Frontiers in Medicine最新文献

Background: The core values and principles of general practice (GP) and family medicine (FM) have been described by various international scientific societies, including the World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians (WONCA). These values and principles, such as continuity of care, a bio-psycho-social approach, and hermeneutic case understanding, are also integrated into FM training programs. The aim of this study was to investigate the knowledge and perspectives of FM trainees regarding the core values and principles of FM.

Methods: In a cross-sectional study, new participants of the postgraduate FM training program KWBW Verbundweiterbildung plus© were asked to complete a self-developed questionnaire on their educational experiences, attitudes toward, and knowledge of core values in GP/FM. Specifically, participants were asked to identify the core values and principles associated with GP/FM. Qualitative analysis was used to explore the answers. Additionally, participants were required to define a set of core values, which were then analyzed semi-quantitatively and rated as correct, semi-correct, wrong, or unknown.

Results: Out of a total of n = 303 trainees, n = 250 completed the questionnaire. The majority (n = 194) were in their third year of training. A third of the participants reported having studied core values in the past. The participants identified several core values and principles associated with GP/FM. The practical relevance and confirmation of becoming an FM doctor were well-evaluated.

Conclusion: The study identified deficits in the active and passive knowledge of GP/FM core values among GP residents. An educational compact intervention about GP/GM core principles and values proved successful in its realization and implementation. To become a reflective practitioner in FM, GP residents must engage in self-reflection on evidence-based medicine, attitudes, core values, and principles. Therefore, core values should be addressed at the beginning of FM training and constantly referred to within the longitudinal curriculum. Family physicians should be continuously empowered to explicitly reflect on and discuss the core principles that shape their professional identity.

Background: Chemoresistance is a critical factor compromising the survival of patients with colorectal cancer (CRC). The "Zhi-Zhen" formula (ZZF), a traditional prescription developed by Chinese national medicine masters, has been extensively used in clinical practice to treat gastrointestinal cancer. Notably, ZZF has the potential to enhance tumor sensitivity to chemotherapy. Although previous in vitro studies have demonstrated the efficacy of ZZF in overcoming chemoresistance in colorectal cancer (CRC), its precise molecular mechanisms remain poorly understood.

Materials and methods: We used an integrated approach of bioinformatics and network pharmacology to predict the potential active ingredients and targets of ZZF in alleviating chemoresistance. The top five active ingredients identified by degree in the network analysis were validated using mass spectrometry. We then established an oxaliplatin-resistant CRC cell model to explore the potential targets and regulatory mechanisms through which ZZF overcomes chemoresistance at the cellular level.

Results: Network pharmacology and bioinformatics analyses jointly identified 29 active compounds and 13 potential key targets of ZZF, associated with chemoresistance. Among these targets, the differential expression of CASP7 significantly affected the progression-free survival of patients with CRC. We established two oxaliplatin-resistant CRC cell lines and observed an upregulation of CASP7 expression in these resistant cells. Furthermore, ZZF increases the expression and activation of CASP7 in resistant cells, promoting apoptosis, and thereby ameliorating chemoresistance. Additionally, β-catenin knockdown led to an upregulation of CASP7 expression, whereas activation of the Wnt/β-catenin signaling pathway reduced CASP7 protein levels. ZZF decreases the activity of the Wnt/β-catenin signaling pathway by decreasing β-catenin transcription and nuclear localization.

Conclusion: ZZF has potential clinical value in the treatment of chemoresistance in CRC by inhibiting the transcription and nuclear localization of β-catenin, thereby increasing the expression of CASP7 and enhancing the apoptotic response in chemoresistant CRC cells.

Introduction: With aging populations, the prevalence of dementia, frailty and malnutrition will increase. The aim of this study is twofold (a) to determine the demographic data, including frailty and malnutrition prevalence in older patients with diagnosis of dementia and/or cognitive impairment and (b) to determine its impact on outcomes such as length of stay (LOS), readmission and mortality stratified by frailty status.

