Internal and Emergency Medicine最新文献_第5页

The application of pleural ultrasound features in different lung diseases characterized by B-lines of lung ultrasound in hemodialysis patients. 胸膜超声特征在血液透析患者肺超声b线表现的不同肺部疾病中的应用

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-11 DOI: 10.1007/s11739-025-04004-3

Haotian Zhao, Yaru Yan, Yi Liu, Xiaona Wang, Li Li

引用次数: 0

A double-edged sword: a narrative review on steroids in sepsis and septic shock. 双刃剑：关于类固醇在败血症和感染性休克中的叙事回顾。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-11 DOI: 10.1007/s11739-025-04008-z

Matteo Guarino, Francesco Luppi, Benedetta Perna, Martina Maritati, Carlo Contini, Michele Domenico Spampinato, Roberto De Giorgio

{"title":"A double-edged sword: a narrative review on steroids in sepsis and septic shock.","authors":"Matteo Guarino, Francesco Luppi, Benedetta Perna, Martina Maritati, Carlo Contini, Michele Domenico Spampinato, Roberto De Giorgio","doi":"10.1007/s11739-025-04008-z","DOIUrl":"https://doi.org/10.1007/s11739-025-04008-z","url":null,"abstract":"Sepsis and septic shock are life-threatening conditions characterized by a dysregulated host response to infection. Although corticosteroids, particularly hydrocortisone, promote positive effects on hemodynamic stability in septic shock, the efficacy of these drugs remains controversial. In this narrative review, we aimed at appraising the actual role of corticosteroids focusing specifically on septic shock. We conducted a comprehensive search of the recent literature, including randomized controlled trials, meta-analyses, and current clinical guidelines, to evaluate the role of corticosteroids in the management of septic shock. Studies were evaluated to determine the impact on mortality, hemodynamics, and other clinical outcomes. The studies showed variability in dosing and time of administration as well as patient selection, which highlighted the lack of a standardized treatment approach. While corticosteroids improved short-term hemodynamic outcomes and reduced vasopressor requirement, their effect on long-term survival was minimal. These results led current guidelines to a weak recommendation for hydrocortisone use in septic shock patients with persistent hypotension despite adequate fluid resuscitation and vasopressor therapy. Corticosteroids, e.g. hydrocortisone, can be beneficial in managing septic shock, but their role remains uncertain. Further research is needed to refine treatment protocols and determine the optimal patient selection for corticosteroid therapy.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274749","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

Letter to the editor "Improving acute care outcome in internal medicine: the role of early stabilization and intermediate care unit". 致编辑的信“改善内科急症护理结果：早期稳定和中期护理单位的作用”。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-11 DOI: 10.1007/s11739-025-04011-4

Sadia Farhana

引用次数: 0

Bystander placement of automated external defibrillators and out-of-hospital cardiac arrest outcomes: a propensity score-matched cohort study between 2021 and 2022. 旁观者放置自动体外除颤器和院外心脏骤停结果：2021年至2022年倾向评分匹配的队列研究

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-09 DOI: 10.1007/s11739-025-03995-3

Kentaro Omatsu, Akira Yamashita, Hideo Inaba

{"title":"Bystander placement of automated external defibrillators and out-of-hospital cardiac arrest outcomes: a propensity score-matched cohort study between 2021 and 2022.","authors":"Kentaro Omatsu, Akira Yamashita, Hideo Inaba","doi":"10.1007/s11739-025-03995-3","DOIUrl":"https://doi.org/10.1007/s11739-025-03995-3","url":null,"abstract":"Bystander automated external defibrillator (AED) placement is expected to benefit all out-of-hospital cardiac arrest (OHCA) cases, even in the absence of prehospital defibrillation. This study investigated the factors influencing bystander-AED placement and evaluated its impact on neurologically favourable outcomes in bystander-witnessed, out-of-home OHCA cases receiving bystander cardiopulmonary resuscitation (CPR). This retrospective cohort study analysed nationwide EMS-transported emergency and OHCA databases (2021-2022), including 22,443 bystander-witnessed, out-of-home OHCAs with bystander CPR, of which 10,324 involved bystander-AED placement. AEDs were placed by bystanders in 25,333 (10.6%) of 238,871 non-EMS-witnessed OHCA cases. Logistic regression showed the associations of prehospital defibrillation, no bystander CPR, male sex, outdoor location, at-home setting, and family- or friend/colleague-witnessed OHCA with lower bystander-AED placement rates. In contrast, rural municipality EMS, daytime, DA-CPR attempt, presumed cardiac aetiology, shockable initial rhythm, conventional bystander CPR, and care/medical facilities were associated with higher rates. Neurologically favourable survival was 2.2% for bystander-AED and 2.3% for EMS-AED placement cases within care/medical facilities, compared to 19.5% and 11.6%, respectively, outside these facilities. In both logistic regression analyses after propensity score matching, bystander-AED placement improved outcomes of OHCA outside care/medical facilities only in the presence of prehospital defibrillation (adjusted odds ratio 1.24 [1.04-1.48]) but worsened outcomes of OHCA within the facilities in the absence of prehospital defibrillation (0.73 [0.54-0.99]). Bystander-AED placement was common in care/medical facilities but had limited benefits. The effectiveness of bystander-AED placement depends on location, early prehospital defibrillation, and responder training.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247731","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

