A clinical update on the role of carfilzomib in the treatment of relapsed or refractory multiple myeloma.

Even though the prognosis of patients with multiple myeloma is continuing to improve, all patients eventually develop relapsed refractory disease. Several novel therapeutics have been developed in the last few years including the second-generation proteasome inhibitor carfilzomib which has been approved for patients with relapsed and refractory multiple myeloma in the United States since 2012. Recently data from several phase III studies have become available showing the promising efficacy of carfilzomib in combination with lenalidomide, which led to the renewed approval of carfilzomib in combination with lenalidomide and dexamethasone for relapsed myeloma in 2015. Furthermore carfilzomib showed superiority over bortezomib on both efficacy and toxicity profiles, especially a profoundly lower incidence in polyneuropathy. Carfilzomib has been shown to partially overcome the negative effects of high-risk cytogenetics. Promising combinations of carfilzomib with histone deacetylase (HDAC) inhibitors, pomalidomide and several other novel therapeutics have been presented in early studies. The optimal dosing regimen and sequence of treatment regimens remain important questions for the future.

AIDA's fourth-generation software functionality.

Aspects characterizing typical, office-like environments are described and common procedures are extracted. These are used to derive the requirements of fourth-generation software packages. Typical fourth-generation software packages are discussed, and a presentation is given of a fourth-generation software package called AIDA, including all its functional aspects.

Structure and software tools of AIDA.

AIDA consists of a set of software tools to allow for fast development and easy-to-maintain Medical Information Systems. AIDA supports all aspects of such a system both during development and operation. It contains tools to build and maintain forms for interactive data entry and on-line input validation, a database management system including a data dictionary and a set of run-time routines for database access, and routines for querying the database and output formatting. Unlike an application generator, the user of AIDA may select parts of the tools to fulfill his needs and program other subsystems not developed with AIDA. The AIDA software uses as host language the ANSI-standard programming language MUMPS, an interpreted language embedded in an integrated database and programming environment. This greatly facilitates the portability of AIDA applications. The database facilities supported by AIDA are based on a relational data model. This data model is built on top of the MUMPS database, the so-called global structure. This relational model overcomes the restrictions of the global structure regarding string length. The global structure is especially powerful for sorting purposes. Using MUMPS as a host language allows the user an easy interface between user-defined data validation checks or other user-defined code and the AIDA tools. AIDA has been designed primarily for prototyping and for the construction of Medical Information Systems in a research environment which requires a flexible approach. The prototyping facility of AIDA operates terminal independent and is even to a great extent multi-lingual. Most of these features are table-driven; this allows on-line changes in the use of terminal type and language, but also causes overhead. AIDA has a set of optimizing tools by which it is possible to build a faster, but (of course) less flexible code from these table definitions. By separating the AIDA software in a source and a run-time version, one is able to write implementation-specific code which can be selected and loaded by a special source loader, being part of the AIDA software. This feature is also accessible for maintaining software on different sites and on different installations.

Information management in an intensive care unit supported by AIDA.

In an internal intensive care unit (ICU), management data is needed for various reasons. For instance, the allocation of resources needs timely information, so management can anticipate changes quickly. Using AIDA, a fourth-generation software package, a simple but adequate system has been created, with which day-to-day operational data is managed, and management information is generated.

MUMPS as a host language for AIDA.

In this contribution, the main characteristics of MUMPS, the host language of AIDA, are briefly discussed. This is basically an introductory text for readers who had had no previous experience with MUMPS, on the programming side. After a short introduction, its history is summarized. Then the language itself is introduced and illustrated with examples; for the sake of brevity not all commands, functions and other features are discussed. In the next section, an introduction to MUMPS' stronghold is given: the database structure. Finally, we give the main reasons why we have chosen MUMPS as AIDA's host language. In the appendices, attention is given to the language standardization process, the visibility of MUMPS and its availability, sources of further information and the most important text books on MUMPS (in English).