bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors and development of machine learning diagnostic models for lateral lymph node metastasis in rectal cancer: multicentre study
Authors: Kasai Shunsuke , Shiomi Akio , Shimizu Hideyuki , Aoba Monami , Kinugasa Yusuke , Miura Takuya , Uehara Kay , Watanabe Jun , Kawai Kazushige , Ajioka Yoichi
Published: July 2024

Background

The diagnostic criteria for lateral lymph node metastasis in rectal cancer have not been established. This research aimed to investigate the risk factors for lateral lymph node metastasis and develop machine learning models combining these risk factors to improve the diagnostic performance of standard imaging.

Method

This multicentre prospective study included patients who underwent lateral lymph node dissection without preoperative treatment for rectal cancer between 2017 and 2019 in 15 Japanese institutions. First, preoperative clinicopathological factors and magnetic resonance imaging findings were evaluated using multivariable analyses for their correlation with lateral lymph node metastasis. Next, machine learning diagnostic models for lateral lymph node metastasis were developed combining these risk factors. The models were tested in a training set and in an internal validation cohort and their diagnostic performance was tested using receiver operating characteristic curve analyses.

Results

Of 212 rectal cancers, 122 patients were selected, including 232 lateral pelvic sides, 30 sides of which had pathological lateral lymph node metastasis. Multivariable analysis revealed that poorly differentiated/mucinous adenocarcinoma, extramural vascular invasion, tumour deposit and a short-axis diameter of lateral lymph node ≥ 6.0 mm were independent risk factors for lateral lymph node metastasis. Patients were randomly divided into a training cohort (139 sides) and a test cohort (93 sides) and machine learning models were computed on the basis of a combination of significant features (including: histological type, extramural vascular invasion, tumour deposit, short- and long-axis diameter of lateral lymph node, body mass index, serum carcinoembryonic antigen level, cT, cN, cM, irregular border and mixed signal intensity). The top three models with the highest sensitivity in the training cohort were as follows: support vector machine (sensitivity, 1.000; specificity, 0.773), light gradient boosting machine (sensitivity, 0.950; specificity, 0.918) and ensemble learning (sensitivity, 0.950; specificity, 0.917). The diagnostic performances of these models in the test cohort were as follows: support vector machine (sensitivity, 0.750; specificity, 0.667), light gradient boosting machine (sensitivity, 0.500; specificity, 0.852) and ensemble learning (sensitivity, 0.667; specificity, 0.864).

Conclusion

Machine learning models combining multiple risk factors can contribute to improving diagnostic performance of lateral lymph node metastasis.
Disentangling genetic risks for development and progression of Alzheimer’s disease
Authors: Mattsson-Carlgren Niklas
Published: July 2024

This scientific commentary refers to ‘Towards cascading genetic risk in Alzheimer’s disease’ by Altmann et al. (https://doi.org/10.1093/brain/awae176).
New scenarios for training in oral radiology: clinical performance and predoctoral students' perception of 3D-printed mannequins
Authors: de Mello Wislem Miranda , Dutra Vinícius , Maracci Lucas Machado , Savegnago Gleica Dal’ Ongaro , Serpa Geraldo Fagundes , Liedke Gabriela Salatino
Published: July 2024

Objectives

This study aimed to evaluate the impact of 3D-printed mannequins on the training of predoctoral students.

Methods

Two 3D-printed training models were developed: a traditional model that simulates a sound adult patient and a customized model with pathological and physiological changes (impacted third molar and edentulous region). Students accomplished their pre-clinical training divided into a control group (CG, n = 23), which had access to the traditional model, and a test group (TG, n = 20), which had access to both models. Afterward, they performed a full mouth series on patients and filled out a perception questionnaire. Radiographs were evaluated for technical parameters. Descriptive statistics and the Mann-Whitney test were used to compare the groups.

Results

Students provided positive feedback regarding the use of 3D printing. The TG reported a more realistic training experience than the CG (P = .037). Both groups demonstrated good clinical performance (CG = 7.41; TG = 7.52), and no significant differences were observed between them.

Conclusions

3D printing is an option for producing simulators for pre-clinical training in Oral Radiology, reducing student stress and increasing confidence during clinical care.
Very late Magmaris scaffold restenosis: a 6-year serial optical coherence tomography case report
Authors: Trøan Jens , Hansen Kirstine Nørregaard , Noori Manijeh , Lassen Jens Flensted , Jensen Lisette Okkels
Published: July 2024

Background

Bioresorbable scaffolds (BRS) have been proposed as an alternative to drug-eluting stents (DES), offering radial support during the early phases of healing, while potentially reducing the risk of long-term complications. A magnesium-based BRS (MgBRS) has shown promising results after implantation. However, there is a lack of knowledge regarding the long-term outcomes.

Case summary

A 62-year-old man with hypertension, dyslipidaemia, family history of ischaemic heart disease, and previous myocardial infarction, presented with non-ST-elevation myocardial infarction (NSTEMI). Six years prior, he also had a NSTEMI and a mid-left anterior descending artery (LAD) lesion was treated with a 3.0/25 mm MgBRS. Post-implantation optical coherence tomography (OCT) revealed proximal edge dissection, and a second MgBRS 3.0/15 mm was implanted. Optical coherence tomography of the scaffold-treated segment was performed after 6 and 12 months with no sign of restenosis. The current angiogram showed a restenosis in the previously MgBRS-treated segment in LAD. Optical coherence tomography showed a plaque rupture in a thin cap fibro-atheroma and scaffold remnants. The lesion was pre-dilated and stented with a 3.0/20 mm DES and post-dilated with a 3.5 mm non-compliant balloon.

