Journal of the American College of Clinical Pharmacy : JACCPJohn P Bomkamp, Benjamin V Craft, Holly Nuest, Matthew Bjornstad, Jennifer Slavens
BACKGROUND: Pharmacist-driven microbiology review programs have been thoroughly described in the emergency department setting. However, there is limited evidence for programs in outpatient settings, especially for urgent care settings. The purpose of this study is to evaluate a pharmacist-driven urgent care microbiology review program to determine the impact of its implementation. METHODS: This retrospective cohort study evaluated urgent care patients who did not receive appropriate treatment based on urine, wound, or respiratory culture, or select sexually transmitted infection testing. A pharmacist-driven microbiology review program at two urgent cares was compared to 11 other urgent cares using only physician/advanced practice provider (APP) review of microbiology results. The primary end point was the time to appropriate treatment in hours from finalized result to prescription of appropriate treatment. Secondary end points included time to appropriate treatment in calendar days and unplanned 30-day revisit rate. RESULTS: A total of 400 patients were included in this study (pharmacist-driven, n = 200; physician/APP, n = 200). Time to appropriate treatment in hours was 11 h in the pharmacist-driven cohort and 13 h in the physician/APP cohort (p = 0.047). Unplanned 30-day revisit rate was similar between the two groups (pharmacist-driven 14% versus physician/APP 12.5%, p = 0.658). CONCLUSION: A pharmacist-driven urgent care microbiology review program achieved a similar time to appropriate antimicrobial treatment compared with a physician/APP process while maintaining comparable clinical outcomes.
Pediatric emergency medicine practiceChristian B Ryckeley, Justin Wimberly, Glenn Goodwin, Michelle N Marin
Abdominal pain is a common reason for pediatric patients to present to the emergency department. Pain assessment is especially challenging when patients are unable to communicate due to their developmental stage or medical conditions. Preverbal and nonverbal children are at increased risk for complications of delayed or missed diagnosis. Inadequate pain control is also a concern in this vulnerable population. This review provides guidance for assessment of abdominal pain in preverbal and nonverbal children, focusing on behavioral measures, which are more applicable and reliable in these patients, and on the effective use of parental input. Recommendations are given for a graduated approach to pain management, including nonpharmacologic and pharmacologic options.
Emergency medicine Australasia : EMAManissa Sufian, Yao Xu, Marietta John-White, Frank Muscara, Franz E Babl, Vicki Anderson, Catherine L Wilson, Meredith L Borland, Bruce J Tonge, Kylie M Gray, …
OBJECTIVE: To explore care recipients (patients' and their caregivers) and care providers (healthcare providers' and law enforcement officers') perspectives on paediatric mental health presentations to emergency departments, to identify challenges to care. METHODS: Secondary qualitative analysis of free-text responses from a Delphi study conducted within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network in 2022. The original Delphi process aimed to identify research themes and key data points for child and adolescent mental health ED presentations; however, a large number of additional free-text responses were received. The primary aim of this specific study was to identify major categories using the General Inductive Approach (GIA) of these free-text responses to explore the experiences, service delivery and perceived challenges of care recipients and care providers. Patients were recruited from 12 EDs across three Australian states, and pre-hospital services (two police and three ambulance departments) across four Australian states. RESULTS: A total of 184 participants provided responses (36 care recipients and 148 care providers). Three main categories are described: (1) care continuity and communication gaps, (2) challenges in the ED environment and (3) need for improved training and education and behavioural support. CONCLUSIONS: Care recipients and care providers identified challenges in service coordination, clinician readiness and the ED environment. Strengthening communication, expanding training, reducing sensory overload and improving privacy in physical EDs and improving links to community care could enhance patient experiences and outcomes.
Intracranial hemorrhage following intravenous thrombolytic therapy most commonly occurs within 12 hours of administration. Because many patients remain in the emergency department during this period, a structured, time-sensitive approach to recognition and management is critical. This review summarizes current recommendations for the diagnostic workup, use of reversal agents, and escalation of care for postthrombolysis intracranial hemorrhage, with particular attention to guidelines addressing stroke and neurocritical care management. Contraindications to intravenous thrombolysis and risk factors for postthrombolysis intracranial hemorrhage are also discussed.
