Risultati per: Approccio farmacologico al trattamento della stipsi indotta da oppioidi: focus su naldemedina

Tor Vergata è capofila come numero di interventi eseguiti

Objectives
Public health interventions are designed to improve specific health-related outcomes; however, they may also produce negative side effects, such as substitution use, psychological or social harms. Knowledge about the unintended effects of school-based smoking preventive interventions is sparse. Hence, this study examined these potential unintended effects of the smoking-reducing intervention, Focus, among students in the vocational education and training setting.

Design
Cluster randomised controlled trial stratified by school type with 5 months follow-up.

Setting and participants
Across Denmark, eight schools were randomised to the intervention group (n=844 students, response proportion 76%) and six schools to the control group (n=815 students, response proportion 75%). This study focused solely on students who smoked at baseline (N=491).

Interventions
The intervention was developed systematically based on theory and a thoroughly mixed-methods needs assessment. Intervention components included a comprehensive school tobacco policy (smoke-free school hours) supported by a 3-day course for school staff and launched by an edutainment session for students; class-based lessons and a quit-and-win competition; and individual telephone smoking cessation support.

Outcomes
Alternative tobacco and nicotine products (regular use of smokeless tobacco, hookah and e-cigarettes), regular cannabis use, boredom and loneliness at school, stress and perceived stigmatisation among smokers.

Results
We found no statistically significant unintended effects of the intervention. Nonetheless, insignificant findings indicated that students in the intervention group were less likely to be bored during school hours (OR 0.59, 95% CI 0.32 to 1.10) and experience stress (OR 0.62, 95% CI 0.35 to 1.10), but more likely to report feeling stigmatised compared with the control group (OR 1.55, 95% CI 0.71 to 3.40).

Conclusions
Overall, findings suggested no unintended effects of the Focus trial with respect to substitution use, psychological, nor group or social harms. Future research is encouraged to report potential harmful outcomes of smoking preventive interventions, and interventions should be aware of the possible stigmatisation of smokers.

Trial registration number
ISRCTN16455577.

Objectives
In older patients, the diagnosis of acute pyelonephritis (APN) is challenging. The aim was to evaluate the added value of CT to history, physical examination and urinalysis for the diagnosis of APN in older patients with suspected infection with an unknown focus.

Design
Retrospective diagnostic study.

Setting
Department of General Medicine in an acute care hospital in Japan.

Participants
Patients aged ≥65 years who underwent blood cultures, a urine culture, and chest and abdominal CT to detect the focus of infection were included.

Primary outcome measures
Two radiologists independently reviewed four non-contrast CT signs: perirenal fat stranding, pelvicalyceal wall thickening, enlargement of the kidney and thickening of Gerota’s fascia. Findings on contrast-enhanced CT could not be evaluated due to an insufficient number of patients in whom contrast-enhanced CT was performed. An expert panel was used as the reference standard for APN. The added value of CT findings was quantified by comparing the diagnostic performance between a model based on 10 predictors available before CT and an extended model including the CT findings.

Results
Of 473 patients, 61 (14.8%) were diagnosed with APN. When the laterality of the CT findings was taken into account, the model fit was not improved by adding them. In the laterality-insensitive analysis, the model performance was significantly improved by adding the CT signs (likelihood-ratio test p=0.03; c-index 0.89 vs 0.91, p=0.03). However, their clinical utility was only to improve the classification of 11.5% of patients with APN.

Conclusions
The added value of non-contrast CT findings to history, physical examination and urinalysis was limited for the diagnosis of APN in older patients with a suspected infection with an unknown focus.

Promoting the science and art of medicine for the betterment of human health is central to JAMA’s mission and is fulfilled in part by publishing articles with up-to-date evidence on common health problems that are timely and practical for clinicians. Narrative reviews, an important component of JAMA’s Clinical Review and Education section, provide evidence-based and timely summaries of topics relevant for the practicing generalist clinician. Recent JAMA narrative reviews have covered prediabetes, hyperthyroidism, and care of adults who survived childhood cancer.

Objectives
To generate qualitative data on the views of Occupational Therapists and Physiotherapists about why people do not receive the Royal College of Physicians’ recommended minimum of 45 minutes (min) of daily therapy after stroke, in order to inform a Delphi study.

Design
Focus group study.

Setting
Stroke services in the South of England.

Participants
A total of nine participants, in two groups, including therapists covering inpatient and Early Supported Discharge (ESD) services with awareness of the 45 min guideline.

Results
Thematic analysis of focus group data identified five factors that influence the amount of therapy a person receives: The Person (with stroke), Individual Therapist, Stroke Multidisciplinary Team, the Organisation and the Guideline. Study findings suggest that the reasons why a person does not receive the therapy recommendation in inpatient and ESD services relate to either the suitability of the guideline for the person with stroke, or the ability of the service to deliver the guideline.

