Search Results for: Approccio farmacologico al trattamento della stipsi indotta da oppioidi: focus su naldemedina

Introduction
Development of clinical skills in areas, such as exercise risk stratification, testing, prescription, monitoring and outcome assessment, is vital for patient safety and clinical effectiveness in clinical exercise physiology (CEP). This study explored how current CEP courses are being taught and assessed and to identify potential best practice recommendations from a variety of stakeholders

Methods
Qualitative methods were employed to explore the thoughts of CEPs, academics and current students regarding the teaching and assessment of CEPs in the UK. Research design involved (1) semistructured interviews with students (n=16) and (2) focus groups with academics (n=8) and CEP (n=5) stakeholders. Data obtained were audio recorded using a portable Dictaphone and transcribed verbatim, then thematically analysed manually.

Results
Three themes: (1) in situ learning/real-world practice (working with patients and specialist practitioners); (2) programme design (scaffold learning and integrated modules) and (3) teaching approach (simulated learning and research competency) were generated concerning teaching methods and approaches across CEP postgraduate degrees. The current use of simulated tasks for the delivery of taught content was identified as lacking effectiveness, with clinical placements identified as being the most important source of knowledge and skill attainment due to the real-world exposure to patients and practitioners. Clinical placements and simulated learning were recognised as the two main methods of problem-based learning used to develop student knowledge, skills and competency to practice. Two themes (placement tariffs/assessors in situ and role play/simulation) were identified for the assessment of students.

Conclusion
Clinical placements remain the optimal method for developing the knowledge, skills and competency to practice for student CEPs. However, suitable placements remain limited, and novel approaches such as university-led exercise services require consideration for student competency development. A standardised and accredited training pathway from undergraduate through to postgraduate level should be explored to allow student competency to be developed over a longer period, to enhance knowledge, skills and competency on graduation and registration.

Objectives
To evaluate the incidence and risk factors for psychiatric disorders, including depression and anxiety, and assess the risk of suicide in patients with polymyositis (PM) and dermatomyositis (DM).

Design
Retrospective cohort study.

Setting
Data were obtained from Taiwan’s National Health Insurance Research Database (NHIRD) between 2000 and 2018.

Participants
A total of 3477 patients with PM/DM and 13 908 age- and sex-matched non-PM/DM controls were included in the study.

Primary and secondary outcome measures
The primary outcome was the incidence and risk of psychiatric disorders in patients with PM/DM compared with controls. Secondary outcomes included the identification of risk factors for psychiatric disorders, mortality and suicide risk in the PM/DM cohort.

Results
The incidence rate ratio (IRR) of psychiatric disorders was significantly higher in the PM/DM cohort than in controls (IRR 1.62, 95% CI 1.39 to 1.89), with depression being the most prevalent disorder (IRR 2.25, 95% CI 1.83 to 2.75). Key risk factors included female sex, intravenous steroid therapy, and high-dose oral steroid use. Additionally, the PM/DM cohort exhibited a higher mortality rate (IRR 3.4, 95% CI 3.15 to 3.67) and elevated suicide risk (IRR 1.99, 95% CI 0.96 to 3.86) compared with controls.

Conclusion
Patients with PM/DM face a significantly higher risk of psychiatric disorders, mortality and suicide. Integrating mental healthcare into the routine management of PM/DM is crucial to improving patient outcomes and reducing mortality. Future research should focus on the impact of early psychiatric interventions on survival outcomes in this population.

Introduction
The quality of care provided in long-term care (LTC) homes has been a concern for many years, and the COVID-19 pandemic has further raised awareness of this issue. Care planning helps identify and prioritise areas to improve LTC residents’ health. Data are routinely collected to support care planning, for example, the interRAI LTC facilities instrument and real-time location systems. However, the best way to use these data to inform care planning and decision-making while including residents and family members remains elusive. This study aims to develop a data-informed care planning improvement intervention that uses routinely collected data to guide resident-centred care planning in LTC. Specifically, we will: (1) examine how, where and why routinely collected data are used in current care planning processes in LTC; (2) identify barriers and facilitators to using data to guide care planning from the perspectives of staff, residents and family caregivers; and (3) develop care planning intervention guided by the Behaviour Change Wheel.

