96 research outputs found
The 2019 European guidelines on pulmonary embolism illustrated with the aid of an exemplary case report
Background
The European Society of Cardiology guidelines for the diagnosis and management of acute pulmonary embolism (PE) developed in collaboration with the European Respiratory Society (ERS) has been updated in 2019. Recommendations were added or updated on all stages of the evaluation and management of pulmonary embolism, encompassing diagnosis, early treatment, and long-term management.
Case summary
We illustrate an exemplary case, assembled for the purposes of this review, of a 70-year-old woman who presented at the emergency department with dyspnoea and thoracic pain. She was diagnosed with intermediate-high-risk acute PE and promptly treated with low molecular weight heparin. After 24 h of stay in intensive care unit, she was transferred to the cardiology department and switched to non-vitamin K-dependent oral anticoagulant apixaban 10 mg b.i.d. for 7 days and then 5 mg b.i.d. After discharge from the hospital 8 days later, she received standard-dose apixaban 5 mg b.i.d. for 6 months; the dose was reduced to 2.5 mg b.i.d. for long-term secondary prevention. During follow-up, investigations for PE sequelae were performed due to persisting dyspnoea.
Discussion
This exemplary case report puts into context the main novel recommendations from the 2019 ESC Guidelines, including the combination of clinical (pre-test) probability and adjusted D-dimer cut-offs for diagnosis of acute PE, the key role of right ventricular dysfunction in risk stratification, the choice and dosage of oral anticoagulant agents in early and extended anticoagulation, and the identification and management of chronic sequelae in the long-term follow-up
Immediate and late impact of reperfusion therapies in acute pulmonary embolism
Haemodynamic instability and right ventricular dysfunction are the key determinants of short-term prognosis in patients with acute pulmonary embolism (PE). Residual thrombi and persistent right ventricular dysfunction may contribute to post-PE functional impairment, and influence the risk of developing chronic thromboembolic pulmonary hypertension. Patients with haemodynamic instability at presentation (high-risk PE) require immediate primary reperfusion to relieve the obstruction in the pulmonary circulation and increase the chances of survival. Surgical removal of the thrombi or catheter-directed reperfusion strategies is alternatives in patients with contraindications to systemic thrombolysis. For haemodynamically stable patients with signs of right ventricular overload or dysfunction (intermediate-risk PE), systemic standard-dose thrombolysis is currently not recommended, because the risk of major bleeding associated with the treatment outweighs its benefits. In such cases, thrombolysis should be considered only as a rescue intervention if haemodynamic decompensation develops. Catheter-directed pharmaco-logical and pharmaco-mechanical techniques ensure swift recovery of echocardiographic and haemodynamic parameters and may be characterized by better safety profile than systemic thrombolysis. For survivors of acute PE, little is known on the effects of reperfusion therapies on the risk of chronic functional and haemodynamic impairment. In intermediate-risk PE patients, available data suggest that systemic thrombolysis may have little impact on long-term symptoms and functional limitation, echocardiographic parameters, and occurrence of chronic thromboembolic pulmonary hypertension. Ongoing and future interventional studies will clarify whether 'safer' reperfusion strategies may improve early clinical outcomes without increasing the risk of bleeding and contribute to reducing the burden of long-term complications after intermediate-risk PE
Land Cover Segmentation with Sparse Annotations from Sentinel-2 Imagery
Land cover (LC) segmentation plays a critical role in various applications,
including environmental analysis and natural disaster management. However,
generating accurate LC maps is a complex and time-consuming task that requires
the expertise of multiple annotators and regular updates to account for
environmental changes. In this work, we introduce SPADA, a framework for fuel
map delineation that addresses the challenges associated with LC segmentation
using sparse annotations and domain adaptation techniques for semantic
segmentation. Performance evaluations using reliable ground truths, such as
LUCAS and Urban Atlas, demonstrate the technique's effectiveness. SPADA
outperforms state-of-the-art semantic segmentation approaches as well as
third-party products, achieving a mean Intersection over Union (IoU) score of
42.86 and an F1 score of 67.93 on Urban Atlas and LUCAS, respectively.Comment: 4 pages, short paper. Accepted to IGARSS 202
Competencias profesionales de los estudiantes de EnfermerÃa del Instituto Tecnológico Bolivariano
