bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary careAdherenceToHeartFailure guidelinesIN Diagnosis,Evaluation andRoutine management (PATHFINDER): a randomised controlled trial protocol
Authors: Dai Liying , Dorje Tashi , Gootjes Jan , Shah Amit , Dembo Lawrence , Rankin Jamie , Hillis Graham , Robinson Suzanne , Atherton John J , Jacques Angela , Reid Christopher M , Maiorana Andrew 
Published: March 2023

IntroductionGeneral practitioners (GPs) routinely provide care for patients with heart failure (HF); however, adherence to management guidelines, including titrating medication to optimal dose, can be challenging in this setting. This study will evaluate the effectiveness of a multifaceted intervention to support adherence to HF management guidelines in primary care.Methods and analysisWe will undertake a multicentre, parallel-group, randomised controlled trial of 200 participants with HF with reduced ejection fraction. Participants will be recruited during a hospital admission due to HF. Following hospital discharge, the intervention group will have follow-up with their GP scheduled at 1 week, 4 weeks and 3 months with the provision of a medication titration plan approved by a specialist HF cardiologist. The control group will receive usual care. The primary endpoint, assessed at 6 months, will be the difference between groups in the proportion of participants being prescribed five guideline-recommended treatments; (1) ACE inhibitor/angiotensin receptor blocker/angiotensin receptor neprilysin inhibitor at least 50% of target dose, (2) beta-blocker at least 50% of target dose, (3) mineralocorticoid receptor antagonist at any dose, (4) anticoagulation for patients diagnosed with atrial fibrillation, (5) referral to cardiac rehabilitation. Secondary outcomes will include functional capacity (6-minute walk test); quality of life (Kansas City Cardiomyopathy Questionnaire); depressive symptoms (Patient Health Questionnaire-2); self-care behaviour (Self-Care of Heart Failure Index). Resource utilisation will also be assessed.Ethics and disseminationEthical approval was granted by the South Metropolitan Health Service Ethics Committee (RGS3531), with reciprocal approval at Curtin University (HRE2020-0322). Results will be disseminated via peer-reviewed publications and conferences.Trial registration numberACTRN12620001069943.
Sex differences in non-communicable disease multimorbidity among adults aged 45 years or older in India
Authors: Sharma Santosh Kumar , Nambiar Devaki , Ghosh Arpita 
Published: March 2023

ObjectiveOlder male and female adults differ in key characteristics such as disease-specific life expectancy, health behaviours and clinical presentations and non-communicable disease multimorbidity (NCD-MM). Therefore, examining the sex differences in NCD-MM among older adults is vital, as this issue is understudied in low-income and middle-income country (LMIC) contexts such as India, and has been growing in the past few decades.DesignLarge scale nationally representative cross-sectional study.Settings and participantsLongitudinal Ageing Study in India (LASI 2017–2018) had data on 27 343 men and 31 730 women aged 45+, drawn from a sample of 59 073 individuals across India.Primary and secondary outcomes measuresWe operationalised NCD-MM based on prevalence of the presence of two or more long-term chronic NCD morbidities. Descriptive statistics and bivariate analysis along with multivariate statistics were used.ResultsWomen aged 75+ had a higher prevalence of multimorbidity as compared with men (52.1% vs 45.17%). NCD-MM was more common among widows (48.5%) than widowers (44.8%). The female-to-male ratios of ORs (RORs) for NCD-MM associated with overweight/obesity and prior history of chewing tobacco were 1.10 (95% CI: 1.01 to 1.20) and 1.42 (95% CI: 1.12 to 1.80), respectively. The female-to-male RORs show that the odds of NCD-MM were greater in formerly working women (1.24 (95% CI: 1.06 to 1.44)) relative to formerly working men. The effect of increasing NCD-MM on limitations in activities of daily living and instrumental ADL was greater in men than women but reversed for the hospitalisation.ConclusionsWe found significant sex differences in NCD-MM prevalence among older Indian adults, with various associated risk factors. The patterns underlying these differences warrant greater study, given existing evidence on differential longevity, health burdens and health-seeking patterns all of which operate in a larger structural context of patriarchy. Health systems in turn must respond to NCD-MM mindful of these patterns and aim to redress some of the larger inequities they reflect.
Association between periodontitis and hypertension: cross-sectional survey from the Fourth National Oral Health Survey of China (2015–2016)
Authors: Zhan Yalin , Jiao Jian , Jing Wudi , Feng Xiping , Tai Baojun , Hu Deyu , Lin Huan-cai , Wang Bo , Wang Chunxiao , Zheng Shuguo , Liu Xuenan , Rong Wensheng , Wang Weijian , Wang Xing , Si Yan , Meng Huanxin 
Published: March 2023

