Search Results for: Linee guida ESC/ERS 2022 per la diagnosi e il trattamento dell'ipertensione polmonare

From 2012 through 2022, rates of drug-resistant infections decreased among hospitalized U.S. patients, with significant variability by pathogen and region.

Objectives
Hospital workers face multiple biopsychosocial stressors in the course of their work, which could potentially be addressed by social prescribing of horticultural activities. However, the effectiveness of such interventions has not been evaluated. We conducted a qualitative study to understand the perceptions of participants and organisers of a horticulture-based social prescribing intervention for staff (SP4S-H) in three community hospitals in Singapore.

Design
The RE-AIM Planning and Evaluation Framework was used to develop our semistructured interview guides and guided our thematic analysis. Indepth interviews were conducted with subsequent transcribing, coding and iterative analysis until thematic saturation was reached.

Setting
Three community hospitals in Singapore, between May 2022 and June 2024.

Participants
26 hospital staff.

Results
SP4S-H was perceived to have a positive impact on staff, including increasing their knowledge on horticulture, team bonding, positive emotions and self-help skills. Barriers to participation included participants preferring not to spend time outside working hours (ie, lunch hours) for SP4S-H or attending physical meetings. Appealing to the interest of staff, overcoming barriers in their attendance, organising the events and improving the working culture of participants were found to influence the reach, implementation and sustainability of SP4S-H.

Conclusion
SP4S-H was perceived to be beneficial by hospital workers in improving social connectedness and their ability to cope with stress. The importance of having the support of senior management, adequacy of resources and deliberate staff engagement in rolling out this initiative cannot be underestimated.

Although the drug overdose death rate in the US remains higher than in any other country, the rate decreased by 4% from 2022 to 2023, according to National Vital Statistics System data from the US Centers for Disease Control and Prevention.

Objective
The UK government’s response to the COVID-19 pandemic included a ‘test, trace and isolate’ strategy. Testing services for healthcare workers, care homes and schools accounted for the greatest spend and volume of tests. We reviewed relevant literature to identify common and unique barriers and facilitators to engaging with each of these testing services.

Design
Scoping review.

Search strategy
PubMed, Scopus and the WHO COVID-19 Research Database were searched for evidence published between 1 January 2020 and 7 November 2022. This was supplemented by evidence identified via free-text searches on Google Scholar and provided by the UK Health Security Agency (UKHSA).

Data extraction and synthesis
Data were extracted by a team of reviewers and synthesised thematically under the broad headings of perceptions, experiences, barriers and facilitators to engaging with the COVID-19 testing programme.

Results
This study included 40 sources, including 17 from projects that informed UKHSA’s decisions during the pandemic. Eight themes emerged and were used to categorise barriers and facilitators to engaging with the testing services for healthcare workers, care homes and schools: (1) perceived value, (2) trust in the tests and public bodies, (3) importance of infrastructure, (4) impact of media and social networks, (5) physical burden of the test, (6) perceived capability to undertake testing, (7) importance of relevant information and 8) consequences of testing.

Conclusions
Universal barriers and facilitators to engagement with the testing programme related to the core elements of each testing service, such as uncomfortable specimen collection and the influence of media and peers; these could be mitigated or leveraged to increase engagement across settings. However, the individuals involved, perceptions of value and available resources differed across services, leading to unique experiences between settings. Thus, consideration of context is crucial when designing and implementing a testing programme in response to a pandemic.

Analizzati 83 studi internazionali, hanno accuratezza del 50%

Nel 2024 6mila diagnosi in Italia, radioterapia strategia chiave

Nel 2024 6mila diagnosi in Italia, radioterapia strategia chiave

Objective
The aim of this exploratory study was to investigate the association between health anxiety and self-triage decisions among emergency department non-urgent patients.

Design
Cross-sectional single-centre study

Setting
Emergency department in the Princess Alexandra Hospital in Brisbane, Australia

Participants
Between 13 December 2022 and 30 August 2023, an exhaustive recruitment strategy was deployed to recruit 400 patients. Eligible participants were patients aged 18 years or above who belonged to the Australasian Triage Scale category four or five (non-urgent), were physically and mentally capable of participating in the study and presented to the emergency department between 6:00 a.m. and 23:00 p.m. during the study period.

Main outcome measures
The primary outcome was accurately self-triaged decisions, while the secondary outcome was inaccurately self-triaged decisions, including both overtriaged and undertriaged decisions. Self-triage decisions were assessed using six hypothetical medical scenarios.

