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Objective Emergency departments (EDs) are high-acuity clinical environments characterized by a high demand for sustained attention and significant cognitive load. This study aimed to evaluate the impact of shift timing and high-stress clinical events, such as cardiac arrest, on the attentional performance of emergency medicine specialists. Methods This prospective observational study was conducted in the emergency department of a tertiary care hospital, enrolling 23 emergency medicine specialists. Participants’ attentional performance was measured using the mobile Stroop Color-Word Test. Assessments were performed at two-hour intervals during 8-hour shifts and also pre- and post-cardiac arrest events. The collected data were analyzed in relation to variables including shift type, number of cardiac arrests, and resuscitation success. Results Stroop scores differed significantly by shift type ( p  = 0.021, η² ≈ 0.07), with the highest attentional performance observed during the evening shift and the lowest during the night shift. A significant decline in attentional performance was noted following cardiac arrest events (median difference: −3 points, p  < 0.001; r  = 0.59), a pattern that was consistent across all shift types. Furthermore, post-resuscitation attentional levels were significantly higher after successful outcomes (Return of Spontaneous Circulation, ROSC) compared to unsuccessful ones ( p  = 0.017; r  ≈ 0.30). Mixed-effects multivariate analysis revealed that working the night shift (β = −3.1), an increased number of cardiac arrests (β = −0.8 per event), and an unsuccessful ROSC outcome (β = −2.4) were all independently associated with lower attentional performance. Conclusion This study demonstrates that night shifts, frequent exposure to cardiac arrests, and unsuccessful resuscitation outcomes adversely affect the attentional performance of emergency physicians. These findings suggest that physicians are more cognitively vulnerable in the ED, particularly during night hours and following high-stress clinical situations. These results underscore the need for a re-evaluation of shift scheduling and the development of structural interventions to support physicians after critical incidents, with the ultimate goal of enhancing clinical safety.

Dyspnea is a common Emergency Department (ED) symptom requiring prompt diagnosis and treatment. The bedside lung ultrasonography in emergency (BLUE) protocol is defined as a bedside diagnostic tool in intensive care units. The aim of this study was to investigate the test performance characteristics of the BLUE-protocol ultrasonography in ED patients presenting with acute dyspnea. This study was performed as a prospective observational study at the ED of a tertiary care university hospital over a 3-month period. The BLUE-protocol was applied to all consecutive dyspneic patients admitted to the ED by 5 emergency physicians who were certified for advanced ultrasonography. In addition to the BLUE-protocol, the patients were also evaluated for pleural and pericardial effusion. A total of 383 patients were included in this study (mean age, 65.5 ± 15.5 years, 183 (47.8%) female and 200 (52.2%) male). According to the BLUE-protocol algorithm, the sensitivities and specificities of the BLUE-protocol are, respectively, 87.6% and 96.2% for pulmonary edema, 85.7% and 99.0% for pneumonia, 98.2% and 67.3% for asthma/COPD, 46.2% and 100% for pulmonary embolism, and 71.4% and 100% for pneumothorax. Although not included in the BLUE-protocol algorithm, pleural or pericardial effusion was detected in 82 (21.4%) of the patients. The BLUE-protocol can be used confidently in acute dyspneic ED patients. For better diagnostic utility of the BLUE-protocol in EDs, it is recommended that the BLUE-protocol be modified for the assessment of pleural and pericardial effusion. Further diagnostic evaluations are needed in asthma/COPD groups in terms of the BLUE-protocol.

Introduction: Myocarditis is an infrequent, possibly life-threatening, and inflammatory myocardial disease with various number of clinical complaints and symptoms, often caused by infectious agents. Case Presentation: A 24‑year‑old male came to the emergency department (ED) with the complaints of angina-like retrosternal chest pain and tightness lasting for three days. The ECG suggesting inferior submural ischaemia and echocardiographic assessment was normal. Laboratory tests showed troponin T levels increased. Coronary angiography was normal. CMRI showed patchy contrast uptake. It looked more like viral myocarditis. Conclusion: Acute myocarditis diagnosis is most difficulty and predictively in connection with the variety of clinical presentations. The differential diagnosis between myocarditis and AMI can be troublesome in ED.

Twitter may be used in disseminating scientific information that can be measured via citations by traditional systems. We aimed to investigate the relationship between Twitter mentions, traditional citations including Google Scholar and Scopus, and the metric value of Altmetric for articles published in emergency medicine journals. Articles published in emergency medicine journals between January 2018 and June 2018 were retrospectively analyzed in February 2021. Journals included with an impact factor of >1 and indexed in Q1. Metric data about citations in Google Scholar and Scopus, the metric value of the Altmetric system, and Twitter mentions were obtained. There were 502 articles published in different seven emergency medicine journals. Fifty-four articles (10.8%) were never cited in Google Scholar or Scopus. There were 79 articles (15.7%) without Twitter mention. Twitter mentions as a tweet or no tweet impacted the number of articles with citation (p > 0.05). The number of citations per article was significantly higher in articles with Twitter mentions (p = 0.002 for Google Scholar citations, p = 0.005 for Scopus citations). Altmetric cited articles were significantly higher for articles with Twitter mentions (p < 0.001). There were significant positive correlations between the number of Twitter mentions and citations in Scopus (r = 0.30, p < 0.001), in both Google Scholar and Scopus (r = 0.19, p < 0.001), and in Altmetrics (r = 0.852, p < 0.001). There were positive correlations between numbers of Twitter mentions, traditional citations, including Google Scholar and Scopus, and metric values of the Altmetric system. This finding supports that increased social media citations are associated with increased dissemination and disclosure of publications. •Social media mentions and scientific citations may be correlated with each other.•Higher Twitter mentions were associated with the increased number of citations.•The number of citations per article was significantly higher in articles with Twitter mentions.•Twitter mentions were correlated with Scopus and Altmetric citations.•Increased social media citations are associated with increased dissemination and disclosure of publications.

