INTRODUCTION The past two decades have witnessed one of the most contentious scientific debates in the field of temperature management after cardiac arrest in adults.It started in 2002,following the publication of two...INTRODUCTION The past two decades have witnessed one of the most contentious scientific debates in the field of temperature management after cardiac arrest in adults.It started in 2002,following the publication of two groundbreaking trials showing lower mortality rates and improved neurologic recovery with the use of active cooling.[1,2]International recommendations advocate active cooling in the range of 32–34℃for comatose survivors of out-of-hospital cardiac arrest (OHCA).[3,4]The year2013 marked the tipping point with the release of the TTM 1 trial.展开更多
BACKGROUND:Readmission to intensive care unit(ICU)after discharge to ward has been reported to be associated with increased hospital mortality and longer length of stay(LOS).The objective of this study was to investig...BACKGROUND:Readmission to intensive care unit(ICU)after discharge to ward has been reported to be associated with increased hospital mortality and longer length of stay(LOS).The objective of this study was to investigate whether ICU readmission are preventable in critically ill cancer patients.METHODS:Data of patients who readmitted to intensive care unit(ICU)at National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences(CAMS)and Peking Union Medical College(PUMC)between January 2013 and November 2016 were retrospectively collected and reviewed.RESULTS:A total of 39 patients were included in the final analysis,and the overall readmission rate between 2013 and 2016 was 1.32%(39/2,961).Of 39 patients,32(82.1%)patients were judged as unpreventable and 7(17.9%)patients were preventable.There were no significant differences in duration of mechanical ventilation,ICU LOS,hospital LOS,ICU mortality and in-hospital mortality between patients who were unpreventable and preventable.For 24 early readmission patients,7(29.2%)patients were preventable and 17(70.8%)patients were unpreventable.Patients who were late readmission were all unpreventable.There was a trend that patients who were preventable had longer 1-year survival compared with patients who were unpreventable(100%vs.66.8%,log rank=1.668,P=0.196).CONCLUSION:Most readmission patients were unpreventable,and all preventable readmissions occurred in early period after discharge to ward.There were no significant differences in short term outcomes and 1-year survival in critically ill cancer patients whose readmissions were preventable or not.展开更多
BACKGROUND Ventilator-associated pneumonia(VAP)is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that.It is the most common infection encountered among intubated patients...BACKGROUND Ventilator-associated pneumonia(VAP)is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that.It is the most common infection encountered among intubated patients.VAP incidence showed wide variability between countries.AIM To define the VAP incidence in the intensive care unit(ICU)in the central gove-rnment hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern.METHODS The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020.It included adult and adolescent patients(>14 years old)admitted to the ICU and required intubation and mechanical ventilation.VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score,which considers the clinical,laboratory,microbiological,and radiographic evidence.RESULTS The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155.Forty-six patients developed VAP during their ICU stay(29.7%).The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period,with a mean age of 52 years±20.Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96±6.55.Gram-negative contributed to most VAP cases in our unit,with multidrug-resistant Acinetobacter being the most identified pathogen.CONCLUSION The reported VAP rate in our ICU was relatively high compared to the international benchmark,which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.展开更多
Introduction: Even though there is a huge burden of both chronic inflammatory rheumatic diseases (CIRD) and cardiovascular diseases in Sub-Saharan Africa, no published study from this region has yet addressed the issu...Introduction: Even though there is a huge burden of both chronic inflammatory rheumatic diseases (CIRD) and cardiovascular diseases in Sub-Saharan Africa, no published study from this region has yet addressed the issue of cardiovascular diseases in a group including different CIRD to the best of our knowledge. Objective: We conducted this research with the aim to explore the association between CIRD and cardiovascular risk in a Cameroonian population based on the World Health Organization (WHO) and International Society for Hypertension (ISH) risk charts. Methods: This cross-sectional study included CIRD patients, followed at the rheumatology unit of the Yaounde Central Hospital, and, who were matched to non-CIRD subjects for sex, age and race. Cardiovascular risk factors were studied and subsequently the cardiovascular risk was estimated using the WHO/ISH risk charts. Analyses were performed in Epi-info and SPSS software and results were considered statistically significant for a p-value less than 0.05. Results: In total, 109 CIRD patients and 111 non-CIRD subjects were included. Their respective mean ages were 44.4 ± 15.2 years and 44.2 ± 15.1 years. Odds ratio 2.09, 95% confidence interval (CI) (1.07 - 4.08);high BMI OR 1.89, 95% CI (1.1 - 3.24);diabetes mellitus (p = 0.03) and physical inactivity (p < 0.001) were all markedly found in CIRD patients compared with controls. Ten (9.2%) CIRD patients had a past history of atherosclerotic cardiovascular events compared with no control (p < 0.001). The cardiovascular risk estimated with the WHO/ISH risk charts was low in 43 (79.6%) patients with CIRD versus 52 (88.1%) non-CIRD subjects. Conclusions: CIRD were associated with hypertension, excess overall adiposity, diabetes mellitus, and physical inactivity. A substantially increased proportion of CIRD patients with a past history of atherosclerotic cardiovascular events were noted. But the WHO/ISH risk charts broadly found a similar and globally decremented cardiovascular risk in both study groups, highlighting the need to pursue research for definite conclusions on their reliability.展开更多
Acinetobacter baumanii is an opportunistic pathogen known to cause hospital acquired infection presenting with varying clinical feature from simply to much more severe manifestation. More importantly, widely improper ...Acinetobacter baumanii is an opportunistic pathogen known to cause hospital acquired infection presenting with varying clinical feature from simply to much more severe manifestation. More importantly, widely improper and overuse of antibiotics consumption have caused an endemic of multidrug-resistant-Acinetobacter baumanii leading to prolonged hospital stay and poorer prognosis for intensive care patients. A descriptive study of pre- and post-education was conducted at an intensive care setting in Indonesia. The microbiology data were collected to evaluate the benefit of education on hand hygiene and management of antibiotic use to reduce the number of MDR-Acinetobacter baumanii infection. Based on the result of previous local susceptibility patterns, Cefoperazone/Sulbactam and Amikacin are favored as the empirical therapy. Chi-square analysis shows the significant reduction of Acinetobacter baumanii cases from 70.8% (17/24) to 38% (3/8) with P-value 0.006. Similarly, the susceptibility rate significantly increased, from 21% to 100% to Amikacin;from 5% to 89% to Piperacillin/Tazobactam, and from 42% to 89% to Meropenem. Education improving around hand hygiene, appropriate antibiotic prescribing following local hospital guidelines and the result of antibiotic susceptibility has been shown to reduce the transmission of MDR-Acinetobacter baumanii in the intensive care in our unit within this Indonesian hospital.展开更多
