Therapeutics and Clinical Risk Management最新文献

{"title":"Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) as a Predictor of Mortality in Patients with Femoral Fracture: A Retrospective Cohort Analysis.","authors":"Pao-Jen Kuo, Shao-Chun Wu, Shiun-Yuan Hsu, Ching-Hua Hsieh","doi":"10.2147/TCRM.S553629","DOIUrl":"10.2147/TCRM.S553629","url":null,"abstract":"<p><strong>Background: </strong>Femoral fractures carry high mortality in elderly patients. The aspartate aminotransferase-to-platelet ratio index (APRI), a noninvasive liver function marker, may reflect physiological vulnerability. Its prognostic role in trauma remains unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed 4,310 adult patients (2009-2023) with femoral fractures undergoing surgery. APRI was calculated on admission. The primary outcome was in-hospital mortality. Multivariable logistic regression and ROC analysis identified independent predictors and optimal APRI cut-off.</p><p><strong>Results: </strong>Among 4,310 patients, 85 (2.0%) died in-hospital. Non-survivors had significantly higher APRI (1.4±1.5 vs 0.7±2.1, p = 0.008), higher AST levels, and greater injury severity. APRI independently predicted mortality (adjusted OR 1.57 per unit, 95% CI 1.41-1.98, p = 0.023). ROC analysis yielded an AUC of 0.670. An APRI ≥0.74 provided 55% sensitivity and 78% specificity. Patients with APRI ≥0.74 had higher mortality (4.9% vs 1.1%, adjusted OR 2.82, p < 0.001) and longer hospital stays.</p><p><strong>Conclusion: </strong>Given APRI's moderate predictive value for adverse outcomes, we cautiously recommend including APRI in preoperative risk assessment for hip fracture patients. This approach may help identify high-risk cases for targeted interventions.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"553629"},"PeriodicalIF":2.6,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13005145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499584","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":"Ten-Year Outcomes of Modular Reverse Shoulder Arthroplasty Assessed by 3D Motion Analysis.","authors":"Pit Hetto, Franz Liewald, Michael W Maier, Stefanos Tsitlakidis, David Spranz","doi":"10.2147/TCRM.S546875","DOIUrl":"10.2147/TCRM.S546875","url":null,"abstract":"<p><strong>Introduction: </strong>Modular reverse total shoulder arthroplasty (RSA) is a widely accepted treatment for cuff tear arthropathy (CTA), aimed at alleviating pain and improving range of motion (ROM). However, objective long-term data on RSA's impact on activities of daily living (ADL) are sparse. This study is the first to evaluate maximum ROM and ADL performance 10 years after RSA using a 3D motion analysis model.</p><p><strong>Materials and methods: </strong>A case control study with a total of 29 patients with RSA was divided into two groups: 14 patients with an average follow up of 10 years (long-term group) and 15 patients with a follow-up after 6 months (postoperative group). 3D motion analysis was conducted using a Vicon measurement system and HUX shoulder model. Maximum ROM and activity-related ROM (AROM) were assessed during predefined ADLs. Statistical analyses included independent <i>t</i>-tests, calculation of effect sizes (Cohen's d), and adjustment for age and sex using ANCOVA with Bonferroni correction for multiple comparisons.</p><p><strong>Results: </strong>At year follow-up, patients demonstrate only slightly lower maximum and activity-related ROM compared to patients 6 months after surgery. Significant differences between the two groups were noted for shoulder flexion during \"neck grip\" (postoperative 87.7 ± 14.3° vs long-term 70.1 ± 24.3°; Δ = 17.6°, p = 0.016, d = 0.86) and \"book\" (postoperative 76.5 ± 8.9° vs long-term 67.8 ± 10.7°; Δ = 8.7°, p = 0.017, d = 0.58) as well as internal/external rotation during \"armpit washing\" (postoperative 27.2 ± 13.0 vs long-term 15.9 ± 7.6°; Δ = 11.3°, p = 0.011, d = 0.64) (p < 0.05), while other movements showed no significant differences.</p><p><strong>Discussion: </strong>3D motion analysis revealed comparable maximum ROM and similar range used during ADL following RSA. Long-term deterioration in flexion aligns with previous studies but remains within an acceptable range. The reduced AROM over time may be influenced by natural aging or implant-related factors, though performing ADL was possible.