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Despite the notable benefits of palliative care (PC) for patients with chronic diseases, its delivery to people with cardiac problems, particularly in the Middle East region (EMR), remains a critical issue. There is a scarcity of research assessing nursing staff's needs and knowledge in providing PC to cardiac patients in the EMR. This study aimed to assess the level of knowledge and needs of PC among nurses towards the provision of PC in intensive coronary care units (ICCUs) in the Gaza Strip, Palestine. It also identified the barriers to the provision of PC services in ICCUs in the Gaza Strip. A hospital-based descriptive quantitative cross-sectional design was adopted to collect data from 85 nurses working in ICCUs at four main hospitals in the Gaza Strip. Knowledge about PC was collected using a developed questionnaire based on the Palliative Care Quiz Nursing Scale (PCQN) and Palliative Care Knowledge Test (PCKT). PC training needs and barriers were assessed using the PC Needs Assessment instrument. Approximately two-thirds of nurses did not receive any PC educational or training programs, which contributed to their lack of PC knowledge. Most nurses would like to enroll in PC training programs, such as family support and communications skills courses. Nurses reported that there was a high demand for PC guidelines and discharge planning for patients with chronic illnesses. Insufficient healthcare professionals' knowledge about PC and a staff shortage were the main barriers to integrating PC into the Gaza healthcare system. This study suggests incorporating PC into nursing curricula and in-service training, and it covers both basic and advanced PC principles. Intensive coronary care unit nurses need knowledge and training about PC, guidance, and support to provide appropriate care to patients with cardiovascular issues. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: Coronary heart disease (CHD) is a dynamic process in which there are interactions between endothelial dysfunction, oxidative stress, and inflammatory responses. The aim of the present study was to investigate the function and mechanism of HSCARG in the treatment of CHD. Methods: Male apolipoprotein E/low-density lipoprotein receptor-deficient mice were given a high-fat diet with 21% fat and 0.15% cholesterol for the in vivo model. Human umbilical vein endothelial cells were incubated with angiotensin II for the in vitro model. HSCARG expression was inhibited in patients or mice with CHD. Results: HSCARG reduced oxidative stress in mice with CHD. HSCARG also reduced reactive oxygen species (ROS)-oxidative stress in the in vitro model. HSCARG induced p47phox expression in the in vitro model by NF-κB activity. The regulation of nuclear factor kappa B (NF-κB) activity or p47phox expression participates in the effects of HSCARG in CHD. Conclusion: Altogether, our data indicate that HSCARG reduced ROS-oxidative stress in in vivo and in vitro models of CHD via p47phox by NF-κB activity and may be a clinical target for CHD.

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Herzschrittmachertherapie und Elektrophysiologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Despite the notable benefits of palliative care (PC) for patients with chronic diseases, its delivery to people with cardiac problems, particularly in the Middle East region (EMR), remains a critical issue. There is a scarcity of research assessing nursing staff’s needs and knowledge in providing PC to cardiac patients in the EMR. This study aimed to assess the level of knowledge and needs of PC among nurses towards the provision of PC in intensive coronary care units (ICCUs) in the Gaza Strip, Palestine. It also identified the barriers to the provision of PC services in ICCUs in the Gaza Strip. A hospital-based descriptive quantitative cross-sectional design was adopted to collect data from 85 nurses working in ICCUs at four main hospitals in the Gaza Strip. Knowledge about PC was collected using a developed questionnaire based on the Palliative Care Quiz Nursing Scale (PCQN) and Palliative Care Knowledge Test (PCKT). PC training needs and barriers were assessed using the PC Needs Assessment instrument. Approximately two-thirds of nurses did not receive any PC educational or training programs, which contributed to their lack of PC knowledge. Most nurses would like to enroll in PC training programs, such as family support and communications skills courses. Nurses reported that there was a high demand for PC guidelines and discharge planning for patients with chronic illnesses. Insufficient healthcare professionals’ knowledge about PC and a staff shortage were the main barriers to integrating PC into the Gaza healthcare system. This study suggests incorporating PC into nursing curricula and in-service training, and it covers both basic and advanced PC principles. Intensive coronary care unit nurses need knowledge and training about PC, guidance, and support to provide appropriate care to patients with cardiovascular issues.

Cardiovascular disease is the primary cause of mortality in women and men with diabetes. Due to age and worsening of risk factors over the menopausal transition, risk of coronary heart disease events increases in postmenopausal women with diabetes. Randomized studies have conflicted regarding the beneficial impact of estrogen therapy upon intermediate cardiovascular disease markers and events. Therefore, estrogen therapy is not currently recommended for indications other than symptom management. However, for women at low risk of adverse events, estrogen therapy can be used to minimize menopausal symptoms. The risk of adverse events can be estimated using risk engines for the calculation of cardiovascular risk and breast cancer risk in conjunction with screening tools such as mammography. Use of estrogen therapy, statins, and anti-platelet agents can be guided by such calculators particularly for younger women with diabetes. Risk management remains focused upon lifestyle behaviors and achieving optimal levels of cardiovascular risk factors, including lipids, glucose, and blood pressure. Use of pharmacologic therapies to address these risk factors, particularly specific hypoglycemic agents, may provide some additional benefit for risk prevention. The minimal benefit for women with limited life expectancy and risk of complications with intensive therapy should also be considered.

