Emergency Care Research Articles

ACVECC-Veterinary Committee on Trauma registry report 2020-2021.

To report summative data from the American College of Veterinary Emergency and Critical Care (ACVECC)-Veterinary Committee on Trauma (VetCOT) registry, with further individual evaluation of university and private practices and level I and II Veterinary Trauma Centers (VTCs). Multi-institutional registry data report, January 1, 2020, to December 31, 2021. VTCs identified and verified by ACVECC-VetCOT. Dogs and cats with evidence of trauma. Data were input to a web-based data capture system (REDCap) by data entry personnel trained in registry software use and operational definitions of data variables. Patient data on demographics, trauma type, preadmission care, trauma severity assessment at presentation (modified Glasgow Coma Score and Animal Trauma Triage score), key laboratory parameters, interventions, and outcome were collected. Summary descriptive data for each species are reported. Twenty-two VTCs contributed data to the VetCOT registry during a 24-month period, culminating in a total of 9758 complete trauma case records for dogs and 11734 for cats. Head trauma in dogs and cats was seen at a higher percentage in both university-only VTCs (encompassing both level I and II) (20.1% and 24.1%, respectively) and level I-only VTCs (24.3% and 24.1%, respectively), in comparison to private-only VTCs (encompassing both level I and II) (13.5% and 16.2%, respectively) and individual level II VTCs (14.1% and 18.9%, respectively). Canine and feline surgical procedures were performed at a higher percentage at university VTCs (50% and 40.5%, respectively) compared to private VTCs (39.2% and 28.6%, respectively). Overall survival to discharge for dogs and cats remains high at 93.1% and 83.6%, respectively. The VetCOT registry has continued to show powerful potential in collating a large, multifaceted, international dataset in trauma for both dogs and cats. As published in previous VetCOT registry reports, survival to discharge has remained static across both university and private practice veterinary hospitals; however, further breakdown has identified university and level I VTCs admitting and managing a higher number of head traumas, as well as university VTCs performing a higher proportion of surgical procedures. Data from this registry will continue to aid in the design of clinical trials, prospective observational studies, and translational research, which will improve the understanding and outcome of trauma patients.

Risk stratification of residual abscess after surgical treatment for gastroduodenal perforation

AbstractAimsResidual abscess is a major complication after emergency surgery for gastroduodenal (GD) perforation. However, there is little evidence regarding potential risk factors contributing to its development. Establishing a risk stratification strategy would be valuable for the entire management process.MethodsThis single‐center, retrospective study analyzed 115 consecutive patients who underwent surgery for GD perforation between 2010 and 2023 at a secondary emergency care hospital. Patients were divided into two groups based on the presence or absence of residual abscesses. Potential risk factors for abscess formation were evaluated from various aspects.ResultsThe incidence of residual abscesses was 19.1% (22 of 115). Multivariable analysis revealed that current use of nonsteroidal antiinflammatory drugs (odds ratio [OR] 3.76, p = 0.037), cancer chemotherapy (OR 13.56, p = 0.005), and preoperative renal dysfunction (OR 4.72, p = 0.018) were independent predictors. A potential scoring model could be created using these three parameters, and the number of risk factors correlated with the likelihood of developing a residual abscess (0 vs. 1 vs. ≥2; 6.2% vs. 29.4% vs. 50.0%, p < 0.001). From a bacteriological point of view, the presence of Enterococcus in the ascites culture was closely related to its occurrence with 100% probability. Moreover, regarding early detection of this complication, C‐reactive protein on postoperative d 5 had the highest predictive ability with an area under the curve of 0.818.ConclusionThe risk of residual abscess formation after surgical treatment of GD perforation can be assessed utilizing both preoperative and postoperative information.

Cautionary lessons from the COVID-19 pandemic: Healthcare systems grappled with the dual responsibility of delivering COVID-19 and non-COVID-19 care.

