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Hogyan tudja segíteni a családorvos az elektrofiziológust a pitvarfibrilláció miatt katéterablációra kerülő beteg ellátása során?
No full textCo-Design and Mixed-Methods Evaluation of a Digital Diabetes Education Intervention for Nursing Homes: Study Protocol
Get PDFBackground: Diabetes is common among nursing home residents, with approximately one in four affected, a figure expected to rise. Despite the complexity of care required, educational support for nursing home staff remains limited. This study will aim to co-design and evaluate a digital intervention to improve staff knowledge, confidence, and practices in diabetes care. Methods: The study will follow a logic model across three workstreams. Workstream 1 (WS1) will inform the model inputs through three phases: (1) a scoping review will be conducted to summarise existing diabetes education initiatives in nursing home settings; (2) approximately 20 semi-structured interviews will be carried out with nursing home staff to explore perceived barriers and supports in delivering diabetes care; and (3) a modified Delphi process involving 50–70 diverse stakeholders will be used to establish educational priorities. Workstream 2 (WS2) will involve co-designing a digital diabetes education intervention, informed by WS1 findings. Co-design participants will include nursing home staff, diabetes professionals, and people living with diabetes or their carers. Workstream 3 (WS3) will consist of a mixed-methods evaluation of the intervention. Pre- and post-intervention questionnaires will assess staff knowledge, confidence, and attitudes. The usability of the intervention will also be measured. Following implementation, focus groups with approximately 32 staff members will be conducted to explore user experiences and perceived impact on resident care. Discussion: This study will address an important gap in staff education and support, aiming to improve diabetes care within nursing home settings through a digitally delivered, co-designed intervention
The tenets of distributed pedagogical leadership in educational contexts - A systematic literature review on perception and practice
Get PDFEfficacy and safety of the subcutaneous implantable cardioverter-defibrillator in patients with and without obesity: A meta-analysis
Get PDFThe subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as an alternative to transvenous systems for preventing sudden cardiac death. However, concerns have been raised regarding its efficacy and safety in obese individuals.This meta-analysis aims to evaluate the efficacy and safety of the S-ICD in patients with obesity by assessing the relationship between body mass index (BMI) and clinical outcomes.A comprehensive search of multiple databases was conducted for English-language peer-reviewed studies reporting clinical outcomes in S-ICD recipients with (BMI ≥30 kg/m2) and without obesity (BMI <30 kg/m2). Data on pre-implantation screening failure, defibrillation testing, complications, appropriate and inappropriate shocks, and survival were analysed using standard random-effect meta-analytical techniques.Twenty-nine studies involving 20,486 patients were included. There was no statistically significant difference in the mean BMI values of patients with failed or successful preimplantation screening (mean difference -0.60 kg/m2, 95% CI -2.06 to 0.86). Obesity was associated with higher rates of failed defibrillation testing at ≤65J (OR 2.16, 95% CI 1.39-3.35), and mal-/suboptimal positioning occurred more frequently in obese compared to non-obese patients (OR 3.37, 95% CI 1.76-6.44). Increased BMI as a continuous variable (per increase in 1 kg/m2 BMI) was associated with elevated defibrillation thresholds (OR 1.05, 95% CI 1.03-1.08), a higher risk of complications (HR 1.04, 95% CI 1.02-1.05), a trend towards increased number of appropriate shocks (HR 1.02, 95% CI 1.00-1.04), and no significant increase in the risk for inappropriate shocks (HR 1.01, 95% CI 0.99-1.03).This meta-analysis underscores the importance of considering obesity in S-ICD implantation decisions. While S-ICD remains effective in obese patients, attention to potential technical challenges and higher complication rates is warranted
