Internal and Emergency Medicine最新文献

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.

Sepsis remains a leading cause of morbidity and mortality worldwide. Increasing evidence suggests that the gut microbiota, long considered a "less relevant" to human body health, it plays a crucial role in the pathophysiology of sepsis. Disruption of the host-microbe balance contributes to impaired barrier integrity, microbial translocation, and dysregulated immune responses. This perspective raises the possibility that dysbiosis is not merely a consequence of critical illness, rather an active driver of septic progression. This narrative review explores the relationship between sepsis and gut microbiome. PubMed, Scopus, and EMBASE were searched from inception to September 2025. Recent studies have highlighted the triangular interplay between the intestinal barrier, gut microbiota, and immune system. Altered microbial composition and increased permeability foster systemic inflammation and immune dysfunction. Biomarkers such as diamine oxidase and intestinal fatty acid-binding protein are emerging as promising indicators of gut injury. Experimental therapies (i.e., faecal microbiota transplantation, targeted probiotics, prebiotics, postbiotics, and personalized antibiotic regimens guided by microbial profiling) provide potential to modulate host-microbe interactions. Integration of microbiome analysis with multi-omics and advanced bioinformatics may enable stratification of septic patients by microbial signatures, paving the way for precision medicine approaches. Modulation of gut microbiota represents a novel therapeutic frontier in sepsis. Conceptualizing sepsis as a disease of disrupted host-microbe symbiosis may unravel new diagnostic and therapeutic strategies. Future research should aim at prioritizing high-quality trials, innovative designs, and equitable implementation to target microbiota to improve survival and recovery in patients with sepsis.

Background: Anemia is a global health issue, especially in resource-limited areas, where traditional hemoglobin (Hb) testing is invasive and costly. This study aimed to develop an electrocardiogram-hemoglobin (ECG-Hb) deep learning model (DLM) for detecting anemia and assess its impact on all-cause mortality and new-onset heart failure.

Methods: This retrospective study analyzed ECGs and corresponding Hb levels from two hospitals. The DLM was trained on 388,166 ECGs from 187,202 patients and tested on 24,279 and 29,247 patients in internal and external sets, respectively. Anemia was defined as moderate (Hb ≤ 10 g/dL) or severe (Hb ≤ 8 g/dL). Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis, and an 8-year follow-up assessed mortality and heart failure risk with Cox regression.

Results: The areas under the ROC curves (AUCs) for detecting moderate-to-severe anemia were 0.8545 (internal) and 0.8243 (external), with sensitivities of 65.9% and 71.0%, and specificities of 84.8% and 77.4%, respectively. ECG-Hb performed better in detecting severe anemia (AUC = 0.9038/0.8766) than in mild anemia. Pearson correlations between ECG-Hb and Hb were 0.56 (internal) and 0.53 (external). Key ECG features, including heart rate variability, significantly influenced ECG-Hb. Patients with severely low ECG-Hb had higher risks of mortality (hazard ratio [HR]: 1.71, 95% confidence interval [CI]: 1.42-2.06) and heart failure (HR: 2.47, 95% CI: 2.07-2.94) compared to those with standard ECG-Hb levels.

Conclusion: The ECG-Hb DLM offers strong diagnostic and prognostic potential for anemia and cardiovascular risks, making it a valuable, non-invasive screening tool in low-resource settings.

Plasma leakage is a hallmark of severe dengue and a major contributor to morbidity and mortality, yet early identification remains difficult, particularly in resource-limited settings. This single-centre retrospective study evaluated the diagnostic accuracy of the neutrophil-to-lymphocyte ratio (NLR) in predicting plasma leakage amongst 507 adults with laboratory-confirmed dengue admitted between January 2022 and December 2023. Plasma leakage was defined sonographically. We assessed NLR trends from illness days 1 to 11 and constructed a bivariate plot of absolute neutrophil and lymphocyte counts to visualise immune dynamics. Ninety-nine patients (19.5%) developed plasma leakage. NLR values differed significantly between groups on days 2-8. Admission NLR showed modest performance (AUROC 0.626), with high sensitivity (87.9%) but low specificity (33.8%). The highest accuracy occurred on day 2 (AUROC 0.923). Whilst NLR alone is insufficient as a diagnostic tool, early phase measurements and visual frameworks of immune cell trajectories may enhance risk stratification for plasma leakage in dengue.