Search Results for: Follow-up dopo colonscopia e polipectomia

Cervical artery dissection (CeAD) occurs when a neck artery that supplies blood to the brain tears, often resulting from a car crash or other trauma. Although CeAD is only responsible for about 2% of all strokes, it accounts for up to a quarter of ischemic strokes in adults aged 55 years or younger.

In Reply In response to the Letter by Ms Chen and colleagues about our recent study, we concur that severe maternal morbidity conditions can arise from both preexisting maternal conditions (eg, cardiac complications) and pregnancy-induced conditions (eg, severe sepsis). Addressing preexisting conditions through targeted preconception and antenatal care, such as prescribing low-dose aspirin to reduce severe preeclampsia, is essential. Early identification of high-risk individuals (eg, women with a history of psychiatric disorders) could potentially improve maternal outcomes. Furthermore, as Chen and colleagues highlight, the effect of interpregnancy interval warrants attention, given that long-term clinical follow-up and reproductive counseling may alleviate the risk of severe maternal morbidity in subsequent pregnancies.

Objective
To understand the importance and potential impact on uptake of different attributes of risk-based innovations in the context of risk-stratified healthcare for cancer screening and symptomatic diagnosis.

Design
The online survey comprised a discrete choice experiment (DCE) in which participants chose between two risk assessment options or to opt out of risk stratification. There were six attributes: test method, type (genetic or non-genetic), location, frequency, sensitivity and specificity. Participants were randomly allocated to consider the choice in an asymptomatic or symptomatic context.

Setting
Members of the public in the UK.

Participants
1202 participants completed the DCE.

Outcome measures
Conditional logistic regression and latent class analysis informed modelling of predicted preferences for a range of innovations with different features.

Results
Overall, participants preferred risk assessments over opting out and prioritised sensitivity, with test method and specificity also important. Genetic and non-invasive tests were favoured. With sensitivity and specificity of 80% or better, participants would be more likely to take up a risk assessment than not. Comparing the asymptomatic and symptomatic contexts, 65% and 73% of participants would be very likely to participate regardless of the innovation used, and 29% and 13% of participants might participate depending on the method, sensitivity and specificity. A minority showed strong dislike of risk-based innovations, particularly within screening.

Conclusions
There are high levels of public support for risk-based innovations within risk-stratified cancer healthcare, especially for referral decision-making and using genetic and non-invasive tests. Optimising risk-based innovations is needed to engage those whose participation is contingent on test methods and performance metrics.

Introduction
Cervical screening rates in the UK are falling, limiting our ability to prevent cervical cancer. Peak incidence of cervical cancer coincides with average age of childbirth, and women with young children are less likely to be screened. Current UK guidelines advise waiting 12 weeks after delivery to perform cervical screening, but this recommendation is not based on evidence from the era of liquid-based cytology or high-risk human papillomavirus (HPV) testing. New mums suggested offering cervical screening at 6 weeks postdelivery, in conjunction with the postnatal check-up with the general practice team in primary care. This study aims to assess the feasibility and acceptability of a paired-sample study design for cervical screening at 6 weeks and 12 weeks postnatal.

Methods and analysis
A study of 100 participants will be performed to assess feasibility and acceptability of cervical screening at both 6 weeks and 12 weeks postnatal, with urine self-sampling using a Colli-pee collection device at each time point. This will inform whether women are prepared to undergo cervical screening at 6 weeks postnatal and the feasibility of a future pair-wise diagnostic test accuracy (of HPV and abnormal cervical cytology) study or whether alternative study designs are needed. Participants must be aged 24.5–64 years old and eligible for the National Health Service Cervical Screening Programme (NHS CSP). At each appointment, participants will complete a questionnaire about their experience and thoughts regarding screening. Substudies ask participants who withdraw or decline to participate their reasons, to identify barriers. The study will be closed for recruitment once 100 participants have completed the 6-week screen in Postnatal Instead of Normally-Timed Cervical Screening (PINCS-1) or if recruitment is poor and 50% not recruited by 6 months, indicating that a paired-sample design is not feasible.

Ethics and dissemination
Ethical approval for PINCS-1 was given by the Stanmore Research Ethics Committee. The results, including participant feedback at each stage, built into the trial design, will inform the design of large studies to determine accuracy and clinical impact of cervical screening at 6 weeks postnatal, identifying whether giving choice (eg, from timing of appointments and/or offering self-sampling) will improve screening uptake. Data will inform the sample size needed for future studies to have adequate power. Results will also inform future NHS CSP management. Results will be shared via scientific publication and via conventional and social media channels accessed by young women.

