Therapeutics and Clinical Risk Management最新文献

{"title":"Analysis of Influencing Factors and Construction of Predictive Model for Persistent Cough After Lung Cancer Resection Under Thoracoscopy.","authors":"Jingling Lan, Xia Lin, Li Liu","doi":"10.2147/TCRM.S464307","DOIUrl":"10.2147/TCRM.S464307","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to explore the influencing factors of cough after pulmonary resection (CAP) after thoracoscopic lung resection in lung cancer patients and to develop a predictive model.</p><p><strong>Methods: </strong>A total of 374 lung cancer patients who underwent lung resection in our hospital from March 2020 to October 2023 were randomly divided into a modeling group (n=262) and a validation group (n=112). Based on the occurrence of CAP in the modeling group, the patients were divided into a CAP group (n=85) and a non-CAP group (n=177). Multivariate Logistic regression analysis was used to identify the influencing factors of CAP in lung cancer patients. A nomogram model for predicting the risk of CAP was constructed using R4.3.1. The consistency of the model's predictions was evaluated, and a clinical decision curve (DCA) was drawn to assess the clinical utility of the nomogram. The predictive performance of the model was evaluated using ROC curves and the Hosmer-Lemeshow test.</p><p><strong>Results: </strong>Multivariate Logistic regression analysis showed that smoking history (OR=6.285, 95% CI: 3.031-13.036), preoperative respiratory function training (OR=20.293, 95% CI: 7.518-54.779), surgical scope (OR=20.667, 95% CI: 7.734-55.228), and peribronchial lymph node dissection (OR=5.883, 95% CI: 2.829-12.235) were significant influencing factors of CAP in lung cancer patients (P<0.05). ROC curves indicated good discriminatory power of the model, and the Hosmer-Lemeshow test showed a high degree of agreement between predicted and actual probabilities. The DCA curve revealed that the nomogram model had high clinical value when the high-risk threshold was between 0.08 and 0.98.</p><p><strong>Conclusion: </strong>The nomogram model based on smoking history, preoperative respiratory function training, surgical scope, and peribronchial lymph node dissection has high predictive performance for CAP in lung cancer patients. It is useful for clinical prediction, guiding preoperative preparation, and postoperative care.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"701-709"},"PeriodicalIF":2.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11453154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381594","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":"Impact of Dexmedetomidine on Hemodynamics, Plasma Catecholamine Levels, and Delirium Incidence Among Intubated Patients in the ICU--A Randomized Controlled Trial.","authors":"Li Qiao, Zheng Wang, Jian Shen, Xiaohui Xing, Hongxun Yuan","doi":"10.2147/TCRM.S471229","DOIUrl":"10.2147/TCRM.S471229","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the impact of various sedative medications on hemodynamics and plasma levels of epinephrine (E) and norepinephrine (NE) in mechanically ventilated patients postoperatively in the intensive care unit (ICU).</p><p><strong>Methods: </strong>Ninety-seven patients admitted to the ICU undergoing postoperative mechanical ventilation with tracheal intubation and continuous analgesic sedation following general anesthesia were randomly assigned to either the observation group (dexmedetomidine) (n = 49) or the control group (propofol) (n = 48) in this randomized controlled trial. Upon transfer to the ICU, vital signs (heart rate [HR], respiratory rate [RR], mean arterial pressure [MAP]) were recorded prior to the initiation of the sedation treatment (T0), at one-hour post sedation (T1) and two hours following tracheal extubation (T2), plasma levels of epinephrine (E) and norepinephrine (NE) were measured at these time points. The incidence of delirium was recorded in both groups.</p><p><strong>Results: </strong>MAP between the two groups at both T0 and T1 At T2 plasma NE and HR were found to be lower in the observation group compared to the control group (<i>P</i> < 0.001). Among the patients receiving antihypertensive medication in the ICU, NE levels were significantly lower in the observation group compared to the control group (<i>P = 0.019</i>) Among the patients not receiving antihypertensive medication, both NE (P < <i>0.001</i>) and MAP (P = <i>0.001</i>) levels were lower in the observation group compared to the control group. The incidence of delirium in the observation group (dexmedetomidine) was not significantly different from that in the control group (propofol).</p><p><strong>Conclusion: </strong>With dexmedetomidine sedation, blood pressure fluctuated less, plasma catecholamine levels were lower, and sympathetic inhibition was stronger in patients before and after extubation. However, it did not significantly reduce the incidence of postoperative delirium.