Risultati per: La gestione del paziente depresso da parte del medico di medicina generale: case reports

Rinviato a metà gennaio voto su piano revisione Rete oncologica

Introduction
There are insufficient scalable, evidence-based treatments to meet increasing mental health needs of young people. Offering interim, brief interventions for young persons with psychological distress can improve access to care and mitigate adverse effects of long waiting times. This study tests the efficacy of solution-focused brief therapy (SFBT), a strength-based, goal-directed intervention, in adolescents and young adults at a community-based youth mental health service in Singapore.

Methods and analysis
This is a fully powered, randomised, single-centre, two-arm, parallel, superiority, controlled trial. From September 2023 to March 2025, the study will recruit 124 participants (aged 16–30) presenting at a national youth mental health service in Singapore (CHAT, Centre of Excellence for Youth Mental Health) with clinically assessed general psychological distress, subthreshold or prodromal symptoms, or a first episode of a mood disorder. Participants will be excluded if they have high risk of suicide, psychosis, cognitive impairments, or current psychological treatments. Participants will be randomised in a 1:1 ratio to receive six-session, case manager delivered SFBT or treatment as usual (TAU) case management, and be followed up for 3 months post-intervention. Participants receiving SFBT are hypothesised to have greater improvements in self-reported psychological distress, from baseline to 8 weeks, compared with the control group. Secondary outcomes are self-reported depression and anxiety symptoms, and functional impairment. The study will also explore whether SFBT is associated with increased self-efficacy and decreased hopelessness, decreased downstream referrals post-intervention, and sustained clinical gains 3 months post-intervention compared with TAU. Adverse events and clinical deterioration will be recorded and reported.

Ethics and dissemination
The Institute of Mental Health (IMH) Institutional Research Review Committee (reference 822–2022) and the Singapore National Health Group Domain Specific Review Board (DSRB) (reference 2023/00052) have approved the study protocol. Findings will be published in international, peer-reviewed scientific journals. Summaries will be disseminated to study funders, mental healthcare systems administrators, and clinicians.

Trial registration number
ISRCTN13671612 https://doi.org/10.1186/ISRCTN13671612

Introduction
A chest X-ray (CXR) is the most common imaging investigation performed worldwide. Advances in machine learning and computer vision technologies have led to the development of several artificial intelligence (AI) tools to detect abnormalities on CXRs, which may expand diagnostic support to a wider field of health professionals. There is a paucity of evidence on the impact of AI algorithms in assisting healthcare professionals (other than radiologists) who regularly review CXR images in their daily practice.

Aims
To assess the utility of an AI-based CXR interpretation tool in assisting the diagnostic accuracy, speed and confidence of a varied group of healthcare professionals.

Methods and analysis
The study will be conducted using 500 retrospectively collected inpatient and emergency department CXRs from two UK hospital trusts. Two fellowship-trained thoracic radiologists with at least 5 years of experience will independently review all studies to establish the ground truth reference standard with arbitration from a third senior radiologist in case of disagreement. The Lunit INSIGHT CXR tool (Seoul, Republic of Korea) will be applied and compared against the reference standard. Area under the receiver operating characteristic curve (AUROC) will be calculated for 10 abnormal findings: pulmonary nodules/mass, consolidation, pneumothorax, atelectasis, calcification, cardiomegaly, fibrosis, mediastinal widening, pleural effusion and pneumoperitoneum. Performance testing will be carried out with readers from various clinical professional groups with and without the assistance of Lunit INSIGHT CXR to evaluate the utility of the algorithm in improving reader accuracy (sensitivity, specificity, AUROC), confidence and speed (paired sample t-test). The study is currently ongoing with a planned end date of 31 December 2024.

Ethics and dissemination
The study has been approved by the UK Healthcare Research Authority. The use of anonymised retrospective CXRs has been authorised by Oxford University Hospital’s information governance teams. The results will be presented at relevant conferences and published in a peer-reviewed journal.

