16 research outputs found
Neurological diseases and ethical complexity: the role of Law 219/2017 in the daily practice of physiotherapists
No full textreservedMalattie neurologiche come le demenze, i tumori, l’ictus con i suoi esiti, il Parkinson ed i Parkinsonismi, la sclerosi multipla e la sclerosi laterale amiotrofica, portano con se’ un elevato carico di disabilità, spesso prolungato nel tempo, con rilevanti ricadute familiari e sociali. Il fisioterapista durante il lavoro quotidiano con questi pazienti, nelle RSA, nei reparti di Medicina e Rianimazione, nei servizi ambulatoriali etc, collabora nelle equipe multiprofessionali in cui le questioni etiche collegate a queste situazioni di grande complessità emergono continuamente nella pratica clinica.
OBIETTIVO PRINCIPALE DELLO STUDIO : Indagare la conoscenza della “Legge 22 dicembre 2017 , n. 219 : Norme in materia di consenso informato e di disposizioni anticipate di trattamento” in ambito neurologico da parte dei fisioterapisti.
Una legge la cui conoscenza approfondita potrebbe offrire un orientamento per dirimere alcune questioni di etica quotidiana che affrontano anche i fisioterapisti, per arrivare a decisioni e proposte terapeutiche più consapevoli ed agevoli, con i pazienti neurologici
Price-concentration analysis in merger cases with differentiated products
Get PDFThis paper considers the empirical assessment of the relationship between prices and number of firms in local markets in geographic or, more generally, characteristic space and its use as evidence in merger cases. It outlines a structural, semi-nonparametric econometric model of competition in such markets, examines its testable implications in terms of price-concentration relationships, and demonstrates that the model is non-parametrically identified. This general approach to price-concentration analysis in differentiated product markets is illustrated in a small-scale application to cinemas in the UK. The application highlights the main decision points faced by an authority when assessing the weight that can be attached to this type of analysis as evidence
A scoping review of scientific concepts concerning motor recovery after stroke as employed in clinical trials
Get PDFThe scientific literature on poststroke rehabilitation is remarkably vast. Over the last decades, dozens of rehabilitation approaches have been investigated. However, sometimes it is challenging to trace new experimental interventions back to some of the known models of motor control and sensorimotor learning. This scoping review aimed to investigate motor control models' diffusion among the literature on motor recovery after stroke. We performed a literature search on Medline, Cochrane, Web of Science, Embase, and Scopus databases. The last search was conducted in September 2023. This scoping review included full-text articles published in English in peer-reviewed journals that provided rehabilitation interventions based on motor control or motor learning frameworks for at least one individual with stroke. For each study, we identified the theoretical framework the authors used to design the experimental treatment. To this aim, we used a previously proposed classification of the known models of motor control, dividing them into the following categories: neuroanatomy, robotics, self-organization, and ecological context. In total, 2,185 studies were originally considered in this scoping review. After the screening process, we included and analyzed 45 studies: 20 studies were randomized controlled trials, 12 were case series, 4 were case reports, 8 were observational longitudinal pilot studies, and 1 was an uncontrolled trial. Only 10 studies explicitly declared the reference theoretical model. Considering their classification, 21 studies referred to the robotics motor control model, 12 to the self-organization model, 8 to the neuroanatomy model, and 4 to the ecological model. Our results showed that most of the rehabilitative interventions purposed in stroke rehabilitation have no clear theoretical bases on motor control and motor learning models. We suggest this is an issue that deserves attention when designing new experimental interventions in stroke rehabilitation
A machine learning-based risk stratification model for ventricular tachycardia and heart failure in hypertrophic cardiomyopathy
