Risultati per: Follow-up ottimale dopo embolia polmonare acuta

Stroke, Ahead of Print. BACKGROUND:White matter hyperintensities of presumed vascular origin (WMH) are the most prominent imaging feature of cerebral small vessel disease (cSVD). Previous studies suggest a link between cSVD burden and intracerebral hemorrhage and worse functional outcome after thrombolysis in acute ischemic stroke. We aimed to determine the impact of WMH burden on efficacy and safety of thrombolysis in the MRI-based randomized controlled WAKE-UP trial of intravenous alteplase in unknown onset stroke.METHODS:The design of this post hoc study was an observational cohort design of a secondary analysis of a randomized trial. WMH volume was quantified on baseline fluid-attenuated inversion recovery images of patients randomized to either alteplase or placebo in the WAKE-UP trial. Excellent outcome was defined as score of 0-1 on the modified Rankin Scale after 90 days. Hemorrhagic transformation was assessed on follow-up imaging 24-36 hours after randomization. Treatment effect and safety were analyzed by fitting multivariable logistic regression models.RESULTS:Quality of scans was sufficient in 441 of 503 randomized patients to delineate WMH. Median age was 68 years, 151 patients were female, and 222 patients were assigned to receive alteplase. Median WMH volume was 11.4 mL. Independent from treatment, WMH burden was statistically significantly associated with worse functional outcome (odds ratio, 0.72 [95% CI, 0.57–0.92]), but not with higher chances of any hemorrhagic transformation (odds ratio, 0.78 [95% CI, 0.60–1.01]). There was no interaction of WMH burden and treatment group for the likelihood of excellent outcome (P=0.443) or any hemorrhagic transformation (P=0.151). In a subgroup of 166 patients with severe WMH, intravenous thrombolysis was associated with higher odds of excellent outcome (odds ratio, 2.40 [95% CI, 1.19–4.84]) with no significant increase in the rate of hemorrhagic transformation (odds ratio, 1.96 [95% CI, 0.80–4.81]).CONCLUSIONS:Although WMH burden is associated with worse functional outcome, there is no association with treatment effect or safety of intravenous thrombolysis in patients with ischemic stroke of unknown onset.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT01525290.

Objective
To assess the magnitude of suicidal ideation, attempts and associated factors among adults living with HIV attending antiretroviral therapy follow-ups at Tirunesh Beijing General Hospital, Addis Ababa.

Design
Hospital-based observational, descriptive, cross-sectional study was conducted.

Setting
A study was conducted in Tirunesh Beijing General Hospital, Addis Ababa from 8 February 2022 to 10 July 2022.

Participants
Two hundred and thirty-seven HIV-positive youth were recruited for interviews, using the systematic random sampling technique. The Composite International Diagnostic Interview was used to assess suicide. Patient Health Questionnaire-9, the Oslo social support and HIV perceived stigma scale instruments were used to assess the factors. Bivariate and multivariate logistic regressions were computed to assess factors associated with suicidal ideation and attempt. Statistical significance was declared at p value

Introduction
It is known that only a limited proportion of developed clinical prediction models (CPMs) are implemented and/or used in clinical practice. This may result in a large amount of research waste, even when considering that some CPMs may demonstrate poor performance. Cross-sectional estimates of the numbers of CPMs that have been developed, validated, evaluated for impact or utilized in practice, have been made in specific medical fields, but studies across multiple fields and studies following up the fate of CPMs are lacking.

Methods and analysis
We have conducted a systematic search for prediction model studies published between January 1995 and December 2020 using the Pubmed and Embase databases, applying a validated search strategy. Taking random samples for every calendar year, abstracts and articles were screened until a target of 100 CPM development studies were identified. Next, we will perform a forward citation search of the resulting CPM development article cohort to identify articles on external validation, impact assessment or implementation of those CPMs. We will also invite the authors of the development studies to complete an online survey to track implementation and clinical utilization of the CPMs.
We will conduct a descriptive synthesis of the included studies, using data from the forward citation search and online survey to quantify the proportion of developed models that are validated, assessed for their impact, implemented and/or used in patient care. We will conduct time-to-event analysis using Kaplan-Meier plots.

Ethics and dissemination
No patient data are involved in the research. Most information will be extracted from published articles. We request written informed consent from the survey respondents. Results will be disseminated through publication in a peer-reviewed journal and presented at international conferences.

OSF registration
(https://osf.io/nj8s9).

