Information processing in healthcare at the start of the third Millennium: potential and limitations.

The 21st century is said to be a century of the information society. We should be aware that continuing progress in information processing methodology (IPM) and information and communication technology (ICT) is changing our societies, including medicine and health care. At the start of the third Millennium we should ask ourselves, what progress can we expect from modern IPM/ICT for healthcare in the coming decade, what concerns does the information society have to face, and what steps have to be taken. These questions were addressed by clinicians, researchers and industrial representatives in a panel discussion at the joint conference ISCB-GMDS-99 of the International Society of Clinical Biostatistics and the German Society for Medical Informatics, Biometry and Epidemiology. Important aspects raised by the panelists and in the subsequent discussion were: (1) the main goal of expanding IPM/ICT should be to further improve quality of care, while maintaining reasonable costs; (2) with the support of modern IPM and ICT the boundaries between inpatient and outpatient care will fade away enabling a more efficient, patient-centered health care; (3) cooperation between health-care professionals will increase; there will be different ways of communication between them and with the patient, including modern ICT and the Internet; (4) society must be concerned with achieving equal opportunities in being informed about and in using new ICT; (5) misuse of data will remain a serious problem and can become an obstacle to progress.

Virtual reality in medicine-computer graphics and interaction techniques.

This paper describes several new visualization and interaction techniques that enable the use of virtual environments for routine medical purposes. A new volume-rendering method supports shaded and transparent visualization of medical image sequences in real-time with an interactive threshold definition. Based on these rendering algorithms two complementary segmentation approaches offer an intuitive assistance for a wide range of requirements in diagnosis and therapy planning. In addition, a hierarchical data representation for geometric surface descriptions guarantees an optimal use of available hardware resources and prevents inaccurate visualization. The combination of the presented techniques empowers the improved human-machine interface of virtual reality to support every interactive task in medical three-dimensional (3-D) image processing, from visualization of unsegmented data volumes up to the simulation of surgical procedures.

Hybrid rendering of multidimensional image data.

The most important rendering methods applied in medical imaging are surface and volume rendering techniques. Each approach has its own advantages and limitations: Fast surface-oriented methods are able to support real-time interaction and manipulation. The underlying representation, however, is dependent on intensive image processing to extract the object surfaces. In contrast, volume visualization is not necessarily based on extensive image processing and interpretation. No data reduction to geometric primitives, such as polygons, is required. Therefore, the process of volume rendering is currently not operating in real time. In order to provide the radiological diagnosis with additional information as well as to enable simulation and preoperative treatment planning we developed a new hybrid rendering method which combines the advantages of surface and volume presentation, and minimizes the limitations of these approaches. We developed a common data representation method for both techniques. A preprocessing module enables the construction of a data volume by interpolation as well as the calculation of object surfaces by semiautomatic image interpretation and surface construction. The hybrid rendering system is based on transparency and texture mapping features. It is embedded in a user-friendly open system which enables the support of new application fields such as virtual reality and stereolithography. The efficiency of our new method is described for 3-D subtraction angiography and the visualization of morpho-functional relationships.

[Toward a European health reporting system--starting points and developmental perspectives]. / Auf dem Weg zu einer europäischen Gesundheitsberichterstattung--Ansatzpunkte und Entwicklungsperspektiven.

This article first offers a brief introduction to the development of the EC health policy mandate from a competence restricted to health protection at the working place to a wider competence embracing health promotion and disease prevention, albeit still based on the principle of self-responsibility of the Member states. Possible focal points of health reporting within the EC framework are worked out on the basis of suggestions made by the EC commission in respect of priority areas of EC activities in the public health sphere and the commission's own priority criteria. It is then examined whether and to what extent the presently available health databases (especially of WHO and OECD) would cover these requirements. As a result, it is argued, that there is no getting around setting up an own health reporting system that would promote and support the development of an EC public health policy. An important task of such health reporting will be to supply users not only with data but also with adequate knowledge on how to interpret them, in view of the multitude of problems involved in bringing the various national health data under one roof; this cannot be achieved either at short notice or on a medium-term basis. Finally, a few alternatives are given in respect of possible organisational structures of EC health reporting, pointing out decision criteria and practical conditions which would be essential of assessing the usefulness of such organisational setups.

