Clinics and Practice最新文献

Background: Awake carotid endarterectomy (CEA) under local anesthesia demands an optimal sedation strategy that ensures patient comfort while preserving the ability for real-time neurological assessment. Dexmedetomidine (DEX) and remifentanil (REMI) are widely used agents, but direct comparisons in this setting remain scarce. Methods: Exploratory, retrospective, single-center study of awake CEA (March-July 2019). DEX or REMI infusions were titrated to a Richmond Agitation-Sedation Scale (RASS) of -1 to -2. Outcomes were sedation failure (RASS ≥ +2 despite maximum infusion rate), bradycardia, hypotension, and neurologic events. Statistical analyses used χ² test (categorical variables) and Student's t-test or Mann-Whitney test (continuous variables). Associations were assessed with Firth's logistic regression (univariable and bivariate models), reporting odds ratios (OR) with 95% confidence intervals (CI_95%). Trends in the Bispectral Index (BIS), hemodynamic, and respiratory parameters were assessed using two-way repeated-measures Analysis of Variance (ANOVA). A p-value < 0.05 was considered significant. Results: Fifty-two patients were included (DEX = 25; REMI = 27). DEX group showed more frequent sedation failure (32.0% vs. 3.7%; p = 0.020), bradycardia (36.0% vs. 3.7%; p = 0.009), and hypotension (28.0% vs. 0%; p = 0.011). DEX was associated with increased risk in sedation failure (OR 8.58, CI_95% 1.70-85.81), bradycardia (OR 10.17, CI_95% 2.05-101.21), and hypotension (OR 22.30, CI_95% 2.46-2959.60); the direction of associations remained consistent in bivariate models adjusted for baseline confounders. ANOVA showed group-by-time interactions for BIS, heart rate, mean arterial pressure, and end-tidal CO₂. No intraoperative complications or adverse outcomes were observed. Conclusions: In this retrospective cohort of awake CEA, DEX was associated with higher rates of sedation failure and hemodynamic adverse events compared with REMI, without an apparent impact on procedural success. Given non-random allocation and baseline imbalances, these findings are hypothesis-generating and warrant confirmation in larger, robust, and prospective studies.

Objective: Although non-hepato-pancreato-biliary (non-HPB) cancer, such as gastric and colorectal cancer, may cause biliary obstruction, the efficacy of endoscopic transpapillary drainage remains unclear. We investigated the clinical outcomes of endoscopic transpapillary drainage for biliary obstruction due to non-HPB cancer. Methods: This was a two-center retrospective observation study. We evaluated the technical success, clinical success, recurrent biliary obstruction (RBO), time to RBO (TRBO), adverse events (AEs), and overall survival (OS). OS was determined using the Kaplan-Meier method, and the significance was tested using the log-rank test. Cox regression hazard models were performed to identify the independent association of clinical parameters with OS. Results: This study included 43 cases. The technical success was achieved in all cases (100%), and the clinical success was achieved in 35 cases (81%). The occurrence rate of RBO and non-RBO AEs were 33% and 12%, respectively. The median TRBO was 176 days. Systemic chemotherapy was introduced in 17 cases (40%) after biliary drainage, and cases with the introduction of systemic chemotherapy had a significantly longer OS. C-reactive protein <3.4 mg/dL and biliary obstruction due to lymph node metastasis were independently associated with the introduction of systemic chemotherapy. In survival analysis, serum albumin >3.1 g/dL and the introduction of systemic chemotherapy were significant and independent predictive factors for the prolongation of OS. Conclusions: The endoscopic transpapillary drainage for biliary obstruction due to non-HPB cancer can provide favorable outcomes with appropriate patient selection.

