International Journal of Clinical Practice最新文献

Studies on depression aggravation in hospitalized elderly patients with chronic heart failure (CHF) are scarce. This study analyzed the influencing factors for depression and depression aggravation in elderly CHF patients in China. A total of 196 elderly CHF patients admitted to Xuanwu Hospital from March 2019 to October 2022 were consecutively selected. Information such as demographics, comorbidities, primary disease and etiology, elderly hospitalization assessment, laboratory test outcomes, cardiac function, oral medications for CHF, and management during hospitalization were collected on admission. The patients were divided into the depressed and nondepressed groups according to their depression scores, and the independent predictors for depression were analyzed using multivariable logistic regression. Another depression assessment was performed at discharge, and independent factors for worsened depression during hospitalization were also analyzed. A high frailty index score was an independent predictor for depression in elderly CHF patients. The overall depression score of the patients at discharge was significantly higher than that on admission. Low educational attainment, a low left ventricular ejection fraction, long hospitalization, and admission to the intensive care unit (ICU) were independent predictors for depression exacerbation during hospitalization. Clinical assessment of depression is necessary for elderly hospitalized CHF patients, particularly for those who have low education, a high frailty index score, a low left ventricular ejection fraction, ICU admission, and long hospitalization. The findings of this study may deepen our understanding of depression in elderly CHF patients.

Background: Chronic kidney disease (CKD) is a global public health concern, affecting approximately 850 million people worldwide. Guidelines recommend early identification and management of CKD to mitigate disease progression and delay the onset of complications. Recording a CKD diagnosis in medical records is associated with improved kidney function and blood pressure monitoring, better use of disease-modifying therapy, and reduced risk of CKD progression. REVEAL-CKD is a multinational, observational study that aims to estimate the prevalence of stage 3 CKD which is unrecorded in administrative databases.

Methods: Data were extracted from country-specific databases of patient medical records in Australia, Brazil, Canada, England, and Spain. Included patients (aged ≥ 18 years) had two consecutive estimated glomerular filtration rate (eGFR) measurements between 30 and < 60 mL/min/1.73 m² taken 91–730 days apart. Patients were considered to have unrecorded CKD if they had no CKD diagnosis code (any stage) at any time before and up to 6 months after study index (date of second qualifying eGFR).

Results: Across countries, median age was 72–78 years, median eGFR was 46.5–53.5 mL/min/1.73 m², and availability of urinary albumin—creatinine ratio testing ranged from 4.9% (Brazil) to 53.5% (Canada). The prevalence of unrecorded stage 3 CKD was 90.0% (1002/1113 patients) in Australia, 97.0% (10,925/11,262) in Brazil, 92.0% (42,226/45,914) in Canada, 56.9% (84,237/148,153 in England, and 84.8% (27,035/31,866) in Spain.

Conclusions: More than half of the patients with laboratory evidence of stage 3 CKD lacked a CKD diagnosis code in all countries examined. Substantial intercountry variations in rates of CKD recording and testing were observed. International sharing of best practice guidance, systematic changes to improve data quality, and increased awareness of the importance of timely coding among healthcare professionals will help to improve accurate recording of stage 3 CKD.

Trial Registration: ClinicalTrials.gov identifier: NCT04847531.

Background: Sepsis is a leading cause of mortality worldwide, and increasing studies have found that high ratio of blood urea nitrogen to blood albumin ratio (BAR) was associated with mortality in inflammatory diseases. We used a multicenter database and propensity score–adjusted approach to address the mortality association of BAR in critically ill septic patients.

Methods: Using the eICU Collaborative Research Database, we enrolled adult septic patients who fulfilled the sepsis-3 criteria. We used Cox proportional hazards analysis and propensity score–adjusted analyses, consisting of propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and covariate balancing propensity score (CBPS) to determine hazard ratios (HRs) and 95% confidence intervals (CIs) of in-hospital all-cause mortality.

Results: We analyzed data from 8069 critically ill septic patients in 335 ICUs. The median age was 67 (interquartile range, 56–79) years, with 46.9% being female. The nonsurvivors (31.4%) were older and had higher APACHE IV scores, more shock, and more mechanical ventilation usage. Cox regression identified that higher BAR was independently associated with increased mortality (adjusted HR 1.247, 95% CI 1.142–1.361) after adjusting for covariates. The propensity score–based approach found a consistent and robust association, with adjHRs in the PSM, IPTW, and CBPS populations were 1.191 (95% CI 1.074–1.321), 1.178 (95% CI 1.068–1.299), and 1.215 (95% CI 1.111–1.329), respectively.

Conclusions: This multicenter study demonstrated that high BAR, which is a ready-for-use biomarker in critical care, correlated with increased mortality in critically ill septic patients, and more studies are warranted to explore the underlying mechanism.

