EMresearch.ch

Greiter, B. M., Sidorov, S., Osuna, E., Seiler, M., Relly, C., Hackenberg, A., Luchsinger, I., et al. “Clinical Characteristics And Serological Profiles Of Lyme Disease In Children: A 15-Year Retrospective Cohort Study In Switzerland”. Lancet Reg Health Eur 48: 101143. doi:10.1016/j.lanepe.2024.101143.

Abstract: BACKGROUND: Lyme disease (LD) is caused by Borrelia burgdorferi and is the most common tickborne disease in the northern hemisphere. Although classical characteristics of LD are well-known, the diagnosis and treatment are often delayed. Laboratory diagnosis by serological testing is recommended for most LD manifestations. The objective of this study was to describe clinical characteristics and associated serological profiles in children with LD. METHODS: This retrospective cohort study included children aged 0-18 years, diagnosed with LD according to current guidelines at University Children's Hospital Zurich between January 1, 2006 and December 31, 2020. Two-tier serological testing with the recomWell enzyme-linked immunosorbent assay and recomLine Western blot (MIKROGEN Diagnostik, MIKROGEN GmbH, Neuried, Germany) was performed at the Institute of Medical Microbiology, University of Zurich. FINDINGS: In total, 469 children diagnosed with LD were included (median age, 7.9 years); 190 patients (40.5%) with Lyme neuroborreliosis (LNB), 171 (36.5%) patients with skin manifestations (erythema migrans, n = 121; multiple erythema migrans, n = 11; borrelial lymphocytoma, n = 37; and acrodermatitis chronica atrophicans, n = 2), and 108 (23.0%) patients with Lyme arthritis. We observed seasonal variations for patients with skin manifestations and LNB, with high prevalence in May-October, but not for patients with Lyme arthritis. Significant differences between LD manifestation groups were found for age, inflammatory parameters, and specificity and concentration of B. burgdorferi-specific serum antibody responses. We observed distinct patterns of pronounced serum antibody responses against B. burgdorferi antigens in LNB (IgM against VlsE, p41, and OspC) and Lyme arthritis (IgG against p100, VlsE, p58, p41, p39, and p18). INTERPRETATION: Our study is one of the largest and most detailed for children with LD. We present unique findings regarding the differences in clinical characteristics and immune responses between various manifestations of LD in children. FUNDING: No specific funding to disclose for this study.

Tags: AstraZeneca) and given presentations (Fomf, FPH Forum, ZAIM MediDays, Insight, authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of, Borrelia burgdorferi, Erythema migrans, Facial nerve palsy, industry sponsored symposia (lllumina, Copan, Bruker), and support from the, Interest., Laboratory Medicine Society of Korea for attendance at and travel to the annual, Lyme arthritis, meeting of the Laboratory Medicine Society of Korea in the past 36 months. All, Meningitis, Neuroborreliosis, Paediatrics) with payments to the institution (University Children's Hospital, to start-up companies), honoraria for presentations at various conferences at, Zurich). A.E. has received consultancy fees from Sefunda and Phast (advisory role.

Fusi, C., and Bulleri, E. “Current Insights Oesophageal Pressure Monitoring: A Real Advanced Tool For Icu Nurses”. Intensive Crit Care Nurs 87: 103923. doi:10.1016/j.iccn.2024.103923.

Nutbeam, T., Stassen, W., Foote, E., and Ageron, F. X. “Derivation And Validation Of The Simplified Bleedingaudit Triage Trauma (Sbatt) Score: A Simplified Trauma Score For Major Trauma Patients Injured In Motor Vehicle Collisions”. Bmj Open 14, no. 12: e090517. doi:10.1136/bmjopen-2024-090517.

Abstract: OBJECTIVES: To develop and validate a simplified Bleeding Audit Triage Trauma (sBATT) score for use by lay persons, or in areas and environments where physiological monitoring equipment may be unavailable or inappropriate. DESIGN: The sBATT was derived from the original BATT, which included prehospital systolic blood pressure (SBP), heart rate, respiratory rate, Glasgow Coma Scale (GCS), age and trauma mechanism. Variables suitable for lay interpretation without monitoring equipment were included (age, level of consciousness, absence of radial pulse, tachycardia and trapped status). The sBATT was validated using data from the UK Trauma Audit Research Network (TARN) registry. SETTING: Data sourced from prehospital observations from multiple trauma systems in the UK. PARTICIPANTS: 70 027 motor vehicle collision (MVC) patients from the TARN registry (2012-2019). Participants included were those involved in MVCs, with exclusion criteria being incomplete data or non-trauma-related admissions. INTERVENTIONS: Not applicable. PRIMARY AND SECONDARY OUTCOME MEASURES: Death within 24 hours of MVC. Secondary: need for trauma intervention. RESULTS: In a cohort of 70 027 MVC patients, 1976 (3%) died within 24 hours. The sBATT showed an area under receiver operating characteristic curve of 0.90 (95% CI: 0.90 to 0.91) for predicting 24-hour mortality, surpassing other trauma scores such as the Shock Index and Assessment of Blood Consumption score. Sensitivity was 96% and specificity 72%, with a negative likelihood ratio below 0.1, indicating strong rule-out capability. Sensitivity analyses confirmed consistent performance across varying SBP and GCS thresholds. The sBATT was equally effective across sexes with no significant predictive discrepancies. CONCLUSIONS: The sBATT is a novel, simplified tool that performs well at predicting early death in the TARN dataset. It demonstrates high predictive accuracy for 24-hour mortality and need for trauma intervention. Further research should validate sBATT in diverse populations and real-world scenarios to confirm its utility and applicability.

Tags: *Accidents, Traffic, *Triage/methods/standards, Accident & emergency medicine, Adult, Aged, Blood Pressure, Female, Glasgow Coma Scale, Hemorrhage/diagnosis/etiology, Humans, Male, Middle Aged, Registries, ROC Curve, Trauma management, Trauma Severity Indices, Triage, United Kingdom, Wounds and Injuries/complications/mortality, Young Adult.

Buyck, M., Desaulniers, P., Chenier, C., and Moussa, A. “Experiential Faculty Development To Increase The Number Of Entrustable Professional Activity Assessments”. Clin Teach 22, no. 1: e70006. doi:10.1111/tct.70006.

Abstract: BACKGROUND: Emergency medicine (EM) residents must complete both adult and paediatric entrustable professional activities (EPAs). During their paediatric emergency medicine rotation at a university paediatric hospital, EM residents struggled to receive EPA assessments because preceptors had not yet been trained due to the stepwise implementation of EPAs. This study aimed to evaluate the impact of a workshop on behaviour change by measuring the number of EPA assessments. METHODS: A comparative pretraining and posttraining study involving 27 invited faculty members was conducted to assess the impact of a faculty development programme. The training was delivered via videoconference with experiential learning techniques to practise every aspect of the supervision of an EPA, including selecting the appropriate EPA according to mirroring real-world situations, giving feedback, evaluating autonomy and recording the EPA in the resident's logbook. RESULTS/FINDINGS: In total, 20 out of 27 eligible faculty members (74%) agreed to participate in the study. Their main challenges reported were a lack of trainee initiative, preceptor training and competence in supervising EPAs. Over the 12-month analysis period, the enrolled faculty assessed 125 EPAs for 38 EM residents, including 52 pre-intervention EPAs and 73 post-intervention EPAs. Calculation of data points above the median showed a 1-point difference in the EPAs assessments to resident ratio between the pre- and post-intervention periods (3/7 vs. 4/7). CONCLUSION: Our findings suggest that faculty training using multiple educational strategies may enable EM residents to receive more EPA assessments during their paediatric emergency medicine rotation.

Tags: *Clinical Competence, *Faculty, Medical, *Internship and Residency/standards, Educational Measurement/methods, emergency medicine, Emergency Medicine/education, entrustable professional activities, faculty development, Humans, Preceptorship/organization & administration/standards, Problem-Based Learning, Staff Development/organization & administration.

Tan, R., Kavishe, G., Kulinkina, A. V., Renggli, S., Luwanda, L. B., Mangu, C., Ashery, G., et al. “A Cluster Randomized Trial Assessing The Effect Of A Digital Health Algorithm On Quality Of Care In Tanzania (Dynamic Study)”. Plos Digit Health 3, no. 12: e0000694. doi:10.1371/journal.pdig.0000694.

Abstract: Digital clinical decision support tools have contributed to improved quality of care at primary care level health facilities. However, data from real-world randomized trials are lacking. We conducted a cluster randomized, open-label trial in Tanzania evaluating the use of a digital clinical decision support algorithm (CDSA), enhanced by point-of-care tests, training and mentorship, compared with usual care, among sick children 2 to 59 months old presenting to primary care facilities for an acute illness in Tanzania (ClinicalTrials.gov NCT05144763). The primary outcome was the mean proportion of 14 major Integrated Management of Childhood Illness (IMCI) symptoms and signs assessed by clinicians. Secondary outcomes included antibiotic prescription, counseling provided, and the appropriateness of antimalarial and antibiotic prescriptions. A total of 450 consultations were observed in 9 intervention and 9 control health facilities. The mean proportion of major symptoms and signs assessed in intervention health facilities was 46.4% (range 7.7% to 91.7%) compared to 26.3% (range 0% to 66.7%) in control health facilities, an adjusted difference of 15.1% (95% confidence interval [CI] 4.8% to 25.4%). Only weight, height, and pallor were assessed statistically more often when using the digital CDSA compared to controls. Observed antibiotic prescription was 37.3% in intervention facilities, and 76.4% in control facilities (adjusted risk ratio 0.5; 95% CI 0.4 to 0.7; p<0.001). Appropriate antibiotic prescription was 81.9% in intervention facilities and 51.4% in control facilities (adjusted risk ratio 1.5; 95% CI 1.2 to 1.8; p = 0.003). The implementation of a digital CDSA improved the mean proportion of IMCI symptoms and signs assessed in consultations with sick children, however most symptoms and signs were assessed infrequently. Nonetheless, antibiotics were prescribed less often, and more appropriately. Innovative approaches to overcome barriers related to clinicians' motivation and work environment are needed.

