Risultati per: Passo 10. Intervenire sul singolo paziente in visita: GPG Patient

Introduction
Cancer remains a major global health challenge, affecting millions annually and ranking as the second leading cause of death worldwide. The complexity of cancer treatment requires an interdisciplinary approach, connecting professionals from various fields to deliver personalised and integrated care. However, structural issues and insufficient interdisciplinary training can impede effective collaboration, which is why effective interprofessional education (IPE) is needed. This protocol depicts the planned procedures for a scoping review that aims to explore the role of IPE in enhancing interdisciplinary collaboration within oncology by mapping and synthesising the implementation, impact and evaluation strategies of patient-centred IPE programmes.

Methods and analysis
This scoping review will be conducted in line with the Joanna Briggs Institute guidelines for scoping reviews. The research team will develop a comprehensive search strategy and apply it to the following databases: CENTRAL, CINAHL, Embase, MEDLINE, PsycInfo, Scopus and Web of Science . Additionally, we will search for grey literature (eg, using OpenDOAR) and contact relevant organisations for pertinent reports. Each database will be searched without date restrictions on 11 September 2024. In the first stage, eligibility criteria will be assessed through a blinded title and abstract screening, followed by a full-text review. The research team will then extract and synthesise data related to the scoping review questions, focusing on implementation, impact and evaluation strategies employed in the included studies.

Ethics and dissemination
As this protocol does not involve collecting primary data, ethical approval is not required. The results of this review will be published in a peer-reviewed journal and disseminated through institutional websites and conferences.

Presidente geriatri, ‘ma ci sono le condizioni per una buona risposta agli antibiotici’

Palamara (Iss), ‘il virus va ancora monitorato anche senza emergenza’

This JAMA Patient Page describes renal cell carcinoma and its risk factors, signs and symptoms, treatment, and prognosis.

Objectives
This study aimed to (1) gauge patients understanding and expectations of real-world data and evidence (RWDE) research and (2) use this understanding and patients lived experience to co-create resources and a framework for embedding meaningful patient and public involvement and engagement (PPIE) in RWDE research within the pharmaceutical industry setting.

Setting and participants
An academic organisation, a pharmaceutical company and a PPIE panel of 12 patients or carers partnered to form the project team. The PPIE panel was purposively selected to maximise diversity.

Design
Participatory and co-design methods were used to engender an understanding of the PPIE perspective on RWDE research and the PPIE role within that. Interactive workshops explored understanding and expectations of RWDE research as well as perceived barriers and facilitators of PPIE within each stage of the RWDE research cycle. Workshops were audio and video recorded, with notes captured. Summaries were analysed thematically and shared back with the PPIE panel for validation and further reflection.

Results
We identified a lack of trust and understanding of real-world data, its collection and use and the need to educate the public and researchers. Four themes were identified for meaningful PPIE in RWDE research; equality, diversity and inclusion; feeling valued; ownership and understanding and evaluating impact. We co-created learning resources (video, infographic) and a novel PPIE framework, incorporating potential PPIE activities, resources and support needs for use by researchers conducting RWDE research.

Conclusions
To our knowledge, this is the first project to explore the practicalities of PPIE in RWDE research from the perspective of patients and carers. Some findings confirm PPIE experience and guidance derived from other areas, with some specific insights into the pharmaceutical industry. These underpin the PPIE framework to enable robust and meaningful PPIE in RWDE research. This article includes a plain language summary in the supplement.

Annals of Internal Medicine, Volume 178, Issue 2, Page 269-278, February 2025.

