Explore the vast range of titles available.

miRNAs are a family of 20–22 non-coding nucleotides that control gene expression by inhibiting the translation of their target messenger RNAs (mRNAs). Two models have been proposed to elucidate the mechanism of action: they act either hindering mRNA translation or enhancing mRNA degradation. Anabolic-Androgenic Steroids (AASs) represent a class of drugs used to treat several diseases. In the last few years, AASs have frequently been used for aesthetic purposes, indeed, they form part of the larger group called image- and performance-enhancing drugs (IPEDs). Long-term AAS use can lead to serious health consequences. In this regard, the present study aimed to analyze the role of several microRNAs (miRNAs) in renal damage after AAS use, to better understand the underlying mechanisms. For this purpose, two miRNAs (miR-21 and miR-205) were tested in two groups: AAS group (seven males, mean age 33.28 ± 4.68 years; mean body mass index (BMI) 27.04 ± 1.07), and chronic kidney disease (CKD) group (seven males, mean age 66.2 ± 5.4 years; mean BMI 24.75 ± 1.35). Finally, the same miRNAs were tested in the “Control” group (seven males, mean age 44.85 ± 5.75 years; mean BMI 26.5 ± 1.88). Kolmogorov-Smirnov Test was used to determine the normality of data distribution. All variables were normally distributed. Student’s t-test was used for comparisons between two groups. Analyzing the results of the present study, the two tested miRNAs (miR-21 and miR-205) were significantly higher in the CKD group compared to the AAS group, with mir-21 being much more expressed than miR-205. This study represents a pilot study to define if these expression patterns could be studied in other biological samples (plasma, urine) in subjects with different kidney injury linked to chronic kidney diseases and AAS use, to identify reliable biomarkers that could be applied in clinical and forensic diagnostics, as well as a target for toxicological investigations or therapeutic treatments.

In the last decade, the development of different methods of brain stimulation by electromagnetic fields (EMF) provides a promising therapeutic tool for subjects with impaired cognitive functions. Emisymmetric bilateral stimulation (EBS) is a novel and innovative EMF brain stimulation, whose working principle is to introduce very weak noise-like stimuli through EMF to trigger self-arrangements in the cortex of treated subjects, thereby improving cognitive faculties. The aim of this pilot study was to investigate in patients with cognitive impairment the effectiveness of EBS treatment with respect to global cognitive function, episodic memory, and executive functions. Fourteen patients with cognitive decline (six with mild cognitive impairment and eight with Alzheimer's disease) underwent three EBS applications per week to both the cerebral cortex and auricular-specific sites for a total of 5 weeks. At baseline, after 2 weeks and 5 weeks, a neuropsychological assessment was performed through mini-mental state examination, free and cued selective reminding tests, and trail making test. As secondary outcomes, changes in behavior, functionality, and quality of life were also evaluated. After 5 weeks of standardized EBS therapy, significant improvements were observed in all neurocognitive assessments. Mini-mental state examination score significantly increased from baseline to end treatment (+3.19, P=0.002). Assessment of episodic memory showed an improvement both in immediate and delayed recalls (immediate recall =+7.57, P=0.003; delayed recall =+4.78, P<0.001). Executive functions significantly improved from baseline to end stimulation (trail making test A -53.35 seconds; P=0.001). Of note, behavioral disorders assessed through neuropsychiatric inventory significantly decreased (-28.78, P<0.001). The analysis concerning the Alzheimer's disease and mild cognitive impairment group confirmed a significant improvement of cognitive functions and behavior after EBS treatment. This pilot study has shown EBS to be a promising, effective, and safe tool to treat cognitive impairment, in addition to the drugs presently available. Further investigations and controlled clinical trials are warranted.

Background: Failure mode and effect analysis (FMEA) is a valuable risk analysis tool aimed at predicting the potential failures of a system and preventing them from occurring. Since its initial use, it has also recently been applied to the healthcare setting, which has been made progressively more complex by technological developments and new challenges. Infection prevention and control (IPC) is an area that requires effective strategies. The aim of this study is to review the literature on the employment of FMEA in the healthcare environment, with special consideration for its application in the infectious disease setting. Methods: An extensive search was carried out in two international and public databases, PUBMED and EMBASE; we included all studies regarding the use of FMEA in hospital settings and human patient care processes. Results: A total of 163 studies published over the period from 2003 to 2023 were included for data extraction. These studies were analyzed regarding bibliometric data (publication year and country of origin), the healthcare issues to be addressed, the application fields, and the utilized FMEA methods. Among these, 13 studies were found that took an interest in infectious diseases. Conclusions: FMEA can be effectively used for healthcare risk assessment. Its implementation as a standard tool in healthcare settings, though demanding, may serve as an important tool for preventing the risk of biohazard incidents, epidemics, and environmental contamination, thereby improving safety for both patients and healthcare workers.

