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At least 19 recordsLinked to original sources

PubMed1997

Utility of Doppler-detectable microbubbles in the diagnosis and treatment of decompression sickness.

BACKGROUND: Doppler-detectable microbubbles (DMB) are frequently used to evaluate altitude decompression stress. However, the role of DMB in the therapy of decompression sickness (DCS) has not been examined. HYPOTHESIS: The ability of Doppler to detect microbubbles during decompression (Doppler test) may be used in the diagnosis of DCS, and to aid clinical decisions about treatment options for DCS. METHODS: We examined the data on DMB and symptoms from NASA Database on DCS (n = 516). The accuracy of Doppler test was obtained from the Receiver Operating Characteristic (ROC) for DMB (grades I through IV), and efficacy was obtained by calculating predictive or post-test probabilities. Threshold analysis was used to obtain the probabilities for testing and/or treatment decisions. RESULTS: The Doppler test was useful for both screening and confirming DCS, when different criteria (grade I for screening; grade IV for confirming) were used for a positive test. Calculation of predictive values and threshold analysis showed that: 1) early recompression was the therapy of choice when post-test probability of disease was > 0.25 in individuals with non-specific pain at altitude, and early recompression with 100% oxygen for 2 h at site level was optimal therapy when this probability was > 0.33; 2) hyperbaric therapy was optimal when post-test probability was > 0.04 in individuals with uncertain symptoms post-flight. CONCLUSIONS: The Doppler test was of greater utility in excluding DCS than confirming its presence, and was useful in making therapeutic decisions on DCS when confronted with non-specific symptoms at altitude.

Aerospace Medicine↗

PubMed1997

Physical examination during space flight.

OBJECTIVE: To develop techniques for conducting a physical examination in microgravity and to describe and document the physiologic changes noted with use of a modified basic physical examination. DESIGN: On the basis of data gathered from physical examinations on KC-135 flights, three physical variables were assessed serially in astronauts during two shuttle missions (of 8- and 10-day duration, respectively). Preflight, in-flight, and postflight examinations were conducted by trained physician-astronauts or flight surgeons, who used this modified examination. MATERIAL AND METHODS: Five male and two female crewmembers participated in the "hands-on" physical examination of all physiologic systems except the genitourinary system. Level of edema, intensity of bowel sounds, and peripheral reflexes were assessed and graded. RESULTS: This investigation identified unique elements of a physical examination performed during space flight that will assist in the development of standard methods for conducting examinations of astronauts in weightlessness. In addition, demonstrable changes induced by microgravity were noted in most physiologic systems examined. CONCLUSION: The data support the hypothesis that the microgravity examination differs from that conducted on earth or in a 1g environment. In addition, alterations in the physiologic response can be detected with use of hands-on technique. These data are invaluable in the development of optimal medical care for humans in space.

Auscultation↗

PubMed1996

Perception of the medical risk of spaceflight.

We conducted an opinion survey to improve the characterization of medical risk during spaceflight, using a questionnaire designed to elicit space medicine experts' perceptions of the probability, health effect, and mission impact of selected medical events occurring during spaceflight missions of 30-90 d. This questionnaire was directed toward those events about which little data currently exist, therefore medical events that have occurred during spaceflights with some frequency, such as space motion sickness, were excluded from the questionnaire. The questionnaire was mailed to 99 clinical and research professionals involved with NASA medical programs; 65 responses were returned, of which 60 could be analyzed. The experts rated skin disorders as the most likely to occur, but which would have little effect on mission completion or astronaut health. Circulatory diseases were rated as having the lowest probability of occurrence, but the highest effect on the mission or on a crewmember's health. The results of this survey will be combined with data from analogous populations and existing astronaut health data to establish a data set to support decisions about allocation of health care resources.

Humans↗

PubMed1996

A field trial of the NASA Telemedicine Instrument Pack in a family practice.

