Showing papers in "Journal of Medical Systems in 2001"

A Versatile Functional–Anatomic Image Fusion Method for Volume Data Sets

Abstract: We describe and validate a volumetric three-dimensional registration method, and compare it to our previously validated two-dimensional/three-dimensional method. CT/MRI and SPECT data from 14 patients were interactively fused using a polynomial warping technique. Registration accuracy was confirmed visually and by a nonsignificant F value from multivariate analysis of the transformed landmarks, a significant difference of the squared sum of intensity differences between the transformed/untransformed and the reference volume both at the 0.05 (p > 0.05) confidence level and an average 31% improvement of the correlation coefficient and cross correlation. For the two-dimensional/three-dimensional method, ROI center-to-center distance ranged from 1.42 to 11.32 mm (for liver) with an average of 6.13 mm ± 3.09 mm. The average ROI overlap was 92.51% with a 95% confidence interval of 90.20–96.88%. The new method is superior because it operates on the true three-dimensional volume. Both methods give good registration results, take 10 to 30 min, and require anatomic knowledge.

Towards More Optimal Medical Diagnosing with Evolutionary Algorithms

Abstract: Efficiency in hospital performance is becoming more and more important. Studies showed that diagnosis can considerably reduce the inefficiency, so one of the most important tasks in achieving greater hospital efficiency is to optimize the diagnostic process. For the best of the patient the diagnostic process has to be optimized regarding the number of the examinations and individualized in order to maximize accuracy, sensitivity and specificity. In addition the duration of the diagnostic process has to be minimized and the process has to be performed on the most reliable equipment. The main contribution of our paper is the introduction of the integrated computerized environment DIAPRO enabling the diagnostic process optimization. The DIAPRO is based on a single approach—evolutionary algorithms.

An Artificial Neural Network Approach to Diagnosing Epilepsy Using Lateralized Bursts of Theta EEGs

Abstract: Determining the cause of seizures is a significant medical problem, as misdiagnosis can result in increased morbidity and even mortality of patients. The reported research evaluates the efficacy of using an artificial neural network (ANN) for determining epileptic seizure occurrences for patients with lateralized bursts of theta (LBT) EEGs. Training and test cases are acquired from examining records of 1,500 consecutive adult seizure patients. The small resulting pool of 92 patients with LBT EEGs requires using a jack-knife procedure for developing the ANN categorization models. The ANNs are evaluated for accuracy, specificity, and sensitivity on classification of each patient into the correct two-group categorization: epileptic seizure or non-epileptic seizure. The original ANN model using eight variables produces a categorization accuracy of 62%. Following a modified factor analysis, an ANN model utilizing just four of the original variables achieves a categorization accuracy of 68%.

An Approach for Integrating Heterogeneous Information Sources in a Medical Data Warehouse

Abstract: In recent years, medical professionals are witnessing an explosive growth in data collected by various organizations and institutions. At the same time, the ongoing developments of networking technologies provide doctor with the capability to access these data across the boundaries of interconnected computers. In this paper we present a medical data warehousing methodology that aims to use data semantics to regroup and merge patients' medical data from different health information systems, which may be autonomous and heterogeneous. The proposed solution takes into account European laws concerning the security and anonymity of personal data.

A Neural Network Approach in Diabetes Management by Insulin Administration

Abstract: Diabetes management by insulin administration is based on medical experts' experience, intuition, and expertise. As there is very little information in medical literature concerning practical aspects of this issue, medical experts adopt their own rules for insulin regimen specification and dose adjustment. This paper investigates the application of a neural network approach for the development of a prototype system for knowledge classification in this domain. The system will further facilitate decision making for diabetic patient management by insulin administration. In particular, a generating algorithm for learning arbitrary classification is employed. The factors participating in the decision making were among others diabetes type, patient age, current treatment, glucose profile, physical activity, food intake, and desirable blood glucose control. The resulting system was trained with 100 cases and tested on 100 patient cases. The system proved to be applicable to this particular problem, classifing correctly 92% of the testing cases.

