bluuebunny/crossref_metadata_2025_split huggingface dataset:
What Is the Optimal Blood Pressure in Patients After Acute Coronary Syndromes?
Authors: Bangalore Sripal , Qin Jie , Sloan Sarah , Murphy Sabina A. , Cannon Christopher P. ,   for the PROVE IT-TIMI 22 Trial Investigators
Published: November 2010

Background—
Aggressive blood pressure (BP) control has been advocated in patients with acute coronary syndrome, but few data exist in this population relative to cardiovascular outcomes.

Methods and Results—
We evaluated 4162 patients enrolled in the PRavastatin Or atorVastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction (PROVE IT-TIMI) 22 trial (acute coronary syndrome patients randomized to pravastatin 40 mg versus atorvastatin 80 mg). The average follow-up BP (systolic and diastolic) was categorized into 10-mm Hg increments. The primary outcome was a composite of death due to any cause, myocardial infarction, unstable angina requiring rehospitalization, revascularization after 30 days, and stroke. The secondary outcome was a composite of death due to coronary heart disease, nonfatal myocardial infarction, or revascularization. The relationship between BP (systolic or diastolic) followed a J- or U-shaped curve association with primary, secondary, and individual outcomes, with increased events rates at both low and high BP values, both unadjusted and after adjustment for baseline variables, baseline C-reactive protein, and on-treatment average levels of low-density lipoprotein cholesterol. A nonlinear Cox proportional hazards model showed a nadir of 136/85 mm Hg (range 130 to 140 mm Hg systolic and 80 to 90 mm Hg diastolic) at which the incidence of primary outcome was lowest. The curve was relatively flat for systolic pressures of 110 to 130 mm Hg and diastolic pressures of 70 to 90 mm Hg.

Conclusions—
After acute coronary syndrome, a J- or U-shaped curve association existed between BP and the risk of future cardiovascular events, with lowest event rates in the BP range of approximately 130 to 140 mm Hg systolic and 80 to 90 mm Hg diastolic and a relatively flat curve for systolic pressures of 110 to 130 mm Hg and diastolic pressures of 70 to 90 mm Hg, which suggests that too low of a pressure (especially <110/70 mm Hg) may be dangerous.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00382460.
Ticagrelor Versus Clopidogrel in Patients With ST-Elevation Acute Coronary Syndromes Intended for Reperfusion With Primary Percutaneous Coronary Intervention
Authors: Steg Philippe Gabriel , James Stefan , Harrington Robert A. , Ardissino Diego , Becker Richard C. , Cannon Christopher P. , Emanuelsson Håkan , Finkelstein Ariel , Husted Steen , Katus Hugo , Kilhamn Jan , Olofsson Sylvia , Storey Robert F. , Weaver W. Douglas , Wallentin Lars ,   for the PLATO Study Group
Published: November 2010

Background—
Aspirin and clopidogrel are recommended for patients with acute coronary syndromes (ACS) or undergoing coronary stenting. Ticagrelor, a reversible oral P2Y12-receptor antagonist, provides faster, greater, and more consistent platelet inhibition than clopidogrel and may be useful for patients with acute ST-segment elevation (STE) ACS and planned primary percutaneous coronary intervention.

Methods and Result—

Platelet Inhibition and Patient Outcomes (PLATO), a randomized, double-blind trial, compared ticagrelor with clopidogrel for the prevention of vascular events in 18 624 ACS patients. This report concerns the 7544 ACS patients with STE or left bundle-branch block allocated to either ticagrelor 180-mg loading dose followed by 90 mg twice daily or clopidogrel 300-mg loading dose (with provision for 300 mg clopidogrel at percutaneous coronary intervention) followed by 75 mg daily for 6 to 12 months. The reduction of the primary end point (myocardial infarction, stroke, or cardiovascular death) with ticagrelor versus clopidogrel (10.8% versus 9.4%; hazard ratio [HR], 0.87; 95% confidence interval, 0.75 to 1.01;
P
=0.07) was consistent with the overall PLATO results. There was no interaction between presentation with STE/left bundle-branch block and randomized treatment (interaction
P
=0.29). Ticagrelor reduced several secondary end points, including myocardial infarction alone (HR, 0.80;
P
=0.03), total mortality (HR, 0.82;
P
=0.05), and definite stent thrombosis (HR, 0.66;
P
=0.03). The risk of stroke, low in both groups, was higher with ticagrelor (1.7% versus 1.0%; HR,1.63; 95% confidence interval, 1.07 to 2.48;
P
=0.02). Ticagrelor did not affect major bleeding (HR, 0.98;
P
=0.76).

