Iris N van Doorn, Filip Eftimov, Luuk Wieske, Ivo N van Schaik, Camiel Verhamme
Abstract: Diagnosing Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) poses numerous challenges. The heterogeneous presentations of CIDP variants, its mimics, and the complexity of interpreting electrodiagnostic criteria are just a few of the many reasons for misdiagnoses. Early recognition and treatment are important to reduce the risk of irreversible axonal damage, which may lead to permanent disability. The diagnosis of CIDP is based on a combination of clinical symptoms, nerve conduction study findings that indicate demyelination, and other supportive criteria. In 2021, the European Academy of Neurology (EAN) and the Peripheral Nerve Society (PNS) published a revision on the most widely adopted guideline on the diagnosis and treatment of CIDP. This updated guideline now includes clinical and electrodiagnostic criteria for CIDP variants (previously termed atypical CIDP), updated supportive criteria, and sensory criteria as an integral part of the electrodiagnostic criteria. Due to its many rules and exceptions, this guideline is complex and misinterpretation of nerve conduction study findings remain common. CIDP is treatable with intravenous immunoglobulins, corticosteroids, and plasma exchange. The choice of therapy should be tailored to the individual patient’s situation, taking into account the severity of symptoms, potential side effects, patient autonomy, and past treatments. Treatment responses should be evaluated as objectively as possible using disability and impairment scales. Applying these outcome measures consistently in clinical practice aids in recognizing the effectiveness (or lack thereof) of a treatment and facilitates timely consideration of alternative diagnoses or treatments. This review provides an overview of the current perspectives on the diagnostic process and first-line treatments for managing the disease.
{"title":"Challenges in the Early Diagnosis and Treatment of Chronic Inflammatory Demyelinating Polyradiculoneuropathy in Adults: Current Perspectives","authors":"Iris N van Doorn, Filip Eftimov, Luuk Wieske, Ivo N van Schaik, Camiel Verhamme","doi":"10.2147/tcrm.s360249","DOIUrl":"https://doi.org/10.2147/tcrm.s360249","url":null,"abstract":"<strong>Abstract:</strong> Diagnosing Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) poses numerous challenges. The heterogeneous presentations of CIDP variants, its mimics, and the complexity of interpreting electrodiagnostic criteria are just a few of the many reasons for misdiagnoses. Early recognition and treatment are important to reduce the risk of irreversible axonal damage, which may lead to permanent disability. The diagnosis of CIDP is based on a combination of clinical symptoms, nerve conduction study findings that indicate demyelination, and other supportive criteria. In 2021, the European Academy of Neurology (EAN) and the Peripheral Nerve Society (PNS) published a revision on the most widely adopted guideline on the diagnosis and treatment of CIDP. This updated guideline now includes clinical and electrodiagnostic criteria for CIDP variants (previously termed atypical CIDP), updated supportive criteria, and sensory criteria as an integral part of the electrodiagnostic criteria. Due to its many rules and exceptions, this guideline is complex and misinterpretation of nerve conduction study findings remain common. CIDP is treatable with intravenous immunoglobulins, corticosteroids, and plasma exchange. The choice of therapy should be tailored to the individual patient’s situation, taking into account the severity of symptoms, potential side effects, patient autonomy, and past treatments. Treatment responses should be evaluated as objectively as possible using disability and impairment scales. Applying these outcome measures consistently in clinical practice aids in recognizing the effectiveness (or lack thereof) of a treatment and facilitates timely consideration of alternative diagnoses or treatments. This review provides an overview of the current perspectives on the diagnostic process and first-line treatments for managing the disease.<br/><br/><strong>Keywords:</strong> CIDP, treatment, diagnosis, NCS, imaging<br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"55 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139759956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Komariah, Shakira Amirah, Muhammad Fahd Abdurrahman, Mohammad Farrel Shaquille Handimulya, Hesti Platini, Sidik Maulana, Annisa Dewi Nugrahani, Aep Maulid Mulyana, Shurouq Ghalib Qadous, Henny Suzana Mediani, Arpit Mago
Background: Cerebral palsy (CP) is the most common motor disorder in childhood. CP limits movement, which can interfere with children’s daily activities. As a technology that provides intensive mass practice to children, virtual reality (VR) can create an interactive and motivating environment. With the intensity set by the therapist and feedback that can be used to produce individualized therapy, VR has great potential to improve CP patients’ quality of life, especially in a safe, enjoyable, and playful environment. Purpose: This systematic review and meta-analysis sought to determine the effectiveness of VR for children with CP. Methods: We conducted a comprehensive literature search based on the PRISMA guidelines through PubMed, Scopus, Embase, Wiley, and ProQuest to assess the efficacy of VR in managing children with CP up to 15 September 2022. Risk assessment of bias was performed using Cochrane RoB 2. Results: Nineteen randomized controlled trials with 467 and 427 patients with CP were included in the intervention and control groups in qualitative and quantitative analyses. Participants consisted of cerebral palsy with hemiplegia (n=7), diplegia (n=2), a combination of both (n=4), and undefined (n=13). From all studies conducted, VR showed significant results where VR could improve balance (MD: 2.71[1.95, 3.48]; p < 0.00001), motor function (MD: 3.73 [1.67, 5.79]; p = 0.0004), and activity daily living (MD: 10.05 [2.89, 17.22]. However, VR showed not effective in improving upper limb function. Conclusion: With its advantages and excellent effectiveness, VR may improve functional mobility and the quality of life of children with CP.
