Journal: Journal of Clinical Medicine

Abbreviation

J Clin Med

Publisher

MDPI

Journal Volumes

ISSN

2077-0383

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2019 - 201932020 - 202537
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Publications 1 - 10 of 40
  • Identification of Medication Prescription Errors and Factors of Clinical Relevance in 314 Hospitalized Patients for Improved Multidimensional Clinical Decision Support Algorithms
    Item type: Journal Article
    Russmann, Stefan; Martinelli, Fabiana; Jakobs, Franziska; et al. (2023)
    Journal of Clinical Medicine
    Potential medication errors and related adverse drug events (ADE) pose major challenges in clinical medicine. Clinical decision support systems (CDSSs) help identify preventable prescription errors leading to ADEs but are typically characterized by high sensitivity and low specificity, resulting in poor acceptance and alert-overriding. With this cross-sectional study we aimed to analyze CDSS performance, and to identify factors that may increase CDSS specificity. Clinical pharmacology services evaluated current pharmacotherapy of 314 patients during hospitalization across three units of two Swiss tertiary care hospitals. We used two CDSSs (pharmaVISTA and MediQ), primarily for the evaluation of drug-drug interactions (DDI). Additionally, we evaluated potential drug-disease, drug-age, drug-food, and drug-gene interactions. Recommendations for change of therapy were forwarded without delay to treating physicians. Among 314 patients, automated analyses by both CDSSs produced an average of 15.5 alerts per patient. In contrast, additional expert evaluation resulted in only 0.8 recommendations per patient to change pharmacotherapy. For clinical pharmacology experts, co-factors such as comorbidities and laboratory results were decisive for the classification of CDSS alerts as clinically relevant in individual patients in about 70% of all decisions. Such co-factors should therefore be used for the development of multidimensional CDSS alert algorithms with improved specificity. In combination with local expert services, this poses a promising approach to improve drug safety in clinical practice.
  • Personalized Treatment Suggestions: The Validity and Applicability of the Risk-Prevention-Index Social in Low Back Pain Exercise Treatments
    Item type: Journal Article
    Wippert, Pia-Maria; Puschmann, Anne-Katrin; Drießlein, David; et al. (2020)
    Journal of Clinical Medicine
    Background The back pain screening tool Risk-Prevention-Index Social (RPI-S) identifies the individual psychosocial risk for low back pain chronification and supports the allocation of patients at risk in additional multidisciplinary treatments. The study objectives were to evaluate (1) the prognostic validity of the RPI-S for a 6-month time frame and (2) the clinical benefit of the RPI-S. Methods In a multicenter single-blind 3-armed randomized controlled trial, n = 660 persons (age 18–65 years) were randomly assigned to a twelve-week uni- or multidisciplinary exercise intervention or control group. Psychosocial risk was assessed by the RPI-S domain social environment (RPI-SSE) and the outcome pain by the Chronic Pain Grade Questionnaire (baseline M1, 12-weeks M4, 24-weeks M5). Prognostic validity was quantified by the root mean squared error (RMSE) within the control group. The clinical benefit of RPI-SSE was calculated by repeated measures ANOVA in intervention groups. Results A subsample of n = 274 participants (mean = 38.0 years, SD 13.1) was analyzed, of which 30% were classified at risk in their psychosocial profile. The half-year prognostic validity was good (RMSE for disability of 9.04 at M4 and of 9.73 at M5; RMSE for pain intensity of 12.45 at M4 and of 14.49 at M5). People at risk showed significantly stronger reduction in pain disability and intensity at M4/M5, if participating in a multidisciplinary exercise treatment. Subjects at no risk showed a smaller reduction in pain disability in both interventions and no group differences for pain intensity. Regarding disability due to pain, around 41% of the sample would gain an unfitted treatment without the back pain screening. Conclusion The RPI-SSE prognostic validity demonstrated good applicability and a clinical benefit confirmed by a clear advantage of an individualized treatment possibility.
  • The Influence of Orthogeriatric Co-Management on Clinical Outcomes After Treatment of Proximal Femoral Fractures—Real World Data of Comparable Cohorts Originating from the Same Geographic Area
    Item type: Journal Article
    Känel, Manuel; Känel, Samuel; Kabelitz, Method; et al. (2025)
    Journal of Clinical Medicine
