bluuebunny/crossref_metadata_2025_split huggingface dataset:
Telemonitoring and protocolized case management for hypertensive community dwelling older adults (TECHNOMED): a randomized controlled trial
Authors: Lau Darren , Ringrose Jennifer , McAlister Finlay A. , Fradette Miriam , Wood Peter W. , Boulanger Pierre , Klarenbach Scott , Holroyd-Leduc Jayna M. , Alagiakrishnan Kannayiram , Rabi Doreen , Padwal Raj 
Published: August 2022

Background:
Home blood pressure (BP) telemonitoring combined with case management leads to BP reductions in individuals with hypertension. However, its benefits are less clear in older (age ≥ 65 years) adults.

Methods:
Twelve-month, open-label, randomized trial of community-dwelling older adults comparing the combination of home BP telemonitoring (HBPM) and pharmacist-led case management, vs. enhanced usual care with HBPM alone. The primary outcome was the proportion achieving systolic BP targets on 24-h ambulatory BP monitoring (ABPM). Changes in HBPM were also examined. Logistic and linear regressions were used for analyses, adjusted for baseline BP.

Results:
Enrollment was stopped early due to coronavirus disease 2019. Participants randomized to intervention (n = 61) and control (n = 59) groups were mostly female (77%), with mean age 79.5 years. The adjusted odds ratio for ABPM BP target achievement was 1.48 (95% confidence interval 0.87–2.52, P = 0.15). At 12 months, the mean difference in BP changes between intervention and control groups was −1.6/−1.1 for ABPM (P-value 0.26 for systolic BP and 0.10 for diastolic BP), and −4.9/−3.1 for HBPM (P-value 0.04 for systolic BP and 0.01 for diastolic BP), favoring the intervention. Intervention group participants had hypotension (systolic BP < 110) more frequently (21% vs. 5%, P = 0.009), but no differences in orthostatic symptoms, syncope, non-mechanical falls, or emergency department visits.

Conclusions:
Home BP telemonitoring and pharmacist case management did not improve achievement of target range ambulatory BP, but did reduce home BP. It did not result in major adverse consequences.
Are you as old as your arteries? Comparing arterial aging in Japanese and European patient groups using cardio-ankle vascular index
Authors: Kirkham Frances A. , Mills Charlotte , Fantin Francesco , Tatsuno Ichiro , Nagayama Daiji , Giani Anna , Zamboni Mauro , Shirai Kohji , Cruickshank John Kennedy , Rajkumar Chakravarthi 
Published: August 2022

Background:Most comparisons of arterial stiffness between ethnic groups focus on pulse wave velocity. This study used the cardio-ankle vascular index (CAVI) in European compared to Japanese individuals to investigate how cardiovascular risk factors affect arterial aging across geographic regions.Methods:Four hundred and ninety-four European and 1044 Japanese individuals underwent measurements of CAVI, blood pressure and information on cardiovascular risk factors. Both datasets included individuals with 0–5 cardiovascular risk factors.Results:Average CAVI was higher in the Japanese than the European group in every age category, with significant differences up to 75 years for males and 85 for females. The correlation of CAVI with age, controlled for cardiovascular risk factors, was slightly higher in Japanese females (r = 0.594 vs. Europeansr = 0.542) but much higher in European males (r = 0.710 vs. Japaneser = 0.511). There was a significant correlation between CAVI and total cardiovascular risk factors in the Japanese (r = 0.141,P < 0.001) but not the European group. On linear regression, average CAVI was significantly dependent on age, sex, diabetes, BMI, SBP and geographic region. When divided into ‘healthy’ vs. ‘high risk’, the healthy group had a steeper correlation with age for Europeans (r = 0.644 vs. Japaneser = 0.472, Fisher'sZ P < 0.001), whereas in the high-risk group, both geographic regions had similar correlations.Conclusion:Japanese patient groups had higher arterial stiffness than Europeans, as measured by CAVI, controlling for cardiovascular risk factors. Europeans had greater increases in arterial stiffness with age in healthy individuals, particularly for males. However, cardiovascular risk factors had a greater impact on the Japanese group.
Decreasing the Rate of Antibiotics Administration to Newborns of Mothers With Prolonged Rupture of Membranes and Unknown Group B Streptococcus Status Using the Plan-Do-Study-Act Quality Improvement Model
Authors: Alaaraj Bayan , Irshaid Ayah , Al-lawama Manar 
Published: August 2022

Background
Prolonged rupture of membranes (PROM) and maternal group B Streptococcus (GBS) colonization are major risk factors for early-onset sepsis. Managing asymptomatic newborns remains burdensome, as exposing them to unnecessary antibiotics or withholding them when needed is potentially harmful. Decreasing the rate of antibiotics administration to newborns of mothers with PROM and unknown GBS status is important.

