Search Results for: Passo 12. Ripulire in modo mirato le cartelle cliniche degli assisiti

Introduction
Dyslipidaemia, affecting approximately 39% of adults worldwide, is a major risk factor for cardiovascular disease. Individuals with dyslipidaemia are often prescribed statins, which effectively lower plasma low-density lipoprotein cholesterol (LDL-C), thereby reducing the risk of cardiovascular events and mortality. Although statins lower LDL-C, emerging evidence suggests that they may counteract the beneficial adaptations to exercise in skeletal muscle mitochondria and whole-body aerobic capacity. The underlying mechanisms remain unclear, and there is a need for studies investigating how statins influence molecular adaptations to exercise. The primary objective of this study is to investigate the combined effects of statin therapy and focused exercise training on mitochondrial function and whole-body aerobic capacity in people with dyslipidaemia. The untargeted proteomic analysis will be incorporated to provide detailed insights into how statins may affect mitochondrial proteins and other muscle metabolic traits, offering molecular explanations for altered functional readouts at both the muscle and whole-body levels.

Methods and analysis
A total of 100 women and men (aged 40–65 years) diagnosed with dyslipidaemia without atherosclerotic cardiovascular disease will be enrolled in this 12-week, double-blinded, randomised, placebo-controlled trial. Participants will be randomised into one of four groups using a block randomisation approach to ensure an allocation ratio of 60:40 for exercise and non-exercise conditions, respectively. The four groups will be: (1) exercise+placebo, (2) exercise+atorvastatin (80 mg/day), (3) atorvastatin (80 mg/day) and (4) placebo. The primary outcome is mitochondrial function, measured by changes in skeletal muscle citrate synthase activity from baseline to post-intervention. Secondary outcomes include whole-body aerobic capacity (VO2peak) and proteomic analyses. Genetic analysis will be conducted to assess the role of genetic polymorphisms in individual responses to statins and exercise.

Ethics and dissemination
The trial has received ethical approval from the Faroe Islands Ethical Committee (2024-10) and adheres to the Declaration of Helsinki and General Data Protection Regulation (GDPR). Results will be published in peer-reviewed international journals.

Trial registration number
NCT06841536.

Purpose
The pathogenesis of the long-lasting symptoms which can follow an infection with the SARS-CoV-2 virus (‘long covid’) is not fully understood. The ‘COroNaVirus post-Acute Long-term EffectS: Constructing an evidENCE base’ (CONVALESCENCE) study was established as part of the Longitudinal Health and Wellbeing COVID-19 UK National Core Study. We performed a deep phenotyping case-control study nested within two cohorts (the Avon Longitudinal Study of Parents and Children and TwinsUK) as part of CONVALESCENCE.

Participants
From September 2021 to May 2023, 349 participants attended the CONVALESCENCE deep phenotyping clinic at University College London. Four categories of participants were recruited: cases of long covid (long covid(+)/SARS-CoV-2(+)), alongside three control groups: those with neither long covid symptoms nor evidence of prior COVID-19 (long covid(-)/SARS-CoV-2(-); control group 1), those who self-reported COVID-19 and had evidence of SARS-CoV-2 infection, but did not report long covid (long covid(-)/SARS-CoV-2(+); control group 2) and those who self-reported persistent symptoms attributable to COVID-19 but no evidence of SARS-CoV-2 infection (long covid(+)/SARS-CoV-2(-); control group 3). Remote wearable measurements were performed up until February 2024.

Findings to date
This cohort profile describes the baseline characteristics of the CONVALESCENCE cohort. Of the 349 participants, 141 (53±15 years old; 21 (15%) men) were cases, 89 (55±16 years old; 11 (12%) men) were in control group 1, 75 (49±15 years old; 25 (33%) men) were in control group 2 and 44 (55±16 years old; 9 (21%) men) were in control group 3.

