Clinics and Practice最新文献

{"title":"Immunosuppression and Outcomes in Patients with Cutaneous Squamous Cell Carcinoma of the Head and Neck.","authors":"Doriana Iancu, Ana Fulga, Doina Vesa, Iuliu Fulga, Dana Tutunaru, Andrei Zenovia, Alin Ionut Piraianu, Elena Stamate, Corina Sterian, Florentin Dimofte, Mihail Alexandru Badea, Alin Laurentiu Tatu","doi":"10.3390/clinpract15010021","DOIUrl":"10.3390/clinpract15010021","url":null,"abstract":"<p><p>Cutaneous squamous scell carcinoma (cSCC) is a frequent non-melanoma skin cancer that originates from keratinocytes with increased prevalence. cSCC can be either in situ, as in Bowen's disease, or extended. Advanced age, accumulated sun exposure, light pigmentation, and prior skin cancer diagnosis are all significant risk factors for cSCC. Although most cSCCs can be treated surgically, some recur and metastasize, resulting in death. The role of immune status is not yet determined in the prognosis of these patients. <b>Objective</b>. Immunosuppressed patients are more likely to develop cSCC, which is often characterized by more aggressive, multifocal lesions. This study aimed to determine the risks of mortality in patients with cSCC and immunosuppression versus non immunosuppression and to compare variations in overall survival based on different clinical features. <b>Method</b>. We evaluated clinical cases of patients at \"Sfantul Apostol Andrei\" Emergency Hospital of Galati, Romania, from 1 March 2018 to 1 April 2024. Subjects in the trial had to be at least 18 years old and have a pathologically confirmed diagnosis of cutaneous head and neck squamous cell carcinoma (cHNSCC). We divided the patients into two different categories based on whether they had immunosuppression. <b>Results.</b> In this cohort of 68 subjects with cSCC, patients with immunosuppression had significantly lower overall survival, as well as lower three- and five-year survival rates compared with those without immunosuppression, even after adjustment for age, sex, stage, and previous surgical treatment. The median survival time for immunosuppressed individuals ranged from 11 to 21 months, varying based on their particular characteristics, and most critically, on the presence of other malignancies, while that of immunocompetent patients ranged from 18 to 51 months. In addition, immune-deficient patients with early-stage disease had a 21-month median survival rate that changed to11 months for advanced-stage cases. In a similar manner, immunocompetent patients with early-stage cancer had a significantly better median survival than those withadvancedstages,43 versus 18months. Our results indicate that immunosuppression is a distinct risk factors associated with a less favorable outcome in patients with cHNSCC.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034471","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":"Evaluating the Efficacy of Combined Intravaginal Estriol Therapy and Kegel Exercises in Managing Menopausal Atrophic Vulvovaginitis.","authors":"Lucian Șerbănescu, Vadym Rotar, Dragoș Brezeanu, Sebastian Mirea, Elena-Valentina Ionescu, Paris Ionescu","doi":"10.3390/clinpract15010020","DOIUrl":"10.3390/clinpract15010020","url":null,"abstract":"<p><p><b>Background</b>: This is a prospective study. Atrophic vulvovaginitis (VVA), a prevalent condition resulting from estrogen deficiency after the menopause, is characterized by symptoms such as vaginal dryness, itching, burning, dyspareunia, and urinary discomfort. Standard treatment involves systemic estrogen replacement therapy (HRT) and localized estrogen treatments, such as estriol. However, many women with moderate-to-severe VVA may not fully benefit from estrogen therapy alone. Non-hormonal adjunctive treatments, such as pelvic floor exercises (e.g., Kegel exercises), are being explored to enhance clinical outcomes. <b>Objectives</b>: This study investigates the combined effect of local estriol therapy and Kegel exercises in improving VVA symptoms in postmenopausal women. <b>Methods</b>: Fifty postmenopausal women diagnosed with VVA were enrolled and divided into three severity groups: mild, moderate, and severe. All participants received estriol therapy (0.5 mg vaginal tablets daily for 10 days each month) for the first three months. Following this, Kegel exercises were introduced for an additional three-month period, alongside continued estriol therapy. Symptom improvement was evaluated after six months, with outcomes categorized as complete remission, partial remission, or no remission. <b>Results</b>: Significant improvements in symptom remission were observed, particularly in the moderate and severe groups. In the mild VVA group, 81.82% achieved complete remission with combined therapy compared to 68.18% with estriol alone. In the severe group, complete remission was observed in 40% of patients receiving combined therapy compared to 20% with estriol therapy alone. These findings suggest that Kegel exercises enhance the effectiveness of estriol by improving local blood circulation, which facilitates better estrogen absorption and distribution. <b>Conclusions</b>: The addition of Kegel exercises to local estriol therapy significantly improves symptom remission rates, especially in moderate and severe VVA cases. This approach offers a promising strategy for managing postmenopausal VVA, particularly in cases that do not fully respond to estrogen therapy alone.