Misirocchi, F., Quintard, H., Rossetti, A. O., Florindo, I., Sarbu, O. E., Kleinschmidt, A., Schaller, K., Seeck, M., and De Stefano, P. “Hypoalbuminemia In Status Epilepticus Is A Biomarker Of Short- And Long-Term Mortality: A 9-Year Cohort Study”. Eur J Neurol 32, no. 1: e16573. doi:10.1111/ene.16573.

Abstract: BACKGROUND: Outcome prediction in Status epilepticus (SE) aids in clinical decision-making, yet existing scores have limitations due to SE heterogeneity. Serum albumin is emerging as a readily available prognostic biomarker in various clinical conditions. This study evaluates hypoalbuminemia in predicting short- and long-term mortality. METHODS: Observational cohort study including non-hypoxic SE adult patients admitted to the University Hospital of Geneva (Switzerland) between 2015 and 2023. Primary outcomes were in-hospital and 6-month mortality. RESULTS: Four hundred and ninety-six patients were included, 46 (9.3%) died in hospital; 6-month outcome was available for 364 patients, 86 (23.6%) were not alive at follow-up. Hypoalbuminemia was associated with older age and patients' comorbidities. Binomial regression showed an independent correlation between hypoalbuminemia and short- (p = 0.005, OR = 3.35, 95% CI = 1.43-7.86) and long-term mortality (p = 0.001, OR = 3.59,95% CI = 1.75-7.35). The Status Epilepticus Severity Score (STESS) had an overall AUC of 0.754 (95% CI = 0.656-0.836) for predicting in-hospital mortality and of 0.684 (95% CI = 0.613-0.755) for 6-month mortality. Through an exploratory analysis, we replaced age with hypoalbuminemia in the STESS, creating the Albumin-STESS (A-STESS) score (0-6). The global A-STESS AUC significantly improved for both in-hospital (0.837, 95% CI = 0.760-0.916, p = 0.002) and 6-month (0.739, 95% CI = 0.688-0.826; p = 0.033) mortality prediction. A-STESS-3 cutoff demonstrated a strong sensitivity-specificity balance for both in-hospital (sensitivity = 0.88, specificity = 0.68, accuracy = 0.70) and 6-month (sensitivity = 0.67, specificity = 0.73, accuracy = 0.72) mortality. CONCLUSIONS: Hypoalbuminemia is an easily measurable biomarker reflecting the overall patient's condition and is independently related to short- and long-term SE mortality. Integrating hypoalbuminemia into the STESS (A-STESS) significantly enhances mortality prediction. Future studies are needed to externally validate the A-STESS and evaluate the benefits of albumin supplementation in SE patient prognosis.

Tags: (163,398, CRS115-180365) and is supported by the 2022 Swiss League Against, (IFCN) Research Fellowship Grant. HQ declares no competing interests. AOR, *Biomarkers/blood, *Hypoalbuminemia/blood/mortality, *Status Epilepticus/mortality/blood, Adult, Aged, Aged, 80 and over, albumin, Cohort Studies, competing interests. MS is a shareholder of Epilog NV (Ghent, Belgium). She, compliance with the Declaration of Helsinki first published in 1964 and its, CRS115-180365). PDS was supported by the Swiss National Science Foundation, declares no competing interests. IF declares no competing interests. OES declares, EliLilly, Lundbeck, Mitsubishi Tanabe, Novartis, and TEVA that were paid to a, Epilepsy Research Support Prize. The study protocol was reviewed and approved by, Female, following amendments., Hospital Mortality, Humans, Icu, Male, Middle Aged, no competing interests. AK has received honoraria for consulting from Abbvie,, outcome, Prognosis, received grants from the Swiss National Science Foundation (163,398,, Severity of Illness Index, status epilepticus, Stess, teaching and research fund at the University Hospital Geneva. KS declares no, the local ethic committee (CCER 2019-00836), and patient's consent was waived in.

Stebler, K., Elia, N., Zaccaria, I., and Fournier, R. M. “Popliteal Plexus Block In Total Knee Arthroplasty: A Single-Center Randomized Controlled Double-Blinded Trial”. Reg Anesth Pain Med. doi:10.1136/rapm-2024-105782.

Abstract: INTRODUCTION: Whether a popliteal plexus block improves postoperative pain following total knee arthroplasty remains debated. This randomized trial tested if adding a popliteal plexus block to a continuous femoral nerve block decreases postoperative opioid requirement. METHODS: We included 66 patients undergoing total knee arthroplasty. 32 received continuous femoral nerve block and popliteal plexus block (intervention), and 34 received continuous femoral nerve block alone (control). The primary endpoint was the 12-hour postoperative morphine-equivalent consumption (mg). Secondary outcomes included opioid consumption, Visual Analog Pain Score (0-10), and sensorimotor extension of the block in postanesthesia care unit, at 12 hours, 24 hours and 48 hours postoperatively. RESULTS: 66 patients with a median body mass index of 28.7 (IQR 26.3-33.8) were included in the study. In an intention-to-treat analysis, the median 12-hour morphine-equivalent consumption was lower in the intervention group (6.1 mg (0.5-14.5) vs 10 mg (5.0-17.3); one-sided Wilcoxon test (p=0.04)). The average pain intensity experienced in postanesthesia care unit was lower in the intervention group (median: 3.0 (3.0-5.0) vs 2.0 (1.0-4.0), two-sided Wilcoxon p=0.01) and fewer patients reported lateroposterior pain of the knee (11 (34.4%) vs 21 (61.8%) p=0.03). These benefits disappeared after 24 hours. The median duration of the popliteal plexus block procedure was 5.0 min (2.0-5.0). CONCLUSIONS: Adding a popliteal plexus block to a continuous femoral nerve block decreases 12-hour opioid utilization, but the effect size is small, calling into question its clinical relevance. TRIAL REGISTRATION NUMBER: NCT04048889.

Tags: Anesthesia, Local, Lower Extremity, Nerve Block, Pain, Postoperative.

Lee, C. C., Porta, L., Liu, Y., Chen, P. T., Pan, H. H., Lee, Y. T., Chen, K. F., et al. “Grade-Based Procalcitonin Guideline For Emergency Departments”. Am J Emerg Med 89: 109-123. doi:10.1016/j.ajem.2024.11.093.

Abstract: Procalcitonin is a useful biomarker for infection. Over the past two decades, there has been much research on the clinical applications of procalcitonin, yet the majority of these studies have been conducted in the intensive care setting. Despite the extensive use of procalcitonin in emergency departments, there have been no guidelines focusing specifically on these clinical settings. Additionally, previous guidelines were predominantly shaped by expert consensus and rarely incorporate evidence-based medicine concepts. To address these shortcomings, the current guideline adopts a novel approach. Initially, we identified the most critical questions regarding the use of procalcitonin in emergency settings through expert voting. This was followed by a systematic literature review and the evaluation of evidence levels using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. Key characteristics of individual studies will be summarized and evaluated by the guideline development group to determine the overall quality of evidence. The GRADE working group's categorization system will be employed to rate evidence quality into four levels. Recommendations will be formulated based on explicit consideration of established criteria. This structured approach ensures that guideline recommendations are founded on robust evidence and transparently assessed for strength and potential caveats. This is the first guideline on the use of procalcitonin to be applied in emergency departments that adopts the principles of evidence-based medicine and encompasses the up-to-date literatures, and it marks an advancement in providing guidance on the utilization of procalcitonin in emergency departments.

Tags: *Emergency Service, Hospital/standards, *Practice Guidelines as Topic, *Procalcitonin/blood, Antibiotic stewardship, Biomarkers/blood, declare., Diagnostic performance, Evidence-Based Medicine, Guideline, Humans, Molecular testing, Procalcitonin, Septic patients.

Le Terrier, C., Bouvier, M., Kerbol, A., Dell'Acqua, C., Nara Network, members, Nordmann, P., and Poirel, L. “In-Vitro Activity Of The Novel Beta-Lactam/Beta-Lactamase Inhibitor Combinations And Cefiderocol Against Carbapenem-Resistant Pseudomonas Spp. Clinical Isolates Collected In Switzerland In 2022”. Eur J Clin Microbiol Infect Dis 44, no. 3: 571-585. doi:10.1007/s10096-024-04994-6.

Abstract: To evaluate the in-vitro activity of the novel commercially-available drugs, including meropenem-vaborbactam (MEV), ceftazidime-avibactam (CZA), ceftolozane-tazobactam (C/T), imipenem-relebactam (IPR) as well as cefiderocol (FDC), against carbapenem-resistant Pseudomonas spp. (CRP) isolates. All CRP isolates collected at the Swiss National Reference Laboratory (NARA) over the year 2022 (n = 170) have been included. Most of these isolates (n = 121) were non-carbapenemase producers. Among the 49 carbapenemase producers, 47 isolates produced metallo-beta-lactamases (MBL) including NDM-1 (n = 11), VIM-like (n = 28), IMP-like (n = 7), and both NDM-1 and VIM-2 (n = 1) and two isolates produced the class A carbapenemase GES-5. Susceptibility testing was determined by broth microdilution method (BMD), or disk diffusion test, and results interpreted following EUCAST guidelines. The susceptibility rates for MEV, CZA, C/T and IPR were found to be 41%, 45%, 59% and 58%, respectively, for the whole set of isolates tested. Among non-carbapenemase producers, susceptibility rates for these beta-lactam/beta-lactamase inhibitors (BL/BLI) combinations were higher, determined at 55%, 61%, 83%, and 82%, respectively. The overall susceptibility of carbapenemase-producing Pseudomonas spp. to novel BL/BLI was relatively low, while 80% of these isolates demonstrated susceptibility to FDC, with a similar proportion (79%) observed among MBL producers. A total of 10 MBL-producing isolates (6%), mainly NDM-1, were found to exhibit resistance to all drugs tested, with the exception of colistin. FDC exhibited an excellent in-vitro activity against this collection of CRP recovered from Switzerland in 2022, including MBL producers. The new BL/BLI combinations displayed significant activity against non-carbapenemase CRP, with IPR and C/T showing the highest susceptibility rates.

