bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Kidney Injury Subsequent to Cardiac Surgery
Authors: Kramer Robert S. , Herron Crystal R. , Groom Robert C. , Brown Jeremiah R.
Published: July 2023

Acute kidney injury (AKI) after cardiac surgery is a common and underappreciated syndrome that is associated with poor short- and long-term outcomes. AKI after cardiac surgery may be epiphenomenon, a signal for adverse outcomes by virtue of other affected organ systems, and a consequence of multiple factors. Subtle increases in serum creatinine (SCr) postoperatively, once considered inconsequential, have been shown to reflect a kidney injury that likely occurred in the operating room during cardiopulmonary bypass (CPB) and more often in susceptible individuals. The postoperative elevation in SCr is a delayed signal reflecting the intraoperative injury. Preoperative checklists and the conduct of CPB represent opportunities for prevention of AKI. Newer definitions of AKI provide us with an opportunity to scrutinize perioperative processes of care and determine strategies to decrease the incidence of AKI subsequent to cardiac surgery. Recognizing and mitigating risk factors preoperatively and optimizing intraoperative practices may, in the aggregate, decrease the incidence of AKI. This review explores the pathophysiology of AKI and addresses the features of patients who are the most vulnerable to AKI. Preoperative strategies are discussed with particular attention to a readiness for surgery checklist. Intraoperative strategies include minimizing hemodilution and maximizing oxygen delivery with specific suggestions regarding fluid management and plasma preservation.
Management of Heparin-Resistant Patients with Benefits? Maximizing Biocompatibility in Cardiopulmonary Bypass: Combining ATryn® Recombinant Antithrombin III and Carmeda® Heparin-Bonded Perfusion Circuits: A Case Series
Authors: Chryssos Antonios , Stroup Scott J. , Pifer Melodie M. , Tawil Mark , Conrad Carl G.
Published: July 2023

As many as 25% of our cardiopulmonary bypass (CPB) patients have a diminished heparin response and fail to reach a therapeutic activated clotting time (ACT). We treat a majority of these patients with antithrombin III (ATryn®, recombinant antithrombin III [rhAT], rEVO Biologics). Our current CPB circuit uses Medtronic Carmeda® coating. We observed less postoperative bleeding in a number of patients treated with rhAT. We theorized that adding rhAT would allow patients with diminished heparin response to safely achieve a therapeutic ACT. On the basis of our postoperative bleeding observations, we wondered if using rhAT with a heparin-bonded CPB circuit enhanced its biocompatibility and perhaps improved patient outcomes. Data were collected on 15 patients undergoing CPB who received antithrombin III (AT) replacement therapy for diminished heparin response. We used patient data from 2012, prior to rhAT usage for comparison. All patients achieved therapeutic ACT after rhAT administration. We also observed decreased postoperative atrial fibrillation rates, improved platelet preservation, decreased intensive care unit and ventilator times in patients receiving rhAT compared to rates commonly observed at our center. Heparin-resistant patients can be treated with rhAT to achieve therapeutic ACTs. Our observations suggest that the use of rhAT in conjunction with Carmeda® heparin-bonded circuits may also have a positive benefit on some of the well-established negative clinical consequences of CPB and improve patient outcomes.
Design and Evolution of the Asporto Heart Preservation Device
Authors: Rivard Andrew L.
Published: July 2023

The Asporto Heart Preservation Device is a system providing perfusion of cardioplegia to the donor heart using a computer-controlled peristaltic pump in a thermoelectrically cooled and insulated container. In 1998, a user interface was developed at the University of Minnesota consisting of a touch screen and battery-backed microcontroller. Power was supplied by a 120 VAC to 12 VDC converter. An upgrade to the insulated cooler and microcontroller occurred in 2002, which was followed by proof of concept experimental pre-clinical transplants and tests demonstrating the efficacy of the device with isolated donor hearts. During the period between 2002 and 2006, a variety of donor organ containers were developed, modified, and tested to provide an optimal sterile environment and fluid path. Parallel development paths encompass formalized design specifications for final prototypes of the touch screen/microcontroller, organ container, and thermoelectric cooler.
A Minimal Model Coupling Communicable and Non-Communicable Diseases
Authors: Marvá M. , Venturino E. , Vera M.C.
Published: July 2023

This work presents a model combining the simplest communicable and non-communicable disease models. The latter is, by far, the leading cause of sickness and death in the World, and introduces basal heterogeneity in populations where communicable diseases evolve. The model can be interpreted as a risk-structured model, another way of accounting for population heterogeneity. Our results show that considering the non-communicable disease (in the end, a dynamic heterogeneous population) allows the communicable disease to become endemic even if the basic reproduction number is less than 1. This feature is known as subcritical bifurcation. Furthermore, ignoring the non-communicable disease dynamics results in overestimating the basic reproduction number and, thus, giving wrong information about the actual number of infected individuals. We calculate sensitivity indices and derive interesting epidemic-control information.
Laminoplasty in Motion: Evolving Techniques and Complications
Authors: Singleton Ian M. , Piple Amit S. , Crawford Ben , Mittal Ashish , Rosinski Alexander A. , Kondrashov Dimitriy G.
Published: July 2023

