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  • 24 days
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Clinics and Practice

Clinics and Practice is an international, peer-reviewed, open access journal on clinical medicine, published monthly online by MDPI (from Volume 11, Issue 1 - 2021).

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All Articles (1,524)

  • Article
  • Open Access

Background: Chronic subdural hematoma (CSDH) recurs in 5–20% of patients despite surgical treatment, and readily accessible biomarkers associated with recurrence remain limited. This study evaluated perioperative hematological, biochemical, and metabolic biomarkers associated with CSDH recurrence, focusing on preoperative lactate and the lactate-to-albumin ratio (LAR). Methods: This retrospective single-center cohort study included 163 adults who underwent burr-hole evacuation for CSDH between January 2021 and December 2025. All patients underwent saline irrigation without placement of a postoperative subdural drain, in accordance with the institutional surgical protocol. Clinical, radiological, laboratory, and perioperative arterial blood gas data were analyzed. Recurrence was defined as symptomatic re-expansion requiring repeat surgery within six months. Receiver operating characteristic (ROC) analysis and multivariable logistic regression were used to assess discrimination and associations with recurrence. Results: Postoperative recurrence occurred in 22 patients (13.5%). Recurrence was associated with higher preoperative lactate, LAR, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index, as well as lower serum albumin. LAR showed moderate discrimination (AUC 0.758, 95% CI 0.652–0.864), while lactate had an AUC of 0.744. Increased LAR (OR 1.42 per 0.1-unit increase, 95% CI 1.15–1.76; p = 0.001), bilateral hematoma (OR 2.91, 95% CI 1.08–7.84; p = 0.035), and mixed-density hematoma (OR 2.64, 95% CI 1.01–6.89; p = 0.047) were independently associated with recurrence in the fitted model. The age × lactate interaction did not reach conventional statistical significance (p = 0.058) and was considered exploratory. Conclusions: Higher preoperative LAR was associated with CSDH recurrence and showed moderate discriminative performance in this cohort. These findings are exploratory and require independent validation before LAR or the combined model can be considered for clinical risk prediction.

Clin. Pract.

14 October 2026

Patient selection flow diagram.
  • Systematic Review
  • Open Access

Physiotherapy Interventions for Migraine: A Systematic Review of Clinical Trials

  • Helena Małgorzata Strachanowska,
  • Martyna Anna Kaczmarska and
  • Michał Brancewicz
  • + 1 author

Background: Migraine is one of the leading causes of disability worldwide and significantly reduces quality of life. Standard pharmacological treatment is often associated with adverse effects and does not always provide satisfactory long-term outcomes. Consequently, increasing attention has been directed toward non-pharmacological interventions such as physiotherapy. The aim of this systematic review was to evaluate the effectiveness of physiotherapy used as a standalone or complementary treatment for migraine. Methods: A systematic review of randomized controlled trials (RCTs) published between 2015 and 2025 was conducted in accordance with PRISMA 2020 guidelines. Electronic databases (PubMed, Cochrane Library, Scopus and PEDro) were searched using predefined search strategies. Studies involving adults diagnosed with migraine who received physiotherapy interventions (e.g., manual therapy, exercise therapy) were included. Two reviewers independently screened records and extracted data. Methodological quality of included studies was assessed using the PEDro scale. Results: Thirteen clinical trials (including 12 RCTs) involving 1021 participants were included. The most frequently investigated interventions were manual therapy and exercise therapy. Improvements in at least one primary clinical outcome (migraine frequency, pain intensity, or disability scores such as MIDAS or HIT-6) were observed in 8 out of 13 studies. A reduction in migraine frequency was reported in 4 studies. However, results were inconsistent across trials, and several studies found no statistically significant differences between the intervention and control groups. Conclusions: Physiotherapy may represent a beneficial complementary approach in migraine management, particularly for improving pain intensity and disability outcomes. However, the available evidence is limited by significant heterogeneity in intervention protocols, outcome measures, and follow-up duration, as well as the lack of quantitative synthesis. Further high-quality randomized trials with standardized methodology and longer follow-up periods are required to strengthen the evidence base.

Clin. Pract.

13 October 2026

  • Correction
  • Open Access

In the original publication [...]

Clin. Pract.

13 October 2026

  • Review
  • Open Access

Contemporary healthcare systems operate in an environment characterized by the rapid development of digital technologies and the growing availability of health data. While these developments may increase the complexity of health policy decision-making, they also create new opportunities to support this process. In addition to clinical trial findings, RWD/RWE, PROMs, and PREMs, as well as analyses in the fields of health economics, HTA, and VBHC, are becoming increasingly important. The aim of this article is to present the current state of knowledge on the integration of these data and evidence sources within the EBPH approach and to discuss their relevance to the planning, implementation, and evaluation of health interventions. Based on a review of the literature, we propose an original conceptual model for health policy decision-making—the Integrated Evidence-Based Public Health Framework, which integrates epidemiological data, RWE, patient-reported information, and economic analyses within a single decision-support framework. The proposed model is consistent with the LHS concept and may provide a useful tool for supporting rational health policy planning and assessing the value of health interventions.

Clin. Pract.

13 October 2026

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Clin. Pract. - ISSN 2039-7283