Palliative Care Program for Community-Dwelling Individuals With Dementia and Caregivers: The IN-PEACE Randomized Clinical Trial.

Importance: Care management benefits community-dwelling patients with dementia, but studies include few patients with moderate to severe dementia or from racial and ethnic minority populations, lack palliative care, and seldom reduce health care utilization.

Objective: To determine whether integrated dementia palliative care reduces dementia symptoms, caregiver depression and distress, and emergency department (ED) visits and hospitalizations compared with usual care in moderate to severe dementia.

Design, Setting, And Participants: A randomized clinical trial of community-dwelling patients with moderate to severe dementia and their caregivers enrolled from March 2019 to December 2020 from 2 sites in central Indiana (2-year follow-up completed on January 7, 2023).

Health Care Resource Use and Costs After Hospitalization With Multiple Organ Dysfunction in Children.

Importance: Multiple organ dysfunction (MOD) is a leading cause of in-hospital child mortality. For survivors, posthospitalization health care resource use and costs are unknown.

Objective: To evaluate longitudinal health care resource use and costs after hospitalization with MOD in infants (aged <1 year) and children (aged 1-18 years).

Use of Body Armor by EMS Clinicians, Workplace Violence, and Racial and Ethnic Disparities in Care.

Importance: There is a clear benefit to body armor against firearms; however, it remains unclear how these vests may influence day-to-day patient encounters when worn by emergency medical services (EMS).

Objective: To determine the association of ballistic vests worn by EMS clinicians with workplace violence (WPV) and disparities in care among racial and/or ethnic minority patients.

Design, Setting, And Participants: Prospective cohort study of a volunteer-based sample of EMS clinicians at a large, multistate EMS agency encompassing 15 ground sites across the Midwest from April 1, 2023, to March 31, 2024.

Longterm efficacy of a patient focused intervention in patients with asplenia- a three year follow-up of the PrePPS trial.

Objectives: This study aimed to reassess the long-term impact of a Health Action Process Approach (HAPA)-informed intervention on guideline adherence among asplenic patients and their physicians, three years post-intervention.

Methods: This follow-up study was conducted within the framework of the interventional PrePSS (Prevention of Postsplenectomy Sepsis Score) study. Patients aged 18 or older with anatomical asplenia were in enrolled in a prospective controlled, two-armed historical control group design.

Which Test is Best for Pain in the Chest?

Chest pain is one of the most common chief complaints seen in both the emergency department (ED) and primary care settings.1,2 It is estimated that 20-40% of the general population will suffer from chest pain at some point throughout their lives.3 Interestingly although obstructive coronary artery disease (CAD) prevalence has declined, chest pain as a presenting symptom has become increasingly common over the last decade.

Short-term costs of alcohol-associated hepatitis care in different clinical settings.

Background: Alcohol-associated hepatitis (AH) leads to high rates of mortality and health care costs. Understanding the immediate costs after an AH diagnosis and identifying key cost factors is crucial for health care policies and clinical decisions.

Objectives: This study quantifies medical costs within 30 days of an AH diagnosis across outpatient (OP), emergency department (ED), and inpatient (IP) settings.

[Acute airway obstruction from a retropharyngeal hemorrhage].

A case is reported of a man in his 70s that presented to the emergency department due to difficulty swallowing after a fall. He was found to have a large retropharyngeal hematoma, which led to complete airway obstruction about an hour after the injury. As oral endotracheal intubation was impossible due to the bleeding, an emergency cricothyrotomy was performed in an ambulance by an emergency medicine trainee.

Comparison of the incidence of recovery agitation with two different doses of ketamine in procedural sedation: A randomized clinical trial.

Objectives: The objective was to compare the incidence of recovery agitation and efficacy of two different intravenous (IV) doses of ketamine (0.5 mg/kg vs. 1 mg/kg) in adult patients who presented to the emergency department (ED) requiring procedural sedation with ketamine.

Persistent cross-species transmission systems dominate Shiga toxin-producing O157:H7 epidemiology in a high incidence region: A genomic epidemiology study.

Several areas of the world suffer a notably high incidence of Shiga toxin-producing . To assess the impact of persistent cross-species transmission systems on the epidemiology of O157:H7 in Alberta, Canada, we sequenced and assembled O157:H7 isolates originating from collocated cattle and human populations, 2007-2015. We constructed a timed phylogeny using BEAST2 using a structured coalescent model.

Glycemic control to improve post-operative outcomes in patients with type 2 diabetes mellitus: Results of the SUGAR (Surgical Universal euGlycemic Attainment during Recovery) initiative.

Objective: Hyperglycemia, or glucose values >180 mg/dL, is associated with adverse post-operative outcomes. Our objective was to determine the impact of improving peri-operative glycemic control and evaluate infectious complications among patients with type 2 diabetes mellitus undergoing open gynecologic surgery.

Methods: A multidisciplinary team standardized pre-operative screening, referral algorithms, and intra-operative and post-operative hyperglycemia management (Surgical Universal euGlycemic Attainment during Recovery initiative).

Diuretics for preventing and treating acute kidney injury.

Background: Acute kidney injury (AKI) is a well-known complication of critical illnesses, significantly affecting morbidity and the risk of death. Diuretics are widely used to ameliorate excess fluid accumulation and oliguria associated with AKI. Their popularity stems from their ability to reduce the energy demands of renal tubular cells by inhibiting transporters and flushing out intratubular casts.

Misses and Near Misses in Paediatric Appendicitis: An Eight-Year, Single-Centre Retrospective Review.

Aim: Diagnostic error can result in the appendectomy of a normal appendix, commonly known as negative appendectomy (NA). Missed appendicitis (MA) is related to a poor outcome. The aim of this study was to determine whether there are factors in presentation associated with NA or MA.

