Internal and Emergency Medicine最新文献_第7页

The impact of COVID-19 pandemic on hospitalization rate, clinical impairment and mortality of cirrhotic patients. 新冠肺炎大流行对肝硬化患者住院率、临床损害和死亡率的影响

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-01 Epub Date: 2025-05-05 DOI: 10.1007/s11739-025-03911-9

Gaia Sinatti, Benedetta Cosimini, Andreea Alina Braicu, Silvano Junior Santini, Valerio Caputo, Ada Ruscitti, Leondino Mammarella, Clara Balsano

{"title":"The impact of COVID-19 pandemic on hospitalization rate, clinical impairment and mortality of cirrhotic patients.","authors":"Gaia Sinatti, Benedetta Cosimini, Andreea Alina Braicu, Silvano Junior Santini, Valerio Caputo, Ada Ruscitti, Leondino Mammarella, Clara Balsano","doi":"10.1007/s11739-025-03911-9","DOIUrl":"10.1007/s11739-025-03911-9","url":null,"abstract":"The COVID-19 pandemic caused widespread disruption to global healthcare systems, necessitating the reallocation of resources to address the immediate demands. This reorganization had significant repercussions on the management of chronic diseases, including cirrhosis. We sought to provide a comprehensive picture of the COVID-19 impact on monthly hospitalization rates of cirrhotic patients at Local Health Board 1 hospitals in the Abruzzo Region, Italy. Using the International Classification of Diseases, Ninth Revision, we identified cases of alcohol-related, nonalcohol-related, biliary, and decompensated cirrhosis. We analyzed 957 Hospital Discharge Records from January 1 to December 31, 2019 (pre-pandemic), and from January 1 to December 31, 2022 (post-pandemic). We evaluated patients' clinical impairment, length of stay, and mortality before and after the pandemic. We identified 494 hospitalizations for nonalcohol-related cirrhosis and 310 for alcohol-related cirrhosis. As key findings, hospitalizations for nonalcohol-related cirrhosis decreased (69% vs. 48%; p < .0001), while hospitalizations for alcohol-related cirrhosis increased (31% vs. 52%; p < .0001), in the post-pandemic period. Additionally, there was a significant rise in decompensated patients with alcohol-related cirrhosis post-COVID (77% vs. 65%; p = .0216). Mortality risk increased for both nonalcohol- (11% vs. 18.5%; p = .0176) and alcohol-related cirrhosis (7.7% vs. 18%; p = .0059) in the post-pandemic era. The increase in hospitalizations for alcohol-related cirrhosis is alarming and likely to have a prolonged impact on the natural history of liver diseases. There is an urgent need to reduce alcohol consumption at the population level. Continued awareness and personalized follow-up are essential for guaranteeing the standard of care during health emergencies.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1059-1067"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018764","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

Testicular ultrasound: an emergency medicine perspective. 睾丸超声：急诊医学视角。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-01 Epub Date: 2025-03-18 DOI: 10.1007/s11739-025-03864-z

José Mariz, Joaquin Martinez, Sheila Arroja, Michael Blaivas

{"title":"Testicular ultrasound: an emergency medicine perspective.","authors":"José Mariz, Joaquin Martinez, Sheila Arroja, Michael Blaivas","doi":"10.1007/s11739-025-03864-z","DOIUrl":"10.1007/s11739-025-03864-z","url":null,"abstract":"Ultrasound of the scrotum plays a crucial role in assessing acute scrotal conditions in the Emergency Department. Although the Emergency Physician and Intensivist have shared responsibility for the care of the critically ill patient, the Emergency Physician typically uses Point-of-care Ultrasound in a broader range of applications than the intensivist to include advanced abdominal, obstetric, testicular, musculoskeletal, and ocular ultrasonography. Acute scrotum refers to the sudden onset of scrotal erythema, swelling, or pain, and it is not a rare condition in the Emergency Department. Prompt intervention is required in cases of testicular torsion or rupture, and ultrasound of the scrotum has high utility for emergency physicians seeing acute scrotal complaints with any frequency. However, the incidence of acute scrotum incidence is low compared to other disease states requiring ultrasound diagnosis. This presents a problem when considering ultrasound training of Emergency Physicians for ultrasound of the scrotum in a Point-of-care perspective. With this narrative review, we will attempt to raise the awareness of emergency medicine doctors to the importance of ultrasound of the scrotum in the Emergency Department. We will also discuss educational aspects in testicular ultrasound and the use of contrast-enhanced ultrasound. Finally, we propose an algorithm for action.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1153-1163"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12130081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657190","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