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034380","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":"Artificial Intelligence in Cardiac Surgery: Transforming Outcomes and Shaping the Future.","authors":"Vasileios Leivaditis, Eleftherios Beltsios, Athanasios Papatriantafyllou, Konstantinos Grapatsas, Francesk Mulita, Nikolaos Kontodimopoulos, Nikolaos G Baikoussis, Levan Tchabashvili, Konstantinos Tasios, Ioannis Maroulis, Manfred Dahm, Efstratios Koletsis","doi":"10.3390/clinpract15010017","DOIUrl":"10.3390/clinpract15010017","url":null,"abstract":"<p><p><b>Background:</b> Artificial intelligence (AI) has emerged as a transformative technology in healthcare, with its integration into cardiac surgery offering significant advancements in precision, efficiency, and patient outcomes. However, a comprehensive understanding of AI's applications, benefits, challenges, and future directions in cardiac surgery is needed to inform its safe and effective implementation. <b>Methods:</b> A systematic review was conducted following PRISMA guidelines. Literature searches were performed in PubMed, Scopus, Cochrane Library, Google Scholar, and Web of Science, covering publications from January 2000 to November 2024. Studies focusing on AI applications in cardiac surgery, including risk stratification, surgical planning, intraoperative guidance, and postoperative management, were included. Data extraction and quality assessment were conducted using standardized tools, and findings were synthesized narratively. <b>Results:</b> A total of 121 studies were included in this review. AI demonstrated superior predictive capabilities in risk stratification, with machine learning models outperforming traditional scoring systems in mortality and complication prediction. Robotic-assisted systems enhanced surgical precision and minimized trauma, while computer vision and augmented cognition improved intraoperative guidance. Postoperative AI applications showed potential in predicting complications, supporting patient monitoring, and reducing healthcare costs. However, challenges such as data quality, validation, ethical considerations, and integration into clinical workflows remain significant barriers to widespread adoption. <b>Conclusions:</b> AI has the potential to revolutionize cardiac surgery by enhancing decision making, surgical accuracy, and patient outcomes. Addressing limitations related to data quality, bias, validation, and regulatory frameworks is essential for its safe and effective implementation. Future research should focus on interdisciplinary collaboration, robust testing, and the development of ethical and transparent AI systems to ensure equitable and sustainable advancements in cardiac surgery.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034140","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 Relevance of the Virchow Node and Virchow Triad in Renal Cancer Diagnosis.","authors":"Luiza-Roxana Dorobantu-Lungu, Viviana Dinca, Andrei Gegiu, Dan Spataru, Andreea Toma, Luminita Welt, Mihaela Florentina Badea, Constantin Caruntu, Cristian Scheau, Ilinca Savulescu-Fiedler","doi":"10.3390/clinpract15010018","DOIUrl":"10.3390/clinpract15010018","url":null,"abstract":"<p><p><b>Background:</b> The purpose of this article is to overview the clinical significance of left supraclavicular adenopathy and review the etiology of inferior vena cava (IVC) thrombosis, starting from a presentation of a rare case of renal cell carcinoma (RCCs) with Xp11.2 translocation involving TFE3 gene fusion. This article also aims to review the literature to understand the characteristics of this rare type of renal tumor. Renal cell carcinoma (RCC) associated with Xp11.2 translocation/gene fusion TFE3 is a rare subtype of kidney cancer that was classified in 2016 as belonging to the family of renal carcinomas with MiT gene translocation (microphthalmia-associated transcription factor). The prognosis for these kidney cancers is poorer compared to other types. <b>Methods:</b> We present a case of a 66-year-old man with Virchow-Troisier adenopathy during physical examination, which raises the suspicion of infra-diaphragmatic tumor. The echocardiography highlighted a heterogeneous mass in the right cardiac cavities, and the abdominal ultrasound exam revealed a solid mass at the upper pole of the left kidney. <b>Results:</b> Following computed tomography, magnetic resonance imaging, PET-CT, and histopathological and immunohistochemical examinations, the patient was diagnosed with renal carcinoma with Xp11.2 translocation and TFE3 gene fusion. <b>Conclusions:</b> IVC thrombosis is often associated with neoplastic disease due to the procoagulant state of these patients, the most common malignancies related to IVC thrombosis being represented by RCCs (38%), genitourinary cancers (25%), bronchus and lung cancers, retroperitoneal leiomyosarcoma, and adrenal cortical carcinoma. Imaging methods play a crucial role in differential diagnosis, allowing for the localization of the primary tumor and assessment of its characteristics.