International Journal of Clinical Practice最新文献

Clinical practice guidelines (CPGs) are tools developed to support evidence-based decision making in healthcare. However, despite the availability of CPGs for the surgical management of female stress urinary incontinence (FSUI), their methodological quality has not been evaluated. The aim of this study was to assess the methodological quality of published guidelines for the surgical management of FSUI using the AGREE II tool. A systematic search of CPGs published between 2017 and 2023 was performed in databases including MEDLINE/PubMed, LILACS, Scopus, and Trip Medical Database. Data extraction and guideline selection were performed independently by two reviewers, as was the assessment using the AGREE II instrument. Of 1459 initial records, six guidelines met the eligibility criteria. The scores for each domain evaluated were as follows: scope and purpose (45.83%; SD: 22.69), stakeholder participation (30.56%; SD: 29.03), development (48.56%; SD: 30.42), presentation clarity (58.80%; SD: 22.25), applicability (24.04%; SD: 26.36), and editorial independence (44.87%; SD: 32.88). One of the six included CPGs was rated as high quality and recommended for clinical practice. Three CPGs with modifications were recommended because there were still areas that needed improvement to enhance their quality, and two CPGs were not recommended for clinical practice because the six domains evaluated scored below 60%. According to these findings, it is essential that new CPGs developed for the surgical management of FSUI adhere to greater methodological rigor to ensure that recommendations are based on the best available evidence. Furthermore, guidelines should take into account patient values and clinical expertise to improve and facilitate effective healthcare decision making.

Background: Glomerular disease is complex and difficult for patients to understand, as it involves various pathophysiology, immunology, and pharmacology areas.

Objective: This study explored whether ChatGPT can maintain accuracy while simplifying glomerular disease terms to enhance patient comprehension.

Methods: 67 terms related to glomerular disease were analyzed using GPT-4 through two distinct queries. One aimed at a general explanation and another tailored for patients with an education level of 8th grade or lower. GPT-4’s accuracy was scored from 1 (incorrect) to 5 (correct and comprehensive). Its readability was assessed using the Consensus Reading Grade (CRG) Level, which incorporates seven readability indices including the Flesch–Kincaid Grade (FKG) and SMOG indices. Flesch Reading Ease (FRE) score, ranging from 0 to 100 with higher scores indicating easier-to-read text, was also used to evaluate the readability. A paired t-test was conducted to assess differences in accuracy and readability levels between different queries.

Results: GPT-4’s general explanations of glomerular disease terms averaged at a college readability level, indicated by the CRG score of 14.1 and FKG score of 13.9. SMOG index also indicated the topic’s complexity, with a score of 11.8. When tailored for patients at or below an 8^th-grade reading level, readability improved, averaging 9.7 by the CRG score, 8.7 by FKG score, and 7.3 by SMOG score. The FRE score also indicated a further improvement of readability from 31.6 for general explanations to 63.5 for tailored explanations. However, the accuracy in GPT-4’s tailored explanations was significantly lower than that in general explanations (4.2 ± 0.4 versus 4.7 ± 0.3, p < 0.0001).

Conclusion: While GPT-4 effectively simplified information about glomerular diseases, it compromised its accuracy in the process. To implement these findings, we suggest pilot studies in clinical settings to assess patient understanding, using feedback from diverse groups to customize content, expanding research to enhance AI accuracy and reduce biases, setting strict ethical guidelines for AI in healthcare, and integrating with health informatics systems to provide tailored educational content to patients. This approach will promote effective and ethical use of AI tools like ChatGPT in patient education, empowering patients to make informed health decisions.

Background: Healthcare workers play a crucial role in limiting the spread of the monkeypox virus. Studies show that healthcare worker’s (HCWs) understanding and communication about preventing infectious diseases can inspire various groups of individuals.

Objective: This study aimed to compare the knowledge of HCWs in India and Saudi Arabia regarding monkeypox virus infection.

Methods: A cross-sectional survey was conducted among HCWs in India and Saudi Arabia. The questionnaire was developed using information from the World Health Organization and Centers for Disease Control and Prevention websites. The validation of the questionnaire (Cronbach’s alpha = 0.87) was conducted for data collection. The mean scores between different demographic groups were compared using Student’s t-test and one-way ANOVA.

Results: A total of 848 participants responded to the questionnaire (India = 424 and Saudi Arabia = 424). The average knowledge score in India was 12.59 ± 2.49, and in Saudi Arabia, it was 13.25 ± 2.99 out of 20. The percentage of participants with good knowledge about monkeypox was 22.2% in India and 36.1% in Saudi Arabia. Participants with poor knowledge about monkeypox constituted 11% in India and 12% in Saudi Arabia.

