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Using XML and XSLT for flexible elicitation of mental-health risk knowledge. 使用XML和XSLT灵活地获取心理健康风险知识。
Pub Date : 2007-03-01 DOI: 10.1080/14639230601097895
C D Buckingham, A Ahmed, A E Adams

Current tools for assessing risks associated with mental-health problems require assessors to make high-level judgements based on clinical experience. This paper describes how new technologies can enhance qualitative research methods to identify lower-level cues underlying these judgements, which can be collected by people without a specialist mental-health background. Content analysis of interviews with 46 multidisciplinary mental-health experts exposed the cues and their interrelationships, which were represented by a mind map using software that stores maps as XML. All 46 mind maps were integrated into a single XML knowledge structure and analysed by a Lisp program to generate quantitative information about the numbers of experts associated with each part of it. The knowledge was refined by the experts, using software developed in Flash to record their collective views within the XML itself. These views specified how the XML should be transformed by XSLT, a technology for rendering XML, which resulted in a validated hierarchical knowledge structure associating patient cues with risks. Changing knowledge elicitation requirements were accommodated by flexible transformations of XML data using XSLT, which also facilitated generation of multiple data-gathering tools suiting different assessment circumstances and levels of mental-health knowledge.

目前评估与心理健康问题相关的风险的工具要求评估人员根据临床经验做出高水平的判断。本文描述了新技术如何增强定性研究方法,以识别这些判断背后的低级线索,这些线索可以由没有专业心理健康背景的人收集。对46位多学科心理健康专家的访谈内容分析揭示了这些线索和它们之间的相互关系,这些线索通过使用将地图存储为XML的软件的思维导图来表示。所有46个思维导图都集成到一个XML知识结构中,并由一个Lisp程序进行分析,以生成与每个部分相关的专家数量的定量信息。专家们使用Flash开发的软件将他们的集体观点记录在XML本身中,对这些知识进行了提炼。这些视图指定了应该如何通过XSLT(一种呈现XML的技术)转换XML,从而产生将患者线索与风险关联起来的经过验证的分层知识结构。使用XSLT对XML数据进行灵活转换,以适应不断变化的知识获取需求,这也有助于生成适合不同评估环境和心理健康知识水平的多种数据收集工具。
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引用次数: 21
Progress towards automated detection and characterization of the optic disc in glaucoma and diabetic retinopathy. 青光眼和糖尿病视网膜病变视盘自动检测和表征的研究进展。
Pub Date : 2007-03-01 DOI: 10.1080/14639230601095865
R A Abdel-Ghafar, T Morris

The shape and appearance of the optic nerve head region are sensitive to changes associated with glaucoma and diabetes that may be otherwise asymptomatic. The changes can be diagnostic of the diseases, and tracking of the changes in sequential images can be used to assess treatment and the progress of the illness. At present, change detection and tracking are performed manually, which can be a cause of poor repeatability. We are concerned with developing automated techniques of generating quantitative descriptions of the retinal images that might be used in diagnosis and assessment. In this paper, we investigate the use of images that have been collected and stored remotely, as this will replicate capture and automated processing by outreach clinics. Normal and abnormal images were collected from a range of sources, to simulate the mass screening process. The images were processed using simple signal-processing methods and divided into two groups. Using a chi-squared test, the separation of normal and abnormal images using this test was found to be highly significant (p < 0.05, n = 60).

