Fever is one of the more common symptoms in children and adolescents, accounting for 20%-40% of all pediatric office visits and ca. 30% of all pediatric contacts with the emergency medical services. The present clinical practice guideline concerns the management of fever of acute onset in otherwise healthy children and adolescents in the outpatient setting. A systematic literature search was conducted, with evaluation according to SIGN and GRADE. For neonates and infants under the age of 3 months, the body temperature should be measured rectally with a digital thermometer. From the age of 1 year onward, it can be measured with an infrared tympanic thermometer (sensitivity 77%, specificity 98%). For infants under the age of 3 months, temperatures above 40°C are associated with an elevated risk of severe bacterial infection (OR 6.3, 95% confidence interval [4.44; 8.95]); in older children, the height of the fever has little prognostic significance (p = 0.11). The decision whether to lower the fever by medical means should be based exclusively on the degree of suffering and impairment of the child. Antipyretic agents should not be given routinely. Parents and other carers should be educated about fever as a normal defense reaction of the body and should be made acquainted with the warning signs (impaired consciousness, cutaneous hemorrhage, dehydration, capillary refill time longer than 3 seconds). Children whose degree of suffering and impairment from fever calls for treatment can be given acetaminophen (10 to 15 mg/kg BW in each individual dose, no more than 4 times per day) or ibuprofen (10 mg/kg BW in each individual dose, no more than 3 times per day). This evidence-based clinical practice guideline establishes a differentiated, symptom-oriented approach to the outpatient management of fever and emphasizes the education of parents and other carers so that the unnecessary administration of antipyretic drugs can be avoided.

To examine the effects of offering non-emergency medical transportation (NEMT) on care utilization among low-income and disabled beneficiaries in Medicare Advantage (MA). We leveraged the 2019 expansion of "primarily health related" benefits to study the impact of offering NEMT on enrollees' utilization of care. We used an event study model to compare changes in care for beneficiaries enrolled in plans that began offering a NEMT benefit in 2019 versus those in plans that did not. We used MA plan benefit package, Medicare enrollment, and MA encounter data for years 2016-2019 to identify plans offering NEMT, low-income and disabled beneficiaries enrolled in these plans, and model covariates. Offering of NEMT was associated with little change in utilization. We found a statistically insignificant 1.4% increase in the probability of receiving an annual wellness visit (Coef. 0.006; 95% CI, -0.007-0.018, p = 0.371) and a 4.0% decrease in ambulance use days (Coef. -0.012; 95% CI, -0.033-0.010, p = 0.290). We did not find evidence of statistically significant or economically meaningful changes in outpatient evaluation and management, procedure, imaging, and emergency room visits. In the first year of NEMT benefit offerings by MA plans, we found no detectable evidence of associated changes in care utilization among low-income and disabled beneficiaries. Conclusions about the potential value of coverage for NEMT are limited by the short evaluation period and lack of data on NEMT benefit generosity and use.

Preterm prelabour rupture of the membranes poses maternal and perinatal risks including maternal sepsis, placental abruption, preterm labour and its sequelae, perinatal mental health complications, and mortality. Optimum management is not well understood. Most recent UK guidance suggested outpatient management may be appropriate, but guidance was not given on frequency or mode of monitoring, and outcomes following this are not well understood. This study aimed to determine monitoring practices and outcomes of women whose pregnancies complicated by preterm prelabour rupture of the membrane who are cared for in the outpatient setting, and to understand their experience. Retrospective data collection including patient demographics, preexisting risk factors, diagnosis and outpatient monitoring (including maternal observations, biochemistry and ultrasound findings), delivery outcomes and placental histopathology. Counselling of women was assessed at two timepoints: diagnosis and first review by a consultant. All women were invited to participate in a service evaluation. Across six units, 233 women were cared for in outpatient services for PPROM. Median gestation at diagnosis was 32weeks (IQR 28+1 - 34+3 weeks). 34% had an equivocal diagnosis. Counselling on outcomes varied across units. Spontaneous preterm birth occurred in 41% of cases with a further 18% being delivered preterm for suspected chorioamnionitis. All units used maternal heart rate, temperature, C-reactive protein and white cell count to monitor for infection although neither absolute values at delivery nor trends in any of these were predictive of histological chorioamnionitis. Most women felt that their outpatient care was acceptable, but highlighted deficiencies in emotional support offered.

