Search Results for: Linee guida ESC/ERS 2022 per la diagnosi e il trattamento dell'ipertensione polmonare

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Objective
This study aimed to analyse the attitudes of physicians working in Estonia towards the legalisation of euthanasia and assisted suicide, their willingness to perform these practices and the association of these factors with a range of physician characteristics.

Design
Cross-sectional study design using a web-based anonymous questionnaire comprising 31 questions or statements.

Setting
Estonia, April–October 2022; data collection via a web-based survey of physicians.

Participants
526 physicians (74% female, 49% under 40 years old).

Primary and secondary outcome measures
The primary outcome was the attitudes of Estonian physicians towards the legalisation of euthanasia and assisted suicide. Secondary outcomes included their self-reported willingness to personally perform euthanasia and their willingness to personally assist in suicide.

Results
Most of the participants (73%) agreed that euthanasia and assisted suicide should be legal in Estonia. Non-religious physicians were significantly more likely to support both (OR 8.0; 95% CI: 3.8, 16.8 for euthanasia; OR 9.7; 95% CI: 4.7, 20.2 for assisted suicide). Physicians who attended palliative care courses were less likely to support euthanasia (OR 0.3; 95% CI: 0.1, 0.8). Over half had not participated in any specialised palliative medicine courses.

Conclusions
This research indicates that the Estonian physician community demonstrates a predominantly accepting view of the legalisation of euthanasia and assisted suicide.

Introduction
Pharmacomechanical thrombectomy (PMT) can be a useful treatment for restoring vein patency quickly, especially for extensive acute deep vein thrombosis (DVT). However, previous evidence failed to validate the effectiveness of PMT in reducing the incidence of post-thrombotic syndrome (PTS). To address this controversy, the reformation study aims to improve rheolytic thrombectomy for acute DVT of the lower limb through primary popliteal vein thrombosis clearance.

Method and analysis
Reformation is a prospective randomised multicentre trial. It has 160 patients in two groups: the modified access group (80 patients) and the traditional access group (80 patients). The purpose of this study is to assess whether the modified access approach for removing inflow thrombus in a one-stage procedure is more effective in enhancing the success rate of the procedure and reducing the incidence of PTS during a 24-month follow-up period, for patients with acute whole limb DVT.

Ethics and dissemination
The reformation study has been registered at www.clinicaltrials.gov. The study protocol has been approved by the Institutional Review Board and Human Research Ethics Committee of Renji Hospital, School of Medicine, Shanghai Jiao Tong University (approved number: KY2021-067-A). The results will be disseminated by publication in a peer-reviewed journal.

Trial registration number
NCT05286710.

Protocol version and date
V.1.2, 20 August 2022.

Circulation, Volume 151, Issue 22, Page 1606-1619, June 3, 2025. The win ratio is a method for analyzing a hierarchical composite outcome. It has been most widely used in randomized clinical trials (RCTs) in cardiovascular disease. We performed a review of cardiovascular RCTs using the win ratio published between January 2022 and July 2024. The aims were to summarize current use and to provide examples to illustrate effective use and communication. We identified 36 eligible RCTs, mainly in heart failure and ischemic heart disease. Intervention was pharmaceutical in 26, a procedure in 7, and treatment strategy in 3 trials. When outcomes were analyzed with both conventional composite end points or hierarchical analysis, the conclusions tended to be similar. The win ratio was often used to combine evidence from event outcomes and quantitative measures together in a hierarchical composite, as was done in 23 RCTs. It was also used to create a clinically more relevant measure in RCTs by recognizing the clinical priorities among event outcomes. Selected example RCTs illustrate how the clarity of win ratio findings can be improved by (1) complementing the win ratio (a relative measure) with the win difference, (2) identifying which components of a hierarchical composite drive the overall results, and (3) clearly prespecifying the outcomes and win ratio analysis to be used. We conclude with a set of recommendations for future use of hierarchical composite outcomes and the win ratio. When used wisely, the win ratio is a valuable tool in the analysis of RCTs.

Objective
To assess the appropriateness, acceptability and feasibility of implementing the Test-it PrCr Urinalysis Dipstick Test (LifeAssay Diagnostics, South Africa) in referral hospitals in Ghana.

