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Background Triage refers to the process of patient prioritisation in the emergency department (ED). This is based on the severity of the patient’s illness and is performed by emergency nurses (ENs). This has a pivotal role in ensuring patient safety and in ensuring that the ED operates smoothly – so continuous and accurate training are essential. As Emergency Nursing has been formally established in Greece since 2019, it is of the uppermost importance that all Greek ENs should be trained in the use of a standardised triage system. The present study aimed to evaluate the effect of triage training of ENs in the use of the Swiss Triage System (STS) after an intervention of one week. Methods The effect of triage training was studied experimentally by comparing performance before and one week after training. A sample of thirty-six ENs from the University Department of Emergency Medicine at AHEPA University Hospital took part. The role of training in triage by the STS was assessed by completing the same self-administered questionnaire before and after a 45-minute e-learning program (presentation video of STS but with simulation scenarios) which was available during the period of a week. The post-training test was taken 2 weeks later, after the training process. Results The most promising finding was that there was a significant improvement in the number of correct answers after the training in triage ( p< 0.001). A significant improvement was also detected ( p< 0.001) in the questions that tested vigilance in providing safe health services by ENs, whereas there was no significant association between the number of correct answers and years of emergency experience or level of education, - either before or after the intervention. Conclusions Triage training seems to successfully improve effective and efficient triage. To the best of our knowledge, this is the first study that has demonstrated that triage training has a significant positive impact on triage performance by ENs in Greece. It is planned to support these findings by real time studies in an ED.

Aim: Older adult pedestrians are at greater risk of severe injuries than younger pedestrians due to gradual physical changes and coexisting medical conditions. This leads to longer hospital stays, increased mortality risk, and higher inpatient costs. Focusing on the aging population, this study explores the characteristics and injury profiles of pedestrian crossing accidents in the capital city of Bern, Switzerland. Methods: Our retrospective cohort study comprised adult patients admitted to our ED between 1 January 2013 and 31 December 2023, as crossing (or zebra crossing)-related pedestrian victims. Two cohorts were formed on the basis of age < 65 and ≥65 years and compared according to the setting of the accident, type, pattern of the injury, and clinical outcomes (short-term mortality, ICU/hospital length of stay). Results: Of a total of 124 patients, 31.5% (n = 39) of patients were elderly (65+ group). In contrast to the younger patients, the aging population was predominantly admitted as inpatients (64.1% vs. 35.3%, p = 0.001) and was hospitalised in the intensive care unit (20.5% vs. 6%, p = 0.020). Older patients were more likely to be polytraumatised (41% vs. 11.8%, p = 0.001) and to have been tossed or hurled than patients under 65 years (75% vs. 47.3%, p = 0.016). Fractures of the upper extremities (17.9% vs. 4.7%, p = 0.016), pelvis (30.8% vs. 9.4%, p = 0.003), and thoracic spine (12.8% vs. 2.4%, p = 0.019) were significantly more common in the elderly population. Intracranial haemorrhage (35.9% vs. 17.6%, p = 0.026), abdominal trauma (17.9% vs. 5.9%, p = 0.035), and relevant vessel damage (30.8% vs. 3.5%, p < 0.001) were also significantly higher in geriatric patients. Trauma indices were slightly more increased in the older population than in the younger group (ISS; p = 0.004 and AIS > 2 of chest and thoracic spine; abdomen, pelvic contents, and lumbar spine; extremities & bony pelvis p < 0.05). The 65+ group had a longer length of hospital stay (p = 0.001) and ICU stay (p = 0.002). A hospital stay longer than 7 days was also significantly more common in elderly individuals (p = 0.007). In-hospital (15.4% vs. 1.2%, p = 0.001) and 30-day mortality (17.9% vs. 1.2%, p < 0.001) were significantly higher in patients over 65 years of age. Conclusion: In our study, the impact of pedestrian crossing accidents was more severe in the elderly, as indicated by the severity of injuries, hospitalisation rate, longer length of hospital and ICU stays, and higher mortality rates. These findings underline the importance of developing tailored strategies to reduce crosswalk accidents and to optimise management approaches for these vulnerable patients.

Accurate decision-making in triage largely determines the amount of time required for a patient to be evaluated and treated while in the emergency department. Nursing staff worldwide have similar learning characteristics with similar working hours and common goals, despite the fact that different triage scales are used globally. The aim of this mini review is to present the different educational methods and identify the most effective for triage training of triage nurses. We screened studies concerning triage education for nurses in Emergency Department, in databases including PubMed, CENTRAL and CINAHL. From November 12, 2023 to February 15, 2024, databases were searched for relevant literature. \"Triage education\" OR \"triage training\" AND \"emergency nurses\" OR \"triage nurses\" were the MeSH terms. There are various educational methods, including traditional, web-based, audiovisual, simulation-based, blended learning, and other specialized approaches. Almost all of the studies that are currently available demonstrate how effectively an educational intervention might improve nurses' comprehension of triage. Except for one, every study concluded that the educational intervention significantly improved nurses' triage knowledge. Comparing the included studies is challenging due to their heterogeneity, and applying the results in practice requires caution. The majority of studies reported that educational interventions effectively increased nurses' triage knowledge. Blended learning in conjunction with refresher courses enhanced triage-related knowledge and decision-making; however, additional research is required to ascertain whether this approach is superior to the others and whether these improvements will last.

