Risultati per: Follow-up ottimale dopo embolia polmonare acuta

Stroke, Volume 55, Issue Suppl_1, Page A137-A137, February 1, 2024. Introduction:Within 5 years of a stroke, approximately 25% of patients will have a recurrent event. Blood pressure (BP) reduction can reduce this risk; every 10 mmHg decrease in systolic BP is associated with a 20% risk reduction. Despite this benefit, 50% of patients with hypertension remain uncontrolled after a stroke. Reasons for poor control may be related to poor post-stroke follow up care. We aim to quantify post-stroke BP control and follow up in a large health system.Methods:We performed a retrospective analysis of patients with stroke admitted to Yale New Haven Health System (YNHHS) between 2013-2021. YNHHS has 5 hospitals and a large outpatient network. Eligible patients included those who received primary care within YNHHS, were discharged alive, and not on dialysis. We analyzed patient features, time to outpatient encounter, and vital signs. The primary outcome was uncontrolled BP ( >140/90) obtained during the office visit closest to and before 6 months from the date of discharge.Results:During the study period 12,561 patients were admitted with stroke to YNHHS. After exclusions, the final cohort was 2,867 patients. Among these patients, 48 % were male, 65% non-Hispanic White, 22% non-Hispanic Black, 9% Hispanic, and 4% other. Mean (standard deviation) age was 68 (12) years. Approximately 25% of patients had uncontrolled BP. When the updated ACC/AHA (2017) BP goal (2 follow up visits. The median (interquartile range [IQR]) number of days to first visit with a PCP or neurologist was 30 (10-97) days and 45 (27-99) days, respectively. The median (IQR) number of visits with either a PCP or neurologist was 0 (0-2).Conclusion:Among patients with recent stroke, more than half do not achieve BP control per current guidelines. The majority of patients do not engage with a PCP or neurologist within 6 months following a stroke, even though they have an established provider within the system. Gaps in follow up represents a notable opportunity for improving post-stroke care.

Stroke, Volume 55, Issue Suppl_1, Page AWP16-AWP16, February 1, 2024. Introduction:Trials using advanced imaging have shown a benefit from intravenous thrombolysis in patients with wake-up stroke, but real-world data is limited. This study presents data on outcomes in patients presenting with wake-up stroke at a comprehensive stroke center comparing those who received thrombolysis to those who did not.Methods:In February 2022, our institution implemented a wake-up stroke protocol utilizing emergent MRI-based evaluation for possible thrombolysis. The protocol combines clinical criteria (suspected ischemic stroke with disabling neurologic deficits; last known normal within 12 hours; time from symptom discovery to arrival within 4.5 hours) and imaging criteria (absence of proximal large vessel occlusion; FLAIR-DWI mismatch; signal intensity ratio < 1.15 in those able to receive perfusion imaging). In this study, we compared discharge outcomes and hospital length of stay for patients with ischemic stroke selected for wake-up protocol with vs. without thrombolytic therapy. In addition, we assessed the proportion of patients with reversibility of diffusion restriction, defined as a decrease in infarct volume on ADC sequence between the pre-treatment to 24-hour post-treatment MRI.Results:Between February 2022 & June 2023, there were 31 wake-up stroke activations (~2 per month). Median admission NIHSS was 6. 30% had medium or distal vessel occlusions. 71% of stroke activations had a final diagnosis of ischemic stroke; 32% of cases were eligible per protocol and treated with thrombolysis. Compared to patients diagnosed with ischemic stroke but not eligible for treatment, those treated with thrombolysis were more likely to be discharged home (70% vs. 17%, p = 0.02) and had a shorter hospital stay by ~1.5 days (mean LOS 3.6 days vs. 4.8 days; median LOS 3 days vs. 4.5 days; p

