Clinics and Practice最新文献

{"title":"Like a Complete Unknown: An Audit of the Quality of the Referrals to the Cancer of Unknown Primary Clinic at a Tertiary Care Centre.","authors":"Ian Hirsch, Jonah Teich, Khaled Abdulalem, Samuel D Saibil","doi":"10.3390/clinpract15070122","DOIUrl":"10.3390/clinpract15070122","url":null,"abstract":"<p><strong>Background: </strong>Carcinoma of Unknown Primary (CUP) constitutes approximately 3% of all advanced cancer cases globally, posing a distinct and complex medical challenge due to its metastatic nature, with no identifiable primary tumour site despite comprehensive investigations.</p><p><strong>Aim: </strong>This study aimed to assess the quality of referrals to the Cancer of Unknown Primary Clinic at the Princess Margaret Cancer Centre (PMCC) by conducting a retrospective audit of initial referrals between January 2022 and March 2023.</p><p><strong>Methods: </strong>The adequacy of referrals was evaluated based on adherence to NICE guidelines, focusing on essential diagnostic investigations such as comprehensive history, physical examination, CT scans, and pathological assessment with immunohistochemistry. Our cohort consisted of 97 patients with a median age of 66 years.</p><p><strong>Results: </strong>The results indicated that only 55% of referrals met the criteria for adequacy, with significant deficiencies in computed tomography (CT) scans and immunohistochemistry (IHC). Notably, the adequacy of referrals varied by specialty, with the lowest rates in emergency medicine and family medicine, and the highest rates in medical oncology, gastroenterology, and neurosurgery.</p><p><strong>Conclusions: </strong>These findings underscore the need for improved standardization and education to enhance referral quality, ensuring that patients with CUP receive appropriate and timely care. This study marks the initial phase of the Knowledge-to-Action cycle, highlighting areas for quality improvement in the referral process to the CUP clinic.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12293142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association Between COVID-19-Related Persistent Symptoms, Psychological Flexibility, and General Mental Health Among People With and Without Persistent Pain in the UK.","authors":"Lin Yu, Lance M McCracken","doi":"10.3390/clinpract15070119","DOIUrl":"10.3390/clinpract15070119","url":null,"abstract":"<p><p><b>Objectives:</b> Persistent symptoms following COVID-19 may adversely impact the general mental health of people with chronic pain, and psychological flexibility may buffer these impacts. However, it remains unclear whether such lasting implications of COVID-19 differ between people with and without chronic pain. This study investigated the relationships between persistent symptoms post-COVID-19, psychological flexibility, and general mental health among people with and without persistent pain during the COVID-19 pandemic in the UK. <b>Methods:</b> A total of 204 adults living in the UK were recruited via social media and completed an online survey, including measures of persistent symptoms, depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), insomnia (the Insomnia Severity Index), and psychological flexibility (the Multidimensional Psychological Flexibility Inventory), and were included in the analyses. <b>Results:</b> Participants with persistent pain (n = 70) experienced more-persistent symptoms, poorer general mental health, and a higher level of psychological inflexibility compared with participants without persistent pain (n = 133). Overall, the relationships between persistent physical symptoms, general mental health, and psychological (in)flexibility showed similar patterns in the two groups. Participants with more-persistent physical symptoms experienced significantly poorer general mental health. Furthermore, people with higher levels of psychological inflexibility reported worse general mental health. There was little evidence that psychological (in)flexibility could \"buffer\" the association between persistent physical symptoms and general mental health. <b>Conclusions:</b> People with chronic pain appear more vulnerable to persistent symptoms and reduced general mental health compared with people without pain. Treatments that reduce psychological inflexibility, such as ACT, may improve outcomes for people with persistent symptoms post-COVID-19.