Individualized Treatment Plans Research Articles

Experience in the diagnosis and treatment of non-invasive bilateral carotid cavernous sinus fistula based on CT image examination

Carotid cavernous fistula is a rare but clinically important vascular abnormality that is challenging to diagnose and treat. The clinical data of a patient with bilateral carotid cavernous fistula diagnosed by CT images were retrospectively analyzed. Through the analysis of CT images, the patient was accurately located and the diagnosis was confirmed. CT images can provide detailed anatomical information and accurately show the location, morphology and hemodynamic characteristics of carotid cavernous fistula. Through CT image examination, we successfully diagnosed bilateral carotid cavernous fistula patients, and can provide an important reference for surgical treatment. Therefore, CT image examination can provide accurate diagnosis and surgical planning information, and provide support for the formulation of individual treatment plans for patients. The application of this method is helpful to improve the early diagnosis rate and treatment effect of carotid cavernous fistula.

AI and Cloud Computing in Healthcare: Transforming Patient Care with AWS and Java

A new era in healthcare is being ushered in by the convergence of artificial intelligence (AI) and cloud computing, which will significantly improve patient care through improved diagnosis, individualized treatment planning, and effective patient management. This article explores the potent combination of Java and Amazon Web Services (AWS) and how these technologies may be used to develop cutting-edge AI-driven healthcare solutions that optimize healthcare operations and dramatically enhance patient outcomes. Together with Java's robust and flexible programming environment, healthcare providers can leverage AWS's scalable infrastructure and advanced machine learning capabilities to create and implement sophisticated AI models that analyze massive amounts of medical data at a speed and accuracy never seen before. These developments are making it possible to make more accurate diagnoses, customized treatment plans, and proactive patient monitoring, which can result in better clinical judgment and possibly life-saving measures. But even as we consider the enormous positive effects these technologies have on society, we also have to face the ethical problems they raise, such as issues with data privacy, potential biases in algorithms, and unequal access to cutting-edge medical treatments.

AI and Cloud Computing in Healthcare: Transforming Patient Care with AWS and Java

A new era in healthcare is being ushered in by the convergence of artificial intelligence (AI) and cloud computing, which will significantly improve patient care through improved diagnosis, individualized treatment planning, and effective patient management. This article explores the potent combination of Java and Amazon Web Services (AWS) and how these technologies may be used to develop cutting-edge AI-driven healthcare solutions that optimize healthcare operations and dramatically enhance patient outcomes. Together with Java's robust and flexible programming environment, healthcare providers can leverage AWS's scalable infrastructure and advanced machine learning capabilities to create and implement sophisticated AI models that analyze massive amounts of medical data at a speed and accuracy never seen before. These developments are making it possible to make more accurate diagnoses, customized treatment plans, and proactive patient monitoring, which can result in better clinical judgment and possibly life-saving measures. But even as we consider the enormous positive effects these technologies have on society, we also have to face the ethical problems they raise, such as issues with data privacy, potential biases in algorithms, and unequal access to cutting-edge medical treatments. The goal of this thorough investigation is to present a fair assessment of the revolutionary potential of artificial intelligence (AI) and cloud computing in the healthcare industry, while also discussing the wider ramifications and obligations associated with incorporating these formidable technologies into our healthcare systems.

Mechanism of renal cyst formation in a child with tuberous sclerosis complex: a case report

BackgroundTuberous sclerosis complex (TSC) is a multisystem genetic disorder characterized by the development of benign tumors in various organs, including the brain, kidneys, heart, lungs, skin, and eyes. Herein, an infant who was followed up with a diagnosis of TSC and multiple cysts which were found in the kidneys was presented, and the mechanism of renal cyst formation in TSC was elucidated.Case presentationAn infant was referred to our hospital after delivery due to multiple cardiac homogeneous echogenicity in the antenatal period. Transthoracic echocardiography showed multiple rhabdomyomas in both ventricles. Three months later, she started to have seizures 1–3 times a day. Electroencephalography was compatible with active multifocal epileptic disorder and hypsarrhythmia. Brain magnetic resonance imaging revealed a thin corpus callosum, cortical and subcortical tubercles, and multiple subependymal nodules. Abdominal ultrasound revealed a multiloculated cyst reaching 1 cm in size in the liver, and multiple cortical cysts smaller than 6 mm were observed in both kidneys, in accordance with autosomal dominant polycystic kidney disease (ADPKD). Pathogenic deletions between 31–42 exons in TSC2 gene and 28–46 exons in PKD1 gene were detected, and the patient was diagnosed as PKD1/TSC2 contiguous gene deletion syndrome.ConclusionThe coexistence of TSC and ADPKD is a rare occurrence but has been documented. Regular follow-up visits with healthcare providers, including nephrologists, cardiologist, neurologists, dermatologists, and other specialists as needed, are essential for the comprehensive management of coexistence of TSC and ADPKD. Individualized treatment plans should be developed based on the specific needs and manifestations of each patient, with a focus on optimizing outcomes and improving quality of life.

