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Introduction
Benzodiazepine receptor agonists (BZRA) deprescribing interventions are needed to tackle high BZRA use in the older population. This study aims to assess the feasibility of the D-PRESCRIBE intervention, adapted from Canada to the Belgian community setting. This pharmacist-led intervention comprises a patient educational brochure and a pharmacist-to-prescriber communication tool.

Methods and analysis
We will conduct a feasibility study of a cluster randomised controlled trial involving 8–10 community pharmacies (clusters) and aiming to recruit 56–80 patients (≥65 years). Intervention pharmacies will deliver the adapted D-PRESCRIBE intervention and control pharmacies, usual care. Patients will be blinded to group allocation. Quantitative data will be collected at baseline, 3 months and 6 months through patients’ and pharmacists’ questionnaires, aiming: (1) to test the feasibility of the intervention, (2) to test the feasibility of the study design needed for its evaluation and (3) to perform an exploratory cost-effectiveness analysis. Hence, data about implementation outcomes, mechanisms of impact (ie, mechanisms through which the intervention is supposed to be effective) and contextual factors will be gathered. Patient-centred outcomes will also be collected as they would be in a full cost-effectiveness trial. The feasibility of the study design will be assessed through participation rate, completeness of the data and a satisfaction survey, sent to participants after the 6-month data collection. Data will be analysed using descriptive statistics. To gain a deeper understanding of pharmacists and patients’ experience with the intervention, interviews will be conducted after the 6-month data collection and the Theoretical Domains Framework will be used as a deductive framework for analysis.

Ethics and dissemination
This study was approved by the Ethics Committee of CHU UCL Namur (NUB: B0392023000036). Participants will receive a summary of the results. Results will also be disseminated through the organisation of a local symposium and a peer-reviewed publication.

Trial registration number
NCT05929417.

Objectives
Transient loss of consciousness (TLOC) is one of the most common neurological complaints in the Emergency Department (ED), but little is known about the patient perspective. We aimed to explore patient perceptions of diagnostic assessment for TLOC.

Setting
ED, Acute Medical Unit and Syncope and Neurology clinics in a single tertiary teaching hospital in the north of England.

Participants
20 adult patients (60% female, age range 17–90 years) attending or referred with a first presentation of TLOC.

Primary and secondary outcome measures
Exploratory thematic analysis of semistructured qualitative interviews.

Results
We identified three themes within the data: satisfaction with care, unanswered questions and being left in limbo/no man’s land. Participants explored these themes through four topics: communication; the role of investigations; the role of authority and the social context of care.

Conclusions
Communication (including differential diagnosis, significance of investigations and further assessments, and interim safety advice) is emphasised in supporting ongoing self-management, even before a definitive diagnosis is made.

We read with great interest the work of Rui and colleagues, who developed and validated a machine learning-based model to predict the risk of moderate to severe hepatic inflammation in chronic hepatitis B patients with concurrent hepatic steatosis.1 The authors assessed the model’s performance in terms of discrimination, calibration and clinical utility within the training cohort. Calibration performance was evaluated using a calibration curve. Additionally, two validation cohorts were used for external validation, employing the same methods for discrimination, calibration and clinical utility as described above.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Background
Telemonitoring is a promising approach to facilitate patients’ self-management and improve health outcomes, especially among people with chronic health conditions. Yet, many healthcare organisations struggle to implement telemonitoring successfully. IT identity, an individual’s self-identification with an information technology (IT) tool, has been suggested to strongly predict and shape the use of technology. IT identity is related to three emotional responses: emotional energy, dependence and relatedness.

Objective
To explore how healthcare professionals’ IT identity is shaped, and how it affects their attitude towards and intended use of telemonitoring.

Design
Qualitative, semistructured interview study.

Setting
Primary care and hospitals (general and academic) in the Netherlands.

Participants
Sixteen nurses, pulmonologists, general practitioners and researchers working in chronic obstructive pulmonary disease (COPD) care.

Results
Participants expressed varying emotional responses regarding the use of telemonitoring. We associated participants’ responses with the three dimensions of IT identity. Regarding emotional energy, some expressed pride in innovating, while others lacked faith in using telemonitoring. Regarding dependence, different perceived intentions and needs for using telemonitoring were identified: to coach patients, prevent deterioration of health, achieve logistical advantages for patients and preserve the accessibility of healthcare. Regarding relatedness, some participants expressed a strong external but weak internal motivation to use telemonitoring.
Based on emotional responses, we identified five manifestations of IT identity that illustrate how different healthcare professionals use telemonitoring in COPD care: the Scientist, Innovator, Protector, Empowerer and Conversationalist. These manifestations differ in their readiness to innovate and in their beliefs what it means to be a good healthcare provider: to protect or to coach.