{"title":"Effectivity of Virtual Reality to Improve Balance, Motor Function, Activities of Daily Living, and Upper Limb Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis","authors":"Maria Komariah, Shakira Amirah, Muhammad Fahd Abdurrahman, Mohammad Farrel Shaquille Handimulya, Hesti Platini, Sidik Maulana, Annisa Dewi Nugrahani, Aep Maulid Mulyana, Shurouq Ghalib Qadous, Henny Suzana Mediani, Arpit Mago","doi":"10.2147/tcrm.s432249","DOIUrl":"https://doi.org/10.2147/tcrm.s432249","url":null,"abstract":"<strong>Background:</strong> Cerebral palsy (CP) is the most common motor disorder in childhood. CP limits movement, which can interfere with children’s daily activities. As a technology that provides intensive mass practice to children, virtual reality (VR) can create an interactive and motivating environment. With the intensity set by the therapist and feedback that can be used to produce individualized therapy, VR has great potential to improve CP patients’ quality of life, especially in a safe, enjoyable, and playful environment.<br/><strong>Purpose:</strong> This systematic review and meta-analysis sought to determine the effectiveness of VR for children with CP.<br/><strong>Methods:</strong> We conducted a comprehensive literature search based on the PRISMA guidelines through PubMed, Scopus, Embase, Wiley, and ProQuest to assess the efficacy of VR in managing children with CP up to 15 September 2022. Risk assessment of bias was performed using Cochrane RoB 2.<br/><strong>Results:</strong> Nineteen randomized controlled trials with 467 and 427 patients with CP were included in the intervention and control groups in qualitative and quantitative analyses. Participants consisted of cerebral palsy with hemiplegia (n=7), diplegia (n=2), a combination of both (n=4), and undefined (n=13). From all studies conducted, VR showed significant results where VR could improve balance (MD: 2.71[1.95, 3.48]; p < 0.00001), motor function (MD: 3.73 [1.67, 5.79]; p = 0.0004), and activity daily living (MD: 10.05 [2.89, 17.22]. However, VR showed not effective in improving upper limb function.<br/><strong>Conclusion:</strong> With its advantages and excellent effectiveness, VR may improve functional mobility and the quality of life of children with CP.<br/><br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139759963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-09eCollection Date: 2024-01-01DOI: 10.2147/TCRM.S438174
Jas Bindra, Ishveen Chopra, Kyle Hayes, John Niewoehner, Mary Prince Panaccio, George J Wan
Introduction: Sarcoidosis is common among African Americans in the United States. Acthar® Gel is a viable option for the treatment of advanced symptomatic sarcoidosis. This study examined patient characteristics, Acthar Gel utilization, co-medication use, and treatment response based on physicians' assessments among African Americans versus non-African Americans with advanced symptomatic sarcoidosis.
Methods: Data from the medical charts of patients were used. During data collection, patients had either completed ≥1 course or received treatment with Acthar Gel for ≥6 months.
Results: This study comprised 168 African Americans and 104 non-African Americans. On average, the time since the first diagnosis of sarcoidosis was slightly longer among African Americans than non-African Americans (5.2 versus 4.3 years). Skin, heart, eyes, and joints were the most common extrapulmonary sites involved among both race groups. Shortness of breath, fatigue, bone and joint pain, and wheezing/coughing were the most frequent symptoms among both race groups. A higher proportion of African Americans versus non-African Americans were first-time Acthar Gel users and had not completed treatment during data collection. Patients in both race groups with higher starting doses of Acthar Gel therapy had a shorter treatment duration and vice-versa. A significantly lower proportion of patients among both race groups were on any co-medication after Acthar Gel initiation (p<0.0001). Further, a higher proportion of African Americans versus non-African Americans had a reduction in any co-medication use after Acthar Gel initiation. The mean daily dose of prednisone decreased among African Americans (18.5 to 10.1 mg) and non-African Americans (17.6 to 10.0 mg) after Acthar Gel initiation. Improvement in patient health status and overall symptoms was similar for both race groups.
Conclusion: Findings suggest that Acthar Gel improves health outcomes for patients with sarcoidosis, which could help to alleviate health disparities among African Americans, who are disproportionately affected by this disease.
