Biomedical subjects
Publications and source records attributed to P Degoulet.
This paper presents the architecture of the Information System of HELIOS, a medical Software Engineering Environment. It is an object oriented framework for the development of medical applications which puts particular emphasis on tools and techniques favouring reuse of previous work and enhancing collaboration between developers.
Modularity, distribution and integration are current trends in Software Engineering. To reach these goals HELIOS, a distributive Software Engineering Environment dedicated to the medical field, has been conceived and a prototype implemented. This environment is made by the collaboration of several, well encapsulated Software Components. This paper presents the architecture retained to allow communication between the different components and focus on the implementation details of the Software Bus, the communication and integration vector of the currently running prototype.
An integrated approach, progressively implemented in the ARTEMIS system since 1975, is described for the computerized management of hypertensive patients. From a medical point of view, computerized programs can be used to memorize patients' individual records and profiles, to facilitate patient management and follow-up, to store medical knowledge about hypertension and to provide facilities for decision making at the level either of the individual patient or of the population followed up. From a technical point of view, the methodology used integrates data and knowledge management facilities into the same software. Five hypertension clinics are presently using the system in France and more than 22,000 records have been registered. Answer rates to 12 mandatory questions regarding past history and examination at first visit were superior to 95% in 19,601 records created between January 1976 and December 1987. Patient database interrogation can be used to evaluate the sensitivity and specificity of various signs and symptoms for the diagnosis of secondary hypertension, and to predict, for each patient, his/her cardiovascular risk, the risk of drop-out, the risk of insufficient blood pressure control and the probable blood pressure level. It also serves to test the content and validity of the associated expert system which is progressively built up. A prospective evaluation of the performance of the expert system on 80 cases of hypertension showed overall agreement between the specialists and the expert system ranging from 58 to 91% depending on the decision.(ABSTRACT TRUNCATED AT 250 WORDS)
In order to evaluate possible correlations between blood pressure levels and sleep quality, 7,901 workers of both sexes living in Paris area have been the subject of a survey during their annual examination performed by workside physicians. The enquiry included questions related to sleep quantity and quality, sleeping pills consumption, awakenings, nightmares, snoring, way of life and working conditions. The information concerning these parameters was available for 7,542 people. Among them, 6,551 (86.9%) did not suffer from high blood pressure (HBP) (blood pressure less than 160/95 mmHg), 618 (8.2%) presented a high blood pressure but were not treated, 371 (4.9%) received a treatment against HBP. The average sleep duration is about 7.4 h (S.D. = 1.0) for men and about 7.6 h (S.D. = 1.0) for women (less than 0.001). It is significatively and negatively correlated with the systolic blood pressure level (SBP) (less than 0.001) and the diastolic blood pressure level (DBP) (less than 0.001). The frequency of patients complaining of nightly awakening and of snoring significatively increase with SBP (p less than 0.05) and DBP (p less than 0.001). The observed association between DBP (but not SBP) and sleep duration and nightly awakening remains significant in multivariate analysis including age, sex, tobacco smoking, alcohol and coffee consumption, use of sleeping pills and hypotensive treatment, as well as the negative correlation between SBP and nightmare frequency. The correlation between SBP or SBP and snoring was no more significant. In conclusion, a significant correlation has been found between the blood pressure levels and the sleep quality whose clinical consequences remain to be explored.(ABSTRACT TRUNCATED AT 250 WORDS)
The health benefits of hypertension treatment at the community level depend both of the quality of the blood pressure control obtained for each patient treated individually and of the percentage of the hypertensive patients actually aware, treated and controlled for hypertension in the entire population. The data collected in 1987 in a group of 7,901 subjects working in medium-sized companies of the Paris region were analysed, and compared with those obtained in a very comparable population in 1979-80. Among patients aware of their disease, the percentage of treated patients was higher in 1987 than in 1979, 55 p. 100 and 46 p. 100 respectively in men (p less than 0.001); 70 p. 100 in 87, 59 p. 100 in 79 for women (p less than 0.01). Hypertension was treated and controlled in 27 p. 100 of the men (16 p. 100 in 1979), and 42 p. 100 of women (27 p. 100 in 1979). Awareness was significantly lower among migrant workers than among european personnel (p less than 0.001). The lower the educational level, the lower the compliance with antihypertensive treatment, ranging from 99 p. 100 for the highest educational level, to 82 p. 100 among low educated subjects (p less than 0.001). The hospitalization rate did not differ according to sociocultural factors. Hypertension was detected by the worksite physician in 51 p. 100 of the male hypertensive patients. He was the sole physician who examined 17 p. 100 of the patients in the previous year. These results suggest a moderate improvement in hypertension detection and control. However, development of intervention strategies and their evaluation are clearly needed.
Forty patients with hypereosinophilic syndrome (HES), defined according to the criteria established by Chusid et al., were studied retrospectively in order to determine the prognostic factors in this heterogeneous disease. A myeloproliferative syndrome (MPS) was diagnosed 17 times when splenomegaly and/or a greater than 5 times the normal vitamin B12, level existed. Cutaneous-visceral involvement was almost always present (95%), but could appear after several years of evolution. Twenty-three patients had cardiac involvement, determined by clinical, radiological, electrocardiographic and echocardiographic examinations; 12 of these had endomyocardiac fibrosis. The overall survival rate was 80% at 5 years and 42% at 10 and 15 years. Among the factors evaluated that are capable of influencing this survival, 5 were found to impair the prognosis; presence of an MPS; non-response of the hypereosinophilia to corticoids; existence of a cardiopathy; being male; and an elevated maximum eosinophilia; the last two factors were significantly associated with the cardiopathy. Because hematological or cardiac anomalies are not always present at the time of the first examination, HES patients require very close surveillance.
