bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pivotal clinical trials, meta-analyses and current guidelines in the treatment of hyperkalemia
Authors: Bianchi Stefano , Regolisti Giuseppe 
Published: October 2019

Abstract
Hyperkalemia (HK) is the most common electrolyte disturbance observed in patients with advanced stages of chronic kidney disease (CKD), is a potentially life-threatening clinical condition due to an increased risk of fatal arrhythmias, and strongly impacts the quality of life and prognosis of CKD patients. Moreover, while renin–angiotensin–aldosterone system inhibitors (RAASIs) represent the most cardio-nephro-protective drugs used in clinical practice, the treatment with these drugs per se increases serum potassium (sK) values, particularly when heart failure and diabetes mellitus coexist. In fact, the onset or recurrence of HK is frequently associated with not starting, down-titrating or withdrawing RAASIs, and is an indication to begin renal replacement treatment in end-stage renal disease. Current strategies aimed at preventing and treating chronic HK are still unsatisfactory, as evidenced by the relatively high prevalence of HK also in patients under stable nephrology care, and even in the ideal setting of randomized clinical trials. Indeed, dietary potassium restriction, the use of sodium bicarbonate or diuretics, the withdrawal or down-titration of RAASIs, or the administration of old potassium binders, namely sodium polystyrene sulphonate and calcium polystyrene sulphonate, have limited efficacy and are poorly tolerated; therefore, these strategies are not suitable for long-term control of sK. As such, there is an important unmet need for novel therapeutic options for the chronic management of patients at risk for HK. The development of new potassium binders may change the treatment landscape in the near future. This review summarizes the current evidence on the treatment of chronic HK in cardio-renal patients.
Smoking Topography Characteristics During a 6-Week Trial of Very Low Nicotine Content Cigarettes in Smokers With Serious Mental Illness
Authors: Denlinger-Apte Rachel L , Donny Eric C , Lindgren Bruce R , Rubin Nathan , Goodwin Christine , DeAtley Teresa , Colby Suzanne M , Cioe Patricia A , Hatsukami Dorothy K , Tidey Jennifer W 
Published: October 2019

Abstract

Introduction
A nicotine-reduction policy could have major benefits for smokers with serious mental illness (SMI). However, potential unintended consequences, such as compensatory smoking, should be considered to ensure that such a policy does not negatively affect this population. The purpose of this secondary analysis was to examine the impact of smoking very low nicotine content (VLNC) cigarettes for 6 weeks on smoking topography characteristics, indicators of compensatory smoking, among smokers with SMI.

Aims and Methods
After a baseline usual brand smoking phase, smokers with SMI (N = 58) were randomly assigned under double-blind conditions to receive either VLNC (0.4 mg nicotine per g tobacco) or normal nicotine content (NNC; 15.8 mg nicotine per g tobacco) research cigarettes for 6 weeks. During two study visits scheduled 6 weeks apart, participants smoked either their usual brand (baseline) or assigned study cigarettes (postrandomization) through a handheld smoking topography device. Univariate analysis of variance compared smoking topography indices with cigarette condition (VLNC vs. NNC) as the between-subjects factor with corresponding baseline topography results included as covariates.

Results
At week 6, participants in the VLNC condition smoked fewer puffs per cigarette and had shorter interpuff intervals compared to participants in the NNC condition (ps &lt; .05). There were no differences between research cigarette conditions at week 6 for cigarette volume, puff volume, puff duration, peak flow rate, or carbon monoxide boost.

Conclusions
Findings are consistent with acute VLNC cigarette topography studies and indicate that a nicotine-reduction policy is unlikely to lead to compensation among smokers with SMI.

