Clinics and Practice最新文献

Background: In an era of unprecedented technology adoption in healthcare, it is imperative to understand and predict factors influencing users' perspective. This study employs a risk-integrated technology acceptance model aiming to identify the determinants of the intention to use mobile health applications among patients with chronic diseases in Romania. Methods: A face-to-face survey method was used to collect research data from 207 subjects, and the partial least squares structural equation modeling approach was employed for data analysis. Results: The behavioral intention to use mobile health applications (INT) was influenced positively by the perceived ease of use (PEOU, f² = 0.358, β = 0.500, p < 0.001) and perceived usefulness (PU, f² = 0.271, β = 0.678, p < 0.001). Another core predictor, with a negative effect on the intention to use, was the user's perceived risk of using the technology (RISK, f² = 0.239, β = -0.321, p < 0.001), in turn influenced by the perceived degree of cyber-insecurity (CYBER, f² = 0.492, β = 0.639, p < 0.001). Digital self-efficacy (DSE) was identified as an external determinant with strong positive influence on PEOU (f² = 0.486, β = 0.610, p < 0.001). The model shows strong performance, reflected in a high Tenenhaus goodness-of-fit index (0.770) and solid explanatory power for the outcome variable (adjusted R² = 0.718). Conclusions: This study validates an extended risk-integrated technology acceptance model, offering robust insights into the determinants of mobile health application adoption among chronic patients in Romania. The findings provide actionable guidance for designing targeted interventions and healthcare policies to enhance technology adoption in this population.

Serum sickness-like reaction (SSLR) is a rare immune-mediated condition that typically affects the skin and joints after exposure to certain drugs, infections, or vaccines. Although it shares clinical similarities with serum sickness (SS), SSLR differs in its underlying mechanisms, histopathology, and causes. Despite its generally benign and self-limiting nature, SSLR is frequently misdiagnosed and may lead to unnecessary hospitalization. This narrative review summarizes current knowledge on epidemiology, pathophysiology, clinical features, diagnosis, treatment, and long-term considerations related to SSLR. The condition is most often associated with antibiotics, monoclonal antibodies, and vaccines, particularly in pediatric populations. Its pathogenesis remains incompletely understood, but proposed mechanisms include immune complex formation, altered drug metabolism, lymphocyte toxicity, and the development of anti-drug antibodies. Diagnosis is primarily clinical, although novel diagnostic tools are emerging. Management involves discontinuation of the offending agent and supportive care, such as antihistamines or nonsteroidal anti-inflammatory drugs (NSAIDs) in mild cases, and corticosteroids in more severe cases. Long-term management, especially in cases requiring potential re-exposure to the causative agent, remains challenging. Skin testing and graded oral challenges appear promising within a structured clinical framework. Increased awareness of SSLR is essential for timely recognition and appropriate care, and further research is needed to elucidate its mechanisms and inform evidence-based management strategies.

Background: Endometrial proliferative lesions are common in the menopausal transition and carry a measurable risk of carcinoma. Early risk stratification may guide evaluation and follow-up. Methods: We performed a single-center retrospective study of 315 women aged 45-55 years (May 2021-May 2024) at a private clinic in Bucharest. Lesions were classified per WHO 2014 as hyperplasia without atypia, atypical hyperplasia/endometrial intraepithelial neoplasia (AH/EIN), or adenocarcinoma; "advanced pathology" was defined as AH/EIN or adenocarcinoma. Clinical comorbidities and transvaginal ultrasound endometrial thickness were recorded. Associations were tested with χ²; odds were estimated with multivariable logistic regression (adjusted ORs), with a modified Poisson sensitivity analysis for adjusted relative risk. Thickness differences were compared by one-way ANOVA, and severity correlations by Spearman's ρ. Internal validation used 1000-bootstrap resampling. Results: Hyperplasia without atypia comprised 74.6% of cases, AH/EIN 20.0%, and adenocarcinoma 5.4% (advanced pathology 25.4%). Diabetes was independently associated with advanced pathology (aOR 2.75; 95% CI 1.14-6.61; p = 0.0237), while a history of non-atypical hyperplasia was inversely associated (aOR 0.31; 95% CI 0.13-0.72; p = 0.0068). Obesity showed a borderline association (aOR 1.79; 95% CI 0.98-3.26; p = 0.058), and long-term oral contraceptive use also approached significance (aOR 0.42; 95% CI 0.18-1.00; p = 0.051). Endometrial thickness increased stepwise with histopathological severity (ANOVA p < 0.0001; η² = 0.44) and correlated with ordered severity (ρ = 0.634). The multivariable model showed moderate discrimination (AUC 0.68; optimism-corrected 0.66) with acceptable calibration (slope 0.92; Hosmer-Lemeshow p = 0.052) and overall accuracy (Brier 0.18). Conclusions: In perimenopausal abnormal bleeding, metabolic comorbidities-especially diabetes-together with increased endometrial thickness identify women at higher risk of AH/EIN or carcinoma. Histopathology remains the diagnostic reference. The model can aid clinical prioritization but requires external validation and should not be used as the sole basis for decisions.