视神经头区域的形状和外观对与青光眼和糖尿病相关的变化很敏感,否则这些变化可能是无症状的。这些变化可用于诊断疾病,跟踪序列图像的变化可用于评估治疗和疾病的进展。目前,变更检测和跟踪是手动执行的,这可能是可重复性差的一个原因。我们关注的是开发自动化技术,生成可能用于诊断和评估的视网膜图像的定量描述。在本文中,我们调查了远程收集和存储的图像的使用,因为这将复制外展诊所的捕获和自动化处理。从一系列来源收集正常和异常图像,以模拟大规模筛选过程。采用简单的信号处理方法对图像进行处理,并分为两组。使用卡方检验,使用该检验发现正常和异常图像的分离非常显著(p < 0.05, n = 60)。
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引用次数: 64
Use of OWL-based tools to aid message development and maintenance. 使用基于owl的工具来帮助消息开发和维护。
Pub Date : 2007-03-01 DOI: 10.1080/14639230601097846
Tom Marley, Alan Rector

The National Health Service National Programme for Information Technology is currently developing messaging standards to make available key information about an individual patient's care across and within different health-care settings. The complexity of this task makes it imperative that adequate tooling support is made available so as to aid consistency of design, implementation, conformance testing, and maintenance. Connecting for Health commissioned a proof of concept study to investigate whether the Object Web Language (OWL) and its associated tools could provide a basis for the message development and implementation environments. This study indicated that OWL is very much suited to such a task and should be seriously considered.

国家保健服务国家信息技术方案目前正在制定信息标准,以便在不同保健机构之间和内部提供关于单个病人护理的关键信息。这项任务的复杂性使得必须提供足够的工具支持,以帮助设计、实现、一致性测试和维护的一致性。“健康连接”委托进行了一项概念验证研究,以调查对象Web语言(OWL)及其相关工具是否可以为消息开发和实现环境提供基础。本研究表明OWL非常适合这样的任务,值得认真考虑。
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引用次数: 0
Using artificial intelligence to bring evidence-based medicine a step closer to making the individual difference. 利用人工智能使循证医学更接近于创造个体差异。
Pub Date : 2007-03-01 DOI: 10.1080/14639230601097804
B Sissons, W A Gray, A Bater, D Morrey

The vision of evidence-based medicine is that of experienced clinicians systematically using the best research evidence to meet the individual patient's needs. This vision remains distant from clinical reality, as no complete methodology exists to apply objective, population-based research evidence to the needs of an individual real-world patient. We describe an approach, based on techniques from machine learning, to bridge this gap between evidence and individual patients in oncology. We examine existing proposals for tackling this gap and the relative benefits and challenges of our proposed, k-nearest-neighbour-based, approach.

循证医学的愿景是经验丰富的临床医生系统地使用最佳研究证据来满足个体患者的需求。这一愿景仍然与临床现实相距甚远,因为没有完整的方法将客观的、基于人群的研究证据应用于现实世界中个体患者的需求。我们描述了一种基于机器学习技术的方法,以弥合肿瘤证据与个体患者之间的差距。我们研究了解决这一差距的现有建议,以及我们提出的基于k-近邻的方法的相对利益和挑战。
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引用次数: 4
Integrating health information: a case study of a health information service for thalidomide survivors. 整合健康信息:沙利度胺幸存者健康信息服务案例研究。
Pub Date : 2007-03-01 DOI: 10.1080/14639230601097523
Martin Johnson

Thalidomide damage comprises a range of rare and complex disorders rarely encountered in normal clinical practice. Specific problems associated with the condition include chronic pain and medical procedures including taking blood. The benefit of international networking and the findings of recent research are mentioned. This leads to the establishment of four key requirements for a specialist database, and four priority issues to be included in the planning of a health information service for this group, of which the creation of a database is first. The other three priority issues are the creation of a web-based delivery system, the need to consolidate the specialist information available, and the need to create a system for evaluating and approving the information to be delivered. System design and implementation are discussed and key tasks identified, showing how the four key components of the service will be developed. Difficulties encountered have included decisions about standards to be adopted and identifying commercial organizations capable of completing different aspects of the work. This study illustrates the relevance and possibility of specialist reference centres for other rare disease groups.

