bluuebunny/crossref_metadata_2025 huggingface dataset:
MEDICATION NON-ADHERENCE IN UNCONTROLLED HYPERTENSION: SELECTIVE DETECTION AND EFFICIENCY AND EFFECTIVENESS OF A PROGRAM TO IMPROVE COMPLIANCE (ATHAN TRIAL)
Authors: Oliveras Anna , Galceran Isabel , Camps Carme , Faura Anna , Pascual Sergi , Fontdevila Laia , Vazquez Susana
Published: June 2022

Objective:

To assess whether the implementation of a specific action plan to improve adherence for 3 months results in reduced peripheral 24h-systolic blood pressure (SBP) in patients with resistant hypertension (RH) or uncontrolled hypertension with at least 2 drugs.

Design and method:

Interventional, prospective, randomized, controlled, parallel groups, open study of patients consecutively attended in a specialized Hypertension Unit with ambulatory 24h-BP equal or more than 130 and/or 80mmHg although receiving at least 2 antihypertensive drugs. The partially or completely non-adherent patients (confirmed by determination of antihypertensive drugs in urine) were randomized (1: 1) to receive a specific program to improve adherence (intervention group) or routine follow-up (control group), with determination of antihypertensive drugs in urine, office-BP measurement and 24h-ambulatory BP monitoring at pre-randomization and 3 months.

Results:

Forty-three patients were randomized (mean age 59+/-14yr, 70% male). Mean+/-S.D. baseline SBP/DBP(mmHg) were 150.4+/-17.1 and 90.7+/-15.5, and the number of prescribed non-detected drugs in urine was 2+/-1.4. At 3 months, the variation of SBP-24 h for the intervention group and the control group was (mean[95%CI]) = -14.3 mmHg (-20.5 to -8.1), p < 0.001 and -3.3 mmHg (-10.2 to 3.7), p = 0.339, respectively. See table. At 3 months, the variation of the number of non-detected antihypertensive drugs in urine was (mean[95%CI]) = -1.29 mmHg (-2.06 to -0.53), p = 0.002 and -0.53 mmHg (-1.26 to 0.2), p = 0.144, respectively.

Conclusions:

A specific nursing intervention to improve therapeutic adherence results in an improvement of BP control in patients with difficult-to-control hypertension and inadequate therapeutic compliance.
HYPERTENSIVE CRISIS AT THE EMERGENCY DEPARTMENT OF A CENTRAL HOSPITAL
Authors: Leite Vanessa , Coelho Rita Passos , Abecasis Francisca , Beirão Pedro , Cunha Vitória
Published: June 2022

Objective:

Hypertension is a well-established cardiovascular risk factor. Its low control can progress to a hypertensive crisis (HC) and the emergency department (ED) is the first point of contact of these patients. This study’s aim was analyzing the profile and management of the patients presenting with HC at the ED of a central hospital in Portugal.

Design and method:

This study is descriptive and retrospective in nature, encompassing three months of adult patients admittances to the ED with symptomatic or asymptomatic hypertension (337 in total). We defined hypertension as blood pressure (BP) greater than or equal to 140/90mmHg and HC as BP greater than or equal to 180/110mmHg.

Results:

Patients presenting to the ED with elevated blood pressure were predominantly women (65%) aged over 60 years. BP values compatible with HC were found in 40,4% of cases. Hypertension was unknown to 13,3% of patients. Despite having previously diagnosed hypertension, 8,5% were not receiving any medication. At admission, headache (45,1%), nausea and dizziness (19,3%), and chest pain (17,2%) were the most frequent symptoms. About 18% were asymptomatic. 71% of patients with elevated BP were receiving treatment with antihypertensive drugs. All off those presenting with HC received pharmacological treatment. Angiotensin-converting enzyme inhibitor was the most used class (75%), followed by benzodiazepines (~52%). Regarding the evolution of the blood pressure in the ED, the majority of patients had controlled or lower blood pressure at the time of discharge. The outpatient antihypertensive medication was adjusted in 25,8% of cases. Adding another drug was the most common strategy (23%), followed by initiating a fixed drug combination (18,4%) or starting therapy with a single drug (15%). At a one-year follow-up, most of patients (90,5%) were not readmitted to the ED due to hypertension.

Conclusions:

Hypertension is still a common cause of admission to the ED, despite only 40% of cases representing real HC. The lack of uniform management at the ED, or after discharge, further demonstrates a missed opportunity to prevent future cardiovascular morbidity/mortality.
ADHERENCE TO ANTIHYPERTENSIVE DRUG TREATMENT IN BRAZIL: SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Coelho Juliana , Guimaraes Mayra , Dos Santos Juliano , Vaz Ana , Higa Camila , Alvisi Joyce , Lee Renata , Drager Luciano , Pierin Angela
Published: June 2022

Objective:

To assess the prevalence of adherence to antihypertensive drug treatment in Brazilian studies.

Design and method:

Systematic review and meta-analysis based on the recommendations of the PRISMA. The search period was from November 2020 to November 2021, in BDENF, SciELO, Cuiden, PsycINFO, CINAHL, Embase, LILACS, MEDLINE, AgeLine, Google Scholar and ScienceDirect academic search engines. Inclusion criteria were: studies carried out in Brazil, with adults, in Portuguese, English and Spanish, with no restriction on the year of publication and which indirectly assessed adherence to antihypertensive drug treatment with specific instruments. Exclusion criteria: studies with pregnant women that did not assess pharmacological adherence or did not consider the prevalence of pharmacological adherence exclusively for hypertension, studies that used the same database, review studies, theoretical and methodological articles, and gray literature were excluded. All steps were performed by two independent reviewers and a third reviewer was consulted in case of disagreement. The quality of the studies was assessed using an instrument adapted for cross-sectional studies and those with a high risk of bias were excluded from the meta-analysis. Descriptive analysis and meta-analysis were performed.

