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Although flow cytometric analysis of peripheral blood neutrophil myeloperoxidase expression can accurately rule out myelodysplastic neoplasms (MDS), it lacks reliability and efficiency due to the practical limitations of laboratory-developed liquid reagent-based assays. This study aimed to quantify the agreement and comparative discriminatory accuracy between a single-use flow cytometric lyophilised reagent tube (BD Lyotube Stain 468) and its laboratory-developed liquid reagent counterpart.
Cross-sectional diagnostic accuracy study of two index tests against a reference diagnosis.
A university hospital in France.
Consecutive adult patients with an indication for bone marrow aspiration due to suspected MDS and unexplained peripheral blood cytopenia.
MDS confirmed by cytomorphological evaluation of the bone marrow aspirate performed in duplicate by experienced haematopathologists blinded to the index test.
Of 103 participants enrolled between July 2020 and August 2021, 37 had MDS (prevalence, 36%). The median intra-individual robust coefficient of variation (RCV) for myeloperoxidase expression was 30.9% using the BD Lyotube Stain 468 and 31.2% using the laboratory-developed liquid reagent assay, with an intraclass correlation coefficient of 0.94 (95% CI 0.91 to 0.96). The areas under the receiver operating characteristic curves were 0.83 (95% CI 0.74 to 0.90) and 0.82 (95% CI 0.73 to 0.89), respectively. Using a prespecified threshold of 30.0%, the corresponding sensitivity estimates were 89% (95% CI 75% to 97%) and 95% (95% CI 82% to 99%).
BD Lyotube Stain 468 performs as well as its laboratory-developed liquid reagent counterpart for the quantification of myeloperoxidase expression by peripheral blood neutrophils. It may obviate the need for invasive bone marrow aspiration in up to 40% of patients with suspected MDS.
High blood pressure (BP) is a significant global health issue, with many treated patients failing to achieve BP control. The Triple Pill vs Usual Care Management for Patients with Mild-to-Moderate Hypertension (TRIUMPH) trial evaluated the effectiveness, cost-effectiveness and acceptability of early use of low-dose triple fixed-dose combination of BP-lowering drugs (‘triple pill’) compared with usual care in the management of hypertension. The TRIUMPH trial showed superior BP control with the triple pill strategy compared with usual care. This process evaluation of the TRIUMPH trial aimed to explore the contextual factors that influenced the trial outcomes, implementation of the triple pill strategy, mechanisms of its effects and potential barriers and facilitators for implementing the triple pill strategy in routine practice.
Guided by the UK Medical Research Council’s framework, semistructured interviews were conducted with 23 patients and 13 healthcare providers involved in the TRIUMPH trial. Data were analysed using the framework analysis method in NVivo.
Hypertension care in Sri Lanka was hindered by the absence of systematic screening and overcrowded public clinics. Despite free medication provision at public clinics, long waiting times and occasional stock-outs posed challenges. In the TRIUMPH trial, both intervention and usual care were delivered in the context of ‘better than usual’ care, including team-based management, reduced waiting times, monetary assistance for travel, routine adherence monitoring and intensive follow-up. The triple pill strategy provided a simplified regimen, better access to BP-lowering medications and better BP-lowering efficacy. Key barriers to implementation in routine practice included the triple pill’s large size, therapeutic inertia and restrictive regulatory policies regarding fixed-dose combinations.
Implementation of the triple pill strategy into routine practice requires health system strengthening, provider training and supportive policy measures to replicate its effectiveness seen in the trial.
ACTRN12612001120864, SLCTR/2015/020.
To determine prognostic factors of disability in multiple sclerosis (MS), that is, (1) identify determinants of the dynamics of disability progression; (2) study the effectiveness of disease-modifying treatments (DMTs); (3) merge determinants and DMTs for creating patient-centred prognostic tools and (4) conduct an economic analysis.
Individuals registered in the French Observatoire Francais de la Sclérose en Plaques (OFSEP) database were included in this OFSEP-high definition cohort if they had a diagnosis of MS, were ≥15 years old and had an Expanded Disability Status Scale (EDSS) score
A cohort of 2842 individuals, 73.4% women, mean (SD) age of 42.7 (11.6) years, median disease duration of 8.8 years, has been recruited from July 2018 to September 2020. The course of MS was relapsing remitting in 67.7%, secondary progressive in 11.9%. The mean annual relapse rate was 0.98. The disease-modifying treatment received was highly effective therapy in 50.3% and moderately effective therapy in 30.7%.
