Abstract Background Emergency department (ED) overcrowding is a recurrent public health concern, which may be alleviated by forecasting ED visits. Numerous ED forecasting models exist, making it challenging for decision makers to select appropriate forecasts and plan under model and forecast uncertainty. It remains unclear whether incorporating environmental covariates as model predictors or aggregating cause-specific ED visit forecasts to obtain total ED visit forecasts can each contribute to improving forecast accuracy. Methods To address this gap, we developed a framework to generate accurate probabilistic forecasts using forecast combination schemes. We developed probabilistic forecast combinations schemes which can directly combine predictive distributions/quantiles in a linear/non-linear fashion, using static/dynamic weighting schemes. These schemes were tested in probabilistically forecasting cause-specific ED visits in Singapore, an equatorial city state. We incorporated a high-dimensional set of predictors to further augment model performance. We documented the forecast performance of all forecasting models across 1- to 12-week ahead horizons. Results Our study showed that aggregating cause-specific forecasts to provide all-cause ED visit forecasts can enhance overall ED visit forecasting performance—particularly for KNN, XGBoost, and Elastic Net. Forecast combinations, in particular, the linear opinion pool can lead to excellent and stable forecasts over all individual forecasts in 164 out of the 180 cause–horizon combinations examined. Within the considered forecast horizons, longer horizons led to more scenarios where forecast combinations outperformed individual models significantly (p < 0.05). Forecast combinations exhibited stable performance across forecast horizons, whereas individual models showed greater variability—some performed well at shorter horizons but deteriorated at longer ones, and vice versa. We also found that quantile forecast combinations can generate confident forecasts while maintaining good accuracy. Conclusion Forecasting cause-specific ED visits can provide fine-scale forward guidance on resource optimization and ED crowding preparedness. Probabilistic forecast combinations can characterize the uncertainty of forecasts and hedge against model selection uncertainty in a robust manner. However, performance during COVID-19 was not assessed, which may limit generalizability under structural breaks.
Special situations and conditions, Medical emergencies. Critical care. Intensive care. First aid
Nanotechnology has emerged as a revolutionary approach in wound healing and scar reduction, offering precise, targeted, and efficient drug delivery systems. This review highlights recent advances in nanotechnology-based solutions, including nanoparticles, nanofibers, hydrogels, and nanoemulsions that address limitations of conventional therapies. These innovations enhance antimicrobial activity, promote angiogenesis, modulate inflammation, and deliver therapeutic agents with remarkable precision. The integration of nanotechnology with scar-reducing agents has transformative potential for collagen remodeling and fibrosis inhibition, improving both functional and esthetic outcomes. Furthermore, smart nanomaterials with biosensing capabilities enable real-time wound monitoring and dynamic treatment adjustments. While these advances are promising, challenges related to biocompatibility, cytotoxicity, and regulatory approval remain critical to address.This review emphasizes the profound impact of nanotechnology in revolutionizing wound care and provides insights into future directions, including personalized therapies and artificial intelligence-integrated systems for optimized outcomes.
Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Diseases of the circulatory (Cardiovascular) system
Objective: This study aimed to investigate the role of oxidant and antioxidant levels in the diagnosis of acute pulmonary embolism (APE).
Materials and Methods: Participants diagnosed with APE were included in group 1, and healthy volunteers were included in Group 2. In addition, Group 1 was divided into two groups according to 30-day mortality.
Results: Sixty-five participants diagnosed with APE were included in Group 1. A total of 52 healthy volunteers were included in Group 2. The total antioxidant capacity (TAC) levels of Group 1 were lower than those of Group 2, and the total oxidant capacity (TOC), oxidative stress index (OSI), and ischemia-modified albumin levels were higher. When receiver operating characteristic analysis was performed for TAC, TOC, OSI, and ischemia-modified albumin, the highest area under the curve was found for OSI, TOC, and ischemia-modified albumin, respectively. Fifteen (23%) participants in Group 1 died within 30 days of admission to the emergency department (Group 1A), and 50 (77%) survived after 30 days (Group 1B).
Conclusion: The oxidant-antioxidant balance is impaired in APE. Therefore, oxidants and antioxidants can be used to diagnose and exclude patients with suspected APE.
