Search Results for: Terapia antibiotica: breve durata vs. lunga durata

Objectives
The US Preventive Services Task Force recommends screening of adults aged 35–70 with a body mass index ≥25 kg/m2 for type 2 diabetes and referral of individuals who screen positive for pre-diabetes to evidence-based prevention strategies. The diabetes burden in the USA is predicted to triple by 2060 necessitating strategic diabetes prevention efforts, particularly in areas of highest need. This study aimed to identify pre-diabetes hotspots using geospatial mapping to inform targeted diabetes prevention strategies. A ‘hotspot’ is defined as a cluster of 3 or more neighbouring census tracts with elevated pre-diabetes prevalence.

Design
A cross-sectional study using ArcGIS software to geospatially map pre-diabetes prevalence hotspots. We used health system and census data to identify pre-diabetes hotspots using a systematic five-step geoprocessing approach that made use of incremental spatial autocorrelation and Getis-Ord Gi*.

Setting
This study was set in Kaiser Permanente Northern California (KPNC), an integrated health delivery system with over four million members.

Participants
KPNC adults ages 35–70 who underwent a haemoglobin A1c (HbA1c) or fasting plasma glucose (FPG) screening test in 2019 were mapped to census tracts in Northern California. People were considered to have pre-diabetes with an HbA1c of 5.7%–6.4% (39–46 mmol/mol) or FPG 100–125 mg/dL.

Primary and secondary outcome measures
Individual and census-level characteristics were compared between hotspots and non-hotspots using 2 and Wilcoxon rank sum tests, as well as risk differences (RDs) and Hodges-Lehmann (HL) estimates of location shift. Individual-level characteristics were derived from electronic health records and administrative data, while census-level characteristics were derived from the 2019 American Community Survey.

Results
A total of 760 044 adults met the study inclusion criteria and 40% had pre-diabetes. Individuals in pre-diabetes hotspots were less likely to be non-Hispanic white (33.6% vs 50.6%, RD: –17.04%, 95% CI –17.26% to –16.81%, p

Introduction
Virtual reality (VR) technology is increasingly used by researchers and healthcare professionals as a therapeutic intervention to improve the quality of life of persons living with dementia (PLwD). However, most VR interventions to date have mainly been explored in long-term or community care settings, with fewer being explored at home. Setting is important, given that the majority of PLwD live at home and are cared for by their family care partners. One of the challenges affecting PLwD and care partner relationships is barriers in communication, which can lead to social isolation and poor quality of life for both parties. Thus, the goal of the proposed project is to explore whether an immersive, multisensory VR intervention can facilitate communication between PLwD and their care partners and, in turn, enhance personal relationships and improve well-being.

Methods and analysis
Thirty dyads comprised of PLwD and their family/friend care partners will participate in this at-home intervention. Their interactions will be recorded as they experience a series of 360° videos together (eg, concert, travel) either using a VR headset (PLwD) with a paired tablet (care partner) or using only a tablet together. The two conditions will allow us to compare immersive VR technology to more common non-immersive tablet-based technology. The study will begin with at-home training and baseline data collection. The intervention will then take place over a 4-week period, with the two conditions (VR vs tablet-only) experienced 2 weeks each. A comprehensive set of measures will be employed to assess the quality and quantity of dyadic interactions, such as verbal/non-verbal language (eg, informativity, gestures) and self-reported measures of well-being and quality of life.

Ethics and dissemination
Ethical approval for the study was granted by the University Health Network (#21–5701). Findings will be shared with all stakeholders through peer-reviewed publications and presentations.

Clinical registration
This study has been registered on clinicaltrials.gov (NCT06568211).

Objectives
This study investigated the prognostic role of log odds of negative lymph node/T stage (LONT) and established a nomogram based on LONT to predict the prognosis in colorectal cancer (CRC) patients.

Design
A retrospective cohort study.

Setting and participants
We enrolled 80 518 CRC patients from the Surveillance, Epidemiology and End Results database between 2010 and 2015. The dataset was split into a training cohort (56 364 patients) and a validation cohort (24 154 patients) at a ratio of 7:3. Furthermore, 500 CRC patients who underwent surgery in the Tenth Affiliated Hospital of Southern Medical University between 1 January 2017 and 20 December 2018, were recruited as the external validation set.

Outcome measures
1-, 3- and 5-year cancer-specific survival (CSS).

Methods
The univariate and multivariate Cox regression analyses were carried out to identify the significant independent prognostic factors of CSS. A nomogram was established based on LONT to predict the prognosis. The performance of the nomogram was comprehensively assessed via the time-dependent receiver operating characteristic curve, concordance index (C-index), calibration curve and decision curve analysis (DCA) comprehensively. Moreover, Kaplan-Meier curves were performed to assess the CSS of the three risk subgroups.

Result
LONT was a significant independent prognostic factor for CSS (LONT1 vs LONT2, HR=0.670, 95% CI 0.642 to 0.698, p

Objectives
Intensive care unit (ICU) clinicians stop antibiotics more often, with a negative infection: point-of-care test (PCR-POCT). Simulated cases of diagnostic uncertainty regarding infection resolution led clinicians to choose options such as procalcitonin (PCT) and/or PCR-POCTs +/– de-escalation to aid stop decisions. We hypothesised that a direct infection indicator, PCR-POCT, would influence stop judgements more than indirect PCT. Accordingly, we tested antibiotic-stop decisions when presented with a negative PCR-POCT despite borderline-positive PCT.

Designs
Observational prospective study.

Setting
ICU.

Participants
66 ICU clinicians from University hospitals.

