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PubMed2005

The first grid for the oral and maxillofacial region and its application for speech analysis.

OBJECTIVES: Introduction of a new grid-based method for analyzing speech functions which takes into account the related information of patients' data and the oral air flow with pronouncing analyzed by computational fluid dynamics. METHODS: An on-line speech analyzer was developed for clinical use utilizing GridPort2.3.1 based on globus2.4.2, comprising several computational tools such as unified data storage, semantic data analysis, computational fluid dynamics analysis and three-dimensional visualization of calculated results from different hardware sources with various types of operation systems. RESULTS: The power transportation layer between dental clinics and computational and storage resources could be provided by using a WWW-based portal. The backend data management system could be constructed using a storage resource broker (SRB) and extensible mark up language (XML). CONCLUSIONS: The new method allows the construction of a data warehouse through this grid-based speech function analysis in order to extract the principal factors related to speech disorders.

Database Management Systems↗
PubMed2004

Assessing medical residents' usage and perceived needs for personal digital assistants.

Health care professionals need information delivery tools for accessing information at the point of patient care. Personal digital assistants (PDAs), or hand-held devices demonstrate great promise as point of care information devices. An earlier study [The Constellation Project: experience and evaluation of personal digital assistants in the clinical environment, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, 1995, 678] on the use of PDAs at the point of care found that hardware constraints, such as memory capability limited their usefulness, however, they were used frequently for accessing medical references and drug information [The Constellation Project: experience and evaluation of personal digital assistants in the clinical environment, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, 1995, 678]. Since this study was completed in 1995, hand-held computer technology has advanced rapidly, and between 26 and 50% of physicians currently use PDAs [Physician's use of hand-helds increases from 15% in 1999 to 26% in 2001: Harris interactive poll results, Harris Poll. 8-24-2002 (electronic citation); ACP-ASIM survey finds nearly half of U.S. members use hand-held computers: ACP-ASIM press release, American College of Physicians, 9-3-2002 (electronic citation)]. This use appears higher among residents, with one recent study finding that over two-thirds of family practice residencies use hand-held computers in their training programs [J. Am. Med. Inform. Assoc. 9 (1) (2002) 80]. In this study, we systematically evaluate PDA usage by residents in our institution using quantitative and qualitative methods. Our evaluation included a brief on-line survey of 88 residents in seven residency programs including primary care and specialty practices. The surveys were completed between 26 October 2001 and 30 April 2002. Follow-up interviews with 15 of the surveyed residents were then conducted between 24 April 2002 and 13 May 2002. The original contributions of this study are the evaluation of residents in primary and specialty programs and evaluation of both medical application software and the conventional personal organizational software (such as calendars and to-do lists). This evaluation was also conducted using significantly advanced hardware and software compared with previous studies [The Constellation Project: experience and evaluation of personal digital assistants in the clinical environment, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, 1995, 678]. Results of our survey and follow-up interviews of residents showed most residents use PDAs daily, regardless of practice or whether their program encourages PDAs. Uses include commercial medical references and personal organization software, such as calendars and address books. Concerns and drawbacks mentioned by these residents included physical size of the PDA and the potential for catastrophic data loss. Another issue raised by our results suggests that security and Health Information Portability and Accountability Act (HIPAA) compliance need to be addressed, in part by resident education about securing patient data on PDAs. Overall, PDAs may become even more widely used if two issues can be addressed: (a) providing secure clinical data for the current patients of a given resident, and (b) allaying concerns of catastrophic data loss from their PDAs (e.g. by educating residents about procedures to recover information from PDA backup files).

Academic Medical Centers↗
PubMed2006

Development and validation of MIX: comprehensive free software for meta-analysis of causal research data.