Emergency medicine Australasia : EMAAkmez Latona, Katherine Stuart, Patricia Valery, Alan Ho, Biswadev Mitra
OBJECTIVE: To describe the epidemiology, healthcare utilisation and outcomes of patients presenting to emergency departments (EDs) with chronic liver disease (CLD) in Queensland, Australia. METHODS: This statewide data linkage study included adult patients with CLD-related diagnoses across 104 Queensland Health EDs between 1 January 2016 and 31 August 2023. Emergency, inpatient and mortality data were linked. Patients were stratified by cirrhosis status and decompensation. Outcome was 30-day mortality. Poisson regression assessed trends, and Cox regression evaluated mortality. RESULTS: Amongst 15,999,186 ED presentations, 23,578 (0.15%) were related to CLD, involving 11,961 patients. Presentations increased by 2% annually (IRR 1.02, 95% CI 1.02-1.03). Cirrhosis accounted for 18,735 presentations (79.5%). Overall, 20,312 presentations (86.1%) resulted in hospital admission, 918 (4.5%) were admitted to intensive care units (ICU), and 963 (4.1%) resulted in in-hospital death. Amongst patients with cirrhosis, 16,968 (90.6%) resulted in admission, 867 (5.1%) were admitted to ICU and 899 (4.8%) died in hospital. Predictors of 30-day mortality included cirrhosis (adjusted hazard ratio (aHR) 6.92, 95% CI 5.36-8.94), malignancy (aHR 3.21, 95% CI 2.90-3.55), hepatorenal syndrome (aHR 3.15, 95% CI 2.72-3.66), encephalopathy (aHR 2.03, 95% CI 1.78-2.32) and spontaneous bacterial peritonitis (aHR 1.47, 95% CI 1.20-1.80). Presentation to tertiary hospitals was associated with lower mortality (aHR 0.75, 95% CI 0.68-0.82). CONCLUSIONS: CLD-related ED presentations are increasing and place substantial demand on hospital services in Queensland. Decompensation events strongly predict mortality and healthcare utilisation. ED-initiated risk stratification and coordinated care models to improve outcomes for patients with cirrhosis require development and evaluation.
The Australian journal of rural healthMary Malakellis, Anna Wong Shee, Laura Alston, Vincent L Versace, Pheona Griffith, Jade Odgers, Kevin Mc Namara
OBJECTIVE: To evaluate: (1) patient experiences and perceptions of Patient Watch; and (2) the effect on emergency department (ED) presentations, healthcare use, quality of life and chronic illness care. DESIGN: A prospective longitudinal cohort study using a convergent-parallel mixed methods study design combining: (1) qualitative semi-structured interviews analysed using reflexive thematic analysis and (2) quantitative assessment of Quality of Life-8D, Patient Assessment of Chronic Illness, routinely collected ED clinical data and Patient Watch programme data. SETTING: A large public health service delivering care across the home, community, aged care and hospital, serving a regional centre and small, medium and large rural towns in Western Victoria, Australia. PARTICIPANTS: Forty-five participants were enrolled in the study. A subsample who completed all study requirements enabled baseline and 6-month follow-up analysis (n = 37). INTERVENTION: Patient Watch, a telehealth case management model of care adapted from a metropolitan to a rural context, to manage the care of frequent presenters to the emergency department. RESULTS: Before enrolment, patients reported health system, medical and situational complexity hindered effective care and contributed to high treatment burden, with acute exacerbations leading to increased healthcare use and negative care experiences. Patient Watch improved perceived care coordination, healthcare access and helped participants manage acute exacerbations. ED presentations (p < 0.001), hospital admissions (p < 0.001), general practitioner (p = 0.02) and specialist visits (p = 0.01) decreased at follow-up. CONCLUSIONS: Cohort heterogeneity challenged the effectiveness of a standardised care model, and the evolving nature of Patient Watch complicated impact evaluation. Frequent presenters showed diverse clinical and demographic profiles with high treatment burdens, highlighting the need for tailored care.
