Search Results for: Gestire la colica renale nel setting delle cure primarie

Objective
To co-design a core outcome set with people living with dementia and other stakeholders that can be used to measure the quality of dementia care in home care and residential settings.

Design
Multilevel modified Delphi consensus study. A priori consensus threshold of 70% was used to include or exclude outcomes.

Setting
Routine dementia care provided through home care and residential aged care facilities in Australia.

Participants
A stakeholder panel comprising people living with dementia, formal and family/informal carers of people living with dementia, advocates, policy experts, allied-health professionals, nurses and professionals working in the aged care industry. Round 1 included 10 panellists; subsequent rounds extended the number of participants to 24.

Results
Seven outcome domains (Death, Physiological and clinical, Functional, Life impact, Resources, Adverse events and Education), encompassing 105 individual outcomes were considered by the panel over four rounds.
The 105 outcomes were distilled to 16 outcomes identified as important in home care and 15 in residential aged care. In both settings, nine outcomes (Dignity, Advanced care planning, Meaningful activities, Feeling safe and secure, Emotional wellbeing, Quality of Life, Resource utilisation, Safety incidents and Dementia-specific qualifications for care staff) were considered important.
Additionally, seven outcomes in the home care setting (Behavioural symptoms of dementia, Diagnosis of dementia, Hygiene, Importance of Relationships, Quality of carer and family lives, Dementia care navigation and Opportunities for unpaid carers) and six outcomes in the residential aged care setting (Neuropsychiatric symptoms of dementia, Pain, Hygiene and comfort, Medication safety, Staff carer morale and Adverse effects) were classified as important.

Conclusions
The outcomes identified during this modified Delphi consensus study provide a promising basis for the development of a meaningful, practical and measurable core outcome set that could be used in dementia care settings to improve the quality of routine care provided to people living with dementia.

Introduction
A substantial portion of the 3.6 million births per year in the USA (approximately 25%–30%) occur in the context of adverse pregnancy outcomes (APOs), including preterm birth (PTB), hypertensive disorders of pregnancy (HDP) and small-for-gestational-age (SGA) birth. Black individuals have a 2–3-fold higher risk of APOs and a similarly increased risk of maternal morbidity and mortality compared with White individuals. Adverse social determinants of health (SDoH) are at the root of this disparity and contribute to it through multiple mechanisms. Maternal anaemia is an upstream factor associated with severe maternal morbidity, maternal mortality and other APOs and is also associated with adverse SDoH. Effectively and efficiently addressing social needs arising from adverse SDoH in the obstetric setting can be difficult due to varying patient preferences, resource accessibility and clinic workflows. The Better Birth Outcomes Through Technology, Education and Reporting (BETTER) intervention attempts to account for these barriers by encouraging patients to address social needs through motivational interviewing and by sending recurring text messages that provide links to multiple kinds of social service resources.

Methods and analysis
We will use a two-arm randomised controlled trial to evaluate the effects of providing patients with a motivational interviewing session and text messages with links to multiple resources to address their social needs compared with patients receiving usual care. We will recruit 550 pregnant individuals less than 21 weeks of gestation from two university prenatal clinics that primarily serve Medicaid-covered individuals in an urban city in the Midwestern USA. We will assess whether the intervention reduces the primary outcome of maternal anaemia measured as haemoglobin

Objectives
To examine changes in cardiovascular disease (CVD) risk factors, lung function and clinical laboratory markers among people who smoke who used e-cigarettes to reduce their cigarette smoking.

Design
Four-arm, parallel-group, double-blind, randomised placebo-controlled trial.

Setting
Two sites—Virginia Commonwealth University (Richmond, Virginia, USA) and Penn State University, College of Medicine (Hershey, Pennsylvania, USA).

Participants
Adults (n=520) aged 21–65 years who smoked at least 10 cigarettes per day, had an expired-air carbon monoxide reading of >9 parts per million at baseline and were interested in reducing their cigarette consumption.

Interventions
E-cigarettes with 0, 8 or 36 mg/mL nicotine liquid concentration or a cigarette substitute.