Categorization of Fetal Heart Rate Patterns Using Neural Networks

Abstract: Digitized data from CTG (cardiotocography) measurements (fetal heart rate and uterine contractions) have been used for categorization of typical heart rate patterns before and during delivery. Short time series of CTG data, about 7 min duration, have been used in the categorization process. In the first part of the study, selected CTG data corresponding to 10 typical cases were used for purely auto associative unsupervised training of a Self-Organizing Map Neural Network (SOM). The network may then be used for objective categorization of CTG patterns through the map coordinates produced by the network. The SOM coordinates were then compared. In the second part of the study, a hybrid neural network consisting of a SOM network and a Back-Propagation network (BP) was trained with data corresponding to a number of basic heart rate patterns as described by eight manually selected indices. Test data (different than the training data) were then used to check the performance of the network. The present study shows that the categorization process, in which neural networks were used, can be reliable and agree well with the manual categorization. Since the categorization by neural networks is very fast and does not involve human efforts, it may be useful in patient monitoring.

Management Strategies and Financial Performance in Rural and Urban Hospitals

Abstract: This study identifies the difference in financial performance between rural and urban hospitals and examines whether or not that difference may be attributed to the emphasis of revenue enhancement over cost management strategies. Hospitals in Virginia were included in this study except for the two state university medical centers. Rural and urban hospitals were compared on 10 performance indicators grouped into four categories: revenues, costs, profits, and productivity. The results suggest that rural hospital profitability is dependent on cost management. Since rural hospitals achieved lower cost, better efficiency and productivity level than urban hospitals in Virginia, they demonstrate a significant higher level of profit.

Possible Electromagnetic Interference with Electronic Medical Equipment by Radio Waves Coming from Outside the Hospital

Abstract: Electromagnetic interference (EMI) with electronic medical equipment by radio waves from mobile telephone handsets has been reported and is currently receiving wide attention. The possibility of EMI with electronic medical equipment by radio waves coming into the hospital has also been pointed out. But so far, there are no reports measuring the frequency distribution of electric field intensity induced by incoming radio waves. Therefore, we measured electric field intensity induced by radio waves coming into our 11-floor hospital, which was under construction. The maximum intensity observed was about 200 V/m at 2.79 GHz, from airport surveillance radar waves. The maximum intensity induced by radio waves from cellular phone base stations was 1.78 V/m. These data show that various frequencies of radio waves are common in this urban area, and that they induce strong electric field intensity. This strong electric field intensity might cause EMI with electronic medical equipment. Measurement of the electromagnetic environment should be done by each hospital in urban areas to prevent EMI with electronic medical equipment.

Factors Affecting Appropriateness of Hospital Utilization in Two Hospitals in Turkey

Abstract: To determine the extent of inappropriate hospital use, to investigate factors related to variations in appropriateness, and to identify reasons for inappropriateness, the Appropriateness Evaluation Protocol (AEP) was applied to 2067 patient days in two hospitals between March 1997 and 1998 in Ankara, Turkey. A substantial amount of inappropriate utilization was found in both hospitals (34.2%, 24.6%). Factors affecting the appropriateness of hospital utilization and reasons for inappropriateness were varied and presented by internal medicine, general surgery, and gynecology services. In general, results of the logistic regression analysis indicated that inappropriateness was significantly associated with admission number (first admission/readmission), admission route (emergent/non-emergent), and day of the week. The most common reason for inappropriateness was diagnostic procedures and/or treatments that could have been carried out on an ambulatory basis. This study demonstrates that the AEP can be used as a tool to improve the efficiency of the Turkish hospitals.

An MRP System for Surgical Linen Management at a Large Hospital

Abstract: Materials Requirements Planning (MRP) has been used extensively in manufacturing and other industries to improve on-time delivery and to reduce costs. In this paper, we illustrate how an MRP-type system was developed to monitor surgical linen at a large teaching hospital. We also describe a bar-code scanning ‘tag and recapture’ study to estimate total inventory. The hospital implemented several changes based upon our recommendations that resulted in time savings and a smoother flow of materials throughout the surgical linen supply chain.

The Turkish Commercial Health Insurance Industry

Abstract: Turkey has experienced significant development in the private health insurance market since 1991. Improvements in private health services, increased public awareness, and insufficient service delivery by the social security organizations have encouraged more people to buy private health insurance. The number of people covered by private health insurance has reached 600,000, forming a d200 million market. The Turkish insurance industry is targeting 6–8 million insurance holders before the year 2005. This study examines the structure of the commercial health insurance industry of Turkey and gives the latest policy and legal changes made in the insurance market by the Turkish government to affect supply and demand.

