bluuebunny/crossref_metadata_2025 huggingface dataset:
Contrastively generative self-expression model for single-cell and spatial multimodal data
Authors: Zhang Chengming , Yang Yiwen , Tang Shijie , Aihara Kazuyuki , Zhang Chuanchao , Chen Luonan
Published: July 2023

Advances in single-cell multi-omics technology provide an unprecedented opportunity to fully understand cellular heterogeneity. However, integrating omics data from multiple modalities is challenging due to the individual characteristics of each measurement. Here, to solve such a problem, we propose a contrastive and generative deep self-expression model, called single-cell multimodal self-expressive integration (scMSI), which integrates the heterogeneous multimodal data into a unified manifold space. Specifically, scMSI first learns each omics-specific latent representation and self-expression relationship to consider the characteristics of different omics data by deep self-expressive generative model. Then, scMSI combines these omics-specific self-expression relations through contrastive learning. In such a way, scMSI provides a paradigm to integrate multiple omics data even with weak relation, which effectively achieves the representation learning and data integration into a unified framework. We demonstrate that scMSI provides a cohesive solution for a variety of analysis tasks, such as integration analysis, data denoising, batch correction and spatial domain detection. We have applied scMSI on various single-cell and spatial multimodal datasets to validate its high effectiveness and robustness in diverse data types and application scenarios.
A comprehensive assessment of hurdle and zero-inflated models for single cell RNA-sequencing analysis
Authors: Cui Tao , Wang Tingting
Published: July 2023

Single cell RNA-sequencing (scRNA-seq) technology has significantly advanced the understanding of transcriptomic signatures. Although various statistical models have been used to describe the distribution of gene expression across cells, a comprehensive assessment of the different models is missing. Moreover, the growing number of features associated with scRNA-seq datasets creates new challenges for analytical accuracy and computing speed. Here, we developed a Python-based package (TensorZINB) to solve the zero-inflated negative binomial (ZINB) model using the TensorFlow deep learning framework. We used a sequential initialization method to solve the numerical stability issues associated with hurdle and zero-inflated models. A recursive feature selection protocol was used to optimize feature selections for data processing and downstream differentially expressed gene (DEG) analysis. We proposed a class of hybrid models combining nested models to further improve the model’s performance. Additionally, we developed a new method to convert a continuous distribution to its equivalent discrete form, so that statistical models can be fairly compared. Finally, we showed that the proposed TensorFlow algorithm (TensorZINB) was numerically stable and that its computing speed and performance were superior to those of existing ZINB solvers. Moreover, we implemented seven hurdle and zero-inflated statistical models in Python and systematically assessed their performance using a real scRNA-seq dataset. We demonstrated that the ZINB model achieved the lowest Akaike information criterion compared with other models tested. Taken together, TensorZINB was accurate, efficient and scalable for the implementation of ZINB and for large-scale scRNA-seq data analysis with DEG identification.
ShinyBioHEAT: an interactive shiny app to identify phenotype driver genes in E.coli and B.subtilis
Authors: Wang Chen , Govindarajan Harikumar , Katsonis Panagiotis , Lichtarge Olivier
Published: July 2023

In any population under selective pressure, a central challenge is to distinguish the genes that drive adaptation from others which, subject to population variation, harbor many neutral mutations de novo. We recently showed that such genes could be identified by supplementing information on mutational frequency with an evolutionary analysis of the likely functional impact of coding variants. This approach improved the discovery of driver genes in both lab-evolved and environmental Escherichia coli strains. To facilitate general adoption, we now developed ShinyBioHEAT, an R Shiny web-based application that enables identification of phenotype driving gene in two commonly used model bacteria, E.coli and Bacillus subtilis, with no specific computational skill requirements. ShinyBioHEAT not only supports transparent and interactive analysis of lab evolution data in E.coli and B.subtilis, but it also creates dynamic visualizations of mutational impact on protein structures, which add orthogonal checks on predicted drivers.

Availability and implementation

Code for ShinyBioHEAT is available at https://github.com/LichtargeLab/ShinyBioHEAT. The Shiny application is additionally hosted at http://bioheat.lichtargelab.org/.
Exploitation of surrogate variables in random forests for unbiased analysis of mutual impact and importance of features
Authors: Voges Lucas F , Jarren Lukas C , Seifert Stephan
Published: July 2023

Motivation

Random forest is a popular machine learning approach for the analysis of high-dimensional data because it is flexible and provides variable importance measures for the selection of relevant features. However, the complex relationships between the features are usually not considered for the selection and thus also neglected for the characterization of the analysed samples.

