1,720,969 research outputs found
How-to: Focus Cardiac Ultrasound in acute settings
No full textFocus cardiac ultrasound (FoCUS) provides vital information at at the bedside which has the potential of improving outcomes in the acute settings. FoCUS could help the clinicians in their daily clinical decision-making while applied within the clinical context as an extension of bedside clinical examination. FoCUS practitioners should be aware of their own limitations with the importance of the timely referral for comprehensive Echocardiography whenever required
Why, when, and how to use lung ultrasound during the COVID-19 pandemic: enthusiasm and caution
No full textTransesophageal Echocardiographic Assessment in Patients with Severe Respiratory Distress due to COVID-19 in the Prone Position: A Feasibility Study
No full textBackground and aim: Our aim was to assess the feasibility, safety, and utility of implementing transesophageal echocardiographic screening in patients with coronavirus disease-2019 (COVID-19)-related acute respiratory distress syndrome (ARDS), receiving mechanical ventilation (MV) and in prone position (PP). Methods: Prospective observational study performed in an intensive care unit; patients 18 years, with ARDS, invasive MV, in PP were included. A total of 87 patients were included. Results: There was no need to change ventilator settings, hemodynamic support, or any difficulties with the insertion of the ultrasonographic probe. Mean duration of transesophageal echocardiography (TEE) was 20 minutes. No displacement of the orotracheal tube, vomiting, or gastrointestinal bleeding was observed. Frequent complication was displacement of the nasogastric tube in 41 (47%) patients. Severe right ventricular (RV) dysfunction was detected in 21 (24%) patients and acute cor pulmonale was diagnosed in 36 (41%) patients. Conclusion: Our results show the importance of assessing RV function during the course of severe respiratory distress and the value of TEE for hemodynamic assessment in PP.Fil: Sosa, Ariel Fernando. Hospital Aleman; ArgentinaFil: Wehit, Jeanette. Hospital Aleman; ArgentinaFil: Merlo, Pablo. Hospital Aleman; ArgentinaFil: Matarrese, Agustín. Hospital Aleman; ArgentinaFil: Torti, Bárbara. Hospital Aleman; ArgentinaFil: Roberti, Javier Eugenio. Hospital Alemán; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: César, Germán. Hospital Aleman; ArgentinaFil: Martínez, Juan Ruiz. Hospital Aleman; ArgentinaFil: Osatnik, Javier. Hospital Alemán; ArgentinaFil: Soliman Aboumarie, Hatem. Harefield Hospital; Reino Unid
Potential Role of Left Atrial Strain to Predict Atrial Fibrillation Recurrence after Catheter Ablation Therapy: A Clinical and Systematic Review
Full text linkPulmonary vein isolation (PVI) with catheter ablation (CA) represents an effective therapy for atrial fibrillation (AF). Unfortunately, it is still not exempt from severe complications. The balance of risks and benefits should be assessed, and a patient-tailored approach is desirable. So far, several clinical and cardiac imaging parameters have been evaluated to investigate pre- and post-procedural features that could help clinicians in the selection of patients at high risk of a poor outcome after CA. This clinical and systematic review analyses the potential role of new LA parameters, such as LA reservoir strain, to predict AF recurrence after CA therapy. Notably, LA reservoir strain gains substantial clinical importance in patients with paroxysmal AF and when a low CHADS2-VASc score is retrieved. LA reservoir strain provides data concerning the risk of AF recurrence after PVI and, thus, in the management of long-term medical therapy in this patient’s group
Echocardiography in the intensive care unit: An essential tool for diagnosis, monitoring and guiding clinical decision-making
Full text linkIn the last years, new trends on patient diagnosis for admission in cardiac intensive care unit (CICU) have been observed, shifting from acute myocardial infarction or acute heart failure to non-cardiac diseases such as sepsis, acute respiratory failure or acute kidney injury. Moreover, thanks to the advances in scientific knowledge and higher availability, there has been increasing use of positive pressure mechanical ventilation which has its implications on the heart. Therefore, there is a growing need for Cardiac intensivists to quickly, noninvasively and repeatedly evaluate various hemodynamic conditions and the response to therapy. Transthoracic critical care echocardiography (CCE) currently represents an essential tool in CICU, as it is used to evaluate biventricular function and complications following acute coronary syndromes, identify the mechanisms of circulatory failure, acute valvular pathologies, tailoring and titrating intravenous treatment or mechanical circulatory support. This could be completed with trans-esophageal echocardiography (TOE), advanced echocardiography and lung ultrasound to provide a thorough evaluation and monitoring of CICU patients. However, CCE could sometimes be challenging as the acquisition of good-quality images is limited by mechanical ventilation, suboptimal patient position or recent surgery with drains on the chest. Moreover, there are some technical caveats that one should bear in mind while performing CCE in order to optimize its use and avoid misleading findings. The aim of this review is to highlight the key role of CCE, providing an updated overview of its main applications and possible pitfalls in order to facilitate its use in CICU for clinical decision-making
Identifying Cardiogenic Shock Sub-Phenotypes with Machine Learning: A Multicenter Study Combining Clinical and Echocardiographic Data
No full textBackground: Subphenotyping cardiogenic shock (CS) patients using nontraditional clustering methods represent a step toward precision medicine, potentially improving outcomes in this heterogeneous and high-mortality condition. Objectives: This study aimed to apply an unsupervised machine learning approach to integrate clinical and advanced echocardiographic data, identifying CS subphenotypes associated with different outcomes and features, beyond etiology. Methods: This multicenter observational study prospectively analyzed 172 patients admitted to cardiac intensive care units with overt CS, from 2021. An exploratory statistical analysis preceded patient clustering using the Elbow Method and K-Means algorithm, based on clinical presentation. Dimensionality reduction was performed with principal component analysis. Phenotypes were further stratified according to the Society for Cardiovascular Angiography and Interventions stages. Results: Five distinct phenotypes (I–V) were identified, showing progressively increasing in-hospital mortality rates: 25% (I), 32% (II), 39% (III), 41% (IV), and 60% (V). Kaplan-Meier analysis demonstrated a stepwise increase in mortality risk. Phenotypes IV and V had significantly higher mortality than phenotype I (HR: 2.78 [95% CI: 1.07-7.19] and HR: 2.80 [95% CI: 1.10-7.14]; P < 0.05). Mortality prediction remained independent after adjustment for confounding factors, and independently of Society for Cardiovascular Angiography and Interventions stage. Phenotype I had the lowest mortality, with higher arterial pressure and moderate left ventricular (LV) dysfunction, whereas phenotype II exhibited marked LV failure. Oppositely, phenotypes IV and V had severe congestion despite only mild LV impairment. Conclusions: Machine learning, newly integrating echocardiographic data, identified 5 distinct CS phenotypes, each with unique clinical/echocardiographic features and mortality risks. These insights could support personalized treatment strategies in CS patients, pending further validation
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
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