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Swiss Emergency Research collection

2026

2025

Ziaka, M. “Targeting Gut–Lung Crosstalk In Acute Respiratory Distress Syndrome: Exploring The Therapeutic Potential Of Fecal Microbiota Transplantation”. Pathogens 14, no. 12. doi:10.3390/pathogens14121206.

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Abstract: The gastrointestinal (GI) tract contributes significantly to the pathogenesis of acute respiratory distress syndrome (ARDS) by influencing systemic inflammation and sepsis, which are key factors in the development of multiple organ dysfunction syndrome (MODS), while the significant impact of gut microbiota in critically ill patients, including those with sepsis and ARDS, further underscores its importance. The intestinal microbiota is vital to immune system function, responsible for triggering around 80% of immune responses. Therefore, it may be hypothesized that modifying fecal microbiota, such as through fecal microbiota transplantation (FMT), could serve as a valuable therapeutic approach for managing inflammatory diseases like lung injury (LI)/ARDS. Indeed, emerging experimental research suggests that FMT may have beneficial effects in ARDS models by improving inflammation, oxidative stress, LI, and oxygenation. However, well-designed randomized clinical trials in patients with ARDS are still lacking. Our study seeks to examine how therapeutic interventions such as FMT might benefit LI/ARDS patients by exploring the interactions between the gut and lungs in this context. © 2025 by the author.

Tags: acute respiratory distress syndrome, adult, critically ill patient, dysbiosis, fecal microbiota transplantation, feces microflora, gut microbiome, gut–lung axis, human, immune response, inflammation, intestine flora, lung injury, lung microbiome, lung microbiota, multiple organ failure, nonhuman, oxidative stress, oxygen saturation, oxygenation, pathogenesis, randomized controlled trial, respiratory distress, respiratory distress syndrome, review, sepsis, therapy.

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van Oppen, J., de Groot, B., Nickel, C. H., and Beil, M. “Response To 'The 'F' In Abcde: Why Frailty Assessment Matters In Geriatric Trauma'”. European Journal Of Emergency Medicine : Official Journal Of The European Society For Emergency Medicine 33, no. 1: 65-66. doi:10.1097/MEJ.0000000000001261.

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Tags: article, frailty, human, injury.

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Coisy, F., Simon, A., Occelli, C., Dupriez, F., Ageron, F. X., N’Diaye, L., Féral-Pierssens, A. L., Yates, G., and Bobbia, X. “Does A History Of Sickle Cell Disease Affect The Prescription Of Morphine? An International, Randomised Study Based On Clinical Vignettes Conducted Among Emergency Physicians”. Bmj Open 15, no. 12: e108836. doi:10.1136/bmjopen-2025-108836.

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Abstract: Objectives To assess whether emergency physicians prescribe morphine differently for patients with or without sickle cell disease (SCD). Given the difficulty of comparing strictly homogeneous patients in real clinical settings, we used a standardised clinical vignette to ensure that all clinical information was identical except for SCD status and sex. Design International, randomised controlled, vignette-based study conducted online. The four vignette versions differed only in patient sex and SCD status, with all other clinical information fully standardised. Vignettes were validated by an expert panel and randomly allocated using a computer-generated sequence. Setting Emergency physicians practising in France, the UK, Belgium and Switzerland were invited to complete an online survey between 17 February and 17 March 2025. Participants A total of 1060 physicians responded, of whom 953 (90%) met eligibility criteria and were included in the analysis. Respondents were practising emergency department (ED) physicians without exclusion based on seniority or training level. Primary and secondary outcome measures The primary outcome was the proportion of simulated patients for whom morphine was prescribed. Secondary outcomes included the number and type of analgesics prescribed and the proportion of cases meeting predefined criteria for maximal level of care (urgent triage category, lactate sampling, CT imaging and morphine administration). Results Morphine was prescribed in 444 of 492 (90%) SCD vignettes and 389 of 461 (84%) non-SCD vignettes (absolute difference: 6% (95%CI 1% to 10%)). Morphine monotherapy was used in 41% of SCD cases and combined analgesia in 50%. No significant differences were observed according to patient sex or physician characteristics. Maximal level of care was recommended in 22% of SCD cases. Conclusion In this randomised vignette study, emergency physicians prescribed morphine more frequently for simulated patients with SCD than for those without SCD, despite identical clinical presentations. These findings contrast with real-world reports of inadequate analgesia in SCD and suggest that the absence of perceptual cues—such as skin colour or names—may reduce implicit bias in opioid prescribing. © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

Tags: adult, Analgesics, Opioid, Anemia, Sickle Cell, Article, Belgium, clinical practice, codeine, comparative study, complication, controlled study, Emergency Departments, emergency physician, Emergency Service, Hospital, female, France, Health Services Accessibility, hospital emergency service, human, Humans, ketamine, lactic acid, major clinical study, male, medical history, middle aged, monotherapy, morphine, narcotic analgesic agent, nitrous oxide, PAIN MANAGEMENT, paracetamol, patient care, patient triage, physician, Physicians, Practice Patterns, Physicians', prescribing practice, prescription, prospective study, questionnaire, randomized controlled trial, search engine, sickle cell anemia, Surveys and Questionnaires, Switzerland, tramadol, United Kingdom, vignette, x-ray computed tomography.

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Bless, P., Blaser, D., Castelain, T., Pugnale, S., Ribordy, V., and Guéchi, Y. “Clinical Approach To Acute Recreational Drug Intoxication In The Emergency Setting: A Practical Guide Based On Swiss Experience”. Toxics 13, no. 12. doi:10.3390/toxics13121034.

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Abstract: Acute intoxications related to recreational drug use represent an increasing challenge for emergency departments (EDs). Worldwide, more than 600,000 deaths are attributable each year to illicit drug consumption, and in Switzerland approximately 190 deaths related to recreational drug use were reported in 2023. Most patients present after the use of recreational drugs such as stimulants (cocaine and amphetamines), opioids, cannabis or hallucinogens, with stimulants representing the majority of acute presentations in European emergency departments. In recent years, a sharp progression of amphetamine-like substance consumption derived from khat has been observed. Clinical presentations range from agitation, psychosis, seizures, and hyperthermia to respiratory depression, multi-organ failure and cardiac arrest. Emergency physicians are frequently the first to provide care, yet management is often complicated by the coexistence of multiple substances, the emergence of new psychoactive compounds, and the limited availability of toxicological testing in the acute setting. This narrative review summarises the current evidence and recommendations relevant for clinical practice. It is based on a literature search conducted in PubMed, EMBASE, Cochrane Library, but also grey literature such as MonAM, Infodrog and Tox Info Suisse regarding the specific Swiss context. The review highlights the recognition of typical toxidromes: stimulants causing sympathomimetic effects; opioids with mainly respiratory depression; hallucinogens and dissociatives; also, this review presents common pitfalls with drugs commonly encountered. Management emphasises oxygen administration, benzodiazepine sedation for agitation, and specific interventions like naloxone for opioids. Given rising trends in cocaine and novel psychoactive substance use, enhanced understanding of pharmacological profiles and standardised emergency protocols are critical for improving patient outcomes. Although specific treatment may be lacking for most drugs, novel psychoactive drugs pose new challenges due to lack of robust data preventing us from presenting a typical clinical picture and providing standardised care. This synthesis aims to support emergency physicians in the structured and evidence-based management of acute recreational drug intoxications. © 2025 by the authors.

Tags: acute intoxication, agitation, amphetamine, amphetamine derivative, benzodiazepine, cannabis, Catha, Catha edulis extract, central stimulant agent, clinical practice, cocaine, Cochrane Library, drug intoxication, drug toxicity, drug use, emergency room, emergency ward, evidence based practice, heart arrest, human, hyperthermia, illicit drug, khat, medical decision making, multiple organ failure, naloxone, novel psychoactive substances, opiate, opioids, oxygen therapy, pharmacology, psychedelic agent, psychosis, psychotropic agent, recreational drug, recreational drug use, respiration depression, review, sedation, seizure, stimulants, substance use, Swiss, toxicology, toxidrome, treatment outcome.

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Meine, L. E., Schaekel, L. S., Thörn, H., Ehlert, U., Brodmann Maeder, M. B., Exadaktylos, A. K., Bingisser, R., et al. “Characterisation Of Intrusive Memories And Prediction From Memory-Related Genes And Cognitive And Emotional Factors”. Scientific Reports 15, no. 1: 45025. doi:10.1038/s41598-025-29775-9.

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Abstract: Frontline caregivers, such as nurses and physicians, face heightened risk of intrusive memories, a core symptom of posttraumatic stress disorder. Understanding intrusions is key to protecting workers’ mental health and sustaining effective patient care. Emergency department (ED) staff (N = 331) were assessed before starting ED work and three and six months later. Baseline measures included demographics, prior trauma, cognitive and emotional processing, and polymorphisms of the memory-related NR3C1, KIBRA, and ADRA2B genes as predictors of intrusions at three months, i.e., peak ED stress exposure. We examined intrusion occurrence, frequency, distress, and content, and investigated whether experiencing intrusions moderated changes in mental health from baseline to follow-ups. Intrusions were prevalent and often concerned potential patient care errors. Being a carrier of the G allele of the BCL1 polymorphism of the NR3C1 gene and ruminating were associated with intrusions at three months, while cognitive flexibility, emotional suppression, and emotion-focused positive rumination appeared protective. From baseline to three and six months, participants’ anxiety increased, and those experiencing intrusions reported significantly lower work performance and engagement. Our results underline the psychological costs of high-stakes ED settings and suggest improvements to error culture and emotion regulation training as promising avenues to support staff and ultimately patients. © The Author(s) 2025.

Tags: adult, cognition, Emergency medicine, Emergency Service, Hospital, emotion, Emotions, female, genetics, glucocorticoid receptor, hospital emergency service, human, Humans, Intrusive memories, male, memory, middle aged, NR3C1 protein, human, physiology, Polymorphism, Single Nucleotide, posttraumatic stress disorder, psychology, Receptors, Glucocorticoid, Rumination, single nucleotide polymorphism, Stress, Stress Disorders, Post-Traumatic.

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Gobron, S., Lestrade, A., Sadiku, A., Bentvelzen, A., Kaci, L. A., Carrier, J. M., Guyot, E., and Carron, P. N. “Gamified Simulation For Onboarding Health Care Teams In Emergency Care: Development And Preliminary Feasibility Study”. Jmir Formative Research 9: e72202. doi:10.2196/72202.

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Abstract: Background: High staff turnover is a widespread issue across nearly all hospital departments, often exceeding 20% annually. This constant flux disrupts continuity of care and creates a recurring challenge: how to rapidly integrate new employees into complex clinical environments, both physically and functionally. Traditional onboarding methods struggle to meet this demand, particularly in services operating 24/7, such as emergency departments (EDs). Objective: This formative study presents the design and implementation of a web-based 3D gamified simulation platform aimed at improving staff onboarding in clinical environments. The paper outlines both the technical architecture-with guidance for hospital IT departments-and the acceptability and usability for permanent staff, who play a key role in ensuring onboarding continuity. We sought to assess whether such a tool could be autonomously managed and well received by health care professionals. Methods: The intervention consisted of 2 linked components: a real-time, browser-based 3D simulation replicating the hospital’s ED and a web-based quest editor allowing nontechnical staff to update training content. The system supports self-paced onboarding through location-based tasks, object searches, quizzes, and simulated staff interactions. Two preliminary usability studies were conducted: one with 37 ED staff members testing the 3D simulation and another with 9 users exploring the quest editor. Feedback was gathered through anonymous questionnaires and a descriptive analysis. Results: Early results showed high feasibility and acceptability. Among 3D simulation testers (n=37), 90% (33/37) found the tool helpful for understanding the department’s structure, and 81% (30/37) believed it would be useful for new staff. The inclusion of personal anecdotes and gamified tasks was viewed as engaging and motivating. The quest editor (n=9) was positively rated by 91% (8/9) of users, who appreciated the ability to autonomously update content without IT support. These findings support the dual promise of the platform (ie, pedagogical flexibility and technical sustainability). Conclusions: This work demonstrates the feasibility of a gamified simulation platform designed for high-turnover clinical environments. It highlights both the operational deployment framework and the early acceptability among key staff members. While further validation with actual new hires is needed, this formative study shows promising potential for generalization beyond emergency care. The modular and editable nature of the system makes it a viable solution for scalable onboarding in other hospital departments. © Stephane Gobron, Antoine Lestrade, Artan Sadiku, Alexandre Bentvelzen, Leila Ait Kaci, Jean-Michel Carrier, Emmanuelle Guyot, Pierre-Nicolas Carron.

