Risultati per: Come si esegue la raccolta delle urine delle 24 ore

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Medication (primarily antipsychotics) is a mainstay of treatment for psychotic disorders such as schizophrenia. Recent NICE guidelines explicitly recommend that Shared Decision Making (when a health care provider and a user work together to make a treatment decision that is best for the service user) in everyday practice across all healthcare contexts. However, mental health, especially psychiatric medication, has lagged behind other areas of medicine. Much of the literature on SDM and medication management in psychiatric care has revealed a paradox in which service users and clinicians alike advocate for it, but service users widely report they are not involved in decisions about their care. Early Intervention in Psychosis (EIP) services provide specialist community-based care for people experiencing a first episode of psychosis (usually in early adulthood). They often have a therapeutic culture oriented towards recovery and optimizing service engagement, and therefore provide fertile ground for SDM relating to medication in first service contacts and early medication use. This study aimed to evaluate how psychiatric medication is managed in relation to SDM using ethnographic techniques in EIP services within a London based service, I observed multidisciplinary staff meetings, clinical consultations and other interactions in which medication was discussed. Observations were recorded as handwritten notes, which were then typed up and analysed using thematic analysis. Findings will focus on strategies used by staff and service users to facilitate SDM, as well as organizational barriers and facilitators to SDM in psychiatric medication management, with an emphasis on risk and power dynamics. Findings will also map the medication journey for service users in EIP services, noting key decision points, types of decision making, and different actors and their roles in the process. This work can inform healthcare improvement and create organisational change models that will be fed back to service providers.

Objective
The ‘To Dip or Not to Dip’ (TDONTD) intervention aims to reduce antibiotic prescribing for urinary tract infection (UTI) by reducing low-value dipstick testing. The aims of this study were to use a qualitative approach to (1) evaluate potential influences on the delivery of the TDONTD intervention in Australian residential aged care homes (RACHs) by identifying perceived barriers and enablers to delivery and acceptance; and (2) propose intervention strategies to address barriers and enhance enablers.

Design
A qualitative before–after process evaluation of a multisite implementation study using interviews with nurse and pharmacist implementers.

Setting
This study was conducted in 12 Australian RACHs.

Participants
Participants included 17 on-site nurse champions and 4 pharmacists (existing contracted providers).

Intervention
Resources from England’s TDONTD intervention were adapted for an Australian context. Key resources delivered were case-based education, staff training video, clinical pathway and an audit tool.

Results
Key barriers to TDONTD were beliefs about nursing capabilities in diagnosing infection, beliefs about consequences (fear of missing infection) and social influences (pressure from family, doctors and hospitals). Key enablers were perceived increased nurse and carer knowledge (around UTI and asymptomatic bacteriuria), resources from a credible source, empowerment of nurse champions to apply knowledge and skills in delivering operational change initiatives, pharmacist-delivered education and organisational policy or process change. Of TDONTD’s key components, the clinical pathway substituted dipstick testing in diagnosing UTI, delivery of case-based education was enhanced by their attendance and support of the intervention and the antibiotic audit tool generated feedback that champions shared with staff.

Conclusions
Our study confirms the core components of TDONTD and strategies to enhance delivery and overcome barriers. To further reduce barriers to TDONTD, broader advocacy work is required to raise awareness of dipstick testing as a low-value test in older persons and by linking it to healthcare professionals and consumer education.

Il suo discorso di laurea dopo l’incidente è diventato virale

Objectives
To evaluate the diagnostic performance of urine HIV antibody rapid test kits in screening diverse populations and to analyse subjects’ willingness regarding reagent types, purchase channels, acceptable prices, and self-testing.

Designs
Diagnostic accuracy studies

Participants
A total of 2606 valid and eligible samples were collected in the study, including 202 samples from female sex workers (FSWs), 304 persons with injection drug use (IDU), 1000 pregnant women (PW), 100 subjects undergoing voluntary HIV counselling and testing (VCT) and 1000 students in higher education schools or colleges (STUs). Subjects should simultaneously meet the following inclusion criteria: (1) being at least 18 years old and in full civil capacity, (2) signing an informed consent form and (3) providing truthful identifying information to ensure that the subjects and their samples are unique.

