Search Results for: Terapia antibiotica: breve durata vs. lunga durata

Objectives
This study aimed to investigate the prevalence of diabetes mellitus in patients with Fabry disease using a nationwide population-based dataset. We hypothesised that patients with Fabry disease would have a higher prevalence of diabetes mellitus compared with the general population.

Design
A cross-sectional study.

Setting
Taiwan.

Participants
We identified a study sample from Taiwan’s LHID2010 Database. There were 9408 sampled patients in this study, 2352 study patients with Fabry disease and 7056 propensity-score-matched comparison patients.

Primary outcome measures
Multiple logistic regression analyses were conducted to explore the association between diabetes mellitus and Fabry disease after taking the variables of age, sex, geographic location, monthly income category, urbanisation level of the patient’s residence, hyperlipidaemia and hypertension into consideration.

Results
The results revealed significantly higher prevalence of diabetes mellitus among patients with Fabry disease than among comparison patients (35.8% vs 29.6%, p

Con gene di Braf mutato. Combinazione allunga sopravvivenza

In Italia 3,5 milioni ne soffrono, torna la ‘terapia sospesa’

Objectives
Subanaesthetic doses of esketamine may attenuate the opioid-induced cough reflex and prevent intraoperative haemodynamic fluctuations. This study aims to evaluate the effect of subanaesthetic doses of esketamine on the quality of recovery in patients who underwent abdominal surgery.

Design
Retrospective cohort study using propensity score matching (PSM) methodology.

Setting
A tertiary academic hospital.

Participants
Patients who underwent abdominal surgery under general anaesthesia with tracheal intubation between 20 December 2022 and 30 April 2023, were retrospectively reviewed. Patients were assigned to the esketamine or control group based on whether they received a subanaesthetic dose of esketamine.

Primary and secondary outcome measures
The primary outcome was extubation time (T1). Secondary outcomes included post-anaesthesia care unit (PACU) observation time (T2), total PACU time (T3), postoperative pain at multiple time points and adverse events including respiratory depression, hypertension and others.

Results
A total of 2177 patients underwent abdominal surgery. After PSM, 1196 patients were analysed, 598 in each group. Esketamine significantly reduced the extubation time compared with the control group (20.00 vs 23.00 min, p=0.001). Total PACU time was shorter in the esketamine group than in the control group (62 vs 66 min, p=0.015), although PACU observation time did not show a significant difference. Compared with the control group, the esketamine group had a lower incidence of severe postoperative pain immediately after extubation (0.33% vs 2.01%, p=0.007) and respiratory depression (2.68% vs 5.35%, p=0.027), but a higher incidence of hypertension (9.53% vs 6.35%, p=0.042). There were no other significant differences in adverse events between the two groups.

Conclusions
The use of subanaesthetic doses of esketamine for induction of anaesthesia in patients undergoing abdominal surgery may shorten the extubation time and reduce the incidence of postoperative complications.

Trial registration number
ChiCTR2300072154.

Objective
To investigate the association between initial discharge planning and transfers of inpatient care with discharge delay. To identify operational changes which could expedite discharge within the Discharge to Assess (D2A) model.

Design
Retrospective cohort study.

Setting
University Hospital Southampton National Health Service Foundation Trust (UHS).

Participants
All adults (≥18 years) who registered a hospital inpatient stay in UHS between 1 January 2021 and 31 December 2022 (n=258 051). After excluding inpatient stays without complete discharge planning data or key demographic/clinical information, 65 491 inpatient stays were included in the final analysis. Data included demographics, comorbidities, ward movements, care team handovers and discharge planning records.

Primary and secondary outcome measures
The primary outcome was discharge delay, defined as the number of days between the final estimated discharge date and the actual discharge date. For the purposes of OR analysis, discharge delay was modelled as a binary outcome: any delay ( >0 days) versus no delay. Logistic regression models were used to examine associations between initial discharge planning accuracy, the number of ward moves and the number of in-specialty handovers and the likelihood of discharge delay, adjusting for demographic and patient complexity factors.

Results
Out of 65 491 inpatient stays, 10 619 had an initial planned discharge pathway that was different from the final discharge pathway. 7790 of these inpatient stays (75.1%) recorded a discharge delay. In contrast, among the 54 872 inpatient stays where the initial and final pathway matched, 10 216 (18.6%) recorded a delay. Using logistic regression modelling a binary outcome (any discharge delay vs no delay), an inaccurate initial pathway was associated with significantly increased odds of delay (adjusted OR (aOR) 2.72, 95% CI 2.55 to 2.91). Each additional ward move (aOR 1.25, 95% CI 1.23 to 1.28) and each in-specialty handover (aOR 1.17, 95% CI 1.14 to 1.20) were also associated with higher odds of discharge delay.

Conclusions
This study finds a strong association between inaccurate initial discharge plans and inpatient transfers of care with discharge delay, after controlling for patient complexity and acuity. This highlights the need to consider how initial plans and inpatient transfers affect discharge planning. Given the lead times for organising onward care, operational inefficiencies are most impactful for patients eventually discharged on pathways with higher planning complexity.

Oncologi, più test genetici per individuare chi ne ha beneficio

A Milano presentato l’Unicredit Longevity Index, Italia 14/ma

Passo verso normalità, ma terapie long acting poco diffuse

This clinical trial compares the efficacy and safety of prothrombin complex concentrate with frozen plasma in patients requiring coagulation factor replacement for bleeding during cardiac surgery.

In Reply We appreciate the comments by Dr Pei about our recent phase 3 trial, CamRelief.