Future plans
The study aims to use a multiorgan score calculated as the cumulative total for each of nine domains (ie, lung, vascular, heart, kidney, brain, autonomic function, muscle strength, exercise capacity and physical performance). The availability of data preceding acute COVID-19 infection in cohorts may help identify the consequences of infection independent of pre-existing subclinical disease and also provide evidence of determinants that influence the development of long covid.

Objectives
To understand and compare women’s antenatal and postnatal views on: (1) priorities for information provided about labour and delivery and (2) decision-making in labour and delivery.

Design
Qualitative interview study using repeat interviews at two time points: during pregnancy (≥13 weeks gestation); and after birth (≥6 weeks).

Setting
Large maternity hospital in the Southwest of England.

Participants
Pregnant women accessing antenatal care were purposively sampled and recruited antenatally by community midwives to ensure representation from different sociodemographic groups, with diverse experiences of low and high-risk care.

Data collection
Telephone interviews with a single researcher using a semistructured interview topic guide.

Data analysis
Interviews were audio recorded, transcribed verbatim, and qualitative thematic analysis was conducted using Braun and Clarke’s six-stage process.

Results
Twelve women participated (12 antenatal interviews; 10 follow-up postnatal interviews). Overall, women’s postnatal views were consistent with their antenatal views about what they wanted to know and the factors that influence decision-making. Three themes were generated. Theme 1 ‘Sources of information’ presents evidence of how women obtain and use information (sub-themes: ‘social influences’, ‘patient responsibility for information seeking’, ‘NHS vs non-NHS resources’). Theme 2 reports women’s views and experiences of ‘The influence of Healthcare Professionals in decision-making’ (sub-themes ‘patient and professional roles in decision-making’, ‘conflicting advice and preferences’, ‘taking authority in emergency decision-making’). The final theme, theme 3, ‘When, how, and what information women want’ shows women want time to process information (sub-themes ‘when: it’s definitely information and time’, ‘how: presentation of information’, ‘what: information required’). Cross-cutting all themes, we found an unmet need for information to be tailored to the individual.

Conclusions
Women understand decision-making during labour and birth is a dynamic process. Women can struggle with the volume, quality and timing of information available. In busy maternity settings, the challenge is to better equip women with the information they want, and health professionals with the information they need to provide for personalised care and shared decision-making. Antenatal interventions that warrant further research include decision aids, birth plans, and structured counselling using core information sets. Insights from both antenatal and postnatal perspectives will help inform their development.

Background
Pharmacists are vital to the multidisciplinary care for transplant patients, but the workforce of their work in China remains unclear.

Objective
To assess the current status of transplant pharmacists’ work in China through a national workforce survey to evaluate service provision across transplantation stages and pharmacist capacity.

Design, setting and participants
Nationwide cross-sectional questionnaire-based study (25 March–1 April 2024) involving 91 transplant centres performing >90% of China’s organ transplants.

Main outcomes and measures
Pharmacy items and duration provided to patients by pharmacists at each transplant centre and used to calculate full-time equivalents (FTEs).

Results
Service provision varied substantially across centres, with only 0.8 pharmacists per 100 transplant patients nationally. Current workforce require 2.6 FTEs/100 transplants for comprehensive services, reducible to 1.2 FTEs if non-clinical duties are excluded. Key challenges included service inconsistency, limited patient coverage and inadequate standardisation/digitalisation. Primary barriers were excessive non-service workloads and insufficient performance incentives. Addressing these issues is an effective way to change the current status of pharmacy services for transplant recipients in China.

Conclusions
A national workforce survey revealed significant gaps in transplant pharmacy services in China, particularly in standardisation and digitalisation. To address these issues, key steps include reducing non-essential workloads for transplant clinical pharmacists, enhancing performance incentives, expanding the number of transplant pharmacists and developing standardised service protocols.

Objectives
To investigate the self-management challenges and influencing factors faced by patients during the waiting period for heart transplantation through the lens of social ecology as well as to explore the family management needs of Chinese patients with end-stage heart disease during this critical waiting period.

