Risultati per: Follow-up ottimale dopo embolia polmonare acuta

Stroke, Volume 55, Issue Suppl_1, Page ATP92-ATP92, February 1, 2024. Introduction:Large cohort studies show substantial variability in poststroke care. We developed a guideline-based poststroke without-fail care rate (PWR) to measure rehabilitation and follow-up care quality (Table 1). Our primary aim was to test PWR feasibility to measure guideline-concordant poststroke care among individuals discharged from an urban safety net hospital. Secondarily, we evaluated socioeconomic strain’s (SES) relationship with PWR.Methods:We reviewed electronic medical records of individuals with acute ischemic stroke (AIS) admitted to an urban safety net hospital from July 1 – August 31, 2022. Individuals were given a pass/fail or ineligible for each process. The PWR, calculated per individual, was passes/total number of eligible processes (score 0-1.0).Results:Out of 30 persons with AIS, 20 were eligible for PWR assessment (Table 2). Mean PWR was 0.598 (SD .210, range .273-.900). Most processes were readily available, with no observable floor or ceiling effects. Lowest pass rates were seen in therapy continuance, PCP follow-up, blood pressure control, and exercise. The PWR difference between individuals with SES (M = .443, SD =.135) and without SES (M = .634, SD = .246) lacked statistical significance but demonstrated a high effect size; t(10) = 1.66, p = .064, d = .961.Conclusion:The PWR is a feasible tool to assess quality of poststroke care and may be useful to identify and evaluate interventions to improve equity and quality of poststroke care. The high effect size of SES warrants further examination in a larger sample.

Introduction
The population-based Inter99 cohort has contributed extensively to our understanding of effects of a systematic screening and lifestyle intervention, as well as the multifactorial aetiology of type 2 diabetes (T2D) and cardiovascular disease. To understand causes, trajectories and patterns of early and overt cardiometabolic disease manifestations, we will perform a combined clinical deep phenotyping and registry follow-up study of the now 50–80 years old Inter99 participants.

Methods and analysis
The Inter99 cohort comprises individuals aged 30–60 years, who lived in a representative geographical area of greater Copenhagen, Denmark, in 1999. Age-stratified and sex-stratified random subgroups were invited to participate in either a lifestyle intervention (N=13 016) or questionnaires (N=5264), while the rest served as a reference population (N=43 021). Of the 13 016 individuals assigned to the lifestyle intervention group, 6784 (52%) accepted participation in a baseline health examination in 1999, including screening for cardiovascular risk factors and prediabetic conditions. In total, 6004 eligible participants, who participated in the baseline examination, will be invited to participate in the deep phenotyping 20-year follow-up clinical examination including measurements of anthropometry, blood pressure, arterial stiffness, cardiometabolic biomarkers, coronary artery calcification, heart rate variability, heart rhythm, liver stiffness, fundus characteristics, muscle strength and mass, as well as health and lifestyle questionnaires. In a subsample, 10-day monitoring of diet, physical activity and continuous glucose measurements will be performed. Fasting blood, urine and faecal samples to be stored in a biobank. The established database will form the basis of multiple analyses. A main purpose is to investigate whether low birth weight independent of genetics, lifestyle and glucose tolerance predicts later common T2D cardiometabolic comorbidities.

Ethics and dissemination
The study was approved by the Medical Ethics Committee, Capital Region, Denmark (H-20076231) and by the Danish Data Protection Agency through the Capital Region of Denmark’s registration system (P-2020-1074). Informed consent will be obtained before examinations. Findings will be disseminated in peer-reviewed journals, at conferences and via presentations to stakeholders, including patients and public health policymakers.

Trial registration number
NCT05166447.

Background
Although the non-alcoholic fatty liver disease (NAFLD) is prevalent in the general population, NAFLD risk in newly diagnosed rheumatoid arthritis (RA) has rarely been explored. In this population-based cohort, we examined NAFLD risk in patients with RA and identified the potential risk factors.

Design
Retrospective study.

Setting
Taiwan.

Participants
2281 newly diagnosed patients with RA and selected 91 240 individuals without RA to match with patients with RA (1:40) by age, gender, income status and urbanisation level of the residence.

Outcomes
In this retrospective study using the 2000–2018 claim data from two-million representative Taiwanese population, we identified and compared the incidence rates (IRs) of NAFLD and alcoholic fatty liver disease (AFLD) between RA and non-RA groups. Using multivariable regression analyses, we estimated adjusted HR (aHR) of NAFLD development in patients with RA compared with individuals without RA, with 95% CIs.

