Department of Medical Computer Sciences, University of Vienna. Wahringer .... DAMS-Software Package to Support the Daily Activities of a Hospital Ward. ..... Greenhalgh, C. and Roberts, J., Greenhalgh and Company Ltd., Macclesfield, U.K. .
Lecture Notes in Medical Informatics Editors: O. Rienhoff, Marburg D. A. B. Lindberg, Washington
45
K. -P. Adlassnig G. Grabner S. Bengtsson R. Hansen (Eds.)
Medical Informatics Europe 1991 Proceedings, Vienna, Austria, August 19-22, 1991
Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong Barcelona Budapest
Editors Klaus-Peter Adlassnig Georg Grabner Department of Medical Computer Sciences, University of Vienna Wahringer GiirteI18-20, 1090 Wien, Austria Stellan Bengtsson Department of Clinical Microbiology, Akademiska Hospital P. O. Box 552, 751 85 Uppsala, Sweden Rolf Hansen National Institute of Public Health Geitmyrsveien 75, 0462 Oslo, Norway Programme Committee S. Bengtsson, Sweden (Chairman) J. Bryant, United Kingdom R. Hansen, Norway (Vice-Chairman) K.-P. Adlassnig, Austria B. Barber, EFMI WG 2 M. Barbosa, Portugal J. Bou, Spain C. Cobelli, IFAC G. de Moor, Belgium G. Dezelic, Yugoslavia
W. Dorda, Austria G. Gell, Austria H. Grabner, Austria P. Grosser, Austria B. Haidl, Austria J. Hofdijk, The Netherlands E. Karjalainen, Finland P. Le Beux, France P. McNair, Denmark A. Naszlady, Hungary J. M. Noothoven van Goor, EC
Executive Committee
Organizing Committee
S. Bengtsson, Sweden J. Bryant, United Kingdom R. Hansen, Norway G. Grabner, Austria K.-P. Adlassnig, Austria
G. Grabner (Chairman) K.-P. Adlassnig (Secretary General) W. Dorda G. Gell H. Grabner P. Grosser Ch. Hay A. Marksteiner E. Schuster
R. O'Moore, Ireland A. Reichert, Israel O. Rienhoff, Germany F. H. Roger, EFMI WG I J. R. Scherrer, Switzerland E. Schuster, Austria A. Serio, Italia K. Staehr Johansen, WHO M. Tallberg, EFMI WG 5 L. Thayer, Council of Europe
e- ISBN -13: 978-3-642-93503-9 ISBN-13: 978-3-540-54392-3 DOl: 10.1007/978-3-642-93503-9 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9, 1965, in its current version, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1991
2127/3140-543210 - Printed on acid-free paper
INTRODUCTION
This volume contains the proceedings of the Tenth International Congress on Medical Informatics, MIE 91, that will be held in Vienna, Austria, August 19-22, 1991. The MIE 91 Congress was organized by the European Federation for Medical Informatics (EFMI) in cooperation with the Austrian Computer Society (OCG) and the Austrian Society for Biomedical Engineering (OGBMT). It follows the previous congresses in Cambridge (1978), Berlin (1979), Toulouse (1981), Dublin (1982), Brussels (1984), Helsinki (1985), Rome (1987), Oslo (1988), and the Congress 1990 in Glasgow. The proceedings contain 199 contributions to the MIE 91 Congress. They cover all presentations which are part of the scientific programme of MIE 91, among them 157 paper presentations with an average of five pages, 28 poster presentations again with an average of five pages, and 14 abstracts of demonstrations with an average of one page. The papers included were selected by an International Programme Committee out of over 300 submissions after careful review by at least two international reviewers (for whose estimable efforts we are especially thankful). The recommendations of the reviewers were incorporated in the final texts. Some papers were reworked by a professional translator to obtain a high quality of presentation. Several submissions could not be considered for presentation at MIE 91 because of shortage of congress time and limitations in the number of pages of the proceedings. The scientific topics present in the proceedings volume at hand range from information and communication systems, knowledge-based systems, signal and image processing, health care, biometry and biomathematics, research and epidemiology, classification and coding, and nursing, up to computerassisted education, medical curricula, and even robotics in medicine. They are interdisciplinary in nature and may therefore be of interest to a variety of professionals: medical informatics and health information scientists, medical computing specialists, public health and hospital administrators, physicians, nurses, other allied health personnel, and consultants in the various health fields. There are several prominent themes that are the main topic of a paper, poster, or demonstration or occur again and again within various contexts: First, a highly prevalent topic is medical information and communication systems: hospital, medical, clinical, ward, nursing, health, and executive information systems, hospital and data communication networks and PACS, drug information systems (database, interaction, monitoring); and related issues such as standardization of information exchange. The proceedings' Subject Index, for example, contains a total of 40 cross-references to the above-mentioned keywords. Although industry has already offered several types of information systems for hospitals, clinical wards, departments, laboratories, and physicians' offices, their application is at least partially not advanced enough and therefore not to the contentment of the medical user, SQ research seems still highly necessary.
v
Second, a "hot" topic is knowledge-based systems with 62 cross-references in the Subject Index. This topic is not only discussed in several Medical Expert Systems' sessions but is also part of sessions such as biosignal and image processing, computer-assisted instruction, and information systems and decision support. Some areas of knowledge-based systems are discussed in detail. This concerns, for example, knowledge representation, knowledge acquisition and learning, knowledge models, and evaluation issues. Several contributions report on clinical applications of knowledge-based systems and thus demonstrate their achieved practical usefulness. Moreover, some recent topics of great research interest were part of the MIE 91 Congress and reports are included in the proceedings: fuzzy set theory, fractals, neural networks, parallel computation, and bioinformatics. These presentations provide an indication of some future developments and may act as a starting point for those becoming more interested. The MIE 91 Congress gathered participants from all over the world, although mainly Europeans. This is reflected by the authors of the proceedings' contributions; altogether, over 550 researchers have reported their results in this volume. By considering only the first author of each paper, 27 different countries can be counted that contributed to this volume. The great variety of scientific topics and countries that will be present should guarantee both an interesting international MIE 91 Congress in Vienna in August and a fruitful study of the proceedings by those interested in Medical Informatics.
