Risultati per: Studio REDUCE-IT e appropriatezza prescrittiva degli acidi grassi omega-3

Annals of Internal Medicine, Ahead of Print.

Amid rising antimicrobial resistance that poses a “global threat,” the World Health Organization (WHO) recently announced recommendations aimed at reducing the number of people who are affected by sepsis and other serious infections caused by catheters placed in blood vessels. Up to 70% of hospital inpatients have a catheter placed in a vein or artery during their stay, which increases their risk of contracting bloodstream and soft tissue infections, the WHO reported.

Iziduh S, Abenoja A, Theodorlis M, et al Priority strategies to reduce socio-gendered inequities in access to person-centred osteoarthritis care: Delphi survey. BMJ Open 2024;14:e080301. doi: 10.1136/bmjopen-2023-080301
The above mentioned article is corrected since it was published. The second author is changed from “Angela Abenoja” to “Angelina Abbaticchio”.

Objectives
Oncologists need competence in clinical prognostication to deliver appropriate care to patients with cancer. Most studies on prognostication have been restricted to patients in palliative care settings. This paper investigates (1) the prognostic accuracy of physicians regarding a broad cohort of patients with cancer with a median life expectancy of >2 years and (2) whether a prognosis training can improve prognostication.

Design
Prospective single-centre study comprising 3 phases, each lasting 1 month.

Setting
Large teaching hospital, department of oncology and haematology, Germany.

Participants
18 physicians with a professional experience from entry level to 34 years. 736 patients with oncological and malignant haematological diseases.

Interventions
Baseline prognostication abilities were recorded during an ‘untrained’ phase 1. As an intervention, a specific prognosis-training programme was implemented prior to phases 2 and 3. In phase 3, physicians had to provide additional estimates with the inclusion of electronic prognostic tools.

Outcome measures
Prognostic estimates (PE) were collected using ‘standard’ surprise question (SQ), ‘probabilistic’ SQ (both for short-term prognostication up to 6 months) and clinician prediction of survival (CPS) (for long-term prognostication). Estimated prognoses were compared with observed survival. Phase 1 was compared with phases 2 and 3.

Results
We included 2427 PE for SQ, 1506 for CPS and 800 for probabilistic SQ. Median OS was 2.5 years. SQ accuracy improved significantly (p

New England Journal of Medicine, Ahead of Print.

Introduction
Health inequalities are rooted in inequality in vital resources for health, including financial resources, a supportive informal network, a stable living situation, work or daytime activities or education and literacy. About 25% of Dutch citizens experience deprivation of such resources. Social policy consists of crucial instruments for improving resources in those groups but can also have adverse effects and lead to additional burdens. This project aims to contribute to the reduction of health inequalities through (1) a better understanding of how social policy interventions can contribute to reducing health inequality through the redistribution of burdens and resources and (2) developing anticipatory governance strategies to implement those insights, contributing to a change in social policy systems.

Methods and analysis
Two systems approaches are combined for establishing a systems change in the Netherlands. First, a realist approach enables insights into what in social policy interventions may impact health outcomes, for whom and under what circumstances. Second, an institutional approach enables scaling up these insights, by acknowledging the crucial role of institutional actors for accomplishing a systems change. Together with stakeholders, we perform a realist review of the literature and identify existing promising social policy interventions. Next, we execute mixed-methods realist evaluations of selected social policy interventions in seven municipalities, ranging from small, mid-size to large, and in both urban and rural settings. Simultaneously, through action research with (national) institutional actors, we facilitate development of anticipatory governance strategies.

Ethics and dissemination
This study is not liable to the Medical Research Involving Subjects Act (WMO). Informed consent to participate in the study is obtained from participants for the use of all forms of personally identifiable data. Dissemination will be codeveloped with target populations and includes communication materials for citizens, education materials for students, workshops, infographics and decision tools for policy-makers and publications for professionals.

This Medical News story discusses new USPSTF recommendations about the timing of screening mammograms.

New England Journal of Medicine, Ahead of Print.

Stricturing Crohn’s disease (CD), a consequence of fibrosis occurring during chronic unresolved gut inflammation, is a common problem in clinical praxis for which we currently lack targeted medical therapy.1 Patients typically present with obstructive bowel symptoms and radiographic signs of a stricture that is commonly (but not exclusively) located in the terminal ileum or at the ileocecal valve.2 Histopathology of the stricture reveals CD features, such as submucosal fibrosis by excess extracellular matrix deposition, fibromuscular hyperplasia, chronic transmural inflammation and epithelioid granulomas that are often associated with creeping fat in the resection specimen.3 Creeping fat is partially driven by translocation of mucosal-associated gut bacteria,4 and fibronectin-mediated communication by muscle cells of the nearby bowel wall.5 Moreover, several mediators such as transforming growth factor β, and the family of interleukin 1 (IL-1), IL-6 and IL-36 cytokines promote gut fibrosis, while…

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Introduction
Tranexamic acid (TXA) is an inexpensive and widely available medication that reduces blood loss and red blood cell (RBC) transfusion in cardiac and orthopaedic surgeries. While the use of TXA in these surgeries is routine, its efficacy and safety in other surgeries, including oncologic surgeries, with comparable rates of transfusion are uncertain. Our primary objective is to evaluate whether a hospital-level policy implementation of routine TXA use in patients undergoing major non-cardiac surgery reduces RBC transfusion without increasing thrombotic risk.

