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PubMedDate not supplied

Primary health care records: an integrated approach.

The extended primary health care team is expected to achieve the government's vision of an integrated service for patients. Key to this vision is an integrated record-keeping system, integrating GP and community nursing functions.

Community Health Nursing↗
PubMed1998

Integration of Systemic Chemotherapy in the Management of Primary Breast Cancer.

Breast cancer cells can metastasize early in the development of primary tumors. Adjuvant chemotherapy improves disease-free survival and overall survival (OS) in patients with early-stage breast cancer, both in premenopausal and postmenopausal women. Tamoxifen improves OS in patients whose tumors are estrogen-receptor-positive, regardless of age. Although the relative risk reduction with these interventions is the same for all patients, the absolute benefit is more prominent in patients at the highest risk of relapse. All patients with involved lymph nodes should receive adjuvant chemotherapy if no contraindications occur. In patients with negative lymph nodes, adjuvant chemotherapy is recommended if the invasive tumor is moderately or poorly differentiated, the tumor size is larger than 1 or 2 cm, or hormone receptors are negative. Other prognostic and predictive indicators of response to chemotherapy and hormonal therapy remain investigational. Models that combine several factors to determine a patient's risk of relapse and death are presented. Neoadjuvant chemotherapy in conjunction with radiation therapy and surgery is the treatment of choice for patients with locally advanced breast cancer. Recently, this approach has been extended to patients with small, operable tumors. Neoadjuvant chemotherapy can downstage tumors effectively, leading to improved cosmetic results and possibly to a reduction in local recurrence rate. Another advantage of neoadjuvant therapy is the in vivo assessment of tumor sensitivity to chemotherapy, which allows optimization of available therapeutic agents. One disadvantage of neoadjuvant chemotherapy is that preoperative treatment causes an alteration of information regarding lymph node status prior to systemic treatment. Although the optimal chemotherapy regimen has not been established, doxorubicin-containing regimens are considered superior to non-doxorubicin-containing regimens. The role of high-dose chemotherapy is not well defined in the adjuvant setting and remains investigational. The taxanes paclitaxel and docetaxel are moving rapidly from the metastatic setting to the adjuvant setting. A better understanding of the biology of breast cancer is providing molecular tools to study novel treatment approaches. Oncogenes and tumor suppressor genes are emerging as important indicators of response to chemotherapy. These molecules, in turn, become targets for therapy. Novel agents under development are presented.

Journal Article↗
PubMed2000

[Intranet-based integrated information system of radiotherapy-related images and diagnostic reports].

PURPOSE: To use an intranet technique to develop an information system that simultaneously supports both diagnostic reports and radiotherapy planning images. METHODS: Using a file server as the gateway a radiation oncology LAN was connected to an already operative RIS LAN. Dose-distribution images were saved in tagged-image-file format by way of a screen dump to the file server. X-ray simulator images and portal images were saved in encapsulated postscript format in the file server and automatically converted to portable document format. The files on the file server were automatically registered to the Web server by the search engine and were available for searching and browsing using the Web browser. RESULTS: It took less than a minute to register planning images. For clients, searching and browsing the file took less than 3 seconds. Over 150,000 reports and 4,000 images from a six-month period were accessible. Because the intranet technique was used, construction and maintenance was completed without specialty. CONCLUSION: Prompt access to essential information about radiotherapy has been made possible by this system. It promotes public access to radiotherapy planning that may improve the quality of treatment.

Computer Communication Networks↗
PubMed2002

Advances towards integrated biodetection systems for environmental molecular microbiology.

To overcome many of the limitations associated with indirect detection methods, new techniques for the sensitive, specific, and direct detection of nucleic acids are required in order to accurately and quantitatively ascribe phenotype/function to uncultivated microorganisms. However, if advanced diagnostic and detection systems are going to be applied in environmental microbiology, future "biodetection" technologies and systems must be developed not from the point of view of the detector, but from the unique aspects of the environmental sample and the entire analytical process. This article highlights recent advances in nucleic acid-based technologies, and looks towards future advances that may address the broad needs and conditions imposed by environmental molecular microbiology.

Bacteria↗
PubMed2002

Accuracy of image coregistration of pulmonary lesions in patients with non-small cell lung cancer using an integrated PET/CT system.

