bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is the disability of elderly patients related to increased blood transfusions after cardiac surgery?
Authors: Wleklik M , Wisnicka A , Chudiak A , Lomper K , Lisiak M , Uchmanowicz I 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Intorduction. Perioperative bleeding occurs in 2 to 15% of patients. Cardiac surgeries are associated with perioperative blood loss due to the invasive nature of the procedures, the need for high doses of anticoagulation and the need for extracorporeal circulation. Both transfusions and reoperations due to excessive postoperative bleeding are associated with adverse clinical outcomes and increased costs of care. In 2017, the common position of the European Association of Cardiac Cancer Surgeons (EACTS) and the European Association of Cardiac Cancer Surgical Anesthesiologists (EACTA) regarding the management of patient blood in order to maintain adequate perioperative homeostasis and minimizing bleeding, and thus reducing the amount of blood transfusions. Advanced age is one of the factors associated with an increased risk of perioperative bleeding, including the need for transfusion and reoperation.
Purpose. Assessment of the relationship between preoperative disability and the amount of blood transfused in elderly patients after cardiac surgeries.
Methods. The study included 100 patients ≥ 65 years of age (40 women and 60 men, mean age M ± SD =71.69 ± 4). A sociodemographic questionnaire and the Nagi scale for disability assessment were used to collect the research material. The Nagi scale assesses the limitations of the patient in seven activities. A significant disability is considered to be ≥ 3 points. The number of blood transfusions was assessed based on the analysis of medical records. The number of blood units transfused during hospitalization was taken into account. Statistically significant was assumed to be p &lt; 0.05.
Results. In the study group the mean score on the Nagi scale was M ± SD = 3.41 ± 1.83 points. Blood transfusions were required by 66% of the study participants. The number of transfused blood units ranged from 1 to 11. The mean number of transfused blood units was 1.41 ± 1.83 points: M ± SD = 1.56 ± 1.93. 28 patients required 1 blood unit, 11 blood units required 1 patient. There was a significant positive correlation between the values of the Nagi scale and the number of blood units transfused (r = 0.233, p = 0.019) . Moreover, the number of blood units transfused to patients with values of the Nagi scale ≥3 points turned out to be significantly higher than in patients with values of this scale &lt;3 points (p = 0.015).
Conclusions. 1) Patients with disability are qualified for cardiac surgeries. 2) Patients with disabilities require more blood units to be transfused.
Family-based eHealth interventions to reduce cardiovascular disease risk: a systematic review
Authors: Kemp B , Thompson DR , Mc Guigan K , Watson CJ , Woodside JV , Ski CF 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Department for the Economy, Northern Ireland

Background
Family-based eHealth interventions have potential to reduce cardiovascular disease (CVD) risk and improve health of parents and children.

Purpose
To evaluate the effectiveness of family-based eHealth interventions to reduce parent and child CVD risk.

Methods
Systematic review. Five electronic databases were searched (CENTRAL; MEDLINE; CINAHL; EMBASE; PsycINFO) up to April 2020. Data extraction included: study design, setting, methodology, eHealth technology, experiment/control group constituents, risk factors, outcomes, incentivisation and limitations. Data were synthesised narratively. Cochrane methodology was used to assess risk of bias and reporting quality.

Results
In total, 2193 articles were screened and seven trials included for review. The most consistently improved CVD risk factor across parents and children was reduced alcohol use, whilst reduction in BMI the least consistently improved. Behaviour-change theoretical underpinning, extended follow-up duration, interactivity and incentivisation were identified as effective components of these interventions. Four studies were assessed as overall ‘low risk’ of bias and three studies had concerns with randomisation and intention-to-treat analysis. Conclusions: This is the first systematic review to evaluate family-based eHealth interventions to reduce CVD risk. Despite a paucity in high-quality trials, there is evidence of their potential effectiveness. Recommended, more high quality, behaviour-change-theory-based, clearly reported interventions with explicit outcomes.
Womens health-related quality of life substantially improves with tailored cardiac rehabilitation: a systematic review and meta-analysis
Authors: Chung S , Candelaria D , Gallagher R 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Women have poorer outcomes from coronary heart disease (CHD) compared to men and participation in exercise-based cardiac rehabilitation (EBCR) offers an opportunity for improvement. However, synthesised evidence for women-specific patient-reported outcomes are often lacking. We aimed to synthesise HRQL outcomes from EBCR in women with CHD.

