Search Results for: Guida pratica all’uso farmaci ipoglicemizzanti inclusi nella Nota 100 AIFA

Objectives
To identify factors that improve retention in under-doctored areas that experience difficulties in maintaining sufficient medical workforce.

Design
Qualitative study based on semi-structured interviews, collected as part of a larger study.

Setting
Four purposely sampled geographic case study sites in England. Three case study sites were selected as areas that struggled to recruit and retain doctors and one as an area that is oversubscribed. This comprised 27 NHS Trusts, plus 1449 GP practices.

Participants
100 National Health Service (NHS)-employed doctors (including general practitioners, consultant specialists, specialty and specialist doctors, resident doctors/doctors in postgraduate training and locally employed doctors) were interviewed between December 2022 and March 2024.

Findings
Participants shared their experiences of organisational levers that impact on decisions about working life and retention in the workforce. Two key themes explained factors influencing retention. First, participants discussed feeling valued by the organisation, both in terms of material circumstances and in relationships with colleagues. Second, the theme of autonomy and opportunity explored why doctors chose to stay in areas that typically experience difficulties in maintaining sufficient staffing.

Conclusions
Many studies focusing on workforce examine why staff leave, but by focusing on factors that influence retention, greater understanding of specific facets of organisational culture can be used to inform policy and practice.

Trial registration number
ISRCTN95452848.

Introduction
The COVID-19 pandemic disrupted healthcare delivery for patients with breast cancer. eHealth solutions enable remote care and may improve patient activation, which is defined as having the knowledge, skills and confidence to manage one’s health. Thus, we developed the Breast Cancer Treatment Application (app) for patients and practitioners to use throughout the cancer care continuum. The app facilitates virtual assistance, delivers educational resources, collects patient-reported outcome measures and provides individualised support via volunteer e-coaches. Among newly diagnosed patients with breast cancer, we will compare changes in patient activation, other patient-reported outcomes and health service outcomes over 1 year between those using the app and Fitbit, and those receiving standard care and Fitbit only.

Methods and analysis
This randomised controlled trial will include 200 patients with breast cancer seen at a tertiary care cancer centre in Ontario, Canada. The intervention group (n=100) will use the app in addition to standard care and Fitbit for 13 months following diagnosis. The control group (n=100) will receive standard care and Fitbit only. Patients will complete questionnaires at enrolment, 6 and 12 months post-diagnosis to measure patient activation (Patient Activation Measure-13 score), distress, anxiety, quality of life and experiences with their care and information received. All patients will also receive Fitbits to measure activity and heart rate. We will also measure wait times and number of visits to ambulatory care services to understand the impact of the app on the use of in-person services.

Ethics and dissemination
Ethics approval was obtained on 6 January 2023. Protocol version 2.0 was approved on 6 January 2023. The trial is registered with ClinicalTrials.gov. Study findings will be disseminated via publication in a peer-reviewed journal and shared with participants, patient programmes and cancer awareness groups. The app has also been approved as a secure communication method at our trial institution, thus we are well-positioned to support future integration of the app into standard care through collaboration with our hospital network.

Trial registration number
NCT05989477.

Objective
Multi-cancer early detection (MCED) tests are novel technologies that detect cancer signals from a broad set of cancer types using a single blood sample. The objective of this study was to estimate the effect of screening with an MCED test at different intervals on cancer stage at diagnosis and mortality endpoints.

Design
The current model is based on a previously published state-transition model that estimated the outcomes of a screening programme using an MCED test when added to usual care for persons aged 50–79. Herein, we expand this analysis to model the time of cancer diagnosis and patient mortality with MCED screening undertaken using different screening schedules. Screening intervals between 6 months and 3 years, with emphasis on annual and biennial screening, were investigated for two sets of tumour growth rate scenarios: ‘fast (dwell time=2–4 years in stage I) and ‘fast aggressive’ (dwell time=1–2 years in stage I), with decreasing dwell times for successive stages.

Setting
Inputs for the model include (1) published MCED performance measures from a large case-control study by cancer type and stage at diagnosis and (2) Surveillance, Epidemiology and End Results (SEER) data describing stage-specific incidence and cancer-specific survival for persons aged 50–79 in the US for all cancer incidence.

Outcome measures
We used the following outcome measures: diagnostic yield, stage shift, and mortality.

Results
Annual screening under the fast tumour growth scenario was associated with more favourable diagnostic yield. There were 370 more cancer signals detected/year/100,000 people screened, 49% fewer late-stage diagnoses, and 21% fewer deaths within 5 years than usual care. Biennial screening had a similar, but less substantial, impact (292 more cancer signals detected/year/100,000 people screened; 39% fewer late-stage diagnoses, and 17% fewer deaths within 5 years than usual care). Annual screening prevented more deaths within 5 years than biennial screening for the fast tumour growth scenario. However, biennial screening had a higher positive predictive value (54% vs 43%); it was also more efficient per 100,000 tests in preventing deaths within 5 years (132 vs 84), but prevented fewer deaths per year.

