Search Results for: Le cause della polmonite nei bambini

In Reply We designed the ADAPT-Sepsis trial as a superiority study, addressing a prioritized research funding brief and international evidence gaps. Our sample size estimate, type I error rate, and power were largely driven by a clinical effectiveness outcome (total antibiotic treatment duration to 28 days after randomization) and not safety (28-day all-cause mortality). The resulting sample size estimate allowed us to measure safety with a noninferior 28-day all-cause mortality margin of 5.4%, the narrowest reported to date, as indicated by Dr Bosch and colleagues. We primarily reported trial safety for a reduction in total antibiotic duration for the PCT group compared with standard care using this approach. The 95% CI for the difference in 28-day mortality did not exceed 5.4% and crossed 0. Therefore, we have shown that PCT is not worse than standard care and that there is no difference between PCT and standard care. Furthermore, there were no differences in the survival curves to day 28 (Figure 2B in our article) or day 90 (eFigure 7 in the article’s Supplement 3). Unlike Bosch and colleagues, we do not believe that implementing daily PCT monitoring will result in excess mortality given the totality of our reported trial data and the body of open-label trial evidence. However, given our concealed trial intervention methods, we suggest that future systematic open implementation of our PCT protocol should be informed by evidence (inducing adherence data) to be presented from an in-trial process evaluation.

In campo un gruppo di bambini in cura nei reparti oncologici

Introduction
Deep brain stimulation (DBS) is a proven effective treatment for Parkinson’s disease (PD). However, titrating DBS stimulation parameters is a labourious process and requires frequent hospital visits. Additionally, its current application uses continuous high-frequency stimulation at a constant intensity, which may reduce efficacy and cause side effects. The objective of the AI-DBS study is to identify patient-specific patterns of neuronal activity that are associated with the severity of motor symptoms of PD. This information is essential for the development of advanced responsive stimulation algorithms, which may improve the efficacy of DBS.

Methods and analysis
This longitudinal prospective observational cohort study will enrol 100 patients with PD who are bilaterally implanted with a sensing-enabled DBS system (Percept PC, Medtronic) in the subthalamic nucleus as part of standard clinical care. Local neuronal activity, specifically local field potential (LFP) signals, will be recorded during the first 6 months after DBS implantation. Correlations will be tested between spectral features of LFP data and symptom severity, which will be assessed using (1) inertial sensor data from a wearable smartwatch, (2) clinical rating scales and (3) patient diaries and analysed using conventional descriptive statistics and artificial intelligence algorithms. The primary objective is to identify patient-specific profiles of neuronal activity that are associated with the presence and severity of motor symptoms, forming a ‘neuronal fingerprint’.

Ethics and dissemination
Ethical approval was granted by the local ethics committee of the Amsterdam UMC (registration number 2022.0368). Study findings will be disseminated through scientific journals and presented at national and international conferences.

Objectives
The study aimed to describe the ethical challenges global health programme (GHP) leaders encounter in their day-to-day work and to understand how they address these ethical challenges, as an important first step toward improving the relevance and precision of ethical guidance for GHPs.

Design
We employed a qualitative case study approach using grounded theory data collection and analysis methods.

Setting
GHPs based at a major GHP hub in Decatur, Georgia, USA, providing a wide range of health services to more than 150 countries globally

Participants
Leaders of all 15 GHPs in the programme hub were invited to participate and 9 were available and consented to participate. Two senior leaders of the programme hub also participated in the study.

Results
We identified 10 categories of ethical challenges encountered by GHP leaders: (1) ethical misalignment between funders and implementing partners; (2) budgets functioning as constraints on ethical decision-making; (3) the limited impact of programmes on improving host country capacity; (4) concerns about missed opportunities to benefit host country communities; (5) shortcomings in current ethics guidance (6) issues in data governance, stewardship and management; (7) navigating complex sociocultural contexts; (8) photography in the context of GHPs; (9) trustworthiness and reputational risks and (10) accountability for unintended consequences. The challenges often result in divided or conflicting loyalties for GHP leaders and uncertainty about what to do. We have characterised this form of uncertainty as ‘moral ambiguity,’ which we define as the inability to discern the best ethical way forward when there is tension or conflict among multiple stakeholder interests.

Conclusions
Our findings suggest that moral ambiguity is a common experience for GHP leaders and that current approaches to global health ethics fail to guide and support GHP leaders to recognise and address moral ambiguity and limit the distress it can cause. The experiences of GHP leaders offer important diagnostic insights for improving the way GHPs are imagined, financed, delivered and evaluated.

