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Swiss Emergency Research collection

2025

  • Wenger, L. S., Saifee, J. F., Macikunas, A., Shetty, J., Fredricks, K., Wiemker, V., Russell, E. A., et al. “Examining Structural And Social Supports Offered To Resettled Refugees In 10 Host Countries - A Scoping Review Acknowledging Health In All Policies”. Current Tropical Medicine Reports 12, no. 1. doi:10.1007/s40475-024-00337-9.
    Abstract: Purpose of ReviewAcknowledging health in all policies, this scoping review aims to describe and compare i) structural and social supports offered by countries participating in the United Nations refugee agency resettlement program and ii) refugees' and service providers' experiences with these supports.Recent FindingsStructural supports in the 10 countries resettling the largest number of refugees in 2021 (United States [US], Canada, and 8 European nations) were summarized, using official national documentation. A scoping review of published literature (1995-2022) sourced from four databases was conducted to capture met and unmet needs of refugees and service providers related to these supports during the first year of resettlement. Study characteristics were enumerated, and needs were descriptively summarized.We found important differences in structural supports offered to resettled refugees by host countries and regions, particularly with access to healthcare, language training, employment and financial support. The 63 included studies originated from the US (34), Canada, (25) and the United Kingdom (UK) (4), with uneven sub-national distributions. Most studies focusing on healthcare reported unmet needs, with language barriers, lack of culturally sensitive care and logistical challenges described in all three countries. Insufficient language training and unmet economic needs were also often reported.Recent FindingsStructural supports in the 10 countries resettling the largest number of refugees in 2021 (United States [US], Canada, and 8 European nations) were summarized, using official national documentation. A scoping review of published literature (1995-2022) sourced from four databases was conducted to capture met and unmet needs of refugees and service providers related to these supports during the first year of resettlement. Study characteristics were enumerated, and needs were descriptively summarized.We found important differences in structural supports offered to resettled refugees by host countries and regions, particularly with access to healthcare, language training, employment and financial support. The 63 included studies originated from the US (34), Canada, (25) and the United Kingdom (UK) (4), with uneven sub-national distributions. Most studies focusing on healthcare reported unmet needs, with language barriers, lack of culturally sensitive care and logistical challenges described in all three countries. Insufficient language training and unmet economic needs were also often reported.SummaryMore research on resettled refugees' and service providers' experiences with structural supports is needed, particularly in Europe and underrepresented regions in the US and Canada. A "Health in All Policies" approach to policies and programs related to resettlement should address unmet needs in healthcare, language training, employment and financial support.
    Tags: barriers, care access, disabilities, experiences, health in all policies approach, migrant health, migrants, migration, needs, newly arrived refugees, refugee health, refugees, unhcr resettlement programme, women.
  • Dünser, Martin W., Behringer, Wilhelm, Dünser, Martin W., Leach, Robert, Al-Haddad, Mo, Arafat, Raed, Baker, Tim, et al. “Reply Of The Authors: “Emergency Critical Care - Life-Saving Critical Care Before Icu Admission: A Consensus Statement Of A Group Of European Experts””. Journal Of Critical Care 89. doi:10.1016/j.jcrc.2025.155148.
    Tags: Belgium, bleeding, burn, critical illness, critically ill patient, emergency care, emergency critical care, emergency ward, heart arrest, hospital admission, human, injury, intensive care, intensive care unit, Letter, morbidity, mortality, opioid poisoning, patient care, resuscitation, thorax pain.
  • Pietsch, U., Muller, M., Hautz, W. E., Jakob, D. A., and Knapp, J. “The Importance Of Normocapnia In Patients With Severe Traumatic Brain Injury In Prehospital Emergency Medicine”. J Am Coll Emerg Physicians Open 6, no. 4: 100193. doi:10.1016/j.acepjo.2025.100193.
    Abstract: OBJECTIVES: Severe traumatic brain injury (TBI) is a leading cause of mortality and morbidity worldwide. Optimal management of cerebral perfusion and intracranial pressure already at the prehospital setting can have a positive influence on the outcome of these patients. Both target values are influenced by the arterial PaCO(2). We investigated the association between PaCO(2) immediately on hospital admission and mortality of patients with severe TBI. METHODS: This study conducted a retrospective analysis of prospectively collected data from trauma patients who were admitted to 2 Swiss level 1 trauma centers with severe TBI between 2017 and 2022 that were selected from the hospitals' databases. Relationship between PaCO(2) obtained from arterial blood gas analysis (aBGA) immediately on hospital admission and 28-day mortality was examined by multivariable logistic regression analysis. RESULTS: Of the 866 eligible patients, we observed an association between PaCO(2) and 28-day mortality, with mortality increasing at values above 35 mm Hg. CONCLUSION: A target PaCO(2) in the lower normal range as early as in the prehospital phase of treatment of patients with severe TBI seems to be associated with a reduced overall 28-day mortality. Our results support the need for a randomized controlled trial of aBGA-guided ventilation in TBI patients in the prehospital setting.
    Tags: hypocapnia, normocapnia, outcome, prehospital, target ventilation, traumatic brain injury.
  • Pradhan, S. K., Furian, M., Todeschini, G., Schurer, Q., Wang, X., Chen, B., Li, Y., and Gantenbein, A. R. “Daith Piercing, A Social Media Hype On Youtube For The Treatment Of Migraine? A Systematic Video Analysis”. Health Sci Rep 8, no. 6: e70880. doi:10.1002/hsr2.70880.
    Abstract: BACKGROUND AND AIMS: Nowadays, the social media video-sharing website YouTube is globally accessible and used for sharing news and information. It also serves as a tool for migraine sufferers seeking guidance about Daith piercing (DP) as a potential migraine treatment; however, shared and disseminated video content is rarely regulated and does not follow evidence-based medicine. This study aims to investigate the content, quality, and reliability of YouTube videos on DP for the treatment of migraine. METHODS: YouTube videos were systematically searched from the video portal inception until 17th January 2024. "Daith piercing" AND "migraine" were the applied search terms. The primary outcome of interest was assessing the Global Quality Scale (GQS) and DISCERN to evaluate each video blog's quality, flow, and reliability. Secondary outcomes included the relapse time of migraine after DP, and further outcomes related to DP. RESULTS: In the final analysis, 246 videos were included (N = 69 categorized as Personal Experience; N = 176 as Others, defined as videos from bloggers, piercers, or other persons; and N = 1 as Healthcare Professionals). The GQS rating in the category Personal Experience revealed that the quality of 50.7% of videos was very poor; 29.0% poor; 11.6% moderate, and 8.7% good. In the category Others, GQS rating showed that the quality of 60.8% of videos was very poor; 25.6% poor; 11.9% moderate, and 1.7% good. The one video in the category Healthcare Professionals was rated "poor quality". Ratings applying the DISCERN tool were comparable. Overall, 111 (45.1%) videos recommended and 14 (5.7%) discouraged DP for migraine relief. CONCLUSION: Based on the GQS and DISCERN scores, the information, usefulness, and accuracy of most YouTube content on DP for migraine treatment are generally of poor quality and reliability. The lack of high-quality and reliable videos might expose users to potentially misleading information and dissemination of unproven medical interventions.
    Tags: acupuncture, analysis., complementary and alternative medicine, headache disorders, migraine piercing, pain, Pradhan had full access to all of the data in this study and takes complete, responsibility for the integrity of the data and the accuracy of the data, YouTube.
  • Hejrati, N., Stengel, F. C., Fehlings, M. G., Maschmann, C., Stienen, M. N., Jensen, K. O., and Swiss Trauma, Registry. “Spinal Cord Injury In Severely Injured Patients: Results From The Swiss Trauma Registry”. Scand J Trauma Resusc Emerg Med 33, no. 1: 103. doi:10.1186/s13049-025-01420-4.
    Abstract: BACKGROUND AND OBJECTIVES: Traumatic spinal cord injuries (SCIs) in the context of severe trauma are rare, and patient demographics are infrequently reported. This study aimed to assess patient demographics in acute traumatic SCI in the context of severe injuries in Switzerland and to evaluate differences in demographics and outcomes stratified by timing of surgery. METHODS: We analyzed data from the Swiss Trauma Registry (STR) from 2015 to 2024. The STR includes patients with major trauma (injury severity score [ISS] >/= 16 and/or abbreviated injury scale [AIS] head >/= 3) admitted to any level-one trauma centre in Switzerland. We evaluated patient characteristics, complications, and hospital outcomes, which were further stratified by early (< 24 h) and late (>/= 24 h) surgery. RESULTS: Among 24,328 patients, 6,819 (28%) sustained spinal injuries, and 383 (1.6%) had a concurrent SCI with an incidence of 0.44 cases per 100'000 inhabitants. The median age was 52 years (IQR 31-70) and 73.6% were male. The primary causes were falls (63.1%) and road traffic accidents (29.6%). The in-hospital mortality rate was 4.7%. Late surgery patients more often had concomitant moderate or severe traumatic brain injuries (31% vs. 14%, p = 0.009) and were more likely to have no fractures or dislocations of the spine (22.8% versus 6.8%, p = 0.001). Patients who underwent early surgery had shorter hospital stays (9d [5-16], versus 16 d [9-24]; F = 13.92, p < 0.001). Late surgery was associated with a higher likelihood of developing two and more complications (OR 2.57, 95% CI 1.18-5.63, p = 0.018), including urinary tract infections (OR 12.13, 95% CI 2.76-53.41, p = 0.001) and multiple organ failure (OR 12.99, 95% CI 1.64-102.83, p = 0.015). CONCLUSIONS: This study offers insights into the characteristics and outcomes of acute SCI care in severely injured patients. Despite its low incidence, the acute management of this patient population remains highly challenging. Our findings suggest early stabilization of spinal injuries in severely injured patients may reduce hospital stays and complications.
    Tags: article, human, register, spinal cord injury.
  • Schuetz, P. “A Key Step Toward Gaining A Deeper Understanding Of Individual Responses To Protein Supplementation”. Am J Clin Nutr. doi:10.1016/j.ajcnut.2025.05.030.
  • Uhl, J. C., Zechner, O., Baetzner, A., Birrenbach, T., Egger-Lampl, S., Schrom-Feiertag, H., and Tscheligi, M. “Mixed Reality Training For Medical First Responders: System Evaluation And Recommendations”. Virtual Reality 29, no. 2. doi:10.1007/s10055-025-01144-x.
    Abstract: This study assesses the integration of mixed reality (MR) technologies in medical first responder (MFR) training, focusing on identifying key factors influencing behavioral intention to use MR systems and practical implications for technology acceptance and enhanced realism through haptic feedback. Through a user-centered design approach, involving co-creation workshops, iterative development, and evaluations in pilot and field trials across six countries, this study evaluated technology acceptance, presence, user experience, and workload among MFRs. Both quantitative measures and qualitative feedback were collected to analyze the determinants of technology acceptance and user engagement. The MED1stMR training system, developed as a result, demonstrates that performance expectancy, effort expectancy, and social presence are significant predictors of behavioral intention to use MR training systems among MFRs. High technology acceptance and positive user experience were reported, with specific emphasis on the educational value of haptic feedback in skill training. Trainer feedback highlighted the importance of real-time performance metrics and openness to AI-driven training assistance for enhancing training outcomes. The study underscores the critical role of realistic patient interaction and the importance of aligning training challenges with users' skills to create engaging MR training environments for MFRs. Identifying factors influencing behavioral intention offers valuable insights for the development of MR training systems, suggesting a focus on social presence and interactive capabilities to improve realism and educational value. The findings advocate for the integration of adaptive training features and further exploration of AI support in scenario optimization and performance enhancement.
    Tags: immersive technologies, information-technology, medical first responders, mixed reality, simulation, training, triage, user acceptance, validation.
  • Starvaggi, Carl A., Affentranger, Sophie, Lengeler, Noelie, Siebert, Johan N., Galetto-Lacour, Annick, Tan, Rainer, Jaboyedoff, Manon, Kuehni, Claudia E., Hartley, Mary-Anne, and Keitel, Kristina. “Infokids+: A Validation Study Of A Pediatric Acuity Risk Stratification Algorithm”. Mayo Clinic Proceedings: Digital Health 3, no. 2. doi:10.1016/j.mcpdig.2025.100220.
    Abstract: Objective: To prospectively validate InfoKids+, a pediatric acuity electronic risk stratification algorithm (eRSA), against a nurse-based triage standard (nbTS). Participants and Methods: We conducted a prospective validation study in a Swiss university hospital pediatric emergency department to assess the performance of a pediatric acuity eRSA, InfoKids+, on the basis of a well-established parental guidance application, InfoKids. Participants completed the eRSA once seated in a consultation booth. We compared the acuity levels from InfoKids+ (urgent, <4 hours; nonurgent, <24 hours; and no emergency, ≥24 hours) against an nbTS. The primary outcome was the level of agreement and rate of alignment between InfoKids+ and the reference standard. Results: We included 1990 participants from June 3, 2020, through January 31, 2022. InfoKids+ showed a slight level of agreement with the nbTS (κlw=0.08; 95% CI, 0.06-0.10). InfoKids+ triaged 1762 (89%) cases as urgent (<4 hours), 106 (5%) as nonurgent (≤24 hours), and 122 (6%) as no emergency (≥24 hours), compared with 810 (41%), 843 (42%), and 337 (17%) triages by the nbTS, respectively (P<.001). InfoKids+ acuity level aligned with the reference standard in 888 (45%) cases, whereas it overreferred and underreferred in 999 (50%) and 103 (5%) cases, respectively (P<.001). Conclusion: In summary, our study uncovered notable discrepancies between the InfoKids+ algorithmic triage and conventional nurse-based triage. Our results highlight the critical need for rigorous validation of such tools for accuracy and safety before public release to ensure these tools are beneficial and do not inadvertently cause harm or misallocation of resources. © 2025 The Authors
  • Starvaggi, Carl A., Affentranger, Sophie, Lengeler, Noelie, Siebert, Johan N., Galetto-Lacour, Annick, Tan, Rainer, Jaboyedoff, Manon, Kuehni, Claudia E., Hartley, Mary-Anne, and Keitel, Kristina. “Infokids+: A Validation Study Of A Pediatric Acuity Risk Stratification Algorithm”. Mayo Clinic Proceedings: Digital Health 3, no. 2. doi:10.1016/j.mcpdig.2025.100220.