    Background: Surgically treated proximal femoral fractures in geriatric patients are a major debilitating condition, with continuously rising numbers, impacting patients and the healthcare system. Models of care based on orthogeriatric co-management (OGCM) have suggested promising clinical outcomes compared with the standard of care (SOC) model in the treatment of frail elderly patients. Methods: A retrospective cohort study investigating clinical outcomes in two comparable cohorts of patients aged 75 and older, who underwent surgical treatment for proximal femoral fractures in 2023 was conducted. Included individuals all originated from the same geographic area, therefore presenting a unique cohort. The cohorts were differentiated by the perioperative care protocols implemented: an OGCM protocol (n = 147) versus a SOC protocol (n = 143). The main outcome measures were readmission, revision, and mortality rates at 30 days and one-year post-surgery, as well as the length of hospital stay. Results: Findings revealed a positive impact for patients treated under the OGCM protocol, with a significant reduction in the length of hospital stay (6 vs. 7 days, p = 0.001), while no consistent differences were observed in readmission (36.2% vs. 39.7%, p = 0.676), surgical revision (8.4% vs. 12.4%, p = 0.485), and mortality (24.1% vs. 31.7%, p = 0.781) rates one-year after surgery. Conclusions: Despite the absence of significant differences in major outcomes such as mortality, readmission, and surgical revision between the two protocols, the implementation of a more resource-intensive multidisciplinary care pathway resulted in a significant reduction in hospital length of stay. Beyond its clinical value, this improvement may contribute to reducing the burden on healthcare staff and support the sustainability of hospital systems facing increasing pressure.
  • The Ascyrus Medical Dissection Stent: A One-Fits-All Strategy for the Treatment of Acute Type A Aortic Dissection?
    Item type: Review Article
    Pitts, Leonard; Moon, Michael C.; Luehr, Maximilian; et al. (2024)
    Journal of Clinical Medicine
    The treatment of DeBakey type I aortic dissection remains a major challenge in the field of aortic surgery. To upgrade the standard of care hemiarch replacement, a novel device called an “Ascyrus Medical Dissection Stent” (AMDS) is now available. This hybrid device composed of a proximal polytetrafluoroethylene cuff and a distal non-covered nitinol stent is inserted into the aortic arch and the descending thoracic aorta during hypothermic circulatory arrest in addition to hemiarch replacement. Due to its specific design, it may result in a reduced risk for distal anastomotic new entries, the effective restoration of branch vessel malperfusion and positive aortic remodeling. In this narrative review, we provide an overview about the indications and the technical use of the AMDS. Additionally, we summarize the current available literature and discuss potential pitfalls in the application of the AMDS regarding device failure and aortic re-intervention.
  • Mechanical Circulatory Support Strategies in Takotsubo Syndrome with Cardiogenic Shock: A Systematic Review
    Item type: Review Article
    von Mackensen, Johanna K.R.; Zwaans, Vanessa I.T.; El Shazly, Ahmed; et al. (2024)
    Journal of Clinical Medicine
    Background: Takotsubo syndrome is, by definition, a reversible form of acute heart failure. If cardiac output is severely reduced, Takotsubo syndrome can cause cardiogenic shock, and mechanical circulatory support can serve as a bridge to recovery. To date, there are no recommendations on when to use mechanical circulatory support and on which device is particularly effective in this context. Our aim was to determine the best treatment strategy. Methods: A systematic literature research and analysis of individual patient data was performed in MEDLINE/PubMed according to PRISMA guidelines. Our research considered original works published until 31 July 2023. Results: A total of 93 publications that met the inclusion criteria were identified, providing individual data from 124 patients. Of these, 62 (50%) were treated with veno-arterial extracorporeal life support (va-ECLS), and 44 (35.5%) received a microaxial left ventricular assist device (Impella). Eighteen patients received an Impella CP and twenty-one an Impella 2.5. An intra-aortic balloon pump (IABP) without other devices was used in only 13 patients (10.5%), while other devices (BiVAD or Tandem Heart) were used in 5 patients (4%). The median initial left ventricular ejection fraction was 20%, with no difference between the four device groups except for the IABP group, which was less affected by cardiac output failure (p = 0.015). The overall survival was 86.3%. Compared to the other groups, the time to cardiac recovery was shorter with Impella (p < 0.001). Conclusions: Though the Impella treatment is new, our analysis may show a significant benefit of Impella compared to other MCS strategies for cardiogenic shock in Takotsubo syndrome.
  • Prevalence and Prognosis of Fever Symptoms, Hypo-, and Hyperthermia in Unselected Emergency Patients
    Item type: Journal Article