K.-P. Adlassnig, G. Grabner, S. Bengtsson, and R. Hansen (Eds.) June 1991
VI
Contents
INTRODUCTION Adlassnig, K.-P., Grabner, G., Bengtsson, S., and Hansen, R . . . . . . . . . . . . . . . . . V
PAPER PRESENTATIONS KEYNOTE ADDRESSES Knowledge-Based Systems in Medicine. Shortliffe, E.H., Stanford University, USA . . Perspectives of Computer Assisted Medical Imaging. Hohne, K.-H., University Hospital Hamburg-Eppendorf, Germany
· 10
Medical Languages: Use, Definition and Processing in Ward Information Systems (WIS). Scherrer, J.-R., Hopital Cantonal Universitaire de Geneve, Switzerland
· 19
Informatics in Molecular Biology. Bilofsky, H., European Molecular Biology Laboratory, Heidelberg, Germany
· 28
· 5
HOSPITAL INFORMATION SYSTEMS WAMIS-Heuristic Approaches to a Medical Information Network. Marksteiner, A., University of Vienna, Austria . . . . . . . . . . . . . .
. . . . . 35
"The Vienna Hospital Information System" EDP-Assisted Management of the City of Vienna. Sack, H., MD-ADV, Vienna, Austria . . . . . . . . . . . . . . . . . . . . . . . . . . 41 The Information System of the Freiburg University Hospital. Klar, R., Zaiss, A., Timmermann, U., and Schrader, U., Freiburg University Hospital, . . . . . 46 Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overview of an Architectural Approach to the Development of the A.Z.-V. U .B. Distributed Clinical Information System. Van de Velde, R., University Hospital of Brussels, Belgium . . . . . . . . . . . . . . . . 51 The Medical Record Linkage Process Within the Diogene Hospital Information System. Berthoud, M., Gurtner, D., and Scherrer, J.-R., Cantonal University Hospital of Geneva, Switzerland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. 57
Computers in Hospitals, Vulnerability Aspects. Bakker, A.R., BAZIS,.Leiden, The Netherlands . . . . . . . . . . . . . .
. 62
Nursing Information Systems-A State of the Art Study. Heemskerk-van Holtz, P.R.B. and Nieman, H.B.J., BAZIS, Leiden, The Netherlands
. 67
VII
Converting American Software for European HIS Requirements. Herlihy, R., Gerber Alley International, Dublin, Ireland . . . . . . . . . . . . . . . . . . 73
DEPARTMENTAL INFORMATION SYSTEMS The Concept of a Ward Information System. Baud, R., Scherrer, J.-R., Coignard, J., Lucas, L., Degoulet, P., Jean, F.-C., Jaulent, M.-C., Springub, A., Engelmann, U., and Meinzer, H.-P., University State Hospital of Geneva, Switzerland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . 81
DAMS-Software Package to Support the Daily Activities of a Hospital Ward. Obradovic, T., Mihaljev, J., Obradovic, D., Periiiic, B., and Latinovic, S., University of Novi Sad, Yugoslavia . . . . . . . . . . . . . . . . . . . . . . . . 86 The FEBE Project: Designing a Clinical Information System. Gregory, R.C., Leaning, M.S., Summerfield, J.A., Browne, J., Wilkinson, D., and McGrath, A., University College London, U.K. . . . . . . . . . . . . . . . . . . . 91 A Ward Nursing System Integrated in a Comprehensive HIS. Thygesen, M., Center for Hospital Information Services, Aarhus, Denmark . . . . . . . 96 A Distributed System for the Integrated Management of General and Subspecialist Pediatric Outpatient Clinic. Bernabei, A., Curro, V., D'Atri, A., and La Cava, G., Universita. di L'Aquila, Italy
101
Experiences with PATSY: An Information System for Pathology. Zaiss, A.W., Schaefer, H.-E., and Klar, R., University Hospital Freiburg, Germany
106
Low-Cost Hospital Informatics in Africa: The lIe-Ife Experience. Makanjuola, R.O.A., Daini, O.A., Soriyan, H.A., and Korpela, M., lle-Ife, Oyo State, Nigeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
111
Data Modelling for Intensive Care within the INFORM Project. Yates, C.E., Leaning, M.S., Patterson, D.L.H., Ambroso, C., and Kalli, S.T., University College London, U.K. . . . . . . . . . . . . . . . . . . .
116
A Temppral Database Management for Medical and Health Care Systems. Ling, D.H.O., Bell, D.A., and Young, I.R., University of Ulster, Jordanstown, U.K.
121
SYGMA: A General Object-Oriented Medical Application Development System. Madjaric, M. and Gell, G., University Hospital of Graz, Austria . . . . . . . . . . . . 127 What Shov.ld We Mean by 'An Electronic Medical Record'? Kay, S., Rector, A.L., Nowlan, W.A., Goble, C.A., Horan, B., Howkins, T.J., and Wilson, A., University of Manchester, U.K. . . . . . . . . . . . . . . . .
132
Requirements for a Medical Workstation Using User-Centred Design. Engelbrecht, R., Fitter, M., and Rector, A., GSF-Medis Institut, Miinchen, Germany
140
The Use of a Touch-Screen Computer for Dental Charting. Richards, B. and Khoury, D., UMIST, Manchester, U.K.
145
A.RE.S.: An Interface for Automatic Reporting by Speech. Antoniol, G., Brugnara, F., Dalla Palma, F., Lazarri, G., and Moser, E., LR.S.T., Trento, Italy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
150
VIII
HOSPITAL COMMUNICATION NETWORKS AND PACS
The NHS Interoperability Testing Facility (ITF). Athwall, P.S. and Mason, S.A., NHS Information Management Center, Birmingham, U.K. PC Network for Hospital Information System. Balogh, N., Hungarian Institute of Cardiology, Budapest, Hungary A Hospital Communication System Based on CON-NECT-Medical User Interfaces. Wentz, B., HergemOder, G., Horbach, L., Seibold, H., and Wolf, F., Universitiit Erlangen-Niirnberg, Germany . . . . . . . . . . . . . . . . . . . . . MIDAM-A Generalised System for Integrating Medical Images and Patient Records. Young, LR., Ling, D.H.O., and Bell, D.A., University of Ulster, U.K. . . . . .
157 162
. . .
169
. .
