Risultati per: Nota 55

L’Istat conferma la carenza di dottori, soprattutto di medicina generale

Istat conferma carenza dottori, soprattutto di medicina generale

Istat conferma carenza dottori, soprattutto di medicina generale

Introduction
Digital health technologies have the potential to provide cost-effective care to remote and underserved populations. To realise this potential, research must involve people not traditionally included. No research focuses on the acceptability and feasibility of older Indigenous people using wearables for early atrial fibrillation (AF) detection. This protocol compares digital augmentation against standard practice to detect AF, evaluate heart health self-efficacy and health literacy changes and identify barriers in collaboration with Aboriginal Community Controlled Health Organisations. It will establish a framework for implementing culturally safe and acceptable wearable programmes for detecting and managing AF in Indigenous adults ≥55 years and older.

Methods
This mixed-methods research will use the Rambaldini model of collective impact, a user-centred, co-design methodology and yarning circles, a recognised Indigenous research methodology to assess the cultural safety, acceptability, feasibility and efficacy of incorporating wearables into standard care for early AF detection.

Analysis
Qualitative data will be analysed to create composite descriptions of participants’ experiences and perspectives related to comfort, cultural safety, convenience, confidence, family reactions and concerns. Quantitative device data will be extracted and analysed via Statistical Product and Service Solutions (SPSS).

Conclusion
Prioritising perspectives of older Indigenous adults on using wearables for detecting and monitoring cardiovascular disease will ensure that the findings are effective, relevant and acceptable to those impacted.

Ethics and dissemination
Findings will be published in open-source peer-reviewed journals, shared at professional conferences, described in lay terms and made available to the public. The AHMRC HREC Reference Number approved 1135/15.

Circulation, Volume 148, Issue Suppl_1, Page A15069-A15069, November 6, 2023. Background:Risk factors for cardiovascular disease (CVD) among young and middle-aged women have increased while knowledge and awareness of CVD remain low. To reverse these trends, it is important to assess whether knowledge and awareness of CVD are associated with intent to change behavior.Aims:Describe the relationship between stage of behavior change and awareness, knowledge, and perceptions of CVD among women 25-55 years and identify the predictors of stage of behavior change.Methods:A cross-sectional, descriptive study of women ages 25-55 living in the United States without a self-reported CVD history was conducted. Participants were recruited through flyers and social media campaigns. Awareness was measured with the question, “What is the leading cause of death for women in the United States?” Knowledge, perceptions, and stage of behavior change were measured with the Heart Disease Fact Questionnaire, Health Beliefs Related to CVD, and the Precaution Adoption Process Model surveys, respectively. All data were collected online via REDCap.Results:A total of 149, primarily minority women, were included (mean=37.15±7.86 years). Over half (53.7%) of the sample had not decided to make changes in their behavior to reduce their likelihood of CVD. A binary logistic regression of stage of behavior change on awareness, knowledge, and perceptions of CVD showed that the perception subscales of susceptibility and severity were significantly associated with intent to change behavior (OR 1.247, p

Circulation, Volume 148, Issue Suppl_1, Page A18270-A18270, November 6, 2023. Introduction:The Impella 5.5 left ventricular assist device (LVAD) can provide temporary mechanical circulatory support (MCS) in select patients with advanced heart failure (HF). The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile provides a standardized grading system for advanced HF patients receiving MCS, ranging from most (1) to least severe (7).Hypothesis:The INTERMACS profile is associated with outcomes in patients supported with an Impella 5.5 LVAD.Methods:From 2019-2022, retrospective review of perioperative characteristics, INTERMACS profile and outcomes in patients supported with an Impella 5.5.Results:When stratified by INTERMACS profile, there were 63 patients (28%) in profile 1, 73 (32%) in profile 2, 20 (8.8%) in profile 3, 72 (32%) in profiles 4-7. Indication for Impella 5.5 implant was primarily cardiogenic shock due to chronic HF (81; 52%), acute MI (33; 21%) or postcardiotomy (22; 14%) in profiles 1-3 and Impella 5.5-assisted cardiac interventions (cardiac surgery, VT ablation, PCI) (68; 94%) in profile 4-7 (p