Methods and analysis
An advisory committee of residents, family members and LTC staff will provide study oversight of this interpretive qualitative description study, conducted in LTC homes in Nova Scotia from May 2023 to April 2025. Participants, including LTC residents, their family members and staff, will be invited to participate in two 60–90 min focus groups or 45–60 min individual interviews and/or three 2-hour observation sessions. Data from interviews, focus groups and care observations will be analysed using inductive content analysis to answer the objectives. Next, we will deductively map the identified barriers and facilitators onto the Behaviour Change Wheel, which suggests that Capability, Opportunity and Motivation are needed for a Behaviour to occur (COM-B system). Subsequently, we will have a 1 day advisory committee meeting to: (1) select the intervention components using the APEASE criteria, which asks whether the function is Affordable, Practicable, Effective, Acceptable, Safe, and promotes Equity; and (2) describe the final intervention using the Template for Intervention Description and Replication checklist to ensure the reproducibility of the intervention in future work. The result of this study has the potential to contribute to the understanding of the process in enhancing care and resident outcomes in LTC homes across Canada.

Ethics and dissemination
This study has been approved by the Dalhousie University Health Sciences Research Ethics Board. Informed consent will be obtained from all participants or their substitute decision-makers before they take part in interviews, focus group discussions and care observations. Data will be de-identified, and privacy and confidentiality will be maintained through secure storage and handling of both electronic and physical documents. Study findings will be shared with participants through lay summaries and infographics after the second interview and observation, as well as at the conclusion of the study. Results will also be disseminated to researchers, healthcare professionals and LTC providers across Canada via presentations at local, national and international conferences, publications in open-access journals and through print and video materials tailored to the audience.

All’ospedale ‘Mazzini’ di Teramo, eseguito intervento complesso

Objective
This study aimed to explore the challenges and opportunities in engaging health development partners in planning healthcare services at a sub-national level in Uganda.

Design
An exploratory qualitative study involving selected health development partner organisations and district local governments.

Setting
A study was conducted in Northern Uganda, specifically in 12 districts that comprise the Lango and Acholi sub-regions. The study area has many health development partners compared with the other regions in the country.

Participants
A total of 18 participants were enrolled in the study. To be considered for inclusion, a participant had to be working for a district local government in Northern Uganda and involved in planning health services or working for a development partner supporting health services in the region. Most of the participants were men aged between 41 and 50 years.

Outcome measures
Factors that affect the involvement of health development partners in planning health services at sub-national levels and opportunities that can facilitate involvement.

Results
The findings show that health development partners serve as a source of information and data, guide the planning and supervision of services, conduct community mobilisation and support infrastructure development. However, differing planning cycles, corruption, power dynamics and budget constraints affect their participation in district health planning. Continuous engagement, even outside budget periods, with respect to the terms agreed upon in the memoranda of understanding (MOU), equitable treatment of all partners and transparency from all parties emerged as opportunities to improve involvement.

Conclusion
The involvement and importance of health development partners in planning district-level health services cannot be overstated. Therefore, addressing the challenges that hinder joint planning through a focus on open communication, mutual respect and adherence to the terms of the MOU can improve working relationships.

Objectives
To assess the demands for support measures of healthcare workers (HCWs) in China’s high-workload provinces during the COVID-19 pandemic and identify specific needs to make evidence-based recommendations.

Design
Prospective cross-sectional study.

Setting
Conducted in three Chinese provinces characterised by their significant healthcare demands during the pandemic.

Participants
The study comprised 683 HCWs, including doctors, nurses, resident physicians and hospital administrators. The sample was predominantly female (68.1%), with the majority aged between 25 and 34 years. Participants were recruited through convenience and snowball sampling methods, with a focus on individuals working in high-intensity clinical environments.

Results
Hierarchical analysis was performed to assess the layered impact of support measures across different roles and genders. Substantial gender disparity was observed, with female staff reporting significantly reduced access to material support (p

Objective
To explore the barriers that hinder and the facilitators that strengthen the implementation of the antimicrobial stewardship (AMS) programme at paediatric units in academic hospitals in Thailand.

Design
A qualitative study using thematic analysis of interviews with healthcare staff.

Setting
Five paediatric units in academic hospitals in Thailand.

Participants
20 healthcare workers and 10 AMS service providers who actively participated in the AMS programme in the sampled hospitals were included from purposive criterion.

Primary outcome measures
Qualitative, interpretive description with semistructured individual interviews were digitally recorded and transcribed. The MAXQDA software was used to facilitate content analysis.

Results
In total, 4 themes emerged from the data: (1) organisational hierarchical culture and individual behaviours influence the acceptance and adherence to AMS implementation, (2) changing healthcare workers’ mindset to improve stewardship is crucial, (3) effective communication and collaboration among healthcare teams are the key to implementing the AMS programme and (4) dedication to antimicrobial stewardship despite resource limitations is important to improve AMS programme implementation.

