bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perioperative diabetes care: development and validation of quality indicators throughout the entire hospital care pathway
Authors: Hommel Inge , van Gurp Petra J , Tack Cees J , Wollersheim Hub , Hulscher Marlies EJL 
Published: September 2015

BackgroundIn this study, we aim to develop a set of quality indicators for optimal perioperative diabetes care throughout the hospital care pathway and to gain insight into the feasibility of the indicator set in daily clinical practice by assessing the clinimetric properties of the indicators in a practice test.MethodsA literature-based modified Delphi method was used to develop a set of quality indicators. To assess clinimetric properties of each indicator (measurability, applicability, reliability, improvement potential and case-mix stability), a practice test was performed in six Dutch hospitals using a sample of 389 major surgery patients with diabetes who underwent abdominal, cardiac or large joint orthopaedic surgery.ResultsWe developed a set of 36 quality indicators for perioperative diabetes care. The practice test showed that one indicator was inapplicable, and nine indicators were unmeasurable. Interobserver reliability was good (0.61≤k≤0.8) for all indicators except for one with moderate (0.41≤k≤0.6) interobserver reliability. Improvement potential was low (<10%) for five indicators. Twenty-one indicators, including three outcome indicators, nine process indicators and nine structure indicators, could be used to assess the quality of care delivered in our six study hospitals.ConclusionWe developed a face and content valid set of quality indicators for optimal perioperative diabetes care throughout the hospital care pathway, using a rigorous and systematic approach. The results from our practice test show that it is essential to subject indicators to a practice test before applying them for quality improvement purposes.Trial registration numberClinicalTrials.gov:NCT01610674.
Treatment Regimen, Surgical Outcome, and T-cell Differentiation Influence Prognostic Benefit of Tumor-Infiltrating Lymphocytes in High-Grade Serous Ovarian Cancer
Authors: Wouters Maartje C.A. , Komdeur Fenne L. , Workel Hagma H. , Klip Harry G. , Plat Annechien , Kooi Neeltje M. , Wisman G. Bea A. , Mourits Marian J.E. , Arts Henriette J.G. , Oonk Maaike H.M. , Yigit Refika , de Jong Steven , Melief Cornelis J.M. , Hollema Harry , Duiker Evelien W. , Daemen Toos , de Bruyn Marco , Nijman Hans W. 
Published: September 2015

Abstract
Purpose: Tumor-infiltrating lymphocytes (TIL) are associated with a better prognosis in high-grade serous ovarian cancer (HGSC). However, it is largely unknown how this prognostic benefit of TIL relates to current standard treatment of surgical resection and (neo-)adjuvant chemotherapy. To address this outstanding issue, we compared TIL infiltration in a unique cohort of patients with advanced-stage HGSC primarily treated with either surgery or neoadjuvant chemotherapy.
Experimental Design: Tissue microarray slides containing samples of 171 patients were analyzed for CD8+ TIL by IHC. Freshly isolated CD8+ TIL subsets were characterized by flow cytometry based on differentiation, activation, and exhaustion markers. Relevant T-cell subsets (CD27+) were validated using IHC and immunofluorescence.
Results: A prognostic benefit for patients with high intratumoral CD8+ TIL was observed if primary surgery had resulted in a complete cytoreduction (no residual tissue). By contrast, optimal (&lt;1 cm of residual tumor) or incomplete cytoreduction fully abrogated the prognostic effect of CD8+ TIL. Subsequent analysis of primary TIL by flow cytometry and immunofluorescence identified CD27 as a key marker for a less-differentiated, yet antigen-experienced and potentially tumor-reactive CD8+ TIL subset. In line with this, CD27+ TIL were associated with an improved prognosis even in incompletely cytoreduced patients. Neither CD8+ nor CD27+ cell infiltration was of prognostic benefit in patients treated with neoadjuvant chemotherapy.
Conclusions: Our findings indicate that treatment regimen, surgical result, and the differentiation of TIL should all be taken into account when studying immune factors in HGSC or, by extension, selecting patients for immunotherapy trials. Clin Cancer Res; 22(3); 714–24. ©2015 AACR.
p53 Deletion or Hotspot Mutations Enhance mTORC1 Activity by Altering Lysosomal Dynamics of TSC2 and Rheb
Authors: Agarwal Stuti , Bell Catherine M. , Taylor Shirley M. , Moran Richard G. 
Published: September 2015

