Search Results for: Sindrome da immunodeficienza umana - AIDS

Dr. Paul Sax explores what the freeze in funding to USAID could mean for the HIV/AIDS program PEPFAR in HIV and ID Observations.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Indicata per la rara sindrome di Wiskott-Aldrich

Stroke, Volume 56, Issue Suppl_1, Page ATMP53-ATMP53, February 1, 2025. Introduction:Cervical artery dissections (CAD) are a leading cause of stroke, particularly among younger individuals. Timely and accurate diagnosis is crucial for appropriate treatment and preventing further complications. This study compares a commonly used imaging modality for evaluating CAD; computed tomography angiography (CTA) with a novel imaging modality; Vessel Wall MR Imaging (VW-MRI). The aim is to highlight distinguishing features of CAD on VW-MRI, demonstrating its ability to offer better visualization of vessel wall abnormalities in select cases compared to conventional CTA.Methodology:Patients were selected from the University of Washington (UW) hospital system between 2022 and 2024. The screened patients included those either admitted directly from the Emergency Department due to new onset of neurological symptoms or transferred from Telehealth and affiliated hospitals after extensive disease was detected on CTA head and neck scans as part of stroke protocols. In accordance with our institutional stroke protocol all patients had initial vessel imaging with CTA followed by a VW-MRI which was obtained using a 3.0 Tesla scanner.Results:A total of 47 patients were identified with intracranial abnormalities initially picked on CTA. Of the total cases, 20 were initially suspected of CAD based on CTA, but only 13 were confirmed with dissections on VW-MRI. Amongst the seven cases which did not have a CAD on VW-MRI – two of them turned out to be artifactual, one of them was Fibromuscular Dysplasia (FMD), three showed atherosclerotic plaque and one was suggestive of a vasculitic process. In two cases, intracranial dissections were easily picked on VW-MRI, and in one case mural hematoma and in other two cases intraluminal thrombus were seen easily on VW-MRI, which were primarily missed on CTA.Conclusion:Upon reviewing the patients during this period, it is evident that VW-MRI not only aids in localizing acute ischemic strokes but also plays a critical role in identifying CAD. Additionally, intracranial artery dissections, intramural hematomas, intraluminal thromboses and pseudoaneurysms had a better visualization on VW-MRI than on conventional CTA. VW-MRI adds value to the diagnosis of CAD, which can be beneficial in determining etiology of acute ischemic strokes for cases which have some degree of uncertainty and eventually may prove to be helpful in their long-term management.

Stroke, Volume 56, Issue Suppl_1, Page ATP172-ATP172, February 1, 2025. Introduction:The 2021 AHA/ASA Scientific Statement on Retinal Artery Occlusion (RAO) indicated treatment with thrombolytics may be effective and systems should prioritize its early recognition. We describe the phased deployment of fundus cameras across 10 Emergency Departments (EDs) in a southern California health system for emergent visualization and diagnosis of monocular vision loss.Methods:Program Development:In 2022, Vascular Neurology, ED and Ophthalmology initiated discussions to deploy fundus cameras to support emergent diagnosis of monocular vision loss. The fundus camera image ordering was integrated with the electronic medical record (EMR). Department leaders socialized the program with training sessions and job aids.Operational Scope:Any medical professional working in the ED was permitted to operate the device. A small group of “superusers” were identified at each medical center to obtain competency in camera operation. In-person training sessions for ED physicians/staff covered order placement, image capture and transmission, troubleshooting and device maintenance.Acute Vision Loss Workflow:Patients presenting with monocular vision loss within 4.5 hours of last known well time follow the code stroke algorithm predicated on BEFAST symptoms. A stat CTH is obtained, followed by a teleneurologist examination. If patient presents with only monocular vision loss, a fundus photo is captured and remotely emergently interpreted by an ophthalmologist. If photo is consistent with an RAO, thrombolysis is offered.Results:From July 2022 to June 2024, 1079 fundus photos were obtained across 10 stroke centers. The mean age (SD) was 55.9yrs (17.6). The percent female was 55%. The racial/ethnic breakdown of individuals who had a fundus photo was 32.4% White, 14.5% Black, 12.1% Asian, 7.9% Other and 33% Hispanic. 27 (2.5%) of patients were diagnosed with RAO, out of which 4 patients received thrombolytics. Non-thrombolytic patients were given antiplatelets and admitted for further assessment of RAO etiology. Those who did not receive thrombolytics were all outside of the 4.5-hour time to treat. 26 (2.5%) had a final diagnosis of a cerebral ischemic stroke.Conclusion:Fundus camera deployment for the assessment of acute monocular vision loss improves management of RAO patients with thrombolytics and/or allows further assessment of the etiology in a more urgent manner.