Medical emergencies. Critical care. Intensive care. First aid
Abstract Background Pneumothorax may occur as a complication of cardiopulmonary resuscitation (CPR) and could pose a potentially life-threatening condition. In this study we sought to investigate the incidence of pneumothorax following CPR for out-of-hospital cardiac arrest (OHCA), identify possible risk factors, and elucidate its association with outcomes. Methods This study was a retrospective data analysis of patients hospitalized following CPR for OHCA. We included cases from 1st March 2014 to 31st December 2021 which were attended by teams of the physician staffed ambulance based at the University Medical Centre Graz, Austria. Chest imaging after CPR was reviewed to assess whether pneumothorax was present or not. Logistic regression analysis was performed to identify factors for the development of pneumothorax relevant and to assess its association with outcomes [survival to hospital discharge and cerebral performance category (CPC)]. Results Pneumothorax following CPR was found in 26 out of 237 included cases (11.0%). History of obstructive lung disease was significantly associated with presence of pneumothorax after CPR. This subgroup of patients (n = 61) showed a pneumothorax rate of 23.0%. Pneumothorax was not identified as a relevant factor to predict survival to hospital discharge or favourable neurological outcome (CPC1 + 2). Conclusions Pneumothorax may be present in greater than one in ten patients hospitalized after CPR for OHCA. Pre-existent obstructive pulmonary disease seems to be a relevant risk factor for development of post-CPR pneumothorax. ClinicalTrials.gov ID: NCT06182007 (retrospectively registered). Trial Registration: NCT06182007 (retrospectively registered)
Medical emergencies. Critical care. Intensive care. First aid
Suman Thakur, Vivek Chauhan, Sagar Galwankar
et al.
Background: The Female Leadership Academy for Medical Excellence, members of the World Academic Council of Emergency Medicine, conducted this systematic review, which explores gender disparities in burnout among emergency physicians (EP) using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Burnout is a critical issue in healthcare, particularly in emergency medicine where high stress and demanding work environments prevail. Methods: Following PRISMA guidelines, we searched PubMed and Epistemonikos for studies using MBI-HSS to measure burnout in EPs. Inclusion criteria encompassed peer-reviewed, English-language articles reporting burnout by sex. Data extraction focused on proportions of burnout and its subcomponents, mean scores, and odds ratios, with quality assessed using Joanna Briggs Institute criteria. Results: We included 18 studies spanning 26,939 EPs from 10 countries. While overall burnout rates did not significantly differ between the sexes, the proportion of female EPs with high emotional exhaustion (EE) (69%) and low sense of personal accomplishment (PA) (45%) were significantly higher compared to males with high EE in 57% and low PA in 29%, respectively (P < 0.001 for both). Proportion with high depersonalization (DP) score was 44% in both male and female EPs. Mean scores revealed females experiencing higher mean EE (26.8 ± 15.7) scores vs males (25.4 ± 15.9) P < 0.001. Males had mean DP scores (8.6 ± 8.0) and mean PA scores (26.6 ± 12.7) compared to females with lower mean DP scores (7.4 ± 7.2) and higher PA scores (27.7 ± 11.9), respectively P < 0.001 for both. Odds ratios indicated varying risks, predominantly higher EE odds among females, varying from 0.72 to 2.3. Conclusion: This review underscores gender-specific manifestations of burnout among emergency physicians, with females more susceptible to emotional exhaustion and lower sense of personal accomplishment. Standardized reporting methods are crucial for future meta-analyses to refine gender-specific interventions combating burnout in emergency medicine. Targeted strategies addressing distinct manifestations of burnout are imperative to support the well-being and retention of EPs, fostering sustainable healthcare delivery.
Medicine, Medical emergencies. Critical care. Intensive care. First aid
Atabak Najafi, Arezoo Ahmadi, Mojtaba Mojtahed-Zadeh
et al.
Background: Cytokine storm in severe Covid-19 disease is one of the leading causes of death in these patients. Hemoperfusion is a method used to purify the blood from toxins and inflammatory factors. The aim of this study was to evaluate the effect of hemoperfusion on mortality and morbidity in patients with severe Covid - 19 disease.
Methods: This was a retrospective study which performed by reviewing the files of 30 patients with severe Covid-19 disease referred to Sina Hospital affiliated to Tehran University of Medical Sciences in 2020. Thirty patients with severe covid-19 disease and positive PCR participated in the study. All patients received routine treatment protocol for covid-19. Hemoperfusion was used for 15 patients in addition to receiving routine care. The remaining 15 patients were included in the control group. Patients in the hemoperfusion group underwent four sessions of hemoperfusion using continuous renal replacement therapy with continuous venovenous hemofiltration.