    Malinovska, Alexandra; Malinovska, Liliana; Nickel, Christian H.; et al. (2022)
    Journal of Clinical Medicine
    Assessments of history and body temperature are cornerstones of the diagnostic workup in all patients presenting to emergency departments (ED). Yet, the objective measurement of temperature and the subjective perception of fever can differ. This is a secondary exploratory analysis of a consecutive all-comer study, performed at an adult ED in Switzerland. Trained medical students interviewed all patients if fever was present. Altered temperature (>38.0◦ C/<36.0◦ C) measured at triage using an ear thermometer was used as the reference standard for diagnostic performance. In case of a disagreement between fever symptoms and altered temperature, discordance was noted. Outcome measures for case severity (acute morbidity, hospitalization, intensive care, and in-hospital mortality) were extracted from the electronic health records. Odds ratios (OR) for discordance between signs and symptoms and outcomes were calculated. Among 2183 patients, 325 patients reported fever symptoms. The sensitivity of fever symptoms as a test for altered temperature was 36.3%. Specificity was 91.5%. The negative predictive value was 84.1%, positive likelihood ratio was 4.2 and negative likelihood ratio was 0.7. The adjusted OR for discordance between fever symptoms and altered temperature was 1.71 (95% CI: 1.2–2.44) for acute morbidity, 1.56 (95% CI: 1.13–2.15) for hospitalization, and 1.12 (95% CI: 0.64–1.59) for intensive care. Unadjusted OR for mortality was 1.5 (95% CI: 0.69–3.25). Fever symptoms and altered temperature broadly overlap, but presentations can be stratified according to concordance between signs and symptoms. In case of discordance, the odds for acute morbidity and hospitalization are increased. Discordance may therefore be further investigated as a red flag for a serious outcome.
  • Knee Osteoarthritis in Relation to the Risk Factors of the Metabolic Syndrome Components and Environment of Origin
    Item type: Journal Article
    Tudorachi, Nicoleta Bianca; Totu, Tiberiu; Eva, Iuliana; et al. (2022)
    Journal of Clinical Medicine
    Background: Knee osteoarthritis (KOA) is a chronic degenerative pathology that is associated with multiple risk factors such as age, sex, obesity, or metabolic syndrome (MetS). The present clinical trial aimed to investigate the influence of the environment of origin, body mass index (BMI), and MetS parameters on the KOA differentiated degrees. Methods: 85 patients were admitted for the clinical study. The KOA presence was investigated using X-rays analysis. The Kellgren–Lawrence classification (KL) of the KOA severity and the MetS characteristic parameters using freshly collected blood were performed for each patient. All data collected were used for ANOVA statistic interpretation. Results: The total cholesterol and glycemia were found to be statistically significant (p < 0.028, and p < 0.03, respectively), with a high level in patients with severe KOA compared to healthy ones. Patients from rural regions are 5.18 times more prone to develop severe KOA when compared to ones from urban areas. Conclusions: The results of the statistical analysis confirmed the correlation between the incidence and severity of KOA and the influence of increased values of BMI, glycemia, triglycerides, and total cholesterol. The investigations revealed a statistically significant influence of the environment of origin on the KOA degree of the patients.
  • Challenges in AAV-Based Retinal Gene Therapies and the Role of Magnetic Nanoparticle Platforms
    Item type: Review Article
    Siontas, Oliver; Ahn, Seungkuk (2024)
    Journal of Clinical Medicine
    Retinal diseases, leading to various visual impairments and blindness, are on the rise. However, the advancement of retinal gene therapies offers new hope for treatment of such diseases. Among different vector systems for conferring therapeutic genetic load to retinal cells, adeno-associated viruses (AAVs) have been most intensively explored and have already successfully gained multiple clinical approvals. AAV-based retinal gene therapies have shown great promise in treating retinal disorders, but usually rely on the heavily disruptive administration methods such as subretinal injection. This is because the clinically well-established, minimally invasive alternative of intravitreal injection (IVI) necessitates AAVs to traverse the retinal inner limiting membrane (ILM), which is hard to penetrate in higher eye models, like human or porcine eyes. Additionally, AAVs’ natural transduction preference, known as tropism, is commonly not specific to cells of only one target retinal layer, which is another ongoing challenge in retinal gene therapy. This review examines strategies to overcome these obstacles with a focus on the potential of magnetic nanoparticles (MNPs) for improved retinal AAV delivery.