Rationale for a community strategy in the field of information and communications technologies applied to health care.

The challenge for Europe in the field of information and communications technologies applied to health care is that of addressing positively the problem of the widening gap between the expectations of the citizens of the type of care that can be made available and the limited resources to provide that care. If the expectations of the population are to be fulfilled, it will be necessary to find innovative ways of delivering health services and to do it more efficiently than has yet been the case. Advanced information and communications technologies will be important tools for Member States to achieve the levels of efficiency required. Based on the results of the Community AIM Exploratory Action, further collaborative work is required at EEC level to create an Integrated Health Information Environment (IHE) allowing essentially for integration, modularity and security.

Analysis and processing of data in a hospital-based diabetes management system.

Both short-term care (blood glucose monitoring) and long-term care (clinical examinations) of diabetes generate an ample amount of data for each patient. Health care in hospitals has to provide services with respect to both demands. The quality of control depends on obtaining the right finding at the right time and taking the individually adequate measures. These repetitive activities follow to a certain extent standardized algorithms and computer-programs are able to support demands like this; however, up to now no attempts have been made to provide useful tools for this environment. DIALIN is a data-bank especially designed for the use in hospitals or outclinics and Camit is a diabetes management system for advanced evaluation of long-term blood glucose monitoring data. The expert-system DIACONS up to now determines diabetes type and adequate initial therapy from data of patients' history alone; it operates on the DIALIN-databank via SQL. DIALIN has proven to be a useful tool for data-processing in hospitals. Camit was well accepted by patients in a feasibility study. DIACONS has been tested with 83 diabetic patients to provide the correct diabetes-type and the proper initial regimen with a precision of 96% compared to the correspondence between two independent experts. The combination of all three systems is a step towards the Munich Medical Information system MAMIS.

[ECG changes in psychiatric patients under long-term therapy with psychopharmaca (author's transl)]. / EKG-Veränderungen bei psychisch Kranken unter Langzeittherapie mit Psychopharmaka.

Within the scope of an epidemiologic study on risk factors and coronary heart diseases, 1726 mentally ill, aged 40-69, under permanent hospitalization were examined electrocardiographically. There were few pronounced indications of a relationship between pathological ECG findings and psychopharmaca. ECG changes were rarest among patients treated exclusively with non-tricyclic drugs, and most often among those patients who received tricyclics and non-tricyclics simultaneously. Statistically ascertained, however, was only the connection with lesser pathological changes in the rest and load ECG's (T-flattening). In this connection, these disturbances appeared more often among women. A reciprocal effect between sex and the influence of psychopharmaca appeared on the ECG. Contrary to males, females under treatment with tricyclica or with several psychopharmaca simultaneously showed more ECG changes than those treated without medication.

[Coronary risk factors and social class. Screening in employees of a large industrial firm (author's transl)]. / Koronare Risikofaktoren und sozialer Status. Untersuchungen bei Angestellten und Arbeitern eines Grossindustriebetriebes.

In Munich, 1477 employees (868 males and 609 females) of a large industrial firm were examined with regard to coronary heart disease risk factors. The known risk factors--overweight, disorders of the lipometabolism, diabetes, cigarette smoking, hypertension, pathologic ECG, physical inactivity--as well as certain somatic complaints and mental stress were checked for their distribution within the various social levels. With the exception of cigarette smoking among women and professional worries among men, in both sexes the members of the upper social group are less burdened with danger factors than the average. Aside from high blood pressure and disorders of the lipometabolism, which predominate in males in the middle layers, and cigarette smoking, which prevails among females in the upper social group, the risk factors pile up in the lowest social level. Our results will be discussed and compared with other studies.

[Coronary heart disease risk factors in white-collar and manual workers at a large Munich industrial firm (author's transl)]. / Risikofaktoren der koronaren Herzkrankheit bei Angestellten und Arbeitern eines Münchner Grossindustriebetriebes.