Objective
Canadian Armed Forces (CAF) post-deployment screening aims to facilitate early care for members with mental health issues. The process consists of a questionnaire to screen for mental health problems, followed by an interview with a healthcare provider during which recommendations for follow-up care are provided if needed. In this study, we examined the association of self-reported mental health from the screening questionnaire with recommendation for follow-up care during the interview.

Design
Using screening data collected from CAF members who deployed from 2009 to 2012 (n=14 957), logistic regression analysis was conducted to examine the association of self-reported mental health from the screening questionnaire with clinicians’ recommendation for follow-up care.

Results
In total, 19.7% of screened individuals were recommended for follow-up care. In the adjusted logistic regression model, some demographic characteristics, as well current and prior mental healthcare and self-reported mental health problems, had a substantial association with recommendation for follow-up. Compared with each mental health problem’s lowest severity category, recommendation for follow-up care was higher by approximately 12%–17% for those with mild to severe depression, 7% for those with panic disorder, 8%–10% for those with mild to severe anxiety, 8% for those experiencing high levels of stressors, 4%–10% for those at risk of alcohol use disorder and 7%–12% for those at risk of post-traumatic stress disorder.

Conclusions
Although the presence of mental health problems was significantly associated with receiving a follow-up recommendation, the relationships between self-reported mental health and subsequent recommendations for care were not as high as expected. Although this may partly reflect time delays between the questionnaire and interview, further research is needed on the extent to which other factors contributed to referral decisions.

Circulation, Volume 147, Issue 20, Page 1554-1555, May 16, 2023.

Introduction
This study aims to investigate whether a pain neuroscience education (PNE) combined with a blended exercises programme including aerobic, resistance, neuromuscular, breathing, stretching and balance exercises and diet education provides greater pain relief and improvement in functional and psychological factors than PNE and blended exercises alone and whether ‘exercise booster sessions (EBS)’ approach may improve outcomes and increase adherence in patients with knee osteoarthritis (KOA) (by telerehabilitation (TR)).

Methods and analysis
In this single-blind randomised controlled trial, 129 patients (both genders; age >40) diagnosed with KOA will be randomly assigned to one of the 22 treatment combinations as: (1) blended exercises alone (36 sessions over 12 weeks), (2) PNE alone (three sessions over 2 weeks), (3) combination of PNE with blended exercises (exercise three times a week for 12 weeks combined with three sessions of PNE) and (4) a control group. Outcome assessors will be blinded towards group allocation. The primary outcome variables are the visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis index in knee osteoarthritis (WOMAC) score. Secondary outcomes include Pain Self-Efficacy Questionnaire (PSEQ), Depression, Anxiety and Stress Scale (DASS), Tampa Scale for Kinesiophobia (TSK), Short Falls Efficacy Scale International (FES-I), Pain Catastrophising Scale (PCS), Short Form Health Survey (SF-12) and Exercise Adherence Rating Scale (EARS), 30 s sit-to-stand test (30CST), Timed Up and Go (TUG), lower limbs’ muscle strength and lower limb joints’ active range of motion (AROM) will be performed at baseline, 3 and 6 months’ postinterventions. The primary and secondary outcomes will assess at baseline, 3 months and 6 months postinterventions.
The findings will be useful in establishing an effective treatment strategy covering multiple aspects behind KOA. The study protocol is conducted in clinical settings, thereby enhancing the possibility of future implementation of the treatments in the healthcare systems and self-care management. Results in comparison between groups will help to clarify the most effective of mixed-method TR (blended exercise, PNE, EBS with diet education) on more improvement in pain, functional and psychological factors in patients with KOA. This study will combine some of the most critical interventions, to be able to introduce a ‘gold standard therapy’ in the treatment of KOA.

Ethics and dissemination
The trial has been approved by the ethics committee for research involving human subjects of the Sport Sciences Research Institute of Iran (IR.SSRC.REC.1401.021). The study findings will be published in international peer-reviewed journals.

Trial registration number
IRCTID: IRCT20220510054814N1.

Introduction
Multimodal interventions have emerged as new approaches to provide more targeted intervention to reduce functional decline after stroke. Still, the evidence is contradictory. The main objective of the Life After Stroke (LAST)-long trial is to investigate if monthly meetings with a stroke coordinator who offers a multimodal approach to long-term follow-up can prevent functional decline after stroke.

