Therapeutics and Clinical Risk Management最新文献

{"title":"Improving Patient Outcomes in mTBI: The Role of Integrated Nursing Interventions in the Emergency Department.","authors":"Ting Feng, Peng Zhao, Jiao Wang, Xiaoye Du, Meimei Ai, Jing Yang, Junjie Li","doi":"10.2147/TCRM.S500328","DOIUrl":"10.2147/TCRM.S500328","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is a major cause of morbidity and mortality, often requiring emergency department (ED) management. Integrated Nursing Interventions play a critical role in the care of TBI patients, but limited research has evaluated their efficacy in this setting. This study aims to assess the impact of Integrated Nursing Interventions on patient outcomes and complications in the ED.</p><p><strong>Methods: </strong>This retrospective study included 246 patients with mild traumatic brain injury (mTBI) treated in the emergency department from January 2022 to December 2022. Of these, 138 patients received Integrated Nursing Interventions, while 108 did not. Baseline characteristics, clinical outcomes, and complications were compared between the two groups. Descriptive statistics, logistic regression, and receiver operating characteristic (ROC) curve analysis were used to evaluate the effect of nursing interventions on outcomes such as mortality, complications, and hospital stay.</p><p><strong>Results: </strong>Among the 246 mTBI patients, those receiving Integrated Nursing Interventions (n=138, 56.1%) experienced significantly lower rates of adverse events, including perioperative intracranial hemorrhage (4.3% vs 12.0%, P=0.025) and shorter hospital stays (6±2 days vs 11±3 days, P<0.001). The study sample included 56.5% female, with 80.1% age ≤ 80. Integrated Nursing Interventions refer to coordinated care strategies that combine multiple nursing approaches tailored to address both physical and psychological needs of patients. For instance, the use of patient education combined with individualized pain management strategies. Logistic regression analysis revealed that Integrated Nursing Interventions were associated with a significant reduction in in-hospital mortality (OR=1.828, 95% CI: 1.619-2.318, P<0.001). ROC curve analysis demonstrated strong predictive accuracy for outcomes such as readmission rate (AUC=0.757), 30-day mortality (AUC=0.836), and 90-day mortality (AUC=0.760).</p><p><strong>Conclusion: </strong>Integrated Nursing Interventions in the emergency department significantly improve patient outcomes for mTBI patients, reducing mortality, complications, and length of hospital stay. These interventions, which include early assessment, timely intervention, patient education, and collaborative care, are essential for optimizing TBI management. The high predictive value of these interventions further underscores their importance in emergency care. Future research should focus on the long-term effects of Integrated Nursing Interventions on patient outcomes across different age groups, particularly in chronic disease management. Further studies could explore the role of digital health tools in enhancing integrated care.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"69-80"},"PeriodicalIF":2.8,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11766206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Delivery of Pain Management in Schwannomatosis: A Literature Review.","authors":"Utaro Hino, Ryota Tamura, Masahiro Toda","doi":"10.2147/TCRM.S362794","DOIUrl":"10.2147/TCRM.S362794","url":null,"abstract":"<p><p>Non-NF2 schwannomatosis is a rare syndrome characterized by multiple benign schwannomas that primarily affect nerve sheaths, with chronic, treatment-resistant pain as the most common symptom. No protocol has been established for pain management, and pharmacotherapies, including molecular target therapies, are being evaluated. Neuromodulation therapies such as scrambler therapy and surgical options are also employed; however, surgery may lead to persistent or recurrent pain caused by nerve damage or tumor recurrence. The lack of accurate animal models hampers understanding of pain mechanisms and tumor development, necessitating further basic research and clinical trials to improve treatment strategies.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"61-68"},"PeriodicalIF":2.