Emergency Department

Key takeaways

• The analysis evaluated thrombolysis initiated more than 4.5 hours after last known well in imaging-selected or otherwise trial-eligible patients.
• Excellent and good functional outcomes at 90 days favored thrombolysis across the pooled evidence.
• Symptomatic intracranial hemorrhage increased, although any hemorrhage and all-cause mortality were similar between groups.
• The findings apply to selected trial populations and do not replace local eligibility, imaging, contraindication, or treatment protocols.

Nursing implications

• Activate the stroke pathway without excluding a patient solely because more than 4.5 hours have elapsed. Capture the timing and eligibility data required by the local protocol, then perform the prescribed neurologic, blood-pressure, and bleeding surveillance if thrombolysis is ordered.

Limitations & cautions

• The meta-analysis combined randomized trials and individual-patient-data meta-analyses with different agents, time windows, imaging strategies, vascular territories, and use of endovascular treatment. Selection criteria were trial-specific, and pooled findings do not define eligibility or treatment for an individual patient.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• Ten publications included 1,045 patients with 1,368 acute MOGAD attacks.
• Eight studies contributed data for meta-analysis, including 710 patients and 1,033 attacks.
• Plasmapheresis was associated with visual improvement in optic neuritis and favorable recovery in other attack presentations.
• High heterogeneity, variable timing and severity, and the absence of randomized comparisons limit treatment-effect and safety conclusions.

Nursing implications

• Document the neurologic and visual baseline before treatment when feasible, follow the ordered plasmapheresis monitoring pathway, and trend the same clinical domains across exchanges. Escalate deterioration, treatment intolerance, or new symptoms promptly through the neurology and apheresis teams.

Limitations & cautions

• The evidence came from heterogeneous, nonrandomized studies with differences in attack type, severity, prior treatment, plasmapheresis timing, and outcome definitions. Recovery estimates had wide intervals, confounding by treatment selection is likely, and a low pooled adverse-effect rate cannot establish comparative safety.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• Ten experimental or quasi-experimental studies evaluated nurse-led interventions for fatigue after stroke.
• Interventions included psychosocial approaches, physical activity, and self-management strategies and were usually delivered individually.
• The review reported beneficial effects and highlighted proactive fatigue assessment in rehabilitation nursing.
• Methodological concerns, including blinding and study-design limitations, reduce confidence and prevent selection of a single best approach.

Nursing implications

• Include fatigue in routine stroke recovery assessment, document its timing and effect on function, and screen for clinical contributors through the established care pathway. Coordinate individualized activity pacing, education, and referrals rather than applying a single intervention package to every survivor.

Limitations & cautions

• The review included only 10 studies, mixed experimental and quasi-experimental designs, and noted methodological concerns involving blinding and study design. The abstract provides no pooled effect size, comparison of specific intervention components, or detailed durability data, so the relative effectiveness of psychosocial, activity, and self-management approaches remains uncertain.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The prospective validation included 472 encounters at two pediatric emergency departments, and 11.7% involved medication for agitation or physical or mechanical restraint.
• The five-item nurse-completed score showed moderate discrimination, with an area under the curve of 0.72.
• Agitation requiring intervention increased across score levels, reaching 31.8% at a score of 4 and 36.0% at 5.
• Low scores had a high negative predictive value but poor specificity, so the score is better used as one input to safety planning than as a stand-alone rule.

Nursing implications

• If the BRACHA-S is part of the local workflow, complete it alongside the full behavioral and safety assessment, communicate elevated scores during handoff, and start protocol-directed de-escalation and environmental planning early. Reassess when behavior or clinical status changes rather than relying on the arrival score alone.

Limitations & cautions

• This was an observational prognostic study at two pediatric emergency departments. The outcome combined medication and restraint use, which may reflect local practice as well as patient behavior. Discrimination was moderate, the positive predictive value for high scores remained about one third, and the abstract does not establish whether using the score improves safety or reduces restrictive interventions.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The analysis included 5,168 patients across 18 randomized trials of thrombolysis given 4.5 to 24 hours after acute ischemic stroke.
• Excellent 90-day recovery increased from 33.2% with control to 40.3% with thrombolysis in the pooled analysis.
• Symptomatic intracranial hemorrhage increased from 1.4% to 3.2%, while 90-day mortality was not significantly different.
• Eleven trials required advanced imaging selection, and thrombectomy availability contributed substantially to heterogeneity.

