Nonlinear heart rate variability features for real-life stress detection. Case study : students under stress due to university examination

Background: This study investigates the variations of Heart Rate Variability (HRV) due to a real-life stressor and proposes a classifier based on nonlinear features of HRV for automatic stress detection. Methods: 42 students volunteered to participate to the study about HRV and stress. For each student, two recordings were performed: one during an on-going university examination, assumed as a real-life stressor, and one after holidays. Nonlinear analysis of HRV was performed by using Poincaré Plot, Approximate Entropy, Correlation dimension, Detrended Fluctuation Analysis, Recurrence Plot. For statistical comparison, we adopted the Wilcoxon Signed Rank test and for development of a classifier we adopted the Linear Discriminant Analysis (LDA). Results: Almost all HRV features measuring heart rate complexity were significantly decreased in the stress session. LDA generated a simple classifier based on the two Poincaré Plot parameters and Approximate Entropy, which enables stress detection with a total classification accuracy, a sensitivity and a specificity rate of 90%, 86%, and 95% respectively. Conclusions: The results of the current study suggest that nonlinear HRV analysis using short term ECG recording could be effective in automatically detecting real-life stress condition, such as a university examination

How should i treat concomitant post - endarterectomy carotid pseudoaneurysm and contralateral symptomatyc stenosis?

Background: A 74-year-old male patient complaining of crescendo TIAs, hypertension and hyperlipidaemia. Investigation: Duplex ultrasound scan MR angiography. Diagnosis: Pseudoaneurysm stemming from the ICA. Treatment: An open or endovascular procedure for the right pECCA repair, or a left CEA or CAS

THE TECHNICAL MANAGEMENT OF HEALTH INFORMATION SYSTEMS

The technical management of ICT/Telemedicine Services is one Hospital Manager's crucial problem. The Biomedical Technologies Market has clearly shown that technical support to the user is one of the most critical issues that contribute to guarantee the quality of service in High-Tech applications. Therefore the ICT/Telemedicine Services, which belong to the high innovation area as well, require adequate competencies and human resources in order to provide users with a proper technical support. All these technologies require on the one hand a specialist who normally works remotely (II level support) and on the other hand an ordinary management activity (I level technical support) in order to avoid that medical staff stop their work in the operative env

Emergency endovascular management of the common femoral artery rupture due to radiotherapy for scrotal carcinoma

We describe the case of a 72-year-old man with massive hemorrhage and shock resulting from rupture of the left common femoral artery as a complication of radiotherapy in the groin for cancer of the scrotum. This complication is extremely rare, presents dramatically, and is usually fatal. The patient was successfully treated with a stent graft deployment in order to achieve immediate hemostasis maintaining blood flow to the leg. Open surgery is not ideal in those cases especially when there is extensive tumor involvement of the groin causing altered anatomy and increasing the risk of re-bleeding

Web-based system for assessing risk factors for falls in community-dwelling elderly people using the Analytic Hierarchy Process

Falls occur frequently among older people and represent the most common cause of injury-related morbidity and mortality in later life. Preventing falls is an important way to reduce injuries, hospitalizations, and injury-related morbidity and mortality among older people. The research literature has identified hundreds of risk factors for falls among elderly people. Prioritizing risk factors for falls is useful for designing effective and efficacious prevention programs. The aim of this study was to use the Analytic Hierarchy Process to develop a hierarchy of risk factors for falls based on the knowledge and experience of experts working in this field

The use of classification and regression tree to predict 15-year survival in community-dwelling older people

Previous research has identified various risk factors for mortality in older people. The aim of this paper was to use Classification and Regression Tree to predict 15-year survival in community-dwelling older people. Data were obtained from a United Kingdom representative sample of 1042 community-dwelling people aged 65 and over. Outcome was time from 1985 interview to death or censorship on February 29, 2000. Classification and Regression Tree is a non-parametric technique widely used in medical domain classification. We applied CART to the set of risk-factors identified in a previous research. The selected CART model is based on age, dose of drug prescribed and handgrip measures. It predicts survival with a sensitivity rate of 76.3% and a specificity rate of 66.3%. The selection of variables are consistent with previous research. Finally, we observed the range of risk factors and their combination associated with increased and decreased mortality