ObjectivesTo evaluate the association between periodontitis severity and hypertension based on Chinese epidemiological data.DesignThis cross-sectional survey enrolled adults from the Fourth National Oral Health Survey of China (2015–2016).SettingThe data were obtained from the Fourth National Oral Health Survey of China (2015–2016).ParticipantsThe study included individuals aged 35–44 years (n=4409), 55–64 years (n=4568) and 65–74 years (n=4218).Primary and secondary outcome measuresPeriodontal status, defined on the basis of the 2017 classification scheme, and periodontal parameters (eg, bleeding on probing (BOP)) were compared between individuals with hypertension and individuals with normotension. Smoothed scatterplots were constructed to demonstrate the associations of periodontal parameters and periodontal status with hypertension.ResultsSevere periodontitis (stages III and IV) was present in 41.4% of individuals with hypertension and 28.0% of individuals with normotension, respectively (p<0.001). The prevalence of severe periodontitis was higher in individuals with hypertension than that in individuals with normotension among participants aged 35–44 years (18.0% vs 10.1%, p<0.001) and 55–64 years (40.2% vs 36.7%, p=0.035), but not in participants aged 65–74 years (46.4% vs 45.1%, p=0.429). Therefore, the difference in periodontal status between individuals with hypertension and individuals with normotension decreased with age. There were higher prevalences of BOP, probing depth (PD) ≥4 mm and PD ≥6 mm in individuals with hypertension than in individuals with normotension (52.1% vs 49.2%, 19.6% vs 14.7% and 1.8% vs 1.1%, respectively). Periodontitis severity and the proportion of teeth with PD ≥4 or ≥6 mm were positively associated with hypertension.ConclusionPeriodontitis is associated with hypertension in Chinese adults. Hypertension prevalence increased with periodontitis severity, particularly among young participants. Accordingly, it is necessary to improve the education, awareness of periodontal treatment and preventive management among individuals at risk of hypertension, particularly in the younger population.
How does discharge against medical advice affect risk of mortality and unplanned readmission? A retrospective cohort study set in a large UK medical admissions unit
Authors: Alagappan Anand , Chambers Thomas J G , Brown Erik , Grecian Sheila M , Lockman Khalida Ann 
Published: March 2023

