bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac Rehabilitation
Authors: Astley Carolyn M. , Neubeck Lis , Gallagher Robyn , Berry Narelle , Du Huiyun , Hill Martha N. , Clark Robyn A. 
Published: April 2016

Background:
Evidence-based guidelines recommend strategies for reducing risk factors for secondary prevention of acute coronary syndromes, yet referral to and completion of programs to deliver this advice are poor.

Purpose:
In this article we describe the complexity of factors that influence referral and delivery of evidence-based cardiac rehabilitation (CR) programs through an Australian context and provide direction for solutions for clinicians and policy makers to consider. The Ecological Approach is used as a framework to synthesize evidence. The approach has 5 categories, the characteristics of which may act as barriers and enablers to the promotion and adoption of health behaviors and includes (a) interpersonal factors, (b) interpersonal factors, (c) institutional factors, (d) community networks, and (e) public policy.

Conclusions:
Despite the context of strong evidence for efficacy, this review highlights systematic flaws in the implementation of CR, an important intervention that has been shown to improve patient outcomes and prevent cardiac events. Recommendations from this review include standardization of program delivery, improvement of data capture, use of technological innovations and social networks to facilitate delivery of information and support, and establishment of a cohesive, consistent message through interorganizational collaboration involved in CR.

Clinical Implications:
These avenues provide direction for potential solutions to improve the uptake of CR and secondary prevention.
The Revised Index for Social Engagement in Long-Term Care Facilities: A Psychometric Study
Authors: Yoon Ju Young , Kim Hongsoo 
Published: April 2016

ABSTRACT

Background:
Social engagement is known to be an important factor that affects the quality of life and the psychological well-being of residents in long-term care settings. Few studies have examined social engagement in long-term care facilities in non-Western countries.

Purpose:
This study aimed to evaluate the validity and reliability of the revised index for social engagement (RISE), which was derived from the Korean version of the interRAI Long Term Care Facilities instrument.

Methods:
Three hundred fourteen older adults from 10 nursing homes in Korea were included in the study. Convergent and discriminant validities were tested using correlation analysis and t tests, respectively. Factor analysis was adopted to examine the factor structure. The reliability of the RISE was tested using Cronbach’s alpha values for internal consistency, and interrater reliability was tested using item kappa values and intraclass correlation coefficients.

Results:
The RISE showed excellent convergent validity with the average time involved in activities (r = .58). The known-group comparison showed a significant difference in the means of RISE between the group with cognitive impairment and the group without cognitive impairment, indicating satisfactory discriminant validity. Factor analysis showed a good model fit for two factors in the RISE: group involvement and interaction with others. The RISE showed satisfactory internal consistency (α ≥ .70) and adequate interrater reliability (≥.40).

Conclusions/Implications for Practice:
The RISE is a valid and reliable tool for measuring the social engagement of nursing home residents in Korea. Furthermore, this tool may be a useful instrument for assessing older ethnic Korean residents who reside in nursing homes that are located outside Korea.
Can Routine Histopathology Distinguish Between Vulvar Cutaneous Candidosis and Dermatophytosis?
Authors: Day Tania , Borbolla Foster Ailsa , Phillips Samuel , Pagano Ross , Dyall-Smith Delwyn , Scurry James , Garland Suzanne M. 
Published: April 2016

Objectives
This study aimed to determine if vulvar cutaneous candidosis and dermatophytosis can be distinguished by routine histopathology.

Materials and Methods
Twenty-four cases of periodic acid-Schiff–stained vulvar biopsies with a diagnosis of cutaneous mycosis were reviewed and histopathological characteristics on both periodic acid-Schiff and hematoxylin and eosin were recorded. Data were collected on age, clinical impression, microbiological results, and treatment, and all specimens underwent multiplex polymerase chain reaction analysis.

