bluuebunny/crossref_metadata_2025_split huggingface dataset:
Precatheterization Use of P2Y
12
Inhibitors in Non‐ST‐Elevation Myocardial Infarction Patients Undergoing Early Cardiac Catheterization and In‐Hospital Coronary Artery Bypass Grafting: Insights From the National Cardiovascular Data Registry
®
Authors: Badri Marwan , Abdelbaky Amr , Li Shuang , Chiswell Karen , Wang Tracy Y. 
Published: September 2017

Background

Current guidelines recommend early P2Y
12
inhibitor administration in non‐
ST
‐elevation myocardial infarction, but it is unclear if precatheterization use is associated with longer delays to coronary artery bypass grafting (
CABG
) or higher risk of post‐
CABG
bleeding and transfusion. This study examines the patterns and outcomes of precatheterization P2Y
12
inhibitor use in non‐
ST
‐elevation myocardial infarction patients who undergo
CABG
.

Methods and Results

Retrospective analysis was done of 20 304 non‐
ST
‐elevation myocardial infarction patients in the
ACTION
(Acute Coronary Treatment and Intervention Outcomes Network) Registry (2009–2014) who underwent catheterization within 24 hours of admission and
CABG
during the index hospitalization. Using inverse probability‐weighted propensity adjustment, we compared time from catheterization to
CABG
, post‐
CABG
bleeding, and transfusion rates between patients who did and did not receive precatheterization P2Y
12
inhibitors. Among study patients, 32.9% received a precatheterization P2Y
12
inhibitor (of these, 2.2% were given ticagrelor and 3.7% prasugrel). Time from catheterization to
CABG
was longer among patients who received precatheterization P2Y
12
inhibitor (median 69.9 hours [25th, 75th percentiles 28.2, 115.8] versus 43.5 hours [21.0, 71.8],
P
<0.0001), longer for patients treated with prasugrel (median 114.4 hours [66.5, 155.5]) or ticagrelor (90.4 hours [48.7, 124.5]) compared with clopidogrel (69.3 [27.5, 114.6],
P
<0.0001). Precatheterization P2Y
12
inhibitor use was associated with a higher risk of post‐
CABG
major bleeding (75.7% versus 73.4%, adjusted odds ratio 1.33, 95% confidence interval 1.22‐1.45,
P
<0.0001) and transfusion (47.6% versus 35.7%, adjusted odds ratio 1.51, 95% confidence interval 1.41‐1.62,
P
<0001); these relationships did not differ among patients treated with clopidogrel, prasugrel, or ticagrelor.

Conclusions

Precatheterization P2Y
12
inhibitor use occurs commonly among non‐
ST
‐elevation myocardial infarction patients who undergo early catheterization and in‐hospital
CABG
. Despite longer delays to surgery, the majority of pretreated patients proceed to
CABG
<3 days postcatheterization. Precatheterization P2Y
12
inhibitor use is associated with higher risks of postoperative bleeding and transfusion.
Resistant Hypertension, Time‐Updated Blood Pressure Values and Renal Outcome in Type 2 Diabetes Mellitus
Authors: Viazzi Francesca , Piscitelli Pamela , Ceriello Antonio , Fioretto Paola , Giorda Carlo , Guida Pietro , Russo Giuseppina , De Cosmo Salvatore , Pontremoli Roberto ,   AMD‐Annals Study Group
Published: September 2017

Background

Apparent treatment resistant hypertension (
aTRH
) is highly prevalent in patients with type 2 diabetes mellitus (T2D) and entails worse cardiovascular prognosis. The impact of
aTRH
and long‐term achievement of recommended blood pressure (
BP
) values on renal outcome remains largely unknown. We assessed the role of
aTRH
and
BP
on the development of chronic kidney disease in patients with T2D and hypertension in real‐life clinical practice.

Methods and Results

Clinical records from a total of 29 923 patients with T2D and hypertension, with normal baseline estimated glomerular filtration rate and regular visits during a 4‐year follow‐up, were retrieved and analyzed. The association between time‐updated
BP
control (ie, 75% of visits with
BP
<140/90 mm Hg) and the occurrence of estimated glomerular filtration rate <60 and/or a reduction ≥30% from baseline was assessed. At baseline, 17% of patients had
aTRH
. Over the 4‐year follow‐up, 19% developed low estimated glomerular filtration rate and 12% an estimated glomerular filtration rate reduction ≥30% from baseline. Patients with
aTRH
showed an increased risk of developing both renal outcomes (adjusted odds ratio, 1.31 and 1.43;
P
<0.001 respectively), as compared with those with non‐
aTRH
. No association was found between
BP
control and renal outcomes in non‐
aTRH
, whereas in
aTRH
,
BP
control was associated with a 30% (
P
=0.036) greater risk of developing the renal end points.