Tags: digital learning environment, feasibility studies, health technology implementation, mobile phone, personnel turnover, self-directed training, simulation training, staff development, user acceptability.

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Eidenbenz, D., Scotti, C., Larréché, S., Pagani, J. L., and Carron, P. N. “Challenges Of A West African Green Mamba (Dendroaspis Viridis) Envenomation In A European Urban Setting: A Case Report With Quantitative Monitoring Of Neuromuscular Transmission”. Toxicon 271: 108951. doi:10.1016/j.toxicon.2025.108951.

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Abstract: Although rare, exotic snakebites are a growing medical concern worldwide, partly due to the rising popularity of exotic pet ownership in high-income countries. Envenomation from family Elapidae snakes may cause severe neurological and local symptoms. Timely antivenom administration is crucial, but often complicated by logistical challenges. We report a case of a West African green mamba (Dendroaspis viridis) envenomation in a 59-year-old male in Switzerland who developed progressive weakness and respiratory failure, associated with swelling of a limb. Quantitative neuromuscular stimulation, also known as a train-of-four monitor, was used to assess neuromuscular transmission after antivenom administration. This case highlights the clinical and organizational challenges following an exotic snakebite. © 2025 The Authors

Tags: adult, allodynia, animal, Animals, Antivenins, Article, artificial ventilation, blood gas, breathing rate, case report, clinical article, Dendroaspis, Dendroaspis viridis, drug therapy, Elapid venom, Elapid Venoms, Elapidae, emergency physician, emergency ward, endotracheal intubation, envenomation, fentanyl, Glasgow coma scale, high income country, human, Humans, male, metabolic acidosis, metabolic stress, middle aged, neurologic examination, neuromuscular blocking, neuromuscular transmission, oxygen saturation, paresthesia, pathophysiology, peak expiratory flow, propofol, quantitative analysis, respiratory alkalosis, respiratory failure, rhabdomyolysis, rocuronium, snake, Snake Bites, Snake envenomation, snake venom, Snakebite, swelling, Switzerland, therapy, Trimeresurus sumatranus, venom antiserum, weakness, wound care.

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Flor, L. S., Spencer, C. N., Cagney, J., Gil, G. F., Aalruz, H., Abd ElHafeez, S., Abdelwahab, S. I., et al. “Disease Burden Attributable To Intimate Partner Violence Against Females And Sexual Violence Against Children In 204 Countries And Territories, 1990–2023: A Systematic Analysis For The Global Burden Of Disease Study 2023”. The Lancet 407, no. 10523: 31-52. doi:10.1016/S0140-6736(25)02503-6.

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Abstract: Background Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels. Methods We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor. Findings Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518–724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764–1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74–30·0) DALYs were attributed to IPV among females and 32·2 million (16·4–52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15–49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (–1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (–1·92 to 13·1) DALYs due to schizophrenia in 2023. Interpretation IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors. Funding Gates Foundation. © 2026 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Tags: abortion, adolescent, adult, aged, alcoholism, anxiety disorder, Article, asthma, automutilation, bipolar disorder, bulimia, child, Child Abuse, Sexual, child sexual abuse, Child, Preschool, childhood, chronic disease, conduct disorder, disability-adjusted life year, Disability-Adjusted Life Years, disease burden, drug dependence, emotional abuse, female, Global Burden of Disease, global disease burden, global health, health hazard, health outcome, health survey, hepatitis, high income country, homicide, human, Human immunodeficiency virus, human rights abuse, Humans, infection, Intimate Partner Violence, linear regression analysis, low income country, major depression, male, mental disease, middle aged, non insulin dependent diabetes mellitus, obstetric hemorrhage, partner violence, physical violence, posttraumatic stress disorder, Preferred Reporting Items for Systematic Reviews and Meta-Analyses, premature mortality, preschool child, prevalence, public health, quality adjusted life year, Quality-Adjusted Life Years, risk factor, Risk Factors, schizophrenia, sexual intercourse, sexual violence, sexually transmitted disease, spontaneous abortion, systematic review, young adult.

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Brinker, V., Exadaktylos, A., Hautz, W., and Ziaka, M. “First Breath Matters: Out-Of-Hospital Mechanical Ventilation In Patients With Traumatic Brain Injury”. Journal Of Clinical Medicine 14, no. 23. doi:10.3390/jcm14238443.

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Abstract: Invasive mechanical ventilation (MV) is often a lifesaving intervention in patients with traumatic brain injury (TBI) to optimize gas exchange and prevent secondary brain injury, thereby avoiding the deleterious effects of both hypoxia and hyperoxia, as well as hypocapnia and hypercapnia. However, MV in these patients represents a unique clinical challenge, as it must take into account multiple parameters, including cerebral autoregulation and autoregulatory reserves, brain compliance, cerebral dynamics such as intracranial pressure (ICP), cerebral perfusion pressure (CPP), and cerebral blood flow (CBF), as well as systemic hemodynamics and respiratory system mechanics. Moreover, the detrimental effects of MV on extracranial organs and systems are well established, with the lungs being the most vulnerable, particularly when non-protective ventilation strategies involving high tidal volumes (TV) and inspiratory pressures are applied. Currently, the optimal ventilation approach in patients with TBI, with or without LI, remains incompletely defined. While protective ventilation practices are recommended for a large number of critically ill patients, their application in individuals with acute brain injury (ABI) may adversely affect cerebral and systemic hemodynamics, as well as brain physiology, potentially leading to secondary damage and poor clinical outcomes. Because the consequences of TBI, such as secondary brain damage and lung complications, begin shortly after the primary event, the role of prehospital MV in these patients is crucial. However, existing data from the out-of-hospital setting are scarce. Thus, in the present review, we aim to summarize the available evidence on MV in patients with TBI, with an emphasis on the prehospital setting. © 2025 by the authors.

Tags: adult, artificial ventilation, autoregulation, brain blood flow, brain damage, brain injury, cerebral autoregulation, cerebral perfusion pressure, clinical outcome, critically ill patient, diffuse brain injury, gas exchange, hemodynamics, human, hypercapnia, hyperoxemia, hyperoxia, hypocapnia, hypoxemia, hypoxia, intracranial pressure, invasive ventilation, lung complication, male, mechanical ventilation, nasal cannula, preclinical setting, protective ventilation, review, therapy, tidal volume, traumatic brain injury, ventilator.

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Yoo, Y., Cleroux, A., Pollock, N. W., and Boet, S. “Quality Of Reporting In Hyperbaric Medicine Clinical Trials: A Cross-Sectional Study”. Diving Hyperb Med 55, no. 4: 352-368. doi:10.28920/dhm55.4.352-368.

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Abstract: INTRODUCTION: Research in hyperbaric oxygen (HBO) medicine is growing, but the quality of HBO studies is variable. Low study quality may compromise evidence-based decision-making and clinical translation. METHODS: This cross-sectional study examined the adherence of 50 randomly selected HBO clinical trials (25 randomised controlled trials [RCTs] and 25 observational studies) to relevant core reporting guidelines: consolidated standards of reporting trials (CONSORT), non-pharmacologic treatments (NPT), and strengthening the reporting of observational studies in epidemiology (STROBE). Studies published in peer-reviewed journals between January 2018 and May 2023 and indexed on PubMed were analysed. Reporting quality was classified as 'excellent' (> 85% of guideline items adequately reported), 'good' (50-85%), or 'poor' (< 50%). RESULTS: The sample represented 29% of RCTs and 16% of observational studies for the timeframe assessed. No study was rated as 'excellent' for completeness, 28 (56%) were rated as 'good', and 22 (44%) as 'poor'. In RCTs, only one study (4%) adequately reported protocol adherence and eight studies (32%) reported blinding procedures. The NPT checklist showed that key items, including care provider adherence (0 studies) and participant adherence (one study; 4%), were frequently not reported. For observational studies, basic design elements were adequately reported, but with significant gaps in bias management (nine studies; 36%) and missing data handling (13 studies; 52%). Only six studies (12%) mentioned the use of reporting guidelines. CONCLUSIONS: Our results showed that quality of reporting of HBO studies is suboptimal. These findings highlight the need for increased awareness and implementation of reporting guidelines, as well as the potential development of HBO-specific guidelines.

Tags: *Guideline Adherence/statistics & numerical data, *Hyperbaric Oxygenation/standards, *Observational Studies as Topic/standards, *Randomized Controlled Trials as Topic/standards, *Research Design/standards, *Research Report/standards, Checklist, Consort, Cross-Sectional Studies, Diving and Hyperbaric Medicine, Equator, Evidence-based medicine, Humans, Hyperbaric oxygenation, Reporting quality, Strobe.

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von Rhein, M., Dratva, J., and Seiler, M. “Editorial: Covid-19 - Lessons Learned In Pediatrics”. Front Pediatr 13: 1737801. doi:10.3389/fped.2025.1737801.

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Tags: commercial or financial relationships that could be construed as a potential, conflict of interest., Covid-19, health care, lessons learned, pediatrics, public health, SARS-CoV-2.

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Sohm, D., Moeckel, J., Wenzel, V., Angerer, V., Roveri, G., Rauch, S., Albrecht, R., and Pietsch, U. “Stability Of Emergency Medications During Extreme Cold: A Controlled Environmental Study”. Scandinavian Journal Of Trauma, Resuscitation And Emergency Medicine 34, no. 1: 5. doi:10.1186/s13049-025-01509-w.

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Abstract: Background: Conditions of extreme cold, encountered during mountain and glacial rescue operations, pose challenges for the storage of emergency medications. Understanding how repeated exposure to extreme cold and ambient temperatures affects drug stability is essential for safe prehospital care. Methods: A controlled environmental study was conducted at the terraXcube, a high-fidelity climate simulation facility at Eurac Research in Bolzano, Italy. The study drugs included Acetazolamide, Amiodarone, Dexamethasone, Epinephrine, Ketamine, Naloxone, Norepinephrine and Rocuronium. Drug ampoules were stored within an insulated storage bag, placed inside a regular mountain rescue backpack. This backpack was then used in a high-fidelity training scenario under conditions of extreme cold. The ampoules remained sealed throughout the experiment. The drugs underwent six cycles of exposure, consisting of 45 min at -15 °C followed by 15 min at + 18 °C, simulating temperature fluctuations during repeated alpine rescue operations. Stability was assessed through visual inspection for physical changes (e.g., crystallization, phase separation) and chemical analysis using mass spectrometry, with results expressed as a percentage of the reference concentration. Results: Visual inspections revealed no overt physical alterations. Mean ± standard deviation (SD) of remaining concentrations ranged from 92.1 ± 1.3% (acetazolamide) to 101.8 ± 7.1% (dexamethasone), with all eight medications retaining ≥ 90% of their labeled concentrations. Conclusion: Emergency medications can remain chemically stable under extreme cold conditions when stored in sealed, insulated packaging. While our study simulated prehospital conditions without direct environmental exposure, these findings support the feasibility of extended storage and transport of emergency medications in challenging field settings. Further research should assess the impact of direct environmental exposure and evaluate additional stability parameters to optimize storage protocols in real-world scenarios. Trial registration: Not applicable. © The Author(s) 2025.

