Search Results for: Anticoagulazione nei pazienti con COVID-19

Objective
To explore the association between perioperative SARS-CoV-2 infection and the postoperative complications during the breakout of the Omicron epidemic wave.

Design
Observational retrospective cohort study. Multivariable logistic regression was performed to explore the association between the duration from surgery to COVID-19 diagnosis and the likelihood of postoperative complications.

Setting
A general hospital in China.

Participants
7927 patients aged 18 years and older who underwent surgical treatment between 1 December 2022 and 28 February 2023.

Primary outcome measures
The outcome was a composite of postoperative adverse events that occurred within the initial 30 postoperative days.

Results
Of all patients, 420 (11.76%) experienced postoperative complications. Compared with No COVID-19, preoperative COVID-19 within 1 week (pre-1w) exhibited a high risk of postoperative complications (adjusted OR (aOR), 2.67; 95% CI 1.50 to 4.78), followed by patients with pre-2w (aOR, 2.14; 95% CI 1.20 to 3.80). For patients with postoperative COVID-19 within 1 week (post-1w), the aOR was 2.48 (95% CI 1.48 to 4.13), followed by patients with post-2w (aOR 1.95; 95% CI 1.10 to 3.45), and those with post-3w (aOR 2.25; 95% CI 1.27 to 3.98). The risks of postoperative complications decreased roughly with the increase of the time interval between the surgery date and SARS-CoV-2 infection. Stratification analyses suggested that perioperative COVID-19 increased the risk of postoperative complications in older patients, smokers, those with comorbidities or experiencing moderate or severe COVID-19 symptoms.

Conclusions
Our findings reveal a significant time-dependent relationship between perioperative COVID-19 and postoperative complications, highlighting the importance of tailored preoperative risk evaluations, enhanced postoperative surveillance, and the implementation of effective postoperative COVID-19 prevention measures.

Trial registration number
ChiCTR2300072473.

Introduction
The COVID-19 pandemic has had a significant impact on medical education, with many institutions shifting to online learning to ensure the safety of students and staff. However, there appears to be a decline in in-person attendance at medical schools across the UK and worldwide following the relaxation of social distancing rules and the reinstatement of in-person teaching. Importantly, this trend was also observed before the pandemic. While reflected within the literature, there is currently no systematic review describing these changes. We aim to find out how medical students’ attendance is changing as documented within the literature and its impact on their educational outcomes.

Methods
This systematic review followed the guidelines of the Centre of Research and Dissemination, Moose and Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched the major databases of Medline via Ovid, Embase via Ovid, Scopus, Web of Science, British Education Index via EBSCOhost and ERIC via EBSCOhost in September 2023. Two reviewers independently screened each paper and extracted the data, with a third reviewer for dispute resolution. All studies reporting on medical students from various universities, both graduate and undergraduate, and describing changes in attendance and/or students’ educational outcomes were included. Risk of bias in individual studies was assessed using the Agency for Healthcare Research and Quality tool. A narrative synthesis of the findings from all included studies was done.

Results
12 papers were included in the analysis. Primary aim: Of the eight papers that measured attendance data over more than one academic year, only one paper demonstrated a statistically significant decrease while one paper demonstrated a statistically significant increase in attendance over the observational period. Other papers either did not perform statistical tests or did not demonstrate statistical significance. Secondary aims: Most papers showed a general positive correlation between attendance and educational outcomes. No studies explicitly explored reasons for changes in attendance seen. Only one paper outlined a possible strategy to address changes in attendance, a mandatory attendance policy, which has mixed outcomes.

Discussion
Despite widespread anecdotally reported attendance decline post-COVID-19, overall, there was no consistent change in attendance noted. However, there was a large heterogeneity in the studies included. Further research is required to elucidate trends in attendance and its impact on medical education.

Nei giovani in 15 anni 25% in più. Il 19/5 la Giornata mondiale

In campo un gruppo di bambini in cura nei reparti oncologici

Objectives
Receiving a false positive in colorectal cancer screening is associated with psychosocial consequences, yet the reasons why some people are more affected than others remain unclear. This study examines the association between sociodemographic factors and psychosocial consequences among screening participants with false positives in colorectal cancer screening.

Design
Prospective cohort study.

Participants
1432 screening participants with positive faecal immunochemical test (FIT) screening with a follow-up colonoscopy with either no abnormalities or benign polyps (low or medium-high risk).

Outcome measures
We measured psychosocial consequences with the Consequences Of Screening – ColoRectal Cancer (COS-CRC) questionnaire, after the positive FIT but before the follow-up colonoscopy and again 1 year later. Sociodemographic factors were obtained from national registers and included sex, age, urbanicity, educational level, occupational status, income, assets, cohabitation status and Charlson Comorbidity Index. Psychosocial consequences were measured before colonoscopy (baseline) and 1 year after, and sociodemographic factors were assessed at baseline.

