Risultati per: La gestione del paziente depresso da parte del medico di medicina generale: case reports

New England Journal of Medicine, Ahead of Print.

Objective
To evaluate the prevalence, resistance and risk factors of community-onset urinary tract infections (COUTIs) caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) for providing a basis for the selection of clinical therapeutic agents.

Design
A retrospective case–control study.

Setting
The Affiliated Dazu Hospital of Chongqing Medical University (also known as The People’s Hospital of Dazu Chongqing), a 1000-bed tertiary hospital in China.

Data and participants
This study encompassed adult patients diagnosed with community-acquired urinary tract infections (UTIs) caused by E. coli between May 2017 and December 2022 with exclusion criteria including incomplete clinical data, disagreement to participate in the study, hospitalisation duration exceeding 48 hours prior to confirmation of diagnosis and prior history of urinary tract infection caused by E. coli.

Outcome measures
The risk factors for COUTIs caused by ESBL-EC were evaluated using a case–control design, defining patients who were diagnosed with UTIs and had an ESBL-positive urine culture as the case group and patients who were diagnosed with UTIs and had an ESBL-negative urine culture as the control group. Perform drug susceptibility testing and resistance analysis on isolated ESBL-EC.

Results
In total, 394 cases of COUTIs caused by E. coli were included; 192 cases were ESBL-positive with a detection rate of 48.7% (192/394). Parenchymal tumour, history of urolithiasis stone fragmentation, history of urological surgery, hospitalisation within 6 months, indwelling catheter outside the hospital and antibiotic use (mainly third-generation cephalosporins) were the factors significantly associated with COUTIs caused by ESBL-EC (p

Background
Behavioural interventions are closely associated with immunosuppressive medication (IM) adherence. We aimed to explore the relationship between physical activity and IM adherence among renal transplant patients (RTPs) to determine potential interventions to improve IM adherence.

Design
A case–control study.

Setting
Single-centre study in Changsha, China.

Participants
The study population included 624 RTPs who were adherent to IM and 417 RTPs who were non-adherent to IM.

Main outcome measures
Sociodemographic characteristics of RTPs, IM adherence and the association between physical activity patterns or frequency and IM adherence.

Results
The proportion of RTPs who were non-adherent to IM was 40.06%. Compared with RTPs non-adherent to IM, those who were adherent were older, more likely to be married, were evaluated closer to initial time of transplant, had shorter pretransplant waiting times and engaged in more physical activity. Multivariate logistic regression analysis showed that, in the pretransplant stage, only high-frequency aerobic physical activity was significantly associated with IM adherence. However, in the post-transplant stage, patients engaging in low-frequency aerobic physical activity, high-frequency resistance physical activity or high-frequency aerobic physical activity had 2.01, 2.96 and 2.67 times greater odds of being adherent to IM, respectively, compared with patients with no physical activity. RTPs without physical activity in the pretransplant stage were more likely to be adherent to IM if they engaged in post-transplant physical activity. RTPs engaging in low-frequency physical activity in the pretransplant stage may have better IM adherence if they engaged in post-transplant physical activity. RTPs engaging in high-frequency post-transplant physical activity were significantly associated with a greater likelihood of being adherent to IM compared with RTPs engaging in low-frequency post-transplant physical activity.

Conclusion
Our study revealed that physical activity, especially in the post-transplant stage, is closely associated with IM adherence and presents a potential intervention for improving IM adherence by RTPs.

New England Journal of Medicine, Volume 391, Issue 16, Page 1529-1538, October 24, 2024.

Platea di 1112 ragazzi di 13 scuole. ‘Insegnare valore ricerca’

L’altra emergenza segnalata dal report di Cittadinanzattiva è la difficoltà del rapporto tra cittadini, medici di famiglia e pediatri.

In early September, the first human case of highly pathogenic avian influenza A(H5), or H5 bird flu, “without a known occupational exposure to sick or infected animals,” occurred in Missouri, the US Centers for Disease Control and Prevention (CDC) announced. The patient, who had underlying medical conditions, was hospitalized, treated with antiviral medication, and discharged. There were no reports of transmission among the patient’s close contacts.

