bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scale-up of ABC care bundle for intracerebral haemorrhage across two hyperacute stroke units in one region in England: a mixed methods evaluation of a quality improvement project
Authors: Brunton Lisa , Sammut-Powell Camilla , Birleson Emily , Boaden Ruth , Knowles Sarah E , McQuaker Clare , Cross Stephen , Greaves Natalie , Paroutoglou Kyriaki , Alzouabi Omran , Patel Hiren C , Suman Appukuttan , Kawafi Khalil , Parry-Jones Adrian R 
Published: April 2022

BackgroundIntracerebral haemorrhage (ICH) accounts for 10%–15% of strokes in the UK, but is responsible for half of all annual global stroke deaths. The ABC bundle for ICH was developed and implemented at Salford Royal Hospital, and was associated with a 44% reduction in 30-day case fatality. Implementation of the bundle was scaled out to the other hyperacute stroke units (HASUs) in the region from April 2017. A mixed methods evaluation was conducted alongside to investigate factors influencing implementation of the bundle across new settings, in order to provide lessons for future spread.MethodsA harmonised quality improvement registry at each HASU captured consecutive patients with spontaneous ICH from October 2016 to March 2018 to capture process and outcome measures for preimplementation (October 2016 to March 2017) and implementation (April 2017 to March 2018) time periods. Statistical analyses were performed to determine differences in process measures and outcomes before and during implementation. Multiple qualitative methods (interviews, non-participant observation and project document analysis) captured how the bundle was implemented across the HASUs.ResultsHASU1 significantly reduced median anticoagulant reversal door-to-needle time from 132 min (IQR: 117–342) preimplementation to 76 min (64–113.5) after implementation and intensive blood pressure lowering door to target time from 345 min (204–866) preimplementation to 84 min (60–117) after implementation. No statistically significant improvements in process targets were observed at HASU2. No significant change was seen in 30-day mortality at either HASU. Qualitative evaluation identified the importance of facilitation during implementation and identified how contextual changes over time impacted on implementation. This identified the need for continued implementation support.ConclusionThe findings show how the ABC bundle can be successfully implemented into new settings and how challenges can impede implementation. Findings have been used to develop an implementation strategy to support future roll out of the bundle outside the region.
Examining the effect of quality improvement initiatives on decreasing racial disparities in maternal morbidity
Authors: Davidson Christina , Denning Stacie , Thorp Kristin , Tyer-Viola Lynda , Belfort Michael , Sangi-Haghpeykar Haleh , Gandhi Manisha 
Published: April 2022

The objective of this study was to evaluate the impact of quality improvement (QI) and patient safety initiatives and data disaggregation on racial disparities in severe maternal morbidity from hemorrhage (SMM-H).Our hospital began monitoring and reporting on SMM-overall and SMM-H rates in 2018 using administrative data. In March 2019, we began stratifying data by race and ethnicity and noted a disparity in rates, with non-Hispanic Black women having the highest SMM rates. The data was presented as run charts at monthly department meetings. During this time, our hospital implemented several QI and patient safety initiatives around obstetric hemorrhage and used the stratified data to inform guideline development to reduce racial disparity. The initiatives included implementation of a hemorrhage patient safety bundle and in-depth case reviews of adverse patient outcomes with a health equity focus. We then retrospectively analyzed our data. Our outcome of interest was SMM-H prior to data stratification (pre-intervention: June 2018-February 2019) as compared to after data stratification (post-intervention: March 2019-June 2020).During our study time period, there were 13,659 deliveries: 37% Hispanic, 35% White, 20% Black, 7% Asian and 1% Other. Pre-intervention, there was a statistically significant difference between Black and White women for SMM-H rates (p<0.001). This disparity was no longer significant post-intervention (p=0.138). The rate of SMM-H in Black women decreased from 45.5% to 31.6% (p=0.011).Our findings suggest that QI and patient safety efforts that incorporate race and ethnicity data stratification to identify disparities and use the information to target interventions have the potential to reduce disparities in SMM.
Burnout in Palliative Care - Difficult Cases: Qualitative Study
Authors: Koh Mervyn Yong Hwang , Gallardo Marysol Dalisay , Khoo Hwee Sing , Hum Allyn 
Published: April 2022

