Risultati per: Follow-up ottimale dopo embolia polmonare acuta

Introduction
School readiness includes cognitive, socio-emotional, language and physical growth and development domains which share strong associations with life-course opportunities. Children with cerebral palsy (CP) are at increased risk of poor school readiness compared with their typically developing peers. Recently, earlier diagnosis of CP has allowed interventions to commence sooner, harnessing neuroplasticity. First, we hypothesise that early referral to intervention for children at-risk of CP will lead to improved school readiness at 4–6 years relative to placebo or care as usual. Second, we hypothesise that receipt of early diagnosis and early intervention will lead to cost-savings in the form of reduced healthcare utilisation.

Methods and analysis
Infants identified as at-risk of CP ≤6 months corrected age (n=425) recruited to four randomised trials of neuroprotectants (n=1), early neurorehabilitation (n=2) or early parenting support (n=1) will be re-recruited to one overarching follow-up study at age 4–6 years 3 months. A comprehensive battery of standardised assessments and questionnaires will be administered to assess all domains of school readiness and associated risk factors. Participants will be compared with a historical control group of children (n=245) who were diagnosed with CP in their second year of life. Mixed-effects regression models will be used to compare school readiness outcomes between those referred for early intervention versus placebo/care-as-usual. We will also compare health-resource use associated with early diagnosis and intervention versus later diagnosis and intervention.

Ethics and dissemination
The Children’s Health Queensland Hospital and Health Service, The University of Queensland, University of Sydney, Monash University and Curtin University Human Research Ethics Committees have approved this study. Informed consent will be sought from the parent or legal guardian of every child invited to participate. Results will be disseminated in peer-reviewed journals, scientific conferences and professional organisations, and to people with lived experience of CP and their families.

Trial registration number
ACTRN12621001253897.

Stroke, Ahead of Print. Background:In first-degree relatives of patients with aneurysmal subarachnoid hemorrhage (aSAH), the risk of an intracranial aneurysm can be predicted at initial screening but not at follow-up screening. We aimed to develop a model for predicting the probability of a new intracranial aneurysm after initial screening in people with a positive family history of aSAH.Methods:In a prospective study, we obtained data from follow-up screening for aneurysms of 499 subjects with ≥2 affected first-degree relatives. Screening took place at the University Medical Center Utrecht, the Netherlands, and the University Hospital of Nantes, France. We studied associations between potential predictors and the presence of aneurysms using Cox regression analysis and the predictive performance at 5, 10, and 15 years after initial screening using C statistics and calibration plots, while correcting for overfitting.Results:In 5050 person-years of follow-up, intracranial aneurysms were found in 52 subjects. The risk of aneurysm at 5 years was 2% to 12%, at 10 years, 4% to 28%, and at 15 years, 7% to 40%. Predictors were female sex, history of intracranial aneurysms/aneurysmal subarachnoid hemorrhage, and older age. The sex, previous history of intracranial aneurysm/aSAH, older age score had a C statistic of 0.70 (95% CI, 0.61–0.78) at 5 years, 0.71 (95% CI, 0.64–0.78) at 10 years, and 0.70 (95% CI, 0.63–0.76) at 15 years and showed good calibration.Conclusions:The sex, previous history of intracranial aneurysm/aSAH, older age score provides risk estimates for finding new intracranial aneurysms at 5, 10, and 15 years after initial screening, based on 3 easily retrievable predictors; this can help to define a personalized screening strategy after initial screening in people with a positive family history for aSAH.

From January 1, 2022, through January 27, 2023, more than 85 000 confirmed human mpox (monkeypox) cases in 110 countries and 86 deaths were reported to the World Health Organization.

Introduction
Very little is known about how the COVID-19 pandemic has affected the health of residents and the healthcare system in Alberta, Canada. The purpose of this study is to establish an observational study to characterise the health of residents in Alberta, Canada, over time, covering a population that tested negative or positive for COVID-19 during the pandemic. The primary outcome is to characterise ‘long COVID-19’ and the health status of residents during the COVID-19 pandemic. Secondary outcomes include the estimation of the risk of and risk factors associated with adverse health outcomes and healthcare utilisation and burdens.

Methods and analysis
This is a population-level provincial observational study which will follow-up with Alberta residents who underwent testing for COVID-19 and completed surveys adapted from the ISARIC COVID-19 long-term follow-up survey. The survey data will be linked with medical records. Statistical analyses will be carried out to characterise ‘long COVID-19’ and the health status of residents during the pandemic. The outcomes of this study will inform strategies for primary care and rehabilitation services to prevent chronic consequences; contribute to healthcare management, interventional studies, rehabilitation and health management to reduce overall morbidity and improve long-term outcomes of COVID-19 and the COVID-19 pandemic and potentially guide a self-evaluation of a remote monitoring system to manage individuals’ health.