Tags: Alpine rescue, Drug stability, Drug storage, emergency health service, Emergency Medical Services, Emergency medications, Extreme Cold, extreme cold weather, HEMS, human, Humans, Italy, Mountain medicine, Prehospital care, procedures, rescue work.

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Birrenbach, T., Hani, S., Jegerlehner, S., Schober, S., Exadaktylos, A. K., and Sauter, T. C. “Feasibility, Subjective Effectiveness, And Acceptance Of Short Virtual Reality Relaxation Breaks For Immediate Perceived Stress Reduction In Emergency Physicians: Single-Arm Pre-Post Intervention Study” 2: e72605. doi:10.2196/72605.

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Abstract: BACKGROUND: Emergency physicians face significant stress in their daily work, adversely affecting patient care and contributing to physician burnout. OBJECTIVE: This pilot study explored the feasibility, immediate effects, and acceptance of virtual reality (VR) relaxation on perceived stress reduction among emergency physicians. METHODS: The study was conducted at the Department of Emergency Medicine, Bern, Switzerland, in February 2023. All junior and senior physicians were eligible, excluding those with epilepsy, claustrophobia, or severe nausea. Voluntary participants underwent a 6- to 8-minute VR meditation program at their workplace. Subjective short-term stress reduction was measured using a numeric rating scale (NRS) ranging from 0 ("not at all stressed") to 10 ("extremely stressed"). Feasibility, user acceptance, and technical aspects were evaluated using validated and self-constructed questionnaires. RESULTS: In total, 35 emergency physicians (median [IQR] age, 32 [30-34] years, 60% female) completed 39 VR simulation sessions. Baseline stress levels (median NRS 4, IQR 2-6.5) were significantly reduced post-intervention (median NRS 2, IQR 1-4; P<.001), particularly among participants with high baseline stress levels. Reported side effects (simulator sickness) were minimal; the median score of presence and immersion according to the questionnaire developed by Slater-Usoh-Steed was 4 (IQR 3-4) (scale 1-7, with 7=full immersion). User satisfaction was high. Implementation challenges mainly included technical issues and time constraints due to high workload. CONCLUSIONS: This pilot study suggests that brief, relaxing VR sessions may help reduce short-term perceived stress levels in emergency physicians with minimal side effects and high user satisfaction. Future studies should address implementation challenges to optimize integration with clinical workflows.

Tags: authors have nothing to disclose., burnout, emergency medicine, relaxation, stress, telemedicine at the University of Bern sponsored by the Touring Club Switzerland., The sponsor has no influence on the research or decision to publish. All other, virtual reality, workplace.

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Schukraft, S., Müller, M., Abdurashidova, T., Soborun, N., Tzimas, G., Pitta-Gros, B., Antiochos, P., et al. “Female Sex And Survival In Patients Hospitalized With Acute Heart Failure And Renal Dysfunction”. International Journal Of Cardiology 445: 134019. doi:10.1016/j.ijcard.2025.134019.

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Abstract: Background: Kidney dysfunction increases the risk of outcomes in patients hospitalized for acute heart failure (AHF). Female sex is associated with better outcomes in kidney dysfunction. The effect of female sex on outcomes in AHF patients with kidney dysfunction remains unclear. Methods and results: This study included Western European and central Asian AHF patients with kidney dysfunction defined as an estimated glomerular filtration rate (eGFR) <90 ml/min. Primary endpoint was 1-year all-cause mortality (ACM), the secondary endpoint was a composite of first HF-related rehospitalization or ACM at 1 year. Overall, 1470 patients were included (46.2 % women, mean age 75.9 ± 12.2 years). Left ventricular ejection fraction was reduced in 40.3 % (n = 593), mildly reduced in 18.9 % (n = 278), and preserved in 40.7 % (n = 599) of study patients. The prevalence of female vs. male sex differed between HF subgroups (HFrEF: 28.3 vs. 50.7 %, HFmrEF: 18.9 vs. 19.0 %; HFpEF: 52.9 vs. 30.3 %, respectively; overall p < 0.001). In multivariable logistic regression analysis adjusted on age among other variables, female sex was associated with a significantly lower risk of 1-year ACM (odds ratio: 0.61, 95 % CI:0.47–0.79, p < 0.001) in all patients as well as in eGFR subgroups (<45 and ≥ 45 ml/min; p = 0.009 and p = 0.030, respectively). No significant association was found between sex and the secondary endpoint (odds ratio 0.83, 95 % CI: 0.66–1.04, p = 0.11). Conclusion: In this real-world cohort of HF patients prospectively enrolled across two different countries, the risk of 1-year ACM was lower among women with AHF and kidney dysfunction © 2024

Tags: acute disease, Acute heart failure, aged, Aged, 80 and over, all cause mortality, area under the curve, Article, atrial fibrillation, body mass, bradycardia, Cardiovascular care, cardiovascular mortality, chronic obstructive lung disease, clinical trial, cohort analysis, Cohort Studies, congenital heart disease, controlled study, coronary artery bypass graft, creatinine, diabetes mellitus, diagnosis, diagnostic test accuracy study, diastolic blood pressure, estimated glomerular filtration rate, female, follow up, Follow-Up Studies, Glomerular Filtration Rate, glomerulus filtration rate, heart failure, heart failure with reduced ejection fraction, heart left ventricle ejection fraction, heart muscle ischemia, hospitalization, human, Humans, Kidney dysfunction, kidney failure, kidney function, lung embolism, major clinical study, male, middle aged, mortality, multicenter study, observational study, outcome assessment, pathophysiology, percutaneous coronary intervention, physiology, prevalence, Prospective Studies, prospective study, receiver operating characteristic, Renal Insufficiency, retrospective study, risk factor, Sex, sex difference, sex factor, Sex Factors, sodium glucose cotransporter 2 inhibitor, survival rate, systolic blood pressure, transthoracic echocardiography, very elderly.

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Klug, J., Roelz, R., Cossu, G., Ben-Hamouda, N., Wolf, S., and Pietsch, U. “Csf Diversion After Aneurysmal Sub-Arachnoid Hemorrhage: Towards Personalized Treatment Strategies”. Critical Care 30, no. 1: 10. doi:10.1186/s13054-025-05788-8.

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Abstract: Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition associated with high morbidity and mortality, with survivors often experiencing long-term neurological and functional deficits. Cerebrospinal fluid (CSF) diversion plays a pivotal role in the acute management of aSAH, both for the treatment of hydrocephalus and for the prevention of delayed cerebral ischemia (DCI) through clearance of blood breakdown products. Four principal modalities are currently employed: lumbar puncture, lumbar, cisternal, and external ventricular drain. Each technique differs in its mechanism of drainage, monitoring capacity, complication profile, and influence on shunt dependency and long-term outcome. High-quality evidence from randomized controlled trials now supports lumbar drainage as the only intervention that significantly reduces the incidence of DCI and has been shown to improve functional outcomes, making it the preferred first-line approach in suitable patients. External ventricular drains remain indispensable in cases of obstructive hydrocephalus or reduced consciousness, while lumbar puncture may be considered in carefully selected low-risk patients. Cisternal drains represent a potential adjunct in those undergoing surgical clipping of the aneurysm. In patients without hydrocephalus, lumbar drains remain the only strategy with demonstrated long-term benefit. Given the heterogeneity of aSAH presentations and the limitations of existing evidence, individualized selection of CSF diversion techniques is warranted. We propose a pragmatic decision-making algorithm to optimize patient outcomes while minimizing iatrogenic complications, which can be adapted to institutional practices and further refined through prospective evaluation. © The Author(s) 2025.

Tags: algorithm, aneurysmal sub arachnoid hemorrhage, Aneurysmal subarachnoid hemorrhage, anticoagulation, Article, Cerebrospinal fluid, cerebrospinal fluid drainage system, Cerebrospinal Fluid Shunts, Cisternal drain, complication, consciousness, decision making, decompressive craniectomy, Delayed cerebral ischemia, deterioration, Drainage, erythrocyte, etiology, External ventricular drain. lumbar drain, fibrinolysis, Glasgow coma scale, human, Humans, Hydrocephalus, iatrogenic disease, intensive care unit, Intracranial hypertension, length of stay, Lumbar puncture, morbidity, mortality, obstructive hydrocephalus, personalized medicine, Precision Medicine, procedures, Spinal Puncture, stereotactic procedure, subarachnoid hemorrhage, surgery, traumatic brain injury, treatment outcome, vasospasm.

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Cantarero Fernandez, A., Nickel, C. H., Dreher-Hummel, T., Grossmann, F., Unlu, L., Carpenter, C. R., Heeren, P., Ruiter, R. A. C., Simon, M., and Zuniga, F. “Contextual Analysis And Implementation Strategies For An Age-Friendly Emergency Department Uptake: The Fred Study Protocol”. J Am Geriatr Soc. doi:10.1111/jgs.70230.

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Abstract: BACKGROUND: Older adults frequently present to the Emergency Department (ED). In response, a Swiss university hospital introduced age-friendly interventions and achieved Geriatric Emergency Department Accreditation (GEDA) by the American College of Emergency Physicians (ACEP). However, the impact of previously introduced interventions and the reasons behind emergency clinicians' varying uptake or lack of continued use remain unclear. To further improve patient outcomes, conducting a contextual analysis to identify implementation barriers and facilitators is crucial, followed by the development of tailored implementation strategies supporting the sustainable uptake of all age-friendly program elements. The project's overall aim is to systematically promote the uptake and sustainable re-implementation of the existing age-friendly ED program. The first study phase outlined in this protocol ("Phase A") focuses on 2 key objectives: (1) to assess current age-friendly interventions in the ED and identify barriers and facilitators affecting their reach, adoption, implementation, and maintenance; (2) to develop tailored implementation strategies for re-implementing program elements. METHODS: This project uses a modified implementation mapping in 5 Steps across 2 Phases. Phase A includes Steps 1-4: (1) conducting a contextual analysis using a mixed-methods design combining observations, interviews, patient chart reviews, E-survey and a Gemba walk; (2) identifying expected intervention and implementation outcomes, performance objectives; (3) adapting, extending, or developing tailored implementation strategies based on the Expert Recommendations for Implementing Change taxonomy; and (4) co-designing an implementation protocol to guide re-implementation. The follow-up Phase B will involve the re-implementation of the intervention elements and co-designing the evaluation protocol (Step 5) for the implementation process. CONCLUSION: Age-friendly EDs are essential for person-centered emergency care, enhancing safety and quality of care for older adults. This study will provide insights into adaptable, evidence-informed implementation strategies that support behavioral change among emergency clinicians to increase patient reach and sustainability of age-friendly interventions for complex ED settings.

Tags: emergency department, frailty, geriatric emergency medicine, implementation science, older adults.

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Wojtovicova, T., Aujesky, D., Schefold, J. C., Daskalakis, M., Furrer, H., Novak, U., Pabst, T., et al. “Hemophagocytic Syndromes In Adults: Real-World Data On Mortality From A Tertiary Reference Center”. Acta Haematologica: 1-13. doi:10.1159/000549812.

