Special Issue "Clinical Medicine for Healthcare and Sustainability"

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: closed (31 December 2019).

Special Issue Editors

Prof. Dr. Teen­-Hang Meen
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Guest Editor
Department of Electronic Engineering National Formosa University, Yunlin 632, Taiwan
Interests: photovoltaic device; dye-sensitized solar cells; nanotechnology
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Prof. Dr. Yusuke Matsumoto
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Guest Editor
Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji-city Tokyo 192-0392, Japan
Interests: computerization of pharmacy business; drug therapy for renal excretory drugs; eradication therapy of Hericobacter pylori
Special Issues and Collections in MDPI journals
Prof. Dr. Kuan-Han Lee
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Guest Editor
Dean of the College of Pharmacy and Science, Chia Nan University of Pharmacy & Science, Tainan, Taiwan
Interests: medicinal chemistry; organic synthesis; computer-aided drug design
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues,

The 2019 IEEE Eurasia Conference on Biomedical Engineering, Healthcare, and Sustainability (IEEE ECBIOS 2019) will be held in Okinawa, Japan between 31 May and 3 June 2019, which will provide a unified communication platform for researchers in the topics of biomedical engineering, healthcare, and sustainability. Recently, healthcare has undergone a sector-wide transformation thanks to advances in computing, networking technologies, big data, and artificial intelligence. Healthcare is not only changing from reactive and hospital-centered to preventive and personalized but is also changing from disease focused to well-being centered. Healthcare systems, as well as fundamental medicine research, are becoming smarter and more enabled in biomedical engineering. Furthermore, with cutting edge sensors and computer technologies, healthcare delivery could also yield better efficiency, higher quality, and lower cost.

In this Special Issue, we expect to select excellent papers presented in IEEE ECBIOS 2019 and other high-quality papers concerning the topics clinical medicine, healthcare, and sustainability. It provides a platform for advances in health care/clinical practices and the study of the direct observation of patients and general medical research.

Prof. Dr. Teen­-Hang Meen
Prof. Dr. Yusuke Matsumoto
Prof. Dr. Kuan-Han Lee
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Biomedical engineering
  • Healthcare
  • Sustainability
  • Networking technologies
  • Big data
  • Artificial intelligence
  • Personalized therapy

Published Papers (31 papers)

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Open AccessArticle
The Optimal Range of Serum Uric Acid for Cardiometabolic Diseases: A 5-Year Japanese Cohort Study
J. Clin. Med. 2020, 9(4), 942; https://doi.org/10.3390/jcm9040942 - 30 Mar 2020
Cited by 1
Abstract
The optimal range of serum uric acid (urate) associated with the lowest risk for developing cardiometabolic diseases is unknown in a generally healthy population. This 5-year cohort study is designed to identify the optimal range of serum urate. The data were collected from [...] Read more.
The optimal range of serum uric acid (urate) associated with the lowest risk for developing cardiometabolic diseases is unknown in a generally healthy population. This 5-year cohort study is designed to identify the optimal range of serum urate. The data were collected from 13,070 Japanese between ages 30 and 85 at the baseline (2004) from the Center for Preventive Medicine, St. Luke’s International Hospital, Tokyo. We evaluated the number of subjects (and prevalence) of those free of the following conditions: hypertension, diabetes, dyslipidemia, and chronic kidney disease (CKD) over 5 years for each 1 mg/dL of serum urate stratified by sex. Furthermore, the odds ratios (ORs) for remaining free of these conditions were calculated with multiple adjustments. Except for truly hypouricemic subjects, having lower serum urate was an independent factor for predicting the absence of hypertension, dyslipidemia, and CKD, but not diabetes. The OR of each 1 mg/dL serum urate decrease as a protective factor for hypertension, dyslipidemia, and CKD was 1.153 (95% confidence interval, 1.068–1.245), 1.164 (1.077–1.258), and 1.226 (1.152–1.306) in men; 1.306 (1.169–1.459), 1.121 (1.022–1.230), and 1.424 (1.311–1.547) in women, respectively. Moreover, comparing serum urate of 3–5 mg/dL in men and 2–4 mg/dL in women, hypouricemia could be a higher risk for developing hypertension (OR: 4.532; 0.943–21.78) and CKD (OR: 4.052; 1.181–13.90) in women, but not in men. The optimal serum urate range associated with the lowest development of cardiometabolic diseases was less than 5 mg/dL for men and 2–4 mg/dL for women, respectively. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Prospective Evaluation of Intensity of Symptoms, Therapeutic Procedures and Treatment in Palliative Care Patients in Nursing Homes
J. Clin. Med. 2020, 9(3), 750; https://doi.org/10.3390/jcm9030750 - 10 Mar 2020
Abstract
The aim of the study is to evaluate the intensity of symptoms, and any treatment and therapeutic procedures received by advanced chronic patients in nursing homes. A multi-centre prospective study was conducted in six nursing homes for five months. A nurse trainer selected [...] Read more.
The aim of the study is to evaluate the intensity of symptoms, and any treatment and therapeutic procedures received by advanced chronic patients in nursing homes. A multi-centre prospective study was conducted in six nursing homes for five months. A nurse trainer selected palliative care patients from whom the sample was randomly selected for inclusion. The Edmonton Symptoms Assessment Scale, therapeutic procedures, and treatment were evaluated. Parametric and non-parametric tests were used to evaluate month-to-month differences and differences between those who died and those who did not. A total of 107 residents were evaluated. At the end of the follow-up, 39 had (34.6%) died. All symptoms (p < 0.050) increased in intensity in the last week of life. Symptoms were more intense in those who had died at follow-up (p < 0.05). The use of aerosol sprays (p = 0.008), oxygen therapy (p < 0.001), opioids (p < 0.001), antibiotics (p = 0.004), and bronchodilators (p = 0.003) increased in the last week of life. Peripheral venous catheters (p = 0.022), corticoids (p = 0.007), antiemetics (p < 0.001), and antidepressants (p < 0.05) were used more in the patients who died. In conclusion, the use of therapeutic procedures (such as urinary catheters, peripheral venous catheter placement, and enteral feeding) and drugs (such as antibiotics, anxiolytics, and new antidepressant prescriptions) should be carefully considered in this clinical setting. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
Open AccessArticle
Evaluation of Transfer Learning with Deep Convolutional Neural Networks for Screening Osteoporosis in Dental Panoramic Radiographs
J. Clin. Med. 2020, 9(2), 392; https://doi.org/10.3390/jcm9020392 - 01 Feb 2020
Cited by 1
Abstract
Dental panoramic radiographs (DPRs) provide information required to potentially evaluate bone density changes through a textural and morphological feature analysis on a mandible. This study aims to evaluate the discriminating performance of deep convolutional neural networks (CNNs), employed with various transfer learning strategies, [...] Read more.
