1,457 research outputs found
Riscontri autoptici e placche pleuriche nel Registro Mesoteliomi della Regione Friuli Venezia Giulia
No full textAims: To describe the cases of MM that occurred in the Friuli Venezia Giulia Region in the period 1995-2009 and evaluate the diagnostic contribution of autopsy findings. Methods: Via the Regional Register a search for MM cases was made following standardized criteria for diagnosis and past asbestos exposure assessment. Pleural plaques were identified by autopsy findings; the relationship between presence of pleural plaques and assessment of past asbestos exposure was analyzed. Results: 834 cases of MM were recorded and 458 autopsy findings were available; for 142 cases (15% of males and 23% of women) the first diagnosis was made at autopsy. Data were available on previous asbestos exposure in 91% (416 subjects) of cases with autopsy findings: 255 had “certain occupational exposure” (group 1), 116 “other occupational and non- occupational exposure” (group 2), 45 “negative and unknown exposure” (group 3). Logistic regression showed that significant predictors for pleural plaques were age at diagnosis (OR=1.03 each year (95% CI=1.01-1.05), asbestos exposure in group 1 versus group 2 (OR=6.8 (95% CI=4-12), and exposure in group1 versus group 3 (OR=6.4 (95% CI=3-13). Among subjects in groups 1 and 2, the presence of pleural plaques was significantly associated with latency (OR=1.03 for each year of latency; 95% CI=1.01-1.22) and asbestos exposure in group 1 versus group 2 (OR=7.8; 95% CI=4.4-13.0). Conclusions: Autopsy findings improved the diagnostic level of MM in elderly subjects, for whom reliable data on past asbestos exposure is often lacking. In subjects suffering from MM direct interview is always the best tool to evaluate past asbestos exposure; autopsy findings of pleural plaques cannot replace the anamnestic history when this is lacking, although such findings can act as a suppor
Prognostic assessment of repeatedly measured time-dependent biomarkers, with application to dilated cardiomyopathy
No full textWe propose newtime-dependent sensitivity, specificity,ROCcurves and net reclassification indices that can take into account biomarkers or scores that are repeatedlymeasured at different time-points. Inference proceeds through inverse probability weighting and resampling. The newly proposed measures exploit the information contained in biomarkers measured at different visits, rather than using only the measurements at the first visits. The contribution is illustrated via simulations and an original application on patients affected by dilated cardiomiopathy. The aim is to evaluate if repeated binary measurements of right ventricular dysfunction bring additive prognostic information on mortality/urgent heart transplant. It is shown that taking into account the trajectory of the new biomarker improves risk classification, while the first measurement alone might not be sufficiently informative. The methods are
implemented in an R package (longROC), freely available on CRAN
La valutazione dei neolaureati infermieri nelle prove di concorso: indagine descrittiva
No full textNella sanità le assunzioni a tempo
indeterminato avvengono per pubblico concorso per titoli
ed esami, con una prova scritta, pratica e orale, su contenuti
professionali definiti dalle singole commissioni, con livelli
molto diversi di complessità e contenuti. Obiettivo. Analizzare
le prove di concorso per infermieri a tempo indeterminato,
il livello di complessità delle domande, le tematiche
indagate. Materiali e metodi. Sono state analizzate un
campione di prove, scritte, pratiche ed orali. Per ciascuna
domanda è stato definito il livello cognitivo secondo la tassonomia
di Bloom, ed i problemi di salute e assistenziali indagati.
Risultati. Sono state analizzate 128 prove concorsuali
di 14 aziende. Le domande più utilizzate sono quelle
aperte, per accertare conoscenze e nozioni più che la loro
applicazione. Le tematiche assistenziali sono estremamente
diversificate non orientate ai problemi prioritari di salute.
Quasi completamente assenti quesiti su prevenzione, educazione
del paziente, monitoraggio dei sintomi. Conclusioni.
