Clinics and Practice最新文献

Background: Rotator cuff-related shoulder pain (RCRSP) is a prevalent musculoskeletal disorder treated by physiotherapists. Although international guidelines support active, exercise-based management, little is known about current physiotherapy practices in Cyprus. Aim: To investigate physiotherapy management practices for RCRSP in Cyprus, assess adherence to recommended clinical guidelines, and compare findings with practices in other countries. Methods: A cross-sectional online survey was conducted among Cypriot physiotherapists between June and July 2024. An English case vignette-based questionnaire, adapted from validated international surveys, examined demographics, clinical reasoning, treatment preferences, and guideline adherence. Descriptive statistics summarised responses; chi-square tests and logistic regression identified associations between demographics and clinical decisions. Content analysis was performed on open-ended responses. Results: A total of 143 physiotherapists completed the survey. Most adhered to guideline-recommended care, with 99.3% (n = 142/143) prescribing exercise and 100% (n = 143/143) providing patient education. Conservative management was preferred, with 64.3% (n = 91/143) not recommending imaging, 72.0% (n = 103/143) not recommending injections, and 73.4% (n = 104/143) not recommending surgical referrals. Significant associations were found between special interest in shoulder conditions and recommendations for surgery (χ² = 4.937, p = 0.026) and injections (χ² = 9.143, p = 0.002). Physiotherapists recommending surgery were nearly seven times more likely to suggest MRI (Exp(B) = 6.944, p < 0.001). Conclusions: Cypriot physiotherapists predominantly use exercise and education for the management of RCRSP, aligning closely with international recommendations. Conservative strategies were favoured, with limited use of imaging, injections, and surgical referrals. However, variation in clinical decision-making, particularly regarding referrals and imaging, indicates partial adherence to best practice and highlights opportunities for enhanced guideline implementation and targeted clinical training.

Background/Objectives: Suicide is the second leading cause of death among adolescents and young adults. Those suffering from psychiatric illnesses are at particular risk. Our study, conducted at an outpatient mental health facility in Northern Italy, aimed at delineating demographic and psychopathological features of youths aged 16-29 who attempted suicide and were referred to our community-based outpatient service. Methods: We identified 63 subjects, most of whom suffered from personality disorders, mood disorders, and schizophrenia spectrum disorders. Analysis of variance and post hoc pairwise comparisons were performed. Results: Inferential analysis yielded significant results in terms of age at index suicide attempt across diagnostic groups. Patients with personality disorders attempted suicide at a younger age (M = 18.70) compared to those with schizophrenia spectrum disorders (M = 23.64; η² = 0.32). Conclusions: Our findings highlighted the period of transition from adolescence to adulthood as a stress on the need of preventive approaches towards suicidality in young people in both clinical and non-clinical settings. Moreover, the difference of age at index suicide attempt across different diagnostic groups stresses the need for tailored clinical interventions based on the specific psychopathological trajectories and natural histories of the diseases.

We read with great interest the article Clinico-Pathological Features and Immunohistochemical Comparison of p16, p53, and Ki-67 Expression in Muscle-Invasive and Non-Muscle-Invasive Conventional Urothelial Bladder Carcinoma by Hasan et al [...].

We would like to thank Harsanyi et al [...].

Background: Potential drug-drug interactions (pDDIs) present substantial challenges to medication safety during care transitions. Warfarin, with its narrow therapeutic index and extensive interaction profile, provides a strategic model for examining pDDIs at discharge. This study aimed to characterize the burden and determinants of major warfarin pDDIs among patients discharged from a tertiary-care hospital. Methods: This retrospective cross-sectional study analyzed electronic health records of 1667 patients discharged home on warfarin. Major pDDIs were identified using the Micromedex^® Drug Interaction database. Log-binomial regression was used to assess predictors of ≥1 major pDDIs, and generalized Poisson regression was used to model the number of pDDIs per patient. Results: Major warfarin pDDIs were identified in 81.6% (95% CI: 79.6-83.4%) of patients at hospital discharge. The burden was considerable: 35.1% (95% CI: 32.8-37.4%) of patients had one major pDDI, while 46.5% (95% CI: 44.1-48.9%) had two or more. Polypharmacy (≥5 concurrent medications) was the strongest predictor, associated with a higher risk of any major pDDI (adjusted risk ratio 1.72, 95% CI: 1.46-2.02) and nearly three times the burden of interactions per patient (adjusted incidence rate ratio (IRR) 2.87, 95% CI: 2.36-3.49). When modeled as a continuous variable, each additional discharge medication was associated with a 9% increase in predicted pDDI burden (IRR 1.09, 95% CI: 1.08-1.10). Conclusions: Using warfarin as a model for high-risk medication safety, major pDDIs were highly prevalent at hospital discharge, with polypharmacy as a significant predictor of both the presence and burden of interactions. These findings emphasize the importance of identifying polypharmacy-related pDDIs to reduce potential drug interaction risk during care transitions.