Conclusions
To implement antimicrobial stewardship in a paediatric setting, there are many issues to overcome. The key barriers to focus were organisational hierarchical culture and perception of healthcare workers. Support from hospital policy and effective communication with contextualised strategies should be considered to improve AMS programme implementation plans.

Objectives
This study aimed to understand antiretroviral therapy (ART) adherence norms and beliefs among men living with HIV (MLHIV) in Mozambique, gauge the impact of misconceptions and harmful beliefs, evaluate perceived HIV service quality and assess the effectiveness of a behaviour change campaign (Somos Iguais), particularly among men aged 25–34 years.

Design
A mixed-methods, cross-sectional study using quantitative and qualitative approaches.

Setting
In Mozambique, over two million individuals live with HIV. This study was conducted in Maputo, Nampula and Sofala provinces.

Participants
The study comprised 10 focus group discussions with MLHIV aged 18–35 years and 58 indepth interviews with MLHIV aged 15–35 years across diverse subpopulations. A quantitative cross-sectional survey was completed by 1934 MLHIV aged 25–34 years.

Intervention
Population Services International developed a behaviour change campaign in 2020 aimed at reaching men age 25–34, who often remain undiagnosed or not virally suppressed.

Outcome measure
The study explores key aspects of HIV-related norms, behaviours and beliefs among people living with HIV, including high-risk subpopulations. These key aspects include misinformation, service quality gaps, perceived treatment benefits and the impact of the Somos Iguais campaign.

Results
Significantly more MLHIV who were on ART believed that HIV treatment reduces the risk of transmission compared with those who were not on ART (33% and 10%, respectively; p

Introduction
Current clinical practice in bariatric surgery follow-up care is highly heterogeneous, and patients have reported needing more and extended personalised support. Especially, they want more support on how to self-manage and cope with the changes and challenges of living with the chronic aspects of obesity and a changing body following surgery. The overall aim of this study protocol is to develop and validate a digital self-management support checklist in bariatric surgery aftercare.

Methods
We propose a protocol for a modified, electronic Delphi study design using qualitative and quantitative methods to develop and validate the content of the checklist. The study is divided into two phases: (1) generation of candidate checklist attributes and (2) validation of candidate checklist attributes. In Phase 1, two qualitative studies involving individual interviews with patients and focus groups with healthcare professionals will be conducted to derive context-specific knowledge. This knowledge will be combined with best-practice evidence and stakeholder input to generate candidate checklist attributes, that is, principles, items and features. In Phase 2, a two-round electronic Delphi survey with an expert panel will be conducted to assess the relevance, comprehensibility and comprehensiveness of candidate checklist attributes and to determine the final checklist attributes based on content validity results from the Delphi process. Reflexive thematic analysis will be used on qualitative data and descriptive statistics on quantitative data.

Ethics and dissemination
The study has been approved by the Regional Committee for Medical and Health Research Ethics, Region West (2023/676367). The Data Protection Officer at Førde Hospital Trust and collaborating hospital trusts have approved the project (4386–4386). The results will be presented at scientific conferences, published and open-accessed in international peer-reviewed journals.

Nuove prospettive da uno studio su Nature Reviews Rheumatology

Nuove prospettive da uno studio su Nature Reviews Rheumatology

Conferenza Icar, ‘attenzione al dialogo medico-paziente’

Introduction
Haematological cancers are common in the UK, with a variety of morphologies. Stem cell transplants and chimeric antigen receptor (CAR) T-cell therapies provide significant options for hard to treat haematological cancers, although with difficult to predict outcomes. Research into the determinates of treatment efficacy, and access to treatments, is key to ensuring equal benefit across patients and patient safety. With this, there are concerns about the small representation of minority groups in related research. We aim to report on the current knowledge to guide future research.

Methods and analysis
A variety of databases will be searched for literature on UK minority ethnic populations receiving haematopoietic stem cell transplant or CAR T-cell therapy. Searches will be restricted to the year 2011 or later. Many outcomes will be analysed, covering the patient care pathway for those of the target population, although with a focus on follow-up after therapy. Plans have been made to conduct narrative synthesis, with meta-analysis where applicable.

Ethics and dissemination
Ethical approval is not required for this study. Outputs will be published in an appropriate journal and discussed with the wider National Institute for Health and Care Research Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics (BTRU) group. Discussions will also be undertaken with the BTRU patient partners group.

Dall’Inghilterra alle Marche per studiare tecniche mini-invasive