Dental panoramic radiographs (DPRs) provide information required to potentially evaluate bone density changes through a textural and morphological feature analysis on a mandible. This study aims to evaluate the discriminating performance of deep convolutional neural networks (CNNs), employed with various transfer learning strategies, on the classification of specific features of osteoporosis in DPRs. For objective labeling, we collected a dataset containing 680 images from different patients who underwent both skeletal bone mineral density and digital panoramic radiographic examinations at the Korea University Ansan Hospital between 2009 and 2018. Four study groups were used to evaluate the impact of various transfer learning strategies on deep CNN models as follows: a basic CNN model with three convolutional layers (CNN3), visual geometry group deep CNN model (VGG-16), transfer learning model from VGG-16 (VGG-16_TF), and fine-tuning with the transfer learning model (VGG-16_TF_FT). The best performing model achieved an overall area under the receiver operating characteristic of 0.858. In this study, transfer learning and fine-tuning improved the performance of a deep CNN for screening osteoporosis in DPR images. In addition, using the gradient-weighted class activation mapping technique, a visual interpretation of the best performing deep CNN model indicated that the model relied on image features in the lower left and right border of the mandibular. This result suggests that deep learning-based assessment of DPR images could be useful and reliable in the automated screening of osteoporosis patients. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Effect of an Electronic Medical Record-Based Screening System on a Rapid Response System: 8-Years’ Experience of a Single Center Cohort
J. Clin. Med. 2020, 9(2), 383; https://doi.org/10.3390/jcm9020383 - 01 Feb 2020
Abstract
An electronic medical record (EMR)-based screening system has been developed as a trigger system for a rapid response team (RRT) that traditionally used direct calling. We compared event characteristics, intensive care unit (ICU) admission, and 28-day mortality following RRT activation of the two [...] Read more.
An electronic medical record (EMR)-based screening system has been developed as a trigger system for a rapid response team (RRT) that traditionally used direct calling. We compared event characteristics, intensive care unit (ICU) admission, and 28-day mortality following RRT activation of the two trigger systems. A total of 10,026 events were classified into four groups according to the activation time (i.e., daytime or on-call time) and the triggering type (i.e., calling or screening). Among surgical patients, the ICU admission was lowest for the on-call screening group (26.2%). Compared to the on-call screening group, the on-call calling group and daytime calling group showed higher ICU admission with an odds ratio (OR) of 2.07 (95% CI 1.50–2.84, p < 0.001) and OR of 2.68 (95% CI 1.91–3.77, p < 0.001), respectively. The 28-day mortality was lowest for the on-call screening group (8.7%). Compared to the on-call screening group, on-call calling (OR 1.88, 95% CI 1.20–2.95, p = 0.006) and daytime calling (OR 1.89, 95% CI 1.17–3.05, p < 0.001) showed higher 28-day mortality. The EMR-based screening system might be useful in detecting at-risk surgical patients, particularly during on-call time. The clinical usefulness of an EMR-based screening system can vary depending on patients’ characteristics. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Ensemble Learning to Improve the Prediction of Fetal Macrosomia and Large-for-Gestational Age
J. Clin. Med. 2020, 9(2), 380; https://doi.org/10.3390/jcm9020380 - 31 Jan 2020
Abstract
Background: The objective of this study was to investigate the use of ensemble methods to improve the prediction of fetal macrosomia and large for gestational age from prenatal ultrasound imaging measurements. Methods: We evaluated and compared the prediction accuracies of nonlinear and quadratic [...] Read more.
Background: The objective of this study was to investigate the use of ensemble methods to improve the prediction of fetal macrosomia and large for gestational age from prenatal ultrasound imaging measurements. Methods: We evaluated and compared the prediction accuracies of nonlinear and quadratic mixed-effects models coupled with 26 different empirical formulas for estimating fetal weights in predicting large fetuses at birth. The data for the investigation were taken from the Successive Small-for-Gestational-Age-Births study. Ensemble methods, a class of machine learning techniques, were used to improve the prediction accuracies by combining the individual models and empirical formulas. Results: The prediction accuracy of individual statistical models and empirical formulas varied considerably in predicting macrosomia but varied less in predicting large for gestational age. Two ensemble methods, voting and stacking, with model selection, can combine the strengths of individual models and formulas and can improve the prediction accuracy. Conclusions: Ensemble learning can improve the prediction of fetal macrosomia and large for gestational age and have the potential to assist obstetricians in clinical decisions. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Seasonal Variation in Physical Activity among Preoperative Patients with Lung Cancer Determined Using a Wearable Device
J. Clin. Med. 2020, 9(2), 349; https://doi.org/10.3390/jcm9020349 - 27 Jan 2020
Abstract
We aim to examine how season and temperature levels affect physical activity using a wearable device among patients scheduled to undergo surgical resection of lung cancer. Physical activity (PA) data from the wearable device were analyzed by seasons for 555 preoperative lung cancer [...] Read more.
We aim to examine how season and temperature levels affect physical activity using a wearable device among patients scheduled to undergo surgical resection of lung cancer. Physical activity (PA) data from the wearable device were analyzed by seasons for 555 preoperative lung cancer patients from the CATCH-LUNG cohort study. The seasons were divided into spring, summer, autumn, and winter using the study enrollment date before surgery. The overall mean (SD) age was 61.1 (8.9) years, and the mean (SD) daily steps at each season were 11,438 (5922), 11,147 (5065), 10,404 (4403), and 8548 (4293), respectively. In the fully-adjusted models, patients in the winter season had 27.04% fewer daily steps (95% CI = −36.68%, −15.93%) and 35.22% less time spent performing moderate to vigorous physical activity (MVPA) compared to patients in the spring. The proportion of participants with over 8000 steps and duration of MVPA were significantly lower in the winter than the spring. In particular, daily steps had a negative linear association with wind chill temperature in patients who lived in Seoul. In conclusion, PA was significantly lower in the winter and it was more robust in patients who had a low cardiorespiratory function. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Postprandial Hypotension as a Risk Factor for the Development of New Cardiovascular Disease: A Prospective Cohort Study with 36 Month Follow-Up in Community-Dwelling Elderly People
J. Clin. Med. 2020, 9(2), 345; https://doi.org/10.3390/jcm9020345 - 27 Jan 2020
Abstract
Postprandial hypotension (PPH) is common among the elderly. However, it is unknown whether the presence of PPH can predict the development of new cardiovascular disease (CVD) in the elderly during the long-term period. This study aimed to prospectively evaluate the presence of PPH [...] Read more.
Postprandial hypotension (PPH) is common among the elderly. However, it is unknown whether the presence of PPH can predict the development of new cardiovascular disease (CVD) in the elderly during the long-term period. This study aimed to prospectively evaluate the presence of PPH and the development of new CVD within a 36 month period in 94 community-dwelling elderly people without a history of CVD. PPH was diagnosed in 47 (50.0%) participants at baseline and in 7 (7.4%) during the follow-up period. Thirty participants (31.9%) developed new CVD within 36 months. We performed a time-dependent Cox regression analysis with PPH, hypertension, diabetes, and body mass index (BMI) as time-varying covariates. In the univariate analyses, the presence of PPH, higher BMI, hypertension, diabetes mellitus, and higher systolic and diastolic blood pressure were associated with the development of new CVD. The multivariate analysis indicated that the relationship between PPH and the development of new CVD remained (adjusted hazard ratio 11.18, 95% confidence interval 2.43–51.38, p = 0.002) even after controlling for other variables as covariates. In conclusion, the presence of PPH can predict the development of new CVD. Elderly people with PPH may require close surveillance to prevent CVD. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Relationship between Morbidity and Health Behavior in Chronic Diseases
J. Clin. Med. 2020, 9(1), 121; https://doi.org/10.3390/jcm9010121 - 02 Jan 2020
Cited by 1
Abstract
This study aimed to analyze the demographic characteristics and health behaviors related to chronic diseases and to identify factors that may affect chronic diseases. Data from the Seventh Korea National Health and Nutrition Examination Survey were used, and 3795 adults aged above 40 [...] Read more.