Objectives
The purpose of this study is to describe and evaluate, in a real-life context, the support and communicate with families (SCF) team’s contribution to maintaining communication and supporting relatives when patients are at the end of their lives by mobilising the points of view of SCF team members, healthcare professionals, managers and the relatives themselves.

Design
An in-depth mixed-method case study (quantitative and qualitative). Individual interviews were conducted with members of the SCF team to assess the activities and areas for improvement and with co-managers of active COVID-19 units. Healthcare professionals and managers completed a questionnaire to assess the contribution made by the SCF team. Hospitalised patients’ relatives completed a questionnaire on their experience with the SCF team.

Setting
The study was conducted in a university teaching hospital in the province of Québec, Canada.

Participants
Members of the SCF team, healthcare professionals, managers and relatives of hospitalised patients.

Results
Between April and July 2020, 131 telephone communications with families and healthcare professionals, 43 support sessions for relatives of end-of-life patients and 35 therapeutic humanitarian visits were carried out by members of the SCF team. Team members felt that they had played an active role in humanising care. Fully 83.1% of the healthcare professionals and managers reported that the SCF team’s work had met the relatives’ needs, while 15.1% believed that the SCF team should be maintained after the pandemic. Fully 95% of the relatives appreciated receiving the telephone calls and visits, while 82% felt that the visits had positive effects on hospitalised patients.

Conclusion
The COVID-19 pandemic forced the introduction of a social innovation involving support for and communication with families. The intention of this innovation was to support the complexity of highly emotional situations experienced by families during the COVID-19 pandemic.

Misure per il supporto psicologico e legale ai sanitari

Alle Molinette di Torino, eseguito anche l’autotrapianto della vena porta

Introduction
Rheumatic heart disease (RHD) is underdiagnosed globally resulting in missed treatment opportunities and adverse clinical outcomes. We describe the protocol for a study which aims to co-design, implement and conduct an evaluation of a task-sharing approach to echocardiographic active case finding for early detection and management of RHD in high-risk settings in Australia and Timor-Leste.

Methods and analysis
Echocardiograms will be obtained by trained local staff using hand-held echocardiographic devices employing the ‘Single Parasternal Long Axis view with a Sweep of the Heart’ (SPLASH) technique and interpreted by experts remote from the site of acquisition. Approximately 1500 children and pregnant women will be screened across high-risk communities in Australia and Timor-Leste over an 18-month period. The study will use a type II effectiveness-implementation hybrid design. A tailored package of implementation strategies will be co-designed with communities and health services and mapped onto a Theory of Change framework. The clinical effectiveness will be assessed as the change in the proportion of the target population that are prescribed secondary prophylaxis for RHD by the end of the study compared with baseline. The implementation will be assessed as the adoption, penetration, sustainability, fidelity and cost of the programme with a mixed-methods theory-based and economic evaluation. Data will include numbers of normal, abnormal and uninterpretable SPLASH echocardiograms obtained, numbers of participants progressing through the cascade of care, interviews with staff and programme costs.

Ethics and dissemination
Ethical approval has been obtained from the Human Research Ethics Committee of the NT Department of Health and Menzies School of Health Research, Darwin (HREC-2022-4479), the Western Australian Aboriginal Health Ethics Committee (HREC-1237) and the Instituto Nasional Saude Publika Timor-Leste Ethics and Technical Committee (03-UEPD/INSP-TL/V/2023). Informed consent is required to be enrolled. Study findings will be disseminated in the communities involved and submitted for publication.

Trial registration number
NCT06002243.

Mantenuta la vitalità dell’occhio. Una nuova tecnica punta al recupero della vista

‘Positivo 30 mila nuove assunzioni tra medici e infermieri’

Ma graduatoria dopo il primo semestre sulla base dell’esito degli esami

New England Journal of Medicine, Volume 391, Issue 15, Page 1441-1450, October 17, 2024.

Già oggi provoca 11mila morti l’anno soltanto in Italia. Secondo l’Oms diventerà la prima causa di morte nel 2050