Results

Here we propose two novel approaches that focus on the mutual impact of features in random forests. Mutual forest impact (MFI) is a relation parameter that evaluates the mutual association of the features to the outcome and, hence, goes beyond the analysis of correlation coefficients. Mutual impurity reduction (MIR) is an importance measure that combines this relation parameter with the importance of the individual features. MIR and MFI are implemented together with testing procedures that generate P-values for the selection of related and important features. Applications to one experimental and various simulated datasets and the comparison to other methods for feature selection and relation analysis show that MFI and MIR are very promising to shed light on the complex relationships between features and outcome. In addition, they are not affected by common biases, e.g. that features with many possible splits or high minor allele frequencies are preferred.

Availability and implementation

The approaches are implemented in Version 0.3.3 of the R package RFSurrogates that is available at github.com/AGSeifert/RFSurrogates and the data are available at doi.org/10.25592/uhhfdm.12620.
Prophylactic mesh augmentation after laparotomy for elective and emergency surgery: meta-analysis
Authors: Frassini Simone , Calabretto Francesca , Granieri Stefano , Fugazzola Paola , Massaro Matteo , Sargenti Benedetta , Schiavone Luca , Zanghì Simone , Dal Mas Francesca , Ansaloni Luca , Cobianchi Lorenzo
Published: July 2023

Background

Incisional hernia is a common short- and long-term complication of laparotomy and can lead to significant morbidity. The aim of this systematic review and meta-analysis is to provide an up-to-date overview of the laparotomy closure method in elective and emergency settings with the prophylactic mesh augmentation technique.

Methods

The Scopus, PubMed, and Web of Science databases were screened without time restrictions up to 21 June 2022 using the keywords ‘laparotomy closure’, ‘mesh’, ‘mesh positioning’, and ‘prophylactic mesh’, and including medical subject headings terms. Only RCTs reporting the incidence of incisional hernia and other wound complications after elective or emergency midline laparotomy, where patients were treated with prophylactic mesh augmentation or without mesh positioning, were included. The primary endpoint was to explore the risk of incisional hernia at different follow-up time points. The secondary endpoint was the risk of wound complications. The risk of bias for individual studies was assessed according to the Revised Cochrane risk-of-bias tools for randomized trials.

Results

Eighteen RCTs, including 2659 patients, were retrieved. A reduction in the risk of incisional hernia at every time point was highlighted in the prophylactic mesh augmentation group (1 year, risk ratio 0.31, P = 0.0011; 2 years, risk ratio 0.44, P < 0.0001; 3 years, risk ratio 0.38, P = 0.0026; 4 years, risk ratio 0.38, P = 0.0257). An increased risk of wound complications was highlighted for patients undergoing mesh augmentation, although this was not significant.

Conclusions

Midline laparotomy closure with prophylactic mesh augmentation can be considered safe and effective in reducing the incidence of incisional hernia. Further trials are needed to identify the ideal type of mesh and technique for mesh positioning, but surgeons should consider prophylactic mesh augmentation to decrease incisional hernia rate, especially in high-risk patients for fascial dehiscence and even in emergency settings.

PROSPERO registration ID

CRD42022336242 (https://www.crd.york.ac.uk/prospero/record_email.php).
Serum Virome of Southern Beaufort Sea polar bears (Ursus maritimus) during a period of rapid climate change
Authors: Fry Tricia L , Owens Leah A , Ketz Alison C , Atwood Todd C , Dunay Emily , Goldberg Tony L
Published: July 2023

Climate change affects the behavior, physiology and life history of many Arctic wildlife species. It can also influence the distribution and ecology of infectious agents. The southern Beaufort Sea (SB) subpopulation of polar bears (Ursus maritimus) has experienced dramatic behavioral changes due to retreating sea ice and other climate-related factors, but the effects of these changes on physiology and infection remain poorly understood. Using serum from polar bears sampled between 2004 and 2015 and metagenomic DNA sequencing, we identified 48 viruses, all of the family Anelloviridae. Anelloviruses are small, ubiquitous infectious agents with circular single-stranded DNA genomes that are not known to cause disease but, in humans, covary in diversity and load with immunological compromise. We therefore examined the usefulness of anelloviruses as biomarkers of polar bear physiological stress related to climate and habitat use. Polar bear anelloviruses sorted into two distinct clades on a phylogenetic tree, both of which also contained anelloviruses of giant pandas (Ailuropoda melanoleuca), another ursid. Neither anellovirus diversity nor load were associated with any demographic variables, behavioral factors or direct physiological measures. However, pairwise genetic distances between anelloviruses were positively correlated with pairwise differences in sampling date, suggesting that the polar bear “anellome” is evolving over time. These findings suggest that anelloviruses are not a sensitive indicator of polar physiological stress, but they do provide a baseline for evaluating future changes to polar bear viromes.
Body image concerns in patients with an implantable cardioverter defibrillator: associations with other patient-reported outcomes
Authors: Frydensberg V S , Moller S , Johansen J B , Stroemberg A , Pedersen S S
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Implantation with an implantable cardioverter defibrillator (ICD) is for some patients associated with body image concerns (BICs). The associations of BICs with other patient-reported outcomes (PROs) have not yet been investigated.

