Risultati per: Passo 10. Intervenire sul singolo paziente in visita: GPG Patient

Il 28 febbraio la Giornata mondiale malattie rare

Alcune sono causa di sordocecità,fondamentale intervento precoce

Alcune sono causa di sordocecità,fondamentale intervento precoce

Objectives
Women with an abdominal aortic aneurysm (AAA) are less likely to receive elective repair than men. This study explored the effect of patient sex and other attributes on vascular surgeons’ decision-making for infrarenal AAA repair.

Design
Discrete choice experiment.

Setting
Simulated environment using case scenarios with varying patient attributes.

Participants
Vascular surgeons.

Interventions
Surgical decision-making.

Main outcome measures
AAA repair versus no repair and endovascular versus open repair.

Results
182 surgeons completed 2987 scenarios. When all other attributes were equal, a woman was more likely to be offered an AAA repair (marginal rate of substitution (MRS) 3.86 (95% CI 2.93, 4.79)), while very high anaesthetic risk (MRS –4.33 (95% CI –5.63, –3.03)) and hostile anatomy (MRS –3.28 (95% CI –4.55, –2.01)) were deterrents. Increasing age did not adversely affect the likelihood of offering repair to men but decreased the likelihood for women, which negated women’s selection advantage from the age of 83 years. Women were also more likely to be offered endovascular repair (MRS 2.57 (95% CI 1.30, 3.84)).

Conclusions
Patient sex alone did not account for real-world disparity observed in selection for surgery. Rather, being a woman was associated with a higher likelihood of being offered AAA repair but also a higher likelihood of being offered less invasive endovascular repair. Increased age decreased the likelihood of surgical selection for women but not men. Preference for less invasive repair, combined with inferior rates of anatomical suitability, and the comparably older age of women at the time of AAA repair selection may account for lower rates of repair for women observed.

Per mutazioni genetiche ‘prevenzione e medicina di precisione’

Introduction
People experiencing homelessness (PEH) have diverse and complex health and social needs and experience significant barriers to accessing support. As a result, PEH often use the emergency department (ED) for their unmet health and social needs. To address these challenges, the ED Outreach Programme at St. Michael’s Hospital was developed with community partners within the Downtown East Toronto Ontario Health Team in Toronto, Canada. PEH presenting in the ED are connected to an outreach worker to identify immediate needs for a safe discharge and to access health and social supports in the community. Following discharge, the outreach worker continues to maintain contact with clients to ensure continuity of care and assists with the coordination, navigation and follow-up of healthcare and community services.

Methods
A three-phase community-based participatory research (CBPR) study will be conducted to evaluate patient experience in the ED Outreach Programme. Phase 1 involves conducting interviews with clients and staff/providers to understand their experiences with the programme and identify patient experience domains, constructs and measures. In Phase 2, programme clients, staff/providers and partners with lived experience co-design a set of patient-reported experience measures (PREMs) through focus groups. In Phase 3, the PREMs are pilot-tested to ensure their applicability and utility in the clinical setting. Central to CBPR principles, shared leadership and ownership of the project are facilitated by engaging and empowering community members. This study will contribute to new knowledge of building partnerships with PEH and marginalised communities in healthcare research, evaluation and quality improvement, particularly in developing PREMs.

Ethics and dissemination
This study has been approved by the Unity Health Toronto Research Ethics Board (REB#21–315). Findings will be disseminated in peer-reviewed journals, conferences and forums, as well as through collaborating with partners with lived experience, community agencies and government bodies.

Introduction
Empathy is a core component of high-quality care yet is expressed and received in different ways depending on the characteristics (including gender, race, socioeconomic status and disability) of both practitioners and patients. However, the evidence exploring how these characteristics or their overlap (‘intersectionality’) influence empathy has not been synthesised.

Methods and analysis
We will systematically review and meta-analyse studies exploring the influence of healthcare practitioners and patient characteristics on empathy in healthcare. MEDLINE, EMBASE (via Scopus), Scopus, PsycINFO, CINAHL, CENTRAL Web of Science, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects will be searched from database inception to present. Reference chasing will be used to identify additional studies. Studies that report empathy levels using either (1) the patient-reported Consultation and Relational Empathy Measure or (2) the practitioner or student-reported Jefferson Scale of Empathy. This will include validated versions or translations of both scales.
Two reviewers will independently screen titles, abstracts, and full texts and extract data using Rayyan. Discrepancies will be resolved in discussion with a third author if necessary. Two independent authors will evaluate the risk of bias using the Joanna Briggs Institute tools.
Continuous data will be analysed based on the mean, SD, sample size and 95% CIs. Sensitivity analyses will be used to explore the potential impact of risk of bias and use of imputed data. We will explore differences between countries, demographic characteristics, disciplines and lengths of time in practice experience, as well as differences over time (comparing more recent with older studies). We will also explore differences between patient-reported and practitioner-reported empathy.
We will report our findings following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and flowchart.

Ethics and dissemination
Ethical approval is not required for this review as primary data will not be collected. The review will be disseminated through peer-reviewed publication and presented at conferences.

