bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cryoballoon ablation for persistent atrial fibrillation in patients without left atrial fibrosis
Authors: Gramlich Michael , Maleck Carole , Marquardt Jonathan , Duckheim Martin , Stimpfle Fabian , Heinzmann David , Scheckenbach Christian , Gawaz Meinrad , Schreieck Jürgen , Seizer Peter 
Published: April 2019

AbstractIntroductionThe role of cryoballoon (CB) pulmonary vein isolation (PVI) for patients with persistent atrial fibrillation (AF) is controversial, since long‐term success can be poor. We performed left atrial voltage mapping before CB PVI and determined AF‐free survival depending on the extent of low‐voltage areas (LVAs).Methods and ResultsWe consecutively enrolled 60 patients with persistent AF (average age, 60.6 ± 12.9 years; CHA2DS
2 VASc score, 2.3 ± 1.6; and left atrial size 46.0 ± 5.2 mm) who were planned for CB PVI. Before ablation, we performed left atrial voltage mapping (Abbott EnSite Precision or Velocity). LVAs were defined if local bipolar signal amplitudes were less than 0.5 mV during sinus rhythm. Thirty‐seven patients did not show significant LVAs (<10%), while 12 patients had LVAs between 10% and 30% and 11 patients showed substantial LVAs greater than 30% of the left atrial area. CB PVI could be successfully performed in all patients. A 7‐day holter monitoring was obtained 3, 6, and 12 months after ablation. After a 12‐month follow‐up time, 83.8% of patients without LVAs (<10%) were free of atrial fibrillation, while 50.0% of patients with 10% to 30% LVAs and 9.1% of patients with LVAs more than 30% had stable sinus rhythm. The degree of atrial fibrosis correlated with the risk of AF recurrence.ConclusionIn patients with persistent AF undergoing CB PVI, the extent of left atrial LVAs predicts an AF‐free survival. CB PVI seems to be a highly effective treatment for patients with persistent AF without atrial fibrosis.
Etiology of tricuspid valve disease is a predictor of bradyarrhythmia after tricuspid valve surgery
Authors: Herrmann Florian E. M. , Graf Helen , Wellmann Petra , Sadoni Sebastian , Hagl Christian , Juchem Gerd 
Published: April 2019

AbstractAimsThe tricuspid valve is situated in close proximity to cardiac conduction tissue and damage to this tissue can affect postoperative rhythm. The aim of this study was to quantify the incidence of pacemaker requirement after tricuspid valve surgery and investigate predictors.MethodsData were collected via our operative data collection system and patient files. All patients who underwent surgical procedures of the tricuspid valve from 2004 until 2017 and lacked a pacemaker preoperatively were included in the study.ResultsIn our cohort of 505 patients 54 required a pacemaker in the first 50 days after surgery. We calculated a 17.5% (95% confidence interval [CI], 13.5‐21.3) risk of pacemaker implantation at 4 years postoperatively. Multivariate analysis identified preoperative active endocarditis (odds ratio 3.17; CI, 1.32‐7.65; P = 0.010) and “inadequate pacemaker dependent rhythm” (defined as any intrinsic heart rate below 45 per minute requiring pacing) upon admission to the intensive care unit after surgery (odds ratio 5.924; CI, 2.82‐12.44; P = 0.001) as predictors for pacemaker requirement in the first 50 days after surgery. Twenty‐six pacemakers (48%) were implanted for atrioventricular block, 16 (30%) for sinus node dysfunction and 12 (22%) for atrial fibrillation. Kaplan‐Meier analysis showed no difference in survival between the pacemaker and no pacemaker group.ConclusionSurgery of the tricuspid valve has a high burden of postoperative pacemaker requirement. Preoperative active endocarditis and the initial postoperative rhythm are predictors. Understanding this allows for better decision‐making regarding further medical/device therapy.
Safety of Ramadan fasting in young patients with type 1 diabetes: A systematic review and meta‐analysis
Authors: Loh Huai Heng , Lim Lee‐Ling , Loh Huai Seng , Yee Anne 
Published: April 2019

