bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stroke prevention in atrial fibrillation: An Asian perspective
Authors: Wang Kang-Ling , Lip Gregory Y. H. , Chiang Chern-En 
Published: February 2014

SummaryAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia. In 2050, it is estimated that there will be 72 million AF patients in Asia, accounting for almost 2.9 million patients suffering from AF-associated stroke. Asian AF patients share similar risk factor profiles as non-Asians, except that more Asians have a history of previous stroke. Clinical challenges are evident in the field of stroke prevention in AF, amongst Asians. Existing stroke and bleeding risk scores have not been well-validated in Asians. Asians are prone to bleeding when treated with warfarin, and the optimal international normalised ratio (INR) for warfarin use is yet to be determined in Asians, though Asian physicians tend to keep it in a lower range (e.g. INR 1.6–2.6) for elderly patients despite limited evidence to justify this. In general, warfarin is ‘difficult’ to use in Asians due to higher risk of bleeding and higher stroke rate in Asians than in non-Asians, as shown in randomised controlled trials. Excess of bleeding was not found in Asians when novel oral anticoagulants (NOACs) were used. Besides, the superiority of NOACs to warfarin in reducing thromboembolism was maintained in Asians. Therefore NOACs are preferentially indicated in Asians in terms of both efficacy and safety. Also, some preliminary data suggest that Asian patients with AF might not be the same. Future prospective randomised trials are needed for the selection of NOACs according to different ethnic background.Note: The review process for this manuscript was fully handled by Christian Weber, Editor in Chief.
Dexamethasone and Risk of Bleeding in Children Undergoing Tonsillectomy
Authors: Mahant Sanjay , Keren Ron , Localio Russell , Luan Xianqun , Song Lihai , Shah Samir S. , Tieder Joel S. , Wilson Karen M. , Elden Lisa , Srivastava Rajendu ,   for the Pediatric Research in Inpatient Settings (PRIS) Network
Published: February 2014

ObjectiveTo determine whether dexamethasone use in children undergoing tonsillectomy is associated with increased risk of postoperative bleeding.Study DesignRetrospective cohort study using a multihospital administrative database.SettingThirty‐six US children's hospitals.SubjectsChildren undergoing same‐day tonsillectomy between the years 2004 and 2010.MethodsWe used discrete time failure models to estimate the daily hazards of revisits for bleeding (emergency department or hospital admission) up to 30 days after surgery as a function of dexamethasone use. Revisits were standardized for patient characteristics, antibiotic use, year of surgery, and hospital.ResultsOf 139,715 children who underwent same‐day tonsillectomy, 97,242 (69.6%) received dexamethasone and 4182 (3.0%) had a 30‐day revisit for bleeding. The 30‐day cumulative standardized risk of revisits for bleeding was greater with dexamethasone use (3.11% vs 2.71%; standardized difference 0.40% [95% confidence interval, 0.13%‐0.67%]; P =. 003), and the increased risk was observed across all age strata. Dexamethasone use was associated with a higher standardized rate of revisits for bleeding in the postdischarge time periods of days 1 through 5 but not during the peak period for secondary bleeding, days 6 and 7.ConclusionsIn a real‐world practice setting, dexamethasone use was associated with a small absolute increased risk of revisits for bleeding. However, the upper bound of this risk increase does not cross published thresholds for a minimal clinically important difference. Given the benefits of dexamethasone in reducing postoperative nausea and vomiting and the larger body of evidence from trials, these results support guideline recommendations for the routine use of dexamethasone.
Does additional acute phase inpatient rehabilitation help people return to work? A subgroup analysis from a randomized controlled trial
Authors: Brusco Natasha Kareem , Watts Jennifer J , Shields Nora , Chan Siew-Pang , Taylor Nicholas F 
Published: February 2014

