Search Results for: Follow-up ottimale dopo embolia polmonare acuta

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.

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

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.

Introduction
The incidence of recurrent implantation failure (RIF) can reach up to 10% among patients undergoing in vitro fertilisation and embryo transfer worldwide. However, the clinical efficacy of low-molecular-weight heparin (LMWH) in RIF remains a subject of controversy. Currently, there is a lack of high-quality clinical research validating the effectiveness of LMWH in treating patients with RIF, particularly during frozen embryo transfer (FET) cycles. Therefore, this randomised controlled trial aimed to investigate the impact of LMWH on pregnancy outcomes in women with RIF undergoing FET.

Methods and analysis
This prospective, single-centre, double-blind randomised, placebo-controlled clinical trial will be conducted in the Second Hospital of Shandong University, China. A total of 414 women with RIF, aged ≤40 years, who are undergoing FET cycles will be recruited and randomly assigned to the study group (LMWH) or the control group (placebo). Only one blastocyst which is from day 5 or day 6 and has a Gardner morphology score ≥4 BC will be transferred. LMWH 4000–6000 IU per day or placebo will be administered by subcutaneous injection from the day of transplantation. The primary outcome is the live birth rate. The secondary outcomes include the clinical pregnancy rate, biochemical pregnancy rate, embryo implantation rate, early miscarriage rate, ongoing pregnancy rate, ectopic pregnancy rate, pregnancy-related complications, perinatal complications, fetal birth weight, congenital malformations and other adverse reactions.

Ethics and dissemination
The protocol received approval from the Ethics Committee of the Second Hospital, Cheeloo College of Medicine, Shandong University (KYLL-2023-442). The findings will be disseminated in peer-reviewed publications.

Trial registration number
Chinese Clinical Trial Registry, ChiCTR2400083577.

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
Prompt recognition and treatment of patients with sepsis improve survival. Patients transported to hospital with sepsis often do not receive treatment until they are assessed in emergency departments. Initiation of treatments by paramedics at the point of first contact may improve outcomes for these patients.

Methods and analysis
The study design involves two randomised controlled trials (RCTs) conducted using a 2×2 factorial design comparing use of (1) early intramuscular ceftriaxone versus placebo and (2) an early liberal intravenous fluid strategy (up to 2 L normal saline) versus usual care resuscitation guided by paramedic medical directives. Patients who are ≥18 years of age will be eligible for inclusion if they have sepsis, defined as (1) paramedic suspicion of infection, (2) fever (temperature ≥38.0°C measured by paramedic or history of fever during the previous 24 hours), and (3) hypotension: SBP 250 mL) within 24 hours of hospital arrival; total amount of crystalloid infused during transport and first 24 hours of hospitalisation; and proportion of enrolled patients not suspected to have sepsis or infection by emergency department physicians. Safety outcomes include the proportion of patients with pulmonary oedema during transport to hospital and on initial chest X-ray and the proportion of patients with anaphylaxis or suspected allergic reactions to study medication.

Ethics and dissemination
This study has been approved through Clinical Trials Ontario’s streamlined ethics review process (board of record, Sunnybrook Health Sciences Centre). It will be conducted in accordance with the Declaration of Helsinki, Good Clinical Practice guidelines and regulatory requirements. The final results will be disseminated to participating paramedic services through educational materials, presentations and interactive training. We anticipate our trial will achieve wide dissemination through publication in a peer-reviewed medical journal and presentation at international conferences targeting the fields of prehospital and emergency medicine, resuscitation and critical care.

Trial registration number
NCT03068741.

Objectives
Patient activation (PAct)—a measure assessing an individual’s perceived knowledge, skills and confidence in managing their health and well-being—is often used to personalise and evaluate care, although its causal link to self-management behaviours (SMBs) and clinical outcomes remains uncertain. We aimed to synthesise the evidence on the causal association between PAct, SMBs and clinical outcomes in type 2 diabetes (T2D).

Design
Systematic review and narrative synthesis of data summarised in a harvest plot.

Data sources
We searched Medline, Embase, CENTRAL, PsycInfo, Web of Science and CINAHL up to April 2024 for relevant English articles.

Eligibility criteria
We included studies of any quantitative design that reported on the association of PAct with clinical outcomes or SMBs in adult patients with T2D.

Data extraction and synthesis
Two independent reviewers were involved, and any disagreements were discussed and resolved collaboratively. Risk-of-bias (RoB) was assessed using an adapted RoB Assessment Tool for Nonrandomised Studies. Levels of evidence were evaluated for each T2D-related outcome.

Results
We identified 21 studies published between 2009 and 2023, including 15 cross-sectional studies and no randomised controlled trials. Eleven studies were conducted in the USA. Seventeen studies used the Patient Activation Measure questionnaire. There is moderate evidence that higher PAct scores are associated with better glycated haemoglobin levels (studies reporting on this association, n=14). There is very limited evidence that PAct improves diet (n=5) and physical activity (n=6). All other clinical outcomes and SMBs had inconclusive results due to either inconsistent or insufficient evidence, or both.

