bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in the pharmacological management of atrial fibrillation in UK general practice 2008–2018
Authors: Phillips Katherine , Subramanian Anuradhaa , Thomas G Neil , Khan Nazish , Chandan Joht Singh , Brady Paul , Marshall Tom , Nirantharakumar Krishnarajah , Fabritz Larissa , Adderley Nicola Jaime 
Published: July 2021

ObjectiveThe pharmacological management of atrial fibrillation (AF) comprises anticoagulation, for stroke prophylaxis, and rate or rhythm control drugs to alleviate symptoms and prevent heart failure. The aim of this study was to investigate trends in the proportion of patients with AF prescribed pharmacological therapies in the UK between 2008 and 2018.MethodsEleven sequential cross-sectional analyses were performed yearly from 2008 to 2018. Data were derived from an anonymised UK primary care database. Outcomes were the proportion of patients with AF prescribed anticoagulants, rhythm and rate control drugs in the whole cohort, those at high risk of stroke and those with coexisting heart failure.ResultsBetween 2008 and 2018, the proportion of patients prescribed anticoagulants increased from 45.3% (95% CI 45.0% to 45.7%) to 71.1% (95% CI 70.7% to 71.5%) driven by increased prescription of non-vitamin K antagonist anticoagulants. The proportion of patients prescribed rate control drugs remained constant between 2008 and 2018 (69.3% (95% CI 68.9% to 69.6%) to 71.6% (95% CI 71.2% to 71.9%)). The proportion of patients prescribed rhythm control therapy by general practitioners (GPs) decreased from 9.5% (95% CI 9.3% to 9.7%) to 5.4% (95% CI 5.2% to 5.6%).ConclusionsThere has been an increase in the proportion of patients with AF appropriately prescribed anticoagulants following National Institute for Health and Care Excellence and European Society of Cardiology guidelines, which correlates with improvements in mortality and stroke outcomes. Beta-blockers appear increasingly favoured over digoxin for rate control. There has been a steady decline in GP prescribing rates for rhythm control drugs, possibly related to concerns over efficacy and safety and increased availability of AF ablation.
Mechanical thrombectomy beyond the circle of Willis: efficacy and safety of different techniques for M2 occlusions
Authors: Renieri Leonardo , Valente Iacopo , Dmytriw Adam A , Puri Ajit S , Singh Jasmeet , Nappini Sergio , Nencini Patrizia , Kaliaev Artem , Abdalkader Mohamad , Alexandre Andrea , Garignano Giuseppe , Vivekanandan Sheela , Fong Reginald P , Parra-Fariñas Carmen , Spears Julian , Gomez-Paz Santiago , Ogilvy Christopher , Regenhardt Robert W , Alotaibi Naif , Beer-Furlan André , Joshi Krishna C , Walker Melanie , Vicenty-Padilla Juan , Darcourt Jean , Foreman Paul , Kuhn Anna L , Nguyen Thanh N , Griessenauer Christoph J , Marotta Thomas R , Thomas Ajith , Patel Aman B , Leslie-Mazwi Thabele M , Chen Michael , Levitt Michael R , Chen Karen , Cognard Christophe , Pedicelli Alessandro , Limbucci Nicola 
Published: July 2021

