bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transgastric drainage of the perforated esophagus: our experiences over 10 years
Authors: Lunt Adam J , Ariyarathenam Arun , Chan David , Humphreys Lee , Sanders Grant , Wheatley Tim , Berrisford Richard G 
Published: July 2023

Summary
We first described the technique of transgastric drainage of esophageal injuries in 2008. The method establishes vacuum drainage of the lumen of the esophagus, while maintaining patency, effectively exteriorizing the perforation to allow healing. We summarize this technique and present our experiences from the largest published series of patients. Our unit has treated selected esophageal injuries with transgastric drainage for 10 years. Indications include perforations not amenable to primary repair and treatment failure following prior surgical intervention. A 36 French silastic chest drain is pulled through the abdominal and stomach wall and introduced into the esophagus so that it crosses the perforation. Gastropexy is performed. Mediastinal decontamination and drainage are performed as needed. Continuous suction of −10 cm water is applied. Leak resolution is assessed with weekly water-soluble swallows. For this retrospective observational study, we analyzed data for patients with esophageal perforation, between 2012 and 2022. Inpatient mortality and time to leak resolution were set as primary and secondary outcomes. Esophageal perforations were treated with transgastric drain in 35 patients, of whom 68% (n = 24) were men. Median age was 67 (26–84). Spontaneous perforations accounted for 60% (n = 21), 31% (n = 11) were iatrogenic and 6% (n = 2) were ischemic. Inpatient and 30-day mortality was 14% (n = 5). Among successful treatments, the median length to resolution of leak on imaging was 34.5 days (6–80). Transgastric drainage can successfully treat esophageal perforations, where primary repair is not feasible. The mortality rate of 14% and reduced morbidity compares favorably with other traditional methods of management for esophageal perforation.
Addressing automatic speech recognition for ELT from a Global Englishes perspective
Authors: Lee Seongyong , Jeon Jaeho 
Published: July 2023

Abstract
Research has indicated that L2 learners frequently encounter challenges when using automatic speech recognition (ASR) in ELT. Therefore, this study explored how critical inquiries into the current ASR technology that is oriented towards native speech might elicit Global Englishes (GE) awareness among Korean pre-service teachers. Qualitative data gathered from interviews with twenty-three Korean students in a teacher education programme and their reflective journals revealed their GE awareness regarding ASR issues in ELT. Furthermore, the findings suggested that their GE awareness was influenced by their previous experiences with taking GE-informed courses and English as a lingua franca communication. Finally, these participants would be willing to incorporate GE perspectives into their future ASR-based ELT classes. It is suggested that the inclusion of GE perspectives into ELT courses be considered to encourage L2 students not to entirely conform to NS norms in ELT.
INFORM-AF: a pilot-feasibility study of an mHealth atrial fibrillation education program
Authors: Ferguson C , Shaikh F , Hickman L , Inglis S C , Bajorek B V , Downie A , Griffin K , Wynne R 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council (Australian Government)

Objective
to determine the feasibility and efficacy of a digital education program for patients living with atrial fibrillation on patient knowledge and AF-related quality of life.

Methods
a single-arm pilot-feasibility study was conducted. Participants with diagnosed AF were recruited from two metropolitan hospitals in Australia, following index hospitalisation. INFORM-AF was delivered by a QStream digital platform directly to participant’s smartphones over 6 weeks. The intervention consisted of a series of 6 interactive micro-learning case studies, multiple choice questions, instant feedback and learning resources delivered using a standardised spaced algorithm with repetition. Topics addressed AF symptoms, risk factors and complications, lifestyle and medication management and seeking assistance. Outcome measures included AF knowledge (JEKQ), AF quality of life (AFEQT) and system usability (SUS). Surveys were completed at in-hospital baseline and via phone at 6 weeks, 3, 6 and 12 months.

