Internal and Emergency Medicine最新文献_第4页

Mental health and substance use evolution in Swiss ED residents: a 6-month prospective longitudinal single-center study. 瑞士急诊科住院患者的心理健康和物质使用演变：一项为期6个月的前瞻性纵向单中心研究。

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-02 DOI: 10.1007/s11739-025-04095-y

Noémie Parejas, Nicolas Beysard, Michael Saraga, Pierre-Nicolas Carron

{"title":"Mental health and substance use evolution in Swiss ED residents: a 6-month prospective longitudinal single-center study.","authors":"Noémie Parejas, Nicolas Beysard, Michael Saraga, Pierre-Nicolas Carron","doi":"10.1007/s11739-025-04095-y","DOIUrl":"https://doi.org/10.1007/s11739-025-04095-y","url":null,"abstract":"The challenging nature of emergency medicine places residents at risk of psychological strain and unhealthy consumption habits. Research on the impact of emergency department (ED) work on residents' mental health, substance use, and lifestyle is scarce. This exploratory mixed methods longitudinal study assessed ED residents at Lausanne University Hospital from 2020 to 2022. Residents completed surveys at the beginning and end of a 6-month ED rotation, including validated tools, such as the Maslach Burnout Inventory and the Hospital Anxiety and Depression Scale, alongside direct questions addressing substance use and lifestyle. Semi-structured interviews were then conducted to explore residents' experiences and coping mechanisms. Primary outcomes included changes in burnout, anxiety, depression, and substance use. Secondary outcome was to gather residents' experiences in ED. Of 47 residents recruited, 31 completed follow-up surveys. Emotional exhaustion and depersonalization scores, subscales of the Maslach Burnout Inventory, increased slightly (p = 0.0259 and p = 0.0064), while personal accomplishment remained stable. Anxiety scores decreased (p = 0.0068), depression scores worsened (p = 0.0185), and sleep quality declined (p = 0.0022). Substance use and personal factors, such as religious beliefs and personal development activities, remained stable over the 6-month period. Interviews highlighted themes including patient flow pressure, irregular shifts, and departmental atmosphere. After 6 months in the ED, residents experienced minor changes in mental health with limited clinical significance. Protective factors like senior peer support may buffer against adverse effects. Future research should explore these dynamics in diverse EDs and over longer periods to better understand the impact on residents' well-being.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953080","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 noninvasive ventilation on 6-month mortality in patients with acute cardiogenic pulmonary oedema: a retrospective study dedicated to older persons. 无创通气对急性心源性肺水肿患者6个月死亡率的影响：一项针对老年人的回顾性研究

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2025-06-15 DOI: 10.1007/s11739-025-04012-3

Linda Haddi, Laure Valerio, Pascal Bilbault, Georges Kaltenbach, Elise Schmitt

{"title":"Effect of noninvasive ventilation on 6-month mortality in patients with acute cardiogenic pulmonary oedema: a retrospective study dedicated to older persons.","authors":"Linda Haddi, Laure Valerio, Pascal Bilbault, Georges Kaltenbach, Elise Schmitt","doi":"10.1007/s11739-025-04012-3","DOIUrl":"10.1007/s11739-025-04012-3","url":null,"abstract":"Noninvasive ventilation (NIV) effectively treats acute cardiogenic pulmonary oedema (ACPE), leading to quicker clinical improvement and reduced intubation needs than medical treatment alone. However, the impact of NIV on mortality in patients with ACPE is unclear. The primary objective was to evaluate the impact of NIV on 6-month mortality in older patients with ACPE compared with medical treatment. Secondary objectives included assessing the effects of NIV on length of hospital stay and rehospitalisation. This retrospective study included patients aged ≥ 75 years with ACPE (acute respiratory distress and/or RR ≥ 25 cycles/min and/or paCO2 ≥ 45 mmHg and/or pH < 7.35 and/or uncorrected hypoxemia). Exclusion criteria: positive for SARS-CoV-2 and contraindication to NIV. Of the 186 patients admitted to emergency care with ACPE and eligible for NIV, 104 received NIV and 82 received medical treatment. Survival analyses were performed using a multivariate Cox model and adjusting for confounding factors. NIV was not significantly linked to reduced mortality risk (HR = 0.82, p = 0.51), except for in the acidosis subgroup (HR = 0.24, p = 0.01). No difference was observed in the length of hospital stay or in terms of rehospitalisation. NIV in older patients with ACPE did not significantly decrease 6-month mortality, except in the subgroup with respiratory acidosis, when the risk of death was reduced by 75%. The use of NIV in older patients with ACPE should be limited to patients with acidosis, to see their risk of death significantly reduced. Trial registration: The study protocol has been retrospectively registered on ClinicalTrials.gov (NCT06107257, 2023-10-30).","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1753-1760"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A rare type of hemophagocytic lymphohistiocytosis in a patient admitted to the emergency department with fever. 一个罕见类型的噬血细胞淋巴组织细胞病在病人入院的急诊科发烧。

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2025-04-27 DOI: 10.1007/s11739-025-03952-0

Zarifa Orta, Selva Ala-Selek, Murat Hakan Kır, Aysun Benli, Arif Atahan Çağatay

引用次数: 0

Severe refractory hypercalcemia unmasking pulmonary tuberculosis: a case report. 严重难治性高钙血症暴露肺结核1例。

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2025-04-29 DOI: 10.1007/s11739-025-03950-2

Sumerah Jabeen, Mahnoor Azam Baig, Abdul Nafey Kazi, Muzeer Ahmed, Fivzia Farooq Herekar