{"title":"Acthar Gel in African Americans versus Non-African Americans with Symptomatic Sarcoidosis: Physician Assessment of Patient Medical Records.","authors":"Jas Bindra, Ishveen Chopra, Kyle Hayes, John Niewoehner, Mary Prince Panaccio, George J Wan","doi":"10.2147/TCRM.S438174","DOIUrl":"10.2147/TCRM.S438174","url":null,"abstract":"<p><strong>Introduction: </strong>Sarcoidosis is common among African Americans in the United States. Acthar<sup>®</sup> Gel is a viable option for the treatment of advanced symptomatic sarcoidosis. This study examined patient characteristics, Acthar Gel utilization, co-medication use, and treatment response based on physicians' assessments among African Americans versus non-African Americans with advanced symptomatic sarcoidosis.</p><p><strong>Methods: </strong>Data from the medical charts of patients were used. During data collection, patients had either completed ≥1 course or received treatment with Acthar Gel for ≥6 months.</p><p><strong>Results: </strong>This study comprised 168 African Americans and 104 non-African Americans. On average, the time since the first diagnosis of sarcoidosis was slightly longer among African Americans than non-African Americans (5.2 versus 4.3 years). Skin, heart, eyes, and joints were the most common extrapulmonary sites involved among both race groups. Shortness of breath, fatigue, bone and joint pain, and wheezing/coughing were the most frequent symptoms among both race groups. A higher proportion of African Americans versus non-African Americans were first-time Acthar Gel users and had not completed treatment during data collection. Patients in both race groups with higher starting doses of Acthar Gel therapy had a shorter treatment duration and vice-versa. A significantly lower proportion of patients among both race groups were on any co-medication after Acthar Gel initiation (p<0.0001). Further, a higher proportion of African Americans versus non-African Americans had a reduction in any co-medication use after Acthar Gel initiation. The mean daily dose of prednisone decreased among African Americans (18.5 to 10.1 mg) and non-African Americans (17.6 to 10.0 mg) after Acthar Gel initiation. Improvement in patient health status and overall symptoms was similar for both race groups.</p><p><strong>Conclusion: </strong>Findings suggest that Acthar Gel improves health outcomes for patients with sarcoidosis, which could help to alleviate health disparities among African Americans, who are disproportionately affected by this disease.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"83-94"},"PeriodicalIF":2.8,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10863497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139730534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-09eCollection Date: 2024-01-01DOI: 10.2147/TCRM.S446113
Nguyen Ngoc Cuong, Le Hoan, Thieu Thi Tra My, Doan Tien Luu, Le Tuan Linh, Pham Hong Canh, Trieu Quoc Tinh, Tran Nguyen Khanh Chi, Nguyen Quang Trung, Tran Quoc Hoa
Objective: Chyle leak (CL) after head and neck surgery is a rare but well-known complication. In patients with high-output leakage, the treatment can be complicated. This study aims to report on a recent innovation in lymphatic intervention for treating such patients.
Materials and methods: A retrospective review of 36 patients with chyle leak after neck surgery for thyroid cancer was conducted to assess the efficacy of percutaneous lymphatic embolization and thoracic duct (TD) disruption.
Results: Antegrade catheterization of the thoracic duct was achieved in 31 of 36 patients (86.1%). Therefore, embolization of the thoracic duct and thoracic duct branches was performed in 26 and 5 patients, respectively. In 5 cases of unsuccessful antegrade catheterization into the thoracic duct, transcervical access embolization was performed in 2 patients, and TD disruption (TDD) was performed in 3 patients. The pooled overall technical success rate of lymphatic embolization was 33/36 patients (91.7%). One patient who underwent thoracic duct embolization (TDE) with technical success (1/33 patients) but clinical failure had additional treatment directly sclerosing the TD under computed tomography scan. Cervical fluid collection sclerotherapy was done in 7 patients as an additional treatment. Resolution of the chyle leak after procedures was observed in all patients (100%). The mean time to resolution was 3 days (1-7 days). There was no complication intra and after procedures.
Conclusion: TDE, selective TD branches embolization and TDD are safe and effective minimally invasive treatments for CL post-surgery for thyroid carcinoma. Sclerosing cervical fluid collection contributes to clinical success.
{"title":"Minimally Invasive Treatment of Chyle Leak After Thyroidectomy and Cervical Lymph Node Dissection in Patients with Thyroid Carcinoma: Results of a Study Involving 36 Patients.","authors":"Nguyen Ngoc Cuong, Le Hoan, Thieu Thi Tra My, Doan Tien Luu, Le Tuan Linh, Pham Hong Canh, Trieu Quoc Tinh, Tran Nguyen Khanh Chi, Nguyen Quang Trung, Tran Quoc Hoa","doi":"10.2147/TCRM.S446113","DOIUrl":"10.2147/TCRM.S446113","url":null,"abstract":"<p><strong>Objective: </strong>Chyle leak (CL) after head and neck surgery is a rare but well-known complication. In patients with high-output leakage, the treatment can be complicated. This study aims to report on a recent innovation in lymphatic intervention for treating such patients.</p><p><strong>Materials and methods: </strong>A retrospective review of 36 patients with chyle leak after neck surgery for thyroid cancer was conducted to assess the efficacy of percutaneous lymphatic embolization and thoracic duct (TD) disruption.</p><p><strong>Results: </strong>Antegrade catheterization of the thoracic duct was achieved in 31 of 36 patients (86.1%). Therefore, embolization of the thoracic duct and thoracic duct branches was performed in 26 and 5 patients, respectively. In 5 cases of unsuccessful antegrade catheterization into the thoracic duct, transcervical access embolization was performed in 2 patients, and TD disruption (TDD) was performed in 3 patients. The pooled overall technical success rate of lymphatic embolization was 33/36 patients (91.7%). One patient who underwent thoracic duct embolization (TDE) with technical success (1/33 patients) but clinical failure had additional treatment directly sclerosing the TD under computed tomography scan. Cervical fluid collection sclerotherapy was done in 7 patients as an additional treatment. Resolution of the chyle leak after procedures was observed in all patients (100%). The mean time to resolution was 3 days (1-7 days). There was no complication intra and after procedures.</p><p><strong>Conclusion: </strong>TDE, selective TD branches embolization and TDD are safe and effective minimally invasive treatments for CL post-surgery for thyroid carcinoma. Sclerosing cervical fluid collection contributes to clinical success.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"75-82"},"PeriodicalIF":2.8,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10863455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139730535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-08eCollection Date: 2024-01-01DOI: 10.2147/TCRM.S434556
Benfa Gong, Li-Jen Cheng, Christopher H Young, Prabhuram Krishnan, Ying Wang, Hui Wei, Chunlin Zhou, Shuning Wei, Yan Li, Qiuyun Fang, Jia Zhong, Eric Q Wu, Yingchang Mi, Jianxiang Wang
Introduction: For acute myeloid leukemia (AML), prognosis is particularly poor in patients harboring FMS-like tyrosine kinase 3 (FLT3) gene mutations, though routine screening for these mutations at diagnosis has been shown to be insufficient. The understanding of the impact of FLT3 mutations on treatment decisions is limited.