ObjectivesTo assess the frequency of discharge against medical advice (DAMA) in a large UK teaching hospital, explore factors which increase the risk of DAMA and identify how DAMA impacts patient risk of mortality and readmission.DesignRetrospective cohort study.SettingLarge acute teaching hospital in the UK.Patients36 683 patients discharged from the acute medical unit of a large UK teaching hospital between 1 January 2012 and 31 December 2016.MeasurementsPatients were censored on 1 January 2021. Mortality and 30-day unplanned readmission rates were assessed. Deprivation, age and sex were taken as covariates.Results3% of patients discharged against medical advice. These patients were younger (median age (years) (IQR)): planned discharge (PD) 59 (40–77); DAMA 39 (28–51), predominantly of male sex (PD 48%; DAMA 66%) and were of greater social deprivation (in three most deprived quintiles PD 69%; DAMA 84%). DAMA was associated with increased risk of death in patients under the age of 33.3 years (adjusted HR 2.6 (1.2–5.8)) and increased incidence of 30-day readmission (standardised incidence ratio 1.9 (1.5–2.2)).LimitationsReadmission to acute hospitals outside of the local health board may have been missed. We were unable to include information regarding comorbidity or severity of presentation.ConclusionsThese data highlight the vulnerability of younger patients who DAMA, even in a free-at-the-point-of-delivery healthcare setting.
Biomarker-guided intervention to prevent acute kidney injury after major surgery (BigpAK-2 trial): study protocol for an international, prospective, randomised controlled multicentre trial
Authors: von Groote Thilo , Meersch Melanie , Romagnoli Stefano , Ostermann Marlies , Ripollés-Melchor Javier , Schneider Antoine Guillaume , Vandenberghe Wim , Monard Céline , De Rosa Silvia , Cattin Lucia , Rahmel Tim , Adamzik Michael , Parise Diego , Candela-Toha Angel , Haaker Jan Gerrit , Göbel Ulrich , Bernard Alice , Lumlertgul Nuttha , Fernández-Valdes-Bango Paula , Romero Bhathal Irene , Suarez-de-la-Rica A , Larmann Jan , Villa Gianluca , Spadaro Savino , Wulf Hinnerk , Arndt Christian , Putensen Christian , García-Álvarez Raquel , Brandenburger Timo , Siniscalchi Antonio , Ellerkmann Richard , Espeter Florian , Porschen Christian , Sadjadi Mahan , Saadat-Gilani Khaschayar , Weiss Raphael , Gerss Joachim , Kellum John , Zarbock Alexander 
Published: March 2023

IntroductionPrevious studies demonstrated that the implementation of the Kidney Disease Improving Global Outcomes (KDIGO) guideline-based bundle, consisting of different supportive measures in patients at high risk for acute kidney injury (AKI), might reduce rate and severity of AKI after surgery. However, the effects of the care bundle in broader population of patients undergoing surgery require confirmation.Methods and analysisThe BigpAK-2 trial is an international, randomised, controlled, multicentre trial. The trial aims to enrol 1302 patients undergoing major surgery who are subsequently admitted to the intensive care or high dependency unit and are at high-risk for postoperative AKI as identified by urinary biomarkers (tissue inhibitor of metalloproteinases 2*insulin like growth factor binding protein 7 (TIMP-2)*IGFBP7)). Eligible patients will be randomised to receive either standard of care (control) or a KDIGO-based AKI care bundle (intervention). The primary endpoint is the incidence of moderate or severe AKI (stage 2 or 3) within 72 hours after surgery, according to the KDIGO 2012 criteria. Secondary endpoints include adherence to the KDIGO care bundle, occurrence and severity of any stage of AKI, change in biomarker values during 12 hours after initial measurement of (TIMP-2)*(IGFBP7), number of free days of mechanical ventilation and vasopressors, need for renal replacement therapy (RRT), duration of RRT, renal recovery, 30-day and 60-day mortality, intensive care unit length-of-stay and hospital length-of-stay and major adverse kidney events. An add-on study will investigate blood and urine samples from recruited patients for immunological functions and kidney damage.Ethics and disseminationThe BigpAK-2 trial was approved by the Ethics Committee of the Medical Faculty of the University of Münster and subsequently by the corresponding Ethics Committee of the participating sites. A study amendment was approved subsequently. In the UK, the trial was adopted as an NIHR portfolio study. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and will guide patient care and further research.Trial registration numberNCT04647396.
Cross-sectional study of characteristics and prevalence of musculoskeletal complaints in 1170 male golfers
Authors: Murray Andrew , Junge Astrid , Robinson Patrick Gordon , Clarsen Ben , Mountjoy Margo Lynn , Drobny Tomas , Gill Lance , Gazzano Francois , Voight Mike , Dvorak Jiri 
Published: March 2023

