Patient Degree Research Articles

Bioimpedance analysis (extracellular mass to body cell mass ratio) as complementary assessment for malnutrition in hemodialysis patients

Background: Protein energy wasting (PEW) is a frequent condition in haemodialysis patients but often goes missed. The diagnosis of PEW is complex even though composite nutritional indices seem to show strong correlations with mortality and cardiovascular events. Bioimpedance analysis in dialysis centres is used to study patient's degree of water load but not to assess nutritional status. Recently, the extracellular mass/body cell mass ratio (ECM/BCM) ≥ 1.2 has also been considered as a parameter of malnutrition in the haemodialysis patients. Objective: To assess the nutritional reliability of ECM/BCM ≥ 1.2 in patients referred to the Dialysis Centre of the “S. Spirito Hospital” Rome. Methods: 16 Patients were enrolled and than evaluated anthropometrically, for nutritional and inflammatory parameters, subjected to the Malnutrition Inflammation Score (MIS) and monitored with impedance measurements before, after and 30 min after the haemodialysis session. Results: ECM/BCM ≥ 1.2 demonstrates a statistically significant direct correlation ( p < 0.001) with MIS. Albumin and pre-albumin were inversely correlated with ECM/BCM ≥ 1.2, cholesterolaemia was directly correlated. Conclusions: ECM/BCM ≥ 1.2 appears to be a simple and reliable indicator for the diagnosis of malnutrition in the chronic haemodialysis patient. Given the small sample size, further studies are needed to support this thesis.

Literature Review on the Effectiveness of Modern Dressing in the Wound Care Process on Diabetic Wound Healing

Background: Diabetes mellitus is a health problem due to insulin deficiency or insulin resistance that causes high blood glucose. A frequent complication is diabetic ulcer, which is a condition of partial or complete tissue deformity. If it does not get proper treatment, it is very risky to get an infection that leads to amputation.Diabetes Mellitus (DM) has become a prevalent disease, imposing a significant burden on public health due to its widespread occurrence and association with numerous disabilities and fatalities. Uncontrolled DM can lead to severe metabolic complications and long-term vascular issues, including microangiopathy and macroangiopathy. Additionally, individuals with DM are highly susceptible to foot infections, which can escalate into gangrene if not properly managed. Purpose: To determine the effectiveness of modern dressing in the wound care process on diabetic wound healing. Methods: Data collection used descriptive analysis and literature study. The databases used were PubMed, CINAHL, ProQuest and Web of Science. Journal inclusion criteria used PICO and article analysis was conducted by 6 authors. Findings: The evaluated article's findings elucidate the patient's degree of comfort and the more important healing process. It has been demonstrated that contemporary wound care applications make patients feel more at ease as their wounds heal, greatly aiding nurses in nursing care. Modern wound care is a practice that will evolve in response to advancements in nursing science; in this instance, it centers on how comfortable patients are while obtaining wound care-related medical treatments. Therefore, nurses must advance the knowledge behind the use of contemporary wound care to promote patient comfort and hasten the healing process. Conclusion: Modern wound care enhances patient comfort and accelerates healing, greatly supporting nursing practice. With evolving knowledge in nursing science, nurses need to master these methods to maximize patient comfort and recovery in wound care

Analyzing the Prevalence of Depression and Anxiety Symptoms Among Relatives of Cancer Patients in Kuwait.

The mental health impact on relatives of cancer patients frequently goes unnoticed and is commonly undervalued. This study aimed to explore how personal factors such as the patient's degree of kin, marital status, cancer stage, and number of diagnosed family members are correlated with the severity of depression and anxiety among relatives of cancer patients. This self-administered cross-sectional survey was conducted in Kuwait, employing a random sampling method to recruit participants. Depression and anxiety symptoms were assessed using the validated Arabic versions of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scale. The mean age of the relatives of the cancer patients was 38.36 years (±13.44), with a female majority (59.72%). The prevalence of depression in the examined population was 60.1%, with the majority having mild depression (39.3%). On the other hand, the prevalence of anxiety in the same group was 51.2%, with the majority having mild disease (27.5%). Being female and having a cancer patient relative in the metastasis stage put patients' relatives at a greater risk of depression and anxiety. The diagnosis of cancer necessitates mental health screenings for patients' relatives, as findings from our study indicate that these individuals are at a high risk of developing depression and anxiety. Targeted support and referrals to specialists are crucial for mitigating the impact on their well-being.

