Cribado oportunista del pulso irregular para la detección de fibrilación auricular asintomática en farmacias comunitarias de cataluña. proyecto: Pren-Te El Pols / Opportunistic screening of irregular pulse to detect asymptomatic atrial fibrillation in community pharmacies: TAKE YOUR PULSE PROJECT

Objetivo: Cribado oportunista de pulso irregular desde las farmacias comunitarias en pacientes mayores de 60 años como indicador de fibrilación auricular asintomática y evaluación de la idoneidad del proceso en cuanto a su factibilidad e implementación. Material y métodos: Estudio observacional descriptivo transversal basado en la toma de pulso radial a pacientes asintomáticos. Profesionales sanitarios de un total de 240 farmacias comunitarias voluntarias y de 105 centros de salud realizaron la formación necesaria para adherirse a la campaña ‘Pren-te el pols’ de 40 días de duración. Los farmacéuticos comunitarios reclutaron a 4.729 sujetos y 666 fueron excluidos. Finalmente se cribaron 4.063 sujetos mayores de 60 años. Se registraron las diferentes variables en una plataforma online creada para el proyecto en la que se accedía mediante un usuario y contraseña. Además, se evaluó la idoneidad del proceso mediante una encuesta autoadministrada a los farmacéuticos participantes. Resultados: El 5,9% de los sujetos cribados presentaron pulso irregular, siendo la proporción de varones estadísticamente significativa respecto a la de mujeres. La media del grado de satisfacción de los farmacéuticos fue de 8,07/10. Conclusiones: El cribado de pulso irregular para la detección de fibrilación auricular asintomática en farmacias comunitarias presenta un alto grado de factibilidad para su incorporación sistemática en grupos de pacientes susceptibles. Además, incorpora la accesibilidad de la determinación al permitir el cribado de muestras amplias en periodos cortos de tiempo. No obstante, aspectos de gestión compartida, trabajando coordinadamente con los equipos de atención primaria, devienen imprescindibles para evaluar de manera fehaciente su efectividad real en el aumento de la tasa de diagnósticos de ciertas patologías prevalentes

Background: Atrial fibrillation is the most common arrhythmia. It is associated with a high morbidity and mortality. It increases fivefold the probability of suffering an ischemic stroke, which is the most serious and incapacitating one. Its early diagnosis and treatment improve its clinical outcome. Objective: This study aims to describe the proportion of irregular pulses found from community pharmacies in patients over 60 years as an indicator of asymptomatic atrial fibrillation and it also evaluates the suitability of the process in terms of its feasibility and implementation. Methods: It was conducted an observational, descriptive and cross-sectional study. It was based on taking the radial pulse (RP) of asymptomatic patients. For a period of 40 days, healthcare professionals from 240 community pharmacists and 105 health centres attended the training and joined the ‘Take your pulse’ campaign. Community pharmacies recruited 4,729 subjects, 666 were excluded. Finally, 4,063 subjects over 60 years were screened. It was created an online platform, which was accessed by validating a user code and password, to record the different variables. In addition, the suitability of the process was evaluated through a self-administered survey of participating pharmacists. The suitability of the organisational model was evaluated using a validated self-report questionnaire completed by the participating pharmacists. Results: An irregular pulse was found in 5.9 % of the subjects among whom the percentage of males was statistically significant. The average level of pharmacists satisfaction was 8.07/10. Conclusion: Irregular pulse screening to detect asymptomatic atrial fibrillation in community pharmacies has a high degree of feasibility to be incorporated systematically into groups of susceptible patients. In addition, it incorporates the accessibility of the determination by allowing the screening of large samples in short periods of time. However, some aspects related to sharing management and working in coordination with Primary Care teams become essential to measure reliably its real effectiveness in the diagnostic rate rise of certain prevalent diseases

Nuevos modelos conceptual y matemático para el contorno de la onda de volumen de pulso arterial / New conceptual and mathematical forms for the contour of volume wave of arterial pulse

