Therapeutics and Clinical Risk Management最新文献

{"title":"Vitamin D and Sarcopenia in the Senior People: A Review of Mechanisms and Comprehensive Prevention and Treatment Strategies","authors":"Fan Zhang, Wenjian Li","doi":"10.2147/tcrm.s471191","DOIUrl":"https://doi.org/10.2147/tcrm.s471191","url":null,"abstract":"<strong>Abstract:</strong> This article reviews the mechanisms and prevention strategies associated with vitamin D and sarcopenia in older adults. As a geriatric syndrome, sarcopenia is defined by a notable decline in skeletal muscle mass and strength, which increases the risk of adverse health outcomes such as falls and fractures. Vitamin D, an essential fat-soluble vitamin, is pivotal in skeletal muscle health. It affects muscle function through various mechanisms, including regulating calcium and phosphorus metabolism, promoting muscle protein synthesis, and modulation of muscle cell proliferation and differentiation. A deficiency in vitamin D has been identified as a significant risk factor for the development of sarcopenia in older adults. Many studies have demonstrated that low serum vitamin D levels are significantly associated with an increased risk of sarcopenia. While there is inconsistency in the findings, most studies support the importance of vitamin D in maintaining skeletal muscle health. Vitamin D influences the onset and progression of sarcopenia through various pathways, including the promotion of muscle protein synthesis, the regulation of mitochondrial function, and the modulation of immune and inflammatory responses. Regarding the prevention and treatment of sarcopenia, a combination of nutritional, exercise, and pharmacological interventions is recommended. Further research should be conducted to elucidate the molecular mechanism of vitamin D in sarcopenia, to study genes related to sarcopenia, to perform large-scale clinical trials, to investigate special populations, and to examine the combined application of vitamin D with other nutrients or drugs. A comprehensive investigation of the interconnection between vitamin D and sarcopenia will furnish a novel scientific foundation and productive strategies for preventing and treating sarcopenia. This, in turn, will enhance the senior people’s quality of life and health.<br/><br/><strong>Keywords:</strong> vitamin D, sarcopenia, senior people, pathogenesis, comprehensive prevention and treatment strategies<br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"63 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142227117","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":"Impact of Isotretinoin on Blood Lipids and Liver Enzymes: A Retrospective Cohort Study in Saudi Arabia","authors":"Abdullah A Alrasheed, Khalid F Alsadhan, Nawaf F Alfawzan, Nasser M AbuDujain, Ali H Alnasser, Hisham Almousa","doi":"10.2147/tcrm.s466113","DOIUrl":"https://doi.org/10.2147/tcrm.s466113","url":null,"abstract":"<strong>Background:</strong> Isotretinoin is an effective treatment for acne but can cause side effects such as changes in blood lipids and liver enzymes. Laboratory monitoring is essential during treatment, but there is variation in monitoring practices.<br/><strong>Aim:</strong> This study aims to investigate the relationship between isotretinoin therapy and its effects on complete blood count in Saudi Arabia to improve patient outcomes.<br/><strong>Methods:</strong> The study was a retrospective cohort study conducted at King Khalid University Hospital in Riyadh, Saudi Arabia, between January 2016 and December 2020. Following the inclusion and exclusion criteria, 515 patients were randomly selected for the study. The data was analyzed using SPSS, and descriptive statistics and paired samples t-tests were employed to analyze the data.<br/><strong>Results:</strong> In this study, 515 patients were enrolled. Of these participants, 76.7% (n=395) were females and 23.3% (n=120) were males. The mean age of the study participants was 23.98± 7.4 years and ranged between 16 and 65 years. The mean dose of Isotretinoin administered was 27.65± 9.6 mg/day, with a range of 10– 60 mg/day. The mean BMI of the study participants was 24.3± 4.1 kg/m2, ranging from 14.3 to 44.8 kg/m2. Regarding the effect of Isotretinoin on laboratory measures, significant statistical differences were found in hemoglobin measurements (t=− 3.379, p=0.001), platelets (t=− 3.169, p=0.002), neutrophils (%) (t=3.107, p=0.002), total cholesterol (t=− 13.017, p=0.000), AST (t=− 6.353, p=0.000), ALT (t=− 4.352, p=0.000), HDL (t=2.446, p=0.015), and LDL (t=− 12.943, p=0.000). However, there were no significant statistical differences in the measurements of WBC, neutrophils (count), or triglycerides. In the Chi-square analysis and Fisher’s Exact test to identify the interaction between BMI, dose, and gender on abnormal lab results, significant interaction was found between participants’ BMI and abnormal HDL measurements (p=0.006). Furthermore, there were significant interactions between Isotretinoin dose (either less than 30 mg/day or 30 mg/day or more) and abnormal neutrophil count (p=0.04), abnormal HDL measurements (p=0.010), and abnormal triglycerides measurements (p=0.020). Moreover, a statistically significant interaction was found between participants’ gender and abnormal hemoglobin measurements (p=0.006), abnormal total cholesterol (p=0.016), abnormal AST measurements (p=0.001), abnormal ALT measurements (p=0.000), abnormal HDL measurements (p=0.000), and abnormal triglycerides measurements (p=0.007).