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034479","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":"Barriers and Factors Affecting Nursing Communication When Providing Patient Care in Jeddah.","authors":"Ruba M Alharazi, Rahaf J Abdulrahim, Alhanouf H Mazuzah, Reem M Almutairi, Hayfa Almutary, Aisha Alhofaian","doi":"10.3390/clinpract15010019","DOIUrl":"10.3390/clinpract15010019","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Effective communication between nurses and patients plays a crucial role in the delivery of quality healthcare services, especially when caring for patients from diverse cultural backgrounds. It fosters trust, understanding, and collaboration and contributes to better health outcomes and satisfactory nurse-patient relationships. The aim of the study is to assess the factors and barriers affecting nurses' communication when providing care for patients from diverse cultural backgrounds in Jeddah, Saudi Arabia. <b>Methods:</b> A cross-sectional quantitative descriptive design is used with an online survey instrument. The study involved registered nurses employed in Jeddah's hospitals. The study utilized a convenience sample for data collection and used the latest version of the statistical package for the social sciences (SPSS version 21) for data entry and analysis. <b>Results:</b> A study of 367 participants found significant barriers to nurse-patient communication, with a mean score of 2.84 on a three-point scale. Key challenges included language differences between nurses and patients with a mean score of 2.87, and cultural and religious differences with a mean score of 2.83 and 2.81, as well as nurses' communication skills, attitudes, and self-confidence and patients' awareness, attitudes, and resistance to communication. The multifaceted nature of these barriers emphasizes the need for targeted interventions to improve nurse-patient interactions and enhance care quality. <b>Conclusions:</b> The study highlights the impact of various factors on effective communication between nurses and patients, emphasizing the need for nurses to develop their communication skills and to receive adequate training from nursing officials.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034150","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":"Role of Cannabis in the Management of Chronic Non-Cancer Pain: A Narrative Review.","authors":"Lou'i Al-Husinat, Shrouq Obeidat, Saif Azzam, Yara Al-Gwairy, Fatima Obeidat, Sarah Al Sharie, Deema Haddad, Fadi Haddad, Martina Rekatsina, Matteo Luigi Giuseppe Leoni, Giustino Varrassi","doi":"10.3390/clinpract15010016","DOIUrl":"10.3390/clinpract15010016","url":null,"abstract":"<p><p>Chronic non-cancer pain, defined by the Center for Disease Control and Prevention (CDC) as lasting beyond three months, significantly affects individuals' quality of life and is often linked to various medical conditions or injuries. Its management is complex. Cannabis, containing the key compounds Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), has garnered interest for its potential in pain management, though it remains controversial due to its psychoactive effects and illegal status in many countries. THC provides pain relief by blocking nociceptive stimuli but has psychoactive effects and may potentially induce dependency. CBD has calming and antipsychotic properties. The inhalation of cannabis offers quick relief but poses respiratory risks, while its oral administrations are safer but act more slowly. Short-term cannabis use can impair cognition and motor skills, while long-term use may lead to dependency and cognitive decline, especially if used from an early age. Adverse effects vary by gender and prior use, with addiction mainly linked to THC and influenced by genetics. Despite these risks, patients often report more benefits, such as improved quality of life and reduced opioid use, although the evidence remains inconclusive. The legal landscape for medical cannabis varies globally, with some positive public health outcomes like reduced opioid-related issues in areas where it is legalized. Cannabis shows promise in managing chronic pain, but its psychoactive effects and dependency risks necessitate cautious use. Future research should prioritize long-term clinical trials to establish optimal dosing, efficacy, and safety, aiding in the development of informed guidelines for safe cannabis use in chronic pain management. This review examines the use of cannabis in managing chronic non-cancer pain, focusing on its benefits, drawbacks, mechanisms, delivery methods, and impact on quality of life.