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Intravenous Selexipag in Managing PAH and Bridging Gaps in Oral Treatment: A Narrative Review.","authors":"Sienna Goren, Nermeen Kidwai, Wilbert S Aronow, Gregg M Lanier","doi":"10.2147/TCRM.S332358","DOIUrl":"10.2147/TCRM.S332358","url":null,"abstract":"<p><p>Pulmonary arterial hypertension (PAH) is a rare and potentially fatal condition characterized by progressive increases in blood pressure in the arteries of the lungs. Oral selexipag, approved by the Food and Drug Administration (FDA) in 2015 for the treatment of PAH, targets prostacyclin receptors on pulmonary arterial vascular smooth muscle and endothelial cells to improve blood flow through the lungs and reduce pulmonary vascular resistance. Oral selexipag is effective, but may be discontinued due to factors like side effects, emergency conditions, or inability to take oral medication, potentially leading to severe adverse events, such as rebound pulmonary hypertension and right heart failure. To address treatment interruptions, intravenous (IV) selexipag was introduced as an alternative for patients who are temporarily unable to take oral medications. IV selexipag bypasses hepatic metabolism, requiring a 12.5% higher dose compared to the oral form to achieve similar therapeutic effects. It is administered via IV infusion twice daily over 80 minutes, typically for short-term use. However, caution is needed when prescribing selexipag to patients with hepatic or renal issues, and it is contraindicated with strong CYP2C8 inhibitors. A Phase III clinical trial confirmed that switching between oral and IV selexipag was safe, with comparable efficacy and tolerability, though it was limited by small sample size and short duration. Given the risks of treatment interruption and the complexity of managing PAH, this review provides essential insights into the practical use of IV selexipag as a bridging therapy. Furthermore, it calls for larger clinical trials to refine dosing strategies, explore long-term outcomes, and identify patient populations most likely to benefit from IV selexipag.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"55-60"},"PeriodicalIF":2.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Rhinosinusitis with Nasal Polyps and Biologics: A Call for Better Data Standardisation and Presentation in Clinical Studies.","authors":"Harsha Hemantha Kariyawasam, Dean Langan, Joanne Rimmer","doi":"10.2147/TCRM.S467250","DOIUrl":"10.2147/TCRM.S467250","url":null,"abstract":"<p><p>Chronic rhinosinusitis with nasal polyps (CRSwNP) is often severe, debilitating and difficult to treat. Recent randomised control trials (RCTs) of biologics that target key inflammatory pathways have demonstrated clinical efficacy in treating CRSwNP. Such RCTs must facilitate meta-analysis. Here we report the need for urgent improvement in double-blind randomised controlled trials of biologics in CRSwNP, having previously undertaken a systematic review and meta-analysis of such studies. The RCTs included in that systematic review did not conform to a standard study design. Patient selection criteria was not consistent in studies with several heterogeneous disease subgroups of CRSwNP patients present in each study. Different durations of treatment and variable outcome measures also made the comparative assessment of efficacy between different biologics difficult. Data presentation to allow extraction for meta-analysis was not always clear, such that on occasion selected data sets or even an entire RCT had to be excluded from further evaluation. As such, the high heterogeneity between studies made the overall interpretation of the findings difficult. We make an urgent call to design and conduct future RCTS of biologics in CRSwNP in a more standardised manner, and to present data in a clear way that is easily extractable. This will facilitate more inclusive and thus robust evaluation and interpretation via meta-analysis, which will in turn enable clearer insight into which CRSwNP patient subgroups might benefit from specific biologics and thus achieve better clinical outcomes.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"27-34"},"PeriodicalIF":2.8,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid Dysfunction After Intensity-Modulated Radiotherapy and PD⁃1 Inhibitor Treatment for Locally Advanced Nasopharyngeal Carcinoma.","authors":"Kai Shang, Qianyong He, Xinyu Xu, Xunyan Luo, Chaofen Zhao, Lina Liu, Zhuoling Li, Yuanyuan Li, Feng Jin","doi":"10.2147/TCRM.S489899","DOIUrl":"10.2147/TCRM.S489899","url":null,"abstract":"<p><strong>Purpose: </strong>Analyze the incidence and risk factors of thyroid dysfunction in patients with advanced nasopharyngeal carcinoma (LA-NPC) after intensity-modulated radiotherapy (IMRT) and PD⁃1 inhibitor treatment and their relationship with treatment efficacy and prognosis.