Search

This prospective study explores health-related quality of life (EQ-5D-5L), event-related distress (IES-R), and depression (CES-D) after cardiac surgery during three COVID-19 lockdowns imposed in the UK. Overall, 253 patients (Lockdown 1 n = 196; 2 n = 45; 3 n = 12) completed the above-mentioned questionnaires at baseline, 1 week after discharge, and 6 weeks and 6 and 12 months after surgery. While EQ-5D-5L values were similar across all cohorts, those who underwent surgery during Lockdowns 2 and 3 had higher IES-R scores at 1 year and higher IES-R and CES-D baseline scores, respectively. Generally, increased distress, worse depression, and poorer HRQoL were observed in women. Registration ClinicalTrials.gov: NCT04366167 [ABSTRACT FROM AUTHOR]

Aims Women are underrepresented in cardiovascular trials. We sought to explore the proportional representation of women in contemporary cardiovascular research and the factors (barriers and enablers) that affect their participation in cardiovascular studies. Methods and results Multiple electronic databases were searched between January 2011 and September 2021 to identify papers that defined underrepresentation of women in cardiovascular research and/or reported sex-based differences in participating in cardiovascular research and/or barriers for women to participate in cardiovascular research. Data extraction was undertaken independently by two authors using a standardised data collection form. Results were summarised using descriptive statistics and narrative synthesis as appropriate. From 548 identified papers, 10 papers were included. Of those, four were conducted prospectively and six were retrospective studies. Five of the retrospective studies involved secondary analysis of trial data including over 780 trials in over 1.1 million participants. Overall, women were reported to be underrepresented in heart failure, coronary disease, myocardial infarction, and arrhythmia trials, compared to men. Barriers to participation included lack of information and understanding of the research, trial-related procedures, the perceived health status of the participant, and patient-specific factors including travel, childcare availability, and cost. A significantly higher likelihood of research participation was reported by women following a patient educational intervention. Conclusion This review has highlighted the underrepresentation of women in a range of cardiovascular trials. Several barriers to women's participation in cardiovascular studies were identified. Researchers could mitigate against these in future trial planning and delivery to increase women's participation in cardiovascular research. Registration The protocol was published on the public Open Science Framework platform on 13th August 2021 (no registration reference provided) and can be accessed at https://osf.io/ny4fd/. [ABSTRACT FROM AUTHOR]

Aims: A cardiac surgery international nursing and allied professional research network titled CONNECT was created to strengthen collaborative cardiac surgery research through shared initiatives including supervision, mentorship, workplace exchange programs, and multi-site clinical research. As with any new initiative, there is a need to build brand awareness to enhance user familiarity, grow membership, and promote various opportunities offered. Social media has been used across various surgical disciplines; however, their effectiveness in promoting scholarly and academic-based initiatives has not been examined. The aim of this scoping review was to examine the different types of social media platforms and strategies used to promote cardiac research initiatives for CONNECT. Methods and results: A scoping review was undertaken in which a comprehensive and thorough review of the literature was performed. Fifteen articles were included in the review. Twitter appeared to be the most common form of social media used to promote cardiac initiatives, with daily posts being the most frequent type of engagement. Frequency of views, number of impressions and engagement, link clicks, and content analysis were the most common types of evaluation metrics that were identified. Conclusion: Findings from this review will inform the design and evaluation of a targeted Twitter campaign aimed at increasing brand awareness of CONNECT, which will include the use of @CONNECTcardiac Twitter handle, hashtags, and CONNECT-driven journal clubs. In addition, the use of Twitter to disseminate information and brand initiatives related to CONNECT will be evaluated using the Twitter Analytics function. Registration: Open Science Framework: osf.io/q54es Graphical Abstract [ABSTRACT FROM AUTHOR]

