bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of order set design on urine culturing practices at an academic medical centre emergency department
Authors: Munigala Satish , Jackups Ronald R , Poirier Robert F , Liang Stephen Y , Wood Helen , Jafarzadeh S Reza , Warren David K 
Published: January 2018

BackgroundUrinalysis and urine culture are commonly ordered tests in the emergency department (ED). We evaluated the impact of removal of order sets from the ‘frequently ordered test’ in the computerised physician order entry system (CPOE) on urine testing practices.MethodsWe conducted a before (1 September to 20 October 2015) and after (21 October to 30 November 2015) study of ED patients. The intervention consisted of retaining ‘urinalysis with reflex to microscopy’ as the only urine test in a highly accessible list of frequently ordered tests in the CPOE system. All other urine tests required use of additional order screens via additional mouse clicks. The frequency of urine testing before and after the intervention was compared, adjusting for temporal trends.ResultsDuring the study period, 6499 (28.2%) of 22 948 ED patients had ≥1 urine test ordered. Urine testing rates for all ED patients decreased in the post intervention period for urinalysis (291.5 pre intervention vs 278.4 per 1000 ED visits post intervention, P=0.03), urine microscopy (196.5vs179.5, P=0.001) and urine culture (54.3vs29.7, P<0.001). When adjusted for temporal trends, the daily culture rate per 1000 ED visits decreased by 46.6% (−46.6%, 95% CI −66.2% to –15.6%), but urinalysis (0.4%, 95% CI −30.1 to 44.4%), microscopy (−6.5%, 95% CI −36.0% to 36.6%) and catheterised urine culture rates (17.9%, 95% CI −16.9 to 67.4) were unchanged.ConclusionsA simple intervention of retaining only ‘urinalysis with reflex to microscopy’ and removing all other urine tests from the ‘frequently ordered’ window of the ED electronic order set decreased urine cultures ordered by 46.6% after accounting for temporal trends. Given the injudicious use of antimicrobial therapy for asymptomatic bacteriuria, findings from our study suggest that proper design of electronic order sets plays a vital role in reducing excessive ordering of urine cultures.
Psychiatric symptoms in preclinical behavioural-variant frontotemporal dementia inMAPTmutation carriers
Authors: Cheran Gayathri , Silverman Hannah , Manoochehri Masood , Goldman Jill , Lee Seonjoo , Wu Liwen , Cines Sarah , Fallon Emer , Kelly Brendan Desmond , Olszewska Diana Angelika , Heidebrink Judith , Shair Sarah , Campbell Stephen , Paulson Henry , Lynch Timothy , Cosentino Stephanie , Huey Edward D 
Published: January 2018

ObjectiveTo characterise psychiatric symptoms in preclinical and early behavioural-variant frontotemporal dementia (bvFTD), a neurodegenerative disorder whose symptoms overlap with and are often mistaken for psychiatric illness.MethodsThe present study reports findings from a systematic, global, prospective evaluation of psychiatric symptoms in 12 preclinical carriers of pathogenicMAPTmutations, not yet meeting bvFTD diagnostic criteria, and 46 familial non-carrier controls. Current psychiatric symptoms, informant-reported symptoms and lifetime prevalence of psychiatric disorders were assessed with The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the Neuropsychiatric Inventory Questionnaire. Fisher exact test was used to compare carriers and non-carriers’ lifetime prevalence of six DSM-IV disorders: major depressive disorder, panic attacks, alcohol abuse, generalised anxiety disorder, panic disorder, and depressive disorder not otherwise specified. Other DSM-IV disorders had insufficient prevalence across our sample for between-group comparisons, but are reported.ResultsNon-carriers had greater prevalence of mood and anxiety disorders than has been reported for a general reference population. Preclinical carriers had lower lifetime prevalence of mood and anxiety disorders than non-carriers, except for depressive disorder not otherwise specified, an atypical syndrome comprising clinically significant depressive symptoms which fail to meet criteria for major depressive disorder.ConclusionFindings suggest that early psychiatric symptoms of emergent bvFTD may manifest as emotional blunting or mood changes not cleanly conforming to criteria for a DSM-defined mood disorder.
Increased blood pressure variability after endovascular thrombectomy for acute stroke is associated with worse clinical outcome
Authors: Bennett Alicia E , Wilder Michael J , McNally J Scott , Wold Jana J , Stoddard Gregory J , Majersik Jennifer J , Ansari Safdar , de Havenon Adam 
Published: January 2018

