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PubMed1994

ARTEMIS-2: an application development experiment with the HELIOS environment.

A medical application is a highly complex system that embraces many data types and a very large number of data processing functions and methods. The development of integrated software engineering environments has deeply changed the conception of applications and the profile of the application developers. In this paper, we address the problem of the development process of a specific multimedia application, called ARTEMIS, within the distributed HELIOS environment. The application is intended to manage information about hypertensive patients, in particular, retrieval and display of administrative, clinical and biological data and display and analysis of digital angiography images and medical reports. The objective is to show how the developer can use, customize and organize the services HELIOS provides. A particular focus is set on reuse strategies and integration during the development process. A scenario has been realized and illustrates the current state of the application. The discussion focuses on the advantages of such distributed environments in medical application development.

Computer Communication Networks↗

PubMed1994

[Self application of preventive measures and opinion about applying them to the population at the health centers of Cantabria].

OBJECTIVE: To establish the degree of fulfillment of preventive measures and health promotion recommended by the Spanish Society of Family and Community Medicine for medical staff; to determine the opinion for medical staff about the application to these preventive measures in the general population and to analyse the relationship between the self application and the recommendation to the population. DESIGN: Cross-sectional observational through questionnaire. SETTING: Health Centers in Cantabria. PARTICIPANTS: Medical staff of Health Centers. MEASUREMENTS AND MAIN RESULTS: A response of 67.9% (146 out of 215) was obtained. The results of the self application had been: smokers, 35.6%; know their TA, 89.5%; know their weight, 99.3%; know their cholesterol, 81.5%; tetanus vaccinated, 41.4%; influence vaccinated, 33.6%; hepatitis B vaccinated, 38.6%; consume alcohol in excess, 5.6%; make breasts annual exploration, 44.4%; mammography, 33.0%; cervical cytology, 73.1% protected against german measles, 87.2%. The opinion of the medical staff about the application of the preventive measures in the general population of was positive in more of 90% the respondent. We found a significant relation (p < 0.01) between self application and recommendations to the population; and the population recommendation also showed an inverse relationship with the number of years of experience in First Aid (p < 0.01). However, the statistical was low for these variables (0.2). CONCLUSION: The self application of the preventive measures in the Health Centers of Cantabria is in general better than in other Spanish regions and although, we found relations between self application and recommendation to the population the statistics potency was low for this variable.

Adult↗

PubMed1993

Clinical and microbiological effects of subgingival application of a chlorhexidine gel in chronic periodontitis. A pilot study.

Clinical and microbiological effects of subgingival application of a 1% chlorhexidine gel were studied. Eleven patients with chronic periodontitis participated in the study. In each patient two pairs of single rooted teeth with at least 20% attachment loss and probing depth > 4 mm were selected. Contralateral sites were randomly allocated to test and control groups receiving chlorhexidine or placebo gel respectively. The gels were applied once daily for two consecutive days. The clinical parameters comprised plaque index, gingival index, probing pocket depth and bleeding on probing. The composition of the subgingival microbiota was estimated with use of dark field microscopy. Baseline measurements were taken two weeks prior to chlorhexidine application. Microbiological and clinical parameters were further monitored 2, 7, 14 and 28 days after the last gel application. Chlorhexidine gel application did not significantly change the composition of the microflora compared to placebo application. There were no major differences in plaque and gingival indices. Effects on probing pocket depth of the chlorhexidine gel application may have been disguised by an influence from the diameter of the needle with which the application was performed. Needles with a diameter of 25G resulted in increases in probing pocket depth which indicates a possible mechanical trauma. This effect was not observed when needles with a diameter of 23G were used.

Adult↗

PubMed1998

Uptake of ethylenediamine tetramethylene phosphonic acid in normal bone after multiple applications. A non-human primate study.

