Measuring the crowding of emergency departments: an assessment of the NEDOCS in Lombardy, Italy, and the development of a new objective indicator based on the waiting time for the first clinical assessment.

Background: There is no ubiquitous definition of Emergency Department (ED) crowding and several indicators have been proposed to measure it. The National ED Overcrowding Study (NEDOCS) score is among the most popular, even though it has been severely criticised. We used the waiting time for the physician's initial assessment to evaluate the performance of the NEDOCS and proposed a new crowding indicator based on this objective measure.

Optimizing older patient care in emergency departments: a comprehensive survey of current practices and challenges in Northern Italy.

Background: The progressive aging of the population and the increasing complexity of health issues contribute to a growing number of older individuals seeking emergency care. This study aims to assess the state of the art of care provided to older people in the Emergency Departments of Lombardy, the most populous region in Italy, counting over 2 million people aged 65 years and older.

Methods: An online cross-sectional survey was developed and disseminated among emergency medicine physicians and physicians affiliated to the Lombardy section of the Italian Society of Geriatrics and Gerontology (SIGG), during June and July 2023.

Assessing the heterogeneity of the impact of COVID-19 incidence on all-cause excess mortality among healthcare districts in Lombardy, Italy, to evaluate the local response to the pandemic: an ecological study.

Objectives: The fragmentation of the response to the COVID-19 pandemic at national, regional and local levels is a possible source of variability in the impact of the pandemic on society. This study aims to assess how much of this variability affected the burden of COVID-19, measured in terms of all-cause 2020 excess mortality.

Design: Ecological retrospective study.

Strategies to convert hospital beds for COVID-19 patients to minimize emergency department overcrowding.

The shortage of hospital beds for COVID-19 patients has been one critical cause of Emergency Department (ED) overcrowding. We aimed at elaborating a strategy of conversion of hospital beds, from non-COVID-19 to COVID-19 care, minimizing both ED overcrowding and the number of beds eventually converted. Observational retrospective study.

Effect of a quality improvement program on compliance to the sepsis bundle in non-ICU patients: a multicenter prospective before and after cohort study.

Objective: Sepsis and septic shock are major challenges and economic burdens to healthcare, impacting millions of people globally and representing significant causes of mortality. Recently, a large number of quality improvement programs focused on sepsis resuscitation bundles have been instituted worldwide. These educational initiatives have been shown to be associated with improvements in clinical outcomes.

Diagnosis of sepsis in the emergency department: a real-world analysis from Lombardy, Italy.

Early identification of sepsis is particularly important in the emergency department (ED). However, data on the diagnosis of sepsis in the ED are scanty, especially within the Italian context. To quantify sepsis incidence and recognition in the ED from Lombardy, Italy, we used EUOL data from the Regional Emergency Agency for the years 2017-2022.

Emergency Department waiting-time in the post pandemic era: new organizational models, a challenge for the future.

Background And Aim: Covid-19 has profoundly changed the Emergency Department system in Lombardy, especially for the type of accesses and the number of diagnoses. Accordingly, the pre-hospital rescue system has undergone heavy changes, in particular regarding the times of rescue. Despite this, studies concerning the post-pandemic phase are lacking to understand whether the conditions of the emergency systems has resumed to the pre-pandemic period.

Prognostic value of respiratory parameters for COVID-19 patients in the emergency department: results from the EC-COVID study.

While several studies have evaluated the prognostic weight of respiratory parameters in patients with COVID-19, few have focused on patients' clinical conditions at the first emergency department (ED) assessment. We analyzed a large cohort of ED patients recruited within the EC-COVID study over the year 2020, and assessed the association between key bedside respiratory parameters measured in room air (pO, pCO, pH, and respiratory rate [RR]) and hospital mortality, after adjusting for key confounding factors. Analyses were based on a multivariable logistic Generalized Additive Model (GAM).

Improving Oxygen Capacity at ITBP Referral Hospital During the Second Wave of COVID-19 Infections in Greater Noida, India: An Operative Targeted Intervention.

Objectives: Due to factors that still remain under debate, both social and virological, the coronavirus disease 2019 (COVID-19) pandemic has continued to flare up in India, particularly in northern and western areas. This has led to an incidence of approximately 350,000 cases per day and a daily death toll of around 4000 in the weeks between May 1 and 14, 2021. The current pandemic is testing the adaptability of the oxygen distribution and consumption.

Algorithm for Individual Prediction of COVID-19-Related Hospitalization Based on Symptoms: Development and Implementation Study.

Background: The COVID-19 pandemic has placed a huge strain on the health care system globally. The metropolitan area of Milan, Italy, was one of the regions most impacted by the COVID-19 pandemic worldwide. Risk prediction models developed by combining administrative databases and basic clinical data are needed to stratify individual patient risk for public health purposes.

