International Journal of Clinical Practice最新文献_第7页

Serum Neuron-Specific Enolase Levels in Patients With Diabetic Peripheral Neuropathy 糖尿病周围神经病变患者血清神经元特异性烯醇化酶水平

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice

Pub Date : 2025-12-01 DOI: 10.1155/ijcp/5569034

Selcen Duran, Asuman Celikbilek, Aysu Yetis, Bilal Ilanbey, Burc Esra Sahin, Aydan Koysuren, Himmet Durmaz

Background

Based on previous reports that elevated NSE levels may predict diabetic neuropathy, we aimed to validate this association in a well-characterized cohort. Using strict exclusion criteria, standardized clinical scales, and nerve conduction studies, we aimed to evaluate the clinical utility of NSE levels in diabetic patients with and without neuropathic pain.

Methods

A total of 144 Type 2 diabetic patients were included in this prospective cross-sectional study. Neuropathic pain symptoms were assessed using the Douleur Neuropathique 4 questionnaire (DN4) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). The diagnosis of diabetic peripheral neuropathy (DPNP) was established based on electrophysiological findings. Patients were divided into three groups as follows: those having neuropathic pain with DPNP (Group 1, n = 60) and without DPNP (Group 2, n = 56). The patients without neuropathic pain (n = 28) were defined as Group 3. Serum NSE levels were derived via electrochemiluminescence immunoassay.

Results

There was no significant between-group difference in age or gender (both p > 0.05). The disease duration was significantly longer in patients having neuropathic pain, compared to those without neuropathic pain (p = 0.004). The serum levels of NSE (p < 0.001) and the scores on the DN4 (p = 0.001) and LANSS (p = 0.016) instruments were higher in Group 1 than in Group 2. The NSE level was positively correlated with the LANSS score (r = 0.260, p = 0.005) and independently associated with the presence of DPNP in a multivariate model (OR 1.33, 95% confidence interval 1.12–1.58, p = 0.001). On the ROC analysis, an NSE cutoff of 9.51 ng/mL predicted the presence of DPNP.

Conclusion

Elevated serum NSE levels were significantly associated with DPNP in diabetic patients, indicating that NSE may serve as a potential biomarker for large-fiber involvement. However, this finding warrants confirmation in larger, multicenter studies.

背景：基于先前的报道，NSE水平升高可能预测糖尿病神经病变，我们的目的是在一个特征明确的队列中验证这种关联。通过严格的排除标准、标准化的临床量表和神经传导研究，我们旨在评估NSE水平在伴有和不伴有神经性疼痛的糖尿病患者中的临床应用。方法对144例2型糖尿病患者进行前瞻性横断面研究。采用双神经性疼痛问卷（DN4）和利兹神经性症状和体征评估（LANSS）评估神经性疼痛症状。糖尿病周围神经病变（DPNP）的诊断是基于电生理结果。将患者分为三组：神经性疼痛伴DPNP组（组1，n = 60）和无DPNP组（组2，n = 56）。无神经性疼痛患者（n = 28）为第三组。通过电化学发光免疫分析法测定血清NSE水平。结果两组患者年龄、性别差异无统计学意义（p > 0.05）。与没有神经性疼痛的患者相比，神经性疼痛患者的病程明显更长（p = 0.004）。组1血清NSE水平（p < 0.001）、DN4评分（p = 0.001）和LANSS评分（p = 0.016）均高于组2。在多变量模型中，NSE水平与LANSS评分呈正相关（r = 0.260, p = 0.005），并与DPNP的存在独立相关（OR为1.33,95%置信区间为1.12-1.58,p = 0.001）。在ROC分析中，NSE截止值为9.51 ng/mL预测DPNP的存在。结论糖尿病患者血清NSE水平升高与DPNP显著相关，提示NSE可能是大纤维病变的潜在生物标志物。然而，这一发现需要在更大的、多中心的研究中得到证实。

{"title":"Serum Neuron-Specific Enolase Levels in Patients With Diabetic Peripheral Neuropathy","authors":"Selcen Duran, Asuman Celikbilek, Aysu Yetis, Bilal Ilanbey, Burc Esra Sahin, Aydan Koysuren, Himmet Durmaz","doi":"10.1155/ijcp/5569034","DOIUrl":"https://doi.org/10.1155/ijcp/5569034","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Based on previous reports that elevated NSE levels may predict diabetic neuropathy, we aimed to validate this association in a well-characterized cohort. Using strict exclusion criteria, standardized clinical scales, and nerve conduction studies, we aimed to evaluate the clinical utility of NSE levels in diabetic patients with and without neuropathic pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 144 Type 2 diabetic patients were included in this prospective cross-sectional study. Neuropathic pain symptoms were assessed using the Douleur Neuropathique 4 questionnaire (DN4) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). The diagnosis of diabetic peripheral neuropathy (DPNP) was established based on electrophysiological findings. Patients were divided into three groups as follows: those having neuropathic pain with DPNP (Group 1, <i>n</i> = 60) and without DPNP (Group 2, <i>n</i> = 56). The patients without neuropathic pain (<i>n</i> = 28) were defined as Group 3. Serum NSE levels were derived via electrochemiluminescence immunoassay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was no significant between-group difference in age or gender (both <i>p</i> > 0.05). The disease duration was significantly longer in patients having neuropathic pain, compared to those without neuropathic pain (<i>p</i> = 0.004). The serum levels of NSE (<i>p</i> < 0.001) and the scores on the DN4 (<i>p</i> = 0.001) and LANSS (<i>p</i> = 0.016) instruments were higher in Group 1 than in Group 2. The NSE level was positively correlated with the LANSS score (<i>r</i> = 0.260, <i>p</i> = 0.005) and independently associated with the presence of DPNP in a multivariate model (OR 1.33, 95% confidence interval 1.12–1.58, <i>p</i> = 0.001). On the ROC analysis, an NSE cutoff of 9.51 ng/mL predicted the presence of DPNP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Elevated serum NSE levels were significantly associated with DPNP in diabetic patients, indicating that NSE may serve as a potential biomarker for large-fiber involvement. However, this finding warrants confirmation in larger, multicenter studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2025 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/5569034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Analysis of Risk Factors for Ureteral Stent–Related Symptoms in Patients Undergoing Short-Term Ureteral Stent Placement due to Ureteroscopy and Urinary Stones 输尿管镜检查和尿路结石导致短期输尿管支架置入术患者输尿管支架相关症状的危险因素分析

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice

Pub Date : 2025-11-30 DOI: 10.1155/ijcp/8677297

Yirixiatijiang Amier, Jiabo Li, Dongfeng Yuan, Xianmiao Li, Wenlong Wan, Junyi Yang, Yisheng Huang, Wenke Ji, Yang Xun, Xiao Yu

Objective

To evaluate the risk factors associated with ureteral stent–related symptoms in patients undergoing short-term ureteral stent placement using a validated questionnaire.