Methods
Four electronic databases (PUBMED, CINAHL, SCOPUS and Cochrane) were searched for studies reporting HRQL using validated measures in women attending EBCR. Two reviewers independently screened papers and extracted data. Random effects model (RevMan v5.4) was used for analysis.

Results
Eleven studies (1292 women participants) were included: six observational, three randomised controlled trials, and two quasi-experimental design. Seven studies were included in the meta-analyses. EBCR participation was associated with HRQL benefits in several domains of the Short-Form (SF-12 or 36). Improvements were greatest in Role Physical (MD 19.09 95% CI 2.37, 35.81), Physical Functioning (MD 10.43, 95% CI 2.60, 18.27) and Vitality (MD 9.59, 95% CI 0.31, 18.86). When tailored components were added to traditional EBCR, gains in HRQL were also observed, specifically in Bodily Pain (MD 9.82, 95% CI 4.43, 15.21), Role Physical (MD 8.48, 95% CI 1.31, 9.97), Vitality (MD 8.17, 95% CI 3.79, 12.55), General Health (MD 5.64, 95% CI 1.31, 9.97), and Physical Function (MD 5.61, 95% CI 0.83, 10.40) domains.

Conclusion
Women attending EBCR achieve clinically meaningful improvements in multiple areas of HRQL, and additional benefits were seen when strategies tailored to their needs and preferences were included. Future research should focus on promoting EBCR uptake in women.
7500 steps per day is associated with lower cardiovascular risk in rural residents with a high prevalence of sedentary lifestyle
Authors: Madujibeya I , Misook L , Lennie T , Mudd-Martin G , Biddle M , Moser D 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Sedentary lifestyle is one of the modifiable risk factors that account for the high prevalence of cardiovascular diseases (CVD) in the rural areas.1,2 Daily step counting, using wearable devices, is increasingly used to monitor physical activity levels in interventions targeting CVD risk reduction in the rural areas.3,4 However, there is a lack of evidence to support a daily step count threshold that may reduce CVD risk among rural residents. The purpose of this study was to examine the relationship between daily step count cut-points and CVD risk.

Methods
This secondary analysis included 312 adults living in the rural areas in the southern United States. Daily step counts from pedometers were collected for 14 consecutive days. Established cut-points were used to categorize participants into groups based on mean daily step count as sedentary (≤ 5000 steps/day), less active (5000 -7499 steps/per), and physically active (≥7500 steps/day).5-7 CVD risk was measured with the Framingham risk score. Generalized additive models were used to examine differences among the 3 activity groups in Framingham risk score, controlling for educational level, perceived physical health status, depressive, marital status, and years of residence in a rural county.

Results
Among the participants (75% female, mean age 50.1 (±13.6) years), 40.7% were sedentary, 35.2% were less active, and 24.0% were physically active. The average Framingham risk score was 11.2% (±9.4%). Framingham risk scores were 1.7% lower in the less active compared to the sedentary group, but the effect was not significant (p &lt; .11), and 2.6% lower in the physically active compared to the sedentary group (p &lt; .04). The model accounted for 22% of the variation in Framingham risk scores.

Conclusion
These findings indicate that rural residents who averaged 7500 steps or more per day had lower CVD risk, and the difference is clinically significant.
Physical function and frailty in elderly patients with acute coronary syndrome
Authors: Ruescas-Nicolau MA , Sastre-Arbona C , Alabadi-Pardines B , Gonzalez-Timoneda A , Sanchis J , Ruiz-Ros V 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by grants from CIBER CV, Madrid, Spain [grant number 16/11/00420] and Instituto de Salud Carlos III-FEDER, Madrid, Spain.

Background
Frailty is described a complex clinical syndrome of increased vulnerability to stressors that places the individual at increased risk of adverse health outcomes. It results from multiple impairments (among others, in physical functioning) and its severity ranges from mild to severe. In older cardiac patients, frailty is reported to be a significant and an independent predictor of functional decline.

