Patient-centered Approach Research Articles

A patient-centered approach to dietary supplements for patients with chronic liver disease.

The use of dietary supplements by patients with chronic liver disease is prevalent and rising. Despite the known risks of dietary supplements, including hepatotoxicity, adulteration, and contamination, patients with chronic liver disease often turn to dietary supplements to support their liver and/or overall health but are not necessarily empowered with the information or guidance from their liver practitioner to do so. This article provides practitioners with a framework for balancing the risks and benefits of dietary supplements in patients with chronic liver disease, offering examples of independent resources and certifications to use this framework in clinical practice. We offer 3 common clinical scenarios to highlight how the use of this framework can improve communication and decision-making in clinical practice. By adapting principles from Integrative Medicine, this article advocates for a patient-centered approach to dietary supplements in patients with chronic liver disease, encouraging open dialogue between clinicians and their patients to facilitate informed decision-making and personalized care.

Optimizing contract negotiations in clinical research: Legal strategies for safeguarding sponsors, vendors, and institutions in complex trial environments

This paper examines the complexities of clinical trial contract negotiations, focusing on legal strategies and technological innovations that safeguard the interests of sponsors, vendors, and institutions. In an increasingly globalized and digital research environment, contract negotiations are pivotal to ensuring compliance, protecting intellectual property, and mitigating legal risks. The study’s purpose was to explore key components of clinical trial contracts, address the challenges involved, and assess future trends, particularly in light of evolving regulatory frameworks and technological advancements. Through a comprehensive review of legal literature and emerging technologies, the study identified crucial aspects of contract negotiations, including risk allocation, indemnification, intellectual property rights, and data privacy. Special attention was given to the role of technology—such as AI, blockchain, and contract management platforms—in streamlining the negotiation process. These tools have proven effective in reducing errors, enhancing collaboration, and ensuring regulatory compliance. The main findings revealed that while traditional contract structures remain integral, the adoption of digital tools and a patient-centric approach are critical in addressing new challenges posed by decentralized trials and cross-border collaborations. The study concluded that stakeholders must embrace flexible contract frameworks, incorporate robust data protection measures, and leverage technology to optimize negotiations. Recommendations include the integration of advanced analytics for decision-making, the adoption of blockchain for contract security, and a heightened focus on patient rights in contract structures to ensure ethical conduct and compliance in clinical research.

Design and development of an ai-driven communication model for stimulating memory recall in patients with Alzheimer’s and other neurodegenerative diseases

This study presents the development and evaluation of an AI-driven communication tool designed to stimulate memory recall in patients with Alzheimer’s disease and other neurodegenerative disorders. The tool integrates machine learning algorithms, including Random Forest and Long Short-Term Memory (LSTM) networks, with mass communication theories to deliver personalized and adaptive communication strategies. The AI models were trained and tested on patient interaction data, enabling the tool to dynamically adjust its prompts based on real-time cognitive states. Performance metrics such as accuracy, precision, and AUC-ROC were used to assess model efficacy, with the Random Forest model achieving the highest performance across all metrics. Clinical trials demonstrated significant improvements in memory recall and emotional engagement in patients using the AI tool compared to standard cognitive stimulation therapy. Caregivers also reported higher satisfaction with the tool's usability and impact on patient interaction quality. These findings highlight the potential of AI-driven, personalized communication tools to revolutionize Alzheimer's care, offering scalable, adaptive interventions that improve cognitive and emotional health. Academically, this work advances the integration of AI and health communication, emphasizing culturally sensitive and patient-centered approaches. In healthcare, it presents a promising non-pharmacological intervention that can be easily scaled for widespread use, potentially reducing caregiver burden and improving patient outcomes.