BACKGROUND: Meta-analysis has become a well-known method for synthesis of quantitative data from previously conducted research in applied health sciences. So far, meta-analysis has been particularly useful in evaluating and comparing therapies and in assessing causes of disease. Consequently, the number of software packages that can perform meta-analysis has increased over the years. Unfortunately, it can take a substantial amount of time to get acquainted with some of these programs and most contain little or no interactive educational material. We set out to create and validate an easy-to-use and comprehensive meta-analysis package that would be simple enough programming-wise to remain available as a free download. We specifically aimed at students and researchers who are new to meta-analysis, with important parts of the development oriented towards creating internal interactive tutoring tools and designing features that would facilitate usage of the software as a companion to existing books on meta-analysis. RESULTS: We took an unconventional approach and created a program that uses Excel as a calculation and programming platform. The main programming language was Visual Basic, as implemented in Visual Basic 6 and Visual Basic for Applications in Excel 2000 and higher. The development took approximately two years and resulted in the 'MIX' program, which can be downloaded from the program's website free of charge. Next, we set out to validate the MIX output with two major software packages as reference standards, namely STATA (metan, metabias, and metatrim) and Comprehensive Meta-Analysis Version 2. Eight meta-analyses that had been published in major journals were used as data sources. All numerical and graphical results from analyses with MIX were identical to their counterparts in STATA and CMA. The MIX program distinguishes itself from most other programs by the extensive graphical output, the click-and-go (Excel) interface, and the educational features. CONCLUSION: The MIX program is a valid tool for performing meta-analysis and may be particularly useful in educational environments. It can be downloaded free of charge via http://www.mix-for-meta-analysis.info or http://sourceforge.net/projects/meta-analysis.

Causality↗
PubMed2005

Privacy protection for HealthGrid applications.

OBJECTIVES: This contribution aims at introducing the problem of privacy protection in e-Health and at describing a number of existing privacy enhancing techniques (PETs). The recognition that privacy constitutes a fundamental right is gradually entering public awareness. Because healthcare-related data are susceptible to being abused for many obvious reasons, public apprehension about privacy has focused on medical data. Public authorities have become convinced of the need to enforce privacy protection and make considerable efforts for promoting through privacy protection legislation the deployment of PETs. METHODS: Based on the study of the specific features of Grid technology, ways in which PET services could be integrated in the HealthGrid are being analyzed. Grid technology aims at removing barriers between local and remote resources. The privacy and legal issues raised by the HealthGrid are caused by the transparent interchange and processing of sensitive medical information. PET technology has already proven its usefulness for privacy protection in health-related marketing and research data collection. RESULTS: While this paper does not describe market-ready solutions for privacy protection in the HealthGrid, it puts forward several cases in which the Grid may benefit from PETs. CONCLUSION: Early integration of privacy protection services into the HealthGrid can lead to a synergy that is beneficial for the development of the HealthGrid itself.

Access to Information↗
PubMed1989

Information systems to support medical practice and scientific discovery.

In many educational applications of the computer, systems are designed to contain information or knowledge that is to be conveyed to the student or user via an interactive learning scheme. In contrast, most NLM systems strive merely to increase the user's access to the broad range of published scientific literature, or to link the user to appropriate factual databases. Providing or enhancing access is, of course, made more difficult than in didactic systems because of the relatively large size of the files that make up the bibliographic and factual databases. For example, the MEDLARS files contain over 12 million records, made up of roughly thirty billion online characters. Users send electronic queries to these files on-line via commercial value-added networks (24 hrs/day, 365 days/year), in total about 4 million queries per year. Of the 4 million, approximately half of the queries were (in the opinion of the users polled) prompted by questions that arose in caring for a particular patient. The remaining 2 million queries concerned research, teaching, and public policy.

Biotechnology↗
PubMed2002

Computer assistance in clinical functional analysis.

The use of computers in the dental practice has been primarily restricted to the acquisition of billing data. Additional possibilities for use of PCs exist in diagnostic data acquisition and evaluation; clinical functional analysis seems a particularly suitable application. Such software is now available: CMDfact. Dentally, it is based on a previously developed and published examination and documentation system, the graphic user interface of which is used in the newly developed software. After the examination data have been acquired by mouse click or numerical entry, these are available for evaluation. A special function, the "Diagnosis pilot" is integrated to support the user. This helps in the assignment of the appropriate "Initial diagnoses", since it brings together the individually existing principal symptoms and suitable diagnoses for the initial diagnosis in question and also states which diagnoses "would be appropriate" for this, but are not available. With 3D animation, the software also helps the dentist to explain aspects of CMD to patients. The software also assists the dentist with a detailed multimedia help system, which provides context-sensitive help for every examination step. These help functions explain the sense of the relevant examinations, their performance and evaluation in the form of short texts and explanatory photographs and videos.