Primary outcome measures
CVD risk factors (blood lipids, C-reactive protein, blood pressure, heart rate, waist-to-hip ratio, body mass index and INTERHEART risk score), lung function (spirometry indices, and pulmonary symptoms and functional state using the Clinical Chronic Obstructive Pulmonary Disorder Questionnaire), and other clinical laboratory markers (complete blood count and complete metabolic panel).

Results
At 6 months, the use of nicotine e-cigarettes caused no significant between-group differences for most measures. However, participants randomised to the 36 mg/mL e-cigarette condition had significantly higher levels of high-density lipoprotein (HDL) (p=0.003 unadjusted, p=0.002 adjusted) and lower levels of low-density lipoprotein (LDL) (p=0.044 adjusted) and cholesterol/HDL ratio (p=0.034 unadjusted, p=0.026 adjusted) compared with the cigarette substitute condition. Also, those in the 36 mg/mL e-cigarette condition had higher HDL levels than those in the 0 mg/mL condition (p=0.016 unadjusted, p=0.019 adjusted).

Conclusions
Participants randomised to the highest nicotine e-cigarette condition showed modest improvements in some measures of blood lipids (eg, increased HDL, and reduced LDL and cholesterol/HDL ratio) as compared with a non-aerosol cigarette substitute among individuals attempting to reduce their cigarette smoking. Future studies of e-cigarettes for smoking cessation would benefit from including these measures to further explore the results found in this study.

Trial registration number
NCT02342795.

Objective
This study investigates consumer views of pharmacist-led professional services in Australia, emphasising factors influencing their uptake and attributes valued by users.

Design
Semi-structured online focus groups explored the awareness, experiences and expectations of pharmacists and pharmacy professional services. Audio recordings were transcribed verbatim and de-identified. Data were analysed using the thematic analysis technique to identify common themes.

Setting
Three online focus groups were conducted, inviting participants from Australia

Participants
15 adults aged 18 years and above, English-speaking and self-identified as a consumer of health services or a health carer.

Results
Participants recognised pharmacists primarily as medication experts but also valued additional services like health screening, vaccination and chronic disease management. Consumer perceptions and experiences of professional pharmacy services focused on three themes: (1) convenience, (2) credibility and trust, and (3) communication and awareness. More specifically, attributes that influence service uptake include pharmacist competency, general practitioner (GP) endorsement, service availability, convenience, awareness and cost. Competency was associated with visible qualifications and specialised training, fostering consumer trust. Limited awareness of available services and privacy concerns posed barriers. Collaborative relationships between pharmacists and GPs, flexible hours and minimal waiting times, provision of services within pharmacists’ scope of practice and recognition from the government were particularly appealing factors.

Conclusions
The findings highlight opportunities to expand pharmacists’ roles in primary care, emphasising the need for tailored attributes, robust competency frameworks, GP endorsement and government support for sustainable service models. This work contributes to the growing evidence base on enhancing consumer-centred pharmacy services, guiding policy and practice improvements to meet evolving healthcare demands. Future research quantifying how much consumers value each attribute can help providers with limited resources prioritise better.

Objectives
To estimate the prevalence of dry eye disease (DED) and explore its association with depression and poor sleep quality.

Design
A cross-sectional study.

Setting
The study was conducted at the ophthalmology outpatient clinic of a tertiary university hospital in Thailand, from September 2022 to April 2023.

Participants
A total of 1321 patients aged 18 years or older, without any history of orbital disease, active superficial or intraocular infection/inflammation, eyelid pathology, or prior intraocular or eyelid surgery within the past 6 months, were enrolled in the study.

Interventions
All patients underwent dry eye examination, including the Ocular Surface Disease Index questionnaire, tear break-up time and ocular surface staining. Physical activity was measured using the Global Physical Activity Questionnaire, which was expressed as total Metabolic Equivalent of Task-minutes per week. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), Composite Scale of Morningness (CSM) and STOP-Bang. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9).

Primary and secondary outcome measures
Prevalence of DED and association pathways involving depression, sleep quality and DED.

