Risultati per: Approccio pre-rete e Cure Palliative di base

Annals of Internal Medicine, Volume 177, Issue 12, Page 1742-1743, December 2024.

Annals of Internal Medicine, Volume 177, Issue 12, Page 1743, December 2024.

Stroke, Ahead of Print. OBJECTIVE:To provide an update on palliative care needs specific to stroke and provide key points for clinicians and health care systems caring for patients with stroke and their families.METHODS:Members of the writing group were chosen to represent the multidisciplinary team of professionals who care for people who have had a stroke. Each member was assigned a topic within their area of expertise, reviewed the literature, and drafted content with a focus on the past decade to complement the 2014 American Heart Association scientific statement on palliative and end-of-life care in stroke.RESULTS:Stroke has multidimensional effects on patients and their families because of threats to personhood, prognostic uncertainty, and the need to adapt to functional changes after stroke. Palliative care has evolved as both a specialty and a skillset with a goal to improve communication about goals of care and quality of life for patients and their families that emphasizes a holistic, all-person approach. After stroke, palliative care needs (eg, to address pain and physical, emotional, psychosocial, and spiritual distress) are insufficiently addressed by current models of care. Integrating palliative care principles is fundamental in all stages of stroke and should include strategies to improve communication about prognosis and goals of care, address psychosocial needs such as coping with loss, navigating complex health care systems, and preparing for death when necessary. We also review strategies to address the substantial inequities that exist across sociodemographic and regional strata in the use of life-sustaining treatment and access to specialists in stroke or palliative care.CONCLUSIONS:Palliative care needs are common after stroke and should be addressed throughout the illness continuum. Research is urgently needed.

Introduction
The global burden of cancer is escalating, with Asia accounting for over half of cancer-related deaths worldwide. As cancer often diminishes patients’ quality of life and sense of dignity, dignity-related interventions have gained prominence in palliative care for patients with cancer. However, a more in-depth exploration of the involvement of families, as the fundamental social units in Confucian Asian cultures, and cultural considerations is currently lacking. This scoping review focuses specifically on patients with cancer receiving palliative care and aims to offer a comprehensive synthesis of the existing evidence on family participatory dignity interventions, addressing the need for a holistic understanding of this emerging field to guide future research and clinical practice.

Methods and analysis
This scoping review will be meticulously structured according to the five-stage framework established by Arksey and O’Malley, complemented by the scoping review methodology of the Joanna Briggs Institute. Our search will encompass a comprehensive array of databases, including PubMed, Embase, The Cochrane Library, CINAHL, Web of Science, PsycINFO, Scopus, CNKI and Wanfang Data, from their inception up to August 2024, targeting both English and Chinese relevant literature. To ensure a thorough exploration, we will also delve into grey literature via OpenGrey, Google Scholar and citation chaining. This scoping review will include all types of quantitative or mixed methods designs and qualitative studies. We will extract data on study design, sample size, intervention details, outcome measures and any other relevant information. The screening process will be conducted by two independent reviewers, who will meticulously assess the titles and abstracts, followed by a full-text review to select relevant studies. Discrepancies will be resolved through consensus discussions with a third reviewer. Data extraction will be executed using a standardised tool, and the findings will be systematically presented in tabular form with an accompanying narrative to summarise all relevant interventions, their characteristics, outcomes and key findings.

Ethics and dissemination
Ethical approval for this scoping review is not required, since the methodology merely involves the collection and review of publicly available literature. Our findings will not only be presented and discussed in a peer-reviewed article but also shared at conferences relevant to the topic.

Trial registration
Our scoping review protocol has been formally registered with the Open Science Framework. Registration details can be accessed at the provided link: https://osf.io/fyhrm/.

