Symptom reporting and vaccination status among SARS-CoV-2-positive encounters - Increasing Community Access to Testing, Treatment, and Response program, United States, September 2023-August 2024.

On September 12, 2023, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended that all persons aged ≥6 months receive 2023-2024 COVID-19 vaccination. This study examines the relationship between vaccination and COVID-19 symptom frequency, using data from the Increasing Community Access to Testing, Treatment, and Response (ICATT) platform. Among 6966 records of first SARS-CoV-2-positive tests collected from September 21, 2023 through August 22, 2024, individuals who received 2023-2024 COVID-19 vaccination consistently reported lower frequencies of 12 symptoms.

The Effect of Heterogeneous Definitions of Massive Transfusion on Using Blood Component Thresholds to Predict Futility in Severely Bleeding Trauma Patients.

In the trauma resuscitation literature, there are inconsistent definitions of what constitutes massive transfusion and a unit of blood, complicating the use of transfusion cut-points to declare futility. This is problematic as it can lead to the inefficient use of blood products, further exacerbating current blood product shortages. Previous studies have used various transfusion cut-points per hour to define futility in retrospective analyses but have not accurately defined futility at the bedside due to patient survival even at large rates and volumes of blood transfused.

Trends in hospice and palliative care consults initiated in the emergency department: An eight-year utilization analysis.

Background: Emergency departments (EDs) play a central role in end-of-life care, yet the early integration of hospice and palliative care (HPC) is often underutilized. Early access to HPC improves outcomes, aligns care with patient goals, and reduces costs. However, incorporating primary and specialized palliative care resources in the ED remains inconsistent, and utilization trends are not well understood.

Impact of Clinician Education on Emergency Department Mechanical Restraint: An Interrupted Time-Series Study.

Objective: Examine the impact of an education-based intervention co-designed with clinicians on attitudes towards and skills in caring for people with behaviours of concern in an emergency department (ED).

Methods: This 20-month interrupted time-series study (and nested 8-month before-and-after study) was conducted at a metropolitan hospital ED in Melbourne, Australia. The primary outcome was episodes of mechanical restraint before (1 January 2023 to 31 January 2023) and after (1 March 2024 to 30 September 2024) exposure of staff to an educational intervention.

Development of a Medication Abortion Simulation for Midwifery and Women's Health Nurse Practitioner Students: Not Just Another Sim.

The US Supreme Court's 2022 decision in Dobb's v Jackson Women's Health Organization, which overturned Roe v Wade, has led to varying state-level restrictions and expansions in abortion access. In Minnesota, certified nurse-midwives and advanced practice registered nurses, including women's health nurse practitioners, were granted the ability to provide medication abortion. This expanded role necessitates comprehensive education to ensure students are equipped with the skills and confidence to provide high-quality abortion care.

Early beta-blocker exposure and association with brain injury biomarkers following moderate to severe traumatic brain injury: A TRACK-TBI study.

Background: Beta-blockers have been studied for potential benefits in traumatic brain injury (TBI). This study aimed to investigate the association between early beta-blocker exposure and brain injury biomarkers following moderate-severe TBI.

Methods: We conducted a retrospective cohort study using data from the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) study.

Scaffolding Case Studies: Advancing Competency-Based Nurse Practitioner Education.

Background: Nursing education is transitioning to competency-based education (CBE). A key principle of CBE is scaffolding curricula from simple to complex to facilitate student learning.

Problem: There is no standardized method of scaffolding nurse practitioner (NP) curricula.

Use of seated positioning device (Smoltap) for ultrasound-guided infant lumbar punctures.

Background: Infant lumbar punctures (LPs) frequently fail at bedside and prompt repeat attempts with image guidance. Conventionally, image-guided LPs are performed with ultrasound or fluoroscopy while infants are in lateral flexed position. The procedure requires infants to be either sedated or held manually to maintain stable positioning.

Fibrinogen depletion and the risk of intracerebral hemorrhage following endovascular mechanical thrombectomy.

BackgroundIntravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are the standard of care for select stroke patients with acute large vessel occlusion (LVO). Fibrinogen levels may drop after IVT, and a significant decrease in fibrinogen is associated with an increased risk of intracranial hemorrhage (ICH). Our pilot study aimed to explore the relationship between fibrinogen levels and the development of ICH in MT-treated patients and whether bridging with IVT further increases that risk.

