1,721,207 research outputs found
Cracking the clot: the RIVAWAR trial challenges warfarin's reign in left ventricular thrombus post-acute coronary syndrome
No full textEvidence before this study Left ventricular thrombosis (LVT) is a severe complication that often arises in patients with left ventricular systolic dysfunction, particularly within 1-14 days after a ST-segment elevation myocardial infarction (STEMI), and is associated with increased risks of stroke, embolization, and mortality. (1,2) Despite modern reperfusion therapy, the prevalence of LVT remains notable, ranging from 2-22%.(3,4) It is more frequent in patients with anterior STEMI and in patients with severe ventricular dysfunction and varies based on the imaging modality employed for detection.(5-7) Vitamin K antagonists (VKAs), such as warfarin, have been the standard treatment for LVT, though they require monitoring and have dietary interactions. (8)In contrast, direct oral anticoagulants (DOACs), including rivaroxaban, have gained attention as alternatives, offering advantages such as fewer food and drug interactions, a lower risk of bleeding, and no requirement for routine laboratory monitoring. (9) The 2023 ESC guidelines for management of acute coronary syndromes (ACS) recommend that oral anticoagulation therapy (warfarin or NOAC) should be considered for 3-6 months in patients with confirmed LVT (class IIa, level of evidence C). (10) Nonetheless, the evidence supporting NOAC use for LVT, particularly in the context of acute coronary syndrome (ACS), remains limited. (11,12) Contribution To Clinical Practice The RIVAWAR trial supports the use of rivaroxaban as a non-inferior alternative to warfarin for LV thrombus management, offering similar efficacy and safety with potential advantages in clinical practice
Should renin-angiotensin system inhibitors be stopped or not before non-cardiac surgery?
No full textThe global annual volume of major surgical procedures is estimated to exceed 300 million, representing ∼5% of the world's population, with numbers likely increasing due to an ageing population. 1 Approximately 85% of these are non-cardiac surgeries (NCSs). Perioperative mortality for patients over 45 years of age following NCS is around 2%, 2 with other complications, such as perioperative myocardial injury or infarction (PMIs), occurring much more frequently. 3 Significant efforts have been made to reduce perioperative complications, with optimal drug management being crucial. 4 Continuation of renin-angiotensin system inhibitor (RASI; angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) during the perioperative period is linked to an increased risk of perioperative hypo-tension, leading to higher use of vasopressors and inotropes. Prolonged intraoperative hypotension may increase the risk of end-organ damage, including kidney injury, myocardial damage, and stroke. 5-7 However, a systematic review of nine studies (five randomized controlled trials and four cohort studies) found that withholding RASI therapy on the morning of NCS did not reduce mortality or major adverse cardiovas-cular events. 8 The POISE-3 trial further evaluated 7490 patients undergoing NCS on blood pressure medications and reported no significant difference in major cardiovascular events within 30 days post-surgery between a hypotension-avoidance strategy (withholding RASI before and for 2 days after surgery) and a hypertension-avoidance strategy (13.9 vs. 14%, P = 0.92). 9,10 Anaesthesiologists maintained a mean arterial pressure (MAP) of ≥80 mm Hg in the hypotension-avoidance group and ≥60 mm Hg in the hypertension-avoidance group. The minimal difference in blood pressure and heart rate between the groups likely accounts for the similar outcomes. Study design The STOP-or-NOT trial (NCT03374449) 11,12 is an investigator-initiated, multicentre, open-label, randomized controlled trial conducted at 40 French hospitals, designed to compare the effect of a strategy of preoperative discontinuation of RASI therapy vs. a strategy of preopera-tive continuation of RASI therapy on all-cause mortality and post-operative complications after major NCS. The target enrolment for the trial was 2222 patients. The study included patients requiring major NCS, defined as a procedure with an expected duration of more than 2 h from incision and an anticipated post-operative hospital stay of at least 3 days. The enrolled patients were required to have been on RASI therapy for a minimum of 3 months prior to surgery. Study endpoint The primary endpoint was a composite of all-cause mortality and major post-operative complications, which included (i) post-operative major cardiovascular events (such as acute myocardial infarction, arterial or venous thrombosis, stroke, acute pulmonary oedema, cardiogenic shock, hypertensive crisis, and cardiac arrhythmias requiring intervention), (ii) sepsis or septic shock, (iii) respiratory failure requiring re-intubation or non-invasive ventilation, (iv) unplanned admission to intensive care, (v) acute kidney injury, (vi) hyperkalaemia, and (vii) surgical complications necessitating reintervention. 11 Prespecified secondary endpoints included intraoperative hypoten-sion (MAP <60 mm Hg or requiring treatment with vasopressors), all-cause mortality, acute kidney injury, post-operative organ failure assessed by the maximum Sequential Organ Failure Assessment score, length of hospital and intensive care stay, and hospital-free days. Study patients At baseline, the mean age of the 2222 patients was 67 years (SD, 10 years); 65% were male, 98% were being treated for hypertension, 9% had chronic kidney disease, 8% had diabetes, and 6% had heart failure. The baseline characteristics of the 2222 patients randomized to a RASI discontinuation strategy (n = 1115 patients) or a RASI continuation strategy (n = 1107 patients) were comparable between the groups. In both groups, it was recommended that RASI therapy was resumed as soon as possible after surgery. Follow-up was for a median of 28 days [interquartile range (IQR) 28-31 days]
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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