The relationship between psoriasis and onychomycosis is controversial, and the exact nature of this association remains to be clearly elucidated. In healthy nails, the compact nail plate acts as a barrier, preventing any infection. In psoriatic nails, the nail plate involvement, together with abnormalities in the blood capillaries, may lead to decreased natural defenses against microorganisms. Moreover, onycholysis (detachment of the nail plate) induces a humid environment that may favor fungal proliferation. Treatment with immunosuppressive drugs may additionally enhance onychomycosis. In this comprehensive review, we present data regarding the incidence and pathogenic action of dermatophytes and other fungi in the development of fungal infection in psoriatic nails.

Background: Large language models (LLMs) are increasingly proposed as clinical decision support tools. However, their reliability in the emergency department (ED) triage remains insufficiently validated. This study aimed to evaluate the performance and limitations of multiple LLMs in triage using a large retrospective dataset. Methods: We conducted a retrospective analysis of 39,375 anonymized patient cases from the ED of AHEPA University General Hospital, Thessaloniki, Greece (June 2024–July 2025), extracted from the hospital’s electronic medical record system. All cases were triaged in real time according to the Emergency Severity Index (ESI) by 25 emergency physicians. In cases of uncertainty, a senior emergency physician was consulted. Seven LLMs (ChatGPT-5 Thinking, ChatGPT-5 Instant, Gemini 2.5, Qwen 3, Grok 4.0, Deep Seek v3.1, and Claude Sonnet 4) were evaluated against the physician-assigned ESI level (reference standard). Outcomes included triage score agreement (quadratic weighted kappa, κw), clinic referral accuracy and admission prediction. Subgroup analyses were performed by referral clinic and admission outcome. The study was conducted in accordance with TRIPOD-AI reporting guidelines. Results: Model performance varied substantially. DeepSeek and Claude Sonnet 4 achieved the highest agreement with physician-assigned ESI (κw ≈ 0.467; raw accuracy: 61.7%). In contrast, GPT-5 Instant performed poorly across all evaluation metrics (κw = 0.176; 95% CI: 0.167–0.186). Claude Sonnet 4 demonstrated the best performance in clinic referral (67.1%; κ = 0.619) and admission prediction (κw ≈ 0.46). Subgroup analyses indicated higher performance in pediatric cases and organ-specific complaints, such as ophthalmology (up to 81% accuracy). LLMs also showed tendencies toward over- or under-triage. Conclusions: Current LLMs demonstrate promising but inconsistent capability in triage. While selected models achieved moderate alignment with physician ESI decisions, none achieved strong agreement (κ > 0.80). LLMs are most suitable as supervised decision support tools, particularly in anatomically well-defined clinical scenarios, rather than as autonomous systems.

Background: Rapid Sequence Induction (RSI) is a widely used method for emergency airway management in critically ill and clinically unstable patients. Beyond the risks inherent to the procedure itself, RSI is almost exclusively performed in emergency settings where patients present with severe physiological derangement and a high risk of aspiration. In postmortem examinations, forensic toxicology results may be influenced by the patient’s clinical condition, the sampling site, the postmortem interval (PMI), and postmortem drug redistribution (PMR). This review aims to evaluate the existing literature regarding PMR of drugs commonly used during RSI. Methods: PubMed/MEDLINE, Embase and the Cochrane Library were searched for studies on PMR of drugs used in intravenous (IV) RSI (up to November 2025). Human and animal studies, patient populations comparable to critically ill individuals requiring RSI, and forensic case reports of exclusively IV drug administration were included. Studies on recreational use, overdose and non-IV administration were excluded. Results: Data on the PMR of IV-administered RSI drugs remain limited. Most available studies involve Intensive Care Unit (ICU) patients or individuals who underwent RSI in emergency settings. Fentanyl and midazolam appear to demonstrate notable PMR. Several factors influencing postmortem drug concentrations were identified. Although these findings are consistent with the existing literature, the small number of studies and the heterogeneity of data preclude definitive conclusions. Conclusions: Critical patient condition, including frailty due to advanced age, hemodynamic instability (particularly in ICU patients), hypoalbuminemia, body mass index (BMI), and injury and/or trauma, as well as the interval between IV drug administration and death, appear to affect postmortem concentrations of drugs used during RSI. The potential for PMR of certain agents, such as fentanyl and midazolam, adds further complexity. Given the scarcity of consolidated evidence and until further research provides more robust data, postmortem drug levels should not be interpreted as directly reflective of antemortem concentrations.