Background and purposeBlood pressure variability has been found to contribute to worse outcomes after intravenous tissue plasminogen activator, but the association has not been established after intra-arterial therapies.MethodsWe retrospectively reviewed patients with an ischemic stroke treated with intra-arterial therapies from 2005 to 2015. Blood pressure variability was measured as standard deviation (SD), coefficient of variation (CV), and successive variation (SV). Ordinal logistic regression models were fitted to the outcome of the modified Rankin Scale (mRS) with univariable predictors of systolic blood pressure variability. Multivariable ordinal logistic regression models were fitted to the outcome of mRS with covariates that showed independent predictive ability (P<0.1).ResultsThere were 182 patients of mean age 63.2 years and 51.7% were female. The median admission National Institutes of Health Stroke Scalescore was 16 and 47.3% were treated with intravenous tissue plasminogen activator. In a univariable ordinal logistic regression analysis, systolic SD, CV, and SV were all significantly associated with a 1-point increase in the follow-up mRS (OR 2.30–4.38, all P<0.002). After adjusting for potential confounders, systolic SV was the best predictor of a 1-point increase in mRS at follow-up (OR 2.63–3.23, all P<0.007).ConclusionsIncreased blood pressure variability as measured by the SD, CV, and SV consistently predict worse neurologic outcomes as measured by follow-up mRS in patients with ischemic stroke treated with intra-arterial therapies. The SV is the strongest and most consistent predictor of worse outcomes at all time intervals.
Concomitant conus medullaris arteriovenous shunts and sacral dural arteriovenous fistulas: pathophysiological links related to the venous drainage of the lesions in a series of five cases
Authors: Rosi Andrea , Consoli Arturo , Condette-Auliac Stéphanie , Coskun Oguzhan , Di Maria Federico , Rodesch Georges 
Published: January 2018

BackgroundSpinal cord arteriovenous shunts (scAVSs) are a group of lesions located in the spinal cord itself or in the surrounding structures. The most common scAVSs are spinal dural arteriovenous fistulas (sDAVFs), which are acquired lesions. The pathogenesis of sDAVFs involves thrombosis and venous hypertension as trigger factors. Intradural scAVSs such as spinal cord arteriovenous nidus type malformations (AVMs) and pial arteriovenous fistulas are less common than sDAVFs and are considered to have a so-called ‘congenital’ origin. The association between different concomitant scAVSs is very rare and the association of sDAVFs with intradural scAVSs has been described in only a few case reports.MethodsWe describe a case series of five patients presenting with a conus medullaris AVS associated with a lower lumbar or sacral DAVF.ResultsThree of our patients were <30 years old at presentation. In four of these five cases the intradural scAVS drained caudally, engorging the epidural plexus in the same location as the sDAVF. In only one case, who presented with thrombosis of the drainage of the main compartment of a conus medullaris pial AVF, was the location of the DAVF opposite to the location of the residual drainage.ConclusionWe discuss the pathophysiological link between scAVS and sDAVF on the basis of the rarity of the DAVF, the uncommon association between scAVS and sDAVF, the presence of sDAVF in young patients, and the venous hypertension created by the venous drainage towards the sacral area responsible for angiogenesis creating the dural shunt.
What to do about fibrin rich ‘tough clots’? Comparing the Solitaire stent retriever with a novel geometric clot extractor in an in vitro stroke model
Authors: Fennell Vernard S , Setlur Nagesh Swetadri Vasan , Meess Karen M , Gutierrez Liza , James Rhys H , Springer Michael E , Siddiqui Adnan H 
Published: January 2018

BackgroundDespite advances in revascularization tools for large vessel occlusion presenting as acute ischemic stroke, a significant subset of clots remain recalcitrant to current strategies. We assessed the effectiveness of a novel thrombectomy device that was specifically designed to retrieve resistant fibrin rich clots, the geometric clot extractor (GCE; Neuravi, Galway, Ireland), in an in vitro cerebrovascular occlusion stroke model.MethodsAfter introducing fibrin rich clot analogues into the middle cerebral artery of the model, we compared the rates of recanalization between GCE and Solitaire flow restoration stent retriever (SR; Medtronic, Minneapolis, Minnesota, USA; control group) cases. A maximum of three passes of each device was allowed. If the SR failed to recanalize the vessel after three passes, one pass of the GCE was allowed (rescue cases).ResultsIn a total of 26 thrombectomy cases (13 GCE, 13 SR), successful recanalization (Thrombolysis in Cerebral Infarction score of 2b or 3) was achieved 100% of the time in the GCE cases with an average of 2.13 passes per case. This rate was significantly higher compared with the Solitaire recanalization rate (7.7%, P<0.0001) with an average of three passes per case. After SR failure (in 92% of cases), successful one pass GCE rescue recanalization was achieved 66% of the time (P<0.005).ConclusionApplication of the GCE in this experimental stroke model to retrieve typically recalcitrant fibrin rich clots resulted in higher successful recanalization rates than the SR.
The 100 most cited articles in the endovascular management of intracranial aneurysms
Authors: Maingard Julian , Phan Kevin , Ren Yifan , Kok Hong Kuan , Thijs Vincent , Hirsch Joshua A , Lee Michael J , Chandra Ronil V , Brooks Duncan Mark , Asadi Hamed 
Published: January 2018

