Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)

Abstract Background: Emergency care systems worldwide face increasing challenges due to overcrowding, limited specialist availability, geographic disparities, and the need for rapid clinical decision-making. Telemedicine has emerged as an innovative approach to improve access to expert consultation, optimize emergency department (ED) workflows, and enhance patient-centered care. This systematic review evaluates the effects of telemedicine integration in emergency care on clinical outcomes, workflow efficiency, and patient satisfaction.

Methods: A systematic review conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases including PubMed, Embase, Scopus, Web of Science, and Cochrane Library searched for studies evaluating telemedicine applications in emergency care. Eligible studies included randomized controlled trials, prospective and retrospective observational studies, and comparative studies reporting clinical outcomes, operational performance, or patient satisfaction measures. Data regarding study characteristics, telemedicine models, emergency conditions, outcomes, and quality indicators extracted and synthesized.

Results: 28 studies involving more than 120,000 emergency care encounters were included. Telemedicine implementation was associated with improved access to specialist consultation, reduced time-to-treatment, decreased emergency department length of stay, and enhanced diagnostic decision-making. The greatest benefits observed in stroke, trauma, cardiac emergencies, and rural emergency care settings. Meta-analysis demonstrated a significant reduction in treatment delays and improved workflow efficiency. Patient satisfaction was generally high, with users reporting improved communication, reduced travel burden, and increased confidence in medical decisions. However, challenges included technological limitations, provider training requirements, and integration with existing healthcare systems.

Conclusion: Telemedicine represents an effective strategy for improving emergency care delivery by enhancing clinical decision-making, accelerating treatment processes, and improving patient experiences. Successful implementation requires reliable technological infrastructure, standardized clinical protocols, and continuous evaluation of outcomes. Future research should focus on large-scale randomized studies and cost-effectiveness analyses to optimize telemedicine integration into emergency healthcare systems.

Abstract Background: Induction of general anesthesia frequently induces hemodynamic instability characterized by hypotension, necessitating timely administration of vasopressors. The causal relationship between heart rate (HR) and blood pressure (BP) during this critical period remains incompletely understood, limiting the development of predictive models for vasopressor requirements.

Objective: This study employed dynamic causal modeling (DCM) to characterize the directional interactions between HR and BP during anesthetic induction and to develop a systems-based predictive framework for vasopressor needs.

Methods: We prospectively enrolled 120 adult patients undergoing elective major surgery under general anesthesia. Continuous HR and invasive arterial BP data were recorded from 5 minutes pre-induction to 10 minutes post-intubation. A time-varying Granger causality analysis was applied to quantify the feedforward (HR→BP) and feedback (BP→HR) causal pathways. A dynamic Bayesian network integrating hemodynamic, pharmacodynamic, and patient-specific parameters was constructed to predict vasopressor requirements.

Results: Propofol induction significantly attenuated the feedback pathway (BP→HR) from baseline (causal coefficient: 0.42±0.11 vs. 0.18±0.09, p<0.001) while preserving the feedforward pathway (HR→BP). The magnitude of feedback attenuation correlated strongly with subsequent vasopressor dose (r=0.73, p<0.001). The DCM-based prediction model achieved an AUC of 0.89 (95% CI: 0.83-0.94) for predicting vasopressor requirements >50 µg phenylephrine equivalent.

Conclusion: Dynamic causal modeling of HR-BP coupling during anesthetic induction provides mechanistic insights into hemodynamic instability and enables accurate, individualized prediction of vasopressor requirements, offering a promising framework for precision hemodynamic management.

Abstract The increasing proportion of older adults presenting to emergency departments (EDs) has created significant challenges for healthcare systems worldwide. Older patients frequently present with complex multimorbidity, functional impairment, cognitive decline, and increased vulnerability to acute stressors. Frailty, defined as a state of decreased physiological reserve and increased susceptibility to adverse health outcomes, has emerged as an important predictor of hospitalization, mortality, and functional deterioration. Emergency department-based frailty assessment tools may provide rapid identification of high-risk older adults and support individualized clinical decision-making. This systematic review and meta-analysis aimed to evaluate the predictive performance of frailty assessment instruments applied in emergency departments for hospitalization, mortality, and other adverse outcomes among older adults. A comprehensive literature search performed in major biomedical databases to identify studies evaluating validated frailty assessment tools in ED populations aged ≥65 years. Eligible studies assessed the association between frailty measurements and clinical outcomes, including hospital admission, short- and long-term mortality, intensive care utilization, functional decline, and adverse events. Data regarding study characteristics, frailty instruments, predictive performance measures, and outcomes extracted and synthesized. The pooled evidence demonstrated that ED-based frailty assessment tools were significantly associated with increased risk of hospitalization and mortality. Instruments including the Clinical Frailty Scale (CFS), Identification of Seniors at Risk (ISAR), Emergency Department Frailty Index (ED-FI), and Frailty Phenotype demonstrated moderate-to-high predictive accuracy. Frailty assessment improved risk stratification beyond chronological age alone and provided clinically meaningful information regarding patient vulnerability. However, heterogeneity existed regarding assessment methods, outcome definitions, and follow-up periods. Frailty screening in emergency departments represents a valuable approach for identifying older adults at increased risk of adverse outcomes. Integration of rapid frailty assessment into routine emergency care may improve triage decisions, facilitate appropriate resource allocation, and support patient-centered management strategies.