Cureus最新文献

{"title":"Attitudes Toward E-Learning Among Undergraduate Nursing Students in Greece: A Multicenter Cross-Sectional Study.","authors":"Panagiotis K Anagnostou, Stefanos Mantzoukas, Konstantinos Poulas, Anastasios Tzenalis, Vasiliki Georgiopoulou, Georgios Vlachopoulos, Nikolaos Bakalis","doi":"10.7759/cureus.118574","DOIUrl":"https://doi.org/10.7759/cureus.118574","url":null,"abstract":"<p><p>Background/objectives E-learning has become an integral component of higher education, including nursing programs that combine theoretical instruction with laboratory and clinical training. This multicenter study investigated undergraduate nursing students' attitudes toward e-learning in Greece and examined the individual, educational, and technology-related factors associated with these attitudes. Methods A multicenter cross-sectional study was conducted among 1,148 undergraduate nursing students from all eight public university nursing departments operating in Greece during the study period. Data were collected using the Greek version of the Attitude toward e-Learning Scale among Nursing Students (ALSNS). Statistical analyses included descriptive statistics, comparative tests, and Bonferroni-adjusted post hoc analyses. Results Students generally recognized the flexibility and accessibility of e-learning and expressed positive intentions toward using digital educational technologies. However, they remained cautious regarding fully online approaches as a replacement for conventional nursing education and showed a preference for blended learning approaches. More positive attitudes were associated with younger age, university affiliation, higher digital competence, higher family income, and advanced year of study (p < 0.05), whereas gender differences were negligible (Cohen's d < 0.15). Conclusions Undergraduate nursing students viewed e-learning as a valuable complement rather than a replacement for conventional teaching. The findings suggest that blended learning models may be appropriate, integrating digital instruction with face-to-face nursing education while considering differences in students' digital readiness and educational context. Future longitudinal studies should examine whether positive attitudes toward e-learning translate into improved academic outcomes and clinical competence.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118574"},"PeriodicalIF":1.3,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When a Contaminant Is Not a Contaminant: A Case Report of Micrococcus luteus Causing Septic Shock in the Absence of Traditional Risk Factors.","authors":"Jewairia Alajab, Mia K Sooch, Mohammed Yeddi, Omer Yeddi, Moayyed Hussein, Ahmed Yeddi, Benjamin Frimodig","doi":"10.7759/cureus.118562","DOIUrl":"https://doi.org/10.7759/cureus.118562","url":null,"abstract":"<p><p><i>Micrococcus luteus</i> is a gram-positive, coagulase-negative coccus commonly regarded as a non-pathogenic commensal organism of human skin and is frequently considered a contaminant when isolated in blood cultures. However, emerging evidence suggests that it may act as an opportunistic pathogen in certain clinical settings. We report a case of septic shock caused by <i>M. luteus</i> in a 47-year-old woman with a history of hypertension and type 2 diabetes mellitus who presented with altered mental status and hemodynamic instability. Despite the absence of indwelling devices, prosthetic material, or structural heart disease, multiple blood cultures were positive for <i>M. luteus</i>, confirming true bacteremia. The patient required aggressive fluid resuscitation, vasopressor support, and intravenous antibiotic therapy, with subsequent clinical improvement and clearance of bacteremia. This case highlights the importance of correlating microbiological findings with clinical presentation and underscores the potential pathogenicity of organisms traditionally considered contaminants.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118562"},"PeriodicalIF":1.3,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13702380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical Presentation of Ramsay Hunt Syndrome in an Immunocompromised Patient: A Case Report.","authors":"David J Rash, Owori Mangeni","doi":"10.7759/cureus.118584","DOIUrl":"https://doi.org/10.7759/cureus.118584","url":null,"abstract":"<p><p>Ramsay Hunt syndrome (RHS), or herpes zoster oticus, is a rare neurological complication of varicella-zoster virus reactivation within the geniculate ganglion, leading to unilateral facial pain, facial paralysis, otalgia, sensorineural hearing loss, and a painful vesicular rash on the face or ear. Reactivation of the virus most often affects the vestibulocochlear (cranial nerve eight) and facial (cranial nerve seven) nerves in RHS. Early recognition of RHS is important as delays in treatment can lead to permanent facial paralysis, scarring, or irreversible sensorineural hearing loss. In this case, we examine an 84-year-old immunocompromised female patient whose diagnosis of RHS was delayed by multiple medical comorbidities and an atypical initial presentation.