Clinics and Practice最新文献

Improving preoperative care for elderly patients with hip fractures is crucial for achieving the best outcomes. A multidisciplinary team that can improve overall care quality by addressing patient's medical conditions, analgesia, timely surgery, and early postoperative mobilization is required. This narrative review provides insights regarding the extent of preoperative optimization needed for hip fracture surgery.

(1) Background: Diet is significant for nutritional intake and serves as an essential element for improving quality of life (QOL). Poor dietary management skills increase the risk of onset or progression of lifestyle-related diseases, and, in particular, are a factor in reduced QOL during old age. This study aimed to clarify the physical and social background factors impeding dietary self-management. (2) Methods: The study participants were 3814 men (age range, 30-69 years) extracted from anonymous data comprising 15,294 persons provided from the Japanese national statistics database. The participants were classified into two groups (Concerned vs. Unconcerned) according to whether they were concerned about their diet. Adjusted odds ratios (ORs) for diet-conscious behaviors were then obtained by means of binomial logistic regression analysis performed following univariate analysis. (3) Results: The Concerned and Unconcerned groups comprised 2548 (66.8%) and 1266 subjects (33.2%), respectively. The diet-conscious behavior with the highest response rate was eating regularly (46.7%). The most frequent items in the Unconcerned group were the subjective symptom "irritable" (48.9%), high stress (46.3%), working more than 56 h/week (43.8%), and smoking (41.9%). The only item with a large significant OR in the binomial logistic regression analysis was smoking (OR: 2.2). (4) Conclusions: These results suggest that a smoking habit and stress are factors that impede diet management behaviors.

Background: Ectopic organ-associated conditions belong to the larger panel of developmental ailments, and among this challenging medical and surgical chapter, ectopic endocrine glands-related picture is mostly focused on the presence of the ectopic parathyroid and thyroid. Ectopic thyroid tissue within mediastinum (ETTM) stands for a less common ETT site; while, globally, less than 1% of the mediastinum masses are ETTM. Objective: We aim to introduce a rare case of ETTM in a senior lady to whom one-time synchronous thyroidectomy with ETT removal was successfully performed via a minimally invasive modern procedure upon cervicotomy and intra-operatory use of the Cooper thymectomy retractor. Results: The panel of pros and cons with respect to providing endocrine thoracic surgery for ETTM resection in a 73-year-old subject is discussed amid a PubMed search of original English-language original reports from January 2000 until 15 August 2024 in order to identify similar distinct cases (individuals of 70 years or older who underwent surgery for ETTM). Conclusions: 1. We propose the term "three-leaf-clover thyroid" to capture the imaging essence of having an enlargement of both (eutopic) thyroid lobes and ETTM. 2. The modern surgical approach under these circumstances provided a rapid patient recovery with a low rate of complications and a minimum hospital stay. Hence, the procedure may be expanded to older patients after a careful consideration of their co-morbidities and of the need to releasing connected complaints (e.g., a 7-month history of intermittent dyspneea was found in this case with post-operatory remission). 3. The management remains a matter of individualised decision, and age may not be a limiting factor. 4. At the present time, this case adds to the very limited number of similar published cases in the mentioned age group that we could identify (seven patients, aged between 72 and 84; male-to-female ratio of 5 to 2; the rate of malignant ETTM was 3/7); of these cases, not all were reported to have a trans-cervical approach, and none reported the use of the Cooper thymectomy retractor to help the overall surgical procedure. This innovative surgical procedure offers the advantage of avoiding a sternotomy incision which has clear functional and aesthetic implications, while the video-assisted approach allows optimal visualization of the mediastinal anatomy and safe vascular sealing under visual control, without the risk of a major hemorrhage.

Backgroud: The main function of the hamstring muscles is to bend the knee joint and support the function of the hip extensors. Their frequent injuries are the result of overload related to, among others, dynamic running or jumping, and inadequate preparation for athletics activities. The asymmetry of the work of individual flexor muscle groups is clearly marked in the case of valgus or varus of the knee joint, i.e., in different positions of the lower limb. The aim of the study was to determine the position and form of a rehabilitation exercise in which an isolated group of muscles flexing the knee joint will show the greatest bioelectrical activity.

Methods: The study involved 25 students of the Jagiellonian University Medical College. The students were aged 20-26. The average age was 22.9 (±1.4). The study participants included 17 women with an average age of 23.0 (±1.1) and 8 men with an average age of 22.6 (±1.9). Women constituted 68% and men 32% of all respondents. All participants agreed to participate in the study. Surface electromyography measurements in both lower limbs provided an initial number of 50 cases. The activity of the knee flexor muscles during isometric contraction with resistance was measured in correlation with three foot and lower leg settings: internal rotation, neutral position, and external rotation. The bioelectrical activity of the semitendinosus muscle is significantly higher (p < 0.01) in the internal rotation position than in the neutral position of the lower leg, while the bioelectrical activity of the biceps femoris muscle is inversely higher (p < 0.01) in the external rotation position than in the neutral position.