Methods and analysis
LAST-long is a pragmatic single-blinded, parallel-group randomised controlled trial recruiting participants living in six different municipalities, admitted to four hospitals in Norway. The patients are screened for inclusion and recruited into the trial 3 months after stroke. A total of 300 patients fulfilling the inclusion criteria will be randomised to an intervention group receiving monthly follow-up by a community-based stroke coordinator who identifies the participants’ individual risk profile and sets up an action plan based on individual goals, or to a control group receiving standard care. All participants undergo blinded assessments at 6-month, 12-month and 18-month follow-up. Modified Rankin Scale at 18 months is primary outcome. Secondary outcomes are results of blood tests, blood pressure, adherence to secondary prophylaxis, measures of activities of daily living, cognitive function, physical function, physical activity, patient reported outcome measures, caregiver’s burden, the use and costs of health services, safety measures and measures of adherence to the intervention. Mixed models will be used to evaluate differences between the intervention and control group for all endpoints across the four time points, with treatment group, time as categorical covariates and their interaction as fixed effects, and patient as random effect.

Ethics and dissemination
This trial was approved by the Regional Committee of Medical and Health Research Ethics, REC no. 2018/1809. The main results will be published in international peer-reviewed open access scientific journals and to policy-makers and end users in relevant channels.

Trial registration number
ClincalTrials.gov Identifier: NCT03859063, registered on 1 March 2019.

Objective
To determine Canadian service members’ level of adherence to a recommendation for mental health services follow-up that was assigned by clinicians during postdeployment screening.

Design
Retrospective cohort study.

Setting
Canadian military population.

Participants
The cohort consisted of personnel (n=28 460) with a deployment within the 2009–2014 time frame. A stratified random sample (n=3004) was selected for medical chart review. However, we restricted our analysis to individuals whose completed screening resulted in a recommendation for mental health services follow-up (sample n=316 (weighted n=2034) or 11.2% of screenings.

Interventions
Postdeployment health screening.

Primary outcome measure
The outcome was adherence to a screening-indicated mental health services follow-up recommendation, assessed within 90 days, a preferred delay, and within 365 days, a delay considered partially associated with the screening recommendation.

Results
Adherence within 90 days of screening was 71.1% (95% CI 59.7% to 82.5%) for individuals with ‘major’ mental health concerns, 36.1% (95% CI 23.9% to 48.4%) for those with ‘minor’ mental health concerns, and 46.8% (95% CI 18.6% to 75.0%), for those with psychosocial mental health concerns; the respective 365-day adherence fractions were 85.3% (95% CI 76.1% to 94.5%), 55.7% (95% CI 42.0% to 69.4%) and 48.6% (95% CI 20.4% to 76.9%). Logistic regression indicated that a 90-day adherence among those with a ‘major’ mental health concern was higher among those screening after 2012 (adjusted OR (AOR) 5.45 (95% CI 1.08 to 27.45)) and lower, with marginal significance, among those with deployment durations greater than 180 days (AOR 0.35 (95% CI 0.11 to 1.06)).

Conclusions
On an individual level, screening has the potential to identify when a care need is present and a follow-up assessment can be recommended; however, we found that adherence to this recommendation is not absolute, suggesting that administrative checks and possibly, process refinements would be beneficial to ensure that care-seeking barriers are minimised.

Stroke, Ahead of Print. BACKGROUND:Reversibility of the diffusion-weighted imaging (DWI) lesion means that not all of the DWI lesion represents permanently injured tissue. We investigated DWI reversibility and the association with thrombolysis, reperfusion and functional outcome in patients from the WAKE-UP trial (Efficacy and Safety of Magnetic Resonance Imaging–Based Thrombolysis in Wake-Up Stroke).METHODS:In this retrospective analysis of WAKE-UP, a randomized controlled trial (RCT) between September 2012 and June 2017 in Belgium, Denmark, France, Germany, Spain and United Kingdom, a convolutional neural network segmented the DWI lesions (b=1000 s/mm2) at baseline and follow-up (24 hours). We calculated absolute and relative DWI reversibility in 2 ways: first, a volumetric (baseline volume−24-hour volume >0) and second, a voxel-based (part of baseline lesion not overlapping with 24-hour lesion) approach. We additionally defined relative voxel-based DWI-reversibility >50% to account for coregistration inaccuracies. We calculated the odds ratio for reversibility according to treatment arm. We analyzed the association of reversibility with excellent functional outcome (modified Rankin Scale score of 0–1), in a multivariable model.RESULTS:In 363 patients, the median DWI volume was 3 (1–10) mL at baseline and 6 (2–20) mL at follow-up. Volumetric DWI reversibility was present in 19% (69/363) with a median absolute reversible volume of 1 mL (0–2) or 28% (14–50) relatively. Voxel-based DWI reversibility was present in 358/363 (99%) with a median absolute volume of 1 mL (0–2), or 22% (9–38) relatively. In 18% of the patients (67/363), relative voxel-based DWI reversibility >50% was present. Volumetric DWI reversibility and relative voxel-based DWI reversibility >50% was more frequent in patients treated with alteplase versus placebo (OR, 1.86 [95% CI, 1.09–3.17] and OR, 2.03 [95% CI, 1.18–3.50], respectively). Relative voxel-based DWI reversibility >50% was associated with excellent functional outcome (OR, 2.30 [95% CI, 1.17–4.51]).CONCLUSIONS:Small absolute volumes of DWI reversibility were present in a large proportion of randomized patients in the WAKE-UP trial. Reversibility was more often present after thrombolysis.

