Search Results for: La qualità dei nutraceutici e position paper per l’appropriato uso in medicina generale

Chalk talks, sometimes called whiteboard mini-lectures, are an effective teaching technique for the clinical learning environment.1 They are brief, interactive sessions with a small group of learners, typically anchored around patient management topics.2 Chalk talks use a blank or templated writing surface (e.g., dry erase or chalkboard, tablet, or piece of paper) with organized text and visual elements that maximize impact and reduce extraneous cognitive load. Unlike traditional lectures, chalk talks engage learners in critical thinking and collaboration by using interactive strategies.

Introduction
Individuals with stroke are at risk of long-term overweight and obesity due to biopsychosocial factors. Being overweight and obese is associated with an increased risk of numerous chronic conditions, including recurrent stroke. Unfortunately, recommendations for nutritional interventions vary. The objective of this scoping review is to identify and map the body of literature on professional nutritional interventions aimed at preventing or reducing overweight and obesity during postacute stroke rehabilitation.

Methods and analysis
The review follows the Joanna Briggs Institute methodology for scoping reviews. A three-step librarian-assisted search strategy will be conducted using the bibliographic databases MEDLINE (PubMed), Embase, CINAHL and Web of Science. Indexed and grey literature in English and Scandinavian languages, from January 2010 to the present, will be considered for inclusion. The scoping review will include materials such as research articles, methodological papers and clinical guidelines that report on nutritional interventions aimed at preventing or reducing overweight and obesity among individuals with stroke (aged ≥18 years) from admission to rehabilitation hospitals. We will map and identify any kind of nutritional intervention in rehabilitation hospitals, nursing homes or their own environments in high-income countries. Two independent reviewers will conduct an iterative process for screening the identified literature, paper selection and data extraction. Disagreements will be resolved through discussion or with an additional reviewer. A data extraction form will be used to guide the data extraction.

Ethics and dissemination
This review will involve the collection and analysis of secondary sources that have been published and/or are publicly available. Therefore, ethical approval is not required. The results will be published in an international peer-reviewed journal, presented at scientific conferences and disseminated through digital science communication platforms.

Trial registration number
The protocol is registered in the Open Science Framework: https://osf.io/ga63n/view_only=ee07beace7bb48d6b9c82cbf79cf2e95.

Il libro di Claudio Giorlandino, ‘da diagnosi per le malattie rare alle cure su misura’

Pochi ospedali monitorano i sintomi dei pazienti. ‘Serve un cambio di passo’

Objectives
This study explored general practitioners’ (GPs) understanding of physical activity advocacy to patients and their own self-care, how GPs perceive their own physical activity behaviours, how their personal experience of physical activity affects how they promote it in practice and how they define the limitations of their role in this.

Design
A qualitative design, involving online semi-structured interviews, was employed. Data was analysed by an interdisciplinary team of researchers using an inductive thematic approach.

Setting and participants
Participants were GPs (n=21) and were recruited from an education and research network.

Findings
A single meta-theme was identified—moving towards more physically active lifestyles through the art of medicine—with three related subthemes. Subthemes relate to how GPs determine the extent of their role and responsibilities, how physical activity promotion is adapted to the context and how ‘what I’ say is not necessarily ‘what I do’. After many consultations, mutual trust can develop when the GP’s role is clarified, and the GP can educate and support the initiation and maintenance of physical activity behavioural change by sharing personal experiences of physical activity behaviour.

Conclusion
Based on personal experience and enduring relationships with their patients, GPs are in a unique position to discuss appropriate physical activity with their patients and perform an important role in explaining and gaining access to physical activity for their patients. Support in the form of community-based resources and programmes as well as brief intervention skills could enhance GP ability to further promote physical activity.

Introduction
Fine motor skill (FMS) development during childhood is essential to many learning processes, especially in school. FMS impairment can have a major impact on children’s quality of life. Developing effective and engaging rehabilitation solutions to train FMS that engage children in the abundant practice required for motor learning can be challenging. Virtual reality (VR) is a promising intervention option offering engaging FMS training tasks and environments that align with evidence-based motor learning principles. Other potential advantages of VR for rehabilitation include accessibility for home-based use and adaptability to individual needs. The objective of this scoping review is to map the extent, range and nature of VR applications focused on FMS training in paediatric rehabilitation, including hardware, software and interventional parameters.

