bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiology intensive care unit nurse in italy: definition of advanced competences. IN-CORE study
Authors: Cruciani F , Barisone M , Cacciavillani L , D'alessandro G , Valente S , Rosati M , Marenzi G , Mazza M , Gasparetto N , Casonato C , Bernardo P , Piccinini C , Luchetti S , Marini M 
Published: July 2024

Abstract

Background/Introduction
Since the establishment of the Cardiology Intensive Care Units to date, there have been many scientific and technological progresses that have involved not only the pathways of diagnosis and treatment of patients in this specialist area, but also the specialist competencies that nurses must acquire in order to work in these settings.
The epidemiological picture and incidence of comorbidities suggest the care of patients requiring intensive and specialised care, with the use of high technology and circulatory support systems, changing the usual setting of a cardiology intensive care unit to a high-intensity cardiology intensive care unit.
To date, a few studies have been described in the literature that have mapped the competences of the cardiology intensive care unit nurse, but the heterogeneity of training education at a European level has not yet made a reference framework for this specialist area generalisable. (Endacott R., et al. 2022). In Italy, there are no specific postgraduate courses focused on specialist cardiac intensive care skills development for nurses. To develop such courses, content incorporating appropriate competencies is required and this study was designed to meet this.

Purpose
To identify the core competencies of nurses working in High-intensity cardiology intensive care units (ICUs) in Italy to develop national competence framework.

Methods
A three-round e-Delphi study was conducted with a group of 30 experienced cardiac intensive care unit nurses; 28 completed all three rounds. The first round asked each participant to write down five competences, which they were asked to prioritize in the second round. In the third round, they were asked to prioritize again, considering the scores made in the second round. The final list of competencies was the one that achieved a greater than 70% agreement among the participants.

Results
We identified 12 core competencies that include a few competence areas, including high-tech care, emergency management, teamwork, and critical decision-making. Only slight differences emerged among the panel of experts regarding the priority given to certain core competencies, such as ECG reading, emergency management and technical and practical skills in the intensive care area.

Conclusions
This is the first study in Italy to identify the core and advanced competencies of nurses working in high level cardiac intensive care units. This study provides an important basis for the development of postgraduate educational programme and a framework for the definition of national standards to be implemented in clinical practice.
Determining what matters most to Marfan syndrome (MFS) patients: a convergent mixed method study of the health-related quality of life and psychosocial effects of MFS aortovascular manifestations
Authors: Magboo R , Oo A , Cooper J , Gibbs D , Owens G , Sanders J 
Published: July 2024

Abstract

Background
Marfan Syndrome (MFS) affects multiple organ systems but the aortovascular manifestations are the most serious and life-threatening. However, there is no available evidence on the effect of the aortovascular manifestations on health-related quality of life (HRQoL) and psychosocial wellbeing of MFS patients.

Purpose
This study aims to determine the HRQoL and the psychosocial effects of the aortovascular manifestation of MFS.

Methods
A convergent mixed-method design was used in this single site study. Specifically, the quantitative study (S1) is an observational exploratory study using seven validated questionnaires relating to HRQoL (SF36, EQ-5D-5L) and psychosocial health (depression [CESD], illness perception [IPQ], fatigue [FSS], self-esteem [RSES], stigma [PSQ]), previously used in MFS research. The qualitative study (S2) is an exploratory study using semi-structured interviews. Analysis consisted of descriptive and inferential statistics and Framework method1 for S1 and S2, respectively. Joint display was used for data integration.

Results
A total of 75 participants completed the questionnaires (S1) and 20 were interviewed (S2). The mean age was 43 years (S1) and 40 years (S2) and the majority (S1: 54 (72%); S2: 17 (85%)) were white British. S1 found the majority of MFS participants experienced depression, anxiety, pain and fatigue. These areas were confirmed in S2. A positive self-esteem was generally reported in S1, but this is not supported by S2, which highlighted patients experience a loss of self-esteem due to perceived body image disturbance. Finally, S2 generated new areas not identified in S1 including health anxiety, loss of personal efficacy, self-stigma and ‘invisible disability’ affecting work and socio-economic condition. Overall, the joint display generated three confirmed, seven expanded and one discordant finding.

Conclusion
MFS patients with aortovascular manifestations experienced several HRQoL and psychosocial issues related to their condition. Collaborative efforts are needed to develop multifaceted interventions and programs to address their needs and provide a holistic and comprehensive service for MFS patients. Finally, four new areas were identified in S2, which added important new evidence in this body of knowledge.
The lived experience of loneliness and social isolation in patients with pulmonary arterial hypertension: A phenomenological study
Authors: Cedrone N C , Lommi M L , Gangemi I G , Iovino P I , Vellone E V 
Published: July 2024

Abstract

Background
Pulmonary arterial hypertension (PAH) is a rare, complex and chronic disease, characterised by a mean pulmonary arterial pressure at rest above 20 mmHg, determined through right heart catheterisation. As the disease progresses, symptoms (e.g., chest pain, syncope, respiratory distress) occur, which negatively impact quality of life. Moreover, symptoms of PAH can impair activities of daily living and social functions, leading to social isolation and loneliness. So far the experience of social isolation and loneliness in PAH patients.