Participants
96 healthcare professionals were trained on the protein-to-creatinine (PrCr) test, which was integrated into protocols alongside standard-of-care tests between November 2021 and April 2022. Test users completed questionnaires post training. Three focus group discussions (FGDs) and seven key informant interviews were conducted to evaluate test procedure comprehension, insights into training effectiveness, usability/user confidence, perceptions, attitudes towards the test and barriers and facilitators of use.

Results
High product usability, user confidence and satisfaction were reported. Staff perceived the test as easy to use and similar to current products. Misinterpretations of test results were less likely for strong results. Facilitators of use included effective trainings, sensitisation of the product and key stakeholder endorsement. Challenges impacting implementation feasibility included the short shelf life of test strips (3 months) after opening cannisters, the added complexity of the ratiometric result interpretation and the test’s lack of other parameters that are included in current products (eg, glucose, nitrate), limiting its broader clinical utility for antenatal care screening. All FGD participants agreed that the use of the PrCr test would not change current practices/protocols for dipstick use.

Conclusion
Although the Test-It PrCr test is easy to use and well accepted, key product attributes limit its implementation feasibility in this setting. It may be more appropriate for monitoring high-risk women in this context.

Objective
To examine the mental ill health burden associated with allergic and atopic disorders, in a UK primary care cohort.

Design
Population-based retrospective open cohort study.

Setting
United Kingdom.

Participants
2 491 086 individuals with primary-care recorded atopic disorder (food allergy, drug allergy, anaphylaxis, urticaria, allergic rhino-conjunctivitis) diagnosis were matched by sex, age (± 2 years), and socio-economic deprivation (Townsend quintile score) at index to 3 120 719 unexposed individuals. The mean age of exposed patients at cohort entry was 39.42 years (SD (SD) 23.65) compared with 35.81 years (SD 22.17) for unexposed patients.

Main outcome measures
The primary outcome was a composite of mental ill health (severe mental illness, anxiety, depression, eating disorders, obsessive-compulsive disorder (OCD), and self-harm), identified using Read codes. Cox regression was used to estimate adjusted hazard ratios with 95% confidence intervals for the composite mental ill health outcome and each of the individual mental health disorders. Covariates adjusted for were age, sex, alcohol use, smoking status, body mass index (BMI), Townsend deprivation quintile score, asthma exposure, and eczema exposure at baseline.

Results
Between first January 1995 to 31st January 2022, a total of 2 491 086 eligible individuals were identified with a primary care recorded diagnosis of atopic disease and were matched to 3 120 719 unexposed individuals. 229 124 exposed individuals developed a mental ill health outcome during the study period (incidence ratio (IR) 144.13 per 10 000 person-years) compared with 203 450 in the unexposed group (IR 117.82 per 10 000 person-years). This translated to an adjusted hazard ratio (aHR) of 1.16 (95% CI 1.15 to 1.17). Notably, the risk of anxiety was greatest, aHR 1.22 (95% CI 1.21 to 1.23). Our findings were robust to a sensitivity analysis, where individuals were also matched for asthma and eczema.

Conclusion
There is an increased risk of mental ill health disorders among patients with diagnosis of an allergic and atopic disorders. There is a need to consider dual delivery of allergy and psychology services to optimise mental well-being among this cohort.

Objective
To investigate the association between initial discharge planning and transfers of inpatient care with discharge delay. To identify operational changes which could expedite discharge within the Discharge to Assess (D2A) model.

Design
Retrospective cohort study.

Setting
University Hospital Southampton National Health Service Foundation Trust (UHS).

Participants
All adults (≥18 years) who registered a hospital inpatient stay in UHS between 1 January 2021 and 31 December 2022 (n=258 051). After excluding inpatient stays without complete discharge planning data or key demographic/clinical information, 65 491 inpatient stays were included in the final analysis. Data included demographics, comorbidities, ward movements, care team handovers and discharge planning records.

Primary and secondary outcome measures
The primary outcome was discharge delay, defined as the number of days between the final estimated discharge date and the actual discharge date. For the purposes of OR analysis, discharge delay was modelled as a binary outcome: any delay ( >0 days) versus no delay. Logistic regression models were used to examine associations between initial discharge planning accuracy, the number of ward moves and the number of in-specialty handovers and the likelihood of discharge delay, adjusting for demographic and patient complexity factors.