Purpose

The purpose of this study was to investigate the associations between BICs and other PROs in a cohort of ICD-recipients.

Methods

A cross-sectional survey design was used. Patients who had the ICD in minimum 3 months up to 2 years, age >18 years, implanted with a first-time ICD (both VVI-ICD, DDD-ICD and CRT-D) completed the 39-item ICD Body Image Concerns Questionnaire (ICD-BICQ) together with the Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), Type D Scale (DS14) and the Florida Patient Acceptance Survey (FPAS). Data were analyzed using linear regression to compare personality constructs between patients with and without BICs. Logistic repression and Reciever Operating Characteristic (ROC) curves were used to predict patients with BICs based on other PROs.

Results

In total 331 patients completed the ICD-BICQ and other PRO questionnaires. Five patients were excluded due to re-operations, and one patient did not complete the ICD-BICQ, leaving 325 patients in the analyses. As anticipated 20% of patients reported body image concerns with a cut-off at the recommended 36 points. We found that patients with BICs reported higher anxiety and depression levels, lower device acceptance using the FPAS, and lower health status, while they were more likely to have a Type D personality as compared to patients without BICs. We observed that FPAS was moderately able to predict BICs, while other PROs only had limited ability to predict BICs in patients, hence indicating that the ICD-BICQ provides relevant clinical information.

Conclusion(s)

In this study, we found that patients with BICs generally reported worse PRO scores. The included PRO instruments were not able to predict BICs the ICD recipients, hence in clinical practice, health care professionals can use the ICD-BICQ to identify and obtain a nuanced picture of patients with BICs. In case of implementing new operation techniques, the ICD-BICQ can be used as a tool for evaluation.
11-years of a nurse-led follow-up service for patients who have undergone percutaneous coronary intervention
Authors: Harrison S , Bellchambers J , Byrne R , Deane S , Dent N , Mackay N , Pottle A
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The nurse-led follow-up service for patients who have undergone percutaneous coronary intervention (PCI) was established in 2001 to standardise post procedural care for this patient group. The appointment focusses on symptom assessment, medication review and optimisation, and risk factor modification and secondary prevention. Timing of appointments is dependent on the procedure the patient has undergone (primary/elective PCI) and the format of the service has changed several times since its inception in response to changes in the PCI service within the hospital. Clinic appointments were carried out face to face or via the telephone until 2020, when all clinics changed to virtual appointments (video or telephone).

Methods

Data for all patients reviewed in the clinic was collected prospectively and retrospectively analysed. This report covers the period 2010-2021.

Results

A total of 21,465 appointments were carried out in the above audit period. Most appointments were carried out in the first-year post PCI in accordance with the follow-up protocol (81.7%). Patients reviewed after 1-year were usually referred to the clinic by their GP due to recurrence of symptoms. 71.3% of patients reviewed within the first year were free of any symptoms of angina or had no limitation to physical activity, and 71.2% were not limited by breathlessness at any follow-up appointment. 33.6% patients reviewed within the first year were either attending or had attended a cardiac rehabilitation programme, with fewer patients declining referral in more recent years. 19.3% patients reviewed within the first year were diabetic, with 5.4% diagnosed on admission. 8.5% patients were still smoking, 41.0% had stopped smoking, and less than 1.0% patients had restarted smoking within the first year. 49.2% patients reviewed within the first year had a systolic blood pressure below 140mmHg, and 56.0% patients had a diastolic blood pressure below 90mmHg, however this data was not available for all patients. The data suggests that lipid management has improved within recent years with more patients achieving LDL levels below 2.0mmol/L, however, this data is also incomplete. Over 92.0% patients were taking Aspirin at 1-month and 1-year, with 95.0% patients taking a second antiplatelet agent at 1 month, and 76.6% at 1-year. Beta blocker, ACE inhibitor and statin use has been relatively consistent at 71.6%, 66.1% and 82.5% respectively at all appointment times.

Conclusion

This nurse-led follow-up service provides consistency of care for patients who have undergone PCI. The nurses in the clinic are able to optimise risk factors and medication, although further work needs to be done to achieve guideline directed targets. Collaboration with primary care is required to ensure secondary prevention is continued.
The value of Cystatin C and NT-proBNP in the diagnosis of type 1 cardiorenal syndrome
Authors: Phan H A O
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The presence of acute kidney injury in the setting of acute heart failure (AHF) is common occurrence and was termed type 1 cardiorenal syndrome (CRS1). Cystatin C has a role in the diagnosis renal dysfunction. NT-proBNP has a role in the diagnosis of acute heart failure. Whether the combination of Cystatin C and NT-proBNP increase diagnostic value of CRS1? This study was aimed to evaluate the diagnostic value of Cystatin C and NT-ProBNP in diagnosis of CRS1.