Results:

100 studies were included in the descriptive analysis and 98 in the meta-analysis of the prevalence. It was found that 89.00% were published in the last decade, in Nursing (37.00%) and Public Health (18.00%) journals. The most used instruments to assess adherence were the Morisky-Green Scale-4 item (59.00%) and the 8-item Morisky Medication Adherence Scale (15.00%). The adherence prevalence estimated according to the instruments were: Morisky-Green Scale-4 item 36.98% (95%CI: 32.11–42.13%); 8-item Morisky Medication Adherence Scale 38.88% (95%CI: 27.43–51.70%); Treatment Adherence Measure 74.11% (95%CI: 59.94–84.56%); Brief Medication Questionnaire 41.65% (95%CI: 29.33–55.11%); Drug Adherence Questionnaire-Qualiaids 49.43% (95%CI: 43.18–55.69%); Hypertension Treatment Adherence Questionnaire 88.38% (95%CI: 78.30–94.13%); Martín-Bayarre-Grade 30.55% (95%CI: 22.80–38.58%); and Primary Care Assessment Tool 89.12% (95%CI: 85.34–92.01%). The overall prevalence estimated by the meta-analysis was 43.47%, (95%CI: 38.47%-48.61%). There was great heterogeneity between studies, with prevalence values ranging from 5.7% to 94.7%.

Conclusions:

The prevalence of adherence found in Brazilian studies was low, demonstrating that this issue remains a global challenge.
ADHERENCE TO THE ANTIHYPERTENSIVE THERAPY – A VIEW FROM THE FAMILY MEDICINE PERSPECTIVE
Authors: Jug Juraj , Prkacin Ingrid
Published: June 2022

Objective:

To check adherence to the antihypertensive medication in patients with arterial hypertension and a possible impact of fixed-dose drug combinations, cardiovascular event in history, and diabetes on it.

Design and method:

In this cross-sectional study, every fifth patient with arterial hypertension in two family medicine practices in Zagreb, Croatia (found by Medicus search engine) was analyzed during February 2022. We included medical records of 210 patients (116 males, 94 females) from which we checked the number and type of used antihypertensive medication (single pill or fixed-dose drug combinations), statin use, diabetes type 2 or cardiovascular event in history, and the date of the last lab test results. The patient was considered adherent if she/he regularly ordered hers/his prescribed medication from January to December 2021. Chi-square and Student t-test were used for statistical analysis in Statistica 12.

Results:

There were no differences between genders. Women were slightly more adherent to the prescribed therapy than men (72.34 vs. 68.11%, P = 0.5076). Statins were prescribed in 65 (30.95%), fixed-dose combination in 139 (66.19%), 39 had diabetes (18.57%), and 28 patients had cardiovascular events in their medical history (13.33%). The adherence was not dependent on the patient’s age (66.75 vs. 66.64 years in adherent patients, P = 0.9509), the existence of diabetes (Chi2 = 1.093, 2, P = 0.2958) or previous cardiovascular event in medical history (Chi2 = 0.384, 2, P = 0.5351). Adherence correlated with the number of prescribed antihypertensive medications (r = 0.263; P < 0.05; and average 2.56 in adherent vs. 1.97 medication per day in non-adherent group, P < 0.001), especially if the therapy was in fixed-dose combination (Chi2 = 11.60, 2, P < 0.001). The age of the lab test results was less in adherent patients (1.25 vs. 1.86 years, P = 0.108). 116 patients (55.24%) had them in 2021, while 16 did not have any result in five and more years (7.14%).

Conclusions:

The adherence to antihypertensive therapy was similar between genders and correlated with the number of prescribed medications with significantly better results in patients with fixed-dose combinations. The existence of the previous cardiovascular event and type 2 diabetes did not show any benefit on this type of adherence.
PERCEIVED STRESS, DEPRESSION AND MEDICATION ADHERENCE AMONG HYPERTENSIVE PATIENTS ATTENDING A SECONDARY CARE HOSPITAL IN LAGOS, NIGERIA
Authors: Ajose Azeezat , Odukoya Oluwakemi Ololade , Akodu Babatunde
Published: June 2022

Objective:

Hypertension is a significant public health problem as it accounts for 19.2% of all deaths globally and 16.4% of all deaths in low- and middle-income countries. Poor medication adherence negatively impacts hypertension control and has been associated with negative self-care behavior such as seen in perceived stress and depression. This study sought to investigate the prevalence of perceived stress, depression, and their association with the level of medication adherence amongst hypertensive patients attending a secondary care hospital in Lagos, Nigeria.

Design and Methods: Descriptive cross-sectional design was adopted, and an interviewer-based questionnaire was administered for this study. Perceived stress, Depression and Medication Adherence were evaluated using the Perceived Stress Scale(PSS-10), Patient Health Questionnaire(PHQ-9) and Hill-Bone Compliance Scale. Data was analyzed by using Epi Info Version 7 and presented using frequency tables. T-test was used to compare continuous variables while the Chi-square and Fishers Exact test were used to compare categorical variables. Significance level was set at p < 0.05.