Patient-reported outcomes (PROs) provide important insights into patients' own perspectives about their health and medical condition, and there is evidence that their use can lead to improvements in the quality of care and to better-informed clinical decisions. Their application in cardiovascular populations has grown over the past decades. This statement describes what PROs are, and it provides an inventory of disease-specific and domain-specific PROs that have been developed for cardiovascular populations. International standards and quality indices have been published, which can guide the selection of PROs for clinical practice and in clinical trials and research; patients as well as experts in psychometrics should be involved in choosing which are most appropriate. Collaborations are needed to define criteria for using PROs to guide regulatory decisions, and the utility of PROs for comparing and monitoring the quality of care and for allocating resources should be evaluated. New sources for recording PROs include wearable digital health devices, medical registries, and electronic health record. Advice is given for the optimal use of PROs in shared clinical decision-making in cardiovascular medicine, and concerning future directions for their wider application. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is a leading cause of death, morbidity, disability, and reduced health-related quality of life, as well as economic burden worldwide, with some 80% of disease burden occurring in the low- and middle-income country (LMIC) settings. With increasing numbers of people living longer with symptomatic disease, the effectiveness and accessibility of secondary preventative and rehabilitative health services have never been more important. Whilst LMICs experience the highest prevalence and mortality rates, the global approach to secondary prevention and cardiac rehabilitation, which mitigates this burden, has traditionally been driven from clinical guidelines emanating from high-income settings. This state-of-the art review provides a contemporary global perspective on cardiac rehabilitation and secondary prevention, contrasting the challenges of and opportunities for high vs. lower income settings. Actionable solutions to overcome system, clinician, programme, and patient level barriers to cardiac rehabilitation access in LMICs are provided. [ABSTRACT FROM AUTHOR]

Aims The outbreak of COVID-19 was potentially stressful for everyone and possibly heightened in those having surgery. We sought to explore the impact of the pandemic on recovery from cardiac surgery. Methods and results A prospective observational study of 196 patients who were ≥18years old undergoing cardiac surgery between March 23 and July 4, 2020 (UK lockdown) was conducted. Those too unwell or unable to give consent/complete the questionnaires were excluded. Participants completed (on paper or electronically) the impact of event [Impact of Events Scale-revised (IES-R)] (distress related to COVID-19), depression [Centre for Epidemiological Studies Depression Scale (CES-D)], and EQ-5D-5L [(quality of life, health-related quality of life (HRQoL)] questionnaires at baseline, 1 week after hospital discharge, and 6 weeks, 6 months and 1 year post-surgery. Questionnaire completion was >75.0% at all timepoints, except at 1 week (67.3%). Most participants were male [147 (75.0%)], white British [156 (79.6%)] with an average age 63.4years. No patients had COVID-19. IES-R sand CES-D were above average at baseline (indicating higher levels of anxiety and depression) decreasing over time. HRQoL pre-surgery was high, reducing at 1 week but increasing to almost pre-operative levels at 6 weeks and exceeding pre-operative levels at 6 months and 1 year. IES-R and CES-D scores were consistently higher in women and younger patients with women also having poorer HRQoL up to 1-year after surgery. Conclusions High levels of distress were observed in patients undergoing cardiac surgery during the COVID-19 pandemic with women and younger participants particularly affected. Psychological support pre- and post-operatively in further crises or traumatic times should be considered to aid recovery. Registration Clinicaltrials.gov ID:NCT04366167. [ABSTRACT FROM AUTHOR]

People living with cardiac sarcoidosis (CS) are likely to have worse clinical outcomes and greater impairment on health-related quality of life (HRQoL) than other sarcoidosis manifestations. CS can result in a constellation of intrusive symptoms (such as palpitations, dizziness, syncope/pre-syncope, chest pain, dyspnoea, orthopnoea, or peripheral oedema) and/or life-threatening episodes, requiring consideration of invasive cardiac procedures for diagnosis and for the management of acute events. Additionally, the presence of multisystemic involvement and persistent non-specific sarcoidosis symptoms negatively affect HRQoL. A systematic review was undertaken to explore the impact of CS on HRQoL in adults with CS. Multiple bibliographic databases were searched for studies with HRQoL as primary or secondary outcomes in CS (PROSPERO registration: CRD42019119752). Data extraction and quality assessments were undertaken independently by two authors. From the initial 1609 identified records, only 11 studies included CS patients but none specifically reported HRQoL scores for CS patients. The average representation of CS patients was 14.5% within these cohorts (range 2–22%). The majority (73%) was conducted in single-centre tertiary care settings, and only one study (9%) included longitudinal HRQoL data. CS patients were among those sarcoidosis patients with impaired HRQoL and worse outcomes, requiring higher doses of sarcoidosis-specific therapy which contribute to further deterioration of HRQoL. Sarcoidosis studies do not incorporate stratified HRQoL scores for CS patients. While there is a need for longitudinal and multicentre studies assessing HRQoL outcomes in CS cohorts, the development of CS-specific tools is also needed. [ABSTRACT FROM AUTHOR]