Tags: *Anti-Bacterial Agents/pharmacology, *beta-Lactamase Inhibitors/pharmacology, *Cephalosporins/pharmacology, *Pseudomonas Infections/microbiology/drug therapy, *Pseudomonas/drug effects/isolation & purification, Avibactam, Azabicyclo Compounds/pharmacology, Bacterial Proteins, Beta-lactamase, beta-Lactamases/metabolism, Carbapenemase, Carbapenems/pharmacology, Cefiderocol, Cefiderocol/pharmacology, Ceftazidime, Ceftolozane, declare no competing interests., Drug Combinations, Humans, Imipenem, Meropenem, Microbial Sensitivity Tests, Relebactam, Switzerland, Tazobactam, Vaborbactam.

Gloor, Y. S., Mouterde, M., Terrier, J., Lenoir, C., Gosselin, P., Rollason, V., Reny, J. L., et al. “Cytochrome P450 Phenotyping Using The Geneva Cocktail Improves Metabolic Capacity Prediction In A Hospitalized Patient Population”. Br J Clin Pharmacol 91, no. 5: 1382-1395. doi:10.1111/bcp.16368.

Abstract: AIMS: Liver cytochromes (CYPs) play an important role in drug metabolism but display a large interindividual variability resulting both from genetic and environmental factors. Most drug dose adjustment guidelines are based on genetics performed in healthy volunteers. However, hospitalized patients are not only more likely to be the target of new prescriptions and drug treatment modifications than healthy volunteers, but will also be more subject to polypharmacy, drug-drug interactions, or to suffer from disease or inflammation affecting CYP activities. METHODS: We compared predicted phenotype based on genetic data and measured phenotype using the Geneva cocktail to determine the extent of drug metabolizing enzyme variability in a large population of hospitalized patients (>500) and healthy young volunteers (>300). We aimed to assess the correlation between predicted and measured phenotype in the two populations. RESULTS: We found that, even in cases where the genetically predicted metabolizer group correlates well with measured CYP activity at group level, this prediction lacks accuracy for the determination of individual metabolizer capacities. Drugs can have a profound impact on CYP activity, but even after combining genetic and drug treatment information, the activity of a significant proportion of extreme metabolizers could not be explained. CONCLUSIONS: Our results support the use of measured metabolic ratios in addition to genotyping for accurate determination of individual metabolic capacities to guide personalized drug prescription.

Tags: *Cytochrome P-450 Enzyme System/genetics/metabolism, Adult, Aged, cytochrome P450, Drug Interactions, drug metabolism, Female, Genotype, genotyping, Healthy Volunteers, Hospitalization, Humans, Male, Middle Aged, Pharmaceutical Preparations/metabolism, Phenotype, phenotyping, Young Adult.

Meyer, H. G., Fah, K., and Christ, M. “An Atypical Presentation Of Acute Cholecystitis With Left Sided Chest Pain And St Elevation - A Case Report”. Open Access Emerg Med 16: 323-328. doi:10.2147/OAEM.S478102.

Abstract: BACKGROUND: ST elevation combined with typical chest pain is an indication for acute coronary vascularization and is usually associated with acute myocardial infarction. Herein, we present an unusual case of ST elevation. CASE PRESENTATION: A 57-year-old male patient presented to the emergency department with chest pain radiating to both arms and the back. Typical clinical presentation and inferolateral ST elevations were suggestive of ST elevation myocardial infarction. Interestingly, coronary occlusion was excluded by coronary angiography. Despite extensive diagnostic workup, no underlying diagnosis was made. Four days later, the patient returned and reported pain in the right upper abdomen. Clinical presentation, laboratory analysis, and imaging features led to a diagnosis of calculous acute cholecystitis. Laparoscopic cholecystectomy was performed, and the diagnosis was confirmed. Electrocardiographic changes and pain resolved completely. CONCLUSION: Acute calculous cholecystitis is initiated by gallbladder distension due to biliary duct occlusion caused by gallstones. ST elevations in response to gallbladder distension have been demonstrated in animal models. We hypothesize that the ST elevations observed in this patient with chest pain were linked to stone-mediated distension of the gallbladder, leading to reflex coronary vasoconstriction.

Tags: case report, chest pain, cope's sign, Ecg, electrocardiography, Stemi.

Schranc, A., Daniels, J., Sudy, R., Fontao, F., Bijlenga, P., Plourde, G., and Quintard, H. “Safety Of Flow-Controlled Ventilation With Positive And Negative End-Expiratory Pressure In A Swine Model Of Intracranial Hypertension”. Intensive Care Med Exp 12, no. 1: 117. doi:10.1186/s40635-024-00703-x.

Abstract: BACKGROUND: Patients with brain damage often require mechanical ventilation. Although lung-protective ventilation is recommended, the application of increased positive end-expiratory pressure (PEEP) has been associated with elevated intracranial pressure (ICP) due to altered cerebral venous return. This study investigates the effects of flow-controlled ventilation (FCV) using negative end-expiratory pressures (NEEP), on cerebral hemodynamics in a swine model of intracranial hypertension. METHODS: A model of intracranial hypertension involving bilateral trepan bolt holes was performed in 14 pigs. Pressure-controlled volume-guaranteed ventilation (PCV-VG) with PEEP and FCV using PEEP and then NEEP were applied. Intracranial pressure and oxygenation, as well as systemic hemodynamics and gas exchange parameters, were continuously monitored. Data were collected at baseline and at varying PEEP levels for both PCV-VG and FCV ventilation modalities. Following this, FCV ventilation and NEEP levels of -3, -6 and -9 cmH(2)O were applied. RESULTS: ICP remained stable with low PEEP levels, but significantly decreased with NEEP. Lower ICP following NEEP improved cerebral perfusion pressure and cerebral tissue oxygenation (p < 0.05 for all). FCV with NEEP at EEP-6 and EEP-9 significantly improved cardiac output and mean arterial pressure (MAP), compared to PCV-VG and FCV using PEEP (p < 0.05, respectively). There were no significant differences in gas exchange parameters between modalities (PCV-VG vs FCV), and between the application of PEEP or NEEP. No significant correlations were observed between DeltaICP and DeltaMAP. CONCLUSION: The application of FCV with NEEP appears to be a safe ventilation mode and offers an additional tool for controlling severe intracranial pressure episodes. These findings warrant validation in future studies and may lead to important potential applications in clinical practice.

Tags: 34446/GE172A-B, 6 March 2023). All procedures were performed in accordance with, Animal Research Reporting of In Vivo Experiments (ARRIVE) guidelines. Consent for, Cerebral hemodynamics, current Swiss animal protection laws (LPA, RS455). The current report follows the, declare., Flow-controlled ventilation, in 2023. Competing interests: The authors have no conflict of interests to, Intracranial hypertension, Mechanical ventilation, Negative end-expiratory pressure, Positive end-expiratory pressure, presented as a poster at the Annual Congress of the European Respiratory Society, protocol was approved by the Animal Welfare Committee of the Canton of Geneva and, publication: Not applicable. Presentation: Preliminary data of this study were, the Experimental Committee of the University of Geneva, Switzerland (No..

Pistritto, E., Schera, F. M. F., Vassilopoulou, E., Corsello, A., Alberti, I., Lava, S. A. G., Betti, C., et al. “Impact Of Adolescents' Binge Drinking On Blood Chemistry”. Eur J Pediatr 184, no. 1: 77. doi:10.1007/s00431-024-05862-3.

Abstract: Adolescent binge drinking is increasingly common. This study investigates the anomalies in glucose, sodium, calcium, potassium, and acid-base homeostasis induced by binge drinking in adolescents. The records of teenagers who sought medical attention for binge drinking (ethanol level >/= 0.80 g/L) at the Pediatric Emergency Department, Ca' Granda Ospedale Maggiore Policlinico, Milan (Italy), spanning the years 2013 to 2023 were retrospectively analyzed. For this analysis, cases were selected if documented blood chemistry encompassed sodium, potassium, total calcium, glucose, acid-base balance, and lactic acid (only for those with metabolic acidosis). Included were 173 adolescents (female-to-male ratio 0.94), 13.2 to 18.4, median 16.4 years of age. Hypoglycemia (</= 3.3 mmol/L; N = 1, 0.6%), hyponatremia (</= 134 mmol/L; N = 7, 4.0%), hypernatremia (>/= 146 mmol/L; N = 3, 1.7%), hypocalcemia (</= 2.19 mmol/L; N = 0) hypercalcemia (>/= 2.61 mmol/L; N = 0), and hyperkalemia (>/= 5.1 mmol/L; N = 0) were infrequent. Acute respiratory acidosis (pCO(2) >/= 46 mm Hg; pH < 7.40; N = 101, 58%) was the most common acid-base imbalance, followed by respiratory alkalosis (pCO(2) </= 34 mm Hg; pH > 7.40; N = 10, 5.6%), and metabolic acidosis (HCO(3)(-) </= 19 mmol/L, pH < 7.40; N = 9, 5.2%). The lactic acid level was increased (>/= 2.1 mmol/L) in all cases with metabolic acidosis. Metabolic alkalosis (HCO(3)(-) >/= 28 mmol/L, pH > 7.40) never occurred. Hypokalemia (</= 3.4 mmol/L; N = 56, 32%) was prevalent, particularly in adolescents with normal acid-base equilibrium or metabolic acidosis, rather than respiratory acidosis or alkalosis.Conclusion: Adolescents who engage in binge drinking often experience a disrupted acid-base balance and hypokalemia, while glucose, sodium and calcium levels are rarely affected. What is known? * Binge drinking is becoming increasingly common among adolescents. * Conflicting data regarding the type and prevalence of biochemical disorders induced by binge drinking are available in this age group. What is new? * Acute respiratory acidosis is prevalent in adolescents with binge drinking, whereas respiratory alkalosis, metabolic acidosis, and hypoglycemia are uncommon. * Hypokalemia develops frequently.