Successful Management of Complex Intestinal Tuberculosis with Ileal Perforation: A Case Report

Background: Intestinal tuberculosis (ITB) with ileal perforation represents a formidable challenge in the realm of extrapulmonary tuberculosis. This case report underscores the complexities inherent in managing such cases, highlighting the critical need for a multidisciplinary approach that integrates pharmacological and surgical interventions. Case presentation: A 57-year-old male presented with a history of both pulmonary and intestinal tuberculosis, complicated by ileal perforation. He had previously undergone a six-month course of anti-tuberculosis treatment and a laparotomy for ileal perforation repair. The patient's current presentation included abdominal pain, nausea, and vomiting, indicative of obstructive ileus. Diagnostic assessments revealed elevated inflammatory markers and imaging confirmed partial obstructive ileus and active pulmonary tuberculosis. The patient was managed with extended anti-tuberculosis therapy and intravenous antibiotics, resulting in significant clinical improvement and enhanced quality of life. Conclusion: This case report emphasizes the importance of early detection, comprehensive assessment, and individualized treatment plans in managing complex ITB cases. The successful outcome achieved in this case underscores the efficacy of a multidisciplinary approach that combines pharmacological and surgical interventions.

What can we do for obstructive sleep apnea patients in China?

AbstractObstructive sleep apnea (OSA) is a heterogeneous disease, having diversity in symptom, polysomnography parameter, etc. Studies have found that apnea–hypopnea index as a single measure cannot reflect its heterogeneity. More personalized diagnostic criteria and treatment measures are needed. But there are different kinds of results with different races and regions. It is essential to consider the characteristics of the local population when formulating individual treatment plan. There are significant discrepancies between Chinese and White race in terms of morphologic features, daily habits, religious beliefs and so on. However, the research based on the Chinese population still suffers from scarcity. This review sums up recent progress of studies on OSA from the Chinese population to provide useful references for related research and treatment in the future.

Assessment of decision-making autonomy in chronic pain patients: a pilot study

BackgroundPatient decision-making autonomy refers to the patients’ ability to freely exert their own choices and make their own decisions, given sufficient resources and information to do so. In pain medicine, it is accepted that appropriate beneficial management aims to propose an individualized treatment plan shared with the patients, as agents, to help them live as autonomously as possible with their pain. However, are patients in chronic pain centers sufficiently autonomous to participate in the therapeutic decisions that concern them? As this question still remains unanswered, a pilot study was set up to that aim.MethodsOver a 2-month period, first-time patients within a tertiary multidisciplinary pain center underwent a systematic evaluation of their autonomy using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), considered the benchmark tool for measuring a patient’s ability to consent to treatment. Demographic data and pain characteristics of the patients were collected and their respective attending pain physicians were asked to clinically assess their patients’ degree of autonomy. Another physician, who had not participated in the initial patient evaluation, subsequently administered the MacCAT-T questionnaire to the same patients.ResultsTwenty-seven patients were included during the study period (21 women and 6 men), with an average age of 50 years. The average duration of pain was 8 years. Based on their clinical experience, the 4 different pain physicians in charge of these patients considered that out of 25 assessed patients, 22 of them (89%) had full decision-making capacity, with no deficit in autonomy. According to the MacCAT-T results, only 13 of these 25 patients (48%) had no deficit, while 7 (26%) had a major deficit in autonomy. The only patient characteristic that appeared to be related to autonomy was pain type, specifically nociplastic pain. The average time taken to complete the test was 20 min, and patients were very satisfied with the interview.ConclusionResults from the present pilot study suggest that patients suffering from chronic pain do not appear to be entirely autonomous in their decision to consent to the proposed treatment plan according to the MacCAT-T questionnaire, and physicians seem to find it difficult to properly assess this competence in a clinical setting. Further studies with larger samples are needed to better evaluate this concept to improve the complex management of these patients.

