Current situation and influencing factors of emergency department visits by non-urgent young and middle-aged patients in China: A retrospective study.

With population growth and aging, the emergence of new diseases and immunodeficiency, the demand for emergency departments (EDs) increases, making overcrowding in these departments a global problem. Due to the disease severity and transmission rate of COVID-19, it is necessary to provide an accurate and automated triage system to classify and isolate the suspected cases. Different triage methods for COVID-19 patients have been proposed as disease symptoms vary by country. Still, several problems with triage systems remain unresolved, most notably overcrowding in EDs, lengthy waiting times and difficulty adjusting static triage systems when the nature and symptoms of a disease changes. In this paper, we conduct a comprehensive review of general ED triage systems as well as COVID-19 triage systems. We identified important parameters that we recommend considering when designing an e-Triage (electronic triage) system for EDs, namely waiting time, simplicity, reliability, validity, scalability, and adaptability. Moreover, the study proposes a scoring-based e-Triage system for COVID-19 along with several recommended solutions to enhance the overall outcome of e-Triage systems during the outbreak. The recommended solutions aim to reduce overcrowding and overheads in EDs by remotely assessing patients’ conditions and identifying their severity levels.

BackgroundThe evidence on age-related differences in outcomes in patients seeking chiropractic care for low back pain is limited. The aims of this study were to (i) to explore differences in patient characteristics and symptoms between older, middle-aged and younger patients with LBP seeking chiropractic care, (ii) to investigate whether age was associated with changes in physical function at 2, 13 and 52 weeks follow-up and (iii) to evaluate if other specific demographic variables were associated with changes in physical function over time.MethodsThis observational cohort study (November 2016 to December 2018) used data from the Danish Chiropractic Low Back Pain Cohort (ChiCo). Participants ≥ 18 years seeking chiropractic care for new onset low back pain were categorised into three age groups: young adults (< 40 years), middle-aged adults (40–59 years), and older adults (≥ 60 years). Disability was assessed at baseline and at 2, 13 and 52 weeks follow-up using the Roland Morris Disability Questionnaire. Associations between age groups and disability outcomes were analysed using linear regression, while associations with demographics, and social and psychological factors were examined using backward stepwise linear regression.Results2777 participants were included. At baseline, there were no significant differences in disability scores between age groups. Older patients reported more non-musculoskeletal comorbidities and prescription pain medication use, compared to younger and middle-aged patients. Younger patients showed higher depression and anxiety levels compared to middle-aged and older patients. Younger and middle-aged patients more frequently reported multiple musculoskeletal comorbidities than older patients. At all follow-ups, older patients had slightly higher disability scores and showed less improvement over time compared to younger and middle-aged patients, indicating a modest association between age and poorer outcomes. Higher baseline disability, more musculoskeletal comorbidities, worse self-reported health, and higher depression scores were more consistently associated with less improvement in disability over time.ConclusionOlder chiropractic patients with low back pain had slightly higher disability scores compared to younger and middle-aged patients, but age was not the strongest factor associated with disability outcomes. Baseline disability, depression, self-perceived general health, and MSK comorbidities were more consistently linked to higher disability scores across all follow-up time points.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12998-025-00589-w.

Objective To investigate the effect of epidural block of ropivacaine on muscle relaxation effect of cisatracurium in young and middle-aged patients, and thus to provide scientific basis for improving the effect of eptdural block in young and middle-aged patients. Methods Eighty-three middle-aged and young patients underwent abdominal surgery from May 2012 to September 2015 were selected, and they were randomly divided into two groups. The research group was given the treatment of general anesthesia combined with epidural block, the control group was given general anesthesia, all of the patients was given general anesthesia of etomidate, fentanyl and midazolam induction, sufentanil and propofol and cis atracurium were used maintainly to anesthesia during operation, electrical double frequency index (BIS) remained at around 45 in intraoperative, T1 remained at around 10%. The muscle relaxation effect of cisatracurium in young and middle-aged patients were observed, and the differences between the two groups were compared. Results The differences of anesthesia work time, TOFR natural recovery time, recovery indicators between the two groups were not significant (P>0.05). The clinical muscle relaxant effect time of research group was longer than that of control group, the difference was significant (P 0.05), maintain dosage of cis atracurium at second and third 30 minutes period in research group were significantly lower than that in control group (P<0.05), the cis atracurium maintain dosage in research group was lower than that in control group (P<0.05). Conclusions In the middle-aged and young patients with abdominal surgery, there is no significant difference between epidural block of ropivacaine and general anesthesia in cis atracurium working time and TOFR natural recovery time, but the clinical muscle relaxant effect time is prolonged, and the muscle relaxant effect is significant. Key words: Cis atracurium; Ropivacaine; Epidural block

3329 The plasma propofol concentration during upper gasrointestinal endoscopy in young, middle-aged, and elderly patients.