Cervical laminoplasty is an increasingly popular surgical option for the treatment of cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL). Over the past few decades, there have been substantial developments in both surgical technique and hardware options. As the field of cervical surgery rapidly evolves, there is a timely need to reassess the evolving complications associated with newer techniques. This review aims to synthesize the available literature on cervical laminoplasty and associated mechanical complications pertaining to different laminoplasty hinge fixation options.
Reality Faced by Dental Students during COVID-19 Pandemic Situation
Authors: Bhosale Trupti , Mathew Roshni , Hegde Amitha M.
Published: July 2023

The COVID-19 pandemic was causing an unfavorable effect on the education and mental health of students. Much information about this virus is available, but its effect on mental health has been overlooked during this pandemic. Also, disruption in the academic year had led to more of virtual learning. The pros and cons of virtual learning need to be assessed, there is a need to evaluate whether there has been a shift in approach toward dental practice.

So in our survey, we evaluated the mental health, efficiency of virtual learning, and attitude toward future dental practices among dental students during the COVID-19 pandemic.

Objectives The aim of this study was to evaluate the mental health, efficiency of virtual learning, and attitude toward future dental practices among dental students during the COVID-19 pandemic.

Materials and Methods In this study, we included 87 final-year dental undergraduate students from A B Shetty Memorial Institute of Dental Sciences (ABSMIDS). The study was conducted through online questionnaire using google link.

Results In our survey, we found that many of the student's mental health was affected as they experienced certain level of depression, isolation, and mood swings, which affected their sleeping pattern. So we can consider counseling sessions for the students. We also found that virtual learning is a convenient alternative, but it also has some drawbacks as it caused physical discomforts like eye strain, back pain, etc. The students' responses were overwhelmingly positive with regard to future dental practices, but they felt there is a need to treat patients with protective equipment and guidance.

Conclusions Our study showed that this pandemic had hampered the mental health status of students in some ways. Also, it showed that virtual learning is helpful and is a convenient alternative, but it has some drawbacks as it causes physical discomforts. The students' responses were overwhelmingly positive with regard to future dental practices, but they need to treat patients with protective equipment.

The Covid pandemic waves had made it difficult to control the situation, which resulted in extended periods of lockdown. Hence, these factors should be considered for the benefit of students in order to manage any future outbreaks in a better way.
Telangiectatic Osteosarcoma—A Single-Center Experience
Authors: Narayanan Geetha , Thambi Sugeeth M , Kattoor Jayasree , Sugath Bhaskar Subin , Nair Sreejith G.
Published: July 2023

Telangiectatic osteosarcoma is an uncommon subtype of osteosarcoma accounting for less than 4% of all cases of osteosarcoma. It is characterized by distinctive radiographic, pathologic features, and prognostic implications. Radiologically and microscopically, it mimics aneurysmal bone cyst. The objective of this study was to study the clinical profile and treatment outcome of patients with telangiectatic osteosarcoma. Thirteen patients were diagnosed with telangiectatic osteosarcoma in the department of medical oncology at a tertiary cancer center in India during a 12-year period. All patients were above 15 years of age. The median age at presentation was 20 years, males were predominant, and the commonest sites of involvement were lower end of femur and upper end of humerus. Ten patients underwent treatment that consisted of neoadjuvant and/or adjuvant chemotherapy with ifosfamide, doxorubicin, cisplatin regimen and limb sparing surgery or amputation. Currently, eight out of ten patients are alive in remission at a median follow-up of 50 months with survival ranging from 18 to 138 months.
Perceived service quality and student satisfaction in higher learning institutions in Tanzania
Authors: Bwachele Victor William , Chong Yee-Lee , Krishnapillai Gengeswari
Published: July 2023

Despite policy efforts to promote higher learning in Tanzania, reports show persistent student dissatisfaction, revealing the extant inadequate quality measurement models. The study examined the fundamental elements causing dissatisfaction using an extended SERVQUAL model with additional variables, perceived transparency mediated by trust. Researchers collected quantitative data from 398 third-year higher learning students. The structural equations modelling result shows that reliability, perceived transparency, and trust in an institution significantly predict satisfaction. Further, trust partially mediates the influence of perceived transparency on student satisfaction. Evidence from this study suggests that education policy geared to promote the expertise of service providers and punctuality of service offering, transparency in service offering, and social responsibility of service provision is adequate for student satisfaction. Future research can look into a cross-level of economic development, groups of students—analysis of satisfaction determinants, and test the transparency—trust-based SERVIQUAL Model in quality struggling sectors in Tanzania and other developing countries. Also, studies can test how satisfaction mediates the effect of quality on academic performance.
A novel and ultra-compact plasmonic filter with a fully controlled rejection band
Authors: Aziz Asad , Aziz Arsalan
Published: July 2023