Results
Regression results revealed that health anxiety was not associated with accurately self-triaged decisions. However, compared with non-urgent patients exhibiting no health anxiety, those in the third and fourth quartiles (the upper two quartiles) of the Whiteley Index-6 were expected to make 0·29 (95% CI 0·09 to 0·50) and 0·25 (95% CI 0·07 to 0·44) more overtriaged decisions (mean=0·42; SD=0·71), respectively. In contrast, negative associations between health anxiety and undertriaged decisions were observed. Subgroup analyses by age showed statistically significant associations between health anxiety and inaccurately self-triaged decisions among the older adult patient group (aged 35–79 years). Moreover, analyses stratified by sex revealed that female and male patients in the fourth quartile of the Whiteley Index-6 were expected to make 0·26 (95% CI 0·02 to 0·49) and 0·27 (95% CI 0·05 to 0·48) more overtriaged decisions, respectively, compared with those with no health anxiety.

Conclusions
Our results suggest no significant association between health anxiety and accurately self-triaged decisions. In contrast, health anxiety was associated with inaccurately self-triaged decisions. This implies that patients with health anxiety overestimate the need for healthcare and therefore could substantially impact the misuse of health services, particularly emergency departments.

Objective
To assess the inter-rater reliability of the Gothenburg direct observation tool-person-centred care in assessing healthcare professionals’ competency in delivering person-centred care (PCC).

Design
Observational, fully-crossed inter-rater reliability study.

Setting
The study was conducted between October and December 2022 at the participants’ homes or offices.

Participants and methods
Six health professionals individually rated 10 video-recorded, simulated consultations against the 53-item, 15-domain tool covering four major areas: PCC activities, clinician manner, clinician skills and PCC goals. Cronbach’s α was used to assess internal consistency. Intraclass correlations (ICC) and 95% CI were computed for the domains.

Results
Two domains (planning and documentation and documentation) were excluded from analyses due to insufficient evaluable data. Cronbach’s α was acceptable ( >0.70) for all evaluated domains. ICC values were high (ICC ≥0.75) for 11 of the 13 domains; however, CIs were generally wide and the lower bounds fell within the good range (ICC=0.60–0.74) for six domains and fair agreement (ICC=0.40–0.59) for the remaining six. The ICC for the domain patient perspective was non-informative due to its wide CIs (ICC=0.74 (0.39–0.92)).

Conclusion
ICC estimates for most domains were comparable to or exceeded those reported for similar direct observation tools for assessing PCC, suggesting that they may reliably be used in, for example, education and quality improvement applications. Reliability for the domains planning and documentation and documentation needs to be assessed in studies sampling more documentation behaviours. Reliability for the patient perspective domain may owe to methodological issues and should be reassessed in larger, better-designed studies.

Objective
To develop a rapid screening tool for the identification of frailty in medical calls and other out-of-hospital acute care services.

Design
Development study based on cross-sectional data. A set of potential items were developed based on existing frailty tools and other relevant literature by a panel with geriatric and primary care expertise. The items and the Clinical Frailty Scale (CFS) were administered on a convenience sample of older urgent care patients. Further development of the tool was based on statistical analyses of this data material and final discussions in the panel.

Setting
Urgent care centre in Norway, data collected between January and August 2022.

Participants
All patients ≥70 years were eligible for inclusion, with the exception of patients triaged to the highest urgency level and patients not able to answer questions with no next of kin present.

Primary outcome
Potential items associated with frailty by CFS, measured by explained variance (adjusted R2 values from linear regression analyses).

Results
Nine potential items were developed and administered on 200 patients (59% female), of whom 48% were 70–79 years, 38% were 80–89 years and 14% were ≥90 years. The median CFS score was 4 (living with very mild frailty). Receiving help weekly, being homebound and using a walking aid were identified as strong indicators of frailty (adjusted R2 values 59%, 48% and 43%, respectively). Together these three factors could explain 74% of the variation in CFS scores.

Conclusions
Receiving help weekly, being homebound and using a walking aid are strong indicators of frailty among urgent care patients. We developed a frailty screening tool for medical calls—FastFrail—consisting of three simple, binary questions (yes/no) on these aspects. We hypothesise that FastFrail can supplement traditional symptom-based triage and enable more accurate assessment of older adults calling for acute medical help. We intend to test the tool in clinical practice.

