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

Soon after the earliest email systems were developed in the late 1960s, electronic messages began to pile up. The onslaught of messages surprised early adopters and spurred the development of message management systems from which modern email applications descended. Sixty years later, health care email has arrived in earnest with the development of patient portal messaging systems. And despite the history, the recent growth of patient portal messaging has caught clinicians and health systems by surprise. As health care systems struggle to adapt, understanding the scale of portal messaging and its potential impacts on clinicians and patients is crucial for designing and implementing effective solutions.

This JAMA Patient Page describes harm reduction strategies for people who use drugs, which include testing for drug contaminants, overdose prevention, and reducing risk of infectious disease transmission.

This systematic review aims to identify and critically appraise the quality of the measurement properties of existing alopecia areata–specific patient-reported outcome measures and to provide evidence-based recommendations on the most valid patient-reported outcome measures.

Il 70% paga le cure, il 30% teme la perdita del lavoro. Pesa la tossicità finanziaria

Introduction
Interventions are needed to increase participation in clinical trials through optimised trial design and enrolment workflows. Patient navigation is a promising intervention for increasing participation in clinical trials by optimising enrolment workflows. Patient navigation is defined as a personalised intervention aimed at overcoming barriers and ensuring timely access to healthcare services, diagnosis, treatment and care. This scoping review aims to fill a gap in current literature by summarising what is known about patient navigation, aiming to increase clinical trial participation.

Methods and analysis
A search was conducted for peer-reviewed literature published in English from inception through 21 December 2023, and the search was updated on 5 March 2025. Sources of literature included Cochrane CENTRAL (Ovid), MEDLINE (Ovid), EMBASE (Ovid), Cumulative Index of Nursing and Allied Health (CINAHL; on EBSCOhost; EBSCO Industries, Inc), Epistemonikos and PROSPERO databases. Searches were also conducted through the Turning Research into Practice and International Clinical Trials Registry Platform (WHO) databases, Google Scholar and the Agency for Health Research and Quality platform to ensure the retrieval of all relevant articles. Reference lists of eligible studies were also examined. The Google Scholar search was limited to the first 10 pages of results. The search strategy focused on the following key concepts: navigation (eg, navigator, care coordination, case management) and clinical trials. Searches were reviewed using the PRESS Peer Review of Electronic Search Strategies 2015. This review was guided based on the JBI methodology for scoping reviews using a five-step review process: identify the research questions; search and identify relevant studies; select studies based on a priori criterion; chart the data; and collate, summarise and report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.

Ethics and dissemination
This scoping review identifies and analyses existing research; therefore, ethics approval is not required. Findings will be disseminated through conference presentations and a publication in a scientific journal.

Introduction
Over the past decades, there has been increasing recognition that assessing patients with cancer’s health-related quality of life (HRQoL) is pivotal to delivering optimal patient-centred healthcare. However, with the increasing number of patient-reported outcome measures (PROMs) available, it becomes more and more challenging to identify the most appropriate PROM to capture HRQoL. Therefore, the aim of this systematic review is to (1) identify all available PROMs assessing HRQoL across the European cancer continuum and (2) critically appraise, compare and summarise the psychometric properties of the identified PROMs.

Methods and analysis
Bibliographic databases MEDLINE and PubMed Central (through PubMed) and EMBASE (through Scopus) will be comprehensively searched from database inception until March 2024. Studies reporting on the measurement properties of PROMs assessing HRQoL throughout the European cancer continuum will be included. The evaluation of the psychometric properties, data extraction and data synthesis will be conducted according to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology. Two reviewers will independently assess the methodological quality using the COSMIN risk of bias checklist and the COSMIN criteria for good measurement properties. Subsequently, findings will be qualitatively summarised. The Grading of Recommendations Assessment, Development and Evaluations (GRADE) guidelines will be used to grade and summarise the quality of the evidence.

