It examines specialist information needs identified within this organization and it indicates how the design of the Rhesus Information Tracking System was able to meet current needs. Rapid Applications Development prototyping forms the basis of the investigation, linked to interview, questionnaire, and observation techniques in order to establish requirements for interoperability. In particular, the place of this specialist database within the much broader information strategy of the National Blood Service will be examined. This unique situation is analogous to management activities in broader environments and a number of generic issues are highlighted by the research.

Blood Banks↗

PubMed2003

Swedish experience in secure health telematics applications.

In the paper, some common questions and parallel development of ICT for eGovernment and eHealth in Sweden are discussed. In that context, front office and back office are two areas of information security development. Furthermore, information will be provided on "Catch 22" getting means for eIdentification and eSignature out to a large part of the population. Thereby, the catch of how to use a Government procurement of eIdentification and eSignature must be solved. The paper evaluates the lessons learned and current situation in Sweden for eServices, certificates and smart cards.

Computer Security↗