AbstractAims/IntroductionAlthough patients with type 1 diabetes are medically exempt, many insist on fasting during Ramadan. Multiple daily insulin injections (MDI), premixed insulin and continuous subcutaneous insulin infusion (CSII) are commonly used. To date, little is known about the safety of Ramadan fasting in these patients.Materials and MethodsWe pooled data from 17 observational studies involving 1,699 patients treated with either CSII or non‐CSII (including premixed and MDI) regimen. The study outcomes were the frequencies of hypoglycemia, hyperglycemia and/or ketosis. Given the lack of patient‐level data, separate analyses for premixed and MDI regimen were not carried out.ResultsThe CSII‐treated group (n = 203) was older (22.9 ± 6.9 vs 17.8 ± 4.0 years), and had longer diabetes duration (116.7 ± 66.5 vs 74.8 ± 59.2 months) and lower glycated hemoglobin (7.8 ± 1.1% vs 9.1 ± 2.0%) at baseline than the non‐CSII‐treated group (n = 1,496). The non‐CSII‐treated group had less non‐severe hypoglycemia than the CSII‐treated group (22%, 95% CI 13–34 vs 35%, 95% CI 17–55). Of the non‐CSII‐treated group, 7.1% (95% CI 5.8–8.5) developed severe hypoglycemia, but none from the CSII‐treated group did. The non‐CSII‐treated group was more likely to develop hyperglycemia (12%, 95% CI 3–25 vs 8.8%, 95% CI 0–31) and ketosis (2.5%, 95% CI 1.0–4.6 vs 1.6%, 95% CI 0.1–4.7), and discontinue fasting (55%, 95% CI 34–76 vs 31%, 95% CI 9–60) than the CSII‐treated group.ConclusionsThe CSII regimen had lower rates of severe hypoglycemia and hyperglycemia/ketosis, but a higher rate of non‐severe hyperglycemia than premixed/MDI regimens. These suggest that appropriate patient selection with regular, supervised fine‐tuning of the basal insulin rate with intensive glucose monitoring might mitigate the residual hypoglycemia risk during Ramadan.
A Team Disclosure of Error Educational Activity: Objective Outcomes
Authors: Krumwiede Kim Hoggatt , Wagner James M. , Kirk Lynne M. , Duval Tara M. , Dalton Thomas O. , Daniel Kathryn M. , Huffman Allison S. , Adams‐Huet Beverley , Rubin Craig D. 
Published: April 2019

Medical errors can involve multiple team members. Few curricula are being developed to provide instruction on disclosing medical errors that include simulation training with interprofessional team disclosure. To explore more objective evidence for the value of an educational activity on team disclosure of errors, faculty developed and assessed the effectiveness of a multimodal educational activity for learning team‐based disclosure of a medical error.This study employed a methodological triangulation research design. Participants (N = 458) included students enrolled in academic programs at three separate institutions. The activity allowed students to practice team communication while: (1) discussing a medical error within the team; (2) planning for the disclosure of the error; and (3) conducting the disclosure. Faculty assessed individual student's change in knowledge and, using a rubric, rated the performance of the student teams during a simulation with a standardized family member (SFM).Students had a high level of preexisting knowledge and demonstrated the greatest knowledge gains in questions regarding the approach to disclosure (P < .001) and timing of an apology (P < .001). Both SFMs and individual students rated the team error disclosure behavior highly (rho = 0.54; P < .001). Most participants (more than 80%) felt the activity was worth their time and that they were more comfortable with disclosing a medical error as a result of having completed the activity.This activity for interprofessional simulation of team‐based disclosure of a medical error was effective for teaching students about and how to perform this type of important disclosure.
Deterioration of nutritional status of patients with locally advanced cervical cancer during treatment with concomitant chemoradiotherapy
Authors: Sánchez M. , Castro‐Eguiluz D. , Luvián‐Morales J. , Jiménez‐Lima R. , Aguilar‐Ponce J. L. , Isla‐Ortiz D. , Cetina L. 
Published: April 2019