Ethics and dissemination
Ethical clearance for this research is not required, as the systematic review will only use information from previously published research. The results of this review will be submitted for publication in a peer-reviewed journal and will be used to provide a set of evidence-based recommendations for a European project (EUonQOL), which aims at developing a new PROM (EUonQOL toolkit) to assess HRQoL across the European cancer continuum. Moreover, findings will be disseminated to a clinical audience and policymakers through conferences, supporting researchers and clinicians in choosing the best measure to evaluate HRQoL in patients with cancer and survivors in Europe.

PROSPERO registration number
CRD42023418616.

‘Più formazione dedicata agli under 40 per migliorare le cure’

Introduction
Although many efforts have been made to reduce racial pain disparities over decades, the pain of black patients is still undertreated. Previous work has identified a host of patient and provider factors that contribute to racial disparities in healthcare in general, and consequently, may contribute to disparities in pain care in particular. That said, there has been limited clinically meaningful progress in eliminating these disparities. This lack of progress is likely because prior research has investigated the influence of patient and provider factors in isolation, rather than examining their interaction. Successful pain care requires constructive patient-provider communication, and constructive communication is both dyadic and dynamic. One well-accepted operationalisation of such dyadic processes is behavioural coordination. We hypothesise that the pain of black patients continues to be undertreated because black patients are more likely than white patients to participate in racially discordant medical interactions (ie, seeing other-race providers) and experience disruptions in behavioural coordination. We further hypothesise that disruptions in behavioural coordination will reflect patient and provider factors identified in prior research. We propose to test these hypotheses in the planned surgical context.

Methods and analysis
Using a convergent mixed methods research design, we will collect data from at least 15 surgeons and their 150 patients (approximately equal number of black and white patients per surgeon). The data sources will include one surgeon survey, four patient surveys, video- and/or audio-recordings of preoperative consultations and medical chart reviews. The recorded preoperative consultations will be analysed both qualitatively and quantitatively to assess the magnitude and pattern of behavioural coordination between patients and surgeons. Those data will be linked to survey data and data from medical chart reviews to test our hypotheses.

Ethics and dissemination
Ethical approval has been obtained from the Virginia Commonwealth University Institutional Review Board (HM20023574). Findings will be disseminated through presentations at scientific conferences, publications in peer-reviewed journals and speaking engagements with clinician stakeholders. We will also share the main findings from this project with patients via a newsletter on completion of the entire project.

Introduction
Although many efforts have been made to reduce racial pain disparities over decades, the pain of black patients is still undertreated. Previous work has identified a host of patient and provider factors that contribute to racial disparities in healthcare in general, and consequently, may contribute to disparities in pain care in particular. That said, there has been limited clinically meaningful progress in eliminating these disparities. This lack of progress is likely because prior research has investigated the influence of patient and provider factors in isolation, rather than examining their interaction. Successful pain care requires constructive patient-provider communication, and constructive communication is both dyadic and dynamic. One well-accepted operationalisation of such dyadic processes is behavioural coordination. We hypothesise that the pain of black patients continues to be undertreated because black patients are more likely than white patients to participate in racially discordant medical interactions (ie, seeing other-race providers) and experience disruptions in behavioural coordination. We further hypothesise that disruptions in behavioural coordination will reflect patient and provider factors identified in prior research. We propose to test these hypotheses in the planned surgical context.

Methods and analysis
Using a convergent mixed methods research design, we will collect data from at least 15 surgeons and their 150 patients (approximately equal number of black and white patients per surgeon). The data sources will include one surgeon survey, four patient surveys, video- and/or audio-recordings of preoperative consultations and medical chart reviews. The recorded preoperative consultations will be analysed both qualitatively and quantitatively to assess the magnitude and pattern of behavioural coordination between patients and surgeons. Those data will be linked to survey data and data from medical chart reviews to test our hypotheses.

Ethics and dissemination
Ethical approval has been obtained from the Virginia Commonwealth University Institutional Review Board (HM20023574). Findings will be disseminated through presentations at scientific conferences, publications in peer-reviewed journals and speaking engagements with clinician stakeholders. We will also share the main findings from this project with patients via a newsletter on completion of the entire project.