During the COVID-19 pandemic, hospitals were challenged to provide both COVID-19 and non-COVID treatment. A survey questionnaire was designed and distributed via email to hospitals empanelled under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana(AB-PMJAY), the world's largest National Health Insurance Scheme. Telephonic follow-ups were used to ensure participation in places with inadequate internet. We applied support vector regression to quantify the hospital variables that affected the use vs. non-use of hospital services (Model-1), and factors impacting COVID-19 revenue and staffing levels (Model-2).We quantified the statistical significance of important input variables using Fisher's exact test. The survey, conducted early in the pandemic, included 461 hospitals across 20 states and union territories. Only 55.5% of hospitals were delivering emergency care, 26.7% were doing elective surgery and 36.7% providing obstetric services. Hospitals with adequate supplies of PPE, including N95 masks, and separate facilities designated for COVID-19 patients were more likely to continue providing emergency surgeries and services effectively. Data analysis revealed that large hospitals (> 250 beds) with adequate PPE and dedicated COVID-19 facilities continued both emergency and elective surgeries. Public hospitals were key in pandemic management, large private hospital systems were more likely to conduct non-COVID-19 surgeries, with not-for-profit hospitals performing slightly better. Public and large private not-for-profit hospitals faced fewer staff shortages and revenue declines. In contrast, smaller hospitals (< 50 beds) experienced significant staff attrition due to anxiety, stress and revenue losses. They requested government support for PPE supplies, staff training, testing kits, and special allowances for healthcare workers. The inclusion of COVID-19 coverage under AB-PMJAY improved access to healthcare for critical cases. Maintaining non-COVID-19 care during the pandemic indicates healthcare system resiliency. A state-wide data-driven system for ventilators, beds, and funding support for smaller hospitals, would improve patient care access and collaboration.

Spatial Patterns of Emergency Dental Care Utilization: Assessing the Influence of Social Vulnerability and Dental Provider Availability

Aim: Our aim was to examine the association between emergency dental care use and dental providers’ availability and ZIP code social vulnerability index. Methods: This cross-sectional observational study mapped variations in emergency dental care and analyzed their association with social vulnerability using generalized spatial two-stage least-squares to address spatial correlation. To perform spatial autoregressive modeling to examine how dental provider capacity and social vulnerability influence emergency care use across neighboring counties, accounting for ZIP Code Tabulation Area (ZCTA) spillover effects, we used secondary data from the Maryland Health Services Cost Review Commission, InfoUSA, and the US Census American Community Survey. We focused on emergency dental care usage in ZIP Code Tabulation Areas, using emergency department visits and inpatient stays per 1000 residents for dental conditions, as the dependent variable. Results: Highly vulnerable ZCTAs saw 5.9× more non-traumatic dental condition (NTDC) ED visits, 5.3× more chronic dental ED visits, 3.3× more NTDC inpatient stays, and 1.3× more chronic dental inpatient stays than less vulnerable areas. For all four measures of emergency dental care use, increased dental provider availability was associated with reductions in use of emergency dental care (ED), while higher social vulnerability was associated with increased use. For example, an increase of one dental provider per 1000 residents was associated with a reduction of 28.2 non-traumatic dental ED visits, while a high social vulnerability index was associated with an increase of 88.6 non-traumatic dental ED visits. Conclusions: There was an association among dental provider availability, social vulnerability, and the use of emergency dental care.

Implications of inadequate communication: Emergency care for deaf and hard-of-hearing patients.

Implications of inadequate communication: Emergency care for deaf and hard-of-hearing patients.

Validation of a diagnostic support tool for early recognition of cervical arterial dissection in primary care

BackgroundCervical arterial dissection (CeAD) is a leading cause of stroke in young adults with an early presentation often mimicking musculoskeletal pain. Currently, no validated tests exist and CAD may be missed. A diagnostic support tool could help guide urgent referral for imaging, when to monitor, or when safe to proceed with treatment, and ultimately help stroke prevention. ObjectivesTo validate a 4-criteria diagnostic support tool for early recognition of CeAD in primary care, to refine tool descriptors as needed, and propose optimal cut-offs for clinical application. DesignProspective observational study MethodParticipants with radiologically confirmed CeAD and controls without CeAD were identified from adults >18 years presenting to a tertiary metropolitan hospital with initial diagnosis of headache or neck pain. All were scored with criteria out of7 (acute onset pain [2], recent trauma/infection [1], neurological features [2], age <55 years [2]). Diagnostic values were calculated to determine cut offs and the tool was refined based on the analysis. ResultsThirty participants with CeAD and 261 controls with non-CeAD causes of headache and neck pain were included. The diagnostic support tool was an ‘excellent’ predictor of CeAD (AUC 0.83) but demonstrated poor specificity. Refining the tool to ‘acute/sudden onset’ [1], ‘unusual/unfamiliar headache/neck pain’ [1], recent trauma/infection [1] and neurological features ≥2 [1], scored out of 4, showed 100 % sensitivity and 74 % specificity to detect CeAD at a cut-off of 3/4 (AUC 0.87). ConclusionsThe refined tool shows acceptable clinical utility at a cut-off ≥3, where referral for vascular imaging is recommended. Further validation in Emergency and primary care is needed.