Results
32 participants were enrolled, 2 were lost to follow up and 2 withdrew. 28 were included in the analyses. The mean age was 61 years (32-79 years), with 56% female. There were significant improvements to AF knowledge (62% pre vs 73% post, p&lt;0.001) and AF quality of life at 6 weeks (54 pre and 68 post, p = 0.016), system usability was excellent (mean 84). Knowledge improvements were the greatest in the risk factor, symptom recognition, and when to seek assistance domains.

Conclusion
INFORM-AF demonstrated good feasibility with significant improvements in AF knowledge and quality of life at 12 months. We plan to evaluate this intervention in a larger clinical trial on outcomes including emergency department visits, hospitalisation and healthcare utilisation.Table 1Figure 1
Do ethnic minorities improve in exercise capacity following cardiac rehabilitation? a secondary analysis
Authors: Candelaria D , Duggan S , Zhang L , Gallagher R 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): SOLVE-CHD NHMRC Grant

Background/Introduction
Ethnic minorities experience higher rates of cardiovascular disease risks due to a combination of risk factors and socio-cultural influences. While comprehensive cardiac rehabilitation (CR) has well-established benefits for reducing mortality, morbidity, and improving physical fitness, little is known about exercise capacity outcomes for ethnic minorities following CR.

Purpose
This secondary analysis of data from an observational study aimed to evaluate exercise capacity outcomes of ethnic minorities following CR using 6-minute walk test (6MWT) or metabolic equivalent of task (METs) and to compare it to the majority group. Multiple linear regression models were used to determine if ethnic minority status was an independent predictor of change in 6MWT and METs after adjusting for baseline characteristics (age, sex, diagnosis, smoking, referral site, and wait time). Additionally, a binary logistic regression model was created for completers versus non-completers accounting for baseline variables.

Results
Participants totalled 2335, of which 326 (14%) were ethnic minorities. The mean age of ethnic minorities was 66.46 (SD 12.12) years, with 228 (70%) males. The most common referral diagnosis was myocardial infarction (27%), angina (25%), other – arrhythmias, cardiac devices, valve diseases/procedures (24%), and cardiac surgery (24%). Ethnic minorities had significantly lower 6MWT scores at baseline compared to the majority (379.9 (SD 118) versus 430.7 (SD 103) meters, p&lt;0.001, but METs were comparable (6.69 (SD 2.73) versus 6.46 (SD 2.28) mg/kg/min, p = 0.69.
At CR completion, improvements in 6MWT were equivalent for minority (71.03 (SD 58.57)) and majority (71.37 (SD 61.16)) groups (p = 0.96), as well as METs (minority 3.01 (SD 1.66) versus majority 3.13 (SD 1.74) p = 0.77). Minority status was not an independent predictor of change in 6MWT and METs after accounting for age, sex, diagnosis, smoking, referral site, and wait time. However, participants that were minorities were half as likely to complete (OR 0.49 95% CI 0.38, 0.65).

Conclusion
Ethnic minorities achieve equivalent improvements in exercise capacity to majority participants following CR. These findings add to the effectiveness evidence of CR, at least for exercise capacity, for diverse populations. However, such benefits would only be gained with adequate participation and CR program completion, which remains poor for ethnic minorities. Improving CR program uptake and completion for ethnic minorities with cardiovascular disease should be prioritised.
The significant value of educated nurse in ECG Holter monitoring interpretation
Authors: Dimishkovska S , Lazevska M L , Tasevska V T , Ignatova B I , Josevska I J , Alii N A , Zafirovska D Z , Klincheva M K , Mitrev Z M 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
ECG Holter monitoring is a non-invasive diagnostic procedure that continuously records electrocardiography during 24 hours daily routine. The primary role of the nurse is to secure that the electrodes are placed correctly, and to advise the patient.

Purpose
The aim of our study is to emphasize the great importance of nurses by involving them into the interpretation of ECG Holter monitoring.

