Internal and emergency medicine
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Liver transplantation (LT) has historically been associated with a high prevalence of osteoporosis, but most of the available data date back to late 1990s-early 2000s with limited sample size. Our aim was to assess the prevalence of bone fragility fractures and contributing factors in a large modern cohort of liver transplant recipients. Retrospective study of 429 consecutive patients receiving liver transplantation from 1/1/2010 to 31/12/2015. ⋯ Independently of age, sex, alcohol use, eGFR, and etiology of liver disease, low BMI was significantly associated with an increased risk for fractures (adjusted OR 1.058, 95%CI 1.001-1.118, P = 0.046). Our study shows a considerable fracture burden in a large and modern cohort of liver transplant recipients. Given the very high prevalence of bone fractures, a metabolic bone disease screening should be implemented in patients awaiting liver transplantation.
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The beneficial effects of a rapid response system (RRS) on clinical outcomes in patients admitted to a ward have been established. However, the relationship between RRS implementation and clinical outcomes in patients in the intensive care unit (ICU) has not yet been established. Therefore, we aimed to investigate whether the RRS affects clinical outcomes in critically ill patients admitted to the ICU. ⋯ In addition, ICU readmission rates and the occurrence rate for adverse events during hospitalization in the RRS group were 3% (OR: 0.97, 95% CI: 0.95, 0.98; P < 0.001) and 21% (OR: 0.79, 95% CI: 0.78, 0.80; P < 0.001) lower than those in the non-RRS group, respectively. RRS deployment was linked to lower in-hospital and 1-year all-cause mortality rates, ICU readmission rates, and the occurrence of adverse events during hospitalization among ICU patients. The findings indicate that using the RRS could assist not only patients in the ward but also critically ill patients in the ICU.
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Heart failure is a multifaceted clinical syndrome, with obesity identified as a significant modifiable risk factor. This study employed a two-sample Mendelian randomization (MR) design, incorporating obesity data across life stages, to elucidate the causal link between obesity and heart failure. Data on heart failure from the 2023 Finngen database and genetic predictors of obesity from the IEU OpenGWAS project were analyzed using the IVW method, MR-Egger regression, weighted median, simple mode, weighted mode, and scatter plots. ⋯ Sensitivity analyses provided further support for the reliability of these results, with no significant indication of horizontal pleiotropy observed. This study shows that obesity, including childhood obesity, is linked to a higher risk of heart failure. These findings highlight the urgent need for early weight management interventions in public health and clinical settings to reduce heart failure rates.
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Overcrowding has become a significant issue in Emergency departments (EDs) around the world. Overcrowding contributes to a chaotic, unsafe and disorganized environment, increasing the burden on healthcare teams, and has led to deteriorating working conditions, with subsequent higher rates of burnout. This review aims to discuss different solutions to improve the process of patient discharge from the ED, either to an inpatient unit, another hospital, or to an outpatient setting, and the impact this component of patient flow can have on physician well being. The solutions presented in this paper have been chosen for their translatability to any setting, regardless of their geographical location.