bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive value of the cardio‐ankle vascular index for recurrence of atrial fibrillation after catheter ablation
Authors: Shinohara Masaya , Fujino Tadashi , Wada Ryo , Yano Kensuke , Akitsu Katsuya , Koike Hideki , Kinoshita Toshio , Ikeda Takanori 
Published: October 2021

AbstractBackgroundThe predictive value of the cardio‐ankle vascular index (CAVI) for estimating the efficacy outcome of catheter ablation (CA) in atrial fibrillation (AF) patients is unclear. We aimed to examine the predictive performance of the CAVI for recurrences of atrial arrhythmias after CA.MethodsWe enrolled a total of 193 patients with AF (paroxysmal 126 and non‐paroxysmal 67) who underwent initial CA procedures at our institute, and CAVI measurements were conducted between January 2016 and March 2017. We evaluated recurrences of atrial arrhythmias after the first CA procedure as a clinical outcome. The CAVI value was assessed and the enrolled patients were divided according to the optimal CAVI value cut‐off point (9.5) in the atrial arrhythmia recurrence group.ResultsDuring a mean follow‐up of 31.3 (17.5–43.0) months, 74 (32.5%; PaAF 41 and 49.3%; non‐PaAF 33) patients had recurrences of atrial arrhythmias. The recurrence ratio of atrial arrhythmias was significantly higher in patients with a high CAVI (≥9.5) than those with a low CAVI (<9.5) (log rank test; p = 0.018). A univariate analysis showed the association between higher CAVI values and recurrences of atrial arrhythmias (p = 0.072). Multivariate analyses using a Cox proportional hazard model after adjusting for other clinical factors revealed that the CAVI value was determined to be a significant predictive factor of a recurrence of atrial arrhythmias after CA (Hazard ratio: 1.44, 95% confidence interval: 1.17–1.78, p < 0.01).ConclusionsThe CAVI was significantly associated with a recurrence of atrial arrhythmias after CA in AF patients.
Post‐infection pulmonary sequelae after COVID‐19 among patients with lung transplantation
Authors: Mahan Luke D. , Lill Isaac , Halverson Quinn , Mohanka Manish R. , Lawrence Adrian , Joerns John , Bollineni Srinivas , Kaza Vaidehi , La Hoz Ricardo M. , Zhang Song , Kershaw Corey D. , Terada Lance S. , Torres Fernando , Banga Amit 
Published: October 2021

AbstractBackgroundThere is limited data on outcomes among lung transplant (LT) patients who survive Coronavirus disease 2019 (COVID‐19).MethodsAny single or bilateral LT patients who tested positive for SARS‐CoV‐2 between March 1, 2020, to February 15, 2021 (n = 54) and survived the acute illness were included (finaln = 44). Each patient completed at least 3 months of follow‐up (median: 4.5; range 3–12 months) after their index hospitalization for COVID‐19. The primary endpoint was a significant loss of lung functions (defined as > 10% decline in forced vital capacity (FVC) or forced expiratory volume in 1 s (FEV1) on two spirometries, at least 3 weeks apart compared to the pre‐infection baseline).ResultsA majority of the COVID‐19 survivors had persistent parenchymal opacities (n = 29, 65.9%) on post‐infection CT chest. Patients had significantly impaired functional status, with the majority reporting residual disabilities (Karnofsky performance scale score of 70% or worse;n = 32, 72.7%). A significant loss of lung function was observed among 18 patients (40.9%). Three patients met the criteria for new chronic lung allograft dysfunction (CLAD) following COVID‐19 (5.6%), with all three demonstrating restrictive allograft syndrome phenotype. An absolute lymphocyte count < 0.6 × 103/dl and ferritin > 150 ng/ml at the time of hospital discharge was independently associated with significant lung function loss.ConclusionsA significant proportion of COVID‐19 survivors suffer persistent allograft injury. Low absolute lymphocyte counts (ALC) and elevated ferritin levels at the conclusion of the hospital course may provide useful prognostic information and form the basis of a customized strategy for ongoing monitoring and management of allograft dysfunction.TweetTwitter handle: @AmitBangaMDLung transplant patients who survive COVID‐19 suffer significant morbidity with persistent pulmonary opacities, loss of lung functions, and functional deficits. Residual elevation of the inflammatory markers is predictive.
Relationship Between Flat-Water Tests and Canoe Slalom Performance on 4 Different Grades of Water Terrain Difficulty
Authors: Vajda Matej , Piatrikova Eva 
Published: October 2021