Methods and analysis
We are following methodological guidelines for scoping review conduct and reporting from the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews recommendations. We will search four databases (Pubmed, Web of Science, PsycInfo and Scopus) for articles that meet inclusion criteria defined by the Population, Concept, Context method; specifically studies focused on development or evaluation of immersive or non-immersive VR applications to deliver FMS training in paediatric rehabilitation. Different populations of children with FMS impairments will be included (such as children with cerebral palsy, children with developmental coordination disorder or attention deficit hyperactivity disorder). The first search took place in December 2023, and a second is planned for February 2025. One reviewer will complete title, abstract and full paper screening, with consultation by a second reviewer in case of uncertainty. A data extraction framework will be tested by two reviewers on five randomly selected studies to ensure inter-rater reliability, and one reviewer will complete data extraction. Quantitative and qualitative extraction will follow JBI guideline recommendations. Results will be presented in a descriptive and tabular format, including a narrative summary. Results will enhance understanding of the potential of FMS training in VR and inform subsequent directions for research and clinical practice.

Ethics and dissemination
Data for this review will be collected from the published literature. Ethical approval is not required. We will present our findings at scientific conferences and submit this review to a peer-reviewed journal for publication.

Introduction
Stroke is a major cause of acquired disability globally, yet the neural mechanisms driving motor recovery post-stroke remain elusive. Recent research has underscored the growing significance of subcortical pathways in neural plasticity and motor control. Among these, the cortico-reticulospinal tract (CRST) has gained attention in rehabilitation due to its unique ascending and descending structural features as well as its cellular properties which position it as an excellent candidate to compensate for inadequate motor control post-stroke. However, the optimal strategies to harness the CRST for motor recovery remain unknown. Non-invasive modulation of the CRST presents a promising though challenging, therapeutic opportunity. Acoustic startle priming (ASP) training and intermittent theta burst stimulation (iTBS) are emerging as potential methods to regulate CRST function. This study aims to investigate the feasibility of segmentally modulating the cortico-reticular and reticulospinal tracts through ASP and iTBS while evaluating the resulting therapeutic effects.

Methods and analysis
This is a randomised, blinded interventional trial with three parallel groups. A total of 36 eligible participants will be randomly assigned to one of three groups: (1) iTBS+ASP group, (2) iTBS+non-ASP group, (3) sham iTBS+ASP group. The trial comprises four phases: baseline assessment, post-first intervention assessment, assessment after 3 weeks of intervention and a 4-week follow-up. The primary outcomes are the changes in the Fugl-Meyer Assessment-Upper Extremity and Modified Ashworth Scale after the 3-week intervention. Secondary outcomes include neurophysiological metrics and neuroimaging results from diffusion tensor imaging and resting-state functional MRI.

Ethics and dissemination
The trial is registered with the Chinese Clinical Trial Registry (Registration No. ChiCTR2400085220) and Medical Ethics Committee of Tongji Hospital, affiliated with Tongji Medical College, Huazhong University of Science and Technology (Registration No.TJ-IRB20231109). It will be conducted in the Departments of Rehabilitation Medicine and Radiology at Tongji Hospital in Wuhan, China. The findings will be disseminated through peer-reviewed journal publications and presentations at scientific conferences.

Trial registration number
ChiCTR2400085220.