Issues in the Design of Medical Ontologies Used for Knowledge Sharing

Abstract: Recent work in Medical Informatics is exploring the development and the use of formal ontologies as a way of specifying content-specific agreements for the sharing and reuse of knowledge among several computer systems. We describe the role of ontologies in supporting knowledge sharing activities in medicine Principles for the design of ontologies have been proposed, mainly in other domains: these principles include parsimony, clarity, representation of categories versus terms, and coherence. We analyze how and why these principles can or cannot be applied from case studies from medical systems. Regarding the fact that most of medical concepts are empirical, selected design decisions are discussed. An alternative representation choice consists in mapping principled general core ontologies and domain ontologies.

Artificial Life Simulation of Living Alga Cells and Its Sorption Mechanisms

Abstract: Resistance mechanisms of organisms against toxic metals are based on a few different mechanisms provided by algae cells. These mechanisms can be localized on the cell wall, on the cell wall and cytoplasm membrane, and intracellular localized mechanisms. Due to these mechanisms, algae populations could be used for sorption of arsenic from contaminated waters. This process takes a long time and it's not very variable. With artificial life simulation based on multi-agent simulation system we are preparing a simulation that could at least partially substitute the real experiments with real cells. Artificial life simulation of alga Chlorella kessleri is based on real biological parameters and together with partial implementation of other mathematical models of algae population growth it will be used for simulating the process of absorbing heavy metals from contaminated water. Model implementation is done in Swarm—multi agent object based simulation system and it's libraries. Simulation is still in testing and debugging phase and it is not yet available for public.

Video Endoscopic Database on WWW Linking with ISDN

Abstract: We report here on a study of creating medical an image library comprised of simple but digitized gastrointestinal video-scope images, which were digitally compressed using MPEG-1 compression, and on the use of this library for clinical and educational applications. We have designed and installed a test-bed database (WWW) for gastrointestinal video-scope images linking with ISDN at 128 Kbps enables Internet access. This paper discusses its development, operation, problems, and educational and clinical use. A test-bed operation of the database was conducted by going on-line on the Internet and through an ISDN circuit (point-to-point connection) at a speed of 128 Kbps. This dynamic image database proved to be effective in diagnostic imaging for endoscopic diagnosis and treatment. It also proved to be useful for improving the clinical levels of geographically isolated physicians.

Effects of Environmental Threats on the Quality of Care in Acute Care Hospitals

Abstract: This study investigates how environmental threats may adversely affect internal resources (slacks) and how hospitals' slack level may mediate the adverse effect of environmental threats on quality. Two testable hypotheses are (1) The environmental threat and level of organizational slack in hospitals are inversely relateds and (2) Hospitals' slack level and quality of care are positively related. Both hypotheses are supported by the data in analysis of the structural relationships among the environmental threat, organizational slack, and quality of care indicators.

Evaluating Training Data Suitability for Decision Tree Induction

Abstract: Dcision tree induction, as well as other inductive learning methods, requires training data of high quality to be able to generate accurate and reliable classification models. Example cases should form a representative sample from the application area, and the attributes used to describe example cases should be relevant and adequate for the classification task to be solved. In this paper, measures of the strength of association and an entropy-based approach have been used to assess the quality of the training data. Studied classification tasks related to three otological data sets: a conscript data set, a vertigo data set, and a postoperative nausea and vomiting data set. The pape suggests that the studied approaches give some guidelines about the quality of the training data, but other approaches are also needed to guide training data building.

The Impact of New Antiretroic Therapeutic Schemes on the Cost for AIDS Treatment in Greece

Abstract: The paper attempts to evaluate the clinical and economic benefits between the administration of the dual and triple antiretroic schemes for the treatment of the HIV disease. Clinical and economic data are derived from patients hospitalized in 1996 and 1997 at the University Department of Dermatology and Venereology of Andreas Sygros Hospital. Methodology is based on the comparison of patients' nosological profile and direct annual cost before and after the administration of the triple treatment. The results of the study present that the triple combination therapy yields superior health outcomes, (decrease in the days of hospitalization and in the opportunistic disease events as well as fewer deaths and loss of production). Cost comparison presents a small decrease in the annual patient's cost, where all cost components are diminished, except the medication cost. A substitution of hospital care by drug therapy is revealed and a great change is taken place in the composition of the drugs' cost. Patient cost for antiretroic drugs has more than doubled from 1996 to 1997.

