Visualizing Study Profiles Using the GMDS Competency Catalog for Medical Informatics Programs.

BACKGROUND: Medical informatics programs cover a variety of topics. OBJECTIVES: To test the utility of the GMDS medical informatics competency catalog in comparing programs by developing study profiles. METHODS: Coverage of 234 competencies is recorded and visualized in a spider diagram. RESULTS: Spider diagrams allow visualizing various study profiles. CONCLUSION: The GMDS catalog seems useful for comparing medical informatics study programs, e.g., for interested students, employers, or accreditation reviewers.

Towards a Recommendation for Good Health Data Modeling (GHDM) - Results of Expert Interviews.

Appropriate data models are essential for the systematic collection, aggregation, and integration of health data and for subsequent analysis. However, recommendations for modeling health data are often not publicly available within specific projects. Therefore, the project Zukunftslabor Gesundheit investigates recommendations for modeling. Expert interviews with five experts were conducted and analyzed using qualitative content analysis. Based on the condensed categories "governance", "modeling" and "standards", the project team generated eight hypotheses for recommendations on health data modeling. In addition, relevant framework conditions such as different roles, international cooperation, education/training and political influence were identified. Although emerging from interviewing a small convenience sample of experts, the results help to plan more extensive data collections and to create recommendations for health data modeling.

On the Effective Dissemination and Use of Learning Objectives Catalogs for Health Information Curricula Development.

Catalogs of competency-based learning objectives (CLO) were introduced and promoted as a prerequisite for high-quality, systematic curriculum development. While this is common in medicine, the consistent use of CLO is not yet well established in epidemiology, biometry, medical informatics, biomedical informatics, and nursing informatics especially in Germany. This paper aims to identify underlying obstacles and give recommendations in order to promote the dissemination of CLO for curricular development in health data and information sciences. To determine these obstacles and recommendations a public online expert workshop was organized. This paper summarizes the findings.

The production of referring expressions is influenced by the likelihood of next mention.

The present study provides converging evidence across three next-mention biases that likelihood of coreference influences the choice of referring expression: implicit causality (IC), the goal bias of transfer-of-possession (ToP) verbs, and implicit consequentiality (I-Cons). A pilot study and four experiments investigated coreference production in German using a forced-reference paradigm. The pilot study used object- and subject-biased IC verbs, showing a statistically marginal influence of next-mention bias on referential expressions, albeit mediated by grammatical function and feature overlap between antecedents. Experiment 1 focused on these features for object reference with ToP verbs, showing effects of coreference bias. In a within-participants comparison, Experiment 2 showed comparable effects for two classes of IC verbs, stimulus-experiencer and experiencer-stimulus predicates. Experiment 3 replicated and extended the IC form effects to another verb class, agent-evocator verbs. Finally, Experiment 4 revealed effects on anaphoric form also for I-Cons, while simultaneously replicating the effect observed for IC.

Tracing the Progression of Sepsis in Critically Ill Children: Clinical Decision Support for Detection of Hematologic Dysfunction.

BACKGROUND: One of the major challenges in pediatric intensive care is the detection of life-threatening health conditions under acute time constraints and performance pressure. This includes the assessment of pediatric organ dysfunction (OD) that demands extraordinary clinical expertise and the clinician's ability to derive a decision based on multiple information and data sources. Clinical decision support systems (CDSS) offer a solution to support medical staff in stressful routine work. Simultaneously, detection of OD by using computerized decision support approaches has been scarcely investigated, especially not in pediatrics. OBJECTIVES: The aim of the study is to enhance an existing, interoperable, and rule-based CDSS prototype for tracing the progression of sepsis in critically ill children by augmenting it with the capability to detect SIRS/sepsis-associated hematologic OD, and to determine its diagnostic accuracy. METHODS: We reproduced an interoperable CDSS approach previously introduced by our working group: (1) a knowledge model was designed by following the commonKADS methodology, (2) routine care data was semantically standardized and harmonized using openEHR as clinical information standard, (3) rules were formulated and implemented in a business rule management system. Data from a prospective diagnostic study, including 168 patients, was used to estimate the diagnostic accuracy of the rule-based CDSS using the clinicians' diagnoses as reference. RESULTS: We successfully enhanced an existing interoperable CDSS concept with the new task of detecting SIRS/sepsis-associated hematologic OD. We modeled openEHR templates, integrated and standardized routine data, developed a rule-based, interoperable model, and demonstrated its accuracy. The CDSS detected hematologic OD with a sensitivity of 0.821 (95% CI: 0.708-0.904) and a specificity of 0.970 (95% CI: 0.942-0.987). CONCLUSION: We could confirm our approach for designing an interoperable CDSS as reproducible and transferable to other critical diseases. Our findings are of direct practical relevance, as they present one of the first interoperable CDSS modules that detect pediatric SIRS/sepsis-associated hematologic OD.