Methods
A quality improvement project applying the Plan-Do-Study-Act model was conducted to test the efficacy of a proposed protocol to lower the rate of antibiotics administration. This protocol uses information on clinical status and biochemical markers, as well as the recommendation of the neonatal early-onset sepsis calculator, to decide whether to start antibiotics administration to newborns of mothers with PROM and unknown GBS status who are asymptomatic at birth. Neonates born at ≥34 weeks' gestation to mothers with PROM and unknown GBS status were included in this work.

Results
Sixty-six babies were included, 2 (3%) of whom had positive blood cultures, and a total of 24 (41.8%) newborns did not receive antibiotics. The rate of antibiotics administration for 2 days only was 55 times lower than the current practice. The rate of no antibiotics administration was 35 times higher than the current practice (P < 0.0001). None of the included newborns were readmitted because of sepsis.

Conclusions
The rate of antibiotics administration was significantly decreased. None of the infants were readmitted because of sepsis, proving protocol safety. The implemented protocol will be adopted, as the aim of this quality improvement project was achieved.
Therapists Predict Discharge Destination More Accurately Than the AM-PAC “6 Clicks” at Evaluation and Discharge for Patients With Isolated Coronary Artery Bypass Graft
Authors: Bradley Rebecca , Tecson Kristen M. , Schuchert Jerry , Topping Michele 
Published: August 2022

Background:
Clinicians and hospital care coordinators seek effective tools to assist with reducing length of stay, delivering appropriate postacute care services, and reducing readmissions for patients following coronary artery bypass grafting (CABG) surgery.

Objective:
To evaluate whether the discharge recommendation by the Activity Measure for Post-Acute Care (AM-PAC) “6 Clicks” Inpatient Basic Mobility and Daily Activity Short Forms agreed with therapists' recommendation and actual discharge disposition for patients who underwent isolated CABG.

Methods:
Physical therapists (PTs) and occupational therapists (OTs) recorded their respective AM-PAC “6 Clicks” score on a cohort of consecutive patients admitted for isolated CABG between March and April 2020. The level of agreement was compared between AM-PAC-projected discharge disposition, therapists' recommendation, and actual discharge disposition.

Results:
There were 58 patients who received discharge recommendations from PTs and OTs following isolated CABG. Upon PT initial evaluation, the AM-PAC “6 Clicks” Basic Mobility tool recommended postacute placement in all 58 (100%) cases, whereas PTs recommended postacute placement for only 1 (2%). Similarly, the AM-PAC “6 Clicks” Daily Activity tool recommended postacute placement in all 58 (100%) cases, whereas OTs recommended discharge to home for 44 (76%) cases and recommended further assessment of discharge needs on the remaining 14 (24%). At the final session, the AM-PAC “6 Clicks” Basic Mobility tool recommended postacute placement in 56 (98%) cases and PTs recommended discharge to home in all 58 (100%) cases. The AM-PAC “6 Clicks” Daily Activity tool recommended postacute placement for 25 (43%) cases, whereas OTs recommended discharge to home for 55 (95%) cases. Nearly all (56; 97%) patients were discharged to home, with the remaining 2 (3%) discharged to postacute placement. The 30- day readmission rate was 2%.

Conclusion:
We found the PT/OT recommendations were strongly associated with discharge disposition, but that the AM-PAC “6 Clicks” scores had poor agreement with therapists' recommendations and with actual discharge dispositions for patients with isolated CABG. The utility of this tool should be explored in other cardiac patient populations, such as valve replacements with and without sternotomy, and heart failure, to corroborate the results.
Voluntary Unemployment Is Associated With Increased Prevalence of Stroke and its Risk Factors in Middle-Aged Adults
Authors: Błaż Michał , Banaszkiewicz Krzysztof , Michalski Michał , Sarzyńska-Długosz Iwona 
Published: August 2022

Objective
The aim of the study is to investigate the association between the prevalence of stroke, its risk factors, and occupational status, with a differentiation between voluntary and involuntary unemployment.