沙利度胺损害包括一系列在正常临床实践中很少遇到的罕见和复杂的疾病。与这种疾病相关的具体问题包括慢性疼痛和包括采血在内的医疗程序。文中提到了国际联网的好处和最近的研究结果。这导致建立一个专家数据库的四项关键要求,以及在为这一群体规划卫生信息服务时应包括的四个优先问题,其中首先是建立一个数据库。其他三个优先事项是建立一个基于网络的交付系统,需要整合现有的专家信息,需要建立一个评估和批准将要交付的信息的系统。讨论了系统设计和实现,并确定了关键任务,展示了如何开发服务的四个关键组件。遇到的困难包括决定应采用的标准和确定有能力完成工作不同方面的商业组织。这项研究说明了其他罕见疾病群体的专家参考中心的相关性和可能性。
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引用次数: 3
Electronic health records: is the evidence base any use? 电子健康记录:证据基础有用吗?
Pub Date : 2007-03-01 DOI: 10.1080/14639230601097903
S Clamp, J Keen

Information-technology policies in many countries are full of aspirational statements and not generally based on the available evidence. This paper aims to contribute to a proper discussion of the evidence on electronic health records (EHR). The paper describes the methods we used in a review of the impact of EHR on clinical work and administration, summarizes our findings, and discusses their relevance in the context of policy makers' information requirements. We argue that the literature has, to date, largely failed to deliver usable findings.

许多国家的信息技术政策充满了雄心勃勃的声明,而通常不是基于现有的证据。本文旨在促进对电子健康记录(EHR)证据的适当讨论。本文描述了我们在回顾EHR对临床工作和管理的影响时使用的方法,总结了我们的发现,并讨论了它们在政策制定者信息需求背景下的相关性。我们认为,迄今为止,这些文献在很大程度上未能提供可用的发现。
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引用次数: 38
Addressing the need for adaptable decision processes within healthcare software. 解决医疗保健软件中对适应性决策过程的需求。
Pub Date : 2007-03-01 DOI: 10.1080/14639230601097580
P Miseldine, A Taleb-Bendiab, D England, M Randles

In the healthcare sector, where the decisions made by software aid in the direct treatment of patients, software requires high levels of assurance to ensure the correct interpretation of the tasks it is automating. This paper argues that introducing adaptable decision processes within eHealthcare initiatives can reduce software-maintenance complexity and, due to the instantaneous, distributed deployment of decision models, allow for quicker updates of current best practice, thereby improving patient care. The paper provides a description of a collection of technologies and tools that can be used to provide the required adaptation in a decision process. These tools are evaluated against two case studies that individually highlight different requirements in eHealthcare: a breast-cancer decision-support system, in partnership with several of the UK's leading cancer hospitals, and a dental triage in partnership with the Royal Liverpool Hospital which both show how the complete process flow of software can be abstracted and adapted, and the benefits that arise as a result.

在医疗保健领域,软件做出的决定有助于直接治疗患者,因此软件需要高水平的保证,以确保对其自动化任务的正确解释。本文认为,在电子医疗保健计划中引入适应性决策过程可以降低软件维护的复杂性,并且由于决策模型的即时、分布式部署,可以更快地更新当前的最佳实践,从而改善患者护理。本文提供了一组技术和工具的描述,这些技术和工具可用于在决策过程中提供所需的适应。这些工具是根据两个案例研究进行评估的,它们分别突出了电子医疗保健的不同需求:与英国几家领先的癌症医院合作的乳腺癌决策支持系统,以及与皇家利物浦医院合作的牙科分诊,这两个案例都展示了如何对软件的完整流程进行抽象和调整,以及由此产生的好处。
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引用次数: 5
Using Unified Modelling Language (UML) as a process-modelling technique for clinical-research process improvement. 使用统一建模语言(UML)作为临床研究过程改进的过程建模技术。
Pub Date : 2007-03-01 DOI: 10.1080/14639230601097705
P Kumarapeli, S De Lusignan, T Ellis, B Jones

