bluuebunny/crossref_metadata_2025 huggingface dataset:
Single-cell and spatial multiomic inference of gene regulatory networks using SCRIPro
Authors: Chang Zhanhe , Xu Yunfan , Dong Xin , Gao Yawei , Wang Chenfei
Published: July 2024

Motivation

The burgeoning generation of single-cell or spatial multiomic data allows for the characterization of gene regulation networks (GRNs) at an unprecedented resolution. However, the accurate reconstruction of GRNs from sparse and noisy single-cell or spatial multiomic data remains challenging.

Results

Here, we present SCRIPro, a comprehensive computational framework that robustly infers GRNs for both single-cell and spatial multiomics data. SCRIPro first improves sample coverage through a density clustering approach based on multiomic and spatial similarities. Additionally, SCRIPro scans transcriptional regulator (TR) importance by performing chromatin reconstruction and in silico deletion analyses using a comprehensive reference covering 1292 human and 994 mouse TRs. Finally, SCRIPro combines TR-target importance scores derived from multiomic data with TR-target expression levels to ensure precise GRN reconstruction. We benchmarked SCRIPro on various datasets, including single-cell multiomic data from human B-cell lymphoma, mouse hair follicle development, Stereo-seq of mouse embryos, and Spatial-ATAC-RNA from mouse brain. SCRIPro outperforms existing motif-based methods and accurately reconstructs cell type-specific, stage-specific, and region-specific GRNs. Overall, SCRIPro emerges as a streamlined and fast method capable of reconstructing TR activities and GRNs for both single-cell and spatial multiomic data.

Availability and implementation

SCRIPro is available at https://github.com/wanglabtongji/SCRIPro.
Step-growth irreversible deactivation radical polymerization: synergistic developments with chain-growth reversible deactivation radical polymerization
Authors: Kamigaito Masami
Published: July 2024

Recent advances in chain-growth reversible deactivation radical polymerization (CG-RDRP), i.e. the so-called “living radical polymerization”, have synergistically developed step-growth radical polymerizations via controlled formation of radical species from covalent bonds followed by irreversible deactivation of the resulting radical species. The monomers for radical polyaddition are thus designed to possess carbon–halogen or thioester bonds, which can generate radical species in the presence of transition metal catalysts and radical initiators, as well as carbon‒carbon double bonds, which will irreversibly form carbon–halogen or thioester bonds. Radical polycondensations are achievable via radical coupling reactions of carbon-centered radicals generated from carbon–halogen bonds or radical quenching reactions with nitroxides. Furthermore, radical addition-condensation polymerizations are achieved by a sequence of reactions, i.e. the formation of radical species from carbon–halogen bonds, radical addition to nitroso or thiocarbonylthio compounds, and coupling or quenching reactions with the resulting stable radical. These step-growth irreversible deactivation radical polymerizations (SG-IDRP) enable the synthesis of a variety of polymers, such as polyethers, polyesters, polyamides, and polyimides, which have aliphatic, aromatic, polar, and degradable groups in their main chains. Sequence-regulated vinyl polymer structures can also be constructed by designing monomers. Combinations with CG-RDRPs further lead to unique hybrid block, multiblock, graft, hyperbranched, and network polymers.
Insights from the first chromosome-level genome assembly of the alpine gentian Gentiana straminea Maxim.
Authors: Kelsang Gyab Ala , Ni Lianghong , Zhao Zhili
Published: July 2024

Gentiana straminea Maxim. is a perennial herb and mainly distributed in the Qinghai-Tibetan Plateau. To adapt to the extreme environment, it has developed particular morphological, physiological, and genetic structures. Also, rich in iridoids, it is one of the original plants of traditional Chinese herb ‘Qinjiao’. Herein, we present its first chromosome-level genome sequence assembly and compare it with the genomes of other Gentiana species to facilitate the analysis of genomic characteristics. The assembled genome size of G. straminea was 1.25 Gb, with a contig N50 of 7.5 Mb. A total of 96.08% of the genome sequences was anchored on 13 pseudochromosomes, with a scaffold N50 of 92.70 Mb. A total of 54,310 protein-coding genes were predicted, 80.25% of which were functionally annotated. Comparative genomic analyses indicated that G. straminea experienced two whole-genome duplication events after the γ whole-genome triplication with other eudicots, and it diverged from other Gentiana species at ~3.2 Mya. A total of 142 enzyme-coding genes related to iridoid biosynthesis were identified in its genome. Additionally, we identified differences in the number and expression patterns of iridoid biosynthetic pathway genes in G. straminea compared with two other Gentiana species by integrating whole-genome sequence and transcriptomic analyses.
Slaying the Servants of the Lord: The Killing of Bishops in Medieval Germany, c.900–1300
Authors: Loud G A
Published: July 2024