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12293660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Case of Infective Endocarditis Caused by <i>Vibrio metschnikovii</i>: Clinico-Diagnostic Complexities and a Systematic Literature Review.","authors":"Alessandro Carrozzo, Vittorio Bolcato, Luigi Martinelli, Ferdinando Dodi, Antonella Vulcano, Giuseppe Basile, Livio P Tronconi","doi":"10.3390/clinpract15070118","DOIUrl":"10.3390/clinpract15070118","url":null,"abstract":"<p><strong>Background: </strong>Non-cholera Vibrio species are rare waterborne pathogens that can cause severe infections. Among these, few cases of <i>Vibrio metschnikovii</i> infections have been reported, especially in the gastrointestinal tract, with no cardiac tissue involvement as a result. Following the PRISMA checklist, we conducted a literature review, and thirteen articles for twenty-two cases overall were included: seven cases of sepsis (in three cases, the echocardiographic results were negative), seven cases of pneumonia, two skin infections, eleven cases of diarrhoea, and a gastroenteritis outbreak. This report documents the expanding clinical spectrum and the role played by <i>V. metschnikovii</i> in infective endocarditis.</p><p><strong>Case report: </strong>A 28-year-old male patient was referred to the cardiac surgery unit for urgent mitral valve replacement due to suspicion of infective endocarditis. Microbiological tests yielded negative results. Following recovery and discharge with antimicrobial therapy for 6 weeks, the patient experienced prosthesis detachment, necessitating re-hospitalisation for an emergency valve replacement. <i>Vibrio metschnikovii</i> was identified on the prosthesis valve through PCR and successfully treated with ciprofloxacin. However, a spontaneous rupture of the ascending thoracic aorta led to a neurological injury.</p><p><strong>Discussion: </strong>This case represents the first case of valve infection caused by <i>Vibrio metschnikovii</i>, characterised by diagnostic and therapeutic challenges and the involvement of the great vessels. Also considered in this case, for a disease with a median age of 58 years (11-83) and a male-to-female ratio of 2.2, were one male neonate and six cases for whom neither sex nor age was indicated. Excluding gastrointestinal cases, the septic forms are associated with high morbidity, although the single case described involved a young and healthy subject. Risk factors for the pathogen or predisposing/pathological conditions for endocarditis did not emerge. The routes and the time of infection could not be determined, deepening the possibility of occupational exposure via the patient's position as a boat worker. Poor sensitivity to third-generation cephalosporins has been reported in the literature: the absence of an antibiogram does not allow for a comparison, although resolution was achieved with ciprofloxacin.</p><p><strong>Conclusion: </strong>The rising global incidence of non-cholera Vibrio infections, driven by environmental changes, calls for urgent research into the factors behind their pathogenicity and infection routes. Diagnostic complexities have emerged together with clinical severity.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12294080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and Predictors of Venous Thromboembolism and Major Hemorrhagic Events in Hospitalized Leukemia Patients: A Cross-Sectional Analysis of the NIS (2016-2020).","authors":"Daniel Antwi-Amoabeng, Bryce D Beutler, Vijay Neelam, Mark Ulanja","doi":"10.3390/clinpract15070117","DOIUrl":"10.3390/clinpract15070117","url":null,"abstract":"<p><strong>Background/objectives: </strong>Venous thromboembolism (VTE) and major hemorrhagic events are significant complications in hospitalized leukemia patients, but contemporary analyses of their epidemiology, predictors, and impact on clinical outcomes remain limited.