Introduction. Recalcitrant skin ulcers are a major burden in elderly patients. Specifically, chronic wounds result in significant morbidity and mortality and have a profound economic impact. Pulsed electromagnetic fields (PEMFs) have proved to be a promising therapy for wound healing. Here we describe the first reported case of an innovative PEMF therapy, Emysimmetric Bilateral Stimulation (EBS), used to successfully treat refractory skin ulcers in two elderly and fragile patients. Case Presentation. Two elderly patients developed multiple chronic skin ulcerations. Despite appropriate treatment, the ulcers showed little improvement and the risk of amputation was high. Both patients underwent daily EBS therapy and standard dressing. After few weeks of treatment, major improvements were observed and all ulcers had healed. Conclusion. In patients with refractory ulceration, EBS therapy may be of real benefit in terms of faster healing. This case supports the supportive role for PEMFs in the treatment of skin ulceration in diabetes and is suggestive of a potential benefit of EBS in this clinical condition.

Background/Objectives: In recent years, scientific literature has illustrated the growing interest in telerehabilitation after ACL reconstruction. The aim of this study is to compare the effectiveness of remotely supervised rehabilitation with traditional supervised rehabilitation after ACLR, focusing on objective postoperative functional assessment outcomes. Methods: A retrospective analysis of prospectively collected data was carried out, selecting patients that underwent arthroscopic ACLR by a single surgeon. Functional assessments of the patients were carried out at 1 and 2 weeks and 1, 2 and 3 months after surgery, including range of motion (ROM), maximal voluntary isometric contractions (MVICs) of extensor and flexor muscles, the sit-to-stand test and the countermovement jump. Intergroup statistics were carried out using a non-inferiority hypothesis. Results: A total of 251 patients were included in this study (supervised rehabilitation n = 165; remotely supervised rehabilitation n = 86). Functional assessment improved over time in both groups. The extension ROM deficit decreased to 0 difference 30 days after surgery. The median flexion ROM ILD at 60 days was significantly different among the groups, with a residual 10° ILD in the Group R compared with 0° ILD in group S (p = 0.01). All other assessments did not achieve statistical significance. Conclusions: The results support the integration of a digital rehabilitation tool in post-ACLR recovery programs. The results suggest that remotely supervised rehabilitation can be a viable alternative to traditional supervised rehabilitation for early-stage recovery. However, more research is needed to optimize protocols and to identify patients who may benefit most from this approach.

Ageing of the global population represents a challenge for national healthcare systems and healthcare professionals, including medico-legal experts, who assess personal damage in an increasing number of older people. Personal damage evaluation in older people is complex, and the scarcity of evidence is hindering the development of formal guidelines on the subject. The main objectives of the first multidisciplinary Consensus Conference on Medico-Legal Assessment of Personal Damage in Older People were to increase knowledge on the subject and establish standard procedures in this field. The conference, organized according to the guidelines issued by the Italian National Institute of Health (ISS), was held in Bologna (Italy) on June 8, 2019 with the support of national scientific societies, professional organizations, and stakeholders. The Scientific Technical Committee prepared 16 questions on 4 thematic areas: (1) differences in injury outcomes in older people compared to younger people and their relevance in personal damage assessment; (2) pre-existing status reconstruction and evaluation; (3) medico-legal examination procedures; (4) multidimensional assessment and scales. The Scientific Secretariat reviewed relevant literature and documents, rated their quality, and summarized evidence. During conference plenary public sessions, 4 pairs of experts reported on each thematic area. After the last session, a multidisciplinary Jury Panel (15 members) drafted the consensus statements. The present report describes Conference methods and results, including a summary of evidence supporting each statement, and areas requiring further investigation. The methodological recommendations issued during the Conference may be useful in several contexts of damage assessment, or to other medico-legal evaluation fields.

Background Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption. Methods Qualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff, and members of the boards of directors ( n  = 30). We used a constant comparative approach to develop a framework for guiding implementation. Results We identified six clusters of experiences of, and attitudes towards CDSSs, which we label as “positions.” The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians’ perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related to the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians’ reasoning and fostering organizational learning. Conclusions Barriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation phase and context, may not be sufficient or useful to facilitate uptake. Factors such as clinicians’ attitudes towards scientific evidences and guidelines, the quality of inter-disciplinary relationships, and an organizational ethos of transparency and accountability need to be considered when exploring the readiness of a hospital to adopt CDSSs.