Design
During March 2023 to March 2024, purposive sampling was adopted to conduct in-depth interviews with 11 patients awaiting heart transplantation and their primary caregivers at a Class III Grade A hospital in Nanjing, China. A phenomenological research approach was adopted, and Colaizzi’s method was applied to analyse the data and extract the key themes.

Setting
The study involved face-to-face interviews at a Grade A hospital in Nanjing, China.

Participants
During March 2023 to March 2024, face-to-face interviews were conducted with 11 patients and their primary caregivers.

Results
The analysis identified the primary reasons for patients’ limited self-management capacity, yielding 3 overarching themes with 12 subthemes. At the micro level, physical discomfort and inadequate self-management abilities were prominent, as patients experienced persistent physical discomfort, challenges in alleviating symptoms, insufficient knowledge about self-management, a lack or loss of belief in their ability to manage their health and prolonged periods of anxiety and depression. At the meso level, the study identified limited family support, inadequate professional medical assistance and insufficient social support. These issues manifested as limited caregiving capacity within families, increased financial burdens on households, insufficient educational resources and guidance provided by medical staff, a lack of continuity in care across different settings and the absence of supportive social networks. At the macro level, systemic challenges such as the unequal distribution of medical resources and the absence of a comprehensive long-term follow-up mechanism were identified as significant barriers to effective patient management.

Conclusion
The dynamic interaction among the micro, meso and macro systems significantly influenced patients’ motivation and capacity for self-management, thereby ultimately affecting the progression of their disease and their overall quality of life. To address these challenges, healthcare providers must prioritise comprehensive health guidance for patients during the heart transplantation waiting period. Emphasis should be placed on developing robust family-centred management plans tailored to the unique needs of these patients. In addition, there is a pressing need to establish a coordinated, three-tiered management system that integrates hospitals, families and community resources so as to provide holistic and continuous care for patients awaiting heart transplantation.

Objectives
This study aims to determine key workforce variables (demographic, health and occupational) that predicted National Health Service (NHS) staff’s absence due to illness and expressed intention to leave their current profession.

Design, setting and participants
Staff from 18 NHS Trusts were surveyed between April 2020 and January 2021, and again approximately 12 months later.

Outcome measures
Logistic and linear regression were used to explore relationships between baseline exposures and four 12-month outcomes: absence due to COVID-19, absence due to non-COVID-19 illness, actively seeking employment outside current profession and regularly thinking about leaving current profession.

Results
22 555 participants (out of a possible 152 286 employees; 15%) completed the baseline questionnaire. 10 831 participants completed the short follow-up questionnaire at 12 months and 5868 also completed the long questionnaire; these participants were included in the analyses of sickness absence and intention to leave, respectively. 20% of participants took 5+ days of work absence for non-COVID-19 sickness in the 12 months between baseline and 12-month questionnaire; 14% took 5+ days of COVID-19-related sickness absence. At 12 months, 20% agreed or strongly agreed they were actively seeking employment outside their current profession; 24% thought about leaving their profession at least several times per week. Sickness absence (COVID-19 and non-COVID-19 related) and intention to leave the profession (actively seeking another role and thinking about leaving) were all more common among NHS staff who were younger, in a COVID-19 risk group, had a probable mental health disorder, and who did not feel supported by colleagues and managers.

Conclusions
Several factors affected both workforce retention and sickness absence. Of particular interest are the impact of colleague and manager support because they are modifiable. The NHS workforce is likely to benefit from training managers to speak with and support staff, especially those experiencing mental health difficulties. Further, staff should be given sufficient opportunities to form and foster social connections. Selection bias may have affected the presented results.