Background: The cardiovascular risk factors including type 2 diabetes mellitus (T2DM) are a public health problem in sub-Saharan Africa. The aim of this study is to determine the prevalence and factors associated with...Background: The cardiovascular risk factors including type 2 diabetes mellitus (T2DM) are a public health problem in sub-Saharan Africa. The aim of this study is to determine the prevalence and factors associated with stroke in T2DM patients admitted to the emergency Unit in Brazzaville. Patients and Methods: This is the preliminary findings of a cross-sectional study including patients with T2DM, admitted in Emergency Unit of University Hospital of Brazzaville from January to April 2011. One hundred and seven patients were included. Sex ratio was 1.5. Results: The mean age was 60.3 ± 10.2 years (range 40 - 80 years). Stroke story was noted in 5 cases (4.6%). The main pathologies were metabolic complications (n = 51;47.6%) and cardiovascular diseases (n = 36;33.6%), dominated by stroke (17 cases). Epidemiological factors associated with stroke were high standard living (OR = 3, 95% CI: 1.02 - 8.9, p = 0.03), polypharmacy (OR = 3.7, 95% CI: 1.27 - 10.8, p = 0.01), previous hospitalization (OR = 3.1, 95% CI: 1.07 - 8.9, p = 0.03), and the absence of antiplatelet therapy (OR = 4.2, 95% CI 1.2 to 15, p = 0.03). Clinical associated factors were coma (OR = 3.3, 95% CI 1.14 to 9.6, p = 0.02) and the presence of severe hypertension (OR = 4, 95% CI: 1.2 - 12, p = 0.02). Finally, prognostic factors were the transfer in intensive care unit (OR = 9.8, 95% CI: 2.7 - 34, p 0.001). Conclusion: The first cardiovascular complication in patients with T2DM admitted in emergency at University Hospital of Brazzaville is stroke. Primary prevention in high-risk patients is still inadequate.展开更多
Hyalomma dromedarii ticks are important disease vectors to camels in the UAE and worldwide. Ticks can be identified using DNA-based techniques. In addition, such techniques could be utilized to study the intraspecific...Hyalomma dromedarii ticks are important disease vectors to camels in the UAE and worldwide. Ticks can be identified using DNA-based techniques. In addition, such techniques could be utilized to study the intraspecific genetic diversity in tick populations. In this study, the genetic diversity of four H. dromedarii populations was investigated using mitochondrial cytochrome c oxidase subunit I (COI) gene and randomly amplified polymorphic DNA polymerase chain reaction (RAPD-PCR). The results showed that both of the aforementioned techniques produced similar grouping patterns. Moreover, they revealed that the four tick populations had high levels of genetic similarity. However, one population was slightly different from the three other populations. The current study demonstrated that H. dromedarii ticks in the UAE are very similar at the genetic level and that investigating more locations and screening larger numbers of ticks could reveal larger genetic differences.展开更多
The development of competency-based thinking is transforming medical education by preparing professionals for the new challenges of the 21st century. Its strategies are key to the development of clinical competence an...The development of competency-based thinking is transforming medical education by preparing professionals for the new challenges of the 21st century. Its strategies are key to the development of clinical competence and to improving critical thinking. Objective: This paper aims to evaluate the level of clinical competence of family medicine residents treating patients attending prenatal care in a medical unit in southern Mexico. Materials and Methods: In 2023, a cross-sectional, retrospective, and analytical study with an educational focus was conducted in two phases. The creation and validation of a clinical competence instrument based on five real real-world problem-based clinical cases of prenatal care patients, with indicators related to clinical aptitude. Three rounds of experts were used to validate the instrument following the Delphi method, with a concordance threshold of 80% or higher (Kappa index > 0.80). The Kuder-Richardson formula was used to calculate internal consistency, yielding a value of 0.87. The evaluation instrument was administered to 40 newly admitted medical residents in the second phase in Villahermosa, Tabasco. A descriptive analysis was performed, and the levels of competence were compared using the Chi-square test. Results: Internal consistency was 0.87. Among the residents, 32.5% demonstrated low knowledge levels (know-what), 37.5% showed intermediate skills levels (know-how), and 67.5% exhibited adequate performance in attitudes (know-be). Conclusions: Inclusive strategies are necessary to improve clinical competence levels in prenatal care.展开更多
BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidit...BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidity and mortality.AIM To define the trends of the rates of central line-associated bloodstream infections(CLABSI)over four years,its predicted risk factors,aetiology,and the antimicrobial susceptibility of the isolated pathogens.METHODS The study was a prospective case-control study,performed according to the guidelines of the Center for Disease Control surveillance methodology for CLABSI in patients admitted to the adult intensive care unit(ICU)and auditing the implementation of its prevention bundle.RESULTS Thirty-four CLABSI identified over the study period,giving an average CLABSI rate of 3.2/1000 central line days.The infection's time trend displayed significant reductions over time concomitantly with the CLABSI prevention bundle's reinforcement from 4.7/1000 central line days at the beginning of 2016 to 1.4/1000 central line days by 2018.The most frequently identified pathogens causing CLABSI in our ICU were gram-negative organisms(59%).The most common offending organisms were Acinetobacter,Enterococcus,and Staphylococcus epidermidis,each of them accounted for 5 cases(15%).Multidrug-resistant organisms contributed to 56%of CLABSI.Its rate was higher when using femoral access and longer hospitalisation duration,especially in the ICU.Insertion of the central line in the non-ICU setting was another identified risk factor.CONCLUSION Implementing the prevention bundles reduced CLABSI significantly in our ICU.Implementing the CLABSI prevention bundle is crucial to maintain a substantial reduction in the CLABSI rate in the ICU setting.展开更多
BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU ad...BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.展开更多
BACKGROUND The adoption of telehealth services surged after the coronavirus disease 2019 pandemic,revolutionizing traditional healthcare delivery models.Amazon Clinic's recent nationwide launch marks a significant...BACKGROUND The adoption of telehealth services surged after the coronavirus disease 2019 pandemic,revolutionizing traditional healthcare delivery models.Amazon Clinic's recent nationwide launch marks a significant milestone in this trend.This study aims to offer a strengths,weaknesses,opportunities,and threats(SWOT)analysis of Amazon Clinic and compare its features with leading virtual healthcare platforms.AIM To evaluate Amazon Clinic's telehealth services through a SWOT analysis and compare its features with other leading virtual healthcare platforms.METHODS The initial search terms included were,amazon clinic odds ratio(OR)amwell OR Teladoc OR Walmart virtual health service OR CVS minute clinic OR CirrusMD OR brightside health,from 2000 to 2023.This search yielded 111 articles,from which duplicates were removed,and unrelated titles were filtered out.Eight articles were retained for a final review,including comparative studies,usability research,retrospective analyses,observational studies,and review articles.The data was organized and analyzed using Rayyan software and summarized in a table and PRISMA flowcharts.RESULTS The review included eight articles focusing on various aspects of telehealth.Comparative studies highlighted differences between Teladoc and traditional physician offices,noting lower diagnostic imaging orders and antibiotic prescriptions for Teladoc.User demographics for Teladoc showed younger,less engaged patients.Usability studies emphasized the importance of website design for telemedicine adoption.Tele-mental health platforms like Brightside showed superior outcomes in treating depression compared to traditional methods.Telemedicine for specialized fields like skin reconstruction demonstrated cost efficiency and reduced waiting times.The SWOT analysis identified Amazon Clinic's strengths,such as its vast consumer base and transparent pricing,and weaknesses like the lack of pediatric care.Opportunities included potential partnerships and service expansions,while threats involved competition and regulatory challenges.CONCLUSION Amazon Clinic's entry into the telehealth sector represents a significant development with various strengths and opportunities.However,it faces challenges from established healthcare providers and regulatory landscapes.The future success of Amazon Clinic will depend on strategic collaborations,addressing service gaps,and navigating competition and regulations.Telemedicine's impact will hinge on its ability to effectively leverage these opportunities and overcome inherent challenges in the ever-evolving healthcare landscape.展开更多
BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not scr...BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not screened.Current practice guidelines include male gender as a predisposing factor for BE and EAC.The population-based clinical evidence regarding female gender remains limited.AIM To study comparative trends of gender disparities in patients with BE in the United States.METHODS A nationwide retrospective study was conducted using the 2009-2019 National Inpatient Sample(NIS)database.Patients with a primary or secondary diagnosis code of BE were identified.The major outcome of interest was determining the gender disparities in patients with BE.Trend analysis for respective outcomes for females was also reported to ascertain any time-based shifts.RESULTS We identified 1204190 patients with BE for the study period.Among the included patients,717439(59.6%)were men and 486751(40.4%)were women.The mean age was higher in women than in men(67.1±0.4 vs 66.6±0.3 years,P<0.001).The rate of BE per 100000 total NIS hospitalizations for males increased from 144.6 in 2009 to 213.4 in 2019(P<0.001).The rate for females increased from 96.8 in 2009 to 148.7 in 2019(P<0.001).There was a higher frequency of obesity among women compared to men(17.4%vs 12.6%,P<0.001).Obesity prevalence among females increased from 12.3%in 2009 to 21.9%in 2019(P<0.001).A lower prevalence of smoking was noted in women than in men(20.8%vs 35.7%,P<0.001).However,trend analysis showed an increasing prevalence of smoking among women,from 12.9%in 2009 to 30.7%in 2019(P<0.001).Additionally,there was a lower prevalence of alcohol abuse,Helicobacter pylori(H.pylori),and diabetes mellitus among females than males(P<0.001).Trend analysis showed an increasing prevalence of alcohol use disorder and a decreasing prevalence of H.pylori and diabetes mellitus among women(P<0.001).CONCLUSION The prevalence of BE among women has steadily increased from 2009 to 2019.The existing knowledge concerning BE development has historically focused on men,but our findings show that the risk in women is not insignificant.展开更多
BACKGROUND Hepatitis A virus(HAV)infection remains the most common cause of acute viral hepatitis globally.In the United States,recent outbreaks have been attributed primarily to person-to-person transmission,with vul...BACKGROUND Hepatitis A virus(HAV)infection remains the most common cause of acute viral hepatitis globally.In the United States,recent outbreaks have been attributed primarily to person-to-person transmission,with vulnerable populations such as people who use illicit drugs,those experiencing homelessness,and men who have sex with men disproportionately affected.AIM To assess the trends in HAV hospitalizations over the past decade and evaluate the impact of substance use on these hospitalizations.METHODS We conducted a retrospective study using the National Inpatient Sample database from 2011 to 2020.Adults(≥18 years)hospitalized with a primary diagnosis of HAV infection were included.We identified active substance use as a secondary diagnosis.Statistical analysis involved descriptive statistics,trend analysis,and propensity score matching to compare HAV hospitalizations with and without substance use.Outcomes included hospitalization trends,complications,length of stay(LOS),and mortality.RESULTS From 2011 to 2020,there were 56972 hospitalizations for HAV infections.Hospitalizations increased from 3917 in 2011 to 8290 in 2020,peaking at 9800 in 2018.Caucasian males(55%)were the most affected,with a mean age of 49 years.The prevalence of active substance use among HAV hospitalizations was 27%,with these patients being younger(mean age:39 years)and predominantly male(63.1%).HAV hospitalizations associated with substance use increased significantly,rising from 235 cases in 2011 to 3200 in 2020(P<0.001).Compared to HAV hospitalizations without substance use,those with substance use had higher rates of co-infections(hepatitis C virus 45%vs 11%,hepatitis B virus 11%vs 6%)and complications,including sepsis(1.9%vs 1%)and infective endocarditis(1.4%vs 0.15%,P<0.001).Hospitalizations with substance use also had longer LOS(4.34 days vs 3.97 days,P<0.05),but mortality rates were comparable.Predictors of mortality in HAV-substance use hospitalizations included acute liver failure,sepsis,and acute respiratory failure.CONCLUSION HAV hospitalizations in the United States have significantly increased over the past decade,with the rise driven by cases involving substance use.These patients face a higher burden of complications and healthcare utilization.Tailored public health strategies,including targeted vaccination and outreach programs for at-risk populations,are essential to reduce the morbidity,mortality,and economic burden associated with HAV.展开更多
BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outc...BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.展开更多
The second edition of the United Arab Emirates inflammatory bowel disease(IBD)consensus guidance provides updated recommendations for diagnosing,treating,and monitoring IBD.Significant therapeutic advances and evolvin...The second edition of the United Arab Emirates inflammatory bowel disease(IBD)consensus guidance provides updated recommendations for diagnosing,treating,and monitoring IBD.Significant therapeutic advances and evolving treatment paradigms since 2020(including risk stratification and treat-to-target approaches)necessitated this comprehensive update to standardize care across the United Arab Emirates.Developed via Delphi consensus methodology,this guidance incorporates a systematic literature review and key international gui-delines.It presents 188 summary statements covering the full spectrum of IBD care,including complex scenarios like perianal disease and pregnancy.Key updates feature guidance on newer pharmacologic therapies-interleukin-23,Janus kinase,and sphingosine-1-phosphate receptor inhibitors-with refined therapeutic positioning informed by recent head-to-head trials.The consensus emphasizes early,effective treatment to prevent irreversible bowel damage,optimization strategies like therapeutic drug monitoring,and achieving objective treat-to-target goals to improve long-term outcomes.Recognizing local healthcare system challenges,it offers practical recommendations on reducing variability and enhancing equitable access to IBD care.By integrating current clinical evidence with United Arab Emirates-specific considerations,the second edition United Arab Emirates IBD consensus guidance aims to standardize care across sectors,provide a benchmark for payers and policymakers,optimize treatment outcomes,and improve IBD outcomes,aligning national practice with international standards.展开更多
BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely ...BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely studied.AIM To determine the short-term mortality outcome and identify the potential prognostic factors of CRC cancer patients admitted to the ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at the ICU departments of 37 cancer specialized hospitals in China,and included patients aged≥14 years with ICU duration≥24 hours.Clinical records of patients with a primary CRC diagnosis were reviewed.Patients were separated into groups according to 90-day survival.Characteristics between groups were compared.Univariate and multivariate regression tests were used to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS In total,189 CRC patients were included in the study.The 90-day mortality was 12.2%.Patients who died showed differences compared to patients who survived mostly in terms of disease severity and ICU complications.It appears that patients admitted to the ICU from a clinical ward due to emergencies may have a higher risk of mortality while surgical management was associated with better survival.In multivariate analysis,only chemotherapy,elective surgery and conventional oxygen therapy were identified as independently correlated with 90-day mortality.Sequential organ failure assessment and acute physiology and chronic health evaluation II scores had moderate accuracy in predicting short-term mortality.CONCLUSION ICU admitted CRC patients appear to have low short-term mortality which requires further confirmation in prospective studies.The prognostic tools for these patients need further optimization.展开更多