AlphaMissense versus laboratory-based pathogenicity prediction of 13 novel missense CPA1 variants from pancreatitis cases
Get PDFUpgrading Right Ventricular Pacing to Cardiac Resynchronization in HFrEF Patients Improves Symptoms and Functional Outcomes
Get PDFIn the BUDAPEST (Biventricular Upgrade on left ventricular reverse remodeling and clinical outcomes in patients with left ventricular Dysfunction and intermittent or permanent APical/SepTal right ventricular pacing)-CRT Upgrade randomized trial, the authors have demonstrated improved mortality and morbidity after cardiac resynchronization therapy (CRT) upgrade in patients with heart failure with reduced ejection fraction (HFrEF) with high right ventricular (RV) pacing burden.This substudy sought to examine the impact of CRT upgrade on symptoms, functional outcome, and exercise capacity.In the BUDAPEST-CRT Upgrade trial, 360 HFrEF patients with pacemaker or implantable cardioverter-defibrillator (ICD) and ≥20% RV pacing burden were randomly assigned (3:2) to cardiac resynchronization therapy with defibrillator (CRT-D) upgrade (n = 215) or ICD (n = 145). The prespecified tertiary endpoints were changes in quality of life (QoL) (EQ-5D-3L), NYHA functional class, 6-minute walk test, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels.Up to 12 months, NYHA functional class improved in the CRT-D upgrade arm compared with ICD only (adjusted OR: 0.50 [95% CI: 0.32-0.80]; P = 0.003). A remarkable decrease was observed in NT-proBNP levels in the CRT-D arm (adjusted difference -1,257 pg/mL [95% CI: -2,287 to -228]; P = 0.017). The progression of age-related worsening of QoL was moderated by CRT-D upgrade (EQ-5D-3L difference by each year: 0.015 [95% CI: 0.005-0.025]; P interaction = 0.003). However, exercise tolerance (6-minute walk test) remained unchanged in both groups.HFrEF patients with pacemaker/ICD and ≥20% RV pacing burden receiving CRT upgrade showed a substantial improvement in NYHA functional class and decrease in natriuretic peptide levels, as compared with ICD alone. Moreover, CRT-D upgrade could moderate the progression of worsening of QoL attributed to ageing in this vulnerable, elderly patient population. (Biventricular Upgrade on left ventricular reverse remodeling and clinical outcomes in patients with left ventricular Dysfunction and intermittent or permanent APical/SepTal right ventricular pacing [BUDAPEST]-CRT Upgrade trial)
Understanding the Role of Different ERCP Techniques in Post-Roux-en-Y Gastric Bypass Patients: a Systematic Review and Meta-analysis
Get PDFWe aimed to compare enteroscopy-assisted ERCP (EA-ERCP), laparoscopy-assisted ERCP (LA-ERCP), and endoscopic ultrasound-directed ERCP (EDGE) in terms of safety and efficacy in post-Roux-en-Y gastric bypass patients. We conducted a rigorous analysis based on a predefined protocol (PROSPERO, CRD42022368788). Sixty-seven studies were included. The technical success rates were 77% (CI 69-83%) for EA-ERCP, 93% (CI 91-96%) for LA-ERCP, and 96% (CI 92-98%) for EDGE. Subgroup differences were significant between the EA-ERCP and other groups (p < 0.05). The overall adverse event rates were 13% (CI 8-22%), 19% (CI 14-24%), and 20% (CI 12-31%), respectively (p = 0.49). Our findings suggest that EDGE and LA-ERCP may be more effective and as safe as EA-ERCP
Consumer behavior factors in green purchasing of food and agriculture products in Hungary
Get PDFIn the contemporary world, the considerable increase in population, followed by the rise in food consumption and industrial production to meet the needs of society, results in environmental destruction. Since large industries carry out the majority of production with a monopoly on the market, the importance of paying attention to this issue is felt more by these companies to boost client satisfaction and green sales. In this study, consumer behavior factors in green purchasing of food and agriculture products in Hungary is discussed. The experts in this study include management and economics professors in Hungarian universities, scientific experts, and active managers in food and agricultural industries in Hungary. Based on the opinion of these experts, it is determined that 35 sub-final factors and 6 final factors can be considered by the managers of food and green agriculture production units to improve sales and increase customer satisfaction in Hungary
