Risultati per: Come si esegue la raccolta delle urine delle 24 ore

Per far scattare le manette si potrà ricorrere a materiale video-fotografico, per questo sarà potenziata la videosorveglianza

Per l’86% degli oncologi sono troppe le disparità di accesso alle cure

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Volume 391, Issue 9, Page 845-852, September 5, 2024.

Commissario straordinario: ‘Ondata ma esagerato dire drammatica’

Objectives
This study employed compositional data analysis to examine the association between 24-hour activity behaviours and emotional and behavioural problems among left-behind children (LBC).

Design
Cross-sectional analysis.

Setting
The research used a cross-sectional approach to analyse data collected from LBC living in Ningbo, Zhejiang Province, southern China, between February and May 2023.

Participants
A total of 275 LBC aged 9–15 years old were recruited.

Outcome measures
The measurement of 24-hour activity behaviour, incorporating sleep, sedentary behaviour (SED), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), was accomplished using accelerometers. Emotional and behavioural problems were assessed through the application of the Strengths and Difficulties Questionnaire. Compositional data analysis was used to evaluate the potential relationship between the composition of 24-hour activity and emotional and behavioural problems.

Results
Changes in allocation, such as transferring time from SED to sleep and LPA, were associated with better internalising (β sleep=–0.53, 95% CI –0.60 to –0.46; β LPA=–0.46, 95% CI –0.55 to –0.38) and externalising problems (β sleep=–0.31, 95% CI –0.39 to –0.22; β LP =–0.23, 95% CI –0.32 to –0.13). Furthermore, reallocating time from LPA to MVPA was associated with reduced internalising problems (β=–0.40, 95% CI –0.84 to –0.12). Positive associations with prosocial behaviour were observed when the time was reallocated to MVPA from sleep (β=0.81, 95% CI 0.57 to 1.05), SED (β=0.75, 95% CI 0.51 to 0.99) and LPA (β=0.82, 95% CI 0.57 to 1.08).

Conclusions
The composition of 24-hour activity behaviours is correlated with emotional and behavioural problems in LBC. The findings indicate that redistributing time from SED to sleep and LPA is linked to improved internalisation and externalisation problem scores. Additionally, the substitution of MVPA for any other behaviours is positively associated with enhanced prosocial behaviours.

Objectives
To explore the relationship between age and postoperative 24-hour moderate-to-severe pain after radical resection of lung cancer and the specific effect of moderate-to-severe pain in the post-anaesthesia care unit (PACU) on this relationship.

Design
Retrospective cohort study.

Setting
Single medical centre.

Participants
Patients ≥18 years having radical resection of lung cancer between 2018 and 2020.

Measurements
Postoperative 24-hour moderate-to-severe pain.

Results
A total of 3764 patients were included in the analysis. The incidence of postoperative 24-hour moderate-to-severe pain was 28.3%. Age had a significant effect on the prediction model of postoperative 24-hour moderate-to-severe pain. Among the whole population and those without moderate-to-severe pain in the PACU, those who were younger than 58.5 years were prone to experience moderate-to-severe pain 24 hours after surgery, and in patients with moderate-to-severe pain in the PACU, the age threshold was 62.5 years.

Conclusion
For patients who underwent elective radical resection for lung cancer, age was related to postoperative 24-hour moderate-to-severe pain, and moderate-to-severe pain in the PACU had a specific effect on this relationship. Patients among the whole population and those patients without moderate-to-severe pain in the PACU were more likely to experience postoperative 24-hour moderate-to-severe pain when they were younger than 58.5 years old, and in patients with moderate-to-severe pain in the PACU, the age threshold was 62.5 years old.

