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Assessment of automated TICI scoring during endovascular treatment in patients with an ischemic stroke
Get PDFBackground The extended Thrombolysis in Cerebral Infarction (eTICI) score is used in digital subtraction angiography (DSA) to quantify reperfusion grade in patients with an ischemic stroke who undergo endovascular thrombectomy (EVT). A previously developed automatic TICI score (autoTICI), which quantifies the ratio of reperfused pixels after EVT, demonstrates good correlation with eTICI.Objective To evaluate the autoTICI model in a large multicenter registry of patients with an ischemic stroke, investigate the association with visual eTICI, and compare prediction of functional outcome between autoTICI and eTICI.Methods Patients in the MR CLEAN Registry with an internal carotid artery, M1, and M2 occlusion were selected if both anteroposterior and lateral views were present in pre- and post-EVT DSA scans. The autoTICI score was compared with eTICI in predicting favorable functional outcome (modified Rankin Scale score 0-2), using area under the receiver operating characteristics curve (AUC) with a multivariable logistic regression model including known prognostic characteristics.Results In total 421 of 3637 patients were included. AutoTICI was significantly associated with eTICI non-linearly (below 70% cOR=2.3 (95% CI 2.1 to 2.5), above 70% cOR=1.6 (95% CI 1.6 to 1.7) per 10% increment). The AUC of the model predicting favorable functional outcome was similar for autoTICI and eTICI (0.86, 95% CI 0.82 to 0.92 vs 0.86, 95% CI 0.83 to 0.90, P=0.73) and was higher than for a model with prognostic patient characteristics alone (0.86 vs 0.84, P=0.01).Conclusion Automatic quantitative assessment of reperfusion after EVT is associated with eTICI, and prediction of functional outcome is similar to that with visual eTICI. Therefore, autoTICI could be used as an alternative or additional review for visual reperfusion assessment to facilitate reproducible and uniform reporting
Well-Being Therapy in systemic sclerosis outpatients:a randomized controlled trial
No full textOBJECTIVES: Systemic Sclerosis (SSc) patients have psychological distress and poor well-being and need a tailored treatment. Psychological interventions, rarely tested for efficacy, showed poor benefits. The present randomized controlled trial tested the efficacy of Well-Being Therapy (WBT) in SSc patients. METHODS: Thirty-two outpatients were randomized (1:1) to WBT (n?=?16) or Treatment As Usual (i.e. routine medical check-ups) (TAU) (n?=?16). Primary outcome was well-being. Secondary outcomes included functional ability related to SSc, psychological distress, mental pain, suffering. All participants were assessed at baseline (T0). The WBT group was assessed after two months (end of WBT session 4) (T1), after four months (end of WBT session 8) (T2), after seven months (3-month follow-up) (T3), and after 10?months (6-month follow-up) (T4). The TAU group was assessed two (T1), four (T2), seven (T3), and ten (T4) months after baseline. RESULTS: WBT produced a significant improvement in subjective well-being (p?=?0.001), personal growth (p?=?0.006), self-acceptance (p?=?0.003) compared with TAU, maintained at T3 as what concerns subjective well-being (p?=?0.012). WBT produced greater decrease in psychological distress (p?=?0.010), mental pain (p?=?0.010), suffering (p?=?0.001) compared with TAU, maintained at T4 as what concerns suffering (p?=?0.001). Participants reported high satisfaction with WBT. CONCLUSION: The study provides preliminary evidence on the benefits of WBT as short-term approach for in- and out-patient SSc healthcare paths. Studies with larger samples are needed to have the evidence for recommending WBT to SSc patients
Memory, post-fascism and the far-right
Get PDFAfter 78 years of democracy, Italy continues to grapple with its recent past in the political, social, and cultural spheres. Its experience of fascism under Mussolini, its dual participation in the Second World War, and the continuous and still existent connections between the ideological factions of the 1930s-1940s and now render the country a rich case for the study of public history and memory. The specificity of these characteristics has often made Italian history and memory look like an outlier, shaped by circumstances difficult to compare with those of other countries'. This paper argues that contemporary Italian memory politics are in reality a valuable source of information about the kind of mnemonic discourses that may arise in other (Western) European countries, given the increasingly polarised and populist European landscape. Our study of discourses put forwarded by the post-fascist party Fratelli d'Italia reveals a set of mnemonic tools with which they successfully banalise fascism and chip at Italian public discourse slowly but surely. The comparison between this discourse and that of VOX and AfD in Spain and Germany, respectively, shows that these tools, ranging from nativism to policy (de)legitimation linked to fascist imagery, has started to transfer to other countries' political strategies
Patient preferences for conservative treatment of shoulder pain:a discrete choice experiment