Methods
This is a cross-sectional study, which included 3013 individuals aged 40 to 65 years. We compared the prevalence of stroke, comorbidities, self-reported stroke-like symptoms, healthy behaviors, and knowledge about stroke among the voluntarily and involuntarily unemployed versus the employed.

Results
Voluntary unemployment was associated with increased chances of stroke (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.05–3.57), hypertension (OR, 1.18; 95% CI, 1.06–1.32), diabetes (OR, 1.16; 95% CI, 1.01–1.35), and obesity (OR, 1.16; 95% CI, 1.05–1.29). Involuntary job loss was associated with increased odds of hypertension (OR, 1.69; 95% CI, 1.16–2.50) and more frequent self-reported stroke-like symptoms.

Conclusions
We found higher chances of stroke among the voluntarily unemployed middle-aged adults, presumably because of increased prevalence of hypertension, diabetes, and obesity.
Pressure Reduction Management System in Three-Dimensional-Printed Transtibial Prosthetic Socket during Stance Phase
Authors: Subih Murad , Arifin Nooranida , Al-Fakih Ebrahim A. 
Published: August 2022

ABSTRACT

Introduction
High pressure on sensitive areas of the residual limb while wearing a prosthetic socket must be minimized to avoid injury and uncomfortable fitting. The purpose of this study was to reduce the peak pressures on sensitive regions within a three-dimensional (3D)-printed transtibial prosthetic socket.

Materials and Methods
This study proposed a 3D-printed socket with three built-in tiny air bladders integrated within the interface between the liner and socket and electronically managed by a pressure and volume control system. A pseudo-artificial residual limb was fabricated to mimic the transtibial residual limb. The interface pressure in the 3D-printed socket was evaluated using F-socket transducers during inflation and deflation of the air bladders in the stance phase through universal tensile machine load.

Results
Based on the statistical analysis, the highest significant pressure reduction (P < 0.05) was 5.71%, which was recorded at the posterior region, and 4.68% (P < 0.05) at the medial region during posterior and medial air bladders inflation, respectively.

Conclusion
Peak pressures were reduced at the lateral tibia condyle, tibia tuberosity, tibia crest, anterior distal end of tibia, fibula head, distal end of fibula, medial femoral condyle, lateral femur condyle, and patellar of the artificial residual limb.

Clinical Relevance
This system has the potential to minimize high pressures at the subregions of the residual limb in clinical settings and in day-to-day activities. Thus, this design could provide an excellent pressure and volume control at the bony areas, which improves satisfaction and socket fit for persons with amputation.
Hearing Aids Enhance Music Enjoyment in Individuals With Hearing Loss
Authors: Chern Alexander , Denham Michael W. , Leiderman Alexis S. , Sharma Rahul K. , Su Irene W. , Ucci Amanda J. , Jones Jennifer M. , Mancuso Dean , Cellum Ilana P. , Galatioto Jessica A. , Lalwani Anil K. 
Published: August 2022

Objective
To investigate music appreciation in hearing aid (HA) users with varying levels of hearing loss (HL).

Study Design
Cross-sectional, within-subjects design.

Setting
Tertiary medical center, community.

Patients
Adults (≥18 yr) bilateral HA users.

Interventions
HA usage.

Main Outcome Measures
Outcome variables included self-reported music enjoyment measures (pleasantness, musicality, naturalness) with and without HAs assessed with visual analogue scales (10 indicates highest level of enjoyment, 0 the least). Exposure variables include HL (better ear pure-tone average) and speech discrimination (word recognition scores [WRS]). Demographic information was collected.

Results
One hundred nine bilateral HA users completed the study. Mean (standard deviation) age was 66.6 years (16.8 yr); 52.3% were female patients. Mean (standard deviation) better ear pure-tone average was 51.1 dB (16.3 dB) HL. Increased severity of HL and worse WRS were associated with decreased music enjoyment (p < 0.05) across all measures without HAs, adjusting for sex, age, education, race, HA type, age of HL diagnosis, duration of HL, duration of HA use, musical preference, and musical experience. However, these associations were attenuated or no longer significant with HA usage. Moreover, among all subjects, HAs (vs. no HAs) provided increased music enjoyment in pleasantness (HA, 6.94, no HA, 5.74; p < 0.01), musicality (HA, 7.35; no HA, 6.13, p < 0.01), and naturalness (HA, 6.75; no HA, 6.02; p = 0.02).