Despite a similar beneficial effect on blood pressure lowering observed with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor (AT1R) blocker (ARBs), several clinical trials and meta-analyses have reported higher cardiovascular mortality and lower protection against myocardial infarction with ARBs when compared with ACEIs. The European guidelines for the management of coronary syndromes and European guidelines on diabetes recommend using ARBs in patients who are intolerant to ACEIs. We reviewed the main pharmacological differences between ACEIs and ARBs, which could provide insights into the differences in the cardiac protection offered by these 2 drug classes. The effect of ACEIs on the tissue and plasma levels of bradykinin and on nitric oxide production and bioavailability is specific to the mechanism of action of ACEIs; it could account for the different effects of ACEIs and ARBs on endothelial function, atherogenesis, and fibrinolysis. Moreover, chronic blockade of AT1 receptors by ARBs induces a significant and permanent increase in plasma angiotensin II and an overstimulation of its still available receptors. In animal models, AT4 receptors have vasoconstrictive, proliferative, and inflammatory effects. Moreover, in models with kidney damage, atherosclerosis, and/or senescence, activation of AT2 receptors could have deleterious fibrotic, vasoconstrictive, and hypertrophic effects and seems prudent and reasonable to reserve the use of ARBs for patients who have presented intolerance to ACE inhibitors. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is the primary cause of mortality in women and men with diabetes. Due to age and worsening of risk factors over the menopausal transition, risk of coronary heart disease events increases in postmenopausal women with diabetes. Randomized studies have conflicted regarding the beneficial impact of estrogen therapy upon intermediate cardiovascular disease markers and events. Therefore, estrogen therapy is not currently recommended for indications other than symptom management. However, for women at low risk of adverse events, estrogen therapy can be used to minimize menopausal symptoms. The risk of adverse events can be estimated using risk engines for the calculation of cardiovascular risk and breast cancer risk in conjunction with screening tools such as mammography. Use of estrogen therapy, statins, and anti-platelet agents can be guided by such calculators particularly for younger women with diabetes. Risk management remains focused upon lifestyle behaviors and achieving optimal levels of cardiovascular risk factors, including lipids, glucose, and blood pressure. Use of pharmacologic therapies to address these risk factors, particularly specific hypoglycemic agents, may provide some additional benefit for risk prevention. The minimal bene- fit for women with limited life expectancy and risk of complications with intensive therapy should also be considered. [ABSTRACT FROM AUTHOR]

• Coronary artery dissection is a critical and can be lethal condition. • Spontaneous coronary artery dissection warrants further arterial investigations. • Traumatic coronary artery dissection is uncommon. • Intervention should be based on the extent of the disease. • Number of vessels involved can be a determining factor for management type. Spontaneous coronary artery dissection (SCAD) is a rare but life-threatening disorder. SCAD is gaining importance as an emerging cause of acute coronary syndrome (ACS), especially in otherwise healthy young women. While SCAD and ACS show similarity in presentation, the management of SCAD differs to that of ACS. If not managed properly SCAD can lead to sudden death. This review examines the pathophysiology, clinical presentation, diagnostic algorithms, and the current and future management of SCAD. [ABSTRACT FROM AUTHOR]

Objective: To implement the Comfort Theory, mediated by research-care, to achieve institutional integrity in the clinical practice of nurses in a coronary care unit. Methods: Care research carried out from April 2014 to January 2015 with nurses and people with coronary diseases at a public hospital in Sobral-Ceará- Brazil. Results: The care-research method facilitated the use of Comfort Theory in the practice of caring for people with coronary artery disease, through dialogues between nurse researchers and nursing assistants. It was possible to guide them in the implementation of a theory and a research method in daily care, with a view to better policies and practices for institutional integrity. Conclusion: The Theory of Comfort, in clinical nursing care directed to people with coronary diseases mediated by research-care, allows dialogues between nurse researchers and nurses in clinical practice and favors the achievement of institutional integrity. [ABSTRACT FROM AUTHOR]

Framework: Although gestation marks some of the most important moments in a woman’s life, it becomes complex when associated with the problems, limitations, and risks inherent in heart disease. Objective: to comprehend the meanings women with heart disease attribute to their high-risk pregnancy and to identify their perception of the risks to the mother-child binomial. Methodology: A quantiqualitative study involving 39 pregnant women with heart disease from a public university of an inland city of São Paulo, Brazil, was conducted. Data were collected through interviews with patients and analyzed using the Discourse of the Collective Subject. Results: This study showed high-risk gestation is a process linked to personal satisfaction and fulfillment of a dream, often associated with a lack of planning, uncertainties and fears. Some participants anchored in religion/spirituality to overcome difficulties, while others used self-reliance as a support. The risks are poorly understood and often underestimated. Conclusion: High-risk gestation is a process associated with personal satisfaction, fulfillment of a dream and even a common experience, often permeated by negative feelings about the inevitable risks to the mother-child binomial.

