Risultati per: Approccio farmacologico al trattamento della stipsi indotta da oppioidi: focus su naldemedina

Objective
To explore patient and public perceptions of planned improvements to the National Health Service (NHS) total joint arthroplasty (TJA) pathway.

Design
Three qualitative focus groups undertaken March–May 2018, as part of a mixed-methods evaluation of Getting It Right First Time. Transcripts were subject to framework analysis to identify thematic content between October 2018 and October 2021.

Setting
Elective TJA surgery in the English NHS.

Participants
Two focus groups including patients who had undergone TJA in the previous 2 years (group 1: n=5; group 2: n=4) and the other individuals who had not but were aged 60+ (group 3: n=5). Participants were recruited via community groups and patient panels.

Results
Fourteen individuals took part in the focus groups; all were aged over 60; seven (50%) were female and nine (64%) had undergone TJA surgery. Participants’ perspectives were categorised into themes and mapped onto stages of the TJA pathway. Although perioperative care is often the focus of improvement efforts, participants argued that the patient journey begins before individuals present to primary care. Participants had concerns about other aspects of the pathway, such as obtaining a surgical referral, with prereferral interventions aimed at potentially avoiding the need for surgery (ie, physiotherapy) being perceived as a mechanism to restrict access to secondary care. Patient experience was also conceptualised as a ‘maze’, rather than the logical, sequential process set out in clinical guidelines; exacerbated by a lack of information, knowledge and power imbalances.

Conclusion
The linear conceptualisation of the TJA pathway is at odds with patient experience. Improvement programmes focused on perioperative care fail to consider patient concerns and priorities. Patients should be directly involved in improvement programmes, to ensure that patient experience is optimised, as well as informing related processes and important outcomes of care.

Objectives
In the UK, over 20% of stroke survivors leave hospital with severe disability. Limited evidence-based clinical guidance is available to support the rehabilitation of these individuals. Our previous research has focused on establishing consensus regarding the core components of home-based rehabilitation for this under investigated group. This study explores the barriers of providing rehabilitation and identifies strategies to overcome them.

Design
Three focus group interviews were conducted with n=20. The context coding framework was employed to organise the transcribed data and to facilitate inductive and deductive analysis and synthesis.

Setting
Online, MSTeams, UK.

Participants
A purposive sample of 20 National Health Service clinical staff participants, from 3 multidisciplinary teams providing home-based stroke rehabilitation for this population (n=7, 6 and 7).

Results
High levels of need were reported across multiple domains for survivors including continence, communication and physical function. Interventions often required multiagency collaboration in order to optimise the available resources and specialist skills. There was lack of clarity regarding who was ultimately responsible for providing components of rehabilitation for stroke survivors with severe disability. Teams provide rehabilitation for this population but are insufficiently commissioned or resourced to fully meet their needs. In-complete and disjointed pathways with resultant healthcare inequalities were commonly reported. Teams used a variety of strategies to overcome these barriers and optimise rehabilitation opportunities. These included upskilling a diverse range of partners to capitalise on the skills and resources across health, social care and voluntary sector boundaries employing multiagency collaboration. Teams established and engaged networks of stakeholders in order to advocate on behalf of stroke survivors.

Conclusions
Collaboration and partnership working is important in the delivery of rehabilitation for stroke survivors with severe disability. Commissioners need to be aware that cross-agency multidisciplinary expertise is required, if rehabilitation opportunities are to be realised and existing health inequalities addressed.

Introduction
The concept of procrastination can be described as a conscious, yet irrational, postponement of important tasks or decisions—despite awareness that the delay may lead to negative consequences. Procrastination behaviours are common among university students and is often described as a failure of self-regulation, and the behaviour is associated with stress, symptoms of depression and anxiety, poorer academic performance and negative effects on overall health and well-being.