Conclusion
HA users report increased music enjoyment with HAs compared with without HAs. Increased severity of HL and worse WRS were independently associated with decreased unaided music enjoyment. HA usage seems to mitigate this effect, particularly for those with worse HL.
Hearing Preservation After Intervention in Vestibular Schwannoma
Authors: Yancey Kristen L. , Barnett Samuel L. , Kutz Walter , Isaacson Brandon , Wardak Zabi , Mickey Bruce , Hunter Jacob B. 
Published: August 2022

Objective
This study aimed to assess the durability of audiological outcomes after radiation and surgery in the management of vestibular schwannoma.

Study Design
Retrospective review.

Setting
Tertiary academic center.

Patients
Adults with sporadic vestibular schwannoma and serviceable hearing at the time of intervention.

Interventions
Gamma Knife, middle cranial fossa, or retrosigmoid approaches.

Main Outcome Measures
Pure-tone audiometry and speech discrimination scores.

Results
Postintervention serviceable hearing (class A/B) was preserved in 70.4% (n = 130; mean follow-up, 3.31 yr; range, 0–15.25 yr). Of the 49 patients treated with radiation, 19 (39.6%) had serviceable hearing at last follow-up, compared with 38 (46.9% of 81) who underwent retrosigmoid (n = 36 [44.4%]) and middle cranial fossa (n = 45 [55.6%]) approaches (odds ratio [OR], 1.40; 95% confidence interval [CI], 0.67–2.82; p = 0.47). A matched analysis by age, tumor volume, and preintervention hearing (n = 38) also found no difference in hearing preservation (HP) likelihood between surgery and radiation (OR, 2.33; 95% CI, 0.24–35.91; p = 0.59). After initial HP, 4 (9.5%) surgical versus 10 (37.0%) radiated patients subsequently lost residual serviceable (A/B) hearing (OR, 0.18; 95% CI, 0.06–0.69; p = 0.01) at a mean 3.74 ± 3.58 and 4.73 ± 3.83 years after surgery and radiation, respectively. Overall, 5- and 10-year HP rates (A/B) after initially successful HP surgery were 84.4 and 63.0%, respectively. However, survival estimates declined to 48.9% at 5 years and 32.7% at 10 years when patients with immediate postoperative serviceable hearing loss were also included, which were comparable to radiation-HP rates at 5 and 10 years of 28.0 and 14.2%, respectively (p = 0.75).

Conclusions
After vestibular schwannoma intervention, overall HP was similar between radiated and surgical cohorts. However, when successful, surgical approaches offered more durable hearing outcomes at long-term follow-up.
Comparison of intracoronary versus intravenous tirofiban in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention
Authors: Tang Xiuying , Li Runjun , Zhang Ting 
Published: August 2022

Objective
This study aimed to investigate the effect of intracoronary (IC) tirofiban compared to intravenously administered tirofiban in STEMI patients treated with PPCI.

Methods
This study included 180 STEMI patients who were underwent PPCI. Patients were randomized into an IC group (n = 90) and intravenous (IV) group (n = 90). During the procedure, the both groups were administered IC or IV injections of tirofiban, respectively, followed by an IV infusion of tirofiban for 24 hours. Changes in TIMI flow grading, TMP grade 3, Sum-STR two hours after the operation, the number of thrombus aspirations during the operation, myocardial enzyme, inflammatory factors,cardiac functional parameters, MACE and bleeding were investigated.

Results
Following treatment, TIMI flow grading and TMP grade 3 were improved in the IC tirofiban compared to the IV group (P = 0.022 and P = 0.014, respectively). Additionally, the Sum-STR two hours after operation, the incidence of MACEs, levels of AST, CRP, ESR, and TNI in the IC group was improved, compared with the IV group (all P < 0.05). Furthermore. Cardiac function including CO and LVEF were significantly improved in the IC group 6 months after discharge.

Conclusion
This study found that IC administration of tirofiban in patients with STEMI who underwent PPCI improved TIMI, TMP flow and cardiac function 6 months after discharge, and reduced CRP, ESR, and TNI. However, the incidence of bleeding between the two groups was comparable. These findings suggest that IC administration should be applied in certain acute STEMI patients.
The role of proteomics and metabolomics in severe infections
Authors: Póvoa Pedro , Bos Lieuwe D.J. , Coelho Luís 
Published: August 2022

Purpose of review
Severe infections are a common cause of ICU admission, with a high morbidity and mortality. Omics, namely proteomics and metabolomics, aim to identify, characterize, and quantify biological molecules to achieve a systems-level understanding of disease. The aim of this review is to provide a clear overview of the current evidence of the role of proteomics and metabolomics in severe infections.