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118584"},"PeriodicalIF":1.3,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Earlobe Purpura as an Unusual Initial Manifestation of Systemic Lupus Erythematosus: A Case Report.","authors":"Lucy Atherton","doi":"10.7759/cureus.118549","DOIUrl":"https://doi.org/10.7759/cureus.118549","url":null,"abstract":"<p><p>Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease characterized by autoantibody production, particularly antinuclear antibodies (ANAs). The broad clinical spectrum and absence of pathognomonic features can make diagnosis challenging, particularly when alternative autoimmune, infectious, and hematological conditions must be considered. We report a case of a 31-year-old woman who presented to the emergency department with a two-week history of bilateral earlobe purpura. Initial investigations demonstrated severe thrombocytopenia and normocytic anemia, and subsequent imaging revealed widespread lymphadenopathy. Early multidisciplinary assessment by acute medicine, hematology, and rheumatology, together with exclusion of hematological malignancy and positive autoimmune serology, supported a diagnosis of SLE. Despite initial treatment with intravenous immunoglobulin (IVIg) and corticosteroids, the bicytopenia persisted. Mycophenolate mofetil was commenced; however, worsening cytopenias and concern for secondary hemophagocytic lymphohistiocytosis led to the initiation of rituximab infusions. Her platelet count subsequently improved, and she was discharged with rheumatology and hematology follow-up. This case highlights an unusual cutaneous presentation of newly diagnosed SLE and the diagnostic challenges associated with severe hematological involvement at initial presentation. It also demonstrates the importance of multidisciplinary assessment and timely escalation of immunosuppressive therapy in severe disease.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118549"},"PeriodicalIF":1.3,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13695845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Rheumatic Heart Disease in Older Brazilians: Hospitalizations and In-Hospital Deaths, 2015-2024.","authors":"Julia R Teixeira, Isabelle S Ciquini, Alana R da Costa Rosa, Lorenzo F Benedet, Mateus F Marques, Tuany C Bernardi, Thaís C Esteves-Pereira","doi":"10.7759/cureus.118576","DOIUrl":"https://doi.org/10.7759/cureus.118576","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Chronic rheumatic heart disease remains a cause of morbidity in older adults. This study analyzed hospitalizations and in-hospital deaths associated with the disease among Brazilians aged 60 years or older from 2015 to 2024, examining differences by sex and macroregion and temporal trends.</p><p><strong>Methods: </strong>This ecological time-series study used data from the Brazilian Unified Health System Hospital Information System and official population estimates. Annual crude hospitalization and in-hospital death rates per 100,000 older adults were calculated by sex and macroregion. Joinpoint regression was used to estimate annual and average annual percent changes.</p><p><strong>Results: </strong>Hospitalizations increased from 2,632 in 2015 to 3,683 in 2024, while crude hospitalization rates changed from 10.56 to 10.78 per 100,000 older adults. In-hospital deaths increased from 362 to 419, whereas corresponding rates declined from 1.45 to 1.23 per 100,000. Nationally, hospitalization rates among women declined by 7.05% annually during 2015-2020 and increased by 10.69% annually during 2020-2024 (both p < 0.001). Among men, rates declined by 6.83% annually during 2015-2021 (p = 0.004) and increased by 16.77% annually during 2021-2024 (p = 0.008). Over the full period, average national trends were not statistically significant for either outcome in either sex. Regional patterns were heterogeneous. In the Northeast, women showed sustained increases in hospitalization rates (5.08% annually; p = 0.021) and in-hospital death rates (11.88% annually; p < 0.001).</p><p><strong>Conclusions: </strong>Hospitalization rates declined and subsequently rebounded, while population-based in-hospital death rates and their temporal patterns varied by sex and region. These patterns reflect the joint contribution of hospitalization frequency and the proportion of admissions ending in death and should not be interpreted as deaths causally attributable to chronic rheumatic heart disease. Regional variation indicates an uneven distribution of recorded hospital utilization and outcomes but does not, by itself, establish inequalities in access to or quality of care. The recent increase in hospitalizations indicates greater hospital utilization and should not be interpreted as evidence of increased disease incidence. Continued surveillance incorporating both hospitalization rates and the proportion of admissions resulting in death is warranted to better characterize temporal and regional patterns among older adults.