BACKGROUND: Previous studies of telemedicine applications have demonstrated that the technology is effective but inefficient. Little attention has been directed to the primary care portion of the connection, especially the use of the medical peripheral devices. This study used a telemedicine testbed that simulates a rural practice environment to describe the effectiveness and efficiency of the NASA Telemedicine Instrument Pack, a small self-contained system of medical peripheral devices. METHOD: This study was an 8-week field trial of a suitcase-sized pack containing a fundus camera, flexible nasopharyngoscope, dermatology macrolens, light source, and video monitor. The pack was first studied in specialty clinics and then was used in a family practice office connected to the consultant node by digital lines. Evaluations were obtained from technicians, patients, and consultants. RESULTS: During 20 video clinic sessions, 59 patients with 38 different diagnoses were examined. The ear, nose, and throat portion of the exam was effective, with some decrement in color and clarity with compression of the signal. The eye portion was marginally effective, limited by a field of view that was too narrow and also by rigorous technician requirements. The skin exam was largely unacceptable primarily because the macrolens did not meet the requirements for color or clarity prior to compression of the signal. CONCLUSIONS: Subsequent design efforts for medical peripheral devices for telemedicine use will require significant modifications to "off the shelf" equipment to be effective and efficient. A family practice telemedicine testbed provides the appropriate environment for such field trials.

Attitude of Health Personnel↗

PubMed2005

Operational behavioral health and performance resources for international space station crews and families.

The Behavioral Health and Performance Section (BHP) at NASA Johnson Space Center provides direct and indirect psychological services to the International Space Station (ISS) astronauts and their families. Beginning with the NASA-Mir Program, services available to the crews and families have gradually expanded as experience is gained in long-duration flight. Enhancements to the overall BHP program have been shaped by crewmembers' personal preferences, family requests, specific events during the missions, programmatic requirements, and other lessons learned. The BHP program focuses its work on four areas: operational psychology, behavioral medicine, human-to-system interface, and sleep and circadian. Within these areas of focus are psychological and psychiatric screening for astronaut selection as well as many resources that are available to the crewmembers, families, and other groups such as crew surgeon and various levels of management within NASA. Services include: preflight, in flight, and postflight preparation; training and support; resources from a Family Support Office; in-flight monitoring; clinical care for astronauts and their families; and expertise in the workload and work/rest scheduling of crews on the ISS. Each of the four operational areas is summarized, as are future directions for the BHP program.

Adaptation, Psychological↗

PubMed2005

Diagnostic instrumentation aboard ISS: just-in-time training for non-physician crewmembers.

INTRODUCTION: The performance of complex tasks on the International Space Station (ISS) requires significant preflight crew training commitments and frequent skill and knowledge refreshment. This report documents a recently developed "just-in-time" training methodology, which integrates preflight hardware familiarization and procedure training with an on-orbit CD-ROM-based skill enhancement. This "just-in-time" concept was used to support real-time remote expert guidance to complete ultrasound examinations using the ISS Human Research Facility (HRF). METHODS: An American and Russian ISS crewmember received 2 h of "hands on" ultrasound training 8 mo prior to the on-orbit ultrasound exam. A CD-ROM-based Onboard Proficiency Enhancement (OPE) interactive multimedia program consisting of memory enhancing tutorials, and skill testing exercises, was completed by the crewmember 6 d prior to the on-orbit ultrasound exam. The crewmember was then remotely guided through a thoracic, vascular, and echocardiographic examination by ultrasound imaging experts. RESULTS: Results of the CD-ROM-based OPE session were used to modify the instructions during a complete 35-min real-time thoracic, cardiac, and carotid/jugular ultrasound study. Following commands from the ground-based expert, the crewmember acquired all target views and images without difficulty. The anatomical content and fidelity of ultrasound video were adequate for clinical decision making. CONCLUSIONS: Complex ultrasound experiments with expert guidance were performed with high accuracy following limited preflight training and multimedia based in-flight review, despite a 2-s communication latency. In-flight application of multimedia proficiency enhancement software, coupled with real-time remote expert guidance, facilitates the successful performance of ultrasound examinations on orbit and may have additional terrestrial and space applications.

Aerospace Medicine↗

PubMed1993

The clinical chemistry and immunology of long-duration space missions.

Clinical laboratory diagnostic capabilities are needed to guide health and medical care of astronauts during long-duration space missions. Clinical laboratory diagnostics, as defined for medical care on Earth, offers a model for space capabilities. Interpretation of laboratory results for health and medical care of humans in space requires knowledge of specific physiological adaptations that occur, primarily because of the absence of gravity, and how these adaptations affect reference values. Limited data from American and Russian missions have indicated shifts of intra- and extracellular fluids and electrolytes, changes in hormone concentrations related to fluid shifts and stresses of the missions, reductions in bone and muscle mass, and a blunting of the cellular immune response. These changes could increase susceptibility to space-related illness or injury during a mission and after return to Earth. We review physiological adaptations and the risk of medical problems that occur during space missions. We describe the need for laboratory diagnostics as a part of health and medical care in space, and how this capability might be delivered.

