Clinics and Practice

16 pages, 939 KiB

Open AccessArticle

The Importance of Periodic Dental Control in the Oral Health Status of Elderly Patients

by Michael Janto, Raluca Iurcov, Cristian Marius Daina, Alina Cristiana Venter, Corina Lacramioara Suteu, Monica Sabau, Dana Badau and Lucia Georgeta Daina

Clin. Pract. 2023, 13(2), 537-552; https://doi.org/10.3390/clinpract13020050 - 18 Apr 2023

Cited by 1 | Viewed by 1668

Abstract

The aim of the present study was to evaluate the status of the elderly patient with oral pathology, comparing two groups of elderly patients, from the point of view of presentation for periodic dental control (regular and irregular). In carrying out the study, [...] Read more.

The aim of the present study was to evaluate the status of the elderly patient with oral pathology, comparing two groups of elderly patients, from the point of view of presentation for periodic dental control (regular and irregular). In carrying out the study, the following parameters were analyzed: the epidemiological profile of the group of patients; associated chronic diseases; dental hygiene; the accessibility of, and attendance at, dental health services; quality of life; and dental clinical diagnosis. Of the 120 elderly patients included in the study, only 25% present regularly for dental checkups. Increasing age leads to a reduction in the share of patients who regularly present themselves for dental checkups, and patients with higher education and those with higher incomes regularly visit the dentist. Associated chronic diseases are found in both groups; patients with regular checkups have a statistically significantly lower drug consumption for dental pain in the last month compared to those who present irregularly for checkups. A better achievement of dental hygiene is observed in patients who regularly see the dentist. It is alarming that we find patients (10% among those who do not visit the dentist regularly) who do not use a toothbrush and toothpaste, and approximately 40% of the patients enrolled in the study do not know which toothpaste they use. Approximately 40% of the interviewed patients indicate a lack of money as the main reason for attending the dentist only when necessary. Difficult access is mentioned by 10% of the group of patients who regularly visit the dentist and who come from rural areas. The reasons for visiting the dentist are different in the two groups: patients who regularly visit the dentist request caries treatment or prosthetic work, or they present with dental bleeding; patients with irregular checkups especially request emergency services such as toothache treatment, assistance with denture problems, and tooth extractions. When undergoing odontal and endodontic examination, 60% of the respondents who go to the dentist as required suffer from periodontal disease, and 50% of them suffer from class I and II edentation. The results of the study demonstrated that elderly patients who regularly attend periodic dental checkups have better self-reported and dentist-confirmed oral health status. Full article

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8 pages, 976 KiB

Open AccessArticle

Post-Exercise Ankle–Brachial Index Is Reduced in Healthy, Young Individuals at a Level Indicating Peripheral Artery Disease

by Karoline Holsen Kyte, Cecilie Lunde and Jonny Hisdal

Clin. Pract. 2023, 13(2), 529-536; https://doi.org/10.3390/clinpract13020049 - 17 Apr 2023

Cited by 1 | Viewed by 1281

Abstract

In young patients referred for exercise-induced pain in the legs, false positive tests are a potential problem for the post-exercise ankle–brachial index (ABI) test when using the current American Heart Association guidelines for diagnosing peripheral artery disease (PAD). The present study aimed to [...] Read more.

In young patients referred for exercise-induced pain in the legs, false positive tests are a potential problem for the post-exercise ankle–brachial index (ABI) test when using the current American Heart Association guidelines for diagnosing peripheral artery disease (PAD). The present study aimed to investigate post-exercise ABI in healthy young people, and to explore whether the current diagnostic criteria for pathological ABI should be revised. Forty-eight volunteers (18–30 years) were included. Resting examinations included ABI and ultrasound of the external iliac artery. Post-exercise examinations after a treadmill load included ABI and ultrasound of the external iliac artery; after 0 min and after 3 min. A total of 60.5% of the participants had a post-exercise decrease in ABI > 20%. A total of 6.5% showed a decrease in ankle systolic blood pressure >30 mmHg. No significant association was observed between a change in blood flow in the external iliac artery and a reduction in ABI post-exercise. Analyses of the ultrasound recordings showed no turbulence in the external iliac artery. According to the results, a 20% decrease in ABI post-exercise seems to be a physiological condition present in young people. We support the need for a reassessment of the criteria for diagnosing PAD. Full article

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9 pages, 737 KiB

Open AccessArticle

Investigation of the Quality of Life of Patients with Gastrointestinal Issues Treated in the Surgical Clinic of a Regional General Hospital in Greece

by Nikos Rikos, Chara Frantzeskaki, Maria Fragiadaki, Anna Kassotaki, Andreas Mpalaskas, Manolis Linardakis and Georgios Vasilopoulos

Clin. Pract. 2023, 13(2), 520-528; https://doi.org/10.3390/clinpract13020048 - 12 Apr 2023

Viewed by 1342

Abstract

As disorders of the gastrointestinal system are among the most prevalent, had a significant impact on patients’ quality of life (QoL). This study aimed to investigate the QoL of 83 patients treated in the surgical clinic of a regional general hospital in Crete-Greece. [...] Read more.

