Internal and Emergency Medicine 

About: Internal and Emergency Medicine is an academic journal published by Springer Science+Business Media. The journal publishes majorly in the area(s): Medicine & Population. It has an ISSN identifier of 1828-0447. Over the lifetime, 3254 publications have been published receiving 34912 citations. The journal is also known as: IEM. Internal and emergency medicine.

Network meta-analysis: an introduction for clinicians.

Abstract: Network meta-analysis is a technique for comparing multiple treatments simultaneously in a single analysis by combining direct and indirect evidence within a network of randomized controlled trials. Network meta-analysis may assist assessing the comparative effectiveness of different treatments regularly used in clinical practice and, therefore, has become attractive among clinicians. However, if proper caution is not taken in conducting and interpreting network meta-analysis, inferences might be biased. The aim of this paper is to illustrate the process of network meta-analysis with the aid of a working example on first-line medical treatment for primary open-angle glaucoma. We discuss the key assumption of network meta-analysis, as well as the unique considerations for developing appropriate research questions, conducting the literature search, abstracting data, performing qualitative and quantitative synthesis, presenting results, drawing conclusions, and reporting the findings in a network meta-analysis.

Contrast-induced nephropathy.

Abstract: Radiological procedures utilizing intravascular iodinated contrast media are being widely applied for both diagnostic and therapeutic purposes and represent one of the main causes of contrast-induced nephropathy (CIN) and hospital-acquired renal failure. Although the risk of CIN is low (0.6–2.3 %) in the general population, it may be very high (up to 50 %) in selected subsets, especially in patients with major risk factors such as advanced chronic kidney disease and diabetes mellitus, and in those undergoing emergency percutaneous coronary interventions (PCI). Due to the lack of any effective treatment, prevention of this iatrogenic disease, which is associated with significant in-hospital and long-term morbidity and mortality and increased costs, is the key strategy. However, prevention of CIN continues to elude clinicians and is a main concern during PCI, as patients undergoing these procedures often have multiple comorbidities. The purpose of this study is to examine the pathophysiology, risk factors and clinical course of CIN, as well as the most recent studies dealing with its prevention and potential therapeutic interventions, especially during PCI.

Overcrowding in emergency department: an international issue

Abstract: Overcrowding in the emergency department (ED) has become an increasingly significant worldwide public health problem in the last decade. It is a consequence of simultaneous increasing demand for health care and a deficit in available hospital beds and ED beds, as for example it occurs in mass casualty incidents, but also in other conditions causing a shortage of hospital beds. In Italy in the last 12-15 years, there has been a huge increase in the activity of the ED, and several possible interventions, with specific organizational procedures, have been proposed. In 2004 in the United Kingdom, the rule that 98 % of ED patients should be seen and then admitted or discharged within 4ho f presentation to the ED ('4 hr ule') was intro- duced, and it has been shown to be very effective in decreasing ED crowding, and has led to the development of further acute care clinical indicators. This manuscript represents a synopsis of the lectures on overcrowding problems in the ED of the Third Italian GREAT Network Congress, held in Rome, 15-19 October 2012, and hope- fully, they may provide valuable contributions in the understanding of ED crowding solutions.

A modified Khorana risk assessment score for venous thromboembolism in cancer patients receiving chemotherapy: the Protecht score

Abstract: The association between cancer and venous thromboembolism (VTE) is well established [1]. Indeed, up to 20 % of cancer patients have a symptomatic VTE, which is recognized to be one of the leading causes of death in these patients [2]. Patients with cancer are heterogeneous concerning the risk for VTE. Some solid malignancies including pancreatic, lung, colon-rectum, ovarian, and brain cancer are associated with a particularly high risk for VTE. A risk assessment score for VTE, known as Khorana score, was validated for cancer patients treated with chemotherapy in order to identify high risk patients [2]. Among cancer patients receiving chemotherapy, rates of VTE seem to be particularly high in those receiving cisplatin or carboplatinbased chemotherapy as well as gemcitabine [3]. We designed a modified Khorana risk assessment score (the Protecht score) by adding platinum or gemcitabine-based chemotherapy to the predictive variables already taken into account in the Khorana score. The role of antithrombotic prophylaxis in cancer patients receiving chemotherapy is currently an area of active investigation. Recently, in the Protecht (PROphylaxis of ThromboEmbolism during CHemoTherapy) study, a 50 % risk reduction in the incidence of thromboembolic complications is associated with nadroparin in these patients (NCT 00951574) [4]. The need for VTE risk assessment in cancer patients receiving chemotherapy has been emphasized in the most recent oncology guidelines [5] to optimize the benefit of antithrombotic prophylaxis in this setting. The aims of this analysis were: (1) to evaluate the Protecht score, in comparison with the Khorana score, for identifying high risk cancer patients in a post hoc analysis of the placebo group of the Protecht study, and (2) to assess the effect of nadroparin for VTE prophylaxis according to the Khorana and Protecht scores. The Khorana predictive score assigns 2 points to very high risk cancer sites (pancreatic or gastric) or 1 point to high risk cancer sites (lung, ovarian or bladder). In addition, 1 point is assigned for each of the following: platelet count C350 9 10/L, hemoglobin B10 g/dL, or use of erythropoietin-stimulating agents, leukocyte count C11 9 10/L and body mass index C35 kg/m. The assigned point for each variable included in the risk model was calculated on bases of the regression coefficients obtained from the derivation model. In the Protecht predictive score, treatment with cisplatin or carboplatin-based chemotherapy or gemcitabine adds 1 point and the association 2 points to the score based on the five predictive variables of the Khorana score. The assigned point for each variable was based on the estimation of risk as extrapolated from the literature. For the purpose of this analysis, the group of high-risk patients was identified by a score C3, whereas patients with a score between 0 and 2 were considered at low-intermediate risk for VTE. For the Protecht investigators.

The elderly in the emergency department: a critical review of problems and solutions

Abstract: The elderly are an ever increasing population in overcrowded emergency departments (EDs) in many countries. They have multiple health problems and consume more time and resources than younger patients. They are more frequently admitted and experience adverse outcomes after they are discharged from the ED. These frail patients could require specific skills, instruments and organisational models of emergency care in order to look after their complex needs. As such, several approaches have been tried and tested to improve emergency care for them. This article analyses the epidemiological load and problems faced when confronted with elder ED patients. We critically review organisational models, clinical approaches and methodologies in order to reduce ED physicians’ difficulties and to improve quality of care and outcomes for elder patients. Triage, clinical assessment and discharge are identified as critical moments during an emergency care process, and interesting and useful instruments are proposed as possible solutions.