BACKGROUNDLimited research exists on attitudes and barriers to organ donation in the UnitedArab Emirates, highlighting the need for a deeper understanding of public perceptionsand challenges.AIMTo assess the attitudes...BACKGROUNDLimited research exists on attitudes and barriers to organ donation in the UnitedArab Emirates, highlighting the need for a deeper understanding of public perceptionsand challenges.AIMTo assess the attitudes and barriers toward organ donation.METHODSA cross-sectional study was adopted and included 607 samples consisting ofstudents, faculty, and staff who were selected from three universities in Ajmanand who had signed consent forms. A validated self-administered questionnairethat included 13 attitudes and 14 barrier items was used as a tool. The reliabilityof the tool was 0.89 (Cronbach's alpha). In the analysis of attitude scores, responseswere rated on a scale from 0 to 4, with 0 representing 'strongly disagree'and 4 representing 'strongly agree' for supportive attitudes towards organdonation. Participants with a total attitude score of 39 or higher indicated agreementor strong agreement with all items, reflecting a generally supportiveattitude toward organ donation. Lower scores suggested that the respondent wasneutral or disagreed with one or more items, indicating a less supportive attitudetoward organ donation. Knowledge about organ donation was assessed by selfadministeredquestionnaire that included 13 items. Analysis was done using SPSSversion 29. χ2 was used to assess associations between variables.RESULTSMost participants were young (≤ 30 years old, 83.7%), female (79.2%), from World Health Organization Eastern Mediterranean Region countries (69.5%), Muslim (82.4%), students (80.6%), single(83.9%), and from a nursing college (33.1%). The majority had no personal or family history of organ donation(93.2% and 93.9%, respectively). Supportive attitudes toward organ donation were significantly associated withreligion (P = 0.003), working status (P = 0.009), university (P = 0.019), and knowledge (P < 0.001). Additionally,those with a personal or family history of organ donation were significantly more supportive (56.8% vs 33.3%, P =0.004). Lack of awareness was the most reported barrier for organ donation (64.1%) followed by being afraid oforgan donation due to medical procedures required (51.9%).CONCLUSIONThe findings suggest that supportive attitudes toward organ donation are influenced by demographic factors,personal experiences, and knowledge levels. Lack of awareness and fear of medical procedures were the mostreported barriers to organ donation. These results highlight the need for targeted educational programs to increaseawareness and promote positive attitudes toward organ donation.展开更多
BACKGROUND Regulatory agencies are increasingly recognizing that minority trial repres-entation is inadequate,contributing to healthcare disparities.The scope of min-ority population disparities in clinical trial part...BACKGROUND Regulatory agencies are increasingly recognizing that minority trial repres-entation is inadequate,contributing to healthcare disparities.The scope of min-ority population disparities in clinical trial participation remains unclear,as previous studies have compiled enrollment data from published trials,which AIM To evaluate sex,racial and ethnic inequities in liver transplantation(LT)trials participation in the United States.METHODS We used data from completed United States liver transplant clinical trials registered and reported on the National Institute of Health(NIH)website(clincaltrials.gov).Demographic data,including race,ethnicity,sex,and age were collected.To make inferences to a larger population,95%CIs were computed for estimates in each demographic group using the Wilson method for binomial proportions.We also computed the simultaneous 95%CIs by applying a Bonferroni correction to reflect the multinomial distribution of race proportions.The numbers and percentages of racial/ethnic minority and female individuals compared with United States census data from 2010 and 2018.Secondary outcome measures were inclusion by trial funding source and year of completion.RESULTS A total of 69 United States based clinical trials involving 6990 participants were included in the analysis.Of these,35 trials(51%)were randomized,and 26(38%)were conducted across multiple United States regions.All trials reported sex,while 42(61%)reported race and 27(39%)reported ethnicity.Compared to United States census data,Asian individuals were overrepresented(9.3%;95%CI:8.1%-10.5%),whereas African American(7.8%;95%CI:6.7%-8.9%)and American Indian or Alaska Native individuals(0.4%;95%CI:0.1%-0.6%)were underrepresented.The proportion of White participants(75.9%;95%CI:74.1%-77.7%)was consistent with census estimates.Hispanic participants were underrepresented(13.3%;95%CI:12.2%-14.5%)regardless of the census year referenced.In industry-sponsored trials,Asian representation was three times higher than in the general population(15%).NIH funded trials showed overrepresentation of White participants(83.8%)and underrepresentation of Black participants(4.1%)relative to census data.Women comprised 31.1%of all participants(95%CI:30.0%-32.2%),in-dicating underrepresentation.Among trials that reported racial data,62(90%)did not include participants of American Indian or Alaska Native,Native Hawaiian,or Pacific Islander descent.CONCLUSION Our analysis indicates that women,African Americans,and Hispanic individuals are underrepresented in LT clinical trials compared to the general United States population.These results highlight the need for regulatory initiatives aimed at enhancing the inclusion of historically marginalized racial and ethnic groups in clinical re-search.展开更多
BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits f...BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.展开更多
Temporary mechanical circulatory support (tMCS) devices such as intra-aorticballoon pumps, veno-arterial extracorporeal membrane oxygenation, and percutaneousventricular assist devices, play a major role in supporting...Temporary mechanical circulatory support (tMCS) devices such as intra-aorticballoon pumps, veno-arterial extracorporeal membrane oxygenation, and percutaneousventricular assist devices, play a major role in supporting patients withend-stage heart failure and bridging them to transplant. In 2018, the United Networkfor Organ Sharing heart allocation criteria was modified by increasing thenumber of statuses in the heart transplant waitlist to differentiate and favor thesickest patients awaiting transplantation. Within this new system, patients withtMCS devices receive the highest priority statuses. While the 2018 allocationsystem has reduced waitlist times and mortality for the highest-priority patients,some studies have shown a concomitant rise in the utilization of tMCS devices asbridge to transplant after its enaction. In this narrative review, we describe thesechanges in tMCS utilization and provide insights on how the upcoming creationof a continuous distribution allocation system may further impact these trends.展开更多
文摘INTRODUCTION The past two decades have witnessed one of the most contentious scientific debates in the field of temperature management after cardiac arrest in adults.It started in 2002,following the publication of two groundbreaking trials showing lower mortality rates and improved neurologic recovery with the use of active cooling.[1,2]International recommendations advocate active cooling in the range of 32–34℃for comatose survivors of out-of-hospital cardiac arrest (OHCA).[3,4]The year2013 marked the tipping point with the release of the TTM 1 trial.