174
The Integration of PACS, Digital Radiography, Nuclear Medicine and Ultrasound Devices: An Opportunity and a Challenge for the General Hospital. Bagni, B., Scutellari, P.N., and Orzincolo, C., S. Anna Hospital, Ferrara, Italy . . . . . . 179 Modular Development of a Hospital Wide Picture Achiving and Communication System (PACS). Ratib, 0., Ligier, Y., Funk, M., Hochstrasser, D., and Scherrer, J.-R., University Hospital of Geneva, Switzerland . . . . . . . . . . . . . . . . . . . . . . . . . . .
182
Planning a Large Scale PACS: The Vienna SMZO-Project. Mosser, H., Ruger, W., Urban, M., and Hruby, W., SMZO Hospital, Vienna, Austria
187
DRUG INFORMATION AND DECISION SUPPORT SYSTEMS
Drug Interactions in Primary Care--A Retrospective Database Study. Linnarsson, R., Linkoping and Kronan Health Center, Sundbyberg, Sweden Drug Utilization Monitoring in the Clinical Hospital Centre-Zagreb. Lovrek, V. and Culig, J., Clinical Hospital Centre, Zagreb, Yugoslavia Knowledge-Based Galenical Development of Drug Products: An Overview on the Design of the Galenical Development System Heidelberg. Haux, R., Wetter, T., Stricker, H., Flister, J., Mann, G., and Oberhammer, L., Universitiit Heidelberg, Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . .
195
200
204
Development of an Expert System for the Detection of Adverse Drug Reactions. Juan-Babot, 0., Ferrer-Salvans, P., Alonso-Valles, L., Ferrer-Salvans, 1., Castells-Nat, C., Vidal-Casas, E., and Rubio-Garcia, R., Hospital Duran i Reynals, Barcelona, Spain . . . . . 209
INFORMATION SYSTEMS AND DECISION SUPPORT
Advice and Warning within HIOS+. Dupuits, F.M.H.M., Hasman, A., Ulrichts, E.M.J.J., and Valkenburg, J.J.M., University of Limburg, Maastricht, The Netherlands . . . . . . . . . . . . . . . . . . ...
217
Strategies for Efficient Implementation of the Arden Syntax for Medical Decision Support. Magyar, G., Arkad, K., Gao, X., Gill, H., Wigertz, 0., and illeldt, H., Linkoping University, Sweden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
IX
Development of Computerized Neurological Decision Support SysteIIl. Redekop, W.K. and Paty, D.W., University Hospital, Vancouver, Canada
. . . . 227
ProtoVIEW: A Workstation for the Use of Clinical Algorithms. van Dessel, P.F.H.M., Hasman, A., and van der Linden, C.J., University of Limburg, Maastricht, The Netherlands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
EXPERT SYSTEMS DIANA 2/ The Diagnostic Analyzer: Diagnostic Consultation in Internal Medicine by Personal COIIlputer. Muscari, A., Universita di Bologna, Italy . . . . . . . . . . . . . . . . . . . . . . . 241 SPES-2: An Expert System for the Intra-Operative Phase of the Pancreas Cancer. Rafanelli, M., and Maceratini, R., Universita 'La Sapienza', Rome, Italy . . . . . .
. ..
246
COIIlputer-Aided Expert System of Diagnostics and Tactics in Acute Urgent Neurologic Pathology. Krupin, E.N., Charms, M.Y., Telesheva, T.Y., GribanoYa, T.N., Leontiev, S.L., and Goldberg, S.I., Medical Information Computer Center, Sverdlovsk, USSR
251
Differential Diagnosis in Breast Histopathology. Bose, D.K., Heathfield, H.A., and Kirkham, N., Brighton Polytechnic, U.K.
255
FUMIDS (Fever of Unknown Origin in Miscellaneous Diseases Diagnosis SysteIIl): Development and AssessIDent. Takabayashi, K., Ogan, S., Satomura, Y., and Yoshida, S., Chiba University, Japan
. . . 260
A Bayesian Approach to the Detection of Acute Disorders in a Respiratory Intensive Care Unit. Fraser, R.B. and Turney, S.Z., Maryland Institute for Emergency Medical Services Systems, Baltimore, USA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Expert System "DINAR-2"-Methodological Basis for the Pediatric Emergency Aid Organization in a Large Region. Goldberg, S.I., Lomovskikh, V.E., Makhanek, A.O., and Sldyar, M.S., USSR Academy of Science, Sverdlovsk, USSR . . . . . . . . . . . . . . . . . . . . . . . . . • • 270 An Expert SysteIIl for the Diagnosis, TreatIDent, and Triage of Head Injuries in ReIIlOte EnviroDIDents. Fraser, R.B., Wolf, A., Dunham, C.M., Turney, S.Z., Cushing, B.M., Ramzy, A.I., and Eastham J.N., Maryland Institute for Emergency Medical Services, Baltimore, USA . . . . 275
EXPERT SYSTEMS-KNOWLEDGE REPRESENTATION A Model for the Systematic Application of Artificial Intelligence in the Diagnosis of Pathologic Conditions in a System or Apparatus. Ferrer-Salvans, P., Alonso-Valles, L., Rubio-Garcia, R., Juan-Babot, 0., and Vidal-Casas, E., Hospital of Duran i Reynals, Barcelona, Spain . . . . . .
283
UnPatient: A Knowledge Base for Medical Diagnostic Expert Systems. Stary, C. and Fasching, K., Florida International University, Miami, USA
289
Interpretation of Clinical Biochemistry Test Profiles by a Method Allowing Communication Between Linked Organ-Related Knowledge Bases. Boran, G., Alexander, D., Grimson, J., and O'Moore, R., Lewisham Hospital, London, U.K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
x
Declarative and Operational in Knowledge-Based Systems. Popper, M. and Hauskrecht, M., Research Institute of Medical Bionics, Bratislava, CSFR . . 299 The Operational Aspects of Object-Oriented Approach in Medical Expert Systems Design. Stanek, J., Popper, M., and Hauskrecht, M., Research Institute of Medical Bionics, Bratislava, CSFR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304 Design of a Well-Protected Patient Record Unit for Multi-Centre Knowledge-Based System CLINAID. Kaliappan, V., Kohout, L.J., and Anderson, J., Florida State University, Tallahassee, USA
. 309
EXPERT SYSTEMS-KNOWLEDGE ACQUISITION AND LEARNING Better Justifiability and Less Rules by Using Deep Knowledge. Kindler, H., Densow, D., and Fliedner, T.M., University of Uhn, Germany
317
Learning Specialized Disease Descriptions in a Rheumatological Expert System. Horn, W., Widmer, G., and Nagele, B., University of Vienna, Austria . . . . . .