</p><p><strong>Methods: </strong>Eighty-five LA-NPC patients treated with IMRT and PD-1 inhibitors were retrospectively collected from March 1, 2019, to May 30, 2022. The incidence of thyroid dysfunction after combination therapy was analyzed. The Kaplan-Meier method was used to analyze the relationship between thyroid dysfunction and patient prognosis. Logistic regression analysis was used to screen independent risk factors for thyroid dysfunction.</p><p><strong>Results: </strong>As of data cutoff (May 31, 2024), the median follow-up time was 27.8 months (range: 25.6 to 32.0 months). The median time of onset of thyroid dysfunction was 8.26 months. The incidence of thyroid dysfunction is 47.06% (40/85), with clinical hypothyroidism being the main cause at an incidence rate of 28.24% (24/85) and clinical hyperthyroidism at an incidence rate of 3.53% (3/85). The incidence of grade 1 thyroid immune-related adverse events (irAEs) was 29.41% (25/85), and the incidence of grade 2 thyroid irAEs was 17.65% (15/85). Patients with thyroid dysfunction had longer overall survival, progression-free survival, and distant metastasis-free survival at both one and two years compared to patients with normal thyroid function, but the difference was not statistically significant (p > 0.05). Multivariate logistic regression analysis showed that pretreatment lactate dehydrogenase (LDH) (p = 0.079) is an independent predictor of thyroid dysfunction after radiotherapy in combination with immunotherapy for LA-NPC.</p><p><strong>Conclusion: </strong>The study found that the addition of immunotherapy increases the risk and shortens the onset time of thyroid dysfunction in LA-NPC patients treated with chemoradiotherapy. Pretreatment LDH may serve as an independent risk factor for thyroid dysfunction for LA-NPC patients.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"15-25"},"PeriodicalIF":2.8,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Prognostic Molecular Phenotype and Clinical Characterization in Grade III Diffuse Gliomas Treatment with Radio-Chemotherapy.","authors":"Weiguo Gu, Jiaming Tang, Penghui Liu, Jinyu Gan, Jianfei Lai, Jinbiao Xu, Jianxiong Deng, Chaoxing Liu, Yuhua Wang, Guohua Zhang, Feng Yu, Chao Shi, Ke Fang, Feng Qiu","doi":"10.2147/TCRM.S478905","DOIUrl":"10.2147/TCRM.S478905","url":null,"abstract":"<p><strong>Background: </strong>The relationship between molecular phenotype and prognosis in high-grade gliomas (WHO III and IV, HGG) treated with radiotherapy and chemotherapy is not fully understood and needs further exploration.</p><p><strong>Methods: </strong>The HGG patients following surgery and treatment with radiotherapy and chemotherapy. Univariate and multivariate Cox analyses were used to assess the independent prognostic factors. The nomogram model was established, and its accuracy was determined via the calibration plots.</p><p><strong>Results: </strong>A total of 215 and 88 patients had grade III glioma and grade IV glioma, respectively. Grade III oligodendroglioma (OG-G3) patients had the longest mPFS and mOS than other grade III pathology, while grade III astrocytoma (AA-G3) patients were close to IDH-1 wildtype glioblastoma (GBM) and had a poor prognosis. The IDH-1 mutant group had a better mPFS and mOS than the IDH-1 wildtype group in all grade III patients, OG-G3 and AA-G3 patients. Furthermore, 1p/19q co-deletion group had a longer mPFS and mOS than 1p/19q non-deletion group in all grade III patients. IDH-1 mutation and 1p/19q co-deletion patients had the best prognosis than other molecular types. Also, the MGMT methylation and IDH-1 mutation or 1p/19q co-deletion group had a longer mPFS and mOS than the MGMT unmethylation and IDH-1 wildtype or 1p/19q non-codeletion of grade III patients. In addition, the low Ki-67 expression group had a better prognosis than high Ki-67 expression group in grade III patients. Univariate and multivariate COX showed that 1p/19q co-deletion and MGMT methylation were the independent prognostic factors for mPFS and mOS. The calibration curve showed that the established nomogram could well predict the survival based on these covariates.</p><p><strong>Conclusion: </strong>The AA-G3 with IDH-1 wildtype, MGMT unmethylation or 1p/19q non-codeletion patients was resistant to radiotherapy and chemotherapy, has a poor prognosis and needs a more active treatment.