Ethics and dissemination
This study was reviewed and approved by the University of Alberta ethics committee (Study ID: Pro00112053 & Pro00113039) on 13 August 2021 and adheres to the Alberta Health Services research information management policy. Study results will be used to manage clinical care, published in peer-reviewed journals and presented at local, national and international conferences.

Protocol version
6 June 2022

EuroQol ID
161 015.

Introduction
Rural residence appears to be a factor of vulnerability among pregnant women with poor clinical antenatal care. Our principal objective is to assess the impact of an infrastructure for a mobile antenatal care clinic on the completion of antenatal care for women identified as geographically vulnerable in a perinatal network.

Methods and analysis
Controlled cluster-randomised study in two parallel arms comparing an intervention group with an open-label control group. This study will concern the population of pregnant women who must live in one of the municipalities covered by the perinatal network and considered to be an area of geographic vulnerability. The cluster randomisation will take place according to the municipality of residence. The intervention will be the implementation of pregnancy monitoring by a mobile antenatal care clinic. The completion of antenatal care between the intervention and control groups will be a binary criterion: 1 will be attributed to each antenatal care that includes all visits and supplementary examinations. Sample size has been estimated to be 330 at least with an 80% participation rate.
The univariate analyses will compare the follow-up rates (with Fisher’s exact test), and all individual characteristics collected (Fisher’s exact test, Student’s t-test) between the two groups. The multivariate analysis will use a mixed linear model analysis and consider the cluster effect as random; the initial model will include known confounders from the literature, confounders identified in univariate analyses, and the clinically relevant prognostic factors. All of these factors will be taken into account in the model as a fixed effect.

Ethics and dissemination
The Patient Protection Committee North-West II approved this study on 4 February 2021 (IRB 2020-A02247-32). The results will be the subject of scientific communications and publications.

Trial registration number
NCT04823104.

Introduction
Adolescence is a critical time for growth and development, but this age group is often neglected in research and development of nutrition interventions. Despite recommendations from the WHO to provide nutrient supplements to adolescents, evidence remains scarce on the most effective supplementation strategy. This study aims to compare weekly iron and folic acid (IFA) supplementation with daily multiple micronutrient supplements (MMSs) in prevention of anaemia and improvement of school outcomes among adolescents in Burkina Faso and Tanzania.

Methods and analysis
A three-arm cluster-randomised, school-based supplementation trial will be conducted among 84 schools (42 schools per site) and roughly 4500 students aged 10–17. Schools will be matched on three characteristics: number of students, school ranking profile, distance to main road (Tanzania) or distance to city council (Burkina Faso). Each school will be randomised to receive either weekly IFA, daily MMSs or serve as a control. Supplements will be delivered to students by teachers, who will provide monitoring data to the study team. Baseline and endline surveys will be conducted prior to and after each supplementation cycle (12 weeks in Burkina Faso; 1 year in Tanzania) to assess haemoglobin, anthropometry and sociodemographic variables. The primary outcome of haemoglobin will be analysed continuously using linear regression, and anaemia status will be analysed using logistic or multinomial regression, depending on categorisation level of the outcome. Secondary analyses of school performance indicators will also be conducted with either logistic or linear regression.

Ethics and dissemination
This protocol has been approved by the Institutional Review Board of the Harvard TH Chan School of Public Health (IRB20-1108) and the Research Ethics Committees for the Ministries of Health in Tanzania (Zanzibar) and Burkina Faso. Results will be disseminated during meetings with the Ministries of Health and the participating communities as well as through peer-reviewed publications.

Trial registration number
NCT04657640; NCT05104554

Objective
Although there is a high risk of drug resistance, empiric treatment is a common approach for pneumonia management. In this respect, it is relevant to know treatment outcomes of patients with pneumonia. This study aimed to assess treatment outcomes and its associated factors among pneumonia patients treated at two public hospitals in Harar, eastern Ethiopia.

Design
Retrospective follow-up study.

Setting
Jugal General Hospital and Hiwot Fana Specialised University Hospital in Harar, eastern Ethiopia.

Participants
Patients admitted and treated for pneumonia in the two public hospitals in eastern Ethiopia between April 2020 and April 2021.

Primary outcome
The primary outcome was unfavourable treatment outcome (died or transferred to intensive care unit) for pneumonia patients.

