bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors associated with amputation-free survival for patients with peripheral arterial disease: a systematic review
Authors: Kim Changhwan , Yang Yong Sook , Ryu Gi Wook , Choi Mona 
Published: January 2021

Abstract

Aims
Peripheral arterial disease (PAD) is associated with morbidity and mortality, comprising a significant percentage of amputations. As it affects the quality of life of patients with PAD, it is an important health issue. Therefore, the risk factors affecting the outcomes of limb salvage after revascularization should be well investigated. The aim of this review is to summarize risk factors of amputation-free survival (AFS) after interventions targeting patients with PAD to develop evidence-based intervention for improving patient outcomes.

Methods and results
A systematic review following PRISMA guidelines was conducted, and the protocol was registered on PROSPERO (CRD42020183076). PubMed, CINAHL, EMBASE, Cochrane Library, and Web of Science were searched for observational studies published between 2008 and 2019. Search terms included ‘peripheral arterial disease’, ‘risk factors’, and ‘amputation-free survival’. The quality of the studies was evaluated using the Joanna Briggs Institute’s Critical Appraisal Tools. Seventeen cohort studies were included in our study, and 16 risk factors were identified. Risk factors exemplifying a significant influence on decreased AFS were divided into three categories: sociodemographic (e.g. older age, male gender, African-American race, low body mass index, high nutritional risk, frailty), disease-related characteristics (e.g. severity of the disease, intervention site), and comorbidities (e.g. cardiovascular disease, kidney disease, diabetes mellitus, chronic obstructive pulmonary disease, dementia, wide pulse pressure).

Conclusion
We found that managing modifiable risk factors, as well as addressing high-risk populations, has the potential to improve outcomes of PAD interventions. More high-quality cohort studies are needed to confirm these findings.
Effect of nurse-initiated forced-air warming blanket on the reduction of hypothermia complications following coronary artery bypass grafting: a randomized clinical trial
Authors: Bezerra Amanda Silva de Macêdo , Santos Vinícius Batista , Lopes Camila Takáo , de Barros Alba Lúcia Bottura Leite 
Published: January 2021

AbstractAimsTo evaluate the effect of postoperative forced-air warming (FAW) on the incidence of excessive bleeding (ExB), arrhythmia, acute myocardial infarction (AMI), and blood product transfusion in hypothermic patients following on-pump CABG and compare temperatures associated with the use of FAW and warming with a sheet and wool blanket.Methods and resultsA randomized clinical trial conducted with 200 patients undergoing isolated on-pump CABG from January to November 2018. Patients were randomly assigned into an Intervention Group (IG, FAW, n = 100) and Control Group (CG, sheet and blanket, n = 100). The tympanic temperature of all patients was measured over a 24-h period. ExB was the primary outcome, while arrhythmia, AMI, and blood product transfusion were secondary outcomes. The effect of the interventions on the outcomes was investigated through using bivariate logistic regression, with a level of significance of 5%. The IG was 79% less likely to experience bleeding than the CG [odds ratio (OR) = 0.21, confidence interval (CI) 95% 0.12–0.39, P &lt; 0.001]; the occurrence of AMI in the IG was 94% lower than that experienced by the CG (OR = 0.06, CI 95% 0.01–0.48, P &lt; 0.001); and the IG was also 77% less likely to experience arrhythmia than the CG (OR = 0.23, CI 95% 0.12–0.47, P &lt; 0.001); no difference was found between groups in terms of blood product transfusion (P &lt; 0.279).ConclusionsThese findings show that FAW can be used following CABG until patients reach normothermia to avoid undesirable clinical outcomes.Trial registrationREBeC RBR-5t582g.
Person-centred care: looking back, looking forward
Authors: Ekman Inger , Ebrahimi Zahra , Olaya Contreras Patricia 
Published: January 2021