Stroke, Volume 56, Issue Suppl_1, Page AWP144-AWP144, February 1, 2025. Introduction:Telestroke improves access to vascular neurology expertise and aids in decision-making for acute ischemic stroke (AIS). Prior studies from the Veterans Health Administration (VHA) demonstrated that the implementation of an acute national telestroke program (NTSP) led to reduction in interhospital transfer rates. Few studies have examined subacute inpatient telestroke services, focusing on inpatient stroke workup and management. We sought to determine the impact of a novel subacute telestroke program on emergency department (ED) transfer rates at participating hospitals.Methods:This was a retrospective cohort study of patients with ED diagnosis of AIS from 10/2021-6/2024. For intervention sites, the period prior to subacute consult “go-live” date was considered the pre-implementation period. Control sites (NTSP acute telestroke sites that had limited ED/inpatient neurology coverage and had expressed interest in the program) were considered pre-implementation prior to 5/22/2023 (the date when approximately half of intervention sites had initiated the subacute program). Logistic regression with a generalized estimating equation approach to handle clustering within facility was used to evaluate the association between implementation time-period (post/pre) and odds of ED transfer (yes/no) in intervention and control sites, adjusting for age, NIHSS, sex, race, and an intervention by time-period interaction term. Given NIHSS missingness of 23%, multiple-imputation using predictive mean matching was performed.Results:1266 patients met eligibility criteria (N=544 patients from 11 control sites and N=722 patients from 11 intervention sites). The ED transfer rate was lower within intervention sites post-implementation (pre: 25.7% to post: 22.5%) and higher in control sites (pre: 25.9% to post: 27.1% ; Table 1). These comparisons were statistically nonsignificant in the multivariable analysis for both complete case and multiple-imputed models where younger age and increased NIHSS were associated with increased odds of transfer (Table 2).Discussion:There was a numerical reduction in interhospital transfers for AIS among intervention sites after implementation of a subacute telestroke consultation service, but the results were statistically nonsignificant in adjusted models. Future analyses should evaluate whether receipt of a subacute telestroke encounter at the patient-level is associated with reduced interhospital transfer for stroke.

This Viewpoint discusses the need to recommit to the fight against HIV/AIDS to reach the United Nation’s 2030 goal of ending the epidemic as a public health threat.

Objectives
Proton pump inhibitors (PPIs) are widely prescribed medications and commonly used for the treatment of gastric acid-related disorders. Nevertheless, PPIs are often overused leading to potential adverse effects and unnecessary healthcare costs. Deprescribing strategies have emerged to safely reduce or substitute inappropriate PPIs and optimise patient care in an evidence-based manner. This protocol describes a study to evaluate the effectiveness of a PPI deprescribing intervention in comparison to usual care in the Swiss primary care setting.

Design
An open-label, cluster randomised controlled trial.

Setting
Swiss primary care settings.

Participants
Included participants will be adults with inappropriate PPI treatment and will be recruited by general practitioners (GPs). Participants treated by the same GP constitute a cluster. Clusters are randomised 1:1 to either the intervention group or the control group.

Interventions
The intervention components consist of deprescribing tools including educational material, decision aids for both participants and GPs, and additional trainings for GPs only. Patients in the control group will receive usual care. Data will be collected at baseline, 3-, 6-, 9- and 12-month follow-up time through online surveys or a phone call for both GPs and participants.

Primary and secondary outcome measures
The first co-primary endpoint is the effectiveness of the deprescribing intervention measured by the change of prescribed PPI dose. The second co-primary endpoint is safety, which is measured with the Reflux Disease Questionnaire assessing change in gastrointestinal symptoms. There are several secondary endpoints, such as the total number of prescribed medications, occurrences of changes in prescription patterns, PPI discontinuation and cost-effectiveness.

Conclusions
The findings from this study will provide evidence on the effectiveness and safety of a PPI deprescribing intervention for patients and GPs. Successful implementation of our PPI deprescribing strategy has the potential to improve patient outcomes and lower costs.

Trial registration number
NCT06129474.

Società Italiana Nutrizione Umana, obiettivi più sani per 60%

Objectives
We explored how to improve communication about low-risk lesions including labels, language and other strategies.

Design
Qualitative description and thematic analysis to examine the transcripts of telephone interviews with patients who had low-risk lesions and physicians; and mapping to Communication Accommodation Theory to interpret themes.

Setting
Canada

Participants
15 patients: 6 (40%) bladder, 5 (33%) prostate and 4 (27%) cervix lesions; and 13 physicians: 7 (54%) cervix, 3 (23%) bladder and 3 (23%) prostate lesions.

Main outcome measures
Patient and physician views of labels, language and other strategies to improve communication about low-risk lesions.

Results
Patients and clinicians held discordant views about low-risk lesion label impact, preferences and rationale. All labels prompted confusion and anxiety among patients. In contrast, physicians perceived that patients understood that labels they used across all label categories (abnormal, precursor-to-cancer and cancer) implied low risk for cancer progression. Patients preferred abnormal cells, particularly when first learning of their diagnosis, and desired additional information to distinguish their diagnosis from cancer and justify treatment. In contrast, physicians favoured precursor-to-cancer and cancer labels out of habit, to match labels that patients saw elsewhere (online, charts) and to convince patients to attend follow-up and treatment visits. However, patients and physicians largely agreed on the need for 16 strategies that could improve communication about low-risk lesions including language (eg, plain language, situate low-risk lesions on cancer spectrum) and complementary communication strategies (eg, longer appointments, visual aids, connect patients with support services or groups).

