Internal and Emergency Medicine最新文献_第10页

COmplexity of CARE and Discharge barriers: the 'modern internal medicine patient'. Results from the CO-CARED Study. 护理的复杂性与出院障碍：“现代内科患者”。共同护理研究结果。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-10 DOI: 10.1007/s11739-024-03823-0

Elisa Ceriani, Olivia Milani, Mattia Donadoni, Alberto Benetti, Sergio Antonio Berra, Ciro Canetta, Fabrizio Colombo, Francesco Dentali, Luigi Magnani, Antonino Mazzone, Nicola Montano, Maria Lorenza Muiesan, Gian Marco Podda, Patrizia Rovere Querini, Alessandro Squizzato, Giovanni Casazza, Chiara Cogliati

{"title":"COmplexity of CARE and Discharge barriers: the 'modern internal medicine patient'. Results from the CO-CARED Study.","authors":"Elisa Ceriani, Olivia Milani, Mattia Donadoni, Alberto Benetti, Sergio Antonio Berra, Ciro Canetta, Fabrizio Colombo, Francesco Dentali, Luigi Magnani, Antonino Mazzone, Nicola Montano, Maria Lorenza Muiesan, Gian Marco Podda, Patrizia Rovere Querini, Alessandro Squizzato, Giovanni Casazza, Chiara Cogliati","doi":"10.1007/s11739-024-03823-0","DOIUrl":"https://doi.org/10.1007/s11739-024-03823-0","url":null,"abstract":"The ongoing demographic, epidemiological and social changes are dramatically raising the clinical and care complexity of patients admitted to internal medicine (IM) departments. Collecting evidence for a better characterization of patients is crucial to tailor future interventions based on patient's real needs. The aim of this prospective multicenter study was to describe the complexity of care of patients hospitalized in IM by calculating the complexity of care (ICC) score, through the combination of clinical instability (NEWS score) and care dependency scales (mICD). Furthermore, social frailty was assessed according to potential difficulty in discharge planning. 3912 patients were enrolled (median age 78 years); 71% had a Charlson Comorbidity Index ≥ 5. The ICC score was high in 14.7% of patients, while 15% exhibited a NEWS score at least moderate. One in four patients presented moderate to critical social frailty. The length of stay was correlated with social frailty, mICD and ICC scores, but not with NEWS. In-hospital mortality was correlated with the severity of all the considered scores. A relevant proportion of IM patients exhibited a high complexity of care. Our data support a model in which approximately 15% of IM beds are designated for clinically unstable patients managed in intermediate care sub-units. The substantial burden of social frailty highlights the urgency of national plans allowing at the same time to cover the needs of not self-sufficient and socially disadvantaged patients, and to efficiently address the issue of emergency department boarding.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Lung ultrasound in pneumonia: a guide for effective implementation. 肺部超声在肺炎中的有效实施指南。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-10 DOI: 10.1007/s11739-024-03807-0

Bram Kok, Pieter R Tuinman, Mark E Haaksma

引用次数: 0

Introduction of a LAT gel and low-dose midazolam sedo-analgesia protocol for pediatric skin suture in the emergency department: simpler is better. 介绍LAT凝胶和低剂量咪达唑仑镇痛方案在急诊科儿科皮肤缝合：越简单越好。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-09 DOI: 10.1007/s11739-024-03825-y

Eleonora Maria Pisano, Marco Barchiesi, Eugenia Belotti, Marta Mazzoleni, Erika Diani, Michela Franzin, Roberto Cosentini