Prova scritta, pratica ed orale vertono in larga misura sugli
stessi temi e valutano soprattutto le conoscenz
Uno sguardo allo scompenso cardiaco con frazione di eiezione preservata: dai trial al mondo reale dell’Osservatorio Cardiovascolare del Friuli-Venezia Giulia
No full textHeart failure with preserved ejection fraction (HFpEF) has been for decades a nosological entity lacking specific therapy, with some even questioning its existence. Recently, targeted therapies have been introduced for specific, albeit rare, phenotypes such as Fabry disease, hypertrophic cardiomyopathy and amyloidosis. Sodium-glucose cotransporter 2 inhibitors (SGLT2i), originally developed as anti-diabetic drugs, have fortuitously emerged as effective molecules in improving the prognosis for both patients with heart failure with reduced ejection fraction (HFrEF) and those with HFpEF, reducing heart failure exacerbations by almost a third. Although there are some epidemiological differences, depending on the country and the context analyzed, it is generally agreed that HFpEF is the most represented phenotype of heart failure, and its prevalence has been increasing in recent years due to the increase in life expectancy, improved diagnostic sensitivity and accuracy, and an exponential increase in risk factors such as diabetes, hypertension, renal failure, chronic obstructive pulmonary disease and obesity. These are often associated, turning out to be an epiphenomenon of a more complex cardio-nephro-metabolic disease. However, data and characteristics from major trials are not always aligned with the features and needs of these patients in real-world settings.The Cardiovascular Observatory of Friuli-Venezia Giulia is a powerful clinical governance tool that allows us to specifically characterize these patients, identifying and directing them towards the most appropriate diagnostic and therapeutic pathways, contributing significantly to improved prognosis and reduced expenditure paid by the National Health System.The use of SGLT2i in HFrEF patients is poised to match that of historic neurohormonal treatments, while, being the only class of drugs currently recommended by the international guidelines, they should even surpass them in HFpEF patients. However, given the high prevalence of HFpEF, it is unlikely for its treatment to be a prerogative of cardiologists alone. In this regard, it will be crucial in the near future to implement shared and integrated pathways with other medical specialists (internists, diabetologists, and nephrologists), and especially with general practitioners, who most frequently encounter these patients, to select the cases with greater complexity and potential for effective therapeutic intervention
Functional source separation and hand cortical representation for a brain-computer interface feature extraction.
No full textA brain-computer interface (BCI) can be defined as any system that can track the person's intent which is embedded in his/her brain activity and, from it alone, translate the intention into commands of a computer. Among the brain signal monitoring systems best suited for this challenging task, electroencephalography (EEG) and magnetoencephalography (MEG) are the most realistic, since both are non-invasive, EEG is portable and MEG could provide more specific information that could be later exploited also through EEG signals. The first two BCI steps require set up of the appropriate experimental protocol while recording the brain signal and then to extract interesting features from the recorded cerebral activity. To provide information useful in these BCI stages, our aim is to provide an overview of a new procedure we recently developed, named functional source separation (FSS). As it comes from the blind source separation algorithms, it exploits the most valuable information provided by the electrophysiological techniques, i.e. the waveform signal properties, remaining blind to the biophysical nature of the signal sources. FSS returns the single trial source activity, estimates the time course of a neuronal pool along different experimental states on the basis of a specific functional requirement in a specific time period, and uses the simulated annealing as the optimization procedure allowing the exploit of functional constraints non-differentiable. Moreover, a minor section is included, devoted to information acquired by MEG in stroke patients, to guide BCI applications aiming at sustaining motor behaviour in these patients. Relevant BCI features - spatial and time-frequency properties - are in fact altered by a stroke in the regions devoted to hand control. Moreover, a method to investigate the relationship between sensory and motor hand cortical network activities is described, providing information useful to develop BCI feedback control systems. This review provides a description of the FSS technique, a promising tool for the BCI community for online electrophysiological feature extraction, and offers interesting information to develop BCI applications to sustain hand control in stroke patients
Fetal magnetocardiographic signals extracted by 'signal subspace' blind source separation.
No full textIn this paper, we apply independent component analysis to fetal magnetocardiographic data. In particular, we propose an extension of the "cumulant-based iterative inversion" algorithm to include a two-step "signal subspace" subdivision, which allows the user to control the number of components to be estimated by analyzing the eigenvalues distribution in an interactive way. Our results show that this method is a powerful means not only for the extraction of the cardiac signals from the background noise but also for a sharp separation of the baby's heart from the mother's
A note on prognostic accuracy evaluation of regression models applied to longitudinal autocorrelated binary data
No full textBackground: Focus of this work was on evaluating the prognostic accuracy of two approaches
for modelling binary longitudinal outcomes, a Generalized Estimating Equation (GEE) and a
likelihood based method, Marginalized Transition Model (MTM), in which a transition model is
combined with a marginal generalized linear model describing the average response as a function
of measured predictors.
