Journal of Medical Systems (J Med Syst )

Publisher: Springer Verlag


Journal of Medical Systems provides a forum for the presentation and discussion of the increasingly extensive applications of new systems techniques and methods in hospital clinic and physician's office administration; pathology radiology and pharmaceutical delivery systems; medical records storage and retrieval; and ancillary patient-support systems. The journal publishes informative articles essays and studies across the entire scale of medical systems from large hospital programs to novel small-scale medical services. Education is an integral part of this amalgamation of sciences and selected articles are published in this area. Since existing medical systems are constantly being modified to fit particular circumstances and to solve specific problems the journal includes a special section devoted to status reports on current installations.

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    Journal of medical systems (Online)
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Springer Verlag

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: In this paper, we used the Hilbert-Huang transform (HHT) analysis method to examine the time-frequency characteristics of spike waves for detecting epilepsy symptoms. We obtained a sample of spike waves and nonspike waves for HHT decomposition by using numerous intrinsic mode functions (IMFs) of the Hilbert transform (HT) to determine the instantaneous, marginal, and Hilbert energy spectra. The Pearson correlation coefficients of the IMFs, and energy-IMF distributions for the electroencephalogram (EEG) signal without spike waves, Spike I, Spike II and Spike III sample waves were determined. The analysis results showed that the ratios of the referred wave and Spike III wave to the referred total energy for IMF1, IMF2, and the residual function exceeded 10 %. Furthermore, the energy ratios for IMF1, IMF2, IMF3 and the residual function of Spike I, Spike II to their total energy exceeded 10 %. The Pearson correlation coefficients of the IMF3 of the EEG signal without spike waves and Spike I wave, EEG signal without spike waves and Spike II wave, EEG signal without spike waves and Spike III wave, Spike I and II waves, Spike I and III waves, and Spike II and III waves were 0.002, 0.06, 0.01, 0.17, 0.03, and 0.3, respectively. The energy ratios of IMF3 in the δ band to its referred total energy for the EEG signal without spike waves, and of the Spike I, II, and III waves were 4.72, 6.75, 5.41, and 5.55 %, respectively. The weighted average frequency of the IMF1, IMF2, and IMF3 of the EEG signal without spike waves was lower than that of the IMF1, IMF2, and IMF3 of the spike waves, respectively. The weighted average magnitude of the IMF3, IMF4, and IMF5 of the EEG signal without spike waves was lower than that of the IMF1, IMF2, and IMF3 of spike waves, respectively.
    Journal of Medical Systems 01/2015; 39(1):170.
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    ABSTRACT: Many outpatients who inadequately prepared for the procedure were cancelled on the day of the examination for various reasons. The aim of study was to investigate whether short message service (SMS) can improve patients' compliance and reduce cancellation rates. Outpatients scheduled for sedation gastrointestinal endoscopy were randomly assigned to mobile phone SMS group or control group. Patients in the control group received a leaflet on preparation instructions, while patients in the SMS group received SMS reminders after making an appointment. A total of 1786 patients were analyzed. There was a significant reduction in the rate of cancellations for patients in the SMS group (4.8 %) compared with patients in the control group (8.0 %) (P < 0.001). Patients in the SMS group were 40 % less likely to be cancelled by medical staff than patients in the control group. The compliance score of the two groups based on demographic and clinic characteristic distribution showed that for both male and female patients, the compliance score was higher in the SMS group than that in the control group (P = 0.023, P < 0.001, respectively). Additionally, the compliance score was also significantly higher in the SMS group among patients who were under 50 years old, less than an undergraduate education level, experiencing their first time for procedure, or whose procedures were gastroscopy, waiting time was between 4 and 15 days, and schedules were in morning (P ≤ 0.032). SMS reminders can be considered a complement to conventional preparation instructions, which could help improve the compliance of outpatients and reduce the rate of cancellations.
    Journal of Medical Systems 01/2015; 39(1):169.
