Tool For Risk Research Articles

Abstract 16832: Biomarker Enhanced Risk Prediction of Incident Heart Failure in Low-Risk Patients: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Primary prevention strategies to reduce heart failure (HF) burden are urgently warranted. The Pooled Cohort equations to Prevent HF (PCP-HF) risk score is a validated risk tool that integrates readily available parameters obtained in primary care setting to estimate the 10-year risk for incident HF. Although PCP-HF performs well for high-risk individuals, the model’s predictive utility for low-risk individuals may potentially be enhanced by integration of biomarkers. Methods: In this study, the PCP-HF risk score was derived from data collected at visit 5 (2011-2013) of the ARIC cohort study and its 5-year predictive accuracy was investigated using surveillance data up to 2019. Participants with <10% PCP-HF risk probability of incident HF were classified as low-risk. Incremental improvement in predicting incident HF by including laboratory and imaging-based biomarkers in the low-risk population was analyzed by logistic regression, by calculating the area under the curve (AUC) from receiver operating characteristics. Results: Of 4980 study participants with 5 years of follow up, 47% had a low PCP-HF risk score (mean age 73 years, 71% women, 32% Black). Of these, 3% developed HF within 5 years. Compared to those with a high PCP-HF risk score, individuals with low PCP-HF risk score were younger, more often female and Black; had lower left ventricular (LV) mass index and left atrial volume index, higher magnitude of LV global longitudinal strain, and lower levels of NT-proBNP and hs-TnT. On further analysis, the model incorporating laboratory and imaging-based biomarkers exhibited greater predictive accuracy for incident HF compared to the original PCP-HF risk score in this low-risk population (AUC: 0.85 vs 0.62). Conclusion: The integration of laboratory and imaging-based biomarkers with the PCP-HF risk score enhances the predictive accuracy of risk modeling for incident HF, especially in individuals identified as low-risk by the 10-year risk prediction tool.

Major clinical outcomes of metabolism and sports physiology: a systematic review

Introduction: In the sports medicine setting, many of the established positive health benefits of exercise have been documented by historic discoveries in the field of exercise physiology. Mitochondrial function is critical in regulating all three of the classic physiological factors that limit endurance performance. Objective: It was to carry out a systematic review to present the main information on exercise physiology in the light of mitochondrial redox activities in sports performance, as well as the guidelines of sports medicine in this regard. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from August to September 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles dated from 2008 to 2023. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 200 articles were found, and of the 77 articles were evaluated in full and 32 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 37 studies with a high risk of bias and 78 studies that did not meet GRADE. It was concluded that sports physicians may seek to use an increasing number of non-invasive techniques to study muscle metabolic functioning, answering how mitochondrial networks interact with O2 kinetics, how to remodel mitochondrial networks to increase performance, and how training affects the interaction between glycogen/lipid storage site and mitochondrial networks. Physiological and psychological demands during training and competition generate fatigue and reduce an athlete's sport-specific performance capacity. The magnitude of this decrease depends on several characteristics of the exercise stimulus, such as type, duration, and intensity, as well as on individual characteristics, such as physical conditioning, profile, and fatigue resistance. Recent evidence suggests that exercise-induced reactive species are essential upstream signals for the activation of redox-sensitive transcription factors and the induction of exercise-associated gene expression. Free radicals and oxidative stress are increasingly included in major reviews of exercise physiology as regulators of responses and adaptations.

Comparing Oral Versus Intravenous Antibiotics Administration for Cellulitis Infection: Protocol for a Systematic Review and Meta-Analysis