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Abstract: – Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening condition characterized by excessive immune activation, cytokine storm, and aberrant macrophage function. Although HLH is well studied in children, data on adult HLH remain limited. Our primary goal was to examine in-hospital mortality and its associated risk factors in patients with HLH in a tertiary center. Methods: This retrospective study at University Hospital Bern queried the hospital database using the i2b2 system to analyze adult HLH patients, assessing clinical, laboratory data, treatments, and outcomes according to the HLH-2004 criteria and Saint-Antoine score. Results: From 845, 846 patients seen in the hospital between 2014 and 2021, a cohort of 54 adult HLH patients was identified. The overall mortality rate was 40.7%. In univariate analysis, we found that deceased patients with HLH were significantly older than surviving patients (median age of 69.6 [range 22–83] vs. 52.5 [24–79] years old [p = 0.002]). Patients with HLH were significantly more likely to have cardiopulmonary and neurological complications, higher alkaline phosphatase levels, lower platelet counts, need platelet transfusions, and lower response rate to the HLH therapy. In multivariate analysis, age (HR 0.94; 95% CI 0.89–0.99; p = 0.024), cardiopulmonary (HR 7.045; 95% CI 1.28–38.66, p = 0.025), neurologic complications (HR 5.55; 95% CI 1.01–30.51; p = 0.04), and the requirement of platelet transfusions (HR 6.22; 95% CI 1.16–33.20; p = 0.032) were all independently associated with in-hospital mortality. Conclusions: This study identifies risk factors whose early presence can be used to stratify management strategies and improve prognosis in patients with HLH. © 2025 S. Karger AG, Basel

Tags: Adults, Hemophagocytic lymphohistiocytosis, Hemophagocytic syndrome, St. Antoine score.

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Hêche, Félicien, Schiller, Philipp, Barakat, Oussama, Desmettre, Thibaut, and Robert-Nicoud, Stephan. “An Analytical Study Of External Factors Influencing Emergency Occurrences In Healthcare”. Healthcare Analytics 8. doi:10.1016/j.health.2025.100426.

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Abstract: This study investigates the impact of 19 external factors, related to weather, road traffic conditions, air quality, and time, on the hourly occurrence of emergencies. The analysis relies on six years of dispatch records (2015–2021) from the Centre Hospitalier Universitaire Vaudois (CHUV), which oversees 18 ambulance stations across the French-speaking region of Switzerland. First, classical statistical methods, including Chi-squared test, Student's t-test, and information value, are employed to identify dependencies between the occurrence of emergencies and the considered parameters. Additionally, SHapley Additive exPlanations (SHAP) values and permutation importance are computed using eXtreme Gradient Boosting (XGBoost) and Multilayer Perceptron (MLP) models. Training and hyperparameter optimization were performed on data from 2015–2020, while the 2021 data were held out for evaluation and for computing model interpretation metrics. Results indicate that temporal features – particularly the hour of the day – are the dominant drivers of emergency occurrences, whereas other external factors contribute minimally once temporal effects are accounted for. Subsequently, performance comparisons with a simplified model that considers only the hour of the day suggest that more complex machine learning approaches offer limited added value in this context. Operationally, this result supports the use of simple time-dependent demand curves for EMS planning. Such models can effectively guide staffing schedules and relocations without the overhead of integrating external data or maintaining complex pipelines. By highlighting the limited utility of external predictors, this study provides practical guidance for EMS organizations seeking efficient, data-driven resource allocation methods. © 2025 Elsevier B.V., All rights reserved.

Tags: air quality, analytical research, Article, chi square test, controlled study, correlation analysis, Data-driven insights, emergency, emergency health service, Emergency healthcare, extreme gradient boosting, Factor assessment, Healthcare analysis, human, humidity, machine learning, multilayer perceptron, nitrogen dioxide, particulate matter 10, Predictive modeling, Quantitative analysis, Shapley additive explanation, Student t test, sunlight, Switzerland, temperature, thunderstorm, time, traffic, weather, wind speed.

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Jakob, P., Heinz, P., Gong, Y., Chen, M., Binder, R. K., Held, U., Taramasso, M., et al. “Left Atrial Appendage Occlusion Using The Amplatzer Amulet Device In High-Risk Patients With Atrial Fibrillation Undergoing Transcatheter Aortic Valve Intervention: A Randomized Pilot Study” 9, no. 12: 100735. doi:10.1016/j.shj.2025.100735.

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Abstract: BACKGROUND: Patients with severe aortic stenosis and atrial fibrillation (AF) undergoing transcatheter aortic valve intervention (TAVI) are at increased risk of bleeding and cerebrovascular events. This investigator-initiated, randomized, multicenter, open-label pilot study assessed left atrial appendage occlusion (LAAO) in patients with AF undergoing TAVI. METHODS: Patients were randomly assigned to LAAO (TAVI + LAAO) or standard medical therapy (SMT) (TAVI + SMT). The primary endpoint was a composite of cerebrovascular events, peripheral embolism, life-threatening/disabling/major bleeding, or cardiovascular mortality at 1 year. A sensitivity analysis was performed in the per-protocol population. RESULTS: Eighty-one patients (Society of Thoracic Surgeons score: 9.0% +/- 5.4%) were enrolled. The primary endpoint occurred in 13 patients (33%) in the TAVI + LAAO group and in 15 patients (37%) in the TAVI + SMT group (adjusted odds ratio [OR], 0.87; 95% CI: 0.32-2.29, p = 0.77). Bleeding rates were comparable between TAVI + LAAO (13%) and TAVI + SMT (17%), with absent nonprocedural bleeding in the TAVI + LAAO group and 5 gastrointestinal bleedings in TAVI + SMT, and cerebrovascular events did not significantly differ between groups (10% in TAVI + LAAO vs. 2.4% in TAVI + SMT). In the per-protocol analysis, occurrence of the primary endpoint was comparable between groups (adjusted OR, 0.55; 95% CI: 0.18-1.56, p = 0.27) with cerebrovascular events in 5.6% and 2.4%, and bleeding events in 8.3% and 17% for TAVI + LAAO and TAVI + SMT, respectively. CONCLUSIONS: This pilot study suggests that among high-risk patients with AF undergoing TAVI, a strategy of a combined procedure with LAAO and early cessation of oral anticoagulation overall showed similar rates of the primary end point as compared to a single TAVI procedure (NCT03088098).

Tags: Abiomed, Alnylam, Amicus Therapeutics, Amgen, AstraZeneca, Bayer, B.Braun,, Abiomed, Edwards Lifesciences, EnCarda Inc, Medtronic, Novartis, Sinomed with, and Boston Scientific. M. Taramasso received consultancy fees from Abbott,, and consultancy fees to the institution from Biotronik, Boston Scientific,, and received grants to the, Antithrombotic therapy, Aortic valve stenosis, Atrial fibrillation, Bioanalytica, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers, consulting and speaker fees from Boston Scientific, Abbott Vascular, Abiomed, and, educational grants to the institution from Abbott, Amgen, AstraZeneca, Boehringer, Edwards Lifesciences, Abbott, Medtronic, Biosensors, and Highlife. F. Paneni, Edwards Lifesciences, Boston Scientific, and Abbott, Edwards Lifesciences, Fumedica, GE Healthcare, Guerbet, IACULIS, Inari Medical,, Foundation and research or travel grants to the institution without personal, Foundation, the Mach-Gaensslen Foundation, and the Monsol Foundation. Research,, from Biotronik, Boston Scientific, Edwards Lifesciences, and ATSens, Haager is a proctor for Abbott. M.A. Kasel is a consultant and proctor for, has outside this work received research and, has received, Ingelheim, Daichi Sankyo, Ely Lilly, Novartis, Novo Nordisk, Roche Diagnostics,, institution from Edwards Lifesciences and Boston Scientific. S. Windecker reports, is also member of the, Iten-Kohaut Foundation, Boston Scientific, and Edwards Lifesciences, Janssen AI, Johnson & Johnson, Medalliance, Medtronic, MSD Merck Sharp & Dohme,, Left atrial appendage occlusion, Lifesciences and Boston Scientific and consultancy fees from Jenscare Scientific., Lifesciences. The other authors had no conflicts to declare., Luscher does no longer accept any honoraria from industry but has received, MedAlliance. F. Nietlispach received consultancy fees from Abbott and Edwards, Medtronic, Edwards Lifesciences, Boston Scientific, Shenqi Medical, CoreQuest,, member of the steering/executive group of trials funded by Abbott, Amgen,, Neovii Pharmaceutica, Neutromedics AG, Novartis, Novo Nordisk, OM Pharma,, of H.H. Sheikh Khalifa bin Hamad Al-Thani to the University of Zurich,, OneCrea Medical, Cardiovalve, CoreMedic, PiCardia, HiD Imaging, and Simulands. T., Optimapharm, Orchestra BioMed, Pfizer, Philips AG, Sanofi-Aventis, Servier,, payments to the institution but no personal payments, Pilgrim reports research grants from the Swiss National Science Foundation, the, R.K. Binder received speaker fees and grants from Pfizer, Daiichi Sankyo, Abbott,, receive funding by industry without impact on his personal remuneration. T.F., remuneration from Bayer and Sanofi-Aventis. M. Chen received grants from Edwards, reports receiving fees for serving on advisory boards from Novo Nordisk. P.K., research and educational grants, research, travel, and/or educational grants to the institution from Abbott,, Sanofi, and Vifor. B.E. Stahli and her research has been supported by a donation, serves as advisory board member and/or, Shockwave Medical, Siemens Healthcare, Sinomed, SMT Sahajanand Medical, speaker fees, Squibb, Cordis Medical, CorFlow Therapeutics, CSL Behring, Daiichi Sankyo,, steering/executive committee group of several investigator-initiated trials that, Swiss Heart Foundation, the Swiss Polar Institute, the Bangerter-Rhyner, Switzerland, and research grants to the institution from the OPO Foundation, the, Technologies, Vascular Medical, V-Wave, Transcatheter aortic valve intervention, travel, or educational grants to the institution without personal remuneration.

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Hêche, Félicien, Schiller, Philipp, Barakat, Oussama, Desmettre, Thibaut, and Robert-Nicoud, Stephan. “An Analytical Study Of External Factors Influencing Emergency Occurrences In Healthcare”. Healthcare Analytics 8. doi:10.1016/j.health.2025.100426.

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Abstract: This study investigates the impact of 19 external factors, related to weather, road traffic conditions, air quality, and time, on the hourly occurrence of emergencies. The analysis relies on six years of dispatch records (2015–2021) from the Centre Hospitalier Universitaire Vaudois (CHUV), which oversees 18 ambulance stations across the French-speaking region of Switzerland. First, classical statistical methods, including Chi-squared test, Student's t-test, and information value, are employed to identify dependencies between the occurrence of emergencies and the considered parameters. Additionally, SHapley Additive exPlanations (SHAP) values and permutation importance are computed using eXtreme Gradient Boosting (XGBoost) and Multilayer Perceptron (MLP) models. Training and hyperparameter optimization were performed on data from 2015–2020, while the 2021 data were held out for evaluation and for computing model interpretation metrics. Results indicate that temporal features – particularly the hour of the day – are the dominant drivers of emergency occurrences, whereas other external factors contribute minimally once temporal effects are accounted for. Subsequently, performance comparisons with a simplified model that considers only the hour of the day suggest that more complex machine learning approaches offer limited added value in this context. Operationally, this result supports the use of simple time-dependent demand curves for EMS planning. Such models can effectively guide staffing schedules and relocations without the overhead of integrating external data or maintaining complex pipelines. By highlighting the limited utility of external predictors, this study provides practical guidance for EMS organizations seeking efficient, data-driven resource allocation methods. © 2025 Elsevier B.V., All rights reserved.