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    ABSTRACT: With rapid development of computer technology and wide use of mobile devices, the telecare medicine information system has become universal in the field of medical care. To protect patients' privacy and medial data's security, many authentication schemes for the telecare medicine information system have been proposed. Due to its better performance, chaotic maps have been used in the design of authentication schemes for the telecare medicine information system. However, most of them cannot provide user's anonymity. Recently, Lin proposed a dynamic identity based authentication scheme using chaotic maps for the telecare medicine information system and claimed that their scheme was secure against existential active attacks. In this paper, we will demonstrate that their scheme cannot provide user anonymity and is vulnerable to the impersonation attack. Further, we propose an improved scheme to fix security flaws in Lin's scheme and demonstrate the proposed scheme could withstand various attacks.
    Journal of Medical Systems 01/2015; 39(1):158.
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    ABSTRACT: Laboratory results are essential for physicians to diagnose medical conditions. Because of the critical role of medical laboratories, an increasing number of hospitals use total laboratory automation (TLA) to improve laboratory performance. Although the benefits of TLA are well documented, systems occasionally become congested, particularly when hospitals face peak demand. This study optimizes TLA operations. Firstly, value stream mapping (VSM) is used to identify the non-value-added time. Subsequently, batch processing control and parallel scheduling rules are devised and a pull mechanism that comprises a constant work-in-process (CONWIP) is proposed. Simulation optimization is then used to optimize the design parameters and to ensure a small inventory and a shorter average cycle time (CT). For empirical illustration, this approach is applied to a real case. The proposed methodology significantly improves the efficiency of laboratory work and leads to a reduction in patient waiting times and increased service level.
    Journal of Medical Systems 01/2015; 39(1):162.
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    ABSTRACT: Information technology, such as real-time location (RTL) systems using Radio Frequency IDentification (RFID) may contribute to overcome patient safety issues and high costs in healthcare. The aim of this work is to study if a RFID specific Participatory Design (PD) approach supports the design and the implementation of RTL systems in the Operating Room (OR). A RFID specific PD approach was used to design and implement two RFID based modules. The Device Module monitors the safety status of OR devices and the Patient Module tracks the patients' locations during their hospital stay. The PD principles 'multidisciplinary team', 'participation users (active involvement)' and 'early adopters' were used to include users from the RFID company, the university and the hospital. The design and implementation process consisted of two 'structured cycles' ('iterations'). The effectiveness of this approach was assessed by the acceptance in terms of level of use, continuity of the project and purchase. The Device Module included eight strategic and twelve tactical actions and the Patient Module included six strategic and twelve tactical actions. Both modules are now used on a daily basis and are purchased by the hospitals for continued use. The RFID specific PD approach was effective in guiding and supporting the design and implementation process of RFID technology in the OR. The multidisciplinary teams and their active participation provided insights in the social and the organizational context of the hospitals making it possible to better fit the technology to the hospitals' (future) needs.
    Journal of Medical Systems 01/2015; 39(1):168.
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    ABSTRACT: Communication among medical informatics communities can suffer from fragmentation across multiple forums, disciplines, and subdisciplines; variation among journals, vocabularies and ontologies; cost and distance. Online communities help overcome these obstacles, but may become onerous when listservs are flooded with cross-postings. Rich and relevant content may be ignored. The American Medical Informatics Association successfully addressed these problems when it created a virtual meeting place by merging the membership of four working groups into a single listserv known as the "Implementation and Optimization Forum." A communication explosion ensued, with thousands of interchanges, hundreds of topics, commentaries from "notables," neophytes, and students - many from different disciplines, countries, traditions. We discuss the listserv's creation, illustrate its benefits, and examine its lessons for others. We use examples from the lively, creative, deep, and occasionally conflicting discussions of user experiences - interchanges about medication reconciliation, open source strategies, nursing, ethics, system integration, and patient photos in the EMR - all enhancing knowledge, collegiality, and collaboration.
    Journal of Medical Systems 01/2015; 39(1):157.