Methods: In this retrospective, observational study, we investigated the key epidemiological characteristics, treatment patterns and responses among adult patients with newly diagnosed (ND) AML in China, who initiated treatment from January 1, 2015, to December 31, 2019, or progressed to relapsed/refractory (R/R) AML by December 31, 2020.
Results: Of the 853 ND AML patients included, 63.4% were screened for FLT3 status, and 20.1% tested positive (FLT3MUT) at initial diagnosis. Of 289 patients who progressed to R/R AML during the study period, 24.9% were screened at the diagnosis of R/R AML, and 19.4% tested positive; 20.5% of screened patients changed FLT3 status at first diagnosis of R/R AML. Initial treatment regimens or treatment responses did not seem to differ in patients with ND AML by FLT3 mutation status. In patients with R/R AML, there was an apparent difference in second-line treatment choices by FLT3 mutation status; however, the number of FLT3-mutated patients were limited to demonstrate any meaningful distinction. FLT3-mutated R/R AML was associated with shorter relapse time.
Conclusion: Study findings showed that there was a lack of routine testing for FLT3 mutations at first diagnosis of R/R AML, and initial treatment decisions did not differ by FLT3 mutation status. Given the clinical burden of FLT3MUT, likelihood of FLT3 status changes, and emerging FLT3 inhibitors, further routine FLT3 screening is needed to optimize treatment of R/R AML.
{"title":"Treatment Patterns and <i>FLT3</i> Mutation Testing Among Patients with Acute Myeloid Leukemia in China: A Retrospective Observational Study.","authors":"Benfa Gong, Li-Jen Cheng, Christopher H Young, Prabhuram Krishnan, Ying Wang, Hui Wei, Chunlin Zhou, Shuning Wei, Yan Li, Qiuyun Fang, Jia Zhong, Eric Q Wu, Yingchang Mi, Jianxiang Wang","doi":"10.2147/TCRM.S434556","DOIUrl":"10.2147/TCRM.S434556","url":null,"abstract":"<p><strong>Introduction: </strong>For acute myeloid leukemia (AML), prognosis is particularly poor in patients harboring FMS-like tyrosine kinase 3 (<i>FLT3</i>) gene mutations, though routine screening for these mutations at diagnosis has been shown to be insufficient. The understanding of the impact of <i>FLT3</i> mutations on treatment decisions is limited.</p><p><strong>Methods: </strong>In this retrospective, observational study, we investigated the key epidemiological characteristics, treatment patterns and responses among adult patients with newly diagnosed (ND) AML in China, who initiated treatment from January 1, 2015, to December 31, 2019, or progressed to relapsed/refractory (R/R) AML by December 31, 2020.</p><p><strong>Results: </strong>Of the 853 ND AML patients included, 63.4% were screened for <i>FLT3</i> status, and 20.1% tested positive (<i>FLT3</i><sup>MUT</sup>) at initial diagnosis. Of 289 patients who progressed to R/R AML during the study period, 24.9% were screened at the diagnosis of R/R AML, and 19.4% tested positive; 20.5% of screened patients changed <i>FLT3</i> status at first diagnosis of R/R AML. Initial treatment regimens or treatment responses did not seem to differ in patients with ND AML by <i>FLT3</i> mutation status. In patients with R/R AML, there was an apparent difference in second-line treatment choices by <i>FLT3</i> mutation status; however, the number of <i>FLT3</i>-mutated patients were limited to demonstrate any meaningful distinction. <i>FLT3</i>-mutated R/R AML was associated with shorter relapse time.</p><p><strong>Conclusion: </strong>Study findings showed that there was a lack of routine testing for <i>FLT3</i> mutations at first diagnosis of R/R AML, and initial treatment decisions did not differ by <i>FLT3</i> mutation status. Given the clinical burden of <i>FLT3</i><sup>MUT</sup>, likelihood of <i>FLT3</i> status changes, and emerging FLT3 inhibitors, further routine <i>FLT3</i> screening is needed to optimize treatment of R/R AML.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"59-73"},"PeriodicalIF":2.8,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10861151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The objective of this study was to utilize LASSO regression (Least Absolute Shrinkage and Selection Operator Regression) to identify key variables in septic patients and develop a predictive model for intensive care unit (ICU) mortality.
