Risultati per: Standard di cura nel diabete 2024

Il campione di nuoto testimonial del progetto Rete Cardiologica

Stroke, Volume 56, Issue Suppl_1, Page AWP90-AWP90, February 1, 2025. Introduction:Over the past decade, Mobile Stroke Treatment Units (MSTU) have enhanced the quality of stroke care in the United States by bringing the hospital to the patient. While MSTUs improve stroke patient outcomes compared to standard hospital care, there are still limited units operating. The implementation of a MSTU requires considerable initial and long-term investment limiting their widespread programmatic formation. We evaluated a MSTU program in Florida between August 2023 and April 2024 for comparative patient associated out of pocket costs with MSTU and standard stroke care.Methods:A discrete time Markov Chain Monte Carlo (MCMC) model was used to estimate incremental cost-savings associated with MSTU treatment compared to standard hospital care. The Markov model captured treatment costs for the care of patients at two functional levels as defined by the modified Rankin Scale (mRS). The potential cost-savings was determined by comparing the estimated costs incurred by the MSTU cohort to a counterfactual scenario of standard care of Emergency Medical Services (EMS) transport to the Emergency Department (ED). Since the model focused on the cost of patient care, costs included only billed ED, inpatient, and outpatient hospital care and services provided in the baseline year and then estimated cost of care over the next four years. All values represent 2024 dollars ($) and a 3% discount rate was applied to years two through four.Results:The MSTU treated 59 acute stroke patients with an average age of 71.86 (SD=13.78). Overall, 76% (N=45) were diagnosed with ischemic stroke, 9% with intracerebral hemorrhage (ICH), and 15% with transient ischemic attack (TIA). At discharge, 54% were independent and 46% dependent. In Year 1 (baseline), out of pocket cost differential between MSTU patients and the standard care was estimated to be $5,306 and $6,485 for the independent and dependent patients respectively. Projected future cost differentials in Years 2 to 4 were $4,571, $3,845, and $2,817 for the independent functioning cohort and $5,586, $4,700, and $4,188 for the dependent functioning cohort.Conclusion:These results suggest that the out of pocket cost for MSTU patients was significantly lower than standard care both at baseline and over the first four years post-stroke, making MSTU acute stroke management a better economic system of care for time metrics, long term patient outcomes, and cost effectiveness.

Stroke, Volume 56, Issue Suppl_1, Page ATP388-ATP388, February 1, 2025. Introduction:Embolic Stroke of Undetermined Source (ESUS) accounts for a critical proportion of all ischemic strokes. Disambiguating embolism etiology is important to improve treatment efficacy and reduce recurrent events. Patient-specific in silico models can shed valuable insights on embolus source-destination mapping. This requires reliable and accurate pre/post-stroke hemodynamic models, which benefit from integrating multiple modes of patient information from imaging and clinical records. This is a major state-of-the-art challenge. Here, we present a workflow for multi-modal data integration from standard-of-care workup towards recreating a data-rich digital twin of stroke patients.Methods:Our workflow integrates non-contrast and contrast-enhanced head-neck CT and cardiac CT, trans-thoracic echo, and perfusion imaging, along with clinical variables such as HR, systolic/diastolic volumes, and stroke locations (with NIHSS scores). Quantitative data from these sources are then integrated into a hemodynamic model by processing features such as arterial structure, inlet flow, tuned resistance boundary conditions, cardiac timing, and stroke location. Resulting hemodynamic data was used to further simulate embolus movement towards stroke site. Statistical sampling simulations using this model were conducted to evaluate the likelihood that an occlusion location corresponded to cardiogenic, aortogenic, or other arterial sources.Results:We present our complete in silico workflow, and demonstrate the outcomes using a small cohort of 5 patients acquired from a clinical database (anonymized, IRB exempt). We demonstrate that the workflow yields high-resolution space-time varying patient hemodynamic patterns. Additionally, the embolus source-destination likelihood mapping provides detailed quantitative insights on the embolism etiology in these stroke patients. These findings indicate that our workflow and resulting digital twins can be a valuable tool in addressing the current clinical challenges in discerning embolism etiology in ESUS cases.Conclusions:We introduce a pipeline of transforming raw patient-specific information from multi-modal imaging and clinical parameters into a cohesive, data-rich in silico model for embolic stroke comprising the full heart-to-brain pathway. This offers a flexible digital twin approach for elucidating stroke etiologies in patient-specific scenarios.