Discussion

Most cases of late scaffold failure showed acquired mal-apposition, which also can be related to the degrading process, or uncovered struts, none of which were seen in our case at 6 or 12 months. This case represents an insight into the vascular healing and potential mechanisms for failure of the MgBRS, with serial OCT recording at implantation, and after 6 months, 12 months, and 6 years.
A comparison of symptoms of anxiety and depression in patients with a primary and secondary prophylactic indication for an implantable cardioverter defibrillator. [Data from the ACQUIRE-ICD RCT]
Authors: Frydensberg V S , Skov O , Moller S M , Skovbakke S J , Vinther M , Melchior T M , Nielsen J C , Riahi S , Johansen J B , Pedersen S S P
Published: July 2024

Introduction

Indication for the implantable cardioverter defibrillator (ICD) is either primary or secondary prophylactic. Symptoms of anxiety and depression are known to be evident in patients with an ICD. However, research has not shown agreement in whether there is a difference in the degree of symptoms in these two indication groups.

Purpose

We investigated the association between anxiety and depression and indication for ICD from implantation and up to 24 months of follow-up.

Methods

Data was derived from a national randomized controlled trial the "Web-based healthcare innovation to advance the quality of life and care of patients with an implantable cardioverter defibrillator [ACQUIRE-ICD]" to perform a secondary analysis. A total of 478 patients with a first-time ICD were included and completed the Generalized Anxiety Disorder Assessment (GAD-7) and the Patient Health Questionnaire (PHQ-9) after ICD implantation and at 6, 12 and 24 months. Mixed effects regression models and estimated marginal means were used to analyze longitudinal data.

Results

Anxiety mean scores did not differ statistically between patients with a primary prophylactic ICD as compared to patients with a secondary prophylactic ICD. Most patients showed limited symptoms of anxiety. However, 9% reported values above the cut-off for clinical relevant anxiety.

Depression mean scores were significantly higher at 24 months in patients with primary prophylactic ICD as compared to patients with a secondary prophylactic ICD (mean 4.15 vs. 3.05; p=0.014) but not statistically significant at other time points. Most patients showed limited levels of depression. However, 13.2% reported values above the cut-off for clinical relevant depression. Both anxiety and depression scores decreased over time from baseline in both groups.

Conclusion

Patients with a primary prophylactic ICD did not differ in symptoms of anxiety and had mostly the same level of depression as compared to patients with a secondary prophylactic ICD. However, at 24 months patients with a primary prophylactic ICD reported more symptoms of depression as compared to patients with a secondary prophylactic ICD.Table 1
Treatment paths and resources used for patients with a left ventricular assist device: an Italian survey
Authors: Trenta A M , Gemelli J , Luciani M , Ausili D
Published: July 2024

Background

The number of people with end-stage Heart Failure implanted with a Left Ventricular Assist Device (LVAD) is constantly increasing, demanding hospitals to develop new and specific treatment paths. No previous studies described services and treatments available for these patients at national level. Knowing how hospitals organize their resources in order to meet patients’ need would be useful to standardize and improve care offered to this population.

Purpose

To investigate how Italian hospitals that are reference centers for people with LVAD organize treatment paths and resources for these patients.

Methods

A cross-sectional observational study was conducted. A survey including questions about all the relevant aspects of treatment paths for people with LVAD was created and validated by 4 LVAD experts (2 nurses and 2 physicians) from 2 different hospitals. The survey was then administered to the 22 (> 95%) of the Italian hospitals that are reference centers for people with LVAD.

Results

Results show a picture of how treatment paths and resources for people with LVAD are organized in Italy nowadays. Nurses play a pivotal role in the multi-professional team that takes care of these patients, being often acknowledged as LVAD Coordinator (case-manager) and being involved in crucial activities such as health education, monitoring of health conditions before and after dismission, and improving patients’ empowerment. Health education is recognized as an essential activity, but many hospitals still struggle to organize it according to patients’ needs and not organizational ones. Palliative care, even if recognized by the most recent guidelines as a crucial element of treatment options in people with LVAD, is a need that remains often unmet.

Conclusion

The growing number of people with LVAD requires an effort for re-organizing resources and treatment paths for them. There is a great need for integrating palliative care in the several treatment options for these patients. Nurses play a pivotal role in all stages of the treatment paths, and should be provided with specific education, as the whole multi-professional team.
The experience of the body image for patients with left ventricular assist device
Authors: Milaniak I M , Witkowska E W , Cebula M C , Tomsia P T , Wisniowska Smialek S W S , Gorkiewicz Kot I G K , Kaleta M K , Wasilewski G W , Wierzbicki K W
Published: July 2024

Background

Improvements in LVAD technology and the survival of LVAD-supported patients led to more extensive use of LVADs also among patients with relative contraindications to HTx as a bridge-to-decision option or as a permanent treatment: destination therapy LVADs have been demonstrated to prolong HF patients' survival and to improve their quality of life. LVAD implantation has been demonstrated to have a considerable effect on patients' body image. Patients feel it hard to accept the device as an extension of their body, especially the driveline.