Non-Surgical Endodontic Management of Large Periapical Lesions After Traumatic Dental Injuries.

Traumatic dental injuries of permanent teeth result in multiple immediate and long-term consequences depending upon the severity of trauma, age of the patient, the status of root maturity, and the emergency care provided. The healing responses may get disturbed due to severe damage, loss of vascularity of the supporting structures, and infections. As a result, the prohealing mediators and pathways are overpowered by the destructive stimuli often manifested by an increased osteoclastic activity. Among the various late complications, the apical periodontitis or the periapical lesions are most worrisome for the patients and create clinical dilemma for the dentists. In the past, many such lesions were classified as cysts and subjected to surgical management. However, better understanding of lesion pathophysiology, three-dimensional imaging, and molecular pathways have established their inflammatory nature. The advancements in materials such as calcium silicates, and regenerative techniques have propelled the research related to non-surgical endodontic management as its clinical acceptability. The treatment largely follows the recommendations of regenerative medicine and is based on four principles: (a) establishing the drainage or an endodontic access to the area, (b) removal of most of the triggering agents such as necrosed pulp, toxins, and inflammatory mediators, (c) disinfection of the area, controlling inflammation and reversal of the acidic pH, and (d) maintenance of this infection/inflammation-free state for a long time through adequate sealing. This review aims to highlight the rationale of the approach, case selection, pathophysiology of the causation and healing, clinical protocols, and the limitations of non-surgical endodontic management of large periapical lesions secondary to traumatic dental injuries.

Identifying signatures of the earliest benthic bulldozers in emergent subaerial conditions during the colonization of land by animals.

The colonization of land by animals was a milestone in the history of life. Approximately 100 million years before full terrestrialization, early animals sporadically traversed emergent subaerial substrates, leaving behind trace fossils recording their activities. However, identifying temporarily emergent environments and determining the affinities, motility and subaerial endurance of the trace-makers, and the timing and magnitude of their impacts on marginal-marine environments, are challenging. Here, we used semi-resolved computational fluid dynamics-discrete element method coupling to simulate trace formation on non-cohesive sediments in submerged and emergent subaerial conditions. This revealed instability-induced morphological signatures that allow us to identify the earliest terrestrial trace fossils. Quantitative metrics enable us to infer that the putative earliest terrestrial trace-makers were molluscs, and dimensional analysis suggests that their subaerial excursions could last at least 15 min. These organisms navigated emergent environments from the early Cambrian (stage 2), tens of millions of years earlier than arthropods. This quantitative paradigm provides new insights into the palaeobiology of the earliest subaerial bulldozers and highlights that mollusc-like animals were among the first ecosystem engineers to enter marginal-marine settings. They may thus have contributed to the establishment of marginal-marine biogeochemical cycles, laying the groundwork for subsequent terrestrialization by other animals.

Impact of Rural School-Based Health Centers on Asthma Management

To test the hypothesis that students with asthma who have access to school-based health centers (SBHCs) receive more recommended preventive care and use less emergency care, we compared patterns of health care utilization among rural students with asthma by SBHC access. Using a cross-sectional design, we analyzed encounters for all patients ages 4 through 19 living in 4 counties covered by a healthcare system that sponsors a network of SBHCs in rural upstate New York. Patient addresses for each encounter were geocoded to school districts, allowing us to determine whether students lived in districts with (n=15) or without (n=23) a SBHC. We measured utilization among students with asthma in 2016 and 2017, comparing measures by SBHC access. Students with asthma were identified using ICD diagnosis codes from visits in the two calendar years prior to each analysis year. Students in districts with SBHCs had greater odds of 2 or more asthma-related office visits (OR=2.23; 95% CI: 1.66-2.99) and 1 or more well-child visits (OR=1.24; 95% CI: 1.03-1.50) than their peers in districts without SBHCs. Students in districts with SBHCs had lower odds of a respiratory-related convenient care or emergency department visit (OR=0.45; 95% CI: 0.30-0.67). Across outcomes, differences were greatest when comparing students who utilized the SBHC in their district with students in districts who did not have access to a SBHC. Rural students with asthma who have access to SBHCs have greater opportunities for preventive asthma care per national guidelines and use emergency departments and convenient care less.