322
Inductive Learning as a Method for Medical Decision Making. Dezelic, G. and Kern, J., University of Zagreb, Yugoslavia . . . . . .
327
Knowledge Acquisition Study and Accuracy Rate Evaluation for CADIAG-2/RHEUMA with 308 Clinical Cases. Leitich, H., Adlassnig, K.-P., and Kolarz, G., University of Vienna, Austria
332
Knowledge Acquisition in Medicine: Enforcing Consistency. Giuse, D.A., Giuse, N.B., and Miller, R.A., University of Pittsburgh, USA .
337
Medical Knowledge Base Consistency Checking and its Application to CADIAG-l/BIN. Moser, W. and Adlassnig, K.-P., National Center for Environmental Sciences, Neuherberg, Germany ........................
. . . 342
Associative Memories in Medical Diagnostic. Barreto, J.M., de Azevedo, F., Zanchin, C.I., and Epprecht, L.R., Universite Catholique de Louvain, Belgium . . . . . . . . . . . . . . . . . . . . . . . . .
348
Using Connectionist Approach for Finding Ideal Cut-Off Values for Quantitative Laboratory Tests. Forsstrom, J. and Fogstrom, M., University of Turku, Finland . . . . . . . . . . . . . . 353
EXPERT SYSTEMS-EVALUATION A Methodology for Evaluation of Knowledge-Based Systems. Clarke, K., O'Moore, R., Smeets, R., Talmon, J., Brender, J., McNair, P., Nykanen, P., ....... Grimson,J., and Barber, B., Trinity College, Dublin, Ireland Outcomes Assessment, Quality Assurance and Evaluation of Expert Diagnostic Systems. Nl/lhr, C., Aalborg University, Denmark . . . . . . . . . . . . . . . . .
. . . 361
. . . . 366
Software Tools for the Development and Validation of HEPAR, an Expert System for the Diagnosis of Hepatobiliary Disease. Lucas, P., University of Amsterdam, The Netherlands . . . . . . . . . . . . . . . . . . 371
XI
Clinical Assessment of a Computer System for Insulin Dosage Adjustment. Lehmann, E.D., Roudsari, A.V., Deutsch, T., Carson, E.R., Benn, J.J., and SOnksen, P.H., St. Thomas's Hospital, London, U.K. . . . . . . . . . . . . . . . . . . 376 A Validation Methodology for Testing Decision-Support Systems for Insulin Dosage Adjustment. Roudsari, A.V., Leicester, H.J., Lehmann, E.D., Hovorka, R., Andreassen, S., Deutsch, T., Carson, E.R., and Sonksen, P.H., City University, London, U.K. . . . 382 Clinical Value of a Decision Support System for the Assessment of Thyroid Function. Nuutila, P., Irjala, K., Viikari, J., Forsstrom, J., Vii.limiiki, M., Nykiinen, P., and ............. . Saarinen, K., University of Turku, Finland
389
Transferability of Knowledge-Based Systems. Schioler, T., Nolan, J., and McNair, P., University of Copenhagen, Denmark
394
The Role of Diagnostic Uncertainty in Health Care Outcomes and its Potential for Modification with Decision Support. Bankowitz, R.A., University of Pittsburgh, USA . . . . . . . . . . . . . . . . . . . . 399
FUZZY SET THEORY IN MEDICINE Decision-Aid Under Uncertainty Based on Separating Power and Fuzzy Measure. Dujet, C. and Si-Kaddour, H., INSA, Villeurbanne, France ....... . 407 Hyperthyroidism Diagnosis Supporting Using Imprecise Rules. Straszecka, J. and Straszecka, E., Silesian Technical University, Gliwice, Poland 412 A Decision Making System in Aviation Medicine. Kuncheva, L., Zlatev, R., and Raicheva, V., Academy of Sciences, Sofia, Bulgaria . . . . . . 418 MEXYS2: A Fuzzy Reasoning Expert System Based on the Subject Emotions Consideration. Boiinovski, S., Martinovska, C., Boiinovska, L., and Pop-Jordanova, N., University of Skopje, Yugoslavia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423 Knowledge-Based Fuzzy Classification of Signal Events. Barro, S., Ruiz, R., Marin, R., Presedo, J., Bugarin, A., and Mira, J., Universidad de Santiago, Spain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . 428
AntibES/Rabat-A Fuzzy Computer-Aided Instruction on the Treatment of Infectious Diseases Designed for Morocco Medical Students and Medical Practitioners. Palmer, G., Morlat, P., Pillet, J.C., Labroille, G., Tilly, B., Nejjari, C., Luguet, J., Aubertin, A., Medahoui, A., Hassar, M., and Salamon, R., Universite de Bordeaux II, France . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434
EXPERT SYSTEMS-KNOWLEDGE MODELS Maccord: A Metamodel for Problem Solving Competence Applied to Medicine. Kraus, D., Petkoff, B., and Mannebach, H., Center for Technology Transfer Biomedicine, Bad Oeynhausen, Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
XII
A Clinical Knowledge Model as Basis for Constructing a Decision Supporting System. Buiting-van der Zon, C.I.C.M., van den Berg, J.M.J., and Berger, H.M., University Hospital Leiden, The Netherlands ..................... . . . . 447 Integration of the Causal and Functional Approaches for Robust Medical Diagnosis. Barahona, P. and Veloso, M., Universidade Nova de Lisboa, Monte da Caparica, Portugal
. . 452
Integrating Closed Form Representations and Qualitative Reasoning for Cancer Treatment. Gaglio, S., Giacomini, M., Nicolini, C., and Ruggiero, C., Palermo University, Italy . . . . . 457
SIGNAL PROCESSING ECG Beat Classification Using Linear Prediction Error Signal. Frankiewicz, Z. and Shrouf, A., Technical University of Silesia, Gliwice, Poland
. . . . 465
Averaged Powerspectra of the Electrocardiograms of Patients After Heart Transplantation. Schreiner, W., Laufer, G., Neumann, M., Premauer, W., Merksa, F., Lahoda, R., and WoIner, E., University of Vienna, Austria . . . . . . . . . . . . . . . . . . .
. ..
