1

Wireless Medical Delivery Configuration for Remote Housing Communities
 
Author: Michael Adeyinka
Laboratory for Biomedical Informatics, Amersfoort, The Netherlands
 

The LBMI wireless medical delivery workstation is configured to constantly monitor the prevailing physiological conditions of people in need at remote sites or during transportation, prior to hospital treatment. The basic configurations, for which several applications are envisaged, consist of processor-controlled mobile as well as hospital display workstations. Based on the GSM data network, the systems guarantee data transmission during transportation of the patient to the hospital. This paper describes one of the field tests, carried out to initiate the air-borne remote medical delivery at the "Nieuve Levenskracht" remote housing community in the city of Amsterdam in the Netherlands.

2

Informatic System for Treatment Assistance Using the Microsystems of Traditional Chinese Medicine (MICROAC)
 
Authors: Simona Alecu, Adina Raclariu, Lavinia Nanu
Software ITC, Bucharest
 

Perceived as a sensitive organ, the skin surface participates in the man-environment information exchanges and allows a better adaptation of the individual to the permanent changes that take place. At this level there are certain areas of energetic projection of certain organs and functions. It is known that the structure of the organism is conceived based on the holographic pr

By the stimulation of certain well-specified points of these areas (face, nose, tongue, hand, foot, ear, skull) new variants of the treatment by acupuncture are defined, grouped under the term of Microsystems.
The indications specific to these points with a local/regional action or action at a distance, are represented by dysfunctionalities and affections of the principal organs and systems. The contraindications are those of acupuncture generally, but risks are smaller.
The MICROAC system, which offers the possibility of choosing the treatment on the basis of Microsystems of Traditional Chinese Medicine (ear-acupuncture, sole-acupuncture, hand-acupuncture, face-acupuncture, nose-acupuncture etc.), has been developed to assist the specialist in acupuncture and supplements the informatic system for diagnosis and treatment assistance in alternative medicine (COMPAC). It can be used as an independent informatic system or can be included in the COMPAC system.
The system provides lists of disfunctionalities of organs and systems, allowing the user to be informed what Microsystems can be used for the treatment for a selected disfunctionalitiy and also the recommended points. For each point detailed are displayed, including:

• The area (example: in hand-acupuncture the area can be the dorsal or palmar face of the hand);
• Location with the aid of anatomic marks either described and described and/or displayed on anatomic charts);
• The energetic action of the point;
• The indications and, where is necessary, the specific contraindications.

3

 
The SIMDS Systems. A Software Product for Assisting Medical Practitioner in Diagnosis-Making

Authors: Marilena Badica*, Nicolae Vasilescu*, M. Munteanu**
*ICI, Bucharest
**"Marie Sklodowska Curie" Children Clinic Bucharest

The MSD model for assisting medical practitioner in diagnosis making is the core of the SIMSD system. The structure and operation of the SIMSD system are described.
The system consists of three subsystems:

• The medical practitioner interface subsystem;
• The medical data acquisition and management subsystem;
• The medical data processing subsystem.

4

 
Medical Informatics Training Programme to Support the Romanian Health Care Management Informatics System

Authors: Mariana Bazavan, Rodica Dimitriu
National Center for Health Statistics, Bucharest, Romania

The Health Management Information System (HMIS) project initiated by the Romanian Ministry of Health as a component of the healthcare reform is aiming to ensure the technical, functional and operative support for:

i) a better overview of the population health status, of the medical care needs and of the Health System performances;
ii) the improvement of the resource allocation and consumption;
iii) reform support.

This system is supposed to assure a better information flow from the lower to upper levels of the healthcare network by help of a modern IT support. In the first development stage the system is planned to link the Ministry of Health with the 41 District Health Authorities (DHAs) and with over 200 pilot health units. The Ministry of Health is now preparing for the big IT change. The implementation of such a large system raises serious problems of acceptability and a through training programme for both technical staff and end users must be considered in order to face this challenge.Before starting the design of the training programme to support HMIs we took into consideration several important premises:

1. Objectives of the training programme:

• how to meet the HMIS needs

• How to manage training resources

• Working frame and standards
• to establish development guide lines for medium and long term.

• knowledge transfer channels
• distorting factors and teaching barriers
• teaching feedback
• catalysts to teaching
• training resources: time, trainers, teaching equipment, rooms, communications, means, costs.

• meeting the HMIS needs:

• Training resources management:

• Training resources assessment: the number of qualified trainers in applied computing in medicine is very small and the peculiarities of the work developed by the people in health care makes difficult their scheduling for training courses. How did we solve these problems? The paper is presenting also.
• Minimal resources estimation: in order to cover Romanian territory four geographical zones where considered to host training centres: Bucharest, Piatra Neam?, Baia Mare and Timi?oara. Ten districts are assigned to each training centre. The selection criteria for establishing the towns to host the new training capacities took into account cost efficiency demands and logical factors.
• Working frame and standards:

• Development guide lines for medium and long term:

 
5

 
 Business Process Reengineering for Medical Information System
 
Authors: Boldur Barbat*, Paltin Sturdza**
* Lucian Blaga University Sibiu, ICI (Research Institute for Informatics), Bucharest, Romania
** IDS Distribution Partner for Romania, Bucharest
 

Key words: Medical Information Systems, Business Process Reengineering, ARIS, ARIS Hospital

ABSTRACT

1. RATIONALE. Business Process Reengineering (BPR) is a major trend in information technology today and it is deemed to shape the medical information systems as well; this holds true particularly for Romania which is involved in an overall social and economic restructuring, including its health care system.

2. PARADIGMS. Processes in modern business are modelled considering technology, business efficiency, and human factors; the three topics are surveyed with emphasis on the role of the last two ones. Products and services tend to become global, knowledge-based and client-driven; hence, the modern enterprise evolves into a reenginered, extended, virtual, and/or learning one. Some of the new key concepts, applicable as well to hospital or regional health care systems, are briefly outlined (e.g. virtual, anthropocentric, holonic).

3. BUSINESS PROCESS REENGINEERING FOR HEALTH CARE. Based on the equivalence between (business) process and (clinical) case, the main paradigms, methods, and concepts are adapted to the context specific to health care. The challenge of "reengineering a virtual hospital" is explored.

4. ARIS: ARCHITECTURE, METHODOLOGY, TOOLS . A software platform for the BPR in the health care systems is presented as an ARIS (Architecture, of Integrated Information Systems) application. The following topics are introduced:

- The "ARIS House of Business Process Engineering" as an architecture for the whole software development life-cycle.
- Integration of the data, control and functional views.
- Process Design (description of processes using event processing chains: events functions, logical connectors).
- Process Management (scheduling monitoring and process control).
- Process Workflow ( activation of manual and automatic activities according to business process logic).
- Process Application (derivation and configuration of software systems using reference models).

The general description is followed by some details about the four-level architecture of its application "ARIS Hospital", tailored for health care systems.

5. CONCLUSIONS. The business - and human - oriented approach rather than the technology-driven paradigms are now a dominant trend in medical information systems. A BPR solution based on ARIS will offer a holistic view at a regional as well as at a clinical hospital level and will constitute a precondition for a successful medical information system.

 
6

 
PUPIL-CAL a WWW Computer Aided Application
 
Authors: Sandor Ianos Bernad*, Elena Silvia Bernad**
*University "Politehnica", Faculty of Mechanical Engineering, Department of  Hydraulic Machinery
**University of Medicine and Pharmacy, Department of Medical Informatics

The testing of pupillary size and reactivity yields important, often vital clinical information. So, we have designed and developed a World Wide Web (WWW) application called: PUPIL-CAL-pupil –computer aided learning application. The theme is: the pathology of the pupils. PUPIL-CAL was realised for a better understanding of the phenomena. We chose WWW and the Internet because is by far, the most sensible approach in terms of universality, low cost and growing potentials.

The program present physiological and pathological aspects of the pupils. The user can navigate very easy through the medical notions using the hyperlinks were created. The included pictures realise a better understanding of the presented notions.
The application was implemented using Internet Assistant for Word program, where we created an HTML-hypertext markup language-document. The pictures were realised with 3D-Studio and Adobe Photo Shop programs.
The system may be used by students and resident doctors, or by anybody who wish to learn more about the pathology of the pupils.
 
 
 
 
 
 

 
7

 
Eye movement pathology by infranuclear injury - a computerized textbook

Authors: Elena Silvia Bernad*, Adrian Frantescu**, Sandor Ianos Bernad***
*University of Medicine and Pharmacy, Department of Medical Informatics
**County Hospital, Department of Neurosurgery
***University "Politehnica", Faculty of Mechanical Engineering

A combination of the theoretical notions and clinical examples is a really good method to learn the medical pathology. Therefore, we realise an application which subject is the pathology of the movement of the eyes, by infranuclear etiology. It is a new version of the MOON-english application, extended for infranuclear injury.

The program contains two parts. The first part is a Visual Basic and Help Compiler application. In this part is presented theoretical aspects of the eye motility. This part is divided according to the categories of the etiological factors, and for each category is presented physiological and pathological aspects. The second part is a database, which contain clinical cases from the Timisoara County Hospital, Department of Neurosurgery. We utilise these clinical cases such examples for the described pathology. This part of the program was realised in Microsoft Acces. In this part, common statistics is available.
So, with this program, the user can learn about this kind of the pathology, can complete the database or can use the data to realise medical statistics.
A demonstrative program is accessible on the Internet.
 
