Panminerva medica最新文献

Background: Clinician-patient rapport is linked to safety, satisfaction, and staff wellbeing, yet large-scale, real-time listening across the National Health Service (NHS) is limited. We examined how public discourse reflects rapport experiences in UK healthcare and assessed the utility of an artificial intelligence-assisted qualitative workflow.

Methods: We conducted an observational qualitative study using reflexive thematic analysis of 5011 publicly available post submissions from the Reddit community r/NHS (1^st January - 31^st December 2024). After cleaning, deduplication, and lexical screening for rapport-related language, a large language model (LLM) supported clustering suggestions and provisional summaries; human researchers led interpretation and theme development. Trustworthiness techniques included analyst triangulation, an audit trail, negative case analysis, and stability checks. Data were non-identifiable and public; research ethics committee review was not required. This study is reported in accordance with the Standards for Reporting Qualitative Research (SRQR).

Results: Five overarching themes were identified: 1) access and delays that erode feelings of being heard; 2) first-contact experiences and gatekeeping at reception/telephone interfaces; 3) professionalism and empathy during clinical encounters; 4) emotional reciprocity and staff wellbeing shaping relational tone; and 5) service variation and perceived inequity across settings. Posts more often described administrative/communication breakdowns than clinical competence issues. Positive narratives highlighted brief empathetic acts that buffered system pressures. Cross-cutting, perceived relational communication moderated how operational strain was experienced. Paraphrased, de-identified exemplars underpin each theme.

Conclusions: Public social-media listening can surface scalable signals about clinician-patient rapport across the NHS. An AI-assisted (LLM-supported) qualitative workflow is feasible and enhances, rather than replaces, human interpretation. Findings suggest targeting first-contact communication and access processes, while aligning patient-facing empathy with staff support.

Background: Achieving optimal skin scarring after surgery is a major concern for patients and physicians worldwide. An innovative form of photobiomodulation, namely Fluorescent Light Energy (FLE), is increasingly used in clinical settings as an adjunct to the Standard of Care (SoC) to treat wounds. In Italy, a post-market observational investigation using data from the Patient and Observer Scar Assessment Scale (POSAS) was conducted to confirm the effectiveness of FLE in managing post-abdominoplasty scars as an adjunct to standard of care (SoC).

Methods: The observational investigation involved the POSAS data of 27 patients treated with FLE treatment, namely LumiHeal. LumiHeal was applied for four weeks during dressing changes following surgery. POSAS questionnaires administered during follow-up visits at three (FU1) and six (FU2) months after surgery were investigated. POSAS scores' percentage decrease and statistically significant P value were calculated.

Results: The results showed a significant decrease in the mean values on POSAS Total Scores from FU1 to FU2, and on each sub-scale of the Observer POSAS, as well as on the Patient POSAS on colour, indicative of healthy healing and aesthetically pleasing scar outcomes. In addition, no patient developed complications, including wound dehiscence or infections, or skin lesions due to FLE applications.

Conclusions: Observational POSAS data evaluation reveals to be a valid tool, suggesting that LumiHeal FLE treatment was an effective adjunctive treatment to the SoC on 27 patients in a real-life setting as an Italian clinic for postoperative scar management.

Cardiac rehabilitation (CR) is a cornerstone in the management of patients recovering from myocardial infarction (MI), significantly improving survival, functional capacity, and quality of life. Recent evidence highlights the critical importance of early initiation of rehabilitation, ideally within days to weeks following the acute event. Early cardiac rehabilitation facilitates prompt recovery of cardiovascular function, reduces complications, and enhances patient motivation and adherence to therapeutic regimens. The multidimensional nature of modern CR programs addresses not only physical reconditioning but also psychological, nutritional, and social factors, recognizing the complex interplay affecting patient outcomes. Physical exercise training, tailored to individual risk profiles and functional status, promotes myocardial perfusion, endothelial function, and autonomic balance. Concurrently, psychosocial support targets anxiety, depression, and stress, common sequelae post-MI, which are known to influence prognosis negatively. Nutritional counseling ensures optimal dietary patterns that support cardiovascular health, while smoking cessation and risk factor management are integral components. The multidisciplinary team - comprising cardiologists, physiotherapists, dietitians, psychologists, and nurses - collaborates to develop personalized care plans that maximize patient engagement and long-term adherence. Early, multidimensional cardiac rehabilitation ultimately reduces rehospitalization rates and mortality, improving comprehensive health outcomes. This review underscores the value of initiating rehabilitation promptly after MI and implementing a holistic approach to enhance recovery, prevent recurrent events, and promote sustained lifestyle changes.

Background: Malnutrition is associated with poor outcomes. Exocrine pancreatic insufficiency (EPI) may be an overlooked factor contributing to malnutrition. Early nutritional support improves the prognosis of critically ill patients. The effect of pancreatic enzyme preparations on nutritional status and prognosis in critically ill patients requires further study.

Methods: An exploratory, single-center, randomized controlled trial was conducted in critically ill adult patients. A total of 768 patients admitted to the Department of Critical Care Medicine between November 2021 and August 2022 were screened, and 317 patients who met the inclusion criteria were randomized into the pancreatic enzyme replacement therapy (PERT) group or the non-pancreatic enzyme replacement therapy (NOT PERT) group. Neither group received a specific enteral nutrition formula. The formula was selected according to the patient's condition to provide the required calories and protein. The primary outcome was the change in the cross-sectional area of the rectus femoris muscle (RFCSA). Secondary outcomes included changes in rectus femoris muscle echogenicity, retinol-binding protein, and prealbumin levels; duration of mechanical ventilation; APACHE II scores; and 14-day and 28-day mortality. This trial was registered in ChiCTR under identifier 2100052385.