Get PDF\ua9 2021 The Author(s). Background: Machine learning (ML) and artificial intelligence are emerging as important components of precision medicine that enhance diagnosis and risk stratification. Risk stratification tools for hypertrophic cardiomyopathy (HCM) exist, but they are based on traditional statistical methods. The aim was to develop a novel machine learning risk stratification tool for the prediction of 5-year risk in HCM. The goal was to determine if its predictive accuracy is higher than the accuracy of the state-of-the-art tools. Method: Data from a total of 2302 patients were used. The data were comprised of demographic characteristics, genetic data, clinical investigations, medications, and disease-related events. Four classification models were applied to model the risk level, and their decisions were explained using the SHAP (SHapley Additive exPlanations) method. Unwanted cardiac events were defined as sustained ventricular tachycardia occurrence (VT), heart failure (HF), ICD activation, sudden cardiac death (SCD), cardiac death, and all-cause death. Results: The proposed machine learning approach outperformed the similar existing risk-stratification models for SCD, cardiac death, and all-cause death risk-stratification: it achieved higher AUC by 17%, 9%, and 1%, respectively. The boosted trees achieved the best performing AUC of 0.82. The resulting model most accurately predicts VT, HF, and ICD with AUCs of 0.90, 0.88, and 0.87, respectively. Conclusions: The proposed risk-stratification model demonstrates high accuracy in predicting events in patients with hypertrophic cardiomyopathy. The use of a machine-learning risk stratification model may improve patient management, clinical practice, and outcomes in general
Reference theories and future perspectives on robot-assisted rehabilitation in people with neurological conditions: A scoping review and recommendations from the Italian Consensus Conference on Robotics in Neurorehabilitation (CICERONE)
Get PDFBACKGROUND: Robot-based treatments are developing in neurorehabilitation settings. Recently, the Italian National Health Systems recognized robot-based rehabilitation as a refundable service. Thus, the Italian neurorehabilitation community promoted a national consensus on this topic.OBJECTIVE: To conceptualize undisclosed perspectives for research and applications of robotics for neurorehabilitation, based on a qualitative synthesis of reference theoretical models.METHODS: A scoping review was carried out based on a specific question from the consensus Jury. A foreground search strategy was developed on theoretical models (context) of robot-based rehabilitation (exposure), in neurological patients (population). PubMed and EMBASE (R) databases were searched and studies on theoretical models of motor control, neurobiology of recovery, human-robot interaction and economic sustainability were included, while experimental studies not aimed to investigate theoretical frameworks, or considering prosthetics, were excluded.RESULTS: Overall, 3699 records were screened and finally 9 papers included according to inclusion and exclusion criteria. According to the population investigated, structured information on theoretical models and indications for future research was summarized in a synoptic table.CONCLUSION: The main indication from the Italian consensus on robotics in neurorehabilitation is the priority to design research studies aimed to investigate the role of robotic and electromechanical devices in promoting neuroplasticity
Modelo de previsão da demanda para as indústrias atuantes no setor de infra-estrutura brasileiro dos segmentos de energia elétrica e telecomunicações
Get PDFDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico. Programa de Pós-Graduação em Engenhara de Produção.Proposição de um modelo de processo de previsão da demanda - combinando métodos quantitativos e qualitativos - para as indústrias atuantes no setor de infra-estrutura brasileiro dos segmentos de Energia Elétrica e Telecomunicações, baseando-se em recentes pesquisas e bibliografia sobre o tema e no estudo de caso do processo de previsão em empresas destes segmentos. O modelo consiste em um processo que combina métodos quantitativos e qualitativos de julgamento, ressaltando a necessidade de se utilizar os primeiros sempre que as séries temporais permitirem - preferencialmente os mais simples - e sistematizando o emprego das técnicas qualitativas de modo a minimizar a introdução de viés por julgamento
COLLABORAZIONE INTERPROFESSIONALE E ORGANIZZAZIONE SANITARIA: uno studio esplorativo sulle sfide e opportunità per i professionisti della riabilitazione.
Get PDFINTRODUZIONE
Nel contesto italiano, la collaborazione interprofessionale nel settore della riabilitazione ha acquisito notevole rilievo negli ultimi cinque anni, sottolineando l'efficacia di un approccio collaborativo nel trattamento dei pazienti con disabilità complesse.