BackgroundAlzheimer's disease (AD) patients frequently present to emergency departments (EDs) with complex comorbidities that complicate triage and management. Yet, little is known about how these multimorbidity patterns have evolved over time.ObjectiveTo identify temporal shifts in comorbidity-based phenotypes among older adults with AD visiting EDs between 2007 and 2022 using unsupervised clustering methods.MethodsWe analyzed ED visits for adults aged ≥60 with an AD diagnosis from the Nationwide Emergency Department Sample (NEDS) for the years 2007, 2012, 2017, and 2022. Using ICD-9/10 codes, we mapped diagnoses to 30 clinically relevant comorbidities per year and applied the k-means clustering method to identify subgroups based on diagnostic co-occurrence. Heatmaps summarized cluster compositions across timepoints.ResultsOver 15 years, four stable but evolving comorbidity clusters emerged in each year. Earlier cohorts (2007-2012) were dominated by cardiovascular and respiratory clusters (e.g., CHF, CAD, respiratory failure), while more recent cohorts (2017-2022) showed increased prevalence of nonspecific, frailty-related presentations (e.g., fatigue, GERD, general symptoms). Despite rising ED utilization among older adults, the proportion of visits documenting AD declined from 2.59% in 2007 to 1.34% in 2022, potentially reflecting shifts in coding, outpatient management, and diagnostic overshadowing by acute symptoms.ConclusionsThe comorbidity landscape of AD-related ED visits is changing, with a shift toward vaguer syndromes and complex multimorbidity. These findings underscore the need for dementia-aware triage strategies and dynamic phenotyping tools to improve emergency care for cognitively impaired older adults.

Current status of early diagnosis of developmental dysplasia of the hip more than 10 years after program implementation: a multicenter study of cases diagnosed in 2023.

Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome predominantly affecting women. Although the knowledge of SCAD has expanded over the past 2 decades, limited evidence exists to guide post-event management and prevention of future adverse events. This review aims to synthesize the current understanding of SCAD and outline considerations for exercise prescription and cardiac rehabilitation (CR) in this unique population. A comprehensive literature review was conducted, incorporating original research articles, systematic reviews, meta-analyses, and current clinical guidelines related to SCAD and CR. Current literature demonstrates that CR is safe in this population and is associated with improvement in measures of physical and mental health. Expert consensus supports reintroduction of exercise and an individualized multidisciplinary CR framework.This review highlights current evidence and expert recommendations for the multidisciplinary outpatient management of patients with SCAD.

Continuous glucose monitoring (CGM) has become the standard of care for outpatient diabetes management, yet its initiation during hospitalization-particularly at discharge-remains underutilized. The transition from hospital to home presents a unique opportunity to start CGM, educate patients, and improve glycemic outcomes. Although preliminary studies suggest that CGM initiation at discharge can increase time-in-range and reduce hypoglycemia and hospital readmissions, widespread adoption faces several challenges, including therapeutic inertia, patient selection, insurance barriers, and limited implementation guidance. At the time of this writing, CGMs are not yet US Food and Drug Administration-approved for inpatient use, but approval is anticipated. In this article, we present an actionable, stepwise protocol for CGM initiation at hospital discharge, developed by the Council for Clinical Excellence in Inpatient Diabetes at Johns Hopkins Medicine. The protocol includes multidisciplinary coordination, inclusive patient selection, structured education, designation of outpatient follow-up providers, and emphasis on consistent postdischarge care. We address common barriers such as impaired cognition during recovery and device compatibility with imaging studies. While further research is needed to confirm long-term cost-effectiveness and clinical outcomes, we believe our protocol can serve as a practical foundation for hospitals and providers seeking to safely and effectively integrate CGM initiation into discharge workflows.