Health Care Resource Utilization for Patients With Suspected Myocardial Infarction: A Secondary Analysis of the RACE-IT Randomized Clinical Trial.

Importance: Evaluation for myocardial infarction (MI) in emergency departments (EDs) is a common, resource-intensive process. High-sensitivity cardiac troponin I (hs-cTnI) assays have become a key tool in rapidly ruling out MI, with the potential to reduce health care resource utilization.

Objective: To determine whether a 0-hour and 1-hour (hereafter referred to as 0/1-hour) hs-cTnI accelerated protocol reduces health care resource utilization compared with a traditional 0/3-hour standard care protocol for MI exclusion in the ED.

Paediatric Emergency Department Mental Health and Behavioural Presentations in Australia Before and After the Onset of the COVID-19 Pandemic: Retrospective Observational Study.

Objectives: Although child and adolescent mental health and behavioural presentations to hospital emergency departments (EDs) increased during the first 2 years of the COVID-19 pandemic (2020 and 2021), little is known about the characteristics of these presentations. We aimed to compare demographic, clinical and psychosocial profiles of paediatric presentations to Australian EDs before and after the onset of the pandemic.

Methods: We conducted a retrospective observational study of 100 randomly sampled presentations by children (6-11-year-olds) and adolescents (12-17-year-olds) to 10 Australian EDs between 1 January and 31 December 2019 (pre-COVID-19) and 1 January and 31 December 2021 (COVID-19).

Contemporary Approach to Acute Pancreatitis in Emergency Medicine.

Acute pancreatitis is a commonly encountered pathology in the emergency department. We presented a clinical review summarizing the contemporary emergency medicine approach to managing acute pancreatitis. Although the diagnostic criteria for acute pancreatitis are straightforward, it has many possible causes, several treatment options, and both short- and long-term sequelae.

Structure-based discovery of hydrocarbon-stapled paxillin peptides that block FAK scaffolding in cancer.

The focal adhesion kinase (FAK) scaffold provides FAK-targeted cancer therapeutics with greater efficacy and specificity than traditional kinase inhibitors. The FAK scaffold function largely involves the interaction between FAK's focal adhesion targeting (FAT) domain and paxillin, ultimately regulating many hallmarks of cancer. We report the design of paxillin LD-motif mimetics that successfully inhibit the FAT-paxillin interaction.

Impact of Individualized Versus Weight-Based Pain Protocols on Patient Satisfaction for Patients With Sickle Cell Disease Experiencing a Vaso-Occlusive Episode.

Introduction: National guidelines for the acute management of sickle cell disease vaso-occlusive episodes recommend the use of a patient-specific or a weight-based protocol. The authors compared patient satisfaction with pain management between those randomized to receive either a patient-specific or weight-based pain protocol in the COMPARE-VOE randomized control trial.

Methods: Participants with sickle cell disease were pre-enrolled and patient satisfaction with pain management was assessed at the time of discharge from the 6 participating emergency departments.

Cerebral blood flow change with fluid resuscitation in acute ischemic stroke.

Background: In acute ischemic stroke (AIS), cerebral autoregulation becomes dysfunctional, impacting the brain's ability to maintain cerebral blood flow (CBF) at adequate levels. Reperfusion of affected and nearby brain tissue in AIS is currently the aim of treatment in AIS, but the effectiveness of fluid resuscitation on increasing the CBF is debated.

Objective: We investigated the hypothesis that early fluid resuscitation with normal saline bolus would improve CBF velocity in the initial resuscitation of patients with AIS.

Resonant acoustic rheometry for assessing plasma coagulation in bleeding patients.

Disordered hemostasis associated with life-threatening hemorrhage commonly afflicts patients in the emergency department, critical care unit, and perioperative settings. Rapid and sensitive hemostasis phenotyping is needed to guide administration of blood components and hemostatic adjuncts to reverse aberrant hemostasis. Here, we report the use of resonant acoustic rheometry (RAR), a technique that quantifies the viscoelastic properties of soft biomaterials, for assessing plasma coagulation in a cohort of 38 bleeding patients admitted to the hospital.

A mixed-methods observational study of strategies for success in implementation science: overcoming emergency departments hurdles.