Emergency medicine Australasia : EMAAndrew Wallace, Hatem Alkhouri, Helen Badge, Toby Fogg, Elliot Long
BACKGROUND: Optimal initial laryngoscope blade selection for paediatric emergency intubation is uncertain. We examined whether Miller or Macintosh blades are associated with differences in first-pass success (FPS) and adverse events in children < 5 years. METHODS: Prospectively collected data from the Australia and New Zealand ED Airway Registry (ANZEDAR) between March 2010 and March 2024 were analysed for children under 5 years of age. We report demographics, FPS and adverse events by initial blade type. Multivariable models examined factors associated with FPS and hypoxia. RESULTS: Among 201 children, 88 (43.8%) were intubated with a Miller blade and 113 (56.2%) with a Macintosh blade. In unadjusted analyses, children intubated with Miller blades were younger (median 0.4 years, IQR 0.08-1.35 vs. median 1.6 years, IQR 0.75-2.00), p < 0.001), had lower FPS (63.6% vs. 80.5%; OR 0.42, 95% CI 0.22-0.80; p = 0.008) and had a higher incidence of hypoxia (33.0% vs. 17.7%; OR 2.28, 95% CI 1.19-4.46; p = 0.01) compared with children intubated with Macintosh blades. Hypotension rates did not differ. CONCLUSION: In this cohort of young children intubated in the ED, Macintosh blade use was associated with higher FPS and fewer hypoxic events compared with Miller blade. Age was a significant confounder and should be considered when choosing which laryngoscope blade to use in young children.
Journal of the American College of Clinical Pharmacy : JACCPAngela Mercado, Jacob M Noble, Adriane N Irwin, Melissa E Badowski, Nitish Bangalore, Gina Caliendo, David C M Chan, Zachary J Dumont, Christine M Groth, Mais …
Key performance indicators (KPIs) are quantifiable measures that describe critical success factors of an organization. Their vital role in ensuring the delivery of quality health care services necessitates the development of KPIs relevant to inpatient clinical pharmacy practice. This opinion paper from the American College of Clinical Pharmacy (ACCP) Clinical Administration Practice and Research Network (CADM PRN) describes the rationale, methodology, and outcomes of a consensus process to identify a focused set of inpatient/acute care clinical pharmacy KPIs. Leveraging a modified Delphi approach, the CADM PRN convened an Expert Panel of clinical pharmacy leader members to build a consensus-driven set of KPIs reflecting clinical, operational, patient-centered, and financial contributions of clinical pharmacists in the inpatient/acute care setting. From a previous ACCP White Paper, a total of 15 KPIs were identified across four domains: (1) clinical practice and patient safety, (2) clinical outcomes and readmissions, (3) medication education and patient engagement, and (4) financial and operational value. The CADM PRN posits that the establishment and implementation of standardized KPIs are essential for measuring and demonstrating the value of clinical pharmacy services in modern health care, offers pragmatic, consensus-based KPIs for evaluating clinical pharmacy services supporting resource justification, and advancing the visibility and impact of pharmacists in acute care practice. As hospitals shift toward value-based care, robust KPI frameworks will be critical for optimizing patient outcomes, supporting financial sustainability, and justifying appropriate staffing. Future efforts should focus on pilot testing, addressing implementation barriers, and achieving broader acceptance for KPIs across the profession.