Nursing implications

• Activate the stroke pathway promptly even when onset is beyond 4.5 hours, document last known well and eligibility information accurately, and expedite protocol-directed imaging and specialist review. After treatment, follow the ordered neurologic, blood-pressure, access-site, and bleeding monitoring schedule and escalate any deterioration immediately.

Limitations & cautions

• Trials differed in thrombolytic agents, imaging selection, stroke territory, severity, and access to thrombectomy. Most participants were selected for favorable imaging rather than treated solely by clock time, and trial-level meta-regression cannot remove all confounding. The findings should not be generalized to unselected patients or used to choose reperfusion therapy without a stroke specialist and local protocol.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The systematic review included 12 ICU studies but could not pool results because methods and outcomes differed.
• Sensitivity ranged from 64% to 100%, while specificity ranged from 0% to 95%.
• Multiple qEEG trends and patient-specific confirmed-seizure templates tended to improve screening performance.
• Low specificity and positive predictive value mean suspected events still require expert raw-EEG review.

Nursing implications

• Use qEEG only within a facility-approved neuromonitoring workflow and apply the display patterns and escalation thresholds taught for that system. When a concerning trend appears, document the timing and clinical context and prompt qualified review of the corresponding raw EEG rather than treating the screen as a diagnosis.

Limitations & cautions

• Only 12 heterogeneous studies were eligible, preventing meta-analysis. qEEG trends, reviewer training, seizure definitions, and outcomes varied, and some studies had patient-selection bias concerns. The very broad sensitivity and specificity ranges limit generalization to a particular ICU or display system.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The Bayesian synthesis included 10 randomized trials and 1,601 adults undergoing stroke thrombectomy.
• Successful reperfusion was higher with general anesthesia than with non-general-anesthesia strategies.
• The functional-independence estimate favored general anesthesia, but its 95% credible interval included no difference.
• Intraoperative hypotension was substantially more frequent with general anesthesia, while mortality did not differ clearly.

Nursing implications

• Do not treat the anesthesia strategy as a bedside nursing choice. During the approved thrombectomy pathway, maintain time-sensitive preparation, closely trend blood pressure and neurologic status, and promptly communicate hypotension or deterioration to the stroke and anesthesia teams.

Limitations & cautions

• The trials were open label and used heterogeneous non-general-anesthesia comparators. The Bayesian functional-independence estimate favored general anesthesia, but its credible interval included no difference, and pneumonia also trended higher without a conclusive credible interval. Confirmatory evidence is still needed.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The review included nine randomized trials and 4,381 adults after thrombolysis or endovascular thrombectomy.
• Intensive systolic targets below 160 mmHg did not produce a clinically meaningful functional benefit.
• Any intracranial hemorrhage was similar with intensive and conventional management.
• Intensive management probably increased all-cause mortality, with a pooled risk ratio of 1.19.

Nursing implications

• Use the prescribed post-reperfusion target and the facility's stroke protocol rather than treating a lower systolic pressure as automatically better. Pair blood-pressure surveillance with neurologic reassessment and promptly communicate out-of-range values or clinical deterioration to the stroke team.

Limitations & cautions

• The intensive targets varied across trials, including thresholds below 120, 140, and 160 mmHg; seven studies involved thrombectomy and two involved thrombolysis. Studies were mainly from upper-middle- and high-income countries, and certainty ranged from high to very low across outcomes.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The trial included 3,869 patients with suspected non-ST-elevation acute coronary syndrome across 12 hospitals and five countries.
• The intervention standardized high-sensitivity troponin T testing at baseline and 1 hour.
• Thirty-day major adverse cardiac events were 1.4% with the pathway and 1.7% with usual care, meeting the trial's noninferiority criterion.
• Emergency-department discharge increased from 35% to 60%, although three 30-day events occurred among 941 patients classified as low risk.

