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Background: Short peripheral catheter (SPC) placement is a routine invasive procedure in clinical settings that is crucial for administering fluids, medications, or blood components. Approximately 11% of adult patients arriving at the Emergency Department (ED) experience difficulties with intravenous access (DIVA), necessitating advanced techniques for successful placement. The Enhanced Adult DIVA (EA-DIVA) score serves as a validated tool to promptly identify patients with DIVA. This study aimed to determine the prevalence of DIVA in the ED by using the EA-DIVA scale, evaluate the time required for venous cannulation in patients with and without DIVA, and establish EA-DIVA score thresholds for the adoption of ultrasound-guided techniques., Methods: This prospective observational study was conducted from May 2023 to January 2024 at the ED of Empoli Hospital, Italy. This study focused on adult patients requiring SPC placement. The nursing staff at the ED performed SPC placements using standard techniques according to clinical protocols., Results: Among 1280 patients, 29.22% required more than one attempt at cannulation independently from their EA-DIVA score, with 12.58% scoring an EA-DIVA of 8 or higher. The time and attempts needed for successful cannulation increased with higher EA-DIVA scores, and ultrasound-guided techniques were more time-consuming but beneficial for these patients. An optimal threshold of 6 on the EA-DIVA scale balanced high sensitivity (96.52%) and specificity (81.37%) for identifying patients who would benefit from ultrasound guidance, minimizing failed attempts and optimizing resource use., Conclusion: The EA-DIVA scale, originally validated in a preoperative setting, was effectively implemented for the first time in the ED. This study established a lower cutoff score for expert intervention utilizing ultrasound guidance compared with previous applications of the EA-DIVA scale. Further validation across diverse clinical settings and among healthcare providers with varying expertise in vascular access is necessary to confirm these findings and broaden their applicability., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To update the 2017 European Alliance of Associations for Rheumatology (EULAR) recommendations for treatment of systemic sclerosis (SSc), incorporating new evidence and therapies., Methods: An international task force was convened in line with EULAR standard operating procedures. A nominal group technique exercise was performed in two rounds to define questions underpinning a subsequent systematic literature review. The evidence derived was discussed and overarching principles, recommendations and future research agenda were iteratively developed with voting rounds., Results: The task force agreed on 22 recommendations covering 8 clinical/organ domains including Raynaud's phenomenon, digital ulcers, pulmonary arterial hypertension, scleroderma renal crisis, skin fibrosis, interstitial lung disease (ILD), gastrointestinal manifestations and arthritis. Most new recommendations are related to skin fibrosis and ILD. These included novel recommendations for the use of mycophenolate mofetil, nintedanib, rituximab and tocilizumab for the treatment of these crucial disease manifestations. The recommendations also included first-line and second-line interventions, providing increased utility for rheumatology practitioners. Important additions to the future research agenda included consideration of novel interventions for the management of vascular, musculoskeletal and gastrointestinal manifestations and calcinosis, as well as for the local management of digital ulcers., Conclusion: These updated recommendations include the first set of synthetic and biological targeted therapies recommended for key fibrotic manifestations of SSc as well as first-line combination treatment for newly diagnosed pulmonary artery hypertension and prioritise a new research agenda for the coming years., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)