bluuebunny/crossref_metadata_2025_split huggingface dataset:
It can be safe to discontinue oral anticoagulants after successful atrial fibrillation ablation: A systematic review and meta-analysis of cohort studies
Authors: Wang Xiangyu , Li Minghua , Wang Xishu , Zhang Zhiguo 
Published: October 2023

Background:
Current guidelines recommended that oral anticoagulants (OACs) should last for a minimum first 2 months after atrial fibrillation (AF) ablation and the long-term decision of anticoagulation after AF ablation should be based on the individual patient’s risk of stroke rather than the rhythm status. There is controversy about the safety of discontinuing OACs in patients with atrial fibrillation after the blanking period due to the divergences between consensus recommendations and clinical practice.

Methods:
Electronic bibliographic sources (PubMed, Embase, and Web of Science) were searched until August 2023 to identify cohort studies about the safety of discontinuing OACs in patients with AF after the blanking period. The primary outcome was thromboembolism (TE). The secondary outcome was major bleeding events (MBEs). Two authors extracted articles independently using predefined data fields. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated based on a random-effects model.

Results:
A total of 16 studies (11 prospective cohorts and 5 retrospective cohorts) enrolling 23,942 patients (14,382 OFF-OAC and 9560 ON-OAC) were included in our analysis. No significant difference emerged in the risk of TE between OFF-OAC and ON-OAC patients following AF ablation after the banking period (OR = 0.66; 95%CI, 0.43–1.01). Similar results emerged in the patients with a high risk of TE after stratification by the risk level of TE (OR = 0.72; 95%CI, 0.25–2.08). A significant reduction in incidences of major bleeding was found in the OFF-OAC patients compared with the ON-OAC patients (OR = 0.23; 95%CI, 0.12–0.42). Subgroup analyses for TE found a reduction of incidences in the subgroups who switched to antiplatelet drugs and with a follow-up duration <3 years. Subgroup analyses for MBEs found a significant reduction of incidences in all subgroups.

Conclusions:
Our study suggests it can be safe to discontinue OACs after successful AF ablation. Discontinuation of OACs may reduce the risk of MBEs while not increasing the risk of TE.
Systematic review and meta-analysis of stress management intervention studies in patients with metabolic syndrome combined with psychological symptoms
Authors: Lihua Ma , Kaipeng Zhuang , Xiyan Ma , Yaowen Chang , Tao Zhang 
Published: October 2023

Background:
Metabolic syndrome is affected by many factors, including lifestyle, mood, etc. Self-management of chronic diseases has attracted significant attention from researchers. Some studies have shown that patient self-management is a very important link, which can effectively alleviate the risk of further deterioration of the disease. However, so far, there has been no report on the basis of the summary of self-management intervention programs based on emotion management, which needs further in-depth discussion by researchers.

Methods:
The Medline (PubMed), Embase (Elsevier), PsycINFO (Ovid), CBM, CNKI and Wanfang databases were searched from the establishment of the databases to June 2022, and a total of 25 studies were traced. The inclusion criteria on stress management in patients of metabolic syndrome complicated with psychological symptoms uses meta-analysis. Two investigators independently assessed the risk of bias for each study using the Cochrane risk of bias tool.16 studies and 2687participants and relevant characteristics of studies.

Results:
In the effects of intervention measures based on stress management on depression, fasting plasma glucose, 2hFPG, high-density cholesterol, self-management behavior and quality of life in patients with psychological symptoms (depression, anxiety, and schizophrenia) complicated with metabolic diseases, there are statistically significant differences between the intervention group and the control group (P < .05).

Conclusions:
Stress management intervention can effectively improve the health outcomes of patients. In all included analysis indicators, the results of the experimental group are better than those of the control group.
Utilization rates of intravenous thrombolysis for acute ischemic stroke in Asian countries:: A systematic review and meta-analysis
Authors: Gajurel Bikram Prasad , Nepal Gaurav , Jaiswal Vikash , Ang Song Peng , Nain Priyanshu , Shama Nishat , Ruchika F.N.U. , Bohara Sujan , Kharel Sanjeev , Yadav Jayant Kumar , Medina Jillian Reeze T. , Shrestha Abhigan Babu 
Published: October 2023

Background:
Despite intravenous thrombolysis (IVT) being used for the treatment of acute ischemic stroke (AIS) for over two decades, its accessibility remains limited in various regions of the world. The Asian region, which experiences the highest age-standardized incidence of AIS, currently lacks comprehensive data on the utilization of IVT.