Literature Review: Gambaran Monitoring Kedalaman Anestesi Pada Anestesi Umum

The term "depth of anesthesia" refers to the extent to which a general anesthetic agent anesthetizes the central nervous system with a specific concentration of force at the time the drug is administered. The depth level of anesthesia plays an important role in determining surgical complications, and it is very important to keep the depth level of anesthesia under control for the operation to be successful. The purpose of this study is to determine the Monitoring Picture of Anesthesia Depth in General Anesthesia. The literature search will be conducted between 2018 and 2023. The methodof journals and scientific articles contained in this study are national and international journals that have been accounted for their validity. Sources of information obtained from databases are Google Scholar, Science Direct, and PubMed. Anesthesia depth monitoring with the most popular modern technique in practice is the Bixpectral Index Score (BIS) monitor. Anesthesia depth monitoring using BIS is more accurate than traditional anesthesia depth monitoring. Objective assessment of the depth of sedation can use the BIS tool that provides the best prediction of the patient's degree of consciousness to] prevent the patient from waking up and remember actions, drug additions, and wake predictions more accurately by looking at changes in brain electrical activity depicted through EEG

Ossified Inflammatory Epulis: A Case Report

Introduction: Etymologically, the epulis is a lesion that develops at the level of the gum. It is classically defined as a benign circumscribed hyperplastic pseudotumor of the gums. Observation: A 59-year-old patient consulted for a posterior left mandibular gingival mass related to 37 and 38 dilapidated. The lesion being well limited, of firm consistency and slow evolution without underlying osteolysis, evoked a fibrous epulis. The treatment consisted of eliminating the local irritant (RSD, extraction of the dental roots) and the complete excision of the lesion. Histological examination reveals the diagnosis of ossified inflammatory epulis. Discussion: Epulis is a common pseudotumor of the oral mucosa. Several varieties of epulis are described. Ossifying epulis is a controversial entity from a terminology point of view but it has the particularity of having bone and sometimes cemental metaplasia within the connective stroma which can sometimes be detectable on radiography. The success of the treatment remains dependent on the technique used by the practitioner, the follow-up, and the patient's degree of motivation for oral hygiene. The role of the first-line dentist remains important in the diagnosis, prevention, and treatment of this type of lesion as well as in the clinical follow-up.

A new method based on deep learning and image processing for detection of strabismus with the Hirschberg test

Strabismus is a condition in which one or both eyes do not work in parallel or in harmony. People with strabismus have one eye looking straight ahead while the other eye looks inwards, outwards, upwards or downwards. This condition can affect both eyes. Strabismus is a common eye condition that affects about 4 % of the world's population. Tests such as Hirschberg, Cover and Krimsky are used to detect strabismus. In the Hirschberg test, a light source is held at a distance of 50 cm so that it falls on the centre of each eye. The horizontal and vertical distance between the centre of gravity of the light reflected from the cornea and the centre of the pupil indicates the degree of strabismus. In this study, deep learning and image processing algorithms are used to detect the eye, corneal reflection, iris and pupil on a patient's facial image. Based on the Hirschberg test, the horizontal and vertical shifts for both eyes were measured to determine the patient's degree of strabismus. In this way, the Hirschberg test used in strabismus screening was performed automatically by software. The correct detection of the pupil and the light reflected from the cornea by the algorithm means that the eye has been measured correctly. The software was tested on the facial images of 88 strabismic patients of different sexes and ages. 91 % of the 88 patients, or 80 patients, had their left eye measured correctly. 90 % of the 88 patients, or 79 patients, had their right eye measured correctly. The results for each eye obtained from the correct measurements were found to have an error of maximum ± 2°. This error is due to the fact that a real eye is in three-dimensional space, while the digital eye image is in two-dimensional space, and was only observed in the test results of some patients. This algorithm can be tested on patients of all ages and is not affected by morphological differences in the patients' faces. Successful results have been observed experimentally that this newly proposed method can be used in strabismus screening.