Results:

331 hypertensive patients (221 women, 66.8%) were included in this study (Mean age of 60.0 ± 13.9 years). 77% had average to high levels of perceived stress (PSS-10 score of > 12) while 55% had varying levels of depression. Mean score on Hill-Bone Compliance Scale was 20.1 ± 3.7. Income level, Number of drugs used daily were significantly associated with perceived stress (p < 0.05,p < 0.01). Younger age, Female Gender, Presence of co-morbidities and Number of drugs used daily were significantly associated with depression(p < 0.01,p < 0.05,p < 0.05,p < 0.01). Perceived stress and depression were significantly associated with lower levels of medication adherence (p < 0.05; p < 0.01).

Conclusion: This study lends credence to the idea that perceived stress and depression results in negative self-care behavior that adversely impacts medication adherence. Greater awareness of the potential for psychological distress in hypertensive patients must be emphasized to all physicians. Improving medication adherence rates requires collaborative care with intensified screening and appropriate management for social and psychological stressors.
VASCULAR STIFFNESS AS AN TARGET OF OPTIMAL ANTIHYPERTENSIVE THERAPY
Authors: Zbyshevskaya Elizaveta , Makeeva Tatiana , Gumerova Victoria , Erinchek Vadim
Published: June 2022

Objective:

To evaluate the 24-hour blood pressure (BP) control and the effect of the triple fixed combination (TFC) amlodipine / indapamide / perindopril on the arterial stiffness parameters according to 24-hour blood pressure monitoring (ABPM) data in patients with uncontrolled hypertension (HTN).

Design and method:

The study involved 78 patients with insufficient BP control, against the background of previous combination therapy. All patients received TFC amlodipine / indapamide / perindopril. The patient’s condition was assessed during 4 observation visits: visit 1- inclusion, visit 2 - 4 weeks, visit 3 -12 weeks, visit 4 - 24 weeks observation. At each visit, the achievement of the target BP level < 130/80 mm Hg was assessed, as well as the effect of therapy on the parameters of arterial stiffness (pulse wave velocity (PWVao), pulse pressure (PP), agumentation index (Aix), arterial stiffness index (ASI)) and central aortic pressure parameters (systolic aortic pressure (SBPao), diastolic pressure in the aorta (DBPao), central pulse pressure (PPao)) according to ABPM

Results:

In subjects with HTN with ineffective antihypertensive therapythe initial office BP was 160.8 ± 10.3 / 91.5 ± 8.1 mm Hg. After 24 weeks of therapy with a TFC there was a significant decrease in blood pressure to 121.3 ± 3.5 / 73.6 ± 4.2 mm Hg (p < 0.001). According to ABPM data, mean values of daily BP significantly (p < 0.001) decreased from 153.9 ± 9.04 / 8.38 ± 9.18 to 120.3 ± 4.7 / 73.4 ± 4.7 mm Hg. Data analysis showed a decrease PWVao (11.39 ± 1.32 m/s vs 9.98 ± 0.91 m/s, p < 0,05) as well as ASI (174 (138, 253) vs 139 (107.196) mmHg; p < 0.001) and Aix -29,9 (-41,12) vs - 33,7 (-53, 9) p < 0,05. There was a statistically significant decrease in the parameters the central pressure in the aorta (Fig.1)

Conclusions:

In patients with HTN and previous uneffective antihypertensive therapy the FTC amlodipine / indapamide / perindopril provided high antihypertensive effectiveness. Parameters of vascular stiffness can serve as criteria for quality control of blood pressure and can be used to assess the effectiveness of antihypertensive therapy.
APPROPRIATENESS OF CARDIOVASCULAR PREVENTIVE MEDICATION IN OLDER PEOPLE: A QUALITATIVE RAM-STUDY
Authors: Ploeg Milly Van Der , Poortvliet Rosalinde , Achterberg Wilco , Mooijaart Simon , Gussekloo Jacobijn , Drewes Yvonne
Published: June 2022

Objective:

In clinical practice and science, there is debate for which older adults the benefits of cardiovascular preventive medications (CPM) still outweigh the risks in older age. Therefore, we aimed to assess how various clinical characteristics influence the judgement of appropriateness of CPM (i.a. antihypertensive treatment) in older adults.

Design and method:

With the RAND/ University of California at Los Angeles appropriateness Method (RAM) the appropriateness of CPM for adults = > 75 year was assessed with regard to clinical characteristics (cardiovascular history, complexity of health problems, age, side-effects and life expectancy). A multi-disciplinary panel (n = 14 panelists) received an up to date overview of the literature, and judged the appropriateness of starting and stopping cholesterol lowering medication, antihypertensives, and platelet aggregation inhibitors, on 1- to 9 point Likert scales (1 = extremely inappropriate; 9 = extremely appropriate), for various clinical scenarios. There were two rating rounds, with one face-to-face discussion in between. The appropriateness judgments were based on the median panel rating and level of disagreement

Results:

The panelists emphasized the importance of the individual context of the patient for appropriateness of CPM. They judged that in general, a history of atherosclerotic cardiovascular disease (ASCVD) strongly adds to the appropriateness of CPM, while increasing complexity of health problems, presence of hindering or severe side-effects, and life expectancy < 1 year all contribute to the inappropriateness of CPM. Age had only minor influence on the appropriateness judgments. The appropriateness judgments were different for the three types of CPM. The literature, time-to-benefit, remaining life-expectancy, number needed to treat, and quality of life, were major themes in the panel discussions. The considerations to stop CPM were different from the considerations not to start CPM.

