Risultati per: Passo 12. Ripulire in modo mirato le cartelle cliniche degli assisiti

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Research taking place in care homes for older adults has rapidly increased in recent decades, which was seen even more during the COVID-19 pandemic. Challenges in including older adults, particularly those living with a level of cognitive decline, have prevented resident voices being at the forefront of research. Furthermore, lack of resources and time pressures within care homes create barriers to accessing staff and care homes. It is important to consider the whole care context within research, alongside resident voices, to consider lived experiences and provide productive and realistic suggestions for change. Co-production is becoming more common in research, and is committed to facilitating inclusion and overcoming individual, social or contextual barriers to communication and inclusivity. The CHAPPI (Care Home Activity Providers Facilitating Public Involvement in Research as a Meaningful Activity for Care Home Residents) project has collaborated with key stakeholders, including care home managers, activity providers and lived experience experts to ensure gaps in knowledge between academia and industry are bridged from project inception. During this ‘Q&A style’ presentation, we (a care home manager and a researcher) will present our experiences of participating in or conducting research, including during the COVID-19 pandemic. We will also highlight lessons learned within the CHAPPI project so far, to discuss how we (as researchers and industry experts) can creatively proceed together, to improve care home research. Finally, we will explore how we can adapt research to fit with care homes to bring an understanding of what is needed to succeed and how we can do better, even during times of extraordinary measures.

This case report describes a woman in her 30s who presented with a 3-year history of anti–PL-12 antisynthetase syndrome characterized by interstitial lung disease, arthritis, and myositis and was diagnosed with antisynthetase syndrome–associated panniculitis.

Oncologi, ma attenzione alla corretta comunicazione dei dati scientifici

Cartabellotta: ‘Oltre 14 milioni in attesa del provvedimento’

«Il via libera del governo allo scudo penale per i medici è un’ottima notizia, non solo per la categoria che in questi anni è letteralmente finita sotto attacco, ma anche per i pazienti con i quali nel tempo si è perso il valore del rapporto medico-paziente». Lo dice il segretario generale Fimmg, Silvestro Scotti

Sinpia: ‘Regole condivise, ma controproducente demonizzare’

Introduction
Concerns about falling (CaF) are common in older people and have been associated with avoidance of activities of daily life. Exercise designed to prevent falls can reduce CaF, but the effects are usually short-lived. Cognitive behavioural therapy (CBT) can reduce CaF for longer but is not readily available in the community and unlikely to prevent falls. A multidomain intervention that combines CBT, motivational interviewing and exercise could be the long-term solution to treat CaF and reduce falls in older people with CaF. This paper describes the design of a randomised controlled trial to test the effectiveness of two different 12 week self-managed eHealth programmes to reduce CaF compared with an active control.

Methods
A total of 246 participants (82 per group) aged 65 and over, with substantial concerns about falls or balance will be recruited from the community. They will be randomised into: (1) myCompass-Own Your Balance (OYB) (online CBT programme) intervention or (2) myCompass-OYB plus StandingTall intervention (an eHealth balance exercise programme), both including motivational interviewing and online health education or (3) an active control group (online health education alone). The primary outcome is change in CaF over 12 months from baseline of both intervention groups compared with control. The secondary outcomes at 2, 6 and 12 months include balance confidence, physical activity, habitual daily activity, enjoyment of physical activity, social activity, exercise self-efficacy, rate of falls, falls health literacy, mood, psychological well-being, quality of life, exercise self-efficacy, programme adherence, healthcare use, user experience and attitudes towards the programme. An intention-to-treat analysis will be applied. The healthcare funder’s perspective will be adopted for the economic evaluation if appropriate.

Ethics and dissemination
Ethical approval was obtained from the South Eastern Sydney Local Health District Human Research Ethics Committee (2019/ETH12840). Results will be disseminated via peer-reviewed journals, local and international conferences, community events and media releases.

Trial registration number
ACTRN12621000440820.

Stroke, Volume 55, Issue Suppl_1, Page A12-A12, February 1, 2024. Background:Socioeconomic deprivation is associated with an increased risk of stroke. However, there is scant evidence on its impact on long-term stroke outcomes. We investigate its long-term impact on stroke incidence, mortality, functional outcome, quality-of-life and life-expectancy.Methods:In a prospective population-based cohort, deprivation (based on residential postcode and stratified into quartiles using the national cut-points for England) was related to incident stroke, 10-year mortality, disability (modified Rankin Scale >2), institutionalisation in long-term care facilities, quality of life (Euroqol-5Dimensions), and life expectancy (including disability-free and quality-adjusted) after first-ever stroke. Cox, logistic and ordinary least squares regression were used to adjust for age, sex, urban-rural mix, previous comorbidity/disability, risk factors, stroke severity and type.Findings:Out of a population of 94,567 people (~1.5 million people years), 2,429 had a first-ever stroke. Higher deprivation was associated with stroke risk in those aged 55 to 74. Compared to the most affluent (quartile 1), stroke risk was higher in those living in quartile 2 (incidence rate ratio: 1.28, p=0.0019), quartile 3 (1.37, p=0.005) and quartile 4 (1.81, p=0.001). Mean follow-up after stroke was 5.2 (S.D. 4.0) years. After multivariable adjustment, increasing deprivation was associated with mortality (p=0.046), disability (p=0.013) and reduced quality of life (p=0.028), but not with institutionalisation (p=0.23). 10-year quality-adjusted life-expectancy was 4.85 (95%CI: 4.67 to 4.04 years) in stroke patients in quartile 1, with life expectancy reducing by 0.46 (-0.75 to -0.16) in quartile 2, 1.10 (-1.58 to -0.67) in quartile 3 and 1.25 (-2.06 to -0.48) years in quartile 4.Interpretation:We show that incidence of stroke, as well as 10-year health outcomes, are worsened with increasing deprivation. Consequently there remains considerable scope for improvements in at risk deprived communities.

Per verificare il percorso dei pazienti con disforia di genere

Anti-TNFs such as infliximab (IFX) continue to be the standard of care to treat moderate-to-severe IBD. Remission and reducing detrimental outcomes are achievable goals when therapeutic drug monitoring (TDM) is implemented to assist with IFX therapy optimization. TDM aids in achieving & maintaining adequate drug exposure to avoid loss of response by offering actionable information to guide treatment adjustments. The value of TDM has been described in numerous studies which show that optimization of anti-TNFs correlates with improved clinical outcomes & the use of TDM is recommended by IBD guidelines and expert consensus.

Stessa scelta in altri 20 paesi nel 2024, 80% vittime under 5

Circulation, Volume 149, Issue 2, Page 164-166, January 9, 2024.