Objectives
Identifying the underlying cause of acute coma is crucial for improving outcomes in this time-sensitive medical emergency. This study aimed to explore the clinical characteristics, incidence, causes and outcomes of acute coma.

Design
A nationwide population-based retrospective cohort study.

Participants
Among 99 217 322 emergency department (ED) visits between 2000 and 2017, 419 480 acute coma events were identified. After excluding visits with only acute coma diagnosis codes lacking detailed information, individuals without socio-demographic data or those with prior nursing home residence or disability, a total of 205 747 first-ever acute coma cases constituted the final research cohort.

Primary and secondary outcome measures
The primary outcomes included the acute coma event rate, incidence rates stratified by age and underlying causes categorised into 23 clinical groups by the Agency for Healthcare Research and Quality Clinical Classification Software (CCS). Secondary outcomes assessed were reversible coma, hospitalisation rates, 30-day mortality, 1-year medical utilisation and long-term functional outcomes. Cox regression models identified factors influencing long-term mortality.

Results
The overall event rate for acute coma was 4.23 per 1000 ED visits, and the incidence rate was 0.93 per 1000 person-years. The median age of cases was 58.27 years (SD 23.04), with a male predominance (58.90%). Infection and central nervous system (CNS)-related causes were most prevalent. Of these cases, 45.49% experienced reversible coma, 41.66% required hospitalisation and the 30-day mortality group accounted for 12.85%. CNS and drug-related causes contributed to increased 30-day mortality, while psychiatric, alcohol, women’s health and perinatal care, and seizure are causes linked to reversible coma. Patients frequently required intensive care (26.54%), life-sustaining treatments (41.09%) or experienced disability (6.57%) within one year. Generalised estimating equations revealed significantly lower odds of reversible coma for CNS (adjusted OR (aOR), 0.68; 95% CI: 0.62 to 0.74; p

Cormann, ‘lavorare per proteggere bambini nel mondo digitale’

Cormann, ‘lavorare per proteggere bambini nel mondo digitale’

Cormann, ‘lavorare per proteggere bambini nel mondo digitale’

Objectives
To investigate the outcomes of patients with ST-elevation myocardial infarction (STEMI) who were treated with coronary artery bypass grafting (CABG) surgery.

Design
Retrospective nationwide cohort study.

Setting
Patients with STEMI in Finland who were treated with CABG between January 2004 and December 2018.

Participants
1069 patients (mean age: 66.4, 21.4% women).

Primary outcome measure
All-cause mortality (median follow-up 6.4 years) and usage of evidence-based secondary preventive medication early after CABG.

Results
In-hospital mortality among the total cohort was 10.0%, with a significant decrease (p90% of patients and ACE inhibitors/angiotensin II receptor blockers by 70% of patients after discharge from the hospital. The proportion of high-dose statin users increased from 33.1% in 2004–2008 to 63.1% in 2014–2018. ADP inhibitors were used by 29.0% of patients, but the proportion increased during the study.

Conclusions
Contemporary in-hospital and long-term outcomes of CABG-treated patients with STEMI are acceptable. In-hospital mortality has decreased, and the usage of secondary prevention medications after CABG procedures has increased in recent years.

Background
Providing support to second victims in workplaces is crucial for maintaining high-quality performance. Peer support approach has proven to be one of the most effective and well-accepted approaches. However, the specific competencies required for peer supporters remain unclear. This review aims to address this gap by identifying and categorising these competencies.

Objective
This scoping review examines the competencies (skills, attitudes and knowledge) needed to support workers where the pressure of their roles may lead to errors that could cause harm to others. In such situations, these individuals may experience intense feelings of responsibility, potentially impacting their ability to perform their duties. In the healthcare sector, these workers are commonly referred to as ‘second victims’.

Eligibility criteria
This review includes studies that define the competencies necessary for peer supporters assisting second victims in any industry. It covers all professional roles susceptible to human errors affecting people’s well-being. The focus is on peer support and psychological first aid, encompassing relevant competencies, attitudes and knowledge for addressing safety-related incidents and workplace errors.

Sources of evidence
The scoping review was conducted following Arksey and O’Malley’s framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Studies were identified through a comprehensive search of databases, including Embase, ProQuest, PsycINFO, PubMed, Scopus and Web of Science. References from eligible studies were also considered.

Charting methods
Data were extracted and categorised into competency domains through a standardised process. Two reviewers independently performed data extraction, with discrepancies resolved by consensus.

Results
A total of 34 studies were included in the review. Across five identified domains, 91 specific and 30 general competencies were categorised. Additionally, the review identified 29 types of peer-based interventions designed to support professionals following incidents or stressful situations.

Conclusions
The findings underscore the need for well-defined competencies for peer supporters of second victims, emphasising training in communication, emotional support and role-specific knowledge. Tailoring peer support programmes to the professional context and industry-specific characteristics is essential for providing effective assistance.

Regione: ‘Campagna si chiude ma la rilanciamo in autunno’

Obstetric hemorrhage remains the leading cause of maternal mortality, accounting for about 27% of deaths during pregnancy and the following 6 weeks, a new study has found.

Objective
Biological age assessed by the Klemera and Doubal method (KDM) and phenotypic age (PhenoAge) was considered as a marker for ageing-related outcomes because it reflects different aspects of biological ageing and health, which are associated with increased risk of death. proBNPage based on N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a novel index for biological age estimation. However, the independence of its relationship with clinical outcomes from established risk factors, KDM or PhenoAge remains uncertain. Their identification could provide valuable information to prognosis.

Design, setting and participants
This study analysed data from the general population included in the National Health and Nutrition Examination Survey (NHANES). Participants who took part in the cross-sectional survey from 1999 to 2004 were included, and all-cause as well as cardiovascular mortality was recorded (up to 31 December 2019).

Outcome measures
All-cause and cardiovascular mortality were considered as outcomes. Clinical risk factors were collected, and biological age was estimated by proBNPage, KDM and PhenoAge. Cox proportional hazards models were used to determine the relationship between proBNPage and outcomes with adjustment for risk factors or other biological age indexes. Restricted cubic spline (RCS) analysis based on multivariate Cox regressions was performed to examine whether there was a non-linear relationship between proBNPage and outcomes.

Results
A total of 9 925 participants were included in this study. The association between proBNPage and outcomes remained significant after adjusting for risk factors, including NT-proBNP (for all-cause mortality, HR 1.14; 95% CI 1.10 to 1.17; for cardiovascular mortality, HR 1.20; 95% CI 1.14 to 1.27). Similar results were obtained after adjusting for KDM plus NT-proBNP (for all-cause mortality, HR 1.31; 95% CI 1.22 to 1.41; for cardiovascular mortality, HR 1.21; 95% CI 1.11 to 1.28) or PhenoAge plus NT-proBNP (for all-cause mortality, HR 1.21; 95% CI 1.16 to 1.28; for cardiovascular mortality, HR 1.35; 95% CI 1.24 to 1.47). These findings were confirmed in most subgroups. A non-linear relationship was observed between proBNPage and all-cause and cardiovascular mortality with an inflection point.

Conclusions
A non-linear positive relationship was observed between proBNPage and clinical outcomes. After adjusting for established risk factors and other biological age estimation indices (KDM or PhenoAge), proBNPage was significantly associated with mortality. The results remain similar after further adjustment for NT-proBNP. These results suggest that proBNPage is a useful surrogate for biological age estimation.

Objectives
Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease. Chest high-resolution CT (HRCT) is instrumental in IPF management, and the Quantitative Lung Fibrosis (QLF) score is a computer-assisted metric for quantifying lung disease using HRCT. This study aimed to assess the change in QLF score associated with a minimum clinically important difference (MCID) of IPF symptoms and physiological lung function, and also determine the MCID of QLF change associated with all-cause mortality to serve as an imaging biomarker to confirm disease progression and response to therapy.

Design and study setting
We conducted post hoc analyses of prospective data from two IPF phase II studies of pamrevlumab, a fully human monoclonal antibody that binds to and inhibits connective tissue growth factor activity.

Participants
Overall, 152 patients with follow-up visits after week 24.

Methods
We used the anchor-based Jaeschke’s method to estimate the MCID of the QLF score that corresponded with the already established MCID of St. George’s Respiratory Questionnaire (SGRQ) and percent-predicted forced vital capacity (ppFVC). We also conducted a Cox regression analysis to establish a sensitive and robust MCID of the QLF score in predicting all-cause mortality.

Results
QLF changes of 4.4% and 3.6% corresponded to the established MCID of a 5-point increase in SGRQ and a 3.4% reduction in ppFVC, respectively. QLF changes of 1% (HR=4.98, p=0.05), 2% (HR=4.04, p=0.041), 20 mL (HR=6.37, p=0.024) and 22 mL (HR=6.38, p=0.024) predicted mortality.

Conclusion
A conservative metric of 2% can be used as the MCID of QLF for predicting all-cause mortality. This may be considered in IPF trials in which the degree of structural fibrosis assessed via HRCT is an endpoint. The MCID of SGRQ and FVC corresponds with a greater amount of QLF and may reflect that a greater amount of change in fibrosis is required before there is functional change.

Trial registration number
NCT01262001, NCT01890265.