International journal of mental health nursingAntony Mullen, Brenda Happell, Bridget Hamilton, Stephanie Skinner
The Safewards model and its ten interventions have been effective in reducing restrictive practices and preventing conflict within acute inpatient mental health units. However, few studies in the current literature explore the consumers' experiences of Safewards. This exploration also needs to consider the views of Mental Health Nurses and the Lived Experience Workforce, who are both important stakeholders in the application of Safewards and how it impacts on consumers' experiences. Despite this, the views of Mental Health Nurses and the Lived Experience Workforce about consumers' experiences of Safewards are limited. This qualitative study explored the views of Lived Experience Workforce leaders about consumers' experiences of Safewards, and Mental Health Nurses' responses to these experiences in acute inpatient mental health units in Australia. Six Lived Experience Workforce leaders participated in individual interviews. Data were analysed using thematic analysis, revealing four themes: (1) consolidating Safewards through understanding consumers' experiences, (2) consumers as leaders in Safewards, (3) acknowledging the realities of acute inpatient mental health units and (4) practice foundations underpinning Safewards. Results highlighted the positive impact of improved consumer involvement in Safewards. Additionally, mechanisms to develop strategic partnerships between Lived Experience Workforce leaders and mental health nurses warrant further investigation. This study highlighted the restrictive nature of acute inpatient mental health units and the need to acknowledge the impact this has on consumers. Further embedding of foundational approaches, such as trauma-informed and recovery-oriented practice within Safewards, is also required to align with consumers' expectations. Greater recognition of consumers' experiences and their agency within the model, and consideration of other Safewards interventions, is also needed. This is required to increase safety, reduce harms associated with restrictive practice, and enhance Safewards effectiveness.
Emergency medicine Australasia : EMAThomas Maouris, Lachlan Clarke, Jasmyn Dew
OBJECTIVE: To describe management, imaging pathways and systems challenges for adult closed head injury presentations to a rural Queensland emergency department without hospital-based CT. METHODS: A retrospective cohort study was conducted at Dalby Hospital from January 2022 to January 2023. Adult patients presenting with closed head injury were identified through manual Emergency Department Information System review. Demographic, clinical, imaging, disposition and documentation variables were extracted from medical records. CT access was categorised as local offsite private radiology or interhospital transfer. RESULTS: A total of 118 patients were included; 73/118 (61.9%) were male and mean age was 48.6 years. CT head was performed in 60/118 (50.8%) patients. Of these, 30/60 (50.0%) underwent CT through an offsite private radiology provider and 30/60 (50.0%) required interhospital transfer. Intracranial haemorrhage was identified in 9/60 (15.0%) imaged patients, comprising 7 subdural and 2 subarachnoid haemorrhages. Documentation of observation and discharge advice was variable. A planned period of observation was documented in 55/118 (46.6%) cases. Among patients discharged from the emergency department or short-stay unit, written patient information was documented in 36/72 (50.0%), red-flag discussion in 32/72 (44.4%), and no-driving advice in 5/72 (6.9%). CONCLUSION: Patients with closed head injury in this rural emergency department had substantial neuroimaging needs despite the absence of hospital-based CT. Imaging was obtained through either local offsite private radiology or interhospital transfer, requiring clinicians to consider both imaging need and pathway safety. Variable documentation of observation and discharge advice highlights an opportunity to strengthen safety-netting in rural head injury care.
Health services researchAnita A Vashi, Liam Rose, Tracy Urech, Allison Engstrom Buggaveeti, Linda Diem Tran
OBJECTIVE: To evaluate whether centralized appointment scheduling and same-day virtual clinician evaluation improved appointment timeliness and follow-up after nurse triage. We also assessed whether these changes were associated with differences in downstream utilization, costs, reach, and Veteran experience. STUDY SETTING AND DESIGN: Retrospective quasi-experimental evaluation of Veteran Administration Health Connect (VAHC) modernization across 18 regions between October 1, 2018, and September 30, 2024. Staggered rollout enabled difference-in-differences and event-study analyses comparing outcomes before and after modernization. DATA SOURCES AND ANALYTIC SAMPLE: Data were drawn from the Veterans Administration Corporate Data Warehouse, Telecare Record Manager, and Customer Relationship Management platforms, and VSignals Veteran experience surveys. The analytic sample comprised 11,118,916 encounters (4,560,677 pre-modernization; 6,558,239 post-modernization). PRINCIPAL FINDINGS: Centralized scheduling was associated with modest and mixed improvements in appointment access. Same-day scheduling increased by 14.3 percentage points (95% CI, 10.1 to 18.5). Time from call to scheduled appointment decreased by 0.37 days (95% CI, -0.49 to -0.26), while time to completed appointment increased by 2.9 days (95% CI, 0.2 to 5.7). Following modernization, time from nurse triage to any subsequent care decreased by 0.28 days (95% CI, -0.45 to -0.11), and the proportion of callers receiving no follow-up care within 7 days declined by 2.3 points (95% CI, -4.0 to -0.5). Modernization was not associated with changes in the proportion of all emergency department (ED) visits preceded by a nurse triage call or in total ED visit volume. Seven-day ED visits, admissions, and total costs did not change meaningfully. Veteran satisfaction was high for post-modernization virtual encounters. CONCLUSIONS: VAHC modernization improved appointment access and follow-up after nurse triage but was not associated with short-term changes in ED use or costs, highlighting gains in navigation and experience without immediate shifts in downstream utilization.