Novoglan device for treatment of adult phimosis: Novoglan-01 open-label clinical trial on safety, efficacy and tolerability.

At present, the only definitive treatment for adult phimosis is circumcision, which is a surgical removal of the prepuce. Novoglan is a novel device that could offer patients with phimosis an alternative to surgery. It is based on application of custom-moulded balloons for gradual skin remodelling and prepuce dilatation. This open-label clinical trial aimed to investigate the safety, efficacy and tolerability of the Novoglan treatment. A prospective trial was conducted on 20 patients with adult phimosis recruited at Macquarie University Hospital and Princess Alexandra Hospital. After eligibility screening and enrolment, patients were provided with the Novoglan product and training. The treatment involved twice daily 10-minute applications for a duration of 4-8 weeks with patient's degree of phimosis assessed before and at 6-8 weeks after the initiation of the treatment. Participants were also asked to complete questionnaires aimed to assess the safety and tolerability of the Novoglan treatment. The treatment was successful with improved foreskin retraction in 90% of patients and all patients achieving full foreskin retraction after the treatment. Ninety-five percent of patients reported reduced level of anxiety, and over 60% of patients reported reduced pain/discomfort during sexual activity or in general. Similarly, 95% of patients were moderately-to-very satisfied with the treatment and would recommend Novoglan to others. No adverse events were observed and only 15% of participants reported minor side effects. The Novoglan-01 trial demonstrated high safety, efficacy and tolerability of the Novoglan treatment for adult phimosis and its high potential as a conservative alternative to circumcision or steroid cream treatment. The Novoglan-01 study has been registered with the Australia and New Zealand Clinical Trial Registry under the reference ACTRN 1262 10009 24853, dated 15 July 2021.

Providers Respond to USPSTF Report on Screening for Breast Cancer

Providers Respond to USPSTF Report on Screening for Breast Cancer

Narrative review of current neuromodulation modalities for spinal cord injury.

Neuromodulation is a developing field of medicine that includes a vast array of minimally invasive and non-invasive therapies including transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), peripheral nerve stimulation, and spinal cord stimulation (SCS). Although the current literature surrounding the use of neuromodulation in managing chronic pain is abundant, there is an insufficient amount of evidence specifically regarding neuromodulation in patients with spinal cord injury (SCI). Given the pain and functional deficits that these patients face, that are not amenable to other forms conservative therapy, the purpose of this narrative review is to examine and assess the use of various neuromodulation modalities to manage pain and restore function in the SCI population. Currently, high-frequency spinal cord stimulation (HF-SCS) and burst spinal cord stimulation (B-SCS) have been shown to have the most promising effect in improving pain intensity and frequency. Additionally, dorsal root ganglion stimulation (DRG-S) and TMS have been shown to effectively increase motor responses and improve limb strength. Although these modalities carry the potential to enhance overall functionality and improve a patient's degree of disability, there is a lack of long-term, randomized-controlled trials in the current space. Additional research is warranted to further support the clinical use of these emerging modalities to provide improved pain management, increased level of function, and ultimately an overall better quality of life in the SCI population.

Low Back Pain Patients' Perceptions Regarding Their Own Radiology Reports: Pre-Intervention Survey.