Effects of the ABC pathway on clinical outcomes in very elderly Chinese patients with atrial fibrillation. A report from the optimal thromboprophylaxis in elderly Chinese patients with atrial fibrillation (ChiOTEAF) registry. ABC通路对中国高龄房颤患者临床转归的影响。中国老年房颤患者最佳血栓预防（ChiOTEAF）登记报告。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-01 Epub Date: 2025-04-27 DOI: 10.1007/s11739-025-03928-0

Ameenathul Mazaya Fawzy, Agnieszka Kotalczyk, Yutao Guo, Yutang Wang, Gregory Y H Lip

{"title":"Effects of the ABC pathway on clinical outcomes in very elderly Chinese patients with atrial fibrillation. A report from the optimal thromboprophylaxis in elderly Chinese patients with atrial fibrillation (ChiOTEAF) registry.","authors":"Ameenathul Mazaya Fawzy, Agnieszka Kotalczyk, Yutao Guo, Yutang Wang, Gregory Y H Lip","doi":"10.1007/s11739-025-03928-0","DOIUrl":"10.1007/s11739-025-03928-0","url":null,"abstract":"The current Atrial fibrillation Better Care (ABC) pathway for holistic or integrated management of AF is associated with improved clinical outcomes; however, data on the very elderly (aged ≥ 85 years) are sparse.To evaluate the impact of ABC pathway on clinical outcomes amongst very elderly AF patients over a follow-up period of 1 year.The ChiOTEAF registry is a prospective, multicenter nationwide study conducted from October 2014 to December 2018. Endpoints of interest were the composite outcome of all-cause death/any thromboembolism (TE), all-cause death, TE events, and major bleeding.The eligible cohort included 1215 individuals (mean age 88.5 ± 3.3; 33.5% female), of which 142 (11.7%) were managed accordingly to the ABC pathway. ABC compliance was independently associated with lower odds of the composite outcome (odds Ratio (OR): 0.23; 95% confidence interval (CI): 0.08-0.66) and all-cause death (OR: 0.22; 95% CI: 0.07-0.75), without a significant increase in major bleeding compared to ABC non-compliance. Health-related quality of life (QOL) was also significantly higher in the ABC compliant group compared to the non-compliant group (EQ score 0.83 ± 0.17 vs. 0.78 ± 0.20; p = 0.004). Independent predictors of ABC non-compliance were prior major bleeding, chronic kidney disease, and dementia.Our findings suggest that adherence to the ABC pathway in very elderly patients is associated with significantly improved survival and health-related QOL.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1087-1095"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985909","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

Holding breath. 拿着呼吸。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-01 Epub Date: 2025-03-08 DOI: 10.1007/s11739-025-03912-8

Silvia Tiraboschi

引用次数: 0

External validation of the TFC (triage frailty and comorbidity) tool: a prospective observational study. TFC（虚弱与合并症分诊）工具的外部验证：一项前瞻性观察研究。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-01 Epub Date: 2024-09-06 DOI: 10.1007/s11739-024-03757-7

Arian Zaboli, Serena Sibilio, Gloria Brigiari, Magdalena Massar, Marta Parodi, Gabriele Magnarelli, Francesco Brigo, Gianni Turcato

{"title":"External validation of the TFC (triage frailty and comorbidity) tool: a prospective observational study.","authors":"Arian Zaboli, Serena Sibilio, Gloria Brigiari, Magdalena Massar, Marta Parodi, Gabriele Magnarelli, Francesco Brigo, Gianni Turcato","doi":"10.1007/s11739-024-03757-7","DOIUrl":"10.1007/s11739-024-03757-7","url":null,"abstract":"Assessing patient frailty during triage evaluations has become increasingly relevant in Emergency Departments (ED). This study aimed to externally validating the Triage Frailty and Comorbidity (TFC) tool. This prospective study was conducted from June 1 to December 31, 2023. During this period, 12 triage nurses applied the TFC tool during triage evaluation of ED patients. We used receiver operating characteristic (ROC) curves and Decision Curve Analysis to assess the predictive ability of the TFC tool for a 90-day mortality (the same endpoint used during tool development) and a 30-day mortality. 1270 patients were included and 56 of them died within 90 days. The TFC tool had an AUROC of 0.894 (0.858-0.929) for 90-day mortality and 0.885 (0.834-0.938) for 30-day mortality. In Decision Curve Analysis, it yielded higher net benefits up to a threshold probability of 0.30. The externally validated TFC tool appears very effective at identifying patients with increased risk of 90-day mortality after ED attendance. It could be implemented in clinical practice and enhance the predictive ability of standard triage systems.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1195-1202"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139982","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

