Internal and emergency medicine
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Crowding in Emergency Departments (EDs) has emerged as a global public health crisis. Current literature has identified causes and the potential harms of crowding in recent years. The way crowding is measured has also been the source of emerging literature and debate. ⋯ The major causes of crowding were grouped into patient, staff, and system-level factors; with the most important factor identified as outpatient boarding. The harms of crowding, impacting patients, healthcare staff, and healthcare spending, highlight the importance of addressing crowding. This overview was intended to synthesize the current literature on crowding for relevant stakeholders, to assist with advocacy and solution-based decision making.
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Chest pain is a common complaint among patients presenting to primary care physicians. The management of chest pain secondary to coronary artery disease is rapidly changing as new evidence increase our knowledge of this complex clinical problem. The 2021 multisociety guidelines developed by the American College of Cardiology and the American Heart Association along with other organizations and imaging societies represent the first international guidelines for the evaluation and diagnosis of patients with acute or stable chest pain. This review will discuss in details the evaluation of low- and intermediate risk subjects presenting with acute and stable chest pain both in the emergency and office settings, providing a practical approach, supported by contemporary evidence, for the management of this important clinical problem leveraging on the central role played by coronary computed tomography angiography as documented by current clinical guidelines and available scientific literature.
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Observational Study
Radiological lung sequelae, functional status and symptoms in older patients 3 and 6 months after hospitalization for COVID-19 pneumonia.
The aim of our study was to assess the lung sequelae and clinical consequences 3 and 6 months after hospitalization for COVID-19 pneumonia in older patients. An observational study was conducted on 55 patients aged 65 years and older. Activities of daily living (ADL) and clinical frailty scale (CFS) were assessed at baseline and after 3 months. ⋯ No association emerged between persistent or new-onset symptoms and evidence of fibrotic-like changes. The typical chest CT abnormalities of the COVID-19 pneumonia acute phase resolved in most of our older patients. Mild fibrotic-like changes persisted in less than half of the patients, especially males, without significantly affecting the functional status and frailty condition, which instead were more likely associated with pre-existing comorbidities.