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[Fundamental and clinical study of three-dimensional compensating filters and direct dose monitoring system for total body irradiation].

We devised 3D-compensating filters to improve dose distribution during total body irradiation (TBI). This study investigated the effect of these 3D-compensating filters and related complications in patients who had undergone bone marrow transplantation (BMT) followed by TBI. The 3D-compensating filters were fabricated by CT measurement of body thickness. The effectiveness of the 3D-compensating filters in producing a homogeneous dose distribution was checked by a thermoluminescent dosimeter (TLD) and semiconductor detectors in all patients. At the pelvis, the dose was measured simultaneously with an ionization chamber. The average dose distribution to each site when the 3D-compensating filter was used was 93% to the head, 97% to the neck, 99% to the thorax, and 98% to the pelvis in TLD when the scheduled dose was taken as 100%. There was no significant difference between the TBI and non-TBI groups with regard to the frequency of lung toxicity. Clinical interstitial pneumonitis occurred in 22.7% of the patients, interstitial pneumonitis with CMV in 13.6%, and idiopathic pneumonitis in 6.1% without any virus infection. Only one patient was regarded as having radiation-induced pneumonitis. 3D-compensating filters can be conveniently produced within a short time following CT measurement, and they seem to be safe and useful for dose flattening during TBI.

Adolescent↗

[Epidemiologic monitoring system for the diabetic patient; use of computerized technology in the quality of medical care].

OBJECTIVE: To describe an instrument for epidemiologic surveillance of diabetes mellitus and evaluating the quality of care in primary health care. MATERIAL AND METHODS: The study was conducted from January 1, 1998, to June 30, 1999, at the Epidemiology and Health Services Research Unit of the Mexican Institute for Social Security (IMSS), in Hermosillo, Sonora. A single data collection form was designed, which contains items included in the diabetes care clinic of the Unit of Family Medicine of the Mexican Institute of Social Security. RESULTS: We developed and implemented a software program to enter data from the paper format and to generate individual and group reports on attendance to scheduled medical visits, medical history, evolution of signs and symptoms, laboratory tests, and medication. CONCLUSIONS: Electronic data systems allow the availability of reliable and continuing information for surveillance of the comprehensive care of the diabetic patient.

Computers↗

Seniors with CHF embrace monitoring system based on automatic voice technology.

Senior CHF patients grow accustomed to automated voice technology. Internet-based tools may have a lot to offer, but they don't necessarily get the best results when used with a mostly elderly population. However, a telephonic system that uses automated voice technology has consistently produced first-rate compliance rates while slashing hospitalization in a population of CHF patients. See how the system works to boost patient education while enhancing access to "knowledge experts".

Aged↗

Prosthetic arm monitoring system using a programmable interface controller.

Children with upper extremity limb deficiency are often prescribed a prosthetic arm to assist with daily function. Three types of prostheses are available: passive, active body-powered, and active myoelectric; costs range from $3,000 to $15,000. Clinicians rely on parent and child feedback regarding the usefulness of the prosthesis, and may assess the child's skill in using the device in a controlled setting. However, these methods do not provide an objective quantification of the wear and use of the device during daily activities. The purpose of this project is to develop a sensor to record the amount of time per day the prosthetic arm is worn, and to count the number of times per day the child activates (closes) the prosthetic hand (or terminal device). The system that has been developed can be integrated unobtrusively into a child's prosthetic arm. A programmable interface controller (PIC) with interface circuitry and memory was developed to record the daily wear pattern and hand usage of the prosthesis at 15-minute intervals. Memory and battery capacities are sufficient to record data over a three-month period. A personal computer interface downloads the collected data and may be used to reprogram the device for different time periods of data collection. All components, including the battery, have a mass of 87 grams and fit inside the forearm cavity of a 9-year old's prosthesis. Controlled trials are underway at Shriners Hospital for Children, Northern California, to determine system reliability.

Arm↗

Serial quantitative PCR analysis of bone marrow samples from breast cancer patients to monitor systemic micrometastases.

BACKGROUND: We have previously developed a quantitative calibrated PCR assay to measure cytokeratin 19 (CK19) expression in haematopoietic tissue in order to detect systemic micrometastases. PATIENTS AND METHODS: Serial measurements of CK19 expression in bone marrow of patients with primary breast cancer were performed at operation, at 3 weeks and 6 months postoperatively. RESULTS: Reference values for CK19 expression were established by analysing bone marrow samples from 48 healthy female volunteers or patients without epithelial cancer. Samples from breast cancer patients with CK19 values above the upper reference limit were considered positive. Bone marrow samples taken at operation were positive in 29 out of 141 patients (20.6%) and remained positive in 12, turned negative in 4 and were unavailable in 13 at 6 months postoperatively. CONCLUSION: Serial measurements increase the reliability of detecting micrometastases perioperatively. Further studies are in progress to evaluate the relationship between elevated CK19 values and clinical outcome.

Adult↗