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A network-based training environment: a medical image processing paradigm. 基于网络的训练环境:医学图像处理范例。
Pub Date : 1998-10-01 DOI: 10.3109/14639239809025365
L Costaridou, G Panayiotakis, P Sakellaropoulos, D Cavouras, J Dimopoulos

The capability of interactive multimedia and Internet technologies is investigated with respect to the implementation of a distance learning environment. The system is built according to a client-server architecture, based on the Internet infrastructure, composed of server nodes conceptually modelled as WWW sites. Sites are implemented by customization of available components. The environment integrates network-delivered interactive multimedia courses, network-based tutoring, SIG support, information databases of professional interest, as well as course and tutoring management. This capability has been demonstrated by means of an implemented system, validated with digital image processing content, specifically image enhancement. Image enhancement methods are theoretically described and applied to mammograms. Emphasis is given to the interactive presentation of the effects of algorithm parameters on images. The system end-user access depends on available bandwidth, so high-speed access can be achieved via LAN or local ISDN connections. Network based training offers new means of improved access and sharing of learning resources and expertise, as promising supplements in training.

交互式多媒体和互联网技术的能力在远程学习环境的实施方面进行了调查。该系统是根据基于Internet基础设施的客户机-服务器架构构建的,该架构由概念上建模为WWW站点的服务器节点组成。站点是通过定制可用组件来实现的。该环境集网络交互式多媒体课程、网络辅导、SIG支持、专业兴趣信息库、课程和辅导管理于一体。这种能力已经通过一个实现的系统来证明,并通过数字图像处理内容,特别是图像增强进行了验证。从理论上描述了图像增强方法并将其应用于乳房x光检查。重点介绍了算法参数对图像影响的交互表示。系统最终用户的访问取决于可用带宽,因此可以通过局域网或本地ISDN连接实现高速访问。以网络为基础的培训提供了改进学习资源和专门知识的获取和分享的新手段,作为培训的有希望的补充。
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引用次数: 7
Enhancing security and improving interoperability in healthcare information systems. 加强医疗保健信息系统的安全性和互操作性。
Pub Date : 1998-10-01 DOI: 10.3109/14639239809025367
D A Gritzalis

Security is a key issue in healthcare information systems, since most aspects of security become of considerable or even critical importance when handling healthcare information. In addition, the intense need for information exchange has revealed interoperability of systems and applications as another key issue. Standardization can play an important role towards both these issues. In this paper, relevant standardization activities are briefly presented, and existing and emerging healthcare information security standards are identified and critically analysed. The analysis is based on a framework which has been developed for this reason. Therefore, the identification of gaps and inconsistencies in current standardization, the description of the conflicts of standards with legislation, and the analysis of implications of these standards to user organizations, are the main results of this paper.

安全性是医疗保健信息系统中的一个关键问题,因为在处理医疗保健信息时,安全性的大多数方面变得相当重要甚至至关重要。此外,对信息交换的强烈需求揭示了系统和应用程序的互操作性是另一个关键问题。标准化可以在这两个问题上发挥重要作用。在本文中,简要介绍了相关的标准化活动,并对现有的和新兴的医疗保健信息安全标准进行了识别和批判性分析。该分析基于为此开发的一个框架。因此,识别当前标准化中的差距和不一致之处,描述标准与立法的冲突,以及分析这些标准对用户组织的影响,是本文的主要成果。
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引用次数: 25
Hippocrates: an integrated platform for telemedicine applications. 希波克拉底:远程医疗应用的集成平台。
Pub Date : 1998-10-01 DOI: 10.3109/14639239809025364
L Makris, E V Kopsacheilis, M G Strintzis

This paper describes 'Hippocrates', an integrated platform for telemedicine applications. Hippocrates allows computer supported co-operative work based on patient data folders consisting of selected diagnostic images, annotation text, patient history and other information. All data transferred is encrypted to ensure confidentiality and integrity. It operates on a local level over TCP/IP LAN environment and on a remote level over public ISDN lines.