A rare complication of acute pancreatitis. 急性胰腺炎的罕见并发症。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-01 Epub Date: 2025-03-28 DOI: 10.1007/s11739-025-03879-6

Alessandro Scuricini, Jeries Zawaideh, Nicholas Bardi, Federico Carbone, Davide Ramoni

引用次数: 0

Severe burn injuries and the impact of mental health: insights from 7 years at Switzerland's leading burn center. 严重烧伤和心理健康的影响：来自瑞士领先烧伤中心7年的见解。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-01 Epub Date: 2025-02-12 DOI: 10.1007/s11739-025-03887-6

Michael-Alexander Pais, Mauro Vasella, Oliver Matthes, Elena Millesi, Alexander Kobler, Tabea Breckwoldt, Gregory Reid, Lukas Naef, Luzie Hofmann, Jennifer Ashley Watson, Philipp Karl Bühler, Pietro Giovanoli, Bong-Sung Kim

{"title":"Severe burn injuries and the impact of mental health: insights from 7 years at Switzerland's leading burn center.","authors":"Michael-Alexander Pais, Mauro Vasella, Oliver Matthes, Elena Millesi, Alexander Kobler, Tabea Breckwoldt, Gregory Reid, Lukas Naef, Luzie Hofmann, Jennifer Ashley Watson, Philipp Karl Bühler, Pietro Giovanoli, Bong-Sung Kim","doi":"10.1007/s11739-025-03887-6","DOIUrl":"10.1007/s11739-025-03887-6","url":null,"abstract":"Severe burn injuries present significant global healthcare challenges, with outcomes significantly influenced by factors such as socioeconomic status, mental health conditions, and substance use, which vary across regions and healthcare systems. This study investigates the etiologies, treatment outcomes, and the impact of psychiatric conditions and controlled substance use on burn injuries in patients admitted to the intensive care unit at Switzerland's largest Burn Center. Data were retrospectively analyzed from 438 patients admitted to the University Hospital Zurich Burn Center ICU between 2016 and 2022. Variables assessed included baseline characteristics, burn etiologies, injury mechanisms, treatment modalities, complications, discharge outcomes, and mortality. Statistical analyses employed generalized linear models and logistic regression. Most burns occurred at home/leisure activities (43.4%), 21.2% at work. Pre-existing psychiatric conditions were present in 38.8% of patients, and 24.4% were under influence of controlled substances at the time of injury. These factors were associated with higher complication rates, increased surgeries, longer hospital stays, and lower survival rates. The overall in-hospital mortality rate was 15.8%, significantly linked to a history of controlled substance use. These findings highlight the significant impact of psychiatric conditions and use of controlled substances on burn injury outcomes, underscoring the importance of an interdisciplinary approach to treatment and management, particularly for patients with mental health and substance abuse histories.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1141-1151"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12130154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407324","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

Partial arterial carbon dioxide and oxygen pressure in patients with cardiogenic shock. 心源性休克患者的部分动脉二氧化碳和氧压。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-01 Epub Date: 2025-05-09 DOI: 10.1007/s11739-025-03926-2

Jonas Rusnak, Tobias Schupp, Kathrin Weidner, Marinela Ruka, Sascha Egner-Walter, Alexander Schmitt, Muharrem Akin, Kambis Mashayekhi, Mohamed Ayoub, Michael Behnes, Ibrahim Akin

