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Update on Pulmonary Embolism: Guideline-Based Diagnosis and Therapy of an Exemplary Case

Pulmonary embolism (PE)-related mortality is decreasing worldwide.Little is known about the burden imposed by pulmonary embolism for Germany, Austria and Switzerland (DACH countries).We aimed to assess pulmonary embolism-related mortality and time trends for the DACH countries based on data from the WHO Mortality Database. Deaths were considered pulmonary embolism-related if the International Classification of Disease-10 code for acute pulmonary embolism or any code for deep or superficial vein thrombosis was listed as the primary cause of death.Between 2000 and 2015, age-standardized annual pulmonary embolism-related mortality rates decreased linearly from 15.6 to 7.8 deaths per 1000 population. In the 5‑year period between 2012 and 2016, an average of 9127 pulmonary embolism-related deaths occurred annually in the DACH countries with a population of 98,273,329. Interestingly, pulmonary embolism-related mortality rates were considerably higher among women aged 15-55 years compared to age-matched men.The observed decreasing trends in pulmonary embolism-related mortality might reflect improved management of the disease including new treatment options as well as advances in imaging technologies. However, pulmonary embolism remains a substantial contributor to total mortality, especially among women aged 15-55 years. For this reason, campaigns to increase physician and public awareness are urgently required to further improve the management and treatment of this preventable thrombotic disorder, which still remains the leading preventable cause of death.HINTERGRUND: Kürzlich veröffentliche Studien zeigen eine steigende Inzidenz für die Lungenarterienembolie (LE) bei gleichzeitigem Rückgangs der LE-assoziierten Mortalität.Detaillierte Daten zur Mortalität der LE in Deutschland, Österreich und der Schweiz (DACH-Region) sind derzeit nicht vorhanden.Datensätze wurden aus der Mortalitätsdatenbank der Weltgesundheitsorganisation (WHO) ausgewertet. Hierbei analysierten wir die Häufigkeit sowohl der akuten LE als auch der tiefen/oberflächlichen Venenthrombose als primärer Todesursache.Demnach sank die jährliche altersstandardisierte Mortalität zwischen Januar 2000 und Dezember 2015 von 15,6 auf 7,8 Todesfälle pro 1000 Einwohner. Zwischen Januar 2012 und Dezember 2016 ereigneten sich in der DACH-Region (Bevölkerungsanzahl: 98.273.320 Menschen) durchschnittlich 9127 durch LE verursache Todesfälle pro Jahr. Interessanterweise ist LE–assoziierte Gesamtmortalität bei Frauen zwischen dem 15. und 55. Lebensjahr deutlich höher als bei gleichaltrigen Männern.Der Rückgang der Mortalität durch die Erkrankung LE seit dem Jahr 2000 ist vermutlich durch eine verbesserte Patientenversorgung mit Einführung neuer Antikoagulanzien und durch den vermehrten Einsatz und diagnostischen Fortschritt bei den computertomographischen Untersuchungen erklärt. Festzuhalten ist, dass die LE eine wichtige Todesursache vor allem im höheren Alter darstellt. Außerdem ist der Anteil der Frauen im gebärfähigen Alter, die nach einer akuten LE sterben, mit 3,5 % hoch. Daher sind, trotz des medizinischen Fortschritts, weitere Anstrengungen für eine Verbesserung der Prävention, Diagnostik und Therapie, aber insbesondere auch des Krankheitsbewusstseins notwendig.

This paper shows how to reduce evaluation time for context inference. Probabilistic Context Inference has proven to be a good representation of the physical reality with uncertain or missing information, giving with the probability also a measure of the quality of information. As the inference complexity is very high, the complexity of the to be evaluated rule (representing a share of the real world) should be reduced as far as possible. Therefore we present an approach to select only relevant values of context types and to adapt this selection during its usage time. A short proof of concept indicates that both targets, reducing inference time and maintaining quality of information, can be reached with the proposed approach.

This paper shows how to reduce evaluation time for context inference. Probabilistic Context Inference has proven to be more powerful and better adapted to the challenges of the physical reality with uncertain or missing information. As the inference complexity is very high, the complexity of the to be evaluated rule (representing a share of the real world) should be reduced as far as possible. Therefore we present an approach to select only relevant values of context types and to adapt this selection during its usage time. In an evaluation we show that with only a few evaluations of the reduced inference rules the reduction costs will have amortized and the system brings significant benefit to context aware computing.

The somatic, psychological and psychosocial findings in a boy with psychosocial dwarfism are presented in a 7-year follow-up report. The positive development achieved by the change of environment is described, particularly a catch-up growth from far below the 3rd percentile up to the 25th percentile.