Background: Emergency departments (EDs) worldwide are dealing with overcrowding, system fragmentation, and coordination problems, which impact patient wait times, staff job satisfaction, and patient outcomes. Inappropriate ED visits, particularly those for low acuity conditions, exacerbate these challenges. However, the motivations behind these visits are poorly understood, with limited data from the patient perspective. This study investigated patient-reported motives behind ED visits triaged as low acuity in Poznan, Poland, to propose health care system flow enhancements. Material and methods A cross-sectional survey and retrospective chart review were conducted in the ED of the Hipolit Cegielski Medical Center in Poznań, Poland, over three months in 2022–23. Patients who were triaged to have low acuity conditions were invited to participate in the survey. The data collected through the questionnaire included patient and ED visit characteristics. Additional information on the visits was extracted from the patient charts. Main results: This study involved 293 patients who underwent low-acuity triage. Among them, 58 % were deemed to have conditions that could have been treated in primary care. Most of the patients (74 %) visited the ED of their own volition due to concerns about their health. Other reasons for ED attendance were challenges accessing primary care or a specialist clinic (11 %), system navigation problems (5 %), or a lack of trust in their primary care provider (2 %). Conclusions: This study showed that of the patients surveyed, the majority had conditions that could have been treated outside of the ED setting. We recommend prioritizing education, particularly among younger adults, to increase awareness about nonurgent care options while improving health care policies.

(1) Alcohol consumption contributes to the development of numerous diseases and is a big organizational burden on emergency departments (EDs). (2) We examined data on alcohol-related ED admissions in Poznan, Poland between 1 April 2019 and 31 March 2022. A total of 2290 patients’ records were collected and analysed. The main goal was to determine the impact that these visits had on the functioning of the ED and the hospital. (3) The alcohol-related admission rate was significantly higher in males (78.95% vs. 21.05%), and the median blood alcohol concentration (BAC) level was 2.60 (1.78–3.38) ‰. Most of the visits took place at weekends and in the evening. Patients with higher BAC tended to stay longer in the ED, but had a lower chance of being admitted. A majority of patients required radiology and laboratory testing, 20.44% needed psychiatric examination, and 19.69% suffered trauma, mainly to the head. (4) Injuries and mental problems were the most common medical emergencies. This study presents trends in alcohol-related ED attendances, examines reasons for visits, and makes an attempt to assess overall burden on EDs.

This comprehensive review examines the complex relationship between sleep disorders and rheumatic diseases, supported by findings from the latest research articles. It encompasses various rheumatic conditions, including rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis. The review reveals the bidirectional relationship between sleep disorders and these diseases, emphasizing their impact on disease progression and quality of life. Conventional and alternative therapeutic interventions for connective tissue diseases are presented, focusing on improving sleep quality and alleviating rheumatic symptoms. The role of pro-inflammatory cytokines and their potential modulation through pharmacological agents is also discussed. In the treatment of sleep disorders, various options are proposed, such as cognitive behavioral therapy for insomnia, physical activity, dietary modifications, and alternative approaches like reflexology and acupuncture. Thus, this review offers a nuanced understanding of the connection between sleep disorders and rheumatic diseases, supported by evidence from diverse studies. Such an approach is particularly important because it enhances sleep quality for overall patient well-being in the holistic management of rheumatic conditions.

To consolidate current evidence on predictors of neurological outcome following extracorporeal cardiopulmonary resuscitation (eCPR) in patients with cardiac arrest. We conducted a systematic review of the literature across databases including PubMed, MEDLINE, Embase, CINAHL, the Cochrane Library, and Web of Science. Studies assessing neurological outcomes post-eCPR were identified, with a total of 10 studies eligible for individual assessment of which 8 comprising 4353 patients allowed to perform collective statistical analysis. Favorable neurological outcomes were associated with age < 65 years (OR = 6.17), shockable rhythm at extracorporeal membrane oxygenation initiation (OR = 6.67) or hospital arrival (OR = 3.68), and initial pH ≥ 7.0 (OR = 2.01). Other factors involved the presence of any life sign (gasping, positive pupillary light reaction, or increased level of consciousness before or throughout cardiopulmonary resuscitation) (OR = 9.63; Se 0.89, Sp 0.46, PPV 0.22, NPV 0.96), transient return of spontaneous circulation, non-hypoxic mechanism of occurred hepatitis, public location, and hypothermic etiology of cardiac arrest; however, each of those findings was supported by only one study. Unfavorable outcomes were linked to hypoxic brain injury on computed tomography (OR = 12.40; Se 0.366, Sp 0.955, PPV 0.767, NPV 0.787) and elevated serum creatinine (OR = 2.22). The TiPS65 scale showed high predictive accuracy in two studies when the cut-off point was set at 4 points (88.4% and 88.6%; Se 0.172, Sp 0.971, PPV 0.423, and NPV 0.906, and Se 0.193, Sp 0.985, PPV 0.646, and NPV 0.896, respectively). Some predictors, like call-to-hospital time and bystander cardiopulmonary resuscitation, had mixed results across studies. Neurological prognostication in eCPR patients is a complex problem requiring the consideration of multiple variables regarding patient’s and cardiac arrest characteristics. Future research should focus on the determination of outcome-affecting factors and assessment of their applicability in clinical settings. New knowledge on this ground will help to create recommendations for eCPR initiation and termination, consequently contributing to treatment results improvement. PROSPERO CRD42024530305.

Burden and Patterns of Electric Scooter-Related Injuries: Insights From 2 Polish Emergency Departments - Article abstract #944448

Acute kidney injury (AKI) and sudden exacerbation of chronic kidney disease (CKD) frequently necessitate urgent kidney replacement therapy (UKRT). Peritoneal dialysis (PD) is recognized as a viable modality for managing such patients. Urgent-start peritoneal dialysis (USPD) may be associated with an increased number of complications and is rarely utilized. This review examines recent literature investigating the clinical outcomes of USPD in CKD and AKI. Relevant research was identified through searches of the MEDLINE (PubMed), Scopus, Web of Science, and Google Scholar databases using MeSH terms and relevant keywords. Included studies focused on the emergency use of peritoneal dialysis in CKD or AKI and reported treatment outcomes. While no official recommendations exist for catheter implantation in USPD, the impact of the technique itself on outcomes was found to be less significant compared with the post-implantation factors. USPD represents a safe and effective treatment modality for AKI, although complications such as catheter malfunctions, leakage, and peritonitis were observed. Furthermore, USPD demonstrated efficacy in managing CKD, although it was associated with a higher incidence of complications compared to conventional-start peritoneal dialysis. Despite its cost-effectiveness, PD requires greater technical expertise from medical professionals. Close supervision and pre-planning for catheter insertion are essential for CKD patients. Whenever feasible, an urgent start should be avoided. Nevertheless, in emergency scenarios, USPD does remain a safe and efficient approach.