In this article, we propose a novel approach to develop an ultra-compact spoof surface plasmon polariton (SSPP) band-rejection filter by loading T-shaped grooves on the SSPP transmission line (TL). This scheme is based on the interaction between two types of grooves, i.e. rectangular grooves of the SSPP TL and T-shaped grooves. This form of interaction has never been addressed before in order to achieve a highly efficient SSPP band-rejection filter. The working principle of this band-rejection filter is clearly revealed via investigation of the dispersion behavior of the SSPP TL in the presence and absence of T-shaped groove loading. Meanwhile, we simulate an SSPP TL loaded with T-shaped grooves. As proof of concept, we fabricate the filter in the microwave regime and perform an experiment which characterizes its functionality. The simulated and experimental results confirm the excellent filtering phenomena exhibited by our structure. The isolation of the filter can be less than −15 dB at rejection frequencies with excellent transmission efficiency in both passbands, before and after the rejection band. Furthermore, simulated near-electric-field results are also presented to demonstrate the authenticity of the filter. When the question of generating a highly efficient SSPP band-rejection filter arises, the proposed method facilitates us with T-shaped grooves, which are declared as an excellent alternative to metamaterial particles in this regard. The proposed band-rejection filter based on SSPPs demonstrates an outstanding capability to take part in the progress and the advancement of integrated plasmonic structures and systems at microwave frequencies.
Drilling of cylindrical holes in Crown glass by a short-pulse flat-top CO2 laser beam
Authors: Rahaman Md. Ekhlasur , Uno Kazuyuki
Published: July 2023

We investigated cylindrical hole drilling in a crown glass with a high thermal expansion coefficient of 94 × 10–7 K−1 and a low melting point of 724 °C using a short-pulse CO2 laser with a flat-top beam, and also examined the drilling characteristics. The short laser pulse consisted of a pulse spike with a pulse width of 276 ns and a pulse tail with a length of 56.9 µs at a repetition rate of 200 Hz. The laser beam had a flat-top profile with an estimated M2 parameter of 13.5 and a diameter of 12.5 mm before a focusing lens. The flat-top beam was focused by the focusing lens, which had a focal length of 12.7 mm, on the glass surface at a focus offset of −0.20 mm to +0.40 mm. The incident flat-top beam produced conical holes at focus offsets of −0.20 mm to 0.00 mm and produced cylindrical holes at focus offsets of +0.20 mm to +0.40 mm. The hole depth of the cylindrical holes was 109 μm to 434 μm, the surface hole diameter was 150 μm to 366 μm, and the aspect ratio, defined as the ratio of the hole depth to the surface hole diameter, was 0.30 to 2.89. The hole depth was influenced by the focus offset and the total irradiation fluence, whereas the surface hole diameter, the taper angle and the ratio of the surface hole diameter to the irradiation diameter were influenced by the focus offset only. The ratio of the surface HAZ (Heat affected zone) diameter to the irradiation diameter was influenced by both the focus offset and the total irradiation fluence.
Direct current measurements of the SPIDER beam: a comparison to existing beam diagnostics
Authors: Shepherd A. , Patton T. , Pimazzoni A. , Pouradier Duteil B. , Rigoni Garola A. , Sartori E. , Ugoletti M. , Serianni G.
Published: July 2023

For negative ion beam sources there are several methods of measuring the accelerated beam
current, most commonly electrical measurements at the power supply and calorimetric
measurements. On SPIDER, the ITER Heating Neutral Beam full-scale beam source prototype,
electrical measurements at the acceleration grid power supply (AGPS) are complemented by
polarizing the diagnostic calorimeter STRIKE to provide an additional electrical measurement of
the accelerated current. This is in addition to the calorimetric measurements provided by
STRIKE. These diagnostics give differing measurements of the beam current. Exploiting the reduced
number of open apertures on SPIDER a new beam diagnostic has been installed to measure the
individual beamlet currents directly. The so called Beamlet Current Monitor (BCM) has been used to
measure the current of five beamlets during the most recent SPIDER campaign. This work compares
the BCM current to the electrical measurements at the AGPS and STRIKE. The average BCM current
agrees well with the STRIKE electrical measurements, indicating that the AGPS overestimates the
beam current. The individual beamlets are compared to the STRIKE calorimetric measurements,
showing similar current trends with the source parameters.
Use of FBG sensors in advanced civil engineering applications
Authors: Caponero M.A.
Published: July 2023

Structural health monitoring (SHM) in civil engineering structures has gained a key role to provide early warning for the occurrence of conditions leading to potential damage and unsafe service. Among the various available technologies, fiber optic ones have proved to be reliable and convenient to perform permanent monitoring in both static and dynamic regimes. Fiber optic sensing solutions based on the fiber Bragg grating (FBG) technology are very versatile and they can be effectively used to provide multipoint sensing systems distributed on large structures. FBG sensors have a point-like form factor, but they can be easily packaged in solid housings in order to fit the necessary measuring gauge and sensitivity, shape and size, mechanical and environmental requirements. As key advantages over electric technologies, FBG sensors offer immunity to electromagnetic interference, in-series cabling of sensors for different physical parameters, stable response to both quasi-static phenomena and fast response transitory phenomena. This paper presents some monitoring solutions developed in ENEA with FBG sensors for civil engineering applications.
Thin film charged particle detectors
Authors: Kim Sungjoon , Berry Vikas , Metcalfe Jessica , Sumant Anirudha V.
Published: July 2023