The Primary Care Data Quality programme (PCDQ) is a quality-improvement programme which processes routinely collected general practice computer data. Patient data collected from a wide range of different brands of clinical computer systems are aggregated, processed, and fed back to practices in an educational context to improve the quality of care. Process modelling is a well-established approach used to gain understanding and systematic appraisal, and identify areas of improvement of a business process. Unified modelling language (UML) is a general purpose modelling technique used for this purpose. We used UML to appraise the PCDQ process to see if the efficiency and predictability of the process could be improved. Activity analysis and thinking-aloud sessions were used to collect data to generate UML diagrams. The UML model highlighted the sequential nature of the current process as a barrier for efficiency gains. It also identified the uneven distribution of process controls, lack of symmetric communication channels, critical dependencies among processing stages, and failure to implement all the lessons learned in the piloting phase. It also suggested that improved structured reporting at each stage - especially from the pilot phase, parallel processing of data and correctly positioned process controls - should improve the efficiency and predictability of research projects. Process modelling provided a rational basis for the critical appraisal of a clinical data processing system; its potential maybe underutilized within health care.

初级保健数据质量计划(PCDQ)是一个质量改进计划,它处理常规收集的全科医生计算机数据。从各种不同品牌的临床计算机系统收集的患者数据被汇总、处理并反馈到教育背景下的实践中,以提高护理质量。流程建模是一种完善的方法,用于获得理解和系统评估,并确定业务流程的改进领域。统一建模语言(UML)是用于此目的的通用建模技术。我们使用UML来评估PCDQ过程,以查看该过程的效率和可预测性是否可以得到改进。活动分析和大声思考会话用于收集数据以生成UML图。UML模型强调了当前过程的顺序性,这是提高效率的障碍。它还确定了过程控制的不均匀分布、缺乏对称的通信通道、处理阶段之间的关键依赖关系,以及未能实现在试验阶段学到的所有经验教训。它还建议,改进每一阶段的结构化报告——特别是从试点阶段开始、并行处理数据和正确定位过程控制——应该提高研究项目的效率和可预测性。过程建模为临床数据处理系统的关键评价提供了合理的基础;它的潜力在卫生保健领域可能没有得到充分利用。
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引用次数: 28
Special issue: Current perspectives in Health Informatics 特刊:健康信息学的当前观点
Pub Date : 2007-01-01 DOI: 10.1080/14639230701195532
It is very appropriate that John Bryant, marking the end of his term as Editor of this Journal, provides the introduction to this special issue. Not least because in doing so, it provides me with an opportunity, on behalf of Taylor & Francis and Informa, to publicly thank him most sincerely for his work on the Journal. John has been the editor in chief for over eight years, and as I just begin the task of succeeding him, I am acutely aware of the hard work and effort he has consistently put in to make the Journal successful. Personally, I am extremely grateful to him for his help in this interim, transitional period. John provides a thoughtful, reflective editorial. He reviews selected outputs of a longstanding conference and considers them in the context of wider changes that have taken place in the field of Health Informatics. One important change in the perspective given by him is the move from what was initially considered to be health computing to the more pervasive perspective of Health Informatics that includes the nature of the information itself, its use and usefulness in care contexts as well as the diversity of systems that are designed to process it. In truth, a selection of papers, from a single conference, and a national one at that, can only provide an incomplete snapshot of the whole field, but John has used them to reflect upon what was current in 1984, as opposed to what is current now. In doing so, John acknowledges the successes that have been achieved but recognizes, too, the lack of progress made. Explicitly, John issues the challenge to us all active within Health Informatics to improve upon what we have, and not to be satisfied with the current state. John concludes his editorial on an optimistic note and ends by looking forward to the future in anticipation. I concur, and in so doing, I hope, with your help as both readers and contributors, to accept his challenge by improving this Journal. The goal will be to use the Journal to showcase the very best in research and practice so as to promote evidence-based informatics and thereby show its relevance and importance for improving health and social care, wherever and however it is delivered.
这是非常合适的,约翰·布莱恩特,标志着他的任期结束,作为本刊的编辑,提供介绍这一期特刊。尤其是因为这样做,使我有机会代表Taylor & Francis和Informa公开最诚挚地感谢他为《华尔街日报》所做的工作。约翰担任总编辑已经八年多了,当我刚刚开始接替他的任务时,我敏锐地意识到他一直以来为《华尔街日报》的成功所付出的辛勤工作和努力。就我个人而言,我非常感谢他在这个过渡时期提供的帮助。约翰写了一篇深思熟虑的社论。他审查了一次长期会议的选定产出,并在卫生信息学领域发生的更广泛变化的背景下加以考虑。他给出的观点的一个重要变化是,从最初被认为是健康计算的观点转向了更普遍的健康信息学观点,其中包括信息本身的性质、信息在护理环境中的使用和有用性,以及设计用于处理信息的系统的多样性。事实上,从单个会议和国家级会议中挑选的论文只能提供整个领域的一个不完整的快照,但约翰用它们来反映1984年的现状,而不是现在的现状。在这样做时,约翰承认已经取得的成功,但也承认没有取得进展。约翰明确地向我们所有活跃在健康信息领域的人提出了挑战,要求我们改进现有的工作,而不是满足于当前的状态。约翰以乐观的语气结束了他的社论,并以对未来的期待结束了他的社论。我同意,我希望在读者和撰稿人的帮助下,接受他的挑战,改进《华尔街日报》。目标将是利用《期刊》展示研究和实践方面的最佳成果,以促进循证信息学,从而显示其对改善保健和社会保健的相关性和重要性,无论在何处以何种方式提供。
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引用次数: 1
Interactive analysis of Belgian vital statistics on the Internet. 互联网上比利时生命统计数据的互动分析。
Pub Date : 2006-12-01 DOI: 10.1080/14639230500512499
Sabine Drieskens, Herman van Oyen, Jean Tafforeau, Marie-France Lafontaine

