Risultati per: Importanza dell’ecografa nel setting della medicina generale. Introduzione con survey

Opere, video e installazioni negli ospedali sono benefici per i pazienti. Cultura e medicina alleate contro i tumori, ma non solo

Objective
We aimed to investigate the relationship between serum neurofilament light chain (NfL) and grip strength using data from the 2013–2014 US National Health and Nutrition Examination Survey (NHANES).

Design
Secondary analysis of cross-sectional, population-based data.

Setting
NHANES sample, 2013–2014.

Participants
We studied 1925 participants aged 20–75 years.

Outcome measures and analysis
We applied a multivariable generalised linear regression model, adjusted for several potential confounders, and restrictive cubic spline models to evaluate the association between serum NfL and grip strength. Subgroup analyses were conducted using stratified multivariable linear regression analysis.

Results
We included 1925 participants (average age: 44.8±0.44 years) from the NHANES database. Participants with higher serum NfL levels had a significantly higher prevalence of medical conditions (hypertension, diabetes, cardiovascular disorder, chronic kidney disease (CKD) and cancer) compared with those with lower NfL levels (all p

Objectives
This study aims to provide an in-depth analysis of the symptoms, coexisting conditions and service utilisation among people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID. The major research questions include the clustering of symptoms, the relationship between key factors and diagnosis time, and the perceived impact of National Institute for Health and Care Excellence (NICE) guidelines on patient care.

Design
Cross-sectional survey using secondary data analysis.

Setting
Community-based primary care level across the UK, incorporating online survey participation.

Participants
A total of 10 458 individuals responded to the survey, of which 8804 confirmed that they or a close friend/family member had ME/CFS or long COVID. The majority of respondents were female (83.4%), with participants from diverse regions of the UK.

Primary and secondary outcome measures
Primary outcomes included prevalence and clustering of symptoms, time to diagnosis, and participant satisfaction with National Health Service (NHS) care, while secondary outcomes focused on symptom management strategies and the perceived effect of NICE guidelines.

Results
Fatigue (88.2%), postexertional malaise (78.2%), cognitive dysfunction (88.4%), pain (87.6%) and sleep disturbances (88.2%) were the most commonly reported symptoms among participants with ME/CFS, with similar patterns observed in long COVID. Time to diagnosis for ME/CFS ranged widely, with 22.1% diagnosed within 1–2 years of symptom onset and 12.9% taking more than 10 years. Despite updated NICE guidelines, only 10.1% of participants reported a positive impact on care, and satisfaction with NHS services remained low (6.9% for ME/CFS and 14.4% for long COVID).

Conclusions
ME/CFS and long COVID share overlapping but distinct symptom clusters, indicating common challenges in management. The findings highlight significant delays in diagnosis and low satisfaction with specialist services, suggesting a need for improved self-management resources and better-coordinated care across the NHS.

Objectives
To explore the views of obstetrics and gynaecology (O&G) and general surgery (GS) trainees and consultants on the laparoscopic skills considered necessary to achieve the certificate of completion of training (CCT) and identify any mismatch between consultants and trainees in their expectations of these skills.

Design
A prospective nationwide cross-sectional study in the UK.

Setting
A national survey distributed through Health Education, England and national training bodies such as the Royal College of Obstetricians & Gynaecologists, British Society for Gynaecological Endoscopy and the Association of Surgeons of Great Britain and Ireland.

Participants
O&G and GS consultants and specialty trainees in O&G and GS. Specialty trainees below ST3 level and consultants performing open surgery or minor laparoscopic surgery only were excluded.

Interventions
Trainees completed a 27-item questionnaire on their training characteristics, rated their confidence and perceived importance of 10 laparoscopic skills required for CCT using a 5-point Likert scale. Consultants answered a 36-item questionnaire on their demographic details, their views on the importance of the same 10 laparoscopic skills, their confidence and the standard of laparoscopic skills they observed among trainees approaching CCT.