Silicon tracking detectors have grown to cover larger surface areas up to hundreds of
square meters, and are even taking over other sub-detectors, such as calorimeters. However,
further improvements in tracking detector performance are more likely to arise from the ability to
make a low mass detector comprised of a high ratio of active sensor to inactive materials, where
dead materials include electrical services, cooling, mechanical supports, etc. In addition, the
cost and time to build these detectors is currently large. Therefore, advancements in the
fundamental technology of tracking detectors may need to look at a more transformative approach
that enables extremely large area coverage with minimal dead material and is easier and faster to
build. The advancement of thin film fabrication techniques has the potential to revolutionize the
next-to-next generation of particle detector experiments. Some thin film deposition techniques
have already been developed and widely used in the industry to make LED screens for TVs and
monitors. If large area thin film detectors on the order of several square meters can be
fabricated with similar performance as current silicon technologies, they could be used in future
particle physics experiments. This paper aims to review the key fundamental performance criteria
of existing silicon detectors and past research to use thin films and other semi-conductor
materials as particle detectors in order to explore the important considerations and challenges to
pursue thin film detectors.
Calibration of the FY-3E particle sensors: High-Energy Particle Detector (HEPD)
Authors: Hou Donghui , Zhang Xiaoxin , Wang Jinhua , Huang Cong , Li Jiawei , Zong Weiguo , Zhang Shenyi , Shen Guohong , Zhang Xianguo , Yuan Bin , Quan Zida , Ji Wentao , Zhou Ping , Yang Yong , Zhang Pengfei , Sun Yueqiang
Published: July 2023

The FY-3 satellites are China's second generation
polar-orbiting meteorological satellites. The high-energy particle
detector (HEPD) suite of FY-3 satellites measures protons and
electrons in different energy ranges. As the fifth satellite of the
FY-3 series, FY-3E continues to observe polar-orbiting high-energy
protons and electrons. Here, we use Monte Carlo simulations based on
GEANT4 code to model the high-energy electron detector and calibrate
the high-energy electron/proton detector campaigns at the Space
Electron Facility, National Space Science Center (NSSC-SEF) and
100 MeV high intensity proton cyclotron at the China Institute of
Atomic Energy (CYCIAE-100). Due to the energy limitation of the
accelerator, the electronic calibration results are also
provided. Overall, the findings of this study can serve as a useful
reference for characterizing the performance of FY-3E HEPD and
verifying the feasibility of on-orbit data.
Exposure to air pollution and risk of haematological malignancies: a systematic review and dose-response meta-analysis of epidemiologic evidence
Authors: Lin Kangqian , Zhou Guoxiu , Guo Hong , Niu Qiang , Guo Heng , Song Guanling , Hu Yunhua , Liu Jiaming , Yan Yizhong
Published: July 2023

Quantifying the potential association between air pollutants exposure and haematological malignancies (HM) risk can provide more direction for its prevention. In this systematic review and meta-analysis, case-control and cohort studies looked at the association between air pollution and the risk of HM in the general population were included. PubMed, Web of Science, Wanfang database, and China National Knowledge Infrastructure were searched as of 14 April 2022. The Mantel–Haenszel random effects model was used to calculate the meta-analysis relative risk (meta-RR). A two-stage random-effects dose-response meta-analysis was performed to estimate the degree of the associations and a dose-response curve was fitted using a restricted cubic spline model, as well as assessed publication bias. This review was registered with International Prospective Register of Systematic Reviews (CRD42022325677). The literature search yielded 7260 articles, and 41 studies were included. Benzene exposure significantly increased the risk of leukaemia (meta-RR 1.24, 95% confidence interval (95%CI) 1.01–1.54). The meta-RR of traffic density, nitrogen dioxide (NO2), particulate matter (PM2.5 and PM10) and leukaemia were 1.08 (95%CI 0.99–1.17), 1.02 (95%CI 0.96–1.09), 1.05 (95%CI 0.99–1.11), 1.04 (95%CI 0.69–1.56). 1.07 (95%CI 0.93–1.22), 1.01 (95%CI 0.96–1.06), 1.06 (95%CI 0.98–1.14) were the meta-RR of traffic density, NO2, PM2.5 and lymphoma. The meta-RR of NO2 and multiple myeloma was 1.00 (95%CI 0.92–1.09). Disease subtype, age and region appeared to modify these associations. When residential distance from a main road was less than 300 m, the risk was relatively high and gradually increased with the decrease of the distance; with the increase of NO2 exposure concentration, the risk of acute myeloid leukaemia (AML) gradually increased, increasing rapidly once NO2 concentration reached 40 μg m−3; with increasing benzene exposure concentration, the risk of AML and acute lymphoblastic leukaemia gradually increased, particularly after the concentration reached 3 μg m−3. These findings can be used as epidemiological evidence for the causal relationship between air pollutants and HM.
On determination of elastic modulus and indentation hardness by instrumented spherical indentation: influence of surface roughness and correction method
Authors: Peng Guangjian , Liu Yu , Xu Fenglei , Jiang Hanyang , Jiang Weifeng , Zhang Taihua
Published: July 2023