Methods
Clinicians saw four scenarios of different clinico-biological trajectories: (1) clear improvement, (2) clear worsening, (3) discordant—clinically better/biologically worse and (4) discordant—clinically worse/biologically better. Participants gave an initial decision (stop/continue/continue–escalate/continue–de-escalate). Then PCR-POCT and/or PCT was offered (accept/decline). After a negative PCR-POCT and borderline-positive PCT result, a final antibiotic decision was taken.

Measures
Proportion of stop decisions before versus after test results per scenario. The association of the final decision with the clinician’s change in confidence, willingness to request the biomarker(s) and the case trajectory was determined.

Results
Fewer clinicians than expected stopped antibiotics versus baseline (36%, 94/264 vs 42%, 110/264, p=0.045). This was so in three of four scenarios, significantly less in the improvement (p

Objective
To investigate the current level of physical activity (PA) and its influencing factors among patients with inflammatory bowel disease (IBD) in East China.

Design
Cross-sectional study.

Setting
Questionnaire survey recruiting from six tertiary referral hospitals in East China between October and December 2023.

Participants
Patients with Crohn’s disease (CD) or ulcerative colitis (UC) aged 18–65 years without conditions limiting PA engagement.

Primary and secondary outcome measures
Primary outcomes comprised total PA, PA levels and sedentary time over 1 week. Demographic and clinical characteristics, disease-related and non-disease-related barriers to PA, and PA outcome expectation score were also assessed.

Results
Of 391 eligible respondents, including 271 CD (69.3%) and 237 males (60.6%), the median total PA in IBD patients was 594 (0–1695) metabolic equivalent of task (MET)-min/week, with 53 patients (13.6%) of high, 140 (35.8%) of moderate and 198 (50.6%) of low level. The median sedentary time was 2325 (1500~3120) min/week in IBD patients, with CD significantly more than UC (p

Objective
To assess the effectiveness of a potent topical corticosteroid (TCS) as an initial treatment in primary care for children with moderate flare-ups of atopic dermatitis (AD), compared to starting on a mild TCS.

Design
An observational prospective cohort study with an embedded pragmatic multicentre open-label randomised controlled trial.

Setting
A total of 53 general practices in the southwest of the Netherlands took part in the study.

Participants
209 children aged 3 months to 17 years diagnosed with AD (International Classification of Primary Care codes S87 or S88) who visited their general practitioner (GP) for AD or received repeat prescriptions for AD in the previous 12 months were included in the cohort study through the general practices. Finally, 32 patients (15%) were randomised and assigned to the trial (13 girls; 19 boys; median age 4.0 years).

Interventions
If cohort participants experienced a moderate flare-up (ie, need to intensify topical treatment from the child’s and/or parents’ point of view of AD and a three-item severity score from three to

Portal vein thromboses (PVTs) are common in patients with cirrhosis and are associated with advanced portal hypertension and mortality. The treatment of PVTs remains a clinical challenge due to limited evidence and competing risks of PVT-associated complications vs bleeding risk of anticoagulation. Significant heterogeneity in PVT phenotype based on anatomic, host, and disease characteristics, and an emerging spectrum of therapeutic options further complicate PVT management. This Clinical Practice Update (CPU) aims to provide best practice advice for the evaluation and management of PVT in cirrhosis, including the role of direct oral anticoagulants and endovascular interventions.

Parte dall’Abruzzo ‘Respirare è un diritto di tutti’

This narrative review explores treatment with surgical aortic valve replacement vs transcatheter aortic valve implantation in older adults with severe symptomatic calcific aortic stenosis, including the type and timing of valve replacement.

Objective
We compared processes of antepartum, intrapartum and postpartum care and obstetrical outcomes between physicians and non-physicians.

Design
This is a population-based retrospective matched cohort study.

Setting
The study was conducted in Ontario, Canada.

Participants
Physicians and non-physicians residing in high-income urban areas from 1 April 2009 to 26 November 2018 were included. Physicians were matched to non-physicians on maternal age, calendar year, parity, conception by assisted reproductive technology and singleton versus multifetal gestation. We compared processes of antepartum, intrapartum and postpartum care between physicians and non-physicians.

Outcome measures
The primary outcome was mode of delivery (caesarean section, C-section vs vaginal delivery). Secondary outcomes included obstetrical anal sphincter injury among those experiencing vaginal birth and differences in urgent healthcare contacts (maternal and neonatal) during the postpartum period.

Results
7327 physicians were matched 1:5 to 36 185 non-physicians and were well balanced except for comorbidities (physicians had fewer comorbidities). Physicians had more antenatal ultrasounds and invasive prenatal testing, received labour anaesthesia more often and were more often delivered by their own care provider. In adjusted analyses, physicians and non-physicians had a similar risk of C-section (aRR 0.97, 95% CI 0.93 to 1.00, p=0.07). There was no difference in neonatal urgent care contacts; non-physicians had a higher risk of maternal urgent postpartum care (adjusted relative risk [aRR] 1.22, 95% CI 1.08 to 1.37, p

L’opposizione critica sul mancato incarico al vicepresidente

Objectives
Recent studies have suggested a potential link between opium consumption and microvascular dysfunction in coronary arteries, which may contribute to the development of coronary slow-flow syndrome. This study aims to investigate the relationship between opium use and coronary slow-flow syndrome.

Design and setting
This retrospective study analysed medical records of patients who underwent coronary angiography at the Tehran Heart Center from 2006 to 2020. It focused on those with coronary slow flow phenomenon (CSFP) or non-obstructive coronary artery disease, excluding patients with significant left ventricular dysfunction (left ventricular ejection fraction