EEG Mapping While Listening to a Text: Differences Between Controls and Schizophrenics. Lacroix, D., Rappelsberger, P., Steinberger, K., Thau, K., and Petsche, H., University of Vienna, Austria . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
471
477
Fractals in EEG Mapping. Jindra, R.H. and Vollmer, R., Krankenhaus Lainz, Vienna, Austria . . . . . . . . . . . . 482 Transputer-Based EMG-Analysis Including Diagnostic Support. Jochtl, G., Rom, G., and Pfurtscheller, G., University of Technology, Graz, Austria Computerized Cephalometry on Orthodontic Radiographs: Towards Flexible and Easily Customized Systems. Alte da Veiga, F. and de Matos Barbosa, M.J., University of Coimbra,Portugal
488
. . 493
EPEXS: An Expert System for Analysis and Interpretation of Human Evoked Potentials. Brai, A., Koutlidis, R.M., and Vibert, J.-F., Universite Pierre et Marie Curie, Paris, France . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....
498
An Integrated Computer Workstation for Epilepsy Monitoring: Technical Concept. Vuong, T.A., Dupre', M., Holthausen, H., Sakamoto, A., Burgess, R.C., Collura, T.F., and Liiders, H., Epilepsy Center Bethel, Bielefeld, Germany . . . . . . . . . . .
503
The Object-Oriented Approach to the Medical Real Time System Design. Arseniev, S.B. and Kiselev, M.V., Academy of Medical Science, Moscow, USSR
508
IMAGE PROCESSING A Knowledge Base Model for the Interpretation of Radiographic Densities. Braccini, G., Caramel1a, D., and Salvetti, 0., Universita di Pisa, Italy . . . . . . . .
515
Automatic Constructional Analysis of Images in Visuoperceptual Evaluation. Fairhurst, M.C. and Smith, S.L., University of Kent, Canterbury, U.K. . . . . . . .
521
XIII
Three Dimensional Reconstruction of a Small Fetal Phantom Using Real-Time Linear Array Ultrasonic Images. Watkin, K.L., Khalife, S., and Nuwayhid, B., McGill University, Montreal, Canada
. . . . 529
Clustering Algorithms for MR!. Di Gesu, V., De La Paz, R., Hanson, W.A., and Bernstein, R., University of Palermo, Italy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . 534
Iterative Image Segmentation via 3-valued Logic for 3-D Display of Medical Data. Gengler, M. and Schuster, E., University of Vienna, Austria
540
Quality Assurance of Reader's Response in Medical Imaging. Steinbach, W.R. and Richter, K., Institut fUr Herz-Kreislauf-Forschung, Berlin, Germany
545
Use of Fractal Dimension in Signal Adaptive Filters for .Speckle Reduction in Ultrasound B-Mode Images. Magnisalis, X., Kotropoulos, C., Pitas, I., and Strintzis, M.G., University of Thessaloniki, Greece . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550
BIOMETRY AND BIOMATHEMATICS
A Computer Methodology for Reducing the Volume of Oxytocin Used in Labour. Richards, B., Cadman, J., Levitt, J., and Liebermann, B., UMIST, Manchester, U.K.
. . . . 557
Non-Parametric Regression Techniques for Biometric Problems: Concepts and Software. Schimek, M.G., University of Graz, Austria
562 Confidence Regions on Optimal Drug or Treatment Combination. de Matos Barbosa, M.J., and Reis, R.O., University of Coimbra, Portugal . 567 Errors in Estimating the Incidence Due to Left-Truncated Data When Using the Hospital's Patient Database-A Modelling Approach. Schrader, U., Zaill, A.W., and KIar, R., Albert-Ludwigs-Universitat, Freiburg, Germany . . . 572 Case Study: Estimation of Drug Effectiveness-Inverse Interpolation of Noisy Data by Nonlinear Least-Squares. Stonebridge, B.R., Lai, T., and Symes, M.O., Bristol University, U.K. . . . . . .
577
A Cellular Grammar to Model Metabolic Processes. Hofestadt, R., Universitat Koblenz-Landau, Rheinau, Germany
582
A Theoretical Study of the Stability of Respiration. Vielle, B. and Chauvet, G., Institut de Biologie Theorique, Angers, France
587
TSOBM: A Tool for the Simulation and Optimization of Biorhythmical Models. Sykora, T. and Richter, R., Universitat Karlsruhe, Germany .
. . . . 592
A Non-Linear Model ofInsulin Kinetics. Hovorka, R., Powrie, J .K., Smith, G.D., Carson, E.R., Sonksen, P.H., and Jones, R.H., City University, London, U.K. . . . . . . . . . . . . . . . . . . . . . . . . .
XIV
597
CURRICULA AND COMPUTER-ASSISTED EDUCATION Thirteen Years of a Nation-Wide Curriculum in Medical Informatics: Does it Still Meet the Requirements? Busse, R. and Rienhoff, 0., Philipps University, Marburg, Germany Introducing Medical Informatics as a Horizontal Theme into a Medical School Curriculum. Jennett, P.A., Edworthy, S.M., and Rosenal, T.W., University of Calgary, Canada
. .
605
. . . . 610
A New Approach to Computerized Medical Knowledge Assessment. Carbo, J.M., Sancho, J.J., Miravitlles, M.J., Gonzruez, J.C., and Sanz, F., Universitat Autonoma de Barcelona, Spain . . . . . . . . . . . . . . . . . . . . . . ....
615
The Use of the Computer in Gastroenterology for Doctor-Training and Patient-Diagnosis. Richards, B., Lugovkina, T., and Obukhov, A., UMIST, Manchester, U.K. . . . .
620
Linking Expert-Systems and Interactive Video for Medical Education. Hobsley, M., Jameson, G., Wallis, M., and Webb, T., The Rayne Institute, London, U.K. 625 ILIAD: An Expert System for Diagnostic Assistance and Teaching: Implementation in France. Lepage, E., Bouhaddou, 0., Tredaniel, J., Chassany, 0., Warner, H., and Warner, H.R., CHU Lariboisiere Saint-Louis, Paris, France . . . . . . . . . . . . . . . . . . . 629 Visualizing Medical Knowledge-An "Intelligent" Textbook Based on Graphical Browsing. Kuhn, K., Kottmann, P., Holderer-Kottmann, U., Zemmler, T., Swobodnik, W., and Ditschuneit, H., Universitat Ulm, Germany . . . . . . . . . . . . . . . . . .