Objective: To investigate if a Saturday rehabilitation service in addition to usual care improved return to work outcomes 12 months post discharge and to report predictors of return to work. Design: Subgroup analysis of a single-blind randomized controlled trial. Setting: General inpatient rehabilitation service. Subjects: A mixed cohort of 137 adults previously engaged in work, who were admitted for inpatient rehabilitation and allocated to a control group ( n=63) or an intervention group (n=74). Intervention: The control group received usual care rehabilitation from Monday to Friday and the intervention group received usual care plus an additional rehabilitation service on Saturdays (physiotherapy and occupational therapy). Main outcome: Return to paid or unpaid work. Results: After 12 months, 36 participants (57%) in the control group and 38 participants (51%) in the intervention group had returned to work. There was no difference between groups (mean difference -1.06 hours per week, 95% CI -8.70 to 6.57) in return to work outcomes. Functional status on discharge (OR 1.05, 95%CI 1.00 to 1.10), an orthopaedic diagnosis (OR 4.92, 95%CI 2.01 to 12.03) and engagement in unpaid work prior to rehabilitation (OR 5.08, 95%CI 1.39 to 18.58) were predictive of return to work at 12 months. Conclusion: A Saturday rehabilitation service in addition to usual care showed no improvement in return to work outcomes at 12 months. Predictors of return to work may help identify those at risk of not returning to work and who require follow-up vocational rehabilitation services.
Headache in chronic cocaine users: A cross-sectional study
Authors: Fofi Luisa , Orlandi Valerio , Vanacore Nicola , Mizzoni Maria C , Rosa Alba , Aurilia Cinzia , Egeo Gabriella , Casella Pietro , Barbanti Piero 
Published: February 2014

Background Headache is one of the most common symptoms after cocaine use. Methods We investigated headache frequency and characteristics and the correlation between headache and acute cocaine intake in a cross-sectional study in a consecutive series of chronic cocaine users. Results Participation rate was 94.1%. Of the 80 subjects enrolled, 72 (90%) reported current headaches, in most cases migraine or probable migraine without aura. Of these 72, 29 (40.3%) had a headache history, whereas 43 (59.7%) reported de novo headache after beginning to use cocaine. After acute cocaine use, a large percentage of users reported headache attacks: 86.2% of previous headache sufferers (migraine or probable migraine without aura in all cases) and 93% of de novo headache sufferers (migraine/probable migraine without aura = 35; episodic tension-type headache = three patients; cocaine-induced headache= two patients). Most subjects reported that when they used cocaine headaches worsened. Conclusion Chronic cocaine use frequently seems to worsen or induce headache with migraine or migraine-like characteristics, probably owing to a serotoninergic and dopaminergic system impairment. In headache sufferers, especially those with migraine headaches, clinicians should enquire into possible cocaine use.
Risk Factors for Lower Extremity Injuries in Elite Female Soccer Players
Authors: Nilstad Agnethe , Andersen Thor Einar , Bahr Roald , Holme Ingar , Steffen Kathrin 
Published: February 2014

Background: The incidence of lower extremity injuries in female soccer players is high, but the risk factors for injuries are unknown. Purpose: To investigate risk factors for lower extremity injuries in elite female soccer players. Study Design: Cohort study; Level of evidence, 3. Methods: Players in the Norwegian elite female soccer league (N = 12 teams) participated in baseline screening tests before the 2009 competitive soccer season. The screening included tests assessing maximal lower extremity strength, dynamic balance, knee valgus angles in a drop-jump landing, knee joint laxity, generalized joint laxity, and foot pronation. Also included was a questionnaire to collect information on demographic data, elite-level experience, and injury history. Time-loss injuries and exposure in training and matches were recorded prospectively in the subsequent soccer season using weekly text messaging. Players reporting an injury were contacted to collect data regarding injury circumstances. Univariate and multivariate regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for ±1 standard deviation of change. Results: In total, 173 players underwent complete screening tests and registration of injuries and exposure throughout the season. A total of 171 injuries in 107 players (62%) were recorded; ligament and muscle injuries were the most frequent. Multivariate analyses showed that a greater body mass index (BMI) (OR, 1.51; 95% CI, 1.21-1.90; P = .001) was the only factor significantly associated with new lower extremity injuries. A greater BMI was associated with new thigh injuries (OR, 1.51; 95% CI, 1.08-2.11; P = .01), a lower knee valgus angle in a drop-jump landing was associated with new ankle injuries (OR, 0.64; 95% CI, 0.41-1.00; P = .04), and a previous knee injury was associated with new lower leg and foot injuries (OR, 3.57; 95% CI, 1.27-9.99; P = .02), whereas none of the factors investigated influenced the risk of new knee injuries. Conclusion: A greater BMI was associated with lower extremity injuries in elite female soccer players. Clinical Relevance: Increased knowledge on risk factors for lower extremity injuries enables more targeted prevention strategies with the aim of reducing injury rates in female soccer players.
Screening for alcohol use disorders in a genitourinary medicine and contraception clinic: a service evaluation
Authors: Thorley Nicola L , Kumar Vinod , Nightingale Peter , Radcliffe Keith 
Published: February 2014