Results: the ICU length of stay in the control and hemoperfusion groups was 3.40 ± 11.40 and 9.65 ± 16.33 days, respectively (P= 0.075). 8 patients died and 7 patients were discharged in the control group, but 11 patients died and 4 patients were discharged in the hemoperfusion group (P= 0.256). The respiratory rate of patients in the control and hemoperfusion groups decreased from 7.43 ± 29.40 to 4.03 ± 24.60 and from 6.11 ± 31.60 to 5.04 ± 24.46, respectively (P < 0.001). The percentage of arterial blood oxygen saturation in the control and hemoperfusion groups increased from 90.86 ± 5.61 to 93.06 30 4.30 and from 92.33 26 3.26 to 92.06 31 5.31, respectively (P= 0.456).
Conclusion: Hemoperfusion could not prevent the mortality of patients and finally out of 15 patients, 11 patients died and 4 patients were discharged. Also, no significant difference was observed between the two groups in terms of arterial blood oxygen saturation.
Anesthesiology, Medical emergencies. Critical care. Intensive care. First aid
Saad M. A. alqahtani, Naif S. Al Saglan, Ali A. AlShehry
et al.
Abstract Background In this study, we aimed to address the prevalence of comorbidities and their impact on the outcomes of hospitalized COVID-19 patients admitted to a large tertiary Saudi Arabian hospital. Methods This is a retrospective study that included all adults with COVID‑19 admitted to a large tertiary Saudi Arabian hospital, between January 1, 2021, and September 30, 2022. The study outcomes were the prevalence of comorbidities among hospitalized COVID-19 patients and the effects of these comorbidities on all‑cause hospital mortality. Results A total of 1118 /1853 (60.3%) patients had one or more comorbidities. The most prevalent comorbidity was diabetes mellitus (48.5%), followed by hypertension (12.5%), and chronic renal disease (10.3%). Age (OR 3.032 (95% CI 0.006 – 0.029, p = 0.002), clinical status (8.194, 0.0350 – 0.709, p < 0.001), the presence (versus absence) of comorbidities (3.167, 0.042—0.233, p = 0.002), the number of comorbidities (2.972, 0.027 – 0.133, p = 0.003), and the 4C score (2.894, 0.010 – 0.054, p = 0.004), were independent significant predictors of mortality. Conclusions A total of 60.3% of hospitalized COVID-19 patients had one or more comorbidities, the most prevalent of which were diabetes mellitus, hypertension, and chronic renal disease. The presence and the number of comorbidities, but not the individual ones, together with age, clinical status at admission, and the 4C mortality score were significant independent predictors of mortality.
Diseases of the respiratory system, Medical emergencies. Critical care. Intensive care. First aid
Mohammadreza Mobinizadeh, Farzan Berenjian, Efat Mohammadi
et al.
Objective: To review the research dimensions of trauma registry data on health policy making. Methods: PubMed and EMBASE were searched until July 2020. Keywords were used on the search process included Trauma, Injury, Registry and Research, which were searched by using appropriate search strategies. The included articles had to: 1. be extracted from data related to trauma registries; 2- be written in English; 3- define a time period and a patient population; 4- preferably have more details and policy recommendations; and 5- preferably have a discussion on how to improve diagnosis and treatment. The results obtained from the included studies were qualitatively analyzed using thematic synthesis and comparative tables. Results: In the primary round of search, 19559 studies were retrieved. According to PRISMA statement and also performing quality appraisal process, 30 studies were included in the final phase of analysis. In the final papers’ synthesis, 14 main research domains were extracted and classified in terms of the policy implication and research priority. The domains with the highest frequency were “The relationship between trauma registry data and hospital care protocols for trauma patients” and “The causes of Disability Adjusted Life Years (DALYs) due to trauma”. Conclusion: Using trauma registry data as a tool for policy-making could be helpful in several ways, namely increasing the quality of patient care, preventing injuries and decreasing their number, figuring out the details of socioeconomic status effects, and improving the quality of researches in practical ways. Also, follow-up of patients after trauma surgery as one of the positive effects of the trauma registry can be the focus of attention of policy-making bodies.
