International Journal of Clinical Practice最新文献

{"title":"Quantitative Anatomical Study of the Supratentorial and Infratentorial “Endoscopic Keyhole” Approach to the Peripineal Region","authors":"Hao Wu,&nbsp;Aierpati Maimaiti,&nbsp;Qiang Xie,&nbsp;Yirizhati Aili,&nbsp;Mamutijiang Muertizha,&nbsp;Guohua Zhu,&nbsp;Maimaitili Mijiti,&nbsp;Yandong Li,&nbsp;Yongxin Wang","doi":"10.1155/2024/6851468","DOIUrl":"https://doi.org/10.1155/2024/6851468","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. The pineal region represents significant challenges in terms of neurosurgery. Currently, anatomical research that simulates surgery for the endoscopic keyhole approach to the pineal region is lacking. This study aims to summarize the exposure range and operational characteristics of total endoscopic surgery under the four supratentorial and infratentorial keyhole approaches, through rigorous quantitative anatomical research. We also aim to understand the surgical exposure characteristics and surgical feasibility under each approach. <i>Method</i>. Six wet cadaveric head specimens (a total of 12 sides) were subjected to simulated surgery with a keyhole bone window size of approximately 3 × 4 cm. The median endoscopic supracerebellar infratentorial approach (M-ESCITA), the paramedian endoscopic supracerebellar infratentorial approach (PM-ESCITA), the endoscopic occipital transtentorial approach (EOTA), and the endoscopic interhemispheric high occipital transtentorial approach (EHOTA) were used to measure the surgical path depth, maximum distance between the tentorial margins, maximum operable area, operable angle, and relative degree of freedom of each approach. <i>Results</i>. There was no difference in the exposure range of the surgical area. The surgical path of PM-ESCITA was the longest (<i>p</i> &lt; 0.001), and its horizontal operating angle was the largest (<i>p</i> &lt; 0.001), whereas the anteroposterior operating angle of EHOTA was the largest (<i>p</i> &lt; 0.001). The maximum operational area of M-ESCITA was the largest in the pineal region (<i>p</i> &lt; 0.01), whereas that of EHOTA was the largest in the tetrapod region (<i>p</i> &lt; 0.001). M-ESCITA had the highest relative degree of freedom during surgery at the pineal gland level (<i>p</i> &lt; 0.001), PM-ESCITA at the splenium of the corpus callosum (<i>p</i> &lt; 0.01), and EHOTA at the corpora quadrigemina (<i>p</i> &lt; 0.001). <i>Conclusions</i>. Each of the four endoscopic keyhole approaches has its own advantages. Through anatomical research, doctors can train themselves and master the differences in surgical procedures through different approaches. The choice of approach and surgical challenge are dependent on the microsurgical techniques employed by the surgeon. A balance between minimally invasive and safe endoscopic surgery should be pursued.</p>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2024 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/6851468","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141968423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbidity Profiles in Inflammatory Rheumatic Diseases: An Analytical Perspective","authors":"Rezan Koçak Ulucaköy,&nbsp;Hakan Babaoğlu,&nbsp;Esra Kayacan Erdoğan,&nbsp;Kevser Orhan,&nbsp;Ebru Atalar,&nbsp;Serdar Can Güven,&nbsp;Hatice Ecem Konak,&nbsp;Bahar Özdemir Ulusoy,&nbsp;Pınar Akyüz Dağlı,&nbsp;Özlem Karakaş,&nbsp;Hakan Apaydın,&nbsp;Mehmet Akif Eksin,&nbsp;Bünyamin Polat,&nbsp;Serdar Esmer,&nbsp;İsmail Dogan,&nbsp;Yüksel Maraş,&nbsp;Ahmet Omma,&nbsp;Orhan Küçükşahin,&nbsp;Şükran Erten,&nbsp;Berkan Armağan","doi":"10.1155/2024/3244597","DOIUrl":"https://doi.org/10.1155/2024/3244597","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Inflammatory rheumatic diseases (IRDs) are often associated with multiple comorbidities. Managing comorbidities now seen as important as management of primary IRDs. The aim of this study was to analyse the profiles and prevalence of comorbidities in patients with IRDs and also to highlight the critical need for comprehensive and routine screening for comorbidities. <i>Methods</i>. This study was a retrospective single-center study conducted between 2019 and 2023. IRDs were classified according to the following categories: rheumatoid arthritis, spondyloarthritis, connective