Conservative treatment of adolescent idiopathic scoliosis (AIS): A narrative review of current evidence and implications for clinical practice

Introduction and purpose: Adolescent idiopathic scoliosis (AIS) is characterized by lateral curvature, vertebral rotation, and disruption of physiological curvature of the spine with the Cobb angle ≥10°. AIS affects 1-3% of children aged 10-16 years, representing the most common form of idiopathic scoliosis. Diagnosis of AIS is by exclusion and can be suspected based on Adams forward bend test and scoliometer. Untreated AIS can lead to serious consequences, such as progression of the deformity, back pain, reduced respiratory and cardiovascular function. The aim of this review is to update overview of conservative treatment options. Description of the state of knowledge: AIS treatment guidelines from the Scoliosis Research Society (SRS) and the Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) advocate for observation, bracing, or surgery depending on curve severity, with a focus on avoiding spinal fusion when possible. Additionally, SOSORT recommends scoliosis-specific physiotherapy exercises for smaller curves or as an adjunct to bracing. Conservative treatment aims to prevent curve progression, manage respiratory and spinal complications, and improve quality of life. Conclusions: AIS can significantly impair the physical and psychosocial well-being of young patients, with potential long-term consequences extending into adulthood Individualized treatment plans and patient/parent education are crucial for optimal outcomes. Schroth exercises are superior to Core Stabilization (CS) exercises in reducing Cobb angle, trunk rotation and improving spinal mobility, cosmetic trunk deformities and quality of life. CS exercises are more effective in increasing peripheral muscle strength, reducing pain and correcting vertebral rotation.

Beyond the spine: a case of ankylosing spondylitis complicated by secondary amyloidosis

BackgroundAnkylosing spondylitis (AS) is a chronic inflammatory condition primarily affecting the spine and sacroiliac joints, often associated with human leukocyte antigen B27 (HLA-B27) positivity. While musculoskeletal symptoms are typical manifestations, AS can also lead to systemic complications, including secondary systemic amyloidosis (SSA), also known as Amyloid A (AA) amyloidosis, involving multiple organs.Case presentationWe present a case of a 45-year-old Asian male with a complex medical history, including diabetes and hypertension, who developed AS complicated by SSA. The patient exhibited a diverse range of symptoms, including cardiac, renal, gastrointestinal, and musculoskeletal manifestations. He reported shortness of breath on exertion, orthopnea, pedal edema, generalized weakness, back pain, neck pain, low-grade fever, decreased appetite, frothy urine, and significant weight loss over the past year. Diagnostic evaluations revealed HLA-B27 positivity and histologically confirmed AA amyloidosis, providing a comprehensive understanding of the systemic involvement.ConclusionThis case report highlights the intricate interplay between AS and SSA, particularly AA amyloidosis, with a focus on its systemic impact beyond musculoskeletal symptoms. The tragic outcome, marked by severe cardiac involvement, underscores the challenges in managing such complex cases. This report emphasizes the importance of early diagnosis and treatment of AS to prevent severe complications, along with vigilant monitoring and individualized treatment plans, as well as the need for further research to enhance our understanding and improve management strategies for AS-related amyloidosis.

The Influence of Pulmonary Arterial Hypertension In Pregnancy: A Review.

Pulmonary arterial hypertension (PAH) is a severe condition characterized by increased pulmonary vascular resistance and right ventricular failure. This review examines the intersection of PAH and pregnancy, highlighting the significant physiological, hemodynamic, and hormonal changes that exacerbate PAH during gestation. Pregnancy is contraindicated in PAH patients due to high maternal and fetal morbidity and mortality rates. However, some patients choose to continue their pregnancies, necessitating a comprehensive understanding of the implications and management strategies. Effective management of PAH in pregnant patients involves individualized treatment plans. Prepartum management focuses on optimizing therapy and monitoring hemodynamic status. Prostacyclin analogs and phosphodiesterase inhibitors are commonly used, though their safety profiles require further investigation. Intrapartum management prioritizes preventing right ventricular failure, utilizing therapies such as intravenous epoprostenol, inhaled iloprost, and inhaled nitric oxide. Managing PAH in pregnancy requires careful planning, continuous monitoring, and tailored therapeutic strategies to navigate the complex interplay of physiological changes and mitigate risks. Future research should focus on elucidating the pathophysiology of PAH during pregnancy and developing safer, more effective treatments to improve maternal and fetal outcomes.