Objectives: This study was carried out to determine the common cardiovascular and congenital heart diseases that required admission and surgical intervention in a tertiary care hospital of Peshawar. Methodology: This was a retrospective study at the cardiothoracic surgery ward of Rehman Medical Institute (RMI). All the admissions over the period of 9 years from 2005 to 2014 into the cardiothoracic surgery ward were reviewed. The data acquired was put into Microsoft Excel 2013 and analyzed using pivot tables for frequencies of different procedures and diagnosis. Results: A total of 9343 patients were admitted during the 9-year period. There were 6516 (69.7%) males and 2827 (30.3%) females. The male to female ratio was 2.30:1. The ages ranged from 1 year to 99 years. Mean age was 41.32 ± 20.56 years. The highest proportion of admissions was in the 50-59 years' age group followed by 60-69 years and 40-49 years. Coronary Artery Bypass Graft (4617) was the most common procedure performed. Triple Vessel Disease (37%) was the most commonly presented disease to the RMI Cardiology Unit. Conclusion: Majority of patients presented with triple vessel disease and male outnumbered female. CABG was the commonest procedure performed at RMI Cardiology Unit, Peshawar. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Objectives: Recent studies on endocrine function have revealed many pathological complications in relation to obesity and metabolic diseases. Thus, the present study was carried out with the aim of investigating the effect of 12-week resistance training on the serum levels adipokine (adiponectin and leptin) and inflammatory markers of cardiovascular diseases in obese men. Methods: In this semi-experimental study, 20 non-athlete obese men were randomly assigned to two groups of experimental and control. The experimental group performed the resistance training protocol, three sessions per week for 12 weeks, while the control group was prohibited to do training program during the research implementation. Five ml of venous blood was taken from the participants at the beginning of the sixth week and at the end of the twelfth week to measure leptin, adiponectin, CRP, IL-6, and TNF-α. The significance level was considered to be >α0.05. Results: Resistance training caused decrease in CRP (p=0.002), IL-6 (p=0.001) and leptin (p=0.002), and increase in adiponectin (p=0.001) in the experimental group compared to the control group. Also, TNF-α level showed a decrease in the experimental group after 12 weeks of resistance training, which was not statically significant. Conclusion: The results of this study showed that regular resistance trainings reduce the potential risk of cardiovascular diseases via improvement of the plasma levels of adiponectin, leptin, CRP, and IL-6, and it can be used as an effective nonpharmacological treatment to prevent these diseases.

FUNDAMENTO: Participantes dos programas de reabilitação cardiopulmonar e metabólica (RCPM) podem apresentar alterações locomotoras que prejudiquem a aderência e a efetividade do tratamento. OBJETIVO: Desenvolver instrumento para avaliar o sistema locomotor e identificar problemas, principalmente aqueles relacionados com o exercício, possibilitando a triagem dos pacientes, ou seja, liberação sem restrições, liberação com restrições e não liberação antes de aval especializado. MÉTODOS: Construção e validação (segundo o alfa de Cronbach) de inventário de avaliação do sistema locomotor (IASL), para subsequente aplicação em participantes da RCPM. RESULTADOS: Por meio do IASL, cuja avaliação interna apresentou parâmetros de validade e confiabilidade satisfatórios, foram avaliados 103 indivíduos participantes de programas de RCPM, sendo 33 homens (32%) e 70 mulheres (68%), com idades entre 36 e 84 anos, dos quais 47 (45,6%) já haviam recebido diagnóstico de problema do sistema locomotor, 39 (37,9%) já haviam recebido tratamento específico para o sistema locomotor, 33 (32%) costumavam usar fármacos para alívio de sintomas do sistema locomotor, e 10 (9,7%) haviam recebido proibição médica para algum tipo de exercício. Ressalte-se que 48 indivíduos (46,6%) relataram sentir dor no sistema locomotor que, em 14 (13,6%) deles, piorava com o exercício, o que deveria impedir a participação em programa de exercícios antes de aval de especialista. CONCLUSÃO: O IASL, que apresentou parâmetros de validade e confiabilidade satisfatórios, evidenciou que, para praticamente metade dos participantes de programas de RCPM, existia alguma restrição para a prática de exercícios e que alguns não deveriam ter sido liberados sem o aval de especialista.BACKGROUND: Participants of cardiopulmonary and metabolic rehabilitation (CPMR) programs may present with musculoskeletal changes that may affect treatment compliance and effectiveness. OBJECTIVE: To develop an instrument for evaluation of the musculoskeletal system and identification of problems, especially those related to exercise, so that patients can be cleared to exercise with no restrictions, cleared with restrictions, or not cleared before approval from a specialist. METHODS: Construction and validation (according to Cronbach’s alpha) of a musculoskeletal system assessment inventory (MSSAI), for subsequent administration to participants in CPMR programs. RESULTS: A total of 103 individuals participating in CPMR programs were evaluated by means of the MSSAI, whose internal validity and reliability proved to be satisfactory. Of these, 33 were men (32%) and 70 were women (68%), with age ranging from 36 to 84 years; 47 (45.6%) had already been diagnosed with musculoskeletal system disorders; 39 (37.9%) had already received specific treatment for the musculoskeletal system; 33 (32%) used to take medications to relieve symptoms related to the musculoskeletal system; and 10 (9.7%) had a medical restriction for performing some type of exercise. We should point out that 48 individuals (46.6%) reported pain in the musculoskeletal system; in 14 (13.6%) of them, the pain worsened by exercise, and this should have prevented them from participating in exercise programs before receiving approval from a specialist. CONCLUSION: The MSSAI, whose internal validity and reliability proved satisfactory, showed that there was some restriction to exercise practice for almost half of the individuals participating in CPMR programs, and that some of them should not have been cleared without approval from a specialist.