Materials and Methods
Senior nurses in our hospital, R. Macedonia were educated, by cardiologists, in electrocardiography interpretation. The nurses proactively ensured the technical quality of the monitoring and the data processing. We analyzed the time from the setting up the 24 hours ECG Holter monitoring to the time when the results were issued to the patient in the period from January 2020 to December 2022. All data used for the study were taken from the Hospital Information System. Our Hospital Information System records the date and exact time (hours and minutes) of the opening and closing of the report. Only the referred cardiologist is authorized to close the report.

Results
Three thousand twenty-three 24 hours ECG Holter monitoring reports were processed. The average time of closing the report was 1680 minutes or 28 hours. If we exclude in average the first 22 hours of wearing the device, then we can conclude that the time from when the device is disconnected from the patient to the completion of the report, including the physician examination is in average 6 hours.

Conclusion
ECG educated nurses can be actively involved in the interpretation of ECG Holter monitoring which reduces the time for obtaining the results to less than 24 hours and enables rapid diagnosis and treatment by a cardiologist/electrophysiologist.
Quality assuring an outsourced ambulatory electrocardiogram pathway
Authors: Amarin M , Issa M , Malcolmson J , Stain N 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The rising demand for arrhythmia care has led to the use of outsourced ambulatory electrocardiogram (ECG) pathways to maintain timely service delivery and meet diagnostic targets. Since COVID-19, our ambulatory ECG service operates primarily through external third-party providers, using the remote (postal) model, where monitors are dispatched to patients for self-application. This pathway was activated to comply with social distancing restrictions and has now been integrated into our diagnostic model of care. A quality assurance (QA) process was introduced to ensure compliance with our internal ECG reporting practice and escalation protocols.

Purpose
To quality assure our outsourced ambulatory ECG reports and pathways against internal practices and protocols.

Methods
We audited our QA records on outsourced services from 1st January 2022 - 31st December 2022. During this period, a total of 4317 patients were provided with an ambulatory ECG monitor via the remote service. We conducted regular (~every 2-3 months) retrospective random sampling of ambulatory ECG reports (~10%) for inclusion in QA. Our QA framework consists of a series of quality and consistency checks related to clinical information, report content, and adherence to escalation protocols (table 1). QA reports are fed back to our providers at quarterly meetings to ensure improved service quality. To obtain the requisite data, a variety of sources were cross-referenced. These included our QA reports, outsourced databases, third-party provider platforms, and our patient information system.

Results
Over a 12-month period, a total of 459 reports were quality assured. Ambulatory ECG reports were checked for clinical information, report content, supporting ECG evidence and amendment requests (table 1). A compliance rate of 99% was achieved. There were few cases (1%) where a request was made to the provider to amend the report or include additional information, namely ECG strips to clarify the findings. We also quality checked compliance to our escalation protocols: appropriate RAG (red, amber, green) rating and action, timely notification to clinicians, and adequate documentation. The reviewed ambulatory ECG reports were RAG rated as: Red 23 (5%), Amber 189 (40%), Green-Amber 142 (30%), Green 117 (25%). These were carried out with 99% accuracy. Activation of the appropriate escalation protocols and timely clinician notification achieved 100% compliance, including 23 red-flagged reports requiring immediate action.

Conclusion
The outsourced ambulatory ECG pathway had a very high rate of compliance with internal ECG reporting practice and escalation protocols. Our QA framework ensures we work in collaboration with our external partners to continually provide high-quality ECG diagnostics. We believe undertaking internal quality checks is a vital part of using outsourced service providers.
Anxiety and depression in community-dwelling elders with cardiovascular risk factors
Authors: Sillero Sillero A , Fernandez-Elgueta A , Retamal-Matus H F , Marques-Sule E , Fuentes-Aparicio L , Moreno-Segura N O E M I , Lopez Dominguez J 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Elders with three or more cardiovascular risk factors (CVRF) are at an increased risk of suffering a cardiac event. Anxiety and depression have been proven to be important outcomes in elders. This study aimed to compare the level of anxiety and depression in elders with three or more CVRF vs. elders with less than three CVRF.