 
 
 
 
 

 
8

 
 Statistical analysis of some epidemiological index in lung cancer
 
Authors: Dr. Cazacu Andreea-Cristina, dr. Comanescu Denise-Georgiana
U. M. F. "Carol Davila" Bucuresti
 

Background: Malignant tumors represent one of the top causes of mortality in the world, but also in Romania. Among them, lung localisation is the most common. The late onset of the signs and symptoms, the difficulty of diagnosis and the limitations of the therapy are some of the causes of high mortality in lung cancer.

Methods: We describe the evolution of incidence, prevalence and mortality from lung cancer during the period 1981 - 1995.

Results: The mean incidence calculated for the period 1981 - 1995 is higher in men than in women and also is higher in the more advanced stages with maximum in the 4th phase. The evolution of the incidence during the period that we mentioned has an ascendent curve with a peak in 1988, then descendent slope until 1993, but we noticed a maximum in 1994. The prevalence evolve almost the same with small differences: the most prevalent stage is the third, the curve is acendent for the whole period and the peak is reached in 1992.
The death rate is higher in women than in men and has an ascendent slope for the period 1981-1995 with the maximum in 1995. Lung cancer remains the firs cause of death among all patients with cancer.

Conclusions: Lung localisation of malignant tumor is one of the main causes of death in patients with cancer. The incidence, prevalence and mortality continue to raise in spite of knowledge and therapy methods that we develop.

9

 
I.C.N.P. in Mures County

Authors: Elisabeta Cioara*, Ioana Moisil**
*Health Administration of "Mures" County, Targu Mures, Romania
**Romanian Medical Informatics Society, Bucharest, Romania

Telenurse project is a European project coordinated by Mrs. Randi Mortensen from the Danish Institute for Health and Nursing Research, Copenhagen, Denmark.
The main objective of the project is to adapt and disseminate the Romanian Version of the International Classification for Nursing Practice (ICPN), as well as, to collect the comments on this version providing the promotion of the use the ICPN an associated with a minimum clinical nursing data set into the computerized care records.

Considering, the fact that, in Mures County there are Clinics and Hospitals all fields of speciality this aspect allows to explore the various concepts related to the Classification of Nursing Practice according to various specialties.

The paper presents the main factors of the strategy at Mures County level for to adopting Alfa version of ICNP in Romanian and also the foreseen actions for disseminating the concepts connected to this classification.
 
 
 
 
 
 
 

 
10

 
Use of Hierarchized Modular Systems as a Micro-Populational Model of Partially Controlled Epidemics
 
 Authors: Al. Cristea, C. N. Zaharia
 Institute of Virology, Bucharest, Romania

A community is presented, in which develops a viral epidemic partially controlled by a hierarchized three-level system:

• the first level, the highest, SUPL, corresponds to the decision compartment of antiepidemic network, which elaborates optimized antiepidemics programs, in dependence on the available resources;
• the second, intermediate level, INTL, corresponds to the implementation compartment of the antiepidemic services to their potential beneficiaries;
• the lowest level, INFL, corresponds to the community, in which the respective viral epidemic spreads by the normal epidemiological interactions between the contamined and the susceptible persons; the epidemiological attributes of the individuals involved in the epidemic (determining the spreading velocity of the respective virosis within the community) make the object of the antiepidemic services, assured by the agents of the epidemiological network.

• to SUPL corresponds an evolutive algorithm optimizing the antiepidemic program;
• to INTL correspond

• a neuronal network, performing the repartition of resources among the various agents of the network;
• a cellular automaton, returning the actions of these agents to the individuals on the INFL;

• to INFL corresponds a cellular automaton, the reccurence rules of which are determined by the intensities of the elementary processes, that condition the spreading of the viral epidemic.

The AI module couplings, which corresponds to the intra-and inter- levels relations, to the inputs and outputs of these levels, are fixed in an integrated functioning of the whole hierarchized modular system; the learning and the restructuration regimes of the system are defined, too.

Numerical applications, simulations, associated to viroses with a fast or slow course, to more simple or to more complex evolutive modalities are shown.
 

11

 
 Integro-Differential Equations of Macro-Populational Models for HIV Virus Induced Epidemics and Their Approximate Analytical Solutions
 
Authors: Al. Cristea, C. N. Zaharia
Institute of Virology, Bucharest, Romania

For the viroses with a slow course HIV virus induced disease type, the respective epidemics can be modelled – at a macro-populational level, by using (for the numbers of patients in the various stages of disease), integro-differential Equations, which take into account the great dispersion of the duration of these stages of the mentioned virosis.

The transition rate from one stage of the virosis to the next stage is obtained by means of a convolution of the number of individuals from the previous stage with the probability duration distribution of the respective transition.

For the initial stage of the epidemics, in which the total number of susceptible individuals is not modified significantly, the equation of the number of asymptomatic contaminated subjects is a linear equation, solvable by a Laplace transformation, which converts the integro-differential equation into an algebraic equation for the Laplace transforms of variables. These magnitudes once determined, the reverse Laplace transforms determine the number of patients in the various stages of the disease, in dependence on time.

By using the theory of Ricatti equations, the gama of the Laplace transforms utilization widens, including also the consideration of typical susceptibility variations over time; the approximate analytical solutions obtained permit us to specify the global parameters of the HIV virus induced epidemics.

The former results are applied to the analysis of AIDS epidemic in various European countries, inclusively in Romania.

12

 
 The it Role in the Hospital Management
 
Authors: Daniela Crivianu-Gaită*, Fl. Miclea**, Dan Farcas***
*County Hospital of Timisoara, Computer Department
** County Hospital of Timisoara
*** National Center for Health Statistics

Hospital are facing increasing demands to control costs, improve productivity and maintain or improve the quality of care.

There are many hospitals in which the administrative activity is fully or partially computerised. We have evaluated the use of information and IT in general practice enviroment. We observed that in many cases the technology was applied only for its own sake. Used effectively, the existing computers and communication systems can greatly enhange managers' ability to make better decisions, monitor their organisation and have firmer control.

We have considered 3 levels of information: operational level, management level and strategic level. The operational level takes into consideration the basic information (at atomic level). The management level implies the monitoring of the organisation and the interpreting and analysing the data. The strategic level refers at the external data and gives possibility to analyse the direction in which the organisation is going.

The IT can help the manager to better understand the organisation situation, to measure the benefits, the mesaure the costs and can be support for the strategic level. Of course, the information is unstructured and the decision is patially intuitive, but the IT role can not be denied.

We developed a project in order to demonstrate the advantages and disavantages of computerisation to general practice and improve the use of existing technology. In many hospitals there is still a lack of IT resource (for example: the number of persons which are dealing with IT is still very small). Many managers expect that their information systems will solve all the problems. In this order, we defined the management culture and the competence to use and manage IT.
 

13

 
Choosing the Modality of 3D Representation
 
Authors: Daniela Crivianu -Gaită*, Fl. Miclea**, Diana Lungeanu***
*County Hospital of Timisoara, Computer Department
** County Hospital of Timisoara, Urology Clinic
*** University of Medicine Timisoara, Medical Informatics Department
 

3D imaging is considering to be a modern tool that can be used both by the radiologist and surgeron, forming a basis for presurgical planning and serving as a reference during surgery. It is also used, with excellent results, in extending the knowledge of the human body.

The displaying of the 3D objects can be done using several algorithms. The authors have tried and implemented two of these algorithms: the depth algorithm and the wireframe techbique.

Highly - complex graphics algorithms (like raytracing algorithm) are leading to real beautiful 3D presentation of anatomic objects, but they took a long time for representations. Whenthe efforts are focused to the clinical usefulness of the software application, these algorithms are not adequate.

When the most important element of the softwatre application is a value (volume, surface) or/and the software is designed for an interactive work - during the consultation - one of the best solutions for 3D representation is the depth algorithm. In this case, the pixels corresponding to points closer to the observer are coded with brighter colours. The depth algorithm is well suited for organs which do not have a complex exterior surface.

Starting from bi-dimensional representations it also possible to built a wireframe representation of the organ of interest. The wireframe representation took into account the hidden parts of the object (which will not be drawn) and the particular irregularities of the organ of interest. The wireframe representation is very close to the real one, offering significance information about the size and the shape of the organ interest. We used this method in the case of the prostate. The 3D representation obtained gave precious information about the shape of the prostate, especially in the case of prostatic cancer, being able to show the asymmetrical modifications of prostate.

 
14

 
 Pattern Recognition with Cellular Automata
 
Authors: Monica Dascalu*, Eduard Franti**
* "Politehnica" University of Bucharest
** National Research and Development Institute of Microtechnology
 

The paper introduces a parallel algorithm for letter recognition and describes the circuit that implements this algorithm. Both the algorithm and circuit are based on the cellular automata model are original contributions of the authors. A two-dimensional cellular automata consists of a lattice of simple processing elements also named cells. Most frequently, the connection network is rectangular. The cells are identical finite automata. All cells evolve synchronously following local rules. This means that all cell's states are update synchronously. The next state of one cell depends on its present state and on the states of its nieghbours in the network. The algorithm for letter recognotion is based on the fact that the significant information about a letter is given in fact by its external contour. In principle, the letter recognition is made in three steps, as follows:

(a) Standardisation - the letters are transformed in a form that can be recognised easier. We have chosen a "stand" form in wich the corners, if they exist, are evidentiated (completed to a rectangular corner).

