To the editor:In the USA alone,there were 1.7 million suicide attempts in 2021.1 Although the majority of suicide attempts are not fatal,immediate medical attention is often necessary,especially when violent methods a...To the editor:In the USA alone,there were 1.7 million suicide attempts in 2021.1 Although the majority of suicide attempts are not fatal,immediate medical attention is often necessary,especially when violent methods are used.2 These methods include jumping from heights,using a firearm,crashing a motor vehicle,and lying down or jumping in front of a moving object.展开更多
BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in...BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in the Netherlands are not staffed by emergency physicians.The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians.METHODS: We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands.Data were gathered using a standardized questionnaire.RESULTS: The response rate was 34.3%(148/432).Of the respondents, 84/148(56.8%) provided adult PSA and 30/148(20.3%) provided paediatric PSA.Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure.The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients.CONCLUSION: The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.展开更多
BACKGROUND The prognostic benefit of complete revascularization in elderly patients(aged over 75 years)with multi-vessel disease and acute coronary syndrome(ACS)is currently unclear.This study aimed to determine the l...BACKGROUND The prognostic benefit of complete revascularization in elderly patients(aged over 75 years)with multi-vessel disease and acute coronary syndrome(ACS)is currently unclear.This study aimed to determine the long-term prognostic impact of complete revascularization in this population.METHODS We conducted this study using data obtained from the BleeMACS(Bleeding complications in a Multicenter registry of patients discharged after an Acute Coronary Syndrome)registry,which was carried out from 2003 to 2014.The objective was to categorize older patients diagnosed with ACS into two groups:those who underwent complete revascularization and those who did not.Propensity score matching and the Kaplan-Meier analysis were employed to examine differences in one-year clinical outcomes.The primary endpoint was major adverse cardiovascular event(MACE),which encompassed a combination of all-cause mortality and myocardial infarction.RESULTS Out of 1263 patients evaluated,445 patients(35.2%)received complete revascularization.Patients who underwent complete revascularization had a higher prevalence of hypertension and prior percutaneous coronary intervention compared to those who did not.During the one-year follow-up period,complete revascularization was associated with a significantly decreased risk of MACE[13.7%vs.20.5%,hazard ratio(HR)=0.63,95%CI:0.45–0.88,P=0.007]and a lower risk of myocardial infarction(5.9%vs.9.9%,HR=0.55,95%CI:0.33–0.92,P=0.02).However,it was not linked to a lower risk of all-cause death(9.5%vs.13.5%,HR=0.68,95%CI:0.45–1.02,P=0.06).Similar results were observed in the subgroup analysis.CONCLUSIONS Long-term clinical improvements were observed in ACS patients aged over 75 years with multi-vessel disease who achieved complete revascularization.Therefore,adhering to guidelines for complete revascularization should be recommended for elderly patients.展开更多
BACKGROUND Haemoglobin drop is common in acute coronary syndrome(ACS)patients and correlates with poor prognosis.However,the association between mild haemoglobin drop and adverse clinical outcome remains insufficientl...BACKGROUND Haemoglobin drop is common in acute coronary syndrome(ACS)patients and correlates with poor prognosis.However,the association between mild haemoglobin drop and adverse clinical outcome remains insufficiently investigated.This study aimed to examine the association between in-hospital haemoglobin drop and risk for adverse clinical outcomes in ACS patients,especially those with mild drop.METHODS Included patients from the BleeMACS(Bleeding complications in a Multicenter registry of patients discharged after an Acute Coronary Syndrome)registry were categorized into three groups by the presence and amount of in-hospital haemoglobin drop(non-drop,mild drop and severe drop).The cut-off point between mild drop and severe drop is≥3 g/dL.Multivariate Cox regression was used to assess the association between haemoglobin drop and major adverse cardiac endpoints(MACE).Patients taking potent P2Y_(12) inhibitors were selected for the additional analysis.Propensity score matching was used to avoid selective bias in the additional analysis.RESULTS Of 6911 patients,4949 patients(71.6%)experienced in-hospital haemoglobin drop.Compare with non-drop group,patients with haemoglobin drop had higher risk of MACE[adjusted hazard ratio(HR)=1.36,95%CI:1.03–1.80 for mild drop group;adjusted HR=1.70,95%CI:1.07–2.68 for severe drop group].Patients in mild drop group were less likely to receive potent P2Y_(12) inhibitors at discharge(mild drop group vs.severe drop group vs.non-drop group:10.9%vs.10.7%vs.23.8%).After propensity score matching adjustment among patients with potent P2Y_(12) inhibitors,patients in mild drop group were not associated with an increased risk of MACE than those in non-drop group(adjusted HR=1.52,95%CI:0.49–4.72).CONCLUSIONS In-hospital haemoglobin drop was common in ACS patients and associated with a higher risk for adverse events.Reduced prescription for potent P2Y_(12) inhibitors may be responsible for poor prognoses among patients with mild haemoglobin drop.展开更多
文摘To the editor:In the USA alone,there were 1.7 million suicide attempts in 2021.1 Although the majority of suicide attempts are not fatal,immediate medical attention is often necessary,especially when violent methods are used.2 These methods include jumping from heights,using a firearm,crashing a motor vehicle,and lying down or jumping in front of a moving object.