Although, surface roughness can influence the determination of elastic moduli and indentation hardness to some extent by instrumented spherical indentation test, limited work has been done to quantitatively reveal and minimize these influences. In the present work, through a large number of finite element (FE) simulations and analyses, we clarified the evolution trend of determined elastic moduli and indentation hardness corresponding to different normalized indentation depths (h/R) and normalized roughness (S
q/R). On this basis, an area correction method was proposed to improve the measurement accuracy in the elastic moduli and indentation hardness. The FE results show that, with the newly proposed correction method, the maximum relative error in determined elastic moduli is reduced from about ±7% to ±2%, and that in the determined indentation hardness is reduced from about ±13% to ±5%, when S
q/R ≤ 2.2 × 10−3 and h/R = 5%. Applications were then illustrated on four typical metallic materials (i.e., AA 7075, AA 2014, steel 316 L, and copper T2). The experimental results demonstrate that the proposed correction method is able to mitigate the effects of surface roughness on the determination of elastic moduli and indentation hardness to obtain more correct results.
Skin models of cutaneous toxicity, transdermal transport and wound repair
Authors: Vilela de Sousa Inês , Ferreira Miguel J S , Bebiano Luís B , Simões Sandra , Matos Ana Filipa , Pereira Rúben F , Granja Pedro L
Published: July 2023

Skin is widely used as a drug delivery route due to its easy access and the possibility of using relatively painless methods for the administration of bioactive molecules. However, the barrier properties of the skin, along with its multilayer structure, impose severe restrictions on drug transport and bioavailability. Thus, bioengineered models aimed at emulating the skin have been developed not only for optimizing the transdermal transport of different drugs and testing the safety and toxicity of substances but also for understanding the biological processes behind skin wounds. Even though in vivo research is often preferred to study biological processes involving the skin, in vitro and ex vivo strategies have been gaining increasing relevance in recent years. Indeed, there is a noticeably increasing adoption of in vitro and ex vivo methods by internationally accepted guidelines. Furthermore, microfluidic organ-on-a-chip devices are nowadays emerging as valuable tools for functional and behavioural skin emulation. Challenges in miniaturization, automation and reliability still need to be addressed in order to create skin models that can predict skin behaviour in a robust, high-throughput manner, while being compliant with regulatory issues, standards and guidelines. In this review, skin models for transdermal transport, wound repair and cutaneous toxicity will be discussed with a focus on high-throughput strategies. Novel microfluidic strategies driven by advancements in microfabrication technologies will also be revised as a way to improve the efficiency of existing models, both in terms of complexity and throughput.
A Sensitive Liquid Chromatography-Mass Spectrometric Method for Determination of Bisoprolol in Rat Serum after Pre-Column Derivatization
Authors: Shaheen Huda A , Bahaffi Saleh O , Khedr Alaa M
Published: July 2023

Two derivatization regents were reacted with bisoprolol (BIS), followed by liquid-chromatography-mass spectrometric analysis. 3-Bromomethyl-propyphenazone (BMP) and dansyl-chloride (Dns-Cl) were reacted via the secondary amino group using a catalyst to accelerate the reaction progress and completeness with minimal reaction byproducts. The sensitivity and the ionization efficiency of both BIS-methyl-propyphenazone (BIS-MP) and BIS-Dns via electrospray ionization were studied. The sensitivity of BIS-MP was superior to BIS-Dns. The derivatization procedure, extraction procedure, and LC-MS method were optimized and validated to achieve the monitoring of BIS in rat serum at a picogram scale. The calibration curve showed a regression coefficient value of 0.999 within a concentration spanning a range of 10–500 pg/mL. The detection limit and quantitation were 4 and 10 pg/mL, respectively. The intraday and inter-day precision values (% relative standard deviation) ranged from 0.53 to 6.91%, whereas the accuracy values (expressed as % error) ranged from −4.20 to −0.77%. The pharmacokinetic parameters were: 15,280 pg/mL for a maximum concentration of BIS (Cmax) at the maximum time (Tmax) of 1 h. BIS’s elimination half-life (t1/2) was determined to be 3 h. The value of the area under the concentration-time curve (AUC0 − t) was 34,370 pg/mL h.
Cumulative complexity: a qualitative analysis of patients' experiences of living with heart failure with preserved ejection fraction
Authors: Forsyth F , Sowden E , Hossain M , Blakeman T , Chew-Graham C A , Deaton C
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): NIHR, Evelyn Trust, Burdett Trust.

Background

Multiple investigations have explored the lived experience of heart failure (HF). However, studies have not interrogated whether differences exist according to HF phenotype and the lived experience of people with Heart Failure with preserved Ejection Fraction (HFpEF) remains unexplored. We hypothesised patients with HFpEF may articulate different experiences from those with other forms of HF, given established problems around awareness, diagnosis and management.

Purpose

To explore how HFpEF impacts upon patients’ lives and interrogate whether and how known challenges impact upon patient experience.

Methods

Secondary thematic analysis of interview transcripts from 77 people diagnosed with HFpEF and their carers. The analysis was informed by the Cumulative Complexity Model (CCM).