Methods and analysis
A two-arm, parallel groups (1:1), single-blind randomised controlled trial will be conducted to assess the effectiveness of a brief digital procrastination intervention (Focus) among university students in Sweden. The intervention consists of a screening and feedback component based on Pure Procrastination Scale (PPS) score, allowing intervention participants to assess their current procrastination behaviours and receive behaviour change advice. Participants in the control group will be shown their total PPS score without any further feedback. Monte Carlo simulations (assuming a standardised effect of 0.35 Cohen’s d of the intervention on the primary outcome, to at least 80% of the time estimate a posterior probability of effect of at least 95%) indicated that data from 1000 participants are required for analysis, meaning that 2000 participants are required to be randomised when assuming a 50% attrition rate. The primary outcome will be procrastination behaviour measured at 2 months postrandomisation. Secondary outcomes will be anxiety and stress symptoms and lifestyle behaviours. Outcomes will be analysed using multilevel regression models estimated using Bayesian inference.

Ethics and dissemination
The study was approved by the Swedish Ethical Review Authority on 2022-08-24 (dnr 2022-00353). Students will be asked to give informed consent before participation and after having been given information about the study. The results will be submitted for publication in open access, peer-reviewed journals.

Trial registration number
ISRCTN13533793

Prevede l’utilizzo di un anticorpo monoclonale come cura preventiva

Fondazione Smile House charity partner della manifestazione

Comunicato del 10/07/2023 n°37

Objectives
Communities in North West England had some of the highest incidence of COVID-19, particularly in their younger populations. Test kits were provided to young people in Blackburn with Darwen to encourage regular testing and reduce COVID-19 transmission. The aim of this study was to identify barriers and facilitators to engaging in regular asymptomatic testing in young people.

Design
Focus groups.

Setting
Young people and parents of school-aged children in North West England.

Participants
14 participants aged 12–15 years, 13 participants aged 16–25 years and 9 participants who were parents of school-aged children.

Results
Six focus groups (36 participants) were conducted. Analysis identified young people were not against testing and many wanted to test to protect others; however, they felt their needs were not met when they were seeking information on the importance of testing and accessing tests. Young people also felt they wanted more autonomy to make decisions and access tests themselves, without having to rely on parents. Language barriers and challenges with the testing process, particularly reporting the results, were also identified as barriers for parents and young people. Parents were reluctant to test in the absence of symptoms and also noted that young people were very adaptable and testing became more acceptable to them as the pandemic progressed.

Conclusions
Tailored messaging for young people would help this group engage in regular testing and feel part of the COVID-19 response. Regular testing is not currently required in England, however, it is important to understand barriers to engaging in testing for young people, as testing may be reintroduced in response to this or future pandemics.

Objective
To explore the experiences, needs and preferences of a group of parents regarding the parenting support received during prenatal and well-child care in the Portuguese National Health Service.

Design and setting
We undertook descriptive-interpretive qualitative research running multiple focus groups in Porto, Northern Portugal.

Participants, data collection and analysis
Purposive sampling was used between April and November 2018. Focus groups were conducted with 11 parents of a 0–3 years old with well-child visits done in primary care units. Thematic analysis was performed in a broadly inductive coding strategy and findings are reported in accordance with Consolidated Criteria for Reporting Qualitative Research guidelines.

Results
Three main themes were identified to describe parents’ experience when participating in their children’s healthcare: (1) logistics/delivery matter, including accessibility, organisation and provision of healthcare activities, unit setting and available equipment; (2) prenatal and well-child care: a relational place to communicate, with parents valuing a tripartite space for the baby, the family and the parent himself, where an available and caring health provider plays a major role and (3) parenting is challenging and looks for support, based on key points for providers to watch for and ask about, carefully explained and consensual among health providers.

Conclusion
This study provides insight into parents’ needs and healthcare practices that affect the parenting experience. To meet parents’ preferences, sensitive health providers should guarantee a relational place to communicate and person-centredness, accounting for the whole family system to support healthy parenting collaboratively. Future studies are warranted to further strengthen the knowledge in the field of a population-based approach for parenting support.

I sanitari devono essere in grado di supportare chi lo sceglie

Il tema «Fine Vita: una questione ancora aperta», è il titolo del primo appuntamento della Road map di Aisla che si è tenuto a Palermo