Risultati per: Approccio pre-rete e Cure Palliative di base

Circulation, Volume 150, Issue Suppl_1, Page A4141883-A4141883, November 12, 2024. Background:Pre-existing significant aortic stenosis (sAS) in patients with out-of-hospital cardiac arrest (OHCA) may lead to ineffective chest compressions due to the pathophysiology and hemodynamics of stenosis, reducing the probability of return of spontaneous circulation, and the resuscitation may be complicated.Aim:To analyze the influence of sAS on the risk of OHCA in patients with acute myocardial infarction (AMI-OHCA), on the complicity of resuscitation and survival.Methods:The analysis was based on the national all-comers’ registry of coronary interventions enriched by information from the National Registry of Reimbursed Health Services and the Registry of Deaths. Complicity of resuscitation was defined as the necessity of mechanical ventilation up to hospital admission. The association between AS, patient characteristics and mortality was analyzed using logistic regression, multivariate model was used for adjusting for co-founders.Results:Our dataset included all patients with AMI-OHCA in the country in the period from 2017 to 2021 (N=4,414), of whom 1.8% (N=80) patients had pre-existing sAS and were followed up at the medical institutions (Table 1). The incidence of sAS was 1.7% in those who suffered OHCA and 1.8% in AMI patients without this complication,p=0.66. The AMI-OHCA patients were divided into three groups – those who died during OHCA (N=238, sAS in 4.2%), those who were admitted after OHCA on mechanical ventilation (N=3,255, sAS in 1.8%), and spontaneously ventilating patients (N=921, sAS in 1.2%). Multivariate analysis showed that sAS was not recognized as a risk factor for the use of mechanical ventilation in AMI-OHCA patients, odds ratio (OR) 1.61 (95%CI 0.83;3.09), p=0.16, however sAS presents a significant risk of pre-hospital mortality of AMI-OHCA patients, multivariate OR 3.4 (95%CI 1.20;9.58), p= 0.02. Additionally, the in-hospital, 30-day, and long-term prognosis of AMI patients after OHCA is adversely affected by AS with odds ratio of 2.47 (95%CI 1.38;4.41), 2.83 (95%CI 1.61;4.95), and 1.81 (95%CI 1.38;2.38) vs. non-VHD respectively.Conclusion:Pre-existing sAS has a significant adverse influence on the survival of AMI-OHCA patients and is a significant risk factor of pre-hospital mortality. Therefore, patients with AS should be carefully screened for coronary artery disease, antithrombotic therapy should be considered, and the earlier planning of valvular intervention after AMI should be evaluated.

Pazienti, pronti a dare contributo per nuova sanità territoriale

Aiom, terapia ormonale salvavita. Soluzioni smart per ricordarla

Background
Pre-exposure prophylaxis (PrEP) is a highly effective, safe and acceptable intervention for preventing HIV infection. However, identifying individuals who could best benefit from PrEP remains a significant challenge. Existing HIV risk assessment tools vary in performance depending on context. This systematic review aims to synthesise evidence on their diagnostic performances to predict incident HIV infection.

Methods and analysis
This protocol is informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Protocols. We will search MEDLINE (Ovid), Embase (Ovid) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases (January 1998–May 2024) for observational and relevant interventional studies assessing the diagnostic performance of HIV risk tools to predict incident HIV for PrEP eligibility. There will be no restrictions on study language or location. Two reviewers will conduct the search, data extraction and risk of bias assessment using the Johanna Briggs Institute Critical Appraisal Checklist for Diagnostic Studies. Standardised templates will be used in Covidence for data extraction. We will conduct a meta-analysis if appropriate, otherwise, a narrative review. We will use the PRISMA guidelines to guide reporting.

Ethics and dissemination of research
Ethical approval is not required as data is publicly available. This review will inform updates to Canadian HIV PrEP guidelines and guide healthcare professionals in using HIV risk assessment tools for identifying PrEP candidates. Findings will be presented at guideline panel meetings and submitted for publication in a peer-reviewed journal and conferences.

PROSPERO registration number
CRD42024543975.

Quality of life for patients with advanced non–small-cell lung cancer was similar with virtual delivery and in-person delivery of early palliative care.

