Assessment of the Diagnostic Accuracy and Reliability of the HEART Score Calculated by Ambulance Nurses Versus Emergency Physicians
The study shows a moderate interrater reliability and lower predictive accuracy of a HEART score calculated by Ambulance Nurse (AN) versus EP. AN underestimate the risk of patients with acute chest pain, with the largest discrepancies in the elements History and Risk factors. Reconsidering the cut-off values of the low-risk HEART category, as well as a carefully developed training program, will possibly lead to a higher interrater reliability of the HEART score and higher predictive accuracy used by AN.
KEY FINDINGS: The study shows a moderate interrater reliability and lower predictive accuracy of a HEART score calculated by AN versus EP. AN underestimate the risk of patients with acute chest pain, with the largest discrepancies in the elements History and Risk factors. Reconsidering the cut-off values of the low-risk HEART category, as well as a carefully developed training program, will possibly lead to a higher interrater reliability of the HEART score and higher predictive accuracy used by AN.
BACKGROUND: Chest pain is a common complaint for consultation of emergency medical services worldwide. Currently, ambulance nurses (AN) base their decision to transport a patient to the hospital on their own professional experience. The HEART score could improve prehospital risk stratification and patient treatment. The aim of this study is to investigate the interrater reliability and predictive accuracy of the HEART score between AN and emergency physicians (EP).
DETAILS: A retrospective analysis on data of 569 patients 18 years and older included in two prehospital HEART score studies. The endpoints are interrater reliability (intraclass correlation [ICC]) and predictive accuracy for major adverse cardiac events within 30 days of the HEART score calculated by AN versus EP. Predictive accuracy is sensitivity, specificity, positive predicted value (PPV) and negative predicted value (NPV). Interrater reliability was good for total HEART score (ICC 0.78; 95% CI 0.75-0.81). However, focusing on the decision to transport a patient, the ICC dropped to 0.62 (95% CI 0.62-0.70). History and Risk factors caused the most variability. Predictive accuracy of HEART differed between AN and EP. The HEART score calculated by AN was sensitivity 91%, specificity 38%, PPV 26%, and NPV 95%. The HEART score calculated by EP was sensitivity 98%, specificity 32%, PPV 26%, and NPV 99%. With a cut-off value of 0-2 for a low HEART score, predictive accuracy significantly improved for the HEART score calculated by AN: sensitivity 98%, specificity 18%, PPV 22%, and NPV 98%.
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Copyright © Wolters Kluwer Health, Inc. All rights reserved.
Source: van der Waarden, N. W. P. L., de Wolf, G. S., van Meerten, K. F., et al. (2024). Assessment of the Diagnostic Accuracy and Reliability of the HEART Score Calculated by Ambulance Nurses Versus Emergency Physicians. Advanced Emergency Nursing Journal. 2024; 46(1): 49-57. Published: January/March, 2024. DOI: 10.1097/TME.0000000000000497.
Comparison of Broad-Spectrum Antibiotic Use According to Hospice Utilization Among Patients with Cancer at the End of Life in South Korea
Hospice involvement was associated with lower use and reduced exposure to broad-spectrum antibiotics among patients with cancer near the end of life. These findings support the alignment of end-of-life treatment decisions with the comfort-oriented goals of hospice care.
KEY FINDINGS: Hospice involvement was associated with lower use and reduced exposure to broad-spectrum antibiotics among patients with cancer near the end of life. These findings support the alignment of end-of-life treatment decisions with the comfort-oriented goals of hospice care.
BACKGROUND: Authors aimed to compare broad-spectrum antibiotic use between hospice and non-hospice patients with cancer at the end of life using nationwide data from Korea.
DETAILS: In this retrospective cohort study, authors analyzed the Korean National Health Insurance Service data of adult patients with cancer who died between 2018 and 2021. Hospice users were defined as patients who received inpatient, home-based, or consultation-based hospice care before death. Authors applied propensity score matching (1:2) to balance the baseline characteristics of the hospice and non-hospice groups. Broad-spectrum antibiotic use, including anti-pseudomonal penicillins, anti-pseudomonal cephalosporins, carbapenems, and glycopeptides, was assessed during the last 3 months of life using prescription proportions and days of therapy per 1,000 patient-days. After matching, 38,102 hospice and 75,736 non-hospice users were analyzed. During the last 3 months of life, 74.6% of hospice and 79.0% of non-hospice users received at least one broad-spectrum antibiotic (P<0.001). The proportion of patients receiving broad-spectrum antibiotics was generally lower among hospice users across all time intervals (P<0.001), and the number of days of therapy was also lower, with the largest differences observed during the final week and last 3 days of life. Subgroup analyses showed the highest antibiotic exposure among patients with hematologic and pancreatobiliary cancers, particularly in the non-hospice group.