Il riconoscimento di otto professioni della riabilitazione delle L/SNT2 ha gettato le basi per un modello di cura incentrato sul paziente e multiprofessionale. Tuttavia, mancano studi dettagliati che esplorino come la collaborazione interprofessionale sia percepita e attuata in Italia, lasciando un significativo vuoto nella letteratura e presentando numerose opportunità per future ricerche.
OBIETTIVO
Questo studio mira a colmare questo vuoto esplorando la percezione della collaborazione interprofessionale tra i professionisti sanitari, identificando barriere e facilitatori alla collaborazione efficace e valutando l'impatto dell'educazione al lavoro in team previsto nel modello di cura interprofessionale.
MATERIALI E METODI
Utilizzando metodologie qualitative, specificamente Gruppi di Discussione e Teoria Fondata, sono state analizzate le esperienze condivise di un gruppo di professionisti all’interno dell’Università Degli Studi di Padova. Questa analisi ha facilitato la generazione di teorie basate sui dati, fornendo dettagli approfonditi sulle dinamiche interprofessionali.
RISULTATI
I risultati evidenziano l'importanza critica della collaborazione interprofessionale e del lavoro di squadra interdisciplinare, mostrando la necessità di migliorare la comunicazione e la condivisione delle conoscenze per ottimizzare l'assistenza ai pazienti. Le priorità emergenti includono la formazione incentrata sulla collaborazione e l'adattamento organizzativo per gestire la complessità e le risorse limitate, suggerendo un'espansione dei modelli di collaborazione e una riorganizzazione degli ambienti di riabilitazione.
L'analisi ha sottolineato la complessità della collaborazione interprofessionale come realtà in continua evoluzione, che necessita dello sviluppo di strategie educative e organizzative che superino le barriere esistenti e valorizzino la diversità professionale.
CONCLUSIONI
In conclusione, la collaborazione interprofessionale è essenziale per un approccio riabilitativo efficace e centrato sul paziente, evidenziando la necessità di politiche sanitarie che incoraggino pratiche interdisciplinari innovative.
Lo studio conferma l'importanza della collaborazione interprofessionale nel migliorare l'assistenza ai pazienti, promuovendo una comunicazione e collaborazione efficace tra le varie discipline sanitarie nel contesto della riabilitazione
INTERPROFESSIONAL COLLABORATION AND HEALTHCARE ORGANIZATION: an exploratory investigation into the challenges and opportunities for rehabilitation professionals.
Get PDFIntroduction: In the past five years, interprofessional collaboration within the rehabilitation sector has gained significant prominence in the Italian context, emphasizing the efficacy of collaborative methodologies in the treatment of patients with complex disabilities. The recognition of eight rehabilitation professions classified under the first cycle degree class L/SNT2 (Health Professions) has established a foundation for a patient-centered and multiprofessional model of care. However, comprehensive studies regarding the perceptions and implementations of interprofessional collaboration in Italy are notably absent, creating a substantial gap in academic literature and presenting numerous avenues for future inquiry.
Aim: The aim of this study is to fill this gap by exploring the perception of interprofessional collaboration among healthcare professionals, identifying barriers and facilitators to effective collaboration and assessing the impact of education on team working provided for in the interprofessional model of care.
Tools and Methods: The shared experiences of a cohort of professionals from the University of Padua were analyzed utilizing qualitative methodologies, specifically Focus Groups and Grounded Theory. This analysis facilitated the development of theory grounded in empirical data, providing nuanced insights into interprofessional dynamics.
Results: The results highlight the critical importance of interprofessional collaboration and teamwork, showing the need to improve communication and knowledge sharing in order to optimize patient care. Emerging priorities include collaboration-centered education and organizational adaptation in order to handle complexities and limited resources, suggesting the expansion of collaboration models and the reorganization of rehabilitations environments.
The analysis highlighted the intricate nature of interprofessional collaboration as an ever-evolving phenomenon that necessitates the formulation of educational and organizational strategies capable of transcending existing barriers while embracing professional diversity.
Conclusion: In conclusion, interprofessional collaboration is essential for a rehabilitative and patient-centered approach, highlighting the need for health policies the encourages innovative interdisciplinary practices.
