bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determinants of Urinary Output Response to IV Furosemide in Acute Kidney Injury: A Pharmacokinetic/Pharmacodynamic Study
Authors: Silbert Benjamin I. , Ho Kwok M. , Lipman Jeffrey , Roberts Jason A. , Corcoran Tomas B. , Morgan David J. , Pavey Warren , Mas Emilie , Barden Anne E. , Mori Trevor A. 
Published: May 2016

Objectives:
This study assessed the determinants of urinary output response to furosemide in acute kidney injury; specifically, whether the response is related to altered pharmacokinetics or pharmacodynamics.

Design:
Prospective cohort.

Setting:
Tertiary ICU.

Patients:
Thirty critically ill patients with acute kidney injury without preexisting renal impairment or recent diuretic exposure.

Intervention:
A single dose of IV furosemide.

Measurements and Main Results:
Baseline markers of intravascular volume status were obtained prior to administering furosemide. Six-hour creatinine clearance, hourly plasma/urinary furosemide concentrations, and hourly urinary output were used to assess furosemide pharmacokinetics/pharmacodynamics parameters. Of 30 patients enrolled, 11 had stage-1 (37%), nine had stage-2 (30%), and 10 had stage-3 (33%) Acute Kidney Injury Network acute kidney injury. Seventy-three percent were septic, 47% required norepinephrine, and 53% were mechanically ventilated. Urinary output doubled in 20 patients (67%) following IV furosemide. Measured creatinine clearance was strongly associated with the amount of urinary furosemide excreted and was the only reliable predictor of the urinary output after furosemide (area under the receiver-operating-characteristic curve, 0.75; 95% CI, 0.57–0.93). In addition to an altered pharmacokinetics (p < 0.01), a reduced pharmacodynamics response to furosemide also became important when creatinine clearance was reduced to less than 40 mL/min/1.73 m2 (p = 0.01). Acute kidney injury staging and markers of intravascular volume, including central venous pressure, brain-natriuretic-peptide concentration, and fractional urinary sodium excretion were not predictive of urinary output response to furosemide.

Conclusions:
The severity of acute kidney injury, as reflected by the measured creatinine clearance, alters both pharmacokinetics and pharmacodynamics of furosemide in acute kidney injury, and was the only reliable predictor of the urinary output response to furosemide in acute kidney injury.
Physiological Responses of the Modified Shuttle Test in Adults With Cystic Fibrosis
Authors: Vallier Jean-Marc , Rouissi Mehdi , Mely Laurent , Gruet Mathieu 
Published: May 2016

PURPOSE:
The modified shuttle test (MST) is increasingly used in clinical practice to assess functional capacity in patients with cystic fibrosis (CF). The purpose of this study was to evaluate the physiological responses of the MST in adults with CF as compared with the gold standard cardiopulmonary exercise test (CPET).

METHODS:
Participants performed an MST and a CPET on a cycle ergometer in random order. Oxygen (O2) uptake (

JOURNAL/jcprh/04.03/01273116-201607000-00009/9FSM1/v/2023-09-11T074056Z/r/image-gif

o
2), carbon dioxide (CO2) retention (end-tidal Pco
2; Petco
2), minute ventilation, heart rate, and peripheral O2 saturation (Spo
2) were continuously monitored. Whole blood lactate, dyspnea, and leg discomfort were recorded immediately after both exercises.

RESULTS:
Twenty patients with CF (aged 33 ± 8 years; forced expiratory volume in 1 second = 48% ± 17%) completed both tests. Peak values for

JOURNAL/jcprh/04.03/01273116-201607000-00009/9FSM1/v/2023-09-11T074056Z/r/image-gif

o
2 (27 ± 7 vs 24 ± 6 mL/kg/min), heart rate (169 ± 19 vs 163 ± 16 bpm), end Petco
2 (42 ± 7 vs 39 ± 8 mm Hg), and O2 desaturation (end Spo
2, 86% ± 7% vs 90% ± 6%) were significantly higher during the MST than during the CPET (all Ps < .05). Leg discomfort and whole blood lactate were significantly higher after the CPET (both Ps < .05). Thirty-five percent and 40% of patients showed significant O2 desaturation and CO2 retention, respectively, during the MST, which was not detected during the CPET. A strong relationship was found between MST peak

JOURNAL/jcprh/04.03/01273116-201607000-00009/9FSM1/v/2023-09-11T074056Z/r/image-gif

o
2 and body weight walking distance product (r = 0.90; P < .01).