Central retinal artery occlusion diagnosis and misdiagnosis in the emergency department. 急诊科视网膜中央动脉闭塞的诊断与误诊。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-09 DOI: 10.1007/s11739-025-03990-8

Anniesha Bista Chhetri, Jacob Kammerman, Murtaza Akhter

引用次数: 0

Fibrobronchoscopy versus laryngotracheal aspiration for bronchial toileting in patients with aspiration pneumonia in the emergency department. FBS-ASaP prospective case-control study. 急诊科吸入性肺炎患者支气管如厕的纤维支气管镜与喉气管吸入法比较。FBS-ASaP前瞻性病例对照研究。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-08 DOI: 10.1007/s11739-025-04002-5

Lorenzo Pelagatti, Alessio Montalbetti, Gabriele Viviani, Ashley Ferretti, Marco Trigiani, Lorenzo Corbetta, Sara Tomassetti, Simone Vanni, Peiman Nazerian

{"title":"Fibrobronchoscopy versus laryngotracheal aspiration for bronchial toileting in patients with aspiration pneumonia in the emergency department. FBS-ASaP prospective case-control study.","authors":"Lorenzo Pelagatti, Alessio Montalbetti, Gabriele Viviani, Ashley Ferretti, Marco Trigiani, Lorenzo Corbetta, Sara Tomassetti, Simone Vanni, Peiman Nazerian","doi":"10.1007/s11739-025-04002-5","DOIUrl":"https://doi.org/10.1007/s11739-025-04002-5","url":null,"abstract":"Aspiration pneumonia (AP) is common in patients with pneumonia evaluated in Emergency Department (ED). The therapeutic management of these patients often involves secretion suctioning through two main techniques: laryngotracheal aspiration (LTA) and fibrobronchoscopic aspiration (FBA). Despite both techniques being employed, there are no studies comparing the clinical outcomes. This prospective single-center observational case control study was conducted in the ED of Careggi University Hospital in Italy. Adult patients with radiological evidence of pneumonia, clinical diagnosis of AP and need for oxygen therapy were included from the 12th December 2023 to the 31st December 2024. The primary endpoints were 30 day-mortality and the length of hospital stay. Secondary endpoints included admission setting, changes in Horowitz index and O2 delivery device, and procedure-related complications. Statistical analysis was conducted on the entire sample and subsequently on a selected population using propensity score matching (PSM). 257 patients with a mean age of 78.0 ± 15.2 years were included in the study. There were no significant differences between LTA and FAB groups regarding 30-day mortality (37.7% FBA group vs 32% LTA group; p = 0.28) and length of hospital stay (11.8 ± 11.0 days FBA vs 9.5 ± 9.1 days LTA group; p = 0.45). No significant differences were observed for all secondary outcomes among the two groups. Also considering selected population based on PSM, no significant differences were observed. No significant differences were found in terms of mortality, length of hospital stay, morbidity and procedure-related complications among patients with AP treated with LTA or FBA.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247734","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

Diagnostic accuracy of point-of-care ultrasonography for obstructive cause in patients with acute kidney injury: a prospective diagnosis cohort. 急诊超声对急性肾损伤患者阻塞性病因的诊断准确性：一项前瞻性诊断队列。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-08 DOI: 10.1007/s11739-025-03996-2

Frederic Balen, Louise Drumare, Florian Laclergerie, Mathilde Gaudreau-Simard, Pierre Guy, Xavier Dubucs

{"title":"Diagnostic accuracy of point-of-care ultrasonography for obstructive cause in patients with acute kidney injury: a prospective diagnosis cohort.","authors":"Frederic Balen, Louise Drumare, Florian Laclergerie, Mathilde Gaudreau-Simard, Pierre Guy, Xavier Dubucs","doi":"10.1007/s11739-025-03996-2","DOIUrl":"https://doi.org/10.1007/s11739-025-03996-2","url":null,"abstract":"The aim of this study was to evaluate the test characteristics of point-of-care ultrasound (POCUS) in the diagnosis of obstructive acute kidney injury (AKI) in patients presenting with AKI to the Emergency Department (ED). This is a prospective diagnostic accuracy study that took place between July 6th, 2021 and July 6th, 2023 in the ED of an academic hospital. Adult patients visiting the ED and presenting with AKI were eligible for inclusion. Exclusion criteria were: pregnancy, dialysis-dependence, and kidney transplant. The index test was urinary tract POCUS (including kidneys and bladder assessment). The reference standard was obstructive origin of AKI using a two expert panel adjudication. One hundred and twenty-nine patients were included, with 22 (17%) obstructive AKI. For the diagnosis of obstructive AKI, POCUS had a sensitivity = 91% (95% CI = [71-99]), a specificity = 88% (95% CI = [80-93]), a PPV = 61% (95% CI = [42-77]), a NPV = 98% (95% CI = [93-100]), a LR + = 7.58 (95% CI = [4.42-12.67]) and a LR - = 0.1 (95% CI = [0.03-0.36]). Our study suggests that POCUS has good sensitivity and specificity for the diagnosis of an obstructive origin in presenting to the ED with AKI. Given a NPV of 98%, POCUS has great potential as a tool to rule out obstructive AKI, while its PPV of 61% suggests that positive POCUS likely requires confirmation with radiology-performed ultrasound. Trial registration number: NCT06190522.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247733","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