{"title":"Introduction of a LAT gel and low-dose midazolam sedo-analgesia protocol for pediatric skin suture in the emergency department: simpler is better.","authors":"Eleonora Maria Pisano, Marco Barchiesi, Eugenia Belotti, Marta Mazzoleni, Erika Diani, Michela Franzin, Roberto Cosentini","doi":"10.1007/s11739-024-03825-y","DOIUrl":"https://doi.org/10.1007/s11739-024-03825-y","url":null,"abstract":"Background: skin lacerations are one of the main causes of children's referral to the emergency department (ED). We introduced in our general ED a pediatric sedo-analgesia protocol (SAP) for suturing skin wounds using LAT gel, a local anesthetic solution of lidocaine, adrenaline and tetracaine, with or without low-dose oral midazolam according to patient's age, to improve the experience of laceration repair.Methods: Primary outcomes were improvement of suturing experience for ED operators (as a reduction in the desire to avoid the procedure) and of the adequacy of sedo-analgesia provided, investigated through two different surveys administered to the ED staff before and after the introduction of the SAP. Children's parents were asked about satisfaction with the sedo-analgesia provided. Data were collected prospectively.Results: The analysis included 85 and 60 healthcare professionals involved in the suture of skin wounds in children, respectively before and after the introduction of our SAP. The introduction of the SAP reduced ED operators' stress and improved the entire suturing experience. The pre-post analysis showed a statistically significant improvement in the perceived adequacy of the provided sedo-analgesia (p < 0.0001) and a significant reduction of operators who would have avoided the procedure (p < 0.0001). The great majority of children's parents expressed a high level of satisfaction.Conclusions: The introduction of a LAT gel and low-dose oral midazolam SAP allows an improvement of both the sedo-analgesia provided and the ED operators' suturing experience of skin lacerations in children. Our SAP appeared to be safe and effective, with low cost and high tolerability.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Interventions to reduce burnout in emergency medicine: a national inventory of the Canadian experience to support global implementation of wellness initiatives. 减少急诊医学职业倦怠的干预措施：加拿大全国经验清单，以支持全球实施健康倡议。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-09 DOI: 10.1007/s11739-024-03811-4

Kathy Liu, Christopher Patey, Paul Norman, Anders Broens Moellekaer, Rodrick Lim, Al'ai Alvarez, Eric Pieter Heymann

{"title":"Interventions to reduce burnout in emergency medicine: a national inventory of the Canadian experience to support global implementation of wellness initiatives.","authors":"Kathy Liu, Christopher Patey, Paul Norman, Anders Broens Moellekaer, Rodrick Lim, Al'ai Alvarez, Eric Pieter Heymann","doi":"10.1007/s11739-024-03811-4","DOIUrl":"https://doi.org/10.1007/s11739-024-03811-4","url":null,"abstract":"Burnout in healthcare workers is a global issue, with Emergency Medicine (EM) particularly impacted. Many countries have tried implementing wellness initiatives to reduce burnout and improve wellness. This paper summarizes interventions implemented in Canada to-date with the aim of supporting the design of wellness interventions in EDs globally. A systematic review and a grey literature search were completed in November 2023. Original studies in both English and French that included the implementation and evaluation of a wellness intervention in EDs in Canada were included. The study design, content of the intervention, target population, and outcomes were extracted and narratively analyzed. 13 studies were included. Each implemented a unique wellness intervention for EDs. All three studies (3/3, 100%) that included a structured wellness curriculum demonstrated significant improvement in burnout as measured by the Maslach Burnout Inventory, physical health (PCS-8), and Brief Resident Wellness Profile (BRWP). Other interventions included Ice Cream Rounds, therapy dogs, changing the duration of night shifts, and sessions on resilience and self-care. Our Canada-wide analysis of wellness interventions identified initiatives geared towards trainees, staff, or entire ED workface groups. Examples include educational programs, dedicated sessions for compassion literacy and resilience, critical events debriefing, and optimizing shift schedules. Structured wellness curriculums seem to be effective, and this area warrants further study. Moreover, we identify a need for global collaboration to build wellness programs and for more easily translatable standardized outcome measures for assessing the efficacy of wellness programs in EM.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

What is your next step? A case of large pericardial effusion during pregnancy. 你的下一步计划是什么？妊娠期大量心包积液1例。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-08 DOI: 10.1007/s11739-024-03831-0

