International Journal of Clinical Practice最新文献

Objective: Optimal therapeutic drug monitoring (TDM), including clinical pharmacokinetics, appropriate interpretation, and dose adjustment of drugs, is required to effectively monitor specific therapeutic drugs. Hospital pharmacists (HPs), being the most qualified healthcare professionals to implement TDM, must understand its applications to determine and adjust drug doses and avoid adverse drug reactions and toxicity. Therefore, in this knowledge, attitude, and practice (KAP) study, we assessed TDM level among HPs in Saudi Arabia.

Methods: This cross-sectional study was conducted with 414 HPs in the Makkah region with a valid pharmacy license from the Saudi Commission for Health Specialties. An overall score of 50% or higher of the total responses in each section was considered good, whereas an overall score lower than 50% was considered poor. Categorical data are expressed as frequency and percentage. Correlations were measured using Pearson’s correlation coefficient (r).

Results: The TDM-KAP levels of the participants were 50%, 80%, and 62% for KAP, respectively. Significant positive linear correlations were found between knowledge and attitude, knowledge and practice, attitude and practice, knowledge and classification, practice and classification, practice and experience, and knowledge and experience. The participants showed acceptable knowledge and practice of TDM levels with elevated attitude levels.

Conclusion: As a lack of TDM knowledge directly contributes to reduced practice levels, increasing TDM knowledge and practice by introducing more intensive pharmaceutical programs that illustrate TDM clinical applications in hospitals is recommended, which will enhance HP integration.

Background and Objective: It is still controversial whether circulating fibroblast growth factor 23 (FGF-23) can be used as a biomarker for the diagnosis of osteoporosis and fractures in patients with chronic kidney disease undergoing hemodialysis. We investigated the association of circulating FGF-23 concentrations with an increased risk of osteoporosis and fractures of hemodialysis patients in the prospective study.

Methods: These data were collected in adult patients with hemodialysis in China from January 1 to December 30, 2016, and patients were followed up for 3.5 years. The association of circulating FGF-23 with the risk of osteoporosis and fractures was analyzed by multivariate analysis.

Results: The study included 1788 hemodialysis patients, with a median age of 56 years (50–64 years) and a female population of 54.5%. Of 1788 patients, 389 (21.8%) developed osteoporosis and 207 (11.6%) developed fractures. High concentrations of FGF-23 were significantly related to osteoporosis and fractures and were significantly related to different types of fractures (vertebral fractures, nonvertebral fractures, and hip fractures). Adjusted for all potential risk factors, high concentrations of FGF-23 were associated with the risk of osteoporosis or fractures.

Conclusion: High concentrations of circulating FGF-23 were associated with the risk of osteoporosis and fractures, including vertebral fractures and hip fractures. FGF-23, along with bALP, CTX, and OC, may be used as a serum biomarker for predicting the risk of osteoporosis and fractures in patients with hemodialysis.

Aim: To assess the role of Pitt bacteremia score (PBS) and Charlson Comorbidity Index (CCI) in predicting mortality among patients with intensive care unit (ICU)–acquired Gram-negative bacterial sepsis and to investigate other factors associated with mortality.

Methods: This retrospective study was carried out between January 2018 and January 2023. Patients diagnosed with ICU-acquired sepsis caused by Gram-negative bacteria were included in the study. Demographics, laboratory data, blood culture results, management, length of ICU stay, mortality, and other clinical data were recorded. PBS and CCI score were calculated based on data collected at time of blood withdrawal. The primary endpoint was mortality in ICU.

Results: Among the 425 patients included in the study, mortality was observed in 268 (63%). Age and sex were distributed similarly in the mortality and survival groups. CCI score with a cutoff value of > 5.5 (AUC = 0.611) and PBS with a cutoff value of > 2.5 (AUC = 0.904) were able to significantly predict mortality. Multivariable logistic regression revealed that mortality was independently associated with having any comorbidity, congestive heart failure, low platelet count, high lactate, high (> 2.5) PBS, and carbapenem resistance (p = 0.001).

Conclusion: PBS was more successful than CCI in predicting mortality in patients with ICU-acquired sepsis caused by Gram-negative bacteria. In addition to higher PBS, having any comorbidity (and additionally, congestive heart failure), lower platelet, higher lactate, and carbapenem resistance were risk factors for mortality.

