Search Results for: Caratterizzazione dell'asma in base all'età di insorgenza: uno studio di coorte multi-database

Studio Candiolo su Science, faro su mutazione Dna

Studio Candiolo su Science, faro su mutazione Dna

Studio Candiolo su Science, faro su mutazione Dna

Studio Candiolo su Science, faro su mutazione Dna

Objective
To determine whether an invasive approach is associated with favourable long-term outcomes among elderly medical patients in the intensive care unit (ICU), compared with a conservative approach.

Design
Nationwide observational study (OCTO-REVERSE study) using data prospectively collected in the National French Healthcare Database (covering 99% of the population, 66 million people).

Setting
Comprehensive multicentre study through the linkage of large-scale national registries (including all public or private facilities) from 2013 to 2018 to avoid ambiguities related to the COVID-19 pandemic.

Participants
All non-surgical patients aged 80 years or older admitted to an ICU in France during the period (n=107 014 patients at 822 hospitals).

Outcome measures
The main outcome was the 1-year survival rate. The association of the two approaches with 1-year survival was estimated using a time-dependent Cox model and a propensity score (PS) adapted to time-to-event analysis, yielding the average treatment effect in the treated and extended weighted Kaplan–Meier curves.

Results
107 014 patients were categorised into two groups based on the type of care received: invasive (n=51 680 (48%) received invasive ventilation and/or vasopressor support) or conservative (n=55 334 (52%) received neither). 1-year survival rate was significantly lower in the invasive group than in the conservative group (27% vs 59% estimated with extended time-dependent Kaplan–Meier method). The risk of death in the invasive group remained significantly higher after time-dependent PS weighting (HR 1.64; 95% CI 1.60 to 1.69; p

Importance
Women are under-represented in senior roles within academic medicine, including as authors in high-impact journals.

Objective
To examine trends and predictors of female authorship in the Canadian Medical Association Journal (CMAJ) as the only high-impact Canadian journal over a 10-year period to understand gender balances in Canadian academic publishing.

Design
This cross-sectional study analysed trends and predictors of female authorship in articles published in CMAJ from 1 January 2013 to 31 December 2023.

Setting
Data were extracted from PubMed for CMAJ, the only high-impact Canadian medical journal (impact factor ≥10). Data extraction used the RISmed package in R Studio.

Participants
The study included articles published in CMAJ within the specified period. Author gender was predicted using the validated Genderize.io software. Articles where the gender of the authors could not be predicted were excluded from analysis.

Main outcomes and measures
The co-primary outcomes were proportions of female first and last authors. Statistical analyses included 2 tests comparing proportions, Jonckheere and linear regression models to evaluate trends. Among multiauthor articles, multivariable logistic regression models assessed predictors of female first and last authorship.

Results
From 5805 included articles, women comprised 47% of first authors and 43% of last authors (p

Introduction
Exercise is the main treatment for patients with breast cancer-related lymphedema (BCRL) and different types of exercises were performed in these patients. However, it is unclear which type of exercise or combination of these is the most effective in reducing arm swelling and lymphedema-related symptoms, and quality of life in patients with BCRL.

Aims
This study aimed to compare the relative efficacy of different types of exercise in treating BCRL and determine the most effective exercise therapy for patients with BCRL.

Methods and analysis
This review will search English-language databases (Cochran Library, Cumulative Index to Nursing and Allied Health Literature, EBSCO, EMBASE, PubMed/Medline and Web of Science). The following Chinese-language databases will also be searched: Chinese Biomedical Literature Database (SinoMed), China National Knowledge Infrastructure, Wanfang Data and China Science and Technology Journal Database. The search was conducted up to 31 December 2024. Randomised controlled trials comparing different types of exercise on BCRL will be eligible. Data will be extracted from eligible trials by two independent researchers based on the selection criteria. Two reviewers will ascertain the risk of bias of the selected studies using a modified version of the Cochrane Risk of Bias Tool. The study’s characteristics (study type, characteristics of the patients, intervention prescriptions) and primary outcomes (limb volume, physical function, physical and psychological symptoms) will be summarised in a narrative format. Meta-analyses (ie, network and pairwise) will be used to assess the indirect and direct effects of the exercise interventions. The relative effects of different types of exercise in treating BCRL will be examined by the surface under the cumulative ranking curve to calculate the ranking of treatments and determine the most effective intervention.

Ethics and dissemination
This review does not require ethical approval. The findings will be submitted for peer-reviewed publication.

PROSPERO registration number
The systematic review protocol has been registered in the International Prospective Register for Systematic Reviews (CRD42022370817).