Conclusion—
In patients with STE-ACS and planned primary percutaneous coronary intervention, the effects of ticagrelor were consistent with those observed in the overall PLATO trial.

Clinical Trial Registration—

URL:
http://www.ClinicalTrials.gov
. Unique identifier: NCT00391872.
Ionizing Radiation Exposure to Patients Admitted With Acute Myocardial Infarction in the United States
Authors: Kaul Prashant , Medvedev Sofia , Hohmann Samuel F. , Douglas Pamela S. , Peterson Eric D. , Patel Manesh R. 
Published: November 2010

Background—
Invasive and noninvasive cardiovascular imaging is beneficial in the care of patients admitted with acute myocardial infarction. Little is known about patients' cumulative radiation exposure.

Methods and Results—

All patients admitted with an acute myocardial infarction to any of 49 University HealthSystem Consortium member hospitals from 2006 to 2009 were reviewed for inpatient procedures involving ionizing radiation that included chest radiograph, computed tomogram scans, radionuclide imaging, diagnostic cardiac catheterization, and percutaneous coronary intervention. The average cumulative effective radiation dose per patient was estimated on the basis of published typical effective radiation doses for imaging procedures. Patients (n=64 071) admitted for acute myocardial infarction had a median age of 64.9 years. A total of 276 651 procedures involving ionizing radiation were performed during the study period, a median of 4.3 procedures per patient per admission. The majority of patients had invasive catheterization (77%), followed by computed tomogram scans (52%), mostly body examinations. The median cumulative effective radiation dose delivered was 15.02 mSv per patient per acute myocardial infarction admission. Postprocedural bleeding was a significant predictor of radiation exposure (odds ratio, 2.01; 95% confidence interval, 1.85 to 2.18), together with postprocedural mechanical complications resulting from device implantation (odds ratio, 2.86; 95% confidence interval, 2.61 to 3.13). Patients with higher underlying clinical complexity (defined by severity of illness scores) had higher radiation exposure and higher mortality (
P
<0.0001). There was also significant geographic variation in radiation exposure; patients in New England received the lowest cumulative exposure (odds ratio, 0.78; 95% confidence interval, 0.74 to 0.81).

Conclusions—
Acute myocardial infarction inpatients are exposed to an approximate median radiation dose of 15 mSv. This exposure is a result of multiple cardiovascular and noncardiovascular procedures. Efforts should be made to understand the risks and benefits of radiation exposure per episode of care for acute myocardial infarction.
Ethnic variations in pathways to acute care and compulsory detention for women experiencing a mental health crisis
Authors: Lawlor Caroline , Johnson Sonia , Cole Laura , Howard Louise M. 
Published: November 2010

Background: Much recent debate on excess rates of compulsory detention and coercive routes to care has focused on young black men; evidence is less clear regarding ethnic variations among women and factors that may mediate these. Aim: To explore ethnic variations in compulsory detentions of women, and to explore the potential role of immediate pathways to admission and clinician-rated reasons for admission as mediators of these differences. Method: All women admitted to an acute psychiatric inpatient ward or a women’s crisis house in four London boroughs during a 12-week period were included. Data were collected regarding their pathways to care, clinician-rated reasons for admission, hospital stays, and social and clinical characteristics. Results: Two hundred and eighty seven (287) women from white British, white other, black Caribbean, black African and black other groups were included. Adjusting for social and clinical characteristics, all groups of black patients and white other patients were significantly more likely to have been compulsorily admitted than white British patients; white British patients were more likely than other groups to be admitted to a crisis house and more likely than all the black groups to be admitted because of perceived suicide risk. Immediate pathways to care differed: white other, black African and black other groups were less likely to have referred themselves in a crisis and more likely to have been in contact with the police. When adjustment was made for differences in pathways to care, the ethnic differences in compulsory admission were considerably reduced. Discussion: There are marked ethnic inequities not only between white British and black women, but also between white British and white other women in experiences of acute admission. Differences between groups in help-seeking behaviours in a crisis may contribute to explaining differences in rates of compulsory admission.
The effect of an arm sling on energy consumption while walking in hemiplegic patients: a randomized comparison
Authors: Han Seung Hoon , Kim Taikon , Jang Seong Ho , Kim Mi Jung , Park Si-bog , Yoon Seoung Ic , Choi Bong-Kun , Lee Michael Y , Lee Kyu Hoon 
Published: November 2010

