暂无摘要。

Despite multiple trials comparing rate with rhythm control, there is no consensus on the optimal management of first-detected atrial fibrillation (AF).
We analyzed current patterns of care for first-detected AF in the nationwide Get With The Guidelines® - Atrial Fibrillation registry.
Patients hospitalized with first-detected AF from 2013 to 2019 were included, and a descriptive analysis was performed comparing planned rate with rhythm control. Multivariable logistic regression analysis was performed to identify predictors for choosing rhythm over rate control.
Of the 86,759 patients with AF, 17.8% (15,473) had first-detected AF; 11,685 patients were included from 126 sites. Overall, 51.3% (5999) of patients were treated with rate control and 48.7% (5686) with rhythm control at admission. Patients with planned rhythm control had a shorter length of stay and were more likely to be discharged home than a facility. A higher percentage of patients with planned rhythm control were discharged on anticoagulation than those with planned rate control (75.6% vs 70.9%) despite a higher underlying stroke risk in the rate control group (higher median CHA2DS2-VASc score 4; Q1-Q3 2-5 for rate control vs 3; Q1-Q3 2-4 for rhyhtm control; P < .001). While Hispanic ethnicity, Medicaid insurance, age >70 years, and liver disease decreased the likelihood of rhythm control, factors such as heart failure, stroke, or prior bleeding diathesis had no association with the chosen treatment strategy.
Less than half of the patients with first-detected AF receive rhythm control at admission. Given recent trial results, further studies should assess the long-term impact of rhythm control on patients\' symptoms and quality of life, cardiovascular morbidity, and mortality.

We examined guideline-concordant initial systemic treatment among women with metastatic breast cancer, its predictors, and if guideline-concordant treatment was associated with mortality, healthcare utilization and Medicare expenditures.
This retrospective observational cohort study was conducted using the Surveillance, Epidemiology, End Results-Medicare linked database. Women aged 66-90 years diagnosed with metastatic breast cancer during 2010-2013 (N = 1282) were included. The National Comprehensive Cancer Network treatment guidelines were used to determine the guideline-concordant initial systemic treatment following cancer diagnosis. A logistic regression analysis was conducted to examine significant predictors of guideline-concordant treatment. Generalized linear regressions were used to examine the association between guideline-concordant treatment and healthcare utilization and average monthly Medicare expenditures.
About 74% of the study cohort received guideline-concordant initial systemic treatment. Women who received guideline-concordant treatment were significantly more likely to be comparatively younger (p < 0.05), were married/partnered (p = 0.0038), had HER2 positive tumors, and had good performance status. Adjusted hazards ratios for all-cause (2.364, p < 0.0001) and breast-cancer specific mortality (2.179, p < 0.0001) were higher for women who did not receive guideline-concordant treatment. Rates of healthcare utilization were also higher for women not receiving guideline-concordant treatment. Average monthly Medicare expenditures were 100.4% higher (95% confidence interval: $77.3%-126.5%) for women who did not receive guideline-concordant treatment compared to those who received guideline-concordant treatment (p < 0.0001).
One fourth of the study cohort did not receive guideline-concordant initial systemic treatment. Guideline-concordant initial treatment was associated with reduced mortality, and lower healthcare utilization and Medicare expenditures in women with metastatic breast cancer.