The purpose of the Centre for Operational Research in Public Health (CORPH) is to optimize the accessibility to health information, thus making it possible to measure and follow up the health status of the Belgian population. The Standardized Procedures for Mortality Analysis (SPMA) software was developed in order to facilitate the use of vital statistics for health policy-makers and scientific researchers. Nowadays, SPMA is available on the Internet, because accessibility to health information is crucial. SPMA serves via a system of menus as the interface between databases (population, birth, and mortality) on one hand and statistical procedures on the other hand. Users can choose the parameters such as year, cause of death, geographical level, and statistical indicator, and so dynamic reports are produced 'on demand'. These procedures are available for the following modules: overall mortality, specific cause mortality, and perinatal statistics. Analysis can be carried out for one specific year or for a period over time. Pre-defined procedures accessible through menus make SPMA user-friendly, as it can be used without any preliminary knowledge of the statistical package. Tables, charts, or maps display the results. Users need only an Internet browser to access the application.

公共卫生业务研究中心(CORPH)的目的是优化获得卫生信息的途径,从而能够衡量和跟踪比利时人口的健康状况。开发死亡率分析标准化程序软件是为了便利卫生政策制定者和科学研究人员使用生命统计数据。如今,SPMA可在互联网上获得,因为获取卫生信息至关重要。SPMA通过菜单系统作为数据库(人口、出生和死亡率)与统计程序之间的接口。用户可以选择诸如年份、死亡原因、地理级别和统计指标等参数,因此可以“按需”生成动态报告。这些程序可用于以下模块:总死亡率、特定原因死亡率和围产期统计。分析可以针对某一年或一段时间进行。通过菜单访问的预定义过程使SPMA用户友好,因为它可以在不了解统计包的任何初步知识的情况下使用。表格、图表或地图显示结果。用户只需要一个Internet浏览器就可以访问该应用程序。
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引用次数: 1
期刊
Medical informatics and the Internet in medicine
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