Search Results for: GOLD 2019: le indicazioni nella terapia in fase stabile del paziente con BPCO

Da 4 anni rifiuta intervento e vaccini ma scatena una polemica

Da 4 anni rifiuta intervento e vaccini ma scatena una polemica

Objective
This study aims to examine the reduction and subsequent recovery of routine digital screening (RDS) uptake in England from 2018 to 2022, exploring national, regional and individual Diabetic Eye Screening Programme (DESP) levels. The COVID-19 lockdown in most areas of England was from 26 March 2020 to 23 June 2020 (first national lockdown), 5 November 2020 to 2 December 2020 (second national lockdown) and 6 January 2021 to 8 March 2021 (third national lockdown).

Design
Retrospective data analysis.

Setting
DESPs of England.

Participants
Individuals with diabetes who were invited to take part in the DESP programmes.

Methods
Publicly available data from Public Health England (2018–2019) and National Health Service England (2019–2022) were examined to identify the rate of uptake (proportion of those who attended the DESPs to those who were invited) of RDS at national and regional levels and by each DESP in England.

Primary outcome measures
Rate of uptake of RDS.

Results
The national uptake of RDS decreased from 82% (2019–2020) to 68% (2020–2021) and then increased to 78% (2021–2022). At the regional level, the sharpest drop was in the Midlands which decreased from 79% (2019–2020) to 53% (2020–2021), increasing to 73% (2021–2022) but did not reach pre-COVID-19 levels. At individual DESP levels across England, the greatest drop in attendance (2020–2021) was recorded in Derbyshire (79% to 45%), Barnsley and Rotherham (78% to 45%) and Arden, Herefordshire and Worcestershire (78% to 46%). Although these DESPs showed an increase in 2021–2022 of 33%, 21% and 31%, they did not reach prepandemic (2018–2019) rates of 81%, 85% and 82%, respectively. Data suggest that West Sussex, East Sussex and East and North Hertfordshire DESPs maintained relatively higher uptake rates (86%–89%) in 2020–2021.

Conclusion
COVID-19 had an impact on England’s diabetic eye screening attendance, with notable variations across regions and DESPs. Different regions and DESPs showed variable post-COVID-19 recovery. More importantly, what was not evident is the increased uptake that should have occurred after the COVID-19 lockdown to compensate for the low uptake during the lockdown. In some areas, addressing some of the barriers that affect retinal screening uptake may improve future attendance.

Objectives
Educational initiatives in residency may lack alignment with residents’ learning objectives. Furthermore, they may overlook residents’ struggle to find fulfilment in their work. Professional identity formation (PIF) is a conceptual lens through which to explore the alignment of educational initiatives with residents’ learning objectives. Few empirical studies have examined PIF in residency in general. PIF outcomes in general practice (GP) residency, from the perspective of residents, are poorly represented in the current literature. This study aimed to explore residents’ perspectives on their professional identity to inform PIF learning objectives in GP residency.

Design
A qualitative descriptive study using a list of predetermined questions to guide focus group interviews.

Setting
Data collection took place between winter and autumn 2019 at four GP training institutes across the Netherlands.

Participants
92 third (final) year GP residents participated in focus group interviews.

Results
Residents’ overall perspectives hinged on how to negotiate the endlessness of the profession. This endlessness was reported to manifest in four areas, namely, the GP: as an accessible healthcare provider, as a spider in the care-web, providing personalised care and maintaining a work–life balance.

Conclusions
GP residents’ narratives highlighted an increasingly challenging profession and posited the importance of guided negotiation for their PIF. Deploying the concept of subjectification in residents’ guided negotiation of the profession’s endlessness possibly improves the supervisor–resident educational alliance. Furthermore, awareness of issues related to work–life balance and fostering residents’ sense of belonging and collegiality may contribute to improving their well-being and sense of fulfilment in their work.

Insulti dai no vax, ‘sono terrorizzato’

Insulti dai no vax, ‘sono terrorizzato’

Ricoverato il 60%, il 13,5 in terapia intensiva, mortalità 10,6%

Per ridurre sprechi e inappropriatezze è fondamentale ridefinire il modello organizzativo della presa in carico del paziente multicronico

Objective
Heart rate serves as a critical prognostic factor in heart failure (HF) patients. We hypothesise that elevated heart rate in critically ill HF patients on discharge from the intensive care unit (ICU) could be linked to adverse outcomes.

Design
A single-centre retrospective cohort study.

Setting
This study used data collected between 2008 and 2019 from the Medical Information Mart for Intensive Care IV (V.2.0) Database.