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"35-53"},"PeriodicalIF":2.8,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental PM_2.5 Exposure: An Ignored Factor Associated with Blood Cadmium Level in Hemodialysis Patients.","authors":"Ching-Wei Hsu, Ming-Jen Chan, Cheng-Hao Weng, Tsung-Yu Tsai, Tzung-Hai Yen, Wen-Hung Huang","doi":"10.2147/TCRM.S496491","DOIUrl":"https://doi.org/10.2147/TCRM.S496491","url":null,"abstract":"<p><strong>Background: </strong>The negative impacts of particulate matter with an aerodynamic diameter of 2.5 μm or less (PM_2.5) are well known. Patients undergoing maintenance hemodialysis (HD) have significantly higher blood cadmium levels (BCLs) than healthy individuals. As elemental cadmium can be found in the PM_2.5 particle fraction, we conducted this study to assess the effect of environmental PM_2.5 exposure and other clinical variables on BCLs in maintenance HD patients.</p><p><strong>Patient and methods: </strong> This cross-sectional study included 754 hD patients who had previously participated in a BCL study. Demographic, hematological, biochemical and dialysis-related data were collected for analysis. For each patient, the mean PM_2.5 concentrations in the living environment during the previous 12 and 24 months were recorded and analyzed.</p><p><strong>Results: </strong>Of all patients, the median BCL of was 0.36 µg/L (range: 0.21, 0.79 µg/L). The mean PM_2.5 concentration was 28.45 ± 3.57 μg/m³ during the 12 months and 29.81 ± 3.47 μg/m³ during the 24 months, respectively. From a multivariate linear regression analysis, log BCL was positively associated with the mean PM_2.5 concentration during the previous 12 and 24 months. In addition, log BCL was positively associated with the number of days with PM_2.5 concentrations above the standard level during the previous 12 and 24 months. Moreover, according to the tertiles of days with a daily mean PM_2.5 concentration above the normal limit in the previous 24 months, patients with the highest exposure days exhibited a significantly higher BCL than those in the other two patient groups.</p><p><strong>Conclusion: </strong>Chronic environmental exposure to PM_2.5 is significantly associated with BCLs in maintenance HD patients, and exposure to PM_2.5-bound cadmium may contribute to the harmful effects on health in this population. Further studies are needed to confirm these observations and to explore the underlying mechanisms.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"1-13"},"PeriodicalIF":2.8,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with Recurrent Emergency Department Visits for Epistaxis in Adults, Cross Sectional Study in Two Tertiary Care Hospitals in Riyadh, Saudi Arabia.","authors":"Mohammed Alghofili, Bader Alwhaibi, Abdullah Mohammed Alassaf, Omar Wahaf Aldhasee, Nawfal Aljerian, Nawaf Alsubaie, Ahmed Alhussien, Saad Alsaleh","doi":"10.2147/TCRM.S480084","DOIUrl":"10.2147/TCRM.S480084","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>This study aimed to investigate the prevalence of recurrent and active epistaxis in adult patients presenting to the Emergency Department (ED) and explored the association of recurrent epistaxis with demographic characteristics, comorbidities and medications, and types of emergency interventions in adult epistaxis patients.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted with data from Eds of two tertiary hospitals over three years, from January 2019 to January 2022. All adult patients aged ≥18 years with active epistaxis not resolved by pressure on the nose or head positioning were included. Demographic data, details of clinical presentation and clinical management were collected from the patient's electronic medical records.</p><p><strong>Results: </strong>Of 404 patients, 73 (18.1%) revisited the ED with recurrence of epistaxis within 28 days. There was a male predilection in the study, with an average age of 55.4 ± 18.03. Most patients had unilateral (n = 328, 81.2%) and anterior (n = 376, 93.1%) nasal bleeding. Heart failure as a comorbidity was associated with a significantly increased risk of recurrent epistaxis (p = 0.001). The most common treatments included expandable polyvinyl acetate packs (EPAP) (n = 198, 49%); topical xylometazoline (n = 108, 26.7%); and chemical cautery (n = 57, 14.1%). EPAP for controlling initial bleeding was significantly associated with ED revisits due to epistaxis (p = 0.033).</p><p><strong>Conclusion: </strong>The prevalence of recurrent epistaxis mostly occurs in older-aged males. Congestive heart failure may be an under-recognised risk factor for recurrent epistaxis. In patients with a high risk of epistaxis recurrence, other treatment modalities should be sought aside from expandable polyvinyl acetate packs as they can increase the risk of rebleeding.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"955-962"},"PeriodicalIF":2.