Implications
Given the high smoking rates among people with SMI, understanding how a nicotine-reduction policy may affect this population is critically important. When considering the smoking topography results as a whole, smokers with SMI did not engage in compensatory smoking behavior when using VLNC cigarettes during a 6-week trial. Study findings suggest that compensatory smoking is not likely to occur among smokers with SMI if nicotine content is lowered to minimally addictive levels.
Cytomegalovirus seropositivity is independently associated with cardiovascular disease in non-dialysis dependent chronic kidney disease
Authors: Karangizi A H K , Chanouzas D , Fenton A , Moss P , Cockwell P , Ferro C J , Harper L 
Published: October 2019

Abstract

Background
Cardiovascular disease (CVD) is the leading cause of early death in patients with chronic kidney disease (CKD). Previous work has described an association between Cytomegalovirus (CMV) seropositivity and CVD amongst patients with dialysis dependent end stage renal disease. Whether CMV seropositivity is associated with CVD in non-dialysis dependent CKD has not been established.

Aim
Investigate whether past CMV infection is associated with prevalent CVD in patients with non-dialysis dependent CKD.

Design
A retrospective observational study using the Renal Impairment in Secondary Care cohort, a study evaluating bio-clinical determinants of outcomes in patients with progressive CKD.

Methods
We assayed cryopreserved serum samples collected at inception for anti-CMV IgG antibodies from 764 patients with stages 2 to 5 CKD (pre-dialysis) and investigated its relationship with prevalent CVD.

Results
Median estimated glomerular filtration was 24 ml/min/1.73 m2 (IQR 19–32). Sixty-eight percent of patients were CMV seropositive. CMV seropositivity was associated with older age, non-Caucasian ethnicity, diabetes and higher social deprivation index score. On univariable analysis, CMV seropositivity correlated with higher systolic blood pressure (P = 0.044), prevalent CVD (P &lt; 0.001), ischaemic heart disease (P &lt; 0.001) and cerebrovascular disease (P = 0.022). On multivariable analysis, CMV seropositive patients nearly twice as likely to have CVD compared to seronegative patients [Odds Ratio (OR) = 1.998, CI 1.231–3.242, P = 0.005].

Conclusions
In patients with non-dialysis CKD, CMV seropositivity is independently associated with a higher prevalence of CVD.
Natural history of excessive daytime sleepiness: a population-based 5-year longitudinal study
Authors: Jaussent I , Morin C M , Ivers H , Dauvilliers Y 
Published: October 2019

Abstract

Study Objectives
To document the rates of persistent, remitted, and intermittent excessive daytime sleepiness (EDS) in a longitudinal 5-year community study of adults and to assess how changes in risk factors over time can predict improvement of daytime sleepiness (DS).

Methods
Participants were recruited in 2007–2008 as part of a population-based epidemiological study implemented in Canada. They completed postal assessments at baseline and at each yearly follow-up. An Epworth Sleepiness Scale total score &gt;10 indicated clinically significant EDS; a 4-point reduction between two consecutive evaluations defined DS improvement. Socio-demographic, lifestyle, health characteristics, and sleep-related measures (e.g. insomnia symptoms, sleep duration, sleep medication) were self-reported at each time point. Cox proportional-hazard models were used to predict EDS and DS remissions over 5 years.

Results
Among the 2167 participants, 33% (n = 714) met criteria for EDS at baseline, of whom 33% had persistent EDS, 44% intermittent EDS, and 23% remitted EDS over the follow-up. Furthermore, 61.4% of 2167 initial participants had stable DS, 27.1% sustained DS improvement and 8.5% transient improvement over the follow-up. The main predictors of EDS remission or DS improvement were normal weight, taking less hypnotics, having hypertension, increased nighttime sleep duration, and decreased insomnia, and depressive symptoms.

Conclusions
EDS waxes and wanes over time with frequent periods of remission and is influenced by behavioral characteristics and changes in psychological, metabolic, and nighttime sleep patterns. Targeting these predictors in future interventions is crucial to reduce DS in the general adult population.
Bi-directional relations between stress and self-reported and actigraphy-assessed sleep: a daily intensive longitudinal study
Authors: Yap Yang , Slavish Danica C , Taylor Daniel J , Bei Bei , Wiley Joshua F 
Published: October 2019

Abstract

Study Objectives
Stress is associated with poor and short sleep, but the temporal order of these variables remains unclear. This study examined the temporal and bi-directional associations between stress and sleep and explored the moderating role of baseline sleep complaints, using daily, intensive longitudinal designs.