Background Cellulitis is defined as an infection of the skin that is usually characterized by localized but poorly demarcated areas of erythema, swelling, and pain. Erysipelas is a subtype of cellulitis that is characterized by a more superficial infection, often involving the face. Because gram-positive bacteria are the most common infective agent, beta-lactam antibiotics such as cephalosporins are commonly used. However, guidelines and physician preference vary widely as different antibiotic options and routes of administration exist, in addition to the fact that most cases are treated empirically without microbiological lab guidance. This lack of standardization in evidence, guidelines, and physician practice prompted this systematic review and meta-analysis of both randomized trial data and cohort studies to aggregate the currently available evidence for the optimal routes of antibiotic administration in cellulitis treatment. Objective The primary objective of our review is to compare the efficacy of oral versus intravenous antibiotic administration for cellulitis infections, thereby providing clinicians with evidence-based guidelines for treatment. Methods We will search MEDLINE, Embase, and CENTRAL through Ovid as well as Web of Science and CINAHL for all available literature comparing different routes of antibiotic administration in the treatment of cellulitis and erysipelas. We will perform title and abstract as well as full-text screening in duplicate according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines and then extract the relevant data using a prepiloted data sheet. The primary outcome for our review is the duration of infection resolution, and secondary outcomes such as incidence of sepsis, mortality, hospital admission, and Clostridium difficile infection. We will assess the risk of bias in our included studies using the RoB 2.0 (revised tool for Risk of Bias in randomized trials) and ROBINS-I (Risk of bias in non-randomized studies for interventions) tools, with a final quality assessment using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework and a sensitivity analysis to examine heterogeneity. Results We will publish the final results of our systematic review in a peer-reviewed academic journal. This project received no funding or financial assistance. Data analysis is currently underway, and the results are expected to be submitted for publication in late November 2023. Conclusions To our knowledge, this will be the most up-to-date review of the best available evidence comparing different routes of antibiotic administration for cellulitis. Because of the vast selection of antibiotic options available and the empirical nature of the treatment, we anticipate heterogeneity within our data but nonetheless hope to provide aggregated evidence on the efficacy of intravenous versus oral administration of antibiotics in cellulitis treatment. We hope the results from this study will better inform physician practices in the future for cellulitis infections. International Registered Report Identifier (IRRID) PRR1-10.2196/48342

Day 100 Risk Assessment Tool Predicts 1 Year Survival in Allogeneic Hematopoietic Cell Transplant Patients

Introduction Allogeneic hematopoietic cell transplant (HCT) is a potentially curative therapy for many advanced malignancies; however, it is associated with a significant risk of non-relapse mortality. Several validated measures have been developed to estimate 1-year overall survival (OS) and non-relapse mortality (NRM), but these rely solely on pre-transplant factors to estimate risk. We previously described a “Day 100 risk assessment tool” (PMID 34628474) that aimed to identify the most effective way to deliver high quality care. The score is based on factors primarily occurring within the first 100 days of HCT, demonstrating that, independent of traditional pre-transplant variables, factors identified at day 100 significantly impacted longer term outcomes. This previous analysis included 163 patients who were transplanted from 2015-2018. We now aim to validate our scoring system in a larger, more contemporary cohort. Methods The Day 100 risk tool includes 11 binary variables: HCT-comorbidity index ≥ 3, distance from transplant center > 1 hour, day 100 ECOG performance status (PS > 2), acute GVHD requiring systemic corticosteroids, infection requiring intravenous antibiotics, concerns regarding caregiver support, coping skills, substance use, poor health literacy, medication compliance, and “other” concerns from the care team. Patients were given a point for each factor (0 or 1) and total points were summed as the risk score for analysis. Patients who survived at least 100 days were included in analysis. One year survival estimates were analyzed using the Kaplan-Meier method (overall survival [OS]) and cumulative incidence methods (non-relapse mortality [NRM]). Prognostic factors were identified with Cox regression (OS) or Fine and Gray regression (NRM). All patients who died after 1-year were censored at 12 months. Results From 1/2018-7/2022, 407 patients underwent first allogeneic HCT and survived at least 100 days without progression of disease. Median age of patients was 61 years old (range 20 - 76) and the majority of patients were: Male (54.3%, N=221), White (88.7%, N=361), diagnosed with acute myelogenous leukemia (AML) (45%, N=183), received peripheral blood stem cells (72%, n=294) had a matched unrelated donor (62.7%, n=255), underwent reduced intensity conditioning (64%, n=259), and received post-transplant cyclophosphamide graft-versus-host disease prophylaxis (52.6%, n=214). Stratified according to best fit for survival, 46.7% (n=190) were classified as “low risk” (0-1), 42.5% (n=173) “intermediate risk” (2-3), and 10.8% (n=44) as “high risk” (≥4) based on Day 100 score. One-year OS was significantly worse for the high risk ≥4) compared to low risk (0-1) and intermediate risk (2-3) (Figure 1). Multivariable analysis demonstrated that the high-risk Day 100 score was significantly associated with 1-year OS and NRM (Table 1). Conclusion In a larger contemporary cohort, we validate our Day 100 risk assessment tool as prognostic for 1-year outcomes. Future dynamic scoring systems incorporating post-transplant events may help to identify high risk patients and potential interventions to improve longer-term outcomes.