Aims:
This study aimed to provide precise estimates of IVT usage for AIS in Asian countries.

Methods:
A literature search was conducted on PubMed and Google using appropriate search terms. English language, peer reviewed articles published after 2010 were included in the analysis. The pooled proportion was calculated utilizing the DerSimonian and Laird random-effects model. Additionally, a subgroup analysis was conducted, taking into account factors such as the study's country, the economic status of the country, specific Asian regions, publication year (before 2015 and from 2015 onwards), study location, study setting, hospital stroke protocol, and national stroke guidelines.

Results:
67 observational studies with 778,046 patients with AIS were included in the meta-analysis. The overall utilization rate of IVT was found to be 9.1%. High-income countries had a higher rate (11.3%) compared to lower-middle-income (8.1%) and upper-middle-income countries (9%). Central and North Asia had the highest rate (17.5%) and Southeast Asia had the lowest rate (6.8%). Studies conducted after 2015 had a higher thrombolysis rate (11.3%) compared to those before 2015 (1.5%). Presence of hospital stroke protocols (10.7%) and national stroke guidelines (10.1%) were associated with higher thrombolysis rates.

Conclusion:
The overall utilization rate of IVT for AIS in Asia stood at 9.1%, showcasing noteworthy disparities across countries, regions, and income brackets. To improve thrombolysis rates in the region, addressing prehospital delays, increasing public awareness, and implementing stroke protocols and national guidelines are key strategies.
Impact of exposure to rational career reflective training on work-related ethics among student-philosophers
Authors: Chukwuma Joseph Nnaemeka , Areji Anthony Chukwudi , Obumse Nneka Anthonia , Eze Emmanuel , Amadi Kingsley , Agbo Christian Onuorah , Nweze Celestina Adaeze , Eze Chima Fidelis , Omeh Samuel O. , Elom Chinyere O. , Ari Abubakar Omame , Obeagu Emmanuel Ifeanyi , Omeje Grace Ngozi 
Published: October 2023

Background:
Teaching individuals at the early-career stage what and how to respect organizational codes of conduct is a good step in creating a democratic working environment. As a result, it is important to coach students in sustaining organizational well-being by seeking the truth, teaching the truth and upholding the truth. Currently, how these are taught in institutions of higher learning lacks structure. In fact, some graduate students are displaying work-deviant behaviors showing that they have poor perceptions of work-related ethics. Using this reason, we tested the impact of exposure to rational career reflective training on work-related ethics among student-philosophers.

Methods:
This is a pretest, posttest with a follow-up pure experimental design was used. A total of 105 student-philosophers were recruited, assessed 3 times using Ethics and irrational beliefs measures, and coached by therapists. The participants were exposed to 12-session rational career reflective training. The data collected were subjected to a multivariate statistical analysis to test how effective the intervention was in changing negative perceptions about ethics.

Results:
It was found that rational career reflective training changes negative perceptions about work-related ethics among student-philosophers. The effectiveness of rational career reflective training is not statistically influenced by gender and group interaction. Gender does not moderate the impact of the intervention.

Conclusion:
This study finally suggests that rational career reflective training effectively changes negative perceptions about ethics among student-philosophers. Thus, recommends the advancement of Ellis principles in other workplaces and across populations.
Is there a weekend effect in spine surgery?: A systematic review and meta-analysis of postoperative outcomes
Authors: Chang Yu , Hsu Heng-Juei , Hsu Hao-Hsiang , Wong Chia-En , Chi Kuan-Yu , Lee Po-Hsuan , Huang Chi-Chen , Lee Jung-Shun , Chen Chien-Min 
Published: October 2023

Background:
The concept of a weekend effect is that patients admitted to hospitals on the weekend tend to have poorer outcomes compared to those admitted on a weekday. Whether there is a weekend effect among patients receiving spine surgery is not well described in the literature. We sought to perform a systematic review with meta-analysis to explore whether a weekend effect exists among patients experiencing spinal surgery.