This study aimed to analyze the demographic characteristics and health behaviors related to chronic diseases and to identify factors that may affect chronic diseases. Data from the Seventh Korea National Health and Nutrition Examination Survey were used, and 3795 adults aged above 40 years were included. The following demographic variables were obtained: sex, age, education, income, type of health insurance, and private insurance. The following health behavior factors were also analyzed: medical checkup, drinking, smoking, exercise, obesity, and hypercholesterolemia. Participants with lower socioeconomic status had a higher risk of developing chronic diseases. Meanwhile, those with private health insurance had a lower risk of developing chronic diseases. In addition, participants who underwent medical checkups and performed exercises had a lower risk, while those with obesity and hypercholesterolemia had a higher risk of developing chronic diseases. It is necessary to manage chronic diseases through comprehensive programs, rather than managing these diseases individually, and through community primary care institutions to improve health behaviors. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Decision Support for the Optimization of Provider Staffing for Hospital Emergency Departments with a Queue-Based Approach
J. Clin. Med. 2019, 8(12), 2154; https://doi.org/10.3390/jcm8122154 - 05 Dec 2019
Abstract
Deployment or distribution of valuable medical resources has emerged as an increasing challenge to hospital administrators and health policy makers. The hospital emergency department (HED) census and workload can be highly variable. Improvement of emergency services is an important stage in the development [...] Read more.
Deployment or distribution of valuable medical resources has emerged as an increasing challenge to hospital administrators and health policy makers. The hospital emergency department (HED) census and workload can be highly variable. Improvement of emergency services is an important stage in the development of the healthcare system and research on the optimal deployment of medical resources appears to be an important issue for HED long-term management. HED performance, in terms of patient flow and available resources, can be studied using the queue-based approach. The kernel point of this research is to approach the optimal cost on logistics using queuing theory. To model the proposed approach for a qualitative profile, a generic HED system is mapped into the M/M/R/N queue-based model, which assumes an R-server queuing system with Poisson arrivals, exponentially distributed service times and a system capacity of N. A comprehensive quantitative mathematical analysis on the cost pattern was done, while relevant simulations were also conducted to validate the proposed optimization model. The design illustration is presented in this paper to demonstrate the application scenario in a HED platform. Hence, the proposed approach provides a feasibly cost-oriented decision support framework to adapt a HED management requirement. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Predicting Long-Term Health-Related Quality of Life after Bariatric Surgery Using a Conventional Neural Network: A Study Based on the Scandinavian Obesity Surgery Registry
J. Clin. Med. 2019, 8(12), 2149; https://doi.org/10.3390/jcm8122149 - 05 Dec 2019
Abstract
Severe obesity has been associated with numerous comorbidities and reduced health-related quality of life (HRQoL). Although many studies have reported changes in HRQoL after bariatric surgery, few were long-term prospective studies. We examined the performance of the convolution neural network (CNN) for predicting [...] Read more.
Severe obesity has been associated with numerous comorbidities and reduced health-related quality of life (HRQoL). Although many studies have reported changes in HRQoL after bariatric surgery, few were long-term prospective studies. We examined the performance of the convolution neural network (CNN) for predicting 5-year HRQoL after bariatric surgery based on the available preoperative information from the Scandinavian Obesity Surgery Registry (SOReg). CNN was used to predict the 5-year HRQoL after bariatric surgery in a training dataset and evaluated in a test dataset. In general, performance of the CNN model (measured as mean squared error, MSE) increased with more convolution layer filters, computation units, and epochs, and decreased with a larger batch size. The CNN model showed an overwhelming advantage in predicting all the HRQoL measures. The MSEs of the CNN model for training data were 8% to 80% smaller than those of the linear regression model. When the models were evaluated using the test data, the CNN model performed better than the linear regression model. However, the issue of overfitting was apparent in the CNN model. We concluded that the performance of the CNN is better than the traditional multivariate linear regression model in predicting long-term HRQoL after bariatric surgery; however, the overfitting issue needs to be mitigated using more features or more patients to train the model. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Clinical Validation of Innovative Optical-Sensor-Based, Low-Cost, Rapid Diagnostic Test to Reduce Antimicrobial Resistance
J. Clin. Med. 2019, 8(12), 2098; https://doi.org/10.3390/jcm8122098 - 01 Dec 2019
Abstract
The antibiotic susceptibility test determines the most effective antibiotic treatment for bacterial infection. Antimicrobial stewardship is advocated for the rational use of antibiotics to preserve their efficacy in the long term and provide empirical therapy for disease management. Therefore, rapid diagnostic tests can [...] Read more.
The antibiotic susceptibility test determines the most effective antibiotic treatment for bacterial infection. Antimicrobial stewardship is advocated for the rational use of antibiotics to preserve their efficacy in the long term and provide empirical therapy for disease management. Therefore, rapid diagnostic tests can play a pivotal role in efficient and timely treatment. Here, we developed a novel, rapid, affordable, and portable platform for detecting uropathogens and reporting antibiogram to clinicians in just 4 h. This technology replicates the basic tenets of clinical microbiology including bacterial growth in indigenously formulated medium, and measurement of inhibition of bacterial growth in presence of antibiotic/s. Detection is based on chromogenic endpoints using optical sensors and is analyzed by a lab-developed algorithm, which reports sensitivity to the antibiotic’s panel tested. To assess its diagnostic accuracy, a prospective clinical validation study was conducted in two tertiary-care Indian hospitals. Urine samples from 1986 participants were processed by both novel/index test and conventional Kirby Bauer Disc Diffusion method. The sensitivity and specificity of this assay was 92.5% and 82%, respectively (p < 0.0005). This novel technology will promote evidence-based prescription of antibiotics and reduce the burden of increasing resistance by providing rapid and precise diagnosis in shortest possible time. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Characteristics of Mild Cognitive Impairment in Northern Japanese Community-Dwellers from the ORANGE Registry
J. Clin. Med. 2019, 8(11), 1937; https://doi.org/10.3390/jcm8111937 - 10 Nov 2019
Abstract
A gradually increasing prevalence of mild cognitive impairment (MCI) is recognized in the super-aging society that Japan faces, and early detection and intervention in community-dwellers with MCI are critical issues to prevent dementia. Although many previous studies have revealed MCI/non-MCI differences in older [...] Read more.