Results
Out of 65 491 inpatient stays, 10 619 had an initial planned discharge pathway that was different from the final discharge pathway. 7790 of these inpatient stays (75.1%) recorded a discharge delay. In contrast, among the 54 872 inpatient stays where the initial and final pathway matched, 10 216 (18.6%) recorded a delay. Using logistic regression modelling a binary outcome (any discharge delay vs no delay), an inaccurate initial pathway was associated with significantly increased odds of delay (adjusted OR (aOR) 2.72, 95% CI 2.55 to 2.91). Each additional ward move (aOR 1.25, 95% CI 1.23 to 1.28) and each in-specialty handover (aOR 1.17, 95% CI 1.14 to 1.20) were also associated with higher odds of discharge delay.

Conclusions
This study finds a strong association between inaccurate initial discharge plans and inpatient transfers of care with discharge delay, after controlling for patient complexity and acuity. This highlights the need to consider how initial plans and inpatient transfers affect discharge planning. Given the lead times for organising onward care, operational inefficiencies are most impactful for patients eventually discharged on pathways with higher planning complexity.

Objectives
Subanaesthetic doses of esketamine may attenuate the opioid-induced cough reflex and prevent intraoperative haemodynamic fluctuations. This study aims to evaluate the effect of subanaesthetic doses of esketamine on the quality of recovery in patients who underwent abdominal surgery.

Design
Retrospective cohort study using propensity score matching (PSM) methodology.

Setting
A tertiary academic hospital.

Participants
Patients who underwent abdominal surgery under general anaesthesia with tracheal intubation between 20 December 2022 and 30 April 2023, were retrospectively reviewed. Patients were assigned to the esketamine or control group based on whether they received a subanaesthetic dose of esketamine.

Primary and secondary outcome measures
The primary outcome was extubation time (T1). Secondary outcomes included post-anaesthesia care unit (PACU) observation time (T2), total PACU time (T3), postoperative pain at multiple time points and adverse events including respiratory depression, hypertension and others.

Results
A total of 2177 patients underwent abdominal surgery. After PSM, 1196 patients were analysed, 598 in each group. Esketamine significantly reduced the extubation time compared with the control group (20.00 vs 23.00 min, p=0.001). Total PACU time was shorter in the esketamine group than in the control group (62 vs 66 min, p=0.015), although PACU observation time did not show a significant difference. Compared with the control group, the esketamine group had a lower incidence of severe postoperative pain immediately after extubation (0.33% vs 2.01%, p=0.007) and respiratory depression (2.68% vs 5.35%, p=0.027), but a higher incidence of hypertension (9.53% vs 6.35%, p=0.042). There were no other significant differences in adverse events between the two groups.

Conclusions
The use of subanaesthetic doses of esketamine for induction of anaesthesia in patients undergoing abdominal surgery may shorten the extubation time and reduce the incidence of postoperative complications.

Trial registration number
ChiCTR2300072154.

Introduction
The COVID-19 pandemic, driven by the SARS-CoV-2 virus, has had a significant global impact, with over 775 million cases reported and more than 7 million deaths as of July 2024. In Chile, approximately 5.4 million people have been infected, with a substantial proportion experiencing persistent symptoms known as post-COVID-19 syndrome. This study aims to estimate the prevalence of post-COVID-19 syndrome in Punta Arenas, Chile, and to explore the associated symptoms, mainly focusing on psychological, physical and molecular impacts on the affected population.

Methods and analysis
This cross-sectional study will use stratified random sampling to select a representative sample of 282 adults from Punta Arenas. Participants eligible for the study are those who had tested positive for SARS-CoV-2 by reverse transcription-quantitative PCR between July 2022 and July 2023. Data collection will include comprehensive clinical assessments, psychological evaluations and laboratory analyses of inflammatory biomarkers. Standardised instruments will be used to ensure consistency and reliability in measuring persistent symptoms. Statistical analyses will include descriptive statistics, regression models and subgroup analyses to identify risk factors and the prevalence of post-COVID-19 syndrome.

Ethics and dissemination
The Human Research Ethics Committee of the Clinical Hospital of the University of Chile approved the study protocol (Memorandum No 007/2023). We will present the results in peer-reviewed publications and national and international professional and academic meetings.

Trial registration number
NCT05855382.

Introduction
The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) may be as high as 38% in the adult population with potential serious complications, multiple comorbidities and a high socioeconomic burden. However, there is a general lack of awareness and knowledge about MASLD and its progressive stages (metabolic dysfunction-associated steatohepatitis (MASH) and fibrosis). Therefore, MASLD is still far underdiagnosed. The ‘Global Research Initiative for Patient Screening on MASH’ (GRIPonMASH) consortium focuses on this unmet public health need. GRIPonMASH will help (primary) healthcare providers to implement a patient care pathway, as recommended by multiple scientific societies, to identify patients at risk of severe MASLD and to raise awareness. Furthermore, GRIPonMASH will contribute to a better understanding of the pathophysiology of MASLD and improved identification of diagnostic and prognostic markers to detect individuals at risk.