</p><p><strong>Methods: </strong>We conducted a cross-sectional study using the National Inpatient Sample (NIS) database from 2016 to 2020. Hospitalized leukemia patients were identified using ICD-10 codes. Trends in the incidence of venous thromboembolism (VTE) and bleeding were assessed across the years, and multivariable logistic regression models were used to evaluate the predictors of VTE and bleeding. We assessed the influence thromboembolic and hemorrhagic complications on length of stay, cost, and mortality outcomes.</p><p><strong>Results: </strong>Among 430,780 leukemia hospitalizations, the overall incidence of VTE was 5.4% and remained stable throughout the study period (<i>p</i> = 0.09), while hemorrhagic events = 5.6%) showed a significant upward trend (<i>p</i> = 0.01). Cerebrovascular accidents, central venous catheter insertion, and protein calorie malnutrition (PCM) were significant predictors of both VTE and hemorrhage. PCM demonstrated a dose-dependent relationship with both complications. VTE was associated with a 33.5% increase in length of stay (LOS) and a 35% increase in cost of care (COC). Hemorrhage was associated with 23.2% increase in LOS and 32.6% increase in COC. Only hemorrhagic events were independently associated with increased mortality (adjusted OR 2.88, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The incidence of VTE in hospitalized leukemia patients has remained stable while hemorrhagic complications have increased significantly. Nutritional status represents a potentially modifiable risk factor for both VTE and bleeding complications. The competing risk between thrombosis and hemorrhage varies with age and nutritional status, suggesting the need for nuanced thromboprophylaxis strategies in this vulnerable population.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12293792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endothelial Damage in Sepsis: The Interplay of Coagulopathy, Capillary Leak, and Vasoplegia-A Physiopathological Study.","authors":"Gianni Turcato, Arian Zaboli, Lucia Filippi, Alessandro Cipriano, Paolo Ferretto, Michael Maggi, Fabrizio Lucente, Massimo Marchetti, Lorenzo Ghiadoni, Christian J Wiedermann","doi":"10.3390/clinpract15070120","DOIUrl":"10.3390/clinpract15070120","url":null,"abstract":"<p><p><b>Background:</b> Sepsis remains a leading cause of mortality worldwide, and understanding endothelial damage is crucial for improving patient outcomes. Endothelial dysfunction in sepsis contributes to coagulopathy, increased capillary permeability, and vasoplegia, but the interplay between these processes remains underexplored. The study aims to evaluate the clinical relationship between those factors due to sepsis-induced endothelial damage. <b>Methods:</b> A prospective single-center study on 75 community-acquired septic patients admitted to an Intermediate Care Unit. The Sepsis-Induced Coagulopathy (SIC) score, serum albumin (as a surrogate for capillary leak), and Total Peripheral Resistance Index (TPRI) (as a surrogate for vasoplegia) were assessed. Structural Equation Modeling (SEM) explored the relationship between variables, hypothesizing a common latent factor (endothelial damage). Principal Component Analysis assessed the shared variance among variables. <b>Results:</b> The mean SIC score was 3.4 (SD 1.3), with 44% of patients affected. TPRI and albumin had mean values of 1954 (SD 738) and 2.58 (SD 0.59), respectively, both negatively correlated with SIC: TPRI -0.263 (<i>p</i> = 0.023) and albumin -0.454 (<i>p</i> < 0.001). SEM showed SIC, albumin, and TPRI are associated with a latent factor (endothelial damage), explaining 68% of the variance (CFI = 1.000, RMSEA = 0.000). Albumin was inversely correlated (<i>p</i> = 0.004), and TPRI was significantly associated (<i>p</i> = 0.003). <b>Conclusions:</b> This pilot study suggests that coagulopathy, increased vascular permeability, and vasoplegia may be clinically interrelated manifestations of endothelial injury in sepsis. These findings support the feasibility of modeling a unified pathophysiological construct using accessible bedside data, potentially guiding future individualized approaches in sepsis management.