While advanced medical technology and unlimited access to medical information might benefit and empower patients, these same advantages may pose some risks, especially in the cases where patients have direct access to advanced imaging studies. The aim of this work was to evaluate three domains related to patients with lower back pain: the patients' perceptions, misconceptions and the experience of anxiety-related symptoms following direct access to their thoraco-lumbar spine radiology report. An additional aim was the assessment of possible associations with catastrophization. Patients who were referred to the spine clinic, following the completion of a CT or MRI of their thoraco-lumbar spine were surveyed. Patient perceptionsof the importance of having direct access to their imaging report and of the concern they attribute to the medical terms found in their report were evaluated using a set of questionnaires. The medical terms severity scores were then correlated to a reference clinical score created for the same medical terms by spine surgeons. Lastly, patients' anxiety-related symptoms and Pain Catastrophizing Scale (PCS) after reading their radiology report were evaluated. Data from 162 participants (44.6% female), with mean age of 53.1 ± 15.6 years, were collected. Sixty-three percent of the patients stated that reading their report helped them gain better understanding of their medical condition and 84% agreed that having early access to the report helped improve communication with the physician. Patients' degree of concern associated with the medical terms in their imaging report ranged between 2.07 and 3.75, on a scale of 1-5. The patient's degree of concerns were significantly higher for six common medical terms and significantly lower in one, when compared to experts' opinions. A mean (± SD) of 2.86±2.79 anxiety-related symptoms was reported. The mean Pain Catastrophizing Scale (PSC) score was 29.18 ±11.86, ranging from 2 to 52. Both the degree of concerns and the number of symptoms reported were significantly associated with the PCS. Direct access to radiology reports might provoke anxiety symptoms, especially in patients with a tendency for catastrophic thinking. Increasing awareness amongst spine clinicians and radiologist about possible risks associated with direct access to radiology reports could contribute to preventing patients' misconceptions and unnecessary anxiety-related symptoms.

Burden of caregivers of people suffering from schizophrenia versus symptom severity, social functioning and treatment satisfaction of patients treated by a CMHT.

This study aims to assess the caregivers' burden in schizophrenia amongst patients treated by Community Mental Health Teams (CMHTs) and its relation to patients' demographic, clinical and social characteristics, with emphasis on their satisfaction with care, and to evaluate the correlation of selected characteristics of caregivers with the level of their burden. A total of 65 patient-caregiver dyads remaining in home treatment were included. Caregivers were assessed with demographic questionnaires, and the Caregiver Burden Inventory (CBI). The patients were assessed with the Positive and Negative Syndrome Scale (PANSS), the Verona Service Satisfaction Scale (VSSS-54), the Disability Assessment Schedule (WHODAS 2.0), the Social Network Index (SNI) and with the UCLA Loneliness Scale. Data were analysed using multiple linear regression. Increased caregiver burden was associated with: greater symptom severity in patients, lower satisfaction with staff professionalism, and a high level of emotional expressiveness in relationships. The regression model explaining 57% of the variance in the caregivers' emotional burden consisted of four factors: the patient's positive syndrome intensity, patient's remaining in an emotional relationship, gender i.e. higher burden amongst female caregivers of male patients, and smaller social network. The caregivers' burden severity is related to patients' sociodemographic, clinical and social characteristics and their satisfaction with treatment. The emotional burden of caregivers is impacted by: greater symptom severity, especially the positive syndrome, lower patient satisfaction with staff professionalism, and a high expression of emotions in family relationships. The patient's and caregiver's gender and education level, the patient's degree of disability, them being in a relationship and social support network size are also significant.

Estimating the direct costs of oral cancer in Spain: a retrospective hospital data analysis.

Studies on the costs incurred from cancer in Spain are scarce and have focused on the most prevalent types such as colorectal, breast, and lung cancer. The aim of this study was to calculate the direct costs associated with the diagnostic, treatment and follow-up procedures for oral cancer in Spain. Applying a bottom-up approach, we retrospectively analyzed the medical records of a cohort of 200 patients with oral cancer (C00-C10), diagnosed and treated in Spain between 2015 and 2017. For each patient, we collected their age, sex, degree of medical impairment (American Society of Anesthesiologists [ASA] classification), tumor extent (TNM classification), relapses and survival during the first 2 years of follow-up. The final calculation of the costs is expressed in absolute values in euros as the percentage of the gross domestic product per capita and in international dollars (I$). The total cost per patient rose to €16,620 (IQR, €13,726; I$11,634), and the total direct cost at the national level was €136,084,560 (I$95,259,192). The mean cost for oral cancer represented 65.1% of the gross domestic product per capita. The costs for the diagnostic and therapeutic procedures were determined by the ASA grade, tumor size, lymph node infiltration and presence of metastases. The direct costs for oral cancer are considerable compared with other types of cancer. In terms of gross domestic product, the costs were similar to those of countries neighboring Spain, such as Italy and Greece. The main determinants of this economic burden were the patient's degree of medical impairment and tumor extent.