AbstractIntroductionTwitter may be used in disseminating scientific information that can be measured via citations by traditional systems. We aimed to investigate the relationship between Twitter mentions, traditional citations including Google Scholar and Scopus, and the metric value of Altmetric for articles published in emergency medicine journals. MethodsArticles published in emergency medicine journals between January 2018 and June 2018 were retrospectively analyzed in February 2021. Journals included with an impact factor of >1 and indexed in Q1. Metric data about citations in Google Scholar and Scopus, the metric value of the Altmetric system, and Twitter mentions were obtained. ResultsThere were 502 articles published in different seven emergency medicine journals. Fifty-four articles (10.8%) were never cited in Google Scholar or Scopus. There were 79 articles (15.7%) without Twitter mention. Twitter mentions as a tweet or no tweet impacted the number of articles with citation ( p > 0.05). The number of citations per article was significantly higher in articles with Twitter mentions ( p = 0.002 for Google Scholar citations, p = 0.005 for Scopus citations). Altmetric cited articles were significantly higher for articles with Twitter mentions ( p < 0.001). There were significant positive correlations between the number of Twitter mentions and citations in Scopus ( r = 0.30, p < 0.001), in both Google Scholar and Scopus ( r = 0.19, p < 0.001), and in Altmetrics ( r = 0.852, p < 0.001). ConclusionThere were positive correlations between numbers of Twitter mentions, traditional citations, including Google Scholar and Scopus, and metric values of the Altmetric system. This finding supports that increased social media citations are associated with increased dissemination and disclosure of publications.

This study aimed to investigate whether ferritin level can predict the severity of coronavirus disease 2019 (COVID-19). The COVID-19 pandemic has been challenging for both patients and caregivers. Many laboratory markers have been used to better understand the causes of poor outcomes and to improve the management of COVID-19 patients. A total of 93 patients who had a positive polymerase chain reaction test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included in this study. Demographic features, comorbidities, clinical and laboratory findings were obtained from the hospital database retrospectively. Patients were divided into two groups according to the disease severity as follows: mild group (n = 70) and severe group (n = 23). The median age of the study population was 42.5 (28.3-62.8) with 69.9% male patients. Patients in the severe group were significantly older and showed a higher frequency of hypertension, diabetes mellitus, coronary artery disease, and heart failure in comparison with those in the mild group. In addition, gamma-glutamyl transferase, C-reactive protein, ferritin, interleukin-6, procalcitonin, and neutrophil to lymphocyte ratio were higher whereas albumin level was lower in patients in the severe group. Linear regression analysis demonstrated that ferritin level was the only significant predictor of disease severity (β = 0.487, t = 2.993, p = 0.004). In receiver operator characteristics curve analysis, ferritin level ≥264.5 ng/mL predicted severe COVID-19 with a sensitivity of 73.9% and specificity of 94.2%. Early analysis of ferritin levels in patients with COVID-19 might effectively predict the disease severity.

Key summary points Aim To determine the prevalence of frailty among older people attending emergency care. Findings Across 14 European countries, 40% of older people using emergency care were living with at least mild frailty. 14% of all adult users were older people with frailty. Message The high prevalence of frailty in emergency care indicates the need to accordingly configure healthcare systems and plan workforces. Introduction Current emergency care systems are not optimized to respond to multiple and complex problems associated with frailty. Services may require reconfiguration to effectively deliver comprehensive frailty care, yet its prevalence and variation are poorly understood. This study primarily determined the prevalence of frailty among older people attending emergency care. Methods This cross-sectional study used a flash mob approach to collect observational European emergency care data over a 24-h period (04 July 2023). Sites were identified through the European Task Force for Geriatric Emergency Medicine collaboration and social media. Data were collected for all individuals aged 65 + who attended emergency care, and for all adults aged 18 + at a subset of sites. Variables included demographics, Clinical Frailty Scale (CFS), vital signs, and disposition. European and national frailty prevalence was determined with proportions with each CFS level and with dichotomized CFS 5 + (mild or more severe frailty). Results Sixty-two sites in fourteen European countries recruited five thousand seven hundred eighty-five individuals. 40% of 3479 older people had at least mild frailty, with countries ranging from 26 to 51%. They had median age 77 (IQR, 13) years and 53% were female. Across 22 sites observing all adult attenders, older people living with frailty comprised 14%. Conclusion 40% of older people using European emergency care had CFS 5 + . Frailty prevalence varied widely among European care systems. These differences likely reflected entrance selection and provide windows of opportunity for system configuration and workforce planning.