Results
The mean age was 60 years, and all but 3 women had at least 1 risk factor for mycosis including 15 (62.5%) with lichen sclerosus and/or planus managed with topical corticosteroids. A clinical suspicion of tinea or candidosis was documented in 12 (50%) of the cases. Vulvovaginal swabs showed Candida species in 9 women; one skin scraping was positive for Trichophyton rubrum. Microbiology was not obtained in 8 patients, 5 had a negative swab, and 1 had negative skin scrapings. No histopathological or morphological features distinguished Candida species from dermatophytes. Organisms appeared as basophilic structures in the stratum corneum in 15 (62.5%) hematoxylin and eosin–stained slides. Polymerase chain reaction results were positive for Candida species in 5 (21%) and for dermatophytes in 3 (13%), negative in 13, and unassessable in 3 cases.

Conclusions
Vulvar cutaneous candidosis and dermatophytosis cannot be reliably distinguished by routine histopathology or specific polymerase chain reaction. A high index of suspicion combined with adequate microbiological testing remains the best approach to differentiating between the 2, which impacts on counseling, treatment, and prognosis.
Management of portal vein thrombosis in cirrhosis: an update
Authors: Mancuso Andrea 
Published: April 2016

Background
Portal vein thrombosis (PVT) is a complication of cirrhosis. However, whether PVT worsens cirrhosis outcome is a debated issue.

Aim
To report an update on the management of PVT.

Methods
A review was performed on the outcome, prevention, and treatment of PVT.

Results
Some studies suggest that PVT could worsen the rate of hepatic decompensation and survival of cirrhosis, whereas others report a non-negative impact of PVT in the outcome of cirrhosis. Therefore, the prognostic value of PVT in cirrhosis remains a gray zone. One single randomized-controlled trial reported that enoxaparin could prevent PVT, delay the occurrence of hepatic decompensation, and improve survival. However, no further study data confirmed this assumption and the issue is not actually generalizable. Numerous studies report that anticoagulation determines a relatively high rate of portal vein recanalization in cirrhotics PVT. However, further data are warranted to confirm the risk-to-benefit of anticoagulation, especially bleeding. Transjugular intrahepatic portosystemic shunt (TIPS) has been reported to be effective as a treatment of PVT in cirrhosis, with the advantage of avoiding the risk of bleeding linked to anticoagulation. However, there are no data comparing TIPS with anticoagulation as a treatment of PVT in cirrhosis. Furthermore, there is no evidence on whether both anticoagulation and TIPS improve survival.

Conclusion
It is uncertain whether PVT affects cirrhosis outcome. Further data are needed to weigh the risk/benefit ratio of enoxaparin for the prevention of PVT in cirrhosis. Anticoagulation or TIPS should probably be indicated in liver transplantation candidates, but avoided in patients not suitable for liver transplantation and with an otherwise poor prognosis. Future studies should evaluate which subgroup of cirrhotics with PVT may benefit from treatment. Management of PVT in cirrhosis should be personalized.
Noncompliance with guidelines on proton pump inhibitor prescription as gastroprotection in hospitalized surgical patients who are prescribed NSAIDs
Authors: van den Bemt Patricia M.L.A. , Chaaouit Naoual , van Lieshout Esther M.M. , Verhofstad Michael H.J. 
Published: April 2016

Background and aims
As NSAIDs can cause serious upper gastrointestinal harm, guidelines have been established for the prescribing of proton pump inhibitors (PPIs) in high-risk patients using NSAIDs. Studies examining guideline compliance in surgical patients are scarce. Therefore, a retrospective cross-sectional database study was carried out aimed at determining the proportion of noncompliance with the Dutch guideline and determining the association of several factors with this noncompliance.

Materials and methods
Hospital admissions of patients on surgical wards of Erasmus University Medical Center between 1 January 2013 and 1 August 2014 were included in which an NSAID was newly prescribed. Preadmission PPI use was excluded. The main outcome was the proportion of noncompliance with the guideline. As a secondary outcome, the association of several potential risk factors with noncompliance was assessed. The proportion of guideline noncompliance was calculated as the percentage of all included surgical ward admissions. For the secondary analysis, univariate and multivariable logistic regression analyses were carried out.

Results
A total of 409 admissions were included. The proportion of admissions in which guideline noncompliance was present was 46.6%, mostly because of incorrectly added PPIs. Coxib use [adjusted odds ratio 0.22 (95% confidence interval 0.12–0.44)], polypharmacy (the use of five or more drugs) [2.18 (1.27–3.76)], and the surgical wards orthopedics [22.32 (5.38–92.55)], plastic surgery [10.82 (2.51–46.59)], trauma surgery [5.78 (1.47–22.70)], and transplant/vascular surgery [4.45 (1.10–18.00)] were statistically significantly associated with noncompliance.