Journal of the American College of Clinical Pharmacy : JACCPHannah Webb, John G Gums
Music-based interventions (MBIs) have emerged as a promising, nonpharmacologic approach to improving patient care across a variety of clinical settings. This narrative review examines the current evidence describing the mechanistic basis through which music engages biological pathways relevant to clinical pharmacy practice, and the clinical evidence supporting MBIs as adjuncts to pharmacotherapy across clinical outcomes. From this evidence, the review proposes a framework through which MBIs may be integrated into clinical practice that comprises: (1) patient selection, (2) MBI selection, and (3) outcome monitoring. The review does not constitute formal practice guidance, as pharmacy-specific clinical protocols and implementation models remain active areas of research. Additionally, the review synthesizes emerging evidence supporting MBIs as a clinical pharmacy workforce well-being strategy. Collectively, these findings highlight the potential for MBIs to serve as an innovative adjunct to traditional pharmacotherapy that aligns with the clinical pharmacist's existing responsibilities for medication optimization, deprescribing, and holistic, patient-centered care.
Australian occupational therapy journalLeanne van Diemen, Genevieve Pepin, Rachel Knight
INTRODUCTION: Occupational therapists are important members of mental health multidisciplinary teams. Despite aligning with mental health reform priorities, including promoting client centredness and participation, the role of occupational therapists in mental health, particularly in acute psychiatric inpatient units, is poorly understood. This study explored the role, function, and scope of practice of occupational therapists in Australian acute psychiatric inpatient units. METHODS: This mixed methods, convergent parallel design study combined in-depth interviewing and a cross-sectional survey. Qualitative and quantitative data were analysed using thematic analysis and descriptive statistics, respectively. Both forms of data were analysed separately and then integrated and merged using a contiguous approach. The Occupational Therapy Australia Mental Health Capability Framework guided survey questions and interview guide development. The Model of Human Occupation informed interview guide development, while maintaining an occupational focus across the study. CONSUMER INVOLVEMENT: Consumer involvement was not relevant for this study. FINDINGS: Fifty-nine mental health occupational therapists participated in the study. All completed the survey, and 13 also participated in interviews. Participants were mostly females (83%), aged under 30 (58%), from Victoria (70%), with less than 3 years' experience in acute psychiatric inpatient units (77%). Four themes were identified: (1) a day in the life-same same but different, (2) the underutilised potential of occupational therapy, (3) an evolving practice and increasing demand, and (4) practice shaped by and shaping the environment. Key functions of the role included assessment, completed by survey participants either once a day (37%) or more (16%); individual interventions, completed once a day (48%); group work, completed several times a day (43%); and discharge planning. CONCLUSION: Occupational therapists working in Australian acute psychiatric inpatient units share common functions, challenges, and experiences. Limited resources and challenges advocating for their role impact occupational therapists' ability to demonstrate their value within multidisciplinary teams.
