Radu-Alexandru Iacobescu

Background and Objectives: Trauma is a frequent cause of emergency healthcare requests that requires timely intervention and transport to definitive care, ideally within the first 60 min. On-scene time is considered a modifiable component of the prehospital phase and holds the greatest potential for optimizing prehospital operational time. However, factors contributing to on-scene delays are emerging across different trauma systems, highlighting the need to optimize operational efforts. Data on these factors vary across settings and have rarely been explored in Europe. Romania is an Eastern European country with a distinct demographic distribution and a unique emergency healthcare system. This study aims to evaluate compliance with the golden hour of prehospital trauma care and factors associated with on-scene and total prehospital operational time in Iasi County, Romania. Materials and Methods: A retrospective analysis of data from the electronic dispatch registry from Iasi County was performed for cases dating from January 2025 to February 2026. Data regarding demographics, trauma characteristics, and operational data were retrieved. Generalized linear modeling was used to investigate associations of total prehospital time or on-scene time with demographic and case-specific factors. Multivariable logistic regression was used to evaluate factors associated with total prehospital time exceeding 60 min and on-scene time of 20 min or more. Further sensitivity analyses were performed to account for scene complexity. Age association with operational time was assessed for non-linearity using restricted cubic splines. Results: Of the 8553 included trauma cases, 33.1% presented with on-scene delays, and 59.5% presented with total prehospital time above 60 min. Factors associated with on-scene time were age, rural environment, nature of trauma and severity, and scene-related complexity factors such as number of performed interventions and multiple victim incidents, while for total prehospital time the moment of intervention was also a relevant factor. Age displayed a non-linear association with on-scene time (p < 0.001), with a more pronounced increase after approximately 60 years of age, while for total prehospital time no evidence of non-linearity was observed (time ratio: 1.0024, 95% CI:1.0019–1.0029, p < 0.001). Rural environment was also a factor associated with both operational measurements (time ratio:1.17, 95%CI:1.15–1.2, p < 0.001 for on-scene time and time ratio:1.42, 95% CI:1.38–1.45, p < 0.001 for total prehospital time) and was associated with higher odds of on-scene time ≥ 20 min (OR:1.74, 95% CI:1.58–1.92, p < 0.001) and total prehospital time >60 min (OR:4.91, 95% CI:4.45–5.43, p < 0.001). Conclusions: The large proportion of cases identified with delayed operational times supports the need for further exploration of modifiable factors. The study highlights that, beyond case-specific factors and scene complexity, age and rural environment are relevant to prehospital operational time in Romanian trauma care settings. Further studies are needed to determine the underlying mechanisms of these associations and find targeted strategies to improve operational efficiency.

Background: Out-of-hospital cardiac arrest (OHCA) remains a major public health challenge in Romania. Although trained first-responder systems have improved prehospital response in other European settings, Romania lacks a structured national framework. This study assessed the knowledge, attitudes, perceived preparedness, and willingness of Inspectorate for Emergency Situations (ISU) personnel to participate as community first responders outside working hours. Methods: A national cross-sectional survey was conducted using a structured online questionnaire distributed to operational ISU personnel. The final sample included 1537 participants from five professional categories: firefighter officers with paramedic training, firefighter sub-officers with paramedic training, firefighter officers, firefighter sub-officers, and other personnel. Multivariable binary logistic regression was used to identify factors associated with high enthusiasm and desire for additional training. Results: More than 70% of respondents supported the integration of firefighter-paramedics into a community first-responder system, and over 75% expressed willingness to participate. Significant differences were observed between professional categories in demographic, professional, and first responder-related variables. In multivariable analysis, firefighter officers with and without paramedic training, as well as other personnel, had higher odds of high enthusiasm compared with firefighter sub-officers without paramedic training. Desire for additional training was independently associated with female sex and firefighter officer status, with or without paramedic training. Conclusions: Romanian ISU personnel showed favorable self-reported attitudes and high willingness to participate in a structured OHCA first-responder system. However, these findings reflect perceived motivation rather than operational feasibility, competence, or improved patient outcomes. Implementation would require standardized training, legal clarification, dispatch integration, adequate AED access, supervision, audit systems, and prospective evaluation using patient-level OHCA outcomes.