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11694024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-Articular Platelet-Rich Plasma versus Hyaluronic Acid in the Treatment of Hip Osteoarthritis: A Cross-Sectional Analysis of the Overlapping Systematic Reviews.","authors":"Shi Yin, Xiyan Zhao, Tian Li, Xingxuan Li, Zongjun Xie, Hao Tang, Yi Wang, Zhiwei Jia, Tianlin Wen, Yaohong Wu","doi":"10.2147/TCRM.S487948","DOIUrl":"10.2147/TCRM.S487948","url":null,"abstract":"<p><strong>Purpose: </strong>The debate over the effectiveness of platelet-rich plasma (PRP) versus hyaluronic acid (HA) in treating hip osteoarthritis (HOA) continues. This cross-sectional analysis of overlapping systematic reviews aims to evaluate the efficacy of intra-articular PRP compared to HA for HOA treatment. The goal is to guide decision-makers in selecting the most reliable systematic reviews and to provide treatment recommendations based on the best available evidence.</p><p><strong>Methods: </strong>We conducted comprehensive searches of PubMed, EMBASE, and Cochrane Library databases to identify systematic reviews comparing intra-articular PRP and HA for HOA treatment. The methodological quality of these reviews was assessed, and relevant data were extracted. The Jadad algorithm was applied to determine which reviews provided the most robust evidence.</p><p><strong>Results: </strong>Five systematic reviews were included, all categorized as Level-II evidence. The Assessment of Multiple Systematic Reviews scores ranged from 4 to 9, with a median score of 8. A high-quality systematic review was chosen according to the Jadad algorithm. It is suggested that there were no significant differences observed in the improvement of any short-term outcome scores (mean follow-up of 12.2 months for PRP, 11.9 months for HA), including the Western Ontario and McMaster Universities Osteoarthritis Index, the Visual Analog Scale for pain, and the Harris Hip Score, from pre-injection to post-injection between the groups.</p><p><strong>Conclusion: </strong>There is inconsistency among the conclusions of the overlapping systematic reviews comparing intra-articular PRP and HA for HOA treatment. The best evidence indicates that PRP and HA injections yield similar short-term clinical benefits for patients with HOA. Further studies with larger sample sizes and longer follow-up periods are needed to provide more definitive conclusions.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"919-927"},"PeriodicalIF":2.8,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adoption of Digital Therapeutics in Europe.","authors":"Amelie Fassbender, Shaantanu Donde, Mitchell Silva, Adriano Friganovic, Alessandro Stievano, Elisio Costa, Tonya Winders, Joris van Vugt","doi":"10.2147/TCRM.S489873","DOIUrl":"10.2147/TCRM.S489873","url":null,"abstract":"<p><p>Digital therapeutics (DTx) are an emerging medical therapy comprising evidence-based interventions that are regulatory approved for patient use, or are under development, for a variety of medical conditions, including hypertension, cancer, substance use disorders and mental disorders. DTx have significant potential to reduce the overall burden on healthcare systems and offer potential economic benefits. There is currently no specific legal regulation on DTx in the EU. Although European countries have similar approaches to digital health solutions, the adoption of DTx varies across the continent. The aim of this narrative review is to discuss the levels of adoption of DTx in Europe, and to explore possible strategies to improve adoption, with the goal of higher rates of adoption, and more consistent use of DTx across the continent. The article discusses the regulatory and reimbursement landscape across Europe; validation requirements for DTx, and the importance of co-design and an ecosystem-centric approach in the development of DTx. Also considered are drivers of adoption and prescription practices for DTx, as well as patient perspectives on these therapeutics. The article explores potential factors that may contribute to low rates of DTx adoption in Europe, including lack of harmonisation in regulatory requirements and reimbursement; sociodemographic factors; health status; ethical concerns; challenges surrounding the use and validation of AI; knowledge and awareness among healthcare professionals (HCPs) and patients, and data standards and interoperability. Efforts to improve rates of access to DTx and adoption of these therapeutics across Europe are described. Finally, a framework for improved uptake of DTx in Europe is proposed.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"939-954"},"PeriodicalIF":2.8,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}