本文描述了“希波克拉底”,一个远程医疗应用的集成平台。希波克拉底允许计算机支持的基于患者数据文件夹的协作工作,这些文件夹由选定的诊断图像、注释文本、患者历史和其他信息组成。所有传输的数据都经过加密,以确保机密性和完整性。它在TCP/IP局域网环境的本地级别上运行,在公共ISDN线路的远程级别上运行。
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引用次数: 4
Backpropagation and adaptive resonance theory in predicting suicidal risk. 反向传播和自适应共振理论预测自杀风险。
Pub Date : 1998-10-01 DOI: 10.3109/14639239809025368
I Modai, S Greenstain, A Weizman, S Mendel

The ability of backpropagation and adaptive resonance theory (ART) neural networks to predict the probability of complete suicide, within a two year span, in major psychiatric patients was investigated. Variables associated with suicide risk were collected from the files of 161 hospitalized psychiatric patients with a 10 year or greater history of illness. 84 patients were hospitalized due to suicide attempts and 77 had no previous suicide attempts or ideations. Suicide attempts were rated as medically serious suicide attempts (MSSA) or non-MSSA and used for training the systems. The ability of the neural networks was evaluated by screening the extremes of the suicidal spectrum (1) 54 records of patients who committed suicide and (2) 150 records of patients who never had suicidal thoughts. The records were taken from 3 hospitals, in various geographic regions in Israel. Neither neural network system is reliable in predicting suicide, however, records from one hospital, Gehah Hospital, were better identified than those from the two other hospitals (p < 0.05 for PPV; p < 0.01 for specificity). At present, neural networks are not reliable instruments for evaluating suicidal risk due to the significant number of false positive results. When low risk was indicated reliability was greater (NPV = 75.28%, specificity = 97.10% with ART; NPV = 91.76%, specificity = 95.12% with backpropagation). However, PPV, NPV and specificity rates of both systems achieved with Gehah Hospital records suggest that using a direct-subjective questionnaire may produce better results in the future. ART and backpropagation performed similarly in all measurements.

研究了反向传播和自适应共振理论(ART)神经网络预测重大精神病患者两年内完全自杀概率的能力。与自杀风险相关的变量从161名有10年或以上病史的住院精神病患者的档案中收集。84名患者因自杀未遂而住院,77名患者以前没有自杀企图或念头。自杀企图被评为医学上严重的自杀企图(MSSA)或非MSSA,并用于训练系统。神经网络的能力是通过筛选自杀谱系的极端来评估的(1)54名自杀患者的记录和(2)150名从未有过自杀想法的患者的记录。这些记录取自以色列不同地理区域的三家医院。两种神经网络系统在预测自杀方面都不可靠,然而,Gehah医院的记录比其他两家医院的记录更好地识别(p < 0.05;特异性P < 0.01)。目前,由于大量的假阳性结果,神经网络并不是评估自杀风险的可靠工具。低风险提示时,ART的可靠性更高(NPV = 75.28%,特异性= 97.10%;NPV = 91.76%,特异性为95.12%)。然而,根据Gehah医院的记录,两种系统的PPV、NPV和特异性表明,使用直接主观问卷可能会在未来产生更好的结果。ART和反向传播在所有测量中表现相似。
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引用次数: 8
A multi-agent architecture for teaching dermatology. 皮肤病学教学的多主体体系结构。
Pub Date : 1998-10-01 DOI: 10.3109/14639239809025366
I D Zaharakis, A D Kameas, G C Nikiforidis

This work proposes the integration of computer-aided instruction systems in the curricula of medical education, and describes an intelligent tutoring system used for teaching Dermatology. The Dermatology Tutor uses a self-organized society of autonomous software agents which have different capabilities or roles. The society contains tutor, medical and information agents which participate in the tutoring process and collaborate through deliberation in order to achieve a tutoring task. The agents are built according to a BDI architecture, which implements the mental attitudes of beliefs (B), desires (D) and intentions (I). Each medical agent is a specialist in a medical field, while a tutoring agent, which implements a widely accepted dermatology teaching process, coordinates the overall operation of the system. Depending on the subject that is to be taught during any session, the tutoring agent forms teams of medical agents, which in turn use search agents to retrieve information. Although the presented multi-agent architecture is dedicated to teaching dermatology (since the tutor agent is specialized in Dermatology), it can be extended to other domains also with the incorporation of other tutor agents.

本文提出了医学教育课程中计算机辅助教学系统的集成,并描述了一种用于皮肤病学教学的智能教学系统。皮肤科导师使用一个自组织的自主软件代理社会,这些代理具有不同的功能或角色。社会中有辅导员、医疗代理人和信息代理人,他们参与到辅导过程中,并通过协商协作来完成一项辅导任务。agent按照BDI架构构建,实现了信念(B)、欲望(D)和意图(I)的心理态度。每个医疗agent都是某一医疗领域的专家,而辅导agent则实现了被广泛接受的皮肤病学教学过程,协调了系统的整体运行。根据在任何会话期间要教授的主题,辅导代理形成医疗代理团队,这些团队反过来使用搜索代理来检索信息。虽然所提出的多智能体架构是专门用于皮肤病学教学的(因为导师智能体是专门研究皮肤病学的),但它也可以通过结合其他导师智能体扩展到其他领域。
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引用次数: 11
A WWW-based information system on resistance of bacteria to antibiotics. 基于www的细菌抗生素耐药性信息系统。
Pub Date : 1998-07-01 DOI: 10.3109/14639239809001396
J Schindler, Z Schindler, J Schindler