Palliation of bone pain in patients with bone metastases has previously been evaluated using 153Sm (samarium) complexed to bone seeking ethylenediamine tetramethylene phosphonic acid (CAS 1429-50-1, EDTMP). Repeated application of the radioligand as needed was found progressively less effective. This study questions whether EDTMP exerts a blocking function, limiting access to bone or osseous tumours with successive administration. The pharmacokinetics and biodistribution of 153Sm-EDTMP in the normal experimental baboon (n = 6) during three successive applications (6 weekly) each with two different concentrations of EDTMP (0.7 and 1.4 mg/kg b.wt.) were investigated using bone scintigraphy. 153Sm-EDTMP (111 MBq) was injected in each case and monitored for 5 h. Curves of tracer kinetics and bone to background uptake were obtained, also blood and cumulative urine curves. Comparisons were statistically assessed in each group between successive applications and between EDTMP concentrations. Partial blocking with the low EDTMP concentration reached statistical significance after the third application. The first application of the high EDTMP concentration yielded lower uptake in the bone than did low EDTMP pointing to blocking by the high concentration, but not seen with repeated applications. Continual application of high concentration EDTMP could lead to a reduced level of calcium in serum and increased parathyroid hormone levels which might trigger osteoblastic activity and bone remodelling. This would partially affect the blocking which was thus more obvious at the low EDTMP concentration.

Animals↗

PubMed1998

Effects of target-controlled anesthesia with propofol and sufentanil on the hemodynamic response to Mayfield head holder application.

The effects of target-controlled anesthesia with propofol and sufentanil on the hemodynamic response to Mayfield head holder (MH) application were evaluated in 18 ASA I and II patients undergoing scheduled intracranial surgery. Premedication consisted of hydroxyzine, alprazolam and atropine given orally 1 h before surgery. Anesthesia was provided with propofol and sufentanil using a target-controlled infusion device; constant calculated plasma concentrations of 4 micrograms ml-1 propofol and 0.5 ng ml-1 sufentanil were maintained throughout the study. Muscle relaxation was obtained with atracurium and ventilation was controlled with air/oxygen. The MH was fixed 45 +/- 12 min (mean +/- SD) after induction of anesthesia. Heart rate and systolic, diastolic, and mean non invasive arterial pressure were monitored and recorded 5 min before induction of anesthesia (control), 1 min before MH application (MH-1), at MH application, and 1 and 2 min after MH application. Systolic, diastolic, mean arterial pressure, and heart rate increased significantly during and after MH application when compared with MH-1 values, but remained constantly lower than control. Hemodynamic parameters measured 1 min before MH application were significantly lower than control. The results of the study indicate that target-controlled anesthesia maintained with constant calculated plasma concentrations of 4 micrograms ml-1 propofol and 0.5 ng ml-1 sufentanil prevents the increase in arterial pressure and heart rate beyond control values following MH application but may induce some degree of arterial hypotension in the absence of nociceptive stimulation.

Adjuvants, Anesthesia↗

PubMed1998

Presymptomatic testing for Huntington's disease by linkage and by direct mutation analysis: comparison of uptake of testing and characteristics of test applicants.

In Edinburgh, we have compared presymptomatic testing by linkage and by direct mutation analysis by investigating the demand for testing and characteristics of test applicants. Annual new requests for the direct test (DT) are now double the peak with the linkage test (LT) but only 6% individuals have requested re-testing. DT applicants were older with a smaller proportion having lived with an affected relative that LT applicants. This was because many were relatives of newly diagnosed first known cases in their family. This may also explain why DT applicants were less likely to expect a negative result and more likely to be uncertain about their risk. A greater proportion of DT applicants first heard about the test from relatives or their GP than LT applicants who were more likely to hear from Genetic Centre. The demand for follow-up by the Geneticist/Genetic Nurse was much less for DT than for LT applicants largely due to the support offered by the HD Advisors.

Adult↗

PubMed1998

Nursing home applications--reasons and possible interventions.