</p><p><strong>Conclusion: </strong>Patients after RSA demonstrate good ROM while being able to perform ADL over the long term. With the exceptions of few outcomes, patients 10 years and 6 months after RSA show similar ROM, with good functionality, underscoring the durability and benefits of RSA in managing CTA. Further research with larger cohorts is recommended to confirm these findings.</p><p><strong>Level of evidence: </strong>Case control study, Level III.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"546875"},"PeriodicalIF":2.6,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499742","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":"Risk Factors for Ileus After Radical Gastrectomy for Gastric Cancer and Construction of a Nomogram Prediction Model.","authors":"Min Niu, Yun Qiao, Bo Wang, Jinjie Zhang","doi":"10.2147/TCRM.S553770","DOIUrl":"10.2147/TCRM.S553770","url":null,"abstract":"<p><strong>Objective: </strong>To construct a nomogram prediction model for ileus after radical gastrectomy for gastric cancer.</p><p><strong>Methods: </strong>The 424 gastric cancer patients were assigned into a modeling group of 297 cases and a validation group of 127 cases. The modeling group was assigned into the ileus group of 54 cases and the non ileus group of 243 cases based on the occurrence of postoperative ileus. LASSO regression analysis and multivariate logistic regression analysis were used to screen the influencing factors of ileus after radical gastrectomy for gastric cancer. The nomogram model was constructed for predicting ileus after radical gastrectomy for gastric cancer. The calibration curve was used to evaluate the calibration degree of the model. ROC curve was used to evaluate the model discrimination. The clinical decision curve was used to analyze the clinical applicability of the model.</p><p><strong>Results: </strong>LASSO regression analysis and multivariate logistic regression analysis showed that age (OR=4.999), previous abdominal surgery (OR=3.836), operative time (OR=3.541), IL-6 (OR=1.339), and TNF-α (OR=8.254) were all independent risk factors for ileus after radical gastrectomy for gastric cancer (P<0.05). The deviation correction curves of the modeling group and the validation group were both close to the ideal curve, with Hosmer-Lemeshow test showed x²=7.785, 6.145, P=0.236, 0.372; the AUC of the ROC curve was 0.940 (95% CI: 0.898~0.981) and 0.904 (95% CI: 0.855~0.954). Both the modeling group and the validation group had high net returns within the threshold probability ranges of 0.02~0.86 and 0.02~0.80.</p><p><strong>Conclusion: </strong>The nomogram prediction model constructed in this study can serve as an early warning indicator for ileus after radical gastrectomy for gastric cancer, guiding clinical decision-making.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"553770"},"PeriodicalIF":2.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499579","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":"Clinical Outcomes of Percutaneous Mitral Valve Repair with Mitraclip^®: A Longitudinal Observational Study (The Mitra-Angio-CDO Study).","authors":"Luis Álvaro Melo-Burbano, Diana Marcela Bonilla-Bonilla, Jorge Enrique Daza-Arana, Heiler Lozada-Ramos, Antonio Enrique Dager, Jaime Andrés Fonseca","doi":"10.2147/TCRM.S549225","DOIUrl":"10.2147/TCRM.S549225","url":null,"abstract":"<p><strong>Background: </strong>The MitraClip device is used as an endovascular therapy for mitral valve repair in patients with severe mitral insufficiency and high surgical risk. This therapy was used for the first time in Colombia in 2013, after its authorization by the National Institute of Drug and Food Surveillance.</p><p><strong>Materials and methods: </strong>A quantitative, observational, descriptive, longitudinal study was conducted, with an analytical component stratified by age, in adults who underwent mitral valve repair with MitraClip from March 2013 to June 2022 to determine the clinical outcomes associated with hospitalization, mortality, complications, and health-related quality of life.