Results
We tested 19x2x3=114 associations between the sociodemographic factors and psychosocial consequences within the three groups of false positives and five associations were significant. We found that for participants with medium- and high-risk polyps, experiencing short-term psychosocial consequences was significantly associated with having a university degree compared with secondary school (OR=5.04 (1.38; 18.37), p=0.0142) and being unemployed compared with being employed (OR=5.61 (1.42; 22.14), p=0.0139). For participants with low-risk polyps, long-term consequences were significantly associated with the mid-income quartile (OR=2.32 (1.13; 4.76), p=0.0224) and the highest income quartile (OR=5.47 (1.13; 26.48), p=0.0349) compared with the lowest quartile. For participants with no abnormalities, there was an association between short-term psychosocial consequences and having comorbidities compared with none (OR=2.95 (1.13; 7.71), p=0.0277).

Conclusion
This study found few significant associations between psychosocial consequences and sociodemographic factors and with no apparent pattern in these. This suggests no strong evidence that specific sociodemographic groups should be especially vulnerable to experiencing psychosocial consequences after a false-positive result from colorectal cancer screening. Thus, there is currently weak evidence for identifying screening participants at higher risk for psychosocial consequences and developing targeted interventions to reduce psychosocial consequences.

Objective
This study was conducted to evaluate the causal analysis of undernutrition among adolescents in the context of the agrarian community of North-West Ethiopia.

Design
A community-based case-control study was conducted among 149 cases and 297 control adolescents.

Setting
Agrarian communities of North-West Ethiopia.

Participants
Adolescents aged 10–19 years, who reside in a randomly selected study setting.

Outcome measures
The stunting and thinness nutritional status of adolescents was determined using the WHO AnthroPlus 2010 software. A general structural equation modelling approach was used to determine a multicausal analysis of undernutrition. The Food Frequency Questionnaire was tested for internal reliability among 30 adolescents. The reliability test for the actual dietary tool was done using Cronbach’s alpha coefficient (α), which was 0.79. The model adequacy was tested using the Akaike information criterion and Bayesian information criterion. The significant direct and indirect determinants were identified with a value of p

Introduction
Acute kidney injury (AKI) is a major complication after cardiac surgery and is associated with postoperative morbidity and mortality. Currently, no effective therapy exists to reduce the incidence of postoperative AKI. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are effective in reducing AKI in outpatient settings for patients with chronic kidney disease. We hypothesised that perioperative SGLT2 inhibition will also reduce AKI incidence after cardiac surgery according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria.

Methods and analysis
We designed a multicentre, randomised, placebo-controlled, triple-blinded, superiority trial. A total of 784 patients, aged above 18 years, undergoing cardiac surgery will be included with stratification for sex and type 2 diabetes in a 1:1 ratio. Patients will receive either dapagliflozin 10 mg or placebo from the day before until 2 days after surgery. Serum creatinine will be measured preoperatively and daily for the first 7 days after the operation, and urine output will be measured until the urinary catheter is removed. The primary outcome is the incidence of postoperative AKI according to the KDIGO criteria.

Ethics and dissemination
The medical ethics committee of the Amsterdam University Medical Centre (UMC) and the Dutch competent authority approved the study protocol (currently, version 9, 19 January 2024). This is an investigator-initiated study. The Amsterdam UMC, as sponsor, retains ownership of all data and publication rights. After completion of the trial, results will be disseminated to participants, patient societies and physicians via a network meeting and digital newsletter. Results will be submitted for publication in a peer-reviewed international medical journal and presented on (inter)national congresses.

Trial registration number
Clinicaltrials.gov identifier: NCT05590143.

Objective
This systematic review investigates the effectiveness of different communication strategies to increase COVID-19 vaccine uptake and willingness.

Design
Systematic review and meta-analysis of randomised controlled trials (RCTs), following recommendations from the Cochrane Handbook and reporting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.

Data sources
We searched the following databases until 27 July 2022: Cochrane COVID-19 Study Register, PsycINFO, CINAHL, Web of Science Core Collection and WHO COVID-19 Global literature.

Eligibility criteria for study selection
We included RCTs investigating, any population, communication-based interventions to increase COVID-19 vaccine uptake and comparing these with no intervention (with or without placebo), another communication strategy or another type of intervention.