Objective: To evaluate the effect of an arm sling on gait speed and energy efficiency of patients with hemiplegia. Design: A randomized crossover design. Setting: A rehabilitation department of a university hospital. Subjects: Thirty-seven outpatients with hemiplegia were included in this study. Interventions: All patients walked on a 20-m walkway twice on the same day, randomly with and without an arm sling, at a self selected speed. Main measures: The heart rate, gait speed, oxygen cost and oxygen rate were measured on all patients. We analysed all values with and without an arm sling and also compared them after all patients being stratified according to demographic and clinical characteristics. Results: When we compared the heart rate between walking with (90.7 ± 17.2 beats/min) and without (91.2 ± 18.6 beats/min) the arm sling, it was significantly decreased while walking with the arm sling. When we compared the gait speed between walking with (32.8 m/min) and without (30.1 m/min), it was significantly increased with the arm sling walking. The O2 rate in hemiplegic patients walking with the arm sling was significantly decreased by 7%, compared to walking without arm sling (5.8 mL/kg min and 6.2 mL/kg min, respectively). The O2 cost in hemiplegic patients walking without arm sling was significantly 1.4 times greater than walking with it (0.2 mL/kg m and 0.3 mL/kg m, respectively). Conclusion: An arm sling can be used to improve the gait efficiency.
Responsiveness and validity of two outcome measures of instrumental activities of daily living in stroke survivors receiving rehabilitative therapies
Authors: Wu Ching-yi , Chuang Li-ling , Lin Keh-chung , Horng Yi-shiung 
Published: November 2010

Objective: To comprehensively investigate and compare the responsiveness and validity of two instrumental activities of daily living (ADL) measures: a modified version of the Nottingham Extended ADL Scale and the Frenchay Activities Index, after stroke rehabilitation. Setting: Rehabilitation clinics. Subjects: Seventy stroke patients received a three-week intervention (mean (SD) age, 55.5 (12.1) years; 46 (65.7%) men; mean (SD) time post stroke, 19.9 (12.5) months). Measures: Four outcome measures (modified Nottingham Extended ADL Scale, Frenchay Activities Index, Stroke Impact Scale and Motor Activity Log) were administered before and after treatment. We used the standardized response mean (SRM) to examine responsiveness and the Spearman correlation coefficient (ρ) to examine concurrent validity. Results: Responsiveness was significantly larger for the modified Nottingham Extended ADL Scale (SRM = 0.9) compared with the Frenchay Activities Index (SRM = 0.5). The correlations between the modified Nottingham Extended ADL Scale and Frenchay Activities Index were good to excellent before (ρ = 0.8) and after treatment (ρ = 0.8). The modified Nottingham Extended ADL Scale and Frenchay Activities Index showed fair correlations with the Stroke Impact Scale ADL/Instrumental ADL domain, Stroke Impact Scale total score and Motor Activity Log before treatment (ρ = 0.3—0.4). After treatment, the modified Nottingham Extended ADL Scale and Frenchay Activities Index demonstrated moderate to good correlations with the Stroke Impact Scale ADL/Instrumental ADL domain (ρ = 0.6) and fair correlations with the Stroke Impact Scale total score and Motor Activity Log (ρ = 0.2—0.5). Conclusions: The modified Nottingham Extended ADL Scale and Frenchay Activities Index are both valid outcome measures but the modified Nottingham Extended ADL Scale is more responsive than the Frenchay Activities Index. While simultaneously considering the properties of responsiveness and validity, the modified Nottingham Extended ADL Scale may be a relatively sound measure of instrumental ADL function in stroke patients receiving rehabilitation.
Feasibility and preliminary effectiveness of ice therapy in patients with an acute tear in the gastrocnemius muscle: a pilot randomized controlled trial
Authors: Prins Jan CM , Stubbe Janine H , van Meeteren Nico LU , Scheffers Frans A , van Dongen Martien CJM 
Published: November 2010