Purpose
To analyze the relationship between physical functioning and frailty of elderly patients with an Acute Coronary Syndrome (ACS).

Methods
A cross-sectional study was carried out. A total of 110 patients, aged ³ 70 years and hospitalized for ACS were included. Frailty status was determined by using the Fried scale. The Short Physical Performance Battery (SPPB), which includes three timed tasks (balance, walking and leg strength), was used to assess physical functioning. The SPPB total score and the partial scores of its different dimensions were compared between frail and pre-frail patients.

Results
Sample characteristics and results are shown in table 1. There were differences between groups for all the studied variables (p&lt;.01). Pre-frail patients achieved higher total and partial scores in the SPPB.

Conclusion
Our results showed that, in elderly patients with ACS, those in a pre-frail status showed better physical function (SPPB total score and partial scores of its dimensions) than those who were frail. Due to unbalanced groups size, these results must be interpreted with caution requiring future research with larger samples.
Handheld ultrasound; point-of-care examinations by intensive care nurses in a cardiac intensive care unit. An interrater agreement study
Authors: Jorgensen M , Oterhals K , Ponitz V , Morken I 
Published: July 2021

Abstract

Background
Adding point-of-care ultrasound to the physical examination of patients to assess early signs of decompensation and fluid overload has been proven to add information and improve quality of care, also when performed by nurses. Few studies have examined intensive care nurses’ point-of-care ultrasound examinations in acute cardiac settings.

Purpose
To evaluate if the findings of intensive care nurses ultrasound examinations, after brief training, were in agreement with conventional ultrasound examination performed by physicians.

Methods
This comparative cross sectional interrater agreement study included 50 patients admitted with signs and symptoms of dyspnoea and suspected cardiac disease to a cardiac intensive care unit. After brief training, the study nurses performed standardized examinations of the patients’ inferior vena cava (IVC) and the pleural- and pericardial cavities using a handheld ultrasound device. A physician repeated the same examinations using conventional ultrasound, blinded of the nurses’ findings.

Results
Analysis using Gwets agreement coefficient (AC2) with quadratic weights showed moderate agreement for the IVC respiration variation 0.60 (95% CI 0.38-0.82), and substantial agreement for the IVC diameter 0.70 (95% CI 0.50- 0.90) and right-sided pleural effusion 0.70 (95% CI 0.52-0.88). For left-sided pleural effusion 0.85 (95% CI 0.75-0.95) and for pericardial effusion 0.95 (95% CI 0.90-1.01) the agreement was almost perfect.

Conclusion
This study indicates that intensive care nurses, after brief training in point-of- care ultrasound, can perform reliable examinations of the IVC and pleural- and pericardial cavities compared to a physicians conventional ultrasound examination.
Health literacy of Icelandic patients with coronary heart disease
Authors: Ingadottir B , Ketilsdottir A , Svavarsdottir MH 
Published: July 2021

Abstract

Funding Acknowledgements
Icelandic Nurses" Assoc., Landspitali Univ Hosp., Icelandic Reg Dev Instit, Univ of Akureyri, Akureyri Hosp,

OnBehalf
KRANS

Background
Sufficient health literacy (HL) is vital for patients to effectively manage their chronic disease. There are indications that around 50% of the public have limited HL, which can lead to difficulties in self-care, such as medication adherence and lifestyle management. In order to develop effective patient education for patients with coronary heart disease (CHD) and support their self-care, more knowledge is needed on their HL. This is one of the first studies on HL in Iceland and the first on HL in the cardiac patient population.

Purpose
To describe HL and related factors in patients, 6 months after hospital admission for their CHD.

Methods
Data was collected from patients with questionnaires (in 2018-2019), six months following an acute or elective treatment for their CHD. Patients answered the European Health Literacy Survey Questionnaire- short version (HLS-EU-Q16), a 16 items instruments with scores ranges from zero (low/no HL) to 16 (high HL). A score of 0 to 8 is considered an indicator of "insufficient" HL, a score from 9 to 12 as "limited" health literacy, and a score of 13 or more as "sufficient" HL. Data on educational needs (on 19 CHD related topics), disease-related knowledge (CADE-Q SV), general (mental and physical) health (SF-12V2) and self-care (SC-CHDI) were collected from patients as background data.