ObjectivesThe primary aim was to describe the characteristics and prevalence of musculoskeletal complaints of a large group of non-professional golfers. Secondary aims were to compare golfers different in (A) skill-level, (B) presence of low back pain (LBP) and (C) performance of prevention exercises.MethodsA sample of 1170 male golfers (mean age 54.98, SD=13.3) were surveyed online on personal and golf-specific characteristics, medical history and complaints in the preceding 7 days. Subgroups (A) with different golfing handicap (0 to 5, >5 to 10, >10), (B) with and without LBP and (C) who performed versus did not perform injury prevention exercises were compared using analysis of variance and χ2test.ResultsThe prevalence and severity of musculoskeletal complaints was similar in everyday life and when playing golf. More than one-third of the golfers (n=436; 37.3%) reported LBP in the preceding 7 days, while other frequently affected body parts were the shoulder and knee. Golfers with different skill level differed in age and most golf-related characteristics but not in prevalence and severity of musculoskeletal complaints. Golfers with and without LBP were similar in almost all variables. Golfers who performed prevention exercises (n=371; 27.1%) were older and had a higher prevalence of complaints.ConclusionThe prevalence and severity of musculoskeletal complaints in golfers were similar to the wider population. It seems that injury prevention exercises were implemented after injury, rather than as primary prevention. Prospective studies looking at the epidemiology of injury, risk factors and interventions are required.
Associations between nailfold capillary aberrations and autoantibodies in children and adults with Raynaud’s phenomenon
Authors: Mueller Markus , Gschwandtner Michael E , Emminger Wolfgang , Kiener Hans , Schnaubelt Sebastian , Giurgea Georgiana-Aura , Ristl Robin , Perkmann Thomas , Koppensteiner Renate , Schlager Oliver 
Published: March 2023

ObjectiveTo characterise associations between individual nailfold capillary aberrations with autoantibodies in a cross-sectional study on children and adults with Raynaud’s phenomenon (RP).MethodsConsecutive children and adults with RP and without previously known connective tissue disease (CTD) systemically underwent nailfold capillaroscopy and laboratory tests for the presence of antinuclear antibodies (ANA). The prevalence of individual nailfold capillary aberrations and ANA was assessed, and the associations between individual nailfold capillary aberrations and ANA were analysed separately in children and adolescents.ResultsIn total, 113 children (median age 15 years) and 2858 adults (median age 48 years) with RP and without previously known CTD were assessed. At least one nailfold capillary aberration was detected in 72 (64%) of included children and in 2154 (75%) of included adults with RP (children vs adults p<0.05). An ANA titre ≥1:80, ≥1:160 or≥1:320 was observed in 29%, 21% or 16% of included children, and in 37%, 27% or 24% of screened adults, respectively. While the occurrence of individual nailfold capillary aberrations was related to the presence of an ANA titre of ≥1:80 in adults (reduced capillary density, avascular fields, haemorrhages, oedema, ramifications, dilations and giant capillaries: each p<0.001), no comparable association between nailfold capillary aberrations and ANA was observed in children with RP without previously known CTD.ConclusionIn contrast to adults, the association between nailfold capillary aberrations and ANA might be less pronounced in children. Further studies are warranted to validate these observations in children with RP.
Breast cancer survivors–supportive care needs: systematic review
Authors: Khajoei Rahimeh , Ilkhani Mahnaz , Azadeh Payam , Zohari Anboohi Sima , Heshmati Nabavi Fatemah 
Published: March 2023

ObjectivesTo achieve optimal survival care outcomes, all healthcare services must be tailored to patients’ specific needs, preferences and concerns throughout the survival period. This study aimed to identify supportive care needs from the point of view of breast cancer survivors.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for reporting systematic reviews, a comprehensive search of PubMed, Web of Science and Scopus was performed. The inclusion criteria were studies published from inception to the end of January 2022, covering all stages of breast cancer. The exclusion criteria were mixed-type studies relating to cancer, such as case reports, commentaries, editorials and systematic reviews, as well as studies that assessed patients’ needs during cancer treatment. Two quality assessment tools were used for the qualitative and quantitative studies.ResultsOf the 13 095 records retrieved, 40 studies, including 20 qualitative and 20 quantitative studies, were retained for this review. Survivors’ supportive care needs were classified into 10 dimensions and 40 subdimensions. The most frequently mentioned supportive care needs of survivors were psychological/emotional needs (N=32), health system/informational needs (N=30), physical and daily activities (N=19), and interpersonal/intimacy needs (N=19).ConclusionsThis systematic review highlights several essential needs for breast cancer survivors. Supportive programmes should be designed in order to take into consideration all aspects of these needs, particularly psychological, emotional and informational needs.
Good versus bad news consultations in advanced breast cancer: the role of empathy in information recall – an observational study
Authors: van Vliet Liesbeth M , Leeuwenburgh Margot L R , Westendorp Janine , van Dulmen Sandra , de Jong Paul C , Stouthard Jacqueline M L 
Published: March 2023

