Risultati per: Follow-up ottimale dopo embolia polmonare acuta

Introduction
Patients with pulmonary embolism (PE) experience impaired functional ability and reduced quality of life long after discharge from the hospital. However, there are no structured follow-up programmes in Denmark for these patients, and there is considerable variation in practice patterns of post-PE management. No studies have investigated the effectiveness of structured follow-up care models in patients with PE. This study aims to investigate the effect and cost-effectiveness of a structured integrated post-pulmonary embolism follow-up care model (Attend-PE) compared with usual care. The Attend-PE model outlines a structured approach for in-hospital follow-up, involving group-based patient education, individual consultations and systematic use of patient-reported outcome measures to assess the patient’s physical and psychological well-being.

Methods and analysis
The study is conducted in Denmark, where the healthcare system is tax-funded and services are freely available for all citizens, with an expected inclusion of 2000 patients in total. A pre-post-intervention study design is used to compare outcomes in the post-implementation cohort with the pre-implementation cohort. The co-primary outcomes are (1) health-related quality of life (patient-reported outcome, PRO) and (2) adherence to medical treatment (register-based data). Secondary outcomes include PROs on disability, treatment satisfaction, self-management, anxiety, depression and work productivity, and register-based outcomes, including recurrent PE, bleeding, mortality and healthcare use. Register-based data will be assessed at baseline (date of PE event), 6 and 12 months, while PRO-data will be assessed at 6 and 12 months after the PE event. The health economic evaluation of the Attend-PE model will include a cost-effectiveness analysis and a cost-utility analysis.

Ethics and dissemination
The project will be conducted by the Declaration of Helsinki. In accordance with the Danish Act on Health Research Ethics §14, the study is exempt from approval. The use of survey responses in research (in anonymous form) is, however, contingent on participants’ consent, and the invitation letter therefore included information about the purpose of the study and participants’ rights to withdraw consent at any time, and that completion of the questionnaire is considered as consent to their survey data to be included in research.
Study findings will be disseminated in scientific peer-reviewed journals, at national and international conferences, and for staff and decision-makers at participating hospitals and patients and relatives via the Danish Heart Association.

Trial registration number
Clinicaltrials.gov NCT06037096.

Objective
The objective of the study is to assess knowledge of diabetic retinopathy, eye check-up service utilisation and associated factors among adult diabetic patients at public hospitals in southeastern Ethiopia in 2022.

Setting
The study was conducted at Ginnir General and Goba Referral Hospital in southeast Ethiopia.

Design
The study was designed as a facility-based cross-sectional study.

Participants
Systematically selected adult diabetic patients were the participants of the study.

Primary outcome
The primary outcomes are knowledge about diabetic retinopathy and eye check-up service utilisation.

Results
Of the 422 samples, 401 study participants participated with a 95% response rate. 254 (63.3%) (95% CI 58.5, 68%) and 37% (95% CI 32.5, 42%) of the participants had good knowledge of diabetic retinopathy and good uptake of eye check-up service, respectively. Educational status of greater than 12th grade, possession of health insurance and good attitude towards diabetic retinopathy prevention were factors associated with good knowledge about diabetic retinopathy. In addition, urban residence, level of education of >grade 12, having health insurance, good knowledge of diabetic retinopathy and good attitude towards prevention of diabetic retinopathy were significantly associated with good utilisation of eye check-up services.

Conclusions
Compared with the WHO and other recommendations, diabetic patients have low knowledge and utilisation of eye check-up services for diabetic retinopathy.

Lo rivela uno studio a livello mondiale coordinato dallo Iov

New England Journal of Medicine, Volume 391, Issue 22, Page 2170-2172, December 5, 2024.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Objectives
This study aimed to assess the prevalence of treatment-resistant depression (TRD) and associated factors among patients with major depressive disorder (MDD) on follow-up at Amanuel Mental Specialised Hospital, Addis Ababa, Ethiopia, 2021.

Design and setting
An institution-based cross-sectional study design was employed using systematic random sampling techniques from 17 February to 26 March 2021.

Participants
The study enrolled 412 participants with a response rate of 97.6%. The study population consisted of Saint Amanuel Mental Specialised Hospital follow-up patients with MDDs and all adult patients aged above 18.

