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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Journal of clinical monitoring and computing 12 (1995), S. 21-24 
    ISSN: 1573-2614
    Keywords: monitoring ; physiologic ; human factors ; display ; head-up ; private eye
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract To solve the problem of monitoring the patient during administration of anesthesia, a commercially available headup display (HUD) was evaluated during one day of surgery at the Ohio State University Hospitals. This monitor is mounted on a headband worn by the anesthesiologist. It projects a monochrome image of monitor data directly into one eye. Eleven anesthesiologists tested the device. Most users were able to adjust to the monitor in about fifteen minutes. Nine of the testers expressed a desire to evaluate the monitor further. Their major complaints were that the connecting cable between the HUD and its computer was too short, the resolution of the monitor was inadequate, and the data on the screen were not organized in a familiar way. If these problems could be corrected, most users believed that this HUD could be a valuable tool to aid the anesthesiologist in the operating room.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Journal of clinical monitoring and computing 15 (1999), S. 57-61 
    ISSN: 1573-2614
    Keywords: Equipment ; monitoring ; anesthesia, inhalational ; anesthetics, volatile ; halothane ; enflurane ; isoflurane ; vaporizer ; key-filling systems ; mixture ; errors ; human factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract The creation of agent mixtures from the addition of the wrong agent to a vaporizer might pose a risk to the patient. Patient injury would be more likely if the anesthesia gas monitor displayed erroneous concentration values. Conventional inhalation agent monitors do not necessarily distinguish anesthetic agents. Some modern monitors have that ability but its clinical significance has not been determined. We wanted to simulate such an erroneous mixture in a laboratory setup. Six comparisons were made. Isoflurane, Enflurane, and Halothane vaporizers were first filled with the correct agent. They were run at 5 liters/minute fresh oxygen flow at a vaporizer dial setting of 5% until it reached the “refill” line. Then, one of two incorrect agents was added to the “full” line. Thereafter, the vaporizer continued at the same flow and the same dial setting until it was exhausted. Vaporizer output was recorded or calculated by using three methods of measurement: mass spectrometry, conventional infrared analysis (at 3.3 micrometer wave length), and piezoelectric crystal analysis. Additional calculations were used to estimate measurements that could not be made because of lack of available equipment. In a Halothane vaporizer: Enflurane added – not a significant problem; Isoflurane added – not a significant problem. In an Isoflurane vaporizer: Halothane added – not a significant problem; Enflurane added – not a significant problem. In an Enflurane vaporizer: Isoflurane added – not a significant problem; Halothane added – The sum of the delivered Halothane MAC and the delivered Enflurane MAC was twice the expected Enflurane MAC output from vaporizer, with conventional agent monitor reading which showed decreasing agent concentration. Patient injury could be more likely in this last case. In this last case and in all cases, piezoelectric crystal monitoring correctly displayed the sum of the two agent concentrations in volumes percent. Automatic agent identification can identify erroneous agents.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1573-7225
    Keywords: Breast cancer ; endogenous hormones ; family history ; postmenopausal women ; reproductive factors ; United States
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Parity, age at first birth, age at menarche, and a family history of breast cancer have each been associated consistently with breast cancer risk. Whether this increase in risk is mediated, at least in part, through changes in endogenous hormone levels is unclear. We conducted a cross-sectional study of the relationships between these factors and plasma hormone levels in 216 healthy postmenopausal women in the Nurses' Health Study (United States). The hormones evaluated were estradiol, percent and total free estradiol, percent and total bioavailable estradiol, estrone, estrone sulfate, and prolactin. After controlling for age, body mass index (weight/height2), and alcohol use, we observed inverse associations between estrone sulfate and parity (r=−0.15, P=0.03) and between percent bioavailable estradiol and age at first birth (r=−0.17, P=0.02). Although women with a family history of breast cancer tended to have higher estrogen levels compared with women without such history, the differences were not statistically significant. Age at menarche was not related significantly to any of the hormones. These data provide some additional evidence that the inverse relationship observed between parity and breast cancer risk may be mediated, at least in part, through decreased estrogen levels. Our data do not support a substantial influence of either family history of breast cancer or age at menarche on postmenopausal estrogen or prolactin levels.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1573-7225
    Keywords: Breast cancer ; diet ; reproductive factors ; women
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To assess more precisely the relative risks associated with established risk factors for breast cancer, and whether the association between dietary fat and breast cancer risk varies according to levels of these risk factors, we pooled primary data from six prospective studies in North America and Western Europe in which individual estimates of dietary fat intake had been obtained by validated food-frequency questionnaires. Based on information from 322,647 women among whom 4,827 cases occurred during follow-up: the multivariate-adjusted risk of late menarche (age15 years or more compared with under 12) was 0.72 (95 percent confidence interval [CI]=0.62-0.82); of being postmenopausal was 0.82 (CI=0.69-0.97); of high parity (three or more births compared with none) was 0.72 (CI=0.61-0.86); of late age at first birth (over 30 years of age compared with 20 or under) was 1.46 (CI=1.22-1.75); of benign breast disease was 1.53 (CI=1.41-1.65); of maternal history of breast cancer was 1.38 (CI=1.14-1.67); and history of a sister with breast cancer was 1.47 (CI=1.27-1.70). Greater duration of schooling (more than high-school graduation compared with less than high-school graduation) was associated significantly with higher risk in age-adjusted analyses, but was attenuated after controlling for other risk factors. Total fat intake (adjusted for energy consumption) was not associated significantly with breast cancer risk in any strata of these non-dietary risk factors. We observed a marginally significant interaction between total fat intake and risk of breast cancer according to history of benign breast disease, with fat intake being associated nonsignificantly positively with risk among women with a previous history of benign breast disease; no other significant interactions were observed. Risks for reproductive factors were similar to those observed in case-control studies; relative risks for family history of breast cancer were lower. We found no clear evidence in any subgroups of a major relation between total energy-adjusted fat intake and breast cancer.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1573-7225