Circulation, Volume 148, Issue Suppl_1, Page A17687-A17687, November 6, 2023. A 59 year-old male with a history of triple-vessel coronary artery bypass graft surgery, ischemic cardiomyopathy with an implantable cardioverter defibrillator, pre- and post-capillary pulmonary hypertension, severe mitral regurgitation, paroxysmal atrial fibrillation, diabetes mellitus, hypertension was referred for transplant evaluation in the setting of cardiogenic shock despite inotropic support. His initial right heart catheterization showed RAP 21 mmHg, RVP 91/9 mmHg, PAP 88/31 mmHg with a mean of 50 mmHg, PCWP 22 mmHg, PVR 6.6 Wood units, SVR 857 dynes, and CO 4.85 l/min/CI 2.59 l/min/m2by thermodilution. His hospital course was complicated by acute renal failure requiring continuous renal replacement therapy. Inotropic support could not be weaned on multiple attempts, and pulmonary and wedge pressures remained significantly elevated despite a trial of inhaled nitric oxide. The patient underwent Impella 5.5 placement to assess the hemodynamic response of unloading the left ventricle. A repeat right heart catheterization showed a RAP 1 mmHg, RVP 42/1 mmHg, PAP 48/13 mmHg with a mean of 26 mmHg, PVR 2.3 Wood units, SVR 829 dynes, and CO 6.75 l/min/CI 3.74 l/min/m2by thermodilution. Measurements were obtained with Impella 5.5 at P-8 level, milrinone 0.2 mcg/kg/min, treprostinil 4 ng/kg/min, epoprostenol 1 mg every 6 hours, and sildenafil 10 mg in morning and afternoon and 15 mg in evening. The patient underwent successful heart and kidney transplantation. Post-transplantation right heart catheterization showed persistent pre-capillary pulmonary hypertension with normal filling pressures and CI. His pulmonary hypertension was managed with sildenafil 40 mg three times daily and ambrisentan 10 mg daily. This case demonstrates favorable hemodynamic effects of left ventricular unloading using Impella support with significant reduction in pulmonary vascular pressure to reach candidacy for heart transplantation.

Circulation, Volume 148, Issue Suppl_1, Page A18247-A18247, November 6, 2023. Introduction:Surgically implanted microaxial ventricular assist devices (VAD) such as Impella 5.5 are increasingly used as temporary mechanical circulatory support (tMCS) in patients at risk for and with cardiogenic shock (CS). Understanding the associations between CS severity and outcomes in patients supported with Impella 5.5 may optimize patient selection and prevent futile interventions.Hypothesis:Increasingly severe Society for Cardiovascular Angiography and Intervention (SCAI) SHOCK stages in patients supported with Impella 5.5 are associated with worse outcomes.Methods:From 2019-2022, retrospective review of perioperative characteristics, SCAI SHOCK stage and outcomes in patients supported with an Impella 5.5.Results:In total, 228 Impella 5.5s were implanted in 226 patients; 28% (63) SCAI SHOCK stage A, 4% (10) stage B, 14% (31) stage C, 46% (104) stage D and 9% (20) stage E. Stage A and B patients more often had elective Impella 5.5s for tMCS-assisted interventions (cardiac surgery, PCI, VT ablation) (30%, 69/228) while stage C-E patients primarily had Impella 5.5 placement for acute MI (AMI), chronic cardiomyopathy and postcardiotomy CS (60%, 136/228) (p

Circulation, Volume 148, Issue Suppl_1, Page A15850-A15850, November 6, 2023. Introduction:Guidelines are increasingly recommending a goal LDL-C

Circulation, Volume 148, Issue Suppl_1, Page A18803-A18803, November 6, 2023. Introduction:Impella 5.5 is an FDA-approved microaxial, continuous flow pump intended to provide left ventricular hemodynamic support for 14 days. We report 107 consecutive patients supported with this device, many for extended durations.Methods:The outcomes of consecutive patients supported with Impella 5.5 at an academic hospital from March 2021 to June 2023 are included.Results:107 patients required 112 Impella 5.5 devices. The majority of patients had a heart failure etiology of NICMP (57, 53%), followed by ICMP (36, 34%), post cardiotomy shock (6, 5%), other (4, 4%), planned post cardiotomy cardiac protection (3, 3%), and congenital heart disease (1, 1%). 60 patients (56%) were SCAI D, 30 patients (28%) SCAI E, and 17 patients (16%) were SCAI C. The majority patients (70,65%) were Intermacs 2. The majority of Impella 5.5 devices were placed as a bridge to decision (55 patients, 51%), followed by BTT (28 patients, 26%), BTR (16 patients, 15%), Bridge to LVAD (7 patients, 7%), and one patient (1%) device was placed for post cardiotomy cardiac protection. 11 patients required interval escalation to concomitant VA-ECMO. Patients requiring ECPELLA were placed on PVA ECMO after an average of 22 days of impella support, and average time of support on ECPELLA was 5.4 days. All patients transitioned to cardiac replacement therapy. Among patients with explant data, 43 supported for < 2 weeks, 38 for 2-4 weeks, and 17 for > 4 weeks. Longest duration of support was 92 days. Of patients reaching a primary endpoint, 42 were transplanted (39%), 21 patients died (20%), 18 patients received durable VAD (17%), 12 were discharged without transplant or VAD (11%), 10 were transferred while on support (9%) and 4 patients are still supported (4%). With respect to complications, 5 patients suffered from strokes, 3 pump thrombosis, 2 had fiber optic cable malfunctions, 2 had purge line leaks, and there were 3 patients with a broken optical sensor, and 2 arterial (brachial and axillary) thrombus.Conclusion:The Impella 5.5 device is a left ventricular support device placed most frequently to successfully stabilize patients undergoing evaluation for advanced therapies who were failing despite inotropic therapy.