(b) Detection of the contour of the new shape of the letter. Note that this contour can be placed anywhere inside the surface.

(c) Decoding the information given by significant points on the contour.

If we use the cellular automata model to apply this algorithm, the picture of the letter will be the initial state of the automata. We have chosen a two-dimensional cellular automata with 45x45 cells, each of them having two possible states, 0 and 1; if the picture of the letter is black on white, than 0 is for white and 1 is for black. Each cell of the automata is connected to its incarest four neighbours. The local rules shall be determined according to the neccessary processing. The first two steps of the algorithm are implemented by the cellular automata by means of appropiate local rules, the last step is a simple transcoding solved by an external logic circuit.

The algorithm described above can be easily implemented with a cellular automata having an external controler (note that this controller plays mainly the role of timer and cannot be considered to be a control unit) and a logic transcoder 12-to-6 bits. Each cell should be able to perform one of two rules at a time, because the recognition sequence has two steps. At a local scale, it is not important capable of performing one of two rules: the simplest way to do this is to select the outputs of two different logic circuits, one for each rule. The algorithm presented can be extended for different sets of characters or other forms, not only for letters. The circuit can also be realised in a generalised form, containing more the transcoders (one for each set of forms). Our results make us belive that is possible also the recognition of letters in any position (rotated).

The algorithm is very simple and efficient, for the dimensions discussed are necessary only 30-35 time steps for the recognition. The circuit is in its turn extremely simple.

 
15

 
 Program Package for the Evaluation of the genetic Factors Involved in the Etiopathology of Type I Diabetes Mellitus
 
Authors: V. Dadarlat, C. Ionescu-Targoviste, I. Ferariu
Software ITC-SA, Bucharest, Romania
"N. Paulescu" Institute of Nutrition and Metabolic Diseases, Bucharest, Romania

The GebDiab program package is designed to assist the medical research of the genetic factors involved in the etiopathogeny of insulin-dependent diabetes mellitus.

The functions provided are:

• record keeping – allows the addition of new ecords, the modification of existing ones, the deletion of records and the printing of one more records.

• generation of genealogical trees – allows the graphic representation as genealogical trees of the information recorded for three generations of the analyzed subject. The system uses characteristic symbols, which vary as a function of sex, presence of diabetes mellitus, type of diabetes mellitus (type I, or type II- by diet, oral medication, insulin-dependency), et.. Each node of tree is characterized by information referring to parents and at most 5 siblings (their year of birth, sex, type of diabetes mellitus, age at onset of diabetes mellitus, year of death etc.). The genealogical tree also reflects other information such as the distance between generations.
• Statistical processing – allows the analysis of the mode of transmission of the disease by genetic factors over 3 generations.
• System administration – function designed for the saving / restoring of the large amount of information recorded on / from diskettes as well as the setting of the type of printer existing in the hardware configuration of the user.

• The GenDiab system allows the recording of a large amount of information;
• The GenDiab system provides facilities for the recording / visualization / modification / deletion / printing of the data;
• It allows the generation of the genealogical tree of the analyzed subject over three generations;
• Provides a wide range of types of statistical processing of the information;
• Allows saving / restoring of the data bases and the settings of the type of printer in the hardware configuration;
• Provides fast and high-quality processing of information, increased maneuverability and an attractive user interface.

The statistic relation between RR-QT in humans is modeled by a non – linear transfer function, relating mean QT to mean RR (Bazett rule), while the dynamic relation is modeled by a low-pass filter with a time constant of about 44s in young. By the latter mechanism, sympathetically-issued RR-waving within 0.1 Hz spectral band (LF: 0.04-0.15 Hz) attenuates to a RR-coherent, one order-of –magnitude lesser fluctuation in QT interval. Physical or mental stress (MS) activate an idioventricular (IV) contribution to QT-LF, that can be disentangled using RR*QT coherence spectrum. While sympathetical message is beyond any question within this band, the neural system(s) involved remain(s) unclear since every efferent traffic to the heart is 0.1 Hz modulated, whereas both a 1 and b 1 , and still, muscarinic stimulation can affect repolariozation in myocardial fibers.

Methods: After informed consent 14 healthy males, aged 19-20, went through: 1) baseline (B) in relaxed supine (10 min.); 2) mental stress (S) by recorded Kraepelin arithmetic test paced at 1 item / 3 s (5 min.); 3) intravenous propanolol (P) 0.4 mg/kg infused in 15 min.; 4) atropine (A) 0.02 mg/ kg in 2 min.; 5) 10 min. rest; 6) repeated S. A thoracic ECG was recorded at 1 ms resolution (Codas Dataq Instruments, Akron, OH ) and beat -by-beat RR and QT series were derived and resampled at 500 ms. The most RR-stationary 3 min epochs yielded RR and QT Fourier autospectra and RR*QT mean squared coherence (MSC) spectrum smoothed with a 9 line moving triangle. To get Qt-LF’s idioventricular fraction (IV QT-LF) by removing RR-coherent influences, we multiplied each QT-LF power-line by [1-MSC] at that frequency-line.

 

Setting/variable	mean  RR[ ms]       RR-LF[ ms2]        QT-LF[ ms2]        IV QT-LF[ ms2]
Stress	740± 124                    631± 545                  1.62± 1.42                0.53± 0.64
Wilcoxon p	0.0017                      NS                            0.0211                     0.0133Ä
Baseline	842± 144                 556± 502                0.93± 0.82              0.38± 0.65
Wilcoxon p	0.0017                      0.0017                     NS                           NS
Propanolol	989± 158                   1030± 693                 0.80± 0.36               0.24± 0.11
Wilcoxon p	0.0017                      0.0017                     0.0207                    NS
Propanolol&Atropine	567± 57                     1.2± 0.8                     0.46± 0.32               0.35± 0.25
Wilcoxon p	0.0592                      0.0057                     NS                           0.0564Ä
Propanolol&Atropine&Stress	578± 49                     2.9± 3.2                     0.57± 0.32               0.38± 0.21
Remarks	P&AvsB=0.031     P&A&SvsP=0.0499

Results and discussion: see table (averages ± ?SD) with 2-tailed Wilcoxon p (Ä 1-tailed to test IV QT-LF stress-responses) for comparisons inter-lines or as remarked. IV QT-LF is significantly higher in ‘propanolol & atropine & stress’ versus "propanolol only", when a ₁-only-mediated stress effects and norepinephrine-release supra-activation by muscarinc blockade and perhaps synergic. Decrease of QT-LF under "propanolol & atropine" versus both "baseline & propanolol" reflects dramatic fall or RR-LF due to vagal blockade.

Conclusions: Sympathetic and/or vagal vehicle may be consequential in using QT-LF as sympathetic drive to ventricle index for reading in terms of stress-dependent arrhythmia and sudden death risk in cardiac patients. In our study, joining cross-spectral methods to a clinical blockade study suggest an adrenergic mechanism involved in QT-LF response to mental stress. Spectral QT cues as derived from high resolution Holter ECG hold promise to non-invasively access adrenergic neural drive to ventricles.

 
17

 
Strategic problems in development of health information systems in Romania
 
Author: dr. Math. Dan D. Farcas
Center for Health Information and Statistics Ministry of Health Bucharest, Romania

The development of health information systems is a complex activity, which has to be designed in the frame of a concept of "system of systems" (rather than in a simple pyramidal structure) with many independent users, having their own goals and means. There are at least five categories of such health information systems:

1. The Health Management Information System (Ministry of Health, Center for Health, Information and Statistics, District Health Autorithies, etc.)
2. Health Insurance Information System (National Health Insurance House, District and Territorial Houses, other health insurance companics).
3. Information systems of health care units (hospitals, polyclinics, dispensaries, emergency units, drug distribution, blood centres etc.).
4. Information systems of health research and education (Academy of Medical Sciences, research institutes, medical universities and faculties, other medical education centres, medical documentation etc.).
5. Information systems of other national medical organizations (College of Physicians, Pharmacisis, trade unions, other NGO-s, etc.)

The development of all these information systems separately will lead to unnecesary parallelism and duplications, differences in definitions and coding, problems in data exchange etc. Resulting in lack of efficiency and high costs. It is recommended therefore to establish some regulations concerning these systems. For example, about data exchange: The Health Management Information Systems could establish a wide palette of coding and lists, as well as will administrate data bases with the main health indicators, giving them to all other systems, The National Health Insurance Systems could offer statistics about health services etc. It is useful to design for the health care units standard interfaces to the many national systems, to avoid unnecesary duplications both in program development and current use. There are many similar issues and it is recommended to include them in a health information systems strategy, approved and susteined by the national management of health care.

 
18

 
Statistical Processing for the Correlation Between the Skull-Facial Types and The Muscles of the Dental-Maxillary Apparatus for Children with Dental-Maxillary Anomalies
 
Authors: Gabriela Georgescu*, Georgeta Zegan**
*Department of Medical Informatics U.M.F. "Gr. T. Popa" Iasi, Romania
**Department of Orthodontic, U.M.F. "Gr. T. Popa" Iasi, Romania

The purpose: The success of the orthodontic treatment is to exactly establish the perturbations for the oral functions and, implicitly, for the lacks of balance muscular masticators and oro-facial groups, to create the synchronism between the three components of the dental-maxillary apparatus (D. M. Ap): teeth, temporal – mandible articulation, nervous-muscular system, to eliminate the contrary forces. The purpose of this paper is to present the correlation which appears between the perturbation caused by the dental-maxillary anomaly (D.M.A) and the growing of the D.M.Ap.