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118576"},"PeriodicalIF":1.3,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allergic to Exercise: A Case of Exercise-Induced Urticaria and Angioedema.","authors":"Puja Patel","doi":"10.7759/cureus.118496","DOIUrl":"https://doi.org/10.7759/cureus.118496","url":null,"abstract":"<p><p>A 23-year-old female presented with urticaria, peri-orbital angioedema, wheeze and cough during intense exercise, with progression slowed by exercise cessation. Additional triggers included passive heating and strong emotion, while low-to-moderate intensity exercise did not provoke symptoms. Symptoms occurred independently of food intake. Past medical history included exercise-induced bronchoconstriction (EIB), eczema and seasonal allergies. Skin-prick and specific IgE testing for food allergens were negative, whilst dermatographia testing was positive. Specific IgE testing demonstrated sensitisation to house dust mite and animal dander as well as several moulds. Initial treatment with antihistamines, famotidine and montelukast provided partial symptom control, whilst later addition of omalizumab resulted in resolution of exercise-induced urticaria and angioedema. This case illustrates the diagnostic overlap between exercise-induced anaphylaxis (EIA), a rare, life-threatening syndrome associated with exercise, and cholinergic urticaria, with a possible contribution from symptomatic dermographism and pre-existing symptoms of EIB. This case highlights that exercise-triggered urticarial syndromes may not fit neatly into a single diagnostic category, and that a thorough, trigger-focused history remains a valuable diagnostic tool.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118496"},"PeriodicalIF":1.3,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13695092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pituitary Apoplexy Complicated by Pulmonary Embolism in a Neurologically Complex Patient: A Diagnostic Challenge.","authors":"Gergis Farag, Abdullatif Farhat","doi":"10.7759/cureus.118537","DOIUrl":"https://doi.org/10.7759/cureus.118537","url":null,"abstract":"<p><p>Pituitary apoplexy is a rare endocrine emergency resulting from either acute haemorrhage or infarction within the pituitary gland. Although apoplexy occurs most frequently in a pre-existing pituitary adenoma, apoplexy could be the first presentation of a previously unknown adenoma. Acute headaches, visual disturbances, and neurological symptoms are common presenting symptoms in apoplexy; however, these symptoms may overlap with other neurological emergencies, which necessitate a holistic approach of clinical, radiological, and hormonal evaluation for suspected cases of apoplexy to confirm the diagnosis. Here we present a diagnostically challenging case of a 66-year-old man who presented with a sudden severe headache. His background history included a presumed intraventricular neurocytoma under surveillance. Initial CT head scan suggested possible haemorrhage within a known intraventricular mass (neurocytoma) with no obvious changes within the pituitary gland. However, subsequent MRI head demonstrated radiological features consistent with pituitary apoplexy. Later in his admission, he exhibited bilateral peripheral visual field constriction and early papilledema on fundoscopy. Hormonal testing showed evidence of hypopituitarism. The patient was managed conservatively with intravenous hydrocortisone replacement. During admission, he developed bilateral pulmonary emboli, for which he was treated with anticoagulation. While he was on anticoagulation, he developed intracranial haemorrhage, which led to his death after discharge from the hospital. This case demonstrates the importance of considering pituitary apoplexy in a challenging radiological and clinical presentation. A pre-existing neurological lesion (neurocytoma) makes a holistic approach, including MRI imaging and early hormonal evaluation are essential for timely diagnosis and treatment of pituitary apoplexy. The clinical challenge of having concurrent haemorrhagic and thrombotic events necessitates an individualised approach after balancing the benefits and risks of using anticoagulation treatment.