[KidsETransplant--a serious game for children with liver disease or liver transplant]. / KidsETransplant--un serious game pour les enfants greffés ou malades du foie.

In Switzerland all children's liver transplants are centralized at the University Hospitals of Geneva (HUG) since 1989. Approximately 150 children have received transplants since then, and their survival rate is higher than 90%--one of the highest in Europe. Maximizing the chances of long-term success requires that patients comply with follow-up treatment, something which mandates a sound understanding of their medical condition. The KidsETransplant project aims to help the child--and his family--to understand better his state of health. To this end, our tool offers secured, unrestricted access to the patient's medical record, with a view to both increase patient autonomy and improve communication with healthcare professionals. This paper describes KidsETransplant, as well as its implemented evaluation process.

[Telemedicine in your suitcase: useful tools for the traveler]. / De la télémédecine dans vos valises: des outils utiles pour le voyageur.

In our digital age, telemedicine becomes, under various forms, a useful companion for the traveler, providing access to up-to-date information about health and security risks, remote consultation of specialists to ascertain a diagnosis of select an appropriate treatment, connection to similar patients in order to obtain contextualized advice, biomedical sensors and other monitoring and diagnostic portable tools, as well as transportable electronic health records enabling continuity of care and mobility. Commercial telemedicine services are being developed specifically for travelers, most of which are using mobile phones as the main device, which thus becomes a real telestethoscope.

Nanoinformatics: developing new computing applications for nanomedicine.

Nanoinformatics has recently emerged to address the need of computing applications at the nano level. In this regard, the authors have participated in various initiatives to identify its concepts, foundations and challenges. While nanomaterials open up the possibility for developing new devices in many industrial and scientific areas, they also offer breakthrough perspectives for the prevention, diagnosis and treatment of diseases. In this paper, we analyze the different aspects of nanoinformatics and suggest five research topics to help catalyze new research and development in the area, particularly focused on nanomedicine. We also encompass the use of informatics to further the biological and clinical applications of basic research in nanoscience and nanotechnology, and the related concept of an extended "nanotype" to coalesce information related to nanoparticles. We suggest how nanoinformatics could accelerate developments in nanomedicine, similarly to what happened with the Human Genome and other -omics projects, on issues like exchanging modeling and simulation methods and tools, linking toxicity information to clinical and personal databases or developing new approaches for scientific ontologies, among many others.

Commentaries on "Informatics and medicine: from molecules to populations".

OBJECTIVE: To discuss interdisciplinary research and education in the context of informatics and medicine by commenting on the paper of Kuhn et al. "Informatics and Medicine: From Molecules to Populations". METHOD: Inviting an international group of experts in biomedical and health informatics and related disciplines to comment on this paper. RESULTS AND CONCLUSIONS: The commentaries include a wide range of reasoned arguments and original position statements which, while strongly endorsing the educational needs identified by Kuhn et al., also point out fundamental challenges that are very specific to the unusual combination of scientific, technological, personal and social problems characterizing biomedical informatics. They point to the ultimate objectives of managing difficult human health problems, which are unlikely to yield to technological solutions alone. The psychological, societal, and environmental components of health and disease are emphasized by several of the commentators, setting the stage for further debate and constructive suggestions.

State of the fight against informal market of medicines in Togo: approaches and limitations.

The extent of medicines sales and consumption in the informal market in Togo raises many ethical and public health issues. In order to report on the situation of public action in the fight against this practice, we conducted a qualitative survey from 15 to 25 February 2016 in the commune of Lomé and in the Maritime Region among the actors of control system and resource people in the general population. This was supplemented by an analysis of Togo's pharmaceutical and health policy documents and a literature review on the illicit drug market issues relating to public health, political science, the social sciences applied to health. In spite of the existence of national and international tools, household poverty, cultural self-medication, ignorance of the population concerning the health risks of informal market medicines, weak political commitment, weakness regulation and enforcement, corruption, constitute obstacles to the success of actions to combat this practice.

Towards health for all: WHO and IMIA intensify collaboration. Joint Communiqué during Medinfo 2007 in Brisbane.

OBJECTIVE: To intensify the collaboration between WHO, the World Health Organization, and IMIA, the International Medical Informatics Association. METHODS: Identifying key areas of collaboration and publishing a joint communiqué during Medinfo 2007 in Brisbane, Australia. RESULTS AND CONCLUSIONS: WHO and IMIA have identified three key areas of joint work for the next three years: the Global Observatory for eHealth, the use of ICT for the development of the health and health care workforce, and sharing eHealth products and services related to intellectual property for development.