Summary National Institute for Health and Clinical Excellence guidance advises that all patients routinely undergo alcohol screening. Our service evaluation in a sexual health clinic assessed the acceptability of alcohol screening, the prevalence of hazardous drinking and the uptake of referral to a specialist alcohol service. Three services were evaluated: a genitourinary medicine service, a contraception service and an integrated sexual health service. AUDIT was used to screen 276 patients; those scoring ≥8 were classified as hazardous drinkers. Screening uptake was 58% overall, 58% for the contraception service, 71% for the genitourinary medicine service and 100% for the integrated sexual health service. Overall, 28% had AUDIT scores ≥8. Hazardous drinking rates were higher in the genitourinary medicine (32%) and integrated sexual health services (52%) compared to the contraception service (21%); 7% of hazardous drinkers accepted referral. High rates of hazardous drinking were identified within all three groups, but uptake of referral was low. Alternative strategies to specialist alcohol service referral are discussed.
Vitamin D Receptor Genetics on Extracellular Matrix Biomarkers and Hemodynamics in Systolic Heart Failure
Authors: Dorsch Michael P. , Nemerovski Carrie W. , Ellingrod Vicki L. , Cowger Jennifer A. , Dyke D. Bradley , Koelling Todd M. , Wu Audrey H. , Aaronson Keith D. , Simpson Robert U. , Bleske Barry E. 
Published: February 2014

Introduction: Vitamin D deficiency has been associated with the development of myocardial hypertrophy and inflammation. These findings suggest that vitamin D status and vitamin D receptor (VDR) genomics may play a role in myocardial fibrosis. The aim of this pilot study was to determine the association between vitamin D levels, VDR polymorphisms, and biomarkers of left ventricular remodeling and hemodynamics. Methods: In a cross-sectional pilot study, patients with ejection fraction (EF) <40% (and New York Heart Association ≥ II) undergoing right heart catheterization were included in the study. Blood was collected for determination of 25-hydroxyvitamin D level (antibody competitive immunoassay), VDR genotypes ( BsmI, ApaI, TaqI, and FokI), and biomarkers (N-terminal propeptide of collagen type III [PIIINP], matrix metalloproteinase 2, and galectin 3). The vitamin D genotypes were determined through the use of pyrosequencing. Results: A total of 30 patients with a mean EF of 17% ± 8% were enrolled. There was a significant association between the BsmI C allele, ApaI G allele, and TaqI A allele, which formed a haplotype block (CGA) for analysis. There were no differences in baseline parameters between patients with the VDR haplotype block (n = 20) and those without (n = 10). Individual genotypes were not associated with any biomarker or hemodynamics. Patients with the CGA haplotype demonstrated significantly higher log PIIINP values (1.74 ± 0.32 mcg/mL vs 1.36 ± 0.31 mcg/mL, P = .0041). When evaluating vitamin D levels below and above the median level (19 ng/mL), there was no significant difference between these 2 groups in regard to biomarker levels for left ventricular remodeling. Conclusion: This study has shown that a biomarker for collagen type III synthesis, PIIINP, was associated with the CGA haplotype of BsmI, ApaI, and TaqI single nucleotide polymorphisms on the VDR. These findings suggest that VDR genetics may play a role in myocardial fibrosis in patients with systolic heart failure.
Baseline SYNTAX Score and Long-Term Outcome in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Authors: Akgun Taylan , Oduncu Vecih , Bitigen Atila , Karabay Can Yucel , Erkol Ayhan , Kocabay Gonenc , Ozveren Olcay , Yildiz Abdulmelik , Cimen Arif Oguzhan , Kirma Cevat 
Published: February 2014