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118537"},"PeriodicalIF":1.3,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13712162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of a Novel Oil Pulling Oral Rinse for Teeth Whitening: A Double-Blind, Randomised, Placebo-Controlled Trial.","authors":"Chetan Patel, Ashwin Prabhu, Deepa Subramanian","doi":"10.7759/cureus.118502","DOIUrl":"https://doi.org/10.7759/cureus.118502","url":null,"abstract":"<p><p>Aim Conventional peroxide-based tooth-whitening systems are effective but are frequently associated with tooth sensitivity and gingival irritation, prompting interest in potentially gentler alternatives. Medium-chain triglyceride (MCT) oil combined with essential oils has been proposed as a possible approach to reducing extrinsic tooth discolouration, but controlled clinical evidence remains limited. This study aimed to evaluate the whitening efficacy and safety of a novel MCT-based oil pulling oral rinse containing an essential oil blend compared with a placebo in adults with tooth shade A2 or darker. Materials and methods In this double-blind, randomised, placebo-controlled, single-centre trial, 100 adults (18-65 years) with a baseline tooth shade of A2 or darker were randomised 1:1 to receive the active oil pulling rinse (n=50) or a matched placebo rinse (n=50). Participants self-administered 10 mL of the assigned rinse each morning before toothbrushing for 4 weeks. Tooth shade was assessed at screening, Week 2, and Week 4 using a VITA classical shade guide (VITA Zahnfabrik, Bad Säckingen, Germany), converted to a 16-point Munsell-based numeric scale, and compared between groups using the Wilcoxon test. Safety was assessed through physical and oral examination, vital signs, haematology and biochemistry, and adverse event monitoring. Results All 100 randomised participants completed the study with no dropouts or protocol deviations. Mean (SD) tooth-whiteness scores in the active group increased from 5.99 (2.627) at screening to 6.97 (2.769) at Week 2 and 7.29 (2.832) at Week 4, whereas placebo scores remained essentially unchanged (6.16 (2.419) at screening, 6.16 (2.421) at Week 2, - 6.22 (2.462)) at Week 4. Between-group differences favoured the active rinse at Week 2 and Week 4 (both p<0.0001), with continued significant improvement between Week 2 and Week 4 (p=0.0008). Treatment compliance was 100% in both arms; 92% of active-group and 90% of placebo-group participants rated tolerability as excellent. No adverse events and no clinically significant changes in physical examination, oral examination, vital signs, or laboratory parameters were observed in either group. Satisfaction with treatment was markedly higher in the active group. Conclusion The active oil pulling oral rinse containing MCT oil and an essential oil blend produced statistically significant, progressive improvement in tooth whiteness over four weeks compared with placebo, with an excellent safety and tolerability profile. These findings support the investigated oil pulling rinse as a viable, gentle adjunct for cosmetic tooth whitening, although confirmation in larger, multi-centre studies is warranted.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118502"},"PeriodicalIF":1.3,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13708271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Career-Choice Regret Among Medical Students in the United Kingdom: An Exploratory Mixed-Methods Study of Occupational and Organizational Perceptions.","authors":"Alexia Davy","doi":"10.7759/cureus.118523","DOIUrl":"https://doi.org/10.7759/cureus.118523","url":null,"abstract":"<p><strong>Background: </strong>Career-choice regret has been reported among medical students internationally, but less is known about how career-choice responses coexist with perceptions of medicine as a profession and the National Health Service (NHS) as a potential employer among United Kingdom (UK) medical students. This study explored career-choice responses and occupational and organizational perceptions among UK medical students.</p><p><strong>Methods: </strong>An exploratory cross-sectional mixed-methods online survey was completed by 31 medical students from 22 UK universities who were recruited through convenience and snowball sampling. The primary outcome was participants' response to whether they would choose medicine again. Occupational and organizational perceptions were assessed using two newly developed, unvalidated 10-item composite perception measures. Participants also rated the importance of and expected satisfaction with career characteristics. Quantitative data were analyzed descriptively, and free-text responses from 18 participants were analyzed thematically.