The medieval Church did its best to discourage both the involvement of clerics in violence and violence against clerics. The murder of a bishop, in particular, was a relatively rare event in this period. Thus the death of Thomas Becket was the exception, and certainly not the rule. Yet there was one kingdom where despite canonical prohibition prelates did frequently die through violence during the central Middle Ages. Between c.900 and c.1300 some thirty German bishops were either murdered or died in battle, and a number of other prelates suffered violence and were often lucky to escape with their lives. This paper seeks to explain why this should have been the case, examining the various different reasons why so many bishops perished in Germany, and looks at a number of particular cases in detail. Why did such killings became a regular feature of political life in the Reich at this period? How did contemporaries react to such events? The article also asks what this phenomenon—and also the prevalence of political assassinations among laymen—may tell us about medieval German society.
Bleeding risk prediction after acute myocardial infarction-integrating cancer data: the updated PRECISE-DAPT cancer score
Authors: Dafaalla Mohamed , Costa Francesco , Kontopantelis Evangelos , Araya Mario , Kinnaird Tim , Micari Antonio , Jia Haibo , Mintz Gary S , Mamas Mamas A
Published: July 2024

Background and Aims

This study assessed the impact of incorporating cancer as a predictor on performance of the PRECISE-DAPT score.

Methods

A nationally linked cohort of ST-elevation myocardial infarction patients between 1 January 2005 and 31 March 2019 was derived from the UK Myocardial Ischaemia National Audit Project and the UK Hospital Episode Statistics Admitted Patient Care registries. The primary outcome was major bleeding at 1 year. A new modified score was generated by adding cancer as a binary variable to the PRECISE-DAPT score using a Cox regression model and compared its performance to the original PRECISE-DAPT score.

Results

A total of 216 709 ST-elevation myocardial infarction patients were included, of which 4569 had cancer. The original score showed moderate accuracy (C-statistic .60), and the modified score showed modestly higher discrimination (C-statistics .64; hazard ratio 1.03, 95% confidence interval 1.03–1.04) even in patients without cancer (C-statistics .63; hazard ratio 1.03, 95% confidence interval 1.03–1.04). The net reclassification index was .07. The bleeding rates of the modified score risk categories (high, moderate, low, and very low bleeding risk) were 6.3%, 3.8%, 2.9%, and 2.2%, respectively. According to the original score, 65.5% of cancer patients were classified as high bleeding risk (HBR) and 21.6% were low or very low bleeding risk. According to the modified score, 94.0% of cancer patients were HBR, 6.0% were moderate bleeding risk, and no cancer patient was classified as low or very low bleeding risk.

Conclusions

Adding cancer to the PRECISE-DAPT score identifies the majority of patients with cancer as HBR and can improve its discrimination ability without undermining its performance in patients without cancer.
How do illness perceptions impact device acceptance in patients with an implantable cardioverter defibrillator?
Authors: Skov O , Johansen J B , Nielsen J C , Riahi S , Vinther M , Skovbakke S , Moeller S , Pedersen S S
Published: July 2024

Background

The implantable cardioverter defibrillator (ICD) is the first-line treatment for the prevention of sudden cardiac death in patients at high risk of a life-threatening arrhythmia. Illness perceptions encompass the cognitive and emotional representations each ICD patient has about their health condition, thus influencing coping strategies and health behaviors essential to adjusting to life with their device and underlying heart disease. We investigate how illness perceptions are prospectively linked to device acceptance in ICD patients.

Purpose

To examine how illness perceptions at ICD implantation are associated with patient device acceptance one-year post-implantation.

Methods

Secondary analysis of the ACQUIRE-ICD, national, multi-center, randomised controlled trial. Illness perceptions were measured with the Brief Illness Perceptions Questionnaire (B-IPQ) with 350 first-time ICD or cardiac resynchronization therapy defibrillator (CRT-D) recipients filling out the questionnaire at ICD implantation. B-IPQ was only assessed at baseline. Patient device acceptance, a disease-specific quality of life measure for ICD patients, was measured at both ICD implantation and at 12 months follow-up with the Florida Patient Acceptance Survey (FPAS). Of the 350 patients, 261 patients (75%) completed FPAS at 12 months follow-up.

Results

The participants’ mean age was 59.7 ± 11.4 years with the majority being male (83%). Total illness perceptions scores were categorised into low experienced threat (n = 182, 52%), medium experienced threat (n = 82, 23%), and high experienced threat (n = 86, 25%).

In the multivariate analysis, high experienced threat at ICD implantation was associated with significantly lower device acceptance at 12 months follow-up compared to low (B = -5.80, 95% CI [- 10.61, – -1.00], p = .018) and moderate experienced illness threat (B = -7.35, 95% CI [- 12.32, – -2.38], p = .004) while adjusting for device acceptance at baseline, age, sex, NYHA-class, indication, ischemic heart disease, education, intervention group and device type.

In an exploratory analysis investigating associations of all 8 B-IPQ illness perception dimensions (single item-scores) simultaneously regressed on 12-months total FPAS-scores with baseline FPAS-scores as covariate, B-IPQ item 4 measuring treatment control showed the strongest association (B = 0.94, 95% CI [0.13, – 1.76], p = .023) with higher perceived treatment control linked with higher device acceptance.