Tags: air quality, analytical research, Article, chi square test, controlled study, correlation analysis, Data-driven insights, emergency, emergency health service, Emergency healthcare, extreme gradient boosting, Factor assessment, Healthcare analysis, human, humidity, machine learning, multilayer perceptron, nitrogen dioxide, particulate matter 10, Predictive modeling, Quantitative analysis, Shapley additive explanation, Student t test, sunlight, Switzerland, temperature, thunderstorm, time, traffic, weather, wind speed.

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Bianchi, C., Maudet, L., Schneider, A., Garcia, E., and Pasquier, M. “Focus On Lazarus: Autoresuscitation Confirmed By Focused Cardiac Ultrasound”. Resusc Plus 26: 101151. doi:10.1016/j.resplu.2025.101151.

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Darie, A. M., Grizé, L., Jahn, K., Salina, A., Röcken, J., Herrmann, M. J., Pascarella, M., et al. “High-Flow Oxygen Does Not Improve Oxygenation During Rigid Medical Thoracoscopy”. Respiration: 1-5. doi:10.1159/000549341.

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Abstract: Introduction: The sedation required for rigid medical thoracoscopy may be associated with hypoventilation and intermittent hypoxaemia. High-flow oxygen administration has been shown to decrease hypoxaemia during sedation for flexible bronchoscopy, a procedure using similar sedation protocols to medical thoracoscopy. Methods: An investigator-initiated randomised controlled trial to compare conventional oxygen (starting at 4 L/min) to high-flow nasal oxygen (starting rate 60 L/min and fraction of oxygen 0.6) during sedation for medical thoracoscopy. The mean nadir oxygen saturation (SpO<inf>2</inf>) during the procedure was the primary endpoint. Results: Between February 2022 and June 2023, 36 patients were randomised to either conventional oxygen (n = 20) or high-flow oxygen (n = 16). The majority of participants (20/36, 55.6%) were male, and the mean age was 75.4 ± 10.4 years. The nadir SpO<inf>2</inf> was 88.3% using high flow as compared to 85.0% for conventional oxygen (p = 0.20). The average SpO<inf>2</inf> (96.3% vs. 96.2%, p = 0.81) was similar between groups. There was a tendency towards a higher peak P<inf>tcCO2</inf> in the conventional oxygen group (49.6 mm Hg vs. 55.5 mm Hg, p = 0.13). Conclusion: Oxygen supplementation using nasal high flow provides similar SpO<inf>2</inf> to conventional nasal oxygen during sedation for rigid medical thoracoscopy. © 2025 S. Karger AG, Basel

Tags: High flow, Interventional pneumology, Thoracoscopy.

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von Allmen, M., Ben Saad, O. A., Schwab, J. M., Gobet, F., Grandjean, C., Marti, D., Tavares Alves, E., Schmutz, T., Ribordy, V., and Guéchi, Y. “Orthogeriatric Multidisciplinary Care For Hip Fractures In Emergency Department Reduces Length Of Stay: A Retrospective Cohort Study”. Bmc Emergency Medicine 25, no. 1: 265. doi:10.1186/s12873-025-01424-4.

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Abstract: Background: Hip fractures represent a frequent reason for emergency department (ED) attendance among older adults and are associated with substantial morbidity and mortality. Orthogeriatric multidisciplinary care models, by allowing for early clinical assessment, rapid diagnostics and tailored analgesia by regional anaesthesia (RA) optimize perioperative management and improve care for these vulnerable patients. The specific impact of such models on ED length of stay (LOS) remains insufficiently studied. This study assessed the effect on ED LOS of implementing an orthogeriatric fast-track based on a multidisciplinary care model. Secondary objectives were to evaluate the impact of this implementation on analgesia efficiency in ED, complications rate and early mortality. Method: This monocentric observational retrospective cohort took place in a Swiss ED and included patients aged ≥ 65 years with hip fractures, before and after fast-track implementation. Exclusion criteria were contraindication to or patient refusal of RA, inability to consent and polytrauma. The primary outcome was ED LOS. Secondary outcomes were analgesia efficiency in the ED (i.e., NRS reduction, cumulative opioid consumption), 72-hours complications rate and 30-day mortality. Wilcoxon rank sum test was used for quantitative variables and Fisher’s test for qualitative variables. Results: A total of 152 patients were included, with 87 in the pre-implementation group and 65 in the post-implementation group. The post-intervention group had significantly shorter ED LOS (180 ± 88 min vs. 327 ± 122 min, p < 0.001) and experiences greater NRS reduction (1.6 +/- 4.1 vs. 0.1 +/- 3.8, p = 0.043), while opioid consumption did not differ between groups (p = 0.46). Rate of fatal complications (0% vs. 6.9%, p = 0.039) and mortality (0% vs. 8%, p = 0.02) were lower in the intervention group. Conclusion: An orthogeriatric fast-track pathway significantly reduces ED LOS and is associated with lower early mortality. Analgesia efficiency is positively impacted; however no opioid sparing effect was observed. © The Author(s) 2025.

Tags: aged, analgesia, analgesic activity, Article, clinical evaluation, cohort analysis, controlled study, demographics, drug use, Emergency department, emergency ward, Fast-track pathway, female, Geriatric analgesia, groups by age, health care planning, Hip fracture, human, Length of stay, major clinical study, male, mortality rate, multidisciplinary care, numeric rating scale, observational study, opiate, Orthogeriatric care, outcome assessment, patient participation, qualitative analysis, quantitative analysis, Regional anaesthesia, regional anesthesia, retrospective study, sample size, Swiss, treatment outcome, very elderly.

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Scholl, E., Gerbershagen, M. U., Vach, W., Rosli, M., and Litz, R. J. “Ultrasound-Guided Supraclavicular Nerves Block For Acute Pain Management In Clavicular Fractures-A Pragmatic Randomized Trial”. J Clin Med 14, no. 22. doi:10.3390/jcm14228249.

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Abstract: Background/Objectives: This pragmatic randomized controlled trial evaluated the efficacy of ultrasound-guided supraclavicular nerve (SCLN) block compared to standard pain management in patients with acute displaced clavicle fractures (CFs) in an emergency department (ED) setting. Secondary outcomes included time to first request for analgesics, opioid consumption, and patient satisfaction. Methods: Forty-one patients with acute displaced CFs were randomized to receive either an SCLN block (n = 19) or routine pain management (n = 22). Pain intensity was recorded at admission and at 1, 2, 4, 6, 12, and 24 h. Patient satisfaction was assessed after 24 h. Analgesic use, adverse reactions, and adverse events were documented for 24 h. Results: Pain intensity, measured by the numeric rating scale (NRS), was significantly lower in the SCLN group at all time points within the first 12 h (p < 0.001). After one hour, 68% of patients in the SCLN group reported an NRS of 0-2, compared to 19% in the control group. The time to first request for analgesics was markedly longer in the SCLN group (9.1 h vs. 0.7 h). In two patients, SCLN visualization was insufficient, and a cervical plexus block was performed instead. Four patients in the SCLN block group reported adverse reactions. Patient satisfaction after 24 h was significantly higher in the SCLN group (p < 0.001), with 85% indicating they would choose the block again. Conclusions: Ultrasound-guided selective SCLN block appears to be an effective and well-tolerated method for acute analgesia in patients with displaced CFs, with the most pronounced benefit observed during the first 12 h. Patient acceptance of the procedure was high.

Tags: clavicle fracture, regional anesthesia, supraclavicular nerve, ultrasound-guided block.

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Scholl, E., Gerbershagen, M. U., Muller, A. M., and Litz, R. J. “Ultrasound-Guided Regional Anesthesia As Primary Analgesic Management In The Orthopedic-Surgical Emergency Department Of An Affiliated Hospital: A Retrospective Analysis Over A 6-Year Period”. Medicina (Kaunas) 61, no. 11. doi:10.3390/medicina61112006.

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Abstract: Background and Objectives: Ultrasound (US)-guided peripheral regional anesthesia (pRA) is gaining increasing importance in emergency medicine as an effective, low-ridsk alternative to general anesthesia (GA), procedural sedation (PS), or opioid therapy. By enabling rapid, direct pain management in the emergency department (ED), pRA can help preserve scarce surgical and anesthetic resources and, in some cases, avoid inpatient admissions. The aim of this study was to analyze the indications, techniques, and clinical impact of pRA in the orthopedic-focused ED of an affiliated hospital. Materials and Methods: All pRA and PS procedures performed over a six-year period were retrospectively reviewed among 35,443 orthopedic-trauma emergency patients. pRA was carried out under US guidance with standardized monitoring. Diagnoses, block techniques, effectiveness, and complications were analyzed descriptively. Results: A total of 1292 patients (3.7%) underwent either pRA (n = 1117; 3.2%) or PS (n = 175; 0.5%). pRA was performed in 22% of cases for interventions such as reductions or extensive wound management. In 78%, pRA was applied for analgesia, for example, in the diagnostic work-up and treatment of non-immediately operable fractures, lumbago, or arthralgia. The most common pRA techniques were brachial plexus blocks (54%) and femoral nerve blocks (25%). Fascial plane blocks (6.1%) and paravertebral blocks (1.5%) were rarely used. PS was performed in 175 of 1292 patients (13%), although pRA would have been feasible in 159 of these cases. No complications of pRA were observed, and GA could routinely be avoided. Conclusions: US-guided pRA proved to be an effective and safe alternative to PS, GA, or systemic analgesia for selected indications, allowing immediate treatment without the need for operative capacities. To ensure safe application, these techniques should be an integral part of the training curriculum for ED personnel.

Tags: *Analgesia/methods, *Anesthesia, Conduction/methods/statistics & numerical data, *Pain Management/methods, *Ultrasonography, Interventional/methods, Adolescent, Adult, Aged, Aged, 80 and over, data, emergency medicine, Emergency Service, Hospital/organization & administration/statistics & numerical, Female, Humans, Male, Middle Aged, Nerve Block/methods, Orthopedic Procedures/methods, orthopedic-trauma emergencies, Orthopedics/methods, pain management, peripheral nerve blocks, Retrospective Studies, ultrasound-guided regional anesthesia.

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Mohajer-Bastami, A., Moin, S., Ahmad, S., Ahmed, A. R., Pouwels, S., Hajibandeh, S., Yang, W., et al. “Artificial Intelligence In Healthcare: Applications, Challenges, And Future Directions. A Narrative Review Informed By International, Multidisciplinary Expertise” 7: 1644041. doi:10.3389/fdgth.2025.1644041.

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Abstract: OBJECTIVES: This narrative review evaluates the role of artificial intelligence (AI) in healthcare, summarizing its historical evolution, current applications across medical and surgical specialties, and implications for allied health professions and biomedical research. METHODS: We conducted a structured literature search in Ovid MEDLINE (2018-2025) using terms related to AI, machine learning, deep learning, large language models, generative AI, and healthcare applications. Priority was given to peer-reviewed articles providing novel insights, multidisciplinary perspectives, and coverage of underrepresented domains. KEY FINDINGS: AI is increasingly applied to diagnostics, surgical navigation, risk prediction, and personalized medicine. It also holds promise in allied health, drug discovery, genomics, and clinical trial optimization. However, adoption remains limited by challenges including bias, interpretability, legal frameworks, and uneven global access. CONTRIBUTIONS: This review highlights underexplored areas such as generative AI and allied health professions, providing an integrated multidisciplinary perspective. CONCLUSIONS: With careful regulation, clinician-led design, and global equity considerations, AI can augment healthcare delivery and research. Future work must focus on robust validation, responsible implementation, and expanding education in digital medicine.

Tags: artificial intelligence, commercial or financial relationships that could be construed as a potential, conflict of interest., deep learning, digital health, generative AI, healthcare, large language models, machine learning, surgery.

