Search Results for: Screening della retinopatia diabetica

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Prehabilitation for frail patients undergoing hip and knee replacement in the UK: Joint PREP feasibility study for a randomised controlled trial

Objective
To determine the feasibility of conducting a randomised controlled trial (RCT) to evaluate a prehabilitation programme for frail patients undergoing total hip replacement (THR) or total knee replacement (TKR).

Design
Randomised feasibility study with embedded qualitative work.

Setting
Three National Health Service hospitals.

Participants
Adults aged ≥65 years, frail and scheduled for primary THR or TKR.

Intervention
Appointment with a physiotherapist to individualise a home-based exercise programme. Participants were encouraged to do the home exercises daily for 12 weeks pre-operative and were provided with a daily protein supplement. Participants were supported by six telephone calls over the 12-week intervention period.

Outcome measures
Eligibility and recruitment rates, intervention adherence, data completion rates of patient-reported outcome measures, retention rates and acceptability of the trial and intervention. Qualitative interviews were conducted with participants and non-participants and analysed using thematic analysis.

Results
Between December 2022 and August 2023, 411 patients were sent a screening pack. Of the 168 patients who returned a screening questionnaire, 79 were eligible and consented to participate, and 64 were randomised. Of the 33 participants randomised to the intervention, 26 attended the intervention appointment. Eighteen participants (69%) received all six intervention follow-up telephone calls. Nineteen participants (73%) completed an intervention adherence log; 13 (68%) adhered to the exercise programme and 11 (58%) adhered to the protein supplementation. The overall retention rate was 86% (55/64 overall) at 12 weeks. The 12-week follow-up questionnaire was returned by 46 of the 55 participants (84%) who were sent a questionnaire. Interviews with 19 patients found that the trial processes and intervention were generally acceptable, but areas of potential improvements were identified.

Conclusions
This study demonstrated that a larger study is possible and has identified improvements to optimise the design of an RCT.

Trial registration number
ISRCTN11121506.

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Iron Deficiency Anemia in Pregnancy

The US Preventive Services Task Force (USPSTF) recently released a Recommendation Statement examining the data to support screening for iron deficiency anemia in pregnancy and finding them lacking. It also found insufficient evidence to make a clear recommendation for or against preventive iron supplementation in pregnancy, which has been a routine practice for decades, with up to 77% to 89% of patients reporting supplement use. As highlighted previously by the USPSTF and others, there is an urgent need for studies and clinical trials to support evidence-based medicine in the obstetric population, and this can only be accomplished by ceasing paternalistic approaches that have led to the exclusion of pregnant patients in research. All of this remains true, and there is still so very far to go.

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USPSTF Recommendation: Iron Deficiency During Pregnancy

This 2024 Recommendation Statement from the US Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening and routine supplementation for iron deficiency and iron deficiency anemia in pregnant persons to prevent adverse maternal and infant health outcomes (I statement).

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