Purpose

The study aimed to examine the relationships between anxiety and depressive symptoms, acceptance of illness, beliefs about pain control, and quality of life with body image among LVAD-implanted patients.

Material and methods

The cross-sectional study included 54 conveniently recruited LVAD-implanted patients who completed the Body Image Scale, SF-12, Acceptance of Illness Scale, The beliefs about Pain Control Questionnaire, NRS, and HADS. The associations between the research variables were examined with multiple regression analyses.

Results

The mean age of the participants was 59.64 (SD=9,63), and 96.3% were men. The mean scores were: Body Image Scale – 28,33 (SD=5,91); Acceptance of Illness Scale- 25,51 (SD=5,92); The beliefs about Pain Control: Internal factors -15,85(SD=4,96), Influence of physicians-17,57 (SD=3,15), Random events-14,37(SD=3,32), NRS=2,80(SD=1,86), HADS anxiety -5,33 (SD=4,12), HADS depression-4,66 (SD=3,10), SF12MCS-45,49(SD=6,48), SF-12PCS-41,33 (SD=6,48). Patients' age (p=0,04), presence of depressive symptoms (p<0,05) and acceptance of illness (p=0,02) significantly predicted body image concerns.

Conclusions

Healthcare professionals should be aware of challenges regarding body image faced by LVAD-implanted patients and address related factors.
Can the use of a structured management approach using ABCDEF mnemonic to manage multi-morbdiity in HFpEF improve clinical outcomes?
Authors: Murphy N , Duvva D , Kelly A M , Nyjo S , Bower C , Jackson C , Oguguo C , Sankaranarayanan R
Published: July 2024

Introduction

Patients with heart failure with preserved ejection fraction (HFpEF) also have other co-morbidities which independently influence clinical outcomes as well as response to treatment. ESC guidelines recommend management of multimorbidity to improve clinical outcomes. The aim of this feasibility study was to test the use of a structured approach by HF specialist nurse using the prompt of an ABCDEF mnemonic to guide management of multimorbidity in HFpEF clinics and compare this with standard care (without prompt by a mnemonic).

Methods

This was a retrospective analysis of a prospective cohort study of 75 patients with recent decompensated HFpEF within 30 days, who were reviewed in a clinic by a HF specialist nurse. (38 patients in the "mnemonic" cohort and 37 patients in the standard care cohort). ABCDEF mnemonic was used to prompt the HF specialist nurse to address co-morbidities in the "mnemonic cohort" (A-Anaemia/Atrial fibrillation/sleep Apnoea, B- Blood pressure control, Body Mass Index, C- Chronic Kidney Disease and Chronic Obstructive Pulmonary disease, D- Diabetes control, E- Exercise rehab, F- Frailty assessment and need for advance care planning) whereas the HF nurse who assessed patients in standard care cohort followed standard national and international HFpEF guidelines for multimorbidity management (without the aid/prompt of a mnemonic). We also compared all-cause readmissions at 30 days and 3 months between the 2 cohorts. Statistical analysis was performed using Chi-squared test or Student’s T test as appropriate.

Results

The mean age was comparable between the 2 cohorts (mnemonic cohort -77.5±13.6, standard care 76.9±10.2 p=0.8) as was the proportion of female patients (mnemonic cohort 54% vs. standard care 46%; p=0.45). There was also no significant difference in terms of co-morbidities (mnemonic cohort 3.7±1.2 vs. std. care 3.6±1.1; p=0.7), frailty (mnemonic cohort 4.3±1.3; std. care 4.5±1.1; p=0.42), NTproBNP (Mnemonic cohort 1590 ng/L (368-11657(; std. care 1926 ng/L IQR- 389-10593; p=0.51). Investigations or interventions were performed to address co-morbidities in lower proportion of HFpEF patients in the standard care cohort (43%) compared to mnemonic cohort (100%; p<0.001). 30-day all-cause re-admissions showed a trend towards being lower in the mnemonic cohort (30 readmissions mnemonic 10% vs. std. care 22%; p=0.1); 3 month (mnemonic cohort 16%, std. care 35% p=0.05).

Conclusions

Use of a structured mnemonic approach to manage multimorbidity appears to be an easy tool to apply in HFpEF clinics, reflected by the high adherence rate and shows a trend towards lower 3-month all-cause readmissions. The results will need to be validated in a a larger randomised controlled trial with longer follow-up.
Quality of life up to one year after revascularisation with percutaneous coronary intervention in patients with previous coronary artery bypass surgery
Authors: Madsen D , Pettersen T R , Hjertvikrem N , Haaverstad R , Rotevatn S , Norekvaal T M
Published: July 2024

Background

Approximately 1 out of 11 patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI) have a history of coronary artery bypass (CABG) surgery. Most studies investigating patients treated with PCI with prior CABG have focused on harder outcomes such as morbidity, mortality and complications. However, quality of life (QoL) is increasingly recognized as an important outcome measure after PCI.

Purpose

To determine QoL after revascularisation with PCI in patients with and without a history of CABG.