    Abstract: Objective: To prospectively validate InfoKids+, a pediatric acuity electronic risk stratification algorithm (eRSA), against a nurse-based triage standard (nbTS). Participants and Methods: We conducted a prospective validation study in a Swiss university hospital pediatric emergency department to assess the performance of a pediatric acuity eRSA, InfoKids+, on the basis of a well-established parental guidance application, InfoKids. Participants completed the eRSA once seated in a consultation booth. We compared the acuity levels from InfoKids+ (urgent, <4 hours; nonurgent, <24 hours; and no emergency, ≥24 hours) against an nbTS. The primary outcome was the level of agreement and rate of alignment between InfoKids+ and the reference standard. Results: We included 1990 participants from June 3, 2020, through January 31, 2022. InfoKids+ showed a slight level of agreement with the nbTS (κlw=0.08; 95% CI, 0.06-0.10). InfoKids+ triaged 1762 (89%) cases as urgent (<4 hours), 106 (5%) as nonurgent (≤24 hours), and 122 (6%) as no emergency (≥24 hours), compared with 810 (41%), 843 (42%), and 337 (17%) triages by the nbTS, respectively (P<.001). InfoKids+ acuity level aligned with the reference standard in 888 (45%) cases, whereas it overreferred and underreferred in 999 (50%) and 103 (5%) cases, respectively (P<.001). Conclusion: In summary, our study uncovered notable discrepancies between the InfoKids+ algorithmic triage and conventional nurse-based triage. Our results highlight the critical need for rigorous validation of such tools for accuracy and safety before public release to ensure these tools are beneficial and do not inadvertently cause harm or misallocation of resources. © 2025 The Authors
  • Pfortmueller, C. A., Hahn, M., Eggimann, A., Rodemund, N., Kokoefer, A., Lindner, G., Schefold, J. C., and Waskowski, J. “Long-Term Mortality After Stage 1 Acute Kidney Injury In Critically Ill Patients - An Observational Cohort Study”. J Crit Care 89: 155130. doi:10.1016/j.jcrc.2025.155130.
    Abstract: BACKGROUND: Acute Kidney Injury (AKI) is prevalent in intensive care units (ICU) and is linked with increased mortality. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines define AKI using serum creatinine and urinary output criteria. While moderate and severe AKI according the creatinine criterion correlate with increased mortality, the significance of stage 1 AKI remains debated. METHODS: Retrospective cohort analysis from two tertiary care centres in Switzerland and Austria (2013-2021) to investigate the association between stage 1 AKI (KDIGO creatinine criterion) in the first seven days after ICU admission and one-year mortality in adult ICU patients. Data were extracted using standardized protocols. Baseline creatinine was determined using estimation formulas. We applied multivariable regression models adjusted for key confounders and conducted sensitivity analyses. RESULTS: Of 42,446 patients, 4667 (11 %) developed stage 1 AKI, 13 % (n = 5449) moderate/ severe AKI and 32,330 patients no AKI (76 %). Stage 1 AKI associates with one-year mortality (OR 1.6 [95 %CI 1.48; 1.73], p < 0.001) and increases length of stay in ICU (beta 1.4 [95 %CI 1.2; 1.5], p < 0.001) and hospital (beta 2.7 [95 %CI 2.1; 3.2], p < 0.001). In subgroup-analyses, we observed similar associations in patients with surgery (OR 1.66 [95 %CI 1.45;1.89], p < 0.001) and without surgery (OR 1.61 [95 %CI 1.46;1.78], p < 0.001). CONCLUSION: Stage 1 AKI is associated with 1-year mortality in adult ICU patients even in steps below 26.5 mumol/L. This highlights the prognostic significance of subclinical renal injury and underlines the need for increased efforts to diagnose AKI in its full spectrum. The analysis is limited by basing the AKI diagnosis on creatinine criterion.
    Tags: Abbott AG, Anandic Medical Systems, Pan Gas AG Healthcare, Bracco, Hamilton, Acute kidney injury, Aki, Astellas, Astra Zeneca, CSL Behring, Novartis, Covidien, Phagenesis Ltd., and, Austrian Research Promotion Agency (FFG). NR and AE reports no conflict of, Clinical Research AG, Nestle, Pierre Fabre Pharma AG, Pfizer, Bard Medica S.A.,, Critically ill, Daiichi-Sankyo, Bayer Pharmaceuticals. AK is currently receiving funding from the, GmbH, Glaxo Smith Kline, Merck Sharp and Dohme AG, Eli Lilly and Company, Baxter,, interest., Kdigo, Kidney diseases, Lifesciences Services GmbH, Kenta Biotech Ltd., Maquet Critical Care AB, Omnicare, Medical AG, Fresenius Kabi, Getinge Group Maquet AG, Drager AG, Teleflex Medical, Mortality, no personal financial gain applied. GL received honoraria from Otsuka Pharma,, Nycomed outside the submitted work. The money was paid into departmental funds, Pharma, Abbott Nutrition International, B. Braun Medical AG, CSEM AG, Edwards.
  • Klocker, E., Wienandts, L., Josi, D., Rauch, S., Albrecht, R., Knapp, J., and Pietsch, U. “High-Altitude Hems Missions-A Retrospective Analysis Of 3,564 Air Rescue Missions Conducted Between 2011 And 2021”. Scand J Trauma Resusc Emerg Med 33, no. 1: 97. doi:10.1186/s13049-025-01419-x.
    Abstract: BACKGROUND: Mountain sport activities are being practiced by an increasing number of people: The number of tourists visiting altitudes greater than 2,500 m above sea level in the Alps has been estimated at around 40 million people per year. For this reason, however, the number of emergencies in remote areas, which can be reached most rapidly by helicopter, has also increased. METHODS: We retrospectively reviewed all rescue missions conducted by the Swiss Air Ambulance (Rega) in the period 2011-2021 that were carried out at an altitude of more than 2,500 m above sea level. Demographic and epidemiological data, medical measures implemented on scene, and the on-scene time were then analyzed for both trauma and non-trauma patients. Patients were categorized based on the National Advisory Committee for Aeronautics (NACA) score into non-injured (NACA 0), minor injured (NACA 0-3), seriously injured (NACA 4-6), deceased during mission (NACA 7), and already deceased on arrival of the HEMS team. RESULTS: A total of 3,564 rescue missions were analyzed. Of the patients, 66.8% were male and the vast majority (88.4%) were adults. In terms of injury level, 88.1% of the patients were minor injured, with an NACA score of 0-3, while 9.4% were seriously injured, with a score of 4-6. Patients who died in scene (NACA 7) accounted for 2.5% of cases. We observed a significant increase in the number of minor injured patients with traumatic injuries over the period of observation. Factors that significantly influenced the on-scene time included the NACA score, hoist missions, and traumatic injuries in summer. CONCLUSION: Over the last ten years, the number of HEMS missions conducted at more than 2,500 m above sea level with non-injured and slightly injured patients has increased. The large number of HEMS missions with uninjured patients are of a preventive nature. Only around 9% of all rescue missions involved the medical treatment and rescue of seriously injured patients who required advanced medical interventions. TRIAL REGISTRATION: Ethics approval and consent to participate BASEC Nr. Req202200189.
    Tags: *Air Ambulances/statistics & numerical data, *Altitude, *Mountaineering/injuries, *Rescue Work/statistics & numerical data, *Wounds and Injuries/epidemiology/therapy, Adolescent, Adult, Aged, Alpine rescue, authors declare no competing interests., Female, Hems, High altitude, Humans, Male, Middle Aged, Mountain medicine, On-scene time, Req-2022-00189. Consent for publication: Not applicable. Competing interests: The, Retrospective Studies, Switzerland/epidemiology.
  • Kuhnen, S. C., Muller, M., Schmeling, A., Zech, W. D., Klaus, J. B., Lombardo, P., Ith, M., Egli, R. J., and Ruder, T. D. “Ct Of The Medial Clavicular Epiphysis For Forensic Age Estimation - Raised Arms Position Recommended”. Int J Legal Med. doi:10.1007/s00414-025-03521-2.
    Abstract: OBJECTIVE: To compare the effect of arm positioning on radiation dose, scan length, and image noise in computed tomography (CT) scans of the medial clavicular epiphysis for forensic age estimation performed with the arms alongside the body (arms-down) versus elevated above the head (arms-up). METHODS: Twenty consecutive CT scans were analysed, ten performed with arms-down and ten with arms-up. The scans were conducted at 120 kVp and 37 mAs reference tube current. Scan length extended from 10 mm above to 10 mm below the medial clavicular epiphysis. Dose-relevant parameters (effective CT tube current, volume CT dose index (CTDIvol), CT dose length product (DLP), and effective dose) as well as scan length and image noise were compared between arms-up and arms-down CT scans. RESULTS: Population characteristics: 19 males, 1 female; mean weight 65.8 +/- 9.2 kg; height 174.6 +/- 7.8 cm; and body mass index (BMI) 21.6 +/- 2.5 kg/m(2). Dose-relevant parameters were significantly lower with arms-up compared to arms-down (effective tube current: 80.9 +/- 21.7 mAs vs. 146.0 +/- 47.5 mAs, p = 0.001; CTDIvol: 5.5 +/- 1.5 mGy vs. 9.9 +/- 3.2 mGy, p = 0.001; DLP: 40.2 +/- 13.7 mGy*cm vs. 63.8 +/- 21.9 mGy*cm, p = 0.010; effective dose: 0.6 +/- 0.2 mSv vs. 0.9 +/- 0.3 mSv, p = 0.010). No significant differences were found in scan length, image noise, or population characteristics. CONCLUSIONS: Removing the arms from the CT beam path reduced radiation dose by 33% without affecting scan length or image noise. Given the importance of dose optimisation in non-medical examinations of potentially minor individuals, CT scans of the medial clavicular epiphysis should be performed with arms elevated above the head.
    Tags: Arm positioning, Computed tomography, Forensic age estimation, Medial clavicular epiphysis, need for informed consent was waived. Conflict of interest: The authors declare, Radiation protection, study by the Ethics Committee of the Canton of Bern (KEK Req-2023-00390) and the, that they have no conflict of interest..
  • von Kanel, R., Neuner-Jehle, S., Kressig, R. W., Guessous, I., Krayenbuhl, P. A., Zimmerli, L., Angelilo-Scherer, A., et al. “Effects Of A Novel Differential Diagnosis Aid For Managing Patients With Unexplained Fatigue In Primary Care: A Prospective Randomized, Controlled, Open And Multicenter Study In Primary Care”. Bmc Prim Care 26, no. 1: 183. doi:10.1186/s12875-025-02873-3.
    Abstract: AIMS OF THE STUDY: Unexplained fatigue is a common reason for encounters in primary care. However, currently no aid orients physicians in detecting its potential causes. The aim of this study was to evaluate whether the novel Fatigue Differential Diagnostic Aid (FDDA) supported clinicians in better managing unexplained fatigue. METHODS: This was a prospective, cluster-randomized, controlled, open, and multicenter study comparing the use of the FDDA vs usual care in patients with unexplained fatigue as the main reason for encounter. The primary endpoint was difference in Patient Global Impression of Change (PGIC) between groups at 3 months. Among pre-defined secondary endpoints were: Difference in change of PGIC between groups at 6 months; percentage of patients with fatigue reduction; mean reduction in fatigue; clinician's confidence in diagnosis; patient satisfaction with quality of care (diagnostic process and treatment); number of clinician-reported visits; number of referrals to specialists; and time until final diagnosis. RESULTS: 112 primary care practitioners (PCPs) recruited in Switzerland between 2017 to 2020 were randomly cluster-assigned to the FDDA = 57 or usual care = 55 arm. Of these, 15 (FDDA) and 22 (usual care) PCPs recruited 93 patients (FDDA: n = 40, usual care: n = 53). The achieved sample size was less than planned. There was no difference in PGIC at 3 months between groups (D = 0.06, 95%-CI: -0.41 - -0.53, p = 0.802). Among secondary endpoints, no significant differences occurred in PGIC at 6 months, nor in fatigue reduction. However, in the FDDA group, more patients reported less fatigue at 3 or 6 months (D = 18.9%, 95%-CI: -33.6 - -4.3%, p = 0.011), and increased satisfaction with treatment management at 1 month (FDDA 56.8% vs usual care 25.0%, p = 0.004) and 3 months (FDDA 64.9% vs usual care 31.0%, p = 0.003); the FDDA was also associated with higher total number of visits (median 4.0 vs 3.0, p < 0.001). CONCLUSIONS: In this pilot study, the FDDA, a structured diagnostic aid for guiding PCPs in identifying the causes of unexplained fatigue in their patients, was not able to show a global improvement in patient outcomes despite improvements in fatigue and satisfaction with care. The evaluation of fatigue in larger-scale studies is warranted. TRIAL REGISTRATION: This trial was retrospectively registered on ClinicalTrials.gov. TRIAL REGISTRATION NUMBER: NCT05861492. Date of registration: 17th May 2023. The ethics committee of Ethikkommission Nordwest- und Zentralschweiz (EKNZ) had originally voiced the opinion that no registration was required because no drug or intervention was involved, i.e., the study was non-interventional and observational. However, the study authors felt that the study should be retrospectively registered because the FDDA could be interpreted to be an active intervention. At the time of registration, two protocol deviations occurred that are explicitly addressed in the Methods section of this manuscript. Because of the low sample size, we statistically compared "patients" instead of "comparing patients nested in doctors" (the latter was performed as an additional analysis). Thus, cluster randomization was performed, but the analysis to consider this was not feasible.
    Tags: (QualiPro Schweiz AG, Switzerland) which was the primary contact for PCPs to, *Fatigue/diagnosis/therapy/etiology, *Medically Unexplained Symptoms, *Primary Health Care, 6-month patient follow-ups by telephone. The study was overseen by an independent, accordance with the European data privacy regulation (GDPR). The study was, Adult, and Health Research, Germany) that hosted the database and carried out data and, as well as writing of the manuscript were conducted independently, and results, by a Contract Research Organization (CRO, Clinical trial, Diagnosis, Differential, Differential diagnosis, Fatigue, FDDA steering committee, no further conflicts. All authors confirm that they have, Female, general practice. The sponsor provided financial support to the study. All, have not been influenced by CSL Vifor., Humans, Male, Member of the FDDA steering committee, no further conflicts. SNJ: Member of the, Middle Aged, or competing interests related to this manuscript. The funding body took part in, participated in the study provided informed consent. Patient data were handled in, Patient relevant outcome, Patient Satisfaction, performed in line with all relevant European and national guidelines and, Primary care, procedures in this study were performed in accordance with the national ethical, project management. The CRO worked in cooperation with a Swiss field organization, Prospective Studies, provide study material and administrative support, as well as conduct the 2- and, psychosomatics, psychiatry, epidemiology, geriatrics, internal medicine, and, read BMC s guidance on competing interests and that they do not have conflicting, regulations for conducting studies with human subjects. Competing interests: RvK:, regulatory authority's requirements (approval no. 2016-01786). The study was, reviewed and approved by the ethics committee "Ethikkommission Nordwest- und, Scientific Steering Committee (the Swiss Fatigue Working Group). This Committee, standards and the Swiss Federal law on data protection (FADP) and met Swiss, Switzerland, the design of the study, however, data collection, analysis, and interpretation,, Treatment outcome, was composed of experts in the field of fatigue, with specialists in hematology,, ZEG Berlin - Center for Epidemiology, Zentralschweiz (EKNZ)" (reference N degrees 2016-01786), Switzerland. All patients who.