Intraoperative cell salvage in ruptured abdominal aortic aneurysms

Aim. The aim of this study was to evaluate the impact of intraoperative cell salvage (ICS) on the early outcome after open repair (OR) of ruptured abdominal aortic aneurysm (rAAA). Methods. This is a retrospective review of 73 consecutive patients who underwent emergency OR of infrarenal rAAA with ICS between 2005 and 2008 (Group I), compared to 51 repairs from 2002-2004 with no ICS (Group II). In addition, a transfusion protocol of platelets and fresh frozen plasma (FFP) administration on admission and during surgery was adopted in patients in Group I to maintain coagulation competence. Results. ICS reduced bank blood demand by 63.6% (from 11 to 4 units, P<0.001) compared to controls, and had a strong impact on rates of postoperative complications (P=0.05), or death (43.8% vs. 52.9%, P<0.05) or in-hospital LOS (P<0.07) in these patients. Patients surviving in Group I had significantly higher postoperative haemoglobin level (11.5 vs. 9.6 g/dL, P<0.05) and platelet count (267 vs. 95 x 109 L, P<0.001 ), a shorter APTT (31 s vs. 47 s, P<0.05) and a lower INR (1.3 vs. 2.1, P<0.01) than patients who died postoperatively. ICS volume was significantly higher in patients with suprarenal aortic clamping and in those who had bifurcated grafting reconstruction (P<0.05), but amount of red blood cells (RBC) collected did not influence outcome. Conclusion. These results suggest that intraoperative cell salvage, minimizing perioperative homologous blood transfusion, is an important determinant of outcome after rAAA repair. Combined administration of balanced blood components may contribute to improve the survival of the patient

Social capital in chronic disease: an ethnographic study

Chronically ill conditions are particularly difficult to manage because of their impact both on the social and on the corporal sphere to such an extent as to involve a series of problems that negatively alter the quality of life of affected patients. Chronicity has also a considerable ef-fect on social capital. In the current literature, it is known that social capital may contribute to a range of advantages to people health. Chronic Venous Disease (CVD) includes several pathologi-cal alterations of the venous system of the lower limbs that cause a wide range of symptoms and signs. The aim of this study is to explore, with a qualitative approach, the dynamics of social cap-ital within people's experience of CVD and describe the roles of family and friends and the health care system. The method used is based on face-to-face semistructured interviews was performed, following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Six-teen patients were included: 11 women and 5 men. The results obtained are completely in line with the current literature, which shows a certain difficulty in terms of daily activities, pain management; work-related difficulties; non-coverage of healthcare costs for medications and drugs prescribed. In the context of social capital, the bonding social capital of the patients inter-viewed was more positively perceived in the role of CVD management than by the patients' fami-lies. Another interesting result concerns the total absence of knowledge of patient associations with CVD. Thus, alongside the biographical destruction that CVD entails, there is evidence of the scarce relevance and presence of health policies capable of improving the quality of life of these people not only from a social and medical point of view but also from an economic point of vie

What the young physician should know about May-Thurner syndrome

May-Thurner syndrome (MTS) is an anatomically variable condition resulting in compression of the left common iliac vein between the right common iliac artery and the underlying spine with subsequent development of a left deep vein thrombosis (DVT). Although this syndrome is rare, its true prevalence is likely underestimated. Mainly, clinical symptoms and signs include, but are not limited to, pain, swelling, venous stasis ulcers, skin pigmentation changes and post-thrombotic syndrome. Correct treatment is not well established and is based on clinical presentation. Staged thrombolysis with/without prophylactic retrievable inferior vena cava filter placement followed by angioplasty/stenting of the left iliac vein appears to be the best option in MTS patients with extensive DVT. The aim of this review is to present in a simple and didactic form all variable clinical presentations of MTS and to outline possible management within the current guidelines