ObjectivesBurnout is common among palliative care clinicians, occurring as a result of emotions experienced in caring for challenging patients or families. Awareness of these scenarios helps clinicians and teams appropriately manage their own emotions and prevent burnout. We studied challenging clinical situations and the emotions encountered by experienced palliative care clinicians which could potentially contribute to burnout.MethodsA qualitative study was conducted using semistructured interviews with purposive sampling of 18 palliative care clinicians—5 doctors, 10 nurses and 3 social workers who worked in various palliative care settings (hospital palliative care team, home hospice and inpatient hospice). The interviews were recorded verbatim, transcribed and analysed using a thematic analysis approach.ResultsThe mean age of the interviewees was 52 years old and the mean number of years practising palliative care was 15.7 years (ranging from 10 to 25 years). The following clinical situations were reported by our respondents as particularly challenging, potentially leading to burnout: (1) abusive patients and families, (2) ‘bad deaths’, (3) death of young patients, (4) complex cases, and (5) having multiple deaths or difficult cases at any one time. Emotions encountered in the course of care of these cases included: (1) feeling overwhelmed, (2) having a sense of helplessness and failure, as well as (3) a sense of injustice.ConclusionThe challenging cases we described evoke strong emotional reactions from palliative care clinicians that need to be adequately addressed to prevent burnout.
Infantile dural sinus malformation: curative embolization in two stages with the Scepter mini balloon microcatheter
Authors: Matsoukas Stavros , Rossitto Christina P , Berenstein Alejandro , Fifi Johanna T 
Published: April 2022

Endovascular embolization is the mainstay for treatment of infantile dural sinus malformations.1 2 Distal access and flow control are limiting factors in controlled embolization.3–6 The Scepter mini catheter (Microvention, Aliso Viejo, California, USA) is a low-profile, dual-lumen balloon microcatheter designed to provide navigability in small-caliber, tortuous intracranial vessels. In this technical video, we demonstrate the staged embolization of a dural sinus malformation with multiple arteriovenous fistulae using the Scepter mini catheter (video 1). In the newborn patient, embolizations were performed through the parietal branches of the left and right middle meningeal arteries. The catheter easily navigated into the small feeding arteries. No neurological complications occurred due to the procedures. Post-embolization injections demonstrated significant flow reduction into the malformation. Three-month follow-up angiography illustrated resolution of the previously dilated left transverse sinus. Complete obliteration of the dural sinus malformation was achieved in the newborn patient.Video 1Curative embolization in two stages with the Scepter mini balloon microcatheter. ΑP, anteroposterior; CCA, common carotid artery.
Emergent microsurgical intervention for acute stroke after mechanical thrombectomy failure: a prospective study
Authors: Fiedler Jiří , Roubec Martin , Grubhoffer Marek , Ostrý Svatopluk , Procházka Václav , Langová Kateřina , Školoudík David 
Published: April 2022

BackgroundDespite all the gains that have been achieved with endovascular mechanical thrombectomy revascularization and intravenous thrombolysis logistics since 2015, there is still a subgroup of patients with salvageable brain tissue for whom persistent emergent large vessel occlusion portends a catastrophic outcome.ObjectiveTo test the safety and efficacy of emergent microsurgical intervention in patients with acute ischemic stroke and symptomatic middle cerebral artery occlusion after failure of mechanical thrombectomy.MethodsA prospective two-center cohort study was conducted. Patients with acute ischemic stroke and middle cerebral artery occlusion for whom recanalization failed at center 1 were randomly allocated to the microsurgical intervention group (MSIG) or control group 1 (CG1). All similar patients at center 2 were included in the control group 2 (CG2) with no surgical intervention. Microsurgical embolectomy and/or extracranial–intracranial bypass was performed in all MSIG patients at center 1.ResultsA total of 47 patients were enrolled in the study: 22 at center 1 (12 allocated to the MSIG and 10 to the CG1) and 25 patients at center 2 (CG2). MSIG group patients showed a better clinical outcome on day 90 after the stroke, where a modified Rankin Scale score of 0–2 was reached in 7 (58.3%) of 12 patients compared with 1/10 (10.0%) patients in the CG1 and 3/12 (12.0%) in the CG2.ConclusionsThis study demonstrated the potential for existing microsurgical techniques to provide good outcomes in 58% of microsurgically treated patients as a third-tier option.
Emergent carotid stenting versus no stenting for acute ischemic stroke due to tandem occlusion: a meta-analysis
Authors: Diana Francesco , Romoli Michele , Toccaceli Giada , Rouchaud Aymeric , Mounayer Charbel , Romano Daniele Giuseppe , Di Salle Francesco , Missori Paolo , Zini Andrea , Aguiar de Sousa Diana , Peschillo Simone 
Published: April 2022