Abstract
An interdisciplinary group of clinical and non-clinical academics in Sweden created a research centre for the study of person-centred care (PCC) in long-term illness: the University of Gothenburg Centre for Person-Centred Care (GPCC). The GPCC steering committee formulated a position paper with three ‘simple routines’ to initiate, implement, and safeguard PCC in daily clinical practice. The EJCN accepted this position paper for publication in 2011. This brief review seeks to present how PCC, as defined in the position paper, has been used in research and published in EJCN during the past 5 years (2016–20). Clinical implications and future research in PCC are also suggested.
Self-care, symptom experience, needs, and past health-care utilization in individuals with heart failure: results of a cross-sectional study
Authors: Schäfer-Keller Petra , Santos Gabrielle Cécile , Denhaerynck Kris , Graf Denis , Vasserot Krystel , Richards David A. , Strömberg Anna 
Published: January 2021

Abstract

Aims
Self-care in heart failure (HF) is generally sub-optimal and impacts morbidity and mortality. To describe self-care prevalence and explore its relationships with symptom experience, patient needs, and health-care utilization in a Swiss hospital providing regional secondary care.

Methods and results
Cross-sectional study, convenience sample of individuals with HF from four campuses of one regional Swiss hospital. Self-care was assessed via the Self-Care of Heart Failure Index (SCHFI) and the European Heart Failure Self-care Behaviour Scale (EHFScBS), symptom experience via the M.D. Anderson Symptom Inventory–HF (MDASI-HF) and needs via the Heart Failure Needs Assessment Questionnaire (HFNAQ). Healthcare utilization reflected the preceding year’s hospitalization incidence. A cut-off level of ≥70% indicated adequate self-care. We analysed SCHFI, EHFScBS, MDASI-HF and HFNAQ scores’ relationships with hospitalizations using Spearman’s rho correlation; no prior hypotheses were stated. Sample of 310 individuals with HF (37.4% female; mean age 76.8; 55% NYHA III). Adequate self-care maintenance, management, and confidence were reported by 24%, 10%, and 61%. respectively. The sample’s mean number of experienced symptoms was 12.8 (SD 4.0) and 14.0 (SD 5.8) for needs. Over the previous year, 269 hospitalizations had occurred (median: 0, IQR 1). Hospitalizations positively correlated with self-care; symptom experience with needs. Neither symptom experience nor needs correlated with hospitalizations.

Conclusion
The findings indicated low self-care levels and suggest a need for increased support to maintain physiological stability, manage symptoms and prevent hospitalizations. This study is the first of its kind in Switzerland and among few studies worldwide to report on self-care, symptom experience, needs, and health-care utilization. Interventional studies are warranted considering baseline self-care capabilities, symptoms, and needs of individuals with HF.
Identification of factors associated with social dysfunction in patients with heart failure
Authors: Wang Lyu , Fang Wenjie , An Yan , Chen Cancan , Fan Xiuzhen 
Published: January 2021

Abstract

Aims
Social dysfunction is adversely associated with individuals’ physical and mental quality of life. However, little is known about the status of social dysfunction and its associated factors in patients with heart failure. Our study aimed to reveal the prevalence of social dysfunction, and the associations between fatigue, dyspnoea, anxiety, depression, social connectedness, and social dysfunction in patients with heart failure.

Methods and results
We assessed the social dysfunction, fatigue, dyspnoea, anxiety, depression, and social connectedness using self-report questionnaires among 291 patients (64.13 ± 11.84 years, 53.3% male) with heart failure. Two stepwise forward logistic regression models were employed to identify the factors associated with social dysfunction, and the area under receiver operating characteristic curve was used to calculate the variance of the associated factors accounting for social dysfunction. Of the 291 patients, 76.6% reported social dysfunction. The logistic regression model after adjusting co-variables showed that fatigue [odds ratio (OR) 4.233, 95% confidence interval (CI) 1.778–10.081], dyspnoea (OR 0.866, 95% CI 0.756–0.991), depression (OR 1.173, 95% CI 1.037–1.328) were positively associated with social dysfunction, whereas social connectedness (OR 0.394, 95% CI 0.203–0.764) was negatively associated with social dysfunction. Four factors explained 84.5% of the variance of social dysfunction in patients with heart failure.