AVALIAÇÃO DA QUALIDADE DE VIDA E APOIO FAMILIAR NO PACIENTE DIAGNOSTICADO COM CÂNCER DE MAMA

Breast cancer is the main cause of death in the female population in almost all regions of Brazil, in addition to being an important global public health problem, due to high incidence and morbidity rates. The aim of the work is to evaluate the quality of life and psychosocial support of patients diagnosed with breast cancer. It refers to an observational study, in which interviews were carried out with women diagnosed with breast cancer treated at the Hospital Regional de Presidente Prudente. It was observed that the more negative the patients' self-perception was in relation to the support they received, their ability to carry out daily activities and their post-surgical mood, the worse their self-perception of quality of life was. This study highlights the importance of adopting multidisciplinary, patient-centered approaches and promoting a support network, which are essential for women to have a better quality of life.

Effect on comprehension of an AI patient-friendly hospital discharge letter: a quasi-RCT

Abstract Background During transition from hospital to home care, discharge letters serve as a bridge of information between hospital physicians, general practitioners, and patients. However, the complexity of these letters often hinders patient comprehension, leading to medication errors and adverse outcomes. We assessed the effect on patients’ comprehension and satisfaction of using AI to transform discharge letters into patient-friendly versions. Methods An online quasi-randomized controlled parallel-group trial was conducted in Italy. A synthetic discharge letter for a chronic obstructive pulmonary disease patient was drafted. GPT-4 rephrased the letter into an easier-to-understand version. Participants were assigned to receive either the original or AI-generated letter and completed comprehension assessments and satisfaction survey. Results Out of 460, 166 participants received the original letter, and 175 the AI version. The AI group showed significantly higher comprehension scores (median 4;IQR 2-4 vs. 2; IQR1-2, p < 0.001) and outperformed the control group in understanding diagnosis, medications, and antibiotic instructions. Perceived satisfaction was higher in the AI group across all measures (p < 0.001). Health literacy was a good predictor of comprehension in both arms (p = 0.013; p = 0.015). Subgroup analysis revealed the AI letter nearly bridged the comprehension gap between non-healthcare individuals and healthcare professionals receiving the original letter. Conclusions AI-optimized discharge letters improved patient understanding, and satisfaction compared to traditional letters. The study underscores the influence of sociodemographic factors like healthcare experience and health literacy on comprehension, advocating for adaptive communication strategies. These findings contribute to discussions about integrating AI in healthcare to develop patient-centered communication approaches. Key messages • AI-generated patient-friendly discharge letters significantly improved comprehension and satisfaction compared to traditional letters. • Integrating AI in healthcare communication can help bridge comprehension gaps and promote patient-centered care.

What matters most to healthy older adults in treatment decision making: a discrete choice experiment

Abstract Introduction Shifting to a patient centered approach is crucial for a sustainable healthcare system. Understanding individuals’ priorities is essential for personalized care, especially in critical illness. Treatment decisions are often aimed at disease-specific outcomes such as life extension or survival, while patient-specific outcomes like maintaining independence may be equally vital. How healthy older adults prioritize treatment outcomes in case of a critical illness is currently unknown. Enhanced insight into their priorities can refine healthcare policy, for more personalized care. This study investigated outcomes (attributes) prioritized in hypothetical decision-making by healthy adults over 50 yr. Methods We conducted a Discrete Choice Experiment with individuals aged ≥50, comparing six pairs of hypothetical treatments with five attributes: life expectancy, independence, pain, memory complaints and societal costs. Attribute utility was analyzed using a conditional logit model, and latent class analyses were employed to explore preferences in groups. Results In 333 participants (mean age 70 +/- 7.7) all attributes emerged as impactful with independence being strongest (p < 0.05). Increased life expectancy had positive utility, but only for a two-year increase. Negative utility was found for all other attributes except mild pain and memory complaints. Latent class analyses identified two groups (22.4% and 77.6%). Group one valued life expectancy more (p .019 vs .940), whereas the second group valued independence (p .058 vs.<.001 and societal costs (p.053 vs. <.001) more. Conclusions In a hypothetical case of life-threatening disease, for people aged ≥ 50 life expectancy was not the sole relevant outcome for treatment decisions; pain, independence and societal costs are important and should be discussed in clinical decision making or healthcare policy. Key messages • Older adults find patient-specific outcomes relevant for decision making. • Societal costs are found relevant for decision making for treatment by older adults.