Objective: To investigate the feasibility of a randomized controlled trial and the preliminary effectiveness of ice therapy in the acute phase of a gastrocnemius tear for the quality of functional recovery. Design: A pilot version of an intended prospective randomized controlled clinical trial was conducted. Participants: A total of 19 patients with an acute tear in the gastrocnemius muscle were randomly allocated to either active or control treatment. Intervention: The intervention consisted of the repeated application of crushed ice. Main measures: Primary outcome measures were functional capacity and reconvalescence time. Secondary outcome measures were pain and work absenteeism. The number of patients we could include within the 6-hour time window and dropping out from the pilot study were regarded as indicators of the feasibility of ice therapy. Results: A total of 16 patients were excluded from the study because diagnosis was not made within 6 hours after onset of the complaint. The 19 patients included completed the treatment. For functional capacity, reconvalescence time, work absenteeism and pain relief, no significant differences between the intervention and control group were found. Conclusions: The execution of a randomized controlled trial on ice therapy for acute gastrocnemius tear is feasible though quite an enterprise. First, it is recommended to improve the recruitment processes. Second, power analysis demands inclusion of 396 participants. Preliminary effectiveness in our limited-sized trial indicates that the use of ice is not beneficial for people who receive ice therapy.
Social activity contributes independently to life satisfaction three years post stroke
Authors: Boosman H , Schepers VPM , Post MWM , Visser-Meily JMA 
Published: November 2010

Objective: To determine social activity and life satisfaction three years post stroke and to investigate the contribution of social activity to life satisfaction controlled for the influence of demographic, physical and cognitive disabilities and social support. Design: Cross-sectional study. Subjects: One hundred and sixty-five patients with a stroke. Main measures: The Life Satisfaction questionnaire (LiSat-9), the Social Support List – Interaction (SSL-12-I), the Barthel Index, the Mini-Mental State Examination (MMSE) and the Frenchay Activities Index. Results: In total, 165 stroke patients participated, of whom 112 (67.9%) reported that they were satisfied with life as a whole. Socially inactive patients were significantly less often satisfied (50%, n = 26) than socially moderately (74.4%, n = 64) and socially highly active (81.5%, n = 22) patients. Lowest satisfaction ratings were found for sexual life (40.6%, n = 58). The socially inactive group was most satisfied with their partner relationship (85.1%, n = 40), the moderately and highly socially active group with their self-care ability (87.2%, n = 75 and 96.3%, n = 26, respectively). ADL and social activity were moderately correlated with life satisfaction. Social activity was found to explain an additional variance of the LiSat-9 total score (6.9%) and overall life satisfaction item (5.2%) after controlling for demographic variables, social support, ADL and cognitive functioning. Conclusions: Three years post stroke, many patients report ongoing dissatisfaction with various life domains. Social activity was related to life satisfaction.
Oxcarbazepine does not suppress cortical spreading depression
Authors: Hoffmann Ulrike , Dileköz Ergin , Kudo Chiho , Ayata Cenk 
Published: November 2010