Results
The sensitivity, specificity and area under the curve (AUC) of the urine HIV-1 antibody rapid test kits were 92.16%, 99.92% and 0.960 (95% CI: 0.952 to 0.968, p

Background
Simultaneous urine testing for albumin (UAlb) and serum creatinine (SCr), that is, ‘dual testing,’ is an accepted quality measure in the management of diabetes. As chronic kidney disease (CKD) is defined by both UAlb and SCr testing, this approach could be more widely adopted in kidney care.

Objective
We assessed time trends and facility-level variation in the performance of outpatient dual testing in the integrated Veterans Health Administration (VHA) system.

Design, subjects and main measures
This retrospective cohort study included patients with any inpatient or outpatient visit to the VHA system during the period 2009–2018. Dual testing was defined as UAlb and SCr testing in the outpatient setting within a calendar year. We assessed time trends in dual testing by demographics, comorbidities, high-risk (eg, diabetes) specialty care and facilities. A generalised linear mixed-effects model was applied to explore individual and facility-level predictors of receiving dual testing.

Key results
We analysed data from approximately 6.9 million veterans per year. Dual testing increased, on average, from 17.4% to 21.2%, but varied substantially among VHA centres (0.3%–43.7% in 2018). Dual testing was strongly associated with diabetes (OR 10.4, 95% CI 10.3 to 10.5, p

Miglioramento della sopravvivenza a 5 anni se il tumore è in fase precoce

‘In Lombardia già mandate a casa’. ‘Altre Regioni ci seguiranno’

New England Journal of Medicine, Ahead of Print.

Il desiderio di Luca, 34 anni, tetraplegico di Casalfiumanese

Stroke, Volume 55, Issue Suppl_1, Page AWP138-AWP138, February 1, 2024. Purpose:Hypoperfusion intensity ratio (HIR) derived from CT perfusion (CTP) has shown to be a useful surrogate marker of collateral status, but prior studies focused on ICA/M1 large vessel occlusions (LVO). We aimed to determine: associations between HIR and clinical/imaging metrics of stroke severity for M2 and M3 medium vessel occlusions (MVO), any differences between 10mL/h (fast progressor).Methods:We retrospectively analyzed consecutive patients arriving within 24h from onset, with M2 or M3 occlusion on CTA, and had concurrent CTP. RAPID generated maps of infarct core defined as rCBF10s/Tmax >6s. IGR was defined as core size/onset-to-CTP time. ASPECTS and NIHSS data were also collected. Correlations were tested using Spearman’s rank analysis, for the cohort and separately for 10mL/h was determined by ROC analysis.Results:78 patients included with median (IQR) age of 79 (64-84), onset of 7.5h (2.5-14.5), NIHSS of 12 (7-18), ASPECTS of 7 (9-10), core size of 4 mL (0-22), and IGR of 0.57 mL/h (0-2.8). 63 M2 and 15 M3 occlusions identified with median HIR of 0.35 (0.06-0.52). For the cohort, HIR was highly correlated to core size r=0.740 and IGR r=0.710, moderately correlated to NIHSS r=0.474 and ASPECTS r=-0.331 (all p