As disorders of the gastrointestinal system are among the most prevalent, had a significant impact on patients’ quality of life (QoL). This study aimed to investigate the QoL of 83 patients treated in the surgical clinic of a regional general hospital in Crete-Greece. They recruited from April-to-June 2021 using the 36-Item Short Form Survey scale (SF-36) and the Spielberger State-Trait Anxiety Inventory (STAI). Logistic regression analysis was performed to evaluate the QoL in relation to patients’ characteristics. The 50.6% were men with mean age of all the 55.0 years. Mental Health was found with highest mean score in relation to Role Physical (p < 0.001) and the Mental Component higher than the Physical (p = 0.029) while 68.7% of patients had high State Anxiety score. For each added year of age, the odds ratio of a moderate-to-high Physical Component was significantly decreased (OR = 0.95, p = 0.012) as married/partnered patients had higher odds of a moderate-to-high Mental Component (OR = 6.59, p = 0.006). Those with high state anxiety had lower odds of a moderate-to-high Mental Component (OR = 0.16, p = 0.005). Action is necessary on a clinical or individual level, guided by health professionals, to promote appropriate dietary choices and interventions for the avoidance of behaviors that could harm or endanger patients’ health. Full article

(This article belongs to the Special Issue Clinical Nursing and Quality of Healthcare)

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5 pages, 901 KiB

Open AccessCase Report

A Novel MSH6 Gene Variant in a Lynch Syndrome Patient with Lipomas

by Ana Paula Giannoni, Ina Sevic, Fernanda Parenti and Laura Alaniz

Clin. Pract. 2023, 13(2), 515-519; https://doi.org/10.3390/clinpract13020047 - 07 Apr 2023

Viewed by 1689

Abstract

Colorectal cancer is one of the most frequently occurring cancers today, with a large percentage of cases having a hereditary basis. Lynch syndrome is the most common cause of hereditary colorectal cancer. The genetic defect characteristics of this syndrome involve mutations in mismatch [...] Read more.

Colorectal cancer is one of the most frequently occurring cancers today, with a large percentage of cases having a hereditary basis. Lynch syndrome is the most common cause of hereditary colorectal cancer. The genetic defect characteristics of this syndrome involve mutations in mismatch repair (MMR) genes, which result in microsatellite instability. Early detection of the mutation can help evaluate the cancer risk and, consequently, a proper course of clinical management for the person harboring the mutation. Herein, we describe the first report of a c.1458dup (p.Glu487*) new mutation in a 53-year-old colorectal cancer patient with diagnosed Lynch syndrome. Additionally, the existence of lipomas in this patient and his family could be related to this syndrome. Further investigation may provide a possible visual clue that can indicate a need for genetic screening. Full article

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10 pages, 971 KiB

Open AccessReview

Palliative Care and Multi-Agent Systems: A Necessary Paradigm Shift

by Kimberley C. Brondeel, Sheina A. Duncan, Patrick M. Luther, Alexandra Anderson, Pranav Bhargava, Chizoba Mosieri, Shahab Ahmadzadeh, Sahar Shekoohi, Elyse M. Cornett, Charles J. Fox and Alan D. Kaye

Clin. Pract. 2023, 13(2), 505-514; https://doi.org/10.3390/clinpract13020046 - 03 Apr 2023

Viewed by 1812

Abstract

Palliative care is intended to relieve caregivers of physical, psychological, and even spiritual elements of care. One of the most prevalent issues facing this form of care is a lack of healthcare resources and structures to deal with an aging population. This aging [...] Read more.

Palliative care is intended to relieve caregivers of physical, psychological, and even spiritual elements of care. One of the most prevalent issues facing this form of care is a lack of healthcare resources and structures to deal with an aging population. This aging population is placing a strain on the healthcare system, prompting a need for a shift in system management. A potential answer to this issue may be the Multi-Agent System (MAS). This category of computerized networking system was created by programmers to gather relevant health information on a patient and allow for the system to act with other agents to decide the best course for disease management. It can also allow for a multidisciplinary healthcare team to make more informed plans of actions for their patients by providing accurate and up-to-date information resulting from a greater synergetic mesh. MASs could fulfill the demands of a rising chronic illness population and deliver high-quality care, indicating a major paradigm shift within the US. In this review, we will evaluate the aging population and contributing factors, palliative care and the need for the multi-agent system, and clinical considerations involving examples from healthcare systems both on and beyond US shores. Full article

(This article belongs to the Special Issue 2023 Feature Papers in Clinics and Practice)

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8 pages, 518 KiB

Open AccessOpinion

Metformin Sustained-Release and Vildagliptin Fixed-Dose Combination for Optimizing Glycemic Control: A Review with Real-World Case Reports

by Manoj Chawla, Purvi Chawla, Pratap Jethwani, Kiran Shah and Sanjay Reddy

Clin. Pract. 2023, 13(2), 497-504; https://doi.org/10.3390/clinpract13020045 - 28 Mar 2023

Viewed by 2348

Abstract

(1) Background: There is a high burden of poor glycemic control in the Indian population with type 2 diabetes mellitus (T2DM). Currently, the use of metformin sustained-release (SR)–vildagliptin fixed-dose combination (FDC) is very low as compared to metformin immediate-release (IR)–vildagliptin FDC which is [...] Read more.

(1) Background: There is a high burden of poor glycemic control in the Indian population with type 2 diabetes mellitus (T2DM). Currently, the use of metformin sustained-release (SR)–vildagliptin fixed-dose combination (FDC) is very low as compared to metformin immediate-release (IR)–vildagliptin FDC which is associated with higher adverse events (AEs). Here, we present real-world effectiveness of metformin SR–vildagliptin FDC treatment in patients with T2DM; (2) Methods: This retrospective analysis was carried out from the medical records of adult T2DM patients visiting a single study center in India (December 2020–February 2021). A total of 10 patients (aged ≥20 years) were treated with vildagliptin 50 mg and metformin SR 500 mg FDC for 15 days. The treatment response was assessed by the percentage of time spent in the target glucose range (TIR at baseline and 15 days after treatment); (3) Results: The glycated hemoglobin (HbA1c) levels at baseline varied between 6.5% to 12%. The glycemic control improved in 70% of patients (mean increase in TIR: 18.9%). Treatment adherence was 100%. No gastrointestinal symptoms or AEs were reported; (4) Conclusions: Early intervention with metformin SR–vildagliptin FDC in patients with T2DM can ensure therapy compliance in terms of superior efficacy along with safety and tolerability. Key summary points: Early initiation of combination therapy helps in early achievement of glycemic goals; Early initiation of metformin and vildagliptin FDC results in significant glycemic control with good tolerability and compliance; Metformin SR–vildagliptin FDC has lower adverse events, compared to metformin IR–vildagliptin FDC; A case series of ten patients with T2DM treated with metformin SR–vildagliptin FDC is presented to assess the real-world effectiveness of this combination. Full article

