Risultati per: Gestione dei sintomi del tratto urinario inferiore femminili (LUTS - Lower Urinary Tract Symptoms)

Annals of Internal Medicine, Ahead of Print.

Recent research has linked weight-loss surgery with several positive outcomes. Metabolic (bariatric) surgery may reduce the risk of major adverse liver outcomes in patients with obesity and cirrhosis due to metabolic dysfunction–associated steatohepatitis (MASH), according to research published in Nature Medicine.

Background
The authority to prescribe drugs has been reserved only for the medical community, mainly clinicians. Recently, more and more countries worldwide have begun implementing reforms to grant advanced practice nurses (APNs) the authority to prescribe from the legislative level. This study aimed to explore the prescription drugs and forms for gastrointestinal and dermatological symptom management of cancer patients that APNs can prescribe in China.

Design
A qualitative study reported in accordance with Conducting and REporting of DElphi Studies guidelines. The modified Delphi technique with two-round email consultations among 36 experts was applied.

Methods
We conducted a study from January 2022 to March 2022 to reach a consensus among medical, nursing and pharmacy experts about drugs that nurses may prescribe for gastrointestinal and dermatological symptom management in cancer patients.

Results
The expert authority coefficients are 0.95 and 0.96, respectively. A total of 35 drugs in 16 categories could be prescribed by APNs for gastrointestinal and dermatological symptoms management in China. Among them, three drugs were determined to be prescribed collaboratively, and 32 drugs were determined to be prescribed independently.

Conclusions
The drug prescription formulated in this study is the basis for APNs to prescribe drugs for controlling gastrointestinal and skin symptoms for cancer patients in mainland China. The results are important as a guide for formulating and implementing policies related to nurse prescribing and will provide some reference for future nurse prescribing in China.

Introduction
Recent guidelines suggest behavioural weight loss (BWL) and pelvic floor muscle training (PFMT) as first-line treatment approaches for women with both obesity and stress urinary incontinence (SUI). However, the optimal therapeutic and management strategies for these populations remain uncertain.

Methods and analysis
This assessor-blinded parallel-group randomised controlled trial aims to compare the efficacy of BWL alone, BWL plus conventional PFMT and BWL plus PFMT with a biofeedback device for women who are overweight or obese experiencing SUI or SUI-predominant mixed urinary incontinence. A total of 120 eligible women will be randomly assigned at a 1:1:1 ratio. All the three groups will be subjected to a 3-month self-supervision intervention after randomisation and will be assessed at baseline, after the 3-month intervention, 6 months after the intervention and 12 months after the intervention. The primary outcome measure is the self-reported severity of urinary incontinence assessed by the International Consultation on Incontinence Questionnaire-Urinary Incontinence short form. The secondary outcomes include weight loss effectiveness, pelvic muscle strength, pelvic floor ultrasound, three-dimensional body posture, adherence to the intervention and questionnaires for symptoms of pelvic organ prolapse, quality of life and sexual function.

Ethics and dissemination
This study has been approved by the Peking Union Medical College Hospital ethics committee (K5504). All results from the study will be submitted to international journals and international conferences.

Trial registration number
This trial has been registered with the Chinese Clinical Trial Registry (ChiCTR2400084015).

Introduction
Recent guidelines suggest behavioural weight loss (BWL) and pelvic floor muscle training (PFMT) as first-line treatment approaches for women with both obesity and stress urinary incontinence (SUI). However, the optimal therapeutic and management strategies for these populations remain uncertain.

Methods and analysis
This assessor-blinded parallel-group randomised controlled trial aims to compare the efficacy of BWL alone, BWL plus conventional PFMT and BWL plus PFMT with a biofeedback device for women who are overweight or obese experiencing SUI or SUI-predominant mixed urinary incontinence. A total of 120 eligible women will be randomly assigned at a 1:1:1 ratio. All the three groups will be subjected to a 3-month self-supervision intervention after randomisation and will be assessed at baseline, after the 3-month intervention, 6 months after the intervention and 12 months after the intervention. The primary outcome measure is the self-reported severity of urinary incontinence assessed by the International Consultation on Incontinence Questionnaire-Urinary Incontinence short form. The secondary outcomes include weight loss effectiveness, pelvic muscle strength, pelvic floor ultrasound, three-dimensional body posture, adherence to the intervention and questionnaires for symptoms of pelvic organ prolapse, quality of life and sexual function.

Ethics and dissemination
This study has been approved by the Peking Union Medical College Hospital ethics committee (K5504). All results from the study will be submitted to international journals and international conferences.

Trial registration number
This trial has been registered with the Chinese Clinical Trial Registry (ChiCTR2400084015).

91% interventi oncologici A in tempi previsti in primi 2 mesi’25

Common prodromal symptoms include light or sound sensitivity, fatigue, neck pain, and difficulty thinking or concentrating.

More-aggressive BP control was associated with a reduced likelihood of ED visits for hypertension within 6 weeks after delivery.

Background
Patients with type 2 diabetes mellitus (T2DM) have higher pancreatic cancer (PC) risk. While aspirin has chemopreventive effects on digestive cancers, its effect on PC among patients with T2DM is unclear.