tissue diseases, autoinflammatory diseases, Behçet’s disease, large vessel vasculitis (LVV), small vessel vasculitis (SVV), and crystal deposition diseases (CDD). The demographic characteristics and comorbidities (including hypertension, diabetes mellitus, hyperlipidemia, obesity, coronary artery disease, arrhythmia, heart failure, chronic kidney disease, asthma, osteoporosis, thyroid diseases, demyelinating diseases, depression, and malignancies) were obtained from the electronic patient files. <i>Results</i>. The study included 10 417 patients with IRDs (mean age 50.9 ± 14.5 years; 66.8% female). The five most prevalent comorbidities were hypertension (34.8%), obesity (29.1%), diabetes mellitus (14.1%), hyperlipidemia (12.1%), and osteoporosis (9.2%). The Poisson regression analysis demonstrated a significant association between the total number of comorbidities and CDD, LVV, and SVV. The most prevalent comorbidities were cardiovascular risk factors. Furthermore, the prevalence of osteoporosis was high in LVV, and the prevalence of chronic kidney disease and asthma was high in SVV. <i>Conclusion</i>. Our study not only presents observational data but also highlights the critical need for comprehensive and routine screening for comorbidities in patients with rheumatic diseases. We found that CDD followed by LVV and SVV were identified as the rheumatic conditions most associated with comorbidities, and these diseases are most commonly accompanied by cardiovascular risk factors. Additionally, our findings suggest that patients with rheumatological conditions may be underscreened, leading to potential underdiagnosis of comorbidities such as hyperlipidemia, osteoporosis, and possibly malignancies.</p>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2024 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/3244597","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141968199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary Networks Identified by Gaussian Graphical Model and Odds of Major Depressive Disorder: A Case-Control Study","authors":"Hossein Shahinfar,&nbsp;Sakineh Shab-Bidar,&nbsp;Mohammad Effatpanah,&nbsp;Reza Askari,&nbsp;Shima Jazayeri","doi":"10.1155/2024/8749041","DOIUrl":"https://doi.org/10.1155/2024/8749041","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. The Gaussian graphical model (GGM) is a new approach that has recently gained attention for identifying dietary patterns. It examines the connections between different food groups and how they are consumed together. The aim of our study was to investigate the link between dietary networks derived from GGM and the odds of major depressive disorder (MDD). <i>Methods</i>. Two hundred drug-free patients with MDD and 200 healthy individuals were enrolled in this age- and sex-matched case-control study. The mean age of the participants was 45.4 years and 67.5% were female. The Beck Depression Inventory-II questionnaire was used for screening depression in the control group. Dietary intake was assessed using a 168-item food frequency questionnaire A GGM was applied to identify dietary networks. The GGM-derived networks were scored, categorized into tertiles, and their association with MDD was determined using a multivariable logistic regression model controlling for energy intake, marital status, job status, income, living status, education, drug use, smoking status, physical activity level, family history of major depressive disorders, comorbidities, and BMI. <i>Results</i>. GGM identified four dietary networks: healthy, prudent, western, and mixed. Nonleafy vegetables in healthy, grains in prudent, and red meat in western dietary networks were identified as hubs, indicating their important position in the identified network. High adherence to a healthy dietary network was associated with decreased odds of MDD (OR: 0.54, 95% CI: 0.31, 0.92; <i>p</i> value = 0.02), whereas, participants at the highest tertile of the western dietary network had greater odds of MDD (OR: 1.80, 95% CI: 1.05, 3.08; <i>p</i> value = 0.03). Neither prudent nor mixed networks were associated with MDD. <i>Conclusions</i>. Healthy and western dietary networks were associated with lower and higher odds of MDD, respectively. Recommendations for reducing the odds of MDD can be focused on increasing nonleafy vegetables and decreasing red meat consumption.