Results

Four themes underpinned by the CCM were generated. Theme 1: Shouldering a Heavy Workload, described the many health related tasks (patient work) people living with HFpEF were expected to perform. Theme 2: The Multiple Threats to Capacity described how patients tried to perform this work, however, were frequently hindered by challenges such as difficult to manage symptoms or mobility/age-related conditions. Patient work and ability to perform this work were complicated by problems synthesised under Theme 3: Deficient Illness Identity. This theme illustrated how healthcare providers sometimes perceived HFpEF to be a more benign or untreatable form of HF, which could lead to limited access or lower priority for supportive services. Together, themes one to three contributed to a range of negative outcomes captured within Theme 4: Spiralling Complexity.

Conclusions

HFpEF, multimorbidity and aging cumulatively create multiple demands that people with HFpEF must attend to, whilst they concurrently negotiate symptoms and physical limitations that make this challenging to achieve. Patient work and patient capacity to perform work are impeded by a system that undermines their candidacy for optimum HF care. Such conditions create unfavourable outcomes that will continue, unless system wide change is implemented.
Observational study of patients with heart failure with reduced ejection fraction (HFrEF) admitted with decompensation
Authors: Mclachlan A
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

HFrEF is associated with significant negative patient outcomes and requires substantial health care resource.

Method

Using the hospital registry from 1st May 2021, 100 consecutive patients were identified, who attended the heart failure clinic following their first hospitalisation with decompensated heart failure with severe LV impairment (ejection fraction <30%). Electronic records were reviewed manually. The first year is described.

Results

Mean age 56.8 yrs. (22-83 yrs.), 72% male, 63% were Maori/Pacific and the time to first contact was 35 days (2-177 days). Risk factors included smoking (19%), diabetes (35%), mean BMI 35.9 (17- 70), AF/AFL (33%), IHD (32%) and eGFR <60 (33%).

By one year, medical therapy included beta-blocker (76% >50% target dose), RAAS inhibitor (81% >50% target dose), MRA (70%), SGLT2i (23%), diuretic (66%). The average number of outpatient contacts were 6.5 with 21% of patients having at least 1 HFrEF admission. At last review, 55% were asymptomatic with 10% receiving device therapy. Follow up imaging was performed in 83% with 78% reporting left ventricular improvement. Nine patients died, average age of 61.2 years.

Conclusion

Despite improving therapies, delivery by our heart failure service could be further optimised. A system co designed with our communities may provide additional advances.
Experiences of older vulnerable people with ischemic heart disease and their peer mentors: a qualitative process evaluation
Authors: Pedersen M , Bennich B B , Petersen R A , Boateng T , Egerod I , Overgaard D
Published: July 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): VELUX FONDEN

Background

Peer-mentoring is a low-cost intervention with the potential of improving self-efficacy and cardiac rehabilitation attendance among older vulnerable patients with cardiovascular disease. The present study is part of an ongoing research program, developing and testing the feasibility of a 24-week peer-mentor intervention.

Objectives

The objective was to understand the content and context of the realized peer-mentor intervention, and to explore how mentors and mentees experienced the intervention.

Methods

The study was designed as a qualitative process evaluation. Semi-structured individual interviews were conducted in a purposeful sample of mentees (n=13), and peer-mentors (n=12), and thematic analysis was used to analyse, categorize, and interpret interview data.

Results

Five themes captured the content and context of the peer-mentor intervention as experienced by peer-mentors and mentees. ‘Takes one to know one’, stressing the importance of the mentor-mentee matching process; ‘Varying demand for mentors’, illustrating the difficulties in predicting who has the greatest need for mentoring; ‘Varying degree of familiarity’, describing the mentor-mentee relationship as a continuum from formal mentor to informal friend; ‘Putting the patient first’, illustrating how mentors support mentees based on their personal experiences of successful recovery while letting the mentee set the pace and goals; and ‘Varying view of success’, showing how intervention success is perceived differently by mentors and mentees.

Conclusions

The study provides new knowledge on how and under what circumstances a mentor intervention works. These findings are important to the implementation of future peer-mentor interventions to achieve successful peer-mentor support and improve cardiac rehabilitation attendance among older vulnerable patients with ischemic heart disease.
Re-engineering the cardiology ward round to improve efficiency of care
Authors: Lymn A , Clark R , Lambrakis K , Chew D
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Flinders Medical Centre and Flinders University.

Background

There is limited literature investigating effective mechanisms improving clinical team cohesion and effectiveness to achieve clinical excellence.

Purpose

To re-engineer the cardiac care unit (CCU) ward rounds through enhanced cardiac-trained nurse input and advocacy to improve decision-making and deliver patient centred care.

Methods

A prospective observational design, ensuring CCU nurse attendance at every ward round (arrhythmia, acute coronary syndrome, heart failure) in consecutive 2-week control and implementation periods, conducted over three 4-week cycles. The primary endpoint was timely administration of cardiac medications. Secondary endpoints were length of stay, time to procedure bookings, patient mobility and education.

Results

206 patients were recruited (control n=101, intervention n=105). Median time to cardiac medication administration was significantly shorter in the intervention cycle, (Intervention:0 hr/med [IQR 0-0.5] versus Control: 0.2 hr/med [IQR 0-1.2],p = 0.012). Heart Failure patients had the most significant improvements; (Intervention 0 hr/med [IQR 0-0.03] versus control 0.9 hr/med [IQR 0.3-1.6], p<0.001). Secondary endpoints trended toward improvement in all ward rounds, but results did not reach statistical significance. See Figure 1.