634
RESEARCH AND EPIDEMIOLOGY EuroHealthDatabase for Hospital Macro and Microcomparisons in Europe: Diabetes Mellitus as an Example. Beguin, C., Van den Heuvel, R., Winkeler, B., Closon, M.C., and Roger, F.H., University of Louvain, Brussel, Belgium . . . . . . . . . . . . . . . . . . . . . . . .
641
The Eurohealth Database-Handling Personal Data Without Access to Personal Identification. Barber, B., Roger-France, F., Winkeler, B., and Olsen, P., NHS Information Management Center, Birmingham, U.K . . . . . . . . . . . . . . . . . .. .. .. .
646
ADAMS: Data-Base Management as a Decision Support System for Epidemiologists. Ferri, F., Grifoni, P., Meo-Evoli, L., and Ricci, F.L., CNR, Rome, Italy
653
An Integrated System to Support the AIDS Research. Sicurello, F., Villa, M., D'Arminio Monforte, A., Formenti, T., Moroni, M., Nicolosi, A., and Saracco, A., Advanced Biomedical Technology Institute, Milan, Italy . . . 658 An International Neurology Database Link, Allowing Global Research Queries Across Languages. Ludtke, M.W., Dutt, S.C., Burgess, R.C., and Vuong, T.A., Epilepsie-Zentrum Bethel, Bielefeld, Germany .............................
xv
663
An Epidemiological Approach to Computerized Medical Diagnosis: The AEDMI Project, a Multicenter Design to Which Different Artificial Intelligence Systems May Be Gathered. Alonso-Valles, L., Ferrer-Salvans, P., Rubio-Garcia, R., Juan-Babot, 0., and ...... Vidal-Casas, E., Hospital Duran i Reynals, Barcelona, Spain . . . . . . . BIOCELL: An Integrated and Interactive Tool for the Management of Linguistic and Eidetic Biological Data. Beltrame, F., Marcenaro, G., and Sassoli, M., University of Genoa, Italy
668
. . . . . 673
The Practical Design and Implementation of Thesauri for Primary Care Information Retrieval Applications. Eliasz, A.W., Mason, A., and Malcolm, L., University College London, U.K. . . .
678
Investigations of Dependencies in the USSR State Computer Information System "Population Health-Environment". Jornitsky, A.B. and Tsurkov, V.I., Scientific Research Institute for Automation of Management, Moscow, USSR . . . . . . . . . . . . . . . . . . . . . . . . . . . .
683
HEALTH CARE SYSTEMS AND SERVICES Harmonisation of Health Data on the Institutional Level the Case Based Model as a European Approach to Health Care Services Planning and Management. Rodrigues, J.M., Catterall, J., Hofdijk, J., Meadows, J., Mennerat, F., and Verin, I., Universite de Saint Etienne Jean Monnet, France . . . . . . . . . . . . . . . .
...
689
Information Modelling in the Dutch Health Care. Ten Hoopen, A.J., Nutma, J., and de Vries Robbe, P.F., University Hospital Groningen, The Netherlands . . . . . . . . . . . . . . . . . . . . . . . . . . .
694
Executive Information Systems for NHS Senior Management. Peterburg, Y., Smithson, S., and Peel, V., London School of Economics, U.K.
701
A Generic Model of Clinical Practice-The COSMOS Project. Cairns, T., Timimi, H., Thick, M., and Gold, G., St. Mary's Hospital, London, U.K.
706
Building a National Health Information System. White, C. and Carroll, T., Rotunda Hospital, Dublin, Ireland
. . . . . . . . . . . . . . 711
HealthPROMPT-A New Initiative in Providing Information for Health Promotion. Woodward, A.M., Hepworth, J.B., and Vidgen, G.A., Health Promotion Authority for Wales, Cardiff, U.K. . . . . . . . . . . . . . . . . . . . . . . . .
717
An Electronic Patient Information System in Mental Health-An Integrated Solution for Better Care and Management. Rigby, M.J., University of Keele, U.K. ............... .
722
Computers in Primary Health Care: The Bhorugram Experience-India. Singh, A.K., Moidu, K., Rathore, B.S., Trell, E., and Wigertz, 0., Linkoping University, Sweden. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
727
Computers and Working Conditions in Nursing: Experiences from German Hospitals. John, J., GSF-MEDIS Institut, Neuherberg, Germany
XVI
...
732
CLASSIFICATION AND CODING Accuracy of Hospital Diagnostic and Operative Procedure Coding. Wilkinson, E.J. and Harvey, I., University of Wales, Cardiff, U.K.
739
GIANO: A Decision Aid to Represent the Semantics of Medical Terms. Pisanelli, D.M., Mori, A.R., and Coacci, V., CNR, Rome, Italy . . . . . . . . .
744
Classification Within HIOS+. Dupuits, F.M.H.M., Hasman, A., and Jansen, P.C.M.H.F., University of Limburg, Maastricht, The Netherlands . . . . . . . . . . . . . . . . . . . . . . . .
. . . 749
The Design and Implementation, Using an Object-Oriented Methodology of a User-Friendly Primary Health Care Patient Management System Based on the ICPC Classification. Eliasz, A.W., University College London, U.K. . . . . . . . . . . . . .
754
CHIC: Community Health Information Classification and Coding. Mechtler, R., Johannes Kepler Universitii.t Linz, Austria . . . . . . . . .
759
Aim(ing) for the Record. Savill, A.W., James, S.D., and Taylor, J.E., Institute for Health Informatics, Aberystwyth, U.K. . . . . . . . . . . . . . . . . . . . . . . . . .
765
The Read Codes and National and International Medical Data Interchange. Read, J.D., NHS, Leicestershire, U.K. . . . . . . . . . . . . . . . . . . . .
770
Towards a European Classification of Procedures in Medicine (ECPM)AIM-SESAME and the Dutch and German Approach. Thurmayr, R. and Graubner, B., Technical University Munich, Germany
775
A Multiaxial Model for the Description of Medico-Surgical Procedures. Burgun, A., Le Beux, P., and Lenoir, P., CHRU Pontchaillou, Rennes, France
782
QUALITY ASSURANCE AND INFORMATION TECHNOLOGY How to Induce Physicians to Engage in QA Activities in a University Hospital Environment. Giraud, A., Hopital de Paris, France . . . . . . . . . . . . . . . . . . . . . . . . .