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Copyright © Journal of Hospice and Palliative Care. All rights reserved.
Source: Jeung, Y. S., Kim, G. J., Yu, J., et al. Comparison of Broad-Spectrum Antibiotic Use According to Hospice Utilization Among Patients with Cancer at the End of Life in South Korea: A Nationwide Analysis. v. 2026; 29(2): 41-50. Published: June, 2026. DOI: 10.14475/jhpc.2026.29.2.41
Incidence and Implications of Abstinence-Induced Recompensation in Alcohol-Related Cirrhosis
Hepatic recompensation reflects the potential to resolve decompensating events once the aetiological driver is removed. Alcohol abstinence enabled recompensation in one-third of patients with decompensated alcohol-related cirrhosis. The likelihood of recompensation increased with early abstinence and in the absence of further decompensation. Prognosis improved after recompensation, with a negligible risk of liver-related death and hepatocellular carcinoma.
KEY FINDINGS: Alcohol abstinence enabled hepatic recompensation in approximately one-third of patients with decompensated alcohol-related cirrhosis, particularly when abstinence was achieved early and in the absence of further decompensation. Recompensation was associated with a substantial survival benefit under sustained abstinence, with a negligible residual risk of liver-related death and hepatocellular carcinoma.
BACKGROUND: Alcohol abstinence enables hepatic recompensation in patients with decompensated alcohol-related cirrhosis. This study investigated the incidence, predictors, and impact of abstinence-induced recompensation.
DETAILS: This multicentre study included patients with decompensated alcohol-related cirrhosis recruited at the time of abstinence up to December 2022. Recompensation was defined by Baveno VII criteria: (i) sustained abstinence (>=3 months), (ii) resolution of ascites and hepatic encephalopathy off therapy, (iii) absence of variceal bleeding for 1 year, and (iv) restored liver function (Child-Pugh A or MELD <10). A total of 633 patients from 17 centres were included (71.7% male; median age 55 years). Alcohol-associated hepatitis superimposed on cirrhosis was present in 40.8%. Median MELD was 19 (13-24), and 47.2% had progressed to further decompensation at abstinence. Median time from index decompensation to abstinence was 0.2 (0.0-7.6) months. Over a follow-up of 36.3 (19.2-63.2) months, 197 patients (31.1%) achieved recompensation (cumulative incidence: 12.3% at 1 year, 23.4% at 2 years, 33.8% at 5 years). Early abstinence (within 1 month of decompensation; adjusted subdistribution hazard ratio [aSHR] 2.042), higher aspartate aminotransferase (aSHR per 10 U/L increase: 1.011) and gamma-glutamyltransferase (aSHR per 10 U/L increase: 1.004) (all p <0.001) increased recompensation likelihood in both supervised and machine-learning models, while the presence of further decompensation decreased it (aSHR 0.650, p = 0.013). During follow-up, 123 patients died (56.1% liver-related). Recompensation was independently associated with lower all-cause mortality (aHR 0.255, p = 0.001). No recompensated patient who remained abstinent died of liver-related causes or developed hepatocellular carcinoma.
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Mirtazapine for Methamphetamine Use Disorder
In this phase 3 randomized clinical trial, mirtazapine produced a modest but statistically significant reduction in methamphetamine use among individuals with moderate to severe methamphetamine use disorder. The medication demonstrated an acceptable safety profile, with drowsiness and weight gain being the most common treatment-related adverse effects. These findings support mirtazapine as a potentially accessible and scalable pharmacologic option for reducing methamphetamine use in routine outpatient clinical practice.
Summary
A Multisite Phase 3 Randomized Clinical Trial
[Posted 9/Jun/2026]
AUDIENCE: Psychiatry, Family Medicine
KEY FINDINGS: In this parallel-group randomized clinical trial, mirtazapine delivered in routine clinical practice reduced methamphetamine use in adults with methamphetamine use disorder. No unexpected safety concerns delivering mirtazapine in this setting were found; this finding has important clinical implications in the absence of any approved pharmacotherapies for methamphetamine use disorder.
BACKGROUND: Methamphetamine use disorder is a global health challenge for which there are no approved pharmacotherapies. The safety and effectiveness of mirtazapine, a promising candidate for methamphetamine use disorder, has not been established in routine clinical practice. Purpose is to determine the safety and effectiveness of mirtazapine as a pharmacotherapy for methamphetamine use disorder in routine clinical practice.