A gradually increasing prevalence of mild cognitive impairment (MCI) is recognized in the super-aging society that Japan faces, and early detection and intervention in community-dwellers with MCI are critical issues to prevent dementia. Although many previous studies have revealed MCI/non-MCI differences in older individuals, information on the prevalence and characteristics of MCI in rural older adults is limited. The aim of this study was to investigate differential characteristics between older adults with and without MCI. The investigation was conducted over one year from 2018 to 2019. Participants were recruited from Akita in northern Japan. Neuropsychological assessments were applied to classify MCI, including the National Center for Geriatrics and Gerontology Functional Assessment Tool (NCGG-FAT) and the Touch panel-type Dementia Assessment Scale (TDAS) based on the Alzheimer’s disease assessment scale. Our samples consisted of 103 older adults divided into 54 non-MCI and 49 MCI. The MCI group had lower scores of all cognitive items. Our results showed that individuals with MCI had significantly slower walking speed (WS) and worse geriatric depression scale (GDS) compared to non-MCI. In addition, WS was significantly associated with some cognitive items in non-MCI, but not in MCI. Finally, we showed that predictive variables of MCI were WS and GDS. Our study provides important information about MCI in rural community-dwellers. We suggest that older adults living in a super-aging society should receive lower limb training, and avoiding depression in older adults through interaction of community-dwellers may contribute to preventing the onset of MCI. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
Open AccessArticle
Cerebral White Matter Hyperintensity as a Healthcare Quotient
J. Clin. Med. 2019, 8(11), 1823; https://doi.org/10.3390/jcm8111823 - 01 Nov 2019
Abstract
To better understand the risk factors and optimal therapeutic strategies of cerebral white matter hyperintensity (WMH), we examined a large population of adults with and without various vascular risk factors (VRFs) or vascular risk conditions (VRCs), such as hypertension (HT), diabetes mellitus (DM), [...] Read more.
To better understand the risk factors and optimal therapeutic strategies of cerebral white matter hyperintensity (WMH), we examined a large population of adults with and without various vascular risk factors (VRFs) or vascular risk conditions (VRCs), such as hypertension (HT), diabetes mellitus (DM), and dyslipidemia (DLP), including the comorbidities. We assessed two participant groups having no medical history of stroke or dementia that underwent brain checkup using magnetic resonance imaging (MRI): 5541 participants (2760 men, 2781 women) without VRCs and 1969 participants (1169 men, 800 women) who had received drug treatments for VRCs and the combination of comorbidities. For data analysis, we constructed WMH-brain healthcare quotient (WMH-BHQ) based on the percentile rank of WMH volume. This metric has an inverse relation to WMH. Multiple linear regression analysis of 5541 participants without VRCs revealed that age, systolic blood pressure (SBP), Brinkman index (BI), and female sex were significant factors lowering WMH-BHQ, whereas body mass index (BMI), male sex, fasting blood sugar, and triglyceride levels were increasing factors. The Kruskal–Wallis test and Dunn tests showed that WMH-BHQs significantly increased or decreased with BMI or SBP and with BI classification, respectively. Regarding the impact of impaired fasting glucose and abnormal lipid metabolism, there were almost no significant relationships. For 1969 participants who had HT, DM, and DLP, as well as their comorbidities, we found that DLP played a substantial role in increasing WMH-BHQ for some comorbidities, whereas the presence of HT and DM alone tended to decrease it. Cerebral WMH can be used as a healthcare quotient for quantitatively evaluating VRFs and VRCs and their comorbidities. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Factors Associated with Health-Related Quality of Life in Community-Dwelling Older Adults: A Multinomial Logistic Analysis
J. Clin. Med. 2019, 8(11), 1810; https://doi.org/10.3390/jcm8111810 - 01 Nov 2019
Abstract
The main aim of this study was to determine the association of various clinical, functional and pharmacological factors with the physical (PCS) and mental (MCS) summary components of the health-related quality of life (HRQoL) of community-dwelling older adults. Design: Cross-sectional study. Patients and [...] Read more.
The main aim of this study was to determine the association of various clinical, functional and pharmacological factors with the physical (PCS) and mental (MCS) summary components of the health-related quality of life (HRQoL) of community-dwelling older adults. Design: Cross-sectional study. Patients and setting: Sample of 573 persons aged over 65 years, recruited at 12 primary healthcare centres in Málaga, Spain. Sociodemographic, clinical, functional, and comprehensive drug therapy data were collected. The main outcome was HRQoL assessed on the basis of the SF-12 questionnaire. A multinomial logistic regression model was constructed to study the relationship between independent variables and the HRQoL variable, divided into intervals. The average self-perceived HRQoL score was 43.2 (± 11.02) for the PCS and 48.5 (± 11.04) for the MCS. The factors associated with a poorer PCS were dependence for the instrumental activities of daily living (IADL), higher body mass index (BMI), number of medications, and presence of osteoarticular pathology. Female gender and the presence of a psychopathological disorder were associated with worse scores for the MCS. The condition that was most strongly associated with a poorer HRQoL (in both components, PCS and MCS) was that of frailty (odds ratio (OR) = 37.42, 95% confidence interval (CI) = 8.96–156.22, and OR = 20.95, 95% CI = 7.55–58.17, respectively). It is important to identify the determinant factors of a diminished HRQoL, especially if they are preventable or modifiable. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
Open AccessArticle
Multidiscipline Stroke Post-Acute Care Transfer System: Propensity-Score-Based Comparison of Functional Status
J. Clin. Med. 2019, 8(8), 1233; https://doi.org/10.3390/jcm8081233 - 16 Aug 2019
Abstract
Few studies have investigated the characteristics of stroke inpatients after post-acute care (PAC) rehabilitation, and few studies have applied propensity score matching (PSM) in a natural experimental design to examine the longitudinal impacts of a medical referral system on functional status. This study [...] Read more.
Few studies have investigated the characteristics of stroke inpatients after post-acute care (PAC) rehabilitation, and few studies have applied propensity score matching (PSM) in a natural experimental design to examine the longitudinal impacts of a medical referral system on functional status. This study coupled a natural experimental design with PSM to assess the impact of a medical referral system in stroke patients and to examine the longitudinal effects of the system on functional status. The intervention was a hospital-based, function oriented, 12-week to 1-year rehabilitative PAC intervention for patients with cerebrovascular diseases. The average duration of PAC in the intra-hospital transfer group (31.52 days) was significantly shorter than that in the inter-hospital transfer group (37.1 days) (p < 0.001). The intra-hospital transfer group also had better functional outcomes. The training effect was larger in patients with moderate disability (Modified Rankin Scale, MRS = 3) and moderately severe disability (MRS = 4) compared to patients with slight disability (MRS = 2). Intensive post-stroke rehabilitative care delivered by per-diem payment is effective in terms of improving functional status. To construct a vertically integrated medical system, strengthening the qualified local hospitals with PAC wards, accelerating the inter-hospital transfer, and offering sufficient intensive rehabilitative PAC days are the most essential requirements. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Relationships between Multimorbidity and Suicidal Thoughts and Plans among Korean Adults
J. Clin. Med. 2019, 8(8), 1094; https://doi.org/10.3390/jcm8081094 - 24 Jul 2019
Abstract
Multimorbidity and suicide rates are rising simultaneously among Korean adults. To address this issue, we assessed the association between multimorbidity and suicidal behavior among adults aged ≥19 years in Korea. We analyzed the data from the 2017 Korea National Health and Nutrition Examination [...] Read more.