Journal of medical economicsJohn Vissing, Geoffroy Coteur, Ibrahim Turkoz, Kavita Gandhi
AIMS: Generalized myasthenia gravis (gMG) is a rare, chronic autoimmune disorder with substantial healthcare resource utilization (HRU) and high economic burden. This study evaluated HRU, costs, and predictors of high-cost events in adults with gMG, using data from VIVACITY-MG3. METHODS: Post-hoc analyses used the primary efficacy dataset from VIVACITY-MG3, a randomized, double-blind, placebo-controlled study of nipocalimab and standard-of-care (SoC) versus placebo and SoC in seropositive adults with gMG. HRU endpoints included hospital admissions (HA), emergency department visits (EDV), and hospital days. Logistic regression analysis identified clinical and demographic HA/EDV predictors. Hospital costs per patient per year (PPPY) were estimated using United States (US) cost data from published sources and from a claims database, adjusted to 2024 US dollars. RESULTS: Among 153 patients, nipocalimab numerically reduced the proportion experiencing ≥1 all-cause (9.1% vs 15.8%) and gMG-related (3.9% vs 7.9%) HA/EDV events versus placebo. The incidence rate of HA/EDV events was 51% numerically lower with nipocalimab. Mean hospital stay duration was numerically shorter with nipocalimab for all-cause (8.4 vs 14.6 days) and gMG-related admissions (11.2 vs 17.6 days). All-cause and gMG-related hospital days per 100 patient-years were statistically significantly reduced by 60% and 68% with nipocalimab, respectively. Estimated cost offsets for reduced HRU were $10,860-$13,253 PPPY. Multivariate analysis identified worsening in Myasthenia Gravis-Activities of Daily Living (MG-ADL) total score and higher baseline Quantitative Myasthenia Gravis (QMG) respiratory total score as independent predictors. Patients switching from placebo to nipocalimab in the VIVACITY-MG3 open-label extension experienced a 64% reduction in hospital days PPPY. LIMITATIONS AND CONCLUSION: Study limitations include the post-hoc nature of the analysis and the relatively short study duration. Nipocalimab added to SoC significantly reduces overall HRU and associated costs in adults with gMG, particularly by lowering rates and severity of HA/EDV events. Clinical deterioration and high baseline disease severity independently predict high-cost events.
International journal of qualitative studies on health and well-beingKumiko Hashiratani, Hiroko Azechi
BACKGROUND: Emergency nurses caring for patients who have attempted suicide face ethical dilemmas and negative emotions that hinder empathetic care. Existing studies have mainly reported emotional burden and mixed attitudes, with limited research examining nurses' internal interest processes. Therefore, this study aimed to clarify the structure and processes underlying nurses' interest in caring for these patients in hospital-based emergency care settings, using a grounded theory approach. METHOD: Data were collected through semi-structured interviews with 25 nurses experienced in emergency care in Japan who had provided care to patients who had attempted suicide. Interviews were conducted from August 2022 to December 2023 and analyzed using constant comparative analysis. RESULTS: Six major categories emerged: "Attention towards care," "Being influenced by one's inner self," "Welling up emotions," "Focusing on attention," "Deciding the direction of care," and "Taking a meta-perspective on oneself within the situation." Nurses' beliefs and values were profoundly challenged by the gravity of suicide attempts, eliciting complex emotional responses combining a sense of moral responsibility, discomfort, and conflicting feelings. CONCLUSIONS: Emergency nurses maintained an interest in patient care despite emotional conflict and a destabilized sense of self. Self-awareness and situational awareness, particularly taking a meta-perspective, supported professional caring and decision-making.
Suicide is a major public health concern, and identifying early indicators of suicidal crisis remains a key clinical challenge. Nightmares have been suggested as potential early markers of suicide risk. This study aimed to investigate dream alterations preceding a suicidal crisis in patients presenting to a psychiatric emergency department. This prospective study was conducted in a psychiatric emergency center in Paris between March and April 2025.42 patients presenting with severe suicidal ideation or following a suicide attempt completed a self-administered questionnaire assessing dream characteristics, sleep disturbances, anxiety, and depressive symptoms using validated clinical instruments. The timing and evolution of bad dreams, nightmares, and suicidal-themed nightmares preceding the crisis were examined. Overall, 83.0% of patients reported at least one dream alteration. Bad dreams were reported by 61.9% of participants, nightmares by 52.4% and suicidal scenarios occurring within nightmares by 35.7%. Nightmares emerged on average 128 days before the suicidal crisis, whereas suicidal-themed nightmares appeared closer to consultation, approximately 16 days before the emergency visits. More than half of patients (54.8%) experienced an evolutionary pattern in dream content involving at least two successive dream alterations. Nightmare severity was significantly correlated with insomnia severity and anxiety symptoms. Nightmares are highly prevalent among patients presenting psychiatric emergency services during a suicidal crisis and often emerge weeks to months before the acute episode. The temporal proximity of suicidal-themed nightmares to crisis onset and their association with insomnia and anxiety suggest that systematic assessment of nightmares may enhance suicide risk in clinical practice.