793
Child Health Quality Assurance-A Practical Approach. Osborne, D. and Lambert, P., Devon, U.K. . . . . . . . . . . . . . . . . . . . . . . 801
NURSING C.N .1. S.-Innovat ion into Practice. Roberts, R., St. Davids Hospital, Dyfed, U.K.
........... .
809
Nomenclature, Coding, Classification, and Standards for Nursing Information Systems. Wiseman, J., Nursing Consultancy Services, Lytham St. Annes, U.K . .
. . . . . . . . 814
A Nursing Minimum Data Set in Production. De1esie, L., Croes, L., Sermeus, W., Tanghe, A., Vanden Boer, G., and Vanlanduyt, J., Catholic University of Leuven, Belgium . . . . . . .
819
Computerized Nursing Care Plan. Hynninen, P., Varkaus Health-Centre, Joroinen, Finland
824
XVII
Nursing Workload Measurement-Computer Support. Greenhalgh, C. and Roberts, J., Greenhalgh and Company Ltd., Macclesfield, U.K. . . . . . 829 Critical Care Nursing Informatics: Promoting the Quality of Life During Crisis. Gantz, N.J., Good Samaritan Hospital, Portland, USA . . . . . . . . . . . .
833
Wound Care Management. Butler, E.A. and Jeune, A.E., St. Thomas' Hospital, London, U.K.
837
HEALTH SERVICES ADMINISTRATION Identification of Groups of Patients Consuming Equal Resources for a Hospital Financing System by Regression Trees. Pfeiffer, K.P., Maier, A., Malli, K., Buchegger, C., Spann, H., Klingler, D., Embacher, G., Pregartbauer, M., and Peer, E., Universitat Graz, Austria . . . . . . . . . 845 Uniform HIS-Cost Modeling: Experiences and First Results for the Leiden University Hospital. Willemsen, W., van Gennip, E.M.S.J., Bakker, A.R., and Louwerse, C.P., BAZIS, Leiden, The Netherlands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
850
One Approach to Assessing Experience/Price Levels at Hospitals. Dale, J., BUPA, London, U.K. . . . . . . . . . . . . . . . . . . . .
855
Nosocomial Infections and Length of Hospitalization According to DRG. Legras, B., Patris, A., Burdin, J .-C., Mayeux, D., and Feldmann, L., Hopital Marin, Nancy, France . . . . . . . . . . . . . . . . . . . . . . . . . . .
859
Appointment Systems-An Information Resource for General Practice. Howkins, T.J., University of Manchester, U.K. . . . . . . . . . . . . . . . .
864
STANDARDIZATION Inter-Institutional Information Exchange in Healthcare. Hasman, A., Ament, A., Arnou, P.G., and van Kesteren, A.C.A., University of Limburg, Maastricht, The Netherlands . . . . . . . . . . . . . . . . . . . . . . . . . . 871 EUCLIDES: A European Clinical Laboratory Data Exchange Standard (AIM-Project: A 1033). De Moor, G.J.E., State University Hospital Gent, Belgium ....... . 876 Linking Medical Data Standards, Knowledge-Based Systems and the Technique of Partial Evaluation. Hammond, P., Aye, L.K.S.A., and Kay, J.D.S., University of Birmingham, U.K.
. . . . . . 881
POSTER PRESENTATIONS
INFORMATION SYSTEMS AND HEALTH CARE A Data Base Management System for an Obstetrics Department. Luis, J.F., Filomena Cardoso, M., Bernardes, J., Marques de Sa, J.P., and Pereira Leite, L., Universidade do Porto, Portugal . . . . . . . . . . . . . . . . . . . 891
XVIII
A Heuristic Approach to a Computerized Database in a Gyneco-Oncologic Outpatient Clinic. Hanzal, E., Hoffmann, G., Gitsch, G., Reinthaller, A., and K51bl, H., University of Vienna, Austria . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . 895
ARZTBRIEF: Generating Medical Reports in a Multimedia Environment. Kraus, D. and Miche, E., Center for Technology Transfer Biomedicine, Bad Oeynhausen, Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . 900
Whole Blood Aggregometry: A PC-Based System for Clinical Routine Application. Schreiner, W., Miiller, M.R., Premauer, W., and WoIner, E., University of Vienna, Austria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . 904
Drug Information Through Online Databases: A Comparison Between External Databases and the In-House Database of a Pharmaceutical Company. Sodha, R.J., Kostrewski, B.J., and Schier, 0., CIBA-GEIGY, Basel, Switzerland
908
Electronic Transfer of Data for Surveillance of Communicable Disease. Catchpole, M., Disease Surveillance Center, London, U.K. . . . . . . . . .
914
Computer-Aided Cluster Analysis of Citation Networks as a Tool of Research Policy in Biomedicine. Burchinsky, S.G. and Duplenko, Y.K., Institute of Gerontology AMS, Kiev, USSR
. . . . .
919
EXPERT SYSTEMS AND DECISION MAKING Some Aspects of the Implementation of Decision Monitoring Logic within a Heterogeneous Hospital Information System. Michel, A., Sebald, P., and Dudeck, J., University of Giellen, Germany . . . . . . .
..
925
Ten Years of Computer Support in a Metabolic Intensive Care Unit. Svacina, S., Hovorka, R., Haas, T., Masek, Z., and Kabrt, J., Charles University, Prague, CSFR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
930
Application of Rule Induction Algorithm in Medical Research. Lasek, M. and Lasek, W., University of Warsaw, Poland . . . . . . .
934
A Fuzzy Logical Model of Nutrition Diagnosis. Kretzschmar, F., St. Georg Hospital, Leipzig, Germany
. . . . . . . . . . . . . .
939
Artificial Intelligence in Contact Dermatitis: The CODEX/E System. Dooms-Goossens, A., Dooms, M., Drieghe, J., and Degreef, H., Katholieke Universiteit Leuven, Belgium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
944
ARZNEPH: Computer-Assisted Drug Dosage in Renal Failure. Giehl, M. and Keller, F., Universitiitsklinikum Steglitz, Berlin, Germany
. . . . . . . . . 948
COMPUTER-ASSISTED TRAINING AND EDUCATION Teaching Electro and Phono Cardiology with Microcomputer. de Lima, W.C., Ojeda, R.G., Zanchin, C.I., and Barreto, J.M., Univ. Federal de St. Catarina, Florian6polis, Brazil . . . . . . . . . . . . . . . . . . . . . . .