Acute pyelonephritis (APN) is one of the most common serious bacterial infections in children and a significant cause of renal morbidity if not promptly diagnosed and adequately treated. In recent years, the concept of ambulatory (outpatient) management of selected pediatric patients with APN has gained increasing attention due to advances in diagnostic tools, antimicrobial therapy, and structured follow-up protocols. However, clear clinical criteria for safe outpatient treatment remain under discussion. The aim of this study was to evaluate the clinical characteristics, treatment strategies, and short-term outcomes of children with acute pyelonephritis managed in ambulatory settings. A retrospective and prospective observational analysis was conducted involving pediatric patients diagnosed with APN based on clinical presentation, laboratory findings, and imaging data. Key parameters included age distribution, severity of symptoms, laboratory markers of inflammation, antimicrobial regimens, duration of therapy, complications, and need for hospitalization. Results demonstrated that carefully selected children with mild to moderate APN, stable hemodynamic status, preserved oral intake, and reliable parental supervision can be effectively managed in outpatient settings. Early initiation of empiric antibiotic therapy followed by targeted treatment based on urine culture results was associated with favorable clinical outcomes and low complication rates. Hospital referral was required in cases of persistent fever, vomiting, systemic toxicity, or laboratory signs of severe inflammation. Ambulatory management of acute pyelonephritis in children appears to be a safe and effective strategy when strict clinical criteria and structured monitoring protocols are applied. This approach may reduce hospital burden while maintaining high standards of pediatric care.

IntroductionEating disorders are complex disorders characterized by a persistent disturbance of eating that impairs health and psychosocial functioning, with accompanying long-lasting effects on the individual’s overall health and well-being. Presumed stereotypes may affect reporting and access to care, especially in the Caribbean, where ethnic groups are mostly non-White. This study reviewed the clinical presentation, management, and outcomes of eating disorders in adolescents and young adults in Kingston, Jamaica. It explored the factors that influence outcomes – hospital admission and recovery.MethodsThis retrospective case review study included male and female adolescents and young adult participants (10–29 years old) being treated for an eating disorder in Kingston, Jamaica. Data were extracted from the medical records of patients meeting the inclusion criteria for the period January 2010 to December 2020. Sociodemographic data, medical and psychological symptoms and signs, management and outcomes were extracted. Descriptive analyses were performed - proportions and frequencies for categorical variables; means and medians for continuous variables. Inferential analyses including the independent student’s t-test and analysis of variance were used to compare means and the Pearson chi-squared test used to determine the association between categorical variables. Logistic regression analyses examined predictors of outcome. Analyses were performed using SPSS version 23. Statistical significance was determined at the 5% level.ResultsThe study included 68 participants with a female preponderance (n = 60, 88.2%). Other specified food and eating disorders (OSFED) (n = 27, 39.7%) was the most common subtype seen in the sample population, and included atypical anorexia nervosa (AAN) (n = 18, 26.5%). Eleven (16.2%) participants were admitted to the hospital, the majority diagnosed with OSFED (n = 6, 54.5%). The most common reason for admission was failure of outpatient management (n = 7, 63.6%) but also included admissions for active suicidal ideation (n = 1) and late presentation of significant severity (n = 2). Multidisciplinary management by an ED-trained physician, ED-psychologist, and dietician was utilized in most participants.DiscussionEating disorders are an emerging health concern worldwide, as well as in Jamaica. OSFED with a preponderance of atypical anorexia nervosa is the most prevalent, with overall female preponderance. These findings necessitate the implementation of measures in Jamaica in the realms of identification, prevention, and treatment.

Background: Bone and joint infections (BJIs), including osteomyelitis, septic arthritis, and periprosthetic joint infections, typically require prolonged antimicrobial therapy and often involve complex outpatient management. Oritavancin, a long-acting lipoglycopeptide approved for the treatment of acute bacterial skin and skin structure infections caused by Gram-positive bacteria, has emerged as a potential off-label option for BJIs owing to its favourable pharmacokinetic and pharmacodynamic properties. Objectives: To provide a comprehensive overview of the pharmacological rationale, microbiological activity, and available clinical evidence supporting the use of oritavancin in BJIs. Methods: A comprehensive narrative review of the literature was performed using MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL), focusing on publications from 2011 to 2025. Observational studies, case series, and case reports describing the off-label use of oritavancin in BJIs were considered. Results: The available literature primarily consists of observational studies and real-world experiences. Eighteen studies met the inclusion criteria. Oritavancin was most frequently evaluated for osteomyelitis (n = 14 studies), prosthetic joint infections (n = 10) and septic arthritis (n = 5). Multi-dose regimens, typically including a 1200 mg loading dose followed by weekly doses of 800-1200 mg, were the most commonly described strategies. Reported clinical success rates generally ranged from approximately 70% to over 90%. Oritavancin was overall well tolerated, with adverse events being mostly mild and self-limiting. Conclusions: Current evidence suggests that oritavancin may represent an effective and well-tolerated off-label option for selected patients with Gram-positive BJIs. Its use may offer practical advantages, including reduced hospitalization and avoidance of prolonged intravenous antimicrobial therapy, particularly in patients for whom standard treatment approaches are challenging.