Stroke, Ahead of Print. BACKGROUND:Perfusion abnormalities in the infarct and salvaged penumbra have been proposed as a potential reason for poor clinical outcome (modified Rankin Scale score >2) despite complete angiographic reperfusion (Thrombolysis in Cerebral Infarction [TICI3]). In this study, we aimed to identify different microvascular perfusion patterns and their association with clinical outcomes among TICI3 patients.METHODS:University Hospital Bern’s stroke registry of all patients between February 2015 and December 2021. Macrovascular reperfusion was graded using the TICI scale. Microvascular reperfusion status was evaluated within the infarct area on cerebral blood volume and cerebral blood flow perfusion maps obtained 24-hour postintervention. Primary outcome was functional independence (90-day modified Rankin Scale score 0–2) evaluated with the logistic regression analysis adjusted for age, sex, and 24-hour infarct volume from follow-up imaging.RESULTS:Based on microvascular perfusion findings, the entire cohort (N=248) was stratified into one of the 4 clusters: (1) normoperfusion (no perfusion abnormalities; n=143/248); (2) hyperperfusion (hyperperfusion on both cerebral blood volume and cerebral blood flow; n=54/248); (3) hypoperfusion (hypoperfusion on both cerebral blood volume and cerebral blood flow; n=14/248); and (4) mixed (discrepant findings, eg, cerebral blood volume hypoperfusion and cerebral blood flow hyperperfusion; n=37/248). Compared with the normoperfusion cluster, patients in the hypoperfusion cluster were less likely to achieve functional independence (adjusted odds ratio, 0.3 [95% CI, 0.1–0.9]), while patients in the hyperperfusion cluster tended to have better outcomes (adjusted odds ratio, 3.3 [95% CI, 1.3–8.8]).CONCLUSIONS:In around half of TICI3 patients, perfusion abnormalities on the microvascular level can be observed. Microvascular hypoperfusion, despite complete macrovascular reperfusion, is rare but may explain the poor clinical course among some TICI3 patients, while a detrimental effect of hyperperfusion after reperfusion could not be confirmed.

This Medical News article is an interview about JAMA Network highlights from the American Society of Clinical Oncology’s annual meeting, hosted by Nora Disis, MD, editor in chief of JAMA Oncology and a JAMA deputy editor.

New England Journal of Medicine, Volume 391, Issue 6, Page 550-557, August 8, 2024.

Objectives
Inappropriate prescribing of antibiotics is a key driver of antimicrobial resistance. This study aimed to describe urine sampling rates and antibiotic prescribing for patients with lower urinary tract infections (UTIs) in English general practice.

Design
A retrospective population-based study using administrative data.

Setting
IQVIA Medical Research Database (IMRD) data from general practices in England, 2015–2022.

Participants
Patients who have consulted with an uncomplicated UTI in England general practices captured in the IMRD.

Outcome measures
Trends in UTI episodes (episodes were defined as UTI diagnosis codes occurring within 14 days of each other), testing and antibiotic prescribing on the same day as initial UTI consultation were assessed from January 2015 to December 2022. Associations, using univariate and multivariate logistic regressions, were examined between consultation and demographic factors on the odds of a urine test.

Results
There were 743 350 UTI episodes; 50.8% had a urine test. Testing rates fluctuated with an upward trend and large decline in 2020. Same-day UTI antibiotic prescribing occurred in 78.2% of episodes. In multivariate modelling, factors found to decrease odds of a urine test included age ≥85 years (0.83, 95% CI 0.82 to 0.84), consultation type (remote vs face to face, 0.45, 95% CI 0.45 to 0.46), episodes in London compared with the South (0.74, 95% CI 0.72 to 0.75) and increasing practice size (0.77, 95% CI 0.76 to 0.78). Odds of urine tests increased in males (OR 1.11, 95% CI 1.10 to 1.13), for those episodes without a same-day UTI antibiotic (1.10, 95% CI 1.04 to 1.16) for episodes for those with higher deprivation status (Indices of Multiple Deprivation 8 vs 1, 1.51, 95% CI 1.48 to 1.54). Compared with 2015, 2016–2019 saw increased odds of testing while 2020 and 2021 saw decreases, with 2022 showing increased odds.

Conclusion
Urine testing for UTI in general practice in England showed an upward trend, with same-day antibiotic prescribing remaining consistent, suggesting greater alignment to national guidelines. The COVID-19 pandemic impacted testing rates, though as of 2022, they began to recover.