Methods
Participants were 326 young adults (Mage = 23.24 ± 5.46), providing &gt;2,500 nights of sleep altogether. Prospective total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE) were measured using actigraphy and sleep diaries. Perceived stress was reported three times daily between: 11:00–15:00, 15:30–19:30, and 20:00–02:00. Sleep complaints were measured at baseline using the PROMIS sleep disturbance scale. Within- and between-person sleep and stress variables were tested using cross-lagged multilevel models.

Results
Controlling for covariates and lagged outcomes, within-person effects showed that higher evening stress predicted shorter actigraphic and self-reported TST (both p &lt; .01). Conversely, shorter actigraphic and self-reported TST predicted higher next-day stress (both p &lt; .001). Longer self-reported SOL and WASO (both p &lt; .001), as well as lower actigraphic (p &lt; .01) and self-reported SE (p &lt; .001), predicted higher next-day stress. Between-person effects emerged only for self-reported TST predicting stress (p &lt; .01). No significant results were found for the moderating role of baseline sleep complaints.

Conclusions
Results demonstrated bi-directional relations between stress and sleep quantity, and a consistent direction of worse sleep quantity and continuity predicting higher next-day stress. Results highlighted within-individual daily variation as being more important than between-individual differences when examining sleep and daytime functioning associations.
Muscle-evoked Potentials After Electrical Stimulation to the Brain in Patients Undergoing Spinal Surgery are Less Affected by Anesthetic Fade With Constant-voltage Stimulation Than With Constant-current Stimulation
Authors: Tanaka Masato , Shigematsu Hideki , Kawaguchi Masahiko , Hayashi Hironobu , Takatani Tsunenori , Iwata Eiichiro , Okuda Akinori , Morimoto Yasuhiko , Kawasaki Sachiko , Masuda Keisuke , Yamamoto Yusuke , Tanaka Yasuhito 
Published: October 2019

Study Design.
A prospective, within-subject study was conducted.

Objective.
We aimed to compare the influence of anesthetic fade under maximum stimulation conditions between constant-current and constant-voltage stimulation techniques.

Summary of Background Data.
The monitoring of muscle-evoked potentials after electrical stimulation to the brain [Br(E)-MSEP)] is useful for assessing the integrity of spinal cord motor tracts during major spine surgery. Nonetheless, Br(E)-MSEP responses are known to deteriorate over the duration of surgeries performed under general anesthesia. This phenomenon is known as anesthetic fade.

Methods.
We recruited 117 patients undergoing various spinal surgeries from the cervical to the lumbar level. We excluded 29 cases with insufficient data. The decrease rate of the Br(E)-MSEP amplitude for each muscle was examined. Br(E)-MSEP monitoring with constant-current and constant-voltage stimulations at the C3 and C4 electrode positions was applied. Compound muscle action potentials (CMAPs) were bilaterally recorded from the abductor pollicis brevis, deltoid, abductor hallucis, tibialis anterior, gastrocnemius, and quadriceps muscles. We defined the decrease rate as follows: (initial CMAPs-final CMAPs)/initial CMAPs × 100. Differences in the decrease rate were evaluated between stimulators, limbs (upper vs. lower), and operative time group (lowest quartile vs. highest quartile).

Results.
The overall decrease rate (across all muscles) increased as the operative time increased, and the rate was higher in the lower limbs than in the upper limbs. In addition, the overall decrease rate was lower with constant-voltage stimulation than with constant-current stimulation. Furthermore, the decrease rate for constant-current stimulation was significantly higher than that for constant-voltage stimulation, regardless of the operative time.

Conclusion.
The CMAP waveform with constant-voltage stimulation is less susceptible to anesthetic fade than that with constant-current stimulation, even during long surgeries.

Level of Evidence: 3
Estimating the Impact of Words Used by Physicians in Advance Care Planning Discussions: The “Do You Want Everything Done?” Effect
Authors: DiDiodato Giulio 
Published: October 2019

Objectives:
To estimate the probability of a substitute decision maker choosing to withdraw life-sustaining therapy after hearing an affirmative patient response to the phrase “Do you want everything done?”

Design:
Discrete choice experiment.