Background
Gastrointestinal (GI) cancers are among the most significant contributors to the global cancer burden, causing substantial physical and emotional distress. Effective management of patient-reported outcomes (PROs) is essential for enhancing quality of life and overall survival in cancer care. Despite significant advances in cancer care, understanding PROs and their integration into clinical practice remains limited. Prediction models for PROs have the potential to support patient-centred care by improving shared decision-making and informing care plans. However, the development and application of clinical tools that predict PROs in patients with GI cancer have not been systematically explored. This scoping review aims to explore clinical prediction tools for PROs and the quality of life in patients with GI cancer, identifying current tools, predictors and outcomes, as well as evaluating their clinical usability and equity considerations.

Methods and analysis
A scoping review methodology, guided by the JBI Manual for Evidence Synthesis and the Arksey and O’Malley framework, will be used. The review will include studies of adult patients with primary GI cancer that developed or validated clinical prediction tools for PROs or quality of life. Inclusion criteria require the use of self-reported PRO measures. A systematic search of Ovid Medline, Embase and CINAHL will be conducted from 1946 to 2024. The search strategy will be updated periodically to incorporate the most recent literature and complemented by hand-searching references. Data extraction will focus on tool characteristics, predictors, statistical methods and equity considerations. The findings will be synthesised descriptively, mapping trends, identifying gaps and highlighting areas for future research.

Ethics and dissemination
Ethical approval is not required for this literature-based study. Results will be disseminated through peer-reviewed publications, conferences and patient advocacy networks to maximise the impact on research, policy and clinical practice.

This JAMA Patient Page describes carbon monoxide poisoning, its causes, symptoms and complications, diagnosis, treatment, and risk reduction measures.

Circulation, Volume 151, Issue 12, Page 890-892, March 25, 2025.

Objective
Despite increasing incidence of genital gender-affirming surgery (GGAS), there is no systematic method of evaluating patient perspectives. The objective of this study is to elucidate transgender and non-binary patient perspectives on gender-affirming phalloplasty/metoidioplasty via structured focus groups and determine convergent themes as the first step towards the development of a GGAS patient-reported outcome measure.

Design
We conducted a systematic qualitative study using a thematic content analysis of four focus groups from April 2021 to April 2022 comprising 8 patients undergoing phalloplasty/metoidioplasty and 10 patients post-phalloplasty/metoidioplasty. Focus groups were hosted virtually and recorded and transcribed. Discussions were guided by participant input and focused on goals, experiences, outcomes, satisfaction, and quality of life.

Setting
This volunteer but purposive sample of patients was recruited directly in clinic, via email, and via social media at NYU Langone Health (primary site), Callen-Lorde Community Health Center (New York, New York, USA) and the San Francisco Community Health Center.

Participants
We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty.

Primary and secondary outcome measurements and statistical analysis
Transcripts were uploaded into ATLAS.ti, a qualitative data analysis software that facilitates coding for thematic content analysis. We performed deductive and inductive coding to identify the themes that were clustered into overarching domains.

Results
The mean duration of focus groups was 81.5 min. Seven themes and 19 subthemes were constructed. The major themes were (1) goals, expectations, and priorities before/after surgery; (2) sexual function; (3) urinary function; (4) peer support; (5) decision-making; (6) mental health and quality of life; and (7) gender dysphoria. Of the major themes, those determined before the study included themes 1–3 and 6–7. Limitations include small sample size and bias in patient selection.

Conclusions
We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. Mental health, quality of life, functional, and aesthetic outcomes are all critical to patients. Phalloplasty/metoidioplasty impact numerous aspects of patients’ lives. Experiential components of the surgical process, mental health, and quality of life are important metrics to consider in addition to functional and aesthetic outcomes.

Objective
Aspiration pneumonia is a common complication post-stroke that increases the patient’s duration of stay in hospital, mortality and morbidity. We examined the incidence, clinical characteristics and outcomes among ischaemic stroke-related aspiration pneumonia patients in Qatar.

Settings and participants
The Qatar Stroke database was reviewed for patients with acute ischaemic stroke admitted to Hamad General Hospital, a tertiary care medical facility, between January 2014 and April 2024.