Methods: Retrospective single-center cohort study conducted using hospital database on older patients ≥65 yrs. admitted to a tertiary hospital between March 2022 and Dec 2023 and discharged with either primary or secondary diagnosis of dementia or cognitive impairment. Data on age, gender, ethnicity, comorbidities, discharge diagnoses, Hospital Frailty Risk Score (HFRS), Clinical Frailty Scale (CFS), activity of daily living (ADL), 3-Minute Nutrition Screening and outcomes such as LOS, readmission, mortality and cost of hospitalization were extracted. Those aged between 65 to 74 years old were categorized as "young-old," and ≥75 years old as "old-old."

Results: Dementia or cognitive impairment diagnosis was prevalent in 8.6% (3090) older patients, and 33.7% were malnourished. 54.5% were female with a mean age of 82.0 years. Almost one fourth were dependent on ADL. Based on frailty defined by (i) HFRS-26.0% had intermediate and 18.2% high frailty (ii) CFS-41.0% were mild/moderately frail, and 32.2% severely frail. Median LOS was 8 days. 30 and 90-days readmission rates were 23.2 and 35.4%, respectively. In-hospital mortality was 7.8% and 30-day mortality 14.0%. High HFRS (aOR 1.511, 95% CI: 1.089-2.097; p = 0.013), severe frailty (aOR 4.325, 95% CI: 0.960-2.684; p < 0.001) and terminal frailty (aOR 39.762, 95% CI: 18.311-86.344; p < 0.001) were significantly associated with inpatient mortality. Intermediate HFRS (aOR 1.682, 95% CI: 1.380-2.050; p < 0.001), mild/moderate frailty (1.609, 95% CI: 1.254-2.065; p < 0.01), high HFRS (aOR 2.178, 95% CI: 1.756-2.702; p < 0.001) and severe frailty (2.333, 95% CI: 1.804-3.017; p < 0.01) were significantly associated with 30-days readmission. The impact of malnutrition on healthcare utilization was highest in the old-old with high HFRS and severe frailty.

Conclusion: Frailty and malnutrition have significant impact on healthcare utilization, readmission rates, and mortality among older adults with dementia and/or cognitive impairment.

Background: Consensus on the use of citrate vs.heparin for catheter locking remains elusive, with ongoing controversy. This meta-analysis investigates the efficacy and safety of citrate lock solutions compared to heparin lock solutions in preventing catheter-related complications.

Methods: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers conducted literature searches based on preferred reporting items from systematic reviews and meta-analyses. PubMed, EMBASE, Medline, and the Cochrane Library were searched for studies comparing citrate and heparin in patients with catheter. Catheter-related bloodstream infection (CRBSI), catheter-related infection (CRI), exit-site infection (ESI), and adverse events were analyzed.

Results: The meta-analysis included 17 randomized controlled trials (RCTs), encompassing 247,431 catheter-days, with 128,904 in the citrate group, and 118,527 in the heparin group. Citrate lock solutions significantly reduced the incidence of CRBSI compared to heparin (RR: 0.48, 95% CI: 0.31-0.73), particularly when combined with antibiotics or used at low concentrations. No significant differences were observed between the groups for CRI, ESI, catheter dysfunction, or local bleeding. Subgroup and sensitivity analyses addressed heterogeneity, confirming the robustness of the primary findings.

Conclusions: Citrate lock solutions effectively prevent CRBSI without increasing systemic coagulation dysfunction or bleeding risk. Citrate lock solutions are a safe and effective alternative to heparin, especially when combined with antibiotics.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024562511.

Sarcoidosis is an inflammatory disease characterized by the formation of granulomas in various organs, leading to inflammation and potential organ dysfunction. Symptoms often start with general signs like fatigue, fever, and weight loss, but vary depending on the affected organ. Diagnosis is challenging due to its diverse clinical presentation and lack of a definitive test, while treatment is complicated by the disease's variable course, requiring a personalized approach. This review explores the role of genetic and environmental factors in sarcoidosis etiology, examines current challenges in diagnosis and treatment, and discusses how understanding etiology informs patient management and future treatment strategies.