Circulation, Ahead of Print. BACKGROUND:Despite the significant global impact of the COVID-19 pandemic, limited studies have investigated the long-term cardiovascular sequelae of SARS-CoV-2 infection, particularly among Asian populations. This large-scale, population-based binational cohort study with long-term follow-up aimed to investigate the association between SARS-CoV-2 infection and the risk of cardiovascular events.METHODS:We used binational, large-scale, and population-based cohorts, including a Korean nationwide cohort (K-COV-N; discovery cohort; n=18 989 129) and a Japanese nationwide cohort (Japan Medical Data Center; validation cohort; n=12 218 680). Individuals aged 20 years or older were included from January 1, 2020, to December 31, 2022. We assessed the long-term risk of incident cardiovascular outcomes after SARS-CoV-2 infection. The primary outcome was the risk of cardiovascular diseases based onInternational Classification of Diseases, Tenth Revisioncode diagnosis. After propensity score–based overlap weighting, Cox proportional hazard models were used to estimate adjusted hazard ratios for cardiovascular outcomes. We assessed the time attenuation effect of cardiovascular outcomes after SARS-CoV-2 infection. Multiple subgroup analyses were conducted by 16 cardiovascular outcomes, COVID-19 severity, vaccination, and SARS-CoV-2 strain.RESULTS:In the overlap-weighted discovery cohort, 7 960 357 individuals were included (mean age, 48.52 years [SD, 9.33]; men, 4 283 878 [53.82%]). SARS-CoV-2 infection was associated with a long-term increased risk of overall cardiovascular outcomes (adjusted hazard ratio, 1.62 [95% CI, 1.60–1.64]), particularly ischemic heart disease (1.81 [95% CI, 1.77–1.84]), heart failure (1.79 [95% CI, 1.73–1.85]), cerebrovascular disorders (1.65 [95% CI, 1.60–1.69]), major adverse cardiovascular events (1.65 [95% CI, 1.60–1.70]), inflammatory heart diseases (1.53 [95% CI, 1.31–1.80]), dysrhythmia (1.44 [95% CI, 1.42–1.46]), and thrombotic disorders (1.42 [95% CI, 1.35–1.48]). The increased risk persisted up to 18 months, with the highest association observed for 1 to 6 months after infection. The risk of cardiovascular diseases was pronounced with COVID-19 severity; however, it decreased with the administration of complete vaccination and subsequent booster doses. A similar risk of cardiovascular outcomes existed across every SARS-CoV-2 era (pre-delta, delta, and omicron). Similar patterns were observed in the validation cohort. The absolute risk of cardiovascular disease events after SARS-CoV-2 infection remained remarkably low (2.12% versus 1.31% in the noninfected population), particularly stroke (0.24% versus 0.13%) and ischemic heart disease (0.73% versus 0.39%).CONCLUSIONS:This binational study observed associations between SARS-CoV-2 infection and cardiovascular events during extended follow-up across viral eras. Complete vaccination was linked to lower cardiovascular events. However, the absolute risk of cardiovascular disease events after SARS-CoV-2 infection remained remarkably low, particularly for stroke and ischemic heart disease. Although these findings suggest ongoing vigilance and preventive measures remain crucial, they should be interpreted within the context of these low absolute risks when considering long-term cardiovascular complications.

In the Brief Report titled “Epistasis of ERAP1 With 4 Major Histocompatibility Complex Class I Alleles in Frontal Fibrosing Alopecia: A Genome-Wide Association Study Meta-Analysis,” published online February 12, 2025, and in the March 2025 issue, there was an error in the Author Affiliations section. Dr Tziotzios’ affiliation was updated to St John’s Institute of Dermatology, King’s College London, London, United Kingdom. This article was corrected online.

Coordinato del San Raffaele, finanziato da associazioni pazienti

Objectives
To systematically evaluate the intervention effect of modified constraint-induced movement therapy (m-CIMT) on upper limb function in patients who had a stroke.

Design
Systematic review and meta-analysis.