Methods

there were 139 patients with AHF in the department of Cardiovascular resuscitation and Interventional cardiology Ho Chi Minh City Vietnam 115 People Hospital from September 2018 to March 2019. This was a prospective cohort study.

Results

the optimal cut-off Cystatin C to diagnosing CRS1 was 1.81 mg/l, AUC 0.787 (95% CI 0.71-0.852, p < 0.001), sensitivity 75%, specificity 83.5%, positive predictive value 70.6%, negative predictive value 86.4%. The optimal cut-off NT-proBNP to diagnosing CRS1 was 17681 pg/ml, AUC 0.710 (95% CI 0.627-0.784, p < 0.001), sensitivity 54.2%, specificity 80.2%, positive predictive value 59.1%, negative predictive value 76.8%. Combination of Cystatin C and NT-proBNP in diagnosing CRS1 with AUC 0.788 (95% CI 0.71-0.852, p < 0.001), sensitivity 70.8%, specificity 85.7%, positive predictive value 72.3%, negative predictive value 84.9%.

Conclusions

Combination of Cystatin C and NT-proBNP in the diagnosis of type 1 cardiorenal syndrome with higher specificity than each biomarker.
Cardiotoxicity and cancer care: scoping review exploring current home-based, self-management cancer care interventions
Authors: Morris R , Talty A , Deighan C , Cameron S , Taylor L
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): NHS Lothian

Background/Introduction

Cardiotoxicity is heart damage that occurs as consequence of some cancer treatments and drugs. Gaining a better understanding of current cancer prehabilitation and rehabilitation programmes, specifically facilitated, home-based programmes, can better illuminate how interventions can aid patients in their cancer, and possible cardiac journey. This scoping review sets out to explore the provision of multimodal, cancer prehabilitation and rehabilitation programmes available to patients.

Home-based, self-management, multidimensional cancer interventions (HSMCIs) are increasing in number, due to the growing population of people living with and beyond cancer. These multimodal programmes target a range of physical and psychosocial factors to improve self-management and quality of life amongst cancer patients during prehabilitation and rehabilitation. However, preliminary searches indicate that the interventions vary significantly in their definitions of key terms, target demographics, implementation success and evidence-base.

Purpose

This scoping review aims to assess the nature, extent and remit of existing HSMCIs, identify their strengths, limitations, potential barriers to access and obstacles to their implementation, and clarify key terms and concepts within the field.

Methods

Key word searches were performed in AMED, Cochrane, PsychInfo, Medline, CINAHL and Embase databases from 2010 to 2022 to identify papers relevant to HSMCIs. Study characteristics for inclusion were home-based, multimodal, non-centre based interventions that dealt with prehabilitaton and/or rehabilitation for cancer patients, while incorporating psychological, physical and nutritional components.

Results

The search gleaned a total of 302 results. These results were screened independently by two investigators with a third member conducting spot checks to ensure rigor. Early findings were then cross-referenced and irrelevant papers and duplicates were removed. A total of 38 results remained that fulfilled inclusion criteria. The scoping review found that few programmes were truly multimodal taking a general approach to cancer, instead targeted one or two specific cancers. Fewer still had mention of cardiotoxicity and how to manage heart health during cancer treatment.

Conclusions

This scoping review has highlighted the gap for a HSMCI in care provision to cover the range of biopsychosocial support needed for those living with and beyond cancer. Consistent with earlier research it emphasises the necessity for promoting cardiovascular health in this population.
Understanding for whom, under what conditions, and how atrial fibrillation screening interventions are successful: a realist review
Authors: Hanson C , Pearsons A , Modi R , Schnabel R B , Engler D , Desteghe L , Neubeck L
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme.

Background/introduction

The treatment of atrial fibrillation (AF) with oral anticoagulants reduces stroke risk. Most initial AF diagnoses result from symptom related rhythm monitoring or are after stroke. However, as AF is often asymptomatic detecting it by screening could initiate oral anticoagulant treatment.

Purpose

We aimed to understand for whom, under what conditions, and how AF screening programmes can increase the number of new AF diagnoses and lead to guideline-adherent care.

Methods

A realist review of AF screening for those aged ≥18 years. We developed an initial programme theory; systematically searched four databases until October 2022; and selected documents that included details about factors relating to the implementation of AF screening programmes. We extracted, analysed, and synthesised data using realist techniques to create context–mechanism–outcome configurations, and a refined programme theory.