AbstractBackgroundIn Mexico, 80% women with cervical cancer are diagnosed at locally advanced stages and are treated with concomitant chemoradiotherapy. The treatment modality and catabolic state confer a nutritional risk. The present study aimed to thoroughly evaluate the nutritional status and change in body composition of locally advanced cervical cancer (LACC) patients throughout treatment.MethodsAn observational prospective study, carried out at the Mexican National Cancer Institute, included 55 LACC patients. Nutritional status was evaluated before, during and after treatment, using anthropometric, dietary and biochemical measurements. Body composition was analysed using computed tomography images obtained at the time of diagnosis and approximately 4 months after treatment completion. Clinical outcomes were associated with changes in body composition.ResultsAt the time of diagnosis, no patients were clinically malnourished, although 33.3% presented sarcopenia and most were overweight; by the end of treatment, 69% became clinically malnourished and 58% were sarcopenic. Average weight loss was 7.4 kg (P = 0.001). Adequacy of energy intake was reduced to 54%, obtained predominantly from carbohydrates. By the week 9, 62.8% patients became anemic and 34.5% had low albumin levels. Body composition analysis revealed that patients lost both, muscle and adipose tissues, although 27% patients were muscle depleted by the end of treatment. Patients who lost ≥10% skeletal muscle presented a higher tumour recurrence (hazard ratio = 2.957, P = 0.006) and a tendency towards diminished overall survival (hazard ratio = 2.572, not significant).ConclusionsThe nutritional status of cervical cancer patients deteriorates during treatment with concomitant chemoradiotherapy and, most importantly, muscle loss impacts the clinical outcome of patients.
Genetic mapping of folate QTLs using a segregated population in maize
Authors: Guo Wenzhu , Lian Tong , Wang Baobao , Guan Jiantao , Yuan Dong , Wang Huan , Safiul Azam Fardous Mohammad , Wan Xing , Wang Weixuan , Liang Qiuju , Wang Haiyang , Tu Jinxing , Zhang Chunyi , Jiang Ling 
Published: April 2019

AbstractAs essential B vitamin for humans, folates accumulation in edible parts of crops, such as maize kernels, is of great importance for human health. But its breeding is always limited by the prohibitive cost of folate profiling. The molecular breeding is a more executable and efficient way for folate fortification, but is limited by the molecular knowledge of folate regulation. Here we report the genetic mapping of folate quantitative trait loci (QTLs) using a segregated population crossed by two maize lines, one high in folate (GEMS31) and the other low in folate (DAN3130). Two folate QTLs on chromosome 5 were obtained by the combination of F2 whole‐exome sequencing and F3 kernel‐folate profiling. These two QTLs had been confirmed by bulk segregant analysis using F6 pooled DNA and F7 kernel‐folate profiling, and were overlapped with QTLs identified by another segregated population. These two QTLs contributed 41.6% of phenotypic variation of 5‐formyltetrahydrofolate, the most abundant storage form among folate derivatives in dry maize grains, in the GEMS31×DAN3130 population. Their fine mapping and functional analysis will reveal details of folate metabolism, and provide a basis for marker‐assisted breeding aimed at the enrichment of folates in maize kernels.
Patients and home carers' experience and perceptions of different modalities of enteral feeding
Authors: Ang Shin Yuh , Lim Mei Ling , Ng Xin Ping , Lam Madeleine , Chan Mei Mei , Lopez Violeta , Lim Siew Hoon 
Published: April 2019

AbstractAims and objectivesTo explore patients and carers' experience and perceptions of different modalities of long‐term enteral feeding.BackgroundWith an ageing population in Singapore, there is a concomitant increase in number of patients with dysphagia and hence increase in prevalence of enteral feeding. It is essential to understand experiences of patients and home carers with long‐term home enteral feeding and perceptions of different modalities to better provide support.DesignA qualitative descriptive approach fulfilling the COREQ checklist criteria (See File S1). Nine patients who were receiving long‐term enteral feeding and nine carers were recruited over the period of August to December 2017. One‐to‐one interviews were conducted and audio‐recorded. An inductive content analysis approach, with open coding, creation of categories and abstraction of data, was adopted.ResultsThree themes were generated: (a) factors influencing choice of mode of enteral feeding; respondents narrated factors such as need to “conceal” illness, need to be independent and previous bad experience with alternative modality (b) identified informational, emotional and physical needs. Respondents reported the need for support in terms of information on the different modalities, and training on how to self‐care or provide care and (c) individual perception and attitude towards life with enteral feeding. Most respondents portrayed a positive outlook to life, despite that they could no longer participate in communal eating.Conclusion and Relevance to clinical practiceUnderstanding patients and carers' experience and perceptions will inform the development of strategies to empower future patients and carers in choice of modality for enteral feeding. Patients with percutaneous endoscopic gastrostomy (PEG) found it easier to integrate enteral tube feeding into daily lives. Carers played a pivotal role in choice of modality, as well as in care of patients on enteral feeding.
Relationship between patient’s health literacy and adherence to coronary heart disease secondary prevention measures
Authors: Lu Minmin , Ma Jianying , Lin Ying , Zhang Xian , Shen Yunzhi , Xia Haiou 
Published: April 2019