Introduction
Early detection of cardiovascular disease in primary care is a public health priority, for which the clinical and cost-effectiveness of an artificial intelligence-enabled stethoscope that detects left ventricular systolic dysfunction, atrial fibrillation and cardiac murmurs is unproven but potentially transformative.

Methods and analysis
TRICORDER is a pragmatic, two-arm, multi-centre (decentralised), cluster-randomised controlled trial and implementation study. Up to 200 primary care practices in urban North West London and rural North Wales, UK, will be randomised to usual care or to have artificial intelligence-enabled stethoscopes available for use. Primary care clinicians will use the artificial intelligence-enabled stethoscopes at their own discretion, without patient-level inclusion or exclusion criteria. They will be supported to do so by a clinical guideline developed and approved by the regional health system executive board. Patient and outcome data will be captured from pooled primary and secondary care records, supplemented by qualitative and quantitative clinician surveys. The coprimary endpoints are (i) difference in the coded incidence (detection) of heart failure and (ii) difference in the ratio of coded incidence of heart failure via hospital admission versus community-based diagnostic pathways. Secondary endpoints include difference in the incidence of atrial fibrillation and valvular heart disease, cost-consequence differential, and prescription of guideline-directed medical therapy.

Ethics and dissemination
This trial has ethical approval from the UK Health Research Authority (23/LO/0051). Findings from this trial will be disseminated through publication of peer-reviewed manuscripts, presentations at scientific meetings and conferences with local and national stakeholders.

Trial registration number
NCT05987670

Introduction
Breast cancer is the most common form of cancer in women. A considerable number of women with breast cancer who have been treated with chemotherapy subsequently develop neurological symptoms such as concentration and memory difficulties (also known as ‘chemobrain’). Currently, there are no validated therapeutic approaches available to treat these symptoms. Cognitive training holds the potential to counteract cognitive impairment. Combining cognitive training with concurrent transcranial direct current stimulation (tDCS) could enhance and maintain the effects of this training, potentially providing a new approach to treat post-chemotherapy subjective cognitive impairment (PCSCI). With this study, we aim to investigate the effects of multi-session tDCS over the left dorsolateral prefrontal cortex in combination with cognitive training on cognition and quality of life in women with PCSCI.

Methods and analysis
The Neuromod-PCSCI trial is a monocentric, randomised, double-blind, placebo-controlled study. Fifty-two women with PCSCI after breast cancer therapy will receive a 3-week tDCS-assisted cognitive training with anodal tDCS over the left dorsolateral prefrontal cortex (target intervention), compared with cognitive training plus sham tDCS (control intervention). Cognitive training will consist of a letter updating task. Primary outcome will be the performance in an untrained task (n-back task) after training. In addition, feasibility, safety and tolerability, as well as quality of life and performance in additional untrained tasks will be investigated. A follow-up visit will be performed 1 month after intervention to assess possible long-term effects. In an exploratory approach, structural and functional MRI will be acquired before the intervention and at post-intervention to identify possible neural predictors for successful intervention.

Ethics and dissemination
Ethical approval was granted by the ethics committee of the University Medicine Greifswald (BB236/20). Results will be available through publications in peer-reviewed journals and presentations at national and international conferences.

Trial registration number
ClinicalTrials.gov; NCT04817566, registered on 26 March 2021.

Objective
Drug-induced ischaemic colitis is a significant adverse event (AE) in clinical practice. This study aimed to recognise the top drugs associated with the risk of ischaemic colitis based on the FDA Adverse Event Reporting System (FAERS) database.

Design
A cross-sectional design.

Setting
All data retrieved from the FAERS database from the first quarter of 2004 to the fourth quarter of 2023.

Participants
A total of 5664 drug-induced ischaemic colitis AEs eligible for screening.

Primary and secondary outcome measures
The Medical Dictionary for Regulatory Activities was used to identify ischaemic colitis (code: 10009895) cases. Disproportionality analysis for drug-associated ischaemic colitis signals.

Results
Drug-induced ischaemic colitis AEs were more prevalent in females (60.12%) and individuals aged ≥65 years (34.25%). The common outcomes were hospitalisation (46.85%) and death (9.73%). Disproportionality analysis identified 91 ischaemic colitis signals and the top 30 drugs mainly involved in the gastrointestinal and nervous systems. The top five drugs with the highest reported OR, proportional reporting ratio, information component and the empirical Bayesian geometric mean, were alosetron, tegaserod, osmoprep, naratriptan and kayexalate. Additionally, 20 of the top 30 drugs did not have ischaemic colitis risk indicated in the package insert.