Results
345 participants responded to the questionnaire: 117 O&G trainees, 95 O&G consultants, 57 GS trainees and 76 GS consultants. O&G trainees and consultants expected similar laparoscopic skills required for CCT for all 10 skills (p >0.050), while GS consultants had higher expectations of GS trainees for use of endovascular devices (p

The SASPI (Society of Antimicrobial Stewardship Practices in India)-led survey underscores the high use of antibiotics in the included tertiary care centers emphasizing the need for point prevalence surveys to guide antimicrobial stewardship programs. It highlights the importance of ongoing AMR surveillance, improved stewardship, and education to refine prescribing practices, targeting hospital-acquired infections, and reducing unnecessary treatments.

Background
Refractive surgery is gaining widespread popularity; however, there remains a limited understanding of the knowledge and attitudes of myopes regarding these procedures.

Objectives
To investigate the knowledge and attitudes of myopes or their guardians towards refractive surgery.

Design
Cross-sectional study.

Participants
581 myopes or their guardians in Suzhou City, Jiangsu Province, China, surveyed between August and October 2022.

Outcome measures
Knowledge and attitude scores before and after refractive surgery, ranging from 0 to 45 and 0 to 36, respectively.

Results
Postsurgery knowledge (32.35±11.48 vs 27.38±11.74, p

Background
Refractive surgery is gaining widespread popularity; however, there remains a limited understanding of the knowledge and attitudes of myopes regarding these procedures.

Objectives
To investigate the knowledge and attitudes of myopes or their guardians towards refractive surgery.

Design
Cross-sectional study.

Participants
581 myopes or their guardians in Suzhou City, Jiangsu Province, China, surveyed between August and October 2022.

Outcome measures
Knowledge and attitude scores before and after refractive surgery, ranging from 0 to 45 and 0 to 36, respectively.

Results
Postsurgery knowledge (32.35±11.48 vs 27.38±11.74, p

Objective
This study aimed to investigate healthcare professionals’ (HCPs’) experiences with the simulation-based Four Habits Model (4HM) course programme and evaluate how they perceived the 4HM’s immediate and persistent significance for practice within the intermediate care (IC) context.

Design
A qualitative approach was combined with a survey design, structured within an exploratory sequential framework consisting of two phases: (1) focus group interviews with HCPs who had completed the course 2–4 weeks postcourse (n=11), and (2) a detailed questionnaire completed 4 months postcourse (n=14).

Setting and intervention
IC serves as a bridge in the patient pathway from hospital to home providing community-based rehabilitation. The 4HM is a well-established framework for improving clinical communication in healthcare. However, it has never been tested in IC. We conducted two 4HM courses in April 2023 at an IC institution in Norway’s capital.

Participants
The study involved clinical HCPs (n=15) working in IC, participating in the 4HM courses, and consisted of seven nursing assistants, five nurses and three therapists.

Results
The HCPs experienced the 4HM course to be important and useful for practice in the IC context. They perceived that the easy-to-use framework could be applied in many patient–HCP interactions, had the potential to frame the ‘what matters to you’ question and increase satisfaction among patients and relatives. The survey conducted after 4 months disclosed that participants believed they had acquired and applied new communication skills.

Conclusion
The 4HM provided a structured framework for interactions in the IC context, enhancing professionalism and streamlining daily tasks. Overall, the model fostered patient participation through improved communication skills. The findings could assist stakeholders, HCPs and IC service managers in developing educational programmes for HCPs to enhance communication skills and improve the quality of care for older patients in transitional care.

This study elucidates a significant non-linear relationship between BMI and asthma risk in populations aged 45 years and older, providing insights for tailored asthma prevention strategies, although the cross-sectional design limits causal inference. Future studies should focus on collecting and stratifying longitudinal data and adjusting for asthma diagnosis timing to obtain more accurate results.

Background
Long wait times impede timely access to mental health treatment for anxiety and depression for adolescents. However, there is limited quantitative research on current wait times for the treatment of anxiety and depression for adolescents in Australia and the impact of wait times on adolescent help-seekers.