Addition of the clinical frailty scale to triage tools and early warning scores improves mortality prognostication at 30 days: A prospective observational multicenter study.

Frailty, assessed with clinical frailty scale (CFS), alone or in combination with aggregated vital signs, has been proposed as a measure to better predict mortality of older patients in the emergency department (ED), but the added predictive value to conventional triage is unclear. This was a secondary analysis of a prospective observational study in three EDs in Sweden that evaluated the prognostic performance of the CFS alone or in combination with the national early warning score (NEWS), triage early warning score (TEWS) or the rapid emergency triage and treatment system (RETTS) triage tool using logistic regression. The primary outcome was 30-day mortality with 7- and 90-day mortality and admission as secondary outcomes reported as area under the receiver operating curve (AuROC) scores with 95% confidence intervals (CIs). The sensitivity, specificity, accuracy, predictive values, and likelihood ratios are reported for all models. A total of 1832 patients were included with 17 (0.9%), 57 (3.1%), and 121 (6.6%) patients dying within 7, 30, and 90 days, respectively. The admission rate was 43% (795/1832). Frailty (CFS>4) was significantly associated with 30-day mortality (odds ratio 6, 95% CI 3‒12, p<0.01). Prognostication of 30-day mortality was similar for all CFS-based models and better compared with models without CFS. The AuROC (95% CI) improved for RETTS from 0.67 (0.61‒0.74) to 0.83 (0.79‒0.88) (p=0.008), for NEWS from 0.53 (0.45‒0.61) to 0.82 (0.77‒0.87) (p<0.001), and for TEWS from 0.63 (0.55‒0.71) to 0.82 (0.77‒0.87) (p=0.002). Frailty measured with the CFS in combination with RETTS or structured vital sign assessment using NEWS or TEWS was better at prognosticating 30-day mortality compared to RETTS or early warnings score alone. Improved prognostication provides more realistic expectations and allows for informed discussions with patients and initiation of individualized treatment plans early in the ED process.

Examining Real-World Evidence of Depression-Related Symptom Reduction Through a Comprehensive Holistic Lifestyle Intervention

Depression is a global health concern, with various treatments available. In this study, participants (n = 430) were self-selected or medically referred to a residential lifestyle program at the Black Hills Health &amp; Education Center (BHHEC), with a mean stay of 19 days. Individualized treatment plans included structured physical activity sessions, counseling sessions, and the provision of a vegan diet. Beck Depression Inventory-II, self-reported total exercise minutes, resistance exercise minutes, and sleep, along with the number of holistic treatments and counseling sessions, were evaluated. Paired samples t-tests indicated a significant decrease in depression scores over time (MT1 = 20.14, MT2 = 6.17, P &lt; .001). Results from the multiple linear regression that evaluated total exercise minutes, resistance exercise, number of treatments and counseling sessions, and average reported hours of nightly sleep on depression scores at time 2 indicated that average reported hours of nightly sleep were the only significant predictor of depression scores at time 2 ( P &lt; .05). While depression scores significantly improved from baseline to post-assessment for all participants, it is possible that an unmeasured variable, or the synergistic intervention effect of the wellness program, accounted for changes in depressive symptoms over time. Future studies should incorporate sleep quality and assessing time spent in nature to explore these relationships further.

Machine learning-based risk prediction model construction of difficult weaning in ICU patients with mechanical ventilation