Introduction: An aging population and the increasing prevalence of chronic conditions challenge healthcare systems in developed countries. In response, there is a growing emphasis on person-centered care, as advocated by the World Health Organization and integrated into national health strategies in countries such as the UK and Sweden. However, transitioning to person-centered care is a complex, long-term process shaped by organizational culture and care environments. These contextual factors play crucial roles in the development and sustainability of person-centered practice, significantly transforming the experiences of both older adults and staff.

Objective: To describe how workplace culture within an inpatient hospital department shapes person-centered care practices for older adults with chronic illnesses.

Methods: A qualitative, descriptive, exploratory-observational study was performed. Data were collected through participant observation guided by the Workplace Culture Critical Analysis Tool^®. In a deductive thematic content analysis, data patterns of meaning were identified. The themes were generated underpinned by the Person-Centered Practice Framework dimensions of prerequisites, the practice environment, and person-centered processes and their respective constructs.

Results: Themes related to all person-centered practice dimensions were identified. Task demands during shifts create tension between routine-oriented work and the holistic, individualized approach required for person-centeredness. The absence of systematic multiprofessional team meetings further exacerbates this issue, limiting collaborative decision-making and personalized care planning. The contrasts in some subthemes may be related to discrepancies in the care provided by different professionals.

Conclusion: This study highlights the tension between routine-driven care and individualized approaches. Addressing identified challenges, such as formalizing multiprofessional meetings and enhancing reflective practices, is crucial for advancing person-centered care in this setting.

Objective: This study aimed to assess chest CT abnormalities and pulmonary function at 6-month and 1-year follow-ups in coronavirus disease 2019 (COVID-19) pneumonia patients of the China epidemic in the turn of 2022-2023.

Methods: A total of 156 hospitalized patients with COVID-19 pneumonia admitted between 29 November 2022 and 10 February 2023 were prospectively assessed at 6-month and 1-year follow-ups. Characteristics and CT scores of pulmonary abnormalities and pulmonary function were compared between different follow-up time points. The correlation of CT abnormalities and pulmonary function at 1-year were evaluated.

Results: Over 1 year, the proportion of pulmonary abnormalities gradually decreased (initial, 100%, 156/156; 6-month, 57.1%, 89/156; and 1-year, 37.8%, 59/156; P < 0.001), whereas fibrotic changes increased (initial, 6.4%, 10/156; 6-month, 14.1%, 22/156; and 1-year, 14.7%, 23/56; P < 0.001). Compared to participants of the subgroup with nonfibrotic changes, diffusion capacity of the lung for carbon monoxide (DLCO)(P = 0.01) and DLCO less than 80% predicted (P < 0.001) showed significantly decrease in participants of the subgroup with fibrotic changes. The extent of fibrotic changes was strongly correlated with lower DLCO (r = -0.734, P < 0.001).

Conclusion: Fibrotic changes might show a tendency to persist over time and correlate strongly with impairment of diffusion function, thus requiring more attention in future follow-ups.