Stroke, Volume 55, Issue Suppl_1, Page A28-A28, February 1, 2024. Introduction:ACTIMIS (NCT03803007) was a randomized phase 1b/2a clinical trial evaluating glenzocimab, a monoclonal antibody fragment targeting platelet receptor glycoprotein VI in patients with acute ischemic stroke treated by thrombolysis. Primary analysis demonstrated a reduction in intracranial hemorrhage occurrence stroke-related mortality. In this sub-analysis, volumetric imaging biomarkers were used to assess efficacy of glenzocimab.Methods:In the phase 2a study, patients were randomized (1:1) with 1000mg glenzocimab or placebo. CT or MRI was acquired at baseline with CT at 24 hours and MRI at 7 days for safety and efficacy analysis. Baseline and follow up imaging were processed as post-hoc analysis using AI core lab software (Brainomix, Oxford, UK). Automated output was reviewed for accuracy by an expert clinician (DC) blinded to treatment allocation.Results and Conclusions:Follow up imaging data were available from 103/106 patients (51 glenzocimab, 52 placebo) at 24 hours. Of these, 54 underwent mechanical thrombectomy (MT, 27 glenzocimab, 27 placebo). Day-7 imaging was available for 9 fewer placebo patients and 1 glenzocimab patient. All except 2 patients (1 placebo, 1 glenzocimab) with missing data at Day-7 died during the study. Preliminary analysis showed smaller volume of hemorrhagic transformation (HT) in the glenzocimab group at 24 hours compared to placebo and a trend towards smaller volume of ischemic injury. Exploratory analysis also highlighted an interaction effect between risk of HT following MT and glenzocimab (lower risk in patients treated with glenzocimab). The full results of the imaging sub-analysis of the ACTIMIS study will be presented at the conference and discussed in the context of current literature.

Stroke, Volume 55, Issue Suppl_1, Page A24-A24, February 1, 2024. Introduction:Tenecteplase (TNK) has arisen as an alternative to alteplase (ALT) for emergent treatment of acute ischemic stroke. Shorter times to prepare and administer TNK raises the possibility that TNK use leads to faster treatment and transfer times.Hypothesis:We hypothesized that treatment with TNK is associated with shorter door-to-needle (DTN) and door-in-door-out (DIDO) times.Methods:Using the US Get With The Guidelines-Stroke registry, we performed a retrospective, observational cohort study of consecutive patients treated with either TNK or ALT between July 1, 2020 and June 30, 2022. The exposure was treatment with TNK vs ALT. The primary endpoints were DTN and DIDO. We fit generalized linear mixed models to determine the association between TNK (vs ALT) and endpoints after adjustment for key demographic, clinical, and hospital-level variables. A secondary analysis compared changes in DTN among hospitals that switched to TNK in 2021 with at least 10 cases per year pre and post switch.Results:From 2092 sites, 133,228 patients received intravenous thrombolysis. Among the 13,988 (10%) treated with TNK, median age was 70 yrs, median NIHSS 7, 47% female, 21% received endovascular thrombectomy (EVT), and 9% were transferred from the hospital emergency department after receiving lytic. Among 119,240 (90%) treated with ALT, median age was 69 yrs, median NIHSS 7, 48% female; 17% received EVT, and 12% were transferred after lytic. In the primary DTN analysis, time to treatment was shorter with TNK, with mean 47.0 vs 52.7 minutes and DTN ≤60 mins in 77.5% vs 70.7% (TABLE). In the primary DIDO analysis, time to departure was shorter with TNK, 108.3 vs 114.1 minutes. In centers that changed from ALT to TNK during this period DTN times were significantly lower after switching.Conclusions:In this largest study of TNK vs ALT workflow time intervals in ischemic stroke using population-based data, TNK use was associated with more favorable DTN and DIDO times relative to ALT use.

Stroke, Volume 55, Issue Suppl_1, Page AWP190-AWP190, February 1, 2024. Purpose:ASPECTS100mL) for reperfusion using endovascular thrombectomy (EVT). While specific, ASPECTS100mL while maintaining similar specificity to ASPECTS.Methods:Retrospective analysis included consecutive stroke patients arriving within 24 hours of onset, with intracranial ICA and/or M1 occlusion on CTA, and had concurrent CT perfusion. RAPID AI software estimated ICV using the rCBF0 but =50 but 100mL. Sensitivity and specificity of that CS threshold vs ASPECTS100mL (9.8%) with median of 136mL (105-172). Using ASPECTS