Risultati per: Sindrome da immunodeficienza umana - AIDS

Introduction
Hearing loss is one of the leading potentially modifiable risk factors for dementia. There is growing evidence suggesting that treating hearing loss with hearing aids could be a relatively low-cost intervention in reducing cognitive decline and the risk of dementia in the long term. However, given the current constraints of the limited evidence, it is premature to draw definitive conclusions about the effect of hearing aids on cognitive functioning. More long-term randomised studies examining this effect would be recommended. Prior to embarking on large-scale lengthy randomised controlled trials (RCTs), it is imperative to determine the viability of such studies. Therefore, the purpose of the current study is to assess the feasibility of a RCT that investigates the effect of hearing aids on cognitive functioning in elderly hearing impaired individuals.

Methods and analysis
In this randomised controlled feasibility trial, 24 individuals aged 65 years or older with mild to moderate hearing loss (≥35–

Nel 2022 quasi duemila nuove diagnosi, il 2% in più rispetto al 2021

Nel 2022 quasi duemila nuove diagnosi, il 2% in più rispetto al 2021

‘L’avventurosa vita di Lalà’ del prof di Unibo e chirurgo Ussia

Circulation, Volume 148, Issue Suppl_1, Page A12041-A12041, November 6, 2023. Introduction:People living with HIV (PLWH) have more subclinical cardiovascular disease than people without HIV (PWOH), but few studies have evaluated risk for mortality based on coronary artery calcium (CAC) among this population.Purpose:This study aimed to determine the association between CAC and all-cause mortality among male PLWH and PWOH and to identify a potential interaction with HIV serostatus.Methods:The study population was derived from the MACS, a US prospective observational cohort study including male PLWH and PWOH. Participants underwent cardiac non-contrast computed tomography from July 2004 to November 2013. Men with atrial fibrillation, coronary heart disease, or coronary revascularization were excluded. Cox proportional hazards model was used to calculate adjusted hazard ratios [aHR] for all-cause mortality among men with vs. without baseline CAC (Agatston score >0) and per standard deviation (SD) increment in continuous Agatston score [log (CAC+1)], controlling for demographic and cardiac risk factors. CAC differences by HIV serostatus were evaluated using multiplicative CACхHIV interaction terms.Results:Among 1344 males (mean age 50 years, CAC prevalence 46%, 823 (61%) PLWH), we observed 110 deaths (13%) among PLWH and 41 deaths (8%) among PWOH during the follow-up period (median: 13.4 years). Among PLWH, 62% had an undetectable plasma HIV viral load, the median CD4 cell nadir was 284 cells/μL, and 17% had a history of clinical AIDS. The age-adjusted mortality rate was 13.5 (95% CI: 11.0-16.5) among PLWH and 7.8 (5.4-10.9) among PWOH per 1000 person-years. CAC presence was associated with all-cause mortality among all participants (aHR=1.47, 95% CI: 1.02-2.11, p=0.04), and among PLWH (aHR=1.61, 1.04-2.47, p=0.03). In PWOH, we found no significant association (aHR=1.27, 0.63-2.59, p=0.50), although the interaction was not significant (p= 0.49). Higher log (CAC+1) was also associated with all-cause mortality among all participants (aHR=1.37 per SD, 1.15-1.63, p

Circulation, Volume 148, Issue Suppl_1, Page A310-A310, November 6, 2023. Introduction:Despite advances such as high-fidelity code blue simulations, pediatric In-Hospital Cardiac Arrest mortality rate has plateaued at 62% in the USA. It is expected to be higher in low-income countries. Studies show deviations from the PALS guidelines despite regular PALS training due to skills and knowledge decay. Use of simple, easily accessible resources as “Cognitive Aids”, that decrease reliance on memory during stressful events, however, has not been studied well.Aim:To evaluate impact of cognitive aids on resuscitative capabilities of code-blue responders during simulations.Method:Performance Improvement (PI) project by Pediatrics Department at King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia. Simulations were run by Consultant, Pediatric Intensivist and PICU nurse on regular pediatric floors. A performance assessment checklist and a scoring tool were designed to evaluate team members for responsiveness, effective resuscitation, effective communication and resource utilization.Results:A total of 94 responders participated multiple times in 35 simulations that were conducted in two phases: Codes 1 – 19 as the Pre-PI phase and Codes 20 – 35 as Post-PI phase. Cognitive aids were not utilized during the Pre-PI codes and based on the assessment scores, interventions were introduced in the form of A3 size PALS resuscitation cards, “Pediatric Cardiac Arrest Resuscitation Direction” document with prompts to facilitate smooth running of the code and SBAR notes. Based on the scores, improvement was observed in responsiveness by 27% (Pre-PI:192/262 vs. Post-PI:222/223), effective resuscitation by 38% (Pre-PI:293/511 vs. Post-PI:409/431), effective communication by 46% (Pre-PI:94/245 vs. Post-PI:173/207) and resource utilization by 56% (PrePI:37/94 vs. Post-PI:76/80). Total of 36 (38%) responders participated in actual pediatric cardiac arrests after project completion and 97% (35/36) reported higher confidence.Conclusion:Cognitive aids were helpful supportive tools in overcoming skills and knowledge decay and enhance team performance and quality of resuscitation during code blue simulations. We suggest use of such tools wherever high-fidelity simulation training may not be available.