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"689-700"},"PeriodicalIF":2.8,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381595","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 Impact of Bispectral Index Monitoring on Outcomes in Spinal Cord Stimulation for Chronic Disorders of Consciousness.","authors":"Xuanling Chen, Xuewei Qin, Yutong Zhuang, Zhengqian Li, Zhenhu Liang, Hua Zhang, Lan Yao, Xiaoli Li, Jianghong He, Xiangyang Guo","doi":"10.2147/TCRM.S478489","DOIUrl":"10.2147/TCRM.S478489","url":null,"abstract":"<p><strong>Objective: </strong>To observe whether maintaining the appropriate depth of anesthesia with Bispectral Index (BIS) can improve the prognosis of Spinal Cord stimulation (SCS) implantation in patients with chronic Disorders of consciousness (DoC).</p><p><strong>Methods: </strong>103 patients with DoC undergoing SCS implantation were reviewed, and 83 patients with DoC were included according to the standard of inclusion and exclusion Criteria. Patients were divided into a BIS group (n =45) and a non-BIS group (n =38) according to whether BIS monitoring was used during the operation. The depth of anesthesia in the BIS group was maintained between 40-60. The anesthesiologist adjusted the depth of anesthesia in the non-BIS group according to clinical experience. Relevant information such as disease course, cause, anesthesia time, and operation time were collected. Preoperative CRS-R_{(preoperative)} score, postoperative CRS-R_(24h), and postoperative CRS-R_(3m) changes were collected.</p><p><strong>Results: </strong>The CRS-R(3m) score in the BIS group was higher than that in the non-BIS group _{(preoperative)}, and the difference was statistically significant (P < 0.05). In CRS-R _(24h), the BIS group was higher than the non-BIS group, and the difference was statistically significant (X²=8.787, P =0.004). The improvement of consciousness was included in the multivariate Logistic regression analysis model, and it was found that the thalamus was an independent factor affecting the improvement of consciousness (P < 0.05). During follow-up, 1 patient in the BIS group had a decrease in consciousness from MCS^- to VS/ UWS and 2 patients in the non-BIS group died during follow-up.</p><p><strong>Conclusion: </strong>Patients can be benefit in hearing in CRS-R _(24h). We recommend the use of BIS to monitor the depth of anesthesia in patients with DoC to improve patient outcomes.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"677-687"},"PeriodicalIF":2.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362124","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":"Frailty Predicts in-Hospital Death in Traumatic Brain Injury Patients: A Retrospective Cohort Study.","authors":"Hua Liu, Wenxi Wu, Min Xu, Xiaoyang Ling, Wei Lu, Feng Cheng, Jian Wang","doi":"10.2147/TCRM.S475412","DOIUrl":"https://doi.org/10.2147/TCRM.S475412","url":null,"abstract":"<p><strong>Background and aim: </strong>Traumatic brain injury (TBI) is a severe public health problem in elderly patients, and frailty is associated with higher mortality rates in older patients. This study aims to assess the prognostic value of frailty in patients with TBI.</p><p><strong>Methods: </strong>Clinical data from 348 TBI patients treated at Affiliated Kunshan Hospital of Jiangsu University and Kunshan Hospital of Traditional Chinese Medicine between December 2018 and December 2020 were retrospectively collected. Univariate and multivariate logistic regression analyses were used to determine risk factors affecting in-hospital mortality, and receiver operating characteristic (ROC) curves were plotted to assess the discriminatory power of the frailty index. Frailty was assessed using the FRAIL scale, where FRAIL stands for Fatigue, Resistance, Ambulation, Illness, and Loss of weight, with each item scored as 0 or 1.</p><p><strong>Results: </strong>Using the FRIAL questionnaire, 122 patients had low frailty and 226 had high frailty. Multivariate logistic regression analysis showed that high frailty was a risk factor for in-hospital mortality in TBI patients (P<0.001, OR=2.012 [1.788-2.412]). The proportion of infections occurring in the two groups was statistically different (P=0.015), with severely infected TBI patients being more likely to develop complications. The ROC curve showed an area under the curve for the FRAIL score of 0.845 [0.752-0.938].</p><p><strong>Conclusion: </strong>Frailty is an important risk factor for in-hospital mortality in elderly TBI patients, and more attention should be paid to patients with high levels of frailty. Clinicians should consider the degree of frailty when assessing TBI and making treatment decisions.