Methods

CONCARDPCI, a prospective multicenter cohort study including 3417 consecutive patients revascularised with PCI, was conducted at seven high-volume referral PCI centres in Norway and Denmark. Of these, 312 had a history with CABG. Baseline clinical data were collected from patient´s medical records and national registers. Sociodemographic characteristics were self-reported. Patient-reported outcomes measures were collected at baseline, 2-, 6- and 12-months after discharge. QoL and health status were measured with the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), RAND-12-Item Short Form Health Survey (RAND-12) and the Seattle Angina Questionnaire 7 (SAQ-7).

Results

Patients with prior CABG were older (mean age 71 vs 65, p<0.001), more often men (84% vs 78%), and had more comorbidities. They were less likely to be current smokers (6% vs 18%, p=0.033) and less likely to be working full time (15% vs 33%). Patients with prior CABG reported a lower QoL on all questionnaires at all measuring time points compared with the no CABG group. Both groups had a significant improvement in the physical and mental component scores from baseline to two months on RAND-12 (p<0.001). In addition, an improvement was found on physical limitation from baseline to two months on SAQ-7 (p<0.001). For both groups QoL was best at baseline using WHOQOL-BREF.

Conclusion

QoL improved in patients with and without a history of CABG throughout the 12-month follow-up period. However, patients with prior CABG scored worse. These findings are important for future clinical decision-making regarding rehabilitation programs after PCI.SAQ-7 mean domain scores over time
Radiation exposure of patients undergoing transcatheter aortic valve implantation and factors contributing to it
Authors: Farrugia M , Foulkes D J
Published: July 2024

Background/ Introduction

Aortic stenosis (AS) is a calcific disease which affects the aortic valve leaflets and is commonly prevalent in people who are 65 years and older. The global burden of AS is expected to keep on increasing due to the longer life expectancy as well as the morbidity and mortality associated with the disease. Transcatheter aortic valve implantation is utilised for the management of AS. Currently, TAVI is recommended as a first-line treatment for patients who are 75 years and older and those who are at an intermediate to high surgical risk, with the aim of becoming the first treatment option for patients who are 65 years and older. However, one of the concerns of TAVI is the need of ionising radiation during valve placement. The study of exposure to ionising radiation in the TAVI population is becoming progressively more important to consider due to the broader population being considered and the long-term effects related to radiation.

Purpose

Locally there was no data available covering this topic, thus the aim of the study was to quantify the radiation dose that patients receive during TAVI procedures and to determine any procedural and patient factors that contribute to this radiation dose.

Methods

Retrospective data analysis was performed for procedures effected between January 2019 and December 2022. All the patients that underwent a transfemoral (TF) TAVI and fit within the inclusion criteria were included in the study. The data was collected from medical databases and underwent a process of data cleaning before information relating to patient and procedural characteristics was extracted. Data about percutaneous coronary interventions (PCI) that were performed during the same time period by the same operators was collected for comparison purposes.

Results

In total the data of 241 TAVI patients was analysed. Dose Area Product (DAP) was the main radiation metric utilised to quantify the radiation dose. Non-parametric statistical tests were performed due to right-skewedness. The median (IQR) DAP for these procedures was 9000 cGym2 (5975-13150) and the median (IQR) fluoroscopy time was 18.25 minutes (15, 23.5). The years 2019 and 2020 had the lowest median DAP. The DAP obtained in this study is lower than the European DRLs of 13000 cGym2.

The median (IQR) DAP (5320cGym2 (2385-9860)), and fluoroscopy time (13.75 mins (8.25-21.62)) for PCIs were lower than for TAVI and this difference is statistically significant (P = <0.001).

DAP was not significantly related only to age category and the operator’s combination. Generalised linear models (GLM) showed that prosthetic valve size, body surface area (BSA) and aortic valve gradient are statistically significant predictors of DAP.

Conclusion

This study shows that the local TAVI patients receive a radiation dose which is within acceptable European limits and that valve size and patient’s BSA are the variables that impacted the radiation dose.
Frailty response in patients with aortic stenosis undergoing transcatheter aortic valve implantation: protocol for a pilot, cluster randomised controlled trial (FRAIL-AS Response Trial)
Authors: Straiton N , Muller D , Macdonald P , Arriagada A , Roy D , Mills N , Middleton S
Published: July 2024

Background

Three in ten severe aortic stenosis patients undergoing transcatheter aortic valve implantation (TAVI) are frail. Frailty correlates with adverse post-procedure patient outcomes, such as higher 1-year mortality, increased adverse events, prolonged hospital stays, and diminished quality of life. Despite the urgency for evidence-based frailty management in this population, research in this area is limited.

Methods

A pilot, cluster randomised controlled trial to assess the feasibility of implementing a Frailty Response Program intervention in 10 hospital TAVI programs for frail patients with aortic stenosis undergoing valve replacement. The intervention includes an implementation strategy and a Frailty Response Clinical Protocol, focused on malnutrition identification, patient education, general practitioner notification, comprehensive geriatric assessment, and cardiac rehabilitation. Eligible hospitals will be randomised (1:1) to either the intervention or control (standard care). Primary outcome: proportion of patients receiving nutritional assessment upon frailty identification. Secondary outcomes include mortality and hospital admissions, frailty improvement, quality of life, and evidence-based frailty management. Implementation outcomes will be evaluated through a process assessment.