Violence in emergency services and preventative measures: results from an online survey from Germany. 紧急服务中的暴力和预防措施：来自德国的一项在线调查的结果。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-06 DOI: 10.1007/s11739-025-03994-4

Ana Zhelyazkova, Matthias Bonigut, Eva Jansen

{"title":"Violence in emergency services and preventative measures: results from an online survey from Germany.","authors":"Ana Zhelyazkova, Matthias Bonigut, Eva Jansen","doi":"10.1007/s11739-025-03994-4","DOIUrl":"https://doi.org/10.1007/s11739-025-03994-4","url":null,"abstract":"Violence in emergency medical services (EMS) presents a critical issue, yet data on its extent and on effective preventative measures are lacking. We aim to explore violence experiences and opportunities for prevention from the actor-centered perspective of EMS workers in Bavaria, Germany. We conducted a questionnaire-based online survey of EMS workers (September 2023-January 2024), comprising standardized items and open questions on experiences and perceptions of workplace violence. In this context, we collected data on requested preventive measures. Mixed-methods analysis was applied, including descriptive statistics and qualitative thematic analysis. Of 224 completed questionnaires, 38.4% reported to have experienced physical and 57.6% non-physical violence at work during the past 12 months. Experiences of physical violence were associated with the female gender, while non-physical violence showed an inverse association with age and seniority. Participants also reported physical (0.022%) and non-physical violence (17.9%) from colleagues. Only a third noted that there are established reporting procedures for violent incidents in their workplace, thereof over a third had refrained from submitting a report despite experiencing violence. Among the most effective and urgently requested preventive measures, respondents listed communication-based de-escalation and crisis management as well as improvement of working conditions including managers' leadership competencies. Results' interpretation is impeded by the limited response. Physical and non-physical violence are prevalent in the workplace context of EMS in Germany. An improvement in the working conditions, which should include transparent and effective reporting mechanisms as well as communication-based prevention strategies is explicitly requested by employees.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247735","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

Differences between xanthogranulomatous cholecystitis and gallbladder adenocarcinoma: an 11-year retrospective study. 黄色肉芽肿性胆囊炎与胆囊腺癌的差异：一项11年的回顾性研究。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-06 DOI: 10.1007/s11739-025-04007-0

Mehmet Berksun Tutan, Ramazan Topcu, İbrahim Tayfun Şahiner

{"title":"Differences between xanthogranulomatous cholecystitis and gallbladder adenocarcinoma: an 11-year retrospective study.","authors":"Mehmet Berksun Tutan, Ramazan Topcu, İbrahim Tayfun Şahiner","doi":"10.1007/s11739-025-04007-0","DOIUrl":"https://doi.org/10.1007/s11739-025-04007-0","url":null,"abstract":"Xanthogranulomatous cholecystitis (XGC) is a benign yet locally aggressive inflammatory condition that often mimics gallbladder adenocarcinoma (GBC) in clinical, radiological, and intraoperative presentation, leading to diagnostic uncertainty and potential overtreatment. This retrospective study aimed to identify distinguishing features between XGC and GBC by analyzing demographic, clinical, biochemical, radiological, and histopathological data from 133 patients who underwent cholecystectomy between 2013 and 2024. Among them, 115 were diagnosed with XGC and 18 with GBC. Gallbladder wall thickness ≥ 7.5 mm was identified as the most powerful predictor of malignancy, demonstrating 94.4% sensitivity, 84.3% specificity, and a 99% negative predictive value. Additional parameters associated with GBC included advanced age (≥ 65.5 years), anemia (hemoglobin ≤ 11.45 g/dL), thrombocytopenia (platelet count ≤ 215 × 10⁹/L), and mild hyponatremia (sodium ≤ 137.5 mmol/L), though their individual diagnostic performance was limited. Gallbladder polyps were significantly more prevalent in GBC cases. While conversion to open surgery was frequent in both groups due to technical complexity, it was not significantly different. These findings highlight the critical role of gallbladder wall thickness as a non-invasive, reliable diagnostic marker, particularly when combined with patient age and laboratory indicators. Incorporating these parameters into the preoperative assessment may improve diagnostic accuracy, reduce unnecessary radical procedures in benign conditions such as XGC, and facilitate timely intervention in malignancy.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234003","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

Embracing error and the unexpected in medical practice. 在医疗实践中接受错误和意外。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-05 DOI: 10.1007/s11739-025-03945-z

Chiara Corvino, Benedetta Colaiacovo, Marta Mocarelli, Marta Piria, Mara Gorli

引用次数: 0