Abstract
The activity of mammalian target of rapamycin complex 1 (mTORC1) is frequently enhanced in carcinomas, an effect thought to contribute to the malignant phenotype. Here, it is demonstrated that either deletion or mutation of TP53 in colon or lung carcinoma cells substantially enhances mTORC1 kinase activity by an effect downstream of and independent of AMPK. Mechanistically, it was determined that loss or mutation of p53 decreased expression of TSC2 and Sestrin2 (SESN2). Complementation of p53 null cells with TSC2 or Sestrin2 reduced mTORC1 activity to levels found in p53 wild-type (wt) cells, whereas their genetic depletion enhanced mTORC1 activity in p53 wt cells. However, the primary causal event in enhanced mTORC1 activity upon loss of p53 appeared to be a diminished distribution of TSC2 to lysosomal membranes containing mTOR. Subsequently, there was increased Rheb in the lysosomal compartment, and a higher mTOR association with Raptor. Transfection of TSC2 into p53 null cells replaced TSC2 and diminished Rheb at the lysosome, recapitulating cells with wt p53. In contrast, transfection of Sestrin2 decreased mTOR in lysosomes, but the lower levels of Sestrin2 in p53 null cells did not change lysosomal mTOR. In summary, loss of the transcriptional activity of p53, either by deletion or by key mutations in the DNA-binding domain, diminishes expression of TSC2 and Sestrin2, thus, shifting membrane-bound TSC2 out of lysosomal membranes, increasing lysosomal Rheb and increasing the kinase activity of mTORC1.
Implications: This study establishes that loss of p53 function decreases lysosomal TSC2 and increases lysosomal Rheb resulting in hyperactive mTORC1, findings that are consistent with a more malignant phenotype. Mol Cancer Res; 14(1); 66–77. ©2015 AACR.
Catheter Ablation of Fascicular Ventricular Tachycardia
Authors: Liu Yaowu , Fang Zhen , Yang Bing , Kojodjojo Pipin , Chen Hongwu , Ju Weizhu , Cao Kejiang , Chen Minglong , Zhang Fengxiang 
Published: September 2015

Background—
Fascicular ventricular tachycardia (FVT) is a common form of sustained idiopathic left ventricular tachycardia with an Asian preponderance. This study aimed to prospectively investigate long-term clinical outcomes of patients undergoing ablation of FVT and identify predictors of arrhythmia recurrence.

Methods and Results—

Consecutive patients undergoing FVT ablation at a single tertiary center were enrolled. Activation mapping was performed to identify the earliest presystolic Purkinje potential during FVT that was targeted by radiofrequency ablation. Follow-up with clinic visits, ECG, and Holter monitoring was performed at least every 6 months. A total of 120 consecutive patients (mean age, 29.3±12.7 years; 82% men; all patients with normal ejection fraction) were enrolled. FVT involved left posterior fascicle and left anterior fascicle in 118 and 2 subjects, respectively. VT was noninducible in 3 patients, and ablation was acutely successful in 117 patients. With a median follow-up of 55.7 months, VT of a similar ECG morphology recurred in 17 patients, and repeat procedure confirmed FVT recurrence involving the same fascicle. Shorter VT cycle length was the only significant predictor of FVT recurrence (
P
=0.03). Six other patients developed new-onset upper septal FVT that was successfully ablated.

Conclusions—
Ablation of FVT guided by activation mapping is associated with a single procedural success rate without the use of antiarrhythmic drugs of 80.3%. Arrhythmia recurrences after an initially successful ablation were caused by recurrent FVT involving the same fascicle in two thirds of patients or new onset of upper septal FVT in the remainder.
Short QT Interval Prevalence and Clinical Outcomes in a Pediatric Population
Authors: Guerrier Karine , Kwiatkowski David , Czosek Richard J. , Spar David S. , Anderson Jeffrey B. , Knilans Timothy K. 
Published: September 2015

Background—
Risk associated with short QT interval has recently received recognition. European studies suggest a prevalence of 0.02% to 0.1% in the adult population, but similar studies in pediatric patients are limited. We sought to determine the prevalence of short QT interval in a pediatric population and associated clinical characteristics and outcomes.