BackgroundM2 segment occlusions represent approximately one-third of non-lacunar ischemic stroke and can lead to permanent neurological deficits. Various techniques are available for mechanical thrombectomy beyond the circle of Willis, but data evaluating their effectiveness and safety are lacking.MethodsA retrospective review of patients with ischemic stroke undergoing mechanical thrombectomy for M2 occlusions from 13 centers in North American and Europe was performed. Tandem or multiple-territory occlusions were excluded. The primary outcome was 90-day modified Rankin Scale and reperfusion rates across stent-retriever, direct aspiration and combined techniques.ResultsThere were 465 patients (mean age 71.48±14.03 years, 53.1% female) with M2 occlusions who underwent mechanical thrombectomy. Stent-retriever alone was used in 133 (28.6%), direct aspiration alone in 93 (20.0%) and the combined technique in 239 (51.4%) patients. Successful reperfusion was achieved with the combined technique in 198 (82.2%; OR 2.6 (1.1–6.9)), with stent-retriever alone in 112 (84.2%; OR 9.2 (1.9–44.6)) and with direct aspiration alone in 62 (66.7%; referencecategory). Intraprocedural subarachnoid hemorrhages (iSAH) were 36 (7.7%) and were more likely to occur in patients treated with the stent-retrievers (OR 5.0 (1.1–24.3)) and combined technique (OR 4.6 (1.1–20.9)). Good clinical outcome was achieved in 260 (61.8%) patients, while 59 (14.0%) patients died. Older age, higher baseline NIHSS (National Institutes of Health Stroke Scale), parenchymal hemorrhage and iSAH were associated with poor outcome while successful recanalization and higher baseline ASPECTS (Alberta Stroke Program Early CT Score) were associated with good outcome. No differences were found among the three techniques in terms of clinical outcome.ConclusionStent-retrievers and a combined approach for M2 occlusions seem more effective than direct aspiration, but with higher rates of iSAH. This leads to no detectable difference in clinical outcome at 3 months.
Potential for inhibition of checkpoint kinases 1/2 in pulmonary fibrosis and secondary pulmonary hypertension
Authors: Wu Wen-Hui , Bonnet Sébastien , Shimauchi Tsukasa , Toro Victoria , Grobs Yann , Romanet Charlotte , Bourgeois Alice , Vitry Geraldine , Omura Junichi , Tremblay Eve , Nadeau Valerie , Orcholski Mark , Breuils-Bonnet Sandra , Martineau Sandra , Ferraro Pasquale , Potus Francois , Paulin Roxane , Provencher Steeve , Boucherat Olivier 
Published: July 2021

BackgroundIdiopathic pulmonary fibrosis (IPF) is a chronic lung disease characterised by exuberant tissue remodelling and associated with high unmet medical needs. Outcomes are even worse when IPF results in secondary pulmonary hypertension (PH). Importantly, exaggerated resistance to cell death, excessive proliferation and enhanced synthetic capacity are key endophenotypes of both fibroblasts and pulmonary artery smooth muscle cells, suggesting shared molecular pathways. Under persistent injury, sustained activation of the DNA damage response (DDR) is integral to the preservation of cells survival and their capacity to proliferate. Checkpoint kinases 1 and 2 (CHK1/2) are key components of the DDR. The objective of this study was to assess the role of CHK1/2 in the development and progression of IPF and IPF+PH.Methods and resultsIncreased expression of DNA damage markers and CHK1/2 were observed in lungs, remodelled pulmonary arteries and isolated fibroblasts from IPF patients and animal models. Blockade of CHK1/2 expression or activity-induced DNA damage overload and reverted the apoptosis-resistant and fibroproliferative phenotype of disease cells. Moreover, inhibition of CHK1/2 was sufficient to interfere with transforming growth factor beta 1-mediated fibroblast activation. Importantly, pharmacological inhibition of CHK1/2 using LY2606368 attenuated fibrosis and pulmonary vascular remodelling leading to improvement in respiratory mechanics and haemodynamic parameters in two animal models mimicking IPF and IPF+PH.ConclusionThis study identifies CHK1/2 as key regulators of lung fibrosis and provides a proof of principle for CHK1/2 inhibition as a potential novel therapeutic option for IPF and IPF+PH.
Clinical Feature-Based Machine Learning Model for 1-Year Mortality Risk Prediction of ST-Segment Elevation Myocardial Infarction in Patients with Hyperuricemia: A Retrospective Study
Authors: Bai Zhixun , Lu Jing , Li Ting , Ma Yi , Liu Zhijiang , Zhao Ranzun , Wang Zhenglong , Shi Bei 
Published: July 2021

Accurate risk assessment of high-risk patients is essential in clinical practice. However, there is no practical method to predict or monitor the prognosis of patients with ST-segment elevation myocardial infarction (STEMI) complicated by hyperuricemia. We aimed to evaluate the performance of different machine learning models for the prediction of 1-year mortality in STEMI patients with hyperuricemia. We compared five machine learning models (logistic regression,

k

-nearest neighbor, CatBoost, random forest, and XGBoost) with the traditional global (GRACE) risk score for acute coronary event registrations. We registered patients aged >18 years diagnosed with STEMI and hyperuricemia at the Affiliated Hospital of Zunyi Medical University between January 2016 and January 2020. Overall, 656 patients were enrolled (average age,