文摘BACKGROUND:Readmission to intensive care unit(ICU)after discharge to ward has been reported to be associated with increased hospital mortality and longer length of stay(LOS).The objective of this study was to investigate whether ICU readmission are preventable in critically ill cancer patients.METHODS:Data of patients who readmitted to intensive care unit(ICU)at National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences(CAMS)and Peking Union Medical College(PUMC)between January 2013 and November 2016 were retrospectively collected and reviewed.RESULTS:A total of 39 patients were included in the final analysis,and the overall readmission rate between 2013 and 2016 was 1.32%(39/2,961).Of 39 patients,32(82.1%)patients were judged as unpreventable and 7(17.9%)patients were preventable.There were no significant differences in duration of mechanical ventilation,ICU LOS,hospital LOS,ICU mortality and in-hospital mortality between patients who were unpreventable and preventable.For 24 early readmission patients,7(29.2%)patients were preventable and 17(70.8%)patients were unpreventable.Patients who were late readmission were all unpreventable.There was a trend that patients who were preventable had longer 1-year survival compared with patients who were unpreventable(100%vs.66.8%,log rank=1.668,P=0.196).CONCLUSION:Most readmission patients were unpreventable,and all preventable readmissions occurred in early period after discharge to ward.There were no significant differences in short term outcomes and 1-year survival in critically ill cancer patients whose readmissions were preventable or not.
文摘BACKGROUND Ventilator-associated pneumonia(VAP)is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that.It is the most common infection encountered among intubated patients.VAP incidence showed wide variability between countries.AIM To define the VAP incidence in the intensive care unit(ICU)in the central gove-rnment hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern.METHODS The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020.It included adult and adolescent patients(>14 years old)admitted to the ICU and required intubation and mechanical ventilation.VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score,which considers the clinical,laboratory,microbiological,and radiographic evidence.RESULTS The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155.Forty-six patients developed VAP during their ICU stay(29.7%).The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period,with a mean age of 52 years±20.Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96±6.55.Gram-negative contributed to most VAP cases in our unit,with multidrug-resistant Acinetobacter being the most identified pathogen.CONCLUSION The reported VAP rate in our ICU was relatively high compared to the international benchmark,which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.
文摘Introduction: Even though there is a huge burden of both chronic inflammatory rheumatic diseases (CIRD) and cardiovascular diseases in Sub-Saharan Africa, no published study from this region has yet addressed the issue of cardiovascular diseases in a group including different CIRD to the best of our knowledge. Objective: We conducted this research with the aim to explore the association between CIRD and cardiovascular risk in a Cameroonian population based on the World Health Organization (WHO) and International Society for Hypertension (ISH) risk charts. Methods: This cross-sectional study included CIRD patients, followed at the rheumatology unit of the Yaounde Central Hospital, and, who were matched to non-CIRD subjects for sex, age and race. Cardiovascular risk factors were studied and subsequently the cardiovascular risk was estimated using the WHO/ISH risk charts. Analyses were performed in Epi-info and SPSS software and results were considered statistically significant for a p-value less than 0.05. Results: In total, 109 CIRD patients and 111 non-CIRD subjects were included. Their respective mean ages were 44.4 ± 15.2 years and 44.2 ± 15.1 years. Odds ratio 2.09, 95% confidence interval (CI) (1.07 - 4.08);high BMI OR 1.89, 95% CI (1.1 - 3.24);diabetes mellitus (p = 0.03) and physical inactivity (p < 0.001) were all markedly found in CIRD patients compared with controls. Ten (9.2%) CIRD patients had a past history of atherosclerotic cardiovascular events compared with no control (p < 0.001). The cardiovascular risk estimated with the WHO/ISH risk charts was low in 43 (79.6%) patients with CIRD versus 52 (88.1%) non-CIRD subjects. Conclusions: CIRD were associated with hypertension, excess overall adiposity, diabetes mellitus, and physical inactivity. A substantially increased proportion of CIRD patients with a past history of atherosclerotic cardiovascular events were noted. But the WHO/ISH risk charts broadly found a similar and globally decremented cardiovascular risk in both study groups, highlighting the need to pursue research for definite conclusions on their reliability.
文摘Acinetobacter baumanii is an opportunistic pathogen known to cause hospital acquired infection presenting with varying clinical feature from simply to much more severe manifestation. More importantly, widely improper and overuse of antibiotics consumption have caused an endemic of multidrug-resistant-Acinetobacter baumanii leading to prolonged hospital stay and poorer prognosis for intensive care patients. A descriptive study of pre- and post-education was conducted at an intensive care setting in Indonesia. The microbiology data were collected to evaluate the benefit of education on hand hygiene and management of antibiotic use to reduce the number of MDR-Acinetobacter baumanii infection. Based on the result of previous local susceptibility patterns, Cefoperazone/Sulbactam and Amikacin are favored as the empirical therapy. Chi-square analysis shows the significant reduction of Acinetobacter baumanii cases from 70.8% (17/24) to 38% (3/8) with P-value 0.006. Similarly, the susceptibility rate significantly increased, from 21% to 100% to Amikacin;from 5% to 89% to Piperacillin/Tazobactam, and from 42% to 89% to Meropenem. Education improving around hand hygiene, appropriate antibiotic prescribing following local hospital guidelines and the result of antibiotic susceptibility has been shown to reduce the transmission of MDR-Acinetobacter baumanii in the intensive care in our unit within this Indonesian hospital.
