Emergency departments(EDs)play a significant role in hospital healthcare systems.[1]According to the US Centers for Disease Control and Prevention,130 million individuals visited the ED in 2018.[2]A previous study has...Emergency departments(EDs)play a significant role in hospital healthcare systems.[1]According to the US Centers for Disease Control and Prevention,130 million individuals visited the ED in 2018.[2]A previous study has demonstrated that unnecessary laboratory tests did not change the management plan.[3]These actions led to ED overcrowding,causing consequences to patient outcomes.展开更多
BACKGROUND Metoclopramide may be used to treat people suffering from acute migraine.However,no comprehensive investigation on this issue has been recorded.This review will provide more solid evidence for the use of me...BACKGROUND Metoclopramide may be used to treat people suffering from acute migraine.However,no comprehensive investigation on this issue has been recorded.This review will provide more solid evidence for the use of metoclopramide in treating acute migraine.AIM To compare the efficacy of intravenous metoclopramide with other therapies in migraine attack treatment in an emergency department(ED).METHODS We included randomized controlled trials of participants older than 18 years with acute migraine headaches,which included at least one arm that received intravenous(IV)metoclopramide at the ED.A literature search of PubMed,Web of Science,Cochrane Collaboration,and Reference Citation Analysis on December 31,2021 retrieved other drugs or placebo-controlled studies without language limitation.The risk of bias was assessed using the Cochrane risk of bias tool.The primary endpoint was pain reduction at 60 min or closest to 1 h after treatment,as measured by the pain scale.Secondary endpoints included adverse effects or reactions resulting from metoclopramide or comparisons.RESULTS Fourteen trials with a total of 1661 individuals were eligible for review.The risk of bias ranged from low to intermediate.IV metoclopramide administration was not associated with higher pain reduction at 1 h(Standard mean difference[SMD]=-0.03,95%confidence interval[CI]:-0.33-0.28,P=0.87).However,metoclopramide was associated with better pain reduction than placebo(SMD=1.04,95%CI:0.50-1.58,P=0.0002).In addition,side effects were not significantly different between IV metoclopramide and other drugs or placebo(odds ratio[OR]=0.76,95%CI:0.48-1.19,P=0.09 and OR=0.92,95%CI:0.31-2.74,P=0.54,respectively).CONCLUSION Metoclopramide is more effective than placebo in treating migraine in the ED.Despite the observed tendency of decreased side effects,its effectiveness compared to other regimens is poorly understood.More research on this area is needed to treat migraine in acute care settings effectively.展开更多
BACKGROUND Several studies have demonstrated that the coronavirus disease 2019(COVID-19)has affected daily living and the healthcare system.No previous study has described the consequences of COVID-19 on emergency dep...BACKGROUND Several studies have demonstrated that the coronavirus disease 2019(COVID-19)has affected daily living and the healthcare system.No previous study has described the consequences of COVID-19 on emergency department(ED)visits and hospital admission among kidney transplant(KT)recipients.AIM To investigate the impact of the COVID-19 pandemic on ED visits and hospital admissions within 1 year in patients who underwent KT in Thailand.METHODS We conducted a retrospective study at a university hospital in Thailand.We reviewed the hospital records of KT patients who visited the ED during the outbreak of COVID-19(from January 2020 to December 2021).We used the previous 2 years as the control period in the analysis.We obtained baseline demographics and ED visit characteristics for each KT patient.The outcomes of interest were ED visits and ED visits leading to hospital admission within the 1^(st)year following a KT.The rate of ED visits and ED visits leading to hospital admissions between the two periods were compared using the stratified Cox proportional hazards model.RESULTS A total of 263 patients were included in this study:112 during the COVID-19 period and 151 during the control period.There were 34 and 41 ED visits after KT in the COVID-19 and control periods,respectively.The rate of first ED visit at 1 year was not significantly different in the COVID-19 period,compared with the control period[hazard ratio(HR)=1.02,95%confidence interval(CI):0.54-1.92;P=0.96].The hospital admission rate was similar between periods(HR=0.92,95%CI:0.50-1.69;P=0.78).CONCLUSION ED visits and hospital admissions within the 1st year in KT recipients were not affected by the COVID-19 pandemic.Despite these findings,we believe that communication between post-KT patients and healthcare providers is essential to highlight the importance of prompt ED visits for acute health conditions,particularly in post-KT patients.展开更多