Multimorbidity and suicide rates are rising simultaneously among Korean adults. To address this issue, we assessed the association between multimorbidity and suicidal behavior among adults aged ≥19 years in Korea. We analyzed the data from the 2017 Korea National Health and Nutrition Examination Survey. Multimorbidity was defined as experiencing two or more chronic diseases. We compared the presence of suicidal thoughts and plans according to multimorbidity using chi-square test, and examined the associations between multimorbidity and suicidal thoughts and plans using multiple binary logistic regression analyses. Multimorbidity was found in 30.8% of total participants. As the number of chronic diseases increased, the percentage of thoughts and plans tended to increase (p < 0.001 and p = 0.002). Among participants with multimorbidities, 8.5% had suicidal thoughts, whereas only 3.4% without multimorbidity had such thoughts (p < 0.001). Participants with multimorbidity had significantly higher odds of suicidal thoughts (OR = 2.14; 95% CI = 1.54–2.97) and suicidal plans (OR = 2.01; 95% CI = 1.08–3.73) compared to those without multimorbidity after adjusting confounding variables. Conclusion: People with multimorbidity had a higher prevalence of suicidal thoughts and plans. Early detection of and intervention for suicidal thoughts and plans are critical for suicide prevention among people with multimorbidity. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
Open AccessArticle
Two-Dimensional Laser-Align Device for Ultrasound-Guided Injection
J. Clin. Med. 2019, 8(7), 1048; https://doi.org/10.3390/jcm8071048 - 18 Jul 2019
Abstract
Ultrasound-guided injection is a widely used technique, however, it takes substantial amounts of time for novices to master the skill. The most critical issue to improve the accuracy of the injection is to align the needle with the scan plane of the ultrasound [...] Read more.
Ultrasound-guided injection is a widely used technique, however, it takes substantial amounts of time for novices to master the skill. The most critical issue to improve the accuracy of the injection is to align the needle with the scan plane of the ultrasound beam and orient the needle angle after piercing skin to aim at the targeted tissue. In the present study, we developed a two-dimensional laser align device to assist physicians to accurately position the needle in the scan plane and advance it at an angle correctly pointing to the target. The device is inexpensive, light-weighted, and easy to fabricate and accommodate for any types of ultrasound probe. Statistical analysis revealed that the assistance with our device significantly reduced the successful targeting time and times of retargeting in comparison with the traditional freehand approach or only with in-plane assistance for inexperience subjects. Our results indicate that the device exhibits great potential in effectively reducing the learning time to master the skill and speeding up the procedure for ultrasound-guided injection. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Comparison of Oncologic Outcomes in Laparoscopic versus Open Surgery for Non-Metastatic Colorectal Cancer: Personal Experience in a Single Institution
J. Clin. Med. 2019, 8(6), 875; https://doi.org/10.3390/jcm8060875 - 19 Jun 2019
Abstract
The oncologic merits of the laparoscopic technique for colorectal cancer surgery remain debatable. Eligible patients with non-metastatic colorectal cancer who were scheduled for an elective resection by one surgeon in a medical institution were randomized to either laparoscopic or open surgery. During this [...] Read more.
The oncologic merits of the laparoscopic technique for colorectal cancer surgery remain debatable. Eligible patients with non-metastatic colorectal cancer who were scheduled for an elective resection by one surgeon in a medical institution were randomized to either laparoscopic or open surgery. During this period, a total of 188 patients received laparoscopic surgery and the other 163 patients received the open approach. The primary endpoint was cancer-free five-year survival after operative treatment, and the secondary endpoint was the tumor recurrence incidence. Besides, surgical complications were also compared. There was no statistically significant difference between open and laparoscopic groups regarding the average number of lymph nodes dissected, ileus, anastomosis leakage, overall mortality rate, cancer recurrence rate, or cancer-free five-year survival. Even though performing a laparoscopic approach used a significantly longer operation time, this technique was more effective for colorectal cancer treatment in terms of shorter hospital stay and less blood loss. Meanwhile, fewer patients receiving the laparoscopic approach developed postoperative urinary tract infection, wound infection, or pneumonia, which reached statistical significance. For non-metastatic colorectal cancer patients, laparoscopic surgery resulted in better short-term outcomes, whether in several surgical complications and intra-operative blood loss. Though there was no significant statistical difference in terms of cancer-free five-year survival and tumor recurrence, it is strongly recommended that patients undergo laparoscopic surgery if not contraindicated. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
The Efficacy and Safety of Eravacycline in the Treatment of Complicated Intra-Abdominal Infections: A Systemic Review and Meta-Analysis of Randomized Controlled Trials
J. Clin. Med. 2019, 8(6), 866; https://doi.org/10.3390/jcm8060866 - 17 Jun 2019
Cited by 6
Abstract
This study aims to assess the clinical efficacy and safety of eravacycline for treating complicated intra-abdominal infection (cIAI) in adult patients. The PubMed, Web of Science, EBSCO, Cochrane databases, Ovid Medline, Embase, and ClinicalTrials.gov were searched up to May 2019. Only randomized controlled [...] Read more.
This study aims to assess the clinical efficacy and safety of eravacycline for treating complicated intra-abdominal infection (cIAI) in adult patients. The PubMed, Web of Science, EBSCO, Cochrane databases, Ovid Medline, Embase, and ClinicalTrials.gov were searched up to May 2019. Only randomized controlled trials (RCTs) that evaluated eravacycline and other comparators for the treatment of cIAI were included. The primary outcome was the clinical cure rate at the test-of-cure visit based on modified intent-to-treat population, microbiological intent-to-treat population, clinically evaluable population, and microbiological evaluable population, and the secondary outcomes were clinical failure rate and the risk of adverse event. Three RCTs were included. Overall, eravacycline had a clinical cure rate (88.7%, 559/630) at test-of-cure in modified intent-to-treat population similar to comparators (90.1%, 492/546) in the treatment of cIAIs (risk ratio (RR), 0.99; 95% confidence interval (CI), 0.95–1.03; I2 = 0%, Figure 3). In the microbiological intent-to-treat, clinically evaluable, and microbiological evaluable populations, no difference was found between eravacycline and comparators in terms of clinical cure rate at test-of-cure (microbiological intent-to-treat population, RR, 0.99; 95% CI, 0.95–1.04; I2 = 0%, clinically evaluable population, RR, 1.00; 95% CI, 0.97–1.03; I2 = 0%, microbiological evaluable population, RR, 0.98; 95% CI, 0.95–1.02; I2 = 0%). In addition, eravacycline had clinical failure rate similar to comparators at test-of-cure in modified intent-to-treat population (RR, 1.01; 95% CI, 0.61–0.69; I2 = 0%), microbiological intent-to-treat population (RR, 1.34; 95% CI, 0.77–2.31; I2 = 16%), clinically evaluable population (RR, 1.03; 95% CI, 0.61–1.76; I2 = 0%), and microbiological evaluable population (RR, 1.32; 95% CI, 0.75–2.32; I2 = 10%). Although eravacycline was associated with higher risk of treatment-emergent adverse event than comparators (RR, 1.34; 95% CI, 1.13–1.58; I2 = 0%), no significant differences were found between eravacycline and comparators for the risk of serious adverse event (RR, 1.04; 95% CI, 0.65–1.65; I2 = 0%), discontinuation of study drug because of adverse event (RR, 0.68; 95% CI, 0.23–1.99; I2 = 13%), and all-cause mortality (RR, 1.09; 95% CI, 0.41–2.9; I2 = 28%). In conclusion, the clinical efficacy of eravacycline is as high as that of the comparator drugs in the treatment of cIAIs and this antibiotic is as well tolerated as the comparators. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Efficacy and Safety of Ceftaroline for the Treatment of Community-Acquired Pneumonia: A Systemic Review and Meta-Analysis of Randomized Controlled Trials
J. Clin. Med. 2019, 8(6), 824; https://doi.org/10.3390/jcm8060824 - 09 Jun 2019
Cited by 6
Abstract
This study aimed to compare the clinical efficacy and safety of ceftaroline with those of ceftriaxone for treating community-acquired pneumonia (CAP). The PubMed, Cochrane Library, Embase, and clinicalTrials.gov databases were searched until April 2019. This meta-analysis only included randomized controlled trials (RCTs) that [...] Read more.