Methods and Results—

Retrospective review of an ECG database at a single pediatric institution. The database was queried for ECGs on patients ≤21 years with electronically measured QTc of 140 to 340 ms. Patients with QTc of 140 to 340 ms confirmed by a pediatric electrophysiologist were identified for chart review for associated clinical characteristics, symptoms, and outcome. Patients with and without symptoms were compared in an attempt to identify variables associated with outcome. The query included 272 504 ECGs on 99 380 unique patients. Forty-five patients (35 men, 76%) had QTc ≤340 ms, for a prevalence of 0.05%. Median age was 15 years (interquartile range, 2–17), median QT 330 ms (interquartile range, 280–360), and median QTc 323 ms (IQR, 313–332). Women had significantly shorter QTc compared with men (312 versus 323 ms;
P
=0.03). Two deaths were noted in chart review—one from respiratory failure and the second of unknown pathogenesis in a patient with dilated cardiomyopathy.

Conclusions—
Short QT interval was a rare finding in this pediatric population, with a prevalence of 0.05%. Male predominance was identified, although the median QT interval was significantly shorter in women. There seem to be no unifying clinical characteristics for this pediatric patient cohort with short QT interval.
Association of Race With Mortality and Cardiovascular Events in a Large Cohort of US Veterans
Authors: Kovesdy Csaba P. , Norris Keith C. , Boulware L. Ebony , Lu Jun L. , Ma Jennie Z. , Streja Elani , Molnar Miklos Z. , Kalantar-Zadeh Kamyar 
Published: September 2015

Background—
In the general population, blacks experience higher mortality than their white peers, attributed in part to their lower socioeconomic status, reduced access to care, and possibly intrinsic biological factors. Patients with kidney disease are a notable exception, among whom blacks experience lower mortality. It is unclear if similar differences affecting outcomes exist in patients with no kidney disease but with equal or similar access to health care.

Methods and Results—

We compared all-cause mortality, incident coronary heart disease, and incident ischemic stroke using multivariable-adjusted Cox models in a nationwide cohort of 547 441 black and 2 525 525 white patients with baseline estimated glomerular filtration rate ≥60 mL·min
−1
·1.73 m
−2
receiving care from the US Veterans Health Administration. In parallel analyses, we compared outcomes in black versus white individuals in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004. After multivariable adjustments in veterans, black race was associated with 24% lower all-cause mortality (adjusted hazard ratio, 0.76; 95% confidence interval, 0.75–0.77;
P
<0.001) and 37% lower incidence of coronary heart disease (adjusted hazard ratio, 0.63; 95% confidence interval, 0.62–0.65;
P
<0.001) but a similar incidence of ischemic stroke (adjusted hazard ratio, 0.99; 95% confidence interval, 0.97–1.01;
P
=0.3). Black race was associated with a 42% higher adjusted mortality among individuals with estimated glomerular filtration rate ≥60 mL·min
−1
·1.73 m
−2
in NHANES (adjusted hazard ratio, 1.42; 95% confidence interval, 1.09–1.87).

Conclusions—
Black veterans with normal estimated glomerular filtration rate and equal access to healthcare have lower all-cause mortality and incidence of coronary heart disease and a similar incidence of ischemic stroke. These associations are in contrast to the higher mortality experienced by black individuals in the general US population.
Association of Physician Certification in Interventional Cardiology With In-Hospital Outcomes of Percutaneous Coronary Intervention
Authors: Fiorilli Paul N. , Minges Karl E. , Herrin Jeph , Messenger John C. , Ting Henry H. , Nallamothu Brahmajee K. , Lipner Rebecca S. , Hess Brian J. , Holmboe Eric S. , Brennan Joseph J. , Curtis Jeptha P. 
Published: September 2015

Background—
The value of American Board of Internal Medicine certification has been questioned. We evaluated the Association of Interventional Cardiology certification with in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) in 2010.