Discussion

The trial aims to bridge the gap between the recognition of frailty in patients with aortic stenosis undergoing TAVI and the implementation of evidence-based frailty management practices to improve patient outcomes and care quality.
Involving patients and families in prioritising research in cardiomyopathies
Authors: Bueser T , Jarman E , Field E , Newbury-Ecob R , Cook L
Published: July 2024

Background/Introduction

Cardiomyopathy affects 1 in 300 of the population and can have profound physical and psychological impacts on patients and families. There remains uncertainty around many aspects of disease management and patient needs. Research can address these uncertainties by identifying definitive treatments, optimal management strategies, and holistic support requirements. To ensure that cardiomyopathy research reflects the shared interests of patients, carers and clinicians, a leading cardiomyopathy patient charity sponsored a Research Priority Setting Partnership (PSP).

Methods

The Cardiomyopathy PSP was run according to the James Lind Alliance (JLA) method(1, Figure 1).

Results

A steering group (SG) comprised eight people with lived experience of cardiomyopathies and nine healthcare professionals (HCPs), representing the multidisciplinary team, decided on the scope and breadth of the PSP to cover cardiomyopathies and for a United Kingdom-wide survey.

The initial survey was open to the cardiomyopathy community from June-August 2023 (six weeks). They were invited to submit questions that they would like answered by research. The survey was online and hard copies were also sent to peer support groups where group leaders encouraged members to complete the form during their in-person meeting. There were 1020 respondents generating just over 2000 questions. The majority of respondents (78%) were people with lived experience.

The SG and an information specialist grouped submitted questions into topic headings, consolidated similar questions, removed those that were out of scope and agreed on the final list of 60 questions for the shortlisting survey. This second survey consisted of 2 steps: 1. Respondents selected from the full list of questions identified by the first survey and 2.They were then asked to choose 10 questions from their selection which were most important to them. A total of 660 responses were collected and selected questions were organised into 2 groups according to the type of respondent (those with lived experience or HCPs). Questions were weighted according to the number of times they were selected within each group and then merged into a single shortlist of 26.

The final workshop was conducted on February 2, 2024 where the Top 10 Research Questions from the shortlist were agreed by a mixed group of lived experience and HCP participants (Figure 2).

Conclusion

A Research PSP using the JLA method facilitates the generation and prioritisation of research questions/uncertainties that address the mismatch between what researchers want to research and the practical solutions/information needed day-to-day by HCPs to give holistic care that is relevant to patients, families and carers.Fig 1James Lind Alliance MethodFig 2Top Ten Research Questions
Association between iron intake with diet and diabetes and impaired fasting glucose among PURE Poland study participants
Authors: Rozanska D , Szuba A , Zatonska K , Regulska-Ilow B
Published: July 2024

Introduction

Different studies results show that higher iron intake and increased iron stores in the body are significantly associated with a higher risk of diabetes mellitus (DM), a risk factor for cardiovascular diseases. Iron metabolism in the body is associated with the production of free oxygen radicals, which, combined with the stressful effect of glycation end products in pre-diabetes, increases the risk of diabetes and cardiovascular events.

The purpose of the study was to assess the relationship between iron intake with diet and diabetes and impaired fasting glucose among PURE Poland study participants.

Methods

Study group consisted of 1889 individuals (1185 women and 704 men, aged 35-70 years, from urban and rural area), who were participants of the Polish arm of the Prospective Urban Rural Epidemiology (PURE) study. The study was approved by the Ethics Committee. The data were collected between 2007-2009, in the first stage of the PURE Poland study. Diabetes was diagnosed when fasting glucose level was ≥ 126 mg/dl or there was a declaration about DM occurrence in the medical interview. Diagnosis of impaired fasting glucose (IFG) was made when fasting glucose level was between 100-125 mg/dl with no statement about DM in the interview. Analysis were conducted for DM+IFG in three models: 1. crude data, 2. adjusted for energy intake, 3. adjusted for energy intake, age, body mass index and smoking. Food Frequency Questionnaire (FFQ) was used to assess food intake. FFQ was developed and validated for this population within the PURE study. Iron intake with diet was calculated based on the data from FFQ. For further analysis the study group was divided into tertiles based on the daily iron intake with diet, separately for men and women.

Results

The prevalence of DM+IFG in each tertile (T) of iron intake with diet was: 27.6% (T1), 37.0% (T2) and 38.7% (T3) among women, and 30.3% (T1), 40.9% (T2) and 37.9% (T3) among men. Taking into account crude data the OR (95% CI) for DM+IFG among women was 1.54 (1.14-2.08) in T2 and 1.66 (1.23-2.24) in T3 when comparing with T1. In model 2 the OR (95% CI) for DM+IFG among women was 1.63 (1.16-2.28) in T2 and 1.88 (1.21-2.94) in T3 when comparing with T1. In model 3 in the group of women the OR (95% CI) for DM+IFG was 1.52 (1.07-2.16) and 1.62 (1.02-2.56) when comparing T2 vs T1 and T3 vs T1, respectively. In the group of men in model 1 the OR (95% CI) for DM+IFG prevalence was 1.59 (1.08-2.32) in T2 vs T1 and 1.40 (0.95-2.05, p>0.05) in T3 vs T1. In the group of men in model 2 and 3 the results were not statistically significant, both in T2 vs T1 and T3 vs T1. Taking into account the whole study group the risk of DM+IFG was significantly higher in T2 vs T1 (model 1, 2 and 3) and in T3 vs T1 (model 1 and 2).