Elderspeak is a form of communication overaccommodation directed toward older adults, characterized by simplified language and an elevated pitch. While typically well-intentioned, it is rooted in ageist stereotypes and linked to negative health outcomes. A literature search was conducted in PubMed, CINAHL, and PsycINFO (2018-2025), yielding 24 key articles focusing on acute and surgical settings. The purpose of this narrative review is to synthesize current evidence on Elderspeak within acute care hospitals and propose a research framework and intervention strategies. Elderspeak is a key determinant of resistiveness to care (RTC), particularly in acute settings where it is triggered by functional impairment. Exposure increases patient distress and negatively impacts vital signs and cooperation with medical interventions. Inconsistent measurement is being addressed through standardized schemes like the Iowa Coding Scheme for Elderspeak (ICodE). This paper proposes that future research must employ mixed-methods, longitudinal designs to capture the impact of Elderspeak on long-term outcomes. Drawing on the ICodE, we propose a qualitative self-reflection tool for clinicians to enhance awareness in high-stakes acute settings. Eliminating Elderspeak is a foundational necessity for patient safety and dignity-affirming care in advanced nursing.

Introduction: Caregiving has been an emerging public health priority mainly due to the rapid pace of population aging, increase in chronic diseases and shortages of health professionals. In clinical settings, caregivers have a crucial role by providing support to patients. Consequently, they may experience physical and emotional burden mainly attributed to environmental, personal or family stressors. The aim of this study was to evaluate fatigue and the associated factors among caregivers of hospitalized patients in medical-surgical wards. Methods and Material: In the present study caregivers of hospitalized patients in medical and surgical wards were enrolled. Collection of data was performed with the following: a. Fatigue Assessment Scale (FAS), b. Zung Self-Rating Anxiety Scale (SAS) and c. Athens Insomnia Scale (AIS), which included patients' characteristics. In this cross-sectional study, participants were selected using the method of convenience sampling. Results: Of the 142 participants, the majority were spouses (64.8%), female (64.8%) and over 60 years old (53.6%). The mean FAS score was 25.9 ± 9.3, the mean SAS was 38.1 ± 9.0, and the mean AIS score was 7.6 ± 4.7, indicating moderate, moderate to low and moderate levels of fatigue, anxiety and insomnia, respectively. Moreover, fatigue showed a positive linear correlation with both anxiety (Spearman's rho = 0.713) and insomnia (Spearman's rho = 0.671). The factors found to be statistically significantly associated with caregivers' fatigue were the following: gender (p = 0.001), length of hospitalization (p = 0.013), experience of environmental stressors (p = 0.045), experience of financial stressors (p = 0.001), and unfamiliarity with the provision of care (p = 0.001). Conclusions: Provided that caregivers' involvement in care not only enhances patient well-being but also supports clinical teams, it is widely comprehended that addressing their needs should be emphasized.

Background: Nuclear protein in testis (NUT) carcinoma is a rare, aggressive, and poorly differentiated epithelial malignancy characterized by the rearrangement of NUTM1 (NUT midline carcinoma family member 1) on 15q14. It primarily originates along the midline structures, including the head, neck, thorax, and mediastinum. Although NUT carcinoma of the pelvic gynecological organs is exceedingly rare, reported cases have been limited to primary or metastatic ovarian tumors. Here, we present the first documented case of primary uterine NUT carcinoma. Case presentation: A 53-year-old postmenopausal woman presented with abnormal uterine bleeding and a uterine mass. She underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. The initial postoperative histopathological evaluation suggested undifferentiated endometrial sarcoma; however, subsequent immunohistochemical (IHC) analysis and fluorescence in situ hybridization revealed NUTM1 rearrangement, confirming the diagnosis of NUT carcinoma. The patient experienced tumor recurrence six months postoperatively and succumbed to the disease nine months later. Discussion: The pathological diagnosis was challenging; the presence of abrupt squamous differentiation prompted further IHC analysis, leading to the definitive diagnosis. Primary uterine NUT carcinoma may be misdiagnosed as other undifferentiated uterine tumors due to its rarity and histological overlap. Conclusions: Given the diagnostic challenges, NUT IHC staining and molecular testing for NUTM1 rearrangement should be considered in undifferentiated uterine tumors with ambiguous histopathological features.

