PubMed Health⌕ Search

Biomedical subjects

J A Swart

Publications and source records attributed to J A Swart.

7 recordsLinked to original sources
PubMed1994

Interactive individualization: patient counselling and drug information supported by knowledge systems.

A model for computer-supported patient counselling and drug information in community pharmacies is described. Two types of informational need are distinguished: the subjective informational need, i.e. the informational need perceived by the patient himself, and the normative informational need, i.e. the patient's informational need according to the professional. Accordingly, individualization is defined as the fine-tuning of information to the informational needs of the participants in the process of communication. A computer-supported process of communication based on this model is defined as 'interactive individualization'. The task of this knowledge system is to support the interactive encounter of the professional and the patient. The process of providing information consists of two subtasks: determining the items of information, e.g. pregnancy, dosage, etc., and subsequently determining the content of information or the advice itself. Based on these subtasks several functionalities of the proposed knowledge system can be derived.

Artificial Intelligence↗
PubMed1990

Graphical method to determine sigmoid ligand binding in vivo at low doses.

In this study, a graphical method is presented to detect sigmoidal binding of in vivo data at low nonsaturating doses. The method can also be applied when the overall binding includes nonspecific binding. Irrespective of the mathematical expression describing the saturation curve, it is shown that a sigmoid curve, in contrast to a nonsigmoid, can be converted into a peak-shaped curve by normalizing the ordinate values with the corresponding value of the abscissa. Computer simulations of in vivo ligand binding demonstrate this principle for in vivo data plots. Experimental results are described to illustrate this approach based on in vivo binding of the neuroleptic drug N-methylspiperone in the rat brain. It is concluded that the method is in particular useful for in vivo applications, e.g., positron emission tomography (PET) studies in human, because low doses are required, and specifically bound, nonspecifically bound, and unbound ligand do not need to be determined separately.

Brain↗
PubMed1990

In vivo binding of spiperone and N-methylspiperone to dopaminergic and serotonergic sites in the rat brain: multiple modeling and implications for PET scanning.

Equilibrium models are derived and applied to in vivo binding of spiperone in the rat brain. The models express the concentration of the ligand in the striatum and frontal cortex as a function of the accumulation in the cerebellum. The models differ with respect to the description of specific binding. Nonlinear regression analysis shows that the in vivo specific binding of 3H-labeled spiperone in the frontal cortex (mainly serotonergic) can be described by a noninteracting sites model, whereas the specific binding in the striatum (mainly dopaminergic) can best be described by models that lead to sigmoid saturation curves. These results were tested and partly confirmed by determining the region-of-interest/cerebellar radioactivity ratio of 11C-labeled N-methylspiperone, with and without pretreatment with haloperidol. The estimated Bmax was 32 fmol/mg wet tissue in the frontal cortex and approximately 90 fmol/mg wet tissue in the striatum. The free plus nonspecific binding of spiperone was similar in the frontal cortex but lower in the striatum than in the cerebellum. The occurrence of sigmoidicity can be best explained by the existence of high-affinity/low-capacity sites in the cerebellum rather than mutual interactions of striatal sites. The consequence of the present analysis for positron emission tomography is that the striatal/cerebellar activity ratio is not an accurate parameter of specific binding features at tracer doses of spiperone or N-methylspiperone.

Animals↗
PubMed1990

Cognitive function testing in comprehensive geriatric assessment. A comparison of cognitive test performance in residential and clinic settings.

Tests of cognitive function are frequently used in geriatric assessment, but the effect of test setting has rarely been explored. To determine the effect of testing site on the performance of elderly patients undergoing a comprehensive geriatric assessment, we administered the Mini-Mental State Exam to 116 geriatric patients in the clinic and at their residence. Their cognitive abilities varied from normal to severely impaired. The patients' scores were 1.5 +/- 3.6 (mean +/- SD) higher at their residence. The clinical importance of a difference in score of 1.5 is not clear. For this reason a second analysis was performed in which a difference in scores of five points or greater between settings was considered clinically meaningful. Twenty-five percent (29 of 116) differed by five points or more. Of these 29 patients, 22 (76%) tested better in the residential setting. These differences were statistically significant (P = .001). We conclude that the testing site may affect test performance and that in-home assessment may reveal the optimal cognitive function of geriatric patients.

Aged↗
PubMed1989

The yield of a home visit in the assessment of geriatric patients.

Elderly patients often have problems not easily detected during an office visit. We investigated the yield of a home visit by a geriatric nurse specialist as part of an interdisciplinary assessment process. Compared with the findings of an office-based assessment by a general internist, the home visit resulted in up to four new problems (median = 2, mean = 1.7, 95% confidence interval = 1.5-1.8) and one to eight new recommendations (median = 4, mean = 3.6, 95% confidence interval = 3.4-3.9). Twenty-three percent of the problems could have resulted in death or significant morbidity. The most frequent problems related to psychobehavioral difficulties (23.1% of problems involving 38.3% of patients), safety (21.6% of problems involving 35.7% of patients), and caregiver related problems (20.4% of problems involving 33.8% of patients). The most common recommendations related to safety (30.7% of recommendations involving 81.8% of patients), caregiver well-being (19.8% of recommendations involving 52.6% of patients), and social issues (12.7% involving 33.8% of patients). Baseline clinical information did not predict the yield of the home visit in this sample. We conclude that an in-home assessment contributes unique and meaningful information to the geriatric assessment process.

Activities of Daily Living↗