Background: Dyspepsia is a common indication for gastroscopy, yet its diagnostic yield for malignancy and other clinically significant findings (CSF) remains low. Improved risk stratification is therefore essential to guide endoscopic referral. This study evaluates the diagnostic yield of gastroscopy in dyspepsia and investigates the predictive roles of age, ethnicity, and alarm symptoms.

Methods: This retrospective single-center study was conducted at a university-affiliated hospital in Israel and included 3022 patients who underwent gastroscopy for dyspepsia over a five-year period. Multivariate logistic regression identified independent predictors of CSF, and receiver operating characteristic (ROC) analysis determined optimal age thresholds for malignancy and CSF.

Results: Functional dyspepsia accounted for 55.9% of cases, while precancerous gastric lesions and upper gastrointestinal malignancies were identified in 12.8% and 0.79%, respectively. In multivariable models, age ≥ 50 years (OR = 2.59; CI: 2.02-3.32) and alarm symptoms (OR = 1.79; 95% CI: 1.33-2.41) independently predicted CSFs. Malignancy was similarly associated with age ≥ 50 years (OR = 4.89; CI: 1.11-21.60) and alarm symptoms (OR = 31.42; CI: 10.26-96.19). ROC analysis identified optimal age thresholds of 50 years for CSF (AUC = 0.65) and 54 years for malignancy (AUC = 0.72). Ethnicity did not independently predict malignancy, though minority patients showed differing precancerous lesion patterns.

Conclusions: Age ≥ 50 years and alarm symptoms significantly increased the likelihood of CSFs and malignancy, supporting a selective approach to gastroscopy. ROC-derived thresholds may support reconsideration of age criteria in settings with similar epidemiologic patterns, highlighting the need for region-specific risk stratification.

Background: Vascular malformations (VMs) are congenital anomalies of the vascular system-capillary, venous, lymphatic, arteriovenous, or combined-frequently associated with notable morbidity and reduced quality of life. Electrochemotherapy (ECT), a locoregional treatment that combines chemotherapeutic agents (most commonly bleomycin) with electroporation, has emerged as a promising alternative in managing therapy-resistant or anatomically challenging lesions. Methods: A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and the Cochrane Library were searched from inception to January 2025 for studies reporting on the efficacy and/or safety of ECT for vascular malformations. Data extraction encompassed study design, patient demographics, VM type, ECT protocols, outcomes, follow-up duration, and adverse events. Studies that lacked relevant outcome data or focused solely on other therapeutic approaches were excluded. Results: Twelve primary studies met the inclusion criteria and were analyzed. These covered diverse VMs, including venous, slow-flow, high-flow malformations, aggressive hemangiomas, and composite lesions in adult and pediatric populations. ECT protocols usually combined bleomycin (or occasionally other agents such as pingyangmycin or polidocanol foam) with various electroporation parameters. Across studies, ECT resulted in meaningful lesion-size reduction (50-97% in most cohorts), symptom relief (e.g., reduced pain and bleeding), and favorable cosmetic outcomes. While side effects (local edema, hyperpigmentation, procedure-related discomfort) were occasionally reported, they were typically mild and transient. Conclusions: ECT represents a valuable minimally invasive option in the therapeutic armamentarium for vascular malformations. Despite consistent demonstrations of efficacy and acceptable toxicity profiles, future high-quality, multicenter studies are warranted to confirm outcomes, refine treatment guidelines, and potentially expand its use as a standard of care.

