O tema deste estudo abrange duas áreas do conhecimento: a Medicina e a Ciência da Computação. Consiste na aplicação do processo de descoberta de conhecimento em base de Dados (KDD - Knowledge Discovery in Databases), a um banco de dados real na área médica denominado Registro Desire. O Registro Desire é o registro mais longevo da cardiologia intervencionista mundial, unicêntrico e acompanha por mais de 13 anos 5.614 pacientes revascularizados unicamente pelo implante de stents farmacológicos. O objetivo é criar por meio desta técnica um modelo que seja descritivo e classifique os pacientes quanto ao risco de ocorrência de eventos cardíacos adversos maiores e indesejáveis, e avaliar objetivamente seu desempenho. Posteriormente, apresentar as regras extraídas deste modelo aos usuários para avaliar o grau de novidade e de concordância do seu conteúdo com o conhecimento dos especialistas. Foram criados modelos simbólicos de classificação pelas técnicas da árvore de decisão e regras de classificação utilizando para a etapa de mineração de dados os algoritmos C4.5, Ripper e CN2, em que o atributo-classe foi a ocorrência ou não do evento cardíaco adverso. Por se tratar de uma classificação binária, os modelos foram avaliados objetivamente pelas métricas associadas à matriz de confusão como acurácia, sensibilidade, área sob a curva ROC e outras. O algoritmo de mineração processa automaticamente todos os atributos de cada paciente exaustivamente para identificar aqueles fortemente associados com o atributo-classe (evento cardíaco) e que irão compor as regras. Foram extraídas as principais regras destes modelos de modo indireto, por meio da árvore de decisão ou diretamente pela regra de classificação, que apresentaram as variáveis mais influentes e preditoras segundo o algoritmo de mineração. Os modelos permitiram entender melhor o domínio de aplicação, relacionando a influência de detalhes da rotina e as situações associadas ao procedimento médico. Pelo modelo, foi possível analisar as probabilidades da ocorrência e da não ocorrência de eventos em diversas situações. Os modelos induzidos seguiram uma lógica de interpretação dos dados e dos fatos com a participação do especialista do domínio. Foram geradas 32 regras das quais três foram rejeitadas, 20 foram regras esperadas e sem novidade, e 9 foram consideradas regras não tão esperadas, mas que tiveram grau de concordância maior ou igual a 50%, o que as tornam candidatas à investigação para avaliar sua eventual importância. Tais modelos podem ser atualizados ao aplicar novamente o algoritmo de mineração ao banco com os dados mais recentes. O potencial dos modelos simbólicos e interpretáveis é grande na Medicina quando aliado à experiência do profissional, contribuindo para a Medicina baseada em evidência. / The main subject of this study comprehends two areas of knowledge, the Medical and Computer Science areas. Its purpose is to apply the Knowledge Discovery Database-KDD to the DESIRE Registry, an actual Database in Medical area. The DESIRE Registry is the oldest world\'s registry in interventional cardiology, is unicentric, which has been following up 5.614 resvascularized patients for more then 13 years, solely with pharmacological stent implants. The goal is to create a model using this technique that is meaningful to classify patients as the risk of major adverse cardiac events (MACE) and objectively evaluate their performance. Later present rules drawn from this model to the users to assess the degree of novelty and compliance of their content with the knowledge of experts. Symbolic classification models were created using decision tree model, and classification rules using for data mining step the C4.5 algorithms, Ripper and CN2 where the class attribute is the presence or absence of a MACE. As the classification is binary, the models where objectively evaluated by metrics associated to the Confusion Matrix, such as accuracy, sensitivity, area under the ROC curve among others. The data mining algorithm automatically processes the attributes of each patient, who are thoroughly tested in order to identify the most predictive to the class attribute (MACE), whom the rules will be based on. Indirectly, using decision tree, or directly, using the classification rules, the main rules of these models were extracted to show the more predictable and influential variables according to the mining algorithm. The models allowed better understand the application range, creating a link between the influence of the routine details and situations related to the medical