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034477","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":"Impact of Comorbidities on Prognosis and Treatment Outcomes in Elderly Patients with Hodgkin Lymphoma.","authors":"Dávid Tóthfalusi, Boglárka Dobó, Fanni Borics, László Imre Pinczés, Árpád Illés, Zsófia Miltényi","doi":"10.3390/clinpract15010015","DOIUrl":"10.3390/clinpract15010015","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Hodgkin lymphoma (HL) primarily affects young adults, but about 20% of cases occur in patients over the age of 60 years. Older individuals often have comorbidities and poorer functional status, which can affect treatment choices. <b>Methods</b>: We retrospectively analyzed data from HL patients over 60 years old who were treated at our institution between January 2010 and December 2023. We examined various factors, such as blood parameters (e.g., platelet count, lactate dehydrogenase (LDH), C-reactive protein (CRP)), PET/CT results and comorbidities (e.g., hypertension, diabetes, cardiovascular diseases), to assess their impact on overall survival (OS) and progression-free survival (PFS). Diagnostic efficiency was determined via receiver operating characteristic analysis, while the survival outcomes were evaluated using the Cox proportional hazards model. <b>Results</b>: A total of 35 patients with a median age of 68 were treated. The most common subtype was nodular sclerosis, and 72% of patients were in advanced stages at diagnosis. Treatment varied by age, with younger patients receiving ABVD and older patients (80-89) receiving brentuximab vedotin with dacarbazine. The survival of older patients, when analyzed by age groups, did not show a significant difference in the OS (<i>p</i> = 0.16) and PFS (<i>p</i> = 0.11). Comorbidities significantly worsened survival, with patients who scored > 7 on the Charlson Comorbidity Index (CCI) showing a 5-year PFS of 41.3%, compared to 91.3% for those who scored ≤ 7. Among the tested laboratory parameters, a platelet count over 310.5 G/L and an absolute lymphocyte count below 0.47 G/L were found to be independent risk factors for OS. Patients with neither or only one of these risk factors demonstrated a 5-year OS of 81.7%, whereas those presenting with both risk factors experienced a reduced 5-year OS of 70%. For PFS, a white blood cell count > 8.48 G/L, a platelet count > 310.5 G/L, and advanced age (>73.5 years) were identified as significant adverse prognostic factors. Patients with none of these risk factors had a 5-year PFS of 100%, whereas those with ≥ 1 risk factor had a 5-year PFS of 35.6%. <b>Conclusions</b>: Comorbidities play a greater role in prognosis than chronological age, emphasizing the need for personalized treatment approaches.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034474","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":"Decoding Urinary Tract Infection Trends: A 5-Year Snapshot from Central Portugal.","authors":"Francisco Rodrigues, Patrícia Coelho, Sónia Mateus, Armando Caseiro, Hatem Eideh, Teresa Gonçalves, Miguel Castelo Branco","doi":"10.3390/clinpract15010014","DOIUrl":"10.3390/clinpract15010014","url":null,"abstract":"<p><strong>Introduction: </strong>This study analyzes urinary tract infections (UTIs) in a hospital in Central Portugal over a five-year period, focusing on bacterial prevalence, patient demographics, and antibiotic resistance patterns. This investigation aims to provide insights that can guide improved infection control and treatment strategies.</p><p><strong>Methods: </strong>A total of 6161 positive urine cultures collected over five years were examined, with particular emphasis on 2019 due to a peak in infection rates. The analysis explored bacterial prevalence, demographic factors such as sex and clinical service origin, and antibiotic resistance. Special attention was given to hospitalized patients, especially those undergoing invasive procedures, due to their increased vulnerability to infection.</p><p><strong>Results: </strong>This study found that UTIs were more prevalent in female patients, reflecting anatomical susceptibilities. Hospitalized individuals, particularly those requiring invasive procedures, were at greater risk. The predominant bacteria were <i>Escherichia coli</i>, <i>Klebsiella pneumoniae</i>, and <i>Enterococcus faecalis</i>, with differences in prevalence by patient sex and service origin. Resistance to Imipenem in <i>E. coli</i> increased, raising concerns about last-resort treatments. However, resistance to other antibiotics declined, suggesting improvements due to recent stewardship measures. During the COVID-19 pandemic, overall antibiotic consumption decreased due to changes in clinical practices.</p><p><strong>Conclusion: </strong>The findings highlight the importance of strict infection control, targeted prevention measures, and rational antibiotic use to combat resistance. Ongoing surveillance and personalized treatment approaches are essential to improve UTI management and outcomes.