A seismic risk assessment method for cultural artifacts based on the Law of Large Numbers

Earthquakes can cause significant damage to cultural artifacts, which often hold significant historical or cultural value. Seismic risk assessments can contribute to a more targeted approach by museum staff to the preventive conservation of cultural artifacts. The primary objective of this research is to suggest a new approach for assessing the seismic risk of cultural artifacts. This innovative method is founded on the Law of Large Numbers and aims to provide a more user-friendly way of evaluating the likelihood of potential seismic threat to cultural artifacts. The proposed method takes into account the statistical distribution of seismic ground motion and the seismic response characteristics of artifacts, and its accuracy and practicality are demonstrated by case studies. Compared with existing methods, the proposed method has the advantages of theoretical simplicity, low computational effort, and easier to be understood and mastered by museum staff. Furthermore, the impact of sample size on the assessment results was investigated. The findings demonstrate that the proposed method represents a valuable tool for cultural heritage risk decision-makers to evaluate the seismic risk of artifacts. By using this method, they can more effectively assess the potential damage caused by seismic effects and design suitable mitigation measures accordingly.

Cardiovascular risk assessment in patients with antiphospholipid syndrome: a cross-sectional performance analysis of nine clinical risk prediction tools

ObjectivesThis study aimed to assess the performance of cardiovascular risk (CVR) prediction models reported by European Alliance of Associations for Rheumatology and European Society of Cardiology recommendations to identify high-atherosclerotic...

Multiparametric MRI-based 5-year Risk Prediction Model for Biochemical Recurrence of Prostate Cancer after Radical Prostatectomy.

Background Current predictive tools to estimate the risk of biochemical recurrence (BCR) after treatment of prostate cancer do not consider multiparametric MRI (mpMRI) information. Purpose To develop a risk prediction tool that considers mpMRI findings to assess the risk of 5-year BCR after radical prostatectomy. Materials and Methods In this retrospective single-center analysis in 1459 patients with prostate cancer who underwent mpMRI before radical prostatectomy (in 2012-2015), the outcome of interest was 5-year BCR (two consecutive prostate-specific antigen [PSA] levels > 0.2 ng/mL [0.2 µg/L]). Patients were randomly divided into training (70%) and test (30%) sets. Kaplan-Meier plots were applied to the training set to estimate survival probabilities. Multivariable Cox regression models were used to test the relationship between BCR and different sets of exploratory variables. The C-index of the final model was calculated for the training and test sets and was compared with European Association of Urology, University of California San Francisco Cancer of the Prostate Risk Assessment, Memorial Sloan-Kettering Cancer Center, and Partin risk tools using the partial likelihood ratio test. Five risk categories were created. Results The median duration of follow-up in the whole cohort was 59 months (IQR, 32-81 months); 376 of 1459 (25.8%) patients had BCR. A multivariable Cox regression model (referred to as PIPEN, and composed of PSA density, International Society of Urological Pathology grade group, Prostate Imaging Reporting and Data System category, European Society of Urogenital Radiology extraprostatic extension score, nodes) fitted to the training data yielded a C-index of 0.74, superior to that of other predictive tools (C-index 0.70 for all models; P ≤ .01) and a median higher C-index on 500 test set replications (C-index, 0.73). Five PIPEN risk categories were identified with 5-year BCR-free survival rates of 92%, 84%, 71%, 56%, and 26% in very low-, low-, intermediate-, high-, and very high-risk patients, respectively (all P < .001). Conclusion A five-item model for predicting the risk of 5-year BCR after radical prostatectomy for prostate cancer was developed and internally verified, and five risk categories were identified. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Aguirre and Ortegón in this issue.