</p>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2024 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/8749041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141967615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of the Impact and Burden of Urinary Urgency on Adults with Overactive Bladder","authors":"Adrian Wagg,&nbsp;A. Lenore Ackerman,&nbsp;H. Henry Lai,&nbsp;Diane K. Newman","doi":"10.1155/2024/5112405","DOIUrl":"https://doi.org/10.1155/2024/5112405","url":null,"abstract":"<div>\u0000 <p>Overactive bladder (OAB) is a prevalent condition that impairs the quality of life in both men and women, and for many, urgency is the most bothersome symptom. Urgency is thought to drive the presentation of the other symptoms (frequency, nocturia, urgency urinary incontinence [UUI]). However, urgency has been understudied in clinical trials, potentially owing to inherent difficulties in its assessment. The definition of urgency related to OAB has been refined over the years, but it may not be easily understood by patients and clinicians, affecting its use in practice. Variability among the tools to measure urgency further complicates the matter. For example, some measure the frequency of urgency episodes and consider reduction of episode frequency as improvement in urgency severity. Others rate the severity of each episode of urgency along a scale, with some including an accompanying incontinence episode as the most severe form. Reduction in UUI episodes is often a primary endpoint in clinical studies, with many studies requiring UUI—sometimes called OAB-wet—as an inclusion criterion, yet approximately two-thirds of those with OAB do not experience UUI. If patients with OAB without UUI (i.e., OAB-dry) are included, they are often not analyzed separately. Thus, it remains unknown if there are differences in treatment outcomes between patients with and without UUI and whether these differences are driven by pathophysiological processes. This narrative review highlights what is known about the pathophysiology of urgency, how urgency affects individuals with OAB, urgency measurement and associated challenges, and assessment of urgency in clinical trials.</p>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2024 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/5112405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141968147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Educational Interventions on Nurses’ Perceptions of Parental Support and Attitudes toward Parental Involvement in Neonatal Intensive Care Units","authors":"Sawsan Abuhammad,&nbsp;Haneen Barakat,&nbsp;Amat-Alkhaleq Mehrass","doi":"10.1155/2024/4816161","DOIUrl":"https://doi.org/10.1155/2024/4816161","url":null,"abstract":"<div>\u0000 <p><i>Aim</i>. To determine the efficacy of interventional programs on nurses’ perceptions of parents’ support and attitudes toward parents’ participation in neonatal care in the neonatal intensive care unit (NICU). <i>Methods</i>. An experimental design was used to determine the efficacy of the interventional program on NICU nurses’ perceptions of parents’ support and attitudes toward parents’ participation in their neonatal care in three hospitals. Nearly 160 nurses from hospitals in North and Middle Jordan participated in the study and were divided into 80 intervention and 80 control groups. <i>Results</i>. The study displayed that nurses had a lower score in the perception of parents’ support and attitude towards their participation in neonatal care in pretest scores than in posttest scores. The mean perception score of parents supported in the control group was 59.17 (SD = 10.1) and in the intervention group was 64.16 (SD = 7.47) (<i>P</i> ≤ 0.01). The mean attitude score of parents’ participation in neonatal care in the control group was 37.08 (SD = 5.76) and that in the intervention group was 38.93 (SD = 5.92) (<i>P</i> = 0.04). <i>Conclusion</i>. The results of the study showed a positive impact of the intervention on nurses’ perceptions of parental support and attitudes toward their participation in neonatal care. Moreover, the study found that the only predictor of NPST and PPAS enhancement among nurses was the implementation of an education program.