1477 employees of a large industrial firm in Munich (868 males and 609 females, aged 40-59) were examined for coronary heart diseases risk factors. Among males, hypercholesterolemia predominates with a distribution of over 40%. Every fifth male has high blood pressure or is a heavy cigarette smoker. The females under 50 years of age clearly show fewer risk factors, but toward 60 years they exceed the males in frequency of some factors. Among women, too, the top risk factor is cholesterol, followed by overweight and high blood pressure. On the average, about 8% of the men and women have a preclinical or manifest diabetes. About every fifth male examined and every seventh female can be considered as especially endangered by the presence of 3 or more risk factors.

[The risk of heart disease in various psychiatric diseases]. / Kardiale Erkrankungsrisiken bei verschiedenen psychiatrischen Krankheiten

The distribution of some risk factors on different psychiatric diseases in 1726 hospitalized patients were investigated within a prevalence study. To all tested factors there was a contrary behaviour of oligophrenic patients opposite to the group with a schizophrenia, organic and affective psychotics. Hypertension only was found more frequently in non psychotic psychopathia and oligophrenia than in psychosis. Therefore the prevalence of hypertriglyceridemia, hypercholesterinemia, diabetes, specific Ecg-changes, smoking of cigarettes and severe physical inactivity in oligophrenics was less except in all other group of diseases, also in consideration of the different frequency of psychopharmacal treatment. Electrocardiographical signs for coronary heart diseases also show a similar distribution of frequency. Likewise in psychiatric patients seems to be an agreement with the coronary morbidity and the somatic risk factors.

[Coronary heart disease in hospitalized mental patients. An electrocardiographic prevalence study]. / Koronare Herzkrankheiten bei hospitalisierten psychisch Kranken. Eine elektrokardiographische Prävalenzstudie

Altogether 1707 permanently hospitalized patients aged from 40 to 69, from 8 psychiatric hospitals in Germany, were investigated for the occurrence of electrocardiographic signs of coronary heart diseases. ECG changes which indicate a past infarction or a coronary insufficiency with great reliability were found almost not at all in patients under the age of 50, in men aged from 50 to 59 years in 7.0%, and aged from 60-69 in 11.8% of cases. In women of corresponding ages the figures were 3.8 and 10.8% respectively. Compared with a non-psychiatric population, there were suggestions of a slightly higher prevalence of coronary heart diseases in the psychiatric patients.

[Course and prognosis of panmyelopathy and isolated aplastic anemia. Retrospective study in 70 patients]. / Verlauf und Prognose der Panmyelopathie und der isolierten aplastischen Anämie. Eine retrospektive Studie an 70 Patienten

From 1967 to 1972, 70 patients with aplastic anemia were observed and followed up to death or at least two years. 3 cases of pure red cell anemia, and 2 cases of amegakaryocytic thrombocytopenia are included. Detailed investigation of drugs taken within 6 months before onset of the disease revealed chloramphenicol in 20, butazones in 11 cases. Acute viral hepatitis preceded the hemopoietic failure in 2 patients. In addition to various combinations of anemia, granulocytopenia and thrombocytopenia, monocytes were diminished in 35 and lymphocytes in 12 cases. Acid serum or sucrose tests were consistently negative. The patients were treated by short-term prednisone, long-term androgens and red cell and platelet substitution as needed. 2 years after onset of the disease, 33 per cent were in partial or complete remission, 30 per cent survived without remission, and 35 per cent had decreased. Correlation of various parameters with remission and survival showed the presence of a subgroup at risque, comprising patients with low marrow cellularity and clinically relevant diminution of all three cell lines at the time of diagnosis. Absolute lymphopenia and increase of plasma cells in the bone marrow were of poor prognostic significance. In this subgroup two years after the onset of the disease only 32 percent survivors and 16 per cent remissions were recorded. There was no conclusive evidence for the therapeutic value of prednisone or androgens in our series. The present situation in severe aplastic anemia requires more effective forms of treatment and justifies experimental therapies like bone marrow transplantation.