Stroke, Volume 55, Issue Suppl_1, Page ATP185-ATP185, February 1, 2024. Introduction:The Resolute Onyx stent has shown promise as an effective treatment for symptomatic intracranial atherosclerotic disease (sICAD), with positive clinical outcomes and low procedural complication rates. However, previous studies were limited by small sample sizes and lacked long-term follow-up.Methods:In this retrospective analysis, we examined patients who underwent Resolute Onyx stent placement for sICAD. Primary outcomes included stroke, intracerebral hemorrhage (ICH), and mortality rates at 1-, 6-, 12-, and 18-month follow-ups, and in-stent restenosis. Multivariable logistic regression identified predictors of stroke and mortality. Subgroup analyses assessed patients who underwent stenting at least 8 days after the qualifying event to ensure comparability with WEAVE registry data.Results:Our study included 77 patients with 84 procedures. The mean age was 61.9±13.0, with 35% being female. The median time from qualifying event to procedure was 5 days (IQR: 2-11). Among adherent patients, no disease-related deaths occurred after the first month. However, one ICH and two strokes occurred within 6 and 12 months, respectively. Comparison of WEAVE-matched and non-matched patients revealed no significant difference in complications during short- and long-term follow-up. Postprocedural complications within 72 hours were

Stroke, Volume 55, Issue Suppl_1, Page ATP176-ATP176, February 1, 2024. Background:High-risk non-stenosing carotid plaque features are emerging as a possible source of embolism in the setting of ESUS. Unless there is a hemodynamically significant stenosis, neuroradiology reports tend to be rarely descriptive of these features.Methods:In our previous study published in September 2022, we analyzed a patient sample drawn from the stroke registry of the HFHS between June 2016 and June 2021. Our results showed a higher incidence of high-risk plaque features including plaque ulceration (19.08% vs 5.26%, p3mm: (19.08% vs 7.24%, p=0.001), and length >1cm (13.16% vs 5.92%, p=0.0218) ipsilateral to ESUS. In this subsequent study, we utilized the same patient dataset and used CTA reports on EPIC to explore how frequently neuroradiologists had mentioned those features. We utilized Fisher’s exact test to compare the frequencies of reporting each plaque characteristic.Results:We analyzed 152 CTA reports in depth. Our findings indicate that the frequency of reporting plaque ulceration compared to the frequency of reporting plaque calcification was significantly different (8.1% vs 100%, p< 0.00001), this is also noticed with plaque length (4.6%, p< 0.00001) and soft plaques (72.1%, p< 0.00001). Notably, none of the CTA reports had commented on any plaque thickness or the presence of any “high-risk” features when encountering stroke ipsilaterally.Conclusion:When carotid plaques are not causing hemodynamically significant stenosis, neuroradiology reports frequently mention the density of plaques, but unfortunately overlook other characteristics. It is essential to conduct algorithms, scoring systems and prediction models to determine which plaque features are highly associated with embolism. These models should help prioritize the description of these features, alongside commonly reported metrics such as plaque density and the degree of stenosis.

Stroke, Volume 55, Issue Suppl_1, Page AWP50-AWP50, February 1, 2024. Introduction:Transition of care (TOC) to home for many stroke patients is suboptimal. Recent studies estimate 30-day all-cause readmission of stroke patients at 17.4%. The Wisconsin (WI) Coverdell Stroke Program partnered with the Milwaukee Fire Department- Mobile Integrated Health Program (MFD-MIH) and Milwaukee County hospitals three times since January 2019. The aim of our MIH focused partnership was to improve follow up care and care coordination after an acute stroke hospitalization to a vulnerable urban population.Methods:A charter, project algorithm, and referral forms were created to guide our work. Patient referral forms and MFD-MIH home visit summaries were sent via secure email. Upon receiving a home visit referral from the hospital MFD-MIH attempted to engage the patient within two business days. After a completed visit, MFD-MIH sent a summary form to the referring hospital mimicking post-discharge data metrics in Get With The Guidelines® (GWTG). Upon receiving the summary form, hospital abstractors entered the data into GWTG. The data was then analyzed by the Coverdell team.Results:As of May 2023, 73 stroke patients have received a home visit from MIH-MFD with data entry in GWTG. Analysis of the third iteration of the program will occur after it ends in April 2024. We compared our first two MIH projects to all Wisconsin hospitals entering into the GWTG Post-Discharge tab. Our results showed:• Coverdell MIH hospitals outperform WI hospitals inBlood Pressure Monitoring by PatientandAppointment Scheduled Prior to Discharge• Coverdell MIH hospitals underperform WI hospitals inED Visits,Falls Reported by Patient,Medication StoppageandTobacco UseConclusions:Many factors influenced our data. First, the population in the Coverdell MIH program was from an urban environment with more proximate post-discharge resources. All WI hospitals do not share this setting. Secondly, MIH data collection involves an in-person home visit. Conversely, WI hospitals data collection occurred via a phone call or chart review. The Coverdell MIH method facilitates a collegial environment where more truthful disclosures may result.