IntroductionEndovascular interventions for intracranial aneurysms have evolved substantially over the past several decades. A citation rank list is used to measure the scientific and/or clinical impact of an article. Our objective was to identify and analyze the characteristics of the 100 most cited articles in the field of endovascular therapy for intracranial aneurysms.MethodsWe performed a retrospective bibliometric analysis between July and August 2017. Articles were searched on the Science Citation Index Expanded database using Web of Science in order to identify the most cited articles in the endovascular therapy of intracranial aneurysms since 1945. Using selected key terms (‘intracranial aneurysm’, ‘aneurysm’, ‘aneurysmal subarachnoid’, ‘endovascular’, ‘coiling’, ‘stent-assisted’, ‘balloon-assisted’, ‘flow-diversion’) yielded a total of 16 314 articles. The top 100 articles were identified and analyzed to extract relevant information, including citation count, authorship, article type, subject matter, institution, country of origin, and year of publication.ResultsCitations for the top 100 articles ranged from 133 to 1832. All articles were cited an average of 27 times per year. There were 45 prospective studies, including 7 level–II randomized controlled trials. Most articles were published in the 2000s (n=53), and the majority constituted level III or level IV evidence. Half of the top 100 articles arose from the USA.ConclusionThis study provides a comprehensive overview of the most cited articles in the endovascular management of intracranial aneurysms. It recognizes the contributions made by key authors and institutions, providing an important framework to an enhanced understanding of the evidence behind the endovascular treatment of aneurysms.
Are changes in objective working hour characteristics associated with changes in work-life conflict among hospital employees working shifts? A 7-year follow-up
Authors: Karhula Kati , Koskinen Aki , Ojajärvi Anneli , Ropponen Annina , Puttonen Sampsa , Kivimäki Mika , Härmä Mikko 
Published: January 2018

ObjectiveTo investigate whether changes in objective working hour characteristics are associated with parallel changes in work-life conflict (WLC) among hospital employees.MethodsSurvey responses from three waves of the Finnish Public Sector study (2008, 2012 and 2015) were combined with payroll data from 91 days preceding the surveys (n=2 482, 93% women). Time-dependent fixed effects regression models adjusted for marital status, number of children and stressfulness of the life situation were used to investigate whether changes in working hour characteristics were associated with parallel change in WLC. The working hour characteristics were dichotomised with cut-points in less than or greater than 10% or less than or greater than25% occurrence) and WLC to frequent versus seldom/none.ResultsChange in proportion of evening and night shifts and weekend work was significantly associated with parallel change in WLC (adjusted OR 2.19, 95% CI 1.62 to 2.96; OR 1.71, 95% CI 1.21 to 2.44; OR 1.63, 95% CI 1.194 to 2.22, respectively). Similarly, increase or decrease in proportion of quick returns (adjusted OR 1.45, 95% CI 1.10 to 1.89) and long work weeks (adjusted OR 1.26, 95% CI 1.04 to 1.52) was associated with parallel increase or decrease in WLC. Single days off and very long work weeks showed no association with WLC.ConclusionsChanges in unsocial working hour characteristics, especially in connection with evening shifts, are consistently associated with parallel changes in WLC.
Comparison of Single-Incision Laparoscopic Cholecystectomy versus Needlescopic Cholecystectomy: A Single Institutional Randomized Clinical Trial
Authors: Umemura Akira , Suto Takayuki , Nakamura Seika , Fujiwara Hisataka , Endo Fumitaka , Nitta Hiroyuki , Takahara Takeshi , Sasaki Akira 
Published: January 2018