Traumatic aorta injuries in a rural area: late manifestations and review of therapeutic aspects.

Traumatic thoracic aortic injuries (TTAI) are associated with high rates of morbidity and mortality. They are classified according to the extent of damage and computed tomography angiography has the highest sensitivity and specificity for identifying the degree of injury and potential associated lesions. Treatment strategies for TTAI are based on the type and extent of injury and associated lesions. The patient's degree of stability can also help to define the choice of treatment, which can be conventional or endovascular surgery (EVAR) or even conservative management in selected cases. Among patients with adequate vascular anatomy, endovascular surgery is associated with better survival and fewer risks. The objective of this article is to describe a series of four cases followed up at a tertiary service in a Brazilian state that has few centers that provide high complexity care. Endovascular therapy was employed as the preferred method. All four patients had favorable outcomes, with no complications up to discharge, and are currently in outpatient follow-up.

Knowledge about warfarin treatment in patients with atrial fibrillation or mechanical prosthetic valves

To determine the degree of knowledge about warfarin treatment in patients with atrial fibrillation or with mechanical prosthetic valves. Descriptive, observational, cross-sectional study. The OAK test was applied to all adult patients with a diagnosis of atrial fibrillation or with mechanical prosthetic valves treated with warfarin, who attended the hematology consultation from May 17 to November 10, 2022, at the "Instituto Nacional Cardiovascular Carlos Alberto Peschiera Carrillo". A total of 150 patients participated, 64% were male, with a mean age of 60.3 ± 15 years, 45.3% with a diagnosis of atrial fibrillation and 54.7% with mechanical prosthetic valves. The mean OAK test score was 44.4% (8.4/19), only 6% (n=9) achieved a satisfactory score ≥75.0%, the percentage of correct answers according to dimensions was: 68 % in forms of use, 39.3% in interactions and complications and 41.1% in INR control. A 40.7% did not understand the meaning of the term INR and 81.3% did not know their optimal values. The patient's degree of knowledge about warfarin treatment was inadequate; both in its use, interactions and complications. Considering that it is a difficult drug to use, due to its narrow therapeutic window and its multiple interactions, inadequate knowledge of its use may contribute to inappropriate anticoagulation.

Cancer clinical trials in the Philippines.

In this Commentary, we discuss disparities in resources for and access to cancer trials from the perspective of the Philippines, a lower-middle-income country in Southeast Asia, where cancer is the fourth leading cause of death. Geographic disparities play out such that academic institutions and clinical trials are centralized in the island of Luzon, particularly in the capital, Manila. These disparities are compounded by the lack of comprehensive cancer patient and clinical trial registries in the Philippines. Additionally, sociocultural considerations influence clinical trial implementation. Providers must consider the role of a patient's family in the decision to participate in clinical trials; a patient's degree of health literacy; and the economic burden of cancer care, with attention to both the direct and indirect financial toxicities associated with cancer care. Our call to action is threefold. (1) Bolster locally led trials and encourage international collaboration to improve diversity in trial participation and trials' generalizability. (2) Strengthen national trial registries to improve awareness of trials for which patients are eligible. (3) Integrate cultural competency frameworks that move beyond parachutism and parasitism in research and instead promote trust, reciprocity, and collaboration. These challenges may yet evolve, but in emphasizing these barriers, we hope to kindle further dialogue, new insights, and innovative action towards solving these disparities in cancer research, not just in the Philippines, but also in other low- and middle-income countries.

Impact of Serum Insulin-Like Growth Factor 1 on Hematopoietic Stem Cell Transplantation Outcome in Pediatric Cancer Patients