UNASSIGNED: Acute calculous cholecystitis (ACC) is the most frequent complication of gallstones requiring cholecystectomy. These patients may have coexisting choledocholithiasis. We aimed to evaluate the role of current guidelines for choledocholithiasis in patients with ACC.
UNASSIGNED: In this retrospective study, we included all patients diagnosed with ACC between December 2018 and May 2019. These patients were substratified according to the guidelines of the American and European Societies of Gastrointestinal Endoscopy (ASGE and ESGE) as having high, intermediate, or low likelihood of choledocholithiasis, and the diagnostic performance was measured. Binomial logistic regression analysis was applied to ascertain independent risk factors for choledocholithiasis.
UNASSIGNED: A total of 173 patients with ACC, mean age (±standard deviation) 49.89±15.74 years and 60.1% male, were included. Sixty-three (36.4%) had confirmed choledocholithiasis. ASGE high likelihood criteria had sensitivity and specificity of 61.9% (95% confidence interval [CI] 48.8-73.9) and 83.4% (95%CI 75.4-90.0) for predicting choledocholithiasis. ESGE high likelihood criteria had sensitivity and specificity of 49.2% (95%CI 36.4-62.1) and 87.3% (95%CI 79.6-92.9). On logistic regression analysis, an alkaline phosphatase level above the upper limit of normal (P=0.003; odds ratio [OR] 4.26, 95%CI 1.66-10.96) and a dilated common bile duct on ultrasound (P=0.001; OR 9.97, 95%CI 4.65-21.36) were independent positive predictors for choledocholithiasis, while acute biliary pancreatitis was an independent negative predictor (P=0.030; OR 0.36, 95%CI 0.14-0.91).
UNASSIGNED: The performance of the ASGE and ESGE guidelines\' risk stratification criteria is inadequate in patients with ACC. We suggest the utilization of a separate predictive model for suspected choledocholithiasis in these patients.

The study aim was to determine relevance and applicability of generic predictors of clinical deterioration in emergency departments based on consensus among clinicians.
Thirty-three predictors of clinical deterioration identified from literature were assessed in a modified two-stage Delphi-process. Sixty-eight clinicians (physicians and nurses) participated in the first round and 48 in the second round; all treating hospitalized patients in Danish emergency departments, some with pre-hospital experience. The panel rated the predictors for relevance (relevant marker of clinical deterioration) and applicability (change in clinical presentation over time, generic in nature and possible to detect bedside). They rated their level of agreement on a 9-point Likert scale and were also invited to propose additional generic predictors between the rounds. New predictors suggested by more than one clinician were included in the second round along with non-consensus predictors from the first round. Final decisions of non-consensus predictors after second round were made by a research group and an impartial physician.
The Delphi-process resulted in 19 clinically relevant and applicable predictors based on vital signs and parameters (respiratory rate, saturation, dyspnoea, systolic blood pressure, pulse rate, abnormal electrocardiogram, altered mental state and temperature), biochemical tests (serum c-reactive protein, serum bicarbonate, serum lactate, serum pH, serum potassium, glucose, leucocyte counts and serum haemoglobin), objective clinical observations (skin conditions) and subjective clinical observations (pain reported as new or escalating, and relatives\' concerns).
The Delphi-process led to consensus of 19 potential predictors of clinical deterioration widely accepted as relevant and applicable in emergency departments.

The coronavirus pandemic is one of the biggest health crises of our time. In response to this global problem, various institutions around the world had soon issued evidence-based prevention guidelines. However, these guidelines, which were designed to slow the spread of COVID-19 and contribute to public well-being, are (deliberately) disregarded by some individuals. In the present study, we aimed to develop and test a multivariate model that could help us identify individual characteristics that make a person more/less likely to comply with COVID-19 prevention guidelines. A total of 525 attentive participants completed the online survey. The results of structural equation modeling (SEM) show that COVID-19 risk perception and trust in science both independently predict compliance with COVID-19 prevention guidelines, while the remaining variables in the model (political conservatism, religious orthodoxy, conspiracy ideation and intellectual curiosity) do so via the mediating role of trust in science. The described model exhibited an acceptable fit (χ2(1611) = 2485.84, p < .001, CFI = .91, RMSEA = .032, SRMR = .055). These findings thus provide empirical support for the proposed multivariate model and underline the importance of trust in science in explaining the different levels of compliance with COVID-19 prevention guidelines.