Participants
From the 76 943 ICU stays, we enrolled 2365 patients in this study.

Primary and secondary outcome measures
We observed correlations between in-hospital mortality and ICU discharge heart rate of 83.56±15.81 beats per minute (bpm) (survivors) vs 93.84±17.28 bpm (non-survivors, p

Objectives
To develop and validate a simplified Bleeding Audit Triage Trauma (sBATT) score for use by lay persons, or in areas and environments where physiological monitoring equipment may be unavailable or inappropriate.

Design
The sBATT was derived from the original BATT, which included prehospital systolic blood pressure (SBP), heart rate, respiratory rate, Glasgow Coma Scale (GCS), age and trauma mechanism. Variables suitable for lay interpretation without monitoring equipment were included (age, level of consciousness, absence of radial pulse, tachycardia and trapped status). The sBATT was validated using data from the UK Trauma Audit Research Network (TARN) registry.

Setting
Data sourced from prehospital observations from multiple trauma systems in the UK.

Participants
70 027 motor vehicle collision (MVC) patients from the TARN registry (2012–2019). Participants included were those involved in MVCs, with exclusion criteria being incomplete data or non-trauma-related admissions.

Interventions
Not applicable.

Primary and secondary outcome measures
Death within 24 hours of MVC. Secondary: need for trauma intervention.

Results
In a cohort of 70 027 MVC patients, 1976 (3%) died within 24 hours. The sBATT showed an area under receiver operating characteristic curve of 0.90 (95% CI: 0.90 to 0.91) for predicting 24-hour mortality, surpassing other trauma scores such as the Shock Index and Assessment of Blood Consumption score. Sensitivity was 96% and specificity 72%, with a negative likelihood ratio below 0.1, indicating strong rule-out capability. Sensitivity analyses confirmed consistent performance across varying SBP and GCS thresholds. The sBATT was equally effective across sexes with no significant predictive discrepancies.

Conclusions
The sBATT is a novel, simplified tool that performs well at predicting early death in the TARN dataset. It demonstrates high predictive accuracy for 24-hour mortality and need for trauma intervention. Further research should validate sBATT in diverse populations and real-world scenarios to confirm its utility and applicability.

Objective
The purpose of this study was to explore experiences of family and professional caregivers of persons with dementia in order to design a tailored community-based support programme.

Design
A two-stage study was deployed. First, qualitative research draws on three focus groups. Two of these comprised family caregivers and the third was made up of care provision professionals. Thematic content analysis was conducted by interpretative description for applied practice. Second, an experience-based codesign methodology was applied to design a tailored support programme in accordance with carers’ demands and contextual realities.

Setting and study period
Rural region in Catalonia, at northeast of Spain. March–June 2019.

Participants
We interviewed 12 family caregivers and 8 primary care providers.

Results
10 main themes were identified: caregivers’ feelings, repercussions of caregiving in caregivers’ lives, education about dementia and caring skills, education about time management and self-care, caregivers’ needs to receive more information and training, improved patients’ follow-up and social assistance and more psychologic support. Finally, three themes related to caregivers’ demands: social services resources, multidisciplinary approach programmes and support from other caregivers. From these results, a multicomponent, professionally led community-based intervention was designed. The main components were the following: education and caring skills, professional psychological support, and social and community resources.

Conclusion
This study allowed the design of a multicomponent support intervention for family caregivers of persons with dementia aimed at reducing their burden and improving their quality of life in ways consistent with their actual needs and the available local resources.

To the Editor As noted by Dr Barnard and colleagues, existing evidence confirms that endometriosis is associated with an elevated risk of ovarian cancer with differences by histotype. However, despite the varying presentations of endometriosis—most notably 3 macrosurgically visualized subphenotypes (endometriomas, superficial peritoneal, and/or deep lesions)—identifying women with endometriosis who are at high risk remains elusive. To address this question, the investigators leveraged data from the Utah Population Database and defined endometriosis subphenotypes by International Classification of Diseases (ICD) codes documented from 1992 to 2019 in more than 450 000 women. A consistent challenge in registry-based studies has been the selection of a comparison group. As demonstrated by Hermens et al in the Dutch nationwide registry, women diagnosed with ovarian cancer may be concurrently diagnosed with endometriosis, biasing estimated risk compared with members of the general population, who typically have not had pelvic surgery and whose endometriosis is more likely to remain undetected, leading to an observed 29 (95% CI, 20.7-40.9) times greater risk of endometrioid ovarian cancer (incident rate per 100 000 person-years, 29.7) when they included concurrent endometriosis diagnosis, but a much lower 2.6 (95% CI, 1.5-4.5)–fold greater risk when they excluded endometriosis diagnosed within 1 year of a diagnosis of ovarian cancer (incident rate per 100 000 person-years, 4.1). Unfortunately, Barnard and colleagues did not exclude concurrent diagnoses of ovarian cancer and endometriosis (17% of endometriosis and ovarian cancer diagnoses were within 5 mm under the peritoneal surface). Furthermore, since deep lesions were combined with endometriomas, the reader is unable to distinguish the true ovarian cancer risk for women with endometriomas vs deep lesions. Ultimately, the results may encourage clinicians to advise women with endometriomas or deep endometriosis toward prophylactic bilateral oophorectomy based on an overestimation of the true risk. Such an approach disregards the growing evidence of harm caused by inducing early menopause unnecessarily, including elevated risk of cardiovascular disease, bone fracture, and Alzheimer disease. As this is an essential question for women’s health, a reanalysis of the data are needed to guide women and clinicians in understanding a realistic estimation of their ovarian cancer risk and valid attribution to an accurately defined endometriosis subtype.