  • Bima, P., Lopez-Ayala, P., Koechlin, L., Morello, F., Boeddinghaus, J., Dimitrova, M., Spagnuolo, C. C., et al. “Derivation And Validation Of Esc-0/1-H Algorithm For High-Sensitivity Troponin T And I In Cancer Patients”. Jacc Adv 4, no. 6 Pt 1: 101821. doi:10.1016/j.jacadv.2025.101821.
    Abstract: BACKGROUND: The diagnostic performance of high-sensitivity cardiac troponin T/I (hs-cTnT/I) and the efficacy of the European Society of Cardiology (ESC) 0/1-h hs-cTnT/I algorithms for the early diagnosis of non-ST-elevation myocardial infarction are lower in cancer patients. OBJECTIVES: The authors aimed to derive new cutoffs for ESC 0/1-h hs-cTnT/I algorithms optimized for use in patients with active or past cancer. METHODS: Patients presenting with suspected non-ST-elevation myocardial infarction to the emergency department enrolled in an international multicenter study were analyzed. Final diagnoses were centrally adjudicated by 2 independent cardiologists according to the fourth universal definition of myocardial infarction. External validation was performed in 2 independent cohorts. RESULTS: Among 541 eligible cancer patients, cancer-optimized ESC 0/1-h hs-cTnT cutoffs, <8 ng/L at presentation (if chest pain onset >3 hours) or <14 ng/L if 0/1 h-delta is <3 ng/L for rule-out and >/=54 ng/L or 0/1-h delta >/=4 ng/L for rule-in, increased the efficacy vs the current cutoffs from 58.6% (95% CI: 54.4-62.7) to 68.0% (95% CI: 64.0-71.8; P < 0.001). Sensitivity and specificity remained high and comparable. Similarly, among 516 eligible patients, cancer-optimized ESC 0/1-h hs-cTnI-Architect cutoffs, <7 ng/L at presentation (if chest pain onset >3 hours) or <10 ng/L if 0/1-h delta is <3 ng/L for rule-out and >/=61 ng/L or 0/1-h delta >/=5 ng/L for rule-in, increased the efficacy vs the current cutoffs from 59.3% (95% CI: 55.0-63.5) to 78.9% (95% CI: 75.2-82.2; P < 0.001). Sensitivity and specificity again remained high and comparable. Findings were confirmed in internal and external validation cohorts (n = 130 and n = 195 patients, respectively). CONCLUSIONS: Cancer-optimized ESC 0/1-h hs-cTnT/I algorithm cutoffs increased efficacy maintaining high safety.
    Tags: advisory, or consulting fees from Novartis, MSD, Bristol-Myers Squibb, Pfizer,, all outside the submitted work. Dr Koechlin has received a research grant from, and Julia Bangerter-Rhyner Foundation, as well as the "Freiwillige Akademische, and travel support from Medtronic and Cordis,, Bando d'Eccellenza 2023 to EL) and, Basel, the University Hospital Basel, as well as speaker/consulting honoraria or, Bayer, MSD, Abbott, and Orion-Pharma, outside the submitted work. Dr Mueller has, Beckman Coulter, Brahms, Idorsia, LSI-Medience, Novartis, Ortho Clinical, Quidel,, Bima, Lopez-Ayala, Wildi, Nestelberger, Boeddinghaus, and Mueller had full access, by the Universita degli Studi di Torino (grants MORF_RILO_21_02 and 23_03 to FM)., cancer, cardiac troponin, considered for publications elsewhere in whole or in part in any language,, Corporation, and Beckman Coulter, cutoffs, data and the accuracy of the data analysis. All authors have read and approved, data, the preparation of the manuscript, or the decision to submit the manuscript, diagnosis, Diagnostics, and Orion Pharma, outside the submitted work. Dr Boeddinghaus is, Division of Internal Medicine, the Swiss Academy of Medical Sciences, the, Fondazione Ricerca Molinette (Torino, Italy, for publication. The authors designed the study, gathered and analyzed the data,, Foundation (FF23062), unrelated to the present work. Dr Lopez-Ayala has received, Foundation, and the "Freie Akademische Gesellschaft Basel", from the Swiss National Science Foundation, the Swiss Heart Foundation, the, Gesellschaft Basel," and speaker honoraria from Roche Diagnostics, Abbott, and, Gottfried and Julia Bangerter-Rhyner Foundation, the Swiss National Science, grants from the University of Basel, the University Hospital of Basel, the, Heart Foundation, the University Hospital Basel, the University of Basel, Abbott,, honoraria from, honoraria/consulting honoraria from Abbott, Astra Zeneca, Bayer, Boehringer, Idorsia, LSI-Medience, Roche, Ortho Clinical Diagnostics, Quidel, Siemens,, including publicly accessible web sites or e-print servers., Ingelheim, BMS, Osler, Novartis, Roche, Siemens, SpinChip, and Singulex, outside, interest with this study. The investigated hs-cTn assay was donated by the, Lupia received grant support from Universita degli Studi di Torino and Fondazione, manufacturer, who had no role in the design of the study, the analysis of the, manuscript and its contents have not been published previously and are not being, Margarete und Walter Lichtenstein-Stiftung (3MS1038), and the University of, myocardial infarction, no role in gathering or analyzing the data or writing the manuscript. The, prognosis, received research support from the Swiss National Science Foundation, the Swiss, research grants from the Spanish Ministry of Health and FEDER, Mapfre, Novartis,, research grants from the Swiss Heart Foundation (FF20079 and FF21103) and, research support from Edwards Lifesciences, Pronova Medical, Meril, Boston, Ricerca Molinette. All other authors declare that they have no conflict of, Roche, Siemens, Singulex, SpinChip, Upstream, and Sphingotec, as well as speaker, Science Foundation (P400PM_191037/1), the Prof Dr Max Cloetta Foundation, the, Scientific, Medtronic, Abbott, Beckman Coulter, Bayer, Ortho Clinical, Siemens Healthineers, Roche Diagnostics, Ortho Clinical Diagnostics, Quidel, Siemens, outside the submitted work. Dr Martin-Sanchez has received speaker,, speaker's honoraria from Quidel, paid to the institution, outside the submitted, SpinChip, and Singulex. The Turin-cancer cohort study was supported by the, submitted work. Dr Morello received grants from the University of Torino. Dr, supported by an Edinburgh Doctoral College Scholarship and received research, the manuscript. The sponsors had no role in designing or conducting the study and, The Medicine Company, Otsuka, Thermo Fisher, Cardiorentis, and Sanofi and, the submitted work, all paid to the institution. Dr Wildi reports funding from, the University of Basel, the Swiss Academy of Medical Sciences, and the Gottfried, the University of Basel, the Swiss National Foundation (320030-231521), the, to all the data in the study and take responsibility for the integrity of the, University Hospital Basel, the University of Basel, Abbott, Beckman Coulter,, vouch for the data and analysis, wrote the paper, and decided to publish. Drs, We disclose that Dr Bima has received a research grant from the Swiss Heart, Wesley Medical Research Foundation, and the University of Queensland, all outside, work. Dr Nestelberger has received research support from the Swiss National.
  • Ahmad, S. J. S., Degiannis, J. R., Head, M., Ahmed, A. R., Gelber, E., Hakky, S., Kieser, A., et al. “Meta-Analysis Of The Optimal Needle Length And Decompression Site For Tension Pneumothorax And Consensus Recommendations On Current Atls And Etc Guidelines”. World J Emerg Surg 20, no. 1: 39. doi:10.1186/s13017-025-00613-7.
    Abstract: BACKGROUND: Tension pneumothorax (TP) is a life-threatening condition. The immediate recommended management is needle decompression (ND), followed by the insertion of an intercostal chest drain. The European Trauma Course (ETC) and the Advanced Trauma Life Support (ATLS) guidelines differ on needle size and decompression site, creating clinical uncertainty. This meta-analysis aims to explore the optimal approach for emergency needle decompression in TP. METHODS: This meta-analysis followed the PRISMA 2020 guidelines. It included English-language RCTs, cohort, case-control, cross-sectional studies, and case series with more than six patients. Studies on adults undergoing needle decompression therapy for TP or with chest wall thickness measurements were included. Ovid MEDLINE, Embase, and Web of Science databases were searched until May 31, 2024. Data were extracted, assessed for quality using OCEBM and GRADE, and analyzed using SPSS and OpenMeta with random-effects models. PRIMARY OUTCOME: needle decompression failure rate. SECONDARY OUTCOMES: patient demographics, cannula size, and chest wall thickness comparisons. RESULTS: This review analyzed 51 studies on needle decompression for TP, with a weighted mean patient age of 36.67 years. Radiological data from 24 studies (n = 8046) indicated a 32.84% failure rate for needle penetration into the pleural cavity (I(2): 99.72%). Increased needle length reduced failure rates by 7.76% per cm. No significant differences in chest wall thickness between genders were observed (T-test, p = 0.77), but thickness at the 5th anterior axillary line (5AAL) and 5th midaxillary line (5MAL) was less than at the 2nd midclavicular line (2MCL). Injury rates were higher at 5AAL than 5MAL, with strong positive correlations between needle length and injury at these sites (0.88, 0.91). CONCLUSION: Based on our meta-analysis, a 7 cm needle may be appropriate for decompression of right-sided tension pneumothorax at either the 5th intercostal space along the midaxillary line or the 2nd intercostal space along the midclavicular line. For left-sided cases, given the potential risk of cardiac injury, the 2nd midclavicular line is a safer option. However, these recommendations should be interpreted with caution due to considerable heterogeneity among the included studies, potential risk of bias, and variability in measurement techniques. Clinical decisions should always be individualized, taking into account patient-specific factors.
    Tags: *Decompression, Surgical/instrumentation/methods/standards, *Needles/standards, *Pneumothorax/surgery, are required for this study. Patients and public involvement: No patients were, authors consent for this version of the paper to be published. Competing, Chest wall thickness, Consensus, Humans, Iatrogenic injury, Intercostal space, interests: The authors declare no competing interests., involved in this study as it is a meta-analysis. Consent for publication: All, Needle decompression, Needle length, Practice Guidelines as Topic, Tension pneumothorax, Trauma care.
  • Schwappach, D., Hautz, W., Krummrey, G., Pfeiffer, Y., and Ratwani, R. M. “Emr Usability And Patient Safety: A National Survey Of Physicians”. Npj Digit Med 8, no. 1: 282. doi:10.1038/s41746-025-01657-4.
    Abstract: Despite widespread adoption of electronic medical records (EMRs), concerns persist regarding their usability and implications for patient safety. This national cross-sectional survey assessed physicians' perceptions of EMR usability across safety-relevant domains. Among 1933 respondents from diverse care settings, 56% reported that their EMR did not enhance patient safety, and 50% perceived their system as inefficient. Usability ratings averaged 52% of the maximum score. Statistically significant differences were observed between EMRs in outpatient (eta(2) = 0.13) and hospital (eta(2) = 0.37) settings. Multilevel modeling attributed 38% of the variance in usability ratings to differences between EMRs, 51% to hospital-level variation within EMRs, and 11% to physician-level differences. Canonical discriminant analysis identified key differentiating usability features, including system response times, excessive alerts, prevention of data entry errors, and support for collaboration. These findings underscore substantial limitations in current EMR systems and reinforce the value of comparative usability assessments to inform targeted improvements in digital health infrastructure.
    Tags: adult, aged, article, Biomedical engineering, Canonical discriminant analysis, controlled study, cross-sectional study, Cross-sectional surveys, digital health, discriminant analysis, Electronic health record, electronic medical record, female, health infrastructure, human, human experiment, Level difference, male, Maximum score, Medical record, middle aged, multilevel analysis, Multilevel modeling, National surveys, outpatient, Patient safety, physician, Physician perceptions, prevention, reaction time, Statistically significant difference, usability, usability testing.
  • Ben Salah, M. H., and Ziaka, M. “Holothoracic Spinal Epidural Lipomatosis: Report Of A Rare Presentation And Review Of Literature”. Sage Open Med Case Rep 13: 2050313X251339051. doi:10.1177/2050313X251339051.
    Abstract: Spinal epidural lipomatosis refers to the abnormal accumulation of unencapsulated fat in the epidural space, possibly associated with spinal canal narrowing and compression of adjacent nerve structures. Risk factors for spinal epidural lipomatosis include older age, male sex, obesity, and systemic corticosteroid use. While spinal epidural lipomatosis typically involves the thoracic or lumbosacral regions of the spinal cord, there are no published cases involving the entire thoracic cord. This report presents the first case of spinal epidural lipomatosis affecting the whole thoracic cord, highlighting the complexity of its diagnosis and management.
    Tags: diabetes/endocrinology, geriatrics/gerontology, research, authorship, and/or publication of this article., surgery.
  • Podsiadlo, P., Mendrala, K., Gordon, L., Pasquier, M., Paal, P., Hymczak, H., Witt-Majchrzak, A., Nowak, E., Czarnik, T., and Darocha, T. “Survival Prediction For Non-Asphyxia-Related Hypothermic Cardiac Arrest Patients After Extracorporeal Rewarming: Development Of The Help Score”. Asaio J. doi:10.1097/MAT.0000000000002456.
    Abstract: The aim of this study was to develop a scoring tool to estimate the probability of survival following extracorporeal rewarming in patients suffering hypothermic cardiac arrest. This is a multicenter retrospective study based on registry data. We included adult patients with hypothermic cardiac arrest not associated with asphyxia, with a core temperature of </=28 degrees C, who underwent extracorporeal rewarming. A multivariable logistic regression model was developed to serve as the predictive tool. Internal validation with bootstrap resampling was performed to adjust model parameters and reduce model optimism. Our study population included 141 patients. The survival rate was 46% (65/141). A total of 88% of the survivors (57/65) had a favorable neurological outcome (Cerebral Performance Category 1-2). The predictive model includes four variables. Outdoor occurrence of hypothermia and a higher hemoglobin level raise survival odds while higher concentrations of potassium and lactate reduce survival odds. The area under the receiver operating characteristic (ROC) curve was 0.812 and p value of the Hosmer-Lemeshow test was 0.8. We developed a prognostic model to estimate the probability of survival in adult patients with non-asphyxia-related hypothermic cardiac arrest. This model may aid in identifying candidates suitable for extracorporeal rewarming, though it should not be used as the sole deciding factor.
