Analysis of financial risk protection indicators in Sri Lanka for pediatric surgery.

Purpose: To investigate the incidence of the Sri Lankan pediatric population who seek emergency surgical services and who are subsequently at risk of impoverishment and catastrophic expenditure.

Methods: Prospective data collection at a tertiary pediatric Sri Lankan hospital of direct out-of-pocket (OOP) medical and nonmedical expenses related to pediatric surgical interventions. Catastrophic expenditure and risk of impoverishment were respectively described as expenses superior to 10% of household income and falling below the impoverishment line due to income drop.

The Role of Emergency and Primary Care in Combating the Rise of Gonorrhea: Another Purview Paradox?

Introduction: Drug-resistant is an urgent threat to public health. Novel prevention and treatment strategies are emerging, including immunizations, pharmacologic post-exposure prophylaxis, rapid molecular resistance assays, and novel antibiotics. However, where and how such strategies are optimally implemented remains unclear.

Hurricane Ida - Mitigation and Preparedness for Flash-Flooding in New York City.

Objectives: Hurricane Ida delivered record rainfall to the northeast, resulting in 11 deaths in New York City. We review these deaths, identify risk factors, and discuss solutions to prevent recurrence.

Methods: Deaths were confirmed by multiple sources.

Efficacy of laundry practices in eliminating monkeypox virus (MPXV) from fabrics.

Background: The declaration of mpox as a Public Health Emergency of International Concern highlights the need for interventions to interrupt virus transmission, including transmission via fabrics. Current World Health Organization guidance on clothes washing is based on a general consensus of virus inactivation; however, there is uncertainty about the efficacy of laundry detergents and disinfectants or the reduction of risk achieved by washing clothes for monkeypox virus (MPXV) specifically.

Methods: This study investigates the efficacy of manual washing for inactivating MPXV from clothes.

Implementation of negative pressure for acute pediatric burns (INPREP): A stepped-wedge cluster randomized controlled trial protocol.

Background: Acute application of adjunctive negative pressure wound therapy (NPWT) significantly improves time to re-epithelialization in pediatric burn patients. This adjunctive treatment has not yet been broadly or routinely adopted as a standard primary burns dressing strategy. The Implementation of Negative PRessurE for acute Pediatric burns (INPREP) trial will implement and evaluate the impact of adjunctive NPWT in parallel with co-designed implementation strategies and resources across four major pediatric hospitals.

Invasive Arterial BP Measurements in the Emergency Department-When, if Ever, is it Indicated?

Purpose Of Review: Extremes of blood pressure (BP) are common among patients that visit emergency departments. In this review article, we discuss the specific indications for invasive blood pressure monitoring in the ED, particularly in the context of undifferentiated shock and hypertensive emergencies.

Recent Findings: In most cases, non-invasive techniques suffice for blood pressure monitoring, however, in certain patient presentations intermittent automated oscillometry bears significant drawbacks.

COmplexity of CARE and Discharge barriers: the 'modern internal medicine patient'. Results from the CO-CARED Study.

The ongoing demographic, epidemiological and social changes are dramatically raising the clinical and care complexity of patients admitted to internal medicine (IM) departments. Collecting evidence for a better characterization of patients is crucial to tailor future interventions based on patient's real needs. The aim of this prospective multicenter study was to describe the complexity of care of patients hospitalized in IM by calculating the complexity of care (ICC) score, through the combination of clinical instability (NEWS score) and care dependency scales (mICD).

An Editorial on Revolutionizing Urinary Care in Pakistan by Embracing the United Kingdom National Health Service Approach to Catheterisation Documentation and Trial Without Catheter.

This editorial highlights the importance of catheterisation documentation and the practice of trials without catheters in improving patient outcomes in Pakistan. Acute urinary retention, a major urological emergency, needs short-term catheter placement, with a trial without a catheter used globally to reduce catheter-associated urinary tract infections. This procedure, often enhanced by alpha-1 blockers, enables patients to regain continence and promotes micturition post-catheterisation, particularly useful following surgeries such as prostatectomy.

Evaluating adoption and reach in a pragmatic randomized trial of community paramedicine for intermediate acuity patient care.

Introduction: Pragmatic trials aim to speed translation to practice by integrating study procedures in routine care settings. This study evaluated implementation outcomes related to clinician and patient recruitment and participation in a trial of community paramedicine (CP) and presents successes and challenges of maintaining pragmatic study features.

Methods: Adults in the pre-hospital setting, emergency department (ED), or hospital being considered for referral to the ED/hospital or continued hospitalization for intermediate-level care were randomized 1:1 to CP care or usual care.