Conclusions:

Next to the patients’ individual context, which was considered decisive in the final decision to start or stop CPM, there were general trends of how clinical characteristics influenced the appropriateness, according to the multi-disciplinary panel. The decision to stop, and not start CPM, appeared to be two distinct concepts. Results of this study may be used in efforts to support clinical decision making about CPM in older adults.
EFFECT OF SACUBITRIL-VALSARTAN ON EARLY RENAL FUNCTION AND VASCULAR FUNCTION IN PATIENTS DURING PERIMENOPAUSE WITH HYPERTENSION
Authors: Pei Ying , Yu Jing
Published: June 2022

Objective:

To evaluate the effects of Sacubitril-Valsartan on early renal function and vascular function in patients during perimenopause with hypertension.

Design and method:

This study was a prospective, randomized, positive control and open label test. The subjects were 427 perimenopausal women (30–65 years old) with mild or moderate hypertension who were treated in the Department of Cardiovascular Medicine of the Second Hospital of Lanzhou University. They were randomly assigned to Sacubitril-Valsartan group (n = 165) or valsartan group (n = 262) for 24 weeks. Renal function, urinary renal function and vascular function were evaluated at baseline and 24 weeks after treatment.

Results:

There was no significant difference in the clinical baseline data between patients with sacubitril-valsartan and patients with valsartan (P> 0.05). Comparison of the systolic blood pressure (oSBP) and diastolic blood pressure(oDBP)before and after treatment: the baseline vs. 24-week difference between the sacubitril-valsartan group and the valsartan group was statistically significant (p < 0.001). The carotid-femoral pulse wave velocity (cfPWV) in the vascular function indexes of the sacubitril-valsartan group was significantly improved (p < 0.001). The improvement of valsartan group was not obvious. Other vascular function parameters such as cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) were not significantly improved in the two groups. Urinary microalbumin (MAU)was significantly improved in both blood renal function and urine renal function. The improvement was observed in the sacubitril-valsartan group (p < 0.001) and valsartan group (p = 0.027), but the improvement was stronger in the sacubitril-valsartan group (p < 0.001).

Conclusions:

Sacubictril-valsartan has a stronger antihypertensive effect than valsartan in patients during perimenopause with hypertension, and can improve MAU and cfPWV in patients.
ANTI-INFLAMMATORY EFFECTS AND PPAR GAMMA-ACTIVATING PROPERTIES OF TELMISARTAN IN PATIENTS WITH THE HYPERTENSION’S ON METABOLIC SYNDROME: METANALYSIS OF RCT
Authors: Greca Elona , Wireko Andrew Awauh , Abdul-Rahman Toufik , Kacimi Salah Eddine Ous
Published: June 2022

Objective:

Metabolic syndrome (MetS) is a collection of disorders including diabetes, hypertension, obesity, and dyslipidemia that increase the risk of cardiovascular diseases and mortality. Several studies have discovered that, in addition to its angiotensin receptor blocker activity, telmisartan is a partial agonist of peroxisome proliferator-activated receptor-gamma (PPAR-gamma), which is a nuclear receptor involved in the regulation of metabolic homeostasis. Evidence also exists that activators of PPAR-gamma exert anti-inflammatory, anti-oxidative, and antiproliferative effects on vascular walls. Therefore through PPAR-gamma modulating activity, telmisartan can be a valuable therapeutic agent for treating MetS.

Design and method:

he PubMed, EMBASE databases and Cochrane Central of Controlled Trials were searched through October 2021. We pooled data extracted from the included studies using the standardized mean difference (SMD). Study-specific estimates were combined using inverse variance-weighted averages of SMDs in both fixed- and random-effects models. Heterogeneity was evaluated using Cochran’s Q- and the I2-test. GRADE tool was used to assess the study’s quality. All analyses were conducted using StatsDirect statistical software Version 2.8.0.

Results:

A total of 582 patients were enrolled in the 11 included randomized clinical trials (RCTs). The pooled analysis revealed significant reduction in the percent changes of homeostasis model assessment index (HOMA) (SMD = -0.24; 95% CI: -0.40 to -0.07; p = 0.0036), changes of fasting glucose (mg/dL) (SMD = -0.49; 95% CI: -0.94 to 0.05; p = 0.0283), insulin (mU/mL) (SMD = -0.21; 95% CI: -0.38 to -0.05; p = 0.0084), and a significant increase in percent changes of adiponectin (umg/mL) (SMD = 0.63; 95% CI: 0.34 to 0.92; p < 0.0001),among patients with metabolic syndrome randomized to telmisartan versus control therapy. There was minimal trial heterogeneity in the analyses for HOMA index (I2 = 21.1%), insulin (I2 = 0%) and adiponectin levels (I2 = 0.1%). However, there was considerable heterogeneity in the analysis for fasting glucose (I2 = 83.6%).

Conclusions:

Our study suggests that PPAR-gamma modulating activity of telmisartan therapy has the potential to be a valuable therapeutic agent for treating MetS.
ANTI-INFLAMMATORY EFFECTS AND PEROXISOME PROLIFERATOR-ACTIVATED RECEPTOR GAMMA (PPAR GAMMA)-ACTIVATING PROPERTIES OF THE ANGIOTENSIN TYPE 1 RECEPTOR BLOCKER TELMISARTAN IN PATIENTS
Authors: Greca Elona , Wireko Andrew Awauh , Toufik Abdul-Rahman , Kacimi Salah Eddine Ous
Published: June 2022

Objective:

Metabolic syndrome (MetS) is a collection of disorders including diabetes, hypertension, obesity, and dyslipidemia that increase the risk of cardiovascular diseases and mortality. Several studies have discovered that, in addition to its angiotensin receptor blocker activity, telmisartan is a partial agonist of peroxisome proliferator-activated receptor-gamma (PPAR gamma), which is a nuclear receptor involved in the regulation of metabolic homeostasis. Evidence also exists that activators of PPAR exert anti-inflammatory, anti-oxidative, and anti proliferative effects on vascular walls. Therefore through PPAR gamma modulating activity, telmisartan can be a valuable agent for treating MetS.