BCAS: Blockchain-based secure access and sharing scheme for EHR data

Sharing Electronic Health Record (EHR) data is critical for improving medical decision-making and emergency care. However, EHRs contain sensitive patient information, making data breaches and misuse a significant concern during sharing. To tackle this challenge, we propose the Blockchain-Based Secure Access and Sharing (BCAS) scheme, a patient-centered, secure, and efficient solution for large-scale EHR access and sharing that intelligently combines blockchain with proxy re-encryption. Four smart contracts are designed for the BCAS to achieve effective user identity registration, precise virtual identity verification, strict access control, and secure data management. The adoption of hybrid on-chain and off-chain storage structures, coupled with the four smart contracts, effectively optimizes the efficiency of the blockchain in BCAS. Proxy re-encryption further enhances data confidentiality and streamlines EHR sharing among authorized users. The security analysis indicates that BCAS can resist DDoS, spoofing, and man-in-the-middle attacks, ensuring the privacy and security of patient EHR data. The performance evaluation demonstrates that the CPU usage of smart contracts does not exceed 15%. The on-chain and off-chain storage structures require less than 30s for uploading and downloading an 800MB file. Additionally, the proxy re-encryption scheme can process a 10MB file in less than 43ms. These results indicate that BCAS offers efficient performance without compromising data security and privacy. Compared with existing blockchain-based EHR sharing systems, BCAS offers superior performance, a more comprehensive solution, and increased resistance to attacks.

A multi-period capacitated facility location problem with maximum travel time and backup service for locating and sizing EMS stations

Emergency medical services (EMS) is a system that provides emergency medical care for incidents involving serious illness or injury. The location of EMS stations plays an essential role in delivering effective and efficient medical services. Numerous location models have been developed for locating and sizing EMS stations. However, it remains challenging to satisfy all EMS planning criteria within a single location model. In this study, a multi-period capacitated facility location problem with maximum travel time and backup service (EMSLSP) is proposed for locating and sizing EMS stations. The most important criteria for EMS planning are taken into account in EMSLSP: the demand changes due to population mobility, the maximum service capacity of an ambulance, the maximum number of ambulances at each EMS station, the maximum travel time from each EMS station to the locations it serves, the full coverage of dynamic demand, the minimum percent of population covered by EMS service in a specific travel time, and a backup station for each demand location in case of need. A case study in Zhengzhou, a large city in China, demonstrates that effective and efficient locations and sizes of EMS stations can be determined by solving the EMSLSP with various planning parameters. Compared with the existing EMS systems, the average ambulance travel time and the percentage of the population served are significantly improved. Simulations of ambulance scheduling confirm that the relocated and resized EMS stations perform better than those in the existing system. The evaluation-optimization-simulation method outlined in this paper provides a comprehensive and effective approach for EMS station planning.

State and National Estimates of the Cost of Emergency Department Pediatric Readiness and Lives Saved

High emergency department (ED) pediatric readiness is associated with improved survival among children receiving emergency care, but state and national costs to reach high ED readiness and the resulting number of lives that may be saved are unknown. To estimate the state and national annual costs of raising all EDs to high pediatric readiness and the resulting number of pediatric lives that may be saved each year. This cohort study used data from EDs in 50 US states and the District of Columbia from 2012 through 2022. Eligible children were ages 0 to 17 years receiving emergency services in US EDs and requiring admission, transfer to another hospital for admission, or dying in the ED (collectively termed at-risk children). Data were analyzed from October 2023 to May 2024. EDs considered to have high readiness, with a weighted pediatric readiness score of 88 or above (range 0 to 100, with higher numbers representing higher readiness). Annual hospital expenditures to reach high ED readiness from current levels and the resulting number of pediatric lives that may be saved through universal high ED readiness. A total 842 of 4840 EDs (17.4%; range, 2.9% to 100% by state) had high pediatric readiness. The annual US cost for all EDs to reach high pediatric readiness from current levels was $207 335 302 (95% CI, $188 401 692-$226 268 912), ranging from $0 to $11.84 per child by state. Of the 7619 child deaths occurring annually after presentation, 2143 (28.1%; 95% CI, 678-3608) were preventable through universal high ED pediatric readiness, with population-adjusted state estimates ranging from 0 to 69 pediatric lives per year. In this cohort study, raising all EDs to high pediatric readiness was estimated to prevent more than one-quarter of deaths among children receiving emergency services, with modest financial investment. State and national policies that raise ED pediatric readiness may save thousands of children's lives each year.

