Risultati per: Screening della retinopatia diabetica

Stroke, Volume 54, Issue Suppl_1, Page A64-A64, February 1, 2023. Introduction:Impaired psychosocial health after stroke in adults is well established, with high prevalence of post-stroke anxiety and depression. Behavioral health following pediatric stroke is less well described. Early data suggest that pediatric stroke patients may experience higher rates of anxiety, depression, ADHD and PTSD. Early detection and treatment of behavioral health concerns can lead to improved psychosocial outcomes. However, screening measures to assess psychosocial functioning in pediatric stroke patients have not yet been explored.Methods:This single-center retrospective cohort study (COMIRB 21-3536) examined behavioral health following pediatric stroke using the Pediatric Symptom Checklist (PSC-17) at an outpatient stroke clinic. The PSC-17 screens for a broad range of behavioral health symptoms including internalizing, externalizing, and attention concerns. This dataset included patients with a diagnosis of ischemic stroke, hemorrhagic stroke, CSVT, or periventricular venous infarction (PVI) between 0-18 years of age. Comparison data included all children seen at general outpatient pediatric appointments. Chi-square goodness of fit tests were performed to compare elevated PSC-17 score proportions in children with stroke to proportions found in the general pediatric population.Results:We identified 65 pediatric stroke patients with a parent-reported PSC-17. Global, internalizing, and externalizing scores were higher among pediatric stroke patients compared to the general pediatric population, but there was no statistically significant difference in attention measures.Conclusions:The PSC-17 identifies a higher prevalence of psychosocial health concerns among children who have experienced a stroke as compared to the general pediatric population. The PSC-17 may serve as an effective screening tool to identify pediatric stroke patients who may benefit from further psychosocial evaluation.

Stroke, Volume 54, Issue Suppl_1, Page AWMP17-AWMP17, February 1, 2023. Introduction:Dysphagia is a complication experienced in patients with acute stroke. Complications can lead to aspiration pneumonia, swallowing difficulties, inadequate nutrition, and increased healthcare costs. Guidelines for stroke care require that stroke patients must be screened for dysphagia before eating, drinking, or receiving oral medications. Registered Nurses (RNs) play a vital role in screening for dysphagia and when provided with the appropriate education are better equipped to assess for dysphagia risk and intervene as needed. The purpose of the study is to determine whether RNs at a hospital in a Midwestern State, who complete a dysphagia screening education, demonstrated knowledge acquisition prior to implementing the Yale Swallow Protocol (YSP). The YSP is an evidenced-based screening tool that identifies aspiration risk and when passed, can recommend oral diets without the need for further instrumental dysphagia testing. Implementation of the YSP required RN education project to increase knowledge and competency for dysphagia screening.Method:This summative study utilized a tracking tool that compared results of a ten-item pre-test and post-test. Summative evaluation was directly related to the identified learning objectives and measured RNs knowledge acquisition.Results:Fifty-seven subjects complete the study. The results were analyzed via paired t test, which showed a statistically significant difference between the pre-test and post-test scores (t = 6.254, df = 56, p = .000), which suggest that the educational activity had a positive impact on learner knowledge. This education promotes positive social change by increasing RNs’ knowledge, confidence, and competence when caring for stroke patients, thus increasing patient quality of care.Conclusion:Project findings showed dysphagia screening education had an impact on knowledge acquisition. In addition, completion of the dysphagia screen education provided the necessary tools and resources to implement use of the YSP at the specialty care hospital. In addition, training will help prevent disparities in the way patients are screened for dysphagia.

Stroke, Volume 54, Issue Suppl_1, Page ANS9-ANS9, February 1, 2023. Background:STK-OP-1 is a relatively new measure that captures the transfer times for all patients transferring out of their presenting facility. The measure encompasses all reasons for transfer and is broken into sub-categories to highlight each patient population that requires care elsewhere. While it has been established that timely and rapid transfer for acute stroke intervention is essential and improves outcomes, the STK-OP-1 measure may be misleading without detailed case review.Purpose:What each facility does with the data from STK-OP-1 is dependent upon the patient population being reviewed and workflows that impact that population. The STK-OP-1d and STK-OP-1g measures focus on patients eligible for mechanical thrombectomy who need to transfer to a facility offering that service. In a center that does not offer thrombectomy, use of a large vessel occlusion (LVO) tool may not only increase the number of patients identified but also improve transfer times.Methods:STK-OP-1d and STK-OP-1g cases from two Primary Stroke Centers and their licensed freestanding emergency departments were reviewed following LVO tool implementation in 2019. Updates to use of the LVO tool in 2020 included early activation of the region’s rotor crew with positive LVO findings. Transfer times for thrombectomy eligible patients and volumes of identified LVO patients were compared from 2019 through 2022.Results:Review of transfer times reflected marked improvement in times for those patients meeting criteria for STK-OP-1d and STK-OP-1g. Following the 2020 workflow updates, the volumes of patients identified also improved. In 2019, there were 7 LVO patients with a median transfer time of 117 minutes. In 2020, there were 9 LVO patients with a median transfer time of 98 minutes. In 2021, there were 17 LVO patients and median transfer time was 93 minutes. For 2022, it is projected there will be 24 transfers with a median transfer time of 95 minutes.Conclusions:In conclusion, further differentiating the STK-OP-1 measure by treatment eligibility highlights those patients that require time sensitive interventions. Implementation of an LVO tool in centers with thrombectomy capabilities can improve the number of LVO patients identified and also support more expeditious transport.