Digital health and the need to develop centers of expertise in sub-Saharan Africa : two examples in Mali and Cameroon.

It is generally agreed today that digital technology provides a lever for improving access to health care, care processes, and public health planning and activities such as education and prevention. Its use in countries that have reached a given level of development has taken place in a somewhat fragmented manner that raises important interoperability problems and sometimes makes synergy impossible between the different projects of digital health. This may be linked to several factors, principally the lack of a global vision of digital health, and inadequate methodological knowledge that prevents the development and implementation of this vision. The countries of Africa should be able to profit from these errors from the beginnings of digital health, by moving toward systemic approaches, known standards, and tools appropriate to the realities on the ground. The aim of this work is to present the methodological approaches as well as the principal results of two relatively new centers of expertise in Mali and Cameroon intended to cultivate this vision of digital governance in the domain of health and to train professionals to implement the projects. Both centers were created due to initiatives of organizations of civil society. The center in Mali developed toward an economic interest group and then to collaboration with healthcare and university organizations. The same process is underway at the Cameroon center. The principal results from these centers can be enumerated under different aspects linked to research, development, training, and implementation of digital health tools. They have produced dozens of scientific publications, doctoral dissertations, theses, and papers focused especially on subjects such as the medicoeconomic evaluation tools of e-health and health information technology systems. In light of these results, we can conclude that these two centers of expertise have well and truly been established. Their role may be decisive in the local training of participants, the culture of good governance of digital health projects, the development of operational strategies, and the implementation of projects.

The delegation of tasks in the era of e-health to support community interventions in maternal and child health: lessons learned from the PACT-Denbaya project.

The PACT-Denbaya project (Program for community access to telemedicine for families) aimed to help improve the health of mothers and child in rural communities through the delegation of obstetric-gynecologic and pediatric tasks, supported by teleconsultations. This operational research took place in 6 community health centers in the Dioïla health district in Mali. Our method was based of the delegation of tasks, supported by teleconsultations. Experts in pediatrics and obstetrics/gynecology provided a week-long training program to general practitioners and midwives, in the management of the most common problems in the field and in the use of the "Bogou" teleconsultation and "Dudal" tele-education platforms to ensure exchanges and follow-up. Overall, 17 healthcare providers, that is, general practitioners, nurse-obstetricians, and midwives participated in sessions to strengthen gynecology-obstetric and pediatric capacity in the field. The evaluation of knowledge and of the indicators compared with the baseline of 8359 pregnancies and 1991 documented deliveries and of user satisfaction showed that this type of service resulted in decreased maternal and child mortality. In view of these results, we can deduce that the delegation of tasks, when it is supported by telehealth, encounters no resistance from the specialists and contributes to the significant improvement of maternal and infant health in remote areas. A long-term impact study is necessary to reinforce these results.

On Contributing to the Progress of Medical Informatics as Publisher.

May 1st, 2017, will mark Dieter Bergemann's 80th birthday. As Chief Executive Officer and Owner of Schattauer Publishers from 1983 to 2016, the biomedical and health informatics community owes him a great debt of gratitude. The past and present editors of Methods of Information in Medicine, the IMIA Yearbook of Medical Informatics, and Applied Clinical Informatics want to honour and thank Dieter Bergemann by providing a brief biography that emphasizes his contributions, by reviewing his critical role as an exceptionally supportive publisher for Schattauer's three biomedical and health informatics periodicals, and by sharing some personal anecdotes. Over the past 40 years, Dieter Bergemann has been an influential, if behind-the-scenes, driving force in biomedical and health informatics publications, helping to ensure success in the dissemination of our field's research and practice.

Impact of CPOE on mortality rates--contradictory findings, important messages.

OBJECTIVE: To analyze the seemingly contradictory results of the Han study (Pediatrics 2005) and the Del Beccaro study (Pediatrics 2006), both analyzing the effect of CPOE systems on mortality rates in pediatric intensive care settings. METHODS: Seven CPOE system experts from the United States and Europe comment on these papers. RESULTS: The two studies are not contradictory, but almost non-comparable due to differences in design and implementation. They demonstrate the range of outcomes that can be obtained from introducing informatics applications in complex health care settings. Implementing informatics applications is a sociotechnical activity, which often depends more on the organizational context than on a specific technology. As health informaticians, we must not only learn from failures, but also avoid both uncritical scepticism that may arise from drawing overly general conclusions from one negative trial, as much as uncritical optimism from limited successful ones. CONCLUSION: The commentaries emphasize the need to promote systematic studies for assessing the socio-technical factors that influence the introduction of increasingly sophisticated informatics applications within complex organizations. The emergence of evidence-based health informatics will be based both on evaluation guidelines and implementation guidelines, both of which increase the chances of successful implementation. In addition, well-educated health informaticians are needed to manage and guide the implementation processes.

