bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pioglitazone and cause-specific risk of mortality in patients with type 2 diabetes: extended analysis from a European multidatabase cohort study
Authors: Strongman Helen , Christopher Solomon , Majak Maila , Williams Rachael , Bahmanyar Shahram , Linder Marie , Heintjes Edith M , Bennett Dimitri , Korhonen Pasi , Hoti Fabian 
Published: January 2018

ObjectivesDescribe and compare the risk of cardiovascular and non-cardiovascular mortality in patients whose antidiabetic therapy is modified to include pioglitazone compared with an alternative antidiabetic medication at the same stage of disease progression.Research design and methodsThis exploratory linked database cohort analysis used pooled health and mortality data from three European countries: Finland, Sweden and the UK. Propensity score together with exact matching was used to match 31 133 patients with type 2 diabetes first prescribed pioglitazone from 2000 to 2011, to 31 133 patients never prescribed pioglitazone. Exact matching variables were treatment stage, history of diabetes, diabetes complications and cardiovascular disease, and year of cohort entry. Mean follow-up time was 2.60 (SD 2.00) and 2.69 (SD 2.31) years in the pioglitazone and non-pioglitazone-exposed groups, respectively. Crude cause-specific mortality rates were ascertained. Association with pioglitazone use was estimated using Cox proportional hazards models adjusted a priori for country, age, sex, the propensity score quintile and time-dependent variables representing use of antidiabetic drugs. Stepwise testing identified no additional confounders to include in adjusted models.ResultsThe crude mortality rate was lower in the pioglitazone-exposed group than the non-exposed group for both cardiovascular and non-cardiovascular mortality. Adjusted HRs comparing pioglitazone to alternative antidiabetic exposure were 0.58 (95% CI 0.52 to 0.63) and 0.63 (95% CI 0.58 to 0.68) for cardiovascular and non-cardiovascular mortality, respectively. A protective effect associated with pioglitazone was also found for all specific cardiovascular causes.ConclusionsThis analysis suggests that pioglitazone is associated with a decrease in both cardiovascular and non-cardiovascular mortality. Results should be interpreted with caution due to the potential for residual confounding in this exploratory analysis. Further studies, specifically designed to test the association between pioglitazone use and patient-focused outcomes, are suggested.Study registration numberEuropean Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP; EUPAS3626).
Expanded cardiac rehabilitation in socially vulnerable patients with myocardial infarction: a 10-year follow-up study focusing on mortality and non-fatal events
Authors: Hald Kathrine , Nielsen Kirsten Melgaard , Nielsen Claus Vinther , Meillier Lucette Kirsten , Larsen Finn Breinholt , Christensen Bo , Larsen Mogens Lytken 
Published: January 2018

ObjectiveCardiac rehabilitation (CR) has been shown to reduce cardiovascular risk. A research project performed at a university hospital in Denmark offered an expanded CR intervention to socially vulnerable patients. One-year follow-up showed significant improvements concerning medicine compliance, lipid profile, blood pressure and body mass index when compared with socially vulnerable patients receiving standard CR. The aim of the study was to perform a long-term follow-up on the socially differentiated CR intervention and examine the impact of the intervention on all-cause mortality, cardiovascular mortality, non-fatal recurrent events and major cardiac events (MACE) 10 years after.DesignProspective cohort study.SettingThe cardiac ward at a university hospital in Denmark from 2000 to 2004.Participants379 patients aged <70 years admitted with first episode myocardial infarction (MI). The patients were defined as socially vulnerable or non-socially vulnerable according to their educational level and their social network. A complete follow-up was achieved.InterventionA socially differentiated CR intervention. The intervention consisted of standard CR and additionally a longer phase II course, more consultations, telephone follow-up and a better handover to phase III CR in the municipal sector, in general practice and in the patient association.Main outcome measuresAll-cause mortality, cardiovascular mortality, non-fatal recurrent events and MACE.ResultsThere was no significant difference in all-cause mortality (OR: 1.29, 95% CI 0.58 to 2,89), cardiovascular mortality (OR: 0.80, 95% CI 0.31 to 2.09), non-fatal recurrent events (OR:1.62, 95% CI 0.67 to 3.92) or MACE (OR: 1.31, 95% CI 0.53 to 2.42) measured at 10-year follow-up when comparing the expanded CR intervention to standard CR.ConclusionsDespite the significant results of the socially differentiated CR intervention at 1-year follow-up, no long-term effects were seen regarding the main outcome measures at 10-year follow-up. Future research should focus on why it is not possible to lower the mortality and morbidity significantly among socially vulnerable patients admitted with first episode MI.
Effect of differentiating exercise guidance based on a patient’s level of low back pain in primary care: a mixed-methods systematic review protocol
Authors: Jorgensen Jens Erik , Afzali Tamana , Riis Allan 
Published: January 2018