Aerospace Medicine↗

PubMed1998

The Spacebridge to Russia Project: internet-based telemedicine.

The National Aeronautics and Space Administration (NASA) has been a pioneer in telemedicine since the beginning of the human spaceflight program in the early 1960s. With the rapid evolution in computer technology and equally rapid development of computer networks, NASA and the Department of Surgery in Yale University's School of Medicine created a telemedicine testbed with the Russia Space Agency, the Spacebridge to Russia Project, using multimedia computers connected via the Internet. Clinical consultations were evaluated in a store-and-forward mode using a variety of electronic media, packaged as digital files, and transmitted using Internet and World Wide Web tools. These systems allow real-time Internet video teleconferencing between remotely located users over computer systems. This report describes the project and the evaluation methods utilized for monitoring effectiveness of the communications. The Spacebridge to Russia Project is a testbed for Internet-based telemedicine. The Internet and current computer technologies (hardware and software) make telemedicine readily accessible and affordable for most health care providers. Internet-based telemedicine is a communication tool that should become integral to global health care.

Computer Systems↗

PubMed1998

Risk of cancer mortality among the Longitudinal Study of Astronaut Health (LSAH) participants.

BACKGROUND: The potential for occupational radiation exposures in the U.S. Space Program makes cancer risk a major health concern. METHODS: The NASA Medical Operations Branch and KRUG Life Sciences Epidemiology Section at the Johnson Space Center (JSC) investigated the rate of cancer mortality among the astronauts and the comparison participants of the Longitudinal Study of Astronaut Health (LSAH). Medical records are maintained by the JSC Flight Medicine Clinic, JSC Occupational Medicine Clinic, and LSAH. Cause of death data from death certificates were reviewed for cancer mortality. These data were compared with cancer mortality data for the general population residing in the Texas Gulf Coast area. RESULTS: The astronauts had a higher age-specific risk of cancer mortality than the comparison group (SMR = 345; 95% CI = 69.5-756.2), but the difference did not reach statistical significance. Both the astronauts and the comparison group had lower age-specific rates than the general population (SMR = 47, 95% CI = 9.6-105.1; SMR = 17, 95% CI = 3.5-37.9, respectively).

Adult↗

PubMed1993

Earthbound applications for NASA's physician workstation.

The dream of a space probe to Mars or an astronaut colony on the moon persists. Despite years of setbacks and delays, NASA continues to lay the foundation for a new frontier in space. The necessity of a self contained health maintenance facility is an integral part of this stellar venture. As a subsystem of this health maintenance facility, the physician or astronaut workstation was envisioned as the vehicle of interface between the computer resources of the space station and the care provider. Our efforts to define and build this interface have resulted in a series of programs which can now be tested and refined using earth-based applications. The modules which have dual-use application from the NASA workstation include: patient scheduling and master patient index, pharmacy, laboratory, medical library, problem list/progress notes, and digital medical records. Our current plan is to develop these tools as objects that can be assembled in a variety of configurations. This will allow the technology to be used by the private sector where each doctor can select the starting point of his outpatient office system and add modules as he makes progress in system integration and training.

Aerospace Medicine↗

PubMed2006

Phototherapy in anti-aging and its photobiologic basics: a new approach to skin rejuvenation.

