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

Rationale
Intensive care units (ICUs) admit the most severely ill patients. Once these patients are discharged from the ICU to a step-down ward, they continue to have their vital signs monitored by nursing staff, with Early Warning Score (EWS) systems being used to identify those at risk of deterioration.

Objectives
We report the development and validation of an enhanced continuous scoring system for predicting adverse events, which combines vital signs measured routinely on acute care wards (as used by most EWS systems) with a risk score of a future adverse event calculated on discharge from the ICU.

Design
A modified Delphi process identified candidate variables commonly available in electronic records as the basis for a ‘static’ score of the patient’s condition immediately after discharge from the ICU. L1-regularised logistic regression was used to estimate the in-hospital risk of future adverse event. We then constructed a model of physiological normality using vital sign data from the day of hospital discharge. This is combined with the static score and used continuously to quantify and update the patient’s risk of deterioration throughout their hospital stay.

Setting
Data from two National Health Service Foundation Trusts (UK) were used to develop and (externally) validate the model.

Participants
A total of 12 394 vital sign measurements were acquired from 273 patients after ICU discharge for the development set, and 4831 from 136 patients in the validation cohort.

Results
Outcome validation of our model yielded an area under the receiver operating characteristic curve of 0.724 for predicting ICU readmission or in-hospital death within 24 hours. It showed an improved performance with respect to other competitive risk scoring systems, including the National EWS (0.653).

Conclusions
We showed that a scoring system incorporating data from a patient’s stay in the ICU has better performance than commonly used EWS systems based on vital signs alone.

Trial registration number
ISRCTN32008295.

E poco dopo è nata un’altra bambina

E poco dopo è nata un’altra bambina

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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’