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    ABSTRACT: The study aims to improve the performance of current computer-aided schemes for the detection of lung lesions, especially the low-contrast in gray density or irregular in shape. The relative position between suspected lesion and whole lung is, for the first time, added as a latent feature to enrich current Three-dimensional (3D) features such as shape, texture. Subsequently, 3D matrix patterns-based Support Vector Machine (SVM) with the latent variable, referred to as L-SVM(3Dmatrix), was constructed accordingly. A CT image database containing 750 abnormal cases with 1050 lesions was used to train and evaluate several similar computer-aided detection (CAD) schemes: traditional features-based SVM (SVM(feature)), 3D matrix patterns-based SVM (SVM(3Dmatrix)) and L-SVM(3Dmatrix). The classifier performances were evaluated by computing the area under the ROC curve (AUC), using a 5-fold cross-validation. The L-SVM(3Dmatrix) sensitivity was 93.0 with 1.23 % percentage of False Positive (FP), the SVM(3Dmatrix) sensitivity was 88.4 with 1.49 % percentage of FP, and the SVM(feature) sensitivity was 87.2 with 1.78 % percentage of FP. The L-SVM(3Dmatrix) outperformed other current lung CAD schemes, especially regarding the difficult lesions.
    Journal of Medical Systems 01/2015; 39(1):171.
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    ABSTRACT: Telecare medical information systems (TMIS) enable healthcare delivery services. However, access of these services via public channel raises security and privacy issues. In recent years, several smart card based authentication schemes have been introduced to ensure secure and authorized communication between remote entities over the public channel for the (TMIS). We analyze the security of some of the recently proposed authentication schemes of Lin, Xie et al., Cao and Zhai, and Wu and Xu's for TMIS. Unfortunately, we identify that these schemes failed to satisfy desirable security attributes. In this article we briefly discuss four dynamic ID-based authentication schemes and demonstrate their failure to satisfy desirable security attributes. The study is aimed to demonstrate how inefficient password change phase can lead to denial of server scenario for an authorized user, and how an inefficient login phase causes the communication and computational overhead and decrease the performance of the system. Moreover, we show the vulnerability of Cao and Zhai's scheme to known session specific temporary information attack, vulnerability of Wu and Xu's scheme to off-line password guessing attack, and vulnerability of Xie et al.'s scheme to untraceable on-line password guessing attack.
    Journal of Medical Systems 01/2015; 39(1):154.
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    ABSTRACT: The growing importance that mobile devices have in daily life has also reached health care and medicine. This is making the paradigm of health care change and the concept of mHealth or mobile health more relevant, whose main essence is the apps. This new reality makes it possible for doctors who are not specialist to have easy access to all the information generated in different corners of the world, making them potential keepers of that knowledge. However, the new daily information exceeds the limits of the human intellect, making Decision Support Systems (DSS) necessary for helping doctors to diagnose diseases and also help them to decide the attitude that has to be taken towards these diagnoses. These could improve the health care in remote areas and developing countries. All of this is even more important in diseases that are more prevalent in primary care and that directly affect the people's quality of life, this is the case in ophthalmological problems where in first patient care a specialist in ophthalmology is not involved. The goal of this paper is to analyse the state of the art of DSS in Ophthalmology. Many of them focused on diseases affecting the eye's posterior pole. For achieving the main purpose of this research work, a literature review and commercial apps analysis will be done. The used databases and systems will be IEEE Xplore, Web of Science (WoS), Scopus, and PubMed. The search is limited to articles published from 2000 until now. Later, different Mobile Decision Support System (MDSS) in Ophthalmology will be analyzed in the virtual stores for Android and iOS. 37 articles were selected according their thematic (posterior pole, anterior pole, Electronic Health Records (EHRs), cloud, data mining, algorithms and structures for DSS, and other) from a total of 600 found in the above cited databases. Very few mobile apps were found in the different stores. It can be concluded that almost all existing mobile apps are focused on the eye's posterior pole. Among them, the most intended are for diagnostic of diabetic retinopathy. The primary market niche of the commercial apps is the general physicians.
    Journal of Medical Systems 01/2015; 39(1):174.