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10 pages, 808 KiB

Open AccessArticle

Psycho-Emotional Well-Being in Caregivers of People with Acquired Brain Injury: An Exploratory Study on the Human Immersion Model during the Omicron Wave

by Rosaria De Luca, Patrizia Pollicino, Carmela Rifici, Natale Mondo, Stefania Iorio, Angela Cassaniti, Donatella Ferrara, Angelo Caminiti, Fausto Famà, Mirjam Bonanno and Rocco Salvatore Calabrò

Clin. Pract. 2023, 13(2), 487-496; https://doi.org/10.3390/clinpract13020044 - 27 Mar 2023

Cited by 1 | Viewed by 1632

Abstract

The purpose of this study was to investigate the effects of a “human immersion model” (HIM) in improving psychological well-being in caregivers of patients with acquired brain injury (ABI) during the Omicron wave in Italy. Fifteen subjects affected by ABI, who attended our [...] Read more.

The purpose of this study was to investigate the effects of a “human immersion model” (HIM) in improving psychological well-being in caregivers of patients with acquired brain injury (ABI) during the Omicron wave in Italy. Fifteen subjects affected by ABI, who attended our intensive neurorehabilitation unit from January to March 2022 and their caregivers were submitted to the HIM. This novel approach consisted of “real” long-lasting meetings between the patients and their careers in a hospital setting (1–72 h meeting per week for 8 weeks). Each ABI caregiver was assessed through the administration of a short psychometric battery before starting the first immersion session with their family member and at the end of the HIM. We found significant changes in the caregivers’ scores analyzed for anxiety, as per SAS (p < 0.0007, d = 1.02), burden and stress (ZBI-22; p < 0.001, d = 0.65), and emotive intelligence (TEIQue-SF; p < 0.0007, d = 0.82). Our data suggest that the HIM may be useful to promote ABI caregivers’ psycho-emotional well-being in the context of critical periods such as the COVID-19 pandemic. Full article

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4 pages, 478 KiB

Open AccessCommunication

Possible Role of Carbocysteine Syrup in the Deflation of Percutaneous Endoscopic Gastrostomy Balloons

by Gabrio Bassotti and Danilo Castellani

Clin. Pract. 2023, 13(2), 483-486; https://doi.org/10.3390/clinpract13020043 - 23 Mar 2023

Viewed by 1319

Abstract

Percutaneous endoscopic gastrostomy is the method of choice to allow enteral access in patients requiring long-term enteral nutrition. However, although generally safe, percutaneous tube positioning may be plagued by several complications. Among these, the deterioration and/or deflation of balloons serving as internal bolster [...] Read more.

Percutaneous endoscopic gastrostomy is the method of choice to allow enteral access in patients requiring long-term enteral nutrition. However, although generally safe, percutaneous tube positioning may be plagued by several complications. Among these, the deterioration and/or deflation of balloons serving as internal bolster is particularly worrisome in that it may lead to gastrostomy cannulas dislocation. Of interest, such balloon deflation may occur in up to 30% of cases for apparently unexplained causes. Here, we provide a hypothesis that could explain some of these causes. Full article

(This article belongs to the Special Issue 2023 Feature Papers in Clinics and Practice)

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13 pages, 659 KiB

Open AccessReview

Telemedicine, E-Health, and Multi-Agent Systems for Chronic Pain Management

by Manar Ahmed Kamal, Zainab Ismail, Islam Mohammad Shehata, Soumia Djirar, Norris C. Talbot, Shahab Ahmadzadeh, Sahar Shekoohi, Elyse M. Cornett, Charles J. Fox and Alan D. Kaye

Clin. Pract. 2023, 13(2), 470-482; https://doi.org/10.3390/clinpract13020042 - 21 Mar 2023

Cited by 11 | Viewed by 4048

Abstract

Telemedicine, telehealth, and E-health all offer significant benefits for pain management and healthcare services by fostering the physician–patient relationship in otherwise challenging circumstances. A critical component of these artificial-intelligence-based health systems is the “agent-based system”, which is rapidly evolving as a means of [...] Read more.