Introduction
Genetic variations impact drug response, driving the need for personalised medicine through pre-emptive pharmacogenetic testing. However, the adoption of pre-emptive pharmacogenetic testing for commonly prescribed drugs, such as statins, outside of tertiary hospitals is limited due to a lack of pharmacoeconomic evidence to support widespread implementation by healthcare policy-makers. The Spanish Consortium for the Implementation of Pharmacogenetics (iPHARMGx Consortium) addresses this by developing a clinical trial master protocol that will govern multiple nested adaptive clinical trials that compare genotype-guided treatments to standard care in specific drug–gene–population triads, asses their cost-efficacy and identify novel biomarkers through advanced sequencing techniques. The first of these studies aims to assess whether a pre-emptive statin therapy genotyping scheme reduces the incidence of statin-associated muscle symptoms (SAMS) in a population at risk of cardiovascular disease susceptible of receiving high-intensity or moderate-intensity doses of statins: The PREVESTATGx trial.

Methods and analysis
the PREVESTATGX trial is a multicentre, adaptive randomised controlled pragmatic phase IV clinical trial nested to the iPHARMGx master protocol with two parallel arms, aiming for superiority. Randomisation will be conducted on an individual basis with a centralised approach and stratification by centre. After inclusion in the trial and genotyping has been performed, subjects will be randomly allocated to experimental group (pharmacogenetic genotype-guided statin prescription) or standard-of-care statin prescription (as deemed by attending physician). The main objective is to assess the efficacy of a statin pre-emptive genotyping strategy in reducing the incidence of SAMS. A total of 225 subjects will be recruited among the 10 participating centres if no futility/efficacy boundary is reached in the prespecified interim analyses. Recruitment will be carried out during a 12-month period and subjects will be followed for a 9-month period.

Ethics and dissemination
The PREVESTATGx trial received ethical approval on 24 April 2024. Results will be disseminated via publication in peer-reviewed journals as well as presentation at international conferences. Trial results will be submitted for publication in an open-access peer-reviewed medical speciality-specific publication.

Trial registration number
EU CT number: 2023-509418-12-00/Clinical trial Identifier (ClinicalTrials.gov): NCT06262685. Protocol version 1.2 12 April 2024 (includes non-substantial modification number 14 June 2024). Trial registration of this study can be located at both the EU Clinical Trials Register available from https:// euclinicaltrials.eu/search-for-clinical-trials/?lang=en and https://clinicaltrials.gov. Registration on both websites was done before the enrolment of the first patient complying with European regulations. EU Clinical Trials Register is a primary registry according to the WHO.

Disturbo da lentezza motoria e deficit di memoria

Chelli: ‘Cala la spesa sanitaria nel 2023 e aumenta il carico per le famiglie’

Background
Persons with COVID-19 may experience limitations in daily functioning and can be referred to occupational therapy.

Objectives
To evaluate changes in daily functioning, cognitive complaints, fatigue and self-management of persons with COVID-19 who received occupational therapy in primary care.

To get insights in the volume and duration of occupational therapy.

Design
A pre-post observational cohort study from October 2020 until April 2021.

Setting
Fifty-eight occupational therapy practices in primary care throughout the Netherlands participated with 68 occupational therapists.

Participants
228 adults (≥18 years) with COVID-19, referred to occupational therapy, gave informed consent and participated in the pre-post evaluation. The mean age was 49 years (SD 13) and 79% of the patients was female. The most frequently reported complaints included fatigue and cognitive complaints.

Interventions
Occupational therapy using Dutch guidelines for occupational therapy in clients with COVID-19.

Outcome measures
Performance and satisfaction with performance using the Canadian Occupational Performance Measure (COPM); the impact of Cognitive Complaints on Participation (CoCo-P); and daily activities, self-management and perceived contribution of occupational therapy using the Patient Reported Outcome Measure for Occupational Therapy (PROM-OT).

Results
COPM-performance score improved with a mean difference of 2.9 points (95% CI 2.7 to 3.2), and COPM-satisfaction score improved with 3.2 points (95% CI 2.9 to 3.5). CoCo-P score improved with a mean difference of 20.9 points (95% CI from 14.4 to 27.4), and PROM-OT improved with 42.8 points (95% CI from 40.2 to 45.4). Participants received a median of seven sessions of occupational therapy (IQR 5–10) with a median duration of 18 weeks (IQR 12–25). They valued the contribution of occupational therapy to their improved functioning with a mean score of 8 (SD 1.4) and recommended this to others with a mean score of 9 (SD 1.2).