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Herzog, A., Luster, M., Keller Lang, D. I., and Slankamenac, K. “Emergency Department Overcrowding: First Swiss Application Of The Emergency Department Work Index And Risk Factors For Overcrowding”. Front Public Health 13: 1691633. doi:10.3389/fpubh.2025.1691633.

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Abstract: INTRODUCTION: Emergency department (ED) overcrowding is associated with increased waiting time, reduced patient satisfaction, and decreased quality of care. Numerous validated scores are available for assessing ED overcrowding. The Emergency Department Work Index (EDWIN) is the most established score for quantifying ED overcrowding. We assessed the applicability of the EDWIN in a Swiss ED and investigated further predictors of ED overcrowding. METHODS: In this retrospective analysis, we included consecutive ED visits at a tertiary care hospital between 1st December and 31st December 2016. The median EDWIN per hour was defined as the first endpoint. To investigate predictors of overcrowding, we grouped ED visits with an EDWIN </=2 as not overcrowded and those with an EDWIN >2 as overcrowded and performed multivariable regression analysis. RESULTS: The median EDWIN score per hour was 1.4 (IQR 1.0-1.9). In 394 calculations (53%), the ED was active; 189 calculations (25.4%) showed a very busy ED; and in 161 observations (21.6%), the ED was severely overcrowded. On average, the ED was severely overcrowded six times per day. The highest EDWIN score was reported on Saturdays [mean 2.1 (SD 1.2)] and Sundays [mean 1.7 (SD 1.0)]. During weekends, overcrowding occurred from 8 p.m. to 05 a.m., and the EDWIN score ranged from 2.2 to 3.1. During the week, the mean EDWIN score ranged from 1.3 to 1.6. A reduced number of emergency physicians during night shifts (p < 0.001), an increased number of patients in the ED treatment area (p < 0.001), patients waiting for admission to the ward (p < 0.001), weekend periods (p = 0.001), and a higher number of isolated ED patients due to infections (p < 0.001) showed a highly significant association with overcrowding. In the case of overcrowding, the waiting time was prolonged (p = 0.034). CONCLUSION: The EDWIN score was easily applicable in a tertiary care Swiss ED, objectively displayed severe overcrowding during weekend nights, and was strongly associated with the number of available attending emergency physicians, the number of patients in the ED treatment area, patients waiting for admission to the ward, weekend periods, and the number of patient isolations.

Tags: *Crowding, *Emergency Service, Hospital/statistics & numerical data/organization &, administration, Adult, Aged, commercial or financial relationships that could be construed as a potential, conflict of interest. The author(s) declared that they were an editorial board, ED staffing, emergency department, Emergency Department Work Index, Female, Humans, Male, member of Frontiers, at the time of submission. This had no impact on the peer, Middle Aged, overcrowding, predictors for ED overcrowding, Retrospective Studies, review process and the final decision., Risk Factors, Switzerland, Tertiary Care Centers.

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Hosszu-Fellous, K., Poncet, A., Cabecinhas, A. R. G., Schibler, M., Meyer, B., Prendki, V., Huttner, A., et al. “Antiviral Treatment In Adult Patients Hospitalized For Influenza: Study Protocol For A Multi-Center, Randomized, Placebo-Controlled Trial On The Efficacy Of Baloxavir Marboxil To Reduce Time To Clinical Improvement And The Risk For Severe Complications (The Influent Trial)”. Trials 26, no. 1: 538. doi:10.1186/s13063-025-09248-0.

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Abstract: BACKGROUND: Seasonal influenza virus leads to more than half a million deaths each year worldwide. Due to its capacity to evolve, it is considered the most likely pathogen to cause a future pandemic. Antiviral treatment options are currently limited, with the most widely used drugs being neuraminidase inhibitors and the cap-dependent endonuclease inhibitor baloxavir marboxil. In adult hospitalized patients, due to the lack of placebo-controlled trials, current available evidence on antiviral treatment benefits is essentially based on observational studies. A placebo-controlled clinical trial is needed to fill this knowledge gap. METHODS: This is an investigator-initiated, randomized, triple-blind, placebo-controlled, superiority, multi-center trial to assess the clinical efficacy of single-dose baloxavir in decreasing time to clinical improvement in adult immunocompetent patients hospitalized with influenza. Patients (n = 484) with confirmed, severe infection (NEWS2 score >/= 4) will be recruited over three influenza seasons in four large Swiss hospitals. PRIMARY OUTCOME: time to clinical improvement (in hours), calculated from treatment administration until NEWS2 score </= 2 maintained for 24 h or until hospital discharge, whichever comes first. The primary outcome is calculated in all patients independently of the duration of symptoms at treatment administration, as well as in participants treated early (<72 h) post onset of symptoms. The main secondary outcomes are the risk of serious influenza complications, length of hospitalization, and difference in viral load at D3 post-treatment administration. DISCUSSION: This trial's results, whether positive or negative, will impact clinical guidance. If baloxavir's clinical benefit is demonstrated, a single-dose pill would be the easiest implementable treatment option in case of large seasonal outbreaks or a new influenza pandemic. If a clear treatment benefit is not shown, antiviral treatment administration in the hospitalized patient population could be reconsidered to prevent unnecessary medication, lower the risk of resistance development linked to treatment overuse, and ultimately save unnecessary treatment-related expenses. TRIAL REGISTRATION: ClinicalTrials.gov NCT06653569. Registered on October 22, 2024, https://clinicaltrials.gov/study/NCT06653569?term=NCT06653569&rank=1 .

Tags: *Antiviral Agents/adverse effects/therapeutic use/administration & dosage, *Dibenzothiepins/adverse effects/therapeutic use/administration & dosage, *Influenza, Human/drug therapy/virology/diagnosis/complications, *Morpholines/therapeutic use/adverse effects, *Pyridones/adverse effects/therapeutic use/administration & dosage, *Triazines/therapeutic use/adverse effects/administration & dosage, Adult, Antiviral, applicable. Competing interests 28: BM received research funds from Moderna, been reviewed and approved by the competent ethics committee (Commission, Clinical trial, consent to participate is obtained from all participants or their close family, d'ethique et de la recherche CCER de Geneve), CCER 2024-01535. Written informed, Equivalence Trials as Topic, Female, Flu, have no competing interests (Laurent Kaiser, Antoine Poncet, Virginie Prendki,, Hospitalization, Humans, Huttner, Enos Bernasconi, Mathias Pouillon, Pierre-Alexandre Bart, Ksenija, Inc. and is a consultant for Rocketvax AG. The other authors declare that they, Influenza, Male, Manuel Oriol, Matteo Mombelli, Manuel Schibler, Ana Rita Goncalves, Angela, member in case of incapacity to consent. Consent for publication 32: Not, Muller Nicolas, Pauline Vetter, Krisztina Hosszu-Fellous, Sebastian Carballo,, Multicenter Studies as Topic, Oxazines/adverse effects/therapeutic use/administration & dosage, Pyridines/adverse effects/therapeutic use/administration & dosage, Randomized, Randomized Controlled Trials as Topic, Slankamenac)., Thiepins/therapeutic use/adverse effects/administration & dosage, Time Factors, Treatment, Treatment Outcome.

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Picart, J., Lienert, J., Metrailler, P., and Moser, A. “Ice Cave Rescue-A Hybrid Approach Between Mountain And Cave Rescue: A Case Report”. Wilderness Environ Med: 10806032251391774. doi:10.1177/10806032251391774.

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Abstract: Ice caving accidents are rare, but when they occur, they represent unique logistical and medical challenges for both explorers and rescuers. Factors such as the dynamic nature of the environment, exposure to cold temperatures, and complex extrication logistics should be taken into account. A hybrid approach between mountain and cave rescue techniques may be necessary. In this article we describe in detail a case of a rescue operation following a 15-m fall into a moulin on a glacier in Switzerland. We discuss the combined use of mountain and cave rescue techniques, adapting to the unique structure of the moulin. Our case demonstrated that even though such incidents are extremely rare, the complexity of this type of rescue can be anticipated and can benefit from optimized rescue strategies based on accumulated experience in both mountain and cave rescue operations.

Tags: accidental hypothermia, cave rescue, crevasse accident, prehospital trauma care.

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Griese, J. A., Unlu, L., van Oppen, J., Buhler, N., Henz, N. M., Dreher-Hummel, T., Grossmann, F., Virant, G., Bingisser, R., and Nickel, C. H. “Assessing What Matters Most In Older Emergency Department Patients”. Age Ageing 54, no. 11. doi:10.1093/ageing/afaf334.

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Abstract: BACKGROUND: Older emergency patients have complex health needs and diverse personal priorities not captured by traditional single-disease approaches. Asking 'what matters most' may facilitate a more patient-centred approach. However, conceptual frameworks to document patient values have neither been implemented nor operationalised for use in the emergency department (ED). OBJECTIVE: To investigate the feasibility of asking 'what matters most' in the ED, assess patient priorities and determine the utility of a conceptual framework for documenting these. METHODS: Prospective, observational study in a Swiss ED with consecutive patients aged >/=65 years. Feasibility was determined as proportion of included patients to eligible patients. Patient responses were categorised using a conceptual framework consisting of 8 domains: principles, relationships, emotions, activities, abilities, possessions, medical and others. Framework evaluation included interrater reliability (IRR), time-to-abstraction rate and a questionnaire assessing utility of the framework. RESULTS: Asking what 'matters most' was feasible, including 1349 of 1625 patients (83.0%). Regarding categories of the conceptual framework, 504 patients (37.4%) reported medical issues, 297 (22.0%) relationships, 268 (19.9%) abilities and 154 (11.4%) emotions as their priority. Patients aged >/=85 years or having frailty more frequently prioritised abilities and emotions, whereas patients 65-84 years or without frailty prioritised medical issues. The framework showed substantial IRR (kappa = 0.668), good time-to-abstraction rates and high ratings in the utility questionnaire. CONCLUSIONS: Asking older people 'what matters most' is feasible and potentially useful in the ED setting. Applying a conceptual framework enables systematic documentation and may support patient-centred and holistic emergency care.

Tags: *Aging/psychology, *Emergency Service, Hospital, *Geriatric Assessment/methods, *Needs Assessment, Age Factors, Aged, Aged, 80 and over, emergency department, Feasibility Studies, Female, frailty, Humans, Male, older adults, Patient-Centered Care, patient-centred care, Prospective Studies, Reproducibility of Results, Surveys and Questionnaires, Switzerland, what matters most.

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Altmann-Schneider, I., Geiger, L. S., Kellenberger, C. J., Callaghan, F., and Seiler, M. “Multivendor Comparison Study Of Artificial Intelligence Software For Automated Fracture Detection In Paediatric Patients”. Pediatr Radiol. doi:10.1007/s00247-025-06461-6.

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Abstract: BACKGROUND: Evidence for artificial intelligence (AI)-assisted paediatric fracture detection is limited. External validation and comparison of AI software are required before reliable use in clinical practice. OBJECTIVE: To evaluate and compare the performance of three commercially available AI software for detecting posttraumatic findings in paediatric patients. MATERIALS AND METHODS: This retrospective study assessed three AI software using radiographs of children aged 2-17 years who presented to the emergency department after trauma. Radiographs of the lower leg, forearm, and elbow were included between January 2014 and January 2024 (lower leg), March 2022 and January 2024 (forearm), and July 2019 and January 2024 (elbow). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for fractures, effusions, and dislocations. RESULTS: A total of 3,013 patients with 3,414 radiographs were included: 1,074 lower leg (mean age 6.6 years), 1,142 forearm (7.4 years), and 1,198 elbow (7.5 years). All AI tools demonstrated high performance for lower leg and forearm radiographs, with sensitivity of 88.4-94.7%, specificity 93.6-99.2%, PPV 94.5-99.2%, and NPV 91.6-95.6%. In contrast, performance for elbow radiographs was reduced (sensitivity 72.8-91.6%, specificity 80.3-98.7%), with the lowest PPV of 86.1% and NPV of 79.5%. Sensitivity was notably reduced for specific paediatric fracture types, elbow effusions (posterior fat pad sign 40.6-82.3%), and dislocations (54.2-93.8%), with significant differences between AI software. CONCLUSIONS: AI tools show promise for paediatric fracture detection, particularly in lower leg and forearm radiographs. Awareness of their limitations is essential for safe clinical use.