ObjectiveWe explored, in advanced breast cancer, whether: (1) patients recall less information following bad versus good news consultations; (2) empathy has a greater effect on recalled information following bad versus good news consultations.MethodsObservational study using audio-recorded consultations. Participants’ recall of provided information about treatment options, aims/positive effects and side-effects was assessed. Clinician-expressed empathy and consultation type were determined. Regression analyses assessed associations between consultation type and recall, exploring moderating influences of clinician-expressed empathy.ResultsFor 41 consultations (18 bad news, 23 good news), recall data were completed; total recall (47% vs 73%, p=0.03) and recall about treatment options (67% vs 85%, p=0.08, trend) were significantly worse following bad news compared with good news consultations. Recall about treatment aims/positive effects (53% vs 70%, p=0.30) and side-effects (28% vs 49%, p=0.20) was not significantly worse following bad news. Empathy moderated the relationship between consultation type and total recall (p<0.01), recall about treatment options (p=0.03) and about aims/positive effects (p<0.01) but not about side-effects (p=0.10). Only following good news consultations empathy influenced recall favourably.ConclusionsThis explorative study suggests that in advanced cancer, information recall is especially impaired following bad news consultations, for which empathy does not improve remembered information.
Prevalence and Clinical Consequences of Multiple Pathogenic Variants in Dilated Cardiomyopathy
Authors: Stroeks Sophie L.V.M. , Lunde Ida G. , Hellebrekers Debby M.E.I. , Claes Godelieve R.F. , Wakimoto Hiroko , Gorham Joshua , Krapels Ingrid P.C. , Vanhoutte Els K. , van den Wijngaard Arthur , Henkens Michiel T.H.M. , Raafs Anne G. , Sikking Maurits A. , Broers Jos L.V. , Nabben Miranda , Jones Elizabeth A.V. , Heymans Stephane R.B. , Brunner Han G. , Verdonschot Job A.J. 
Published: March 2023

Background:
Dilated cardiomyopathy (DCM) was considered a monogenetic disease that can be caused by over 60 genes. Evidence suggests that the combination of multiple pathogenic variants leads to greater disease severity and earlier onset. So far, not much is known about the prevalence and disease course of multiple pathogenic variants in patients with DCM. To gain insight into these knowledge gaps, we (1) systematically collected clinical information from a well-characterized DCM cohort and (2) created a mouse model.

Methods:
Complete cardiac phenotyping and genotyping was performed in 685 patients with consecutive DCM. Compound heterozygous digenic (LMNA [lamin]/titin deletion A-band) with monogenic (LMNA/wild-type) and wild-type/wild-type mice were created and phenotypically followed over time.

Results:
One hundred thirty-one likely pathogenic/pathogenic (LP/P) variants in robust DCM-associated genes were found in 685 patients with DCM (19.1%) genotyped for the robust genes. Three of the 131 patients had a second LP/P variant (2.3%). These 3 patients had a comparable disease onset, disease severity, and clinical course to patients with DCM with one LP/P. The LMNA/Titin deletion A-band mice had no functional differences compared with the LMNA/wild-type mice after 40 weeks of follow-up, although RNA-sequencing suggests increased cardiac stress and sarcomere insufficiency in the LMNA/Titin deletion A-band mice.

Conclusions:
In this study population, 2.3% of patients with DCM with one LP/P also have a second LP/P in a different gene. Although the second LP/P does not seem to influence the disease course of DCM in patients and mice, the finding of a second LP/P can be of importance to their relatives.