Methods
This was a cross-sectional study. 112 community-dwelling elders participated in this study. Sociodemographic characteristics, (age, sex, marital status), clinical outcomes (systolic and diastolic blood pressure, heart rate) and CVRF (hypertension, diabetes, dyslipidaemia, smoking, personal and family history of cardiac events) were assessed. Participants were divided in two groups: i) elders with three or more CVRF (n=46); ii) elders with less than three CVRF (n=66). We evaluated anxiety and depression using the Hospital Anxiety and Depression Scale.

Results
The age of the sample ranged from 60 to 88 years, 71,4% were women, and 55,4% were married. The participants who presented at least three CVRF significantly showed a higher level of depression (HADS-D, p = 0,009) than those who presented less than three CVRF. However, no differences in anxiety (HADS-A, p = 0,087) were obtained when comparing between-group differences.

Conclusion
Elders with at least three CVRF might show higher levels of depression than elders with less than three CVRF. It seems important to measure depression when assessing cardiac outcomes in community-dwelling elders, in order to establish specific programs and treatments for elders who present CVRF.
A Nordic study of adolescents experiences of living with a parent having heart disease
Authors: Rotvig C , Berg S K , Andreasson F , Norekval T M , Stromberg A , Amofah H A , Holmbom M , Bernild C 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Novo Nordic Foundation

Background
An estimated 35% of heart disease occurs in individuals between 35 to 54 years of age, which is the prime child-bearing and parenting years. Even though heart disease often has a good prognosis, its treatment and symptoms can cause changes in everyday life within the family. Existing research shows that adolescents who live with a parent having serious illness are to a higher degree at risk of psychosocial, behavioural, and emotional challenges than peers if they are not accommodated. To our knowledge, limited research exists about adolescents´ experiences of living with parental heart disease.

Purpose
To explore how adolescents experience having a parent with heart disease.

Methods
This qualitative study is performed with semi-structured individual interviews guided by relevant theory. Interviews of 33 adolescents from 13 to 19 years old, who either had a mother or father with one of the diagnoses: ischemic heart disease, arrhythmia, heart failure, or cardiac arrest were conducted. Their parent had been ill for at least six months and up to 5 years and the study was carried out in Denmark, Norway, and Sweden from 2019 until 2022. The analysis was inspired by Reflexive methodology.

Results
The findings of the present study highlighted three central themes: Response to parental heart disease, Strategies in a changed life situation, and Altered relationships. While the heart was experienced as the most vital organ for adolescent’s feelings of fear of losing their parent both physically and mentally appeared and led to a range of different reactions. Adolescents pursued normality as a strategy to overcome their new life situation with parental heart disease where they prioritized a safe space to seek away from the disruption. Adolescents took adult responsibility at home, and through the process, enhanced maturity and new practical skills were developed.

Conclusion(s)
This study has contributed to new knowledge in regard to how parental heart disease changes everyday life as experienced by their young relatives. In order to reconstruct the adolescent’s new lives and cope with parental heart disease the adolescent’s pursued normality, which is a significant coping strategy that must be taken into account in relation to supporting them. To expand our knowledge more research is needed to explore what adolescents’ needs from healthcare professionals are.
Comparison of in-hospital outcomes and complications of left atrial appendage closure with the Watchman device between males and females
Authors: Alhuarrat Majd Al Deen , Pargaonkar Sumant , Rahgozar Kusha , Safiriyu Israel , Zhang Xiadong , Faillace Robert T , Di Biase Luigi 
Published: July 2023

Abstract

Aims
Left atrial appendage occlusion (LAAO) with WATCHMAN device is being used for patients with atrial fibrillation (AFB) and, as an off-label use, atrial flutter (AFL) who can't comply with long-term anticoagulation. We aim to study the differences in outcomes between sexes in patients undergoing Watchman device implantation.