Conclusions

ATRH
entails a worse renal prognosis in T2D with hypertension.
BP
control is not associated with a more‐favorable renal outcome in
aTRH
. The relationship between time‐updated
BP
and renal function seems to be J‐shaped, with optimal systolic BP values between 120 and 140 mm Hg.
The
D
ecisions,
I
nterventions, and
G
oals in Impla
N
table Cardioverter‐Def
I
brillator
T
herap
Y
(DIGNITY) Pilot Study
Authors: Kramer Daniel B. , Habtemariam Daniel , Adjei‐Poku Yaw , Samuel Michelle , Engorn Diane , Reynolds Matthew R. , Mitchell Susan L. 
Published: September 2017

Background

Implantable cardioverter‐defibrillators (
ICD
s) are commonly implanted in older patients, including those with multiple comorbidities. There are few prospective studies assessing the clinical course and end‐of‐life circumstances for these patients.

Methods and Results

We prospectively followed 51 patients with
ICD
s for up to 18 months to longitudinally assess in terms of (1) advance care planning, (2) health status, (3) healthcare utilization, and (4) end‐of‐life circumstances through quarterly phone interviews and electronic medical record review. The mean age was 71.1±8.3, 74.5% were men, and 19.6% were non‐white. Congestive heart failure was predominant (82.4%), as was chronic kidney disease (92%). At baseline, a total of 12% of subjects met criteria for major depression, and 78.4% met criteria for mild cognitive impairment. From this initial study cohort, 76% survived to 18 months and completed all follow‐up interviews, 18% died, and 19% withdrew or were lost to follow‐up. Though living will completion and healthcare proxy assignment were common (cumulative outcome at 18 months 88% and 98%, respectively), discussions of prognosis were uncommon (baseline, 9.8%; by 18 months, 22.7%), as were conversations regarding
ICD
deactivation (baseline, 15.7%; by 18 months, 25.5%). Five decedents with available data received shocks in the days immediately prior to death, including 3 of whom ultimately had their
ICD
s deactivated prior to death.

Conclusions

We demonstrated the feasibility of prospective enrollment and follow‐up of older, vulnerable
ICD
patients. Early findings suggest a high burden of cognitive and psychological impairment, poor communication with providers, and frequent shocks at the end of life. These findings will inform the design of a larger cohort study designed to further explore the experiences of living and dying with an
ICD
in this important patient population.
The Protective Effect of Middle Cerebral Artery Calcification on Symptomatic Middle Cerebral Artery Infarction
Authors: Baek Jang-Hyun , Yoo Joonsang , Song Dongbeom , Kim Young Dae , Nam Hyo Suk , Heo Ji Hoe 
Published: September 2017

Background and Purpose—
The presence of intracranial artery calcification is associated with an increased risk for stroke. However, calcified atherosclerotic plaques are also known to be less vulnerable to rupture. Given this discrepancy, we investigated whether the vulnerability of intracranial arterial atherosclerosis differed based on the presence or absence of calcification.

Methods—
We considered consecutive patients with acute stroke in the unilateral middle cerebral artery (MCA) territory. Patients with any stenotic MCAs were included in this study. Symptomatic MCA was defined as the occurrence of infarctions relevant to the stenotic MCA. The presence of calcification in the MCA was evaluated on noncontrast thin-section computed tomography images using a 3dimensional software package. Generalized estimating equations were used to compare the frequency of calcification between symptomatic and asymptomatic stenosis.

Results—

Of the 1066 MCAs examined in 533 patients, 645 MCAs were stenotic and were included in the study. Among the 645 stenotic MCAs, 406 MCAs (62.9%) were symptomatic. Calcification was observed in 36 MCAs (5.6%). Calcification in the MCA was more frequently observed in the asymptomatic group (7.9% versus 4.2%;
P
=0.032). On multivariable analysis, the presence of calcification in MCA atherosclerosis was less frequent in the symptomatic group (odds ratio, 0.46; 95% confidence interval, 0.23–0.92;
P
=0.027).

