Search Results for: Artrite psoriasica e altre comorbilità in pazienti con psoriasi nel setting della medicina generale

Objectives
Chronic diseases pose significant challenges to primary care, requiring patient-centred strategies to improve chronic care delivery. As telehealth emerges as a promising tool, this study aims to examine patient experiences with chronic care and their preferences for self-management support (SMS) through telehealth services in primary care settings.

Design
A multicentre, cross-sectional survey was conducted (June–August 2022) using the Patient Assessment of Chronic Illness Care (PACIC), the Patient Assessment of Self-Management Tasks (PAST) and a telehealth preferences questionnaire. Linear regression assessed the association between PACIC and PAST scores. Multivariate logistic regression identified factors associated with telehealth preferences, with variables selected according to Andersen’s model of healthcare utilisation.

Settings
Five diverse primary care settings in Central Vietnam, operating under Family Medicine principles.

Participants
290 individuals with hypertension and/or diabetes managed at primary care for at least 6 months.

Results
The average PACIC score was 2.52 (SD 0.7); 25.5% rated their care as high quality (PACIC score ≥3). Among PACIC domains, goal-setting and follow-up/coordination domains received the lowest ratings. Participants perceived lifestyle changes as their priority self-management tasks, followed by medical management, communication with providers and coping with disease consequences. Higher PACIC scores were significantly associated with greater engagement across most PAST domains. Live video conferencing and mobile health were the most preferred formats for SMS. Participants strongly preferred remote patient monitoring for medical management (OR 8.8, 95% CI 2.0 to 38.1). Rural residents were more likely to prefer other telehealth modalities (ORs 3.8–4.6), particularly for coping with disease consequences (OR 4.1, 95% CI 1.8 to 9.4) and lifestyle changes (OR 5.8, 95% CI 1.1 to 28.9). Telehealth preferences were associated with factors across Andersen’s domains, including education (predisposing), resident area and digital access (enabling), and pill count, disease control, and perceived care quality (need-related).

Conclusions
Most elements of the chronic care model remained unmet. Patients’ care experiences and self-management priorities aligned with their telehealth preferences, underscoring the need for personalised telehealth strategies to enhance SMS in primary care. Given the cross-sectional design and absence of patient and public involvement, further studies should incorporate these stakeholders and confirm associations in more diverse and underserved populations.

Per pazienti di nuova diagnosi non idonei alla chemioterapia

Studio firmato da due docenti di Unibz con un collega di Colonia

Capacità controllo infezione in pazienti trattati dall’infanzia

Capacità controllo infezione in pazienti trattati dall’infanzia

Studio della Società italiana di medicina Interna

Via alla seconda edizione del Barometro del patient engament

Objective
To examine hospital discharge practices, including clinical and laboratory assessments, in patients with type 2 diabetes mellitus (T2DM) following their first hospitalisation for cardiovascular disease (CVD), and to explore the association of these practices with adverse events, defined as hospital readmission, emergency department visits and mortality.

Design
Retrospective cohort study.

Setting
Follow-up for 100 days after a newly diagnosed CVD among patients with T2DM in Region Halland, Sweden.

Participant
A total of 1482 patients with T2DM and a new diagnosis of CVD during hospitalisation were included. Patients were followed from hospital discharge for up to 100 days. Inclusion criteria were a hospital discharge diagnosis of CVD and a prior diagnosis of T2DM. Patients with incomplete discharge data or without follow-up records were excluded.

Primary and secondary outcome measures
The primary outcome was the overall risk of serious adverse events after hospital discharge, including mortality, hospital readmission and ED encounters, within 100 days of discharge. Secondary outcomes included primary care visits and pharmacotherapy adjustments for CVD and T2DM during the same period.

