Search Results for: Position paper della French Headache Society sul trattamento dell'emicrania

Annals of Internal Medicine, Ahead of Print.

This Editorial discusses key components to consider when seeking to publish in a top-tier journal.

Mission Statement: JAMA Psychiatry strives to publish original, state-of-the-art studies and commentaries of general interest to clinicians and researchers in psychiatry, mental health, behavioral science, and allied fields. The journal seeks to inform its readers, to stimulate discussion into the nature, causes, treatment, and public health importance of mental illness, and to promote equity and justice for those affected by mental illness and for society.

Per la fase avanzata. Al San Carlo di Potenza

Introduction
Drug-related problems (DRPs) associated with oral anticancer drugs are frequent and require a new healthcare organisation to manage them on an outpatient basis. The aim of this article is to present the study protocol of the Drug Related problems in Oncology Practice (DROP) randomised controlled trial (RCT), endorsed by the French Society for Oncology Pharmacy. The main objective of the DROP RCT is to measure the impact at 6 months of the DROP community/hospital pharmaceutical intervention programme, compared with usual treatment, on the mean number of DRP (ie, adverse effects, drug–drug interactions, medication errors) related to oral anticancer drugs in at-risk outpatients.

Methods and analysis
The DROP protocol is a prospective, multicentre controlled clinical trial, with individual randomisation, comparing in parallel and in open, two groups of outpatients treated with oral anticancer drugs. The interventional group benefits from the DROP multidisciplinary intervention on oral anticancer treatment. The control group receives usual care. The primary outcome of the DROP RCT is the number of DRP due to oral anticancer drugs, per patient, identified between the inclusion of the patient and 6 months after inclusion

Ethics and dissemination
Approval to conduct this study was obtained for all participating centres from an Ethics Committee (Comité de Protection des Personnes Sud-Méditerranée V) in August 2018 in accordance with French law. The trial results will be disseminated at clinical conferences and published in peer-reviewed journals.

Trial registration number
ClinicalTrials.gov: NCT03257969, recruitment started in June 2019. The current protocol version is V.9, 13 December 2023.

Objectives
To identify distinct profiles among elderly patients in primary care so that general practitioners (GPs) can develop more targeted care strategies.

Design
A cross-sectional analysis of baseline data from the French nationwide ‘Elderly Appropriate Treatment in Primary Care’ trial.

Setting
Primary care in France: 277 GPs included patients.

Participants
The study participants were aged 75 or over, living at home, and taking five or more prescription medications. Of the 2724 patients included, 2651 were analysed.

Primary and secondary outcome measures
To identify specific patterns of multimorbidity, polypharmacy and frailty, we applied an unsupervised clustering analysis with self-organising maps.

Results
Seven clusters were identified: cluster 1 (16% of the patients) comprised frail men and women with cardiovascular, respiratory, musculoskeletal and endocrine diseases and marked polypharmacy; cluster 2 (9.3%, mainly men) comprised frail patients with cancer and cardiovascular or urogenital/renal diseases; cluster 3 (15.5%, mainly men) comprised not-very-frail patients with cardiovascular and urogenital/renal diseases; cluster 4 (18.1%) comprised not-very-frail men and women with cardiovascular diseases; cluster 5 (13.5%, mainly women) comprised mainly lonely, very frail patients with hypertension and endocrine, musculoskeletal and neuropsychiatric disorders; cluster 6 (19.1%, mainly women) comprised frail, socially isolated patients with digestive, musculoskeletal and neuropsychiatric diseases; lastly, cluster 7 (8.6%, mainly women) comprised frail, socially isolated patients with hypertension, cancer, or musculoskeletal, psychological and digestive disorders.

Conclusion
Our phenotypic classification of elderly patients might facilitate efforts to align healthcare services with the care needs that are encountered by GPs in their everyday practice.

Trial regestration number
(NCT03298386).