Setting:
Single community hospital in Ontario.

Subjects:
Nonrandom sampling of healthcare providers and the public.

Intervention:
Online survey.

Measurements and Main Results:
Of the 1,621 subjects who entered the survey, 692 consented and 432 completed the survey. Females comprised 73% of subjects. Over 95% of subjects were under 65 years old, and 50% had some intensive care–related exposure. Healthcare providers comprised 29% of the subjects. The relative importance of attributes for determining the probability of withdraw life-sustaining therapy by substitute decision makers was as follows: stated patient preferences equals to 23.4%; patient age equals to 20.6%; physical function prognosis equals to 15.2%; length of ICU stay equals to 14.4%; survival prognosis equals to 13.8%; and prognosis for communication equals to 12.6%. Using attribute level utilities, the probability of an substitute decision maker choosing to withdraw life-sustaining therapy after hearing a patient answer in the affirmative “Do you want everything done?” compared with “I would not want to live if I could not take care of myself” was 18.8% (95% CI, 17.2–20.4%) versus 59.8% (95% CI, 57.6–62.0%) after controlling for all the other five attribute levels in the scenario: age greater than 80 years; survival prognosis less than 1%; length of ICU stay greater than 6 months; communication equals to unresponsive; and physical equals to bed bound.

Conclusions:
Using a discrete choice experiment survey, we estimated the impact of a commonly employed and poorly understood phrase physicians may use when discussing advance care plans with patients and their substitute decision makers on the subsequent withdraw life-sustaining therapies. This phrase is predicted to dramatically reduce the likelihood of withdraw life-sustaining therapy even in medically nonbeneficial scenarios and potentially contribute to low-value end-of-life care and outcomes. The immediate cessation of this term should be reinforced in medical training for all healthcare providers who participate in advance care planning.
Comparison of efficacy and safety between ultrathin bioresorbable polymer sirolimus-eluting stents and thin durable polymer drug-eluting stents: a systematic review and meta-analysis of the literature
Authors: Zhai Zhen-yu , Li Ju-xiang 
Published: October 2019

Objective
Ultrathin bioresorbable polymer sirolimus-eluting stents (BP SES) have been proposed as an alternative to thin durable polymer drug-eluting stents (DP DES). Although BP SES show a significant decrease in target lesion failure rates, clear superiority with respect to efficacy and safety of BP SES in comparison to DP EES has not been consistently proven.

Methods and Results
A comprehensive search of several electronic databases identified studies that assessed efficacy and safety of BP SES, compared with DP EES. Relative risks (RRs) were pooled across studies using a fixed-effects model and a random-effect model, respectively, calculating pooled RRs and associated 95% confidence intervals (CIs). The I2 statistic was used to assess heterogeneity. We retrieved six studies enrolling >7000 patients. BP SES significantly reduced the risk of target vessel myocardial infarction (RR, 0.79; 95% CI, 0.64–0.97; I2 = 0%; Test for overall effect: z = 2.24, P = 0.03) in comparison with DP EES using a random-effects model. Use of BP SES was associated with a significant reduction in any myocardial infarction (RR, 0.83; 95% CI, 0.70–0.98; I2 = 12%; Test for overall effect: z = 2.19, P = 0.03), using a fixed-effects model. The subgroup analyses demonstrated, following-up ≥2 years, a statistically significant 27% RR increase in the risk of all-case death for patients randomized to BP SES (RR, 1.27; 95% CI, 1.01–1.60; I2 = 0%; Test for overall effect: z = 2.08, P = 0.04). No differences in cardiac death, stent thrombosis events (STE), target lesion revascularization (TLR) and target vessel revascularization (TVR) between BP SES and DP EES were observed.

Conclusion
BP SES significantly reduced the risk of any myocardial infarction and target vessel myocardial infarction in comparison with DP EES. There were no differences in cardiac death, STE, TLR, TVR and all-cause death with its follow-up time <2 year between BP SES and DP EES. Following-up ≥2 years, a statistically significant 27% RR increase in the risk of all-case death for patients randomized to BP SES was observed.
Strategies to alter the trajectory of atherosclerotic cardiovascular disease
Authors: Packard Chris J. 
Published: October 2019

Purpose of review
Cardiovascular disease prevention trials of lipid lowering with statins have shown unexpected long-term benefits after the formal randomized treatment stopped. This finding needs further exploration because it raises the possibility that the trajectory of the disease can be modified.

