Articles: outcome.
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Chronic pancreatitis is a progressive fibroinflammatory disease primarily caused by a complex interplay of environmental and genetic risk factors. It might result in pancreatic exocrine and endocrine insufficiency, chronic pain, reduced quality of life, and increased mortality. ⋯ Management of chronic pancreatitis consists of prevention and treatment of complications, requiring a multidisciplinary approach focusing on lifestyle modifications, exocrine insufficiency, nutritional status, bone health, endocrine insufficiency, pain management, and psychological care. To optimise clinical outcomes, screening for complications and evaluation of treatment efficacy are indicated in all patients with chronic pancreatitis.
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Meta Analysis
Clinical outcomes of atrial fibrillation screening: a meta-analysis of randomized controlled trials.
Several randomized controlled trials (RCTs) have investigated the benefits of atrial fibrillation (AF) screening. However, since none have shown a significant reduction in stroke rates, the impact of screening on clinical outcomes remains uncertain. ⋯ Systematic AF screening is associated with a modest yet statistically significant 7% relative reduction in stroke and systemic embolism, with no observed impact on major bleeding or all-cause mortality.
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Ruptured peripheral cerebral aneurysm (PPCA) associated with moyamoya disease (MMD) is rarely reported, and its optimal treatment remains controversial. This study aims to present the clinical characteristics, treatment strategies, and outcome predictors of this rare clinical entity. ⋯ PPCA should be considered in the differential diagnosis of hemorrhagic MMD. Aneurysm rebleeding appears to be a potential predictor of poor outcome and therefore aggressive intervention should be advocated. Endovascular embolization may be safe and feasible, and conservative observation should be carefully chosen given the high risk of aneurysm re-rupture.
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This study aimed to investigate the demographics and to evaluate long-term outcomes of acute type A aortic dissection (ATAAD) in surgically treated patients ≤40 years in China. ⋯ The prevalence of HTAD is high in the cohort of younger patients with ATAAD. HTAD is associated with high rates of in-hospital mortality and late reoperation. Extensive primary aortic repair is safe and has long-term benefits in young patients with ATAAD. Regular imaging assessment of the thoracoabdominal aorta after surgery is imperative for improving the long-term prognosis.
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Collaborative and stepped care (CSC) models are recommended in guidelines because of their documented effectiveness in treating depression and anxiety disorders. The evidence for their efficacy against other mental disorders is limited. In this study, we evaluated the effectiveness of a collaborative and stepped care model (COMET) for patients with depressive, anxiety, somatoform and/or alcohol-related disorders and related comorbidities in the outpatient care setting in Germany. ⋯ We found no superiority of CSC in the treatment of the mental disorders addressed in this study. Methodological issues, including differences at baseline and high dropout rates, make these findings challenging to interpret. Future studies should ensure comparability of groups, allocate resources for quality management, and investigate more suitable outcome measures, with attention to factors of implementation.