Material and method: It is was studied a lot of 52 children with ages between 6-18 years old, with D.M.A., and it was accomplished global electromiographies on the buccinator muscles, orbicularis oris and mentalis. It was used an MEDIKOR 21 electrmiograph, with 2 channels and surface electrodes, and it was made the detection examination for the voluntary contraction of the studied muscles. It was established by anthropometric measurements the cephalic and facial index and the type on facial growing for each patient. The statistical processing were made on a Pentium computer, using the SPSS and EPI-INFO 6 software, and t-Student and Fischer statistical tests.

Results: The analysis of the mean values for the EMG voltages of the masticators and facial muscles shows significant differences between muscles, determined by the skull-type, the facial-type and the facial rotation (p< 0.05).

We establish also a correlation (+) or (-) between muscles and cephalic, facial index and type of facial growing, using the linear regression (C_alculated<F_table).

Conclusions: The genetic patterns of cephalic and facial growing and of facial rotation influence the maximal voluntary contraction of the masticators and facial muscles, in interaction with the D.M.A.

 
19

 
 Education Assisted by the Computer.Ways of Achievement and possible Applications
 
Authors: Gabriela Georgescu*, Cristina Dascalu**
*Department of Medical Informatics U.M.F. "Gr. T. Popa" Iasi, Romania
**Department of Orthodontic, U.M.F. "Gr. T. Popa" Iasi, Romania

The purpose: To achieve programs for information and research, with a "friendly" interface, which allows to find quickly a special subject, in a easy well-useful in any scientific domain.

Material and method: We use the program "Help Compiler", which allows to create hypertext; the files created are collected in a hyper-document using the Visual Basic language programming. Strong functions "Help Compiler" program (used and presented):

• The possibility to use text created in Word for Windows, with any type of fonts and any height for letters, including the True-Type fonts and the special commands for formatting in Word for Windows, which are accepted without problems in a file with the "Help file" type;
• The possibility to include drawings or pictures created in Corel Draw, for example; we can use such pictures without special troubles, after we convert them;
• The possibility to create pages for jump: we can activate a new page by moving the cursor on a special word or picture; this page can contain a short definition, showed in a small window, or another picture showed in the same way, or a different paragraph, showed in a main window with the same aspect like the start window; we can use any number of levels for these pages for jump, so our document becomes unitary.
• The possibility to create an index with a number of keys words, so we can find quickly the information about a special subject.

Conclusions: This method allows a quick find, based on the logical links used by each reader, a quick search of words or information and a pleasant browse of information, with pictures and, eventually, animation and sounds with a high level of accuracy, in any activity domain and using database with an access at information on the "hyper-text" way.

 
20

 
The Multiple Regression Analysis in the Evaluation of Mitral Valve Prolapse (MVP)
 
Authors: Gabriela Georgescu*, Catalina Arsenescu**, George Georgescu**
*U.M.F. "Gr.T.Popa"- Medical Informatics
**U.M.F. "Gr.T.Popa"-Clinical of Cardiology

The purpose: The evaluation of correlation between clinical and echordiographic parameters using the multiple regression analysis method. The sample analysed: Was analysed a cohort of 166 patient (67 M/67 F) with the age between 14-76 years (37.2 15.7) with certainly diagnosis of MVP established on the standard criteria.

Material and method:

The parameters analysed: Demographics and anthropometrics: age, size, weight, bodily area, parameter Quetelet, deviation of ideal bodily weight.

Clinics: symptom (palpitation, chesty pain, syncope), ascultatie, cardiac failures, infective endocarditis, embolies, demises.
Radiology: Cardithoracic index.
Electrocardiography: left atrial/ventricular hypertrophy, arrhythmia.
Ecocardiography: amplitude, location and chronology MVP, size of mitral valve, redundant of the valve, mitral annular diameter, the location of the coaptation point, injure association, sizes of cavities and of walls, kinetic parietal, ejection fraction, brief fraction.
Statistic analysis: Developing on the IBM Dx – 486 computer with the statistical programme SPSS witch determines the variable y dependence from the independence variables x1…xn.

Results: Between the numerously correlation examined present only those with the maximum relevance clinic and statistic significant (p<0.005).

Systolic breath in PVM=0.1+0.62* NYHA2 class +0.6^* NYHA3 class +36* vegetation VM +0.24* ruptured leaflets or chordae

endocardita infectioasa = 0.01+0.2 * systolic breath in PVM

mitral diameter annular 1 (DIM) = 7.32 + 0.16 * ^short axis AS + 0.08 ^* long axis + 1.46 *

thickness VM(PAL) + 0.43 * amplitude PVM + 2.56 * coaptarea în AS a VM + 4.65 *

NYHA3 class

amplitude PVM =1.11 + 0.44 * thickness VM(M mod) + 0.11 * DIM + 1.81 * coaptation în AS a VM

 The polynomial regression permit establishing the intensity of the dependence between the different clinic and echocardiographic parameters who characterize the MVP.

 
21

 
Evaluation and Validation of the Health Care System by the Theory of Pathologic
 
Authors: Dr. Andrei Dumitru Iacobas, Ionela Iacobas
Department of Biophysics and Biomathematics, Faculty of Medicine, Ovidus State University, Constanta , Romania.

Purpose: The major difficulty in mathematical modeling of medical treatments is the high diversity of the involved parameters. The natural parameters must be transformed into standard scores, to have the same units. This transformation allows the practitioner to introduce rigorous criteria in evaluating the quality of the medical treatments, and to (re)define mathematically the synergism of medical treatments.

Method: The pre-Hilbert space of normal and pathological states of the human body is built based on the set of standards scores associated to an orthonormal set of parameters describing the actual situation of the patient. Every point represents a possible state and every continuos and smooth curve a possible evolution of the situation. Whatever be the behavior of the body, the space is transformed homothetically into itself, so that the 0-centred unit hypersphere, representing the subspace of the physiological stable states, remains invariant. A good therapy must produce a big therapeutical effect in a small interval, with high protection (i.e. small stress) and small relative cost. Therefore, the best global criterion to choose the treatment is the value of its therapeutical efficiency. The evolution of the sufferer because of two distinct treatments, as applied independently or simultaneously, is analyze the synergism of treatments. They are the protection index and the therapeutical efficiency.

Results: Old medical notions and indices, like: the pathologic of a state, the drug, the treatment, the therapeutical effect, the therapeutical stress, the protection index, and the therapeutical efficiency got new mathematical definitions in relation with pre-Hilbert space of states. The intensity of the synergism of two treatments is expressing their therapeutical effect, their protection index, and their therapeutical efficiency. The formulas are generalized by complete induction to fit the usage of any number of simultaneous treatments. Every theoretical results illustrated by some applications in internal medicine. Interesting clinical results of the theory have been obtained recently by a group of students from our medical faculty.

Conclusions: The theory is a general framework to represent and optimize the medical action. It provides a mathematical background that makes possibly the computer modelling of the treatment to choose the best posology and to find the best combination of two or more synergistic treatments. It introduces new and rigorous criteria to evaluate the health care system and to promote the personnel.
 

22

 
Computer Based Program for Psychiatric Assist Diagnostic
 
Author: Rodica Jeican
Psychiatric Clinic, Cluj-Napoca, Romania

This software draws up a method with the computer’s help, witch can assist the psychiatrist to an accurate and correct diagnosis of the patient with the psychiatric problems. With this software it can be modernize the act of diagnosis in psychiatry. The minimum requirements of this software are a 386SX (or better) with 4 Mb RAM and 4 Mb HARD, and can run on Windows 3.1 and on Windows 95 system

Because it is different than other medical specialties, the psychiatric diagnosis can not be fit for computer models. Anyway, certainly, in our country, the psychiatric diagnosis is not carry out with computer methods, and as know till today, abroad, the known diagnosis methods give information about groups of psychiatric diseases. They were not relevant or efficient till the end, and they were not generalized in the current medical practice.

I mention from the beginning, that this method is use after the psychiatric examination by the doctor, and it doesn’t interfere with the patient to doctor relations, witch may and can follow normally. The final diagnosis remains anyway the doctor decision.
This method consist in a create and follow up three essential steps.

1. The display of the psychiatric observation sheet, witch is complete and synthetic. This sheet includes the psychiatric semiology from where the doctor selects the data for his diagnosis. This sheet is fill in by the doctor.
2. The full display on the computer’s screen of the psychiatric diseases as in the World Health Organization classification, codify with with one, two, three or four numbers from where, the doctor can choose more easy (there are 435 codes).
3. Based on the signs, the data witch were noted in estimation of the present syndromes will make an probabilistic estimation of the present syndromes of the current case, giving an approximate orientation of diagnosis.

23

 
 
Dental Informatics at the University of Medicine and Pharmacy in Timisoara
 
Authors: Diana Lungeanu, G.I. Mihalas
University of Medicine and Pharmacy Timisoara, Department of Medical Informatics

The paper presents our strategy for adapting a curriculum in medical informatics for the students in dentistry. The objectives of our courses and the design of the curriculum, as well as the examination methods are presented. These are also presented some considerations related to our "external" collaborations meant to compensate for the lack of medical informatics specialization in our universities. Finally, future trends and perspectives of informatics in dentistry and dental informatics education are discussed.