Implementation of a Mobile Application in Acute Stroke Care Documentation.

Acute stroke care is a time-critical process. Improving communication and documentation process may support a positive effect on medical outcome. To achieve this goal, a new system using a mobile application has been integrated into existing infrastructure at Hannover Medical School (MHH). Within a pilot project, this system has been brought into clinical daily routine in February 2022. Insights generated may support further applications in clinical use-cases.

Towards a Didactic Concept for Heterogeneous Target Groups in Digital Learning Environments-First Course Implementation.

In the context of the ongoing digitization of interdisciplinary subjects, the need for digital literacy is increasing in all areas of everyday life. Furthermore, communication between science and society is facing new challenges, not least since the COVID-19 pandemic. In order to deal with these challenges and to provide target-oriented online teaching, new educational concepts for the transfer of knowledge to society are necessary. In the transfer project "Zukunftslabor Gesundheit" (ZLG), a didactic concept for the creation of E-Learning classes was developed. A key factor for the didactic concept is addressing heterogeneous target groups to reach the broadest possible spectrum of participants. The concept has already been used for the creation of the first ZLG E-Learning courses. This article outlines the central elements of the developed didactic concept and addresses the creation of the ZLG courses. The courses created so far appeal to different target groups and convey diverse types of knowledge at different levels of difficulty.

Development of a Didactic Online Course Concept for Heterogeneous Audience Groups in the Context of Healthcare IT.

Building a well-founded understanding of the concepts, tasks and limitations of IT in all areas of society is an essential prerequisite for future developments in business and research. This applies in particular to the healthcare sector and medical research, which are affected by the noticeable advances in digitization. In the transfer project "Zukunftslabor Gesundheit" (ZLG), a teaching framework was developed to support the development of further education online courses in order to teach heterogeneous groups of learners independent of location and prior knowledge. The study at hand describes the development and components of the framework.

The HiGHmed Didactical Framework for Online Learning Modules on Medical Informatics: First Experiences.

Within the HiGHmeducation consortium various online learning modules shall be developed by members of the consortium to address the increasing need for skilled professionals in a networked and digitalized healthcare system. Transferability of these modules to other locations is one main objective for the design of online learning modules. Thus, a didactical framework for online learning modules was developed. To ensure feasibility of the framework, the participating universities were analyzed concerning availability of e-learning support structures and infrastructures including learning management systems (LMS). The analysis especially focuses on the various LMS learning tools and their suitability for the framework. The framework is the basis for 12 HiGHmeducation online learning modules of which a part has firstly been conducted in winter 2019/20 and leads to a comparable structure of the modules.

Integration of Unstructured Data into a Clinical Data Warehouse for Kidney Transplant Screening - Challenges & Solutions.

After kidney transplantation graft rejection must be prevented. Therefore, a multitude of parameters of the patient is observed pre- and postoperatively. To support this process, the Screen Reject research project is developing a data warehouse optimized for kidney rejection diagnostics. In the course of this project it was discovered that important information are only available in form of free texts instead of structured data and can therefore not be processed by standard ETL tools, which is necessary to establish a digital expert system for rejection diagnostics. Due to this reason, data integration has been improved by a combination of methods from natural language processing and methods from image processing. Based on state-of-the-art data warehousing technologies (Microsoft SSIS), a generic data integration tool has been developed. The tool was evaluated by extracting Banff-classification from 218 pathology reports and extracting HLA mismatches from about 1700 PDF files, both written in german language.

Simulation of scattered radiation during intraoperative imaging in a virtual reality learning environment.

PURPOSE: Scattered radiation, which occurs when using a C-arm for intraoperative radiography, can be better understood through interactive visualization. We developed a virtual reality (VR) approach for the simulation of scattered radiation (SSR) as part of a C-arm training system. In VR, it is important to avoid cyber sickness, which is often caused by increased latency between head motion and image presentation inside the head-mounted display. As the latency requirement interferes with the computational complexity of the SSR, the goal has been to maintain a low latency during the simultaneous computation of the SSR on moderate-cost consumer hardware. METHODS: For use with a VR C-arm simulator, a CUDA-based Monte Carlo SSR has been improved to utilize GPU resources unused by the VR image generation. Resulting SSR data are visualized through volume rendering with pseudo-colored scattered radiation superimposed onto the virtual operating room. The resulting interactive VR-SSR environment was evaluated with operating room personnel (ORP) and surgeons using questionnaires. RESULTS: Depending on the imaged body part and computation parameters, the required computation time to complete one SSR run was between 1.6 and 4.2 s (ankle) and between 7.9 and 14.9 s (thigh), and VR frame times from 11 to 12 ms (95th percentile). The system was evaluated with ORP (n = 46) and surgeons (n = 25). The median of professional C-arm experience was 5 (range 1 to 34) years (ORP) and 12.5 (range 2 to 48) years (surgeons), respectively. The demonstrated prototype was found useful by 78% of ORP and 88% of the surgeons. On a Likert scale, more than 90% of both groups "agreed fully" that the presented way of visualizing SSR in VR helps understanding intraoperative exposure to scattered radiation. CONCLUSIONS: Leveraging off-the-shelf computer equipment, the feasibility of SSR and VR for interactive training has been demonstrated. Evaluation participants showed a high interest for the presented approach. Feedback suggests that the visualization experienced by the users helps understanding radiation hazards in the operating room.