</p><p><strong>Results: </strong>A total of 94 patients with a mean age of 70.3±10.3 years were evaluated, most of whom were male (65%), hypertensive (80%), and had New York Heart Association class III-IV classification (90.4%) and functional mitral insufficiency (93.6%) classified as severe (74.5%). The recurrence of all-cause hospitalization was 39.4%, of which 88% corresponded to heart failure. The immediate success of the procedure, determined as mitral insufficiency classified as ≤moderate after implantation, was 93.6% (p < 0.001). In-hospital mortality was 2.1%, mortality at 6 months was 12.8% (≤70 years 11.6% vs >70 years 13.7%, p = 0.007), mortality at 1 year was 16%, and mortality at 2 years was 20.2%. The incidence of complications was low, the most frequent one being <i>de novo</i> atrial fibrillation (7.4%), followed by major bleeding requiring transfusion (4.3%). The Kansas City Cardiomyopathy Questionnaire scale was used, with a mean score of 69.9±19.3.</p><p><strong>Conclusion: </strong>Percutaneous mitral valve repair with MitraClip is a safe technique that directly affects survival and quality of life. There was a low incidence of complications related to the procedure and the patient's preoperative condition, with results comparable to those of studies carried out in Europe and the United States.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"549225"},"PeriodicalIF":2.6,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12794652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676618","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":"Prospective Evaluation of Postoperative SIRS and Serum Inflammatory Indices in Percutaneous Nephrolithotomy Patients.","authors":"Yusuf Bugra Arslantas, Gokhan Sonmez, Numan Baydilli, Unsal Bas, Halil Tosun, Deniz Demirci, Emre Can Akinsal","doi":"10.2147/TCRM.S568497","DOIUrl":"10.2147/TCRM.S568497","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate the relationship between postoperative systemic inflammatory response syndrome (SIRS) and a broad set of 30 commonly used clinical parameters, along with novel acute inflammation predictive indices such as the systemic immune-inflammation index (SII), the aggregate index of systemic inflammation (AISI), and the systemic inflammation response index (SIRI), in patients undergoing percutaneous nephrolithotomy (PCNL).</p><p><strong>Methods: </strong>A total of 233 patients aged 18-75 years who underwent PCNL were prospectively included. All clinical variables and serum-based inflammatory indices, including SII, SIRI, and AISI, were prospectively pre-defined in the study protocol prior to patient enrollment. All patients had sterile preoperative urine cultures and no known disease that could cause fever. Clinical characteristics, operative findings, laboratory parameters, and serum-based inflammatory indices (SII, SIRI, AISI) were recorded. The median preoperative stone size was 270.0 mm² (IQR: 180.0-447.0). Stone-free rates and postoperative SIRS development were assessed. Multivariate logistic regression analysis was used to determine independent predictors of SIRS. ROC analyses were conducted to evaluate the predictive performance of inflammatory indices.</p><p><strong>Results: </strong>The clinically significant stone-free rate was 89.3% (208/233), while the complete stone-free rate was 79.1% (182/233). Postoperative SIRS occurred in 75 patients (32.1%). According to multivariate logistic regression analysis, operation position, residual stone, white blood cell count (10³/µL), serum hemoglobin drop (g/dl), amount of physiological serum used (L), and positive renal pelvis urine culture were independently associated with SIRS. Inflammatory indices calculated from serum values, including SII, SIRI, and AISI, were directly associated with SIRS. ROC analysis demonstrated a moderate correlation between these indices and SIRS.</p><p><strong>Discussion: </strong>The findings of this prospective study indicate that postoperative SIRS risk can be predicted preoperatively and intraoperatively using a combination of commonly utilized clinical parameters and serum-based inflammatory indices. Higher values of SII, SIRI, and AISI were moderately predictive of SIRS development. Identifying high-risk patients prior to or during PCNL may help clinicians implement early preventive strategies and optimize postoperative management.