Trial registration number
ISRCTN10071810.

Objectives
To systematically evaluate the intervention effect of modified constraint-induced movement therapy (m-CIMT) on upper limb function in patients who had a stroke.

Design
Systematic review and meta-analysis.

Data sources
A computer-based search was conducted in PubMed, Cochrane Library, Embase, Web of Science and China National Knowledge Infrastructure for randomised controlled trials (RCTs) on the intervention effect of m-CIMT on upper limb function in patients who had a stroke, with the search conducted up until 23 May 2024.

Eligibility criteria
We included only RCTs in which patients who had a stroke performed m-CIMT or m-CIMT in addition to the control group, and the outcome was upper limb function.

Data extraction and synthesis
Data extraction and synthesis used the reporting checklist for systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias and methodological quality of included studies were evaluated by two independent investigators under the guidance of Cochrane risk of bias. Effect sizes were pooled, funnel plots were created and subgroup analyses were conducted using Stata V.17.0. If I² >50%, a random-effects model was applied; otherwise, a fixed-effects model was used. Publication bias was assessed through funnel plots and Egger’s test. In the presence of publication bias, a trim-and-fill method was employed for further examination. The quality of evidence was evaluated using GRADEpro.

Results
A total of 16 studies including 612 patients were included. Rehabilitation outcomes were assessed using the Fugl–Meyer Assessment (I²=90.34%), Motor Activity Log—Quality of Movement (I²=36.02%), Motor Activity Log—Amount of Use (I²=65.76%), Action Research Arm Test (I²=62.66%) and the Wolf Motor Function Test (I²=36.78%). Low-level evidence suggests that m-CIMT improves upper limb function in patients who had a stroke (all p2 months’ (p=0.005). Intervention periods of ‘2–4 weeks’ (p=0.008) and ‘5–12 weeks’ (p

Introduction
Multiple sclerosis (MS) is an immune-mediated neurological disorder that affects one million people in the USA. Up to 50% of patients with MS experience depression, yet the mechanisms of depression in MS remain underinvestigated. MS is characterised by white matter lesions, suggesting that brain network disruption may underlie depression symptoms. Studies of medically healthy participants with depression have described associations between white matter variability and depressive symptoms, but frequently exclude participants with medical comorbidities and thus cannot be extrapolated to people with intracranial diseases. The purpose of this current study is to investigate how brain network disruption underlies depression by learning from the example of MS.

Methods and analysis
We will obtain structured clinical and cognitive assessments from 250 participants with MS and prospectively evaluate white matter disease burden as a predictor of depressive symptoms. White matter lesion burden will be quantified by identifying streamlines within white matter fascicles that intersect lesions along any portion of their trajectory, classifying these streamlines as injured, and calculating the total volume of injured streamlines to serve as the metric of disease burden.

Ethics and dissemination
Ethics approval was obtained from The University of Pennsylvania Institutional Review Board (protocol #853883). The results of this study will be presented at scientific meetings and conferences and published in peer-reviewed journals.

Introduction
Systemic racism exposes Black and Latinx adolescents to a range of traumatic stressors that increase the risk for long-term emotional and behavioural health (EBH) problems. Researchers have theorised that critical consciousness (CC)—awareness of societal inequities and engagement in action to promote social justice—may serve as a protective factor that promotes youth well-being. There are few rigorous longitudinal research studies, however, that examine the development of CC among adolescents, the association over time of CC with EBH and the potential of CC to protect against harmful effects of race-related stress. This longitudinal study, Resilience in a Stressful Era (RISE), addresses these gaps using a mixed methods approach with Black, Latinx and White adolescents in Baltimore.

Methods and analysis
We plan to enrol up to 650 Black, Latinx and White adolescents ages 14–19 who reside in Baltimore, Maryland. The recruitment will include outreach through youth-serving organisations, community events, youth networks, social media, snowball sampling and re-contacting adolescents who participated in a prior study (R01HD090022; PI: Mendelson). Participants will complete online questionnaires assessing exposure to pandemic- and race-related stress, CC and EBH twice per year over 4 years as they transition into early adulthood. Using an explanatory sequential mixed methods approach, in-depth interviews exploring the development and impact of CC will be conducted with a subset of participants selected based on their CC scores and, separately, their caregivers. A Youth Advisory Board comprised of adolescents who are representative of our target study population will be developed to provide input on the study and its implementation. Growth mixture modelling and latent variable modelling will be used to analyse quantitative data. Themes identified through qualitative analyses will expand the understanding of quantitative findings.