CONCLUSIONS:
The MST may provide a strong indicator of exercise tolerance in adults with CF as indicated by high peak

JOURNAL/jcprh/04.03/01273116-201607000-00009/9FSM1/v/2023-09-11T074056Z/r/image-gif

o
2 values. In clinical practice, body weight walking distance should be considered as the primary outcome. This test is also better than cycle ergometry CPET for detecting O2 desaturation and CO2 retention, further emphasizing its clinical interest.
Lower Experiential Avoidance Is Associated With Psychological Well-being and Improved Cardiopulmonary Endurance Among Patients in Cardiac Rehabilitation
Authors: Goodwin Christina L. , Emery Charles F. 
Published: May 2016

PURPOSE:
Patients with a diagnosis of cardiac disease are often asked to make significant lifestyle changes, but they may experience difficulty initiating and maintaining lifestyle changes, especially when engaging in experiential avoidance (EA), the tendency to push away unpleasant emotions and sensations. This study examined the relationship between EA, psychological functioning, cardiac-quality of life (cardiac-QOL), program adherence, and cardiopulmonary endurance among patients entering an outpatient cardiac rehabilitation (CR) program.

METHODS:
Patients completed study questionnaires pre-CR, including 2 measures of EA (general and cardiac-specific), and assessments of psychological functioning and cardiac-QOL. Adherence was calculated as the proportion of insurance-approved CR sessions attended. Thirty participants completed stress testing pre-CR and post-CR.

RESULTS:
Forty-seven patients completed the questionnaires. General EA was associated with greater depression (r = 0.73, P < .001), anxiety (r = 0.56, P < .001), and stress (r = 0.65, P < .001) and lower cardiac-QOL (r =−0.69, P < .001). In addition, when controlling for the influence of general EA, greater cardiac-specific EA was associated with depression (∆R
2 = 0.05, P = .01), anxiety (∆R
2 = 0.18, P < .001), and poorer cardiac-QOL (∆R
2 = 0.04, P = .04). However, lower cardiac-specific EA predicted greater increases in cardiopulmonary endurance (

JOURNAL/jcprh/04.03/01273116-201611000-00006/6FSM1/v/2023-09-11T074110Z/r/image-gif

o
2peak) during the CR program (b =−0.18, P = .002; ∆adjusted R
2 = 0.07). Experiential avoidance was not associated with adherence.

CONCLUSIONS:
Lower EA is associated with better psychological well-being among patients entering a CR program and with better exercise outcomes. Strategies for reducing EA may be important to consider in future clinical studies.
Effect of Baseline Red Blood Cell Distribution Width on Short- and Intermediate-term Mortality of Patients Under Primary Percutaneous Coronary Intervention
Authors: Bozorgi Ali , Khaki Siavash , Mortazavi Seyedeh Hamideh , Sadeghian Saeed , Khoshnevis Maryam , Tofighi Salar , Khaki Arash 
Published: May 2016

Objective:Considering the limited studies specifically evaluating the role of Red blood cell distribution width (RDW) in primary percutaneous coronary intervention (PCI), we aimed to investigate the role of baseline RDW in short- and intermediate-term cardiovascular events in ST-elevation myocardial infarction patients under primary PCI.Methods:This is a historical cohort registry analysis of 1161 patients with ST-elevation myocardial infarction under primary PCI. According to inclusion criteria, 838 patients were allocated for analysis. Patients with RDW levels of 13.6% or higher were considered as high RDW group (third tertile). All the individuals were followed up for in-hospital and 6-month mortality along with readmission and composite major adverse cardiac events.Results:In-hospital deaths occurred in 53 (6.3%) patients and at 6-month follow-up 79 (9.4%) cases of mortality were documented. In-hospital and 6-month mortalities showed a significant trend in favor of high RDW group (13.3% vs. 5.9%,P= 0.003; 19.7% vs. 7.9%,P< 0.001, respectively). Multivariate analysis showed that high RDW was significantly and independently associated with higher rates of 6-month mortality (hazard ratio: 2.909; 95% confidence interval: 1.166–7.257;P= 0.022). RDW was also a significant predictor for 6-month mortality independent of anemia (hazard ratio: 2.811; 95% confidence interval: 1.047–7.551;P= 0.040).Conclusions:We found a significant association between high RDW and in-hospital and 6-month mortality as well as the occurrence of major adverse cardiac event. Meanwhile RDW was found to be a significant predictor for 6-month mortality independent of anemia. Thus, it would be beneficial to use RDW as a risk stratification index to identify high risk intent-to-treat patients.
Association of Early Stress Testing with Outcomes for Emergency Department Evaluation of Suspected Acute Coronary Syndrome
Authors: Sun Benjamin C. , Laurie Amber , Fu Rongwei , Ferencik Maros , Shapiro Michael , Lindsell Christopher J. , Diercks Deborah , Hoekstra James W. , Hollander Judd E. , Kirk J. Douglas , Peacock W. Frank , Gibler W. Brian , Anantharaman Venkataraman , Pollack Charles V. 
Published: May 2016