Methods

A total of 263 patients who underwent short-term stent placement following upper urinary tract stone surgery or ureteroscopy were included in this prospective study. The linguistically validated Chinese version of the Ureteral Stent Symptom Questionnaire was administered to all patients on Days 7 and 28 after stent placement to assess stent-related symptoms. Univariate and multivariate linear regression analyses were performed to identify risk factors, and a two-tailed p < 0.05 was considered statistically significant.

Results

Compared to Day 7, scores for urinary symptoms, body pain, general health, work performance, sexual matters, and additional problems significantly decreased by Day 28 (p < 0.05). Multivariate linear regression revealed that stent placement due to urinary tract stone surgery, stent positioning beyond the midline, and a lower distal length ratio (positioned closer to the bladder neck) were common risk factors for both early and late stent-related symptoms. Stent positioning beyond the midline was associated with at least three symptom domains. In addition, a higher body mass index and no history of previous stent placement were risk factors for worse body pain and more additional problems in the early phase, respectively. The presence of recurrent urinary tract infections was a risk factor for more severe urinary symptoms and poorer general health in the late phase.

Conclusions

The stent-related symptoms are most pronounced in the early period, with a noticeable reduction in these effects over time. The distal position characteristics of the stent have the greatest impact on patient discomfort. Stent placement due to urinary tract stone surgery, presence of recurrent urinary tract infections, and higher BMI are also risks for experiencing severe stent-related symptoms.

目的通过一份有效的问卷调查，评估短期输尿管支架置入术患者输尿管支架相关症状的相关危险因素。方法本前瞻性研究共纳入263例在上尿路结石手术或输尿管镜检查后接受短期支架置入的患者。在输尿管支架放置后第7天和第28天，对所有患者使用经语言验证的中文版输尿管支架症状问卷，以评估支架相关症状。采用单因素和多因素线性回归分析确定危险因素，双尾p <； 0.05认为有统计学意义。结果与第7天相比，第28天泌尿系统症状、身体疼痛、一般健康状况、工作表现、性问题和其他问题的得分显著下降（p < 0.05）。多元线性回归显示，由于尿路结石手术而放置支架、支架放置在中线以外、远端长度比较低（放置在更靠近膀胱颈的位置）是早期和晚期支架相关症状的常见危险因素。超过中线的支架定位与至少三个症状域相关。此外，较高的身体质量指数和没有支架植入史分别是早期更严重的身体疼痛和更多其他问题的危险因素。复发性尿路感染的存在是后期更严重的泌尿系统症状和较差的一般健康状况的危险因素。结论：支架相关症状在早期最为明显，随着时间的推移，这些症状明显减轻。支架的远端位置特性对患者的不适影响最大。由于尿路结石手术而放置支架、尿路感染复发和较高的BMI也是发生严重支架相关症状的风险。

{"title":"Analysis of Risk Factors for Ureteral Stent–Related Symptoms in Patients Undergoing Short-Term Ureteral Stent Placement due to Ureteroscopy and Urinary Stones","authors":"Yirixiatijiang Amier, Jiabo Li, Dongfeng Yuan, Xianmiao Li, Wenlong Wan, Junyi Yang, Yisheng Huang, Wenke Ji, Yang Xun, Xiao Yu","doi":"10.1155/ijcp/8677297","DOIUrl":"https://doi.org/10.1155/ijcp/8677297","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the risk factors associated with ureteral stent–related symptoms in patients undergoing short-term ureteral stent placement using a validated questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 263 patients who underwent short-term stent placement following upper urinary tract stone surgery or ureteroscopy were included in this prospective study. The linguistically validated Chinese version of the Ureteral Stent Symptom Questionnaire was administered to all patients on Days 7 and 28 after stent placement to assess stent-related symptoms. Univariate and multivariate linear regression analyses were performed to identify risk factors, and a two-tailed <i>p</i> < 0.05 was considered statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to Day 7, scores for urinary symptoms, body pain, general health, work performance, sexual matters, and additional problems significantly decreased by Day 28 (<i>p</i> < 0.05). Multivariate linear regression revealed that stent placement due to urinary tract stone surgery, stent positioning beyond the midline, and a lower distal length ratio (positioned closer to the bladder neck) were common risk factors for both early and late stent-related symptoms. Stent positioning beyond the midline was associated with at least three symptom domains. In addition, a higher body mass index and no history of previous stent placement were risk factors for worse body pain and more additional problems in the early phase, respectively. The presence of recurrent urinary tract infections was a risk factor for more severe urinary symptoms and poorer general health in the late phase.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The stent-related symptoms are most pronounced in the early period, with a noticeable reduction in these effects over time. The distal position characteristics of the stent have the greatest impact on patient discomfort. Stent placement due to urinary tract stone surgery, presence of recurrent urinary tract infections, and higher BMI are also risks for experiencing severe stent-related symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2025 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/8677297","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sinapic Acid Attenuates Hypertrophic Scarring by Modulating the TGF-β1/Smad Pathway: An In Vivo and In Vitro Investigation 辛酸通过调节TGF-β1/Smad通路减轻增生性瘢痕：体内和体外研究

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice

Pub Date : 2025-11-29 DOI: 10.1155/ijcp/3671828

Zhe Jin, Libo Yin, Zhiguang Huang

Rationale

Hypertrophic scars are formed as a result of excess collagen and fibroblast activity during the tissue healing process and can result in loss of function. Sinapic acid (SA) is a naturally occurring phenolic compound with antifibrotic, anti-inflammatory, and antioxidant properties.

Aims and Objectives

This study aims to evaluate the ability of SA to inhibit hypertrophic scar generation and explain the mechanisms through which this happens by performing both in vivo and in vitro experiments.

Methods

A rat tail wound model in vivo was employed to assess the impact of SA on the pathological scar area, biomolecule deposition, and fibroblast multiplication. Histopathological, immunohistochemistry, and molecular tests were also performed. Fibroblast cell culture of hypertrophic scar fibroblast cells was used in addition to SA treatment to measure cell growth, movement activity, cell division phases, and fibrotic-related proteins.

Results

In vivo results showed that SA reduced the area of scarring in skin tissues and enhanced the organization of collagen, with the high-concentration group showing the most improvement. The reduction in TGF-β1 and P-SMAD2 was established through immunohistochemistry assays. In vitro findings indicated SA to decrease cell proliferation and movement capabilities of fibroblasts, as well as blocking the G1 phase and resulting in apoptosis. SA also downregulated key fibrosis markers including COL1A1, COL3A1, and α-SMA.

Conclusions

Modulation of the TGF-β1/Smad pathway, reduction of fibroblast proliferation, and the improvement of collagen organization are effects of SA, which aid in attenuation of hypertrophic scar formation. Our findings support the suggestion for further studies in this regard in order to test the safety and efficacy of SA, which can have great potentials for use in antiscarring therapies. These findings provide a mechanistic rationale for the translational development of SA as a topical antiscarring therapy.