IntroductionLow back pain (LBP) is one of the health conditions that lead to the most disability worldwide. Guidelines aimed at management of LBP recommend non-invasive and non-pharmacological management, including patient education, advice to stay active and exercise therapy; however, the guidelines offer no recommendation as to the allowable level of pain during exercise or how specific levels of pain should be reflected in the stage and progression of exercises or activities. The purpose of this review is to study the effect of differentiation of exercise guidance based on the level of LBP in patients in primary care.Methods and analysisA systematic search will be performed on PubMed, EMBASE, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Physiotherapy Evidence Database (PEDRO), Cochrane and PROSPERO from their inception until September 2017. Published peer-reviewed human experimental and observational studies with quantitative or qualitative designs will be included. Two independent reviewers will identify papers by reviewing titles and abstracts. Papers passing the initial selection will be appraised by two reviewers, based on their full texts. Furthermore, the reference lists of included studies will be snowballed for identification of other relevant studies. Data will be extracted using a standard extraction sheet by two independent reviewers. Disagreements will be resolved by discussion and consensus with a third reviewer. The methodological quality of studies will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation risk of bias tool, or the Critical Appraisal Skills Programme. Results will be reported narratively. Search histories will be documented on EndNote X8 (Clarivate Analytics).Ethics and disseminationEthical approval for this review was not required as primary data will not be collected. The results will be disseminated through a peer-reviewed international journal and conference presentations.PROSPERO registration numberCRD42017074880.
Bereaved caregivers of patients with high-grade glioma: a systematic review
Authors: Piil Karin , Nordentoft Sara , Larsen Anders , Jarden Mary 
Published: January 2018

ObjectiveCaregivers to patients with primary malignant brain tumours neglect their own physical and emotional needs during the disease trajectory. The aim of the systematic review was to explore how informal caregivers of patients with primary malignant brain tumour (high-grade glioma (HGG)) experience and manage their life situation after the death of the patient.MethodsA systematic literature search was carried out in December 2016 and revised in September 2017. The following six databases were searched: PubMed, Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database, Scopus, PsycINFO and The Social Sciences Citation Index. Studies eligible for inclusion met the following criteria: (1) included bereaved caregivers to patients diagnosed with HGG ≥18 years, (2) described the caregiver’s perspective at post bereavement (3) had been peer-reviewed. The papers included were assessed for methodological quality using the Critical Appraisal Skills Programme.ResultsFour qualitative articles, published from 2004 to 2015, met the eligibility criteria. Bereaved informal caregivers expressed profound grief and had unmet needs and questions related to the disease and their role as caregiver. Moreover, they experienced depressive symptoms and fatigue, resulting in a reduced work capability and social network.ConclusionsWe conclude that bereaved informal caregivers experience psychosocial consequences and emotional reactions after bereavement, resulting in feelings of isolation and loneliness. This review identified limited evidence on how the bereaved caregivers prefer to be supported, and further study is warranted. We suggest incorporating systematic information on bereavement in clinical practice and a cooperation across sectors.
Using high-fidelity simulation to teach fundamental principles of cardiac catheterisation to pharmacy students
Authors: Serag-Bolos Erini , Patel Radha V , Chudow Melissa , Chowdhury Rowshan , Miranda Aimon Chantara 
Published: January 2018

