bluuebunny/crossref_metadata_2025_split huggingface dataset:
PERCEIVED STRESS, DEPRESSION AND MEDICATION ADHERENCE AMONG HYPERTENSIVE PATIENTS ATTENDING A SECONDARY CARE HOSPITAL IN LAGOS, NIGERIA
Authors: Ajose Azeezat , Odukoya Oluwakemi Ololade , Akodu Babatunde 
Published: June 2022

Objective:
Hypertension is a significant public health problem as it accounts for 19.2% of all deaths globally and 16.4% of all deaths in low- and middle-income countries. Poor medication adherence negatively impacts hypertension control and has been associated with negative self-care behavior such as seen in perceived stress and depression. This study sought to investigate the prevalence of perceived stress, depression, and their association with the level of medication adherence amongst hypertensive patients attending a secondary care hospital in Lagos, Nigeria.

Design and Methods: Descriptive cross-sectional design was adopted, and an interviewer-based questionnaire was administered for this study. Perceived stress, Depression and Medication Adherence were evaluated using the Perceived Stress Scale(PSS-10), Patient Health Questionnaire(PHQ-9) and Hill-Bone Compliance Scale. Data was analyzed by using Epi Info Version 7 and presented using frequency tables. T-test was used to compare continuous variables while the Chi-square and Fishers Exact test were used to compare categorical variables. Significance level was set at p < 0.05.

Results:
331 hypertensive patients (221 women, 66.8%) were included in this study (Mean age of 60.0 ± 13.9 years). 77% had average to high levels of perceived stress (PSS-10 score of > 12) while 55% had varying levels of depression. Mean score on Hill-Bone Compliance Scale was 20.1 ± 3.7. Income level, Number of drugs used daily were significantly associated with perceived stress (p < 0.05,p < 0.01). Younger age, Female Gender, Presence of co-morbidities and Number of drugs used daily were significantly associated with depression(p < 0.01,p < 0.05,p < 0.05,p < 0.01). Perceived stress and depression were significantly associated with lower levels of medication adherence (p < 0.05; p < 0.01).

Conclusion: This study lends credence to the idea that perceived stress and depression results in negative self-care behavior that adversely impacts medication adherence. Greater awareness of the potential for psychological distress in hypertensive patients must be emphasized to all physicians. Improving medication adherence rates requires collaborative care with intensified screening and appropriate management for social and psychological stressors.
VASCULAR STIFFNESS AS AN TARGET OF OPTIMAL ANTIHYPERTENSIVE THERAPY
Authors: Zbyshevskaya Elizaveta , Makeeva Tatiana , Gumerova Victoria , Erinchek Vadim 
Published: June 2022

Objective:
To evaluate the 24-hour blood pressure (BP) control and the effect of the triple fixed combination (TFC) amlodipine / indapamide / perindopril on the arterial stiffness parameters according to 24-hour blood pressure monitoring (ABPM) data in patients with uncontrolled hypertension (HTN).

Design and method:
The study involved 78 patients with insufficient BP control, against the background of previous combination therapy. All patients received TFC amlodipine / indapamide / perindopril. The patient’s condition was assessed during 4 observation visits: visit 1- inclusion, visit 2 - 4 weeks, visit 3 -12 weeks, visit 4 - 24 weeks observation. At each visit, the achievement of the target BP level < 130/80 mm Hg was assessed, as well as the effect of therapy on the parameters of arterial stiffness (pulse wave velocity (PWVao), pulse pressure (PP), agumentation index (Aix), arterial stiffness index (ASI)) and central aortic pressure parameters (systolic aortic pressure (SBPao), diastolic pressure in the aorta (DBPao), central pulse pressure (PPao)) according to ABPM

Results:
In subjects with HTN with ineffective antihypertensive therapythe initial office BP was 160.8 ± 10.3 / 91.5 ± 8.1 mm Hg. After 24 weeks of therapy with a TFC there was a significant decrease in blood pressure to 121.3 ± 3.5 / 73.6 ± 4.2 mm Hg (p < 0.001). According to ABPM data, mean values of daily BP significantly (p < 0.001) decreased from 153.9 ± 9.04 / 8.38 ± 9.18 to 120.3 ± 4.7 / 73.4 ± 4.7 mm Hg. Data analysis showed a decrease PWVao (11.39 ± 1.32 m/s vs 9.98 ± 0.91 m/s, p < 0,05) as well as ASI (174 (138, 253) vs 139 (107.196) mmHg; p < 0.001) and Aix -29,9 (-41,12) vs - 33,7 (-53, 9) p < 0,05. There was a statistically significant decrease in the parameters the central pressure in the aorta (Fig.1)