Purpose
To explore the lived experience of social isolation and loneliness in patients with PAH.

Methods
A multicentre descriptive phenomenological study was conducted with semi-structured interviews driven by the Middle Range Theory of Social Isolation. This study followed the COREQ guidelines, and data analysis was conducted using the Elo and Kyngäs method.

Results
Seventeen patients (mean age 55,3 years; range 21-83 years; n=3 male) recruited from specialized clinics or patient associations across different Italian regions, participated in the interviews. The results show that patients with a marked symptomatology experience daily moments of loneliness and social isolation that inevitably impact the quality of life. While, patients with a mild symptomatology or with drug support can lead a life similar to that before diagnosis. Three main categories emerged. First, within the main category of loneliness emerged generic categories including emotions associated with loneliness (anger, depression, frustration, guilt, fear)as well as the influence of loneliness on the disease and the various strategies to limit it. Second, for the main category of social isolation were also identified other generic categories including networks of support of the person with PAH (family, social and work), emotions related to social isolation (dismissal and pretend to be well) and the influence of social isolation on the path of illness. Finally, generic categories related to well-being, autonomy, health, self-care activity or health promotion performed by the patient emerged for the main quality of life category.

Conclusion
The findings of this study contribute to a more in depth understanding of the factors influencing the quality of life of patients with PAH and enlighten the design of interventions aimed at improving their condition. Integration of these results with quantitative data regarding the extent of the influence of loneliness and social isolation is warranted.
Incidence of heart disease and stroke among patients with bipolar disorder
Authors: Szczepanowski R , Krzyzanowski D , Kulinska J , Palej-Cieplinska M , Ferdinan T , Hernandez Ibarburu G 
Published: July 2024

Abstract

Background
Increased vulnerability to cardiovascular diseases (CVD) and stroke has been observed among people with mental disorders, such as bipolar disorder (BP). Yet, the evidence for the association between severe mental disorders and CVD and stroke events remains inconclusive.

Purpose
By running a cohort study based on large retrospective data, we aimed to establish the relative risk of CVD problems and stroke in patients admitted to the hospital and diagnosed with BP.

Methods
The study was conducted on electronic health records provided by 113 healthcare organizations worldwide from the TriNetX Global Collaborative Network, containing at least 690,946 patients with BP symptoms. The assessment was focused on the first incidence of ischemic heart diseases, nontraumatic brain hemorrhage, or cerebral infarction among patients after BP diagnosis. After propensity score matching age, gender, race and comorbidities, the rates were compared against a cohort of patients with no mental, behavioral, or neurodevelopmental disorders who also suffered from similar CVD and stroke events. In addition, Kaplan-Meier Analysis was performed to compare their survivability to CVD, taking into account patient censoring.

Results
Patient count after applying the score matching yielded 532,082 per cohort. The odds ratio (OR) of ischemic heart diseases, nontraumatic brain hemorrhage, or cerebral infarction on BP compared to people without any mental disorder was equal to 2.349, indicating a significantly elevated risk for such events. The Kaplan-Meier analysis showed that patients with BP diagnosis had 9.88% less survival probability to having CVD problems after 20 years since the diagnosis than patients without any mental disorder. With a hazard ratio of 1.970 (95%CI 1.935-2.005), the risk of developing a CVD problem on the former (patients with BP diagnosis) was almost twice greater than for patients suffering without mental health disorders.

Conclusion
There is an increased risk of developing cardiovascular problems and stroke among patients with bipolar disorder compared to patients affected by such symptoms without mental disorders. The robust results were ensured by limiting the potential confounders with the propensity score matching procedure, such as demographics, comorbidity, and medication. The study implies that monitoring and prevention approaches for cardiovascular and cerebral vascular diseases must be tailored to symptoms of mental disorders.
Comprehensive assessment of the results of zorba dance-based rehabilitation in patients after myocardial infarction
Authors: Rzepka-Cholasinska A , Ratajczak J , Nowaczyk A , Grzelakowska K , Kubica A 
Published: July 2024

Abstract

Introduction
Dance movement engages global muscle sequences of the human body, improves physical performance, and helps reduce stress and excessive muscle tension. Dance exercises allow you to better control your movement and muscles. Zorba Greek dancing as a form of physical activity brings benefits in the form of improved mental health, well-being and quality of life. Rehabilitation may contribute to improving cardiorespiratory fitness and mental condition in the group of patients after myocardial infarction.