Tags: Artificial intelligence, Emergency service, Fractures, Joint dislocations, Software.

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Husoy, A. K., Xu, Y. Y., Steinmetz, J. D., Aalipour, M. A., Aalruz, H., Abdulah, D. M., Aboagye, R. G., et al. “Global, Regional, And National Burden Of Headache Disorders, 1990–2023: A Systematic Analysis For The Global Burden Of Disease Study 2023”. The Lancet Neurology 24, no. 12: 1005-1015. doi:10.1016/S1474-4422(25)00402-8.

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Abstract: Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 estimates health loss from migraine, tension-type headache, and medication-overuse headache. This study presents updated results on headache-attributed burden from 1990 to 2023, along with clinical and public health implications. Methods: Data on the prevalence, incidence, or remission of migraine, tension-type headache, and medication-overuse headache were extracted from published population-based studies. We used hierarchical Bayesian meta-regression modelling to estimate global, regional, and country-level prevalence of headache disorders. For the first time in GBD 2023, age-specific and sex-specific estimates of time in symptomatic state were applied by meta-analysing individual participant data from 41 653 individuals from the general populations of 18 countries from all parts of the world. Disability weights were applied to calculate years lived with disability (YLDs). Since medication-overuse headache is a sequela of a mistreated primary headache (due to medication overuse), its burden was reattributed to migraine or tension-type headache, informed by a meta-analysis of three longitudinal studies. Findings: In 2023, 2·9 billion individuals (95% uncertainty interval 2·6–3·1) were affected by headache disorders, with a global age-standardised prevalence of 34·6% (31·6–37·5) and a YLD rate of 541·9 (373·4–739·9) per 100 000 population, with 487·5 (323·0–678·8) per 100 000 population attributed to migraine. The prevalence rates of these headache disorders have remained stable over the past three decades. YLD rates due to headache disorders were more than twice as high in females (739·9 [511·2–1011·5] per 100 000) as in males (346·1 [240·4–481·8] per 100 000). Medication-overuse headache contributed 58·9% of the YLD estimates for tension-type headache in males and 56·1% in females, as well as 22·6% of the YLD estimates for migraines in males and 14·1% in females. Interpretation: Headache disorders, in particular migraine, continue to be a major global health challenge, emphasising the need for effective management and prevention strategies. Much headache-attributed burden could be averted or eliminated by avoiding overuse of medication (including over-the-counter medication), underscoring the importance of public education. Funding: Gates Foundation. © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license

Tags: adult, Africa south of the Sahara, Article, controlled study, cost of illness, disability-adjusted life year, drug induced headache, epidemiology, female, Global Burden of Disease, global disease burden, global health, headache and facial pain, Headache Disorders, human, Humans, incidence, longitudinal study, male, meta analysis, middle aged, migraine, Migraine Disorders, non communicable disease, prevalence, systematic review, tension headache, Tension-Type Headache, uncertainty.

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Bresgen, T. U., Salinaro, F., Barcella, B., Perlini, S., Mascherona, I., and Di Pietro, S. “Acute Pain Management Of Rib Fractures: A Narrative Review”. Injury 56, no. 12: 112857. doi:10.1016/j.injury.2025.112857.

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Abstract: BACKGROUND: Rib fractures are common conditions often associated with significant complications, including respiratory failure, pneumonia, prolonged hospitalisation, and chronic pain. Adequate pain management is crucial to improve outcomes and reduce morbidity in these patients. Despite the wide adoption of multimodal analgesia, the optimal combination of analgesic strategies remains uncertain. OBJECTIVE: To review and synthesize current evidence on analgesic strategies for acute pain management in patients with rib fractures. METHODS: We conducted a narrative review by searching scientific literature on PubMed and Scopus to identify randomised controlled trials (RCTs) on analgesia for rib fractures from blunt trauma. Included studies assessed pharmacologic, non-pharmacologic and regional anaesthesia interventions. Studies describing surgical treatment of multiple rib fractures or addressing analgesia for non-traumatic causes of rib fractures (e.g. neoplasms) or study design other than RCTs were excluded. Forty-seven RCTs met the inclusion criteria. RESULTS: Opioids remain the most studied class of analgesics in the context of rib fracture. While effective for acute pain relief, they pose significant risks, especially in the elderly population. Non-opioid agents - especially non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol -are effective components of opioid-sparing strategies. Thoracic epidural and paravertebral blocks offer superior analgesia and respiratory benefits but are associated with a steep learning curve, are time-consuming, and carry a significant risk of procedural complications. Emerging regional anaesthesia techniques, such as the erector spinae plane (ESP) and serratus anterior plane (SAP) blocks, demonstrated promising results due to their ease of administration and favourable safety profiles. Non-pharmacologic approaches, including cryotherapy, transcutaneous electrical nerve stimulation (TENS), and kinesiotaping, represent additional pain relief options, although evidence remains limited. CONCLUSIONS: Multimodal analgesia - combining pharmacologic, non-pharmacologic and regional anaesthesia approaches -is considered the most effective strategy to guarantee pain relief in patients with multiple rib fractures. However, substantial heterogeneity remains in the regimens employed. Further research is needed to standardize multimodal analgesic protocols and to assess their impact on long-term, patient-centred outcomes.

Tags: *Acute Pain/drug therapy/etiology/therapy/physiopathology, *Analgesics/therapeutic use, *Pain Management/methods, *Rib Fractures/complications/physiopathology/therapy, *Wounds, Nonpenetrating/complications, Analgesia/methods, Analgesics, Opioid/therapeutic use, Anti-Inflammatory Agents, Non-Steroidal/therapeutic use, Emergency medicine, Humans, Multimodal analgesia, Nerve Block, of interest related to this work., Pain management, Randomized Controlled Trials as Topic, Regional anesthesia, Rib fracture, Thoracic trauma.

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Lopez-Ayala, P., Boeddinghaus, J., Koechlin, L., Bima, P., Glaeser, J., Spagnuolo, C. C., Crisanti, L., et al. “Incremental Value Of Cardiac Myosin-Binding Protein C For The Early Diagnosis Of Acute Myocardial Infarction”. J Am Coll Cardiol 86, no. 25: 2616-2632. doi:10.1016/j.jacc.2025.09.008.

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Abstract: BACKGROUND: Cardiac myosin-binding protein C (cMyC) is a cardiac-specific sarcomeric protein with faster release kinetics compared with those of high-sensitivity cardiac troponin (hs-cTn). OBJECTIVES: The aim of this study was to compare the diagnostic performance of cMyC, measured with a novel prototype automated immunoassay, with high-sensitivity cardiac troponin T (hs-cTnT) and high-sensitivity cardiac troponin I (hs-cTnI) for the early diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI). Furthermore, we derived a single blood draw dual-biomarker strategy combining hs-cTn and cMyC and compared it with the hs-cTnT/I-only strategy endorsed by the European Society of Cardiology. METHODS: This was a secondary analysis from an international prospective study recruiting adult patients presenting to the emergency department (ED) with suspected NSTEMI. cMyC, hs-cTnT, and hs-cTnI concentrations were measured upon ED presentation. Final diagnoses were centrally adjudicated by 2 independent cardiologists blinded to cMyC values. To compare the single- and dual-biomarker strategy, safety (defined as the sensitivity and negative predictive value for ruling out index NSTEMI) and triage efficacy (defined as the proportion of patients triaged to either rule-out or rule-in) were assessed. The diagnostic endpoint was index NSTEMI. The prognostic endpoint was 30-day, 1-year, and 5-year cardiovascular death or MI. Findings were externally validated in an independent international cohort. RESULTS: Among 4,735 eligible patients, 854 (18%) were diagnosed with NSTEMI. The discrimination for NSTEMI at presentation was higher for cMyC (area under the curve [AUC]: 0.943; 95% CI: 0.936-0.95) than for hs-cTnT (AUC: 0.936; 95% CI: 0.929-0.944; P = 0.008). Differences were mainly driven by patients with chest pain onset </=3 hours (AUC of 0.939 [95% CI: 0.928-0.951] vs 0.921 [95% CI: 0.907-0.936], respectively; P < 0.001). The dual-biomarker strategy increased overall triage efficacy from 26.8% (hs-cTnT only) to 60.0% (hs-cTnT and cMyC), without compromising safety during the index visit. Despite identifying up to 3 times more patients for rule-out, the dual-biomarker strategy showed comparable cumulative incidences of cardiovascular death or myocardial infarction at 30 days, 1 year, and 5 years. Similar results were observed with hs-cTnI and in the external validation cohort. CONCLUSIONS: CMyC adds significant incremental value to hs-cTn values in the early diagnosis of NSTEMI, improving diagnostic discrimination and enabling more patients to be safely and immediately ruled out for NSTEMI. The single blood draw dual-biomarker strategy is particularly attractive in busy ED settings due to its simplicity and quick time-to-decision. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE]; NCT00470587).

Tags: "Freiwillige Akademische Gesellschaft Basel," as well as speaker honoraria from, Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, BMS, Idorsia, Novartis, Osler,, and has received speaker honoraria from Quidel, Roche Diagnostics, and Polymedco, and has received speaker honoraria/consulting honoraria from, and has received speaker/consulting honoraria or, and has received travel support from Medtronic and Vascular Medical, all, and he has received, Bayer, Boehringer Ingelheim, Inari, Medtronic, Merck, ReCor Medical, Servier, and, Beckman Coulter, Brahms, Idorsia, LSI Medience Corporation, Novartis, Ortho, Brahms, Idorsia, LSI Medience Corporation, Ortho Clinical Diagnostics, Quidel,, cMyC, Coulter, Diagnostics, and Orion Pharma, outside the submitted work. Dr Mahfoud has, Diagnostics, Quidel, Roche, Siemens, Singulex, and SphingoTec, outside the, disclose., Division of Internal Medicine, the Swiss Academy of Medical Sciences, the, Forschungsgemeinschaft (SFB TRR219, Project-ID 322900939), and Deutsche, Foundation, the Margarete und Walter Lichtenstein-Stiftung (3MS1038), and the, Foundation, the Swiss Heart Foundation, from Ablative Solutions, Medtronic, and ReCor Medical, Gottfried and Julia Bangerter-Rhyner Foundation, the Swiss National Science, grants from the Swiss National Science Foundation, the Swiss Heart Foundation,, grants from the University of Basel, the University Hospital of Basel, the, has received honoraria from Siemens,, has received research, Herzstiftung, his employer (Saarland University) has received scientific support, in the last 36 months, all outside the submitted work. Dr Boeddinghaus is, myocardial infarction, National Science Foundation (P400PM_191037/1), the Prof Dr Max Cloetta, outside the submitted work. Dr Koechlin has received a research grant from the, Queensland (PhD scholarship), the Wesley Medical Research Foundation, and the, received research grants from Deutsche Gesellschaft fur Kardiologie, Deutsche, research grants from the Swiss Heart Foundation (FF20079, FF21103, and FF24149), research support from Edwards Lifesciences, Pronova Medical, Meril, Boston, Roche Diagnostics, Abbott, and Siemens, paid to the institution and outside the, Roche Diagnostics, Ortho Clinical Diagnostics, Quidel Corporation, and Beckman, Roche, and Sanofi, all paid to the institution. All other authors have reported, Roche, Siemens, Singulex, and SpinChip Diagnostics. Dr Lopez-Ayala has received, Sciences, and the Gottfried and Julia Bangerter-Rhyner Foundation, the, Scientific, Medtronic, Abbott, Beckman Coulter, Bayer, Ortho Clinical, speaker honoraria/consulting fees from Ablative Solutions, Amgen, AstraZeneca,, Stiftung fur kardiovaskulare Forschung Basel, the University of Basel, Abbott,, submitted work, submitted work. Dr Wildi has received research support from the University of, supported by an Edinburgh Doctoral College Scholarship, Swiss Heart Foundation, University of Basel, the Swiss Academy of Medical, Swiss National Science Foundation, the Swiss Heart Foundation, the KTI, the, Terumo (all until May 2024). Dr Mueller has received research support from the, that they have no relationships relevant to the contents of this paper to, the University Hospital Basel, the University of Basel, Abbott, Beckman Coulter,, troponin, University Hospital Basel, University of Basel. Dr Nestelberger has received research support from the Swiss.