procedures. The model made possible to analyse the probability of occurrence or not of events in different situations. The induction of the models followed an interpretation of the data and facts with the participation of the domain expert. Were generated 32 rules of which only three were rejected, 20 of them were expected rules and without novelty and 9 were considered rules not as expected but with a degree of agreement higher or equal 50%, which became candidates for an investigation to assess their possible importance. These models can be easily updated by reapplying the mining process to the database with the most recent data. There is a great potential of the interpretable symbolic models when they are associated with professional background, contributing to evidence-based medicine.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2017-03-09T18:38:01Z No. of bitstreams: 1 Gabriela Cristina Oliveira de Miranda.pdf: 1625176 bytes, checksum: 330da45485a147b6c4d362d3ebb7256b (MD5) / Made available in DSpace on 2017-03-09T18:38:01Z (GMT). No. of bitstreams: 1 Gabriela Cristina Oliveira de Miranda.pdf: 1625176 bytes, checksum: 330da45485a147b6c4d362d3ebb7256b (MD5) Previous issue date: 2016 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / O estresse é um fator associado ao desenvolvimento de inúmeras enfermidades psíquicas e orgânicas, dentre as quais as cardiopatias. Esse estudo aborda como se caracteriza o estresse no paciente cardiopata hospitalizado e tem como objetivos caracterizar o perfil de pacientes com cardiopatias hospitalizados e descrever os resultados da aplicação da escala fatorial de estresse em pacientes cardiopatas hospitalizados. Trata-se de estudo quantitativo e descritivo, realizado no período de junho a novembro de 2015 com 30 pacientes com cardiopatias internados em enfermarias de clinica médica de um hospital universitário no Estado do Rio de Janeiro por meio de análise documental de prontuários e aplicação da escala fatorial de estresse. Para análise dos dados utilizou-se o programa Microsoft Excel® seguido de análise estatística simples. Os dados são apresentados em tabelas, expressos em frequência (n) e percentual (%) para dados categóricos e média ± DP para dados numéricos. Dos 30 participantes do estudo, 16 (53,33%) são mulheres e 14 (46,66%) homens, na faixa etária média de 51,9 anos, sendo 12 (40,00%) casados, 28 (93,33%) com filhos, 9 (30,00%) tendo como fonte de rendimentos a aposentadoria, 17 (56,66%) negros, 14 (46,66%) de origem nos municípios de Niterói e 14 (46,66%) São Gonçalo, 19 (63,33%), tendo como doença cardiovascular de maior prevalência a hipertensão. Quanto aos resultados da aplicação da escala fatorial de estresse, houve predominância de sintomas físicos relacionados ao sistema cardiovascular, com taquicardia 14 (46,66%), aumento de pressão arterial 19 (63,00%), e sintomas respiratórios, com aumento da frequência respiratória 15 (50,00%), dificuldades para respirar 14 (47,00%%) e cansaço constante 18 (60,00%). Sobre os sintomas psicológicos houve predominância de redução na capacidade de concentração 15 (50,00%), mudanças bruscas de humor 17 (56,66%), irritabilidade fácil 15 (50,00%), maior nervosismo 21 (70,00%) e desleixo com a aparência 14 (46,66%). Em analise da associação do estresse com a cardiopatia constatou-se que para cada uma, isoladamente, os sintomas físicos e psicológicos se apresentaram de modo diferenciado, demonstrando a necessidade de estudos direcionados para cada tipo de cardiopatia apresentadas pelos participantes. A aplicação da escala fatorial de estresse evidenciou que a presença do fator de risco estresse possui repercussões físicas e psicológicas que podem interferir na evolução do tratamento de pacientes cardiopatas hospitalizados / Stress is a factor associated with the development of numerous psychic and organic diseases, among which the heart diseases. This study describes how stress is characterized in the hospitalized cardiopathy patient and aims to characterize the profile of patients with hospitalized cardiopathy and to describe the results of the application of the factorial stress scale in hospitalized patients with a heart disease. This is a quantitative and descriptive study, conducted in the period from June to November 2015 with 30 patients with heart diseases admitted to a medical clinic in a university hospital in the State of Rio de Janeiro through documentary analysis of medical records and application of the factorial stress scale. For data analysis, the Microsoft Excel® program was used, followed by