BACKGROUND: The diagnostic criteria for hypertension have recently been redefined by the American College of Cardiology/ American Heart Association (ACC/AHA). Data on the new prevalence of hypertension in different countries are emerging, but none, to date, from Saudi Arabia.
OBJECTIVE: This study aimed to determine the impact of the 2017 ACC/AHA hypertension guideline on the prevalence and determinants of hypertension in young Saudi women.
METHODS: 518 female college students, 17-29 years of age were prospectively enrolled in a survey during the period from January 1, 2016, to April 15, 2016 at Princess Nourah University. The participants completed a previously validated questionnaire, that assessed their risk factors for hypertension, and their blood pressure, weight and height were measured.
RESULTS: Application of the 2017 ACC/AHA diagnostic criteria resulted in approximately 7-fold increase in the prevalence of hypertension, from 4.1% to 27.1% (P < 0.001). At a cut-off value of ≥140/90, hypertension was significantly associated with increased age, increased body mass index (BMI), increased heart rate, history of chronic illnesses, prior diagnosis with diabetes mellitus and family history of hypertension. Whereas, with the ≥130/80 cut-off value, only increased BMI and heart rate were significant predictors (P < 0.001).
CONCLUSIONS: The prevalence of hypertension markedly increased among young adult Saudi women with the 2017 ACC/AHA classification for hypertension, and the main predictors were increased BMI and heart rate. Further studies on the new prevalence and predictors of hypertension in the Saudi population are warranted. This information is important for healthcare authorities to plan cost effective screening, prevention and control programmes.
الأثر الناجم عن المبدأ التوجيهي المعني بارتفاع ضغط الدم الصادر عام 2017 عن الكلية الأمريكية لأمراض القلب/الجمعية الأمريكية للقلب على معدل انتشار ارتفاع ضغط الدم في صفوف الشابات السعوديات.
مها المحيسن، قماشة العبيد، وفاء الغامدي، حنين العلياني، شيماء دهمان، نورا الوهابي، نورا العوجي، تيري لي.
UNASSIGNED: قامت الكلية الأمريكية لأمراض القلب/الجمعية الأمريكية للقلب مؤخرا بإعادة تعريف معايير تشخيص ارتفاع ضغط الدم. وأخذت البيانات تظهر حول معدلات الانتشار الجديدة لارتفاع ضغط الدم في بُلدان متفرقة، غير أنها لم تتضمن حتى الآن بيانات من المملكة العربية السعودية.
UNASSIGNED: هدفت هذه الدراسة إلى تحديد الأثر الناجم عن المبدأ التوجيهي المعني بارتفاع ضغط الدم الصادر عام 2017 عن الكلية الأمريكية لأمراض القلب/الجمعية الأمريكية للقلب على معدل انتشار ومحددات ارتفاع ضغط الدم في صفوف الشابات السعوديات.
UNASSIGNED: استبق الدراسة تسجيل 518 طالبة جامعية تتراوح أعمارهن بين 17 و 29 سنة في مسح أُجري في الفترة من 1 يناير/كانون الثاني 2016 وحتى 15 أبريل/نيسان 2016 في جامعة الأميرة نورة بنت عبد الرحمن. واستكملت المشاركات استبيانا مجاز مسبقا هدف إلى تحديد عوامل خطر إصابتهن بارتفاع ضغط الدم، وقياس ضغط الدم لديهن، وكذلك قياس أوزانهن وأطوالهن.
UNASSIGNED: أسفر استخدام معايير تشخيص الكلية الأمريكية لأمراض القلب/الجمعية الأمريكية للقلب عن وجود زيادة في معدل انتشار ارتفاع ضغط الدم بمقدار 7 أضعاف تقريبا، إذ ارتفعت النسبة من %4.1 إلى %27.1 (0.001 > P). وعند وصول القيمة الحدية إلى 140/90 أو أعلى، بدا الارتباط واضحا بين ارتفاع ضغط الدم وتقدُّم العمر، وزيادة منسب كتلة الجسم، وزيادة سرعة القلب، وتاريخ الإصابة بأمراض مزمنة، والتشخيص المسبق بالسكريّ، وتاريخ الإصابة بارتفاع ضغط الدم في الأسرة. وعندما بلغت القيمة الحدية 130/80 أو أعلى، كانت زيادة منسب كتلة الجسم وزيادة سرعة القلب العاملين المُنبئيْ الوحيديْن المرتبطيْ بارتفاع ضغط الدم (0.001 > P).
UNASSIGNED: زاد معدل انتشار ارتفاع ضغط الدم بصورة ملحوظة في صفوف الشابات السعوديات البالغات وفق تصنيف الكلية الأمريكية لأمراض القلب/الجمعية الأمريكية للقلب الصادر عام 2017 بشأن ارتفاع ضغط الدم، وتمثلت العوامل الرئيسية المنبِئة في زيادة منسب كتلة الجسم وزيادة سرعة القلب. ويوصى بإجراء مزيد من الدراسات حول معدلات الانتشار الجديدة والعوامل المنبِئة بارتفاع ضغط الدم في صفوف السكان السعوديين. وتنطوي تلك المعلومات على أهمية بالنسبة للسلطات الصحية من أجل التخطيط الفعّال من حيث التكلفة لبرامج التحري، والوقاية، والمكافحة.
Impact des lignes directrices 2017 sur l’hypertension de l’American College of Cardiology/American Heart Association sur la prévalence de l’hypertension chez les jeunes femmes saoudiennes.
BACKGROUND: Les critères de diagnostic de l’hypertension ont récemment été redéfinis par l’American College of Cardiology/American Heart Association (ACC/AHA). Des données sur la nouvelle prévalence de l’hypertension dans différents pays commence à voir le jour, mais il n’y a, pour l’heure, aucune donnée pour l’Arabie saoudite.
OBJECTIVE: La présente étude avait pour objectif de déterminer l’impact des lignes directrices 2017 sur l’hypertension de l’ACC/AHA sur la prévalence et les déterminants de l’hypertension chez les jeunes femmes saoudiennes.
UNASSIGNED: 518 étudiantes de l’Université Princesse Nourah, âgées de 17 à 29 ans ont été recrutées de manière prospective pour participer à une enquête entre le 1er janvier et le 15 avril 2016. Les participantes ont rempli un questionnaire préalablement validé, qui évaluait les facteurs de risque de l’hypertension et indiquait leur tension artérielle, leur poids et leur taille.
UNASSIGNED: L’application des critères de diagnostic définis par les lignes directrices 2017 sur l’hypertension de l’ACC/AHA s’est traduite par une multiplication approximative par 7 de la prévalence de l’hypertension, qui est passée de 4,1 % à 27,1 % (p < 0,001). À une valeur seuil supérieure ou égale à 140/90, l’hypertension était significativement associée à l’âge, à un indice de masse corporelle (IMC) plus élevé, à une fréquence cardiaque accrue, à des antécédents de maladies chroniques, à un diagnostic antérieur de diabète sucré et à des antécédents familiaux d’hypertension. En revanche, avec une valeur seuil supérieure ou égale à 130/80, seule l’augmentation de l’IMC et de la fréquence cardiaque constituait des facteurs prédictifs significatifs (p < 0,001).
CONCLUSIONS: La prévalence de l’hypertension a nettement augmenté chez les jeunes femmes adultes saoudiennes suite à l’application des lignes directrices 2017 de l’ACC/AHA sur l’hypertension. Les principaux facteurs prédictifs étaient l’augmentation de l’IMC et de la fréquence cardiaque. Des études supplémentaires sur les nouvelles données concernant la prévalence et les facteurs prédictifs de l’hypertension dans la population saoudienne sont nécessaires. Ces informations sont importantes pour les autorités sanitaires afin de prévoir la mise en place de programmes de dépistage, de prévention de l’hypertension et de lutte contre cette affection ayant un bon rapport coût-efficacité.