Results

We screened 2,707 documents and included 70. The refined programme theory included 15 context–mechanism–outcome configurations to explain how different screening programme implementation affects outcomes. Key factors in successful implementation included 1) locations accessible to those at most risk of undiagnosed AF; 2) targeted, inclusive invitations; 3) training to increase understanding and competence of those undertaking screening; 4) using digital technology for convenience and accuracy; 5) organisational support mechanisms such as automated prompts to increase awareness of who to screen; and 6) standardised follow-up pathways. The best system for screening is unclear. Single time point screening is convenient, potentially leading to higher uptake. Prolonged screening may result in a higher paroxysmal AF yield (Figure 1).

Conclusions

Well implemented AF screening programmes could increase the number of new AF diagnoses and lead to guideline-adherent care, thereby reducing stroke risk.
Results of the nursing care standardization program in cardiac electrophysiology patients
Authors: Carrasco Camacho M , Poza Gonzalez M , Carro Fernandez E , Niebla Bellido N , Domingo Criado R , Hevia Puyo S , Tarrela Redonda N , Gimenez Lajara M A , Cano Valls A
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Patients undergoing surgery in the electrophysiology unit pass through the hands of several nurses from different hospital units throughout the care process. Multiple studies show the importance of interprofessional communication in improving patient health outcomes. In our hospital we have standardized protocols for each procedure. In addition, it is convenient to have the relevant information available in a more visual and accessible way in order to enhance the agility of care.

Purpose

To design a summary table of the procedures performed in the electrophysiology unit with the most important points on nursing care.

Methods

A descriptive analysis of the nursing care of patients undergoing surgery in the cardiac electrophysiology unit was performed. For this purpose, meetings were held between the electrophysiology, the intensive care unit, the cardiology day hospital and the resuscitation unit nursing teams to standardize protocols between services. The needs of each service were detected and the most important nursing care notes were included in the table.

Results

A table was drawn up with a total of 8 surgical procedures performed in electrophysiology. For each of them, 3 parts of the care process were identified: pre-operative, intraoperative and post-procedure care. Each of the parts had subdivisions (Picture 1 and 2). In addition, important contact telephone numbers were added. Once the table was done and validated, it was shared through the hospital intranet and hung in a poster in all hospital units where a cardiac patient may be attended.

Conclusions

The electrophysiology patient care table improved communication between professionals of the different services where the patient is attended and it also helped standardize protocols to reduce peri-surgery risks and improve morbidity and mortality, since it could prevent complications. Therefore, it guarantees the continuity of nursing care.Poster TS EF Procedure
Exploring the implemented guidelines for dyslipidemia treatment and care among nurses and physicians in jordanian hospitals
Authors: Bani Salameh R , Al-Smadi A , Eshah N , Musa A , Al-Rawajfah O , Jarrah M
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Dyslipidemia is a major risk factor for ischemic heart disease in the world. The last updated American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology/ European Atherosclerosis Society (ESC/EAS) guidelines for dyslipidemia management aimed to control blood cholesterol and reduce cardiovascular risk. In Jordan, no national guidelines have been published to date, so these guidelines are commonly used. There are a few studies exploring the implementation of these guidelines in Jordan.

Purpose

To explore the implementation of updated ACC/AHA and ESC/EAS guidelines for the treatment and care of dyslipidemia among nurses and physicians in Jordan.

Methods: A mixed-method study was utilized with a convenience sample from three hospitals in Jordan to provide a comprehensive understanding for the investigated concepts in the current study. The quantitative part, the researcher developed a questionnaire. A questionnaire was completed by 150 nurses and 50 physicians, and moreover, 250 patients' medical records were reviewed. The qualitative part, three focus group with open-ended questions was conducted.

Results

The total mean scores to implement the guidelines among nurses were (1.67, 1.6 out of 4) for ACC/AHA and ESC/EAS guidelines respectively. The percentages for implementing dyslipidemia management guidelines among physicians were 22.6% consistent with ACC/AHA and 29.6% with ESC/EAS. There were high percentages of uncontrolled lipids among patients with dyslipidemia as observed in medical records. Focus group interviews revealed many barriers, like workload and limited resources and many suggestions to implement dyslipidemia management guidelines.

Conclusion

Results indicated limited implementation of any dyslipidemia management guidelines among Jordanian nurses and physicians in their clinical practices.
Physical activity and glycemic control among adults living with coronary heart disease
Authors: Svavarsdottir M H , Bjornsdottir K M
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): University of Akureyri Research Fund Landspitali University Hospital Science Fund

Background

The most common comorbidity in coronary heart disease (CHD) is diabetes mellitus (DM). The presence of DM or pre-diabetes mellitus in addition to CHD further increases health risks. Engagement in regular physical activity (PA) has been shown to improve health and well-being and increase life expectancy. For that reason, it is important to explore the role of PA when the diseases coexist and how PA can be used effectively as part of treatment to improve coronary patients’ health.

Purpose

The aim of the study was to explore the relationship between the level of PA and glycemic control in adults with CHD.