Results
The incidences of NALFD and AFLD were not significantly different between individuals with RA and without RA during the 17-year follow-up period. However, patients with RA had significantly increased NAFLD risk during the first 4 years after RA diagnosis, with IR ratio of 1.66 fold (95% CI 1.18 to 2.33, p

Artificial Intelligence (AI) has notably transformed the realm of healthcare, especially in diagnosing and treating Inflammatory Bowel Disease (IBD) and other digestive disorders. Essential AI tools, such as ChatGPT and Google Bard, can interpret endoscopic imagery, analyze diverse samples, simplify administrative duties, and assist in assessing medical images and the automation of devices. By individualizing treatments and forecasting adverse reactions, these AI applications have notably enhanced the management of digestive diseases.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/policies-and-standards/article-withdrawal).

In this narrative medicine essay, a first-year medical student contrasts the life of her young daughter with the older cadaver that she dissects and explores in her anatomy laboratory.

Objective
To investigate how changes in levels of physical activity (PA) in regard to acute disease severity relate to perceived difficulties in performing daily life activities 18 months after COVID-19 infection.

Design
An observational study with an 18-month follow-up survey based on registry data from a national cohort.

Participants
5464 responders to the 18-month follow-up survey of a Swedish national cohort of 11 955 individuals on sick leave due to COVID-19 during the first wave of the pandemic.

Outcomes
The follow-up survey included questions on daily life activities, as well as present and retrospective level of PA. Changes in PA level from before COVID-19 to follow-up were assessed by the Saltin-Grimby PA Level Scale and analysed by the Wilcoxon signed-rank test. Comparisons of groups were analysed by the Student’s t-test, Mann-Whitney U test and 2. Multiple binary logistic regression was performed to assess the association of changes in PA with perceived difficulties in performing daily life activities.

Results
Among the 5464 responders (45% of national cohort), the PA level decreased. Hospitalised individuals had a lower PA level both prior to COVID-19 (p=0.035) and at the 18-month follow-up (p=0.008) compared with non-hospitalised responders. However, the level of PA decreased in both groups. A decrease in PA level increased the odds (OR 5.58, 95% CI 4.90 to 6.34) of having difficulties performing daily life activities.

Conclusions
PA levels were reduced 18 months after COVID-19 infection. A decrease in PA over that time was associated with perceived difficulties performing daily life activities 18 months after COVID-19. As PA is important in maintaining health and deconditioning takes time to reverse, this decline may have long-term implications for PA and health.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Over the past 2 decades, there have been significant advancements in early detection and treatment of colorectal cancer (CRC), resulting in improved survival rates across all stages. It is estimated that, as of January 1, 2022, there were more than 1.4 million CRC survivors in the United States. Unfortunately, approximately 30% of patients with stage I to III CRC still experience recurrences after curative-intent surgical resection of the primary tumor, presenting challenges for follow-up care.

New England Journal of Medicine, Volume 389, Issue 26, Page 2413-2424, December 2023.

Objective
To report and compare psychological distress as symptoms of anxiety, depression and post-traumatic stress among intensive care units’ (ICU) nurses, physicians and leaders at 12 months after the baseline survey (spring 2020), during the COVID-19 pandemic in Norway. Furthermore, to analyse which baseline demographic and COVID ICU-related factors have a significant impact on psychological distress at 12 months.

Design
Prospective, longitudinal, observational cohort study.

Setting
Nationwide, 27 of 28 hospitals with COVID ICUs in Norway.

Participants
Nurses, physicians and their leaders. At 12 month follow-up 287 (59.3%) of 484 baseline participants responded.

Primary and secondary outcome measures
Symptoms of anxiety and depression using the Hopkins Symptoms Checklist-10 (HSCL-10). Symptoms of post-traumatic stress using the post-traumatic stress disease checklist for the Diagnostic and Statistical Manual of Mental Disorders 5 (PCL-5).
Demographics (included previous symptoms of anxiety and depression) and COVID ICU-related factors (professional preparations, emotional experience and support) impacting distress at 12 months.