simple statistical analysis. Data is presented in charts expressed in frequency (n) and percentage (%) for categorical data and mean ± SD for numerical data. Of the 30 participants in the study, 16 (53.33%) were women and 14 (46.66%) were men, with average of 51.9 years old, 12 (40.00%) being married, 28 (93.33 (56.66%) black, 14 (46.66%) of origin in the boroughs of Niterói and 14 (46.66%) São Gonçalo, 19 (63.33%) with hypertension being the most prevalent cardiovascular disease. Regarding the results of the application of the factorial stress scale, there was predominance of physical symptoms related to the cardiovascular system with tachycardia 14 (46.66%), increased blood pressure 19 (63.00%), and respiratory symptoms, with increased respiratory frequency 15 (50.00%), shortness of breath 14 (47.00%) and constant fatigue 18 (60.00%). About the psychological symptoms, there was predominance of reduction in the ability to concentrate 15 (50.00%), abrupt mood changes 17 (56.66%), easy irritability 15 (50.00%), greater nervousness 21 (70.00%) and sloth with appearance 14 (46.66%). In an analysis of the association of stress with heart disease, it was observed that for each one, the physical and psychological symptoms were presented in a different way, showing the need for studies directed to each type of heart disease presented by the participants. The application of the factorial stress scale showed that the presence of the stress risk factor has physical and psychological repercussions that may interfere in the evolution of the treatment of hospitalized cardiac patients

Cardiac magnetic resonance (MR) imaging can non-invasively assess heart function. Displacement encoding with stimulated echoes (DENSE) is an advanced cardiac MR imaging technique that measures tissue displacement and can be used to quantify cardiac mechanics (e.g. strain and torsion). When combined with clinical risk factors, cardiac mechanics have been shown to be better predictors of mortality than traditional measures of heart function. End-expiratory breath-holds are typically used to minimize respiratory motion artifacts. Unfortunately, requiring subjects to breath-hold introduces limitations with the duration of image acquisition and quality of data acquired, especially in patients with limited ability to hold their breath. Thus, DENSE acquisitions often require respiratory navigator gating, which works by measuring the diaphragm during normal breathing and only acquiring data when the diaphragm is within a pre-defined acceptance window. Unfortunately, navigator gating results in long scan durations due to inconsistent breathing patterns. Also, the navigator echo can be used in different ways to accept or reject image data, which creates several navigator configuration options. Each respiratory navigator configuration has distinct advantages and disadvantages that directly affect scan duration and image quality, which can affect derived cardiac mechanics. Scan duration and image quality need to be optimized to improve the clinical utility of DENSE. Thus, the goal of this project was to optimize those parameters. To accomplish this goal, we set out to complete 3 aims: 1) understand how respiratory gating affects the reproducibility of measures of cardiac mechanics, 2) determine the optimal respiratory navigator configuration, and 3) reduce scan duration by developing and using an interactive videogame to optimize navigator efficiency. Aim 1 of this project demonstrated that the variability in torsion, but not strain, could be significantly reduced through the use of a respiratory navigator compared to traditional breath-holds. Aim 2 demonstrated that, among the configuration options, the dual-navigator configuration resulted in the best image quality compared to the reference standard (traditional breath-holds), but also resulted in the longest scan duration. In Aim 3, we developed an interactive breathing-controlled videogame and demonstrated that its use during cardiac MR can significantly reduce scan duration compared to traditional free-breathing and also led to a small improvement in signal-to-noise ratio of the acquired images. In summary, respiratory navigator gating with DENSE 1) reduces the variability in measured LV torsion, 2) results in the best image quality with the dual-navigator configuration, and 3) results in significantly shorter scan durations through the use of an interactive videogame. Selecting the optimal navigator configuration and using an interactive videogame can improve the clinical utility of DENSE.