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"568497"},"PeriodicalIF":2.6,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499558","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 the Charlson Comorbidity Index on the Short-Term and Long-Term Prognoses of Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention.","authors":"Yixin Ma, Hongyu Luo, Huan Zhao, Ou Zhao, Lina Ma, Wei Yang, Ming Yi, Lijie Sun, Jing Li","doi":"10.2147/TCRM.S559412","DOIUrl":"10.2147/TCRM.S559412","url":null,"abstract":"<p><strong>Background: </strong>The Charlson Comorbidity Index (CCI) is widely used to assess comorbidity burden, its prognostic role in patients undergoing percutaneous coronary intervention (PCI) remains underexplored. This study aimed to investigate the impact of CCI on in-hospital adverse events and long-term major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with coronary artery disease (CAD) treated with PCI.</p><p><strong>Methods: </strong>A total of 572 consecutive CAD patients who underwent PCI between October 2016 and October 2020 were included. Patients were divided into low (CCI ≤ 4, n = 453) and high (CCI > 4, n = 119) comorbidity burden groups. Clinical characteristics, in-hospital adverse events, and long-term MACCEs were compared. Multivariate logistic regression and Cox proportional hazards models were used to identify independent predictors of outcomes.</p><p><strong>Results: </strong>Compared to the low-CCI group, patients in the high-CCI group were older, more frequently male, and had higher rates of diabetes, left main CAD, and multivessel disease (all p < 0.05). In-hospital adverse events were significantly more common in the high-CCI group (13.4% vs 2.0%, p < 0.01). CCI was an independent predictor of in-hospital events (OR = 3.13; 95% CI: 1.40-7.02). During a median follow-up of five years, the high-CCI group had a significantly higher incidence of MACCEs (51.3% vs 6.2%; HR = 2.72; 95% CI: 2.25-3.30, p < 0.01).</p><p><strong>Conclusion: </strong>CCI is a significant and independent predictor of both in-hospital and long-term adverse outcomes in CAD patients undergoing PCI.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"559412"},"PeriodicalIF":2.6,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12998903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487396","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":"Real-World Clinical Effectiveness and Migraine-Related Healthcare Resource Utilization in Patients Initiating Fremanezumab in Germany and the United Kingdom.","authors":"Axel Heinze, Shazia K Afridi, Todor I Totev, Lynda J Krasenbaum, Emi Terasawa, Hasan Akcicek, Joachim Hipp, Dalbir Dhiraj, Rochelle Sun, Erica Yim, Binyam Yilma, Maurice T Driessen","doi":"10.2147/TCRM.S529550","DOIUrl":"10.2147/TCRM.S529550","url":null,"abstract":"<p><strong>Purpose: </strong>Fremanezumab, a humanized monoclonal antibody targeting calcitonin gene-related peptide, is approved in Germany and the United Kingdom (UK) for patients experiencing migraine ≥4 days per month, and it is reimbursed for patients where ≥4-5 (Germany) or ≥3 (UK) prior migraine preventive treatments have failed. We evaluated real-world clinical effectiveness and healthcare resource utilization (HCRU) in patients initiating fremanezumab in Germany and the UK.</p><p><strong>Methods: </strong>This non-interventional, retrospective, physician panel-based, online, multicenter chart review study included adult patients with chronic migraine (CM) or episodic migraine (EM) with first fremanezumab treatment initiation (index date) from June 2019 or later (Germany), and from June 2020 or later (UK). Changes in monthly migraine days (MMD), monthly headache days (MHD), and disability outcomes (Migraine Disability Assessment [MIDAS] and Headache Impact Test-6 [HIT-6]) were evaluated from baseline (pre-index) to 3 months post-index, and changes in HCRU were evaluated from 6 months pre-index to 6 months post-index.</p><p><strong>Results: </strong>The study population included 207 German and 183 UK patients (CM, 48.3% and 95.1%; monthly dosing, 59.4% and 51.9%, respectively). Reductions in MMD and MHD were observed in the German cohort (percent reductions: 60.2% and 55.1%, respectively) and the UK cohort (51.9% and 47.3%, respectively; all <i>p</i> < 0.001 vs baseline). Reductions in mean MIDAS and HIT-6 scores (all <i>p</i> < 0.01 vs baseline), outpatient office visits, urgent care/emergency room visits, and inpatient admissions were also observed (all <i>p</i> < 0.05 vs baseline) for both countries.</p><p><strong>Conclusion: </strong>Fremanezumab demonstrated real-world clinical effectiveness in German and UK cohorts and may decrease the burden of migraine for patients and providers.