<br/><strong>Conclusion:</strong> In conclusion, the study found that isotretinoin therapy has significant effects on several laboratory measures, including hemoglobin, platelets, neutrophils, total cholesterol, AST, ALT, HDL, and LDL. The study also revealed significant interactions between BMI, dose, gender, and abnormal lab results.<br/><br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142227116","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":"Optimizing Infusate Flow Patterns for Minimizing Vein Wall Trauma: An Exploratory Study with a Modified off-Axis Catheter Tip Opening.","authors":"Amit Bahl, S Matthew Gibson, Alexis Walton","doi":"10.2147/TCRM.S479846","DOIUrl":"10.2147/TCRM.S479846","url":null,"abstract":"<p><strong>Objective: </strong>Modifying the PIVC tip to direct infusates toward areas of highest hemodilution may reduce vein wall damage. This study compared flow patterns between a traditional PIVC with a central opening and one with an off-axis aperture.</p><p><strong>Methods: </strong>This was an exploratory observational analysis conducted at a tertiary care emergency department (ED) comparing flow patterns of two intravenous catheters: PIVC 1 (2.95 cm 20 gauge [Autoguard, Becton Dickinson]) and PIVC 2 (3.68 cm 20 gauge [Osprey, SkyDance Vascular]). Adult ED patients with PIVCs placed via traditional palpation/visualization method and with ultrasound capturing the flushing were eligible participants. Ultrasounds were reviewed to determine vein, catheter, and flow characteristics. The primary outcome was angle of the infusate leaving the catheter. Secondary outcomes included direction of catheter tip against vein wall, distance away from vein wall, vasospasm, and laminar/turbulent flow.</p><p><strong>Results: </strong>Data from December 2023 included 28 catheters (10 PIVC 1, 18 PIVC 2). The average patient age was 53.7 years; 53.6% were female. Vein diameter/depth were similar: 0.35 cm/0.41 cm for PIVC 1 and 0.37 cm/0.47 cm for PIVC 2. The catheter tip pointed posteriorly towards the vein wall in 60% of PIVC 1 vs 11.1% in PIVC 2 (P=0.018). The angle of infusate flow away from the vein wall was 0.20° (SD 0.63) for PIVC 1 and 7.61° (SD 5.71) for PIVC 2 (P<0.001). Flow at 0° occurred in 90% of PIVC 1 vs 16.7% in PIVC 2 (P<0.001).</p><p><strong>Conclusion: </strong>In this exploratory investigation, a peripheral vascular access device with an off-axis tip aperture of demonstrated a sharper infusate flow angle away from the vein wall compared to a traditional central opening device. This redirection may reduce vein wall trauma and complications, though further research is needed to pair clinical outcomes with this technology.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"559-566"},"PeriodicalIF":2.8,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154983","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":"Erratum: Comparison Study Among Three Surgical Methods in the Treatment of Isolated Fractures of the Greater Tuberosity of the Humerus [Corrigendum].","authors":"","doi":"10.2147/TCRM.S493493","DOIUrl":"https://doi.org/10.2147/TCRM.S493493","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2147/TCRM.S455379.].</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"557-558"},"PeriodicalIF":2.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11370774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126717","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":"Validation of the Global Leadership Initiative on Malnutrition Criteria for Predicting Adverse Outcomes in Acute Pancreatitis.","authors":"Hao Fu, Ping Li, Shuang Sun, Ling Li","doi":"10.2147/TCRM.S471127","DOIUrl":"10.2147/TCRM.S471127","url":null,"abstract":"<p><strong>Background and aim: </strong>The Global Leadership Initiative on Malnutrition (GLIM) has proposed criteria for the diagnosis of malnutrition. No studies validated the GLIM criteria in acute pancreatitis (AP). The present study aimed to validate the predictive capacity of GLIM criteria for adverse outcomes in AP patients.</p><p><strong>Patients and methods: </strong>Clinical data of 269 patients with AP were analyzed retrospectively. The Nutritional Risk Screening 2002 (NRS2002) was chosen as the screening tool. Multivariate logistic regression analyses evaluated the adverse clinical outcomes in malnourished patients.