Background:
Professional society guidelines suggest early stress testing (within 72 hours) after an emergency department (ED) evaluation for suspected acute coronary syndrome (ACS). However, there is increasing concern that current practice results in over-testing without evidence of benefit. We test the hypothesis that early stress testing improves outcomes.

Methods:
We analyzed prospectively collected data from 9 EDs on patients with suspected ACS, 1999–2001. We excluded patients with an ED diagnosis of ACS. The primary outcome was 30-day major adverse cardiac events (MACEs), including all-cause death, acute myocardial infarction, and revascularization. We used the HEART score to determine pretest ACS risk (low, intermediate, and high). To mitigate potential confounding, patients with and without early stress testing were matched within pretest risk strata in a 1:2 ratio using propensity scores.

Results:
Of 7127 potentially eligible patients, 895 (13%) received early stress testing. The analytic cohort included 895 patients with early stress testing matched to 1790 without early stress testing. The overall 30-day MACE rate in both the source and analytic population was 3%. There were no baseline imbalances after propensity score matching (P > 0.1 for more than 30 variables). There was no association between early stress testing and 30-day MACE [odds ratio, 1.0; 95% confidence interval (CI), 0.6–1.7]. There was no effect modification by pretest risk (low: odds ratio, 1.0; 95% CI, 0.2–3.7; intermediate: 1.2; 95% CI, 0.6–2.6; high: 0.4; 95% CI, 0.1–1.6).

Conclusions:
Early stress testing is not associated with reduced MACE in patients evaluated for suspected ACS. Early stress testing may have limited value in populations with low MACE rate.
Utility of the Diamond-Forrester Classification in Stratifying Acute Chest Pain in an Academic Chest Pain Center
Authors: Hamburger Robert F. , Spertus John A. , Winchester David E. 
Published: May 2016

Background:
Because the Diamond–Forrester (DF) model is predictive of obstructive coronary artery disease (CAD), it is often used to risk stratify acute chest pain patients. We sought to further evaluate the clinical utility of the DF model within a chest pain evaluation center.

Methods:
Consecutive patients with chest pain and no known CAD or evidence of active ischemia were asked to participate in a prospective registry. Patients were classified based on cardiovascular risk factors, age, and DF classification. We compared data from the emergency department course, Duke Activity Status Index (DASI) and Seattle Angina Questionnaire (SAQ), hospitalization rates, and results of testing between patients with typical angina and all others. Multivariate logistic regression was also used to assess for predictors of CAD by computed tomography coronary angiography (CTCA) or positive exercise treadmill testing (ETT).

Results:
Among 209 patients, 163 had atypical/noncardiac and 46 had typical chest pain. The SAQ and DASI scores were lower in the typical chest pain group (indicating more severe impairment), which were not statistically significantly different. There were no significant differences in risk factors or the results of CTCA, ETT, or cardiac catheterization. In the regression analysis, SAQ score, DASI score, and DF classification were not predictive of CAD by CTCA. Worsening angina frequency scores on the SAQ were marginally associated with positive ETT (OR, 1.04; P=0.04).