Conclusion
Healthcare professionals’ emotional energy, dependence and relatedness regarding telemonitoring in COPD care shaped their IT identity and how they used telemonitoring. Implementation strategies tailored towards the five manifestations of IT identity could help the sustainable implementation of telemonitoring in clinical practice.

Objectives
Incontrovertible evidence surrounds the need to support healthcare professionals after patient safety incidents (PSIs). However, what characterises effective organisational support is less clearly understood and defined. This review aims to determine what support healthcare professionals want for coping with PSIs, what support interventions/approaches are currently available and which have evidence for effectiveness.

Design
Systematic research review with narrative synthesis.

Data sources
Medline, Scopus, PubMed and Web of Science databases (from 2010 to mid-2021; updated December 2022), reference lists of eligible articles and Connected Papers software.

Eligibility criteria for selecting studies
Empirical studies (1) containing information about support frontline healthcare staff want before/after a PSI, OR addressing (2) support currently available, OR (3) the effectiveness of support to help prevent/alleviate consequences of a PSI. Study quality was appraised using the Quality Assessment for Diverse Studies tool.

Results
Ninety-nine studies were identified. Staff most wanted: peer support (n=28), practical support and guidance (n=27) and professional mental health support (n=21). They mostly received: peer support (n=46), managerial support (n=23) and some form of debrief (n=15). Reports of poor PSI support were common. Eleven studies examined intervention effectiveness. Evidence was positive for the effectiveness of preventive/preparatory interventions (n=3), but mixed for peer support programmes designed to alleviate harmful consequences after PSIs (n=8). Study quality varied.

Conclusions
Beyond peer support, organisational support for PSIs appears to be misaligned with staff desires. Gaps exist in providing preparatory/preventive interventions and practical support and guidance. Reliable effectiveness data are lacking. Very few studies incorporated comparison groups or randomisation; most used self-report measures. Despite inconclusive evidence, formal peer support programmes dominate. This review illustrates a critical need to fund robust PSI-related intervention effectiveness studies to provide organisations with the evidence they need to make informed decisions when building PSI support programmes.

PROSPERO registration number
CRD42022325796.

pearls slipping off a string, one slick diver followed by another, round and containing light, pried from a cool oyster shell and brought out to swelter in summer,

Introduction
The PRIME-UK randomised controlled trial (RCT) aims to establish whether a model of care that seeks to be proactive, integrated and empower participants, caregivers and healthcare professionals can improve outcomes in people with parkinsonism. Given that this intervention is novel and complex, understanding whether and how the intervention will be acceptable, implementable, cost-effective and scalable across contexts are key questions beyond that of whether ‘it works’. We describe an embedded process evaluation to answer these questions, which aims to support interpretation of the trial results, refinement of the intervention and support future scaling of the PRIME-Parkinson model of care.

Methods and analysis
A mixed-methods approach will be used to collect data across four process evaluation domains: implementation, mechanism of change, acceptability and context. Quantitative data will be collected prospectively from all participants and analysed descriptively with exploratory tests of relationships as power allows. Qualitative data will be collected through semistructured interviews with a purposively sampled subpopulation of participants, caregivers and staff members as well as case studies where relevant. Interview transcripts will be analysed thematically using interpretive qualitative analysis. Synthesis of quantitative and qualitative data will also be performed to draw conclusions.

Ethics and dissemination
The quantitative data will be collected as part of the main PRIME-UK RCT which was been granted NHS REC approval (21/LO/0387) on 27 July 2021. The qualitative data will be collected as part of a substudy, ‘PRIME-Qual’, which was granted NHS REC approval (21/LO/0388) on 14 July 2021. The mixed-methods process evaluation will be published after the conclusion of the trial in addition to the main trial findings.

Trial registration number
NCT05127057.