Conclusion

Empowering CCU nurses on ward rounds reduced medication delays, with clinically valuable improvements in secondary endpoints observed. Further research into implementable and sustainable interventions to drive clinical excellence is essential.Cardiac Medication Delays
Procedure videos to support rare clinical procedures in acute cardiac nursing, an implementation evaluation
Authors: Colgan J , Miles K , Kourouche S , Tofler G , Buckley T
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Central Coast Local Health District Research Grant.

Background

Cardiology procedures are often lifesaving and time-critical, but some are so infrequent that nurses may have rarely encountered them in practice. Videos demonstrating rare procedures can potentially support clinicians performing rare clinical procedures. We evaluated using locally created nursing clinical procedure videos as an adjunct to traditional written procedures.

Purposes

This study evaluated the implementation of 7 newly created clinical procedure videos on temporary cardiac pacing (n=3), non-invasive ventilation (NIV) (n=2) and pericardiocentesis (n=2).

Methods

A pre/ post -implementation Survey based on the Theoretical Domains Framework (TDF), Clinical Reasoning Cycle and the Spielberger State-Trait Anxiety Inventory (STAI) was distributed via email and Facebook groups to over 500 eligible nurses in the implementation sites. In addition, data from the hosting platform Vimeo for the implementation period and procedure numbers (15 October 2020 to 15 March 2021) were analysed.

Results

122 respondents, 86% female, viewed the videos, mean age of 40.75 years (20 to 71 years). The most common procedure during the implementation period was NIV (n=170), followed by Pericardiocentesis (n=7) and Temporary Cardiac Pacing (n=5). The total number of video views over the 6 months was 598, temporary pacing-preparation (n=152), NIV Mask why and when (n=137), NIV Set up and Patient Care (n=89), Pacing: Procedure (n=62), Cardiac Tamponade (n=52), Pacing: Threshold testing and Pericardiocentesis Procedure (n=51 each). Participants agreed /strongly agreed that video procedures increased their recall (93.8%), made learning a better experience (98.3%), and was time-saving (88.0%) (Figure 2). Participants preferred videos to be an adjunct to existing written procedures and not a replacement (78%). Major themes from qualitative feedback included participants describing them as "clear and easy to understand" and the benefits of videos for rare procedures "Rarely seen in ED easy to follow and fast refresher when the procedure is time critical".

Prior to implementation, the mean score for state anxiety before a rare procedure was 41.43 (SD= 9.307) with scores over 40 indicating clinically significant levels of anxiety. Older age and a higher number of years in the role were significantly correlated with lower anxiety levels (r = -0.144 p = .037; and r = 0.532 p = .000) perceived anxiety related to rare procedures did not significantly change from pre- to post-implementation.

Conclusion

Clinical procedure videos at the point of care are acceptable and valued. Findings suggest videos are a useful adjunct to written procedures for time-critical or rare procedures.Figure 2:Experience with video.
Patient experiences of remote hypertension management during covid-19: a qualitative study
Authors: Mchale S , Hanley J , Paterson M
Published: July 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): British Heart Foundation.

Background

Telemonitoring of blood pressure [BP] managed within primary care is effective in reducing the risk of cardiovascular disease in patients with hypertension. However, COVID-19 disrupted service delivery and affected the support of people living with hypertension. It is unknown how patients who did or did not utilise telemonitoring self-managed their BP during the pandemic.

Purpose

To understand patients’ experience of hypertension service delivery in Scotland during the COVID-19 pandemic, with a focus on the use of remote BP telemonitoring technology.

Methods

Qualitative individual semi-structured telephone interviews were conducted between April and November 2022. Interview transcripts were analysed using the framework approach to code and categorise the data into key concepts and overarching themes.

Results

We interviewed 43 participants (23 males and 20 females) from 6 primary care practices. From the views of 25 patients utilising telemonitoring technology and 18 who did not, we identified five overarching themes that represented participants' experiences of hypertension services delivery during the COVID-19 pandemic. 1) Adapting NHS services. Covid-19 disrupted routine services and resulted in infrequent in-person health checks for BP, asthma, and diabetes for both groups and a lack of primary care feedback for non-telemonitored patients’ home-monitored BP. 2) Navigating access to services. Gaining timely and/or in-person access to services was challenging. Also there was fear and delay in access because it was viewed as a source of covid infection. 3) Telemonitoring. Remote telemonitoring permitted telemonitoring participants to continue receiving hypertension management during the pandemic. 4) Self-management of BP. Some non-telemonitoring participants were motivated to self-measure BP readings using home monitoring equipment to increase self-care for hypertension and lifestyle. Also, some telemonitoring participants were empowered to self-manage medication changes. 5) Experiences of covid. Upon contracting the covid-19 virus, some participants experienced an immediate increase in their BP, and post-virus, longer-term increased BP readings and/or feelings of chest discomfort and breathlessness.