Conclusion

ICD patients with high experienced illness threat at ICD implantation had substantially lower device acceptance at one-year post-implantation compared to patients with low-to-moderate experienced illness threat. Perceptions of treatment control at ICD implantation appear to be a potential mediator of this relationship.
Preventing medication errors in patients with decompensated heart failure and cognitive impairment following hospital discharge, in Saudi Arabia
Authors: Amodi L , Hill L , Stark P , Rogers K
Published: July 2024

Background

Heart failure (HF) is a progressive health challenge, with an increased prevalence of 30% in older adults. It is estimated that approximately 50% of patients with HF have a degree of cognitive impairment, affecting adherence to self-care and medication taking. Therefore, medication errors are becoming a global health challenge and account was estimated at 44.4% in Saudi Arabia.

Purpose

To explore the perspectives of patients with cognitive impairment and their caregivers on the pre-discharge medication education received.

Methods

A qualitative study, using semi-structured interviews. 7 dyads were recruited from a Cardiac center in Saudi Arabia

The purposive sample was selected of patients who are identified as having cognitive impairment, as assessed by Montreal Cognitive Assessment scale (MoCA). Caregivers were nominated by the respective patient. Interviews were audio recorded, transcribed in Arabic, and translated into English. Transcripts were checked for authenticity.

Data were analysis using thematic analysis.

Results

Most patients identified as male (n=5), including both patients with mild cognitive impairment (n=4) and moderate cognitive impairment (n=3).

Four major themes were identified

Complexity of Medication Management: Patients and caregivers struggle with the multifaceted nature of medication regimens, indicating a need for simplified schedules and clear instructions.

Importance of Clear Communication and Education: There’s a critical need for comprehensive, understandable information about the indications and side effects of the medications. This should be tailored to individual learning preferences.

Crucial Role of Caregiver Support: Caregivers have an important role in ensuring medication adherence. Some highlighted the benefit of being included in educational interventions.

Challenges with Post-Discharge Support: All participants expressed a sense of abandonment post-discharge, with difficulties in accessing follow-up.

Conclusion

The study highlights the need for simplified medication regimens, enhanced communication, and comprehensive education for heart failure patients with cognitive impairment and their caregivers. Addressing these interconnected challenges through a multifaceted approach is crucial for improving medication management, adherence, and overall patient outcomes.
Xerostomia in patients with heart failure - prevalence, intensity and reported strategies of symptom reduction
Authors: Wefer F , Koeberich S
Published: July 2024

Background

Xerostomia is a common symptom in patients with chronic heart failure (CHF), with a reported prevalence rate of up to 62%. It is defined as the perception of oral dryness, along with swallowing difficulties, oral burning, and altered taste. Despite being a widespread symptom, xerostomia is insufficiently studied CHF patients from german-speaking countries.

Purpose

The purpose of this study was to assess the prevalence, perceived intensity, and severity of xerostomia in German CHF patients. Additionally, patients´ reported strategies of symptom reduction were investigated.

Methods

Multi-center, cross-sectional study. Patients with a confirmed diagnosis of heart failure were recruited during visits to heart failure outpatient clinics or while hospitalized for any reason. If they consented to participate, they received a self-administered questionnaire containing questions about xerostomia, perceived distress and severity of xerostomia, and patients' measures to reduce xerostomia. Disease-related data were extracted from the patients' medical records. Perceived intensity of mouth dryness was measured using a visual analog scale (VAS) with 0 for "little dry" and 100 for "maximum imaginable dryness." To assess the severity of xerostomia, the short version of the xerostomia inventory (XI) was used with 5 items inquiring about the frequency of specific xerostomia symptoms. Sumscores of the XI ranged from 5 to 15, with higher scores indicating a higher severity of xerostomia. Measures to reduce dry mouth could be stated in patients' own words.

Results

Overall, 371 patients with a mean age of 62.4 (± 14.9) took part in this study. Most patients (230; 62%) had CHF with reduced ejection fraction. The main aetiology for heart failure was ischemic heart disease (118; 31.8%), followed by dilated cardiomyopathy (116; 31.3%).

Out of 371 patients, 361 answered the question of whether they had suffered from dry mouth in the last three days. The prevalence rate of xerostomia was 65% (n=234) (95% CI: 60%; 70%). Perceived intensity of mouth dryness, using VAS, was 55.5 (± 22.3). The median severity score of the XI was 9 (Interquartile-Range: 8;11). Patients mostly experienced dry mouth in the morning and at night. The most frequently mentioned measures against dry mouth were drinking something (water, juice, coffee, tea, buttermilk), rinsing or moistening the mouth, sucking candies (sugar-free candies, peppermint, lemon, menthol), eating fruits, and using chewing gums.