Purpose: To assess the relationship between flat-water tests and canoe slalom performance on 4 different grades of water terrain difficulty. Methods: Nineteen elite canoe slalom athletes racing in category K1 men (n = 7), K1 women (n = 5), or C1 men (n = 7) completed flat-water tests: (1) a sprint with a turn to the preferred side, (2) a sprint with a turn to the nonpreferred side, (3) a sprint with a turn to both sides, and (4) a 12 × 15-m all-out shuttle test. Canoe slalom performance was measured in competitions with 4 different grades of water terrain difficulty. Results: There were relationships between 12 × 15-m all-out shuttle test and performance across different water terrain grades (P < .001; r = .706–.871)); however, the magnitude of the relationship decreased with increasing water terrain grade difficulty. Similar trends were observed for the sprint with a turn to the preferred side (r = .588–.884), sprint with a turn to the nonpreferred side (r = .544–.864), and sprint with a turn to both sides (r = .638–.909). In addition, small to moderate differences were observed between preferred and nonpreferred side in K1 women (P = .050, ES = 0.37), K1 men (P = .019, ES = 0.66), and C1 men (P = .003, ES = 0.69). Conclusion: The novel battery of flatwater tests can be used to measure the performance-related physical fitness of canoe slalom athletes. Sprint with a turn to the preferred side and sprint with a turn to the nonpreferred side can also be used to assess the imbalance between an athlete’s preferred and nonpreferred side. Accordingly, to our findings, practitioners could consider adapting the training program in preparation for important competitions specifically to water terrain difficulty grades where these competitions will be organized.
Friedreich’s ataxia-associated childhood hypertrophic cardiomyopathy: a national cohort study
Authors: Norrish Gabrielle , Rance Thomas , Montanes Elena , Field Ella , Brown Elspeth , Bhole Vinay , Stuart Graham , Uzun Orhan , McLeod Karen A , Ilina Maria , Adwani Satish , Daubeney Piers , Delle Donne Grazia , Linter Katie , Jones Caroline B , Bharucha Tara , Cervi Elena , Kaski Juan Pablo 
Published: October 2021

ObjectiveHypertrophic cardiomyopathy (HCM) is an important predictor of long-term outcomes in Friedreich’s ataxia (FA), but the clinical spectrum and survival in childhood is poorly described. This study aimed to describe the clinical characteristics of children with FA-HCM.Design and settingRetrospective, longitudinal cohort study of children with FA-HCM from the UK.Patients78 children (<18 years) with FA-HCM diagnosed over four decades.InterventionAnonymised retrospective demographic and clinical data were collected from baseline evaluation and follow-up.Main outcome measuresThe primary study end-point was all-cause mortality (sudden cardiac death, atrial arrhythmia-related death, heart failure-related death, non-cardiac death) or cardiac transplantation.ResultsThe mean age at diagnosis of FA-HCM was 10.9 (±3.1) years. Diagnosis was within 1 year of cardiac referral in 34 (65.0%) patients, but preceded the diagnosis of FA in 4 (5.3%). At baseline, 65 (90.3%) had concentric left ventricular hypertrophy and 6 (12.5%) had systolic impairment. Over a median follow-up of 5.1 years (IQR 2.4–7.3), 8 (10.5%) had documented supraventricular arrhythmias and 8 (10.5%) died (atrial arrhythmia-related n=2; heart failure-related n=1; non-cardiac n=2; or unknown cause n=3), but there were no sudden cardiac deaths. Freedom from death or transplantation at 10 years was 80.8% (95% CI 62.5 to 90.8).ConclusionsThis is the largest cohort of childhood FA-HCM reported to date and describes a high prevalence of atrial arrhythmias and impaired systolic function in childhood, suggesting early progression to end-stage disease. Overall mortality is similar to that reported in non-syndromic childhood HCM, but no patients died suddenly.
Measuring facility readiness to provide childbirth care: a comparison of indices using data from a health facility survey in Ethiopia
Authors: Stierman Elizabeth K , Ahmed Saifuddin , Shiferaw Solomon , Zimmerman Linnea A , Creanga Andreea A 
Published: October 2021