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    ABSTRACT: It is not always possible for a patient to go to a doctor in critical or urgent period. Telecare Medical Information Systems (TMIS) provides a facility by which a patient can communicate to a doctor through a medical server via internet from home. To hide the secret information of both parties (a server and a patient), an authentication mechanism is needed in TMIS. In 2013, Khan and Kumari proposed the authentication schemes for TMIS. In this paper, we have shown that Khan and Kumari's scheme is insecure against off-line password guessing attack. We have also shown that Khan and Kumari's scheme does not provide any security if the password of a patient is compromised. To improve the security and efficiency, a new authentication scheme for TMIS has been proposed in this paper. Further, the proposed scheme can resist all possible attacks and has better performance than the related schemes published earlier.
    Journal of Medical Systems 01/2015; 39(1):145.
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    ABSTRACT: Recent medical information systems are striving towards real-time monitoring models to care patients anytime and anywhere through ECG signals. However, there are several limitations such as data distortion and limited bandwidth in wireless communications. In order to overcome such limitations, this research focuses on compression. Few researches have been made to develop a specialized compression algorithm for ECG data transmission in real-time monitoring wireless network. Not only that, recent researches' algorithm is not appropriate for ECG signals. Therefore this paper presents a more developed algorithm EDLZW for efficient ECG data transmission. Results actually showed that the EDLZW compression ratio was 8.66, which was a performance that was 4 times better than any other recent compression method widely used today.
    Journal of Medical Systems 01/2015; 39(1):161.
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    ABSTRACT: Decision support systems (DSSs) which are able to automatically supervise and control physical exercise training of patients affected by chronic obstructive pulmonary disease (COPD) are regarded as a novel method to promote rehabilitation. The objective of our research work for this paper was to evaluate the feasibility of a rule-based DSS for autonomous bicycle ergometer training of COPD patients. Load control is based on real-time analysis of sensor parameters oxygen saturation and heart rate. Ten COPD patients have participated in a study, performing altogether 18 training sessions. On average, 7.4 rules were fired in each training session. Four sessions had to be stopped for different reasons. The average ergometer training load ranged between 31 and 47 W. The average percentage of heart rate in or lower than the intended target zone was 45.9 and 41.6 %, respectively. The average patient-perceived Borg value was 12.6 ± 2.4. Patients reported a high satisfaction for the automatically controlled training. With the help of the DSS, patients may change their training place from a rehabilitation center to their own homes. More studies are needed to assess long-term clinical and motivational effects of the DSS in home environment.
    Journal of Medical Systems 01/2015; 39(1):150.
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    ABSTRACT: The medical organizations have introduced Telecare Medical Information System (TMIS) to provide a reliable facility by which a patient who is unable to go to a doctor in critical or urgent period, can communicate to a doctor through a medical server via internet from home. An authentication mechanism is needed in TMIS to hide the secret information of both parties, namely a server and a patient. Recent research includes patient's biometric information as well as password to design a remote user authentication scheme that enhances the security level. In a single server environment, one server is responsible for providing services to all the authorized remote patients. However, the problem arises if a patient wishes to access several branch servers, he/she needs to register to the branch servers individually. In 2014, Chuang and Chen proposed an remote user authentication scheme for multi-server environment. In this paper, we have shown that in their scheme, an non-register adversary can successfully logged-in into the system as a valid patient. To resist the weaknesses, we have proposed an authentication scheme for TMIS in multi-server environment where the patients can register to a root telecare server called registration center (RC) in one time to get services from all the telecare branch servers through their registered smart card. Security analysis and comparison shows that our proposed scheme provides better security with low computational and communication cost.
    Journal of Medical Systems 12/2014; 38(12):142.