Aim Reports of sex-specific differences in mortality after coronary artery bypass graft surgery (CABGS) are contradictory. The review aim was to determine whether CABGS is differentially efficacious than alternative procedures by sex, on short- and longer-term mortality. Methods and results EMBASE, CINAHL, Medline, and the Cochrane Library were searched. Inclusion criteria: English language, randomized controlled trials from 2010, comparing isolated CABGS to alternative revascularization. Analyses were included Mantel–Haenszel fixed-effects modelling, risk of bias (Cochrane RoB2), and quality assessment (CONSORT). PROSPERO Registration ID: CRD42020181673. The search yielded 4459 citations, and full-text review of 29 articles revealed nine studies for inclusion with variable time to follow-up. Risk of mortality for women was similar in pooled analyses [risk ratio (RR) 0.94, 95% confidence interval (CI) 0.84–1.05, P = 0.26] but higher in sensitivity analyses excluding 'high risk' patients (RR 1.22, 95% CI 1.01–1.48, P = 0.04). At 30 days and 10 years, in contrast to men, women had an 18% (RR 0.82, 95% CI 0.66–1.02, P = 0.08) and 19% (RR 0.81, 95% CI 0.69–0.95, P = 0.01) mortality risk reduction. At 1–2 years women had a 7% (RR 1.07, 95% CI 0.69–1.64, P = 0.77), and at 2–5 years a 25% increase in risk of mortality compared with men (RR 1.25, 95% CI 1.03–1.53, P = 0.03). Women were increasingly under-represented over time comprising 41% (30 days) to 16.7% (10 years) of the pooled population. Conclusion Meta-analysis revealed inconsistent sex-specific differences in mortality after CABGS. Trials with sex-specific stratification are required to ensure appropriate sex-differentiated treatments for revascularization. [ABSTRACT FROM AUTHOR]

Previous studies have shown that differences in experimental design factors may alter the potency of genotoxic compounds in in vitro genotoxicity tests. Most of these studies used traditional statistical methods based on the lowest observed genotoxic effect levels, whereas more appropriate methods, such as the benchmark dose (BMD) approach, are now available to compare genotoxic potencies under different test conditions. We therefore investigated the influence of two parameters, i.e. cell type and exposure duration, on the potencies of two known genotoxicants [aflatoxin B1 and ethyl methanesulfonate (EMS)] in the in vitro micronucleus (MN) assay and comet assay (CA). Both compounds were tested in the two assays using two cell types (i.e. CHO-K1 and TK6 cells). To evaluate the effect of exposure duration, the genotoxicity of EMS was assessed after 3 and 24 h of exposure. Results were analyzed using the BMD covariate approach, also referred to as BMD potency ranking, and the outcome was compared with that of more traditional statistical methods based on lowest observed genotoxic effect levels. When comparing the in vitro MN results obtained in both cell lines with the BMD covariate approach, a difference in potency was detected only when EMS exposures were conducted for 24 h, with TK6 cells being more sensitive. No difference was observed in the potency of both EMS and aflatoxin B1 in the in vitro CA using both cell lines. In contrast, EMS was more potent after 24 h exposure compared with a 3 h exposure under all tested conditions, i.e. in the in vitro MN assay and CA in both cell lines. Importantly, for several of the investigated factors, the BMD covariate method could not be used to confirm the differences in potencies detected with the traditional statistical methods, thus highlighting the need to evaluate the impact of experimental design factors with adequate approaches. [ABSTRACT FROM AUTHOR]

Background Postoperative morbidity places considerable burden on health and resources. Thus, strategies to identify, predict, and reduce postoperative morbidity are needed. Aims To identify and explore existing preoperative risk assessment tools for morbidity after cardiac surgery. Methods Electronic databases (including MEDLINE, CINAHL, and Embase) were searched to December 2020 for preoperative risk assessment models for morbidity after adult cardiac surgery. Models exploring one isolated postoperative morbidity and those in patients having heart transplantation or congenital surgery were excluded. Data extraction and quality assessments were undertaken by two authors. Results From 2251 identified papers, 22 models were found. The majority (54.5%) were developed in the USA or Canada, defined morbidity outcome within the in-hospital period (90.9%), and focused on major morbidity. Considerable variation in morbidity definition was identified, with morbidity incidence between 4.3% and 52%. The majority (45.5%) defined morbidity and mortality separately but combined them to develop one model, while seven studies (33.3%) constructed a morbidity-specific model. Models contained between 5 and 50 variables. Commonly included variables were age, emergency surgery, left ventricular dysfunction, and reoperation/previous cardiac surgery, although definition differences across studies were observed. All models demonstrated at least reasonable discriminatory power [area under the receiver operating curve (0.61–0.82)]. Conclusion Despite the methodological heterogeneity across models, all demonstrated at least reasonable discriminatory power and could be implemented depending on local preferences. Future strategies to identify, predict, and reduce morbidity after cardiac surgery should consider the ageing population and those with minor and/or multiple complex morbidities. [ABSTRACT FROM AUTHOR]