Methods

This study had a cross-sectional design. The participants were adults who had been admitted to one of two main hospitals in Iceland between October 2017 and November 2018 following a CHD incident. Data was collected six months after hospital discharge with questionnaires, physical measurements, blood samples, and from medical files. The Leisure-Time Physical Activity Questionnaire was used to measure PA. The participants were categorized into four groups according to their PA level (mostly sedentary; light; moderate; or high PA) and the relationship between PA levels and long-term glycemic control (glycated hemoglobin percentage (HbA1c%)) was explored using one-way ANOVA with Tukey post-hoc test.

Results

The sample consisted of 346 individuals. Their mean age was 64.6 years (SD = 8.9), 80.1% were males and 20.9% had diabetes. The mean HbA1c% was 5.9% (SD = 0.9; range = 4.6%-12.8%). The PA questionnaire classified 15.1% of the participants as mostly sedentary, 43.6% engaged in light PA, 33.2% engaged in moderate PA and 8.1% engaged in high levels of PA (Figure 1). An analysis of variance revealed a significant difference in mean HbA1c% values between groups F(3, 343) = 8.56, p < 0.001. Post-hoc comparisons showed that the mean HbA1c% of the least active individuals (M = 6.4%, SD = 1.5) was significantly higher than in all other groups. However, there were no significant group differences between those who engaged in light PA (M = 5.8%, SD = 0.7), moderate PA (M = 5.8%, SD = 0.6) and high levels of PA (M = 5.7%, SD = 0.8), (Figure 2).

Conclusion

PA was associated with small benefits in glycemic control among individuals with CHD. These findings emphasize the importance of PA in the treatment and management of CHD, and indicate that even small amounts of PA may be of value.Figure 1:Distribution of PA levelsFigure 2:HbA1c% according to PA level L
The effect of surgical aortic valve replacement on the quality of life of patients with aortic valve stenosis
Authors: Sigala E , Terentes-Printzios D , Baikoussis N , Koumallos N , Koutsokosta F , Christou V , Roumeliotaki G , Stamatopoulou E , Milas T , Theodorakis E , Tsioufis C , Vlachopoulos C
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

The increasing efficacy of transcatheter aortic valve implantation (TAVI) justifies a renewed assessment of quality of life (QOL) after surgical aortic valve replacement (SAVR).

Purpose

The aim of this study was to evaluate long-term QOL in elderly patients undergoing isolated SAVR.

Methodology

60 patients with severe aortic stenosis (AS) enrolled in our study (mean age 70.25±8.76, n=21 women). Clinical and QOL data collected pre surgery and at 1 year. For the assessment of QOL we used the instruments SF-36 (36-Item Short Form Health Survey Questionnaire), Euro-QOL 5 Dimensions (EQ-5D) and the visual analogue scale (VAS). Bivariate and multiple logistic regression analyses were performed.

Results

QoL is significantly improved 1 year after SAVR according to the three assessment tools. The physical health score (PCS) was 58±10% preoperatively and 80±10% (p<.001) after 1 year. Similarly, mental health score (MCS) improved (55±6% vs 77±9%, p<.001). Multivariate analysis showed that patients with a biological or Perceval valve and a preoperative EF <50% had greater improvement in PCS 1 year after SAVR than patients who received a mechanical valve or had a preoperative EF >50%.

Conclusions

The perceived QOL of patients with AS improved significantly 1 year after SAVR. The results could be useful in informing future patients and giving them realistic expectations.
Shared decision-making for the treatment of aortic stenosis (SEEK-AS): rationale and study design of the implementation of a patient decision aid to facilitate a high-quality treatment decision
Authors: Lauck S , Lewis K B , Turgeon R , Wells J , Wijeysundera H , De Sousa I , Adhami N , Stacey D , Webb J G
Published: July 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Heart & Stroke Foundation (Canada)

Background

Shared decision-making (SDM) is endorsed by multiple guidelines to help clinicians and patients achieve a high-quality treatment decision that integrates patients’ priorities, preferences and values. Patient decision aids (PDAs) are evidence-based tools designed to support the process of SDM. There is a gap in knowledge translation to facilitate the adoption of guideline recommendations for the treatment of aortic stenosis (AS).

Rationale: There is strong evidence of improved outcomes associated with SDM; in contrast, implementation research is needed to address the pressing question of "how to do SDM". Therefore, the SEEK-AS study aims to plan and evaluate the implementation of a PDA for AS to facilitate the integration of SDM in the treatment of valvular heart disease.

