European Journal of Internal Medicine最新文献

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High-flow nasal oxygen therapy in patients with hypercapnic respiratory failure: A systematic review and meta-analysis.

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-08 DOI: 10.1016/j.ejim.2025.02.015

Lili Guan, Jianyi Niu, Qiaoyun Huang, Shanshan Zha, Zhenfeng He, Jieying Hu, Shengchuan Feng, Luqian Zhou, Rongchang Chen

Background: Noninvasive ventilation (NIV) is recommended as the first-line respiratory support method for patients with hypercapnic respiratory failure (HRF). However, the need for well-trained operators and the occurrence of treatment discomfort may limit its efficacy. High-flow nasal oxygen therapy (HFNO) is a convenient respiratory support with user-friendly operation, high comfort, and good compliance. This systematic review and meta-analysis was performed to compare the therapeutic effects of HFNO and other noninvasive respiratory support methods [NIV or conventional oxygen therapy (COT)] in patients with acute HRF (AHRF) or chronic HRF (CHRF).

Methods: We searched the PubMed, Web of Science, Embase, and Cochrane Library databases from inception to May 2024 to identify randomized clinical trials comparing the impact of HFNO and NIV/COT in adults with HRF.

Results: Sixteen studies (1630 patients) were included. Compared with NIV, HFNO did not improve the primary outcome of PaCO₂ in patients with AHRF or CHRF [AHRF: MD = -0.81, 95 % CI = -3.40 to 1.77; CHRF: MD = 1.82, 95 % CI = 0.44 to 3.20]. However, HFNO showed advantages over COT (AHRF: MD = -2.03, 95 % CI = -3.48 to -0.59; CHRF: MD = -2.64, 95 % CI = -4.24 to -1.03).

Conclusions: The evidence of its clinical efficacy in hypercapnic patients remains inconclusive. Further studies are needed to generate more evidence for the application of HFNO in patients with HRF and to determine the subset of patients for whom may be preferable.

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引用次数: 0

Rising ischemic stroke-related mortality among young adults in the United States: Insights from CDC WONDER.

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-08 DOI: 10.1016/j.ejim.2025.02.008

Usama Qamar, Farhan Naeem, Maaz Asif, Waleed Qamar, Eisha Mazhar

引用次数: 0

Reevaluating hypoxia and cancer as determinants of prognosis in COPD and Takotsubo syndrome. Author's reply.

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-08 DOI: 10.1016/j.ejim.2025.02.012

Luca Arcari, Giacomo Tini, Beatrice Musumeci, Emanuele Barbato, Luca Cacciotti

引用次数: 0

Bedside CEUS: A feasible option to consider.

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-06 DOI: 10.1016/j.ejim.2025.02.001

Andrea Boccatonda, Alice Brighenti, Valeria Tiraferri, Rossella Loiacono, Carla Serra

引用次数: 0

Refining risk assessment for intra-abdominal infections in immunocompromised intensive care unit patients. Author's reply.

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-06 DOI: 10.1016/j.ejim.2025.02.005

Stijn Blot, Mieke Deschepper, José Artur Paiva

引用次数: 0

Bridging the gap: Time to integrate sex and gender differences into research and clinical practice for improved health outcomes.

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-05 DOI: 10.1016/j.ejim.2025.01.030

Roberta Gualtierotti

The integration of sex and gender in medical research and clinical practice is increasingly recognized as a cornerstone for achieving equitable health outcomes. Biological sex and gender influence the manifestation, progression, and treatment response in numerous diseases. Biological sex influences health and disease outcomes through genetic, hormonal, and physiological factors, while gender impacts them via identity, societal roles and behaviors. Historically, medical research has focused predominantly on the male body, leading to diagnostic and therapeutic gaps for women and gender-diverse populations. In particular, women remain underrepresented in clinical trials, leading to suboptimal treatment strategies and outcomes. In addition, in many conditions, such as cardiovascular, metabolic and neurological diseases, sex-specific variations in risk factors and disease presentation are prominent. The present review discusses the critical importance of distinguishing between sex and gender in preclinical and clinical research, and the necessity of incorporating these variables across all stages of research, from study design to analysis and reporting of preclinical studies and clinical trials. By incorporating sex and gender as distinct but interacting variables, we propose a framework to advance health equity and foster personalized, inclusive healthcare. This approach will promote the development of gender-sensitive clinical guidelines, enhance the accuracy of diagnostic tools, and ultimately contribute to improved health outcomes for all individuals, regardless of their sex or gender identity.