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"529550"},"PeriodicalIF":2.6,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499601","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":"Low-Dose Dexmedetomidine Reduces Median Effective Doses of Propofol Required for Successful Gastroscope Insertion: A Prospective Randomized Controlled Dose-Finding Trial.","authors":"Qian Zhu, Pei-Pei Hao, Ling-Li Cui, Fu-Kun Liu, Fu-Shan Xue","doi":"10.2147/TCRM.S571057","DOIUrl":"10.2147/TCRM.S571057","url":null,"abstract":"<p><strong>Purpose: </strong>Patients undergoing painless gastrointestinal endoscopy (GIE) typically receive propofol-based sedation. However, the exact dose of propofol when combined with low-dose dexmedetomidine for this procedure remains unclear. The objective of this study was to determine and compare the median effective doses (ED₅₀, the doses required for successful gastroscope insertion in 50% of the subjects) of propofol when used with low-dose dexmedetomidine (0.3 µg/kg) premedication versus propofol alone during painless GIE.</p><p><strong>Patients and methods: </strong>Adult outpatients aged 18 to 65 years scheduled for GIE were enrolled. Participants were randomized to receive either 0.9% saline (Group S) or 0.3 µg/kg of dexmedetomidine (Group D) intravenously over 5 min before induction with propofol. Using modified Dixon's up-and-down method (MDUDM), the initial induction dose of propofol was 1.5 mg/kg, adjusted in a step size of 0.1 mg/kg. ED₅₀ of propofol required for successful endoscope insertion was calculated by averaging the midpoints of all sequential crossovers. Using isotonic regression analysis, ED₅₀ and ED₉₅ (the effective doses required for successful gastroscope insertion in 95% of the subjects) were then extrapolated. All adverse events during painless GIE were recorded.</p><p><strong>Results: </strong>Thirty patients were enrolled per group. Using MDUDM, the ED₅₀ of propofol for successful gastroscope insertion was significantly lower in Group D (1.48 ± 0.10 mg/kg) than in Group S (1.82 ± 0.16 mg/kg; <i>P</i> < 0.001). The ED₅₀ and ED₉₅ of propofol were extrapolated to 1.80 mg/kg (83% confidence interval [CI], 1.649-1.882) and 2.10 mg/kg (83% CI, 2.081-2.124) for Group S, respectively, using isotonic regression analysis. These values were significantly lower in Group D, at 1.40 mg/kg (83% CI, 1.297-1.452) and 1.70 mg/kg (83% CI, 1.667-1.753).</p><p><strong>Conclusion: </strong>Premedication with low-dose dexmedetomidine (0.3 µg/kg) significantly reduces the median effective doses of propofol required for successful gastroscope insertion during painless GIE.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"571057"},"PeriodicalIF":2.6,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12998894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487359","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":"Comparison of a Kidney Intensive Care Unit Healthcare-Led Model versus a Traditional Haemodialysis Nurse-Led Model for Continuous Renal Replacement Therapy: A Retrospective Observational Study.","authors":"Ting Zhang, Gaiying Jiang, Huinan Yan, Juzi Wang, Xin Lan, Jianming Bai, Yonghong Deng, Nan Zhang, Qian Gao, Yanting Shen, Xueqing Wang, Ruxian Wei","doi":"10.2147/TCRM.S545995","DOIUrl":"10.2147/TCRM.S545995","url":null,"abstract":"<p><strong>Background: </strong>The optimal organisational model for delivering continuous renal replacement therapy (CRRT) to critically ill patients remains a subject of investigation.</p><p><strong>Objective: </strong>This study compared the impact of a kidney intensive care unit (KICU) healthcare-led model with a traditional haemodialysis nurse-led model on key clinical process indicators and patient outcomes during CRRT.</p><p><strong>Methods: </strong>In this retrospective observational study, patients requiring CRRT admitted to the KICU of a tertiary hospital between January 2022 and December 2023 were selected. Patients were divided into two groups based on the treatment leadership: the KICU group, where CRRT was led by intensive care unit supervising physicians and nurses certified in critical care blood purification techniques, and the control group, led by supervising physicians and haemodialysis nurses. Data were collected via the hospital information system and nursing records. After propensity score matching, 1180 patients were included in each group. Supplementary multivariable regression analyses were performed to provide adjusted effect estimates. Outcomes included treatment interruption rate, catheter-related infection rate, complication rate, actual delivered effluent dose, catheter insertion to treatment initiation time and patient satisfaction.