BackgroundEmergent carotid artery stenting (eCAS) is performed during mechanical thrombectomy for acute ischemic stroke due to tandem occlusion. However, the optimal management strategy in this setting is still unclear.ObjectiveTo carry out a systematic review and meta-analysis to investigate the safety and efficacy of eCAS in patients with tandem occlusion.MethodsSystematic review followed the PRISMA guidelines. Medline, EMBASE, and Scopus were searched from January 1, 2004 to March 7, 2022 for studies evaluating eCAS and no-stenting approach in patients with stroke with tandem occlusion. Primary endpoint was the 90-day modified Rankin Scale score 0–2; secondary outcomes were (1) symptomatic intracerebral hemorrhage (sICH), (2) recurrent stroke, (3) successful recanalization (Thrombolysis in Cerebral Infarction score 2b–3), (4) embolization in new territories, and (5) restenosis rate. Meta-analysis was performed using the Mantel-Haenszel method and random-effects modeling.ResultsForty-six studies reached synthesis. eCAS was associated with higher good functional outcome compared with the no-stenting approach (OR=1.52, 95% CI 1.19 to 1.95), despite a significantly increased risk of sICH (OR=1.97, 95% CI 1.23 to 3.15), and higher successful recanalization rate (OR=1.91, 95% CI 1.29 to 2.85). Restenosis rate was lower in the eCAS group than in the no-stenting group (2% vs 9%, p=0.001). Recanalization rate was higher in retrograde than antegrade eCAS (OR=0.51, 95% CI 0.28 to 0.93). Intraprocedural antiplatelets during eCAS were associated with higher rate of good functional outcome (60% vs 46%, p=0.016) and lower rate of sICH (7% vs 11%; p=0.08) compared with glycoprotein IIb/IIIa inhibitors.ConclusionsIn observational studies, eCAS seems to be associated with higher good functional outcome than no-stenting in patients with acute ischemic stroke due to tandem occlusion, despite the higher risk of sICH. Dedicated trials are needed to confirm these results.
A national survey of venous sinus stenting practices for idiopathic intracranial hypertension
Authors: Fargen Kyle M , Kittel Carol , Amans Matthew R , Brinjikji Waleed , Hui Ferdinand 
Published: April 2022

BackgroundLittle is currently known about physician opinions and preferences on venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH), practice patterns, or clinical volumes.MethodsA 19 question online survey was designed and distributed to physician members of the Society of Neurointerventional Surgery (SNIS).ResultsA total of 107 individual survey responses were obtained (14% of SNIS members). The majority of respondents (85%) indicated that they had performed at least one VSS procedure independently during their careers. Mean (SD) and median (range) career case volumes were 20.9 (33.8) and 10.0 (0.0–200.0), respectively. On a 1–10 scale, most respondents reported a high level of interest in treating IIH patients with VSS (median 8), a high level of comfort/expertise in treating IIH patients with VSS (median 9), and that VSS was effective in the long term reduction of symptoms and papilledema in IIH patients (median 8). Fifty-nine per cent of respondents reported increasing VSS volumes compared with previous years. A major complication during a VSS procedure, including two deaths, was reported by 11% of respondents.ConclusionsThis is the first study designed to understand the opinions and practices of neurointerventionists regarding VSS for IIH. Overall physician opinion on VSS was quite positive, supported by increasing procedural volumes reported by most over the past few years. However, only a small percentage of respondents had substantial experience with VSS and major complications were not rare.
Comparative efficacy and safety of oral P2Y12inhibitors after non-ST-elevation acute coronary syndromes: a network meta-analysis
Authors: Farmakis Ioannis T , Zafeiropoulos Stefanos , Doundoulakis Ioannis , Pagiantza Areti , Karagiannidis Efstratios , Moysidis Dimitrios V , Stalikas Nikolaos , Kassimis George , Michalis Lampros K , Karvounis Haralambos , Giannakoulas George 
Published: April 2022