Results
The readmission rate within the study period was 27%, while 86% of patients visited primary care within 100 days after discharge. Cardiovascular pharmacotherapy increased, with beta-blocker usage rising to 73% and statin use reaching 82%. A significant, though modest, increase in pharmacotherapy for T2DM was observed, with metformin use increasing from 53% to 57% (p

Objective
Amoxicillin-clavulanate is commonly used to prevent infections following snakebites despite the lack of clinical evidence. We aimed to demonstrate that clinically directed initiation of amoxicillin-clavulanate would be non-inferior to routine use in this setting.

Design
Open-label, randomised, non-inferiority trial with blinded adjudication of endpoints.

Setting
Emergency department of a teaching hospital in southern India.

Participants
Adults with local swelling following snakebites within 24 hours of bite.

Interventions
In the routine use strategy, intravenous followed by oral amoxicillin-clavulanate was administered for at least 5 days. In the clinically directed strategy, the antibiotic was only initiated for clinical failures.

Primary and secondary outcome measures
Primary outcomes were protocol-defined clinical failure and total antibiotic consumption. Non-inferiority margin was prespecified as 10%. Secondary outcomes were the length of hospital stay, total antivenom consumption, new-onset organ failure, bleeding requiring transfusion, death/need for surgical intervention and drug-related adverse events.

Results
The trial was prematurely stopped due to the COVID-19 situation after randomising 66 patients—34 to clinically directed initiation and 32 to routine use arms. Russell’s viper was the most common (21 (32%)) biting snake species identified; 52 (79%) patients had evidence of haemotoxic envenomation at baseline, and 24 (36%) patients developed AKI. There were 10 clinical failures—six in the clinically directed initiation arm and four in the routine use arm. The difference in clinical failure between the two arms was 5.2% (–12.0%–21.7%; p=0.291); the upper bound of the CI exceeded the prespecified non-inferiority margin. Total antibiotic consumption, expressed in DDDs, was significantly lower in the clinically directed initiation arm (0 (0–1) vs 5.31 (4.67–6.17); p

Introduction
The cardiovascular (circulatory) system is a closed-loop system. The dynamic interaction of the heart and vascular system plays a pivotal role in maintaining adequate cardiac output. Heart failure (HF) is commonly described as a problem of the pump, that is, mechanical myocardial failure causing poor perfusion to the body. Still, the contribution of the vasculature is often neglected. Acute decompensated heart failure (ADHF) carries a poor prognosis and is often accompanied by concomitant chronic kidney disease (CKD) and acute kidney injury (AKI), which inevitably lead to adverse outcomes. The interaction of the heart with the vasculature is conceptualised as ventricular–vascular (arterial) coupling. Arterial stiffness, a non-traditional risk factor for cardiovascular disease, can be measured non-invasively using carotid–femoral pulse wave velocity (cf-PWV). High cf-PWV values mimicking increased arterial stiffness could be a causational factor towards precipitating ADHF or AKI. This study aims to assess whether cf-PWV is higher during the hospitalisation phase of patients with HF (ADHF) and CKD (AKI in CKD) compared with stable compensated HF and stable CKD.

Methods and analysis
This prospective non-randomised observational study aims to recruit 120 patients aged≥60 years. Arterial stiffness will be assessed in three groups. These groups are decompensated HF with reduced ejection fraction (n=40), decompensated HF with preserved ejection fraction (n=40) and AKI in CKD stage 3a, 3b and 4, n=40. After 4 weeks from hospital discharge, patients in a stable, compensated state will be asked to attend a follow-up clinic visit to repeat the cf-PWV measurement. The primary outcome measure is variation in cf-PWV during hospitalisation against follow-up.

Ethics and dissemination
Ethical approval was granted in October 2021 (REC reference 21/EM/0239), recruitment started in February 2022 and the results are expected in late 2025. The findings will be published in peer-reviewed journals.

Trial registration number
NCT05012722.