Results
A total of 693 patients with pneumonia were included in the study. 88 (12.7%) of these patients had an unfavourable treatment outcome, which included 14 (2%) transfers to the intensive care unit and 74 (10.7%) deaths. Patients with comorbidity (adjusted OR, AOR=2.96; 95% CI: 1.47 to 5.97) and with clinical features including abnormal body temperature (AOR=4.03; 95% CI: 2.14 to 7.58), tachycardia (AOR=2.57; 95% CI: 1.45 to 4.55), bradypnoea or tachypnoea (AOR=3.92; 95% CI:1.94 to 7.92), oxygen saturation below 90% (AOR=2.52; 95% CI:1.37 to 4.64) and leucocytosis (AOR=2.78, 95%, CI:1.38 to 5.58) had a significantly increased unfavourable treatment outcome.

Conclusion
We found that nearly one out of eight patients with pneumonia had unfavourable treatment outcomes. It was considerably high among patients with comorbidities and apparent abnormal clinical conditions. Therefore, taking into account regionally adaptable intervention and paying close attention to pneumonia patients admitted with comorbidity and other superimposed abnormal conditions might help improve the treatment outcomes of these populations.

Objectives
This study evaluated the relationship between status of oral function and related long-term care service costs.

Design
This was a prospective 6-year follow-up study of previous survey data.

Setting
The data were obtained from the Japan Gerontological Evaluation Study conducted between 2010 and 2011.

Participants
The participants were functionally independent older adults in 12 municipalities across Japan.

Interventions
Care service benefit costs were tracked over 6 years using publicly available claims records (n=46 616) to monitor respondents’ cumulative care costs.

Primary and secondary outcome measures
The primary outcome variable was the cumulative cost of long-term care insurance services during the follow-up period. We adjusted for the presence or absence of oral function problems, age, sex, physical function and socioeconomic and lifestyle background at the time of the baseline survey.

Results
Tobit analysis revealed that, compared with those with no oral function problems, cumulative long-term care service benefit costs for those with one, two or three oral function problems were approximately US$4020, US$4775 and US$82 92, respectively, over 6 years. Compared with those with maintained oral function, there was a maximum difference of approximately US$8292 in long-term care service costs for those with oral function problems. With increase in number of oral function problems, there was a concomitant elevation in the cost of long-term care.

Conclusions
Oral function in older people was associated with cumulative long-term care insurance costs. The oral function of older people should be maintained to reduce future accumulated long-term care insurance costs. Compared with those with maintained oral function, there was a maximum difference of approximately US$8292 in long-term care service costs for those with oral function problems. The cost of long-term care was amplified as oral problems increased.

Svolta per i casi più difficili, studio italiano

Svolta per i casi più difficili, studio italiano

Stroke, Volume 54, Issue Suppl_1, Page ATP75-ATP75, February 1, 2023. Introduction:Up to 25% of strokes are recognized upon awakening. Recent studies have demonstrated that a “tissue clock” rather than a time clock can be used to identify patients who may benefit from intravenous thrombolytics (IVT) beyond 4.5 hours from last known well (LKW). Consistent access to hyperacute MRI limits many centers from treating wake-up stroke patients. We created a formal protocol of clinical and imaging criteria to standardize evaluation and management of wake-up strokes.Methods:This retrospective, observational study reviewed consecutive patients admitted to our Comprehensive Stroke Center who qualified for the wake-up protocol between February 2022 and June 2022. The implemented protocol, based on clinical trials’ inclusion criteria, is comprised of the following: 1) arrival within 12 hours from LKW and within 4.5 hours from symptom discovery; 2) high suspicion for acute ischemic stroke; 3) no contraindication to MRI; 4) NIHSS of at least 4; 5) baseline mRS 0-3; 6) no absolute contraindications to IVT. For patients meeting above inclusion criteria, emergent MRI with perfusion was performed. Diffusion-FLAIR mismatch (signal intensity ratio) and diffusion-perfusion mismatch were reviewed to determine thrombolysis eligibility by a trained neuroradiologist or vascular neurologist.Results:Ten patients qualified for the wake-up protocol in the first five months of protocol implementation. Median NIHSS was 7, median LKW to arrival time was 8 hours, and median door to MRI time was 72.5 minutes. A final diagnosis of ischemic stroke was made in 80% of these cases. Overall, 50% were eligible for IVT based on our criteria, and 30% received thrombolysis. Median door to needle time was 92 minutes (range 75-117). There were no symptomatic intracranial hemorrhages. All patients treated with IVT were discharged home with no to minimal residual deficits with mRS 0-1 and median NIHSS at discharge of 2 (range 0-4).Conclusion:A formal protocol for wake-up stroke management allowed a streamlined approach to expand the number of IVT-eligible cases. Continued efforts are needed to improve door to needle times in such cases and to follow clinical courses of treated patients.