Main outcome measures
The main outcome of this study was TRD, which was measured using the Hospital Anxiety and Depression Scale-Depression (HADS-D). The collected data were entered into Epi-data software version 3.1 and exported to the statistical package for social science version 20 for analysis. Bivariate and multivariate logistic regression analyses were used to identify associated factors with TRD. The OR with a 95% CI was used to assess the strength of the association.

Results
The prevalence of TRD was 41.5% (95% CI: 37.2 to 46.1). Female sex [AOR=2.43, 95% CI: 1.57 to 3.75], comorbid psychosis [AOR=1.89, 95% CI: 1.19 to 2.99], comorbid medical illness [AOR=1.67, 95% CI: 1.09 to 2.55] and family history of mental illness [AOR=2.27, 95% CI: 1.38 to 3.74] were factors significantly associated with TRD.

Conclusion and recommendation
In this study, the prevalence of TRD among patients with MDDs on follow-up was high. Therefore, to improve outcomes, screening for TRD and creating specific diagnostic techniques are necessary. Additionally, preventive interventions against TRD must be established.

Otsuka celebra i 50 anni di attività in Europa. Focus sulle malattie rare

Introduction
Hysterosalpingography (HSG) and hysterosalpingo-foam sonography (HyFoSy) are commonly used tubal patency tests during the fertility work-up. Besides its diagnostic purpose, HSG with oil-based contrast can also be applied for its fertility-enhancing effect, by tubal flushing. HyFoSy is considered as less painful compared with HSG, it lacks exposure to iodinated contrast medium and ionising radiation. The fertility-enhancing effects of HyFoSy are less studied and randomised controlled trials comparing pregnancy rates after HSG and HyFoSy are lacking. This study (FOil study) is initiated to compare the effectiveness of tubal flushing during HSG with oil-based contrast and HyFoSy.

Methods and analysis
The FOil study is a nationwide, multicentre, open label, randomised controlled trial with a superiority design. Infertile women with an indication for tubal patency testing during their fertility work-up will be randomly assigned to HSG with oil-based contrast medium or HyFoSy. The primary outcome is conception within 6 months after randomisation leading to live birth. To demonstrate or refute an 8% difference in conception leading to live birth in favour of HSG with oil-based contrast, 1102 women will be included in the trial. A cost-effectiveness analysis from a societal perspective will be performed alongside the trial.

Ethics and dissemination
The trial is approved by the Medical Ethics Review Committee of the Amsterdam University Medical Centers (Ref. No. 2022.0884, date: 17 March 2023) and by the boards of the participating hospitals. The findings will be disseminated in peer-reviewed journals and participants will be informed through the patient organisation.

Trial registration number
NCT05882188.

Objective
This study was conducted to assess knowledge of stroke risk factors and prevention among hypertensive patients on follow-up at Addis Ababa University Tertiary Hospital, Addis Ababa, Ethiopia.

Design
Cross-sectional study design.

Setting
This study was conducted at Addis Ababa University Tertiary Hospital in Addis Ababa, Ethiopia.

Participants
The sample size was determined using the single population proportion calculation. A list of all patients with hypertension on follow-up was framed from the appointment book of the cardiovascular clinic. Then, 316 participants were recruited by simple random sampling procedure from 18 April 2022 to 19 May 2022. The study included all patients with hypertension >18 years of age who were on follow-up during the data-collecting period. In contrast, patients with memory loss or cognitive impairment and who are unable to communicate were excluded from the study.

Result
With a response rate of 96.8%, 306 respondents in total were questioned. The average age of the participants was 53.6 years (SD±13.4). More than half of participants (52.9%) were female. The average score for understanding stroke risk factors and prevention is 44.1% and 49.7%, respectively. Knowledge of stroke risk factors was substantially correlated with residency and educational level, while knowledge of stroke prevention was significantly associated with sex, income and educational level.

Conclusion
This study indicates that patients with hypertension who participated in the study had poor knowledge of stroke risk factors and prevention. The mean score of knowledge on risk factors and prevention strategies of stroke is 44.1% and 49.7%, respectively, and needs improvement.

Introduction
The allostatic load (AL) is a framework for conceptualising the physiological multisystemic impact of prolonged exposure to stress and its related side effects on mental health.
Stress due to AL can influence the development and outcomes of cardiovascular diseases. AL increases the risk of coronary and peripherical artery diseases. AL emerges from the detection of emotional dimensions related to the disease, low psychosocial functioning and high rates of psychopathological signs in patients with hypertension or coronary heart disease.