Background: Frailty has been linked with systemic inflammation in elderly oncology patients. In this paper, we report the results of an analysis evaluating the association between blood cell biomarkers of inflammation and frailty in patients with operable non-small-cell lung cancer (NSCLC). Methods: A retrospective analysis was performed on patients undergoing surgery for NSCLC between March 2022 and March 2023. Frailty was assessed using the modified Frailty Index-5 (mFI-5) and 11 (mFI-11). Inflammation was evaluated using the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune–inflammation index (SII), and systemic immune–inflammation response index (SIRI), all calculated from preoperative assessments. Results: In this sample of surgical NSCLC patients (n = 106), frailty prevalence was 29.2% with mFI-11 and 17% with mFI-5. The log of the neutrophil-to-lymphocyte ratio (logNLR) emerged as the most significant predictor of frailty (OR of 3.13, 95% CI: 1.12–9.09, p = 0.03 for mFI-11 and 3.82, 95% CI: 1.28–11.11, p = 0.02 for FI-5). The platelet-to-lymphocyte ratio (PLR) was predictive only in the model assessing mFI-5. Furthermore, both the NLR and PLR showed an inverse linear correlation with frailty severity, a finding that remained consistent regardless of age, gender, disease stage, nutrition status, or comorbidity burden. Conclusions: Frail patients with operable NSCLC exhibit distinct inflammatory response patterns compared with those observed in non-frail lung cancer patients. Using these biomarkers could help identify patients suitable for preoperative interventions that could improve their postoperative course. However, further studies are needed to explore these preliminary findings prospectively and to understand the causal relationship between the observed association with frailty status and severity.

Background: Medical emergencies occur at varying rates across the globe. Given the significant effort invested in identifying them and assessing dentists’ preparedness to deliver treatment in these life-threatening conditions, a global overview was needed. Materials and Methods: In this scoping review, data from PubMed, Cochrane Library, and Google Scholar databases were examined to identify all relevant studies reporting on the impact of medical emergencies on dentists and determine their operational preparedness at a national or regional level. Operational preparedness was determined in accordance with existing emergency operational preparedness frameworks across six domains: Anticipate, Assess, Prevent, Prepare, Respond, and Recover. Significant Findings: Global data show that dentists will invariably encounter medical emergencies across their careers. However, our investigation found that in countries where there is strong foundational training and regular refresher training, fewer frequent emergencies and stronger operational preparedness are reported. Governmental regulation emerged as a key facilitator of operational preparedness. Still, barriers exist, primarily limited access to medical emergency courses, shortages of office supplies for emergency drugs and materials, and the absence of medical emergency registries. Conclusions: A reassessment of the medical emergency training courses’ content appropriateness is paramount. Training interventions should also focus on raising awareness about the importance of preventive measures and office optimization through planning. Further research is needed to identify any overlooked facilitators and barriers to operational preparedness in medical emergencies. This will help identify opportunities for improvement and minimize the impact of emergencies on dental practices.

Risk assessment for immediate mortality is a vital component of the preoperative assessment in elective cardiac surgeries of the adult population. It is generally used to inform consent and plan postoperative care, but can also help identify patients who need preoperative optimization. Risk assessment for open cardiac interventions remains difficult, as an absolute risk assessment tool is still lacking. In this narrative review, we examine recent data on the predictive performance of commonly used risk assessment tools in cardiac surgery and explore missed opportunities to improve predictive performance, including overlooked independent predictors and alternative calculation strategies, such as machine learning. The literature shows that the most popular risk assessment tools are the Parsonnet score, EuroSCORE II, STS-PROM, and ACEF. These have reasonable discriminative capabilities across most populations but occasionally suffer from poor calibration and over- or underprediction. Preoperative inflammation, functional status, physical performance, nutrition, and frailty are potentially relevant clinical factors that could improve mortality prediction modeling using traditional approaches. By far, the largest advancement comes from artificial intelligence-based models that demonstrate superior predictive capabilities utilizing the same predictors. These models are still in development, have not received external validation, are not yet trusted by physicians, and may not be accessible to all institutions due to computing limitations, and thus are not ready for global rollout. Further research in identifying novel predictors of mortality is required, and efforts are needed to validate machine learning models in external cohorts.

Background: Disasters, although predictable, often occur unexpectedly, and efforts must be directed towards reducing their impact. Emergency healthcare workers, key players in disaster response, should maintain a high level of preparedness to act in catastrophic situations. Data on knowledge, attitude, and disaster preparedness among emergency healthcare workers is scarce, particularly for developed countries in Europe. This study aimed to measure the perceived preparedness of various health practitioners in emergency care in Iași county (Romania) and identify factors that influence it. Materials and methods: A self-assessment web-based questionnaire was developed to measure knowledge (K), attitude (A), and preparedness (P). Nonparametric tests compared measurements between demographic groups. Spearman correlation, linear univariate, and multivariate regression models were used to test the effect of perceived knowledge, attitude, and other work-related factors (such as experience, training, and leadership) on disaster preparedness. Results: 211 valid entries were recorded (114 female and 97 male), of which 33.6% were doctors, 25.1% were nurses, and 23.7% were paramedics. There were differences in exposure to training across health professions for disasters and trauma management (p = 0.03 and p = 0.009). The sample’s overall scores for the three primary domains assessed were moderate. Univariate analyses identified a significant effect of knowledge and attitude on preparedness (B = 0.9, 95% CI: 0.79–1.01, p < 0.001, and B = 0.81, 95% CI: 0.66–0.97, p < 0.001, respectively), which was maintained in multivariate regression. Workplace factors (disaster plans and institutional collaboration), along with experience in disaster management and emergency care, were determinants of preparedness, while the effect of training was insignificant. Conclusions: Most healthcare workers displayed moderate preparedness for disasters, while exposure to training and practice was found to be inadequate. Focus should be placed on identifying barriers and enhancing training delivery, strengthening institutional involvement in staff preparedness, and improving inter-professional collaborations. Adequate training methods must be developed and validated in further studies.