Background: Heart failure is a major public health concern, affecting 6.7 million Americans. An estimated 16% of emergency department (ED) patients with acute heart failure (AHF) are discharged home.

Early Autonomic Dysfunction in Traumatic Brain Injury: An Article Review on the Impact on Multiple Organ Dysfunction.

Traumatic brain injury (TBI) is a complex condition and a leading cause of injury-related disability and death, with significant impacts on patient outcomes. Extracranial organ involvement plays a critical role in the outcome of patients following TBI. This review aims to provide a comprehensive overview of the pathophysiology, clinical presentation, and challenges in diagnosing patients with autonomic dysfunction after TBI.

Consumer experiences of emergency department pre-triage waiting period: A mixed-methods study.

Background: Emergency department pre-triage waiting periods have received limited attention. We aimed to explore the pre-triage experiences and perspectives of consumers attending emergency departments.

Methods: This mixed-methods cross-sectional study included 92 participants (patients, carers, and guardians) who attended one of three public hospital emergency departments in metropolitan Melbourne (Victoria, Australia).

Palliative Care Initiated in the Emergency Department: A Cluster Randomized Clinical Trial.

Importance: The emergency department (ED) offers an opportunity to initiate palliative care for older adults with serious, life-limiting illness.

Objective: To assess the effect of a multicomponent intervention to initiate palliative care in the ED on hospital admission, subsequent health care use, and survival in older adults with serious, life-limiting illness.

Design, Setting, And Participants: Cluster randomized, stepped-wedge, clinical trial including patients aged 66 years or older who visited 1 of 29 EDs across the US between May 1, 2018, and December 31, 2022, had 12 months of prior Medicare enrollment, and a Gagne comorbidity score greater than 6, representing a risk of short-term mortality greater than 30%.

Thiamine Deficiency Is Common and Underrecognized in Emergency Department Oncology Patients.

: Wernicke's encephalopathy can occur in oncology patients independent of alcohol use, likely resulting from poor dietary thiamine intake. High metabolic demands, such as those in acute illnesses seen in the emergency department (ED), can exacerbate thiamine deficiency. In this study, our objective was to assess the incidence of thiamine deficiency in ED oncology patients, which could lead to Wernicke's encephalopathy or other thiamine deficiency disorders if left untreated.

Short-term Postoperative Complications of Lymphatic Malformation Surgical Excision: A 20-Year Institutional Review.

Objective: To evaluate outcomes and postoperative complications following surgical resection of lymphatic malformations (LMs) at a single multidisciplinary vascular anomalies center.

Methods: A single-center retrospective review of all patients ≤21 years old who underwent surgical resection of a lymphatic malformation at a quaternary referral center with a multidisciplinary vascular anomalies team from 2004 to 2024. Data pertaining to postoperative outcomes and treatments was abstracted.

Data analysis protocol for early autonomic dysfunction characterization after severe traumatic brain injury.

Background: Traumatic brain injury (TBI) disrupts normal brain tissue and functions, leading to high mortality and disability. Severe TBI (sTBI) causes prolonged cognitive, functional, and multi-organ dysfunction. Dysfunction of the autonomic nervous system (ANS) after sTBI can induce abnormalities in multiple organ systems, contributing to cardiovascular dysregulation and increased mortality.

A mini review of leveraging biobanking in the identification of novel biomarkers in neurological disorders: insights from a rapid single-cell sequencing pipeline.

Recent successes in the identification of biomarkers and therapeutic targets for diagnosing and managing neurological diseases underscore the critical need for cutting-edge biobanks in the conduct of high-caliber translational neuroscience research. Biobanks dedicated to neurological disorders are particularly timely, given the increasing prevalence of neurological disability among the rising aging population. Translational research focusing on disorders of the central nervous system (CNS) poses distinct challenges due to the limited accessibility of CNS tissue pre-mortem.

Multicenter Clinical Performance Evaluation of the NeuMoDx CT/NG Assay 2.0.

Background: Given the continued increases in rates of both Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection, additional diagnostic assays may be useful in increasing access to testing for these sexually transmitted infections. We evaluated the performance of the NeuMoDx CT/NG Assay 2.0 on the NeuMoDx-96 and NeuMoDx-288 Molecular Systems.