73 research outputs found
Perception of thromboembolism risk. differences between the departments of internal medicine and emergency medicine
No full textThe latest developments in emergency medicine (EM) have introduced new typologies of patients that have not been taken into account in previous studies of venous thromboembolism (VTE) risk. The aim of the current study was to evaluate by comparing the main international risk scores whether different perceptions of VTE risk exist in internal medicine (IM) departments and in EM departments. This cross-sectional observational study involved 23 IM and 10 EM departments of 21 different hospitals. The patient data were collected by physicians who were blinded to the purpose of the study. The data were analyzed using the main international risk scores. We analyzed 742 patients, 222 (30%) hospitalized in EM departments and the remaining 520 (70%) in IM departments. We found that fewer patients at risk for VTE were treated with low-molecular-weight heparin (LMWH) in EM departments than in IM departments. Moreover, there was significant statistical difference in the use of LMWH between IM and EM departments when the Padua score and immobilization criteria were used to assess the risk. The infrequent use of LMWH in EM patients may have several causes. For example, in EM departments, treatment of acute illness often takes higher priority than VTE risk evaluation. Moreover, immobilization criteria cannot be evaluated for all EM patients because of the intrinsic time requirements. For the aforementioned reasons, we believe that a different VTE risk score is required that takes into account the peculiarities of EM, and establishing such a score should be the object of future study
On the use of mechanics-informed models to structural engineering systems: Application of graph neural networks for structural analysis
No full textThis paper investigates the application of mechanics-informed artificial intelligence to civil structural systems. Structural analysis is a traditional practice that involves engineers to solve different real-life problems. Several approaches can be used for this task, going from "by hand" computation to the recent advanced finite element method. However, when structures become complex, the success of the analysis can be complicated, often requiring high computational efforts and time. To tackle this challenge, traditional high-demanding methods can be supported by new technologies, such as machine-learning tools. This new paradigm aims to solve structural problems by defining the desired output after directly elaborating input data. One of the current limitations is that often the physics behind the problem is ignored. To solve this issue, resolution models can combine empirical data and available mechanics prior knowledge to improve the predictive performance involving physical mechanisms. In this paper, a method to develop a Mechanics-Informed Surrogate Model (MISM) on structural systems is proposed, for which input structured data are used to enrich the informative content of mechanics systems. Then, Graph Neural Networks (GNNs) are explored, as a method capable of properly rep-resenting and embedding knowledge about a structural system, such as truss structures. The main advantage of the proposed approach is to provide an alternative way to the usual black-box machine-learning-based models. In fact, in the proposed MISM, the mechanics of the structural system plays the key role in the surrogate model definition, in order to obtain physically based outputs for the investigated problem. For the case at hand, MISMs are developed and employed to learn the deformations map of the system, starting from the knowledge of the structural features. The proposed approach is applied to bi-dimensional and tri-dimensional truss structures and the results indicate that the proposed solution performs better than standard surrogate models
Improving quality through clinical risk management: A triage sentinel event analysis
No full text"Triage" is a useful tool used in emergency departments (EDs) to prioritize the care of patients. Through a methodical process of different sequential steps, the triage nurse assigns a color code which goes from red-critical patient with immediate access to medical examination-to a white code that represents no urgency. Clinical studies have shown that patients can be victims of errors during the process of care, especially in complex systems such as EDs. To reduce errors it is essential to map the risks in order to identify the causes (both individual and organizational); the introduction of corrective changes cannot be postponed. The incorrect assessment at triage represents one of the major errors in EDs. By monitoring this activity, through the analysis of sentinel events we can reduce adverse consequences. Missed recognition of a red code indicates a sentinel event. We used a "root cause analysis" to explain an episode of missed recognition of red code at triage. A nurse without specific training in triage and inexperienced in critical care was identified as the "root cause" of the sentinel event. To make improvements we planned a triage training course (for newly employed nurses and a refresher course for existing staff) and created a team of dedicated triage nurses. © 2011 SIMI
Cigarette smoke and increased COX-2 and survivin levels in exhaled breath condensate of lung cancer patients: How hot is the link?
No full textValidation of IAEA Electron Beam Data for Radiotherapy and Their Use to Model Total Skin Irradiation
No full textMonte Carlo simulation for external beam radiotherapy requires precise modeling of the treatment linear accelerator head and of the primary electron beam. Detailed modeling of medical accelerators is complex and could require proprietary data, and the production of an adequate sample of primary particles to simulate statistically significant dosimetric observables requires intensive computational resources. To facilitate these tasks, IAEA (International Atomic Energy Agency) released a phase-space database for external beam radiotherapy, consisting of primary particle distributions deriving from Monte Carlo simulations of widely utilized linear accelerators, which can be used as input to dosimetric simulations. The IAEA data have been released more that 10 years ago along with a Geant4 interface. This presentation addresses the ability to produce realistic dosimetric distributions in Geant4-based simulations using IAEA electron beam data and to endeavour the simulation of beams for non-conventional radiotherapy settings that are not covered by the IAEA database, such as those needed for Total Skin Irradiation (TSI, as performed in Total Skin Electron Therapy procedures). We report the results of validation tests, involving the comparison of dosimetric quantities measured in quality control standard procedures and simulated with Geant4 using IAEA phase-space data
In-hospital mortality in the emergency department: clinical and etiological differences between early and late deaths among patients awaiting admission
No full textObjective: Given that there are no studies on diseases that occur by waiting for hospitalization, we aimed to evaluate the main causes of death in the emergency room (ER) and their relationship with overcrowding. Methods: Patients who died in the ER in the past 2 years (pediatrics and trauma victims excluded) were divided into two groups: patients who died within 6 hours of arrival (emergency department [ED] group) and patients who died later (LD group). We compared the causes of death, total vital signs, diagnostic tests performed, and therapy between the groups. We assessed for possible correlation between the number of monthly deaths per group and four variables of overcrowding: number of patients treated per month, waiting time before medical visit (W-Time), mean intervention time (I-Time), and number of patients admitted to the ward per month (NPA). Results: During the two years, 175 patients had died in our ER (52% in ED group and 48% in LD group). The total time spent in the ER was, respectively, 2.9±0.2 hours for ED group and 17.9± 1.5 hours for LD group. The more frequent cause of death was cardiovascular syndrome (30%) in ED group and sepsis (27%) and acute respiratory failure (27%) in LD group. Positive correlations between number of monthly deaths and W-Time (R2 0.51, P<0.001), I-Time (R2 0.73, P< 0.0001), and NPA (R2 0.37, P<0.01) were found only in LD group. Conclusion: Patients with sepsis and acute respiratory failure die after a long stay in the ER, and the risk increases with overcrowding. A fast-track pathway should be considered for hospital admission of critical patients
Is the Exhaled Breath Temperature Sensitive to Cigarette Smoking?