BackgroundActionable information about the readiness of health facilities is needed to inform quality improvement efforts in maternity care, but there is no consensus on the best approach to measure readiness. Many countries use the WHO’s Service Availability and Readiness Assessment (SARA) or the Demographic and Health Survey (DHS) Programme’s Service Provision Assessment to measure facility readiness. This study compares measures of childbirth service readiness based on SARA and DHS guidance to an index based on WHO’s quality of maternal and newborn care standards.MethodsWe used cross-sectional data from Performance Monitoring for Action Ethiopia’s 2019 survey of 406 health facilities providing childbirth services. We calculated childbirth service readiness scores using items based on SARA, DHS and WHO standards. For each, we used three aggregation methods for generating indices: simple addition, domain-weighted addition and principal components analysis. We compared central tendency, spread and item variation between the readiness indices; concordance between health facility scores and rankings; and correlations between readiness scores and delivery volume.ResultsIndices showed moderate agreement with one another, and all had a small but significant positive correlation with monthly delivery volume. Ties were more frequent for indices with fewer items. More than two-thirds of items in the relatively shorter SARA and DHS indices were widely (>90%) available in hospitals, and half of the SARA items were widely (>90%) available in health centres/clinics. Items based on the WHO standards showed greater variation and captured unique aspects of readiness (eg, quality improvement processes, actionable information systems) not included in either the SARA or DHS indices.ConclusionSARA and DHS indices rely on a small set of widely available items to assess facility readiness to provide childbirth care. Expanded selection of items based on the WHO standards can better differentiate between levels of service readiness.
Potential impact of oral flora dispersal on patients wearing face masks when undergoing ophthalmologic procedures
Authors: Angaramo Santiago , Law Janice C , Maris Alexander Spyros , Schmitz Jonathan Edward , Liu Yuhan , Chen Qingxia , Chomsky Amy 
Published: October 2021

ObjectiveThe purpose of this study is to investigate the amount of oral flora dispersion towards the ocular surface in relation to various face mask scenarios.Methods and analysisThirty participants were recruited for this prospective cross-sectional study. Each participant was seated and instructed to hold a blood agar plate perpendicular to the bridge of their nose and facing downward. Participants then partook in three unique face mask scenarios: no face mask, surgical face mask and surgical face mask with tape securing the superior edge. During each scenario, participants were instructed to forcefully exhale for 5 s three times. The primary outcome measure was the number of colony-forming units (CFUs) grown on each face mask scenario-specific plate.ResultsThirty participants were recruited for the study, and a total of 90 chocolate agar plates were successfully incubated. The proportion of detecting any CFU was 6.67% (95% CI: 0.818% to 22.1%) for no mask scenario, 0% (95% CI: 0% to 11.6%) for mask scenario and 3.33% (95% CI: 0.0844% to 17.2%) for mask-taped scenario. The mean differences in proportion of detecting any CFU were 3.33% (95% CI: 0% to 10%, p=0.309) for no mask versus mask taped, 3.35% (95% CI: 0% to 10%, p=0.307) for mask taped versus mask and 6.68% (95% CI: 0% to 16.7%, p=0.142) for no mask versus mask.ConclusionThis study showed no difference in bacterial dispersion towards the ocular surface when comparing no face mask, a surgical face mask without tape or a surgical face mask with tape.
Concordance with urgent referral guidelines in patients presenting with any of six ‘alarm’ features of possible cancer: a retrospective cohort study using linked primary care records
Authors: Wiering Bianca , Lyratzopoulos Georgios , Hamilton Willie , Campbell John , Abel Gary 
Published: October 2021