Results
Psychological distress, defined as caseness on either or both HSCL-10 and PCL-5, did not change significantly and was present for 13.6% of the participants at baseline and 13.2% at 12 month follow-up. Nurses reported significantly higher levels of psychological distress than physicians and leaders. Adjusted for demographics and the COVID ICU-related factors at baseline, previous symptoms of depression and fear of infection were significantly associated with higher levels of anxiety and depression at 12 months. Previous symptoms of depression, fear of infection and feeling of loneliness was significantly associated with more symptoms of post-traumatic stress.

Conclusion
One year into the COVID-19 pandemic 13.2% of the ICUs professionals reported psychological distress, more frequently among the nurses. Fear of infection, loneliness and previous symptoms of depression reported at baseline were associated with higher levels of distress. Protective equipment and peer support are recommended to mitigate distress.

Trial registration number
ClinicalTrials.gov. Identifier: NCT04372056.

Stroke, Ahead of Print.

Introduction
Nutritional ultrasound (US) is an emerging technique in clinical nutrition for the morphological and structural study of muscle mass. Currently, all definitions of malnutrition include the measurement of muscle mass; however, there is no single way to assess it. It is necessary to develop new techniques to identify muscle involvement in malnutrition that are valid, standardised, reliable, accurate and profitable.

Objective
To value the new muscle US techniques aimed to measure muscle and functional status, to make a more accurate diagnosis and a better prediction of complications and morbidity and mortality in patients at nutritional risk. Primary outcome: to assess the feasibility of US or muscle US techniques in both nutritional diagnosis and follow-up in a nutritional intervention programme.

Methods and analysis
Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) is a prospective, multicentre (25 Spanish hospitals), uncontrolled clinical study in standard clinical practice to value the usefulness of nutritional US (muscle US) in the nutritional diagnosis and follow-up, over 3–6 months, after standard nutritional clinical practice intervention and physical activity, to control their disease-related malnutrition. 1000 patients are expected to be included in.

Discussion
This study will standardise nutritional US measures. It will validate and define specific cut-off values for nutritional US and correlate it with already well-known nutritional tools such as Subjective Global Assessment or Global Leadership Initiative on Malnutrition criteria. Thus, muscle US will become not only a tool to diagnose malnutrition, but it will also be integrated in the daily practice to evaluate nutritional interventions.

Ethics and dissemination
All DRECO study materials have been approved by each of the IRB/IEC of all the sites enrolled (either approval of the own IRB/IEC or validating the approval of the IRB/IEC of another hospital). The study has been registered with ClinicalTrials.gov, on 27 June 2022. The results from this study will be presented at scientific conferences and in peer-reviewed scientific journals.

Trial registration number
NCT05433831.

In an observational study, estimated 10-year and 20-year lung cancer–free survival were both 81%.

Introduction
Many depressed patients do not achieve remission with available treatments. Anhedonia is a common residual symptom associated with treatment resistance as well as low function and quality of life. There are currently no specific and effective treatments for anhedonia. Some trials have shown that dopamine agonist pramipexole is efficacious for treating depression, but more data is needed before it could become ready for clinical prime time. Given its mechanism of action, pramipexole might be a useful treatment for a depression subtype characterised by significant anhedonia and lack of motivation—symptoms associated with dopaminergic hypofunction. We recently showed, in an open-label pilot study, that add-on pramipexole is a feasible treatment for depression with significant anhedonia, and that pramipexole increases reward-related activity in the ventral striatum. We will now confirm or refute these preliminary results in a randomised controlled trial (RCT) and an open-label follow-up study.

Methods and analysis
Eighty patients with major depression (bipolar or unipolar) or dysthymia and significant anhedonia according to the Snaith Hamilton Pleasure Scale (SHAPS) are randomised to either add-on pramipexole or placebo for 9 weeks. Change in anhedonia symptoms per the SHAPS is the primary outcome, and secondary outcomes include change in core depressive symptoms, apathy, sleep problems, life quality, anxiety and side effects. Accelerometers are used to assess treatment-associated changes in physical activity and sleep patterns. Blood and brain biomarkers are investigated as treatment predictors and to establish target engagement. After the RCT phase, patients continue with open-label treatment in a 6-month follow-up study aiming to assess long-term efficacy and tolerability of pramipexole.

Ethics and dissemination
The study has been approved by the Swedish Ethical Review Authority and the Swedish Medical Products Agency. The study is externally monitored according to Good Clinical Practice guidelines. Results will be disseminated via conference presentations and peer-reviewed publications.

Trial registration number
NCT05355337 and NCT05825235.