Internal and emergency medicine
-
Point-of-care ultrasound (POCUS) has been shown to be beneficial in facilitating patient care, but its adoption is variable among emergency medicine (EM) clinicians. We identified the patterns of POCUS use and gaps in POCUS integration in a tertiary care emergency department (ED). These data provide a user-centered platform for subsequent development of a tele-ultrasound (tele-US) consultation program. ⋯ APPs were less comfortable with POCUS image interpretation and clinical integration of POCUS findings compared to residents (χ2: 16.3, p < 0.0001 and χ2: 5.1, p = 0.02, respectively). 65% (54/83) of clinicians would use POCUS more if real-time supervision via tele-US was available for image acquisition and image interpretation. EM clinicians indicated a substantial need for further real-time POCUS training and supervision, especially for image interpretation. A clinician-centered strategy, such as tele-US, has potential to increase proficient use of POCUS.
-
Understanding the patients' clinical profile, barriers to optimal inhaler use, and adherence are crucial in achieving the treatment goal for asthma and chronic obstructive pulmonary disease (COPD). This study aimed to assess the inhaler technique and identify the predictors of inhaler adherence among asthma and COPD patients who presented to the Emergency Department (ED). This prospective cross-sectional study recruited patients who presented to the outpatient ED of a tertiary hospital for mild-to-moderate exacerbation from March 2022 to February 2023. ⋯ The high rate of wrong inhaler techniques among asthma and COPD patients is worrisome. Identified predictors of inhaler adherence should be targeted when managing this group of patients. In addition to the exacerbation treatment in the ED, referrals to public primary health clinics for regular follow-ups, evaluation of inhaler techniques, and counseling to enhance patient knowledge are crucial.
-
Lactose intolerance (LI) is a very common condition but, despite many efforts of the Italian National Health Service to reduce diagnostic delay of chronic disorders and provide prompt treatments, its early diagnosis remains an unmet need. In addition, the COVID-19 pandemic has exacerbated this problem, due to the conversion of many public health services to COVID centers. This study aims to analyze the diagnostic journey of patients suffering from LI, taking into account the duration of the process, associated costs, and impact on quality of life. ⋯ The data were analyzed to determine the time required for a reliable LI diagnosis and average costs. Diagnostic delay of LI proved to be longer than 2 years, its impact on quality of life proved to be moderate to high in most of participants, especially in their psychosocial domain, and average costs proved to be high. Further investigations are needed to determine the economic burden of maintaining an asymptomatic status in patients with LI.