104 research outputs found
Effectiveness of communicative and educative strategies in chronic low back pain patients: A systematic review
Objective: To investigate the effectiveness of communicative and educative strategies on 1) patient's low back pain awareness/knowledge, 2) maladaptive behavior modification and 3) compliance with exercise in patients with chronic low back pain. Methods: A systematic review was conducted. Searches were performed on 13 databases. Only randomized controlled trials enrolling patients 65 18 years of age were included. Risk of bias was assessed with the Cochrane Collaboration's tool and interrater agreement between authors for full-texts selection was evaluated with Cohen's Kappa. No meta-analysis was performed and qualitative analysis was conducted. Results: 24 randomized controlled trials which intervention included communicative and educative strategies were selected. Most of the studies were judged as low risk of bias and Cohen's Kappa was excellent ( = 0.822). Interventions addressed were cognitive behavioral therapy as unique treatment or combined with other treatments (multimodal interventions), coaching, mindfulness, pain science education, self-management, graded activity and graded exposure. Conclusions, practice implication: Patient's low back pain awareness/knowledge is still a grey area of literature. Pain science education, graded exposure and multimodal interventions are the most effective for behavior modification and compliance with exercise with benefits also in the long-term, while self-management, graded activity and coaching provide only short-term or no benefits
Sleep/wake rhythm modifications in the Italian population during SARS-CoV2 pandemic: a web-based cross-sectional survey.
Abstract. – OBJECTIVE: The study aims to
investigate in a representative sample of the
Italian population whether the SARS-CoV2 pandemic and the subsequent home isolation had
repercussion on the daily sleep/wake cycling
and habits.
MATERIALS AND METHODS: A web-based
cross-sectional survey consisted of various multiple-choice questions concerning demographic characteristics, sleep habits, and sleep-related problems was broadcast through mainstream social-media. Individuals were randomly allowed to participate from April 29th to May
17th, namely 50 days after the lockdown imposition and the day before its abrogation.
RESULTS: 58.84% of respondents experienced a change in their sleep habits. 71% of
those whose sleep changed showed a delayed
sleep pattern. Overall, a two-fold risk of delayed
sleep pattern without any change in total sleep
time emerged during the investigation period.
Females emerged almost 2 times more likely
to modify their sleep habits than males. Youths
were also more likely to experience modifications than old people, who conversely appeared
protected. A significant improvement in daytime
sleepiness occurred during the home isolation
which additionally correlated with delayed bedtime and less sleep time.
CONCLUSIONS: A high rate of change in
sleep habits, especially among youths and females, occurred in Italian population during the
home isolation to limit the SARS-CoV2 pandemic. Moreover, self-reported daytime sleepiness
decreased in severity
Prevalence and incidence of low back pain among runners: A systematic review
Background: Running is one of the most popular sports worldwide. Despite low back pain (LBP) represents the most common musculoskeletal disorder in population and in sports, there is currently sparse evidence about prevalence, incidence and risk factors for LBP among runners. The aims of this systematic review were to investigate among runners: prevalence and incidence of LBP and specific risk factors for the onset of LBP. Methods: A systematic review has been conducted according to the guidelines of the PRISMA statement. The research was conducted in the following databases from their inception to 31st of July 2019: PubMed; CINAHL; Google Scholar; Ovid; PsycINFO; PSYNDEX; Embase; SPORTDiscus; Scientific Electronic Library Online; Cochrane Library and Web of Science. The checklists of The Joanna Briggs Institute Critical Appraisal tools were used to investigate the risk of bias of the included studies. Results: Nineteen studies were included and the interrater agreement for full-text selection was good (K = 0.78; 0.61-0.80 IC 95%). Overall, low values of prevalence (0.7-20.2%) and incidence (0.3-22%) of LBP among runners were reported. Most reported risk factors were: running for more than 6 years; body mass index > 24; higher physical height; not performing traditional aerobics activity weekly; restricted range of motion of hip flexion; difference between leg-length; poor hamstrings and back flexibility. Conclusions: Prevalence and incidence of LBP among runners are low compared to the others running related injuries and to general, or specific population of athletes. View the low level of incidence and prevalence of LBP, running could be interpreted as a protective factor against the onset of LBP. Systematic review registration: PROSPERO CRD42018102001
Comorbidity and in-hospital mortality in peritoneal dialysis patients: data of the Emilia Romagna region of Italy
Objective: Kidney failure increases in-hospital mortality (IHM); however, comorbidity is crucial for predicting mortality in dialysis patients. Our aim was to evaluate the impact of comorbidity, assessed by modified Elixhauser index (mEI), Charlson Comorbidity Index (CCI), and age-adjusted CCI, on IHM in a cohort of peritoneal dialysis patients admitted to hospitals of the Emilia Romagna region (ERR) of Italy. Patients and methods: All hospital admissions of peritoneal dialysis patients recorded between 2007 and 2021 in the ERR database were analyzed. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) was used for detecting diagnoses and procedures, and the inclusion criterion was code 5498. Comorbidity burden was evaluated by three different scores, and hemodialysis (HD) treatment need was considered. IHM was our outcome. Results: During the 15 years of the study, 3,242 hospitalized peritoneal dialysis patients (62.7% males) were evaluated. Mean age was 62.8±20.6 years, 9.6% underwent HD, and IHM was 5.9% (n=192). IHM mortality was stable throughout the study period. Deceased subjects were older, were hospitalized longer, had a higher comorbidity burden, and had a higher percentage of HD treatment needs than survivors. Age, male sex, comorbidity burden, and HD treatment were predictors of IHM. Receiver operating characteristics (ROC) analysis confirmed the impact of comorbidity burden on IHM, especially when age was considered. Conclusions: We conclude that in male, elderly hospitalized peritoneal dialysis patients with failing dialysis technique, comorbidity burden should be considered being a predictor of IHM
