Internal and Emergency Medicine最新文献

Despite efforts to mitigate high opioid prescription frequencies, previous research showed minimal change within emergency departments (ED) in the United States, and a few studies investigate prescription provider types. Thus, our primary objective was to assess opioid prescribing rates by differing healthcare team members using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Using the 2019-2021 NHAMCS, we calculated the overall opioid prescription rate during ED visits by provider type. Next, we estimated opioid prescription rates by provider type annually and determined differences by year using design-based X² tests and regression models. From 2019 through 2021, 7428 of 50,548 visits involved opioids, representing 15.62% of all ED visits. During this timeframe, 16.59% of total encounters with opioid prescriptions were among attending/consulting physicians. This was followed by physician assistants (13.91%), nurse practitioners (10.67%), and residents (7.28%). Compared to 2019, opioid prescribing rates showed no significant changes; however, resident physicians showed a significant decrease, and RNs showed a significant increase. From our analysis, opioid prescribing rates in the ED were highest among attending/consulting physicians, and rates among physician assistants and nurse practitioners were higher than 10%. Resident physicians had a significant decrease in opioid prescriptions, while RNs had an increase-likely due to new laws enacted during this timeframe. Removing barriers to alternative pain management for acute and long-term care may lessen rates of opioid prescriptions-including patient and provider training, physical therapists inclusion, and osteopathic manipulative therapy incorporation.

Toxicological and epidemiological studies suggest that new-generation nicotine delivery products will reduce the harmful exposures associated with combustible cigarettes and toxic forms of smokeless tobacco products. However, enhanced study designs are needed to support epidemiological research that was more appropriate when the ways of consuming nicotine were limited and methods to assess causality in less than decades were unavailable. Given their different perspectives and scientific capabilities, progress in THR requires deeper and transparent engagement between industry scientists and those in academia that rigorously applies conflicts of interest norms.

Loneliness is a major concern for public health in contemporary societies. Older adults are particularly vulnerable to loneliness because of their reduced social connections following life changes, such as retirement. Loneliness is often investigated and discussed together with social isolation. While social isolation implies an actual lack of social connections, loneliness implies a perceived deficit of social relations regardless of the real amount of social contacts. However, since living alone may lead to loneliness, individuals can experience both loneliness and social isolation together. Loneliness is not an inevitable consequence of aging and can be tackled with various interventions that can be classified into individual- and group-based formats and can be conducted either in-person or online. In terms of contents, interventions for lonely older adults vary widely, from psychological therapies to contacts with nature and pet company. Although many lonely patients are seen in primary care settings, they are often hospitalized through emergency departments. Social prescriptions, which are more and more perceived as an important add-on to clinical treatments, are non-medical interventions designed to help patients to improve their health by linking traditional clinical practice with social activities and support services within the community. Health- and social-integrated care in the community has become a major priority among older adults to ensure their continuity and quality of care. A European model for welfare systems should be framed by a full integration of care across health and social services. Investing in integrated community care should improve the broad efficiency of the European welfare systems.

Malignant Peritoneal Mesothelioma (MPM) is a rare and aggressive cancer originating in the mesothelial serosal membranes, often associated with pleural mesothelioma. Its diagnosis is challenging due to its nonspecific symptoms, such as abdominal distension, pain, weight loss, and ascites, which overlap with other abdominal conditions. This case study details a 64-year-old male patient with a complex clinical presentation, initially misdiagnosed with seronegative celiac disease, before ultimately being diagnosed with MPM through video-laparoscopy. Despite extensive workup-including CT, PET scans, and colonoscopy-the diagnosis was delayed until peritoneal nodules were identified. MPM remains difficult to detect, often identified at advanced stages, with a poor prognosis and a median survival of less than 1 year post-diagnosis. This case underscores the importance of a comprehensive diagnostic approach, particularly in patients with nonspecific abdominal symptoms, to improve early detection and treatment outcomes for MPM.

Ultrasound of the scrotum plays a crucial role in assessing acute scrotal conditions in the Emergency Department. Although the Emergency Physician and Intensivist have shared responsibility for the care of the critically ill patient, the Emergency Physician typically uses Point-of-care Ultrasound in a broader range of applications than the intensivist to include advanced abdominal, obstetric, testicular, musculoskeletal, and ocular ultrasonography. Acute scrotum refers to the sudden onset of scrotal erythema, swelling, or pain, and it is not a rare condition in the Emergency Department. Prompt intervention is required in cases of testicular torsion or rupture, and ultrasound of the scrotum has high utility for emergency physicians seeing acute scrotal complaints with any frequency. However, the incidence of acute scrotum incidence is low compared to other disease states requiring ultrasound diagnosis. This presents a problem when considering ultrasound training of Emergency Physicians for ultrasound of the scrotum in a Point-of-care perspective. With this narrative review, we will attempt to raise the awareness of emergency medicine doctors to the importance of ultrasound of the scrotum in the Emergency Department. We will also discuss educational aspects in testicular ultrasound and the use of contrast-enhanced ultrasound. Finally, we propose an algorithm for action.

Sodium-glucose co-transporter type-2 (SGLT2) inhibitors have been identified to have a crucial hepatoprotective role in patients with type 2 diabetes (T2DM) and metabolic-associated steatotic liver disease (MASLD). Thus, we aimed to assess the effect of SGLT2 inhibitors on hepatic steatosis in patients with T2DM and MASLD added to the standard of care (SOC) treatment. Our study was a single-arm clinical trial with trial no ISRCTN85961860. Thirty T2DM patients with MASLD were recruited from the outpatient endocrinology and diabetes clinic of the Internal Medicine Department at Kasr Al-Aini Hospital, Cairo University, Egypt. Our Patients received Empagliflozin 10 mg daily which was added to SOC treatment and followed up for 24 weeks. Magnetic resonance imaging proton density fat fraction (MRI-PDFF) was done at baseline and after 24 weeks to assess the percentage change in hepatic fat mass. Also changes in Fib-4 and NAFLD fibrosis scores were calculated. Our study showed a statistically significant decrease in the mean MRI-PDFF measurement of hepatic steatosis after 24 weeks of adding empagliflozin to SOC treatment (13.297 ± 7.15) compared to the mean at baseline (15.288 ± 8.72), P = 0.006 with overall percentage decrease about 13.16% of liver steatosis. There were significant decreases in BMI, fasting blood glucose, and Alanine transaminase, (P < 0.001, 0.03, 0.01) respectively. There were no significant differences in Fib-4 or NAFLD fibrosis scores. Adding empagliflozin 10 mg to the standard treatment in patients with diabetes and MASLD could reduce hepatic fat mass significantly after 24 weeks of treatment. Thus, adding SGLT2 inhibitors to the clinical practice guidelines could be a therapeutic agent for patients with MASLD and T2DM.