No full textBACKGROUND: Shoulder pain is common amongst adults, but little is known about patients' preferences. OBJECTIVE: The aim of this study was to determine patients' preferences for treatment options offered for shoulder pain in primary care. METHODS: A discrete choice experiment was used to investigate these preferences. Adults with shoulder pain were asked to make 12 choices between two treatment options, or to opt-out. The attributes of the 12 treatment options were presented as varying in: treatment effectiveness (50%, 70%, or 90%), risk of relapse (10%, 20%, or 30%), time to pain reduction (2 or 6 weeks), prevention of relapse (yes/no), requiring injection (yes/no), and including physiotherapy (none, 6, or 12 sessions). A conditional logit model with latent class analysis was used for the analysis and a class assignment model. RESULTS: Three hundred and twelve participants completed the questionnaire with mean age of 52 ± 15.2 years. Latent class analysis revealed three groups. Group 1 preferred to opt-out, unless the attributes were highly favorable (90% effectiveness). Group 2 preferred treatment, but not an injection. Group 3 preferred to opt-out and did not opt for treatment. The likelihood of a participant belonging to one of these groups was 68.8%, 9.3%, and 21.9%, respectively. The class assignment was related to having previously received injection or physiotherapy, as they did not prefer that same treatment again. CONCLUSION: This study showed that most patients with shoulder pain prefer to opt-out, unless treatment attributes are highly favorable. Characteristics of influence on this decision was whether the patient had received an injection or physiotherapy before
Effects of atrial fibrillation ablation on arrhythmia burden and ventricular function in end-stage heart failure:Lessons from CASTLE-HTx
No full textAims: The CASTLE-HTx trial showed the benefit of atrial fibrillation (AF) ablation compared to medical therapy in decreasing mortality, need for left ventricular assist device implantation or heart transplantation (HTx) in patients with end-stage heart failure (HF). Herein we describe the effects of catheter ablation on AF burden, arrhythmia recurrences, and ventricular function in end-stage HF. Methods and results: The CASTLE-HTx protocol randomized 194 patients in end-stage HF with AF to catheter ablation and medical therapy or medical therapy alone. AF burden, left ventricular ejection fraction (LVEF), and type of AF were assessed at baseline and at each follow-up visit. Overall, 97 patients received ablation; 66 patients (68%) underwent pulmonary vein isolation (PVI) and 31 patients (32%) were treated with PVI and additional ablation. Electroanatomic mapping showed the extent of left atrial low voltage (cardiomyopathy) >10% in 31 (31.9%) patients. At 12 months post-ablation, persistent AF was present in 31/89 patients (34.8%), which was significantly less frequent compared to baseline (p = 0.0001). Median AF burden reduction was 36.3 (interquartile range 13.6–63.3) percentage points at 12 months and LVEF improved from 29.2 ± 6.2% to 39.1 ± 8.3% (p < 0.001) following ablation. AF burden reduction <50% was significantly associated with LVEF improvement ≥5% at 12 months after ablation (p = 0.017). Conclusion: Atrial fibrillation ablation in end-stage HF leads to a substantial decrease in AF burden, a regression from persistent to paroxysmal AF and notably improved LVEF. Favourable ablation outcomes were observed in patients regardless of the presence or absence of signs indicating left atrial cardiomyopathy.</p
Navigating contradictions:justifications and imaginaries of the initiators of European migration information campaigns
No full textEuropean states employ migration information campaigns (MICs) to discourage irregular migration to Europe by people from the Global South. Campaigns are justified by their initiators in various ways. On the one hand, campaigns are said to protect ‘potential migrants’ by helping them to make informed decisions (‘care’). On the other hand, campaigns respond to Europe's security objective of restricting migration flows (‘control’). Researchers have looked at various intermediaries involved in these campaigns. Yet, little attention has been given to individual European policy actors who decide on the funding and design of campaigns and how they navigate between campaigns' contradictory intentions to care for ‘potential migrants’ and to control borders. How do European campaign initiators justify the need for MICs? And what does this tell us about the migration imaginaries of those who develop migration governance measures? Based on interviews with European policymakers and campaign designers in the Netherlands and Senegal, this article examines their discursive acts of legitimation. It shows that in justifying their everyday work, they imagine themselves as humanitarian actors, and ‘potential migrants’ as depoliticized subjects in need of care. While initiators do sometimes examine campaigns critically, they build a worldview in which care is instrumental to border enforcement and in which compassion becomes a form of repressive ‘soft’ bordering.</p
Associations Between Problems in Oral Health, Oral Function and Malnutrition in Older People:Results From Three Databases