Conclusion

Xerostomia is a widespread symptom in German heart failure patients, affecting more than half of the patients included in the study. The intensity and degree of severity appear to be in a medium range. CHF patients used various interventions to relieve the burden of xerostomia. These measures should be further investigated for their effectiveness.
Functional capacity evaluation in acute isquemic patients
Authors: Delgado B M , Lopes I V O , Neto C E L I A , Pereira A N A , Rodrigues F A T I M A , Novo A N D R E
Published: July 2024

Background

An acute ischemic event may cause a functional deterioration even in previously autonomous patients. The determination of functional capacity is relevant to determine health indicators for rehabilitation nursing care, allowing at the same time to determine the patient's functional status throughout their health-disease cycle and to prescribe exercise-based rehabilitation for home-based programs. The six-minute walking test is widely used in studies involving cardiac patients, however, reference values for ischemic population after immediate clinical stabilization are not known. Also the 6MWT has a prognostic value for cardiac patients, being of utmost importance to evaluate it, after clinical stabilization in order to properly determine goals for patient´s rehabilitation process.

Aim

Determine the functional capacity level of ischemic patients, by gender and type of event, after clinical stabilization using the 6-minute walking test.

Methods

Using the 6-minute walking test, the functional capacity of ischemic inpatients was evaluated at discharge, after clinical stabilization. Patients with acute coronary syndrome with and without ST-segment elevation were included. All patients were accompanied by the rehabilitation nursing team during the in-hospital stay period and performed phase 1 cardiac rehabilitation. The 6MWT was performed based on the 2016 ATS guidelines and the expected value of the distance covered was determined based on the Enright equation. The sample was divided by gender, taking into account their widely known differences in functional capacity and also by event, namely ST elevation and Non ST-segment elevation myocardial infraction. The profile of modifiable cardiovascular risk factors (CRF) was also evaluated, being considered the following: Hypertension, Dyslipidemia, obesity, tobacco, sedentary lifestyle and stress.

Results

A total of 303 patients were studied (229 male), with a mean age of 62 years (men) and 62 (women). About 36% of men and 7% of women were admitted with ST elevation Myocardial Infraction, with a mean number of cardiovascular risk factors (CVRF) of 3.2 in men and 3.9 in women. The most prevalent CVRF in females is dyslipidemia and sedentary lifestyle, while in males it is dyslipidemia.

The sample was divided in two groups by type of event, namely ST-elevation (group A) and NonST-elevation (group B) and in each group, data was evaluated by gender.

A statistically significant difference (p<0.01 for males and p<0.02 for female) was found between the value of the 6MWT performed (441.2 meters – males; 369.5 meters - females) compared to the value estimated by the equation (559.9 males; 482.8 female gender). There is a very significant difference between the expected value and the value actually covered in the walking test. It may be pertinent to define reference values for this typology of patients, so that their functional capacity can be properly measured.
Evaluating the integration of CTCA as part of an accelerated diagnostic pathway for patients presenting to the Emergency Department with acute chest pain: a two-year review
Authors: Farrand N , Mcguone D , Stuart L , Carmody D , Roe A , Curtin E , Blennerhassett L , Emeka-Okafor U , Daly C , Sheehy N , Mcmahon G
Published: July 2024

Introduction

Chest pain accounts for 8.8% of all presentations to an Hospital Emergency Department. In line with ESC guidelines (2019), an adapted HEART pathway, utilising CT Coronary Angiogram (CTCA) is delivered by our Emergency Cardiology Advanced Nurse Practitioners (ANP) and Clinical Nurse Specialists (CNS) as part of an ambulatory chest pain pathway. It is our first line diagnostic test for patients with a non-ischaemic 12-lead ECG and normal cardiac biomarkers, with a low-to-intermediate HEART score. Responsibility for the referral of patients onto the pathway is shared with the Cardiology Registrars. This is a collaborative interdisciplinary pathway between Emergency Medicine, Cardiology, and Radiology.

Purpose

To evaluate the effectiveness and safety of CTCA as part of an Accelerated Diagnostic Pathway (ADP), for evaluation of chest pain of possible cardiac origin in low-to-intermediate risk chest pain patients.

Methods

We examined the CTCA and safety outcomes of patients presenting between Jan 1st 2022 – Dec 31st 2023 who were risk stratified as low-to-intermediate risk for coronary artery disease, based on Heart score, 12-lead ECG and biomarker testing, using the electronic patient records. Institutional ethics was in place.

Results

Between January 1st and December 31st 2022, 290 patients were referred for CTCA, with a total of 268 CTCAs completed. The number of patients referred on the ADP increased by 53.4% in 2023 with 445 being referred for CTCA, 416 of which have been completed, with 12 pending completion.

38% of patients were found to have evidence of coronary artery disease (CAD). Coronary artery disease causing at least 50% stenosis was identified in 11% of patients. 4.5% of these patients required revascularisation, 17 of whom underwent Percutaneous Coronary Intervention (PCI) with a further 13 being referred for Coronary Artery Bypass Grafting. A positive family history was the most dominant risk factor associated with significant CAD. An equivalent number of males to females were referred for CTCA, however, men were more than 7 times more likely to have severe disease. (12% vs 88%). All patients referred for CTCA via the chest pain pathway were followed up by the Emergency Cardiology ANP/CNS in a virtual clinic, delivering risk factor modification advice and preventative therapies, when indicated. There was no evidence of any major adverse cardiovascular events within a 30-day period for this patient cohort.