DETAILS: This phase 3, parallel-group, double-blind, placebo-controlled randomized clinical trial was conducted between November 16, 2022, and May 1, 2025, at 6 outpatient alcohol and other drug clinics in Australia among adults with moderate to severe methamphetamine use disorder. Data analysis was conducted from May to September 2025. The primary end point was the change in days of methamphetamine use in the past 28 days from baseline to week 12. Secondary end points were depression, insomnia, HIV risk behavior, quality of life, and methamphetamine-negative oral fluid samples. Of 344 participants randomized, 339 participants received the intervention (167 in the placebo group and 172 in the mirtazapine group). Mean (SD) age was 42.0 (8.6) years, 126 participants (37.2%) were female, and participants had used methamphetamine for a median (IQR) of 24 days (17-28) of the past 28 days at baseline. The mean reduction in days of methamphetamine use from baseline to week 12 was greater in the mirtazapine group (7.0 days of 28 days) than in the placebo group (4.8 days of 28 days; mean difference, 2.2 days; 95% CI, -4.2 to -0.2 days; P = .02). More participants in the mirtazapine group reported drowsiness (47% vs 33%) and weight gain (10% vs 3%). Forty participants (23%) discontinued mirtazapine due to adverse events compared to 25 participants (15%) in the placebo group. No significant effects of mirtazapine on secondary end points were found.
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Impulse Oscillometry in Preschool-Aged Children with Bronchopulmonary Dysplasia
The substantial improvement observed after bronchodilator administration indicates that a significant proportion of preschool children with BPD have reversible airway obstruction. Furthermore, improvements in IOS parameters among children receiving ICS/LABA therapy suggest that IOS may serve as an objective method for monitoring treatment response and guiding therapeutic decisions during early childhood.
Summary
Assessment of Lung Function and Bronchodilator Responsiveness
[Posted 2/Jun/2026]
AUDIENCE: Pediatrics, Emergency Medicine
KEY FINDINGS: This study demonstrates that IOS is a practical and clinically informative tool for assessing lung function in preschool-aged children with BPD, particularly in those who are unable to perform spirometry. The findings reveal a high prevalence of abnormal respiratory mechanics characterized by increased airway resistance and reduced lung compliance. Reactance measures appeared especially sensitive for detecting pulmonary abnormalities and were more strongly associated with respiratory morbidity than resistance measures.
The substantial improvement observed after bronchodilator administration indicates that a significant proportion of preschool children with BPD have reversible airway obstruction. Furthermore, improvements in IOS parameters among children receiving ICS/LABA therapy suggest that IOS may serve as an objective method for monitoring treatment response and guiding therapeutic decisions during early childhood.
BACKGROUND: Bronchopulmonary Dysplasia (BPD) affects approximately 10,000-15,000 infants annually in the United States and remains one of the most common chronic respiratory conditions in childhood. Although pulmonary function impairment in older children and adults with BPD has been well documented, objective assessment during the preschool years remains challenging because conventional spirometry requires substantial patient cooperation. The Impulse Oscillometry System (IOS) offers a noninvasive alternative that evaluates respiratory mechanics during normal tidal breathing and may provide valuable insights into lung function in young children who cannot reliably perform spirometry.
DETAILS: This retrospective study evaluated IOS performance and respiratory outcomes in preschool-aged children with BPD followed at Cincinnati Children's Hospital Medical Center. The investigators reviewed IOS assessments performed between June 2023 and May 2025 in children aged 3 to 6 years who were born between 2017 and 2022. Lung function was assessed using measures of airway resistance and reactance before and after bronchodilator administration. Clinical data, neonatal history, respiratory morbidity, medication use, and respiratory health status were collected through electronic medical records and a modified St George’s Respiratory Questionnaire (SGRQ).
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A total of 103 IOS reports from 73 children were analyzed. Researchers examined the feasibility of IOS testing, the prevalence of abnormal pulmonary function findings, bronchodilator responsiveness, associations with respiratory outcomes, and longitudinal changes following inhaled therapy. Among the 103 IOS reports reviewed, 54 reports (52.4%) met acceptable and repeatable testing standards. The median age of participants was 4.1 years (IQR 3.5-5.0). Testing success improved substantially with age, increasing from 31% in 3-year-old children to 100% in 6-year-old children.
Abnormal pulmonary function was highly prevalent, with 78.0% of reports demonstrating at least one abnormal IOS parameter. Total airway resistance was elevated, with a median R7 z score of 1.8 (IQR 0.9-2.8), while peripheral airway resistance measured by R7-20 showed a median z score of 1.4 (IQR 0.8-2.2). Reactance measures indicated reduced lung compliance and increased respiratory system stiffness, with median X7 z score of -2.4 (IQR -3.7 to -1.4), AX of 2.6 (IQR 0.8-3.3), and Fres of 1.4 (IQR 0.6-2.4).