In intensive care unit (ICU) patients undergoing mechanical ventilation (MV), the occurrence of difficult weaning contributes to increased ventilator-related complications, prolonged hospitalization duration, and a significant rise in healthcare costs. Therefore, early identification of influencing factors and prediction of patients at risk of difficult weaning can facilitate early intervention and preventive measures. This study aimed to strengthen airway management for ICU patients by constructing a risk prediction model with comprehensive and individualized offline programs based on machine learning techniques. This study involved the collection of data from 487 patients undergoing MV in the ICU, with a total of 36 variables recorded. The dataset was divided into a training set (70% of the data) and a test set (30% of the data). Five machine learning models, namely logistic regression, random forest, support vector machine, light gradient boosting machine, and extreme gradient boosting, were compared to predict the risk of difficult weaning in ICU patients with MV. Significant influencing factors were identified based on the results of these models, and a risk prediction model for ICU patients with MV was established. When evaluating the models using AUC (Area under the Curve of ROC) and Accuracy as performance metrics, the Random Forest algorithm exhibited the best performance among the five machine learning algorithms. The area under the operating characteristic curve for the subjects was 0.805, with an accuracy of 0.748, recall (0.888), specificity (0.767) and F1 score (0.825). This study successfully developed a risk prediction model for ICU patients with MV using a machine learning algorithm. The Random Forest algorithm demonstrated the highest prediction performance. These findings can assist clinicians in accurately assessing the risk of difficult weaning in patients and formulating effective individualized treatment plans. Ultimately, this can help reduce the risk of difficult weaning and improve the quality of life for patients.

Combined treatment of submacular hemorrhage with low-dose subretinal recombinant tissue plasminogen activator and intravitreal conbercept

BackgroundPars Plana Vitrectomy (PPV) combined with subretinal injection of low-dose recombinant tissue plasminogen activator (rt-PA) and intravitreal injection of Conbercept as a novel therapy for submacular hemorrhage (SMH) requires evaluation.MethodsIn a retrospective interventional clinical study, 14 eyes of 14 patients with SMH underwent PPV along with rt-PA (subretinal) and Conbercept (intravitreal) injections. The main outcomes included best-corrected visual acuities (BCVAs), degrees of blood displacement, and adverse events. All patients completed at least 6-month follow-up visits.ResultsMean BCVAs significantly improved at 7 days (22.29 ± 15.35), 1 month (30.71 ± 16.42), 3 months (38.29 ± 13.72), 4 months (38.86 ± 14.15), and 6 months (41.21 ± 14.91) post-treatment compared to baseline (16.36 ± 13.97) (F = 12.89, P = 0.004). The peak improvement in BCVAs occurred at 6 months postoperatively. The procedure effectively eliminated subfoveal hemorrhages in all eyes, with clots removal and absorption occurring within one month and complete regression by 3-month follow-up visits. Postoperatively, two cases of AMD resulted in discoid scars on the fundus. No instances of rt-PA-related retinal toxicity were observed during the follow-up period.ConclusionThe combined approach of PPV with low-dose rt-PA and anti-VEGF shows promise in enhancing both vision and anatomical structure in SMH therapy. Individualized treatment plans tailored to the primary disease should be developed to optimize visual prognoses.Trial registrationRetrospectively registered No.ChiCTR2100053034. Registration date: 10/11/2021.

Functions of CAFs in microenvironment of non-small cell lung cancer: based on updated hallmarks of cancer

Abstract Non-small cell lung cancer (NSCLC) is the most common subtype of lung cancer, which ranks as the first malignant tumor in mortality. The occurrence and development of NSCLC are closely related to the tumor microenvironment (TME). Cancer-associated fibroblasts (CAFs) in the tumor microenvironment are considered to be critical regulators of the occurrence and development of NSCLC, which have essential effects on multiple biological characteristics of NSCLC. The hallmarks of cancer biology have been updated recently, however, there are no reviews revisiting the function of CAFs in tumor microenvironment. This article reviews the origin, markers, and classification of CAFs, their impacts on the characteristics of NSCLC, and potential therapeutic targets of CAFs to help develop individualized treatment plans for NSCLC.

Evaluating the Accuracy and Completeness of Artificial Intelligence Responses Against Established Otology Guidelines