Tags: *Binge Drinking/blood/epidemiology, 4384_17.04.2024_P]) for the data analysis, which involved the use of anonymized, Acid-base balance, Acid-Base Equilibrium, Acid-Base Imbalance/blood, Adolescence, Adolescent, appropriate request. Generative Artificial Intelligence: Generative artificial, Binge drinking, Blood Glucose/analysis, Calcium/blood, Competing interests: Gregorio P Milani is currently one of the Editors of the, conducted, the consent to participant was not requested in agreement with current, European Journal of Pediatrics., Female, findings of this study can be obtained from the corresponding authors upon, Glucose, Humans, intelligence was used to improve readability and language of the manuscript., Italy/epidemiology, Lactic Acid/blood, legislation (Reg. UE 679/2016 and D.Lgs 196/2003 (Codice della Privacy) as, Maggiore Policlinico Milan (Italy) granted approval (ID 4384 - approval number:, Male, nature of the study and the nature of the Institution where the study was, of Helsinki. Consent to participate: Giving the observational retrospective, patient information. The study was conducted in accordance with the Declaration, Potassium, Potassium/blood, reported by D.Lgs 101/2018). Data Access Statement: The data supporting the, Retrospective Studies, Sodium, Sodium/blood.

Kliem, P. S. C., Tisljar, K., Grzonka, P., Berger, S., Amacher, S. A., De Marchis, G. M., Dittrich, T. D., et al. “Effects Of A Scoring Aid On Glasgow Coma Score Assessment And Physicians' Comprehension: A Simulator-Based Randomized Clinical Trial”. J Neurol 272, no. 1: 57. doi:10.1007/s00415-024-12825-z.

Abstract: PURPOSE: Examining the impact of scoring aids on the accuracy of assessing the Glasgow Coma Score (GCS) in a standardized trauma scenario (primary outcome). Evaluating physicians' understanding of the GCS assessment and clinical application (secondary outcome). MATERIALS AND METHODS: This randomized trial was performed at the simulator center of a Swiss tertiary academic medical hospital. Participants included intensivists, emergency physicians, internists, and neurologists. The setting involved a trauma patient portraying a GCS of 8 (eyes 1, verbal 2, motor 5). Participants were randomized to receiving or not receiving a scoring aid. Video/audio recordings of the assessments and questionnaires were analyzed by two investigators. RESULTS: Among 109 participants, 55 received a scoring aid. Overall, 52% scored correctly (score interquartile range 7-8); 43% scored too low and 90% scored within a range of +/- 1. A scoring aid increased accuracy (62% vs. 43%, p = 0.045) and participants' confidence, whilst decreasing assessment duration. Clinical experience further improved reliability. 89% found assessing a GCS of 8 most challenging, particularly with motor response evaluation (64%). 26% indicated tracheal intubation to be mandatory with a score of GCS </= 8. CONCLUSIONS: GCS assessment is improved by professional experience and a scoring aid, the use of which needs to be promoted in daily clinical practice. Frequent inaccuracy and misunderstanding regarding clinical applications may alter patient management and misguide treatment and prognosis. TRIAL REGISTRATION: ISRCTN registry (IDISRCTN12257237) https://www.isrctn.com/ISRCTN12257237 Retrospectively registered (last amendment 08/22/2023).

Tags: (according to article 51(2) of the Human Research Act). Consent was received from, (payments from UCB). Stefano Bassetti reports no disclosures. Roland Bingisser, (SSGIM). Stephan Ruegg received unconditional research grants from UCB-pharma. He, *Glasgow Coma Scale/standards, *Physicians/standards, 10001C_192850/1 and 10531C_182422), the Gottfried Julia Bangerter-Rhyner, 33CM30_140338/1, Adult, against Epilepsy (no payments), Editor of EPILEPTOLOGIE (Journal of the Swiss, Bangerter-Rhyner-Stiftung, Berger reports no disclosures. Simon Amacher is supported by the Mach-Gaensslen, BMS/Pfizer. Tolga Dittrich was or is supported by the Swiss Heart Foundation, the, Clinical Competence/standards, Comprehension/physiology, De Quervain research grant, digital SRCTN registry (ID ISRCTN12257237) [20]. Consent for publication: Consent, Eisai, and UCB-pharma, and from serving as a consultant for Arvelle, Eisai,, Ethics approval and consent to participate: The study was approved by the local, ethics committee (EKNZRequ_2019-00168), who ascertained that this study complies, excellent young researchers of the University of Basel. He holds shares from, Female, Fondazione Dr. Ettore Balli, for publication was obtained from our author P.G. (seen in the picture) to, Foundation (8472/HEG-DSV), and the Swiss Society of General Internal Medicine, Foundation Switzerland and the Nora van Meeuwen-Haefliger Foundation of the, funding from UCB-pharma, and Swiss National Science Foundation Grants: grant, Glasgow Coma Score, Gottfried Julia Bangerter-Rhyner Foundation. He received personal grants from, he disclosed that he is the past president of the Swiss League, Humans, Intensive care, Johnson & Johnson, Roche, Lilly, Bristol-Myers Squibb, Merck, and Novo Nordisk., League against Epilepsy) (no payments), and Editor of the Swiss EEG Bulletin, Male, Middle Aged, Neurocritical care, number 320030_169379/1 and coapplicant for grants numbers 33CM30_125115/1 and, Pfizer, Novartis, Sandoz, and UCB-pharma. He does not hold any stocks of any, pharmaceutical industries or manufacturers of medical devices. He received, portray a participating physician in Fig. 1., Randomized controlled trial, received honoraria from serving on the scientific advisory boards of Arvelle,, received research grants from the Swiss National Foundation (No 320030_169379),, received travel honoraria by Bayer and speaker honoraria by Medtronic and, recordings of their performances. The Reporting Guidelines for Health Care, Reporting Trials) and STROBE (Strengthening The Reporting of OBservational, reports no disclosures. Stephan Marsch reports no disclosures. Raoul Sutter, Reproducibility of Results, Sabina Hunziker is supported by the Swiss National Foundation (SNF) (Ref, science funds of the University Hospital Basel, and the Research fund for, Science Funds [Wissenschaftsfonds] of the, Simulation Research-and extensions to the CONSORT (CONsolidated Standards Of, studies in Epidemiology) Statements-for randomized trials were followed. The, study was retrospectively registered online (last amendment 08/22/2023) at the, Swiss Neurological Society, Swisslife Jubilaumsstiftung for Medical Research, the Research Fund of the University Basel, the Scientific Society Basel, and the, the Swiss National Science Foundation, the volunteering physicians for the anonymized analyses of the video- and audio, Thermo Fisher GmbH. He, Tisljar reports no disclosures. Pascale Grzonka reports no disclosures. Sebastian, UCB-pharma and holds stocks from Novartis, Roche, Alcon, and Johnson & Johnson., University Hospital Basel and University of Basel, University of Basel, Switzerland. Gian Marco De Marchis was or is supported by, with the general ethical principles for research involving human subjects.

Arleth, T., Baekgaard, J., Siersma, V., Creutzburg, A., Dinesen, F., Rosenkrantz, O., Heiberg, J., et al. “Early Restrictive Vs Liberal Oxygen For Trauma Patients: The Traumox2 Randomized Clinical Trial”. Jama 333, no. 6: 479-489. doi:10.1001/jama.2024.25786.

Abstract: IMPORTANCE: Early administration of supplemental oxygen for all severely injured trauma patients is recommended, but liberal oxygen treatment has been associated with increased risk of death and respiratory complications. OBJECTIVE: To determine whether an early 8-hour restrictive oxygen strategy compared with a liberal oxygen strategy in adult trauma patients would reduce death and/or major respiratory complications. DESIGN, SETTING, AND PARTICIPANTS: This randomized controlled trial enrolled adult trauma patients transferred directly to hospitals, triggering a full trauma team activation with an anticipated hospital stay of a minimum of 24 hours from December 7, 2021, to September 12, 2023. This multicenter trial was conducted at 15 prehospital bases and 5 major trauma centers in Denmark, the Netherlands, and Switzerland. The 30-day follow-up period ended on October 12, 2023. The primary outcome was assessed by medical specialists in anesthesia and intensive care medicine blinded to the randomization. INTERVENTIONS: In the prehospital setting or on trauma center admission, patients were randomly assigned 1:1 to a restrictive oxygen strategy (arterial oxygen saturation target of 94%) (n = 733) or liberal oxygen strategy (12-15 L of oxygen per minute or fraction of inspired oxygen of 0.6-1.0) (n = 724) for 8 hours. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of death and/or major respiratory complications within 30 days. The 2 key secondary outcomes, death and major respiratory complications within 30 days, were assessed individually. RESULTS: Among 1979 randomized patients, 1508 completed the trial (median [IQR] age, 50 [31-65] years; 73% male; and median Injury Severity Score was 14 [9-22]). Death and/or major respiratory complications within 30 days occurred in 118 of 733 patients (16.1%) in the restrictive oxygen group and 121 of 724 patients (16.7%) in the liberal oxygen group (odds ratio, 1.01 [95% CI, 0.75 to 1.37]; P = .94; absolute difference, 0.56 percentage points [95% CI, -2.70 to 3.82]). No significant differences were found between groups for each component of the composite outcome. Adverse and serious adverse events were similar across groups, with the exception of atelectasis, which was less common in the restrictive oxygen group compared with the liberal oxygen group (27.6% vs 34.7%, respectively). CONCLUSIONS AND RELEVANCE: In adult trauma patients, an early restrictive oxygen strategy compared with a liberal oxygen strategy initiated in the prehospital setting or on trauma center admission for 8 hours did not significantly reduce death and/or major respiratory complications within 30 days. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05146700.

Tags: *Oxygen Inhalation Therapy/methods/adverse effects, *Oxygen/administration & dosage/adverse effects/blood, *Wounds and Injuries/blood/complications/mortality/therapy, Adult, Aged, Female, Humans, Injury Severity Score, Length of Stay, Male, Middle Aged, Oxygen Saturation, Time Factors, Trauma Centers, Treatment Outcome.

Arleth, T., Baekgaard, J., Siersma, V., Creutzburg, A., Dinesen, F., Rosenkrantz, O., Heiberg, J., et al. “Early Restrictive Vs Liberal Oxygen For Trauma Patients: The Traumox2 Randomized Clinical Trial”. Jama 333, no. 6: 479-489. doi:10.1001/jama.2024.25786.