Esperta, ‘serve una strategia di prevenzione. Cruciali dieta e movimento’

Nicotine e-cigarettes and 2 types of medications—varenicline, marketed as Chantix or Champix, and cytisine, marketed as Tabex—are the most effective aids for helping people quit smoking for 6 months or longer compared with controls, according an analysis of 319 randomized clinical trials involving nearly 160 000 participants. High-certainty evidence suggested that these interventions translated into 7 or 8 additional people who quit smoking per 100 individuals. Cytisine is unavailable in most of the world, however, including the UK and US.

Da un libro di Cinthia Caruso, ancora tanto da scoprire

Introduction
Febrile infants 90 days and younger are at risk of invasive bacterial infections (bacteraemia and meningitis) and urinary tract infections. Together this is previously termed serious bacterial infection with an incidence of approximately 10–20%. The National Institute for Health and Care Excellence guidance advocates a cautious approach with most infants requiring septic screening, parenteral broad-spectrum antibiotics and hospital admission. Internationally, variations exist in the approach to febrile infants, with European and North American guidance advocating a tailored approach based on clinical features and biomarker testing. None of the available international clinical decision aids (CDAs) has been validated in the UK and Irish cohorts. The aim of the Febrile Infant Diagnostic Assessment and Outcome (FIDO) Study is to prospectively validate a range of CDAs in a UK and Irish population including CDAs that use procalcitonin testing.

Methods and analysis
The FIDO Study is a prospective multicentre mixed-methods cohort study conducted in UK and Irish hospitals. All infants aged 90 days and younger presenting with fever or history of fever (≥38°C) are eligible for inclusion. Infants will receive standard emergency clinical care without delay. Clinical data and blood samples will be collected, and consent will be obtained at the earliest appropriate opportunity using research without prior consent methodology. The performance and cost-effectiveness of CDAs will be assessed. An embedded qualitative study will explore clinician and caregiver views on different approaches to care and perceptions of risk.

Ethics and dissemination
This study was reviewed and approved by the Office for Research Ethics Committees Northern Ireland-Health and Social Care Research Ethics Committee B, Public Benefit and Privacy Panel for Health and Social Care Scotland, and Children’s Health Ireland Research and Ethics Committee Ireland. The results of this study will be presented at academic conferences and in peer-reviewed publications.

Trial registration number
NCT05259683.

Solo l’83% dei positivi nel vecchio continente sa di esserlo

New England Journal of Medicine, Ahead of Print.

Presidente contesta che il disturbo gli sia stato diagnosticato

Objective
The purpose of this scoping review was to synthesise the effectiveness and acceptability of decision aids for critically ill patients and family members in the intensive care unit (ICU).

Methods
A systematic search of four electronic databases and grey literature was undertaken to identify relevant studies on the application of decision aids in the ICU, without publication date restriction, through March 2023. The methodological framework proposed by Arksey and O’Malley was used to guide the scoping review.

Results
Fourteen papers were ultimately included in this review. However, only nine decision aids were available, and it is noteworthy that many of these studies focused on the iterative development and testing of individual decision aids. Among the included studies, 92% (n=13) were developed in North America, with a primary focus on goals of care and life-sustaining treatments. The summary of the effect of decision aid application revealed that the most common indicators were the level of knowledge and code status, and some promising signals disappeared in randomised trials.

Conclusions
The complexity of treatment decisions in the ICU exceeds the current capabilities of existing decision aids. There is a clear gap in decision aids that are tailored to different cultural contexts, highlighting the need to expand the scope of their application. In addition, rigorous quality control is very important for randomised controlled trial, and indicators for assessing the effectiveness of decision aids need to be further clarified.