Ethics and dissemination
All study procedures were approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board. Findings will be disseminated through publications in peer-reviewed journals and presentations at academic conferences. We will also communicate research findings with study participants and disseminate findings to the Baltimore community, such as developing briefs for the Baltimore City Health Department and/or hosting a town hall meeting for Baltimore families.

Introduction
Post-induction hypotension (PIH) is particularly common in elderly patients undergoing general anaesthesia and is associated with severe postoperative complications. Autonomic nervous system (ANS) dysfunction is a potential risk factor for significant haemodynamic fluctuations during general anaesthesia in elderly patients. Tools to identify ANS are currently lacking in perioperative clinical practice. Postprandial hypotension (PPH) is closely linked to ANS dysfunction and is also common among elderly individuals. Therefore, this study aims to explore the relationship between PPH and PIH in elderly patients undergoing non-cardiac surgery. By examining this correlation, we hope to better understand the factors contributing to PIH and explore the potential role of PPH in predicting PIH.

Methods and analysis
This is a prospective observational cohort study. 120 elderly Chinese patients aged ≥65 years and scheduled to undergo non-cardiac surgery under general anaesthesia at Peking Union Medical College Hospital (PUMCH) will be included. PPH assessments will include baseline pre-prandial records and blood pressure measurements immediately after meal completion, followed by every 5 min for 120 min. To evaluate PIH, blood pressure will be monitored from the patients’ entry into the operating room until 20 min after anaesthesia induction or the initiation of surgery. PIH is defined as systolic blood pressure of

Stroke, Ahead of Print. Perioperative stroke, defined as a cerebrovascular event occurring during surgery or within 30 days postoperatively, remains a devastating complication associated with substantial morbidity, disability, mortality, and increased healthcare utilization. Although overall incidence is relatively low—up to 1% in most surgical populations—it is significantly elevated in cardiac, major vascular, and neurosurgical procedures, often exceeding 5%. The rising prevalence of perioperative stroke, primarily driven by an aging surgical population burdened by multiple chronic vascular conditions and increasingly eligible for high-risk surgical interventions, underscores the urgency of optimizing preventive and management strategies. This review synthesizes insights into patient- and procedure-related risk factors, highlighting the intricate interplay of embolic, thrombotic, and hypoperfusion mechanisms underpinning perioperative ischemic strokes. Key patient-specific risks include advanced age, recent cerebrovascular events, atrial fibrillation, carotid stenosis, and chronic cardiovascular comorbidities. Procedural factors, such as the type and complexity of surgery, intraoperative hypotension, and vascular manipulations, further modulate stroke risk. Emphasizing an evidence-based approach to risk mitigation, this review examines preoperative risk stratification, intraoperative techniques designed to minimize cerebral embolization and preserve adequate perfusion, and structured postoperative protocols aimed at rapid stroke detection. Acute management complexities are also discussed, with careful consideration of intravenous thrombolysis and mechanical thrombectomy in the postoperative setting. Finally, gaps in current guidelines and promising areas for future research are identified, advocating a multidisciplinary approach involving neurology, surgery, anesthesiology, and allied specialties to enhance patient outcomes and reduce the perioperative stroke burden.

Background
Few studies have investigated the prevalence of chronic wounds and the clinical and sociodemographic characteristics of hospitalised patients affected by them. Understanding these characteristics within the inpatient setting can support improved follow-up, inform care strategies, enhance quality and safety and reduce associated healthcare costs. This study aimed to determine the prevalence and the sociodemographic profile of adult inpatients with chronic wounds admitted to the eight hospitals of the Catalan Institute of Health between 2016 and 2020.

Methods
A descriptive, observational, cross-sectional and retrospective multicentre study was conducted using routinely collected clinical data from 1 January 2016 to 31 December 2020. The study encompassed hospital wards, step-down units and home hospitalisation services across eight public hospitals managed by the Catalan Institute of Health, the main public healthcare provider in Catalonia, Spain. The study included all patients aged 18 years or older who were hospitalised with chronic wounds during the study period. The main variables were nursing diagnoses of chronic wound types: pressure injuries (PIs), arterial ulcers (AUs), venous ulcers (VUs), mixed ulcers and diabetic foot ulcers (DFUs), as recorded in nursing electronic health records. Secondary variables included age, sex, reason for admission, unit of admission, hospital type, source of admission and discharge destination. A descriptive and comparative analysis was performed.