Circulation, Ahead of Print. BACKGROUND:Patients with acute myocardial infarction and angiographically obstructive non-culprit lesions are at high risk for recurrent major adverse cardiac events (MACEs). However, it remains largely unknown whether events are due to stenosis severity or due to the underlying high-risk lesion morphology.METHODS:Between January 2017 and December 2021, 1312 patients with acute myocardial infarction underwent optical coherence tomography of all the 3 main epicardial arteries after successful percutaneous coronary intervention. Patients and lesions were categorized according to the presence or absence of (1) 1 or more non-culprit angiographic obstructive stenoses with a visual diameter stenosis of ≥50% and (2) 1 or more lesions with an underlying high-risk morphology defined as an optical coherence tomography thin-cap fibroatheroma (TCFA). Patients were followed for up to 5 years (median 4.1 [interquartile range: 3.0–5.0] years). MACEs comprised cardiac death, non-fatal myocardial infarction, and unplanned coronary revascularization.RESULTS:Overall, 492 patients had at least 1 obstructive non-culprit lesion, 352 had a single lesion, and 140 had multiple obstructive non-culprit lesions. The presence and number of angiographic obstructive non-culprit lesions correlated with the proportion and number of optical coherence tomography–derived TCFAs. At the lesion level, the prevalence of TCFA was twice as high in obstructive lesions compared with nonobstructive lesions. Patients with obstructive non-culprit lesions had an increased risk of overall MACEs (17.7% versus 12.8%; hazard ratio, 1.39 [95% CI, 1.02–1.91]) and non-culprit lesion–related MACEs (8.7% versus 3.9%; HR, 2.13 [95% CI, 1.26–3.59). Results were similar when patients were categorized on the basis of the underlying TCFA. A proportionally higher rate of overall and non-culprit lesion–related MACEs was observed as the number of obstructive stenoses or TCFAs in non-culprit segments increased. The lesion-specific HRs for obstructive lesion and TCFA were 2.03 (95% CI, 1.06–3.89) and 2.39 (95% CI, 1.29–4.43), respectively. Optical coherence tomography–derived TCFA, but not angiographic obstructive stenosis, was independently predictive of recurrent MACEs in both patient-level and lesion-level multivariable models in which these 2 characteristics were introduced simultaneously.CONCLUSIONS:The long-term prognostic implications of the presence and extent of angiographic obstructive non-culprit lesions in patients with acute myocardial infarction are primarily due to their correlation with the underlying high-risk morphology, which confers an increased risk of recurrent MACEs.

Stroke, Volume 56, Issue Suppl_1, Page AWP84-AWP84, February 1, 2025. Purpose:Decreasing door to needle and door to transfer times drives patient outcomes. When treating acute stroke patients, time is brain. The shorter the door to treatment time the faster patients can receive the thrombolytic therapy. The rapidly evolving use of telemedicine in acute stroke is state-of-the-art for identifying therapeutic indications such as IV thrombolysis and mechanical thrombectomy in patients with large vessel occlusion (LVO) (Schröter et al., 2023).Method:Our facility is a Joint Commission certified Primary Stroke Center with two Acute Stroke Ready certified freestanding emergency departments (ED), caring for >67,000 patients a year with >700 being diagnosed with stroke. In 2023 our EDs transferred 35 patients with an LVO and 21 year to date in 2024.A review of data illustrated an opportunity with our teleneurology program, staffed by an internal team of neurologists from our comprehensive stroke center. The development of the teleneurology program began at our health system in March 2021. ED providers had the ability to consult teleneurology, via telephone or video consult. When first launched, the new process was inconsistent.Through ongoing chart audits, we identified ED providers were reliant on the recommendations from the teleneurologists. Upon review, a barrier to care was identified which caused delays in door to decision. In November 2023, we implemented a new stroke alert process, mandating that all stroke alert activations automatically received a teleneurology consult. By refining the process, we have demonstrated improvements in our door to needle and door to transfer times. Since the therapeutic success is strongly dependent on time, an early, accurate decision-making process is essential for timely transfer of the patient to a mechanical thrombectomy-competent center for appropriate stroke-oriented imaging and therapy (Schröter et al., 2023).Results:Post-implementation, our door in door out times decreased by 20% within eight months. Our median door in door out time decreased by 22.5 minutes. Of the LVO’s we have transferred, five patients were transferred in