Results: RFCSA decreased over time. PERT combined with enteral nutrition appeared to slow the decline in RFCSA but had no significant effect on rectus femoris muscle echogenicity. PERT had no significant effect on retinol-binding protein, prealbumin, or the duration of mechanical ventilation. No significant differences were observed in APACHE II scores, 14-day mortality, or 28-day mortality.

Conclusions: PERT may serve as an effective adjunct to nutritional support in critically ill patients.

Introduction: Limitations in mobility caused by pain, injury, or external immobilization can lead to adverse neuroplastic changes affecting the brain, the nervous system, and sensorimotor function. Mental imagery (MI) has been proposed as a non-invasive, low-cost intervention that may help mitigate these negative effects during periods of immobilization following surgery or trauma. This systematic review and meta-analysis aims to analyse the effects of MI applied during post-surgical or post-traumatic immobilization.

Evidence acquisition: A systematic literature search was performed in the databases PubMed, CINAHL, Web of Science, Medline, and PEDro. The methodological quality of the included studies was assessed using the PEDro scale, and the risk of bias was evaluated with the Cochrane RoB 2 tool. Only randomized controlled trials were included.

Evidence synthesis: A total of 11 studies met the inclusion criteria. Overall, the studies showed moderate methodological quality and a high risk of bias. The meta-analysis revealed a statistically significant effect on pain reduction in favour of mental imagery, with a Hedges' g of 1.187 (95% CI: 0.492 to 1.882; P=0.001). Additionally, several studies reported improvements in secondary outcomes such as range of motion, muscle strength, mental health, and quality of life.

Conclusions: MI appears to be a beneficial intervention to reduce pain in patients undergoing immobilization after surgery or trauma. Moreover, promising effects have been observed on range of motion, strength, mental health, and quality of life, supporting its inclusion as a complementary strategy in rehabilitation settings.

Background: This prospective observational study aimed to evaluate the efficacy and safety of a new multicomponent medical device containing Gingigel Pro^®, sodium alginate, Tamarindus indica, hyaluronic acid, and vegetal extracts in patients with laryngopharyngeal reflux disease (LPRD).

Methods: Twenty-two adult patients (13 females, 9 males; mean age: 49.9 years) with a clinical diagnosis of LPRD (R-RSI ≥18 and RSA >14) were enrolled. All patients were treated with the device (one stick twice daily for 2 months) and received standardized behavioral and dietary counseling. Assessments were performed at baseline and after treatment using the Revised Reflux Symptom Index (R-RSI), Voice Handicap Index-10 (VHI-10), and Reflux Sign Assessment (RSA). Patients were stratified into three subgroups based on symptom duration: 0-4 months, 5-8 months, and ≥9 months. Statistical analyses evaluated changes in total and item-specific scores across the overall population and subgroups. Tolerability and adverse events were also recorded.

Results: All outcome scores improved significantly after treatment (P<0.0001 for R-RSI, VHI-10, and RSA). The proportion of patients with pathological R-RSI scores decreased from 100% to 9.1%, and with pathological RSA scores from 100% to 59.1%. Most R-RSI items improved significantly. Specific RSA signs related to acute inflammation (e.g., erythema and edema of the uvula, epiglottis, and vocal folds) also showed significant improvement. No adverse events were reported. Subgroup analysis showed that both symptoms and objective signs improved in all subgroups, with the greatest reductions observed in patients with symptom onset within 0-4 months.

Conclusions: This study provides the first clinical evidence that the tested multicomponent device is effective and safe in improving both subjective symptoms and objective signs of LPRD. The observed greater benefit in patients with recent symptom onset supports early intervention. These findings are consistent with current recommendations that prioritize non-acid-suppressive agents in LPRD management. Further randomized controlled trials are warranted.

Obesity is a chronic disease associated with multiple health risks. Multimodal treatments including lifestyle interventions, pharmacotherapies and bariatric surgery should be the standard of care for obesity management. Bariatric surgery remains the most effective treatment yielding to sustainable weight loss (WL) of about 20-30%. Having understood better the role of the gut-brain axis on appetite, the field of obesity pharmacotherapy has been advancing rapidly. The recent approvals for glucagon-like peptide-1 (GLP-1) receptor agonist (RA) semaglutide 2.4 mg and the dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) agonist tirzepatide as treatments for obesity have raised the bar for WL efficacy for the emerging obesity pharmacotherapies. Combining GLP-1 RA and other entero-pancreatic hormones including GIP, glucagon or amylin receptor agonists (RAs) as well as GIP receptor antagonists have shown promising data in early phases of clinical trials, with some progressing to phase III clinical trials. Notably, the combinations of GLP-1 RA, GIP and glucagon RA (retatrutide) have shown WL efficacy closing on to that observed in bariatric surgery. While entero-pancreatic hormone-based therapies have been the centre of attention for obesity pharmacotherapies, non- entero-pancreatic hormone treatments also hold promise. In this review, we present the future pharmacotherapies for weight management in people with obesity, focusing on entero-pancreatic hormone-based molecules.