 Keywords: Dental Informatics, Curriculum, Medical Informatics, Medical Education.
 
 
 
 
 
 
 
 
 
 
 
 

24
 

A computer-assisted study in Dermatoglyphics: a tool for diagnosis in under-developed countries
 
Authors: Silvia Mandasescu*, Bernard Richards*
*Department of Endocrinology, Roman County Hospital, Roman, Romania
**Department of Medical Informatics, UMIST, Manchester, England

At conception, babies inherit chromosomes from both parents. The result is usually 22 autosomes and 2 sex-chromosomes. However, the result can be an abnormal pattern is not present: instead an abnormal one with additional, or absent, chromosomes prevails. At conception therefore the chromosomes influence the patterning on the finger-tips and on the palms of the hand.The study of those patterns is the science of . As the foetus grows in the womb, these inherited patterns are modified in the early weeks of growth caused by pressure on the finger - pads as the foetus moves in the womb. Hence every individual has the different finger and palmar pattern. No two individuals have same finger print, not even twins. However, having said that the patterns are not the same, only the characteristics of that pattern are determined by the chromosomes. So by studying these patterns it is possible to work back to determining the chromosomes and hence to make a diagnosis. The present study has produced tables quantifying these patterns to aid in that diagnosis. Because the only costs are physicians' time, and paper and ink for the palmar prints, this system, based on the tables, can be used as a first-line diagnostic tool in these countries and areas where no expensive chromosomal laboratories exist. The study was carried out on 50 "normal" boys and 50 "normal" girls, and on patients with proven (by chromosomal analysis) genetic chromosomal abnormalities. The results are presented for the case of Turner' s Syndrome (females) and Klinefelter's Syndrome (boys). The tables provide a vehicle for rapid and cheap diagnosis which should prove beneficial in deciding the future course of action but also in reassuring the patients.

 Keywords:
Dermatoglyphics, Diagnosis, Congenital Syndromes, Decision Support.

 
25

 
 The Value of Internet Technologies in the Education of Healthcare Staff
 
Author: Colin McMurchie
School of Healthcare, Liverpool, John Moores University

The rapid growth of the "Internet", both in terms of the volume of information accesible within it, and the number of people with the potential to access that information, is well known. Importantly, all information placed on the Internet is potentially equally available to all users, wherever they are in the world, and whatever their educational, social or professional backgrounds, thus breaking down national and professional barriers between knowledge bases. All knowledge is available to all, provided that they can use appropiate hardware and have a command of English, the "Lingua Franca" of the Internet. This presents the new opportunities and challenges for learners, for example Healthcare Professionals, and their teachers.

Drawing of his experiences as a University Lecturer in Healthcare Management and his role as a "webspinner" for the Nursing Specialist Group of the British Computer Society, the author will discuss several aspects of the use of the Internet in Healthcare Education, including methods of accessing the Internet and its various components (World Wide Web, E-mail, etc), searching and finding information on the Net, and assessing the value of the information found.
 
 
 
 
 

 
26

 
Programs for molecular pharmacology studies
 
Authors: G.I. Mihalas*, Anca Kyongosi*, M.G. Plauchitiu**, Diana Lungeanu*, Corina Vernic*
* University of Medicine and Pharmacy, Timisoara.
** University "Vasile Goldis", Arad, România.

Molecular pharmacology studies have a sound theoretical basis, set in late 50' s by Ariens and colab. Starting from the hypothesis of the existence of specific drug receptors, on which drug molecules can reversibly bind, the theoretical development yields a set of equations describing the so-called dose-response. A dose-response curve:

  = f ( [ A ] ) is -theoretically- fully determined by two main parameters:

- the maximal response the drug A can produce (for high doses), and

- the dissociation constant of drug - receptor complex (RA):

= / ( 1+/ [ A ] ) .

 When represented as  = f( log[A]), is has the well -known S- shape. Another parameter, m, is required for a higher order stoechiometry of drug - receptor interaction, when the receptor has a multiple site and the active complex is RA_m. There are several "classical" methods for computing E_Amax and K_A (eventually m, too) for a given set of (experimentally measured) pairs dose [A] and the corresponding response E_A, most of them based on the linear transformations of Lineweaver - Burke (1/E_A = f(1/[A])), Scatchard ([A]/E = f[A]), or Dowd-Riggs (E_A= f(E/[A])), or introducing the Hill version for including the coefficient m: (1/E_A = f(1/[A]^m)).
 
Our computer program has an input values a set of ([A],E_A) pairs and computes E_Amax and K_A using both the three linear transforms and a direct iterative method. It was written in Visual Basic 4.0, appropriate also for didactic purposes, for both medical students and for students in pharmacy.

 
27

 
 Medical Informatics Course Presentation with the "Power Point" Files Recorded on a Compact Disk
 
Authors: Nicolae Mihail Mocanu, Ph.D.*, Virgil Enatescu, M.D., Prof.Dr. **
* Medicine Faculty, "Transilvania" University, Brasov, Romania and Military-Medical Scientific Research Center, Bucharest, Romania
** Medical Informatics Laboratory and County Hospital, Satu Mare, Romania

Teaching of the Medical Informatics course at the Medicine Faculty, "Transilvania" University from Brasov, are made in the last 5 years through slides made with the "Picture Maker" program, linked with the "Story Executive" program and showed with the "Story Teller" program. Those programs are made in early ’80, having the disadvantage of an old graphical standard (CGA), but the advantage of old computers (type 80286) using and low memory needs on internal memory or hard disk and only a bunch of diskettes, as the faculty can afford in his early time of the beginning ’90.

The modernization of the Medicine Faculty is now in progress, the students having few high performance computers and a network of 12 computers (type 80486). After the publishing of the Medical Informatics course (issued in May 1996), it was imposed a new course presentation, based on new, up to date slide show.

Because of the large spreading of the Microsoft’s "OFFICE" programs package, we used the "Power Point" facilities to present our new selected images. In this case, the memory support can not be diskettes, because of the large memory request, and we choose a racordable compact disk (CD) as the best portable media. Our CD contain tens of "Power Point " files, hundreds of slide with texts, drawings, tables, graph and charts, on hundreds of MB.

Files structure made possible the slide presentation automatically (with a preselected time interval for each slide) or manually (by using the mouse or a keystroke to select the next slide to be viewed on the monitor’s screen).
Running of our files can be made also with the Power Point Viewer or Power Point under the "Windows 3.1 x" or "Windows 95".

The CD include also and the file (CIMBv.doc) for the Word 6 word processor (also from the "OFFICE" package) containing the whole 267 pages of the Medical Informatics Course published at Brasov.
In our paper we present the final parameters of this issue, the contents of the recorded files on the CD, some slides sequences and the course structure. Our CD is made to make aquitance with Medical Informatics not only for medicine students, but for any one working in the medical field and interested to increase his efficiency by computer using.

A future issue will include a new, up to date version of the Medical Informatics book, now in the final stage on the author’s working table.

 
28

 
Preparing Nursing Information Systems through Education

Author: Ioana Moisil
Centrul de Calcul, Statistica Sanitara si Documentare Medicala

The paper is presenting the educational aspects concerning the dissemination of the International Classification for the Nursing Practice (ICNP) and for the development of a Minimum Data Set for Nursing (MDSN), two very important topics related to the Health Information System (HIS) that has to incorporate nursing data, i.e. nursing applications has to benefit nurses and to support the delivery of care. They must be designed for nurses and integrated in HIS. Our main research was focused on modeling nursing information. More precisely, with the dissemination and adapting in Romania of the International Classification for nursing Practice (ICNP), without which no modeling is possible. The author has been locking up for the most suitable strategy for promoting ICNP in a community that does not have yet the desired computer literacy level.

The solution proposed is that of the Learning Resources Centres (LRC). Pilot studies on the benefits of Learning Resources Centres has proved that is valuable concept and continuing the development of such projects is essential. The concept of LRC has been defined as a space with several training media, as multimedia workstations, videos, audio programs, text based materials and mini book library, located in an institution or organization. Teaching materials and we understand here by "materials", text-books as well as computer based training software, are addressing a large range of topics on interest for both the organization and individual staff. The use of multimedia facilities is a quarantee of success.
 
 
 

29

 
 
"MEFARO" – Informational System for the General Practitioner
 
Authors: Mariana Morariu, Gabi Ivancescu, Nicolae Bosneag, Carmen Antonovici
The Society of Informatic Services-Suceava S.A., Suceava, Romania

The informational system MEFARO is designed to realise local database at the sanitary centers, consulting rooms, where is assured the primary assistance.

This program is very useful and efficient for any general practitioner who desires to have more real time information referring to his patient. That information is memorized and updated permanently in the product’s database.

MEFARO has to manipulate a database containing the next categories of informations:

• Specialty data from the medical sphere, referring to: disease (codified after C.I.M.)and diagnosis alghoritms, first aid, medical preparates; vaccines and immunology products, medical services;
• Regarding to the patients: identification and social data, health state data, treatments and medication, medical services they benefit etc.;
• Regarding to the medical activity at the sanitary center’s level (consulting room): personal consultation record, based on the doctor’s observations, situations and reports regarding to the health situation of the collectivity who beneficiated by the medical services in the sanitary center, data collection and reports.