Conclusions—
This study showed that calcified atherosclerosis in the MCA was less frequently symptomatic.
Crisis in the Eurozone: Austerity and Economic Transformation
Authors: Gualerzi Davide 
Published: September 2017

The paper presents an interpretation of austerity that sheds light on the crisis in the Eurozone. It argues that austerity is a long-term policy rather than an ill-conceived short-term remedy. To go beyond the by now familiar criticisms of austerity, we need to examine the crisis in its totality. Especially important are the impediments to a strong recovery driven by market incentives. This might ultimately undermine the very existence of the common currency and the future of the European Union. JEL Classification: E2, O4, B5.
No ‘Emperor of Europe’
Authors: Oschema Klaus 
Published: September 2017

Recent research on the use of the notion of Europe during the Middle Ages has confirmed that the name of the continent only rarely acquired a political meaning, if at all, in this period. What is particularly surprising is the observation that several authors in the Latin world used expressions such as regnum Europae or regna Europae, especially in the Carolingian period, without elaboration. Hence, although Charlemagne has been praised as ‘father of Europe’ by one contemporary author, the idea of an ‘Emperor of Europe’ was never developed, with the exception of two brief notices in early medieval Irish annalistic compilations. Even during the High Middle Ages, when the name of the continent came to be more widely used in different contexts, only a small set of figures, historical as well as fictitious, were ascribed with the aspiration or quality of ruling all of Europe.  Towards the end of the Middle Ages, however, the notion of an ‘Emperor of Europe’ became more common in a particular context: Christian authors accused non-Christian rulers of Asian origin (Mongols, Turks) of seeking to subdue the entire continent. Latin authors, in turn, started to perceive Europe as being the home of Christendom.  This article demonstrates how those Christian authors accept a pluralistic order for their own continent (on a political level), and contrasts this with the quest for hegemonic rule that becomes a motive of polemic, which they ascribe to non-Christian rulers. Although their arguments do not lead to the explicit presentation of Europe as the ‘continent of freedom’, they do recognise and value the existence of a multitude of political entities which they contrast with a hegemonic and homogenous political role of ‘Asian tyrants’. In a broader perspective, these findings open insights into late medieval political thought that go beyond what we can learn from contemporary ‘political discussion’ in a more limited sense.
Assessment of venous thromboembolism treatment in patients with cancer on low molecular weight heparin, warfarin, and the direct oral anticoagulants
Authors: Uppuluri Ellen M , Burke Kelly R , Haaf Christina Mactal , Shapiro Nancy L 
Published: September 2017

Background Direct oral anticoagulants (DOACs) are not recommended for venous thromboembolism (VTE) treatment in patients with cancer because their safety and efficacy have not been compared to low molecular weight heparin (LMWH) in large trials. Routine anti-Xa monitoring in cancer patients on LMWH is also not recommended due to limited data correlating anti-Xa levels and outcomes. Objective Compare the safety and efficacy of DOACs to LMWH and warfarin and assess the relationship of anti-Xa monitoring and outcomes in patients with cancer taking LMWH in an urban university setting. Methods This retrospective, cohort study analyzed the recurrence of VTE and number of bleeding events in patients with cancer. Results There were 131 patients included in the analysis. There was no difference seen in the rate of recurrent VTEs between the LMWH, warfarin and DOAC groups (9.3%, 5.9%, 9.1%, p = 0.89). There was also no difference in the rate of bleeding between groups (10.5%, 14.7%, 9.1%, p = 0.576). There was an increased rate of mortality seen in the LMWH group (26.7% vs. 2.9% vs. 18.2%, p = 0.006). There was no difference seen in recurrent VTE (10.3% vs. 8.5%, p = 0.53) or bleeding (10.3% vs. 10.7%, p = 0.661) between the monitored and unmonitored LMWH patients. Conclusion Results of this analysis suggest DOACs may be as safe and effective as LMWH and warfarin for the treatment of VTE in patients with cancer, and there may be no clinical benefit to routine anti-Xa monitoring in patients on LMWH treatment. However, larger studies are needed to confirm these observations.
Pharmacy workload benchmarking: Establishing a health-system outpatient infusion productivity metric
Authors: Reichard Jeffrey S , Garbarz David M , Teachey Amanda L , Allgood Jonathan , Brown M Jay 
Published: September 2017

