893 research outputs found
Managerial features and outcome in neonatal intensive care units: results from a cluster analysis
Background: Healthcare organisations differ in performance even if they are located in the same country or region. Suitable managerial practices and organisational processes can lead to better health outcomes. As a result, hospitals are constantly looking for managerial arrangements that can improve outcomes and keep costs down. This study aims to identify different managerial models in neonatal intensive care units (NICUs) and their impact on a large number of outcomes. Methods: The research was conducted in Italy, within the SONAR project. SONARās aim was to identify the characteristics of NICUs, monitor outcomes and promote best practices. This study includes 51 of the 63 NICUs that took part in the SONAR project. Questionnaires on the activities and managerial features were administered to doctors and nurses working in NICUs. A total of 643 questionnaires were analysed from doctors and a total of 1601 from nurses. A cluster analysis was performed to identify managerial models of NICUs. Results: Three managerial models emerged from cluster analysis: traditional, collaborative and individualistic. In the ātraditionalā model the doctor is above the nurse in the hierarchy, and the nurse therefore has exclusively operational autonomy. The ācollaborativeā model has as key elements professional specialisation and functional coordination. The āindividualisticā model considers only individual professional skills and does not concern the organisational conditions necessary to generate organisational effectiveness. The results also showed that there is an association between managerial model and neonatal outcomes. The collaborative model shows best results in almost all outcomes considered, and the traditional model has the worst. The individualistic model is in the middle, although its values are very close to those of traditional model. Conclusions: Health management needs to assess NICU strategically in order to develop models to improve outcomes. This study provides insights for management useful for designing managerial characteristics of NICUs in order to achieve better results. NICUs characterised by a collaborative model in fact show better neonatal outcomes
Transapical off-pump echo-guided mitral valve repair with neochordae implantation mid-term outcomes
Background: The NeoChord echo-guided transapical beating heart repair is a promising early-stage
minimally invasive surgical procedure for degenerative mitral valve (MV) regurgitation (DMR) correction.
The technique has been improved since its inception following procedure standardization, patient selection
optimization, and learning curve stabilization. We hereby present the mid-term clinical results through three
years of our large single center experience.
Methods: All consecutive patients with severe symptomatic DMR due to prolapse or flail of one or both
mitral leaflets that underwent the NeoChord procedure between November 2013 and June 2019 were
included. Patients were categorized according to MV anatomy; Type A isolated central posterior leaflet
prolapse and/or flail, Type B posterior multi-segment prolapse and/or flail, Type C anterior and/or bi-leaflet
prolapse or flail, Type D paracommissural prolapse and/or flail and/or significant leaflet and/or annular
calcifications. Patients underwent clinical and echocardiographic follow-up at one, three, six, twelve months
and yearly thereafter. Clinical outcomes and the composite primary endpoint (patient success) were defined
according to Mitral Valve Academic Research Consortium (MVARC) criteria. Mitral regurgitation (MR)
severity was graded as absent, mild, moderate and severe according to American Society of Echocardiography
(ASE) and European Society of Cardiology (ESC) guidelines.
Results: Two hundred and three patients were included; median follow-up was 24 months [interquartile
range (IQR), 9ā36]. Median age was 64 years (IQR, 54ā74 years), median Society of Thoracic Surgeons
(STS) Predicted Risk of Mortality (PROM) was 0.60% (IQR, 0.32ā1.44%). There were 106 Type A patients
(52.2%), 68 Type B (33.5%), 16 Type C (7.9%), and 13 Type D (6.4%). Kaplan-Meier estimate of survival
was 99.0%Ā±0.7% at one and two years and 94.0%Ā±2.9% at three years. At one-year follow-up patient success
was 91.2%Ā±2.0% and 111 patients (74%) presented a residual MR mild or less (1+). At three-year follow-up
patient success was 81.2%Ā±3.8% and 32 patients (64%) had a residual MR mild or less (1+). Patient success
was significantly different according to anatomical type (P=0.001). Echocardiographic analysis showed a
significant acute left ventricle and left atrial reverse remodeling that was maintained up to three years.
Conclusions: The NeoChord echo-guided transapical beating heart repair procedure demonstrated good
clinical outcomes and echocardiographic results up to three-year follow-up
COVID-19 Vaccinations: Perceptions and Behaviours in People with Primary Ciliary Dyskinesia.