• Determines the raise of medical activity’s speed and of the medical act;
• The user has, in real time, all the information existing in the database;
• Along the medical service, the physician will have all data regarding to the patient’s health state evolution, through accessing the health file;
• Through linking to a public network, the public situation of health will be known at high level, very useful for pertinent and immediate decisions.

At present, the combination of Occidental and Oriental Medicine for Diagnosis and Treatment plays an important role in the health care for many countries in the world because this combination often results in the best diagnostic and therapeutic outcome in specific cases. In fact, the "integrated" medicine seeks to applay the best of both systems and to offset the weaknesses of each.

The computer based system CompAc, for Chinese Traditional Medicine, has two objectives:
1. Diagnosis assistance and proposal of therapeutic recommendations;
2. The use of the information in the data bases for medical training.

The constitution determination of patient is based on the "Five Element Law". Toghather with the theory of Yin-Yang, the theory of 5 Elements constitues the basis of Chinese Medical theory. It could be said this theoryand its aplication to medicine marks beginning of what one maight call "scientific" medicine.

By constitution we mean the fundamental physical and mental make-up of an individual. According to Chinese Medicine, the constitution is made up of three factors, i.e. Essence, Qi and Mind. Of these three elements, Essence is foundation for other two. If the Essence is strong, this will constitute a basis for a healthy life from the physical and mental point of view. Obviously this does not mean a totally disease-free life as many other causes of disease can undetermine a person's health, but it does mean that the person will have a strong resistance to disease.
Essence, Qi and Mind are called in Chinese the "three Treasures". Health, strengh, vitality, happiness, volition, mental stability and clarity, all depend on a good supplay of these three vital substances and their harmonious interaction. Essence is related to the Kidneys, Qi to the Lungs, and Mind to the Heart.
Five constitutional types are identified each reffering to one of the Five Elements which are Wood, Fire, Metal, Earth and Wather. Identying a particular type it is used in determining the caracter and prognosis of disease.

The therapeutical recommendations refinement of the system through acupuncture, herbaltherapy and acupressure take into account the constitution determination of the patient and opening times of the acupuncture points. The treatment according to the constitution it established only towards the end of the treatment in order to consolidate the results.

The system is suitable for therapy advice and teaching purpose. Also it may play a role in popularing integration of Occidental and Oriental Medicine especially in self-help therapy by Acupressure and Herbaltherapy.?

 
31

 
Five years of Medical Informatics in a private Company
 
Author: Cristian Rusu
SINTEC Ltd. Baia Mare

Some highly trained professionals that are working now at SINTEC Ltd. had remarkable results in health information systems even in the eighties. In the last five years the SINTEC Study Center activity focused on two major fields:

• Financial & Accouting Information Systems;
• Health Information Systems.

SINTEC Study Center has developed a large set of applications for the medical activities. Each of them solves a specific problem, but they can also work together as an integrated informational system. The programs have been designed to autoconfigure themselves according to the actual structure of the medical unit that uses them. They are equally suitable in managing the activities in a small surgery and in the largest hospital or District Health Authorities. A lot of sanitary units are using this programs all over the country: Maramures District Health Authorities, Sibiu District Health Authorities, Baia Mare County Hospital, Suceava County Hospital, Baia Sprie Hospital, Cavnic Hospital, Sighet Hospital, Somcuta Hospital, Targu Lapus Hospital, Viseu Hospital, Maramures Sanitary Police, Special Telecommunications Service - Sanitary Office and many others.

Due to the system modularity, the projects can be implemented step-by-step. The programs' built-in self-correction system proved its reliability even under difficut operating conditions, such as an unsteady electric network, or dozens of concurent users, even unfamiliar with computers. All SINTEC programs have friendly interface, user's guide and self-adjustment features.

32

 
On Spatial Data Analisis in Health Statistics
 
Author: Cristian Rusu
SINTEC Ltd. Baia Mare

As part of SINTEC's integrated health information system I developed two programs which purpose is to achieve the statistical reports the Ministry of Health expects from District Health Authorities. STASAN offers an image of the population's health status and EFISAN computes rates of efficiency for medical units. Both of them can generate scattered data (x,y,z) where (x,y) are geographic coordinates of localities and z is computed rate. Thus data becomes "spatial" and can be process as such.

One of the major field I worked on is data processing in geology. Step by step I designed and developed a whole software package (ZAZA) solving all surface modeling aspects. It is a general purpose surface modeling software package, therefore I used it not only in geologic data processing but also in health statistics.
ZAZA provides gridding, contouring, cross-sections, profiles, 3D-views and a wide range of surface computations. Users can control working parameters in all phases of data processing. All input/output files format are Surfer compatible (Golden Software Inc.).
Using ZAZA for graphic presentation of health statistics data these get much more eloquently.
 
 
 
 
 

 
33

 
 
An Information Server on Health Informatics / Telematics
 
Authors: Alexandru Trica, Elena Jitaru
Research Institute for Informatics, Bucharest

An information server able to offer data and knowledge concerning Health Informatics / Telematics is recognised as an imperative need. A such server was implemented at European level by EHTO project and we are trying to set-up a national one.

The European Health Telematics Observatory (EHTO) is a strategic support measure for health Telematics Applications Programme which was launched by European Union as part of the 4-Th. Framework Programme for research and Technological Development. The mission on EHTO is to disseminate the results of the European funded projects and to raise awareness in the potentialities of telematics in the healthcare field in order to increase the speed of deployment of applications.

EHTO offers a more efficient integration of telematics within the different health systems in Europe. It contributes to the deployment of health telematics technologies, applications and standards, collecting, analysing and making available in coherent and user-friendly format a wide range of information on developments in the field of health telematics.
 
The paper presents an overview on the information available on the EHTO Brussels site who will continue to adopt the most appropriate techniques and solutions to cope with new demands which require guaranteed high-level performance networking across the world.
For even better information dissemination, EHTO is currently setting up "satellite" sites in the national languages. The objective is not to copy and translate the central site information, but more ambitiously to create a network of observatories, each one reflecting the activities and culture pertaining to the local health system regulations and priorities. These national language sites will be required to maintain their links with EHTO Brussels, which is responsible for European information. The satellite sites will contribute to the deployment of healthcare telematics in regions and will create synergies that will have an impact at European level.

The paper presents the Romanian initiative to set-up a Relay Unit based on an Internet information server which will act as EHTO Romanian Satellite Site also. It will be a dissemination and communication tool for both the national and European information and products of health telematics and a forum for discussions and debates.

 
34

 
 Standardization in Healthcare Informatics
 
Authors: Alexandru Trica*, Elena Jitaru*, Dan Ursuleanu**
* Research Institute for Informatics, Bucharest
** Computing Center for Health Statistics and Medical Documentation, Bucharest.

The activity of standardisation, that enables compatibility and interoperability between independent systems in healthcare, is needed for efficient use of information and communications technology, allowing new ways of interaction between different actors promoting cost-effective procedures giving better quality of care for patients.
The paper emphasises the special importance of Standardisation of Healthcare Informatics, presenting the news at world, European and national levels.

 In Europe, an intensive regional work program started in 1900 within CEN/TC 251 has resulted in more than 30 European standards which are also adopted as national standards in the 18 CEN countries. Other European countries, as Romania, began also activity, organising national committees and preparing national standards. In the other countries of the world, national standards bodies developed formal standards. So, in USA a very large number of standards exist, and examples can be found also in Canada or Australia.

A number of standards bodies were looking forward to the establishment of international work in the area of Healthcare Informatics. In the initial initiative by ANSI, it was assumed that such a committee would be hosted by ISO. An alternative is to form a new subcommittee within JTC1, the large organisation between ISO and IEC.

The international committee, as the CEN/TC 251 will use the name "Standardisation of Healhcare Informatics" instead of "Standardisation of Medical Informatics", acknowledging the already established fact that the scope includes all aspects of healthcare and not only those related to medicine in a restricted sense.

We must also notify that CEN/TC 251 decided to change its present seven working groups to a new structure of four groups entitled:

WG1: Information models.
WG2: Terminology and knowledge bases.
WG3: Security, Safety and Quality.
WG4: Technology for Interoperability.

  In the last year, the ICI team continued the work for preparing new standards in Healthcare Informatics adopting some European prestandards: MI MEDICOM - Media Interchange in Medical Imaging Communication, Healthcare Information System Architecture, Medical Image Management and Medical Informatics Vocabulary and its development, for which the drafts are already prepared. The paper presents widely the content of the projects of standards above mentioned.
 

35

 
MSD- A Support for Assisting Medical Practitioners in Diagnosis-Making
 
Author: Math. Nicolae Vasilescu
ICI Bucharest, Romania

MSD will always consider the modelling of the interactions (symptom- symptom, disease-disease) and a type of modelling the medical practitioner’s reasoning. Fuzzy techniques will be used in modelling. The model is created to simulate the patient state over a finite or discrete T = { t₀, t₁ ,..., t_f} time horizon.

For modelling the reasoning at the back of diagnosis-symptom such fuzzy function as e : S® [ 0,1] will be used.
The paper fully describes such functions as m , b , e .
The model formal description will make use the following notations:

IS – the set of functions of type m (which models the interaction symptom- symptom)
IB – the set of functions of type b (which models the interaction disease-disease)
ID - the set of functions of type e (which models the degree of diseases featuring by symptoms).