在组织愈合过程中，增生性疤痕是由于胶原蛋白和成纤维细胞活性过剩而形成的，可导致功能丧失。辛酸（SA）是一种天然存在的酚类化合物，具有抗纤维化、抗炎和抗氧化特性。目的和目的本研究旨在通过体内和体外实验来评估SA抑制增生性瘢痕生成的能力，并解释其发生的机制。方法采用活体大鼠尾外伤模型，观察SA对病理性瘢痕面积、生物分子沉积及成纤维细胞增殖的影响。同时进行组织病理学、免疫组织化学和分子检测。增生性瘢痕成纤维细胞培养除SA处理外，还使用成纤维细胞来测量细胞生长、运动活性、细胞分裂期和纤维相关蛋白。结果体内实验结果显示，SA减少皮肤组织瘢痕面积，增强胶原组织，其中高浓度组改善效果最大。免疫组化检测发现TGF-β1和P-SMAD2均明显降低。体外实验结果表明，SA可降低成纤维细胞的增殖和运动能力，阻断成纤维细胞G1期，导致成纤维细胞凋亡。SA还下调关键纤维化标志物，包括COL1A1、COL3A1和α-SMA。结论SA可调节TGF-β1/Smad通路，减少成纤维细胞增殖，改善胶原组织，减轻增生性瘢痕的形成。我们的研究结果支持在这方面进一步研究的建议，以测试SA的安全性和有效性，它在抗疤痕治疗中具有很大的潜力。这些发现为SA作为局部抗疤痕疗法的转化发展提供了机制基础。

{"title":"Sinapic Acid Attenuates Hypertrophic Scarring by Modulating the TGF-β1/Smad Pathway: An In Vivo and In Vitro Investigation","authors":"Zhe Jin, Libo Yin, Zhiguang Huang","doi":"10.1155/ijcp/3671828","DOIUrl":"https://doi.org/10.1155/ijcp/3671828","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Hypertrophic scars are formed as a result of excess collagen and fibroblast activity during the tissue healing process and can result in loss of function. Sinapic acid (SA) is a naturally occurring phenolic compound with antifibrotic, anti-inflammatory, and antioxidant properties.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>This study aims to evaluate the ability of SA to inhibit hypertrophic scar generation and explain the mechanisms through which this happens by performing both in vivo and in vitro experiments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A rat tail wound model in vivo was employed to assess the impact of SA on the pathological scar area, biomolecule deposition, and fibroblast multiplication. Histopathological, immunohistochemistry, and molecular tests were also performed. Fibroblast cell culture of hypertrophic scar fibroblast cells was used in addition to SA treatment to measure cell growth, movement activity, cell division phases, and fibrotic-related proteins.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In vivo results showed that SA reduced the area of scarring in skin tissues and enhanced the organization of collagen, with the high-concentration group showing the most improvement. The reduction in TGF-β1 and P-SMAD2 was established through immunohistochemistry assays. In vitro findings indicated SA to decrease cell proliferation and movement capabilities of fibroblasts, as well as blocking the G1 phase and resulting in apoptosis. SA also downregulated key fibrosis markers including COL1A1, COL3A1, and α-SMA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Modulation of the TGF-β1/Smad pathway, reduction of fibroblast proliferation, and the improvement of collagen organization are effects of SA, which aid in attenuation of hypertrophic scar formation. Our findings support the suggestion for further studies in this regard in order to test the safety and efficacy of SA, which can have great potentials for use in antiscarring therapies. These findings provide a mechanistic rationale for the translational development of SA as a topical antiscarring therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2025 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/3671828","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Challenges of Discharge Summary Documentation: A Qualitative Study of Medical Doctors’ Perspectives 出院总结文件的挑战：医生观点的定性研究

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice

Pub Date : 2025-11-27 DOI: 10.1155/ijcp/8838260

Asma Mohamedsharif, Alrumaisa Alhassan, Imtinan Yousif, Ayat Mohamed, Omaima Mohamed, Fatima Himedan, Masra Abubaker, Ghayda Mohamed

In fragile healthcare systems such as Sudan, discharge summaries play a critical role, as they often serve as the only documentation of a patient’s hospitalization. Incomplete or poorly written discharge summaries reduce care quality, compromise patient safety, and negatively affect the overall patient experience. This study aimed to explore medical doctors’ perceived challenges in documenting discharge summaries for patients with chronic diseases in Sudan. We conducted a qualitative study using semistructured interviews with medical doctors involved in patient discharge and working in public hospitals. Two independent analysts performed content analysis on the data. The analysis revealed six interrelated themes: missing or incomplete information, inadequate education and supervision, lack of standardized templates, absence of quality monitoring, overwhelming workload, and individual accountability. These findings highlight key systemic, structural, and behavioral barriers that hinder the continuity and quality of postdischarge care.

在苏丹等脆弱的卫生保健系统中，出院摘要发挥着关键作用，因为它们往往是患者住院的唯一文件。不完整或写得不好的出院总结会降低护理质量，危及患者安全，并对患者的整体体验产生负面影响。本研究旨在探讨医生在记录苏丹慢性病患者出院摘要时所面临的挑战。我们对参与病人出院和在公立医院工作的医生进行了半结构化访谈，进行了定性研究。两位独立的分析师对数据进行了内容分析。分析揭示了六个相互关联的主题：信息缺失或不完整、教育和监督不足、缺乏标准化模板、缺乏质量监控、工作量过大和个人责任。这些发现突出了阻碍出院后护理连续性和质量的关键系统、结构和行为障碍。

{"title":"Challenges of Discharge Summary Documentation: A Qualitative Study of Medical Doctors’ Perspectives","authors":"Asma Mohamedsharif, Alrumaisa Alhassan, Imtinan Yousif, Ayat Mohamed, Omaima Mohamed, Fatima Himedan, Masra Abubaker, Ghayda Mohamed","doi":"10.1155/ijcp/8838260","DOIUrl":"https://doi.org/10.1155/ijcp/8838260","url":null,"abstract":"<p>In fragile healthcare systems such as Sudan, discharge summaries play a critical role, as they often serve as the only documentation of a patient’s hospitalization. Incomplete or poorly written discharge summaries reduce care quality, compromise patient safety, and negatively affect the overall patient experience. This study aimed to explore medical doctors’ perceived challenges in documenting discharge summaries for patients with chronic diseases in Sudan. We conducted a qualitative study using semistructured interviews with medical doctors involved in patient discharge and working in public hospitals. Two independent analysts performed content analysis on the data. The analysis revealed six interrelated themes: missing or incomplete information, inadequate education and supervision, lack of standardized templates, absence of quality monitoring, overwhelming workload, and individual accountability. These findings highlight key systemic, structural, and behavioral barriers that hinder the continuity and quality of postdischarge care.</p>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2025 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/8838260","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Cross-Sectional Survey on the Current Status and Influencing Factors of Clinical Investigators’ Competencies in Beijing, China 北京市临床调查员胜任力现状及影响因素的横断面调查

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice

Pub Date : 2025-11-26 DOI: 10.1155/ijcp/7171237

Shuang Zhao, Miao Miao, Pengcheng Liu, Mengjiao He, Yuwei Zhang, Xin Wang

Objective

Clinical investigators are essential for assessing the clinical value, safety, and efficacy of innovative drugs. However, comprehensive data on their competency levels are limited in China. This study aimed to evaluate the current status and key determinants of clinical investigators’ competencies.