Conclusion
Noncompliance with the guideline on NSAID use and gastroprotection is present in almost half of surgical hospital admissions and mainly involves overprescribing.
How do patients with chest pain access Emergency Department care?
Authors: Van Severen Evie , Willemsen Robert , Vandervoort Pieter , Sabbe Marc , Dinant Geert-Jan , Buntinx Frank 
Published: April 2016

Background
It is important that patients with symptoms of acute coronary syndrome receive appropriate medical care as soon as possible. Little is known about the preadmission actions that patients with chest pain take before arrival at the Emergency Department (ED).

Objective
This study aimed to describe the actions of patients with chest pain or pressure after onset of symptoms. What is the first action following onset of symptoms? Who is the first lay or professional person to be contacted? Which steps are taken first? How is the patient transported to the hospital?

Methods
Consecutive patients, arriving at the ED of two large hospitals in Belgium, were asked additional questions during the initial assessment.

Results
Overall, 35% of 412 consecutive patients with chest pain admitted to the ED were diagnosed with acute coronary syndrome. A total of 57% contacted a GP between symptom onset and arrival at the ED. Only 32% of the patients were transported to the ED by ambulance, 16% drove themselves and 52% arrived by other means of transport (by family, neighbour, GP, public transport).

Conclusion
In Belgium, the GP is still the first professional to be contacted for most patients. Other patients initially rely on their partner, family or friends when symptoms emerge. Too often, patients with chest pain rely on other transport to get to the ED instead of calling the Emergency Medical Services. This study included only patients who ultimately attended the ED.
Anticoagulation therapy among patients presenting to the emergency department with symptomatic atrial fibrillation – the FinFib2 study
Authors: Penttilä Tero , Mäkynen Heikki , Hartikainen Juha , Lauri Timo , Lehto Mika , Lund Juha , Mäkijärvi Markku , Raatikainen Pekka 
Published: April 2016

Objectives
Atrial fibrillation (AF) causes numerous visits to emergency departments (EDs). We evaluated the thromboembolic and bleeding risk profile and use of oral anticoagulation (OAC) therapy among patients presenting with symptomatic AF to ED.

Methods
Within a 2-week period, all patients whose primary reason for the ED visit was AF were enrolled into this prospective study in 35 EDs around Finland. The risk of thromboembolic and bleeding events was assessed by the CHA2DS2VASc and the HAS-BLED score, respectively. Thereafter, we evaluated whether OAC was used according to the contemporary management guidelines.

Results
The study population included 1013 patients (mean age 70±13 years, 52.4% men) with newly or previously diagnosed symptomatic AF. The mean CHA2DS2VASc and HAS-BLED score was 3.1±2.1 and 1.9±1.2, respectively. At admission, 76.3% of the patients with previously diagnosed AF and CHA2DS2VASc score of at least 2 were using OAC (warfarin 92.3%). However, the international normalized ratio was not at the therapeutic level in 41.9% of them. At discharge, 84.1% of the high-risk patients (85.5% of previously diagnosed and 79.6% of newly diagnosed) and 57.0 and 37.0% of the moderate-risk and low-risk patients were on OAC, respectively. Of the high-risk patients, 5.4% were treated with aspirin.

Conclusion
These data showed that OAC was prescribed frequently to patients with symptomatic AF and risk factors for stroke. However, in patients using warfarin, international normalized ratio was not at the therapeutic level in a large proportion of the patients with previously diagnosed AF.
Impact of CYP2C19 Polymorphisms on Clinical Outcomes and Antiplatelet Potency of Clopidogrel in Caucasian Poststroke Survivors
Authors: Tomek Aleš , Mat'oška Václav , Frýdmanová Alena , Magerová Hana , Šrámek Martin , Paulasova-Schwabová Jaroslava , Růžičková Tereza , Janský Petr , Šarbochová Ivana , Hadačová Ivana , Kaplan Vojtěch , Lacinová Zuzana , Táborský Luděk , Serebruany Victor 
Published: April 2016

Background:
Variable response after clopidogrel is well documented and may affect major adverse clinical events after stroke. Impact of CYP2C19 genetic polymorphisms is an established marker linked to variable response after clopidogrel. However, the association of certain genetic polymorphisms with prediction of major adverse clinical events following stroke still remains controversial, especially in Caucasians.