Circulation, Volume 148, Issue Suppl_1, Page A16787-A16787, November 6, 2023. Introduction:Metabolically healthy obesity’s (MHO) impact on cardiovascular outcomes is debated. However, MHO’s impact on cardiovascular outcomes in postmenopausal women is unexplored. Our study explored MHO’s prevalence and correlation with in-hospital major adverse cardiac and cerebrovascular events (MACCE) in postmenopausal women.Methods:Data was analyzed from National Inpatient Sample 2020 for admissions of postmenopausal women ( >age 55 years) with and without obesity. Metabolically healthy patients were identified by excluding diabetes, hypertension, and hyperlipidemia using Elixhauser comorbidity software. After propensity score matching (PSM) patients with MHO and non-MHO for age, we performed a multivariable regression analysis for in-hospital MACCE. Also, using tests of model effects, we determined predictors of MACCE in postmenopausal women with MHO.Results:In 2020, 1304185 metabolically healthy postmenopausal women over age 55 years were admitted; 1155935 (88.6%) had no MHO, and 148250 (11.4%) had MHO. However, after PSM for age, there were 148250 in each cohort. In MHO cohort, median age was 65 years, 78.6% were white, 8.1% were African-American, and 28.2% were from lowermost income quartile. Most common comorbidities in MHO cohort were chronic pulmonary disease (29.2%), hypothyroidism (20.7%), and tobacco use disorder (23.9%). We observed a statistically significant difference in overall MACCE [odds ratio (OR) 1.08, 95% confidence interval (CI) 1.01-1.16, p=0.028] among MHO and non-MHO cohorts, especially in patients from African-American ethnicity (OR 1.23, 95% CI 1.01-1.49, p=0.035) and lowermost income quartile (OR 1.24, 95% CI 1.06-1.44, p= 0.007). However, no significant all-cause mortality was observed (OR 1.02, 95% CI 0.94-1.12, p=0.621). Several predictors of MACCE in postmenopausal women with MHO were observed, with non-elective admission being the strongest (OR 7.38, 95% CI 5.91-9.22, p

A fine luglio erano 6. Il virus rilevato in 7 Regioni

Ricerca del Centro Nazionale Trapianti con l’Università di Padova

A partire dal 27 giugno 2023 è disponibile un aggiornamento dei documenti allegati alla Nota 100 (schede di prescrizione ed elenco dei farmaci)

L’Agenzia Italiana del Farmaco ha aggiornato la Nota 96 (determina AIFA n. 48/2023 pubblicata nella Gazzetta Ufficiale n. 43 del 20 febbraio 2023) sui criteri di appropriatezza prescrittiva della supplementazione con vitamina D e suoi analoghi (colecalciferolo, calcifediolo) per la prevenzione e il trattamento degli stati di carenza nell’adulto

Stroke, Volume 54, Issue Suppl_1, Page A55-A55, February 1, 2023. Introduction:Perivascular spaces (PVS) contribute to brain waste clearance pathways, possibly via arterial pulsatility, and are implicated in neurodegenerative disease. Aging, hypertension, and small vessel disease are associated with enlarged PVS, but the effect of intensive blood pressure (BP) control on PVS structure is unknown.Methods:This is a secondary analysis of the SPRINT-MIND MRI substudy, in which participants with cardiovascular risk but without clinical stroke were randomized to intensive BP control (systolic