BackgroundPharmacy students often find the pathophysiology and treatment of comorbid heart conditions challenging to understand. The objective of this study is to evaluate the impact of a cardiac catheterisation lab simulation on pharmacy students’ knowledge related to cardiology and critical care pharmacotherapy.MethodsThird-year pharmacy students at the University of South Florida completed a high-fidelity cardiac catheterisation simulation. Specific aspects within the activity involved review of clinical parameters and images during catheterisation, identification of access points for catheter insertion, review of the types of stents available and associated pharmacotherapeutic considerations, and discussion of protective measures to prevent radiation exposure. Students completed knowledge-based presimulation and postsimulation assessments regarding these aspects of cardiac catheterisation.ResultsAll students (n=111, 100%) completed the presimulation and postsimulation assessments. There was an increase in knowledge after the simulation, which was statistically significant in five out of nine questions, P<0.001. Based on course evaluations, students believed this activity enhanced their learning and ability to apply the material due to the close alignment and timing with their acute coronary syndrome lectures and the critical care module in the Pharmacotherapeutics course.ConclusionsParticipation in the simulation improved students’ knowledge related to cardiology pharmacotherapy and associated acute procedures.
Orthostatic blood pressure recovery patterns in suspected syncope in the emergency department
Authors: van Wijnen Veera K , Ten Hove Dik , Gans Reinold O B , Nieuwland Wybe , van Roon Arie M , Ter Maaten Jan C , Harms Mark P M 
Published: January 2018

IntroductionOrthostasis is a frequent trigger for (pre)syncope but some forms of orthostatic (pre)syncope have a worse prognosis than others. Routine assessment of orthostatic BP in the ED can detect classic orthostatic hypotension, but often misses these other forms of orthostatic (pre)syncope. This study aimed to determine the frequency of abnormal orthostatic BP recovery patterns in patients with (pre)syncope by using continuous non-invasive BP monitoring.MethodsWe performed a prospective cohort study in suspected patients with (pre)syncope in the ED of a tertiary care teaching hospital between January and August 2014. Orthostatic BP was measured during the active lying-to-standing test with Nexfin, a continuous non-invasive finger arterial pressure measurement device. Orthostatic BP recovery patterns were defined as normal BP recovery, initial orthostatic hypotension, delayed BP recovery, classic orthostatic hypotension and reflex-mediated hypotension.ResultsOf 116 patients recruited, measurements in 111 patients (age 63 years, 51% male) were suitable for analysis. Classic orthostatic hypotension was the most prevalent abnormal BP pattern (19%), but only half of the patients received a final diagnosis of orthostatic hypotension. Initial orthostatic hypotension and delayed BP recovery were present in 20% of the patients with (pre)syncope of whom 45% were diagnosed as unexplained syncope. Reflex-mediated hypotension was present in 4% of the patients.ConclusionContinuous non-invasive BP measurement can potentially identify more specific and concerning causes of orthostatic (pre)syncope. Correct classification is important because of different short-term and long-term clinical implications.
Does adiposity mediate the relationship between socioeconomic position and non-allergic asthma in childhood?
Authors: Lewis Kate Marie , Pikhart Hynek , Morrison Joana 
Published: January 2018

BackgroundDespite its high prevalence, early onset and chronic nature, the causes of asthma are not clearly established. The present study examined a plausible but untested relationship in the development of non-allergic asthma; an asthma phenotype closely linked to deprivation and other preventable risk factors. Our aim was to determine the mediating role of adiposity in the relationship between socioeconomic position in infancy and non-allergic asthma emergence in mid-childhood.MethodsTo estimate the causal indirect effect of adiposity we applied the parametric g-computational procedure to 6203 singleton children from the UK Millennium Cohort Study. Adiposity was measured at age 7 by body mass index, waist circumference and waist circumference-to-height ratio. Children who developed non-allergic asthma between the age of 7 and 14 were compared with children without allergies or allergic asthma at these ages.ResultsWe found no evidence to suggest that adiposity is a mediator in the relationship between socioeconomic position and the development of non-allergic asthma in mid-childhood. After adjustment for risk factors, the direct effect of socioeconomic position remained; children in the lowest tertile of socioeconomic position had a 43% (OR 1.43, 95% CI 1.38 to 1.49) greater odds of developing non-allergic asthma compared with the highest tertile.ConclusionsAdiposity at age 7 does not mediate the relationship between socioeconomic position and non-allergic asthma. The results suggest that improving socioeconomic conditions and promoting healthy weight are both important in reducing the development of non-allergic asthma in early to mid-childhood.
Effect of increasing the price of sugar-sweetened beverages on alcoholic beverage purchases: an economic analysis of sales data
Authors: Quirmbach Diana , Cornelsen Laura , Jebb Susan A , Marteau Theresa , Smith Richard 
Published: January 2018