Medical emergencies. Critical care. Intensive care. First aid
Jairo Corrêa da Silveira Júnior, Eder Kröeff Cardoso, Marcelo de Mello Rieder
RESUMO Objetivo: Identificar a existência de associação entre os valores de driving pressure e mechanical power e do índice de oxigenação no primeiro dia de ventilação mecânica com a mortalidade de pacientes vítimas de trauma sem diagnóstico de síndrome do desconforto respiratório agudo. Métodos: Foram incluídos pacientes ventilados em modo de pressão ou volume controlado, com coleta de dados 24 horas após sua intubação orotraqueal. O acompanhamento do paciente foi realizado por 30 dias para obter o desfecho clínico. Os pacientes estiveram internados em duas unidades de terapia intensiva do Hospital de Pronto Socorro de Porto Alegre, no período de junho a setembro de 2019. Resultados: Foram avaliados 24 pacientes. Os valores de driving pressure, mechanical power e do índice de oxigenação foram similares entre os pacientes que sobreviveram e os que tiveram desfecho de óbito, sem diferença estatisticamente significativa entre os grupos. Conclusão: Os valores de driving pressure, mechanical power e índice de oxigenação obtidos no primeiro dia de ventilação mecânica não demonstraram ter associação com a mortalidade de pacientes vítimas de trauma sem síndrome do desconforto respiratório agudo.
Medical emergencies. Critical care. Intensive care. First aid
Ryuta Nakae, Tetsuro Sekine, Takashi Tagami
et al.
Abstract Background Sepsis is often associated with multiple organ failure; however, changes in brain volume with sepsis are not well understood. We assessed brain atrophy in the acute phase of sepsis using brain computed tomography (CT) scans, and their findings’ relationship to risk factors and outcomes. Methods Patients with sepsis admitted to an intensive care unit (ICU) and who underwent at least two head CT scans during hospitalization were included (n = 48). The first brain CT scan was routinely performed on admission, and the second and further brain CT scans were obtained whenever prolonged disturbance of consciousness or abnormal neurological findings were observed. Brain volume was estimated using an automatic segmentation method and any changes in brain volume between the two scans were recorded. Patients with a brain volume change < 0% from the first CT scan to the second CT scan were defined as the “brain atrophy group (n = 42)”, and those with ≥ 0% were defined as the “no brain atrophy group (n = 6).” Use and duration of mechanical ventilation, length of ICU stay, length of hospital stay, and mortality were compared between the groups. Results Analysis of all 42 cases in the brain atrophy group showed a significant decrease in brain volume (first CT scan: 1.041 ± 0.123 L vs. second CT scan: 1.002 ± 0.121 L, t (41) = 9.436, p < 0.001). The mean percentage change in brain volume between CT scans in the brain atrophy group was –3.7% over a median of 31 days, which is equivalent to a brain volume of 38.5 cm3. The proportion of cases on mechanical ventilation (95.2% vs. 66.7%; p = 0.02) and median time on mechanical ventilation (28 [IQR 15–57] days vs. 15 [IQR 0–25] days, p = 0.04) were significantly higher in the brain atrophy group than in the no brain atrophy group. Conclusions Many ICU patients with severe sepsis who developed prolonged mental status changes and neurological sequelae showed signs of brain atrophy. Patients with rapidly progressive brain atrophy were more likely to have required mechanical ventilation.
Medical emergencies. Critical care. Intensive care. First aid
Goodarz Kolifarhood, Mohammad Aghaali, Hossein Mozafar Saadati
et al.
There are significant misconceptions and many obstacles in the way of illuminating the epidemiological and clinical aspects of COVID-19 as a new emerging epidemic. In addition, usefulness of some evidence published in the context of the recent epidemic for decision making in clinic as well as public health is questionable. However, misinterpreting or ignoring strong evidence in clinical practice and public health probably results in less effective and somehow more harmful decisions for individuals as well as subgroups in general populations of countries in the initial stages of this epidemic. Accordingly, our narrative review appraised epidemiological and clinical aspects of the disease including genetic diversity of coronavirus genus, mode of transmission, incubation period, infectivity, pathogenicity, virulence, immunogenicity, diagnosis, surveillance, clinical case management and also successful measures for preventing its spread in some communities.
Medical emergencies. Critical care. Intensive care. First aid
Cholecystoduodenal fistula (CDF) is a rare complication of gallbladder disease. Clinical presentation is variable, and preoperative diagnosis is challenging due to the non-specific symptoms of CDF. We discuss a 61-year-old male with a history of atrial fibrillation who presented with severe abdominal pain out of proportion to exam. The patient was diagnosed promptly and successfully managed non-operatively. This case presentation emphasizes the need to maintain a broad differential diagnosis for abdominal pain out of proportion to exam, with the possibility of a biliary-enteric fistula as a possible cause. It also stresses the importance of a multimodality imaging approach to arrive at a final diagnosis.
Medical emergencies. Critical care. Intensive care. First aid