Methods: We conducted a cohort consisting of septic patients admitted to the ICU between December 2016 and July 2019. The disease severity and laboratory index were analyzed using LASSO regression. The selected variables were then used to develop a model for predicting ICU mortality. AUCs of ROCs were applied to assess the prediction model, and the accuracy, sensitivity and specificity were calculated. Calibration were also used to assess the actual and predicted values of the predictive model.
Results: A total of 1733 septic patients were included, among of whom 382 (22%) died during ICU stay. Ten variables, namely mechanical ventilation (MV) requirement, hemofiltration (HF) requirement, norepinephrine (NE) requirement, septicemia, multiple drug-resistance infection (MDR), thrombocytopenia, hematocrit, red-cell deviation width coefficient of variation (RDW-CV), C-reactive protein (CRP), and antithrombin (AT) III, showed the strongest association with sepsis-related mortality according to LASSO regression. When these variables were combined into a predictive model, the area under the curve (AUC) was found to be 0.801. The AUC of the validation group was 0.791. The specificity of the model was as high as 0.953. Within the probability range of 0.25 to 0.90, the predictive performance of the model surpassed that of individual predictors within the cohort.
Conclusion: Our findings suggest that a predictive model incorporating the variables of MV requirement, HF requirement, NE requirement, septicemia, MDR, thrombocytopenia, HCT, RDW-CV, CRP, and AT III exhibiting an 80% likelihood of predicting ICU mortality in sepsis and demonstrates high accuracy.
{"title":"LASSO-Based Identification of Risk Factors and Development of a Prediction Model for Sepsis Patients.","authors":"Chengying Hong, Yihan Xiong, Jinquan Xia, Wei Huang, Andi Xia, Shunyao Xu, Yuting Chen, Zhikun Xu, Huaisheng Chen, Zhongwei Zhang","doi":"10.2147/TCRM.S434397","DOIUrl":"https://doi.org/10.2147/TCRM.S434397","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to utilize LASSO regression (Least Absolute Shrinkage and Selection Operator Regression) to identify key variables in septic patients and develop a predictive model for intensive care unit (ICU) mortality.</p><p><strong>Methods: </strong>We conducted a cohort consisting of septic patients admitted to the ICU between December 2016 and July 2019. The disease severity and laboratory index were analyzed using LASSO regression. The selected variables were then used to develop a model for predicting ICU mortality. AUCs of ROCs were applied to assess the prediction model, and the accuracy, sensitivity and specificity were calculated. Calibration were also used to assess the actual and predicted values of the predictive model.</p><p><strong>Results: </strong>A total of 1733 septic patients were included, among of whom 382 (22%) died during ICU stay. Ten variables, namely mechanical ventilation (MV) requirement, hemofiltration (HF) requirement, norepinephrine (NE) requirement, septicemia, multiple drug-resistance infection (MDR), thrombocytopenia, hematocrit, red-cell deviation width coefficient of variation (RDW-CV), C-reactive protein (CRP), and antithrombin (AT) III, showed the strongest association with sepsis-related mortality according to LASSO regression. When these variables were combined into a predictive model, the area under the curve (AUC) was found to be 0.801. The AUC of the validation group was 0.791. The specificity of the model was as high as 0.953. Within the probability range of 0.25 to 0.90, the predictive performance of the model surpassed that of individual predictors within the cohort.</p><p><strong>Conclusion: </strong>Our findings suggest that a predictive model incorporating the variables of MV requirement, HF requirement, NE requirement, septicemia, MDR, thrombocytopenia, HCT, RDW-CV, CRP, and AT III exhibiting an 80% likelihood of predicting ICU mortality in sepsis and demonstrates high accuracy.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"47-58"},"PeriodicalIF":2.8,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10859107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Sharp esophageal foreign body (SEFB) impaction can cause varying degrees of damage to the esophagus. There are few studies analyzing the postoperative fasting time in SEFB patients. Methods: We retrospectively collected 835 SEFB patients. According to the fasting time after the endoscopic removal (ER) of SEFBs, the patients were divided into two groups: short fasting time (SFT, fasted ≤ 24 h) and long fasting time (LFT, fasted > 24 h). Results: There were 216 and 619 patients in the SFT and LFT group, respectively. The average age of the SFT group (52.97 years) was younger than that of the LFT group (55.96 years) (p = 0.025). The LFT group had lower proportion of duration of impaction (DOI) within 12 hours (14.2% vs 22.2%, p = 0.006) and erosion rates (89.0% vs 94.0%, p = 0.034) as well as higher proportion of esophageal perforation (19.5 vs 6.5%, p = 0.010) and patients who got intravenous anesthesia (63.78% vs 31.9%, p = 0.000) than the SFT group. The longest diameter of the foreign body (Lmax) in the LFT group (2.60 ± 1.01 cm) was greater than that in the SFT group (2.41 ± 0.83 cm; p = 0.01). Multivariate regression analysis found that age (OR = 1.726[1.208– 2.465], p = 0.003), DOI (OR = 1.793[1.175– 2.737], p = 0.007), Lmax (OR = 1.477[1.033– 2.111], p = 0.032), perforation (OR = 3.698[2.038– 6.710]; p < 0.01) and intravenous anesthesia (OR = 3.734[2.642– 5.278]; p < 0.01) were the independent factors that prolonged fasting time in patients with SEFBs, while esophageal mucosal erosion (OR = 0.433[0.229– 0.820]; p = 0.01) was the influencing factor leading to shortened fasting time. Conclusion: For the first time, we analyzed factors influencing the fasting time after ER in SEFB patients. Age, DOI, Lmax, perforation and intravenous anesthesia were risk factors for a prolonged postoperative fasting time.