Conclusion:
In a contemporary low-risk acute chest pain population, typical angina, as defined by the DF classification, was not predictive of CAD or useful for identifying patients with higher symptom burden.
Postgraduate Education in Quality Improvement Methods
Authors: Winchester David E. , Burkart Thomas A. , Choi Calvin Y. , McKillop Matthew S. , Beyth Rebecca J. , Dahm Phillipp 
Published: May 2016

Objective:
Training in quality improvement (QI) is a pillar of the next accreditation system of the Accreditation Committee on Graduate Medical Education and a growing expectation of physicians for maintenance of certification. Despite this, many postgraduate medical trainees are not receiving training in QI methods. We created the Fellows Applied Quality Training (FAQT) curriculum for cardiology fellows using both didactic and applied components with the goal of increasing confidence to participate in future QI projects.

Methods and Results:
Fellows completed didactic training from the Institute for Healthcare Improvement’s Open School and then designed and completed a project to improve quality of care or patient safety. Self-assessments were completed by the fellows before, during, and after the first year of the curriculum. The primary outcome for our curriculum was the median score reported by the fellows regarding their self-confidence to complete QI activities. Self-assessments were completed by 23 fellows. The majority of fellows (15 of 23, 65.2%) reported no prior formal QI training. Median score on baseline self-assessment was 3.0 (range, 1.85–4), which was significantly increased to 3.27 (range, 2.23–4; P = 0.004) on the final assessment. The distribution of scores reported by the fellows indicates that 30% were slightly confident at conducting QI activities on their own, which was reduced to 5% after completing the FAQT curriculum. An interim assessment was conducted after the fellows completed didactic training only; median scores were not different from the baseline (mean, 3.0; P = 0.51).

Conclusion:
After completion of the FAQT, cardiology fellows reported higher self-confidence to complete QI activities. The increase in self-confidence seemed to be limited to the applied component of the curriculum, with no significant change after the didactic component.
Prognostic Factors in Chest Pain Patients
Authors: Backus Barbra E. , Six A. Jacob , Doevendans Pieter A. , Kelder Johannes C. , Steyerberg Ewout W. , Vergouwe Yvonne 
Published: May 2016

Objectives:
Risk stratification for chest pain patients at the emergency department is recommended in several guidelines. The history, ECG, age, risk factors, and troponin (HEART) score is based on medical literature and expert opinion to estimate the risk of a major adverse cardiac event. We aimed to assess the predictive effects of the 5 HEART components and to compare performances of the original HEART score and a model based on regression analysis.

Methods:
We analyzed prospectively collected data from 2388 patients, of whom 407 (17%) had a major adverse cardiac event within 6 weeks (acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, significant stenosis with conservative treatment and death due to any cause).

Results:
Univariate regression analysis showed the same ordering of predictive effects as used in the HEART score. Based on multivariable logistic regression analysis, an adjusted score showed slightly better calibration and discrimination (c statistic HEART, 0.83, HEART-adj, 0.85). In comparison to HEART, HEART-adj proved in a decision curve analysis clinically useful for decision thresholds over 25%. Nevertheless, the original HEART classified patients better than HEART-adj (net reclassification improvement = 14.1%).

Conclusion:
The previously chosen weights of the 5 elements of the HEART score are supported by multivariable statistical analyses, although some improvement in calibration and discrimination is possible by adapting the score. The gain in clinical usefulness is relatively small and supports the use of either the original or adjusted HEART score in daily practice.
Collection of Patients' Disability Status by Healthcare Organizations: Patients' Perceptions and Attitudes
Authors: Morris Megan A. , Schliep Megan , Liesinger Juliette , Cameron Kenzie A. 
Published: May 2016

Abstract:Recent policies call for healthcare organizations to consistently document patients' disability status for the purpose of tracking the quality of care experienced by patients with disabilities. The purpose of the study was to explore patients' attitudes toward healthcare organizations collecting disability status. We surveyed a convenience sample of patients in three outpatient clinics, including primary care and rehabilitation clinics. A total of 303 patients participated; 49% self-identified as disabled, 59% were female and the mean age was 52 years. The majority of participants (88%) either agreed or strongly agreed that it is important for healthcare organizations to collect information about disabilities; 77% stated that they were comfortable or very comfortable with healthcare organizations collecting this information. By contrast, we found that almost a quarter of participants had concerns with front desk staff collecting disability status information. When we presented disability questions endorsed by the Health and Human Services Department, over a quarter of participants (28%) felt that the questions were not inclusive of all disability categories. Although patients are supportive of healthcare organizations collecting disability status information, concerns exist regarding how the information is collected and which categories are included, suggesting the need for continued development of evidence-based, patient-centered methods and questions.
Domperidone is Commonly Prescribed With QT-Interacting Drugs
Authors: Ehrenpreis Eli D. , Roginsky Grigory , Alexoff Aimee , Smith Dylan G. 
Published: May 2016