Circulation, Ahead of Print. The growing morbidity, mortality, and health care costs related to heart failure (HF) underscore the urgent need to prioritize its primary prevention. Whereas a risk-based approach for HF prevention remains in its infancy, several key opportunities exist to actualize this paradigm in clinical practice. First, the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America HF guidelines provided recommendations, for the first time, on the clinical utility of multivariable risk equations to estimate risk of incident HF. Second, the American Heart Association recently developed the PREVENT (Predicting Risk of Cardiovascular Disease Events) equations, which not only enable prediction of incident HF separately, but also include HF in the prediction of total cardiovascular disease. Third, the predominant phenotype of HF risk has emerged as the cardiovascular-kidney-metabolic syndrome. Fourth, the emergence of novel therapies that prevent incident HF (eg, sodium-glucose cotransporter-2 inhibitors) and target multiple cardiovascular-kidney-metabolic axes demonstrate growing potential for risk-based interventions. Whereas the concept of risk-based prevention has been established for decades, it has only been operationalized for atherosclerotic cardiovascular disease prevention to date. Translating these opportunities into a conceptual framework of risk-based primary prevention of HF requires implementation of PREVENT-HF (Predicting Risk of Cardiovascular Disease Events–Heart Failure) equations, targeted use of cardiac biomarkers (eg, natriuretic peptides) and echocardiography for risk reclassification and earlier detection of pre-HF, and definition of therapy-specific risk thresholds that incorporate net benefit and cost-effectiveness. This scientific statement reviews the current evidence for accurate risk prediction, defines strategies for equitable prevention, and proposes potential strategies for the successful implementation of risk-based primary prevention of HF.

Objective
On 6 February 2023, two massive earthquakes occurred in Kahramanmaras province in Türkiye. In addition to direct physical damage, earthquakes can also significantly affect individuals’ respiratory health in the postdisaster period. This study aimed to investigate respiratory diseases and related mortality following earthquakes.

Design
This is a retrospective observational study. 1 month following the earthquake, all cases that came to the emergency department between 6 February 2023 and 6 March 2023 who required a pulmonologist consultation were included (n=278). All cases requiring a pulmonologist consultation who were admitted to the emergency department within the same date period 1 year ago (6 February 2022–6 March 2022) were included in the control group (n=255).

Setting
Türkiye, Adana Province.

Outcome measures
Respiratory diseases, mortality risks in 3 weeks and 3 months, and factors that may affect mortality were investigated in the population exposed to the earthquake.

Results
Pneumonia had the highest rate among admissions in the postearthquake period (36.0%). The pneumonia rate and pneumonia-related deaths were significantly higher compared with those in the previous year (OR: 2.28, 95% CI: 1.05 to 4.94 and OR: 2.49, 95% CI: 1.15 to 5.39; 3-week and 3-month mortality, respectively). The disease that had the second highest admissions rate was chronic obstructive pulmonary disease exacerbation (25.9%). Earthquake exposure is associated with increased risk of 3-week (OR: 1.58, 95% CI: 1.03 to 2.43) and 3-month mortality (OR: 1.55, 95% CI: 1.03 to 2.36).

Conclusions
The period after the earthquake is associated with an increase in the incidence of pneumonia and a poor prognosis for patients with pneumonia. Considering all cases, earthquake exposure has a negative impact on the prognosis of respiratory diseases.

Objectives
This cross-sectional study aimed to assess parents’ knowledge, attitude and practice (KAP) towards myopia amidst increased children’s online course participation during the COVID-19 pandemic, potentially impacting visual health.

Design
The study adopted a cross-sectional design to analyse parent KAP regarding myopia.

Setting and participants
Conducted from 19 August 2022 to 19 October 2022, in the Jinan High-tech District, the study included 3261 participants, comprising 800 males (24.5%).

Interventions
A self-administered questionnaire assessed KAP, with a good KAP defined as a score >75% of the total.

Primary and secondary outcome measures
The KAP scores were the primary outcome measures. The factors associated with a practice score >75% were also investigated.

Results
Parents had mean KAP scores of 10.2±2.4 (10.2/14=72.9%), 41.8±4.9 (41.8/50=83.6%) and 54.3±7.1 (54.3/65=83.5%), respectively. The knowledge scores (OR 1.11, 95% CI 1.06 to 1.16, p