Abstract Background Borderline Personality Disorder (BPD) is a severe mental illness whose treatment has long relied on specialized psychological and pharmacological interventions within hospitals. However, patients often experience high relapse rates upon returning to the community due to social dysfunction and weak support systems. In recent years, participatory governance models integrating community resources have demonstrated potential in mental health. However, research on their specific application and efficacy assessment for BPD patients remains limited. This study investigates a community-based participatory governance model grounded in the biopsychosocial framework. It aims to explore whether a novel approach—integrating patients, family members, community workers, and healthcare providers into a collaborative governance alliance—can effectively enhance patients’ long-term rehabilitation outcomes and social adaptation capabilities. This research seeks to provide crucial practical evidence and theoretical reference for optimizing the comprehensive management of BPD. Methods The randomized controlled trial was performed for 12 months. One hundred twenty BPD patients meeting diagnostic criteria were assigned at random to the experimental group (EG, n = 60) and control group (CG, n = 60). The CG received routine outpatient treatment and case management. The EG, in addition to routine treatment, implemented a structured community engagement intervention comprising: establishing a multi-stakeholder “Community Support Group” holding regular shared-decision case conferences, conducting family empowerment workshops, and organizing peer support activities led by recovering patients. All patients were evaluated at baseline, 6/12 months post-intervention by the Symptom Checklist-90 (SCL-90), Interpersonal Trust Scale, and Global Assessment of Functioning (GAF) scale. Repeated measures ANOVA was taken to compare group differences. Results After 12 months of intervention, data indicated that the community participation governance model were significantly positive on the recovery of BPD patients. The EG exhibited a mean reduction of 28.5 points in SCL-90 total scores compared to the CG (p<.01), with particularly pronounced improvements in the hostility, depression, and interpersonal sensitivity subscales (reductions of 4.2, 5.1, and 4.8 points, all p<.05). Regarding social functioning, the EG’s GAF score improved to an average of 68.3 points, obviously higher than the CG’s 59.7 points (p<.01). Specifically, 71.7% (43/60) of patients in the EG achieved a GAF score of “mild functional impairment” or better, whereas only 41.7% (25/60) of patients in the CG reached this level. Additionally, the EG exhibited a lower rate of emergency department visits (15%) compared to the CG (36.7%), and their interpersonal trust scores increased by 22.4%, both demonstrating obvious differences (p<.05). Discussion The findings confirm that the community-participatory governance model effectively alleviates core BPD symptoms, significantly enhances social functioning, and reduces crisis incidents, demonstrating clear practical value. By establishing an inclusive, empowering supportive environment, this model transforms external interventions into patients’ internalized social capital and self-management capabilities, serving as a potent complement to traditional medical approaches. Future research should focus on optimizing standardized operational procedures for this model, exploring its cost-effectiveness and long-term sustainability in broader community settings, and examining its differential effects on patients with different BPD subtypes. These efforts will advance the transformation of public mental health services from a “treatment-centered” to a “health management-centered” approach. Funding No. 21VMZ016.