Conclusion

The integration of CTCA into an adapted HEART pathway has resulted a safe and timely discharge for patients presenting to ED with acute chest pain, of possible cardiac origin. CTCA offers excellent early detection of coronary artery disease in this patient cohort with normal ECGs and cardiac biomarkers, but with a history of chest pain suggestive of CAD.
Differences between non-obese and obese patients with hypertension according to gender
Authors: Uchmanowicz B , Lokiec K , Kwasny A , Kubielas G , Smereka J , Juarez-Vela R , Czapla M
Published: July 2024

Introduction

In recent years, obesity has escalated markedly, emerging as a one of major worldwide health issue. The frequency of obesity in both adults and children is rising at an alarming rate, leading to severe consequences for public health. The World Health Organization (WHO) reports that as much as 13% of the global population is grappling with obesity. Numerous research studies have established that obesity not only heightens the risk of cardiovascular diseases (CVD) including hypertension, coronary heart disease, and heart failure, but also exacerbates complications in individuals already suffering from these conditions.

Purpose

The aim of this study was to retrospectively analyze the differences between non-obese and obese patients admitted to the cardiology department due to hypertension according to gender.

Methods

We performed a retrospective analysis of 486 medical records of patients who had been admitted to the Institute of Heart Diseases of the University Clinical Hospital in Wroclaw (Poland) between January 2017 and June 2021. The study group was divided in two ways. The division of patients was into one of two groups based on the following cut-off BMI values: non-obese (BMI < 30) and obese (BMI ≥ 30). The study was conducted following the principles of the Declaration of Helsinki and approved by the independent Bioethics Committee of Wroclaw Medical University, protocol no. KB-837/2022. The significance level for all statistical tests was set to 0.05. R 4.3.0. was used for computations.

Results

Women accounted for 53% of the study group and were significantly older than men (64.7±12.8 vs. 60.5±11.8, p=0.466). Women with obesity had significantly higher triglycerides (TG), high-sensitivity C-reactive protein and thyroid-stimulating hormone concentrations and significantly lower high-density lipoprotein (HDL) concentrations than women who were not affected by obesity. Men with obesity had significantly higher TG levels, lower HDL levels, more more frequent to have diabetes (DM) and less frequent stroke in the past compared to men without obesity. (Table 1 and 2)

Conclusions

This study highlights important differences between patients with hypertension without and with obesity, with notable gender differences. Women with obesity showed differences only in laboratory test results, while men with obesity showed differences in laboratory test results and comorbidities. These findings emphasize the need for gender-specific management strategies and research in hypertension and obesity, underscoring the distinct cardiovascular risks associated with obesity in both genders.
Adiponectin and visfatin as potential biomarkers of cardiovascular disease in postmenopausal women
Authors: Cybulska A , Schneider-Matyka D , Cwiek D , Grochans E , Rachubinska K
Published: July 2024

Background

Adiponectin and visfatin are involved in many changes associated with obesity and metabolic disorders so may be related to metabolic syndrome and cardiovascular disease. During the perimenopausal period, the risk of obesity and cardiometabolic diseases increases. Therefore, the aim of this study was to assess the relationship between cardiometabolic parameters and circulating levels of visfatin and adiponectin in perimenopausal women with regard to their obesity status.

Material and methods

This survey-based study was conducted among 168 perimenopausal women. It involved the use of questionnaires, anthropometric measurements, blood pressure measurements, and venous blood collection.

Results

Our study found that visceral adiposity index (VAI) and lipid accumulation product (LAP) were negatively correlated with adiponectin levels. Preliminary multivariate linear regression analysis revealed a positive correlation between circulating visfatin and IL-6 levels. Adiponectin was negatively correlated with HbA1C, fasting blood glucose, insulin, and triglycerides. Furthermore, circulating adiponectin was positively correlated with HDL, and negatively with HOMA-IR.

Conclusions

In the women studied, some adipokines may have played a significant role in the development of obesity, metabolic syndrome, and cardiometabolic diseases.
Increased heart attack mortality in a medium sized city in Germany: key informant interviews with local medical health care workers
Authors: Jost U , Joggerst B , Baernighausen T , Souares A
Published: July 2024

Background

Cardiovascular diseases are the leading cause of death worldwide. However, there are significant regional differences regarding mortality rates. A city located in Southwest Germany with approximately 125.000 inhabitants, has revealed a significantly increased heart attack mortality for the last two decades. In most of these years it recorded the highest rate in the federal state.

Purpose

The aim of this study was to assess influencing factors on the increased heart attack mortality in this city.

Methods

The study recruited health care workers in regular contact with heart attack patients in this city. Using a heterogenous sampling approach, the selection included different medical specializations (e.g. family doctor, intensive care nurse). We conducted qualitative interviews following a semi-structured guideline. Audio records of interviews were transcribed and processed using content analysis.

Results

We performed 17 interviews (female=6, immigration background=4). The central theme was an unhealthy cardiovascular lifestyle predominantly focusing on modifiable risk factors. Interviewees described the intensity of risk factors as much higher in the city than in the surrounding districts. Mostly they connected this to a high population share of people with low socioeconomic status or immigration background. Most interviewees did not see severe differences in health care provision and institutions in the city compared to other districts.

