SAGE Open Medicine最新文献

Background: Optimal guideline-directed medical therapy is rarely attained in practice, resulting in inadequate control of diseases such as hypertension, with poorer results in under-resourced communities. Technology, including artificial intelligence-driven decision support and software-driven workflow transformation, can potentially improve disease outcomes at a reduced cost, although it must be integrated with a holistic approach.

Methods: We describe the design of a software platform that enables rapid iterative remote management of >20 conditions across cardiac-kidney-metabolic disease. The platform distributes work across a care team of providers and care navigators, automates decision-making, ordering, and documentation, supports rapid incorporation of new evidence, and launches pragmatic trials. We describe software used in a 500-person community-based blood pressure control implemented as a single-arm quality improvement program. The primary endpoint was the proportion of patients meeting the Healthcare Effectiveness Data and Information Set quality measure blood pressure goal (<140/90) at 12 weeks.

Results: A total of 1609 patients were screened, 945 (59%) were found to have uncontrolled hypertension, and 512 patients consented to join the program. The average age was 61 ± 11 years; 59% were female, and 99% self-identified as Black. Blood pressure distribution was: 10% Stage 1 (SBP 130-139 mmHg or DBP 80-89 mmHg), 69% Stage 2 (SBP 140-179 mmHg or DBP 90-119 mmHg), and 21% Stage 3 (SBP >180 mmHg or DBP >120 mmHg). Two hundred four patients (39%) proceeded to a provider encounter, and 160 of these (78%) completed the program. The Healthcare Effectiveness Data and Information Set blood pressure goal was achieved in <12 weeks of enrollment for 141 participants (69% of those enrolled, 88% of those who completed the program).

Conclusion: Software-driven remote blood pressure is feasible, although strategies to improve patient enrollment will be needed to achieve maximum impact. Future work will be required to compare outcomes to usual care and evaluate concurrent management of multiple cardiac-kidney-metabolic conditions.

Objectives: Both dyslipidemia and hypertension contribute to poor glycemic control in patients with type 2 diabetes mellitus, but the combined effect of dyslipidemia and hypertension on glycemic control in patients with type 2 diabetes mellitus has not been evaluated. The aim of this study was to analyze the interaction effect between dyslipidemia and hypertension on glycemic control in patients with type 2 diabetes mellitus.

Methods: A total of 2485 patients with type 2 diabetes mellitus were selected from the Xuzhou community of China by multi-stage cluster random sampling for a cross-sectional survey. Their glycated hemoglobin, dyslipidemia, and hypertension were assessed, and the interaction effects between dyslipidemia and hypertension on glycemic control were analyzed using relative excess risk due to the interaction, the synergy index, and the attributable proportion of the additive interaction.

Results: Of the participants, 62.13% (1544/2485) had dyslipidemia and 55.01% (1367/2485) had hypertension. Of the participants, 76.66% (1905/2485) who had both dyslipidemia and hypertension also had poor glycemic control. The prevalence of poor glycemic control was higher in those with both dyslipidemia and hypertension (odds ratio 2.735, 95% confidence interval 2.117-3.532; p < 0.001) compared with those who had normal blood lipids and without hypertension, after adjustment for confounders. The relative excess risk due to the interaction, the attributable proportion, and the synergy index were 1.077 (95% confidence interval 0.558-1.596), 2.637 (95% confidence interval 1.268-4.006), and 0.394 (95% confidence interval 0.230-0.558), respectively, for the interaction between dyslipidemia and hypertension.

Conclusions: Dyslipidemia and hypertension have an additive interaction on poor glycemic control in patients with type 2 diabetes mellitus.

Objectives: Understanding the role of TRIB3 in cellular chemotherapy responsiveness and survival could facilitate its development as a prognostic marker that could be used to improve chemotherapeutic efficiency against specific tumors. Therefore, the role of TRIB3 to reflect the cytotoxic abilities of chemotherapeutic agents was clarified in the tested gastric cancer cell lines.

Methods: We have comprehensively investigated the protein expression of TRIB3 in three gastric cancer cell lines AGS, TMK-1, and MKN-45 cells treated with the anticancer drugs, 5-fluorouracil, cisplatin, and docetaxel. The Cell Count kit-8 was used to evaluate cell viability. Immunoblotting was performed to assay protein levels after drug treatment. Flow cytometry was carried out to evaluate the levels of sub-G1 cell population.

Results: Treatment of the tested gastric cancer cell lines dose-dependently decreased cell viability and protein levels of TRIB3 while increasing apoptosis. Overexpression of TRIB3 protects MKN-45 cells from endoplasmic reticulum stress-induced apoptosis but does not influence the induction of autophagy by anticancer drugs. In addition, overexpression of TRIB3 also rescued paroxetine-induced apoptosis and endoplasmic reticulum stress.

