bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Secondary Prevention Medication Use and Outcomes in Frail Older Adults After Acute Myocardial Infarction
Authors: Zullo Andrew R. , Mogul Amanda , Corsi Katherine , Shah Nishant R. , Lee Sei J. , Rudolph James L. , Wu Wen-Chih , Dapaah-Afriyie Ruth , Berard-Collins Christine , Steinman Michael A. 
Published: April 2019

Background
Secondary prevention medications are often not prescribed to frail, older adults following acute myocardial infarction, potentially because of the absence of data to support use, perceived lack of benefit, and concern over possible harms. We examined the effect of using more guideline-recommended medications after myocardial infarction on mortality, rehospitalization, and functional decline in the frailest and oldest segment of the US population—long-stay nursing home residents.

Methods and Results
We conducted a retrospective cohort study of nursing home residents aged ≥65 years using 2007 to 2010 national US Minimum Data Set clinical assessment data and Medicare claims. Exposure was the number of secondary prevention medications (antiplatelets, β-blockers, statins, and renin-angiotensin-aldosterone system inhibitors) initiated after myocardial infarction. Outcomes were 90-day death, rehospitalization, and functional decline. We compared outcomes for new users of 2 versus 1 and 3 or 4 versus 1 medications using the inverse probability of treatment-weighted odds ratios with 95% CI. The cohort comprised 4787 residents, with a total of 509 death, 820 functional decline, and 1226 rehospitalization events. Compared with individuals who initiated 1 medication, mortality odds ratios were 0.98 (95% CI, 0.79–1.22) and 0.74 (95% CI, 0.57–0.97) for users of 2 and 3 or 4 medications, respectively. Rehospitalization odds ratios were 1.00 (95% CI, 0.85–1.17) for 2 and 0.97 (95% CI, 0.8–1.17) for 3 or 4 medications. Functional decline odds ratios were 1.04 (95% CI, 0.85–1.28) for 2 and 1.12 (95% CI, 0.89–1.40) for 3 or 4 medications. In a stability analysis excluding antiplatelet drugs from the exposure definition, more medication use was associated with functional decline.

Conclusions
Use of more guideline-recommended medications after myocardial infarction was associated with decreased mortality in older, predominantly frail adults, but no difference in rehospitalization. Results for functional decline from the main and stability analyses were discordant and did not rule out an increased risk associated with more medication use.
Atrial Fibrillation Known Before or Detected After Stroke Share Similar Risk of Ischemic Stroke Recurrence and Death
Authors: Yang Xiao-Meng , Rao Zhen-Zhen , Gu Hong-Qiu , Zhao Xing-Quan , Wang Chun-Juan , Liu Li-Ping , Liu Chelsea , Wang Yi-Long , Li Zi-Xiao , Xiao Rui-Ping , Wang Yong-Jun ,   on behalf of the China National Stroke Registry II Investigators
Published: April 2019

Background and Purpose—
We aim to compare the risk of 1-year ischemic stroke recurrence and death for atrial fibrillation diagnosed after stroke (AFDAS), atrial fibrillation known before stroke (KAF), and sinus rhythm (SR).

Methods—
From June 2012 to January 2013, 19 604 patients with acute ischemic stroke were admitted to 219 urban hospitals in the China National Stroke Registry II. Based on heart rhythm assessed during admission, we classified patients as AFDAS, KAF, or SR. We explored the relationship between heart rhythm groups and 1-year ischemic stroke recurrence or death by using Cox regression adjusted for multiple covariates. Considering that death is a competing risk for stroke recurrence, we used the competing risks analysis of Fine and Gray and subdistribution Cox proportional hazards to test the association between heart rhythm and 1-year outcomes.