Methods

We conducted a multicenter, cross-sectional study in 40 tertiary hospitals in Beijing in August 2023, enrolling 1397 clinical investigators. Competency was assessed via a self-administered questionnaire, and influencing factors were identified using multivariate logistic regression.

Results

The median overall competency score was 103 (range: 32–160). Among 194 principal investigators (PIs), prominent competency scores ranged from 25 to 120, with a median of 93. Several factors were significantly associated with higher competency, including advanced education (doctoral degree: aOR = 1.75, 95% CI: 1.21–2.55), professional title (midlevel title: aOR = 1.77, 95% CI: 1.20–2.59; senior-level title: aOR = 2.91, 95% CI: 1.78–4.75), experience leading clinical trials (≥ 1 trial as PI: aOR = 2.38, 95% CI: 1.69–3.36), and GCP training frequency (at least semiannually: aOR = 1.39, 95% CI: 1.07–1.81).

Conclusions

Efforts should target areas of underperformance, particularly by encouraging the pursuit of advanced degrees, senior professional accreditation, PI experience, and regular GCP training. Competency development requires systematic training rather than mere seniority. Consistent GCP training and adherence to international competency standards are crucial for elevating trial quality and facilitating China’s integration into global drug development.

目的临床研究者是评估创新药物临床价值、安全性和有效性的关键。然而，关于他们能力水平的综合数据在中国是有限的。本研究旨在评估临床研究人员能力的现状和关键决定因素。方法于2023年8月在北京市40家三级医院开展多中心横断面研究，纳入1397名临床研究者。通过自填问卷评估胜任力，并使用多元逻辑回归确定影响因素。结果综合胜任力得分中位数为103分（范围：32 ~ 160）。在194名主要研究人员中，突出的能力得分在25到120之间，中位数为93。有几个因素与较高的胜任力显著相关，包括高学历（博士学位：aOR = 1.75, 95% CI: 1.21-2.55）、职称(中级职称：aOR = 1.77, 95% CI: 1.20-2.59；高级职称：aOR = 2.91, 95% CI: 1.78-4.75)，有主导临床试验经验（≥1项试验：aOR = 2.38, 95% CI: 1.69-3.36），以及GCP培训频率（至少半年一次：aOR = 1.39, 95% CI: 1.07-1.81）。结论应针对表现不佳的领域，特别是鼓励追求更高的学位，高级专业认证，PI经验和定期GCP培训。能力发展需要系统的培训，而不仅仅是资历。持续的GCP培训和遵守国际能力标准对于提高试验质量和促进中国融入全球药物开发至关重要。

{"title":"A Cross-Sectional Survey on the Current Status and Influencing Factors of Clinical Investigators’ Competencies in Beijing, China","authors":"Shuang Zhao, Miao Miao, Pengcheng Liu, Mengjiao He, Yuwei Zhang, Xin Wang","doi":"10.1155/ijcp/7171237","DOIUrl":"https://doi.org/10.1155/ijcp/7171237","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Clinical investigators are essential for assessing the clinical value, safety, and efficacy of innovative drugs. However, comprehensive data on their competency levels are limited in China. This study aimed to evaluate the current status and key determinants of clinical investigators’ competencies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a multicenter, cross-sectional study in 40 tertiary hospitals in Beijing in August 2023, enrolling 1397 clinical investigators. Competency was assessed via a self-administered questionnaire, and influencing factors were identified using multivariate logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median overall competency score was 103 (range: 32–160). Among 194 principal investigators (PIs), prominent competency scores ranged from 25 to 120, with a median of 93. Several factors were significantly associated with higher competency, including advanced education (doctoral degree: aOR = 1.75, 95% CI: 1.21–2.55), professional title (midlevel title: aOR = 1.77, 95% CI: 1.20–2.59; senior-level title: aOR = 2.91, 95% CI: 1.78–4.75), experience leading clinical trials (≥ 1 trial as PI: aOR = 2.38, 95% CI: 1.69–3.36), and GCP training frequency (at least semiannually: aOR = 1.39, 95% CI: 1.07–1.81).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Efforts should target areas of underperformance, particularly by encouraging the pursuit of advanced degrees, senior professional accreditation, PI experience, and regular GCP training. Competency development requires systematic training rather than mere seniority. Consistent GCP training and adherence to international competency standards are crucial for elevating trial quality and facilitating China’s integration into global drug development.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2025 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/7171237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Secondary Prevention Adherence and Clinical Outcomes in Diabetic Patients After Acute Coronary Syndrome 急性冠脉综合征后糖尿病患者二级预防依从性和临床结局

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice

Pub Date : 2025-11-26 DOI: 10.1155/ijcp/7678078

Nur Kamer Kaya İnalkaç, Fuat Polat, İbrahim Keleş

Background

Patients with coronary artery disease (CAD) and Type 2 diabetes mellitus (DM) represent a high-risk population for recurrent cardiovascular events following acute coronary syndrome (ACS). Despite evidence-based guidelines, adherence to secondary prevention strategies remains suboptimal. This study evaluated the impact of comprehensive guideline-based secondary prevention adherence, including contemporary heart failure therapies, on major adverse cardiovascular events (MACE) in patients with CAD and DM post-ACS, extending prior work that examined rehospitalization and all-cause mortality outcomes.

Methods

This retrospective cohort study included 712 patients with confirmed CAD and Type 2 DM who presented with ACS between September 2019 and December 2022. Adherence to ten evidence-based secondary prevention measures was assessed before the index ACS event and at 3-year follow-up, including antiplatelet therapy, high-intensity statins, blood pressure control, ACE inhibitors/ARBs, beta-blockers, SGLT-2 inhibitors, mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNI), lifestyle modifications, and other guideline-recommended interventions. Patients were stratified into low (≤ 3), moderate (3–6), and high (> 6) adherence groups. Primary outcomes were MACE, including cardiovascular death, nonfatal myocardial infarction, stroke, and urgent revascularization over 3 years.

Results

Mean patient age was 61.7 ± 12.1 years, with 58.4% male participants. Dramatic improvements in adherence occurred post-ACS: high adherence increased from 12.6% to 62.1% (p < 0.001). Significant increases were observed in statin therapy (22.5%–84.7%), antiplatelet therapy (58.3%–91.2%), and blood pressure control (33.6%–87.4%). Cox regression analysis identified better adherence scores as an independent protective factor (HR 0.798, 95% CI 0.686–0.929, p = 0.004). Kaplan–Meier analysis demonstrated superior event-free survival in high adherence patients (88% vs. 70% in the low adherence group, p < 0.001). Statin therapy showed the strongest protective effect (HR 0.512, 95% CI 0.386–0.679, p < 0.001).