Physicians ought to be skilled communicators, given the importance of the information necessary to convey to patients and their loved ones regarding the diagnosis and treatment of health conditions. Effective communication is associated with greater patient satisfaction and better health outcomes. Yet many clinicians are notorious for using too much jargon, interrupting frequently and redirecting, expressing harmful biases, and using closed-ended questions in encounters with patients. Might poetry, and especially its concision, be helpful in improving patient-physician communication? “Triple Bypass” is a poem so concise that it might at first glance seem inconsequential. Yet a close reading shows just how much can be communicated, and how seamlessly, using few and familiar words. The title of the poem is as clinical as the language gets, so the poem is easily accessible despite the gravity of the medical condition invoked; moreover, the clever contrast between the complexity of open heart surgery and the ostensible simplicity of the poem is telling, as it yields an important insight into how much information it might be possible to assimilate in such worrying scenarios. Another important ingredient for meaningful communication, empathy, is also subtly depicted here, in the familiarity and trust of “elbows quietly touching” in another contrast, this time with the all-consuming, interminably expressive technology of cellphones. “Brevity is the soul of wit,” Shakespeare famously wrote in Hamlet; perhaps poetry can remind us that sometimes saying less, and choosing our words carefully, can convey much more than we might realize.

This JAMA Patient Page describes osteoporosis and the US Preventive Services Task Force recommendations for screening for osteoporosis.

This cross-sectional study compares global patient measures to determine whether patients experienced a change in care and whether hospital communication, clinical process, and environment changed from before a hospital had been acquired to after it had been acquired by private equity firms.

Annals of Internal Medicine, Ahead of Print.

Objectives
Incontrovertible evidence surrounds the need to support healthcare professionals after patient safety incidents (PSIs). However, what characterises effective organisational support is less clearly understood and defined. This review aims to determine what support healthcare professionals want for coping with PSIs, what support interventions/approaches are currently available and which have evidence for effectiveness.

Design
Systematic research review with narrative synthesis.

Data sources
Medline, Scopus, PubMed and Web of Science databases (from 2010 to mid-2021; updated December 2022), reference lists of eligible articles and Connected Papers software.

Eligibility criteria for selecting studies
Empirical studies (1) containing information about support frontline healthcare staff want before/after a PSI, OR addressing (2) support currently available, OR (3) the effectiveness of support to help prevent/alleviate consequences of a PSI. Study quality was appraised using the Quality Assessment for Diverse Studies tool.

Results
Ninety-nine studies were identified. Staff most wanted: peer support (n=28), practical support and guidance (n=27) and professional mental health support (n=21). They mostly received: peer support (n=46), managerial support (n=23) and some form of debrief (n=15). Reports of poor PSI support were common. Eleven studies examined intervention effectiveness. Evidence was positive for the effectiveness of preventive/preparatory interventions (n=3), but mixed for peer support programmes designed to alleviate harmful consequences after PSIs (n=8). Study quality varied.

Conclusions
Beyond peer support, organisational support for PSIs appears to be misaligned with staff desires. Gaps exist in providing preparatory/preventive interventions and practical support and guidance. Reliable effectiveness data are lacking. Very few studies incorporated comparison groups or randomisation; most used self-report measures. Despite inconclusive evidence, formal peer support programmes dominate. This review illustrates a critical need to fund robust PSI-related intervention effectiveness studies to provide organisations with the evidence they need to make informed decisions when building PSI support programmes.

PROSPERO registration number
CRD42022325796.

Il ministero della Salute pubblica l’Annuario del Ssn relativo al 2023

Objective
To describe the incidence and key demographic, socioeconomic and clinical characteristics of individuals with liver disease in Wales.

Design and setting
This study is designed as a retrospective observational study that linked data of anonymised identified individuals from primary, secondary care and mortality data from the Secure Anonymised Information Linkage (SAIL) Databank in Wales.

Participants
All Welsh residents who registered with a SAIL-contributing general practitioner (GP) and diagnosed with liver disease from 2004 to 2022.

Primary and secondary outcome measures
Our primary outcome is the annual age-standardised incidence rate of liver disease. Secondary outcome is the numbers and frequencies of underlying aetiology and the associated comorbidities.

Results
Between 2004 and 2022, 111 098 individuals received a diagnosis of liver disease in Wales and were included in this study. The incidence of liver disease increased threefold during the study period (97.7 per 100 000 inhabitants in 2004 to 316.2 per 100 000 inhabitants in 2022). A total of 79 992 individuals (72%) entered the cohort with the underlying aetiology of liver disease, including alcohol-related liver disease, non-alcoholic fatty liver disease (NAFLD), viral hepatitis, metabolic, haemochromatosis and autoimmune liver diseases. NAFLD has contributed to most of the change in incidence.