Results—

Among 19 604 ischemic stroke patients, 17 727 had SR, 495 AFDAS, and 1382 KAF. At 1 year, 54 (10.9%) patients with AFDAS, 182 (13.2%) with KAF, and 1008 (5.7%) with SR had recurrent ischemic strokes (
P
<0.0001). Mortality was 22.0% in patients with AFDAS, 22.1% in patients with KAF, and 7.0% in patients with SR (
P
<0.0001). AFDAS-related ischemic stroke recurrence adjusted risk was higher than that of SR (adjusted subdistribution hazard ratios, 1.61; 95% CI, 1.29–2.01) but not different from that of KAF (adjusted subdistribution hazard ratio, 1.12; 95% CI, 0.87–1.45]). The adjusted risk of 1-year death for AFDAS was also higher than that of SR (hazard ratio, 1.70; 95% CI, 1.37–2.12) and not different from that of KAF (hazard ratio, 1.10; 95% CI, 0.86–1.41).

Conclusions—
This study showed that AFDAS had similar risk of 1-year ischemic stroke recurrence and mortality when compared with KAF and higher risk when compared with SR. The potential risk of AFDAS should be given more emphasis, and appropriate treatment is needed to achieve reduction in the incidence of stroke recurrence and mortality.
Global Warming Will Aggravate Ozone Pollution in the U.S. Mid-Atlantic
Authors: Archer Cristina L. , Brodie Joseph F. , Rauscher Sara A. 
Published: April 2019

AbstractThe goal of this study is to evaluate the effects of anthropogenic climate change on air quality, in particular on ozone, during the summer in the U.S. mid-Atlantic region. First, we establish a connection between high-ozone (HO) days, defined as those with observed 8-h average ozone concentration greater than 70 parts per billion (ppb), and certain weather patterns, called synoptic types. We identify four summer synoptic types that most often are associated with HO days based on a 30-yr historical period (1986–2015) using NCEP–NCAR reanalysis. Second, we define thresholds for mean near-surface temperature and precipitation that characterize HO days during the four HO synoptic types. Next, we look at climate projections from five models from phase 5 of the Coupled Model Intercomparison Project (CMIP5) for the early and late midcentury (2025–34 and 2045–54) and analyze the frequency of HO days. We find a general increasing trend, weaker in the early midcentury and stronger in the late midcentury, with 2 and 5 extra HO days per year, respectively, from 16 in 2015. These 5 extra days are the result of two processes. On one hand, the four HO synoptic types will increase in frequency, which explains about 1.5–2 extra HO days. The remaining 3–3.5 extra days are explained by the increase in near-surface temperatures during the HO synoptic types. Future air quality regulations, which have been successful in the historical period at reducing ozone concentrations in the mid-Atlantic, may need to become stricter to compensate for the underlying increasing trends from global warming.
Referral of Terminally Ill Patients for Hospice: Frequency and Correlates
Authors: Bradley Elizabeth H. , Fried Terri R. , Kasl Stanislav V. , Cicchetti Domenic V. , Johnson-Hurzeler Rosemary , Horwitz Sarah M. 
Published: April 2019

Background Despite the central role of hospice in end-of-life care, little is known about the proportion of terminally ill patients referred for hospice and the physician factors associated with hospice referral. Methods Cross-sectional data from a self-administered survey of 231 physicians were used to estimate the proportion of terminally ill patients who were referred for hospice and to assess the independent effects of physician factors on hospice referral. Results On average, physicians reported referring about 55% of their terminally ill patients for hospice; 26.7% of the physicians referred less than one quarter of their terminally ill patients. Physician specialty, board certification, and physicians’ knowledge level about hospice were independently associated with the proportions of terminally ill patients referred for hospice. Conclusion Many terminally ill patients are not referred for hospice care and physician factors influence the use of hospice significantly. The study suggests effective factors and groups to target with interventions to enhance the appropriate use of hospice.
Perceived Skills in Palliative Medicine of Newly Qualified Doctors in the U.K.
Authors: Charlton Rodger , Smith Gary 
Published: April 2019