To the Editor A recent trial reported that camrelizumab in combination with chemotherapy significantly improved the pathological complete response (pCR) compared with placebo in combination with chemotherapy among patients with early or locally advanced triple-negative breast cancer (TNBC), with pCR rates of 56.8% vs 44.7%, respectively. However, the 18-month event-free survival rates were 86.6% vs 83.6% (hazard ratio, 0.80 [95% CI, 0.46-1.42]), showing no statistical significance, and the wide CI indicates that the study had a relatively short follow-up period and immature survival data.

Background
Aortic valve stenosis (AVS) represents the most prevalent primary valvular lesion necessitating surgical intervention or transcatheter intervention in Europe and North America. Its prevalence is increasing at a rapid rate as a consequence of the ageing population. A variety of mechanical interventions are available to determine the management of AVS; however, there is currently a paucity of robust data with which to perform a comparative analysis of the efficacy of surgical aortic valve replacement (SAVR) and that of conventional stented xenograft bioprostheses (BP) or sutureless aortic valves (SAV) and transcatheter aortic valve implantation (TAVI). The present study aims to compare the effectiveness and clinical outcomes of SAVR using BP or SAV technique and TAVI in patients with severe AVS.

Methods and analysis
A collaboration between three cardiac surgery centres across two European countries has resulted in the conception of the Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve Replacement trial. This prospective non-randomised trial is designed to evaluate the long-term outcomes of TAVI in comparison to SAVR for AVS in patients at risk of severe valve obstruction. The registry will enrol successive patients who have undergone mechanical intervention for AVS between January 2015 and December 2025. Investigators will assess the difference between replacement procedures for both the standard surgical approach and the transcatheter procedure. The principal clinical outcome under consideration will be the composite degree of all-cause mortality, ischaemic stroke or rehospitalisation at 10 years. The present study will also have a number of secondary endpoints, including all-cause mortality, followed by functional status, hospitalisation, neurocognition, physiological measures (echocardiographic assessment), adverse events and reoperation.

Ethics and dissemination
It is hypothesised that the nature of the trials will serve to minimise bias related to institutional volume and surgical experience. Each participating centre is required to have an aortic valve programme that enables proper follow-up and management of any late aortic events following replacement surgery for the AVS. The data collected will provide valuable insight into the comparative effectiveness of various surgical approaches, both standardised and advanced, in aortic valve surgery and TAVI. This comprehensive analysis will contribute significantly to the development of robust international guidelines.

Trial registration number
Clinical Trial Gov.Com. ID: NCT05261204 IRB. ID: 2022011057

Objectives
We aimed to evaluate the effect of projection mapping (PM) on the quality and safety of central venous catheter (CVC) insertion under real-time ultrasound guidance.

Design
Prospective, observational, simulation study.

Setting
This study was conducted at the Yokohama City University Medical Center (Yokohama, Japan). Volunteer residents were enrolled over 12 months from January to December 2023.

Participants and methods
12 rotating residents (postgraduation year (PGY) 1 and 2) and eight anaesthesia residents (PGY 3–5) placed the CVC in the internal jugular vein in a simulator under the real-time ultrasound guidance using the short-axis out-of-plane approach. The ultrasound image was provided either just caudad to the puncture site using the PM method or on the monitor of the ultrasound machine (conventional method) placed next to the simulator’s right shoulder. Each resident performed four punctures alternating between the PM and conventional methods, and the first method for each resident was chosen randomly. Eye-tracking analysis was also used to evaluate differences in gaze behaviour.

Primary and secondary outcome measures
The primary outcome was the procedure time defined as the time from the application of the ultrasound probe on the puncture field until successful puncture of the vein. The secondary outcomes were incidence of complications and eye-tracking analysis data.

Results
The time to complete the line placement was significantly shorter for the PM than for the conventional method (median (IQR) 22.5 (15.5–30.6) s vs 30.0 (20.4–95.4) s; p=0.02, Wilcoxon’s signed-rank test). The incidence of posterior vessel wall puncture was significantly lower in the PM method (0% vs 25%; p=0.02, McNemar’s test). Eye-tracking analysis revealed that the percentage of time spent gazing at the ultrasound image was higher in the PM than in the conventional method (61.6% (55.0–69.2) vs 45.7% (34.1–54.5); p

Convegno Icar a Padova, al centro l’emersione del ‘sommerso’

Convegno Icar a Padova, al centro l’emersione del ‘sommerso’

Objective
To determine whether an invasive approach is associated with favourable long-term outcomes among elderly medical patients in the intensive care unit (ICU), compared with a conservative approach.

Design
Nationwide observational study (OCTO-REVERSE study) using data prospectively collected in the National French Healthcare Database (covering 99% of the population, 66 million people).

Setting
Comprehensive multicentre study through the linkage of large-scale national registries (including all public or private facilities) from 2013 to 2018 to avoid ambiguities related to the COVID-19 pandemic.

Participants
All non-surgical patients aged 80 years or older admitted to an ICU in France during the period (n=107 014 patients at 822 hospitals).

Outcome measures
The main outcome was the 1-year survival rate. The association of the two approaches with 1-year survival was estimated using a time-dependent Cox model and a propensity score (PS) adapted to time-to-event analysis, yielding the average treatment effect in the treated and extended weighted Kaplan–Meier curves.

Results
107 014 patients were categorised into two groups based on the type of care received: invasive (n=51 680 (48%) received invasive ventilation and/or vasopressor support) or conservative (n=55 334 (52%) received neither). 1-year survival rate was significantly lower in the invasive group than in the conservative group (27% vs 59% estimated with extended time-dependent Kaplan–Meier method). The risk of death in the invasive group remained significantly higher after time-dependent PS weighting (HR 1.64; 95% CI 1.60 to 1.69; p