Design and method:

The PubMed, EMBASE databases and Cochrane Central of Controlled Trials were searched through October 2021. We pooled data extracted from the included studies using the standardized mean difference (SMD). Study-specific estimates were combined using inverse variance-weighted averages of SMDs in both fixed- and random-effects models. Heterogeneity was evaluated using Cochran’s Q- and the I2-test. GRADE assess the study’s quality. All analyses were conducted using StatsDirect statistical software Version 2.8.0.

Results:

A total of 582 patients were enrolled in the 11 included randomized clinical trials (RCTs). The pooled analysis revealed significant reduction in the percent changes of homeostasis model assessment index (HOMA) (SMD = -0.24; 95% CI: -0.40 to -0.07; p = 0.0036), changes of fasting glucose (mg/dL) (SMD = -0.49; 95% CI: -0.94 to 0.05; p = 0.0283), insulin (mU/mL) (SMD = -0.21; 95% CI: -0.38 to -0.05; p = 0.0084), and a significant increase in percent changes of adiponectin (umg/mL) (SMD = 0.63; 95% CI: 0.34 to 0.92; p < 0.0001),among patients with metabolic syndrome randomized to telmisartan versus control therapy. There was minimal trial heterogeneity in the analyses for HOMA index (I2 = 21.1%), insulin (I2 = 0%) and adiponectin levels (I2 = 0.1%). However, there was considerable heterogeneity in the analysis for fasting glucose (I2 = 83.6%).

Conclusions:

Our study suggests that the PPAR gamma modulating activity of telmisartan has the potential to be a valuable therapeutic agent for treating MetS.
BLOOD PRESSURE TARGETS AND MORTALITY IN HYPERTENSIVE PATIENTS WITH CHRONIC RENAL DISEASE. SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Méndez Iván , Saiz Luis Carlos , Leache Leire , Gutierrez Marta , Pijoan José Ignacio , Menéndez-Orenga Miguel , Salzwedel Douglas M. , Erviti Juan
Published: June 2022

Objective:

To compare the effects of intensive vs standard blood pressure (BP) targets on the mortality of hypertensive patients with chronic renal disease.

Design and method:

A bibliographic search of all relevant databases was carried out without restriction by language, year of publication or publication status.

We considered randomized controlled clinical trials on patients older than 18 years, diagnosed with hypertension and chronic renal disease who were allocated to either “intensive’’ BP target (less than or equal to 130/80 mmHg) or “standard’’ BP target (less than or equal to 140–160/90–100 mmHg). Additionally, trials should include more than 50 participants per group followed during at least one year. Trials were not limited by any concomitant disease or baseline cardiovascular risk.

We contacted trials’ authors to obtain Individual Patient Data and, if necessary, extracted information from chronic renal patients.

COVIDENCE software was used for screening, the Cochrane Review Manager (RevMan web) for data synthesis and analysis, and the Cochrane Risk of Bias Tool (ROB2) to assess the risk of bias for each trial.

Results:

A total of 2298 records were identified by the bibliographic search. We obtained the full text of 29 publications from the pre-selected studies. Of these, six studies met the inclusion criteria and we obtained Individual Patient Data for all of them (AASK, SPRINT, HOT, ACCORD BP, MDRD, SPS3).

There was no statistically significant difference in total mortality between the intensive and standard blood pressure target groups (RR 0.92, 95%CI 0.75–1.13, p = 0.42, 6 studies, 7,348 participants). In absolute terms, there were 5 additional deaths per 1000 participants in the standard target group (95% CI: 6 fewer to 16 more deaths per 1000 participants). Overall deaths were 227/3352 (6.8%) in the intensive target group vs 285/3996 (7.9%) in the standard target group (Figure).

The quality of evidence was moderate according to the GRADE assessment.

Conclusions:

Intensive blood pressure lowering targets in patients with arterial hypertension and chronic renal disease do not result in lower mortality compared to standard blood pressure lowering.
Understanding attributes and characteristics of the PA leader-physician relationship
Authors: Louwagie Victoria , Ness Becky , O'Laughlin Danielle , Fisher Karen , Halasy Michael
Published: June 2022

Purpose:

This study sought to evaluate the attributes and characteristics of physician mentors, dual-roled physician assistant (PA) leaders, and how this relationship affects PA leaders and the PA leader-physician relationship. Dual-role PA leaders may possess additional formal job titles and duties as well as having direct reports.

Method:

We surveyed PA leaders at a single large academic medical center and its associated health system. The survey instrument evaluated perceptions, attitudes, and characteristics of the PA leader and influential physician and their relationship.

Results:

Of the 56 PA leaders surveyed, 34 responded, for a 60.7% response rate. Effective communication was the most prevalent relational characteristic ranked as most important for both PA leaders (30%) and physician mentors (36%). Additional self-identified positive attributes of the team included collaborative mindset, reliability/trustworthiness, work ethic, and delivery of patient care. Influential physician mentors may have a significant effect on PA leader job satisfaction and career advancement.