Endometrial pathology among premenopausal patients seeking emergency care for abnormal uterine bleeding: High risk of endometrial malignancy and premalignancy

Endometrial pathology among premenopausal patients seeking emergency care for abnormal uterine bleeding: High risk of endometrial malignancy and premalignancy

Intraprofessional boundary crossing in acute paediatric care: A rich journey for general practice and paediatric residents.

Achieving optimal collaboration between general practitioners and hospital-based critical care doctors is vital yet challenging, necessitating targeted collaborative training during residency. Despite apparent benefits, implementing intraprofessional learning faces constraints. Understanding its occurrence is crucial for engaging and educating residents. Considering boundaries' learning potential, we developed and evaluated an educational programme for general practitioner (GP) and paediatric (P) residents in paediatric emergency care based on Akkerman's Boundary Crossing Theory. The study investigated how intraprofessional learning mechanisms occurred and what learning conditions facilitated or impeded learning of GP and P residents, aiming to optimise educational programme design for intraprofessional collaboration. We developed an educational programme with three activities: joint medical assessments of paediatric patients in each other's context, mutually mini-Clinical Evaluation Exercises (mini-CEXs) about intraprofessional collaboration skills and educational meetings about collaborative care. We performed a qualitative study with a constructivist approach to explore experiences of the programme. We conducted focus group interviews and analysed mini-CEXs, utilising Boundary Crossing theory for template analysis. Ten GP and eight P residents participated in our study. Learning mechanisms of identification and coordination dominated the joint medical assessments. Mini-CEXs stimulated reflection. Educational meetings with supervisors about intraprofessional barriers initiated transformation. Facilitated learning conditions were bidirectional crossing, enthusiastic supervisors, residents being familiar with each other, clear mini-CEX design and authentic paediatric cases. Unclear mutual expectations during joint medical assessments impeded learning of residents. Working in each other's context triggers learning mechanisms of identification, coordination and reflection, forming the basis for intraprofessional learning in paediatric emergency care for GP and P residents. For development of new collaboration practices, supervisors are necessary to translate reflection into transformation. Mutual responsibilities and expectations should be made more explicit to create a safer intraprofessional learning environment. Our findings extend to other medical training contexts, leveraging boundaries for learning.

Interventions to Reduce Imaging in Children With Minor Traumatic Head Injury: A Systematic Review.

Reducing unnecessary imaging in emergency departments (EDs) for children with minor traumatic brain injuries (mTBIs) has been encouraged. Our objective was to systematically review the effectiveness of interventions to decrease imaging in this population. Eight electronic databases and the gray literature were searched. Comparative studies assessing ED interventions to reduce imaging in children with mTBIs were eligible. Two independent reviewers screened studies, completed a quality assessment, and extracted data. The median of relative risks with interquartile range (IQR) are reported. A multivariable metaregression identified predictors of relative change in imaging. Twenty-eight studies were included, and most (79%) used before-after designs. The Pediatric Emergency Care Applied Research Network (PECARN) rule was the most common intervention (71%); most studies (75%) used multifaceted interventions (median components: 3; IQR: 1.75 to 4). Before-after studies assessing multi-faceted PECARN interventions reported decreased computed tomography (CT) head imaging (relative risk = 0.73; IQR: 0.60 to 0.89). Higher baseline imagine (P < .001) and additional intervention components (P = .008) were associated with larger imaging decreases. The limitations of this study include the inconsistent reporting of important outcomes and that the results are based on non-randomized studies. Implementing interventions in EDs with high baseline CT ordering using complex interventions was more likely to reduce head imaging in children with mTBIs. Including the PECARN decision rule in the intervention strategy decreased orders by a median of 27%. Further research could provide insight into which specific factors influence successful implementation and sustained effects.