</p>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2024 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/4816161","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141967260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Pelvic Floor Muscle Damage Postpartum: Vaginal Delivery vs. Cesarean Section","authors":"Shaohui Chen,&nbsp;Ling Wang,&nbsp;Huitao Guo,&nbsp;Min Jiang,&nbsp;Xiaojun Wang","doi":"10.1155/2024/1169924","DOIUrl":"https://doi.org/10.1155/2024/1169924","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Evaluation of pelvic floor muscle (PFM) strength damage across different delivery modes, providing insights into potential preventive measures for pelvic floor dysfunctions (PFDs) in the early postpartum period. <i>Aim</i>. Compare the differences in PFM strength and endurance between full-term cesarean section (CS) and vaginal delivery (VD) in the early postpartum period of primiparous women. <i>Methods</i>. The assessment included stress urinary incontinence (SUI), pelvic organ prolapse (POP), and pelvic floor electromyography (PFE). Muscle fiber strength was categorized into four modes at a threshold level of 3: I &lt; 3 II &lt; 3, I &lt; 3 II &gt; 3; I &gt; 3 II &lt; 3, I &gt; 3 II &gt; 3. Multinomial logistic regression was employed for CS and VD, and a sensitivity analysis was conducted using level 2 as the threshold. <i>Outcomes</i>. When muscle fiber strength was categorized into four modes at a threshold level of 3, Type I, and Type II fiber muscle endurance (FME) are differences between the CS and VD groups. <i>Results</i>. The CS and VD groups differed significantly in SUI and anterior and posterior vaginal wall conditions. MDVP was below the normal range in both groups, and MDVP, PFM strength, and PFM endurance did not differ significantly (<i>P</i> &gt; 0.05). Logistic regression results indicated that higher MDVP, Type I, and Type II FME were protective factors when I &lt; 3 in the VD group. However, I &lt; 3-II &gt; 3, higher MDVP, and Type I FME were protective factors (OR: 0.339, 95% CI: 0.223, 0.516) in the CS group. <i>Clinical Implications</i>. The study introduces a nuanced understanding of the impact of different delivery modes on PFM, contributing valuable insights for clinical prevention and treatment strategies in the early postpartum period. <i>Strengths and Limitations</i>. Muscle fiber strength was categorized into four modes and further sensitivity analysis was conducted. This study only conducted a correlation analysis of outcome variables without considering intervenable variables. <i>Conclusions</i>. The VD group had a higher incidence of pelvic floor dysfunction in the early postpartum period than the CS group. Both groups experienced a decline in PFM function without significant differences. CS was primarily associated with Type I muscle fiber damage, while VD was related to both Type I and II muscle fiber damage. Improving PFM endurance is beneficial for muscle strength recovery.</p>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2024 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/1169924","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141967212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Experimental Propolis-Based Toothpastes on Dentin Hypersensitivity: A Randomized Clinical Trial","authors":"Elma Vieira Takeuchi,&nbsp;Alexandra Melo Pingarilho Carneiro,&nbsp;Brennda Lucy Freitas de Paula,&nbsp;Roberta Pimentel de Oliveira,&nbsp;Antônia Patricia Oliveira Barros,&nbsp;Cecy Martins Silva","doi":"10.1155/2024/8563084","DOIUrl":"https://doi.org/10.1155/2024/8563084","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Propolis is a natural bee product that has garnered attention due to its harmlessness and numerous beneficial biological properties. This randomized, double-blinded, placebo-controlled clinical trial aimed to assess the effect of toothpastes containing different concentrations of propolis (10% and 15%) on the control of dentin hypersensitivity (DH). <i>Methods</i>. From adults aged 18–40 years with DH, 66 teeth were randomly divided into 3 treatment groups as follows (<i>n</i> = 22): control (toothpaste without active ingredient), 10% propolis toothpaste, and 15% propolis toothpaste. DH was