Methods and Results—
We identified physicians who performed ≥10 PCIs in 2010 in the CathPCI Registry and determined interventional cardiology (ICARD) certification status using American Board of Internal Medicine data. We compared in-hospital outcomes of patients treated by certified and noncertified physicians using hierarchical multivariable models adjusted for differences in patient characteristics and PCI volume. Primary end points were all-cause in-hospital mortality and bleeding complications. Secondary end points included emergency coronary artery bypass grafting, vascular complications, and a composite of any adverse outcome. With 510 708 PCI procedures performed by 5175 physicians, case mix and unadjusted outcomes were similar among certified and noncertified physicians. The adjusted risks of in-hospital mortality (odds ratio, 1.10; 95% confidence interval, 1.02–1.19) and emergency coronary artery bypass grafting (odds ratio, 1.32; 95% confidence interval, 1.12–1.56) were higher in the non–ICARD-certified group, but the risks of bleeding and vascular complications and the composite end point were not statistically significantly different between groups.

Conclusions—
We did not observe a consistent association between ICARD certification and the outcomes of PCI procedures. Although there was a significantly higher risk of mortality and emergency coronary artery bypass grafting in patients treated by non–ICARD-certified physicians, the risks of vascular complications and bleeding were similar. Our findings suggest that ICARD certification status alone is not a strong predictor of patient outcomes and indicate a need to enhance the value of subspecialty certification.
Assessment of patients’ awareness of their rights in teaching hospitals in Iran
Authors: Bazmi Shabnam , Kiani Mehrzad , Hashemi Nazari Seyed Saeed , Kakavand Mona , Mahmoodzade Razieh 
Published: September 2015

Introduction Respecting patients’ rights is an essential component in health care. Passing a regulation is not a guarantee for the protection of patients’ rights. This article aimed to assess patients’ awareness of the contents of the Patient’s Bill of Rights in Iran and to determine if they had received a service compatible with their rights charter. Methods This is a descriptive study in 202 hospitalised patients. A questionnaire was used, and associations between variables were examined using Pearson’s correlation test. The significance level was p < .05. Results The patients’ ages ranged from 18 to 87 years of age, 33% were male and 79% were married. Patients’ knowledge was lowest regarding the need for consent for the treatment process and was highest regarding the patient’s right to know the expertise of the treatment team. The mean of patients’ knowledge was 77.56%. As for patients’ exercising their rights, the highest score belonged to the patient’s right for attending doctors and treatment team’s confidentiality; the lowest score belonged to the right to receive necessary information about probable complications, other treatment options and participation in the final selection of treatment method. The mean score of patient satisfaction was 8.06 (out of 11). There was no significant relationship with their education level or the number of admissions. Conclusion Health-care professionals can provide care based on patients’ rights, and their knowledge of patients’ rights needs to be evaluated. Educational programmes, leaflets, booklets and posters can be helpful in this regard. In addition, professional organisations and the Ministry of Health need to be more sensitive to this issue.
Monthly air-conditioning energy demand calculations for building energy performance rating
Authors: Hitchin Roger 
Published: September 2015

A new calculation method for monthly cooling energy demand is presented which extends the utilisation factor method of standard EN ISO 13790:2008 to take account of a number of important features of air-conditioning systems that are currently ignored. In all other respects it is compatible with this method, which is the most widely used means of producing building Energy Performance Certificates in Europe. In particular it enables the impact of free cooling, and of the tempering of supply air to be quantified; calculates tailored seasonal efficiency figures for chillers, and provides initial estimates of the potential savings of inter-room heat recovery and of the energy penalties associated with terminal reheat and dual duct systems. Practical application: This paper proposes an extension to the most widely used calculation method for Energy Performance Certificates in Europe, improving its ability to reflect important features of central air-conditioning systems. This is of particular importance for climates and buildings where cooling is required when the outdoor air temperature is relatively low. In particular it enables the impact of free cooling, and of the tempering of supply air to be quantified, calculates tailored seasonal efficiency figures for chillers, and provides initial estimates of the potential savings of inter-room heat recovery and of the energy penalties associated with some other systems.
Risk factor for respiratory death after lung cancer surgery in octogenarians
Authors: Matsuoka Katsunari , Ueda Mitsuhiro , Miyamoto Yoshihiro 
Published: September 2015