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    ABSTRACT: This study aimed to assess the accuracy of time-of-flight magnetic resonance angiography, computed tomography, and conventional angiography in depicting the actual length of the blood vessels. Three-dimensional time-of-flight magnetic resonance angiography and computed tomography angiography were performed using a flow phantom model that was 2.11 mm in diameter and had a total area of 0.26 cm(2). After this, volume rendering technique and the maximum intensity projection method as well as two-dimensional digital subtraction angiography and three-dimensional rotational angiography based on conventional angiography were conducted. For three-dimensional time-of-flight magnetic resonance angiography, 8 channel sensitivity encoding (SENSE) head coil for the 3.0 Tesla equipment was used. Fluid was added to the normal saline solution at various rates, such as 11.4, 20.0, 31.4, 40.0, 51.5, 60.0, 71.5, 80.1, 91.5, and 100.1 cm/s using an automatic contrast media injector. Each image was thoroughly examined. After reconstructing the image using the maximum intensity projection method, the length of the conduit in the center of the coronal plane was measured 30 times. After performing computed tomography angiography with the 64-channel CT scanner and 16-channel CT scanner, the images were sent to TeraRecon. Then, the length of the conduit in the center of the coronal plane of each image was measured 30 times after reconstructing the images using volume rendering and maximum intensity projection techniques. For conventional angiography, three-dimensional rotational angiography and two-dimensional digital subtraction angiography were used. Images obtained by three-dimensional rotational angiography were reconstructed and enhanced by 33, 50, and 100 % in the 128 Matrix and the 256 Matrix, respectively on the Xtra Vision workstation. The maximum intensity projection was used for the reconstruction, and the length of the conduit was measured 30 times in the center of the coronal plane of each image. Measurements using the two-dimensional digital subtraction angiography were obtained 30 times in the center of the image. As a result, the lumen length measured by three-dimensional enhanced flow MR angiography images was a minimum of 2.51 ± 0.12 mm when the fluid velocity was 40 cm/s. The images obtained by computed tomography angiography were larger than the actual images obtained by using the test equipment and the reconstruction method. Among the reconstruction methods of three-dimensional rotational angiography, the lumen length in the image reconstructed by 100 % in the 256 matrix was the smallest; 2.76 ± 0.009 mm. In the 128 matrix, as the scope of reconstruction was widened, the length of the vessel was increased by 0.710 units. In the 256 matrix, as the scope of reconstruction was widened, the length of the vessel was decreased by 0.972 units. In two-dimensional digital subtraction angiography, the lumen length in the image was 2.22 ± 0.095 mm. Although this image was magnified similar to the image reconstructed by 100 % in the 256 matrix of three-dimensional rotational angiography (P < 0.05), it was closest to the actual image among the images compared in this study. In conclusion, images obtained by two-dimensional digital subtraction angiography were closer to the actual images compared to the images obtained by other procedures. It can be concluded that vascular images obtained by magnetic resonance angiography, CT angiography, and conventional angiography were larger than the actual images.
    Journal of Medical Systems 12/2014; 38(12):146.
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    ABSTRACT: Nowadays, with comprehensive employment of the internet, healthcare delivery services is provided remotely by telecare medicine information systems (TMISs). A secure mechanism for authentication and key agreement is one of the most important security requirements for TMISs. Recently, Tan proposed a user anonymity preserving three-factor authentication scheme for TMIS. The present paper shows that Tan's scheme is vulnerable to replay attacks and Denial-of-Service attacks. In order to overcome these security flaws, a new and efficient three-factor anonymous authentication and key agreement scheme for TMIS is proposed. Security and performance analysis shows superiority of the proposed scheme in comparison with previously proposed schemes that are related to security of TMISs.
    Journal of Medical Systems 12/2014; 38(12):136.
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    ABSTRACT: Recently, mass casualty incidents (MCIs) have been occurring frequently and have gained international attention. There is an urgent need for scientifically proven and effective emergency responses to MCIs, particularly as the severity of incidents is continuously increasing. The emergency response to MCIs is a multi-dimensional and multi-participant dynamic process that changes in real-time. The evacuation decisions that assign casualties to different hospitals in a region are very important and impact both the results of emergency treatment and the efficiency of medical resource utilization. Previously, decisions related to casualty evacuation were made by an incident commander with emergency experience and in accordance with macro emergency guidelines. There are few decision-supporting tools available to reduce the difficulty and psychological pressure associated with the evacuation decisions an incident commander must make. In this study, we have designed a mobile-based system to collect medical and temporal data produced during an emergency response to an MCI. Using this information, our system's decision-making model can provide personal evacuation suggestions that improve the overall outcome of an emergency response. The effectiveness of our system in reducing overall mortality has been validated by an agent-based simulation model established to simulate an emergency response to an MCI.