Results
The mean age of the participants was 58.3±14.0 years, with a female predominance of 73.7%. Of the 1321 patients, 668 were diagnosed with DED, resulting in a hospital-based prevalence of 50.6% (95% CI: 47.8%, 53.3%). After adjusting for age, sex and underlying disease, PSQI, PHQ-9, STOP-Bang and CSM scores remained significantly associated with DED with adjusted ORs of 2.48 (95% CI: 1.96, 3.14; p

Introduction
Transition of care from hospital is a period when the risks of medication errors and adverse events are high, with 50% of adults discharged having at least one medication-related problem. Pharmacist-led medication reviews can reduce medication errors and unplanned readmission when completed promptly post-discharge; however, they are underutilised. A Transition of Care Stewardship pharmacist has been proposed to facilitate and coordinate a patient’s discharge process and facilitate a timely post-discharge medication review. Access to pharmacist medication review in rural and regional areas can be limited. This protocol describes a randomised controlled trial (RCT) to determine whether a virtual Transition of Care Stewardship pharmacist reduces medication-related harm in rural and regional Australia.

Method and analysis
Multicentre RCT involving patients at high risk of medication-related harm discharged from regional and rural hospitals to a domiciliary residence. Eligible patients must be aged≥18 years, admitted under a medical specialty, be discharged to a domiciliary setting, have a regular general practitioner (GP) or be willing to visit a GP or an Aboriginal Medical Service after discharge for medical follow-up, have a Medicare card and be at high risk of readmission. High risk of readmission is defined as either a previous admission to the hospital or Emergency Department (ED) presentation in the past 6 months AND≥three regular medications OR on at least ONE high-risk medication. A total of 922 participants will be recruited into the study. Enrolled participants will be randomised to the intervention or control (usual care). The intervention will include a virtual Transition Of Care Stewardship pharmacist to ensure that patients receive discharge medication reconciliation, medication counselling, medication list and communicate directly with primary care providers to facilitate a timely post-discharge medication review. Usual care will include informing the patient’s clinical inpatient treating team that the patient is at high risk of medication misadventure and may benefit from a post-discharge Home Medicines Review (a GP-referred pharmacist medication review funded by the Australian Government).
Data analysis will be performed on a modified intent-to-treat basis. The primary outcome assessed is a composite of a first unplanned medication-related hospitalisation or ED presentation within 30 days of hospital discharge. Comparisons between the intervention and usual care groups for the primary outcome will be made using a mixed-effects logistic regression model, adjusting for site-level clustering as a random effect.

Ethics and dissemination
This study is approved to be conducted at the Western New South Wales Local Health District via the Research Ethics and Governance Information System (approval number: 2023/ETH00978). To ensure the needs of Aboriginal and Torres Strait Islander patients are appropriately addressed, ethics for this study were submitted and approved by the Aboriginal Health and Medical Research Council (approval number: 2148/23). Manuscripts resulting from this trial will be submitted to peer-reviewed journals. Results may also be disseminated at scientific conferences and meetings with key stakeholders.

Trial registration number
ACTRN12623000727640.

Objectives
To examine the association between cigarette price increase and youth smoking initiation in Bosnia and Herzegovina (B&H), and to assess additional factors—including parental smoking, peer influence, pocket money, anti-tobacco media exposure and smoking in school environments—that potentially affect smoking initiation among adolescents.

Design
A pseudopanel study using WHO Global Youth Tobacco Survey (GYTS) data from two compatible surveys conducted in 2018 (Republic of Srpska) and 2019 (Federation of B&H). A split-population duration model was employed to estimate the hazard of youth smoking initiation.

Setting
Primary and secondary schools across two entities in B&H, covering both urban and rural areas.

Participants
A total of 9702 students aged 13–15 years completed the surveys. Inclusion criteria involved being enrolled in grades 7–9 of primary school or the first year of secondary school. No additional exclusion criteria were applied beyond incomplete or invalid survey responses.

Interventions
None.

Primary outcome measure
Self-reported smoking initiation, defined as having tried or experimented with cigarette smoking, even one or two puffs.

Results
A 10% increase in cigarette prices was associated with a 4.9% reduction in the probability of youth smoking initiation (price elasticity of –0.491, p

Introduction
Urinary tract infections (UTIs) are highly prevalent and pose a significant burden among older adults. Accurate diagnosis in this population is challenging due to the high prevalence of pre-existing lower urinary tract symptoms, inability to express symptoms and asymptomatic bacteriuria. Current diagnostic tests are unreliable, often resulting in over- and underdiagnosis. A previous pilot study proposed a higher cut-off for pyuria and identified five promising biomarkers for the diagnosis of UTIs in older adults. The UTI-GOLD study aims to validate these five new biomarkers and the higher leucocyte cut-off as a diagnostic tool for UTIs in older people in a real-world setting.