</p><p><strong>Results: </strong>Overall, 160 patients (59.5%) were at nutritional risk and 38 (14.1%) were malnourished. Reduced muscle mass/ low body mass index + inflammation combinations contributed most to malnutrition overall and in each subgroup. The malnourished group had lower hemoglobin, neutrophils, albumin, total cholesterol, and triglycerides than the well-nourished group. The malnourished group had higher hospitalization costs (CNY, 11319.34 vs 9258.22, p <0.001) and more local complications (34.2% vs 14.7%, p =0.009) than the well-nourished group. There was an interaction between malnutrition and overweight/obesity on local complications (p for interaction = 0.023). Multivariate logistic regression showed malnutrition was significantly associated with local complications (OR 12.2, 95% CI: 2.51-59.37), infectious complications (OR 9.95, 95% CI: 1.25-79.44) and composite adverse outcome (OR 4.78, 95% CI: 1.05-21.73) in the overweight/obesity subgroup. There was no association between malnutrition and the rate of various adverse outcomes in the non-overweight/obesity subgroup. Additionally, we observed an association between malnutrition and composite adverse outcome (OR 6.75, 95% CI: <i>1</i>.49-30.68) in patients <70 years only in females.</p><p><strong>Conclusion: </strong>Malnourished AP patients were more likely to have adverse outcomes than well-nourished patients. Malnutrition was associated with various adverse outcomes only in the overweight/obesity subgroups.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"543-556"},"PeriodicalIF":2.8,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112315","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 Assessment Tool in Predicting the Therapeutic Outcomes of Antiseizure Medication in Adults with Epilepsy.","authors":"Rose Aniza Rusli, Mohd Makmor Bakry, Noraida Mohamed Shah, Xin Ling Loo, Stefanie Kar Yan Hung","doi":"10.2147/TCRM.S467975","DOIUrl":"10.2147/TCRM.S467975","url":null,"abstract":"<p><strong>Aim: </strong>Identifying a patient's risk for poor outcomes after starting antiseizure medication (ASM) therapy is crucial in managing epilepsy pharmacologically. To date, there is a lack of designated tools to assess such risks.</p><p><strong>Purpose: </strong>To develop and validate a risk assessment tool for the therapeutic outcomes of ASM therapy.</p><p><strong>Patients and methods: </strong>A cross-sectional study was carried out in a hospital-based specialist clinic from September 2022 to August 2023. Data was analyzed from patients' medical records and face-to-face assessments. The seizure control domain was determined from the patients' medical records while seizure severity (SS) and adverse effects (AE) of ASM were assessed using the Seizure Severity Questionnaire and the Liverpool Adverse Event Profile respectively. The developed tool was devised from prediction models using logistic and linear regressions. Concurrent validity and interrater reliability methods were employed for validity assessments.</p><p><strong>Results: </strong>A total of 397 patients were included in the analysis. For seizure control, the identified predictors include ≥10 years' epilepsy duration (OR:1.87,95% CI:1.10-3.17), generalized onset (OR:7.42,95% CI:2.95-18.66), focal onset seizure (OR:8.24,95% CI:2.98-22.77), non-adherence (OR:3.55,95% CI:1.52-8.27) and having ≥3 ASM (OR:3.29,95% CI:1.32-8.24). Younger age at epilepsy onset (≤40) (OR:3.29,95% CI:1.32-8.24) and neurological deficit (OR:3.55,95% CI:1.52-8.27) were significant predictors for SS. For AE, the positive predictors were age >35 (OR:0.12,95% CI:0.03-0.20), <13 years epilepsy duration (OR:2.89,95% CI:0.50-5.29) and changes in ASM regimen (OR:2.93,95% CI: 0.24-5.62). The seizure control domain showed a good discriminatory ability with a <i>c-index</i> of 0.711. From the Bonferroni (ANOVA) analysis, only SS predicted scores generated a linear plot against the mean of the actual scores. The AE domain was omitted from the final tool because it did not meet the requirements for validity assessment.</p><p><strong>Conclusion: </strong>This newly developed tool (RAS-TO) is a promising tool that could help healthcare providers in determining optimal treatment strategies for adults with epilepsy.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"529-541"},"PeriodicalIF":2.8,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112314","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":"Comparative Analysis of AI-SONICTM Thyroid System and Six Thyroid Risk Stratification Guidelines in Papillary Thyroid Cancer: A Retrospective Cohort Study.","authors":"Mingyan Wang, Siyuan Yang, Linxin Yang, Ning Lin","doi":"10.2147/TCRM.S458576","DOIUrl":"10.2147/TCRM.S458576","url":null,"abstract":"<p><strong>Aim: </strong>The study aimed to compare the diagnostic performance of AI-SONICTM Thyroid System (AI-SONICTM) with six thyroid nodule ultrasound risk stratification systems, as well as the interobserver agreement among different-year ultrasound examiners using the same diagnostic approach.