Conclusion
A causal relationship between PAct, clinical outcomes and SMBs in T2D cannot be established due to inconsistent evidence and a lack of high-quality studies. Thus, the use of PAct scores as a tailoring tool and an outcome measure in healthcare services requires further evaluation.

PROSPERO registration number
CRD42021230727.

Introduction
Heart failure with preserved ejection fraction (HFpEF) is common and causes functional limitation, poor health-related quality of life (HRQoL) and impairs prognosis. Exercise-based cardiac rehabilitation is a promising intervention for HFpEF, but there is currently insufficient evidence to support its routine use. This trial will assess the clinical and cost-effectiveness of a 12-week health professional-facilitated, home-based rehabilitation intervention (REACH-HF), in people with HFpEF, for participants and their caregivers.

Methods and analysis
REACH-HFpEF is a parallel two group multicentre randomised controlled trial with 1:1 individual allocation to the REACH-HF intervention plus usual care (intervention group) or usual care alone (control group) with a target sample size of 372 participants with HFpEF and their caregivers recruited from secondary care centres in United Kingdom. Outcome assessment and statistical analysis will be performed blinded; outcomes will be assessed at baseline and 4-month and 12-month follow-up. The primary outcome measure will be patients’ disease-specific HRQoL, measured using the Minnesota Living with Heart Failure questionnaire, at 12 months. Secondary outcomes include patient’s exercise capacity, psychological well-being, level of physical activity, generic HRQoL, self-management, frailty, blood biomarkers, mortality, hospitalisations, and serious adverse events, and caregiver’s HRQoL and burden. A process evaluation and substudy will assess the fidelity of intervention delivery and adherence to the home-based exercise regime and explore potential mediators and moderators of changes in HRQoL with the intervention. Qualitative studies will describe facilitators’ experiences of delivery of the intervention. A cost-effectiveness analysis (CEA) of the REACH-HF intervention in participants with HFpEF will estimate incremental cost per quality-adjusted life year at 12 months. The CEA will be conducted from a UK NHS and Personal Social Services perspective and a wider societal perspective. The adequacy of trial recruitment in an initial 6-month internal pilot period will also be checked.

Ethics and dissemination
The study is approved by the West of Scotland Research Ethics Committee (ref 21/WS/0085). Results will be disseminated via peer-reviewed journal publication and conference presentations to researchers, service users and policymakers.

Trial registration number
ISRCTN47894539.

Introduction
Amyotrophic lateral sclerosis (ALS) is a devastating illness that leads to muscle weakness and death usually within around 3 years of diagnosis. People with ALS (pwALS) often lose weight due to raised energy requirements and symptoms of the disease presenting significant challenges to taking adequate oral diet, with those who lose more weight being at a greater chance of earlier death. There is also some evidence to suggest that a higher calorie diet may benefit the disease course in pwALS, but further research is needed.

Methods and analysis
Two armed, parallel group, superiority, open labelled, randomised controlled trial, with internal pilot, to assess the effectiveness of an early high calorie diet on functional outcomes in ALS, comprising two treatment arms: (1) standard care, (2) standard care with additional active management using the OptiCALS complex intervention to achieve a high calorie diet (initially randomised 1:1, then 1:2 following a protocol amendment). Using a food first approach, pwALS will be encouraged and supported to follow a diet that meets an individualised calorie target from food before prescribing oral nutritional supplements. 259 pwALS will be recruited from up to 20 ALS centres across the United Kingdom and Ireland and followed up for a period of 12 months. Primary outcome is functional change measured over 12 months, using the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale. Secondary end points include measures of functional health, quality of life, calorie intake and weight, as well as time to gastrostomy and survival. A health economic analysis and process evaluation will also be undertaken. Participant recruitment is expected to complete in September 2025, and participant follow-up is expected to complete in September 2026. The results of this study are expected in March 2027.

Ethics and dissemination
The trial was approved by Greater Manchester—North West Research Ethics Committee, reference 20/NW/0334 on 8 September 2020. We will publish the study findings in peer-reviewed academic journals and present at local, national and international conferences where possible.

Trial registration number
ISRCTN30588041.

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.

Introduction
Adenoid hypertrophy has a high prevalence in children, often causing early orofacial muscle dysfunction that worsens facial deformities over time. While adenoidectomy (AT) alleviates airway obstruction, it only partially addresses the condition, leaving persistent neuromuscular habits. Orofacial myofunctional therapy is necessary for post-AT recovery but faces challenges such as poor adherence and ineffective parent-child communication. Dyadic interventions, which actively involve both parents and children, have shown advantages in improving treatment adherence and enhancing orofacial muscle function. Evidence suggests that dyadic intervention addresses both the child’s recovery needs and the caregiving capacity of parents, offering a more comprehensive solution for long-term intervention. Therefore, our team developed a parent-child dyadic orofacial myofunctional therapy (PCD-OMT) programme, offering insights into its potential application in paediatric healthcare to support comprehensive family-centred care.

