Internal and Emergency Medicine最新文献

The 2025 focus update of the European society of cardiology (ESC) and European atherosclerosis society (EAS) guidelines for dyslipidemia management highlight a significant evolution in patient care, shifting from an intensive, target-driven approach to earlier and more personalized strategies. The transition from SCORE to SCORE2 and SCORE2-OP has improved risk stratification accuracy by including non-fatal cardiovascular events and expanding the evaluable population, particularly among older adults. The introduction of the "extreme risk" category and the early adoption of combination therapies allow previously theoretical LDL targets (< 40 mg/dL) to be achieved through the synergistic use of non-statin lipid-lowering agents. Additionally, the 2025 update emphasizes the role of biomarkers such as lipoprotein(a) and elevated triglycerides, as well as traditionally underrepresented populations, including HIV-positive and oncology patients, with recommendations grounded in recent clinical evidence. At the same time, the lack of efficacy of supplements and nutraceuticals without scientific support is reaffirmed. This update consolidates the paradigm of "earlier, more intensive, more personalized" management, underscoring that the current challenge lies not only in scientific knowledge but also in its clinical implementation, with the goal of optimizing cardiovascular prevention and improving patient prognosis and quality of life.

Emergency departments (EDs) are high-pressure environments where healthcare workers face ongoing acute and chronic stressors, increasing the risk of burnout, anxiety, and depression. These challenges affect staff well-being, job satisfaction, and patient care. Although various interventions have been developed to improve well-being, their effectiveness remains insufficiently understood. This systematic review aims to examine interventions targeting the well-being of ED healthcare workers, focusing on individual, group, and organizational-level strategies. Following the PRISMA guidelines, a comprehensive search was conducted across four databases (PubMed, PsycINFO, Scopus, Web of Science) to identify peer-reviewed studies published between 2021 and 2024. A total of 26 articles met inclusion criteria, each evaluating well-being interventions for ED staff. Studies were categorized by intervention type-individual, group, organizational, or multilevel-and outcomes assessed. Most interventions targeted the individual level (n = 21), including mindfulness training, resilience programs, and educational approaches. Fewer studies addressed group (n = 1), organizational (n = 2), or multilevel (n = 2) interventions. Eighteen studies reported improvements in at least one well-being outcome, most commonly reductions in stress and burnout. However, only six included long-term follow-up. Overall, interventions in ED settings primarily focus on individual-level strategies and demonstrate short-term benefits. Less frequent multilevel approaches may provide more sustainable improvements. Future research should emphasize longer follow-up periods, robust study designs, and context-specific implementation to better assess and enhance the effectiveness of well-being interventions for ED healthcare workers.

With a rapidly aging population, accurately predicting rehabilitation outcomes in older adults is increasingly important. As the impact of age on recovery trajectories in geriatric rehabilitation remains unclear, we conducted a retrospective observational study to evaluate the effect of older age on improvements in rehabilitation functional outcomes. We included 158 patients (median age: 84 years; IQR: 77.0-88.0) admitted in 2024 to a geriatric rehabilitation unit. Functional status was assessed at admission and discharge using the Modified Barthel Index (autonomy), Hendrich II Fall Risk Model (fall risk), and Tinetti Scale (balance and gait). Patients were stratified into age tertiles and compared using the Kruskal-Wallis and Mann-Whitney U tests. Multivariable linear regression models evaluated the independent associations of age, sex, and frailty index with functional outcomes. Comparisons of changes in functional outcomes between the youngest (T1) and oldest (T3) age tertiles were performed using the Mann-Whitney U test. Older age was associated with worse baseline functional status, reflected by lower Barthel and Tinetti scores and higher Hendrich II scores. However, in multivariable models, frailty index-but not chronological age-was the strongest independent predictor of all functional outcomes, including Barthel (β =  -89.9, p < 0.001), Tinetti (β =  -39.9, p < 0.001), and Hendrich II (β = 6.8, p < 0.001). Both younger and older patients achieved significant functional gains, particularly in mobility, whereas improvements in autonomy and fall risk were more limited among the oldest individuals. In conclusion, chronological age was associated with poorer baseline performance but did not impair motor recovery. Frailty, rather than age itself, emerged as the key determinant of rehabilitation outcomes. These findings underscore the importance of integrating standardized frailty assessments to guide rehabilitation strategies and promote equitable access to multidisciplinary rehabilitation for older adults.

The application of Artificial Intelligence (AI) in medical imaging has demonstrated substantial potential in enhancing diagnostic accuracy, reducing inter-operator variability, and improving workflow efficiency. This review examines the integration of AI into three ultrasound pillars: echocardiography, carotid ultrasound, and transcranial Doppler (TCD). These techniques have long relied on expert interpretation, but AI-driven advancements now promise to revolutionize clinical practice by providing automated image analysis, improving diagnostic capabilities, and enhancing prognostic prediction. While echocardiography remains a cornerstone in the diagnosis of heart disease, carotid ultrasound and TCD are critical for assessing brain atherosclerosis and stroke risk and management. This narrative review explores AI applications in these domains, highlighting the current state of technology, clinical implications, challenges, and future prospects.