A prolonged outbreak of tuberculosis associated with an intellectual disability daycentre in Ireland

Abstract One of the factors impeding tuberculosis elimination in low burden countries is its persistence and concentration in vulnerable populations. This is a complex, prolonged Tuberculosis (TB) outbreak in a daycentre for adults with intellectual disability in Ireland. This is a particularly vulnerable population with special considerations for Public Health (PH) management. There are eight cases of active TB, 46 cases of Latent TB Infection (LTBI) and a cumulative total of 116 contacts associated with this outbreak, with diagnosis spanning 15 years. The last three cases were identical on Whole Genome Sequencing. The index case was an Irish-born, Caucasian, social care worker, with smear positive pulmonary TB, who was symptomatic in the facility for three months prior to diagnosis. Case 2 was a household contact of the index case and the other 6 cases were Service Users (SUs) at the facility. At least five of the subsequent seven cases are secondary cases of the index case. Significant to this outbreak was the change in Irish guidance, 2010, relating to the management of contacts of cases. Following the notification of the most recent case, July 2023, the Outbreak Control Team decided a retrospective review be conducted of all SU contacts of the seven cases associated with the facility. The contacts were stratified according to hierarchical risk. A total of six contacts met the criteria for review and offered screening, re-screening or treatment as appropriate. In this outbreak 21.8% of the total contacts and 16.1% of SU contacts completed treatment for LTBI. The significance of this outbreak lies in its duration, infectivity of the index case and particular vulnerabilities of the SUs. There were issues with overcrowding and difficulties in relation to symptom recognition, diagnosis and treatment. The PH team tailored their approach to meet the SU needs, demonstrating the importance of person-centred contact tracing in the disruption of transmission. Key messages • A factor impeding tuberculosis elimination in low burden countries is it’s persistence and concentration in vulnerable populations. • Adapting a patient-centred approach to contact tracing can lead to higher participation rate and the disruption of infection transmission.

A digital, decentralized trial of exercise therapy in patients with cancer

We developed and evaluated the Digital Platform for Exercise (DPEx): a decentralized, patient-centric approach designed to enhance all aspects of clinical investigation of exercise therapy. DPEx integrated provision of a treadmill with telemedicine and remote biospecimen collection permitting all study procedures to be conducted in patient’s homes. Linked health biodevices enabled high-resolution monitoring of lifestyle and physiological response. Here we describe the rationale and development of DPEx as well as feasibility evaluation in three different cohorts of patients with cancer: a phase 0a development study among three women with post-treatment primary breast cancer; a phase 0b proof-of-concept trial of neoadjuvant exercise therapy in 13 patients with untreated solid tumors; and a phase 1a level-finding trial of neoadjuvant exercise therapy in 53 men with localized prostate cancer. Collectively, our study demonstrates the utility of a fully digital, decentralized approach to conduct clinical trials of exercise therapy in a clinical population.

Advancing diabetes management: Exploring pancreatic beta-cell restoration’s potential and challenges

Diabetes mellitus, characterized by chronic hyperglycemia due to insulin deficiency or resistance, poses a significant global health burden. Central to its pathogenesis is the dysfunction or loss of pancreatic beta cells, which are res-ponsible for insulin production. Recent advances in beta-cell regeneration research offer promising strategies for diabetes treatment, aiming to restore endogenous insulin production and achieve glycemic control. This review explores the physiological basis of beta-cell function, recent scientific advan-cements, and the challenges in translating these findings into clinical applications. It highlights key developments in stem cell therapy, gene editing technologies, and the identification of novel regenerative molecules. Despite the potential, the field faces hurdles such as ensuring the safety and long-term efficacy of regen-erative therapies, ethical concerns around stem cell use, and the complexity of beta-cell differentiation and integration. The review highlights the importance of interdisciplinary collaboration, increased funding, the need for patient-centered approaches and the integration of new treatments into comprehensive care strategies to overcome these challenges. Through continued research and collaboration, beta-cell regeneration holds the potential to revolutionize diabetes care, turning a chronic condition into a manageable or even curable disease.

