Risultati per: Approccio farmacologico al trattamento della stipsi indotta da oppioidi: focus su naldemedina

Objectives
This study aimed to explore the role of occupational physicians (OPs) in supporting transgender and gender-diverse (TGD) workers during gender transition and return to work (RTW) following gender-affirming (medical) interventions.

Design
We conducted a qualitative study (ONZ-2023-0026) using focus groups.

Setting
This study involved OPs in Belgium.

Participants
Two semistructured focus group interviews were held with 19 OPs working in occupational health services in Belgium in May and November 2023. Purposeful sampling was used, which included OPs with at least 2 years of seniority and experience with TGD people or inclusive company culture. Participants were predominantly white and cisgender, with varying levels of seniority and sectoral coverage.

Methods
Qualitative data was thematically analysed using Braun and Clarke to find patterned meaning.

Results
The analysis created four themes: (1) ‘What is the right professional attitude?: You never get a second chance to make a good first impression’ discusses the aspects of professional attitude alongside ethical considerations; (2) ‘Controlled open-mindedness’ entails values and views of gender in light of medicine, the individual worker, organisations and society; (3) ‘The balance game: “Fingerspitzengefühl” (intuitive flair or instinct) without treating’ and (4) ‘Being gender-bombarded: the need for OP-tailored training and best practices’. These themes highlighted the limited knowledge and experience of OPs regarding gender-affirming care (GAC) and their need for additional training. Participants struggled to find the best gender-inclusive professional approach to support TGD workers as well as employers and require ‘best practices’. Implementing overarching legislative frameworks can help OPs and companies create an inclusive work environment considering the differences in occupational sectors and company culture. RTW policies should focus on abilities without medicalisation and stigmatisation and involve multiple stakeholders.

Conclusions
Occupational medicine can be crucial in improving the health and well-being of TGD workers. However, with the ageing workforce, gender diversity poses new ‘hidden’ challenges for sick leave management, RTW and sensitive health surveillance. Multidisciplinary training with stakeholders and GAC professionals can enhance occupational practice and equip future OPs with the necessary competencies and confidence.

Didona, ‘fondamentale colloquio costante con le Associazioni’

‘Stato gold’ nell’ambito del programma ‘Eso-Angels Awards

Objectives
This study aimed to establish a consensus on key factors that influence medication choices for Parkinson’s disease and to identify the behavioural determinants of these factors using behavioural change theory as a theoretical lens.

Design
This qualitative study used the nominal group technique to conduct structured online focus group meetings. A facilitator guided participants to (1) individually generate a list of factors that influence their decision to prescribe, (2) collectively share these factors, (3) refine and clarify factors and (4) rank the most important factors. Subsequently, the most important factors identified were mapped to the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation–Behaviour (COM-B) model to identify the behavioural determinants that influence medication choice.

Participants
Eighteen healthcare professionals, including neurologists, consultants and specialist nurses/practitioners who prescribe medication, were recruited across Europe and participated in one of seven focus groups.

Results
There was good consensus among the participants about which factors influence their prescribing decisions. Overall, participants identified 60 unique factors that were broadly categorised into the following themes: medical or symptom concern, patient characteristics, side effects, access to treatment, clinical guidelines, social support and patient preference. Factors discussed and prioritised by the participants aligned with seven of the 14 TDF domains: knowledge; memory, attention and decision processes; beliefs about consequences; goals; social/professional role and identity; environment context and resources; and social influences. Together, these were subsequently mapped onto four of the six subdomains of the COM-B model: psychological capability, reflective motivation, physical opportunity and social opportunity.

Conclusions
These findings suggest that prescribing decisions for Parkinson’s disease are determined by a complex range of factors linked to the COM-B components capability, motivation and opportunity. These can be further understood by specific behavioural domains, as identified by the TDF, which should be targeted to help optimise subsequent prescribing decisions.

Car-T da donatore contro neuroblastoma che non risponde a cure

Car-T da donatore contro neuroblastoma che non risponde a cure

Stroke, Volume 56, Issue Suppl_1, Page ATP166-ATP166, February 1, 2025. Introduction:Deep-learning (DL)-based applications for Intracerebral Hemorrhage (ICH) detection on non-contrast computed tomography (NCCT) scans have demonstrated the potential to enhance diagnostic accuracy and efficiency amid the increasing radiologist workload. However, the sensitivity and specificity of these applications remain suboptimal, particularly in cases with subtle ICH (ICH volume < 5ml) and when confounding factors are present. This study aimed to enhance DL-based application, reduce false positives and improve the detection of subtle ICH.Methods:This study compared two versions of the DL-based application for ICH detection (CINA-ICH, Avicenna.AI, La Ciotat, France), both using a hybrid 2D/3D architecture. The first version, CINA-ICH, was trained on 8,994 representative CT scans (1,034 ICH+) from a cohort diverse in patient characteristics and acquisition parameters. The improved version, CINA-ICH(i), was trained on the same dataset enriched with 600 challenging cases (several confounding factors present) and included a specialised 3D network for subtle ICH detection, that underwent independent training on 2,238 CT-scans including 399 subtle ICH. The evaluation dataset included 479 NCCT scans (131 ICH+ including 24 subtle ICH) from over 200 U.S. hospitals, 4 scanner makers and 35 scanner models. Ground truth was determined by consensus among three board-certified radiologists. Sensitivity, Specificity, Accuracy and Matthews Correlation Coefficient (MCC) of CINA-ICH and CINA-ICH(i) were evaluated with a detailed analysis of false positive cases and subtle ICHs.Results:CINA-ICH(i) demonstrated a statistically significant (p

Objectives
This qualitative study explored public and prescriber awareness of pharmaceutical pollution in the water environment and eco-directed sustainable prescribing (EDSP) as a mitigation strategy to reduce the environmental impact of prescribing in Scotland.