Conclusions:
In patients with HTN and previous uneffective antihypertensive therapy the FTC amlodipine / indapamide / perindopril provided high antihypertensive effectiveness. Parameters of vascular stiffness can serve as criteria for quality control of blood pressure and can be used to assess the effectiveness of antihypertensive therapy.
APPROPRIATENESS OF CARDIOVASCULAR PREVENTIVE MEDICATION IN OLDER PEOPLE: A QUALITATIVE RAM-STUDY
Authors: Ploeg Milly Van Der , Poortvliet Rosalinde , Achterberg Wilco , Mooijaart Simon , Gussekloo Jacobijn , Drewes Yvonne 
Published: June 2022

Objective:
In clinical practice and science, there is debate for which older adults the benefits of cardiovascular preventive medications (CPM) still outweigh the risks in older age. Therefore, we aimed to assess how various clinical characteristics influence the judgement of appropriateness of CPM (i.a. antihypertensive treatment) in older adults.

Design and method:
With the RAND/ University of California at Los Angeles appropriateness Method (RAM) the appropriateness of CPM for adults = > 75 year was assessed with regard to clinical characteristics (cardiovascular history, complexity of health problems, age, side-effects and life expectancy). A multi-disciplinary panel (n = 14 panelists) received an up to date overview of the literature, and judged the appropriateness of starting and stopping cholesterol lowering medication, antihypertensives, and platelet aggregation inhibitors, on 1- to 9 point Likert scales (1 = extremely inappropriate; 9 = extremely appropriate), for various clinical scenarios. There were two rating rounds, with one face-to-face discussion in between. The appropriateness judgments were based on the median panel rating and level of disagreement

Results:
The panelists emphasized the importance of the individual context of the patient for appropriateness of CPM. They judged that in general, a history of atherosclerotic cardiovascular disease (ASCVD) strongly adds to the appropriateness of CPM, while increasing complexity of health problems, presence of hindering or severe side-effects, and life expectancy < 1 year all contribute to the inappropriateness of CPM. Age had only minor influence on the appropriateness judgments. The appropriateness judgments were different for the three types of CPM. The literature, time-to-benefit, remaining life-expectancy, number needed to treat, and quality of life, were major themes in the panel discussions. The considerations to stop CPM were different from the considerations not to start CPM.

Conclusions:
Next to the patients’ individual context, which was considered decisive in the final decision to start or stop CPM, there were general trends of how clinical characteristics influenced the appropriateness, according to the multi-disciplinary panel. The decision to stop, and not start CPM, appeared to be two distinct concepts. Results of this study may be used in efforts to support clinical decision making about CPM in older adults.
EFFECT OF SACUBITRIL-VALSARTAN ON EARLY RENAL FUNCTION AND VASCULAR FUNCTION IN PATIENTS DURING PERIMENOPAUSE WITH HYPERTENSION
Authors: Pei Ying , Yu Jing 
Published: June 2022

Objective:
To evaluate the effects of Sacubitril-Valsartan on early renal function and vascular function in patients during perimenopause with hypertension.

Design and method:
This study was a prospective, randomized, positive control and open label test. The subjects were 427 perimenopausal women (30–65 years old) with mild or moderate hypertension who were treated in the Department of Cardiovascular Medicine of the Second Hospital of Lanzhou University. They were randomly assigned to Sacubitril-Valsartan group (n = 165) or valsartan group (n = 262) for 24 weeks. Renal function, urinary renal function and vascular function were evaluated at baseline and 24 weeks after treatment.

Results:
There was no significant difference in the clinical baseline data between patients with sacubitril-valsartan and patients with valsartan (P> 0.05). Comparison of the systolic blood pressure (oSBP) and diastolic blood pressure(oDBP)before and after treatment: the baseline vs. 24-week difference between the sacubitril-valsartan group and the valsartan group was statistically significant (p < 0.001). The carotid-femoral pulse wave velocity (cfPWV) in the vascular function indexes of the sacubitril-valsartan group was significantly improved (p < 0.001). The improvement of valsartan group was not obvious. Other vascular function parameters such as cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) were not significantly improved in the two groups. Urinary microalbumin (MAU)was significantly improved in both blood renal function and urine renal function. The improvement was observed in the sacubitril-valsartan group (p < 0.001) and valsartan group (p = 0.027), but the improvement was stronger in the sacubitril-valsartan group (p < 0.001).