Results
Among 796 698 hospitalised patients, 16 935 (2.1%) presented with at least one chronic wound. The most common types of chronic wounds were PIs and AUs. A slight decline in the prevalence of chronic wounds was observed over the study period. Cardiovascular and respiratory conditions were the leading causes of admission among these patients. AUs and DFUs were more prevalent in men, whereas VUs were more frequently observed in women. Patients with PIs had longer hospital stays, higher rates of intensive care unit admissions and increased in-hospital mortality. In contrast, patients with vascular ulcers more often required continued care after discharge (p

Objectives
This study aimed to assess self-care practices and the factors associated with them among adult asthmatic patients receiving follow-up care at public hospitals in the East Wollega Zone of West Ethiopia in 2023.

Design
A cross-sectional study conducted in an institutional setting.

Setting
The research was carried out in government hospitals, including two primary hospitals, one general hospital and two comprehensive specialised hospitals, from 29 May to 29 July 2023.

Participants
A systematic random sample of 413 adult asthmatic patients undergoing follow-up care at public hospitals in the East Wollega zone was selected. Data were collected using a structured, self-administered questionnaire, which was then entered into Epidata V.4.6 and analysed using SPSS V.27.

Outcome measures
The primary outcome measure was the classification of asthma self-care practices as either good or poor.

Results
The findings revealed that 51.6% (95% CI: 46.7% to 56.4%) of participants exhibited good asthma self-care practices. Significant factors associated with good self-care included the absence of comorbidities (adjusted OR (AOR) 2.0, 95% CI: 1.26 to 3.10), non-consumption of alcohol (AOR 4.33, 95% CI: 2.52 to 7.44), non-smoking status (AOR 6.67, 95% CI: 2.46 to 18.1) and the presence of social support (AOR 1.57, 95% CI: 1.00 to 2.48).

Conclusion
The study found a relatively high prevalence of good asthma self-care practices among participants. Key factors positively associated with these practices included the absence of comorbidities, non-consumption of alcohol and tobacco and strong social support. It is recommended that public hospitals and healthcare management implement strategies to promote behavioural changes and enhance self-care education aimed at reducing asthma exacerbation triggers.

Background
Minimally invasive approaches, including video-assisted thoracoscopic thymectomy (VATT) and robot-assisted thoracoscopic thymectomy (RATT), have emerged as alternatives to median sternotomy for resectable thymic epithelial tumours (TETs). However, their comparative clinical efficacy remains inconclusive due to limited prospective evidence. This phase II randomised controlled trial aims to provide the first direct comparative analysis of perioperative outcomes between RATT and VATT in stage I–II TETs.

Methods and analysis
This phase II clinical trial is a prospective, multicentre, randomised controlled study. A total of 100 patients with stage I–II TETs will be recruited and randomly allocated into two groups: RATT and VATT groups, with a 1:1 ratio. Follow-up visits will be scheduled at 1 month, 3 months and 6 months postsurgery, and semiannual visits will continue until November 2027, including the record of tumour recurrence, metastasis, survival outcomes and overall long-term effects. The primary endpoint is total postoperative thoracic drainage. Secondary outcomes encompass intraoperative factors like R0 resection rate, operative time, postoperative drainage duration, hospital stay length, conversion rates, levels of stress markers, pain scores, quality of life assessments, perioperative complication rates, mortality rates and 3-year disease-free and overall survival rates.

Ethics and dissemination
The study protocol is approved by the ethics committees of Zhongshan Hospital, Fudan University (No. B2024-365), and will be conducted under the guidance of the Helsinki Declaration. All data and findings will be disseminated and published through peer review.

Trial registration number
NCT06654830.

New England Journal of Medicine, Volume 392, Issue 20, Page 2062-2064, May 29, 2025.

Purpose
We are conducting a longitudinal cohort study—the Community Burden of Acute Respiratory Infections in Shanghai—to assess age-stratified incidence, healthcare utilisation and risk factors of influenza virus, respiratory syncytial virus (RSV) and SARS-CoV-2 associated acute respiratory infections (ARIs) in Shanghai, China.

