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Selected AbstractsCauses and place of death in Italian patients with amyotrophic lateral sclerosisACTA NEUROLOGICA SCANDINAVICA, Issue 3 2010R. Spataro Spataro R, Lo Re M, Piccoli T, Piccoli F, La BellaV. Causes and place of death in Italian patients with amyotrophic lateral sclerosis. Acta Neurol Scand: 122: 217,223. © 2010 The Authors Journal compilation © 2010 Blackwell Munksgaard. Objectives,,, To determine the causes and place of death in a cohort of Italian patients with amyotrophic lateral sclerosis (ALS). A better understanding of the likely causes of death in ALS might improve the palliative care at the end-of-life, whereas knowing the place of death will help to verify the need for highly specialized care services, e.g. hospice and nursing home. Patients and methods,,, Between 2000 and 2008, 182 ALS patients (onset: spinal, 127; bulbar, 55; M/F: 1.6) were followed in a single ALS Tertiary Centre in Palermo, Sicily, Italy until death. Medical data for each individual patient were recorded in a large database throughout the disease course. Information concerning causes and place of death were obtained by consultation with relatives or the family physician. Results,,, Respiratory failure (terminal respiratory insufficiency, pneumonia) was the most frequent cause of death (81.3%), which included six cases (3.3%) who requested a terminal sedation. Sudden death and death during sleep accounted for by 6.0% and 6.6% of all deaths, respectively. Heart-related causes of death were relatively infrequent in our cohort, accounting for by 7.1% of all deaths (i.e. sudden death: 6.0% and myocardial infarct: 1.1%). Patients (85.2%) died at home. Conclusions,,, The leading cause of death in ALS remains the respiratory failure, followed by the sudden death and death during sleep. Most patients in our cohort died at home, a choice that might be only partially driven by cultural factors. These findings might have a great impact on the development of the advanced and end-of-life palliative care and in the planning of specialized care services, as hospice and nursing home. [source] Principles and Applications of Computer Graphics in MedicineCOMPUTER GRAPHICS FORUM, Issue 1 2006F.P. Vidal Abstract The medical domain provides excellent opportunities for the application of computer graphics, visualization and virtual environments, with the potential to help improve healthcare and bring benefits to patients. This survey paper provides a comprehensive overview of the state-of-the-art in this exciting field. It has been written from the perspective of both computer scientists and practising clinicians and documents past and current successes together with the challenges that lie ahead. The article begins with a description of the software algorithms and techniques that allow visualization of and interaction with medical data. Example applications from research projects and commercially available products are listed, including educational tools; diagnostic aids; virtual endoscopy; planning aids; guidance aids; skills training; computer augmented reality and use of high performance computing. The final section of the paper summarizes the current issues and looks ahead to future developments. [source] Extracting new patterns for cardiovascular disease prognosisEXPERT SYSTEMS, Issue 5 2009Luis Mena Abstract: Cardiovascular diseases constitute one of the main causes of mortality in the world, and machine learning has become a powerful tool for analysing medical data in the last few years. In this paper we present an interdisciplinary work based on an ambulatory blood pressure study and the development of a new classification algorithm named REMED. We focused on the discovery of new patterns for abnormal blood pressure variability as a possible cardiovascular risk factor. We compared our results with other classification algorithms based on Bayesian methods, decision trees, and rule induction techniques. In the comparison, REMED showed similar accuracy to these algorithms but it has the advantage of being superior in its capacity to classify sick people correctly. Therefore, our method could represent an innovative approach that might be useful in medical decision support for cardiovascular disease prognosis. [source] Acquiring knowledge with limited experienceEXPERT SYSTEMS, Issue 3 2007Der-Chiang Li Abstract: From computational learning theory, sample size in machine learning problems indeed affects the learning performance. Since only few samples can be obtained in the early stages of a system and fewer exemplars usually lead to a low learning accuracy, this research compares different machine learning methods through their classification accuracies to improve small-data-set learning. Techniques used in this paper include the mega-trend diffusion technique, a backpropagation neural network, a support vector machine, and decision trees to explore the machine learning issue with two real medical data sets