Methods
Screening, data extraction and bias assessment, using the Cochrane ROB 1.0 tool, were conducted by two authors independently. We performed meta-analyses if studies were homogeneous using the Review Manager (RevMan 5) software, synthesised the remaining results narratively and assessed the certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results
We identified 49 studies reporting on the predefined four categories of communication interventions. Evidence from our meta-analyses shows that COVID-19 vaccine uptake may increase when education and information strategies are applied (risk ratio (RR) 1.23, 95% CI 1.17 to 1.28; high-certainty evidence) or social norms are communicated (RR 1.28, 95% CI 1.23 to 1.33; high-certainty evidence) compared with no intervention. The different communication strategies mostly have little to no impact on vaccine intention; however, there may be a slight increase in vaccine confidence when gain framing is applied compared with no intervention.

Conclusion
Overall, we found that education and information-based interventions or social norm-framing strategies are most effective compared with no intervention given. Our findings show that some of the investigated communication strategies might influence policy decision-making, and our results could be useful for future pandemics as well.

PROSPERO registration number
PROSPERO (CRD42021296618).

Introduction
Depressive disorders in adolescents are highly prevalent and debilitating and are a risk factor for self-harm and death by suicide. In the context of recovery from the COVID-19 pandemic, strained healthcare resources are compounded by an increased demand for treatment services for adolescents with depression. The objective of this study protocol is to delineate the proposed economic evaluation of an integrated care pathway for depression in adolescents within the Care for Adolescents who Received Information ‘Bout Outcomes, 2nd iteration (CARIBOU-2) non-randomised, cluster-controlled trial.

Methods and analysis
Two economic evaluations of the CARIBOU-2 trial (n=300) will be conducted—a cost-effectiveness analysis and a cost-utility analysis. In the cost-effectiveness analysis, we will examine the primary clinical outcome of the trial, change in the Mood and Feelings Questionnaire total score. In the cost-utility analysis, the clinical outcome will be quality-adjusted life-years, a generic measure of health burden. Data on the resources and respective costs required to deliver the intervention will be collected by the research team. Data on resource use post-intervention will be obtained from a mix of administrative data holdings and self-report; relevant unit costs will be obtained from existing data sources. The outcome of both economic evaluations will be the incremental cost-effectiveness ratio. Relevant sensitivity analyses will be undertaken, and cost-effectiveness acceptability curves will be produced to characterise any sources of uncertainty in the analysis. Equity considerations will also be examined, where relevant.

Ethics and dissemination
Ethical approval for the larger CARIBOU-2 trial, including the economic evaluation, has been obtained by the Centre for Addiction and Mental Health as well as site-level ethics boards (019/2021; Centre for Addiction and Mental Health). All participants will provide informed consent for their data to be analysed and reported. The results of the main trial and the economic evaluation will be submitted for publication in a peer-reviewed journal and shared with relevant policy makers across Canada.

Trial registration number
NCT05142683.

Background
During the COVID-19 pandemic, many physicians experienced burnout, underscoring the need to identify factors associated with this condition to develop effective prevention and treatment strategies.

Objective
To examine the relationship between physician burnout and individual factors, medical errors, medical leave and the work environment.

Design
A cross-sectional online survey conducted from November 2020 to December 2020.

Participants
Physicians registered with the Medical College of Chile.

Setting
Registered physicians working in Chile across primary, secondary and tertiary levels of healthcare.

Primary outcomes
Burnout was assessed using the Maslach Burnout Inventory for Human Services.

Secondary outcomes
Self-reported medical errors, medical leave and turnover.

Independent variables
Sociodemographic characteristics, personality factors, psychological well-being, mindfulness factors, self-compassion and work environment factors. Descriptive statistics, linear and logistic regressions and regression analyses with cross-validation using least absolute shrinkage and selection operator (LASSO) tests were applied.

Results
Of the 23 481 registered physicians, 795 (3.4%) completed the survey. The sample included 64.1% women, with a mean age of 37.7 years (SD=11.3). The prevalence of burnout syndrome was 20.4% based on strict criteria and 68.9% based on lax criteria. Burnout scores predicted days of medical leave (ß=0.086, p

De Lorenzo, volontariato oncologico oggi è nella stanza bottoni

Rapporto Favo,’pazienti parte attiva Ssn,svolta da manovra 2025′

Objective
This longitudinal study aimed to document shifts in specialty preferences, career pathways and intended practice locations among medical students following the implementation of structured career initiatives during the 2023–2024 academic year.

Design
A longitudinal observational survey study.

Setting
A private, not-for-profit institution, VinUniversity in Hanoi, Vietnam during the 2023–2024 academic year.

Participants
All year 2, year 3 and year 4 medical students (n=144 eligible), of whom 105 (73%) completed both baseline and follow-up surveys.