    Tags: accidental hypothermia, cardiac arrest, extracorporeal life support, patient outcome assessment, resuscitation.
  • Klug, J., Cortier, D., Wolf, S., Carrera, E., Cerf, C., and Pietsch, U. “Effect Of Extended Intravenous Diclofenac Infusions On Brain Tissue Oxygenation In Patients With Acute Brain Injury”. Intensive Care Med Exp 13, no. 1: 50. doi:10.1186/s40635-025-00759-3.
    Abstract: BACKGROUND: Fever is associated with worse outcomes in patients with acute brain injury. Diclofenac, a non-steroidal anti-inflammatory drug, is commonly used as antipyretic therapy. As evidence emerged that short diclofenac infusions (< 1 h) decrease brain tissue oxygen (PtO2) and cerebral perfusion pressure (CPP), clinical practice has shifted to extended infusions (12 h). The purpose of this study was to investigate the effects of extended diclofenac infusion for the treatment of fever on cerebral perfusion and tissue oxygenation after acute brain injury. RESULTS: We conducted a retrospective study of prospectively collected data from a cohort of 18 patients with acute brain injury and PtO2 monitoring admitted between November 2018 and April 2024. The hour before and the 12 h during an extended diclofenac infusion were compared. Additionally, we compared the 12 h prior and 12 h during the diclofenac infusion. Cerebral autoregulation and metabolites obtained by microdialysis were assessed in a subgroup of patients. Thirty-nine interventions were analyzed. Core temperature decreased from 38.1 degrees C in the hour before to 37.4 degrees C during an extended diclofenac infusion (p < 0.0001). ICP (11.0 vs 10.0 mmHg, p < 0.0001) and heart rate (84 vs. 77 bpm, p < 0.0001) decreased. CPP and PaCO2 did not vary significantly. PtO2 decreased from 23.1 mmHg (IQR 19.0-31.4) during fever peak to 21.7 mmHg (IQR 17.8-27.2) (p < 0.0001). Median PtO2 during the 12 h before diclofenac was 23.3 mmHg (IQR 18.9-30.5). In a multivariable analysis the effect of treatment was significantly influenced by heart rate and temperature (p < 0.0001). CONCLUSIONS: Extended diclofenac infusions for the treatment of fever in patients with acute brain injury achieve a clinically significant reduction in temperature but are associated with a small decrease in PtO2, even in the setting of maintained CPP.
    Tags: accordance with Article 34 of the Swiss Federal Act on Human Research. Consent, Brain tissue oxygen, Diclofenac, Fever, for publication: Not applicable. Competing interests: The authors declare that, in accordance with the Helsinki declaration and approved by the local, institutional review board (EKOS22/179 and EKOS 22/198). Consent was waived in, Subarachnoid hemorrhage, Temperature control, they have no competing interests., Traumatic brain injury.
  • Jegerlehner, S., Harris, T., Mueller, M., and Bloom, B. “Association Of Central Capillary Refill Time With Mortality In Adult Trauma Patients: A Secondary Analysis Of The Crash-2 Randomised Controlled Trial Data”. Scand J Trauma Resusc Emerg Med 33, no. 1: 82. doi:10.1186/s13049-025-01407-1.
    Abstract: BACKGROUND: Trauma-related injuries account for up to 4.4 million deaths annually worldwide. Failure to identify haemorrhage in trauma patients increases mortality. This study examines the association of central capillary refill time (CRT) and mortality in adult trauma patients, especially in the subgroup with normal heart rate (HR) and blood pressure (BP). METHODS: This retrospective observational study analysed data from the CRASH-2 trial, conducted in 274 hospitals across 40 countries and 5 continents between May 2005 and January 2010. A total of 19,054 out of 20,207 adult trauma patients with recorded CRT and complete dataset were included. CRT was taken centrally (sternum) and categorized as </= 2, 3-4, and >/= 5 s. The primary outcome was 28-day mortality, while secondary outcomes included need for transfusion, surgical intervention and thromboembolic events. Univariable and multivariable logistic regression analysis were conducted, incorporating random effects for continent/cluster. Receiver operating characteristic curves were used to assess the discriminatory ability of central CRT measurement. RESULTS: Among the patients, 6,756 (35.5%) had a CRT </= 2 s, 9,142 (48%) had a CRT of 3-4 s, and 3,156 (16.6%) had a CRT >/= 5 s. Compared to the reference category (CRT </= 2 s), the odds of death were significantly higher in patients with CRT of 3-4 s (OR 1.7, 95% CI 1.6-1.9) and CRT >/= 5 s (OR 3.2, 95% CI 2.8-3.5). Higher CRT was also associated with an increased likelihood of blood transfusion, surgical intervention, and thromboembolic events. The AUC values ranged from 0.63 to 0.74 and were consistent with a significant association between the variables. CONCLUSION: Central CRT is associated with increased mortality and adverse outcomes in trauma patients. In bleeding trauma patients, an increasing central CRT is linked to higher mortality risk, with a central CRT >/= 5 s being particularly predictive of worse outcomes. This also applies to patients with stable vital signs (normal HR and BP), suggesting that CRT may offer additional value as an indicator of hidden hypoperfusion.
    Tags: *Capillaries/physiopathology, *Hemorrhage/mortality/physiopathology/etiology, *Wounds and Injuries/mortality/physiopathology/complications, Adult, applicable. Competing interests: The authors declare no competing interests., Central capillary refill time, conducted in accordance with the Declaration of Helsinki, ensuring adherence to, Data Monitoring and Ethics Committee (DMEC) had the responsibility for, Emergency medicine, ethical principles for medical research involving human subjects. The CRASH-2, ethics committees in all 274 participating hospitals. Informed consent procedures, Female, Humans, Injury Severity Score, Male, Middle Aged, Mortality, Pre-hospital, randomization. This is a secondary analysis of data from this trial, and, Retrospective Studies, ROC Curve, Shock, therefore no additional ethics approval was needed. Consent for publication: Not, Trauma, trial had UK Research Ethics Committee approval and was approved by the relevant, were established by local regulation and the appropriate ethics committees. The.
  • Wildi, K., Gimenez, M. R., Boeddinghaus, J., Nestelberger, T., Lopez-Ayala, P., Koechlin, L., Gerstenberger, M., et al. “Possible Misdiagnosis Of Myocardial Infarction Using Regulatory-Approved And Close-To-Bioequivalent Upper Limits Of Normal For Cardiac Troponin”. J Am Heart Assoc 14, no. 10: e040468. doi:10.1161/JAHA.124.040468.
    Abstract: BACKGROUND: Possible misdiagnosis of acute myocardial infarction (AMI) may occur due to inappropriate upper limit of normal (ULN) for cardiac troponin and has the potential to harm patients. In this observational international multicenter study, we aimed to assess to what extent the novel hs-cTn-assays are affected. METHODS: A total of 6646 patients presenting with suspected AMI to the emergency department were enrolled. All level pairs (n=18 732) of 4 widely used high-sensitivity cardiac troponin T/I (hs-cTnT/I) assays using (1) the regulatory-approved uniform and sex-specific clinical ULN and (2) mathematically derived close-to-bioequivalent ULNs were assessed. The primary outcome was the quantification of the incidence of inconsistencies in the diagnosis of AMI. Inconsistency was defined as hs-cTnT/I concentration above the recommended ULN in one but not the other assay: for example, hs-cTnT-Elecsys+/hs-cTnI-Architect- or hs-cTnT-Elecsys-/hs-cTnI-Architect+. RESULTS: AMI was the adjudicated diagnosis in 1422 patients (21.4%). When the regulatory-approved uniform ULN was used, the rate of inconsistent AMI diagnoses was 17.6% (Elecsys/Architect), 18.8% (Elecsys/Centaur), 14.2% (Elecsys/Access), 4.9% (Architect/Centaur), 8.3% (Architect/Access), and 7.4% (Access/Centaur), respectively. Overall, diagnostic mismatches were not decreased, but in fact increased using regulatory-approved sex-specific ULNs. In women as compared with men, they were 23.8% versus 17.6% (Elecsys/Architect), 30.1% versus 19.1% (Elecsys/Centaur), 23.2% versus 15% (Elecsys/Access), 7.2% versus 4.5% (Architect/Centaur), 8.3% versus 8.7% (Architect/Access) and 7.8% versus 8.2% (Access/Centaur), respectively. Using close-to-bioequivalent ULNs reduced inconsistencies by 15% to 20% (P<0.001). Findings were confirmed in a sensitivity analysis among all level pairs with final diagnosis of AMI (mismatches in 7.3%-20.5%). CONCLUSIONS: Current regulatory-approved uniform and sex-specific ULNs for hs-cTnT/I result in discordances in binary assay results, possibly impacting the diagnosis of AMI. A regulatory process that defines bioequivalent ULNs could reduce inconsistencies significantly. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00470587.
    Tags: *Diagnostic Errors, *Myocardial Infarction/diagnosis/blood, *Troponin I/blood, *Troponin T/blood, Aged, Biomarkers/blood, Female, high-sensitivity cardiac troponin T and I, Humans, Male, Middle Aged, misdiagnosis of acute myocardial infarction, Predictive Value of Tests, Reference Values, upper limit of normal clinical decision values.
  • Rudolph, S. S., Root, C. W., Tvede, M. F., Fedog, T., Wenger, P., Gellerfors, M., Apel, J., and Unlu, L. “Confined Space Airway Management: A Narrative Review”. Scand J Trauma Resusc Emerg Med 33, no. 1: 79. doi:10.1186/s13049-025-01357-8.
    Abstract: BACKGROUND: Airway management is a critical component of prehospital and emergency care, often complicated by the environment in which it is performed. Confined space airway management (CSAM) refers to scenarios were restricted physical space challenges conventional airway techniques. These situations may occur in unpredictable environments, such as vehicle entrapments or collapsed structures, and controlled settings like helicopters. This narrative review aims to synthesize current knowledge, expert opinions, and evidence on CSAM. MAIN BODY: CSAM poses logistical and technical challenges, including limited access to the patient, restricted movement, and reduced visibility. These factors increase the difficulty of performing standard airway management procedures and increase the risk of complications. Supraglottic airways (SGA), due to their ease of insertion and high success rates, are recommended as a first-line approach in CSAM, especially when intubation is delayed or infeasible. Tracheal intubation (TI) may require significant modifications in technique. Alternative methods and adjuncts such as face-to-face intubation and stylets may be considered but are highly dependent on provider expertise and the specific scenario. Emergency front of neck access (eFONA) is provided with high success rated in confined spaces. In controlled settings, systematic preparation can improve success rates and reduce procedural times. In uncontrolled environments, prioritizing patient extrication and maintaining oxygenation is essential, as definitive airway management may conflict with rescue efforts. CONCLUSION: CSAM requires a strategic blend of medical expertise, adaptive techniques, and logistical planning. A focus on training, preparedness, and the use of supraglottic airway devices may mitigate challenges in these high-stakes scenarios.
    Tags: *Airway Management/methods, *Emergency Medical Services/methods, *Intubation, Intratracheal/methods, Airway management, Confined spaces, conflicts of interest have been mitigated. All other authors have no conflict of, Emergency medical services, from the Stryker Corporation, a medical device manufacturer. All relevant, Humans, interests do declare., Prehospital care, Supraglottic airway devices, Tracheal intubation.
  • van Oppen, J. D., de Groot, B., Nickel, C. H., and Beil, M. “Abcde-Frailty For Critical Presentations: Summary Of The 2025 Esicm Expert Consensus Recommendations”. Eur J Emerg Med 32, no. 3: 158-159. doi:10.1097/MEJ.0000000000001227.
    Tags: article, consensus, diagnosis, frailty, human.
  • Bockemuehl, D., Fuchs, A., Albrecht, R., Greif, R., Mueller, M., and Pietsch, U. “Age-Specific Considerations In Aetiology Of Paediatric Out-Of-Hospital Cardiac Arrest”. Scand J Trauma Resusc Emerg Med 33, no. 1: 70. doi:10.1186/s13049-025-01385-4.
    Tags: age, etiology, human, letter, male, out of hospital cardiac arrest, therapy.
  • Kemnitz, M. G., Lupan-Muresan, E. M., Somville, F., Barcella, B., Shopen, N., de Los Angeles Lopez Hernandez, M., and Heymann, E. P. “A Team Without A Name: Emergency Medicine Recognition And Its Impact On Working Conditions And Well-Being”. Med Klin Intensivmed Notfmed. doi:10.1007/s00063-025-01275-8.
    Abstract: Emergency medicine (EM) has evolved significantly over the past 50 years, transitioning from a focus on acute injuries and illnesses to include primary and specialty care, disaster response, and social issues. To date, nearly 60 countries have officially recognized EM as a medical specialty. However, growing patient demands, healthcare staff shortages, and an aging population have strained emergency departments, worsening working conditions for EM professionals and compromising patient care. To address these challenges, formal recognition of EM as a specialty is crucial.As a specialty, EM offers significant benefits. It improves patient outcomes by ensuring structured, standardized training that equips specialists with the skills to manage acute conditions such as trauma, stroke, and myocardial infarction. Countries with recognized EM specialties have reported reduced morbidity and mortality and enhanced healthcare resilience during crises like pandemics and mass casualty events. Additionally, professional recognition aids in recruitment, retention, and reducing burnout among EM practitioners by establishing clear career pathways. Furthermore, it ensures specific paraclinical training in areas such as patient flow, and it strengthens healthcare systems. However, despite these benefits, challenges remain. Resource diversion from primary care, increased healthcare costs, and the initial investment required for training programs are potential drawbacks to EM specialty recognition. Achieving EM recognition will require a strategic collaborative approach, focusing on education, professional support, and collaboration across healthcare sectors.
    Tags: All studies mentioned were in accordance with the ethical standards indicated in, E.P. Heymann declare that they have no competing interests. For this article no, each case., Emergency medical services, Empowerment, F. Somville, B. Barcella, N. Shopen, M. de los Angeles Lopez Hernandez and, Medical specialty, Primary care, Psychosocial risk, studies with human participants or animals were performed by any of the authors..