Background Population ageing, together with the rise of chronic conditions, comorbidities, and polypharmacy, poses major challenges for ensuring therapeutic adherence among older adults. In this context, digital technologies emerge as potential support tools, although their integration into nursing practice warrants further investigation. Methods This qualitative study explored the experiences of primary care nurses in Extremadura (Spain) using a virtual voice assistant (Assistant on Care and Health Offline, ACHO) to support therapeutic adherence among older adults. In-depth interviews were conducted to examine nurses’ views on ACHO’s usability and the incorporation of digital technologies into daily care delivery. Results Participants found ACHO intuitive and valued its offline functionality and custom features. Some saw opportunities for promoting independent living while improving medical data collection and follow-up care. However, concerns emerged regarding the potential weakening of fundamental professional values, such as empathy and face-to-face interaction, as well as risks to data confidentiality and demands for additional training and workload. Conclusions Despite positive feedback on usability, nursing staff’s deep-rooted professional values and ideological reservations remain significant barriers to the broader adoption of digital technologies in primary care.

Sophisticated evidence-based information resources can filter medical evidence from the literature, integrate it into electronic health records, and generate recommendations tailored to individual patients. To assess the effectiveness of a computerized clinical decision support system (CDSS) that preappraises evidence and provides health professionals with actionable, patient-specific recommendations at the point of care. Open-label, parallel-group, randomized clinical trial among internal medicine wards of a large Italian general hospital. All analyses in this randomized clinical trial followed the intent-to-treat principle. Between November 1, 2015, and December 31, 2016, patients were randomly assigned to the intervention group, in which CDSS-generated reminders were displayed to physicians, or to the control group, in which reminders were generated but not shown. Data were analyzed between February 1 and July 31, 2018. Evidence-Based Medicine Electronic Decision Support (EBMEDS), a commercial CDSS covering a wide array of health conditions across specialties, was integrated into the hospital electronic health records to generate patient-specific recommendations. The primary outcome was the resolution rate, the rate at which medical problems identified and alerted by the CDSS were addressed by a change in practice. Secondary outcomes included the length of hospital stay and in-hospital all-cause mortality. In this randomized clinical trial, 20 563 patients were admitted to the hospital. Of these, 6480 (31.5%) were admitted to the internal medicine wards (study population) and randomized (3242 to CDSS and 3238 to control). The mean (SD) age of patients was 70.5 (17.3) years, and 54.5% were men. In total, 28 394 reminders were generated throughout the course of the trial (median, 3 reminders per patient per hospital stay; interquartile range [IQR], 1-6). These messages led to a change in practice in approximately 4 of 100 patients. The resolution rate was 38.0% (95% CI, 37.2%-38.8%) in the intervention group and 33.7% (95% CI, 32.9%-34.4%) in the control group, corresponding to an odds ratio of 1.21 (95% CI, 1.11-1.32; P < .001). The length of hospital stay did not differ between the groups, with a median time of 8 days (IQR, 5-13 days) for the intervention group and a median time of 8 days (IQR, 5-14 days) for the control group (P = .36). In-hospital all-cause mortality also did not differ between groups (odds ratio, 0.95; 95% CI, 0.77-1.17; P = .59). Alert fatigue did not differ between early and late study periods. An international commercial CDSS intervention marginally influenced routine practice in a general hospital, although the change did not statistically significantly affect patient outcomes. ClinicalTrials.gov identifier: NCT02577198.

Heart failure (HF) is becoming increasingly common, especially in older females, and displays marked sex-related differences in pathophysiology, treatment, and outcomes. Submaximal exercise capacity (SEC), frequently measured by the six-minute walk test (6MWT), is an important marker of aerobic function, prognosis, and quality of life in HF. However, evidence regarding sex differences in SEC remains limited and inconsistent. This single-centre, prospective cohort study included 1069 patients with chronic HF enrolled between 2004 and 2014. SEC was assessed using the 6MWT, and extensive clinical and psychosocial data were collected. Multivariate models evaluated the independent association between sex and SEC. Results showed that females had significantly shorter 6MWT distances (155 ± 149 m) than males (265 ± 164 m; p < 0.001). Female sex was an independent predictor of impaired SEC in both unadjusted and adjusted analyses (odds ratios 2.226–3.609; p < 0.001). Additional determinants of reduced SEC included advanced age, higher NYHA class, elevated heart rate, diabetes, iron deficiency, dependence in activities of daily living, cognitive impairment, and depressive symptoms. These findings demonstrate that female sex is a strong, independent predictor of reduced functional capacity in chronic HF and emphasize the need for sex-specific strategies addressing both clinical and psychosocial factors to improve outcomes.