Introducción: El análisis del contorno de la onda de volumen de pulso arterial ha sido útil para el diagnóstico no invasivo de enfermedades cardiovasculares, pero los orígenes patofisiológicos que contribuyen a este contorno no están totalmente explicados. El objetivo de este trabajo fue hallar el nivel de coincidencia de un nuevo modelo conceptual simple, basado en las fuerzas hemodinámicas, con respecto a un nuevo modelo matemático aplicado a las diferentes clases de ondas de volumen de pulso arterial en dedos de miembros inferiores. Métodos: la propuesta del modelo conceptual se basó en que este contorno es la suma de pares de gradientes de fuerzas hemodinámicas de acción, provenientes del corazón, la aorta y el distrito arterial periférico, y las de reacción, provenientes de la pared arterial músculo-elástica bajo estudio. El modelo matemático fue diseñado como un problema de programación no lineal, para hallar las 6 incógnitas numéricas de cada par de gradientes, bajo restricciones no lineales basadas en sus relaciones temporales. Se registraron los contornos desde los dedos de miembros inferiores, en pacientes en los que se pudieran observar las 4 clases de contornos de onda de volumen de pulso arterial conocidos. Se analizó la calidad de ajuste de 4 403 contornos de onda de volumen de pulso arterial experimentales, contra su onda de volumen de pulso arterial resultante del modelo matemático, desde 123 registros de 14 pacientes (7 mujeres). Resultados: La clase III fue la predominante, las clases I y II fueron frecuentes en pacientes con menos riesgo cardiovascular y la clase IV, en los de mayor riesgo...

Introduction: The analysis of volume wave contour of arterial pulse has been useful for non-invasive diagnosis of cardiovascular diseases, but the pathophysiological origins contributing to this contour are not totally explained. The objective of present paper was to find the coincidence level of a new simple conceptual form, based on the hemodynamic strengths regarding a new mathematical form applied to different classes of volume waves of arterial pulse in toe fingers. Methods: The proposal of conceptual form was based on that this contour is the addition of pairs of action hemodynamic strengths gradients from the heart, aorta and the peripheral arterial zone and of the reactions coming from study musculoelastic arterial wall. The mathematical form was designed as a non-lineal programming problem to find the six numeral unknown quantities of each pair of gradients, under non-lineal restriction based on its temporary relations. The contours from toe fingers were registered in patients with four potential classes of volume wave known contours of arterial pulse. The fitting quality of 4 403 experimental above mentioned contours was analyzed versus the arterial pulse volume resulting from mathematical form of 123 registries of 14 patients (7 women). Results: There was predominance of III class, the I and II ones were frequent in patients with less cardiovascular risk and the IV class in those of great risk. The 64 percent of the wave volume of arterial pulse had a quality fitting > 95 percent and the 36 percent had the presence of oscillating waves from skeletal muscle. Conclusions: The coincidence of both forms is accepted to characterize in a morphologic way the contour of any class of wave volume of arterial pulse

Nuevos modelos conceptual y matemático para el contorno de la onda de volumen de pulso arterial / New conceptual and mathematical forms for the contour of volume wave of arterial pulse

Introducción: El análisis del contorno de la onda de volumen de pulso arterial ha sido útil para el diagnóstico no invasivo de enfermedades cardiovasculares, pero los orígenes patofisiológicos que contribuyen a este contorno no están totalmente explicados. El objetivo de este trabajo fue hallar el nivel de coincidencia de un nuevo modelo conceptual simple, basado en las fuerzas hemodinámicas, con respecto a un nuevo modelo matemático aplicado a las diferentes clases de ondas de volumen de pulso arterial en dedos de miembros inferiores. Métodos: la propuesta del modelo conceptual se basó en que este contorno es la suma de pares de gradientes de fuerzas hemodinámicas de acción, provenientes del corazón, la aorta y el distrito arterial periférico, y las de reacción, provenientes de la pared arterial músculo-elástica bajo estudio. El modelo matemático fue diseñado como un problema de programación no lineal, para hallar las 6 incógnitas numéricas de cada par de gradientes, bajo restricciones no lineales basadas en sus relaciones temporales. Se registraron los contornos desde los dedos de miembros inferiores, en pacientes en los que se pudieran observar las 4 clases de contornos de onda de volumen de pulso arterial conocidos. Se analizó la calidad de ajuste de 4 403 contornos de onda de volumen de pulso arterial experimentales, contra su onda de volumen de pulso arterial resultante del modelo matemático, desde 123 registros de 14 pacientes (7 mujeres). Resultados: La clase III fue la predominante, las clases I y II fueron frecuentes en pacientes con menos riesgo cardiovascular y la clase IV, en los de mayor riesgo...(AU)