Abstract: IMPORTANCE: Early administration of supplemental oxygen for all severely injured trauma patients is recommended, but liberal oxygen treatment has been associated with increased risk of death and respiratory complications. OBJECTIVE: To determine whether an early 8-hour restrictive oxygen strategy compared with a liberal oxygen strategy in adult trauma patients would reduce death and/or major respiratory complications. DESIGN, SETTING, AND PARTICIPANTS: This randomized controlled trial enrolled adult trauma patients transferred directly to hospitals, triggering a full trauma team activation with an anticipated hospital stay of a minimum of 24 hours from December 7, 2021, to September 12, 2023. This multicenter trial was conducted at 15 prehospital bases and 5 major trauma centers in Denmark, the Netherlands, and Switzerland. The 30-day follow-up period ended on October 12, 2023. The primary outcome was assessed by medical specialists in anesthesia and intensive care medicine blinded to the randomization. INTERVENTIONS: In the prehospital setting or on trauma center admission, patients were randomly assigned 1:1 to a restrictive oxygen strategy (arterial oxygen saturation target of 94%) (n = 733) or liberal oxygen strategy (12-15 L of oxygen per minute or fraction of inspired oxygen of 0.6-1.0) (n = 724) for 8 hours. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of death and/or major respiratory complications within 30 days. The 2 key secondary outcomes, death and major respiratory complications within 30 days, were assessed individually. RESULTS: Among 1979 randomized patients, 1508 completed the trial (median [IQR] age, 50 [31-65] years; 73% male; and median Injury Severity Score was 14 [9-22]). Death and/or major respiratory complications within 30 days occurred in 118 of 733 patients (16.1%) in the restrictive oxygen group and 121 of 724 patients (16.7%) in the liberal oxygen group (odds ratio, 1.01 [95% CI, 0.75 to 1.37]; P = .94; absolute difference, 0.56 percentage points [95% CI, -2.70 to 3.82]). No significant differences were found between groups for each component of the composite outcome. Adverse and serious adverse events were similar across groups, with the exception of atelectasis, which was less common in the restrictive oxygen group compared with the liberal oxygen group (27.6% vs 34.7%, respectively). CONCLUSIONS AND RELEVANCE: In adult trauma patients, an early restrictive oxygen strategy compared with a liberal oxygen strategy initiated in the prehospital setting or on trauma center admission for 8 hours did not significantly reduce death and/or major respiratory complications within 30 days. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05146700.

Tags: *Oxygen Inhalation Therapy/methods/adverse effects, *Oxygen/administration & dosage/adverse effects/blood, *Wounds and Injuries/blood/complications/mortality/therapy, Adult, Aged, Female, Humans, Injury Severity Score, Length of Stay, Male, Middle Aged, Oxygen Saturation, Time Factors, Trauma Centers, Treatment Outcome.

Liu, K., Patey, C., Norman, P., Moellekaer, A. B., Lim, R., Alvarez, A., and Heymann, E. P. “Interventions To Reduce Burnout In Emergency Medicine: A National Inventory Of The Canadian Experience To Support Global Implementation Of Wellness Initiatives”. Intern Emerg Med 20, no. 4: 1245-1264. doi:10.1007/s11739-024-03811-4.

Abstract: Burnout in healthcare workers is a global issue, with Emergency Medicine (EM) particularly impacted. Many countries have tried implementing wellness initiatives to reduce burnout and improve wellness. This paper summarizes interventions implemented in Canada to-date with the aim of supporting the design of wellness interventions in EDs globally. A systematic review and a grey literature search were completed in November 2023. Original studies in both English and French that included the implementation and evaluation of a wellness intervention in EDs in Canada were included. The study design, content of the intervention, target population, and outcomes were extracted and narratively analyzed. 13 studies were included. Each implemented a unique wellness intervention for EDs. All three studies (3/3, 100%) that included a structured wellness curriculum demonstrated significant improvement in burnout as measured by the Maslach Burnout Inventory, physical health (PCS-8), and Brief Resident Wellness Profile (BRWP). Other interventions included Ice Cream Rounds, therapy dogs, changing the duration of night shifts, and sessions on resilience and self-care. Our Canada-wide analysis of wellness interventions identified initiatives geared towards trainees, staff, or entire ED workface groups. Examples include educational programs, dedicated sessions for compassion literacy and resilience, critical events debriefing, and optimizing shift schedules. Structured wellness curriculums seem to be effective, and this area warrants further study. Moreover, we identify a need for global collaboration to build wellness programs and for more easily translatable standardized outcome measures for assessing the efficacy of wellness programs in EM.

Tags: *Burnout, Professional/prevention & control/psychology, *Emergency Medicine/methods, *Health Promotion/methods/standards, Burnout, Canada, conflict of interest. Human and animal rights statement and Informed consent:, Emergency departments, Humans, International insights, Occupational resilience, This study did not involvement of human or animal participants., Wellness.

Dawoud, A., Youness, R. A., Elsayed, K., Nafae, H., Allam, H., Saad, H. A., Bourquin, C., Szabo, C., Abdel-Kader, R., and Gad, M. Z. “Emerging Roles Of Hydrogen Sulfide-Metabolizing Enzymes In Cancer”. Redox Rep 29, no. 1: 2437338. doi:10.1080/13510002.2024.2437338.

Abstract: Gasotransmitters play crucial roles in regulating many physiological processes, including cell signaling, cellular proliferation, angiogenesis, mitochondrial function, antioxidant production, nervous system functions and immune responses. Hydrogen sulfide (H(2)S) is the most recently identified gasotransmitter, which is characterized by its biphasic behavior. At low concentrations, H(2)S promotes cellular bioenergetics, whereas at high concentrations, it can exert cytotoxic effects. Cystathionine beta-synthetase (CBS), cystathionine-gamma-lyase (CSE), 3-mercaptopyruvate sulfurtransferase (3-MST), and cysteinyl-tRNA synthetase 2 (CARS2) are pivotal players in H(2)S biosynthesis in mammalian cells and tissues. The focus of this review is the regulation of the various pathways involved in H(2)S metabolism in various forms of cancer. Key enzymes in this process include the sulfide oxidation unit (SOU), which includes sulfide:quinone oxidoreductase (SQOR), human ethylmalonic encephalopathy protein 1 (hETHE1), rhodanese, sulfite oxidase (SUOX/SO), and cytochrome c oxidase (CcO) enzymes. Furthermore, the potential role of H(2)S methylation processes mediated by thiol S-methyltransferase (TMT) and thioether S-methyltransferase (TEMT) is outlined in cancer biology, with potential opportunities for targeting them for clinical translation. In order to understand the role of H(2)S in oncogenesis and tumor progression, one must appreciate the intricate interplay between H(2)S-synthesizing and H(2)S-catabolizing enzymes.

Tags: *Hydrogen Sulfide/metabolism, *Neoplasms/metabolism/enzymology, Animals, cysteine aminotransferase (CAT), ethylmalonic encephalopathy protein 1 (ETHE1), H2s, Humans, metabolism, sulfide quinone oxidoreductase (SQOR), sulfite oxidase (SUOX).

Koechlin, L., Boeddinghaus, J., Doudesis, D., Lopez-Ayala, P., Zimmermann, T., Rumora, K., du Fay de Lavallaz, J., et al. “Diagnostic And Prognostic Performance Of High-Sensitivity Cardiac Troponin T Vs I”. J Am Coll Cardiol 85, no. 4: 381-385. doi:10.1016/j.jacc.2024.10.076.

Tags: (CH/F/21/90010), Programme Grant (RG/20/10/34966), and a Research Excellent Award, (FS/18/25/33454). Dr Lopez-Ayala has received research grants from the Swiss, (P400PM_191037/1), the Prof. Dr. Max Cloetta Foundation, the Margarete und Walter, (RE/18/5/34216) from the British Heart Foundation, 2024, has received speaker honoraria/consulting fees from Ablative Solutions,, Abbott, Abbott Diagnostics, Roche Diagnostics, Siemens Healthineers, and LumiraDx. Dr, Academy of Medical Sciences, and the Gottfried and Julia, acute myocardial infarction, Akademische Gesellschaft Basel", Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Inari, Medtronic, Merck, ReCor, analysis of the data, the preparation of the manuscript, or the decision to, and analysis, wrote the paper, and decided to publish. The sponsors had no role, and has, and has received honoraria or consultancy from, and has received research grants from the Swiss Heart Foundation. Dr, and has received speaker honoraria from, and has received speaker honoraria/consulting, and until May, authors designed the study, gathered, and analyzed the data, vouched for the data, award from the Medical Research Council (MR/N013166/1). Dr Ken Lee is supported, Bangerter-Rhyner Foundation, the Prince Charles Hospital Foundation, and a PHD, Bangerter-Rhyner-Foundation, Basel (Switzerland), the University Basel (Switzerland), Brahms Diagnostica,, Bayer, Boehringer Ingelheim, BMS, Idorsia, Novartis, Osler, Roche, Sanofi,, Bayer, Ortho Clinical Diagnostics, and Orion Pharma, outside the submitted work., Brahms, Idorsia, Novartis, LSI Medience Corporation, Ortho Clinical Diagnostics,, by a British Heart Foundation Clinical Research Training Fellowship, Coulter, Coulter, Brahms, Idorsia, LSI Medience Corporation, Ortho Clinical Diagnostics,, data or writing the manuscript. The manuscript and its contents have not been, diagnostic algorithms, Dr Mahfoud has been supported by Deutsche Gesellschaft fur Kardiologie, Deutsche, e-print servers. Dr Koechlin has received a research grant from the Swiss Heart, European Union, the University Hospital Basel, the University of Basel, Abbott,, Forschungsgemeinschaft (SFB TRR219, Project-ID 322900939), and Deutsche, Foundation (Australia) and the Emergency Care Foundation (New Zealand). The, Foundation, Brisbane, Australia. Dr Rubini has received speaker honoraria from, Foundation, outside the submitted work. Dr Wildi has received a research grant, Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation, Foundation, the University of Basel, the Swiss Academy of Medical Sciences and, from the "Freiwillige Akademische Gesellschaft Basel," the Gottfried and Julia, from the University of Basel and the Division of Internal Medicine, the Swiss, from the University of Edinburgh, grants from the Swiss National Science Foundation, the Swiss Heart Foundation,, has received research grants, has received research support from the Swiss National Science Foundation, Heart Foundation (FF20079 and FF21103), Herzstiftung, high-sensitivity cardiac troponin T and I, honoraria from Siemens and Roche Diagnostics. Dr Doudesis is supported by an, in designing or conducting the study and no role in gathering or analyzing the, institution. All other authors have reported that they have no relationships, Lichtenstein-Stiftung (3MS1038), and the University Hospital Basel, Medical, Servier, and Terumo. Dr Mills is supported by a Chair Award, Mueller has received research support from the Swiss National Science Foundation,, Nestelberger has received speaker honoraria/consulting honoraria from Beckman, Novartis, AstraZeneca, Boehringer Ingelheim, Roche, and Singulex. The Basel IX, Polymedco, Dr Risch, Roche Diagnostics, Siemens, and Abbott outside the submitted, prognostic, published previously and are not being considered for publication elsewhere in, Quidel, paid to the institution, outside the submitted work. Dr Wussler has, Quidel, Roche, Siemens, Singulex, and SpinChip Diagnostics. The BASEL VIII study, Quidel, Roche, Siemens, Singulex, Sphingotec, and SpinChip Diagnostics, received research support from the University of Basel and the Swiss Heart, received speaker honoraria/consulting honoraria from Abbott, Amgen, AstraZeneca, received speaker honoraria/consulting honoraria from Siemens, Beckman Coulter,, relevant to the contents of this paper to disclose. The investigated hs-cTn assay, Saarland University (former affiliation) has received scientific, scholarship from the University of Queensland and The Wesley Medical Research, Singulex, and SpinChip Diagnostics, all outside the current work and paid to the, Singulex, the University Hospital Basel (Switzerland), and the Emergency Medicine, study was supported by research grants from the Swiss National Science, submit the manuscript for publication., support from Ablative Solutions, Medtronic, and ReCor Medical, the Gottfried and Julia Bangerter-Rhyner Foundation, as well as the "Freiwillige, the KTI, the University Hospital Basel, the University of Basel, Abbott, Beckman, the Swiss Heart Foundation, the KTI, the University Hospital Basel, the, University of Basel, Abbott, AstraZeneca, Beckman Coulter, Boehringer Ingelheim,, was donated by the manufacturers, who had no role in the design of the study, the, was supported by research grants from the Swiss Heart Foundation, the KTI, the, whole or in part in any language, including publicly accessible web sites or, work and paid to the institution. Dr Boeddinghaus has received research grants.