Conclusions:
Sacubictril-valsartan has a stronger antihypertensive effect than valsartan in patients during perimenopause with hypertension, and can improve MAU and cfPWV in patients.
ANTI-INFLAMMATORY EFFECTS AND PPAR GAMMA-ACTIVATING PROPERTIES OF TELMISARTAN IN PATIENTS WITH THE HYPERTENSION’S ON METABOLIC SYNDROME: METANALYSIS OF RCT
Authors: Greca Elona , Wireko Andrew Awauh , Abdul-Rahman Toufik , Kacimi Salah Eddine Ous 
Published: June 2022

Objective:
Metabolic syndrome (MetS) is a collection of disorders including diabetes, hypertension, obesity, and dyslipidemia that increase the risk of cardiovascular diseases and mortality. Several studies have discovered that, in addition to its angiotensin receptor blocker activity, telmisartan is a partial agonist of peroxisome proliferator-activated receptor-gamma (PPAR-gamma), which is a nuclear receptor involved in the regulation of metabolic homeostasis. Evidence also exists that activators of PPAR-gamma exert anti-inflammatory, anti-oxidative, and antiproliferative effects on vascular walls. Therefore through PPAR-gamma modulating activity, telmisartan can be a valuable therapeutic agent for treating MetS.

Design and method:
he PubMed, EMBASE databases and Cochrane Central of Controlled Trials were searched through October 2021. We pooled data extracted from the included studies using the standardized mean difference (SMD). Study-specific estimates were combined using inverse variance-weighted averages of SMDs in both fixed- and random-effects models. Heterogeneity was evaluated using Cochran’s Q- and the I2-test. GRADE tool was used to assess the study’s quality. All analyses were conducted using StatsDirect statistical software Version 2.8.0.

Results:
A total of 582 patients were enrolled in the 11 included randomized clinical trials (RCTs). The pooled analysis revealed significant reduction in the percent changes of homeostasis model assessment index (HOMA) (SMD = -0.24; 95% CI: -0.40 to -0.07; p = 0.0036), changes of fasting glucose (mg/dL) (SMD = -0.49; 95% CI: -0.94 to 0.05; p = 0.0283), insulin (mU/mL) (SMD = -0.21; 95% CI: -0.38 to -0.05; p = 0.0084), and a significant increase in percent changes of adiponectin (umg/mL) (SMD = 0.63; 95% CI: 0.34 to 0.92; p < 0.0001),among patients with metabolic syndrome randomized to telmisartan versus control therapy. There was minimal trial heterogeneity in the analyses for HOMA index (I2 = 21.1%), insulin (I2 = 0%) and adiponectin levels (I2 = 0.1%). However, there was considerable heterogeneity in the analysis for fasting glucose (I2 = 83.6%).

Conclusions:
Our study suggests that PPAR-gamma modulating activity of telmisartan therapy has the potential to be a valuable therapeutic agent for treating MetS.
ANTI-INFLAMMATORY EFFECTS AND PEROXISOME PROLIFERATOR-ACTIVATED RECEPTOR GAMMA (PPAR GAMMA)-ACTIVATING PROPERTIES OF THE ANGIOTENSIN TYPE 1 RECEPTOR BLOCKER TELMISARTAN IN PATIENTS
Authors: Greca Elona , Wireko Andrew Awauh , Toufik Abdul-Rahman , Kacimi Salah Eddine Ous 
Published: June 2022

Objective:
Metabolic syndrome (MetS) is a collection of disorders including diabetes, hypertension, obesity, and dyslipidemia that increase the risk of cardiovascular diseases and mortality. Several studies have discovered that, in addition to its angiotensin receptor blocker activity, telmisartan is a partial agonist of peroxisome proliferator-activated receptor-gamma (PPAR gamma), which is a nuclear receptor involved in the regulation of metabolic homeostasis. Evidence also exists that activators of PPAR exert anti-inflammatory, anti-oxidative, and anti proliferative effects on vascular walls. Therefore through PPAR gamma modulating activity, telmisartan can be a valuable agent for treating MetS.

Design and method:
The PubMed, EMBASE databases and Cochrane Central of Controlled Trials were searched through October 2021. We pooled data extracted from the included studies using the standardized mean difference (SMD). Study-specific estimates were combined using inverse variance-weighted averages of SMDs in both fixed- and random-effects models. Heterogeneity was evaluated using Cochran’s Q- and the I2-test. GRADE assess the study’s quality. All analyses were conducted using StatsDirect statistical software Version 2.8.0.