. . . 955
Computer-Aided Teaching in Neurology. Mihaljev-Martinov, J., Zikic, M., Mateja.sev, S., and Nikolic, I., University of Novi Sad, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 960 Yugoslavia
XIX
An AI-Based Training for Nosocomial Infections Control. Pozo, A.R., de Lima, W.C., and Barreto, J.M., Universidade Regional de Blumenau, Brazil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
965
BIOMETRY AND BIOSTATISTICS Can Automatic "Scoring" Improve Comparability of Cases and Statistical Results in Emergency Medicine? Inglis, R., Windolf, J., and Pannike, A., Frankfurt University Hospital, Germany
973
Summary Attributable Risk Estimation in 2 X 2 X K-Tables. Gefeller, 0., Georg-August-Universitat, Gottingen, Germany . . . . . . . . .
978
A Comparative Study on Hazard Function Estimators Employing Nearest Neighbour Distances as Bandwidths. Gefeller, O. and Dette, H., Georg-August-Universitat, Gottingen, Germany
. . . 983
Asymptotic Variance Estimation of Association Measures: A New Approach to Overcome Computational Problems. Gefeller, O. and Woltering, F., Georg-August-Universitat, Gottingen, Germany
988
BIOSIGNAL PROCESSING AND BIOMEDICAL ENGINEERING Intelligent Peripheral Module for Data Acquisition and Control. Pavkov, D., Misic-Pavkov, G., Mihaljev-Martinov, J., and Pecujlija, M., University of Novi Sad, Yugoslavia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 995 A Software to Acquire and to Treat Holter Test Analysed by Pathfinder 3 MK2 Model. Conti, P., Polzonetti, A., Moretti, F., Coderoni, B., and Bocci, G., Universita di Camerino, Italy . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1000
PC-Supported 64-Channel DC-EEG Amplifier. Lindinger, G., Svasek, P., Lang, W., and Deecke, L., University of Vienna, Austria
1005
EEG Probability Mapping While Listening to a Text: A Group and a Single Case Study. Rappelsberger, P., Lacroix, D., Steinberger, K., Thau, K., and Petsche, H., University of Vienna, Austria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1010 Analysis of Sleep Patterns in Babies Using Neural Networks-Preliminary Results. Pfurtscheller, G. and Litscher, G., Graz University of Technology, Austria . . . . . . . . . 1014 Spectral Analysis of Breathing in Infants in the First Year of Life During Quiet Sleep-Preliminary Results. Litscher, G. and Pfurtscheller, G., Graz University of Technology, Austria . . . .
. . . . 1021
Electra 800 Data Management Program. Cambus, J.P., Dousset, B., Bierme, R., and Valdiguie, P., CHU Rangueil, Toulouse, France . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1027
Robotics in Medicine: A Brief Survey. Ernst, E. and Adlassnig, K.-P., University of Vienna, Austria
1032
xx
DEMONSTRATIONS EXPERT SYSTEMS AND DECISION MAKING Integrated Medical Database and Expert System HEPAXPERT-II: Automatic Interpretation of Tests for Hepatitis A and B. Adlassnig, K.-P., Horak, W., and Chizzali-Bonfadin, C., University of Vienna, Austria
. . . 1041
VARY-The First Expert System for Analysis of Genome Variability. Wojahn, C., Hofestadt, R., and Muller, H.-P., University of Technology, Aachen, Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . 1042
PEN&PAD: A Multi-Lingual Patient Care Workstation Based on a Unified Representation of the Medical Record and Medical Terminology. Nowlan, W.A., Kay, S., Rector, A.L., Horan, B., and Wilson, A., University of Manchester, UK . . . . . . . . . . . . . . . . . . . . . . . . .
1043
Consultation System for Insulin Dosage Adjustment. Hovorka, R., Svacina, S., and Carson, E.R., City University, London, UK
1044
A Metabolic Prototype to Assist in the Management of Insulin-Treated Diabetic Patients. Lehmann, E.D., Deutsch, T., Carson, E.R., and Sonksen, P.H., St. Thomas's Hospital, London, UK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1045
COMPUTER-ASSISTED TRAINING AND EDUCATION Computer-Based Clinical Teaching with Multimedia Technology. Sweeney, M.A., Mercer, Z., Randall, D.C., McHugh, D., Skiba, D., and Trynda, R., University of Texas, USA . . . . . . . . . . . . . . . . . . . . . . .
. . . . 1049
Multimedia and Hypertext Programs for Nursing Education. Becchio, D., Cavicchioli, A., Magnino, M.E., Berra, I., Zara, G.P., Narduzzo, G., and Eandi, M., Centro Professioni Intermieristiche, Torino, Italy . . . . . . . . . . . . . . . 1050
INFORMATION SYSTEMS AND HEALTH CARE ARZTBRIEF: Generating Medical Reports in a Multimedia Environment. Kraus, D. and Miche, E., Center for Technology Transfer Biomedicine, Bad Oeynhausen, Germany. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Spreadsheets as Convivial Tools for Biological Follow-Up Management of Hospitalized Patients. Vancraeynest, B., Vael, T., and Baudhuin, P., University of Louvain, Brussels, Belgium
. . 1053
. . . 1054
The Feedback Programme for Nursing Minimal Data Set Registration. Delesie, L., Vanlanduyt, J., Tanghe, A., Sermeus, W., Vanden Boer, G., and Croes, L., Catholic University of Leuven, Belgium . . . . . . . . . . . . . . . . . . . 1055 A PC-Based System to Audit Radiology Referral Practice, Costs and Exposure. Donnelly, P.D., Ennis, W.P., and Roberts, C.J., University of Wales College of Medicine, UK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1056
Measurement Data Analysis Language "MAL". Holzreiter, S., Forschungsinstitut fUr Orthopiidietechnik, Vienna, Austria
1057
XXI
LIMDET: A PrograIIl for the Calculation of the Detection LiIIlit in Clinical Chemistry. Perez, J. and Marancho, J., Hospital Insular de Gran Canaria, Spain . . . . . . . . . . . 1058
IMAGE PROCESSING Digital Filters Used to IIIlprOVe Medical IIIlBge Quality. Radulescu, A., Institute for Computer and Informatics, Cluj, Romania
. . . . . . . . . . 1061
AUTHOR INDEX
1063
SUBJECT INDEX
1079
XXII