Telemedicine, telehealth, and E-health all offer significant benefits for pain management and healthcare services by fostering the physician–patient relationship in otherwise challenging circumstances. A critical component of these artificial-intelligence-based health systems is the “agent-based system”, which is rapidly evolving as a means of resolving complicated or straightforward problems. Multi-Agent Systems (MAS) are well-established modeling and problem-solving modalities that model and solve real-world problems. MAS’s core concept is to foster communication and cooperation among agents, which are broadly considered intelligent autonomous factors, to address diverse challenges. MAS are used in various telecommunications applications, including the internet, robotics, healthcare, and medicine. Furthermore, MAS and information technology are utilized to enhance patient-centered palliative care. While telemedicine, E-health, and MAS all play critical roles in managing chronic pain, the published research on their use in treating chronic pain is currently limited. This paper discusses why telemedicine, E-health, and MAS are the most critical novel technologies for providing healthcare and managing chronic pain. This review also provides context for identifying the advantages and disadvantages of each application’s features, which may serve as a useful tool for researchers. Full article

(This article belongs to the Special Issue 2023 Feature Papers in Clinics and Practice)

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16 pages, 1513 KiB

Open AccessReview

Treatment with Testosterone Therapy in Type 2 Diabetic Hypogonadal Adult Males: A Systematic Review and Meta-Analysis

by Kajol Kumari, Rohan Kumar, Areeba Memon, Beena Kumari, Moniba Tehrim, Pooja Kumari, Muhammad Shehryar, Hamza Islam, Rabia Islam, Mahima Khatri, Satesh Kumar and Ajay Kumar

Clin. Pract. 2023, 13(2), 454-469; https://doi.org/10.3390/clinpract13020041 - 20 Mar 2023

Cited by 9 | Viewed by 3025

Abstract

Testosterone replacement therapy (TRT) has been used to treat hypogonadal males with type 2 diabetes mellitus (T2DM) for a long time, despite variable results. This meta-analysis examines TRT’s role in hypogonadal males with T2DM. The databases PubMed, Embase, and Google Scholar were searched [...] Read more.

Testosterone replacement therapy (TRT) has been used to treat hypogonadal males with type 2 diabetes mellitus (T2DM) for a long time, despite variable results. This meta-analysis examines TRT’s role in hypogonadal males with T2DM. The databases PubMed, Embase, and Google Scholar were searched for relevant RCTs and observational studies. Estimated pooled mean differences (MDs) and relative risks with 95% confidence intervals were used to measure the effects of TRT (CIs). When compared to the placebo, TRT improves glycemic management by significantly reducing glycated hemoglobin (HBA1c) levels (WMD = −0.29 [−0.57, −0.02] p = 0.04; I2 = 89.8%). Additionally, it reduces the homeostatic model assessment levels of insulin resistance (WMD = −1.47 [−3.14, 0.19]; p = 0.08; I2 = 56.3%), fasting glucose (WMD = −0.30 [−0.75, 0.15]; p = 0.19; I2 = 84.4%), and fasting insulin (WMD = −2.95 [−8.64, 2.74]; however, these results are non-significant. On the other hand, HBA1c levels are significantly reduced with TRT; in addition, total testosterone levels significantly increase with testosterone replacement therapy (WMD = 4.51 [2.40, 6.61] p = 0.0001; I2 = 96.3%). Based on our results, we hypothesize that TRT can improve glycemic control and hormone levels, as well as lower total cholesterol, triglyceride, and LDL cholesterol levels while raising HDL cholesterol in hypogonadal type 2 diabetes patients. To this end, we recommend TRT for these patients in addition to standard diabetes care. Full article

(This article belongs to the Special Issue 2023 Feature Papers in Clinics and Practice)

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12 pages, 235 KiB

Open AccessArticle

Teaching Deprescribing and Combating Polypharmacy in the Pharmacy Curriculum: Educational Recommendations from Thematic Analysis of Focus Groups

by Devin Scott, Alina Cernasev, Rachel E. Barenie, Sydney P. Springer and David R. Axon

Clin. Pract. 2023, 13(2), 442-453; https://doi.org/10.3390/clinpract13020040 - 14 Mar 2023

Cited by 2 | Viewed by 1330

Abstract

In the last two decades in the United States (US), the previous research has focused on medication optimization, including polypharmacy. Polypharmacy is associated with several negative outcomes, which may be resolved by deprescribing medications that are no longer necessary. Although deprescribing is a [...] Read more.

In the last two decades in the United States (US), the previous research has focused on medication optimization, including polypharmacy. Polypharmacy is associated with several negative outcomes, which may be resolved by deprescribing medications that are no longer necessary. Although deprescribing is a critical aspect of a pharmacist’s role, some studies have demonstrated that student pharmacists are less familiar with their future role in deprescribing. Thus, this study aimed to explore student pharmacists’ perceptions of deprescribing in the pharmacy curriculum. This qualitative study was conducted with student pharmacists enrolled in three Doctor of Pharmacy (Pharm.D.) programs in the US. The participants, all student pharmacists at the time of the study, were identified via an email requesting their voluntary participation in a focus group study. The focus groups were conducted via an online platform over three months in 2022, and recruitment continued until thematic saturation was obtained. Using thematic analysis, the corpus of the transcribed data was imported into Dedoose^®, a qualitative software that facilitated the analysis. Three themes emerged from the data: (1) the importance of deprescribing; (2) barriers to deprescribing; (3) education recommendations. The data highlight that the student pharmacists believe integrating deprescribing content into the clinical, didactic, and simulation education would help them overcome the identified obstacles. Colleges of pharmacy should consider emphasizing the importance of deprescribing in their curriculum, creating programs to assist future pharmacists in addressing the barriers to deprescribing, and adopting the suggested educational strategies to improve the deprescribing education that is offered. Full article

7 pages, 455 KiB

Open AccessOpinion

Population Dynamics, Plasma Cytokines and Platelet Centrifugation: Technical and Sociodemographic Aspects of ‘Ovarian Rejuvenation’

by E. Scott Sills and Seang Lin Tan

Clin. Pract. 2023, 13(2), 435-441; https://doi.org/10.3390/clinpract13020039 - 10 Mar 2023

Viewed by 1891

Abstract

While advanced reproductive technologies have attained remarkable increases in sophistication, success, and availability since the 1980s, clinicians always meet a therapeutic impasse when the ovarian reserve reaches exhaustion. Irrespective of fertility aspirations, the decline in and eventual collapse of ovarian estrogen output means [...] Read more.