BACKGROUND: With a rapidly ageing population like Singapore, the need for nursing homes will increase. Admission to a nursing home may be for medical and/or social reasons. We carried out case studies with the Care Liaison Service (CLS) of the Ministry of Health to determine reasons why the elderly applied for nursing home admission, and whether it was possible to prevent an admission. PATIENTS: During the 6-month study period, 331 applications were received, of which 280 (84.6%) were > or = 60 years. There was an equal distribution of male (50.4%) and female (49.6%) applicants. Applicants were predominantly Chinese (86.0%), followed by Indians (8.0%), Malays and other races (3.0% each). Most of the applicants were semi-ambulant (50.0%), fully ambulant (31.4%) and non-ambulant (18.6%). The most common medical problems of the applicants were neurological (e.g. stroke, normal pressure hydrocephalus, epilepsy), heart diseases (e.g. hypertension, ischaemic heart disease, heart failure), orthopaedic conditions (e.g. osteoarthritis, fractures neck of femur and other fractures), and psychiatric problems (e.g. dementia, depression and history of schizophrenia/paranoid psychosis). METHOD: Fifty-seven applicants (20.4%) were selected for intervention. They were 'non-psychiatric' patients whose caregivers were willing but unable to look after them. About half (28, 49.1%) of these applicants required nursing home care. The remaining 29 patients (50.9%) had the potential of improving or able to remain at home with appropriate community services. These 29 patients were contacted by the CLS nurse and the following recommendations were made: 1) inpatient rehabilitation in a community hospital (7 patients); 2) rehabilitation and day care in a community-based day care centre (17 patients); 3) domiciliary medical care (4 patients), and 4) reassessment by psychiatrist to control psychotic symptoms (1 patient). Only 6 patients were willing to accept the new recommendations. This poor result may imply that attempts at intervention at this stage may be too late. CONCLUSION: We need to identify the group at risk for nursing home admissions early, take a proactive stance towards them, increase support to their caregivers to prevent burnt-out and continue to develop and publicize community-based services. More studies need to be done in this area.

Aged↗

PubMed2005

The resident application process and its correlation to future performance as a resident.

Many authors have attempted to determine predictors for success within a residency program. There is very little agreement about what is useful. We hypothesized that our residency selection process is effective in determining which resident applicants would be most likely to excel in our program. To test this hypothesis, we reviewed the scores that applicants received after their interview day to determine if there was a correlation with any measures used to evaluate residents once they entered residency training. Our results determined that the score given to an applicant fails to correlate with any of the areas that are evaluated throughout their residency. The only statistically significant correlation was between the scores assigned by the selection committee to applicants and the applicant scores on their first year in training examination. We concluded that our residency selection process score does not accurately predict which applicants will excel in our program.

Anesthesiology↗

PubMed2002

End-to-end performance measurement of Internet based medical applications.

We present a method to obtain an end-to-end characterization of the performance of an application over a network. This method is not dependent on any specific application or type of network. The method requires characterization of network parameters, such as latency and packet loss, between the expected server or client endpoints, as well as characterization of the application's constraints on these parameters. A subjective metric is presented that integrates these characterizations and that operates over a wide range of applications and networks. We believe that this method may be of wide applicability as research and educational applications increasingly make use of computation and data servers that are distributed over the Internet.

Evaluation Studies as Topic↗

PubMed2005

Pediatric emergency medicine fellowships adopt a new application process.

The growth of the subspecialty of pediatric emergency medicine has created a subsequent growth in the demands of pediatric emergency medicine fellowship training. To facilitate the application process for both applicants and fellowship training programs, a uniform application and uniform deadlines have been adopted by the Pediatric Emergency Medicine Fellowship Director's Subcommittee. The Electronic Residency Application Service will provide online support necessary for the implementation of this new process. A description of the new process and a description of theoretical benefits from this change are described. Pediatric emergency medicine fellowship applicants should be encouraged to investigate resources describing the new application process.

Emergency Medicine↗

PubMed2005

Pediatric emergency medicine fellowships adopt a new application process.

Emergency Medicine↗

PubMed2000

Postoperative application of mitomycin for trabeculectomies.

BACKGROUND: Persistent hypotony is a severe complication following trabeculectomy with intraoperative application of mitomycin. OBJECTIVE: To reduce this rate of hypotony by using a lower concentration of mitomycin and applying the mitomycin only topically to the filtering bleb following surgery. METHODS: Patients were enrolled on a consecutive basis and prospectively followed up. Standard trabeculectomies were performed and mitomycin applied postoperatively on the 3 days following surgery (group 1). For comparison, data from previous studies were used for control eyes with intraoperative mitomycin application (group 2) and no mitomycin application (group 3). Preoperative and postoperative data, complications, and the need for further surgical procedures were evaluated. RESULTS: The study group (group 1) consisted of 22 cases. The mean follow-up was 13.4 and 13.5 months for groups 1 and 2, respectively. Average intraocular pressure values decreased from 33. 6 and 31.0 mm Hg (P =.32; t test) to 16.0 and 12.5 mm Hg in the 2 groups (P =.03; t test). The average number of medications decreased from 2.5 and 2.5 to 0.6 and 0.4 (P =.35; t test) in groups 1 and 2, respectively, at the last visit. Hypotony lasting for more than 3 months occurred only in eyes with intraoperative mitomycin application (14/22). Choroidal detachment (3/22) and hypotony maculopathy (2/22) also were only noted in eyes from group 2. In group 3, success rates were much lower. CONCLUSIONS: This is the first clinical study, to our knowledge, to evaluate the efficacy of this new technique of mitomycin application. From the results, it appears that the postoperative application of mitomycin following trabeculectomy is associated with a lower risk of severe and long-standing hypotony. This technique may be promising in eyes at low risk for failure.