The CPORT and Risk Matrix 2000 for Men Convicted of Child Sexual Exploitation Material (CSEM) Offenses: A Predictive Accuracy Comparison and Meta-Analysis

There is demand for valid risk assessment of individuals with child sexual exploitation material (CSEM) offenses. We compared the predictive performance of the Risk Matrix 2000/Sex (RM2000/S) and the Child Pornography Offender Risk Tool (CPORT) among 365 men convicted of CSEM offenses. In fixed 5-year follow-up analyses, the CPORT (area under the curve [AUC] = .73) had significantly higher predictive accuracy than the RM2000/S (AUC = .66) for any sexual recidivism. The predictive difference for CSEM recidivism was not statistically significant. A meta-analysis found the CPORT had large effects in predicting sexual recidivism (AUC = .75) and moderate accuracy for CSEM recidivism (AUCs = .65 and .66), while the RM2000/S had moderate accuracy in predicting any sexual recidivism (AUC = .66; insufficient studies of CSEM recidivism). Results suggest a tool developed specifically for CSEM offending, such as CPORT, may perform better at predicting any sexual recidivism than adapting a general sexual offending risk tool.

Opioid use disorder in two samples of the Lebanese population: scale validation and correlation with sleep and mood disorders.

The revised Opioid Risk Tool (ORT-OUD) is a brief, self-report scale designed to provide clinicians with a simple, validated method to screen for the risk of developing an Opioid Use Disorder (OUD) in patients without a prior history of substance abuse. This study aimed to translate and validate the Arabic version of ORT-OUD in the Lebanese population and assess its clinical validity in a sample of patients with OUD. This cross-sectional study in the Lebanese population used several validated scales to assess the risk of OUD, including the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Other tools evaluated chronotype and sleep and mood disturbances. Principal component analysis with Varimax rotation was applied to assess ORT-OUD construct validity. Convergent validity with the Arabic version of ASSIST was evaluated. The ORT-OUD criterion validity was then assessed in a clinical sample of patients with OUD. This study included 581 participants. The prevalence of the OUD risk in the Lebanese population using the ORT-OUD scale and the ASSIST-opioids scale was estimated at 14.5% and 6.54%, respectively. No items of the ORT-OUD were removed; all items converged over a solution of four factors with an eigenvalue > 1, explaining a total of 68.2% of the variance (Cronbach's alpha = 0.648). The correlation coefficients between the ORT-OUD total score and ASSIST subscales were as follows: ASSIST-opioids (r = 0.174; p = < 0.001), ASSIST-sedatives (r = 0.249; p < 0.001), and ASSIST-alcohol (r = 0.161; p = < 0.001). ORT-OUD clinical validation showed a correlation with ASSIST-opioids (r = 0.251; p = 0.093) and ASSIST-sedatives (r = 0.598; p < 0.001). Higher ORT-OUD scores were associated with a family and personal history of alcohol and substance consumption and higher insomnia and anxiety scores. This study is the first to validate the Arabic version of ORT-OUD in the Lebanese population, an essential step towards improving the detection and management of OUD in this population.

Ethical and legal implications of implementing risk algorithms for early detection and screening for oesophageal cancer, now and in the future.

Oesophageal cancer has significant morbidity and mortality but late diagnosis is common since early signs of disease are frequently misinterpreted. Project DELTA aims to enable earlier detection and treatment through targeted screening using a novel risk prediction algorithm for oesophageal cancer (incorporating risk factors of Barrett's oesophagus including prescriptions for acid-reducing medications (CanPredict)), together with a non-invasive, low-cost sampling device (CytospongeTM). However, there are many barriers to implementation, and this paper identifies key ethical and legal challenges to implementing these personalised prevention strategies for Barrett's oesophagus/oesophageal cancer. To identify ethical and legal issues relevant to the deployment of a risk prediction tool for oesophageal cancer into primary care, we adopted an interdisciplinary approach, incorporating targeted informal literature reviews, interviews with expert collaborators, a multidisciplinary workshop and ethical and legal analysis. Successful implementation raises many issues including ensuring transparency and effective risk communication; addressing bias and inequity; managing resources appropriately and avoiding exceptionalism. Clinicians will need support and training to use cancer risk prediction algorithms, ensuring that they understand how risk algorithms supplement rather than replace medical decision-making. Workshop participants had concerns about liability for harms arising from risk algorithms, including from potential bias and inequitable implementation. Determining strategies for risk communication enabling transparency but avoiding exceptionalist approaches are a significant challenge. Future challenges include using artificial intelligence to bolster risk assessment, incorporating genomics into risk tools, and deployment by non-health professional users. However, these strategies could improve detection and outcomes. Novel pathways incorporating risk prediction algorithms hold considerable promise, especially when combined with low-cost sampling. However immediate priorities should be to develop risk communication strategies that take account of using validated risk algorithms, and to ensure equitable implementation. Resolving questions about liability for harms arising should be a longer-term objective.