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Boeddinghaus, J., Bima, P., Crisanti, L., Keller, D. I., Slankamenac, K., Christ, M., Schuetz, P., et al. “Prospective Evaluation Of The European Society Of Cardiology 0/1H-Algorithm`s Safety And Efficacy For Triage Of Patients With Suspected Myocardial Infarction (Presc1Se-Mi): Rationale And Design Of A Prospective International Multicenter Stepped-Wedge Cluster Randomized Controlled Trial”. American Heart Journal 292: 107299. doi:10.1016/j.ahj.2025.107299.

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Abstract: Background International practice guidelines recommend the more rapid European Society of Cardiology (ESC) 0/1h-algorithm for the triage of patients with suspected myocardial infarction (MI) as the preferred option and consider the ESC 0/3h-algorithm as an alternative. However, many centers worldwide have not yet adopted the ESC 0/1h-algorithm in clinical practice due to uncertainty which approach best balances safety and efficacy. Methods PRESC1SE-MI (PRospective Evaluation of the European Society of Cardiology 0/1h-algorithm`s Safety and Efficacy for Triage of Patients with Suspected Myocardial Infarction) is an international, investigator-initiated multicenter, stepped-wedge, cluster randomized controlled trial. At least 52,156 consecutive adult patients with nontraumatic acute chest discomfort and suspected MI presenting to the Emergency Department (ED) will be enrolled. Sites still using the ESC 0/3h-algorithm as standard-of-care will be randomized to implement the more rapid ESC 0/1h-algorithm at an early or late implementation step. During the validation phase, participating sites continue to use the ESC 0/3h-algorithm. The co-primary outcomes are a composite of type 1 MI or all-cause death at 30 days (safety), and the length of stay in the ED (efficacy). The trial is designed to show noninferiority for safety and superiority for efficacy, with a power of at least 90%. Conclusions PRESC1SE-MI is the largest international multicenter trial to date evaluating the safety and the efficacy of the implementation of the more rapid ESC 0/1h-algorithm at late adopting centers across multiple countries and healthcare systems. Its findings have the potential to improve patient care and reduce healthcare costs. Trial registration: https://clinicaltrials.gov/study/NCT05649384 . © 2025 Elsevier Inc.

Tags: adult, algorithm, Algorithms, all cause mortality, Article, cardiology, cause of death, clinical practice, cohort analysis, controlled study, cost effectiveness analysis, cross validation, diagnosis, Emergency Service, Hospital, Europe, female, follow up, health care quality, heart infarction, hospital emergency service, hospital readmission, hospitalization, human, Humans, major clinical study, male, medical society, Multicenter Studies as Topic, multicenter study, multicenter study (topic), Myocardial Infarction, outcome assessment, outpatient, patient care, patient coding, patient recruitment, patient safety, patient triage, procedures, Prospective Studies, prospective study, randomized controlled trial, randomized controlled trial (topic), Randomized Controlled Trials as Topic, sensitivity analysis, Societies, Medical, therapy, thorax pain, Triage.

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Uccheddu, G., Lim, R., Dai, S. C., Romann, V., Bosio, S., Heymann, E. P., and Petrino, R. “Burnout And Resilience In Emergency Medicine Health Professionals”. Intern Emerg Med. doi:10.1007/s11739-025-04142-8.

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Abstract: Emergency physicians (EPs) are particularly susceptible to burnout because of the high-stress environment in which they operate, characterized by rapid decision-making, long shifts, and limited resources. This review aims to explore the prevalence and contributing factors to burnout among EPs and to describe different interventions to mitigate this issue. The most used tool to measure burnout is the Maslach Burnout Inventory (MBI), which evaluates emotional exhaustion, depersonalization, and personal accomplishment. Various studies identified both organizational and individual risk factors contributing to high burnout rates, exceeding 70% in some regions. Key organizational factors include increased workload, poor collegial relationships, and work-life conflict, while individual factors involve maladaptive coping strategies. This paper emphasizes the importance of personal and system resilience, defined as the ability to manage stress and thrive under hardship, in combating burnout. It highlights the Stanford Model of Professional Fulfillment, which focuses on cultivating a culture of wellness, enhancing practice efficiency, and fostering personal resilience through self-care and peer support. According to our literature review, proposed interventions include improving shift length and scheduling, managing workload, and reducing bureaucratic tasks. These measures aim to create a supportive environment that prioritizes clinician well-being and enhances job satisfaction. Recognizing the need for a multifaceted approach, this paper suggests combining organizational changes with individual support strategies to effectively reduce burnout rates. This paper underscores the necessity for systemic changes in EM settings to ensure sustainable healthcare delivery and improved outcomes for both patients and healthcare professionals. Implementing these strategies can lead to a more resilient workforce, capable of providing high-quality care while maintaining personal well-being.

Tags: available or on request from the corresponding author., Burnout, clinician well-being, coping strategies, Emergency Physicians, historical archives. Informed consent: Authors denay any financial, personal, or, professional relationships that could influence their work, including funding, resilience, sources, patents, and affiliations. Data supporting this study are openly, study as it did not involve human or animal subjects. The research utilized.

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Pavol, P., Topalis, V., Zagalioti, S. C., Kuzyo, O., Muller, M., Exadaktylos, A. K., Ziaka, M., and Klukowska-Rotzler, J. “When Pedestrian Crossings Become Danger Zones: Trauma And Mortality Risks In Elderly Pedestrians”. Int J Environ Res Public Health 22, no. 10. doi:10.3390/ijerph22101556.

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Abstract: AIM: Older adult pedestrians are at greater risk of severe injuries than younger pedestrians due to gradual physical changes and coexisting medical conditions. This leads to longer hospital stays, increased mortality risk, and higher inpatient costs. Focusing on the aging population, this study explores the characteristics and injury profiles of pedestrian crossing accidents in the capital city of Bern, Switzerland. METHODS: Our retrospective cohort study comprised adult patients admitted to our ED between 1 January 2013 and 31 December 2023, as crossing (or zebra crossing)-related pedestrian victims. Two cohorts were formed on the basis of age < 65 and >/=65 years and compared according to the setting of the accident, type, pattern of the injury, and clinical outcomes (short-term mortality, ICU/hospital length of stay). RESULTS: Of a total of 124 patients, 31.5% (n = 39) of patients were elderly (65+ group). In contrast to the younger patients, the aging population was predominantly admitted as inpatients (64.1% vs. 35.3%, p = 0.001) and was hospitalised in the intensive care unit (20.5% vs. 6%, p = 0.020). Older patients were more likely to be polytraumatised (41% vs. 11.8%, p = 0.001) and to have been tossed or hurled than patients under 65 years (75% vs. 47.3%, p = 0.016). Fractures of the upper extremities (17.9% vs. 4.7%, p = 0.016), pelvis (30.8% vs. 9.4%, p = 0.003), and thoracic spine (12.8% vs. 2.4%, p = 0.019) were significantly more common in the elderly population. Intracranial haemorrhage (35.9% vs. 17.6%, p = 0.026), abdominal trauma (17.9% vs. 5.9%, p = 0.035), and relevant vessel damage (30.8% vs. 3.5%, p < 0.001) were also significantly higher in geriatric patients. Trauma indices were slightly more increased in the older population than in the younger group (ISS; p = 0.004 and AIS > 2 of chest and thoracic spine; abdomen, pelvic contents, and lumbar spine; extremities & bony pelvis p < 0.05). The 65+ group had a longer length of hospital stay (p = 0.001) and ICU stay (p = 0.002). A hospital stay longer than 7 days was also significantly more common in elderly individuals (p = 0.007). In-hospital (15.4% vs. 1.2%, p = 0.001) and 30-day mortality (17.9% vs. 1.2%, p < 0.001) were significantly higher in patients over 65 years of age. CONCLUSION: In our study, the impact of pedestrian crossing accidents was more severe in the elderly, as indicated by the severity of injuries, hospitalisation rate, longer length of hospital and ICU stays, and higher mortality rates. These findings underline the importance of developing tailored strategies to reduce crosswalk accidents and to optimise management approaches for these vulnerable patients.

Tags: *Accidents, Traffic/statistics & numerical data/mortality, *Pedestrians/statistics & numerical data, *Wounds and Injuries/epidemiology/mortality, Adult, Age Factors, Aged, Aged, 80 and over, aging population, crosswalk accidents, elderly, Female, Hospitalization/statistics & numerical data, Humans, Length of Stay, Male, Middle Aged, pedestrians, Retrospective Studies, Switzerland/epidemiology, zebra crossings.

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Ntenti, C., Papakonstantinou, E., Grize, L., Pascarella, M., Frye, B. C., Fahndrich, S., Ioannidou, D., Savic Prince, S., Goulas, A., and Stolz, D. “Sumf1 Common Variant Rs793391 Is Associated With Response To Inhaled Corticosteroids In Patients With Copd”. Int J Mol Sci 26, no. 20. doi:10.3390/ijms262010225.

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Abstract: This study investigated whether specific sulfatase modifying factor-1 (SUMF1) SNPs-previously linked to lung function-are associated with COPD progression and response to inhaled corticosteroid (ICS) treatment, specifically budesonide, given that SUMF1 expression is altered in COPD and its variants linked to increased disease risk. A subgroup of 165 COPD patients from the HISTORIC study were genotyped for two common SUMF1 SNPs, rs11915920 and rs793391. Patients first underwent a six-week run-in phase with open-label triple inhaled therapy (LAMA/LABA/ICS), then were randomized to receive either LAMA/LABA/placebo or LAMA/LABA/ICS for 12 months. Associations between SNPs, baseline characteristics, and response to ICS-based on FEV(1) change over 12 months-were evaluated. Heterozygotes (TG) for the rs793391 polymorphism treated with LAMA/LABA/ICS showed a significant and clinically meaningful FEV(1) improvement compared to the placebo group. This was supported by improved patient-reported outcomes, with lower SGRQ and CAT scores and a clinically relevant increase in General Health Questionnaire scores. These findings suggest that rs793391 may be linked to both COPD progression and ICS response and could contribute to more personalized treatment strategies in COPD.

Tags: *Adrenal Cortex Hormones/administration & dosage/therapeutic use, *Polymorphism, Single Nucleotide, *Pulmonary Disease, Chronic Obstructive/drug therapy/genetics, Administration, Inhalation, Aged, Budesonide/therapeutic use/administration & dosage, COPD pharmacogenetics, Female, Humans, inhaled corticosteroids, Male, Middle Aged, personalized therapy, precision medicine, single nucleotide polymorphism, sulfatase modifying factor 1, sulfatases, Treatment Outcome.

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