Using openEHR Archetypes for Automated Extraction of Numerical Information from Clinical Narratives.

Up to 80% of medical information is documented by unstructured data such as clinical reports written in natural language. Such data is called unstructured because the information it contains cannot be retrieved automatically as straightforward as from structured data. However, we assume that the use of this flexible kind of documentation will remain a substantial part of a patient's medical record, so that clinical information systems have to deal appropriately with this type of information description. On the other hand, there are efforts to achieve semantic interoperability between clinical application systems through information modelling concepts like HL7 FHIR or openEHR. Considering this, we propose an approach to transform unstructured documented information into openEHR archetypes. Furthermore, we aim to support the field of clinical text mining by recognizing and publishing the connections between openEHR archetypes and heterogeneous phrasings. We have evaluated our method by extracting the values to three openEHR archetypes from unstructured documents in English and German language.

Results of a Literature Review to Prepare Data Modelling in the Context of Kidney Transplant Rejection Diagnosis.

Due to demographic change the number of serious kidney diseases and thus required transplantations will increase. The increased demand for donor organs and a decreasing supply of these organs underline the necessity for effective early rejection diagnostic measures to improve the lifetime of transplants. Expert systems might improve rejection diagnostics but for the development of such systems data models are needed that encompass the relevant information to enable optimal data aggregation and evaluation. Results of a literature review concerning published data models and information systems concerned with kidney transplant rejection diagnostic lead to a set of data elements even if no papers could be identified that publish data models explicitly.

Incremental generation of answers during the comprehension of questions with quantifiers.

The paper presents a study on the online interpretation of quantified questions involving complex domain restriction, for instance, are all triangles blue that are in the circle. Two probe reaction time (RT) task experiments were conducted to study the incremental nature of answer generation while manipulating visual contexts and response hand overlap between tasks. We manipulated the contexts in such a way that the incremental answer to the question changed from 'yes' to 'no' or remained the same before and after encountering the extraposed relative clause. The findings of both experiments provide evidence for incremental answer preparation but only if the context did not involve the risk of answer revision. Our results show that preliminary output from incremental semantic interpretation results in response priming that facilitates congruent responses in the probe RT task.

On Teaching International Courses on Health Information Systems. Lessons Learned during 16 Years of Frank - van Swieten Lectures on Strategic Information Management in Health Information Systems.

BACKGROUND: Health information systems (HIS) are one of the most important areas for biomedical and health informatics. In order to professionally deal with HIS well-educated informaticians are needed. Because of these reasons, in 2001 an international course has been established: The Frank - van Swieten Lectures on Strategic Information Management of Health Information Systems. OBJECTIVES: Reporting about the Frank - van Swieten Lectures and about our students' feedback on this course during the last 16 years. Summarizing our lessons learned and making recommendations for such international courses on HIS. METHODS: The basic concept of the Frank - van Swieten lectures is to teach the theoretical background in local lectures, to organize practical exercises on modelling sub-information systems of the respective local HIS and finally to conduct Joint Three Days as an international meeting were the resulting models are introduced and compared. RESULTS: During the last 16 years, the Universities of Amsterdam, Braunschweig, Heidelberg/Heilbronn, Leipzig as well as UMIT were involved in running this course. Overall, 517 students from these universities participated. Our students' feedback was clearly positive. The Joint Three Days of the Frank - van Swieten Lectures, where at the end of the course all students can meet, turned out to be an important component of this course. Based on the last 16 years, we recommend common teaching materials, agreement on equivalent clinical areas for the exercises, support of group building of international student groups, motivation of using a collaboration platform, ensuring quality management of the course, addressing different levels of knowledge of the students, and ensuring sufficient funding for joint activities. CONCLUSIONS: Although associated with considerable additional efforts, we can clearly recommend establishing such international courses on HIS, such as the Frank - van Swieten Lectures.

Understanding spatial relationships in US: a computer-based training tool that utilizes inexpensive off-the-shelf game controllers.