Continuous glucose monitoring (CGM) devices are routinely used in the outpatient management of diabetes. They are not yet approved for use in intensive care units (ICUs). The main objective of this study was to determine the accuracy of CGM glucose determinations made in an ICU by comparing them with standard glucose measurements obtained during routine care. Secondary objectives were to determine the frequency of device malfunctions or adverse events and to assess acceptance of CGM use by caregivers. Dexcom™ G7 CGM sensors were placed on non-randomized, consented ICU patients with known hyperglycemia. CGM glucose concentrations were recorded in a Dexcom Clarity™ database and compared with near-simultaneous (±5 min) measurements obtained by laboratory or point-of-care measurements recorded in an electronic medical record. Determinations of accuracy were made using a Clarke Error Grid plot and by calculating mean absolute relative difference (MARD). Device failure and adverse event data were recorded in the electronic record. Caregiver acceptance was assessed by interview. During a 9-month period, 16 subjects were enrolled after obtaining informed consent. The median duration of CGM use on subjects was 5.5 (range 1-20) days. A total of 941 near-simultaneous CGM and routine care data were collected. Clarke Error Grid comparison of CGM and routine care data showed 99.7% of readings in regions A or B and 0.3% in other regions. The MARD of all readings was 12.25%. There were no adverse events attributable to the CGM recorded. Qualitative analysis of nursing responses revealed no concerns regarding the addition of CGM to the routine workflow. CGM glucose readings in the ICU may be reliable to use in certain critically ill patient populations. CGM may not be reliable in patients requiring high-dose vasopressors. The use of CGM to enhance patient care in ICUs merits additional research.

Cryptococcal meningitis (CM) remains a leading cause of mortality among people with advanced HIV disease (AHD) in sub-Saharan Africa. Current guidelines recommend induction therapy with amphotericin B and flucytosine, typically administered in an inpatient setting due to concerns over severe clinical presentation and drug-related toxicities. This requirement poses a significant burden on resource-limited health systems. We evaluated the real-world outcomes of a fully outpatient model for CM therapy in Maputo, Mozambique. A longitudinal retrospective cohort study was conducted at the Centro de Referência de Alto-Maé (CRAM), a specialized AHD outpatient clinic. We included 83 PLWH with laboratory-confirmed CM treated between October 2020 and December 2024. The primary outcome was hospitalization-free survival (HFS) within the first 10 weeks of treatment. Secondary outcomes included the frequency and severity of adverse drug reactions (ADRs), analysed by tracking haemoglobin (Hgb), potassium (K+), and creatinine (Creat) levels on days 1, 3, and 7 of induction therapy, and retention in care (RIC) at 6, 12, and 24 months. Statistical analyses included Kaplan-Meier survival estimates and paired t-tests. The median age was 37 years (IQR: 27-42), 63.9% were male, and the median CD4 count was 62 cells/µL (IQR: 27-105). Most patients (95.2%) were symptomatic at presentation, and 56.6% had concurrent tuberculosis. For the 52 patients who completed the full induction protocol at CRAM, the HFS rate at 10 weeks was 84.6% (44/52), with an overall survival of 90.4% (47/52). ADR analysis (n = 52) showed a predictable pattern of mild, manageable toxicity: a significant decline in Hgb (11.2 ± 1.8 to 10.6 ± 2.0 g/dL, p < 0.001) and K+ (4.27 ± 0.66 to 3.86 ± 0.78 mmol/L, p = 0.008), and a transient increase in Creat (0.83 ± 0.42 to 1.13 ± 0.64 mg/dL, p = 0.001) from day 1 to day 3, with stabilization or a trend toward recovery by day 7. No significant differences in ADRs were found between single-dose (47%) and multiple-dose (53%) L-AmB regimens. RIC for the entire cohort (n = 83) was high at 81.9% at 6 months, declining to 74.0% at 12 months and 70.4% at 24 months. An ambulatory model for CM therapy is feasible and effective in a resource-limited setting, demonstrating high hospitalization-free survival, manageable and reversible adverse drug reactions, and excellent medium-term retention in care. These findings suggest potential benefits and provide support for re-evaluating the standard of inpatient care. They indicate that integrating outpatient CM management into advanced HIV disease (AHD) care packages could help alleviate health system burdens and may contribute to improved patient outcomes.