Aim To ascertain the perceived skills of students at U.K. medical schools in palliative medicine. Design A validated questionnaire survey. Participants Newly qualified U.K. pre-registration house officers (PRHOs). Measures: A Likert scale from 0 to 5 for respondents to rate their perceived skills in four clinical scenarios, and their anxiety in caring for the dying. Results Mean confidence rating in breaking bad news was 2.9, in ability to empathize was 3.2, in discussing prognosis was 3.3, and in providing symptom control was 2.8. Mean anxiety rating in caring for a dying patient was 2.9. Of the comments, 24% wished for more “hands on” experience and 23% suggested further curriculum recommendations. Conclusion Teaching of palliative medicine is still inadequate for the needs of recently qualified doctors. Although PRHOs have identified a need for further instruction there is also acknowledgment that it is a difficult subject to teach. Recommendations are made for coordination of current interdepartmental teaching programs.
Pain Relief with Short Term Irradiation in Locally Advanced Carcinoma of the Pancreas
Authors: Morganti Alessio G. , Trodella Lucio , Valentini Vincenzo , Barbi Sergio , Macchia Gabriella , Mantini Giovanna , Turriziani Adriana , Cellini Numa 
Published: April 2019

Objectives To evaluate whether a short radiation treatment (30 Gy, 3.0 Gy/fraction) had analgesic efficacy in patients with unresectable pancreatic carcinoma. Methods Twelve patients were included in this analysis. Before starting and at four weeks after radiation therapy, pain intensity was evaluated and analgesic drug therapy was adjusted until a 0–3 pain score was reached (WHO). Results No radiotherapy interruptions, no hospitalisation due to toxic reactions, and no severe toxicity were observed. Six patients (50%) had pain control without pharmacological therapy, three patients (25%) reduced their use (35%–72%) of analgesics, while in the remaining three patients (25%) there was no change in analgesic use. Overall, mean reduction in the use of analgesics was 63.1% ± 43.8%. During follow-up (44 months), two patients (16.7%) showed a worsening of pain that required increased analgesia; in one patient, percutaneous splanchnicectomy was necessary. Conclusion In patients excluded from standard concomitant chemoradiation, hypofractionated-accelerated radiotherapy is feasible and results in pain relief in most patients, documented as a reduced need for analgesics.
Place of Death and Use of Health Services in the Last Year of Life
Authors: Grande Gunn E. , Mckerral Angela , Addington-Hall Julia M. , Todd Chris J. 
Published: April 2019

Aim To investigate whether health service input in the last year of life differs between cancer patients who die at home versus those dying in inpatient care. Methods Post hoc exploratory case-control study of 127 home deaths and 200 inpatient deaths. Retrospective electronic record linkage of patients’ community and inpatient care during the last year of life. Results Patients who died at home began their home nursing care closer to death than those who died as inpatients. Their first contact with inpatient hospice care began further from death. Before their final month, home death patients also had more specialist and district nursing than patients who died in inpatient care. Conclusions Patients who began their home nursing early were less likely to die at home than those who began such care late. This suggests that it may be difficult to sustain end-of-life care at home for an extended period. Further research incorporating assessment of informal care input and disease trajectory is required to investigate this issue.
Withdrawal of Ventricular Assist Device Support
Authors: MacIver Jane , Ross Heather J. 
Published: April 2019

Objective Ventricular assist devices (VAD) are mechanical pumps implanted into patients with advanced heart failure who are at risk of imminent death. VADs are a treatment and not a cure, and mortality on device support remains high. Recognizing the dire nature of the decisions for patients and families and the associated high mortality rates, we actively included processes for device withdrawal as Part of our program mandate. Methods At Toronto General Hospital, from October 2001 to December 2004, 22 patients underwent implantation of a VAD. Seven patients died following device withdrawal. Results The average time spent on support prior to device withdrawal was seven days. In four of the seven cases, family members initiated discussions regarding device withdrawal. Family-initiated discussions were more likely to occur if patients were implanted electively, as a bridge to transplantation. Disagreements occurred between the ICU and the transplant teams regarding the timing of device withdrawal and responsibility for stopping the pump. Discussion Establishing a process for device withdrawal has been a key factor in the success of our VAD program. This process relies heavily on pre-implantation preparation, a strategy for resolving disagreements, and a process for withdrawing device support.
Determinants of Oregon Hospice Chaplains’ Views on Physician-Assisted Suicide
Authors: Goy Elizabeth R. , Carlson Bryant , Simopoulos Nicole , Jackson Ann , Ganzini Linda 
Published: April 2019