Introduction
Patient safety incidents during healthcare cause a high burden and mortality, but many go unreported. Involving patients and caregivers in the identification and reporting of safety incidents would add value to the current incident reporting systems used by health professionals. Identifying and analysing patient safety incidents is essential to prevent future events, allowing organisations to apply a learning-from-error approach and to implement improvement plans. Patient-Reported Incident Measures are tools for patients and caregivers to report safety issues related to their healthcare. In accordance with WHO’s patient safety taxonomy, the term patient safety incidents is used throughout this protocol to encompass events that do and do not reach the patient, including what are commonly referred to as near misses and adverse events. We aim to identify and describe the published literature about tools for patients or caregivers to report patient safety incidents in healthcare.

Methods and analysis
We will conduct a scoping review. We have developed inclusion criteria using the PCC (population, concept and context) format, where population includes adult patients or caregivers; concept refers to documents describing formal tools used to report patient safety incidents; and context includes any healthcare setting, such as hospitals or mental health centres, during or immediately after care. The scoping review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Evidence sources include primary research, systematic reviews, meta-analyses, conference abstracts, letters, guidelines, as well as policy documents, reports, blogs and websites, without language restriction. An initial database search in Medline, Embase, CINAHL, and Cochrane Library from database inception up to June 2023 identified 4500 initial citations, of which 4103 were selected for evaluation after duplicates were removed. We will supplement the search by checking the reference lists of included studies for additional sources of evidence and an additional search in Google to identify non-peer-reviewed documents. This initial search will be updated before completing the review. We will use a self-created data collection form for data extraction and perform a narrative synthesis to integrate and summarise the review findings. We will describe the general characteristics of the tool: setting, scope, format, content, type of patient safety incident and severity, the moment of notification, relation to patient safety incident reporting and learning systems, development process, testing, validation, or piloting, among other characteristics. As a result of this scoping review, we intend to provide an index of patient/caregiver-reported safety notification tools and a list of descriptive or evaluation studies.

Ethics and dissemination
We will only use published data. Approval from the human research ethics committee is not required. The results of this scoping review will be submitted for publication in an international peer-reviewed journal and scientific meetings. Findings will also be disseminated through digital science platforms and academic social media.

Background
Type 2 diabetes is a growing public health concern, and it continues to disproportionately impact priority populations. Although earlier and more frequent screening of diabetes promotes early detection to prevent adverse outcomes, this is a significant barrier for priority populations due to inequities that hinder access to critical preventive screening in primary care settings. The purpose of this scoping review is to better understand the design and implementation of screening and early detection of type 2 diabetes in community settings for priority populations to reduce missed or delayed diagnoses and future potential adverse outcomes.

Methods
This scoping review will adopt the methodological framework of Arksey and O’Malley and be enhanced using Levac et al recommendations. A search strategy was designed using insights from experienced librarians through the Peer Review for Electronic Search Strategies to conduct a comprehensive search using the following databases: Medline, Embase, PsycINFO, Web of Science, Scopus, CINAHL and Google. The search will capture studies focused on community-based diabetes screening using point-of-care testing and deployed in community settings serving priority populations with undiagnosed diabetes. Studies will be excluded if priority populations were not a focus, individuals living with diabetes, the intervention is not implemented in a community setting and did not use point-of-care screening. Two authors will independently review and screen the articles (title, abstract and full-text), while a team-based approach will be applied to chart the data. A thematic analysis will be used to identify emerging themes and subthemes according to barriers and enablers of implementing an equitable community-based diabetes screening intervention.

Ethics and dissemination
The findings from this review will inform future diabetes screening interventions in community settings to enable an equity-informed approach in the design, planning and implementation of such strategies. Equally important, it will inform a larger project, in which the team plans to implement a community-based diabetes screening programme in Ontario, Canada.

Objective
To examine whether influenza transmission risk decreased during summer and winter vacations and increased after vacations and statutory holiday.

Design
An ecological study.

Setting
Guangzhou, Guangdong Province of China.

Participants
A total of 458 343 influenza cases in school-aged children were included, including 160 067 (35.05%) in kindergarten, 223 817 (48.83%) in primary school, 50 053 (10.92%) in middle school and 23 801 (5.19%) in high school.