Liu, K., Young, C., Norman, P., Yaremko, H., Moellekaer, A. B., Lim, R., Heymann, E. P., and Patey, C. “Modulating Throughput: Practical Emergency Department (Ed) Flow Models From A Rural Canadian Ed To Directly Increase Patient Throughput”. Intern Emerg Med. doi:10.1007/s11739-024-03834-x.

Bar, S., Diaper, J., Fontao, F., Belin, X., Abrard, S., Albu, G., Dupont, H., Habre, W., and Schiffer, E. “Early And Concomitant Administration Of Norepinephrine And Ilomedin Improves Microcirculatory Perfusion Without Impairing Macrocirculation In An Intestinal Ischemia-Reperfusion Injury Swine Model: A Randomized Experimental Trial”. Shock 63, no. 4: 606-613. doi:10.1097/SHK.0000000000002533.

Abstract: Background: Intestinal ischemia-reperfusion injury is associated with both macrocirculatory and microcirculatory failure. Association of a vasoconstrictor in combination with a vasodilator such as ilomedin may improve macrocirculation parameters, microcirculation perfusion and reduce endothelial dysfunction. The primary objective was to demonstrate a difference in mean arterial pressure (MAP) after intestinal reperfusion with the concomitant administration of norepinephrine and ilomedin during ischemia compared with traditional hemodynamic treatment strategies (fluid resuscitation and vasopressors only). Secondary objectives were to demonstrate an improvement in peripheral and intestinal microcirculatory perfusion and endothelial dysfunction after intestinal reperfusion using this association. Methods: We conducted a randomized preclinical trial in 21 large white pigs, in which a 2-h small bowel ischemia was performed using a segmental mesenteric occlusion model, followed by a 2-h reperfusion. Pigs were randomized into the following three groups: goal-directed fluid therapy, early administration of norepinephrine before reperfusion and early administration of ilomedin and norepinephrine before reperfusion. Macrocirculatory (MAP and Cardiac Index (CI), microcirculatory (Sublingual with SideStream Dark Field system and intestinal hemoglobin oxygen saturation with hyperspectral imaging) measurements and biological analysis (biomarkers of endothelial dysfunction) were performed. Results: There were no significant differences in the MAP ( P = 0.499) and the CI ( P = 0.659) between the three groups. Perfused vessel density in sublingual microcirculation was significantly higher immediately after reperfusion and 2 h after reperfusion in the early administration of ilomedin and norepinephrine group compared with the other two groups ( P < 0.05). Hemoglobin oxygen saturation measured at the intestinal level was significantly higher immediately after reperfusion in the early administration of ilomedin and norepinephrine group compared with the other two groups ( P < 0.01). There were no significant differences in biomarkers of endothelial dysfunction between the three groups. Creatinine, AST and alkaline phosphatases increased significantly 2 h after reperfusion in the early administration of ilomedin and norepinephrine group compared with baseline ( P < 0.05). Conclusions: Early administration of norepinephrine and ilomedin during ischemia improved short-term postreperfusion sublingual and intestinal microcirculation without worsening macrocirculatory parameters in an intestinal ischemia-reperfusion injury model. However, use of this strategy seemed to worsen both liver and kidney function.

Tags: *Intestines/blood supply, *Microcirculation/drug effects, *Norepinephrine/therapeutic use/administration & dosage/pharmacology, *Reperfusion Injury/drug therapy/physiopathology, Animals, Disease Models, Animal, Male, Random Allocation, Swine.

Wirz, Y. A., and Marti, F. “Repetition Of Sugammadex Up To An Equimolar Dose In Cases Of Accidental Subcutaneous Rocuronium Administration”. Eur J Anaesthesiol 42, no. 1: 86. doi:10.1097/EJA.0000000000001997.

Trolliet, M., Pasquier, M., Blancher, M., Albrecht, R., Lovis, A., Brugger, H., and Kottmann, A. “The Impact Of A Dedicated Checklist On The Quality Of Onsite Management Of Critically Buried Avalanche Victims In Cardiac Arrest In A Swiss Helicopter Emergency Medical Service”. Scand J Trauma Resusc Emerg Med 32, no. 1: 124. doi:10.1186/s13049-024-01300-3.

Abstract: BACKGROUND: The management of avalanche victims in cardiac arrest (CA) is a challenging situation for rescuers. Despite existing specific management algorithms, previous studies have reported poor compliance with international guidelines and incomplete documentation and transmission of the information required for patient management. The Avalanche Victim Resuscitation Checklist (AVRC) was developed in 2014 in response by the International Commission for Mountain Emergency Medicine. Our aim was to assess the impact of the AVRC on the quality of onsite management of critically buried avalanche victims in CA, i.e. the compliance of management with international guidelines and the completeness of documentation of avalanche specific information. METHODS: We assessed compliance and documentation in a Swiss helicopter emergency medical service (HEMS) between January 2010 and April 2020. Victims buried for more than 24 h were excluded. RESULTS: In the 10-year study period, 87 critically buried avalanche victims in CA were treated by the HEMS, 44 of them after the introduction of the AVRC. Enough information was available to assess management compliance in over 90% of cases (n = 79). Inadequate management (n = 25, 32%) and incomplete documentation occurred more often in patients with a long burial duration. After the introduction of the AVRC, the compliance of patient management with the guidelines increased by 36% (from 59 to 95%, p < 0.05) and led to complete documentation of the required information for patient management. CONCLUSIONS: The use of the AVRC improves the quality of management of critically buried avalanche victims in CA and ensures complete documentation of avalanche specific information. Quality improvement efforts should focus on the management of avalanche victims with a long burial duration. The use of the AVRC enables identification and appropriate treatment of patients with hypothermic cardiac arrest.

Tags: *Air Ambulances, *Avalanches, *Checklist, *Emergency Medical Services/standards, approval from the Cantonal Commission for Ethics in Human Research (Zurich,, Avalanche, Cardiac arrest, Cardiopulmonary Resuscitation/methods/standards, Checklist, Compliance, Documentation, Female, Guideline Adherence, Heart Arrest/therapy, Humans, Male, Not applicable. Competing interests: The authors declare no competing interests., Out-of-Hospital Cardiac Arrest/therapy, Quality, Retrospective Studies, Switzerland, Switzerland) on 6 March 2020 (protocol no. 2020-048). Consent for publication:.

Taheri, O., Samain, J., Mauny, F., Puyraveau, M., Desmettre, T., and Marx, T. “Contribution Of Point-Of-Care Ultrasound In The Prehospital Management Of Patients With Non-Trauma Acute Dyspnea: A Systematic Review And Meta-Analysis”. Eur J Emerg Med 32, no. 2: 87-99. doi:10.1097/MEJ.0000000000001205.

Abstract: Acute dyspnea is a common symptom whose management is challenging in prehospital settings. Point-of-care ultrasound (POCUS) is increasingly accessible because of device miniaturization. To assess the contribution of POCUS in the prehospital management of patients with acute nontraumatic dyspnea, we performed a systematic review on nontrauma patients of any age managed in the prehospital setting for acute dyspnea and receiving a POCUS examination. We searched seven databases and gray literature for English-language studies published from January 1995 to November 2023. Two independent reviewers completed the study selection, data extraction, and risk of bias assessment. The primary outcome was the assessment of the contribution of POCUS to feasibility, diagnostic, therapeutic, prognosis, patient referral, and transport vector modification. Twenty-three studies were included. The risk of bias assessment identified 3 intermediate-risk, 18 serious-risk, and 2 critical-risk studies. Three studies reported moderate to excellent feasibility for lung POCUS, and three studies reported poor to mediocre feasibility for cardiac POCUS. The median duration of the POCUS examination was less than 5 minutes (six studies). POCUS improved diagnostic identification (seven studies). The diagnostic accuracy of POCUS was excellent for pneumothorax (sensitivity = 100%, specificity = 100%, two studies), very good for acute heart failure (sensitivity = 71-100%, specificity = 72-95%, eight studies), good for pneumonia (sensitivity = 88%, specificity = 59%, one study), and moderate for pleural effusion (sensitivity = 26-53%, specificity = 83-92%, two studies). Treatment was modified in 11 to 54% of the patients (seven studies). POCUS had no significant effect on patient prognosis (two studies). POCUS contributed to patient referrals and transport vectors in 51% (four studies) and 25% (three studies) of patients, respectively. The evidence supports the use of POCUS for managing acute nontraumatic dyspnea in the prehospital setting in terms of feasibility, overall diagnostic contribution, and, particularly, lung ultrasound for acute heart failure diagnosis. Moreover, POCUS seems to have a therapeutic contribution. There is not enough evidence supporting the use of POCUS for pneumonia, pleural effusion, pneumothorax, chronic obstructive pulmonary disease, or asthma exacerbation diagnosis, nor does it support prognostic, patient referral, and transport vector contribution. A high level of evidence is lacking and needed.