Recent findings
Extended follow up data are now available from further major primary prevention studies and from meta-analyses of the legacy effect of statin trials. New outcome studies have been proposed and launched to test the ability of early intervention to slow or regress atherosclerosis.

Summary
Legacy effects are apparent in trials of LDL lowering in hypercholesterolemic and hypertensive patient cohorts. Over follow up periods of decades, both cardiovascular mortality and all-cause mortality are reduced in individuals who received 3 to 5 years of statin therapy. The phenomenon is observed also in studies of intensive glycemic control suggesting that it is possible to impact plaque development with long-term beneficial consequences. Novel strategies for primary prevention are being devised that include the early use of both prolonged-moderate and short-term aggressive LDL lowering.
Common parenting misconceptions regarding infant care: setting the record straight for parents (and some pediatricians)
Authors: Kahan Tamara , Adesman Andrew 
Published: October 2019

Purpose of review
First-time parents often turn to friends and family for advice regarding feeding, sleeping, bathing, diapering and toilet training, and childhood illnesses. Unfortunately, parents may at times be given incorrect and potentially dangerous advice as several widely embraced parenting practices are no longer deemed appropriate. In addition, young children are cared for by family and friends – many of whom are older and may still subscribe to outdated parenting practices.
Parents and grandparents are not the only ones who subscribe to child care myths and misconceptions. Pediatricians also believe in the effectiveness of some outdated child care practices. Although some of these parenting myths are relatively benign, others may indeed pose a significant health risk or safety hazard to a young child. The purpose of this article is to review 10 commonly held myths or misconceptions regarding infant care.

Recent findings
In this review article, we not only highlight many of the studies that document which outdated health beliefs are still endorsed by parents and/or pediatricians, but also review the specific health risks associated with these parenting myths or misconceptions.

Summary
It is important that pediatricians educate parents and other primary caregivers about the potential risks of following outdated parenting practices.
Implementation of a Risk Assessment Tool to Reduce Aspiration Pneumonia in Nonstroke Patients
Authors: Cipra Elizabeth J. 
Published: October 2019

Background:
Aspiration pneumonia is one of the most common forms of pneumonia in hospitalized adults. Aspiration is potentially preventable when healthcare providers take action to decrease its occurrence. Standardized protocols can improve consistency with identification, assessment, and treatment of hospitalized patients at risk of aspiration pneumonia.

Problem/Purpose:
There was no process in place to identify patients at risk of aspiration who did not present with stroke symptoms. The aims of this project were to assess that action steps were taken in patients who assessed positive for aspiration risk and to determine the aspiration risk assessment tool’s impact on the incidence of aspiration pneumonia.

Methods:
After implementing an adapted evidence-based aspiration risk assessment tool and aspiration precautions protocol, consistency of actions taken was assessed descriptively, and rates of aspiration pneumonia were compared from preimplementation to postimplementation using χ
2 analysis.

Interventions:
An aspiration risk assessment tool was adapted to include local hospital findings and implemented.

Results:
All adult patients admitted (n = 10 973) during the initial evaluation period (July 2016 to December 2016) were screened using the adapted aspiration risk assessment tool. Three hundred twenty-six patients (19%) were identified at risk of aspiration and referred to speech therapy for evaluation, with 87.1% evaluated in less than 24 hours. Signs for aspiration risk and speech therapy recommendations were posted on 40% (n = 12). During the 18-month preintervention and postintervention period, hospital-acquired aspiration pneumonia decreased from preimplementation (n = 58 cases/26 738 admissions, 0.22%) to postimplementation (37/28 164, 0.13%), P = .018.

Conclusions:
Implementation of an adapted aspiration risk assessment screening tool to document risk of hospital-acquired aspiration pneumonia and aspiration precautions protocol was associated with a decrease in aspiration pneumonia rates.