Conclusion
Adding MCED test screening to usual care at any interval could improve patient outcomes. Annual MCED test screening provided more overall benefit than biennial screening. Modelling the sensitivity of outcomes to different MCED screening intervals can inform timescales for investigation in trials.

Introduction
Acute pneumonia (AP) remains a leading cause of death in the older population. Excess risk of death after AP is partly due to cardiovascular (CV) events. We aim to evaluate whether aspirin at a preventive dose (100 mg daily) introduced at the acute phase of AP reduces 90-day mortality.

Methods and analysis
The ASPirin for Acute Pneumonia in the elderlY study is a phase III multicentre randomised double-blind, placebo-controlled, superiority clinical trial, which will investigate the efficacy and safety of aspirin in older patients with AP hospitalised in a French university and non-university hospitals. Patients will be randomised in a 1:1 ratio between two groups receiving daily either 100 mg of aspirin or a placebo, within 84 hours following radiologically proven AP diagnosis for 90 days. This study aimed at assessing the efficacy of aspirin on all-cause mortality after AP at 90 days (D90) (primary objective), D30 and D120 after randomisation, CV mortality, major adverse CV events (MACE) (ie, myocardial infarction, stroke, heart failure, new atrial fibrillation and pulmonary embolism, CV death and sudden death) incidence, length of intensive care unit and hospital stay, unscheduled rehospitalisation, dependence, overall and MACE-free survival, as well as safety outcomes (bleeding incidence). The sample size, calculated considering a 90-day mortality of 25% and a reduction of 10% in the aspirin group, a two-sided alpha risk at 5% and power of 80%, is 500 patients to prove the superiority of aspirin over placebo. To account for screening failures and consent withdrawals, 600 patients (300 per arm) will be included.

Ethics and dissemination
This study has full approval from an independent Ethics Committee. Participants will sign a written informed consent ahead of participation. Findings will be published in peer-reviewed journals and conference presentations.

Trial registration number
EU CTIS: 2024-510811-32-00.

Ultimo a Barletta da un 89enne. Record mondiale in Italia a 100 anni

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We recently read with great interest the article by Devin Abrahami et al.1 We would like to raise some concerns that warrant further discussion. The association between proton pump inhibitors (PPIs) and the risk of inflammatory bowel disease (IBD) remains a debate, the authors mostly focus on the protopathic bias introduced by study design. However, in this study, the authors used histamine-2 receptor antagonists (H2RAs) as an active comparator. While this partially balanced the bias introduced by indications, it may have masked the potential impact of PPIs on the incidence of IBD. In the general population, the age-standardised and sex-standardised incidence of IBD is 10.9 per 100 000 person-years.2 Bin Xia et al through the NHS and UK Biobank cohorts, investigated the association between PPIs and the risk of IBD, reporting incidence rates of 12.8 and 34.6 per 100 000 person-years for non-regular PPI users, respectively.

Case presentation A 71-year-old man presented with a 2-months history of arrhythmia of undetermined cause, dysphagia, vomiting and 10 kg weight loss. The patient’s history was unremarkable except for multinodular goitre and hypertension. Laboratory exams did not demonstrate significant alterations, white cell count was 7.8×109/L (ref range: 4.0–10.0), haemoglobin 16.2 g/L (ref range: 12.0–15.0), platelet 281×109/L (ref range: 150–450), C reactive protein

Introduction
Rapid-cycle randomised testing holds high potential to enhance quality improvement practice but remains under-utilised because it requires significant resource commitment. However, infrastructure for learning networks, such as collaborative quality initiatives and large-scale quality improvement consortia, holds potential to support rapid-cycle testing at low cost and with minimal effort. For example, rapid-cycle randomised testing could be used to optimise ‘precision feedback’, which prioritises highly motivating tailored content to improve engagement with audit and feedback. We combined these concepts (rapid cycle, randomised testing and precision feedback) with a low-resource emphasis in conceiving this trial.

Methods and analysis
A stepped wedge randomised controlled trial will deliver an intervention consisting of precision feedback and modifications to audit and feedback communication to 100 urologists performing ureteroscopy within the Michigan Urological Surgery Improvement Collaborative (MUSIC) and will be compared with a control consisting of standard ‘one-size-fits-all’ audit and feedback. The study’s primary endpoint is online dashboard engagement, measured as the clickthrough rate through the tracking of embedded links in emails. The stent rate following pre-stented ureteroscopy will also be measured. The primary hypothesis is that precision feedback will increase engagement with an audit and feedback dashboard and decrease rates of stenting following pre-stented ureteroscopy. Endpoints will be analysed by linear modelling accounting for repeated measures within individuals, exploring the primary hypothesis through a main effect by the study arm.

Ethics and dissemination
Ethics and regulatory approval have been obtained from the Institutional Review Board of the University of Michigan (HUM#00248876). The findings will be disseminated in peer-reviewed journals and conferences.