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"665-675"},"PeriodicalIF":2.8,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11430268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354289","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":"Performance of Machine Learning Algorithms in Predicting Prolonged Mechanical Ventilation in Patients with Blunt Chest Trauma.","authors":"Yifei Chen, Xiaoning Lu, Yuefei Zhang, Yang Bao, Yong Li, Bing Zhang","doi":"10.2147/TCRM.S482662","DOIUrl":"https://doi.org/10.2147/TCRM.S482662","url":null,"abstract":"<p><strong>Purpose: </strong>Mechanical ventilation (MV) is one of the most common treatments for patients with blunt chest trauma (BCT) admitted to the intensive care unit (ICU). Our study aimed to investigate the performance of machine learning algorithms in predicting the prolonged duration of mechanical ventilation (PDMV) in patients with BCT.</p><p><strong>Methods: </strong>In this single-center observational study, patients with BCT who were treated with MV through nasal or oral intubation were selected. PDMV was defined as the duration of mechanical ventilation ≥7 days after endotracheal intubation (normal vs prolonged MV; dichotomous outcomes). K-means was used to cluster data from the original cohort by an unsupervised learning method. Multiple machine learning algorithms were used to predict DMV categories. The most significant predictors were identified by feature importance analysis. Finally, a decision tree based on the chi-square automatic interaction detection (CHAID) algorithm was developed to study the cutoff points of predictors in clinical decision-making.</p><p><strong>Results: </strong>A total of 426 patients and 35 characteristics were included. K-means clustering divided the cohort into two clusters (high risk and low risk). The area under the curve (AUC) of the DMV classification algorithms ranged from 0.753 to 0.923. The importance analysis showed that the volume of pulmonary contusion (VPC) was the most important feature to predict DMV. The prediction accuracy of the decision tree based on CHAID reached 86.4%.</p><p><strong>Conclusion: </strong>Machine learning algorithms can predict PDMV in patients with BCT. Therefore, limited medical resources can be more appropriately allocated to BCT patients at risk for PDMV.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"653-664"},"PeriodicalIF":2.8,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354290","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":"Experts’ Opinion in Fabry Disease Management and the Unmet Medical Need: The Saudi Perspective","authors":"Majid Alfadhel, Nouriya Al Sannaa, Rawda Sunbul, Huda Al-Khawaja, Sumayah Askandarani, Talal Alanzi, Mamoun Elawad, Konstantinos Fourtounas","doi":"10.2147/tcrm.s475744","DOIUrl":"https://doi.org/10.2147/tcrm.s475744","url":null,"abstract":"<strong>Abstract:</strong> Fabry disease (FD) is an X-linked lysosomal storage disorder caused by α-galactosidase A gene mutations. Its global incidence ranges from 1:40,000 to 1:170,000. This expert review evaluates the available guidelines, the status of diagnosed but untreated patients with FD, and the challenges in diagnosing and managing FD in the Kingdom of Saudi Arabia (KSA). An advisory board meeting (ABM) was conducted in two phases, with a survey that aimed to receive insights on the current unmet needs in the management of patients with FD in November 2022, and a second, offline meeting in February 2023. The goal of this ABM was to discuss current unmet needs in the management of Fabry patients in the Kingdom of Saudi Arabia. In the first ABM, experts opined on the best practices in the diagnosis, screening, and management of FD for healthcare professionals. These opinions on the management of FD relied on data from research and expert clinical judgments. In the second ABM, the same panel discussed different aspects of FD diagnosis, treatment, and management in the member countries of the Gulf Cooperation Council. The experts discussed the stigma associated with FD, patient awareness and knowledge, genetic screening, biomarkers, and home infusion therapy. They reviewed international guidelines and clinical criteria for enzyme replacement therapy (ERT). Furthermore, they also discussed the diagnosis of FD in men and women, the current guidelines followed for monitoring patients with FD, monitoring untreated patients with FD, Fabry Stabilization IndeX (FASTEX) as an assessment tool for the diagnosis of FD, FD management in KSA, challenges encountered while prescribing ERT in patients with FD, and the clinical criteria for starting ERT. The discussions led to the conclusion that currently, ERT is the only available therapy to manage FD and research should be focused on the early diagnosis and management of FD.<br/><br/><strong>Keywords:</strong> classical, enzyme replacement therapy, Fabry disease, late-onset, monitoring, phenotype<br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"7 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142227078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thromboelastography in Long-Term Antiplatelet Therapy for Patients Diagnosed with Benign Prostate Hyperplasia Undergoing Holmium Laser Enucleation of the Prostate: A Retrospective Study","authors":"Zhi-Bo Gu, Lei Qiu, Hua Zhu, Ming Lu, Jian-Gang Chen","doi":"10.2147/tcrm.s472153","DOIUrl":"https://doi.org/10.2147/tcrm.s472153","url":null,"abstract":"<strong>Objective:</strong> To compare low- vs high-power HoLEP effects on coagulation in patients on antiplatelet (AP) therapy via thromboelastography (TEG).