When vasa previa is diagnosed, guidelines support recommendations about timing and route of delivery, as well as steroid administration. While elective admission to ensure proximity to care is common, the evidence does not support a clear recommendation. Our objective was to compare patients with vasa previa managed as inpatients versus outpatients.This is a single-institution cohort study of patients with a prenatal diagnosis of vasa previa from 2013 to 2023. Decisions about inpatient versus outpatient management and delivery planning were made by physicians and patients. Data was obtained through chart review. Cohorts managed with elective admission for vasa previa were compared with those managed as outpatients. Mann-Whitney U and Fisher's Exact test were used for statistical comparison.Eighty-nine patients were included, including 72 (80.9%) electively admitted versus 17 (19.1%) managed as outpatients. The groups were of similar age and parity. A higher proportion of patients managed as outpatients had public insurance. There were no differences in the rate of short cervix or vaginal bleeding between the cohorts, and the rates of nonscheduled cesarean delivery were similar. Betamethasone was administered at a median gestational age of 32 to 33 weeks in both groups. Elective admission was associated with earlier delivery overall, as well as earlier scheduled delivery. There were no stillbirths or neonatal deaths, and the rates of NICU admission were not significantly different.Patients electively admitted for vasa previa do not appear to have been at higher risk for emergent delivery, though admission was associated with earlier delivery, including scheduled deliveries. The lower rate of admission in those with public insurance could indicate a disparity in management, though further study is necessary. While our data do not rule out a benefit to routine admission, the benefits remain unproven. · Inpatient admission was associated with earlier gestational age at delivery.. · Inpatient versus outpatient management showed no difference in neonatal morbidity.. · Rates of unscheduled (urgent or emergent) delivery were not significantly different between groups..

Heart failure (HF) is a chronic disease with increasing prevalence, with rural communities having HF worse outcomes and higher mortality. The aim of this systematic review is to consolidate and evaluate existing evidence for the outpatient management of chronic HF in rural-dwelling adults. A librarian assisted in the design and implementation of the search strategy. Overall, 14 studies met criteria and were included in this review, with 5 overarching strategies identified. Despite the overall differences in outcomes for those with HF living in rural communities, there remains a lack of randomized trial evidence to inform outpatient care management strategies.

Thrombosis of the jugular vein and upper extremities are much rarer than thrombosis of the lower extremities. The diagnostic tool of choice is duplex sonography of the vessels. A thorough clarification of the cause is necessary after diagnosis if an obvious cause is not initially found. The focus here should be on searching for malignancy as well as hypercoaguability. The recommended minimum duration of anticoagulation with low-molecular-weight heparin is at least 3 months for primary thromboses of the upper extremities and 6 months for secondary thromboses. Rivaroxaban therapy is also a suitable option for outpatient management.

The prognosis of acute pulmonary embolism (PE) ranges from rapid symptom resolution to cardiovascular collapse and death. The Pulmonary Embolism Severity Index (PESI) is a rigorously derived and studied clinical prediction rule for PE prognosis that stratifies patients with acute PE into 5 classes (I-V) of increasing short-term overall mortality, based on 11 objective clinical variables readily available at the time of presentation. Numerous independent validation studies across the globe have demonstrated its accuracy and generalizability in identifying low-risk (class I-II) patients with PE who are potential candidates for less costly outpatient care. To facilitate the use of the PESI by busy clinicians, a simplified 6-variable version and auto-populating e-versions integrated into electronic health records have been developed and validated. Because of their methodological rigor, prognostic accuracy, and proven effectiveness and safety in both randomized and non-randomized controlled trials for managing low-risk patients in the outpatient setting, the original and simplified PESI (sPESI) have become reference standards for risk stratification of PE. Despite explicit guideline recommendations since 2014 to use the (s)PESI as a decision aid to identify low-risk patients with PE who are suitable for home care or early discharge, both the (s)PESI as well as outpatient management of low-risk patients remain largely underutilized.

Pulmonary embolism (PE) is associated with high cardiovascular morbidity and mortality. Timely diagnosis and accurate prognostication are extremely important for guiding patient management and treatment selection. Risk stratification and clinical scoring systems are crucial for rapid assessment, effective triage, and accurate outcome prediction. Traditional tools have demonstrated strong prognostic value, and the role of dynamic risk assessment is increasingly recognized. Pretest probability scores including the Wells clinical prediction rule and the revised Geneva score, act as first line assessments to determine the need for further diagnostic testing. The Hestia criteria, Pulmonary Embolism Severity Index (PESI) and simplified Pulmonary Embolism Severity Index (sPESI) help to identify patients appropriate for outpatient management. For hospitalized patients, several additional scoring systems, imaging findings, and biomarkers can be used for further risk stratification and treatment planning. The development of multidisciplinary pulmonary embolism response teams (PERTs) and the integration of hybrid predictive models are demonstrating a shift toward a multimodal approach to PE risk stratification. The objective of this review is to summarize current approaches to risk assessment in pulmonary embolism, evaluate existing and emerging prediction models, as well as discuss future directions aimed at improving individualized care in the management and treatment of pulmonary embolism.