Methods:
The Cochrane Library, PubMed, Embase, and MEDLINE electronic databases were searched for relevant articles. Meta-analyses were performed using functions available in the metafor package within the R software. We obtained adjusted odds ratios (OR) from included studies and pooled OR through an inverse variance method. A random-effects model was applied for meta-analysis and effect sizes were presented with their corresponding 95% confidence intervals (CI).

Results:
Our search strategy identified 316 references from electronic databases and eventually 6 studies were included in the analysis. The pooled result of 5 studies reporting overall complication rate indicated significant increased risk of complications among the weekend admission group (OR, 1.35; 95% CI, 1.01 to 1.80). The pooled results of 3 studies demonstrated no difference in overall mortality rates between these 2 groups of patients (OR, 1.18; 95% CI, 0.67 to 1.97).

Conclusions:
In spinal surgical patients, the weekend effect significantly contributes to a higher complication rate. Knowledge of potential adverse events in patients admitted on weekends is necessary for spinal surgeons and caregivers to improve patient outcomes with spinal surgery.
Intravenous high-dose vitamin C monotherapy for sepsis and septic shock: A meta-analysis of randomized controlled trials
Authors: Zeng Yiqian , Liu Zhao , Xu Fei , Tang Zhanhong 
Published: October 2023

Background:
Vitamin C has been used as an adjuvant in the treatment of sepsis and septic shock; however, its role remains controversial. This study aimed to assess the effectiveness of intravenous high-dose vitamin C in sepsis and septic shock patients by meta-analysis.

Methods:
The PubMed, Embase, and Cochrane Library electronic databases were searched to identify relevant studies. The primary outcome was defined as the short-term all-cause mortality rate. Secondary outcomes included duration of vasoactive drug use, intensive care unit length of stay, sequential organ failure assessment scores up to 96 hours after treatment and 90-day mortality. Review Manager version 5.4 was used to perform the meta-analysis. Relative risk and mean differences (MD) with 95% confidence intervals were determined using fixed- or random-effects models.

Results:
Eight randomized controlled trials (RCTs) comprising 1394 patients were eligible for assessment. Overall, the pooled results showed that high-dose vitamin C decreased short-term all-cause mortality in patients with sepsis, but no significant differences were observed in patients with septic shock. Additionally, high-dose vitamin C was associated with decreased duration of vasoactive drug use in patients with sepsis, but not in patients with septic shock. However, it did not significantly affect the duration of intensive care unit stay in RCTs of patients with sepsis and septic shock. Additionally, it did not significantly affect sequential organ failure assessment scores 96 hours post-treatment or 90-day mortality.

Conclusion:
These results suggest that intravenous high-dose vitamin C may improve outcomes in patients with sepsis, but do not benefit patients with septic shock. Further RCTs and other studies should be conducted to determine whether vitamin C should be recommended as an adjunctive sepsis treatment.
Assessing attentional task-related electroencephalogram signal variations by using mobile electroencephalogram technology: An experimental study
Authors: Matsuo Moemi , Higuchi Takashi , Miyabara Hiroya , Higashijima Misako , Oshikawa Takeshi , Nakamura Masatoshi , Yamaguchi Yuji , Higashionna Takuya 
Published: October 2023

Background:
A better understanding of the network responses of cortical activities during rest and cognitive tasks is necessary. Therefore, in this study, we aimed to evaluate cerebral activities during attentional tasks by using mobile electroencephalography, identifying the types of attentional components and brain waves.

Methods:
In this experimental study, we enrolled 12 healthy young adults. The attentional tasks comprised parts A and B of the Trail-Making Test (TMT). Nineteen electroencephalography electrodes were placed over various brain regions. The Wilcoxon signed-rank test was used to examine the differences in power levels between the rest and TMT conditions.

Results:
During TMT part A, the electroencephalography power level of the delta waves was significantly higher in the right frontal, left central, left occipital, left inferior frontal, right mid-temporal, right posterior temporal, and middle parietal areas (P < .05) than those during the resting state; that of the alpha waves was significantly lower in the left posterior temporal area (P = .006); and that of the high gamma waves was significantly lower in the left parietal (P = .05) and left occipital (P = .002) areas. During TMT part B, the electroencephalography power level of the beta waves was significantly higher in the right frontal area (P = .041) than that during the resting state, and that of the low gamma waves was significantly higher in the left frontal pole, right frontal, and right inferior frontal areas (P < .05). During the focused attentional task, the power level of the delta waves increased and that of the alpha waves decreased, and during the alternating attentional task, those of both the beta and gamma waves increased. The delta waves were related to the whole brain, the alpha and high gamma waves to the left posterior lobe, and the beta and low gamma waves to both frontal lobes.