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12293470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of the Quality of Care for Adults with Acute Asthma in the Emergency Department of a Tertiary Hospital: A 1-Year Follow-Up Study.","authors":"Carlos Martinez Rivera, Agnes Hernandez Biette, Anna Núñez Condominas, Ignasi Garcia Olive, María Basagaña Torrentó, Clara Padró Casas, Leandro Tapia Barredo, Antoni Rosell Gratacós","doi":"10.3390/clinpract15070116","DOIUrl":"10.3390/clinpract15070116","url":null,"abstract":"<p><p><b>Background/Objectives</b>: This study evaluates the adherence to guidelines for the management of asthma exacerbations in the ED, recommendations at discharge, and impact at a 1-year of follow-up. <b>Methods</b>: An observational study of 87 asthma patients who attended the ED during 2022 and were discharged within 24 h was carried out. Data before the ED admission, care in the ED, and discharge reports, as well as the clinical characteristics at follow-up, were recorded. The relationship between complete ED discharge reports and outcome at 1 year, and factors associated with new exacerbations were analyzed. <b>Results</b>: The mean age was 51 years, 80% of the patients were women, and 50% had severe asthma. Prior to ED admission, 58.8% of patients used ICS-LABA, 26.2% triple therapy, 31.8% had not been treated, and 51.2% had presented at least one exacerbation. On ED admission, PEF was measured in 21% of patients only, decreasing to 6.8% at 3 h. In the ED discharge reports, the use of systemic corticosteroids was recommended in 76.5% of the cases and ICS-LABA in 46.9%. However, complete ED discharge reports were recorded for only 18.2% of patients. A total of 6.7% of patients were referred to a primary care physician and 29.9% to a pneumologist. Complete ED discharge forms did not improve asthma control at follow-up or reduce new exacerbations. Exacerbations before ED admission (OR 2.49, 95% CI 1.47-4.22, <i>p</i> = 0.001) and the use of any asthma controller treatment (OR 1.84, 95% CI 1.84-507, <i>p</i> = 0.017) were associated with ≥2 exacerbations at follow-up. <b>Conclusions</b>: Contact with ED did not improve disease control or reduce exacerbations. It is necessary to optimize care before, during, and after exacerbations by developing integrated programs with primary care to improve asthma management.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12293119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Gallstones in Patients with Obesity After Bariatric Surgery in Northern Saudi Arabia: A Cross-Sectional Study.","authors":"Abdulrahman Omar A Alali, Abdualaziz Fayez Alhumidi Alanazi, Mohammed Abdulaziz M Albarghash, Rakan Nasser Abdullah Alruweli, Mohammed Bader H Alanazi, Ibrahim Farhan B Alanazi, Turkey Saleh H Alrowaily, Rakan Khalid Marzouq Alanazi, Baraah AbuAlsel, Fadih Nada M Alenezi, Rashad Qasem Ali Othman, Manal S Fawzy","doi":"10.3390/clinpract15070115","DOIUrl":"10.3390/clinpract15070115","url":null,"abstract":"<p><strong>Background/objectives: </strong>Gallstone formation (cholelithiasis) is a common and important consequence following bariatric surgery, though regional data from the Northern Border Region are limited. This study aimed to investigate the incidence and risk factors of gallstones in this population, with the goal of optimizing postoperative treatment and reducing morbidity.</p><p><strong>Methods: </strong>We conducted a cross-sectional study using a non-probability convenience sampling technique to recruit 509 participants with varying degrees of obesity. Four hundred and ten study participants underwent bariatric surgery, of whom 73 were excluded for preoperative cholelithiasis and/or cholecystectomy. Data were collected through a self-administered, pre-validated questionnaire distributed via various social media platforms. These data included demographics, type/timing of surgery, pre/postoperative BMI, medical history, use of gallstone prophylaxis, and gallstone outcomes. Logistic regression analysis was used to identify independent predictors of gallstone formation.