Stroke, Volume 55, Issue 8, Page 1982-1990, August 1, 2024. BACKGROUND:Clinicians need simple and highly predictive prognostic scores to assist practical decision-making. We aimed to develop a simple outcome prediction score applied 24 hours after anterior circulation acute ischemic stroke treatment with endovascular thrombectomy and validate it in patients treated both with and without endovascular thrombectomy.METHODS:Using the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) collaboration data set (n=1764), patients in the endovascular thrombectomy arm were divided randomly into a derivation cohort (n=430) and a validation cohort (n=441). From a set of candidate predictors, logistic regression modeling using forward variable selection was used to select a model that was both parsimonious and highly predictive for modified Rankin Scale (mRS) ≤2 at 90 days. The score was validated in validation cohort, control arm (n=893), and external validation cohorts from the ESCAPE-NA1 (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischaemic Stroke; n=1066) and INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography; n=614).RESULTS:In the derivation cohort, we selected 2 significant predictors of mRS ≤2 (National Institutes of Health Stroke Scale score at 24 hours and age [β-coefficient, 0.34 and 0.06]) and derived the HERMES-24 score: age (years)/10+National Institutes of Health Stroke Scale score at 24 hours. The HERMES-24 score was highly predictive for mRS ≤2 (c-statistic 0.907 [95% CI, 0.879–0.935]) in the derivation cohort. In the validation cohort and the control arm, the HERMES-24 score predicts mRS ≤2 (c-statistic, 0.914 [95% CI, 0.886–0.944] and 0.909 [95% CI, 0.887–0.930]). Observed provability of mRS ≤2 ranged between 3.1% and 3.4% when HERMES-24 score ≥25, while it ranged between 90.6% and 93.0% when HERMES-24 score

Objectives
Long-term sickness absence from employment has negative consequences for the economy and can lead to widened health inequalities. Sick notes (also called ‘fit notes’) are issued by general practitioners when a person cannot work for health reasons for more than 7 days. We quantified the sick note rate in people with evidence of COVID-19 in 2020, 2021 and 2022, as an indication of the burden for people recovering from COVID-19.

Design
Cohort study.

Setting
With National Health Service (NHS) England approval, we used routine clinical data (primary care, hospital and COVID-19 testing records) within the OpenSAFELY-TPP database.

Participants
People 18–64 years with a recorded positive test or diagnosis of COVID-19 in 2020 (n=365 421), 2021 (n=1 206 555) or 2022 (n=1 321 313); general population matched in age, sex and region in 2019 (n=3 140 326), 2020 (n=3 439 534), 2021 (n=4 571 469) and 2022 (n=4 818 870); people hospitalised with pneumonia in 2019 (n=29 673).

Primary outcome measure
Receipt of a sick note in primary care.

Results
Among people with a positive SARS-CoV-2 test or COVID-19 diagnosis, the sick note rate was 4.88 per 100 person-months (95% CI 4.83 to 4.93) in 2020, 2.66 (95% CI 2.64 to 2.67) in 2021 and 1.73 (95% CI 1.72 to 1.73) in 2022. Compared with the age, sex and region-matched general population, the adjusted HR for receipt of a sick note over the entire follow-up period (up to 10 months) was 4.07 (95% CI 4.02 to 4.12) in 2020 decreasing to 1.57 (95% CI 1.56 to 1.58) in 2022. The HR was highest in the first 30 days postdiagnosis in all years. Among people hospitalised with COVID-19, after adjustment, the sick note rate was lower than in people hospitalised with pneumonia.

Conclusions
Given the under-recording of postacute COVID-19-related symptoms, these findings contribute a valuable perspective on the long-term effects of COVID-19. Despite likely underestimation of the sick note rate, sick notes were issued more frequently to people with COVID-19 compared with those without, even in an era when most people are vaccinated. Most sick notes occurred in the first 30 days postdiagnosis, but the increased risk several months postdiagnosis may provide further evidence of the long-term impact.

Scade il 30 giugno il termine per opporsi al caricamento dei propri dati e dei documenti clinici precedenti il 19 maggio 2020

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.