  • Grosjean, L., Sancosme, Y., Morisod, K., Francois, A., Caitlin, R., Jachmann, A., Grazioli, V. S., and Bodenmann, P. “Experiences Of Healthcare And Administrative Staff Working With Asylum Seekers In The Current Polycrisis Context: A Qualitative Study”. Bmc Health Serv Res 25, no. 1: 620. doi:10.1186/s12913-025-12758-x.
    Abstract: BACKGROUND: Healthcare and administrative staff working with asylum seekers are at risk of burnout, compassion fatigue and vicarious traumatization. Moreover, they face a series of crises, with the refugee crisis in 2015-2016, the Covid-19 pandemic, the war in Ukraine and climate change, complexifying their daily practice and increasing the number of asylum seekers. Despite this alarming context, scarce research has explored the personal experiences of healthcare and administrative staff working with asylum seekers. In response, this qualitative study aimed to explore their work-related experiences, resources and needs in the current polycrisis context in Switzerland. METHODS: Participants (N = 24) were part of the front-line care team working with asylum seekers in the Canton of Vaud (Switzerland). The sample included nurses, administrative staff, physicians and psychologists. They participated in semi-structured interviews exploring the personal experiences of their work, difficulties and challenges encountered and their resources and needs. Inductive content analysis was used to organize data and identify themes. RESULTS: Main findings highlighted a significant emotional burden for staff related to their patients' migratory journey and experiences in the asylum system. Next, participants expressed various challenges associated with their work, such as heavy workload, lack of partners in the healthcare network, communication barriers and the polycrisis context. Further, findings documented that participants' strong intrinsic motivation and personal and institutional resources support them in overcoming these difficulties. Finally, participants made some suggestions for the improvement of their working environment, including promotion of exchange between colleagues, collaboration with partners and hiring additional staff. CONCLUSIONS: Healthcare and administrative staff working with asylum seekers are exposed to multiple challenges and emotional difficulties linked to their patients' experiences. Findings suggest the need to address the well-being of this population by developing measures to enhance support for them at individual and structural levels, particularly within the current polycrisis context.
    Tags: *COVID-19/epidemiology, *Health Personnel/psychology, *Refugees/psychology, Administrative staff, Adult, Asylum seekers, Attitude of Health Personnel, Burnout, Professional, Competing interests: The authors declare no competing interests., Experiences, Female, followed the ethical guidelines outlined in the Declaration of Helsinki. All, Healthcare staff, Hospital because it did not involve clinical data measurement. All procedures, Humans, Interviews as Topic, Male, Middle Aged, participants provided written informed consent. Consent for publication: NA., Polycrisis, Qualitative Research, Qualitative study, SARS-CoV-2, Switzerland, was deemed exempt by the Human Research Ethics Committee of Lausanne University.
  • Ünlü, Luca, Margenfeld, Felix, Zendehdel, Adib, Griese, Johannes, Poilliot, Amélie, Müller-Gerbl, Magdalena, Nickel, Christian H., and Dedic, Mirza. “Ultrasound-Guided Emergency Pericardiocentesis Simulation On Human Cadavers: A Scoping Review”. Western Journal Of Emergency Medicine 26, no. 3: 685-691. doi:10.5811/westjem.39696.
    Abstract: Objectives: Emergency pericardiocentesis is a critical but infrequently performed procedure in emergency medicine, necessitating effective training modalities for emergency physicians. In this scoping review we aimed to identify existing literature on simulation of ultrasound-guided pericardiocentesis in human cadavers. Methods: We carried out a scoping review based on a search on the use of sonography on human cadavers. The following databases were searched: MEDLINE; EMBASE; CENTRAL; BIOSIS Previews; and Web of Science Core Collection. Additionally, we performed a gray literature search. Title and abstract screening were done by a single reviewer, and full-text review was performed by two independent reviewers. Studies included were limited to those published in English or German, focusing specifically on ultrasound-guided pericardiocentesis training models in human cadavers, with no restrictions on publication year or outcomes. Results: Our search strategy yielded 9,821 publications and 1,440 reports were assessed for eligibility. Ultimately, four studies met the inclusion criteria. All were conducted in the USA; two used soft-embalmed cadavers, one reported using fresh frozen cadavers, and one did not specify the cadaver type used. All studies accessed the pericardial sac using large-bore catheters or peripheral lines, filling it with (colored) water for simulation. Conclusions: Evidence on ultrasound-guided emergency pericardiocentesis simulation on human cadavers remains limited, but based on the four studies we reviewed human cadavers could be used for (emergency) pericardiocentesis simulation. © 2025 Ünlü et al.
  • Ebrahimi, R., Ebrahimi, F., Niess, J. H., Mahdi, A., Chen, S., Di Vece, D., Bian, W., Kutz, A., and Forss, A. “Increased Risk Of Cardiovascular Events After Coronary Interventions In Inflammatory Bowel Disease: A Nationwide Matched Cohort Study”. Aliment Pharmacol Ther. doi:10.1111/apt.70162.
    Abstract: BACKGROUND: Inflammatory bowel diseases (IBD) have been associated with an increased long-term risk of coronary artery disease due to chronic systemic inflammation. AIM: To evaluate the risk of major adverse cardiovascular events (MACE) after coronary interventions. METHODS: In this nationwide cohort study of adults undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) (2012-2022), patients with IBD were propensity score-matched 1:10 to comparators without IBD. The primary outcome was MACE, a composite of acute myocardial infarction, stroke, hospitalisation for heart failure, or mortality. Secondary outcomes included each MACE component, 30-day all-cause readmission, revascularisation and in-hospital outcomes including intensive care unit admission and length of hospital stay. We calculated hazard ratios (HRs) and incidence rates (IRs) using Cox proportional hazards modelling. RESULTS: We included 987 patients with IBD and 9571 matched comparators. After a median follow-up of 3.5 years, MACE occurred in 488 patients with IBD (49.4%, IR: 96.5/10,000 person-years [PY]) and in 3857 matched comparators (40.3%, IR: 68.9/10,000 PY); HR 1.37 (95% CI, 1.24-1.52). This equates to one additional MACE for every 36 patients with IBD over 10 years. The risk of each MACE component was increased, except for stroke. There were no differences between IBD subtypes or coronary intervention (PCI vs. CABG). Risks were highest in older individuals and elective interventions. CONCLUSIONS: Patients with IBD were at 37% higher risk of MACE after coronary intervention, indicating a need for intensified cardiovascular risk reduction in these high-risk individuals.
    Tags: coronary artery bypass grafting, epidemiology, Ibd, Mace, mortality, percutaneous coronary intervention.
  • Voruz, P., Vieira Ruas, M., Fellay, N., Romano, N., Mussini, M., Saubade, M., Faivre, V., et al. “Cluster-Specific Urban Contexts Associated With High Levels Of Sleep Impairment And Daytime Sleepiness: Findings From The Urbasan Collaborative Study”. J Affect Disord 382: 392-398. doi:10.1016/j.jad.2025.04.133.
    Abstract: INTRODUCTION: Impaired sleep is a global health concern. However, the environmental factors contributing to sleep impairment in urban settings are still not well understood. METHODOLOGY: This study involved 179 participants from a Swiss municipality (Yverdon-les-Bains), where sleep quality and diurnal sleepiness were measured using validated questionnaires, alongside environmental and geo-referenced data. RESULTS: The findings revealed a high prevalence of sleep disorders across diverse demographic groups (respectively 15.6 % for diurnal sleepiness and 91.1 % for significantly altered sleep quality). Additionally, sleep disorders were associated with both environmental and socio-demographic factors. Geospatial analysis identified clusters of sleep disturbances in specific neighborhoods, with distinct associations to specific sub-scores (factors) of the sleep evaluation. CONCLUSION: Assessing sleep in urban environments is crucial, as it is linked to elevated levels of sleepiness. Environmental and socio-demographic variables play significant roles in these disturbances. The incorporation of geospatial analyses allows for a more precise identification of patterns within the city, offering opportunities for tailored interventions to address the different patterns of sleep disorders.
    Tags: adult, aged, Article, body mass, controlled study, cross-sectional study, disease association, Epworth sleepiness scale, excessive daytime sleepiness, female, geographic distribution, human, hypnotic agent, hypothesis, major clinical study, male, Pittsburgh Sleep Quality Index, population research, prevalence, sleep disorder, sleep efficiency, sleep latency, sleep quality, sleep time, sociodemographics, Swiss, traffic noise, urban area.
  • Klail, T., Sachs, L., Panos, L. D., Urban, O. Y., Siller, T., Pilgram-Pastor, S., Giger, R., Muller, M., and Wagner, F. “Styloid Process-Related Internal Carotid Artery Dissection: Extensive Literature Review Of Diagnosis, Treatment And Outcomes (Exemplified With A Single-Center Case Series)”. Neuroradiology. doi:10.1007/s00234-025-03616-y.
    Abstract: PURPOSE: Internal carotid artery dissection (ICA-D) frequently leads to ischemic stroke in individuals under 50 years. There is mounting evidence on the role of the styloid process (SP) in ICA-D, particularly SP length and the SP-ICA distance. Despite having clear guidelines on the treatment of SP-related Eagle syndrome and ICA-D, the concept of SP-related ICA-D is relatively new and no therapeutic guidelines exist. METHODS: A narrative literature search was performed to identify all articles pertaining to the diagnosis and treatment of ICA-D linked to an ipsilateral elongated SP or short SP-ICA distance. The treatments were evaluated in terms of symptom recurrence after the treatment. As illustrative examples of clinical management, we present an in-house case series of patients with suspected ICA-D related to SP. RESULTS: Treatment efficacy was assessed, with an in-house case series provided. Seventy-five reports and case studies involving 84 patients were analyzed. Conservative treatments were common (52%) but had a high symptom recurrence rate (33%). It is noteworthy that no patients treated initially with styloidectomy exhibited symptom recurrence. CONCLUSION: In case of a correctly diagnosed SP-related ICA-D, a styloidectomy may offer a curative option, but more research is needed for clear indications and standardized guidelines to prevent recurrent symptoms or strokes.
    Tags: Conflict of interest: All authors approved the final manuscript and there are no, conflicts of interest to declare., consent: For all three patients the general informed consent was provided., Dissection, Internal carotid artery, require ethical approval in accordance with local/national guidelines. Informed, Stroke, Styloid process.
  • Wunderle, C., Martin, E., Wittig, A., Tribolet, P., Lutz, T. A., Koster-Hegmann, C., Stanga, Z., Mueller, B., and Schuetz, P. “Comparison Of The Inflammatory Biomarkers Il- 6, Tnf-Alpha, And Crp To Predict The Effect Of Nutritional Therapy On Mortality In Medical Patients At Risk Of Malnutrition : A Secondary Analysis Of The Randomized Clinical Trial Effort”. J Inflamm (Lond) 22, no. 1: 16. doi:10.1186/s12950-025-00442-0.
    Abstract: BACKGROUND: Inflammation is a key driver of disease-related malnutrition and patients with high inflammation may not show the same benefits from nutritional therapy as other patients. We compared in an exploratory manner the prognostic ability of interleukin- 6 (IL- 6), tumor necrosis factor-alpha (TNF-alpha) and C-reactive protein (CRP) to predict outcome and response to nutritional therapy, respectively, within a large cohort of patients from a previous nutritional trial. METHODS: This is a secondary analysis of the Swiss-wide, multicenter, randomized controlled Effect of early nutritional therapy on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT) trial comparing individualized nutritional support with usual care nutrition in medical inpatients. The primary endpoint was 30-day all-cause mortality. RESULTS: We included 996 patients with an overall mortality rate of 6% within 30 days. Compared to patients with low IL- 6 level < 11.2pg/mL, patients with high levels had a more than 3-fold increase in mortality at 30-days (adjusted HR 3.5, 95% CI 1.95-6.28, p < 0.001), but tended to have a less pronounced mortality benefit from individualized nutritional therapy as compared to usual nutritional care (hazard ratio 0.82 vs. 0.32). CRP and TNF-alpha were not associated with mortality, but patients with increased CRP levels > 100 mg/dl also showed a trend towards a diminished response to nutritional intervention (hazard ratio 1.25 vs. 0.47). CONCLUSION: Our findings support the thesis that a high inflammatory state is linked to reduced benefits from nutritional therapy. Apparently, CRP and IL- 6 effectively predict treatment response, but IL- 6 may additionally serve as a prognostic marker for increased mortality. This finding might help to develop improved treatment strategies for patients with elevated inflammatory profiles. TRIAL REGISTRATION: Clinicaltrials.gov as NCT02517476 (registered 7 August 2015).
    Tags: 2014_001) approved the study protocol., All participants or their authorized representatives provided written informed, appeared to influence the work reported in this paper., B. Braun that includes: funding grants. All other authors declare that they have, bioMerieux, Nestle Health Science and Abbott Nutrition that includes: funding, Clinical outcomes, competing interests: PS reports a relationship with Roche, Thermo Fisher,, consent. The trial was registered at ClinicalTrials.gov (, Crp, financial interests/personal relationships which may be considered as potential, grants. ZS reports a relationship with Nestle Health Science, Fresenius Kabi and, https://clinicaltrials.gov/ct2/show/NCT02517476 ). Consent for publication:, Il- 6, in this secondary analysis. All authors accept responsibility for the decision to, Individualization, Inflammation, Informed consent for participation and publication was obtained from all, Mortality, no known competing financial interests or personal relationships that could have, Northwestern/Central Switzerland (EKNZ, Nutritional therapy, participants included in the study. All authors read and approved the final, Polymorbid, submit for publication. Competing interests: The authors declare the following, TNF alpha, version of the manuscript. All authors confirm, they had full access to all data.
  • Schregenberger, S., Graup, V., Schibli, A., Preiswerk, B., Laube, I., Huber, L. C., and Stussi-Helbling, M. “Immune Reconstitution Inflammatory Syndrome (Iris): Case Series And Review Of The Literature”. Respir Med Case Rep 55: 102213. doi:10.1016/j.rmcr.2025.102213.