FUNDAMENTO: O conhecimento sobre a doença arterial coronariana pode ser considerado o primeiro passo para reduzir o risco de complicações cardíacas. OBJETIVOS: Construir e validar um instrumento capaz de avaliar e descrever o conhecimento do paciente coronariano em programas de reabilitação cardíaca, com a finalidade de educação. MÉTODOS: Para construção, foi realizada análise de artigos e estudo de campo para a apresentação de itens a uma equipe multidisciplinar associada à reabilitação cardíaca. Após análise, foi gerada a versão testada em um estudo-piloto. O instrumento, nomeado CADE-Q (Questionário para Educação do Paciente Coronariano), foi aplicado em 155 pacientes com idade de 61 ± 9 anos (mín = 36 ; máx = 86), participantes de programas de reabilitação cardíaca. Dos 155 pacientes, 114 eram homens. A consistência interna foi verificada pelo coeficiente Alpha de Cronbach. A reprodutibilidade foi testada através do coeficiente de correlação intraclasse (CCIC) e a validade de construto por análise fatorial exploratória. Foi realizada análise comparando os escores totais em função de características da população e entre os grupos de reabilitação (privado e público). RESULTADOS: A versão final possui 19 questões com 4 alternativas, com 4 quadrantes de conhecimento. O Alpha de Cronbach foi de 0,68 e CCIC foi de 0,783. A análise fatorial revelou 6 fatores, abrangendo três áreas de conhecimento, o que demonstra a multifatoriedade do instrumento. A análise das características da população em função do escore total apresentou diferenças significativas em função das variáveis do nível socioeconômico (tipo de reabilitação, renda familiar e escolaridade). CONCLUSÃO: O instrumento CADE-Q apresenta validade e confiabilidade adequadas para sua utilização na população brasileira em futuras pesquisas.BACKGROUND: Being aware of the coronary artery disease can be considered the first step to reduce the risk of cardiac complications. OBJECTIVE: Building and validating a tool to assess and describe coronary patients' awareness in cardiac rehabilitation programs, with the purpose of education. METHODS: For the construction, we analyzed articles and field studies to submit items to multidisciplinary team associated to cardiac rehabilitation. After this analysis, we generated the version tested in a pilot study. The tool, named CADE-Q (Questionnaire for Coronary Patient Education) was applied in 155 patients aged 61 ± 9 (min = 36, max = 86) in response to cardiac rehabilitation programs. Out of the 155 patients, 114 were men. Internal consistency was measured by Cronbach's alpha coefficient. Reproducibility was tested by the intraclass correlation coefficient (ICC) and construct validity was performed by exploratory factor analysis. The analysis compared the total scores as a function population characteristics and rehabilitation groups (private and public). RESULTS: The final version has 19 questions with 4 alternatives, with 4 quadrants of awareness. Cronbach's alpha was 0.68 and ICC was 0.783. The factor analysis revealed 6 factors, covering three areas of awareness, which demonstrates the multifactorial nature of the instrument. The population characteristics as a function of the total score showed significant differences depending on the socioeconomic status variables (type of rehabilitation, household income and education level). CONCLUSION: CADE-Q has proper validity and reliability to be used in the Brazilian population in future research.