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Cell fractions highly enriched either for monocytes of for B lymphocytes were separated from human peripheral blood. They were tested for their capacity to stimulate allogeneic lymphocytes in mixed leukocyte cultures, using dose-response titrations. Neither population could be stimulated to proliferate by allogeneic cells, but both proved strong stimulators. In this respect monocytes were more efficient than B cell preparations. Differences were pronounced at the lower numbers of stimulating cells but were no longer significant with large amounts of cells.
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The sixth report of the "Diaphane Dialyse Informatique" Program concerns 2,518 adult patients (age 15 and over) treated by chronic hemodialysis or hemofiltration in 33 French dialysis centres between June 1972 and December 1978. 1) The number of centers participating to the program is progressively increasing. Overall duration of follow-up represents 4,192 patient-years, allowing precise evolutive studies of terminal renal failure treated by hemodialysis. 2) Mean age at start of treatment continues to increase. Among 709 patients who started treatment in 1977-1978, 8,8 p. 100 of men and 11 p. 100 of women were over 69 years old. 3) Patients with diabetic nephropathy represent 4,4 p. 100 of all patients dialyzed between 1972 and 1978 and 5,9 p. 100 of the patients starting treatment in 1977-1978. 4) The percentage of patients temporarily treated by peritoneal dialysis before hemodialysis decreases from 32,9 p. 100 in 1973-1974 to 15,9 p. 100 in 1977-1978. 5) In 1978, 65,3 p. 100 of patients are dialyzed 3 times a week with a mean weekly duration of 14,0 h for male and 12,9 for female. 73 p. 100 of the patients are dialyzed during the night. 6) Disposable parallel plate hemodialyzers (71,8 per cent of dialysis sessions in 1978) and hollow fiber hemodialyzers (11,6 per cent) progressively replace disposable coil dialyzers and non disposable Kiil dialyzers. 7) Transient hypotensive episodes during dialysis sessions remain the most frequent complications (21,7 per cent of sessions in 1978). Transient hypotensive episodes are more frequently observed with coils than with parallel plate hemodialyzers or with hollow fiber dialyzers. 8) Mean diastolic blood pressure (DBP) +/- SD is 101,9 +/- 21,7 mmHg at start of dialysis and 81,4 +/- 11,8 mmHg when dialysed. During the course of treatment 28,7 per cent of the patients receive long term antihypertensive treatment. In spite of dialysis and antihypertensive treatments 11 per cent of all patients followed up maintain DBP greater than or equal to 95 mmHg. 9) Viral hepatitis remain the most prominent infectious problem with 30 per cent of patients being chronic Hbs antigen carriers. 10) Annual death rate calculated in the 2,518 patients dialyzed between 1972 and 1978 (78/1000) is 12 times superior to the death rate of the French population, adjusted for sex and age to the dialysis population. 43,1 per cent of deaths are of cardiovascular origin. Risk factors for overall mortality are age, sex (male), existence of a vascular or diabetic nephropathy, twice weekly dialysis strategy, elevation of systolic or diastolic blood pressure during the course of dialysis treatment, hypocholesterolemia and to a lesser extent hypotriglyceridemia. On the contrary, hypercholesterolemia, hypertriglyceridemia and hyperuricemia do not appear as risk factors for overall mortality or cardiovascular mortality. These results plead for a perfect control of hypertension and to the extension of thrice weekly dialysis for the whole population of patients treated by maintenance hemodialysis.
Data of the DIAPHANE Dialyse-Informatique system of the Society of Nephrology have been collected by patients just on a home dialysis program after training in the hemodialysis Unit of the Hospital of Montreuil. 35 patients have been using the computerized records since January 1978. A critical analysis of the first year has been made and results obtained have been compared with those obtained during the same period in patients dialysed in the Hospital. Results show that home dialysis patients are well able to fill in the computerized medical record concerning the dialysis session follow-up, and that the quality of the recorded information is similar to that recorded in hospital by nurses. Nevertheless few simplifications of home dialysis data sheet are considered. Computerized treatment of data collected on home dialysis program should allow useful comparisons required to improve the quality of care and expansion of this dialysis method.
Labeled IgG was evaluated versus labeled albumin for measurement of plasma volume, to see whether it would give a smaller initial dilution volume (indicating a smaller premixing extravascular loss of label) and a smaller difference between initial dilution volume and dilution volume at time 10 min (indicating a negligible extravascular loss in the first 10 min after mixing). IgG was found to have a lower transcapillary escape rate than albumin (P less than 0.01) in eight normal volunteers and in eight hypertensive subjects, hypertension being associated with an increased transcapillary escape of both proteins. Despite this, the dilution volumes obtained were indistinguishable and the need for a correction through a retropolation procedure was the same with both proteins. Albumin and IgG dilution volumes were highly correlated in 21 subjects (r=0.977) so that use of labeled IgG is a proper alternative to use of labeled albumin for plasma volume determination. However, since IgG brings no consistent advantage, labeled albumin remains the best available tracer for that purpose.
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