Aims Postoperative cognitive dysfunction (POCD) is often experienced by cardiac surgery patients; however, it is not known if some groups of patients experience this more frequently or severely than others. The aim of this systematic review was to identify preoperative and postoperative predictors of cognitive dysfunction in adults following cardiac surgery. Methods and results Eight bibliographic databases were searched (January 2005 to March 2021) in relation to cardiac surgery and cognition. Studies including adult patients who had undergone open cardiac surgery and using a validated measurement of cognitive function were included. Full-text review for inclusion, quality assessment, and data extraction were undertaken independently by two authors. A total of 2870 papers were identified, of which 36 papers met the inclusion criteria and were included in the review. The majority were prospective observational studies [ n  = 28 (75.7%)]. In total, 61 independent predictors (45 preoperative and 16 postoperative) were identified as significant in at least one study; advancing age and education level appear important. Age has emerged as the most common predictor of cognitive outcome. Conclusion Although a number of predictors of POCD have been identified, they have inconsistently been reported as significantly affecting cognitive outcome. Consistent with previous research, our findings indicate that older patients and those with lower educational levels should be prioritized when developing and trialling interventions to improve cognitive function. These findings are less than surprising if we consider the methodological shortcomings of included studies. It is evident that further high-quality research exploring predictors of POCD is required. Registration This review was registered on Prospero, CRD42020167037 [ABSTRACT FROM AUTHOR]

Background This year marks the 20th birthday of the European Journal of Cardiovascular Nursing (EJCN). The official journal of the Association of Cardiovascular Nursing and Allied Professionals, is now recognized as one of the leading nursing and allied professional journals. Aims This article reflects on the developments and impact of the journal over its 20-year lifespan. Methods and results We present a descriptive account of the journal from inception (2002) until present day (2021), using data provided by the EJCN editorial office and extracted from published and available information. In the last 20 years, the EJCN has published 20 volumes, 106 issues, and 1320 papers from 79 countries. The volume and quality of papers has been consistently increasing, culminating in a 2020 impact factor of 3.908, the highest in its history, ranking second for nursing science. Papers are predominantly patient focused with a range of research methods that cover an extensive range of cardiovascular conditions. Authors who contributed to the first issue continued their contribution; 293 articles in total. Conclusion The EJCN has evolved into a leading journal of cardiovascular care. As the journal enters its next era, with a new Editor-in-Chief, it is appropriate to have reflected on the phenomenal contribution of the outgoing Editor-in-Chief, and the editorial team, over the last 20 years. [ABSTRACT FROM AUTHOR]

The authors reflect on the importance of doctorally prepared cardiovascular disease (CVD) nurses, as well as the top tips from the Association of Cardiovascular Nursing and Allied Professions (ACNAP) on how nurses can properly select a doctoral supervisor.

The article reports that cardiovascular disease (CVD) remain the leading cause of death for women, but CVD burden persists affecting women worldwide, even after sex-specific targeted health campaigns in cardiovascular trials regularly making up about a third of cardiovascular trial populations.

An editorial is presented on outlook for patients with cardiovascular disease during COVID-19 is grim and the evidence indicates a relationship exists between COVID-19 and the onset or exacerbation of heart disease are two conditions are categorized as pandemics by the World Health Organization.

Aims A sequence variant, rs7025486[A], in DAB2IP on chromosome 9q33 has recently been associated with coronary heart disease (CHD). We sought to replicate this finding and to investigate associations with a panel of inflammatory and haemostatic biomarkers. We also sought to examine whether this variant, in combination with a chromosome 9p21 CHD variant (rs10757278) and the Framingham risk score (FRS), could improve the prediction of events compared with the FRS alone. Methods and results rs7025486 was genotyped in 1386 CHD cases and 3532 controls and was associated with CHD [odds ratio (OR) of 1.16, 95% confidence interval (CI) 1.05–1.29, P= 0.003]. Meta-analysis, using data from the original report and from genome-wide association studies in both the Wellcome Trust Case Control Consortium and the Cardiovascular Health Study, comprising 9968 cases and 20 048 controls, confirmed the association (OR of 1.10, 95% CI 1.06–1.14, P= 3.2 × 10−6). There was no association with a panel of CHD biomarkers, including any lipid, inflammation, or coagulation trait, nor with telomere length. Addition to the FRS of this variant plus rs10757278 on chromosome 9p21 improved the area under the receiver-operating characteristic curve (AROC) from 0.61 to 0.64 (P= 0.03) as well as improving the reclassification (net reclassification index = 11.1%, P= 0.007). Conclusion This study replicates a previous association of a variant in DAB2IP with CHD. Addition of multiple variants improves the performance of predictive models based upon classical cardiovascular risk factors. [ABSTRACT FROM PUBLISHER]