Background and Objectives: The incidence and prevalence of cancers are increasing worldwide, with special emphasis placed on prevention, early detection, and the development of new therapeutic strategies that strongly impact patient outcomes. Limited data are available about emergency care’s role in treating patients with cancer. This study aims to determine the burden of end-stage and first-time diagnosis of cancer on emergency care in a high-turnover emergency care center. Materials and Methods: A retrospective observational study was conducted to identify patients requesting emergent aid for cancer-related symptoms in the Emergency Department of “St. Spiridon” Hospital from Iasi (Romania) between 1 October 2022 and 30 September 2023. The proportion and demographic characteristics of end-stage patients and those who received a first-time diagnosis during the emergency visit were evaluated. Risk analysis was performed to understand these patients’ care needs (such as medical care, surgical care, specialty consults, intensive care, ward admission, and other hospital transfers) and immediate care outcomes (such as in-hospital mortality and home discharge). Results: 2318 patients with cancer requested emergent care (patient presentation rate of 3.08%), of which 444 (19.15%) were diagnosed for the first time, and 616 (26.57%) were at the end-stage. First-time diagnosed patients had a significantly different distribution of cancer types (p < 0.001), were more likely to need any form of medical care, to require a specialty consultation, or to be admitted to a ward (OR 2.65, 95% CI: 2.12–3.32; p < 0.001; OR 3.28, 95% CI: 2.48–4.35, p < 0.001; OR 2.09, 95% CI: 1.70–2.59; p < 0.001, respectively) but were less severe, while end-stage patients were more likely to address repeatedly to the emergency room (OR 1.86, 95% CI: 1.32–2.59; p = 0.001) and had higher odds of needing intensive care, assisted ventilation and death (OR-4.63, 95% CI: 1.10–19.45, p = 0.04; OR 2.59, 95% CI: 1.57–4.28; p < 0.001, and OR 4.06, 95% CI: 1.73–9.54; p = 0.001, respectively). Conclusions: The emergency department often carries the weight of diagnosing patients with cancer and treating patients with end-stage disease. These data highlight the importance of prehospital care, particularly for cancer screening and palliative care, and the importance of fostering multidisciplinary collaboration in the emergency room with oncologists, geriatricians, and palliative care specialists to improve patient outcomes.

Background and Objectives: The incidence and prevalence of cancers are increasing worldwide, with special emphasis placed on prevention, early detection, and the development of new therapeutic strategies that strongly impact patient outcomes. Limited data is available about emergency care's role in diagnosing cancer patients. This study aims to determine the prevalence of novel cancer diagnoses in the emergency department and identify their therapeutic needs. Materials and Methods: A retrospective observational study was conducted to identify patients diagnosed with cancer in the Emergency Department of “St. Spiridon” Hospital between 1st October 2022 and 30th September 2023. The percentage of patients who received a first-time diagnosis during an emergency visit was determined. Clinical factors, such as gender, age, localization of cancer, and the need for hospitalization, were evaluated in relation to the emergency presentation. Results: The rate of cancer presentations to the emergency department was 3.08%. 2318 patients with cancer requested emergent care in the evaluated period, of which 444 (19.15%) were diagnosed for the first time. These patients had a significantly different distribution of cancer types (p<0.001), were more likely to need any form of medical care, to require a specialty consultation, or to be admitted to a ward (OR 2.65, 95% CI: 2.12-3.32; P < 0.001, P < 0.001; OR 3.28, 95% CI: 2.48-4.35, P < 0.001; OR 2.09, 95% CI: 1.70-2.59, respectively). There was a slight increase in the odds of death for de novo cases (OR-1.01, 95% CI 1.01-1.02, p = 0.01). Conclusions: A significant number of patients receive a first-time cancer diagnosis in the emergency department. Neoplasms can present symptoms similar to those of other conditions, making diagnosis challenging in the busy and resource-limited environment of the emergency department, where time constraints can limit thorough patient evaluation. A multidisciplinary approach is needed to manage these cases.