</p><p><strong>Results: </strong>Postoperative cholelithiasis developed in 60.8% of patients, most commonly within the first postoperative year, with risk peaking between 7 and 12 months after surgery. Rapid and substantial postoperative weight loss, as reflected in a lower current BMI and a transition to normal or overweight status within one year, was significantly associated with an increased incidence of gallstones. Female sex (OR: 2.62, 95% CI: 1.38-4.98, <i>p</i> = 0.003) and non-use of gallstone prevention medication (OR: 4.12, 95% CI: 1.34-12.64, <i>p</i> = 0.013) were independent predictors of gallstone formation. A longer time since surgery (OR: 0.76, 95% CI: 0.63-0.91, <i>p</i> = 0.004) and a lower current BMI (OR: 0.48, 95% CI: 0.28-0.83, <i>p</i> = 0.008) were associated with a reduced risk. Smoking status and comorbidities were not significantly related to the risk of gallstones.</p><p><strong>Conclusions: </strong>Gallstone formation after bariatric surgery in this population is influenced by female sex, rapid postoperative weight loss, and lack of prophylactic medication, while the type of surgical procedure does not significantly affect risk. Focused monitoring and preventive strategies, particularly in high-risk groups, are recommended to reduce gallstone-related complications following bariatric surgery.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12293454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone Marrow Aplasia and Neutropenic Fever Following Azathioprine Dose Escalation in a TPMT-Deficient Patient with Crohn's Disease and Psoriatic Arthritis-A CARE-Compliant Case.","authors":"Krzysztof Wroński, Michał Tadeusz Holecki, Natalia Boguszewska, Marzena Skrzypczak-Zielińska, Jerzy Tadeusz Chudek","doi":"10.3390/clinpract15060114","DOIUrl":"10.3390/clinpract15060114","url":null,"abstract":"<p><p><b>Background:</b> Myelotoxicity, usually manifested by moderate leukopenia (particularly neutropenia), is a well-known adverse drug reaction to azathioprine (AZA) therapy. Thiopurine methyltransferase (<i>TMPT</i>) and nucleoside diphosphate-linked moiety X-type motif 15 (<i>NUDT15)</i> genotyping are not routinely performed in patients starting AZA therapy due to their low cost-effectiveness. Additionally, the concomitant use of xanthine oxidase inhibitors and 5-aminosalicylates may slow the metabolism of 6-mercaptopurine. <b>Case Description:</b> We describe a case of a 26-year-old Caucasian man with Crohn's disease and psoriatic arthritis treated with mesalazine and AZA (100 mg daily) who developed prolonged bone marrow aplasia and neutropenic fever after increasing the daily dose of AZA from 100 to 150 mg (from 44 to 66 mg/m²), without frequent total blood count monitoring. Discontinuation of AZA, multiple transfusions of red blood cells and platelet concentrate, filgrastim, empirical antibiotic therapy, and antiviral and antifungal prophylaxis were obtained after 11 days complete recovery of bone marrow aplasia. <b>Methods:</b> Genomic DNA genotyping of coding regions of <i>TPMT</i> (exons 2-9) and <i>NUDT15</i> (exons 1-3). <b>Results:</b> Heterozygous alleles in the untranslated region (c.460G>A and c.719A>G) associated with TPMT deficiency and a benign variant (c.*7G>A) in the 3'-UTR of <i>NUDT15</i> with no effect on enzyme activity were found. <b>Conclusions:</b> This case highlights the importance of monitoring the total blood count frequently during the first weeks of treatment with moderate-to-high doses of AZA. Furthermore, the interaction between AZA and mesalazine may play a significant role in the development of prolonged bone marrow aplasia.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Stenting with Medical Therapy Versus Medical Therapy Alone in Patients with Intracranial Atherosclerotic Stenosis: A Current Systematic Review and Meta-Analysis.","authors":"Khalid Bin Aziz, Hussam Alhathlol, Fahad Bin Aziz, Mohammed Alshammari, Mohammed Ali Alhefdhi, Abdulrahman M Alrasheed, Nawwaf Alfayez, Thamer S Alhowaish","doi":"10.3390/clinpract15060113","DOIUrl":"10.3390/clinpract15060113","url":null,"abstract":"<p><p><b>Background:</b> Intracranial atherosclerotic stenosis (ICAS) is a significant cause of ischemic stroke worldwide, with high recurrence rates despite optimal medical therapy. While endovascular stenting has been proposed as an adjunctive treatment, its clinical benefit remains controversial as a first line therapy. <b>Objective:</b> To evaluate the efficacy and safety of stenting plus medical therapy (STN+MT) compared to medical therapy alone (MT) in patients with symptomatic ICAS through a systematic review and meta-analysis of randomized controlled trials (RCTs). <b>Methods</b>: We systematically