Conclusion: HCWs in both countries had moderate to poor knowledge about the monkeypox outbreak. This might be because monkeypox is not prevalent in these countries. More education is needed to improve HCWs knowledge about monkeypox infection.

Background: Osteosarcoma (OS) is the most common malignant bone tumor in children and adolescents. FBXO43, a member of the F-box protein family, has been identified as a crucial prognostic factor in several cancers. However, its role in osteosarcoma remains largely unexplored.

Methods: This study investigated the expression and potential role of FBXO43 across the TCGA pan-cancer cohort, with a particular focus on sarcoma (SARC). We analyzed the relationship between FBXO43 expression and various cancer-related pathways, immune infiltration, and genomic features, including TP53 mutations. We also conducted immunotherapy predictive analyses using TIDE and Submap algorithms. To validate our findings, we performed a series of in vitro experiments, including cell invasion and wound healing assays.

Results: FBXO43 was found to be significantly overexpressed in various cancers and was particularly associated with pathways such as E2F_TARGETS and G2M_CHECKPOINT in SARC samples. Differential FBXO43 expression was linked to distinct immune infiltration patterns and pathway enrichments. Notably, high FBXO43 expression in osteosarcoma was associated with a higher TP53 mutation rate. Predictive analyses indicated that patients with low FBXO43 expression had better immunotherapy responses, suggesting its potential as a diagnostic and prognostic biomarker. These findings were corroborated by our in vitro functional assays.

Conclusion: Our comprehensive analysis reveals that FBXO43 plays a critical role in the progression of osteosarcoma, impacting both immune infiltration and genomic stability. FBXO43 expression levels may serve as valuable biomarkers for predicting immunotherapy responses in osteosarcoma patients. Future studies should aim to elucidate the molecular mechanisms driving FBXO43’s role and validating these findings in clinical settings to develop targeted therapeutic strategies.

Introduction: Knowledge of kidney disease (KD) is an essential element that is needed in the scope of every healthcare professional. This study assessed the level of awareness and understanding of allied health sciences undergraduates of University of Cape Coast regarding KDs and their risk factors.

Methodology: Among the regular allied health sciences undergraduates of the University of Cape Coast, a cross-sectional study was conducted from March 2022 to June 2022. A well-structured questionnaire on knowledge of KDs and their risk factors was administered to consented participants. Data were analyzed accordingly using R Studio statistical software version 2022.02.3.

Results: The study involved 383 participants (the majority being males (52.7%)) with an average age of 22.23 ± 3.03 years. Age (p < 0.001), year of study (p < 0.001), program of study (p < 0.001), frequency of 30 min of exercise per week (p = 0.002), and body mass index (p = 0.023) showed statistically significant differences between males and females. The mean knowledge score of KD was 20.86 ± 3.88 (out of a maximum score of 27) with the majority of study participants having a high knowledge of KD (61.9% (237/383)). High knowledge level was observed for types and stages, diagnosis, and risk factors for KD (76.8% (3.84/5), 75.3% (5.27/7), and 81.6% (8.98/11), respectively) while moderate knowledge level was observed for signs and symptoms (69.3% (2.77/4)). Multivariate analysis showed that participants were found to be more knowledgeable about KDs if they indicated taking alcohol (OR = 5.96; 95% CI = 2.01–22.35; p = 0.003), being in second (OR = 3.27; 95% CI = 1.22–9.02; p = 0.020) or fourth (OR = 4.72; 95% CI = 1.63–14.37; p = 0.005) year of study, or classified themselves as being underweight (OR = 3.93; 95% CI = 1.22–15.85; p = 0.033). Students reporting alcohol use had almost six times higher odds of high KD awareness compared to those who did not report alcohol intake (OR = 5.96, 95% C = 2.01–22.35, p = 0.003).

Conclusion: This study revealed an adequate knowledge level of KDs and their risk factors among allied health sciences undergraduates. However, an inadequate knowledge of its signs and symptoms was observed indicating a need for improved training.

Review studies play a key role in the development of clinical practice by synthesizing data and drawing conclusions from multiple scientific sources. In recent decades, there has been a significant increase in the number of review studies conducted and published by researchers. In clinical research, different types of review studies (systematic, scoping, umbrella, and narrative reviews) are conducted with different objectives and methodologies. Despite the abundance of guidelines for conducting review studies, researchers often face challenges in selecting the most appropriate review method, mainly due to their overlapping characteristics, including the complexity of matching review types to specific research questions. The aim of this article is to compare the main features of systematic, scoping, umbrella, and narrative reviews in clinical research and to address key considerations for selecting the most appropriate review approach. It also discusses future opportunities for updating their strategies based on emerging trends in clinical research. Understanding the differences between review approaches will help researchers, practitioners, journalists, and policymakers to effectively navigate the complex and evolving field of scientific research, leading to informed decisions that ultimately enhance the overall quality of healthcare practices.

