The techniques of systems analysis have been applied to the metabolism of phenylalanine in healthy subjects and in phenylketonuria to derive a computer model. The model consists of seven compartments and four biological functions. Enzyme reactions are assumed to obey Michaelis-Menten kinetics. The computer program is written in FORTRAN. A biological validation of the model has been performed. The computer model has potential value for estimating concentrations of key metabolites in human organs which are not accessible to direct analysis from measurements of metabolites in blood and urine and phenylalanine intake. Such estimates would be helpful in clinical decisions concerning modification or termination of dietary treatment in phenylketonuria.

Computers↗

PubMedDate not supplied

Telemedicine: a pilot study in nursing home residents.

BACKGROUND: Telemedicine has been applied successfully in various fields of medicine. This mode of health care delivery may potentially be useful in supporting frail nursing home residents who require multidisciplinary geriatric services. OBJECTIVE: To assess the feasibility of telemedicine in providing geriatric services to nursing home residents, and whether this mode of care resulted in increased productivity and savings. METHODS: A local 200-bed nursing home supported by the Community Geriatric Assessment Team (CGAT) was recruited. Over a 1-year period, teleconferencing was used to replace conventional geriatric outreach services. The feasibility of telemedicine was evaluated by participating specialists. Productivity gains, consumption of hospital services and user satisfaction were measured. RESULTS: Telemedicine was adequate for service delivery in up to 99% of cases, depending on the specialty. A greater number of clients were served and follow-up intervals were shortened. The service was cheaper than conventional outreach or clinic activities, and acceptable to users and clients. In particular, savings were made through a 9% reduction in visits to the Accidents and Emergency Department and in 11% fewer admissions to acute hospital wards. CONCLUSION: telemedicine is a feasible means of delivering multidisciplinary care to frail nursing home residents, and may result in increased productivity and significant savings.

Aged↗

PubMedDate not supplied

Cyclosporin A and its metabolites, distribution in blood and tissues.

Cyclosporin A (CsA), a non-myelotoxic immunosuppressant, and its metabolites are widely distributed in the body. Highest concentrations of CsA have been detected in the pancreas, adipose tissue and liver, lowest concentrations in brain, muscle, blood and other body fluids. Metabolites are distributed differently to CsA. In addition to lipid partition, intracellular binding to cyclophilin, a peptidyl-prolyl cis-trans isomerase, appears to play a role in its tissue distribution. The temperature dependence of such binding in erythrocytes poses difficulty in serum or plasma measurements. Tissue specific processes may also influence action and toxicity of CsA and its metabolites; thus, a better understanding of the complex distribution pattern of CsA and its metabolites would be important for establishing improved strategies and selection of appropriate specific methodologies for drug monitoring.

Animals↗