<b><i>Background:</i></b> Both single-incision laparoscopic cholecystectomy (SILC) and needlescopic cholecystectomy (NSC) are superior to conventional laparoscopic cholecystectomy in terms of cosmetic outcome and incisional pain. We conducted a prospective, randomized clinical trial to evaluate the surgical outcome, postoperative pain, and cosmetic outcome for SILC and NSC procedures. <b><i>Methods:</i></b> In this trial, 105 patients were enrolled (52 in the SILC group; 53 in the NSC group). A visual analogue scale (VAS) was used to evaluate the cosmetic outcome and incisional pain for patients. Logistic regression analyses were used to evaluate the operative difficulty that was present for both procedures. <b><i>Results:</i></b> There were no significant differences in patient characteristics or surgical outcomes, including operative time and blood loss. The mean VAS scores for cosmetic satisfaction were similar in both groups. There were significant differences in the mean VAS scores for incisional pain on postoperative day 1 (<i>p</i> = 0.009), and analgesics were required within 12 h of surgery (<i>p</i> = 0.007). Obesity (body mass index ≥25 kg/m<sup>2</sup>) was the only significant influential factor for operating time over 100 min (<i>p</i> = 0.031). <b><i>Conclusion:</i></b> NSC is superior to SILC in terms of short-term incisional pain. Experienced laparoscopic surgeons can perform both SILC and NSC without an increase in operative time.
Inhibition of Endothelial Notch Signaling Impairs Fatty Acid Transport and Leads to Metabolic and Vascular Remodeling of the Adult Heart
Authors: Jabs Markus , Rose Adam J. , Lehmann Lorenz H. , Taylor Jacqueline , Moll Iris , Sijmonsma Tjeerd P. , Herberich Stefanie E. , Sauer Sven W. , Poschet Gernot , Federico Giuseppina , Mogler Carolin , Weis Eva-Maria , Augustin Hellmut G. , Yan Minhong , Gretz Norbert , Schmid Roland M. , Adams Ralf H. , Gröne Hermann-Joseph , Hell Rüdiger , Okun Jürgen G. , Backs Johannes , Nawroth Peter P. , Herzig Stephan , Fischer Andreas 
Published: January 2018

Background:
Nutrients are transported through endothelial cells before being metabolized in muscle cells. However, little is known about the regulation of endothelial transport processes. Notch signaling is a critical regulator of metabolism and angiogenesis during development. Here, we studied how genetic and pharmacological manipulation of endothelial Notch signaling in adult mice affects endothelial fatty acid transport, cardiac angiogenesis, and heart function.

Methods:
Endothelial-specific Notch inhibition was achieved by conditional genetic inactivation of Rbp-jκ in adult mice to analyze fatty acid metabolism and heart function. Wild-type mice were treated with neutralizing antibodies against the Notch ligand Delta-like 4. Fatty acid transport was studied in cultured endothelial cells and transgenic mice.

Results:
Treatment of wild-type mice with Delta-like 4 neutralizing antibodies for 8 weeks impaired fractional shortening and ejection fraction in the majority of mice. Inhibition of Notch signaling specifically in the endothelium of adult mice by genetic ablation of Rbp-jκ caused heart hypertrophy and failure. Impaired heart function was preceded by alterations in fatty acid metabolism and an increase in cardiac blood vessel density. Endothelial Notch signaling controlled the expression of endothelial lipase, Angptl4, CD36, and Fabp4, which are all needed for fatty acid transport across the vessel wall. In endothelial-specific Rbp-jκ–mutant mice, lipase activity and transendothelial transport of long-chain fatty acids to muscle cells were impaired. In turn, lipids accumulated in the plasma and liver. The attenuated supply of cardiomyocytes with long-chain fatty acids was accompanied by higher glucose uptake, increased concentration of glycolysis intermediates, and mTOR-S6K signaling. Treatment with the mTOR inhibitor rapamycin or displacing glucose as cardiac substrate by feeding a ketogenic diet prolonged the survival of endothelial-specific Rbp-jκ–deficient mice.

Conclusions:
This study identifies Notch signaling as a novel regulator of fatty acid transport across the endothelium and as an essential repressor of angiogenesis in the adult heart. The data imply that the endothelium controls cardiomyocyte metabolism and function.
D-Dimer Predicts Long-Term Cause-Specific Mortality, Cardiovascular Events, and Cancer in Patients With Stable Coronary Heart Disease
Authors: Simes John , Robledo Kristy P. , White Harvey D. , Espinoza David , Stewart Ralph A. , Sullivan David R. , Zeller Tanja , Hague Wendy , Nestel Paul J. , Glasziou Paul P. , Keech Anthony C. , Elliott John , Blankenberg Stefan , Tonkin Andrew M. ,   For the LIPID Study Investigators
Published: January 2018

Background:
D-dimer, a degradation product of cross-linked fibrin, is a marker for hypercoagulability and thrombotic events. Moderately elevated levels of D-dimer are associated with the risk of venous and arterial events in patients with vascular disease. We assessed the role of D-dimer levels in predicting long-term vascular outcomes, cause-specific mortality, and new cancers in the LIPID trial (Long-Term Intervention with Pravastatin in Ischaemic Disease) in the context of other risk factors.

