Background
The aim of this study was to compare the ability to predict 30‐day in‐hospital mortality of lactate versus the modified Rapid Emergency Medicine Score (mREMS) versus the arithmetic sum of ...the mREMS plus the numerical value of lactate (mREMS‐L).
Methods
A prospective, multicentric, emergency department delivery, pragmatic study was conducted. To determine the predictive capacity of the scales, lactate was measured and the mREMS and mREMS‐L were calculated in adult patients (aged>18 years) transferred with high priority by ambulance to the emergency department in five hospitals of Castilla y Leon between 1 January 2020 and 31 December 2021. The area under the receiver operating characteristic (ROC) curve of each of the scales was calculated in terms of mortality for 30 days.
Results
A total of 5371 participants were included, and the in‐hospital mortality rate at 30 days was of 11.4% (615 cases). The best cut‐off point determined in the mREMS was 7.0 points (sensitivity of 67% and specificity of 84%), and for lactate, the cut‐off point was 1.4 mmol/L (sensitivity of 88% and specificity of 67%). Finally, the combined mREMS‐L showed a cut‐off point of 7.9 (sensitivity of 83% and a specificity of 83%). The area under the ROC curve of the mREMS, lactate and mREMS‐L for 30‐day mortality was 0.851, 0.853, and 0.903, respectively (p < 0.001 in all cases).
Conclusions
The new score generated, mREMS‐L, obtained better statistical results than its components (mREMS and lactate) separately.
Black and red raspberries are fruits with a high phenolic and vitamin C content but are highly susceptible to deterioration. The effect of high hydrostatic pressure (HHP 400−600 MPa/CUT-10 min) and ...pulsed electric fields (PEF, frequency 100−500 Hz, pulse number 100, electric field strength from 11.3 to 23.3 kV/cm, and specific energy from 19.7 to 168.4 kJ/L) processes on black/red raspberry juice was studied. The effect on the inactivation of microorganisms and pectin methylesterase (PME) activity, physicochemical parameters (pH, acidity, total soluble solids (°Brix), and water activity (aw)), vitamin C and phenolic compounds content were also determined. Results reveal that all HHP-treatments produced the highest (p < 0.05) log-reduction of molds (log 1.85 to 3.72), and yeast (log 3.19), in comparison with PEF-treatments. Increments in pH, acidity, and TSS values attributed to compounds’ decompartmentalization were found. PME activity was partially inactivated by HHP-treatment at 600 MPa/10 min (22% of inactivation) and PEF-treatment at 200 Hz/168.4 kJ/L (19% of inactivation). Increment in vitamin C and TPC was also observed. The highest increment in TPC (79% of increment) and vitamin C (77% of increment) was observed with PEF at 200 Hz/168.4 kJ/L. The putative effect of HHP and PEF on microbial safety, enzyme inactivation, and phytochemical retention is also discussed in detail. In conclusion, HHP and PEF improve phytochemical compounds’ content, microbial safety, and quality of black/red raspberry juice.
Urea is the most common nitrogen (N) fertilizer used in the tropics but it has the risk of high gaseous nitrogen (N) losses. Use of nitrification inhibitor has been suggested as a potential ...mitigation measure for gaseous N losses in N fertilizer-applied fields. In a field trial on a tropical Andosol pastureland in Costa Rica, gaseous emissions of ammonia (NH3) and nitrous oxide (N2O) and grass yield were quantified from plots treated with urea (U; 41.7 kg N ha–1 application–1) and urea plus the nitrification inhibitor nitrapyrin (U + NI; 41.7 kg N ha–1 application–1 and 350 g of nitrapyrin for each 100 kg of N applied) and control plots (without U and NI) over a six-month period (rainy season). Volatilization of NH3 (August to November) in U (7.4% ± 1.3% of N applied) and U + NI (8.1% ± 0.9% of N applied) were not significantly different (P > 0.05). Emissions of N2O in U and U + NI from June to November were significantly different (P < 0.05) only in October, when N2O emission in U + NI was higher than that in U. Yield and crude protein production of grass were significantly higher (P < 0.05) in U and U + NI than in the control plots, but they were not significantly different between U and U + NI. There was no significant difference in yield-scaled N2O emission between U (0.31 ± 0.10 g N kg–1 dry matter) and U + NI (0.47 ± 0.10 g N kg–1 dry matter). The results suggest that nitrapyrin is not a viable mitigation option for gaseous N losses under typical N fertilizer application practices of pasturelands at the study site.
The ability of COVID-19 to compromise the respiratory system has generated a substantial proportion of critically ill patients in need of invasive mechanical ventilation (IMV). The objective of this ...paper was to analyze the prognostic ability of the pulse oximetry saturation/fraction of inspired oxygen ratio (SpO2/FiO2) and the ratio of SpO2/FiO2 to the respiratory rate–ROX index–as predictors of IMV in an emergency department in confirmed COVID-19 patients. A multicenter, retrospective cohort study was carried out in four provinces of Spain between March and November 2020. The discriminative power of the predictive variable was assessed through a prediction model trained using a derivation sub-cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC) on the validation sub-cohort. A total of 2040 patients were included in the study. The IMV rate was 10.1%, with an in-hospital mortality rate of 35.3%. The performance of the SpO2/FiO2 ratio was better than the ROX index–AUC = 0.801 (95% CI 0.746–0.855) and AUC = 0.725 (95% CI 0.652–0.798), respectively. In fact, a direct comparison between AUCs resulted in significant differences (p = 0.001). SpO2 to FiO2 ratio is a simple and promising non-invasive tool for predicting risk of IMV in patients infected with COVID-19, and it is realizable in emergency departments.