This cluster randomized clinical trial assesses whether the use of population-based electronic screening in addition to standard targeted clinician education increases the early detection of psychosis and decreases the duration of untreated psychosis, compared with clinician education alone.

Introduction
The elevated rates of neurodevelopmental disorders (NDDs) among siblings of children with autism spectrum disorder (ASD) raise concerns about their developmental monitoring and development. The main aim of this study is to assess the feasibility and acceptability of a standardised screening process on a large sample of siblings.

Methods and analysis
This prospective study will assess the feasibility of a selective and multi-stage screening process for NDD performed on 384 siblings of children with confirmed ASD. Stage 1 will consist of the screening of NDD performed using online parental questionnaires (Social Responsiveness Scale, IdentiDys scale, DCDQ, parental concerns) through a web platform. In cases of a positive result, the second stage, consisting of a clinical semi-structured interview with a psychologist, will be proposed to the sibling before referral for diagnosis and treatment, if necessary. Approximately 12 months after stage 2, parents will be contacted by telephone to collect the diagnosis established following the referrals and their level of satisfaction concerning the screening process. Based on an expected participation rate of 50%, to estimate this rate with an accuracy of 5%, it is necessary to screen 384 subjects.

Ethics and dissemination
The Ethics Committee on the Research of Human Subjects of Paris (Ile de France VII) approved this study in March 2022 (number: 2021-A02241-40). Express consent is required from all participants. Findings from the cohort study will be disseminated by publication of peer-reviewed manuscripts, presentations at scientific meetings and conferences with associated teams.

Trial registration number
NCT05512637.

Objective
To describe the thyroid function test among children with abdominal distention and to follow up the treatment received by children with abnormal thyroid function.

Design
Cross-sectional study.

Setting and participants
A total of 1089 children (median age:30 days (IQR=21–60 days) with abdominal distension were included in this single centre study in Nanjing, China.

Result
Thyroid dysfunction was found in 43 of 148 Hirschsprung’s disease (HSCR) cases, with 3 (2.03%) having hypothyroidism, 3 (2.03%) having subclinical hypothyroidism and 3 (2.03%) having subclinical hyperthyroidism. Thyroid dysfunction was found in 206 of 941 functional abdominal distension cases, with 4 (0.43%) having hypothyroidism, 23 (2.4%) having subclinical hypothyroidism, 28 (2.9%) having subclinical hyperthyroidism and 1 (0.11%) having hyperthyroidism. Among total 65 cases (9 from HSCR, 56 from functional abdominal distension) diagnosed with thyroid diseases, 12 were treated with levothyroxine (LT-4), of which 9 were discontinued treatment at about 2 years old, and 3 were still receiving LT-4. Thirty-two cases received no treatment and thyroid function returned to normal in about 1 month. Twenty-one cases were lost during the follow-up.

Conclusion
The paediatrician should be vigilant for hypothyroidism when dealing with children with abdominal distension. Thyroid function should be followed up rather than simply administering a short-term levothyroxine treatment.

New England Journal of Medicine, Volume 388, Issue 4, Page 376-379, January 2023.

Prevalence of advanced neoplasm was much lower at repeat screening colonoscopies than at all screening colonoscopies.

Background
In elite football, periodic health examination (PHE) may be useful for injury risk prediction.

Objective
To explore whether PHE-derived variables are prognostic factors for indirect muscle injuries (IMIs) in elite players.

Design
Retrospective cohort study.

Setting
An English Premier League football club.

Participants
134 outfield elite male players, over 5 seasons (1 July 2013–19 May 2018).

Outcome and analysis
The outcome was any time-loss, lower extremity index IMI (I-IMI). Prognostic associations were estimated using odds ratios (ORs) and corresponding statistical significance for 36 variables, derived from univariable and multivariable logistic regression models. Missing data were handled using multiple imputation. Non-linear associations were explored using fractional polynomials.