Data sources
A computer-based search was conducted in PubMed, Cochrane Library, Embase, Web of Science and China National Knowledge Infrastructure for randomised controlled trials (RCTs) on the intervention effect of m-CIMT on upper limb function in patients who had a stroke, with the search conducted up until 23 May 2024.

Eligibility criteria
We included only RCTs in which patients who had a stroke performed m-CIMT or m-CIMT in addition to the control group, and the outcome was upper limb function.

Data extraction and synthesis
Data extraction and synthesis used the reporting checklist for systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias and methodological quality of included studies were evaluated by two independent investigators under the guidance of Cochrane risk of bias. Effect sizes were pooled, funnel plots were created and subgroup analyses were conducted using Stata V.17.0. If I² >50%, a random-effects model was applied; otherwise, a fixed-effects model was used. Publication bias was assessed through funnel plots and Egger’s test. In the presence of publication bias, a trim-and-fill method was employed for further examination. The quality of evidence was evaluated using GRADEpro.

Results
A total of 16 studies including 612 patients were included. Rehabilitation outcomes were assessed using the Fugl–Meyer Assessment (I²=90.34%), Motor Activity Log—Quality of Movement (I²=36.02%), Motor Activity Log—Amount of Use (I²=65.76%), Action Research Arm Test (I²=62.66%) and the Wolf Motor Function Test (I²=36.78%). Low-level evidence suggests that m-CIMT improves upper limb function in patients who had a stroke (all p2 months’ (p=0.005). Intervention periods of ‘2–4 weeks’ (p=0.008) and ‘5–12 weeks’ (p

Objectives
This study explored knowledge of dementia, attitudes towards dementia risk prediction and barriers and facilitators to accessing dementia services for diverse populations in England.

Design
Qualitative study using task group methodology, interrogated through framework analysis.

Setting
Task groups were held primarily in-person at local community venues (n=12) with one task group conducted online.

Participants
147 individuals (mean age=63 years old, 62% female) were recruited, representing low-income and ethnically diverse groups from two sites (Nottingham and Newcastle, UK). Participants were from diverse ethnic backgrounds with 37% Black or Black British, 24% Asian or Asian British, 20% white, 9% not provided, 7% Arab and 1% other ethnicities.

Results
Participants possessed some knowledge about dementia but highlighted a need for better access to information about dementia. Participants were knowledgeable about dementia risk factors, but knowledge of risk prediction was low. Attitudes towards dementia risk prediction were cautiously optimistic, and the use of risk prediction tools was viewed as empowering. However, participants stressed the need to consider the psychological impact of a high-risk result. Barriers to accessing dementia services included stigma, denial, language, cultural and religious views about dementia. Recommendations for service improvement included engaging with communities in their spaces, workforce training around dementia awareness, cultural competency and communicating with diverse groups, improving the provision of information in different languages and access to translators.

Conclusions
As international policy on dementia shifts focus to prevention, there is a growing interest in identifying those at high risk and intervening early. This study illustrates current levels of dementia knowledge and attitudes towards risk prediction among socioeconomically and ethnically diverse groups in the UK. Barriers to health services for diverse populations and service improvement recommendations offer a starting point for providers to develop culturally aware and inclusive dementia services.

Introduction
Cervical screening rates in the UK are falling, limiting our ability to prevent cervical cancer. Peak incidence of cervical cancer coincides with average age of childbirth, and women with young children are less likely to be screened. Current UK guidelines advise waiting 12 weeks after delivery to perform cervical screening, but this recommendation is not based on evidence from the era of liquid-based cytology or high-risk human papillomavirus (HPV) testing. New mums suggested offering cervical screening at 6 weeks postdelivery, in conjunction with the postnatal check-up with the general practice team in primary care. This study aims to assess the feasibility and acceptability of a paired-sample study design for cervical screening at 6 weeks and 12 weeks postnatal.