We compared the efficacy and safety of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) in young, middle-aged, and elderly patients. Intersociety guidelines suggest based on limited evidence that young patients with medically refractory symptoms of obstructive HCM should undergo surgical myectomy while elderly patients may be more appropriate for ASA. Data for 360 patients undergoing 389 ASAs were prospectively collected and retrospectively analyzed according to age. Young (<45 years), middle-aged (45-64 years), and elderly (≥65 years) patients comprised 28, 40, and 32% of the study population, respectively. Young patients had thicker left ventricular septal walls at baseline, and elderly patients had more comorbidity and dyspnea. Resting, mean left ventricular outflow tract gradients (LVOTGs) were similar across the age groups at baseline (62, 66, and 68 mm Hg, respectively; P = NS for all comparisons). LVOTGs and dyspnea were significantly and similarly improved in all age groups immediately after ASA and through 12 months of follow-up (P < 0.001 for before and after comparisons; P = NS for intergroup comparisons). Complication rates were similar for young and middle-aged patients but higher for elderly patients (9.1 and 6.3% vs. 20.8%, respectively; P ≤ 0.016 for elderly vs. others). Mortality rates for young and middle-aged patients were lower than for elderly patients, but the differences were not statistically significant. Patients undergoing ASA had significant and similar improvements in LVOTGs and symptoms regardless of age. Procedural complications were increased in elderly patients, who had numerically but not statistically significantly higher mortality rates.

Clinical Outcomes, Return to Sports, and Patient Satisfaction After Anterior Cruciate Ligament Reconstruction in Young and Middle-Aged Patients in an Asian Population—A 2-Year Follow-up Study

Effects of posttraumatic growth on psychosocial adjustment in young and middle-aged patients with acute myocardial infarction: The mediating role of rumination

Objective: To explore the mediating effect of social support on self-efficacy and quality of life in young and middle-aged T2DM patients, in order to improve their self-efficacy and quality of life. Methods: A total of 189 young and middle-aged T2DM patients who were hospitalized in the Department of Endocrinology, Affiliated Hospital of Youjiang Medical University for Nationalities from June 2024 to June 2025 were selected by convenience sampling. The social support scale, self-efficacy scale and concise health survey scale were used to investigate and analyze the social support level, self-efficacy level and quality of life level of young and middle-aged T2DM patients. Results: The total score of social support in young and middle-aged T2DM patients was (44.05±6.16), the total score of self-efficacy was (30.79±2.60), and the total score of quality of life was (75.21±6.25). Social support was positively correlated with self-efficacy (r =0.410, P&lt;0.001), social support was positively correlated with quality of life (r =0.368, P&lt; 0.001), and self-efficacy was positively correlated with quality of life (r=0.445, P &lt;0.01). Social support played a partial mediating role between self-efficacy and quality of life in T2DM patients, and the mediating effect accounted for 25.07 % of the total effect. Conclusion: There is a positive correlation between social support, self-efficacy and quality of life in young patients with T2DM. Social support not only directly improves the quality of life, but also plays a partial mediating role by enhancing self-efficacy, and the mediating effect is significant.

A Research Agenda for Studying the Effect of Emergency Department Crowding on Clinical Education

Anterior cruciate ligament (ACL) reconstruction is commonly performed to prevent decreased knee function and restore stability in middle-aged and even older patients. However, few studies have compared the long-term clinical outcomes of ACL reconstruction between older, younger, and middle-aged patients. The purpose of this study was to compare the long-term clinical outcomes of ACL reconstruction in older patients with those in younger and middle-aged patients. A total of 352 patients who underwent primary ACL reconstruction between January 2003 and March 2008 were retrospectively reviewed and classified into three groups (group A: 246 [age, 20-29 years], group B: 72 [age, 40-49 years], group C: 34 [age, 50-65 years]). The mean follow-up period was 14.2 ± 1.6 years. Clinical outcomes were evaluated and compared between groups. The differences in the range of motion, clinical scores, and stability tests were not statistically significant among the three groups. The difference in the graft failure rate among the three groups was significant (group A: 16 [6.5%], group B: 7 [9.7%], group C: 6 [17.6%]; p = 0.040). In particular, when compared between the two groups, there was a significant difference between group A and group C (p = 0.036). The 10-year survival rates were 93.5%, 90.3%, and 82.4% for groups A, B, and C, respectively (p = 0.048). Although graft failure rates were higher in older patients than younger and middle-aged patients, clinical outcomes of ACL reconstruction in older patients were comparable to those of younger and middle-aged patients in terms of the range of motion, clinical scores, and stability tests at a minimum follow-up of 10 years.