PROSPERO registration number
CRD42024604677.

This Medical News article is an interview with Eden English, MD, senior medical director of informatics for UCHealth, about an AI tool that writes the first draft of answers to patients’ messages.

This JAMA Patient Page describes bedbug infestation and bedbug eradication and prevention measures.

This study compares knowledge of diagnosis and worry among adults presented with prostate biopsy reports in a patient-centered format, which presents important clinical data in plain language, vs standard report format.

Anziano con infezione polmonare, evitati rischi da anestesia

Our novel risk prediction tool uses a simple method to adjust for temporal changes and can be implemented to facilitate uptake of evidence-based therapies. The study provides proof-of-concept for leveraging real-time data to support risk prediction that incorporates changing population-level trends and variation patient-level risk.

Eseguito difficile intervento da equipe multidiscilinare

Introduction
Chronic depression represents a common and highly disabling disorder. Several randomised controlled trials (RCTs) investigated the effectiveness of psychological, pharmacological and combined treatments for chronic depression. This is the first overarching systematic review and network meta-analysis (NMA) based on aggregated and individual patient data comparing the efficacy and acceptability of various treatment options for all subtypes of chronic depression. Furthermore, individual demographic and clinical characteristics that predict or moderate therapy outcomes will be investigated.

Methods and analysis
A systematic literature search of the Cochrane Library, MEDLINE via Ovid, PsycINFO, Web of Science and metapsy databases will be conducted from database inception without language restrictions to include all available samples from RCTs that investigated the efficacy of psychotherapy versus pharmacotherapy, or their combination in adult inpatients or outpatients with a primary diagnosis of chronic depression. Exclusively internet-based treatment studies will be excluded. The main outcome is depression severity measured on a continuous observer-rated scale for depression at 6 months post-treatment (range 3–12 months). Two reviewers will independently screen and select eligible studies based on the predefined inclusion and exclusion criteria. Risk of bias will be assessed using version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). Individual patient data (IPD) will be requested and incorporated in the network when provided, as it is the gold standard of evidence. For studies which do not provide IPD, aggregate data (AD) will be extracted and incorporated in lieu of IPD for the NMA, strengthening the evidence base and leveraging all existing evidence regardless of data availability restrictions. An NMA comparing psychotherapies and a network meta-regression estimating individualised treatment effects of psychotherapy will be implemented assuming a Bayesian framework. All models will be fitted in R with calls to JAGS. Empirical informative prior distributions will be used for model parameters where available, and non-informative priors will be used in cases where empirical priors are not available.

Ethics and dissemination
This IPD-NMA requires no ethical approval. All results will be disseminated as peer-reviewed publication in a leading journal in this field and presented at (inter)national scientific conferences.

PROSPERO registration number
CRD42024526755.

Alle Molinette di Torino. La massa alla ghiandola del timo comprimeva anche un polmone. La testimonianza del paziente

Introduction
Hereditary haemochromatosis (HH) is the most common genetic condition among populations of northern European ancestry, but it does not have a specific International Classification of Diseases 10th revision (ICD-10) diagnosis code. HH is commonly assigned the ICD-10 code E83.1 defined as ‘disorders of iron metabolism’. However, the E83.1 diagnosis code is also applied to patients with transfusion-related iron overload and hyperferritinaemia from non-iron loading conditions. Venesection is the main treatment option for patients with HH and is assigned the Office of Population, Census and Surveys Classification of Interventions and Procedures, 4th revision (OPCS-4) code X36.2. We aimed to develop a novel algorithm to identify haemochromatosis patients with C282Y homozygosity from electronic patient records (EPR) using ICD-10 and OPCS-4 codes.

Methods
The Hospital Episode Statistics Admitted Patient Care (APC) database was used to identify all patients with the ICD-10 code E83.1 from 1 April 2018 to 31 March 2023 in our NHS Trust. Case notes were reviewed to evaluate the presence of HH, genotype, medical history and associated procedures. Algorithms were generated using Stata MP V.18 by applying a combination of ICD-10 and OPCS-4 codes to all patients with the diagnosis code E83.1 including those without HH gene mutations.

Results
A total of 9264 patient episodes were identified from the HES APC database corresponding to 787 unique patients: 479 (60.9%) C282Y homozygous, 107 (13.6%) C282Y/H63D compound heterozygotes, 42 (5.3%) other HH genetic mutations and 159 (20.2%) without any HH gene mutations. Six algorithms were developed to identify patients with HH within inpatient EPR, all of which showed improved positive predictive value (PPV) compared with the baseline cohort. The application of the OPCS-4 code for venesection (X36.2) in five of the algorithms resulted in large improvements in specificity and increased all their PPVs to >70%. Algorithms 4 and 6 had the best PPV at 74.3% and 74.4%, respectively, and included the removal of patients with ICD-10 codes associated with transfusion-related iron overload and other conditions treated with venesection.

Conclusion
These novel algorithms represent a more reliable method to detect haemochromatosis patients with C282Y homozygosity from EPR than the single ICD-10 code E83.1. It may be applied to large administrative datasets for investigation of HH in population studies.