Background Although religiousness is a strong predictor of attitudes towards physician-assisted suicide (PAS), Oregon hospice chaplains express wide variation in their opposition to or support for legalized PAS. We explored factors associated with chaplains’ views on PAS. Methods A mailed survey to chaplains from 51 Oregon hospices. Results Fifty of 77 eligible hospice chaplains (65%) returned surveys. Views on PAS were associated with views on suicide in general. Moral and theological beliefs were the most important influences on views on PAS. Chaplains who were opposed to PAS believed that God alone may take life, that life is an absolute good, and that suffering has a divine purpose. Those who supported PAS placed emphasis on the importance of self-de-termination and sanctity of life as defined by quality of life. Conclusions Oregon hospice chaplains’ diverse views towards PAS are closely related to their views on suicide in general, and their personal and theological beliefs.
Lived Experiences of Canadian Women with Metastatic Breast Cancer in Preparation for Their Death: A Qualitative Study.: Part II-Enabling and Inhibiting Factors; the Paradox of Death Preparation
Authors: Chunlestskul Kanoknuch , Carlson Linda E. , Koopmans Janice P. , Angen Maureen J. 
Published: April 2019

Objectives This study examined the essence of lived experiences of a sample of women with metastatic breast cancer in preparing themselves for their own death, with the goal of informing health provider interventions that support an acceptance of and preparation for death. Methods A phenomenological qualitative approach was used. Five women with metastatic breast cancer were interviewed on two occasions. Themes were analyzed, described, and validated, until saturation was met. Qualitative outcomes of the thematic analysis related to the enabling and inhibiting factors involved in preparing for one's own death. Results Factors that enabled and inhibited death preparation tasks in these women included: personal past death experiences; the availability of time and a place to think, learn, and work on death preparation activities; a chance to connect with others in similar situations; and personal and cultural attitudes towards death. Gaps and unmet needs within the health care system were identified. Finally, the paradoxical nature of various aspects of death preparation was highlighted. Conclusions Death preparation can be accomplished through enhancing supportive care from health care professionals, with beneficial outcomes for patients and families. Nurses should be conscious of the paradoxical nature of death preparation, and help women to confront and manage these.
Characteristics of Referral to a Multidisciplinary Palliative Home Care Team
Authors: Drieskens Katrien , Bilsen Johan , Van Den Block Lieve , Deschepper Reginald , Bauwens Sabien , Distelmans Wim , Deliens Luc 
Published: April 2019

Introduction Until now, in Belgium at least, no scientific information has been available about which patients are referred to multidisciplinary palliative home care teams (MHCT) and by which caregivers, nor about timing of referral and factors associated with it. Methods A prospective cohort study was carried out during a nine-month period in the oldest Flemish MHCT, and included all patients for whom a palliative care trajectory had been initiated. Results In total, 325 patients (54% male, mean age 71 years, 83% cancer patients) were referred: 25% by their GP, 24% by hospital social workers, and 22% by the patient's family. Median timing of referral was 26 days (IQR 8–78) before death. Patients of 75 years or older were more likely to have been referred later by comparison with younger patients. Discussion Timely referral to a MHCT seems to be difficult and not equal for all patients. Referral timing varies largely by age groups and diseases.
Performance and Receiver Operating Characteristics of the Mini-Mental State Examination Instrument in Detecting Dementia in a Rapidly Aging Developing Country (Jamaica)
Authors: James Kenneth , Thompson Camelia , Willie-Tyndale Douladel , Holder Nevins Desmalee , Gibson Roger , Johnson Peter , McKoy Davis Julian , Eldemire-Shearer Denise 
Published: April 2019