While advanced reproductive technologies have attained remarkable increases in sophistication, success, and availability since the 1980s, clinicians always meet a therapeutic impasse when the ovarian reserve reaches exhaustion. Irrespective of fertility aspirations, the decline in and eventual collapse of ovarian estrogen output means that menopause arrives with tremendous physiologic changes and reduced overall productivity. Because more women are gaining in longevity or delaying the age at pregnancy, the number of affected patients has never been larger. As concerns regarding standard hormone replacement therapy and the limitations of IVF are confronted, a workable path to enable primordial germ cell recruitment and de novo oocyte development would be welcome. Proof-of-concept case reports and clinical studies on autologous activated platelet-rich plasma (PRP) or its condensed cytokine derivatives suggest a way to facilitate these goals. However, ovarian PRP faces vexing challenges that place ‘ovarian rejuvenation’ under caution as it enters this therapeutic space. Here, we review key features of experimental human ovarian stem cell isolation/handling and reaffirm the need to harmonize laboratory protocols. Recognizing the regenerative science borrowed from other disciplines, specimen centrifugation, platelet processing, and condensed plasma cytokine enrichment are highlighted here. As the refinement of this rejuvenation approach would promise to reprogram adult ovarian physiology, the disruption of established treatment paradigms for infertility, menopause, and perhaps overall women’s health seems likely. Emerging roles in reproductive biology and clinical practice are thus placed in a broader social and demographic context. Full article

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13 pages, 264 KiB

Open AccessArticle

The Psychological and Professional Burden Experienced by Nurses Who Worked in COVID-19 Clinics during the Pandemic: A Content Analysis

by Areti Stavropoulou, Maria Prasianaki, Dimitris Papageorgiou, Evridiki Kaba, Evdokia Misouridou, Chrysoula Dafogianni, Georgia Gerogianni and Martha Kelesi

Clin. Pract. 2023, 13(2), 422-434; https://doi.org/10.3390/clinpract13020038 - 09 Mar 2023

Cited by 1 | Viewed by 1798

Abstract

Introduction: Since the beginning of the pandemic, nurses have played a key role in providing care for COVID-19 patients. Infection risk and fear, use of personal protective equipment, and social isolation were related to high levels of stress and extreme psychological drain among [...] Read more.

Introduction: Since the beginning of the pandemic, nurses have played a key role in providing care for COVID-19 patients. Infection risk and fear, use of personal protective equipment, and social isolation were related to high levels of stress and extreme psychological drain among front-line healthcare providers. Aim: The aim of this study was to explore how front-line nurses experienced psychological and professional burdens during the coronavirus outbreak. Material and Methods: The study used a qualitative research design. Semi-structured interviews were applied as the method of data collection. Ten nurses from COVID-19 wards and units of two general public hospitals participated in the study. A content analysis approach was employed to analyze the data. Results: Data analysis revealed two main categories, namely: (A) front-line experience “From fear to empowerment”, and (B) caring and management “From powerlessness to adaptation”. Eight sub-categories were developed and included within the corresponding main categories. The study’s findings demonstrated that the pandemic caused significant psychological and professional strain on front-line nurses, with feelings of fear, anxiety, and uncertainty predominating. Nonetheless, the process of adaptation and adjustment brought about sentiments of self-actualization and empowerment. Conclusions: A thorough understanding of the psychological and professional burden experienced by the front-line nurses is crucial to ensure that nurses receive appropriate support and that quality care is sustained under highly demanding healthcare conditions. Full article

(This article belongs to the Special Issue Clinical Nursing and Quality of Healthcare)

12 pages, 1201 KiB

Open AccessArticle

A Conceptual Model to Strengthen Integrated Management of HIV and NCDs among NIMART-Trained Nurses in Limpopo Province, South Africa

by Nthuseni Sharon Murudi-Manganye, Lufuno Makhado and Leepile Alfred Sehularo

Clin. Pract. 2023, 13(2), 410-421; https://doi.org/10.3390/clinpract13020037 - 09 Mar 2023

Viewed by 1410

Abstract

Integrated management of human immune deficiency virus (HIV) and non-communicable diseases (NCDs) in primary health care facilities remains a challenge. Despite research that has been conducted in South Africa, it is evident that in Limpopo Province there are slits in the implementation thereof. [...] Read more.

Integrated management of human immune deficiency virus (HIV) and non-communicable diseases (NCDs) in primary health care facilities remains a challenge. Despite research that has been conducted in South Africa, it is evident that in Limpopo Province there are slits in the implementation thereof. There is a need to develop a conceptual model to guide in strengthening the clinical competence of nurse-initiated management of antiretroviral therapy (NIMART)-trained nurses to implement the integrated management of HIV and NCDs to improve clinical outcomes of patients with the dual burden of diseases in Limpopo Province, South Africa. This study aimed to develop a conceptual model to strengthen the implementation of integrated management of HIV and NCDs amongst NIMART nurses to improve clinical outcomes of patients with the dual burden of communicable and non-communicable diseases in Limpopo Province, South Africa. An explanatory, sequential, mixed-methods research design was followed. Data were collected from patient records and the skills audit of 25 Primary Health Care (PHC) facilities and from 28 NIMART trained nurses. Donabedian’s structure process outcome model and Miller’s pyramid of clinical competence provided a foundation in the development of the conceptual model. The study revealed a need to develop a conceptual model to strengthen the implementation of integrated HIV and NCDs implementation in PHC, as evidenced by differences in the management of HIV and NCDs. Conclusion: The study findings were conceptualised to describe and develop a model needed to strengthen the implementation of integrated management of HIV and NCDs amongst NIMART nurses working in PHC facilities. The study was limited to Limpopo Province; the model must be implemented in conjunction with the available frameworks to achieve better clinical outcomes. Full article