concerning cancer. The result of the experiment shows that the mega-trend diffusion technique and backpropagation approaches are effective methods of small-data-set learning. [source] Relationship of work injury severity to family member hospitalizationAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 5 2010Abay G. Asfaw PhD Abstract Background Working while under stress due to a family health event may result in injuries of greater severity. Work leave might mitigate such consequences. Data and Methods Workers' compensation data for 33,817 injured workers and inpatient medical data for 76,077 members of their families were extracted from the 2002,2005 Thomson Reuters Medstat MarketScan Health and Productivity Management (HPM) and Commercial Claims and Encounter (CCE) datasets. Using a probit model, the impact of family hospitalization on the probability that a subsequent injury would be severe (above average indemnity costs) was estimated, adjusting for age, sex, hourly versus salaried status, industry sector, state, and family size. Results Family hospitalization within 15 days before injury increased the likelihood that the injury would be severe (from 12.5% to 21.5%) and was associated with 40% higher indemnity costs and 50% higher medical costs. Hospitalizations over 30 days before injury had no impact. Conclusion The observed higher severity of work injuries following family hospitalizations suggests additional analyses may find higher injury rates as well, and that timely family leaves might help prevent severe workplace injuries. Am. J. Ind. Med. 53:506,513, 2010. © 2010 Wiley-Liss, Inc. [source] Bayesian methods for proteomicsPROTEINS: STRUCTURE, FUNCTION AND BIOINFORMATICS, Issue 16 2007Gil Alterovitz Dr. Abstract Biological and medical data have been growing exponentially over the past several years [1, 2]. In particular, proteomics has seen automation dramatically change the rate at which data are generated [3]. Analysis that systemically incorporates prior information is becoming essential to making inferences about the myriad, complex data [4,6]. A Bayesian approach can help capture such information and incorporate it seamlessly through a rigorous, probabilistic framework. This paper starts with a review of the background mathematics behind the Bayesian methodology: from parameter estimation to Bayesian networks. The article then goes on to discuss how emerging Bayesian approaches have already been successfully applied to research across proteomics, a field for which Bayesian methods are particularly well suited [7,9]. After reviewing the literature on the subject of Bayesian methods in biological contexts, the article discusses some of the recent applications in proteomics and emerging directions in the field. [source] Correlation Relationship Assessment between Left Ventricular Hypertrophy Voltage Criteria and Body Mass Index in 41,806 Swiss ConscriptsANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2009Roger Abächerli Ph.D. Introduction: Electrocardiographic criteria for left ventricular hypertrophy (LVH) have been limited by low sensitivity at acceptable levels of specificity. A number of studies have demonstrated that body mass index (BMI) is associated with decreased sensitivity of ECG LVH classification in hypertensive patients. The objective of this study is to investigate the correlation relationship between LVH voltage criteria and BMI in Swiss conscripts. Methods: A database of 41,806 young Swiss people, who underwent compulsory conscription for the Swiss Army, was compiled. Along with other medical data, an ECG was taken. Statistical analyses, such as linear regression and calculation of correlation coefficient, were carried out between LVH voltage criteria and BMI. Results: The mean age in the studied population was 19.2 ± 1.1 years with a median age of 19 years (range from 17 to 38 years). We found an overweight prevalence of 25.1%. The results showed that body habitus had significant association with Sokolow-Lyon voltages. A mean decrease of 13%, 5%, 19%, 14%, and 12% for the five studied Sokolow-Lyon indexes were found between normal range subjects (18.5 , BMI < 25) and obese subjects (25, BMI). Conclusions: Our study confirms the hypothesis that people with higher BMI, a growing section of the population, have lower ECG amplitudes. Therefore, the Sokolow-Lyon voltage criteria may underestimate the presence of LVH for subjects with higher BMI, which is not the case for the Cornell voltage. Our analysis suggests that computerized electrocardiography for the diagnosis of left ventricular hypertrophy based on Sokolow-Lyon voltages should incorporate the BMI factor. [source] Evolution of the complications of laparoscopic hysterectomy after a decade: A follow up of the Monash experienceAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2009Jason J. TAN A retrospective review of medical records was performed to assess the incidence and types of significant complications encountered during laparoscopic