Conclusions
Persons with COVID-19 who received occupational therapy in primary care improved significantly in daily functioning and highly valued occupational therapy.

Stroke, Ahead of Print. BACKGROUND:Sex critically determines stroke pathophysiology and recovery. To reveal potential gaps in stroke care, we analyzed sex-specific differences in the stroke patient hospital admission and treatment process.METHODS:In this single-center retrospective analysis, we screened all patients referred to our stroke center between 2014 and 2020 with suspicion of stroke (n=7112). Patients with different cerebrovascular events and stroke mimics were included. We collected demographic hospitalization and 90-day follow-up data and stratified results according to sex. In a logistic regression analysis for 90-day functional outcome, we estimated the effect of sex corrected for the clinically most relevant confounders.RESULTS:Of 7102 patients, 56.7% were male and 43.3% female. Women were older (median, 76.3 years; interquartile range (IQR), 64–84, versus 70.7; IQR, 59–79;P

Azienda ospedaliero universitaria Marche tra i migliori ospedali

A Milano la Convention Anmco per ottimizzare le terapie

L’analisi dell’Iss, più in difficoltà le donne e chi vive al Sud

Background
With the rise of non-communicable diseases in Tanzania, palliative care (PC) is increasingly needed to improve the quality of life for these patients through pain and symptom management and providing psychological care, social and spiritual support. Despite a larger portion of the population having access to healthcare services at primary healthcare (PHC) facilities in Tanzania, PC services are limited and less organised at this level. This study explored the challenges facing the provision of PC and the opportunities for strengthening PC services at PHC facilities in Tanzania.

Methods
We adopted an exploratory qualitative case study to conduct in-depth interviews with 15 health facilities in charge from 15 purposefully selected PHC facilities in Dar es Salaam City, Tanzania, in August 2023. We analysed the gathered information using qualitative content analysis.

Results
Two categories emerged from the analysis of the gathered information. These are (1) challenges facing the provision of PC services at PHC facilities and (2) opportunities for strengthening PC services at PHC facilities. The challenges are grouped as provider-level, facility-level and patient-level challenges. The opportunities are organised into three subcategories. These are the increasing demand for PC services, the availability of multiple supporting systems and a functional referral system.

Conclusion
This study underscores the challenges and opportunities for providing PC services at PHC facilities. These findings call for a collaborative effort from health system players to strengthen the available PC services. The efforts should include expanding the coverage of PC services at the PHC facilities and healthcare providers’ training. Expansion of PC services should include introducing them in places where they are unavailable and improving them where they are not available. PC training should consider preservice training in the health training institutions’ curricula and continued medical education to the existing staff. Furthermore, we recommend community health education to raise awareness of PC services.

Introduction
Pre-diabetes indicates an elevated risk of developing type-2 diabetes and presents a window for preventive actions. The Pre-diabetes Intervention, Management and Evaluation (PRIME) programme is a community pharmacy-based pre-diabetes management programme that uses a mobile application for self-monitoring and pre-diabetes education, aiming to promote lifestyle changes among participants with pre-diabetes.

Methods and analysis
This is a protocol for a cluster randomised controlled trial that aims to evaluate the impact of the PRIME programme on participants’ clinical outcomes and explore participants’ and pharmacists’ views towards its implementation. This protocol describes the development of the PRIME programme and mobile app, its feasibility and implementation in community pharmacy settings. 16 pharmacies from two states in Malaysia will be randomised to the intervention arm or standard care. The study will include overweight or obese adults with pre-diabetes. During each follow-up visit at the pharmacy, intervention participants will receive in-depth counselling from pharmacists after reviewing their self-monitoring data recorded in the PRIME app. They will also receive pre-diabetes education through the app and join a peer support chatgroup. The primary clinical outcome includes changes in body weight at 6 months, while the secondary clinical outcomes include changes in blood glucose profile, lipid profile, blood pressure and adiposity measures. The sustainability of the PRIME programme will be accessed using a follow-up questionnaire, while participants’ engagement with the intervention will be evaluated using attendance rate and the app data. Focus group discussions and one-to-one interviews will be conducted for process evaluation. This study will inform the impact of community pharmacists-led digital health intervention in pre-diabetes management.

Ethics and dissemination
This study has been registered with clinicaltrials.gov (NCT04832984) and approved by the Monash University Human Research Ethics Committee (Project ID: 27512).

Trial registration number
clinicaltrials.gov (NCT04832984).