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W Bruns

Publications and source records attributed to W Bruns.

113 records · Page 7Linked to original sources
PubMedDate not supplied

DIABETEX decision module 2--calculation of insulin dose proposals and situation recognition by means of classifiers.

Current research in the field of medical decision making tries to represent and to analyse complex, uncertain and complicated situations. The first version of DIABETEX, which is a decision support system for the treatment of diabetic out-patients, accepts the challenge to overcome these difficulties. It includes a network of rules on the basis of known glucose-insulin relationships under different situations. The insulin dose for type I diabetic patients is suggested accordingly. In this, the application of special cybernetic methods offers the chance to overcome complexity, uncertainty, fuzzyness and incompleteness of data. Two methods of classification are presented to complete the DIABETEX decision unit: (1) the Bayes' classification is used in the calculation of insulin doses for type I diabetic patients on multiple subcutaneous insulin injections considering the basis-bolus concept; (2) fuzzy classification is employed in separating 'normal diabetic days' from days with information on special situations such as exercise, illness, menstruation on the one side, from stress, hypoglycaemia etc. on the other.

Bayes Theorem↗
PubMedDate not supplied

[Cervical collars: a clinical and biomechanical study].

AIM: Cervical collars have been used for years in the non-operative and postoperative management of cervical spine problems. They offer considerable differences in design, stability, bearing comfort and costs. In the background of controversies about the indication and in view of the limited number of scientific publications on the topic we have conceived this paper as a biomechanical and clinical investigation. METHODS: During the biomechanical investigations a defined load was exerted on 10 cervical collars of 4 producers. The clinical part was the measurement of the limitation of movement due to the 10 cervical collars in 30 healthy subjects aged 20 to 60 years. RESULTS: The biomechanical investigations showed differences of stiffness which were obvious during axial load, sideward and backward bending and less obvious in forward bending. The clinical study in 30 subjects indicated, on the other hand, only small differences in the limitation of movement. Softer cervical collars were slightly better accepted in the subjective judgment. CONCLUSION: For the aimed limitation of movement, a minimum of stiffness is obviously necessary, which is common with every tested collar. Higher degrees of stiffness do not result in further limitation of movement but only in a reduction of bearing comfort.

Adult↗
PubMedDate not supplied

Use of the artificial B-cell (Biostator) in improving insulin therapy in unstable insulin-dependent diabetes.

The present study was designed to improve the conventional subcutaneous insulin treatment of labile insulin-dependent diabetic patients by means of the artificial B-cell (Biostator) during a combination of conventional treatment and a glucose-controlled insulin infusion. Eleven patients with no residual B-cell function and poor metabolic control were studied. All patients were treated as effectively as possible by conventional methods using a combination of regular and intermediate insulin under clinical conditions. In order to determine the inadequacy of previous insulin treatment, all patients were connected to the Biostator, and the profile of daily physical activity was simulated using a bicycle ergometer. Metabolic control was compared during a 6-day period before and after a 30-50-h connection to the artificial B-cell. Using a preselected blood glucose level of 80 mg/dl (4.44 mmol/L), the additional insulin requirement amounted to 45.5 +/- 11.1 U/24 h (N = 6). The day after connection to the artificial B-cell, the patients received a new insulin regimen according to the additional insulin delivery determined by the Biostator. No better metabolic control was achieved and frequent hypoglycemic episodes occurred in this group. Another group (N = 5) was therefore studied at a preselected blood glucose level of 130 mg/dl (7.22 mmol/L). The mean additional insulin delivery by the Biostator was lower (17.2 +/- 2.1 U/24 h; P less than 0.05) and all patients were significantly better equilibrated after the new insulin regimen derived from data given by the Biostator. The ratio of short-acting to intermediate-acting insulin was 3:1; 40% of the total dosage was given in the morning. This study demonstrates that using the Biostator in addition to subcutaneous insulin allows determination of the amount of additional regular insulin that should be administered to improve glycemic control in labile diabetes.

Adult↗
PubMedDate not supplied

Reproducibility of insulin dosage on consecutive days of blood glucose control by an artificial beta-cell in brittle diabetic patients.

The profiles of blood glucose and of insulin dosage were compared between the first and second of 2 consecutive days of Biostator administration under constant conditions in 12 brittle type I diabetic inpatients. All blood glucose criteria and the daily insulin doses were reproducible between these 2 days for the entire group of patients. In nearly all patients, however, there were distinct but unsystematic differences between the 2 days in the diurnal patterns of insulin dose distribution. These differences could be ascribed to some stress reaction or inherent metabolic lability. It is concluded that, in these extremely labile diabetic patients, due to the insufficient short-term reproducibility of the outcome of an extracorporal artificial beta-cell, caution must be used when constant profiles are to be predicted from these doses for open-loop insulin delivery systems or for conventional subcutaneous injection therapy.

Adolescent↗