No full textIntroductionPoor oral health can influence an individual's dietary intake, which may result in malnutrition. Both problems in oral health and function and malnutrition are common in older people. The aim of the present study was to explore the associations between oral health and oral function and malnutrition in community-dwelling older people within three different databases.MethodsData analyses were performed on three existing Dutch databases (Interrai: n = 3876, LPZ: n = 966, PRIMa mouth CARE: n = 975). Logistic regressions (adjusted for age and gender) tested the relation between oral health and oral function (independent variable) and malnutrition (dependent variable).ResultsProblems in oral health and oral function such as broken teeth (OR: 1.43 [95%CI: 1.12-1.81]), oral pain and discomfort (OR: 2.58 [95%CI: 1.52-4.39]), chewing difficulties (OR: 1.99 [95%CI: 1.54-2.57]), swallowing problems (OR: 6.63 [95%CI: 2.85-15.42]), coughing (OR: 6.05 [95%CI: 2.08-17.61]) and food adaptations (OR: 5.46 [95%CI: 2.60-11.4]) were found to be significantly associated with malnutrition in older people.ConclusionsThis study demonstrated a significant link between oral health problems and oral function with malnutrition in community-dwelling older people. Oral health care and healthcare professionals need to consider oral health and oral function in relation to nutritional status and vice versa in community-dwelling older people
Conditionality, Compensation, or Both? Comparative Experiences of Third-Country Cooperation on Migration with the EU
No full textSince the late 1990s, the EU has increasingly sought "cooperation" in the field of migration and mobility with countries external to the EU. This paper investigates the EU's engagement with third countries through the conditionality and compensation nexus - where funding has taken a more prominent place in recent years, alongside other legal and political tools. More specifically, as the EU is less willing to commit to e.g., legal pathways or visa facilitation schemes, it needs to promise other incentives. Building on a comparative analysis, it proposes a new typology casting light on diversity in EU migration partnerships. We show that both conditionality and compensation tools form complex and specific constellations which tend to revolve around one core objective of EU migration policy: reducing irregular migration towards the EU
Experiences and needs of residents with dementia in relocating to an innovative living arrangement within long-term care:A qualitative study
No full textDuring the last decade, an increasing number of care organizations have chosen to rebuild or build a new care facility to provide better person-environments for residents with dementia. This has inevitably led to an increase in relocations. This study investigated how residents with dementia experienced a relocation from a regular nursing home to an innovative living arrangement. A qualitative study was performed, using semi-structured interviews and observations. Two nursing homes offering 24 h care to residents with psychogeriatric symptoms that planned a relocation to an innovative living arrangement were selected. Sixteen residents were included. Five themes from the data described what was of importance to residents when moving, including (1) the physical environment of the new location, (2) the belongings of residents, (3) feeling at home, (4) the importance of social contact when relocating, and (5) the need to be engaged in daily life. This study found that the residents were not actively involved in the relocation process, despite the clear desire they expressed to be involved and of importance. As the residents with dementia were able to express what was important to them in this study, relocation processes should focus more on involving such residents and incorporating them within relocation processes
A stratified treatment algorithm in psychiatry:a program on stratified pharmacogenomics in severe mental illness (Psych-STRATA): concept, objectives and methodologies of a multidisciplinary project funded by Horizon Europe
No full textSchizophrenia (SCZ), bipolar (BD) and major depression disorder (MDD) are severe psychiatric disorders that are challenging to treat, often leading to treatment resistance (TR). It is crucial to develop effective methods to identify and treat patients at risk of TR at an early stage in a personalized manner, considering their biological basis, their clinical and psychosocial characteristics. Effective translation of theoretical knowledge into clinical practice is essential for achieving this goal. The Psych-STRATA consortium addresses this research gap through a seven-step approach. First, transdiagnostic biosignatures of SCZ, BD and MDD are identified by GWAS and multi-modal omics signatures associated with treatment outcome and TR (steps 1 and 2). In a next step (step 3), a randomized controlled intervention study is conducted to test the efficacy and safety of an early intensified pharmacological treatment. Following this RCT, a combined clinical and omics-based algorithm will be developed to estimate the risk for TR. This algorithm-based tool will be designed for early detection and management of TR (step 4). This algorithm will then be implemented into a framework of shared treatment decision-making with a novel mental health board (step 5). The final focus of the project is based on patient empowerment, dissemination and education (step 6) as well as the development of a software for fast, effective and individualized treatment decisions (step 7). The project has the potential to change the current trial and error treatment approach towards an evidence-based individualized treatment setting that takes TR risk into account at an early stage