Background: The incorporation of artificial intelligence (AI), especially large language models like Generative Pretrained Transformer 4 (GPT-4), into medical practice is a burgeoning field of interest. This research evaluates the applicability of GPT-4 in otology by analyzing its responses to queries based on otologic clinical practice guidelines. Methods: Key guidelines from otology were selected, and corresponding questions were formulated to examine GPT-4’s interpretation and response accuracy. Two independent reviewers assessed the AI-generated answers for accuracy and completeness, using a structured Likert scale. A re-evaluation was conducted to evaluate the reproducibility of the results. Results: The analysis showed a high accuracy level (mean score: 4.75 of 5) and completeness (mean score: 2.88 of 3) in GPT-4’s responses. The interrater agreement, as indicated by Cohen κ, was substantial. GPT-4 consistently advised on individualized treatment plans and professional consultation, particularly for guidelines with weaker evidence, demonstrating its cautious approach to handling medical information. Conclusion: GPT-4 exhibits promising potential as an auxiliary tool in otology, providing accurate and comprehensive information. However, its role should be viewed as supplementary, with emphasis on continual updates and careful monitoring to align with evolving medical knowledge. Future studies are recommended to further explore the depth of AI application in diverse clinical scenarios and its real-time impact on clinical outcomes.

Risk Factors for Nonunion After Nonoperative Treatment for Pediatric Lumbar Spondylolysis: A Retrospective Case-Control Study.

Pediatric lumbar spondylolysis, a stress fracture of the lumbar spine, frequently affects young athletes, and nonoperative treatment is often the first choice of management. Because the union rate in lumbar spondylolysis is lower than that in general fatigue fractures, identifying risk factors for nonunion is essential for optimizing treatment. To determine the risk factors for nonunion after nonoperative treatment of acute pediatric lumbar spondylolysis through multivariate analysis. Case-control study; Level of evidence, 3. We analyzed 574 pediatric patients (mean age, 14.3 ± 1.9 years) with lumbar spondylolysis who underwent nonoperative treatment between 2015 and 2022. Nonoperative treatment included the elimination of sports activities, bracing, and weekly athletic rehabilitation, with follow-up computed tomography. Patient data, lesion characteristics, sports history, presence of spina bifida occulta at the lamina with a lesion or at the lumbosacral spine excluding the lesion level, and lumbosacral parameters were examined. Differences between the union and nonunion groups were investigated using multivariate analysis to determine the risk factors for nonunion. Of the 574 patients, 81.7% achieved bone union. Multivariate analysis revealed that an L5 lesion and the progression of the main and contralateral lesion stages were significant independent risk factors for nonunion. An L5 lesion had a lower union rate than non-L5 lesions. As the main lesion progressed, the likelihood of nonunion increased significantly, and the progression of the contralateral lesion also showed a similar trend. Spina bifida occulta and lumbosacral parameters were not significant predictors of nonunion in this study. We identified the L5 lesion level and the progression of the main and contralateral lesion stages as independent risk factors for nonunion in pediatric lumbar spondylolysis after nonoperative treatment. These findings aid in treatment decision-making. When bone union cannot be expected with nonoperative treatment, symptomatic treatment is required without prolonged external fixation and rest, and without aiming for bone union. Individualized treatment plans are crucial based on identified risk factors.

Progression of Quality of Life in Patients with Plaque Psoriasis Who Achieved Three or More Years of Complete Skin Clearance with Guselkumab Treatment: a Post hoc Analysis of the VOYAGE 1 Clinical Trial.

The interleukin-23p19 subunit inhibitor, guselkumab, has demonstrated improvements in clinical and patient-reported outcome (PRO) measures in patients with moderate-to-severe psoriasis. Understanding the relationship among clinical response, PRO measures and baseline characteristics could help clinicians individualize treatment plans. The objective of this analysis was to examine changes in signs, symptoms and quality-of-life (QoL) PRO measures in patients who maintained complete skin clearance through ≥ 3years in the phase 3 VOYAGE 1 trial. A descriptive post hoc analysis of data from VOYAGE 1 was conducted to compare baseline characteristics of patients who maintained complete skin clearance (Psoriasis Area and Severity Index [PASI] = 0 for ≥ 156 consecutive weeks) versus patients who did not. Mean scores for individual domains of the Dermatology Life Quality Index (DLQI) and Psoriasis Symptom and Sign Diary (PSSD) were evaluated in patients who maintained complete skin clearance, and baseline characteristics of patients who achieved PRO scores of DLQI = 0/1 and PSSD = 0 were compared with those who did not. Of the 329 patients included in this post hoc analysis, 73 (22.2%) maintained PASI = 0 for ≥ 156weeks. This group had a numerically lower proportion of patients at baseline with obesity, depression or previous biologic treatment and a higher proportion who had never smoked. Patients who maintained PASI = 0 generally achieved positive DLQI and PSSD outcomes, though some impact of residual disease was observed, largely related to the DLQI "Symptoms and feelings" sub-scale and PSSD components "Dryness," "Redness" and "Itch." Patients reporting continued disease impact (despite sustaining PASI = 0) had greater disease severity at baseline versus those achieving DLQI = 0/1 and PSSD = 0. Clinical measures alone do not capture the full patient experience. While both QoL and clinical symptoms are responsive to highly effective treatment, a subset of patients with complete clinical response is still impacted by their psoriasis. Further investigation into this population is warranted. ClinicalTrials.gov, NCT02207231.