Method and analysis
The primary endpoint of the PLAY-UP protocol is the implementation of a multidimensional model underlying the clinical treatment of patients with cardiovascular disease through the integration of medical and psychological clinical variables.
PLAY-UP is a cohort study that will last for 24 months. 200 participants will be recruited and divided into three groups: early disease, midterm disease and long disease. All patients will undergo a clinical evaluation based on the detection of biological, medical and psychological indicators and variables. The evaluation battery will comprise three types of measurements: medical, psychological and pharmacological treatments. Clinical and psychological measurements will be processed in an integrated manner through the combination of all variables examined, elaborating the Allostatic Load Index from a longitudinal time perspective. The Allostatic Load Index will be calculated by measuring the z-score.

Ethics and dissemination
Ethical Committee Approval was obtained from CEtRA Abruzzo Region (IT) (ID 0461499/23). The results of the present project will be published in peer-reviewed journals, disseminated electronically and in print, and presented as abstracts and/or personal communications during national and international conferences.

La Presidenza del Consiglio aderisce a ‘Illumina novembre’

Introduction
Post-intensive care syndrome (PICS) seriously affects the quality of life of intensive care unit (ICU) survivors, their ability to return to work and society and the quality of life of their families, increasing overall care costs and healthcare expenditures. ICU follow-up services have important potential to improve PICS. However, the best clinical practice model of ICU follow-up service has not been fully defined and its benefits for ICU survivors are not clear. This review will synthesise and map the current types of follow-up services for ICU survivors and summarise the impact of follow-up services on PICS.

Methods and analysis
This scoping review will be conducted by applying the five-stage protocol proposed by Arksey and O’Malley in an updated version of the Joanna Briggs Institute. Eight academic databases including the Cochrane Library, MEDLINE, Web of Science, Embase, EBSCO Academic, CINAHL, PsycInfo and SinoMed (China Biology Medicine) will be systematically searched from inception to the present. Peer-reviewed literature and grey literature will be included. Qualitative, quantitative and mixed methods studies will be included. Studies published in English or Chinese will be included. There will be no time restriction. Two reviewers will screen and select the articles independently and if there is any disagreement, the two reviewers will discuss or invite a third reviewer to make decisions together. Descriptive analysis will be used to conduct an overview of the literature. The results will be presented in a descriptive format in response to the review questions accompanied by the necessary tables or charts.

Ethics and dissemination
Ethical approval is not required for this scoping review because data could be obtained by reviewing published primary study results and do not involve human participants. Findings should be disseminated at scientific meetings and published in peer-reviewed journals.

Circulation, Volume 150, Issue Suppl_1, Page A4140140-A4140140, November 12, 2024. Managing low-density lipoprotein (LDL) cholesterol is crucial for secondary cardiovascular prevention. Despite ACC/AHA recommendations for maintaining LDL below 70 mg/dL, achieving this target remains suboptimal. This study investigates the impact of consistent cardiologist involvement on LDL cholesterol management.Methods:We conducted a multicenter, cross-sectional cohort study within the Steward Healthcare System in Massachusetts, analyzing data from 10,211 patients hospitalized from January 2019 to March 2024. This study offers a detailed snapshot of data across the study period, capturing both recent and long-standing cases identified through ICD codes for conditions like NSTEMI, CAD, STEMI, or CABG, specifically as markers for secondary cardiovascular prevention. We utilized the most recent LDL cholesterol measurements for our analysis and compared the distribution of lipid-lowering medications across groups. Notably, follow-ups with cardiologists outside our network were not tracked, potentially omitting relevant data. Statistical analysis employed the Chi-square test for categorical variables and binary logistic regression to adjust for confounders.Results:showed that patients with regular cardiology visits more often achieved LDL levels below 70 mg/dL (57.45% vs. 46.67%; OR 1.54, 95% CI: 1.42-1.68; P