Elisa Ceriani, Massimo Pancrazi, Silvia Berra, Francesco Agozzino, Antonio Brucato

引用次数: 0

Evaluation of pre-endoscopy risk scores and base deficit for prediction adverse clinical outcomes in patients with upper gastrointestinal bleeding. 评估内镜前风险评分和基础缺陷预测上消化道出血患者不良临床结局。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-08 DOI: 10.1007/s11739-024-03830-1

Çağrı Safa Buyurgan, Akif Yarkaç, Seyran Bozkurt, Ataman Köse, Buğrahan Güldür, Gülhan Orekici Temel

引用次数: 0

Optimising risk stratification in diabetic ketoacidosis: a re-evaluation of acid-base status and hyperosmolarity using observational data. 优化糖尿病酮症酸中毒的风险分层：使用观察数据重新评估酸碱状态和高渗透压。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-06 DOI: 10.1007/s11739-024-03818-x

Sebastiaan Paul Blank, Ruth Miriam Blank

{"title":"Optimising risk stratification in diabetic ketoacidosis: a re-evaluation of acid-base status and hyperosmolarity using observational data.","authors":"Sebastiaan Paul Blank, Ruth Miriam Blank","doi":"10.1007/s11739-024-03818-x","DOIUrl":"https://doi.org/10.1007/s11739-024-03818-x","url":null,"abstract":"Accurate assessment of severity in diabetic ketoacidosis (DKA) can optimise early management and facilitate prioritisation for high acuity care. The primary aim was to evaluate the relationship between severity of acidosis (considering pH, bicarbonate, and anion gap) and hyperosmolarity with hospital mortality. Secondary outcomes included intensive care mortality, mechanical ventilation, vasopressor/inotrope use, and dialysis. A retrospective cohort study was conducted of adults (≥ 16 yr) with DKA admitted to US intensive care units. Data were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV dataset and eICU Collaborative Research Database. Univariable and multivariable logistic regression analyses were used to evaluate biochemistry obtained within 4 h of admission and the primary and secondary outcomes. We identified 4071 eligible admissions. There was no clear relationship between serum bicarbonate or anion gap and any outcome. Almost half the population did not have blood gas analysis within 4 h of admission; for 2292 patients with blood gases available, pH < 7 and inappropriately high PCO2 were associated with significant increases in mortality and all secondary outcomes. Osmolarity ≥ 320mosm/L was associated with fourfold increased mortality and higher rates of mechanical ventilation, use of vasopressors/inotropes, and dialysis. Failure of adaptive mechanisms (thirst and hyperventilation) indicating physiological decompensation may be more important for risk stratification in DKA than the degree of acidosis, which was only associated with outcome when severely abnormal. Blood gas analysis is essential to adequately assess disease severity as bicarbonate and anion gap were not predictive of outcome.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Characteristics of a revised quick sequential organ failure assessment score (RqSOFA) to predict in-hospital mortality of patients visiting the emergency department via ambulance: an observational cohort study. 修订的快速序贯器官衰竭评估评分（RqSOFA）预测通过救护车就诊的急诊科患者的院内死亡率的特点：一项观察性队列研究

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-05 DOI: 10.1007/s11739-024-03833-y