文摘BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in the Netherlands are not staffed by emergency physicians.The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians.METHODS: We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands.Data were gathered using a standardized questionnaire.RESULTS: The response rate was 34.3%(148/432).Of the respondents, 84/148(56.8%) provided adult PSA and 30/148(20.3%) provided paediatric PSA.Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure.The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients.CONCLUSION: The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.
基金supported by the Ministry of Science and Technology of China(2020YFC2004800)the National Natural Science Foundation of China(No.82100260)the Beijing Hospitals Authority Youth Program(QML20210605)。
文摘BACKGROUND The prognostic benefit of complete revascularization in elderly patients(aged over 75 years)with multi-vessel disease and acute coronary syndrome(ACS)is currently unclear.This study aimed to determine the long-term prognostic impact of complete revascularization in this population.METHODS We conducted this study using data obtained from the BleeMACS(Bleeding complications in a Multicenter registry of patients discharged after an Acute Coronary Syndrome)registry,which was carried out from 2003 to 2014.The objective was to categorize older patients diagnosed with ACS into two groups:those who underwent complete revascularization and those who did not.Propensity score matching and the Kaplan-Meier analysis were employed to examine differences in one-year clinical outcomes.The primary endpoint was major adverse cardiovascular event(MACE),which encompassed a combination of all-cause mortality and myocardial infarction.RESULTS Out of 1263 patients evaluated,445 patients(35.2%)received complete revascularization.Patients who underwent complete revascularization had a higher prevalence of hypertension and prior percutaneous coronary intervention compared to those who did not.During the one-year follow-up period,complete revascularization was associated with a significantly decreased risk of MACE[13.7%vs.20.5%,hazard ratio(HR)=0.63,95%CI:0.45–0.88,P=0.007]and a lower risk of myocardial infarction(5.9%vs.9.9%,HR=0.55,95%CI:0.33–0.92,P=0.02).However,it was not linked to a lower risk of all-cause death(9.5%vs.13.5%,HR=0.68,95%CI:0.45–1.02,P=0.06).Similar results were observed in the subgroup analysis.CONCLUSIONS Long-term clinical improvements were observed in ACS patients aged over 75 years with multi-vessel disease who achieved complete revascularization.Therefore,adhering to guidelines for complete revascularization should be recommended for elderly patients.
文摘BACKGROUND Haemoglobin drop is common in acute coronary syndrome(ACS)patients and correlates with poor prognosis.However,the association between mild haemoglobin drop and adverse clinical outcome remains insufficiently investigated.This study aimed to examine the association between in-hospital haemoglobin drop and risk for adverse clinical outcomes in ACS patients,especially those with mild drop.METHODS Included patients from the BleeMACS(Bleeding complications in a Multicenter registry of patients discharged after an Acute Coronary Syndrome)registry were categorized into three groups by the presence and amount of in-hospital haemoglobin drop(non-drop,mild drop and severe drop).The cut-off point between mild drop and severe drop is≥3 g/dL.Multivariate Cox regression was used to assess the association between haemoglobin drop and major adverse cardiac endpoints(MACE).Patients taking potent P2Y_(12) inhibitors were selected for the additional analysis.Propensity score matching was used to avoid selective bias in the additional analysis.RESULTS Of 6911 patients,4949 patients(71.6%)experienced in-hospital haemoglobin drop.Compare with non-drop group,patients with haemoglobin drop had higher risk of MACE[adjusted hazard ratio(HR)=1.36,95%CI:1.03–1.80 for mild drop group;adjusted HR=1.70,95%CI:1.07–2.68 for severe drop group].Patients in mild drop group were less likely to receive potent P2Y_(12) inhibitors at discharge(mild drop group vs.severe drop group vs.non-drop group:10.9%vs.10.7%vs.23.8%).After propensity score matching adjustment among patients with potent P2Y_(12) inhibitors,patients in mild drop group were not associated with an increased risk of MACE than those in non-drop group(adjusted HR=1.52,95%CI:0.49–4.72).CONCLUSIONS In-hospital haemoglobin drop was common in ACS patients and associated with a higher risk for adverse events.Reduced prescription for potent P2Y_(12) inhibitors may be responsible for poor prognoses among patients with mild haemoglobin drop.