Pharmacological management of heart failure: a patient-centered approach.

Heart failure (HF) is a global health challenge that requires a multidisciplinary approach. Despite recent advances in pharmacological and interventional therapy, morbidity and mortality in these patients remain high. For this reason, and because of its interplay with other cardiovascular and non-cardiovascular diseases, HF represents a major area of research, with new trials being published every year and international guidelines constantly updated. The authors review the current status and possible future developments in HF pharmacotherapy. The treatment of HF has made significant advances in recent years, and the current recommendations are based on large outcome trials. This has led to significant reductions in both mortality and morbidity, but the death rate remains unacceptably high. In this context, a patient-centered approach that considers comorbidities and specific clinical scenarios when dosing HF medication is essential. Prevention of hospital admissions for cardiac decompensation is of utmost importance in patients with HF as is the enablement of activities of daily living, an endpoint which has only recently been incorporated into major HF trials.

Patient-Centered Healthare as Part of Medical Corporate Culture

Patient-centered medicine is a relatively new model for planning, implementing, and evaluating healthcare services. It is based on mutually beneficial partnerships between healthcare providers, patients, and their families. However, the existing models of patient-centered healthcare have a number of disadvantages. The article introduces patient-centered healthcare as part of corporate culture adopted by various medical organizations. The authors developed a component model for the empirical study of patient-centered healthcare in terms of corporate culture. It involved five components, i.e., corporate culture, attitude to patient, attitude to work / professional image, adherence to ethical principles, and motivation. The model was tested using assessment methods developed by the authors, as well as using the Questionnaire of Professional Motivation by K. Zamfir as modified by A. A. Rean and the Mouton-Blake Corporate Culture Test. The sample involved 267 medical employees of urban medical organizations, Primorye Region. The respondents demonstrated a general understanding of patient-centered approach, which they interpreted as communication skills with patients. The dominant culture was that of task, which allowed medical staff to achieve their goals through collective decisions and mutual assistance. However, this mutual assistance was mandated to them due to the lack of personnel. The model demonstrated a good potential for yielding psychological and organizational technologies for training, support, and correction of patient-centered issues in medical organizations.

Бережливые технологии как инструмент организации пациентоцентричного подхода к оказанию медицинской помощи пациентам центра амбулаторной онкологической помощи

It is crucial to implement and use patient-centered approach towards communication between doctors and patients and towards management of treatment and diagnostics. The instruments of lean production can be used in order to find problems of organizational processes and to solve and improve them. Purpose of the study is to evaluate the possibility of using lean production to improve patient-centered approach towards the work of Outpatient Cancer Center. Materials and methods. The scientific articles from databases pubmed, cyberleninka, elibrary were studied. The performance results of Outpatient Cancer Center were analyzed. Results. During research the performance of Outpatient Cancer Center and its change as a result of using lean production instruments was analyzed. The positive results including the improvement of availability of diagnostics and consultations were found out. The medical and patient ratings of organizations have also shown significant improvement. Findings. Thus, the use of lean production not only in outpatient clinic but also in Outpatient Cancer Center is relevant nowadays. The instruments of lean production can improve healthcare processes and make them more patient-centered.

Optimizing use of an electronic medical record system for quality improvement initiatives in hemodialysis: Review of a single center experience.