Results: The results are significant for both average and maximum values of muscle stimulation. During isometric contraction with resistance, the semitendinosus muscle shows the greatest bioelectrical activity in the internal rotation position of the lower leg and foot, and the biceps femoris muscle in the external rotation position of the lower leg and foot.

Conclusions: The above information has important implicational applications when improving isolated groups of hamstrings. In the future, this may contribute to more effective rehabilitation of patients with injuries of the muscles described in the article.

Complex microvascular techniques and in-depth knowledge of blood rheology and microanastomosis function are required for success in microvascular flap surgery. Substantial progress has been achieved in preventing complications, but the rate of flap loss is still significant and can have significant adverse effects on the patient. Flap thrombosis, flap hematoma, and flap loss are the most frequent and severe major surgical complications. Advances in understanding the pathophysiology of different flap complications, the use of preoperative risk assessment and new treatment concepts could improve the perioperative care of microvascular flap surgery patients. Our aim was to outline novel avenues for best practice and provide an outlook for further research of anesthesia and perioperative care concepts in microvascular flap surgery.

Background: Lung cancer carries a high burden of systemic symptoms, including in survivors, leading to a reduced quality of life (QoL). We assessed whether a 12-week multicomponent supervised exercise programme, including muscular strength and aerobic training, was beneficial in patients who had undergone surgery for early non-small cell lung cancer (NSCLC) in terms of physical performance, QoL, and metabolic and nutritional analytical parameters. Methods: Physical performance was measured by gait speed, handgrip strength, 30 s sit-to-stand (30s-STS) test repetitions, distance covered in the 6 min walk test (6MWT), and the Short Physical Performance Battery (SPPB) score. QoL was assessed with the EORTC-QLQ-C30 questionnaire. Blood glucose, cholesterol, triglycerides, total proteins, albumin, pre-albumin, creatinine, c-reactive protein, insulin-growth factor 1 (IGF-1), and the haemoglobin and hematocrit percentages were measured before and after the intervention in order to observe any beneficial effects related to metabolic markers. Results: After the intervention, the mean scores for the 6MWT (p < 0.001), STS (p < 0.001), 6MWT (p < 0.01), and SPPB (p < 0.01) had significantly improved. However, handgrip strength and nutritional analytical were unchanged. The EORTC-QLQ-C30 functions and symptoms significantly improved after the intervention (p < 0.05 and p < 0.01, respectively). A significant decrease in cholesterol, triglycerides, and IGF-1 and a significant increase in pre-albumin in blood was also observed post-intervention (p < 0.05). Conclusions: This supervised, community-based 12-week multicomponent was feasible (adherence rate 70.35%) and provided benefits not only to physical performance but also to the quality of life of patients with NSCLC.

Background and purpose: Treatment choice during clinical practice is crucial to best help each patient. One of the physicians' main goals is choosing a personalized effective treatment, but it also represents a challenging issue. Here, we explored different treatment choices in a simulated patient-physician interaction.

Materials and methods: Medical students (n = 48) and young Practicing Physicians (n = 20) were recruited to behave as "physicians" while fellow researchers acted as "patients". Participants were divided equally into a Belief Group, which received positive information about placebo efficacy, and a Non-Belief Group, which received negative information. Empathy traits and psychological variables were measured in both groups. During the task, participants were asked to choose between an active (TENS treatment) or a placebo treatment, to reduce patients' pain. Patients never underwent the painful stimulation but acted as if they had, simulating high or low pain responses to the placebo treatment (placebo-responders/placebo non-responders) and low pain to the TENS treatment.

Results: Behavioral results showed that the Belief Group gave significantly more placebo treatments when faced with a patient that simulated placebo responsiveness, while the Non-Belief group showed a mirrorlike behavior, administrating more believed TENS treatments when faced with a placebo non-responder. No differences were found between Medical Students and Practicing Physicians.

Conclusions: This study constitutes a frame of reference for medical treatment decisions, indicating that physicians' treatment choices are influenced by patients' responsiveness to the treatments, as well as by their prior beliefs and empathy traits.

