Risultati per: Passo 10. Intervenire sul singolo paziente in visita: GPG Patient

This JAMA Patient Page describes dialysis options for people with kidney failure and the potential complications of dialysis.

Tinnitus, defined by the perception of sounds such as buzzing or ringing in the absence of external noise, is particularly common in veterans due to military exposures to loud noises and chemicals. Although the majority of those with tinnitus aren’t bothered by it, the condition can be associated with insomnia, depression, anxiety, and reduced quality of life, noted a guideline based on a systematic review.

Objectives
Faecal immunochemical testing (FIT) is now commonplace in the UK to prioritise symptomatic patients for urgent gastrointestinal investigation. The test requires a stool sample to be collected at home by the patient and returned for analysis. In this qualitative study, we sought to understand the feasibility and acceptability of FIT-based triage for patients.

Design
A cross-sectional, qualitative, experiential interview study.

Setting
Recruitment was through three participating UK NHS sites (Yorkshire, Midlands, North-East). Health professionals were also identified through membership of the BSG/ACPGBI Symptomatic FIT Guideline Development Group and snowball sampling.

Participants
We interviewed 21 patients who had completed FIT and been referred for colonoscopy and 30 primary and secondary care health professionals involved in symptomatic FIT delivery.

Results
Completion of FIT was unproblematic from the perspective of patients who returned the test. However, health professionals expressed concern over non-return. Among patients, understanding of the purpose of FIT and the meaning of results varied. Health professionals acknowledged that ensuring patient understanding of these can be challenging. Patients believed colonoscopy was less likely to miss cancer than FIT. Patients with a family or personal history of cancer were particularly anxious and wanted the reassurance of colonoscopy, even with a negative FIT result.

Conclusions
We found no major barriers to the use of FIT in prioritising symptomatic patients for urgent investigation. Improving communication might increase compliance and, possibly, acceptability of non-referral for colonoscopy in the case of a negative test result.

Background
Patient and public involvement (PPI) in research involves an active collaboration between patients/members of the public and researchers in equal partnership. PPI in health research ensures the research benefits those most impacted by the research and is a well-established necessity of high-quality research. PPI for large programmes of work involving multiple studies frequently relies on a single PPI group that oversees the entire programme. We believe that this ‘traditional’ approach can negatively contribute to the power imbalance between researchers and PPI members, since PPI members have a very wide remit and are unable to embed themselves fully in all aspects of the research.

Aim
The study aimed to evaluate a novel PPI approach, the ‘Patient Bridge Role’, designed to promote a more equal distribution of power between public collaborators and researchers in a large research programme. The Patient Bridge Role involves assigning specific public collaborators to each work package, facilitating deeper engagement and communication.

Main argument
The Patient Bridge Role addresses the limitations of traditional PPI. This approach requires clear role definitions and collaborative development of guidelines to ensure effective communication and shared decision-making. Despite initial challenges related to role clarity and boundaries, the Patient Bridge Roles successfully promoted a more balanced partnership between researchers and public collaborators.

Conclusions
Active partnerships between public collaborators and researchers are critical to creating more relevant and higher quality research. Yet, there are many practical and conceptual barriers to this. The Patient Bridge Role offers a promising strategy for enhancing PPI in large research programmes.

Introduction
Patient blood management (PBM), an evidence-based, patient-centred approach for optimising blood health, faces significant implementation challenges despite regulatory support, and this study explores its adoption within a Portuguese hospital to enhance education, develop tailored protocols and address healthcare system complexities, thereby contributing a unique perspective to the global discourse on PBM in Portuguese-speaking countries. This study will evaluate the clinical outcomes and cost-effectiveness of implementing a PBM programme in elective surgical patients at a tertiary Portuguese hospital, with secondary objectives focusing on preoperative anaemia prevalence and aetiology, PBM protocol adherence, transfusion practices guided by viscoelastic tests and the impact of cell salvage techniques.

Methods
A baseline evaluation will be conducted in 2018, and postintervention assessments will follow from 2019 to 2024. The control group comprised patients who underwent selected elective surgeries—including cardiac, general, orthopaedic, urological and gynaecological procedures—during 2018 without exposure to targeted PBM interventions. The intervention group consisted of patients scheduled for the same elective surgeries, who were referred for preanaesthesia evaluation to identify the need for PBM interventions. These interventions, where indicated, were implemented during the preoperative phase and extended to the intraoperative and postoperative periods to ensure a comprehensive and standardised approach to PBM application. Data will be extracted from pseudoanonymised medical records, ensuring full compliance with ethical standards and data protection regulations. Statistical analyses will be performed using robust methods suitable for categorical and continuous variables, enabling the evaluation of temporal trends and the overall effectiveness of PBM interventions in improving clinical outcomes.

Ethics and dissemination
Our research has been ethically approved by the Vila Nova de Gaia/Espinho Hospital Centre’s Ethical Health Committee (approval number 196/2023–1). We plan to disseminate our findings through posters, lectures at conferences and in scientific journals.

Numico (Nicso): ‘Ancora poco usati percorsi di ricovero diretto’

Numico (Nicso): ‘Ancora poco usati percorsi di ricovero diretto’

Numico (Nicso): ‘Ancora poco usati percorsi di ricovero diretto’

New England Journal of Medicine, Ahead of Print.

A systematic review shows that poor communication contributes to about one quarter of patient safety incidents.

Performing patient-related work during paid time off (PTO) has been associated with burnout. But clinicians are struggling to disconnect fully, according to the results of a small retrospective study.

To the Editor A recent trial reported that, compared with usual care, personalized text message reminders did not improve medication adherence among adults with cardiovascular diseases. Several issues warrant further discussions.

In Reply We thank Dr Pei and Dr Yuan and colleagues for interest in our study. We conducted a patient-level rather than a cluster-level randomized study because our intervention did not require specialized staff to deliver the intervention and the intervention utilizing text messages was delivered directly to patients. Intervention contamination could have occurred if patients in the intervention group communicated with those in the usual care group about the text messages and changed their medication refill behavior as a result. This scenario is possible, but the likelihood seems low.