Stroke, Volume 56, Issue Suppl_1, Page ATP321-ATP321, February 1, 2025. Introduction:The African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) study is focused on developing an integrated mHealth community-based interactive Stroke Information and Surveillance System. This is the first paper to qualitatively investigate and contrast community beliefs, attitudes, and practices related to stroke prevention, risk factors and care from alternative/complementary medicine providers/healers, orthodox/modern medicine/health care providers, community members and leaders in Nigeria.Methods:Six focus groups with community members and leaders (n=57) and key informant interviews with health providers (n=24) from alternative/complementary medicine providers and orthodox/modern medicine providers were conducted to qualitatively explore beliefs, attitudes, practices, and recommendations related to stroke in urban (Ibadan) and rural (Ibarapa) communities in Nigeria. The Health Belief Model and Social Ecological Model guided the questions and thematic analysis of the qualitative data.Results:Participants perceived stroke as disabling though manageable but with odds of repeat stroke for survivors. High blood pressure, stress, sleep issues, heredity, and lifestyle factors were some stroke risk factors perceived by participants from both sites although God, witchcraft/evil people were reported by rural participants. Hospital visits and consumption of herbal concoction, self-medication and visit to church for prayers were some actions taken to manage stroke by both urban and rural participants. Low literacy levels, limited funds, fear of and distance to hospitals, and absence of insurance were some barriers to uptake of recommendations from orthodox medicine practitioners which are drivers to unorthodox practitioners. To improve stroke care and prevention across communities, free risk factor screening, indigenous stroke awareness programs via print, audio-visual and electronic media were suggested by all participants.Conclusion:Diverse beliefs and practices are related to stroke risk factors, prevention and care and barriers with obtaining care. There is need to work across systems to improve stroke prevention and care in communities.

Stroke, Volume 56, Issue Suppl_1, Page AWP177-AWP177, February 1, 2025. Introduction:Automated imaging analysis tools are increasingly used in clinical decision-making for stroke. Rapid ASPECTS (iSchemaView, Menlo Park, CA) assists physicians by automatically calculating Alberta Stroke Program Early CT Scores (ASPECTS) and reducing inter-reader variability. To understand why the tool’s performance in real-world settings sometimes varies compared to published literature, we investigated how different imaging acquisition protocols affect its performance.Materials&Methods:Consecutive code stroke NCCT scans with thin (1.25 mm slice; 0.625 mm spacing) and thick (5.0 mm slice; 3 mm spacing) series were collected from a retrospective database between February 2020 and May 2021. Ground truth ASPECTS reads were collected from radiology reports, which neuroradiologists determined in real-time. Automated reads were obtained using Rapid ASPECTS 1.0 and 3.0 (iSchemaView, Menlo Park, CA). Agreement between automated and manual reads was defined as ASPECTS scores within two points.Results:A total of 682 cases were included in this analysis. 67 cases were excluded for technical inadequacy (hemorrhages, tumors, and artifacts). A review of the source imaging revealed that many cases had thick overlapping slices and incorrect head positioning (neck extended instead of the standard neutral position). These cases required significant tilt correction to align the patient data with the Rapid ASPECTS regions template. These corrections led to partial voluming artifacts, which caused lower Hounsfield unit (HU) values and ASPECTS scores. When adjusting protocols from thick to thin slices, agreement between ASPECTS V1 and manual reads improved from 85% (581/682) to 89% (606/682). ASPECTS V3 showed further improvement, with agreements of 91% (619/682) and 95% (648/682) for thick and thin slice scans, respectively.Conclusion:The combination of neck extension head positioning and thick overlapping slices caused partial voluming artifacts, resulting in artificially low ASPECTS scores on automated software. Our findings indicate that adjusting imaging protocols and working with the AI provider can enhance an algorithm’s accuracy. To ensure that commercially available automated analysis tools deliver accurate results, it is crucial to follow the recommended imaging acquisition protocols.

