Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department.

The best management of patients who suffer from traumatic brain injury (TBI) while on oral anticoagulants is one of the most disputed problems of emergency services. Indeed, guidelines, clinical decision rules, and observational studies addressing this topic are scarce and conflicting. Moreover, relevant issues such as the specific treatment (and even definition) of mild TBI, rate of delayed intracranial injury, indications for neurosurgery, and anticoagulant modulation are largely empiric.

Minor head injury in anticoagulated patients: performance of biomarkers S100B, NSE, GFAP, UCH-L1 and Alinity TBI in the detection of intracranial injury. A prospective observational study.

Objectives: Data in literature indicate that in patients suffering a minor head injury (MHI), biomarkers serum levels could be effective to predict the absence of intracranial injury (ICI) on head CT scan. Use of these biomarkers in case of patients taking oral anticoagulants who experience MHI is very limited. We investigated biomarkers as predictors of ICI in anticoagulated patients managed in an ED.

Early administration of tofacitinib in COVID-19 pneumonitis: An open randomised controlled trial.

Background: Controversies on sub-populations most sensitive to therapy and the best timing of starting the treatment still surround the use of immunomodulatory drugs in COVID-19.

Objectives: We designed a multicentre open-label randomised controlled trial to test the effect of prompt adding of tofacitinib to standard therapy for hospitalised patients affected by mild/moderate COVID-19 pneumonitis.

Methods: Patients admitted to three Italian hospitals affected by COVID-19 pneumonitis not requiring mechanical ventilation were randomised to receive standard treatment alone or tofacitinib (10 mg/bid) for 2 weeks, starting within the first 24 h from admission.

Role of bronchoscopy in critically ill patients managed in intermediate care units - indications and complications: A narrative review.

Flexible bronchoscopy (FB) has become a standard of care for the triad of inspection, sampling, and treatment in critical care patients. It is an invaluable tool for diagnostic and therapeutic purposes in critically ill patients in intensive care unit (ICU). Less is known about its role outside the ICU, particularly in the intermediate care unit (IMCU), a specialized environment, where an intermediate grade of intensive care and monitoring between standard care unit and ICU is provided.

[Patient reported outcomes measures (PROMs): definitions and perspectives for their use as quality indicators in emergency rooms.].

There is a growing emphasis on including patients' perspectives on outcomes as a measure of quality care. This recent interest has spawned the rapid development and testing of patient-reported outcome measures (PROMs), through which patients report on their perception of the outcomes of the care they received. Their use has moved significantly from medical research toward applications in the clinical setting, quality measurement, and system accountability.

Patient-Reported Outcome Measurements (PROMs) After Discharge From the Emergency Department: A Cross-Sectional Study.

Background: The purpose of a patient-reported outcome (PRO) is to elicit the perspectives of patients and translate them into a reliable measurement questionnaire.

Objectives: The objective of this cross-sectional study was to detect a set of PROs and PRO measurements (PROMs) about patients with isolated trauma of the limbs receiving emergency department (ED) care.

Methods: A survey was performed in the ED using a questionnaire among the enrolled patients to identify which proposed outcomes were perceived as important by the patients according to their expectations.

Predictors of readmission requiring hospitalization after discharge from emergency departments in patients with COVID-19.

Introduction: Little is known on prevalence of early return hospital admission of subjects with COVID-19 previously evaluated and discharged from emergency departments (EDs). This study aims to describe readmission rate within 14 days of patients with COVID-19 discharged from ED and to identify predictors of return hospital admission.

Methods: We performed a retrospective cohort study of adult patients with COVID-19 discharged from two EDs.

Predictors of Worse Prognosis in Young and Middle-Aged Adults Hospitalized with COVID-19 Pneumonia: A Multi-Center Italian Study (COVID-UNDER50).

Obesity as well as metabolic and cardiovascular comorbidities are established, significant predictors of worse prognosis in the overall COVID-19 population, but limited information is available on their roles in young and middle-aged adults (aged ≤ 50 years). The main objectives of the present Italian multi-center study were to describe clinical characteristics and role of selected prognostic predictors in a large cohort of young and middle-aged hospitalized patients. Nine pulmonology units, across north and center of Italy, were involved in this retrospective study.

Rituximab for eosinophilic granulomatosis with polyangiitis: a systematic review of observational studies.

Objective: To analyse the available evidence about the use of rituximab (RTX) and other biologic agents in eosinophilic granulomatosis with polyangiitis (EGPA) patients and to provide useful findings to inform the design of future, reliable clinical trials.

Methods: A systematic review was performed. A systematic search was conducted in PubMed/MEDLINE, Scopus, Web of Science and the Cochrane library databases on RTX, and an extensive literature search was conducted on other biologic agents.