Background: Medical malpractice is a significant global issue affecting various aspects of healthcare, including ethical, legal, and managerial perspectives. Defensive medicine, where physicians engage in excessive practices to avoid malpractice lawsuits, is prevalent. In Turkey, the impact of malpractice fears on obstetricians and gynecologists (OB/GYNs) has not been extensively studied. This study aims to investigate the frequency of medical malpractice lawsuits, defensive medicine practices, the prevalence of medical malpractice stress syndrome (MMSS), and potential preventive measures among OB/GYNs in Turkey.

Methods: A cross-sectional survey was conducted with 212 OB/GYNs in Turkey, following ethical approval. Participants completed a questionnaire on their experiences with malpractice, defensive practices, and MMSS. The survey included sociodemographic questions, standardized scales for defensive medicine practices, and MMSS-related questions. Data were analyzed using SPSS 18 with a 95% confidence level.

Results: The majority of participants were experienced professionals aged 30–39, predominantly female, and working in the public sector with limited subspecialty training. Defensive medicine was widespread, with 95.5% of participants engaging in such practices, and 79.2% reported altering their practice due to malpractice fears. Older age, female gender, extensive experience, private sector employment, and specific subspecialties were associated with higher defensive practices and MMSS.

Conclusion: Defensive medicine is common among Turkish OB/GYNs, driven by malpractice fears. The study highlights the need for improved support systems, better legal protections, and educational interventions to address defensive practices and reduce malpractice-related stress.

Objective: To investigate the relationship between peripheral blood neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-C-reactive-protein ratio (LCR), and monocyte-to-leukocyte ratio (MWR) and the efficacy of neoadjuvant chemotherapy (NAC) for patients with locally advanced rectal cancer before and after chemotherapy.

Methods: Seventeen rectal cancer patients who underwent NAC at West China Hospital of Sichuan University from March 31, 2022, to April 30, 2024, were selected as the study subjects, and the predictive value of peripheral blood NLR, LMR, PLR, LCR, and MWR were included in the least absolute shrinkage and selection operator (LASSO) regression analysis for the pathological efficacy, and the significant variables were screened out and the nomogram was constructed from them. Decision curve analysis (DCA) was applied to evaluate the predictive performance of the model.

Results: LASSO regression screened three predictive variables of NLR, LMR and LCR before neoadjuvant therapy that could predict pathological complete remission (pCR), as well as changes in PLR, LCR, and MWR after neoadjuvant therapy that could predict chemotherapy inefficacy. Nomograms and DCA curves were drawn based on the variables, and internal validation showed that the model had good predictive ability.

Conclusion: The comprehensive hematological prediction model for effective NAC in rectal cancer has a good predictive ability for NAC efficacy, which can provide guidance for individualized patient treatment.

Objective. The genuine causal nexus between mitochondrial function-related proteins and diabetic nephropathy remains enigmatic and arduous to delineate conclusively. In this study, we employed a bidirectional two-sample Mendelian randomization analysis, a robust approach, to scrutinize and discern the causal interplay between them. Methods. In this investigation, the datasets pertaining to diabetic nephropathy and mitochondrial function-related proteins were meticulously extracted from the comprehensive IEU OpenGWAS Project database. The principal analytical method employed was the inverse variance weighted approach. In addition, MR-Egger regression, simple median, and weighted median methodologies were utilized as supplementary tools to interrogate the causal associations of mitochondrial function-related proteins with the risk of diabetic nephropathy. Semsitivity analyses were conducted using the Cochran’s Q test and MR-Egger regression intercept. The significance level, as indicated by the P value, was employed as the pivotal metric for interpreting the findings. Result. A total of 90 single nucleotide polymorphisms associated with mitochondrial function-related proteins were meticulously screened as instrumental variables. The inverse variance weighted analysis unveiled a positive causal nexus between mitochondrial glutamate carrier 2, 2,4-dienoyl-CoA reductase mitochondrial levels, 39S ribosomal protein L52 mitochondrial, ATP synthase subunit beta mitochondrial, Serine--tRNA ligase mitochondrial, itochondrial sodium/hydrogen exchanger 9B2, and Esseential MCU regulator mitochondrial, and diabetic nephropathy. Conversely, pyruvate dehydrogenase (acetyl-transferring) kinase isozyme 1 mitochondrial exhibited a negative causal relationship with diabetic nephropathy., the MR-Egger intercept test yielded non-multiplicative results (P  >  0.05), affirming the robustness and validity of Mendelian randomization as an effective method for causal inference in this investigation. Furthermore, the reverse Mendelian randomization analysis failed to demonstrate any causal link between diabetic nephropathy and an augmented risk associated with positively identified mitochondrial function-related proteins. Conclusion. Pyruvate dehydrogenase (acetyl-transferring) kinase isozyme 1 mitochondrial stands out as an independent protective factor against diabetic nephropathy. The findings bear significant clinical implications, offering pivotal insights into the development of targeted preventive and therapeutic interventions, tailored specifically for combating diabetic nephropathy.