Conclusions: Our previous and present results indicate that TRIB3 can protect gastric cancer cells against anticancer drug treatment and that downregulating TRIB3 may increase these cells' sensitivity to anticancer drugs. We thus suggest that the capability of anticancer drugs to downregulate TRIB3 can indicate tumors' potential susceptibility to these drugs.

Objective: Venous structures of the transverse-sigmoid sinus region have been insufficiently studied by magnetic resonance venography, especially in the healthy Han Chinese population.

Methods: Magnetic resonance venography data were reconstructed. The relevant parameters were recorded. A paired t-test was used to compare the diameters of the inferior petrous sinus at the origin and termination. An unpaired t-test, a chi-squared test or Fisher's exact test was used to compare other data.

Results: One hundred healthy participants were included. The average age was 36.6 ± 17.1 years, and the ratio of males to females was 1:1. The development of the transverse-sigmoid sinus had a right-sided predominance in 51% of patients. Statistical analysis revealed significant differences (p < 0.05) in the lengths of bilateral TSs, the lengths of bilateral partial TSs from the torcular to lateral tentorial sinus, the diameters between bilateral TSs at the origin and the lateral tentorial sinus, the diameters between bilateral TS-sigmoid sinus junctions and sigmoid sinus terminations, and the inferior petrous sinus diameters at the origin and termination. Statistical analysis revealed that the right lateral tentorial sinus was more likely to originate from the TS (p < 0.05). Statistical analysis revealed no significant differences (p < 0.05) between transverse-sigmoid sinus development and inferior petrous sinus continuity or between transverse-sigmoid sinus development and inferior petrous sinus continuity and bilateral inferior petrous sinus continuity.

Conclusions: This study revealed that the right transverse-sigmoid sinus was predominantly larger in diameter, the torcular Herophili tended to deviate to the right, and the right lateral tentorial sinus tended to drain into the TS. The inferior petrous sinus at the origin was thicker than that at the termination, and the right inferior petrous sinus was thicker than the left inferior petrous sinus. transverse-sigmoid sinus development had no effect on inferior petrous sinus continuity, and there was no difference in inferior petrous sinus continuity between the left and right sides.

Objective: To assess the nurses' knowledge of vascular access devices for patients undergoing hemodialysis programs in the Gaza Strip, Palestine.

Methods: A descriptive cross-sectional study was conducted to assess the nurses' knowledge of hemodialysis vascular access using the convenience sampling technique. The assessment tool comprised 60 items related to the nurses' knowledge and 7 items on demographic characteristics at hemodialysis units in 5 governmental hospitals in the Gaza Strip, between March and June 2023. Statistical analysis of the collected data was performed using SPSS version 22.

Results: A total of 65 nurses in hemodialysis units were included. Of the majority of study nurses 71% were male, 21.5% of nurses had fair knowledge, and 78.5% had good knowledge about vascular access devices. The overall average score was more than 70% in all dimensions, which revealed good knowledge about vascular access devices. The study indicated that there was a statistically significant association between nurses' knowledge of vascular access devices and (years of experience in the hemodialysis unit, and received training of nurses).

Conclusions: The knowledge of hemodialysis nurses toward vascular access devices for patients undergoing hemodialysis was good. The years in the hemodialysis unit and having training have shown significant association with knowledge among hemodialysis nurses on vascular access devices care. Thus, interventions should focus on providing training for nurses about vascular access devices care in hemodialysis units to improve the comprehensive knowledge of nurses and to maintain patient's health status.

Objectives: To assess the feasibility, acceptability, and preliminary effectiveness of implementing a home-based aerobic and resistance exercise for patients with breast cancer receiving endocrine treatment in Indonesia.

Methods: This is a mixed methods study with concurrent design consisting of quantitative single-arm pre-post intervention and qualitative study. We recruited patients with breast cancer (N = 36) receiving endocrine treatment and assigned 12 weeks of home-based pedometer-driven walking and resistance exercises using therapeutic bands. Descriptive statistics were used to assess the feasibility (recruitment, retention, and adherence) and safety. The modified Bruce treadmill test was used to measure predicted aerobic capacity (V̇O₂ peak). Quality of life and fatigue were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and fatigue severity scale. Measurements were performed at baseline and post-intervention and analyzed with the paired t-test or Wilcoxon test. Semi-structured interviews and thematic analysis were conducted post-intervention to explore patients' acceptability.