To provide up-to-date evidence-based guidelines for the management of smoking cessation during pregnancy.
Systematic review of the international literature. We identified papers published between January 2003 and April 2019 in Cochrane PubMed, and Embase databases with predefined keywords. All reports published in French and English relevant to the areas of focus were included and classified according the level of evidence ranging from 1 (highest) to 4 (lowest). The strength of the recommendations was classified according to the Haute Autorité de santé, France (ranging from A, highest to C, lowest).
\"Counseling\", involving globally all kind of non-pharmacological interventions, has a modest benefit on smoking cessation, birth weight and prematurity. Moderate physical activity did not show a significant effect on smoking cessation. The systematic use of feedback by measuring the expired air carbon monoxide concentration do not influence smoking abstinence but it may be used in establishing a therapeutic alliance. The use of self-help interventions and health education are recommended in helping pregnant smokers quit. The prescription of nicotine replacement therapies (NRT) may be offered to any pregnant woman who has failed stopping smoking without medication This prescription can be initiated by the health care professional taking care of the pregnant woman in early pregnancy. There is no scientific evidence to propose the electronic cigarette for smoking cessation to pregnant smokers; it is recommended to provide the same advice and to use methods that have already been evaluated. The use of waterpipe (shisha/narghile) during pregnancy is associated with decreased fetal growth. It is recommended not to use waterpipe during pregnancy. Breastfeeding is possible in smokers, but less often initiated by them. Although its benefit for the child\'s development is not demonstrated to date, breastfeeding allows the mother to reduce or stop smoking. The risk of postpartum relapse is high (up to 82% at 1 year). The main factors associated with postpartum abstinence are breastfeeding, not having a smoker at home, and having no symptoms of postpartum depression.
Smoking during pregnancy concerns more than hundred thousand women and their children per year in France. It is a major public health burden. Health care professionals should be mobilized for reducing or even eradicating it.