Guarantying the quality of chemotherapy: from the order to the administration.

Ensuring the quality and security when prescribing drugs like chemotherapies is a complex task if one wants to cover the whole chain from the prescribing physician to the administrant nurse. At the University hospitals of Geneva, new applications covering the whole chain from the prescription up to and including the fabrication of the products have been developed in three phases and are being used in a production stage. In order to cover the "last yard" at the bed level, a fourth phase has been started with a pilot study based on labels containing RFID chips for preparations and for patients. The last phase will make use of all traceability data acquired from the prescription to the preparation to validate that the right product is administered to the right patient, and to record who is administrating it.

Discussion of "Combining Health Data Uses to Ignite Health System Learning".

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Combining Health Data Uses to Ignite Health System Learning" written by John D. Ainsworth and Iain E. Buchan [1]. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the paper of Ainsworth and Buchan. In subsequent issues the discussion can continue through letters to the editor. With these comments on the paper "Combining Health Data Uses to Ignite Health System Learning", written by John D. Ainsworth and Iain E. Buchan [1], the journal seeks to stimulate a broad discussion on new ways for combining data sources for the reuse of health data in order to identify new opportunities for health system learning. An international group of experts has been invited by the editor of Methods to comment on this paper. Each of the invited commentaries forms one section of this paper.

A rotating PET scanner using BGO block detectors: design, performance and applications.

Recent advances in fully three-dimensional reconstruction for multi-ring PET scanners have led us to explore the potential of a prototype scanner based on the rotation of two opposing arrays of BGO block detectors. The prototype contains only one-third of the number of detectors in the equivalent full ring scanner, resulting in reduced cost. With a lower energy threshold at 250 keV, the absolute efficiency of the scanner is 0.5% and the scatter fraction is 35% for a 20-cm cylinder. Transaxial and axial spatial resolution is about 6 mm. The maximum noise equivalent count rate estimated for a 15-cm diameter cylinder is 36,000 cps at a concentration of 26 kBq/ml. The minimum scan time for a 18F-fluoro-2-deoxyglucose (FDG) brain study is 55 sec. The camera has been validated for clinical applications using both FDG and 82Rb.

Fully three-dimensional reconstruction for a PET camera with retractable septa.

A fully 3-D reconstruction algorithm has been developed to reconstruct data from a 16 ring PET camera (a Siemens/CTI 953B) with automatically retractable septa. The tomograph is able to acquire coincidences between any pair of detector rings and septa retraction increases the total system count rate by a factor of 7.8 (including scatter) and 4.7 (scatter subtracted) for a uniform, 20 cm diameter cylinder. The reconstruction algorithm is based on 3-D filtered backprojection, expressed in a form suitable for the multi-angle sinogram data. Sinograms which are not measured due to the truncated cylindrical geometry of the tomograph, but which are required for a spatially invariant response function, are obtained by forward projection. After filtering, the complete set of sinograms is backprojected into a 3-D volume of 128x128x31 voxels using a voxel-driven procedure. The algorithm has been validated with simulation, and tested with both phantom and clinical data from the 953B.

2D and 3D imaging of small animals and the human radial artery with a high resolution detector for PET.

The performance of a pair of multicrystal, high-resolution, bismuth germanate (BGO) block detectors for positron emission tomography (PET) has been investigated. Utilizing the detectors at a separation of 100 mm, the spatial resolutions and count rate response of the block have been measured. These measurements indicate maximum spatial resolutions of 3.6 and 4.5 mm (FWHM) in the two axes of the block and a maximum coincidence rate of 3400 cps. The system has been used to observe the regional kinetics of positron-emitting radionuclides in the rat brain and the human radial artery. Designs for a small diameter, no-septa tomograph incorporating these detectors have been considered. Simulations demonstrate the possibilities of following tracer uptake within the rat brain and radial artery. Three-dimensional tomographic data-sets of a 20-mm uniform cylinder, obtained from rotating the two blocks, indicate good uniformity in the field of view (FOV) of 25 mm.

Implementation of three-dimensional image reconstruction for multi-ring positron tomographs.