Conclusions
This study identified key drugs associated with ischaemic colitis, particularly alosetron, tegaserod, osmoprep, naratriptan and kayexalate. Notably, two-thirds of these drugs lacked ischaemic colitis warnings in their package inserts. These findings underscore the need for greater clinical vigilance, improved regulatory oversight and further research to clarify underlying mechanisms and support safer medication use.

Objective
A growing body of evidence points to a role for herpesviruses in the development of Alzheimer’s disease (AD) and a reduced risk of AD among patients receiving antiherpetic medications. We investigated the association between herpes simplex virus type 1 (HSV-1) and AD using real-world data (RWD) from USA.

Design
In a matched case–control study, patients with AD aged ≥50 years diagnosed between 2006 and 2021 were identified from the IQVIA PharMetrics Plus claims database. Controls were matched in a 1:1 ratio with subjects with AD on age, sex, region, database entry year and healthcare visit numbers.

Results
The study included 344 628 AD case–control pairs. History of HSV-1 diagnosis was present in 1507 (0.44%) patients with AD compared with 823 (0.24%) controls. HSV-1 diagnosis was found to be associated with AD (adjusted OR 1.80; 95% CI 1.65 to 1.96). Patients with HSV-1 who used antiherpetics were less likely to develop AD compared with those who did not use antiherpetics (adjusted HR 0.83, 95% CI 0.74 to 0.92).

Conclusions
Findings from this large RWD study implicate HSV-1 in the development of AD and highlight antiherpetic therapies as potentially protective for AD and related dementia.

A fronte di 1.434 posti vacanti ci sono state 349 domande

A fronte di 1.434 posti vacanti ci sono state 349 domande

Introduction
Patients who have undergone lung cancer surgery often experience reduced exercise tolerance, impaired lung function and increased negative emotions such as anxiety and depression. Baduanjin, a traditional Chinese mind-body exercise, has shown benefits in improving exercise tolerance and lung function in populations with chronic diseases. However, evidence on the effectiveness of Baduanjin for post-lung cancer surgery patients remains limited. This study aims to systematically assess the impact of Baduanjin on exercise tolerance, lung function and emotional well-being in these patients.

Methods and analysis
We will conduct a comprehensive search of PubMed, the Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literatures database, Wangfang database and China Science and Technology Journal Database (VIP) to identify randomised controlled trials (RCTs) assessing Baduanjin in postoperative lung cancer patients. The primary outcome measure will be the 6-minute walk test distance. We will assess the risk of bias in included RCTs using the bias risk assessment form from the Cochrane Collaboration Handbook. This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols 2015 guidelines.

Ethics and dissemination
Ethical approval is not required as no primary data are collected. The results will be presented at scientific conferences or submitted to a peer-reviewed scientific journal.

PROSPERO registration number
CRD42024570196.

Objectives
To explore urologists’ perceptions of barriers to, and facilitators of, adherence to international antimicrobial prophylaxis (AP) guidelines for endourological procedures in Jordan and to identify strategies to optimise guideline-concordant AP prescribing.

Design
The present study is a qualitative study undertaken through semi-structured interviews and inductive thematic analysis. Study results are reported per Consolidated Criteria for Reporting Qualitative Research.

Setting
Secondary and tertiary care across multiple public, private and academic hospitals in Jordan.

Participants
Nineteen practising urologists (all male; median age 32 years, IQR 8; nine residents, 10 specialists) who routinely prescribe AP for endourological procedures. Participants were recruited via convenience snowball sampling and interviewed until thematic saturation was reached.

Interventions
Not applicable.

Primary and secondary outcome measures
The main outcomes were themes describing perceived barriers to guideline adherence and potential facilitators to support appropriate AP use.

Results
Participants identified several barriers: (1) patient level, strong expectations for antibiotics post-procedure and concerns about procedure-site hygiene; (2) clinician level, fear of postoperative infections and litigation, lack of familiarity with updated guidance and doubts about applying international guidelines locally; (3) system level, hierarchical prescribing dynamics, referral communication gaps, high workloads and time pressures, and concerns over sterilisation practices. Facilitators included targeted professional training and regular guideline updates for urologists, development of local AP guidelines informed by local resistance data, enhanced patient education campaigns and active involvement of clinical pharmacists in preoperative antibiotic review and auditing.

Conclusions
Urologists in Jordan face multifaceted barriers to AP guideline adherence. Future stewardship programmes can use insights from this study to develop locally tailored guidelines, targeted clinician training and pharmacist-led audits. Pilot testing with metrics such as prescribing rates, guideline concordance, antibiotic consumption and postoperative infection incidence will be essential to validate their impact before wider implementation.

Una campagna sui rischi e uno studio sui pericoli del tribulus