Introduction:
Domperidone, a peripheral D2 dopamine receptor antagonist, has efficacy for treatment of nausea, dyspepsia, and gastroparesis. Domperidone prolongs the QT interval (QTc), and may cause life-threatening arrhythmias.

Methods:
Electronic medical records for all patients receiving domperidone in the NorthShore University HealthSystem from January 1, 2008 to December 1, 2013 were reviewed. All concomitant medications were noted. The coadministration of QT-interacting medications was determined. Electrocardiogram (EKG) evaluation before and during domperidone therapy was noted. A query of the FDA Adverse Event Reporting System (FAERS) database was also performed. Individual reports from the FAERS Web site from January 2008 to June 2014 were downloaded and analyzed. The database was queried for all reports of adverse events with domperidone. Coadministration of QT-interacting medications was noted. Cardiac events that potentially were related to prolongation of the QTc were examined.

Results:
In total, 108 of 155 patients (69.7%) were coprescribed QT-interacting drugs along with domperidone. Fifty-nine of 155 patients (38.1%) underwent a baseline EKG and 9 (15.3%) had prolongation of the QTc at initiation. Forty patients (25.8%) had a follow-up EKG and 13 (32.5%) had prolongation of the QTc. All 13 were coprescribed QT-interacting medications. On the FAERS, 221 nonfatal cardiac events were reported in domperidone patients; of these, 162 (73.3%) occurred in patients receiving QT-interacting medications. Coprescription occurred in 53 of 151 deaths (35.1%) and in 16 of 61 cardiac arrests (26.2%).

Conclusions:
Coprescribing of QT-prolonging medications and inconsistent EKG monitoring occur in patients receiving domperidone, placing these patients at risk for arrhythmias.
Histologic Disease in Chinese Chronic Hepatitis B Patients With Low Viral Loads and Persistently Normal Alanine Aminotransferase Levels
Authors: Wang Hong , Ru Guo Qing , Yan Rong , Zhou Yin , Wang Ming Shan , Cheng Mei Juan 
Published: May 2016

Background/Aim:
We aimed to evaluate the histopathologic characteristics of HBeAg-negative chronic hepatitis B patients with low hepatitis B virus (HBV) DNA levels (<2000 IU/mL) and persistently normal ALT levels and to determine indicators of significant liver disease.

Methods:
We examined 102 consecutive subjects who underwent percutaneous liver biopsy. Significant predictors of liver disease (stage ≥2 fibrosis or stage 1 fibrosis plus grade ≥2 inflammation), including demographic, clinical, and laboratory variables, were evaluated by means of univariate and multivariate logistic regression analyses.

Results:
Among the patients, 75.5% (77/102) had grade 0-1 inflammation and 77.5% (79/102) had stage 0-1 fibrosis. However, 38.2% (39/102) had significant liver disease. There were no statistically significant differences in clinical parameters such as age, biochemical profile, HBV DNA levels, HBsAg levels, and platelet count between patients with significant and those with nonsignificant liver disease. Patients with significant liver disease had higher values of aspartate transferase-to-platelet ratio index (APRI) and FIB-4 index compared with those with nonsignificant liver disease (0.35±0.21 vs. 0.27±0.12, P=0.02; 1.58±0.97 vs. 1.13±0.54, P=0.009, respectively). The area under the receiver operating characteristic (AUROC) curve of APRI for identifying active liver histology was 0.64 (95% CI, 0.53-0.75; P=0.019); the cutoff value was 0.24 with a sensitivity of 74% and specificity of 55%. In comparison, FIB-4 had equal power (the AUROC was 0.66) in predicting active liver histology.

Conclusion:
Among patients presenting with low HBV DNA levels and normal ALT levels, about 38.2% had significant liver disease. Neither serum HBsAg nor HBV DNA levels correlate with liver histology. However, APRI≥0.24 might be considered an indicator of liver biopsy.