Nursing implications

• ED teams can use the findings when evaluating a locally approved 0/1-hour high-sensitivity troponin T pathway with clear eligibility, timing, interpretation, and escalation rules. The study does not support substituting a single result for the full protocol or applying its cutoffs to a different assay without validation.

Limitations & cautions

• This was a stepped-wedge cluster trial rather than individual randomization and used high-sensitivity troponin T in Asian emergency departments. Transfer to other populations, assays, cutoffs, and workflows requires local validation, and a small number of 30-day events still occurred among patients classified as low risk.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The study compared nurse triage with a blinded physician reference standard across 2,584 systematically sampled adult ED records.
• Exact agreement was 85.3%, with good overall weighted agreement and only 0.4% severe mismatches.
• Undertriage occurred in 12%, compared with 3% overtriage, and red-case sensitivity was 79%.
• Trauma and alert presentation were independent predictors of an incorrect nurse-assigned triage category.

Nursing implications

• The undertriage signal supports focused review of trauma presentations, ambulatory bias, and reassessment practices where appropriate. It does not validate this modified protocol for every ED or replace the facility's triage scale, reassessment rules, required competencies, or clinical judgment.

Limitations & cautions

• This was a retrospective, single-center study of a modified local protocol over three months in India. The expert reference raters had a quadratic-weighted kappa of 0.61 before adjudication, and the cross-sectional design cannot show that training or decision-support changes would improve triage accuracy or patient outcomes.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The network meta-analysis included 24 randomized controlled trials, 8,014 adults, and 11 difficult-access interventions.
• Ultrasound guidance improved both first-attempt and overall cannulation success compared with standard practice.
• Local warming improved first-attempt success and reduced procedure time and pain, but its evidence base was more limited.
• The sparse comparison network and its transitivity assumption limit certainty about intervention rankings.

Nursing implications

• For nurses following an approved difficult-access pathway, the findings support timely escalation to an ultrasound-trained clinician when standard attempts are unlikely to succeed and consideration of local warming where protocol permits. The rankings should not replace patient assessment, local competency requirements, or the unit's vascular-access policy.

Limitations & cautions

• The analysis combined trials of 11 interventions through direct and indirect comparisons, so rankings depend on the assumption that studies were sufficiently comparable. The network was sparse, evidence for some options was limited, and the abstract does not provide certainty ratings or enough setting detail to establish one universal pathway.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The intervention embedded trained stewardship nurses into prescription review, device-practice monitoring, diagnostic review, and audit-and-feedback with the emergency clinical team.
• Adherence to the hospital's antibiotic guidelines increased from 82.4% before the intervention to 91.0% during it.
• Cultures collected before antibiotic initiation increased from 23.0% to 40.3%, while culture positivity rose from 8.0% to 22.0%.
• Antibiotic de-escalation increased, but the abstract did not report its size or patient-centered clinical outcomes.

Nursing implications

• For infection-prevention and emergency nurses, the findings support formal nurse participation in locally approved stewardship workflows, particularly checking whether ordered cultures are obtained before the first antibiotic when clinically feasible and escalating guideline mismatches through the designated team. The study does not justify independent antibiotic changes outside local scope, orders, or stewardship policy.

Limitations & cautions

• This was a single-center, nonrandomized pre-post study, so secular changes, case mix, staffing, or clinician behavior may have contributed to the differences. The abstract does not report the number of patients or prescriptions, intervention and baseline durations, statistical uncertainty, antibiotic consumption, adverse events, resistance outcomes, or patient outcomes.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• Manual fever checking by nurses was the most sensitive method at 100% (95% CI 97.5 to 100.0), with a negative likelihood ratio of 0.
• The non-contact forehead infrared thermometer had the lowest sensitivity (85.71%) but the highest specificity (98.48%) and accuracy (97.5%).
• Lowering the forehead scanner's fever threshold to 37.5 degrees C raised its sensitivity to 99% while specificity held at 98%.
• Manual checking and patient-perceived fever could rule out fever but required the forehead scanner or tympanic thermometer to confirm it.