Conclusions

Higher iron intake with diet was associated with a higher risk of diabetes and impaired fasting glucose in the study group, especially among women.
Determinants of anxiety and depression disorders among patients with pulmonary arterial hypertension
Authors: Sarzynska K , Beata Jankowska-Polanska B J P
Published: July 2024

Introduction

Pulmonary arterial hypertension (PAH) is a rare chronic disease that, as it progresses, contributes to decreased ability to perform daily activities, deterioration of physical and mental well-being and social functioning. Patients with PAH experience anxiety and depression-like disorders that directly affect their quality of life. In view of the above, it is necessary to determine the determinants that affect the deterioration of mental functioning in this group of patients.

Purpose

The aim of the study was to determine the prevalence of anxiety and depression and their determinants.

Material and methods

The study included 89 patients , pulmonary arterial hypertension (PAH), who participated in the Therapeutic Treatment of Pulmonary Arterial Hypertension program by the National Health Service. Patients were asked to complete a standardized questionnaire (HADS) to assess Anxiety and Depression and a self-report questionnaire assessing sociodemographic factors and severity of symptoms. Medical data were taken from the hospital registry.

Results

In the study group, the mean anxiety score (HADS-A) was M=5.33 (SD=3.31), and the mean depression score (HADS-D) was M=4.4 (SD=3.78), indicating their low level of severity. Significant levels of the studied mood disorders are observed in one in five patients covered by the NHF drug program. Factors significantly (p<0.05) correlating with the severity of anxiety symptoms were chest pain (r=0.343), weakness (r=0.256), fatigue (r=0.327), MWT score 6 (r= -0.266), and arrhythmias (r=0.42). In addition to the above-mentioned factors, significant correlations (p<0.05) were obtained with the severity of depressive symptoms, for such factors as WHO FC Class (r=0.427), eldery age (r=0.263), NT-pro BNP (r=0.239).

Conclusions

Drug and depressive disorders in the study group of PAH patients are not common and may affect one in five patients (study participants on PAH treatment). The occurrence of anxiety disorders correlates with many PAH symptoms, sociodemographic and clinical factors. Learning about the factors associated with the occurrence of mental disorders can help to better identify them and prevent their occurrence.
Determinants of sleep disturbances in patients with pulmonary arterial hypertension
Authors: Sarzynska K , Beata Jankowska-Polanska B J P
Published: July 2024

Introduction

Pulmonary arterial hypertension (PAH) is a rare, chronic disease that leads to the development of a range of cardiopulmonary and cardiovascular symptoms. Studies indicate that sleep problems may contribute to the deterioration of function in patients with PAH. Identifying factors that are related to the occurrence of sleep disorders can help identify them, and will also allow you to take steps to minimize the risk of insomnia.

Purpose

The aim of this study was to determine the determinants affecting the incidence of sleep disorders among patients with pulmonary arterial hypertension.

Material and methods

The study included 89 patients with a diagnosis of pulmonary arterial hypertension (PAH) who are chronically treated and participate in the state program for Therapeutic Treatment of Pulmonary Arterial Hypertension by the National Health Service. The study used standardized tools: a self-administered survey questionnaire, as well as the Pittsburgh Sleep Quality Index (PSQI) questionnaire.

Results

Patients had a mean PSQI score of M=8.7 (SD=4.64), indicating low sleep quality. Factors that had a significant impact on sleep disturbance were: old age (r=0.373), chest pain (r=0.307), weakness (r=0.296), fatigue (r=0.316), shortness of breath (r=0.242), MWT score 6 (r= -0.237), NT-proBNP (r=0, 517), social support (r=0.237), staying in a relationship (r= -0.21), arrhythmia (r=0.211), number of hospitalizations (r=0.33), male gender (r=0.257), WHO FC class (r=0.503).

Conclusions

In the study group of patients with PAH, sleep disorders are present in the majority. The progression of clinical symptoms and selected sociodemographic data significantly correlate with the occurrence of insomnia.
Factors influencing high cardiovascular risk in subpopulation of young adults
Authors: Banaszak-Zak B , Mizia-Stec K , Mizia-Szubryt M , Mlynarska A
Published: July 2024

Introduction

The cardiovascular risk factors determine the development of early atheriosclerotic lesions, and the susceptibility to their proartheriosclerotic action is programmed by external factors and also those present during fetal development. The occurrence of atherosclerotic risk factors depends on an age. In population of children and young adults it seems reasonable to assess the classical risk factors for atherosclerosis in the connection with such additional given as family history being an indirect surrogate of genetic factors, and a low birth weight.

Aim of the study was to categorize the study group into two groups - those who exhibit a low-risk and those who exhibit a high-risk of cardiovascular disease, and to determine the factors characteristic for each risk group.

Materials and Methods

The study was done on 512 volunteers, students in the following Faculties: Health Care Faculty: Nursing Course (178 / 34,7%), Physiotherapy Course (109 / 21,3%), Obstetrics Course (49 / 9,5%), Faculty of Medicine (176 / 34,3%). The questionnaire on cardiovascular risk factors was constructed. According to the results of its assessment the following groups were divided: the group of high risk (10% of investigated with the highest awarding of points) and the group of low risk (10% of investigated with the lowest awarding of points).