Background and objectives Current productivity assessment models lack the ability to measure the quality of pharmacy services through workload validation. The goal of our efforts was to create a model to more accurately assess workload at multiple outpatient infusion centers. Method Current procedural terminology codes were identified as representative of the key drivers of pharmacy workload. Fourteen current procedural terminology codes representing medication orders were selected and categorized into eight distinctive groups associated with varying amounts of pharmacy workload. A three-month average of current procedural terminology volumes were calculated and used to create a workload baseline. Results Our study found a usable productivity assessment and coefficient to compare relevant clinical workload across outpatient oncology sites. The current procedural terminology codes were readily retrievable from our system electronic medical record. By assigning activities, e.g. clinical review, verification, barcoding, batch preparation, we were able to compute a workload and then adjust staffing to achieve a median coefficient across sites. Discussion This study evaluated the use of administration current procedural terminology codes for an outpatient oncology productivity model. Based upon our analysis, it can be successfully used to determine workload for pharmacists and technicians across variable locations. We believe it is the first study to demonstrate a productivity model for this setting.
Parent participation in alcohol prevention
Authors: Adolfsen Frode , Strøm Henriette Kyrrestad , Martinussen Monica , Handegård Bjørn Helge , Natvig Henrik , Eisemann Martin , Koposov Roman 
Published: September 2017

Aim: The main purpose of this study was to evaluate the effectiveness of the parental part of the Norwegian Unge & Rus (Youth and Alcohol) programme. The intervention was aimed at changing parents’ rules and attitudes towards adolescent alcohol use, and their ability to talk with their adolescents about alcohol, as well as improving parents’ relationships with and knowledge about their adolescents. These topics were addressed during parent meetings at school. Method: The effectiveness of the parent programme was tested using a longitudinal quasi-experimental control group design. Parents completed four online questionnaires N = 1166 at T1 in 2011 and N = 591 at T4 in 2013. Mixed models with observations nested in individuals were used to test the difference in rates of change between the groups. Results: Parents in both groups reported strict rules and attitudes towards alcohol use. There were no significant differences in the changes between the two parent groups in terms of rules and attitudes at the three follow-up time points. The parents in the intervention did not change significantly compared to the parents in the comparison group on other alcohol-related questions. Conclusions: Parents are important facilitators for the transmission of alcohol-related attitudes and rules. However, our study did not show significant differences between changes experienced by the intervention group and those of the comparison group for the main outcome variables, such as rules, attitudes and talking about alcohol with their adolescents.
Flexible lateral isocenter: A novel mechanical functionality contributing to dose reduction in neurointerventional procedures
Authors: Borota Ljubisa , Patz Andreas 
Published: September 2017

Aim of the study A new functionality that enables vertical mobility of the lateral arm of a biplane angiographic machine is referred to as the flexible lateral isocenter. The aim of this study was to analyze the impact of the flexible lateral isocenter on the air-kerma rate under experimental conditions. Material and methods An anthropomorphic head-and-chest phantom with anteroposterior (AP) diameter of the chest varying from 22 cm to 30 cm simulated human bodies of different body constitutions. The angulation of the AP arm in the sagittal plane varied from 35 degrees to 55 degrees for each AP diameter. The air-kerma rate (mGy/min) values were read from the system dose display in two settings for each angle: flexible lateral isocenter and fixed lateral isocenter. Results The air-kerma rate was significantly lower for all AP diameters of the chest of the phantom when the flexible lateral isocenter was used: (a) For 22 cm, the p value was 0.028; (b) For 25 cm, the p value was 0.0169; (c) For 28 cm, the p value was 0.01005 and (d) For 30 cm, the p value was 0.01703. Conclusion Our results show that the flexible lateral isocenter contributes significantly to the reduction of the air-kerma rate, and thus to a safer environment in terms of dose lowering both for patients and staff.
Influence of carotid tortuosity on internal carotid artery access time in the treatment of acute ischemic stroke
Authors: Kaymaz ZO , Nikoubashman O , Brockmann MA , Wiesmann M , Brockmann C 
Published: September 2017

