1,721,065 research outputs found
Globalization of the Epidemiologic, Clinical, and Financial Burden of Atrial Fibrillation
No full textCost of illness in atrial fibrillatio
Building Up the Diagnosis of Cardiac Device Infections: The Role of Imaging
No full textAmong the complications of cardiac implantable electronic devices (CIED), infections represent one of the nastiest in view of the heavy impact on clinical outcomes and associated costs for healthcare systems. CIED-related infections (CIEDI) can present with several different clinical manifestations increasing the complexity of the diagnostic process. Clinical examination, laboratory exams, blood cultures, and swabs all are mandatory steps for the diagnostic process, similarly to what occurs during diagnosis of endocarditis. However, since signs and symptom may be mild or confusing, imaging has a key role in providing the correct diagnosis. In the present chapter we will discuss the various aspects of echocardiography (transthoracic, transesophageal, and intracardiac) in ruling out CIEDI diagnosis. Later we will discuss the role of computer tomography and magnetic resonance in view of their increasing use in the management of endocarditis, focusing on their pros and cons in the CIEDI setting. Finally, we will focus on nuclear imaging discussing all the various aspects of 18F-FDG PET scan and white blood cell SPET for diagnosis of CIEDI elucidating the advantages among the other imaging techniques but also clarifying how to obtain the maximum from these tools. Notably, the role of imaging techniques is not limited to help defining the diagnosis of CIEDI. For this reason we will dedicate a large part of this chapter to discuss their role in assessment of the extension of the infectious process, detection of complications, supporting transvenous lead extraction (TLE) procedures, planning CIED reimplantation, and helping in predicting post-TLE risk of reinfection or death
Adverse events with sacubitril/valsartan in the real world: emerging signals to target preventive strategies from the FDA adverse event reporting system
Full text linkAims: The aim of this study was to characterise clinical priority of adverse events with sacubitril/valsartan for targeting preventive measures. Methods: We used the US Food and Drug Administration adverse event reporting system (worldwide pharmacovigilance database) to compare adverse events recording sacubitril/valsartan as suspect with other cardiovascular drugs. Disproportionality analyses were performed by calculating the reporting odds ratios, deemed significant when the lower limit of the 95% confidence interval was greater than 1. Clinical priority was assigned to adverse events with significant disproportionality by scoring (range 0–10 points) five features (number of events, magnitude of the lower limit of the 95% confidence interval, mortality frequency, important/designated medical event, biological plausibility). Results: Sacubitril/valsartan was recorded in 20,021 reports, with 178 adverse events associated with significant disproportionality: 71.9%, 25.9% and 2.2% were classified as weak, moderate and strong clinical priorities, respectively. Increased reporting emerged for several cardiovascular adverse events, including ‘renal failure’ (N = 388; lower limit of the 95% confidence interval 2.26), ‘hyperkalaemia’ (314; 2.42) and ‘angioedema’ (309; 1.56). Sudden cardiac death (priority score 9 points) was the only designated medical event with strong clinical priority. Notably, sudden cardiac death occurred early after sacubitril/valsartan administration (average onset 124 days), with concomitant drugs known for pro-arrhythmic potential (e.g. amiodarone, escitalopram, mirtazapine, loop diuretics) in 26.2% of records. Conclusion: The increased cardiovascular reporting of sacubitril/valsartan in the real world was largely predictable from pre-approval evidence, underlying disease and likely patients’ comorbidities. The unexpected reporting of sudden cardiac death occurred well before the complete development of positive electrical remodelling induced by sacubitril/valsartan, and calls for stringent clinical monitoring (to reduce the pro-arrhythmic burden related to co-medications), and further investigation on appropriate combination with other preventive measures
Prevention of Device Infection: Procedural Aspects, Drugs, and Preventive Tools
No full textAlthough the recently reported results of the PADIT study [1] indisputably bring a positive message by showing that the infection rate within the first year after cardiac implantable electronic device (CIED) implantation in advanced care systems was “only” 1% in high-risk patients, infection associated with the use of CIED (CIEDI) remains a serious complication leading to significant morbidity and mortality. These infections can be the result of initial pocket infection, usually due to surgical site contamination (more frequently) or secondary to hematogenous seeding of the leads or pocket during an episode of bacteremia due to remote septic foci or associated with either intravascular catheters or invasive procedures. As previously discussed in Chaps. 3 and 4, the principal agents involved in the development of CIEDI are gram-positive Staphylococci, and the main factors promoting the infective process can be classified into (a) patient-related, (b) device-related, (c) procedure-related, and (d) related to operators’ experience. In this chapter, we will focus on the various aspects of periprocedural modifiable risk factors: anticoagulation, antisepsis, antibiotic prophylaxis, and wound care. We will discuss both available evidence supporting standard approaches and recently introduced devices to improve CIED procedures. On the contrary, prevention of CIEDI through adoption of new CIED technologies, patient-tailored choice of the device, implanting procedure, and long-term follow-up are discussed in Chaps. 10 and 12
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
- …