Adolescent↗

PubMed1998

Interstitial laser coagulation: evaluation of the effect of normal liver blood perfusion and the application mode on lesion size.

BACKGROUND AND OBJECTIVE: The effect of temporarily interrupted hepatic blood flow and multiple-fiber application on necrosis volume in interstitial laser coagulation (ILC) was investigated. STUDY DESIGN/MATERIALS AND METHODS: Single- and multiple-fiber ILC were performed in porcine livers with normal as well as interrupted perfusion. Temperatures were determined. Lesions were measured and studied by light microscopy 4 hours post-treatment. RESULTS: ILC with multiple-fiber application led to significantly greater individual lesion volumes (3.7 +/- 0.5 cm3) than single-fiber application (2.5 +/- 0.5 cm3) (P < .01). The interruption of hepatic perfusion led to a significant increase in lesion volume with single- (7.5 +/- 1.0 cm3) as well as multiple-fiber application (12.6 +/- 2.2 cm3) (P < .01). Superposition of the lesions in the multiple-fiber application mode was only determined with interrupted perfusion (total volume: 50.3 +/- 6.6 cm3). CONCLUSION: Interruption of hepatic perfusion increases lesion volumes significantly. ILC for treating liver tumors should preferably be performed by application routes that permit temporary interruption of hepatic perfusion.

Animals↗

PubMed1998

Exposure opportunities of families of farmer pesticide applicators.

BACKGROUND: Families of farmer pesticide applicators have unusual opportunities for exposure, directly or indirectly, to pesticides. These exposures are not well characterized. METHODS: Subjects were 26,793 licensed private pesticide applicators enrolled in the Agricultural Health Study, a cohort study being conducted in Iowa and North Carolina. Questionnaires were completed by the applicators and their spouses. RESULTS: Many indirect exposure opportunities exist; for example, 21% of homes are within 50 yards of pesticide mixing areas, 27% of applicators store pesticides in their homes, and 94% of clothing worn for pesticide work is washed in the same machine as other laundry. Direct exposure opportunities also occur; for example, 51% of wives of applicators worked in the fields in the last growing season, 40% of wives have ever mixed or applied pesticides, and over half of children aged 11 or more do farm chores. DISCUSSION/CONCLUSIONS: The extent of the opportunities for exposure of family members of farmer pesticide applicators makes studies of their health important.

Adult↗

PubMed1993

Presymptomatic DNA-testing for Huntington disease: pretest attitudes and expectations of applicants and their partners in the Dutch program.

We studied the baseline attitudes, prior to testing, of 70 applicants at risk for Huntington disease (HD) and their partners in the Dutch presymptomatic DNA-testing program. Two thirds of the applicants were female; 36% already had children. The main reason (60%) for undertaking the test was for family planning. Other reasons were either to reduce uncertainty (43%) or to obtain certainty (38%). Partners of applicants stated that planning for the future was for them the most important reason (76%). Significantly more at-risk females (42%) than males (16%) anticipated an unfavorable test outcome. Quite remarkably, most applicants and partners denied that a positive result might have adverse effects on either personal mood, quality of life, or marriage. Only a few did not expect that a favorable result would induce relief. The eventual outcome of the test was expected to enable applicants to gain control over their future, whatever the results. Hence, we propose that the applicants form a self-selected group, based on their expectation that they will not be emotionally affected by either result.

Adult↗

PubMed1992

Evaluation of microwave hyperthermia applicators.