文摘Background: The cardiovascular risk factors including type 2 diabetes mellitus (T2DM) are a public health problem in sub-Saharan Africa. The aim of this study is to determine the prevalence and factors associated with stroke in T2DM patients admitted to the emergency Unit in Brazzaville. Patients and Methods: This is the preliminary findings of a cross-sectional study including patients with T2DM, admitted in Emergency Unit of University Hospital of Brazzaville from January to April 2011. One hundred and seven patients were included. Sex ratio was 1.5. Results: The mean age was 60.3 ± 10.2 years (range 40 - 80 years). Stroke story was noted in 5 cases (4.6%). The main pathologies were metabolic complications (n = 51;47.6%) and cardiovascular diseases (n = 36;33.6%), dominated by stroke (17 cases). Epidemiological factors associated with stroke were high standard living (OR = 3, 95% CI: 1.02 - 8.9, p = 0.03), polypharmacy (OR = 3.7, 95% CI: 1.27 - 10.8, p = 0.01), previous hospitalization (OR = 3.1, 95% CI: 1.07 - 8.9, p = 0.03), and the absence of antiplatelet therapy (OR = 4.2, 95% CI 1.2 to 15, p = 0.03). Clinical associated factors were coma (OR = 3.3, 95% CI 1.14 to 9.6, p = 0.02) and the presence of severe hypertension (OR = 4, 95% CI: 1.2 - 12, p = 0.02). Finally, prognostic factors were the transfer in intensive care unit (OR = 9.8, 95% CI: 2.7 - 34, p 0.001). Conclusion: The first cardiovascular complication in patients with T2DM admitted in emergency at University Hospital of Brazzaville is stroke. Primary prevention in high-risk patients is still inadequate.
文摘Hyalomma dromedarii ticks are important disease vectors to camels in the UAE and worldwide. Ticks can be identified using DNA-based techniques. In addition, such techniques could be utilized to study the intraspecific genetic diversity in tick populations. In this study, the genetic diversity of four H. dromedarii populations was investigated using mitochondrial cytochrome c oxidase subunit I (COI) gene and randomly amplified polymorphic DNA polymerase chain reaction (RAPD-PCR). The results showed that both of the aforementioned techniques produced similar grouping patterns. Moreover, they revealed that the four tick populations had high levels of genetic similarity. However, one population was slightly different from the three other populations. The current study demonstrated that H. dromedarii ticks in the UAE are very similar at the genetic level and that investigating more locations and screening larger numbers of ticks could reveal larger genetic differences.
文摘The development of competency-based thinking is transforming medical education by preparing professionals for the new challenges of the 21st century. Its strategies are key to the development of clinical competence and to improving critical thinking. Objective: This paper aims to evaluate the level of clinical competence of family medicine residents treating patients attending prenatal care in a medical unit in southern Mexico. Materials and Methods: In 2023, a cross-sectional, retrospective, and analytical study with an educational focus was conducted in two phases. The creation and validation of a clinical competence instrument based on five real real-world problem-based clinical cases of prenatal care patients, with indicators related to clinical aptitude. Three rounds of experts were used to validate the instrument following the Delphi method, with a concordance threshold of 80% or higher (Kappa index > 0.80). The Kuder-Richardson formula was used to calculate internal consistency, yielding a value of 0.87. The evaluation instrument was administered to 40 newly admitted medical residents in the second phase in Villahermosa, Tabasco. A descriptive analysis was performed, and the levels of competence were compared using the Chi-square test. Results: Internal consistency was 0.87. Among the residents, 32.5% demonstrated low knowledge levels (know-what), 37.5% showed intermediate skills levels (know-how), and 67.5% exhibited adequate performance in attitudes (know-be). Conclusions: Inclusive strategies are necessary to improve clinical competence levels in prenatal care.
文摘BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidity and mortality.AIM To define the trends of the rates of central line-associated bloodstream infections(CLABSI)over four years,its predicted risk factors,aetiology,and the antimicrobial susceptibility of the isolated pathogens.METHODS The study was a prospective case-control study,performed according to the guidelines of the Center for Disease Control surveillance methodology for CLABSI in patients admitted to the adult intensive care unit(ICU)and auditing the implementation of its prevention bundle.RESULTS Thirty-four CLABSI identified over the study period,giving an average CLABSI rate of 3.2/1000 central line days.The infection's time trend displayed significant reductions over time concomitantly with the CLABSI prevention bundle's reinforcement from 4.7/1000 central line days at the beginning of 2016 to 1.4/1000 central line days by 2018.The most frequently identified pathogens causing CLABSI in our ICU were gram-negative organisms(59%).The most common offending organisms were Acinetobacter,Enterococcus,and Staphylococcus epidermidis,each of them accounted for 5 cases(15%).Multidrug-resistant organisms contributed to 56%of CLABSI.Its rate was higher when using femoral access and longer hospitalisation duration,especially in the ICU.Insertion of the central line in the non-ICU setting was another identified risk factor.CONCLUSION Implementing the prevention bundles reduced CLABSI significantly in our ICU.Implementing the CLABSI prevention bundle is crucial to maintain a substantial reduction in the CLABSI rate in the ICU setting.
文摘BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.