This study assesses the feasibility of collecting real-time perceptions of emergency department (ED) crowding from different professional roles and compares the recorded perceptions with two crowding indicators: the NEDOCS and the recently proposed Fenice score. We conducted a prospective observational study in an Italian university hospital. ED staff received two SMS questionnaires daily, assessing perceived crowding and workload pressure on 0-10 scales. Simultaneously, the NEDOCS and Fenice scores were recorded every 15 min. Spearman correlations, regression models, and generalized additive models were used to assess associations. Among 49 staff members, 830 valid on-shift responses were collected (response rate: 62.6%). Perceived crowding was generally high (median: 7; Q1-Q3: 5-9) and varied significantly by role (p-value < 0.001), with healthcare assistants and boarding nurses perceiving the ED as more crowded and process management nurses perceiving it as less crowded. The Fenice and NEDOCS scores correlated strongly with perceived crowding (ρ: 0.71 and 0.69; p value = 0.06) and moderately with workload pressure (ρ < 0.60). The Fenice score explained slightly more variance in perceived crowding (R²: 0.65 vs. 0.59). While the correlation between the two scores in the study ED was high (ρ: 0.85), a wide range of correlation coefficients emerged in a cohort of 83 Italian EDs (average ρ: 0.80; min-max: 0.24-0.99; Q1-Q3: 0.73-0.93). Real-time monitoring of ED staff perceptions is feasible and informative. Both the NEDOCS and Fenice scores correlate well with staff perception, but the simplicity and fully automatable implementation of the Fenice score make it a promising alternative to be evaluated in future studies.

Managing relapsing ulcerative colitis (UC) remains a clinical challenge despite therapeutic advances. Metformin, primarily an antidiabetic agent with demonstrated anti-inflammatory properties, has been proposed as an adjunctive treatment for UC. This double-blind, randomized, placebo-controlled pilot trial evaluated the effectiveness of adjunctive metformin in reducing disease activity among patients with mild-to-moderate UC experiencing acute exacerbations. A total of 112 patients with UC were enrolled at Sabzevar, Iran, between 2017 and 2024. The mean age of participants was 34.52 ± 5.79 years, and 57 patients (50.1%) were male. Patients were randomly assigned to receive either 1000 mg metformin tablets twice daily (after breakfast and dinner) in addition to routine treatment or placebo tablets with routine treatment for 2 months. The primary outcome was the change in UC Disease Activity Index (UCDAI) scores after the follow-up period. Ordinal logistic regression demonstrated that the odds of having a higher UCDAI score were approximately 54% lower in the metformin group compared with the control group (OR 0.46; 95% CI 0.21-0.97; P = 0.044). Multiple linear regression further confirmed significantly lower mean UCDAI scores in the metformin group (β =  - 1.11; 95% CI - 1.86 to - 0.37; P = 0.004). These findings suggest that adjunctive metformin is associated with meaningful reductions in disease activity scores, supporting its potential therapeutic role in managing acute exacerbations of UC. While the results are promising, larger-scale clinical trials are needed to validate these outcomes and investigate the underlying mechanisms by which metformin may exert its anti-inflammatory effects in UC management.

The purpose is to investigate the effects of caffeinated chewing gum on the cognitive performance of emergency physicians (EPs) during a night shift. In this randomized, double-blind, placebo-controlled crossover exploratory pilot trial, 14 young male EPs (mean age: 29.9 ± 1.44) working an 8-h night shift received either caffeinated gum (200 mg) or a placebo mid-shift. A comprehensive cognitive battery assessing executive function, cognitive flexibility, and spatial memory was administered at three time points: pre-shift (baseline), mid-shift (10 min post-intervention), and end-of-shift. Performance changes between conditions were analyzed using the Wilcoxon signed-rank test, with effect sizes quantified via rank-biserial correlation. Caffeinated gum elicited immediate and large improvements in key executive functions. Compared to placebo, the caffeine condition was associated with significantly enhanced cognitive flexibility (reduced task-switching interference: r = -0.784, 95% CI [-1.000 to -0.354], p = 0.009; improved accuracy: r = 0.673, 95% CI [0.154-1.000], p = 0.026) and superior cognitive inhibition (improved Incongruent Stroop task performance: r = -0.745, 95% CI [-1.000 to -0.273], p = 0.015). These benefits were not sustained at the end-of-shift assessment, and no significant effects were observed for spatial memory or other cognitive domains at any time point. This exploratory trial found that 200 mg of caffeinated gum produced immediate, domain-specific gains in cognitive flexibility and response inhibition, functions closely linked to medical error risk. As the effects were transient, caffeinated gum may serve as a short-term "tactical safety tool" in high-risk scenarios, aligning with strategies in aviation and military operations, though larger studies are needed to confirm these findings and test for a direct impact on clinical performance.