Background: Aripiprazole is an atypical antipsychotic that acts as a partial agonist on the dopamine receptor D2 while also displaying agonistic activity on the 5-HT1A and antagonistic activity on the 5-HT2A receptors. As a partial agonist, aripiprazole stabilizes the activity of the D2 receptor, preventing overactivation. Case presentation: Within our deprescribing activity, we came across the case of a 30-year-old antipsychotic-naïve patient treated with the depot formulation of aripiprazole for bipolar disorder and acute mania, possibly developing hypersexuality due to an overdose that impacted negatively and heavily on his personal life. Results: The patient developed a peculiar subset of hypersexuality, changing his sexual orientation. Of interest, one month after discontinuing aripiprazole and switching to paliperidone, all the sexual-related symptoms and impulse control disorders resolved. Conclusions: We suggest stronger communication among the clinical teams involved in the patient's care and screening patients for impulse control disorder prior to the administration of aripiprazole and monitoring them during treatment.

Introduction: Patients with colorectal cancer who undergo ileostomy surgery confront multifaceted challenges that significantly impact their daily lives and cause symptoms of anxiety and depression. The aim of this study was to explore the anxiety and depression experienced by colorectal cancer patients undergoing ileostomy with three assessments. Materials and Methods: This longitudinal study included 96 patients with newly diagnosed colorectal cancer who underwent scheduled ileostomy surgery at two public hospitals in Attica. The Hospital Anxiety and Depression Scale (HADs) was used, which included patients' characteristics. Measurements were collected at three distinct time points: preoperatively (Time 1), postoperatively between the 12th and 14th day (Time 2), and after stoma closure, approximately one year later (Time 3). Statistical analysis was performed using the SPSS 26.0 statistical package and the statistical significance level was set at p < 0.05. Results: The proportion of participants reporting moderate levels of anxiety (scores 8-10) was 15.6% at Time 1, which increased to 27.1% at Time 2, and had a slight increase to 28.1% at Time 3. The increase was statistically significant between Time 1 and Time 2 and at Time 1 and Time 3 (p < 0.001). Regarding high levels of anxiety (scores >11), the percentage of affected individuals increased from 13.5% at Time 1 to 17.7% at Time 2 and reached 15.6% at Time 3. The comparison between Time 1 and Time 2 revealed a statistically significant increase (p = 0.016), while the subsequent decrease between Time 2 and Time 3 was not statistically significant (p = 0.508). In terms of depression, at Time 1, 84.4% of patients had low depression, which decreased significantly to 56.3% at Time 2 and 39.6% at Time 3 (p < 0.001 for all comparisons). The percentage of patients who were moderately depressed at Time 1 was 9.4%; this percentage increased significantly to 32.3% at Time 2 and remained high, reaching 29.2% at Time 3. Finally, the proportion of patients who had high levels of depression at Time 1 was 6.3%, a figure that rose to 11.5% and 31.3% for Time 2 and Time 3, respectively. Conclusions: Anxiety and depression experienced by colorectal cancer patients undergoing ileostomy surgery escalate postoperatively and remain at high levels after ileostomy closure. Understanding these mental health challenges is crucial for providing comprehensive patient care. Further research is needed on the early recognition and management of these emotional difficulties, which are key elements of holistic oncology care.

Background: Cardiac amyloidosis is characterized by progressive myocardial and atrial infiltration, leading to atrial mechanical dysfunction, atrial fibrillation, and thromboembolic complications. Left atrial (LA) strain is an established marker of atrial function; however, data on triplane LA strain in cardiac amyloidosis are limited.

Methods: We evaluated transthoracic echocardiographic examinations of 24 patients with cardiac amyloidosis and 24 age-, sex-, rhythm-, and ejection fraction-matched control subjects (9 with atrial fibrillation in each group). Among amyloidosis patients, 21 had transthyretin and 3 had light-chain cardiac amyloidosis. All examinations were performed during 2025. Triplane and biplane LA reservoir strain were assessed using speckle-tracking echocardiography. Two-way analysis of variance tested the effects of disease (amyloidosis vs. control) and rhythm (sinus rhythm vs. atrial fibrillation). Agreement between triplane and biplane measurements was evaluated using Pearson correlation and Bland-Altman analyses.