Introduction
The population-based Inter99 cohort has contributed extensively to our understanding of effects of a systematic screening and lifestyle intervention, as well as the multifactorial aetiology of type 2 diabetes (T2D) and cardiovascular disease. To understand causes, trajectories and patterns of early and overt cardiometabolic disease manifestations, we will perform a combined clinical deep phenotyping and registry follow-up study of the now 50–80 years old Inter99 participants.

Methods and analysis
The Inter99 cohort comprises individuals aged 30–60 years, who lived in a representative geographical area of greater Copenhagen, Denmark, in 1999. Age-stratified and sex-stratified random subgroups were invited to participate in either a lifestyle intervention (N=13 016) or questionnaires (N=5264), while the rest served as a reference population (N=43 021). Of the 13 016 individuals assigned to the lifestyle intervention group, 6784 (52%) accepted participation in a baseline health examination in 1999, including screening for cardiovascular risk factors and prediabetic conditions. In total, 6004 eligible participants, who participated in the baseline examination, will be invited to participate in the deep phenotyping 20-year follow-up clinical examination including measurements of anthropometry, blood pressure, arterial stiffness, cardiometabolic biomarkers, coronary artery calcification, heart rate variability, heart rhythm, liver stiffness, fundus characteristics, muscle strength and mass, as well as health and lifestyle questionnaires. In a subsample, 10-day monitoring of diet, physical activity and continuous glucose measurements will be performed. Fasting blood, urine and faecal samples to be stored in a biobank. The established database will form the basis of multiple analyses. A main purpose is to investigate whether low birth weight independent of genetics, lifestyle and glucose tolerance predicts later common T2D cardiometabolic comorbidities.

Ethics and dissemination
The study was approved by the Medical Ethics Committee, Capital Region, Denmark (H-20076231) and by the Danish Data Protection Agency through the Capital Region of Denmark’s registration system (P-2020-1074). Informed consent will be obtained before examinations. Findings will be disseminated in peer-reviewed journals, at conferences and via presentations to stakeholders, including patients and public health policymakers.

Trial registration number
NCT05166447.

Background
Although the non-alcoholic fatty liver disease (NAFLD) is prevalent in the general population, NAFLD risk in newly diagnosed rheumatoid arthritis (RA) has rarely been explored. In this population-based cohort, we examined NAFLD risk in patients with RA and identified the potential risk factors.

Design
Retrospective study.

Setting
Taiwan.

Participants
2281 newly diagnosed patients with RA and selected 91 240 individuals without RA to match with patients with RA (1:40) by age, gender, income status and urbanisation level of the residence.

Outcomes
In this retrospective study using the 2000–2018 claim data from two-million representative Taiwanese population, we identified and compared the incidence rates (IRs) of NAFLD and alcoholic fatty liver disease (AFLD) between RA and non-RA groups. Using multivariable regression analyses, we estimated adjusted HR (aHR) of NAFLD development in patients with RA compared with individuals without RA, with 95% CIs.

Results
The incidences of NALFD and AFLD were not significantly different between individuals with RA and without RA during the 17-year follow-up period. However, patients with RA had significantly increased NAFLD risk during the first 4 years after RA diagnosis, with IR ratio of 1.66 fold (95% CI 1.18 to 2.33, p

Artificial Intelligence (AI) has notably transformed the realm of healthcare, especially in diagnosing and treating Inflammatory Bowel Disease (IBD) and other digestive disorders. Essential AI tools, such as ChatGPT and Google Bard, can interpret endoscopic imagery, analyze diverse samples, simplify administrative duties, and assist in assessing medical images and the automation of devices. By individualizing treatments and forecasting adverse reactions, these AI applications have notably enhanced the management of digestive diseases.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/policies-and-standards/article-withdrawal).