(This article belongs to the Special Issue Clinical Nursing and Quality of Healthcare)

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12 pages, 514 KiB

Open AccessArticle

Association of Depression and Anxiety with Cardiac Structural and Functional Characteristics in Heart Failure with Reduced and Mildly Reduced Ejection Fraction

by Timea Magdolna Szabo, Előd Ernő Nagy, Ádám Kirchmaier, Erhard Heidenhoffer, Hunor-László Gábor-Kelemen, Marius Frăsineanu and Attila Frigy

Clin. Pract. 2023, 13(2), 398-409; https://doi.org/10.3390/clinpract13020036 - 09 Mar 2023

Cited by 2 | Viewed by 1597

Abstract

Heart failure and mental health conditions frequently coexist and have a negative impact on health-related quality of life and prognosis. We aimed to evaluate depression and anxiety symptoms and to determine the association between psychological distress and cardiac parameters in heart failure with [...] Read more.

Heart failure and mental health conditions frequently coexist and have a negative impact on health-related quality of life and prognosis. We aimed to evaluate depression and anxiety symptoms and to determine the association between psychological distress and cardiac parameters in heart failure with reduced and mildly reduced ejection fraction. A total of 43 patients (33 male, mean age 64 ± 10 years) with heart failure and left ventricular systolic dysfunction (29 with HFrEF, 14 with HFmrEF) underwent comprehensive echocardiographic evaluation. All study participants completed questionnaires for the assessment of depression (PHQ-9), anxiety (GAD-7), and health-related quality of life (MLHFQ). Ten (34%) patients with HFrEF and two (14%) participants with HFmrEF had moderate-to-severe depression symptoms. Significant anxiety symptoms were more frequent in HFrEF (10 vs. 2 patients; 34% vs. 14%). Poor quality of life was also more common among patients with HFrEF (17 vs. 5 patients; 59% vs. 36%), showing higher MLHFQ scores (p = 0.009). Moreover, PHQ-9, GAD-7, and MLHFQ scores showed significant correlations between NYHA class severity and the presence of peripheral edema. The symptoms of dyspnea correlated with both PHQ-9 and MLHFQ scores. Significant correlations were observed between MLHFQ scores and a large number of clinical features, such as exercise capacity, 6MWT distance, the need for furosemide, echocardiographic parameters (LVEDVI, LVESVI, LVEF, LVGLS, SVI), and laboratory variables (albumin, GFR, NT-proBNP). In the multiple linear regression analysis, dyspnea proved to be a significant predictor of higher PHQ-9 and MLHFQ scores, even after adjusting for potential confounders. High symptom burden due to psychological distress is common among patients with HFrEF and HFmrEF. More efficient control of congestion may improve depression, anxiety symptoms, and health-related quality of life. Full article

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14 pages, 661 KiB

Open AccessReview

Potential Role of Global Longitudinal Strain in Cardiac and Oncological Patients Undergoing Cardio-Oncology Rehabilitation (CORE)

by Gianluigi Cuomo, Francesca Paola Iannone, Anna Di Lorenzo, Crescenzo Testa, Michele Ciccarelli, Elio Venturini, Arturo Cesaro, Mario Pacileo, Ercole Tagliamonte, Antonello D’Andrea, Carmine Vecchione, Carlo Vigorito and Francesco Giallauria

Clin. Pract. 2023, 13(2), 384-397; https://doi.org/10.3390/clinpract13020035 - 07 Mar 2023

Cited by 2 | Viewed by 2043

Abstract

Although shown to be effective in improving survival and quality of life in patients with cancer, some treatments are well-known causes of cardiotoxicity, such as anthracyclines, monoclonal antibodies against human epidermal growth factor receptor 2 (HER2) and radiotherapy. To prevent cardiovascular disease (CVD) [...] Read more.

Although shown to be effective in improving survival and quality of life in patients with cancer, some treatments are well-known causes of cardiotoxicity, such as anthracyclines, monoclonal antibodies against human epidermal growth factor receptor 2 (HER2) and radiotherapy. To prevent cardiovascular disease (CVD) in patients living with cancer, cardiologists and oncologists promoted the development of cardio-oncology, an interdisciplinary field which aims to further improving life expectancy in these patients. Cardio-oncology rehabilitation (CORE), through correction of risk factors, prescription of drug therapies and structured exercise programs, tries to improve symptoms, quality of life, cardiorespiratory fitness (CRF) and survival in patients with cancer. Different imaging modalities can be used to evaluate the real effectiveness of exercise training on cardiac function. Among these, the global longitudinal strain (GLS) has recently aroused interest, thanks to its high sensitivity and specificity for cardiac dysfunction detection due to advanced ultrasound programs. This review summarizes the evidence on the usefulness of GLS in patients with cancer undergoing cardiac rehabilitation programs. Full article

(This article belongs to the Special Issue 2023 Feature Papers in Clinics and Practice)

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12 pages, 514 KiB

Open AccessReview

The Importance of Psychometric and Physical Scales for the Evaluation of the Consequences of Scars—A Literature Review

by Gabriel Mihai Mekeres, Camelia Liana Buhaș, Andrei Nicolae Csep, Corina Beiușanu, Gineta Andreescu, Paula Marian, Cornel Dragoș Cheregi, Radu Fodor and Felicia Manole

Clin. Pract. 2023, 13(2), 372-383; https://doi.org/10.3390/clinpract13020034 - 03 Mar 2023

Cited by 12 | Viewed by 1904

Abstract

Background: Scars affect patients after trauma, burns, or surgical procedures and can generate both physical and psychosocial changes. The aesthetic damage represents the modification of a person’s physical appearance, in its bodily integrity, causing numerous sufferings and determining social or economic consequences. The [...] Read more.

