Risultati per: Nuovo test rapido per distinguere le infezioni virali

Studio, sono meno capaci di combattere il virus

San Raffaele Roma, Italia prima al mondo per pazienti coinvolti

Objectives
Faecal occult blood testing (FOBT) and faecal immunochemical testing (FIT) are among the most used screening modalities for colorectal cancer (CRC). Colonoscopy is also widely used as a screening and diagnostic test for adults with a positive FOBT/FIT. Patient experience of colonoscopy is an important component for most CRC screening programmes. Individuals with negative experiences are less likely to engage with colonoscopy in the future and can deter others from attending colonoscopy when invited. This review synthesised data on patient experience with colonoscopy, following a positive result, to provide insights into how to improve patient experience within the English Bowel Cancer Screening Programme.

Methods
MEDLINE, EMBASE and PsycINFO were searched for quantitative questionnaire studies evaluating patient-reported experience with colonoscopy, following a positive screening FOB/FIT result. The search was limited to studies published between 2000 and 2021 (ie, when the first FOBT/FIT screening programmes for CRC were introduced). Data-driven and narrative summary techniques were used to summarise the literature.

Results
In total, six studies from the UK (n=4), Spain (n=1) and the Netherlands (n=1) were included in the review (total participants: 152 329; response rate: 68.0–79.3%). Patient experiences were categorised into three ‘stages’: ‘pre-colonoscopy’, ‘during the test’ and ‘post-colonoscopy’. Overall, patients reported a positive experience in all six studies. Bowel preparation was the most frequently endorsed issue experienced pre-test (experienced by 10.0–41.0% of individuals, across all studies), pain and discomfort for during the test (experienced by 10.0–21.0% of participants) and abdominal pain and discomfort after the test (these were experienced by 14.8–22% of patients).

Conclusion
This review highlighted that patient-reported experiences associated with colonoscopy were generally positive. To improve the colonoscopy experience, bowel screening centres should investigate means to: make bowel preparation more acceptable, make colonoscopy less painful and reduce post-colonoscopy symptoms.

Background and aims
Liver transplantation is a life-saving procedure for end-stage liver disease. However, post-transplant medication regimens are complex and non-adherence is common. Post-transplant medication non-adherence is associated with graft rejection, which can have long-term adverse consequences. Transplant centres are equipped with clinical staff that monitor patients post-transplant; however, digital health tools and proactive immunosuppression adherence monitoring has potential to improve outcomes.

Methods and analysis
This is a patient-randomised prospective clinical trial at three transplant centres in the Northeast, Midwest and South to investigate the effects of a remotely administered adherence programme compared with usual care. The programme monitors potential non-adherence largely levering text message prompts and phenotypes the nature of the non-adhere as cognitive, psychological, medical, social or economic. Additional reminders for medications, clinical appointments and routine self-management support are incorporated to promote adherence to the entire medical regimen. The primary study outcome is medication adherence via 24-hour recall; secondary outcomes include additional medication adherence (ASK-12 self-reported scale, regimen knowledge scales, tacrolimus values), quality of life, functional health status and clinical outcomes (eg, days hospitalised). Study implementation, acceptability, feasibility, costs and potential cost-effectiveness will also be evaluated.

Ethics and dissemination
The University of Pennsylvania Review Board has approved the study as the single IRB of record (protocol # 849575, V.1.4). Results will be published in peer-reviewed journals and summaries will be provided to study funders.

Trial registration number
NCT05260268.

Un Manifesto per ‘Cambiare Rotta’

Un Manifesto per ‘Cambiare Rotta’

Ordine dei medici, progetto per l’orientamento in 300 istituti

Basato sull’intelligenza artificiale, ha il 91% di accuratezza

il ministero della Salute ha deciso di intervenire con una circolare per regolare la questione dei test per chi entra in ospedale: pazienti o visitatori

Autism spectrum disorder (hereafter, “autism”) affects the ability to socially interact and communicate with others and is diagnosed in 1 in 36 children in the United States. The early course and clinical presentation of autism are variable, and differential diagnosis of young children can be challenging even for autism specialists. For example, one study found that only 60% of autism diagnoses were made with certainty in a sample of 478 toddlers and preschoolers who had been referred to specialists for an autism evaluation. In a 6-site study where diagnostic evaluations were conducted by experienced clinicians with 496 children aged 16 to 30 months referred to specialized centers, only 70.2% of diagnoses were made with a high level of certainty. Thus, approximately 1 in 3 autism diagnostic evaluations of young children are associated with uncertainty. Children with higher cognitive and language abilities and milder autism-related behaviors are more likely to be missed and often receive their diagnoses later than those with greater language delays and more pronounced autism-related behaviors. The high degree of diagnostic uncertainty for young autistic children contributes to delays in access to supports and services. Receiving an autism diagnosis is a first step to qualifying for early behavioral therapies that have been shown to improve outcomes, including language, cognitive, social, and adaptive skills.

Colpiti i giovani, spesso senza diagnosi. Oggi la giornata mondiale

Colpiti i giovani, spesso senza diagnosi. Il 4 settembre giornata mondiale

In this issue of JAMA Psychiatry, Marcotte et al report that field sobriety tests (FSTs) as administered by highly trained police officers are insufficient to detect cannabis-induced impairment in a double-blind, placebo-controlled, parallel randomized clinical trial involving a large sample of 184 cannabis users. Although the group receiving active doses of Δ-9-tetrahydrocannabinol (THC), the active ingredient in cannabis, performed worse on the FSTs as compared with the placebo group; about half of the participants in the placebo group were classified as impaired. These findings are in line with previous placebo-controlled studies that also reported high false-positive FST rates under placebo. The legal implication of these findings can be major given that FSTs are currently part of the evaluation protocol in North America to detect drivers who are cannabis impaired. Yet, the lack of sensitivity of FSTs to detect THC-impaired individuals does not come as a big surprise, as FSTs have primarily been validated to detect gross alcohol impairment at high (more than 0.10%) blood alcohol concentrations. To add to this problem, there is no cannabis equivalent of a breathalyzer to verify exposure induced impairment, as trace amounts of THC in biomarkers correlate poorly with cannabis-induced behavioral impairment.

Low-grade dysplasia (LGD) is associated with an increased risk of progression in Barrett’s esophagus (BE). However, the diagnosis of LGD is limited by substantial interobserver variability. Multiple studies have shown that an objective tissue systems pathology test (TissueCypher Barrett’s Esophagus Assay, TSP-9), can effectively predict neoplastic progression in patients with BE. This study aimed to compare the risk stratification performance of the TSP-9 test versus benchmarks of generalist and expert pathology.