Conclusions
We observed increasing incidence rates of liver disease in Wales, with NAFLD showing a particularly sharp increase and frequently identified as an underlying condition. A better understanding of the incidence of liver disease is the first step towards effective prevention, early detection and targeted intervention to improve patient outcomes.

Objectives
To investigate the association of individual patient health with their characteristics, including income deprivation, ethnicity and gender, with the size, quality and staffing of their general practices, and how these associations and income-related health inequality vary across chronic conditions, regions and age bands.

Design
Using observational pooled cross-sectional individual patient survey data linked with data on general practice clinical quality and staffing and deprivation at Lower-Layer Super Output Area level. Ordinary least-squares multiple regression models of patient health estimated on the full sample and on eight condition-specific, nine region-specific and six age-specific subsamples. Three concentration indices embodying different value judgements summarise income-related health inequality in the full sample and subsamples.

Setting
Primary care in England.

Participants
Over 1 million adult patients in 6426 general practices in 2015/2016 and 2016/2017.

Primary outcome measures
Patient-reported health (the 5-level EQ-5D version or EQ-5D-5L).

Results
Patients who are younger, male, more satisfied with their practice, have fewer chronic conditions and live in less-income or education-deprived areas report better health. White ethnicity is associated with worse health up to age 64 and better health from age 65, with better health in five of the eight chronic condition samples, and in the regional samples except for London and Yorkshire and Humber regions. Practice clinical quality is positively associated with health in the full sample but only in 4 of the 23 subsamples. Income-related health inequality is worst for patients with a mental health problem, residents in the northwest and northeast regions and is greatest for those aged 55–64. The three concentration indices are highly positively correlated across chronic condition and age-band samples. One index has a much weaker correlation relationship with the other two indices in the region-specific samples.

Conclusion
Income-related health inequality and the associations of health with patient and practice characteristics are heterogeneous by patients’ chronic condition, age and region.

Objectives
To determine patient-reported symptoms and clinical factors associated with mimics and differences in health-seeking behaviour versus stroke.

Design
This is a post-hoc analysis of a cross-sectional survey of interviews on patient-reported factors in patients admitted with suspected stroke. Patients were categorised as genuine stroke or mimic. The surveys were conducted from February 2018 to January 2019.

Setting
Two non-comprehensive stroke centres in Denmark.

Participants
Patients≥18 years (no upper age limit) admitted with symptoms of stroke to one of the non-comprehensive stroke centres or transferred from a comprehensive- or primary stroke centre were eligible for inclusion. 592 patients were included.

Outcome measures
Symptoms or clinical factors associated with stroke mimics. Logistic regression analysis was performed to identify factors associated with mimics. Secondarily, the number of strokes versus mimics presenting at a healthcare facility within 3 hours contacted the emergency medical service (EMS) and arrived by ambulance.

Results
Of 592 suspected patients with stroke, 113 (19.1%) were mimics; most frequently peripheral vertigo (24.7%) and migraine (11.5%). Factors associated with a higher likelihood of mimics were female sex (OR 1.79, 95% CI 1.14 to 2.79), high Scandinavian Stroke Scale scores (OR 1.05, 95% CI 1.02 to 1.09, per point increase), and vertigo (OR 1.86, 95% CI 1.18 to 2.95). Factors associated with a lower likelihood of mimics were increasing age (OR 0.96, 95% CI 0.95 to 0.98 per year increase), reported limb weakness (OR 0.52, 95% CI 0.30 to 0.89) and difficulty steering (OR 0.51, 95% CI 0.28 to 0.93).
There was no difference between groups in the proportion of patients for whom time from symptom onset to healthcare services contact exceeded 3 hours (52.2% vs 53.7%, p=0.78). Fewer mimics contacted the EMS first, were accepted at a primary stroke centre and arrived by ambulance (p

Iniziativa presa dall’Unità operativa di Oncologia del profili