Results:
A total of 582 patients were enrolled in the 11 included randomized clinical trials (RCTs). The pooled analysis revealed significant reduction in the percent changes of homeostasis model assessment index (HOMA) (SMD = -0.24; 95% CI: -0.40 to -0.07; p = 0.0036), changes of fasting glucose (mg/dL) (SMD = -0.49; 95% CI: -0.94 to 0.05; p = 0.0283), insulin (mU/mL) (SMD = -0.21; 95% CI: -0.38 to -0.05; p = 0.0084), and a significant increase in percent changes of adiponectin (umg/mL) (SMD = 0.63; 95% CI: 0.34 to 0.92; p < 0.0001),among patients with metabolic syndrome randomized to telmisartan versus control therapy. There was minimal trial heterogeneity in the analyses for HOMA index (I2 = 21.1%), insulin (I2 = 0%) and adiponectin levels (I2 = 0.1%). However, there was considerable heterogeneity in the analysis for fasting glucose (I2 = 83.6%).

Conclusions:
Our study suggests that the PPAR gamma modulating activity of telmisartan has the potential to be a valuable therapeutic agent for treating MetS.
BLOOD PRESSURE TARGETS AND MORTALITY IN HYPERTENSIVE PATIENTS WITH CHRONIC RENAL DISEASE. SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Méndez Iván , Saiz Luis Carlos , Leache Leire , Gutierrez Marta , Pijoan José Ignacio , Menéndez-Orenga Miguel , Salzwedel Douglas M. , Erviti Juan 
Published: June 2022

Objective:
To compare the effects of intensive vs standard blood pressure (BP) targets on the mortality of hypertensive patients with chronic renal disease.

Design and method:
A bibliographic search of all relevant databases was carried out without restriction by language, year of publication or publication status.
We considered randomized controlled clinical trials on patients older than 18 years, diagnosed with hypertension and chronic renal disease who were allocated to either “intensive’’ BP target (less than or equal to 130/80 mmHg) or “standard’’ BP target (less than or equal to 140–160/90–100 mmHg). Additionally, trials should include more than 50 participants per group followed during at least one year. Trials were not limited by any concomitant disease or baseline cardiovascular risk.
We contacted trials’ authors to obtain Individual Patient Data and, if necessary, extracted information from chronic renal patients.
COVIDENCE software was used for screening, the Cochrane Review Manager (RevMan web) for data synthesis and analysis, and the Cochrane Risk of Bias Tool (ROB2) to assess the risk of bias for each trial.

Results:
A total of 2298 records were identified by the bibliographic search. We obtained the full text of 29 publications from the pre-selected studies. Of these, six studies met the inclusion criteria and we obtained Individual Patient Data for all of them (AASK, SPRINT, HOT, ACCORD BP, MDRD, SPS3).
There was no statistically significant difference in total mortality between the intensive and standard blood pressure target groups (RR 0.92, 95%CI 0.75–1.13, p = 0.42, 6 studies, 7,348 participants). In absolute terms, there were 5 additional deaths per 1000 participants in the standard target group (95% CI: 6 fewer to 16 more deaths per 1000 participants). Overall deaths were 227/3352 (6.8%) in the intensive target group vs 285/3996 (7.9%) in the standard target group (Figure).
The quality of evidence was moderate according to the GRADE assessment.

Conclusions:
Intensive blood pressure lowering targets in patients with arterial hypertension and chronic renal disease do not result in lower mortality compared to standard blood pressure lowering.
Understanding attributes and characteristics of the PA leader-physician relationship
Authors: Louwagie Victoria , Ness Becky , O'Laughlin Danielle , Fisher Karen , Halasy Michael 
Published: June 2022

ABSTRACT

Purpose:
This study sought to evaluate the attributes and characteristics of physician mentors, dual-roled physician assistant (PA) leaders, and how this relationship affects PA leaders and the PA leader-physician relationship. Dual-role PA leaders may possess additional formal job titles and duties as well as having direct reports.

Method:
We surveyed PA leaders at a single large academic medical center and its associated health system. The survey instrument evaluated perceptions, attitudes, and characteristics of the PA leader and influential physician and their relationship.

Results:
Of the 56 PA leaders surveyed, 34 responded, for a 60.7% response rate. Effective communication was the most prevalent relational characteristic ranked as most important for both PA leaders (30%) and physician mentors (36%). Additional self-identified positive attributes of the team included collaborative mindset, reliability/trustworthiness, work ethic, and delivery of patient care. Influential physician mentors may have a significant effect on PA leader job satisfaction and career advancement.