Background As society ages, the frequency of elderly patients undergoing surgery for lung cancer is increasing. However, the indications for surgery in octogenarians are still controversial. We examined the outcomes of elderly patients undergoing thoracic surgery for lung cancer, focusing especially on non-cancer-related death. Methods Between January 2004 and March 2011, 1673 patients with lung cancer underwent surgical resection at our institution. Of these, we retrospectively examined 174 patients aged 80 years or older. Results Perioperative morbidity and mortality were 24.3% and 1.15%, respectively. Of 163 patients who were followed up completely, 78 (47.9%) died. The overall postoperative survival rate at 3 and 5 years was 63.6% and 48.3%, respectively. Almost half of the deaths were due to causes other than lung cancer recurrence, with respiratory disease accounting for the majority. We found that a low body mass index was a significant risk factor for death due to respiratory disease after lung cancer surgery in this patient cohort. Conclusion The overall survival rate of octogenarians undergoing lung cancer surgery is acceptable. However, because octogenarians with a low body mass index have a significantly higher risk of death due to respiratory disease, surgeons and pulmonologists should take this into account when performing postoperative follow-up in these patients.
Relationship of thymic changes and complications after congenital heart surgery
Authors: Nafakhi Hussein , Mahdi Liwaa H , Albasri Alaa M , Jumaa Alaa S , Hussein Hussein R 
Published: September 2015

Background The true role of thymic function in children with congenital heart defects is largely unknown. Aim To study the possible role of thymic CD3 (T-lymphocyte marker) and CD20 (B-lymphocyte marker) expression and thymic histopathological changes in complications after surgery for congenital heart defects. Methods Between January and July 2014, thymic tissue samples were obtained from 13 (69% male, 31% female, mean age 10.9 ± 2 years) of 25 Iraqi patients who underwent open heart surgery with partial thymectomy for correction of congenital heart defects. The samples were evaluated for thymic expression of CD markers (CD3 and CD20) and histopathological changes. For up to 6 months after surgery, data on complications were collected from each patient, including wound infection, cardiac arrhythmias, heart failure, rehospitalization, chest infection, and death. Results The prevalence of thymic hypoplasia was 15% and it occurred more frequently in patients with absent thymic CD3 expression ( p = 0.005). Only wound infection ( n = 2) and atrial fibrillation ( n = 1) comprised the postoperative complications in our patients. Absence of thymic CD20 expression correlated significantly with postoperative complications and obstructive cardiac defects ( p = 0.04), whereas no significant correlations were found between thymic hypoplasia with CD3 expression and postoperative complications ( p > 0.05). Conclusion Patients with absent thymic CD20 expression had significantly more postoperative complications and cardiac obstructive defects than those with positive CD20 expression.
The Falls In Care Home study: a feasibility randomized controlled trial of the use of a risk assessment and decision support tool to prevent falls in care homes
Authors: Walker Gemma M , Armstrong Sarah , Gordon Adam L , Gladman John , Robertson Kate , Ward Marie , Conroy Simon , Arnold Gail , Darby Janet , Frowd Nadia , Williams Wynne , Knowles Sue , Logan Pip A 
Published: September 2015

Objective: To explore the feasibility of implementing and evaluating the Guide to Action Care Home fall prevention intervention. Design: Two-centre, cluster feasibility randomized controlled trial and process evaluation. Setting: Purposive sample of six diverse old age/learning disability, long stay care homes in Nottinghamshire, UK. Subjects: Residents aged over 50 years, who had fallen at least once in the past year, not bed-bound, hoist-dependent or terminally ill. Interventions: Intervention homes ( n = 3) received Guide to Action Care Home fall prevention intervention training and support. Control homes ( n = 3) received usual care. Outcomes: Recruitment, attrition, baseline and six-month outcome completion, contamination and intervention fidelity, compliance, tolerability, acceptance and impact. Results: A total of 81 of 145 (56%) care homes expressed participatory interest. Six of 22 letter respondent homes (27%) participated. The expected resident recruitment target was achieved by 76% (52/68). Ten (19%) residents did not complete follow-up (seven died, three moved). In intervention homes 36/114 (32%) staff attended training. Two of three (75%) care homes received protocol compliant training. Staff valued the training, but advised greater management involvement to improve intervention implementation. Fall risks were assessed, actioned and recorded in care records. Of 115 recorded falls, 533/570 (93%) of details were complete. Six-month resident fall rates were 1.9 and 4.0 per year for intervention and control homes, respectively. Conclusions: The Guide to Action Care Home is implementable under trial conditions. Recruitment and follow-up rates indicate that a definitive trial can be completed. Falls (primary outcome) can be ascertained reliably from care records.