Therapeutics and Clinical Risk Management最新文献

{"title":"Serum Periostin as a Novel Biomarker for Predicting 30-Day Major Adverse Cardiac Events After Off-Pump Coronary Artery Bypass Grafting.","authors":"Qian Su, Zhipeng Deng, Xiangqing Wei, Lu Li, Boxiang Du, Fei Guo, Yi Gu, Jie Song, Lei Yao","doi":"10.2147/TCRM.S507435","DOIUrl":"10.2147/TCRM.S507435","url":null,"abstract":"<p><strong>Background: </strong>The identification of predictors for major adverse cardiovascular events (MACEs) is essential for reducing mortality associated with off-pump coronary artery bypass grafting (OPCAB). The objective of this study is to assess serum periostin levels as a novel predictor of MACEs in patients undergoing OPCAB.</p><p><strong>Methods: </strong>This prospective study included 79 patients diagnosed with coronary artery disease (CAD) who underwent OPCAB between May 2022 and May 2023. The changes in periostin levels (ΔPOSTN) were calculated using the formula: postoperative POSTN levels minus preoperative POSTN levels. Based on the optimal cut-off value determined from the receiver operating characteristic (ROC) curve, patients were categorized into Low POSTN Change (LPC) and High POSTN Change (HPC) groups for subgroup analysis. The primary outcomes assessed were MACEs, including cardiac death, myocardial infarction (MI), heart failure, and stroke.</p><p><strong>Results: </strong>Follow up for the patients was conducted for 30 days, with 71 patients ultimately being included in the final analysis. During this period, 13 MACEs were recorded, representing an incidence rate of 18.3%. The events included 2 cases of cardiac death (2.8%), 5 cases of MI (7.0%), 5 cases of heart failure (7.0%), and 1 case of stroke (1.4%). The risk of MACEs increased by 4% for each unit increase in the ΔPOSTN (Odds Ratio [OR]: 1.04, 95% Confidence Interval [CI]: 1.01-1.06; p = 0.005). The area under the ROC curve was 0.869 (95% CI: 0.768-0.938; p < 0.001). Based on the Youden index (J = 0.683), the optimal threshold for ΔPOSTN was determined to be 16.6 µg/L, with a sensitivity of 76.9% and a specificity of 91.4%.</p><p><strong>Conclusion: </strong>Changes in serum periostin levels during the perioperative period may serve as an independent predictor of 30-day MACEs in patients undergoing OPCAB.</p><p><strong>Trial registration: </strong>Link of the registry: https://www.chictr.org.cn. Date of registration: 2022/05/22. Trial registration number: ChiCTR2200060220.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"161-176"},"PeriodicalIF":2.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483621","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 Development of Publications on Catheter-Related Bladder Discomfort: A Bibliometric Analysis.","authors":"Wencai Jiang, Xuemeng Chen, Yanhua Peng, Wenhu Zhai, Xianjie Zhang, Yukai Zhou, Rui Zhou","doi":"10.2147/TCRM.S493703","DOIUrl":"10.2147/TCRM.S493703","url":null,"abstract":"<p><strong>Background: </strong>Catheter-related bladder discomfort (CRBD) is a risk factor that impacts postoperative recovery and still troubles patients and healthcare staff. The present study is a bibliometric analysis of CRBD.</p><p><strong>Methods: </strong>The publications on CRBD were retrieved from the Web of Science Core Collection. VOSviewer and Excel were applied to present the current status and hot spots of CRBD research. We analyzed parameters such as the annual number of publications, countries/regions, organizations, authors, journals, and keywords of the articles in this area by generating visualization graphs.</p><p><strong>Results: </strong>A total of 127 articles were eligible, recorded by 78 journals, and drafted by 672 authors from 169 organizations in 26 countries/regions. The main type of these articles is randomized trial. Park Hee-Pyoung, Kim Hyun-Chang, and Cui Yuanshan are the most productive authors with 5 articles. Sichuan University, Seoul National University, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Capital Medical University, and Qingdao University published more articles on CRBD worldwide. China ranks No. 1 in terms of the number of publications, followed by South Korea and India. Journals specialized in anesthesiology, such as BMC Anesthesiology, Journal of Anesthesia, and British Journal of Anesthesia, are more popular with researchers in this area. The research hot spots of CRBD have concentrated on the prevention and treatment of CRBD.</p><p><strong>Conclusion: </strong>Though formal research on CRBD started late, there is a rising tendency for the number of publications. Authors and academic teams from Asia have made significant contribution to CRBD. Journals specialized in anesthesiology are priorities for publishing articles. Previous studies mainly focused on the pharmacological and pharmacological methods to CRBD. However, CRBD is not fully settled. Either clinical or experimental studies are still needed to further improve CRBD.