Recent findings
Proteomics and metabolomics are technologies that are being used to explore new markers of diagnosis and prognosis, clarify mechanisms of disease, and consequently discover potential targets of therapy and finally of a better disease phenotyping. These technologies are starting to be used but not yet in clinical use.

Summary
Our traditional way of approaching the disease as sepsis is believing that a process can be broken into its parts and that the whole can be explained by the sum of each part. This approach is highly reductionist and does not take the system complexity nor the nonlinear dynamics of the processes. Proteomics and metabolomics allow the analysis of several proteins and metabolites simultaneously, thereby generating diagnostic and prognostic signatures. An exciting future prospect for proteomics and metabolomics is their employment towards precision medicine.
New antimicrobial treatment options for severe Gram-negative infections
Authors: Hetzler Lauren , Kollef Marin H. , Yuenger Valerie , Micek Scott T. , Betthauser Kevin D. 
Published: August 2022

Purpose of review
This review will provide rationale for the development of new antibiotics to treat severe or multidrug-resistant (MDR) Gram-negative infections. It will also provide an overview of recently approved and pipeline antibiotics for severe/MDR Gram-negative infections.

Recent findings
MDR Gram-negative infections are recognized as critical threats by global and national organizations and carry a significant morbidity and mortality risk. Increasing antibiotic resistance amongst Gram-negative bacteria, including carbapenem-resistant Acinetobacter baumannii, extended-spectrum β-lactamase-producing Enterobacterales, carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa, with difficult-to-treat-resistance has made both empiric and definitive treatment of these infections increasingly problematic. In recent years, several antibiotics have been approved for treatment of MDR Gram-negative infections and ongoing clinical trials are poised to provide additional options to clinicians’ armamentarium. These agents include various β-lactam/β-lactamase inhibitor combinations, eravacycline, plazomicin and cefiderocol.

Summary
Severe/MDR Gram-negative infections continue to be important infections due to their impact on patient outcomes, especially in critically ill and immunocompromised hosts. The availability of new antibiotics offers an opportunity to improve empiric and definitive treatment of these infections.
The Feasibility, Safety, and Long-term Outcomes of Endoscopic Submucosal Dissection for Colorectal Neoplasia in Patients With Inflammatory Bowel Disease
Authors: Akiyama Shintaro , Hamdeh Shadi , Sakamoto Taku , Suzuki Hideo , Tsuchiya Kiichiro 
Published: August 2022

Background:
Evidence regarding the utility of endoscopic submucosal dissection (ESD) for neoplasia in patients with inflammatory bowel disease (IBD) is limited. This meta-analysis aims to understand the feasibility, safety, and long-term outcomes of ESD in IBD patients.

Methods:
Electronic databases were searched for observational and case-controlled studies. Primary endpoints were en bloc resection and margin-negative resection of neoplastic lesions. Secondary endpoints included procedure-related bleeding and perforation, local recurrence, and metachronous neoplasia.

Results:
We analyzed 25 studies with a total of 585 neoplastic lesions in 552 patients. The rates of en bloc resection and margin-negative resection were 0.88 [95% confidence interval (CI) 0.82-0.92] and 0.78 (95% CI 0.72-0.83), respectively. Meta-regression analysis showed longer disease duration was significantly associated with the higher rate of en bloc resection. The rates of procedure-related bleeding and perforation were 0.080 (95% CI 0.057-0.11) and 0.055 (95% CI 0.038-0.081), respectively. The rates of local recurrence and metachronous neoplasia were 0.008 events/person-year (95% CI 0.002-0.013) and 0.031 event/person-year (95% CI 0.016-0.046), respectively. Meta-analysis of case-controlled studies found no significant differences in the endpoints between IBD patients treated by ESD and those treated by endoscopic mucosal resection, or non-IBD patients treated by ESD.

Conclusions:
ESD is a feasible and safe procedure to remove neoplastic lesions in IBD patients. Given there is a considerable risk of metachronous neoplasia development, postoperative surveillance colonoscopy with an appropriate consultation with surgeons is essential to monitor not only local recurrence but also neoplastic changes in the remaining colon.