Methods: A retrospective study on cardiovascular patients and a prospective study on sciatic
pain were used to evaluate discrimination by computing the Area Under the Receiver-Operating-
Characteristics curve, (AUC ), the Integrated Discrimination Improvement (IDI) and the Net
Reclassification Improvement (NRI) at different time occasions. Calibration was also evaluated. A
simulation study was run in order to compare model’s performance in a context of a perfect knowledge
of the data generating mechanism.
Results: Similar regression coefficients estimates and comparable calibration were obtained; an
higher discrimination level for MTM was observed. No significant differences in calibration and MSE
(Mean Square Error) emerged in the simulation study; MTM higher discrimination level was confirmed.
ConclusionS: The choice of the regression approach should depend on the scientific question being
addressed: whether the overall population-average and calibration are the objectives of interest, or
the subject-specific patterns and discrimination. Moreover, some recently proposed discrimination
indices are useful in evaluating predictive accuracy also in a context of longitudinal studies
Echocardiographic evaluation of systolic and mean pulmonary artery pressure in patients with pulmonary hypertension: Reply
No full textAdding sufentanil to levobupivacaine or ropivacaine intrathecal anaesthesia affects the minimum local anaesthetic dose required.
No full textWe carried out this prospective, randomized, double-blind study in order to evaluate whether the intrathecal addition of sufentanil 3.3 mcg affects both the minimum local anaesthetic dose (MLAD) of spinal levobupivacaine and ropivacaine for a caesarean section and enhances the spinal block characteristics.One hundred and eighty women were randomly allocated into four groups: levobupivacaine (Group L), levobupivacaine plus sufentanil (Group L+S), ropivacaine (Group R) and ropivacaine plus sufentanil (Group R+S). Each received 3 ml of the study solution intrathecally as part of a combined spinal/epidural technique. The initial dose was 12 mg for Groups L and L+S, and 15 mg for Groups R and R+S. The test solution was required to achieve a visual analogue pain score (VAPS) of 30 mm or less to be considered effective at skin incision, uterine incision, birth, peritoneal closure and at the conclusion of surgery. Effective or ineffective responses determined a 0.5 mg decrease or increase of the same drug, respectively, for the next patient in the same group, using an up-down sequential allocation.Using the Dixon and Massey formula, the MLAD was 10.65 mg [confidence interval (CI) 95\%: 10.14-11.56] in Group L, 4.73 mg (CI 95\%: 4.39-5.07) in Group L+S, 14.12 mg (CI 95\%: 13.50-14.60) in Group R and 6.44 mg (CI 95\%: 5.86-7.02) in Group R+S.The addition of sufentanil reduced the MLAD of both the local anaesthetics. It did not affect their potency ratio significantly and resulted in enhanced spinal anaesthesia
Prospective validation of a predictive scoring system for deep sternal wound infection after routine bilateral internal thoracic artery grafting
No full textOBJECTIVES:
The Gatti score is a weighted scoring system based on risk factors for deep sternal wound infection (DSWI) that has been specifically created to predict DSWI risk after routine bilateral internal thoracic artery (BITA) grafting. It has not undergone an external validation. The aim of the present study was to perform this validation.
METHODS:
BITA grafts were used as skeletonized conduits in 304 (90.7%) of 335 consecutive patients with multivessel coronary artery disease who underwent isolated coronary bypass surgery at the authors' institution between January 2014 and July 2015. Baseline characteristics, operative data and immediate outcomes of every patient were prospectively collected in a computerized data registry. A score was assigned to each patient preoperatively. The goodness-of-fit and the discrimination power of both models, preoperative and combined, of the Gatti score were assessed with the Hosmer-Lemeshow test and the calculation of the area under the receiver-operating characteristic curve, respectively.
RESULTS:
Eighteen (5.9%) patients suffered from DSWI. Major differences were found between the original series whence the Gatti score has been derived and the present prospective series. The Gatti score goodness-of-fit was satisfactory for both the preoperative (P = 0.61) and the combined model (P = 0.81). The area under the receiver-operating characteristic curve was 0.82 (95% confidence interval: 0.72-0.91) for the preoperative model and 0.8 (95% confidence interval: 0.71-0.9) for the combined model.
CONCLUSIONS:
On the basis of the results of the present prospective study, the Gatti score has proved to be effective in predicting DSWI following BITA grafting despite some differences between the original and the present series of patients. More studies have to be performed in order to strengthen the evidence of this first external validation
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