Ultrasound quarterlyEric Meng, Kirun Baweja, Claire Weersink, Monish Ahluwalia, Wilma M Hopman, Roslyn Mainland, Ana Alexandru, Emma Neary, Rob Clayden, Clementine Janet Lui, Jeff…
Splenomegaly is an important clinical sign associated with diverse pathologies. Traditional bedside physical examination maneuvers used to detect splenomegaly demonstrate poor diagnostic performance. Point-of-care ultrasound (POCUS) is a potential alternative. We sought to compare the diagnostic performance of structured physical examination maneuvers and POCUS in the bedside detection of splenomegaly. Internal medicine and hematology inpatients at Kingston Health Sciences Centre from February 2023 to June 2024 were prospectively enrolled. Participants underwent a structured physical exam comprised of Castell's Method, Traube's Method, Nixon's Method, and one-handed palpation followed by a POCUS examination. Radiographic confirmation of splenomegaly (spleen length >12 cm) was obtained via abdominal ultrasound, computed tomography, or magnetic resonance imaging within 1 month of enrollment. The performance of each diagnostic test was determined. Of 130 patients enrolled, 55 (38.5%) had radiographically confirmed splenomegaly. POCUS demonstrated higher diagnostic performance (sensitivity 70.9%, specificity 72.0%, Matthew's correlation coefficient 0.43) compared with physical exam maneuvers. The most specific physical exam maneuver was Nixon's method (90.8%), while percussion of Traube's space had the highest sensitivity (52.7%). POCUS measurements strongly correlated with formal imaging (Spearman rho=0.630; P<0.001). The diagnostic accuracy of POCUS was reduced in patients with elevated body mass index (P=0.027) and in those scanned within 2 hours of eating (P=0.047). The POCUS examination took almost twice as long as the combined physical exam maneuvers (median 142 vs. 82). POCUS outperforms traditional physical examination in detecting splenomegaly and correlates well with formal imaging, supporting its integration into bedside practice and medical education.
International journal of medical informaticsAudrey Dintilhac, Laura Lohan, Marion Laureau, Damien Perier, Philippe Cestac, Blandine Juillard-Condat, Cyril Breuker
INTRODUCTION: Adverse drug events (ADEs) constitute a major clinical and economic burden in Europe. While hospital pharmacy activities improve prescription safety, pharmacists cannot review all orders in time and must prioritize high-risk patients. Rule-based clinical decision support systems (CDSS) offer an additional preventive strategy but often generate excessive, low-relevance alerts. OBJECTIVE: To develop rules for detecting iatrogenic risk in accordance with methodological standards reported in the literature, using ADEs identified in a prospective cohort of adult patients admitted to the emergency department of a French healthcare institution (2,600-bed tertiary care center). METHODS: ADEs were identified through a structured medication history interview conducted by a trained clinical pharmacist upon the patient's admission to the emergency department. To focus on the most critical situations, drug classes defined at the fourth level of the Anatomical Therapeutic Chemical (ATC) classification system (ATC4) and associated with the highest risk were identified by considering prescription frequency, ADE occurrence, and ADE severity. For each selected ATC level 4 class, logistic regression models were used to assess the association between ADE probability and specific explanatory factors. These factors were then operationalized into rules designed to detect iatrogenic risk. RESULTS: A total of 245 ATC4 classes were involved in at least one ADE. Among these, 22 classes were identified as high iatrogenic risk, accounting for approximately 50% of prescriptions leading to an ADE, with vitamin K antagonists and heparins showing the highest risk. Regression analyses resulted in 58 distinct rules: 31 (53.4%) combined prescription data with at least one laboratory parameter, 8 (13.8%) incorporated demographic variables (age or sex), and 19 (32.8%) were based solely on medication prescription data. CONCLUSION: The clinical and pharmaceutical relevance of the proposed rules must be further evaluated to reduce excessive alert generation, which may lead to disengagement from both pharmacists and prescribers. The institutional health data warehouse could provide an appropriate environment for this evaluation.