Factors Associated With Satisfaction With Diabetes Care Among Patients Attending Public Diabetic Clinics in Dar es Salaam, Tanzania: A Cross‐Sectional Study

ABSTRACTBackgroundDiabetes is a major public health problem worldwide, currently affecting more than 537 million people. The disease is associated with high morbidity and mortality rates. Modern diabetes care has evolved toward more patient‐centered approaches, emphasizing individualized treatment plans and targets. This study sought to assess the level of satisfaction with diabetes care and related factors among patients attending public diabetes clinics in Dar es Salaam, Tanzania.MethodsThis descriptive cross‐sectional study used a simple random sampling method to recruit 423 diabetic patients from May to October 2023. Data collection was conducted using a structured questionnaire administered by an interviewer. The collected data were coded and analyzed using Statistical Package for the Social Sciences (SPSS) version 25.ResultsThe mean (±SD) age of participants was 58.7 (±11.68) years. About half (51.1%) of participants reported being satisfied with the diabetes care provided, 26.2% were very satisfied, and 22.7% were dissatisfied. Participants who usually spend 1–3 h pursuing services at the facilities had 0.40 less odds of being dissatisfied with diabetes care offered at the clinics compared to those who spend more than 3 h on each attendance (adjusted odds ratio [adjusted OR] 0.40, 95% confidence interval [CI] 0.21–0.76, p = 0.005). For each one‐unit increase in the communication subscale score, the likelihood of satisfaction (as opposed to being very satisfied) increased (adjusted OR 1.23, 95% CI 1.09–1.38, p = 0.001). Each one‐unit increase in the accessibility subscale score increased the probability of satisfaction (adjusted OR 1.12, 95% CI 1.02–1.24, p = 0.023) and decreased the probability of dissatisfaction (adjusted OR 0.85, 95% CI 0.76–0.95, p = 0.004).ConclusionThese findings highlight the importance of effective communication and accessibility in improving patient satisfaction with diabetes care in public clinics. Health facilities and allied stakeholders should engage in continual capacity building among healthcare providers. Furthermore, other studies should be conducted at different levels of health facilities across the country to capture new insights on the satisfaction of homogenous sub‐groups of patients.

Peculiarities of approaches to the treatment of arterial hypertension in the Maldives in the practice of general practitioners from the point of view of evidence-based medicine

Background: Arterial Hypertension (AH), commonly known as high blood pressure, is a significant chronic condition affecting millions globally and is a primary cause of cardiovascular diseases (CVD). In the Maldives, the management of AH by general practitioners (GPs) is crucial due to its high prevalence and associated health complications. This study examines the approaches of GPs in treating AH, emphasizing evidence-based medicine (EBM) to ensure effective management and prevention strategies. Methods and Materials: The study involves a comprehensive review of current evidence-based methods used for AH management in the Maldives. It focuses on lifestyle modifications, dietary changes, increased physical activity, stress reduction techniques, and pharmacotherapy. Data were collected through clinical guidelines, patient records, and interviews with GPs to understand the practical application of these methods in Maldivian healthcare settings. Results: The findings indicate that lifestyle modifications, including healthier diets and increased physical activity, are critical in managing AH. Traditional Maldivian diets and community-based exercise programs play significant roles. Pharmacotherapy, involving antihypertensive medications, is essential but faces challenges such as limited access and patient adherence. GPs also highlighted the importance of stress reduction techniques and individualized treatment plans tailored to patient needs and cultural sensitivities. Conclusion: Effective management of AH in the Maldives requires a multifaceted approach combining evidence-based medical practices with local context sensitivity. GPs play a pivotal role in diagnosing, treating, and educating patients about AH. Addressing socioeconomic barriers, enhancing healthcare resources, and promoting cultural competence are essential for improving AH management and overall public health