    Journal of Medical Systems 12/2014; 38(12):149.
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    ABSTRACT: Operating room (OR) turnover time (TT) has a broad and significant impact on hospital administrators, providers, staff and patients. Our objective was to identify current problems in TT management and implement a consistent, reproducible process to reduce average TT and process variability. Initial observations of TT were made to document the existing process at a 511 bed, 24 OR, academic medical center. Three control groups, including one consisting of Orthopedic and Vascular Surgery, were used to limit potential confounders such as case acuity/duration and equipment needs. A redesigned process based on observed issues, focusing on a horizontally structured, systems-based approach has three major interventions: developing consistent criteria for OR readiness, utilizing parallel processing for patient and room readiness, and enhancing perioperative communication. Process redesign was implemented in Orthopedics and Vascular Surgery. Comparisons of mean and standard deviation of TT were made using an independent 2-tailed t-test. Using all surgical specialties as controls (n = 237), mean TT (hh:mm:ss) was reduced by 0:20:48 min (95 % CI, 0:10:46-0:30:50), from 0:44:23 to 0:23:25, a 46.9 % reduction. Standard deviation of TT was reduced by 0:10:32 min, from 0:16:24 to 0:05:52 and frequency of TT≥30 min was reduced from 72.5to 11.7 %. P < 0.001 for each. Using Vascular and Orthopedic surgical specialties as controls (n = 13), mean TT was reduced by 0:15:16 min (95 % CI, 0:07:18-0:23:14), from 0:38:51 to 0:23:35, a 39.4 % reduction. Standard deviation of TT reduced by 0:08:47, from 0:14:39 to 0:05:52 and frequency of TT≥30 min reduced from 69.2 to 11.7 %. P < 0.001 for each. Reductions in mean TT present major efficiency, quality improvement, and cost-reduction opportunities. An OR redesign process focusing on parallel processing and enhanced communication resulted in greater than 35 % reduction in TT. A systems-based focus should drive OR TT design.
    Journal of Medical Systems 12/2014; 38(12):148.
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    ABSTRACT: In this paper we present an instrumentation amplifier with discrete elements and optimized noise for the amplification of very low signals. In amplifying signals of very weak amplitude, the noise can completely absorb these signals if the used amplifier does not present the optimal guarantee to minimize the noise. Based on related research and re-viewing of recent patents Journal of Medical Systems, 30:205-209, 2006, we suggest an approach of noise reduction in amplification much more thoroughly than re-viewing of recent patents and we deduce from it the general criteria necessary and essential to achieve this optimization. The comparison of these criteria with the provisions adopted in practice leads to the inadequacy of conventional amplifiers for effective noise reduction. The amplifier we propose is an instrumentation amplifier with active negative feedback and optimized noise for the amplification of signals with very low amplitude. The application of this method in the case of electro cardio graphic signals (ECG) provides simulation results fully in line with forecasts.
    Journal of Medical Systems 12/2014; 38(12):152.
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    ABSTRACT: The central nervous system (CNS) plays an important role in regulation of human gait. Parkinson's disease (PD) is a common neurodegenerative disease that may cause neurophysiologic change in the CNS and as a result change the gait cycle duration (stride interval). This article used the Hidden Markov Model (HMM) with Gaussian Mixtures to separate the patients with PD from healthy subjects. The results showed that the performance of the HMM classifier in classifying the gait data corresponding to 16 healthy and 15 PD subjects is comparable to the results obtained from the least squares support vector machine (LS-SVM) classifier. In this study, the leave-one-out cross-validation method was used to evaluate the performance of each classifier. The HMM method could effectively separate the gait data in terms of stride interval obtained from healthy subjects and PD patients with an accuracy rate of 90.3 % . All in all, the results showed that the proposed method can be used for distinguishing PD patients from healthy subjects based on the gait data classification.
    Journal of Medical Systems 12/2014; 38(12):147.