The information system on resistance of bacteria to antibiotics (WARN--World Antibiotic Resistance Network) is implemented as a WWW server at Charles University in Prague (http:/(/)www.warn.cas.cz). Its main goal is to give information about problems of antibiotic resistance of bacteria and to process data on isolated strains. The WARN web-site contains six main topics. Four of them form the core of the system: Topics of Interest bring information on selected timely topics in antibiotic resistance--pneumococci, staphylococci, beta-lactamases, glycopeptide--and aminoglycoside resistance. Global Monitor brings references and reports on resistance in the world as well as recommended method of surveillance. The topic Data contains raw data on strains in particular countries and hospitals. Data can be viewed in their original form as a list of records (strains) or processed to provide statistics about the resistance rates in the selected country or hospital respectively. The topic Search allows one to search for one or several terms in the whole document. Counts of accessed pages show, that there is a standing demand for information about the serious problems of antibiotic therapy of infectious diseases.

细菌对抗生素的耐药性信息系统(WARN——世界抗生素耐药性网络)在布拉格查尔斯大学作为WWW服务器实施(http:/(/)www.warn.cas.cz)。其主要目标是提供有关细菌抗生素耐药性问题的信息,并处理分离菌株的数据。WARN网站包含六个主要主题。其中四个构成了系统的核心:感兴趣的主题提供了有关抗生素耐药性(肺炎球菌、葡萄球菌、β -内酰胺酶、糖肽)和氨基糖苷耐药性的精选及时主题的信息。《全球监测》提供关于世界各地耐药性的参考资料和报告,以及建议的监测方法。数据专题载有关于特定国家和医院的菌株的原始数据。数据可以作为记录(菌株)清单的原始形式查看,也可以进行处理,分别提供有关选定国家或医院的耐药率的统计数据。主题搜索允许在整个文档中搜索一个或多个术语。被访问的页数显示,人们对传染病的抗生素治疗的严重问题的信息有长期的需求。
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引用次数: 1
A browser based image bank, useful tool or expensive toy? 一个基于浏览器的图片库,有用的工具还是昂贵的玩具?
Pub Date : 1998-07-01 DOI: 10.3109/14639239809001399
P J Liepins, K M Curran, C R Renshaw, M N Maisey

DIBS, the Digital Image Banking System, is a web browser based environment for depositing and withdrawing generic medical images. These can be annotated or modified on an individual's computer for use in talks and lectures. DIBS is programmed in 'C', to query and update a database as well as producing web pages on the 'fly'. Images are deposited using an interactive form, minimizing data entry and are received in a digital format or are digitized on demand. Three interfaces allow DIBS to be searched; an image map of the human body presents a simple graphical interface, whilst more specific searches can be performed by selecting categories from predefined scrolling menus or using a full text search. When a DIBS search is performed, preview thumbnail images and descriptions are provided, linked to the full size images that can be saved locally along with the text description. DIBS offers fast and convenient access to a wide range of medical images, eliminating the time consuming process of producing one's own slides or borrowing from colleagues. It is proving to be a useful tool within our Medical School but some copyright, ethical and image security issues still need to be resolved.

DIBS,即数字图像银行系统,是一个基于web浏览器的环境,用于存储和提取通用医学图像。这些内容可以在个人电脑上进行注释或修改,以便在演讲和讲座中使用。DIBS是用C语言编程的,用于查询和更新数据库以及在“飞行”中生成网页。使用交互式形式存储图像,最大限度地减少数据输入,并以数字格式接收或按需数字化。有三个接口允许搜索DIBS;人体图像地图提供了一个简单的图形界面,而更具体的搜索可以通过从预定义的滚动菜单中选择类别或使用全文搜索来执行。当执行DIBS搜索时,将提供预览缩略图图像和描述,并链接到可与文本描述一起保存在本地的完整尺寸图像。DIBS提供了对各种医学图像的快速和方便的访问,消除了自己制作幻灯片或从同事那里借用的耗时过程。它被证明是我们医学院的一个有用的工具,但一些版权、道德和形象安全问题仍然需要解决。
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引用次数: 8
A web-based data collection system for clinical studies using Java. 基于web的临床研究数据收集系统。
Pub Date : 1998-07-01 DOI: 10.3109/14639239809001402
H Sippel, C Ohmann

Data collection in multi-centre controlled clinical trials is a major problem. We describe a web-based documentation system for data collection via the Internet we have developed in Java. It keeps both the platform independent program (a Java applet) and the database on a single server to which the participating centres have access at any time. It is based on a three-tier model where client requests are handled and monitored by an application server (a Java application). We show the advantages such a system has over the HTML/CGI combination which is often used for database access, as well as possible extensions, e.g. connection to a data dictionary. Finally, we discuss the security problems which arise by the use of the Internet for data collection.