Prehospital Care and Clinical Characteristics of Patients With Diabetic Emergencies at A Tertiary Care Hospital in Mysuru, India: An Observational Study with Emphasis on Geospatial Analysis

Background: Diabetes Mellitus is a chronic, progressive disease with serious complications, and its prevalence is rising, especially in India. This study evaluates the clinical characteristics, prehospital care, and proximity to healthcare facilities among patients presenting with diabetic emergencies at a tertiary care hospital. Methodology: A cross-sectional study was conducted with 70 diabetic emergency patients (hyperglycemia, hypoglycemia, and DKA). Data were collected using a semi-structured questionnaire assessing clinical characteristics, prehospital care, and health-seeking behavior. Geospatial analysis measured the distance from patients' residences to the hospital. Results: Among the 70 participants, 36 (51.4%) were over 60 years old, and 55 (78.6%) were male. The most common symptoms were polyuria (85.7%) and excessive thirst (57.1%). Hyperglycemia was diagnosed in 68 (97.1%) cases, with 46 (65.7%) showing high random blood sugar levels (&gt;200 mg/dl). Severe symptoms led 55 (78.6%) to seek emergency care, with 17 (24.3%) requiring ambulance services. Geospatial analysis revealed that 50% of patients lived 1-50 km from the hospital. Conclusion: The study emphasizes the need for improved access to diabetes care near patients' homes to prevent emergencies, highlighting the importance of decentralizing services to improve health outcomes.

Nurse-led framework to improve the safety and quality of residential aged care (HIRAID® Aged Care): protocol for a stepped-wedge cluster randomised controlled trial

BackgroundThe health issues experienced by older people can often be severe and complex, and an increasing number are using residential aged care services to meet their care needs. High-quality nursing care is fundamental to the health and safety of aged care residents and is contingent on nurses’ accurate assessment, informed decision-making, and delivery of timely interventions. However, the role of the aged care nurse is often challenging, impeded by factors such as understaffing, high workloads, and a lack of access to clinical infrastructure and resources. When these challenges mount, residents are put at greater risk of adverse outcomes, such as avoidable clinical deterioration and hospital transfers. This study describes the adaptation and implementation of the emergency nursing framework, HIRAID® (History including Infection risk, Red Flags, Assessment, Interventions, Diagnostics, reassessment, communication and plan)—a tool to assist nurses’ assessment, decision-making and care in residential aged care.MethodsThe HIRAID® framework will be adapted for residential aged care using a real-time Delphi and panel of aged care and nursing experts. The co-designed HIRAID® Aged Care framework will be trialled in 23 residential aged care homes in Sydney, Australia, in a modified stepped-wedge cluster randomised controlled trial design. All homes will be randomised into one of four clusters. Outcomes of interest include the rate of clinical deterioration events resulting from nurses’ actions, the rate of hospital transfers determined to be inappropriate, performance against the national mandatory aged care quality indicators, resident satisfaction with care, nurse and medical staff satisfaction with communication, and the quality of nursing documentation. These outcomes will be evaluated using a combination of qualitative and quantitative analysis of routinely collected resident data, expert assessments of facility documentation events against validated criteria, and pre- and post-intervention surveys of residents, family carers, nurses, and medical staff.DiscussionThis protocol describes a pragmatic trial that aims to translate an evidence-based framework from the emergency care context into residential aged care. The adapted HIRAID® Aged Care framework will be the first of its kind to standardise and guide holistic nursing assessment, decision-making, and documentation in residential aged care in Australia.Ethics and disseminationThis research has been approved by the Western Sydney Local Health District Human Research Ethics Committee: 2023/ETH00523. A waiver of consent has been approved to access resident health data and nursing documentation at each participating site.Trial registrationAustralian and New Zealand Clinical Trial Registry, ACTRN12623000481673. Registered 12 May 2023.Protocol versionVersion 1.0 6 February 2024.

Emergency department visits, inpatient hospitalizations, and non-fatal and fatal drug overdoses during COVID-19 among Veterans with opioid use disorder.