Ultrasonography of quadriceps femoris muscle and subcutaneous fat tissue and body composition by BIVA in chronic dialysis patients
Protein Energy Wasting (PEW) in hemodialysis (HD) patients is a multifactorial condition due to specific pathology-related pathogenetic mechanisms, leading to loss of skeletal muscle mass in HD patients. Computed Tomography and Magnetic Resonance Imaging still represent the gold standard techniques for body composition assessment. However, their widespread application in clinical practice is difficult and body composition evaluation in HD patients is mainly based on conventional anthropometric nutritional indexes and bioelectrical impedance vector analysis (BIVA). Little data is currently available on ultrasound (US)-based measurements of muscle mass and fat tissue in this clinical setting. The purpose of our study is to ascertain: (1) if there are differences between quadriceps rectus femoris muscle (QRFM) thickness and abdominal/thigh subcutaneous fat tissue (SFT) measured by US between HD patients and healthy subjects; (2) if there is any correlation between QRFM and abdominal/thigh SFT thickness by US, and BIVA/conventional nutritional indexes in HD patients. We enrolled 65 consecutive HD patients and 33 healthy subjects. Demographic and laboratory were collected. The malnutrition inflammation score (MIS) was calculated. Using B-mode US system, the QRFM and SFT thicknesses were measured at the level of three landmarks in both thighs (superior anterior iliac spine, upper pole of the patella, the midpoint of the tract included between the previous points). SFT was also measured at the level of the periumbilical point. The mono frequency (50 KHz) BIVA was conducted using bioelectrical measurements (Rz, resistance; Xc, reactance; adjusted for height, Rz/H and Xc/H; PA, phase angle). 58.5% were men and the mean age was 69 (SD 13.7) years. QRFM and thigh SFT thicknesses were reduced in HD patients as compared to healthy subjects (p < 0.01). Similarly, also BIVA parameters, expression of lean body mass, were lower (p < 0.001), except for Rz and Rz/H in HD patients. The average QRFM thickness of both thighs at top, mid, lower landmarks were positively correlated with PA and body cell mass (BCM) by BIVA, while negatively correlated with Rz/H (p < 0.05). Abdominal SFT was positively correlated with PA, BCM and basal metabolic rate (BMR) (p < 0.05). Our study shows that ultrasound QRFM and thigh SFT thicknesses were reduced in HD patients and that muscle ultrasound measurements were significantly correlated with BIVA parameters
A hybrid approach to clinical guideline and to basic medical knowledge conformance
Abstract. Several computer-based approaches to Clinical Guidelines have been developed in the last two decades. However, only recently the community has started to cope with the fact that Clinical Guidelines are just a part of the medical knowledge that physicians have to take into account when treating patients. The procedural knowledge in the guidelines have to be complemented by additional declarative medical knowledge. In this paper, we analyse such an interaction, by studying the conformance problem, defined as evaluating the adherence of a set of performed clinical actions w.r.t. the behaviour recommended by the guideline and by the medical knowledge
Enrollment of Neonates in More Than One Clinical Trial
Because the highest rates of morbidity and mortality in neonates are seen in those born at 1 clinical trial. Neonatal units that have the infrastructure and resources to engage in research frequently face the question of whether it is permissible to enroll a neonate in >1 trial. This article examines the pertinent scientific, ethical, regulatory, and industry issues that should be taken into account when considering enrolling neonates in multiple clinical studies
Testing Careflow Process Execution Conformance by Translating a Graphical Language to Computational Logic
Careflow systems implement workflow concepts in the clinical domain
in order to administer, support and monitor the execution of health care
services performed by different health care professionals and structures. In this
work we focus on the monitoring aspects and propose a solution for the conformance
verification of careflow process executions.
Given a careflow model, we have defined an algorithm capable of translating it
to a formal language based on computational logic and abductive logic programming
in particular. The main advantage of this formalism lies in its operational
proof-theoretic counterpart, which is able to verify the conformance of a given
careflow process execution (in the form of an event log) w.r.t. the model.
The feasibility of the approach has been tested on a case study related to the
careflow process described in the cervical cancer screening protocol
Agent Societies and Service Choreographies: a Declarative Approach to Specification and Verification
The need for specifying choreographies when developing service
oriented systems recently arose as an important issue. Although
declarativeness has been identified as a key feature, several
proposed approaches model choreographies by focusing on procedural aspects, e.g. by specifying control and message flows of the interacting services. A similar issue has been addressed in
Multi-Agent Systems (MAS), where declarative approaches based on
social semantics have been used to capture the nature of agents
interaction without over-constraining their behavior.
In this paper we show how DecSerFlow can be mapped to sciff in an automatic and complete way. DecSerFlow is a graphical language
capable to model in an intuitive and declarative fashion service
flows, whereas sciff is a framework based on abductive logic
programming originally developed for dealing with social
interactions in MAS. By means of a running example, we show how the conjunct use of both approaches could be fruitfully exploited to
declaratively specify and verify service choreographies
Using social integrity constraints for on-the-fly compliance verification of medical protocol
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