This study aimed to compare the clinical efficacy and safety of ceftaroline with those of ceftriaxone for treating community-acquired pneumonia (CAP). The PubMed, Cochrane Library, Embase, and clinicalTrials.gov databases were searched until April 2019. This meta-analysis only included randomized controlled trials (RCTs) that evaluated ceftaroline and ceftriaxone for the treatment of CAP. The primary outcome was the clinical cure rate, and the secondary outcome was the risk of adverse events (AEs). Five RCTs were included. Overall, at the test of cure (TOC), the clinical cure rate of ceftaroline was superior to the rates of ceftriaxone for the treatment of CAP (modified intent-to-treat population (MITT) population, odds ratio (OR) 1.61, 95% confidence interval (CI) 1.31–1.99, I2 = 0%; clinically evaluable (CE) population, OR 1.38, 95% CI 1.07–1.78, I2 = 14%). Similarly, the clinical cure rate of ceftaroline was superior to that of ceftriaxone at the end of therapy (EOT) (MITT population, OR 1.57, 95% CI 1.16–2.11, I2 = 0%; CE population, OR 1.64, 95% CI 1.15–2.33, I2 = 0%). For adult patients, the clinical cure rate of ceftaroline remained superior to that of ceftriaxone at TOC (MITT population, OR 1.66, 95% CI 1.34–2.06, I2 = 0%; CE population, OR 1.39, 95% CI 1.08–1.80, I2 = 30%) and at EOT (MITT population, OR 1.64, 95% CI 1.20–2.24, I2 = 0%; CE population, OR 1.65, 95% CI 1.15–2.36, I2 = 0%). Ceftaroline and ceftriaxone did not differ significantly in the risk of serious AEs, treatment-emergent AEs, and discontinuation of the study drug owing to an AE. In conclusion, the clinical efficacy of ceftaroline is similar to that of ceftriaxone for the treatment of CAP. Furthermore, this antibiotic is as tolerable as ceftriaxone. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Use of Secukinumab in a Cohort of Erythrodermic Psoriatic Patients: A Pilot Study
J. Clin. Med. 2019, 8(6), 770; https://doi.org/10.3390/jcm8060770 - 31 May 2019
Cited by 5
Abstract
Erythrodermic psoriasis (EP) is a dermatological emergency and its treatment with secukinumab is still controversial. Furthermore, no data exist regarding the prognostic value of drug abuse in such a condition. We performed a multi-center, international, retrospective study, enrolling a sample of EP patients [...] Read more.
Erythrodermic psoriasis (EP) is a dermatological emergency and its treatment with secukinumab is still controversial. Furthermore, no data exist regarding the prognostic value of drug abuse in such a condition. We performed a multi-center, international, retrospective study, enrolling a sample of EP patients (body surface area > 90%) who were treated with secukinumab (300 mg) during the study period from December 2015 to December 2018. Demographics and clinical data were collected. Drug abuses were screened and, specifically, smoking status (packages/year), cannabis use (application/week) and alcoholism—tested with the Alcohol Use Disorders Identification Test (AUDIT)—were assessed. All patients were followed for up to 52 weeks. We enrolled 13 EP patients, nine males, and four females, with a median age of 40 (28–52) years. Patients naïve to biologic therapy were 3/13. Regarding drug use, seven patients had a medium-high risk of alcohol addiction, three used cannabis weekly, and seven were smokers with a pack/year index of 295 (190–365). The response rate to secukinumab was 10/13 patients with a median time to clearance of three weeks (1.5–3). No recurrences were registered in the 52-week follow-up and a Psoriasis Area Severity Index (PASI) score of 90 was achieved. The entire cohort of non-responders (n = 3) consumed at least two drugs of abuse (alcohol, smoking or cannabis). Non-responders were switched to ustekinumab and obtained a PASI 100 in 24 weeks. However, given our observed number of patients using various drugs in combination with secukinumab in EP, further studies are needed to ascertain drug abuse prevalence in a larger EP cohort. Secukinumab remains a valid, effective and safe therapeutic option for EP. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Epidemiology and Burden of Diabetic Foot Ulcer and Peripheral Arterial Disease in Korea
J. Clin. Med. 2019, 8(5), 748; https://doi.org/10.3390/jcm8050748 - 25 May 2019
Cited by 2
Abstract
Information about the epidemiology of diabetic foot ulcer (DFU) with peripheral arterial disease (PAD) is likely to be crucial for predicting future disease progression and establishing a health care budget. We investigated the incidence and prevalence of DFU and PAD in Korea. In [...] Read more.
Information about the epidemiology of diabetic foot ulcer (DFU) with peripheral arterial disease (PAD) is likely to be crucial for predicting future disease progression and establishing a health care budget. We investigated the incidence and prevalence of DFU and PAD in Korea. In addition, we examined costs of treatments for DFU and PAD. This study was conducted using data from Health Insurance Review and Assessment Service from 1 January 2011 to 31 December 2016. The incidence of DFU with PAD was 0.58% in 2012 and 0.49% in 2016. The prevalence of DFU with PAD was 1.7% in 2011 to 1.8% in 2016. The annual amputation rate of DFU with PAD was 0.95% in 2012 and 1.10% in 2016. Major amputation was decreased, while minor amputation was increased. The direct cost of each group was increased, especially the limb saving group. which was increased from 296 million dollars in 2011 to 441 million dollars in 2016. The overall incidence of DFU with PAD was about 0.5% of total population in Korea, from 2012 to 2016. Furthermore, costs for treatments of diabetic foot ulcer are increasing, especially those for the limb saving group. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Association between Serum Urate and Risk of Hypertension in Menopausal Women with XDH Gene
J. Clin. Med. 2019, 8(5), 738; https://doi.org/10.3390/jcm8050738 - 23 May 2019
Cited by 1
Abstract
Elevated serum urate (sUA) concentrations have been associated with an increased risk of hypertension. We aimed to examine the association of sUA concentration on the risk of hypertension in pre- and post-menopausal women and investigated the association between the polymorphism of the xanthine [...] Read more.