Introduction: The analysis of volume wave contour of arterial pulse has been useful for non-invasive diagnosis of cardiovascular diseases, but the pathophysiological origins contributing to this contour are not totally explained. The objective of present paper was to find the coincidence level of a new simple conceptual form, based on the hemodynamic strengths regarding a new mathematical form applied to different classes of volume waves of arterial pulse in toe fingers. Methods: The proposal of conceptual form was based on that this contour is the addition of pairs of action hemodynamic strengths gradients from the heart, aorta and the peripheral arterial zone and of the reactions coming from study musculoelastic arterial wall. The mathematical form was designed as a non-lineal programming problem to find the six numeral unknown quantities of each pair of gradients, under non-lineal restriction based on its temporary relations. The contours from toe fingers were registered in patients with four potential classes of volume wave known contours of arterial pulse. The fitting quality of 4 403 experimental above mentioned contours was analyzed versus the arterial pulse volume resulting from mathematical form of 123 registries of 14 patients (7 women). Results: There was predominance of III class, the I and II ones were frequent in patients with less cardiovascular risk and the IV class in those of great risk. The 64 percent of the wave volume of arterial pulse had a quality fitting > 95 percent and the 36 percent had the presence of oscillating waves from skeletal muscle. Conclusions: The coincidence of both forms is accepted to characterize in a morphologic way the contour of any class of wave volume of arterial pulse(AU)

Improving ECG classification accuracy using an ensemble of neural network modules.

This paper illustrates the use of a combined neural network model based on Stacked Generalization method for classification of electrocardiogram (ECG) beats. In conventional Stacked Generalization method, the combiner learns to map the base classifiers' outputs to the target data. We claim adding the input pattern to the base classifiers' outputs helps the combiner to obtain knowledge about the input space and as the result, performs better on the same task. Experimental results support our claim that the additional knowledge according to the input space, improves the performance of the proposed method which is called Modified Stacked Generalization. In particular, for classification of 14966 ECG beats that were not previously seen during training phase, the Modified Stacked Generalization method reduced the error rate for 12.41% in comparison with the best of ten popular classifier fusion methods including Max, Min, Average, Product, Majority Voting, Borda Count, Decision Templates, Weighted Averaging based on Particle Swarm Optimization and Stacked Generalization.

Pulse image recognition using fuzzy neural network.

The automatic recognition of pulse images is the key in the research of computerized pulse diagnosis. In order to automatically differentiate the pulse patterns by using small samples, a fuzzy neural network to classify pulse images based on the knowledge of experts in traditional Chinese pulse diagnosis was designed. The designed classifier can make hard decision and soft decision for identifying 18 patterns of pulse images at the accuracy of 91%, which is better than the results that achieved by back-propagation neural network.

Baseline wander correction in pulse waveforms using wavelet-based cascaded adaptive filter.

Pulse diagnosis is a convenient, inexpensive, painless, and non-invasive diagnosis method. Quantifying pulse diagnosis is to acquire and record pulse waveforms by a set of sensor firstly, and then analyze these pulse waveforms. However, respiration and artifact motion during pulse waveform acquisition can introduce baseline wander. It is necessary, therefore, to remove the pulse waveform's baseline wander in order to perform accurate pulse waveform analysis. This paper presents a wavelet-based cascaded adaptive filter (CAF) to remove the baseline wander of pulse waveform. To evaluate the level of baseline wander, we introduce a criterion: energy ratio (ER) of pulse waveform to its baseline wander. If the ER is more than a given threshold, the baseline wander can be removed only by cubic spline estimation; otherwise it must be filtered by, in sequence, discrete Meyer wavelet filter and the cubic spline estimation. Compared with traditional methods such as cubic spline estimation, morphology filter and Linear-phase finite impulse response (FIR) least-squares-error digital filter, the experimental results on 50 simulated and 500 real pulse signals demonstrate the power of CAF filter both in removing baseline wander and in preserving the diagnostic information of pulse waveforms. This CAF filter also can be used to remove the baseline wander of other physiological signals, such as ECG and so on.

Self-organizing arterial pressure pulse classification using neural networks: theoretical considerations and clinical applicability.

A self-organizing classification system for the arterial pressure pulse based on the ART2 (adaptive resonance theory) network was developed. The system consists of a preprocessor and an ART2 recognition network. The preprocessor removes the arterial pressure pulse servo component signals from Finapres, detects the systolic pressure points and divides the acquired signals into minimal cardiac cycles. The ART2 network input is the minimal cardiac cycle detected by the preprocessor. The classification results can be used to assist physicians in evaluating the signs of abnormal and normal autonomic control and has shown its clinical applicability for the examination of the autonomic nervous system.