Background: Scars affect patients after trauma, burns, or surgical procedures and can generate both physical and psychosocial changes. The aesthetic damage represents the modification of a person’s physical appearance, in its bodily integrity, causing numerous sufferings and determining social or economic consequences. The aim of this research is to evaluate the advantages and disadvantages offered by the available psychosocial and physical scar scales in assessing the physical, aesthetic, psychosocial, and juridical consequences of scars. This will aid to inform medical examiners about the most valued existing scales to allow them to select the most appropriate instrument to manage their patient. Methods: A broad search of relevant scientific studies on the psychosocial determinants of post-traumatic and surgical scars was conducted by using the following international database tools: PsycINFO, MedLine Social Science Index, Scopus, Web of Science, published from 1960 until 2022. Results: We analyzed 63 scientific studies to assess the advantages and limits of several psychometric and physical scar evaluation scales. Conclusions: The researchers analyzed in this review highlight the advantages and limitation of existing instruments, evidencing the demand for future scar evaluation instruments and a scar-assessing algorithm that takes into account the physical, aesthetic, psychosocial, and legal consequences of scars. Full article

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5 pages, 1091 KiB

Open AccessCommunication

Seborrheic Keratosis Caused by Human Papillomavirus Type 20 Ameliorated by Zinc Oxide Ointment

by Makoto Kondo, Yoshiaki Matsushima, Takehisa Nakanishi, Shohei Iida, Koji Habe and Keiichi Yamanaka

Clin. Pract. 2023, 13(2), 367-371; https://doi.org/10.3390/clinpract13020033 - 24 Feb 2023

Cited by 1 | Viewed by 6104

Abstract

A 91-year-old woman visited our department with scattered small nodule lesions and multiple pules or plaques with a stuck-on appearance. The lesions were intractable and resistant to several treatments. Immunodeficiency was excluded by examinations including a CT scan, white blood cell (WBC) counts, [...] Read more.

A 91-year-old woman visited our department with scattered small nodule lesions and multiple pules or plaques with a stuck-on appearance. The lesions were intractable and resistant to several treatments. Immunodeficiency was excluded by examinations including a CT scan, white blood cell (WBC) counts, natural killer and neutrophil function assays, and IgG titers against human papillomavirus (HPV) 20. HPV20 was identified using the PCR method. The finding of the skin biopsy showed an irritated type of feature of seborrheic keratosis. Additionally, immunohistochemical staining of the lesion revealed that both TNF-α and IFN-ɤ were produced at the skin lesions. The patient‘s serum zinc level was slightly low. We noticed that zinc deficiency has been reported to decrease the cytotoxic activity of natural killer cells, which play an important role in eliminating virus-infected cells and tumor cells. Finally, zinc oxide ointment was found to improve the lesions dramatically. HPV20 causes tumors only in immunodeficient patients or in patients with epidermodysplasia verruciformis (EV). In EV, EVER1- or EVER2-encoding membrane proteins, of which are related to zinc transport protein-1 expressed on the membrane of the endoplasmic reticulum, were mutated, leading to increased susceptibility to various viral and bacterial infections due to the decreased intracellular zinc concentration. We speculated that the reduction in local zinc concentration was ameliorated by using zinc oxide ointment, resulting in the recovery from HPV20 infection. Full article

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10 pages, 255 KiB

Open AccessCommunication

Measuring Importance of Physical Self-Care Behavior in Patients with Heart Failure: Validation and Reliability Analysis of 14-item IPSC Scale

by Athanasia Tsami, Ioannis Koutelekos, Georgia Gerogianni, Niki Pavlatou, Antonia Kalogianni, Theodore Kapadohos, Georgia Toulia and Maria Polikandrioti

Clin. Pract. 2023, 13(2), 357-366; https://doi.org/10.3390/clinpract13020032 - 24 Feb 2023

Viewed by 1563

Abstract

Introduction: Heart failure (HF) is a complex clinical syndrome associated with increased disability, morbidity and mortality globally. HF is characterized by recurrent exacerbations and a high rate of hospital readmissions. Self-care is a crucial component of treatment. The way patients assess the importance [...] Read more.

Introduction: Heart failure (HF) is a complex clinical syndrome associated with increased disability, morbidity and mortality globally. HF is characterized by recurrent exacerbations and a high rate of hospital readmissions. Self-care is a crucial component of treatment. The way patients assess the importance of self-care may shed light on planning effective individualized interventions. The aim of this study was to conduct a validity and reliability analysis of the new 14-item IPSC scale, which measures how important HF patients consider their physical self-care behavior (IPSC, Importance of Physical Self-Care). Material and Methods: The 14-item IPSC scale was created by the researchers to explore how important HF patients consider their physical self-care behavior. The validation of the IPSC scale included face and content validity, construct validity, internal consistency, repeatability and discriminant validity. Patients’ characteristics were also included. Results: In the present study, 52 hospitalized HF patients were enrolled, of whom 55.8% were female, 34.6% above 70 years old, 48.1% of NYHA class III and 32.7% suffered this illness from 6 to 10 years. The total IPSC score had a possible range of 14–56, with higher scores indicating a low importance of self-care. The descriptive statistics in the IPSC scale showed a mean score of 27.9 ± 4.9 and a median score of 29, indicating that HF patients evaluated self-care behavior as moderately important. All items were found to be statistically significantly correlated with total scale scores (p ≤ 0.05), with correlation coefficients rho > 0.250, indicating moderate to strong correlations and meaning that all items are important in the calculation of the final score (construct validity). The internal consistency of the items that constituted the total score was found to be high (Cronbach’s a > 0.7). Furthermore, it was found that scores had high repeatability (p ≤ 0.001 and ICCs > 0.7). Regarding discriminant validity, a statistically significant association was observed between the importance of physical self-care behavior and both years suffering the illness (p = 0.007) and the NYHA class (p = 0.030). Conclusion: The 14-item IPSC scale is a reliable instrument that help nurses in clinical settings to gain a better and prompt understanding of the importance which patients invest in their physical self-care behavior. Full article