Chinese government had implemented 8 rounds of National Centralized Drug Procurement (NCDP) in mainland China from 2019 to 2023. The purpose of this study is to assess the affordability profile and variation of policy-related antihypertensive drugs in the context of NCDP, generic substitution, and basic medical insurance policy pre-NCDP (in 2018) and post-NCDP (in 2023) in Xi’an. The affordability of 34 NCDP policy-related drugs, including 17 bid-winning generic drugs (GDs) in the NCDP list and 17 originator brands (OBs) containing the same ingredients with these GDs, was analyzed and compared, respectively, by the standard survey method of World Health Organization and Health Action International (i.e., the ratio of monthly out-of-pocket expenditure to minimum daily wage standard). Under pre-NCDP policy, the monthly out-of-pocket drug cost of all OBs and 10 GDs was more than 1 day’s wage and was unaffordable. Under post-NCDP policy, the affordability of all drugs was improved dramatically; for uninsured patients, 11 OBs and only GD (lercanidipine tablets) were still unaffordable; for patients with Urban Employee Basic Medical Insurance, all of OBs and GDs were affordable, and for patients with Urban and Rural Residents Basic Medical Insurance, 7 OBs were unaffordable, and all of GDs was considered affordable. The implementation of the NCDP policy had remarkably enhanced affordability of selected drugs. GDs are more affordable than OBs. There was obvious affordability discrepancy between outpatients with different types of medical insurance in Xi’an. To enhance affordability of antihypertensive drugs, more effective and long-term measures should be implemented, such as expanding the scope of centralized purchased drugs, promoting substitution of GDs for OBs, and increasing reimbursement of outpatient drug expenses for patients with urban and rural residents’ basic medical insurance.

Sport concussion receives substantial attention as a public health concern. Conversely, performing artists, including dancers, sustain concussions, but these aesthetic athletes do not receive the same level of consideration nor care for this injury as that offered to traditional athletes. The concussion literature pertaining to dance is sparse, and, to our knowledge, no recommendations exist for the crucial aspect of care related to returning to dance following a concussion. The purpose of this article is to assimilate the current knowledge about post-concussion return to activity management in sport—the closest analog of the physical demands required in dance—as a means to delineate a framework for returning to dance following a concussion. Specific guidance is provided based on a review of evidence-based practice so clinicians can ensure that dancers return safely to both their dance activity and any academic work they are required to undertake. Concussion in dance is not an infrequent occurrence and dancers and healthcare practitioners alike will benefit from dance-specific guidance for returning to dance post-concussion. Overall, the principles that form the foundation for return-to-sport decisions are remarkably robust for application to dance.

Introduction: The working principle of artificial intelligence in medicine is primarily as follows: The data are collected and entered into the system, the computer uses an algorithm to gather information via these data, and finally, it analyzes this algorithm to utilize in the diagnosis and treatment of the disease. In this study, we investigated the achievement of mammographic breast area/microcalcification cluster area ratio (BA/MCA) in the grouping of BI-RADS 4 (a, b, c) lesions. We planned to contribute to the development of artificial intelligence in medicine with a simple calculation program to be attached to the mammography computer.

Methods: 125 patients who underwent surgery with the diagnosis of mammographic BI-RADS 4 lesion (could not be detected in lesion-specific ultrasonography) between 2019 and 2022 in the Department of Surgical Oncology of Health Sciences University Gulhane Medical Faculty Training and Research Hospital were retrospectively examined. The mammographic MCA was divided by the breast area and their ratio was calculated. The relationship between the ratios we found and the BI-RADS values defined by radiology was analyzed.

Results: We found the median BA/MCA value of BI-RADS 4a patients to be 24943.5, BI-RADS 4b patients to be 12609.2, and BI-RADS 4c patients to be 11547.1 (p = 0.003). According to ROC curve analysis, we detected the BA/MCA ratio for BI-RADS 4c to be 14183.34 (AUC = 0.686, p = 0.005, sensitivity 54.2%). This ratio is inversely related, and the probability of BI-RADS 4c increases in patients with a BA/MCA ratio less than 14183.34. We revealed that the malignancy rate of radiological BI-RADS 4c patients was 90%, and the cutoff value of BI-RADS 4c patients was 72%. Using both classifications together, we detected the malignancy rate to be 98%.

Conclusion: The increase in the ratio of MCA to BA might have a place in the differentiation of BI-RADS 4 lesions. We foresee that artificial intelligence could also have a place in the classification of BI-RADS lesions with software to be installed on the mammography computer.

Aims: Medication discrepancies during transitions of care pose substantial risks, particularly in older patients receiving complex medication regimens. Obtaining the best possible medication history (BPMH) is crucial to minimize this risk. This study aimed to evaluate the effectiveness of a pharmacist-led BPMH using various information sources including a nationwide medication history sharing program compared to conventional interviews in a tertiary hospital setting. In addition, we identified factors contributing to medication inaccuracies.