引用次数: 0

Lost in translation: how acronyms could kill our patients. 迷失在翻译中：缩略词是如何杀死我们的病人的。

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2025-04-09 DOI: 10.1007/s11739-025-03946-y

Pietro Fusaroli, Emilija Rakichevikj

引用次数: 0

Added value of inflammatory markers to vital signs for predicting mortality in patients with suspected infection: external validation and model development. 炎症标志物对生命体征预测疑似感染患者死亡率的附加值：外部验证和模型开发。

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2024-11-20 DOI: 10.1007/s11739-024-03815-0

Toshihiko Takada, Jeroen Hoogland, Kotaro Fujii, Masataka Kudo, Sho Sasaki, Tetsuhiro Yano, Yu Yagi, Ryuto Fujiishi, Karel G M Moons, Shunichi Fukuhara

{"title":"Added value of inflammatory markers to vital signs for predicting mortality in patients with suspected infection: external validation and model development.","authors":"Toshihiko Takada, Jeroen Hoogland, Kotaro Fujii, Masataka Kudo, Sho Sasaki, Tetsuhiro Yano, Yu Yagi, Ryuto Fujiishi, Karel G M Moons, Shunichi Fukuhara","doi":"10.1007/s11739-024-03815-0","DOIUrl":"10.1007/s11739-024-03815-0","url":null,"abstract":"It is crucial to identify high-risk patients with infectious conditions for appropriate management. We previously found that inflammatory markers added value to vital signs for predicting mortality in patients with suspected infection. In this study, the aim was to externally validate the added value of the inflammatory markers and to develop a new prediction model. For the external validation, consecutive adult patients with suspected infection admitted to the department of general medicine at two acute care hospitals were evaluated. A prognostic model for 30-day in-hospital mortality based on vital signs (systolic blood pressure, respiratory rate, and mental status) was compared with an extended model that also included four inflammatory markers (C-reactive protein, neutrophil-lymphocyte ratio, mean platelet volume, and red cell distribution width). Similar to the previous finding, all inflammatory markers except C-reactive protein showed significant contributions. Subsequently, a prediction model was developed using vital signs and markers with significant added value using a dataset that combined the external validation data with the data of the previous study. The new model was compared with a model based on the quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) score. The newly developed model showed a higher c-index than the qSOFA model [0.756 (95% CI 0.726-0.786) vs. 0.663 (0.630-0.696), p < 0.001]. Using the new model, 9.0% of patients who died were correctly reclassified compared with the qSOFA model at the threshold of 10% mortality risk. The new model including these markers showed potential to outperform the qSOFA model.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1923-1931"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675821","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

Health effects of e-cigarettes, heated tobacco, and oral nicotine products. 电子烟、加热烟草和口服尼古丁产品对健康的影响。

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2025-07-18 DOI: 10.1007/s11739-025-04057-4

Riccardo Polosa, Brad Rodu, Konstantinos Farsalinos

引用次数: 0

Selecting patients for ICU up-grade from general wards: role of prognostic tools. 从普通病房选择ICU升级患者：预后工具的作用。

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2025-06-04 DOI: 10.1007/s11739-025-03998-0

Victor Galvani Vianna Amarilla, Isabel Mieko Miamoto, Daiane Dyba, João Manoel Silva-Jr, Brenno Cardoso Gomes

{"title":"Selecting patients for ICU up-grade from general wards: role of prognostic tools.","authors":"Victor Galvani Vianna Amarilla, Isabel Mieko Miamoto, Daiane Dyba, João Manoel Silva-Jr, Brenno Cardoso Gomes","doi":"10.1007/s11739-025-03998-0","DOIUrl":"10.1007/s11739-025-03998-0","url":null,"abstract":"The decision to admit patients to the intensive care unit (ICU) can be difficult, especially when it is unclear which patients will benefit the most. Therefore, identifying the determinants of complications can aid in patient therapy. The aim of this study was to evaluate the characteristics of patients who were admitted late to the ICU and identify the main factors that contribute to their admission. This case‒control study was conducted in a tertiary hospital and included 4 years of follow-up (using medical records). The study included patients who were at risk for deterioration and admitted to clinical wards. The main measure, whether ICU admission was needed or not, was compared among the patients. We included 170 patients aged 60.6 ± 13.6 years. The multivariate analysis revealed that the qSOFA and CCI values were independent factors in determining whether a patient required ICU admission (OR = 8.25, CI 95% = 4.4-15.3 and OR = 1.37, CI 95% = 1.03-1.82, respectively); the ROC value was 0.89 (95% CI 0.83-0.93). The Cox regression model used to assess 90-day survival revealed that only the qSOFA value was strongly associated with shorter survival (qSOFA = 1, HR = 9.42, P = 0.03; qSOFA = 2, HR = 17.7, P = 0.005; and qSOFA = 3, HR = 73.7, P < 0.001). Although selecting high-risk patients for ICU admission is a difficult task, the qSOFA score appears to be a useful tool for differentiating patients.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1713-1720"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225367","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

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 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub 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":"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":"1933-1940"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","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

Emergency medicine: a global perspective on its past, evolution, and future. 急诊医学：从全球视角审视其过去、演变和未来。

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2024-11-07 DOI: 10.1007/s11739-024-03812-3

Eric P Heymann, Rodrick Lim, James Maskalyk, Simon Pulfrey, Shannon Chun, Maxwell Osei-Ampofo, Kimberly deSouza, Megan Landes, Eddy Lang

引用次数: 0