Hyperthermia has been used in conjunction with radiation and chemotherapy for cancer treatment. When using electromagnetic heating, applicators are critical components in contact with or in proximity to patients and can be the determining factor for effective and safe treatment. Tissue absorption of electromagnetic energy is determined by many factors. Three cases are shown to illustrate the complexity of microwave heating: 1) The BSD MA-151 applicator has good center heating on a muscle-only phantom as shown in the operation manual. When fat slabs of 0.25, 0.5, 1, and 2 cm thick were added, two hot spots near the periphery of the applicator were evident on all fat surfaces, exposed at 631 MHz. At 915 MHz, the heating was elongated on the surface of the models with 0.25- and 2-cm fat, and two hot spots were observed on the 0.5- and 1-cm fat surfaces. 2) Heating patterns of the Clini-Therm applicators on a muscle-only phantom, as indicated in the operations guide, are elliptical with their major axes perpendicular to the electric field. However, when a bolus is used, the elliptical pattern is parallel to the E field. 3) Heating patterns in cylindrical structures were studied with inhomogeneous models of limbs. Arm and thigh models consisting of fat, bone, and muscle material were heated with Clini-Therm L, M, and MS applicators at 915 MHz. In addition to the geometric effect, the results indicated that placing the applicators with E field parallel to the long axis of cylindrical structures can minimize required power, produce less heating of fats and reduce stray radiation. In conclusion, to apply penetrating microwave or other RF fields for tissue heating, one must simulate the clinical exposure conditions as closely as possible to obtain useful heating patterns.

Evaluation Studies as Topic↗

PubMed1984

Prolonged application of pressure in transluminal coronary angioplasty.

We investigated the morphologic structure and fluid content of atherosclerotic specimens of fresh human postmortem artery segments before and after application of a pressure of 5 atmospheres simulated by a weight of 5 kg per 1 cm2. After applying pressure in nonorganized atheromata, we noticed a marked reduction in thickness while in fibrotic atheromata we observed only smaller differences in thickness. Reduction in fluid content was significantly more pronounced in nonorganized atheromatous tissue. Reduction in thickness was closely related to reduction in weight (i e, fluid content). The time of pressure application necessary to achieve the optimal result averaged 60 sec. The conclusions drawn from these experiments were incorporated into clinical application of coronary angioplasty. Prolonged balloon inflation was applied to the last 400 out of a total of 600 coronary angioplasty procedures, performed between October 1977 and October 1983. Stenoses not sufficiently responsive to balloon inflation periods of 5-10 sec were exposed to periods of 60 sec (30-120 sec). The number of "non dilatable" stenoses was 15% with the standard short pressure procedure, but only 5% with the prolonged pressure application. No serious complications related to prolonged pressure application were observed. Thus, from experimental data and clinical experience the application of longer pressure periods appears justified and beneficial.

Angioplasty, Balloon↗

PubMed2005

The applicability and the inter-rater reliability of the Comprehensive Psychopathological Rating Scale in an elderly clinical population.

BACKGROUND: Psychopathological rating scales are developed and tested on a relatively young population. Their applicability and psychometric performance in the elderly (aged above 60-65 years) are mostly unknown. It is unknown how factors related to ageing or mild cognitive dysfunction influence the applicability and the reliability of these scales. We tested the applicability and the inter-rater reliability of the Dutch version of the Comprehensive Psychopathological Rating Scale (CPRS) on an elderly (age > 60 years) inpatient population. METHODS: The applicability and reliability (expressed by differently weighted Kappa coefficients) of the CPRS was assessed by investigating 62 consecutively referred patients in a ward for elderly patients with acute psychiatric problems that were primarily functional in nature. The results are compared with those found in a younger population. RESULTS: The applicability and reliability of the CPRS on the elderly can be categorised as sufficient to good and is comparable with results for a younger population. We did not find any specific factors influencing the practicality, or the reliability of the CPRS when applied to an elderly group of people with a mild cognitive dysfunction. CONCLUSIONS: The CPRS does not loose its clinical relevance with age, as the applicability and the reliability of the CPRS is not influenced by ageing or mild cognitive dysfunction. The CPRS can detect a broad range of symptoms and due to its psychometric properties it is a useful instrument for measuring an elderly or young population.

Age Factors↗