BACKGROUNDYoung and middle-aged cancer patients in intensive care unit (ICU) often suffer from stress and pressure, causing huge physical and mental damage. Currently, there is few research on post-traumatic stress disorder (PTSD) among young and middle-aged cancer patients in ICU in China, and the psychological status of patients who have experienced both cancer development and ICU stay is still unclear.AIMTo explore the risk factors for PTSD in young and middle-aged patients with cancer in ICU.METHODSUsing convenient sampling method, we enrolled 150 young and middle-aged patients with cancer who were admitted to the ICU of our center during the period from July to December 2020. The general data of the patients and PTSD-related indicators were collected. The Impact of Event Scale-Revised (IES-R) was used for assessing PTSD one month after the discharge from the ICU. Binary Logistic regression analysis was performed to assess the independent risk factors for PTSD in these patients.RESULTSAmong these 150 patients, 32 (21.33%) were found to be with PTSD. Binary Logistic regression analysis revealed that factors significantly associated with PTSD among young and middle-aged patients with cancer in ICU included monthly income (OR = 0.24, P = 0.02), planned transfers (OR = 0.208, P = 0.019), and Acute Physiology and Chronic Health Evaluation (APACHE II) score (OR = 1.171, P = 0.003).CONCLUSIONThe low monthly income, unplanned transfers, and increased APACHE II score are the risk factors for PTSD in young and middle-aged patients with cancer in ICU.

There are few reported studies on post-stroke fatigue (PSF) in young and middle-aged stroke patients, however, PSF plays a key role in the patient’s disease regression. Exploring the level of PSF and the influencing factors in young and middle-aged stroke patients is crucial for determining how to reduce the level of PSF and improve the patients’ motivation for rehabilitation treatment. Therefore, this study investigated the level of PSF in young and middle-aged stroke patients and analyzed the factors influencing PSF to provide a reference or basis for healthcare professionals to develop effective and targeted PSF intervention programs. The purpose of this study was to investigate the incidence of fatigue and its related influencing factors in young and middle-aged stroke patients. A total of 300 young and middle-aged stroke patients hospitalized in the Neurology Department of a tertiary hospital in Xi’an, China, from June 13 to December 31, 2024 were consecutively recruited by convenience sampling method. According to the Fatigue Severity scale (FSS), the patients were divided into a fatigue group (FSS ≥ 36 points, 187 cases) and a non-fatigue group (FSS < 36 points, 113 cases). The general situation questionnaire, Modified Rankin Scale (mRS), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI) and Stroke Specific Quality of Life Scale (SS-QOL), Chronic Disease Self-efficacy Scale (CDSES) were used to investigate and study them. A logistic regression model was established and stratified analysis was conducted to explore the factors influencing PSF in young and middle-aged patients. The incidence of PSF among 300 young and middle-aged stroke patients was 62.3%, Univariate analysis showed that Pre-Stroke Fatigue (PrSF), mRS score, SAS score, SDS score, PSQI score, SS-QOL score, CDSES score, marital status and occupation were related to PSF (P < 0.05). Multivariate regression analysis revealed that marital status (OR = 8.908, 95%CI 1.776–44.674), PrSF( OR = 2.909, 95%CI 1.555–5.443), SDS score (OR = 1.099, 95%CI 1.046–1.154) and SS-QOL score (OR = 0.985, 95%CI 0.972–0.998) were associated with the occurrence of PSF. Stratified analysis showed that in the group of patients with PrSF, Be married (OR = 0.438, 95%CI 0.046–4.203), SDS score (OR = 1.052, 95%CI 0.965–1.146), SS-QOL score (OR = 0.960, 95%CI 0.937–0.984), among which the SS-QOL score was associated with the risk of PSF (P < 0.001); In the group of patients without PrSF, SDS score (OR = 1.086, 95%CI 1.033–1.142) was associated with a high risk of PSF (P < 0.001), Be married (OR = 0.060, 95% CI 0.007–0.490) and SS-QOL score (OR = 0.984, 95% CI 0.974–0.995) were associated with a low risk of PSF (P < 0.05). The fatigue status of young and middle-aged stroke patients is more serious. Clinically, we should strengthen the protection of high-risk patients with the above risk factors, and corresponding intervention programs should be formulated in time to reduce the incidence of PSF, alleviate the fatigue symptoms of patients, and enhance their quality of life.Trial registration: Registration number of China Clinical Trials Registration Center ChiCTR2500099037.