Study Question:
The primary aim was to evaluate the impact of CYP2C19 allele *2 in heterozygote form on major adverse clinical events in Caucasian poststroke survivors treated with clopidogrel. The secondary aim was to analyze the potential link between CYP2C19 genetic polymorphism and variable response after clopidogrel.

Study Design:
One hundred thirty patients of Caucasian origin following documented ischemic stroke were included. Platelet reactivity was assessed by light transmittance aggregometry (LTA) and matched with various CYP2C19 loss-of-function genetic polymorphisms and major adverse clinical events (composite of vascular deaths, stroke/transient ischemic attack, and myocardial infarction).

Results:
Over the mean follow-up of 14.9 months, 19 patients experienced major adverse clinical events. The risk of major adverse clinical events was nearly 3-fold in loss-of-function allele carriers (hazard ratio = 2.904; 95% confidence interval, 1.083–7.786; P = 0.013), whereas the risk of ischemic stroke or transient ischemic attack alone was also higher (hazard ratio = 3.170; 95% confidence interval, 1.281–7.849; P = 0.034). Platelet activity was strongly associated with allele *2 status (rs = 0.21, P = 0.016) but not with other genetic polymorphisms. Carriers of allele*2 exhibited lower platelet response to adenosine diphosphate—mean LTA (30.1% vs. 42.0%; P = 0.017). There were no significant differences in LTA results with other agonists. Strong association of increase in adenosine diphosphate–induced aggregation with diabetes mellitus (rs = 0.20, P = 0.023), increasing age (rs = 0.23, P = 0.008), and conversely diminishing over increased weight (rs = 0.23, P = 0.009) was also detected. The carriers of other gene allele variants lack uniformed impact on variable response after clopidogrel.

Conclusions:
Even heterozygous CYP2C19*2 allele carriers among Caucasian patients after ischemic stroke had a higher risk of major adverse clinical events. The LTA, however, did not predict major adverse clinical events. The exact clinical utility of these findings is still uncertain and requires large outcome-driven randomized trial in Caucasians for proof of concept.
What Works in Readmissions Reduction
Authors: Brewster Amanda L. , Cherlin Emily J. , Ndumele Chima D. , Collins Diane , Burgess James F. , Charns Martin P. , Bradley Elizabeth H. , Curry Leslie A. 
Published: April 2016

Background:
Hospitals across the United States are pursuing strategies to reduce avoidable readmissions but the evidence on how best to accomplish this goal is mixed, with no specific clinical practice shown to reduce readmissions consistently. Changes to hospital organizational practices, a key component of context, also may be critical to improving performance on readmissions, but this has not been studied.

Objective:
The aim of this study was to understand how high-performing hospitals improved risk-stratified readmission rates, and whether their changes to clinical practices and organizational practices differed from low-performing hospitals.

Design:
This was a qualitative study of 10 hospitals in which readmission rates had decreased (n=7) or increased (n=3).

Participants:
A total of 82 hospital staff drawn from hospitals that had participated in the State Action on Avoidable Readmissions quality improvement initiative.

Results:
High-performing hospitals were distinguished by several organizational practices that facilitated readmissions reduction, that is, collective habits of action or interpretation shared by organization members. First, high-performing hospitals reported focused efforts to improve collaboration across hospital departments. Second, they helped postacute providers improve care by sharing the hospital’s clinical and quality improvement expertise and data. Third, high performers enthusiastically engaged in trial and error learning to reduce readmissions. Fourth, they emphasized that readmissions represented bad outcomes for patients, de-emphasizing the role of financial penalties. Both high-performing and low-performing hospitals had implemented most clinical practice changes commonly recommended to reduce readmissions.