Background. We aimed to determine the multifocality and detectability of prostate cancer (Pca) with 3-Tesla (3T) multiparametric magnetic resonance imaging (mpMRI). Methods. The data of the patients who underwent radical prostatectomy in our institution between April 2020 and April 2021 were analyzed. Patients were included in the study at the stage of radical prostatectomy. Demographic and histopathological data were retrospectively collected, and then MRIs of eligible patients were re-evaluated for the study. Suspicious regions of interest (ROIs) were evaluated by a radiologist with 4 years of experience in uroradiology and scored based on Prostate Imaging Reporting and Data System (PIRADS) v2.1. The reader was blinded to the pathological outcomes of any biopsy specimen. Lesions with a PIRADS score ≥3 were considered positive and included in the study. All cases were evaluated histopathologically by a pathologist with ten years of experience in uropathology. We utilized the mapping method which provided exactly the same information as the whole-mount histopathology along with processing the entire prostatectomy specimen. Results. A total of 142 histopathologic tumoral lesions were detected among 70 patients. In relation to postoperative histopathology, tumor multifocality was established in 78.6% (n = 55), and 52.1% (n = 74) of 142 foci recognized were clinically significant. By detecting a total of 67 lesions, mpMRI showed an overall sensitivity of 47%. Whilst the sensitivity was 73% (54/74) in clinically significant lesions, the sensitivity was only 17.6% (12/68) in clinically insignificant lesions. For the group with detected tumors, the mean prostate-specific antigen (PSA) and PSA density were higher, there were more high-grade lesions, and the rate of the extraprostatic extension was significantly greater (p < 0.05, respectively). According to the multivariate analysis, only tumor size and Gleason Score (GS) were independent predictors regarding the ability of mpMRI to detect tumor foci within the prostate (p < 0.0001). Conclusion. mpMRI exhibited an acceptable sensitivity in detecting high-risk and large Pca foci. The diagnostic accuracy is observed to be markedly diminished in small, low GS, and nonindex tumors. A considerable percentage of missed lesions are clinically significant.

Aims and Objectives. Admission in the intensive care unit is highly stressful, for both the child and family. This study aimed to identify the factors influencing the nurse-parent partnership in the pediatric intensive care units. Methods. The data were collected from 71 ICU nurses through a web-based survey by the Pediatric Nurse-Parent Partnership (NPP) Scale, Wong and Law Emotional Intelligence (EI) Scale, and patient-centered communication (PCC) proficiency by Park and Oh’s. Descriptive and inferential statistics were used to analyze the data. Results. The mean scores for NPP, EI, and PCC skills were 67.91 ± 9.62, 55.16 ± 5.77, and 33.38 ± 4.81, respectively. There was a positive correlation between NPP, EI (r = 0.71, p < 0.001), and PCC skills (r = 0.59, p < 0.001). In hierarchical multiple regression analysis, EI (p < 0.01) and PCC skills (p = 0.05) were the two stronger primary variables influencing NPP than the general variables such as gender, children, and an additional qualification in pediatric nursing with higher variance (59% vs 14%). Conclusion. The findings of the study supported that nurses’ EI and PCC skills as well as additional qualification or training in pediatric nursing were the primary factors influencing nurse-parent partnership in intensive care settings. Thus, effective intervention programs focusing on these factors should be initiated to strengthen NPP.