Objectives
To describe the epidemiology, patient characteristics and comorbidities in patients with Wilson disease (WD) in the USA.

Design
Retrospective, population-based study.

Setting
The study used the US Komodo claims database containing records regarding medical claims for over 120 million individuals.

Participants
Patients with WD were identified via ICD-10 (10th revision of the International Classification of Diseases) code during the study period 2016–2019 and no age restriction was applied. A further stratification by disease subtype (‘hepatic’, ‘neurologic’ and ‘psychiatric’) was performed.

Main outcome measures
WD prevalence was reported by age, sex and US census regions/divisions. Adjusted prevalence was calculated using age-specific prevalence standardised to the USA (2010 US census) and to the world (WHO 2000–2025) to enable comparisons across countries, using direct standardisation of prevalence estimates by age group.

Results
Overall, 2115 patients with WD were identified during the study period. Among them, 56.8% had hepatic symptoms, 57.0% neurologic symptoms and 47.4% psychiatric symptoms. The most frequent manifestations in hepatic patients were liver signs and symptoms (90.8%), in neurologic patients cognitive defects (50.7%) and in psychiatric patients mood disorders (86.4%). The mean age in the overall cohort was 39.9 years. Prevalence estimation was based on 1481 patients with WD between 2017 and 2019. The 2017–2019 crude period prevalence was 21.2 patients per million (95% CI: 20.1 to 22.3), with similar prevalence observed for both sexes.

Conclusions
This study provides important real-world data on the diagnosed prevalence of WD in the USA and revealed the comorbidities associated with various disease subtypes, thereby providing a comprehensive basis for guiding physicians and policy makers in the management of this chronic disease.

Introduction
Infertility is a complex condition that affects millions worldwide, with significant physical, emotional and social implications. Mobile apps have emerged as potential tools to assist in the management of infertility by offering features such as menstrual cycle tracking, ovulation prediction, fertility education, lifestyle modification guidance and emotional support, thereby promoting reproductive health. Despite promising advancements such as the development of apps with sophisticated algorithms for ovulation prediction and comprehensive platforms offering integrated fertility education and emotional support, there remain gaps in the literature regarding the comprehensive evaluation of mobile apps for reproductive endocrinology and infertility. This scoping review distinguishes itself by systematically mapping and synthesising evidence on mobile apps specifically for reproductive endocrinology and infertility, unlike previous reviews that may not have focused exclusively on this intersection. This review aims to analyse recent trends, identify outcomes used to assess usability and highlight knowledge gaps.

Methods and analysis
This scoping review will adhere to the methodological frameworks outlined by Arksey and O’Malley and Levac et al, alongside the Joanna Briggs Institute’s recommendations. The research question, ‘What is known about mobile apps in reproductive health and infertility?’ was formulated using the Population, Concept, Context (PCC) strategy. We will include studies published from January 2019 to April 2024 in English, Portuguese and Spanish that focus on the use of mobile apps in reproductive health and infertility. Searches will be conducted across electronic databases (EMBASE, ERIC, PubMed, Science Direct, Scopus and Web of Science) and grey literature sources. Two independent reviewers will carry out the study selection using Covidence software. Data extraction will follow a standardised format and will be synthesised narratively using tables and graphs. Expert consultations will be conducted to validate the findings.

Ethics and dissemination
Ethical approval is not required for this scoping review as it will only use published data. The findings will be disseminated through publication in a peer-reviewed journal, conference presentations and stakeholder meetings. The review protocol will be registered with the Open Science Framework to ensure transparency and reproducibility.