Conclusions
The findings build on prior research by revealing that modifying labels is not the only or best strategy needed to improve communication about low-risk lesions. Ongoing research should examine how best to implement the strategies recommended by patients and physicians.

Objectives
To explore nursing home (NH) staff’s experiences implementing an automated blister packaging system for solid, orally ingestible drugs.

Design
This was a descriptive qualitative study. Semistructured interviews were used for data collection, and qualitative content analysis was applied for data analysis.

Setting
Four NHs in a region in Northern Italy participated in the piloting of an automated blister packaging system.

Participants
The purposive sample comprised 40 NH staff (seven registered nurses, 11 certified nursing assistants, three nursing aids, seven nursing managers, four directors and eight physicians)

Results
Six main categories emerged from the data analysis: (1) impacting safety, including improved medication process, perceived insecurities and remaining error sources; (2) creating free spaces, including time, individualised care and drug storage and logistics; (3) serving residents, (4) meeting expectations, including met and unmet expectations; (5) generating efforts and (6) producing waste. They all merged into one theme ‘It pays off!’

Conclusions
As experienced by NH staff, the automated blister packaging system improved medication safety and reduced the workload of registered nurses, but it is not an ‘all-around carefree package’. Continuous quality improvement and risk management strategies are recommended to accompany and sustain implementation, as well as further clarification of roles and duties among the different care workers involved in medication management. Further research is needed to gain a better understanding of the impact of an automated blister packaging system on registered nurses’ competencies in NHs regarding medication management and residents’ therapies and safety.

The 2024 IAS-USA Guidelines highlight simplified ART regimens, long-acting agents, cardiovascular disease prevention, prevention of STIs, and ongoing equity issues.

Introduction
Individuals with hearing loss and hearing aid users report higher levels of listening effort and fatigue in daily life compared with those with normal hearing. However, there is a lack of objective measures to evaluate these experiences in real-world settings. Recent studies have found that higher sound pressure levels (SPL) and lower signal-to-noise ratios (SNR) are linked to increased heart rate and decreased heart rate variability, reflecting the greater effort required to process auditory information. This study aims to establish physiological and acoustic predictors of self-reported listening effort and fatigue in daily life. Additionally, the moderating effects of cognitive abilities, personality traits, stress, fatigue, suprathreshold abilities, noise annoyance, lifestyle and health on the development of listening effort and fatigue will be investigated.

Methods and analysis
A 4-week field trial will be conducted, in which physiological responses will be continuously recorded using Empatica Embrace Plus wristbands. Ambient acoustics will be captured every 20 s via the participants’ (n=60) personal hearing aids, and the participants will provide self-reported momentary assessments through a mobile app throughout the day. Questionnaires will be used to assess personality traits, fatigue, stress and noise annoyance, and gather relevant background information. Cognitive and suprathreshold abilities will also be evaluated. Associations between physiological responses, ambient acoustics and momentary assessments, as well as the potential influence of participant characteristics, will be analysed using multilevel regression models and time-series analyses.

Ethics and dissemination
Informed consent will be obtained from all participants. The study has been exempted from ethical application by the Science Ethics Committee for the Capital Region of Denmark (journal no. F-23028367). Results will be presented at conferences and submitted for publication in peer-reviewed journals.

Introduction
Adolescents living with HIV/AIDS in sub-Saharan Africa have heightened risk for mental health and psychosocial burden owing to their exposure to a multiplicity of adverse conditions such as stigma and discrimination. However, there is no comprehensive evidence synthesis and evaluation of the effectiveness of mental health interventions for adolescents living with HIV/AIDS in this region. We aim to conduct a systematic review to synthesise the literature on existing mental health interventions for adolescents living with HIV/AIDS in sub-Saharan Africa.

Methods and analysis
This review will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guidelines. Eligible studies will include those investigating the effectiveness of psychosocial, psychological or other forms of interventions on mental health outcomes, conducted in sub-Saharan African countries and involving adolescents (aged 10–19 years) living with HIV/AIDS. Comprehensive searches will be conducted in electronic databases (PubMed, MEDLINE, CINAHL, Scopus and PsycINFO) and grey literature sources. The search will be restricted to studies published from 2004 onwards and in the English language. Study authors will be contacted, and reference lists of retrieved articles will be reviewed for additional papers. Study selection and data extraction will be performed by two independent reviewers, with any disagreements resolved by consensus or involving a third party. A narrative synthesis will be conducted, and if possible, meta-analyses will be performed to estimate the overall effect sizes of interventions on mental health outcomes. Eligible studies will undergo quality assessment using standardised criteria appropriate for each respective study design.

Ethics and dissemination
No primary data collection will be undertaken; therefore, no ethical approval is required. The findings of this review will be disseminated through publication in a peer-reviewed journal and presented at relevant conferences.

PROSPERO registration number
CRD42024538975