La presente investigación aborda una problemática que se evidencia en las insuficiencias de las competencias profesionales del estudiante de la carrera de enfermerÃa, se relaciona con la adquisición e integración de los saberes; saber ser, automotivación, iniciativa, creación y trabajo colaborador; saber conocer, observar, explicar, comprender y analizar situaciones y eventos; saber hacer, desempeñarse con eficiencia y eficacia; saber actuar, aportando a la construcción y transformación del entorno. El objetivo general es determinar las competencias profesionales de los estudiantes de enfermerÃa del Instituto Tecnológico Bolivariano periodo enero a junio 2017. Analizar las diferentes definiciones según la lÃnea semántica; conocer los tipos de competencias generales como especÃficas. La metodologÃa tiene un enfoque cualitativo, se utilizó el método descriptivo, observacional y encuesta. Los resultados más importantes son: Aplicación de los principios de asepsia y cumplir con las normas bioseguridad. Desarrollo de habilidades para la comunicación efectiva. Desarrollo habilidades de observación e intervención en la identificación. Aplicación el proceso de atención de enfermerÃa como método cientÃfico. Desarrollo de habilidades organizativas para la recepción, atención y traslado del paciente. Dominio de procedimientos y precauciones en la administración de medicamentos por las diferentes vÃas enterales y parenterales; toma de muestras, y preparaciones. Desarrolla habilidades y destrezas que le permitan realizar acciones de enfermerÃa encaminadas a la solución de problemas de emergencia
y urgencia. Aplicación de técnica cualitativa y cuantitativa de investigación. Se concluye que los estudiantes no adquieren las suficientes competencias para el desempeño profesiona
Land Cover Segmentation with Sparse Annotations from Sentinel-2 Imagery
Land cover (LC) segmentation plays a critical role in various applications, including environmental analysis and natural disaster management. However, generating accurate LC maps is a complex and time-consuming task that requires the expertise of multiple annotators and regular updates to account for environmental changes. In this work, we introduce SPADA, a framework for fuel map delineation that addresses the challenges associated with LC segmentation using sparse annotations and domain adaptation techniques for semantic segmentation. Performance evaluations using reliable ground truths, such as LUCAS and Urban Atlas, demonstrate the technique's effectiveness. SPADA outperforms state-of-the-art semantic segmentation approaches as well as third-party products, achieving a mean Intersection over Union (IoU) score of 42.86 and an F1 score of 67.93 on Urban Atlas and LUCAS, respectively
Performance Status and Long-Term Outcomes in Cancer-Associated Pulmonary Embolism: Insights From the Hokusai-VTE Cancer Study
BACKGROUND
Performance status (PS) is a reliable prognostic tool for overall survival in patients with cancer-associated pulmonary embolism (PE). However, its association with venous thromboembolism (VTE) recurrence and bleeding remains unclear.
OBJECTIVES
The aim of this study was to investigate whether PS at the time of PE diagnosis and its course during follow-up are linked to VTE-related outcomes.
METHODS
In this post hoc analysis of the Hokusai-VTE Cancer study, multivariable survival analysis was used to examine the association of PS with anticoagulation discontinuation and the composite primary outcome of VTE recurrence or major bleeding in patients with cancer-associated PE. PS was assessed using the Eastern Cooperative Oncology Group (ECOG) scale at baseline and at predefined study follow-up visits.
RESULTS
Overall, 652 patients with cancer-associated PE were included. During 12-month follow-up, PS worsened in 317 of 642 patients (49.4%) with complete ECOG data at the end of follow-up. Those with worse ECOG values over follow-up were more likely to discontinue anticoagulation for any reason apart from death (adjusted HR: 1.59; 95% CI:Â 1.31-1.93). The composite primary outcome occurred in 57 of 500 patients with baseline ECOG status 0 or 1 and in 32 of 152 patients with ECOG status 2 (cumulative incidence at 12Â months 10.7% [95% CI: 8.2%-13.9%] vs 14.4% [95% CI:Â 9.7%-21.3%]). Worse ECOG values during follow-up were associated with greater risk for the composite outcome (adjusted HR: 2.13; 95% CI: 1.24-3.67).
CONCLUSIONS
ECOG PS is a valuable indicator for predicting VTE-related outcomes and may inform decision making regarding anticoagulation during follow-up in patients with cancer-associated PE
Quality of Life 3 and 12 Months Following Acute Pulmonary Embolism: Analysis From a Prospective Multicenter Cohort Study
BACKGROUND
Few data are available on the long-term course and predictors of quality of life (QoL) following acute pulmonary embolism (PE).
RESEARCH QUESTION
What are the kinetics and determinants of disease-specific and generic health-related QoL 3 and 12Â months following an acute PE?
STUDY DESIGN AND METHODS
The Follow-up after Acute Pulmonary Embolism (FOCUS) study prospectively followed up consecutive adult patients with objectively diagnosed PE. Patients were considered for study who completed the Pulmonary Embolism Quality of Life (PEmb-QoL) questionnaire at predefined visits 3 and 12Â months following PE. The course of disease-specific QoL as assessed using the PEmb-QoL and the impact of baseline characteristics using multivariable mixed effects linear regression were studied; also assessed was the course of generic QoL as evaluated by using the EuroQoL Group 5-Dimension 5-Level utility index and the EuroQoL Visual Analog Scale.