    Abstract: BACKGROUND: Immune-reconstitution inflammatory syndrome (IRIS) is a dysregulated host inflammatory response following the initiation of appropriate therapy targeting an infectious disease. It is most commonly reported in human immunodeficiency virus patients following the initiation of antiretroviral therapy; however, IRIS can also be seen in immunocompromised patients without HIV, when the immune system is recovering. The diagnosis is confirmed using clinical and laboratory data after excluding differential diagnoses and concomitant infections. CASE SERIES: Here, we describe three cases of patients with IRIS that were treated at our tertiary care center. The first case involves a paradoxical IRIS in an HIV-positive patient with TB, where the re-initiation of ART led to an inflammatory response despite effective anti-tuberculous treatment (ATT). The second case highlights unmasking IRIS in an HIV-positive patient, where the initiation of ART revealed an underlying Epstein-Barr virus (EBV)-associated B-cell lymphoma. The third case describes paradoxical worsening of pulmonary TB in an HIV-negative patient, expanding the scope of IRIS beyond its conventional association with HIV infection. CONCLUSION: These cases illustrate the various manifestations of IRIS and emphasize the need for timely diagnosis and appropriate management strategies to mitigate the potentially severe outcomes associated with this syndrome. Our report highlights the challenges faced in the diagnosis of IRIS which impede prompt onset of therapy.
    Tags: Hiv, Immune reconstitution inflammatory syndrome, Iris, Lymphoma, personal relationships that could have appeared to influence the work reported in, Tb, this paper., Tuberculosis.
  • Lindner, G., and Ravioli, S. “Performance Of The Artificial Intelligence-Based Swiss Medical Assessment System Versus Manchester Triage System In The Emergency Department: A Retrospective Analysis”. Am J Emerg Med 94: 46-49. doi:10.1016/j.ajem.2025.04.023.
    Abstract: BACKGROUND: The emergence of artificial intelligence (AI) offers new opportunities for applications in emergency medicine, including patient triage. This study evaluates the performance of the Swiss Medical Assessment System (SMASS), an AI-based decision-support tool for rapid patient assessment, in comparison with the well-established Manchester Triage System (MTS). METHODS: In this retrospective analysis, patients aged 18 years or above presenting to the Department of Emergency Medicine at Kepler University Hospital in Linz, Austria, during November and December 2024 with non-traumatic complaints were included. Each patient underwent emergency triage using MTS, conducted by a registered nurse, with SMASS applied in parallel. SMASS had no influence on clinical decision-making. RESULTS: In the study period, 1021 patients were triaged with both MTS and SMASS. The mean patient age was 60 years (SD: 21), and 53 % were women. Of the patients categorized as "orange" by MTS, 19 % were classified as non-urgent by SMASS. Conversely, 28 % of the patients triaged as "green" by MTS were classified as urgent by SMASS. Additionally, 23 % of patients classified as non-urgent by SMASS required hospitalization following emergency department evaluation and treatment. Agreement between SMASS and MTS in triaging emergency patients was low as measured by a Cohen's kappa of 0.167. CONCLUSIONS: In this study of patients presenting to a large tertiary-care emergency department, SMASS demonstrated considerable discrepancies in triage classification compared to MTS, with significant rates of both over- and undertriage. Further validation is necessary before integrating AI-based triage tools into routine clinical practice.
    Tags: Artificial intelligence, Chatbot, Emergency, relation to this submission., Triage.
  • Schnetzler, N., Taramarcaz, V., Herren, T., Golay, E., Regard, S., Mach, F., Nasution, A., et al. “Recruiting Medical, Dental, And Biomedical Students As First Responders In The Immediate Aftermath Of The Covid-19 Pandemic: Prospective Follow-Up Study”. Jmir Med Educ 11: e63018. doi:10.2196/63018.
    Abstract: BACKGROUND: Basic life support improves survival prognosis after out-of-hospital cardiac arrest, but is too rarely provided before the arrival of professional rescue services. First responder networks have been developed in many regions of the world to decrease the delay between collapse and initiation of resuscitation maneuvers. Their efficiency depends on the number of first responders available and many networks lack potential rescuers. Medical, dental, and biomedical students represent an almost untapped source of potential first responders, and a first study, carried out during the COVID-19 pandemic, led to the recruitment of many of these future professionals even though many restrictions were still in effect. OBJECTIVE: The objective of this study was to determine the impact of an enhanced strategy on the recruitment of medical, dental, and biomedical students as first responders in the immediate aftermath of the COVID-19 pandemic. METHODS: This was a prospective follow-up study, conducted between November 2021 and March 2022 at the University of Geneva Faculty of Medicine, Geneva, Switzerland. A web-based study platform was used to manage consent, registrations, and certificates. A first motivational intervention was held early in the academic year and targeted all first-year medical, dental, and biomedical students. Participants first answered a questionnaire designed to assess their initial basic life support knowledge before following an e-learning module. Those who completed the module were able to register for a face-to-face training session held by senior medical students. A course certificate was awarded to those who completed these sessions, enabling them to register as first responders on the Save a Life first responder network. Since the number of students who had enlisted as first responders 2 months after the motivational intervention was markedly lower than expected, a second, unplanned motivational intervention was held in an attempt to recruit more students. RESULTS: Out of a total of 674 first-year students, 19 (2.5%) students had registered as first responders after the first motivational intervention. This was significantly less than the proportion achieved through the initial study (48/529, 9.1%; P<.001). The second motivational intervention led to the enrollment of 7 more students (26/674, 3.9%), a figure still significantly lower than that of the original study (P<.001). At the end of the study, 76 (11.3%) students had been awarded a certificate of competence. CONCLUSIONS: Contrary to expectations, an earlier presentation during the academic year outside the COVID restriction period did not increase the recruitment of medical, dental, and biomedical students as first responders in the immediate aftermath of the COVID-19 pandemic. The reasons underlying this drop in motivation should be explored to enable the design of focused motivational interventions.
    Tags: *COVID-19/epidemiology, *Emergency Responders, *Students, Dental/statistics & numerical data, *Students, Medical/statistics & numerical data, Adult, basic life support, biomedical students, blended learning, cardiopulmonary resuscitation, Covid-19, dental students, e-learning, Female, first responder, Follow-Up Studies, Humans, life support, Male, medical student, motivational interventions, motivational strategies, out-of-hospital cardiac arrest, pandemic, Pandemics, Prospective Studies, SARS-CoV-2, student motivation, survival prognosis, Switzerland/epidemiology, undergraduate medical education.
  • Tribolet, P., Wunderle, C., Kaegi-Braun, N., Buchmueller, L., Laager, R., Stanga, Z., Mueller, B., Wagner, K. H., and Schuetz, P. “Evaluating Repeated Handgrip Strength Measurements As Predictors Of Mortality In Malnourished Hospitalized Patients. Secondary Analysis Of A Randomized Controlled Trial”. Eur J Clin Nutr. doi:10.1038/s41430-025-01618-w.
    Abstract: BACKGROUND: Handgrip strength (HGS) is a simple yet effective bed-side tool for assessing muscle strength, which plays an important role in clinical evaluation and monitoring. We hypothesize that repeated measurements of HGS during the hospital stay may serve as a reliable and robust indicator of clinical course and outcomes. METHODS: We re-analyzed data from 565 out of 2028 patients who had repeated handgrip measurement (on admission and on day 7) included in EFFORT, a Swiss-wide multicenter, randomized controlled trial comparing individualized nutritional support with usual care nutrition in medical inpatients. The primary endpoint was 180-day all-cause mortality. RESULTS: The mean change in HGS from baseline to day 7 was 0.6 kg (SD 4.2) in female and 0.7 kg (SD 3.7) in male patients. Patients with a positive HGS trend had a lower risk of dying within 180 days compared to patients without a positive trend (mortality 11.4% vs. 25.4%, adjusted HR 0.45 [95% CI 0.27 to 0.77], p = 0.003). The change in HGS was also associated with the nutritional intake during the hospitalization in male patients: those who met their energy and protein targets were twice as likely to have an increase in HGS during hospitalization (adjusted OR 2.05 [95% CI 1.23 to 3.42], p = 0.006). CONCLUSIONS: Achieving nutritional targets was associated with a short-term increase in HGS during hospitalization, and a positive HGS trend was associated with a lower risk of mortality after 180 days. These data provide evidence that repeated HGS measurements are a robust bedside tool for assessing and monitoring patients receiving nutritional therapy in the hospital. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02517476.
  • Stetsyk, V., Apostol, I., Belamaric, N., Panico, C., Grbic, M., Kenbaeva, Z., Tereshchenko, H., and Chumak, A. A. “Building While Responding: Moldova's Experience In Developing Clinical Surge Capacity For Radiation Emergency Response”. Disaster Med Public Health Prep 19: e95. doi:10.1017/dmp.2025.72.
    Abstract: To enhance radiological and nuclear emergency preparedness of hospitals while responding to the refugee crisis, the Government of the Republic of Moldova implemented an innovative approach supported by the World Health Organization (WHO). This initiative featured a comprehensive package that integrated health system assessment, analysis of existing plans and procedures, and novel medical training component. The training, based on relevant WHO and International Atomic Energy Agency (IAEA) guidance, combined theory with contemporary adult learning solutions, such as practical skill stations, case reviews, and clinical simulation exercises.This method allowed participants to identify and address gaps in their emergency response capacities, enhancing their ability to ensure medical management of radiological and nuclear events. This course is both innovative and adaptable, offering a potential model for other countries seeking to strengthen radiological and nuclear emergency response capabilities of the acute care clinical providers.
    Tags: *Capacity Building/methods, *Civil Defense/methods, *Disaster Planning/methods/organization & administration, *Radioactive Hazard Release, *Surge Capacity/trends/standards, Clinical pathways, Hospital readiness, Humans, Moldova, Radiological and nuclear preparedness, Simulation, World Health Organization/organization & administration.
  • Unlu, L., Stephan, F. P., Riede, F. N., Mettler, A. C., Dutilh, G., Capoferri, G., Bosia, T., Sticherling, C., Bingisser, R., and Nickel, C. H. “Diagnostic Accuracy Of Emergency Department Ecgs In Hyperkalemia Detection: A Cross-Sectional Study”. Eur J Intern Med. doi:10.1016/j.ejim.2025.03.038.
    Abstract: OBJECTIVE: To assess the diagnostic accuracy of ECG readings in detecting hyperkalemia and predicting outcome in the ED. METHODS: A retrospective cross-sectional analysis was conducted on ED patients, including patients with confirmed hyperkalemia (>/= 5 mmol/l) and a normokalemic control group. The predictive value of ECG readings for the detection of hyperkalemia was studied. For this purpose, the subjective probability of hyperkalemia was rated from 0-100 (Hyperkalemia Probability Scoring) by two attending acute care physicians. Logistic regression and ROC analysis were used to assess predictive power and sensitivity/specificity of Hyperkalemia Probability Scorings. Prediction of 7-day adverse outcomes (ICU admission, hemodialysis, in-hospital mortality) based on Hyperkalemia Probability Scorings was analyzed. RESULTS: We studied 1608 patients, thereof 805 served as normokalemic control patients. Sensitivity and specificity of ECG readings for hyperkalemia detection were 0.47 and 0.76 for cardiologist 1, and 0.39 and 0.81 for cardiologist 2. The AUC was 0.63 (95 % CI 0.60-0.65) and 0.61 (95 % CI 0.59-0.63) for the respective cardiologists. With a Hyperkalemia Probability Scoring of 100 compared to 0, the Odds Ratios (ORs) of diagnosing hyperkalemia were 8.2 (95 % CI 5.3-12.6) and 9.1 (95 % CI 5.8-14.7), while the ORs for 7-day adverse outcomes were 2.14 (95 % CI 1.34-3.38) and 2.22 (95 % CI 1.39-3.49) respectively. CONCLUSION: The ECG is not an accurate tool for ruling-in or ruling-out hyperkalemia in ED patients. Higher Hyperkalemia Probability Scorings are associated with 7-day adverse outcomes.
    Tags: Arrhythmias, Electrocardiogram, Electrocardiography, Emergency department, Humans, Hyperkalemia, Risk Assessment.
  • Huwiler, V. V., Tribolet, P., Rimensberger, C., Roten, C., Schonenberger, K. A., Muhlebach, S., Schuetz, P., and Stanga, Z. “Implementation Of Evidence-Based Clinical Nutrition: Usability Of The New Digital Platform Clinicalnutrition.science”. Swiss Med Wkly 155, no. 1: 3764. doi:10.57187/s.3764.
    Abstract: AIM OF THE STUDY: Malnutrition is a common and complex challenge in inpatient and outpatient settings, associated with increased risk of morbidity and mortality. Its management is often neglected, despite strong evidence of the benefits of adequate nutritional therapy. We introduced clinicalnutrition.science (https://clinicalnutrition.science/en/), a digital platform that provides healthcare professionals with easy online access to evidence and streamlines the nutritional care process. The aim of this study was to assess the usability and to validate improvements in nutritional management when the digital platform is used by healthcare professionals. METHODS: The usability study, conducted from 28 September to 16 November 2023, involved 56 healthcare professionals from the University Hospital of Bern and the Cantonal Hospital of Aarau. In an adapted cross-over study design, participants completed key steps of nutritional management for a simulated hepatology and oncology case both with and without the clinicalnutrition.science platform. Usability was assessed using the validated Healthcare Systems Usability Scale questionnaire, supplemented by collection of demographic data. Subgroup analysis was performed for recommended protein and energy intakes by different professional representatives. RESULTS: Clinicalnutrition.science achieved a good overall usability score of 71.8%. Use of the platform significantly improved the protein intake recommendation (p = 0.03; median 96.5 and 80.0 g/d) and the basal metabolic rate estimate (p <0.01; median 1420.8 and 1755.5 kcal/d) of the simulated oncology case. The variance in protein and energy intake recommendations, basal metabolic rate estimation and energy deficit estimation was reduced by using the digital platform. These improvements were achieved without increasing the time required to complete key steps in nutritional management for the two patient cases (median between 10.5 and 15.0 minutes; p = 0.09 and p = 0.67) and without prior training on the platform. There was no effect on the malnutrition detection rate, the selection of an appropriate nutritional product or the identification of the most appropriate guideline. CONCLUSIONS: The use of clinicalnutrition.science improved evidence-based clinical practice in prescribing personalised nutritional therapy and increased the accuracy of both protein and energy intake recommendations, without increasing the time taken to complete key steps in the nutritional management process.
    Tags: *Health Personnel, *Malnutrition/diet therapy, *Nutrition Therapy/methods, Adult, Cross-Over Studies, Energy Intake, Evidence-Based Medicine, Female, Humans, Male, Middle Aged, Nutrition Assessment, Surveys and Questionnaires, Switzerland.
  • van Oppen, J. D., Mooijaart, S., Nickel, C. H., and Conroy, S. “Considering Frailty And Meaningful Outcomes In Geriatric Emergency Care”. Intern Emerg Med. doi:10.1007/s11739-025-03940-4.