Stroke, Volume 56, Issue Suppl_1, Page ATMP77-ATMP77, February 1, 2025. Ischemic strokes often disrupt white matter (WM) microstructure, particularly affecting the corticospinal tract (CST) in the internal capsule (IC), leading to significant motor deficits. While evidence shows that axon sprouting occurs post-stroke, it often follows erratic paths, limiting functional recovery. Recent advances in 3D-printed hydrogel scaffolds have shown promise in guiding axon regeneration in spinal cord injury models. We hypothesize that implanting these scaffolds at white matter sites affected by stroke, aligned with CST fibers, will enhance functional axonal regeneration and motor recovery. Our aim is to develop and validate a precise and clinically applicable scaffold delivery system for future human studies.We have developed a novel, minimally invasive stereotaxic method for the precise deployment of 1.3 mm diameter scaffolds within the IC of non-human primates (NHPs). Our approach utilizes a clinically available stereotactic robot (ROSA, ZimmerBiomet) combined with a linear cannula system (AlphaOmega) to plan scaffold placement. Then, we attempted to deploy scaffolds devices into thermally coagulated lesions in NHPs (n=2) and simulated lesions within hydrogel phantoms (n=2). Post-implant MRI, co-registered with high-resolution diffusion tensor imaging were applied to check for scaffold placement accuracy (n=4). We further complement the scaffold placement method by using a novel neurosurgical microrobot (Robeauté) designed for navigation along 3D nonlinear curves, with accuracy confirmed by CBCT imaging in phantom tests.Our implantation methods accurately placed scaffolds in the intended locations and orientations, aligning with CST fibers in both phantom models and NHP brains. The deviation angle between the scaffold and CST fibers was 17.83° (SD 6.71°, n=3). The scaffolds were precisely positioned within the IC, validating our approach. Our robot-guided method accurately steered them to their intended position, demonstrating minimal errors in targeted white matter regions.The methods described are poised for clinical translation, potentially extending the applicability of scaffold technology for improving motor function post-stroke. We are preparing NHPs for behavioral and upper limb motor assessments to evaluate the impact of scaffold implantation on axon regeneration, recovery, and performance. This research aims to enhance our understanding of ischemic stroke and develop innovative therapies to restore motor function in patients.

Stroke, Volume 56, Issue Suppl_1, Page ATP365-ATP365, February 1, 2025. Introduction:Polymorphonuclear leukocytes (PMNs) are among the first leukocytes recruited to the infarct following reperfusion in ischemic stroke. Although transendothelial migration (TEM) blockade in preclinical studies was found to reduce infarct size, TEM blockade in clinical trials has been unsuccessful. Studying PMN recruitment and lifespan in ischemic stroke may offer insight into these failures in clinical trials and advance therapeutic development.Methods:PMNs were briefly pulse-labeled with 5-Ethynyl-2’-deoxyuridine (EdU) to determine PMN lifespan and migration pattern following ischemia/reperfusion in stroke. Large vessel occlusion and reperfusion were simulated using the transient middle cerebral artery occlusion model (tMCAO, 90 minutes of ischemia followed by reperfusion). Infarct size was determined via triphenyl tetrazolium chloride staining. The percentage of EdU+ PMN in circulation was assessed each day following tMCAO and compared to the percentage of EdU+ PMNs in the ischemic hemisphere at sacrifice by flow cytometry. The position of PMN in coronal sections was examined by wide field fluorescence microscopy.Results:Large cortical ischemic strokes involving over 20% of cerebral volume were induced in mice. A majority of PMN recruitment and extravasation was localized to the cortical surface of the infarct at early time points (12 and 24 h post stroke), contrasting other vascular beds where there is PMN migration deep into the infarcted tissue by 24 h. EdU+ PMNs persisted in the ischemic hemisphere until 96 h post stroke despite their clearance from circulation at least 48 h prior, indicating PMN can survive for days in the infarct. Additionally, the percentage of EdU+ PMN in the ischemic hemisphere was similar to the percentage of EdU+ PMN in circulation at 24 h post stroke, suggesting PMN recruitment centers around 24 h.Conclusions:Our findings demonstrate PMN recruitment and infiltration post stroke evolves over several days. This data suggests that the majority of PMNs are recruited to the infarct within the first 48 hours and likely can persist within the infarct for days. Modulating the timing of PMN labeling via EdU can lead to a better understanding of PMN spatiotemporal infiltration and persistence and will help inform future therapeutic interventions targeting leukocytes.