assessed thrice (baseline and 15 and 30 days after treatment) by tactile and evaporative stimuli using the visual analog scale. Data were analyzed using Friedman and Kruskal–Wallis tests. A significance level of 5% was used in all analyses. <i>Results</i>. All the groups showed a reduction in DH during the study (<i>p</i> &lt; 0.05). The experimental groups (10% and 15% propolis) showed significantly greater reduction in DH than the control group (<i>p</i> &lt; 0.05) after 30 days of treatment; however, the experimental groups displayed similar results (<i>p</i> &gt; 0.05). <i>Conclusion</i>. Toothpastes containing propolis at concentrations of 10% and 15% were equally effective in controlling DH, regardless of their concentration. <i>Trial Registration</i>. This trial is registered with NCT05083052. Date of registration: 19/10/2021.</p>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2024 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/8563084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Polytrauma at a Teaching Hospital in Northern Ghana: A Cross-Sectional Study","authors":"Anwar Sadat Seidu,&nbsp;Abdul Rauf Alhassan,&nbsp;Alexis Dun Bo-ib Buunaaim","doi":"10.1155/2024/4131822","DOIUrl":"https://doi.org/10.1155/2024/4131822","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Polytrauma refers to multiple life-threatening injuries to more than 2 bodily regions with some significant physiologic derangement. It is a major cause of morbidity and mortality globally. This study aimed to evaluate the epidemiological profile of polytrauma and outline the distribution of extremity fractures among cases in Northern Ghana. <i>Methods</i>. A retrospective cross-sectional study was conducted at the Accident and Emergency Department of Tamale Teaching Hospital. Data were extracted using a data collection tool onto MS Excel, cleaned, and exported onto SPSS version 26 for analysis. Descriptive statistics was used to present data in tables and charts. Analysis of variance (ANOVA) was used to assess whether there was a significant difference in the mean ISS and mean length of stay of the direct causes of death. <i>Results</i>. About 186 out of 5413 attendants to the emergency department were polytrauma, period prevalence of 3.4%. The male-to-female ratio was 1.9 : 1. Young adults (21–40 years) contributed 64% of the participants. The mean age of participants was 32.9 ± 15.4 years, and the mean ISS was 40.6 ± 13.1. Road traffic accidents (68.8%) were the most common cause of polytrauma. The mortality was 33.0%. Traumatic brain injury (TBI) was the most common direct cause of mortality (54.1%). There was a significant mean difference (MD) in the length of stay between multiple organ failure (MOF) and TBI (MD = 3.169, 95% C.I. = 0.48–5.86) and between MOF and hemorrhage (MD = 6.212, 95% C.I. = 2.62–9.80). Most fractures were closed (75.3%) and affected the lower limbs (61.5%). Open reduction and internal fixation were the most common surgery for extremity fractures. <i>Conclusion</i>. We recommend a concerted multidisciplinary policy framework geared towards promoting road safety and reducing accidents in Ghana. We also recommend a tailored robust treatment algorithm for managing traumatic brain injury in our settings to reduce mortality thereof.</p>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2024 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/4131822","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcomes in Patients with ST-Elevation Myocardial Infarction: A Comparative Study of Direct Admissions versus Interhospital Transfers—Insights from a Single-Center Experience in the United Kingdom","authors":"Tarek Abdeldayem,&nbsp;Ashan Gunarathne","doi":"10.1155/2024/7112494","DOIUrl":"https://doi.org/10.1155/2024/7112494","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Primary percutaneous coronary intervention (PPCI) is the treatment of choice for patients with ST-elevation myocardial infarction (STEMI). Delayed reperfusion leads to increased morbidity and mortality. Secular trends in the impact of interhospital transfers (IT) on long-term mortality in the United Kingdom (UK) have not been previously investigated. We analyzed the impact of IT on 5-year mortality in STEMI patients admitted to a tertiary care