BACKGROUND The clinical benefits of steroid administration during cardiac arrest remain unclear.Several studies reported that patients who received steroids after achieving a return of spontaneous circulation(ROSC)had...BACKGROUND The clinical benefits of steroid administration during cardiac arrest remain unclear.Several studies reported that patients who received steroids after achieving a return of spontaneous circulation(ROSC)had better outcomes,but few studies have investigated the benefits of steroid administration during resuscitation.We hypothesized that administration of steroid during cardiac arrest would be associated with better clinical outcomes in adults with cardiac arrest.AIM To investigate the effect of steroid administration during cardiac arrest and the outcomes of resuscitation.METHODS We included studies of participants older than 18 years of age who experienced cardiac arrest and included at least one arm that received corticosteroids during cardiac arrest.A literature search of PubMed and Embase on 31 January 2021 retrieved placebo-controlled studies without limitation for type,location,and initial presenting rhythm of cardiac arrest.The study outcomes were reported by odds ratios(ORs)compared with placebo.The primary outcome was survival rate at hospital discharge.Secondary outcomes included a sustained ROSC,survival rate at hospital admission,and neurological outcome at hospital discharge.RESULTS Six studies including 146262 participants were selected for analysis.The risk of bias ranged from low to high for randomized-controlled trials(RCTs)and low(for non-RCTs).Steroid administration was associated with increased survival at hospital discharge[OR:3.51,95%confidence interval(CI):1.98-6.20,P<0.001],and steroid administration during cardiac arrest was associated with both an increased rate of sustained ROSC(OR:1.81,95%CI:1.91-4.02,P<0.001)and a favorable neurological outcome at hospital discharge(OR:3.02,95%CI:1.26-7.24,P=0.01).CONCLUSION Steroid administration during cardiac arrest was associated with better outcomes of resuscitation.Further study of the use of steroid in the selected circumstances are warranted.展开更多
The 2019 coronavirus disease(COVID-19),resulting from the severe acute respiratory syndrome 2 virus,has transformed our globe and provided a new perspective on respiratory tract infections.However,COVID-19 would not b...The 2019 coronavirus disease(COVID-19),resulting from the severe acute respiratory syndrome 2 virus,has transformed our globe and provided a new perspective on respiratory tract infections.However,COVID-19 would not be recognized as a condition restricted to only pneumonia.This narrative review was conducted by searching manuscripts in several databases,including PubMed/MEDLINE,Web of Science,and Reference Citation Analysis,from December 2019 to July 2022.Many studies have revealed a broad spectrum of potential systemic symptoms,including biliary complications.Although biliary injury has been observed in a very low proportion of COVID-19 patients,it is associated with increased mortalities and long-term morbidities.We identify a cholangiopathy condition in individuals during infection and after recovering from severe COVID-19,defined by a significant increase in serum alkaline phosphatase and signs of bile duct injury.Understanding the pathogeneses behind this condition would help us develop new techniques to prevent these complications.This review thoroughly discusses and summarizes the current information regarding COVID-19-associated cholangiopathy.In addition,the possible explanations for COVID-19-associated cholangiopathy are presented.Since the exact pathogenesis may not be concluded,this review could provide relevant information to encourage additional investigations shortly.展开更多
文摘Emergency departments(EDs)play a significant role in hospital healthcare systems.[1]According to the US Centers for Disease Control and Prevention,130 million individuals visited the ED in 2018.[2]A previous study has demonstrated that unnecessary laboratory tests did not change the management plan.[3]These actions led to ED overcrowding,causing consequences to patient outcomes.
文摘BACKGROUND Metoclopramide may be used to treat people suffering from acute migraine.However,no comprehensive investigation on this issue has been recorded.This review will provide more solid evidence for the use of metoclopramide in treating acute migraine.AIM To compare the efficacy of intravenous metoclopramide with other therapies in migraine attack treatment in an emergency department(ED).METHODS We included randomized controlled trials of participants older than 18 years with acute migraine headaches,which included at least one arm that received intravenous(IV)metoclopramide at the ED.A literature search of PubMed,Web of Science,Cochrane Collaboration,and Reference Citation Analysis on December 31,2021 retrieved other drugs or placebo-controlled studies without language limitation.The risk of bias was assessed using the Cochrane risk of bias tool.The primary endpoint was pain reduction at 60 min or closest to 1 h after treatment,as measured by the pain scale.Secondary endpoints included adverse effects or reactions resulting from metoclopramide or comparisons.RESULTS Fourteen trials with a total of 1661 individuals were eligible for review.The risk of bias ranged from low to intermediate.IV metoclopramide administration was not associated with higher pain reduction at 1 h(Standard mean difference[SMD]=-0.03,95%confidence interval[CI]:-0.33-0.28,P=0.87).However,metoclopramide was associated with better pain reduction than placebo(SMD=1.04,95%CI:0.50-1.58,P=0.0002).In addition,side effects were not significantly different between IV metoclopramide and other drugs or placebo(odds ratio[OR]=0.76,95%CI:0.48-1.19,P=0.09 and OR=0.92,95%CI:0.31-2.74,P=0.54,respectively).CONCLUSION Metoclopramide is more effective than placebo in treating migraine in the ED.Despite the observed tendency of decreased side effects,its effectiveness compared to other regimens is poorly understood.More research on this area is needed to treat migraine in acute care settings effectively.