Methods:
LIPID randomized patients to placebo or pravastatin 40 mg/d 5 to 38 months after myocardial infarction or unstable angina. D-dimer levels were measured at baseline and at 1 year. Median follow-up was 6.0 years during the trial and 16 years in total.

Results:

Baseline D-dimer levels for 7863 patients were grouped by quartile (≤112, 112–173, 173–273, >273 ng/mL). Higher levels were associated with older age, female sex, history of hypertension, poor renal function, and elevated levels of B-natriuretic peptide, high-sensitivity C-reactive protein, and sensitive troponin I (each
P
<0.001). During the first 6 years, after adjustment for up to 30 additional risk factors, higher D-dimer was associated with a significantly increased risk of a major coronary event (quartile 4 versus 1: hazard ratio [HR], 1.45; 95% confidence interval, 1.21–1.74), major cardiovascular disease (CVD) event (HR, 1.45; 95% confidence interval, 1.23–1.71) and venous thromboembolism (HR, 4.03; 95% confidence interval, 2.31–7.03; each
P
<0.001). During the 16 years overall, higher D-dimer was an independent predictor of all-cause mortality (HR, 1.59), CVD mortality (HR, 1.61), cancer mortality (HR, 1.54), and non-CVD noncancer mortality (HR, 1.57; each
P
<0.001), remaining significant for deaths resulting from each cause occurring beyond 10 years of follow-up (each
P
≤0.01). Higher D-dimer also independently predicted an increase in cancer incidence (HR, 1.16;
P
=0.02).The D-dimer level increased the net reclassification index for all-cause mortality by 4.0 and venous thromboembolism by 13.6.

Conclusions:
D-dimer levels predict long-term risk of arterial and venous events, CVD mortality, and non-CVD noncancer mortality independent of other risk factors. D-dimer is also a significant predictor of cancer incidence and mortality. These results support an association of D-dimer with fatal events across multiple diseases and demonstrate that this link extends beyond 10 years’ follow-up.
Excessive Daytime Sleepiness Independently Predicts Increased Cardiovascular Risk After Myocardial Infarction
Authors: Xie Jiang , Sert Kuniyoshi Fatima H. , Covassin Naima , Singh Prachi , Gami Apoor S. , Chahal C. Anwar A. , Somers Virend K. 
Published: January 2018

Background

Excessive daytime sleepiness (
EDS
), a common symptom among patients with sleep‐disordered breathing, is closely associated with the development of cardiovascular diseases, but its long‐term prognostic value is not completely understood. The aim of this study was to investigate whether
EDS
would be an independent prognostic factor after myocardial infarction.

Methods and Results

We prospectively recruited 112 post–myocardial infarction patients. The Epworth Sleepiness Scale was completed before polysomnography, and
EDS
was defined as a score ≥11. After exclusion of 8 patients who accepted treatment with continuous positive airway pressure, 104 patients were followed up for 48 months. The primary composite end point was major adverse cardiac events. Patients with
EDS
had higher rates of major adverse cardiac events (48.4% versus 27.4%, χ
2
=5.27,
P
=0.022) and reinfarction (29.0% versus 5.5%, χ
2
=13.51,
P
=0.0002) compared with those without
EDS
. In the Cox proportional hazards model, patients with
EDS
had 2.15 times (95% confidence interval, 1.08–4.18;
P
=0.030) higher crude risk of major adverse cardiac events, with prognostic significance persisting after adjusting for age, diabetes mellitus, depression, left ventricular ejection fraction, apnea–hypopnea index, and nocturnal nadir oxygen saturation (hazard ratio: 2.13, 95% confidence interval, 1.04–4.26,
P
=0.039). Furthermore, among participants with moderate to severe sleep‐disordered breathing, the presence of
EDS
was associated with higher risk of major adverse cardiac events than those without
EDS
, after adjusting for age and nadir oxygen saturation (hazard ratio: 3.17, 95% confidence interval, 1.22–7.76,
P
=0.019).

Conclusions

EDS
may be an independent prognostic factor of adverse outcome in post–myocardial infarction patients with moderate to severe sleep‐disordered breathing. Evaluation of
EDS
may shed new light on risk stratification and identify treatment responders for this patient population.