The MSD = { B,S,T,IB,IS,ID} that build up a Simulation Model for Medical Diagnosis are referred. Finally, the paper presents how the MSD model can be simulated by a fuzzy automaton.
 

36

 
 Mathematical study of the evolution models of epidemics
 
Authors: Corina Vernic*, Virgil Obadeanu**
* University of Medicine and Pharmacy Timisoara
** Western University Timisoara

The paper studies the elementary model of population 's evolution which if improved conducts to the simple epidemic model and then to the Kermack -McKendrick epidemic model.

The biological systems used by derive from the classical methods known from the Newtonian dynamics, which we adapt to the dynamic systems describes by ordinary differential equation of the first order showing the necessary changes. We define so the system, there are deduced the differential equations of evolution and after we make a qualitative, quantitative study (by determining the general solution, particular solution, critical points) and also the analytical study of model.

 This study consists in the determination of the integrating factors, the self-adjoined conditions Helmoltz, the equation Euler-Lagrange, Euler-Lagrange-Birkhoff, the Lagrange function, the function of Hamilton and conservation laws of systems.
 
 
 
 
 
 
 
 

 
37

 
A Computer – Based Patient Record System in General Surgery
 
Authors: Adriana Vladu*, Elena Silvia Bernad**, Sandor Ianos Bernad***
* West University Timisoara, Romania
** University of Medicine and Pharmacy, Department of Medical Informatics, Timisoara, Romania
***University "Politehnica", Faculty of Mechanical Engineering,Timisoara, Romania

Traditional Clinical Records collect a variety of data (patient’s history, physical examination, reports etc.) with different nature (laboratory data, medical images, text – description, biosignals etc.), documented on different media (films, paper, etc.). In order to be easy to access the information about each patient, we created a model of a Computerised Patient Record (CPR). Its structure was adapted from general surgery domain.

One important goal with CPR was to create a common medical records to be shared by all professionals in the team. Another goal was to create a computerised version of the Paper-based Patient Records (PPR), for a better management of the data. It is possible also to print the data from the database in different format, which is very useful in medical practice.
The user can instantly retrieve medical information of a single patient and analyse the care process. The database can be completed only with the physician agreement, which examined the patient. The simply user has no possibility to modify or delete record, but he can use the data for documentation and statistics.

The electronic patient record was built with Microsoft Access program. Microsoft Word was used print in different format the database information.
 
 
 
 
 

38

 
Can Deferoxamine, an Iron Chelate Compound, Be used in tricyclic Antidepressants Overdose?
 
Authors: Prof. V. A. Voicu, Cristina A. Sarbulescu, M.I. Ionica
National Center of Clinical Toxicology, Bucharest, Romania
University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania

Tricyclic antidepressants represent 7.3% from the over dose drugs hospitalized in the Clinical Toxicology Department and frequently occupy the fourth place.
The cardiotoxical effects of tricyclics have been studied from the point of view of "myocardial stunning". This is a new phisiopathological concept including transient ischemia, characterized by the implication of the oxidant stress depending on iron as a prooxidant agent, modification of intracellular calcium and no hystological tissue injuries.

Under this functional background, the effect of Deferoxamine, an iron chelate compound with antioxidant action above mentioned phenomena, was studied.
The establishing of the therapeutic dose which should not lead to marked modification of the iron level, and of the best interval of administration has imposed the experimental approach of the study (two groups each containing 10 dogs).

Statistical result was computerized by Student test.
As a result from the obtained experiments, some conclusions were drawn:

• The characteristics of myocardial ischaemia in tricyclis antidepressants over dose corresponds to the phisiopathological concept of stunned myocardium;
• The pathogenic implication of the oxidant stress caused by freeradicals depending on iron as prooxidant agent, recommends the use of deferoxamine (0.01 g/kg i.m.) as an antioxidant, associated to the classical therapy;
• The role of free radicals in the pathogenesis of arrhythmia and conduction defects has not shown up.

 
39

 
Consideration Regarding Flumazenil Administration in Multiple Drugs Overdose
 
Authors: Prof. V. A. Voicu, R. C. Macovei, Dida Ardeleanu, Cristina N. Sarbulescu, M. I. Ionica
National Center of Clinical Toxicology, Bucharest, Romania
University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania

Flumazenil (Anexate) - imidazo – benzodiazepine – is a specific benzodiazepine antagonist. Anexate by means of competitive inhibition, spefically blocks the central effects of substance via the benzodiazepine receptor.

The hypnotic-sedative effects of benzodiazepine are reversed within thirty to sixty seconds after intravenous Anexate injection. Even if the effects are specific to benzodiazepine intoxication, we have also chosen Anexate in complex cure of multiple drugs coma. For this paper we choice four coma patients as a result of drugs overdoses. The following drugs were involved: benzodiazepines and barbiturates (3 patients), benzodiazepines and glutetimid (1 patient).

All patients were in deep coma (IV degree) with respiratory distress and collapse of hemodynamic parameters. They received endotracheal intubation and mechanical ventilation. Anexate was used in intensive care after 6 hospitalizations hours. The result was considered very good. The patient’s status was changed from deep coma to superficial coma in 12 hours together with vital functions normalization.
The patients regained consciousness after 24-48 hours. They leaven the hospital 4 days later.

Anexate using in the complex cure in intensive care unit, was decisive for the rapid reversal of coma and it was decisive to eliminate the complications. It also responds for decreasing the half-time of the hospitalization (comparative with the half-time of hospitalization in the other multiple drugs overdose with coma).

For established the certitude diagnostic authors used the computerised system GC/MS Varian Saturn 3. The new MS spectra is established and introduced in the GC/MS computerised library, NIST 92, PMW and MIC4H10.

 Keywords: GC/MS computerised library, benzodiazepine, flumazenil.

 
40

 
Considerations Regarding Tricyclic Antidepressants Cardiovascular Toxicity
 
Authors: Prof. V. A. Voicu, Dida Ardeleanu, R. C. Macovei, M. I. Ionica
National Center of Clinical Toxicology, Bucharest, Romania
University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania

A variety of different chemical structures has been found to have antidepressant activity. Tricyclic antidepressants (so called because of the characteristic 3-ring nucleus) have been used clinically for over two decades. Imipramine and amitryptiline are the prototypical drug of the class and the most commonly used. Tricyclic are dangerous when taken in overdose quantity, and depressed patients are more likely than others suicidal. Major symptoms include: coma with shock and sometimes metabolic acidosis; respiratory depression with a tendency to sudden apnoea and a great variety of cardiac manifestations, including conduction defects and arrhythmia’s. How does the poisoned patients die? Asystole and lethal arrhythmia’s such as ventricular tachycardia and fibrillation can occur with overdose of tricyclic antidepressants.

The study is made in the Clinical Emergency Hospital of Bucharest, Department of Clinical Toxicology, in 1996. In 1996 were admitted into the hospital (intensive care ward) 898 patients with acute poisoning, 37 of them with tricyclic antidepressants (31 women, 6 male), and one demise was registered. Amitrityline was the commonest drug accounting for 22 patients (59.4). In order of frequency the other drugs were: imipramine, doxepin and clomipramine. The commonest cardiac complications in amitriptyline poisoning were hypotension (63.6%), sinus tachycardia (anticholinergic effect) (59.1%), sinus bradycardia (4.5%) and other cardia arrhythmia’s (sinus tachycardia with right bundle branch block, ventricular ectopic beats, ventricular tachycardia, first degree atrioventricular block and the cardia arrest) (22.7%). Plasma level for amitriptyline was between 0.3-1.20 mg %. The therapy of cardiovascular toxicity induced by tricyclic antidepressant agents is also included in the study.

For established the certitude diagnostic authors used the computerised system GC/MS Varian Saturn 3. The new MS spectra is established introduced in the GC/MS computerised library.

Keywords: GC/MS computerised library, tricyclic antidepressants.

41

 
Increasing Performance of Positive Diagnosis in Polidrug Poisoning
 
Authors: Prof. V. A. Voicu, R. Macovei, Dida Ardeleanu, Cristina Sarbulescu, Gh. Cretu, M. Ionica
National Center of Clinical Toxicology, Bucharest, Romania
University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania

Laboratories certainly positive diagnosis in polidrug poisoning raises special problems. Polidrug poisoning are most frequent cases (34%) in the Department of Clinical Toxicology – Emergency Hospital Bucharest.

Between the techniques used in our laboratory, the one that offers results is gas chromatography/mass spectrometry; GC/MS. As a rule, mass spectrometry uses electronic ionization –EI. The advantage is that the spectrum obtained can be compared with thousands of spectre already existing in computerised library (PMW, NIST 92, Whilley). Sometimes the identification of drugs and/or their metabolites incriminated in overdosing cannot be performed only in EI.

From this reason sometimes we use another ionisation techniques too, but these can present the disadvantage of histories with a lower number of spectres.
In this paper is presented the analyse of a urine probe from a coma patient, admitted in our department.
EI analyse showed the presence of metamizol together with 3 of its metabolites, but the clinical state of the patient couldn’t be explored only by presence of metamizol so, the reprocessing of the probe by chemical ionisation type SECI – using as gas for ionisation buthan: C₄H₁₀ – demonstrated the presence of Phenobarbital too.