62.5
±
13.6

years

; 83.6%, male). All patients underwent emergency percutaneous coronary intervention. We evaluated the performance of five machine learning classifiers and the GRACE risk model in predicting 1-year mortality. The area under the curve (AUC) of the six models, including the GRACE risk model, ranged from 0.75 to 0.88. Among all the models, CatBoost had the highest predictive accuracy (0.89), AUC (0.87), precision (0.84), and F1 value (0.44). After hybrid sampling technique optimization, CatBoost had the highest accuracy (0.96), AUC (0.99), precision (0.95), and F1 value (0.97). Machine learning algorithms, especially the CatBoost model, can accurately predict the mortality associated with STEMI complicated by hyperuricemia after a 1-year follow-up.
Practices and Patterns of Hourly Neurochecks: Analysis of 8,936 Patients With Neurological Injury
Authors: LaBuzetta Jamie Nicole , Hirshman Brian R. , Malhotra Atul , Owens Robert L. , Kamdar Biren B. 
Published: July 2021

Background: Patients experiencing acute neurological injury often receive hourly neurological assessments (“neurochecks”) to capture signs of deterioration. While commonly utilized in the intensive care unit (ICU) setting, little is known regarding practices (i.e., variations by age and ordering services) and patterns (i.e., duration and post-discontinuation plans) of hourly neurochecks. To inform future quality improvement intervention efforts, we performed an analysis of hourly neurochecks using an electronic health record-based dataset. Study Design and Methods: Our 75-month retrospective dataset consisted of all health system ICU patients who received hourly neurochecks. Variables included age, admission diagnosis category, ordering provider, post-discontinuation order, and discharge destination. Multivariable Cox regression was used to evaluate factors associated with hourly neurocheck duration. Results: We evaluated 9,513 first admission hourly neurocheck orders in 8,936 patients. The trauma, neurosurgery, and neurocritical care services were responsible for 4,067 (43%), 2,071 (22%) and 1,697 (18%) hourly neurocheck orders, respectively. Median (interquartile range) hourly neurocheck duration was 1.09 (0.69, 2.35) days, and was greater than 3 and 7 days, respectively, for 1,773 (19%) and 640 (7%) patients. Median hourly neurocheck duration ranged from 0.87 (0.65, 1.68) to 1.60 (0.83, 2.97) days for neurosurgical and non-neurological ICU services, respectively. Upon discontinuation, 2,225 (23%) of hourly neurochecks were transitioned to no neurochecks. Conclusion: Substantial differences exist between ICU services and practice patterns surrounding hourly neurochecks. Understanding these differences will help inform intervention efforts aimed at streamlining hourly neurocheck practices and outcomes for patients with acute neurological injury.
Relationship Between Body Mass Index and Survival Among Critically Ill Patients With Cirrhosis
Authors: Choi Chansong , Lennon Ryan J. , Choi Dae Hee , Serafim Laura Piccolo , Allen Alina M. , Kamath Patrick S. , Shah Vijay H. , de Moraes Alice Gallo , Simonetto Douglas A. 
Published: July 2021

Background: Obesity paradox is a phenomenon in which obesity increases the risk of obesity-related chronic diseases but paradoxically is associated with improved survival among obese patients with these diagnoses. Objectives: The aim of this study was to explore the obesity paradox among critically ill patients with cirrhosis admitted to the Intensive Care Unit. Methods: A retrospective cohort of 1,143 consecutive patients with cirrhosis admitted to the ICU between January of 2006 and December of 2015 was analyzed. Primary outcome of interest was in-hospital mortality with secondary end points including ICU and short-term mortality at 30 days post ICU admission. Results: Logistic regression with generalized additive models was used, controlling for clinically relevant and statistically significant factors to determine the adjusted relationship between body mass index (BMI) and ICU, post-ICU in-hospital, and 30 day mortality following ICU discharge. ICU and hospital length of stay was similar across all BMI classes. Adjusted ICU mortality was also similar when stratified by BMI. However, a significant reduction in post-ICU hospital mortality was observed in class I and II obese patients with cirrhosis (BMI 30-39.9 kg/m2) compared to normal BMI (OR = 0.41; 95% CI, 0.20 to 0.83; P = 0.014). Similarly, overweight (BMI 25-29.9 kg/m2) and class I and II obese patients with cirrhosis had significantly lower 30-day mortality following ICU discharge (OR = 0.52, 95% CI 0.31 to 0.87; P = 0.014; OR = 0.50, 95% CI 0.29 to 0.86; P = 0.012, respectively) compared to those with normal BMI. Conclusion: The signal of obesity paradox is suggested among critically ill patients with cirrhosis.
CMS ESRD quality incentive program has not improved patient dialysis vascular access
Authors: Shah Sapan , Feustel Paul J , Manning Christina E , Salman Loay 
Published: July 2021

