Risultati per: Caratterizzazione dell'asma in base all'età di insorgenza: uno studio di coorte multi-database

Maggior rischio di parto prematuro e complicanze dopo i 45 anni

Maggior rischio di parto prematuro e complicanze dopo i 45 anni

Objectives
To evaluate changes in oral corticosteroid (OCS) use after the publication of the 2014 Japanese clinical practice guidelines for myasthenia gravis (MG).

Design
Retrospective cohort study performed in three Japanese health insurance databases: the JMDC database between 2005 and 2021; the DeSC database covering the National Health Insurance (NHI) and the DeSC database covering the Late-Stage Elderly Healthcare Service (LSEHS) between 2014 and 2021. Achievement of OCS ≤5 mg/day was defined as ≥90 days of consecutive OCS ≤5 mg/day during follow-up, without any gap longer than 60 days between two consecutive claims. The time to achieve OCS ≤5 mg/day was estimated using Kaplan-Meier survival analysis.

Setting
Real-world treatment setting in Japan.

Participants
Patients aged ≥16 years with a record of MG (International Classification of Diseases 10th edition code: G70.0) with a serological test, who had baseline period ≥180 days before inclusion with no MG claim and who started immunotherapy (including OCS) within 90 days of MG diagnosis.

Outcome measures
Prescription of OCS and other therapies for MG.

Results
Overall, 811 patients were included. The mean age was 49 years in the JMDC, 61 years in the NHI and 80 years in the LSEHS. In the JMDC, the median time to achieve OCS ≤5 mg/day was significantly shorter (p=0.042; log-rank test) in patients included in 2015 or later (11.0 months) than in patients included before 2015 (17.9 months). The median time to achieve OCS ≤5 mg/day was shorter in the LSEHS (6.5 months) than in the JMDC (11.0 months) and the NHI (11.7 months).

Conclusions
Faster tapering of the OCS dose was observed in patients starting treatment after the publication of the 2014 guidelines, although use of higher-dose OCS remained widespread after this date. This highlights the need to improve awareness of guidelines by healthcare providers in order to decrease the burden of higher-dose OCS.

Trial registration number
Clinical Trials Registry (UMIN-CTR): UMIN000051155; Post-results.

Background
There is increasing awareness of the impact of living with multiple long-term conditions (referred to as multimorbidity) on patients and health systems. Managing multimorbidity remains a challenge for primary care providers; necessitating tailored interventions that are both clinically and cost effective. In the Irish health system, two pilot trials have demonstrated promising results for patients living with multimorbidity. The first, MultimorbiditY COllaborative Medication Review And DEcision making (MyComrade), involved pharmacists supporting the management of polypharmacy, and the second, Link MultiMorbidity (LinkMM), involved link workers delivering social prescribing. This definitive trial aims to evaluate the clinical and cost effectiveness of both these interventions, as well as conduct a process evaluation.

Methods
This is a pragmatic, multi-arm, definitive, cluster randomised controlled trial in Irish general practices. The trial will include three arms: (1) MyComrade; (2) LinkMM and (3) usual care, acting as an efficient shared control arm for both interventions. For this trial, 672 patients will be recruited from 48 general practices. The eligibility criteria for the patients will be: (1) over 18 years of age; (2) has two or more chronic conditions; (3) taking 10 or more regular medicines and (4) attending their general practice team for chronic disease management. Outcome data will be collected for all participants, across all trial arms at baseline and 6 months. Primary outcomes include the number of medicines (reflecting the MyComrade intervention) and patient capability (reflecting the LinkMM intervention). Secondary outcomes include proportions and types of potentially inappropriate medications, patient experience of care, patient activation, self-rated health, health-related quality of life, mortality and healthcare utilisation. Quantitative and qualitative data will be collected to inform the process evaluation. Additionally, an economic evaluation will be conducted to evaluate the cost-effectiveness of both interventions compared with the control arm.

Ethics and dissemination
The trial protocol was approved by the Irish College of General Practice (ICGP) Ethical Review Board (ref: ICGP_Rec_2023_016). A formal knowledge dissemination plan has been developed for the trial, which includes peer-reviewed publications, conference presentations and reports to healthcare professionals, commissioners and policymakers.

Trial registration number
ISRCTN11585238.

Nessun effetto sul cervello se vengono consumate da adulti

Realizzato con Barilla e pubblicato su Food Science Nutrition

Introduction
Multi-disciplinary discussions (MDDs) improve diagnosis and management of interstitial lung disease (ILD). The value of a virtual multi-centre MDD (V-MCMDD) incorporating expertise from multiple institutions remains underexplored. This study aimed to evaluate the impact of a V-MCMDD on diagnosis and management in ILD.

Methods
We conducted a retrospective multi-centre cohort study involving tertiary and secondary hospital clinics, private practices and community outpatient centres, all participating via a virtual platform. Between August 2020 and June 2023, patient cases were reviewed through V-MCMDDs, which included clinical, radiological, pathological and laboratory data. Each case was discussed to reach a consensus diagnosis and management plan.

Results
Following the V-MCMDD review, the diagnosis was revised in 51% of patients (p=0.031), and management plans were modified in 41% of cases. A significant shift in treatment was observed in patients with changed diagnoses vs unchanged diagnoses (p value=0.002).

Conclusions
Our findings suggest that the implementation of V-MCMDDs can be valuable in the diagnostic and therapeutic process for ILD. Incorporating input from multiple centres via a virtual format can lead to significant changes in both diagnosis and management, potentially improving patient outcomes.

Objectives
Systemic immune-inflammation index (SII) is a biomarker of inflammatory conditions; however, no scoring system has been evaluated for predicting mortality in patients with renal failure in intensive care unit (ICU). This study aimed to determine associations between SII level and mortality in patients with renal failure.