Studio dell’Istituto nazionale tumori su terapia non chirurgica

Studio dell’Istituto nazionale tumori su terapia non chirurgica

Objectives
Medication management is a demanding task for family caregivers of older adults, adding to their care burden. The aim was to identify the challenges family caregivers experience in managing medications of older care recipients to obtain caregiver-centred evidence for developing social and health services to meet their needs.

Design
The qualitative data were collected during two consecutive home visits using thematic interviews with a narrative approach during the period of October 2017 to September 2018. The interview data were qualitatively analysed using the framework method with a combination of the inductive and deductive approaches. Human error theory with systems approach and prospective risk management was used as a theoretical framework.

Setting
Family caregiving of older adults.

Participants
21 officially contracted family caregivers and their older (≥65 years) care recipients using >1 prescription medicine from the capital region of Finland.

Results
Three conceptual models were constructed: (1) to position family caregiving in the public social and healthcare system, (2) to identify challenges and (3) needs for development in medication management prioritised from challenges. Family caregivers were not well integrated as a part of the health system, but left alone to manage the care recipient’s medications. When urgent treatment-related matters arose, caregivers were not able to reach the physician. The major development needs concerned (1) identification of the caregivers as family caregivers in healthcare and community pharmacies, (2) making familiar healthcare professionals accessible, (3) ensuring sufficient customised support for managing medications at home (up-to-date medication list, monitoring and medicines information), (4) more active involvement and communication in the care process and (5) adopting compatible electronic health records between primary and secondary care, and pharmacies and social services.

Conclusions
Family caregiving practices and support services should be developed in cooperation with the caregivers to meet their needs and place the families at the centre of the medication use process. Strengthening the integration of family caregiving to the social and healthcare system is vital, for example, by making easy access to family physician and involving pharmacists more actively in supporting medication management.

Objective
There are no clearly defined family profiles with an overall view of the predictors of early childhood caries (ECCs). The aim of our study was to identify the profiles of families that are particularly affected by ECCs. We also examined the factors that can be acted on to promote oral health.

Design
In this single-centre cross-sectional study, the researchers examined the mouths of 300 children with caries and recorded the Decayed, Missing and Filled Teeth Index (dmft). These observations were supplemented by a questionnaire completed by the families, focusing in particular on their sociodemographic characteristics (e.g. age, parents’ professions and jobs, social assistance and family composition).

Setting
This work was conducted at Lille University Hospital between 2019 and 2024.

Participants
The participants included 300 caregiver-child dyads with children under the age of 6 years.

Primary and secondary outcome measures
Childhood Caries Index (dmft) and family characteristics associated with ECCs.

Statistical analyses
A multiple correspondence analysis was used, followed by a hierarchical clustering on principal components analysis, to identify the family profiles associated with ECC risk.

Result
Of the patients included in the study, 42% were girls, 58% were boys and their mean age was 4 years (±1.1 years). The mean dfmt index was 8.7 (±4.6); 77% of the participants had lesions on the smooth surfaces of the teeth, and 80% of the participants had a severe stage of caries disease. The analysis revealed three high-risk profiles based on the characteristics of the child’s mother and the family sibling composition. The first profile was larger families where the focal child was not the eldest. The second profile was families with foreign-born mothers and a low socioeconomic level. The third profile was families with mothers facing geographical and financial difficulties in accessing healthcare.

Conclusion
This study enabled us to identify the profiles of families at risk of caries. These at-risk profiles highlight the need to implement specific interventions acting at different levels and focused on oral health education in interprofessional practice during the key period of the first 1000 days of life. These factors could help to bridge the gap between oral health and general health, improve children’s oral health and reduce social health inequalities.

Ethics and dissemination
This human study has been ethically approved by the French Committee for the Protection of Individuals (N° 2019-A00827-50).

Trial registration number
The protocol is recorded on clinicaltrials.gov, with ID: NCT04195607.

Mesoterapia – Come funziona la mesoterapia in medicina estetica? Per cosa viene utilizzata, come si svolge il trattamento, quali sono le controindicazioni.