Biosensors & bioelectronicsJiangnan Zhao, Hanbo Xu, Shifang Fei, Cifu Xu, Wenlong Yin, Qingshan Wei, Jianhan Lin, Gang Liu, Shilun Feng, Fang Gao, Yan Wang
Potato late blight, caused by the oomycete pathogen Phytophthora infestans (P. infestans), is one of the most devastating diseases threatening global potato production. Conventional plant disease detection methods rely on a labor-intensive and time-consuming workflow and require bulky and expensive benchtop equipment, limiting their in-field applications. Here, we report a portable RPA-CRISPR/Cas12a-based diagnostic platform integrated with a polyvinyl alcohol (PVA) microneedle (MN) patch, which allows rapid in-field sampling, and smartphone-based fluorescence acquisition and analysis to detect P. infestans in potato at the early stage. The PVA MN enables leaf sampling rapidly within 1 min, and yields efficient DNA extraction of 56.3 ± 4.2 ng/mg, which is ∼3-fold higher than the traditional CTAB method (18.1 ± 2.1 ng/mg). The RPA-CRISPR/Cas12a isothermal assay achieved specific detection of P. infestans with no cross-reactivity against closely-related species Phytophthora sojae or Phytophthora capsici. The smartphone-based point-of-care test (POCT) system demonstrates a detection limit of 4 pg/μL for P. infestans genomic DNA, which is comparable to that acquired with commercial laboratory equipment. The method enables early-stage diagnosis of potato late blight as early as Day 2 post-inoculation, with detection rates of 37.5% on Day 2 and 75% on Day 3, prior to the development of visible symptoms on leaves. This portable "sample-to-result" platform provides a promising strategy for rapid, field-deployable early diagnosis and surveillance of plant disease.
The Journal of emergency medicineMegan Hoffer, Aditya Loganathan, Fatemeh W Nasri, Jordan Dow, Margarita Popova, Elizabeth Dearing, Kristina Jacomino, Soroush Shahmatdar, Mohammed Reza Taheri,…
BACKGROUND: Airway emergencies and respiratory failure represent a frequent reason for Emergency Department (ED) visits. Surgical cricothyrotomy is a critical, time-sensitive procedure, infrequently performed and therefore at risk for complications. Correct identification of the cricothyroid membrane (CTM) has been demonstrated to be reliable and reproducible using point-of-care ultrasound in emergent airway cases. OBJECTIVES: This study assessed CTM identification accuracy comparing traditional landmark palpation and point-of-care ultrasound-guided visualization with neck computed tomography (CT) as the reference standard. METHODS: A prospective randomized study was performed at a university-based tertiary care center. Adult patients receiving a CT of the neck were identified through the electronic health record. CTM identification through landmark or ultrasound was performed by emergency physicians following randomization. Once identified, a 1.5 mm radiopaque metallic pellet sticker was placed over the site. A neuroradiology fellow or attending blinded to placement technique of the marker measured the distance between the marker on CT and the midpoint of the CTM. Correct placement was defined as the marker being within a 5 mm distance radially of the CTM midpoint. RESULTS/FINDINGS: Sixty-seven patients were enrolled, 31 were randomized to ultrasound-guided and 36 to landmark techniques. The mean age was 54.7 ± 18.2 years, 38 (56.7%) were female. The median body mass index (BMI) was 26.7 (IQR 18.3-35.1); the median BMI for the ultrasound group was 28.5 (IQR 19.5-37.5) and 26.6 (IQR 19.3-33.9) for the landmark group. 37 (55%) had the pellet within 5 mm of the center point of the CTM, with 16/31 (51.6%) accurately placed by ultrasound and 21/36 (58%) accurately placed by landmark (p = 0.63). CONCLUSION: No significant difference in accuracy was found between landmark- or ultrasound-guided identification of the cricothyroid membrane in the current cohort. Future studies should focus on patients selected for higher BMI, where palpation may be challenging.