{"title":"Factors Influencing the Fasting Time in Adult Patients After the Endoscopic Management of Sharp Esophageal Foreign Bodies","authors":"Da-Quan Wu, Shu-Yang Chen, Ke-Guang Chen, Tan Wang, Guang-Yao Li, Xin-Sheng Huang","doi":"10.2147/tcrm.s451517","DOIUrl":"https://doi.org/10.2147/tcrm.s451517","url":null,"abstract":"<strong>Background:</strong> Sharp esophageal foreign body (SEFB) impaction can cause varying degrees of damage to the esophagus. There are few studies analyzing the postoperative fasting time in SEFB patients.<br/><strong>Methods:</strong> We retrospectively collected 835 SEFB patients. According to the fasting time after the endoscopic removal (ER) of SEFBs, the patients were divided into two groups: short fasting time (SFT, fasted ≤ 24 h) and long fasting time (LFT, fasted > 24 h).<br/><strong>Results:</strong> There were 216 and 619 patients in the SFT and LFT group, respectively. The average age of the SFT group (52.97 years) was younger than that of the LFT group (55.96 years) (p = 0.025). The LFT group had lower proportion of duration of impaction (DOI) within 12 hours (14.2% vs 22.2%, p = 0.006) and erosion rates (89.0% vs 94.0%, p = 0.034) as well as higher proportion of esophageal perforation (19.5 vs 6.5%, p = 0.010) and patients who got intravenous anesthesia (63.78% vs 31.9%, p = 0.000) than the SFT group. The longest diameter of the foreign body (Lmax) in the LFT group (2.60 ± 1.01 cm) was greater than that in the SFT group (2.41 ± 0.83 cm; p = 0.01). Multivariate regression analysis found that age (OR = 1.726[1.208– 2.465], p = 0.003), DOI (OR = 1.793[1.175– 2.737], p = 0.007), Lmax (OR = 1.477[1.033– 2.111], p = 0.032), perforation (OR = 3.698[2.038– 6.710]; p < 0.01) and intravenous anesthesia (OR = 3.734[2.642– 5.278]; p < 0.01) were the independent factors that prolonged fasting time in patients with SEFBs, while esophageal mucosal erosion (OR = 0.433[0.229– 0.820]; p = 0.01) was the influencing factor leading to shortened fasting time.<br/><strong>Conclusion:</strong> For the first time, we analyzed factors influencing the fasting time after ER in SEFB patients. Age, DOI, Lmax, perforation and intravenous anesthesia were risk factors for a prolonged postoperative fasting time.<br/><br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"4 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139690008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hesti Platini, Keyzha Amartya Adammayanti, Sidik Maulana, Putu Moradha Kharisma Putri, Welly Grivin Layuk, Juan Alessandro Jeremis Maruli Nura Lele, Hartiah Haroen, Sri Hartati Pratiwi, Faizal Musthofa, Arpit Mago
Introduction: Poorly controlled diabetes mellitus can lead to the development of diabetic foot ulcers (DFU), which is a frequent complication in patients. However, several diabetes management guidelines for older adults do not mention the occurrence of DFUs. Nowadays, Autologous Platelet-Rich Gel (APG) is being used for treating diabetic ulcers. APG is an innovative platelet-derived product with many advantages, such as being low-cost, easy to produce, and readily available materials. Additionally, it does not lead to any rejection reaction. Objective: This study aims to assess the safety and efficacy of APG as a novel treatment of DFU compared with standard treatment in older adult patients. Methods: Randomized Controlled Trials (RCTs) were searched using PubMed, Cochrane, Google Scholar, Wiley, and PlosOne. The keywords have been arranged using the Boolean operator, including autologous platelet-rich gel, DFU, and elderly. The data was screened by inclusion and exclusion criteria. The final inclusion study was analyzed and synthesized by tabulation, clusterization, contextual and thematic approach, and assessed for risk of bias using ROB 2.0. Meta-analysis was conducted by using Review Manager 5.4 and the Mantel Haenszel method. Results: Eight RCTs with 598 patients were eligible for the present analysis. Compared with standard care/conventional treatment, APG could significantly improve the healing wound in patients with diabetic foot ulcers (Relative risk (RR) 1.32, 95% confidence interval (CI) 1.22– 1.57, p < 0.0001), shortened the healing time (Mean difference [MD] − 16.97 days (95% CI: − 32.64 to − 1.29; p < 0.00001), shortened the length of hospital stay (MD= − 20.11, 95% CI: − 38.02, − 2.20; p = 0.03), and amputation rate (MD= 0.36, 95% CI: 0.16, 0.84; p = 0.02). Conclusion: APG treatment can better treat DFU in terms of duration of healing, wound healing, length of hospital stay, and amputation prevention than the standard treatment.
