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Biomedical subjects

F Estrella

Publications and source records attributed to F Estrella.

6 recordsLinked to original sources
PubMed2006

Experiences of engineering Grid-based medical software.

OBJECTIVES: Grid-based technologies are emerging as potential solutions for managing and collaborating distributed resources in the biomedical domain. Few examples exist, however, of successful implementations of Grid-enabled medical systems and even fewer have been deployed for evaluation in practice. The objective of this paper is to evaluate the use in clinical practice of a Grid-based imaging prototype and to establish directions for engineering future medical Grid developments and their subsequent deployment. METHOD: The MammoGrid project has deployed a prototype system for clinicians using the Grid as its information infrastructure. To assist in the specification of the system requirements (and for the first time in healthgrid applications), use-case modelling has been carried out in close collaboration with clinicians and radiologists who had no prior experience of this modelling technique. A critical qualitative and, where possible, quantitative analysis of the MammoGrid prototype is presented leading to a set of recommendations from the delivery of the first deployed Grid-based medical imaging application. RESULTS: We report critically on the application of software engineering techniques in the specification and implementation of the MammoGrid project and show that use-case modelling is a suitable vehicle for representing medical requirements and for communicating effectively with the clinical community. This paper also discusses the practical advantages and limitations of applying the Grid to real-life clinical applications and presents the consequent lessons learned. CONCLUSIONS: The work presented in this paper demonstrates that given suitable commitment from collaborating radiologists it is practical to deploy in practice medical imaging analysis applications using the Grid but that standardization in and stability of the Grid software is a necessary pre-requisite for successful healthgrids. The MammoGrid prototype has therefore paved the way for further advanced Grid-based deployments in the medical and biomedical domains.

Humans↗
PubMed2005

Resolving clinicians' queries across a Grid's infrastructure.

OBJECTIVES: The past decade has witnessed order of magnitude increases in computing power, data storage capacity and network speed, giving birth to applications which may handle large data volumes of increased complexity, distributed over the internet. METHODS: Medical image analysis is one of the areas for which this unique opportunity likely brings revolutionary advances both for the scientist's research study and the clinician's everyday work. Grids [1] computing promises to resolve many of the difficulties in facilitating medical image analysis to allow radiologists to collaborate without having to co-locate. RESULTS: The EU-funded MammoGrid project [2] aims to investigate the feasibility of developing a Grid-enabled European database of mammograms and provide an information infrastructure which federates multiple mammogram databases. This will enable clinicians to develop new common, collaborative and co-operative approaches to the analysis of mammographic data. CONCLUSION: This paper focuses on one of the key requirements for large-scale distributed mammogram analysis: resolving queries across a grid-connected federation of images.

Algorithms↗
PubMed2003

[Clinical trial of the month. The STENO-2 study: a plea for global and intensive management of the type 2 diabetic patient].

Cardiovascular morbidity is a major burden in patients with type 2 diabetes. The Steno-2 Study compared the effect of a targeted, intensified, multifactorial intervention (n = 80) with that of a conventional treatment (n = 80) on modifiable risk factors for cardiovascular disease in patients with type 2 diabetes and microalbuminuria. After a mean follow-up of 7.8 years, the risk of cardiovascular events was reduced by 53% in the intensive group, and the risk of microvascular events (nephropathy, retinopathy, autonomic neuropathy) by 58-63%. Thus, a target-driven, long-term, intensified intervention aimed at multiple risk factors should be recommended in patients with type 2 diabetes and microalbuminuria.

Albuminuria↗
PubMed2000

[Guidelines for the treatment of arterial hypertension in diabetic patients].

Diabetes mellitus is frequently associated with arterial hypertension and the combination of the two entities markedly increases the cardiovascular risk and accelerates the progression of microangiopathy (more particularly nephropathy) in both type 1 and type 2 diabetic patients. Numerous international guidelines have been published during the last few years to help the practitioner in targeting ideal arterial blood pressure levels (lower in diabetic than in non-diabetic patients) and in selecting first-choice antihypertensive agents. We will concisely summarize the main messages of these recommendations and insist upon the persistence of uncertainties, or even the existence of inconsistencies, more particularly regarding preferential indications of antihypertensive agents in diabetic patients.

Antihypertensive Agents↗
PubMed1999

[Arterial hypertension and type 2 diabetes].

Diabetes mellitus is frequently associated with arterial hypertension and the combination of both entities markedly increases the vascular risk. In type 2 diabetes, hypertension appears very early, especially in the presence of obesity, is part of the insulin resistance syndrome, and contributes to high cardiovascular morbidity and mortality rates in this population. Appropriate regulation of blood pressure is crucial in order to reduce not only microangiopathy (nephropathy and retinopathy) but also macroangiopathy (coronary heart disease and stroke) in hypertensive type 2 diabetic patients. Target blood pressure values have been decreased in recent years and should be < 130/85 mmHg, and may be even lower according to recent data. The optimal modalities of pharmacological treatment remain controversial, but obviously several medications are required to reach such objectives in most hypertensive patients with type 2 diabetes.

Angiography↗