Elevated serum urate (sUA) concentrations have been associated with an increased risk of hypertension. We aimed to examine the association of sUA concentration on the risk of hypertension in pre- and post-menopausal women and investigated the association between the polymorphism of the xanthine dehydrogenase gene and the risk of hypertension. Among 7294 women, 1415 premenopausal and 5879 postmenopausal women were recruited. Anthropometric parameters as risk factors of hypertension were identify by logistic regression models. In addition, we investigated an association between xanthine dehydrogenase gene and sUA and their combined associations on the risk of hypertension. Body mass index (BMI) and waist circumference (WC) were significantly increased in accordance to the increase of sUA levels (p < 0.001). Multivariate logistic regression analysis showed postmenopausal women with a high sUA and high BMI were 3.18 times more likely to have hypertension than in those with normal and lower sUA (Odds ratio: 3.18, 95% confidence interval: 2.54–3.96). Postmenopausal women with a high WC were 1.62 times more likely to have hypertension than in those with normal and lower sUA. Subjects with the AG genotype of rs206860 was found to be at lower risk of hypertension (odd ratio: 0.287, 95% confidence interval: 0.091–0.905, p = 0.033). This cross-sectional study indicated a high sUA is associated with a higher risk of hypertension in postmenopausal women. Further well-designed prospective studies in other populations are warranted to validate our results. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Preoperative Health-Related Quality of Life Predicts Minimal Clinically Important Difference and Survival after Surgical Resection of Hepatocellular Carcinoma
J. Clin. Med. 2019, 8(5), 576; https://doi.org/10.3390/jcm8050576 - 27 Apr 2019
Cited by 1
Abstract
Despite the growing use of minimal clinically important difference (MCID) as a cancer outcome measure, no study has reported clinically significant outcomes in cancer patients. We defined MCID and evaluated the use of preoperative HRQoL for predicting MCID and survival after surgical resection [...] Read more.
Despite the growing use of minimal clinically important difference (MCID) as a cancer outcome measure, no study has reported clinically significant outcomes in cancer patients. We defined MCID and evaluated the use of preoperative HRQoL for predicting MCID and survival after surgical resection of hepatocellular carcinoma (HCC). In total, 369 patients completed the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) and the SF-36 at baseline and at two years post-operative at three tertiary academic hospitals. The corresponding MCID values were 3.6 (SF-36 physical component summary), 4.2 (SF-36 mental component summary), 5.4 (FACT-General total score), and 6.7 (FACT-Hep total score). The predictors of achieving postoperative MCID were significantly higher in patients who had low preoperative HRQoL score, advanced age, high education level, and high BMI (p < 0.05). However, patients with a high preoperative HRQoL score, high education level, high BMI, and low Charlson comorbidity index score were significantly associated with survival (p < 0.05). Preoperative HRQoL scores were predictive of MCID and overall survival after surgical resection of HCC. The findings of this study may be useful for managing the preoperative expectations of candidates for HCC resection and for developing shared decision-making procedures for patients undergoing surgical resection of HCC. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Re-Evaluating the Protective Effect of Hemodialysis Catheter Locking Solutions in Hemodialysis Patients
J. Clin. Med. 2019, 8(3), 412; https://doi.org/10.3390/jcm8030412 - 25 Mar 2019
Abstract
Catheter-related bloodstream infections (CRBSIs) and exit-site infections (ESIs) are common complications associated with the use of central venous catheters for hemodialysis. The aim of this study was to analyze the impact of routine locking solutions on the incidence of CRBSI and ESI, in [...] Read more.
Catheter-related bloodstream infections (CRBSIs) and exit-site infections (ESIs) are common complications associated with the use of central venous catheters for hemodialysis. The aim of this study was to analyze the impact of routine locking solutions on the incidence of CRBSI and ESI, in preserving catheter function, and on the rate of all-cause mortality in patients undergoing hemodialysis. We selected publications (from inception until July 2018) with studies comparing locking solutions for hemodialysis catheters used in patients undergoing hemodialysis. A total of 21 eligible studies were included, with a total of 4832 patients and 318,769 days of catheter use. The incidence of CRBSI and ESI was significantly lower in the treated group (citrate-based regimen) than in the controls (heparin-based regimen). No significant difference in preserving catheter function and all-cause mortality was found between the two groups. Our findings demonstrated that routine locking solutions for hemodialysis catheters effectively reduce the incidence of CRBSIs and ESIs, but our findings failed to show a benefit for preserving catheter function and mortality rates. Therefore, further studies are urgently needed to conclusively evaluate the impact of routine locking solutions on preserving catheter function and improving the rates of all-cause mortality. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessArticle
Predictors of Discordance in the Assessment of Skeletal Muscle Mass between Computed Tomography and Bioimpedance Analysis
J. Clin. Med. 2019, 8(3), 322; https://doi.org/10.3390/jcm8030322 - 07 Mar 2019
Cited by 1
Abstract
Computed tomography (CT) and bioimpedance analysis (BIA) can assess skeletal muscle mass (SMM). Our objective was to identify the predictors of discordance between CT and BIA in assessing SMM. Participants who received a comprehensive medical health check-up between 2010 and 2018 were recruited. [...] Read more.
Computed tomography (CT) and bioimpedance analysis (BIA) can assess skeletal muscle mass (SMM). Our objective was to identify the predictors of discordance between CT and BIA in assessing SMM. Participants who received a comprehensive medical health check-up between 2010 and 2018 were recruited. The CT and BIA-based diagnostic criteria for low SMM are as follows: Defined CT cutoff values (lumbar skeletal muscle index (LSMI) <1 standard deviation (SD) and means of 46.12 cm2/m2 for men and 34.18 cm2/m2 for women) and defined BIA cutoff values (appendicular skeletal muscle/height2 <7.0 kg/m2 for men and <5.7 kg/m2 for women). A total of 1163 subjects were selected. The crude and body mass index (BMI)-adjusted SMM assessed by CT were significantly associated with those assessed by BIA (correlation coefficient = 0.78 and 0.68, respectively; p < 0.001). The prevalence of low SMM was 15.1% by CT and 16.4% by BIA. Low SMM diagnosed by CT was significantly associated with advanced age, female gender, and lower serum albumin level, whereas low SMM diagnosed by BIA was significantly associated with advanced age, female gender, and lower BMI (all p < 0.05). Upon multivariate analysis, age >65 years, female and BMI <25 kg/m2 had significantly higher risks of discordance than their counterparts (all p < 0.05). We found a significant association between SMM assessed by CT and BIA. SMM assessment using CT and BIA should be interpreted cautiously in older adults (>65 years of age), female and BMI <25 kg/m2. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessReview
Abuse of Licit and Illicit Psychoactive Substances in the Workplace: Medical, Toxicological, and Forensic Aspects
J. Clin. Med. 2020, 9(3), 770; https://doi.org/10.3390/jcm9030770 - 12 Mar 2020
Abstract
About one-third of adult life is spent in the workplace. The use of psychoactive substances is a major preventable cause of morbidity and mortality. The consumption of psychoactive substances during or outside working hours greatly increases the frequency and severity of labor accidents, [...] Read more.