Background The observational Frailty in European Emergency Departments (FEED) study found 40% of older people attending for care to be living with frailty. Older people with frailty have poorer outcomes from emergency care. Current best practice calls for early identification of frailty and holistic multidisciplinary assessment. This survey of FEED sites explores variations in frailty-attuned service definitions and provision. Methods This cross-sectional survey included study sites across Europe identified through snowball recruitment. Site co-ordinators (healthcare professionals in emergency and geriatric care) were surveyed online using Microsoft Forms. Items covered department and hospital capacity, frailty and delirium identification methods, staffing, and frailty-focused healthcare services in the ED. Descriptive statistics were reported. Results A total of 68 sites from 17 countries participated. Emergency departments had median 30 (IQR 21–53) trolley spaces. Most defined \"older people\" by age 65+ (64%) or 75+ (25%). Frailty screening was used at 69% of sites and mandated at 38%. Night-time staffing was lower compared to day-time for nursing (10 [IQR 8–14] vs. 14 [IQR 10–18]) and physicians (5 [IQR 3–8] vs. 10 [IQR 7–15]). Most sites had provision for ED frailty specialist services by day, but these services were rarely available at night. Sites mostly had accessible facilities; however, hot meals were rarely available at night (18%). Conclusion This survey demonstrated variability in case definitions, screening practices, and frailty-attuned service provision. There is no unanimous definition for older age, and while the Clinical Frailty Scale was commonly used, this was rarely mandated or captured in electronic records. Frailty services were often unavailable overnight. Appreciation of the variation in frailty service models could inform operational configuration and workforce development.

Endoscopic retrograde cholangiopancreatography (ERCP) is very important in the diagnosis and treatment of hepatopancreatic biliary diseases. This study shares 5.5 months of general surgical endoscopy unit experience. This study retrospectively evaluated clinical, medical, and radiological data of 213 patients with cholangitis who underwent ERCP between May 15, 2019, and January 1, 2020. Patients were 22 90 (average 53.2) years old, and there were 148 women (69%) and 65 men (31%). The most common indication was biliary obstruction and pancreatitis with fistula due to hydatid cyst surgery. The procedure time ranged from 20 min to 90 min (average, 37 min). Cannulation was done successfully in 203 patients (95%). Four of 10 patients who could not be cannulated were then cannulated with a precut technique, two of them underwent PTK, and three patients underwent open choledochal exploration. ES was performed in 203 patients, choledochal stone excision was performed in 164 patients, and stents were placed in 18 patients. After ERCP, 72 patients had hyperamylasemia that did not require treatment. Eighteen patients had acute pancreatitis, and they recovered within 3 days of medical treatment. Two patients had bleeding, which was stopped with adrenaline balloon. No mortality was recorded.

Atherosclerosis is one of the most important causes of cardiovascular diseases. A disintegrin and metalloprotease (ADAM)10 and ADAM17 have been identified as important regulators of inflammation in recent years. Our study investigated the effect of inhibiting these enzymes with selective inhibitor and propolis on atherosclerosis. In our study, C57BL/6J mice (n = 16) were used in the control and sham groups. In contrast, ApoE-/- mice (n = 48) were used in the case, water extract of propolis (WEP), ethanolic extract of propolis (EEP), GW280264X (GW-synthetic inhibitor), and solvent (DMSO and ethanol) groups. The control group was fed a control diet, and all other groups were fed a high-cholesterol diet for 16 weeks. WEP (400 mg/kg/day), EEP (200 mg/kg/day), and GW (100 µg/kg/day) were administered intraperitoneally for the last four weeks. Animals were sacrificed, and blood, liver, aortic arch, and aortic root tissues were collected. In serum, total cholesterol (TC), triglycerides (TGs), and glucose (Glu) were measured by enzymatic colorimetric method, while interleukin-1β (IL-1β), paraoxonase-1 (PON-1), and lipoprotein-associated phospholipase-A2 (Lp-PLA2) were measured by ELISA. Tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), myeloperoxidase (MPO), interleukin-6 (IL-6), interleukin-10 (IL-10), and interleukin-12 (IL-12) levels were measured in aortic arch by ELISA and ADAM10/17 activities were measured fluorometrically. In addition, aortic root and liver tissues were examined histopathologically and immunohistochemically (ADAM10 and sortilin primary antibody). In the WEP, EEP, and GW groups compared to the case group, TC, TG, TNF-α, IL-1β, IL-6, IL-12, PLA2, MPO, ADAM10/17 activities, plaque burden, lipid accumulation, ADAM10, and sortilin levels decreased, while IL-10 and PON-1 levels increased (p < 0.003). Our study results show that propolis can effectively reduce atherosclerosis-related inflammation and dyslipidemia through ADAM10/17 inhibition.