Results
Preliminary data analysis shows that patients (N = 376, mean age 65 (SD 8.9), 80% male, 30% with basic education only) had a mean HL score of 13.7 (SD 2.5). Sufficient HL was observed in 71.7% of patients, limited HL in 24.5% and 3.8% had insufficient HL. Health literacy was inversely associated with educational needs (odds ratio (OR) 0.58 (0.35;0.98). An increase in HL level was associated with an increase in knowledge (OR 1.13 (0.01; 1.26), self-care maintenance (OR 1.03 (1.01; 1.06), self-care confidence (OR 1.03 (1.01; 1.04) and mental health (OR 1.02 (1.01;1.04).

Conclusions
The health literacy of patients in this study is satisfactory. Their HL is associated with their disease-related knowledge, educational needs, confidence, mental health and self-care maintenance. HL should be assessed when planning patient education for patients with CHD and the education tailored to individual needs.
The barts heart attack centre early discharge pathway:- a novel protocol for next day discharge after primary pci for ST-elevation myocardiai infarction
Authors: Comer K , Casey-Gillman O , Moore E , Adey S , Mower S 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
To respond to the challenges of COVID-19 and based on evidence confirming low rates of Major Adverse Cardiac Events (MACE) occurring between 24- and 48-hours post AMI (Acute Myocardial Infarction), we sought to design and implement a novel Early Hospital Discharge (EHD) pathway

Aim
The goal of the EHD protocol is to accurately and efficiently identify low-risk AMI patients who can be safely discharged between 24 and 48 hours after successful primary PCI, aiming to provide a safe discharge for low risk patients, reduce length of stay enhance the follow up of patients post AMI
Methodology :
Project was designed a QI project and patients were discharged with a structured follow up at 48 hours , 2 weeks and 8 weeks and with a interventional cardiologist at 3 months
Virtual follow up was conducted using a bespoke application enable a 2 way messaging and video consultation
Patients with AMI are taken for primary PCI in an unselected manner which includes post cardiac arrest, intubated and ventilated patients
Results :The median follow-up was 201 days (OQR: 98-268 days). In the early discharge group, there were 2 deaths (0.5%), both due to COVID-19 (both &gt;30 days after d/c) with 0% cardiovascular mortality (comparator group 5% mortality, 2.5% cardiovascular
Overall, this resulted in a significant reduction in the overall length of stay for all patients presenting with STEMI undergoing primary PCI over the time period. The median length of stay was 3 days (IQR 2-5 days) from October 2019 to March 2020 before the pathway was introduced. Following the pathway introduction, from April 2020 to February 2021 the median length of stay was 2 days (1-4 days) (p &lt; 0.0001), significantly reduced from pre pathway introduction
Conclusion :Driven by the necessity to adapt to the pandemic, we report the safe and successful implementation of an early post MI discharge pathway with an integrated and structural multidisciplinary virtual follow up schedule. This has shortened hospital admission times, decreasing the risk of nosocomial infections and optimised resource utilization, while at the same time enhancing the quality of post discharge care with high levels of patient satisfaction.
Same day CT angiography in a nurse-led Rapid Access Chest Pain Clinic
Authors: Pottle A , Deane S , Dent N , Mackay N , Marshall G , Mittal T 
Published: July 2021

Abstract

Funding Acknowledgements
None

Background
Rapid Access Chest Pain clinics (RACPCs) were established in the UK in 2000 following the publication of the National Service Framework for Coronary Heart Disease. Patients underwent an exercise test (ETT) in the clinic as part of a ‘one-stop’ protocol with follow-up only if further investigation was required. In 2010, the National Institute for Health and Care Excellence (NICE) produced guidelines for the assessment and diagnosis of chest pain of recent onset (CG95), replacing the recommendation for ETT with non-invasive functional testing for patients with an intermediate pre-test probability of coronary artery disease (CAD), necessitating multiple appointments to evaluate the patient’s symptoms. The guidelines were updated in 2016, with a new recommendation that patients with atypical or typical chest pain should undergo CT coronary angiography (CTCA) as the first diagnostic test.