Conclusion

Socioeconomic factors were seen as the most powerful influence on the heart attack mortality. A healthier cardiovascular lifestyle of the population can only be achieved addressing social disparities within the city.
Communicate, support and integrate: strategies to improve engagement with cardiac rehabilitation
Authors: Caughers G , Bradley J , Wilson A , Donnelly P , Fitzsimons D
Published: July 2024

Background

Factors beyond Cardiac Rehabilitation (CR) service continue to negatively impact CR attendance and programme completion. Intrapersonal, socioeconomic, health perception/co-morbidity and logistical factors can have a significant impact on CR uptake. During the COVID-19 pandemic many services reconsidered their approach and utilised novel but more flexible delivery solutions (1). As clinical services remodel post-COVID we sought to incorporate the patient perspective.

Purpose

To identify and co-design strategies to improve engagement with CR.

Methods

Experience Based Co-Design (EBCD) is a Codesign methodology that incorporates the experiences of patients, caregivers and service providers (2). The project involved staff, patients and caregivers linked to CR across the region. In an iterative process, a literature review followed by focus groups and co-design workshops were conducted by the research team during 2019-2021.

Results

The co-design workshops identified numerous multifaceted issues in relation to engagement with CR. These can be described in three distinct themes.

Communicate

Misunderstandings about CR content and efficacy persist amongst patients and the public. Health Care Professionals must streamline, and focus information provided to patients in order to highlight the multifaceted benefits of CR, a patient-led information video for patients and public was produced and shared through CR networks.

Support

Patients require additional emotional and social support following a cardiac event. Significant concerns described by patients relate to family, work, socialising and future health. A supportive, facilitated discussion was warranted and a brief cardiac intervention (CABIN) was developed and will be tested in a feasibility trial.

Integrate

Following COVID-19 patients are more receptive to hybrid approaches to delivering CR. Diverse options for delivery of CR should be integrated into standard practice. Patient suggestions included online learning modules, social exercise, video libraries, online support meetings, text chat facilities, and regionally specific webpages.

The study resulted in three key outputs; a short regional information video, a regional webpage and the brief supportive intervention, CABIN.

Conclusion

Co-designing with staff and patients provides relevant and important information about highlighting the importance of and accessing and delivering a service which can be incorporated into future service changes.
Co-designing an information map guiding patients on their journey to cardiac rehabilitation in Austria
Authors: Hoeppchen I , Kulnik S T , Meschtscherjakov A , Niebauer J , Pfannerstill F , Smeddinck J D , Strumegger E M , Young F , Wurhofer D
Published: July 2024

Background

Cardiac rehabilitation (CR) is underutilised worldwide. Cardiac patients lack sufficient information about CR, for example, regarding the health benefits of CR and how to obtain a referral. This gap presents a significant barrier to CR uptake.

Purpose

The purpose of this study was (1) to define patients’ needs during their transition from the acute hospital setting to CR and (2) to design a need-based information map.

Methods

We conducted three sequential co-design workshops with 17 participants: ten cardiac patients, most of whom had completed a CR programme, six healthcare professionals who worked within the CR pathway, and one who was a healthcare professional with a cardiac condition who had completed a CR programme. Patients’ needs and design suggestions were elicited through generative co-design methods [1], such as paper prototyping, persona scenarios, group discussions and presentations, and card sorting. Data were analysed with thematic analysis.

Results

Workshop participants identified three "steps" at which orientation is required to guide patients along their journey: (1) during the hospital stay, (2) while at home, and (3) throughout the CR programme. Patients’ needs changed accordingly, prompting us to tailor information and tips to these steps (s. Figure).

In the hospital, patients needed orientation about follow-up care. The patients sought facts about CR, enabling them to make an informed decision for or against participation. Particularly, info about programme duration, content and health benefits were appreciated. Information about common symptoms related to the treatment and explanations of the hospital environment were also perceived as helpful. After discharge, the time at home was characterised by a need for calm after the stressful time in the hospital. Patients reflected on their cardiac events. Information on adopting a heart-healthy lifestyle and guidance on preparing for CR were perceived as helpful. Contact details for medical support were appreciated. During the CR programme, patients sought motivational support for programme adherence. They appreciated tips such as making use of the time for bonding and seeking out friendships with other patients. Testimonials sharing experiences and tips presented by fellow patients were considered helpful at any point along the patient journey.

Conclusion

When transitioning from the acute hospital to CR, cardiac patients’ needs change in distinctive steps, which the settings hospital, home and CR represent. Information and tips should be tailored accordingly. Our information map may support patients’ CR uptake and facilitate cardiac patient pathways in Austria, for example, by developing patient-facing technology.Patients' needs and required information
Cardiovascular malformation associated with esophageal atresia
Authors: Rozensztrauch A
Published: July 2024

Background

Congenital heart disease (CHD) is the commonest abnormality associated with esophageal atresia (EA). EA is a rare congenital malformation occurring in 3-4 in 10,000 births, in 87% occurs along with a distal tracheoesophageal fistula (TEF). The coexistence of a cardiac malformation and in addition, prematurity can be challenging and affects the further treatment and quality of life (QOL) of the child and family. Knowledge of the anatomical type and physiological consequences of CHD allows a well-coordinated treatment plan.