  • Complete Blood Count Alterations Prior to the Diagnosis of Colorectal Cancer May Help in the Detection of Synchronous Liver Metastases
    Item type: Journal Article
    Sala, Rafael J.; Ery, John; Cuesta-Peredo, David; et al. (2023)
    Journal of Clinical Medicine
    Background and Aims: Colorectal cancer (CRC) represents 10% of all cancers worldwide with the highest incidence in developed countries; its incidence is also increasing in middle- and low-income countries. Population screening programs facilitate early diagnosis of the disease. When the diagnosis is carried out in advanced stages, approximately 80% of patients with liver metastases (LM) are considered unresectable at the time of diagnosis. In our study, variations in blood counts prior to CRC diagnosis were analyzed to assess whether they could be useful in identifying smaller, more manageable metastases at earlier stages for more effective treatment. Methods: A study was carried out using complete blood counts (CBCs) from CRC patients, obtained from primary health centers and the La Ribera University Hospital within La Ribera Health Department, Valencian Community, Spain, between July 2012 and September 2020. Data from CRC patients who presented synchronous liver metastasis (CRLM) were compared with those with CRC without LM at diagnosis (CRC patients). Results: Our analysis shows that at least 15 months before CRC diagnosis, a progressive alteration was observed in CBC parameters in both groups. A higher incidence of anemia (p < 0.001) was observed among CRLM patients in the three months prior to CRC diagnosis than in CRC patients showing no LM. Conclusions: A statistically significant deterioration of CBC was observed in patients with advanced-stage CRC and synchronous or early LM (CRLM) in the three months prior to diagnosis. The primary goal of incorporating CBC variations into predictive models is to identify individuals who are at a greater risk of developing metastatic colon cancer, leading to early diagnosis. Our research improves these models by highlighting a more pronounced and rapid decline in hemoglobin levels among CRLM patients. Identification of metastases at an earlier stage when they are smaller, more manageable, and more amenable to treatment may be a valuable tool to prevent their further progression.
  • A Randomized Controlled Trial of an Enhanced Version of a Cognitive–Behavioral Video Game Intervention Aimed at Promoting Active Aging: Assessments of Perceived Health and Healthy Lifestyle Habits at Pre- and Post-Intervention
    Item type: Journal Article
    Cotardo , Tania; Otero , Patricia; de Bruin , Eling D.; et al. (2025)
    Journal of Clinical Medicine
    Background/Objective: Video games offer an innovative tool for delivering active aging interventions. The objective of this study was to analyze the efficacy of an enhanced version of a cognitive–behavioral intervention to promote active aging, administered through a video game, on perceived health and healthy lifestyle habits. Methods: A total of 556 participants aged 45 or older (74.3% women, mean age of 60.8 [SD = 8.0]) were randomly assigned to a cognitive–behavioral intervention to promote active aging administered via an interactive, multimedia, online, and serious video game with a complementary smartphone app (CBI-V; n = 279) or to a control group receiving non-specific online information (CG; n = 277). Perceived health (General Health, Body Pain, Physical Functioning, Physical Role, Vitality, Social Functioning, Emotional Role, Mental Health, Physical and Mental Summary Indices); healthy habits, including sleep hygiene behaviors, physical activity, and eating habits; dropouts; adherence to the intervention (completed modules; total playtime; time devoted to cognitive training; number of cognitive task attempts and tasks completed between modules); and satisfaction with the intervention were assessed by independent, blind evaluators via an online platform before and after the intervention. Results: At the post-intervention, the CBI-V group obtained significantly better scores in General Health (p < 0.001), Mental Health (p = 0.015), sleep hygiene (p < 0.001), physical activity (p = 0.024), and eating habits (p = 0.001) than the CG. The effect sizes were small (d = −0.188 to 0.334). Clinically significant changes were higher in the CBI-V group than in the CG in General Health (p = 0.029), Physical Function (p = 0.028), Social Function (p = 0.011), Emotional Role (p = 0.008), Mental Health (p = 0.026), Physical Summary Index (p = 0.010), sleep hygiene (p = 0.020), and eating habits (p = 0.019). Participants reported a high level of satisfaction with the intervention, with a mean score of 25.4 (SD = 4.0) out of a maximum of 32 on the intervention satisfaction measure. Conclusions: These findings support the efficacy of a cognitive–behavioral video game intervention in enhancing perceived health and promoting healthy lifestyle habits among people aged 45 and above.
Publications 1 - 10 of 40