Risultati per: Standard di cura nel diabete 2024

Aumento storico del 20% grazie ai contributi fissi degli Stati

È una delle più frequenti malattie croniche non trasmissibili conseguenza non solo di stili di vita inappropriati, ma anche correlata a contesti socio-economici degradati.

Studio di un gruppo di medici su 58 persone

To the Editor A recent randomized clinical trial reported that children who received early high-flow nasal oxygen therapy for mild to moderate acute hypoxemic respiratory failure had a significantly longer length of stay in the hospital than those who initially received standard oxygen therapy. Although we appreciate the authors’ list of hypotheses for why children allocated to high-flow oxygen therapy had a prolonged length of stay, we believe there may be some other important explanations for this trial’s finding.

In Reply The Letter by Dr Hsu and colleagues provides further insight into the reasons why children who were randomized to high-flow nasal oxygen therapy had a longer length of hospital stay than children treated with standard oxygen therapy in our study. We agree with the Letter authors’ comments, except that our study protocol provided no additional observation period after cessation of high-flow oxygen therapy, so this factor could not have substantially contributed to the results. We support the notion that there are excessive ICU admissions for infants with bronchiolitis. The PARIS-2 trial excluded infants with bronchiolitis because they were studied in the PARIS-1 trial.

We thank Barkun et al1 for their comments on our study.2 We are aware of the limitations of our study, which have extensively been discussed in our manuscript. However, we would like to make some additional comments. We aimed to select high-risk patients only and used complete Rockall Score as selection criteria. Whether this score is the perfect tool to identify patients benefiting most from primary over-the-scope clips (OTSC) therapy remains unclear. Indeed, we did not balance baseline characteristics and the number of large lesions ( >20 mm) was three times higher in the standard group. This might have influenced study outcomes, as large ulcers are more difficult to treat with standard clips, which might have resulted in OTSC rescue therapy more frequently. However, large lesions can be difficult to treat with OTSC as well. Barkun et al comment that limited benefit for primary OTSC therapy for…

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Introduction
Hypotension is common during cardiac surgery and often persists postoperatively in the intensive care unit (ICU). Still, treatment is mainly reactive, causing a delay in its management. The Hypotension Prediction Index (HPI) can predict hypotension with high accuracy. Using the HPI combined with a guidance protocol resulted in a significant reduction in the severity of hypotension in four non-cardiac surgery trials. This randomised trial aims to evaluate the effectiveness of the HPI in combination with a diagnostic guidance protocol on reducing the occurrence and severity of hypotension during coronary artery bypass grafting (CABG) surgery and subsequent ICU admission.

Methods and analysis
This is a single-centre, randomised clinical trial in adult patients undergoing elective on-pump CABG surgery with a target mean arterial pressure of 65 mm Hg. One hundred and thirty patients will be randomly allocated in a 1:1 ratio to either the intervention or control group. In both groups, a HemoSphere patient monitor with embedded HPI software will be connected to the arterial line. In the intervention group, HPI values of 75 or above will initiate the diagnostic guidance protocol, both intraoperatively and postoperatively in the ICU during mechanical ventilation. In the control group, the HemoSphere patient monitor will be covered and silenced. The primary outcome is the time-weighted average of hypotension during the combined study phases.

Ethics and dissemination
The medical research ethics committee and the institutional review board of the Amsterdam UMC, location AMC, the Netherlands, approved the trial protocol (NL76236.018.21). No publication restrictions apply, and the study results will be disseminated through a peer-reviewed journal.

Trial registration number
The Netherlands Trial Register (NL9449), ClinicalTrials.gov (NCT05821647).

Previene metastasi e morte in malati ad alto rischio di recidive

Previene metastasi e morte in malati ad alto rischio di recidive

Aiuta a gestire la malattia e ad affrontare sfide quotidiane

Forma che ha colpito Silvio Berlusconi non tra più gravi. In forma cronica possibile buona qualità vita