Trial registration number
ClinicalTrials.gov registration number: NCT06465667. Registered 6/20/2024.

Objectives
To examine the associations between glucose levels from the antepartum 100 g oral glucose tolerance test (OGTT) and the 6-week postpartum 75 g oral glucose tolerance test (OGTT) and fatty liver disease (FLD) at 1 year postpartum in women with a history of gestational diabetes mellitus (GDM).

Design
A prospective cohort study.

Setting
A tertiary hospital centre in Bangkok, Thailand.

Participants
A total of 130 women with a history of GDM who underwent liver fat assessment at 1 year postpartum.

Outcome measures
FLD and metabolic dysfunction-associated steatotic liver disease were assessed at 1 year postpartum, with diagnosis based on transient elastography and specific cardiometabolic criteria. The associations between OGTT glucose values and FLD were evaluated using logistic regression models, adjusted for potential confounders, including age, pre-pregnancy weight, weight and waist circumference at 1 year postpartum and exclusive breastfeeding. Receiver operating characteristic analyses were also conducted to assess the predictive performance of glucose parameters from antepartum and postpartum OGTTs.

Results
A total of 44 participants (33.8%) were diagnosed with FLD, with 97.7% meeting metabolic dysfunction-associated steatotic liver disease criteria. Elevated fasting plasma glucose levels during pregnancy (adjusted odds ratio (aOR): 1.49; 95% CI: 0.93 to 3.57), in the early postpartum period (aOR: 1.77; 95% CI: 0.92 to 5.05), or across both periods combined (aOR: 2.16; 95% CI: 0.93 to 7.41) were not independently associated with FLD. In contrast, four abnormal glucose values during pregnancy (aOR: 2.53; 95% CI: 1.03 to 7.87) and two abnormal values on the 6-week postpartum 75 g OGTT (aOR: 2.95; 95% CI: 1.06 to 11.20) were independently associated with FLD. The combined presence of abnormal OGTT values from both periods showed the strongest association with FLD (aOR: 3.04; 95% CI: 1.03 to 13.99), demonstrating high specificity (95.3%) but low sensitivity (13.6%).

Conclusions
Elevated glucose levels from the antepartum 100 g OGTT and the 6 week postpartum 75 g OGTT were associated with FLD at 1 year postpartum in women with a history of GDM. Comprehensive glucose monitoring during and after pregnancy may aid early identification of individuals at higher risk.

Trial registration number
Thai Clinical Trials Registry: Registration no. TCTR20211027007. Date of registration: 27 October 2021. Date of initial participant enrolment: 1 November 2021.

Introduction
Gait recovery remains one of the most determining factors in social participation for poststroke individuals, in whom ankle dorsiflexor function is closely related to gait speed. Focal muscle vibration has shown promising neurophysiological and clinical effects in neuromotor recovery. However, it remains to be determined whether tibialis anterior focal muscle vibration applied to the paretic limb could improve walking speed when implemented in early rehabilitation after stroke occurrence.

Methods and analysis
This study describes a multicentric randomised controlled trial in which 70 participants will be randomly assigned in a 1:1 ratio to the tibialis anterior focal muscle vibration group or the sham group, in addition to their conventional rehabilitation. Participants will receive 100 Hz vibration/sham for 30 min, five times per week, for 8 weeks. The primary outcome will be gait speed, as assessed through a 10 m walking test and will be compared between groups at the end of the intervention. Secondary outcomes will include gait abilities, neuromuscular clinical evaluations and neurophysiological measures. Outcomes will be assessed at baseline and across five visits during and after the intervention, until 16 weeks of follow-up.

Ethics and dissemination
Ethics approval was obtained from the French Ethics Committee ‘Protection des Personnes Nord Ouest III’ in 30 May 2023 (IDRCB: 2023-A00489-36). The results will be published in a peer-reviewed journal and presented at scientific conferences.

Trial registration number
NCT05945212.

Tra i giovani pazienti cresce l’uso di microinfusori di insulina

Idrocefalo normoteso, malattia curabile ma poco nota. Possibili fino a 35 miliardi di euro di risparmio in un anno per il Servizio sanitario nazionale

Objectives
This study aimed to investigate the association between the type and severity of disabilities and depression among adolescents aged 15–17 years living in underdeveloped areas of Indonesia.

Design
Cross-sectional study.

Setting
Data were derived from the 2018 Indonesia Basic Health Research, a nationally representative data of Indonesia.

Participant
We used information collected from 4811 adolescents aged 15–17 living in underdeveloped areas of Indonesia.

Primary outcome
The primary outcome was depression, based on the conditions experienced by respondents during the last 2 weeks.

Results
The analysis showed that 5.65% of adolescents aged 15–17 years living in underdeveloped areas of Indonesia had depressive symptoms. Adolescents with severe physical and psychological disabilities were most at risk, exhibiting significantly higher odds of developing depression (aOR=12.09, 95% CI: 5.41 to 27.03, p