Methods and analysis
A pragmatic, registry-based, blinded, cluster-crossover randomised controlled trial at 10 Canadian sites, enrolling patients undergoing non-cardiac surgeries at high risk for RBC transfusion. Sites are randomised in 4-week intervals to a hospital policy of intraoperative TXA or matching placebo. TXA is administered as 1 g at skin incision, followed by an additional 1 g prior to skin closure. Coprimary outcomes are (1) effectiveness, evaluated as the proportion of patients transfused RBCs during hospital admission and (2) safety, evaluated as the proportion of patients diagnosed with venous thromboembolism within 90 days. Secondary outcomes include: (1) transfusion: number of RBC units transfused (both at a hospital and patient level); (2) safety: in-hospital diagnoses of myocardial infarction, stroke, deep vein thrombosis or pulmonary embolism; (3) clinical: hospital length of stay, intensive care unit admission, hospital survival, 90-day survival and the number of days alive and out of hospital to day 30; and (4) compliance: the proportion of enrolled patients who receive a minimum of one dose of the study intervention.

Ethics and dissemination
Institutional research ethics board approval has been obtained at all sites. At the completion of the trial, a plain language summary of the results will be posted on the trial website and distributed in the lay press. Our trial results will be published in a peer-reviewed scientific journal.

Trial registration number
NCT04803747.

This randomized study showed no benefit for krill oil, a source of high-bioavailablity ω-3 fatty acids.

Introduction
Compulsory admissions are associated with feelings of fear, humiliation and powerlessness. The number of compulsory admissions in Germany and other high-income countries has increased in recent years. Peer support has been shown to increase the self-efficacy of individuals with mental health conditions in acute crises and to reduce the use of coercive measures in clinical settings. The objective of this study is to reduce the number of compulsory admissions by involving peer support workers (PSWs) in acute mental health crises in outreach and outpatient settings.

Methods and analysis
This one-year intervention is an exploratory, cluster randomised study. Trained PSWs will join the public crisis intervention services (CIS) in two of five regions (the intervention regions) in the city of Bremen (Germany). PSWs will participate in crisis interventions and aspects of the mental health services. They will be involved in developing and conducting an antistigma training for police officers. The remaining three regions will serve as control regions. All individuals aged 18 and older who experience an acute mental health crisis during the operating hours of the regional CIS in the city of Bremen (around 2000 in previous years) will be included in the study. Semistructured interviews will be conducted with PSWs, 30 patients from control and intervention regions, as well as two focus group discussions with CIS staff. A descriptive comparison between all participants in the intervention and control regions will assess the proportion of compulsory admissions in crisis interventions during the baseline and intervention years, including an analysis of temporal changes.

Ethics and dissemination
This study was approved by the Ethics Committee of the University of Bremen (file 2022-09) on 20 June 2022. The results will be presented via scientific conferences, scientific journals and communicated to policy-makers and practitioners.

Trial registration number
DRKS00029377.

Using a salt substitute instead of table salt might lower all-cause and cardiovascular mortality, according to a meta-analysis in Annals of Internal Medicine. The data were based on 16 randomized clinical trials involving more than 35 000 participants, most of whom were from China or Taiwan.

Objectives
Researchers face numerous challenges when recruiting participants for health and social care research. This study reports on the challenges faced recruiting older adults for Being Your Best, a co-designed holistic intervention to manage and reduce frailty, and highlights lessons learnt amidst the COVID-19 pandemic.

Design
A qualitative study design was used. Referrer interviews were conducted to explore the recruitment challenges faced by the frontline workers. An audit of the research participant (aged ≥65) database was also undertaken to evaluate the reasons for refusal to participate and withdrawal from the study.

Setting
Hospital emergency departments (EDs) and a home care provider in Melbourne, Australia.

Participants
Frontline workers and older adults.

Results
From May 2022 to June 2023, 71 referrals were received. Of those referrals, only 13 (18.3%) agreed to participate. Three participants withdrew immediately after baseline data collection, and the remaining 10 continued to participate in the programme. Reasons for older adult non-participation were (1) health issues (25.3%), (2) ineligibility (18.3%), (3) lack of interest (15.5%), (4) perceptions of being ‘too old’ (11.2%) and (5) perceptions of being too busy (5.6%). Of those participating, five were female and five were male. Eleven referrer interviews were conducted to explore challenges with recruitment, and three themes were generated after thematic analysis: (1) challenges arising from the COVID-19 pandemic, (2) characteristics of the programme and (3) health of older adults.

Conclusion
Despite using multiple strategies, recruitment was much lower than anticipated. The ED staff were at capacity associated with pandemic-related activities. While EDs are important sources of participants for research, they were not suitable recruitment sites at the time of this study, due to COVID-19-related challenges. Programme screening characteristics and researchers’ inability to develop rapport with potential participants also contributed to low recruitment numbers.

Trial registration number
ACTRN12620000533998; Pre-results.