Trial registration number
Protocol ID 310995-B (awaiting approval), ClinicalTrials.gov

Stroke, Ahead of Print. BACKGROUND:Cardiac computed tomography (CT) is increasingly used to search for cardioembolic sources of acute ischemic stroke (AIS). We assessed the association between high-risk cardioembolic sources on cardiac CT and AIS.METHODS:We performed a case-control study using data from a prospective cohort including consecutive adult patients with suspected stroke who underwent cardiac CT acquired during the initial stroke imaging protocol between 2018 and 2020. Cases were patients with a final diagnosis of AIS. Controls were patients with a stroke mimic (SMi). We excluded patients with a transient ischemic attack. Diagnoses were established by an adjudication committee. Cardiac radiologists assessed the presence of structural high-risk sources of cardioembolism according to predefined criteria. We used the Firth penalized likelihood method to perform a logistic regression, adjusted for age, sex, and history of myocardial infarction to determine the association between high-risk embolic sources and AIS. For the primary analysis, we excluded patients with a history of atrial fibrillation. In a secondary analysis, patients with known atrial fibrillation were included.RESULTS:Of 774 patients, we excluded 167 patients due to no written informed consent or the diagnosis of transient ischemic attack. Of 607 patients, 107 patients had known atrial fibrillation and were excluded from the primary analysis. Of 500 included patients, 375 had AIS (75%, median age 70, 61% male) and 125 SMi (25%, median age 69, 42% male). A high-risk cardioembolic source was found on CT in 32/375 (8.5%) patients with AIS and 0/125 (0%) patients with SMi (adjusted odds ratio, 23.8 [95% CI, 3.3–3032.5]). Cardiac thrombi were the most commonly observed abnormality, present in 23 (6.1%) patients with AIS and 0 (0%) patients with SMi.CONCLUSIONS:A high-risk source of cardioembolism was detected on cardiac CT more frequently in patients with AIS than in patients with SMi. These data substantiate the clinical relevance of cardioembolic sources detected on acute cardiac CT in patients with ischemic stroke.

Domani ad Ancona congresso scientifico alla Politecnica Marche

Stroke, Ahead of Print. BACKGROUND:The pathogenesis of spontaneous cervical artery dissection remains unclear, and no established predictors of recurrence exist. Our goal was to investigate the potential association between cervical artery tortuosity, a characteristic of patients with connective tissue disorder, and spontaneous cervical artery dissection.METHODS:The ReSect study (Risk Factors for Recurrent Cervical Artery Dissection) is an observational study that invited all spontaneous cervical artery dissection patients treated at the Innsbruck University Hospital between 1996 and 2018 for clinical and radiological follow-up. Internal carotid and vertebral artery tortuosity was assessed on magnetic resonance angiography using a validated 3-dimensional algorithm. Differences between patients and healthy controls as well as dependent on recurrence status were assessed by applying χ2, Mann-WhitneyUtest, and Kruskal-Wallis test where applicable, and confounders were established by bivariable Pearson correlation. Logistic regression was used to address the impact of tortuosity on dissection occurrence and recurrence as well as its association to extracellular matrix proteome data derived from skin biopsies in a subset of patients.RESULTS:Magnetic resonance angiography was performed a median of 6.5 years after dissection in the included dissection patients. Patients with dissection (n=125) had significantly increased values of internal carotid artery tortuosity compared with healthy controls (n=24; odds ratio, 2.65 [95% CI, 1.68–3.86], 1 SD increase;P

New England Journal of Medicine, Volume 391, Issue 24, Page 2361-2369, December 2024.

Ordinaria di Medicina interna a Perugia, si insedierà nel 2028

Objectives
Recent studies have suggested a potential link between opium consumption and microvascular dysfunction in coronary arteries, which may contribute to the development of coronary slow-flow syndrome. This study aims to investigate the relationship between opium use and coronary slow-flow syndrome.

Design and setting
This retrospective study analysed medical records of patients who underwent coronary angiography at the Tehran Heart Center from 2006 to 2020. It focused on those with coronary slow flow phenomenon (CSFP) or non-obstructive coronary artery disease, excluding patients with significant left ventricular dysfunction (left ventricular ejection fraction

Situazione sotto controllo. Sta bene 24enne con sospetta malaria

New England Journal of Medicine, Volume 391, Issue 23, Page 2256-2265, December 12, 2024.

With great interest, we carefully read the article by Lei et al.1 The authors introduced a novel ‘family index-case method’ to efficiently screen for and eradicate Helicobacter pylori (H. pylori) infections by reaching out to the family members of individuals who tested positive. However, the article predominantly focused on detailing the methodology of the ‘family index-case method’, rather than providing mathematical simulations to theoretically explain the underlying mechanisms of its efficacy. Therefore, based on data from a prior household-based H. pylori epidemiological survey, we aimed to validate the familial clustering pattern of H. pylori infections and offer theoretical justification for the observed phenomenon. From September 2021 to December 2021, a household-based H. pylori epidemiological survey was conducted in 29 provinces across mainland China.2 Familial clustering refers to the phenomenon where multiple H. pylori carriers tend to be concentrated within the same household, rather than being…