Methods: A single-center prospective study involving older patients scheduled for thoracic surgery at a tertiary hospital was conducted. Medication histories obtained through conventional interviews during the initial assessment on admission were compared with those obtained through BPMH by pharmacist-led interviews. Logistic regression analysis was used to identify factors associated with medication inaccuracies.

Results: This study included 216 patients, a significant proportion of whom were experiencing polypharmacy. The pharmacist-led BPMH approach demonstrated superior accuracy in documenting medication histories, with conventional methods showing inaccuracies in over 70% of the cases. Factors that significantly increased the likelihood of inaccuracies included the number of medications and number of prescribers. Nonoral and as-needed medications are particularly prone to inaccuracies.

Conclusions: Pharmacist-led BPMH significantly improved medication history accuracy compared to conventional methods, which had inaccuracies in over 70%. It is important to be careful when obtaining BPMH for older adults, particularly those with complex medication regimens, nonoral medications, or PRN medications, to enhance patient safety and reduce medication-related risks.

Trial Registration: Clinical Trial Registry identifier: KCT-006813.

Clostridium innocuum (CI) is an emerging pathogen associated with a diverse range of diseases. This review primarily delves into clinical studies pertaining to CI and its potential pathogenic mechanisms, aiming to provide guidance for future research endeavors on this topic.

Objective: To assess the association between polycystic ovary syndrome and pancreatic cancer in Taiwan.

Methods: We used the 2013–2020 claims data of Taiwan National Health Insurance Program. A case-control study was performed, including female subjects 20 years or older with and without pancreatic cancer. Cases comprised female subjects diagnosed with pancreatic cancer, identified based on diagnosis codes. Controls were selected from female subjects without pancreatic cancer and matched to cases on age and comorbidities. Polycystic ovary syndrome was identified through diagnosis codes. A conditional logistic regression model was used to assess the association between polycystic ovary syndrome and pancreatic cancer, with results presented as odds ratio (OR) and 95% confidence interval (CI).

Results: This case-control study included 12,466 cases with pancreatic cancer and 49,864 matched controls. The proportions of polycystic ovary syndrome were 2.6% among cases with pancreatic cancer and 1.4% among controls without pancreatic cancer (p < 0.001). After controlling for confounding factors, the conditional logistical regression model revealed a statistically significant association between polycystic ovary syndrome and pancreatic cancer, with an OR of 1.38 (95% CI = 1.21–1.59, p < 0.001).

Conclusion: This case-control study reveals that there is a statistically significant association between polycystic ovary syndrome and pancreatic cancer. More studies are needed to provide robust evidence.

Background and Aims: The impact of thiazide diuretics on cardiac remodeling and prognosis in heart failure remains uncertain. This study aims to investigate whether hydrochlorothiazide can improve cardiac function and remodeling by inhibiting oxidative stress.

Methods: The rat model of heart failure was established by ligating the left anterior descending branch of the coronary artery, and hydrochlorothiazide (12.5 mg/kg, ig, Qd) was administered by gavage for 6 weeks. The cardiac function was evaluated using echocardiography and hemodynamics. Various methodologies were used to evaluate the effects of hydrochlorothiazide on myocardial fibrosis, inflammation, oxidative stress, and apoptosis. The effects of hydrochlorothiazide were validated in vitro using H9c2 cell cultures. The binding mechanism of hydrochlorothiazide to carbonic anhydrase 2 (CAII) was investigated using molecular docking and dynamics simulations.

Results: The decreases in ejection fraction, fractional shortening, and left ventricular end-systolic pressure and the increases in left ventricular end-diastolic diameter, left ventricular end-diastolic pressure, and B-type natriuretic peptide in heart failure rats were improved by hydrochlorothiazide. Hydrochlorothiazide can reduce the expression of myocardial collagen I. In terms of oxidative stress, hydrochlorothiazide can decrease MDA, p47phox, and p67phox while increasing SOD2, total oxidation capacity, and mitochondrial respiratory chain complexes I and IV. Additionally, hydrochlorothiazide can inhibit the p38MAPK/JNK signaling pathway, leading to reduced expression of inflammatory markers (NF-ĸB p65) and apoptotic markers (Bax, caspase3, and cytochrome C). The possible mechanism involves hydrochlorothiazide inhibiting the expression of sodium hydrogen exchanger 1 (NHE1), which is an upstream molecule involved in oxidative stress. H9c2 cell culture further confirmed the effects of hydrochlorothiazide on oxidative stress, inflammation, and apoptosis. Molecular docking and dynamics simulation results demonstrated that hydrochlorothiazide directly binds to CAII forming an unstable conformation. Gene knockout studies showed that CAII knockout reduces the expression of NHE1, NCX1, p67phox, Bax, and NF-ĸB p65.

Conclusions: Hydrochlorothiazide can enhance cardiac function and mitigate cardiac fibrosis remodeling in rats with heart failure by reducing the oxidative stress and inhibiting the p38MAPK/JNK signaling pathway, wherein CAII and NHE1 play a crucial role.