Purpose

The aim of this paper is to investigate whether the presence of underlying associated malformations, disease-specific problems and prematurity would have a considerable influence on the family of a child after surgical repair of EA.

Methods

We used a crossed-sectional questionnaire study. The impact of EA was assessed using an Authors-Designed Questionnaire (ADQ) to collect medical and sociodemographic background data (gestational week (HBD), comorbidities, type of EA, according to the Gross classification) as well as standardized questionnaire: the PedsQL™ Family Impact Module (PedsQL-FIM).

Results

Of the 76 children born with EA/TEF included in this study, 26% had a vascular malformation. Mean age was 5.3 years (SD = 3.7 years). Cardiovascular malformation associated with EA significantly (p=0.037) affects the functioning of the family in the emotional domain (FIM – ED). The QOL (p < 0,034) of children born before 37th HBD is lower that children born in term The presence of concomitant anomalies does affect the overall generic QoL. No statistical correlation was found between the type of anomaly (with/without TEF) and patients' QoL.

Conclusions

Cardiovascular malformation and prematurity significantly affect child’s QOL and the functioning of the family with EA. Patients who have undergone EA treatment require specialist outpatient care, not only in the first years of life, but also in adolescence and adulthood.
Rural dyadic collaboration in heart failure
Authors: Durante A , Grant J S , Abbott L , Bassi E , Dal Molin A , Graven L J
Published: July 2024

Background

Dyads (patient/care partner) living with heart failure have shared responsibility for patient care. While theoretical and empirical literature regarding heart failure dyadic care is evolving rapidly, sociocultural contexts are unique and affect relationship dynamics. Yet, dynamics and underlying structures of rural dyadic collaboration in heart failure remains unknown.

Purpose

The purpose of this secondary analysis was to describe the dynamics and underlying structures of dyadic collaboration in heart failure among rural dyads.

Methods

A semi-structured interview was used to evaluate the acceptability and usefulness of a 12-week problem-solving intervention in addressing dyadic heart failure-related issues and the development of effective management strategies in week 5. Initially, in the qualitative analysis, an adjusted matrix analysis for each rural dyad was used to identify these dyadic issues and strategies. Subsequently, dynamics and underlying structures of collaboration occurring within these dyads in addressing these issues and strategies were analyzed and thematic codes generated. Finally, a multiple correspondence analysis of dyadic collaboration was performed within these thematic codes and a Benzécri equation used to normalize results, helping to determine the underlying structure and variance explained by the model on a Cartesian graph.

Results

Twenty-eight living in the rural southeastern U.S. were included. Patients were mostly Caucasian (73.3%), female (60%), married (70%), and college-educated (43%), with an average age of 67.7 years. Care partners were primarily women (n = 50%), Caucasian (82.1%), married (89.3%), and high school-educated (46.4%), with an average age of 64.5 years. Using inductive coding, four codes emerged regarding dyadic relational and collaborative aspects between dyads: role awareness, requesting or receiving help, and improving dyadic communication. XLStat was used for a multiple correspondence analysis (Fig. 1), with checking and then normalizing results using the Benzécri equation on R (Fig.2). There were two gender-determined patterns within dyads. In dyads in which the patient was female and the care partner male, communication improved, requests for assistance were verbalized, and there was an improvement in collaborative orientation. However, partners were unaware of their collaborative role. In contrast, when the care partner was a woman and the patient a man, communication and requests for help were implied, and there was no improvement in collaborative orientation. In this situation, partners had full role awareness.

Conclusion(s)

These findings suggest gender constitutes a key element in communication, verbalization of needs, and collaborative orientation within rural dyads living with heart failure. The importance of gender roles may be useful in designing future dyadic interventions for rural individuals with heart failure and their informal care partners.
Perceived social support and stress-coping strategies among cardiac patients
Authors: Schneider-Matyka D , Wojcik J , Rachubinska K , Grochans E , Cybulska A M
Published: July 2024

Social support is one of the most important factors influencing human health. It is particularly important for patients after myocardial infarction, as it helps them reduce feelings of anxiety, uncertainty and isolation.

Objectives

The aim of this study was to determine the influence of sociodemographic variables and social support on the choice of stress coping styles among patients hospitalized for myocardial infarction.

Methods

This survey-based study involved 120 patients after myocardial infarction, hospitalized in the Department of Cardiology with the Intensive Cardiac Care Unit of the Independent Public Clinical Hospital No. 2, Pomeranian Medical University in Szczecin. The research instruments used in this study were: the author’s questionnaire and The Inventory of Socially Supportive Behaviors (ISSB), The Perceived Stress Scale (PSS-10), and The Coping Inventory for Stressful Situations (CISS).