Background. There is still no consensus on the treatment of frozen shoulder (FS). Clinical studies on extracorporeal shockwave therapy (ESWT) combined with arthroscopic capsular release (ACR) for FS are still lacking. Objectives. To investigate the effect of ESWT on short-term functional recovery after arthroscopic capsular release (ACR). Methods. A randomized clinical trial including 49 patients who under ACR was included. The patients were assigned to the ESWT group (n = 24) or non-ESWT group (n = 25) 2 weeks after surgery. Routine advanced rehabilitation program are given to all participants, while the ESWT group additionally received 5 times shockwave therapy. Visual analog scale (VAS) pain score, Constant score, University of California Los Angeles score (UCLA), UCLA-satisfaction, and shoulder range of motion (ROM) in four directions of flexion, abduction, internal, and external rotation were analyzed at the baseline (2 weeks postsurgery), 2 weeks, 8 weeks, and 12 weeks of follow-up. Repeated measure ANOVA is used to analyze the above outcomes. Results. A total of 46 participants completed all assessments. Pain and function improved in both groups. Comparing between the groups, we found that lower VAS pain scores and higher internal rotation were found in the ESWT group at each follow-up stage (all P < 0.05, 12 weeks VAS-pain 95% CI: [ESWT: 1.55–2.19, non-ESWT: 2.11–2.76], and 12 weeks internal rotation 95% CI: [ESWT: 5.42–7.27, non-ESWT: 7.20–9.06]). Regarding functional scores, the UCLA and UCLA-satisfaction of the ESWT group was significantly higher than that of the control group at 8 weeks and 12 weeks of follow-up (all P < 0.05, 12 weeks UCLA 95% CI: [ESWT: 31.94-33.45, non-ESWT: 27.94-29.45], 12 weeks UCLA-satisfaction 95% CI: [ESWT: 4.32–5.00, non-ESWT: 2.50–4.32]), but there was no significant difference in Constant (P > 0.05, 12 weeks Constant 95% CI: [ESWT: 82.98-92.94, non-ESWT: 78.24–88.20]). Conclusion. Extracorporeal shockwave therapy has a good analgesic effect and improves internal rotation after arthroscopic capsular release through short-term follow-up.

Objective. The aim of the study was to assess some psychological factors that may be related to the attitude towards vaccination against COVID-19. Methods. The study involved 419 responders, including 317 people aged 36.10 ± 13.41 years who received vaccination against COVID-19 and 102 people aged 38.16 ± 12.33 years who decided not to be vaccinated. The study was conducted online in January-June 2022 in the Polish population. The following methods were used for the study: the generic conspiracist beliefs scale (GCBS), the perceived stress scale (PSS-10), and the state-trait anxiety inventory (STAI-X2). Results. In the conspiracy beliefs questionnaire, an average score of 34.41 ± 12.95 points was obtained in the vaccinated group and in the unvaccinated group 48.67 ± 13.62 points. The difference was statistically significant (P < 0.01). In the PSS-10 questionnaire, the vaccinated respondents obtained an average score of 19.55 ± 6.75 points, and in the unvaccinated group, the mean score was 18.44 ± 7 points. When comparing the two groups, no statistically significant differences were found. In the vaccinated group, the mean score was 46.96 ± 7.69 points in the state anxiety questionnaire (X2), and 45.85 ± 8.18 points in the unvaccinated group. There were no statistically significant differences between the study groups. Significant positive correlations were found in the results obtained in the conspiracy thinking scale (GCBS), the PSS-10 stress scale, and the anxiety scale as a personality trait (STAI-X2) in both study groups. Conclusions. People presenting conspiracy thinking may be more likely to show antivaccine attitudes compared to people not showing a tendency to this kind of thinking. Conspiracy thinking may not only be associated with a high level of anxiety as a personality trait but also with the level of experienced stress. In the group of unvaccinated people, stress was a significant predictor of conspiratorial thinking. In the group of vaccinated people, anxiety turned out to be a significant predictor of conspiracy thinking. Due to the presence of antivaccine groups, the task of the medical personnel is to educate the public. Moreover, extensive information campaigns are needed to promote vaccination safety in an accessible and understandable language.