    Tags: applicable., conflict of interest. Human and animal rights statement and informed consent:, Emergency department, Frailty, Health services research, Patient-reported outcome measure, Person-centered care, This paper does not present primary data and ethics or consent were not.
  • Knapp, J., Hoftmann, D., Albrecht, R., Straumann, S., Pasquier, M., and Pietsch, U. “Management And Outcome Of Patients With Cardiac Arrest After Avalanche Accidents In The Swiss Alps: A Retrospective Analysis”. Resusc Plus 22: 100922. doi:10.1016/j.resplu.2025.100922.
    Abstract: AIM: Our aim is to evaluate the management and outcome of avalanche victims in cardiac arrest (CA), focusing on the adherence to international management guidelines and to identify ways to improve the future care of avalanche victims through retrospective evaluation of the missions. METHODS: We analysed a retrospective cohort of all avalanche victims in CA treated by Swiss Air-Rescue Rega between 2010 and 2024. Data regarding the avalanche burial (type of burial, burial duration, presence of a patent airway) were evaluated, as were helicopter operational data, data on prehospital medical care [cardiopulmonary resuscitation (CPR) efforts, airway management, core temperature], transport destination, data from further in-hospital treatment if applicable [core temperature, type of rewarming, serum potassium levels, extracorporeal life support (ECLS)] as well as patient outcome. RESULTS: 147 patients could be evaluated. 50 (34%) were declared dead without CPR efforts. CPR was started in 97 patients (66%), of whom 19 achieved ROSC (13%). Only 4 of these patients survived to hospital discharge (3%), 3 of whom had a good neurological outcome (2%). 34 patients (23%) were transported to hospital while CPR was ongoing, of whom in 11 (7%) ECLS was tried to initiate. None of these patients survived to hospital discharge. 27 patients (18%) were not treated in accordance with the guidelines. 22 of these (15%) were (potentially) undertreated (mainly in the sense of transport to a non-ECLS centre, although an ECLS centre would have been correct), 5 (3%) were overtreated (mainly in the sense of transport under ongoing CPR, although not indicated). 61% were tracheally intubated. On admission, core temperature was 1.9 degrees C (95% confidence interval 1.1-2.7) lower than the temperature measured on scene. CONCLUSIONS: Patients who suffer a CA in avalanche accidents have a very poor outcome. A high proportion of patients were not tracheally intubated during transport, cooled down further during resuscitation and transport or were not transported to ECLS centres although indicated. On the other hand, the outcome of ECLS patients is extremely poor.
    Tags: Accidental, Asphyxia, Avalanche, Cardiopulmonary resuscitation, Extracorporeal life support, Helicopter emergency medical service, Hypothermia, Outcome, personal relationships that could have appeared to influence the work reported in, this paper..
  • Raven, W., Candel, B. G. J., Wali, N., Gaakeer, M. I., Avest, E. T., Sir, O., Lameijer, H., et al. “Comparison Of Standardized Mortality Ratios In Seven Dutch Eds Based On Presenting Complaints”. Bmc Emerg Med 25, no. 1: 49. doi:10.1186/s12873-025-01200-4.
    Abstract: BACKGROUND: Comparison of emergency departments (EDs) becomes more important, but differences are difficult to interpret because of the heterogeneity of the ED population regarding reason for ED presentation. The aim of this study was two-fold: First to compare patient characteristics (including diagnoses) across 7 EDs. Secondly, to compare Standardized Mortality Ratios (SMRs) across 7 EDs and in subgroups of ED patients categorized by presenting complaints (PCs). METHODS: Observational multicenter study including all consecutive visits of 7 Dutch (two tertiary care centre and 5 teaching hospitals) EDs. Patient characteristics, including PCs as part of triage systems, and SMRs (observed divided by expected in-hospital mortality) per ED and for the most common PCs (PC-SMRs) were compared across EDs and presented as funnel plots. The expected mortality was calculated with a prediction model, which was developed using multivariable logistic regression in the overall population and for PCs separately. Demographics, disease severity, diagnoses, proxies for comorbidity and complexity, and PCs (overall population only) were incorporated as covariates. RESULTS: We included 693,289 ED visits from January 1, 2017 to June 31, 2023, with a median age of 56 years, of which 47.9% were women and 1.9% died. Patient characteristics varied markedly among EDs. Expected mortality was similar in prediction models with or without diagnoses as covariate. SMRs differed across EDs, ranging from 0.80 to 1.44. All EDs had SMRs within the 95%-Confidence Intervals of the funnel plot apart from one ED, which had an higher than expected SMR. However, PC-SMRs showed more variation and more EDs had SMRs falling outside the funnel, either higher or lower than expected. The ranking of SMRs across EDs was PC-dependent and differences across EDs are present only for specific PC-SMRs, such as in "dyspnea" and "feeling unwell". CONCLUSION: In summary, patient characteristics and mortality varied largely across Dutch EDs, and expected mortality across EDs is well assessed in PC subgroups without adjustment for final diagnoses. Differences in SMRs across EDs are PC-dependent. Future studies should investigate reasons of the differences in PC-SMRs across EDs and whether PC-targeted quality improvement programs can improve outcomes.
    Tags: *Emergency Service, Hospital/statistics & numerical data, *Hospital Mortality, Adolescent, Adult, Aged, competing interests., Emergency department, Female, Humans, In-hospital mortality, individual informed consent as this was a pure observational study. Consent for, Male, Middle Aged, Netherlands/epidemiology, Presenting complaints, publication: Not applicable. Competing interests: The authors declare no, Risk stratification, Standardized mortality ratio, Symptom-based, Symptom-oriented research, Triage/standards, was approved by the medical ethics committee of the LUMC, who waived the need for.
  • Asthma, G. B. D., and Allergic Diseases, Collaborators. “Global, Regional, And National Burden Of Asthma And Atopic Dermatitis, 1990-2021, And Projections To 2050: A Systematic Analysis Of The Global Burden Of Disease Study 2021”. Lancet Respir Med 13, no. 5: 425-446. doi:10.1016/S2213-2600(25)00003-7.
    Abstract: BACKGROUND: Asthma and atopic dermatitis are common allergic conditions that contribute to substantial health loss, economic burden, and pain across individuals of all ages worldwide. Therefore, as a component of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we present updated estimates of the prevalence, disability-adjusted life-years (DALYs), incidence, and deaths due to asthma and atopic dermatitis and the burden attributable to modifiable risk factors, with forecasted prevalence up to 2050. METHODS: Asthma and atopic dermatitis prevalence, incidence, DALYs, and mortality, with corresponding 95% uncertainty intervals (UIs), were estimated for 204 countries and territories from 1990 to 2021. A systematic review identified data from 389 sources for asthma and 316 for atopic dermatitis, which were further pooled using the Bayesian meta-regression tool. We also described the age-standardised DALY rates of asthma attributable to four modifiable risk factors: high BMI, occupational asthmagens, smoking, and nitrogen dioxide pollution. Furthermore, as a secondary analysis, prevalence was forecasted to 2050 using the Socio-demographic Index (SDI), air pollution, and smoking as predictors for asthma and atopic dermatitis. To assess trends in the burden of asthma and atopic dermatitis before (2010-19) and during (2019-21) the COVID-19 pandemic, we compared their average annual percentage changes (AAPCs). FINDINGS: In 2021, there were an estimated 260 million (95% UI 227-298) individuals with asthma and 129 million (124-134) individuals with atopic dermatitis worldwide. Asthma cases declined from 287 million (250-331) in 1990 to 238 million (209-272) in 2005 but increased to 260 million in 2021. Atopic dermatitis cases consistently rose from 107 million (103-112) in 1990 to 129 million (124-134) in 2021. However, age-standardised prevalence rates decreased-by 40.0% (from 5568.3 per 100 000 to 3340.1 per 100 000) for asthma and 8.3% (from 1885.4 per 100 000 to 1728.5 per 100 000) for atopic dermatitis. In 2021, there were substantial variations in the burden of asthma and atopic dermatitis across different SDI groups, with the highest age-standardised DALY rate found in south Asia for asthma (465.0 [357.2-648.9] per 100 000) and the high-income super-region for atopic dermatitis (3552.5 [3407.2-3706.1] per 100 000). During the COVID-19 pandemic, the decline in asthma prevalence had stagnated (AAPC pre-pandemic -1.39% [-2.07 to -0.71] and during the pandemic 0.47% [-1.86 to 2.79]; p=0.020); however, there was no significant difference in atopic dermatitis prevalence in the same period (pre-pandemic -0.28% [-0.33 to -0.22] and during the pandemic -0.35% [-0.78 to 0.08]; p=0.20). Modifiable risk factors were responsible for 29.9% of the global asthma DALY burden; among them, high BMI was the greatest contributor (39.4 [19.6-60.2] per 100 000), followed by occupational asthmagens (20.8 [16.7-26.5] per 100 000) across all regions. The age-standardised DALY rate of asthma attributable to high BMI was highest in high-SDI settings, whereas the contribution of occupational asthmagens was highest in low-SDI settings. According to our forecasting models, we expect 275 million (224-330) asthma cases and 148 million (140-158) atopic dermatitis cases in 2050, with population growth driving this increase. However, age-standardised prevalence rates are expected to remain stable (-23.2% [-44.4 to 5.3] for asthma and -1.4% [-9.1 to 7.0] for atopic dermatitis) from 2021 to 2050. INTERPRETATION: Although the increases in the total number of asthma and atopic dermatitis cases will probably continue until 2050, age-standardised prevalence rates are expected to remain stable. A considerable portion of the global burden could be managed through efforts to address modifiable risk factors. Additionally, the contribution of risk factors to the burden substantially varied by SDI, which suggests the need for tailored initiatives for specific SDI settings. The growing number of individuals expected to be affected by asthma and atopic dermatitis in the future suggests that it is essential to improve our understanding of risk factors for asthma and atopic dermatitis and collect disease prevalence data that are globally generalisable. FUNDING: Gates Foundation.
    Tags: (CASAC), Johns Hopkins EHE Advisory Board, Harvard external advisory committee, (published), A method to transform cow dung into the wall paint by using natural, (published), A system for disposed personal protection equipment (PPE) into, *Asthma/epidemiology/mortality, *Dermatitis, Atopic/epidemiology/mortality, *Global Burden of Disease/trends, 113-2314-B-003-002), Adult, advocacy group, paid or unpaid as a past steering committee member of the, advocacy group, unpaid as The Bursar and Council Member of Malaysian Academy of, aid for formulation of gel and method thereof (Published), Herbal drug, and previous ownership of stock, and the National Academies Panels and Committees, outside the submitted work. T C, ANI/Exeltis USA, Frictionless Solutions, Schipher, Crealta/Horizon, Medisys,, Assessment, Lancet Countdown, US EPA Clean Air Scientific Advisory Committee, Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life, attending meetings or travel from OMERACT, Bayes Theorem, biofuel through pyrolysis and method (published), A novel herbal pharmaceutical, BioPharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals,, board, society, committee or advocacy group, paid or unpaid as the Executive, College of Rheumatology, Yale University, Hulio, Horizon Pharmaceuticals, DINORA,, Committee, committee or advocacy group, paid or unpaid as the Technical Editor, Journal of, committee or advocacy group, paid or unpaid with Fifth National Climate, consulting fees, consulting fees from ROMTech, Atheneum, ClearView Healthcare Partners, American, Corrente 34/2017), payments made to the Institute for Maternal and Child Health, Cost of Illness, Council Member, Indian Meteorological Society, Jaipur Chapter (India) and as, development, Republic of Serbia (project No 175042, 2011-2023). J J Jozwiak, Disability-Adjusted Life Years, Education Chapter Committee, outside the submitted work. L Ronfani reports, Effects Institute, Yale Women Faculty Forum, Robert Wood Johnson Foundation, Yale, Ekundayo reports grants or contracts from PDF Research Fellowship, University of, electricity generation through crop stubble by using microbial fuel cells, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals Holding Corp, Aebona, Female, Fidia, PK Med, Two Labs, Adept Field Solutions, Clinical Care Options, Putnam, fiduciary role in other board, society, committee, or advocacy group, paid or, for attending meetings or travel from Colorado School of Public Health,, for training grant, WHO Global Air Pollution and Health Technical Advisory Group,, Forecasting, formulation for treating lung tissue degenerated by particulate matter exposure, from Clinique and ToxiMap, from the National Science and Technology Council, Taiwan (NSTC, Fund Fellowship, Harvard University, University of Montana, and SciQuest, Global Health, Humans, Incidence, Institute for Biospheric Studies, and Wellcome Trust Foundation, Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech, Vaxart, Atyu, IRCCS Burlo Garofolo. B Oancea reports grants or contracts from, IRCCS Burlo Garofolo. Y L Samodra and J H V Ticoalu report a leadership or, leadership or fiduciary role in other, leadership or fiduciary role in other board, society,, leadership or fiduciary role in other board, society, committee or, Male, manuscript writing or educational events from Novartis, Adamed, and Amgen,, manuscript writing or educational events from Simply Speaking, materials and composition thereof (filed), Member Secretary of DSTPURSE Program, outside the submitted work. M Zielinska, Monitoring Board or Advisory Board as a member of the FDA Arthritis Advisory, National Institutes of Health (NIH), Hutchinson Postdoctoral Fellowship, Health, Nature Conference, of Public Health, Duke University, University of Texas, Data4Justice, Korea, of reusable filters for anti-pollution mask (published), A system and method for, OMERACT, options in Amarin, Viking, and Moderna Pharmaceuticals, outside the submitted, outside the submitted work. All other authors declare no competing interests., outside the submitted work. M-C Li reports support for the present manuscript, participation on a Data Safety, payment or honoraria for lectures, presentations,, payment or honoraria for lectures, presentations, speakers bureaus,, Pharmaceuticals, and Charlotte's Web Holdingss, Pharmacy (Malaysia) and as Committee Member of Malaysian Pharmacists Society, PNRR/2022/C9/MCID/I8 project 760096, outside the submitted work. N E Ismail, present manuscript from the Ministry of Education, Science and Technological, Prevalence, Public Health, Columbia University, Harvard University, CMAS Conference, and, reports leadership or fiduciary role in other board, society, committee, or, reports other financial or non-financial interests as an Alexion employee,, reports payment or honoraria for lectures, presentations, speakers bureaus,, Risk Factors, Science, UBM, Trio Health, Medscape, WebMD, Practice Point Communications, and, South Africa, outside the submitted work. I M Ilic reports support for the, speakers bureaus, manuscript writing or educational events from Colorado School, stock or stock options in atai Life Sciences, Kintara Therapeutics,, submitted work. J I Shin reports other financial or non-financial interests from, support, support for, support for the present manuscript from the Italian Ministry of Health (Ricerca, the American Heart Association, outside the submitted work. L Monasta reports, the NIH, the Yonsei Fellowship, funded by Lee Youn Jae (to J I Shin). J A Singh reports, University of Texas, Duke University, Harvard University, American Journal of, University, IOP Publishing, NIH, Health Canada, EHS, PAC-10, UKRI, AXA Research, University, University of Pennsylvania, Brown University, Northeastern, unpaid as the co-founders of Benang Merah Research Center, Indonesia, outside the, work. E Upadhyay reports patents planned, issued, or pending: A system and method.