FUNDAMENTOS: Modelos de estratificação de risco são utilizados em cirurgia para avaliar risco de morte. OBJETIVO: Fazer análise crítica da aplicação do EuroSCORE (ES) em amostras de prontuários de 2692 pacientes submetidos à cirurgia de revascularização miocárdica em 4 hospitais públicos do município do Rio de Janeiro, no período de 1999 a 2003. MÉTODOS: Foram selecionadas, em quatro hospitais públicos da cidade do Rio de Janeiro, amostras aleatórias de 150 prontuários de pacientes por hospital, sobreviventes e óbitos. Aplicou-se o ES utilizando-se o modelo logístico. A letalidade observada e prevista pelo modelo foi comparada. A aferição do poder discriminante foi estimada pela área sob a curva ROC. RESULTADOS: Localizados 546 dos 600 prontuários selecionados. Observou-se significativa diferença entre prevalências dos fatores de risco entre nossa população e européia. Letalidade prevista foi 3,62% (IC-95%: 3,47-3,78) e observada estimada foi 12,22% (IC-95%- 10,99-13,46). Em todas as faixas de risco, há subestimação da letalidade prevista, com diferenças notáveis entre prevista e observada.Área sob a curva ROC foi estimada em 0,62. CONCLUSÃO: Diferenças das prevalências dos fatores de risco que compõem o ES associado ao baixo poder discriminatório desaconselham a utilização do modelo em nosso meio sem devidos ajustes.BACKGROUND: Risk stratification models are used to assess the risk of death in surgery. OBJECTIVE: To conduct a critical analysis of the EuroSCORE logistic model (ES) application in 2,692 patients undergoing Coronary Artery Bypass Grafting (CABG) in four public hospitals in the Rio de Janeiro Municipality, from 1999 through to December 2003. METHODS: Random samples of 150 medical records for surviving and deceased patients were selected at four public hospitals in the City of Rio de Janeiro. The ES was applied, using the logistical model. The observed lethality rate and that forecast by the model were compared. The measurement of the discriminatory power was estimated by the area under the ROC curve. RESULTS: 546 of the 600 selected medical records were located. A significant difference was noted between the prevalence rates for the risk factors in the Brazilian and European populations. The forecast lethality rate was 3.62% (CI-95%: 3.47-3.78) while the estimated observed rate was 12.22% (CI-95%- 10.99-13.46). In all risk ranges, the predicted lethality rate is under-estimated, with notable differences between the predicted and observed rates. The area under the ROC curve was estimated at 0.62. CONCLUSION: The differences in the prevalence rates for the risk factors constituting the ES, associated with its low power of discrimination, hamper any recommendation of the use of this model in Brazil, without the necessary adjustments.