hysterectomy which would affect the use of a laparoscopic approach versus other routes of hysterectomy. A total of 526 consecutive patients' medical data between January 1994 and August 2007 were reviewed. Two hundred and thirty-two laparoscopic-assisted vaginal hysterectomies and 294 total laparoscopic hysterectomies were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and three Melbourne private hospitals, by or under the supervision of three surgeons. Sixteen significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, four postoperative haematomas, one case of a bladder fistula, four conversions to laparotomy and one superficial epigastric artery injury. Inpatient stay ranged from two to six days. Our complication and inpatient stay rates are consistent with the previously reported rates, although there has been a reduction of incidence of visceral injuries with experience and introduction of new equipment. [source] Current density threshold for the stimulation of neurons in the motor cortex areaBIOELECTROMAGNETICS, Issue 6 2002T. Kowalski Abstract The aim of this study was to determine a current density threshold for exciting the motor cortex area of the brain. The current density threshold for excitation of nerve fibres (20 ,m in diameter) found in the literature is approximately 1 A/m2 at frequencies lower than 1 kHz. In consideration of a safety factor of 100, the International Commission on Non-Ionizing Radiation Protection (ICNIRP) recommends to restrict the exposure to 0.01 A/m2. The electromagnetic stimulation of neurons in the motor cortex is used in the clinical diagnosis of nerve lesions and neuropathy by means of magnetic or electrical transcranial stimulation. Combining medical data from clinical studies and technical specifications of the Magstim® Model 200 stimulator, we were able to compute the current density threshold for the excitation of the human motor cortex by means of the finite element method (FEM). A 3D-CAD head model was built on the basis of magnetic resonance imaging (MRI) slices and segmented into four anatomical structures (scalp, skull, brain, and ventricular system) with different conductivities. A current density threshold for the stimulation of the motor cortex area of the upper limbs of 6 and 2.5 A/m2 at 2.44 kHz and 50 Hz, respectively, was calculated. As these values lie above the recommended ICNIRP values by two orders of magnitude there is no need for lower safety standards with regard to stimulation of the brain. Bioelectromagnetics 23:421,428, 2002. © 2002 Wiley-Liss, Inc. [source] Nonparametric Modeling of the Mean Survival Time in a Multi-factor Design Based on Randomly Right-Censored DataBIOMETRICAL JOURNAL, Issue 5 2004M. H. Rahbar Abstract Statistical procedures and methodology for assessment of interventions or treatments based on medical data often involves complexities due to incompleteness of the available data as a result of drop out or the inability of complete follow up until the endpoint of interest. In this article we propose a nonparametric regression model based on censored data when we are concerned with investigation of the simultaneous effects of the two or more factors. Specifically, we will assess the effect of a treatment (dose) and a covariate (e.g., age categories) on the mean survival time of subjects assigned to combinations of the levels of these factors. The proposed method allows for varying levels of censorship in the outcome among different groups of subjects at different levels of the independent variables (factors). We derive the asymptotic distribution of the estimators of the parameters in our model, which then allows for statistical inference. Finally, through a simulation study we assess the effect of the censoring rates on the standard error of these types of estimators. (© 2004 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Neoadjuvant chemotherapy: a new criterion for selection of candidate patients for surgery of low tumour burden metastases from malignant melanoma?BRITISH JOURNAL OF DERMATOLOGY, Issue 1 2010T. Jouary Summary Background, Surgery of limited metastatic lesions from malignant melanoma can achieve long-term remission and better survival than chemotherapy. Existing criteria for selection of candidate patients for this surgery do not seem sufficient to avoid useless excisions. Objectives, To test use of neoadjuvant chemotherapy as a new criterion in this setting. Methods, All patients who underwent thoracic surgery for one or two lung metastases from melanoma during 1999,2007 were included in the study. Demographic and medical data were collected and analysed. Several possible prognostic factors were evaluated based on the overall survival curves. Results, Thirteen patients were included in this retrospective study. All but two patients had no evidence of disease after surgery. Ten patients received neoadjuvant chemotherapy. Six responded (absence of progression) and four had progressive disease. Response to chemotherapy and no evidence