Objective: We aimed to detect rates of metabolic syndrome and overweight, patients screened for obesity within the scope of the Disease Management Platform (DMP).

Methods: This cross-sectional study was completed with 387 patients who were examined for fasting plasma glucose, triglyceride, and high-density lipoprotein levels, waist circumference, blood pressure measurements, chronic diseases, body mass index, and medication use.

Results: In total of whom 387 underwent blood tests as recommended by the DMP. The mean age and body mass index were 55.26 ± 14.50 years and 27.02 ± 3.69 kg/m², respectively. While 26.6% of the patients had normal weight, 56.1% had overweight. Metabolic syndrome was present in 52.2% of the patients.

Conclusion: The significant increases in the rates of overweight and metabolic syndrome have drawn attention in the community. Therefore, family physicians necessitate additional platforms, such as the DMP, to effectively combat metabolic syndrome and overweight, a pivotal initial step in tackling obesity.

Background: Pre-eclampsia is a severe pregnancy complication affecting about 4%–5% of pregnancies, but the causes and clinical management were full of controversial. Bone turnover markers (BTMs) were sensitive indicators for estimating bone metabolism and were found to be changed in many pregnancy-related diseases. However, the characteristic and prognostic value of serum BTMs with pre-eclampsia was uncovered.

Methods: A multicenter prospective cohort study was performed in three different hospitals in West China. Pre-eclampsia patients and healthy pregnant women were recruited from January 2023 to January 2024. Clinical information of included participants was collected, and serum BTM levels were detected by electrochemiluminescence immunoassay. Clinical outcomes including disease aggravation (severe pre-eclampsia, eclampsia, and HELLP syndrome), low live birth weight (LBW), and premature delivery were followed up.

Results: A total of 69 pre-eclampsia patients and 75 healthy pregnant women were recruited finally, and 48 pre-eclampsia patients and 48 healthy controls who matched for age and gestational weeks were selected among them. The pre-eclampsia patients had elevated BTM levels compared with healthy controls. ß-CTX was an independent risk factor for disease aggravation, LBW, and premature delivery among pre-eclampsia patients. ß-CTX was a valuable predictive factor for disease aggravation, LBW, and premature delivery among pre-eclampsia patients (AUC were 0.772, 0.768, and 0.930, respectively, and p values were 0.001, 0.002, and < 0.001, respectively).

Conclusion: Pre-eclampsia patients may have an activated bone metabolism status compared with healthy controls. Pre-eclampsia patients with elevated bone resorptive marker ß-CTX should pay more attention to the risk of disease aggravation and adverse pregnancy outcomes.

Objective: The aim of this study was to investigate the role of NT5E and its mechanism in cisplatin (diamminedichloroplatinum, DDP) resistance in non-small cell lung cancer (NSCLC) and to explore the value of NT5E in the clinical prognosis of NSCLC patients.

Methods: First, the genes related to drug resistance were identified by constructing an A549/DDP cell line with DDP resistance and performing transcriptome sequencing and bioinformatics analysis. Gene ontology (GO) as well as the Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathways were enriched for the related genes using the Metascape database. The STRING database was further applied to construct protein–protein interaction networks (PPIs), and heatmaps were used to visualize the coexpression relationships of genes in the modules, as well as to screen for key genes. Subsequently, immunohistochemistry and molecular biology experiments were conducted to confirm the expression levels of NT5E in DDP-resistant NSCLC tissues and cells. Additionally, its effects on cell proliferation, migration, and invasion were assessed through NT5E knockdown assays. Finally, RNA sequencing and signaling pathway analyses revealed that NT5E regulates DDP resistance in NSCLC cells through the PI3K-AKT signaling pathway and analyzed the correlation between the expression of NT5E and survival outcomes in NSCLC patients.

Results: NT5E was found to be upregulated in drug-resistant cells and increased in DDP-resistant NSCLC tissues and cells. The drug-resistant genes were primarily involved in cell adhesion and the extracellular matrix. Functional experiments confirmed that the knockdown of NT5E inhibited cell proliferation, migration, and invasion. Signaling pathway analysis indicated that NT5E mediated the resistance of NSCLC cells to DDP through the PI3K/AKT signaling pathway. Moreover, high NT5E expression was found to be negatively correlated with the overall survival of NSCLC patients.

Conclusion: NT5E may be a key gene for DDP resistance in NSCLC cells, while its high expression may indicate a poor prognosis for patients. This finding provides important insights for a deeper understanding of the mechanism of drug resistance in lung cancer and serves as a theoretical basis for the development of new therapeutic strategies and drugs.