Purpose
The aim of this study was to investigate the feasibility and potential benefit of performing same -day CTCA in the RACPC.

Method
From November 2016 all patients with atypical or typical chest pain attending the RACPC at this tertiary cardiac centre were referred for CTCA unless alternative investigation was clinically indicated. From February 2018, same day CTCA was offered to some patients. Up to two scans could be performed in each clinic, which was increased to up to three in June 2018.

Results
A total of 985 patients were seen in the nurse-led clinic between 12/02/2018 and 30/11/2019. 473 patients were referred for CTCA (48.0%) and 314 scans were carried out in the clinic (66.4%). Of those scans carried out in clinic, 128 patients had a CTCA which showed no evidence of CAD (40.8%) and 34.4% of scans showed non-obstructive CAD. In 18.2% of patients, the CTCA showed significant CAD and in 21 patients (6.7%) the scan was inconclusive. Patient with inconclusive scans underwent further testing which was negative in all cases. The outcome for patients with significant CAD (57 patients) is shown in the table.

Conclusion
CTCA on the same day as the RACPC appointment is feasible and facilitates rapid further investigation and treatment of patients with potentially significant CAD. It also enables patients with non-significant or no CAD to be reassured that their symptoms are unlikely to be cardiac which will reduce anxiety and allow timely investigation of other causes of the chest pain. Nurses need training in the risks of radiation in order to be able to request the scans and enable the clinic to be nurse-led.
Usefulness of the japanese version of rapid dementia screening test for mild cognitive impairment in older patients with cardiovascular disease
Authors: Adachi T , Tsunekawa Y , Kameyama T , Kobayashi K , Matsuoka A , Tanimura D 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI

Background
Cognitive decline is common among older patients with cardiovascular disease and can decrease their self-management abilities. Therefore, early detection of cognitive decline is clinically important, as it can help guide effective home-based care measures, including education of family members and deployment of healthcare resources. However, the standard instruments for identifying mild cognitive impairment (MCI) are not always feasible in clinical practice.

Purpose
This study evaluated whether MCI could be detected using the Japanese version of the Rapid Dementia Screening Test (RDST-J), which is a simple screening tool for identifying cognitive decline.

Methods
This cross-sectional study included patients who were ≥ 65 years old and hospitalised because of cardiovascular disease. Patients with a pre-hospitalisation diagnosis of dementia were excluded. Each patient’s cognitive function had been measured at discharge using the RDST-J and the Japanese version of the Montreal Cognitive Assessment (MoCA-J), which is a standard tool for MCI screening. The RDST-J includes a number transcoding task and a supermarket task, and can be completed in 3 min (range: 0–12 points). The MoCA-J assesses nine domains of cognition and requires 10–15 min to complete (range: 0–30 points). The correlation between the two scores was evaluated using Spearman’s rank correlation coefficient. Receiver operating characteristic (ROC) analysis was also conducted to evaluate whether the RDST-J could identify MCI, which was defined as a MoCA-J score of ≤ 25 points.

Results
The study included 78 patients (the mean age: 77.2 ± 8.9 years, men: 56.4%). Based on a MoCA-J score of ≤ 25 points, MCI was identified in 73.1% (n = 57) of the patients. The RDST-J and MoCA-J scores were strongly correlated (r = 0.835, p &lt;0.001). The ROC analysis revealed that an RDST-J score of ≤ 9 points provided 75.4% sensitivity and 95.2% specificity for identifying MCI, with an area under the curve of 0.899 (95% confidence interval: 0.835–0.964, Figure 1). The same cut-off value was identified when excluding patients with a high probability of dementia (RDST-J score of ≤ 4 points).

Conclusions
The RDST-J is a simple instrument and its score was highly correlated with the standard test for identifying MCI in older patients with cardiovascular disease. Our results suggest that the RDST-J may be useful for routine cognitive assessments in clinical practice. Longitudinal studies are needed to evaluate whether the RDST-J scores respond to changes in cognitive status, as well as whether this tool can be used to predict adverse health outcomes after discharge.