BackgroundTaxing soft-drinks may reduce their purchase, but assessing the impact on health demands wider consideration on alternative beverage choices. Effects on alcoholic drinks are of particular concern, as many contain similar or greater amounts of sugar than soft-drinks and have additional health harms. Changes in consumption of alcoholic drinks may reinforce or negate the intended effect of price changes for soft-drinks.MethodsA partial demand model, adapted from the Almost Ideal Demand System, was applied to Kantar Worldpanel data from 31 919 households from January 2012 to December 2013, covering drink purchases for home consumption, providing ~6 million purchases aggregated into 11 groups, including three levels of soft-drink, three of other non-alcoholic drinks and five of alcoholic drinks.ResultsAn increase in the price of high-sugar drinks leads to an increase in the purchase of lager, an increase in the price of medium-sugar drinks reduces purchases of alcoholic drinks, while an increase in the price of diet/low-sugar drinks increases purchases of beer, cider and wines. Overall, the effects of price rises are greatest in the low-income group.ConclusionIncreasing the price of soft-drinks may change purchase patterns for alcohol. Increasing the price of medium-sugar drinks has the potential to have a multiplier-effect beneficial to health through reducing alcohol purchases, with the converse for increases in the price of diet-drinks. Although the reasons for such associations cannot be explained from this analysis, requiring further study, the design of fiscal interventions should now consider these wider potential outcomes.
Transformational leadership capabilities for medical leaders
Authors: Rooke David 
Published: January 2018

Background/aimThis paper summarises and extends information presented at the Lilly Lecture 2017. It is based on the author’s experience and research in working to develop senior leaders in many sectors over the last 30 years. The aim is to provide practical, usable insights into an aspect of leadership capability that is often overlooked in order to enable greater effectiveness in leaders.MethodsThe paper draws on the author’s own experience, of the research of Harthill and other organisations working with the concepts that have been labelled constructivist development or more lately ‘vertical’ development.ResultsResearch, both qualitative and quantitative, points to the need for leaders to develop the meaning-making capacities to deal with increased levels of complexity and ambiguity. Fewer than 5% of leaders across multisectors are seen to develop these capacities.ConclusionLeaders within the National Health Service are particularly challenged by complex and ambiguous contexts. They need to extend their leadership capacities to be able to lead effectively in such contexts. Leaders today are not being supported to develop these capacities and more needs to be done. There are actions that individuals as well as organisations can take to support this development.
Comparison of tricuspid annular plane systolic excursion with fractional area change for the evaluation of right ventricular systolic function: a meta-analysis
Authors: Lee Justin Z , Low See-Wei , Pasha Ahmed K , Howe Carol L , Lee Kwan S , Suryanarayana Prakash G 
Published: January 2018