Even in the Phenobarbital was present in high quantity explaining this way the clinical state of the patient it was masked in EI by the presence of the metamizol metabolite M1.

The authors present the comparative study of this analises.
SECI method is recommended for all cases of polidrug poisoning avoiding this way the falls negative results.
The SECI spectres are sought for in our computerised library MIC4H10.
Developing the computerised library is a very important scientific objective of the future activity of the authors.

Keywords: Computerised library, GC/MS, SECI.

 
42

 
 Statistical Study of Admitted Patients in Department of Clinical Toxicology in 1996
 
Authors: Prof. V. A. Voicu, Rodica Mirescu, R. Macovei, Dida Ardeleanu, Cristina Sarbulescu, M.I. Ionica, Gh. Cretu
National Center of Clinical Toxicology, Bucharest, Romania
University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania

In 1996 in Department of Clinical Toxicology – Floreasca Emergency Hospital Bucharest were admitted 2932 patients with acute intoxication by drugs or non-drugs substances. 998 patients (34.03%) required admission in Intensive Care Toxicology Unit and 1943 patients (65.96%) were admitted and treatment in Medical Toxicology Unit.

On Intensive Care Unit from 998 patients:

• 510 were women (51.1%)

• maximal frequency registered on age group 21-30 years (145 cases – 28.43%);
• polidrugs ethiology was the most frequent on the same age group (43 cases – 8.43%);

• 488 were male (48.9%):

• maximal frequency registered on age group 61-70 years (118 cases – 24.18%);
• alcoholic ethiotology was the most frequent on the age group 41-50 (25 cases – 5.12%)

• 1341 were women (69.33%):

• maximal frequency registered on age group 21-30 years (450 cases – 33.56%);
• benzodiazepines poisoning was the most frequent on the same age group (152 cases – 11,33%);

• 593 were male (30,66%):

• maximal frequency registered on age group 21-30 years (209 cases -35,24%);
• polidrug ethiology was the most frequent at the same age group (52 cases – 8,76%).

 
Conclusions

From the 998 patients admitted in Intensive Care Unit, maximal frequency was registered on women (51,1%) and on Medical Toxicology Unit the same distribution (69,33%) on women.
Only in Intensive Care Unit we were registered demises.

The maximal frequency was registered on age group 21-30 years.
Polidrugs and benzodiazepines ethiology was the most frequent on male for Intensive Care Unit respectively Medical Toxicology Unit.
 

43

 
Probability Distributions of the Durations of HIV Induced Infectious Stages and Relations Between the Numbers of Patients in These Stages
 
Authors: C. N. Zaharia, Al. Cristea
Institute of Virology, Bucharest, Romania

The transition from the number of patients of certain HIV virus induced stage to the number of patients of the next stage of the same disease in performed by using an integral convolution operator, the nucleus of which is given by the probability distribution of the duration of the respective transition between the successive stages of the disease.

Three essential distributions are considered:

• of the incubation period of the AIDS stage (duration of the asymptomatic phase);
• of the patient’s survival duration, the AIDS phase of the HIV virus induced infection;
• of the convolution of the mentioned distributions, respectively the distribution of the survival durations of the HIV virus contaminated subject.

In these cases, the convolutions are obtained as analytical, relatively simple expressions of the parameters of the functions, participating in these convolutions. The distributions of asymptotic state durations, respectively of the survival duration of HIV virus contaminated patients and the time dependence of numbers of such contaminated individuals – determine the development over time of the number of AIDS cases, respectively of deaths from AIDS.
By means of a simulation program (Scientist) the defining parameters of the development over time of the number of HIV contaminated persons are determined, for the optimal fitting of data regarding the numbers of AIDS cases and deaths from AIDS.

These data are used for the extrapolation (prognosis) of the development in the future of the number of asymptotic and symptomatic contaminated individuals and of the deceased from HIV virus induced infection.
The information contained in data banks, refereeing to AIDS epidemics in the European countries are used to obtain the duration of the asymtomatic and symptomatic phases and of the numbers of AIDS cases and deaths from AIDS during the last 15 years.

By using the data of 1981-1991 period as starting data, the reliability of the mentioned methodology is checked by comparing the observation data of years 1992-1996 with those, resulted from the previous performed by the above described methods.

 
44

 
 Two Databases Used for the Epidemiological Surveillance In Viral Respiratory Infectious
 
Authors: C. N. Zaharia, Al. Petrescu
"St. S. Nicolau" Institute of Virology, Bucharest, Romania

The databases refer to the morbidity and serology of some viral respiratory infections. The setting up, the loading and the exploitation of these bases are archived by using the package of Epi-Info 5/6 programs, respectively of modules of questionnaire editing. EPED, of data introduction, ENTER and CHECK, and of data analysis, ANALYSIS (by .PGM programs).

The database referring to morbidity contains the number of cases of disease notified weekly at the district level (in 9 districts) for the disease codes 230-231-232 (312-321-322, acute respiratory infections of the upper airways, viral pneumonia and influenza), by age groups (4-5 groups). The values for the population belonging to the respective age group of the analyzed district are automatically introduced and calculations for the total number of sickness cases for each disease code are concomitantly perfomed. The program calculates in the same stage the morbidity by age groups and the total morbidities. The database contains informations from 1992 up to the present. The calculations necessary to the drawing up of the weekly report forwarded to the competent national authorities are performed in the analysis module. For this purpose, the individual morbidities and the means cumulated by age groups are evaluated for each week, each age group and each disease code, regardless of the district. The data synthesized in tables (Lotus 1-2-3) are graphically represented in Epi-Info and in other programs (Harvard Graphics) by morbidity curves in dependence on the week of year, for each age group, separately for each district. The synthetic graphs by age groups contain the morbidities in dependence on the week of the year, cumulated for all the age groups and all the surveyed districts.

Another database uses the laboratory results of the serological diagnostic reactions for influenza (influenza viruses type A, subtypes A (H1N1) and A (H3N2), and type B). For five age groups (from 0 to over 60 years), the number of sera corresponding to a certain binary dilution (0 – negative, 1/8, 1/16,…, 1/512) for which the hemagglutination-inhibition reaction (HAI) is considered positive are recorded for each week. Each of this the numbers makes up a parameter, which can be used individually in further calculations. Simultaneously with the loading of values in the database, the percent values of the number of sera are calculated automatically by reporting to the sample of sera under study, 40-100 sera for each age group. The structure of the database permits to calculate automatically for each week, the total values of the number of sera with various titres (8 classes of titres) for each antigen, cumulated for all the age groups, and separately for all the titres, including the number of negative sera with titres differing from 0, for various age groups. Another section of the database contains the percent calculations for above mentioned parameters. The database was loaded with information obtained from the district MM for the period 1985-1996.

The two database were set up, on the one hand, for the purpose of drawing up reports regarding the course of the epidemiological process of the viral respiratory infections and, on the other hand, in order to furnish input data in view of structuring and testing models representing the influenza virus circulation in a certain areal and for a certain period.

The databases are in a continuous development by their further loading with a new informations; they are permanently at the disposal of any interested user in the future they will be availables also by INTERNET.
 

45

 
 Contributions at the Study of the Maximal Muscular Activity from the Dental-Maxillary Anomalies for Children And Teen-Agers
 
Authors: Georgeta Zegan*, Gabriela Georgescu**
* Department of Orthodontic U.M.F. "Gr. T. Popa", Iasi, Romania.
** Department of Medical Informatics "Gr. T. Popa", Iasi, Romania.
 

The muscular lacks of balance from the dental-maxillary anomalies (D.M.A.) can be detected by clinical examination, but the diagnostic of certainty can be established only by an electromiographic examination (E.M.G.).

The purpose: To point out the importance of the current utilisation of the E.M.G. examination, which is necessary for a muscular diagnosis in D.M.A. and to show the modifications of parameters for maximal muscular contraction of masticator and facial muscles to children and teen-ager with D.M.A.

Material and method: On a lot of 52 children and teen-agers (20 boys and 32 girls) with age between 6-18 years old, with D.M.A. , we achieved global E.M.G. on the muscles: temporalis, superficial masseter, buccinator, orbicularis oris and mentalis. We used a MEDIKOR 21 electromiograph with 2 channels and surface electrodes. The method to examination by E.M.G. was made by detection examination for the voluntary contraction of studied muscles. For technical processing we used the SPSS and EPI-INFO 6, with the statistical test t-Student and Fisher.

Results: The analysis of mean values for the amplitude of biopotentials of masticator muscles shows they are not depending on age, the maximal curve of value being touched at the age of 10-13 years old, in the puberty period. The mean maximal values for the potentials of facial muscles are touched at a small ages (6-9 years old) during the 1-st stage of mixed dentition. The duration and types of path are in normal limits for temporalis muscles and they are different for the other types of muscles, depending on how much D.M.A. affects them.
We can see significant differences inD.M.A. 2-nd class Angle between the 2 divisions of the downing and facial muscles (p<0.05), and in D.M.A. 3-rd class Angle, between the functional form and the anatomical at the masticator muscles (p<0.05).

Conclusions: The early detect of muscular lack of balance in D.M.A. by E.M.G. examination can avert by precocious treatment the anatomical forms of D.M.A., which requires an orthodontic surgical treatment.