文摘BACKGROUND Several studies have demonstrated that the coronavirus disease 2019(COVID-19)has affected daily living and the healthcare system.No previous study has described the consequences of COVID-19 on emergency department(ED)visits and hospital admission among kidney transplant(KT)recipients.AIM To investigate the impact of the COVID-19 pandemic on ED visits and hospital admissions within 1 year in patients who underwent KT in Thailand.METHODS We conducted a retrospective study at a university hospital in Thailand.We reviewed the hospital records of KT patients who visited the ED during the outbreak of COVID-19(from January 2020 to December 2021).We used the previous 2 years as the control period in the analysis.We obtained baseline demographics and ED visit characteristics for each KT patient.The outcomes of interest were ED visits and ED visits leading to hospital admission within the 1^(st)year following a KT.The rate of ED visits and ED visits leading to hospital admissions between the two periods were compared using the stratified Cox proportional hazards model.RESULTS A total of 263 patients were included in this study:112 during the COVID-19 period and 151 during the control period.There were 34 and 41 ED visits after KT in the COVID-19 and control periods,respectively.The rate of first ED visit at 1 year was not significantly different in the COVID-19 period,compared with the control period[hazard ratio(HR)=1.02,95%confidence interval(CI):0.54-1.92;P=0.96].The hospital admission rate was similar between periods(HR=0.92,95%CI:0.50-1.69;P=0.78).CONCLUSION ED visits and hospital admissions within the 1st year in KT recipients were not affected by the COVID-19 pandemic.Despite these findings,we believe that communication between post-KT patients and healthcare providers is essential to highlight the importance of prompt ED visits for acute health conditions,particularly in post-KT patients.
文摘BACKGROUND The clinical benefits of steroid administration during cardiac arrest remain unclear.Several studies reported that patients who received steroids after achieving a return of spontaneous circulation(ROSC)had better outcomes,but few studies have investigated the benefits of steroid administration during resuscitation.We hypothesized that administration of steroid during cardiac arrest would be associated with better clinical outcomes in adults with cardiac arrest.AIM To investigate the effect of steroid administration during cardiac arrest and the outcomes of resuscitation.METHODS We included studies of participants older than 18 years of age who experienced cardiac arrest and included at least one arm that received corticosteroids during cardiac arrest.A literature search of PubMed and Embase on 31 January 2021 retrieved placebo-controlled studies without limitation for type,location,and initial presenting rhythm of cardiac arrest.The study outcomes were reported by odds ratios(ORs)compared with placebo.The primary outcome was survival rate at hospital discharge.Secondary outcomes included a sustained ROSC,survival rate at hospital admission,and neurological outcome at hospital discharge.RESULTS Six studies including 146262 participants were selected for analysis.The risk of bias ranged from low to high for randomized-controlled trials(RCTs)and low(for non-RCTs).Steroid administration was associated with increased survival at hospital discharge[OR:3.51,95%confidence interval(CI):1.98-6.20,P<0.001],and steroid administration during cardiac arrest was associated with both an increased rate of sustained ROSC(OR:1.81,95%CI:1.91-4.02,P<0.001)and a favorable neurological outcome at hospital discharge(OR:3.02,95%CI:1.26-7.24,P=0.01).CONCLUSION Steroid administration during cardiac arrest was associated with better outcomes of resuscitation.Further study of the use of steroid in the selected circumstances are warranted.
文摘The 2019 coronavirus disease(COVID-19),resulting from the severe acute respiratory syndrome 2 virus,has transformed our globe and provided a new perspective on respiratory tract infections.However,COVID-19 would not be recognized as a condition restricted to only pneumonia.This narrative review was conducted by searching manuscripts in several databases,including PubMed/MEDLINE,Web of Science,and Reference Citation Analysis,from December 2019 to July 2022.Many studies have revealed a broad spectrum of potential systemic symptoms,including biliary complications.Although biliary injury has been observed in a very low proportion of COVID-19 patients,it is associated with increased mortalities and long-term morbidities.We identify a cholangiopathy condition in individuals during infection and after recovering from severe COVID-19,defined by a significant increase in serum alkaline phosphatase and signs of bile duct injury.Understanding the pathogeneses behind this condition would help us develop new techniques to prevent these complications.This review thoroughly discusses and summarizes the current information regarding COVID-19-associated cholangiopathy.In addition,the possible explanations for COVID-19-associated cholangiopathy are presented.Since the exact pathogenesis may not be concluded,this review could provide relevant information to encourage additional investigations shortly.