Background: Cortical spreading depression is the electrophysiological substrate of migraine aura, and may trigger headache. Recently, chronic treatment with five migraine prophylactic drugs was shown to suppress cortical spreading depression, implicating spreading depression as a common therapeutic target in migraine prophylaxis.Materials and methods: In order to assess the negative predictive value of spreading depression susceptibility as a preclinical drug screening tool, we tested oxcarbazepine, an anti-epileptic ineffective in migraine prophylaxis. Valproate served as the positive control. Cortical spreading depression susceptibility was measured in rats using topical KCl or electrical stimulation.Results: Oxcarbazepine did not suppress spreading depression either after a single dose or after daily treatment for 5 weeks. As previously shown, valproate suppressed spreading depression susceptibility after chronic dosing, while a single dose was ineffective.Conclusions: These data provide further support for spreading depression as a relevant target in migraine prophylaxis, and demonstrate the predictive utility of employed spreading depression models.
Behavioural treatment programme contributes to normalization of contingent negative variation in children with migraine
Authors: Siniatchkin Michael , Müller Gabriele Gerber-von , Darabaneanu Stephani , Petermann Franz , Stephani Ulrich , Gerber Wolf-Dieter 
Published: November 2010

Background: Migraine is a disorder of central information processing which may be characterized by increased amplitudes and reduced habituation of evoked and event-related potentials. In this pilot study, special behavioural training of habituation to aversive stimuli (MIPAS-Family = Migraine Patient Seminar for Families) was developed and proven effective in children suffering from migraine without aura. Methods: 13 children with migraine participated in the MIPAS-Family programme and 13 other children with migraine were treated with biofeedback. The influence of both treatments on abnormal cortical information processing in migraine was assessed using recordings of the contingent negative variation (CNV), an event-related slow cortical potential. Results: Both MIPAS training and biofeedback caused an equal reduction of migraine frequency and severity. However, MIPAS treatment was associated with a significant increase in iCNV habituation. Changes in the clinical course of migraine correlated positively with normalization of habituation: the greater the reduction in headache frequency, the greater the increase in CNV habituation was. These effects were not observed in the biofeedback group. Conclusions: This study demonstrates that the specific treatment programme which was evolved from knowledge of pathogenetic mechanisms of migraine influences central information processing and leads to a clinical effect.
‘In our experience’: Chairing and commissioning Serious Case Reviews in adult safeguarding in England
Authors: Manthorpe Jill , Martineau Stephen 
Published: November 2010

• Summary: The article reports findings from an audit of Serious Case Reviews into the death or harm of a vulnerable adult in England. Serious Case Reviews may be undertaken by local authorities in partnership with other agencies. There is little government guidance and practice appears variable. • Findings: Interviews were undertaken in 2007 with persons who had been appointed to Chair Serious Case Reviews and with those who commissioned such Reviews or managed the process. The findings confirm the aspiration of such Reviews to be opportunities for learning from mistakes, if any, and to thereby offer greater safeguards for vulnerable adults. In practice however, the conduct of such Reviews may be difficult if there is a lack of cooperation, a lack of resources and if there is little opportunity to share findings and recommendations outside the locality. • Application: This study supports the sharing of Serious Case Reviews to encourage learning from mistakes and missed opportunities to safeguard vulnerable adults. It also found agreement among those with experience in such Reviews that greater guidance on conduct and collaboration would be welcome.
‘Love them to bits; spend time with them; have fun with them’: New Zealand parents’ views of building attachments with their newly adopted Russian children
Authors: Johnstone Jocelyn , Gibbs Anita 
Published: November 2010

• Summary: Focus groups and semi-structured interviews were conducted with 15 parents from New Zealand who had adopted Russian born children. The aim of the research was to explore the ways in which parents establish and build their parenting and attachment relationships with their ‘new’ children. • Findings: Findings revealed the immense commitment, child-centred focus, and conscious parenting of parents. The range of strategies used to build relationships and attachments included: quality time, play, touch and holding, and communication. Parents’ high levels of commitment were established through preparation to adopt, especially the acquisition of knowledge about and understanding of attachment issues. Support groups, notably other adoptive parents were also critical to enhancing relationships between children and their adoptive parents. Fathers were actively engaged in the process of building attachments. • Applications: Intercountry adoptive parenting is a special kind of parenting, especially because of the challenges presented by children often neglected or abused prior to adoption. Helping prepare parents for both the rewards and challenges of intercountry adoption and supporting them post-adoption still needs to be improved by professional social work services. Acknowledgement of parents’ and children’s resilience and strengths that they bring to the new relationship will help create realistic expectations on the part of professionals and would-be adopters.