Emilia più attrattiva. Cittadinanzattiva, nodo malattie croniche

Emilia più attrattiva. Cittadinanzattiva, nodo malattie croniche

In alcuni casi di recidiva si possono colpire mutazioni geniche

Introduction
Patients with pulmonary embolism (PE) experience impaired functional ability and reduced quality of life long after discharge from the hospital. However, there are no structured follow-up programmes in Denmark for these patients, and there is considerable variation in practice patterns of post-PE management. No studies have investigated the effectiveness of structured follow-up care models in patients with PE. This study aims to investigate the effect and cost-effectiveness of a structured integrated post-pulmonary embolism follow-up care model (Attend-PE) compared with usual care. The Attend-PE model outlines a structured approach for in-hospital follow-up, involving group-based patient education, individual consultations and systematic use of patient-reported outcome measures to assess the patient’s physical and psychological well-being.

Methods and analysis
The study is conducted in Denmark, where the healthcare system is tax-funded and services are freely available for all citizens, with an expected inclusion of 2000 patients in total. A pre-post-intervention study design is used to compare outcomes in the post-implementation cohort with the pre-implementation cohort. The co-primary outcomes are (1) health-related quality of life (patient-reported outcome, PRO) and (2) adherence to medical treatment (register-based data). Secondary outcomes include PROs on disability, treatment satisfaction, self-management, anxiety, depression and work productivity, and register-based outcomes, including recurrent PE, bleeding, mortality and healthcare use. Register-based data will be assessed at baseline (date of PE event), 6 and 12 months, while PRO-data will be assessed at 6 and 12 months after the PE event. The health economic evaluation of the Attend-PE model will include a cost-effectiveness analysis and a cost-utility analysis.

Ethics and dissemination
The project will be conducted by the Declaration of Helsinki. In accordance with the Danish Act on Health Research Ethics §14, the study is exempt from approval. The use of survey responses in research (in anonymous form) is, however, contingent on participants’ consent, and the invitation letter therefore included information about the purpose of the study and participants’ rights to withdraw consent at any time, and that completion of the questionnaire is considered as consent to their survey data to be included in research.
Study findings will be disseminated in scientific peer-reviewed journals, at national and international conferences, and for staff and decision-makers at participating hospitals and patients and relatives via the Danish Heart Association.

Trial registration number
Clinicaltrials.gov NCT06037096.

Introduction
The use of hydroxychloroquine (HCQ) during pregnancies complicated by systemic lupus erythematosus or refractory antiphospholipid antibody syndrome has demonstrated a significant ability to prevent pre-eclampsia (PE). As such, the potential for the administration of HCQ to prevent PE in other high-risk pregnancies is an important clinical research agenda among maternal and fetal medicine specialists. Mechanistically, the anti-inflammatory and immunomodulatory effects of HCQ can offer vascular protection and inhibit the placental dysfunction-associated thrombotic changes underlying the pathophysiology of PE, fetal growth restriction (FGR) and fetal death in utero (FDIU). Placenta-mediated complications exhibit a distinctive overlapping syndrome between pregnancies, and low-dose aspirin is the only prevention method currently in use. This study investigated the effects of improvements in outcomes with HCQ administration in high-risk pregnancies complicated by a previous experience of PE, FGR or FDIU.

Methods and analysis
This multicentre, open-label, single-arm trial commenced on 31 May 2022, in three tertiary hospitals in Korea. Pregnant women with a prior history of PE, FGR or FDIU are eligible to participate. This single-arm study set the previous study with the most similar inclusion criteria, aspirin dose and drug administration period as the comparison group. The required sample size was determined to be 58, with an expected dropout rate of 10%.

Ethics and dissemination
This study protocol was approved by the following institutions and committees: Institutional Review Boards of Chung-Ang University Gwangmyeong Hospital (2304-082-056), Samsung Medical Center (2021-11-087-003) and Kyungpook National University Chilgok Hospital (2021-06-005-006) and the Ministry of Food and Drug Safety. The results will be disseminated to the general public, grant funder, maternal–fetal medicine specialists and other researchers.

Trial registration number
NCT05287321.