<br/><strong>Methods:</strong> 210 patients was retrospectively analyzed and stratificated into three discrete groups, specifically: Group A (AP therapy, high-power HoLEP, n = 72); Group B (AP therapy, low-power HoLEP, n=73); Group C (no AP therapy, low-power HoLEP, n = 65). Baseline characteristics and coagulation profiles via TEG were compared. Univariate and multivariate analyses were conducted to identify independent risk factors associated with hematuria. Furthermore, parameters such as IPSS, Qmax, post-void residual volume V₂ and PSA levels were recorded during 1year follow-up.<br/><strong>Results:</strong> No differences in terms of baseline characteristics across all groups. Significant differences were observed in the duration of enucleation, morcellation, bladder irrigation, post-operative catheterization, length of hospital stay and the extent of hemoglobin reduction (F = 54.06, 8.54, 6.68, 9.24, 17.06, 5.97, p &lt; 0.05). No differences were noted in postoperative hematuria, urine retention, transfusion rates, and SUI (x₁² = 1.082 ; x₂² = 0.197,; x₃²= 3.981;x₄² = 0.816, p &gt; 0.05). Univariate and multivariate analyses revealed that prostate volume emerged as an independent risk factor for hematuria (OR 1.080, 95% CI: 1.007– 1.158, p = 0.031). Clinical outcomes including Qmax, IPSS, V₂, and PSA demonstrated significant enhancement during 1 year follow-up.<br/><strong>Conclusion:</strong> Compared to HP-HoLEP, LP-HoLEP effectively reduces surgical and subsequent processing times, decreases hospital stay duration, and diminishes hemoglobin decline, offering a viable option without discontinuing AP therapy.<br/><br/><strong>Keywords:</strong> anti-platelet therapy, BPH, high power, HoLEP, low power<br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"1 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142227079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug Therapy Problems Identified by Clinical Pharmacists at a General Surgery Ward of an Academic Referral Hospital in Jordan","authors":"Hiba Al Fahmawi, Abla Albsoul-Younes, Mohammad Saleh, Mahmoud Abu-Abeeleh, Violet Kasabri","doi":"10.2147/tcrm.s465128","DOIUrl":"https://doi.org/10.2147/tcrm.s465128","url":null,"abstract":"<strong>Introduction:</strong> Drug therapy problems (DTPs) continuously occur in hospitalized patients. This study aims to emphasize the role of clinical pharmacists in evaluating the DTP’s frequencies, causes, severity ratings, and contributing factors at a general surgery ward in Jordan.<br/><strong>Methods:</strong> This prospective observational study was conducted at one of the major teaching and referral hospitals in Jordan. Data were collected through clinical pharmacist reviews of paper and electronic medical records as well as patient interviews. DTPs were identified using Cipolle’s classification system and rated for severity on a scale of 10. Multiple linear regression was performed to identify factors contributing to DTPs. Drug classes primarily associated with DTPs were specified.<br/><strong>Results:</strong> During enrollment, a total of 80 patients were recruited in this study. The mean age of the enrolled patients was 52.35 ± 14.82 years, and 49 (61.25%) of them were males. Within the study period, 192 DTPs were identified by clinical pharmacists in 87.5%of the total recruited patients. The mean number of DTPs per patient was 2.40 ± 1.83. The most common categories of DTPs were “needs additional therapy” 46 (23.96%), “unnecessary drug therapy” 45 (23.44%), and “dosage too low” 39 (20.31%). Of the total DTPs, 127 (66.15%) were rated as severe. Multiple linear regression revealed that patients’ length of hospital stay and the number of current medications had a statistically significant effect on the number of DTPs identified during hospitalization. Endocrine and metabolic drugs 51 (26.56%) and cardiovascular drugs 36 (18.75%) were the most frequent classes of drugs contributing to DTPs.<br/><strong>Conclusion:</strong> DTPs are common in the general surgery ward. Clinical pharmacists can provide medication reviews for surgical patients to identify DTPs and rate their severities. Detecting risk factors for DTPs and the most common drug classes associated with them can assist in decision-making relevant to reducing DTPs in the surgical ward.