Computer Graphics↗
PubMed1998

Creating a vision for your medical call center.

MCC technologies and applications that can have a positive impact on managed care delivery are almost limitless. As you determine your vision, be sure to have in mind the following questions: (1) Do you simply want an efficient front end for receiving calls? (2) Do you want to offer triage services? (3) Is your organization ready for a fully functional "electronic physician's office?" Understand your organization's strategy. Where are you going, not only today but five years from now? That information is essential to determine your vision. Once established, your vision will help determine what you need and whether you should build or outsource. Vendors will assist in cost/benefit analysis of their equipment, but do not lose sight of internal factors such as "prior inclination" costs in the case of a nurse triage program. The technology is available to take your vision to its outer reaches. With the projected increase in utilization of call center services, don't let your organization be left behind!

Computer Communication Networks↗
PubMed2003

[Doctor-initiated clinical trials and the revised pharmaceutical affairs law].

In Japan, clinical trials aiming at application for approval of new drugs take a long time and a lot of money, and their quality thought to be poor. Japanese pharmaceutical companies tend to conduct more clinical studies in the United States and/or Europe than in Japan. The Ministry of Health, Labour and Welfare (MHLW) announced a three-year plan to facilitate clinical trials in Japan; the establishment of a large-scale clinical trial network, the improvement of the clinical research infrastructure, and the utilization of doctor-initiated clinical trials. The revised Pharmaceutical Affairs Law enables doctors and medical institutions to perform clinical trials using unapproved products spontaneously without any corporate sponsorship. Drugs needed by some patients but unapproved because they are unprofitable for companies are expected to be approved under this system. MHLW stipulated the ethical and scientific quality standard of doctor-initiated clinical trials, which is consistent with the principles of the Declaration of Helsinki, and Good Clinical Practice (GCP). To establish a system that allows expedited approval of safer and more effective products, the integration of the functions of the current review bodies, such as the Organization for Pharmaceutical Safety and Research (OPSR) and the Pharmaceuticals and Medical Devices Evaluation Center (PMDEC), into an independent administrative agency is scheduled.

Clinical Trials as Topic↗
PubMed2002

Data, network, and application: technical description of the Utah RODS Winter Olympic Biosurveillance System.

Given the post September 11th climate of possible bioterrorist attacks and the high profile 2002 Winter Olympics in the Salt Lake City, Utah, we challenged ourselves to deploy a computer-based real-time automated biosurveillance system for Utah, the Utah Real-time Outbreak and Disease Surveillance system (Utah RODS), in six weeks using our existing Real-time Outbreak and Disease Surveillance (RODS) architecture. During the Olympics, Utah RODS received real-time HL-7 admission messages from 10 emergency departments and 20 walk-in clinics. It collected free-text chief complaints, categorized them into one of seven prodromes classes using natural language processing, and provided a web interface for real-time display of time series graphs, geographic information system output, outbreak algorithm alerts, and details of the cases. The system detected two possible outbreaks that were dismissed as the natural result of increasing rates of Influenza. Utah RODS allowed us to further understand the complexities underlying the rapid deployment of a RODS-like system.

Algorithms↗
PubMed2004

Accurate volumetric measurements of anatomical cavities.

OBJECTIVES: The volumetric assessment of anatomical cavities is of high relevance for various applications in medicine. Based on 3D scanning (i.e., CT) of these cavities, the volume can be determined by counting the volume elements of a segmentation of that cavity. Unfortunately, elements on the boundary of the segmentation require special treatment to obtain accurate volumetric measurements. In this paper, we propose a novel technique that in particular increases the accuracy of the volume estimation for the boundary elements of segmented anatomical objects. METHODS: Based on a 3D segmentation of an anatomical cavity, we recursively subdivide boundary volume elements into a set of simple situations, where the volume can be estimated easily. RESULTS: We performed volumetric measurements on seven datasets of phantom models made of plexiglass (see Fig. 1) scanned by a biplane angiography unit and assessed the quality of our method by comparing the measured volume by our novel method and by the fluid required to fill the phantom cavities. CONCLUSIONS: Our method calculates a significantly more accurate volume of the segmented cavities than previous methods. Nevertheless, it is only slightly more computationally expensive.