</p><p><strong>Methods: </strong>This retrospective study included patients who underwent thyroid ultrasound examination and surgery between 2010 and 2022. Three ultrasound examiners with 2, 5, and 10 years of experience, respectively, used AI-SONICTM and six guidelines to risk-stratify the nodules. The diagnostic performance and interobserver agreement were assessed.</p><p><strong>Results: </strong>A total of 370 thyroid nodules were included, including 195 papillary thyroid carcinomas (PTC) and 175 benign nodules. For physicians of varying seniority from low to high, AI-SONICTM had a moderate sensitivities of 82.56%, 83.08%, 84.62%, respectively, while AACE/ACE/AME had the highest diagnostic sensitivities (96.41%, 95.38%, 96.41%, respectively); And relatively higher specificities were 85.14%, 85.71%, 85.71% for KSThR, while moderate specificities with values of 84.0%, 85.14%, and 85.71%, respectively were found for AI-SONICTM; The accuracy was highest for ATA (excluding non-classifiable nodules), with values of 87.26%, 87.93%, and 88.82%, respectively, while the accuracy for AI-SONICTM were 83.24%, 84.05%, and 85.14%, respectively. The Kendall's tau coefficient indicated strong or moderate interobserver agreement among all examiners using different diagnostic methods (Kendall's tau coefficient >0.6, P<0.001). AI-SONICTM showed the highest interobserver agreement (Kendall's tau coefficient=0.995, P<0.001). A binary probit regression analysis showed that nodules with cystic components had a significantly higher regression coefficient value of 0.983 (P=0.002), indicating that AI-SONICTM may have higher accuracy for nodules with cystic components.</p><p><strong>Conclusion: </strong>AI-SONICTM and the six thyroid nodule ultrasound risk stratification systems showed high diagnostic performance for papillary thyroid carcinoma. All examiners showed strong or moderate interobserver agreement when using different diagnostic methods. AI-SONICTM may have higher accuracy for nodules with cystic components.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"515-528"},"PeriodicalIF":2.8,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081556","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 Stratification of Penicillin Allergy Labeled Children: A Cross-Sectional Study from Jordan.","authors":"Jomana W Alsulaiman, Khalid A Kheirallah, Ahmad Alrawashdeh, Tareq Saleh, Maha Obeidat, Yareen J Alawneh, Ziydoun Abu Sanad, Wajdi Amayreh, Rama J Alawneh","doi":"10.2147/TCRM.S464511","DOIUrl":"10.2147/TCRM.S464511","url":null,"abstract":"<p><strong>Background: </strong>Implementing allergy testing among children with a reported history of penicillin allergy could be challenging, particularly in developing countries with limited resources. This study screened and risk-stratified the likelihood of true penicillin allergy among children labeled with penicillin allergy in Jordan.</p><p><strong>Methods: </strong>A web-based survey, completed by parents, assessed history, type, and severity of penicillin allergic reactions, including age at diagnosis, symptoms, time to the reaction, reaction's course and resolution, and received medical evaluation/testing. Low-risk allergic symptoms were defined as vomiting, diarrhea, headache, dizziness, itching, rash, cough, or runny nose without evidence of anaphylaxis or severe cutaneous reactions.</p><p><strong>Results: </strong>A total of 530 parents of \"penicillin allergy\"-labeled children completed the survey. Of these, 86.4% reported allergic reactions to penicillin and 13.6% reported avoidance of penicillin due to family history. Among the former, 52.2% were male, 67.3% were three years old or younger when the reported reaction was established, and 68.3% experienced exclusively low-risk symptoms. Overall, skin rash was the most reported symptom (86.0%). High-risk symptoms were reported in 31.5% of children. About two-thirds (64.0%) of children were reported to have experienced symptoms after the first exposure to penicillin. The most common indication for antibiotic use was a throat infection (63.8%). Asthma comorbidity was significantly higher among high-risk (24.8%) compared low-risk group (11.5%).</p><p><strong>Conclusion: </strong>In Jordan, many parent-reported penicillin allergic reactions seem to be clinically insignificant and unlikely to be verifiable, which can adversely affect patients' care and antimicrobial stewardship. An appropriate clinical history/evaluation is a key step in identifying true immunoglobulin E-mediated allergic reactions and risk stratifying patients for either de-labeling those with obviously non-immune-mediated reactions or identifying candidates for direct oral challenge test.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"20 ","pages":"505-514"},"PeriodicalIF":2.