Tags: *Dyspnea/therapy/diagnostic imaging, *Emergency Medical Services/methods, *Point-of-Care Systems, Acute Disease, Humans, Pneumothorax/diagnostic imaging, Ultrasonography/methods.

Lurtz, J., T, C. Sauter, and Jacob, C. “Factors Impacting The Adoption And Potential Reimbursement Of A Virtual Reality Tool For Pain Management In Switzerland: Qualitative Case Study”. Jmir Hum Factors 11: e59073. doi:10.2196/59073.

Abstract: BACKGROUND: Pain and its adequate treatment are an issue in hospitals and emergency departments (EDs). A virtual reality (VR) tool to manage pain could act as a valuable complement to common pharmaceutical analgesics. While efficacy could be shown in previous studies, this does not assure clinical adoption in EDs. OBJECTIVE: The main aim of this study was to investigate which factors affect the adoption and potential reimbursement of a VR tool for pain management in the ED of a Swiss university hospital. METHODS: Key informant interviews were conducted using in-depth semistructured interviews with 11 participants reflecting the perspectives of all the relevant stakeholder groups, including physicians, nurses, patients, health technology providers, and health insurance and reimbursement experts. The interviews were recorded and transcribed, and the extracted data were systematically analyzed using a thematic analysis and narrative synthesis of emergent themes. A consolidated framework for eHealth adoption was used to enable a systematic investigation of the topic and help determine which adoption factors are considered as facilitators or barriers or as not particularly relevant for the tool subject of this study. RESULTS: According to the participants, the three key facilitators are (1) organizational environment; (2) tension for change, ease of use, and demonstrability; and (3) employee engagement. Further, the three key barriers to adoption are (1) workload, (2) changes in clinical workflow and habit, and (3) reimbursement. CONCLUSIONS: This study concludes that the adoption of a VR tool for pain management in the ED of the hospital subject of this study, although benefiting from a high tension for change in pain and workload management, is highly dependent on the respective organizational environment, engagement of the clinical staff, and reimbursement considerations. While tailored incentive structures and ambassador roles could benefit initial adoption, a change in the reimbursement landscape and further investigation of the positive effects on workflow effectiveness are required to drive long-term adoption.

Tags: *Pain Management/economics/methods, *Qualitative Research, *Virtual Reality, acceptance, adoption, Adult, attitude, digital health, eHealth, emergency, Emergency Service, Hospital, experience, Female, hospital, Humans, implementation, Insurance, Health, Reimbursement, interview, Interviews as Topic, Male, mHealth, Middle Aged, mobile health, opinion, pain, perception, qualitative, reimbursement, Reimbursement Mechanisms, Switzerland, technology adoption, technology assessment, virtual reality, Vr.

Dos Santos Rocha, A., Betello, M., Nikolaou, A., Sudy, R., Albu, G., and Schiffer, E. “Failure Of Neuromuscular Blockade Despite High Doses Of Rocuronium And Atracurium In A Patient With Colorectal Carcinoma: A Case Report”. Eur J Anaesthesiol 42, no. 1: 73-76. doi:10.1097/EJA.0000000000002076.

Abstract: Resistance to the effects of rocuronium and other neuromuscular blocking agents (NMBA) has been previously reported, including delayed onset of relaxation, rapid recovery and incomplete paralysis under recommended doses. These conditions have been associated with denervation injury, burns, immobilisation, infections, metabolic disorders, and drug interactions. In this report, we describe the case of a young male without any known pre-disposing factor for NMBA resistance, who failed to attain muscle relaxation with non-depolarising NMBA despite high doses of rocuronium and atracurium during two surgeries for colorectal cancer, several months apart. Investigations for drug failure and genetic testing did not indicate a plausible cause. After chemotherapy and tumour resection, the patient underwent a third surgical procedure under general anaesthesia with normalised NMBA response. Patient's written consent was obtained for publication.

Tags: *Atracurium/administration & dosage, *Colorectal Neoplasms/surgery, *Neuromuscular Blockade/methods/adverse effects, *Neuromuscular Nondepolarizing Agents/administration & dosage, *Rocuronium/administration & dosage, Adult, Androstanols/administration & dosage, Humans, Male.

Zünd, S., Stuby, L., Suppan, L., Siebert, J. N., and Tinembart, J. M. “Impact Of The First Swiss Conference On Prehospital Emergency Care And Trauma Research (Spectre) On Paramedics' Intention To Engage In Research: Cross-Sectional Study”. In, 2024. doi:10.1016/j.jemermed.2024.11.017.

Abstract: Background: In Switzerland, paramedics lack academic training, meaning they do not receive specialized education in the field of research. Like many other European countries, paramedics are seldom included in prehospital research. However, considering the significant gaps in knowledge within prehospital emergency medicine, educating and involving paramedics could markedly enhance prehospital emergency medicine research and decrease knowledge gap in this area. Study Objective: This cross-sectional study aimed to evaluate the impact of the inaugural Swiss Conference on Prehospital Emergency Care and Trauma Research on paramedics’ inclination to participate in prehospital research. Methods: A questionnaire was administered using Likert-type scales. All participants (100) were asked to answer a web-based questionnaire after attending the conference. Results: Out of 80 responses (80%), 72 were filled by paramedics and therefore included in the analysis. Participants were significantly more willing to engage in prehospital research after attending the conference (40/56, 71.4%) than before (23/56, 41.1%); p < 0.001. Among participants already actively involved, 46.7% (7/15) responded that the event had a positive impact on their level of involvement. The results revealed a noteworthy increase in willingness to engage in research. Conclusions: A one-day conference solely focused on pre-hospital scientific research serves as a motivating factor for paramedics to partake in research in this domain. Whether this will lead to a higher scientific output is unknown. © 2024 The Author

Tags: emergency medical services, paramedic, public health systems research, research.

Giovannoni, L., Pierzchala, K., De Roo, M., Braissant, O., Bruce, S., McLin, V. A., and Vutskits, L. “Effects Of Cholestasis And Hyperammonemia On Dendritic Spine Density And Turnover In Rat Hippocampal Neurons”. Sci Rep 14, no. 1: 29841. doi:10.1038/s41598-024-80871-8.

Abstract: Adults and children with cholestatic liver disease are at risk for type C hepatic encephalopathy (HE) and may present lifelong neurocognitive impairment. While the underlying cellular and molecular mechanisms are still incompletely understood, ammonium and bile acids (BAs) seem to play a key role in this pathology, by crossing the blood-brain-barrier and modifying neuronal homeostasis and synaptic plasticity. This experimental study aimed to investigate the effects of ammonium and BAs on dendritic spines of rat hippocampal CA1 neurons. Taking advantage of the bile duct ligated (BDL) in vivo rat model and a hippocampal organotypic rat ex vivo slice model, we analyzed dendritic spine density in both models and spine turnover ex vivo. BDL rats showed decreased dendritic spine densities after 8 weeks, paralleled with increased concentrations of blood ammonium. In organotypic hippocampal slices, exposure to ammonium, tauro-alpha-muricholic and taurocholic acid induced a decrease in dendritic spine density during the first 3 days, followed by an increase in dendritic spinogenesis during days 4-5, resulting in an increased number of dendritic spines. These observations provide new insights into the effects of ammonium and BAs on dendritic spines and consequently synaptic plasticity in chronic cholestatic liver disease.

Tags: *Cholestasis/pathology/metabolism, *Dendritic Spines/metabolism/pathology, *Hippocampus/pathology/metabolism, *Hyperammonemia/metabolism/pathology, Ammonium Compounds/metabolism, Animals, Bile Acids and Salts/metabolism, CA1 Region, Hippocampal/pathology/metabolism, Disease Models, Animal, Hepatic Encephalopathy/pathology/metabolism/etiology, Male, Neuronal Plasticity, Neurons/metabolism/pathology, Rats, Rats, Wistar.

Stirnemann, J., Serratrice, J., Mann, T., Louge, P., Christophe, C., Samii, K., Pignel, R., et al. “Protocol For A Multicentric, Double-Blind, Randomised Controlled Trial Of Hyperbaric Oxygen Therapy (Hbot) Versus Sham For Treating Vaso-Occlusive Crisis (Voc) In Sickle Cell Disease (Scd) In Patients Aged 8 Years Or Older (Hbot-Scd Study)”. Bmj Open 14, no. 11: e084825. doi:10.1136/bmjopen-2024-084825.