Purpose: Over 468,000 patients in the United States use hemodialysis to manage End Stage Renal Disease (ESRD). The purpose of this study was to determine whether the dialysis access Clinical Performance Measures (CPMs) of Centers for Medicare & Medicaid Services (CMS) ESRD Quality Incentive Program (QIP) have increased arteriovenous fistula (AVF) rates and decreased long-term tunneled hemodialysis catheter (TDC) rates among hemodialysis patients in United States. Methods: Retrospective observational study: evaluated reported AVF and long-term TDC rates of 4804 dialysis facilities which reported dialysis access data as part of the ESRD QIP from Payment Year (PY) 2014–2020. Facilities were also sorted by specific additional criteria to examine disparities in dialysis access. Results: Mean AVF rates of included facilities increased from 63.7% in PY 2014 to 67.2% in PY 2016 ( p < 0.05), did not change in PY 2017 ( p > 0.05), and declined significantly in PY 2018–2020 to 64.1% in PY 2020, near AVF rates at the inception of program. Long-term TDC rates decreased from 10.4% in PY 2014 to 9.88% in PY 2015 ( p < 0.05), then increased in PY 2015–PY 2020 to rates higher than at the inception of program, at 11.8% in PY 2020 ( p < 0.05). Facilities serving majority Black ZIP Code Tabulation Areas (ZCTAs) or ZCTAs with median income <$45,000 achieved significantly lower AVF rates ( p < 0.05) with no significant difference in long-term TDC rates ( p > 0.05). AVF rates correlated positively and long-term TDC rates correlated negatively with star rating of facilities ( p < 0.05). Conclusion: As one of the first financial QIPs in healthcare, the ESRD QIP has not achieved the stated goals of the CMS to increase AVF access rates above 68% and reduce long-term TDC clinical rates below 10%. Systemic disparities in race, geographic region, economic status, healthcare access, and education of providers and patients prevent successful attainment of goal metrics.
Validating a model for indicating the professionalisation of social work in China
Authors: Lei Jie , Luo Mengsha , Wang Yean 
Published: July 2021

Summary The social work profession has developed at an unprecedented rate in the past decade in China. This article addresses the much-debated question of whether the international standards of social work can be applied in the Chinese context. Employing Weiss-Gal and Welbourne’s conceptual framework of the professionalisation of social work, this study aimed to identify validated indicators to define social work professionalisation in China. A questionnaire with 11 indicators was designed, and responses were received from 748 social workers in Guangzhou. Formative measurement was adopted as an analytic strategy. Findings Five of the 11 indicators were validated: perception of public recognition, perceived adequacy of the knowledge base, involvement in professional organisations, congruence with ethical standards, and perception of professional autonomy. Contrarily, six indicators had no significant impact on social work professionalisation in China: public recognition in terms of qualification levels, professional education, satisfaction with professional organisations, monopoly (self-perception and entrance criteria) and prestige and remuneration. Applications This study extends the application of Weiss-Gal and Welbourne’s conceptual framework to China. Utilisation of this framework suggests that social work professionalisation in China may diverge from international standards in social work, while the professionalisation measures for social work implemented by the Chinese governments may be ineffective. In particular, this study highlights the continuing challenges for the development of social work in China and provides evidence of the need to strengthen the professional power of Chinese social work.
The Accuracy of Continuous Glucose Monitoring in the Medical Intensive Care Unit
Authors: Tingsarat Wannita , Buranasupkajorn Patinut , Khovidhunkit Weerapan , Boonchaya-anant Patchaya , Laichuthai Nitchakarn 
Published: July 2021