searched PubMed, Web of Science, the Cochrane Library, Embase, Scopus, and EBSCO for RCTs comparing STN+MT with MT in adult patients with symptomatic ICAS. Primary outcomes included transient ischemic attack (TIA), stroke, intracerebral hemorrhage (ICH), and death at 30 days and 1 year. Pooled risk ratios with 95% confidence intervals were calculated using random-effects or fixed-effects models as appropriate. Meta-regression was conducted to assess effect modification by study-level characteristics. <b>Results</b>: Four trials comprising 990 patients were included. STN+MT was associated with significantly higher 30-day risk of stroke and ICH compared to MT alone. No significant differences in TIA, stroke, ICH, or death were found at 1 year. Meta-regression revealed no significant effect modifiers, suggesting consistent findings across subgroups. <b>Conclusions</b>: Our meta-analysis consolidates the evidence that intracranial stenting as a first line therapy offers no significant advantage over medical therapy in preventing stroke in symptomatic ICAS, while it does pose added early risks. This holds true across different trials, patient demographics, and clinical scenarios examined. The consistency of this message across multiple RCTs provides a high level of evidence to guide practice. At present, aggressive medical therapy alone should be the default management for most patients. Endovascular intervention should be reserved for clinical trial settings or carefully selected salvage cases, until and unless new evidence emerges to change the risk-benefit calculus such as the promising use of balloon angioplasty in the BASIS trial.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation, Content Validity, and Reliability of the Spanish SE-OAM Questionnaire: Assessing Nursing Self-Efficacy in Oral Anticoagulant Therapy Management.","authors":"Juan Ramón de-Moya-Romero, Raquel Valera-Lloris, Elena Chover-Sierra, Laura Fernández-Puerta, Alexis Caballero-Bonafé, Antonio Martínez-Sabater","doi":"10.3390/clinpract15060111","DOIUrl":"10.3390/clinpract15060111","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Oral anticoagulant therapy (OAT) has been prescribed for over seventy years to prevent thromboembolic complications associated with various conditions. The emergence of direct-acting oral anticoagulants (DOACs) has reduced the use of vitamin K antagonists (VKAs), but specific clinical scenarios still necessitate VKAs. Nurses play a crucial role in managing OAT, and their self-efficacy is essential for optimal patient outcomes. This study aims to validate and adapt the Nursing Self-Efficacy for Oral Anticoagulant Therapy Management (SE-OAM) questionnaire to Spanish (SE-OAM-SV) to assess nurses' self-efficacy in managing OAT. <b>Methods:</b> A methodological design was employed to develop the validity and reliability of the SE-OAM-SV. The process included translation and back-translation, expert review, and a pilot study. Content validity was analyzed using the content validity index (CVI), modified kappa coefficient, and Aiken's V. A descriptive cross-sectional study was conducted with 100 nurses across Spain to test the SE-OAM-SV and identify comprehension issues. Internal consistency was assessed via Cronbach's alpha. <b>Results:</b> The translation process highlighted some items requiring clarification, which were resolved through expert consultation. The SE-OAM-SV demonstrated adequate content validity with a global CVI of 0.86. The pilot study revealed an average participant age of 41.3 years and 17.3 years of professional experience. The SE-OAM-SV showed high internal consistency with a Cronbach's alpha of 0.96. The average score of participants on the SE-OAM-SV was 56.8 points, indicating room for improvement in all aspects of the scale. <b>Conclusion</b>: The SE-OAM-SV is a reliable and valid tool for measuring nurses' self-efficacy in managing OAT in Spanish-speaking communities. This tool can facilitate the development of educational programs and public policies to enhance nurses' self-efficacy and improve patient outcomes. The availability of the SE-OAM-SV supports larger-scale studies and validation in other Spanish-speaking countries.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}