The aim of this study was to determine the ability of the Sequential Organ Failure Assessment score (SOFA) and modified SOFA score (mSOFA) as predictive tools for 2-day and 28-day mortality and ICU ...admission in patients with acute neurological pathology treated in hospital emergency departments (EDs).
An observational, prospective cohort study in adults with acute neurological disease transferred by ambulance to an ED was conducted from 1 January 2019 to 31 August 2022 in five hospitals in Castilla-León (Spain). Score discrimination was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve of the score.
A total of 640 adult patients with neurological disease were included. For the prediction of 2-day mortality (all-cause), mSOFA presented a higher AUC than SOFA (mSOFA = 0.925 vs. SOFA = 0.902). This was not the case for 28-day mortality, for which SOFA was higher than mSOFA (mSOFA = 0.852 vs. SOFA = 0.875). Finally, ICU admission showed that SOFA was higher than mSOFA (mSOFA = 0.834 vs. SOFA = 0.845).
Both mSOFA and SOFA presented similar predictive ability, with mSOFA being the best predictor for short-term mortality and SOFA being the best predictor for medium-term mortality, as well as for ICU admission. These results in a cohort of patients with acute neurological pathology pave the way for the use of both predictive tools in the ED. The inclusion of these tools could improve the clinical assessment and further treatment of neurological patients, who commonly present the worst outcomes.
(1) Background: The aim was screening the performance of nine Early Warning Scores (EWS), to identify patients at high-risk of premature impairment and to detect intensive care unit (ICU) admissions, ...as well as to track the 2-, 7-, 14-, and 28-day mortality in a cohort of patients diagnosed with an acute neurological condition. (2) Methods: We conducted a prospective, longitudinal, observational study, calculating the EWS Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), VitalPAC Early Warning Score (ViEWS), Modified Rapid Emergency Medicine Score (MREMS), Early Warning Score (EWS), Hamilton Early Warning Score (HEWS), Standardised Early Warning Score (SEWS), WHO Prognostic Scored System (WPSS), and Rapid Acute Physiology Score (RAPS) upon the arrival of patients to the emergency department. (3) Results: In all, 1160 patients were included: 808 patients were hospitalized, 199 cases (17%) required ICU care, and 6% of patients died (64 cases) within 2 days, which rose to 16% (183 cases) within 28 days. The highest area under the curve for predicting the need for ICU admissions was obtained by RAPS and MEWS. For predicting mortality, MREMS obtained the best scores for 2- and 28-day mortality. (4) Conclusions: This is the first study to explore whether several EWS accurately identify the risk of ICU admissions and mortality, at different time points, in patients with acute neurological disorders. Every score analyzed obtained good results, but it is suggested that the use of RAPS, MEWS, and MREMS should be preferred in the acute setting, for patients with neurological impairment.
Drowning is a public health problem. Interrupting the drowning process as soon as possible and starting cardiopulmonary resuscitation (CPR) can improve survival rates. Inflatable rescue boats (IRBs) ...are widely used worldwide to rescue drowning victims. Performing CPR in special circumstances requires adjusting the position based on the environment and space available. The aim of this study was to assess the quality of over-the-head resuscitation performed by rescuers aboard an IRB in comparison to standard CPR.
A quasi-experimental, quantitative, cross-sectional pilot study was conducted. Ten professional rescuers performed 1 min of simulated CPR on a QCPR Resuscy Anne manikin (Laerdal, Norway) sailing at 20 knots using two different techniques: 1) standard CPR (S-CPR) and 2) over-the-head CPR (OTH-CPR). Data were recorded through the APP QCPR Training (Laerdal, Norway).
The quality of CPR was similar between S-CPR (61%) and OTH-CPR (66%), with no statistically significant differences (p = 0.585). Both the percentage of compressions and the percentage of correct ventilations did not show significant differences (p > 0.05) between the techniques.
The rescuers can perform CPR maneuvers with acceptable quality in the IRB. The OTH-CPR technique did not show inferiority compared to S-CPR, making it a viable alternative when boat space or rescue conditions do not allow the conventional technique to be performed.
Since a great number of infant cardiopulmonary arrests occur outside of the hospital, it is crucial to train laypersons in cardiopulmonary resuscitation techniques, especially those professionals ...that will work with infants and children. The main objective of this study was to evaluate the efectiveness of ventilations performed by professional training students. The secondary objective was to analyze the preference between different ventilation and chest-compression methods. The sample consisted of 32 professional training students, 15 preschool students, and 17 physical education students. The activity was conducted separately for each group, and we provided a 10 min theoretical training about infant basic life support followed by a 45 min practical training using a Laerdal Little Anne QCPR CPR manikin. A practical test in pairs was organized to record the ventilation as performed by the participants, establishing the difference between the efficacious and the non-efficacious ones. Furthermore, we handed out a survey before and after training to evaluate their knowledge. More than 90% of the students completely agreed with the importance of learning cardiopulmonary resuscitation techniques for their professional future. More than half of the sample considered that they perform the rescue breathings with the mouth-to-mouth method better. We observed that through mouth-to-mouth-nose ventilations, the number of effective ventilations was significantly higher than the effective ventilations provided by a self-inflating bag and mask (EffectiveMtoMN 6.42 ± 4.27 vs. EffectiveMask 4.75 ± 3.63 (
= 0.007)), which was the preferred method. In terms of the compression method, hands encircling the chest was preferred by more than 85% of students. Mouth-to-mouth nose ventilation is more efficient than bag-face-mask ventilation in CPR as performed by professional training and physical activity students. This fact must be considered to provide higher-quality training sessions to professional training students.
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