Results

Significant quantitative and qualitative differences were found between the low-risk and high-risk groups. Groups of the high and low risk did not differ in respect of sexes investigated and in respect of the direction of studies. One ascertained essential differences in variable qualitative and quantitative between the group of the low and high risk. Family history of diabetes, arterial hypertension, cardiovascular diseases, lipid disturbances, stroke were indeed greater in the group of high risk. The low birth weight was significantly lower in the group of high risk (p=0,02). The current and chronic stress status grading according to the punctual scale (0-10) was significantly higher in the group of high risk as compared to the low risk group (p=0,01, p=0,03, respectively). The systolic pressure was significantly higher in the high risk group in comparison to the low risk subjects (p=0,01).

Conclusions

High cardiovascular risk in subgroup of young adults results from high smoking status, low physical activity, diet and family history of cardiovascular disorders. The numerous cardiovascular risk factors that occur in some students are associated with low birth weight and a positive family medical history. The above observations show the influence of genetic and fetal factors on the development of atherosclerosis. Young adults with high cardiovascular risk are characterized by higher subjective stress level.

Quantitative differences in high risk Medical family history
Factors affecting health-related quality of life after coronary artery bypass grafting
Authors: Giorgalla T
Published: July 2024

Background

Cardiovascular diseases are one of the major causes of mortality in the world. According to the World Health Organization (WHO), approximately 17.9 million people die annually due to cardiovascular diseases worldwide. The most common cardiovascular disease is coronary artery disease (CAD), which involves the narrowing or blockage of the heart arteries as a result of atherosclerosis. Coronary Artery Bypass Grafting (CABG) is a common surgical approach for patients with coronary heart disease (CHD), which improves symptoms and survival, and expected to enhance Health-Related quality of life (HR-QoL). Patients, even after recovery from GABG, may have physical and psychological limitations that reduce HR-QoL.

Aim

The investigation of factors that affecting the HR-QoL of people after coronary artery bypass grafting (CABG). The secondary aim of the study was the investigation of demographic or clinical factors, physical activity, stress or depression may affect the HR-QoL of people after CABG.

Methods

This is a descriptive correlational study with a cross-sectional design. Data were collected from the cardiac surgery department of two large general hospitals in Cyprus after consent from both, the management and their ethics committee. The study sample (N=56) included all patients who had undergone CABG surgery from January to June 2022. At, the patients completed a questionnaire at three to six months postoperatively. The data collection tool included: Demographic and Clinical Characteristics Record Form, the SF12 Health Survey Tool for assessing the Health-Related Quality of Life (HR-QoL) of patients, the HADS Tool for evaluating the anxiety and depression levels of patients, and the IPAQ tool for assessing Physical Activity. Descriptive statistic was used for the analysis and presentation of the data and ANOVA analysis to investigate the factors that affect the health-related quality of life.

Results

Gender (64.2±19.3 vs. 49.8±11.9, p<0.05) and education level (78.5±6.7) (P<0.05) were both found to influence HR-QoL. Other factors that affect the HR-QoL of subjects after CABG are intense physical activity, increased anxiety levels, severe depression and patient's symptoms such as dyspnea (53.3±18.6 vs. 64.6±18.4, p<0.05) and orthopnea (45.4±17.4 vs. 65.6±17.3, p<0.05).

Conclusion

The identification of the factors that were found to affect the HR-QoL of patients after coronary artery bypass grafting enlighten health professionals where they should pay attention when they develop rehabilitation programs.
Feasibility and effectiveness of cardiac telerehabilitation for older adults with coronary heart disease patients: a pilot randomized controlled trial
Authors: Su J , Lin R , Batalik L
Published: July 2024

Background

Cardiac rehabilitation is a standard and multidisciplinary treatment of exercise promotion, patient education, risk factor management, and psychosocial counseling for people with coronary heart disease (CHD) that is underutilized due to disparities in access, referral, and participation. Empirical studies suggest that cardiac telerehabilitation (CTR) have safety and efficacy comparable to traditional in-person CR, however, older adults are under-reported with effectiveness, feasibility, and usability of CTR for this population remains unclear .

Purpose

This study investigates the effects, usability, and feasibility of 12-week CTR on health outcomes of older people with CHD.

Design

A pilot randomized controlled trial with qualitative process evaluation.

Methods

The study randomized 43 older adults with CHD to the 12-week CTR intervention or usual care. Guided by Social Cognitive Theory, intervention group participants received individualized in-person assessment and orientation session, followed by CTR usage at home. Participants were encouraged to visit the CR website for self-learning and data uploading, use the pedometer for daily step tracking, and chat with peers and CR nurse via social media for problem-solving and mutual support. Data were collected at baseline (T0), six-week (T1), and 12-week (T2).

Results

Participants in the CTR intervention group showed significant improvement in daily steps (T1: β=4126.58, p=0.001; T2: β=5285, p=0.01) and health-promoting lifestyle profile (T1: β= 23.26, p<.001; T2: β=12.18, p=0.008) across study endpoints. No significant difference was observed regarding self-efficacy, quality of life, psychological symptoms, and body weight and blood pressure. Twenty participants completed the intervention, with 100% used social media for tele-consultation, 90% used the pedometer for tele-monitoring, 40% (n=8) used the website. Improving awareness on rehabilitation and a clear action focus were considered as key enablers while physical discomforts and difficulties in using the technology were described as main barriers.