Aims
This study examined adolescents’ experiences of wait times for the treatment of anxiety and depression in Australia, including the providers they were waiting to access, the self-reported duration and perceived acceptability of wait times, the association between these wait times and psychological distress and the support and coping behaviours used by adolescents during this time.

Method
From April to June 2022, 375 adolescents aged 13–17 years who were living in Australia and currently waiting, or had previously waited in the past 12 months, for mental health treatment for anxiety and depression completed a cross-sectional online survey.

Results
Most adolescents initiated care with psychologists and psychiatrists, with mean wait times of 100.1 days (SD: 77.25) and 127.5 days (SD: 78.80), respectively. The mean wait time across all treatment providers was 99.6 days (SD: 80.44). Most participants (85.2%) felt their wait times were ‘too long’. Longer wait times were associated with increased psychological distress, and many adolescents perceived that their mental health worsened during the wait time. Most participants did not receive any support from their healthcare providers during the wait time and engaged in maladaptive and risky coping behaviours while waiting. However, self-reported treatment attendance remained high.

Conclusions
Adolescents in Australia face lengthy wait times when accessing mental health treatment, and this may exacerbate distress and maladaptive coping.

Objectives
To investigate long-acting injectable (LAI) antipsychotic prescribing patterns and their associations with transition and continuation of care and healthcare resource utilisation (HCRU) for patients with schizophrenia in the USA.

Design
A retrospective cohort study.

Setting
Electronic health record data from adults in the USA with schizophrenia were extracted from the NeuroBlu Database V.21R2.

Participants
Adults (aged ≥18 years) with a schizophrenia diagnosis who initiated LAI antipsychotic treatment during psychiatric inpatient admission. The index date was the date of LAI initiation. Patients who had ≥1 primary, secondary or tertiary ICD-9/10 (International Classification of Diseases) diagnosis of schizophrenia at clinical sites that had both inpatient and outpatient facilities were included.

Primary outcome measures
Transition-of-care (eg, risk of rehospitalisation, number of hospital readmissions, number of outpatient visits post discharge), continuation-of-care (eg, first treatment path after discharge, time to index LAI discontinuation and number of patients who restarted LAIs after discontinuation) and HCRU endpoints (eg, length of stay of index hospitalisation and estimated cost for psychiatric outpatient visits pre-index and post-index) were the primary outcome measures.

Results
A total of 1197 patients were included who initiated an LAI in an inpatient setting. Of 339 patients with ≥3 months pre-index and post-index data, median time to rehospitalisation was 135 days. Patients discharged taking an LAI alone had lower frequency of rehospitalisation (incidence rate ratio (IRR)=0.62 (95% CI, 0.46 to 0.84)), lower risk of longer hospital stays (IRR=0.60 (95% CI, 0.43 to 0.84)), lower risk of becoming rehospitalised (HR=0.49 (95% CI, 0.35 to 0.69)) and lower risk of outpatient visits (IRR=0.50 (95% CI, 0.36 to 0.70)) versus patients co-prescribed an oral antipsychotic (LAI+OA). Patients discharged taking an LAI dosed once every 1–2 months or once every 2 weeks had lower frequency of rehospitalisation (IRR=0.85 (95% CI, 0.64 to 1.14)), lower risk of longer hospital stays (IRR=0.90 (95% CI, 0.70 to 1.15)) and lower risk of becoming rehospitalised versus an LAI dosed once every 2 weeks; risk of becoming rehospitalised was no different (HR=1.00 (95% CI, 0.76 to 1.32)) and risk of outpatient visits was greater (IRR=1.25 (95% CI, 0.96 to 1.63)). During hospitalisation, 73.4% of patients were co-prescribed an OA, most frequently risperidone, with their index LAI. From pre-admission to post-discharge, psychiatric clinic costs significantly increased (US$14 231, p

This Viewpoint discusses the challenges facing US leadership in improving the state of the country’s public health and outlines 5 classes of candidates for public health intervention and 4 criteria to guide public health priority setting.

Objective
Ensuring equitable access to emergency obstetric care is essential for reducing maternal mortality. This study examines the prevalence and associated factors of caesarean section (CS) delivery in Nepal during 2022.

