Risultati per: Standard di qualità sulla Fibrillazione Atriale

This phase 3 randomized clinical trial conducted in France investigates whether systemic weekly radiotherapy replanning compared with standard intensity-modulated radiotherapy decreases xerostomia in adult patients with squamous cell oropharyngeal cancer.

Giorlandino (Sidip), per il picco endocrino che avviene in Primavera

Circulation, Volume 148, Issue 4, Page 375-377, July 25, 2023.

Introduction
Colonoscopy plays important roles in bowel cancer screening and treatment. Poor bowel preparation occurs in 20–25% of colonoscopies. This negatively impacts adenoma and sessile serrated lesion detection rates, procedural time, requirement for repeat colonoscopies, healthcare costs and likelihood of patient withdrawal from screening programmes. It is unclear whether a combination of multimedia modalities can improve bowel preparation quality, adenoma detection rates and patient-reported measures in those undergoing colonoscopy assessment.

Methods
The DIGICLEAN trial is a prospective, parallel, multicentre, colonoscopist-blinded, randomised controlled trial. The trial will enrol 1294 participants aged 45 years and older who are indicated for a colonoscopy as an outpatient with a positive faecal occult blood test, iron deficiency anaemia or rectal bleeding. Participants will be randomised into the interventional arm, where bowel preparation instructions are delivered via a web-based application which uses scheduled short messaging service, regular patient survey assessment, email and videos; or the control arm, where routine standard written, verbal or emailed instructions are administered. The web-based application will assess patient-reported bloating, constipation and dietary adherence leading up to the colonoscopy. Depending on patient responses, additional aperients may be encouraged digitally in the interventional arm with same instructions made available in written format for the control arm. Patient-reported measures will be collected in both arms the day after the procedure using the validated Newcastle ENDOPREM questionnaire. In some sites, participants will undergo digital pre-anaesthetic screening as well. The co-primary endpoints are the adenoma detection rates and patient-reported measures taken after the colonoscopy.

Ethics and dissemination
Ethics approval for this study was obtained from the Western Sydney Local Health District Human Research Ethics Committee (2022/ETH00059). Findings will be reported at national and international gastroenterology meetings and published in peer-reviewed journals.

Trial registration number
ACTRN12622000747729.

Intervento su paziente di 28 anni con sistema elettroanatomico

Introduction
Febrile urinary tract infection is one of the most common bacterial infections in children. Currently, recommended antibiotic duration is 10 days. However, recent evidence suggests that 90%–95% of children with febrile urinary tract infections are afebrile and clinically improved 48–72 hours after treatment initiation. Accordingly, individualised duration of antibiotic therapy, according to the recovery time, might be more beneficial than current recommendations, but no evidence exists.

Methods and analysis
An open-label randomised clinical trial equally randomising children aged 3 months to 12 years from eight Danish paediatric departments with uncomplicated febrile (≥38°C) urinary tract infection to either individualised or standard duration of antibiotic therapy. Children allocated to individualised duration of antibiotic therapy will terminate antibiotic therapy 3 days after clinical improvement with no fever, flank pain or dysuria. Children allocated to standard duration will receive 10 days of antibiotic therapy. Co-primary outcomes are non-inferiority for recurrent urinary tract infection or death within 28 days after the end of treatment (non-inferiority margin 7.5 percentage points) and superiority for the number of days with antibiotic therapy within 28 days after treatment initiation. Seven other outcomes will also be assessed. A total of 408 participants are needed to detect non-inferiority (one-sided alpha 2.5%; beta 80%).

Ethics and dissemination
This trial has been approved by the Ethics Committee (H-21057310) and the Data Protection Agency (P-2022-68) in Denmark. Regardless of the trial’s findings (whether positive, negative or inconclusive), the results will be compiled into one or more manuscripts for publication in international peer-reviewed scientific journals and presented at conferences.

Trial registration number
NCT05301023.

Studio, può influire più di alcune gravi malattie

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

Current guidelines vary as to their recommendations addressing the role of hemostatic powders when managing patients with malignant gastrointestinal (GI) bleeding as these are based on very-low to low quality evidence in large part due to a paucity of randomized trial data.

In Reply The Letter by Dr Hsu and colleagues provides further insight into the reasons why children who were randomized to high-flow nasal oxygen therapy had a longer length of hospital stay than children treated with standard oxygen therapy in our study. We agree with the Letter authors’ comments, except that our study protocol provided no additional observation period after cessation of high-flow oxygen therapy, so this factor could not have substantially contributed to the results. We support the notion that there are excessive ICU admissions for infants with bronchiolitis. The PARIS-2 trial excluded infants with bronchiolitis because they were studied in the PARIS-1 trial.

To the Editor A recent randomized clinical trial reported that children who received early high-flow nasal oxygen therapy for mild to moderate acute hypoxemic respiratory failure had a significantly longer length of stay in the hospital than those who initially received standard oxygen therapy. Although we appreciate the authors’ list of hypotheses for why children allocated to high-flow oxygen therapy had a prolonged length of stay, we believe there may be some other important explanations for this trial’s finding.

We thank Barkun et al1 for their comments on our study.2 We are aware of the limitations of our study, which have extensively been discussed in our manuscript. However, we would like to make some additional comments. We aimed to select high-risk patients only and used complete Rockall Score as selection criteria. Whether this score is the perfect tool to identify patients benefiting most from primary over-the-scope clips (OTSC) therapy remains unclear. Indeed, we did not balance baseline characteristics and the number of large lesions ( >20 mm) was three times higher in the standard group. This might have influenced study outcomes, as large ulcers are more difficult to treat with standard clips, which might have resulted in OTSC rescue therapy more frequently. However, large lesions can be difficult to treat with OTSC as well. Barkun et al comment that limited benefit for primary OTSC therapy for…