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"137-147"},"PeriodicalIF":2.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383329","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":"Video Laryngoscopy for Endotracheal Intubation: A Consideration for Manual In-Line Stabilization Without Cervical Collar Versus Full Immobilization.","authors":"Kasamon Aramvanitch, Sittichok Leela-Amornsin, Welawat Tienpratarn, Promphet Nuanprom, Supassorn Aussavanodom, Chaiyaporn Yuksen, Sirinapa Boonsri, Natcha Boonjarus, Somchoak Sanepim","doi":"10.2147/TCRM.S486978","DOIUrl":"https://doi.org/10.2147/TCRM.S486978","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic patients with cervical spine motion restriction have difficulty with endotracheal intubation (ETI) due to the limitations of neck movement and mouth opening. Nevertheless, the removal of the cervical collar for ETI in a prehospital setting may lead to a deterioration in neurological outcomes. This study compares the success rate of ETI utilizing a video laryngoscope (VL) on a manikin, contrasting manual in-line stabilization (MILS) without a cervical hard collar against full immobilization.</p><p><strong>Methods: </strong>A randomized, non-crossover study was conducted involving 56 paramedic students assigned by SNOSE to utilize various box sizes for VL intubation with MILS without a cervical hard collar or full immobilization technique on a manikin. The primary outcome was the intubation success rate. Secondary outcomes included attempts, time for successful intubation, and Cormack-Lehane classification.</p><p><strong>Results: </strong>Fifty-six participants were evaluated; 28 were in the full immobilization group, and another 28 were in the MILS without cervical hard collar group. Baseline characteristics showed no difference between both groups. The success rate of VL intubation showed no difference between the full immobilization group and the MILS without a cervical hard collar group (28 [100%] vs 28 [100%]; 24 [85.71%] vs 27 [96.43%] on first attempt; 4 [14.29%] vs 1 [3.57%] on second attempt; p-value 0.352). Time required to perform successful intubation (median [IQR] 17.20 [12.53, 24.40] vs 17.53 [14.06, 23.73], p-value 0.694) and Cormack-Lehane classification (11 [39.29%] vs 10 [35.71%] in grade I; 16 [57.14%] vs 17 [60.71%] in grade II; 1 [3.57%] vs 1 [3.57%] in grade III, p-value 1.000) showed no statistical difference between the two groups.</p><p><strong>Conclusion: </strong>It is unnecessary to remove the cervical hard collar when performing endotracheal intubation while using a video laryngoscope.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"103-109"},"PeriodicalIF":2.8,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068053","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":"Obstacles to Early Diagnosis of Gaucher Disease.","authors":"Samantha Nishimura, Charis Ma, Ellen Sidransky, Emory Ryan","doi":"10.2147/TCRM.S388266","DOIUrl":"10.2147/TCRM.S388266","url":null,"abstract":"<p><p>Gaucher disease (GD) is a rare lysosomal storage disorder resulting from a deficiency of the lysosomal enzyme glucocerebrosidase caused by biallelic variants in the <i>GBA1</i> gene. Patients may present with a wide spectrum of disease manifestations, including hepatosplenomegaly, thrombocytopenia, bone manifestations, and in the case of GD types 2 and 3, neurodegeneration, cognitive delay, and/or oculomotor abnormalities. While there is no treatment for neuronopathic GD, non-neuronopathic manifestations can be efficiently managed with enzyme replacement therapy or substrate reduction therapy. However, many patients with GD experience a lengthy diagnostic odyssey, which can negatively affect their access to care and clinical outcomes. The cause of this diagnostic delay is multifaceted. Since genotype/phenotype correlations in GD are not always clear, it is difficult to predict the presence, severity, and onset of clinical manifestations. This heterogeneity, combined with the molecular complexity of the <i>GBA1</i> locus, low disease prevalence, and limited knowledge of GD among providers serves as a barrier to early diagnosis of GD. In this review, we discuss such obstacles and challenges, considerations, and future steps toward improving the diagnostic journey for patients with GD.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"93-101"},"PeriodicalIF":2.8,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068051","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":"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":"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":"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}