Intrinsic aging and photoaging of the face are constantly ongoing, and eventually result in the typical "aged" face, with visible lines and wrinkles at rest, a variety of dyschromia and a tired, dull and lax epidermis over poorly organized elastotic dermal architecture characterized by many interfibrillary spaces. Both ablative and nonablative resurfacing have been reported as solutions, the former providing excellent results, but a long patient downtime, and the latter giving little or no downtime, but less-than-ideal results. In ablative resurfacing, the epidermis is removed and replaced with a "new" epidermis, whereas in the nonablative approach the epidermis is spared through some form of cooling. In both approaches, however, the goal is to create controlled amounts of thermal damage in the dermis to stimulate the wound healing process, thus generating a tighter, better organized, "younger" dermal matrix. A better approach might be to apply prevention, rather than the cure, and to treat subjects in their very early 20s, before even fine lines have begun to appear. This "photoanti-aging" approach could be achieved with the use of very low incident levels of photon energy to stimulate the skin cells, both epidermal and dermal, at cell-specific wavelengths based on the photobiological findings of the literature over the past two decades or so, in order to increase their resistance to the effects of chronological and photoaging. Lasers and IPL systems could be used, but are extremely expensive and therapist-intensive. A new generation of light-emitting diodes (LEDs) has appeared as the result of a spin-off from the US NASA Space Medicine Program, which are much more powerful than the previous generation with quasimonochromatic outputs. These LEDs can offer target specificity to achieve photobiomodulated enhanced action potentials of the skin cells, in particular mast cells, macrophages, endotheliocytes, and fibroblasts, plus increases in local blood and lymphatic flow, in a noninvasive, athermal manner. New phototherapeutic LED-based systems have appeared to meet the need for a less-expensive but clinically useful light source to enable photoantiaging as a reality in clinical practice. Some studies proving the efficacy of LED therapy have already appeared, and based on their results LED therapy represents a potential new approach to prevention in anti-aging, so that further studies are warranted to prove its efficacy.

Humans↗

PubMed1985

Training of aerospace medicine physicians.

In the U. S. there are 23 recognized medical specialty boards. One of these is preventive medicine. Within preventive medicine there are three areas: Aerospace Medicine, Occupational Medicine, and Public Health/General Preventive Medicine. The preventive medicine specialties have a common core of required training including biostatistics, epidemiology, health services administration and environmental health. These, plus associated topics are covered during year one of training. Year two of training involves clinical rotations specifically tailored to the eye, ear, heart, lungs and brain, plus flight training to the private pilot level, and a Masters Degree research project for the required thesis. During year three the physicians in aerospace medicine practice full-time aerospace medicine in a NASA or other government laboratory or a private facility. To date, more than 40 physicians have received aerospace medicine training through the Wright State University School of Medicine program. Among these are physicians from Japan, Australia, Taiwan, Canada and Mexico. In addition to the civilian program at Wright State University, there are programs conducted by the U. S. Air Force and Navy. The Wright State program has been privileged to have officers from the U. S. Army, Navy and Air Force. A substantial supporter of the Wright State program is the National Aeronautics and Space Administration and a strong space component is contained in the program.

Aerospace Medicine↗

PubMedDate not supplied

James P. Bagian on patient safety initiatives. Interview by Deborah Mears.

James P. Bagian, MD, is director of the Veterans Health Administration (VHA) National Center for Patient Safety (NCPS). With a focus on systems and an emphasis on "prevention not punishment," NCPS is working to improve patient safety, prevent health care errors, and nurture a culture of safety throughout the 173 VHA medical centers. Previously, Dr. Bagian served as deputy director of the Regional and State Programs Division, Office of Mobile Sources, Environmental Protection Agency. From 1980 to 1995, Dr. Bagian served as a NASA astronaut. He took part in both the planning and provision of emergency medical and rescue support for the first six Space Shuttle flights. In 1986, Dr. Bagian served as an investigator for the Space Shuttle Challenger accident. A veteran of two space flights (STS-29 in 1989 and STS-40 in 1991), Dr. Bagian has logged more than 337 hours in space. Dr. Bagian is currently an adjunct assistant professor of military and emergency medicine at the Uniformed Services University of Health Sciences at F. Edward Herbert School of Medicine and also a clinical assistant professor of preventive medicine and community health at the University of Texas Medical Branch. He is a Colonel in the U.S. Air Force Reserve where he is a pararescue flight surgeon with the 920th Air Rescue Group. He has received the American Medical Association's Nathan S. Davis Award for outstanding public service in the advancement of public health. The NCPS received the 2001 Innovations in American Government Award given by the Institute for Government Innovation at the John F. Kennedy School of Government of Harvard University. The NCPS was the only federal organization to be so identified in 2001.

Hospitals, Veterans↗

PubMed1987

Controversies in cardiovascular care: silent myocardial ischemia.

The objective evidence of silent myocardial ischemia--ischemia in the absence of classical chest pain--includes ST-segment shifts (usually depression), momentary left ventricular failure, and perfusion defects on scintigraphic studies. Assessment of angina patients with 24-hour ambulatory monitoring may uncover episodes of silent ischemia, the existence of which may give important information regarding prognosis and may help structure a more effective therapeutic regimen. The emerging recognition of silent ischemia as a significant clinical entity may eventually result in an expansion of current therapy--not only to ameliorate chest pain, but to minimize or eliminate ischemia in the absence of chest pain.