Nursing implications

• For emergency nurses, the findings suggest that a hands-on fever check or the patient's own sense of fever is a reasonable way to rule fever out, given the perfect sensitivity seen here, but a device reading is needed to confirm it before acting. Where a non-contact forehead thermometer is used for screening, this study found a 37.5 degrees C cutoff caught far more true fevers than the standard 38 degrees C setting.

Limitations & cautions

• This was a single-center study of 279 adults in one emergency department triage area over a few months in 2023, so results may not transfer to other settings, populations, or devices. Only five nurses performed the manual checks, the tympanic thermometer served as the reference rather than a core temperature standard, and the very high manual-check sensitivity may reflect local technique and the specific patient mix.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The study reviewed 728 acute-care stroke hospitalizations (429 ischemic, 236 hemorrhagic, and 63 TIA), with 4,136 nursing diagnoses and 27,528 nursing actions recorded.
• Nursing complexity, measured as nursing diagnoses within 24 hours of admission, differed across subtypes (F = 5.81, P = 0.003), with TIA lower than both stroke types and no significant difference between ischemic and hemorrhagic stroke.
• Nursing intensity, measured as nursing actions during the stay, followed a clear gradient (H = 16.73, P less than 0.001): highest in hemorrhagic stroke, intermediate in ischemic stroke, and lowest in TIA.
• Nursing intensity still differed after standardizing by length of stay (H = 12.999, P = 0.002), suggesting the gradient is not just a function of longer admissions.

Nursing implications

• For neuroscience and stroke nurses, the findings reinforce that hemorrhagic stroke patients tend to carry the heaviest hands-on nursing load, while TIA patients generally require the least, which can help teams anticipate workload and advocate for appropriate assignments. Because complexity was similar between ischemic and hemorrhagic stroke while intensity was not, the number of nursing problems on admission may not, on its own, predict how much bedside work a stroke patient will need.

Limitations & cautions

• This was a single-center retrospective study using routinely collected data and ICD-9-CM coding, so its findings depend on local documentation practices and may not generalize to other hospitals or nursing languages. It measured counts of nursing diagnoses and actions rather than patient outcomes, so it does not show whether higher nursing intensity changed how patients fared.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• 610 hospital nurses in the Czech Republic, Poland, and Slovakia reported how often they omit 32 nursing activities using the standardized BERNCA-R scale.
• Nurses' age, marital status, parenthood, education, and years of experience were not significantly associated with the overall level of rationing.
• The type of ward was more strongly associated with rationing, and emergency departments reported the highest frequency of omitted care.
• Activities requiring extended patient communication, assessment, or monitoring were most often rationed, while basic hygiene tasks were rarely omitted.

Nursing implications

• For nurses and nurse leaders, the findings suggest that when care is missed, the more productive response is to examine staffing structures, workload, and workflow, especially in high-intensity units like emergency departments, rather than attributing it to individual nurses. The pattern that communication, assessment, and monitoring are rationed first can help teams watch for exactly the care most likely to slip under pressure.

Limitations & cautions

• This was a cross-sectional survey in three hospitals in three countries, so it captures associations at one point in time and cannot establish cause, and self-reported rationing may differ from care actually missed. The findings from these specific Central European sites may not generalize to other countries or health systems, and the study did not directly measure patient outcomes.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• Among 1076 adults aged 40 or older with acute myocardial infarction, 19.0% presented without any chest-related symptoms.
• Reduced level of consciousness was independently associated with atypical presentation (odds ratio 4.93; 95% CI 2.41 to 10.05; P < .001).
• Greater functional dependence in activities of daily living was also independently associated (odds ratio 1.10; 95% CI 1.06 to 1.15; P < .001).
• Patients with atypical presentations tended to be older with lower body mass index and lower Glasgow Coma Scale scores.

Nursing implications

• For emergency nurses, the findings suggest a heart attack cannot be ruled out on the absence of chest pain alone, especially in older adults or those with reduced consciousness or high dependence in activities of daily living. Folding functional status and Glasgow Coma Scale into the triage picture, and keeping a lower threshold for cardiac workup in impaired patients, may help catch atypical presentations earlier.