The International Consortium on Primary Graft Dysfunction: Redefining Clinical Risk Factors in the Contemporary Era of Heart Transplantation

Background: Primary Graft Dysfunction (PGD) is the leading cause of morbidity and mortality early after heart transplant (HT). The International Consortium on PGD is a multicenter collaboration dedicated to identifying the clinical risk factors for PGD in the contemporary era of HT. The objectives of the current report were to 1) assess the incidence of severe PGD in an international cohort, 2) evaluate the performance of the most validated PGD risk tool, the RADIAL score, in a contemporary cohort, and 3) redefine clinical risk factors for severe PGD in the current era of HT. Methods: This is a retrospective, observational study of consecutive adult HT recipients between 2010 and 2020 in 10 centers in the United States, Canada, and Europe. Patients with severe PGD were compared to those without severe PGD (comprising those with no, mild and moderate PGD). The RADIAL score was calculated for each transplant recipient. The discriminatory power of the RADIAL score was evaluated using receiver operating characteristic (ROC) analysis and its calibration was assessed by plotting the percentage of PGD predicted versus observed. To identify clinical risk factors associated with severe PGD, we performed multivariable mixed-effects logistic regression modeling to account for among-center variability. Results: A total of 2,746 patients have been enrolled in the registry to date, including 2,015 (73.4%) from North America, and 731 (26.6%) from Europe. 215 participants (7.8%) met the criteria for severe PGD. There was an increase in the incidence of severe PGD over the study period (p-value for trend by difference sign test = 0.004). The Kaplan Meier estimate for 1-year survival was 75.7% [95%CI 69.4-80.9%] in patients with severe PGD as compared to 94.4% [95% CI 93.5-95.2%] in those without severe PGD (log-rank p-value <0.001). The RADIAL score performed poorly in our contemporary cohort and was not associated with severe PGD with an AUC of 0.53 (95%CI 0.48-0.58). In the multivariable regression model, acute preoperative dialysis (OR 2.41, 95% CI 1.31 – 4.43), durable LVAD support (OR 1.77, 95% CI 1.13 – 2.77), and total ischemic time (OR 1.20 for each additional hour, 95% CI 1.02 – 1.41) were associated with an increased risk of severe PGD. Conclusions: Our consortium has identified an increasing incidence of PGD in the modern transplant era. We identified contemporary risk factors for this early post-transplant complication, which confers a high mortality risk. These results may enable the identification of patients at high risk for developing severe PGD in order to inform peri-transplant donor and recipient management practices.

Major clinical findings on the safety and effectiveness of ozone therapy in endodontic treatment: a concise systematic review

Introduction: In the scenario of endodontic diseases, microorganisms, and their byproducts are the main causes of pulpal and periradicular diseases. Sodium hypochlorite (NaOCl) is the most commonly used root canal irrigant. Ozone (O3) therapy has been investigated to reduce or eliminate the microbiota load within the root canal system, improving endodontic results. Objective: It was to highlight the main clinical findings of the safety and effectiveness of ozone therapy in endodontic treatment. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from July to September 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 87 articles were found, and 23 articles were evaluated in full and 14 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 18 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=47.7%&lt;50%. It was concluded that ozone has been accumulating scientific evidence regarding its success in endodontic treatment, more specifically in the decontamination of root canals and activation of regenerative processes. Ozone therapy is a minimally invasive treatment method, without discomfort or pain. It also minimizes the patient's anxiety and stress level, as it reduces the duration of treatment. The beneficial role of ozone in treating different oral and dental conditions is still limited. There are possible side effects during intraoral application, as it can reach the upper respiratory tract.