Conclusions:

This is a novel study of PA leaders examining perceptions, beliefs, and characteristics of the PA leader-physician relationship. PAs are integral healthcare team members and medical providers. As PAs work closely in physician-led teams, further understanding the PA leader-physician relationship could influence PA and physician professional development, career trajectory, and healthcare team outcomes.
Arthroscopic Management for Carpometacarpal Boss of Third Joint and Synovectomy: Technique and Case Report
Authors: Rezende Luis G.R.A. , Shimaoka Filipe J. , Mandarano-Filho Luiz G. , Mazzer Nilton
Published: June 2022

The carpometacarpal boss (CMCB) is painful bony prominence in the dorsum of the hand that can lead to functional and aesthetic impairment. Nonoperative methods are the management of choice, achieving good outcomes. However, operative management could be an alternative in the absence of improvement. Nevertheless, open procedures are more likely to be done, but there are complications, and it is more aggressive to the soft tissue. The use of arthroscopic techniques has increased in the last decade, being a safe alternative for CMCB management. It has the advantage of being a minimally invasive technique, allowing the early range of motion. This minimally invasive method allows synovectomy and preserves tendon attachments, achieving good functional outcomes. This case report presents an arthroscopic technique for managing the middle finger CMCB.
Loop Anchor Tension Band Fixation for Olecranon Fractures and Chevron Olecranon Osteotomy
Authors: Ho Wei , Yao Shu-Hsin , Chen Chun-Ho
Published: June 2022

Although tension band wiring is effective for treating olecranon fractures, it is associated with a high reoperation rate because of hardware-related problems. The loop anchor tension band technique is a novel modification of the Arbeitsgemeinschaft für Osteosynthesefragen (AO)-modified tension band wiring technique. This technique is suitable for treating olecranon fractures without severe comminution and olecranon osteotomy. In the current case series, 2 intramedullary 1.25-mm Kirschner wires (K wires) were inserted as temporary fixation into the ulnar shaft from the olecranon after anatomical reduction. The proximal end of each K-wire was bent into a loop shape and advanced deep into the triceps tendon. A transverse hole was drilled distal to the fracture site, and a 1.0-mm metal wire was passed through the bone tunnel and the loops. The wire was tightened to form a figure-of-eight tension band construct. In total, 10 patients with a mean age of 49 (range: 19 to 85) years were included in this pilot series. The mean and minimum follow-up periods were 13.9 and 12 months, respectively. All fractures achieved favorable union, both radiographically and clinically. The mean QuickDASH score was 15.4 (range: 13.6 to 18.2) and the mean Mayo elbow performance score was 94 (range: 85 to 100). None of the patients experienced K-wire migration. The loop anchor tension band technique is a simple, cost effective modification of conventional tension band wiring and exhibited no implant migration in a pilot series.
Single-stage Congenital Polysyndactyly Release: Outcomes and Long-term Followup
Authors: Nazerani Shahram , Nazerani Tina , Keramati Mohammad Reza
Published: June 2022

The current surgical strategy for syndactyly is multistage operations in which every other web is released, leaving adjacent webs unoperated for the next stage to avoid a presumed possible digital vascular compromise. In this series, we present our experience with single-stage multiple syndactylies release. A total of 7 patients, including 2 patients with bilateral hand involvement, were included. Dorsal and volar triangular flaps were created for commissure reconstruction, and zigzag manner volar and dorsal incisions were made to release the webbed fingers. Sterile thermoplastic splints were molded directly over the skin grafts without any dressing or tie-over. Following the surgical operation, minimal flexion contracture was seen in three patients that needed future correction procedures. Cosmesis and functional outcome were acceptable. This study shows that the release of all webs in 1 setting can be accomplished by no vascular compromise, and there is no need for a preoperative vascular imaging study.
Ulnar Superficial Slip Resection for Resistant Trigger Finger: A Minimally Invasive Technique
Authors: Azarpira Mohammadreza , Asmar Ghada , Falcone Marc-Olivier
Published: June 2022

Primary trigger finger is a common hand disorder for which nonoperative treatment or release of A1 pulley is usually effective. For resistant or recurrent cases, there are different surgical techniques including partial or complete opening of A2 pulley, reduction tenoplasty, and resection of the ulnar slip of the flexor digitorum superficialis tendon. Here, we present our minimally invasive technique for ulnar superficial slip resection surgery. Our indications are the patients with persistent residual proximal interphalangeal joint contracture after A1 pulley release and also the recurrent cases. Then, we report the clinical outcomes of our patients operated using this technique.
Professional Coaching as a Continuing Professional Development Intervention to Address the Physician Distress Epidemic
Authors: Boet Sylvain , Etherington Cole , Andreas Cecile , Denis-LeBlanc Manon
Published: June 2022

Physician distress and burnout are reaching epidemic proportions, threatening physicians' capacities to develop and maintain competencies in the face of the increasingly demanding and complex realities of medical practice in today's world. In this article, we suggest that coaching should be considered both a continuing professional development intervention as well as an integral part of a balanced and proactive solution to physician distress and burnout. Unlike other interventions, coaching is intended to help individuals gain clarity in their life, rather than to treat a mental health condition or to provide advice, support, guidance, or knowledge/skills. Certified coaches are trained to help individuals discover solutions to complex problems and facilitate decision-making about what is needed to build and maintain capacity and take action. Across many sectors, coaching has been shown to enhance performance and reduce vulnerability to distress and burnout, but it has yet to be systematically implemented in medicine. By empowering physicians to discover and implement solutions to challenges, regain control over their lives, and act according to their own values, coaching can position physicians to become leaders and advocates for system-level change, while simultaneously prioritizing their own well-being.
Nonoperative Management Following Complete Response in Rectal Cancer After Short-course Radiation Therapy and Consolidation Chemotherapy
Authors: Reddy Abhinav V. , Safar Bashar , Jia Angela Y. , Azad Nilofer S. , Christenson Eric S. , Atallah Chady , Efron Jonathan E. , Gearhart Susan L. , Zaheer Atif , Narang Amol K. , Meyer Jeffrey
Published: June 2022

Purpose:

The purpose of his study was to report on a cohort of patients managed with nonoperative management (NOM) with a watch-and-wait strategy after achieving complete response (CR) to sequential short-course radiation therapy (SCRT) and consolidation chemotherapy.