Objective: To assess the accuracy of continuous glucose monitoring (CGM) in medical intensive care unit (MICU) patients. Methods: A Medtronic Enlite® sensor accuracy was assessed versus capillary blood glucose (CBG) and plasma glucose (PG) using the mean absolute relative difference (MARD), surveillance error grid (SEG) analysis and modified Bland-Altman plots. Results: Using CBG as a reference, MARD was 6.6%. Overall, 99.7% of the CGM readings were within the “no risk” zone. No significant differences in accuracy were seen within vasopressor subgroups. Using PG as the reference, MARD was 8.8%. The surveillance error grid analysis showed 95.2% of glucose readings were within the “no risk” zone. There were no device-related adverse events. Conclusion: The CGM sensor showed acceptable accuracy in MICU patients, regardless of vasopressor use.
Extracorporeal shockwave therapy in spinal cord injury, early to advance to clinical trials? A systematic review and meta-analysis on animal studies
Authors: Alavi Seyedeh Niloufar Rafiei , Neishaboori Arian Madani , Yousefifard Mahmoud 
Published: July 2021

Background As there is no consensus over the efficacy of extracorporeal shockwave therapy in the management of spinal cord injury complications, the current meta-analysis aims to investigate preclinical evidence on the matter. Methods The search strategy was developed based on keywords related to ‘spinal cord injury’ and ‘extracorporeal shockwave therapy’. A primary search was conducted in Medline, Embase, Scopus and Web of Science until the end of 2020. Studies which administered extracorporeal shockwave therapy on spinal cord injury animal models and evaluated motor function and/or histological findings were included. The standardised mean difference with a 95% confidence interval (CI) were calculated. Results Seven articles were included. Locomotion was significantly improved in the extracorporeal shockwave therapy treated group (standardised mean difference 1.68, 95% CI 1.05–2.31, P=0.032). It seems that the efficacy of extracorporeal shockwave therapy with an energy flux density of 0.1 mJ/mm2 is higher than 0.04 mJ/mm2 ( P=0.044). Shockwave therapy was found to increase axonal sprouting (standardised mean difference 1.31, 95% CI 0.65, 1.96), vascular endothelial growth factor tissue levels (standardised mean difference 1.36, 95% CI 0.54, 2.18) and cell survival (standardised mean difference 2.49, 95% CI 0.93, 4.04). It also significantly prevents axonal degeneration (standardised mean difference 2.25, 95% CI 1.47, 3.02). Conclusion Extracorporeal shockwave therapy significantly improves locomotor recovery in spinal cord injury animal models through neural tissue regeneration. Nonetheless, in spite of the promising results and clinical application of extracorporeal shockwave therapy in various conditions, current evidence implies that designing clinical trials on extracorporeal shockwave therapy in the management of spinal cord injury may not be soon. Hence, further preclinical studies with the effort to reach the safest and the most efficient treatment protocol are needed.
A proposed framework for cerebral venous congestion
Authors: Arun Anirudh , Amans Matthew R , Higgins Nicholas , Brinjikji Waleed , Sattur Mithun , Satti Sudhakar R , Nakaji Peter , Luciano Mark , Huisman Thierry AGM , Moghekar Abhay , Pereira Vitor M , Meng Ran , Fargen Kyle , Hui Ferdinand K 
Published: July 2021

Background While venous congestion in the peripheral vasculature has been described and accepted, intracranial venous congestion remains poorly understood. The characteristics, pathophysiology, and management of cerebral venous stasis, venous hypertension and venous congestion remain controversial, and a unifying conceptual schema is absent. The cerebral venous and lymphatic systems are part of a complex and dynamic interaction between the intracranial compartments, with interplay between the parenchyma, veins, arteries, cerebrospinal fluid, and recently characterized lymphatic-like systems in the brain. Each component contributes towards intracranial pressure, occupying space within the fixed calvarial volume. This article proposes a framework to consider conditions resulting in brain and neck venous congestion, and seeks to expedite further study of cerebral venous diagnoses, mechanisms, symptomatology, and treatments. Methods A multi-institution retrospective review was performed to identify unique patient cases, complemented with a published case series to assess a spectrum of disease states with components of venous congestion affecting the brain. These diseases were organized according to anatomical location and purported mechanisms. Outcomes of treatments were also analyzed. Illustrative cases were identified in the venous treatment databases of the authors. Conclusion This framework is the first clinically structured description of venous pathologies resulting in intracranial venous and cerebrospinal fluid hypertension. Our proposed system highlights unique clinical symptoms and features critical for appropriate diagnostic work-up and potential treatment. This novel schema allows clinicians effectively to approach cases of intracranial hypertension secondary to venous etiologies, and furthermore provides a framework by which researchers can better understand this developing area of cerebrovascular disease.