Meta-analysis of clinical efficacy of ankle arthrodesis and total ankle arthroplasty in the treatment of end-stage ankle arthritis

To systematically review the clinical efficacy of total ankle arthroplasty (TAA) and ankle arthrodesis (AA) in the treatment of end-stage ankle arthritis. The PubMed, EMBASE and Cochrane Library databases were searched for articles published in the treatment of end-stage ankle arthritis with AA or TAA from the establishment of the database to June 2021. Bias risk tool was used to evaluate the quality of the literature. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale(AOFAS), visual analog scale (VAS), ankle osteoarthritis scale(AOS), gait analysis (pace, frequency, stride), range of motion (ROM), satisfaction, complications and reoperation rate were analyzed by meta-analysis between AA and TAA groups by RevMan 5.3 software. A total of 12 articles were included, including 1 050 patients in the AA group and 3 760 patients in the TAA group, totaling 4 810 patients. Meta-analysis showed that the total score of AOFAS[MD=-3.12, 95%CI(-9.02, 2.96), P=0.31], pain score [MD=1.60, 95%CI(-1.35, 4.54), P=0.29], alignmentl score[MD=-0.04, 95%CI(-0.52, 0.44), P=0.88], VAS[MD=0.10, 95%CI(-0.49, 0.68), P=0.74], and AOS total score [MD=-4.01, 95%CI(-8.28, 0.25), P=0.06], the difference was not statistically significant (P>0.05). The score of AOFAS functional in TAA group was significantly higher than that in TAA group[MD=44.22, 95%CI(-8.01, -0.43), P=0.03]. There was no significant difference in gait analysis between the two groups (P>0.05). Postoperative ROM [MD=-4.93, 95%CI(-6.35, -3.52), P<0.000 01] and change in ROM from preoperative to follow-up[MD=-5.74, 95%CI(-8.88, -2.61), P=0.0003] between two groups, the difference was statistically significant. There was no significant difference in satisfaction between the two groups [OR=1.011, 95%CI(0.46, 2.23), P=0.98]. Complications [OR=1.61, 95%CI(1.26, 2.06), P=0.0002] and non-revision reoperation [OR=1.61, 95%CI(1.17, 2.21), P=0.003] were significantly lower in the TAA group than in the AA group. There was no significant difference in the rate of revision and reoperation(P>0.05) between the two groups [OR=1.02, 95%CI(0.37, 2.78), P=0.97]. The clinical efficacy of AA is similar to that of TAA, but the non revision reoperation rate and main surgical complications of TAA are significantly reduced. Therefore, further high-quality methodological research and long-term follow-up are needed to confirm this conclusion.

Scoring tool to identify patients at increased risk for drug-related problems: results of a point prevalence study at hospital admission

Drug therapy is a high-risk process and requires special attention, especially at sectoral borders. Pharmaceutical services such as medication review are appropriate measures to identify drug-related problems and thus improve the safety of drug therapy. Risk-scoring tools have been described in the literature as helpful for prioritizing medication reviews for patients at high risk for drug-related problems. In a multi-centre point prevalence study, we identified patients at increased risk for medication-related problems at hospital admission using the medication risk tool. In addition, the current level of implementation of pharmacy services was surveyed. A total of 11 (58%; 11/19) hospital pharmacies in Saxony participated in the point prevalence survey. The scoring tool identified 32% (279/875) of patients at increased risk for medication-related problems (Meris score >12 group) at admission. Thereby, the number of drugs in the Meris score >12 group was 10.6 (average; standard deviation 3.5; n=279), while in the Meris score ≤12 group it was only five drugs per patient (average 4.6; standard deviation 2.8; n=596). The age of patients in the Meris score >12 group averaged 75.9 ± 11 years, while the age of patients in the Meris score ≤12 group averaged 60.6 ± 17.9 years. Prioritization with the help of a risk-scoring tool is essential as pharmacy services in Saxon hospitals still need to be regularly established and in order to identify patients with an increased risk for drug-related problems at an early stage.