Conclusions:
This is a novel study of PA leaders examining perceptions, beliefs, and characteristics of the PA leader-physician relationship. PAs are integral healthcare team members and medical providers. As PAs work closely in physician-led teams, further understanding the PA leader-physician relationship could influence PA and physician professional development, career trajectory, and healthcare team outcomes.
Professional Coaching as a Continuing Professional Development Intervention to Address the Physician Distress Epidemic
Authors: Boet Sylvain , Etherington Cole , Andreas Cecile , Denis-LeBlanc Manon 
Published: June 2022

Abstract:
Physician distress and burnout are reaching epidemic proportions, threatening physicians' capacities to develop and maintain competencies in the face of the increasingly demanding and complex realities of medical practice in today's world. In this article, we suggest that coaching should be considered both a continuing professional development intervention as well as an integral part of a balanced and proactive solution to physician distress and burnout. Unlike other interventions, coaching is intended to help individuals gain clarity in their life, rather than to treat a mental health condition or to provide advice, support, guidance, or knowledge/skills. Certified coaches are trained to help individuals discover solutions to complex problems and facilitate decision-making about what is needed to build and maintain capacity and take action. Across many sectors, coaching has been shown to enhance performance and reduce vulnerability to distress and burnout, but it has yet to be systematically implemented in medicine. By empowering physicians to discover and implement solutions to challenges, regain control over their lives, and act according to their own values, coaching can position physicians to become leaders and advocates for system-level change, while simultaneously prioritizing their own well-being.
Nonoperative Management Following Complete Response in Rectal Cancer After Short-course Radiation Therapy and Consolidation Chemotherapy
Authors: Reddy Abhinav V. , Safar Bashar , Jia Angela Y. , Azad Nilofer S. , Christenson Eric S. , Atallah Chady , Efron Jonathan E. , Gearhart Susan L. , Zaheer Atif , Narang Amol K. , Meyer Jeffrey 
Published: June 2022

Purpose:
The purpose of his study was to report on a cohort of patients managed with nonoperative management (NOM) with a watch-and-wait strategy after achieving complete response (CR) to sequential short-course radiation therapy (SCRT) and consolidation chemotherapy.

Methods:
This was a retrospective study of patients treated SCRT and chemotherapy who achieved a CR and were managed with NOM. Bowel function was assessed with European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30, EORTC Quality of Life Questionnaire-Colorectal Cancer 29, and the low anterior resection syndrome (LARS) questionnaires. Endpoints included overall survival (OS), freedom from local failure (FFLF), freedom from distant metastasis, and disease-free survival (DFS).

Results:
Twenty-six patients met inclusion criteria. Seven (26.9%) patients developed local failure at a median of 6.8 months following CR, of which 5 were successfully salvaged. Median FFLF was not reached, with 6-month, 1-, and 2-year FFLF rates of 100.0%, 82.3%, and 71.3%. Median OS was not reached, with 6-month, 1-, and 2-year OS rates of 100%. Median DFS was not reached, with 6-month, 1-, and 2-year DFS rates of 100%, 95.0%, and 89.4%. Questionnaire response rate was 83.3%. Median LARS score was 27. Major, minor, and no LARS occurred in 3 (20%), 6 (40%), and 6 (40%) patients, respectively. There were no differences in questionnaire scores between patients who had the majority of their anal sphincter complex irradiated and those who did not.

Conclusion:
NOM with a watch-and-wait strategy is safe and feasible in patients with locally advanced rectal cancer who achieve CR after sequential SCRT and chemotherapy, with evidence for good anorectal function.
A Practical Method for EPR Dosimetry Using Alanine Powder
Authors: Hassan Amna , Tzivaki Margarita , Felner Lukas , Waller Edward 
Published: June 2022

Abstract
This work investigates alanine powder, an inexpensive and versatile material compared to alanine pellets, as a standardized dosimeter for the alanine-EPR system using a Bruker EMX-Micro spectrometer. The feasibility of this method was investigated, and a calibration curve was produced using 40 dosimeters, which were prepared by tightly packing DL-alanine powder in polypropylene microcentrifuge tubes. The dosimeters were irradiated to doses ranging from 0.2–20 Gy using a 60Co source. A dosimeter handling and measurement protocol was established for all dosimeters. The dosimetric signal was evaluated by measuring the peak-to-peak height of the central resonance peak, and the dose response of alanine powder dosimeters showed a linear behavior in the investigated dose range with relative errors below 13%. Measurement repeatability and reproducibility were tested to show the errors associated with sample placement in the cavity and with the overall measurement method, with both tests showing relative errors below 7%. As an inexpensive material compared to pellet dosimeters, alanine powder has a strong potential to be used as a standardized material for radiation dosimetry applications. The scope of this work is to present an effective and comprehensive methodology with accompanying analysis scripts for dosimetry with alanine powder that is useful in a wide range of applications and dose requirements.