Dysphagia is a high-profile dysfunction that often occurs after a stroke, with a prevalence of 50%-80%. Post-stroke dysphagia (PSD) often leads to serious complications such as pneumonia and malnutrition, reducing the quality of life and leading to poor prognosis or even death. PSD causes these adverse physical and psychological impairments to patients, which becomes a challenge for both patients and physicians. This review intends to contribute to the international debate on evidence-based options on Stroke Rehabilitation and to better understand the need for further research on PSD and summarizing evidence on some of the most relevant topics and clarifying its clinical practice value for Neurology, stroke rehabilitation experts, rehabilitation and nursing staff, as well as patients. The article identifies and discusses the gaps in knowledge on PSD and elaborates on current evidence concerning the selection of subjects, examination methods, patient data extraction and analysis, classification of stroke lesions, details of dysphagia, significance of results, and neuromodulation of dysphagia, from the perspective of rehabilitation physicians. The review identified a set of 10 points and parameters for the international debate on PSD, namely: stroke onset, cognitive impairment, feeding method, contrast medium, swallowing reflex delay, swallowing evaluation form, division of brainstem, multiple stroke sites, basal ganglia lesions and neuromodulation techniques. The article explores available evidence on factors associated with dysphagia and stroke site. Although there is plenty of evidence exploring the correlation between stroke site and swallowing disorders, the pathophysiological mechanisms between the two are complex, and expert interpretations of the evidence and clinical opinions vary on which swallowing abnormalities occur. The study generates evidence on current evidence-based options on Stroke Rehabilitation and a better understanding of the need for further research on Post-Stroke Dysphagia. Taking a patient-centric approach, the ultimate goal is to generate on how can available evidence influence policy or practice or research or clinical education. The article provides a structured discussion clarifying key points on the relationship between stroke lesions and swallowing dysfunctions and contributes to clarifying the gaps in evidence to further improve the quality of life of the patients suffering from Post-Stroke Dysphagia.

Background: MPT64 protein is an effective marker for detecting Mycobacterium tuberculosis (MTB) in liquid culture and clinical tissue samples. However, some MTB clinical isolates test negative for this antigen because of varied mutation types across different regions.

Methods: DNA samples of MPT64 antigen assay-negative MTB strains were collected from a tertiary hospital from January 2016 to January 2024, and mpt64 gene mutations were detected by sequencing. Clinical records of patients with negative MPT64 antigen results were collected and compared with those of patients with positive results. The global distribution of mpt64 gene mutations was analyzed using MTB genome sequences from the National Center for Biotechnology Information (NCBI) database.

Results: Among 821 mycobacterial specimens with negative MPT64 antigen assay results, 77 MTB strains were collected from 73 patients. Compared with MPT64-positive patients (n = 301), a higher percentage of MPT64-negative patients had a history of anti-tuberculosis therapy (n = 7, 11.1%; P = 0.01). Moreover, MPT64-negative patients demonstrated a lower percentage of positive Gene Xpert results than MPT64-positive patients (73.8% vs 95.1%, P < 0.001). Several gene mutations were detected in the MPT64-negative MTB strains, including 63 bp deletion, single nucleotide mutations, and IS6110 insertion. Among 7,324 MTB genomes from the NCBI database, 87 strains had mutations in the mpt64 gene sequence, with four common mutation sites causing single amino acid changes, including G34A (8.0%), A103G (27.6%), T128A (9.2%), and C477A (24.1%).

Conclusion: A negative MPT64 antigen result in MTB cultures can be attributed to mutations in the mpt64 gene, and infections caused by these strains are more likely to be misdiagnosed.

Objective: Early craniotomy evacuation in hematoma surgery does not significantly improve the prognosis of patients with spontaneous intracerebral hemorrhage (ICH). The YL-1 hematoma crushing puncture needle, specifically designed for ICH evacuation, has an uncertain therapeutic efficacy. This study aimed to evaluate its clinical effectiveness.

Materials and methods: We retrospectively reviewed medical records of patients with ICH who underwent twist intraosseous drill needle (TIDN) surgery at our institution between September 2016 and March 2023. Clinical outcomes were analyzed.

Results: The surgical group demonstrated a significantly shorter hematoma resolution time, averaging 14.71 days less than the conservative group (p < 0.001). The Barthel Index improved more in the surgical group, with an average increase of 8.214 points (p < 0.001). Seven days post-admission, the increase in Glasgow Coma Scale (GCS) scores was significantly higher in the surgical group, with an average improvement of 1.471 points (p < 0.001). Additionally, the duration of mannitol administration was significantly reduced in the surgical group (p < 0.001).

Conclusion: TIDN surgery combined with hematoma drainage may serve as a viable surgical alternative for basal ganglia hemorrhage patients. This approach appears to reduce mannitol usage, mitigate craniotomy-associated risks, and promote short-term improvements in GCS scores and Barthel Index, highlighting its potential clinical benefits.