<br/><br/><strong>Keywords:</strong> drug therapy problems, clinical pharmacist, surgery ward, observational study<br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142227080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time in Therapeutic Range of Unfractionated Heparin-Based Therapy in Critically Ill Patients with COVID-19 Pneumonia","authors":"Tereza Romanová, Filip Burša, Peter Sklienka, Jiří Sagan, Michelle Vaňková, Denis Buršík, Markéta Bílená, Martin Pulcer, Michal Burda, Jan Máca","doi":"10.2147/tcrm.s476187","DOIUrl":"https://doi.org/10.2147/tcrm.s476187","url":null,"abstract":"<strong>Purpose:</strong> Anticoagulation therapy aims to improve the outcome of critically ill patients with severe COVID-19-associated pneumonia. Activated partial thromboplastin time (aPTT) is commonly used to maintain the target therapeutic range of continuous infusion of unfractionated heparin (UFH). The UFH infusion efficacy can be evaluated by determining the time in therapeutic range (TTR) using a modified Rosendaal method. The present study’s primary aim was to evaluate TTR based on the aPTT in critically ill patients with severe forms of COVID-19 pneumonia and its influence on survival. The secondary aim was to evaluate the time spent above (TATR) and below the therapeutic range (TBTR).<br/><strong>Patients and Methods:</strong> We performed a retrospective analysis of critically ill patients with COVID-19-associated pneumonia. All patients received a continuous infusion of UFH from the 2nd to 8th day since admission to the ICU. TTR, TATR, and TBTR were calculated using the modified Rosendaal method, and survival days were analyzed by regression (censored after 60 days).<br/><strong>Results:</strong> Of 103 patients, the median TTR was 49% (IQR 38– 63%), TATR 11% (IQR 5– 20%), and TBTR 33% (IQR 22– 51%). The regression analysis indicated a positive impact of higher TTR and TATR on the number of survival days [β=0.598 (p=0.0367) and β=1.032 (p=0.0208), respectively] and a negative impact of higher TBTR [β=− 0.681 (p=0.0033)] on the number of survival days.<br/><strong>Conclusion:</strong> Higher TTR and TATR were associated with better survival of critically ill patients with a severe course of COVID-19-associated pneumonia. Higher TBTR was associated with worse survival in these patients.<br/><br/><strong>Keywords:</strong> unfractionated heparin, COVID-19, pneumonia, critical care<br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"89 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142227114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Umbilical Vascular Thromboembolism: High-Risk Factors, Diagnosis, Management, and Pregnancy Outcomes: A Scoping Review","authors":"Jun Zhan, Dingding Wang, Chuanxiang Luo, Haiyan Bi","doi":"10.2147/tcrm.s478593","DOIUrl":"https://doi.org/10.2147/tcrm.s478593","url":null,"abstract":"<strong>Abstract:</strong> Umbilical vascular thromboembolism is a rare condition that can lead to serious consequences such as fetal hypoxia, fetal growth restriction, and even stillbirth. However, there is currently a lack of research on the pathology, pathogenesis, clinical management, and prognosis of this condition. Therefore, the purpose of this article is to analyze this condition’s high-risk factors, clinical characteristics, pregnancy management, and discuss its corresponding pregnancy outcomes. Databases such as PubMed are searched using the relevant keywords of umbilical vascular thromboembolism in worldwide. And related information is analyzed such as maternal risk factors, fetal risk factors, umbilical cord and placental risk factors, and pregnancy outcomes. The literature search yields 113 articles, 64 of which meet the inclusion criteria for umbilical vascular thromboembolism. There are 4 retrospective cohort studies and 8 case series, the rest are all case reports. A total of 262 cases of umbilical vascular thromboembolism are found. The most common maternal complications and fetal related risk factors are diabetes (25 cases, 9.5%) and stillbirths (106 cases, 40.5%), respectively. Among these 262 cases, 98 (37.4%) cases are found by prenatal ultrasound to have umbilical vascular thromboembolism and the fetus is in a viable state with complete clinical information. In addition, considering the effectiveness and safety of low molecular weight heparin in thromboembolic conditions, twenty-four patients of umbilical artery thromboembolism attempted to use low molecular weight heparin during observation. Maternal diabetes was the highest risk factor for this condition. When umbilical artery thromboembolism occurs, the incidence of stillbirth increases. Premature patients with this condition can continue their pregnancy under close external monitoring. However, due to the small sample size, further research is needed.<br/><br/><strong>Keywords:</strong> umbilical vascular thromboembolism, umbilical vein thromboembolism, umbilical artery thromboembolism, fetal growth restriction, umbilical vein varix, low molecular weight heparin<br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"319 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142227115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}