Design
Focus groups explored prescriber and public perceptions of the topic. Common questions were asked through semistructured facilitation. Focus groups were digitally recorded and transcribed verbatim using an artificial intelligence system, then anonymised and thematically analysed using NVivo software. Data were iteratively analysed using the one sheet of paper technique.

Setting
Public focus groups were held in-person (Inverness, Scotland, April 2023), and prescriber focus groups were held virtually (MS Teams, August 2023).

Participants
Nine public representatives and 17 NHS Scotland prescribers participated in one of four focus groups. Purposive and opportunistic sampling approaches were used to recruit participants through social media and other channels (ie, community groups, professional emails, general practitioner and hospital flyers). Prescriber representatives registered interest through an online survey to gather information about their professional background. Responses were reviewed to ensure representation of a mixture of medical backgrounds, experience, sectors and health boards.

Results
There is growing awareness among the public and healthcare professionals of pharmaceutical pollution in the environment, but further education is required on the drivers, potential effects and possible interventions. Suggestions for more sustainable healthcare included public health awareness campaigns, better provision for pharmacy take-back schemes, clear medicine/packaging labelling, regular medicines reviews and more considered patient-centred care. From the prescriber perspective, EDSP resonated well with current sustainability initiatives (eg, Realistic Medicine, switching to dry-powder inhalers), but barriers to EDSP included lack of knowledge, confidence, time and resources to implement changes. Although the public representatives were generally open to the concept of EDSP, this decision required weighing pros/cons considering personal health choices, information accessibility and transparency, and trust in and time with prescribers.

Conclusions
This study identified new insights from prescribers and the public related to the concept of, and barriers to, EDSP in Scotland, as well as perspectives regarding knowledge support tools and information communication. Cross-sector and transdisciplinary collaborative approaches are needed to address the challenges identified here. Nonetheless, EDSP merits further exploration in developing more sustainable, appropriate and effective healthcare which contributes to improved public and planetary health.

Background
The second victim (SV) experience limits the performance of health and care workers and places patients at risk. Peer support is recognised as the most effective, feasible and acceptable intervention to mitigate its impact.

Objective
To define a set of success factors when designing interventions to support SVs in health and care facilities based on expertise in different European countries.

Setting
International collaboration involving countries with diverse cultures, structures and legal frameworks.

Design
Qualitative research.

Method
Focus groups involving a total of 43 participants were conducted in five countries. Prominent professionals in European peer support interventions were engaged. Analysis of common elements considered key to the success of these programmes was underscored.

Results
Critical success factors for designing effective SV support interventions included the need for an occupational health approach, the establishment of a strong organisational safety culture, immediate psychological first aid, long-term resilience building, the engagement and training of peer supporters, the provision of adequate resources and ongoing support, the importance of leadership commitment and the necessity of tailoring interventions to the specific context and needs of each institution and country considering their diverse sociocultural and legal framework. The expected benefits included ensuring optimal patient care and reducing associated costs such as staff turnover and litigation.

Conclusion
Effective SV support interventions are essential for enhancing the resilience and performance of health and care workers, ultimately improving patient safety. By implementing tailored and well-resourced interventions, healthcare institutions can mitigate the negative impact of the SV phenomenon, promoting optimal care.

Objectives
Effective, real-time surveillance of dengue may provide early warning of outbreaks and support targeted disease-control intervention but requires widespread accurate diagnosis and timely case reporting. Research directing innovation in diagnostics for dengue surveillance is lacking. This study aimed to describe experience and requirements of relevant prospective users.

Design
A qualitative, focus group study was conducted.

Participants
Data were collected from 19 users of diagnostic technology who work across the Thai dengue surveillance system.

Data collection and analysis
Contextual knowledge, experience and needs were explored in focus groups. Discussions were translated, transcribed, analysed thematically and mapped to Consolidated Framework for Implementation Research domains.

Results
Participants expressed a need for rapid, accurate, serotype-specific tests which can be operated easily by non-expert users without laboratory equipment. They supported integration of diagnostics with surveillance systems and felt this would increase the quantity and speed of case reporting as well as provide healthcare professionals with up-to-date information about the number of cases locally, thereby aiding interpretation of test results. Concerns included those relating to data security and the cost of tests.

Conclusions
Engagement to understand prospective user experience and requirements can improve relevance and uptake of new technology, leading to system efficiencies. The present study highlights specific needs for accurate, serotype-specific, remote-connected diagnostics which are integrated with surveillance systems and support dengue case reporting at the point-of-care.

A Trieste 22/23 novembre. Confronto di esperienze sui progressi

A Trieste 22/23 novembre. Confronto di esperienze sui progressi