No full textThe smoking habit is accompanied by an acute inflammatory response which follows tissue injury. It would be desirable to find a non-invasive inflammatory marker that would simplify the task of studying and monitoring smokers more simply and allow us to identify populations at risk of contracting Chronic Obstructive Pulmonary Disease (COPD). Today's expectations regarding research focus on issues ranging from inflammatory markers to those of exhaled breath temperature (EBT) are considerable. That said, although the EBT has been largely studied in asthma and COPD, there have not been any studies thus far that have analysed the effect of cigarette smoking on the EBT. Bearing this in mind, in this longitudinal study we aim to analyse the EBT in current smokers, monitor the effects both of cigarette smoking on EBT and of what happens after smoking cessation. Twenty-five (25) smokers (59.5 ± 3.1 yrs, 12 M) who participated in a multi-disciplinary smoking cessation programme and 25 healthy never-smokers (58.7 ± 2.9, 13 M) underwent EBT measurement. EBT values were higher in smokers before smoking (T0) than in never-smokers [34.6 (34.2–35) vs 33.2 (32.4–33.7)°C, p < 0.001. The smokers repeated measurement 5 minutes after smoking a cigarette (T1) and 2 hours after (T2). They repeated EBC measurement after 1 week (T3) and then after 3 months (T4) from smoking cessation. EBT is higher in smokers compared to controls. EBT increases after cigarette smoking and progressively decreases with the increase of time from when the last cigarette was smoked. Thus, we can conclude that EBT is increased in smokers and also sensitive to the acute effect of cigarette smoke
Exhaled breath temperature in NSCLC: Could be a new non-invasive marker?
No full textThe exhaled breath temperature (EBT) has been proven to be the expression of airways inflammation as well as of the increased vascularity. Although both these conditions characterize lung cancer pathogenesis, this is the first study where the EBT has been analysed in patients affected by non-small-cell lung cancer. The aim of this study was to verify whether and how the lung cancer being examined influences the EBT for possible future clinical implications. Eighty-two consecutive subjects with a radiological suspicion of lung cancer were enrolled and underwent standard diagnostic and staging procedures for cancer. EBT was measured in all the subjects at the enrolment with the X-Halo device. Forty patients resulted as affected by lung cancer while 42 as false-positive (controls). We found a higher EBT in NSCLC patients compared to healthy subjects. The EBT was correlated with number of packs/year and associated with the stage of lung cancer. We identified a cut-off value for the EBT that is able to screen patients with lung cancer with a high sensitivity and specificity. Our results suggest that lung cancer causes an increase in the EBT, which, whether confirmed and validated, could become a new non-invasive clinical tool in the screening and monitoring of this disease
Consensus document: A model of integrated management of patients with psycomotor agitation
No full textL’agitazione psicomotoria (APM) rappresenta un quadro clinico eterogeneo, esito di una varietà di processi patologici differenti, sulla cui corretta valutazione e gestione la letteratura scientifica e le linee-guida attualmente disponibili presentano una notevole disomogeneità e mancanza di standardizzazione, in particolare riguardo alle terapie farmacologiche. Partendo da questa carenza, e dalla consapevolezza della necessità di un approccio multidisciplinare a questa condizione, che comprende aspetti comuni a diverse professionalità sanitarie così come fattori relativi a competenze di farmacoeconomia e di gestione del rischio, è stato intrapreso un progetto teso all’elaborazione di un modello condiviso di gestione integrata del paziente con APM. Tale modello, basato sul lavoro di un board scientifico e di un panel multidisciplinare di esperti, chiamato a raggiungere un consenso attraverso la metodologia Delphi-RAND, si propone come indicazione di buona pratica clinica nella gestione di questi pazienti. Il presente documento riporta i risultati di questo percorso di consenso, i cui principi fondamentali sono la centralità del paziente considerato come soggetto attivo e partecipante, la necessità di intervenire precocemente con azioni non contenitive in grado di evitare l’escalation sintomatologica e permettere il proseguimento dell’iter diagnostico-terapeutico, l’impiego di trattamenti farmacologici adeguati al grado di gravità della sintomatologia e l’importanza di integrare e armonizzare fra loro gli interventi delle diverse professionalità coinvolte
- …
