Emergency medical care in Pakistan remains uncoordinated due to the absence of a platform to connect hospitals, patients, and ambulances. Consequently, during periods of resource shortage and crowding of the emergency department at hospitals, patients and ambulances are unable to select the best site for patient management or transfer of patients, resulting in suboptimal care and poor outcomes.

We developed a digital platform called EMCON (Emergency Connection) application, which can be used for inter-hospital and hospital-to-patient/ambulance communication to coordinate patient care. The platform offers real-time information on resource availability, facilitates interhospital patient transfers, coordinates ambulance responses, and assists patients in making decisions about seeking emergency care.

The platform offers real-time information on resource availability, facilitates interhospital patient transfers, coordinates ambulance responses, and assists patients in making decisions about seeking emergency care. It has a range of features that allow hospitals to control the data that they share to maintain hospital buy-in, incorporates both electronic and manual data entry for real-time updates in low-resource settings or during electronic medical record disruption, and provides visual content and appointment scheduling services to keep patients engaged.

The pilot testing of the EMCON platform yielded promising outcomes, highlighting its adaptability and effectiveness in diverse health care settings. Integration with an electronic medical record (EMR)-equipped tertiary hospital demonstrated seamless real-time data updates, ensuring efficient resource management and coordination. Meanwhile, the successful implementation at a resource-reliant blood bank underscored EMCON’s versatility, allowing manual data entry for hospitals without EMR systems. These results emphasize the platform’s practicality and potential to revolutionize emergency health care access in low- and middle-income countries (LMICs). EMCON’s ability to bridge coordination gaps and enhance resource allocation holds great promise for improving patient outcomes, particularly in resource-constrained settings.

EMCON serves as a promising solution to address critical coordination issues in emergency care, bridging the gap between hospitals, patients, and ambulances to improve emergency health care access in low-resource settings.

To evaluate the accessibility and acceptability of implementing a telephone-based psychological support intervention for patients with metastatic cancer in the Indian palliative care settings.

The present single centered experimental study was conducted on 181 adult metastatic cancer patients who were referred to the pain and palliative medicine department by medical oncologists at a tertiary hospital, India. The patients were purposely assigned to two groups: In Group-A 90, patients received a combination of palliative and psychological support. In Group-B, 91 patients received only structured palliative care. As per the department protocol, patients in each group were followed up on days 0, 7, 14, 21, and 28. Before each session, patients completed questionnaires that are based on disease-related symptoms and psychological well-being.

It was found out that patients with telephone based psychological support integrated with palliative care has shown gradual improvement in physical and psychological symptoms from day 7 to day 28 when compared to the control group with p-value < 0.05. Additionally, 67% of patients continued their follow-up with the psychologist, indicating the accessibility and acceptability of the treatment. Furthermore, 87% of patients preferred voice calls over video calls because of the limited internet access (N = 72%).

Therefore, it can be concluded that the combined approach of pain management through palliative care and continuous telephone based psychological support has contributed to their holistic well-being.

The findings highlight that integrating telephone-based psychological support within palliative care services is both feasible and acceptable for patients with metastatic cancer in India. This approach not only improves physical and psychological outcomes but also enhances the continuity of care, especially in resource-limited settings where in-person psychological services may not always be accessible.

In Canada, the management of migraine is commonly carried out by primary care providers. Guidelines for the acute and preventative management of migraine in Canada are published by the Canadian Headache Society (CHS). There are currently limited data describing prescribing patterns among clinicians caring for patients with migraine in Canada.

Our aim for this exploratory study was to characterize the current pharmacological treatments prescribed for patients with migraine in Nova Scotia, Canada, seeking care through their primary care providers.

We conducted a retrospective cross-sectional analysis of deidentified electronic medical record (EMR) data collected from January 2019 to December 2023 from the Maritime Research Network for Family Practice (MaRNet-FP) to identify prescribing patterns for the acute and preventative management of migraine in Nova Scotia.