Methods and analysis
Between August 2024 and December 2027, an observational multicentre diagnostic accuracy study is being conducted across primary, secondary and tertiary healthcare facilities in the Netherlands and the UK. Adults ≥65 years with a suspected UTI will be considered eligible. Patients with pre-existing decision-making incapacity or an indwelling catheter will be excluded. UTI will be defined according to an international consensus-based reference standard. Biomarkers will be measured by liquid chromatography-mass spectrometry (neutrophil gelatinase-associated lipocalin, tissue inhibitor of metalloproteinase 2 and CXC motif chemokine ligand 9) and enzyme-linked immunosorbent assay (interleukin 6 and azurocidin). Pyuria will be quantified by automated microscopy and/or flow cytometry. Diagnostic accuracy measures will be calculated using the receiver operating characteristic curves, and sensitivity, specificity, likelihood ratios and predictive values will be reported for optimal cut-offs.

Ethics and dissemination
The protocol was reviewed by the local Leiden University Medical Center research committee, who declared on 15 April 2024 that the medical research involving human subject act (Dutch abbreviation: WMO) does not apply to the current study (reference number nWMODIV2_2024025). The study also received approval from the NHS Research Ethics Committee in the UK (reference number 24/LO/0649).
The study findings will be published in a peer-reviewed journal, presented at academic congresses and shared with healthcare providers.

Trial registration number
The study was registered at clinicaltrial.gov on the 24 September 2024 with registration number: NCT06610721.

Objectives
This study aimed to explore the relationship between oral health and the knowledge, attitudes and practices (KAP) of parents and teachers of kindergarten students towards oral health.

Design
This web-based cross-sectional survey was conducted in Ningbo City from February 2023 to March 2023.

Setting
The study targets parents and teachers of kindergarten students in Ningbo City (five kindergartens selected using convenience sampling). The research aimed to explore the relationships between oral health practices, knowledge and attitudes among parents and teachers.

Participants
A total of 540 valid questionnaires were collected from parents and teachers. Clear definitions of selection, entry and exclusion criteria were followed to ensure comprehensive data collection.

Outcome measures
Assessment of oral health KAP among parents and teachers and correlation between KAP levels and students’ oral hygiene habits.

Results
Key findings include comparatively high levels of oral health knowledge among parents (7.29±1.74), positive attitudes towards oral health (23.69±2.97), and commendable practices (51.92±4.76). The structural equation model suggested a direct positive influence of attitude (β=0.27, p

‘Oltre 25 miliardi per cure non garantite, non è fuga da Ssn’

Objectives
Investigate determinants of post-COVID-19 condition (PCC) clinic attendance among participants not hospitalised versus hospitalised during the SARS-CoV-2 infection.

Design
Retrospective cohort study.

Setting
Six population-based registers with high coverage to cover all adults residing in Stockholm County, Sweden.

Participants
Adults residing in Stockholm County on 31 January 2020, with a SARS-CoV-2 infection through 30 November 2022, who did not die or move out of Stockholm County within 90 days.

Primary outcome measures
PCC clinic attendance from 90 days after the SARS-CoV-2 test until date of death, date of moving out, or 30 November 30,2023.

Results
Of non-hospitalised and hospitalised participants, 737 of 464 674 (0.2%) and 433 of 23 374 (1.9%), respectively, attended a PCC clinic. A total of 75 878 (16.3%) of non-hospitalised participants and 6190 (26.5%) of hospitalised participants presented with new-onset symptoms that could indicate PCC in primary care. The strongest determinants of attendance among non-hospitalised participants were mental health disorder (adjusted risk ratio (aRR) 2.57, 95% CI 2.21 to 2.98), asthma (2.39, 1.97–2.92) and >4 PCC symptoms in 2019 (2.27, 1.60–3.24), and among hospitalised participants were >31 sick days in 2019 (1.94, 1.47–2.56), 1–30 sick days in 2019 (1.56, 1.06–2.29) and obesity (1.51, 1.19–1.93). The most common clinical presentation was fatigue (n=526, 71.4%) among non-hospitalised and dyspnoea (n=148, 34.2%) among hospitalised participants.