文摘BACKGROUND The adoption of telehealth services surged after the coronavirus disease 2019 pandemic,revolutionizing traditional healthcare delivery models.Amazon Clinic's recent nationwide launch marks a significant milestone in this trend.This study aims to offer a strengths,weaknesses,opportunities,and threats(SWOT)analysis of Amazon Clinic and compare its features with leading virtual healthcare platforms.AIM To evaluate Amazon Clinic's telehealth services through a SWOT analysis and compare its features with other leading virtual healthcare platforms.METHODS The initial search terms included were,amazon clinic odds ratio(OR)amwell OR Teladoc OR Walmart virtual health service OR CVS minute clinic OR CirrusMD OR brightside health,from 2000 to 2023.This search yielded 111 articles,from which duplicates were removed,and unrelated titles were filtered out.Eight articles were retained for a final review,including comparative studies,usability research,retrospective analyses,observational studies,and review articles.The data was organized and analyzed using Rayyan software and summarized in a table and PRISMA flowcharts.RESULTS The review included eight articles focusing on various aspects of telehealth.Comparative studies highlighted differences between Teladoc and traditional physician offices,noting lower diagnostic imaging orders and antibiotic prescriptions for Teladoc.User demographics for Teladoc showed younger,less engaged patients.Usability studies emphasized the importance of website design for telemedicine adoption.Tele-mental health platforms like Brightside showed superior outcomes in treating depression compared to traditional methods.Telemedicine for specialized fields like skin reconstruction demonstrated cost efficiency and reduced waiting times.The SWOT analysis identified Amazon Clinic's strengths,such as its vast consumer base and transparent pricing,and weaknesses like the lack of pediatric care.Opportunities included potential partnerships and service expansions,while threats involved competition and regulatory challenges.CONCLUSION Amazon Clinic's entry into the telehealth sector represents a significant development with various strengths and opportunities.However,it faces challenges from established healthcare providers and regulatory landscapes.The future success of Amazon Clinic will depend on strategic collaborations,addressing service gaps,and navigating competition and regulations.Telemedicine's impact will hinge on its ability to effectively leverage these opportunities and overcome inherent challenges in the ever-evolving healthcare landscape.
文摘BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not screened.Current practice guidelines include male gender as a predisposing factor for BE and EAC.The population-based clinical evidence regarding female gender remains limited.AIM To study comparative trends of gender disparities in patients with BE in the United States.METHODS A nationwide retrospective study was conducted using the 2009-2019 National Inpatient Sample(NIS)database.Patients with a primary or secondary diagnosis code of BE were identified.The major outcome of interest was determining the gender disparities in patients with BE.Trend analysis for respective outcomes for females was also reported to ascertain any time-based shifts.RESULTS We identified 1204190 patients with BE for the study period.Among the included patients,717439(59.6%)were men and 486751(40.4%)were women.The mean age was higher in women than in men(67.1±0.4 vs 66.6±0.3 years,P<0.001).The rate of BE per 100000 total NIS hospitalizations for males increased from 144.6 in 2009 to 213.4 in 2019(P<0.001).The rate for females increased from 96.8 in 2009 to 148.7 in 2019(P<0.001).There was a higher frequency of obesity among women compared to men(17.4%vs 12.6%,P<0.001).Obesity prevalence among females increased from 12.3%in 2009 to 21.9%in 2019(P<0.001).A lower prevalence of smoking was noted in women than in men(20.8%vs 35.7%,P<0.001).However,trend analysis showed an increasing prevalence of smoking among women,from 12.9%in 2009 to 30.7%in 2019(P<0.001).Additionally,there was a lower prevalence of alcohol abuse,Helicobacter pylori(H.pylori),and diabetes mellitus among females than males(P<0.001).Trend analysis showed an increasing prevalence of alcohol use disorder and a decreasing prevalence of H.pylori and diabetes mellitus among women(P<0.001).CONCLUSION The prevalence of BE among women has steadily increased from 2009 to 2019.The existing knowledge concerning BE development has historically focused on men,but our findings show that the risk in women is not insignificant.
文摘BACKGROUND Hepatitis A virus(HAV)infection remains the most common cause of acute viral hepatitis globally.In the United States,recent outbreaks have been attributed primarily to person-to-person transmission,with vulnerable populations such as people who use illicit drugs,those experiencing homelessness,and men who have sex with men disproportionately affected.AIM To assess the trends in HAV hospitalizations over the past decade and evaluate the impact of substance use on these hospitalizations.METHODS We conducted a retrospective study using the National Inpatient Sample database from 2011 to 2020.Adults(≥18 years)hospitalized with a primary diagnosis of HAV infection were included.We identified active substance use as a secondary diagnosis.Statistical analysis involved descriptive statistics,trend analysis,and propensity score matching to compare HAV hospitalizations with and without substance use.Outcomes included hospitalization trends,complications,length of stay(LOS),and mortality.RESULTS From 2011 to 2020,there were 56972 hospitalizations for HAV infections.Hospitalizations increased from 3917 in 2011 to 8290 in 2020,peaking at 9800 in 2018.Caucasian males(55%)were the most affected,with a mean age of 49 years.The prevalence of active substance use among HAV hospitalizations was 27%,with these patients being younger(mean age:39 years)and predominantly male(63.1%).HAV hospitalizations associated with substance use increased significantly,rising from 235 cases in 2011 to 3200 in 2020(P<0.001).Compared to HAV hospitalizations without substance use,those with substance use had higher rates of co-infections(hepatitis C virus 45%vs 11%,hepatitis B virus 11%vs 6%)and complications,including sepsis(1.9%vs 1%)and infective endocarditis(1.4%vs 0.15%,P<0.001).Hospitalizations with substance use also had longer LOS(4.34 days vs 3.97 days,P<0.05),but mortality rates were comparable.Predictors of mortality in HAV-substance use hospitalizations included acute liver failure,sepsis,and acute respiratory failure.CONCLUSION HAV hospitalizations in the United States have significantly increased over the past decade,with the rise driven by cases involving substance use.These patients face a higher burden of complications and healthcare utilization.Tailored public health strategies,including targeted vaccination and outreach programs for at-risk populations,are essential to reduce the morbidity,mortality,and economic burden associated with HAV.
文摘BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.
文摘The second edition of the United Arab Emirates inflammatory bowel disease(IBD)consensus guidance provides updated recommendations for diagnosing,treating,and monitoring IBD.Significant therapeutic advances and evolving treatment paradigms since 2020(including risk stratification and treat-to-target approaches)necessitated this comprehensive update to standardize care across the United Arab Emirates.Developed via Delphi consensus methodology,this guidance incorporates a systematic literature review and key international gui-delines.It presents 188 summary statements covering the full spectrum of IBD care,including complex scenarios like perianal disease and pregnancy.Key updates feature guidance on newer pharmacologic therapies-interleukin-23,Janus kinase,and sphingosine-1-phosphate receptor inhibitors-with refined therapeutic positioning informed by recent head-to-head trials.The consensus emphasizes early,effective treatment to prevent irreversible bowel damage,optimization strategies like therapeutic drug monitoring,and achieving objective treat-to-target goals to improve long-term outcomes.Recognizing local healthcare system challenges,it offers practical recommendations on reducing variability and enhancing equitable access to IBD care.By integrating current clinical evidence with United Arab Emirates-specific considerations,the second edition United Arab Emirates IBD consensus guidance aims to standardize care across sectors,provide a benchmark for payers and policymakers,optimize treatment outcomes,and improve IBD outcomes,aligning national practice with international standards.