The COVID-19 pandemic had dramatic adverse impacts on people with opioid use disorder (OUD), as evidenced by significant disruptions to care and unprecedented increases in drug overdoses. In this study, we evaluated the impacts of COVID-19 on utilization of emergency and inpatient care, and fatal and non-fatal overdoses among veterans with OUD. We used Veterans Health Administration (VHA) electronic medical record and mortality data to compare emergency department (ED) visits, inpatient hospitalizations, and fatal and non-fatal overdoses between a pandemic-exposed cohort of veterans with OUD observed both pre- and post-pandemic onset (n = 53,803; observed January 2019-March 2021) to a matched pre-pandemic control group (n = 53,803; observed October 2017-December 2019). Compared to pre-pandemic trends, there were significant decreases in the odds of ED and inpatient admissions and total number of ED and inpatient admissions during COVID-19. There was a significant decrease in the odds of having a recorded non-fatal overdose. The odds of overdose death increased during the pandemic compared to pre-pandemic trends. We observed significant decreases in the utilization of ED and inpatient care services, and fewer non-fatal overdoses, post-pandemic onset. Healthcare disruptions limiting access to emergency and inpatient care could account for the lower number of recorded non-fatal overdoses, potentially reflecting an underestimate of risk. In contrast, fatal overdoses increased during the pandemic compared to pre-pandemic trends. Lower utilization of emergency and inpatient care, and higher rates of fatal overdoses during the pandemic, suggest an exacerbation of unmet treatment need post-pandemic onset.

The effect of a new coronavirus infection on hemogram parameters in the early convalescence period of patients with coronary heart disease

Laboratory data, especially a general blood test, play an important role in the treatment of infectious diseases, including COVID-19. However, in patients with coronary heart disease (CHD) and COVID-19, a general blood test is rarely analyzed and is insufficient to fully assess an impact of the new coronavirus infection on patients with cardiac diseases. The aim of the study was to analyze a COVID-19 effect on hemogram parameters in the early recovery period of patients with coronary heart disease. The study was performed at the Kursk City Clinical Hospital for Emergency Medical Care in the years 2021–2022, which involved 58 mature-aged patients (45–59 years old) suffering from coronary heart disease who had a new coronavirus infection and 62 elderly patients suffering from coronary heart disease alone. Morning blood sampling was carried out from the forearm superficial veins into Vacutainer test tubes added with a coagulation activator. In elderly patients, 3–4 weeks after recovery, significant changes in red blood parameters persisted — a decline in the level of peripheral blood erythrocytes, hemoglobin and hematocrit. Elderly patients with coronary heart disease comorbid with a moderate new coronavirus infection, 3–4 weeks later had also higher count of leukocytes, neutrophils, segmented neutrophils and ESR level relative to comparison group. It should be noted that in the early convalescence period elderly patients with coronary heart disease and COVID-19 had significantly elevated ESR, which confirms ongoing sustained inflammatory process. After evaluating the information content according to the calculated Kullback informativeness assessment for analyzed general blood test parameters, it was found to peak for platelet and leukocyte counts as well as ESR level. Thus, among the analyzed indicators in the general blood test, it turned out that platelet and leukocyte count along with ESR level were most informative and of prognostic significance during early convalescent period of elderly patients with coronary heart disease comorbid with a new coronavirus infection, which are proposed to be used as biomarkers of early convalescent period.

The Role of Newborn Pulse Oximetry Screening for Detecting Critical Congenital Heart Defects: A Narrative Review.

Critical congenital heart diseases are life-threatening, with a high morbidity rate and mortality among newborns; in fact, a newborn discharged from the hospital with undiagnosed heart disease may experience severe complications during the initial days or weeks of their life, necessitating emergency care and even death. Among all kinds of critical congenital heart disease, coarctation of the aorta is one of the most difficult to diagnose because it only becomes noticeable a few days after birth, when patients have already been discharged from the hospital. This underlines the importance of having a reliable diagnostic tool to discover these diseases. The identification of some of these patients can be achieved through newborn screening with pulse oximetry, but only a small number are diagnosed. Hence, the objective of this review was to determine the value of pulse oximetry screening for the early detection of congenital heart defects in newborns, with a focus on coarctation of the aorta. A literature search was conducted between December 2023 and February 2024 using four electronic databases: Pubmed, Google Scholar, Embase, and Scopus to identify studies that evaluated the efficacy of pre- and post-discharge neonatal ductal saturation monitoring for the diagnosis of critical congenital heart defects before discharge. Twenty research studies with a large number of patients, demonstrating moderate sensitivity and high specificity of pulse oximetry test in detecting critical heart defects, especially coarctation of the aorta, were selected and analyzed. Many confirmations have been found of how good the specificity of screening is, reaching an average value of 99.9% in each study analyzed. The problem still lies in the sensitivity of the screening, which is not as good as the specificity, never reaching 90% in any of the studies analysed. So, it is crucial to keep up with efforts to improve the efficacy of the pulse oximetry screening method.