Conclusions
PCC clinic attendance characteristics differed between non-hospitalised and hospitalised participants. Distinguishing PCC from conditions with overlapping symptoms and determining the appropriate level of care may be challenging, with risk of resource displacement effects and inappropriate care.

Introduction
Patients with frailty are at risk of adverse outcomes such as mortality, falls, deconditioning and hospital readmissions. With an increasingly ageing population and a greater likelihood of frailty, there is a significant need to ensure that patients are managed in the right place and at the right time. There has been a focus on offering hospital-level care at home as a way to meet this need, incorporating strategies to integrate care and use digital solutions. Digital twin (DT) technology is one advancement, offering a virtual replica of an object/environment, which has the potential to make use of real-time data personalised for an individual patient and/or setting to inform and support patient management decisions. We are yet to realise the full potential of this new way of integrated working and technological advancements. This scoping review aims to ascertain the current evidence for the components of the DT architecture to enable the monitoring and management of patients with frailty living at home.

Methods
This scoping review will follow the Joanna Briggs Institute methodology for scoping reviews and will be reported following the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews guidelines. The following electronic databases will be searched: Medline, Embase, CINAHL, Cochrane CENTRAL, Web of Science and Scopus. Relevant websites will be searched for grey literature or case reports to capture the required information, as well as any documents provided by stakeholders. Primary studies, published in the English language from 2019 to the present day, which report on the monitoring or management of patients with long-term conditions and frailty within their home environment, will be included. Screening will be conducted by at least two independent reviewers against eligibility criteria, and a piloted data extraction form will be used to align with the research questions. Qualitative content analysis will be used. Data will be presented in tabular form, as well as descriptive and illustrative formats, to address the objectives of this review.

Ethics and dissemination
This scoping review does not require ethical approval. The findings of this review will be disseminated through peer-reviewed journals and conferences and will support the development of a conceptual model of a hospital-at-home DT for the management of patients with frailty.

Objectives
This study aimed to investigate the incidence of oral mucous membrane medical device-related pressure injury (MDR-MM PI) and identify its risk factors in critically ill patients undergoing orotracheal intubation, guided by the conceptual framework of pressure injury development. The findings aim to inform effective preventive strategies in intensive care settings.

Design
Prospective cohort study.

Setting
General intensive care unit (ICU) of a tertiary care hospital in China.

Participants
Patients aged ≥18 years who underwent oral endotracheal intubation were included between July 2023 and July 2024. Exclusion criteria were (1) existing oral mucosal injuries before intubation, (2) radiotherapy-induced oral mucositis, (3) patients undergoing oral surgery and (4) intubation duration of less than 24 hours. A total of 420 patients met the criteria and were included in the final analysis.

Outcomes
The outcomes included the incidence of oral MDR-MM PI, the time to oral MDR-MM PI occurrence and the identification of risk factors using multivariate Cox regression analysis.

Results
Among the 420 patients, 43.10% (n=181) developed oral MDR-MM PI, with Stage I accounting for 38.67% and Stage II for 61.33%. The lower lip (38.67%) and upper lip (38.12%) were the most common injury sites. The median time to oral MDR-MM PI occurrence was 8 days (95% CI: 7.134 to 8.866). Significant risk factors identified through multivariate Cox regression included sepsis (HR=2.090, 95% CI: 1.273 to 3.431), lower platelet (PLT) counts (HR=0.997, 95% CI: 0.995 to 0.999) and use of hard bite blocks (HR=1.553, 95% CI: 1.082 to 2.230). Probiotics showed a protective effect (HR=0.632, 95% CI: 0.468 to 0.854, p

Objectives
This study aimed to evaluate the impact of the Charlson Comorbidity Index (CCI) on in-hospital outcomes in patients with aortic stenosis (AS) undergoing aortic valve replacement (AVR) and to compare the efficacy of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with different comorbidity burdens.