Study Design: We will present the design of a prospective multi-method implementation study of a novel set of paper-based and individualised web-based PDAs for AS. We aim to explore diverse perspectives and uncover barriers and enablers to investigate the "real-world" implementation of the PDAs. The study prioritises patient and family engagement, and is informed by the Ottawa Model for Research Use (OMRU) conceptual model to guide the sequential objectives: (1) select and tailor implementation strategies in four distinct healthcare organisations, across diverse patient and clinician populations to develop distinct implementation blueprints, and (2) evaluate the implementation of the PDAs across health care organisations and users. Data collection will include a series of in-depth focus group and individual interviews with patients treated with different modalities and multidisciplinary clinicians using content analysis organised under the OMRU levels (innovation, potential adopters, and practice environment; objectives 1 and 2), and patient and clinician surveys using outcomes mapped to OMRU levels and patient/clinician levels (objective 2).

Anticipated Research Output: We will present the stakeholder engagement plan and patient engagement strategies. The findings of the study will include the identification of barriers and facilitators of regional implementation, and provide evidence to guide the successful adoption of PDAs to help shift the culture of care from clinician-driven to patient-centred and improve the care of patients with valvular heart disease.
Risk factors for readmission after isolated coronary bypass graft surgery: context matters
Authors: Wynne R , Mctier L , Matthews S , Nolte J , Ferguson C
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Risk prediction scores are primarily based on preoperative factors and most applicable to their country of origin. Factors that contribute to these scores are commonly used to predict risk of readmission that is also highly variable. A recent systematic review of risk factors for unplanned readmission after first time isolated coronary artery bypass grafting (CABG)1 included cohort studies from the USA alone.

Purpose

To contrast risk factors for unplanned readmission in an Australian cohort with those identified in the systematic review.

Methods

A single centre, retrospective cohort analysis of adult patients from a major metropolitan tertiary teaching hospital having first time isolated CABG (N = 6155) between August 2002 and 2022. Unplanned inpatient readmission within 30-days of surgery was the primary outcome measure. Direct entry logistic regression modelling was used to identify risk factors for readmission in this cohort.

Results

The rate of readmission was 10.6% (n = 655). Female sex (OR 1.0, 95%CI 1-1.01), preoperative dialysis (OR 3.3, 95%CI 2.19-5.12), preoperative atrial fibrillation (OR 1.4, 95%CI 1.06-1.87), diabetes (OR 1.22, 95%CI 1.03-1.45), and peripheral vascular disease (OR 1.3, 95%CI 1.05-1.67) were the only significant predictors retained in the full model (c2(27, N = 6155) = 111.28, p <0.001) that correctly classified 89.3% of cases but only explained 3.6% (Nagelkerke R squared) of variation in readmission rate. The Hosmer-Lemeshow goodness of fit test indicated good support for the model despite this (p 0.841).

Conclusion(s): Risk factors predicting readmission in this patient cohort were not consistent with those identified in the review of studies from the USA. Risk prediction is context specific. Research investigating factors associated with risk needs to capture variables that impact on context.
Perceptions of patients with heart failure before and after CRT implantation regarding their self-care
Authors: Westland H , Van Rijn M R , Meine M , Jaarsma T
Published: July 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): ESC Nursing Training Grant

Background

Cardiac Resynchronization Therapy (CRT) is increasingly used to improve ventricular contraction and physical performance in patients with heart failure (HF). Although implantation of a CRT is associated with improved health status, not all patients benefit from a CRT implantation. Physical activity is an important self- care behaviour but some patients struggle with physical activity and experience lack of improvement of their physical condition and symptoms of HF. To optimise support to improve self-care of patients after a CRT implantation, information is needed on their expectations of the CRT and their needs and preferences towards self-care support.

Purpose

To explore perceptions of patients before and after CRT implantation regarding their expectations and explore factors that influence their physical activity, HF symptom monitoring and management and their needs and preferences towards self-care support.

Methods

An explorative generic qualitative study with semi-structured interviews is currently performed. A total of 18 adult patients were interviewed: 8 patients <3 months prior to the CRT implantation and 10 patients 5 to 24 months after CRT implantation. Patients varied in age and gender. Interviews were audio-recorded and thematically analysed according to Braun & Clarke.

Results

Prior to the CRT implantation, patients expected to feel more energetic and experience less dyspnea to resume activities they could not perform due to their poor cardiac condition. Remote monitoring of the CRT made them feel safe. Patients trusted the professional opinion of the healthcare providers. Few patients experienced support in their self-care from a HF nurse. Patients felt the need to easily contact their healthcare provider when experiencing symptoms or having HF–related questions. Informal caregivers play a key role in supporting patients in being physically active and monitoring and managing HF symptoms.

Conclusion

Before implantation patients have high expectations of the effects of CRT implantation. It is important to consider patients’ need for support to improve physical activity, symptom monitoring and thoughtfully responding to symptoms and engaging assistance of informal caregivers in their health.
Usage and the effect on knowledge about atrial fibrillation of an educational application, AF-EduApp
Authors: Knaepen L , Delesie M D , Theunis R T , Gorissen P G , Vijgen J V , Dendale P D , Desteghe L D , Heidbuchel H H
Published: July 2023

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): The AF-EduApp study is supported by an BMS/Pfizer European Thrombosis Investigator Initiated Research Program (ERISTA) grant.