Successful treatment of acute spleno-porto-mesenteric vein thrombosis after ChAdOx1 nCoV-19 vaccine. A case report.

Several cases of deep venous thrombosis in people who had recently received Vaxzevria (previously known as COVID-19 Vaccine AstraZeneca) have recently been reported, mainly presenting as cerebral vein/cerebral venous sinus thrombosis. This syndrome has been termed "vaccine-induced immune thrombotic thrombocytopenia (VITT)". Acute spleno-porto-mesenteric vein thrombosis is an uncommon but serious condition with potential sequelae, such as small-bowel gangrene and end-stage liver failure.

Utility of hospitalization for elderly individuals affected by COVID-19.

Background: During the COVID-19 pandemic, the number of individuals needing hospital admission has sometimes exceeded the availability of hospital beds. Since hospitalization can have detrimental effects on older individuals, preference has been given to younger patients. The aim of this study was to assess the utility of hospitalization for elderly affected by COVID-19.

The role of lung ultrasound as a frontline diagnostic tool in the era of COVID-19 outbreak.

The diffusion of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) worldwide prompted the World Health Organization to declare the status of pandemic. The molecular diagnosis of SARS-CoV-2 infection is based on the detection of viral RNA on different biological specimens. Unfortunately, the test may require several hours to be performed.

Lung ultrasound for monitoring cardiogenic pulmonary edema.

Several studies address the accuracy of lung ultrasound (LUS) in the diagnosis of cardiogenic pulmonary edema (CPE) evaluating the interstitial syndrome, which is characterized by multiple and diffuse vertical artifacts (B-lines), and correlates with extravascular lung water. We studied the potential role of LUS in monitoring CPE response to therapy, by evaluating the clearance of interstitial syndrome within the first 24 h after Emergency Department (ED) admission. LUS was performed at arrival (T0), after 3 (T3) and 24 (T24) hours.

Accuracy of point of care ultrasound to identify the source of infection in septic patients: a prospective study.

Sepsis is a rapidly evolving disease with a high mortality rate. The early identification of sepsis and the implementation of early evidence-based therapies have been recognized to improve outcome and decrease sepsis-related mortality. The aim of this study was to compare the accuracy of the standard diagnostic work-up of septic patients with an integrated approach using early point of care ultrasound (POCUS) to identify the source of infection and to speed up the time to diagnosis.

Towards a less invasive approach to the early goal-directed treatment of septic shock in the ED.

Introduction: Early goal-directed therapy (EGDT) in septic shock defined by Rivers et al was proven to reduce mortality and validated by observational studies. However, criticism is centered in particular on the early requirement of a central venous catheter (CVC) and on central venous pressure (CVP) as an indicator of volume responsiveness. The present study is a pivotal study to investigate the reliability of a less invasive approach, which uses inferior vena cava (IVC) and lung ultrasounds (US) to guide the infusion of fluids and lactate clearance to monitor tissue perfusion.

Contrast enhanced ultrasound vs chest x-ray to determine correct central venous catheter position.

Purposes: We aimed to analyze the diagnostic accuracy of contrast enhanced ultrasonography (CEUS), compared with chest x-ray (CXR), in the detection of correct central venous line (CVL) placement. Our hypothesis was to verify whether CEUS could substitute CXR as a reference standard for correct placement of CVL or function as a triage test to limit the execution of CXR only for selected patients.

Basic Procedures: CEUS was carried out in 71 non consecutive patients to verify the correct positioning of a central venous line.

Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department.

Objective: The aim of this study was to evaluate the diagnostic accuracy of bedside lung ultrasound and chest radiography (CXR) in patients with suspected pneumonia compared with CT scan and final diagnosis at discharge. Design A prospective clinical study.

Methods: Lung ultrasound and CXR were performed in sequence in adult patients admitted to the emergency department (ED) for suspected pneumonia.

Noninvasive pressure support ventilation vs. continuous positive airway pressure in acute hypercapnic pulmonary edema.

Objective: This study compared noninvasive pressure support ventilation (NIPSV) and continuous positive airway pressure (CPAP) in patients with acute hypercapnic pulmonary edema with regard to resolution time.

Design And Setting: Randomized prospective study in an emergency department.

Patients And Participants: We randomly assigned 36 patients with respiratory failure due to acute pulmonary edema and arterial hypercapnia (PaCO(2) >45 mmHg) to NIPSV (n=18) or CPAP through a face mask (n=18).

Myocardial infarction rate in acute pulmonary edema: noninvasive pressure support ventilation versus continuous positive airway pressure.

Objective: Noninvasive pressure support ventilation (NIPSV) delivered by face mask has proved an effective treatment for patients with acute pulmonary edema. However, an increase in acute myocardial infarction rate has been reported with this ventilation modality. We investigated whether the use of NIPSV increases the incidence of acute myocardial infarction compared with continuous positive airway pressure (CPAP) in patients with acute pulmonary edema.