Conclusion
This study provides evidence for possible reasons why some people do not receive a minimum of 45 minutes of therapy, 5 days per week, related to (1) the suitability of the guideline for people with stroke and (2) services’ ability to deliver this amount of intervention. These two factors are related; therapists decide who should receive therapy and how much in the context of (a) resource availability and (b) people’s need and the benefit they will experience. The study findings, combined with the findings from other studies, will be used to initiate a Delphi study, which will establish consensus among therapists regarding the reasons why some people do not receive the guideline amount of therapy.

A new committee focused on digital health technologies, including artificial intelligence, machine learning, and virtual reality, will advise the US Food and Drug Administration (FDA) on the risks, benefits, and clinical outcomes linked with these tools, the agency announced.

Circulation, Volume 148, Issue Suppl_1, Page A18190-A18190, November 6, 2023. Introduction:Guideline-directed medical therapy (GDMT) has proven to significantly reduce morbidity and mortality in Heart Failure. We highlighted the differences in renal function among HF patients managed on GDMT, comparing those within a dedicated HF unit (HFU) to those under General Medical (GM) and Geriatrics (GER).Aim:The purpose of this single-centre cohort study is to highlight differences in renal function outcome between these groups.Methods:Our database consists of 540 patients with AHF admitted to HFU or GM/GER from 01/08/2021 to 31/07/2022. We divided this group as follows:Group A: 267 patients from GM/GER.Group B: 273 patients in HFU.Groups were classified by ejection fraction(HFrEF/HFmrEF/HFpEF). We analyzed eGFR, K+ and Creatinine(Cr) on admission(adm) and discharge(dc).Results:Group A(GM/GER): HFrEF patients had average eGFR of 45.70(mL/min) on adm and 43.58 on dc. HFmrEF subgroups had eGFR of 48.60 on adm and 46.54 on dc. HFpEF subgroups had eGFR of 50.16 on adm and 47.75 on dc.Group B(HFU):Patients with HFrEF had eGFR of 53.50 on adm and 50.74 on dc. HFmrEF subgroup had adm eGFR of 49.48 and 47.01 on dc. HFpEF subgroups had eGFR of 45.95 on adm and 41.72 on dc.Group A and B comparison: We have previously demonstrated (Fig.1) that among patients with AHF managed in HFU, there is better optimisation of GDMT. Within the HFrEF cohort, eGFR decreased -2.76 in Group B, with reduction of -2.12 in Group A. Group B HFmrEF showed reduced eGFR of -2.47; Group A decreased -2.06. In HFpEF, eGFR reduced -4.23 in Group B. In Group A, eGFR decreased -2.41. An inpatient mortality of 15.73% was calculated in Group A, contrasting significantly with 6.23% among the HFU cohort.Conclusion:This study highlights differences in renal function outcome between these two groups. It demonstrates that despite optimisation and initiation of GDMT in Group B – which may lead to concern for its impact on renal function – eGFR, Cr and K+ levels were not markedly different between both cohorts.

Circulation, Volume 148, Issue Suppl_1, Page A18492-A18492, November 6, 2023. Background:Icosapent ethyl was approved in Dec 2019 to reduce CV event risk in statin-treated adults with elevated TG (≥150 mg/dL) and established CVD or diabetes with other risk factors of CVD.Hypothesis:Patients who take icosapent ethyl have demographic/clinical characteristics consistent with its indication.Aims:This study describes demographic/clinical characteristics of US patients taking icosapent ethyl, focusing on those with diabetes.Methods:A database of >89 million US electronic medical records identified patients taking icosapent ethyl (ie, ≥2 prescriptions on 2 separate days). Patient demographic/clinical baseline data were retrieved.Results:As of Jan 19, 2023, 40,408 patients taking icosapent ethyl were identified, with a mean (SD) age of 60.3 (12.9) y, BMI of 31.9 (6.07) kg/m2, HbA1c of 7.24% (1.88), and glucose level of 143 (67.8) mg/dL. Most were men (60.5%), White (75.2%), and taking statins (71.8%). Mean (SD; median) TG in the 3 mo before icosapent ethyl initiation was 422 (506; 300) mg/dL; 8.1% of patients had TG ≥500 mg/dL. In line with the indication of icosapent ethyl, 65.3% had prior atherosclerotic CVD or diabetes and ≥1 risk factor. Among 16,564 patients with diabetes (Figure), 13.0% had a history of myocardial infarction, 12.5% had stroke, and 10.4% had revascularization. Overall, 14.2% had chronic kidney disease and 5.5% had type 2 diabetes mellitus with diabetic kidney disease. Common risk factors for CVD were hypertension (68.4%), obesity (40.9%), and history of cigarette smoking (21.6%). Common antidiabetic medications were metformin (37.4%), insulin (27.9%), and sulfonylurea (15.1%).Conclusions:Patients using icosapent ethyl often had diabetes and/or CVD, took statins, and had elevated TG, meeting indications for its use. However, the high median TG before therapy suggests that many physicians reserve icosapent ethyl for more severe TG; thus many patients with more moderate levels ( >150 mg/dL) could potentially benefit.