{"title":"Partial arterial carbon dioxide and oxygen pressure in patients with cardiogenic shock.","authors":"Jonas Rusnak, Tobias Schupp, Kathrin Weidner, Marinela Ruka, Sascha Egner-Walter, Alexander Schmitt, Muharrem Akin, Kambis Mashayekhi, Mohamed Ayoub, Michael Behnes, Ibrahim Akin","doi":"10.1007/s11739-025-03926-2","DOIUrl":"10.1007/s11739-025-03926-2","url":null,"abstract":"In patients with acute cardiovascular diseases, hypocapnia, hypoxia and hyperoxia are known to be associated with increased mortality. This monocentric prospective registry study included 238 consecutive patients with cardiogenic shock (CS). The study aimed to assess the prognostic impact of partial arterial carbon dioxide (PaCO2) and oxygen pressure (PaO2) on 30-day all-cause mortality. Statistical analyses included t-tests, Spearman´s correlation, Kaplan-Meier and Cox regression analyses. No difference was found between quartiles of PaCO2 (log-rank p = 0.416) and PaO2 (log-rank p = 0.946) in the entire cohort. In the subgroup of patients with ventilation on admission, patients with PaCO2 ≤ 33 mmHg showed the highest 30-day all-cause mortality compared to the other quartiles (82.6% vs. 46.9% vs. 54.0% vs. 59.6% log-rank p = 0.026). No differences were found between levels of PaO2, when stratified by quartiles (log-rank p = 0.895). After differentiation between patients with PaCO2 ≤ 33 mmHg and PaCO2 > 33 mmHg the association with 30-day all-cause mortality remained significant (82.6% vs. 54.5% log-rank p = 0.006) in ventilated patients, whereas still no difference could be seen in the entire cohort (log-rank p = 0.264). Even after multivariable adjustment PaCO2 ≤ 33 mmHg remained an independent risk factor for 30-day all-cause mortality (HR 1.936; 95% CI 1.131-3.316; p = 0.016) in ventilated CS-patients. In conclusion, no association was found between different levels of PaCO2 and PaO2 with 30-day all-cause mortality in patients with CS. However, in the subgroup of CS-patients requiring ventilation, PaCO2 ≤ 33 mmHg was associated with an increased 30-day all-cause mortality.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1077-1086"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12130108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997154","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

Proton pump inhibitors and 1-year risk of adverse outcomes after discharge from internal medicine wards: an observational study in the REPOSI cohort. 质子泵抑制剂和内科病房出院后1年不良后果风险：REPOSI队列的观察性研究

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-01 Epub Date: 2025-04-06 DOI: 10.1007/s11739-025-03937-z

Chiara Elli, Alessio Novella, Luca Pasina

{"title":"Proton pump inhibitors and 1-year risk of adverse outcomes after discharge from internal medicine wards: an observational study in the REPOSI cohort.","authors":"Chiara Elli, Alessio Novella, Luca Pasina","doi":"10.1007/s11739-025-03937-z","DOIUrl":"10.1007/s11739-025-03937-z","url":null,"abstract":"Proton pump inhibitors are widely prescribed at hospital discharge from internal medicine wards and inappropriate use is common. We retrospectively conducted a survival analysis on data collected from the Registro Politerapie SIMI (REPOSI) registry to evaluate the 1-year risk of hospitalization or mortality associated with the use of PPI, with a particular focus on the appropriateness of use and newly initiated prescriptions at discharge. 7280 patients were discharged from hospital and 4579 (62.9%) had a PPI prescription. The use of PPI was significantly associated with 1-year risk of mortality in the univariate model (hazard ratio (HR) 1.33, p = 0.0012) and also when adjusted for confounders (adjusted HR 1.47, p = 0.0009). In the sensitivity analysis, new PPI prescription use at discharge was associated with an increased risk of mortality (adjusted HR of 1.53, p = 0.006). Inappropriate use was also linked to a nearly 60% higher risk of 1-year mortality and 27% increased risk of 1-year re-hospitalization. Among new PPI users, inappropriate use was associated with nearly 70% increased risk of 1-year mortality (HR 1.69). PPI use was associated with an increased risk of 1-year mortality and re-hospitalization in older adults discharged from hospitals. A higher risk of mortality was observed among new inappropriate PPI users, underscoring the importance of carefully evaluating the unnecessary initiation of new medications at discharge to maintain a favorable benefit-risk ratio.Impact of findings on practice statements. Proton pump inhibitors are among the most commonly prescribed medications. Use of proton pump inhibitors at hospital discharge was associated with a risk of 1-year mortality. Unnecessary PPI use was associated with higher risk of mortality. Patients discharged from internal medicine wards had high rates of inappropriate PPI use. The unnecessary initiation of new drugs at discharge for a favorable benefit-risk ratio was evaluated.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1119-1126"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795226","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

Empowering the vulnerable in internal medicine: a narrative review on physical exercise as a tool to tackle frailty. 赋予内科学中的弱势群体权力：关于体育锻炼作为解决脆弱的工具的叙述回顾。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2025-06-01 DOI: 10.1007/s11739-025-03988-2

Marco Vincenzo Lenti, Alice Silvia Brera, Antonio Di Sabatino, Gino Roberto Corazza

引用次数: 0