Les cardiopathies congénitales (CC) représentent la première cause d’anomalie malformative à la naissance. Les progrès considérables des années 80 (CEC néonatale, diagnostic prénatal) en ont modifié l’épidémiologie, avec un transfert de la mortalité de la pédiatrie à l’âge adulte. Dans ce contexte, l’évaluation de la qualité de vie liée à la santé (QdV) des enfants et adultes porteurs de CC devient un critère de jugement important, en recherche clinique comme dans les soins. Nous avons mené 4 études prospectives de QdV chez des patients avec CC: une étude chez 282 enfants de 8 à 18 ans avec CC comparés à 180 enfants contrôles; une étude sur 202 enfants avec CC corrélant QdV et VO2; une étude de QdV sur 208 adolescents et adultes porteurs d'HTAP sur CC; et une étude sur l’évolution de la QdV de 111 enfants sous AVK participant à un programme d’éducation thérapeutique. Les patients avec CC simple ont manifesté une QdV similaire à celle de la population générale. Ceux avec une cardiopathie complexe ont été préférentiellement impactés sur leur bien-être physique mais ont développé aussi des mécanismes de coping. En pédiatrie, l’évaluation de la QdV par les parents était plus péjorative mais parfois plus pertinente que celle des enfants. Nous avons mis en évidence le lien entre QdV et VO2 chez l’enfant cardiaque. Les résultats de nos travaux devraient permettre d’aider les cardiologues, cardiopédiatres et chirurgiens cardiaques dans leurs annonces diagnostiques, en particulier lors des moments cruciaux de notre sur-spécialité médico-chirurgicale: diagnostic prénatal, réanimation, transition vers l’âge adulte, prise en charge palliative d’une cardiopathie sévère. / Congenital heart diseases (CHD) are the leading cause of birth malformations. The tremendous progress since the 80’s (neonatal bypass, prenatal diagnosis) have changed the epidemiology, transferring mortality from pediatrics to adulthood. Therefore assessing the health-related quality of life (QoL) of children and adults suffering from CHD has become an important issue, in both clinical research and patients’ follow-up. We carried out 4 prospective QoL studies in patients with CHD: a study in 282 CHD children aged 8 to 18 compared with 180 controls; a study among 202 CHD children correlating their QoL scores to VO2; a QoL study among 208 adolescents and adults with PAH-CHD; and a study among 111 children in a therapeutic anticoagulation education program aiming to measure the evolution of their QoL. Patients with simple CHD showed a similar QoL to that of the control population. Those with complex heart diseases were preferentially affected in their physical well-being but also developed mechanisms of coping in other dimensions. In pediatrics, the evaluation of the QoL by parents is essential, sometimes more accurate than that of children themselves. As in previous studies in adults with heart failure, we found a significant relationship between QoL and physical performance during exercise in CHD children. The results of our work should help cardiologists, cardiac surgeons and pediatric cardiologists in their diagnostic announcement, especially during crucial moments of this medical and surgical subspecialty: prenatal diagnosis, intensive care, transition of care from adolescence to adulthood, palliative treatment of a complex CHD.

Liver cancer accounts for nearly 10% of all cancers in the US. Intrahepatic Arterial Radiomicrosphere Therapy (RMT), also known as Selective Internal Radiation Treatment (SIRT), is one of the evolving treatment modalities. Successful patient clinical outcomes require suitable treatment planning followed by delivery of the microspheres for therapy. The production and in vitro evaluation of various polymers (PGCD, CHS and CHSg) microspheres for a RMT and RMT planning are described. Microparticles with a 30±10 µm size distribution were prepared by emulsion method. The in vitro half-life of the particles was determined in PBS buffer and porcine plasma and their potential application (treatment or treatment planning) established. Further, the fast degrading microspheres (≤ 48 hours in vitro half-life) were labeled with 68Ga and/or 99mTc as they are suitable for the imaging component of treatment planning, which is the primary emphasis of this dissertation. Labeling kinetics demonstrated that 68Ga-PGCD, 68Ga-CHSg and 68Ga-NOTA-CHSg can be labeled with more than 95% yield in 15 minutes; 99mTc-PGCD and 99mTc-CHSg can also be labeled with high yield within 15-30 minutes. In vitro stability after four hours was more than 90% in saline and PBS buffer for all of them. Experiments in reconstituted hemoglobin lysate were also performed. Two successful imaging (RMT planning) agents were found: 99mTc-CHSg and 68Ga-NOTA-CHSg. For the 99mTc-PGCD a successful perfusion image was obtained after 10 minutes, however the in vivo degradation was very fast (half-life), releasing the 99mTc from the lungs. Slow degrading CHS microparticles (> 21 days half-life) were modified with p-SCN-b-DOTA and labeled with 90Y for production of 90Y-DOTA-CHS. Radiochemical purity was evaluated in vitro and in vivo showing more than 90% stability after 72 and 24 hours respectively. All agents were compared to their respective gold standards (99mTc-MAA for 68Ga-NOTA-CHSg and 99mTc-CHSg; 90Y-SirTEX for 90Y-DOTA-CHS) showing superior in vivo stability. RMT and RMT planning agents (Therapy, PET and SPECT imaging) were designed and successfully evaluated in vitro and in vivo.

