A simple prognostic index in acute heart failure

Background Rapid effective triage is integral to emergency care in patients hospitalized for heart failure, to guide the type and intensity of therapy. Several indexes and scores have been proposed to predict outcome; most of the them are complex and unfit to use at the bedside. Methods We propose a new prognostic index for in hospital mortality in acute heart failure. The index was built according to the formula; 220 – age – heart rate + systolic blood pressure – ( creatinine X 10). The index was tested in 1628 patients admitted for acute heart failure and enrolled, from November 2007 to December 2009, in the Italian Registry on Heart Failure Outcome ( IN-HF); a prospective, multicentre, observational study. Results The prognostic index was an independent predictor for in hospital mortality risk ( c statistic= 0.74) (p<0.0001), together with left ventricular ejection fraction (p= 0.001), Glycemia ( p= 0.019) and hemoglobin concentration (p = 0.002). Conclusion A simple prognostic index based on variables easily assessed can be useful to predict mortality in acute heart failure at the first arrival in hospital

Assessing ICD-9-CM and ICPC-2 Use in Primary Care. An Italian Case Study

Controlled vocabularies and standardized coding systems play a fundamental role in the healthcare domain. The International Classification of Diseases (ICD) is one of the most widely used classification systems for clinical problems and procedures. In Italy the 9th revision of the standard is used and recommended in primary care for encoding prescription documents. This paper describes a statistical and terminological study to assess ICD-9-CM use in primary care and its comparison to the International Classification of Primary Care (ICPC), specifically designed for primary care. The study has been conducted by analyzing the clinical records of about 199,000 patients provided by a set of 166 General Practitioners (GPs) in different Italian areas. The analysis has been based on several techniques for detecting coding practice and errors, like natural language processing and text-similarity comparison. Results showed that the selected GPs do not fully exploit the diseases and procedures descriptive capabilities of ICD-9-CM due to its complexity. Furthermore, compared to ICPC-2, it resulted less feasible in the primary care setting, particularly for the high granularity of the structure and for the lack of reasons for encounters

Strutture tassonomiche e linguaggi specialistici in ambito biomedico

Il presente lavoro di ricerca analizza la terminologia in ambito biomedico ed in particolare nel sottodominio delle patologie rare e propone la costruzione di un modello di classificazione per le malattie rare che possa essere di supporto non solo per i professionisti del settore, ma anche e soprattutto per tutti coloro i quali sono affetti da tali patologie affinch\ue9 possano utilizzarlo come strumento necessario per la ricerca di informazioni cliniche utili ai percorsi di diagnosi e cura

La genitorialità reclusa: essere padri in carcere

Essere padri detenuti rientra nella categoria di genitorialità a rischio, in quanto la condizione di detenzione fa venire meno alcuni presupposti fondamentali dell’esercizio della funzione genitoriale. Il genitore dovrebbe riuscire trasmettere al bambino fiducia nelle sue capacità di crescita perché il bambino si nutre di questo e non di tutte le cose che gli possono essere date materialmente (Bouregba, 2004)1. Per i detenuti, la famiglia, molto spesso, costituisce la più importante fonte di speranza, benessere e legame con l’esterno (Magaletta, Herbst, 2001)2. Ma l'ingresso in carcere interrompe ed altera la natura bidirezionale e reciproca dello scambio comunicativo e interattivo genitore-figlio. Un padre detenuto non può esercitare nella contiguità fisica, spaziale e temporale il ruolo di genitore. Va inoltre considerato che stereotipi e pregiudizi possono contribuire a creare una rappresentazione culturalmente condivisa del detenuto come soggetto incapace di essere un buon genitore, e ciò potrebbe determinare, nei soggetti in questione, un vissuto di fallimento e di inadeguatezza rispetto alla percezione di sé come padre e al proprio ruolo (Cassibba, Luchinovich, Montatore, Godelli, 2008)3. Inoltre l’assenza di modelli di riferimento adeguati, le condizioni iniziali di svantaggio, la povertà degli strumenti cognitivi, comunicativi e relazionali disponibili, uniti all’esperienza di un contesto restrittivo quale il carcere, rendono difficile la costruzione e il mantenimento di un legame fra padre-figlio adeguato alle esigenze di sviluppo del minore e stabile nel tempo (Cassibba et al, op cit, 2008). Sulla base di tale impostazione teorico-concettuale, l'obiettivo del presente contributo è quello di presentare i dati preliminari di una ricerca che ha visto la collaborazione tra l'Università di Bari e di Modena e Reggio Emilia, coinvolgendo nel contempo le amministrazioni penitenziarie delle due rispettive regioni, con lo scopo di indagare l'auto-percezione del ruolo paterno in padri in stato detentivo, esplorando nel contempo la relazione tra tale forma di auto-percezione e lo stile di attaccamento dei partecipanti alla ricerca. Dal punto di vista metodologico, per la misurazione delle variabili in oggetto sono stati utilizzati l'Attachment Style Questionnaire- ASQ (Feeney, Noller e Hanrahan, 1994) e il questionario sull'Auto-percezione del Ruolo Paterno (Harter, 1982)