  • Ivanova, S., Hilverdink, E. F., Bastian, J. D., Jakob, D. A., Exadaktylos, A. K., Keel, M. J. B., Schefold, J. C., Anwander, H., and Lustenberger, T. “Short- And Long-Term Mortality In Severely Injured Older Trauma Patients: A Retrospective Analysis”. J Clin Med 14, no. 6. doi:10.3390/jcm14062064.
    Abstract: Background/Objectives: Older trauma patients experience increased in-hospital mortality due to the physiological challenges associated with aging and injury severity. However, limited data exist on long-term mortality rates beyond hospital discharge, particularly among severely injured elderly trauma patients. Understanding these outcomes is essential for improving clinical management and rehabilitation strategies. The objective of this study was to evaluate cumulative mortality rates (in-hospital, 28-day, 1-year, 2-year, and 3-year) in older trauma patients with an Injury Severity Score (ISS) >/= 16. Independent risk factors for 1-year mortality were also identified. Methods: This retrospective cohort study included all trauma patients aged >/= 65 years with ISS >/= 16 admitted to the Emergency Department of our level 1 trauma center between January 2017 and December 2022. Demographic characteristics, injury patterns (Abbreviated Injury Scale (AIS) scores, ISS), and mortality rates were collected from electronic health records. Patients were stratified into two age groups: 65-80 years and >80 years. Mortality rates were compared with those in the corresponding age groups in the general Swiss population. Statistical analysis included Kaplan-Meier survival curves and logistic regression for identifying risk factors associated with 1-year mortality. Results: A total of 1189 older trauma patients with a mean ISS of 24.3 +/- 7.9 were included. The most common injury was severe head trauma (AIS head >/= 3: 70.6%), followed by chest trauma (AIS chest >/= 3: 28.2%) and extremity injuries (AIS extremity >/= 3: 17.4%). The overall in-hospital mortality rate was 10.3%. Mortality rates at 28 days, 1 year, 2 years, and 3 years were 15.8%, 26.5%, 31.5%, and 36.3%, respectively. Age-stratified analysis showed significantly higher mortality rates in patients aged > 80 years compared to the 65- to 80-year group at all post-discharge time points (28-day: 22.6% vs. 11.9%, p < 0.001; 1-year: 39.9% vs. 18.8%, p < 0.001; 2-year: 46.5% vs. 22.8%, p < 0.001; 3-year: 56.4% vs. 24.9%, p < 0.001). Compared to the general Swiss population, we observed significantly higher mortality rates at all measured time points in elderly trauma patients, particularly in those aged over 80 years, with 1-year mortality rates of 39.9% vs. 10% in the general population and 3-year mortality rates of 56.4% vs. 30% in the general population. Independent risk factors for 1-year mortality included advanced age and severe head injury (AIS head >/= 3, p < 0.001). Conclusions: Severely injured elderly trauma patients face high long-term mortality risks, with 1-year mortality rates reaching 26.5% overall and nearly 40% in patients aged > 80 years. These findings highlight the need for research on tailored, holistic management strategies, including comprehensive in-hospital care, specialized neurorehabilitation, and post-discharge follow-up programs to improve survival and functional recovery in this vulnerable population.
    Tags: mortality, older patients, orthogeriatrics, polytrauma.
  • Jachmann, A., Brandenberger, J., and Schick, M. “Equitable Health Care In The Context Of Migration”. Swiss Med Wkly 155, no. 3: 4245. doi:10.57187/s.4245.
    Abstract: The health policy guiding principle of equitable access to healthcare faces barriers in the context of migration, on the part of both those affected and the health system. The operationalised measurement of health inequity, the training and sensitisation of healthcare professionals regarding needs-based care, diversity, transcultural and socio-medical aspects, and ensuring high-quality communication are among the measures that can contribute to reducing inequitable care (e.g. underuse) in this population.
    Tags: *Health Services Accessibility, Delivery of Health Care, Emigration and Immigration/legislation & jurisprudence, Health Equity, Health Policy, Healthcare Disparities, Humans.
  • Degen, B., Szczesna, A., Nickel, C. H., Bingisser, R., Gaab, J., and Minotti, B. “Open-Label Placebo For Non-Specific Pain In The Emergency Department (Olp Em): Study Protocol For A Mixed-Method Randomised Control Feasibility Study In Switzerland”. Bmj Open 15, no. 3: e090508. doi:10.1136/bmjopen-2024-090508.
    Abstract: INTRODUCTION: Non-specific pain (NSP), defined as pain without a clear pathological cause, is a common presentation in the emergency department (ED). There is no universally accepted analgesic strategy, but non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often prescribed. However, the established efficacy of NSAIDs for NSP is limited. Additionally, NSAIDs are associated with an increased risk of upper gastrointestinal bleeding, acute kidney injury and cardiovascular events, such as myocardial infarction and stroke. There is increasing evidence supporting the analgesic effects of open-label placebo (OLP), defined as placebo administered to patients without deception, in a broad variety of settings. Accordingly, OLP could be a safer, effective analgesic treatment option for NSP. To our knowledge, this is the first study investigating the feasibility of OLP for NSP in the ED. Therefore, our primary objective is to assess whether OLP is a feasible treatment option in this setting. METHODS AND ANALYSIS: Patients diagnosed with acute NSP will be prospectively recruited at discharge in the ED at the University Hospital of Basel, Switzerland. Patients treated with pain medication for >7 days prior to ED visit or with chronic pain will be excluded. Patients will be randomised to receive either OLP (intervention) or ibuprofen (control). Rescue medication will be ibuprofen in both groups. Daily online self-assessment will take place during the first 7 days after the baseline visit as well as on day 30. A qualitative interview will be conducted on day 30. The primary outcome is feasibility, consisting of acceptability, adherence to the protocol and patient satisfaction. Clinical outcomes will focus on pain intensity and interference according to the Brief Pain Inventory Short Form as well as adverse events. ETHICS AND DISSEMINATION: The study protocol has received approval from the ethics committee for Northwestern and central Switzerland (EKNZ; project ID 2024-00089). The results will be disseminated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION NUMBER: Swiss National Clinical Trials Portal (SNCTP000005852); Clinicaltrial.gov (NCT06408519).
    Tags: *Emergency Service, Hospital, *Feasibility Studies, *Randomized Controlled Trials as Topic, Accident & emergency medicine, Analgesics/therapeutic use, Anti-Inflammatory Agents, Non-Steroidal/therapeutic use, Feasibility Studies, Humans, Ibuprofen/therapeutic use, Pain management, Pain Management/methods, Pain Measurement, Placebos, Prospective Studies, Switzerland.
  • Goldman, R. D., Hart, R. J., Bone, J. N., Seiler, M., Olson, P. G., Keitel, K., Manzano, S., et al. “Adverse Events Among Early Caregivers' Covid-19 Vaccination Correlated Inversely With Intention To Vaccinate Their Children”. Vaccine 55: 127001. doi:10.1016/j.vaccine.2025.127001.
    Abstract: OBJECTIVES: Vaccine hesitancy increased during the COVID-19 pandemic. We evaluated if manifestation of adverse events when caregivers received their vaccine was associated with their willingness to vaccinate their children. METHODS: A multicenter, cross-sectional, multi-lingual survey of caregivers presenting to 19 pediatric Emergency Departments in the USA, Canada, Israel, and Switzerland early during the early stage of the pandemic, before vaccines for children were available. We asked caregivers if they were vaccinated against COVID-19, to report any side effects and if they would give vaccine to their child. We categorized all reported side effects and report the most common ones. We report willingness to vaccinate based on child's age. RESULTS: Of 4261 caregivers, mean caregiver age was 38.3 years, 2893 (68.3 %) mothers, 3108 (73.3 %) greater than high school education. 43.6 % reported side effects, 35.7 % reported no side effects and 20.7 % were unvaccinated. The lowest rate of caregivers planning to vaccinate their children was the unvaccinated (6.9 %) and the highest was among caregivers who did not report any side effects (74.4 %). Caregivers with no reported side effects after vaccination were more likely to vaccinate their children compared to those that had some side effects (aOR of 1.34, 1.52 and 2.14 for ages <5, 5-11 and >/=12 years, respectively). Reporting general illness/feeling unwell, experiencing weakness, and breathing difficulty were associated with caregivers unlikely to plan to vaccinate their children. The OR to vaccinate children for each additional side effect was 0.86, 95 %CI = 0.78-0.95, p = 0.004, representing a decrease of 14 % in the odds of planning to vaccinate for each additional side effect. CONCLUSIONS: Side effects experienced by caregivers are associated with their intention to vaccinate their children. Building of trust in vaccines, including communicating risks and benefits in the context of caregiver's experience, is important and may help enhance rate of vaccination of children.
    Tags: competing financial interests or personal relationships that could have appeared, Covid-19, Emergency medicine, Sars-cov-2, to influence the work reported in this paper., Vaccination, Vaccine hesitancy.
  • Diethelm, J., Wunderle, C., van Zanten, A. R. H., Tribolet, P., Stanga, Z., Mueller, B., and Schuetz, P. “Urea-To-Creatinine Ratio As A Biomarker For Clinical Outcome And Response To Nutritional Support In Non-Critically Ill Patients: A Secondary Analysis Of A Randomized Controlled Trial”. Clin Nutr Espen 67: 242-249. doi:10.1016/j.clnesp.2025.03.042.
    Abstract: BACKGROUND: Assessing a patient's catabolism in clinical practice is challenging but could help guide nutritional interventions. The urea-to-creatinine ratio (UCR) reflects muscle breakdown and protein metabolism and has been associated with risk for overfeeding and adverse outcomes in the critical care setting. We validated this concept in a well-characterized population of medical ward patients from a previous nutritional trial. METHODS: This secondary analysis of the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT) examined baseline UCR and changes during follow-up in medical inpatients at risk for malnutrition. A catabolic state was defined as a high baseline UCR or an increase in UCR over 7 days. The primary endpoint was mortality at 30 days. RESULTS: We included 1595 of 2028 EFFORT patients with baseline UCR measurements and 870 who also had UCR measurements on day 7. A high baseline UCR, as well as an increase in UCR over 7 days, were associated with increased mortality (adjusted HR for 30-day mortality 2.05 (1.47-2.87) p < 0.001 and 2.02 (1.34-3.06) p = 0.001). There was no difference in treatment response when stratifying patients based on baseline or follow-up UCR. CONCLUSION: Assessment of catabolism through UCR measurement at baseline and changes during follow-up was associated with increased mortality and adverse outcomes in medical inpatients at nutritional risk. However, this stratification was not associated with response to nutritional therapy in our sample. Further studies into the dynamic changes in UCR are needed to better understand the clinical implications for medical ward patients. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov as NCT02517476 (registered 7 August 2015).
    Tags: and Fresenius Kabi. No other disclosures are reported., Biomarker, Diagnostics, not related to this project. Arthur van Zanten reports receiving, from AOP Pharma, Abbott, Baxter, Cardinal Health, Danone-Nutricia, DIM3, Dutch, from Nestle Health Science, Thermo Fisher, bioMerieux, Abbott Nutrition and Roche, honoraria for advisory board meetings, lectures, research, and travel expenses, Lyric. Zeno Stanga reports grants to the institution from Nestle Health Science, Medical Food, Fresenius Kabi, GE Healthcare, InBody, Mermaid, Rousselot, and, Mortality, Nutritional risk, Nutritional support, Urea-to-creatinine ratio.
  • Troxler, David. “Letter To The Editor: “Short – Term Outpatient Parenteral Antimicrobial Therapy Administration In The Pediatric Emergency Department””. Pediatric Emergency Care. doi:10.1097/pec.0000000000003367.
  • Scotti, B., Szczesna, A., Nickel, C. H., Degen, B., Hugli, O., Jean-Scherb, S., Rovati, L., et al. “Defining The Need For Analgesia In The Emergency Department: Protocol For An International Delphi Process”. Bmj Open 15, no. 3: e089396. doi:10.1136/bmjopen-2024-089396.
    Abstract: INTRODUCTION: The high prevalence of pain in the emergency department (ED) highlights the importance of accurate assessments to provide effective interventions. However, common pain scales such as the Numerical Pain Rating Scale have shown limitations in assessing analgesic requirements and adequacy. The ideal outcome for evaluating a pain scale predicting analgesic requirements would be the 'need for analgesia', for which there is no universally accepted definition. Accordingly, the primary aim of this study is to define the 'need for analgesia' using an interdisciplinary approach. The secondary aim is to define the 'adequacy of analgesia'. METHODS AND ANALYSIS: A two-stage modified Delphi process will be conducted by a core study group chosen for its expertise in ED pain management. A larger expert panel, identified through a comprehensive search in Scopus and CINAHL databases, will be invited to participate in the study and will be supplemented by patients recruited via international patient organisations or snowballing. In stage 1, the expert panel will complete a written survey to collect potential clinical variables for defining the 'need for analgesia' and 'adequacy of analgesia'. The core study group will elaborate on these variables. In stage 2, the same participants will use a five-point Likert scale to achieve consensus defined as >/=80% of combined agreement on the proposed variables, over a maximum of three rounds. The same process will be used to define the 'adequacy of analgesia'. ETHICS AND DISSEMINATION: The Ethics Committee of Northwestern and Central Switzerland exempted the project from committee approval under the Human Research Act. Written consent will be obtained from all participants. Results will be disseminated through publication in peer-reviewed journals and conferences.
    Tags: *Analgesia/methods, *Delphi Technique, *Emergency Service, Hospital, *Pain Management/methods, *Pain Measurement, Analgesics/therapeutic use, Consensus, Emergency Departments, Humans, Pain management, Patient Participation, Patient Reported Outcome Measures, Research Design.
  • Damke, K., Lowinski, A., Friederich, M., Grosse, G. M., and Nickel, C. H. “Woman With Unilateral Facial Paleness”. Ann Emerg Med 85, no. 4: 364-365. doi:10.1016/j.annemergmed.2024.10.009.
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