Conclusions
Social dysfunction is prevalent in patients with heart failure, and fatigue, dyspnoea, depression, and social connectedness are the associated factors. The findings indicate that the key to helping heart failure patients return to social life may be to attenuate fatigue, dyspnoea, and depression and to improve social connectedness.
Gender differences in the impact of frailty on 90-day hospital readmission in heart failure patients: a retrospective cohort study
Authors: Son Youn-Jung , Shim Dae Keun , Seo Eun Koung , Won Mi Hwa 
Published: January 2021

Abstract

Aims
Frequent hospital readmissions after heart failure (HF) are common, however, there is limited data on the association between frailty status and hospital readmission in HF patients. This study aimed to examine the 90-day hospital readmission rates and gender differences in the impact of frailty on 90-day hospital readmission in HF patients.

Methods and results
We retrospectively analysed hospital discharge records of 279 patients (men = 169, women = 110) who were diagnosed with HF between January 2017 and December 2018. Frailty was assessed using the Korean version of the FRAIL scale. A logistic regression analysis was conducted to explore the factors predicting 90-day hospital readmission by gender. The prevalence of frailty and 90-day hospital readmissions were ∼54.4% and 22.7% in women, compared with 45.6% and 27.8% in men, respectively. Frail patients with HF have an increased risk of 90-day hospital readmission in both males and females. Particularly, women with frailty had a higher risk of 90-day hospital readmission [adjusted odds ratio (OR) 6.72, 95% confidence interval (CI) 1.41–32.09] than men with frailty (adjusted OR 4.40, 95% CI 1.73–11.17).

Conclusion
Our findings highlight that readmission within 90 days of hospitalization for HF can be predicted by patients’ frailty. More importantly, we found that women with frailty have a greater risk of readmission than men with frailty. Screening for frailty should therefore be integrated into the assessment of HF patients. Tailored interventions for preventing adverse outcomes should consider gender-associated factors in HF patients with frailty.
Implementation of an accelerated discharge process following percutaneous coronary intervention for patients with non-ST elevation acute coronary syndromes
Authors: Slone Sarah E , Barringhaus Kurt G , Feldman Barry , Vismara Vince , Baker Deborah 
Published: January 2021

Abstract

Aims
Historically, patients with non-ST elevation acute coronary syndrome (NSTE-ACS) are monitored as inpatients following successful percutaneous coronary intervention (PCI), but accumulating evidence demonstrates that accelerated discharge is safe, reduces cost, and enhances patient satisfaction. This quality improvement project examined the impact of implementing a post-PCI streamlined discharge process for NSTE-ACS patients on length of stay (LOS), major adverse cardiovascular events, and provider utilization at a university-affiliated hospital system.

Methods and results
Clinical characteristics, the timing of admission, PCI, and discharge data were collected prospectively from patients presenting to the catheterization laboratory for intervention for NSTE-ACS during 90-day historical control and implementation periods. The knowledge to action implementation model was employed to establish a peer-coaching based educational tool for educating interventional cardiologists and inpatient clinicians regarding patients with low-risk characteristics suitable for same-day discharge (SDD) following PCI. Patient characteristics were similar between the historical and implementation periods. Although total hospital LOS did not decrease (51 ± 24 vs. 41 ± 18 h; P = 0.14), the discharge process reduced LOS after PCI among low-risk patients (22 ± 6 vs. 17 ± 8 h; P = 0.003). Complication and readmission rates were unchanged by SDD. Provider utilization of the discharge process increased four-fold during the implementation period (8% vs. 32%; P = 0.02).

Conclusions
Implementation of an accelerated discharge process following PCI for low-risk NSTE-ACS patients reduced post-PCI LOS without increasing readmissions or complications. Increased utilization of the process throughout the implementation period may be attributed to peer coaching.
Effects of the non-contact cardiopulmonary resuscitation training using smart technology
Authors: Kim Young , Han Heeyoung , Lee Seungyoung , Lee Jia 
Published: January 2021

Abstract

Aims
Accurate cardiopulmonary resuscitation (CPR) performance is an essential skill for nursing students so they need to learn the skill correctly from the beginning and carry that forward with them into their clinical practice. For the new normal after coronavirus disease 2019 (COVID-19), safe training modules should be developed. This study aimed to develop non-contact CPR training using smart technology for nursing students and to examine its effects, focusing on the accuracy of their performance. The study used a prospective, single-blind, randomized, and controlled trial with repeated measures.