Primary ciliary dyskinesia (PCD) is a rare genetic disease that causes recurrent respiratory infections. People with PCD may be at higher risk of severe coronavirus disease 2019 (COVID-19), and therefore vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is important. We studied vaccination willingness, speed of vaccination uptake, side effects, and changes in social contact behaviour after vaccination in people with PCD. We used data from COVID-PCD, an international participatory cohort study. A COVID-19 vaccination questionnaire was emailed to participants in May 2021 and 423 participants from 31 countries replied (median age: 30 years, range 1ā85 years; 261 (62%) female). Vaccination uptake and willingness were high, with 273 of 287 adults (96%) being vaccinated or willing to be in June 2021; only 4% were hesitant. The most common reason for hesitancy was fear of side effects, reported by 88%. Mild side effects were common, but no participant reported severe side effects. Half of the participants changed their social behaviour after vaccination by seeing friends and family more often. The high vaccination willingness in the study population might reflect the extraordinary effort taken by PCD support groups to inform people about COVID-19 vaccination. Clear and specific information and involvement of representatives is important for high vaccine uptake
Definition of the Prognostic Role of MGMT Promoter Methylation Value by Pyrosequencing in Newly Diagnosed IDH WildāType Glioblastoma Patients Treated with Radiochemotherapy: A Large Multicenter Study
Background. O6āmethylguanine (O6āMeG)āDNA methyltransferase (MGMT) methylation status is a predictive factor for alkylating treatment efficacy in glioblastoma patients, but its prognostic role is still unclear. We performed a large, multicenter study to evaluate the association between MGMT methylation value and survival. Methods. We evaluated glioblastoma patients with an assessment of MGMT methylation status by pyrosequencing from nine Italian centers. The inclusion criteria were histological diagnosis of IDH wildātype glioblastoma, Eastern Cooperative Oncology Group Performance Status (ECOGāPS) ā¤2, and radioāchemotherapy treatment with temozolomide. The relationship between OS and MGMT was investigated with a timeādependent Receiver Operating Characteristics (ROC) curve and Cox regression models. Results. In total, 591 newly diagnosed glioblastoma patients were analyzed. The median OS was 16.2 months. The ROC analysis suggested a cutāoff of 15% for MGMT methylation. The 2āyear Overall Survival (OS) was 18.3% and 51.8% for MGMT methylation <15% and ā„15% (p < 0.0001). In the multivariable analysis, MGMT methylation <15% was associated with impaired survival (p <0.00001). However, we also found a nonālinear association between MGMT methylation and OS (p = 0.002): median OS was 14.8 months for MGMT in 0ā4%, 18.9 months for MGMT in 4ā40%, and 29.9 months for MGMT in 40ā 100%. Conclusions. Our findings suggested a nonālinear relationship between OS and MGMT promoter methylation, which implies a varying magnitude of prognostic effect across values of MGMT promoter methylation by pyrosequencing in newly diagnosed IDH wildātype glioblastoma patients treated with chemoradiotherapy
Search for squarks and gluinos in events with isolated leptons, jets and missing transverse momentum at sā=8 TeV with the ATLAS detector
The results of a search for supersymmetry in final states containing at least one isolated lepton (electron or muon), jets and large missing transverse momentum with the ATLAS detector at the Large Hadron Collider are reported. The search is based on proton-proton collision data at a centre-of-mass energy sā=8 TeV collected in 2012, corresponding to an integrated luminosity of 20 fbā1. No significant excess above the Standard Model expectation is observed. Limits are set on supersymmetric particle masses for various supersymmetric models. Depending on the model, the search excludes gluino masses up to 1.32 TeV and squark masses up to 840 GeV. Limits are also set on the parameters of a minimal universal extra dimension model, excluding a compactification radius of 1/R c = 950 GeV for a cut-off scale times radius (ĪR c) of approximately 30
Evidence for the Higgs-boson Yukawa coupling to tau leptons with the ATLAS detector
Results of a search for H ā Ļ Ļ decays are presented, based on the full set of proton-proton collision data recorded by the ATLAS experiment at the LHC during 2011 and 2012. The data correspond to integrated luminosities of 4.5 fbā1 and 20.3 fbā1 at centre-of-mass energies of ās = 7 TeV and ās = 8 TeV respectively. All combinations of leptonic (Ļ ā `Ī½Ī½ĀÆ with ` = e, Āµ) and hadronic (Ļ ā hadrons Ī½) tau decays are considered. An excess of events over the expected background from other Standard Model processes is found with an observed (expected) significance of 4.5 (3.4) standard deviations. This excess provides evidence for the direct coupling of the recently discovered Higgs boson to fermions. The measured signal strength, normalised to the Standard Model expectation, of Āµ = 1.43 +0.43 ā0.37 is consistent with the predicted Yukawa coupling strength in the Standard Model
Measurements of fiducial and differential cross sections for Higgs boson production in the diphoton decay channel at sā=8 TeV with ATLAS
Measurements of fiducial and differential cross sections are presented for Higgs boson production in proton-proton collisions at a centre-of-mass energy of sā=8 TeV. The analysis is performed in the H ā Ī³Ī³ decay channel using 20.3 fbā1 of data recorded by the ATLAS experiment at the CERN Large Hadron Collider. The signal is extracted using a fit to the diphoton invariant mass spectrum assuming that the width of the resonance is much smaller than the experimental resolution. The signal yields are corrected for the effects of detector inefficiency and resolution. The pp ā H ā Ī³Ī³ fiducial cross section is measured to be 43.2 Ā±9.4(stat.) āā2.9 +ā3.2 (syst.) Ā±1.2(lumi)fb for a Higgs boson of mass 125.4GeV decaying to two isolated photons that have transverse momentum greater than 35% and 25% of the diphoton invariant mass and each with absolute pseudorapidity less than 2.37. Four additional fiducial cross sections and two cross-section limits are presented in phase space regions that test the theoretical modelling of different Higgs boson production mechanisms, or are sensitive to physics beyond the Standard Model. Differential cross sections are also presented, as a function of variables related to the diphoton kinematics and the jet activity produced in the Higgs boson events. The observed spectra are statistically limited but broadly in line with the theoretical expectations
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