FUNDAMENTO: A prevalência de depressão em portadores de doença arterial coronariana (DAC) é alta. A escala de depressão geriátrica (EDG) é um instrumento amplamente usado para rastrear a depressão em idosos. No Brasil, as propriedades psicométricas da versão curta ainda não foram adequadamente exploradas. OBJETIVO: Avaliar as propriedades psicométricas da versão curta da EDG em portadores de DAC em ambulatório de cardiologia. MÉTODOS: Estudo transversal que avaliou 209 idosos (≥ 65 anos) com DAC utilizando a EDG-15, Cumulative Illness Rating Scale for Geriatrics (CIRS), Brazilian OARS Multidimensional Function Assessment Questionnaire (BOMFAQ) e The Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). A consistência interna da EDG-15 foi calculada pelo KR-20. Uma análise fatorial dessa escala foi conduzida. Escores da EDG-15 foram comparados com os diagnósticos de depressão (DSM-IV) para a validade de critérios. Na análise de validade concorrente, os mesmos escores foram correlacionados com os das escalas de depressão CAMDEX, Miniexame do Estado Mental (MEEM), Cambridge Cognitive Examination (CAMCOG) e BOMFAQ. RESULTADOS: A depressão clínica foi diagnosticada em 35,71% da amostra avaliada de acordo com o DSM-IV. Para o diagnóstico de depressão maior ou distimia, o ponto de corte 5/6 apresentou acurácia moderada (AUROC = 0,84), sensibilidade de 79,92% e especificidade de 78,29%. A consistência interna foi de 0,80. Na análise fatorial, três fatores obtidos explicaram 52,72% da variância total observada. Os escores da EDG-15 correlacionaram-se com os da escala de depressão CAMDEX. CONCLUSÃO: No geral, a EDG-15 apresentou boa confiabilidade e validade (concorrente e de critério). Em settings cardiológicos, seu uso pode auxiliar no rastreamento de quadros depressivos de forma simples e rápida.FUNDAMENTO: La prevalencia de depresión en portadores de enfermedad arterial coronaria (EAC) es alta. La escala de depresión geriátrica (EDG) es un instrumento ampliamente utilizado para rastrear la depresión en adultos mayores. En Brasil, las propiedades psicométricas de la versión corta aún no fueron adecuadamente estudiadas. OBJETIVO: Evaluar las propiedades psicométricas de la versión corta de la EDG en portadores de EAC en ambulatorio de cardiología. MÉTODOS: Estudio transversal que evaluó 209 adultos mayores (> 65 años) con EAC utilizando la EDG-15, Cumulative Illness Rating Scale for Geriatrics (CIRS), Brazilian OARS Multidimensional Function Assessment Questionnaire (BOMFAQ) y The Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). La consistencia interna de la EDG-15 fue calculada mediante el KR-20. Se llevó a cabo un análisis factorial de esa escala. Los escores de la EDG-15 fueron comparados con los diagnósticos de depresión (DSM-IV) para la validez de criterios. En el análisis de validez concurrente, los mismos escores fueron correlacionados con los de las escalas de depresión CAMDEX, Miniexamen del Estado Mental (MEEM), Cambridge Cognitive Examination (CAMCOG) y BOMFAQ. RESULTADOS: En un 35,71% de la muestra evaluada se diagnosticó depresión clínica, de acuerdo al DSM-IV. Para el diagnóstico de depresión mayor o distimia, el punto de corte 5/6 presentó precisión moderada (AUROC = 0,84), sensibilidad del 79,92% y especificidad del 78,29%. La consistencia interna fue de 0,80. En el análisis factorial, tres factores obtenidos explicaron el 52,72% de la variancia total observada. Los escores de la EDG-15 se correlacionaron con los de la escala de depresión CAMDEX. CONCLUSIÓN: En general, la EDG-15 presentó buena confiabilidad y validez (concurrente y de criterio). En settings cardiológicos, su uso puede auxiliar en el rastreo de cuadros depresivos de forma simple y rápida.BACKGROUND: The prevalence of depression in individuals with coronary artery disease (CAD) is high. The Geriatric Depression Scale (GDS) is a broadly used tool to screen for depression in elderly individuals. In Brazil, the psychometric properties of the short version have not been adequately assessed. OBJECTIVE: To evaluate the psychometric properties of the short version of the GDS in patients with CAD treated at a Cardiology Outpatient Clinic. METHODS: The present is a cross-sectional study that assessed 209 elderly individuals (≥ 65 years) with CAD using the GDS-15, the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), the Brazilian OARS Multidimensional Function Assessment Questionnaire (BOMFAQ) and The Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). The internal consistency of the GDS-15 was calculated through the KR-20. A factorial analysis of this scale was carried out. The GDS-15 scores were compared with the diagnoses of depression (DSM-IV) for the validity of criteria. At the analysis of concurrent validity, the same scores were correlated with those of the CAMDEX, mini-mental state examination (MMSE), Cambridge Cognitive Examination (CAMCOG) and BOMFAQ depression scales. RESULTS: Clinical depression was diagnosed in 35.71% of the sample assessed according to the DSM-IV. For the diagnosis of major depression or dystimia, the cutoff 5/6 presented moderate accuracy (AUROC = 0.84), sensitivity of 79.92% and specificity of 78.29%. The internal consistency was 0.80. At the factorial analysis, three obtained factors explained 52.72% of the total variance that was observed. The GDS-15 scores correlated with those of the CAMDEX depression scale. CONCLUSION: In general, the GDS-15 presented good reliability and validity (concurrent and of criterion). In cardiologic settings, its use, which is simple and fast, can be utilized in the screening for depression.

As cardiopatias congênitas apresentam elevada prevalência no Brasil, sendo responsáveis por morbi-mortalidade importante, principalmente em menores de 5 anos de idade. Relacionam-se a um perfil complexo de alterações hemostáticas, predispondo tanto a eventos trombóticos como hemorrágicos, e cujo conhecimento é fundamental para o manejo adequado de cada paciente. O presente artigo objetiva descrever as alterações da coagulação relacionadas às cardiopatias congênitas, cianogênicas ou não, em menores de 18 anos de idade, submetidos ou não a procedimentos cirúrgicos.There is a high prevalence of congenital heart diseases in Brazil, which are responsible for high morbidity and mortality, mainly in under 5-year-old children. They are related to a complex profile of hemostatic disorders that lead to thrombotic and hemorrhagic events. Thus knowledge of the diseases is imperative for the adequate management of each patient. The objective of this article is to describe coagulation abnormalities related to congenital cyanotic and non-cyanotic heart diseases, in children, undergoing surgical procedures or not.

Aim Coronary and heart diseases (CHD) represent one of thegreatest medical problems in the developed world. To facilitatethe CHD probability estimation procedure, as well as to speed upthe procedure of making and issuing patient’s final diagnosis, wedeveloped the Risk estimation application (‘’CHD Risk’’).Methods Risk estimation is based upon a multivariate analysis ofstatistical data by using logistic regression as a method for probabilityestimation. The method estimates how the final outcome isinfluenced by every single factor. Risk factors represent independentvariables of the model, while a coronary disease risk indicatoris dependent variable.Results The ‘’CHD Risk” was tested for three cases and showedapplication credibility. The system provides coronary disease riskprobability estimation for the given risk factor values, as well asadvice for factors whose values exceed the range of normal values.The system allows input of additional statistical data, whichimproves its learning properties.Conclusions Although the “CHD Risk” system can neither makefinal decisions nor replace the medical professionals themselves, itfulfills the aim to develop the web based tool to help the physiciansto monitor their patients’ health condition, as well as to suggestpreventive measures and therapy.