Abdominal Cavity↗
PubMedDate not supplied

Structure and software tools of AIDA.

AIDA consists of a set of software tools to allow for fast development and easy-to-maintain Medical Information Systems. AIDA supports all aspects of such a system both during development and operation. It contains tools to build and maintain forms for interactive data entry and on-line input validation, a database management system including a data dictionary and a set of run-time routines for database access, and routines for querying the database and output formatting. Unlike an application generator, the user of AIDA may select parts of the tools to fulfill his needs and program other subsystems not developed with AIDA. The AIDA software uses as host language the ANSI-standard programming language MUMPS, an interpreted language embedded in an integrated database and programming environment. This greatly facilitates the portability of AIDA applications. The database facilities supported by AIDA are based on a relational data model. This data model is built on top of the MUMPS database, the so-called global structure. This relational model overcomes the restrictions of the global structure regarding string length. The global structure is especially powerful for sorting purposes. Using MUMPS as a host language allows the user an easy interface between user-defined data validation checks or other user-defined code and the AIDA tools. AIDA has been designed primarily for prototyping and for the construction of Medical Information Systems in a research environment which requires a flexible approach. The prototyping facility of AIDA operates terminal independent and is even to a great extent multi-lingual. Most of these features are table-driven; this allows on-line changes in the use of terminal type and language, but also causes overhead. AIDA has a set of optimizing tools by which it is possible to build a faster, but (of course) less flexible code from these table definitions. By separating the AIDA software in a source and a run-time version, one is able to write implementation-specific code which can be selected and loaded by a special source loader, being part of the AIDA software. This feature is also accessible for maintaining software on different sites and on different installations.

Database Management Systems↗
PubMed1997

Epidemiology tools program and selected medical applications.

In epidemiological research the calculation of appropriate measures of disease frequency is the basis for a comparison of populations and, therefore, the identification of disease determinants. Two frequencies being compared can be combined into a single summary parameter that estimates the association between an exposure and a disease. This can be accomplished by calculating either the ratio of the measures of disease frequency for two populations which indicates how much more likely one population is to develop a disease than another, or the difference between the frequencies which indicates how much greater the frequency of a disease is in one population compared with the other. In epidemiology we often need to compute measures of disease frequency mentioned above. We can do that by means of complex statistical software, but sometimes it is not easy or possible to use this software for an analysis of epidemiological data. At the EuroMISE Center of Charles University and Academy of Sciences in the framework of the research supported from grant COPERNICUS JRP-10053 the E. T. program (Epidemiology Tools) was developed. This program can be used for practical analysis of data from retrospective (case-control) studies or prospective (cohort) studies and for standardization. However, the program can be also a useful teaching tool in the epidemiology courses.

Adolescent↗
PubMed2005

GEMSS: privacy and security for a medical Grid.

OBJECTIVES: The GEMSS project is developing a secure Grid infrastructure through which six medical simulations services can be invoked. We examine the legal and security framework within which GEMSS operates. METHODS: We provide a legal qualification to the operations performed upon patient data, in view of EU directive 95/46, when using medical applications on the GEMSS Grid. We identify appropriate measures to ensure security and describe the legal rationale behind our choice of security technology. RESULTS: Our legal analysis demonstrates there must be an identified controller (typically a hospital) of patient data. The controller must then choose a processor (in this context a Grid service provider) that provides sufficient guarantees with respect to the security of their technical and organizational data processing procedures. These guarantees must ensure a level of security appropriate to the risks, with due regard to the state of the art and the cost of their implementation. Our security solutions are based on a public key infrastructure (PKI), transport level security and end-to-end security mechanisms in line with the web service (WS Security, WS Trust and SecureConversation) security specifications. CONCLUSION: The GEMSS infrastructure ensures a degree of protection of patient data that is appropriate for the health care sector, and is in line with the European directives. We hope that GEMSS will become synonymous with high security data processing, providing a framework by which GEMSS service providers can provide the security guarantees required by hospitals with regard to the processing of patient data.