RESULTS
In 620 patients (44% women; median age, 62 years), overall disease-specific QoL improved from 3 to 12 months, with a decrease in the median PEmb-QoL score from 19.4% to 13.0% and a mean individual change of -4.3% (95% CI, -3.2 to -5.5). Female sex, cardiopulmonary disease, and higher BMI were associated with worse QoL at both 3 and 12 months. Over time, the association with BMI became weaker, whereas older age and previous VTE were associated with worsening QoL. Generic QoL also improved: the mean ± SD EuroQoL Group 5-Dimension 5-Level utility index increased from 0.85 ± 0.22 to 0.87 ± 0.20 and the visual analog scale from 72.9 ± 18.8 to 74.4 ± 19.1.
INTERPRETATION
In a large cohort of survivors of acute PE, the change of QoL was quantified between months 3 and 12 following diagnosis, and factors independently associated with lower QoL and slower recovery of QoL were identified. This information may facilitate the planning and interpretation of clinical trials assessing QoL and help guide patient management.
CLINICAL TRIAL REGISTRATION
German Clinical Trials Registry (Deutsches Register Klinischer Studien: www.drks.de); No.: DRKS00005939
Mortality trend of ischemic heart disease (2008-2022): A retrospective analysis of epidemiological data
BACKGROUND
Age-sex specific trend analyses of ischemic heart disease (IHD)-related mortality and prevalent risk factors can improve our understanding and approach to the disease.
METHODS
We performed a 15-year retrospective epidemiological analysis of acute and chronic IHD-related mortality and prevalent cardiovascular risk factors using administrative data from Veneto, a socio-economically homogeneous Italian region. Standard mortality statistics using the underlying cause of death (UCOD) and deaths with any mention of IHD in death certificates (MCOD) from ICD-10 codes I20-I25 was performed between 2008 and 2022.
RESULTS
A total of 134,327 death certificates reported IHD-related deaths, representing 18.6% of all deaths. Proportional mortality decreased from 14.6% in 2008 to 7.8% in 2022 for deaths with IHD as the UCOD and from 23.5% to 14.6% for deaths with IHD among the MCOD. A more pronounced decline of proportionate and case-specific mortality rate was seen in women. The decline in mortality over the whole study period was larger for acute (vs. chronic) IHD. The COVID-19 pandemic led to a marked increase in mortality in 2020 (+12.2%) with a subsequent further decline. IHD-related deaths displayed a typical seasonal pattern with more deaths during winter. The prevalence of cardiovascular risk factors was higher in IHD (vs. no IHD) deaths: this association appeared more pronounced in younger adults.
CONCLUSIONS
We provided an analysis of epidemiological trends in IHD-related mortality and prevalence of risk factors. Our findings indicate a change in the pattern of cardiovascular deaths and may suggest a switch in death from acute to chronic conditions
Mortality rate related to peripheral arterial disease: A retrospective analysis of epidemiological data (years 2008-2019).
BACKGROUND AND AIMS
Peripheral arterial disease (PAD) is one of the most prevalent cardiovascular diseases with more than 230 million people being affected worldwide. As highlighted by the recent European Society of Cardiology guidelines, data on the epidemiology of PAD is urgently needed.
METHODS AND RESULTS
We accessed the vital registration data of the Veneto region (Northern Italy, approximately five millions inhabitants) covering the period 2008-2019. We computed annual age-standardized rates for PAD reported as the underlying cause of death (UCOD) or as one of multiple causes of death (MCOD). Age-adjusted odds ratios (OR) served to study the association between PAD and cardiovascular comorbidities. The age-standardized mortality rate for PAD as MCOD slightly declined from 19.6 to 17.8 in men and from 10.8 to 9.1 deaths per 100,000 population-years in women. The age-standardized PAD-specific mortality rate (UCOD) remained stable: 3.1 to 3.7 per 100,000 person-years in women (Average Annual Percent Change 1.3, 95% CI -0.8; 3.4%) and 4.4 to 4.3 per 100,000 person-years (Average Annual Percent Change -0.2, 95% CI -3.6; 3.4%) in men. PAD contributed to 1.6% of all deaths recorded in the region. Ischemic heart disease, diabetes mellitus and neoplasms were the most prevalent UCOD among PAD patients. PAD was associated with diabetes mellitus (OR 3.79, 95%CI 3.55-4.06) and chronic kidney diseases (OR 2.73, 95%CI 2.51-2.97) in men, and with atrial fibrillation (OR 2.26, 95%CI 2.10-2.44) in women.
CONCLUSION
PAD remains a substantial cause of death in the general population of this high-income region of Western Europe with marked sex-specific differences
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