Aim: To propose a standardized clinical protocol for cone-specific neuromodulation that classifies therapeutic filters for selective stimulation of S-, M-, and L-cones and translates optical and safety parameters into condition-specific frameworks for amblyopia, strabismus, and ADHD.

Methods: Previously characterized spectral filters were re-evaluated using published transmittance and cone-excitation data to identify a reduced set of monochromatic and combined options with meaningful cone bias. These were integrated with α-opic metrology, international photobiological and flicker standards, and condition-specific neurophysiological evidence to define reproducible ranges for wavelength, corneal illuminance, exposure timing, temporal modulation, and safety verification.

Results: The protocol consolidates eleven monochromatic and six combined filters into operational classes mapped onto mechanistic profiles for amblyopia, esotropia, exotropia, vertical deviations, and exploratory ADHD applications. All time frames and applications are presented as methodological anchors rather than efficacy claims.

Conclusions: This work provides a structured, safety-anchored framework intended to guide protocol design and comparability in future cone-specific neuromodulation trials; therapeutic benefit must be demonstrated in prospective clinical studies.

Background: Clinical pharmacists are increasingly demonstrating their value within primary care; this process directly improves patient experiences and outcomes. However, many undergraduate pharmacy students have little or no experience in this area, so that when they first qualify from training, their previous lack of exposure could affect future patient care in this environment. Aim: This study aims to evaluate how pharmacy undergraduate students' learning and development of competencies are managed and received by general practitioner (GP) educators, clinical tutors, students, and patients in a general practice setting. Design and setting: The General Practice Pharmacy Educational Placement (GPEP) for undergraduates was designed and delivered in half-a-day each week across five weeks in general practice. Students observed patient consultations, interviewed patients, conducted medication reviews, used medicines reconciliation techniques, and also produced patient care plans. Method: Students participating in GPEP completed both pre- and post-course questionnaires rating eight learning outcomes, using a five-point Likert scale. Data analysis incorporated multivariate principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) strategies, and thematic analysis was applied to student focus groups, patient interviews, and GP staff interviews. Following the patient medication interview, students recorded findings and potential interventions for consideration. Results: A total of 112/157 students (71%) completed the questionnaires (June 2016-March 2019), with significant statistical differences in student confidence (p < 0.0005 for all learning outcomes). Thematic analysis revealed largely positive attitudes towards GPEP. Healthcare professionals highlighted benefits and challenges of GPEP. More than 40 issues relating to medicines optimisation and patient safety were identified, with some requiring immediate interventions from GP teams. Conclusions: GPEP demonstrated a positive clinical impact, improving patient safety. The undergraduate activities may encourage students to consider roles in primary and community care, enabling a resilient and able future workforce.

Background: Measles re-emergence has been reported across Europe, with Romania being among the most affected countries in 2023-2024. Although ocular manifestations are recognized in measles, their frequency and inflammatory correlates in hospitalized adults have not been well characterized.

Methods: This study retrospectively analyzed the medical records of adults treated for laboratory-confirmed measles at a Bucharest hospital between July 2023 and July 2024. Data from specialist eye examinations were used to compare patients with keratitis against those with other ocular issues.

Results: A total of 250 adult patients were included. Of the 88 patients referred for ophthalmologic examination, 93.2% showed ocular lesions. Keratitis was the primary form, identified in 64.6% of these cases. Patients with keratitis had blood markers indicating a more activated inflammatory profile (higher neutrophile-to-lymphocytes ratio). Pneumonia and respiratory failure were not associated with ocular lesion status; inflammatory markers were more strongly linked to respiratory failure than to ocular involvement.

Conclusions: Ocular lesions were highly prevalent in hospitalized adult measles cases during the 2023-2024 Romanian epidemic wave, and keratitis was common. Ocular involvement correlated with mucosal disease expression and systemic inflammatory activation. Systematic ophthalmologic assessment should be considered during measles epidemic peaks to improve early identification of clinically relevant ocular complications.