Results
During 317 participant-seasons, 138 I-IMIs were recorded. Univariable associations were determined for previous calf IMI frequency (OR 1.80, 95% CI 1.09 to 2.97), hamstring IMI frequency (OR 1.56, 95% CI 1.17 to 2.09), if the most recent hamstring IMI occurred >12 months but 12 months but 12 months but

Obiettivo progetto internazionale con ricercatori italiani

Objectives
A cross-sectional and a policy document review study was performed to investigate perceived acceptability and feasibility to implementing different integration measures for tuberculosis (TB) and diabetes mellitus (DM) healthcare among healthcare workers (HCWs) and health managers, and to describe policy influence through a policy documents review in Malawi.

Setting
The survey was performed at eight hospitals, ministry of health offices and 10 non-governmental organisations. We collected data in March and April 2021.

Participants
Of 95 HCWs and health managers invited; 92 participated. 21/92 (23%) were female, and 17/92 (18%) participants were from clinics that piloted the integrated care for TB and DM.

Outcome measures
We described awareness levels on TB/DM comorbidity, perceptions and experiences in TB/DM care. Furthermore, development processes and contents of included documents were analysed.

Results
16/17 (94%) of HCWs from clinics piloting integrated care and 65/75 (86%) HCWs from hospitals that do not use integrated care for TB and DM responded that integrated care was acceptable and feasible. In qualitative data, shortage of resources, inadequate information sharing were common themes. We included seven relevant documents for the analysis. On development process and content, six of seven documents were scored ≥70%. In these documents, DM is a recognised risk factor for TB, and integration of healthcare services for infectious diseases and non-communicable diseases is recommended, however, these documents lacked information specifically on integrated care for TB and DM.

Conclusion
In this study, we identified inadequate information sharing, and lack of resources as major factors impeding implementation of integration of services, however, awareness on TB/DM comorbidity was high.

Objective
The Surviving Sepsis Campaign guidelines recommend the implementation of systematic screening for sepsis. We aimed to validate a paediatric sepsis screening tool and derive a simplified screening tool.

Design
Prospective multicentre study conducted between August 2018 and December 2019. We assessed the performance of the paediatric sepsis screening tool using stepwise multiple logistic regression analyses with 10-fold cross-validation and evaluated the final model at defined risk thresholds.

Setting
Twelve emergency departments (EDs) in Queensland, Australia.

Participants
3473 children screened for sepsis, of which 523 (15.1%) were diagnosed with sepsis.

Interventions
A 32-item paediatric sepsis screening tool including rapidly available information from triage, risk factors and targeted physical examination.

Primary outcome measure
Senior medical officer-diagnosed sepsis combined with the administration of intravenous antibiotics in the ED.

Results
The 32-item paediatric sepsis screening tool had good predictive performance (area under the receiver operating characteristic curve (AUC) 0.80, 95% CI 0.78 to 0.82). A simplified tool containing 16 of 32 criteria had comparable performance and retained an AUC of 0.80 (95% CI 0.78 to 0.82). To reach a sensitivity of 90% (95% CI 87% to 92%), the final model achieved a specificity of 51% (95% CI 49% to 53%). Sensitivity analyses using the outcomes of sepsis-associated organ dysfunction (AUC 0.84, 95% CI 0.81 to 0.87) and septic shock (AUC 0.84, 95% CI 0.81 to 0.88) confirmed the main results.

Conclusions
A simplified paediatric sepsis screening tool performed well to identify children with sepsis in the ED. Implementation of sepsis screening tools may improve the timely recognition and treatment of sepsis.

This economic evaluation study of Swedish men compares the cost-effectiveness of magnetic resonance imaging–aided screening for prostate cancer with strategies using no screening or prostate-specific antigen alone.

This cross-sectional study analyzes patterns in the rates of routine screening and diagnosis for breast, cervical, and colorectal cancer before and after the COVID-19 pandemic.

Entrance surveillance screenings have been widely implemented in health care settings during the COVID-19 pandemic. These measures, which are required by the US Department of Labor, rely on self-reported factors such as symptoms or exposure history and are intended to reduce risk to patients and health care workers. In this issue of JAMA Internal Medicine, Roberts and colleagues examine the usefulness of entrance surveillance screenings at a single academic medical center. They find that during the first wave of the pandemic, about 1 in every 38 people screened positive. However, during later periods, the catch rate was considerably lower, closer to 1 in every 3000 people. This lower rate was constant regardless of community incidence of disease. It cannot be known from their findings if the screening requirement itself acted as a deterrent to those who might have otherwise sought entry to the health care center. Awareness of the screening procedure or of the nature of COVID-19 symptoms may have increased over the course of time.

This quality improvement study analyzes the rate of failures in entrance screening for COVID-19 among individuals entering a large academic medical center.