导言：糖尿病控制不佳会导致糖尿病足溃疡（DFU）的发生，这是患者经常出现的并发症。然而，一些针对老年人的糖尿病管理指南并未提及糖尿病足溃疡的发生。如今，自体富血小板凝胶（APG）正被用于治疗糖尿病溃疡。自体富血小板凝胶是一种创新的血小板衍生产品，具有成本低、易于生产、材料易得等诸多优点。此外，它还不会导致任何排异反应：本研究旨在评估 APG 作为一种新型的 DFU 治疗方法与老年患者标准治疗方法相比的安全性和有效性：方法：使用 PubMed、Cochrane、Google Scholar、Wiley 和 PlosOne 搜索随机对照试验 (RCT)。使用布尔运算符排列关键词，包括自体富血小板凝胶、DFU 和老年人。根据纳入和排除标准对数据进行筛选。通过制表、聚类、上下文和主题方法对最终纳入的研究进行分析和综合，并使用 ROB 2.0 评估偏倚风险。使用 Review Manager 5.4 和 Mantel Haenszel 方法进行 Meta 分析：共有 8 项 RCT，598 名患者符合本次分析的条件。与标准护理/常规治疗相比，APG能显著改善糖尿病足溃疡患者的伤口愈合情况（相对风险（RR）1.32，95% 置信区间（CI）1.22- 1.57，p <0.0001），缩短愈合时间（平均差[MD] - 16.97天 (95% CI: - 32.64 to - 1.29; p < 0.00001)，缩短了住院时间（MD= - 20.11, 95% CI: - 38.02, - 2.20; p = 0.03）和截肢率（MD= 0.36, 95% CI: 0.16, 0.84; p = 0.02）：自体富血小板血浆凝胶治疗在愈合时间、伤口愈合、住院时间和预防截肢方面均优于标准治疗。
{"title":"The Potential of Autologous Platelet-Rich Plasma Gel for Diabetic Foot Ulcer Care Among Older Adults: A Systematic Review and Meta-Analysis","authors":"Hesti Platini, Keyzha Amartya Adammayanti, Sidik Maulana, Putu Moradha Kharisma Putri, Welly Grivin Layuk, Juan Alessandro Jeremis Maruli Nura Lele, Hartiah Haroen, Sri Hartati Pratiwi, Faizal Musthofa, Arpit Mago","doi":"10.2147/tcrm.s433033","DOIUrl":"https://doi.org/10.2147/tcrm.s433033","url":null,"abstract":"<strong>Introduction:</strong> Poorly controlled diabetes mellitus can lead to the development of diabetic foot ulcers (DFU), which is a frequent complication in patients. However, several diabetes management guidelines for older adults do not mention the occurrence of DFUs. Nowadays, Autologous Platelet-Rich Gel (APG) is being used for treating diabetic ulcers. APG is an innovative platelet-derived product with many advantages, such as being low-cost, easy to produce, and readily available materials. Additionally, it does not lead to any rejection reaction.<br/><strong>Objective:</strong> This study aims to assess the safety and efficacy of APG as a novel treatment of DFU compared with standard treatment in older adult patients.<br/><strong>Methods:</strong> Randomized Controlled Trials (RCTs) were searched using PubMed, Cochrane, Google Scholar, Wiley, and PlosOne. The keywords have been arranged using the Boolean operator, including autologous platelet-rich gel, DFU, and elderly. The data was screened by inclusion and exclusion criteria. The final inclusion study was analyzed and synthesized by tabulation, clusterization, contextual and thematic approach, and assessed for risk of bias using ROB 2.0. Meta-analysis was conducted by using Review Manager 5.4 and the Mantel Haenszel method.<br/><strong>Results:</strong> Eight RCTs with 598 patients were eligible for the present analysis. Compared with standard care/conventional treatment, APG could significantly improve the healing wound in patients with diabetic foot ulcers (Relative risk (RR) 1.32, 95% confidence interval (CI) 1.22– 1.57, p < 0.0001), shortened the healing time (Mean difference [MD] − 16.97 days (95% CI: − 32.64 to − 1.29; p < 0.00001), shortened the length of hospital stay (MD= − 20.11, 95% CI: − 38.02, − 2.20; <em>p</em> = 0.03), and amputation rate (MD= 0.36, 95% CI: 0.16, 0.84; p = 0.02).<br/><strong>Conclusion:</strong> APG treatment can better treat DFU in terms of duration of healing, wound healing, length of hospital stay, and amputation prevention than the standard treatment.<br/><br/><strong>Keywords:</strong> autologous platelet-rich plasma gel, diabetic foot ulcers, older adult<br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"1 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139551812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Corrigendum for the article Hard-Candy Consumption Does Not Have an Effect on Volume and pH of Gastric Content in Patients Undergoing Elective Gastrointestinal Endoscopic Procedures: A Randomized Controlled Trial
{"title":"Hard-Candy Consumption Does Not Have an Effect on Volume and pH of Gastric Content in Patients Undergoing Elective Gastrointestinal Endoscopic Procedures: A Randomized Controlled Trial [Corrigendum]","authors":"Pawit Somnuke, Nuanprae Kitisin, Phornprasurt Chumklud, Pishsinee Kunavuttitagool, Penpuk Deepinta, Araya Wadrod, Warayu Prachayakul, Somchai Amornyotin, Nattaya Raykateeraroj","doi":"10.2147/tcrm.s459875","DOIUrl":"https://doi.org/10.2147/tcrm.s459875","url":null,"abstract":"Corrigendum for the article Hard-Candy Consumption Does Not Have an Effect on Volume and pH of Gastric Content in Patients Undergoing Elective Gastrointestinal Endoscopic Procedures: A Randomized