67,280 research outputs found
Computer Aided ECG Analysis - State of the Art and Upcoming Challenges
In this paper we present current achievements in computer aided ECG analysis
and their applicability in real world medical diagnosis process. Most of the
current work is covering problems of removing noise, detecting heartbeats and
rhythm-based analysis. There are some advancements in particular ECG segments
detection and beat classifications but with limited evaluations and without
clinical approvals. This paper presents state of the art advancements in those
areas till present day. Besides this short computer science and signal
processing literature review, paper covers future challenges regarding the ECG
signal morphology analysis deriving from the medical literature review. Paper
is concluded with identified gaps in current advancements and testing, upcoming
challenges for future research and a bullseye test is suggested for morphology
analysis evaluation.Comment: 7 pages, 3 figures, IEEE EUROCON 2013 International conference on
computer as a tool, 1-4 July 2013, Zagreb, Croati
The SOAR stroke score predicts hospital length of stay in acute stroke: an external validation study
Statistical and Clinical Aspects of Hospital Outcomes Profiling
Hospital profiling involves a comparison of a health care provider's
structure, processes of care, or outcomes to a standard, often in the form of a
report card. Given the ubiquity of report cards and similar consumer ratings in
contemporary American culture, it is notable that these are a relatively recent
phenomenon in health care. Prior to the 1986 release of Medicare hospital
outcome data, little such information was publicly available. We review the
historical evolution of hospital profiling with special emphasis on outcomes;
present a detailed history of cardiac surgery report cards, the paradigm for
modern provider profiling; discuss the potential unintended negative
consequences of public report cards; and describe various statistical
methodologies for quantifying the relative performance of cardiac surgery
programs. Outstanding statistical issues are also described.Comment: Published in at http://dx.doi.org/10.1214/088342307000000096 the
Statistical Science (http://www.imstat.org/sts/) by the Institute of
Mathematical Statistics (http://www.imstat.org
Knowledge Summary 27: Death reviews: maternal, perinatal and child
Many maternal, perinatal and child deaths are preventable and progress towards Millennium Development Goals 4&5, to reduce child mortality and improve maternal health, has been insufficient in many parts of the world. Well-implemented death reviews provide opportunities to examine the circumstances surrounding a woman’s or child’s death, and improve the delivery of health services to prevent such deaths in the future. Several types of review processes exist to evaluate deaths in diverse settings, given different data availability and levels of service delivery. Both consistent surveillance and effective response are needed to ensure that maternal, perinatal and child deaths are identified and reviewed, so that recommendations can be made, and action can be taken to prevent further deaths
Determination of Pericardial Adipose Tissue Increases the Prognostic Accuracy of Coronary Artery Calcification for Future Cardiovascular Events
Objectives: Pericardial adipose tissue (PAT) is associated with coronary artery plaque accumulation and the incidence of coronary heart disease. We evaluated the possible incremental prognostic value of PAT for future cardiovascular events. Methods: 145 patients (94 males, age 60 10 years) with stable coronary artery disease underwent coronary artery calcification (CAC) scanning in a multislice CT scanner, and the volume of pericardial fat was measured. Mean observation time was 5.4 years. Results: 34 patients experienced a severe cardiac event. They had a significantly higher CAC score (1,708 +/- 2,269 vs. 538 +/- 1,150, p 400, 3.5 (1.9-5.4; p = 0.007) for scores > 800 and 5.9 (3.7-7.8; p = 0.005) for scores > 1,600. When additionally a PAT volume > 200 cm(3) was determined, there was a significant increase in the event rate and relative risk. We calculated a relative risk of 2.9 (1.9-4.2; p = 0.01) for scores > 400, 4.0 (2.1-5.0; p = 0.006) for scores > 800 and 7.1 (4.1-10.2; p = 0.005) for scores > 1,600. Conclusions:The additional determination of PAT increases the predictive power of CAC for future cardiovascular events. PAT might therefore be used as a further parameter for risk stratification. Copyright (C) 2012 S. Karger AG, Base
Blood pressure response to renal denervation is correlated with baseline blood pressure variability: a patient-level meta-analysis
Background: Sympathetic tone is one of the main
determinants of blood pressure (BP) variability and
treatment-resistant hypertension. The aim of our study was
to assess changes in BP variability after renal denervation
(RDN). In addition, on an exploratory basis, we investigated
whether baseline BP variability predicted the BP changes
after RDN.