Following administration of albuterol, median z scores for all IOS parameters shifted into the normal range. Bronchodilator responsiveness was identified in 33.3% of children using established criteria. Among children with abnormal baseline measurements, normalization after bronchodilator administration occurred in 94.4% of R7 measurements, 75.0% of R7-20 and AX measurements, 79.2% of X7 measurements, and 81.3% of Fres measurements.
Respiratory morbidity remained substantial. The median total modified SGRQ score was 12.1 (IQR 7.6-25.6), with symptom score of 32.5 (IQR 17.2-46.8), activity score of 7.6 (IQR 0-29.8), and impact score of 7.4 (IQR 0-17.1). Children with respiratory readmissions demonstrated significantly worse reactance measurements, suggesting poorer lung compliance. In a subset of children who underwent repeat testing, those treated with inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) therapy showed significant improvements in airway resistance and reactance, whereas untreated children demonstrated no significant changes.
Copyright © Elsevier Inc. All rights reserved.
Source: Bullard Elias, D., Amin, R., Ignatiuk, D., et al. Impulse Oscillometry in Preschool-Aged Children with Bronchopulmonary Dysplasia. The Journal of Pediatrics. 2026; 293(115013). Published: June, 2026. DOI: S0022-3476(26)00041-7.
Risks of Using TRUE METRIX Blood Glucose Monitoring Systems by Trividia Health
TRUE METRIX glucose meters recalled after FDA identifies software-related safety concerns involving E-5 Error Code interpretation. Misinterpretation may result in delayed recognition of severe hyperglycemia or inappropriate treatment of normal glucose levels. FDA recommends switching to alternative glucose monitoring systems, especially for high-risk patients on insulin or sulfonylureas.
KEY FINDINGS: The FDA recommends that users of TRUE METRIX blood glucose monitoring systems seek alternative testing methods as soon as feasible while continuing glucose monitoring without interruption. The primary concern involves the E-5 Error Code being unable to distinguish between severe hyperglycemia and a test strip malfunction. This ambiguity may lead to delayed treatment or inappropriate interventions. High-risk patients, particularly those using insulin intensively or prone to unstable glucose levels, should prioritize switching to another glucose monitoring system. The recall has already been associated with 114 serious injuries and one reported death, emphasizing the potential severity of the issue.
BACKGROUND: The U.S. Food and Drug Administration (FDA) issued a safety communication regarding potential risks associated with the use of TRUE METRIX Blood Glucose Monitoring Systems manufactured by Trividia Health. The recall affects all TRUE METRIX, TRUE METRIX AIR, TRUE METRIX GO Self-Monitoring Blood Glucose Systems, and the TRUE METRIX PRO Professional Monitoring Blood Glucose System, including co-branded versions marketed under partner or store names. The communication highlights concerns related to the software design of the device’s E-5 Error Code, which may create confusion during blood glucose testing and potentially delay or lead to inappropriate treatment decisions.
DETAILS: The FDA reported that the E-5 Error Code used in TRUE METRIX devices is programmed to represent two separate situations: either a very high blood glucose level greater than 600 mg/dL or a test strip error. Because the same code is displayed for both conditions, users may incorrectly interpret the meaning of the error message. Patients experiencing severe hyperglycemia may mistakenly assume the issue is due to a defective test strip and delay urgent medical care. Conversely, some users may believe the reading indicates severe hyperglycemia when their glucose levels are actually normal or low, potentially resulting in unnecessary corrective treatment.
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The FDA advised all users to transition to alternative blood glucose monitoring methods whenever possible. Patients were instructed not to discontinue glucose monitoring until another reliable testing method becomes available. Particular concern was raised for individuals receiving intensive insulin therapy, taking sulfonylureas, or those with frequent episodes of hypo- or hyperglycemia, as these groups are considered especially vulnerable to complications arising from inaccurate interpretation of glucose readings.
Healthcare professionals were advised to promptly notify affected patients and support them in transitioning to alternative glucose monitoring systems. Medical facilities were also encouraged to display the FDA communication in areas where the affected products are stored or used.
The FDA classified the February 2026 TRUE METRIX recall as a Class I recall, which represents the most serious category of medical device recalls. As of January 16, 2026, Trividia Health reported 114 serious injuries and one death associated with this issue. Potential consequences of delayed recognition or mismanagement of abnormal glucose levels include dehydration, altered mental status, loss of consciousness, and death. The FDA stated that it will continue monitoring device performance reports and work closely with the manufacturer to evaluate additional mitigation strategies and provide updated public information when necessary.
Source: Risks of Using TRUE METRIX Blood Glucose Monitoring Systems by Trividia Health: FDA Safety Communication. FDA. Published: May 19, 2026.
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