The phase I RELEASE clinical trial to evaluate the safety of NK cells in COVID-19.

The severity of COVID 19 symptoms has a direct correlation with lymphopenia, affecting natural killer (NK) cells. SARS-CoV-2 specific "memory" NK cells obtained from convalescent donors can be used as cell immunotherapy. In 2022 a phase I, dose-escalation, single center clinical trial was conducted to evaluate the safety and feasibility of the infusion of CD3/CD56 NK cells against moderate/severe cases of COVID-19 (NCT04578210).

Intramural pregnancy after intrauterine insemination in a nulligravid patient without previous uterine trauma, complicated by idiopathic thrombocytopenic purpura: A case report.

Intramural pregnancy (IMP) is an extremely rare form of ectopic pregnancy (EP), typically associated with previous uterine trauma, adenomyosis, or assisted reproductive technology (ART), such as embryo transfer (ET). Despite its potentially life-threatening nature, the absence of definitive preoperative diagnostic criteria for IMP complicates its early detection and management, especially in patients without known risk factors. Additionally, management becomes more challenging when there is an elevated risk of hemorrhage.

"Breaking the Bleed" Spontaneous Hemorrhage in an Emphysematous Bulla Complicated by Anticoagulation: A Case Report.

We present a case of spontaneous hemorrhage in an emphysematous bulla, complicated by anticoagulation. Bullous emphysema is a well-recognized complication of chronic obstructive pulmonary disease (COPD), and a rare manifestation is hemorrhage into preexisting pulmonary bullae. A 69-year-old male patient presented to the emergency department with hemoptysis, shortness of breath, and productive cough.

Examining the Time to Diagnosis in Idiopathic Intracranial Hypertension Presentations in a Specialist Eye Emergency Department.

Idiopathic intracranial hypertension (IIH) is a neurological disorder characterized by chronic headaches, cognitive difficulties, reduced quality of life, and rarely irreversible visual loss. Community diagnosis is often challenging due to unfamiliarity with current guidelines and a lack of clinical experience, leading to misdiagnosis and treatment delays, which can negatively impact visual recovery and quality of life. Our study examined the time to diagnosis and investigated the barriers to timely diagnosis in adults with newly diagnosed IIH.

Seasonal Variations in Testicular Torsion: A Retrospective Study.

Background: Testicular torsion (TT) is a urological emergency requiring prompt intervention to prevent irreversible damage to the testicle.

Objective: This study aims to assess trends in men's TT referrals, diagnostic evaluation through Doppler sonography (DS) scan, symptoms before surgery, orchidectomy rates, and TT laterality in relation to age and seasons of the year.

Methods: This observational retrospective cohort study included all patients treated for TT at King Abdullah University Hospital between 2009 and 2021.

Patterns and Outcomes of Acute Poisoning Among Children Presenting to Emergency Department in AlAhsa, Saudi Arabia.

Introduction Acute poisoning in children is still a global health concern that necessitates visiting the emergency department that might associated with morbidity and mortality. It has an impact on social, economic, and health issues, particularly for children under five who account for the majority of poisonings worldwide. Poisoning can result in mild cases, serious complications, or even death; oral ingestion is the most common way that poisoning occurs in children.

Association between D-dimer to lymphocyte ratio and in hospital all-cause mortality in elderly patients with sepsis: a cohort of 1123 patients.

Background: The D-dimer to lymphocyte ratio (DLR), a novel inflammatory biomarker, had been shown to be related to adverse outcomes in patients with various diseases. However, there was limited research on the relationship between the DLR and adverse outcomes in patients with infectious diseases, particularly those with sepsis. Therefore, this study aimed to explore the association between the DLR and in hospital all-cause mortality in elderly patients with sepsis.

Evaluation of systemic immune-inflammation index and systemic inflammation response index in the differentiation of acute Ischemic stroke and transient Ischemic attack.

Objective: The aim of this study was to examine the levels of hematologic parameters in acute ischemic stroke (AIS) and transient ischemic attack (TIA) and to evaluate the use of Neutrophil/Lymphocyte ratio (NLR), Systemic Immune-Inflammation Index (SII), and systemic inflammation response index (SIRI) in the differentiation of AIS and TIA.

Materials And Methods: Data and hematological results of patients admitted to the emergency department and diagnosed with AIS and TIA were compared retrospectively.

Results: The study included 36 TIA patients (M/F = 15/21) with a mean age of 64.

A Rare Case of Poorly Differentiated Neuroendocrine Carcinoma of the Descending Colon with Regional Lymph Node Involvement Presenting in a Young Adult Nigerian Male: A Case Report.

Malignant colonic neuroendocrine tumours are rare. Even more uncommon is their occurrence in the left colon. They also infrequently occur in males and young adults.

Geospatial Distribution, Accessibility and Utilization of Basic Emergency Obstetric and New-born Care in Jigawa State, Northwest Nigeria.

Background: High maternal mortality has remained a problem, especially in developing countries. Ensuring availability and utilization of Basic Emergency Obstetric and Newborn Care services (BEmONC) reduce maternal morbidity and mortality. The study aimed to determine the geospatial distribution, accessibility and utilization of BEmONC services in Jigawa State.

Sepsis in Northern Tanzania: A Prospective Observational Study of Clinical Characteristics, Management, and Outcomes for Adolescents and Adults With Sepsis.

Background: Despite a high burden of sepsis in Sub-Saharan Africa, clinical data for adolescent and adult sepsis in this setting are limited. We sought to describe clinical characteristics, management, and outcomes in adolescents and adults with sepsis in northern Tanzania. We also assessed for clinical associations with in-hospital mortality.