Methods and analysis
A study of 100 participants will be performed to assess feasibility and acceptability of cervical screening at both 6 weeks and 12 weeks postnatal, with urine self-sampling using a Colli-pee collection device at each time point. This will inform whether women are prepared to undergo cervical screening at 6 weeks postnatal and the feasibility of a future pair-wise diagnostic test accuracy (of HPV and abnormal cervical cytology) study or whether alternative study designs are needed. Participants must be aged 24.5–64 years old and eligible for the National Health Service Cervical Screening Programme (NHS CSP). At each appointment, participants will complete a questionnaire about their experience and thoughts regarding screening. Substudies ask participants who withdraw or decline to participate their reasons, to identify barriers. The study will be closed for recruitment once 100 participants have completed the 6-week screen in Postnatal Instead of Normally-Timed Cervical Screening (PINCS-1) or if recruitment is poor and 50% not recruited by 6 months, indicating that a paired-sample design is not feasible.

Ethics and dissemination
Ethical approval for PINCS-1 was given by the Stanmore Research Ethics Committee. The results, including participant feedback at each stage, built into the trial design, will inform the design of large studies to determine accuracy and clinical impact of cervical screening at 6 weeks postnatal, identifying whether giving choice (eg, from timing of appointments and/or offering self-sampling) will improve screening uptake. Data will inform the sample size needed for future studies to have adequate power. Results will also inform future NHS CSP management. Results will be shared via scientific publication and via conventional and social media channels accessed by young women.

Trial registration number
ISRCTN10071810.

Introduction
Post-induction hypotension (PIH) is particularly common in elderly patients undergoing general anaesthesia and is associated with severe postoperative complications. Autonomic nervous system (ANS) dysfunction is a potential risk factor for significant haemodynamic fluctuations during general anaesthesia in elderly patients. Tools to identify ANS are currently lacking in perioperative clinical practice. Postprandial hypotension (PPH) is closely linked to ANS dysfunction and is also common among elderly individuals. Therefore, this study aims to explore the relationship between PPH and PIH in elderly patients undergoing non-cardiac surgery. By examining this correlation, we hope to better understand the factors contributing to PIH and explore the potential role of PPH in predicting PIH.

Methods and analysis
This is a prospective observational cohort study. 120 elderly Chinese patients aged ≥65 years and scheduled to undergo non-cardiac surgery under general anaesthesia at Peking Union Medical College Hospital (PUMCH) will be included. PPH assessments will include baseline pre-prandial records and blood pressure measurements immediately after meal completion, followed by every 5 min for 120 min. To evaluate PIH, blood pressure will be monitored from the patients’ entry into the operating room until 20 min after anaesthesia induction or the initiation of surgery. PIH is defined as systolic blood pressure of

Objective
To evaluate the user experience of the joint National Institute of Health and Care Excellence (NICE)/Keele University Shared Decision Making (SDM) learning package.

Design
A qualitative study using online semistructured interviews. Data were analysed using open coding followed by the construction of themes.

Setting
Participants were recruited and interviewed online via Microsoft Teams.

Participants
Healthcare professionals who had used the NICE SDM learning package and provided contact details between June 2021 and April 2022 were eligible to be contacted.

Intervention
The online learning package developed to support the implementation of the NICE SDM guideline.

Findings
12 participants from a variety of different professional backgrounds were interviewed and reported that the learning package was easy to use and the different formats for presenting the information were engaging. The package was available in discrete sections—‘bitesize’ chunks—which allowed the participants to fit their learning around their busy schedules. The package included virtual patients (VPs) which allowed users to practice their SDM skills and put the learning into practice. The VPs also stimulated reflection on current performance and a shift in approach to SDM in practice. Suggestions were made by participants to improve the usability and accessibility of the learning package.

Conclusion
The NICE SDM learning package was viewed favourably by the participants. The bitesize structure and interactivity were key positive elements. Many participants suggested that they had made changes to their practice as a result of using the package.

Giuseppino Conti: “Passo avanti termini condivisione e ascolto”