文摘BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely studied.AIM To determine the short-term mortality outcome and identify the potential prognostic factors of CRC cancer patients admitted to the ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at the ICU departments of 37 cancer specialized hospitals in China,and included patients aged≥14 years with ICU duration≥24 hours.Clinical records of patients with a primary CRC diagnosis were reviewed.Patients were separated into groups according to 90-day survival.Characteristics between groups were compared.Univariate and multivariate regression tests were used to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS In total,189 CRC patients were included in the study.The 90-day mortality was 12.2%.Patients who died showed differences compared to patients who survived mostly in terms of disease severity and ICU complications.It appears that patients admitted to the ICU from a clinical ward due to emergencies may have a higher risk of mortality while surgical management was associated with better survival.In multivariate analysis,only chemotherapy,elective surgery and conventional oxygen therapy were identified as independently correlated with 90-day mortality.Sequential organ failure assessment and acute physiology and chronic health evaluation II scores had moderate accuracy in predicting short-term mortality.CONCLUSION ICU admitted CRC patients appear to have low short-term mortality which requires further confirmation in prospective studies.The prognostic tools for these patients need further optimization.
文摘BACKGROUNDLimited research exists on attitudes and barriers to organ donation in the UnitedArab Emirates, highlighting the need for a deeper understanding of public perceptionsand challenges.AIMTo assess the attitudes and barriers toward organ donation.METHODSA cross-sectional study was adopted and included 607 samples consisting ofstudents, faculty, and staff who were selected from three universities in Ajmanand who had signed consent forms. A validated self-administered questionnairethat included 13 attitudes and 14 barrier items was used as a tool. The reliabilityof the tool was 0.89 (Cronbach's alpha). In the analysis of attitude scores, responseswere rated on a scale from 0 to 4, with 0 representing 'strongly disagree'and 4 representing 'strongly agree' for supportive attitudes towards organdonation. Participants with a total attitude score of 39 or higher indicated agreementor strong agreement with all items, reflecting a generally supportiveattitude toward organ donation. Lower scores suggested that the respondent wasneutral or disagreed with one or more items, indicating a less supportive attitudetoward organ donation. Knowledge about organ donation was assessed by selfadministeredquestionnaire that included 13 items. Analysis was done using SPSSversion 29. χ2 was used to assess associations between variables.RESULTSMost participants were young (≤ 30 years old, 83.7%), female (79.2%), from World Health Organization Eastern Mediterranean Region countries (69.5%), Muslim (82.4%), students (80.6%), single(83.9%), and from a nursing college (33.1%). The majority had no personal or family history of organ donation(93.2% and 93.9%, respectively). Supportive attitudes toward organ donation were significantly associated withreligion (P = 0.003), working status (P = 0.009), university (P = 0.019), and knowledge (P < 0.001). Additionally,those with a personal or family history of organ donation were significantly more supportive (56.8% vs 33.3%, P =0.004). Lack of awareness was the most reported barrier for organ donation (64.1%) followed by being afraid oforgan donation due to medical procedures required (51.9%).CONCLUSIONThe findings suggest that supportive attitudes toward organ donation are influenced by demographic factors,personal experiences, and knowledge levels. Lack of awareness and fear of medical procedures were the mostreported barriers to organ donation. These results highlight the need for targeted educational programs to increaseawareness and promote positive attitudes toward organ donation.
文摘BACKGROUND Regulatory agencies are increasingly recognizing that minority trial repres-entation is inadequate,contributing to healthcare disparities.The scope of min-ority population disparities in clinical trial participation remains unclear,as previous studies have compiled enrollment data from published trials,which AIM To evaluate sex,racial and ethnic inequities in liver transplantation(LT)trials participation in the United States.METHODS We used data from completed United States liver transplant clinical trials registered and reported on the National Institute of Health(NIH)website(clincaltrials.gov).Demographic data,including race,ethnicity,sex,and age were collected.To make inferences to a larger population,95%CIs were computed for estimates in each demographic group using the Wilson method for binomial proportions.We also computed the simultaneous 95%CIs by applying a Bonferroni correction to reflect the multinomial distribution of race proportions.The numbers and percentages of racial/ethnic minority and female individuals compared with United States census data from 2010 and 2018.Secondary outcome measures were inclusion by trial funding source and year of completion.RESULTS A total of 69 United States based clinical trials involving 6990 participants were included in the analysis.Of these,35 trials(51%)were randomized,and 26(38%)were conducted across multiple United States regions.All trials reported sex,while 42(61%)reported race and 27(39%)reported ethnicity.Compared to United States census data,Asian individuals were overrepresented(9.3%;95%CI:8.1%-10.5%),whereas African American(7.8%;95%CI:6.7%-8.9%)and American Indian or Alaska Native individuals(0.4%;95%CI:0.1%-0.6%)were underrepresented.The proportion of White participants(75.9%;95%CI:74.1%-77.7%)was consistent with census estimates.Hispanic participants were underrepresented(13.3%;95%CI:12.2%-14.5%)regardless of the census year referenced.In industry-sponsored trials,Asian representation was three times higher than in the general population(15%).NIH funded trials showed overrepresentation of White participants(83.8%)and underrepresentation of Black participants(4.1%)relative to census data.Women comprised 31.1%of all participants(95%CI:30.0%-32.2%),in-dicating underrepresentation.Among trials that reported racial data,62(90%)did not include participants of American Indian or Alaska Native,Native Hawaiian,or Pacific Islander descent.CONCLUSION Our analysis indicates that women,African Americans,and Hispanic individuals are underrepresented in LT clinical trials compared to the general United States population.These results highlight the need for regulatory initiatives aimed at enhancing the inclusion of historically marginalized racial and ethnic groups in clinical re-search.
文摘BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.
文摘Temporary mechanical circulatory support (tMCS) devices such as intra-aorticballoon pumps, veno-arterial extracorporeal membrane oxygenation, and percutaneousventricular assist devices, play a major role in supporting patients withend-stage heart failure and bridging them to transplant. In 2018, the United Networkfor Organ Sharing heart allocation criteria was modified by increasing thenumber of statuses in the heart transplant waitlist to differentiate and favor thesickest patients awaiting transplantation. Within this new system, patients withtMCS devices receive the highest priority statuses. While the 2018 allocationsystem has reduced waitlist times and mortality for the highest-priority patients,some studies have shown a concomitant rise in the utilization of tMCS devices asbridge to transplant after its enaction. In this narrative review, we describe thesechanges in tMCS utilization and provide insights on how the upcoming creationof a continuous distribution allocation system may further impact these trends.