Stroke, Volume 56, Issue Suppl_1, Page AHUP6-AHUP6, February 1, 2025. Introduction:Prior studies have demonstrated social determinants of health (SDoH) are associated with reduced rates of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS), including in disadvantaged populations. Mechanisms of disparity may include financial/resource limitations and systemic bias. Neighborhood measures of socioeconomic status are predictors of interest in stroke research, as they may influence emergency response, transportation, and health seeking behaviors. We sought to identify SDoH factors influencing time to presentation for AIS.Methods:This is a retrospective cohort study of 432 patients ages ≥18 presenting to Tufts comprehensive stroke center with AIS and last known well (LKW)

Stroke, Volume 56, Issue Suppl_1, Page ATP299-ATP299, February 1, 2025. Introduction:Prior studies have demonstrated social determinants of health (SDH) are associated with reduced rates of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS), including in disadvantaged populations. Mechanisms of disparity may include financial/resource limitations and systemic bias. Neighborhood measures of socioeconomic status are predictors of interest in stroke research, as they may influence emergency response, transportation, and health seeking behaviors. We sought to identify SDH factors influencing time to presentation for AIS.Methods:This is a retrospective cohort study of 432 patients ages ≥18 presenting to Tufts comprehensive stroke center with AIS and last known well (LKW)

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA.

Stroke, Volume 56, Issue 2, Page e98-e98, February 1, 2025.

Purpose
To investigate the characteristics and publication status of minimally invasive glaucoma surgery (MIGS) clinical trials registered on ClinicalTrials.gov.

Design
A cross-sectional study.

Methods
All 1212 interventional glaucoma trials registered on ClinicalTrials.gov with start dates between 1 October 2007 and 30 April 2024 were included. All trials were categorised into ‘MIGS trials’ and ‘other interventional glaucoma trials’. Based on the anatomical site of action and the research content, MIGS trials were classified into different groups, and intergroup comparisons were conducted. The characteristics and publication status of MIGS trials were comprehensively analysed.

Results
Compared with all other interventional glaucoma trials, MIGS trials had a higher proportion of single-arm trials (p

Introduction
Nociception monitoring has recently gained recognition as a valuable tool for guiding intraoperative opioid administration. Several nociception monitors, including the Surgical Pleth Index, the Index of Consciousness (IoC) and the Nociception Level, have been introduced for managing intraoperative analgesia. While these technologies show promise in initial applications, the effectiveness of IoC2 in guiding pain management during anaesthesia, particularly in elderly patients who require precise opioid use, remains unclear. This study aims to evaluate the effectiveness of IoC2 in guiding intraoperative opioid use in elderly patients.

Methods and analysis
We will conduct a prospective, randomised, controlled, single-blind, single-centre study with recruitment carried out from 1 February to 30 November 2025. Patients will be randomly assigned to either the IoC2 group or the control group. In the IoC2 group, sufentanil dosing will be guided by intraoperative IoC2 measurements, while in the control group, it will be guided by haemodynamic parameters. The primary outcome will be to compare intraoperative sufentanil consumption between the two groups to assess the potential role of IoC2 in optimising perioperative analgesia in elderly patients.

Ethics and dissemination
This study has been approved by the ethics committee of China-Japan Friendship Hospital (2024-KY-148-3) and registered in the Chinese Clinical Trial Registry (ChiCTR2400089115). The findings will be disseminated through academic presentations and peer-reviewed journal publications, providing valuable data and insights into the role of IoC2 in guiding intraoperative pain management.

Trial registration number
ChiCTR2400089115.

Introduction
Surgical trauma induces a metabolic stress response, resulting in reduced insulin sensitivity and hyperglycaemia. Postoperative insulin resistance (IR) is associated with postoperative complications, and extended preoperative fasting may further aggravate the postoperative metabolic stress response. Nutritional strategies, such as carbohydrate loading (CHL), have been successfully used to attenuate postoperative IR. Recent evidence suggests that time-restricted feeding (TRF), a form of intermittent fasting, improves IR in the general population, even after a short period of TRF. We hypothesise that TRF, as well as CHL, improve postoperative IR.

Methods and analysis
This open-label, single-centre, randomised controlled trial will compare the effect of short-term preoperative TRF, CHL and standard preoperative fasting on perioperative IR. A total of 75 orthopaedic patients presenting for elective intermediate to major surgery at a Dutch academic hospital will be randomly assigned to a control group (standard preoperative fasting), a TRF group or a CHL group. The primary outcome is postoperative IR, based on the updated homeostasis model assessment of IR, on the first day after surgery. Statistical analyses are performed using Student’s t-tests or Mann-Whitney U tests.

Ethics and dissemination
The local medical ethics committee of the Amsterdam UMC, the Netherlands, approved the trial protocol in January 2023 (NL81556.018.22). No publication restrictions apply, and the results of the study will be disseminated through a peer-reviewed journal.

Trial registration number
NCT05760339.

Riconoscimento che premia il loro approccio multidisciplinare

Colpiti 10 milioni di italiani. Esperta, ‘verso trattamenti personalizzati’

Annals of Internal Medicine, Ahead of Print.