Methods and results
The non-contact CPR training with smart technology consisted of a 40-min theoretical online lecture session and an 80-min non-contact practice session with real-time feedback devices and monitoring cameras. Sixty-four nursing students were randomly assigned to either an experimental group (n = 31) using non-contact training or a control group (n = 33) using general training. The accuracy of chest compression and mouth-to-mouth ventilation, and overall performance ability were measured at pretest, right after training, and at a 4-week post-test. The non-contact CPR training significantly increased the accuracy of chest compression (F = 63.57, P &lt; 0.001) and mouth-to-mouth ventilation (F = 33.83, P &lt; 0.001), and the overall performance ability (F = 35.98, P &lt; 0.001) compared to the general CPR training over time.

Conclusions
The non-contact CPR training using smart technology help nursing students develop their techniques by self-adjusting compression depth, rate, release and hand position, and ventilation volume and rate in real time. Nursing students can learn CPR correctly through the training allowing real-time correction in safe learning environments without face-to-face contact.
Instant electrocardiogram feedback with a new digital technique reduces symptoms caused by palpitations and increases health-related quality of life (the RedHeart study)
Authors: Carnlöf Carina , Schenck-Gustafsson Karin , Jensen-Urstad Mats , Insulander Per 
Published: January 2021

Abstract

Aims
Palpitations, particularly common in women, are generally considered benign symptoms rarely caused by clinically important arrhythmias. Nevertheless, palpitations may cause anxiety, depression, and decreased health-related quality of life (HRQOL). This study investigates to what degree palpitations cause symptoms such as anxiety and depression and affect HRQOL in women and whether direct feedback of underlying heart rhythm during palpitations decrease anxiety and depression and increase HRQOL in women.

Methods and results
The study included 821 women, age 21–88 years (mean 57 ± 11 years), with symptomatic palpitations recruited using social media. For 60 days, the participants used a handheld electrocardiogram (ECG)-recording device (Coala Heart Monitor) connected to their smartphones. ECG was recorded twice a day and when symptoms were present and was automatically algorithm-interpreted with immediate response to the user. Non-benign arrhythmias were also analysed manually. Questionnaires addressing anxiety and depression—Hospital Anxiety and Depression Scale (HADS), Generalized Anxiety Disorder (GAD-7), HRQOL (RAND-36), and Symptoms Checklist: Frequency and Severity (SCL)—were analysed before and after the data were collected. A total of 101 804 ECG recordings were automatically analysed. In 94%, sinus rhythm or premature atrial/ventricular contraction were recorded; in 6%, atrial fibrillation or supraventricular tachycardia were recorded. Apart from premature ventricular contractions, no ventricular arrhythmias were documented. Anxiety and depression (HADS and GAD-7) decreased (P &lt; 0.001) as did frequency and severity of symptoms, and HRQOL increased in all domains (P &lt; 0.001) at the 2-month follow-up.

Conclusion
Instant analysis of the ECG with direct response during palpitations decreases symptoms, anxiety, and depression and increases HRQOL in women.
Grounded theory: what makes a grounded theory study?
Authors: Turner Carley , Astin Felicity 
Published: January 2021

Abstract
Grounded theory (GT) is both a research method and a research methodology. There are several different ways of doing GT which reflect the different viewpoints of the originators. For those who are new to this approach to conducting qualitative research, this can be confusing. In this article, we outline the key characteristics of GT and describe the role of the literature review in three common GT approaches, illustrated using exemplar studies.
Patients’ reflections on prehospital symptom recognition and timely treatment of myocardial infarction
Authors: Fålun Nina , Langørgen Jørund , Fridlund Bengt , Pettersen Trond , Rotevatn Svein , Norekvål Tone M 
Published: January 2021

Abstract

Aims
Early treatment is crucial to successful therapy in patients with acute myocardial infarction (MI). Prehospital delay is associated with increased morbidity and mortality. There is little empirical evidence of patients’ reflections on prehospital symptoms of MI and timely treatment at the time of discharge from hospital. To explore patients’ reflections on prehospital symptoms of MI and their experiences of interaction with local hospitals, general practitioners, and laypersons.