Conclusions

The covid-19 pandemic disrupted care for patients with hypertension and although it was clear that service delivery had been adapted, patients were unwilling to access the NHS due to covid-19 risk and found access to effective primary care support difficult. When compared to non-telemonitoring, telemonitoring provided a more direct link to the primary care team who were able to manage hypertension remotely. The service disruption may have longer-term implications for patient health outcomes; however, this study suggests there is greater scope for self-management of hypertension than currently recommended.
Delivery of virtual acute cardiac care- a pilot study
Authors: Martin L , Naismith C , Horrigan M
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The increasing incidence of chronic conditions, along with the SARS CoV-2 pandemic, put unprecedented capacity restraints on hospital bed access. New models of care are required to meet the increasing clinical demand for hospital services. Digital health technologies to support virtual hospital in the home services may address this need by offering patient-centered, safe and efficient models of care that are not reliant on physical hospital infrastructure. Specific cardiac conditions are well suited to a virtual model of care.

Purpose

To describe and evaluate a novel virtual model of care for cardiac patients that delivers early supported discharge from the acute inpatient ward to home.

Model of Care

The cardiac hospital in the home (cHITH) model was designed to provide an early supported discharge in a virtual ward environment by an expert team of advanced practice cardiac nurses, pharmacists and cardiologists. This 48-hour model of care utilized wearable technology to monitor cardiac rhythm and vital signs in conjunction with daily virtual ward rounds to manage recognised post operative/ procedural complications. Escalation pathways for clinical deterioration were designed to support patient safety. Transitional care to discharge was a key element of this model. Quality, safety, efficiency and patient experience were evaluated.

Key Results

From March-November 2022, 260 patients were referred to cHITH with 191 (74%) patients accepted according to the risk-stratification criteria. This cohort included post cardiac surgery (CSUR) patients (54%); post interventional procedures (31%), post device implant (6%) and other (9%). The cHITH length of stay (LOS) was 1.9 ± 0.1 days reflecting 20% of the episode of acute care delivered in the virtual environment. Re-admission rates were 9.4% at 30-days, with 0% mortality. Patient satisfaction was >90% (net promoter score).

The CSUR cohort (n=103) had a mean age of 62 ± 4 years; male 82%; isolated CABG 62%; 30-day re-admission rate 7.8%. Total post-operative LOS was 7.1 ± 2.4 days with 35% of post-operative care delivered in the virtual cHITH environment. A total of 258 bed days were realized.

Conclusion

This pilot virtual model of care has demonstrated safety, efficiency and high levels of patient satisfaction. Ongoing analysis is required to understand the broader applications of this model and to further evaluate quality, safety and efficiency metrics.
Physical and perceived effort of patients with stroke during hospital-based rehabilitation when performing sit to stand: a pilot study
Authors: Roos R , Harington T , Comley-White N
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Information

Rehabilitation of patients with stroke includes optimisation of function and increasing individuals’ physical activity levels as a means of improving independence and preventing recurrence of cardiovascular events. Physical effort evaluation and monitoring is important to highlight exercise intensity level during rehabilitation. Sit to stand (STS) is a mechanically demanding functional task. Little is known about the physical effort experienced by patients with stroke when performing this activity during hospital-based rehabilitation.

Purpose

The study assessed the perceived effort, energy expenditure and metabolic equivalent of task (MET) levels of patients with stroke when performing STS as a means of outlining their physical effort.

Methods

A descriptive cross-sectional pilot study took place at two hospitals in Johannesburg, South Africa, between November 2018 to February 2020 and March to September 2021. Participants reported their perceived effort using the Modified Borg Scale (MBS) and their energy expenditure and MET level were assessed with a triaxial accelerometer. The Shapiro-Wilk Test was used to test for normality of data and descriptive and inferential statistics were used to determine findings (p-value set at ≤ 0.05).

Results

The team screened four hundred and twenty eight individuals for potential inclusion in the study. The pilot study consisted of nine participants (n=5 female, 55.5%), with a mean age of 52.77 (SD ± 11.33) years and mean body mass index of 24.31 (±5.36) kg/m2. Most had a haemorrhagic stroke (n=6, 66.6%), left hemiplegia (n=6, 66.6%), ‘mild’ stroke (n=7, 77.8%) as per the National Institutes of Health Stroke Scale and were assessed 9.11 (SD ±6.57) days post stroke. The mean time it took participants to complete STS was 6.04 (±4.03) seconds. Most participants (n=7, 77.8%) perceived STS at a ‘moderate’ or stronger effort level on the MBS. The calculated mean physical energy expenditure during STS was 2.82 (±1.9) kCal/min and the mean MET level 2.99 (±1.89). The correlation coefficient between the subjective perceived effort and physical effort as per energy expenditure was r = 0.61 (p = 0.08) and subjective perceived effort and MET level r = 0.34 (p = 0.38).

Conclusion

The ability to come from STS is one of the most frequent functional tasks used daily and a prerequisite to walking. Study participants’ exercise intensity during STS was much higher when compared to published literature in healthy individuals. This study found a fair to moderate positive correlation between physical effort parameters and MBS for patients with stroke during STS. The results did not meet statistical significance due to the small sample size, indicating further research is warranted.