</p><p><strong>Results: </strong>The KICU group demonstrated a significantly lower overall complication rate (1.8% vs 3.7%, <i>p</i> = 0.004) and a higher rate of achieving the prescribed effluent dose (87.7% vs 81.2%, <i>p</i> < 0.001). Time to CRRT initiation was shorter in the KICU group (23.75 ± 2.43 vs 30.60 ± 6.36 minutes, <i>p</i> < 0.05). Patient satisfaction was also higher (<i>p</i> < 0.05). No significant differences were found in treatment interruption or catheter-related infections. The benefits of the KICU model on these key outcomes remained statistically significant in multivariable-adjusted analyses.</p><p><strong>Conclusion: </strong>Continuous renal replacement therapy management by a dedicated KICU multidisciplinary team was associated with a lower complication rate, improved delivery of the prescribed dialysis dose, faster treatment initiation and higher patient satisfaction compared with a traditional model. These findings suggest that a structured, healthcare-led model can optimise the CRRT process for critically ill patients. Further multicentre studies are warranted to confirm these results.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"545995"},"PeriodicalIF":2.6,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12998925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487361","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":"Retrospective Analysis: Comparative Effects of General Anesthesia versus Quadratus Lumborum Block-Supplemented General Anesthesia on Postoperative Outcomes in Patients Undergoing Laparoscopic Myomectomy.","authors":"Ruchun Yan, Man Kuang","doi":"10.2147/TCRM.S561612","DOIUrl":"10.2147/TCRM.S561612","url":null,"abstract":"<p><strong>Background and objective: </strong>This retrospective study analyzed to compare the effects of general anesthesia (GA) versus combined anesthesia (CA) on postoperative pain and negative emotions in patients undergoing uterine fibroid surgery, providing evidence for optimizing anesthesia protocols aiming to achieve more effective analgesia and improve patient satisfaction scores.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on data from 148 patients who underwent uterine fibroid surgery at a tertiary hospital between April 2023 and December 2024. Patients were divided into a control group (GA) and a study group (CA) based on anesthesia type. The control group received conventional GA, while the study group received ropivacaine quadratus lumborum block (QLB) combined with GA. After propensity score matching (PSM), 74 patients were included in each group. The primary outcome was postoperative 2-12h visual analog scale (VAS) pain scores. Secondary outcomes included stress indicators (ACTH, Cor), emotional scales (SAS/SDS), cognitive function (MMSE), and sleep quality (PSQI).</p><p><strong>Results: </strong>The study group had shorter anesthesia duration, postoperative flatus time, postoperative ambulation time, and hospital stay compared to the control group (all P<0.05). VAS scores at 2h, 4h, 8h, and 12h postoperatively were significantly lower in the study group (all P<0.05). Preoperative differences in emotional, stress, cognitive, and sleep indicators were not statistically significant (all P>0.05). Postoperatively, the study group showed significantly lower SAS/SDS scores, ACTH/Cor levels, and PSQI scores, alongside higher MMSE scores compared to the control group (all P<0.05).</p><p><strong>Conclusion: </strong>Combined anesthesia effectively reduces postoperative pain and negative emotions in uterine fibroid patients, lowers stress levels, improves sleep quality, and promotes rapid recovery, making it worthy of clinical promotion.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"561612"},"PeriodicalIF":2.6,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12794652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967209","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}