Development of a model predicting falls in older emergency department patients using smartphone-based mobility measures.

Objective: While emergency departments (EDs) are crucial for identifying patients at risk for falls, existing fall risk measures are often inaccurate. This study aimed to assess whether iPhone sensor-based mobility measures collected after ED discharge can improve fall prediction compared with traditional ED-based screening measures.

Methods: This single-center, observational cohort study recruited ED patients aged 60 or older who owned an iPhone.

Emergency clinician perceptions of end-of-life care in Irish emergency departments: a cross-sectional survey.

Background: Patients with end-of-life care (EoLC) needs present to the emergency departments (ED) frequently and at times, it can be difficult to provide a high standard of care. Within the Irish setting, there is limited literature on the provision of EoLC in EDs and this study, therefore, aimed to evaluate the perceptions of emergency medicine (EM) clinicians regarding the provision of EoLC in EDs in Ireland.

Methods: The End-of-Life Care in Emergency Department Study was a cross-sectional electronic survey study of EM doctors working across 23 of the 29 EDs in the Ireland.

Association of Blood-Based Biomarkers and 6-Month Patient-Reported Outcomes in Patients With Mild TBI: A CENTER-TBI Analysis.

Background And Objectives: There is seemingly contradictory evidence concerning relationships between day-of-injury biomarkers and outcomes after mild traumatic brain injury (mTBI). To address this issue, we examined the association between a panel of biomarkers and multidimensional TBI outcomes.

Methods: Participants with mTBI (Glasgow coma scores [GCSs] 13-15) were selected from Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury, a European observational study recruiting patients with TBI with indication for brain CT and presentation within 24 hours.

Interventions to reduce burnout in emergency medicine: a national inventory of the Canadian experience to support global implementation of wellness initiatives.

Burnout in healthcare workers is a global issue, with Emergency Medicine (EM) particularly impacted. Many countries have tried implementing wellness initiatives to reduce burnout and improve wellness. This paper summarizes interventions implemented in Canada to-date with the aim of supporting the design of wellness interventions in EDs globally.

Pediatric Emergency Medicine Physicians' Perspectives of Concussion in Young Children.

Study Objective: Traumatic brain injury (TBI) during early childhood (before 6 years) is prevalent, accounting for rising rates of emergency department visits. These injuries may lead to postconcussive symptoms, which may be subtle and difficult to diagnose in young children. Inadequate discharge counseling may lead to prolonged duration of symptoms and possible developmental delays.

Triage knowledge, perceived skills, and associated factors among nurses working in adult emergency departments of selected public hospitals in Addis-Ababa, Ethiopia, 2023: multicenter cross-sectional study.

Background: Triage is an essential function in the emergency department. Knowledge of nurses working in triage has been cited as an influential factor in triage decision-making. As there are increased numbers of clients with life-threatening traumatic injuries and medical patients in the emergency department in Addis-Ababa, triage knowledge and skill are essential competencies required for the nurses working in the emergency department.

The diagnostic challenge of differentiating tumefactive multiple sclerosis (TMS) from other brain lesions: a case report and literature review on a rare subtype of MS.

Introduction And Importance: This case report is a clinical diagnosis walk through of a rare subtype of multiple sclerosis (MS). It gives an overview of how tumefactive multiple sclerosis (TMS) is systematically narrowed down as the definitive diagnosis.

Case Presentation: This 29-year-old male patient presented to the emergency department.

International consensus statement on microbiome testing in clinical practice.

There is growing interest in the potential exploitation of the gut microbiome as a diagnostic tool in medicine, but evidence supporting its clinical usefulness is scarce. An increasing number of commercial providers offer direct-to-consumer microbiome diagnostic tests without any consensus on their regulation or any proven value in clinical practice, which could result in considerable waste of individual and health-care resources and potential drawbacks in the clinical management of patients. We convened an international multidisciplinary expert panel to standardise best practices of microbiome testing for clinical implementation, including recommendations on general principles and minimum requirements for their provision, indications, pre-testing protocols, method of analyses, reporting of results, and potential clinical value.

Increasing incidence of concussion and head injury due to electric biking: a 10-year sex- and age-specific analysis of national injury data.

Objectives: Electric biking (e-biking) is a rapidly growing recreation, sport, and mode of transportation that often presents to emergency departments (EDs) with high-impact head injuries. This study aimed to evaluate the epidemiology of e-bike-related concussions and closed-head injuries (CHI) to inform more effective injury prevention strategies.

Methods: The National Electronic Injury Surveillance (NEISS) was queried for e-bike related concussions and CHIs presented to national EDs from 1 January 2013-31 December 2022.