Risultati per: Quotidianosanita.it

In this narrative medicine essay, a neurosurgeon works through his grief over ending his surgical career due to intractable pain from an elbow injury by appreciating what he can do instead of focusing on what he lost.

This Medical News article discusses a bill introduced in Idaho that would ban administering mRNA vaccines.

Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal cancer. In cases of invisible or non-endoscopically resectable dysplasia found at colonoscopy, total proctocolectomy with ileal pouch anal anastomosis can be offered with good long-term oncological outcomes and pouch survival, however, little is known regarding cancer-related outcomes when dysplasia is found incidentally after surgery. We hypothesized incidental colorectal dysplasia is associated with worse oncologic outcomes compared to dysplasia diagnosed preoperatively.

New England Journal of Medicine, Volume 388, Issue 12, Page 1139-1141, March 2023.

Finding SARS-CoV-2 RNA on floors of long-term care facilities predicted COVID-19 outbreaks at these facilities.

This Medical News article discusses US initiatives to improve health care worker well-being as burnout and intent to leave to medicine reach record levels.

Objective
To describe the implementation and impact of the Getting it Right First Time (GIRFT) national orthopaedic improvement programme at the level of individual National Health Service (NHS) Trusts.

Design
Qualitative case studies conducted at six NHS Trusts, as part of a mixed-methods evaluation of GIRFT.

Setting
NHS elective orthopaedic surgery in England.

Participants
59 NHS staff.

Intervention
Improvement bundle, including bespoke routine performance data and improvement recommendations for each organisation, delivered via ‘deep-dive’ visits to NHS Trusts by a senior orthopaedic clinician.

Results
Although all case study sites had made improvements to care, very few of these were reportedly a direct consequence of GIRFT. A range of factors, operating at three different levels, influenced their ability to implement GIRFT recommendations: at the level of the orthopaedic team (micro—eg, how individuals perceived the intervention); the wider Trust (meso—eg, competition for theatre/bed space) and the health economy more broadly (macro—eg, requirements to form local networks). Some sites used GIRFT evidence to support arguments for change which helped cement and formalise existing plans. However, where GIRFT measures were not a Trust priority because of more immediate demands—for example, financial and bed pressures—it was less likely to influence change.

Conclusion
Dynamic relationships between the different contextual factors, within and between the three levels, can impact the effectiveness of a large-scale improvement intervention and may account for variations in implementation outcomes in different settings. When designing an intervention, those leading future improvement programmes should consider how it sits in relation to these three contextual levels and the interactions that may occur between them.

Objectives
Secondary distribution of HIV self-test (HIVST) kits from pregnant women attending antenatal care (ANC) to their male partners is shown to increase HIV couples testing and disclosure, and is being scaled up in sub-Saharan Africa. Understanding couples-level barriers and facilitators influencing HIVST uptake is critical to designing strategies to optimise intervention coverage.

Design
To investigate these couples-level barriers and facilitiators, we conducted focus group discussions and in-depth interviews. Transcripts were analysed thematically and the interdependence model of communal coping and health behaviour change was adapted to explore factors impacting HIVST acceptability.

Setting
We recruited pregnant women attending two public ANC clinics in Kampala, Uganda, and male partners of pregnant women between April 2019 and February 2020.

Participants
We conducted gender-stratified focus group discussions (N=14) and in-depth interviews (N=10) with pregnant women with and without HIV attending ANC, and male partners of pregnant women (N=122 participants).

Intervention
We evaluated pregnant women’s and male partners’ perceptions of HIVST secondary distribution in Uganda, leveraging the interdependence model of communal coping and health behaviour change.

Primary and secondary outcome measures
Key areas of focus included HIVST interest and acceptability, perspectives on HIV status disclosure to partners and gender roles.

Results
Participants felt that predisposing factors, including trust, communication, fear of partner and infidelity, would influence women’s decisions to deliver HIVST kits to partners, and subsequent communal coping behaviours such as couples HIV testing and disclosure. Pregnancy was described as a critical motivator for men’s HIVST uptake, while HIV status of pregnant women was influential in couples’ communal coping and health-enhancing behaviours. Generally, participants felt HIV-negative women would be more likely to deliver HIVST, while women with HIV would be more hesitant due to concerns about discovery of serodifference and relationship dissolution. Participants stressed the importance of counsellor availability throughout the process including guidance on how women should approach their partners regarding HIVST and post-test support in case of a positive test.

Conclusions
HIV-negative women in relationships with positive predisposing factors may be most likely to deliver HIVST and leverage interdependent coping behaviours. Women with HIV or those in relationships with negative predisposing factors may benefit from targeted counselling and disclosure support before and after HIVST kit distribution. Results can help support policy guidelines for HIVST kit distribution.

In this narrative medicine essay, a medical student recounts the high price to their mental health for embracing the advice of their childhood therapist to “fake it ‘til you make it.”

Due to the beneficial effects of FMT, a placebo-controlled trial assessing this treatment for first or second episodes of C. difficile infection was stopped at the interim analysis.

Circulation, Volume 147, Issue 1, Page e1-e3, January 3, 2023.

This Medical News feature examines how the expiration of states’ pandemic-related licensure waivers is limiting telemedicine services.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.