Access to Information↗
PubMed1998

Application of artificial neural networks to eating disorders.

An experimental application of Artificial Neural Networks to Eating Disorders is presented. The sample, composed of 172 cases (all women) collected at the Centre for the Diagnosis and Treatment of Eating Disorders of the 1st Medical Division of the St. Eugenio Hospital of Rome, was subdivided, on the basis of the diagnosis made by the specialist of the St. Eugenio, into four classes: Anorexia Nervosa (AN), Nervous Bulimia (NB), Binge Eating Disorders (BED) and Psychogenic Eating Disorders that are Not Otherwise Specified (PED-NOS). The data base was composed of 124 different variables: generic information, alimentary behavior, eventual treatment and hospitalization, substance use, menstrual cycles, weight and height, hematochemical and instrumental examinations, psychodiagnostic tests, etc. The goal of this experiment was to verify the accuracy of the Neural Networks in recognising anorexic and bulimic patients. This article describes 6 experiments, using a Feed Forward Neural Network, each one using different variables. Starting from only the generic variables (life styles, family environment, etc.) and hematoclinical and instrumental examinations, a Neural Networks provided 86.94% of the prediction precision. This work is meant to be a first contribution to creating diagnostic procedures for Eating Disorders, that would be simple and easy-to-use by professionals who are neither psychologists nor psychiatrists nor psychotherapists but who are, however, among the first to meet these patients and who are therefore called upon to give such patients the very first pieces of advice on seeking proper treatment.

Anorexia Nervosa↗
PubMed2000

[Comparison of software programs for data analysis of complex surveys].

OBJECTIVE: To compare specific software programs for data analysis of complex surveys regarding the following characteristics: ease of application, computer efficiency and accuracy of the results. METHODS: Secondary data from the Pesquisa Nacional sobre Demografia e Saúde (National survey on demography and health) (1996) with a target population of women aged 15 to 49 years old were used. This was a probabilistic subsampling drawn in two stages, then stratified, with the probability proportional to size in the first stage. The northern and mid-western regions of the country were selected for the study. The parameters of interest were mean for the age variable, and the proportion for five other qualitative variables. The software programs used were Epi Info, Stata and WesVarPC. RESULTS: The programs have two common options for the files import: the dBASE and text type files. The number of steps previous to the execution of the analyses were twenty- one for Epi Info, eleven for Stata and nine for WesVarPC. Efficiency was high for all them, that is, less that three seconds. The standard errors estimated using Epi Info and Stata were the same, with approximation up to the third decimal; those for WesVarPC were generally higher. CONCLUSIONS: Epi Info is the most limited software program regarding the analyses currently performed; however it is easy to use and free. Stata and WesVarPC are far more complete, however the disadvantage is their cost. The choice of the software program will depend mainly on the user's specific needs.

Adolescent↗
PubMed2002

Benchmarking the clinical prosthetic dental literature on MEDLINE.