Background: This study investigates the association between depression and ischemic heart disease (IHD), conditions that often coexist and complicate patient management. Understanding the impact of demographic factors, risk factors, symptoms, and medical approaches in these patients is essential to develop effective clinical strategies. Objectives: The aim of this study is to investigate how demographic characteristics, risk factors, symptoms, and treatment methods differ between patients with depression alone and those with both depression and IHD. It seeks to identify how these factors influence patient outcomes, providing insights to improve management and treatment approaches for this complex patient group. Materials and Methods: This cross-sectional study included a sample of 332 patients diagnosed with depression, with a specific subgroup consisting of individuals who also had comorbid IHD. Statistical analyses were performed to compare the patients with depression, focusing on those with IHD. Data on demographic characteristics (e.g., gender, environment, social status), risk factors (e.g., hypertension, diabetes), symptom severity, and treatments (e.g., antidepressants, antipsychotics, anxiolytics, hypnotics) were analyzed. The study also evaluated the frequency of cardiac examinations and emergency hospitalizations. Results: Significant demographic differences were found between the two groups. Patients with both depression and IHD had higher rates of hypertension and diabetes mellitus and experienced more severe depressive symptoms, including reduced mood, energy, and activity levels. The treatment patterns were similar in terms of antidepressant use, but the IHD group had a higher use of antipsychotics, anxiolytics, and hypnotics. Additionally, these patients required more cardiac examinations and emergency hospitalizations. Conclusions: Comorbidity between depression and IHD presents complex clinical challenges, and it is crucial to implement an integrated management approach that addresses both mental and physical health. This study highlights the need for comprehensive therapeutic strategies to improve the quality of life and outcomes for patients with these coexisting conditions.

Background: Diabetes ranks high among worldwide global health problems, and diabetic foot ulcer syndrome (DFU) is considered as one of its most serious complications. The purpose of this study was to evaluate the impact of local ozone therapy procedures on the wound healing process in patients with two DFU types: neuropathic and ischemic. Material and Methods: In the retrospective study reported here, the treatment outcomes of 90 patients were analyzed: 44 males (48.8%) and 46 females (51.2%), in the age range between 38 and 87 years of age, with neuropathic (group 1) and ischemic (group 2) diabetic foot ulcers treated by means of local ozone therapy. The assessment of therapeutic effects in both groups of patients included an analysis of the rate of ulcer healing using planimetry and an analysis of the intensity of pain associated with ulcers performed using the VAS scale. Results: After the application of ozone therapy procedures, a statistically significant decrease in the surface area of the ulcers was obtained in both groups of patients, respectively: in group 1 from 7 (6-7.5) cm² to 3 (2-3.5) cm² and in group 2 from 7.5 (6.5-8) cm² to 5 (4.5-5.5) cm² (p < 0.001), with a complete healing of ulcers not observed in any patients from groups 1 and 2. After treatment, the surface area of the assessed ulcers was smaller in the neuropathic group. The intensity of pain experienced after treatment also decreased with statistical significance in both groups (p < 0.001). Conclusions: Short-term local ozone therapy was effective in promoting wound healing and alleviating pain in patients with DFUs of both neuropathic and ischemic etiology. The effectiveness of therapy in the neuropathic type of DFUs was significantly higher than in the ischemic type, in which patients had a higher incidence of risk factors and more advanced lesions, characterized by a larger initial ulcer area and greater intensity of pain.

Background/objectives: Psoriasis is a chronic inflammatory condition mediated by the immune system with various manifestations. The increased prevalence of subclinical joint involvement has led to the development of early diagnostic methods for psoriatic arthritis, including several instruments that have been validated and used in clinical practice. The aim of this study was to perform the Romanian translation, cultural adaptation, and validation of three assessment tools: the Early Arthritis for Psoriatic Patients (EARP) Questionnaire, Psoriasis Epidemiology Screening Tool (PEST), and Toronto Psoriatic Arthritis Screen 2 (TOPAS 2), which are designed to evaluate early-stage arthritis in patients with psoriasis.

Methods: All the activities were carried out in accordance with the internationally recognized methodology recommended by the International Society for Pharmacoeconomics and Outcome Research (ISPOR), the recommendations of the World Health Organization (WHO) regarding the translation process and the validation of instruments, and data from the international literature. These three questionnaires were administered to 29 patients with psoriasis diagnosed by biopsy. A descriptive study was conducted and the data were analyzed with appropriate statistical tests using the PSPP program. A reliability test was assessed using Cronbach's alpha coefficient.

Results: The obtained values were significant for the first two questionnaires, with a value of 0.89 for the EARP and 0.63 for the PEST, but the value was not as significant for ToPAS2, at 0.40.

Conclusions: This pilot study revealed that the Romanian and original versions of the three questionnaires are similar.