Articles: hospitals.
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In response to the escalating overdose crisis there is an urgent need for innovative strategies to reduce overdose death. Emergency Medical Services (EMS) is uniquely poised to reduce mortality and other harms associated with opioid use through prevention, harm reduction, and treatment, yet there is a paucity of nationally recognized best practices or quality measures to guide prehospital quality improvement (QI) efforts related to opioid use disorder (OUD). ⋯ Grounded in evidence-based practices and informed by collaborative expertise, this framework represents a pivotal step toward enhancing the effectiveness and responsiveness of EMS in combating the multifaceted challenges posed by OUD.
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Observational Study
Differential features of Infective endocarditis caused by oral streptococci in the Reina Sofia University Hospital, Córdoba (Spain): 1987-2023 period.
Infective endocarditis (IE) caused by oral streptococci is considered to be a 'more benign' IE than those caused by other microorganisms. Our aim is to analyse the changes in its incidence and its differential characteristics in our setting. ⋯ Oral streptococcal IEs account for almost 20% of all IEs in our setting. They have a better prognostic clinical profile, with a lower incidence of serious complications, and their mortality is significantly lower than that of other IE. Their incidence seems to be decreasing in recent years.
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Observational Study
Preoperative prediction of microvascular/nerve invasion in locally advanced gastric cancer by differentiation and enhanced CT features.
The purpose of the article is to determine whether differentiation and enhanced CT features can preoperatively predict microvascular/nerve invasion in locally advanced gastric cancer. Retrospective analysis of the CT and pathological data of 325 patients with locally advanced gastric cancer confirmed by pathology in our hospital from July 2011 to August 2023. The patient's age, gender, tumor location, T stage, N stage, TNM stage, differentiation, Lauren classification, as well as tumor thickness, tumor longest diameter, plain CT value, arterial CT value, venous CT value, arterial phase enhancement rate, and venous phase enhancement rate were assessed. ⋯ Multivariate analysis suggested that TNM stage and differentiation were independent risk factors for microvascular/nerve invasion. The receiver operating characteristic analysis showed that the diagnostic efficacy of the combined parameter of TNM stage and differentiation was better than that of the single parameter, in which area under the curve, sensitivity, and specificity were 0.819 (95%CI: 0.770-0.867), 66.7%, and 83.8%, respectively. Differentiation and enhanced CT are helpful in predicting whether microvascular/nerve invasion occurs in locally advanced gastric cancer before operation, especially the combined parameters of TNM stage and differentiation.
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Presenting to primary care with fatigue is associated with a wide range of conditions, including cancer, although their relative likelihood is unknown. ⋯ This study ranked the likelihood of possible diagnoses in patients who presented with fatigue, to inform diagnostic guidelines and doctors' decisions. Age-specific findings support recommendations to prioritise cancer investigation in older men (aged ≥70 years) with fatigue, but not in women at any age, based solely on the presence of fatigue.
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Emergency Medical Services (EMS) patient care reports (PCRs) are an important component for the transfer of patient care from EMS systems to hospitals and a foundational element of EMS quality improvement (QI). The PCR may serve as the only objective source of information for EMS patient presentation. Surprisingly little data, either objective or anecdotal, exists regarding the reliability of this process. Our objective is to describe the frequency of missing PCRs and the time of their receipt following EMS transport to hospital emergency departments (EDs). ⋯ Many PCRs are missing after EMS transport, with marked variation in submission rates and time to upload by agency and hospital. Many PCRs were infrequently available for use in a timely manner. Further assessment is needed to quantify the degree to which the lack of transfer of documentation of EMS patient care exists across emergency care systems.