Methods:

This was a retrospective study of patients treated SCRT and chemotherapy who achieved a CR and were managed with NOM. Bowel function was assessed with European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30, EORTC Quality of Life Questionnaire-Colorectal Cancer 29, and the low anterior resection syndrome (LARS) questionnaires. Endpoints included overall survival (OS), freedom from local failure (FFLF), freedom from distant metastasis, and disease-free survival (DFS).

Results:

Twenty-six patients met inclusion criteria. Seven (26.9%) patients developed local failure at a median of 6.8 months following CR, of which 5 were successfully salvaged. Median FFLF was not reached, with 6-month, 1-, and 2-year FFLF rates of 100.0%, 82.3%, and 71.3%. Median OS was not reached, with 6-month, 1-, and 2-year OS rates of 100%. Median DFS was not reached, with 6-month, 1-, and 2-year DFS rates of 100%, 95.0%, and 89.4%. Questionnaire response rate was 83.3%. Median LARS score was 27. Major, minor, and no LARS occurred in 3 (20%), 6 (40%), and 6 (40%) patients, respectively. There were no differences in questionnaire scores between patients who had the majority of their anal sphincter complex irradiated and those who did not.

Conclusion:

NOM with a watch-and-wait strategy is safe and feasible in patients with locally advanced rectal cancer who achieve CR after sequential SCRT and chemotherapy, with evidence for good anorectal function.
A Practical Method for EPR Dosimetry Using Alanine Powder
Authors: Hassan Amna , Tzivaki Margarita , Felner Lukas , Waller Edward
Published: June 2022

This work investigates alanine powder, an inexpensive and versatile material compared to alanine pellets, as a standardized dosimeter for the alanine-EPR system using a Bruker EMX-Micro spectrometer. The feasibility of this method was investigated, and a calibration curve was produced using 40 dosimeters, which were prepared by tightly packing DL-alanine powder in polypropylene microcentrifuge tubes. The dosimeters were irradiated to doses ranging from 0.2–20 Gy using a 60Co source. A dosimeter handling and measurement protocol was established for all dosimeters. The dosimetric signal was evaluated by measuring the peak-to-peak height of the central resonance peak, and the dose response of alanine powder dosimeters showed a linear behavior in the investigated dose range with relative errors below 13%. Measurement repeatability and reproducibility were tested to show the errors associated with sample placement in the cavity and with the overall measurement method, with both tests showing relative errors below 7%. As an inexpensive material compared to pellet dosimeters, alanine powder has a strong potential to be used as a standardized material for radiation dosimetry applications. The scope of this work is to present an effective and comprehensive methodology with accompanying analysis scripts for dosimetry with alanine powder that is useful in a wide range of applications and dose requirements.
Short-Term Efficacy and Safety of Open Conjunctiva Ab Externo XEN45 Gel Stent Implantation in Glaucoma Patients
Authors: Thatcher Mitchell D. , Coupal Dustin J. , Cheng Yanzhao , Podbielski Dominik W.
Published: June 2022

Précis:

We examined the safety and efficacy of the open conjunctiva ab externo approach for XEN45 gel stent implantation. There was a significant reduction in intraocular pressure (IOP) and number of glaucoma medications at 12 months follow-up.

Purpose:

This study aims to determine the safety and efficacy of the open conjunctiva ab externo approach to XEN45 stent implantation.

Materials and Methods:

Retrospective chart review of all patients between July 2018 and March 2020 who underwent XEN45 implantation. IOP and the number of glaucoma medications were measured at the preoperative, 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperative appointments. The primary outcome of this study is the number of cases achieving complete success at 12 months postoperatively.

Results:

Forty-four eyes of 44 patients were included. Mean preoperative IOP was 26.2±8.7 mm Hg on 3.2±0.7 IOP-lowering medications. At 12 months postoperative, mean IOP was 18.9±9.1 mm Hg (n=35, P<0.0001; mean reduction of 27.9%) on 0.9±1.4 (n=35, P<0.0001) IOP-lowering medications. Postoperative needling was performed in 5 cases (11.4%). Of the 35 cases with a postoperative visit at 12 months, complete success was achieved in 14 cases (40.0%) and qualified success in 3 cases (8.6%). Eighteen cases (51.4%) were recorded as failures at 12 months, comprised of 4 cases requiring reoperation for glaucoma (2 XEN45 implants, 1 trabeculectomy, and 1 Baerveldt implant), and 14 cases that did not meet the IOP-lowering criteria for success. During the postoperative course, there was 1 case of self-limited hypotony, 2 self-resolving choroidal effusions, and 3 cases of bleb leakage.