The complexity of managing patients with end-stage kidney disease on hemodialysis underscores the importance of implementing quality improvement (QI) initiatives to enhance patient safety and prioritize patient-centered care. To address this, we established a QI committee at our tertiary academic center focusing on evidence-based practices, patient-centered approaches, and cost efficiency. To facilitate the seamless implementation of QI initiatives, we leveraged the capabilities of our electronic medical record (EMR) system. This review details effective strategies for optimizing use of an EMR system to successfully implement QI efforts. Drawing from our experience, we provide detailed descriptions and practical insights that can be applied to other EMRs. The creation of a secure and accessible dashboard, offering real-time data on quality metrics, stands out as the most notable feature. This dashboard operates through an algorithm that merges data from both our dialysis and hospital EMR systems. Its primary objectives are to streamline the identification of high-priority patients, enhance team communication, and facilitate tracking of quality indicators. Additionally, we integrated clinical pathways, checklists, and standardized protocols into the renal EMR to ensure smooth implementation of QI interventions. Notable examples of these interventions include an incremental hemodialysis protocol, a new hemodialysis start checklist, vaccination care plans, and personalized kidney transplant workups. Programmed electronic automatic reminders have proven invaluable in ensuring timely follow-ups of assigned tasks. The EMR has also contributed to medication optimization and deprescribing by generating patient lists based on specific medication classes. Finally, the EMR's capability to swiftly generate lists of patients with specific features has significantly facilitated targeted QI interventions. Leveraging the capabilities of an EMR system can be crucial for enhancing care of hemodialysis patients and implementing effective QI initiatives.

Menopausal hormone therapy for breast cancer survivors.

The global incidence of breast cancer continues to increase and increasing efficacy of treatments has improved overall prognosis and survival with a resulting requisite focus on improving quality of life after cancer. Treatment inevitably results in symptoms of menopause and these symptoms may be more severe after cancer treatment compared to natural menopause and may pose a potential risk of early treatment discontinuation. Consequently, the global burden of successfully managing these symptoms is significant. There is a discordance between randomized and observational data regarding the risk of systemic menopausal hormone therapy and breast cancer recurrence; hormone receptor status is significant to recurrence risk in this setting. The systemic absorption of local oestrogen is not a consistent surrogate marker for cancer recurrence and clinical data has not demonstrated a consistent increase in the risk of cancer recurrence with local therapy. Nonhormonal treatments remain first-line management of menopause symptoms in breast cancer survivors to minimize the risk of cancer recurrence. However, severe symptoms not responding to nonhormonal interventions require a multidisciplinary, patient-centred approach to discuss the evidence base for hormonal treatments.

A study of implementation factors for a novel approach to clinical trials: constructs for consideration in the coordination of direct-to-patient online-based medical research

BackgroundTraditional medical research infrastructures relying on the Centers of Excellence (CoE) model (an infrastructure or shared facility providing high standards of research excellence and resources to advance scientific knowledge) are often limited by geographic reach regarding patient accessibility, presenting challenges for study recruitment and accrual. Thus, the development of novel, patient-centered (PC) strategies (e.g., the use of online technologies) to support recruitment and streamline study procedures are necessary. This research focused on an implementation evaluation of a design innovation with implementation outcomes as communicated by study staff and patients for CoE and PC approaches for a randomized controlled trial (RCT) for patients with vasculitis.MethodsIn-depth qualitative interviews were conducted with 32 individuals (17 study team members, 15 patients). Transcripts were coded using the Consolidated Framework for Implementation Research (CFIR).ResultsThe following CFIR elements emerged: characteristics of the intervention, inner setting, characteristics of individuals, and process. From the staff perspective, the communication of the PC approach was a major challenge, but should have been used as an opportunity to identify one “point person” in charge of all communicative elements among the study team. Study staff from both arms were highly supportive of the PC approach and saw its promise, particularly regarding online consent procedures. Patients reported high self-efficacy in reference to the PC approach and utilization of online technologies. Local physicians were integral for making patients feel comfortable about participation in research studies.ConclusionsThe complexity of replicating the interpersonal nature of the CoE model in the virtual setting is substantial, meaning the PC approach should be viewed as a hybrid strategy that integrates online and face-to-face practices.Trial registrations1) Name: The Assessment of Prednisone In Remission Trial – Centers of Excellence Approach (TAPIR).Trial registration number: ClinicalTrials.gov NCT01940094.Date of registration: September 10, 2013.2) Name: The Assessment of Prednisone In Remission Trial – Patient Centric Approach (TAPIR).Trial registration number: Clinical Trials.gov NCT01933724.Date of registration: September 2, 2013.