Angina Pectoris↗

PubMed2005

Human behavioral research in space: quandaries for research subjects and researchers.

With the advent of long-duration spaceflight on board the International Space Station (ISS) and possible future missions beyond low Earth orbit (LEO) such as Mars, it is critical that those at NASA have a realistic assessment of the challenges that will face individuals on long-duration missions so that they can develop preventive and real-time countermeasures to behavioral health issues. While space travellers are very interested in having countermeasures to the deleterious effects of space missions, they have a powerful disincentive to participate in this research if they feel it could in any way negatively affect their flight status. The behavioral issues of isolation and confinement for extended-duration space missions are reviewed. Areas of basic and clinical behavioral research are listed. And the classical clinical model for research is not considered appropriate for the current configuration of the space program. The use of analogue environments and advanced statistical analysis are suggested as ways to address the limited spaceflight research opportunities. The challenge of research subject or patient confidentiality vs. mission safety and issues of personal flight status are addressed.

Adaptation, Physiological↗

PubMed1991

Can the adult skeleton recover lost bone?

The loss of bone mineral with aging and subsequent development of osteoporosis is a common problem in elderly women, and as life expectancy increases, in elderly men as well. Space flight also causes bone loss and could be a limiting factor for long duration missions, such as, a Mars expedition or extended occupation of a space station. Before effective countermeasures can be devised, a thorough knowledge of the extent, location, and rate of bone loss during weightlessness is needed from actual space flight data or ground-based disuse models. In addition, the rate and extent that these losses are reversed after return from space flight are of primary importance. Although the mechanisms are not likely to be the same in aging and space flight, there are common elements. For example, strategies developed to prevent disuse bone loss or to enhance the rate of recovery following space flight might have direct applicability to clinical medicine. For various reasons, little attention has been given to recovery of bone mass following space flight. As a prelude to the design of strategies to enhance recovery of bone, this paper reviews published literature related to bone recovery in the adult. We conclude that recovery can be expected, but the rate and extent will be individual and bone site dependent. The development of strategies to encourage or enhance bone formation following space flight may be as important as implementing countermeasures during flight.

Adult↗

PubMed1981

Evaluation of the NASA/JSC blood pressure screening clinic.

This study evaluated the NASA/Johnson Space Center's blood pressure screening program, which was designed to identify the proportion of NASA employees who were hypertensive and to identify self-report variables related to elevated pressures. In 1978, a random sample of 3892 employees was selected from over 2,100 NASA employees. Twenty-eight percent were classified as hypertensive by the criterion of systolic pressure of 140 or above or diastolic pressure of 90 or greater. Approximately 16% of all employees had a history of hypertension; the remaining 12% of the identified hypertensives were unaware of their potential health problem. Multivariate analysis showed that elevated systolic pressures were more prevalent in the older, heavier employees. Of hypertensives under treatment, about 74% were under poor control as judged from blood pressures randomly taken at their place of employment. These results demonstrated the effectiveness of screening for unsuspecting hypertensives in industry.

Adult↗

PubMed1987

Spacelab experiments on space motion sickness.

Recent research results from ground and flight experiments on motion sickness and space sickness conducted by the Man Vehicle Laboratory are reviewed. New tools developed include a mathematical model for motion sickness, a method for quantitative measurements of skin pallor and blush in ambulatory subjects, and a magnitude estimation technique for ratio scaling of nausea or discomfort. These have been used to experimentally study the time course of skin pallor and subjective symptoms in laboratory motion sickness. In prolonged sickness, subjects become hypersensitive to nauseogenic stimuli. Results of a Spacelab-1 flight experiment are described in which four observers documented the stimulus factors for and the symptoms/signs of space sickness. The clinical character of space sickness differs somewhat from acute laboratory motion sickness. However SL-1 findings support the view that space sickness is fundamentally a motion sickness. Symptoms were subjectively alleviated by head movement restriction, maintenance of a familiar orientation with respect to the visual environment, and wedging between or strapping onto surfaces which provided broad contact cues confirming the absence of body motion.

Adaptation, Physiological↗