Patients with isolated pulmonary embolism in comparison to those with deep venous thrombosis. Differences in characteristics and clinical evolution.

Background: Patients with acute pulmonary embolism (PE) often have leg deep vein thrombosis (DVT); sometimes, however, a DVT is not detected (isolated PE, I-PE). We aimed at assessing the proportion of patients with I-PE, and their characteristics and clinical evolution compared to those with DVT with/without PE (DVT/PE).

Methods: Among 3573 patients included in the START2-Register for a venous thromboembolic event, 2880 (80.

Pulmonary embolism: a retrospective comparative study between patients with atypical vs typical clinical presentation.

Background: Natural history and outcomes of patients with pulmonary embolism (PE) without typical symptoms (atypical PE) remain unclear. The aim of the study is to compare the clinical characteristics and the prognosis between typical PE and atypical PE.

Methods: We retrospectively analyzed data from consecutive patients admitted to the Emergency Department (ED) because of a diagnosis of PE and classified them in two groups: typical PE and atypical PE.

Management of spontaneous soft-tissue hemorrhage secondary to anticoagulant therapy: A cohort study.

Study Objective: The optimal management of patients receiving heparin, warfarin or direct anti-coagulant therapy who experience spontaneous, severe, life-threatening soft-tissue hemorrhage (SSTH) is unclear. The purpose of this study is to investigate efficacy and safety of the interventional protocol implemented in our department.

Methods: In this retrospective cohort study, we analyzed data from 80 consecutive patients with SSTH secondary to anticoagulation therapy diagnosed by the appropriate computed tomography scan.

Emergency Department Non-Urgent Visits and Hospital Readmissions Are Associated with Different Socio-Economic Variables in Italy.

Objective: The aim of this paper was to evaluate socio-economic factors associated to poor primary care utilization by studying two specific subjects: the hospital readmission rate, and the use of the Emergency Department (ED) for non-urgent visits.

Methods: The study was carried out by the analysis of administrative database for hospital readmission and with a specific survey for non-urgent ED use.

Results: Among the 416,698 sampled admissions, 6.

[Burnout syndrome in pre-hospital and hospital emergency. Cognitive study in two cohorts of nurses].

Introduction: Burnout syndrome (BOS) associated with stress has been documented in health care professionals in many specialties. The emergency department and the pre-hospital healthcare services are highly stressful environments. Little is known about the BOS in critical care nursing staff.

[The nursing approach to pre-hospital pediatric emergencies: cognitive study in 2 cohorts of nurses].

Pediatric emergencies have a relatively low incidence compared to the total number of pre-hospital events. The quality of emergency care for pediatric patients can be improved by specific training, a dedicated team and uniformity of pediatric protocols. The aim of this study is to assess how nurses perceive pediatric emergencies in a non-hospital environment by means of two questionnaires issued to two cohorts of nurses working on ambulances.

A management of blunt thoracic trauma in an emergency department observation unit: pre-post observational study.

Background: The best management of patients with isolated blunt thoracic trauma at high risk of pulmonary complications (HRPC-BTT: ≥3 isolated rib fractures, sternal fracture, single or few pulmonary contusions or minimal pneumothorax) is still unclear. We compared efficacy and cost-effectiveness of a new clinical pathway involving an Emergency Department Observation Unit (EDOU) with routine care.

Design: Retrospective before-after study.

Hernia of Morgagni and mediastinal lipoma: a case report.

A hernia of Morgagni (also called hernia of Morgagni-Larrey) is a congenital herniation of abdominal contents into the thoracic cavity through a retrosternal diaphragmatic defect. The Morgagni hernia can create uncertainty in its diagnosis and difficulty for subsequent treatment. If after clinical examination and x-ray we suspect the hernia, computed tomography imaging should be the desired imaging method to confirm the diagnosis.

Metaphylaxis of urolithiasis.

The urolithiasis is a growing disease because of the changes in dietary habits and in he general life style. Urolithiasis is characterized by the recurrent clinical manifestation and possible effect of structural damage of the kidneys and of the urinary tract ast well as the potential increase in systemic blood pressure. Moreover, frequent need for medical cure and invasive urological treatment exposes the patient to the complications of such procedures.

Intra-bone marrow injection of bone marrow and cord blood cells: an alternative way of transplantation associated with a higher seeding efficiency.

Objective: Intravenous (IV) injection is currently the normal method for transplanting hematopoietic cells. However, the problem of seeding efficiency and homing is relevant especially when a limited number of stem cells is available. Intra-bone marrow (IBM) injection of bone marrow cells (BMCs) may overcome this problem.