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034434","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":"Emergency Airway Management: A Systematic Review on the Effectiveness of Cognitive Aids in Improving Outcomes and Provider Performance.","authors":"Raisa Chowdhury, Ostap Orishchak, Marco A Mascarella, Bshair Aldriweesh, Mohammed K Alnoury, Guillaume Bousquet-Dion, Jeffrey Yeung, Lily Ha-Nam P Nguyen","doi":"10.3390/clinpract15010013","DOIUrl":"10.3390/clinpract15010013","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Emergency airway management is a critical skill for healthcare professionals, particularly in life-threatening situations like \"cannot intubate, cannot oxygenate\" (CICO) scenarios. Errors and delays in airway management can lead to adverse outcomes, including hypoxia and death. Cognitive aids, such as checklists and algorithms, have been proposed as tools to improve decision-making, procedural competency, and non-technical skills in these high-stakes environments. This systematic review aims to evaluate the effectiveness of cognitive aids in enhancing emergency airway management skills among health professionals and trainees. <b>Methods:</b> A systematic search of MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov was conducted from February to March 2024. Studies examining the use of cognitive aids, such as the Vortex method, the ASA difficult airway algorithm, and visual airway aids, in emergency airway scenarios were included. Outcomes assessed included decision-making speed, procedural success rates, and non-technical skills. Data were extracted using standardized protocols, and the quality of included studies was appraised. <b>Results:</b> Five studies met inclusion criteria, encompassing randomized controlled trials, controlled studies, and mixed-methods research. Cognitive aids improved decision-making times (reduced by 44.6 s), increased procedural success rates, and enhanced non-technical skills such as teamwork and crisis management. Participants reported reduced anxiety and improved confidence levels (self-efficacy scores increased by 1.9 points). The Vortex method and visual cognitive aids demonstrated particular effectiveness in simulated scenarios. <b>Conclusions:</b> Cognitive aids significantly enhance emergency airway management skills, improving performance, reducing errors, and increasing provider confidence. Integrating cognitive aids into training programs has the potential to improve patient safety and outcomes. Further research is needed to validate these findings in clinical settings and optimize cognitive aid design and implementation.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034453","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":"Clinical Characteristics and Mortality-Associated Factors in Trauma Patients Undergoing Permanent Versus Temporary Tracheostomy.","authors":"Ahmad K Alnemare","doi":"10.3390/clinpract15010012","DOIUrl":"10.3390/clinpract15010012","url":null,"abstract":"<p><p><b>Objective:</b> This study evaluated the characteristics, outcomes, and mortality-associated factors in patients who underwent tracheostomy after traumatic injury to optimize clinical decision-making and patient care in critical trauma settings. <b>Materials and Methods:</b> A retrospective cohort analysis was conducted using the National Trauma Data Bank (NTDB) records from 2013 to 2016. This study included 41,630 adult trauma patients who underwent tracheostomy procedures. Data analysis included descriptive statistics, univariate comparisons, and multivariate logistic regression analyses. The study protocol adhered to STROBE guidelines for observational studies. <b>Results:</b> Analysis of the total cohort revealed that patients with tracheostomy demonstrated high rates of severe injuries (75.2%) and a notable comorbidity burden, including cardiovascular disorders (4.0%) and blood disorders (5.8%). Multivariate analysis revealed that mortality risk was independently associated with advanced age (OR 1.018, 95% CI 1.016-1.021), higher injury severity scores (OR 1.004, CI 1.002-1.007), female sex (OR 1.187, CI 1.078-1.308), and cardiovascular surgical intervention (OR 1.487, CI 1.350-1.638). Among the study population, 7.6% underwent permanent tracheostomy procedures, with these patients showing some distinct clinical characteristics in terms of injury severity and comorbidity profiles. <b>Conclusions:</b> This comprehensive analysis demonstrates the complex clinical characteristics and mortality-associated factors in trauma patients requiring tracheostomy. Key factors influencing survival outcomes include age, injury severity, sex, and cardiovascular surgical intervention. These findings provide valuable insights for clinical decision-making and risk assessment in trauma patients requiring tracheostomy. The observed differences between permanent and temporary tracheostomy patients warrant further investigation with more detailed timing and indication data.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034317","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}