Risultati per: Standard di qualità sulla Fibrillazione Atriale

New England Journal of Medicine, Ahead of Print.

La presidente dell’Associazione americana ricerca sul cancro, ‘vedremo grandi cambiamenti’

In 80 centri italiani. ‘Non si parla più solo di sopravvivenza’

Patients at average risk for progression to severe disease did not benefit.

New England Journal of Medicine, Ahead of Print.

Introduction
Despite the high number of operations and surgical advancement, rehabilitation after rotator cuff repair has not progressed for over 20 years. The traditional cautious approach might be contributing to suboptimal outcomes. Our aim is to assess whether individualised (early) patient-directed rehabilitation results in less shoulder pain and disability at 12 weeks after surgical repair of full-thickness tears of the rotator cuff compared with current standard (delayed) rehabilitation.

Methods and analysis
The rehabilitation after rotator cuff repair (RaCeR 2) study is a pragmatic multicentre, open-label, randomised controlled trial with internal pilot phase. It has a parallel group design with 1:1 allocation ratio, full health economic evaluation and quintet recruitment intervention. Adults awaiting arthroscopic surgical repair of a full-thickness tear are eligible to participate. On completion of surgery, 638 participants will be randomised. The intervention (individualised early patient-directed rehabilitation) includes advice to the patient to remove their sling as soon as they feel able, gradually begin using their arm as they feel able and a specific exercise programme. Sling removal and movement is progressed by the patient over time according to agreed goals and within their own pain and tolerance. The comparator (standard rehabilitation) includes advice to the patient to wear the sling for at least 4 weeks and only to remove while eating, washing, dressing or performing specific exercises. Progression is according to specific timeframes rather than as the patient feels able. The primary outcome measure is the Shoulder Pain and Disability Index total score at 12-week postrandomisation. The trial timeline is 56 months in total, from September 2022.

Trial registration number
ISRCTN11499185.

Comunicato del 22/03/2024 n°17

L’80% delle pazienti seguite da Breast Unit

In a unique review, experts discuss conditions for which warfarin or antiplatelet drugs are preferable to DOACs and conditions for which DOAC safety and efficacy is uncertain.

Objective
To evaluate the quality and analyse the content of clinical practice guidelines regarding central venous catheter-related thrombosis (CRT) to provide evidence for formulating an evidence-based practice protocol and a risk assessment scale to prevent it.

Design
Scoring and analysis of the guidelines using the AGREE II and AGREE REX scales.

Data sources
Pubmed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and the Chinese Biomedical Literature, and the relevant websites of the guideline, were searched from 1 January 2017 to 26 March 2022.

Eligibility criteria
Guidelines covering CRT treatment, prevention, or management were included from 1 January 2017 to 26 March 2022.

Data extraction and synthesis
Three independent reviewers systematically trained in using the AGREE II and AGREE REX scales were selected to evaluate these guidelines.

Results
Nine guidelines were included, and the quality grade results showed that three were at A-level and six were at B-level. The included guidelines mainly recommended the prevention measure of central venous CRT from three aspects: risk screening, prevention strategies, and knowledge training, with a total of 22 suggestions being recommended.

Conclusion
The overall quality of the guidelines is high, but there are few preventive measures for central venous CRT involved in the guidelines. All preventive measures have yet to be systematically integrated and evaluated, and no risk assessment scale dedicated to this field has been recommended. Therefore, developing an evidence-based practice protocol and a risk assessment scale to prevent it is urgent.

We appreciate the considerations of Hsu et al about the recommendation of empiric first-line therapies in our Maastricht VI/Florence consensus report for the management of Helicobacter pylori.1 2 We fully agree that H. pylori eradication therapy should aim at a cure rate of ≥90%. This also meets the expectation of patients as referred by the authors from a real-world expectation survey of the Asia-Pacific region.3 However, we disagree that the cut-off for clarithromycin resistance, at least for now, is too high at 15% for triple therapy consisting of proton pump inhibitor (PPI), amoxicillin and clarithromycin used as empirical first-line option.2 Hsu et al suggest a cutoff for clarithromycin resistance at or below 5 % for the empirical use of PPI-amoxicillin-clarithromycin and base their claim on a recent systematic review.4 However, this review has several relevant limitations: First, the…