Conclusion:
These findings contribute to the basic knowledge necessary to develop new attentional assessment methods for clinical situations.
The Effects of Organizational Characteristics, Individual Nurse Characteristics, and Occupational Fatigue on Missed Care at Night
Authors: Crincoli Suzanne , de Cordova Pamela , Thomas-Hawkins Charlotte , Flynn Linda , Zha Peijia , Sagherian Knar 
Published: October 2023

Background
Missed care is defined as the omission or delay of necessary patient care and is internationally reported by nurses as a significant safety risk. Nurses working at night also report high levels of occupational fatigue that, coupled with inadequate staffing and practice environment support, may impede a nurse’s ability to carry out the nursing process and lead to more missed care.

Objective
The study’s objective was to examine the interrelationships among organizational and nurse characteristics, occupational fatigue, and missed care among nurses working at night.

Methods
A cross-sectional design was used. Participants included registered nurses (RNs) who worked at night in New Jersey acute care hospitals. Multiple linear regression and simple moderation analyses were performed to examine the associations.

Results
Nurses reported missing necessary care at night. Unsupportive practice environments, high RN workloads, high patient–RN ratios, high chronic fatigue levels, and low intershift recovery were individually associated with missed care at night. High patient-to-RN ratios and chronic fatigue were independently associated with missed care. However, patient-to-registered-staffing levels had the most considerable effect on missed care at night. Nurses’ years of experience and the number of hours of sleep between shifts were significant moderators of the relationship between occupational fatigue states and missed care.

Discussion
This study is the first to examine the interrelationship between occupational fatigue levels, organizational and nurse characteristics, and missed care at night. There is an urgent need to implement strategies in hospital organizations that foster work schedules and adequate staffing patterns that lessen nurses’ occupational fatigue levels to ensure our workforce’s and patients’ safety.
Hospital Environmental Disruptors and Caregiver Sleep During Hospitalization
Authors: Fernández-Puerta Laura , Prados Germán , Quiñoz-Gallardo María Dolores , Vellido-González Dolores , González-Guerrero María Leticia , Rivas-Campos Antonio , Jiménez-Mejías Eladio 
Published: October 2023

Purpose
Caregivers must cope with a poor sleep environment when caring for someone admitted to the hospital. The aim was to study the environmental factors associated with a sleep disruption pattern in caregivers during hospitalization and to test their association with caregivers' insomnia symptoms.

Design
This was a cross-sectional study.

Methods
One hundred twenty-three caregivers completed the study. The effect of environmental stimuli on sleep disruption was measured on a scale from 1 to 10 (1 = no disruption, 10 = significant disruption). Type of room (single vs shared), insomnia symptoms, anxiety and depression, and patients' dependence (Barthel Index) were assessed as well. Caregiver and patient characteristics as well as identified hospital disruptors were compared with Student t test, χ
2 test, and Fisher exact test according to the caregivers' type of room. A linear regression model using main caregiver and patient sociodemographic variables, questionnaires, and the sum of all hospital disruptors determined the factors associated with caregivers' insomnia symptoms.

Results
Of the caregivers and their care recipients, 51.2% shared a room with 1 to 2 other patients. Higher self-reported levels of sleep disruption due to environmental stimuli were found in shared rooms when compared with single rooms (eg, nursing care, noise, and light) (P < .05). Hospital sleep disruptors (adjusted regression coefficient, 0.15; 95% confidence interval, 0.06–0.24) and caregiver anxiety (adjusted regression coefficient, 0.57; 95% confidence interval, 0.33–0.81) were predictors for insomnia (P < .01). However, caregivers' type of room was not associated with insomnia severity symptoms (P > .05).