Conflicting results from previous studies on gastric adenocarcinoma (GC) in young patients have led to controversy surrounding the prognosis for young GC patients. The authors studied 6954 patients with GC who received curative resections. They were classified into three groups: those aged 40 years or less ("young," 12.7%); those aged 41-65 years ("middle-aged," 66.7%); and those aged more than 65 years ("elderly," 20.6%). Clinicopathologic characteristics and overall survival rates were analyzed. Young patients were predominately female and had tumors that were histologically undifferentiated. However, in regard to T4 invasion, N3 lymph node metastasis, and TNM stage IV, the characteristics of the tumors of young patients were similar to those of middle-aged and elderly patients. Overall survival rate was significantly better in young patients than middle-aged patients (P = .018) and elderly patients (P < .001). Stratified by TNM stage, young patients showed better overall survival at stage I than middle-aged patients, and at stages I, II, and IIIa than elderly patients. Multivariate analysis indicated that age was an independent prognostic factor (as well as gender, operation type, depth of invasion, and lymph node status). The predominance of female cases and tumors that were histologically undifferentiated were distinctive characteristics in young patients. Young patients could gain a survival benefit after curative resection with stage I disease.

Why Is This an Issue?&#x0D; &#x0D; Emergency department (ED) overcrowding is a known issue in Canada that puts patients’ lives and health at risk when treatment needs within the ED exceed the resources required to address them.&#x0D; The causes and consequences of ED overcrowding are complex, varied, and extend beyond the ED. Left unchecked, ED overcrowding contributes to a deteriorating standard of care as staff become overworked and burned out.&#x0D; &#x0D; What Are the Potential Interventions to Address ED Overcrowding?&#x0D; &#x0D; This roundup of 87 new and emerging interventions intended to alleviated ED overcrowding complements CADTH’s Emergency Department Overcrowding: An Environmental Scan of Contributing Factors and a Summary of Systematic Review Evidence on Interventions.&#x0D; Interventions were included in this report if they are not captured in CADTH’s complimentary report Emergency Department Overcrowding: An Environmental Scan of Contributing Factors and a Summary of Systematic Review Evidence on Interventions because they are either new or are not yet in wide use in EDs and health systems across Canada and could be reasonably be expected to affect ED overcrowding (e.g., by improving patient flow through the ED or reducing the number of people seeking care in the ED). Interventions that could address multiple causal factors (e.g., e-consult services) were also included.&#x0D; &#x0D; What Is the Potential Impact?&#x0D; &#x0D; Decreasing ED overcrowding has the potential to improve the standard of care delivered to those accessing EDs and contribute to decreasing the burden on ED staff, regardless of the intervention or which contributing factor it aims to act upon.&#x0D; Some interventions that can alleviate ED overcrowding also have an impact on primary and community care; bolstering preventive care, increasing access to diagnostic testing for those who need it, and improving access to health care supports can improve health outcomes.&#x0D; &#x0D; What Else Do We Need to Know?&#x0D; &#x0D; The pan-Canadian issue of ED overcrowding calls for real solutions. CADTH is examining the evidence and expert-informed considerations and producing a series of publications about the causes and consequences of, and solutions to, ED overcrowding in health care systems across the country.&#x0D; &#x0D; The interventions identified in this report may be of interest to senior health care decision-makers who are anticipating health system innovation and transformation.

To compare measurements of emergency department (ED) patient flow during periods of acute ED overcrowding and times of normal patient volume (NPV). Retrospective ED chart review comparing ED flow for patients treated in a tertiary care teaching hospital during periods of ED overcrowding, defined as critical bed status (CBS), and NPV. All periods of CBS during July 2001 were identified. CBS time intervals were matched with NPV times by month, day of the week, time of day, and number of care providers. All patients registered during these matched time intervals were reviewed. Times were collected for each of the following activities: check-in, bed placement, physician assessment, first intervention, and disposition. Corresponding intervals were calculated in minutes. Triage category was used as a marker of illness severity (1 = most severe, 5 = least severe). Descriptive statistics were performed. One hundred eighteen patient charts were reviewed: 61 CBS and 57 NPV. There was no statistical difference in illness severity between the two groups. In the cumulative analysis, patients waited significantly longer for an ED bed (30.4 min, p = 0.01) but did not experience significant delays in other intervals. Triage category analysis revealed no significant difference in triage 2 patients. Intermediate-severity patients (triage 3) waited longer in every interval and significantly longer for physician assessment (30.8 min longer, p < 0.05). Low-severity patients (triage 4) waited longer for an ED bed (40 min, p = 0.02) but did not experience other significant delays. During times of acute overcrowding, the most significant delay occurs awaiting placement in the ED bed.