Conclusion

ACS events significantly improve adherence to secondary prevention strategies in CAD patients with diabetes, with high adherence associated with substantial reductions in MACE and improved long-term survival.

背景冠心病（CAD）和2型糖尿病（DM）患者是急性冠脉综合征（ACS）后心血管事件复发的高危人群。尽管有循证指南，坚持二级预防策略仍然不是最佳选择。本研究评估了基于指南的综合二级预防依从性的影响，包括当代心力衰竭治疗，对冠心病和糖尿病acs后患者的主要不良心血管事件（MACE）的影响，扩展了先前检查再住院和全因死亡率结果的工作。方法本回顾性队列研究纳入了2019年9月至2022年12月期间出现ACS的712例确诊CAD和2型DM患者。在ACS指数事件发生前和3年随访时，评估了10项循证二级预防措施的依从性，包括抗血小板治疗、高强度他汀类药物、血压控制、ACE抑制剂/ arb、β受体阻剂、SGLT-2抑制剂、矿皮质激素受体拮抗剂（MRA）、血管紧张素受体-neprilysin抑制剂（ARNI）、生活方式改变和其他指南推荐的干预措施。患者被分为低（≤3）、中（3 - 6）和高（> 6）依从组。主要结局为MACE，包括心血管死亡、非致死性心肌梗死、卒中和3年内的紧急血运重建术。结果患者平均年龄为61.7±12.1岁，男性占58.4%。acs后依从性显著改善：高依从性从12.6%增加到62.1% （p < 0.001）。他汀类药物治疗（22.5%-84.7%）、抗血小板治疗（58.3%-91.2%）和血压控制（33.6%-87.4%）均显著增加。Cox回归分析发现，较好的依从性评分是独立的保护因素（HR 0.798, 95% CI 0.686-0.929, p = 0.004）。Kaplan-Meier分析显示，高依从性患者的无事件生存率更高（88% vs.低依从性组的70%，p < 0.001）。他汀类药物治疗表现出最强的保护作用（HR 0.512, 95% CI 0.386-0.679, p < 0.001）。结论：ACS事件显著提高冠心病合并糖尿病患者对二级预防策略的依从性，高依从性与MACE的显著降低和长期生存率的提高相关。

{"title":"Secondary Prevention Adherence and Clinical Outcomes in Diabetic Patients After Acute Coronary Syndrome","authors":"Nur Kamer Kaya İnalkaç, Fuat Polat, İbrahim Keleş","doi":"10.1155/ijcp/7678078","DOIUrl":"https://doi.org/10.1155/ijcp/7678078","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with coronary artery disease (CAD) and Type 2 diabetes mellitus (DM) represent a high-risk population for recurrent cardiovascular events following acute coronary syndrome (ACS). Despite evidence-based guidelines, adherence to secondary prevention strategies remains suboptimal. This study evaluated the impact of comprehensive guideline-based secondary prevention adherence, including contemporary heart failure therapies, on major adverse cardiovascular events (MACE) in patients with CAD and DM post-ACS, extending prior work that examined rehospitalization and all-cause mortality outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included 712 patients with confirmed CAD and Type 2 DM who presented with ACS between September 2019 and December 2022. Adherence to ten evidence-based secondary prevention measures was assessed before the index ACS event and at 3-year follow-up, including antiplatelet therapy, high-intensity statins, blood pressure control, ACE inhibitors/ARBs, beta-blockers, SGLT-2 inhibitors, mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNI), lifestyle modifications, and other guideline-recommended interventions. Patients were stratified into low (≤ 3), moderate (3–6), and high (> 6) adherence groups. Primary outcomes were MACE, including cardiovascular death, nonfatal myocardial infarction, stroke, and urgent revascularization over 3 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean patient age was 61.7 ± 12.1 years, with 58.4% male participants. Dramatic improvements in adherence occurred post-ACS: high adherence increased from 12.6% to 62.1% (<i>p</i> < 0.001). Significant increases were observed in statin therapy (22.5%–84.7%), antiplatelet therapy (58.3%–91.2%), and blood pressure control (33.6%–87.4%). Cox regression analysis identified better adherence scores as an independent protective factor (HR 0.798, 95% CI 0.686–0.929, <i>p</i> = 0.004). Kaplan–Meier analysis demonstrated superior event-free survival in high adherence patients (88% vs. 70% in the low adherence group, <i>p</i> < 0.001). Statin therapy showed the strongest protective effect (HR 0.512, 95% CI 0.386–0.679, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ACS events significantly improve adherence to secondary prevention strategies in CAD patients with diabetes, with high adherence associated with substantial reductions in MACE and improved long-term survival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2025 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/7678078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of Efficacy and Safety Between Supine and Prone Percutaneous Nephrolithotomy in Elderly Patients With Staghorn Kidney Stones 仰卧位与俯卧位经皮肾镜取石术治疗老年鹿角型肾结石的疗效与安全性比较

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice

Pub Date : 2025-11-23 DOI: 10.1155/ijcp/8841894

Hakan Polat, Ubeyd Sungur, Yavuz Onur Danacıoğlu, Azad Akdağ, Salih Polat, Mithat Ekşi, Serdar Karadağ, Taner Kargı, İsmail Evren, Alper Bitkin

Introduction

In this study, we aimed to compare the efficacy, safety, and complications of percutaneous nephrolithotomy (PNL) performed in supine and prone positions in elderly patients with staghorn stones.

Materials and Methods

The data of patients over 65 years who underwent PNL due to staghorn stones in the supine or prone position between 2017 and 2024 were retrospectively examined. The patients’ demographic and clinical characteristics and outcomes were compared. Then, univariate and multivariate analyses were performed to determine the factors predicting the development of complications.

Results

The supine (Group 1) (n = 72) and prone (Group 2) (n = 67) PNL groups were similar in terms of mean age, gender, and BMI. The operation time, decrease in hemoglobin levels, and overall complication rates were significantly lower in Group 1 (p < 0.001, p < 0.001, and p = 0.011, respectively). Group 2 demonstrated a significantly higher transfusion requirement (p = 0.039). At the 1-month follow-up, stone-free status was achieved in 52 patients (72.2%) in Group 1 and 42 patients (62.6%) in Group 2. In multivariate analyses, the prone position and lower pole location of the stone were determined as factors predicting the development of complications.

Conclusion

Supine PNL is a safe and effective treatment method with shorter operative time and lower complication rates compared to prone PNL in elderly patients.