Brain Stimulation in Alzheimer's Disease Trials.

Alzheimer's disease (AD) continues to lack definitive curative therapies, necessitating an urgent exploration of innovative approaches. This review provides a comprehensive analysis of recent clinical trials focusing on invasive and non-invasive brain stimulation techniques as potential interventions for AD. Deep brain stimulation (DBS), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and transcranial alternating current stimulation (tACS) are evaluated for their therapeutic efficacy, safety, and applicability. DBS, though invasive, has shown promising results in mitigating cognitive decline, but concerns over surgical risks and long-term effects persist. On the other hand, non-invasive methods like rTMS, tDCS, and tACS have demonstrated potential in enhancing cognitive performance and delaying disease progression, with minimal side effects, but with varied consistency. The evidence hints towards an individualized, patient-centric approach to brain stimulation, considering factors such as disease stage, genetic traits, and stimulation parameters. The review also highlights emerging technologies and potential future directions, emphasizing the need for larger, multi-center trials to confirm preliminary findings and establish robust clinical guidelines. In conclusion, while brain stimulation techniques present a promising avenue in AD therapy, further research is imperative for more comprehensive understanding and successful clinical implementation. Through this review, we aim to catalyze the scientific discourse and stimulate further investigation into these novel interventions for AD.

Beyond Treatment: A Narrative Review of Humanization Practices, Empathetic Communication, and Comprehensive Support in Oncology Patient Care in Brazil Over the Last Two Decades (2003-2023).

Humanization in oncology patient care represents a significant innovation in health care practice, shifting the traditional focus solely on treating physical conditions to encompass the emotional and psychosocial dimensions of patient experience. This study aimed to explore the importance of humanization in oncology and the application of practices that promote a patient-centered approach. Through a narrative review of the past 2 decades, the objective was to analyze the practices, benefits, and challenges of humanization in the oncology context. The methodology involved reviewing the relevant literature on empathetic communication, psychological support, and the integration of these aspects into oncology care. The results indicated that humanization significantly contributes to improving patients' quality of life, increasing treatment adherence, and fostering a more satisfying work environment for health care teams. However, effective implementation faces challenges, such as the need for ongoing training, resource limitations, and resistance to change. Despite these obstacles, humanization is essential to provide more comprehensive and patient-centered care. The adoption of humanized practices transforms the oncology care experience, making it more empathetic and holistic.

Physiotherapy in the digital age: A narrative review of the paradigm shift driven by the integration of artificial intelligence and machine learning

Abstract: A variety of physical impairments and functional restrictions are assessed and treated in the practice of physiotherapy. Subjective measures, rater variability, and restricted access to high-quality care are some of the unavoidable problems that contemporary physical therapy practice approaches must overcome. In light of these challenges, cutting-edge technologies such as artificial intelligence (AI) and machine learning (ML) are demonstrating remarkable efficacy in tackling these issues head-on. The focus of this review is to explore how the integration of AI and ML might change physical therapy practice and education in the age of digital communication. It delves into the challenges accompanying this integration and considers future prospects in this domain. A literature search was conducted using data base PubMed, Google Scholar, Web of Science, and Scopus with keywords such as ‘physiotherapy’, ‘artificial intelligence’, and ‘machine learning’, limited to English articles from 2014 to 2024. Results were imported into reference management software, duplicates removed, and relevant articles were screened and assessed for inclusion, with reasons for exclusion documented. Emerging technologies like AI and ML use algorithms to examine patient data and make automatic decisions, enhancing areas such as virtual reality therapy (VR), tele-rehabilitation, clinical decision support, individualized rehabilitation and physical function evaluation. These advance technologies optimize physical therapy and improve outcomes, but further research is needed to address obstacles like bias and data privacy to ensure responsible implementation. AI and ML can revolutionize physical therapy by improving therapy precision, patient monitoring, optimization and individualized therapy plan. However, it’s crucial for physiotherapists to balance technological advancements with compassionate, patient-centred approach.