Setting
The National Clinical Research Center for Cardiovascular Diseases.

Participants
A retrospective analysis was conducted on 3380 AS patients who underwent AVR in Beijing Anzhen Hospital from January 2015 to October 2021.

Interventions
Patients were stratified into low (0–1) and high (≥2) CCI groups.

Primary and secondary outcome measures
The primary outcome was Valve Academic Research Consortium-2 (VARC-2) composite early safety endpoints.

Results
Patients with high CCI scores exhibited significantly higher rates of VARC-2 composite adverse outcomes compared with those with low scores (50.3% vs 44.2%, p=0.001). After adjusting for confounding factors, high CCI scores were independently associated with the VARC-2 composite adverse outcomes (OR=1.36, 95% CI 1.17 to 1.58, p

Objectives
Clinical trials are needed to advance interventions such as chemoprevention that have potential to reduce the risk of malignant transformation in individuals with oral potentially malignant disorders. We explored the perspectives of those screened or invited to join an early phase clinical trial (the SAVER trial: Sodium valproate for the epigenetic reprogramming of high-risk oral epithelial dysplasia). Our objectives were to inform the SAVER trial while it was ongoing and to provide insights for future trials and chemoprevention therapy development more broadly.

Design
Qualitative study involving audio-recorded, semistructured interviews. Analysis of transcribed interviews drew on thematic approaches.

Setting
Five UK-based sites involved in SAVER.

Participants
Purposive sample of individuals (n=20) with suspected or diagnosed oral epithelial dysplasia (OED) who were approached about SAVER.

Results
Most interviewees readily accepted that OED warranted preventive treatment and were positive about the potential of chemoprevention. However, they were often concerned about the side effects of the trial medication, and together with a dislike of biopsies and a perception that the trial might disadvantage treatment, these concerns made some hesitant to participate in SAVER. Interviewees indicated that the communication of staff influenced their understanding and experience of the trial and identified several opportunities for enhancing these aspects.

Conclusions
In indicating that individuals at risk of malignant transformation are accepting of chemoprevention in principle, our findings are supportive of future research on chemoprevention for this group. The findings also draw attention to the crucial role of communication in recruitment to chemoprevention trials. We provide recommendations to support staff during recruitment and enhance individuals’ experience of the trial.

Trial registration number
ISRCTN12448611; Pre-results.

Objectives
This study aimed to examine the impact of the first COVID-19 lockdown period on access to postnatal contraception (PNC) and wider postnatal care and to explore the experiences of PNC care within the North East and North Cumbria (NENC) Integrated Care System (ICS) during the same period.

Design
This study reports a subanalysis of the NENC Postnatal Contraception (PoCo) study, an online survey of a convenience sample of women in the NENC ICS who completed pregnancies between 2019 and 2023.

Setting
Women who completed pregnancies between 2019 and 2023 in the NENC ICS.

Participants
Out of the total 2509 eligible participants who completed the PoCo survey, women who delivered in April–June 2020, April–June 2021 and April–June 2022 were included within this subanalysis, resulting in 457 eligible survey responses. There were no additional exclusion criteria.

Primary and secondary outcome measures
Primary outcome measures were PNC uptake and number of healthcare professional contacts during the postnatal period. Secondary outcome measures were self-reported experiences of PNC care.

Results
Women who delivered in April–June 2020 had fewer postnatal contacts than women who delivered in subsequent non-lockdown cohorts and were less likely to be offered PNC prior to discharge. There were no significant differences in relation to PNC uptake. In qualitative analyses, several women who delivered in 2020 highlighted COVID-19 as a factor perceived to be associated with poor postnatal care. Across all three groups, experiences of PNC care were diverse; feeling pressured to accept PNC was frequently reported.

Conclusions
While the first COVID-19 lockdown appears to have had a significant impact on women’s experiences of postnatal care, this did not result in a substantive decrease in PNC provision, likely reflecting pre-existing shortcomings. These women and families may benefit from additional support postpandemic to mitigate the potential life course implications of restricted support in the postpartum period, and policy-makers and healthcare providers should continue to explore innovative and patient-centred approaches to improving PNC provision. Future research should continue to evaluate the longer-term impacts of these changes in non-pandemic contexts.