Stroke, Volume 56, Issue Suppl_1, Page ATP9-ATP9, February 1, 2025. Introduction:Tenecteplase (TNK) is now an accepted alternative to Alteplase (ALT) for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Hemorrhagic transformation (HT), a complication of IVT, is more frequent in acute hyperglycemia and diabetes (DM) and is associated with poor clinical outcomes. We previously reported better clinical outcomes in DM patients treated with TNK. In this study we explored if HT is associated with the observed less favorable outcomes in ALT-treated DM patients.Methods:In this 4-year retrospective cohort of AIS patients from 2 comprehensive stroke centers, DM was defined by known history, antidiabetic medication use, and admission glycated hemoglobin ≥6.5%. Time to IVT was grouped as ultra-early (0-90 min), early (91-180 min), and late (181-270 min). Peripheral blood indices, neutrophil to lymphocyte ratio (NLR), and systemic immune inflammation index (SII) were used to assess acute immune response at admission and 24 hours. Non-parametric tests compared intergroup differences with statistical significance at p-value

Objective
To describe, through the phenomenological lens, the experiences of mothers following preterm birth and admitted at a tertiary hospital.

Methods

Design
Descriptive phenomenological study.

Setting
Neonatal intensive care unit (NICU) of a tertiary hospital in Ghana.

Population
Mothers who delivered prematurely and were admitted.

Main outcome measures
Experiences of mothers who delivered prematurely and had their neonates admitted to the NICU.

Results
Four themes and three subthemes were realised: (1) maternal anxiety about unknown outcomes of the newborn condition, (2) the positive impact of family-centred care, (3) maternal roles for preterm care and (4) poor support for maternal involvement in care.

Conclusions
Mothers of preterm newborns sustained varying degrees of emotional trauma and faced challenges that deprived them of active involvement in their newborn care. Despite these, family-centred care was impactful and gave a window of opportunity for mothers to provide maternal roles. We highly recommend tailored emotional and psychological supports for mothers who have delivered prematurely, as it is crucial to ensuring both maternal and neonatal survival.

Objective
To explore awareness and acceptance of menstrual cups and associated factors among healthcare professionals in Wolaita Zone, South Ethiopia.

Design
Institution-based cross-sectional study.

Setting
The current study was carried out among governmental health facilities in Wolaita Zone, South Ethiopia Regional State between 1 September and 30 September 2023.

Participants
Using a simple random sampling technique, 425 healthcare providers were selected. Data were collected using a self-administered, pre-tested questionnaire.

Outcome measures
The data were entered using Epi-data version 3.1, and after being exported, were analysed using SPSS version 25. Bivariate and multivariable logistic regression analyses were carried out to identify relevant components. An adjusted OR and a 95% CI were used to report the relationship between the covariates and the outcome variable.

Results
The level of awareness towards menstrual cups was 16.2% (95% CI 12.9% to 19.8%). Type of healthcare profession 5.75 (aOR=5.75, 95% CI 1.94 to 17.01), the use of broadcast media 4.40 (aOR=4.40, 95% CI 1.80 to 10.70), and social media use (aOR=3.24, 95% CI 1.53 to 6.88) were significantly associated with awareness towards menstrual cups.

Conclusion
The awareness of menstrual cups among female healthcare providers was incredibly low. Type of healthcare profession, broadcast media, and social media use were the main determinants of menstrual cup awareness. Therefore, both government and non-governmental organisations should focus on promoting and providing menstrual cups nationwide.

Objectives
There is a paucity of qualitative research exploring the patient experience of living with a meniscal tear, vital to effective patient management. The aim of this study was to explore the experiences and expectations of treatment of patients aged 18–55 years with a meniscal tear of the knee.

Design
Qualitative study involving semistructured interviews.

Setting
Participants were selected from nine secondary care centres in England.

Participants
10 participants diagnosed with a meniscal tear were recruited from the Meniscal Tear Outcome cohort study using a purposive sampling strategy until data saturation was achieved. Semistructured interviews were conducted between April and May 2021 and thematic analysis was used to identify key patient experiences.

Results
Themes identified relate to the broad areas of symptoms, clinical consultation and experience of treatment. Meniscal tears have a profound impact on pain and many patients experience effects on their family and financial life in addition to physical symptoms. Participants expected most of their management to occur in secondary care and most thought surgery would be a definitive treatment, while they believed the effectiveness of physiotherapy could not be guaranteed as it would not fix the physical tear.

Conclusion
This study is one of the first to explore patient experiences of a meniscal tear and their perceptions of treatment options. Patient experiences and perceptions are important for clinicians to understand in order to provide the best possible care. It is important to elicit these experiences, listen to the patient, discuss their perspectives and build these experiences and expectations into clinical care.

Trial registration number
ISRCTN11534691.