BackgroundClinical guidelines advise GPs in England which patients warrant an urgent referral for suspected cancer. This study assessed how often GPs follow the guidelines, whether certain patients are less likely to be referred, and how many patients were diagnosed with cancer within 1 year of non-referral.MethodsWe used linked primary care (Clinical Practice Research Datalink), secondary care (Hospital Episode Statistics) and cancer registration data. Patients presenting with haematuria, breast lump, dysphagia, iron-deficiency anaemia, post-menopausal or rectal bleeding for the first time during 2014–2015 were included (for ages where guidelines recommend urgent referral). Logistic regression was used to investigate whether receiving a referral was associated with feature type and patient characteristics. Cancer incidence (based on recorded diagnoses in cancer registry data within 1 year of presentation) was compared between those receiving and those not receiving referrals.Results48 715 patients were included, of which 40% (n=19 670) received an urgent referral within 14 days of presentation, varying by feature from 17% (dysphagia) to 68% (breast lump). Young patients (18–24 vs 55–64 years; adjusted OR 0.20, 95% CI 0.10 to 0.42, p<0.001) and those with comorbidities (4 vs 0 comorbidities; adjusted OR 0.87, 95% CI 0.80 to 0.94, p<0.001) were less likely to receive a referral. Associations between patient characteristics and referrals differed across features: among patients presenting with anaemia, breast lump or haematuria, those with multi-morbidity, and additionally for breast lump, more deprived patients were less likely to receive a referral. Of 29 045 patients not receiving a referral, 3.6% (1047) were diagnosed with cancer within 1 year, ranging from 2.8% for rectal bleeding to 9.5% for anaemia.ConclusionsGuideline recommendations for action are not followed for the majority of patients presenting with common possible cancer features. A significant number of these patients developed cancer within 1 year of their consultation, indicating scope for improvement in the diagnostic process.
Association between anticoagulants and mortality and functional outcomes in older patients with major trauma
Authors: Sato Nobuhiro , Cameron Peter , Mclellan Susan , Beck Ben , Gabbe Belinda 
Published: October 2021

BackgroundThe number of trauma patients taking anticoagulants and antiplatelet agents is increasing as society ages. However, there have been limited and inconsistent reports of the association between anticoagulants and mortality and functional outcomes. This study aimed to quantify the association between anticoagulant/antiplatelet medication at the time of injury and both short-term and longer-term outcomes in older major trauma patients.MethodsThis was a population-based registry study using data from the Victorian State Trauma Registry from July 2017 to June 2018. We included patients with major trauma aged 65 years and older. The outcomes of interest were in-hospital mortality, hospital length of stay, intensive care unit length of stay and the Extended Glasgow Outcome Scale (GOS-E) at 6 months after injury. We examined the association between the outcomes and anticoagulants/antiplatelet agents at the time of injury and used multivariable logistic regression models to account for known confounders.ResultsThere were 1323 older adults eligible for inclusion in the study, of which 249 (18.8%) were taking anticoagulants (n=8 were taking both anticoagulants and antiplatelet agents), 380 (28.7%) were taking antiplatelet agents and 694 (52.5%) were not using either. Any anticoagulant use was associated with higher odds of in-hospital mortality (adjusted OR (AOR), 2.38; 95% CI 1.58 to 3.59) compared with not using anticoagulants. No differences were observed in the GOS-E at 6 months after injury between any anticoagulants use, antiplatelet use and no anticoagulant use (anticoagulant AOR, 0.71; 95% CI 0.48 to 1.05, antiplatelet AOR, 1.02; 95% CI 0.73 to 1.42).ConclusionAnticoagulant use at the time of injury was associated with higher odds of in-hospital mortality but did not adversely impact functional outcomes at 6 months after injury. These findings demonstrate the importance of seeking an accurate history of anticoagulant use and its indication, as well as the immediate initiation of reversal therapies.
Integrated emergency care reduces hospital admissions and reduces in hospital mortality
Authors: Boyle Adrian 
Published: October 2021