Stroke, Volume 54, Issue Suppl_1, Page AWP25-AWP25, February 1, 2023. Background:AHA/ASA guidelines recommend obtaining early vessel imaging with CT angiography (CTA) or MR angiography (MRA) only in a select group of acute ischemic stroke (AIS) patients suspected to have large vessel occlusion (LVO). There is limited data on the utility of early cerebrovascular imaging in all suspected AIS patients presenting within 24 hours and its impact on door in-door out (DIDO) time.Methods:In January 2020, our Primary Stroke Center implemented a protocol to obtain upfront head and neck CTA simultaneously with a non contrast head CT for all suspected ischemic stroke patients screening positive for BE-FAST stroke symptoms within 24 hours from last known normal time. We retrospectively reviewed patients before (January 1-December 31, 2019) and after protocol implementation (January 1, 2020-June 30, 2022) to assess time metrics for patients receiving IV thrombolysis and/or transfer for thrombectomy.Results:A total of 86 AIS patients were evaluated during the study period. Time metrics before and after protocol implementation for thrombectomy eligible patients are shown in the figure. Compared to 2019, up-front CTA was associated with significant reductions in Door-to-CTA start (median 37 vs 14 minutes, p=0.05), Door-to-CTA interpretation (median 83 vs 52 minutes, p=0.02) and DIDO times (median 150 vs 106 minutes, p=0.02) in the final 12 months of the study period. There was no significant difference in door-to-needle time before and after protocol implementation (median 48 vs 43 minutes, p=0.40).Conclusion:In conclusion, up-front cerebrovascular imaging with CTA in suspected AIS patients presenting within 24 hours resulted in shorter DIDO times without delaying door-to-needle times. Primary Stroke Centers should consider this approach to detect LVO early and accelerate patient transport to thrombectomy capable centers.

Stroke, Volume 54, Issue Suppl_1, Page ATMP2-ATMP2, February 1, 2023. Background:The unknown onset stroke can be categorized into two groups; wake-up stroke (WUS) and non-wake-up unwitnessed stroke with a time of onset unavailable due to aphasia, impaired consciousness, or cognitive impairment (non-wake-up unknown onset stroke, non-WUS). We aimed to assess the differences in efficacy and safety of intravenous thrombolysis (IVT) for these subgroups.Methods:Patients with an unknown onset stroke from the Evaluation of unknown Onset Stroke thrombolysis trials (EOS) collaboration were evaluated using an individual patient-level database of randomized controlled trials comparing IVT with placebo/standard treatment. A favorable outcome was defined as a modified Rankin Scale score 0-1 at 90 days. Safety outcomes included symptomatic intracranial hemorrhage (sICH) at 22-36 hours and 90-day mortality. The effect of IVT was compared between the treatment groups in the WUS and non-WUS with mixed-effect logistic-regression analysis.Results:A total of 634 patients (233 women [36.8%], median age 70 years [IQR 61-76]) were analyzed. In patients with non-WUS (n=92 [14%]), advanced age, atrial fibrillation, vessel occlusion on MRA and high NIHSS score were more prevalent (P

Stroke, Volume 54, Issue Suppl_1, Page ATP76-ATP76, February 1, 2023. Introduction:Improving rates of in-hospital survival in intracerebral hemorrhage (ICH) have led to opportunities to implement secondary prevention and recovery measures. Lost to follow up is not well characterized in this disabled population. The objective of this analysis was to describe the frequency of lost to follow up for ICH survivors from an urban comprehensive stroke center and thrombectomy capable center.Methods:We included n=409 ICH patients from December 2016 to February 2022. With chart review, we collected data regarding the admission, discharge and follow-up. Our primary outcome measure was a modified Rankin scale (mRS) score of 0 – 3 during their last recorded follow-up. Pearson correlation analyses were performed using R statistical software to determine if there was a significant correlation between the number of follow-ups a patient received and their final recorded mRS score.Results:Of 409 ICH patients, 80 died within the first month of their index hospitalization or had incomplete records that prevented further analysis. Of the 329 patients, 181 were minorities (83 blacks, 49 asian and 49 hispanics) and 90 were white. About 85% (279/329) had insurance. Only 162 received 3 or more follow-ups post-index hospitalization, with 47 patients never receiving any follow-ups after their initial discharge. Of those that received follow up, the average number of follow ups was 2.57, with an average time of 366.17 days between discharge and the last recorded follow-up. Among the 282 patients that received at least one follow-up, there was a significant negative correlation between the number of follow-ups a patient received and their final recorded mRS score (p = 0.0000339, r = -0.246). There was no significant differences related to age, race or insurance status for those who followed up versus those who were lost to follow up.Conclusions:In a large urban health system, 14% ICH survivors were lost to follow-up. ICH survivors with good functional outcomes received more follow-up. There is a need to improve systems of care to prevent ICH patients from getting lost to follow-up and improving long term outcomes.