Data and methods
Data on influenza cases were obtained from the Notifiable Infectious Disease Surveillance System operated by Guangzhou Centre for Disease Control and Prevention. Influenza incidence rate ratio (IRR) by negative binomial regression model was used to analyse the influenza risk of school-age children during/after vacation to before/during breaks.

Results
In all four groups, there was significantly lower incidence of influenza during winter and summer vacations compared with the 4 weeks preceding vacations. Compared with the 2 weeks preceding return, kindergarten students experienced the highest influenza risk in the third week after summer vacation (IRR=3.40, 95% CI 2.43to 4.79). Primary school students had the highest risk in the fourth week after winter vacation (IRR=9.59, 95% CI 6.71 to 13.87). Middle school students had the highest risk in the fourth week after summer (IRR=11.60, 95% CI 6.17 to 22.62). High school students also experienced the highest risk in the fourth week following summer (IRR=17.96, 95% CI 8.10 to 42.05). Despite the risk of influenza increasing after returning to school, it remained lower compared with before vacations and holidays.

Conclusions
Due to changes in contact patterns, influenza incidence was high towards the end of term, significantly decreased during vacations and started to rise on returning to school, peaking in the third or fourth week. These findings suggested using holiday periods strategically to promote influenza vaccination and implementing enhanced non-pharmaceutical interventions on students returning to school.

Background
Studies examining the association between Medicaid expansion (ME) under the Affordable Care Act (ACA) and colon cancer incidence have produced mixed results.

Objective
To re-visit the association between the ACA-ME and annual cases of colon cancer.

Design
Difference-in-differences (DiD).

Setting
The primary analyses used data from the National Cancer Database from 2010 to 2018, a hospital-based cancer registry in the USA. We also conducted exploratory analyses using data from the Surveillance, Epidemiology and End Results (SEER) registry.

Patients
Patients aged 40 and older with newly diagnosed colon cancer.

Measurements
The primary outcome was the percent change in colon cancer of all stages. Secondary outcomes were percent changes in stage I and stage IV cases.

Results
Among those aged 40–49, we observed a statistically significant greater increase in stage I colon cancer in expansion states relative to non-expansion states (DiD (percent change) 9.7% (95% CI, 2.5% to 17.4%)). In those aged 50–64, we did not observe statistically significant differences between the two state groups in any of the outcomes. Among those aged 65+, we observed a statistically significant relative decrease for all stages in ACA-ME states (–1.0% (95% CI, –1.0% to –3.0%)) and for stage IV (–3.0% (95% CI, –2.0% to –5.0%)). We explored our findings among younger individuals (

Background
Stillbirths and associated outcomes remain a significant concern in sub-Saharan Africa (SSA), with approximately 41% of global stillbirths.

Design
Our cross-sectional analysis included a weighted sample of women aged 15–49 years who had given birth or experienced stillbirth.

Setting
Sub-Saharan African Countries.

The main outcome measures
Determinants of stillbirth among women in 29 SSA countries.

Result
Among a sample of 197 328, stillbirth prevalence was 8.4/1000 live births. Among individual-level factors, the risk increased with age. Higher maternal educational levels were significantly associated with decreased stillbirth risk (aOR=0.62, 95%CI: 0.44 to 0.89, higher versus no education). Single women had significantly lower odds of stillbirth compared with those who no longer lived together or were separated from their partners (aOR=0.38, 95%CI: 0.25 to 0.60). Contextually, women with a job had an increased risk compared with women without a job (aOR=1.19, 95%CI: 1.06 to 1.34), and living in a rural residential area was a significant factor (aOR=1.30, 95%CI: 1.13 to 1.50).

Conclusion
The complex interplay between individual-level and contextual factors continues to influence stillbirth outcomes in SSA. Cross-sector integrative care approaches to maternal and neonatal health are needed to address the multifaceted determinants of stillbirths.