UNLABELLED: The purpose of this study was to evaluate the accuracy of image coregistration of PET and CT (PET/CT) images in patients with lung lesions and the influence of the breathing protocol during CT. METHODS: Seventy-five patients with a solitary and well-circumscribed pulmonary lesion (non-small cell lung cancer; size, 10-30 mm) underwent PET/CT on a combined scanner. CT was acquired during shallow breathing in 37 patients and during normal expiration (i.e., the level reached when the patient exhaled without forcing expiration and then held the breath) in 38 patients. The volume of interest of each lesion was defined separately on PET and CT images, and the geometric center of gravity (COG) was assessed. The distance of COGs between the PET image and the CT image was measured. All lesions were classified according to 4 lung regions: apical, peripheral, central, and lung base. The mismatch between COG(PET) and COG(CT) was compared between regions and patient groups using a 2-way ANOVA with the Bonferroni-Dunn test for post hoc comparisons. RESULTS: The range of COG distance between PET and CT was 1.7-5.4 mm in the apex, 0.5-14.7 mm in the periphery, 0.7-5.9 mm centrally, and 2.9-11.3 mm in the lung base. The match between PET and CT was significantly better in patients who had the CT scan obtained during normal expiration than in patients who performed shallow breathing during CT scanning (P = 0.024). No reciprocal effects were found (interaction P = 0.76). The mismatch of lesions depends significantly on lung region (P < 0.0001). Post hoc analysis showed a significant difference between the upper 2 regions and the lower 2 regions (all P < or = 0.002) but not between the apex and the central region (P = 0.95) and between the peripheral region and the lung base (P = 0.15). The lesion size had no influence on the COG mismatch. CONCLUSION: The match of lung lesions in coregistered PET/CT images is better when acquiring the CT scan during normal expiration. The coregistration accuracy is better in the upper and central parts of the lung. The normal expiration protocol is suggested to be superior to shallow breathing during CT scanning.

Adolescent↗
PubMed1992

Role of the carotid sinus in response of integrated venous system to pulsatile and nonpulsatile perfusion.

Effects of pulsatile and nonpulsatile perfusion on capacity system were investigated in 33 open-chest mongrel dogs with extracorporeal circulation. In 28 dogs with intact carotid sinus nerves, after changing from nonpulsatile to pulsatile systemic perfusion the mean arterial pressure decreased by 14 +/- 1.5 mm Hg, peripheral resistance by 423 +/- 15 dyne.cm-5.sec, and venous blood volume by 3.3 +/- 0.4 ml/kg. After changing from pulsatile perfusion to nonpulsatile systemic perfusion the mean arterial pressure increased by 15 +/- 2.2 mm Hg, the peripheral resistance by 431 +/- 15 dyne.cm-5.sec, and venous volume by 3.9 +/- 0.5 ml/kg. The same effects were observed in five dogs with bilateral isolated carotid pulsatile perfusion or nonpulsatile perfusion and systemic nonpulsatile perfusion. These effects were abolished after denervation of pressor receptors and pharmacologic blockade of alpha and beta receptors. It is proposed that with nonpulsatile perfusion carotid sinus-mediated vasoconstriction occurs in the downstream part of the capacitive system, where more pronounced wall musculature with increased number of adrenergic receptors is present. The throttle effect caused by this "resistance" part of venous circulation leads to increase of pressure in the upstream section of the capacitive system, compensates for the constrictive effect of the sympathetic tone, and leads finally to an increased volume of the capacity system. We conclude that venous response to different perfusion modalities is critically dependent on intact carotid sinus nerves and adrenergic receptors in the veins.

Animals↗
PubMed2005

[The software design of an ultrasonic hyperthermia instrument based on an ARM embedded system].

Development of an ultrasonic hyperthermia instrument's software based on ARM32 microprocessor is here introduced. The system integrates the embedded SOC system, memory system, PWM system, A/D system, JTAG debug system, UART communication system, I/O system and GUI system (include LCD, keyboard) in one PCB board. It effectively completes the control and constance of temperature through the improved PID algorithm, and the instrument miniaturization. Experiments have proved that the system accords with the design requirements.

Algorithms↗