Design
This study used secondary data from the 2022 Nepal Demographic and Health Survey (NDHS) for the analysis, employing stratified two-stage cluster sampling. The sample comprised 1977 live births from women aged 15–49 years, with CS delivery serving as the outcome variable. Independent variables were categorised into residency, socio-economic, maternal health service and maternal factors. Binary logistic regression was applied to estimate crude and adjusted odds ratios (AORs) for associations, with statistical significance assessed at p

Objectives
This study aimed to employ machine learning algorithms to predict the factors contributing to zero-dose children in Tanzania, using the most recent nationally representative data.

Design
Cross-sectional study.

Setting
This study was conducted in Tanzania and used the most recent 2022 Tanzania Demographic and Health Survey, accessed from http://www.dhsprogram.com.

Participants
A total of 2120 children aged 12–23 months were included in this study.

Outcome measure
Seven classification algorithms were used in this study: logistic regression, decision tree classifier, random forest classifier (RF), support vector machine, K-nearest neighbour, XGBoost (XGB) and Naive Bayes. The dataset was randomly divided into training and testing sets, with 80% allocated for training and 20% for testing. After training the models, the testing data were used to evaluate their performance. This evaluation measured the models’ ability to generalise to unseen data using performance metrics such as accuracy, precision, recall, F1-score and AUC.

Results
Approximately 7.45% of children (95% CI 6.73%, 8.65%) were categorised as zero-dose children. The RF classifier achieved the highest performance metrics among the evaluated algorithms, with accuracy=0.95, precision=0.94, recall=0.96, F1 score=0.95 and AUC=0.99, making it the most effective supervised machine learning method for predicting zero-dose children in Tanzania. Maternal unemployment had the most significant positive impact (+0.060) on predicting zero-dose children. Lack of maternal education was the second most significant positive factor (+0.048), indicating that mothers without formal education are more likely to have zero-dose children. Small family size was the third most influential factor, with a positive effect (+0.040) on predicting zero-dose children in Tanzania.

Conclusions
The RF classifier emerged as the top-performing model for predicting children in Tanzania who have not received any vaccinations. This comprehensive approach enabled the accurate identification of zero-dose children, highlighting the effectiveness of machine learning in enhancing public health initiatives and optimising vaccination strategies. Using this algorithm can enhance health outcomes and reduce the prevalence of vaccine-preventable diseases in Tanzania.

Objective
A multidisciplinary team is essential to providing high-quality, patient-centred care. However, its effectiveness can be either hindered or facilitated by various factors, such as the need for rapid decision-making, which may compromise patient outcomes despite individual efforts. The aim of this study is to synthesise the factors that may act as barriers and facilitators to the work of multidisciplinary teams in managing labour within acute care settings.

Design
A systematic qualitative review and meta-synthesis was conducted following the five-step methodology proposed by Sandelowski et al.

Data source
Three databases (Medline, Embase and Scopus) were systematically searched without time restrictions up to 25 May 2024.

Eligibility criteria for selecting studies
Qualitative studies exploring perspectives, experiences and other similar factors were included. These studies were assessed for methodological quality using the Critical Appraisal Skills Programme.

Data extraction and synthesis
The reviewers independently searched, screened and coded the results of the included studies. Data were synthesised using the method proposed by Thomas and Harden.

Results
Seventeen studies were included in the meta-synthesis. Four key dimensions emerged, reflecting both the barriers and the facilitators of multidisciplinary team performances: (1) organisational variables, (2) individual variables, (3) collaborative variables and (4) role variables. A total of 36 variables were identified, which could function as barriers (n=6; eg, high staff turnover), facilitators (n=6; eg, strong listening skills) or both (n=24; eg, team climate), depending on the context.

Conclusions
This meta-synthesis identifies specific barriers and facilitators and variables that can act as both. Understanding these factors enables targeted interventions to enhance the performance of multidisciplinary teams in clinical practice, particularly in acute care settings.

PROSPERO registration number
CRD42022297395.