In this narrative medicine essay, a first-year medical student contrasts the life of her young daughter with the older cadaver that she dissects and explores in her anatomy laboratory.

Objective
To investigate how changes in levels of physical activity (PA) in regard to acute disease severity relate to perceived difficulties in performing daily life activities 18 months after COVID-19 infection.

Design
An observational study with an 18-month follow-up survey based on registry data from a national cohort.

Participants
5464 responders to the 18-month follow-up survey of a Swedish national cohort of 11 955 individuals on sick leave due to COVID-19 during the first wave of the pandemic.

Outcomes
The follow-up survey included questions on daily life activities, as well as present and retrospective level of PA. Changes in PA level from before COVID-19 to follow-up were assessed by the Saltin-Grimby PA Level Scale and analysed by the Wilcoxon signed-rank test. Comparisons of groups were analysed by the Student’s t-test, Mann-Whitney U test and 2. Multiple binary logistic regression was performed to assess the association of changes in PA with perceived difficulties in performing daily life activities.

Results
Among the 5464 responders (45% of national cohort), the PA level decreased. Hospitalised individuals had a lower PA level both prior to COVID-19 (p=0.035) and at the 18-month follow-up (p=0.008) compared with non-hospitalised responders. However, the level of PA decreased in both groups. A decrease in PA level increased the odds (OR 5.58, 95% CI 4.90 to 6.34) of having difficulties performing daily life activities.

Conclusions
PA levels were reduced 18 months after COVID-19 infection. A decrease in PA over that time was associated with perceived difficulties performing daily life activities 18 months after COVID-19. As PA is important in maintaining health and deconditioning takes time to reverse, this decline may have long-term implications for PA and health.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Over the past 2 decades, there have been significant advancements in early detection and treatment of colorectal cancer (CRC), resulting in improved survival rates across all stages. It is estimated that, as of January 1, 2022, there were more than 1.4 million CRC survivors in the United States. Unfortunately, approximately 30% of patients with stage I to III CRC still experience recurrences after curative-intent surgical resection of the primary tumor, presenting challenges for follow-up care.

New England Journal of Medicine, Volume 389, Issue 26, Page 2413-2424, December 2023.

Objective
To report and compare psychological distress as symptoms of anxiety, depression and post-traumatic stress among intensive care units’ (ICU) nurses, physicians and leaders at 12 months after the baseline survey (spring 2020), during the COVID-19 pandemic in Norway. Furthermore, to analyse which baseline demographic and COVID ICU-related factors have a significant impact on psychological distress at 12 months.

Design
Prospective, longitudinal, observational cohort study.

Setting
Nationwide, 27 of 28 hospitals with COVID ICUs in Norway.

Participants
Nurses, physicians and their leaders. At 12 month follow-up 287 (59.3%) of 484 baseline participants responded.

Primary and secondary outcome measures
Symptoms of anxiety and depression using the Hopkins Symptoms Checklist-10 (HSCL-10). Symptoms of post-traumatic stress using the post-traumatic stress disease checklist for the Diagnostic and Statistical Manual of Mental Disorders 5 (PCL-5).
Demographics (included previous symptoms of anxiety and depression) and COVID ICU-related factors (professional preparations, emotional experience and support) impacting distress at 12 months.

Results
Psychological distress, defined as caseness on either or both HSCL-10 and PCL-5, did not change significantly and was present for 13.6% of the participants at baseline and 13.2% at 12 month follow-up. Nurses reported significantly higher levels of psychological distress than physicians and leaders. Adjusted for demographics and the COVID ICU-related factors at baseline, previous symptoms of depression and fear of infection were significantly associated with higher levels of anxiety and depression at 12 months. Previous symptoms of depression, fear of infection and feeling of loneliness was significantly associated with more symptoms of post-traumatic stress.

Conclusion
One year into the COVID-19 pandemic 13.2% of the ICUs professionals reported psychological distress, more frequently among the nurses. Fear of infection, loneliness and previous symptoms of depression reported at baseline were associated with higher levels of distress. Protective equipment and peer support are recommended to mitigate distress.

Trial registration number
ClinicalTrials.gov. Identifier: NCT04372056.