Highlight the major clinical outcomes of vitamins and minerals in healthy aging: a systematic review

Introduction: In the context of healthy longevity, aging is a natural phenomenon that promotes a senescent phenotype, with the shortening of telomeres. The main ways to increase a healthy life expectancy include lifestyle modifications and pharmacological manipulations. Vitamins, minerals (as micronutrients), essential amino acids, polyunsaturated fatty acids (PUFA), probiotics, and plant metabolites such as polyphenols and terpenoids are widely recognized for preventing aging. Objective: It was to carry out a systematic review to highlight the main clinical outcomes of vitamins and minerals in healthy aging. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to September 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 122 articles were found, and 40 articles were evaluated in full and 38 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=72.4%&gt;50%. Zinc and copper govern many functions that characterize the so-called “oxy-aging”. Selenium (Se) is a fundamental cofactor in many redox functions, vitamin C's role in aging has been investigated particularly for skin health and immunity, particularly in inflammatory and degenerative diseases. Retinoids, which represent a synthetic form of vitamin A, appear effective in preventing skin degeneration due to aging. The role of vitamin E in preventing and reducing ROS-induced injuries has been well described. Supplementation with selenium and coenzyme Q10 influenced the biomarkers analyzed to indicate an anti-aging effect. It was concluded that micronutrients such as vitamins and minerals have anti-oxidant, protective, and regenerative properties to promote healthy aging.

Reversal of medication abortion with progesterone: a systematic review

BackgroundWe sought to determine whether there is evidence to recommend progesterone for individuals not wishing to complete a medication abortion after taking mifepristone.MethodsWe undertook an updated systematic review including a...

Ten-Year Cardiovascular Risk as Predicted by the QRISK®3 Calculator in Diabetic Patients Attending a Tertiary Care Teaching Hospital in Central India and Its Application to Stratify Statin Over-Users and Under-Users.

Cardiovascular disease (CVD) is an important cause of morbidity and mortality in diabetic patients. As such, risk stratification is essential to identify the risk factors of CVD and provide early intervention. The QRISK®3 tool, recommended by the National Institute for Health and Care Excellence (NICE) guidelines, has the option to choose the patient's ethnicity, which is not available in other tools. However, there is a paucity of data regarding the use of this tool in the Indian population. Therefore, this study was planned to predict 10-year CVD risk using the QRISK®3 tool and to determine statin eligibility in diabetic patients. We enrolled diabetic patients visiting our general medicine outpatient department and diabetic clinic in the study. We collected data from clinical and prescription records, as well as through patient interviews. We analyzed the data to determine the 10-year CVD risk using the QRISK®3 risk tool, which is available online. A cut-off QRISK score of 10%, as recommended by the NICE guidelines (2014), was used to stratify patients as "over-users" and "under-users." We also analyzed the data to determine any correlation between other risk factors and QRISK scores. Of the 134 diabetic patients recruited in this study, 43 (32.09%) had a CVD risk score of <10%, of which 16 (37.21%) were categorized as "over-users." Of the patients,91 had a CVD risk score of ≥10%, of which 17 (18.68%) were categorized as "under-users." Risk factors showing a positive correlation with QRISK score included duration of diabetes, age, blood pressure treatment, waist circumference, and non-high-density lipoprotein cholesterol level. QRISK score can be useful to predict10-year CVD risk in the Indian population and to stratify patients as statin over-usersand under-users. This tool can be used in the Indian set-up to identify potential candidates for statin initiation.

Effects of cannabidiol on metabolic modulation and improving sports performance: a systematic review

Introduction: In the sports scenario, cannabidiol (CBD) is a phytocannabinoid that has been accumulating important scientific evidence in various metabolic and metabolomic effects. Δ9 tetrahydrocannabinol (Δ9-THC) may be responsible for some adverse effects on sports performance and this makes cannabis unattractive for athletes. Extracellular vesicles (exosomes and microRNAs) induced by exercise emerged as potential mediators of tissue crosstalk. Objective: It was to carry out a systematic review study to highlight the main outcomes of cannabidiol in metabolic modulation and microRNA signaling in increasing sports performance. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from March to May 2023 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 127 articles were found. A total of 87 articles were evaluated in full and 62 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 5 studies with a high risk of bias and 11 studies that did not meet GRADE. It has been shown that cannabidiol exerts some physiological, biochemical, and psychological effects with the potential to benefit athletes. For example, there is preliminary supporting evidence for the anti-inflammatory, neuroprotective, analgesic, and anxiolytic actions of cannabidiol and the possibility that it may protect against gastrointestinal damage associated with inflammation and promote healing of traumatic skeletal injuries. However, it is important to recognize that these findings are very preliminary, sometimes inconsistent, and largely derived from preclinical studies. These studies are limited in their generalizability to athletes and often administer high doses of cannabidiol. The central observation is that there is a lack of studies that directly investigate cannabidiol and sports performance. Furthermore, we identified a specific repertoire of microRNAs that are regulated by cannabinoids, at rest (vigilant), and in microglia activated by lipopolysaccharides. Modulated microRNAs and their target genes are controlled by TLR, Nrf2, and Notch cross-signaling and are involved in the immune response, cell cycle regulation, as well as cellular stress and redox homeostasis.