Background/Objectives: Gender (roles as household load and job strain, and identity) represent an effect modifier of the interference between pain experience and sex because it is different between men and women. This study validates a new scale developed to assess how life functioning is impacted by Chronic Non-Cancer Pain (CNCP) due to gender. Methods: A total of 193 Spanish ambulatory CNCP patients (60 [51-73] years old, 69.4% women, 31% retired) were interviewed. Exploratory Factor Analysis (EFA) yielded 3-factor structure: Gender Self-identity, Roles, and Chronic Pain Impact on Social, Familial, Work and Sexual Life. Results: The Gender-Pain Questionnaire, with the presented factor structure, is an evaluation instrument with enough reliability and internal validity for CNCP patients. Conclusions: This study presents the psychometric properties of a scale for assessing the interference of CNCP patients' experience on gender and how it affects their daily life activities, relationships and self-identity. It represents the first original questionnaire known in Spanish language to date. This measure could potentially help researchers and clinicians to obtain gender key information to design appropriate and equity healthcare interventions.

Background: Themanagement of occupational respiratory diseases (ORDs) requires a multidisciplinary approach, yet collaboration between pulmonologists and occupational physicians is often fragmented, potentially compromising patient outcomes. This study aimed to systematically compare the management strategies for ORDs between these two specialties in Italy to identify gaps and opportunities for integration. Methods: A cross-sectional survey was conducted using a structured 12-item questionnaire distributed to board-certified pulmonologists and occupational physicians across Italy. The questionnaire assessed diagnostic pathways, therapeutic strategies, preventive measures, and patterns of interdisciplinary collaboration. A total of 102 specialists (51 pulmonologists and 51 occupational physicians) completed the survey. Comparative analyses were performed using Pearson's χ2 tests. Results: Significant divergences in practice were identified. Pulmonologists primarily focused on clinical diagnosis, utilizing pulmonary function tests (34.3%) and imaging (11.8%), and favored pharmacotherapy (27.5%) as the first-line treatment, in alignment with clinical guidelines. Conversely, occupational physicians prioritized detailed occupational and exposure histories (15.7%) and preventive interventions aimed at exposure reduction (15.7%). While both groups acknowledged the importance of collaboration, a substantial number reported that it occurred only occasionally (17.6% of pulmonologists and 12.7% of occupational physicians), indicating a significant gap in integrated care. Shared barriers included poor patient adherence and limited access to advanced diagnostic tools. Conclusions: While sharing a common foundation in diagnostic and preventive principles, pulmonologists and occupational physicians in Italy operate with distinct, complementary approaches that remain insufficiently integrated. The observed fragmentation in diagnostic and therapeutic pathways underscores an urgent need for shared national guidelines, structured interdisciplinary training, and formalized communication protocols. Bridging this disciplinary divide is essential to delivering holistic care, optimizing worker health, and preserving work ability.

Background/Objectives: Heart failure with reduced ejection fraction (HFrEF) remains a major global health burden. Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), improves outcomes in HFrEF but may cause hyperkalemia. Methods: A single-center retrospective cohort study was conducted at King Abdulaziz Cardiac Center, Riyadh, including 238 HFrEF patients initiated on sacubitril/valsartan (2016-2021). Potassium levels were assessed pre-initiation and at 0-3, 3-6, and 6-12 months post-initiation. Hyperkalemia was analyzed at thresholds >5.0, >5.5, and >6.0 mmol/L. Results: Median age was 58 years (IQR 48-69); 75.2% were male. Hyperkalemia >5.0 mmol/L occurred in 44.4% (95% CI: 38.1-51.0) within three months post-initiation versus 8.2% (95% CI: 5.3-12.4) pre-initiation. Only 17.3% exceeded 5.5 mmol/L. Treatment discontinuation occurred in 7.1% of patients, with 1.3% stopping due to clinically significant hyperkalemia. McNemar's test confirmed a significant increase in prevalence across time points (p < 0.0001). Conclusions: Despite increased hyperkalemia incidence, discontinuation rates were low, consistent with prior trials (PARADIGM-HF, PARAGON-HF). Sacubitril/valsartan remains an effective and generally safe therapy for HFrEF, with hyperkalemia manageable through monitoring. Limitations include missing potassium data, potential confounding factors, and the lack of a control group; future prospective studies with regular electrolyte monitoring are recommended.

Cancer pain remains a significant challenge in oncology, profoundly affecting patients' quality of life, function, and prognosis. Historically under-recognized and managed with a uniform, opioid-centric approach, cancer pain was often inadequately treated. Advances in pain assessment, multimodal analgesia, and supportive care have improved outcomes, yet traditional algorithms frequently fail to address the complex, heterogeneous nature of cancer pain. Contemporary management is shifting toward precision and personalized medicine, integrating genetic, molecular, and biomarker data with individual patient characteristics to inform treatment decisions. To address this complexity, we propose a five-domain framework encompassing biological, pharmacologic, psychological, sociocultural, and functional domains. This multidimensional approach enables clinicians to tailor pain management strategies to each patient's unique profile, aiming for equitable and individualized care. However, challenges remain, including tumor and patient heterogeneity, limited biomarker validation, data integration, disparities in access, and the need for multidisciplinary coordination. This review traces the evolution of cancer pain management, highlights the promise of precision and personalized strategies, and presents a comprehensive framework for optimizing pain control in oncology.