Results: Triplane LA reservoir strain was significantly lower in patients with cardiac amyloidosis compared with controls (6.7 ± 2.7% vs. 16.2 ± 8.3%, p < 0.001). Even in sinus rhythm, amyloidosis patients demonstrated markedly impaired LA strain, with mean values similar to those observed in control subjects with atrial fibrillation. Two-way ANOVA revealed significant main effects of disease (F = 68.9, p < 0.0001) and rhythm (F = 45.0, p < 0.0001), as well as a significant disease-rhythm interaction (F = 26.5, p < 0.0001). Triplane and biplane LA strain showed strong correlation (r = 0.90, p < 0.0001) with good agreement. Reproducibility was excellent (intra-observer ICC = 0.97; inter-observer ICC = 0.94).

Conclusions: Triplane LA reservoir strain is markedly reduced in cardiac amyloidosis and enables comprehensive visualization of atrial mechanical dysfunction. The technique demonstrates high reproducibility and strong agreement with biplane analysis, supporting its use as a complementary tool for characterizing amyloid atriopathy.

Background/Objectives: The aim of this study was to assess the short-term and long-term effectiveness of group voice therapy in changing vocal behaviour and improving voice quality (VQ) among teachers with hyperfunctional voice disorders (HFVD), using both subjective and objective measures. Methods: Thirty-one teachers participated in a structured group voice therapy programme. Participants underwent videoendostroboscopic evaluation of laryngeal morphology and function, perceptual assessment of voice, acoustic analysis of voice samples, and aerodynamic measurements of phonation. Patients' self-assessment of VQ and its impact on quality of life were measured using a Visual Analogue Scale (VAS) and the Voice Handicap Index-30 (VHI-30). Evaluations were conducted at four time points: pre-therapy (T0), immediately post-therapy (T1), and at 3-month (T3) and 12-month (T12) follow-up visits. Results: Significant improvement was observed between T0 and T1 in perceptual voice evaluations: grade, roughness, asthenia, strain, loudness, fast speaking rate, as well as in neck muscle tension, shimmer, patients' most harmful vocal behaviours, VHI-30 scores, patients VQ evaluation, and its impact on quality of life (all p < 0.05). Almost all parameters of subjective and objective voice assessment improved over the 12-month observation period, with the greatest improvement between T0 and T12 (all p < 0.05), indicating lasting reduced laryngeal tension and improved phonatory efficiency. Conclusions: Group voice therapy has been shown to be an effective treatment for teachers with HFVD, leading to significant and long-lasting improvements in perceptual, acoustic, and self-assessment outcomes. Therapy also promoted healthier vocal and lifestyle behaviours, supporting its role as a successful and cost-effective rehabilitation and prevention method for occupational voice disorders.

Objective: The aim of this study was to systematically map evidence to inform best practices for sexual and reproductive healthcare delivered via telehealth (TeleSRH) in United States-based Title X-funded clinics.

Methods: We searched three databases (2017-2025) for studies evaluating effectiveness, harms, patient and provider experiences, barriers/facilitators, and engagement strategies encompassing TeleSRH for sexually transmitted infections (STIs), contraceptive care/family planning (CC/FP), and sexual wellness, in countries with a human development index of ≥0.8.

Results: From 5963 references and 436 articles, we included 142 eligible publications. TeleSRH use declined since the COVID-19 pandemic's peak but remains higher than pre-pandemic. Evidence comes mostly from poor-quality studies. TeleSRH increases access and adherence to STI prevention (e.g., pre-exposure prophylaxis for HIV). Tele-follow-up may safely facilitate HIV care continuity. For CC/FP, TeleSRH is comparable to in-person care for patient satisfaction and uptake; patients are less likely to select long-acting reversible contraception but post-initiation tele-follow-up may increase its continuation rates. Vasectomy completion rates may be similar between pre-procedural counseling via telehealth versus in-person. TeleSRH's potential benefits might include reduced travel time, wait times, no-show rates, and clinic human resource burden (via tele-triaging) and increased preventative screening rates for STIs and non-communicable diseases, prescription refill rates, ability to receive confidential care in preferred settings, and rural/marginalized community outreach. Implementation challenges span technological and capital constraints, provider availability, staff capability building, restrictive policies, language incompatibility, and patient mistrust. Supplementing synchronous TeleSRH with asynchronous communication (e.g., mobile application) may improve continued patient engagement.

Conclusions: Preventive, diagnostic, and therapeutic TeleSRH can be effective, with high patient acceptability; however, effectiveness and adoption hinge on contextual factors outlined in this review.