VISION2003: virtual learning units for medical training and education.

The project VISION2003 consists of several partners with different professions ranging from medicine to medical informatics, from computer science to didactics. Its aim is the development, testing, introduction and a long-time maintenance of an open, web-based, intelligent and adaptive teaching and learning system for medical education. The system is expected to enhance the acceptance and efficiency of conventional ways of learning by supplementing and supporting them and creating new methods for imparting knowledge ["VISION2003, Lehr-und Lernsysteme in der Medizin: Intelligente und Multimediale, Internetbasierte adaptive und intelligente Autorensysteme für kooperatives Training in der Medizin", (last valid on 17 January 2003) and Ein offenes sprachkonzept für verteilte wissensverarbeitung in der medizin, Tagungsabstract XVI International Congress of the European Federation for Medical Informatics MIE, September 2000]. This is done exemplarily in the specific fields of oncology, accident-surgery and cardiology in consideration of actual standards and didactical measures. The range of possible applications is wide, from electronically accessible scripts through example cases to complex simulations. The main focus of the project is the creation of an open and flexible internet platform for delivering multimedia-based learning units and the development of adaptive and intelligent authoring systems.

From a urinalysis strategy to an evaluated urine protein expert system.

Urine single protein analysis has developed into a routine method for the screening and monitoring of kidney diseases. In order to support clinical decision making by an interpretative report, a urine protein expert system (UPES) has been developed. Based on a database containing more than 500 excretion patterns, a modular knowledge base was extracted in production rules and implemented in a modern expert system shell. The resulting interpretation system has been thoroughly verified and validated. After the need of interpretation of the complex findings had been documented in a survey, its usability in routine and its knowledge representation was evaluated in 11 hospitals. A user conference confirmed a high quality level of the reports proposed by UPES. It revealed that the problem of automatic data transfer as well as the common definition of diagnostic terms by laboratorians and clinicians play a crucial role for the use of knowledge-based systems in laboratory medicine.

Audit and quality control in angioplasty in Europe: procedural results of the AQUA Study 1997: assessment of 250 randomly selected coronary interventions performed in 25 centres of five European countries. AQUA Study Group, Nucleus Clinical Issues, Working Group Coronary Circulation, of the European Society of Cardiology.

AIMS: Percutaneous transluminal coronary angioplasty (PTCA) has become the most widely used major intervention in western medicine. However, there is disparate use of this technique among different European countries and the U.S.A. In an attempt at quality assurance, the working group Coronary Circulation of the European Society of Cardiology has carried out a study on appropriateness, necessity, and performance of PTCA in Europe. The present paper reports on the procedural results of this survey. METHODS: In a multicentre case-control study in Europe, 750 patients (544 men, 206 women) with documented vascular disease of the From the countries participating in the European Registry of Coronary Intervention, the three countries with the highest absolute PTCA volume (Germany, France, and the United Kingdom) and two randomly selected countries (Belgium and Italy) were chosen for investigation. In these countries, five centres were selected at random according to the following criteria: one centre with >1000, three centres with 300-1000, and one centre with <300 procedures per year. In each of these, 10 cases from the first half of 1997 were randomly identified and all pertinent documentation was collected. RESULTS: In 250 cases, 325 stenoses were addressed as target lesions. Single vessel disease was present in 41%. History included stable angina in 49%, unstable angina in 32%, atypical chest pain in 6%, no anginal pain in 12%, and acute/subacute myocardial infarction in 13%. The percentage of patients with either positive stress test and/or unstable angina, acute/subacute infarction, previous infarction (within 6 months) or coronary revascularization amounted to 98%. Single vessel intervention accounted for 90%. In 41% balloon-only angioplasty was performed and in 54% at least one stent was implanted with considerable variation among countries. The use of other new devices amounted to only 3%. In 92%, the operators documented a successful procedure. Major complications (myocardial infarction, emergency bypass surgery, or death) were found in 4.8%. CONCLUSIONS: Based on scrutinized hospital and operator data, the present study revealed a satisfactorily high percentage of justifiable indications, an adequate procedural success rate, and an acceptably low complication rate. Further analysis by an expert panel will address appropriateness, necessity, and procedural performance of the individual cases.

A prognostic computer model to individually predict post-procedural complications in interventional cardiology: the INTERVENT Project.

AIMS: The purpose of this part of the INTERVENT project was (1) to redefine and individually predict post-procedural complications associated with coronary interventions, including alternative/adjunctive techniques to PTCA and (2) to employ the prognostic INTERVENT computer model to clarify the structural relationship between (pre)-procedural risk factors and post-procedural outcome. METHODS AND RESULTS: In a multicentre study, 2500 data items of 455 consecutive patients (mean age: 61.1+/-8.3 years: 33-84 years) undergoing coronary interventions at three university centres were analysed. 80.4% of the patients were male, 16.7% had unstable angina, and 5.1%/10.1% acute/subacute myocardial infarction. There were multiple or multivessel stenoses in 16.0%, vessel bending >90 degrees in 14.5%, irregular vessel contours in 65.0%, moderate calcifications in 20.9%, moderate/severe vessel tortuosity in 53.2% and a diameter stenosis of 90%-99% in 44.4% of cases. The in-lab (out-of-lab) complications were: 0.4% (0.9%) death, 1.8% (0.2%) abrupt vessel closure with myocardial infarction and 5.5% (4.0) haemodynamic disorders. CONCLUSION: Computer algorithms derived from artificial intelligence were able to predict the individual risk of these post-procedural complications with an accuracy of >95% and to explain the structural relationship between risk factors and post-procedural complications. The most important prognostic factors were: heart failure (NYHA class), use of adjunctive/alternative techniques (rotablation, atherectomy, laser), acute coronary ischaemia, pre-existent cardiac medication, stenosis length, stenosis morphology (calcification), gender, age, amount of contrast agent and smoker status. Pre-medication with aspirin or other cardiac medication had a beneficial effect. Techniques, such as laser angioplasty or atherectomy were predictors for post-procedural complications. Single predictors alone were not able to describe the individual outcome completely.