Lengthening Short Noses in Rhinoplasty.

Objective: Rhinoplasty aims to create a nose in harmony with an ideal face, help patients with specific aesthetic concerns, and improve the nose's function. So, learning all types of deformities and rhinoplasty procedures is essential to solving that particular problem. So, we aimed to point at a neglected nasal deformity to serve as a guide in short nose rhinoplasty. Methods: Hereditary factors usually determine the length of a nose, such as cephalo-caudal patterning. Nowadays, individuals who want a change on their nose neglect whether it suits their face. Therefore, a considerable change may cause a paradox and lead to losing the operated nose and face harmony. As a general rule, it should be remembered that short nose elongation sounds more complicated than reduction rhinoplasty. Indeed, multiple soft tissues, mucosa, and structures exist, and short noses may get fibrotic, thickened, and inflamed skin for various reasons. Results: Dorsal augmentation through autologous cartilage grafts or implants is often used in patients with short noses. This demands a primary focus on lengthening the short nasal base. The simplest method of lengthening the short nose is dorsal onlay or radix implants. Silicone implants with a reported non-negligible tendency of infection are no longer used. Autologous cartilage grafts can be harvested from the septum, auricular cartilage, or rib. In the case of short noses, the surgeon can remove the septum as a graft and increase the nasal dorsum or undertake dorsal augmentation through septal cartilage grafts. Conclusion: Dorsal augmentation through autologous cartilage grafts or implants remains valuable for patients with short noses. Surgeons can achieve the desired length and proportional rotation by employing various methods, such as dorsal onlay or radix implants, septal cartilage grafts, and careful tip rotation. Through skillful execution and a patient-centered approach, surgeons can help patients with short noses achieve improved facial harmony and self-confidence.

Non-Steroidal Anti-Inflammatory Drugs: What Is the Actual Risk of Chronic Kidney Disease? A Systematic Review and Meta-Analysis.

Non-steroidal anti-inflammatory drugs (NSAIDs) are common cause of acute kidney injury, but chronic kidney disease (CKD) risk of NSAIDs is controversial. Prior systematic reviews are outdated with some methodological flaws. We conducted this systematic review to clarify the association between chronic NSAIDs use and occurrence and/or progression of CKD. MEDLINE, Cochrane Library, Web of Science and Science direct were searched for observational and interventional studies from inception to May 2023. Qualitative synthesis was performed. The meta-analysis used pooled odds ratios (OR) and hazard ratios (HR) to estimate the association between chronic NSAID use and CKD occurrence or progression. Forty studies with a total of 1757118 participants were included in the systematic review; of them 39 studies were suitable for meta-analysis. 56% of our included studies were recent, published within the last 10 years. The meta-analysis revealed a significant association between chronic NSAIDs use and CKD occurrence and progression. The pooled odds ratio was 1.24 (95% CI: 1.11-1.39, p <0.001, I² = 91.21%), and the pooled hazard ratio was 1.50 (95% CI: 1.31-1.7, p <0.001, I² = 90.77%). The pooled hazard ratio (HR) for individuals with no CKD at baseline was 1.31 (95% CI, 1.26-1.40), while for those with preexisting CKD, the HR was significantly higher at 1.67 (95% CI, 1.38-2.02). The HR for individuals with no specific chronic disease was 1.6 (95% CI, 1.32-1.94). For populations with diabetes mellitus (DM) and/or hypertension (HTN), the HR was 1.35 (95% CI, 1.27-1.43), and for those with rheumatic disease, the HR was 1.36 (95% CI, 0.88-2.10). Long-term NSAID use increases the risk of chronic kidney disease (CKD) occurrence and progression, especially in individuals with pre-existing CKD, who have a 67% risk compared to the general population's 60%. A patient-centered approach for safe and effective pain management is crucial, with special caution for those with pre-existing CKD.