Methods
This retrospective cohort study identified newly diagnosed adult patients with T2DM in Hong Kong between 2001 and 2015 from a territory-wide healthcare registry. Exclusion criteria were history of PC, pancreatic cyst, IgG4 disease, or pancreatectomy. To address reverse causality between PC and T2DM, we excluded patients with PC diagnosed within 1 year of T2DM. We also excluded patients with less than 1 year of observation. Primary outcome was PC, and secondary outcomes were PC-related and all-cause mortality. Aspirin use was treated as time-varying variable (≥180 day-use/year) to address immortal-time bias, and multivariable Cox regression model was employed to derive adjusted HR (aHR). Propensity-score (PS) matching was used as secondary analysis.

Results
Among 343 966 newly diagnosed patients with T2DM (median follow-up: 10.5 years; IQR: 7.7–14.5 years), 1224 (0.36%) developed PC. There were 51 151 (14.9%) deaths from any cause, and 787 (0.2%) died from PC. Aspirin use was associated with lower PC risk in both time-dependent (aHR: 0.58; 95% CI 0.49 to 0.69) and PS matching analysis (aHR: 0.61; 95% CI 0.48 to 0.77). An inverse relationship was observed with increasing dose and duration of aspirin use (P trend

Objectives
The aim of this study is to explore patients with persistent somatic symptoms and functional disorders’ (PSS/FD) experiences of and preferences for multidisciplinary care across Europe. A further aim is to compare the experiences of and preferences for multidisciplinary care of patients to those of healthcare professionals (HCPs) in the Netherlands.

Design
Cross-sectional online survey.

Setting
Patients with PSS/FD from across Europe (Germany, Italy, the Netherlands and Poland) and HCPs working in the care for PSS/FD across all levels of care in the Netherlands.

Primary and secondary outcome measures
Outcome measures for both patients and HCPs related to experiences of multidisciplinary care, communication between professionals and patients, as well as the main point of contact for patients.

Results
600 patients responded (Germany: n=198; Italy: n=174; Netherlands: n=137; Poland; n=91), and 152 HCPs responded from the Netherlands. Compared with the other countries, patients from the Netherlands generally received less multidisciplinary care, from fewer disciplines. Regarding most variables related to interprofessional communication, patients in Italy rated their experience significantly better than in most other countries. Generally, patients preferred either their general practitioner (GP) or a medical specialist as their main point of contact, and not mental health professionals. In contrast, HCPs preferred mental health professionals as the main point of patient contact, followed by GPs. In all variables, patients in the Netherlands rated interprofessional communication significantly lower than HCPs in the Netherlands did.

Conclusions
Patients have different experiences of interdisciplinary communication, also reporting lower-quality communication than HCPs, though differences are seen between countries. Future studies should look at the reasons for this and how this can lead to improved care for PSS/FD.

Nigicser I, Identeg F, Sansone M, et al. Do Swedish rock-climbers exhibit more eating disorder and body dissatisfaction symptoms than non-climbers? A crosssectional study. BMJ Open 2024;14:e085265. doi:10.1136/bmjopen-2024–0 85 265.
This article has been corrected since it was published online. The correction is regarding a value in table 4 regarding levels of body dissatisfaction. In the Female column, it says that the percentage with at least a mild concern with shape is 29.1%. This is incorrect, and it should instead read 47.4%. It is stated correctly in the Results portion of the paper, but the value in the table is incorrect.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Objective
The objective of this study is to perform a comprehensive systematic review and meta-analysis of the accuracy of signs, symptoms and case definitions for the diagnosis of influenza.

Design
Systematic review and meta-analysis of diagnostic accuracy.

Setting
Inpatient or outpatient setting.

Participants
Three databases (PubMed, CINAHL and EMBASE) were searched through February 2024 for studies of clinical diagnosis of influenza using prospective data collection and a high-quality reference standard. Data were abstracted by researchers working in parallel and resolving discrepancies by discussion.

Primary and secondary outcome measures
Quality was assessed using QUADAS-2. Summary estimates (or ranges) of sensitivity and specificity, likelihood ratio (LR), the Youden Index and the area under the receiver operating characteristic curve were calculated.

Results
The final meta-analysis included 67 studies, each with between 119 and 155 866 participants. Most were judged to be low risk of bias. The signs and symptoms with the highest overall accuracy for all studies based on the Youden Index were any fever (0.32), overall clinical impression (0.28), coryza (0.25), cough and fever (0.25), and measured fever (0.25). Accuracy varied widely by age group. Only the overall clinical impression had a positive LR greater than 2.0. Cough was the most sensitive finding (0.92) with a negative LR of 0.28 in adults. The absence of any fever also had a low negative LR (0.30). The Centers for Disease Control and Prevention (CDC) definition of influenza-like illness (ILI) had good specificity but poor sensitivity in adults, while in infants, it had good sensitivity but widely varying specificity. The European CDC and WHO case definitions for ILI had modest sensitivity and specificity.

Conclusions
Individual signs and symptoms, their combinations, and ILI case definitions have very limited accuracy for identifying persons with influenza. More accurate surveillance and diagnosis will require the development and validation of accurate risk scores or greater use of point-of-care testing.