Although many studies discussed evidence-based practice among general nurses, few studies were found by the researchers among intensive care unit nurses. Also, no study has been conducted to investigate the predictors of evidence-based practice among intensive care unit nurses in Jordan. Therefore, this study aims to identify the predictors of evidence-based practice among intensive care unit nurses in Jordan. A descriptive cross-sectional design was used to conveniently recruit 132 participants. Self-reported questionnaires were utilized including the Evidence-Based Practice Questionnaire and Evidence-Based Practice barrier scale. Participants\' rate of evidence-based practice was 60% (M = 4.2/7), which was significantly correlated with their knowledge (r = 0.739, P < .01) and attitudes (r = 0.564, P < .01) of evidence-based practice. The results revealed a 2-predictor model that explained 62.2% of the variance in evidence-based practice among intensive care unit nurses. The 2 variables were attitude (β = 0.245) and knowledge (β = 0.563). The outcomes of this study added new information regarding the prediction of evidence-based practice among intensive care unit nurses. An educational program for nurses regarding this issue is crucial to improve their practice aiming at enhancing nursing care. Also, nursing schools should update their curricula to explain the importance of evidence-based practice and to enhance students\' competencies in research utilization and statistical skills.

Modification of guideline-directed medical therapy (GDMT) in hospitalized patients with heart failure (HF) has not been extensively evaluated.
The community surveillance arm of the Atherosclerosis Risk in Communities Study identified 6959 HF hospitalizations from 2005-2011. Predictors of GDMT modification and survival were assessed using multivariable logistic regression and Cox proportional hazards models.
For 5091 hospitalizations, patient mean age was 75 years, 53% were female, 69% were white, and 81% had acute decompensated heart failure (ADHF). Regarding ejection fraction (EF), 31% of patients had HF with reduced EF (HFrEF), 24% had HF with preserved EF (HFpEF), and 44% were missing EF values. At admission, 52% of patients received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), 66% β-blockers (BBs), 9% aldosterone-receptor antagonists, 16% digoxin, 10% hydralazine, and 29% nitrates. Modification of GDMT occurred in up to 23% of hospitalizations. Significant predictors of GDMT initiation included ADHF and HFrEF; discontinuation of medications was observed with select comorbidities. In HFrEF, initiation of any GDMT was associated with reduced 1-year all-cause mortality (adjusted hazard ratio [HR] 0.41, 95% confidence interval [CI] 0.23-0.71) as was initiation of ACEI/ARBs, BBs, and digoxin. Discontinuation of any therapy versus maintaining GDMT was associated with greater mortality (HR 1.30, 95% CI 1.02-1.66). Similar trends were observed in HFpEF.
Our study suggests that GDMT initiation is associated with increased survival, and discontinuation of therapy is associated with reduced survival in hospitalized patients with HF. Future studies should be conducted to confirm the impact of GDMT therapy modification in this population.