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引用次数: 0

Disability and caregivers in Italy: Results from an online survey. 意大利的残疾与护理人员：在线调查结果。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-03 DOI: 10.1016/j.ejim.2025.01.029

Sergio Harari, Antonella Caminati, Luigi Ripamonti, Paolo Marveggio, Pier Mannuccio Mannucci

引用次数: 0

Tecovirimat and mpox: A regulatory balancing act between hope, hurdles, and high-risk populations.

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-03 DOI: 10.1016/j.ejim.2025.01.031

John G Rizk, Giuseppe Lippi, Brandon M Henry, Kin Israel Notarte, Youssef Rizk

引用次数: 0

Linear lesions on the chest.

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-03 DOI: 10.1016/j.ejim.2025.01.023

Pei-Chun Weng, Pei-Rong Gao

引用次数: 0

External validation of a prognostic score to identify low-risk outpatients with acute deep venous thrombosis in the lower limbs 外部验证用于识别急性下肢深静脉血栓低风险门诊患者的预后评分。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.ejim.2024.10.007

Francisco Galeano-Valle , Rubén Alonso-Beato , Sergio Moragón-Ledesma , Tatiana Pire-García , Olaya Huergo-Fernández , Lucía Ordieres-Ortega , Crhistian-Mario Oblitas , Luis Antonio Alvarez-Sala Walther , Pablo Demelo-Rodríguez

Background

Current clinical guidelines suggest home treatment for patients diagnosed with acute deep venous thrombosis (DVT). A prognostic score has been proposed to identify low-risk patients; however, its validation remains limited.

Method

This prospective observational study aimed to externally validate the prognostic score in selecting low-risk outpatients with acute DVT in the lower limbs. Consecutive outpatients diagnosed with acute DVT in a tertiary hospital were included. The score included 6 variables: heart failure, kidney failure, recent major bleeding, altered platelet count, immobilization, and cancer. The primary outcome was the incidence of a composite outcome, including confirmed diagnosis of PE, major bleeding, or all-cause death at 7 days. Patients meeting zero criteria were considered low risk.

Results

Among the 1035 patients included, 485 (46.9 %) met zero criteria. Of these, 0.2 % (95 % CI 0.0–1.1 %) and 0.4 % (95 % CI, 0.0–1.5 %) patients experienced the composite outcome at 7 and 30 days, respectively. Among patients who met 1 or more criteria for admission, 344 patients (62.5 %) were discharged. Among these, the composite outcome at 7 and 30 days occurred in 2 (0.6 %) and 5 (1.4 %) patients, respectively. The C-statistics of the score were 0.68 (95 % CI, 0.57–0.79) and 0.69 (95 % CI, 0.64–0.76) at 7 and 30 days, respectively.

Conclusion

This study demonstrates the efficacy of the prognostic score in identifying low-risk outpatients with acute DVT. It also suggests that a considerable proportion of patients with acute DVT may benefit from outpatient treatment despite having some risk criteria, highlighting the potential for optimizing ambulatory care pathways.

背景：目前的临床指南建议对确诊为急性深静脉血栓（DVT）的患者进行居家治疗。有人提出了一个预后评分来识别低风险患者，但其验证仍然有限：这项前瞻性观察研究旨在从外部验证预后评分在选择下肢急性深静脉血栓形成低风险门诊患者方面的有效性。研究纳入了在一家三甲医院确诊为急性深静脉血栓的连续门诊患者。该评分包括 6 个变量：心力衰竭、肾衰竭、近期大出血、血小板计数改变、固定和癌症。主要结果是综合结果的发生率，包括确诊为 PE、大出血或 7 天后全因死亡。符合零标准的患者被视为低风险患者：在纳入的 1035 名患者中，有 485 人（46.9%）符合零标准。其中，分别有 0.2 %（95 % CI，0.0-1.1 %）和 0.4 %（95 % CI，0.0-1.5 %）的患者在 7 天和 30 天后出现综合结果。在符合一项或多项入院标准的患者中，有 344 名患者（62.5%）已经出院。其中，分别有 2 名（0.6%）和 5 名（1.4%）患者在 7 天和 30 天后出现综合结果。在 7 天和 30 天时，该评分的 C 统计量分别为 0.68（95 % CI，0.57-0.79）和 0.69（95 % CI，0.64-0.76）：这项研究证明了预后评分在识别低风险急性深静脉血栓门诊患者方面的有效性。研究还表明，相当一部分急性深静脉血栓患者尽管有一定的风险标准，但仍可从门诊治疗中获益，这凸显了优化非住院治疗路径的潜力。

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