(This article belongs to the Special Issue Clinical Nursing and Quality of Healthcare)

10 pages, 598 KiB

Open AccessBrief Report

A Survey of Saudi General Practitioners on the Use of Thromboprophylaxis Guidelines and Risk Assessment Tools in Atrial Fibrillation

by Mohammed Ibrahim Alnami, Ali Mansoor Alsalim, Ruwaida Faisal Alhakeem, Bushra Abdulrahman Al-Somali, Haitham Ali Bahkali, Hanaa Ali Alhabshi, Hailah Talaq Alotaibi, Rahma Abdulrazzaq Alqallaf and Sheraz Ali

Clin. Pract. 2023, 13(2), 347-356; https://doi.org/10.3390/clinpract13020031 - 23 Feb 2023

Viewed by 1697

Abstract

Clinical practice guidelines advise patients with atrial fibrillation who are at risk for stroke to undergo thromboprophylaxis with oral anticoagulants. However, it is noted that guidelines are not always followed. We sought to learn how Saudi Arabian general practitioners (GPs) self-reported using risk [...] Read more.

Clinical practice guidelines advise patients with atrial fibrillation who are at risk for stroke to undergo thromboprophylaxis with oral anticoagulants. However, it is noted that guidelines are not always followed. We sought to learn how Saudi Arabian general practitioners (GPs) self-reported using risk assessment tools and atrial fibrillation clinical practice guidelines created by cardiology associations, as well as how GPs felt about the resources that were available. Through the use of a self-administered questionnaire, we carried out a cross-sectional survey. A total of two-hundred GPs participated in the study. The guidelines were frequently used when a clinical decision regarding anticoagulation therapy appeared difficult (n = 57, 28.4%). The most predominant strengths of participants’ chosen clinical guidelines were clear recommendations (n = 56, 27.9%), easy-to-follow algorithms (n = 39, 16.9%), detailed recommendations supported by evidence (n = 34, 16.9%), and online availability (n = 27, 13.4%). Many respondents said they used a formal stroke risk assessment tool in addition to their clinical judgment as a GP for most decisions (60%). Most respondents preferred using the CHA2DS2-VASc (n = 106, 52.7%), CHA2DS2-VA (n = 45, 22.4%), CHADS2 (n = 35, 17.4%), and GARFIELD (n = 14, 7.0%). HAS-BLED (n = 100, 49.8%) and HEMORR2HAGES (n = 50, 24.9%) were the most frequently utilized formal tools for assessing the risk of bleeding among GPs. Over half of the participants referred to guidelines when deciding thromboprophylaxis in patients with atrial fibrillation. Additionally, many respondents used formal procedures for assessing the risks of bleeding and stroke in addition to their clinical judgement in their roles as GPs. The guideline was assessed as being extremely helpful overall by GPs who used it to make thromboprophylaxis decisions. Full article

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21 pages, 4037 KiB

Open AccessReview

Carcinogenic Effects of Areca Nut and Its Metabolites: A Review of the Experimental Evidence

by Kalpani Senevirathna, Roshan Pradeep, Yovanthi Anurangi Jayasinghe, Shalindu Malshan Jayawickrama, Rasika Illeperuma, Saman Warnakulasuriya and Ruwan Duminda Jayasinghe

Clin. Pract. 2023, 13(2), 326-346; https://doi.org/10.3390/clinpract13020030 - 21 Feb 2023

Cited by 7 | Viewed by 6017

Abstract

Oral cancers (OC) are among the most frequent malignancies encountered in Southeast Asia, primarily due to the prevalent habit of betel quid (BQ) and smokeless tobacco use in this region. Areca nut (AN), the primary ingredient in BQ, contains several alkaloids, including arecoline, [...] Read more.

Oral cancers (OC) are among the most frequent malignancies encountered in Southeast Asia, primarily due to the prevalent habit of betel quid (BQ) and smokeless tobacco use in this region. Areca nut (AN), the primary ingredient in BQ, contains several alkaloids, including arecoline, arecaidine, guvacoline, and guvacine. These have been associated with both the AN abuse liability and carcinogenicity. Additionally, variations in AN alkaloid levels could lead to differences in the addictiveness and carcinogenic potential across various AN-containing products. Recent studies based on animal models and in vitro experiments show cellular and molecular effects induced by AN. These comprise promoting epithelial-mesenchymal transition, autophagy initiation, tissue hypoxia, genotoxicity, cytotoxicity, and cell death. Further, clinical research endorses these undesired harmful effects in humans. Oral submucosal fibrosis, a potentially malignant disease of the oral cavity, is predominantly reported from the geographical areas of the globe where AN is habitually chewed. OC in chronic AN users presents a more aggressive phenotype, such as resistance to anti-cancer drugs. The available evidence on the carcinogenicity of AN based on the findings reported in the recently published experimental studies is discussed in the present review. Full article

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Clin. Pract., Volume 13, Issue 2 (April 2023) – 21 articles

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