Introduction: TPE (therapeutic plasma exchange) has proven to be an extremely effective treatment for a range of conditions, especially over the past 20 years. Anticoagulation with heparin is currently the accepted recommendation for therapeutic plasma exchange sessions. However, the hypercoagulable state and hyperviscosity in some patients requiring TPE present a challenge, particularly during the first session, due to an increased risk of circuit clotting. Citrate anticoagulation has been proposed for extracorporeal therapies such as hemodiafiltration where heparin is contraindicated. Nevertheless, citrate anticoagulation is still generally avoided in patients undergoing TPE. Materials and Methods: A total of 26 patients underwent 52 TPE sessions using citrate. Fifteen patients received citrate from the beginning of therapy, accounting for 29 sessions, and eleven patients were switched to citrate after initially starting with heparin, when an imminent risk of circuit clotting quickly became evident-23 sessions in total. The imminent risk of circuit clotting was assessed by a continuous and accelerated increase in transmembrane pressure despite heparin anticoagulation. The effectiveness of citrate anticoagulation and its safety for patients were evaluated. Results: Of the 23 sessions where there was a risk of circuit clotting, citrate was added on top of heparin in those sessions; 21 sessions were successfully completed. It can be said that the kits were saved in these cases. Among the 29 TPE sessions that used citrate from the start, 27 were completed successfully, even though the patients were considered to have a hypercoagulable status. No cases of citrate toxicity were identified. Conclusions: TPE with citrate is a safe option for patients. It can preserve TPE kits from the beginning or during treatment in patients with hypercoagulability. Citrate can be also be used when heparin is contraindicated or ineffective.

Background: Tongue piercing has gained popularity among teenagers and young adults as a form of self-expression, cultural identity, and fashion. However, patients are often unaware of the harmful effects tongue piercings can have on their oral health. Despite its popularity, this form of body modification carries considerable risk, particularly when performed or maintained without proper care. This review summarizes findings from clinical case reports, observational studies, and previous literature reviews, with a focus on the clinical outcomes of tongue piercings and their appropriate management.

Methods: An internet-based literature review was conducted to evaluate the short- and long-term oral health implications of tongue piercings. Only articles published between January 1990 and April 2025 were included. The databases searched were PubMed, Google Scholar, Scopus, and Web of Science, using keywords such as "tongue piercing," "oral piercing," "oral complications," and "dental trauma."

Results: The literature revealed that tongue piercings can lead to numerous adverse effects on oral health, including dental fractures, gingival recession, enamel wear, and localized tissue overgrowth, in addition to localized and systemic infections. The presence of foreign objects in the oral cavity, combined with poor oral hygiene, habitual trauma, and long-term contact with oral tissues, often worsens these complications.

Conclusions: The results of this literature review suggest that tongue piercings pose significant and often underestimated risks to oral health. Clinicians should remain vigilant, educate patients on potential complications, and be well-equipped to prevent, monitor, and manage associated dental problems effectively in clinical practice.

Background: This prospective pilot study included four participants with chronic visual impairment and assessed functional and electrophysiological recovery following visual evoked potential (VEP)-guided auditory biofeedback across diverse etiologies. Low vision affects more than two billion people worldwide and imposes a sustained personal and socioeconomic burden. Conventional rehabilitation emphasizes optical aids and environmental modification without directly stimulating the visual pathway. Emerging evidence indicates that auditory biofeedback based on real-time cortical activity can leverage adult neuroplasticity. Methods: Four men (mean age 58 ± 12 years) with chronic visual impairment attributable to occipital stroke, stage IV macular hole, end-stage open-angle glaucoma, or diabetic maculopathy completed ten 10-min monocular sessions with the Retimax Vision Trainer over three weeks (15 Hz pattern reversal, 90% contrast). Primary end points were best corrected visual acuity (BCVA, ETDRS letters) and P100 amplitude/latency. Fixation stability was recorded with MAIA microperimetry when feasible. A focused PubMed review (2010-2025) mapped current evidence and research gaps. Results: Median BCVA improved by seven letters (IQR 0-15); three of eight eyes gained ≥ 10 letters and none lost vision. Mean P100 amplitude increased from 1.0 ± 1.2 µV to 3.0 ± 1.1 µV, while latency shortened by 3.9 ms. Electrophysiological improvement paralleled behavioural gain irrespective of lesion site. No adverse events occurred. Conclusions: A concise course of VEP-guided auditory biofeedback produced concordant functional and neurophysiological gains across retinal, optic nerve, and cortical pathologies. These pilot data support integration of closed-loop biofeedback into routine low vision care and justify larger sham-controlled trials.