Conclusions:

The open conjunctiva ab externo approach to XEN45 implantation achieved successful levels of IOP reduction in 48.6% of glaucoma cases within the first year. The most common adverse events included the need for additional glaucoma surgery (excluding needling procedures), transient hypotony, and bleb leak.
Neural mechanisms underlying the conditioned pain modulation response: a narrative review of neuroimaging studies
Authors: Nahman-Averbuch Hadas , Timmers Inge
Published: June 2022

Processing spatially distributed nociceptive information is critical for survival. The conditioned pain modulation (CPM) response has become a common psychophysical test to examine pain modulation capabilities related to spatial filtering of nociceptive information. Neuroimaging studies have been conducted to elucidate the neural mechanisms underlying the CPM response in health and chronic pain states, yet their findings have not been critically reviewed and synthesized before. This narrative review presents a simplified overview of MRI methodology in relation to CPM assessments and summarizes the findings of neuroimaging studies on the CPM response. The summary includes functional MRI studies assessing CPM responses during scanning as well as functional and structural MRI studies correlating indices with CPM responses assessed outside of the scanner. The findings are discussed in relation to the suggested mechanisms for the CPM response. A better understanding of neural mechanisms underlying spatial processing of nociceptive information could advance both pain research and clinical use of the CPM response as a marker or a treatment target.
The Role of Bronchoscopy in the Management of Children With Cystic Fibrosis
Authors: Tosco Antonella , Poli Piercarlo , Casale Alida , De Gregorio Fabiola , Sepe Angela , Buonpensiero Paolo , Di Pasqua Antonio , Castaldo Alice , Cimbalo Chiara , Buzzetti Roberto , Raia Valeria , Berlucchi Marco , Timpano Silviana , Badolato Raffaele , Padoan Rita , Orlando Claudio
Published: June 2022

Background:

Currently, no consensus guidelines recommend routine bronchoscopy procedure in cystic fibrosis (CF), as no evidence is available concerning its use as either a diagnostic or therapeutic tool. Its efficacy is controversial, and no randomized controlled prospective trials are available to check its effectiveness. The aims of the present study were to evaluate the effectiveness of bronchoscopy as a diagnostic/therapeutic tool in CF children and adolescents; and to verify the effect of serial bronchoscopy on lung disease progression in subjects with CF not responding to a single procedure.

Methods:

Data of patients who received bronchoscopy at 2 Italian CF centers were collected. Bronchoalveolar lavage was performed during the procedure including airway clearance with mucolytics, inhaled antibiotics, and/or surfactant instillation.

Results:

A total of 16 patients in center 1 and 17 in center 2 underwent, respectively, 28 and 23 bronchoscopic procedure in the study period. Five patients in each center underwent >1 procedure. All procedures were generally well tolerated. No patient required admission to the pediatric intensive therapy unit. In 19.6% of bronchoalveolar lavages, growth of Aspergillus fumigatus was evident, although not detected by sputum analyses. After the procedure, an increase in mean percent predicted forced expiratory volume in the 1 second >10% was observed, and a significant decrease in pulmonary exacerbations yearly was evident.

Conclusion:

Based on the results, we suggest bronchoscopy is not to be considered an obsolete tool, and it remains useful in CF management, although in selected cases. We encourage to support longitudinal observational studies to standardize the procedure, focusing on the choice of drugs to be instilled, modalities and timing of serial bronchoscopy and subsequent follow-up in selected severe clinical conditions.
Clinical Features of Pancreatic Neuroendocrine Microadenoma
Authors: Okawa Yuki , Tsuchikawa Takahiro , Hatanaka Kanako C. , Matsui Aya , Tanaka Kimitaka , Nakanishi Yoshitsugu , Asano Toshimichi , Noji Takehiro , Nakamura Toru , Mitsuhashi Tomoko , Okamura Keisuke , Hatanaka Yutaka , Hirano Satoshi
Published: June 2022

Objectives

Pancreatic neuroendocrine microadenoma (NEMA) is a nonfunctioning neuroendocrine tumor of less than 5 mm. Most studies of NEMA were based on autopsies, and few reports have revealed the clinical frequency of NEMA. We investigated the clinicopathological features of NEMA.

Methods

The pathological results of the pancreatic resection specimens of patients, older than 18 years, who underwent pancreatic resection at Hokkaido University Hospital between April 2008 and December 2020 were retrospectively reviewed. The NEMAs were re-examined in detail and examined by immunohistochemical staining.

Results

Among 850 patients enrolled in this study, 24 NEMAs were identified in 12 patients (1.4%). Of the 12 patients, 2 patients had multiple endocrine neoplasia type 1, and the others had no hereditary disease, including 2 patients with multiple NEMAs. A difference in the number of NEMA was observed between patients with multiple endocrine neoplasia type 1 and sporadic NEMA. Intratumoral Ki-67 heterogeneity was correlated with the Ki-67 index. One grade 2 NEMA (Ki-67 index, 4.6%) was detected, but ATRX and DAXX labeling showed intact nuclear protein expression.

Conclusions

Multiple sporadic NEMAs and grade 2 NEMAs were observed, suggesting that NEMA may have malignant potential. Thus, NEMAs should be carefully monitored for lymph node metastasis and postoperative recurrence.
Successful Treatment With Everolimus for Multifocal Lymphangioendotheliomatosis With Thrombocytopenia in an Infant
Authors: Hoshino Yusuke , Arai Junichi , Kato Keisuke , Tagawa Manabu
Published: June 2022

Multifocal lymphangioendotheliomatosis with thrombocytopenia (MLT) is a rare disease characterized by the presence of multiple cutaneous lesions and bleeding from the gastrointestinal tract with thrombocytopenia. Because of the varied phenotypes and rarity of MLT, a treatment strategy has not been standardized thus far. We describe a case of infantile MLT that did not respond to treatment with propranolol, prednisolone, or vincristine. We successfully treated the patient with everolimus, an inhibitor of the mammalian target of rapamycin. Our case provides the first evidence of the effectiveness of everolimus for the treatment of MLT.