Circulation, Volume 150, Issue Suppl_1, Page A4147647-A4147647, November 12, 2024. Background and Objectives:Yoga may be a promising form of mind-body rehabilitation for patients with long term illness. Digitally delivered yoga increases access to participation but has not previously been evaluated in the heart failure population. The aim of this study was to examine the effects of tele-yoga on cognition, sleep, health-related quality of life and exercise capacity in persons with heart failure.Methods:The Tele-yoga study (ClinicalTrials.gov, ID: NCT 03703609) was a parallel two-arm randomised controlled trial (RCT) with 1:1 distribution to an intervention and control group. Study participants were randomised to tele-yoga including live-streamed group-yoga for 60 minutes twice weekly during 12 weeks and yoga individually for 10 minutes/day using an app, or to a control group receiving individual exercise advice. Cognition (Montreal Cognitive Assessment: MoCA), sleep (minimal insomnia symptom scale; MISS), health-related quality of life (EQ-5D VAS) and sub-maximal exercise capacity (6 minute walk test; 6MWT) were assessed at baseline, after 3 and 6 months. Linear mixed model with random intercept for patients as the random effect and group-time interaction along with age was taken as the fixed effects to analyse outcomes.Results:A total of 311 participants were included (tele-yoga n=156 and active controls n=155), mean age 66 years, 70% men. Adherence to the group yoga was very good. The linear mixed models showed a significant change in cognition, health-related quality of life and exercise capacity favouring the tele-yoga group. No significant differences between the groups were seen regarding sleep. When analysing the fixed effects of all outcomes, age, group assignment and time-points interaction had significant effects on EQ-5D VAS score, 6MWT distance and MoCA scores. For EQ-5D VAS the tele-yoga group performed significantly better than the control group at 3 months, but not at 6 months. For the 6MWT distance, the tele-yoga group performed better than the control group at 3 months, but not at 6 months. The tele-yoga group had significantly higher MoCA scores than the control group at both 3 and 6 months.Conclusion:This adequately powered RCT showed that digitally delivered mind-body training in the format of group and individual yoga during 12 weeks lead to an improvement in cognition, quality of life and exercise capacity at the end of the intervention. The effect was sustained for cognition also after 6 months.

Circulation, Volume 150, Issue Suppl_1, Page A4140142-A4140142, November 12, 2024. Background:Cardiovascular-kidney metabolic (CKM) syndrome is exacerbated among individuals experiencing chronic exposure to both environmental and psychosocial stressors. Both neighborhood and individual-level stressors increase chronic inflammation resulting in worsened CKM factors, such as hypertension, diabetes, and dys/hyperlipidemia. However, associations between neighborhood perceptions (NP) and lipid profiles remain understudied. Therefore, we examined associations between NP domains and lipid profiles among African-American (AA) women with ≥Stage 1 CKM syndrome (overweight/obesity) residing in resource-limited neighborhoods within the Washington, DC area.Methods:Participants were enrolled in Step It Up, a technology-enabled, community-engaged physical activity (PA) intervention. Fasting blood samples were drawn at baseline to measure lipoproteins using Nuclear Magnetic Resonance (NMR) spectroscopy. Factor analysis of overall NP identified four perception sub-scores: disorder, social cohesion, violence, and safety (higher score=favorable perception). Associations between NP domains and lipoprotein particles were analyzed using multivariable regression adjusting for BMI, ASCVD 10-year risk score, and lipid-lowering therapy.Results:Participants (n=169) had mean age=57.16 ± 12.00 and BMI 35.99 ± 6.57. Perceptions of safety were positively associated with LDL concentrations (LDLc) and large LDL particles (L-LDLp) (β=4.70 [SD=2.41], p=0.05, β= 43.75 [17.70], p= 0.01), respectively). Perceptions about neighborhood violence were positively associated with L-LDLp (marginally) and very-low-density lipoprotein size (VLDLz) (β= 7.10 [3.96], p=0.08, β= 0.31 [0.14], p= 0.02, respectively). No associations were found between disorder and social cohesion with lipid biomarkers.Conclusions:After adjusting for BMI, ASCVD risk, and lipid-lowering therapy, there were significant associations between neighborhood perceptions of safety and violence with lipid profiles among AA women with CKM syndrome. Greater perceived safety was associated with higher LDLc and L-LDLp while more favorable perception about neighborhood violence was associated with higher L-LDLp. Future work should examine whether improving neighborhood resources and perceptions may improve CKM health among urban AA women.