Methods
This is a prospective multicentre observational study in which 10 000 high-risk patients (type 2 diabetes mellitus, obesity, metabolic syndrome or hypertension) will be screened in 10 European countries using at least two non-invasive tests (Fibrosis-4 index and FibroScan). Blood samples and liver biopsy material will be collected and biobanked, and multiomics analyses will be conducted.

Ethics and dissemination
The study will be conducted in compliance with this protocol and applicable national and international regulatory requirements. The study initiation package is submitted at the local level. The study protocol has been approved by local medical ethical committees in all 10 participating countries. Results will be made public and published in scientific, peer-reviewed, international journals and at international conferences.

Registration details
NCT05651724, registration date: 15 Dec 2022.

Objective
To evaluate the user experience of the joint National Institute of Health and Care Excellence (NICE)/Keele University Shared Decision Making (SDM) learning package.

Design
A qualitative study using online semistructured interviews. Data were analysed using open coding followed by the construction of themes.

Setting
Participants were recruited and interviewed online via Microsoft Teams.

Participants
Healthcare professionals who had used the NICE SDM learning package and provided contact details between June 2021 and April 2022 were eligible to be contacted.

Intervention
The online learning package developed to support the implementation of the NICE SDM guideline.

Findings
12 participants from a variety of different professional backgrounds were interviewed and reported that the learning package was easy to use and the different formats for presenting the information were engaging. The package was available in discrete sections—‘bitesize’ chunks—which allowed the participants to fit their learning around their busy schedules. The package included virtual patients (VPs) which allowed users to practice their SDM skills and put the learning into practice. The VPs also stimulated reflection on current performance and a shift in approach to SDM in practice. Suggestions were made by participants to improve the usability and accessibility of the learning package.

Conclusion
The NICE SDM learning package was viewed favourably by the participants. The bitesize structure and interactivity were key positive elements. Many participants suggested that they had made changes to their practice as a result of using the package.

Stroke, Ahead of Print. BACKGROUND:Treatment burden is the workload of health care for people with long-term conditions and the impact on wellbeing. A validated measure of treatment burden for use as an outcome measure in stroke trials is needed. We adapted a patient-reported measure of treatment burden in multimorbidity, Patient Experience With Treatment and Self-Management (PETS), version 2.0, to create a stroke-specific measure, PETS-stroke, and examined its psychometric properties.METHODS:We conducted an observational cohort study. Stroke and transient ischemic attack survivors were recruited between February 2022 to June 2023 from 10 hospitals in the United Kingdom and through the Scottish Health Research Register. Participants completed the PETS-stroke questionnaire along with 3 other patient-reported measures (the Stroke Southampton Self-Management Questionnaire, the Satisfaction With Stroke Care Measure, and the Shortened Stroke Impact Scale). We performed confirmatory factor analysis to test the factor structure of the PETS-stroke. We assessed Spearman rank correlations between PETS-stroke and other patient-reported measures to determine convergent validity. An intraclass correlation coefficient was performed to assess test-retest reliability. Proportions of missing data along with feedback from qualitative interviews were used to determine feasibility. T-tests were conducted to examine variations in PETS-stroke scores based on multimorbidity and socioeconomic factors.RESULTS:Three hundred eighty-one participants were included (mean age, 68.2 [SD, 11.2] years; female, 43.3%). The best fit was achieved with a 9-factor structure, and internal consistency was good (Omega values, 0.729–0.921). The factor loadings for the individual indicator items across 8 of the 9 domains were moderate to strong. All domains of PETS-stroke showed moderate to strong correlations with at least one other patient-reported measure. Test-retest reliability was good for all domains (intraclass correlation coefficient >0.7). Qualitative feedback on feasibility was positive: participants found the questionnaire to be easy and quick to complete, and missing data were within acceptable limits for 7 domains. PETS-stroke scores significantly differed based on multimorbidity in 3 domains and in 8 domains based on socioeconomic status.CONCLUSIONS:Psychometric performance suggests that PETS-stroke is a valid and feasible measure of treatment burden after stroke.