在这项研究中，我们旨在比较在仰卧位和俯卧位对老年鹿角结石患者进行经皮肾镜取石术（PNL）的疗效、安全性和并发症。材料与方法回顾性分析2017年至2024年65岁以上因鹿角结石在仰卧位或俯卧位行PNL的患者资料。比较两组患者的人口学、临床特征及结局。然后进行单因素和多因素分析，以确定预测并发症发生的因素。结果仰卧位组（组1）（n = 72）和俯卧位组（组2）（n = 67） PNL患者的平均年龄、性别和BMI相似。1组手术时间、血红蛋白水平下降及总并发症发生率均显著低于对照组（p < 0.001, p < 0.001, p = 0.011）。第2组输血需要量显著增高（p = 0.039）。在1个月的随访中，第1组有52例患者（72.2%）达到无结石状态，第2组有42例患者（62.6%）达到无结石状态。在多变量分析中，结石的俯卧位和下极位置被确定为预测并发症发生的因素。结论与俯卧位PNL相比，仰卧位PNL是一种安全有效的治疗方法，手术时间短，并发症发生率低。

{"title":"Comparison of Efficacy and Safety Between Supine and Prone Percutaneous Nephrolithotomy in Elderly Patients With Staghorn Kidney Stones","authors":"Hakan Polat, Ubeyd Sungur, Yavuz Onur Danacıoğlu, Azad Akdağ, Salih Polat, Mithat Ekşi, Serdar Karadağ, Taner Kargı, İsmail Evren, Alper Bitkin","doi":"10.1155/ijcp/8841894","DOIUrl":"https://doi.org/10.1155/ijcp/8841894","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In this study, we aimed to compare the efficacy, safety, and complications of percutaneous nephrolithotomy (PNL) performed in supine and prone positions in elderly patients with staghorn stones.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>The data of patients over 65 years who underwent PNL due to staghorn stones in the supine or prone position between 2017 and 2024 were retrospectively examined. The patients’ demographic and clinical characteristics and outcomes were compared. Then, univariate and multivariate analyses were performed to determine the factors predicting the development of complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The supine (Group 1) (<i>n</i> = 72) and prone (Group 2) (<i>n</i> = 67) PNL groups were similar in terms of mean age, gender, and BMI. The operation time, decrease in hemoglobin levels, and overall complication rates were significantly lower in Group 1 (<i>p</i> < 0.001, <i>p</i> < 0.001, and <i>p</i> = 0.011, respectively). Group 2 demonstrated a significantly higher transfusion requirement (<i>p</i> = 0.039). At the 1-month follow-up, stone-free status was achieved in 52 patients (72.2%) in Group 1 and 42 patients (62.6%) in Group 2. In multivariate analyses, the prone position and lower pole location of the stone were determined as factors predicting the development of complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Supine PNL is a safe and effective treatment method with shorter operative time and lower complication rates compared to prone PNL in elderly patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2025 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/8841894","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluating the Causal Effects of Oxidative Stress Biomarkers on Cerebral Small Vessel Disease Using Mendelian Randomization 使用孟德尔随机化评估氧化应激生物标志物对脑血管疾病的因果影响

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice

Pub Date : 2025-11-22 DOI: 10.1155/ijcp/4799973

Yinjiao Wang, Yu Lou, Lang Chen, Aihong Cao, Peng Du

Purpose

The aim of the study was to evaluate the causal relationships of oxidative stress–related biomarkers with the risk of cerebral small vessel disease (CSVD) using Mendelian randomization (MR) analysis.

Methods

Summary single-nucleotide polymorphisms (SNPs) linked to oxidative stress–related biomarkers, including uric acid, bilirubin, glutathione transferase (GST), catalase (CAT), and glutathione peroxidase (GPX), were found from previous genomewide association studies (GWAS). Qualified SNPs strongly related to oxidative stress–related biomarkers were selected through a rigorous screening process. As the main method, the inverse variance weighted (IVW) was employed for assessing the causal link between oxidative stress–related biomarkers and the risk of CSVD. Leave-one-out analysis was utilized to measure whether the outcome was influenced by any individual SNP correlated to oxidative stress–related biomarkers. The reverse causality was assessed via reverse MR analysis. The estimates were subject to an odds ratio (OR) with a 95% confidence interval (CI).

Results

The results from IVW revealed that uric acid was causally linked to the increased risk of lacunar stroke (OR = 1.181, 95% CI: 1.042–1.339). There was a causal association between total bilirubin and decreased risk of WMH (OR = 0.984, 95% CI: 0.974–0.994). The scatter plot demonstrated that higher uric acid was positively related to the increased risk of lacunar stroke, and elevated levels of total bilirubin were causally correlated with the reduced risk of WMH. Leave-one-out analysis indicated that there was no single SNP that could affect the causal link between uric acid and lacunar stroke, as well as the causal relationship between total bilirubin and WMH.

Conclusion

Uric acid levels were causally linked with the increased risk of lacunar stroke, and total bilirubin levels were causally related to the decreased risk of WMH.

目的：利用孟德尔随机化（MR）分析评估氧化应激相关生物标志物与脑血管病（CSVD）风险的因果关系。方法总结：从之前的全基因组关联研究（GWAS）中发现与氧化应激相关生物标志物（包括尿酸、胆红素、谷胱甘肽转移酶（GST）、过氧化氢酶（CAT）和谷胱甘肽过氧化物酶（GPX））相关的单核苷酸多态性（snp）。通过严格的筛选过程，选择了与氧化应激相关的生物标志物密切相关的合格snp。作为主要方法，采用逆方差加权（IVW）来评估氧化应激相关生物标志物与心血管疾病风险之间的因果关系。使用留一分析来测量结果是否受到与氧化应激相关的生物标志物相关的任何个体SNP的影响。反向因果关系通过反向磁共振分析进行评估。估计值采用比值比（OR），置信区间为95%。结果IVW结果显示，尿酸与腔隙性卒中风险增加有因果关系（OR = 1.181, 95% CI: 1.042-1.339）。总胆红素与WMH风险降低之间存在因果关系（OR = 0.984, 95% CI: 0.974-0.994）。散点图显示，尿酸升高与腔隙性卒中风险增加呈正相关，总胆红素水平升高与WMH风险降低呈正相关。留一分析表明，没有单一的SNP可以影响尿酸与腔隙性卒中的因果关系，也没有总胆红素与WMH的因果关系。结论尿酸水平与腔隙性卒中风险增加有因果关系，总胆红素水平与WMH风险降低有因果关系。