Participants
Study participants were enrolled by family doctors in all 47 community health services centres in Pudong New Area District, Shanghai, China. All permanent residents 6 months and older living in Pudong for at least 6 months were eligible for enrolment; residents who planned to leave Pudong for more than 1 month in the first study year were excluded. During enrolment, study staff conducted baseline assessments of sociodemographics, underlying medical conditions, vaccination history and household and self-rated health status. Study participants are being followed for ARIs for 3 years. Nasopharyngeal and oropharyngeal swab specimens are being obtained from suspected ARI cases. Influenza virus, RSV, SARS-CoV-2 and other respiratory pathogens are tested for by multiplex respiratory pathogen real-time quantitative PCR assays. Illness courses and clinical recoveries of ARI cases are assessed through weekly contact with ARI cases for 28 days post ascertainment.

Findings to date
Between 14 October 2024 and 22 November 2024, we enrolled 5387 community residents into the cohort, including 233 children aged from 6 months to 2 years, 278 preschool children aged 3–6 years, 575 school-age children aged 7–18 years, 2150 adults aged 19–64 years and 2151 older adults aged 65+years. All finished baseline assessment and started follow-up. Surveillance of ARI symptoms, collection of specimens and laboratory testing are ongoing.

Future plans
Findings from this study will be used to provide valuable scientific data to inform ongoing control efforts and future pandemic preparedness for respiratory diseases in China. Planned analyses include analysis of annual pathogen-specific incidence by age group and exploration of healthcare seeking behaviour and factors associated with ARIs and severe ARIs. We will also assess transmission dynamics of common respiratory pathogens in a household transmission subcohort.

Objective
Older adults are prone to developing multiple chronic diseases and have increased medication usage. This has led to the prescription of potentially inappropriate medications (PIMs). This study aimed to assess PIM prevalence among patients visiting the primary care unit (PCU) of a tertiary care hospital and evaluate the associated factors.

Design
A retrospective cross-sectional study by reviewing medical records in the hospital information system.

Setting
The PCU of a tertiary care hospital.

Participants
Patients aged ≥65 years who visited the PCU between 1 June and 30 November 2023 and received at least one oral medication.

Primary and secondary outcome measures
PIMs were diagnosed using the updated American Geriatrics Society Beers criteria 2023, and logistic regression was used to identify factors associated with PIM prescriptions.

Results
The study included 1600 participants, of whom 62.9% were female, with a median age of 72.0 years (IQR=68.0–77.0). The prevalence of PIMs was 39.4%. The three most common PIMs prescribed were diuretics, benzodiazepines and sulfonylureas. An increasing number of underlying diseases, presenting with acute illness (compared with follow-up only) and being treated by staff physicians (compared with trainee physicians) were significantly associated with increased odds of PIM prescriptions (adjusted OR (95% CI) = 1.59 (1.42 to 1.79), 1.58 (1.28 to 1.94) and 1.84 (1.33 to 2.54), respectively).

Conclusion
PIM prescriptions among older patients in the PCU were high, particularly in those with multiple comorbidities and acute illness presentations. Therefore, physicians should prescribe medications with caution, and various explicit criteria can be used as screening tools to prevent PIM prescriptions.

Introduction
Olfactory dysfunction (OD) following COVID-19 affected up to 70% of patients, with more than 30% still reporting lingering symptoms a year later. Treatment is essential, as previous research has linked (postviral) OD to depression, impaired quality of life (QoL) and even heightened mortality rates.

Methods and analysis
We designed a monocentric, single-blinded randomised controlled trial evaluating the efficacy of olfactory training (OT) in individuals with persisting COVID-19-associated loss of smell. Randomisation will be done in a 1:1 manner. OT will be performed using the Sniffin’ Sticks Duft Quartett over a period of 12 weeks, two times per day. The primary endpoint of this study is the change in olfactory score between baseline and after 12 weeks, measured by the combined score of the identification and discrimination subscales of the Sniffin’ Sticks testing battery. QoL, overall health, mood, personal well-being and symptom severity will be assessed at baseline and during a follow-up visit, using multiple validated questionnaires and scales. OT is offered to the second cohort during an open-label phase extension. This manuscript highlights and discusses the study protocol.

Ethics and dissemination
Ethical approval for the study was obtained from the Ethics Commission of the Medical University of Innsbruck, Austria. Results of this study will be shared through conferences and publications in peer-reviewed journals.

Trial registration number
NCT05421221.