of disease after surgery were predictive of long-term survival. Conclusions, Neoadjuvant chemotherapy can be considered as a new criterion for better selection of candidate patients for lung metastasis surgical resection. This would also avoid useless surgical procedures in rapidly progressive disease and give information on the chemosensibility of the metastatic disease. This study needs further confirmation, particularly with chemotherapy regimens that have demonstrated better objective responses. [source] Fitness to drive in glaucoma patients- Preliminary study resultsACTA OPHTHALMOLOGICA, Issue 2009AM STEVENS Purpose To develop a useful binocular 30° visual field criterion to predict safe driving behaviour in glaucoma patients by comparing perimetric data with an actual driving test on the road. Methods The sample will consist of 200 driving glaucoma patients, recruited in 2 university based glaucoma clinics (Ghent and Leuven, Belgium). Inclusion criteria are glaucomatous optic disc damage and/or glaucomatous field defects. Exclusion criteria are concomitant ocular disease, cataract > LOCS 2, systemic disease or medication affecting the visual field. Data collection will include demographic and medical data, driving habits, and Mini Mental Status. A complete ophthalmic examination wil be done including Goldmann, SAP and Esterman visual field testing. In addition, UFOV test, stereopsis and contrast sensitivity testing will be performed. All subjects will perform an on the road driving test with a driving expert of the Belgian Institute for Traffic Safety. Subjects can pass, fail, or pass the test with limitations. An attempt will be made to develop an algorithm of visual field abnormalities that predict as accurately as possible the outcome of the practical driving test. Results Preliminary results of the first 50 included patients will be presented. [source] Cognitive outcome at 2 years of age in Finnish infants with very low birth weight born between 2001 and 2006ACTA PAEDIATRICA, Issue 3 2010P Munck Abstract Aim:, To study cognitive outcome of premature, very low birth weight (VLBW) infants in relation to parental education and neonatal data. Methods:, A regional cohort of 182 VLBW infants born between 2001 and 2006 was followed up. Brain ultrasounds (US) were examined serially until term age and brain magnetic resonance imaging at term age. Neurological status was examined systematically. Cognitive development was assessed using the Mental Developmental Index (MDI) of Bayley Scales at 2 years of corrected age. A total of 192 healthy full-term (FT) controls were assessed with the MDI at 2 years of age. Results:, The mean MDI in VLBW infants was 101.7 (SD 15.4), which was lower compared with FT controls (109.8, SD 11.7, p < 0.001). In regression analysis of the demographic and medical data of VLBW infants, postnatal corticosteroids (p = 0.04), intestinal perforation (p = 0.03) and major brain pathology (p = 0.02) were negatively associated with the MDI. In VLBW infants, the prevalence of neurodevelopmental impairment was 9.9% (3.3% MDI below 70, 7.1% cerebral palsy, 2.2% hearing aid, no blind infants). Conclusion:, Cognitive development of VLBW infants seemed to have improved in comparison with earlier publications, but it differed from the FT controls. Neonatal factors affected cognitive development. Therefore, updated regional follow-up data are important for clinicians. [source] Family functioning and juvenile chronic physical illness in Northern RussiaACTA PAEDIATRICA, Issue 2 2009A Zashikhina Abstract Aim: To study family functioning of adolescents with chronic physical illnesses and factors related to it. The following research questions were addressed: (i) if families with adolescents with chronic physical illnesses were at increased risk for problematic functioning compared to the healthy control families; (ii) was disease severity associated with family dysfunction; and (iii) did family functioning level differ in three disease groups (diabetes, asthma and epilepsy). Methods: Self-report family inventory and socio-economic status questions were individually completed by 148 adolescents with physical illnesses aged 13,16 years and their mothers; medical data were obtained from the files at the outpatient clinics. Comparative data were collected from a group of 301 schoolchildren. Results: Overall there were no differences found in functioning of families with physically ill adolescents compared to controls. Family functioning was significantly associated with the number of disease-specific (disease severity and duration) and non-disease (socio-economic status and family type) factors. Conclusion: In our study, families with physically ill adolescents showed considerable resilience and tolerance to the changes in habitual functioning of the family unit. While greater disease severity, longer disease duration, as well as single-parent household were the factors that contributed to the family dysfunction. [source] | ||||||||||