In total, 3075 active patients who received a diagnosis of migraine were identified in the MaRNet-FP EMR database (6.53% of total patients). Migraine patients were predominantly female (81%) with an average age of 44 ± 16 years. Between 2019 and 2023, 50% of patients with a migraine diagnosis received a prescription for a medication that can be used for the acute management of migraine, most commonly, nonsteroidal anti-inflammatory drugs and triptans. Over the same period, 60.4% of patients were prescribed a medication that can be used for the prevention of migraine, the most common of which were anti-depressants and beta-blockers.

Our findings demonstrate alignment with CHS guidelines but highlight potential undertreatment of migraine.

Although first performed several years ago, percutaneous total cavopulmonary connection has not yet become a widely adopted procedure in patients with univentricular circulation.

We describe a case involving a novel, modified technique for the percutaneous completion of the Fontan circulation using covered stents in a 12 kg patient.

The transcatheter Fontan completion was successfully performed. Minimal surgical preparation included banding of the inferior vena cava during the preceding superior cavopulmonary connection. Using needle puncture to create the anastomosis and implanting covered stents, a total cavopulmonary connection with an intra-atrial tunnel was established. The patient recovered uneventfully.

Percutaneous total cavopulmonary connection is feasible and may represent a less invasive alternative for selected patients. However, data on this approach are currently very limited, and further studies are urgently needed.

Just as prospective differentiation between true emergencies and calls for subacute patients is critical to the delivery of prehospital care, retrospective differentiation is critical to research and quality improvement. Determining the acuity of patients based on the type of care they received could complement the vital-sign-based instruments currently popular, yet imperfect. The study aim was to create a consensus definition of time-dependent care and a list of time-dependent interventions in paramedicine.

The study was a Delphi approach consisting of four rounds of voting by a bi-provincial panel of 22 Canadian key informants representing medical first responders, paramedics, and physicians – first to agree on a definition of time-dependent care – then to categorize 29 clinical and 34 pharmacological interventions.

Based on the consensus definition of “A majority of patients who should receive the intervention, according to provincial protocols, would suffer a direct prejudice to their health or safety if the intervention, provided on its own, was not performed within eight minutes of the initial call,” the panel reached consensus on 52 of 63 interventions (82.5%), of which 17 (32.7%) were voted time-dependent (11 clinical [64.7%] and six pharmacological [35.3%]). Clinical interventions included airway suction or de-obstruction, cricothyrotomy, positive pressure ventilation, chest decompression, cardiopulmonary resuscitation, defibrillation, cardioversion, pacing, and hemorrhage control. Pharmacological interventions included medication classed as sympathomimetics, caloric agents, antiarrhythmic agents, anticonvulsants, or tranquilizers.

The panel reached a consensus on a definition of time-dependent care and used this to identify prehospital interventions that could serve as an instrument to improve care and system performance.

This study aimed to determine the prevalence of paternal perinatal depression (PPND) using the Edinburgh Postnatal Depression Scale (EPDS) among fathers/co-parents at an urban obstetric hospital and identify key predictors of positive screening outcomes.

A cross-sectional anonymous online survey was completed by 115 respondents between July 2023 and January 2024. The questionnaire included demographic and clinical items, the EPDS, and the Social Safety and Pleasure Scale (SSPS). An EPDS score ≥ 9 indicated a positive screen for depression. A composite variable for history of mental illness was created based on prior diagnosis, mental health service engagement, and medication use.

Thirty-three percent of participants screened positive for depression (EPDS ≥ 9); 17.4% had scores ≥ 12. A self-reported history of mental illness significantly predicted positive screening (OR = 4.38, p = 0.001). No significant associations were found with demographic, obstetric, or infant-related variables. Lower SSPS scores were significantly associated with higher EPDS scores.

Despite limitations, in particular selection bias and small sample size, fathers and co-parents are at increased risk for depressive symptoms in the perinatal period, particularly those with a mental health history. Routine screening and inclusive models of care are needed to support paternal mental health during this vulnerable time.