No description available.

Background: Management of atrial fibrillation (AF) is complex and requires active patient engagement in shared decision making to achieve better clinical outcomes, greater medication adherence, and increased treatment satisfaction. Efficacy in patient-physician interactions is a critical component of patient engagement, but factors associated with efficacy in older AF patients have not been well-characterized. Methods: We performed a cross-sectional analysis of baseline data from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) study, a cohort study of older adults (age ≥ 65) with non-valvular AF and CHA2DS2-VASc score ≥ 2. Participants were classified according to their Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) score (lower: 0-44; higher: 45-50). Logistic regression analysis was used to identify sociodemographic, clinical (AF type, AF treatment, medical comorbidities), and geriatric (cognitive impairment, sensory impairment, frailty, independent functioning) factors associated with lower reported efficacy. Results: Participants (n = 1209; 49% female) had a mean age of 75. A majority (66%) reported higher efficacy in their interactions with physicians. Lower efficacy was associated with persistent AF (adjusted odds ratio [aOR] = 1.52; 95% confidence interval [CI] = 1.13-2.04) and with symptoms of depression (aOR = 1.67; CI = 1.20-2.33) or anxiety (aOR = 1.40; CI = 1.01-1.94). Decreased odds of lower efficacy were observed in participants with chronic kidney disease (aOR = 0.68; CI = 0.50-0.92) and those classified as pre-frail compared to those classified as not frail (aOR = 0.71; CI = 0.53-0.95). Conclusion: Older patients with persistent AF or symptoms of depression or anxiety have decreased efficacy in patient-physician interactions. These individuals merit greater attention from physicians when engaged in shared decision making.

No description available.

- 4 - Abstract Adaptation to hypoxia or exercise training has cardioprotective effects against acute ischemic injury, but can potentially negatively influence heart function. Possible negative changes depend on the degree of hypoxia and exercise training intensity. It is therefore necessary to evaluate the effects of the specific adaptation protocols used. The ideal technique is echocardiography, which enables non-invasive, repeated and long-term measurements of the same individual allowing to study the development of changes in the course of adaptation. The aim of this study was to determine the effects of selected protocols of adaptation to intermittent hypobaric hypoxia (corresponding to the altitude of 4,000 to 8,000 meters above sea level, for 15 weeks in total) and exercise training (running speed 30 m.min-1 for 60 min a day, 4 weeks in total) on the left ventricle geometry and systolic function in rats. We assessed basic echocardiographic parameters of the ventricle geometry and function such as fractional shortening, ejection fraction, stroke volume, cardiac output etc. The adaptation of rats to intermittent hypobaric hypoxia lead neither to the impairment of systolic function nor to the development of left ventricle hypertrophy compared to controls; signs of moderate hypertrophy were observed only...

The objective of the dissertation thesis has been the information-lexical analysis of Czech medical reports and the usability of international classification systems in the Czech healthcare environment. The analysis of medical reports has been based on the attributes of the Minimal Data Model for Cardiology (MDMC). Narrative medical reports and structured medical reports from the ADAMEK software application have been used. For the thesis SNOMED CT and ICD-10 classification systems have been used. There has been compared how well attributes of MDMC are recorded in narrative and structured medical reports. The language analysis of the Czech narrative medical reports has been made. A new application for measuring diversity in medical reports written in any language is proposed. The application is based on the general concepts of diversities derived from f-diversity, relative f- diversity, self f-diversity and marginal f-diversity. The thesis has come to the conclusion that using a free text in medical reports is not consistent and not standardized. The standardized terminology would bring benefits to physicians, patients, administrators, software developers and payers and it would help healthcare providers as it could provide complete and easily accessible information that belongs to the process of...