Hematopoietic stem cell transplantation (HSCT) is associated with severe medical complications and variable outcomes depending on the recipient's disease stage and health condition. Biomarkers predicting outcome may have therapeutic relevance in pediatric cancer care. Insulin-like growth factor 1 (IGF-1), a mitogenic and anabolic peptide hormone expressed in almost all tissues, is the major growth factor in childhood. Decreased IGF-1 concentration in conditions that cause catabolic metabolism may reflect a patient's degree of physical robustness and serve as a predictive biomarker for transplantation outcome. We evaluated the impact of pretransplantation serum IGF-1 level on both survival and adverse events in 587 pediatric cancer patients who underwent autologous or allogeneic HSCT between 1987 and 2014 at the University Children's Hospital Tübingen. Survival probabilities of the entire cohort and of defined subgroups according to pretransplantation serum IGF-1 level were estimated using the Kaplan-Meier method. The mean pretransplantation IGF-1 level (n = 498) was low: -1.67 SDS (SD, 1.54). Completeness of follow-up was 96% at 3 years post-HSCT and 83% at 10 years. Overall survival (OS) at 10 years was 44.8% (95% confidence interval, 40.6% to 48.9%). Decreasing IGF-1 SDS was associated with significant increases in transplantation-related mortality (P = .027), sinusoidal obstruction syndrome (quartiles 4 to 1: 3%, 1%, 12%, and 12%; P < .001), and thrombotic microangiopathy (quartiles 4 to 1: 0%, 0%, 2%, and 5%; P = .004). Compared with patients in IGF-1 deciles 2 to 10, patients in IGF-1 decile 1 had significantly poorer outcome (P = .042) with lower median survival (12 months versus 68 months) and 10-year OS (37% versus 52%). This retrospective study suggests that pretransplantation serum IGF-1 level has utility as a predictor of survival and selected vascular adverse events that may have diagnostic and therapeutic relevance in pediatric cancer care.

Continuation of Hemodialysis in a Patient With Global Hypoxic Brain Injury: Ethical Considerations and Factors That May Influence Decision Making.

Survivors of an out-of-hospital cardiac arrest are at a high risk of mortality and morbidity especially when there is resultant global hypoxic brain injury. In these situations, the patient's degree of neurologic recovery may be uncertain and family decision making is often difficult. Decision making may also be complicated by the age of the patient and one's underlying cultural and spiritual beliefs stressing the importance of patient- and family-centered care. In this article, this clinical case demonstrates the challenges in decision making and highlights the importance of communication among the health care team and the family to align the patient's goals, values, and preferences in light of a poor neurological prognosis.

Dupuytren's Disease-Etiology and Treatment.

The worldwide prevalence of Dupuytren's disease (DD) is 8%. DD is a chronic disease for which there is no cure. Various treatments are available. This review is based on pertinent publications retrieved by a selective search in PubMed and Embase. Genetic factors account for 80% of the factors involved in causing this disease. Diabetes mellitus, hepatic diseases, epilepsy, and chronic occupational use of vibrating tools are also associated with it. Limited fasciectomy is the most common treatment and is considered the reference standard. Possible complications include persistent numbness in areas where the skin has been elevated, cold sensitivity, and stiffness, with a cumulative risk of 3.6 -39.1% for all complications taken together. The recurrence rate at 5 years is 12-73%. Percutaneous needle fasciotomy is the least invasive method, with more rapid recovery and a lower complication rate than with limited fasciectomy. 85% of patients have a recurrence after an average of 2.3 years. Radiotherapy can be given before contractures arise in patients with high familial risk, or postoperatively in selected patients with a very high individual risk of recurrence. Although DD is not curable, good treatments are available. Recurrences reflect the pathophysiology of the disease and should not be considered complications of treatment. When counseling patients about the available treatment options, particularly the modalities and timing of surgery, the physician must take the patient's degree of suffering into account. Nowadays, fast recovery from surgery and less postoperative pain are a priority for many patients. Different surgical methods can be used in combination. It remains difficult to predict the natural course and the time to postoperative recurrence in individual patients; these matters should be addressed in future studies.