STATEMENT OF PROBLEM: The utility of evidence-based clinical prosthetic dental decision making is, in part, predicated on the availability of high-quality clinical trials and the use of current best evidence. With literature or outcomes continually evolving, it is difficult to know how much information is available, how fast it changes, or where it is located. PURPOSE: This study identified and quantified the availability of high-quality prosthetic dental clinical trials, determined the dynamics of literature increase, and identified the location of relevant literature published within a specific decade. MATERIAL AND METHODS: A search strategy based on the Medical Subject Headings (MeSH) vocabulary for prosthetic dentistry was developed to examine MEDLINE with use of the Ovid Web Gateway search engine between the years 1990-1999. Specific and sensitive methodologic search filters identified 4 categories of information: etiology, diagnosis, therapy, and prognosis. The identified studies were limited to human subjects and to articles written in English. The results were subdivided by year to identify trends and location of the literature. This evaluation did not include the following: (1) other databases or languages or (2) an evaluation of the validity or clinical applicability of the literature. The first factor would increase the estimated number of relevant articles, whereas the second factor would decrease it. RESULTS: Between 1990 and 1999, MEDLINE identified 10,258 articles published in English on human prosthodontic issues. When subdivided by clinical category, the number of articles per year (mean +/- SD) for specific and sensitive searches, respectively, was as follows: etiology, 10 +/- 6 and 95 +/- 27; diagnosis, 11 +/- 5 and 77 +/- 21; therapy, 6 +/- 2 and 153 +/- 52; and prognosis, 13 +/- 6 and 91 +/- 27. For sensitive searches, this amounted to approximately 416 articles per year. The time-course analysis indicated that the number of articles in each category increased by approximately 7% per year. The articles were published in more than 60 different journals: approximately 50% of the articles were published in 14 journals, whereas the remaining articles were published in 46 journals. CONCLUSION: There appears to be substantial clinical prosthetic dental literature upon which to base clinical decisions. With the sensitive search strategy used as an estimate, to stay current, one would need to read and absorb approximately 8 articles per week, 52 weeks per year, across 60 different journals. Increases in the volume of literature each year make access even more difficult. These trends suggest the need for computer-based clinical knowledge systems.

Analysis of Variance↗
PubMed1998

The use of artificial neural networks methodology in the assessment of "vulnerability" to heroin use among army corps soldiers: a preliminary study of 170 cases inside the Military Hospital of Legal Medicine of Verona.

This article describes a preliminary study of screening/diagnostic instruments for prediction for large-scale application in the military field at the Neuropsychiatric Department of the Military Hospital of Legal Medicine of Verona and for the prevention of self-destructive behaviors, particularly through the use of drugs. 170 subjects divided into three subsamples were examined. The first subsample was characterized by a strong tendency towards normalcy, the second by a strong tendency towards pathology, and the third by a great variety of expressions of psychological and social problems, which were not necessarily related to drug use. These subjects were administered a questionnaire designed according to Squashing Theory principles (Buscema, 1994a). Answers were processed by an Artificial Neural Network created by Semeion in Rome (Buscema, 1996) and were compared with a standard clinical psychiatric assessment report and with the results of psychodiagnostic tests. Results document ANNs' remarkable ability to recognize subjects with declared, in exordium and "at risk" pathological behaviors. Blind results on learning and trial samples show a very high predictive capacity (over 90%). A comparison with the examined subjects' clinical report and the results of the first follow-up also document very high agreements. The broad variation of answers obtained in the third subsample allows further methodological reflections on the contribution of Artificial Neural Networks and Squashing Theory to the study of deviance, for both sociologists and clinicians, and not only for those in the field of drug addiction.

Adult↗
PubMed2002

Does size really matter--using a decision tree approach for comparison of three different databases from the medical field of acute appendicitis.

Decision trees have been successfully used for years in many medical decision making applications. Transparent representation of acquired knowledge and fast algorithms made decision trees one of the most often used symbolic machine learning approaches. This paper concentrates on the problem of separating acute appendicitis, which is a special problem of acute abdominal pain, from other diseases that cause acute abdominal pain by use of an decision tree approach. Early and accurate diagnosing of acute appendicitis is still a difficult and challenging problem in everyday clinical routine. An important factor in the error rate is poor discrimination between acute appendicitis and other diseases that cause acute abdominal pain. This error rate is still high, despite considerable improvements in history-taking and clinical examination, computer-aided decision-support, and special investigation such as ultrasound. We investigated three databases of different size with cases of acute abdominal pain to complete this task as successful as possible. The results show that the size of the database does not necessary directly influence the success of the decision tree built on it. Surprisingly we got the best results from the decision trees built on the smallest and the biggest database, where the database with medium size (relative to the other two) was not so successful. Despite this we were able to produce decision tree classifiers that were capable of producing correct decisions on test data sets with accuracy up to 84%, sensitivity to acute appendicitis up to 90%, and specificity up to 80% on the same test set.

Acute Disease↗