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11346476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073926","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 Attendance to a Pharmacist-Managed Medication Adherence Clinic on Glycemic Control and Risk Factors for Non-Completion Among Persons with Type 2 Diabetes Mellitus in Selangor, Malaysia","authors":"Fahmi Hassan, Ernieda Hatah, Wei Wen Chong, Adliah Mhd Ali","doi":"10.2147/tcrm.s442026","DOIUrl":"https://doi.org/10.2147/tcrm.s442026","url":null,"abstract":"<strong>Background:</strong> Diabetes mellitus (DM) is a chronic metabolic disorder affecting millions globally. Adherence to treatment is crucial for effective management.<br/><strong>Objective:</strong> To compare clinical outcomes, specifically changes in haemoglobin A1c (HbA1c) and fasting blood sugar (FBS) levels, between DM patients who completed the pharmacist-managed Diabetes Medication Therapy Adherence Clinic (DMTAC) sessions and those who did not, and to identify risk factors associated with non-completion of DMTAC.<br/><strong>Methods:</strong> This multicenter, retrospective study included patients with DM attending DMTAC at five Ministry of Health centers from January 2018 to December 2020. Patients were categorized based on their completion of DMTAC sessions: those who completed at least four sessions and those who did not as per DMTAC protocol. The changes in HbA1c and FBS levels between the groups were analyzed. Logistic regression was employed to identify risk factors for non-completion of DMTAC.<br/><strong>Results:</strong> A total of 198 patients were included, comprising 49% male with a mean age of 56.52, ± 12.91 years. The complete group consisted of 49% (n=99) of the patients, while the did not complete group included 50.5% (n=100). A statistically significant reduction in FBS levels from initial to final measurements was observed in the complete group compared to the did not complete group (P=0.024). Female gender, higher education levels, and a longer duration since DM diagnosis were significantly associated with non-completion of DMTAC.<br/><strong>Conclusion:</strong> Diabetic patients attending at least four DMTAC sessions showed potential improvements in FBS levels. To enhance attendance at DMTAC sessions, healthcare professionals should focus on patients identified with risk factors for non-completion of DMTAC.<br/><br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"25 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141948113","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":"Comparison Study Among Three Surgical Methods in the Treatment of Isolated Fractures of the Greater Tuberosity of the Humerus","authors":"Fulin Tao, Lin Li, Dawei Wang, Jinlei Dong, Dongsheng Zhou, Wenhao Song","doi":"10.2147/tcrm.s455379","DOIUrl":"https://doi.org/10.2147/tcrm.s455379","url":null,"abstract":"<strong>Introduction:</strong> This study aimed to compare the efficacy of three methods for isolated greater tuberosity fractures of the humerus.<br/><strong>Methods:</strong> A retrospective review of patients with isolated humeral greater tuberosity fractures between January 2013 and June 2021 in our institution. We recorded data on patient demographics, injury characteristics, preoperative and postoperative imaging findings, length of incision, operative time, and intraoperative blood loss.<br/><strong>Results:</strong> A total of 107 patients met the inclusion criteria and were divided into three groups. 50 patients in group A were administered a proximal humeral internal locking system (PHILOS) plate fixed using the deltopectoral approach, 26 patients in group B were administered a PHILOS plate fixed using the deltoid-splitting approach, and 31 patients in group C were administered a novel anatomical plate fixed using the deltoid-splitting approach. No significant differences were identified in sex, age, injury mechanism, type of fracture, dominant side limb, or shoulder anterior joint dislocation. However, the operative time, blood loss, and the length of incision was shorter than in Group C. Moreover, pain was evaluated on the third and fifth days after surgery; pain was lower in Group C, and pain at the last follow-up was not different between the groups. No significant differences were identified in the Constant score, DASH score, and ROM at the last follow-up. 2 patients were diagnosed with subacromial impingement, 1 in Group A one in Group B, and 1 patient in Group B experienced axillary nerve injury after surgery.<br/><strong>Conclusion:</strong> The novel anatomical plate fixed using the deltoid-splitting approach can achieve good results in the treatment of isolated humeral greater tubercle fractures with less blood loss, shorter operative time, and shorter surgical incisions, and can relieve pain in the early postoperative period.<br/><br/><strong>Keywords:</strong> PHILOS plate, a novel anatomical plate, deltopectoral approach, deltoid-splitting approach, greater tuberosity fracture of humerus<br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"64 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141948178","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}