Interventions
Structured career counselling initiatives introduced at the start of the academic year, including academic mentoring, clinical mentoring, hands-on clinical exposure in year 4 and multiple career counselling activities.

Primary and secondary outcome measures
The primary outcome was change in specialty preference over time, measured by students’ self-reported first-choice specialty at baseline and follow-up. Secondary outcomes included shifts in factors influencing career decisions (eg, personal interest, income and family expectations), intended practice location (domestic or international) and preferred career pathways (residency, Specialist Level I, master’s degree or direct workforce entry).

Results
Personal interest remained the strongest influence on specialty choice from baseline to follow-up (mean scores 4.27 vs 4.36 on a 5-point scale). A notable decrease occurred in the importance of income (3.82 to 3.22; p

Background
The COVID-19 pandemic had detrimental effects on routine health and social care as countries instituted widespread public health measures to control transmission of SARS-CoV-2. This affected care delivery for many chronic and non-communicable diseases, including oral health and dental diseases with implications in the postpandemic period.

Objectives
This scoping review, conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Review guidelines, aims to synthesise evidence regarding the impact of COVID-19 on access to dental services among children and their implications for future models of care, especially for children from low-income families, to inform policy decision making around subsidised dental services in Australia.

Data sources
PubMed, Web of Science, Embase, Cochrane Library of Systematic Reviews and Cochrane Central Register of Controlled Trials.

Eligibility criteria
Primary studies of any design published between 1 January 2020 and 31 July 2024. Included studies described provision of paediatric dental services, considered components of access or utilisation and were published in English. Excluded studies were those that only evaluated maxillofacial services.

Data extraction and synthesis
Data were extracted using a standardised template in MS Excel then analysed to thematically classify findings based on key areas of impact. Quality assessment of studies was not conducted.

Results
54 articles from 17 countries were included. Studies identified reductions in service availability and utilisation, including patient and parent-driven demand. Changes to the configuration of services included greater rates of emergency treatment, reductions in use of aerosol-generating procedures and more use of teledentistry, as well as self-management and prevention approaches. Substantial delays to routine dental care, leading to more dental problems and ongoing need, especially untreated dental caries, were observed with a disproportionate impact on socioeconomically disadvantaged and vulnerable children and families.

Conclusion
The COVID-19 pandemic has had pronounced negative effects on the provision of primary and secondary dental care for children around the world. Access to care was affected by disruptions to service availability and by changes in demand for services related to parental anxiety around the risk of COVID-19 transmission. Delays in receipt of routine dental care and changes to oral health behaviours are likely to lead to an increased need for oral health services, with service adaptations needed to ensure this increased demand can be met.

Introduction
The combination of a reduction in the Danish hospital bed count, the shortage of hospital staff and demographic changes challenges the Danish hospital capacity. This was further highlighted during the COVID-19 pandemic when hospitals worldwide were overwhelmed by infected patients requiring acute hospital care. To address these challenges, a hospital-at-home (HaH) programme offers an alternative to conventional in-hospital admission. Furthermore, HaH has the potential to improve patient outcomes, reduce costs and increase patient satisfaction. However, few studies have evaluated HaH in a Scandinavian setting, and this article describes the protocol for a randomised controlled trial (RCT) comparing an HaH model with continued conventional in-hospital admission. The main aim of the trial is to evaluate physical activity level and mental wellbeing in patients admitted at home compared with conventionally admitted patients.

Methods and analysis
110 clinically stable patients from two internal medical wards at Nordsjaellands Hospital in Denmark will be included and randomised in a ratio of 1:1 to either continued conventional in-hospital admission (control group) or virtual HaH model (intervention group). The control group will receive standard hospital treatment, and the intervention group will be transferred home for continued treatment (eg, intravenous antibiotics or oxygen treatment). The primary outcome measures are physical activity assessed using daily step count (during the first 24 hours after inclusion, as an intermediary indicator of the risk of adverse events) and treatment satisfaction (assessed using a patient satisfaction survey). Secondary outcome measures are adverse events of special interest, escalation of care, readmission rate postdischarge (30 days and 90 days), mortality (associated and 7 days, 30 days and 90 days postdischarge), process data (eg, the number of teleconsultations) and a health economic evaluation.

Ethics and dissemination
The study was approved by the Danish Research Ethics Committees (no. 2303051) and the Danish Medicines Agency (CIV-23-03-042542) and will be monitored by the Copenhagen University Hospital Good Clinical Practice unit. Results will be published in peer-reviewed journals and presented at relevant national and international conferences. We also plan to communicate the results to relevant stakeholders in the Danish healthcare system.

Trial registration number
NCT05920304.