Results: The results showed a recruitment rate of 75%, retention rate of 89%, and adherence rates were 53% for aerobic and 78% for resistance exercise. No severe adverse events were reported. Post-intervention interviews identified positive attitudes toward the intervention, with low burden and high perceived benefit. Exercise duration and predicted V̇O₂ peak increased significantly (+1.1 min, p = 0.001 and +2.3 ml/kg/min, p = 0.043), but no significant change was detected for Quality of Life (p > 0.050) or fatigue severity (p = 0.299).

Conclusions: A home-based aerobic and resistance exercise was feasible when implemented in the context of routine care in our study population, improving predicted aerobic capacity. Further research is required to understand limited changes to Quality of Life and fatigue and adaptations to support implementation in additional sites in Indonesia.

Background: The present study investigates the effect of resilience training in improving the ability to cope with stress and hope of mothers with cancer children.

Methods: In this interventional study, 70 mothers parenting children with cancer were selected as available and randomly classified into the control and experimental groups. The mothers of the two groups completed the parenting stress and hope questionnaire. In the test group, nine sessions of resilience training were held by the researcher for 60 min. One month after the intervention, they were again asked to complete the parenting stress and hope questionnaires. Moreover, in the control group, the mothers completed the parenting stress and hope questionnaires again 2 months later without any intervention.

Result: The difference between the average scores of hope and parental stress showed that the mean score of hope in the intervention and control groups increased by about 5.45 and 2.74 units, and the hope variable was improved in both groups. The mean score of parental stress in the intervention group decreased by 39.62 units. However, in the control group, it increased by 2.45 units, and parental stress in this group declined.

Conclusion: Resilience training significantly reduced the level of parental stress and increased the level of hope in the mothers of the test group. Therefore, it is recommended to use resilience in reducing the level of parental stress and increasing the hope level of mothers with children with cancer.

Objective: The establishment of a medication take-back program is an important intervention to prevent the improper disposal of expired or unused household medications. However, such a program has not been established in Indonesia. A significant step in establishing the program is to gain a better understanding of pharmacists' perspectives on the associated challenges and facilitators. Therefore, this study aimed to explore pharmacists' perspectives on the associated challenges and facilitators in initiating medications take-back program in Indonesia.

Methods: This qualitative study was conducted through Key Informant Interviews with a purposive sample of nine pharmacists working in community health centers (CHC) in Bandung City, Indonesia. The discussions were transcribed, coded, and analyzed using Atlas.ti9 software.

Results: Pharmacists' perspectives on initiating medications take-back program were categorized into two main themes, including challenges and facilitators. The identified challenges comprised a lack of personnel, financial constraints, geographical constraints, lack of facilities, and inadequate knowledge. Meanwhile, the facilitators included the good responsibility of pharmacists, incentives, and convenient locations.

Conclusion: The identified challenges and facilitators should be considered when initiating medication take-back programs in Indonesia.

Objectives: Pre-hepatic jaundice results from an imbalance between bilirubin production and clearance, often linked to hemoglobinopathies. Antioxidant vitamin C, malondialdehyde, and trace elements play roles in jaundice, yet their specific associations remain unclear. The objective is to assess and compare these biomarkers in pre-hepatic jaundice patients and healthy controls, aiming to identify potential diagnostic markers and understand distinctive characteristics related to the disease's pathogenesis.

Methods: This case-control study enrolled 50 pre-hepatic jaundice patients and 50 healthy controls, utilizing advanced techniques for biomarker quantification. We completed blood sample collection from study participants between 1 September 2023 and 31 December 2023. This study investigates the correlation between various biomarkers and pre-hepatic jaundice using serum samples with a focus on antioxidant vitamin C, malondialdehyde, and trace elements.

Results: This study demonstrates elevated concentrations of malondialdehyde in patients with pre-hepatic jaundice, suggesting alterations in bilirubin metabolism and increased oxidative stress. We found that the serum levels of malondialdehyde were significantly higher in pre-hepatic jaundice patients compared to healthy controls. Our observations revealed a notable decrease in the average serum vitamin C levels in patients with pre-hepatic jaundice compared to healthy controls. The patients had lower serum Zn levels and higher serum Cu and Mn levels compared to the healthy controls. The correlation study demonstrates robust positive correlations among these biomarkers in pre-hepatic jaundice. As the levels of vitamin C rise, the levels of the other criteria often fall, and vice versa. There is an inverse relationship between higher levels of vitamin C and lower levels of malondialdehyde. The current investigation identifies possible changes in antioxidant vitamins, malondialdehyde levels, and trace elements, which provide significant insights for targeted interventions.

Conclusions: The present research highlights the integrated significance of vitamin C, malondialdehyde, and trace elements in the progression of the disease.