Abstract Introduction Fractional flow reserve-computed tomography (FFR-CT) is a new tool to improve diagnostic accuracy. However, its impact in Spain remains untested. Purpose This study evaluates the clinical and economic implications of incorporating FFR-CT into routine practice in Spain, versus standard approach, in patients with moderate coronary stenosis. Methods This is a retrospective, observational, single-center intervention simulation study conducted on patients with stable chest pain who underwent a coronary CT angiography (July 2021 -December 2022) in Spain. Patients were eligible if they had a CAD-RADS 2.0 grading system of 3 (50–69% stenosis), body mass index &amp;lt;35 kg/m2 and coronary artery calcium score &amp;lt; 1000 Agatston Units. The CT report was provided to five clinical cardiologists, who reviewed independently the findings and made decisions on any additional tests or interventions they felt were necessary. This process was repeated after applying FFR-CT, with the same set of questions asked to evaluate how their decisions changed based on the additional information from FFR-CT. For each clinical scenario, the cardiologists were asked to respond to a set of questions, both before and after FFR-CT analysis: (1) What additional diagnostic tests would you request? (2) Would you recommend admission, outpatient management, or discharge? (3) What treatment approach would you suggest based on the available results? (4) Did you find the information provided by FFR-CT to be useful?. The cost analysis assessed the total cost or savings resulting from these decisions. Results In the clinical simulation analysis, a total of 215 clinical scenarios were finally evaluated, corresponding to the individual assessment of all 43 cases by each of the 5 participating cardiologists. FFR-CT substantially reduced the need for additional tests. Stress cardiac magnetic resonance dropped from 54.8% to 12% (p=0.00), while invasive coronary angiography decreased from 21% to 15% (p=0.00). The total cost savings of diagnostic procedures after FFR-CT amounted to 45,976.64 euros, or 213.84 euros per case. Notably, end of diagnostic process increased from 11% to 48% after its implementation (p=0.00) Conclusions According to the results of this simulation study, FFR-CT was associated with a significantly lower rate of additional testing, substantial cost savings, and a higher discharge rate.Graphical abstract Table 1.Cost analysis

The MASCC (Multinational Association for Supportive Care in Cancer) score is widely used to identify low-risk febrile neutropenia (FN) patients eligible for outpatient management. However, its performance specifically in patients with solid tumors remains insufficiently validated. We conducted a retrospective cohort study at the Centre Hospitalier Universitaire de Sherbrooke (CHUS) between 2011 and 2022. Adult patients admitted for FN secondary to chemotherapy for solid tumors were included. Patients were classified as high-risk (MASCC < 21) or low-risk (MASCC ≥ 21). The primary outcome was the score's ability to predict an uncomplicated clinical course with a specificity of 95%. Secondary outcomes included ICU admission, mortality, duration of hospitalization, intravenous antibiotics, neutropenia, and potential days saved with outpatient treatment. Among 329 oncologic patients, 227 (69%) were classified as low risk. The MASCC score showed a sensitivity of 83.5% (95% CI 77.8-88.2%) and a specificity of 57.3% (95% CI 47.8-66.4%) for predicting the absence of complications. ICU admission rates were significantly lower among low-risk patients (0.4% vs. 32.7%, p < 0.001), as were mortality rates (0.9% vs. 16.8%, p < 0.001). Median hospitalization duration was 4days [IQR (interquartile range) 3-6] for low-risk patients compared to 6days [IQR 4-10] for high-risk patients (p < 0.001). Applying outpatient eligibility criteria could have prevented 486 hospitalization days across 161 patients, with 80.7% experiencing no complications. The MASCC score does not accurately identify solid tumor FN patients who would evolve without complications, given its moderate specificity. However, it remains associated with a substantial reduction in hospitalization burden among low-risk patients. Clinical judgment remains essential in outpatient management decisions. Integrating additional clinical parameters may further improve risk stratification in this population.