A DAC continua sendo uma das principais causas globais de morbimortalidade. Programas amplos de desenvolvimento de drogas para novas estratégias de tratamento medicamentoso freqüentemente utilizam estudos com desfechos de mortalidade/morbidade tradicionais e outros com desfechos substitutos. Essa abordagem paralela permite uma avaliação da eficácia vários anos antes dos dados de estudos com desfechos clínicos estarem disponíveis. Vários marcadores imagenológicos de aterosclerose foram introduzidos nessas estratégias de desenvolvimento de drogas, incluindo angiografia, ultrassonografia de carótida, USIV, RM e TC. Esta revisão discutirá a situação atual dos métodos por imagem da aterosclerose como um desfecho em estudos de progressão/regressão, com ênfase em dados baseados em evidências. Além de uma discussão sobre os resultados das modalidades de métodos por imagem individuais, serão apresentados os dados que têm surgido comparando as diferentes modalidades e abordagens.CAD remains a major global cause of morbidity and mortality. Comprehensive drug development programs of novel pharmacological treatment strategies frequently utilize traditional mortality/morbidity endpoints studies and additional surrogate endpoints trials. This parallel approach allows an assessment of efficacy several years in advance of the availability of data from clinical endpoint trials. Several atherosclerosis imaging markers have been introduced into these drug-development strategies, including angiography, carotid ultrasound, IVUS, MRI, and CT. This review will discuss the current status of atherosclerosis imaging as an endpoint in progression/regression trials, with an emphasis on evidence-based data. In addition to a discussion of the results of individual imaging modalities, the emerging data comparing different modalities and approaches are presented.

OBJETIVO: O objetivo deste estudo é verificar o valor de previsão da angina de peito no diagnóstico da DAC em pacientes portadores de EA, a partir da quinta década de vida. MÉTODOS: A população estudada foi constituída por 186 pacientes consecutivos com EA e idade e" 50 anos, referidos para cirurgia de troca valvar aórtica entre junho de 1989 e setembro de 2004. Cinecoronariografia de rotina foi realizada em todos os pacientes. Cento e um eram homens (54,3%) e 85, mulheres (45,7%), com idade de 66±8 anos. Angina estava presente em 124 pacientes (66,7%). O gradiente máximo transvalvar aórtico foi de 89,4±27,6 mmHg e a área valvar aórtica de 0,59±0,17 cm2. Calculamos a sensibilidade, a especificidade, o valor de previsão positivo e negativo e a razão de verossimilhança positiva da angina na predição da presença de DAC. RESULTADOS: DAC estava presente em 93 pacientes (50%). Dos 124 pacientes com angina, 68 (54,8%) apresentavam DAC; enquanto dos 62 sem angina, 25 apresentavam DAC (40,3%). Portanto, a sensibilidade da angina para DAC foi de 73,1%, a especificidade de 39,7%, valor preditivo positivo de 54,8%, valor preditivo negativo de 59,6% e razão de verossimilhança positiva de 1,6. CONCLUSÃO: A angina de peito não é bom preditor da presença de DAC em pacientes com EA a partir da quinta década de vida.OBJECTIVE: The objective of this study is to evaluate the value of angina pectoris as a predictor of CAD (coronary artery disease) in patients with AS (aortic stenosis) during and beyond the 5th decade of life. METHODS: The study population consisted of 186 consecutive patients with AS and e" 50 years of age, referred for surgical aortic valve replacement (AVR) between June 1989 and September 2004. Routine coronary angiography was performed for all patients. One hundred and one patients were males (54.3%) and 85 were females (45.7%), and the mean age was 66±8 years. One hundred and twenty-four patients (66.7%) had angina. The maximum transvalve gradient was 89.4±27.6 mmHg, and the aortic valve area measured 0.59±0.17 cm2. We calculated the sensitivity, specificity, positive and negative predictive values, as well as the likelihood ratio of a positive test result for angina in predicting the presence of CAD. RESULTS: Ninety-three patients (50%) had CAD. Of the 124 patients with angina, 68 (54.8%) had CAD, whereas of the 62 patients without angina, 25 had CAD (40.3%) (p=0.087). Therefore, the diagnostic sensitivity of angina to detect CAD was 73.1%, specificity was 39.7%, positive predictive value was 54.8%, negative predictive value was 59.6%, and the likelihood ratio of a positive test result was 1.6. CONCLUSION: Angina pectoris is not a good predictor of CAD in patients with AS who are more than 50 years of age.