Method and analysis
This two-arm, parallel-design, randomised controlled trial will recruit 80 dyads whose children performed AT from two hospitals in Qingdao, China. Dyads will be randomly allocated to two arms. Dyads randomly assigned to the intervention group will receive the PCD-OMT programme. Dyads randomly assigned to the control group will receive regular care. The primary outcomes are orofacial myofunction in children and parental care abilities. The secondary outcomes are children’s engagement and parental functioning. A feasibility and acceptability process will be employed to evaluate the viability in clinical practice. Outcomes will be collected at three checkpoints: baseline (T0), postintervention (T1) and after a 12-week follow-up phase (T2).

Ethics and dissemination
This study was approved by the Ethics Committee of Medical College of Qingdao University (QDU-HEC-2023216). The results will be published in peer-reviewed publications and presented in international conferences.

Trial registration number
ChiCTR2400091466.

Objectives
This study aimed to develop risk prediction equations for the 5-year incidence of diabetes among the Japanese population using health check-up data. We hypothesised that demographic and laboratory data from health check-ups could predict diabetes onset with high accuracy.

Design
Retrospective cohort study.

Setting
Data from a health examination in Japan between 2008 and 2016.

Participants
Data were analysed from 31 084 participants aged 30–69 years. The presence of baseline diabetes and endocrine disease was included in the exclusion criteria, as were participants with missing data for the analysis. The study population was randomly divided into derivation and validation cohorts in a 1:1 ratio.

Primary outcome measures
The primary outcome was the incidence of diabetes at the 5-year follow-up, defined as a fasting blood glucose level ≥126 mg/dL, glycosylated haemoglobin A1c (National Glycohemoglobin Standardization Program (NGSP)) ≥6.5%, or initiation of diabetes treatment. Predictor variables included age, sex, body mass index, blood pressure, underlying diseases, lifestyle factors and laboratory measurements. The primary measure was the area under the receiver operating characteristic curve (AUC) for the predictive equations.

Results
In the derivation cohort, diabetes incidence was 5.0%. The prediction equation incorporating age, sex, body mass index, fasting blood glucose and glycosylated haemoglobin A1c showed good discriminatory ability with an AUC of 0.89, sensitivity of 0.81 and specificity of 0.81 in the validation cohort.

Conclusions
The equation with laboratory measures effectively predicted the 5-year diabetes risk in the general Japanese population. It has potential clinical utility for identifying individuals at high risk of diabetes and guiding preventive interventions.

Objectives
Our study was designed to assess whether paired normal-tumour testing increased access to targeted therapy, clinical trials and influenced cancer screening recommendations given to patients and their families.

Design
Prospective cohort study.

Setting
Academic cancer centre in the Pacific Northwest region of the USA.

Participants
Patients newly diagnosed between 01 January 2021 and 31 December 2022 with cancers of the oesophagus, gastro-oesophageal junction and stomach (CEGEJS) were included. All other cancer diagnoses such as head and neck, duodenal and lower gastrointestinal tract cancers were excluded.

Intervention
Paired germline and tumour genetic test within 90 days of new patient visit.

Primary outcome measures
Number of targeted therapies received (or not) when eligible, follow-up treatment data and number of inherited predispositions to cancers identified. No secondary outcome measures.

Results
Of 42 patients, 32 (76.2%) were eligible for at least one targeted therapy. 19 patients received immunotherapy, when 16 had a biomarker predicting immunotherapy benefit, and benefit of immunotherapy was unclear for 3. Another 11 did not have this biomarker, and 6 of them received immunotherapy. Six pathogenic variants were identified in four high-risk genes. By 01 January 2024, 18 patients (42.9%) had died of complications of cancer.

Conclusion
More than 75% of patients who received tumour testing were eligible for a targeted therapy regardless of their stage at diagnosis, emphasising the need to expand access to testing with staging workup to improve survival outcomes. Six families received personalised screening recommendations, thanks to this study.

To the Editor A recent trial reported that camrelizumab in combination with chemotherapy significantly improved the pathological complete response (pCR) compared with placebo in combination with chemotherapy among patients with early or locally advanced triple-negative breast cancer (TNBC), with pCR rates of 56.8% vs 44.7%, respectively. However, the 18-month event-free survival rates were 86.6% vs 83.6% (hazard ratio, 0.80 [95% CI, 0.46-1.42]), showing no statistical significance, and the wide CI indicates that the study had a relatively short follow-up period and immature survival data.