About one-third of adult life is spent in the workplace. The use of psychoactive substances is a major preventable cause of morbidity and mortality. The consumption of psychoactive substances during or outside working hours greatly increases the frequency and severity of labor accidents, as well as the workers’ poor general state of health and productivity, implying higher costs for enterprises. It is the responsibility of organizations to ensure the safety and health of their workers. These cannot be limited to traditional routine clinical exams, as other aspects also have an impact on health. Thus, prevention and intervention in the consumption of psychoactive substances (e.g., ethanol, opioids, central nervous system stimulants or depressants, hallucinogens, Cannabis derivatives, dissociative substances, and inhalants) in labor activity should be considered as an investment of organizations and not as a cost, in view of the professional, personal, and family advantages for workers and employers, with a potential impact on productivity, security, health, and quality of life at work. Despite the extensive literature on the subject, each article generally focuses on one or another aspect of a very specific nature, not tackling the problem in a holistic way by confronting clinical, safety, and legal issues. This article presents a reflection on the legal, laboratorial, clinical, ethical, forensic, and safety concerns related to the consumption of psychoactive substances in the workplace, and can be a cross-cutting contribution to occupational medicine, forensic medicine, and insurance medicine, as well as for entrepreneurs, lawyers, judges, workers, and technicians from the public and private sectors that develop projects in this area. This discussion is based on general principles established internationally and highlights the role of the occupational healthcare system and other decision-making actors in the prevention and supervision of workplace psychoactive consumption. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
Open AccessReview
Role of Nutrition and Exercise Programs in Reducing Blood Pressure: A Systematic Review
J. Clin. Med. 2019, 8(9), 1393; https://doi.org/10.3390/jcm8091393 - 05 Sep 2019
Cited by 3
Abstract
The combined effect of diet and strength training (ST) on blood pressure (BP) seems to be very important for the treatment of prehypertension and hypertension (HT). Therefore, the aim of this study was to determine whether ST alone or combined with nutrition or [...] Read more.
The combined effect of diet and strength training (ST) on blood pressure (BP) seems to be very important for the treatment of prehypertension and hypertension (HT). Therefore, the aim of this study was to determine whether ST alone or combined with nutrition or supplementation has an impact on the arterial pressure reduction in normotensive and hypertensive populations. A systematic computerized literature search was performed according to the PRISMA guidelines using PubMed, Scopus and Google Scholar; only English language studies published from 1999 until 2018 were included. This systematic search identified the results of 303 individuals from nine studies. The ST program alone had a similar effectiveness as the nutrition program (NP) alone; however, their combination did not result in increased effectiveness in terms of a high BP reduction. The consumption of L-citrulline had a similar effect as ST on lowering BP; on the other hand, caffeine led to an increase in BP during the ST session. Our data suggest that a combination of ST 2–3 times a week at moderate intensity and a NP seems to be equally effective in terms of lowering BP (systolic and diastolic) as ST and NP alone. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessReview
The Efficacy and Safety of Doripenem in the Treatment of Acute Bacterial Infections—A Systemic Review and Meta-Analysis of Randomized Controlled Trials
J. Clin. Med. 2019, 8(7), 958; https://doi.org/10.3390/jcm8070958 - 02 Jul 2019
Cited by 1
Abstract
This study aims to assess the efficacy and safety of doripenem on treating patients with acute bacterial infections. The Pubmed, Embase, and Cochrane databases were searched up to April 2019. Only randomized clinical trials comparing doripenem and other comparators for the treatment of [...] Read more.
This study aims to assess the efficacy and safety of doripenem on treating patients with acute bacterial infections. The Pubmed, Embase, and Cochrane databases were searched up to April 2019. Only randomized clinical trials comparing doripenem and other comparators for the treatment of acute bacterial infection were included. The primary outcome was the clinical success rate and the secondary outcomes were microbiological eradication rate and risk of adverse events. Eight randomized controlled trials (RCTs) were included. Overall, doripenem had a similar clinical success rate with comparators (odds ratio [OR], 1.15; 95% CI, 0.79–1.66, I2 = 58%). Similar clinical success rates were noted between doripenem and comparators for pneumonia (OR, 0.84; 95% CI, 0.46–1.53, I2 = 72%) and for intra-abdominal infections (OR, 1.00; 95% CI, 0.57–1.72). For complicated urinary tract infection, doripenem was associated with higher success rate than comparators (OR, 1.89, 95% CI, 1.13–3.17, I2 = 0%). The pool analysis comparing doripenem and other carbapenems showed no significant differences between each other (OR, 0.96, 95% CI, 0.59–1.58, I2 = 63%). Doripenem also had a similar microbiological eradication rate with comparators (OR, 1.08; 95% CI, 0.86–1.36, I2 = 0%). Finally, doripenem had a similar risk of treatment-emergent adverse events as comparators (OR, 0.98; 95% CI, 0.83–1.17, I2 = 33%). In conclusion, the clinical efficacy of doripenem is as high as that of the comparator drugs in the treatment of acute bacterial infection; furthermore, this antibiotic is as well tolerated as the comparators. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessReview
A Scoping Review of The Efficacy of Virtual Reality and Exergaming on Patients of Musculoskeletal System Disorder
J. Clin. Med. 2019, 8(6), 791; https://doi.org/10.3390/jcm8060791 - 04 Jun 2019
Cited by 6
Abstract
To assess the effects of virtual reality on patients with musculoskeletal disorders by means of a scoping review of randomized controlled trials (RCTs). The databases included PubMed, IEEE, and the MEDLINE database. Articles involving RCTs with higher than five points on the Physiotherapy [...] Read more.
To assess the effects of virtual reality on patients with musculoskeletal disorders by means of a scoping review of randomized controlled trials (RCTs). The databases included PubMed, IEEE, and the MEDLINE database. Articles involving RCTs with higher than five points on the Physiotherapy Evidence Database (PEDro) scale were reviewed for suitability and inclusion. The methodological quality of the included RCT was evaluated using the PEDro scale. The three reviewers extracted relevant information from the included studies. Fourteen RCT articles were included. When compared with simple usual care or other forms of treatment, there was significant pain relief, increased functional capacity, reduced symptoms of the disorder, and increased joint angles for the virtual reality treatment of chronic musculoskeletal disorders. Furthermore, burn patients with acute pain were able to experience a significant therapeutic effect on pain relief. However, virtual reality treatment of patients with non-chronic pain such as total knee replacement, ankle sprains, as well as those who went through very short virtual reality treatments, did not show a significant difference in parameters, as compared with simple usual care and other forms of treatment. Current evidence supports VR treatment as having a significant effect on pain relief, increased joint mobility, or motor function of patients with chronic musculoskeletal disorders. VR seems quite effective in relieving the pain of patients with acute burns as well. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Open AccessReview
Patient Experience in Home Respiratory Therapies: Where We Are and Where to Go
J. Clin. Med. 2019, 8(4), 555; https://doi.org/10.3390/jcm8040555 - 24 Apr 2019
Cited by 2
Abstract
The increasing number of patients receiving home respiratory therapy (HRT) is imposing a major impact on routine clinical care and healthcare system sustainability. The current challenge is to continue to guarantee access to HRT while maintaining the quality of care. The patient experience [...] Read more.
The increasing number of patients receiving home respiratory therapy (HRT) is imposing a major impact on routine clinical care and healthcare system sustainability. The current challenge is to continue to guarantee access to HRT while maintaining the quality of care. The patient experience is a cornerstone of high-quality healthcare and an emergent area of clinical research. This review approaches the assessment of the patient experience in the context of HRT while highlighting the European contribution to this body of knowledge. This review demonstrates that research in this area is still limited, with no example of a prescription model that incorporates the patient experience as an outcome and no specific patient-reported experience measures (PREMs) available. This work also shows that Europe is leading the research on HRT provision. The development of a specific PREM and the integration of PREMs into the assessment of prescription models should be clinical research priorities in the next several years. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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