Purpose Carotid artery anatomy is thought to influence internal carotid artery access time (ICA-AT) in patients requiring mechanical thrombectomy for acute ischemic stroke. This study investigates the association between ICA-AT and carotid anatomy. Material and methods Computed tomography angiography (CTA) data of 76 consecutive patients presenting with acute ischemic stroke requiring mechanical thrombectomy for middle cerebral artery or carotid T occlusion were evaluated. The supraaortic extracranial vasculature was analyzed regarding take-off angles and curvature of the affected side. Digital subtraction angiography data were primarily analyzed regarding ICA-AT and secondarily regarding recanalization time and radiographic result. Results ICA-AT was significantly influenced by vessel tortuosity. Take-off angle of the left common carotid artery ( p = 0.001) and the brachiocephalic trunk ( p = 0.002) as well as the tortuosity of the common carotid artery ( p = 0.002) had highest impact on ICA-AT. For recanalization time, however, we found only the take-off angle of the left common carotid artery to be of significance ( p = 0.020). There was a tendency for ICA-AT to correlate with successful (mTICI ≥ 2 b) revascularization (average time of successful results was 24.3 minutes, of unsuccessful was 35.6 minutes; p = 0.065). Every evaluated segment with less carotid tortuosity showed a carotid AT below 25 minutes. Conclusion Supraaortic vessel tortuosity significantly influences ICA-AT in mechanical thrombectomy for an acute large vessel. There furthermore was a trend for lower successful recanalization rates with increasing ICA-AT.
The genetics of multiple sclerosis in Latin America
Authors: Rivas Alonso Verónica , Flores Rivera José de Jesús , Rito García Yamel , Corona Teresa 
Published: September 2017

Background In today’s globalised world, the heterogeneity of diseases such as multiple sclerosis has been studied since it has been suggested that ethnic differences, in conjunction with geographical and environmental factors, influence its incidence and prevalence. Aim Based on this, an attempt has been made to identify the genetic factors that may confer risk or protection, not only for developing multiple sclerosis but also for determining the course of its evolution. Results In Latin America we have some data about this, which have been replicated in different populations in the entire region, with very different results compared with other regions, which could explain not only the different frequencies in some populations, such as Caucasians, but also the course of the disease and the response to actual treatments. However, in addition to these findings, other associated epigenetic mechanisms have also been found in our populations, such as levels of vitamin D, parasitic diseases, and indigenous populations. Therefore, the study of epigenetics plays a crucial role in understanding the physiopathology of multiple sclerosis. It must be studied in each population, especially in Latin America, due to its broad heterogeneity. Conclusion It is very important to understand not only the genetic and external factors with these very specific effects in multiple sclerosis patients, but also the way they interact and are able to explain the frequency and some specific phenotypes of the disease in our populations besides the posibility to be a very specific treatment target.
Translation, Cross-Cultural Adaptation, and Validation of the Activity Rating Scale for Disorders of the Knee
Authors: Flosadottir Vala , Roos Ewa M. , Ageberg Eva 
Published: September 2017

Background: The Activity Rating Scale (ARS) for disorders of the knee evaluates the level of activity by the frequency of participation in 4 separate activities with high demands on knee function, with a score ranging from 0 (none) to 16 (pivoting activities 4 times/wk). Purpose: To translate and cross-culturally adapt the ARS into Swedish and to assess measurement properties of the Swedish version of the ARS. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The COSMIN guidelines were followed. Participants (N = 100 [55 women]; mean age, 27 years) who were undergoing rehabilitation for a knee injury completed the ARS twice for test-retest reliability. The Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale (TAS), and modernized Saltin-Grimby Physical Activity Level Scale (SGPALS) were administered at baseline to validate the ARS. Construct validity and responsiveness of the ARS were evaluated by testing predefined hypotheses regarding correlations between the ARS, KOOS, TAS, and SGPALS. The Cronbach alpha, intraclass correlation coefficients, absolute reliability, standard error of measurement, smallest detectable change, and Spearman rank-order correlation coefficients were calculated. Results: The ARS showed good internal consistency (α ≈ 0.96), good test-retest reliability (intraclass correlation coefficient >0.9), and no systematic bias between measurements. The standard error of measurement was less than 2 points, and the smallest detectable change was less than 1 point at the group level and less than 5 points at the individual level. More than 75% of the hypotheses were confirmed, indicating good construct validity and good responsiveness of the ARS. Conclusion: The Swedish version of the ARS is valid, reliable, and responsive for evaluating the level of activity based on the frequency of participation in high-demand knee sports activities in young adults with a knee injury.