Results

Based on the collected data, it was observed that the vast majority of respondents experienced high levels of stress. Women had significantly higher levels of stress than men (0 = 0.039), and were more likely to choose an emotion-oriented coping style (p = 0.011). It was also observed that avoidance-oriented coping was significantly more often used by retirees and pensioners than by employees (0.008). The study showed that information support statistically significantly correlated with avoidance-oriented coping (AOC) (r = -0.235, p = 0.01), including social diversion (seeking social contact) (r = -0.222, p = 0.015). Emotional support statistically significantly correlated with task-oriented coping (r = -0.224, p = 0.014), and avoidance-oriented coping (r = -0.24, p = 0.008), including social diversion (r = -0.284, p = 0.002). Instrumental support statistically significantly correlated with social diversion (r = -0.259, p = 0.004). Furthermore, valuation support statistically significantly correlated with task-oriented coping (r = -0.341, p < 0.001) and emotion-oriented coping (r = 0.195, p = 0.033).

Conclusion

The vast majority of patients hospitalized for heart attack experience high levels of stress and receive instrumental and information support. Women have usually higher levels of stress than men, and are more likely to utilize emotion-oriented coping strategies. There is a statistically significant negative correlation between receiving information support and adopting stress-coping styles focused on avoidance and seeking social contacts.
Health-related quality of life and arrhythmia frequency following coronary artery bypass grafting surgery: a descriptive study
Authors: Manthou P , Alexandrou K , Sigala E , Lioliousis G , Koumallos N , Sarafis P
Published: July 2024

Introduction

Coronary Artery Bypass Grafting (CABG) surgery is the preferred method in Coronary Artery Disease, particularly in patients with multi-vessel disease and impaired left ventricular function. Besides the success of surgical intervention, achieving a good level of Health-Related Quality of Life (HRQoL) is the primary goal of the entire process.

Objective

The aim of our study is to evaluate HRQoL before and after CABG surgery and to assess the adherence to pharmacotherapy and the frequency of arrhythmias postoperatively during a 6- month follow-up period.

Methods

The study design involves a descriptive longitudinal study. The study was conducted in one public hospital and two private hospitals of Cyprus. The follow-up period for participants was determined at 6 months post-CABG surgery. HRQoL assessment was conducted using the MacNew questionnaire, and the evaluation of arrhythmias and other clinical data was performed using a Clinical Data Evaluation Form created for the study purposes.

Results

Our study included 103 people who had undergone CABG surgery. HRQoL decreased at 3 months post-CABG surgery compared to the preoperative period (Mean: 5.03, SD: ±1.02 vs Mean: 4.75, SD: ±1.00) but improved at 6 months post-surgery (Mean: 6.19, SD: ±0.67). Among the total of patients, 21 (20.6%) developed Atrial Fibrillation (AF) postoperatively. All patients with AF received immediate treatment, and sinus rhythm was restored. Additionally, 6 patients developed other types of arrhythmias, among whom 1 patient experienced cardiac arrest with an initial asystole rhythm and eventually passed away.

Conclusion

CABG significantly affects HRQoL, showing a temporary decline postoperatively followed by improvement. Arrhythmias and compliance with pharmacotherapy are crucial aspects of postoperative care.
Including patient perspectives in secondary prevention: one step closer to patients needs
Authors: Jesus T , Gomes A F , Mesquita Bastos J
Published: July 2024

Introduction

Including patients in the decisions regarding their health is challenging. Patients’ understanding of their health conditions and lifestyle behaviors are strongly influenced by the interactions between patients and health care providers (1). Putting their needs up-front when you are designing projects for a global approach on Secondary Prevention is even more defiant. Following up to the person-centered care approach, the best way to tailor anything is to focus on the patients’ needs, by including the patient in the choices of the services they can have/need available. Having initiated the partnership, it is also necessary to implement it and safeguard it (2).

Purpose

To identify the patients’ needs, regarding the Prevention Program, in order to better shape the health care services provision.

Methods

A qualitative design approach was carried out. A focus group was conducted with patients enrolled in the Cardiovascular Risk Prevention Program (N=8), that have participated in more than two components of the program. The aim of this focus group was to obtain feedback from patients in order to improve and develop the services included in the Secondary Prevention Program. Content analysis was performed, results were assessed with dedicated software.

Results

There were tree specific topics that were evidenced: communication/access; education; time. Regarding the communication/access, patients mostly outlined the need for a close-up partnership, in order for them to have faster and easier communication channel with the health care professionals team. In the education topic, patients identified the need for increasing the number of educational sessions and repeating some contents, in order to have more discussion moments. The need for increase of the interactive component of certain sessions was also outlined. Patients also identified time as an issue, considering that the sessions are during lunch time, the multidisciplinary consultations take longer than the pre-established timings, and they’re only one day per week.

Conclusion(s)

The obtained results were used for Program improvement, by creating new communication and educational opportunities. They also served as fuelers for safeguarding this partnerships, as patients were involved in the update and further development of the Program, that they were and are still benefiting from. Patient involvement in the development of healthcare services is a great step towards improvement of health systems performance globally.