Codificação médica ICD-9-CM automatizada de relatórios clínicos de pacientes diabéticos

The assignment of ICD-9-CM codes to patient’s clinical reports is a costly and wearing process manually done by medical personnel, estimated to cost about $25 billion per year in the United States. To develop a system that automates this process has been an ambition of researchers but is still an unsolved problem due to the inherent difficulties in processing unstructured clinical text. This problem is here formulated as a multi-label supervised learning one where the independent variable is the report’s text and the dependent the several assigned ICD-9-CM labels. Different variations of two neural network based models, the Bag-of-Tricks and the Convolutional Neural Network (CNN) are investigated. The models are trained on the diabetic patient subset of the freely available MIMIC-III dataset. The results show that a CNN with three parallel convolutional layers achieves F1 scores of 44.51% for five digit codes and 51.73% for three digit, rolled up, codes. Additionally, it is shown that joining several binary classifiers, with the binary relevance method, produces an improvement of almost 7% over its multi-labeling equivalent in a restricted classification task of only the eleven most common labels in the dataset.A atribuição de códigos ICD-9-CM a relatórios clínicos de pacientes é um processo dispendioso e cansativo, realizado por pessoal médico especializado e com um custo estimado de 25 mil milhões de dólares por ano nos Estados Unidos. É uma constante ambição de investigadores desenvolver um sistema que automatize esta atribuição. No entanto, o problema mantém se irresoluto dadas as dificuldades inerentes em processar texto clínico não estruturado. Este problema é aqui formulado como um de aprendizagem supervisionada multi-label em que a variável independente é o texto do relatório e a dependente os vários códigos ICD-9-CM atribuídos. São investigadas diferentes variações de dois modelos baseados em redes neurais, o Bag-of-Tricks e a Rede Neural Convolucional (RNC). Os modelos são treinados no subconjunto de pacientes diabéticos dos dados MIMIC-III. Os resultados mostram que uma RNC com três níveis convolucionais em paralelo obtém avaliações F1 de 44.51% para códigos de cinco dígitos e 51.73% para códigos abreviados de três dígitos. Além disto, é mostrado que a combinação de vários classificadores binários num só, com o método de relevância binária, produz uma melhoria de 7% em relação ao seu equivalente multi-label, num problema de classificação limitado aos onze códigos mais comuns nos dados.Mestrado em Engenharia de Computadores e Telemátic

Thrombus aspiration in patients with ST-elevation myocardial infarction: results of a national registry of interventional cardiology

BACKGROUND: We aimed to evaluate the impact of thrombus aspiration (TA) during primary percutaneous coronary intervention (P-PCI) in 'real-world' settings. METHODS: We performed a retrospective study, using data from the National Registry of Interventional Cardiology (RNCI 2006-2012, Portugal) with ST-elevation myocardial infarction (STEMI) patients treated with P-PCI. The primary outcome, in-hospital mortality, was analysed through adjusted odds ratio (aOR) and 95% confidence intervals (95%CI). RESULTS: We assessed data for 9458 STEMI patients that undergone P-PCI (35% treated with TA). The risk of in-hospital mortality with TA (aOR 0.93, 95%CI:0.54-1.60) was not significantly decreased. After matching patients through the propensity score, TA reduced significantly the risk of in-hospital mortality (OR 0.58, 95%CI:0.35-0.98; 3500 patients). CONCLUSIONS: The whole cohort data does not support the routine use of TA in P-PCI, but the results of the propensity-score matched cohort suggests that the use of selective TA may improve the short-term risks of STEMI..info:eu-repo/semantics/publishedVersio

Percepção sobre o apoio social do homem colostomizado na região Norte de Portugal

Objetivo: Avaliar a percepção do homem colostomizado sobre o apoio social recebido; verificar a relação entre o apoio social percebido e as variáveis sociodemográficas, a informação prestada, o apoio efetivamente recebido, e a realização do ensino no hospital. Métodos: Trata-se de um estudo descritivo-correlacional, transversal, de abordagem quantitativa, com uma amostra de 112 homens portadores de uma colostomia há mais de um ano, em três unidades da região Norte de Portugal. Resultados: A média de idades dos inquiridos era de 59,9 anos, 67,9% encontrava-se não ativo perante o trabalho, 49,5% percepcionou o apoio social como suficiente, mas 36,2% apoio social insuficiente. A percepção do apoio social é menor nos sujeitos mais velhos (r = -0,166; p = 0,018). Conclusão: Este estudo permitiu perceber que o cônjuge é muito importante na vida do homem colostomizado, nomeadamente nos momentos de dificuldades inerentes à doença, sendo a sua principal rede de apoio

Prevalence, risk factors and global impact of musculoskeletal injuries among endoscopists: a nationwide European study

Background and study aims Previous studies have suggested a high prevalence of musculoskeletal injuries (MI) in endoscopists. Little evidence has come from European countries. Our main aim was to evaluate the prevalence, type, and impact of MI among Portuguese endoscopists. We also sought to identify risk factors for the development, severity and number of endoscopy-related MI. Material and methods A 48-question electronic survey was developed by a multidisciplinary group. The electronic survey was sent to all members of Portuguese Society of Gastroenterology (n = 705) during May 2019. Study data were collected and managed using REDCap electronic data capture tools hosted at SPG - CEREGA. Results The survey was completed by 171 endoscopists (response rate of 24.3 %), 55.0 % female with a median age of 36 years (range 26-78). The prevalence of at least one MI related to endoscopy was 69.6 % (n = 119), the most frequent being neck pain (30.4 %) and thumb pain (29.2 %). The median time for MI development was 6 years (range 2 months-30 years). Severe pain was reported by 19.3 %. Change in endoscopic technique was undertaken by 61.3 % and reduction in endoscopic caseload was undertaken by 22.7 %. Missing work was reported by 10.1 %, with the median time off from work being 30 days (range 1-90). Female gender and ≥ 15 years in practice were independently associated with MI and severe pain. Years in practice, weekly-time performing endoscopy, and gender were significant predictors of the number of MI. Conclusions Prevalence of MI was significant among Portuguese endoscopists and had a relevant impact on regular and professional activities.info:eu-repo/semantics/publishedVersio

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved