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

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.

Secondo la rivista Nature Medicine tra le sperimentazioni cliniche da tenere d’occhio nel 2024 ci sono tra l’altro nuovi farmaci, app per aiutare le donne che soffrono di depressione durante la gravidanza, nuovi vaccini e trapianti di neuroni ottenuti da cellule staminali embrionali per combattere il Parkinson

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Objective
This study aims to collect data on the experience and impact of gender-based violence experienced by women attending health clinics in Honiara, Solomon Islands.

Method
Any woman over the age of 18 who attended a local health clinic in Honiara, Solomon Islands during the time of recruitment (ten consecutive weekdays in May 2015) was eligible to participate in an interviewer administered, in-person survey, gathering data on gender-based violence over the past 12 months.

Results
A total of 100 women were recruited into this study. Of these women, 47% of women reported experiencing physical or sexual violence in the past 12 months. The most common perpetrators were the woman’s husband or boyfriend. There are low rates of reporting, particularly through formal avenues such as to police or village leaders. Alcohol was involved in more than half the cases of reported violence.

Conclusion
Women in this study report high rates of gender-based violence. To our knowledge, this is the only study examining women’s personal experience of gender-based violence in the Solomon Islands, with self-reported data on the frequency and nature of the violence, and the impact on women, including physical and mental, utilisation of healthcare services, police and legal involvement. Efforts to reduce gender-based violence should aim to reduce intimate partner violence, increase reporting and address wider social attitudes towards gender equality.

Circulation, Volume 148, Issue Suppl_1, Page A13832-A13832, November 6, 2023. Background/Rationale:Myocardial scar, identified by late gadolinium enhancement (LGE) on MRI, is associated with sudden death in HCM. Unlike ECG, MRI is expensive and adversely affected by artifacts from implanted devices. However, little is known about ECG features of LV-scar in HCM.Objective:Develop an ECG-based explainable machine learning method to identify and localize LV-scar in HCM.Method:We retrospectively studied 500 HCM patients (JH HCM Registry) for model development, and 248 patients (UCSF HCM Registry) for validation. All patients underwent MRI and ECHO within 1 year of ECG. LV-LGE (scar) was assessed using QMass. After excluding RV-insertion-point-LGE, the LV was divided into basal, mid, and apical regions for scar detection. Resting 12-lead ECGs were segmented, features were extracted and adjusted for LV-mass, age, sex. We utilized unsupervised and self-supervised ECG representation learning, where patients are partitioned into groups of several sub-clusters, each sharing similar ECG patterns, but with high separation between scar and no-scar classes. In each group, a self-supervised neural net and a fully connected neural net successfully predicted LV-scar (see Figure) and revealed ECG features of scar.Results:Our method identifies LV-scar in the JH-dataset with high precision (90%), sensitivity (95%), specificity (80%), F1-score (90%), and generalizes well to UCSF-data (precision:88%, sensitivity:90%, specificity:78%, F1-score:89%). The top ECG features for basal-scar are Q-amplitude, Q-slope, non-terminal QRS duration in aVR, and area under QRS and T wave energy in V1-V2. T-wave inversion in V4-V6, area under QRS in V3, TP slope in V3-V4 predicted apical scar. Features selected for mid scar prediction combine features for basal and apical scar.Conclusion:This is the first ECG-based ML model to identify/localize LV-scar in HCM. Our model demonstrates good performance and reveals ECG features of scar in HCM.

Circulation, Volume 148, Issue Suppl_1, Page A12019-A12019, November 6, 2023. Background:A treatment goal for obstructive hypertrophic cardiomyopathy (oHCM) is to reduce symptom burden and improve health status, which can be measured with the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ-23). While the KCCQ-23 has been validated in oHCM, the shorter 12-item version (KCCQ-12) is more feasible in clinical care but has not been validated.Hypothesis:The construct validity, reliability, and responsiveness of the KCCQ-12 will support its use for patients with oHCM.Aims:To validate the psychometric performance of the KCCQ-12 in patients with oHCM and its interpretability categorized by Patient Global Impression of Change (PGIC).Methods:The psychometric properties of the KCCQ-12 and domains were tested in 196 participants with symptomatic oHCM from the EXPLORER-HCM trial. Construct validity was assessed against clinical and patient-reported standards using Spearman Correlation coefficients. Reliability was assessed by Cronbach’s alpha ( > 0.70). Test-retest reliability was determined using intra-class correlation (ICC) coefficient (good correlation being ICC > 0.70) and paired t-tests of clinically stable patients (defined as no change in PGIC from baseline to 6 weeks and no change in Patient Global Impression of Severity from 18-30 weeks). Responsiveness and interpretability were assessed within categories of the 6-week PGIC.Results:KCCQ-12 domains and summary scores had moderate to strong correlations with most clinical standards (NYHA class, exercise duration, pVO2) and patient-reported scales (Table 1). The KCCQ-12 showed strong internal and test-retest reliability (Table 2). All KCCQ-12 scores demonstrated significant and proportional changes of different magnitudes of clinical change delineated by the PGIC (Table 3).Conclusion:The KCCQ-12 demonstrates good psychometric performance for patients with oHCM and can be confidently used to monitor the health status of patients with oHCM in clinical practice.

Circulation, Volume 148, Issue Suppl_1, Page A13260-A13260, November 6, 2023. Background:Aortic stenosis (AS) is associated with significant morbidity and mortality and is increasing in prevalence. Limited data exist regarding circulating biomarkers of AS risk.Methods:Among Atherosclerosis Risk in Communities study participants with available proteomics (Somascan v4) at study Visit 5 (2011-13; n=4,899; age 76 ± 5 years, 57% women), we used multivariable linear regression to evaluate the association of 4,877 plasma proteins with peak aortic valve (AV) velocity and AV dimensionless index. We then tested their association, when assessed at study Visit 3 (1993-95; n=11,430; age 60 ± 6, 54% women), with incident AV-related hospitalization post-Visit 3 (median follow-up 22, IQR 14 – 25 years) using multivariable Cox PH regression models. For the resulting candidate proteins, we assessed the association of Visit 5 protein levels with change in AV peak velocity over 6 years from Visit 5 to 7 (2018-19; n=2,314) and with quantitative AV calcification by cardiac CT at Visit 7 (n=1,804); associations with incident adjudicated AS in the Cardiovascular Health Study (CHS; n=3,413); and differences in AV tissue expression in normal, fibrotic, and calcific segments of explanted stenotic human AVs (n=3).Results:We identified 52 plasma proteins with consistent associations with AV peak velocity, AV dimensionless index, and incident AV hospitalization. Of these 52 proteins, MMP12 was also associated with magnitude of increase in AV peak velocity between Visits 5 and 7 (Figure), and with magnitude of AV calcification by CT at Visit 7 (adjusted OR 1.25 [95% CI 1.19-1.32], p=1.7×10-17). Higher MMP12 was also associated with incident moderate or severe AS in CHS, an independent cohort. MMP12 expression was greater in calcific compared to fibrotic or normal AV tissue segments.Conclusions:Plasma MM12 is a potential novel circulating biomarker of AS risk.