AbstractAims and ObjectivesTo examine the relationship between health literacy (HL) and adherence to secondary coronary heart disease (CHD) prevention behaviours in patients in China.BackgroundAdherence of patients to secondary CHD prevention behaviours is important in order to slow or reverse disease progression. The relationship between HL and adherence is varied across populations and warrants further research in order to inform nurses caring for such patients how to direct their teaching.DesignA descriptive cross‐sectional design.MethodsA total of 598 patients with CHD were recruited during hospitalisation for a myocardial revascularization procedure at either of two tertiary hospitals in China. Data were collected by self‐report on demographics, HL and adherence to secondary CHD prevention behaviours (medication‐taking and heart‐healthy lifestyle) prior to this admission. HL was measured by the short version of European Health Literacy Survey Questionnaire (HLS‐EU‐Q16), while adherence was measured with the Medical Outcomes Study Specific Adherence Scale (MOS‐SAS). Descriptive, chi‐square test and regression analyses were conducted. The study was reported based on STROBE checklist.ResultsOverall, 74.5% of the patients had limited HL. Adherence rates to medication‐taking and heart‐healthy lifestyle were 84.7% and 53.2%, respectively. HL was not significantly associated with medication adherence, but in regression models patients with limited HL demonstrated significantly increased odds for nonadherence to heart‐healthy lifestyle (OR 1.69).ConclusionHL was not significantly associated with medication adherence but was related to heart‐healthy lifestyle adherence.Relevance to clinical practiceNurses should assess the health literacy of discharging patients with CHD and focus on patients with limited health literacy to improve heart‐healthy lifestyle behaviours, and not just taking medications.
Critical care nurses’ clinical reasoning about physiologic monitor alarm customisation: An interpretive descriptive study
Authors: Ruppel Halley , Funk Marjorie , Whittemore Robin , Wung Shu‐Fen , Bonafide Christopher P. , Powell Kennedy Holly 
Published: April 2019

AbstractAims and objectivesTo explore clinical reasoning about alarm customisation among nurses in intensive care units.BackgroundCritical care nurses are responsible for detecting and rapidly acting upon changes in patients’ clinical condition. Nurses use medical devices including bedside physiologic monitors to assist them in their practice. Customising alarm settings on these devices can help nurses better monitor their patients and reduce the number of clinically irrelevant alarms. As a result, customisation may also help address the problem of alarm fatigue. However, little is known about nurses' clinical reasoning with respect to customising physiologic monitor alarm settings.DesignThis article is an in‐depth report of the qualitative arm of a mixed methods study conducted using an interpretive descriptive methodological approach.MethodsTwenty‐seven nurses were purposively sampled from three intensive care units in an academic medical centre. Semi‐structured interviews were conducted by telephone and were analysed using thematic analysis. Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines were used.ResultsFour themes were identified from the interview data: unit alarm culture and context, nurse attributes, motivation to customise and customisation “know‐how.” A conceptual model demonstrating the relationship of these themes was developed to portray the factors that affect nurses’ customisation of alarms.ConclusionsIn addition to drawing on clinical data, nurses customised physiologic monitor alarms based on their level of clinical expertise and comfort. Nurses were influenced by the alarm culture on their clinical unit and colleagues’ and patients’ responses to alarms, as well as their own technical understanding of the physiologic monitors.Relevance to clinical practiceThe results of this study can be used to design strategies to support the application of clinical reasoning to alarm management, which may contribute to more appropriate alarm customisation practices and improvements in safety.
A cross‐validation study of the incident‐reporting attitude scale for staff in long‐term care facilities—A cross‐sectional study
Authors: Lin Shu‐Yuan , Yang Hui‐Ching , Chiang Hui‐Ying , Lee Shu‐Li 
Published: April 2019

