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Background: Supraventricular tachycardia (SVT) is a common arrhythmia requiring prompt intervention in the emergency department (ED). Despite evidence-based guidelines recommending a stepwise approach, significant variability in clinical practice persists, particularly in adenosine dosing strategies. Objective: This study assessed adherence to SVT treatment protocols in the ED, focusing on the efficacy of an initial 6 mg versus 12 mg adenosine dose and the use of alternative pharmacologic agents. Methods: This multi-center, retrospective cohort study analyzed adult patients (≥18 years) diagnosed with stable SVT in urban EDs across North Texas between 1 January 2019, and 16 January 2022. Patients who spontaneously converted to normal sinus rhythm or presented with hemodynamically unstable SVT requiring immediate cardioversion were excluded. The primary outcome was the rate of successful conversion to sinus rhythm. Secondary outcomes included frequency of adenosine administration, deviations from 2020 AHA ACLS guidelines in SVT treatment, and risk factors associated with failure to convert to sinus rhythm following adenosine administration. Results: A total of 439 patients were included in the final analysis. Vagal maneuvers were attempted in 26% of cases, achieving a 31% success rate. Adenosine was used in 83% of pharmacologic interventions, with 57.5% receiving 6 mg and 42.5% receiving 12 mg as the initial dose. The 12 mg dose had a significantly higher conversion rate (54.2% vs. 40.6%, p = 0.03). Regression analysis identified key predictors of treatment success, including comorbidities, and baseline hemodynamics. Documentation inconsistencies, particularly regarding vagal maneuvers, were noted. Conclusions: In our cohort, an initial 12 mg adenosine dose was more effective than 6 mg for SVT conversion in the ED. Recognizing and addressing variations in guideline adherence can play a key role in improving patient care. Further prospective research is warranted to optimize dosing strategies and evaluate the impact of standardized protocols on clinical outcomes.
The leading cause of death among people experiencing homelessness is overdose. New York City operates the Relay initiative, which sends trained peer "Wellness Advocates" (WAs) to meet patients in the emergency department (ED) who have presented with an opioid-involved overdose. A high proportion of Relay patients experience homelessness. We conducted in-depth, one-on-one qualitative interviews with patient recipients of Relay services, Relay peer Wellness Advocates (WA), and emergency department providers. Interview transcripts were analyzed using iterative line-by-line coding to identify themes related to experiences of homelessness among Relay patients, including barriers and facilitators to engagement with Relay. Twenty-three participant interviews were included in this study. The results were organized into three overarching themes: (1) Multi-level barriers to engagement in services for patients experiencing homelessness; (2) Wellness Advocates as facilitators to participation and follow-up in Relay and other necessary services; and (3) Frustrations experienced by ED providers and stigma experienced by patients in the ED setting. This qualitative study illustrated that peers provided an important resource for overcoming some immediate barriers to service delivery presented by patient homelessness. However, policy interventions are needed to address the multi-level structural barriers to overdose prevention for people experiencing homelessness.
Background:Despite advancements in rheumatoid arthritis (RA) treatment, effective pain management remains challenging, with many patients also experiencing insomnia, anxiety, and depression. Cannabis, with its analgesic properties, offers a promising nonopioid alternative. This study evaluated outcomes in hospitalized RA patients using cannabis through the National Inpatient Sample (NIS) database. Methods:This retrospective study analyzed NIS data (2016-2021) using ICD-10 codes to identify RA patients. Demographic and clinical characteristics and inpatient outcomes were compared between cannabis users and nonusers. Results:RA patients using cannabis (n = 42,415) were younger (mean age 51.8 vs 67.8 years), less likely to be female (60.65% vs 73.71%), and more likely to be African American (24.02% vs 12.86%) and Native American (2.25% vs 0.86%). Cannabis use was associated with lower mortality (0.98% vs 2.71%) and hospital charges ($57,773 vs $63,681). After adjusting for age, gender, race, and comorbidities, cannabis use was linked to decreased mortality (odds ratio [OR]: 0.50), depression (OR: 0.47), chronic pain (OR: 0.45), and anxiety (OR: 0.55). Conversely, cannabis use increased the risk of opioid use (OR: 1.10), nicotine dependence (OR: 1.35), and alcohol use (OR: 1.35). Conclusion:RA patients using cannabis had lower mortality, depression, chronic pain, and anxiety, but higher risks of opioid, nicotine, and alcohol use. Further research is needed on the long-term effects of cannabis in RA management.
OBJECTIVES:Acute pancreatitis (AP) can lead to severe complications and high mortality. Previous studies suggest that epidural analgesia (EA) may improve outcomes in AP. This systematic review and meta-analysis aimed to evaluate the efficacy of EA on in-hospital outcomes in AP patients. METHODS:Electronic databases (PubMed, Medline-Ovid, Scopus, CINAHL, Web of Science) were systematically searched until May 2024 for RCTs comparing EA with other pain strategies in AP patients. Variables were pooled using weighted mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Data analysis employed random-effects the Mantel-Haenszel method and I 2 statistic was used for heterogeneity. RESULTS:Five RCTs with 260 participants were included. Meta-analysis showed no significant differences in in-hospital mortality (RR, 0.69; 95% CI [0.29-1.65]; P = 0.40), mechanical ventilation (RR, 0.82; 95% CI [0.61-1.10]; P = 0.19), sepsis (RR, 0.88; 95% CI [0.42-1.86]; P = 0.74), hospital/ICU stay (WMD, 0.49 days; 95% CI [-1.13 to 2.10]; P = 0.55), and pain score (WMD, 1.49; 95% CI [-0.42 to 3.40]; P = 0.13). Opioid requirements were significantly lower, with one study reporting MME of 15 mg/d compared to 52 mg/d in the control group ( P = 0.001). Heterogeneity was low to moderate for most outcomes but high for pain score ( I2 = 92%). Small number of studies, risk of bias, and sample size limited overall certainity. CONCLUSIONS:EA did not significantly improve in-hospital outcomes in AP patients. However, findings suggested potential benefits in pain management. High-quality randomized trials are needed to understand the potential benefits of EA in this population.
Recurrent weight gain after laparoscopic sleeve gastrectomy (LSG) is common. Revisional endoscopic sleeve gastroplasty (r-ESG) has been shown to be a promising endoscopic bariatric therapy (EBT) to treat weight recurrence after LSG. However, to date, weight loss outcomes beyond 1-year follow-up are unknown. Our study aims as follows: (1) examine 1 year, 18-month, and 24-month weight loss outcomes post-r-ESG and (2) determine if weight loss outcomes post-LSG predict clinical outcomes post-r-ESG. This was a retrospective cohort data of patients who completed r-ESG from December 2020 to November 2023. The primary outcome was percentage of total body weight loss (TBWL) at 1-year post-r-ESG. Secondary outcomes included TBWL at 18- and 24-month post-r-ESG. Multivariable logistic regression analysis was used to determine predictors of weight loss ≥ 5