{"title":"Evaluating the Causal Effects of Oxidative Stress Biomarkers on Cerebral Small Vessel Disease Using Mendelian Randomization","authors":"Yinjiao Wang, Yu Lou, Lang Chen, Aihong Cao, Peng Du","doi":"10.1155/ijcp/4799973","DOIUrl":"https://doi.org/10.1155/ijcp/4799973","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The aim of the study was to evaluate the causal relationships of oxidative stress–related biomarkers with the risk of cerebral small vessel disease (CSVD) using Mendelian randomization (MR) analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Summary single-nucleotide polymorphisms (SNPs) linked to oxidative stress–related biomarkers, including uric acid, bilirubin, glutathione transferase (GST), catalase (CAT), and glutathione peroxidase (GPX), were found from previous genomewide association studies (GWAS). Qualified SNPs strongly related to oxidative stress–related biomarkers were selected through a rigorous screening process. As the main method, the inverse variance weighted (IVW) was employed for assessing the causal link between oxidative stress–related biomarkers and the risk of CSVD. Leave-one-out analysis was utilized to measure whether the outcome was influenced by any individual SNP correlated to oxidative stress–related biomarkers. The reverse causality was assessed via reverse MR analysis. The estimates were subject to an odds ratio (OR) with a 95% confidence interval (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results from IVW revealed that uric acid was causally linked to the increased risk of lacunar stroke (OR = 1.181, 95% CI: 1.042–1.339). There was a causal association between total bilirubin and decreased risk of WMH (OR = 0.984, 95% CI: 0.974–0.994). The scatter plot demonstrated that higher uric acid was positively related to the increased risk of lacunar stroke, and elevated levels of total bilirubin were causally correlated with the reduced risk of WMH. Leave-one-out analysis indicated that there was no single SNP that could affect the causal link between uric acid and lacunar stroke, as well as the causal relationship between total bilirubin and WMH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Uric acid levels were causally linked with the increased risk of lacunar stroke, and total bilirubin levels were causally related to the decreased risk of WMH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2025 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/4799973","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145572624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Quality Indicators and Patient Perceptions From a U.S. Osteoarthritis Management Program (OAMP) 美国骨关节炎管理项目（OAMP）的质量指标和患者感知

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice

Pub Date : 2025-11-21 DOI: 10.1155/ijcp/1564175

Kathryn A. Miller, Alex Mathew Lasinski, Linda Baier Manwell, Anthony J. Robniak, Fauzia Hollnagel, Angela Morgan

Background

Despite guidelines for osteoarthritis management, gaps in delivering recommended treatments persist. Osteoarthritis Management Programs (OAMPs) aim to address gaps, but patient perceptions of this care model remain unclear.

Methods

This mixed-methods study evaluated feedback on patient-centered, guideline-adherent care provided by a multidisciplinary team at an American university-based OAMP. Adult patients with visits between July 1, 2017, and January 15, 2021, were categorized into groups by visit number: 1, 2–3, and 4+. Seventy patients randomly selected per group were sent a mailing containing the revised OsteoArthritis Quality Indicator (OA-QI) questionnaire assessing receipt of guideline-recommended care and an interview invitation regarding OAMP experiences. Semistructured interviews were conducted in-person or via telephone.

Results

Of the 953 eligible patients, most were female (72.6%) with an average age of 62.1 years (±10.8) and a mean BMI of 40.9 (±10.0). The 210 patients who were sent the study mailing were similar: 74.8% female, age 63.0 (±1.45), and BMI 40.7 (±1.33). Fifty-nine patients completed the OA-QI, with an overall mean pass rate (care items achieved divided by care items eligible) of 77.5% (SD 17.1%). Pass rates of ≥ 80% were reported by 50.0% of patients with one visit, 59.1% with 2–3 visits, and 52.0% with 4+ visits. Of the 17 interviewees, 16 (94.1%) identified at least one barrier to OA management, predominantly poor social support and comorbid conditions. Fifty-three percent endorsed nonsurgical osteoarthritis management, and 41.2% reported increased knowledge and confidence in self-management. Patient characteristics remained consistent across visit frequencies, with no significant differences among surveyed or interviewed patients.

Conclusions

This OAMP was designed to bridge gaps between recommended and received care. The overall OA-QI pass rate of 77.5% surpassed rates reported by other studies. Interviews indicated improvements in knowledge and attitudes toward nonsurgical OA management; however, identified barriers to care necessitate adjustments to care delivery.

背景尽管有骨关节炎治疗指南，但在提供推荐治疗方面仍然存在差距。骨关节炎管理计划（oamp）旨在解决差距，但患者对这种护理模式的看法仍不清楚。方法：本混合方法研究评估了美国一所大学OAMP多学科团队提供的以患者为中心、遵循指南的护理反馈。2017年7月1日至2021年1月15日期间就诊的成年患者按就诊次数分为1、2-3和4+组。每组随机选择70名患者发送邮件，其中包含经修订的骨关节炎质量指标（OA-QI）问卷，评估指南推荐护理的接受情况，并邀请患者接受OAMP的采访。半结构化访谈是亲自或通过电话进行的。结果953例符合条件的患者中，女性居多（72.6%），平均年龄62.1岁（±10.8），平均BMI 40.9（±10.0）。发送研究邮件的210例患者相似：74.8%为女性，年龄63.0（±1.45），BMI 40.7（±1.33）。59例患者完成了OA-QI，总体平均合格率（达到的护理项目除以符合条件的护理项目）为77.5% （SD为17.1%）。1次就诊的通过率为50.0%，2-3次为59.1%，4次以上为52.0%。在17名受访者中，16名（94.1%）确定了OA管理的至少一个障碍，主要是社会支持不足和合并症。53%的人赞同非手术治疗骨关节炎，41.2%的人表示增加了自我管理的知识和信心。患者特征在访问频率上保持一致，在被调查或访问的患者之间没有显着差异。结论：该OAMP旨在弥合推荐和接受治疗之间的差距。总OA-QI通过率为77.5%，超过其他研究报告的通过率。访谈表明，对非手术治疗OA的知识和态度有所改善；然而，已确定的护理障碍需要调整护理提供。

{"title":"Quality Indicators and Patient Perceptions From a U.S. Osteoarthritis Management Program (OAMP)","authors":"Kathryn A. Miller, Alex Mathew Lasinski, Linda Baier Manwell, Anthony J. Robniak, Fauzia Hollnagel, Angela Morgan","doi":"10.1155/ijcp/1564175","DOIUrl":"https://doi.org/10.1155/ijcp/1564175","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite guidelines for osteoarthritis management, gaps in delivering recommended treatments persist. Osteoarthritis Management Programs (OAMPs) aim to address gaps, but patient perceptions of this care model remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This mixed-methods study evaluated feedback on patient-centered, guideline-adherent care provided by a multidisciplinary team at an American university-based OAMP. Adult patients with visits between July 1, 2017, and January 15, 2021, were categorized into groups by visit number: 1, 2–3, and 4+. Seventy patients randomly selected per group were sent a mailing containing the revised OsteoArthritis Quality Indicator (OA-QI) questionnaire assessing receipt of guideline-recommended care and an interview invitation regarding OAMP experiences. Semistructured interviews were conducted in-person or via telephone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 953 eligible patients, most were female (72.6%) with an average age of 62.1 years (±10.8) and a mean BMI of 40.9 (±10.0). The 210 patients who were sent the study mailing were similar: 74.8% female, age 63.0 (±1.45), and BMI 40.7 (±1.33). Fifty-nine patients completed the OA-QI, with an overall mean pass rate (care items achieved divided by care items eligible) of 77.5% (SD 17.1%). Pass rates of ≥ 80% were reported by 50.0% of patients with one visit, 59.1% with 2–3 visits, and 52.0% with 4+ visits. Of the 17 interviewees, 16 (94.1%) identified at least one barrier to OA management, predominantly poor social support and comorbid conditions. Fifty-three percent endorsed nonsurgical osteoarthritis management, and 41.2% reported increased knowledge and confidence in self-management. Patient characteristics remained consistent across visit frequencies, with no significant differences among surveyed or interviewed patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This OAMP was designed to bridge gaps between recommended and received care. The overall OA-QI pass rate of 77.5% surpassed rates reported by other studies. Interviews indicated improvements in knowledge and attitudes toward nonsurgical OA management; however, identified barriers to care necessitate adjustments to care delivery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2025 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/1564175","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145581032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparing the Effectiveness of Different Treatment Methods on Pain, Symptoms, Function, Quality of Life, and Hand–Forearm Muscle Strength in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Trial 比较不同治疗方法对腕管综合征患者疼痛、症状、功能、生活质量和手-前臂肌力的影响：一项随机对照试验