In view of the number of PET studies involving low count rate acquisitions, there has been increasing interest recently in the development of positron cameras capable of fully three-dimensional acquisition and reconstruction. This interest has given impetus to the study of algorithms for 3D reconstruction, including those algorithms suitable for application to multi-ring PET scanners. While 2D reconstruction methods can often be generalised to 3D, a number of implementation problems arise which are unique to the 3D approach. This paper examines some of the difficulties associated with the generalisation of the filtered backprojection algorithm to 3D, paying particular attention to the approximations and variable transformations required for application to data from a multi-ring scanner.

A performance study of 3D reconstruction algorithms for positron emission tomography.

This paper investigates the statistical and systematic accuracy of five three-dimensional reconstruction algorithms for multi-ring PET scanners operated without septa: the reprojection method, the direct Fourier reconstruction, the FAVOR algorithm, and the single-slice and multi-slice rebinning algorithms. Simulated data of a uniform cylinder, of Gaussian sources, and of spherical sources are used to compare respectively the noise properties, the modulation transfer function, and the recovery coefficients of the algorithms. Brain scans reconstructed with the different algorithms are compared by calculating the linear regression of the mean values within regions of interest. The most significant observations are a slight loss of transaxial resolution with the reprojection algorithm in the external slices of the scanner, and increased noise in the images reconstructed using multi-slice rebinning.

Rotating positron tomographs revisited.

We have compared the performance of a PET scanner comprising two rotating arrays of detectors with that of the more conventional stationary-ring design. The same total number of detectors was used in each, and neither scanner had septa. For brain imaging, we find that the noise-equivalent count rate is greater for the rotating arrays by a factor of two. Rotating arrays have a sensitivity profile that peaks in the centre of the field of view, both axially and transaxially. In the transaxial plane, this effect offsets to a certain extent the decrease in the number of photons detected towards the centre of the brain due to self-absorption. We have also compared the performance of a rotating scanner to that of a full-ring scanner with the same number of rings. We find that a full-ring scanner with an axial extent of 16.2 cm (24 rings) is a factor of 3.5 more sensitive than a rotating scanner with 40% of the detectors and the same axial extent.

A normalization technique for 3D PET data.

Prior to reconstruction, emission data from a multi-ring PET camera must be corrected (normalized) for variations in detector sensitivity. The appropriate correction coefficients are obtained by measuring the response of all coincidence lines to a calibrated source of activity (a blank scan). State-of-the-art cameras may contain up to a million such lines of response (LORs), and therefore around 400 million counts will be required to calibrate each LOR to a statistical accuracy of 5%. Alternatively, by modelling the LOR sensitivity as the product of the individual detector efficiencies and a geometrical factor, a calibration procedure has been proposed which requires the determination of only 6000 parameters from this same data set. A significant improvement in the statistical accuracy of the coefficients can therefore be expected. Recently, multi-ring scanners have been operated with the septa retracted, increasing the number of measured LORs by a factor of eight. The acquisition of the calibration data necessary to achieve adequate statistical accuracy then becomes prohibitive. We show that, by modelling the LOR sensitivity, it is possible, with certain approximations, to normalize a septa-retracted emission data set with good accuracy. The input to the model is a high statistics blank scan acquired with the septa extended, which offers a number of practical advantages.

A humanist's legacy in medical informatics: visions and accomplishments of Professor Jean-Raoul Scherrer.

OBJECTIVE: To report about the work of Prof. Jean-Raoul Scherrer, and show how his humanist vision, his medical skills and his scientific background have enabled and shaped the development of medical informatics over the last 30 years. RESULTS: Starting with the mainframe-based patient-centered hospital information system DIOGENE in the 70s, Prof. Scherrer developed, implemented and evolved innovative concepts of man-machine interfaces, distributed and federated environments, leading the way with information systems that obstinately focused on the support of care providers and patients. Through a rigorous design of terminologies and ontologies, the DIOGENE data would then serve as a basis for the development of clinical research, data mining, and lead to innovative natural language processing techniques. In parallel, Prof. Scherrer supported the development of medical image management, ranging from a distributed picture archiving and communication systems (PACS) to molecular imaging of protein electrophoreses. Recognizing the need for improving the quality and trustworthiness of medical information on the Web, Prof. Scherrer created the Health-On-the-Net (HON) foundation. CONCLUSIONS: These achievements, made possible thanks to his visionary mind, deep humanism, creativity, generosity and determination, have made of Prof. Scherrer a true pioneer and leader of the human-centered, patient-oriented application of information technology for improving healthcare.