The Performance and Problems of the Turkish Pharmaceutical Industry: Is There a Need to Develop a National Drug Policy?

Abstract: Turkey has a big pharmaceutical industry—of the drugs consumed there, 90% are manufactured domestically. Eighty percent of this manufacturing is run by foreign companies. In this study, the performance of the Turkish pharmaceutical industry in terms of the technology and production is examined and compared with that of some other countries, and the importance of the essential drugs list and national drug policy is discussed. At the end of the study, strategies are suggested toward meeting the main current challenges in the Turkish pharmaceutical industry.

Design of Digital Hardware System for Pulse Signals

Abstract: In this study, we have developed the digital hardware system which performs signal processing necessary for the filtering to eliminate noises by inputting pulse wave signals from the sensor group. With a view to obtain clinically effective information, we analyzed structural elements of pulse waveform and, thus, conducted a systematic classification. What is more, we performed the modeling of the digital filter by using the Steiglitz–McBride iteration method in order to get the same results with output signals coming out of an galvanometer of analog type of existing Pulse diagnosis system with input signals entering into galvanometer and coming out of the amp group of the Pulse diagnosis system.

An Intelligent Tele-Healthcare Environment Offering Person-Centric and Wellness-Maintenance Services

Abstract: Worldwide healthcare delivery trends are undergoing a subtle paradigm shift—patient centerd services as opposed to provider centerd services and wellness maintenance as opposed to illness management. In this paper we present a Tele-Healthcare project TIDE—Tele–Healthcare Information and Diagnostic Environment. TIDE manifests an ‘intelligent’ healthcare environment that aims to ensure lifelong coverage of person-specific health maintenance decision-support services—i.e., both wellness maintenance and illness management services—ubiquitously available via the Internet/WWW. Taking on an all-encompassing health maintenance role—spanning from wellness to illness issues—the functionality of TIDE involves the generation and delivery of (a) Personalized, Pro–active, Persistent, Perpetual, and Present wellness maintenance services, and (b) remote diagnostic services for managing noncritical illnesses. Technically, TIDE is an amalgamation of diverse computer technologies—Artificial Intelligence, Internet, Multimedia, Databases, and Medical Informatics—to implement a sophisticated healthcare delivery infostructure.

Intranet Usage and Potential in Acute Care Hospitals in the United States: Survey-2000

Abstract: This paper provides the results of the Survey-2000 measuring Intranet and its potential in health care. The survey measured the levels of Internet and Intranet existence and usage in acute care hospitals. Business-to-business electronic commerce and electronic commerce for customers were measured. Since the Intranet was not studied in survey-1997, no comparisons could be made. Therefore the results were presented and discussed. The Intranet data were compared with the Internet data and statistically significant differences were presented and analyzed. This information will assist hospitals to plan Internet and Intranet technology. This is the third of three articles based upon the results of the Survey-2000. Readers are referred to prior articles by the author, which discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.(1) The first article based upon the survey results discusses technology transfer, system design approaches, user involvement, and decision-making purposes.(2) The second article based upon the survey results discusses distribution of Internet usage and rating of Internet usage applied to specific applications. Homepages, advertising, and electronic commerce are discussed from an Internet perspective.

Tutorial on Technology Transfer and Survey Design and Data Collection for Measuring Internet and Intranet Existence, Usage, and Impact (Survey-2000) in Acute Care Hospitals in the United States

Abstract: This paper provides a tutorial of technology transfer for management information systems in health care. Additionally it describes the process for a national survey of acute care hospitals using a random sample of 813 hospitals. The purpose of the survey was to measure the levels of Internet and Intranet existence and usage in acute care hospitals. The depth of the survey includes e-commerce for both business to business and with customers. The relationships with systems approaches, user involvement, user satisfaction and decision-making will be studied. Changes with results of a prior survey conducted in 1997 can be studied and enabling and inhabiting factors identified. This information will provide benchmarks for hospitals to plan their network technology position and to set goals.

The Study on the Web-Based Clinical Database Management System of Oriental Pulse Waveform

Abstract: There are many database-oriented sites on the web, which provide basic medical knowledge, hospital information, and medical counseling. However, there are only a few oriental pulse databases on the web. In this perspective, the goal of this study is to develop the Clinical Database Management System of Oriental Pulse Wave Form using the World Wide Web. Accordingly, this study has conducted researches in the Web-based diagnosis data management system of pulse waveform as well as the method of transmitting the data of pulse waveform. In order to set the standard for the documents of the pulse waveform of patients, the web-based clinical database management system has been developed.