This study confirms the importance of interprofessional collaboration in improving patient care, promoting effective communication and collaboration among the different healthcare disciplines in the rehabilitation environment
Genetic and Phenotypic Characterization of Nexilin (NEXN)–Related Cardiomyopathy:Results From a Multicentric Study
Get PDFBackground: Nexilin (NEXN)–related cardiomyopathies (CMPs) are largely unexplored. Objectives: This study investigated the causative role of NEXN in CMPs, examining its phenotypic expression and prognostic profile. Methods: Twelve referral centers collected phenotypic/genotypic data of patients with NEXN variants. Variant rarity was determined according to gnomAD allele frequency in CMPs. Burden enrichment tested rare NEXN variants in hypertrophic (HCM) and dilated cardiomyopathy (DCM)/nondilated left ventricular cardiomyopathy (NDLVC) CMPs against gnomAD non-Finnish Europeans (NFE). Outcomes of validated variants were detailed, with prognostic comparisons to Titin (TTN)– and Filamin C (FLNC)–related CMP cohorts. Results: Involving 60 NEXN carriers with rare, protein-altering variants, a significant enrichment of NEXN-truncating variants (tvs) was found in the DCM/NDLVC cohort (0.39% vs 0.09% in gnomAD NFE; P = 0.0001), whereas no association was observed with HCM. Patients with DCM/NDLVC with NEXNtv (n = 17; median age: 45 years [Q1-Q3: 36-55 years], 88% probands, 53% male) showed mild left ventricular dilatation (indexed end-diastolic volume 69 mL [Q1-Q3: 46-87 mL]), mildly reduced left ventricular ejection fraction (44% [Q1-Q3: 31%-53%]), and myocardial fibrosis (64%). NYHA functional class I was common (71%). During a 45-month median follow-up (Q1-Q3: 11-130 months), 53% of patients were implanted with an implantable cardioverter-defibrillator and 25% had malignant ventricular arrhythmias (MVAs). Compared with TTN-CMP, NEXN-CMP exhibited earlier and more frequent MVAs at higher ejection fractions, and no significant differences were found against FLNC-CMP. Conclusions: NEXNtvs were significantly associated with DCM/NDLVC, characterized by mild cardiac abnormalities, infrequent heart failure, common fibrosis, and arrhythmias. This largest NEXN variant carrier cohort to date contributes to defining the causative role of this rare genotype and its associated phenotype
Table_1_A scoping review of scientific concepts concerning motor recovery after stroke as employed in clinical trials.docx
No full textThe scientific literature on poststroke rehabilitation is remarkably vast. Over the last decades, dozens of rehabilitation approaches have been investigated. However, sometimes it is challenging to trace new experimental interventions back to some of the known models of motor control and sensorimotor learning. This scoping review aimed to investigate motor control models’ diffusion among the literature on motor recovery after stroke. We performed a literature search on Medline, Cochrane, Web of Science, Embase, and Scopus databases. The last search was conducted in September 2023. This scoping review included full-text articles published in English in peer-reviewed journals that provided rehabilitation interventions based on motor control or motor learning frameworks for at least one individual with stroke. For each study, we identified the theoretical framework the authors used to design the experimental treatment. To this aim, we used a previously proposed classification of the known models of motor control, dividing them into the following categories: neuroanatomy, robotics, self-organization, and ecological context. In total, 2,185 studies were originally considered in this scoping review. After the screening process, we included and analyzed 45 studies: 20 studies were randomized controlled trials, 12 were case series, 4 were case reports, 8 were observational longitudinal pilot studies, and 1 was an uncontrolled trial. Only 10 studies explicitly declared the reference theoretical model. Considering their classification, 21 studies referred to the robotics motor control model, 12 to the self-organization model, 8 to the neuroanatomy model, and 4 to the ecological model. Our results showed that most of the rehabilitative interventions purposed in stroke rehabilitation have no clear theoretical bases on motor control and motor learning models. We suggest this is an issue that deserves attention when designing new experimental interventions in stroke rehabilitation.</p