Abstract: Background : The rate of cardiac device implantation has risen significantly secondary to an increase in the number of indications. Wound infection and lead displacement are two common and potentially life-threatening complications. No national/international guidelines address postoperative care and controversy exists regarding wound management and arm movement following cardiac device implantation. Aims : We aimed to explore and review the evidence behind current practice but found that certain aspects of established practice. Methods : An electronic search of the databases EMBASE, British Nursing Index, CINAHL, Cochrane and PubMed to identify evidence regarding wound management and lead displacement. Findings : We found that certain aspects of established practice are based on tradition rather than evidence. Recent guidelines on wound management published by The National Institute for Health and Clinical Excellence in the UK recommend covering the wound postoperatively for 48h with a low-adherent transparent dressing and letting patients shower thereafter. Since specific guidelines for cardiac device patients are lacking, we suggest that further research address whether or not the NICE guidelines can be extrapolated to this area. Studies showed that early mobilisation and allowing a full range of arm movements following device implantation is safe. Further research must validate these findings. Conclusion : We discuss the reasons behind these gaps in the evidence base and support the idea that nursing education has not placed enough emphasis on how to critically appraise research. This accounts for the very small proportion of nurses that get involved in conducting research and generating guidelines. Additionally, we argue that nurses can play a key role in identifying and addressing research questions that lead to improved patient outcome. Thus, we support proposals to enhance nurses'' opportunities to pursue academic careers to achieve adequate research skills. [Copyright &y& Elsevier]

The article presents the discussion on researchers and members of the European Society of Cardiology (ESC) including feasibility and importance of the project with an assessment of the sustained benefits for local/global CVD reduction.

This chapter has three sections: 1. Editions and Textual Scholarship; 2. Theatre History; 3. Criticism. Section 1 is by Sarah Poynting; section 2 is by Peter J. Smith; section 3(a) is by Matthew Steggle; section 3(b) is by Darryll Grantley; section 3(c) is by Julie Sanders. [ABSTRACT FROM PUBLISHER]

This chapter has four sections: 1. Editions and Textual Matters; 2. Shakespeare in the Theatre; 3. Shakespeare on Screen; 4. Criticism. Section 1 is by Gabriel Egan; section 2 is by Peter J. Smith; section 3 is by Julie Sanders; sections 4(a) and (f) are by Nick Cox, section 4(b) is by Susan Bruce, section 4(c) is by Debra Tuckett, section 4(d) is by Andrew Hiscock and section 4(e) is by Stephen Longstaffe. [ABSTRACT FROM PUBLISHER]

The article presents Chapter VII of the book "Year's Work in English Studies" which discusses literary works on Renaissance drama except the works of author William Shakespeare. Among of the literary works are the books "A New History of Early English Drama," edited by John D. Cox and David Scott Kastan, "Issues of Death: Mortality and Identity in English Renaissance Tragedy," by Michael Neill, and "The Fury of Men's Gullets: Ben Jonson and the Digestive Canal," by Bruce Thomas Boehrer. It adds the book "Jonson's Magic Houses," by Ian Donaldson.

The article presents the chapter IV of the book "Year's Work in English Studies," by . It highlights Shakespeare in Theater and Shakespeare on screen. It discusses the editing of Stephen Orgel to the poem "The Winter's Tale" and the theme of obscurity. It explores how Herbert Weil and Judith Weil edit the book "The First Part of King Henry VI." It mentions other works edited, including "The Tragedie of Julius Caesar," "The Two Noble Kinsmen," and "True Chronicle of King Leir," and editors, including Stephen Greenbalt, James Rigney, and G. Blakemore Evans.

The article focuses on the editions and textual scholarship, and the final volume of the book "The Dramatic Works in the Beaumont and Fletcher Canon." It states that the editors enjoyed the interpretation of Bower's editorial principles while sharing information of authorship, dating, and textual transmission. It highlights several plays including "The Honest Man's Fortune," "Duke of Normandy," and "The Laws of Candy." It adds that the plays "The Honest Man's Fortune" and "The Laws of Candy," both edited by Cyrus Hoy, demonstrate the relationship between the texts and manuscript.