The recognition that early-onset colorectal cancer (EO-CRC) rates are rising has sent shockwaves through the field of gastroenterology in recent years. Cases of celebrities affected by EO-CRC have similarly shocked the broader public and have drawn attention to the importance of screening. After television anchor Katie Couric’s husband died of EO-CRC at age 42, she underwent an on-air colonoscopy in 2000, which led to a significant increase in screening colonoscopy rates that was dubbed ‘the Katie Couric effect’.1 More recently, the acclaimed actor Chadwick Boseman tragically died of EO-CRC at age 43, again increasing awareness and discussion of the need for screening. Colonoscopy is an excellent screening tool but of limited utility to individuals younger than the recommended age of initiation of screening, which is 50 in many parts of the world.2 While overall CRC rates have progressively decreased over time due to systematic screening,…

Objective
This study aimed to assess the incidence and identify predictors of perioperative mortality among the adult age group at Tibebe Ghion Specialised Hospital.

Design
A single-centre prospective follow-up study.

Setting
A tertiary hospital in North West Ethiopia.

Participants
We enrolled 2530 participants who underwent surgery in the current study. All adults aged 18 and above were included except those with no telephone.

Primary outcome measures
The primary outcome was time to death measured in days from immediate postoperative time up to the 28th day following surgery.

Result
A total of 2530 surgical cases were followed for 67 145 person-days. There were 92 deaths, with an incidence rate of 1.37 (95% CI 1.11 to 1.68) deaths per 1000 person-day observations. Regional anaesthesia was significantly associated with lower postoperative mortality (adjusted hazard ratio (AHR) 0.18, 95% CI 0.05 to 0.62). Patients aged ≥65 years (AHR 3.04, 95% CI 1.65 to 5.75), American Society of Anesthesiologist (ASA) physical status III (AHR 2.41, 95% CI 1.1.13 to 5.16) and IV (AHR 2.74, 95% CI 1.08 to 6.92), emergency surgery (AHR 1.85, 95% CI 1.02 to 3.36) and preoperative oxygen saturation

Via libera dell’Aifa. Sopravvivenza sale anche senza chemio

Objectives
The aim of this systematic review was to identify from published literature the available evidence regarding the effects of warm-up intervention implemented in the workplace on work -related musculoskeletal disorders (WMSDs) and physical and psychosocial functions.

Design
Systematic review.

Data sources
The following four electronic databases were searched (from inception onwards to October 2022): Cochrane Central Register of Controlled Trials (CENTRAL), PubMed (Medline), Web of Science and Physiotherapy Evidence Database (PEDro).

Eligibility criteria
Randomised and non-randomised controlled studies were included in this review. Interventions should include a warm-up physical intervention in real-workplaces.

Data extraction and synthesis
The primary outcomes were pain, discomfort, fatigue and physical functions. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used the Grading of Recommendations, Assessment, Development and Evaluation evidence synthesis. To assess the risk of bias, the Cochrane ROB2 was used for randomised controlled trial (RCT) and the Risk Of Bias In Non-randomised Studies-of Interventions was used for the non-RCT studies.

Results
Three studies met the inclusion criterion, one cluster RCT and two non-RCTs. There was an important heterogeneity in the included studies principally concerning population and warm-up intervention exercises. There were important risks of bias in the four selected studies, due to blinding and confounding factors. Overall certainty of evidence was very low.

Conclusion
Due to the poor methodological quality of studies and conflicting results, there was no evidence supporting the use of warm-up to prevent WMSDs in the workplace. The present findings highlighted the need of good quality studies targeting the effects of warm-up intervention to prevent WMSDs.

PROSPERO registration number
CRD42019137211.

Annals of Internal Medicine, Ahead of Print.

This cohort study examines the association of estimated life expectancy with colonoscopy findings and recommendations for surveillance colonoscopy among adults older than 65 years in New Hampshire.

This case report describes a patient in their early 70s with frequent paroxysmal chest pain.