The authors present a simulation-based ultrasonographic (US) training tool that can help improve the understanding of spatial relationships in US. Use of a game controller to simulate a US probe allows examination of different virtual three-dimensional (3D) objects. These 3D objects are either completely artificial simple geometric objects (eg, spheres, tubes, and ellipsoids, or more complex combinations thereof) or derived from photographed gross anatomic data (eg, the Visible Human dataset [U.S. National Library of Medicine]) or clinical computed tomographic (CT) data. The virtual US probe allows infinitely variable real-time positioning of a "slice" that is displayed as a two-dimensional (2D) cross-sectional image and as part of a 3D view. Combining the 2D and 3D views helps elucidate the spatial relationships between a 3D object and derived 2D images. This training tool provides reliable real-time interactivity and is widely available and easily affordable, since it utilizes standard personal computer technology and off-the-shelf gaming hardware. For instance, it can be used at home by medical students or residents as a complement to conventional US training. In the future, this system could be adapted to support training for US-guided needle biopsy, with use of a second game controller to control the biopsy needle. Furthermore, it could be used as a more general interactive visualization tool for the evaluation of clinical 3D CT and magnetic resonance imaging data, allowing efficient and intuitive real-time creation of oblique multiplanar reformatted images.

SIScaR-GPU: fast simulation and visualization of intraoperative scattered radiation to support radiation protection training.

Scattered radiation caused by the intraoperative use of mobile image intensifier systems (referred to as "C-arms") is the main source of radiation exposure for operating room personnel and surgeons. To keep this possibly harmful exposure at a minimum level, a deliberate use of radiation, knowledge about distribution of scattered radiation and appropriate behavior pattern are indispensable. Therefore in several countries knowledge concerning these aspects is taught in mandatory courses on radiation protection. Currently this teaching is typically based on non-interactive didactical methods (texts, pictures and videos). Because of the complexity of the knowledge field this restriction might lead to an insufficient understanding of the facts, an inappropriate behavior and therefore to an avoidable radiation exposure. This paper presents a new software module, which is able to simulate and visualize intraoperative radiation distribution and the resulting dose values for the attending persons within a few seconds (less than 30s). The developed components, which simulate the radiation transport using a graphics processing unit three times faster than comparable approaches, were integrated exemplarily in the computer based C-arm training system virtX. This extended training system improves the teaching through a prompt visual feedback on non-trivial scattered radiation facts in freely adoptable situations.

Informatics in radiology: use of a C-arm fluoroscopy simulator to support training in intraoperative radiography.

Mobile image intensifier systems (C-arms) are used frequently in orthopedic and reconstructive surgery, especially in trauma and emergency settings, but image quality and radiation exposure levels may vary widely, depending on the extent of the C-arm operator's knowledge and experience. Current training programs consist mainly of theoretical instruction in C-arm operation, the physical foundations of radiography, and radiation avoidance, and are largely lacking in hands-on application. A computer-based simulation program such as that tested by the authors may be one way to improve the effectiveness of C-arm training. In computer simulations of various scenarios commonly encountered in the operating room, trainees using the virtX program interact with three-dimensional models to test their knowledge base and improve their skill levels. Radiographs showing the simulated patient anatomy and surgical implants are "reconstructed" from data computed on the basis of the trainee's positioning of models of a C-arm, patient, and table, and are displayed in real time on the desktop monitor. Trainee performance is signaled in real time by color graphics in several control panels and, on completion of the exercise, is compared in detail with the performance of an expert operator. Testing of this computer-based training program in continuing medical education courses for operating room personnel showed an improvement in the overall understanding of underlying principles of intraoperative radiography performed with a C-arm, with resultant higher image quality, lower overall radiation exposure, and greater time efficiency. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.313105125/-/DC1.

Acceptance and adverse events of the 2009 H1N1 vaccination in immunosuppressed pediatric liver transplant recipients.

A retrospective analysis of H1N1 vaccination in 127 children at ≥ 1 year after liver transplantation found only moderate acceptance (56%) of the vaccination. Physical adverse events were of moderate severity, but frequent (74%). Protection against infection was good, with infection rates of 4% in vaccinated children versus 25% in nonvaccinated children.

An approach to simulate and visualize intraoperative scattered radiation exposure to improve radiation protection training.

Intraoperative radiography based on mobile image intensifier systems (C-arms) is widely used during the treatment of trauma and emergency patients. These devices produce scattered radiation, potential hazardous for surgeon and operation room personal (ORP). The propagation and intensity of scattered radiation is not intuitive, is not perceivable by human senses and depends on many variables. At courses on radiation protection the knowledge of the behavior of scattered radiation and the modus operandi to minimize the radiation exposure should be taught to ORP and surgeons. Currently this can only be done theoretically using fixed pictures and precalculated videos. This paper presents an approach to interactively simulate and visualize scattered radiation with a computer based training system for mobile image intensifier systems. The simulation depicts radiation propagation and intensity for arbitrary C-arm adjustments and different irradiated materials. This teaching component focuses on improving the current radiation protection training with interactive visual and practical aspects.