AbstractAims and objectivesTo test the construct and concurrent validity and reliability of the incident‐reporting attitude scale used for staff in long‐term care facilities (IRA‐LTC) by the two‐phase cross‐validation method.BackgroundLack of accurate measurement on incident‐reporting attitude might hinder improvements of safety practice in long‐term care facilities.Design/MethodsA two‐phase cross‐sectional questionnaire survey was conducted in Taiwan. A fixed proportion of long‐term care facilities were randomly selected that included 20 and 15 long‐term care facilities at phases one and two separately. Nursing and administrative staffs in these facilities were recruited at the first phase (N = 207) for testing the validity and reliability of the newly developed scale and for cross‐validation of the scale at the second phase (N = 251). The scale of IRA‐LTC was a self‐developed structured questionnaire consisting of 31 items. The data were analysed usingspssfor Windows 20.0 and AMOS 24.0. Descriptive statistics, correlation analysis, Cronbach'sα, exploratory and confirmatory factory analysis were carried to examine the homogeneity of items, reliability, construct and concurrent validity. The STROBE checklist was adhered (See Appendix S1).ResultsThe IRA‐LTC scale comprised two dimensions: “cognition and intention to report” and “barriers to report.” The two‐factor structure explained 60.20%–61.89% of the total variance at two phases. Validation of the initial factorial model gained at the first phase was satisfactorily supported at the second phase. Concurrent validity of the IRA‐LTC scale was satisfied.Cronbach'sαfor the scale and subscales was 0.94–0.97.ConclusionsThis IRA‐LTC scale is valid and reliable and can be recommended to evaluate the incident‐reporting attitude among all kinds of staff in long‐term care facilities.Relevance to clinical practicePositive incident‐reporting attitude can lead to positive incident‐reporting behaviour. Using the IRA‐LTC scale for assessing staff's incident‐reporting attitude is recommended as the first step to enhance staff's safety performance in long‐term care facilities.
Co‐development of “BRAIN‐TRK”: Qualitative examination of acceptability, usability and feasibility of an App to support nurses' care for patients with behavioural and psychological symptoms of neurocognitive disorders in hospital
Authors: Redley Bernice , Richardson Ben , Peel Charlotte , Ockerby Cherene , Rawson Helen , Tomlinson Emily , Hutchinson Alison 
Published: April 2019

AbstractAims and objectives(a) Describe the co‐development of a point‐of‐care App to promote uptake of best practice recommendations and consolidate nurses' knowledge for managing symptoms of neurocognitive disorders. (b) Report acceptability, usability and feasibility of the App to nurses for patient care in hospital.BackgroundStrategies used in hospitals to reduce symptoms, risk of harm, or complications of behavioural and psychological symptoms associated with neurocognitive disorders are frequently inconsistent with best practice recommendations.DesignThree‐stage, mixed‐methods, process and outcome evaluation.MethodsThe App was co‐developed with experts, nurse end‐users and a consumer. Evaluation data were collected from a convenience sample of nurses observed during delivery of 80.5 hr of care to 38 patients; the App (n = 32 patients); and individual and focus group interviews with nurses (n = 25). Reporting adhered to an adapted STROBE checklist.ResultsThe App included three components: cognition and risk assessment; tailored evidence‐based strategies; and monitoring and evaluation of effectiveness. Observation data captured nurses using the App with 44.7% (n = 17) of eligible inpatients. Cognitive screening was completed at least once for each patient, with 146 risk assessments recorded. Interview data indicated the App's acceptability was enhanced by familiarity and perceived benefits, but hindered by perceived increases in workload, inconsistent use, pressure to use the App and resistance to change. Feasibility and usability were enhanced by easy navigation, and clear and useful content, but hindered by unclear expectations, unfamiliarity and device‐related factors.ConclusionsThe App provided an evidence‐based tool that was, overall, considered feasible and acceptable to support best practice. Findings provide guidance to enhance usability for future implementation.Relevance to clinical practiceCo‐development using best evidence and key stakeholders enabled creation of a novel, feasible and acceptable technology. Real‐time access to assessment tools and tailored knowledge supported nurses' clinical decision‐making; workload and unfamiliarity were barriers to use.