Design
Using the Medical Information Mart for Intensive Care IV (V.2.0) database (USA), this retrospective study included 837 patients who were admitted to ICU with end-stage renal disease (ESRD), between 2008 and 2019.

Primary and secondary outcome measures
Cox proportional-hazards models were used to evaluate correlations between SII and outcomes, expressing results as hazard ratios (HRs) with 95% confidence intervals (95% CIs). Regression analysis was used to determine associations between variables and SII.

Results
In total, 837 adult patients from a total of 76 943 patients admitted to ICU were included, comprising 59.60% males with mean age 62.27±14.9 years and mean BMI 28.36±7.43 Kg/m2. Using median SII (1628 X 109 /L) as cut-off value, high (≥ 1628X109 /L) SII was also associated with an increased risk of ICU mortality (HR 1.97 (95% CI 1.15 to 3.35), p=0.034), in-hospital mortality (HR 1.95 (95% CI 1.23 to 3.09), p=0.017) and total mortality (HR 1.30 (95% CI 1.07 to 1.58), p=0.024).

Conclusions
SII may predict mortality in critically ill patients admitted to ICU with ESRD. SII ≥ 1628×109 /L correlates significantly with increased ICU mortality, in-hospital mortality and total mortality.

Objectives
The cardiotoxicity of immune checkpoint inhibitors (ICIs) has garnered significant clinical attention due to its high mortality rate. However, limited clinical research and inconsistent results have hindered a comprehensive understanding of this issue. This study seeks to elucidate gender and age differences in cardiac-related adverse reactions, aiming to offer scientific evidence to inform clinical practice.

Design
A retrospective pharmacovigilance study.

Setting
Based on the reports of ICIs in the FDA Adverse Event Reporting System database from 2003–2023, we conducted a disproportionality analysis to identify cardiac immune-related adverse events (irAEs) and explored the correlation of age and gender with these adverse events.

Main outcome measures
The main cardiac irAEs were defined by four preferred terms: myocarditis, atrial fibrillation, cardiac failure and pericardial effusion. Both the proportional reporting ratio (PRR) and reporting odds ratio (ROR) are frequency methods. Data mining was performed using the PRR method, which assesses the relative risk of adverse drug reactions by comparing the frequency of reports associating a specific drug with a particular adverse reaction to the frequency of reports linking any drug to the same reaction. A higher PRR indicates a more robust adverse event signal, suggesting a stronger statistical association between the drug of interest and the target adverse event. In the research process, we primarily used the ROR and PRR from disproportionality analysis to screen for cardiac irAEs, while also elucidating the correlation between these reactions and factors such as age and gender.

Results
A total of 2033 adverse events were retrieved, and myocarditis was the most common cardiac irAEs. Gender disparities exist in the incidence of various adverse reactions to the same medication. Female patients need to be particularly vigilant for cardiac adverse events when taking atezolizumab, and male patients should be especially cautious for cardiac adverse events when using ipilimumab. Furthermore, ipilimumab produced a positive signal for pericardial effusion in the elderly group but not in the younger group, suggesting that elderly patients may be more susceptible to adverse reactions. Therefore, increased vigilance and careful monitoring are warranted during clinical administration of this medication to elderly patients.

Conclusion
Our study highlights the gender and age differences in cardiac adverse events with ICIs, providing valuable insights for clinical application.

L’appello, ‘concretizzare quanto previsto da legge di Bilancio’

The evidence of the heterogeneity of WAS and XLT outcomes could be instrumental to draw updated recommendations for the management of the patients affected by these rare conditions. It would be desirable to expand the tools to estimate the risk of infectious and autoimmune events in patients with XLT and the impact of their treatment, including HSCT over time.

Dati promettenti per somministrazione meno invasiva isatuximab

Objective
This study explored the experience of stigma and access to healthcare by persons with long COVID from the majority Dutch and two ethnic minority populations (Turkish and Moroccan) living in the Netherlands.

Design
This was a cross-sectional qualitative study that employed inductive and deductive thematic approaches to data analysis using MAXQDA.

Setting and participants
Between October 2022 and January 2023, 23 semi-structured interviews were conducted with participants of Dutch, Moroccan and Turkish ethnic origins with long COVID living in the Netherlands. Participants were men and women aged 30 years and above.

Results
Guided by the concepts of stigma and candidacy, the findings are structured according to the broader themes of stigma and access to care. The findings show that people with long COVID suffer self and public stigma resulting from the debilitating illness and symptoms. Especially among Turkish and Moroccan ethnic minority participants, strong filial obligations and gendered expectations of responsibility and support within their communities further worsen self-stigma. This experience of stigma persisted within healthcare where lack of information and appropriate care pathways led to feelings of frustration and abandonment, especially for participants with pre-existing health conditions which further complicate candidacy. Under the access to healthcare theme, the findings show multiple challenges in accessing healthcare for long COVID due to several multifaceted factors related to the various stages of candidacy which impacted access to care. Particularly for Turkish and Moroccan ethnic minority participants, additional challenges resulting from limited access to information, pre-existing structural challenges and experience of stereotyping based on ethnicity or assumed migrant identity by health professionals further complicate access to health information and long COVID care.

Conclusions
The findings call for urgent attention and research to identify and coordinate healthcare for long COVID. There is also a need for accessible, informative and tailored support systems to facilitate patients’ access to information and care pathways for long COVID. Providing tailored information and support, addressing the various barriers that hinder optimal operating conditions in healthcare and leveraging on social networks is crucial for addressing stigma and facilitating candidacy for persons with long COVID towards improving access to care.