Objectives: The SYNTAX score (SXscore) has emerged as a reproducible angiographic tool to quantify the extent of coronary artery disease based on the location and complexity of each lesion. The aim of this study was to evaluate whether the SXscore is an independent predictor of long-term cardiovascular outcomes in patients treated with primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods: A total of 2993 patients with acute STEMI who underwent primary PCI were stratified into the 4 groups according to the SXscore quartiles; quartile 1(Q1, SXscore ≤ 9, n = 819), Q2 (9 < SXscore < 16, n = 715), Q3 (16 ≤ SXscore < 20, n = 710), and Q4 (SXscore ≥ 20, n = 749). Results: There were significant differences among the quartiles with respect to age, basal creatinine and glucose levels, and the incidences of diabetes mellitus, Killip ≥2, and anemia. From Q1 to Q4, there were increasing rates of culprit left anterior descending lesion ( P < .001), multivessel disease ( P < .001), chronic total occlusion ( P < .001), and proximal lesion localization ( P < .001). At long-term follow-up, all-cause mortality, nonfatal myocardial infarction, stroke, rehospitalization due to heart failure, and the need of revascularization were significantly more frequent among the patients in the highest SXscore quartile. In multivariate analysis, after including the SXscore as a numerical variable into the model, every point of increase was determined as an independent predictor for long-term mortality (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = .008) and for overall major adverse cardiac events (MACEs; HR 1.02, 95% CI 1.01-1.04, P < .001). Conclusion: The SXscore is an independent predictor of both in-hospital and long-term mortality and MACE in patients with acute STEMI undergoing primary PCI.
Evaluation and implementation of chemotherapy regimen validation in an electronic health record
Authors: Diaz Amber H , Bubalo Joseph S 
Published: February 2014

Introduction: Computerized provider order entry of chemotherapy regimens is quickly becoming the standard for prescribing chemotherapy in both inpatient and ambulatory settings. One of the difficulties with implementation of chemotherapy regimen computerized provider order entry lies in verifying the accuracy and completeness of all regimens built in the system library. Our goal was to develop, implement, and evaluate a process for validating chemotherapy regimens in an electronic health record. Methods: We describe our experience developing and implementing a process for validating chemotherapy regimens in the setting of a standard, commercially available computerized provider order entry system. The pilot project focused on validating chemotherapy regimens in the adult inpatient oncology setting and adult ambulatory hematologic malignancy setting. Results: A chemotherapy regimen validation process was defined as a result of the pilot project. Over a 27-week pilot period, 32 chemotherapy regimens were validated using the process we developed. Results of the study suggest that by validating chemotherapy regimens, the amount of time spent by pharmacists in daily chemotherapy review was decreased. In addition, the number of pharmacist modifications required to make regimens complete and accurate were decreased. Both physician and pharmacy disciplines showed improved satisfaction and confidence levels with chemotherapy regimens after implementation of the validation system. Conclusion: Chemotherapy regimen validation required a considerable amount of planning and time but resulted in increased pharmacist efficiency and improved provider confidence and satisfaction.
Gender and autoimmune comorbidity in multiple sclerosis
Authors: Magyari Melinda , Koch-Henriksen Nils , Pfleger Claudia C , Sørensen Per Soelberg 
Published: February 2014

Background: The female preponderance in incidence of multiple sclerosis (MS) calls for investigations into sex differences in comorbidity with other autoimmune diseases (ADs). Objectives: To determine whether male and female patients with MS have a higher frequency of autoimmune comorbidity than controls, and to describe the type and frequency of ADs that are associated with MS. Methods: Our database was established by linkage of the Danish MS Registry to The Danish National Patient Register and consisted of 1403 patients of both sexes with clinical onset of MS between 2000 and 2004, and 25 matched controls for every case. Results: None of the ADs occurred more frequently in female cases than in controls. Male cases were more likely to have Type I diabetes mellitus (odds ratio (OR) = 3.34; 95% CI 1.40 – 7.02; p < 0.008), Crohn’s disease (OR = 5.03; 95% CI 1.18 – 16.10; p = 0.03) and systemic lupus erythematosus (OR = 12.55; 95% CI 1.62 – 69.95; p = 0.02) than male controls. Conclusions: Autoimmune disorders are rare, but some of them tend to occur together with MS at a higher rate than in controls. Although women are generally more prone to ADs than men, significantly increased occurrence of other ADs were only found in male MS patients.
Innovation strategies: The implementation of creativity principles in Egyptian hotels
Authors: Kattara Hanan S , El-Said Osman A 
Published: February 2014