IntroductionWe closed our Medical Admissions Unit and relocated the staff into an enlarged Emergency Department. We streamlined our assessment processes to reduce duplication of effort. We aimed to evaluate the effect of this on mortality, admission ratios and quality of care.MethodsWe evaluated the effectiveness of this approach using multiple routinely collected measures. We studied the 3 years before the change and 3 years afterward in our centre. We obtained an independent analysis of our standardised admission ratios by the Dr Foster unit. We evaluated mortality with Dr Foster data. We evaluated quality of care by comparing the numbers of complaints, incident forms and re-admissions.ResultsThere was a decline in the standardised admissions ratios from 105.8 (95% CI 104.9 to 106.6) in 2003 to 89.5 (95% CI 88.8 to 90.2) in 2009. Hospital Mortality for non-elective admissions also fell slightly. All measures of quality improved or were unchanged after the change.DiscussionIntegrating Emergency Care in one place is associated with substantial reductions in admissions. This system is associated with a slight reduction in mortality and improved quality of care measures.
An investigation into the cognitive and neuropsychological sequelae of minor head injury in children – a prospective pilot study
Authors: Kerr Jacques 
Published: October 2021

ObjectivesAlthough the majority of head-injured children are Glasgow Coma Scale (GCS) 15 and do not require admission or further investigations there is evidence that some children with a minor head injury (MHI) will go on to experience significant morphological and functional brain deficits. In view of the lack of controlled studies into the sequelae of MHI in children we carried out a pilot study that examined the neuropsychological performance in children who had sustained an MHI.MethodsChildren aged 6–12 years who presented to the Emergency Department of the Royal Hospital for Sick Children in Edinburgh with a MHI (GCS 15) were recruited to the study. Neuropsychological assessment was performed using the Cambridge Neuropsychological Test Automated Battery (CANTAB); a computerised battery of tests, which measures motor skills, visual attention, spatial memory, working memory and non-verbal memory span. CANTAB also assesses executive function, which is the highest level of cognitive function that manages planning and allows flexible thought and action.Results15 head-injured children were recruited over the study period (eleven boys and four girls). A 2 (subject groups) × 3 (time points) repeated measures Analysis of variance was used on the number of problems solved using the minimum number of computer moves at each time point, which showed a significant interaction (p=0.003). Bonferroni posthoc comparisons demonstrated that in week 1 the head-injured group were significantly lower in performance compared to normative data (p=0.03), but significantly increased in performance between week 1 and 12 months (p=0.0001). The difference in the head-injured group performance between week 1 and week 6 approached significance (p=0.05).ConclusionThe MHI group show a significantly poorer performance with regards to problem-solving in a minimum number of moves, which may indicate impulsive tendencies and insufficient planning ability. Children with a MHI may therefore be at risk of developing problems with high-level cognitive function postinjury.
Economic analysis of the randomised assessment of treatment using panel assay of cardiac markers trial
Authors: Goodacre Steve 
Published: October 2021

BackgroundThe randomised Assessment of Treatment using Panel Assay of Cardiac markers (RATPAC) trial showed that diagnostic assessment with a point-of-care biomarker panel increased successful discharges among patients presenting to hospital with acute chest pain. We aimed to determine whether point-of-care panel assessment reduced healthcare costs and whether it was likely to be cost-effective.MethodsEconomic analysis was undertaken using individual patient resource use data from the RATPAC trial (n=2263) and health utility measured on the EQ-5D at one and 3 months. Resource use was valued using national unit costs. Quality-adjusted life years (QALYs) were calculated from EQ-5D scores using the trapezium rule. Mean costs and QALYs accrued after point-of-care and standard care were compared and cost-effectiveness estimated in terms of probability of dominance and incremental cost per QALY.ResultsPoint-of-care panel assessment was associated with higher emergency department costs, coronary care costs and cardiac intervention costs, but lower general inpatient costs. Mean costs per patient were £1217 with point-of-care versus £1006 with standard care (p=0.047), while mean QALYs were 0.158 versus 0.161 (p=0.250). The probability of standard care being dominant (ie, cheaper and more effective) was 0.888, while the probability of the point-of-care panel being dominant was 0.004. These probabilities were not markedly altered by sensitivity analysis varying the costs of the point-of-care panel and excluding intensive care costs.ConclusionPoint-of-care panel assessment does not reduce costs despite reducing admissions and may even increase costs. It is unlikely to be considered a cost-effective use of national healthcare resources.