Aim of the study
The aim of the study was to evaluate a rehabilitation program based on Zorba dance on selected clinical parameters in patients after myocardial infarction.

Materials and methods
The study included 99 patients after myocardial infarction who were rehabilitated for 5 weeks. Patients were enrolled into two groups. Group I (50 patients) performed cycle ergometer training and the Greek dance Zorba. Group II (49 patients) performed cycle ergometer training and rehabilitation exercises. At the beginning and after rehabilitation, patients' BMI, balance (scales: Tinetti, Berg, 30CST), gait (6MWT), psychophysical status (SF-36, WHO-5, FCIS), and breathlessness (mMRC scale) were assessed.

Results
After undergoing rehabilitation, there was a reduction in BMI (I vs. II p&lt;0.01), improvement in balance on the Tinetti (I vs. II p&lt;0.01) and Berg scale (I vs. II p&lt;0.01), improvement in the 30CS test score (I vs. II p= 0.018), improvement in WHO-5 (I vs. II p&lt; 0.01), and reduction in dyspnea (mMRC)
(I vs. II p&lt; 0.01) in the Zorba group.

Conclusions
Both methods of rehabilitation improve functional efficiency; However, rehabilitation with the use of Zorba dance additionally improves balance in patients after myocardial infarction.
Complications in the postoperative period of heart transplantation: a retrospective cohort
Authors: Molinari Genari P , Malaman Galhardi N , Batista Dos Santos Pedrosa R 
Published: July 2024

Abstract

Introduction
Primary graft dysfunction, graft rejection, renal dysfunction, and infections are frequent complications after heart transplantation (HT), and there is evidence that previous comorbidities and risk factors, such as arterial hypertension, diabetes, dyslipidemia, and smoking can predispose or even aggravate the development and evolution of these disorders.

Objectives
This study verified the association between previous comorbidities and risk factors in the development of complications after HT.

Methods
A retrospective cohort study was conducted and included 91 HT patients and followed up to 10 years postoperatively, in a Brazilian hospital between 1988 and 2020. The study was designed according to the recommendations of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Data were collected by retrospective analysis of medical records. The independent variables were the following: Demographic and clinical conditions of the subjects during the preoperative period, such as age, sex, arterial hypertension, diabetes, dyslipidemia, and smoking. The outcome variables were: Acute cellular rejection, infection, renal dysfunction, hemodialysis therapy after the HT, and death. Data were submitted to descriptive, Fisher’s Exact Test and Chi-square analyses, with p &lt; 0.05 as the level of statistical significance. The local Ethics Committee approved the study (CAAE: 53026321.4.0000.5404).

Results
There was a predominance of women (67.0%), with a mean age of 49.4 (11.1) years. Most of them were diagnosed with hypertension (49.45%), smokers (38.46%), dyslipidemia (18.68%), and diabetes (16.48%). Regarding complications, 73.63% of the sample of this study developed acute cellular rejection, 61.54% had infections, 25.47% developed renal dysfunction, in addition to 24.18% of patients received hemodialysis treatment after HT. More than half of patients died (58.24%). Positive associations of strong magnitude were found between renal dysfunction and hypertension (p=0.0018); of moderate magnitude between acute cellular rejection and smoking (p=0.0386) and between infection and smoking (p=0.0156). Furthermore, it was observed that those who developed renal dysfunction had a high association with hemodialysis (p&lt;0.0001).

Conclusion
This study demonstrated that hypertension may be associated with the development of renal dysfunction, and smoking may contribute to acute cellular rejection and infection after HT. These findings provide support to health professionals to implement prevention strategies and early detection of complications in the postoperative period.
Virtual reality and cardiac rehabilitation: a new middle-range theory to outline its mechanism of effectiveness
Authors: Micheluzzi V , Casu G , Sanna G D , Vellone E , Iovino P 
Published: July 2024

Abstract

Background
To reduce symptoms and improve outcomes in patients with cardiovascular diseases, international guidelines recommend cardiac rehabilitation. However, patients’ adherence to rehabilitation programs remains suboptimal, compromising its beneficial effects. Virtual reality has proven to be effective in enhancing adherence to rehabilitation in different fields (e.g., neurological and post-trauma). In the cardiological field, it has been proven effective in improving functional capacity and several psychological parameters (e.g., anxiety, depression, and emotional stress). Despite the increasing use of this digital technology, there is still a lack of information regarding its underlying mechanism of effectiveness.

Purpose
This middle-range theory aims to explain the mechanism of effectiveness of virtual reality in cardiac rehabilitation.

Methods
An inductive-deductive approach was used to develop this middle-range theory. Three steps were conducted including synthesis of key concepts, definition of the relationship between these concepts, and setting up of a hypothetical model.