Classification of Procedures in the Domain of Thoracic Surgery—A Study of Reliability in Coding

Abstract: This paper relates a study of reliability of coding of surgical procedures in the domain of thoracic surgery. The reliability measured is inter-coder variability in form of agreement. Four classifications were used by four physicians on 100 patient cases. The classifications, having differing granularity and structure, were analyzed using a statistical method (kappa). These results are discussed and related to the differences between the classifications. One of the topics for discussion is how the granularity affects the degree of agreement, coupled to the usefulness of the classification. Also the concept of using formal methods for representing classifications is discussed, how this will affect how classifications are designed and used.

Technology Transfer with System Analysis, Design, Decision Making, and Impact (Survey-2000) in Acute Care Hospitals in the United States

Abstract: This paper provides the results of the Survey-2000 measuring technology transfer for management information systems in health care. The relationships with systems approaches, user involvement, user satisfaction, and decision-making were measured and are presented. The survey also measured the levels Internet and Intranet presents in acute care hospitals, which will be discussed in future articles. The depth of the survey includes e-commerce for both business to business and customers. These results are compared, where appropriate, with results from survey 1997 and changes are discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the first of three articles based upon the results of the Srvey-2000. Readers are referred to a prior article by the author that discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.

Tools for Acquisition, Processing and Knowledge-Based Diagnostic of the Electroencephalogram and Visual Evoked Potentials

Abstract: The objective of our research is to develop computer-based tools to automate the clinical evaluation of the electroencephalogram (EEG) and visual evoked potentials (VEP). This paper describes a set of solutions to support all the aspects regarding the standard procedures of the diagnosis in neurophysiology, including: (1) acquisition and real-time processing and compression of EEG and VEP signals, (2) real-time brain mapping of spectral powers, (3) classifier design, (4) automatic detection of morphologies through supervised neural networks. (5) signal analysis through fuzzy modelling, and (6) a knowledge based approach to classifier design.

Internet and Technology Transfer in Acute Care Hospitals in the United States: Survey-2000

Abstract: This paper provides the results of the survey-2000 measuring technology transfer and, specifically, Internet usage. The purpose of the survey was to measure the levels of Internet and Intranet existence and usage in acute care hospitals. The depth of the survey includes e-commerce for both business-to-business and customers. These results are compared with responses to the same questions in survey-1997. Changes in response are noted and discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the third of three articles based upon the results of the survey-2000. Readers are referred to prior articles by the author, which discuss the survey design and provide a tutorial on technology transfer in acute care hospitals.(1) The first article based upon the survey results discusses technology transfer, system design approaches, user involvement, and decision-making purposes.(2)

Design of an SHD-Distributed Database over IP to Support Telemedicine

Abstract: We have conducted tests utilizing super high-definition CRTs (hereafter, referred to as a “super high-definition image system,” or “SHD”: 2048 × 2048 pixels, 24-bit RGB gradation, noninterlace system) for autonomous and distributed medical image database systems. The system is capable of providing six times the image definition of a hi-vision television (HDTV). The aim in designing and testing the system is to enable gigabit network connectivity while displaying images on a DOS-V machine. This paper discusses how we devised an integrated environment for managing and operating distributed an SHD image database to support Telemedicine linking with ATM, with INS-1500, and with dial-up IP connection.

Neural Network in Communication with Medical Computer System

Abstract: The paper presents a concept of an experimental module designed to recognize spoken utterances that cover a limited range of words indispensable in dialogs with computer medical systems. Research into the recognition of spoken words by a module based on artificial neural network is described. Usefulness of the obtained results for surgery-assisting multimedia systems and for a patient simulator supporting medical education of students in case history-taking and diagnosing is also discussed.

Software Development for Medical Instrumentation

Abstract: Computer-assisted medical instrumentation has recently become more common. For accuracy and precision, the computer and interfacing circuit with the associated digital signal processing algorithm can be used for the evaluation of biological signal. The measurement system based on this structure has a very high degree of efficieny and flexibility because different algorithms can be used. In addition, the system can employ some newly developed software packages. This paper will submit a procedure for computer-assisted medical instrumentation, and also will show a specific application on blood flow.