Abstract: INTRODUCTION: Sickle cell disease (SCD) is one of the most common genetic diseases in the world, annually affecting approximately 310 000 births and causing >100 000 deaths. Vaso-occlusive crisis (VOC) is the most frequent complication of SCD, leading to bone pain, thoracic pain (acute chest syndrome) and/or abdominal spasms. It is the main cause of mortality in patients with SCD, reducing life expectancy. Hyperbaric oxygen therapy (HBOT) is a safe and well-established method of increasing tissue oxygen delivery immediately by up to 10-fold to 20-fold. In the context of VOC, HBOT has the potential to limit sickling. A previous pilot study of nine patients showed the safety and potential benefits of HBOT on VOC-induced pain. Our study aimed to assess the clinical safety and effectiveness of HBOT for treating VOC, its biological mechanisms of actions and its cost-effectiveness. METHODS AND ANALYSIS: This is a multicentric, triple-blinded, randomised controlled trial. Patients aged 8 years or above with a diagnosed major form of SCD, presenting at one of the participating centres' emergency departments (EDs) with a VOC requiring level 3 analgesia (according to WHO definition), will be eligible. Exclusion criteria are pregnancy, mechanical ventilation, previous history of stroke or prior transcranial Doppler ultrasound anomaly, contraindication to HBOT and the need for above 2 L/min of oxygen. All patients will receive the usual care for VOCs, including hydration, analgesics, normobaric oxygen therapy and when medically indicated, antibiotic therapy and/or transfusions. Within 24 hours of their arrival in the ED (or longer in specific cases), and after obtaining informed consent, patients will be randomised into the HBOT intervention group (2.0 atmosphere absolute (ATA), 90 min, FIO(2)=1) or the sham group (1.3 ATA, 90 min, FIO(2)=0.21). After their first HBOT session, patients will return to their acute-care ward. Patients in both arms will undergo a second and third session within 24-36 hours of the first, unless their Visual Analogue Scale (VAS)-pain is </=2 without use of level 3 analgesics. The difference in the pain-VAS before and after HBOT and other outcomes will be compared between the intervention and sham groups. Our composite primary outcome will be (1) the change in global VAS-pain 6 hours after initiation of HBOT; (2) the number of patients with a VAS-pain score >4 and/or a morphine dosage >1 mg/hour intravenous after the HBOT/sham session. Other outcomes to be reported are morphine usage, length of stay, biological parameters, satisfaction, complications and cost. ETHICS AND DISSEMINATION: Ethical approval CER Geneva 2019-01707 (last submission V.5.1, 06.15.2023). The results of the studies will be disseminated by several media, including publications in peer-reviewed international medical journals, and presentations at national and/or international conferences. TRIAL REGISTRATION NUMBER: NCT04978116.

Tags: *Anemia, Sickle Cell/complications/therapy, *Hyperbaric Oxygenation/methods, Adolescent, Adult, Anaemia, Child, Double-Blind Method, Emergency Service, Hospital, Female, Humans, Internal medicine, Male, Multicenter Studies as Topic, Randomized Controlled Trials as Topic, Young Adult.

Legouis, D., Monard, C., Ourahmoune, A., Sgardello, S., Quintard, H., Criton, G., Sangla, F., and Schneider, A. “Differential Effects Of Thiamine And Ascorbic Acid In Clusters Of Septic Patients Identified By Latent Variable Analysis”. Crit Care 28, no. 1: 396. doi:10.1186/s13054-024-05188-4.

Abstract: BACKGROUND: Thiamine and ascorbic acid have been proposed to mitigate the devastating consequences of sepsis and septic shock. To date, randomized controlled trials have failed to demonstrate a benefit of these therapies and heterogeneity of treatment effect is suspected. In this study, we aimed at assessing the heterogeneity of treatment effect of thiamine (B1) and the combination of B1 plus ascorbic acid (AA + B1) in critically ill patients with sepsis. METHODS: We conducted a bi-centric retrospective cohort study. All adult patients admitted to the ICU with sepsis or septic shock between January 2012 and August 2022 were included. Patient clusters were identified using latent variable analysis based on demographics and physiological variables obtained within 24 h of admission. Within each cluster and using inverse probability weighted Cox models, we compared in-hospital mortality between patients who received standard treatment (control), standard treatment plus B1 (B1 group), and standard treatment plus a combination of thiamine and ascorbic acid (AA + B1 group). RESULTS: A total of 3465 septic patients were included, 2183, 1054 and 228 in the standard, B1 and AA + B1 groups respectively. Five clusters of patients were identified in an unsupervised manner. The "Cluster Severe" included the most severely ill patients, the "Cluster Resp" patients presented with predominantly respiratory failure, the "Cluster Old" included elderly patients with multiple comorbidities, the "Cluster Fit" patients were young, healthy with low severity indices and "Cluster Liver" included patients with predominant liver failure. B1 treatment was associated with different outcomes across the five clusters. It was associated with a lower in-hospital mortality in the "Cluster Severe" and "Cluster Resp". On the other hand, the combination of thiamine and ascorbic acid was not associated with reduced mortality in any cluster but an increased mortality in"Cluster Old". CONCLUSIONS: These results reinforce the lack of efficacy of the combination of AA + B1 reported in recent trials and even raise concerns about potential harm in older patients with comorbidities. On the contrary, we reported improved ICU survival associated with B1 supplementation in the most severe patients and those with predominant respiratory failure, supporting the need for further trials in this specific population.

Tags: *Ascorbic Acid/therapeutic use/pharmacology, *Sepsis/drug therapy/mortality, *Thiamine/therapeutic use/pharmacology, 2023-00147, Commission Cantonale d'Ethique de la Recherche). The study was, Adult, Aged, Aged, 80 and over, Ascorbic acid, by the local ethical committee for human studies of Geneva, Switzerland (CCER, Cluster Analysis, Cohort Studies, Female, HAT therapy, Hospital Mortality, Humans, Intensive Care Units/organization & administration/statistics & numerical data, interests: The authors declare no competing interests., Male, Middle Aged, performed according to the Declaration of Helsinki principles. Consent for, publication: All authors have approved the manuscript for submission. Competing, Retrospective Studies, Sepsis, Thiamine.

Monaghan, M. N., Lang-Hodge, A. M., Chun, S., Lim, R., Lang, E., and Heymann, E. P. “Restructuring The Role Of Emergency Departments In The Healthcare Systems: A Vector To Improving Physician Resilience”. Intern Emerg Med 20, no. 2: 535-540. doi:10.1007/s11739-024-03814-1.

Abstract: Healthcare systems are continuously evolving to respond to new geodemographic demands, among other challenges. At the forefront of this exercise of malleability, Emergency Departments (EDs) are often put to test as the default access point, while the rest of the system takes time to adapt. Once highly adaptable, years of cumulative strain have stressed the limits of the current organization of Emergency Departments (ED) within the healthcare system worldwide. The consequences are many, most notably for Emergency Physicians (EPs), who now face the highest rate of burnout among all medical specialties, with career resilience at an all-time low and diminished interest in the profession. Understanding how EDs are structured within their respective healthcare system provides a unique lens through which areas of improvement can be assessed. This paper discusses solutions to improve the overall structure of the healthcare system to help improve responsiveness, reduce relegation of tasks to the ED, and help improve working conditions and wellbeing for EPs.

Tags: *Emergency Service, Hospital/organization & administration, *Physicians/psychology, *Resilience, Psychological, Burnout, Professional/psychology/prevention & control, conflict of interest. Human and animal rights statement: This article does not, contain any studies involving human participants or animals as it is a review of, Delivery of Health Care/organization & administration, Emergency department, Healthcare, Humans, Physician wellness, previously published data. Informed consent: Formal consent is not required for, Restructuring, this type of study., Wellbeing.

Piletta-Zanin, A., Scherl, A., Benhamou, A., Braendle, G., Caubet, J. C., Graham, F., Grosgurin, O., et al. “The Severity Of Allergic Reactions In A Real-World Environment Is Independent Of The Eliciting Amounts Of Foods”. Allergy 80, no. 1: 238-247. doi:10.1111/all.16413.

Abstract: INTRODUCTION: Patients with food allergies need personalized information on their risk of reaction in "real-life" situations. This multicentric study aimed to investigate the link during accidental reactions between the nature and amount of food allergens consumed in "real-life situation" and the severity of the symptoms. METHODS: Patients were prospectively recruited from December 1, 2020, to December 31, 2021, at the emergency departments in the Geneva University Hospitals and local pediatric emergency facilities, through an allergy outpatient clinic, at school and daycare facilities and trough their primary care physicians. Medical history of patients presenting reactions suggestive with immediate food allergy and suspected food samples were collected. Allergy diagnostic tests were retrospectively and prospectively collected. The samples were analyzed for their allergen content. RESULTS: We recruited 147 subjects with an accidental immediate-type allergic reaction to a food. We were able to collect 115 reaction-eliciting food samples allowing to quantify the allergen amount causing the reaction, as well as correlating this amount to the severity of the reaction. Children represented a large part of the reactors, and most reactions were to common food allergens such as tree nuts, cow's milk as well as peanuts and hen's egg. Reactions were mostly to prepackaged foods and seven reactions were to products with precautionary allergy labeling, or without labelling to the eliciting allergen. Reactions were of various degrees of severity, and independent to the amount of allergen ingested. DISCUSSION: The severity of reactions did not show a direct correlation with allergen quantity, emphasizing individual sensitivity. Some reactions occurred with allergen amounts significantly below the legal limit for mandatory labelling of 1 g/kg (1000 ppm) in Switzerland. The study also highlighted considerable variability in allergen concentrations in foods labeled with possible "contaminations" or "traces". These findings raise questions about the accuracy of allergen labeling and regulations in Switzerland.

Tags: *Allergens/immunology/adverse effects, *Food Hypersensitivity/diagnosis/epidemiology/immunology/etiology, *Food/adverse effects, Adolescent, Adult, Child, Child, Preschool, Female, Humans, Infant, Male, Middle Aged, Prospective Studies, Retrospective Studies, Severity of Illness Index.

Freund, Y., Kabrhel, C., Casey, S. D., Vinson, D. R., Stubblefield, W. B., Kline, J., Douillet, D., et al. “Ruling Out Pulmonary Embolism Safely: Standardized Reporting Of The Failure Rate”. Acad Emerg Med 32, no. 3: 360-362. doi:10.1111/acem.15055.

Tags: article, computer assisted tomography, D dimer, deep vein thrombosis, diagnostic imaging, emergency physician, emergency ward, follow up, human, lung embolism, Note.

Fehlmann, C. A., Loughlin, K. M., Cosgrif, E. J., Ferrick, J. F., van Oppen, J. D., and European Taskforce for Geriatric Emergency, Medicine. “Correction: Service Provision For Frailty In European Emergency Departments (Feed): A Survey Of Operational Characteristics”. Scand J Trauma Resusc Emerg Med 32, no. 1: 119. doi:10.1186/s13049-024-01293-z.

Abstract: https://doi.org/10.1186/s13049-024-01234-w. Following the publication of the Original Article, the authors reported that they missed including two names from the collaborators’ list, namely Effie Polyzogopoulou (Greece) and Lluís Llauger (Spain). The original article has been updated to include the two names on the collaborators’ list. © The Author(s) 2024.

Tags: cross-sectional study, erratum, human.

Swiss Emergency Research collection

2025

2024