Controlled Trial","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"17 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139483426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To evaluate the effectiveness and safety of diazepam in maintaining stable intraoperative blood pressure (BP) in hypertensive patients undergoing vitrectomy under nerve block anesthesia. Methods: A total of 180 hypertensive patients undergoing vitrectomy with nerve block anesthesia were randomized into two groups. The intervention group was given oral diazepam 60 min before operation, while the control group was given oral placebo 60 min before operation. The primary outcome is the effective rate of intraoperative BP control, defined as systolic blood pressure (SBP) during the operation maintained < 160 mmHg at all timepoints. The logistic regression model will be performed to analyze the compare risk factors for ineffective BP control. Results: The effective rate of intraoperative SBP control in the diazepam group was significant higher than that in the placebo group from 15 min to 70 min of the surgery (P < 0.05). The proportion of patients with SBP ≥ 180 mmHg at any timepoint from operation to 1 h postoperation was higher in the placebo group (12.22%) than in the diazepam group (2.22%) (P = 0.0096). We observed that the change in SBP from baseline consistently remained higher in the placebo group than in the diazepam group. In the logistic regression analysis, age, years of diagnosed hypertension and SBP 1h before surgery were significant risk factors for ineffective BP control. Conclusion: This study provides robust evidence supporting the effectiveness of oral diazepam as a pre-surgery intervention in maintaining stable blood pressure during vitrectomy in hypertensive patients. Trial Registration: Chinese Clinical Trial Registry (ChiCTR), ChiCTR2100041772.
{"title":"The Efficacy and Safety of Diazepam for Intraoperative Blood Pressure Stabilization in Hypertensive Patients Undergoing Vitrectomy Under Nerve Block Anesthesia: A Prospective, Single-Center, Double-Blind, Randomized, Controlled Trial","authors":"Tianwei Qian, Qiaoyun Gong, Yiyang Shu, Hangqi Shen, Xia Wu, Weijun Wang, Zhihua Zhang, Hui Cao, Xun Xu","doi":"10.2147/tcrm.s441152","DOIUrl":"https://doi.org/10.2147/tcrm.s441152","url":null,"abstract":"<strong>Purpose:</strong> To evaluate the effectiveness and safety of diazepam in maintaining stable intraoperative blood pressure (BP) in hypertensive patients undergoing vitrectomy under nerve block anesthesia.<br/><strong>Methods:</strong> A total of 180 hypertensive patients undergoing vitrectomy with nerve block anesthesia were randomized into two groups. The intervention group was given oral diazepam 60 min before operation, while the control group was given oral placebo 60 min before operation. The primary outcome is the effective rate of intraoperative BP control, defined as systolic blood pressure (SBP) during the operation maintained < 160 mmHg at all timepoints. The logistic regression model will be performed to analyze the compare risk factors for ineffective BP control.<br/><strong>Results:</strong> The effective rate of intraoperative SBP control in the diazepam group was significant higher than that in the placebo group from 15 min to 70 min of the surgery (<em>P</em> < 0.05). The proportion of patients with SBP ≥ 180 mmHg at any timepoint from operation to 1 h postoperation was higher in the placebo group (12.22%) than in the diazepam group (2.22%) (<em>P</em> = 0.0096). We observed that the change in SBP from baseline consistently remained higher in the placebo group than in the diazepam group. In the logistic regression analysis, age, years of diagnosed hypertension and SBP 1h before surgery were significant risk factors for ineffective BP control.<br/><strong>Conclusion:</strong> This study provides robust evidence supporting the effectiveness of oral diazepam as a pre-surgery intervention in maintaining stable blood pressure during vitrectomy in hypertensive patients.<br/><strong>Trial Registration:</strong> Chinese Clinical Trial Registry (ChiCTR), ChiCTR2100041772.<br/><br/><strong>Keywords:</strong> nerve block anesthesia, vitrectomy, diazepam, blood pressure stabilization<br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"268 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139464235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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