Methods: We analyzed 24-h BP recordings obtained at
baseline and 6 months after RDN in 167 treatmentresistant
hypertension patients (40% women; age, 56.7
years; mean 24-h BP, 152/90 mmHg) recruited at 11 expert
centers. BP variability was assessed by weighted SD [SD
over time weighted for the time interval between
consecutive readings (SDiw)], average real variability (ARV),
coefficient of variation, and variability independent of the
mean (VIM).
Results: Mean office and 24-h BP fell by 15.4/6.6 and 5.5/
3.7 mmHg, respectively (P < 0.001). In multivariable-adjusted
analyses, systolic/diastolic SDiw and VIM for 24-h
SBP/DBP decreased by 1.18/0.63 mmHg (P 0.01) and
0.86/0.42 mmHg (P 0.05), respectively, whereas no
significant changes in ARV or coefficient of variation
occurred. Furthermore, baseline SDiw (P ¼ 0.0006), ARV
(P ¼ 0.01), and VIM (P ¼ 0.04) predicted the decrease in
24-h DBP but not 24-h SBP after RDN.
Conclusion: RDN was associated with a decrease in BP
variability independent of the BP level, suggesting that
responders may derive benefits from the reduction in BP
variability as well. Furthermore, baseline DBP variability
estimates significantly correlated with mean DBP decrease
after RDN. If confirmed in younger patients with less
arterial damage, in the absence of the confounding effect
of drugs and drug adherence, baseline BP variability may
prove a good predictor of BP response to RDN
Near-universal hospitalization of US emergency department patients with cancer and febrile neutropenia
IMPORTANCE:
Febrile neutropenia (FN) is the most common oncologic emergency and is among the most deadly. Guidelines recommend risk stratification and outpatient management of both pediatric and adult FN patients deemed to be at low risk of complications or mortality, but our prior single-center research demonstrated that the vast majority (95%) are hospitalized.
OBJECTIVE:
From a nationwide perspective, to determine the proportion of cancer patients of all ages hospitalized after an emergency department (ED) visit for FN, and to analyze variability in hospitalization rates. Our a priori hypothesis was that >90% of US cancer-associated ED FN visits would end in hospitalization.
DESIGN:
Analysis of data from the Nationwide Emergency Department Sample, 2006-2014.
SETTING:
Stratified probability sample of all US ED visits.
PARTICIPANTS:
Inclusion criteria were: (1) Clinical Classification Software code indicating cancer, (2) diagnostic code indicating fever, and (3) diagnostic code indicating neutropenia. We excluded visits ending in transfer.
EXPOSURE:
The hospital at which the visit took place.
MAIN OUTCOMES AND MEASURES:
Our main outcome is the proportion of ED FN visits ending in hospitalization, with an a priori hypothesis of >90%. Our secondary outcomes are: (a) hospitalization rates among subsets, and (b) proportion of variability in the hospitalization rate attributable to which hospital the patient visited, as measured by the intra-class correlation coefficient (ICC).
RESULTS:
Of 348,868 visits selected to be representative of all US ED visits, 94% ended in hospitalization (95% Confidence Interval [CI] 93-94%). Each additional decade of age conferred 1.23x increased odds of hospitalization. Those with private (92%), self-pay (92%), and other (93%) insurance were less likely to be hospitalized than those with public insurance (95%, odds ratios [OR] 0.74-0.76). Hospitalization was least likely at non-metropolitan hospitals (84%, OR 0.15 relative to metropolitan teaching hospitals), and was also less likely at metropolitan non-teaching hospitals (94%, OR 0.64 relative to metropolitan teaching hospitals). The ICC adjusted for hospital random effects and patient and hospital characteristics was 26% (95%CI 23-29%), indicating that 26% of the variability in hospitalization rate was attributable to which hospital the patient visited.
CONCLUSIONS AND RELEVANCE:
Nearly all cancer-associated ED FN visits in the US end in hospitalization. Inter-hospital variation in hospitalization practices explains 26% of the limited variability in hospitalization decisions. Simple, objective tools are needed to improve risk stratification for ED FN patients
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