The participants will be followed until December 2026. Disease course up to four landmarks will be examined as predictors of disease progression: (1) diagnosis of MS; (2) relapse activity worsening and independent progression; (3) any recent disease activity and (4) any visit with absence of disease activity in the past 5 years. The marginal effectiveness and tolerability of treatments will be assessed. Stratified algorithms will be proposed for medical decision-making. Economic evaluation of disease cost and cost-effectiveness of new DMTs will be conducted from a public payer perspective.
by Xuanqi Pan, Katerina Togka, Hilde ten Berge, Lisa de Jong, Harry Groen, Maarten J. Postma, Eleftherios Zervas, Ioannis Gkiozos, Christoforos Foroulis, Kyriaki Tavernaraki, Sofia Lampaki, Georgia Kourlaba, Antonios Moraris, Sofia Agelaki, Konstantinos Syrigos
ObjectiveThis study aimed to assess the cost-effectiveness of lung cancer screening (LCS) employing volume-based low-dose computed tomography (LDCT) in contrast to the absence of screening, targeting an asymptomatic high-risk population in Greece, leveraging the outcomes derived from the NELSON study, the largest European randomized control trial dedicated to LCS.
MethodsA validated model incorporating a decision tree and an integrated state-transition Markov model was used to simulate the identification, diagnosis, and treatments for a population at high risk of developing lung cancer, from a healthcare payer perspective. Screen-detected lung cancers, costs, life years (LYs), quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) were predicted. Sensitivity and scenario analyses were conducted to assess the robustness and reliability of the model’s outcomes under varying parameters and hypothetical situations.
ResultsAnnual LCS with volume-based LDCT detected 17,104 more lung cancer patients at early-stage among 207,885 screening population, leading to 8,761 premature lung cancer deaths averted. In addition, in contrast to no screening, LCS yielded 86,207 LYs gained and 50,207 incremental QALYs at an additional cost of €278,971,940, resulting in an ICER of €3,236 per LY and €5,505 per QALY, over a lifetime horizon. These estimates were robust in sensitivity analyses.
ConclusionsLCS with volume-based LDCT, targeting an asymptomatic high-risk population, is highly cost-effective in Greece. Implementing LCS ensures efficient allocation of public healthcare resources while delivering substantial clinical benefits to lung cancer patients.
This study investigated the association between perceived nursing workload and occupational fatigue in clinical nurses. We specifically focused on how nursing teamwork moderates this relationship.
Hospital nurses often face heavy workloads, leading to significant fatigue. Understanding the link between workload, fatigue and teamwork is crucial to addressing nurse burnout.
A cross-sectional study was conducted among 356 clinical nurses from five educational-therapeutic hospitals in Ardabil, Iran. Data were collected using validated instruments, including the Occupational Fatigue Exhaustion Recovery-15 (OFER) scale, the Quantitative Workload Inventory (QWI) and the Nursing Teamwork Survey (NTS). Hierarchical linear regression analysis assessed the relationships between perceived workload, occupational fatigue and nursing teamwork.
The study's findings show that increased nursing workloads were significantly linked to higher levels of both acute (B = 5.70 to 6.76, p < 0.001) and chronic fatigue (B = 6.71 to 7.16, p < 0.001). Additionally, effective nursing teamwork, comprising trust, team orientation, support, shared mental models and team leadership was associated with reduced fatigue levels.
Our study shows high workloads are linked to increased fatigue among nursing professionals. Teamwork can help lessen the adverse effects of workload on fatigue. Healthcare organisations should focus on optimising workload distribution and strengthening teamwork. Further research is needed to understand these dynamics and develop targeted interventions to support nursing staff in high-demand environments.
The study emphasises the need for healthcare organisations to prioritise workload management and enhance teamwork among nursing staff. Implementing structured workload assessments and fostering a collaborative work environment, along with policies promoting work–life balance, can improve patient care quality, benefit nursing professionals and contribute to a more resilient healthcare system.
To evaluate the effect of a novel, co-designed, digital AF educational program, ‘INFORM-AF’, to reduce re-hospitalisation of people with AF.