    Keywords: Breast cancer ; oral contraceptives ; United States ; women
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Results of previous epidemiologic studies have provided reassurance that there is little, if any, increase in risk of breast cancer with oral contraceptive (OC) use in general. However, in several studies, an increased risk of breast cancer has been observed in two subgroups, young women who used OCs for extended durations and in women who used OCs prior to a first-term pregnancy. We evaluated these relationships using data from the ongoing Nurses' Health Study cohort (United States). We documented 3,383 cases of breast cancer from 1976 to 1992 among 1.6 million person-years of follow-up. We observed no overall relationship between duration of OC use and breast cancer risk, even among women who reported using OCs for 10 or more years (multivariate relative risk [RR]=1.11, 95 percent confidence interval [CI]=0.94-1.32). Among women less than 45 years of age, the multivariate RR for using OCs for 10 or more years was 1.07 (CI=0.70-1.65) compared with never-users. The risk associated with five or more years of OC use prior to a first full-term pregnancy compared with never-use was 0.96 (CI=0.65-1.43). Among women less than 45 years of age, we observed no evidence of an increased risk with OC use before a first full-term pregnancy (use for five or more years: RR=0.57, CI=0.24-1.31). Because of the age distribution of our cohort, we were unable to evaluate these relationships among women less than 40 years of age. Our study provides considerable evidence that long-term past OC use, either overall or prior to a first full-term pregnancy, does not result in any appreciable increase in breast cancer risk in women over 40 years of age.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1573-7225
    Keywords: Breast cancer ; maternal age ; paternal age ; prospective study ; USA
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: We examined the relation between parental age at birth and risk of breast cancer among daughters in a population of 118,309 US women who were 30 to 55 years of age in 1976 and without prior diagnosis of cancer. During 1,140,239 person-years of follow-up, we documented 1,799 incident cases of breast cancer in this population. After adjusting for established breast cancer risk factors, we observed only a weak and nonsignificant trend in risk of breast cancer with increasing maternal age at birth and no relation for paternal age. After adjusting for other risk factors, the chi trend was 1.10, P=0.27 for increasing maternal age at birth. Daughters born to mothers 30 to 34 years of age had an age-adjusted relative risk of breast cancer of 1.11 (95% confidence interval: 0.89, 1.37) compared to daughters born to mothers less than 20 years of age. The weak positive trend in risk with increasing maternal age was present among both pre-and postmenopausal women. These findings suggest that there is little or no association between maternal age and risk of breast cancer, and that paternal age is not related to risk of breast cancer.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Journal of clinical monitoring and computing 16 (2000), S. 541-546 
    ISSN: 1573-2614
    Keywords: Alarms ; alarm sounds ; human factors ; medical devices ; monitoring ; medical ; music ; standardization ; national standards ; international standards
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Journal of clinical monitoring and computing 14 (1998), S. 89-94 
    ISSN: 1573-2614
    Keywords: Anesthesia ; automatic ; recordkeeping ; medical records ; computers ; human factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Objective. To install and successfully use early commercial automatic anesthesia recordkeepers, the Diatek Arkive “Organizer” units, in the operating rooms at a major university medical center. Methods. Because of the history of previous academic attempts at automatic anesthesia recordkeeping, the units were installed on a “surprise” basis, with hardly any discussion of the devices beforehand. Results. The devices themselves had a number of minor difficulties at the start, most of which were promptly corrected. Eventually the units were in use in all non-cardiac general operating rooms. At one point, usage reached over 90% of possible cases. Continued opposition to the device on the part of certain individuals, coupled with the obsolescence of the present devices in light of new technology, led to the eventual abandonment of the system and removal of the devices from service. Discussion. Total resistance to the new devices on the part of a few vocal faculty members was a major factor in the ultimate downfall of the system. The method of introduction, and especially the lack of involvement of faculty, residents, surgeons, operating room personnel, hospital computer personnel, and the hospital administration in the installation also played a role in the failure of the system. Lack of a workable training mechanism for new residents prevented that user group from rapidly gaining comfort with the systems.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1573-7225
    Keywords: Breast cancer ; cohort study ; estrogens ; progestins ; Nurses' Health Study ; USA
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: We prospectively examined the use of hormone replacement therapy in relation to breast cancer incidence in a cohort of women 30 to 55 years of age in 1976. During 12 years of follow-up (480,665 person-years) among postmenopausal women, 1,050 incident cases of breast cancer were documented. Overall, past users of replacement estrogen were not at increased risk. After adjustment for established risk factors, type of menopause, age at menopause, and current age, the rate ratio (RR) was 0.91, 95 percent confidence interval (CI) = 0.78–1.07. the risk of breast cancer was elevated significantly among current users (RR = 1.33, CI = 1.12–1.57); after adjusting for age, we observed no evidence of increasing risk with increasing duration of use among current users (P trend = 0.41), or among past users (P trend = 0.46). Women currently using unopposed estrogen (RR = 1.42, CI = 1.19–1.70), estrogen and progesterone (RR = 1.54, CI = 0.99–2.39), or progesterone alone (RR = 2.52, CI = 0.66–9.63), were all at increased risk of breast cancer compared with never users. These data suggest that long-term past use of estrogen replacement therapy is not related to risk, that current estrogen use increases risk of breast cancer to a modest degree, and that the addition of progesterone does not remove the increased risk observed with current use of unopposed estrogen.
    Type of Medium: Electronic Resource
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