Yohei Kamikawa, Hiroyuki Hayashi, Jeffrey N Bone, Ran D Goldman

{"title":"Characteristics of a revised quick sequential organ failure assessment score (RqSOFA) to predict in-hospital mortality of patients visiting the emergency department via ambulance: an observational cohort study.","authors":"Yohei Kamikawa, Hiroyuki Hayashi, Jeffrey N Bone, Ran D Goldman","doi":"10.1007/s11739-024-03833-y","DOIUrl":"https://doi.org/10.1007/s11739-024-03833-y","url":null,"abstract":"The National Early Warning Score (NEWS), Quick Sequential Organ Failure Assessment (qSOFA), and modified qSOFA (MqSOFA) are scoring systems that rely on vital signs. However, NEWS is time-consuming, qSOFA has low sensitivity, and MqSOFA includes a difficult calculation. To address these issues, we developed the Revised qSOFA score (RqSOFA) that consists of percutaneous oxygen saturation, oxygen usage, Simple Shock Index, and the parameters of qSOFA. The predictability of RqSOFA was examined for in-hospital mortality among patients who were transported by ambulance. This observational cohort study included all patients transported via ambulance to an Emergency Department between 2019 and 2021. Patients who had prehospital cardiopulmonary arrest, were pregnant, were younger than 15 years old, arrived from another hospital, and had missing data were excluded. The Area Under the Receiver Operating Characteristic curve (AUROC) of RqSOFA, as well as its sensitivity and specificity at the optimal cut-off point, were determined and compared to those of qSOFA, NEWS and MqSOFA. Among 1849 included patients, 53 died in the hospital. The AUROC for RqSOFA was 0.867 and the optimal cut-off point was 2. The sensitivity and specificity were 0.849 and 0.802, respectively. The AUROC of RqSOFA was larger than qSOFA but had no significance with NEWS and MqSOFA. RqSOFA exhibited the same sensitivity and better specificity compared to NEWS. There were no differences in sensitivity and specificity between RqSOFA and MqSOFA. In conclusion, RqSOFA exhibited superior predictability for in-hospital mortality to qSOFA and NEWS, while offering similar predictability to MqSOFA despite relying only on simple measurements.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effect of traditional Chinese medicine on cardiovascular death and all-cause death among patients with heart failure and/or atrial fibrillation. 中药对心力衰竭和/或房颤患者心血管死亡和全因死亡的影响

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-04 DOI: 10.1007/s11739-024-03821-2

Wei-Syun Hu, Cheng-Li Lin

{"title":"Effect of traditional Chinese medicine on cardiovascular death and all-cause death among patients with heart failure and/or atrial fibrillation.","authors":"Wei-Syun Hu, Cheng-Li Lin","doi":"10.1007/s11739-024-03821-2","DOIUrl":"https://doi.org/10.1007/s11739-024-03821-2","url":null,"abstract":"We tried to define the association of adverse cardiovascular (CV) events, such as CV death and all-cause death among patients with heart failure (HF) and/or atrial fibrillation (AF) receiving traditional Chinese medicine (TCM) or not. We used data from the Taiwan National Health Insurance Research Database in a retrospective cohort study using propensity scoring (PS) matching. We matched 54,859 and 18,307 patients each to the treatment vs. non-treatment group and found a significantly decreased risk of adverse CV events after PS score matching, suggesting that TCM reduces the risk of these adverse outcomes. Compared to HF patients without AF in non-TCM user, HF patients without AF in TCM user and HF patients with AF in TCM user had decreased risk of CV death by 0.50 times (95% CI 0.49, 0.52) and 0.84 times (95% CI 0.49,0.52), respectively. HF patients without AF in TCM user and HF patients with AF in TCM user had decreased risk of all-cause death relative to HF patients without AF in non-TCM user by 0.53 times (95% CI 0.52, 0.54) and 0.74 times (95% CI 0.72,0.76), respectively. The results said that there is significant reduction of decrease in risk of CV death and all death among the patients receiving TCM, especially those without AF.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Modulating throughput: practical emergency department (ED) flow models from a rural Canadian ED to directly increase patient throughput. 调节吞吐量：实用的急诊科（ED）流量模型从农村加拿大ED直接增加病人吞吐量。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-04 DOI: 10.1007/s11739-024-03834-x

Kathy Liu, Christina Young, Paul Norman, Hannah Yaremko, Anders Broens Moellekaer, Rodrick Lim, Eric Pieter Heymann, Christopher Patey

引用次数: 0