An opioid-minimizing multimodal pain regimen reduces opioid exposure and pain in trauma-injured patients at high risk for opioid misuse: Secondary analysis from the mast trial

BackgroundScreening to identify patients at risk for opioid misuse after trauma is recommended but not commonly used to guide perioperative opioid management interventions. The Multimodal Analgesic Strategies for Trauma trial demonstrated that an opioid-minimizing multimodal pain regimen reduced opioid exposure in a heterogeneous trauma patient population. Here, we assess the efficacy of the Multimodal Analgesic Strategies for Trauma multimodal pain regimen in a critical patient subgroup who screened at high risk for opioid misuse. MethodsThe Multimodal Analgesic Strategies for Trauma trial compared an opioid-minimizing multimodal pain regimen (oral acetaminophen, naproxen, gabapentin, lidocaine patch, as-needed opioid) against an original multimodal pain regimen (intravenous followed by oral acetaminophen, 48-hour celecoxib and pregabalin, followed by naproxen and gabapentin, scheduled tramadol, as-needed opioid), in a randomized trial conducted from April 2018 to March 2019. A total of 631 enrolled patients were classified either as low- or high-risk via the Opioid Risk Tool. Bayesian analyses evaluated the moderating influence of Opioid Risk Tool risk (high/low) on the effect of Multimodal Analgesic Strategies for Trauma multimodal pain regimen (versus original) on opioid exposure (morphine milligram equivalents/day), opioids prescribed at discharge, and pain scores. ResultsMultimodal Analgesic Strategies for Trauma multimodal pain regimen effectively reduced morphine milligram equivalents/day in low- and high-Opioid Risk Tool risk groups. Moderation was observed for opioids at discharge and pain scores; Multimodal Analgesic Strategies for Trauma multimodal pain regimen was effective in the high-risk group only (opioids at discharge: 63% vs 77%, relative risk = 0.86, 95% Bayesian credible interval [0.66–1.08], posterior probability (relative risk <1) = 90%; pain scores: b = 3.8, 95% Bayesian credible interval [3.2–4.4] vs b = 4.0, 95% Bayesian credible interval [3.4–4.6], posterior probability (b <0) = 87%). ConclusionThis study is the first to show the moderating influence of opioid misuse risk on the effectiveness of an opioid-minimizing multimodal pain regimen. The Opioid Risk Tool was useful in identifying high-risk patients for whom the Multimodal Analgesic Strategies for Trauma multimodal pain regimen is recommended for perioperative pain management.

Main clinical and surgical outcomes of crossbite treatment: a concise systematic review

Introduction: In the crossbite scenario, the prevalence of malocclusion is 56%, with 10% of crossbites in the primary dentition, 11% in the mixed dentition, and 5% in the permanent dentition. The etiology is multifactorial and early diagnosis of crossbite is essential to reduce the risk of dental, alveolar, and skeletal malocclusions. In this sense, malocclusions are a disorder that is increasingly present in the population. Objective: It was to carry out a concise systematic review of the main considerations of crossbite and malocclusions. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from June to September 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total 117 articles were found, and 22 articles were evaluated in full and 13 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 7 studies with a high risk of bias and 43 studies that did not meet GRADE. Early bite correction will provide benefits, restoring the normal redirection of the eruption of permanent teeth, providing correction of asymmetries in condylar positioning, and favoring ideal occlusion. Furthermore, early expansion with a removable expansion plate is a successful method for correcting crossbites and increasing intermolar width in the early phase of mixed dentition. Results remain stable until comprehensive treatment of the permanent dentition begins. Rapid maxillary expansion is a resource of great value to the orthodontist that can be used to treat maxillary transverse deficiencies.