Search Results for: Il MMG e le cure palliative. Le cure del medico di famiglia ai malati in fine vita

This cluster randomized clinical trial compares the effect of a multicomponent intervention to initiate palliative care in the emergency department during a preintervention period vs a postintervention period on hospital admission, subsequent health care use, and survival in older adults with serious, life-limiting illness.

Palliative care has become standard in many inpatient settings, with about three-quarters of US hospitals currently offering such services. Although early integration of palliative care can yield substantial benefits for patients and their caregivers (eg, enhanced quality of life, psychological well-being, improved coping), the optimal timing and best clinical settings for initiating palliative care are not yet established.

Every year in the US, 800 000 people experience strokes, and although most survive, current treatment plans fail to adequately address their physical, emotional, psychosocial, and spiritual distress, according to a new scientific statement from the American Heart Association. Palliative care could aid in the quality of life for both patients and their families by helping during all stages of poststroke care, including adapting to functional changes, navigating complex health care systems, and preparing for death when necessary. However, such care is often underused.

L’organismo viene colpito da più agenti. Effetti delle cure dopo qualche giorno

Introduction
The treatment of patients with cardiogenic shock (CS) has been focused historically on single interventions (medical treatments, percutaneous and surgical interventions and, more recently, various temporary mechanical circulatory supports). However, none of these interventions has significantly changed the short-term prognosis of CS. Moreover, considerable interest in interventions applied in the acute setting has not been matched with comprehensive assessment of patients’ long-term follow-up, not only for survival and rehospitalisation but also for quality of life and functional status, recovery from critical illness and its destructive sequelae, and a global evaluation of the overall sustainability of pathways of care. To fill this knowledge gap, the ENIGMA study will be conducted.

Methods and analysis
This is a prospective and retrospective multicentre registry conducted under the scientific coordination of the IRCCS Fondazione Don Gnocchi and funded by the Italian Ministry of Health (PNRR-MCNT2-2023-12377767). Data referring to 2000 patients included in the Altshock registry, the largest multicentre CS registry in Italy, will be analysed. A standardised protocol of high-intensity cardiac rehabilitation has been defined and will be followed by the involved institutions after the inclusion of the first 1000 patients. Where feasible, this new pathway will be implemented in every institution. All the patients enrolled will be evaluated according to the Long-Term Conditions Questionnaire, the Kansas City Cardiomyopathy Questionnaire and a questionnaire on the patient experience at 6-month follow-up, to evaluate real-life comparative effects on patient outcomes and experiences. In conclusion, a health technology assessment (HTA) analysis, grounded in the EUnetHTA Core Model, will be conducted to define the potential multidimensional benefits and effects with regard to the overall economic, organisational and social sustainability of the innovative dedicated pathway. Various data sources will be used to conduct the HTA: (1) literature evidence, to define the evidence-based comparative indicators considering both surgical approaches; (2) real-world anonymised data from the hospitals included in the study, to enable costing of the rehabilitative pathways; and (3) healthcare professionals’ perceptions, defining the perceived added value of the innovative pathway versus the historical one, based on an evaluation scale ranging from –3 to +3.

Ethics and dissemination
The study was approved by the ethical committee (EC) of Lombardy Region (CET 44/24), on 28 May 2024, and is under evaluation by the EC of three other centres. The study protocol will be evaluated for ethics by 10 more centres in January 2025. Study results will be published in peer-reviewed publications and disseminated through conference presentations. The Associazione Nazionale Scompensati Cardiaci (AISC; ‘National Association of Patients with Heart Failure’), the Progetto Vita initiative and the non-profit organisation ‘Heart Helps Heart’ have endorsed the project and will be involved in disseminating information about the project and its outcomes to the general public.

Clinical trial registration number
The ENIGMA-shock study has been registered at ClincialTrials.gov: NCT06572826.

Car-T da donatore contro neuroblastoma che non risponde a cure

Car-T da donatore contro neuroblastoma che non risponde a cure

Per riempire il vuoto tra cure ospedaliere e hospice

In 5 Regioni nessun centro dedicato, ma la situazione migliora

L’organizzazione accoglie a Roma chi viene da fuori per le cure

The remarkable success of direct-acting antivirals in curing hepatitis C led to concerted efforts in developing a cure for hepatitis B. Unlike hepatitis C, it is accepted that a sterilising cure is not feasible in the foreseeable future. Instead, functional cure defined as hepatitis B surface antigen (HBsAg) loss (below detection) and HBV DNA suppression (below quantification) sustained for at least 24 weeks after completion of treatment has been embraced.1 Nucleos(t)ide analogues (NA) currently in use, entecavir and tenofovir, are highly effective in maintaining suppression of HBV DNA replication and yields substantial clinical benefits including reduced rates of cirrhosis and hepatocellular carcinoma, but HBsAg loss remains elusive. Yet, if a functional cure is achieved, the benefits are multiple, with further reductions in the risk for liver-related outcomes,2 elimination of the need for long-term monitoring and NA treatment and addressing the stigma associated with HBsAg-positivity. Strategies…

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

Le testimonianze dopo la malattia, ora più innamorate della vita

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

Lungo post della modella che sarà sul palco di Sanremo