Objectives
To evaluate the cost-effectiveness of long-acting progestogens (LAP), including levonorgestrel-releasing intrauterine system (LNG-IUS) and depot-medroxyprogesterone acetate (DMPA), compared with the combined oral contraceptives pill (COCP) in preventing recurrence of endometriosis-related pain postsurgery.

Design
Within-trial economic evaluation alongside a multicentre, pragmatic, parallel-group, open-label, randomised controlled trial (Preventing Recurrence of Endometriosis by means of Long-Acting Progestogen Therapy trial).

Setting
Thirty-four UK hospitals recruiting participants from November 2015 to March 2019.

Patients
Four hundred and five women aged 16–45 years undergoing conservative endometriosis surgery.

Interventions
The ratio of 1:1 randomisation to receive LAPs (LNG-IUS or DMPA) or COCP.

Main outcome measures
The primary evaluation was a cost-utility analysis based on cost per quality-adjusted life-year (QALY) gained at 3 years. We adopted a UK National Health Service perspective. Secondary analyses in the form of cost-effectiveness analysis based on a range of outcomes were also undertaken.

Results
For the primary analysis, the COCP group incurred an additional cost of £533 (95% CI £52 to £983) per woman compared with LAPs. Treatment with COCP generated additional QALYs of 0.031 (95% CI –0.079 to 0.139) compared with the LAP group over 36-month follow-up. The incremental cost-effectiveness ratio for COCP compared with LAPs is therefore approximately £17 193 per QALY. The probabilistic sensitivity analysis suggested that there was a 54.7% probability that COCP would be cost-effective at the £20 000/QALY threshold. The secondary analyses revealed results more in favour of LAPs.

Conclusion
Although the COCP has a slightly higher probability of being cost-effective at £20 000/QALY threshold, there remains considerable uncertainty, with only marginal differences in outcomes between the two treatments. The lower rates of further surgery and second-line medical treatment for women allocated to LAPs may make this option preferable for some women.

Trial registration number
ISRCTN 97865475.

Stabilizza vista e può ridurre necessità iniezioni intravitreali

‘Assistenza sul territorio, investiamo con le case di comunità’

Impegno per scambio di dati e studi per il recupero pazienti

In Italia una legislazione molto avanzata, ma applicata male a livello regionale

Assessore ai 40 anni del Cro, esperienza straordinaria

Objectives
To assess the current state-of-the-art in deep learning methods applied to pre-operative radiologic staging of colorectal cancer lymph node metastasis. Specifically, by evaluating the data, methodology and validation of existing work, as well as the current use of explainable AI in this fast-moving domain.

Design
Scoping review.

Data sources
Academic databases MEDLINE, Embase, Scopus, IEEE Xplore, Web of Science and Google Scholar were searched with a date range of 1 January 2018 to 1 February 2024.

Eligibility criteria
Includes any English language research articles or conference papers published since 2018 which have applied deep learning methods for feature extraction and classification of colorectal cancer lymph nodes on pre-operative radiologic imaging.

Data extraction and synthesis
Key results and characteristics for each included study were extracted using a shared template. A narrative synthesis was then conducted to qualitatively integrate and interpret these findings.

Results
This scoping review covers 13 studies which met the inclusion criteria. The deep learning methods had an area under the curve score of 0.856 (0.796 to 0.916) for patient-level lymph node diagnosis and 0.904 (0.841 to 0.967) for individual lymph node assessment, given with a 95% confidence interval. Most studies have fundamental limitations including unrepresentative data, inadequate methodology, poor model validation and limited explainability techniques.

Conclusions
Deep learning methods have demonstrated the potential for accurately diagnosing colorectal cancer lymph nodes using pre-operative radiologic imaging. However, several methodological and validation flaws such as selection bias and lack of external validation make it difficult to trust the results. This review has uncovered a research gap for robust, representative and explainable deep learning methods that are end-to-end from automatic lymph node detection to the diagnosis of lymph node metastasis.