多中心对照临床试验的数据收集是一个主要问题。我们描述了一个基于web的文档系统,用于通过Internet收集我们用Java开发的数据。它将独立于平台的程序(Java applet)和数据库保存在一个服务器上,参与的中心可以随时访问该服务器。它基于三层模型,其中客户机请求由应用程序服务器(Java应用程序)处理和监视。我们展示了这种系统相对于HTML/CGI组合的优势,后者通常用于数据库访问,以及可能的扩展,例如连接到数据字典。最后,我们讨论了使用互联网进行数据收集所产生的安全问题。
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引用次数: 23
Telepathology applications of the Internet multimedia electronic mail. 远程病理学在因特网多媒体电子邮件中的应用。
Pub Date : 1998-07-01 DOI: 10.3109/14639239809001404
V Della Mea, C A Beltrami

Telepathology is based on the sharing of medical images coming from the microscope, and comprises different applications: intra-operative telediagnosis, second opinion teleconsultation, reference case archives, remote data and image processing, quality assessment. Since the Internet is available worldwide, it can be of interest to define which of these tasks can be performed by means of some telepathology method based on it. This paper focuses particularly on the use of Internet multimedia electronic mail for exchanging multimedia cases. To test the validity of the proposed approach for transmission of multimedia cases, the first step is to evaluate its diagnostic accuracy. Trials involving the transmission of 299 cases have been carried out between two departments of Pathology in Italy (at the University of Udine and at the City Hospital of Trento, respectively) in order to evaluate the diagnostic accuracy as well as the time needed for acquisition and transmission. First results show that good diagnostic agreement can be reached, but the time needed for transmission, generally low, is not sufficiently affordable to be adopted in those cases where time is important. In particular, telepathology through multimedia e-mail can be adopted for second opinion consultation, remote image processing, quality assessment and continuing education possibly by means of software that integrates acquisition and delivery of cases with HIS functionalities.

远程病理学是基于共享来自显微镜的医学图像,并包括不同的应用:术中远程诊断,第二意见远程咨询,参考病例档案,远程数据和图像处理,质量评估。由于互联网在世界范围内都是可用的,因此定义这些任务中的哪些可以通过基于它的某种精神病理学方法来执行是很有趣的。本文着重介绍了利用因特网多媒体电子邮件交换多媒体案例。为了验证该方法在多媒体案例传输中的有效性,首先要评估其诊断准确性。在意大利的两个病理学部门(分别在乌迪内大学和特伦托市医院)之间进行了涉及299例病例传播的试验,以评估诊断的准确性以及获得和传播所需的时间。最初的结果表明,可以达成良好的诊断一致性,但传播所需的时间通常较低,在时间很重要的情况下不足以负担得起。特别是,通过多媒体电子邮件进行的心灵病理学可以用于第二意见咨询、远程图像处理、质量评估和继续教育,这可能是通过将病例的获取和传递与医疗信息系统功能结合起来的软件来实现的。
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引用次数: 40
Lessons learned from an Internet GP information system. 互联网全科医生信息系统的经验教训。
Pub Date : 1998-07-01 DOI: 10.3109/14639239809001405
J S Briggs, M P Bradley

We describe the prototype of an application that in actual use would allow GPs to find out more information about consultants at hospitals. This would aid the GP in making the decision about which consultant a patient should be referred to. The requirements of the application from the GP's perspective are described, together with some of the issues that have to be resolved before hospitals can provide the necessary information in a standard format. The application is implemented as a client--server system using standard Internet technologies such as Java and HTML. This architecture has a number of advantages but also revealed some issues concerning security and the format of data, among other things. The project showed that there is a desire for such a system and that that desire can be fulfilled at a relatively low cost.

我们描述了一个应用程序的原型,在实际使用中,它将允许全科医生在医院找到有关会诊医生的更多信息。这将有助于全科医生决定病人应该转介给哪个咨询师。从全科医生的角度描述了应用程序的要求,以及在医院能够以标准格式提供必要信息之前必须解决的一些问题。该应用程序使用标准的Internet技术(如Java和HTML)作为客户机-服务器系统实现。这种体系结构有许多优点,但也暴露了一些有关安全性和数据格式等方面的问题。该项目表明,有这样一个系统的愿望,这种愿望可以在一个相对较低的成本实现。
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引用次数: 2
期刊
Medical informatics = Medecine et informatique
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