Introduction: Few studies have demonstrated the cost burden of cardiovascular events (CVEs) among patients with hyperlipidemia. The primary objective of this study was to determine the mean costs associated with CVEs among patients with hyperlipidemia by follow-up time period. Secondary objectives of this study included characterizing costs by CVE type and coronary heart disease (CHD) risk.Methods: This retrospective cohort study used longitudinal claims to calculate payer costs according to CHD risk level and type of CVE, during several follow-up periods (acute and short-term, comprising year 1; plus years 2 and 3).Results: There were 193,385 patients with hyperlipidemia with a CVE. Costs in the acute (30-day) period were highest ($22,404) driven by inpatient care (77%). Costs remained high ($15,133 in year 3) with ambulatory care (from 14% in acute to 37% in year 3) and pharmaceutical costs (from 2% in acute to 24% in year 3) representing a greater proportion. After second and third CVEs, acute costs were lower than for the first CVE. But in the post-acute periods, costs were higher after second and third CVEs than after first CVEs. Acute costs varied considerably by type of CVE ($9149 for transient ischemic attack to $54,251 for coronary artery bypass graft; P < 0.001), but post-acute costs were more similar across types. Costs differed by baseline CHD risk for all follow-up periods (P < 0.001), but less than by CVE type. As expected, patients without CVEs had significantly lower costs.Conclusion: Among patients with hyperlipidemia, the economic burden of CVEs is substantial up to 3 years after a CVE. Costs remain high after subsequent CVEs and actually increase for non-inpatient utilization.Funding: Amgen Inc. [ABSTRACT FROM AUTHOR]

Estudo observacional, descritivo, que objetivou identificar as crenças segundo a centralidade/perifericidade, e verificou como elas interferem no comportamento de pacientes portadores de coronariopatias, para aderirem ou não ao tabagismo. Utilizamos um dos referenciais de crenças mencionados na literatura, que evidenciou, na análise das entrevistas realizadas com 56 pacientes portadores de doença coronariana, internados em uma instituição hospitalar do Estado de São Paulo, um predomínio de crenças primitivas de consenso zero e uma tendência à centralidade, o que permitiu identificar fatores que dificultam a adesão às recomendações terapêuticas feitas pelos profissionais da saúde e inferir sobre a resistência para mudança de comportamento que tal população possui.Estudio observacional, descriptivo que buscó identificar las creencias según la centralidad/perifericidad y verificó como ellas interfieren en el comportamiento de pacientes portadores de coronariopatías para convertirse o no en fumadores. Utilizamos unos de los referenciales de creencias, que evidenció, en el análisis de las entrevistas realizadas con 56 pacientes portadores de la enfermedad coronariana internados en una institución hospitalaria del Estado de São Paulo, un predominio de creencias primitivas de consenso cero y una tendencia a la centralidad que permitió identificar factores obstaculizadores para la aceptación de las recomendaciones terapéuticas realizadas por los profesionales de salud e inferir sobre la resistencia para el cambio de comportamiento que dicha población posee.This is a descriptive observational study that aimed at identifying beliefs according to centrality/periphery by verifying how they interfere in the behavior of patients with coronary diseases regarding their adherence or non-adherence to smoking. The belief-related frameworks mentioned in the literature were used and findings, pointed out from the analysis of the interviews with 56 people with coronary diseases who were inpatients in a hospital in the interior of São Paulo State, showed a prevalence of primitive beliefs with zero consensus and a tendency to centrality that enabled the identification of hiding factors to the adherence to therapeutic recommendations by health professionals as well as inferences concerning the reluctance to behavioral changes presented by the population.

Machine learning-based risk models built from Electronic Health Records (EHR) can support medical decision-making. However, the lack of standardization of EHR data and the "black-box" nature of the machine learning approaches have imposed difficulties to their acceptance as support tools in a clinical environment. This paper presents a method able to predict and explain the diagnostic of Atrial Fibrillation (AF), Sleep Apnea (SA) and, Coronary Arterial Disease (CAD); the proposed model is learned using EHR's structured data (commonly used screening variables) and non-structured data (textual data drawn from medical reports) of patients. An embedding scheme of variables together with a labeling approach is used to mimic the ability of an expert in categorizing the non-structured textual data. The method relies on complex models to predict such diseases combined with the SHAP approach to explaining the prediction. A comparison of prediction models with different settings of input variables has shown that the use of non-structured data improved the performances of CAD risk prediction models. Moreover, such a comparison pointed out that the patients' medical histories is an important factor that should be considered during the data-driven learning process. • Novel method for risk prediction of diseases with accurate and explainable prediction. • Embedding and weak supervision method to extract knowledge from EHR unstructured data • Empirical evidence that the join of EHR unstructured data improves the risk model. [ABSTRACT FROM AUTHOR]