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice

Pub Date : 2025-11-21 DOI: 10.1155/ijcp/6688423

Serdar Kilinc, Mustafa Fatih Yasar

<div> <section> <h3> Background</h3> <p>The most used conservative treatments for carpal tunnel syndrome (CTS) are splints, tendon/nerve gliding exercises (TNGEs), and local corticosteroid injections (LSIs).</p> </section> <section> <h3> Objective</h3> <p>The aim of this study was to evaluate the effect of different conservative treatments such as splint, TNGE, and LSI on clinical status, pain, symptoms, signs, function, quality of life, and hand and forearm muscle strengths in mild and moderate CTS.</p> </section> <section> <h3> Population</h3> <p>Patients who had clinical findings during routine examinations in the physical therapy outpatient clinic and were diagnosed with mild to moderate CTS with electrophysiological nerve conduction studies.</p> </section> <section> <h3> Methods</h3> <p>Sixty subjects consisting of female patients with CTS were randomly assigned to 3 groups (<i>n</i> = 20). Group S was only applied to splint. Group SE underwent TNGE and splint. Group SI received LSI and splint. Hand grip and forearm muscle strengths during flexion/extension, radial/ulnar deviation, and supination/pronation movements were tested at different angular velocities by isokinetic test system. Pain with Visual Analog Scale (VAS), symptoms and functions with Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), and Quality of life with SF-36 were evaluated before and after 8 weeks of treatment.</p> </section> <section> <h3> Results</h3> <p>Significant improvements in VAS, SF-36, BCTQ, and DASH scores, as well as hand grip strength, were observed at the endpoint of treatment period in all groups (<i>p</i> < 0.05). Group SI had significantly lower DASH total scores than the other groups after treatment and showed greater improvement in Boston Functional Capacity Scale (BFCS) scores than Group S (<i>p</i> < 0.05). There was no significant difference in hand grip and forearm muscle strengths between the groups; however, Group SI showed greater increases in forearm muscle strengths in different directions and angular speeds at the end of the treatment.</p> </section> <section> <h3> Conclusions</h3> <p>Steroid injection provided superior improvements in functional outcomes, particularly in DASH and Boston Functional Capacity scores, compared with other groups. Although hand grip and forearm muscle st

背景腕管综合征（CTS）最常用的保守治疗方法是夹板、肌腱/神经滑动练习（TNGEs）和局部皮质类固醇注射（LSIs）。目的评价夹板、TNGE、LSI等不同保守治疗方法对轻中度CTS患者的临床状态、疼痛、症状、体征、功能、生活质量、手部和前臂肌力的影响。人群在物理治疗门诊常规检查中有临床表现，经神经电生理研究诊断为轻中度CTS的患者。方法60例女性CTS患者随机分为3组（n = 20）。S组仅用于夹板。SE组行TNGE +夹板。SI组采用LSI和夹板。在不同的角速度下，用等速测试系统测试了手握和前臂肌肉在屈伸、桡/尺偏、旋前/旋前运动中的力量。采用视觉模拟疼痛量表（VAS）、波士顿腕管综合征问卷（BCTQ）和臂、肩、手残疾问卷（DASH）的症状和功能、SF-36治疗前后的生活质量进行评估。结果治疗结束时，各组患者VAS、SF-36、BCTQ、DASH评分及握力均有显著改善（p < 0.05）。SI组治疗后DASH总分明显低于其他组，Boston Functional Capacity Scale （BFCS）评分明显高于S组（p < 0.05）。两组间握力、前臂肌力差异无统计学意义；然而，在治疗结束时，SI组在不同方向和角速度下的前臂肌肉力量增加更大。结论：与其他组相比，类固醇注射在功能结局方面提供了更好的改善，特别是在DASH和波士顿功能能力评分方面。虽然握力和前臂肌肉力量没有显著差异，但类固醇组在多个方向和角速度上观察到前臂肌肉力量有更大的增加。结果表明，在CTS治疗中加入类固醇注射可促进功能恢复。试验注册：ClinicalTrials.gov标识符：NCT05475808

{"title":"Comparing the Effectiveness of Different Treatment Methods on Pain, Symptoms, Function, Quality of Life, and Hand–Forearm Muscle Strength in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Trial","authors":"Serdar Kilinc, Mustafa Fatih Yasar","doi":"10.1155/ijcp/6688423","DOIUrl":"https://doi.org/10.1155/ijcp/6688423","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The most used conservative treatments for carpal tunnel syndrome (CTS) are splints, tendon/nerve gliding exercises (TNGEs), and local corticosteroid injections (LSIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of this study was to evaluate the effect of different conservative treatments such as splint, TNGE, and LSI on clinical status, pain, symptoms, signs, function, quality of life, and hand and forearm muscle strengths in mild and moderate CTS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Patients who had clinical findings during routine examinations in the physical therapy outpatient clinic and were diagnosed with mild to moderate CTS with electrophysiological nerve conduction studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixty subjects consisting of female patients with CTS were randomly assigned to 3 groups (<i>n</i> = 20). Group S was only applied to splint. Group SE underwent TNGE and splint. Group SI received LSI and splint. Hand grip and forearm muscle strengths during flexion/extension, radial/ulnar deviation, and supination/pronation movements were tested at different angular velocities by isokinetic test system. Pain with Visual Analog Scale (VAS), symptoms and functions with Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), and Quality of life with SF-36 were evaluated before and after 8 weeks of treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant improvements in VAS, SF-36, BCTQ, and DASH scores, as well as hand grip strength, were observed at the endpoint of treatment period in all groups (<i>p</i> < 0.05). Group SI had significantly lower DASH total scores than the other groups after treatment and showed greater improvement in Boston Functional Capacity Scale (BFCS) scores than Group S (<i>p</i> < 0.05). There was no significant difference in hand grip and forearm muscle strengths between the groups; however, Group SI showed greater increases in forearm muscle strengths in different directions and angular speeds at the end of the treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Steroid injection provided superior improvements in functional outcomes, particularly in DASH and Boston Functional Capacity scores, compared with other groups. Although hand grip and forearm muscle st","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2025 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ijcp/6688423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145572489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0