The concept of employee creativity enhancement is an important factor that impacts hotel position. Therefore, this study aims at studying the implementation of creativity and idea generation principles in upscale hotels in Egypt. It tries, as well, to identify the internal barriers that hinder the greatest implementation of creativity principles in hotels. The study is the first outcome of a series of research examining innovation strategies in hotels. Results of the study revealed that means of scores, regarding the agreement of hotel managers that creativity principles are implemented in their hotels, are high. The results proved that creativity was well valued in hotels and the general work climate and culture promoted creativity. Results reveal that managers face several internal barriers which slow down the proper implementation of creativity principles and make it complicated to grasp the perspective of employees in this context. Moreover, international hotel chains were found to be more innovative than independent hotels, and no significant differences were detected between managers of different educational and experience levels. The study ended up with valuable recommendations and implications of the results.
Medical student syndrome: fact or fiction? A cross-sectional study
Authors: Waterman Lauren Z , Weinman John A 
Published: February 2014

Objectives It is often reported by medical practitioners that medical students develop hypochondriacal concerns and symptoms relating to diseases they are studying, a phenomenon labelled ‘medical student syndrome’. However, the evidence that this syndrome exists and particularly that it contributes to an increased number of consultations (as typical hypochondriasis does) is weak. The present study investigates this phenomenon in terms of differences between medical and non-medical students in help-seeking behaviour. Design Cross-sectional survey. Setting Three universities in London. Participants Medical students ( n = 103), non-medical science student controls ( n = 107) and law student controls ( n = 78), all third-year undergraduates, were recruited from within their universities. Main outcome measures Help-seeking behaviour was measured using the ‘Health Anxiety Questionnaire’ reassurance-seeking behaviour subscale; the overall number of doctors’ visits made for new health complaints since beginning university; a new ‘Hypochondriacal and Help-Seeking Behaviour’ scoring-system, which asked questions pertaining to not just the number but the nature of consultations, identifying participants who had experienced health concerns that were disproportionate to the diseases diagnosed. Results No significant differences were found between medical students and either control group in any of the main outcome variables. Conclusions These findings fail to support the notion that medical students, more so than other students, seek medical advice for hypochondriacal health concerns. They are pertinent to clinicians due to the potentially negative consequences of incorrectly assuming medical students to behave in this way, including cursory evaluations and disintegration of the doctor–patient relationship.
A retrospective review of the assessment of current perioperative management of diabetes in patients undergoing knee replacement surgery
Authors: Howieson Alan J , Brunswicker Annmarie , Dhatariya Ketan 
Published: February 2014

Objectives The prevalence of diabetes mellitus is increasing. Previous work has shown that suboptimal glycaemic control is associated with poor perioperative outcomes with increased rates of postoperative morbidity and mortality in several surgical specialities. Recently published UK guidelines have laid out the standards of perioperative care for patients with diabetes. Because an increasing number of patients with diabetes undergo surgery, it is important that these nationally agreed standards of care are adhered to. Design A retrospective review of the standard of care of patients against existing audit standards laid down in national guidelines, and a comparison of outcomes with people without diabetes. Setting A single major orthopaedic department. Participants Fifty consecutive patients undergoing knee arthroplasty between July 2010 and June 2011. Main outcome measures Postoperative complications; pre, peri and postoperative glucose control; hospital length of stay. Results Although there were no serious postoperative complications, the pre, peri and postoperative management was found to be suboptimal, particularly with reference to optimization of blood glucose control, both in terms of HbA1c preoperatively and blood glucose monitoring perioperatively. The average length of hospital stay was not different between groups; however, 36 patients with diabetes had at least one documented hyperglycaemic episode and four at least one hypoglycaemic episode. Conclusions Perioperative care of diabetes in patients undergoing knee arthroplasty could be improved. Several changes have been made since this audit was carried out, in particular adoption of the comprehensive Joint British Diabetes Societies Guideline on the perioperative management of adult patients with diabetes.