Methods and results
An inductive explorative design with a qualitative method approach was used to conduct in-depth interviews of patients after confirmed MI. Twenty patients were purposefully selected based on age and gender. Face-to-face, semi-structured interviews were conducted prior to hospital discharge. The interviews were organized around a set of predetermined, open-ended questions, transcribed verbatim and analysed using qualitative content analysis. There were patients who acted upon severe symptoms of MI by seeking medical assistance. Patients commonly experienced that the time from the onset of symptoms to treatment posed a transitional challenge. They did not take subtle signs of MI seriously; they underestimated symptoms of MI and delayed seeking medical assistance. Patients frequently experienced that healthcare professionals did not take them seriously, as they struggled to gain access to healthcare services.

Conclusion
This study highlights patients’ unique experiences of the pathway from symptom onset to confirmed MI. Severe chest pain is associated with MI and triggers an immediate need for care. However, patients often underestimated moderate chest pain or subtle signs and symptoms of MI. Existing knowledge gaps concerning the misinterpretation of symptoms in primary care need to be addressed in order to reduce this clinical challenge.
Associating modifiable lifestyle factors with multimorbidity in community dwelling individuals from mainland China
Authors: Shao Jing , Wang Xiyi , Zou Ping , Song Peige , Chen Dandan , Zhang Hui , Tang Leiwen , Huang Qingmei , Ye Zhihong 
Published: January 2021

Abstract

Aims
Lifestyle factors have been well-established as essential targets for fighting individual chronic diseases, but little research has concentrated on multimorbidity from the perspective of multiple lifestyle factors in the Chinese population. Thus, this study aimed to explore the associations of lifestyle factors with the occurrence of multimorbidity.

Methods and results
Cross-sectional data retrieved from the China Health and Retirement Longitudinal Study were used for analysis. Multimorbidity was calculated on a simple count of self-reported chronic conditions. Lifestyle factors included sleep duration, physical activity, alcohol intake, smoking status, and body mass index. Logistic regression analysis was used to examine the independent and accumulating effects of lifestyle factors on multimorbidity. Latent class analysis was performed to explore the lifestyle patterns. Six thousand, five hundred, and ninety-one valid subjects were included for analysis. Overall, the community dweller’s median number of chronic conditions was 1 (range 1–11) and median number of high-risk lifestyle factors was 2 (range 0–5). All lifestyle factors were associated with the occurrence of multimorbidity but varied between genders. We also identified that participants who accumulated more unhealthy lifestyle factors having a higher likelihood of multimorbidity. ‘Physical activity and weight’, ‘smoke and drink’, and ‘sleep and weight’ dominated high-risk lifestyles were the most common lifestyle patterns.

Conclusion
This study revealed the associations of unhealthy lifestyle factors and their accumulating effect with multimorbidity in Chinese community dwellers. Three common lifestyle patterns indicated that a holistic approach focused on engaging and changing multiple modifiable lifestyle behaviours within an individual might be more effective in managing multimorbidity.
Oxygen and pulmonary arterial hypertension: effects, mechanisms, and therapeutic benefits
Authors: Green Simon , Stuart Deidre 
Published: January 2021

Abstract
Oxygen is a pulmonary vasodilator. Although treatment of pulmonary arterial hypertension (PAH) is focused on pulmonary vasodilation, treatment guidelines do not recommend O2 therapy for patients unless they develop hypoxaemia. These guidelines point to a lack of evidence of benefit of O2 therapy from randomized controlled trials (RCTs) and to evidence of lack of benefit in a single RCT involving patients with Eisenmenger syndrome. These guidelines did not identify major limitations with the Eisenmenger study or consider other evidence of therapeutic benefit. Recent advances in mechanistic understanding of O2 effects on pulmonary vascular tone, along with substantial evidence of acute effects of O2 in PAH patients, challenge the view that benefits of O2 arise only through correction of hypoxaemia. Evidence presented in this review shows that O2 acts as a pulmonary vasodilator in patients who are normoxaemic; that this probably involves an alveolar mechanism in addition to a blood-borne (oxyhaemoglobin) mechanism; and that therapeutic benefit of O2 does not depend on arterial O2 levels. This suggests that O2 has potential therapeutic benefit for all patients with PAH. Clinical guidelines and practice related to O2 therapy need to be reassessed, and further research is needed.