Background: Cardiac arrest is a time-critical medical emergency during which prompt and effective drug delivery plays a key role in patient outcomes. Current resuscitation guidelines recommend intravenous (IV) access as the first-line route, with intraosseous (IO) access recommended as an alternative when IV access is delayed or not feasible. Although the endotracheal (ET) route was previously included in resuscitation protocols, it is no longer recommended. This study aims to evaluate the pharmacokinetic (PK) and pharmacodynamic (PD) effects of resuscitation drugs administered through different injection sites and under varying hemodynamic conditions in in vivo animal models. Methods: PubMed, CENTRAL and ClinicalTrials.gov were searched up to August 2025 for studies comparing different injection sites for the same drug (adrenaline/epinephrine, amiodarone, lidocaine and vasopressin) during CPR. Study selection, data extraction, and quality assessments were performed independently by two reviewers. Frequentist random-effects models were used to calculate mean differences and odds ratios (ORs) with 95% confidence intervals (CIs). Results: Fourteen prospective experimental studies (sample sizes ranging from 15 to 49 animals) conducted on swine were included. For epinephrine under normovolemia, humeral IO (HIO) access achieved significantly higher maximum concentrations (Cmax; p = 0.0238) and a shorter time to the maximum concentration (Tmax; p < 0.01) compared to IV, translating into faster return of spontaneous circulation (ROSC) (p = 0.0681). Under hypovolemia, IV access proved superiority over IO for epinephrine administration (MD = +382.80 ng/mL; p = 0.0022). The time to ROSC was significantly shorter with sternal IO (SIO) compared to tibial IO (TIO) (p = 0.0109). For amiodarone and vasopressin, no consistent or statistically significant differences were observed between administration routes, and in several cases, the findings were based on a single study. Conclusions: The injection site significantly influences the PK and PD of epinephrine during cardiac arrest. Proximal IO routes may offer advantages under normovolemic conditions, while IV access appears superior in cases of hypovolemic shock. Further research is needed to guide optimal drug delivery in varying hemodynamic conditions during cardiac arrest.

Background/Objectives: Stress-induced hyperglycemia (SIH) is frequently observed in critically ill patients and has been associated with adverse outcomes in individuals both with and without known diabetes mellitus (DM). However, evidence regarding its prognostic utility for in-hospital mortality in high-acuity emergency department (ED) populations remains limited. Methods: We conducted a retrospective observational cohort study of consecutive adult ED patients classified as Emergency Severity Index (ESI) triage level 1. SIH was defined a priori as an admission serum glucose > 140 mg/dL, a pragmatic cutoff widely applied in clinical practice despite ongoing debate regarding optimal pathophysiological thresholds. Associations with in-hospital mortality were assessed using logistic regression in the overall cohort and stratified by DM status. Additional analyses assessed the prognostic performance of admission glucose as a continuous variable. Results: Of 470 included patients, 435 had complete mortality data; 247 (56.8%) died during hospitalization. SIH was present in 258/435 (59.3%)and known DM in 114/435 (26.2%). SIH was associated with higher in-hospital mortality in univariate analysis (OR 2.90, 95% CI 1.91–4.43; p < 0.001) and remained independently associated after adjustment (adjusted OR 2.22, 95% CI 1.41–3.51; p < 0.001). The association between SIH and mortality persisted in both non-DM and DM subgroups, with no significant interaction by DM status. SIH alone showed modest discrimination for mortality (AUC 0.625, 95% CI 0.572–0.669), whereas continuous admission glucose performed better. Discrimination improved in the multivariable model (AUC 0.728, 95% CI 0.677–0.779). Restricted cubic spline analysis demonstrated a strong overall association between admission glucose and mortality without evidence of nonlinearity, indicating an approximately linear risk increase across the observed glucose range. Conclusions: Regarding severely ill ED patients, classified as ESI triage 1, SIH is an independent predictor of in-hospital mortality irrespective of DM status. Admission glucose may improve early risk stratification when incorporated into clinical models.

Postoperative pain is the unpleasant sensory and emotional experience after surgery, its origin being both the inflammatory reaction induced by the surgical trauma on the abdominal wall and the splanchnic pain induced by the activation of nociceptors of the viscera, which are highly sensitive to distension, ischemia, and inflammation. Nowadays, it is well recognized that there is a close relationship between the gut microbiome and pain perception, and that microbiome is highly affected by both anesthesia and surgical manipulation. Thus, efforts to restore the disturbed microbiome via supplementation with beneficial bacteria, namely probiotics, seem to be effective. In this article, the knowledge gained mainly from experimental research on this topic is analyzed, the concluding message being that each probiotic strain works in its own way towards pain relief.

Dear Editor,Emergency Medicine (EM) is a promising novel specialization in Greece. EM is a young but fast-developing field that should benefit by adopting and incorporating elements from countries where the specialization is already well-established. The first and most crucial stage in every overcrowded Emergency Department (ED) is triage, namely the process by which patients are categorized according to their clinical severity. In a recent study, we aimed to evaluate the effect of triage training of Emergency Nurses (ENs) in the use of the Swiss Triage System (STS) manual translated into Greek, after an intervention of one week. [...]