Methodology
The National Inpatient Sample was queried between 2016 and 2019 using ICD-10 clinical modification codes I48x for AFB and AFL. Patients who underwent LAAO were identified using the procedural code 02L73DK. Comorbidities and complications were identified using ICD procedure and diagnosis codes. Differences in primary outcomes were analyzed using multivariable regression and propensity score matching.

Results
38 105 admissions were identified, of which 16 795 (44%) were females (76 ± 7.6 years) and 21 310 (56%) were males (75 ± 8 years). Females were more likely to have cardiac (frequencies: 5.8% vs 3.75%, aOR: 1.5 [1.35-1.68], p1 day inpatient (1.79 [1.67-1.93], P &lt; 0.01) and be discharged to a facility (1.54 [1.33-1.80], P &lt; 0.01).

Conclusion
Females are more likely to develop cardiac, renal, bleeding, pulmonary and TEE-related complications following LAAO procedure, while concurrently showing higher mortality, length of stay and discharge to facilities.
Understanding the Experiences of Family Caregivers of Nursing Home Residents With Dementia: A Grounded Theory Study
Authors: Piersol Catherine Verrier , Martínez Jenny , Chew Felicia , Perry Bonnie , Leland Natalie E 
Published: July 2023

Abstract

Background and Objectives
Alzheimer’s disease and related dementias progress over time and result in cognitive decline, loss of independence, and behavioral and psychiatric symptoms of dementia that can lead to nursing home placement. Research has focused on examining the effects of nursing home placement on the family caregiver; however, their experiences are less understood. We sought to investigate the experiences and perceptions of family caregivers of nursing home residents with dementia. The objective was to create a conceptual model that explains the complex nature of the family caregiver experience.

Research Design and Methods
This study is part of a larger randomized controlled trial. Following a grounded theory approach, we completed 30 in-depth, one-on-one interviews with family caregivers of nursing home residents with dementia. Data analysis followed an iterative process that employed open, axial, and selective coding.

Results
Our conceptual model depicts the interrelationship between contributing factors that interrelate and impact family caregiver satisfaction with nursing home care. Six factors contribute to family caregiver satisfaction: family caregiver interactions with nursing home staff; staff management of resident behavioral symptoms; nursing home context; family caregiver knowledge of dementia; family caregiver strain; and the resident experience.

Discussion and Implications
Our findings revealed family caregiver experiences that are unique to the institutional nursing home setting and not reflected in prior work focusing on experiences within community-based settings. Understanding family caregiver experiences and the contributors to how satisfaction in care is perceived, may foster collaboration and teamwork among families and staff.
Associations Between Family Caregiving and Romantic Relationships: An Exploratory Study With Nondistressed Couples Caring for an Outside Family Member
Authors: Cannon Christopher J , Barry Robin A 
Published: July 2023

Abstract

Background and Objectives
Family caregiving—providing emotional and physical health care for a family member or friend with an illness or disability—can result in many outcomes, including stress and beneficial experiences. Both romantic and caregiving relationships are complex and varied. Nevertheless, little research has examined how caregiving and romantic relationships influence one another. The purpose of this study was to understand ways romantic partners who care for a family member outside of their romantic relationship perceive that their romantic relationship and caregiving experiences influence one another.

Research Design and Methods
A qualitative study using thematic analysis was conducted. A sample of 5 couples where one or both partners were caring for a relative with dementia participated in interviews about their experiences in family caregiving and in their romantic relationship, as well as how the 2 roles interacted with each other. Couple members were interviewed separately and together.

Results
From these interviews, themes reflecting ways that caregiving influences romantic relationships, as well as ways romantic relationships influence caregiving emerged. Themes about caregiving influencing romantic relationships were caregiver stress interacting in the romantic relationship, the romantic relationship becoming less of a priority, and benefits experienced in the romantic relationship due to caregiving. Themes about romantic relationships influencing caregiving were partners improving the caregiving experience, and workload inequality.

Discussion and Implications
These findings broaden our understanding of how dyadic coping affects family caregiving and may suggest ways that the mutual influences caregivers experience between romantic relationships and caregiving benefits and challenges.