Usages et bon usage des benzodiazépines anxiolytiques et hypnotiques

Since 60 years, benzodiazepines have replaced barbiturates and are now the most prescribed anxiolytic and hypnotic drugs at the international level. France is one of the largest users of benzodiazepines in the world, with more than 13% of its population exposed to this pharmacological class. At the European level, France is in 2nd place just behind Spain. Benzodiazepine use has spread for the management of sleep disorders and anxiety, because of their effectiveness and their relative safety in case of acute intoxication, compared to previous drugs. Epidemiology data show that benzodiazepine use increases with age, and reaches a peak in the elderly. Benzodiazepine use is more common in women (with a ratio of 2 women for one man of the same age). The co-prescription of 2 benzodiazepines at the same time is found in 1 user in 5. Some prescriptions do not comply with the regulations in force, in terms of duration of treatment (15%), dosage and therapeutic indication. However, the evidence of their effectiveness is limited to the legal duration of their prescription, with a risk of reversing the balance of benefits and risks in the instance of prolonged use. The main undesirable effects are due to depressive effects on the central nervous system, and consist of drowsiness, falls, or orthostatic hypotension, which occur during prolonged use, including substance use disorders. Moreover, prolonged use can lead to the occurrence of a withdrawal syndrome, as well as cognitive disorders. In the context of epidemiological overconsumption, this review aims to synthesize the evidence on the risk/benefit ratio of these molecules in their most common indications. Moreover, this article also provides practical rules of good practice, which include in an objective of overall patient care before prescribing anxiolytic or hypnotic benzodiazepines, the reminder of non-medicinal measures such as those of lifestyle, psychotherapy and, if necessary, the use of alternative medicines. If a prescription is initiated, it will then be necessary to choose the minimum effective dosage, the minimum effective duration of treatment, and the molecule which fits the most with recommendations. Finally, deprescribing, a too-often forgotten phase of treatment, allows for a controlled cessation of treatment. Deprescribing should be performed gradually and after evaluation of the patient's degree of pharmacological dependence and of his expectations and motivations. Planned deprescribing also finds its place from the initiation of a treatment, on the basis of a therapeutic alliance with the patient, informed therefore of the benefits and risks of his treatment, and therefore of the resulting modalities such as its limited duration. comprising a decrease in doses until discontinuation. The pharmacist and the prescribing physician are two guarantors of the correct use of benzodiazepines and related drugs. They must work in a coordinated manner and have a common discourse with patients to explain to them, during their initiation, the transient benefits, risks and alternatives to these treatments. These professionals must also support patients in the deprescribing phase, a phase which is too-often overlooked in situations of chronic prescribing.

Analysis of diagnosis, treatment and risk classification of blunt thoracic aortic injury

Objective: Propose a new risk classification system for blunt thoracic aortic injury and explore its treatment strategies. Methods: After the retrospective analysis of clinical data from 68 patients with blunt thoracic aortic injury in the First Affiliated Hospital of Zhengzhou University from November 2016 to October 2020, there were 56 males and 12 females, among these patients, the median age was 45(21-69). According to the degree of aortic injury and the combined injury, the patients were scored for aortic injury, and the risk of the patients were graded into following three types: low-risk group (score ≤ 2 points) 12 cases, intermediate-risk group (3 points ≤ score ≤ 5 points) 41 cases, high-risk group (score ≥ 6 points) 15 cases. Analyzing the effects of treatments received by patients in different grades on the prognosis. Patients were followed up through hospitalization or outpatient clinics at 1, 3, 6, 12 months after surgery and every year thereafter. Results: Of the 68 patients, 21 received non-surgical treatment and 47 received surgical repair, including 6 open surgery and 41 thoracic aortic endovascular repair. There were 16 cases of emergency operation and 31 cases of delayed operation. Twelve low-risk patients were treated with non-surgical treatment, and only 1 patient died of lung infection, with a mortality rate of 8.3% (1/12). There were 8 deaths in 41 moderate-risk patients, with a mortality rate of 19.5% (8/41), and the aortic-related mortality rate was 9.8% (4/41), and the operative mortality rate was 10.8% (4/37). The total mortality of 15 high-risk patients was 40% (6/15), and the aortic-related mortality rate was 30.0% (5/15), and the mortality rate of surgical patients was 10% (1/10). During the follow-up period of 5 to 52 months, no deaths occurred outside the hospital. According to the risk grading, there were significant differences in the aortic-related mortality of each grade (χ²=7.840, P=0.020). During the follow-up of 5-52 months, 1 case had type Ⅰ endoleak, 1 case of cerebral infarction, and 1 case of acute renal failure. Conclusion: According to the patient's degree of aortic injury and combined injury, the risk classification helps to choose the appropriate treatment.