BackgroundCurrently, potent P2Y12inhibition with the use of prasugrel or ticagrelor is the mainstay of treatment after an acute coronary syndrome (ACS). The 2020 European Society of Cardiology (ESC) Guidelines recommend the use of prasugrel over ticagrelor in patients with non-ST-elevation ACS (NSTE-ACS) intended to receive invasive management (class IIa recommendation), however there are contradictory views regarding this recommendation.AimTo compare oral P2Y12inhibitors in NSTE-ACS in terms of efficacy and safety with a focus on patients intended to proceed to invasive management.MethodsWe systematically searched PubMed, Cochrane Central Register of Controlled Trials and Web of Science to identify studies that compared different oral P2Y12inhibitors (clopidogrel, prasugrel and ticagrelor) in patients with NSTE-ACS. Efficacy outcomes included the major adverse cardiovascular events outcome and safety outcomes included minor and major bleedings. We performed a frequentist network meta-analysis.ResultsNine studies (n=35 441 patients) were included in the systematic review. There was no difference between prasugrel and ticagrelor in the composite cardiovascular end point (prasugrel vs ticagrelor HR=0.80, 95% CI=0.61 to 1.06) in all patients with NSTE-ACS. In patients intended to receive invasive management, prasugrel resulted in a reduction of the composite cardiovascular end point both versus clopidogrel (HR=0.76, 95% CI=0.61 to 0.95) and ticagrelor (HR=0.74, 95% CI=0.56 to 0.98). Inconsistency was moderate and non-significant (I2=27%, total Q p=0.2). Prasugrel ranked as the most efficient treatment in the composite cardiovascular efficacy outcome, all-cause death, myocardial infarction and definite stent thrombosis, while clopidogrel ranked as safest in the bleeding outcomes.ConclusionIn patients with NSTE-ACS intended to receive invasive management, an antiplatelet strategy based on prasugrel is more efficient than a similar strategy based on ticagrelor on a moderate level of evidence. This analysis supports the current recommendations by the ESC guidelines.
Considerations on anomalous photon and Z-boson self-couplings from the Born–Infeld weak hypercharge action
Authors: Neves M. J. , Ospedal L. P. R. , Helayël-Neto J. A. , Gaete Patricio 
Published: April 2022

AbstractWe investigate the effects of the Born–Infeld action on the Abelian sector of the electroweak model. The consequence of this approach is the emergence of anomalous couplings in the neutral sector of the Z-gauge boson and photon. These new couplings consist of quartic interactions of the photon with the Z-particle, as for example, three-photon-and-one-Z vertex. With that, we obtain the decay width of $$Z \rightarrow 3\,\gamma $$

Z
→
3

γ

from which we impose a bound on the Born–Infeld parameter. Other bounds are also obtained from the photon quartic couplings. Subsequently, we consider the presence of an external uniform magnetic field in connection with this Born–Infeld weak hypercharge model. The magnetic background field yields new kinematic effects, like the kinetic mixing between the photon and the Z-boson, and we obtain thereby the corresponding dispersion relations for the mixed photon-Z-particle system. Finally, we calculate the lowest-order modifications to the interaction energy for the anomalous coupling $$3\gamma -Z$$