The secondary aims are to examine the effect of the intervention on: (a) reducing cardiovascular-related hospitalisation, (b) increasing medication adherence, AF-related knowledge, and Atrial fibrillation (AF)-related quality of life and (c) determining the cost-effectiveness of the intervention.
AF is an increasingly prevalent cardiac arrythmia that involves complex clinical management. Comprehensive education is essential for successful self-management of AF and is associated with positive health-related outcomes. There has been an increase in technology-based education for AF. However, its effects on hospitalisation, medication adherence and patient-reported outcomes are unclear.
A prospective, randomised (1:1), open-label, blinded-endpoint, multicentre clinical trial.
Eligible participants are aged 18 years or above, diagnosed with AF, and own a smartphone. The study will be conducted at two metropolitan hospitals. In the intervention group, participants will receive the AF educational program delivered via Qstream®. In the control group, participants will receive the Stroke Foundation ‘Living with AF’ booklet. The primary outcome is re-hospitalisation within 12 months from an indexed presentation or hospital admission.
This clinical trial is part of a developing program of work that will examine mHealth educational-behavioural interventions on cardiovascular outcomes. Findings from this pilot study will inform the development of a digital educational framework for patients living with AF.
There remain many gaps in providing high-quality patient education for patients with AF. This trial will test a new theory-driven, smartphone-based education program on important clinical outcomes, including rehospitalisation.
This study evaluates a novel, co-designed, digital AF educational program, ‘INFORM-AF’, to reduce the re-hospitalisation of people with AF. Study results are expected to be reported in 2025. Findings are expected to inform practice recommendations for AF patient education that may be included in future clinical practice guideline recommendations.
SPIRIT Checklist.
JL is a consumer co-researcher on the project and provided critical input into intervention design, and feedback and input across the study duration.
Introducción: Las intervenciones que realizamos a los RN ingresados en nuestra unidad pueden causar dolor y estrés, traduciéndose en signos conductuales y fisiológicos. Método: Se realizó un ensayo clínico controlado aleatorizado en la UCI de neonatos durante un año, el objetivo fue conocer si existen diferencias significativas en cuanto al uso de leche materna vs sacarosa 25% como método analgésico no farmacológico en la realización de procedimientos dolorosos (punción venosa y punción del talón). Se usó para evaluar el dolor la escala de Susan Given Bells (antes y tras 2minutos de nuestra intervención). Material: Se incluyeron los recién nacidos entre 25-40 se-manas de gestación y que no cumpliesen criterios de exclusión. Resultados: Se usó para el análisis estadístico la t-student y el test de chi cuadrado, observando como principal resultado que en la extracción venosa (N=59) es más efectivo el uso de leche materna, sufriendo menor aumento del dolor tras la misma(p<0,029). También se observa relación significativa entre la edad gestacional corregida y el dolor tras la extracción venosa, obteniendo que los recién nacidos > 32 semanas tienen mayor aumento de dolor posterior (p<0,011). En la de punción de talón (N=76), no se hallaron diferencias entre la sacarosa y leche materna, tampoco al analizar otras variables (sexo, edad gestacional, crecimiento intrauterino retardado, llanto o canguro) Conclusiones: Se propone el uso de leche materna como método anal-gésico para el control del dolor en punción de talón y extracción venosa. Ya que demuestra su eficacia y carece de efectos secundarios.
Objetivo: analizar los componentes de la Red de Atención Psicosocial (RAPS) orientadas a la atención de adolescentes usuarios de crack. Método: estudio exploratorio y descriptivo con enfoque cualitativo de los datos, desarrollado en el Centro de Atención Psicosocial Alcohol y Drogas (CAPSad) y en el Centro de Atención Psicosocial Infanto-juvenil (CAPSi). Participaron 20 profesionales del CAPSad y 10 del CAPSi. Los datos se recopilaron mediante entrevistas semiestructuradas y se analizaron conforme al Análisis Temático. Resultados: se identificaron como componentes de la RAPS orientadas a la atención de los adolescentes usuarios de crack: Atención Psicosocial Especializada; Atención Residencial de Carácter Transitorio; Atención Hospitalaria – Hospital Psiquiátrico y Atención Primaria – Unidad de Atención Primaria. Conclusión: el desempeño del CAPSad se subrayó en la atención de los adolescentes usuarios de crack, con acciones dirigidas a rescatar los lazos escolares y en entornos más saludables, así como la atención a la familia de estos jóvenes.
FreshRSS 