center in the UK (East Midlands North). <i>Methods</i>. Data of STEMI patients admitted to Nottingham University Hospitals NHS Trust from 2011 to 2016 were acquired from the National Institute for Cardiovascular Outcomes Research dataset (NICOR) and then combined with local patient-level data and mortality data from National Statistics. The baseline characteristics and mortality data of the interhospital transfer (IT) group were compared to those of a gender and age-matched direct admission (DA) group. <i>Results</i>. Of the total cohort (<i>N</i> = 2386), 29.9% of patients were admitted to the PPCI center via the interhospital transfer (IT) route. Cardiovascular risk profiles in both DA and IT groups were comparable. Five-year Kaplan–Meier (KM) survival analysis revealed better survival in the direct admission group (83% vs. 77.3%; <i>p</i> ≤ 0.001). In multivariate analysis, increased mortality was associated with severe left ventricular impairment (HR 4.7, 95% CI 2.9–7.6), the presence of cardiogenic shock (HR 3.6 (2.7–4.8)), chronic kidney disease (HR 2.56 (1.4–4.5)), smoking (HR 1.45 (1.1–1.8)), male gender (HR 1.7 (1.4–2.01)), and diabetes (HR 1.4 (1.07–1.8)). The radial access and call-to-balloon time less than 120 minutes were also associated with lower mortality (HR 0.52 (0.43–0.63): HR 0.75 (0.61–0.92)). <i>Conclusion</i>. Despite advancements in communication, technology, patient education, transportation systems, and guidelines within the UK’s NHS over the last decade, the delays incurred by IT for STEMI patients remain substantial and are associated with a poor prognosis.</p>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2024 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/7112494","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141624434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Diabetes Mellitus on Atrial Fibrillation Recurrence and Major Adverse Cardiac and Cerebrovascular Events following Catheter Ablation","authors":"Mingjie Lin,&nbsp;Juntao Wang,&nbsp;Bing Rong,&nbsp;Kai Zhang,&nbsp;Tongshuai Chen,&nbsp;Wenqiang Han,&nbsp;Tong Hu,&nbsp;Tianyu Wang,&nbsp;Haonan Deng,&nbsp;Jingquan Zhong,&nbsp;Lin Wu","doi":"10.1155/2024/1087623","DOIUrl":"https://doi.org/10.1155/2024/1087623","url":null,"abstract":"<div>\u0000 <p><i>Introduction</i>. Further evidence is required to understand the impact of preexisting and newly diagnosed diabetes mellitus (DM) on atrial fibrillation (AF) recurrence and major adverse cardiac and cerebrovascular events (MACCEs) following catheter ablation. <i>Materials and Methods</i>. Data from 1,685 patients (1,406 without DM vs. 279 with DM) who underwent AF catheter ablation between 2015 and 2019 were analyzed. These participants were prospectively monitored for incidents of AF recurrence and MACCE over an average period of 58.1 months. <i>Results</i>. A higher incidence of AF recurrence (24.6% vs. 34.4%) and a greater frequency of MACCE (6.5% vs. 9.3%) were observed among DM patients. Kaplan–Meier curves indicated that DM significantly increased the rates of AF recurrence, with a hazard ratio (HR) of 1.506 and a 95% confidence interval (CI) of 1.165–1.948 (<i>p</i> = 0.0003). This association persisted in the propensity-matched cohort. DM was independently predictive of AF recurrence after adjusting for potential risks using Cox regression analysis. Notably, new-onset DM was also found to be an independent predictor of AF recurrence. Similarly, DM was an independent risk of MACCE (HR [95% CI], 2.273 [1.120–4.615], <i>p</i> = 0.023). <i>Conclusions</i>. Both existing DM and newly diagnosed DM were identified as independent risk factors for AF recurrence following ablation; they also significantly impacted MACCE outcomes. This study underscores the urgent need for careful management of DM among individuals undergoing AF ablation in order to reduce the likelihood of arrhythmic relapse. This analysis utilized data from a prospective observational study registered in the Chinese Clinical Trial Registry on July 20, 2014 (ChiCTR-OCH-14004674).</p>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2024 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/1087623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141596942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}