3
γ
-
Z

, within the framework of the gauge-invariant but path-dependent variables formalism. Our results show that the interaction energy contains a linear term leading to the confinement of static probe charges. With the help of the potential that comes out, interparticle forces are estimated.
Composition and technological features of ceramics manufactured by Benito de Valladares in the seventeenth century from the Alcazar Palace in Seville, Spain
Authors: Perez-Rodriguez J. L. , Robador M. D. , Duran A. 
Published: April 2022

AbstractThe walls of the Alcazar Palace in Seville have been covered with ceramic tiles of different styles that were manufactured with different techniques. Several studies have been carried out on these ceramics, but no interest has been paid to the tiles manufactured by the workshop of the Valladares family, one of the most productive ceramic workshops in Triana (Seville). In this work, tiles that were made in the Valladares workshop are studied for the first time. The tiles from the Cenador del Leon built in 1645–1646 were chosen. The experimental studies suggest that the ceramic body was manufactured with silico-calcareous clay. This raw material was heated to a temperature of ca. 900 °C. A nondestructive and on-site analytical procedure was applied first. Microsamples were also taken and studied through microanalytical techniques. The maiolica style was used by Benito de Valladares for tile manufacture. The glaze phases were constituted by two layers. The pigments and doping elements used to obtain different colors were characterized. Valladares’ work is considered as a continuation of Augusta's work; therefore, a comparison between both ceramists has been realized to better understand the ceramics production in southern Spain during the sixteenth to seventeenth centuries.
Analysis of Clinicopathological Factors Associated with Radiation-Induced Cystitis in Patients with Cervical Cancer
Authors: He Ling , Wang Zhenyu , Chen Jianhui , Chen Ling , Chen Peijuan , Cai Wenzhi 
Published: April 2022

Objective. To analyze the clinicopathological characteristics associated with radiation-induced cystitis (RIC) in patients with cervical cancer treated with chemoradiotherapy (CRT) alone or postoperational (post-op) CRT. Methods. 107 patients with cervical cancer were retrospectively recruited into the study. The surgical status, FIGO staging, total and fractionated doses of radiotherapy (RT), and multiparameters including the dose, volume irradiated to the total bladder, and bladder wall were evaluated for RIC. The criteria on RIC were referred to CTCAE v5.0. Results. Surgical operation and post-op CRT were delivered in 65 patients and CRT or RT alone in 42 patients. Among those with post-op CRT, 33/34 (97.06%), 22/43 (51.16%), and 10/30 (33.33%) patients were classified as FIGO stage I, II, and III/IV, respectively. The incidence of RIC was 30.84% for the whole group with 87.87% occurred in stage I and II patients. The incidence of CTCAE grade 2 and beyond was significantly higher in patients treated with post-op CRT than those with CRT alone (13.85% vs 2.38%,

p

= 0.043). Further analyses showed that the CTCAE level of RIC in the post-op CRT group was related to the relatively smaller average bladder volume (

p

= 0.029), whereas the difference in volume of bladder and bladder wall irradiated to 35.0 Gy or 40.0 Gy was not statistically significant between patients with or without RIC. Conclusion. The combination of surgery and post-op CRT may increase the incidence and severity of radiation-induced cystitis when compared to CRT alone, suggesting that bladder dysfunction associated with surgical procedure might increase the frequency and severity radiation related bladder toxicity. Further study is merited.
Myeloid-Derived Suppressor Cells and Radiotherapy
Authors: Jiménez-Cortegana Carlos , Galassi Claudia , Klapp Vanessa , Gabrilovich Dmitry I. , Galluzzi Lorenzo 
Published: April 2022

AbstractMyeloid-derived suppressor cells (MDSC) are a heterogeneous population of pathologically activated, mostly immature, myeloid cells that exert robust immunosuppressive functions. MDSCs expand during oncogenesis and have been linked to accelerated disease progression and resistance to treatment in both preclinical tumor models and patients with cancer. Thus, MDSCs stand out as promising targets for the development of novel immunotherapeutic regimens with superior efficacy. Here, we summarize accumulating preclinical and clinical evidence indicating that MDSCs also hamper the efficacy of radiotherapy (RT), as we critically discuss the potential of MDSC-targeting strategies as tools to achieve superior immunotherapeutic tumor control by RT in the clinic.