Conclusions
Interventions are urgent to implement, such as relieving caregivers from patient needs during the night, providing them with single rooms, and conducting multiple nursing tasks in 1 visit to minimize night hospital noise.
Hepatitis B surface antigen loss in individuals with chronic hepatitis B virus and HIV-1 infections in Botswana
Authors: Mpebe Gorata G.A. , Phinius Bonolo B. , Mutenga Sharon , Baruti Kabo , Bhebhe Lynnette , Choga Wonderful T. , Jongman Mosimanegape , Pretorius-Holme Molly , Gaolathe Tendani , Mmalane Mompati , Shapiro Roger , Makhema Joseph , Lockman Shahin , Moyo Sikhulile , Anderson Motswedi , Gaseitsiwe Simani 
Published: October 2023

Objectives:
We sought to determine hepatitis B surface antigen (HBsAg) loss and its predictors among people with chronic hepatitis B (CHB) infections and HIV (PWH) in Botswana.

Methods:
Archived plasma samples from a cohort of PWH in Botswana (2013–2018) with 3 yearly time-points were used. Samples were screened for HBsAg, immunoglobulin M HBV core antibodies (anti-HBc IgM) and HBV e-antigen (HBeAg) at all time points. HBV deoxyribonucleic acid (DNA) quantification was done at baseline. The Wilcoxon rank-sum was used to compare continuous variables while the chi-squared test and Fishers exact test were used for categorical data wherever appropriate. Logistic regression was used to assess predictors of seroclearance.

Results:
Of 141 participants with HBsAg-positive serology (HBsAg+) at baseline, 92.2% (131/141) [95% confidence interval (CI) 87.4–96.1] were persistently HBsAg+ at year 1. We report a HBsAg loss of 7.1% (10/141) (95% CI 3.9–12.6) among participants with negative HBeAg and negative IgM serologies. HBsAg loss was 6.3% (7/111) among antiretroviral therapy (ART)-experienced participants and 10.7% (3/28) (95% CI 0.4–5.0) in ART-naive participants. Most participants who had positive anti-HBc IgM serology and did not lose HBsAg were on either lamivudine (3TC)-based therapy or non-tenofovir disoproxil fumarate (TDF)-based therapy, except for one participant. The participants also had varying HBeAg status. HBsAg loss was independent of HIV viral load, CD4+ cell count, age, and sex.

Conclusion:
We report a HBsAg loss of 6.3% over a 3-year period among ART-experienced CHB participants. Future studies that focus on HBsAg loss in mono-infected patients and the possible correlation between HBeAg status and HBsAg loss are warranted.
Racial Disparity among Youth Decedents of Legal Intervention Trauma
Authors: Yu Peter T , Goodman Laura F , Riley John S , Giron Annie , Guner Yigit S , Peranteau William H , Schomberg John 
Published: October 2023

BACKGROUND:
Legal intervention trauma (LIT) is defined as injury due to any encounter with law enforcement. This study investigates associations between demographics, violent status, and law enforcement tactics among youth decedents of LIT.

STUDY DESIGN:
Decedents of LIT age 26 years or younger were identified using the CDC’s National Violent Death Reporting System from 2003 to 2018. Decedents were classified as “violent” if they possessed a weapon, were committing a violent crime, or if law enforcement reported justified use of force. All others were classified as “nonviolent.” Law enforcement tactics were stratified into “lethal” (firearm with standard ammunition) or “less lethal” (any other) force. Differences in the racial distribution across these classifications were assessed using chi-square tests of proportions.

RESULTS:
We identified 1,281 youth decedents of LIT; of which, 92.5% met violent criteria. Black youths were less likely than White youths to possess a weapon (71.6% vs 77.4%, p = 0.02) and were not more likely to be committing a violent crime (63.6% vs 60.4%, p = 0.27). They were, however, more likely than White youths to experience force reported as justified by law enforcement (89.9% vs 82.4%, p = 0.002) and to experience exclusively lethal force not preceded by less-lethal tactics (94.0% vs 88.7%, p = 0.001). Among the subset of 85 cases where law enforcement reported justified use of force despite the decedent not possessing a weapon or committing a violent crime, the precipitating event was more often a traffic stop for Black youths than for White youths (28.5% vs 6.66%, p = 0.02).

CONCLUSIONS:
These findings indicate a racial disparity among youth decedents of LIT.