Outcomes
Patients were retrospectively assessed for mortality at 90 days, modified Rankin Score at 90 days and length of stay. Several clinical characteristics were also compared between patients with acute ischaemic stroke who developed aspiration pneumonia versus those without.

Results
Patients with stroke who developed aspiration pneumonia tended to be older and of the male sex. Patients who developed aspiration pneumonia were also more likely to present with a higher National Institute of Health Stroke Scale (NIHSS) at admission (p10). They were also more likely to have higher mortality rates at 90 days (16.9% vs 1.9% for an NIHSS admission score of 5–9 and 22.3% vs 13.8% for an NIHSS admission score >10) and major adverse cardiovascular events at 1 year (23.7% vs 3.8% for an NIHSS admission score of 5–9 and 27.5% vs 16.2% for NIHSS >10).

Conclusion
Age, sex, admission NIHSS severity, stroke subtypes and admission location are independent predictors of aspiration pneumonia post-stroke.

Background
Sustained viral suppression is critical not only for ensuring long and healthy livelihoods among the people who are living with Human immunodefficiency virus (HIV), but it is also crucial for prevention of new infections of HIV perinatally and to HIV negative sexual partners through unsafe sex. Available data, however, suggest that some of the patients who are on antiretroviral therapy (ART) fail to maintain the suppressed state once they have achieved it, with others reporting subsequent episodes of viral rebound following resuppression. The association of depression, social issues including day-to-day routine and stigma with poor adherence inadvertently calls for the formulation of intervention strategies that are patient centric. The proposed systematic review and meta-analysis study will identify studies of intervention strategies that are in place to address viral suppression and viral rebound among HIV positive patients who are on ART.

Methods and analysis
The proposed study will conduct a systematic search of peer-reviewed articles through PubMed, Scopus and EBSCOhost databases. Data collection will occur in March 2025. The reviewers will include studies if they were published in South Africa, between 2013 and 2024, and if they were observational in design and written in English. Identified articles will be exported onto Rayyan software where processes of de-duplication and screening by two independent reviewers will be performed. A meta-analysis of data will be conducted on Stata 17 software using the random effects model. The results will be generated in a table and displayed graphically in a forest plot which will indicate type of study, type of intervention, point effect size and the corresponding 95% CI, weight per cent contributed by each study to the pooled estimate, pooled estimate and the 95% CI and measures of heterogeneity. Sensitivity analysis will be performed to identify the source of heterogeneity. Publication bias will be assessed by funnel plot and the Egger’s asymmetry test.

Ethics and dissemination
The study protocol has obtained ethical clearance from the ethics committee of Sefako Makgatho Health Sciences University (SMUREC/H/31/2024:PG). As this will be a systematic review study, involving no human participants, informed consent will not be required. However, for integrity, the findings will be prepared and disseminated widely through peer-reviewed publication and in various media, including conferences, congresses or symposia.

PROSPERO registration number
CRD42024532244.

Objective
To examine patient engagement (PE) levels of atrial fibrillation (AF) patients with multimorbidity, to identify distinct personas based on sociodemographic and clinical characteristics, as well as engagement levels, and to compare PE in disease management with health-related quality of life, medication adherence, and perceptions of care quality.

Design
A cross-sectional survey.

Setting
Data were collected through an online survey platform between 31 May 2022 and 31 January 2023 from five European countries (Denmark, Italy, Romania, Spain and the UK).

Participants
The study involved 659 AF patients older than 18 years who were diagnosed with one or more concomitant chronic health conditions.

Primary and secondary outcome measures
The survey focused on identifying the needs and quality performance indicators (QPIs) of patients. Emotional engagement was evaluated using the Patient Health Engagement Scale (PHE-s), and cognitive-behavioural engagement was assessed using the Altarum Consumer Engagement Measure (ACE). Engagement scores of each measure were grouped as high or low and compared by age group, sex, level of education and country of recruitment, health-related quality of life, medication adherence and perception of care quality using 2 and Mann-Whitney U tests (p