Conclusions

The CTR is effective in improving physical activity and healthy behaviors for older adults. Considering the variation in individual cardiovascular risk factors, full-scale RCT with larger sample is needed to determine the effect of CTR on psychological symptoms, body weight and blood pressure, and quality of life. Strategies to improve user intervention usage is needed.
Psychometric analysis of the kansas city cardiomiopathy questionnaire-23 in a european population
Authors: Hamilton Dollaku H D , Paolo Iovino P I , Gianluca Pucciarelli P G , Laura Rasero L R , Izabella Uchmanowicz I U , Rosaria Alvaro R A , Ercole Vellone E V
Published: July 2024

Background

People affected by heart failure (HF) often exhibit poor quality of life, which places a great deal of burden on the healthcare systems. The Kansas City Cardiomyopathy Questionnaire (KCCQ)-23 is one of the most widespread instruments to measure quality of life in this population. So far, its psychometric properties have been investigated by a broad array of research, but the overall findings reveal inconsistency of the factorial structure and lack of rigorous psychometric testing.

Objective

The aim of this study was to evaluate the psychometric properties of the KCCQ-23 in a European cohort of HF patients.

Methods

The data used for this study were collected for the MOTIVATE-HF study, which was a three-arm, multicenter, randomized controlled trial to evaluate the effect of motivational interviewing for improving self-care in HF. A group of 510 patients (median age 74 years, IQR=18, 58% males) completed the KCCQ-23 along with clinical and psychosocial measures. Factorial validity was established with confirmatory factor analysis (CFA); omega and model-based internal consistency indexes were computed to examine the internal consistency of the scale. Convergent validity was established by correlating the KCCQ-23 scores with several clinical and psychosocial measures. Measurement invariance testing was conducted within a multigroup framework across patients with preserved vs those with reduced ejection fraction.

Results

Two CFA solutions were tested, which confirmed the theoretical and empirical models postulated by the original author. The internal consistency coefficients for the latent dimensions were adequate (Omega range =0.77-0.93; internal consistency coefficient =0.89-96)- KCCQ-23 scores were found to be correlated with ejection fraction, NYHA levels, quality of life, self-care confidence, anxiety and depression, and symptom burden, supporting its convergent validity. Finally, the KCCQ-23 was invariant across ejection fraction levels, both in the theoretical and empirical factor solution.

Conclusion

Overall, this study provides for the first time evidence that the KCCQ-23 has satisfactory psychometric properties, promoting its use in clinical settings and research to investigate the quality of life in patients with HF.
Fatigue in women after percutaneous coronary intervention - results from CONCARDPCI
Authors: Hamre M , Pettersen T R , Valaker I , Wentzel-Larsen T , Norekvaal T M
Published: July 2024

Background

Better and more efficient treatment have led to decreased mortality rates and shorter hospital stays in patients with coronary artery disease (CAD). Nevertheless, fatigue is a prominent and distressing symptom in patients with CAD more frequently reported in women. Therefore, further investigation through follow-up studies focusing on women and fatigue in the context of CAD is imperative to address this knowledge gap and enhance clinical outcomes.

Purpose

To investigate fatigue in women with CAD at baseline, 2, 6 and 12 months after percutaneous coronary intervention (PCI), and to determine whether self-reported health, and clinical and sociodemographic characteristics are associated with fatigue after PCI.

Methods

CONCARDPCI is a multicentre, prospective cohort study including 3417 consecutive patients after PCI. Of these, 22% (n=746) were women and included in this analysis. Clinical data were collected from patients’ medical records and national registries. Sociodemographic characteristics were self-reported at baseline registration. Self-reported health was assessed with RAND-12 Item Short Form Health Survey (RAND-12) and the Myocardial Infarction Dimensional Assessment Scale (MIDAS). Fatigue was measured with a Visual Analogue Fatigue scale providing scores from 0-10 with higher scores indicating higher levels of fatigue. Patient-reported outcomes measures were completed at baseline and 2-, 6- and 12 months after hospital discharge.

Results

A substantial proportion was living alone (39%), retired (55%) or had three or more comorbidities (67%). Meanage was 68 years (SD 10). Age was significantly associated with fatigue at baseline (p<0.001), 6 months (p=0.002) and 12 months (p<0.001) in the RAND-12 model and at 2 months (p=0.018) and 12 months (p= 0.003) in the MIDAS model. Cohabitation status was significantly associated with fatigue at baseline (p=0.001), 2 months (p=0.033) and 12 months (p=0.016) in the RAND-12 model and at 2 months (p=0.032) in the MIDAS model. The degree of fatigue was at the highest level at baseline (5.2, SD 2.7) but was still present after one year (4.4, SD 2.6) (p≤0.004 for all comparisons). In RAND-12, self-reported physical health was associated with fatigue (p <0.001 for all comparisons). Furthermore, mental health was associated with fatigue at all meassuring time points (p<0.001- p=0.006). In MIDAS, physical health was associated with fatigue (p<0.001 for all comparisons).

Conclusion

A substantial proportion of women reported challenges with fatigue long after hospital discharge. Therefore, healthcare providers must identify the most vulnerable patients and tailor interventions accordingly. Person-centered treatment strategies may be developed by identifying factors associated with fatigue, such as age, cohabitation status, and self-reported physical and mental health.