Risk scores of bleeding complications in patients on dual antiplatelet therapy. how to optimize identification of patients at risk of bleeding after percutaneous coronary intervention

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor in patients undergoing percutaneous coronary intervention (PCI) reduces the risk of ischemic events but reduces the risk of ischemic events but increases the risk of bleeding, which in turn is associated with increased morbidity and mortality. With the aim to offer personalized treatment regimens to patients undergoing PCI, much effort has been devoted in the last decade to improve the identification of patients at increased risk of bleeding complications. Several clinical scores have been developed and validated in large populations of patients with coronary artery disease (CAD) and are currently recommended by guidelines to evaluate bleeding risk and individualize the type and duration of antithrombotic therapy after PCI. In clinical practice, these risk scores are conventionally computed at the time of PCI using baseline features and risk factors. Yet, bleeding risk is dynamic and can change over time after PCI, since patients can worsen or improve their clinical status and accumulate comorbidities. Indeed, evidence now exists that the estimated risk of bleeding after PCI can change over time. This concept is relevant, as the inappropriate estimation of bleeding risk, either at the time of revascularization or subsequent follow-up visits, might lead to erroneous therapeutic management. Serial evaluation and recalculation of bleeding risk scores during follow-up can be important in clinical practice to improve the identification of patients at higher risk of bleeding while on DAPT after PCI

Ranolazine reduces symptoms of palpitations and documented arrhythmias in patients with ischemic heart disease — The RYPPLE randomized cross-over trial

Background: Ranolazine decreases the frequency of arrhythmias during the acute phases of ischemic heart disease (IHD), but it remains unknown if it has similar effects in the chronic phase of the disease. We performed a prospective, randomized, cross-over pilot trial to test the hypothesis that chronic treatment with ranolazine can reduce the incidence of documented arrhythmias and the related symptoms of palpitation in stable patients with IHD. Methods: We randomized 105 patients with stable IHD and symptoms of angina and palpitations already on therapy with betablockers and/or calcium antagonists to ranolazine (750 mg bid, N = 53) or placebo (N = 52) for 30 days (until T-1). After a washout period to avoid any carryover effect, cross-over was performed,and patients were switched to the other drug which was continued for 30 days (until T-2). All patients underwent symptomlimited exercise stress testing and 48-hour ECG Holter monitoring at T1 and T2. During the study period, patients were told to use a OmronN® portable ECG monitor HCG-801 device in case of symptoms of palpitations. Results: Ranolazine reduced the number of anginal episodes more commonly than placebo (5 ± 8 episodes/30 days vs. 21 ± 24 episodes/30 day, p = 0.001) and increased exercise durations at 1 mm ST-segment depression (514 ± 211 s vs. 402 ± 287 s, p = 0.025) and at onset of angina (614 ± 199 s vs. 519 ± 151 s, p = 0.007) at stress testing. These effects were coupled by significant decreases with ranolazine as compared with placebo treatment periods in the occurrence of frequent (N1000 beats) supraventricular arrhythmias (33% vs 52%, p = 0.01) and complex ventricular arrhythmias (17% vs 30%, p = 0.045). Complete resolution of symptoms of palpitations was significantly more common with ranolazine than placebo (31/53 vs 16/52 patients, p = 0.008). Also, portable ECG recordings showed that arrhythmias were less common during ranolazine vs. placebo, with significant decreases in number (7 ± 10 episodes/30 days vs. 23 ± 29 episodes/30 day, p = 0.001) and duration (10 ± 18 min/ 30 days vs. 19 ± 21 min/30 day, p = 0.021) of symptomatic arrhythmic episodes. No severe side effects were recorded during the trial period. Conclusion: The antianginal and antiischemic properties of ranolazine are paralleled by significant decreases in the occurrence of both arrhythmias and the related symptoms of palpitations in stable patients with IHD. (ClinicalTrials.gov identifier: NCT01495520)

Pharmacodynamic effects of atorvastatin vs. rosuvastatin in coronary artery disease patients with normal platelet reactivity while on dual antiplatelet therapy — The PEARL randomized cross-over study

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Towards a rule-based support system for the coding of health conditions in the patient summary

In the frame of federated and interoperable Electronic Health Records (EHRs), specific coding systems are mandatory for filling out healthcare documents such as the Patient Summary (PS). PS cannot be automatically generated from the patient’s EHR data, because of the sensitivity of its content. For this reason it needs to be validated by a General Practitioner (GP), who is the sole responsible of this document. The literature shows that the practice of coding is recognized as a difficult task for GPs and it often generates coding errors and misspecifications of clinical data. To overcome this issue, a support system based on standardized and formalized coding rules for the domain of application is proposed, to facilitate a more accurate coding process without breaking the law

Visualization of coronary arteries and coronary stents by low dose 320-slice multi-detector computed tomography in a patient with atrial fibrillation

Abstract Cardiac multi-detector computed tomography (MDCT) is widely used in the diagnosis of coronary disease. However, the predictive value of this technique is limited in the presence of atrial fibrillation and coronary stents. Here we present a case showing the ability of the new 320-slice MDCT to assess coronary anatomy in a patient with atrial fibrillation and coronary stents