Results
This middle-range theory proposes both proximal and distal outcomes of virtual reality. Proximal outcomes are classified as responses at the psychological (i.e., emotional stress, depression, and anxiety) and physical (i.e., exercise capacity) level, which, in turn, influence adherence to rehabilitation (i.e., distal outcome). Mediators of the relationship between virtual reality and outcomes are both at a proximal and distal level. The proximal mediators are activated at the neurological level to generate a multisensory experience of sight, hearing, and touch. This alters perception, by inducing an immersive altered state of consciousness and activating the distal mediators of attention, enjoyment, and sense of presence. The activation of the distal mediators promotes distraction from negative external stimuli related to the disease and healthcare setting and perception of positive emotions by interacting with the virtual world. Consequently, these mediators influence physical and psychological responses that enhance overall adherence to cardiac rehabilitation. Moderators of the relationship between virtual reality and rehabilitation adherence include age, gender, trust in technology, and cognitive status (Figure 1).

Conclusions
This middle-range theory aims to clarify the mechanism by which virtual reality enhances adherence to cardiac rehabilitation. Further qualitative and quantitative studies are warranted to test its hypothetical model.
Early heart rate recovery after a 6-min walking test in patients after percutaneous aortic valve implantation coresponds with clinical benefits
Authors: Aleksandrowicz K 
Published: July 2024

Abstract

Background
Time-appropriate return to a resting heart rate (HR) after cessation of exercise is a marker for predicting outcomes in patients with heart failure (HF). We aimed to evaluate the prognostic value of HR recovery in functional improvement in patients with severe aortic stenosis after percutaneous aortic valve implantation (TAVI).

Methods
6 min walk test (6MWT) was performed in 93 individuals before TAVI and in 3 months follow up. The change in walking distance was measured. We analyzed also the differences between baseline HR, HR at the end of the test, and HR at the 1st, 2nd and 3rd minute of recovery.

Results
After 3 months the distance of 6MWT in TAVI patients improved by 39±63 m and reached a total of 322±117 m. The differences between HR after 2 min of recovery and baseline HR in pre-TAVI after a 6MWT was the only significant predictor of waking distance improvement during follow-up in multiple linear regression model.

Conclusions
Our study showes that changes of HR recovery after a 6MWT may be a helpful and easy parameter to assess improvement in exercise capacity after TAVI. This simple method can also help to identify patients in whom no significant benefit in functional improvement can be expected despite successful valve implantation.Demographics
A pan-Europe comparative review of allied profession roles in cardiac science
Authors: Stain N , Bayne S , Bruce D , Malcolmson J 
Published: July 2024

Abstract

Introduction
Over the last 75 years, Cardiac Science (CS) has evolved into a widely practised Allied Profession (AP) throughout Europe. Despite this prominence, there are limited comparative works on AP titles, regulation, scope of practice (SoP) and training routes. The recognition of CS as a profession in the United Kingdom dates from 1948 when the Society for Cardiac Science and Technology (SCST) was established. In the UK, the AP role has evolved into Cardiac Physiologists with education at bachelor’s degree level and Clinical Scientists at master’s level. The SoP has also developed over time, leading to more advanced training and practice. Similar progression in professional titles, SoP, education and training routes also occurred in other European countries.

Purpose
To compare Allied Professions in Cardiac Science (APCS) including professional nomenclature, regulation, education, SoP, and pan-European identity.

Methods
Data were collected from November 2023 to January 2024. European and country databases were scrutinised to determine nomenclature, professional status, regulation, and educational requirements. Online translation was used when information was not available in English.

Results
The analysis of databases revealed 15 APCS roles (Table 1). In 60% of the countries, the role is officially recognised by a professional body that provides advocacy, education, training, and defines SoP (Figure 1). Moreover, 47% of countries operate a mandatory licensing or registration scheme. In 33% of countries, APCS roles are incorporated within the Biomedical Science profession. In the remaining countries, nine alternate titles are used to describe the discipline. In most cases (66%), education is at bachelor’s level, while in others, particularly where recognition is more limited, it is at a vocational level. In four countries (Austria, Ireland, Iceland, and The Netherlands), SoP is broadly in line with the UK, covering electrocardiography, echocardiography, haemodynamics for invasive procedures, implantable devices, and electrophysiology. Conversely, in other countries SoP varies and can include nuclear medicine (Sweden and Denmark) or perfusion and respiratory (Italy and Portugal). Some countries restrict SoP to defined roles such as pacemaker or echo technicians (Spain, Luxembourg, and Switzerland). Notably, Finland, France, and Norway, as well as most Eastern European countries do not recognise APCS roles.

Conclusion
While APCS roles are widely acknowledged in Europe, they lack visibility compared to other health professions. The variability in professional titles, education, and SoP constrain the development of a unified identity. Collaborative works connecting APCS roles across Europe may enhance identity, improve quality of care and raise the profile of this discipline.