BackgroundAccurate determination of right ventricular ejection fraction (RVEF) is challenging because of the unique geometry of the right ventricle. Tricuspidannular plane systolic excursion (TAPSE) and fractional area change (FAC) are commonly used echocardiographic quantitative estimates of RV function. Cardiac MRI (CMRI) has emerged as the gold standard for assessment of RVEF. We sought to summarise the available data on correlation of TAPSE and FAC with CMRI-derived RVEF and to compare their accuracy.MethodsWe searched PubMed, EMBASE, Web of Science, CINAHL, ClinicalTrials.gov and the Cochrane Library databases for studies that assessed the correlation of TAPSE or FAC with CMRI-derived RVEF. Data from each study selected were pooled and analysed to compare the correlation coefficient of TAPSE and FAC with CMRI-derived RVEF. Subgroup analysis was performed on patients with pulmonary hypertension.ResultsAnalysis of data from 17 studies with a total of 1280 patients revealed that FAC had a higher correlation with CMRI-derived RVEF compared with TAPSE (0.56vs0.40, P=0.018). In patients with pulmonary hypertension, there was no statistical difference in the mean correlation coefficient of FAC and TAPSE to CMR (0.57vs0.46, P=0.16).ConclusionsFAC provides a more accurate estimate of RV systolic function (RVSF) compared with TAPSE. Adoption of FAC as a routine tool for the assessment of RVSF should be considered, especially since it is also an independent predictor of morbidity and mortality. Further studies will be needed to compare other methods of echocardiographic measurement of RV function.
Body mass index as a risk factor for coronary events and mortality in patients with type 1 diabetes
Authors: Vestberg Daniel , Rosengren Annika , Eeg-Olofsson Katarina , Miftaraj Mervete , Franzen Stefan , Svensson Ann-Marie , Lind Marcus 
Published: January 2018

ObjectiveTo investigate the potential relationship between body mass index (BMI) and the risk for myocardial infarction and coronary death in patients with type 1 diabetes.MethodsWe studied patients with type 1 diabetes included in the Swedish National Diabetes Registry during 2002–2004 and followed them until a discharge diagnosis for myocardial infarction, acute coronary event, death or until 31 December 2011. Cox regression was used to estimate relative risks.ResultsIn 17 499 patients with type 1 diabetes (mean age 39.4 years; mean BMI 25.2 kg/m2), 819 were diagnosed with myocardial infarction as a primary or secondary diagnosis during a mean follow-up of 8.5 years (maximum 9.9 years). Estimated with Cox regression, there was no significant effect of increased BMI on the risk of myocardial infarction (HR 1.4 (95% CI 0.7 to 2.5) in the group with BMI >35 kg/m2compared with BMI 18.5–25 kg/m2. There was no association between BMI and coronary mortality, acute coronary events or all-cause mortality after adjusting for other known risk factors. Underweight patients (BMI <18.5 kg/m2) had increased hazard for coronary (HR 5.0 (95% CI 1.5 to 16.9)) and all-cause mortality (HR 5.4 (95% CI 3.1 to 9.6)) compared with BMI 18.5–25 kg/m2.ConclusionsAmong patients with type 1 diabetes, increased BMI is not a significant independent risk factor for myocardial infarction or coronary death after adjustment for other risk factors. Low BMI (less than 18.5 kg/m2) is associated with mortality from coronary or any cause.
Beating heart minimally invasive mitral valve surgery in patients with previous sternotomy: the operative technique and early outcomes
Authors: Xu Robert B , Rahnavardi Mohammad , Nadal Mart , Viana Fabiano , Stuklis Robert G , Worthington Michael , Edwards James 
Published: January 2018

ObjectiveReoperative mitral valve surgery is increasingly required and can be associated with significant morbidity and mortality. The beating heart minimally invasive mitral valve surgery has a proposed benefit in avoiding the risks of repeat sternotomy, with reducing the need for adhesiolysis and cardioplegia reperfusion injury. We describe our experience with such a technique in patients with previous sternotomy.MethodsA retrospective study was performed and all patients undergoing surgery of mitral valve through a right limited thoracotomy without application of an aortic cross-clamp (beating heart) as a redo cardiac surgery between January 2006 and January 2015 were included (n=25). Perioperative data as well as the operative technique are presented.ResultsSix patients (24%) had two previous sternotomies and one (4%) had three previous sternotomies. Mitral valve repair was performed in 11 patients (44%). No patient required conversion to median sternotomy. Inotropic support beyond 4 hours after operation was required in seven patients (28%). Ventilation time was less than 12 hours in 14 patients (56%) with another six patients (24%) extubated within 24 hours after surgery. Postoperative course was complicated with cerebrovascular accident in two patients (8%). In-hospital mortality was 4% (n=1). There was no 30-day mortality after discharge.ConclusionsReoperative mitral valve surgery can be safely performed through a limited right thoracotomy approach on a beating heart while on full cardiopulmonary bypass. The technique can be associated with potentially shorter operation, shorter cardiopulmonary bypass and a less complicated recovery.