Conclusions:
Our findings highlight several organizational practices that hospitals may be able to use to enhance the effectiveness of their readmissions reduction efforts.
The many layers of epigenetic dysfunction in B-cell lymphomas
Authors: Jiang Yanwen , Dominguez Pilar M. , Melnick Ari M. 
Published: April 2016

Purpose of review
Perturbation of the epigenome is emerging as a central driving force in the pathogenesis of diffuse large B-cell lymphomas (DLBCL) and follicular lymphoma. The purpose of this review is to explain how alteration of different layers of the epigenome contributes to the biology and clinical features of these tumors.

Recent findings
Key new findings implicate DNA methylation heterogeneity as a core feature of DLBCL. Epigenetic diversity is linked to unfavorable clinical outcomes, clonal selection at relapse, and is driven at least in part because of the actions of activation-induced cytosine deaminase, which is a unique feature of B-cell lymphomas. Somatic mutations in histone modifier genes drive lymphomagenesis through the establishment of aberrant gene-specific histone modification signatures. For example, EZH2 somatic mutations drive silencing of bivalent gene promoters through histone 3 lysine 27 trimethylation, whereas KMT2D (MLL2) mutations disrupt specific sets of enhancers through depletion of histone 3 lysine 4 mono and dimethylation (H3K4me1/me2).

Summary
Appreciation of the epigenome in determining lymphoma clonal heterogeneity and in driving lymphoma phenotypes through altered promoter and enhancer histone modification profiles is leading to a paradigm shift in how we understand and design therapies for DLBCL and follicular lymphoma.
NASPGHAN Clinical Report on the Diagnosis and Treatment of Gluten‐related Disorders
Authors: Hill Ivor D. , Fasano Alessio , Guandalini Stefano , Hoffenberg Edward , Levy Joseph , Reilly Norelle , Verma Ritu 
Published: April 2016

ABSTRACTDietary exclusion of gluten‐containing products has become increasingly popular in the general population, and currently ~30% of people in the United States are limiting gluten ingestion. Although celiac disease (CD), wheat allergy (WA), and nonceliac gluten sensitivity (NCGS) constitute a spectrum of gluten‐related disorders that require exclusion of gluten from the diet, together these account for a relatively small percentage of those following a gluten‐free diet, and the vast majority has no medical necessity for doing so. Differentiating between CD, WA, and NCGS has important prognostic and therapeutic implications. Because of the protean manifestations of gluten‐related disorders, it is not possible to differentiate between them on clinical grounds alone. This clinical report will compare and contrast the manifestations of gluten‐related disorders, emphasize the importance of differentiating between these conditions, discuss initial and subsequent tests needed to confirm the diagnosis, and provide recommendations on treatment and follow‐up for each condition.
Radiologic Predictors of Surgery in Newly Diagnosed Pediatric Crohn Disease Patients
Authors: Parker Damien , Karmazyn Boaz , Steiner Steven J. 
Published: April 2016

ABSTRACTObjectives:The aim of the present study was to assess whether small bowel imaging conducted at the time of diagnosis could be used as a predictor of small bowel surgical intervention in a population of pediatric patients with Crohn disease (CD).Methods:A retrospective analysis of small bowel imaging within 30 days of diagnosis of pediatric CD was conducted. Patients were divided into 2 groups based on small bowel imaging: those with no or minor abnormalities (71%) and those with more extensive or obstructive abnormalities (29%). Medical records were reviewed for small bowel surgical intervention and clinic follow‐up visits.Results:A total of 232 patients were included in the study group (average age at diagnosis 11.7 years). Twenty‐seven patients (12%) underwent small bowel surgical intervention. The relative risk for small bowel surgical intervention was 2.91 in the group with more extensive imaging abnormalities. The majority of increased surgical risk occurred in the first year after diagnosis, when the normal‐minor group had a 2% surgical risk and the more abnormal group had a 17% surgical risk. Both groups had a 2% to 3% surgical risk per year after the first year.Conclusions:Small bowel imaging at the time of diagnosis in pediatric CD can help predict the risk of small bowel surgical intervention and should be recommended for all newly diagnosed patients. Nearly one third of our cohort underwent small bowel surgical intervention through 8 years of follow‐up. Surgical complications of CD often occur in the small bowel, and counseling families about surgical risk is an integral part of pediatric CD management.