Stroke, Ahead of Print. BACKGROUND:National studies on reversible cerebral vasoconstriction syndrome (RCVS) point to differences between Asian and European patients. We investigated geographic variations in neurological complications, outcomes, and causes.METHODS:We conducted an exploratory analysis of pooled individual patient data from the Reversible Cerebral Vasoconstriction Syndrome International Collaborative network, a multicenter observational cohort study including patients with definite RCVS from 2 French, 32 Italian, 1 South Korean, and 1 Taiwanese centers. Data on demographics, precipitants, symptoms, imaging, treatment, and outcomes were collected. The primary end point was RCVS-associated brain lesions, including ischemic stroke, cortical subarachnoid hemorrhage, intracerebral hemorrhage, posterior reversible encephalopathy syndrome, and subdural hematoma. Secondary end points included unfavorable 3-month outcomes (modified Rankin Scale score ≥1) and causes (idiopathic versus secondary). Odds ratios and 95% CIs were calculated using multivariable logistic regression, adjusting for potential confounders.RESULTS:From 2009 to 2021, we included 1127 patients (528 European and 599 Asian). Recruitment occurred either through emergency settings or outpatient clinics, with most Asian patients recruited from outpatient clinics (65.8%) and most European patients from emergency settings (99.8%). Brain lesions were more frequent in European patients (29.2% versus 6.3%; odds ratio, 4.09 [95% CI, 2.66–6.30]). In a sensitivity analysis restricted to hospitalized patients (n=651), the association persisted. Unfavorable 3-month outcomes (5.5% versus 1.7%; odds ratio, 3.01 [95% CI, 1.35–6.68]) and secondary RCVS (50.4% versus 10.9%; odds ratio, 7.09 [95% CI, 5.14–9.76]) were also associated with European residency.CONCLUSIONS:RCVS presentations vary across regions, with higher lesion rates, more secondary forms, and worse outcomes in European patients. While these exploratory results may reflect selection bias from differing health care structures, further research is needed to determine the contribution of genetic, environmental, and societal factors.

Introduction
Type 1 diabetes (T1D) is associated with changes in brain structure, cognition, mental health, and functional outcomes. While these changes have been linked to dysregulated glycaemic control, findings are inconsistent, and their long-term impact remains unclear. Most evidence comes from cross-sectional or short-term longitudinal studies, limiting insights into causal associations. To address this, we aim to study individuals with T1D approximately 30 years after onset to assess how early dysglycaemic insults during neurodevelopment influence cognitive and functional outcomes in mid-adulthood.

Methods and analysis
This protocol paper outlines an observational, case/control, cross-sectional/longitudinal and descriptive study that follows up the original Royal Children’s Hospital (RCH) Diabetes Cohort Study. The initial study recruited children in Australia diagnosed with T1D between 1990 and 1992, conducting five waves of data collection. We now introduce the Cognition and Longitudinal Assessments of Risk Factors over 30 Years (CLARiFY) Diabetes Complications Study to assess brain, cognition and functional outcomes in mid-adulthood, approximately 30 years post-T1D onset. Both T1D participants from the original cohort and healthy controls will participate in semistructured interviews, neuroimaging and cognitive testing. T1D participants will also undergo complications screening. Data from this study and previous waves will be used to (Aim 1) explore cross-sectional and longitudinal impacts of T1D on brain health over 30 years. Linear regression will analyse cross-sectional outcomes, and multivariate analysis will assess cognitive variables jointly. Longitudinal outcomes will be examined using linear mixed-effects regression for IQ patterns, with secondary outcomes analysed via generalised linear models. Additionally, linear mixed-effects regression (Aim 2) will identify T1D-related metabolic factors affecting brain outcomes, with covariate selection informed by the construction of directed acyclic graphs (DAGs).

Ethics and dissemination
The study was approved by the Royal Children’s Hospital Human Research Ethics Committee (HREC 35 240F and 2019.065). The research findings will be disseminated through peer-reviewed publications, conference presentations, and print and social media. Participants will receive a summary of the study findings on its completion.

Intervento su fegato. “Innovazione trattamento neoplasie”

Intervento su fegato. “Innovazione trattamento neoplasie”