</p><p><strong>Results: </strong>Of 31 participants, 14 (45.2%) reported that they would choose medicine again, 10 (32.3%) were unsure, and 7 (22.6%) reported that they would not. Mean occupational and organizational composite scores were 25.23 (SD 6.34) and 38.97 (SD 8.20), respectively. Item-level responses suggested positive views of medicine as a profession alongside negative perceptions of several aspects of NHS employment. The largest gaps were between the importance attached to career characteristics and expected satisfaction related to work location, access to specialty training, work-life balance, and the work environment. Twenty-seven participants (87.1%) considered regret and dissatisfaction among medical students to be a common problem. Free-text responses highlighted concerns about medical education and postgraduate training, work-life balance, future career prospects, financial and working conditions, and feeling undervalued by the NHS. Other responses conveyed continued enthusiasm for medicine despite concerns about the organizational context.</p><p><strong>Conclusions: </strong>In this small, self-selected sample, positive perceptions of medicine as a profession coexisted with negative perceptions of the NHS as an organization, while fewer than half of participants reported that they would choose medicine again. These exploratory findings describe career-choice responses and occupational and organizational perceptions but do not establish a causal relationship between organizational dissatisfaction and stated willingness to choose medicine again or predict future career decisions. Larger studies using more diverse samples, validated measures, and longitudinal follow-up are needed to investigate how these perceptions relate to career choices over time.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118523"},"PeriodicalIF":1.3,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13695578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Audit on the Management of Adult Patients With Renal Colic Presenting to the Emergency Department.","authors":"Heba M Ahmed, Sara E Almheiri, Esra M Aldarmaki, Reem S Al Thehli, Khawla S Abdulrahman, Shahla K Al Marrawi, Neena A Roy, Tamadur A El Shikhidris, Maha E Aljaberi, Maryam Al Nuaimi, Nasser Ahmed, Kenneth C Dittrich, Ismail Mohamed Al Ramahi, Hasan Qayyum","doi":"10.7759/cureus.118507","DOIUrl":"https://doi.org/10.7759/cureus.118507","url":null,"abstract":"<p><strong>Introduction: </strong> Renal colic is a common emergency department presentation requiring timely assessment, appropriate analgesia, and investigation. This clinical audit evaluated adherence to predefined standards for pain assessment, timely analgesia, investigations, imaging, and medication selection, and assessed changes in practice following a structured implementation phase.</p><p><strong>Methods: </strong> A retrospective, single-center, two-cycle clinical audit was conducted in an adult emergency department. The primary audit included 100 patients presenting between December 2020 and December 2024, and the re-audit included 100 patients presenting between March and September 2025, giving a total sample of 200 patients. Nine audit criteria were derived from the Royal College of Emergency Medicine (RCEM) and the National Institute for Health and Care Excellence (NICE) guidance. Following the primary audit, departmental education, audit feedback, an educational infographic, and a standardized renal colic analgesia pathway were implemented. Categorical outcomes were reported as frequencies and percentages and compared between audit cycles using two-sided Chi-square or Fisher exact tests, as appropriate.</p><p><strong>Results: </strong> First-line nonsteroidal anti-inflammatory drug (NSAID) administration increased from 39/100 patients (39.0%) in the primary audit to 60/100 patients (60.0%) in the re-audit, representing an absolute increase of 21.0 percentage points (95% CI: 7.5-34.5). This difference was statistically significant (χ²(1, N = 200) = 8.00; p = 0.005). Avoidance of first-line opioid administration increased from 89/100 patients (89.0%) to 94/100 patients (94.0%); however, this difference was not statistically significant (χ²(1, N = 200) = 1.03; p = 0.310). Pain-score documentation, timely analgesia, urine dipstick testing, laboratory investigations, computed tomography (CT) imaging, and avoidance of antispasmodic medication remained broadly consistent between the two audit cycles.</p><p><strong>Conclusion: </strong> Following implementation of a standardized renal colic pathway, departmental education, an educational infographic, and audit feedback, first-line NSAID use increased significantly and first-line opioid use decreased. Other key measures of assessment, investigation, and analgesic care remained generally stable between audit cycles. These findings support the value of a structured departmental approach to promoting guideline-concordant analgesic prescribing and provide a basis for continued quality-improvement activity and future re-audit.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118507"},"PeriodicalIF":1.3,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}