Limitations & cautions

• This was a single-center retrospective cohort at one regional teaching hospital in Taiwan, drawing on electronic health record data from 2016 to 2023, so practice and documentation patterns may not generalize elsewhere. The observational design shows association, not causation, and only patients already diagnosed with acute myocardial infarction were included, so the study cannot speak to how often atypical presentations are missed entirely.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• Across 16 studies and 24 models, pooled discrimination for post-stroke delirium was an AUC of 0.83 (95% CI 0.81 to 0.85).
• The most common significant predictors were age, NIHSS score, neutrophil-to-lymphocyte ratio, visual impairment, and infection.
• Individual model AUCs ranged from 0.72 to 0.94, with sample sizes from 100 to 14,475.
• PROBAST rated every study at high overall risk of bias, mainly from analysis-domain shortcomings, and clinical utility was rarely tested.

Nursing implications

• For neuro nurses, the recurring predictors (older age, higher NIHSS or stroke severity, signs of infection, and visual impairment) are practical cues to screen more vigilantly for delirium with a validated tool such as CAM-ICU or 4AT and to reinforce non-pharmacologic prevention (reorientation, sleep, early mobility, sensory aids). Because all models carried a high risk of bias, treat any risk score as a prompt for closer assessment, not a substitute for it.

Limitations & cautions

• The review pooled model-development and validation studies of varying design, and PROBAST rated all 16 at high overall risk of bias, so the true performance of these models is uncertain and may vary markedly between settings. Diagnostic criteria for post-stroke delirium differed across studies, calibration was reported in only six, and clinical utility was seldom evaluated; the analysis synthesizes predictors, not proof that acting on them changes outcomes.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The framework synthesis reviewed 25 articles linking ED crowding to patient-initiated violence against emergency nurses.
• Crowding was examined across input, throughput, and output stages, alongside staffing factors, rather than as a single metric.
• Patients with severe symptoms triaged to lower-priority categories were a notable high-risk group, partly due to perceptions of injustice about their wait.
• The authors call for accurate, multidimensional crowding assessment and understanding of high-risk patients' emotional state to guide violence prevention.

Nursing implications

• Treat ED crowding as a safety condition, not just a flow problem, and watch for escalating frustration in patients who are visibly unwell but waiting in lower-priority queues. Keep these high-risk patients informed about waits and reassessment, use de-escalation early, and report violence and near-misses so staffing and environmental risks are acted on rather than normalized.

Limitations & cautions

• This is a qualitative framework synthesis of heterogeneous studies, so it organizes contributing factors rather than proving that reducing crowding lowers violence rates. The authors note limited evidence on family members' perspectives, and findings reflect the included literature through March 2024.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• Strategies fell into three buckets: education (64% of studies), technology (30%), and audit and feedback (6%).
• All three were associated with short-term improvements in triage accuracy and skills.
• Workload and overcrowding were the biggest barriers; nurse experience and teamwork were the biggest facilitators.
• The authors emphasize continuous training, nurse input into triage tools, and validated audit tools.

Nursing implications

• Treat triage accuracy as a skill to refresh, not a one-time orientation task. Use validated triage tools and engage with audit-and-feedback when offered, and recognize that overcrowding and workload degrade triage quality, which is worth escalating as a safety issue.

Limitations & cautions

• Most included studies measured only short-term outcomes, so the durability of triage improvements is uncertain. A systematic review summarizes diverse studies and does not prescribe a single triage protocol; follow your facility's validated triage system.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• Across eight studies, stroke nurse involvement was linked to a roughly 20-minute shorter door-to-needle time.
• Three-month mortality was lower (OR 0.56) and good functional outcomes more likely (OR 1.33).
• Intravenous thrombolysis rates increased (OR 1.52).
• Length of hospital stay was similar with or without a stroke nurse.

Nursing implications

• Support streamlined stroke-nurse workflows that compress door-to-needle steps such as rapid assessment, imaging coordination, and thrombolysis setup, use BE-FAST recognition with prompt pathway activation, and advocate for a defined stroke-nurse role where one does not exist.

Limitations & cautions

• Only eight studies were pooled, with variation in stroke systems and possible bias. These are associations from observational and trial data, not proof that the nurse role alone causes the outcomes.
• AI-summarized from the linked source. Review the original article before applying to practice.