Objective: To examine the performance of the Mini-Mental State Examination (MMSE) in community-dwelling older persons in a developing country (Jamaica) undergoing rapid population aging. Methods: An embedded validity study was conducted utilizing participants from a nationally representative sample of 2782 older persons. Standardized MMSE scores were obtained for study participants. A random selection of 170 persons with MMSE scores greater than 20 and 170 persons with scores 20 or less was done. Field staff were trained to apply the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for the diagnosis of dementia. In total, 300 participants (167 participants with MMSE score of 20 or less, 133 participants with scores greater than 20) were assessed and categorized according to dementia status. Performance characteristics of the MMSE tool were determined for study participants and appropriate adjustment and analyses subsequently applied to facilitate extrapolation to the nationally representative sample. Results: The mean MMSE scores for participants with score of 20 and less was 17.1 (standard deviation [SD] = 3.2) and 24.5 (SD = 2.8) for those with scores greater than 20. Dementia was identified in 34 participants. The receiver operating characteristic curve for MMSE scores in relation to dementia diagnosis had an area under the curve value of 0.935 (95% confidence interval, 0.893-0.977). The optimal MMSE cut-point was 18/19 and was consistently so regardless of age category, gender, educational level, and number of chronic illnesses. Conclusion: There is merit in using the MMSE examination as a screening tool for dementia in Jamaica. The findings of this study coupled with widespread use and familiarity among practitioners give credence to the MMSE as a reasonable screening tool for dementia in Jamaica—rapidly aging society.
Non-pharmacologic therapies for systemic lupus erythematosus
Authors: Fangtham M , Kasturi S , Bannuru R R , Nash J L , Wang C 
Published: April 2019

Background Non-pharmacologic therapies have been deemed as potentially beneficial for patients with systemic lupus erythematosus. We conducted an updated review to determine the effects of these therapies to inform practice. Methods A literature search was performed using PubMed (MEDLINE), EMBASE, Cochrane, PsychINFO, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Google Scholar from inception until August 2018. We included randomized controlled trials of non-pharmacologic therapies in systemic lupus erythematosus patients with sample size ≥10. Systemic lupus erythematosus was defined by 1982 or 1997 American College of Rheumatology criteria. Studies were synthesized separately by patient-reported outcomes and disease activity. Due to the heterogeneity of interventions and comparisons, a meta-analysis was not performed. Results A total of 15 randomized controlled trials involving 846 participants met the inclusion criteria. Of the 15 trials, eight used exercise interventions, six used psychological interventions (one group psychotherapy, three cognitive behavioral therapies, one psychoeducation, one mindfulness-based cognitive therapy) and one used electro-acupuncture. Five of 15 studies utilized control groups consisting of usual medical care. Other studies included control interventions of relaxation, attention placebo, symptom monitoring support, education, minimal needling, isotonic and resistance exercise. Compared with the control conditions, non-pharmacological interventions were associated with a significant improvement in fatigue in three out of six studies. Three out of eight studies reported improved anxiety and depression, and one study reported improved pain after interventions. Seven out of 11 studies reported improvement in overall quality of life in at least one domain of the Short-Form Health Survey. Of note, no studies demonstrated an improvement in disease activity after 5–52 weeks of non-pharmacological therapies. Conclusion This review showed promising results for physical exercise and psychological interventions as adjuncts to traditional medical therapy for improvement in fatigue, depression, pain and quality of life for systemic lupus erythematosus. Further high-quality randomized controlled trials with longer follow-up periods are warranted.
Threshold Effect of Bank-specific Determinants of Non-performing Assets: An Application in Indian Banking
Authors: Bardhan Samaresh , Sharma Rajesh , Mukherjee Vivekananda 
Published: April 2019

The article investigates role of bank-specific factors on non-performing assets (NPAs) in Indian banking system in a panel threshold framework (Hansen, 1999, Journal of Econometrics, 93(2), 345–368), using an unbalanced panel of 82 scheduled commercial banks over the period of 1995–1996 to 2010–2011. We consider capital to risk-weighted assets ratio (CRAR) and credit growth as alternative threshold variables (and regime dependent) along with relevant bank-specific variables treated as regime independent. Findings reveal that CRAR exerts negative and significant impact on NPAs once it reaches a critical threshold. Possible implication is that banks extend less risky loans in a high CRAR regime than in low CRAR regime that helps reduce NPAs. With credit growth as threshold as well as regime dependent, we observe statistically significant non-linear effect of credit growth on NPAs. Beyond threshold, credit growth exerts significant negative effect on NPAs that may imply that banks extend good quality loans. However, we cannot rule out the possibility of evidence of ‘ever-greening hypothesis’ of bad debts in Indian banking, that is, banks just roll over previous bad debts into fresh performing loans. JEL Classification: G21, G28, C13, C33