Introduction

As the management of atrial fibrillation patients (AF) is complex, an integrated care approach is suggested, including tackling modifying risk factors together with rate and rhythm control and anticoagulation therapy. Patients often underestimate the effect of these pillars on their health and often have poor knowledge about these aspects. As smart devices have become more important in the past decades, they create opportunities to educate patients and improve the follow-up of these patients.

Purpose

We aimed to evaluate the usage of an in-house developed application, AF-EduApp, and its effect on patients’ AF knowledge levels.

Methods

A total of 152 patients with AF were included in this multicenter study with a follow-up of 12 to 15 months. One of the modules of the AF-EduApp contains information on AF, its treatment and related self-care. Knowledge about AF and its treatment was assessed through the Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ) with direct feedback on incorrectly answered questions. The JAKQ (and immediate feedback) were given to the patients via the application at baseline and after 1, 3, 6 and 12 months. Patients are free to decide how frequently they want to use the app (except when questionnaires are available).

Results

The 152 patients had a total follow-up of 386.8±108.1 days and used the application on 130.1±144.7 days (33.6%). The education module was visited by 135 patients with a median time of 3.1 (IQR: 1.3-21.8) min (mean: 18.6±32.9 min) spent on education. The most visited education chapters were AF treatment (3.1 (0.4-9.5) min) and selfcare (3.1 (0.9-7.1) min)(Fig1). A significant increase in the knowledge level was seen in the 130 patients who completed all 5 moments (p<0.001, Fig 2A). This increase was driven by a significant increase during the first month of follow-up (baseline: 70.4±14.4 vs FU1: 82.4±14.4; p<0.001). The number that one of the 8 questions on AF in general was correctly answered at these 5 time points ranged from 2.7±1.6 to 4.8±0.7 (p<0.001, Fig 2B). The questions ‘Why are most patients with AF prescribed with oral anticoagulation?’ and ‘What is AF?’ were answered best, whereas the questions ‘Is AF always accompanied by symptoms?’ and ‘Can medication prevent AF?’ were most difficult to get right.

Conclusion

The AF application was reasonably used, about 1 out of every 3 days. Targeted education focused on JAKQ answers that were answered incorrectly significantly improved knowledge level over time. Stronger incentives need to be developed to have patients effectively look at the educational sections that pertain to incomplete knowledge.
Improving secondary prevention knowledge in immigrants after a heart attack: adapting and evaluating a virtual patient education resource to promote behaviour change
Authors: Shi W , Zhang L , Ghisi G L M , Panaretto L , Gallagher R
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Coronary heart disease (CHD) is prevalent and recurrent (40%), whereas an estimated 75% of events could be avoided by secondary prevention of modifiable risk factors and healthy lifestyle. Structured in-person secondary prevention and patient education programs are both efficient and effective strategies; however, these programs may not meet immigrants’ care or home-based learning needs, and thus alternative educational models are needed.

Purpose

To adapt and evaluate the simplified Chinese version of Cardiac College, a co-designed evidence-based virtual patient education resource for heart attack, in Chinese immigrants on secondary prevention knowledge and behaviour change outcomes.

Methods

A prospective longitudinal pre-post study was undertaken in heart attack survivors recruited from cardiac rehabilitation programs at four metropolitan tertiary hospitals from May 2021 to November 2022. Chinese Cardiac College intervention was adapted and provided education via nine booklets and 10 pre-recorded video sessions structured and delivered to patients for four weeks following hospital discharge. Validated surveys measured health literacy, disease-related knowledge, physical activity, heart-healthy diet, and self-management behaviours at baseline and one to two weeks post-intervention. Acceptability, engagement, and satisfaction were also assessed post-intervention.

Results

From 81 patients assessed for eligibility, 67 were recruited, and 64 (95.5%) completed the study. The sample was aged mean 67.23 ± 8.12 years, and 81.25% were males. Participants had significant improvement in disease-related knowledge in total and in each domain, with the most improvement identified in medical, followed by exercise and psychological domains (p<0.001) (Table 1). Healthy dietary behaviour and other self-management behaviours also significantly improved (all p<0.05). All participants (100%) self-reported being engaged with the materials, rating content as highly acceptable (n=20, 31.3%) and highly satisfactory (n=30, 46.9%). In addition, most participants reported that the delivered information amount was adequate (n=44, 68.8%), and 26.6% (n=17) found it overwhelming.

Conclusion

A virtual patient-education intervention adapted for Chinese immigrants (Chinese Cardiac College) significantly improves secondary prevention knowledge and self-care behaviour in heart attack survivors and offers a suitable model for intervention, especially where there are limited bilingual staff or resources. Further testing of randomised controlled trials and multiple populations is required.