Stroke, Volume 56, Issue Suppl_1, Page AHUP12-AHUP12, February 1, 2025. Introduction:The African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) study is focused on developing an integrated mHealth community-based interactive Stroke Information and Surveillance System. This is the first paper to qualitatively investigate and contrast community beliefs, attitudes, and practices related to stroke prevention, risk factors and care from alternative/complementary medicine providers/healers, orthodox/modern medicine/health care providers, community members and leaders in Nigeria.Methods:Six focus groups with community members and leaders (n=57) and key informant interviews with health providers (n=24) from alternative/complementary medicine providers and orthodox/modern medicine providers were conducted to qualitatively explore beliefs, attitudes, practices, and recommendations related to stroke in urban (Ibadan) and rural (Ibarapa) communities in Nigeria. The Health Belief Model and Social Ecological Model guided the questions and thematic analysis of the qualitative data.Results:Participants perceived stroke as disabling though manageable but with odds of repeat stroke for survivors. High blood pressure, stress, sleep issues, heredity, and lifestyle factors were some stroke risk factors perceived by participants from both sites although God, witchcraft/evil people were reported by rural participants. Hospital visits and consumption of herbal concoction, self-medication and visit to church for prayers were some actions taken to manage stroke by both urban and rural participants. Low literacy levels, limited funds, fear of and distance to hospitals, and absence of insurance were some barriers to uptake of recommendations from orthodox medicine practitioners which are drivers to unorthodox practitioners. To improve stroke care and prevention across communities, free risk factor screening, indigenous stroke awareness programs via print, audio-visual and electronic media were suggested by all participants.Conclusion:Diverse beliefs and practices are related to stroke risk factors, prevention and care and barriers with obtaining care. There is need to work across systems to improve stroke prevention and care in communities.

Stroke, Volume 56, Issue Suppl_1, Page AWMP36-AWMP36, February 1, 2025. Introduction:ICD-10 codes are often used for stroke research in administrative databases. Few studies have assessed their reliability in large, representative populations of the United States. We validated ICD-10 codes in a large population-based study of stroke in the Greater Cincinnati/Northern Kentucky (GCNK) region.Methods:We ascertained all acute strokes in the GCNK region during 2020 using validated methodology. All hospitalizations were screened using a comprehensive list of ICD codes in any diagnosis position (G45-46/H34/I60-69). Additional cases were captured through cold pursuit. Each case was adjudicated by a stroke-trained physician. Only acute ischemic stroke (AIS) and hemorrhagic strokes (HS, defined as intracerebral hemorrhage or subarachnoid hemorrhage) were included in this analysis. We examined how many AIS cases were identified using the standard codes used for administrative studies (G46/I63), assessing their sensitivity and positive predictive value (PPV) in the primary or secondary positions. A similar analysis was conducted using standard HS codes (I60/I61). Differences in the demographics of cases identified with standard codes in the primary position, standard codes in the secondary position, or through other methods were then evaluated with Chi-squared and Kruskal-Wallis tests.Results:We identified 3,522 AIS/HS events in 2020. For AIS (Table 1), we found that standard codes in the primary position had a sensitivity of 72.8% and a PPV of 89.1%. When the standard AIS codes were considered in any diagnosis position, sensitivity improved to 89.3%, but PPV decreased to 82.3%. For HS, standard codes in the primary position had a sensitivity of 80.0% and a PPV of 81.0%. When the standard HS codes were considered in any position, the sensitivity improved to 93.4% but the PPV decreased to 54.4%. When looking at baseline characteristics (Table 2), patients identified through a standard code in the primary position had a lower baseline mRS (overall P

Stroke, Volume 56, Issue Suppl_1, Page AWMP60-AWMP60, February 1, 2025. Background:MOST (Multi-arm Optimization of Stroke Thrombolysis) was a multicenter, randomized controlled trial of adjuvant argatroban, eptifibatide, or placebo in moderate to severe acute ischemic stroke patients who received intravenous thrombolysis within three hours of stroke onset. We compared protocol deviations between participants consented using conventional paper informed consent documents (ICDs) versus electronic informed consent (eConsent).Methods:MOST began in 2019 and was completed in 2023. When obtaining informed consent, research teams could elect to use conventional paper ICDs or an eConsent platform managed centrally by the NIH StrokeNet. We studied informed consent-related data clarification requests (DCRs) and reportable unanticipated events (UE) (i.e. protocol deviations). Data for all modalities of consent (paper-in person, paper-remote, eConsent-in person, eConsent-remote) were collected in WebDCU™. REDCap was used as a repository for completed eConsents. We used Chi-squared and Kruskal Wallis tests to detect differences between consent modalities and stratified by whether they were remote or in-person. Two authors reviewed UEs to determine if they were consent-related and to categorize themes; in cases of disagreement a third reviewer adjudicated the final decision.Results:The rate of DCRs and UEs per 100 enrollments for each consent modality is shown in Table 1. Pairwise testing revealed that eConsent-in person had significantly less DCRs than both paper-in person and eConsent-remote (p